By Megan Murdock Krischke, contributor
January 24, 2014 - Have you ever had to use your nursing skills in an emergency at 30,000 feet? It happened recently to two nurses who were flying from Des Moines, Iowa, to Denver, Colo. over the holidays, and it’s an experience they won’t soon forget.
Amy Sorensen, RN, flight medic with the Wyoming National Guard and ER nurse at Wyoming Medical Center in Casper, was watching an in-flight movie at the back of the plane when the request for a medical professional came over the PA system. As a young nurse with 14 months of experience in med-surg and ER nursing, she initially decided not to respond because there seemed to be plenty of people turning on their call lights in reply to the request.
Amy Sorensen, RN, used her ER nursing experience to help save the life of a commercial pilot mid-flight. Photo credit: The Casper Star-Tribune
But then the crew issued a second request for a medical professional and she hit her call button.
“As it turns out, people were hitting their call lights because they were curious, not because they could help,” said Sorensen. “When I told the flight attendant I was an ER nurse, she said, ‘We need you up front right way--it is the captain.’”
Linda Aleweiss, RN, a pediatric ICU nurse from Camarillo, Calif. was already in the cockpit talking with the pilot, who appeared to be pale and sweating. His lips were also turning blue and he appeared disoriented.
Aleweiss asked the copilot if she would be able to land the plane. “Yes,” she replied, and then informed the nurses and flight staff that she would be diverting the flight to the closest airport in Omaha, Neb.
But first, they had to get the captain out of the cockpit and somewhere that he could be treated.
Alewiess’s husband helped to pull the pilot out, and the group laid him on some blankets in the galley. One attendant pulled out an oxygen tank, and the nurses realized they were probably dealing with a cardiac problem. After cutting off the captain’s uniform, they attaching the plane’s automated external defibrillator [AED], which showed that the captain was in ventricular tachycardia--an irregular heart rhythm which, if sustained, can be lethal.
“He complained of chest pressure and by then the attendant had pulled out a container of medications. I gave him a nitroglycerin tab to dilate the blood vessels of the heart to make sure they were getting enough blood,” Sorensen explained.
“Originally I’d wanted to get a set of vitals, but we didn’t’ have a blood pressure cuff,” she added. A cuff was soon found, and the nurses could see that their patient’s blood pressure was dangerously low. Just as Sorensen said to Aleweiss that she wished they had IV fluids to help get his blood pressure up, one of the attendants handed her an IV setup.
The AED on board did not have the ability to deliver the kind of shock the patient would need if he were to lose a pulse, so Sorensen went back to the basics of nursing care: treating the patient’s airway, breathing and circulation.
As the pilot began to lose consciousness and wouldn’t respond to questions, Sorenson began eliciting pain responses.
“At first, I was able to get pulses on his wrists, but those weakened as the flight continued. Then I was able to find a strong femoral pulse, but then that started fading,” she recounted. The nurses realized they may have to start CPR if his condition didn’t improve.
By the time the plane landed in Omaha, the pilot was unconscious with a very weak femoral pulse. By the nurses’ request, emergency crews met the plane on the tarmac in order to save precious response time. They had had the captain in their care for approximately 25 to 30 minutes.
Besides the obvious differences of being in the air vs. on the ground, Sorensen reflected that this emergency experience was very different than working in her normal environment.
“In the ER, when we get a critical patient we are moving quickly with many nurses working at once. On the plane there were only two of us and I was the only one who could sit right next to him because it was such a small space. In the ER we have a physician saying do this or that, but basically I was doing the intervention.”
While she was pleasantly surprised that the aircraft was equipped with a blood pressure cuff, IV equipment and medications in addition to the AED, she said the one thing she wished they had was an advanced heart monitoring system.
“We were definitely hovering on the line of needing to shock him,” she stated. “I’m glad we were able to land when we did.”
Despite the unusual circumstances, Sorensen says that her time in the ER helped to prepare her for this in-flight emergency.
“I’ve had excellent preceptors who have prepared me for what to do. Doctors are not always available and so we have to go off of what we know to treat patients. I’ve seen patients like the pilot in the ER, so I knew what steps to take,” she said.
Sorensen said the scariest moment for everyone was probably when the crew asked over the PA system if there was anyone on board with flight experience. Fortunately, there was an Air Force pilot on board who assisted the copilot in landing the plane.
“I was very focused on treating the patient, but there was this moment where I thought, ‘This could go badly for the whole plane,’” she admitted.
After the pilot was handed off to on the emergency responders on the tarmac and the plane was taxiing up the runway, the passengers erupted in cheering and clapping.
“Even though we were getting stuck in Omaha overnight, I never heard anyone complain,” Sorensen commented. “The passengers were very grateful that it all turned out as best it could.”
“My advice to other nurses who might find themselves out of their element is, no matter how critical the patient, go back to the ‘ABCs’ of nursing and treat the airway, breathing and circulation.”
The next morning, as the nurses resumed their trip, Aleweiss sat next to the copilot who informed her that the captain had been taken to a cardiac unit and had survived. The nurses were thanked again for their heroic efforts.
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