A Scream At 30,000 Feet: What Happened When A Bride's Heart Gave Out On Her Flight Home

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• Dr. Jacquelyn Lacera suffered a medical emergency on an American Airlines flight from Hawaii to Los Angeles.
• Emily Haley, an emergency room physician assistant, helped stabilize Lacera using an AED.
• The incident highlights the potential dangers of in-flight medical emergencies and the need for better medical equipment and training on airplanes.

Dr. Jacquelyn Lacera's Hawaii honeymoon almost ended in tragedy. During her flight back to Los Angeles she suffered a sudden medical emergency.

Lacera, a Riverside, California-based family medicine doctor, was seated in first class with her husband Leonardo. About an hour into the American Airlines flight on Feb. 5, she started to feel intense chest pain and nausea. Lacera, 61, kept running to the lavatory to vomit.

"It was terrible, like 10 out of 10 chest pain," she told USA TODAY. "I've had a child – and I can take pain – but this was horrible." Her mind instantly went to her sister's sudden and mysterious cardiac death at 37.

She was scared she was having a heart attack.

As a silver lining, the incident forged a new bond between two women – in what Lacera called a miracle.

The flight crew made a call over the announcement system for help from any medical personnel onboard. Seated in the back row was Emily Haley, an emergency room physician assistant from Baltimore. Haley, 43, was on her way back home with her family after visiting her aunt who lives on Hawaii Island. When no one else stood up, Haley's husband hit the call button, and she stepped up to the plate.

"When I saw her, my heart kind of sank a little bit," Haley said. "She was holding an oxygen mask, and she was clutching her chest. When she said she was a physician, I think it was almost worse. It takes a lot for medical professionals to ask for help."

Haley did her best to stay calm as she went through Lacera's vital signs. She tried to read Lacera's pulse, but the plane's pulse oxygen monitor and glucose monitor weren't working. All commercial planes in the U.S. are required to carry medical kits onboard with basic supplies. Advocates say the supplies the kits contain are often low-quality and the regulations about what should be required in them need an update.

The stethoscope was also twisted up, so they improvised with Lacera's Apple Watch. Lacera's heart was reaching 220 beats per minute – more than double what it should be. She was suffering from atrial fibrillation, or an irregular but rapid heartbeat.

Haley inserted an IV into Lacera's arm without a tourniquet, but she said Lacera continued to "go downhill." Lacera said she felt herself fading.

"I think that's what prompted the flight attendant to finally get the AED (automated external defibrillator), you know? I mean, it took forever," Haley said. "I know in hospital situations and emergency situations, you bring everything to the patient right away."

At this point, Lacera was lying on the ground in first class. Haley's options were to administer medication or shock her, which usually happens when the patient is sedated – and she was not. Due to Lacera's "very concerning and unstable" condition, the physician assistant realized her best option was to shock the doctor with the AED.

The pain from the electric shock sent Lacera screaming. "I'm sure I woke up the plane," Lacera said. But Haley was relieved. Screaming meant she was alive. Lacera stabilized shortly afterward.

The plane landed in less than an hour – a flight that Haley called "the fastest, longest trip of my life." Upon arrival at Los Angeles International Airport, Lacera was taken to the hospital, where she stayed for three days, and continues to be in cardiac rehabilitation today with an upcoming procedure for her heart.

Since the emergency, both women have become friends and stay in touch over their shared advocacy for better medical care on flights.

Although these in-flight emergencies may seem rare, the American Heart Association estimates there are 350 air travel-related cardiac arrests each year in the U.S. and 2,000 worldwide, with a quarter of those happening directly on planes. A 2021 medical review in the American Family Physician journal found that cardiac arrests are the most common reasons for medical emergency-related flight diversions.

Federal Aviation Administration regulations require at least one crew member trained to properly use an AED and for each plane to have at least one approved emergency medical kit with basic bandages, medications and resuscitation devices. However, there's no standardization of curriculum or hours of instruction, so it's up to the individual airlines to make that call.

"We’re proud of the incredible care our crew members show our customers in the air every day – especially when passengers experience an in-flight medical event," American Airlines spokesperson Josh deBerge told USA TODAY in a statement. "Our pilots and flight attendants complete rigorous and regular training to support the customer in need and any onboard medical professionals who lend their expertise, and importantly, quickly and safely divert the aircraft when needed. Key to their response is the onboard emergency medical kit that includes all FAA-required equipment, materials and medications – and exceeds those requirements."

Some European airlines, such as Lufthansa, Austrian Airlines and SWISS offer a program called Doctor on Board, in which medical professionals register ahead of time to be identified by crew members if an emergency arises on their flight. They also go through a training course for continuing education credits by the carrier.

Following the incident, both women have spoken out about the lack of medical equipment and called for more comprehensive training for crew members on commercial planes. Commercial flight attendants are not allowed to directly administer some medications without approval by an on-call medical professional on the ground. While they think the flight attendants acted urgently, Haley said essential medical supplies were missing from the plane. Only basic medications were available, and some equipment wasn’t functioning properly.

"I think that in terms of the physics of flying literally puts certain populations at risk for these events," Haley said. "This is not an isolated incident. There are more people who are flying who are older. There are more people flying longer distances. The mechanics of it are putting certain populations are at risk of like arrhythmias and heart attacks and blood clots and all these other things that are cardiac."

For older fliers, cardiac problems on flights can be a major concern, stirred by confined spaces, dehydration, low oxygen and stress. A 2019 study published in Frontiers in Physiology found that passengers over age 50, who are already medically vulnerable, could show signs of cardiac stress at 7,000 feet equivalent cabin pressures.

Lacera has since reached out to her CongressmanKen Calvertand American Airlines, and received an apology from the airline, and hopes her incident sheds light on the issue.

"I don't know. To rely solely on the passengers is a real big issue because, I mean, I got lucky," she said.

Contributing: Zach Wichter, USA TODAY