Is there a doctor on board?

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Viewing 15 posts - 46 through 60 (of 99 total)

  • SUAQ1910
    Participant

    Some years ago, on a CX 747 en route from JNB-HKG (at 4am local time with 3 hours to run), crew called for a doctor to help passenger in severe pain with breathing difficulties. On the second call, a doctor and a South African Army medical orderly appeared, brought the patient forward to recline in a First Class angle-flat seat and gradually stabilised him. Although the Captain offered to divert to KUL or PEN, the doctor recommended continuing to HKG, where passenger was (against his wishes) stretchered off and – at the Captain’s insistence – officially refused boarding of his CX connecting flight to TPE.

    The cabin crew gave each medic breakfast in First Class and a bottle of champagne (“the least we can do”) while the Captain promised CX would refund their fare. Result: the passenger got the best possible treatment in the circumstances, the (modest) medics were relieved they had saved him (although the doctor said se didn’t think it would be for long!) and 250 disembarking passengers decided they’d just flown the world’s best airline and would be very happy to do so again.


    MarcusUK
    Participant

    It is interesting searching on the subject…that NOT rendering assistance could be a professional misconduct / negligence…?

    Researching some net comments on the issue, these were added…

    A Military / US perspective
    ——————————–

    “When I was in the military, I went through a string where I flew a lot and there were medical mishaps. After one episode where the pax required CPR and died prior to landing, I contacted the JAG lawyer who looked into it… apparently you can be sued in any state that the plane took off, landed in, or flew over. Which means that if the plane crosses over a state without a good samaritan law, you can be sued (and theoretically loose)”

    A New Zealand Professional medicine Journal advice (though 2002)
    ——————————————————————–

    http://journal.nzma.org.nz/journal/115-1165/244/content.pdf

    A recent US article on the issue…
    ——————————————-

    http://www.theatlantic.com/health/archive/2013/04/medical-emergencies-at-40-000-feet/274623/

    Add a few aspects to also consider.

    There was also comment on “some idenminity offered by KLM AF Swiss, stating that a dr treating someone is included and insured as an ocassional emplyee…?

    I think this could be better researched by BT on having an Airlines Policy..?


    Cool333
    Participant

    Some Universities & Airlines offer courses for Doctors/Nurses to train them how to help during a medical emergency onboard. A course I took years ago was “Onboard Medical Emergencies” given by McGill University and Air Canada.
    Was a great course, lasted a day long and we spent 2 hours in their motion simulator doing role playing! All the topics mentionned here were addressed: Good Samaritain law, Medical kits, aviation physiology, etc…

    Their website is: http://www.onboardme.com

    For those who wants a great course on that subject, I really recommend it. I would do it again anytime!


    HappytobeSilver
    Participant

    As a GP I’m disappointed that rferguson has found it less than helpful to have some of my medical colleagues assist during an inflight emergency and that a nurse or paramedic would win every time. When the call has gone out ” is there a doctor on board ?”, I have offered my assistance on each occasion. Sometimes I’ve been the only healthcare professional onboard while at other times I have contributed alongside nursing and other medical colleagues.

    It’s essential to realise the limits of your capabilities, and to that end I’ve happily stepped back if others are involved and I don’t think that I can add any value.

    I’ve had a range of issues including alcohol/drug intoxication, breathlessness and chest pain to deal with and to be honest I wouldn’t want to ignore a call for assistance if one was made.

    In terms of reward by the airline, while an upgrade on the return journey was very much appreciated together with champagne and some FF miles on other occasions- and on several flights no reward at all- while these were nice to receive, I have never been upset when no recompense for my time/skills was offered- including when I’ve had to assist ‘down the back’ for a prolonged period when I’ve been travelling ‘up the front’.


    MartynSinclair
    Participant

    Putting the reward issue to one side, I am keen to read from medics if and how they decided to assist, if the aircraft was in USA and Middle East airspace and whether any questions are directly asked regarding the jurisdiction and whether they are actually permitted to treat.

    All very well have the Good Samaritan………. and Prof Ethics……… but do the airline actually offer any practical support other than can you fix or treat it?


    junkbondman
    Participant

    Thanks for this post. I learned quite a bit about the UAE and their laws. I will no longer do any medical assistance for flights there or back. I did divert a flight to Frankfurt for a ill passenger from the UAE. It was the correct thing to do but you have to face the realities of their system and adapt to them. I plan on taking care of people as needed but now am much more aware of the legal ramifications since the “good samaritan” laws really don’t apply in any of the Arabic countries. It is a work of the Jews and Christians.

    I do agree that even though the work we do is not compensated, it would be nice of the airlines to provide some recognition for the work we provide to their customers. I don’t think I have ever gotten compensated for any of the patients I have treated including situations where I have decided not to divert a flight saving the airline tens of thousands of dollars.

    Are there any legal experts who can say something about the legalities for such non compensated services performed in adverse conditions where the risk of error is high? Is there any UN statutes or opinions on this subject?


    Airtrails
    Participant

    I am quite shocked at the motives of some medically trained personnel that have commented that you would hesitate to help onboard an aircraft in flight because you didn’t receive so much as a thank you in the past.

    You clearly had the determination and passion to go through all that medical training – sure for some the financial rewards to be paid fairly for what you do, but surely the main motive for going through such rigorous schooling was to help people in need?

    Does this mean that you would also hesitate to help should you be unfortunate to be witness to a horrific car crash on the motorway – in the absence of any emergency service. Would you willingly watch someone in pain and in need of assistance just because you wouldn’t receive some sort of token from the highways agency or emergency services for your efforts?

    You have been skilled with medical talent and to waste that because you feel you won’t be recognised is something that is becoming too common in this country.


    MartynSinclair
    Participant

    Jackdobbins116 – I am quite shocked at the thought of these highly skilled people being caught in the middle of a jurisdiction war with possible dire consequences of detainment for treating what effectively is a client of the airline.

    I personally believe the airline should provide a volunteer medic with absolute protection against prosecution or litigation when the AIRLINE ACCEPT their offer of help. On the other side the airline will claim, how do we know the medic is qualified.

    Its another chicken and egg situation, but all I do know is that if somebody has the courage to volunteer, they should receive at least the protection of the airline.

    If not, the answer is simple – the airline should not ask for volunteers, but deal with the issue themselves………….ie. carry medically trained personnel …. (which I know is both costly and probably not practical)

    EDIT – Medic = Doctor/Nurse and all things similar…


    lloydah
    Participant

    re – jackdobbins116 @ 08 00
    I think if you read the post again you’ll see that nowhere was it stated that the poster would not help because of lack of remuneration. It’s all about law and the differing laws of different countries. If you can land yourself in jail for helping to save a life you’d think twice perhaps. Hardly the same as a motorway crash perhaps?


    DavidGordon10
    Participant

    jackdobbins116 @ 08 00 – as I started all this off, I should join in again. I think you have missed the original point, and another most important point that has come up during the discussion.

    To make it quite clear: whenever the call has gone out, I have always responded, and not worried about the risks. This is the new point that has come up in discussion, the risk of a malpractice suit or worse. I take the view that the patient comes first, and the worries come later.

    The original point of the thread was to ask other travellers: what do they expect when the doctor is called on a flight? My expectation has never been of reward, and any reward that comes is a bonus. I singled out Air Canada and Czech Airlines in my original post because the important thing that came from them was a letter from the airline expressing genuine thanks. What one does not want is a letter that clearly has just come out of the word-processor without going through the brain of the person signing it, and worst of all is smething that is meant to be a “thank you” but is an insult. The doctor on the plane does sometimes save the airline a very great deal of money so – polite thank yous, please.


    Airtrails
    Participant

    I was responding to the original post. And the thought of putting a price or reward on assisting in life and death situations is what filled me with sadness really:

    “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?”


    canucklad
    Participant

    Hi rferguson……

    Many years ago I was well trained first aider and have dealt with a whole range of issues…….oddly as a first aider the one ailment I struggle with dealing with is people throwing up!!

    Anyway, your point about doctor versus paramedic is valid…….to a degree….

    Our highly respected and ancient St. Andrews trainer, advised us to be assertive and take charge at a scene…..including if doctor was already tending…..His reasoning was Doctors are trained to care for the patient First aiders are there to stabilize……

    For those telly addicts out there, the analogy I would use is from the programme MASH…….the wounded were dealt with at the front line station by paramedics, then transported to the MASH unit….A doctor would just over complicate matters at the front line !!

    On an aircraft I would have thought that the CC are trained enough to deal with the ABC’s before deferring care to a medical professional….

    This would also sort out the insurance issue’s raised, as it would be the CC who would make the initial assessment on the passenger on not the called for professional!!


    DavidGordon10
    Participant

    jackdobbins116 @ 09:41 – well, I am sorry if it fills you with sadness, but I think I am being realistic. I don’t answer in-flight emergencies with the hope of any reward, I do it to help the person who is unwell. But there is often a non-medical outcome as well – a saving to the airline in money (often very large amounts) and time. If someone saved your business €10,000 what would you do? Nothing? A refund of the ticket, or an upgrade seems pretty reasonable.


    JasmineBear
    Participant

    @rferguson

    I don’t think it is as black and white as you describe, in terms of medic vs. nurse. It depends on the situation in front of you.

    Personally, if I was in the situation of being seriously ill on a plane, I would want to know that someone could effectively triage the immediacy of the situation (appropriately trained medic or nurse). In the UK, in A&E (Emergency Room settings) the Manchester Triage System (MTS) is used widely where as the Emergency Severity Index (ESI) is widely used in the USA. They broadly deliver the same intent, which is to address 3 key questions in the context of multiple patients, but the rationale also applies to the individual.

    1). Who should be seen first?
    2). How long could / should a patient wait before need of an intervention?
    3). What resources are required to stabilise?

    Once triaged, there are a variety of Life Support training courses and qualifications addressing Basic Life Support (BLS), Advanced Life Support (ALS), adult or paediatric versions including support for the pregnant woman if this is the situation. For situations related to traumatic injuries, the Advance Trauma Life Supoprt (ATLS) qualification also exists.

    I don’t mind whether it is a nurse or physician that looks after me, provided they are trained to triage and trained to stabilise. I would not impose on a psychiatrist to assess a traumatic injury, but an ER trained nurse with ATLS would be highly appropriate. The reverse exists in that I would take the assistance of an anaesthetist over an ER nurse for an airway issue requiring intubation.

    To go back to the original point… I don’t know of any of my medic or healthcare colleagues who “seek” recompense, but they do want to know that if they offer their services, that this is accepted as being provided with the intent of helping, and provided they do not do anything negligent, to not be sued for any undesirable outcome that may have occurred anyway without their intervention or more importantly for an adverse outcome that is an unintended part of the treatment.

    An example of the later would be to administer cardiac life support but breaking a rib on the patient, which is not an uncommon event in providng chest compressions to elderly women with low bone density.


    LondonSurgeon
    Participant

    This is a very interesting topic.

    A few comments from a uk perspective. I am a surgeon in the NHS. So use to treating patients for “free”. We are regulated by the GMC who have published guidance for these issues.

    If a call is put out a doctor is obliged morally and ethically to respond. If a doctor was not to respond and it later this was recognised by someone that doctor could be referred to the gmc for dismissal for failing in their duty as a doctor. That is unless the doctor is incapacitated or drunk.

    The Good Samaritan act does protect us to a certain degree but if an error occurs then there is a chance of prosecution and/or lawsuit from patient and airline.

    Airlines for years have used good faith and good will of doctors to provide free medical treatments on flights. It is only right that a reward/token of appreciation should be given to the doctor. I think that should be a free flight or upgrade. It is a small cost to the airline and a huge moral boost to the doctor.

    It is not a simple black and white issue with many ethical and legal problems. I know of a few doctors that will have a couple of whiskies before boarding a plane so they are too drunk to treat someone on board.

    Just because we are doctors by profession does not mean that society must expect us to be doctors every minute of our lives. There must be time for us to be humans enjoying some free time.

    This could easily solved by airlines employing paramedics or nurses to be on board planes who could also be air stewards.

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