Being a "Good Samaritan"

[wareagle726]

Though y'all might have some input on this. Obviously this doesn't pertain to the true emergency(arrest, bad trauma, etc...). Just wondering how far you will go to help someone when you're off duty. My example is that my family and I were at a trampoline park and a young girl, probably 14 or 15, fell and had an obvious patellar dislocation. Screaming in pain. I thought about reducing it but didn't and just let EMS take her. On the one hand it definitely would have made her feel a lot better. On the other hand, in the litigious society we live in I know she would have had a fracture that would have come back to me. This isn't so much about the patellar dislocation as we all know how to handle that but instead about how you look at situations that you can actually do something about but is maybe not a life-saving situation. Thanks as always.

---

Members don't see this ad.

 

[GeneralVeers]

Wouldn't touch anything, short of a cardiac arrest outside of the hospital.

 

[wareagle726]

Wouldn't touch anything, short of a cardiac arrest outside of the hospital.

And that's kind of what I figured. And it sucks so bad having the ability to help someone but holding off because of the system we live in.

 

[Sushirolls]

Society wants to encourage good Samaritan physician behavior in these scenarios they'll choose to indemnify all physicians from any liability and do away with malpractice claims. Until then, save if for true emergency.

 

[southerndoc]

I do more than most docs would in the county where I live because I serve as the public safety medical director. Outside the county, it would have to be a life or death situation. In county, it's mainly with EMS that I do things (fracture/ankle reductions, field amputations for entrapments, etc.).

 

[cyanide12345678]

What about when you're in flight and they ask for a doctor? What would you guys do then ?

Do good Samaritan laws not apply in these cases?

 

[gamerEMdoc]

What about when you're in flight and they ask for a doctor? What would you guys do then ?

Do good Samaritan laws not apply in these cases?

They probably protect you. This is a common question that gets posed to risk management experts. But realize that good sam laws pertain if you aren’t being compensated for helping. So I’ve heard some experts say to be careful about accepting gifts from the airline for helping out. IDK. Personally if they bumped me to first class on the flight, I’d probably take it.

 

[turkeyjerky]

I do more than most docs would in the county where I live because I serve as the public safety medical director. Outside the county, it would have to be a life or death situation. In county, it's mainly with EMS that I do things (fracture/ankle reductions, field amputations for entrapments, etc.).

Wait, you've done a field amputation? Holy, ****.

 

[BoardingDoc]

What about when you're in flight and they ask for a doctor? What would you guys do then ?

Do good Samaritan laws not apply in these cases?

Someone did a talk on this when I was a resident. As of 5 or 6 years ago, apparently no doctor has ever been sued for responding to an in flight emergency.

My question though has always been, what if I've had a bloody Mary or two? I'm the only doc on board. I honestly don't know that I would get up, barring a cardiac arrest given my perceived massive liability in that situation.

I don't know that good Sam would protect me in that scenario, but I do know that there is no legal duty to act. In short, I try to save a life, I may destroy my livelihood. I let a person die, I'm in the clear.

Our legal system is f***ing stupid.

 

[EM Junkie]

Old lady tripped on the curb in front of me the other day, striking her face and dislocating her finger. I did an assessment, cleared her Cspine, checked for Neuro findings, reduced her finger, and advised her husband to get her checked out. At least she’ll be comfortable while she’s waiting.

I think it all depends on the community you’re in.

 

[Fox800]

It's insane that we live in a world where this is even a concern. We should just do the right thing, but lawyers won't.

If you aren't receiving compensation, would you be covered by Good Samaritan legislation as long as you follow the standard of care? Probably state by state.

 

[WilcoWorld]

If the diagnosis is clear and the treatment is at hand - I help. I’m not afraid of being sued over the things I do in that setting.

I think that if you aren’t accepting payment and you’re administering emergent treatment, no jury is going to decide against you. Just don’t start getting too cute or getting a big head about it.

 

[Fox800]

If the diagnosis is clear and the treatment is at hand - I help. I’m not afraid of being sued over the things I do in that setting.

I think that if you aren’t accepting payment and you’re administering emergent treatment, no jury is going to decide against you. Just don’t start getting too cute or getting a big head about it.

I agree. It's a person in need. Invasive procedures, nah I'm probably not doing that. But reducing a patellar dislocation? Absolutely and I wouldn't lose any sleep over it. I live in a physician-friendly state and as long as you are following the standard of care and aren't accepting compensation, I wouldn't worry.

 

[BoardingDoc]

I live in a physician-friendly state

There's the rub. I don't. I completely agree that it's insane not to help, and I personally find it morally questionable not to do so.... but the risk/benefit ratio is skewed enough where I live that I legitimately am forced to weigh the benefit to the stranger vs the risk to my family.

 

[RoyBasch]

Though y'all might have some input on this. Obviously this doesn't pertain to the true emergency(arrest, bad trauma, etc...). Just wondering how far you will go to help someone when you're off duty. My example is that my family and I were at a trampoline park and a young girl, probably 14 or 15, fell and had an obvious patellar dislocation. Screaming in pain. I thought about reducing it but didn't and just let EMS take her. On the one hand it definitely would have made her feel a lot better. On the other hand, in the litigious society we live in I know she would have had a fracture that would have come back to me. This isn't so much about the patellar dislocation as we all know how to handle that but instead about how you look at situations that you can actually do something about but is maybe not a life-saving situation. Thanks as always.

I would have had the same dilemma, (seems easy, can save the patient and family thousands in EMS fees and hospital bills, be the hero), but yeah liability, significant potential downside, I'd just call EMS to. I think short of someone coding and me doing CPR while calling 911 is about all I'd do in the field. Perhaps manually position an airway of spontaneously breathing and has a pulse but unresponsive.

 

[RoyBasch]

What about when you're in flight and they ask for a doctor? What would you guys do then ?

Do good Samaritan laws not apply in these cases?

I'm not sure why but I have responded to 5 different in flight emergencies in a period of a few years. (seems like long odds, but I travel a lot with many longhaul international flights). Several different airlines. The international carriers are generally low key. American carriers are pretty different. Welcome to the land of the lawyer. I responded once on United and got an email when I landed offering some number of free miles, but there was very extensive legalese-type "small print" in the email, which I did read carefully and stipulated that accepting the miles would constitute accepting reward for services rendered and I would no longer be indemnified, and they would hold me completely liable for any outcome or malpractice real or perceived. Suffice to say I did not accept the miles.

 

[Birdstrike]

...wondering how far you will go to help someone when you're off duty. My example is that my family and I were at a trampoline park and a young girl, probably 14 or 15, fell and had an obvious patellar dislocation. Screaming in pain. I thought about reducing it but...

Thanks to lawyers, these situations involve zero chance of getting paid and a non-zero chance of getting sued for a lot of money. No thanks. Call a lawyer; they'll fix it!

 

[Birdstrike]

If .... if ...no jury is going to decide against you...

"If I'm a good guy, with good intentions, doing a good deed, certainly others will agree and treat me the same."

 

[Siggy]

What about when you're in flight and they ask for a doctor? What would you guys do then ?

Do good Samaritan laws not apply in these cases?

" In the United States, the Aviation Medical Assistance Act (also referred to as a “Good Samaritan” shield) protects passengers who provide medical assistance from liability except in cases of gross negligence or willful misconduct.68 Medical volunteers who seek compensation in return for providing aid (such as money, seat upgrades, mileage points, or other items of value) may jeopardize their standing under existing immunity laws, although no case law related to this exists.69 "

Review of In-Flight Medical Emergencies

This narrative review summarizes evidence about the prevalence and management of in-flight medical emergencies and provides guidance for health care professionals who may be called on to help during these events.

jamanetwork.com

I got a $100 voucher a few years ago for telling the outpatient NP not to shove a bite block into an actively seizing patient's mouth.

 

[WilcoWorld]

'When I say that all men have a mind which cannot bear to see the sufferings of others, my meaning may be illustrated thus:-- even now-a-days, if men suddenly see a child about to fall into a well, they will without exception experience a feeling of alarm and distress. They will feel so, not as a ground on which they may gain the favour of the child's parents, nor as a ground on which they may seek the praise of their neighbours and friends, nor from a dislike to the reputation of having been unmoved by such a thing.'

- Mencius

 

[GeneralVeers]

I've responded at least 4 times to "emergencies" in the air. Most of the time it's just someone with vaso-vagal syncope, or air sickness.

I respond because the consequence of not doing so means the flight gets diverted to the nearest airport and everyone gets delayed.

I did help a Qantas FA once with a kidney stone mid-flight. That was at least rewarding.

 

[Birdstrike]

'When I say that all men have a mind which cannot bear to see the sufferings of others, my meaning may be illustrated thus:-- even now-a-days, if men suddenly see a child about to fall into a well, they will without exception experience a feeling of alarm and distress. They will feel so, not as a ground on which they may gain the favour of the child's parents, nor as a ground on which they may seek the praise of their neighbours and friends, nor from a dislike to the reputation of having been unmoved by such a thing.'

- Mencius

That's a great quote. I like it. Where did Mencius stand on abusive bullying and toxic harassment of doctors with frivolous malpractice suits?

 

[Birdstrike]

... protects passengers who provide medical assistance from liability except in cases of gross negligence or willful misconduct.68 Medical volunteers who seek compensation in return for providing aid (such as money, seat upgrades, mileage points, or other items of value) may jeopardize their standing under existing immunity laws, although no case law related to this exists.69 "

This bolded phrase renders the protection meaningless. Anywhere you see it, the tort reform is meaningless. It's easy for lawyers to slap "gross negligence" on the accusation and judges will allow cases, no matter how frivolous, to proceed all day long.

Read about a case of a child with a PE in Georgia where they have tort "reform" with this standard. It didn't stop testimony from Dr. Peter Rosen (yes, that Rosen) from giving the case legs it shouldn't have had, even with testimony so bad Rosen was sanctioned by ACEP for giving it.

 

[namethatsmell]

What about when you're in flight and they ask for a doctor? What would you guys do then ?

Do good Samaritan laws not apply in these cases?

You can be sued by anybody for anything. Anything. That said, in-flight the Good Sam law will almost certainly protect you unless your onboard resuscitation plan includes decapitation. Further, you'll also be protected by the lack of a "standard of care" for things like evaluating and managing a half-conscious person in the aisle of a 737 at 40k feet with only the little rando medical bag they have aboard.

 

[namethatsmell]

You can be sued by anybody for anything. Anything. That said, in-flight the Good Sam law will almost certainly protect you unless your onboard resuscitation plan includes decapitation. Further, you'll also be protected by the lack of a "standard of care" for things like evaluating and managing a half-conscious person in the aisle of a 737 at 40k feet with only the little rando medical bag they have aboard.

Right after I posted this I had a vision of the association of trial lawyers teaming up with envision+hca to create the first dedicated commercial airline in-flight emergency fellowship. The lawyers would create some bogus expert tools they'd use to start litigating with and the for-profits would get some additional slave labor for a year. Hopefully I didn't just jinx this...

 

[Sushirolls]

Airlines call out for physicians for basically the equivalent of admit or discharge... Land the plane now or keeping going to the original destination. Land the plane now, allows the pilot to save face with a plane full of silent but still angry people to say, 'Hey, doc says land the plane, we land the plane.'

 

[BoardingDoc]

You can be sued by anybody for anything. Anything. That said, in-flight the Good Sam law will almost certainly protect you unless your onboard resuscitation plan includes decapitation. Further, you'll also be protected by the lack of a "standard of care" for things like evaluating and managing a half-conscious person in the aisle of a 737 at 40k feet with only the little rando medical bag they have aboard.

Agree to disagree. In the words of a good lawyer: "you give me a sympathetic plaintiff and I'll find the malpractice."

Also, I again ask about my earlier and slightly more complicated scenario (which no one has deigned to answer). You're in a flight. The patient is critically ill, but you think you can help. You've had 2 drinks. You feel sober enough, but the flight attendant who served you those drinks definitely remembers doing so. Who here is standing up?

 

[gutonc]

Agree to disagree. In the words of a good lawyer: "you give me a sympathetic plaintiff and I'll find the malpractice."

Also, I again ask about my earlier and slightly more complicated scenario (which no one has deigned to answer). You're in a flight. The patient is critically ill, but you think you can help. You've had 2 drinks. You feel sober enough, but the flight attendant who served you those drinks definitely remembers doing so. Who here is standing up?

I never have, and I never will. They make headphones for a reason.

 

[dadaddadaBATMAN]

Agree to disagree. In the words of a good lawyer: "you give me a sympathetic plaintiff and I'll find the malpractice."

Also, I again ask about my earlier and slightly more complicated scenario (which no one has deigned to answer). You're in a flight. The patient is critically ill, but you think you can help. You've had 2 drinks. You feel sober enough, but the flight attendant who served you those drinks definitely remembers doing so. Who here is standing up?

I would probably be willing to say land the plane, but I would bluntly tell them I couldn’t care for a patient while intoxicated. It doesn’t matter what the outcome is if you treat the patient and anything bad happens after drinks you are fn toast.

 

[RoyBasch]

Airlines call out for physicians for basically the equivalent of admit or discharge... Land the plane now or keeping going to the original destination. Land the plane now, allows the pilot to save face with a plane full of silent but still angry people to say, 'Hey, doc says land the plane, we land the plane.'

This is wrong. You will not be asked to make the decision to land the plane. The airlines have a ground-based medical command physician who will follow a pre-arranged protocol regarding which situations to land prematurely. The decision for an international flight has hundreds of thousands of dollars in implications (sold tickets, need to rebook, possibly pay for hotel for passengers depending on the time). The airline medical command medical physician may speak to you over the radio to clarify the clinical situation, but they will decide whether or not to divert the flight.

 

[Apollyon]

This is wrong. You will not be asked to make the decision to land the plane. The airlines have a ground-based medical command physician who will follow a pre-arranged protocol regarding which situations to land prematurely. The decision for an international flight has hundreds of thousands of dollars in implications (sold tickets, need to rebook, possibly pay for hotel for passengers depending on the time). The airline medical command medical physician may speak to you over the radio to clarify the clinical situation, but they will decide whether or not to divert the flight.

When I worked in HI, my hospital was the closest to HNL. I had 5 pts from 4 separate returns (one pt was an add-on, as they had figured, since the plane got turned around, they might as well go along, to be seen for their possibly infected tattoo - it was). Not one of those pts was even near needing to be admitted. Every single one was an ESI 4 or less. Whomever it was with whom someone spoke on the plane - if they even did - must have been massively misled.

HI is just under 2700 miles from the mainland (2699 to SFO, something like 2684 to LAX), so, if it is less than 1350, they turn around. You are right with a lot, but, you are giving too much credit to someone. Those 4 flights that were returned to HNL had literal hundreds of people inconvenienced, and for nearly trivial reasons.

 

[Sushirolls]

I'm Psych... and if I'm on a plane and I say it needs to land, I don't give a *** what some doc on the phone says a few hours away. I will announce it very loud and clear to many of the passengers in the vicinity so essentially the plane knows my recommendations.

The pilot/airline/and doc several hours away will have fun defending that one if things go south.

 

[GeneralVeers]

I've never talked to the ground physician before. Most of the "emergencies" were minor and I suspect the pilot talked with ground and didn't involve me.

 

[alpinism]

Agree to disagree. In the words of a good lawyer: "you give me a sympathetic plaintiff and I'll find the malpractice."

Also, I again ask about my earlier and slightly more complicated scenario (which no one has deigned to answer). You're in a flight. The patient is critically ill, but you think you can help. You've had 2 drinks. You feel sober enough, but the flight attendant who served you those drinks definitely remembers doing so. Who here is standing up?

I never have, and I never will. They make headphones for a reason.

So if a kid is choking on a peanut and stops breathing you're going to sit there and watch them die because you had a couple bloody marys?

 

[Brigade4Radiant]

So if a kid is choking on a peanut and stops breathing you're going to sit there and watch them die because you had a couple bloody marys?

And if the kid doesn’t come back you get sued and you lose your license for a scenario Were you weren’t on duty and you didn’t get paid for. This is what society wants this is what lawful means. This is a problem for society. Also it’s more likely that that kid would have a peanut allergy and would start going to anaphylaxis.

 

[namethatsmell]

Agree to disagree. In the words of a good lawyer: "you give me a sympathetic plaintiff and I'll find the malpractice."

Also, I again ask about my earlier and slightly more complicated scenario (which no one has deigned to answer). You're in a flight. The patient is critically ill, but you think you can help. You've had 2 drinks. You feel sober enough, but the flight attendant who served you those drinks definitely remembers doing so. Who here is standing up?

We may actually somewhat agree. You can be sued for anything. I'm not saying you couldn't still be sued for responding to an inflight emergency. You certainly can be. But for me personally I'd feel pretty comfortable knowing such a suit would be highly unlikely to go anywhere given the Good Sam law and a lack of standard of care in the air.

To address your scenario: if I'd had some G&Ts and was then alerted that a kid was choking I'd probably ask the FA who'd served me if there was another qualified medical person available to help given the booze. If there was, great. If not, then yup I'd step up to the plate and do my best. I'd rather lose sleep about a BS suit than not helping the kid.

To think about the scenario in another way: lets say the pilots of a plane become incapacitated shortly before landing. The only other pilot aboard is deadheading in coach and has had a few beers. Is the best option to let that guy try and land the plane or give Johnny Sober, a nice dude but never flown, a chance to be a hero?

 

[thegenius]

Me: "Please sign here, here, here......here.......and here." Turn the page. "Now sign here...here....and finally.....here. Now I will be able to help your choking kid because I don't want to get sued."

 

[bravotwozero]

You'd be surprised at what you'll find in the airline kits. They have an intubation kit, saline, iv's, cardiac meds

 

[namethatsmell]

I don’t think there is a lot you are going to be able to do to help at 30K feet up with just a little first aid kit without all of the tools in an ED. Thoughts of gallantly helping in the lay world as a physician are better TV than practical. Most ‘emergencies’ like in real life have time to wait until the plane lands. You won’t be making the decision to land the plane prematurely. True emergencies are going to be incredibly hard to take care of mid flight. CPR for an hour until the plane lands? Odds of a good neurological outcome aren’t great. Anyone can perform CPR. There isn’t anything magical about being an EP that should mean you should be the one. Besides, you are going to have to trade out anyways. Let others do it. You could certainly help after a drink or two, but if anything remotely goes bad and anyone knows you were drinking, that is a lawsuit waiting to happen.

I agree with your first part -- we're limited on what we can do a plane. But then the 2nd part doesn't seem to jive as by that logic there'd be even less liability since...well...what could we realistically do for the pt anyway?

Anyone can perform CPR. There isn’t anything magical about being an EP that should mean you should be the one.

Bolded part is only true if John Q Public actually has some training and the mindset to actually do CPR well. And most Johns and Janes don't. Tons of evidence on this. Not saying it's rocket science or you need a doc to do it, but if you want good CPR on a person who actually needs it having a medic, nurse, or doc is ideal. And they don't grow on trees or airplanes.

Sure, I’d also rather have the copilot who has had a few drinks land the plane. It’s not a fair analogy. It’s entirely their skill set and work environment. Landing a plane for a buzzed pilot isn’t a fair comparison to a sober EP outside of the ED at 30K feet up. Also, when the plane piloted by the buzzed copilot is crash landed, primarily because of mechanical failure and not even due to the copilot’s negligence (which a jury not of the copilot’s peers will have trouble determining causality), with people getting injured even mildly, then you can bet passengers with lawyers are going to come after the pilot and airline. No one is going to consider all of the lives saved because the sober EP wasn’t instead given the chance to accidentally dive bomb the plane into the ground trying to be a hero with ineptitude at being a pilot. I don’t like it either, but that’s the sad reality of our litigious society.

I do agree it's not the perfect analogy. Analogies rarely are and please offer a better one.

Again, I'm not naively suggesting our society isn't litigious. It very much is and plently of my past posts talk about this. Rather, I'm saying that in certain situations I don't let the concern of litigation stop me from doing the right thing for the patient in front of me. I view it as preventing moral injury/burnout. Mind you this is not me trying to virtue signal...it's grown out of my attempts to not give a f*ck as the wiser people than me have talked about on the forum before.

 

[BoardingDoc]

So if a kid is choking on a peanut and stops breathing you're going to sit there and watch them die because you had a couple bloody marys?

You'd be surprised at what you'll find in the airline kits. They have an intubation kit, saline, iv's, cardiac meds

Depends on the airline. That was part of the presentation that I referenced above. Apparently some have what you mentioned. A lot have a BVM, and inhaler and some benadryl/similar meds.

EDIT: found the actual list of what is required to be aboard. No intubating equipment. Just an OPA and a BVM. Several required drugs as well.

 

[Apollyon]

Not as easy to do in an aisle between crammed seats without good lighting, limited meds, monitoring and support staff. Not as easy either after you intubate. Now what, bag for an hour?

It's funny/ironic (that is, not amusing "funny") that you mention this. In 1999, I ran a code as a paramedic in a house that was so strewn with garbage and hoarding that Buffalo Fire was on the bed, reaching down to do compressions, with the pt in the narrow aisle next to the bed, and I tubed the pt, and started the IV upside down (ie, with the needle facing me, not away from me), and bagged for whatever goodly time it was. To be frankly honest, not difficult. Oh, and, by the way, there was an earthquake during/after (in the words of Dave Barry, I Am Not Making This Up). Guy still ended up dead.

I mean, I'm just sayin'.

 

[Apollyon]

That sounds just about like how I visualize it going down on an airplane. I can certainly imagine an earthquake or airplane turbulence would make for a trickier grade 1 view. Something I haven't ever anticipated in my airway algorithm. Can still keep preparing for more airway scenarios!

Just sayin' not difficult (because sounds like it to me, strong work)? Or just sayin' dead people often stay dead (I agree)?

I meant, just an anecdote. If I can find it on an old hard drive, I'll post the one page story I wrote about it. The title, though, I'll give you - "He Woke Up Dead Today".