The Pan Am flight to San Francisco was about an hour out of London when Dr. Richard Selby, a Santa Ana neurologist, heard a flight attendant ask if there was a physician on board.
A man in his 60s had collapsed, unconscious, in the aisle six rows behind Selby.
Within seconds, Selby, a British nurse and an emergency room doctor from San Jose, were at the side of the stricken passenger. In examining the cold and clammy man, Selby detected a faint pulse.
Seizure or Coma
"His pupils were reactive, which would indicate to me his brain was still functioning," Selby said. "At that point I determined he either had a seizure or was in a diabetic coma."
Looking through the man's belongings for clues, Selby found insulin and a diabetic test kit.
Selby got a drop of blood from the man by sticking him with one of his syringe needles, then applied the drop of blood to a test tape in the kit that measures blood sugar levels by color change.
"We then decided it was a hypoglycemic diabetic coma--his blood sugar had dropped to very low levels," Selby said. "The problem was we had to get sugar into him."
It was then that Selby discovered what countless other physicians have learned in in-flight medical emergencies: Beyond a basic first-aid kit, which consists primarily of bandages and ammonia inhalants, U.S. airlines are not equipped to deal with most medical emergencies.
That situation, however, is about to change.
Beginning Aug. 1, a new Federal Aviation Administration ruling will require that all U.S. airlines carrying 30 or more passengers per flight be equipped with an expanded medical kit. This kit, according to the FAA, must contain equipment and supplies for treating such medical emergencies as acute allergic reactions, angina (chest pain due to an insufficient blood supply to the heart), insulin shock and hypoglycemic diabetic coma.
Had Selby had such a kit, presumably he could have treated his in-flight patient almost as effectively as most hospital emergency rooms where, Selby said, "he would have been given 50% glucose and water intravenously, and he would have been awake in minutes.
"But without the i.v., he could die or sustain severe brain damage."
Improvising Pays Off
In the case of Selby's flight in March, however, ingeniousness made up for short emergency medical supplies.
"We took Coca-Cola and packages of sugar and one man--a kiwi farmer from Northern California --stood there continuously stirring that solution," Selby said. "The problem was getting it into the man because he was comatose and not swallowing."
Selby took the rubber tubing off a stereo earphone set and inserted the tube through the man's mouth into his stomach. He then forced the liquid down the tube.
"His (the patient's) blood sugar was zero on the test kit, so we knew he didn't have much time," Selby said, adding that he remained in constant touch with the plane's captain, who was prepared to land in Iceland if necessary.
As it turned out, the plane did not have to divert to Iceland.
"By the second hour he regained consciousness and was talking. . . . The man actually walked off the plane to meet his daughter," Selby said.
Despite the happy ending, the experience left Selby feeling frustrated and concerned about public safety on board airlines.
Over the years, the airline industry has been opposed to carrying more fully equipped medical kits--which would contain surgical instruments, controlled substances and other major medical supplies--on board passenger planes. Such kits, the airlines argue, would not only be expensive but could lead to misuse and potential liability. And, they maintain, cases of passengers becoming seriously ill are extremely rare.
"A noisy airline cabin is not the place to perform an accurate diagnosis," said Thomas Tripp, manager of technical information for the Air Transport Assn., a trade and service organization for U.S. scheduled airlines.
"We've always considered the airlines to be a 500-m.p.h. ambulance . . . that the first course of action should be to divert the airline and put the passengers on the ground," said Tripp. "Anywhere in the United States, we can put a passenger into the hands of trained emergency personnel within 20 minutes at the most."
Selby, however, is not the only physician concerned about the lack of emergency medical supplies on board airplanes.
"On all the flights I've been on, there usually are other physicians on board," said Dr. Edward Austin, a Century City pediatric surgeon. "But you feel helpless not having the medications and the instruments" to use in an emergency.