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🎙️ Episode Summary

In this engaging and surprisingly eye-opening episode, the crew sits down with Dr. Jordan Singer, an emergency medicine physician with unique experience providing in-flight medical command. Together, they explore the complexities of managing medical emergencies in one of the most austere environments imaginable—an airplane at cruising altitude. From physiology at altitude and cabin pressurization to legal protections and what’s actually in those onboard emergency kits, this episode offers critical insights for any EMS or healthcare provider who’s ever heard the overhead call: “Is there a doctor on board?”

✈️ Key Topics Covered

1. Understanding In-Flight Emergencies

• ~1 in 20 commercial flights involves some form of medical incident.
  
  

• Most common: syncope, GI issues, respiratory distress, chest pain.
  
  

• ~1 in 600 flights requires an emergency diversion.
  
  

2. Physiology of Flight

• Cabin pressure is equivalent to 6,000–8,000 ft elevation.
  
  

• Lower partial pressure of oxygen may affect patients with CHF, COPD, PH.
  
  

• Dehydration, skipped meds, alcohol use, and anxiety contribute to incidents.
  
  

3. Medical Command at 30,000 ft

• Physicians give consults through multi-step airline communication pathways.
  
  

• Recommendation-based: ultimate diversion call rests with the pilot.
  
  

• Often handled via phone with minimal info; must ask high-yield, targeted questions.
  
  

• Considerations change dramatically before flying over oceans ("the pond").
  
  

4. Legal Considerations

• Aviation Medical Assistance Act protects providers in the U.S.
  
  

• Offers Good Samaritan-style protections if care is non-negligent and uncompensated.
  
  

• Gray areas in international airspace or foreign jurisdictions.
  
  

5. Emergency Medical Kits (EMKs) & Equipment

• EMKs typically contain:
  
  

  • Basic wound/IV supplies
    
    

  • Select ACLS meds: Epi, Atropine, Dextrose, Lidocaine (sometimes Narcan, Zofran)
    
    

  • AED (required)
    
    

  • Basic BP cuff, stethoscope, possibly glucometer
    
    

  • Limited oxygen (2–3L/min x ~30–40 minutes max)
    
    

• Ask for the EMK to instill confidence and access necessary tools.
  
  

• Expect basic, not robust, resources.
  
  

6. When Diversion Is Recommended

• Ongoing seizure without benzodiazepines available.
  
  

• Suspected acute MI (especially with symptoms like chest pain + diaphoresis).
  
  

• Situational awareness: fuel weight, location of capable hospitals, and ocean crossings all influence diversion decisions.
  
  

7. Fitness to Fly Evaluations

• Considerations for patients with:
  
  

  • CHF, COPD, pulmonary hypertension
    
    

  • Seizure history (must be >24 hrs seizure-free)
    
    

  • Pneumothorax, GI bleed, recent TIA/stroke, jaw wired shut (must carry wire cutters)
    
    

• Airlines may deny boarding based on physician fitness recommendations.
  
  

8. What Can You Do As A Provider?

• Always act within your training—do what you know is right.
  
  

• You’re not alone: medical command will assist the captain.
  
  

• Don’t delay care waiting for med command if immediate action is needed (e.g., hypoglycemia, respiratory distress).
  
  

9. Realities of the Role

• Dr. Singer took calls from home during overnight shifts post-fellowship.
  
  

• Provided online medical control for both EMS and airlines.
  
  

• Used simplified decision-making protocols based on minimal info and time pressure.
  
  

🧠 Memorable Quotes

“I can’t lay my own eyes on the patient. I have to trust someone else’s story and make a recommendation from 30,000 feet.”
— Dr. John Hill

“Ask for the EMK. Not only will it help, it signals to the crew that you know what you’re doing.”
— Dr. Jordan Singer

“Do what you think is right—most of the time, it will be.”
— Scott Wildenheim

📌 Takeaways for EMS & Medical Providers

• Know what to expect if you answer the call for help on a flight.
  
  

• Stay within your scope but don’t hesitate to act in good faith.
  
  

• Syncope, hypoglycemia, and basic respiratory issues are the most common—basic interventions go a long way.
  
  

• AEDs and EMKs are on every U.S. airline—use them if needed.
  
  

• Understand the system in place: you may be one part of a much bigger decision-making chain.

From The Episode