After her flight home was delayed for two hours due to weather and a mechanical issue, Rishelle Zhou, DNAP, LLB, CRNA, was just glad to finally board the plane. She was looking forward to eating dinner and going home. She didn’t expect that she’d use her skills as a Certified Registered Nurse Anesthetist (CRNA) to save a woman’s life during the flight.
Zhou, who is a CRNA at the Portland VA Medical Center in Portland, Oregon, and faculty at Oregon Health and Science Nurse Anesthesia Program, noticed a commotion two rows in front of her about 45 minutes into the cross-country flight. An elderly woman sat in the row’s middle seat, unresponsive, and passed out.
When Zhou heard someone call for medical personnel, she knew she had to help. As a CRNA, she is highly trained and skilled in not just anesthesia, but in airway management, trauma stabilization, advanced patient assessment, and critical care.
CRNAs are advanced practice registered nurses who must have at least one year of critical care nursing experience prior to attending a nurse anesthesiology program; as a whole, CRNAs have an average of three and a half years
of critical care experience. CRNAs are the only anesthesia professionals with this level of critical care experience prior to beginning formal anesthesia education. CRNAs attain seven to eight years of education, training, and work experience.
“I went up and introduced myself as a nurse anesthetist and said I’m Basic Life Support and Advanced Cardiac Life Support certified. Can I help?” she said.
Zhou said she tapped the woman’s arm, shouted at her, and rubbed her sternum, but she didn’t respond.
“I could tell as soon as I looked at her that she was spontaneously breathing. I touched her wrist, and she had a left radial pulse. We at least had a patent airway, and we had a pulse.”
A flight attendant came with an oxygen tank, so Zhou gave the woman oxygen. “I told the flight attendant there is no way we can help this woman when she’s sitting up in this position, stuck in the middle seat. We need to get her out of here.”
Zhou said at that point, another passenger showed up and identified himself as a physician.
“I turned around and asked, ‘What’s your specialty?’ He said he was a dermatologist. I said I was a CRNA, and then he said he’d follow my lead.”
They moved the woman to the aisle and laid her down while the flight attendants frantically tried to call for help using a satellite phone. The airline protocol in emergency medical situations is to call for medical help on the ground using the phone, Zhou said. Meanwhile, she continued to provide care to the woman.
“Once we laid the lady down, I checked again and she was still breathing on her own,” Zhou said. “She still had a pretty strong pulse, so when the flight attendant said, ‘I’m going to get the AED,’ I told her at this point, an AED doesn’t really help much.”
Another flight attendant began asking if anyone on the flight knew the unresponsive woman. They also found the woman’s personal belongings, but the only medication she had on her was Pepcid. A relative who was traveling with her, but whose seat was in a different part of the plane, identified himself and came forward.
“Based on my professional training, I asked, ‘When was the last time she had anything to eat or drink?’ The relative said the woman had something to drink, but her last meal was at 8 a.m.,” Zhou said.
It was almost 9 p.m. when the woman passed out.
“Things pointed to her being dehydrated and hypoglycemic. With the combination of that, I decided it was important to get blood back to her brain,” Zhou said.
Because she was near the woman’s head to assess her airway, Zhou instructed the relative to raise the woman’s legs and move them as if she were riding a bicycle.
“Because of my direct intervention, I think within a couple of seconds it helped to return some blood to her brain. She started moving, and then a couple of seconds later she became conscious. Naturally, once she was conscious, the passenger was a little confused as to why she was on the airplane floor. We propped her up and asked the flight attendant to get her some juice.”
Once the woman became responsive, she drank the juice and perked up. Zhou asked her if she had any pain, especially any chest pain or difficulty breathing. She said no, but she did say she felt better after having some juice and some food.
“She was able to tell us her name and recognized she was on an airplane. She knew which year and which day it was. The flight attendants had given me a manual blood pressure cuff, so I was able to check the woman’s blood pressure and it was normal,” Zhou said.
The pilot and the medical personnel on the satellite phone wanted to know more information about what had happened and if an emergency landing was necessary. Zhou gave them an update on the woman’s condition and said she was stable enough to continue on the flight to her destination. The medical personnel on the phone advised Zhou to leave the patient on oxygen for another 10 to 15 minutes and to call if her condition changed.
Zhou said she was glad she could help a fellow passenger and was proud to use her skills beyond the perioperative area. She also encouraged other CRNAs to follow her lead.
“I want to encourage other CRNAs to respond in a crisis moment because our training is more valuable than you realize. Our skills — especially our critical thinking skills and airway training — are invaluable. We’re extremely qualified and experienced to handle critical moments and medical emergencies because we deal with them all the time.”