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Would having medical professionals on flights save lives?

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Les Jakielaszek after his stroke (image supplied).

On September 21, 2015, Les Jakielaszek, a fit and healthy 47-year-old boarded a Jetstar plane from Melbourne to Darwin. It was a routine flight back to the mines where Jakielaszek worked.

Just as the plane was boarding, Jakielaszek made a quick call to his wife Agnes to remind her about an appointment the next day and continued to chat until he took his seat.

Forty-eight hours earlier, Jakielaszek and his daughter Violetta Jakielaszek won a golf tournament and were ecstatic about the upcoming tournament in Queensland. Life was finally heading in the right direction for the Jakielaszeks.

After being made redundant four years earlier, Jakielaszek was eager to get his life back on track and took on a job as a plant operator, 3,587 kilometres away working in the mines at Kakadu National Park.

Once the family packed up the house in Sunshine West in Victoria and Violetta completed her first year of university, they planned to join him in Jabiru, Darwin.

It was going to be a fresh start for the family: new jobs, a new house and a new lease on life.

This dream was shattered after Jakielaszek suffered a massive stroke onboard a flight. Cabin crew found him unconscious once all the passengers disembarked.

Medical emergencies are an everyday occurrence on flights. "Is there a doctor on board this aircraft?” is a question many of us will hear as we are flying through the skies at 35,000 feet. Thousands of people board flights each day, yet there is currently no mandated law that a doctor or paramedic should be onboard flights. According to an International Air Transport Association (IATA) document, 2.8 billion people were passengers in 2011.

Therefore, on average, there are 690,000 passengers in the air at any given time. Given this figure, the issue requires addressing by airlines and aviation authorities.

When the Jetstar crew found Jakielasek, who appeared to be sleeping, they realised he was unresponsive and an ambulance was called to the airport. As every second counts with a stroke, Jakielaszek was initially given little chance of survival.

Agnes Jakielaszek, Les’ wife of 25 years, received a call at 2.40am from Darwin Hospital to inform her that her husband had a massive stroke mid-air. It was a phone call that turned her life upside down.  Boarding an early morning flight, Agnes rushed to Darwin to be by her husband’s side.

The situation was precarious.

The next day Les’ condition worsened and he was taken to the emergency to remove part of his skull to help alleviate pressure on his brain and was put in an induced coma for the next few days.

At one point the family were advised that they should consider taking him off life support. “The doctors told me to prepare myself for the worst,”  Mrs Jakielaszek said.

Mrs Jakielaszek, continuing, said: 

We still don’t know exactly when Les had the stroke onboard. However, in my opinion if a doctor was on board he would have received immediate treatment and at the very least an ambulance would have been called immediately.

 

This would have saved precious time. Les’ doctor later told me that with a stroke the first few hours are critical.

Jakielaszek was paralysed on the right side of his body and was unable to able to walk and talk or eat without a feeding tube.

“It just felt like a bad dream and I couldn’t believe this was happening," says Mrs Jakielaszek.

Les Jakielaszek spent weeks in intensive care at Darwin Hospital with his wife and daughter by his side. Given the severity of Les’ condition, his extended family also flew to Darwin.

“We were in shock and decided to take the next flight to Darwin,” says Les’ sister-in-law Rose Jakie. “It was heartbreaking as we thought we were going there to say our goodbyes.”

Incredibly Jakielaszek pulled through and in November 2015, he was transported back to Melbourne by the Royal Flying Doctor Service. A doctor, two nurses and his wife Agnes were on board as the situation was still quite tenuous.

According to a 2013 study by the New England Journal of Medicine, it was established that approximately 44,000 in-flight medical emergencies occur each year worldwide.

From the 1 January 2016 until 31 March 2016, Ambulance Victoria was called out to Melbourne Airport 74 times to meet a plane where a passenger experienced a mid-flight emergency and were then transported to hospital as a result, according to information obtained under the Freedom of Information Act. On average this equates to approximately 296 call-outs to the Melbourne airport per year and approximately 1,480 in a 5-year period.

The main event types listed by Ambulance Victoria requiring an ambulance to meet either a domestic or international flight were for chest pains and breathing difficulties, followed by convulsions, fainting and unconscious passengers.

Due to the growing number of deaths on board, Singapore Airlines has recently introduced a discreet cupboard to store corpses in the event of an unexpected death on board. They are used for long-haul flights where an unscheduled landing would be difficult.

Medical emergencies inevitably also occur on short-haul flights but the main concern is flights where turning back is not an option due to remoteness and distance or flying over an ocean.

When an airline puts through an announcement asking if a doctor is on board, it demonstrates their under-preparedness in the face of a true emergency. 

“Over the past seven years, I have responded to five in-flight medical events, three of which were true emergencies,” says Dr Celine Gounder in a recent article in The Atlantic.

This demonstrates the need for doctors to be onboard long-haul flights where emergency landings could potentially take too long.

Dr Damian Kristof from Melbourne has been in practice in the health field for nearly 20 years and has heard the call for a doctor two times. “I tended to one emergency that was in the seat next to me. This was the case of a man having a diabetic hypo-glycemic attack”, Dr Kristof says.

Currently in Australia there is no legal obligation for doctors or medical students to offer assistance as a "Good Samaritan" in an emergency. They do, however, have an ethical obligation to offer assistance in an emergency, taking into account their own safety and skill set.

Flying can be very stressful on the body and crossing time zones, mixed with alcohol and sedatives taken by passengers can also complicate pre-existing conditions.

Dr Kristof told IA

“Hypoxia, hyperventilation, low blood sugar, increased heart rate, increased stress, decreased blood flow and many other issues may arise from the panic through the terminal to the seat in the plane."

Although passengers generally need to be "cleared to fly" if they have certain medical conditions or are elderly, many ailments could potentially be missed.

Flight crews are trained to respond to medical emergencies, and to perform CPR, however, flight crews also rely heavily on the aid of medical professionals on board.

 Former post-anaesthetic critical care nurse, Anne Holland believes a paramedic on board would help:

 As a recommendation I think a paramedic with advanced life support skills is superior to flight attendants that are first aid trained.

 

Although flight crew are well trained, a paramedic has got additional skills whereby they can insert an intravenous and communicate with ground medical facilities and can relay information.

 

A paramedic (on board) is not a bad thing given that there are air marshals and security staff on board. 

Jakielaszek has come a long way but he still requires daily assistance and the dream of working in the mines of Darwin are now a distant memory.

“It was a big opportunity for the family to move to Darwin and we were all excited to start a brand-new life.” At this point Mrs Jakielaszek stops for a moment as she is overcome by emotions.

After a bit of time, she says:

After Les’ stroke all our plans crashed. Everything we are going through now is very hard and we are doing all that we can. In one split second, our lives changed.

 

Having a doctor on a flight would be a very good idea as a diagnosis can be given on board as well as first aid and an ambulance can be organised, which will save precious minutes

Jetstar was approached for a comment and given a series of questions in relation to Les Jakielaszek and procedures on board in the case of an emergency.

At this time Jetstar have not responded.

Cate Altamura is a freelance journalist and has worked in Uganda as a broadcast reporter.

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