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 their stricken fellow passenger. In examining the cold and clammy man, Selby determined that although he still had a heart beat, his pulse was faint.
"His pupils were reactive, which would indicate to me his brain was still functioning," Selby recalled. "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 which 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 when they have responded to an in-flight medical emergency: 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 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, he could presumably 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 IV," Selby added, "he could die or sustain severe brain damage."
In the case of Selby's flight in March, however, ingeniousness made up for the shortage of 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," said Selby. "The problem was getting it into the man because he was comatose and not swallowing."
Failing to get a swallow-reaction, Selby took the double rubber tubing off one of the stereo earphone sets, sliced it in half and inserted the tube through the man's mouth into his stomach.
Selby first tried to get the liquid down the tube by using the headset's ear piece as a funnel. When that failed, he said, he used an insulin syringe to push it 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, a costly maneuver that would have required dumping the plane's fuel before landing.
"We were able to test the man's blood sugar with his test kit. After getting two zero readings, we started to detect glucose in his blood, and we continued the treatment," said Selby. "By the second hour he regained consciousness and was talking. . . . The man actually walked off the plane to meet his daughter."
Despite the happy ending, the experience left Selby feeling "frustrated and concerned" about public safety on board airlines. "I don't think people realize when they go on a plane that there's nothing there," he said.
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. Furthermore, "a noisy airline cabin is not the place to perform an accurate diagnosis," says Thomas Tripp, manager of technical information for the Air Transport Assn., the trade and service organization for scheduled U.S. airlines.
"We've always considered the airlines to be a 500-mile-per-hour ambulance . . . that the first course of action should be to divert the airline and put the passengers on the ground," Tripp said. "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 airlines.