Nurse Celebrates 50th by Giving Emergency Care in the Air

April 21, 2021

On March 12, 2021, McLean Hospital’s April Totman, RN, was on a surprise 50th birthday trip to Nevada when she heard an American Airlines flight crew member call for medical assistance. Totman immediately responded.

J.B., a young man in his 20s, was experiencing a seizure toward the front of the plane. As she arrived to help, Totman—who has vast experience in providing critical care—saw that another passenger was trying to “wake” J.B. up by shaking him. Totman calmly asked the fellow passenger to stop shaking J.B., explaining that someone experiencing a seizure shouldn’t be shaken or restrained, as either action increases the patient’s risk of physical harm.

Totman wasn’t surprised that the passenger was trying to shake J.B. awake as it is often people’s gut reaction when they see someone struggling or not fully conscious.

“He obviously hadn’t seen someone have a seizure before,” she said. “He was doing what he thought was right, but you can’t wake a person from a seizure. They have to wake on their own.”

Assessing His Condition

Totman tried to create a safe environment for J.B., removing hard and/or sharp objects from where he was sitting to minimize his risk of injuring himself during the seizure or any potential follow-up seizure.

“The most important thing when someone has a seizure is keeping them safe,” she explained, “making sure they don’t hurt themselves.”

She then focused on monitoring J.B., constantly checking his vital signs and making sure that his airway was clear. Totman explained that assessing these aspects of J.B.’s condition was critical for determining whether the plane should land as soon as possible.

Woman outside large home on sunny day
Totman is a staff nurse at McLean’s Signature Addiction Recovery Program at Borden Cottage in coastal Maine

“I wanted to assess his heart rate and his blood pressure, and I also listened to his lungs to make sure that there wasn’t any aspiration,” Totman said. “I was able to get some significant data points. Nurses always want data points.”

After J.B.’s seizure was over, Totman struck up a conversation with him. Through this conversation—as well as consultations with his friends—she was able to determine that J.B. had experienced seizures before, and this most recent seizure was unrelated to substance use.

She described J.B.’s seizure as being a nocturnal tonic-clonic seizure. Also known as a grand mal seizure, a tonic-clonic seizure involves both tonic (stiffening) and clonic (twitching) phases of muscle activity.

Upon establishing the type of seizure and determining that J.B.’s condition was stable, Totman was convinced that an immediate landing wasn’t necessary.

To reduce the risk of another nocturnal seizure—one that commences when a person is asleep—Totman kept up a steady conversation with J.B. for about two hours. She said that J.B. was in a postictal state, an altered state of consciousness akin to the experience of coming off of anesthesia, for about two hours.

Always Ready to Help

The calmness, thoroughness, and humility with which Totman described the medical event onboard American Airlines flight 1483 betrayed her clinical expertise.

Before joining the clinical team at McLean’s Signature Addiction Recovery Program at Borden Cottage, Totman was a special care nurse in a progressive care unit at Pen Bay Medical Center in Rockport, Maine, for 8 years. Leveraging that background, she annually trains staff at Borden Cottage, a residential addiction and recovery program, on how to evaluate and treat someone who is having a seizure.

According to Frederick Goggans, MD, Borden Cottage’s medical director, J.B. was fortunate to have Totman by his side.

“Grace and competence, especially under pressure, are traits I always associate with April,” said Goggans. “We are so fortunate to have her on our team at Borden.”

Totman dismissed any notion that what she did was anything near to being heroic and expressed her reticence to talk about the events on flight 1483. She noted that she has provided medical care on the side of the road many times and stressed that nurses all over the world routinely—and without hesitation—attend to those in need while away from work.

Caring for the Patient and the Passengers

Totman said that while seizures can be life-threatening, particularly seizures related to substance withdrawal, most are not—as in J.B.’s case. She explained that for most seizures, the focus is on monitoring the patient and making sure that they don’t injure themselves.

She recognized, however, that witnessing a medical emergency can be especially stressful when it happens on an airplane. Passengers end up becoming captive, helpless witnesses, often for a lengthy amount of time.

She, therefore, tried to comfort the passengers and crew, explaining that J.B. was okay and that she knew how to care for someone in his condition. She stayed with J.B. for the remainder of the flight.

“I felt for everyone on the plane who was witnessing it,” said Totman. “They were scared to death, and no one wanted to be near him. I knew that my presence, just sitting next to him, would calm a lot of people.”

“Grace and competence, especially under pressure, are traits I always associate with April. We are so fortunate to have her on our team at Borden.” – Dr. Frederick Goggans, medical director, Borden Cottage

J.B. was doing well when the plane landed, and an ambulance crew came onto the plane to take him to a hospital. Totman gave his friends a detailed list of what they needed to tell the doctors at the emergency department, and she also gave them instructions on how to help care for J.B. after he was discharged from the hospital.

Totman’s trip after leaving J.B. was relatively uneventful but pleasant. She and her boyfriend visited Hoover Dam and Red Rock Canyon and ate plenty of good food.

After returning home, Totman received a commendation letter from American Airlines thanking her for her medical assistance on flight 1483. She said that while she appreciated the letter and the numerous expressions of gratitude from passengers and flight attendants, being able to help was enough of a birthday gift.

She explained that nurses get into the profession to “make a difference in someone’s life.”

“Nurses do things like this every day, without recognition,” said Totman. “None of us expect anything in return.”

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