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EP Providers and Medical Emergencies — You Have No Backup

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Imagine this scenario: You are accompanying your CEO on a private jet flying at flight level 33,000 feet. Your client looks at you and states he has chest pain and feels short of breath. At face value, this may look like many other medical emergencies. So, ask yourself:

  • What are you going to do?
  • What is your medical plan?
  • Are you carrying advanced medical equipment?

This is not a situation an EP provider wants to be in without the proper knowledge, training, medical equipment, and supplies. Have you set yourself up for success in a situation like this?

As a security company owner or team lead, you have a few questions to consider when working with clients and/or their families.

  • Are your security personnel trained to manage medical emergencies or provide advanced care?
  • Do you carry the appropriate equipment and supplies, including proper medications, to carry out that advanced care?

Executive protection has changed since 1970, when the Secret Service first coined it. The White House Police Force was renamed the Executive Protective Service and increased its responsibilities to include the protection of diplomatic missions in the Washington, D.C., area.

Dramatic Improvements

Executive protection is currently a highly specialized field within the private security industry. EP personnel has a variety of specific training categories available to them, including:

  • Security operations,
  • Transportation operations,
  • Threat and risk assessment,
  • Covert operations,
  • First aid,
  • Marksmanship, etc.

A lot has changed since the 1970s. In fact, the advances in medical technology and treatment that can be done in the pre-hospital setting have improved dramatically since that time. No longer should first aid be the standard for the executive protection industry.

Although we have been improving our training, we have focused mainly on stabilizing traumatic injuries. This includes courses like TECC/TCCC while leaving initial treatment and stabilizing medical emergencies to local EMS.

The fact is that your client and their associates are far more likely to have medical emergencies than traumatic injuries. As an industry, we need to recognize and embrace this and start training EP personnel to recognize the signs and symptoms of the most common medical emergencies and to start treating them until we can get our clients to a higher level of medical care.

Scenario With Positive Outcome

Let’s take a look at the scenario introduced at the beginning of the article.

You’re flying with your client and a few company board members on a corporate jet from Los Angeles to New York.

Your client is a 55-year-old CEO, who works 80+ hours a week, and doesn’t exercise as much as they would like. He is under a lot of stress, but more so this week because quarterly financials are coming out, and the numbers are not what analysts expect.

As you level off to 33,000 feet over the state of Arizona, you look at your client and realize he is pale and clammy and looks uncomfortable. You ask if he’s okay, and he looks at you and says he’s not feeling well. As a result, he takes his right hand and clutches the left side of his chest.

What do you do? Are you prepared to ask pertinent questions to determine what is going on?

If so, and you are able to determine what may be going on, is this cardiac chest pain? Is it reflux? Is it anxiety?

Do you have oxygen, a blood pressure cuff, and a monitor that has EKG capabilities?

If you have EKG capabilities, are you able to determine the reading, or have a telemedicine service available?

If it’s determined that the client needs medications, are you traveling with aspirin and nitroglycerin?

What is your instinct at this time?

Are you going to advise the client and the pilots to declare an emergency and land at the closest, most appropriate airport in the vicinity of a major hospital?

Are you dealing with a strong-willed CEO that will not want to land unless you can give him definitive answers to what’s occurring?

medical emergencies

Medical Training for Medical Emergencies 101

Depending on your medical training and how you handle the situation, this scenario can end in disaster. For example, the CEO may be having an acute myocardial infarction (“heart attack”) which could lead to imminent cardiac arrest.

Do you have an AED available, and are you trained in high-performance CPR until you can deploy the AED?

This is where your medical training comes into play. In this scenario, imagine you’ve been trained and asked the correct questions. The CEO describes his symptoms as 8 out of 10 crushing chest pain that radiates to his neck and left arm, he’s nauseated, short of breath, and you notice he’s diaphoretic.

These are classic signs and symptoms of cardiac chest pain and are very concerning for acute myocardial infarction. Since you are well-trained and prepared, you carry a small monitor with EKG capabilities. As you perform the EKG, it reveals an ST-segment elevation MI.

Following Protocol

With medical advancement technology, the AI built into the cardiac monitor will give you reading for classic myocardial infarction. You don’t have to be a cardiologist or emergency room physician to know the basics of reading and interpreting EKGs.

At this point, you’re able to administer treatment per the protocols designated by your medical director, placing oxygen nasal cannula, chewable aspirin, and nitroglycerin until the pain subsides. You’ve discussed with the CEO the emergent need to land and make arrangements with the pilot to do so.

During the descent, you are able to get a hold of your medical director via satellite phone or your pre-designated telemedicine service and discuss this case with them, transmit the EKG, and have them help you relay medical information to the ground units at the airport to help make a smooth transition of care to the ground ambulance and be taken to the nearest emergency department or cardiac cath center.

Same Scenario With a Negative Outcome

This same scenario can go sideways if you are not prepared. In this same scenario, you’re not really sure what to ask him or what to do next. Because your CEO is under a lot of stress, needs to get to New York for an important meeting, and is in denial about his cardiac health, he tells you that his pain is just his acid reflux and indigestion and he’ll be fine.

Your medical training is basic BLS/CPR and TECC. Thus, you’re not confident about this medical situation and unsure what questions to ask. Therefore, you assume that your client knows best, which seems like a recurrent problem, and continue on your flight.

A few hours later, you see him slumped over, you check him, and he’s pale and pulseless. You start CPR and tell the pilot to declare an emergency and needs to land at the nearest airport. As you perform CPR, the pilot tells you that the descent to the nearest appropriate airport will take approximately 20 minutes.

  • Are you prepared to manage your client for the next 20 minutes?
  • Do you have an AED on board?
  • Are you ready to handle such medical emergencies?

Admittedly, neither of these scenarios is common, but they have been exaggerated to demonstrate the importance of being well-trained and prepared. Furthermore, these scenarios show how being aware and knowledgeable in treating common medical emergencies can lessen the chance of situations deteriorating.

Conclusion

We work in an industry where clients and their families travel to secluded places and frequently fly over open oceans where advanced medical care is not accessible unless we provide it. Therefore, we must be:

  • Aware of our client’s medical conditions,
  • Have completed a medical threat assessment based on region, and
  • Performed a medical advance for all legs of the trip.

Suppose you fly on a private charter, visit a secluded island, vacation on a yacht 15 miles off the coast, or in a third-world country. In this case, it’s very likely that you — as the security personnel — will be the initial and prolonged field provider of medical care in traumatic or medical emergencies.

Not only should you be skilled at basic medical care, but you may be put in a situation where you may be performing prolonged field care.

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