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On a 9-hour flight home recently this week I was identified as a doctor and invited to administer metoclopramide by injection. Staff on board had reported a ‘medical issue’ to base advisors who diagnosed asthma leading to vomiting and advised the treatment.
While a raft of drugs was made available to me (together with an indemnity letter), monitoring equipment on an aircraft costing about a third of a billion dollars was notably sparse. An ancient cheap stethoscope accompanied an anaeroid sphygmomanometer — but the high ambient noise allowed only assessment of systolic pressure by pulse. Temperature was assessed as normal using the back-of-hand method and I was able to take a pulse and assess the respiratory rate as well as the colour of the patient. The history was consistent with a urinary tract infection with some suprapubic tenderness.
Without local guidance on interactions (and disagreeing with a remote diagnosis made thousands of miles away) I declined the invitation to administer metoclopramide, as there was certainly a risk of interactions with existing medication. I endorsed the continuing provision of bottled oxygen. At the destination a local paramedic took over care using an integrated monitoring suite that he carried on his bicycle.
As a former Royal Navy GP, I have experience of delivering care in varied environments at distance from support services but was frankly appalled that a multimillion dollar industry fails to provide inexpensive and up-to-date monitoring equipment and simple paper forms for aircrew to complete in taking advice from base. A proforma taking basic details including known pre-existing conditions and current medication would enhance care but equipment such as a pulse oximeter, thermometer, and automatic sphygmomanometer could be carried at less than a millionth of the cost of the plane and would probably reduce occasional expensive diversion events.
I will, in future, pack a pulse oximeter in my carry-on bag; others may wish to do the same. Following publication of this letter in the BJGP, I will forward a copy to CEOs of all UK airlines and to the Civil Aviation Authority.
- © British Journal of General Practice 2024
