Assistance During In-Flight Medical Emergency Becomes Learning Experience for USU Student
Uniformed Services University medical student Army 2nd Lt. Cole Crandall assisted in a medical emergency aboard a flight recently
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Army 2nd Lt. Cole Crandall assisted in a medical emergency aboard a flight to Hawaii as he headed for his nephrology rotation. (Airplane photo courtesy of the U.S. State Department. Crandall photo credit: Tom Balfour, USU) |
July 13, 2023 by Vivian Mason
Flying over the Pacific Ocean, third-year Uniformed Services University (USU) medical student Army 2nd Lt. Cole Crandall heard some commotion in the back of the plane. He had just completed his internal medical rotation at Madigan Army Medical Center in Washington and was headed for his nephrology rotation at Tripler Army Medical Center in Hawaii.
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Army 2nd Lt. Cole Crandall (Photo credit: Tom Balfour, USU) |
By then, everyone wanted to know what was going on in the back of the plane.
“As a medical student,” Crandall continues, “I didn’t want to impose myself and act like I knew what I was doing. But, I realized that I might be able to help in a limited capacity. The stethoscope I had in my backpack could be useful, and I wanted to offer it just in case it was needed.”
As he headed for the back of the plane, Crandall was stopped by a flight attendant who said that no one should go back there.
“At that point, I could see someone was standing over an older male,” he recalls. “I let the attendant know that I was a medical student and had a stethoscope if it was needed. So, she let me through. It was then that I met the nephrologist from the University of Washington who was the person tending to the elderly gentleman.”
The flight crew had access to only limited medical supplies, including an oxygen saturation meter and a blood pressure cuff with its associated basic stethoscope that was difficult to hear through on the noisy aircraft. The nephrologist was relieved when Crandall offered his USU-issued stethoscope. She then asked Crandall to take the elderly man’s blood pressure. Even though he was a bit surprised and nervous, Crandall kept his composure and agreed to do so.
First, however, the nephrologist briefed Crandall on the initial medical history that she was able to obtain from the patient. Crandall was able to get further information about the patient's condition by taking a medical history directly from the elderly gentleman and his sister who accompanied him on the flight.
The patient experienced severe chest pain below his sternum with some radiating to his left arm, suggestive of a possible heart attack. Shortly after he began having chest pain, the patient took a nitroglycerin tablet. To avoid causing additional distress for the patient, Crandall got the rest of the history from his sister.
She revealed that the gentleman was in his 70s, had a history of unstable angina, and had a heart attack in the past. She also said that it was the man’s first time flying in a while. She was carrying all of her brother’s medications, including the nitroglycerin tablets.
When it was time to take the man’s blood pressure, Crandall recalled his USU training on how to take a manual blood pressure. He reported that the patient’s blood pressure was 90/60 mm Hg. Because the patient was hypotensive, a subsequent dose of nitroglycerin was not provided for pain control because of concerns about further decreasing the patient’s blood pressure. Crandall also used his stethoscope to listen to the patient’s heart. He didn’t hear any abnormal heart sounds or a new onset of a heart murmur, and the nephrologist agreed with his assessment.
Crandall explains that he thought it was ironic that he was going back to doing the manual blood pressure training he learned at USU because, “Taking blood pressure is one of those skills that we practice in school, yet wonder why we have to do it all the time. In the hospital, there’s always an automated blood pressure cuff to use. Thankfully, that training came in handy for this situation.”
The airline also had oxygen tanks to provide additional support for the patient. His oxygen saturation was 88%, which was on the low side. The flight crew, at the recommendation of the nephrologist, hooked the patient up to the oxygen tank (that was kept onboard) to allow the patient to breathe better.
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Army 2nd Lt. Cole Crandall (2nd from left) with USU classmates during M4 weapon range day. (Photo courtesy of 2nd Lt. Cole Crandall) |
“The flight crew was able to talk by phone with a hospital in Honolulu,” recalls Crandall. “They contemplated whether to turn the plane around mid flight because of the patient’s presentation. The major problem was that the plane was in the middle of the Pacific Ocean, right at the halfway point with nowhere to land.”
Continues Crandall, “It was a matter of continuing for two and a half more hours or turning back. Ultimately, the decision was made to proceed forward, since there was a physician on the flight with appropriate medical supplies to help monitor and stabilize the patient.”
After things settled down, the nephrologist provided additional learning points for Crandall. With the nephrologist’s increasing support, Crandall reviewed the blood pressure log that she’d been keeping. The gentleman’s vitals stabilized, his blood pressure rose to 115/75, and his oxygen saturation increased to about 95%.
“I felt like my contribution to this emergency was just being fortunate enough to be carrying a stethoscope with me during the flight,” Crandall says. “The nephrologist was very appreciative and encouraged me to be part of the patient’s medical care. She supported me as I was able to reassess the patient’s vitals later in the flight as well.”
When the plane landed, there was an ambulance waiting on the tarmac. The patient was loaded onto a stretcher and taken off the plane.
“He gave us a thumbs up as he was being transported to the hospital. The flight attendants and passengers thanked us for what we had done.”
Crandall says that, while he doesn’t know what the patient’s outcome ultimately was, he assumes the patient would be assessed for a heart attack at the hospital, which could have required further intervention in the cardiac catheterization lab.
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Army 2nd Lt. Cole Crandall (left) with classmates at the Class of 2025 White Coat Ceremony at USU. (Photo courtesy of 2nd Lt. Cole Crandall) |
“Sometimes, we take for granted the efficiency and access to resources that we are accustomed to in the hospital. If this patient had presented to the Emergency Department, we would have been able to get an EKG and other tests right away. However, in this particular emergency, we didn’t have this ability, thus reaffirming the need to learn our fundamental physical exam skills.”
Crandall expresses that communication was also a significant skill necessary in this emergency.
“We relayed information to the flight crew who relayed it to the hospital. Continuity of patient care is essential in military medicine. We have to know how to communicate accurately thousands of miles away and be able to properly input, translate, and interpret this data quickly to ensure mission success.”
Recalling the emergency, Crandall says that it “felt great to be of help,” but notes that his time reflecting on the experience after the fact has been more impactful than his work in the moment of crisis.
“There were many parallels to military medicine that I took away from this situation,” Crandall says. “Addressing a medical emergency on a plane with limited medical resources and no immediate transfer to higher levels of care changes how you are able to assess and treat patients.”
This same message has been repeated by military physicians in the deployed setting because they have to similarly adapt and treat patients during urgent situations despite having limited resources and adverse environments.
“There’s so much to learn about military medicine,” says Crandall. “It demonstrates the impact of that learning and the difference it can make.”
Ultimately, Crandall believes this experience reinforces that medicine is the path he’s meant to be on, and studying at USU is where he’s meant to be.
“There’s a need for physicians and medicine, whether in the field, on a plane, deployed, or in a hospital. I hope my knowledge will make a difference in people’s lives. It’s moments like this that truly define why I chose to be a physician.”
