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The Doctor Who Jerry-Rigged a Nebulizer Mid-Flight to Save a Two-Year-Old Asthmatic

According to a 2013 study, medical emergencies occur only in about one in 604 flights. Flights do carry enough medical equipment and supplies, and the crew is trained to deal with the rare medical emergencies. But, the assistance and presence of an actual doctor is reassuring for the patient as well as the crew. A few years ago, Dr. Kurushid Guru had to help a toddler who was having an asthma attack while on board an Air Canada flight, and here’s what happened.

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On September 18, 2015, Dr. Khurshid Guru was aboard a transatlantic flight when he found a two-year-old boy short of breath and crying in distress. The boy was having an asthma attack, and his oxygen level was getting dangerously low.

Dr. Khurushid Guru with the Device
Dr. Khurushid Guru with the Device. Image Source: Dr. Khurshid Guru/Twitter

Dr. Guru is the director of Robotic Surgery and Applied Technology Laboratory for Advanced Surgery (ATLAS) at the Roswell Park Cancer Institute in Buffalo, New York. He was traveling back to the US after attending ERUS15 in Bilbao, Spain on an Air Canada flight when the incident occurred.

Three or four hours into the flight, the doctor was told of the toddler who was having an asthma attack. According to the doctor, the boy had developed a cold. After checking his oxygen levels using an oxygen meter, the doctor found that it was only about 87 or 88%. Though he doesn’t treat pediatric patients, he knew the boy needed immediate medical attention to prevent him from getting worse. Unfortunately, the parents accidentally packed his asthma medication in their checked luggage and had none with them.

The only available asthma medication on board was an adult inhaler which the toddler was too young to understand how to use. So, the doctor jerry-rigged a nebulizer using a water cup, the inhaler, and oxygen.

Jerry-Rigged Nebulizer
Jerry-Rigged Nebulizer. Image Source: Dr. Khurshid Guru/Twitter

To make the nebulizer, he put a hole in the water bottle to insert and tape the inhaler. At the bottle’s base, he attached the plane’s yellow oxygen mask which was connected to an oxygen tank. The idea was to administer both oxygen and the medication to the child through the bottle’s opening, the little boy pushed away from the bottle, so the doctor made a hole in the cap, attached a water cup, and directed it to his face.

A nebulizer (“nebula” literally meaning mist, fog, or cloud in Latin), as the name suggests, turns a liquid into a mist. The device uses compressed air or oxygen or ultrasonic power to disperse medical solutions in the air and convert them into a mist that can be directly inhaled into the lungs. It is commonly used for administering medicine to people suffering from respiratory disorders like chronic obstructive pulmonary disease (COPD, which is prevalent among smokers and miners) or asthma.

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Childhood asthma often begins before the age of 12 and is influenced by genetics, especially the genes responsible for the function of the immune system.

Asthma Episode (Before and After)
Asthma Episode (Before and After). Image Source: FDA

An asthma attack occurs when substances such as dust or pollen are inhaled into the lungs, and the immune system overreacts. As a result, the airways undergo an inflammatory response which closes them up making it difficult to breathe. Normally, a two-year-old child takes 25-35 breaths per minute. If they are taking more, it is known as “tachypnea” (abnormally rapid breathing). It indicates that the child is finding it difficult to breathe or is not getting enough oxygen, and it can be a symptom of asthma.

During such instances, the treatment must be fast-acting and administering the medicine directly into the lungs will help clear congestion and reduce inflammation helping the person breathe better. Immediate action helps prevent problems associated with oxygen deprivation which is especially not good in the case of children as it might interfere with their brain development.

Following two treatments in a half-an-hour’s time, the toddler began to breathe better. His oxygen levels rose to around 94 to 95%, and he began to play with his mother towards the end of their journey.

Child with Asthma Spacer (Not the Same Boy)
Child with Asthma Spacer (Not the Same Boy). Image Source: Tradimus/Wikimedia Commons

Dr. Guru instructed the parents to keep the device on the toddler so that he could recover. According to ABC News, the doctor also told the father that “the most important thing is that you never, ever put those medications in a place where you cannot get them.” After the unusual but successful treatment, he tweeted about the incident. Air Canada did not disclose the identity of the family for obvious privacy reasons but thanked the doctor for his actions in helping one of their customers.

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In another incident in 2015, a pregnant woman went into labor while her flight was 30,000 feet above the Pacific and almost five hours away from the nearest airport. Luckily, a pediatric resident aboard was able to deliver the baby. 

New Born Baby
New Born Baby. Image Source: Brooke Raymond/Flickr

On October 8, a doctor named Angelica Zen, then a resident physician in internal medical-pediatrics at UCLA, was on her way to the US from Bali after honeymooning with her husband when she was called upon to help a woman experiencing stomach pains or motion sickness. When she saw her, Zen found that the woman was obviously pregnant. Zen was not trained in delivering a baby and had only “caught at most two babies in my OB-GYN rotation in med school.”

She made a makeshift tent with blankets for privacy, and the crew provided her with scissors, clamps, sterilized gloves, and more blankets and paper towels. Fortunately, there were no complications, and after only three-and-a-half-hours’ labor, Zen delivered a healthy baby girl.

There is, however, a comforting fact for those who are afraid of having medical emergencies – they are extremely rare. Even if they do occur, there will be a doctor aboard your flight 11 out of 12 times. 

Inside the Plane
Inside the Plane. Image Source: Michael Coté/Flickr

Every year, over 2.75 billion people fly on commercial airlines all over the world. According to a study that reviewed all the calls to medical communications centers from five domestic and international airlines, there have been 11,920 in-flight medical problems between January 1, 2008 and October 31, 2010. That is one in every 604 flights. The most common problems among them were lightheadedness, fainting, and nausea. Serious cases that required hospitalization after the flight only occurred in 8.6% of the cases.

What these statistics suggest is that medical emergencies on flights are extremely rare. Even if there is one, it’s highly likely that there will be a trained physician on board. To be precise, it’s 92% of the times (11 out of 12 flights), according to a study by Gatwick Airport, UK.

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