MakeShift Challenge: Outbreak on a Plane: Most Plausible Entry

Dr. Robert Baker’s Most Plausible Winning Entry
by Lee D. Zlotoff
December 17, 2008

General Problem: Outbreak of vomiting on an airplane.

Unknowns: Number of passengers affected, other symptoms such as diarrhea, fever, etc.

Solution by Dr. Robert Baker


  1. First, inventory the number of passengers affected and those who are starting to feel affected.
  2. Isolation is unlikely to be helpful in cramped spaces on an aircraft. Air is recirculated and there are common water supplies.
  3. It’s beyond the scope of the magazine suggestions, but it would be helpful to know if the members had common links (such as being from the same families) prior to departure.
  4. Assuming that this sickness is either from ingesting something on the plane, such as a toxin, or from a very rapid viral or bacterial source, some kind of common source exposure can be postulated. Typically, common food poisoning does have a rapid onset. If so, diarrhea will be shortly following the vomiting.
  5. No one should consume anything that is not bottled and capped. It’s after the second meal, so that advice will only help a few.

Specific Actions

  1. Deal with the vomiting and other gastrointestinal symptoms. Some suggest a brief period of bowel rest, but oral rehydration solution (ORS) can be given even if the patient is still vomiting.
  2. a, Oral rehydration solution should be prepared from available ingredients. Here are instructions: Wash your hands with soap and water before preparing solution. Prepare a solution, in a clean pot, by mixing:

    • 8 level teaspoons of sugar and
    • 1 level teaspoon of salt
    • in 1 liter of clean water (bottled in this case and preferably boiled before use). Batches can be made depending on the number of the affected.

    Note: ORS should be given in small amounts, as frequently as possible. If water runs out then diet sodas could be used. The solution can be flavored with packets of lemonade powder if present, or using diet sodas as a base. Gatorade is not a very good choice as it is too sugary and does not have enough salt.

  3. The medical kit on-board may have a limited amount of IV fluids and needles. These should be reserved for those not responding to ORS.
  4. I’d suggest use of oxygen and air freshener for and nearby the nauseated. The smell of vomitus is, in and of itself, emetogenic. Areas contaminated should be washed with a neutral or good-smelling soap if no cleaner is available. Washroom soap would be OK if nothing else is around. Some passengers may have gloves that can be used to protect hands. Gloves, latex and non-latex, should be in medical kits.
  5. Comfort stations may need to be set up, particularly if numbers of affected are large and diarrhea gets out of hand. Blankets can be draped to create privacy areas; umbrellas or canes could serve as supports. A row of seats could be removed to make more space, if needed. Plastic bags or buckets can be used and sealed with plastic wrap after defecation or vomiting.

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