painful experience in-flight

[non-newtonian]

Thought you guys might be interested in this, from todays British Medical Journal.
Cannot understand why this guy thinks an aircraft
should be as well equipped as the local ER.



A painful experience

I was on an Airtours flight from Florida recently
when medical assistance was called for. The
patient had benign
prostatic hyperplasia and was in retention. Since we had another seven hours to fly,
holding on was not an
option. He needed a catheter, so I was reassured that the plane's
inventory of medical equipment included catheters and collecting bags.

But I then found
that there was no lignocaine gel, no lubricating jelly, and no gloves.

Performing a catheterisation without gloves or anaesthetic was not pleasant,
but the lack of lubricating jelly proved a bridge too far, so when the patient
started screaming I deputised
some antiseptic cream as an ersatz lubricant.

As the catheter was non-retaining, I advised the greatly relieved patient
not to drink any fluids for the rest of the flight and to attend accident and
emergency on his way home.
I then had to remain on alert for the next seven hours. Before disembarking I was asked to sign a form indemnifying
Airtours against any claim arising from the procedure and was
offered a bottle of wine as a gesture of appreciation.

I had expressed my concerns to the steward, but having heard nothing after a
few weeks I contacted Airtours. The company's flight officer explained that
Airtours
usually received inflight medical advice from an institute in the United States and the airline's medical officer assured me that
gloves had been
present in the equipment boxI just hadn't found them. He said that he had done hundreds of catheterisations and had never
used lignocaine gel. In a
subsequent letter, he insisted that the company's equipment was standard to all airlines, and that "the catheters are self lubricating, and being small and
atraumatic do not need lubrication or local anaesthetic." Really?

As a doctor, I had no choice but to respond to the patient's needs,
and without that choice I was forced to perform a difficult procedure with inadequate
equipment.
The poverty of the Airtours response was depressing, especially considering how much money I had saved the company;
if a doctor hadn't just
happened to be on board, the plane would have had to return to Florida.
Maybe in future Airtours should take one fewer passenger and a bit more
equipment, and maybe omit those magical self lubricating catheters.
I won't be travelling with Airtours againnot without taking my own lubricating jelly.


Liam Farrell, general practitioner.

Crossmaglen, County Armagh