Delivering Care in the Air

If you’re an EMT, paramedic, nurse, physician or other medical professional traveling by air to EMS World Expo (or anywhere), you can serve as a first responder to in-flight emergencies. There are, however, protocols and a strict chain of command you’ll have to follow.

As you take your first step onto the plane, say hello to the flight attendant (FA), identify yourself as an EMT or whatever type of first responder you are, and share your seat number. For example, “Hello! I’m an EMT in seat 17C.” I’ve done this several times and gotten back an enthusiastic variation of, “I so wish you were on my flight two weeks ago! Now, what seat did you say you were in?”

Flight attendants are taught to evaluate who can potentially serve as an ABP, an able-bodied passenger. It’s basically like the scene survey we do all the time. When you introduce yourself like this, you just identified yourself as an ABP.

What is an ABP to the cabin and flight crews? This is a person who can assist when called upon. FAs are trained and proficient in all kinds of situations, but sometimes help is a wonderful thing. We’ve been in situations where we had too much help, so assist when asked. To be clear, the directions of the cabin or flight crew must be followed. There is one person in charge during flight, and that is the pilot-in-command (PIC)—in other words, the captain. Standing procedures are in place for the FAs just as they are for EMTs, but final authority rests with the captain.

A medical problem in flight is not something any FA looks forward to having. This doesn’t mean they aren’t trained and prepared for a wide range of occurrences.

Here’s how a medical problem might evolve: A passenger might get the attention of an FA and say, “I don’t feel well.” In my view as a captain, this is a big statement—they are asking for help. It also might happen that someone traveling with the person or sitting nearby will bring it to the attention of an FA. Just like in EMS, when people don’t feel good, they seem to head for the bathroom. They might be inside the lavatory for a long time and even become unresponsive in there—that makes it quite a bit harder to recognize a problem. Fortunately, it isn’t hard to open a locked airplane lav door. The last situation is that a passenger stands up and falls. Injuries from the fall can add to the confusion.

If Asked to Help

If you’re asked to assist, start with a good scene survey, just as you do on other calls. Gather information to help determine how serious a problem might be. Even if several people have already identified themselves as medically trained, it is often procedure for the FA to make a PA announcement asking for medically trained help—a clinician with greater training or expertise might be aboard but did not identify themselves at boarding. If you’ve identified yourself previously, consider that you were just asked to assist. It is common for the FA to ask a responder for some kind of identification; don’t be offended.

How does medical control work during a flight? Just about the same way it does in an ambulance. Each passenger airline has a medical control. I’m most familiar with MedAire. First, stay within your level of training. Gather information and provide it, in writing, to the FA, who will get it to the pilot (there is zero possibility of a passenger being allowed into the cockpit). When I’ve called in with a report as a pilot, we’ve been patched by phone through our dispatcher to a hospital ED, where a paramedic did intake. A good written report includes all the obvious items: age, pulse, respiration rates, etc. Could you test blood glucose? Yes, if it’s within your level of training, you can do this prior to contact with medical control. The intake paramedic obtains the information, and then the physician comes on the line to talk to the captain. He gives directions and then, most important, advises the captain if a diversion is medically recommended. In MedAire’s case, it would then coordinate for support at arrival.

Disruptive Passengers

A reality of flight is that sometimes disturbances occur. Some people get loud, emotional or even physical, just as they do on EMS calls. What should you do in this scenario?

Be observant and look around but don’t respond until asked. Why? This is not the cabin crew’s first rodeo, so let them do their job without interjecting yourself. Totally unknown to you, any federal law enforcement officer who may be on aboard will have identified themselves already to the entire crew. LEOs will decide according to their procedures and the situation to respond or not. You might be asked to assist by the FAs prior to a LEO. De-escalating the situation would be a good first choice. Follow the directions of the FAs.

Regardless if you’re assisting on a medical incident or for a disruptive passenger, assume everything is being recorded by cell phones from multiple angles.

Conclusion

By assisting, you might be able to resolve a simple situation. You want to get to your destination, just like everyone else (especially if it’s EMS World Expo!). By helping, you further that objective.

Happy travels—they’re a little bit safer with you aboard.

Dick Blanchet, BS, MBA, worked as a paramedic for Abbott EMS in St. Louis, Mo., and Illinois for more than 22 years. He was also a captain with Atlas Air and a USAF pilot.