Emergencies happen anywhere, anytime, and sometimes medical professionals find themselves in situations where they are the only ones who can help. Is there a doctor at home? is a Medscape Medical News series that tells these stories.
My husband Scott and I were flying back to Washington State with our two children, ages 1 and 4. We had been to Florida on a family vacation and were nearing the end of the flight, with both children asleep on top of me.
Audra Podruzny with her two children, moments before the incident occurred
Suddenly, there was shouting and a lot of movement from the flight attendants. The announcement was heard: “Is there a doctor on board?” My husband and I are nurses. We looked at each other and looked at our sleeping children. Should we say something?
One of the flight attendants walked by looking very nervous. My husband was in the aisle seat, so she looked over and told him we were nurses. His eyes went wide and he said, “Oh, yeah, come on.”
She looked at the two of us. I said, “I think he’ll do it.” I figured it wasn’t that big of a deal. Plus, there were kids sleeping on top of me.
Scott went to the front of the plane. But a few minutes later, the flight attendant came back and said, “You have to help.” I was holding my one-year-old son, so I handed him to her. She sat with him, and I went to the front of the plane.
I arrived at the first class passenger area, where the toilets and cupboards with all the food and drink are. I could see an elderly man lying face up on the floor. He was unconscious and bleeding profusely from his scalp.
When I saw the bleeding, my first reaction was that pressure needed to be applied. I asked for a towel. There were no towels. A blanket? Something to help absorb the blood? Nothing. They had nothing. They gave me a pair of gloves that were too big and a handful of cocktail napkins.
It was such a small space that there was no way to be close to the man. So I crouched on top of him to reach behind his head. I put down a bunch of napkins and pressed down as much as I could with the fingertips of one hand.
Audra Podruzny, RN
I’m a nurse in the post-anesthesia care unit, so the next thing I could do was check his pupils and make sure he had a clear airway. I pulled his jaw up and lifted his chin. I saw that he had blood in his mouth and was breathing in rapid gasps. I was trying to do all of this with my free hand without crushing him with my body.
Scott had made some ice packs, so I applied those as well, which helped slow the bleeding. He then checked the plane’s first aid kit to try to give me an IV. It wasn’t easy. The kit was very different from the one normally used. Also, the plane had started to descend for landing, so we were tilted. But he tried.
We asked what had happened. The flight attendant said the man had fallen and hit his head on one of the stainless steel cabinets. He looked to be in his 70s or 80s, a tall, robust guy.
His wife was sitting nearby, fairly calm and stoic given the circumstances. We asked her for her medical history to find out why she was unconscious. She was still completely unconscious. She told us that she had diabetes. She was on a blood pressure medication and also a blood thinner.
The plane continued to descend. I was in a really uncomfortable position, crouching and holding on to the cupboards. I kept talking to the man, trying to wake him up: “Can you hear me? Everything is fine. He hit his head.”
Someone brought us an oxygen tank. I looked for the mask. And I realized it wasn’t a mask, but a plastic bag. I put it on his face and felt like I was suffocating him, so I tried to blow on it to increase the oxygen in the air near his face.
At one point, his breathing was agonizing for a few minutes, which worried me greatly. I was afraid he would stop breathing. I rubbed his chest and said, “Hey, not that!”
I would have felt much better resuscitating him with a real oxygen mask instead of a plastic bag.
The amount of blood looked alarming, I couldn’t tell how much was actively bleeding, but it was a lot. At least it wasn’t turning grey, so that was a good sign.
He finally came to and opened his eyes. I introduced myself and asked him, “Do you know where he is? Do you know what’s going on?” I was trying to find out if he was oriented.
Eventually, he was able to talk to me, so I kept asking him questions: “Are you on vacation? Where are you going? Where are you staying?”
She told me that they were going to visit her granddaughter and she was able to talk about it. She didn’t try to get up, which I was glad for, because that would have been very difficult to handle.
I could tell he was embarrassed by what had happened. I have helped many elderly men after they fell and they often have a bruised ego. They don’t want to be put in the position of needing help.
Finally, the plane landed. There was blood everywhere. The ice packs had melted and the water had mixed with the pool of blood. It was a mess.
The pilots had called the airport in advance to let them know that we needed medical services, so the first responders were on the scene right away. They stabilized the man with a board, put him in a neck brace, and did everything else you would do with a patient after a fall.
I gave them a briefing, that’s my style, but it didn’t seem like they needed much information at the time.
Finally, I was able to speak to the man’s wife, who was clearly terrified. I hugged her and told her he would be okay. She thanked us.
The emergency team also appeared to have nothing to help stem the bleeding, as the rolling stretcher left pools of blood all over the walkway, causing a major biohazard issue.
One person with a connecting flight was let off, but everyone else had to get out the back of the plane and walk along the tarmac.
When we finally got back to our seats, the flight attendant was still sitting with our children. They were both completely calm, watching some program, seemingly very well behaved. Our daughter asked us what was going on, and I told her, “Oh, someone got hurt in the front of the plane.” She’s so used to hearing that we work with sick people that she didn’t flinch at all.
When we left, we received many thanks from people who had been sitting in front and saw what happened.
When we got home, there was still blood on my shoes. I remember looking at them and thinking, Disinfect or throw away? I disinfected them. They were still a good pair of shoes.
A few days later, we received an email from the airline with a voucher, expressing their gratitude for our help. It was nice and unexpected.
I responded with a suggestion: How about having some protocols for medical incidents on airplanes? Pilots go through checklists for almost everything they do. Why wouldn’t they have something like that for medical incident responses?
I also asked how the man and his wife were doing, but they could not reveal that information.
It was strange being out of my element, helping a patient in that small space; I’m used to working in a recovery room where you have literally everything you need at your fingertips: the bag-valve-mask, the suction, and the dressings. And for airway management, there’s usually more than one person in the room to help. If there’s a problem, a bunch of people are around the bed very quickly.
I definitely think a lot more about field medicine. I wonder what I would do in certain situations. While talking to my mother (an advanced registered nurse), she told me that we should have asked passengers for bandages or diapers to stabilize bleeding instead of cocktail napkins. A brilliant idea, it didn’t occur to me at the time. But I’m keeping that advice in my pocket for future hemorrhages.
Audra Podruzny, RN, MSN, RN, lives in Washington State, USA, and is currently pursuing a Doctor of Family Nursing Practice program at Washington State University.
Are you a physician with a dramatic medical history outside the clinic? Medscape would love to consider your story for “Is There a Doctor at Home?” Please email your contact information and a brief summary of your story.
This content was originally published in the English edition of Medscape.
