By Mass Communication Specialist 3rd Class Jessica Tounzen Naval Medical Center San Diego Public Affairs
SAN DIEGO - Two doctors from Naval Medical Center San Diego (NMCSD) boarded a plane to San Antonio, Texas, Feb. 8, for a training course that would help them further their knowledge and their careers. But en route to their scheduled destination, they encountered a different sort of training.
Third-year NMCSD Otolaryngology residents Lt. (Dr.) Gregory Capra and Lt. (Dr.) Art Ambrosio were slated to attend a cadaver dissection course located at Ft. Sam Houston's Brooke Army Medical Center. They had operated on cadavers before, but this time they would be training in a joint environment, alongside Air Force and Army personnel. A couple hours into their non-stop flight, however, things changed.
"The flight crew started asking if there were any medical personnel on the plane, especially physicians," said Ambrosio. "At first I thought it was just heartburn, someone who could walk and talk, maybe someone was choking, like you see in movies and television."
He and Capra immediately identified themselves as physicians and made their way toward the front of the plane, where flight crew and passengers were carrying a male passenger to the aisle. Ambrosio and Capra started taking an inventory of the plane's first-aid kits. They found an Ambu bag (self-inflating bag valve mask resuscitator), advanced cardiac life support medication, and an automated external defibrillator (AED). Meanwhile, an anesthesiologist on the flight had found the man's pulse and began performing bag-mask ventilation using the Ambu bag. Capra and Ambrosio continued to re-assess the patient's status, as they had been taught during their time at NMCSD. A check of the patient's carotid artery yielded no pulse, and they proceeded onto the next step: cardiopulmonary resuscitation (CPR).
After completing approximately two cycles of CPR, the team placed the AED on the patient to check for a shockable heart rhythm, but that was unsuccessful: the AED read the patient's heart rhythm as one that was non-shockable, so Capra and Ambrosio had to resume chest compressions.
The next step would normally be an injection of epinephrine, which is commonly used to treat cardiac arrest and other situations of reduced cardiac output. But the patient's veins were proving inaccessible after a nurse on the plane attempted to place an intravenous (IV) line without any success.
A quick interview with the patient's wife revealed he had a history of airway obstruction. To combat this, Capra performed a jaw thrust, elevating the jaw and opening up the patient's airway. Ambrosio inserted an oropharyngeal airway, a plastic hook-shaped device that helps improve ventilation.
At last, the patient began to respond.
"He started squeezing my hand really hard and tried to move it when I was performing the jaw thrust," said Capra. "He wasn't very strong, but there was intent-it was a purposeful movement, and that was a good sign that he was becoming more responsive."
Meanwhile, in the cockpit, the pilot began routing the plane for an emergency landing in El Paso, Texas.
"We were still unbelted, kind of sitting in the aisle, and we were preparing for a rough landing," said Ambrosio, laughing. "When the flight crew announced that we'd landed, we were both like, 'That's it?'. It was very smooth. We never once felt like our safety was in jeopardy."
Soon, paramedics came on board and took custody of the patient. Capra and Ambrosio received a quick debriefing from the airline. They were asked their names, where they were from, where they worked, what equipment they used and whether it was useful. Both doctors agreed the available first-aid supplies were more high-tech than they had expected to see on an airplane, miles and miles from a medical facility.
The third-year residents returned to their seats amid clapping and cheering. One passenger gave Capra a high-five. Once they were able to sit down and take a breath, reality began to sink in.
"We were in shock that it had actually happened, and that we were in the middle of it all," said Capra. "We were like, 'Did that just happen to us?'. It was very surreal."
Both doctors agreed the situation might have gone quite differently had they not received the proper training and experience during their residency at NMCSD's Otolaryngology clinic.
"We deal with a lot of airway issues in the clinic," said Ambrosio. "Identifying the carotid artery, checking for a pulse and establishing airways are all things we do every day and things we're pretty comfortable with. At the hospital, we've also gotten accustomed to different types of patients and various surgeries as well: kids' tonsils, thyroid cancer, airway reconstructions, sinus surgeries, and so on. And there are different things they teach us here like poise under pressure, no wasted movements, knowing what you mean and meaning what you say.all of that helped us respond to this situation quickly and efficiently."
For more news from Naval Medical Center San Diego, visit www.navy.mil/local/sd/ or http://www.med.navy.mil/sites/nmcsd.