While returning from a nine-day visit to American Samoa earlier this year, Robert Jay Amrien's overnight Hawaiian Airlines flight was interrupted by an announcement asking if there were any medical personnel on board.
"I'm here. What do you need?"
"I waited for a moment to see if there was a specialist that might respond," says Amrien, Director of Bryant University's Master of Physician Assistant Studies program. He had been visiting the LBJ Tropical Medical Center, where Bryant's Physician Assistant students participate in clinical rotations. "Then I told the attendants 'I'm here. What do you need?'"
The attendants led Amrien, an expert in cardiac care who works as a Clinical Physician Assistant at Massachusetts General Hospital, to a man who was clutching his chest and turning ashen. The man didn't speak English, but his wife told Amrien that he was having chest pains.
Amrien asked "the typical medical questions," such as how bad the pain was, and had this happened before. The man suddenly stopped breathing and Amrien was unable to find a pulse.
"Having practiced a long time, I know that having a cardiac arrest outside a hospital is a devastating event," Amrien says. "It's easy to get panicked. There are too many people around. It's an unfamiliar environment. You might not know the equipment."
"Our Physician Assistant program is what's known as a 'high-touch' program."
It was a situation that Amrien, a 22-year Coast Guard veteran and former Emergency Medical Technician, Paramedic, was well-prepared for. "I've deployed to Africa. I've deployed to Antarctica. I've deployed to a lot of places where I was the only medical provider on the ship or in a remote area."
Still, he says, "It's never just business. There's a patient on the other end of it. That's a big deal."
Acting quickly, Amrien and the flight crew laid the man out in the aisle and Amrien began CPR. Flight attendants retrieved oxygen, a medical bag, and other items from the plane's medical stores.
Flexibility and adaptability
Flexibility and the ability to adapt are paramount to Amrien's educational philosophy, and define the Physician Assistant program he runs. "In medical education," he notes, "it's less about if you've memorized 50 drug doses and 20 diseases. It's about whether or not you can recognize that your patient has one of those 20 diseases and then prescribe them the appropriate therapy."
Amrien's experience is a teaching tool for his students.
He sees his experience as a great teaching tool that he can include in his lecture on providing medical care in what he describes as "austere environments."
"Our Physician Assistant program is what's known as a 'high-touch' program," Amrien says. "We do a lot of practical application in the classroom." The program features a clinical correlations course, in which students practice and apply the information they've learned in their clinical medicine courses to patient-care scenarios, as well as high-fidelity medical simulation and physical examination laboratories.
Offering a helping hand
Using the plane's Automated External Defibrillator, Amrien delivered a shock to the man's heart and immediately resumed CPR. Two minutes later, he delivered another shock and the man suddenly awoke with a yell. Amrien started an IV and delivered appropriate medications as the plane landed in Honolulu.
Once home, Amrien received a thank you letter, accompanied by a box of chocolate cookies, from the President and CEO of Hawaiian Airlines, Inc. "Thank you for showing the true spirit of aloha," it read. "We appreciate your willingness to step forward and offer a helping hand to a fellow passenger in need."
"They were good cookies," Amrien says with a laugh, "but that's not why I did it. I got a hug from the man's wife and I think he'll be ok. That's all I need."