November 26, 2019

Call to Action: "Is there a doctor onboard?"

by Michael A. Chorney, MD, a PGY5/IR4, interventional radiology resident at the University of Pennsylvania. Follow him on Twitter @chorneymd.

Inflight Emergencies 

The 2019 holiday season approaches, including countless annual national and societal meetings. Many radiologists, myself especially, will go up into the clouds onboard the airline whom our loyalty and frequent flyer miles beholden. Prior to takeoff, during the seemingly endless taxiing on runway, the last thought to cross the mind of the radiologist as the engines roar likely goes “Oh my, what if the captain announces ‘Attention passengers: Is there a doctor on the plane?’”

Candidly, the thought never occurred to me until a few years ago I found myself aboard a flight to which my quick assessment of my co-travelers yielded the majority to be geriatric, some with walkers and oxygen tanks. At that moment, the thought above eerily surfaced. How would I answer the call to action in a time of need with limited equipment and no internet connection to UptoDate®?

Thankfully, I stand on the shoulder of giants, and not the first traveling physician to broach this issue. The annals of medical knowledge have produced several, comprehensive papers which address the common medical emergencies to occur. I have provided a short index of articles below which you should find useful in such a situation.

To this day, my pre-boarding ritual includes a quick skim of these articles to refresh my dormant medical training as I stream the backlog of audio podcasts to quell any anxiety. For my fellow travelers, I may dress comfortably and unassumingly for a physician, but I am silently ready to your needs as I board economy seating in the rear of the plane. Yes you! The presyncopal medicare recipient with >70% carotid stenosis; the middle aged adult scarfing down fast food purchased in Terminal B; and the child with anaphylaxis to peanuts sitting next to that burger-eating adult who also found some nuts next to the register.

Despite having limited legroom, a small complimentary cup of coffee or diet cola, and, hopefully, cabin space for my modest carry-on luggage, I remain humbly your doctor should you need me 30,000 feet above ground. So will you answer the call? Or hope that just prior to meekly raising your hand, another comes forward?

Dr. Chorney’s Short-list:

1. Martin-Gill, Christian, Thomas J. Doyle, and Donald M. Yealy. "In-flight medical emergencies: a review." Jama 320.24 (2018): 2580-2590. Link

2. Nable, Jose V., et al. "In-flight medical emergencies during commercial travel." New England Journal of Medicine 373.10 (2015): 939-945. Link

3. Donner, Howard J. "Is there a doctor onboard? Medical emergencies at 40,000 feet." Emergency Medicine Clinics 35.2 (2017): 443-463. Link