Rushing to the Hong Kong airport to catch her 14-hour return flight to London, Paula Dixon tumbled off the back of a motor scooter. The shaken woman missed that plane but caught the next, British Airways Flight 032. The delay probably saved her life.

The first sign that Dixon was in trouble occurred before takeoff when her left forearm began to swell. The call for a doctor was answered by two physicians: Dr. Tom Wong, a resident practitioner at a Scottish hospital, and Dr. Angus Wallace, who heads the department of orthopedic surgery at Queen's Medical Centre in Nottingham, England.

To Wallace and Wong, it looked as though Dixon's forearm was slightly fractured. They placed it on a pillow and promised to return after takeoff.

Once the 747 reached cruising altitude, the two physicians again made their way to Dixon's seat at the back of the aircraft. From the plane's medical kit they applied a bandage and a flexible aluminum and rubber splint, fixing a sling around Dixon's neck to hold her arm steady.

The crisis seemed to be resolved, but less than an hour later the cabin staff informed the two doctors that Paula Dixon was once again in distress. While bending over to remove her shoes, Dixon had experienced an excruciating pain in the left side of her chest. After re-examining their patient, Wallace and Wong concluded that several of Dixon's ribs must have been fractured along with her arm.

Wallace prepared an injection of a strong analgesic, nalbuphine, from the British Airways medical kit. Before he could administer the narcotic, however, Dixon began to have trouble breathing. Wallace deduced that one of her broken ribs had punctured her left lung, collapsing it and allowing the air it contained to escape and form a bubble inside her chest--a condition known as a pneumothorax.

By then the plane was over India, not an opportune place for an emergency medical landing under the best of circumstances. In this particular instance, Wallace feared that the decompression of the cabin during a descent might make Dixon's condition worse.

"If the collapsed lung had progressively worsened, which it appeared to be doing, then she would undoubtedly have died before she got onto the ground," Wallace said. "The air that had escaped from the collapsed lung would have compressed the other lung, and she would have suffocated."

In Wallace's opinion, the only option for Paula Dixon was to insert a tube through her chest wall to allow the trapped air to escape. Although a relatively simple procedure in a hospital emergency room, it would prove more challenging at 39,000 feet.

The only tube in the medical kit was a flexible urinary catheter, which Wallace stiffened by inserting a wire coat hanger through the center. "The catheter is strong enough to get into the bladder," said British Airways' head of aviation medical services, Dr. Michael Bagshaw, "but when it's a question of getting the catheter through the chest wall and the layers of muscles, he needed something stiff."

To numb Dixon's chest Wallace chose lidocaine, a cardiac drug that doubles as a local anesthetic. To keep air from entering the other end of the tube, he and Wong fashioned a one-way valve by threading a piece of oxygen-mask tubing through a hole in the cap of a half-filled bottle of Evian water.

Then Wallace inserted the catheter, which he had disinfected with a bottle of five-star brandy from the first-class cabin (the British Airways medical kit includes alcohol swabs; Wallace explained later that he hadn't had time to inventory its contents).

The makeshift procedure took less than 15 minutes, and it worked. "Within five minutes the patient had almost fully recovered," Wallace wrote last year in the British Medical Journal. "The patient was left sitting in her passenger seat and settled down to enjoy her meal and the in-flight entertainment . . . subsequent recovery in hospital was uneventful."

Arriving in London, Paula Dixon had high praise for Angus Wallace and Tom Wong. "These two big heroes saved my life," she said.

Wallace acknowledges that he never could have attempted such a procedure with the medical kits carried by the U.S. airlines, which contain none of the items he employed in his makeshift surgery. "There needs to be a major change in attitudes in the U.S.," Wallace says, "both from the government and from the airlines."