Doctor on-board?

[Nabin]

I had been trying to read some specific topics on this but couldn't find anything other than a few abstract newspaper articles and few personal experiences. While this is not a common situation to find oneself in, but can we shed some light on what are the possible situations a doctor/med student/health professional may have to face on-board a flight? What resources will be available to use while inside a place? etc.. Let's also take into account professionals who have specialized in different fields and have long lost touch with handling emergency patients.

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[DrBowtie]

I had been trying to read some specific topics on this but couldn't find anything other than a few abstract newspaper articles and few personal experiences. While this is not a common situation to find oneself in, but can we shed some light on what are the possible situations a doctor/med student/health professional may have to face on-board a flight? What resources will be available to use while inside a place? etc.. Let's also take into account professionals who have specialized in different fields and have long lost touch with handling emergency patients.

Jose V. Nable, M.D., N.R.P., Christina L. Tupe, M.D., Bruce D. Gehle, J.D., and William J. Brady, M.D. N Engl J Med 2015; 373:939-945

 

[gro2001]

Based on what I recall from a lecture in residency:

1) Most important resource is that all airlines contract with telemedicine services that are on call to assist with medical decision making. The crew can patch you through to whatever service the airline is contracted with, you can describe the situation and your findings, and really it's on them to make decisions if you don't feel comfortable or are not sure what needs to be done. In this way, even a physician not used to dealing with emergencies (or even a medical student) can be very helpful because they can describe what is actually going on (i.e.: he is aphasic vs "he is out of it").

2) Medico-legally it's totally not clear which laws apply. Some sources say source country, some say destination, or maybe the stop over (if that's your situation) or the airline's country... Either way, it is probably a reasonable assumption that some sort of "good samaritan" logic applies, and you shouldn't have the medico-legal stuff hold you back from helping. If anything, a number of countries have laws obligating physicians to help in emergencies! Either way, you won't be able to figure it out in the midst of the situation, so just do what seems the most reasonable at the time. Keep in mind that usually "good samaritan" only applies if you do not receive compensation. I am not saying you would ever bill the passenger you assisted for your services, but receiving upgrades from the very grateful airline (even later) may be seen as compensation and likely void your good sam protection.

3) You will have access to oxygen at the very least, as well as the passenger's own medications. You will probably have access to a stethoscope, sphingomanometer, and some basic meds. If you are lucky you may have more advanced equipment (including AED, intubation equipment), but this is not standardized the world over. You will probably have access to other passengers' medications if you ask the crew to make an announcement, but this is likely to be useful in only a few situations (asthma attack, lost inhaler at the airport).

4) Biggest decision is likely to be is should we divert to nearest airport or can the crew continue to planned destination. Bear in mind that sometimes diverting to nearest airport may have a small increased risk that applies to a whole plane full of people and DEFINITELY has a huge cost associated with it. This will often be a moot point except on the longer flights.

5) Let the local EMTs take over once you land.

6) Seats in business/first class often go completely flat, so if your patient is pale, bleeding, syncopyzing, or just looks like crap, tell the airline staff they need to move his to business class seating so he can be flat. They should be able to arrange that. Also ask them for oxygen. It will at the very least make you look professional while you are figuring things out.

7) They will probably ask for your credentials.

 

[Nabin]

Based on what I recall from a lecture in residency:

1) Most important resource is that all airlines contract with telemedicine services that are on call to assist with medical decision making. The crew can patch you through to whatever service the airline is contracted with, you can describe the situation and your findings, and really it's on them to make decisions if you don't feel comfortable or are not sure what needs to be done. In this way, even a physician not used to dealing with emergencies (or even a medical student) can be very helpful because they can describe what is actually going on (i.e.: he is aphasic vs "he is out of it").

2) Medico-legally it's totally not clear which laws apply. Some sources say source country, some say destination, or maybe the stop over (if that's your situation) or the airline's country... Either way, it is probably a reasonable assumption that some sort of "good samaritan" logic applies, and you shouldn't have the medico-legal stuff hold you back from helping. If anything, a number of countries have laws obligating physicians to help in emergencies! Either way, you won't be able to figure it out in the midst of the situation, so just do what seems the most reasonable at the time. Keep in mind that usually "good samaritan" only applies if you do not receive compensation. I am not saying you would ever bill the passenger you assisted for your services, but receiving upgrades from the very grateful airline (even later) may be seen as compensation and likely void your good sam protection.

3) You will have access to oxygen at the very least, as well as the passenger's own medications. You will probably have access to a stethoscope, sphingomanometer, and some basic meds. If you are lucky you may have more advanced equipment (including AED, intubation equipment), but this is not standardized the world over. You will probably have access to other passengers' medications if you ask the crew to make an announcement, but this is likely to be useful in only a few situations (asthma attack, lost inhaler at the airport).

4) Biggest decision is likely to be is should we divert to nearest airport or can the crew continue to planned destination. Bear in mind that sometimes diverting to nearest airport may have a small increased risk that applies to a whole plane full of people and DEFINITELY has a huge cost associated with it. This will often be a moot point except on the longer flights.

5) Let the local EMTs take over once you land.

6) Seats in business/first class often go completely flat, so if your patient is pale, bleeding, syncopyzing, or just looks like crap, tell the airline staff they need to move his to business class seating so he can be flat. They should be able to arrange that. Also ask them for oxygen. It will at the very least make you look professional while you are figuring things out.

7) They will probably ask for your credentials.

Thank you so much Doctor for taking the time. These info are gold. I get the picture a bit well now. When I traveled, I came across a dehydrated, confused elderly and a few cases of anxiety attacks. There were experienced doctors on-board during all those encounters who handled the situation pretty well because everyone (including the crew) were panicking and making the situation more intimidating in the closed space at that height.

Jose V. Nable, M.D., N.R.P., Christina L. Tupe, M.D., Bruce D. Gehle, J.D., and William J. Brady, M.D. N Engl J Med 2015; 373:939-945

Thank you Doctor.

 

[Zebra Hunter]

Had this happen to me my last year in medical school while flying during interview season. It ended up being nothing serious, but I was ****ting bricks when they had asked for a doctor the third time over the PA and no one had responded. I did, however, make it clear I was a medical student when I spoke with the flight attendant and sick individual.

Also, to the post above, I was under the impression that we have absolutely no say whether the plane should divert. That is up to the telemedicine doc they have on call, seeing as some of the transcontinental flights can cost them hundreds of thousands of dollars to divert, and it is still quite a chunk of change for the regional flights, too.

 

[Jabbed]

 

[deuist]

I responded once on a flight. The patient was unresponsive and tachycardic. The only equipment I had immediately available was oxygen, an AED, and I think I had a blood pressure cuff with a rudimentary stethoscope. The flight attendant asked me if I wanted to ground the plane. Since I had no idea what was wrong with the patient – she was unresponsive – I requested that the pilot land at the nearest airport. 15 minutes later we were on the ground and a paramedic crew came on board to retrieve the patient.

 

[Hair Police]

Thank you for citing Dr Nable's article. I would also say that if you ask the passengers, there's a high likelihood of someone having an albuterol MDI, some sort of benzo, and some sort of low-level antibiotic (like amox or augmentin).

 

[iish]

Did CPR on a plane once. 6 minutes of it. Witnessed arrest. Got ROSC. Took a while to get the AED on him, only after ROSC achieved. Plane was close to landing so we went to destination and EMS took passenger off the plane immediately.

The meds they had on the plane were pretty amazing. Could easily run a code. Layout of the kit was confusing though. Lots of needles and not enough angiocaths.

 

[zurned]

They asked for a doctor onboard once and I responded. Turns out a baby needed Benadryl for an allergic rash, and the airlines protocol is to ask for a medical professional to open the Benadryl bottle and pour he amount into the measuring cup. If there was no medical professional, then the flight attendant would have to do it herself.

So I opened the bottle, read the instructions on the back and poured the correct amount, and then I handed it to the mom. The airlines actually gave me miles as their reward. Crazy I know...

 

[Angry Birds]

I wish all journal articles had to be made into such youtube videos.