Emergency in the Sky

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What happens when a passenger gets sick at 30,000 feet?

Think being seasick is a nightmare? Consider falling ill while you're on a plane several hours from landing, with no doctor onboard.

Late last month, it was a famous passenger -- former President Jimmy Carter -- who made headlines after he got "airsick" on a Delta flight from Atlanta to Cleveland. But every day, passengers from all walks of life are struck with illnesses while traveling on commercial flights -- with issues ranging from intoxication-related symptoms to viruses, anxiety attacks, heart attacks and everything in between.

The good news?

Airline crews are trained to deal with these situations. "You actually have more access to medical attention onboard an airplane than you do on a bus or any other means of public transport," says David Castelveter, a spokesman with the Washington D.C.-based Air Transport Association. "Every flight attendant goes through basic training for CPR as part of their hiring training and recurrent training," he explains, "But their protocol is always to ask if a medical professional is onboard."

Castelveter says that first aid kits of a basic and advanced variety are available on all planes (the only official FAA medical requirement, according to agency spokeswoman Alison Duquette). Basic kits contain things like bandages and aspirin that flight attendants can readily administer. But captains also have access to advanced medical kits, says Castelveter, with items like insulin injections and allergy medications that can be released to medical professionals onboard (doctors, nurses, EMTs, etc.) for treating passengers in flight.

And thanks to contracts that airlines have with medical professionals on the ground, says Castelveter, pilots can be in constant contact during the flight to get advice when dealing with an ill passenger.

"One thing people might feel better knowing is that the airlines do have physicians that are always on call," explains Gailen David, the Sky Steward, a lead purser with a major American airline and longtime flight attendant with 23 years of experience. "So even if there's not a doctor actually on the airplane, the captain can be in constant contact with them to relay symptoms." Gailen says that in addition to being trained in CPR, flight attendants are trained in the use of automated external defibrillators (AEDs), too.

Emergency in the Sky

JoshuaDavisPhotography, flickr

Standard on US commercial jets and present on most regional carriers, too, AEDs can be used to check an unresponsive passenger or crewmember for a heartbeat, diagnose the situation and advise whether CPR or electric shock should be employed.

"If someone is unconscious or they don't respond, we go to the defibrillators," says Gailen, who has dealt with many in-flight emergencies and sicknesses but never an in-flight death. "I've mostly dealt with people fainting or being sick because of intoxication," he says.

And fainting, it turns out, is a fairly common occurrence at altitudes where oxygen levels are lower than on the ground. Diana Lambdin Meyer, an author from Kansas City, Mo., can testify to that firsthand. During an Air Canada flight in 2002 to Toronto, Lambdin Meyer, who has always had "very low blood pressure," suddenly felt sick.

I'd fallen asleep in my seat and then woke up with this odd feeling," she says. " I couldn't breathe, and wanted to get some water to splash on my face. I stood up in the aisle and went right down, flat in the aisle."

Lambdin Meyer's husband and son, who were seated a few rows behind her, saw a commotion and realized she was passed out in the aisle. "My husband said he thought I was dead. He said I had no color in my face, I was totally grey and my blouse was soaked in perspiration," she recalls.

The flight attendants called to see if there was a doctor on board and stretched her out on the ground, as protocol dictates, bringing water and cold towels. "They brought a little oxygen tank, and I came to really quickly and had everyone looking at me," Lambdin Meyer says. Though she felt better, the pilot had declared a medical emergency and cleared the plane for an immediate landing.

"My husband said they had made an announcement earlier that the Pope was coming in and was going to be landing in Toronto, too, so they were holding air traffic," says Lambdin Meyer. "We were supposed to circle for an hour or so. Well, instead they declared a medical emergency, bumped the Pope from landing and we landed."

Upon landing, EMTs boarded the plane with a stretcher and carried Lambdin Meyer out. "By this point I was totally functioning, feeling fine, but just absolutely embarrassed," says Lambdin Meyer. How the situation unfolded, it turns out, is pretty much standard operating procedure when someone passes out on a plane (although it's not every day that the Pope is delayed!).

"If a passenger gets ill to the point of needing immediate medical attention, we contact a medical doctor who advises us on the radio of what they assess the situation to be," confirms a pilot for a major US airline. "Or, if it's an actual emergency, like a heart attack, we'll get priority handling from air traffic control, get the aircraft on the ground and get an ambulance to meet us."

The pilot, who wishes to remain anonymous, says that he, too, has fallen ill while flying. "I came down with some kind of flu on the way into our hub one night," he says. "I starting feeling it about 10 minutes after taking off on a two-hour flight. By the time we landed, I was in a cold sweat and had chills."

As they pulled off the runway after landing, says the pilot, "I tried to speak on the radio but had to grab the trash bag instead to throw up." The protocol in this case, he says, is "to notify the company en route that you aren't feeling well and that they need a replacement." And that's just what he did, canceling his next leg and heading home instead.

Of course, the worst-case in-flight scenario is when someone dies -- and it has happened in the past to both pilots and passengers (and has happened as recently as October 13th, when a Qatar Airways flight was diverted after a pilot died onboard).

Peter Rothholz, a travel writer and frequent flier, has been on two flights when passengers have passed away. The first instance happened in the 1970s, on a flight from St. Thomas to New York City. The passenger, who Rothholz knew, was seated a few rows in front of him and had a heart attack.

"They moved him up to first class and stretched him out on the floor and tried to give him CPR," Rothholz recalls. "The crew asked if there was a doctor on board, I don't think there was." The passenger died, and when the flight landed several hours later at JFK, the airplane was diverted to a remote area where an ambulance was waiting to collect the body. "A couple of EMTs came aboard, they took him on the stretcher, covered him in a blanket and took him off," says Rothholz, adding that the man's wife also exited the plane to accompany his body.

Another time, a decade later, Rothholz was en route to Amsterdam when a woman several rows behind him died fairly early into the flight. "I was not aware of what was going on until it was all over," he says. "She was left in a seat and they put a blanket over her. It was a pretty full flight -- I don't know what could have been done. It was an overnight flight, so they put the lights out and everyone tried to go to sleep."

Making sure a dead passenger remains secured in a seat, according to David, the lead purser, is also standard operating procedure. With space so limited on airliners these days, he says, there isn't usually a cabinet onboard used to store bodies in the event of a death. (If it were procedure to store a deceased passenger in a compartment or closet, he says, it wouldn't even be possible these days, as most planes are short of this type of space since airlines have made room for more seats.)

And when a passenger dies, he says, there are clear procedures to follow. "If they don't respond, we move them to the floor for possible CPR," he says. "If after 30 minutes, there's still no sign of improvement and they're dead, then we have to go ahead and put them into a seat." Standard airline procedures dictate the person is to be secured in the seat, says Gailen, "so we move the person to a seat -- preferably where few customers are nearby -- and ask for volunteers to assist in moving the person, if necessary."

Directives also require that the deceased not block an exit row, that the eyes are closed, that a blanket is placed under the body, and that the body is also covered with a blanket.

Have you ever been sick on a plane or been on a flight when a fellow passenger died? Share your experiences in the comments below.

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