Exaggerated concept of a medical emergency

MEDICAL MATTERS: Cabin crews flying in the face of appropriate action

SINCE THE terrorist attacks of 9/11, air travel has become increasingly difficult. And it's not just the many security hoops you have to jump through. A malaise has descended on those working in the airline industry.

In An Irishman's Diarylast week, Wesley Boyd wrote: "Don't get sick on an aeroplane. And I am not talking about puking into a paper bag during a spate of turbulence . . ."

On a flight from Malaga to Dublin Mr Boyd had a brief "turn" shortly after take-off. From his description of the event it is clear he fainted momentarily.

In the old days, some TLC and a bit of watchful waiting by a senior cabin crew member would have been the considered response. Not now, I'm afraid. An announcement from the flight deck inquiring if there was a doctor on board followed. A retired nurse appeared by his side, oxygen materialised and even though he was now feeling fine, Mr Boyd was startled to hear the captain was diverting the plane to Nantes, France, because of a medical emergency on board.

He was duly offloaded and transported by ambulance to the city's main hospital. Ninety minutes and some tests later he was discharged with a clean bill of health.

Fast forward to Galway airport and the night of Sunday, November 18th. According to a report in the Connacht Tribune, onlookers at the airport were shocked to see a large number of gardaí at the terminal building prior to the arrival of a flight from Manchester. It had all the appearance of a major terrorist alert.

Meanwhile, some thousands of feet above the airport, one middle-aged male passenger was getting even more urgent messages from his bladder. Unfortunately the aircraft was preparing to land and everyone was under strict orders to remain in their seats.

However, when the unnamed passenger heard from the crew that there were landing problems due to fog, the urge to get to a toilet became even greater. Eventually, the decision was made to divert the flight to Shannon, but the poor man was "under such pressure" he undid his seatbelt and went to the toilet at the rear of the plane.

The crew's response? They raised a security alert. The plane was met by gardaí and the passenger interviewed about his behaviour. He told the police that he returned to his seat without in anyway being offensive or abusive to anyone. "I just couldn't hold any longer," he told the newspaper.

The airline concerned has generously indicated that no further proceedings would be taken in the case. Which is a pity really. It would have been edifying to hear its explanation as to how aircrews are trained to raise a full security alert when presented with a passenger with a full bladder.

And were they aware of the (admittedly rare) phenomenon of the "exploding bladder"? Bladder rupture is a predominantly male problem. Men have a longer urethra than women (the tube connecting the bladder to the outside). You need a lot more pressure to force the urine out of a bladder through a male urethra.

Therefore, when under pressure, a woman's bladder is more likely to leak than to rupture, because it is easier for urine to be forced out by pressure rather than to rupture through the bladder.

But whether male or female, the consequences of bladder rupture can be serious. Urine leaks into the abdominal cavity. It contains toxins flushed out of the body by the kidneys.

When a bladder ruptures, these toxins are reabsorbed into the bloodstream via the abdominal lining. The resultant uremia is highly toxic and potentially fatal if not reversed. Studies of men with burst bladders show a mortality rate of 1-5 per cent due to blood poisoning. Victims also require surgery to patch over the bladder at the point where it has burst.

The Galway passenger did the right thing to relieve the pressure on his bladder. Apart from urinating where he sat, he really had no option but to visit the aircraft toilet. And he certainly displayed a greater presence of mind than the cabin crew did in judging his actions worthy of a full-blown security alert.

• Dr Houston is please to hear from readers at mhouston@irish-times.ie but regrets he is unable to reply to individual medical queries