On take-off, the flight seemed like any other. But it would become one that the four HUP providers onboard — ICU nurses Molly Bussinger and Ryan Bidden (an engaged couple), and Chamaio Cheyenne-Rindge; as well as Ronald Collman, MD, an ICU physician in Pulmonary, Allergy & Critical Care — would never forget.
All three nurses, along with Cheyenne-Rindge’s wife, Grace, were on their way to Salt Lake City for a ski trip. Collman, who is director of the Penn Center for AIDS Research, was going to an international conference in Seattle. The five had snagged the last tickets on this plane to Chicago after their initial flight had been cancelled and were all sitting in the same row.
About 30 minutes into the flight, Bussinger noticed that the woman sitting in the seat in front of her started “fidgeting” and had thrown her hands up over the back of her seat. “I immediately saw that the top of her fingers and fingernails were grey,” a sign indicating a lack of oxygen. When the woman yelled out “Help!” both she and Bidden quickly leaned over the seat, identified themselves as nurses, and tried to help. “I can’t breathe,” the woman gasped. “I’m going to pass out.”
The flight attendant quickly brought over an oxygen mask and Bussinger helped put it on. Cheyenne-Rindge had moved across the aisle to speak with woman’s teenage daughter — who was sitting next to her — trying to get her mother’s medical history. Collman was listening to her lungs and heart with a stethoscope. Together, they tried to assess the situation to discover a cause.
But suddenly — within minutes — the situation took a major turn for the worse. The woman’s entire face started turning blue. “She was just staring ahead … and no longer breathing,” Bussinger said. Without a moment’s hesitation, the ICU “team” that regularly saves lives at HUP went into action, telling the flight attendant that the plane needed to make an emergency landing.
They carefully laid the woman down across the three seats, with her head near the aisle.
Bussinger climbed over the seat to check for a femoral pulse but there wasn’t one. Bidden immediately started chest compressions while leaning over the woman’s seat, and Collman began to deliver oxygen into the woman’s body with an ambu bag from the on-board medical kit over her mouth and nose. As this was happening, Cheyenne-Rindge was trying to start an IV using the needle from the plane’s medical kit in an effort to administer epinephrine (which can help restore circulation), but the compressions and the movements of the plane made it nearly impossible.
A call went out to other passengers for help in administering compressions, and several passengers came forward, including two orthopaedic surgeons, a firefighter, and two CCU nurses. CPR must be stopped every two minutes, to check the person’s pulse and heart rhythm, and to switch compressors. “You have to do 100 beats per minute, with complete recoil,” Cheyenne-Rindge said. And in this situation, “we were all doing it while leaning over a soft seat.” Bussinger kept her finger on the woman’s femoral pulse to make sure each compression was successfully moving blood in her body. An AED (automated external defibrillator) was connected to the woman, but it showed no heart rhythm suitable for electrical shock.
These intense efforts — doing compressions and giving rescue breath with the ambu bag — continued for 30 minutes. Cheyenne-Rindge asked nearby passengers to brace those doing compressions and ventilation during landing to make sure they weren’t jarred. When the plane finally landed, in Detroit, EMTs quickly boarded and took over the life-saving measures as they brought the woman off the plane and rushed her to a hospital. The HUP team had done all they could; the rest would be up to the local medical providers.
Afterwards, as they waited for their connecting flights, the four took the time to process what had happened. “There were so many factors against us — so many obstacles to providing emergency care — but we didn’t think about them,” Cheyenne-Rindge said. “We just all dealt with them as they came.”
“There was no panic, no egos. We never gave up on her,” Bussinger added. “It was a humbling experience.”
In an email to both UPHS and HUP leadership about the efforts of the ICU nurses, Collman wrote, “These three professionals were absolutely awesome. Despite the unusual and challenging circumstances, this was a code carried out in the most professional and expert manner that I could possibly imagine. There was incredible teamwork and communication, and top-tier skills.
“It reiterated what I’m already well-aware of from working in the medical ICU — that your critical care nursing staff is the best.”