Representative Raul Ruiz, MD, MPH, a former ED physician, steps up to aid a sick airline passenger and imparts valuable lessons for handling a mid-air health emergency
Thirty minutes into American Airlines Flight 175 from Washington, DC, to Dallas/Fort Worth on October 24, 2013, Rep. Raul Ruiz, MD, MPH (D-CA, 36th District), heard a call for medical help on the plane’s public-address intercom. Dr. Ruiz made his way to the front of the plane, where a passenger was lying on the floor. The flight attendants were already attending to a man who had initially collapsed but was now conscious. Another passenger, a firefighter, was also helping.
Dr. Ruiz introduced himself as an emergency physician and began taking the patient’s history. The man’s companion indicated that he was diabetic, so Dr. Ruiz initially hoped that this would be a simple case of hypoglycemia. But testing with the passenger’s glucometer revealed a normal blood glucose level of 122 mg/dL. Further history revealed the man had an internal pacemaker and a history of stroke. “That alerted us to the high risk of serious possibilities,” says Dr. Ruiz.
Dr. Ruiz called for an AED (an FAA requirement for all planes with a maximum payload capacity of more than 7,500 pounds and with at least one flight attendant) so that he could monitor his patient. As they were talking, the man again lost consciousness and became “very pale and diaphoretic,” according to Dr. Ruiz. He looked at the others who were helping and said, “I think we need to land this plane.”
The pilot agreed with that assessment and, working with air-traffic controllers, quickly agreed to divert the flight to Raleigh-Durham International Airport, where an EMS team would be waiting.
How Common Are Mid-Air Emergencies?
A New England Journal of Medicine (NEJM) review of in-flight medical-emergency calls made between 2008 and 2010 to a ground-based medical communications center found that medical emergencies occurred at a rate of 16 per 1 million passengers, or one medical emergency per 604 flights.1 The study showed that, while the vast majority of in-flight medical emergencies can be handled with on-board medical equipment and typical providers available, cases where more assistance was needed involved physicians 48.1 percent of the time. Christian Martin-Gill, MD, MPH, assistant professor of emergency medicine at the University of Pittsburgh School of Medicine in Pittsburgh, Pa, is a co-author of the NEJM study. “One of the main reasons we wanted to publish our data was so that health care providers who might be asked to provide assistance would have an idea of the types of medical emergencies they might encounter,” he says. The University of Pittsburgh Medical Center provides medical consultations for 17 commercial airlines, logging approximately one consultation per hour and 8,500 per year. The most frequent in-flight medical emergencies are related to syncope and respiratory and gastrointestinal symptoms.
A First for Dr. Ruiz
The Flight 175 incident was not the first time that Dr. Ruiz has stepped in to help stabilize a fellow passenger. In 2013 alone, he aided four different people in flight; however, this was the first time he had to recommend that the plane be diverted for an emergency landing. It was also the first time that he received national attention for doing what, he notes, “every emergency medicine physician is trained to do.” Rep. Pete Gallego (D-TX, 23rd District) was on the same flight and tweeted, “Medical emergency on flight from DC to TX. Passenger collapses. @CongressmanRuiz, an MD, on board. Passenger stabilized. Landing in Raleigh.”
“What was interesting about this experience [on October 24],” says Dr. Ruiz, “is that we were all in sync. I had never met the fireman before, but you know we, as emergency medicine physicians, work so well with EMS and firemen in the field—you can put us anywhere, and we synchronize. The flight attendants were also very skilled, professional, and helpful. And no one on the plane complained that we had to do an emergency landing. Our focus was on the passenger.”
Dr. Ruiz says valuable lessons can be learned from the actions of the flight attendants, the firefighter, the captain, and passengers in the Flight 175 case. “We can prioritize service and improving the lives of people we serve above all else. When we do that, then we start to find that common ground that’s going to help us work together as a team. That’s what can happen when you put your skills to use for the betterment of your patients,” he says, adding wryly, “I just wish Congress worked that way.”
—Raul Ruiz, MD, MPH
Be Ready and Step Up
Dr. Ruiz and the firefighter sat on either side of the patient until the plane landed. He then relayed the pertinent history to the EMS personnel who met the plane, gave the flight attendants a tally of the emergency supplies that had been depleted, then went back to his seat and fell asleep for the next leg of the flight to Texas.
“It is a commonality of those who work in the emergency field,” notes Dr. Martin-Gill, “that we want to volunteer and assist. Our society looks upon us to help in such situations.”
Based on his experiences, what advice does Dr. Ruiz have for emergency medicine colleagues who find themselves in similar situations? “I don’t think I need to inform my colleagues about the ABCs and whatnot,” he says, “but it’s always good to introduce yourself as an emergency physician. Always think one or two steps ahead of all the possibilities and make sure that you have the equipment nearby that you need or that you may potentially need to help the passenger.” (See sidebar, “Be Prepared to Volunteer,” for a link to the FAA’s requirements regarding standard emergency medical equipment on commercial airlines.)
“My takeaway lesson to my colleagues,” continues Dr. Ruiz, “is to always heed the call of service. We are the most prepared to deal with emergencies, whether in the emergency department or on a plane. And when we step up, then good things happen.”