[Anonymous]

[DavidGordon10]

We are all familiar with that call, but what do other travellers hope will happen? I have been the doctor answering the call a few times, and I am sometimes surprised by the reaction of the airline.

Case one. On takeoff from a West African city, a catering trolley goes loose, knocks a flight attendant to the floor, and breaks her leg (tibia and fibula, to those interested in the details).

There is not a single empty seat on the plane. She is cared for lying on the galley floor. The captain does not agree to medical requests to turn back, or to put down at the next available airport, and continues to the European destination. (This is a major European airline, but not a UK airline.) The injured young woman has a very painful flight.

What would other travellers wish? There is, of course, a considerable cost in fuel and time involved in turning back. If you had been on that flight, and had known exactly what had happened, would you want to make the extra stop, or push on to the destination?

Case two. About 1.5 hours out from Europe on the way to JFK, a passenger complains of chest pain. It could be a heart attack, but after a lot of thought and going over the patient’s history, I decide probably not. Then a good discussion on the flight deck with the captain … and we carry one. There are spare seats in F so the patient and I are moved there (with a nurse, also on the flight) and we run a mini-hospital ward and land safely – with the patient well – in JFK.

The nurse and I joke between us that, if we went round F and C with a hat and said “our decision got you to the USA on time” the hat would have been full of folding money. As it was, the reward was (a) a grateful patient (b) a grateful flight crew and (c) an unusable voucher from the airline worth about €60.

Now, doctors don’t attend medical emergencies in mid-flight with the hope of getting rich, but what is the right way for the airline to recognise what has been done? I think that, probably, a free flight, or the refund of your ticket for the flight where you stepped in to help, is right and enough. Do other travellers agree?

I’ve obscured the names of the airlines involved in the two cases above, but for the record, Air Canada and CSA win my prize for thanking the doctor suitably and not excessively.

[BelperFlyer]

sad world that people expect reward for doing the right moral thing.

Look at the reaction of the women in Woolwich who intervened to prevent further bloodshed – what is a suitable reward for them

[BigDog.]

Wrt your first inst. David, given the stop would be in mid/north Africa I would prefer the pain than take a risk in African hospitals.

If it was in the US then a stop would be preferred.

Your final point is interesting, maybe you could get some element of reimbursement from the pax insurance company but if one were to accept the principle that the venue of the emergency should chip in then it opens a much broader discussion (especially as many Doctors have opted out of late call-outs).

Interestingly Virgin sourced many, if not the majority, of their cabin crew from the NHS when they first started up. They knew the service, caring and people orientation of nurses would make ideal Cabin Crew – just offer them a bit more and recruitment solved. Plus you get the bonus of medically trained people on board.

Edit – The type of aircraft is not disclosed, however I thought most LH aircraft had crew bunks for rest periods. Were there any bunks? Was it too painful to manoeuvre the patient?

[lloydah]

There’s no easy answer to this question. On one hand it’s right that rewards for doing the right thing are not to be expected but on the other hand the professional has had a “working” flight and probably – in the above case- saved the airline time and money. The doctor could remain in his/her seat and keep quiet? I don’t think so. The airline should be grateful and at least offer some recompense. David does not say he expected a reward but 60 euros?? better not to bother than offer an insult. “Nothing tastes of nothing” as they say.

[LuganoPirate]

I think people react to emergencies in different ways and while not expecting a “reward” it’s still nice when appreciation is shown.

I’m sure the two ladies in Woolwich will,be recognised in some way and perhaps the gratitude of several hundred passengers is enough, though I think maybe an upgrade voucher for the next flight would also be appreciated.

As to stopping mid-route. I’d perhaps prefer an African hospital to a NHS one if on BA, but if Swiss, I’d wait till Zurich 😉

[NameRemoved-18/12/14]

Very interesting topic DavidGordon

In the case of the CC member with the broken leg, I believe the captain made the right decision to push on to Europe. On a much longer flight, hopefully this would not happen and the captain would immediately return.

On a flight to Tel Aviv, we suddenly found ourselves landing at Bucharest due to a medical emergency. Yes, it was a very long delay but I don’t think anyone would object to this type of diversion.

As for recompense, if I was a doctor on board I would be happy in the knowledge I had used my skills and anything received would be a bonus, although I do agree with lloydah’s comment about the €60.

And in the event of no doctor being on board, do all CC have training in emergency first aid?

[canucklad]

Solution to scenario 1 …….Push on to Europe and Lee Marvin the FA….nothing like a few whiskies to dampen the pain! Or if she was British…a nice cup of tea!!

On the 2nd scenario…..A total judgement call, if you’re out over the Atlantic, Reykjavik is on route then Gander if the situation deteriorates….
I’m also assuming David that you’re cardiology knowledge would allow for a misdiagnosis?

On the remuneration…..as an expired first aider I’ve attended and dealt with a few incidents, a couple life threatening…..I didn’t even expect a thank you but hey ho, I see you point from a corporate perspective , whilst holidaying in Greece a fellow reveller slipped and thought they broke their collar-bone…….a quick trick with a 2lte fanta bottle and dislocated shoulder was fixed…..Big thank you from the victim, none from the hotel management…Not even an Ouzo…although that was the probable cause! LOL

[DavidGordon10]

Interesting replies! Thank you.

BelperFlyer @ 9.48 – of course there is an absolute moral and professional obligation, but do you expect your doctor to work for free?

In general one does not expect a reward, of course, but on three occasions I could have said “turn back” but, based on my diagnosis and on the state of the patient, made a judgement that it was OK to carry on – and thereby saved the airline a lot of money and my fellow passengers a lot of time. Also, it is a risk to the doc – imagine what it feels like to be sued if someone thinks you didn’t do do all the right things. A thank you in kind, such as a refund of the ticket, is a nice gesture. A real thank-you letter from the airline would have been a better reward than the €60 voucher. I think most of you agree with that.

Canucklad @ 11.37 – yes, on the routing we were on it was a choice between Shannon, Reykjavik and Gander. I’m not a cardiologist but a professor of internal medicine so OK with the diagnostic problems (which were difficult) but nothing in medicine is ever certain, except that we are going to die one day. Preferably not on a plane.

[Guest_Poster]

DavidGordon10

If an airline asks a doctor to attend an emergency, they should pay the market rate for the intervention and there should be a standard rate agreed with the medical profession to cover this.

After all, the doctor is still liable for his intervention and possibly subject to lawsuits etc and if the airline asked a medical company on the ground for assistance, they would pay for it.

The airline could raise a very small levy on all passengers to pay for it. Given the very small percentage of medical incidents versus the number of pax flown, the additional levy would be miniscule.

I believe that would be fair for doctors and paramedics.

[HarryMonk]

Other than the courtesy of a ‘thank you’ I don’t see any further need for any reward / compensation from the airline if it involves a passenger, if its crew then perhaps a greater gesture would be in order. But to take the case of passengers, if you would like a reward then perhaps you would should take it up with the passengers or their travel insurance company?

As a point of interest, in the event of a diversion on medical grounds does anyone know if an airline would bill a passenger or their insurance company for the costs involved to the airline? It probably wouldn’t make great publicity but why should an airline be liable for the cost of a passenger’s ill heath.

[PhilipHart]

Around Xmas 2000, along with some colleagues – two of whom were GPs – I helped develop a service called SkyDoc, which provided a “Medic as a Service” (MaaS) offering to commercial airlines.

The rational for MaaS being that this was the only way to guarantee that a flight would have a medic on-board. And naturally the only way to achieve this was to pay the medics for their service.

Initially there was some pushback from airlines, because they felt they could rely on the perceived “moral and professional obligation” indicated by DavidGordon10.

However, one particularly renowned entrepreneurial airline – no names, no pack drill – saw a real commercial advantage to be had from MaaS, and agreed to trial the SkyDoc service on a number of test routes after the switchover from summer to winter schedules in 2001.

Alas, SkyDoc never got to trial the service, let alone roll it out across other routes or airlines, because 911 happened, and the airlines themselves were in severe need of medical care.

Of course it was clear that it would be many years before the opportunity for MaaS would once again be needed. So we packed our bags, kissed goodbye to our dotcom dreams, and flew off into the sunset 🙁

[Californian]

I was wondering if, as a doctor, you don’t have the right not to get involved? I thought that, in speaking with a friend who is a doctor some time back, he once told me there is no formal obligation to assist in a medical emergency on board but that, once you do assist, you are bound to stay with the patient until you can pass them off to medical services on the ground.

As for compensation, I think the rules are a bit different when a group of people are thrown together in a confined space with limited facilities. Given the situation, I would hope doctors would help as good Samaritans without any expectation of compensation. On the other hand, I would hope the airline would offer something that would be seen as meaningful as a thank you rather than nothing or a 60 euro voucher.

[MartynSinclair]

On this topic DavidFordon10 – how does the airline react when you identified yourself being a Dr. Did they ask for proof – and what about your professional indemnity? Are you covered by the airline or are you treating patients at your risk.

I have known Dr’s not to ID themselves, for many reasons including the airline not supporting their actions in the way the patient is being treated.

I also wonder if a Dr has suggested to the pilot that a diversion is necerssary and the pilot has refused.

[LetsFlyNow]

@Canucklad
You always make me laugh!

So, i’m a doctor too and have so far been lucky enough to be on flights where “Is there a doctor on board?” didn’t come up.
I’m the kind of person who really enjoys airline booze (we had booze on a morning flight to DXB – Hey i was a fan of LOST) but i have to say i now feel obliged not to drink or even take sleep heavily during a long haul flight.

I’d be happy with a simple genuine Thank you. But airlines could honestly step it up by say… offering a juicy discount on one’s next booking or even an upgrade on the return leg (if the incident doesn’t happen on the return leg). Such would make me want to fly to airline again (if the next airfares sale doesn’t!).

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