2023-09-11 06:30:00
Qit is reassuring to travel with the Dr Vincent Liu-Bousquel. This anesthesiologist-resuscitator in Nice found himself twice, six months apart, having to provide emergency care on a person having a stroke and another, a heart attack. And this, each time, at an altitude of 10,000 meters, during an Air France flight. In both cases, the trip fortunately ended well.
But the doctor, who recounts it here to Point, lifts the veil on the weaknesses of the rescue organization, on-board emergency equipment and on the lack of training of personnel. He draws from his adventures some recommendations which would greatly improve the care of patients in these extreme conditions that are international flights lasting several hours.
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A first rescue on board Air France
“My name is Vincent Liu-Bousquel, I am 34 years old and I am an anesthetist-resuscitator in Nice. I would like to tell you about a rescue experience on board an airliner that happened to me on an Air France 267 flight flying from Seoul to Icheon – Paris CDG on August 26, 2023.
To begin with, karma definitely doing things well, a similar experience had taken place six months previously on board an Air France flight from Paris to Bucharest. A cabin announcement called for a doctor for temporary discomfort. Seeing no one come forward, I went to the patient.
Various clinical signs such as the beginnings of aphasia (a speech disorder) associated with paresthesias (tingling sensation, tingling) and motor disorders then made it possible to suggest a stroke. No specific therapy can be undertaken on board, as no clinical examination can discriminate between ischemic (blood clot in the cerebral circulation) or hemorrhagic form.
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In the ischemic form of this pathology, the notion of timing is essential with a classic delay of 4.5 hours following the onset of symptoms for optimal recovery, a delay that can be exceeded using specific imaging sequences prognosticating cerebral viability. even this period of time exceeded, if adequate therapeutic means are put in place.
I contacted the local Samu, who took care of the liaison with an adequate technical platform and the presence of a transport vehicle when getting off the plane for “scope and run” type support. », a method of transport favoring speed of transfer to a suitable center.
At the end of this adventure, the company asked me to join the Community of Doctors on Board program, listing the doctors available on board each flight and thus ensuring rapid treatment of patients.
Second rescue during 14-hour flight
Return to flight AF 267 on August 26, 2023 between Seoul and Paris. This is a 14-hour non-stop flight on a Boeing 777-300 ER. The flight was pleasant and I was able to interact with the crew as part of my professional pilot training, which I carry out alongside my job and which is soon coming to an end. At the twelfth hour of the flight, the steward came directly to inform me that a passenger was seriously ill, put on the ground at the end of the row.
When I arrived, the patient’s state of consciousness was altered with objective signs of the body’s reaction observed during the initial phase of shock. The only information I have at the time is that the onset of symptoms was sudden chest pain.
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The crew, very helpful indeed, provided me with all the therapeutic arsenal on board. I can thus take a blood pressure measurement demonstrating a relatively preserved hemodynamic state. Likewise, blood oxygen saturation was 100%. Combined with the severity of symptoms, this makes massive pulmonary embolism or tension pneumothorax less likely. A letter was given to me, showing that this patient was able to benefit from a stent in the coronaries a month and a half previously, confirming the supposed diagnosis.
A united crew
In the care kit, I find a medication, Natispray® (to spray under the tongue), to dilate the coronaries. This medication then allows the regression of certain symptoms. The problems are starting, I want to put in an IV to try to increase the patient’s cardiac output. The crew, once again very supportive, cannot provide me with the necessary equipment due to lack of knowledge of medical jargon. When I ask for a dressing to secure the infusion once it has been placed with great difficulty, I am handed a Mercurochrome!
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In addition, there is as standard an injection tap on the infusion to administer medications intravenously. Here, this tap simply does not exist. I had to systematically manipulate the IV in order to inject the medication, reconnect everything and secure it using tape found on site. The device used to check blood sugar levels does not work despite several attempts. The care kit is sorely lacking in medications useful in this situation, such as therapy to constrict the blood vessels in the event of an alteration of the cardiovascular state, the only one available being adrenaline, a strong cause of myocardial arrhythmia. as well as many other side effects.
At the same time, the question of the diversion of the flight arises. As in stroke, a delay of 90 minutes must be respected between the first medical contact and the medical procedure in the coronaries. Due to the considerable time taken to stabilize the patient, we are now only an hour from Paris. I go to the cockpit to transmit information directly to the Samu and optimize the medical care chain.
We then have the surprise of being put on hold with voice server music, improbable in the context! I do not want the passenger to be put back in a seated position, the descent to CDG is carried out with the passenger still on the ground blocked by the cabin crew (PNC). A rapid landing allows rapid treatment of the patient then entrusted to ground teams, after further transmissions to the aircraft door.
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The need for reorganization of equipment
Some lessons can be learned from these experiences.
For the general public, the warning signs of stroke, as well as the main life-threatening emergencies in flight. In particular, it is important to respect the recommended time limits for contraindication to air travel, approximately three weeks minimum after a pneumothorax or myocardial infarction.
For my sisters and brothers: the difficulty in managing equipment, a bundle of arguments pointing towards a diagnosis without specific means of certainty, the cumbersomeness of a diversion decision, the obligation to be able to infuse a severely ill patient when we haven’t practiced this gesture for some time.
For the company: perhaps a reorganization of equipment, greater ease of access, training of a member of the crew in a minimum of medical jargon in order to best assist, boarding on long-haul flights certain remote diagnostic means (electrocardiogram in particular) as well as exceptional medications (medication allowing clots to dissolve) the responsibility for the use of which must be taken by an authorized doctor, either by near diagnostic certainty, or by constraint to the given the patient’s condition (cardiac arrest with suspicion of pulmonary embolism, for example).
These events, statistically rare, occur and jeopardize the vital prognosis of these patients in a context of health hostility. It would be fair to be able to provide them with a “best” solution without imposing excessive costs on the company. I am lucky enough to be able to discuss this with Air France during the month of September.
In the meantime, as they often say in the aviation world: Fly Safe! »
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