Proud mama moment

[Eos]

Dd was on a flight this morning when a man two rows up collapsed.  His wife called for medical help and an RN and a WFR responded, got him on oxygen, lost his pulse, started giving chest compressions.  RN asks the wife if he has any medical issues and wife says no, but Type 1 diabetic dd asks directly "does he have diabetes?" and wife says yes.  So dd checks his glucose while he's seizing and getting chest compressions, she already has the app on her phone that converts it to metric (she's flying from Canada) then stood by with her glucagon at the ready.

He received a half hour of chest compressions then revived, which is an actual miracle.  The plane diverted to a different city and dd said they cleared the airport then came in super hot, faster than she's ever landed before. EMTs came for him and he was talking and aware. I'm proud of my girl's small part in the situation! The RN was an actual hero for directing the terrified flight attendants and giving chest compressions for so long.

Edited March 14 by Eos

[kbutton]

5 minutes ago, Eos said:

RN asks the wife if he has any medical issues and wife says no, but Type 1 diabetic dd asks directly "does he have diabetes?" and wife says yes. 

Good quick thinking on your DD’s part!

[TexasProud]

So proud of your daughter!  Definitely entitled to a mom brag!

[Harriet Vane]

Good for her!! I am glad the guy got such attentive care.

[MEmama]

Amazing response! You must be so proud! 

[lauraw4321]

Amazing!  This is awesome!

[Scarlett]

That is amazing and brought tears to my eyes. 

[KSera]

Wow, that is amazing. Good thinking on your dd’s part. And immense effort on the part of the RN giving chest compressions for half an hour (do planes not always have an AED?).

[Eos]

Just now, KSera said:

Wow, that is amazing. Good thinking on your dd’s part. And immense effort on the part of the RN giving chest compressions for half an hour (do planes not always have an AED?).

They had the pads on and were about to shock him when he got a pulse. Incredible effort of the RN! Dd said she could hear his rib break. When he came to and they asked him if he knew where he was etc he said wow my chest hurts and she said I'm sorry but i broke your ribs!

[wathe]

13 minutes ago, KSera said:

Wow, that is amazing. Good thinking on your dd’s part. And immense effort on the part of the RN giving chest compressions for half an hour (do planes not always have an AED?).

I've volunteered to assist in on-board medical emergencies, and I know a bit about Canadian standards (apparently very similar if not identical to US), and no, and AED is not required.  But most airlines carry one, as well as a lot of other medical equipment that's not required.

Canadian standards require a Canadian standard emergency medical kit (section 725.91, copy-pasted at end of post) for flights with greater than 100 passengers.  This is in addition to first-aid kits, which contain very basic supplies, required for all flights no matter how many passengers.

Air Canada and West Jet have great kits (with both AED and glucometer).   CMAJ ran a great article few years ago, with photo and table listing contents of the actual kits carried by these airlines.  Which I happened to have read a few weeks before an international flight that had a medical emergency happen mid-flight over the Pacific.

This is actually a thorny issue in the medical community.  We have an ethical obligation to assist (but, interestingly, not a legal obligation in most jurisdictions).   Airlines lean on our goodwill as part of their business model.  Some believe it's exploitative.  Their medical kits are loaded with drugs and equipment that can only be used by medical professionals (flight attendants cannot use), --- utilization depends entirely on chance and goodwill.  Legal protection for volunteer responders is murky, especially on international flights.  

They do generally have a air-to-ground medical consulting service  with and MD advising from the ground to advise and direct airline staff, which is better than nothing. 

725.91 Emergency Medical Kit

For aeroplanes with more than one hundred (100) passenger seats, an emergency medical kit must be carried and shall contain as a minimum, the following:

ItemsQuantity

a) Sphygmomanometer1

b) Stethoscope1

c) Syringes (sizes necessary to administer required drugs)4

d) Needles (sizes necessary to administer required drugs) and one safe disposal unit
(amended 2005/06/01)6

e) 50% dextrose injection, 50cc1

f) Epinephrine/Adrenalin 1:1000, single dose ampoule or equivalent
(amended 2005/06/01)4
(amended 2005/06/01)

g) Diphenhydramine HCl injection, single dose ampoule or equivalent2

h) Nitroglycerin
(amended 2000/12/01)10 tablets or equivalent
(amended 2000/12/01)

i) Protective non-permeable latex gloves or equivalent, disposable
(amended 2005/06/01)2 pairs
(amended 2005/06/01)

j) Bronchodilator inhaler (metered dose or equivalent)
(amended 2005/06/01)1
(amended 2005/06/01)

k) Acetylsalicylic acid (ASA)
(amended 2005/06/01)4
(amended 2005/06/01)

l) (i) CPR mask with an oxygen port and
(ii) valves
(amended 2005/06/01)1
2
(amended 2005/06/01)

m) Intravenous (IV) administration kit (incl. Alcohol sponges, tape, bandage scissors and tourniquet)
(amended 2005/06/01)1
(amended 2005/06/01)

n) appropriate intravenous (IV) solution (e.g. normal saline 0.9%(500cc)
(amended 2005/06/01)1
(amended 2005/06/01)

o) (i) Airways, oropharyngeal (3 sizes) or
(ii) Ambu bag
(amended 2005/06/01)1 set
1
(amended 2005/06/01)

p) Atropine (0.4-0.6 mg per ml, single dose ampoule or equiv.)
(amended 2005/06/01)1
(amended 2005/06/01)

q) Basic instructions for use of the drugs in the kit.
(amended 2005/06/01)1
(amended 2005/06/01)

[wathe]

@Eos I'm glad that your daughter stepped up to help, and I'm glad that there was a good outcome.

 I hope she is OK.  Resuscitation can be traumatic for responders (both professional and lay-responders alike) and witnesses.  

Peel Regions's Lay-Responder and Bystander Resource Guide is excellent.

[Eos]

47 minutes ago, wathe said:

@Eos I'm glad that your daughter stepped up to help, and I'm glad that there was a good outcome.

 I hope she is OK.  Resuscitation can be traumatic for responders (both professional and lay-responders alike) and witnesses.  

Peel Regions's Lay-Responder and Bystander Resource Guide is excellent.

I hear that, thank you. I actually think she is a bit less traumatized than had she not participated. Having diabetes gives her a fair amount of worry about responders not knowing how to work with it. She wears a bracelet with insulin pump CGM and glucagon written on it. The patient today was not wearing a bracelet and his wife froze for a minute, so I hope he gets one now. 

Dd was quite disturbed by the movie Knives Out and the plot with someone getting an accidental overdose of otherwise benign medication., too close to home for an insulin-dependent diabetic.

I once did CPR on someone who had had an aneurysm which we of course didn't know at the time but he was dead by the time he hit the floor. That was kinda horrible until the ER doc called me weeks later to tell me that it was an aneurysm.

Edited March 14 by Eos

[Eos]

1 hour ago, wathe said:

(i) Airways, oropharyngeal (3 sizes) or
(ii) Ambu bag
(amended 2005/06/01)1 set

It was Air Canada and they didn't have an ambu bag, just a tank and mask. The RN was doing super fast compressions with no puffs, just mask oxygen, which seems to prove the modern protocol of slipping in rescue breaths but focusing on compressions. That, plus probably lots of prayers...

[Eos]

57 minutes ago, wathe said:

@Eos I'm glad that your daughter stepped up to help, and I'm glad that there was a good outcome.

 I hope she is OK.  Resuscitation can be traumatic for responders (both professional and lay-responders alike) and witnesses.  

Peel Regions's Lay-Responder and Bystander Resource Guide is excellent.

Downloaded, thank you.

[wathe]

26 minutes ago, Eos said:

It was Air Canada and they didn't have an ambu bag, just a tank and mask. The RN was doing super fast compressions with no puffs, just mask oxygen, which seems to prove the modern protocol of slipping in rescue breaths but focusing on compressions. That, plus probably lots of prayers...

I am surprised that there wasn't an Ambubag or other BVM on-board.   It's usually stored with the AED (NOT in the medical kit)

Video of Air Canada medical kit.  BVM is mentioned at the very end.

[Eos]

14 minutes ago, wathe said:

I am surprised that there wasn't an Ambubag or other BVM on-board.   It's usually stored with the AED (NOT in the medical kit)

Video of Air Canada medical kit.  BVM is mentioned at the very end.

That is odd. Editing to say the RN was focused but also fully directing everyone else.

Edited March 14 by Eos

[wathe]

21 minutes ago, Eos said:

That is odd, I can only guess the RN was too focused to clearly ask for it and the flight attendants were having a rough time.

Yes. I would be very, very surprised if there weren't one on board.  More likely that they failed to find it, or there was miscommunication.

Resusc in the air by volunteers is seriously stressful, and errors are inevitable.  Volunteers don't know what equipment is on board, or where to find it. And are working in a seriously challenging environment, often well outside their usual scope of practice.  

I really do think that airlines need a better plan than relying on volunteers.   I would love to see an airline medic type role, staffed on commercial flights - someone medically trained who can lay medical eyes on the medically distressed person, get a set of vitals, start an IV, do chest compressions, manage an airway,  administer meds, and  expertly communicate with base MD on the ground (both of whom know what resources are available equipment-wise and medication-wise, and are familiar with all the aviation angles - both practical and policy.procedural).  Particularly on large overseas flights where diversion may not be possible.  That would be so much better than hoping there is a medical professional on board with the right skills willing to step up (and then the flight staff having to trust to that -- that the person who steps up actually knows what they are doing.   People who are pushed out-of-scope in emergencies sometimes do very dumb things, and bystanders will defer to their authority).   There are probably a million legal and jurisdictional and financial reasons why this will never happen, and airlines will just continue to lean on the goodwill of volunteers instead.

 

Edited March 14 by wathe

[lovinmyboys]

Great job to your dd!

So interesting that his wife forgot about his diabetes. A couple of years ago my son collapsed on the baseball field. When I called 911 the operator asked if he had any known medical issues and I said no. She then went on to ask if he had allergies, epilepsy, diabetes. I am ashamed to admit I yelled “I said he has no medical condition quit asking me about medical conditions.” She kind of just ignored me and kept asking questions. I guess it makes sense that people may forget important things in an emergency. (My son was totally fine. It turned out he had gotten hit in the neck with a ball and I guess where it hit him caused his blood pressure to drop and he fainted.)

[wathe]

4 minutes ago, lovinmyboys said:

Great job to your dd!

So interesting that his wife forgot about his diabetes. A couple of years ago my son collapsed on the baseball field. When I called 911 the operator asked if he had any known medical issues and I said no. She then went on to ask if he had allergies, epilepsy, diabetes. I am ashamed to admit I yelled “I said he has no medical condition quit asking me about medical conditions.” She kind of just ignored me and kept asking questions. I guess it makes sense that people may forget important things in an emergency. (My son was totally fine. It turned out he had gotten hit in the neck with a ball and I guess where it hit him caused his blood pressure to drop and he fainted.)

This happens all the time.  

You quickly learn to ask about medical conditions in at least 3 different ways when taking a history, and even then will miss some.  People often say "no" when asked if they have any medical conditions, even when they clearly do.   Then, when asked about medications, will produce a list of medications as long as my arm, with meds for at least 5 different chronic medical conditions. Which I will then guess at based on the meds, and the patient will then endorse.   Or worse, when asked about meds, will say "Oh, yes, quite few," but not have brought them or be able to name them.  Or will name medical conditions that they actually don't have (often occurs when pt uses medical vocabulary that means something different than the patient thinks it does - not blaming patients here, medical terminology can be complicated). All.the.time.

Always believe the patient.  But also, patients (and families) sometimes say things that are objectively wrong.  It's not always easy to find the balance.

[Alice]

Just now, wathe said:

This happens all the time.  

You quickly learn to ask about medical conditions in at least 3 different ways when taking a history, and even then will miss some.  People often say "no" when asked if they have any medical conditions, even when they clearly do.   Then, when asked about medications, will produce a list of medications as long as my arm, with meds for at least 5 different chronic medical conditions. Which I will then guess at based on the meds, and the patient will then endorse.   Or worse, when asked about meds, will say "Oh, yes, quite few," but not have brought them or be able to name them.  Or will name medical conditions that they actually don't have (often occurs when pt uses medical vocabulary that means something different than the patient thinks it does - not blaming patients here, medical terminology can be complicated). All.the.time.

Always believe the patient.  But also, patients (and families) sometimes say things that are objectively wrong.  It's not always easy to find the balance.

Yes, 100% agree. People forget in an emergency. People sometimes say things wrong. People don't define things the same ways medical people would. "I don't have asthma but I just always use an inhaler when I exercise or have a cold." That IS asthma. 

With the meds..the best is being told the colors. "A pink pill and a yellow one." Okay, well that narrows it down. 

[Tree Frog]

3 hours ago, wathe said:

This happens all the time.  

You quickly learn to ask about medical conditions in at least 3 different ways when taking a history, and even then will miss some.  People often say "no" when asked if they have any medical conditions, even when they clearly do.   Then, when asked about medications, will produce a list of medications as long as my arm, with meds for at least 5 different chronic medical conditions. Which I will then guess at based on the meds, and the patient will then endorse.   Or worse, when asked about meds, will say "Oh, yes, quite few," but not have brought them or be able to name them.  Or will name medical conditions that they actually don't have (often occurs when pt uses medical vocabulary that means something different than the patient thinks it does - not blaming patients here, medical terminology can be complicated). All.the.time.

Always believe the patient.  But also, patients (and families) sometimes say things that are objectively wrong.  It's not always easy to find the balance.

My mIl did this when we went to the ER due to difficulty breathing when there was a nearby controlled burn. She told the medical staff she had no medical problems. Thankfully, someone here said to take all her meds with us, so I took them all in a bag. When I asked why she had so many prescriptions, mil downplayed each one. "Oh, that's only when I'm short of breath." or "That's just my water pill." or "That helps my heart." Even when we think we remember, sometimes we might not remember the medical condition, but only the effect/reason to take the medicine. I can't imagine how much more difficult it would be in an actual emergency in the air.

[KSera]

1 hour ago, Tree Frog said:

She told the medical staff she had no medical problems. Thankfully, someone here said to take all her meds with us, so I took them all in a bag. When I asked why she had so many prescriptions, mil downplayed each one. "Oh, that's only when I'm short of breath." or "That's just my water pill." or "That helps my heart."

I think this is why almost no one thinks they have any conditions that put them at higher risk from illnesses, when a huge number do.

[DawnM]

wonderful!   Being in the air and having a medical issue is terrifying.   My dad often was called during flights.   He would wait to see if "any younger doctors" were on board first.   That always cracked me up.   Then he would volunteer if no one else was available.