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Is there a Doctor on-board?
June 28, 2013 12:55 AM   Subscribe

The Epidemiology of In-Flight Medical Emergencies Friday SLYT- No time to read the NEMJ paper? (Previous Blue Medical emergency goodness). Doctors of Metafilter, what are you're favourite stories?
posted by Wilder (31 comments total) 9 users marked this as a favorite

 
For those who would like to read the article, it appears to be freely available at NEJM.
posted by gingerest at 1:55 AM on June 28, 2013 [1 favorite]


Important details from video: doctors are not required to provide assistance, but they should do so and should not worry about being sued, because the 1998 Aviation Medical Assistance Act protects passengers from liability "outside of gross negligence or willful misconduct."

And watch out for guitars.
posted by pracowity at 2:01 AM on June 28, 2013 [3 favorites]


but they should do so and should not worry about being sued, because the 1998 Aviation Medical Assistance Act protects passengers from liability "outside of gross negligence or willful misconduct."

Wouldn't they be covered under Good Samaritan laws as well?
posted by louche mustachio at 2:08 AM on June 28, 2013


but they should do so and should not worry about being sued, because the 1998 Aviation Medical Assistance Act protects passengers from liability "outside of gross negligence or willful misconduct."

But if you read the Act (pdf) it is clear that this is limited to the use of AEDs which are mandated equipment on aircraft and in airports.

Moreover, protected from liability and protected from lawsuit are two different things entirely. For US doctors, medical malpractice insurance may not even cover you if you are outside the US, or engaged in life saving activities outside your specific area of medical expertise.

Hey, it's nice to help out some stranger, but if it means putting your family's financial future at risk, the wise thing to do is nothing at all. Unless it's the pilot and you're unable to fly the plane yourself.
posted by three blind mice at 2:29 AM on June 28, 2013


I'm not a doctor, but I'll be glad to examine you.
posted by item at 2:37 AM on June 28, 2013 [1 favorite]


In which case, hope there's a British doctor on board, as they're obliged to help. Good Medical Practice: "You must offer help if emergencies arise in clinical settings or in the community, taking account of your own safety, your competence and the availability of other options for care."
posted by Coobeastie at 2:38 AM on June 28, 2013 [6 favorites]


In-Flight Advice For Volunteer Docs

"1. Introduce yourself to the cabin crew and state your qualifications.

2. Ask the patient for his or her permission before performing a thorough history and physical exam.

3. Use an interpreter if necessary.

4. If the patient's condition is critical, request diversion to the nearest appropriate airport.

5. Cooperate with a medical response center and coordinate with airport medical staff.

6. Keep a written medical record of your patient encounter.

7. Perform only treatments you are qualified to administer.

Source: N. Engl. J. Med. 2002;346:1067-73"

Qualified to administer at ground level and normal atmospheric pressure that is. Even experienced ER docs are probably working outside their comfort zone in the cramped and noisy confines of a pressurized cabin.
posted by three blind mice at 2:42 AM on June 28, 2013 [2 favorites]


Hey, it's nice to help out some stranger, but if it means putting your family's financial future at risk, the wise thing to do is nothing at all.

So... your advice to doctors would be to keep quiet when they ask whether there's a doctor on the plane?

Maybe there needs to be a law that requires them to help.
posted by pracowity at 2:52 AM on June 28, 2013 [2 favorites]


three blind mice: But if you read the Act (pdf) it is clear that this is limited to the use of AEDs which are mandated equipment on aircraft and in airports.

Actually, Section 4 deals with defibrillators while Section 5 deals with liability for the airline and for individuals "providing assistance in the case of an in-flight medical emergency". Nothing in Section 5 mentions defibrillators or refers back to Section 4, so I would think that the statement in the video is correct and the limitation of liability covers the general case.
posted by ltl at 3:55 AM on June 28, 2013


A hospital?! What is it?
posted by Horace Rumpole at 4:05 AM on June 28, 2013 [11 favorites]


Coobeastie: "In which case, hope there's a British doctor on board, as they're obliged to help."
Danish Doctors as well. "§ 42. Any authorized physician is required, if requested, to perform emergency treatment when immediate treatment appears to be of urgent importance, such as in cases of poisoning, major bleeding, asphyxiation and childbirth where no midwife is present, or where a midwife requests medical assistance."
posted by brokkr at 4:21 AM on June 28, 2013 [1 favorite]


"There's no reason to become alarmed, and we hope you'll enjoy the rest of your flight. By the way, is there anyone on board who knows how to fly a plane?"
posted by RobotVoodooPower at 4:45 AM on June 28, 2013 [6 favorites]


Oh, you need a medical doctor. I'll just go back to my seat then.

Mind you, if the pilot reports that she is unable to land the plane due to uncertainty about whether the external world exists I'm all over that.
posted by justsomebodythatyouusedtoknow at 4:46 AM on June 28, 2013 [43 favorites]


item: "I'm not a doctor, but I'll be glad to examine you."

Oh, good! I've got these piles and they're especially...

where are you going?
posted by jquinby at 5:10 AM on June 28, 2013 [2 favorites]


Likewise, I'm no use in a medical situation, but if the pilot needs help knowing where we are, I can explain how it's his insistence on knowing or speed so precisely that is the problem.
posted by stevis23 at 5:31 AM on June 28, 2013 [2 favorites]


A Brief Guide to In-Flight Epistemological Emergencies

1) Introduce yourself to the cabin crew. State your qualifications, or at least try to act really pompous.

2) Ask the patient for permission to question his fundamental beliefs. He will decline, but what does he know?

3) Use as many interpreters as necessary.

4) Most aircraft do not carry a Cartesian Demon Exorcism Kit, but ask the flight crew if they have a CDEK.

5) Remember that your job is not to resolve long-standing philosophical dilemmas. That work will need to be done on the ground at the nearest university, seminary or pub. Your goal is just to keep the patient in contact with reality long enough for the plane to land.

6) Best practices call for immediate application of field-expedient Pyrrhonism. "Sure, there are arguments for and against the notion that we are all just ideas in the mind of god. Perhaps those arguments seem equally strong to you. Might as well suspend belief in either direction. Now if you happen to have a gut feeling that you'd rather not let go of the controls because that makes you have an unpleasant mental image of us all plunging to our deaths you have no principled reason not to run with that feeling."

7) As a last resort, attempt the philosophical equivalent of the precordial thump. "No external world? I REFUTE IT THUS!" While shouting that, punch something as hard as you can, preferably not something covered in blinking lights.

8) Restrain yourself prior to landing. Even if you do not expect to be arrested immediately after landing, the ground crew will appreciate the gesture.
posted by justsomebodythatyouusedtoknow at 5:54 AM on June 28, 2013 [18 favorites]


Having recently administered emergency first aid to a young woman (not on a plane) exhibiting food allergy symptoms (tachycardia, tight throat, itchiness), let me state again that it is a vital life skill to know first aid. When I approached, I could see the typical signs of "something bad is happening and nobody else has a clue", which is a visibly ill person surrounded by a ring of people all wringing their hands or otherwise looking agitated, but nobody doing anything.

I am not a doctor.

Take a first aid class (I've taken several). Over my adult life, I have aided 5 people including having to give the Heimlich maneuver to my daughter.
posted by plinth at 6:18 AM on June 28, 2013 [6 favorites]


A hospital?! What is it?

It's a big building with patients, but that's not important right now.
posted by TheWhiteSkull at 6:46 AM on June 28, 2013 [10 favorites]


Excuse me, Stewardess. I speak Jive.
posted by liketitanic at 6:49 AM on June 28, 2013 [3 favorites]


Apparrently it's pretty common for British doctors to make sure that they have a drink before flying, to disqualify themselves from being required to help. A couple of the medical doctors I know explained to me that they're required to help if they can, but their insurance coverage when working under another country's laws and in an unfamiliar environment leaves them uncomfortably vulnerable to personal lawsuits if the patient (...or their next of kin, I guess) isn't totally happy with the care provided. So many would rather make sure that they can't be asked, just to avoid the risk of being sued into oblivion.

On the flipside, I once heard a lecture that included the story of a guy who was having what looked like a heart attack, on a Friday evening flight out of some West Coast city. The call for a doctor went out through the plane and, after some shuffling of feet and akward glances, hands went up from about fifty cardiologists, all travelling home from a conference with fistfulls of free drug samples and new treatment protocols. I've no idea whether the guy survived, but I bet he had an interesting flight.

I've only been on one flight with a medical emergency, and I thought that the announcement was interesting. They didn't ask for a doctor, they asked for "a qualified, medical doctor", with very heavy emphasis on the first two words. It really sounded like they were expecting a stream of people to jump up shouting "Hey, I've watched a lot of Casualty!", or "I wrote 120,000 words on motifs of dispair in Danish poetry!" and were trying to head that off. As someone whose passport says "Doctor firstname lastname", because I renewed it just after getting my PhD and was still excited about seeing it in print, their very sensible approach was a massive relief.
posted by metaBugs at 6:54 AM on June 28, 2013 [5 favorites]


I'm not a doctor, but I can make a hat, or a brooch or a pterodactyl!
posted by Sophie1 at 7:01 AM on June 28, 2013 [1 favorite]


I picked a bad day to quit Metafilter...
posted by toastchee at 7:11 AM on June 28, 2013 [1 favorite]


Sigh...liability is really the catch-22 of modern society isn't it? No one would argue that people shouldn't be allowed to sue. I'm even uncomfortable with laws creating exemptions for certain situations, because everyday life is complex, and legislators are ill-equipped to cover all possible scenarios or head off unintended consequences.

But it really does suck that someone capable of doing their best to assist another person in need has to think twice about stepping in for fear of getting the legal system getting involved.

And believe me, even if you live in a country with a trustworthy legal system, you pretty much still want to avoid it at all costs. Relatively simple matters can become soul-crushingly draining, both emotionally and financially.
posted by dry white toast at 7:14 AM on June 28, 2013 [1 favorite]


Apparrently it's pretty common for British doctors to make sure that they have a drink before flying, to disqualify themselves from being required to help.

It's pretty common for British people to make sure that they have a drink before flying. And then perhaps several more in flight. But it's not very heartening to hear that doctors do it purposely to make themselves unable to save a life. That's somewhat shitty.

But I agree that a law requiring them to help people should also make sure they aren't put in jeopardy for helping people. If they're acting under government compulsion, they should be fully insured by the government.

It might also be good to offer doctors a discount on airline tickets (one doctor per flight) if they are willing to declare themselves up front as a doctor who will not be drinking and will be available for emergency medical assistance during the flight. Governments pay sky marshals to ride planes just in case someone causes trouble. Why not offer a small perk to make sure there's a doctor there when you need one.
posted by pracowity at 7:14 AM on June 28, 2013 [4 favorites]


BBC's Health Check (June 12 episode) had an item on this research recently, interviewing a doctor who improvised treatment for a collapsed lung in a MacGyver fashion.
posted by idb at 8:15 AM on June 28, 2013


Oh, you need a medical doctor. I'll just go back to my seat then.

Mind you, if the pilot reports that she is unable to land the plane due to uncertainty about whether the external world exists I'm all over that.
posted by justsomebodythatyouusedtoknow at 4:46 AM on June 28 [24 favorites −] Favorite added! [!]


Yeah, upon booking a flight after getting my PhD I did have to have a bit of a think about whether to put my title down as Doctor, given the meaning that that word has for most people, particularly if there is a medical emergency unfolding.

But then, I reasoned, what if a fellow passenger was having an existential crisis, or a heated argument broke out between those who favour the inductive method and those that favour the deductive. What if both the pilot and co-pilot had some kind of breakdown related to their reading of Heidegger's Being and Timem which would not only be quite a reasonable response but one that you'd be unable to place a bet on with a bookie given its inevitable likeliness. What if there was a situation that could only be solved by someone calmly explaining the development of empirical epistemology, or to convince someone that they actually weren't experiencing a Baudrillardian Simularca, and could they please just land the plane thank you.

On a related note, the tax return software developed by the Australian Tax Office has only just this year been made compatible with operating systems other than Windows, but it has offered a veritable cornucopia of possible job titles. I have been sorely tempted for many a year to list mine as 'Rear Admiral' or 'The Right Honourable' and to wait and see if anything happens.
posted by Hello, I'm David McGahan at 8:18 AM on June 28, 2013 [1 favorite]


Here's an interesting interview with a Calgary doctor about flying and emergencies. Posted because I like listening to this guy.
posted by sneebler at 9:00 AM on June 28, 2013


IANAD, but on a small, 16-seat plane from Quebec City to Toronto, the dude next to me woke up from a nightmare and started screaming (in French) and throwing punches (in the universal language of Fight Club).

I sat on him for a minute or so until he calmed down.

Good times.
posted by Cool Papa Bell at 9:12 AM on June 28, 2013 [3 favorites]


MetaBugs, Mr Wilder and I both work in healthcare the UK. I'm no longer clinically active, he is an intensivist and anaesthetist so he's usually the Dr most qualified when such a call goes out.

Over 10 years I've worked with hundreds of surgeons & anaesthetists from Foundations years up to retirement and I've heard plenty of in flight stories.

I have NEVER once heard anyone say they have a drink to avoid the Good Samaritan requirements, nor have I ever heard of a UK doctor being in difficulty due to actions taken during an in flight emergency.

I would love to hear more genuinely, I'm gobsmacked. Its a very interesting turn I hadn't expected when posting this.
posted by Wilder at 9:26 AM on June 28, 2013 [4 favorites]


A Brief Guide to In-Flight Epistemological Emergencies

Sweet sufferin' Job--I want to favorite this so hard it crash lands!



I know I'm not the greatest in an emergency, but I did take a FA class, and believe me, I wouldn't be standing with my thumb up my butt if there were no one else to do something.

And I would hope someone would do something for me, if they could.

Oh, and plinth, you rock!
posted by BlueHorse at 8:13 PM on June 28, 2013


Wilder - this conversation was a few years ago with newly qualified medics, perhaps FY2/registrar level. It was a slightly jokey pub conversation and maybe I misunderstood how much comedic exagguration was going on. That said, my lasting impression was that they had heard some horror stories or dire warnings about the liability problems involved, had been left genuinely worried, and referred to that as a route that people used to avoid being put into a vulnerable position.
posted by metaBugs at 6:56 AM on June 29, 2013


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