Managing a Medical Emergency at 35,000 feet

I posted a few days ago about my experience on the way back from Kauai.  I had received a bottle of wine from American Airlines but I’m so proud of this experience I wanted to tell the story.  More so, in that I received a very nice thank you email.  It’s an email like this that makes my year.  I don’t practice medicine for financial reasons or accolades, I just like to have a positive impact on people’s lives. 

I was on a red eye on the way to LAX, and around 2 and a half hours, falling asleep and watching Planet of the Apes, over the intercom “All flight attendants come immediately to the first class cabin”.  As a physician, we never like hearing words like immediately or stat and also seeing people sprint, which the attendants did.  I didn’t see much as the curtain was drawn, and the next words on the intercom were “any medical personnel on board to come to the front of the plane”.  So I thought many would come forward and gave it about 15-20 seconds.  When no one showed, I went up.  A lady was face down and had an altered level of consciousness.  She had been ill in Kauai and had been dehydrated, nauseous, and weak and fainted.  The head flight attendant asked my credentials and allowed me to take over and manage her case.  I utilized their medical kit, which is stocked with nearly every item one needs, and it’s much like my medical bag I use when I cover my MMA/Boxing and marathon/triathlon events.  She stabilized and was in fine condition after tending to her. 

The point I’m so proud of, is that in all my years as a physician, and have managed many emergency cases in sporting events, hospital etc, is that I felt that it was just me and had to get to it done now attitude.  I was 35,000 feet in the air in the middle of the Pacific ocean. I didn’t have the comfort of just stabilizing her and calling the EMS to transport to the ER.  I also had tremendous influence based on her medical condition, the status of the plane’s route.  The moment the pilot asked me if we should divert back to Kauai or go to LAX, I confidently told him, she’ll be fine and let’s proceed.  If I wasn’t there or if I didn’t get up, which crossed my mind honestly, the plane would have returned back and who knows how her condition would have progressed. 

 I’ve told this to many of my collegaues and medical students/resident doctors I teach on how important it is to help and get involved.  I had no hesitation and am very comfortable in situations like this.  I teach my students in coverage of events to get comfortable with situations like this.  And even if it’s not an emergency, and you see someone struggling or ailing, such as an elderly person crossing the street with a cane or wheelchair, give them assistance even for a few feet, it’s humane, it’s compassionate and it will make them and you feel good and warm hearts.


Thank you email:


           This is ….., you tended to my friend, ….. whom collapsed/fainted on the flight from Kauai to LA. 

I am sorry I was not able to Thank you properly & in person after the flight.  We had a connection to Seattle, which left at 8:00am - (ironically we did make it, just in time).  WOW!!! 

            I ‘we’ appreciate EVERYTHING you did to take care of ….., it was very honorable of you. You not only took care of her medical needs, worked with the airline crew, & the doctor the pilot had on call.... what an ordeal! 

I think the entire flight had they known ‘if it wasn’t for you, we might have been turning around to land that plane.” They too would ALL be sharing in my gratitude to your obvious calling to treat patients. …. is doing much better after getting her to the hotel, some good rest & food. ‘I Just thought I would give you an update.’

           I hope you and your entire staff made it safely to your final destinations as well. 

Follow up thank you email:


      Sure, that would be fine! Happy for YOU to tell the story! I was a pharmaceutical rep for Oncology & hospitals, so I understand why & how this story should be told! 

   To be honest, I actually have told it to ‘many of not only my friends, but my doctor friends as well... (another ‘Truth’ I even looked you up on line, I like to see about physicians I come across & I have to say, I was extremely impressed w/ your ‘CV’ ) 

   We were EXTREMELY lucky, to have had you on our flight! 

American Airlines Thank You Email

Dear Dr. Carfagno:

Please accept our company's formal "Thank You" for the assistance you provided aboard your recent flight. We are all grateful that you were on board and freely offered your medical expertise when it was needed most. Without a doubt, you greatly improved a difficult situation.

As a tangible expression of our appreciation for volunteering your time and experience, we have added 25,000 miles to your AAdvantage® account. This mileage adjustment should appear in your account in a few days. You can view your account via These miles can also be used to claim AAdvantage® awards.

I realize your offer of assistance was not motivated by any potential reward. Nevertheless, we wanted you to know how much your efforts were appreciated -- and that we look forward to serving you again soon. It will be our privilege to welcome you aboard American when your plans call for travel by air.

Dr. ….., MD.
Director, Medical and
Occupational Health Services