FIRST PERSON “Is There a Doctor or Nurse on Board?”

By Lily Leitner Berrin, MD

“Is there a doctor or a nurse on board?”

As a first-year emergency medicine resident, I was both excited and terrified to hear the call on my recent flight home from SAEM23 in Austin, Texas. I’ve been told that every doctor responds to an inflight medical emergency at least once in his or her career, I didn’t realize my moment would come so soon. I paused my Netflix show and made my way to the front of the plane.

The patient, a man in his 60s, had been in the restroom for about 20 minutes and was acting strangely. Thankfully, William “Bill” Toon, EdD, NREMT-P, was already there. On our quick assessment, we noted that the patient was altered, diaphoretic, and unstable on his feet. Bill took his vitals, and the flight attendant brought forward the patient’s medicine bag, which was full of insulin. There was no glucometer in the plane’s medical kit, but a call overhead had one quickly brought to us from another passenger. The patient’s glucose was 29. We quickly started giving him juice, and attempted an IV, which was challenging since the patient was still in the airplane bathroom. The plane did have D50, which we mixed with the cranberry cocktail, since it had the most sugar of the available beverages. As Bill and I took turns giving the patient the juice, we learned that we had both come from SAEM23, and were surprised we were the only medical providers on the flight. We rechecked the patient’s glucose, which had increased only to 34. After a little more juice and an episode of emesis, the patient’s glucose rose to the 70’s. The flight attendants and captain arranged for an emergency medical services crew to meet us at the airport. When we landed, the patient was mentating and we were able to successfully transfer him to the paramedics for assessment at a local hospital.

Bill and I deplaned, shook hands, took a photo, and went our separate ways — he to his final destination in Phoenix and I to my connecting flight back home to Oakland, California. One of the reasons

I chose emergency medicine is for the interdisciplinary teamwork. I was grateful to learn from and work with Bill, whose career as a paramedic prepared him to expertly care for a patient on a plane with limited resources. From this experience, I learned that I could help stabilize a patient using collaboration, my medical knowledge, and limited medical tools. I also learned that not all airlines carry the same medical kit, and I have written to the airline to recommend that they add a glucometer and pulse oximeter to their kit. I am grateful that as an emergency medicine resident I will continue to gain the knowledge and experience to help care for patients in all settings, and I am grateful to continue learning from colleagues in and out of the emergency department.

About The Author

Dr. Berrin is a first-year emergency medicine resident at Highland Hospital, in Oakland, California. She completed her medical degree at the University of Pittsburgh School of Medicine in 2022. She is the resident representative on the SAEM Academy of Geriatric Emergency Medicine (AGEM) executive board. @LilyBerrin