I’m experimenting with a new publishing platform: Medium. I’ll eventually post the entire essay here, but for now I’d love it if you would check out this story — and recommend it to others if you like it!
Escaping from an airplane is a lot like navigating health care — you need help from the people around you
I can hardly sit through the standard pre-flight safety demonstrations anymore. It all seems like a farce now that I know the truth: Your survival of an emergency may depend more on the people around you than on professionals’ skills or even your own abilities. And that goes double for health care crises.
In 2011, I was getting ready to board a Boeing 757 bound for San Francisco. I noticed that older adults outnumbered the young by a 2-to-1 margin (and, adding a little star quality to the older crowd, Supreme Court Justice Ruth Bader Ginsburg was in the waiting area).
Once I got to my window seat in the back of the plane, I put my suitcase and jacket into the overhead above my row, stashed my purse under the seat in front of me, and strapped in. (First practical tip: Remember what you brought on board and where you put it.)
As we pulled away from the gate, there was a disturbance on the left side of the plane, just behind the wing. People were yelling, “Smoke!” but there wasn’t any smoke in the cabin. “The engine blew out!” someone yelled. At the same time, the pilot cut the electricity and spoke calmly over the intercom that we were going to evacuate the plane. We were close enough to the terminal that we could see people lined up at the windows. But they couldn’t extend the jetway to reach us. We would all have to go down the slides.
A line from the safety demonstration popped into my head like a snippet of an old song: “the closest exit may be behind you.” That was true in my case, but there was a bottleneck. People were refusing to go down the slide. I craned my neck and saw that some of the people hesitating at the back of the plane were older adults who were understandably afraid of hurting themselves. I could hear the flight attendants cajoling them, telling them that we had no choice: The only way out was down the slide. Their voices grew increasingly sharp as the time ticked by.
Meantime, I was stuck in my seat, unable to even get into the aisle. But since there was still no smoke, I wasn’t scared. I decided to ignore the rule to leave everything behind. I wanted my phone. When my row cleared, I grabbed my purse and joined the line at the exit over the wing since the bottleneck at the back looked like it wasn’t moving at all. (Second tip: You can get away with bringing a bag that’s small and hands-free, like a light backpack or a purse with a strap that you can sling across your body.)
At that point, people were getting a little agitated. We were not winning any time trials for plane evacuation that day. I could see an older man standing in the hatch over the wing, staring down at the slide as a flight attendant implored him to jump. I couldn’t see through the crowd to know if there was another open exit.
That’s when I heard a very loud male voice saying, “Come to the front! The exit is open at the front!” A passenger had taken it upon himself to help direct traffic. The female flight attendant next to him was shouting, too, but her voice was not projecting.
A bunch of us moved quickly down the aisle. Without hesitating I jumped out the door and onto the slide. Whoosh! Down I went. It was fast and, I have to admit, pretty fun. The slide is made of a somewhat slick material and you definitely pick up speed as you go. At the bottom, two fellow passengers caught me and helped me to my feet. I walked away, marveling at the help I’d just received from total strangers, untrained but ready to step up. (Third and most universal tip: Follow the leader, no matter who emerges to take on that role. And pitch in yourself.)
Some people were walking around with green slime all over their legs, but they weren’t hurt. It turns out that a woman seated in the bulkhead row had boarded the plane, taken off her shoes, opened up her lunch, and started eating. When the flight attendant opened the escape hatch, this woman was one of the first ones out, apparently clutching her salad. No shoes, and, by the time she hit the tarmac, not much salad. Lettuce, dressing, and a double helping of avocado were scattered all over the slide, making it a messy ride for everyone else. (Fourth tip: Leave the salad. Take your shoes.)
Anyone wearing shorts or a skirt was now dealing with rug burn on their legs. Also, they tell you to cross your hands over your chest for a good reason. If you try to slow yourself down with your hands, you will get a wicked burn on your palms. (Fifth and sixth tips: Wear pants. Don’t put your hands down.)
I pulled out my phone and tweeted, “Just evacuated United flight 586 on tarmac at IAD. All OK and I kinda liked the slide.” Unfortunately, it was such an old Blackberry that I couldn’t take pictures, much less video, which I found out later was very disappointing to all the TV reporters trying to reach me. (Seventh tip: Know your flight number and use it in all social media updates.)
We were herded into a VIP lounge while the only actual VIP, Justice Ginsburg, was taken to another location. I started chatting with some other passengers. An older couple overheard that I had posted to Twitter and they said, “That was you? Thank you! Our son saw it and knew we were OK.” My tweet had gotten picked up by the Associated Press, and my voicemail at work was filling up with reporters’ messages.
To retrieve our stuff, we had to write our seat number on a piece of paper, along with a list of everything we had left behind. Everything came off the plane eventually, with some items being held up for people to claim. (Here’s where the tip about knowing where your stuff is will come in handy — you’ll get your bag faster if you can give an exact location and description.)
They scrambled another jet and, as we all settled into our seats for the second time that day, a new crew ran through the pre-flight safety demonstration. It seemed more like theater than usual, divorced from the reality of what we had all been through, and even a little bit insulting. The people who had really come through in the clutch were my fellow passengers — my peers — not the professionals. Maybe that should be part of the safety demonstration: an acknowledgment that passengers will play a key role in any emergency.
A National Transportation Safety Board study of more than 200 emergency evacuations found that most people were able to escape the plane without incident. However, in some cases, passengers failed to open exit doors because they had not (or could not) read the safety card, misunderstood the diagrams, or were physically too weak. Some passengers became confused and even aggressive. Others met the challenge, such as a passenger who held down a slide that was blowing in the wind on the tarmac in San Juan, Puerto Rico, allowing others to escape.
The impatience I felt on that second flight has never gone away. I have my antennae up for situations when professional guidance falls short but peers bridge the gap. It’s my observation that your best advisor in many situations is someone who has just been through the same thing and can tell you about it.
Wouldn’t it be great if there were something like a matching service for people going through a tough health care situation? Such things do exist for certain conditions, but uptake is still low. How might we change that? How might we spread the lessons learned by people with rare conditions to those who are dealing with common, but just as life-changing, diagnoses?
I see examples of this every day in my fieldwork as a health and technology entrepreneur. A woman posts a picture on Instagram that prompts someone to ask a doctor a new question – and it turns out to be the key to a diagnosis. Someone else shoots a quick video of how to use a baker’s spatula to safely turn her incapacitated father in bed so the sheets can be changed – and shares it with her sisters so they can save their back muscles. Someone hears about a drug interaction and shares the news with his online community – alerting a patient in need of that just-in-time advice.
What if people had more ways to tell—and archive—stories like these? How can we help people to be ready to think for themselves and see past the rote advice that is sometimes offered? How might we create the equivalent of an engaging pre-flight safety demonstration for patients and family caregivers, to acknowledge the importance of being part of a community of peers?
For example, I think airports should have an area where you can practice opening a hatch, jumping onto an escape slide, and inflating a life vest. We could learn, for example, how to assist someone who is nervous or physically unable to go down the slide alone — you set them between your legs, like you would do with a toddler on a playground slide, and wrap your arms around their torso.
Just like on the flight that day, older adults are becoming the majority age group in the U.S.
We are less likely to live in multi-generational households now, so caregiving skills are not being learned and passed down. And people are being sent home in need of more complex care than ever before. Family caregivers not only need to connect with each other for emotional support, but for practical tips.
I would like to try out different monitors and lifts before I need to install any in my home. How about a gallery of home care “hacks” — the inexpensive, elegant work-arounds that people create, often for not much money? Let’s talk about the “unmentionables” of health, like how to prevent your demented loved one from flushing their adult diaper down the toilet (this is a real problem, believe me).
Call me an optimist, but I think empathy and peer leadership can spread, especially if we find ways to share what we know and allow people into our lives. I think we can handle the responsibility of knowing how important each of us can be to one another. I saw it on the plane that day, and I see it among the patients and caregivers I follow in my research.
The next time you have a health crisis, consider taking your questions beyond Dr. Google, beyond your doctor’s office. Tap into a “just-in-time someone-like-you” network. Look for peer leaders who can guide you to the best information and care available. And step up to that leadership role when you see the opportunity to help someone else.