From the Psychiatry Forum

[Apollyon]

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Regarding "is there a doctor on board", earlier this year I was flying with my wife and they called over head for a doctor. No one responded so I stood up and took a look, turned out to be elderly women who was dizzy, nauseated and fell trying to make it to the bathroom. I did the ABC's and spoke over the radio to the airport with the pilot. Did vitals which were stable and I asked for the medical kit which was very weak, no AED. I started O2 and stayed with her until we landed. Not much I could do but the woman did well and I briefed the EMS when they boarded. When I walked back to my seat two guys mentioned "you did a great job" and I said are you docs and they responded "yup anesthesiologists." They asked me what I did and I said psychiatry and their jaws dropped. My point is regardless of what we do, start with the basics which even techs know, and just being there to help may be therapeutic with the limited resources you may have on a plane.

Happened to notice this. I'm a platinum flyer, and I've never been on a flight when they ask "is there a doctor on board?" A friend I flew out here last year had a guy in cardiogenic shock when flying back to the mainland - she's a paramedic. A good friend of mine has been on 3 flights where they needed help - she's a neuroradiologist!

 

[rsgillmd]

Happened to notice this. I'm a platinum flyer, and I've never been on a flight when they ask "is there a doctor on board?" A friend I flew out here last year had a guy in cardiogenic shock when flying back to the mainland - she's a paramedic. A good friend of mine has been on 3 flights where they needed help - she's a neuroradiologist!

I've been on flight where they asked for a doctor. But our flight had a different response. I walked toward the back of the plane and found the patient surrounded by a firefighter/EMT, paramedic, and a pediatrician. It was just an 18 year old girl with what seemed like vasovagal syncope (now awake and seemed fine). The pediatrician was taking charge of the scene so we all walked back to our seats.

I wonder why the anesthesiologists didn't respond. If they are worried about legal ramifications, I believe our response is protected under the good samaritan act. I responded because it seemed like the morally right thing to do. You can't live in fear of lawsuits.

 

[bne_12mne]

I've been on flight where they asked for a doctor. But our flight had a different response. I walked toward the back of the plane and found the patient surrounded by a firefighter/EMT, paramedic, and a pediatrician. It was just an 18 year old girl with what seemed like vasovagal syncope (now awake and seemed fine). The pediatrician was taking charge of the scene so we all walked back to our seats.

I wonder why the anesthesiologists didn't respond. If they are worried about legal ramifications, I believe our response is protected under the good samaritan act. I responded because it seemed like the morally right thing to do. You can't live in fear of lawsuits.

Perhaps they missed the announcement, were sleeping, or had been drinking.

 

[Noyac]

Maybe they were crna's? They frequently pose as anesthesiologists .

 

[IlDestriero]

Perhaps they missed the announcement, were sleeping, or had been drinking.

When I have to take a long flight alone, I often get a couple of drinks early and go to sleep. Things would have to be pretty dire for me to offer medical aid when I have had a couple.

 

[orangele]

I fly quite a bit, and I was quite surprised that I had never been on a flight where the crew requested someone with medical training.

Last year, I was in row 2 when I notice quite a bit of activity in the foward cabin, and then I saw the other crew members sitting an attendent on the floor. They then asked if there was any medical personnel on board. I started to get up when a gentleman in the first row got up to assist.

Too many doctors in first class I guess, LOL.

 

[IN2B8R]

Happened to notice this. I'm a platinum flyer, and I've never been on a flight when they ask "is there a doctor on board?" A friend I flew out here last year had a guy in cardiogenic shock when flying back to the mainland - she's a paramedic. A good friend of mine has been on 3 flights where they needed help - she's a neuroradiologist!

Now why would any self respecting physician leave the hot flight attendant in the rear and rise to help the old geezer in the front?

 

[notinkansas]

I was on a flight (Amsterdam to Detroit) a couple months ago, and was actually in the bathroom when the request for medical people was made. When I came out of the bathroom, the woman was surrounded by people, awake, alert, good color so I decided not to add myself to the mix. I did keep an eye out to make sure things were covered. Flight was uneventful. I did start thinking about how limited things we could do on board an airplane are.

 

[2win]

When I have to take a long flight alone, I often get a couple of drinks early and go to sleep. Things would have to be pretty dire for me to offer medical aid when I have had a couple.

Tell me when you book the next flight to the ASA meeting and I'll get a seat near to you.
Happened few times with me but I had other guys much faster than me - so seems that they believed the old urban legend that you get a free airplane ticket....It isn't true anymore I guess - my wife "helped " 2 times and not even a "thank you " note. Seems that people are "entitled"...Didin't happened to me me when a pipe burst and they asked for 80 bucks/hour plus materials . That's a fu..ck..ing fascinating subject.

 

[sevo85288]

I helped on a Southwest flight years ago when a 22 y/o female had bad n/v, diarrhea and was passing out. I went to the back, she was laying on the floor next to the restroom. The flight attendants brought out their medical supplies which included an IV start kit and fluids. Keep in mind, the back of the plane was dark (night flight) and this young woman was very dehydrated and was a difficult IV stick. I looked for veins using a flash light while the plane swayed back and forth over Nebraska (Chicago to SF) flight. A pulled a short 20 G they had there and got lucky on the first stick. Secured the IV with scotch tape. The flight crew noticed how awkward the whole process was, dark, tight space with no way to around the patient. They asked me if I was ok, and I said "yes, I am used to this. I am an anesthesiologist" They didn't know how to respond, (I thought I was being funny)

The young woman did well after 2 liters of NS and walked to her seat holding up her IV bag above her head. They also had some D50 and I gave her 1/2 amp, thinking she may be hypoglycemic.

I got a thank you from the captain and they let me off the plane first; Southwest was happy they didn't have to land for medical reasons ($$$) and gave me a free flight voucher. It was a fun experience. Of course they got all my info/name/address/etc. Surprisingly they had a reasonably stocked medical kit.

 

[Apollyon]

My paramedic friend and my neurorads friend both got "goody boxes" from the airlines (unrequested), and my rads friend got an upgrade to first class (which didn't mean much with 1/2 hour left in the flight). I think my doctor friend only got the "thank you" box for one of the 3 assists.

And, yeah, the number one concern for the pilot is "do I have to turn around or land?" Deviating is expensive, but the pilot - who is a professional - defers to the opinion of the doctor - who is a professional - as to whether the patient can wait to destination, or needs to get to ground NOW.

 

[2win]

My paramedic friend and my neurorads friend both got "goody boxes" from the airlines (unrequested), and my rads friend got an upgrade to first class (which didn't mean much with 1/2 hour left in the flight). I think my doctor friend only got the "thank you" box for one of the 3 assists.

And, yeah, the number one concern for the pilot is "do I have to turn around or land?" Deviating is expensive, but the pilot - who is a professional - defers to the opinion of the doctor - who is a professional - as to whether the patient can wait to destination, or needs to get to ground NOW.

That's freaking discrimination!!!!😍

 

[Apollyon]

That's freaking discrimination!!!!😍

Maybe it's because they're both hot chicks??

 

[joshmir]

whats the normal sat in a healthy normal person on a plane? I think its low, like around 90-92%, but I could be misremembnering...there was an asa poster about this a few years ago...

 

[pgg]

When I have to take a long flight alone, I often get a couple of drinks early and go to sleep. Things would have to be pretty dire for me to offer medical aid when I have had a couple.

I took some Ambien once as we were taking off from Turkey and woke up 1/2 way across the Atlantic with drool all over myself. I still try to make a point of being impaired on long flights, though not quite to that degree.

And literally days after I graduated from medical school I was on a flight to Peru ... attendant asked if there was a doctor on board. I got all tachycardic but someone else responded right away.

 

[Jay K]

We were having dim-sum in Boston Chinatown, when the staff began asking for physicians table to table. I suppose being so close to Tufts, they were probably facing good odds. Table behind me happened to be a bunch of surgeons and reps; After much goading by others at his table, one of the surgeons volunteered his efforts.

 

[doctor712]

8 years ago...on way back from Rio de Janeiro, plane had to land in Puerto Rico so a woman could give birth. One doc on board. I wished they had ambien back then...I could have slept through the whole ordeal...

note: i think i took an ambien for the first time not too long after 2002... close to 2004...

 

[Planktonmd]

I have to confess that I am not a fast responder in these situations and I always wait alittle bit for some young energetic hero type to show up and save the day.
If the hero does not show up (very unlikely) and if in my assessment the situation seems real enough I might get involved but it is very rare.
I stopped my car once to help a police officer get a baby from the back seat of a smashed SUV, and did my best to assure the mother and make sure the baby was OK until the EMT's showed up, I was anticipating a subpoena of some sort but it never happened.

 

[dhb]

Responded once for a little girl with asthma who's medication where not allowed onboard 😡 and who had difficulty breathing due to the A/C probably. Got a thank you but no benefits.

 

[Bertelman]

I wonder why the anesthesiologists didn't respond. If they are worried about legal ramifications, I believe our response is protected under the good samaritan act. I responded because it seemed like the morally right thing to do. You can't live in fear of lawsuits.

C'mon. You know they were listening to their iPods, playing Sodoku and flirting with the attendants.

There was a good article on this a couple years back.

 

[doctor712]

I gave the heimlich once to an 80 yo guy choking.

Culprit: a gluttonous bite of a tuna salad sandwich.

(Couldn't make that one up.)

Gave me a 5$ tip.

Swell guy,
D712

 

[urge]

I got to try ambien. I hate flying. It's really really boring.

I have never been on a plane where they call for a physician. A couple of my friends have. One had a free plane ticket about 7 yrs ago.

 

[Apollyon]

There was a good article on this a couple years back.

I've seen that article before, and it's good. However, maybe it's because of who wrote it, but the line

Anesthesiologists receive training in physiology, critical care, and crew resource management and are uniquely qualified to provide assistance.

overstates it a bit - "uniquely"? Yet the private agency cited - "MedAire" - has "emergency and aerospace medicine" consultants. As I am biased towards EM, I might say that EM, anesthesiology, and IM-Critical Care types would be best. Subsets like peds and cardiology are only specifically good, but not across the board (abdominal pain is more than 'atypical angina'!).

 

[Coastie]

I've seen that article before, and it's good. However, maybe it's because of who wrote it, but the line



overstates it a bit - "uniquely"? Yet the private agency cited - "MedAire" - has "emergency and aerospace medicine" consultants. As I am biased towards EM, I might say that EM, anesthesiology, and IM-Critical Care types would be best. Subsets like peds and cardiology are only specifically good, but not across the board (abdominal pain is more than 'atypical angina'!).

I'd agree with the article: anesthesiologists are the best at airway control, difficult IV access..

 

[Bertelman]

I've seen that article before, and it's good. However, maybe it's because of who wrote it, but the line



overstates it a bit - "uniquely"? Yet the private agency cited - "MedAire" - has "emergency and aerospace medicine" consultants. As I am biased towards EM, I might say that EM, anesthesiology, and IM-Critical Care types would be best. Subsets like peds and cardiology are only specifically good, but not across the board (abdominal pain is more than 'atypical angina'!).

I'd agree with ICU and EM being equally qualified. I don't think he intended to overstate anything, just an observation that compared to many other specialties, anesthesiology is uniquely qualified. Not necessarily exclusively qualified.

 

[Apollyon]

I'd agree with the article: anesthesiologists are the best at airway control, difficult IV access..

The article doesn't say anything about airway control or difficult access; the in-flight emergency is a rarefied event, and the likelihood of then the incident needing airway control or it being a difficult IV event compounds the very low probability of either skill being needed. Without even a laryngoscope or a central line kit, the skills you mentioned couldn't be used even if needed.

I'm just saying that you are stating strengths of anesthesiologists as compared to other medical doctors; for an in-flight emergency, unless you're bringing your own ruck sack "just in case", you're like Batman without his utility belt.

anesthesiology is uniquely qualified. Not necessarily exclusively qualified.

Just for the sake of argument, wouldn't critical care docs or EM docs say the same thing? I mean, I know virtually nothing besides the name of THAM or dexmedetomidine, but they're not, in any general sense, the first thing you reach for. For the undifferentiated patient, with a full belly, +/- ETOH, the rapid recognition of sickness and health is the key component, and the underlined phrase is what is striven to be taught in EM residency.

 

[Bertelman]

Just for the sake of argument, wouldn't critical care docs or EM docs say the same thing? I mean, I know virtually nothing besides the name of THAM or dexmedetomidine, but they're not, in any general sense, the first thing you reach for. For the undifferentiated patient, with a full belly, +/- ETOH, the rapid recognition of sickness and health is the key component, and the underlined phrase is what is striven to be taught in EM residency.

Of course they would, and they would be right, but the article was printed in the journal Anesthesiology, thus the primary audience is anesthesiologists. Hence, in this context, the primary audience is uniquely qualified, but not necessarily supremely qualified.

 

[pgg]

I've seen that article before, and it's good. However, maybe it's because of who wrote it, but the line

Anesthesiologists receive training in physiology, critical care, and crew resource management and are uniquely qualified to provide assistance.

overstates it a bit - "uniquely"? Yet the private agency cited - "MedAire" - has "emergency and aerospace medicine" consultants. As I am biased towards EM, I might say that EM, anesthesiology, and IM-Critical Care types would be best. Subsets like peds and cardiology are only specifically good, but not across the board (abdominal pain is more than 'atypical angina'!).

Dude, you're trying too hard to be offended if you can read an article in Anesthesiology and get annoyed that your own specialty wasn't given equally pointless props.

Yes, yes, you EM guys are good at crisis management too. You're valued members of the healthcare team, and you're good enough, smart enough, and doggone it, people like you. 😉

 

[Apollyon]

However, maybe it's because of who wrote it

Dude, you're trying too hard to be offended if you can read an article in Anesthesiology and get annoyed that your own specialty wasn't given equally pointless props.

I'm not offended - I noted it above (and above).

It's more of me being a "grouper" (not the fish) instead of a "separator". I see more people being able to do it, instead of fewer. As much as we wish it weren't so, there is much overlap in medicine, with more people able to do jobs, instead of less.

It's the idea of being "unique" - just like a snowflake, each being individually unique, but, then, therefore, equal.

 

[old_boy]

And, yeah, the number one concern for the pilot is "do I have to turn around or land?" Deviating is expensive, but the pilot - who is a professional - defers to the opinion of the doctor - who is a professional - as to whether the patient can wait to destination, or needs to get to ground NOW.

I've liked every professional pilot I've met. Generally a great group of men and women (mostly men), and if you're implying that physicians and pilots share a certain professional respect I'd be inclined to agree. Too bad the pittance they're being paid these days. Over the past couple of decades they've face some of the same market problems physicians are currently facing, only it hasn't turned out so well for their bottom line.

 

[foxtrot]

Maybe they were crna's? They frequently pose as anesthesiologists .

So true, so true