I did send my concerns to the upper management of the organization, noting that the timeshare is 30 to 40 miles from the mainland, with only one ALS unit and two BLS units on the island. Though I never received any feedback, I asked the next year what the emergency plan was and where an AED was located. I was happy to know that they had a plan in place and that trained personnel were assigned for just that purpose, with an AED on their golf cart.
The young man was a survivor of 9/11 as a firefighter who responded to the towers with his unit. It had taken him a few years to muster the ability to get on an airplane for a family vacation.
Sometimes it takes a fatality to put the gears in motion, sad to say.
Fran Newman, FNP, Newport News, VA
Your story of the inflight emergency reminded me of my encounter. Several years ago, a similar call was made for a medical person. I also identified myself and visited the patient in the back of the plane. He was Spanish-speaking, coming from the Dominican Republic, but I had learned Spanish so did not need a translator (which makes history taking much better).
He complained of back pain and headache. His blood pressure was 190/130 mm Hg. No history of treatment; he was tachycardic and boisterous. I assumed that his aggression was a mental status change due to elevated blood pressure. I asked if anyone on board had nitroglycerin sublingual tablets; two people volunteered theirs. I administered one tablet and rechecked his blood pressure five minutes later, at which point it was reduced to 110/90 mm Hg. His back pain had subsided, and his behavior calmed. During this time, I used up three canisters of oxygen at 3 L/min.
The fun part was that I visited the cockpit of this 757 to communicate with the medical personnel on the ground. The plane was flying itself, with the pilot and copilot merely monitoring the systems and constantly writing things down.
I didn’t feel the need to divert because I didn’t think the patient was having an MI. I was initially concerned about aortic dissection, but the dramatic response of the blood pressure, the patient’s mood and otherwise normal vital signs (pulse was regular and decreased from 120 to 88 beats/min), and resolution of the back pain helped me to rule it out. Just as in Dr. Danielsen’s case, when we landed, the medics came on board and whisked him off.
I was rewarded by the flight crew with a bottle of champagne. I was also upgraded to first class, where I had a lively discussion with my fellow passengers about the physician assistant profession. This memory is priceless; I only wish I could have known the outcome and final diagnosis. And yes, I documented every single thing that I did and turned it over to the medics.
Lincoln Allen, RPA, Bronx, NY