Angus Wallace: The Doctor Who Operated on a Patient During a Commercial Flight

In a medical emergency, protocol dictates that commercial aircraft should land as quickly as possible, but sometimes that maneuver could put the patient's life at risk. That's what happened in 1995 on a flight from Hong Kong to London, when a 39-year-old woman began complaining of chest pain. With her health worsening rapidly, orthopedic surgeon Angus Wallace had no choice but to perform an intervention in mid-flight...

The Scottish orthopedic surgeon Angus Wallace was already well known for his work with UK aviation authorities. He was one of the specialists who treated several victims of the Kegworth air disaster in January 1989 (where 47 people lost their lives), and helped design a new "brace position" that was adopted by all British airlines in 1999. But Wallace shot to world fame for a different kind of emergency: he operated on a patient in the air.

A 39-year-old woman named Paula Dixon had a traffic accident (she had fallen off a motorcycle) while on her way to Hong Kong airport. Although she missed her original flight, Dixon managed to board British Airways flight 032 on the Hong Kong–London route. Moments before takeoff, Dixon began complaining of pain in her right forearm. Dr. Wallace and his colleague Tom Wong briefly examined the woman, determined that she had a minor fracture, stabilized her arm, and promised to return after takeoff. Considering that injury, Wallace did not think a more advanced examination was necessary.

However, Dixon's condition was more serious than initially indicated. At around 45 minutes into the flight, flight attendants reported to Wallace and Wong that the patient was not feeling well, with pain on the left side of her chest. A second examination revealed broken ribs, and a case of pneumothorax, a collapse of her left lung due to a perforation caused by one of the ribs, and the subsequent formation of an air bubble in the chest.

The plane could have landed in Delhi, but Wallace warned that the decompression of the cabin during descent carried the risk of worsening his patient's condition, and even killing her. The solution was to insert a tube into Dixon's chest to release the pressure, a relatively simple procedure in a hospital with the right equipment, but a real challenge at 10,000 meters of altitude.

Wallace and his colleague were forced to combine a urinary catheter available in the plane's medical kit with a clothes hanger (used as an improvised trocar), a bottle, lidocaine as a local anesthetic, and Courvoisier cognac to sterilize their 'equipment'. With Wong using a knife and fork to keep the incision open, Wallace inserted the catheter and managed to release the pressure. The procedure was a success, and apart from a new episode of pain eight hours later, Dixon arrived safely at Heathrow, where she was transferred to Ashford Hospital for a full recovery.

As expected, Wallace's actions were analyzed, and even criticized by some colleagues. The main conflict centered on his initial examination. Other specialists insisted that Wallace should have detected his patient's advanced condition, and that the plane should never have left the airport. Wallace provided more details: the patient had used the word 'bike' to describe the vehicle from which she had fallen, and the doctor incorrectly assumed it was a bicycle. It was during the flight that he learned about the motorcycle and the details of the accident. This suggests that Dixon decided to omit certain information to avoid missing a second flight.

At the same time, Wallace said there were three reasons for not performing a more advanced examination: the patient reported no problems beyond her forearm, she was seated in the back of a completely full plane with very little space available, and a full examination resulting from a forearm fracture could have been interpreted as "inappropriate behavior".

However, the public's perception was much more positive. The patient declared both doctors heroes, Margaret Thatcher herself congratulated him for his rapid response, and the case also served to highlight the limitations in the type and quality of equipment available in emergency kits. Wallace even said that his operation would have been impossible on a US airline, whose medical kits don't even have aspirin. The doctor continued his career in sports medicine, and helped none other than Wayne Rooney recover for the 2006 World Cup. Dr. Wallace retired from practice at the end of 2015.