Is there a doctor on board

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WallowaWanderer said:
But the trick is that you don't know whether the patient is having a STEMI or a muscle ache when you're up in the air. It would be an easy decision if you knew the patient was having a real MI.
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Certainly, but if you had a strong enough presentation +/- unstable vitals, wouldn't that prompt a diversion even in the absence of an ECG?
 
The thing I've wondered about the Good Sam. law is that as professionals, does the definition of "grossly negligent" sit at a different threshold for us than for a regular layperson? I'm thinking it does.
 
leviathan said:
The thing I've wondered about the Good Sam. law is that as professionals, does the definition of "grossly negligent" sit at a different threshold for us than for a regular layperson? I'm thinking it does.
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I thought that, legally, you have to be at the level of your peers - would another EM-trained doc in the same situation do the same thing? If you are rendering care, you would be expected to do more (as the "reasonable man" standard has the bar set higher for professionals than for the lay public).
 
Apollyon said:
I thought that, legally, you have to be at the level of your peers - would another EM-trained doc in the same situation do the same thing? If you are rendering care, you would be expected to do more (as the "reasonable man" standard has the bar set higher for professionals than for the lay public).
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You may know a lot more on the subject than I, but I thought that definition applies more to general civil liability. In other words, if a bad outcome results from a medical act you perform, you cannot be liable in court if your performance was the same as any of your peers in a similar situation. Any lawyers around these parts?
 
leviathan said:
You may know a lot more on the subject than I, but I thought that definition applies more to general civil liability. In other words, if a bad outcome results from a medical act you perform, you cannot be liable in court if your performance was the same as any of your peers in a similar situation. Any lawyers around these parts?
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I'm not a lawyer, but I've always been told (CPR/First Aid stuff) that if you're doing what your training tells you is the right thing AND you are doing it properly then GS applies.
 
leviathan said:
You may know a lot more on the subject than I, but I thought that definition applies more to general civil liability. In other words, if a bad outcome results from a medical act you perform, you cannot be liable in court if your performance was the same as any of your peers in a similar situation. Any lawyers around these parts?
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That was my intent - if my post wasn't clear, my apologies.
 
docB said:
So here's one that's gonna be a nightmare for the docs and nurses who tried to help out on the plane:

http://news.aol.com/story/_a/dispute-over-womans-death-on-flight/20080225074609990001

Obviously the family is talking lawsuit. At worst those people will get named in the suit. At best they're gonna have to testify because the family will need them to say the O2 wasn't working. And just to make that pill harder to swallow where will the trial be? Haiti? New York? Miami? The witnesses will get to travel to which ever destination the legal system chooses. Granted that won't be for several years but they're sure to see a string of subpoenas and depositions until then.
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The trial can be held in any of those places. It will depend on where the plaintiff's lawyer thinks the law is most favorable for their client.
 
FDGB said:
The trial can be held in any of those places. It will depend on where the plaintiff's lawyer thinks the law is most favorable for their client.
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No. Anything on an airplane in flight is federal. The law is the same everywhere. I have no idea how they decide which district it's in, but the rules will be the same.
 
WallowaWanderer said:
I heard (in a lecture on this, I think), that the airlines have contracts with certain hospitals that serve as medical control, and the pilot will choose to divert based on that physician's decision via radio instead of on the suggestion of the physician on board. Don't know if this is really true, but I wouldn't be surprised due to the legal risk on the part of the airline. It would be frustrating if you disagreed with the physician on the ground however.

Wow, that's pretty wild that you had a STEMI patient on an airplane.
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I know this is going back to the beginning of the thread but thought I could help clarify a few things. I'm a commercial pilot, I flew for a major airline for ten years and I'm now a pilot for Life Flight. Our airline has a team of medical advisors that can be reached over the radio at anytime. When the pilots ask for "A doctor on board" they are looking for someone usually that can talk with the physician over the radio so that they can determine the severity of the situation; this doesn't always happen but should for legal reasons. The captain takes the recommendation of the company physician and makes a judgment call from there, if the situation is very serious the captain may declare an "emergency" and land at the nearest suitable airport without consulting the company (this happens more often than not). There are so many factors involved in diverting a flight; I have flown many flights that have been diverted for medical reasons and we often get attacked for not landing at the nearest airport. The nearest airport is not always the fastest or best place to go, and getting a jet cruising at 41,000 ft. at 600mph is not like making a u-turn in your BMW.

We had a man have a heart attack on one of our flights several years ago when we were about 30 minutes from our destination. There were several doctors on board and we determined that our destination was the safest and fastest option. One of the family members on board looked out and spotted an airport just below us and wanted to know why we were not landing there. The man having the heart attack ended up not making it and we were on the ground within 25 minutes. You guessed it, the family sued the airline, the captain, myself and went after the doctors on board as well. It would have taken longer to get down to the airport just below us than our destination but people think that if you can see it you should go there. The case was eventually thrown out but not without putting everyone through hell. It had to be the fault of the flight crew or the doctors on board that he died, I'm sure it had nothing to do with him being severely overweight and probably ate nothing but cheeseburgers for the last 50 years! It's always someone else's fault as you in medicine understand this all too well.
 
marinehrnt said:
I know this is going back to the beginning of the thread but thought I could help clarify a few things. I'm a commercial pilot, I flew for a major airline for ten years and I'm now a pilot for Life Flight. Our airline has a team of medical advisors that can be reached over the radio at anytime. When the pilots ask for "A doctor on board" they are looking for someone usually that can talk with the physician over the radio so that they can determine the severity of the situation; this doesn't always happen but should for legal reasons. The captain takes the recommendation of the company physician and makes a judgment call from there, if the situation is very serious the captain may declare an "emergency" and land at the nearest suitable airport without consulting the company (this happens more often than not). There are so many factors involved in diverting a flight; I have flown many flights that have been diverted for medical reasons and we often get attacked for not landing at the nearest airport. The nearest airport is not always the fastest or best place to go, and getting a jet cruising at 41,000 ft. at 600mph is not like making a u-turn in your BMW.

We had a man have a heart attack on one of our flights several years ago when we were about 30 minutes from our destination. There were several doctors on board and we determined that our destination was the safest and fastest option. One of the family members on board looked out and spotted an airport just below us and wanted to know why we were not landing there. The man having the heart attack ended up not making it and we were on the ground within 25 minutes. You guessed it, the family sued the airline, the captain, myself and went after the doctors on board as well. It would have taken longer to get down to the airport just below us than our destination but people think that if you can see it you should go there. The case was eventually thrown out but not without putting everyone through hell. It had to be the fault of the flight crew or the doctors on board that he died, I'm sure it had nothing to do with him being severely overweight and probably ate nothing but cheeseburgers for the last 50 years! It's always someone else's fault as you in medicine understand this all too well.
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Great points. There's also some danger involved in diverting a flight as well as a lot of expense. When you start deviating from the established flight plan and throwing alternate airports into the mix the possibility of badness increases. You can imagine a situation where the previously mentioned incident with a dead person on the plane would be faulted for not diverting but I would argue that diverting under that circumstance would be absolutely unwarrented.
 
docB said:
Great points. There's also some danger involved in diverting a flight as well as a lot of expense. When you start deviating from the established flight plan and throwing alternate airports into the mix the possibility of badness increases. You can imagine a situation where the previously mentioned incident with a dead person on the plane would be faulted for not diverting but I would argue that diverting under that circumstance would be absolutely unwarrented.
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This sounds like the talk of a pilot with an instrument rating? Do you fly? When ever I here someone talk about alternates they have to have some aviation experience.

About two years ago we had another passenger die on the plane; we were half way between Miami and Portland, Oregon. Because of the distance remaining we landed in Denver, no one wants to sit next to a dead person for three hours. It just depends on the situation when it comes to diverting and how serious it is to the person in trouble and the rest of the passengers.
 
I recently listened to an audio lecture on this. A doctor has NEVER been sued for rendering assistance during an inflight emergency. The Good Sam laws are pretty strict on this. Also, the pilot in command has the ultimate decision on whether a plane diverts or not. If a plane has too much fuel it can't land safely, or weather etc...The guy also said that only 50% of doctors on a plane will admit they're doctors. It's not illegal to be the worlds greatest EM doctor and the guy next to you has passes out and you keep reading your Sky Mall magazine without doing anything. Half of the docs out there just stay in their seats. The airlines do comp a tickets if you help.
 
enfuegoEP said:
I recently listened to an audio lecture on this. A doctor has NEVER been sued for rendering assistance during an inflight emergency. The Good Sam laws are pretty strict on this. Also, the pilot in command has the ultimate decision on whether a plane diverts or not. If a plane has too much fuel it can't land safely, or weather etc...The guy also said that only 50% of doctors on a plane will admit they're doctors. It's not illegal to be the worlds greatest EM doctor and the guy next to you has passes out and you keep reading your Sky Mall magazine without doing anything. Half of the docs out there just stay in their seats. The airlines do comp a tickets if you help.
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never been sued? or never successfully been sued? there's a difference b/c as discussed earlier, just being named in a suit involves a lot of time, money, and grief
 
enfuegoEP said:
I recently listened to an audio lecture on this. A doctor has NEVER been sued for rendering assistance during an inflight emergency. The Good Sam laws are pretty strict on this. Also, the pilot in command has the ultimate decision on whether a plane diverts or not. If a plane has too much fuel it can't land safely, or weather etc...The guy also said that only 50% of doctors on a plane will admit they're doctors. It's not illegal to be the worlds greatest EM doctor and the guy next to you has passes out and you keep reading your Sky Mall magazine without doing anything. Half of the docs out there just stay in their seats. The airlines do comp a tickets if you help.
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You are correct! The pilot in command does have the ultimate decision when it comes to diverting, but this is not to say that the FAA and the lawyers always agree with the final outcome. A pilot can divert and take all necessary action in an emergency but it's not a "get out of jail free card". Pilots are often held responsible for the events leading up to an emergency; not in a case such as this but just trying to say having the ultimate authority doesn't mean you are not responsible. As the physicians on this board would understand, ultimate authority also means ultimate responsibility. As far as I know the doctors involved were initially named in the suit but that was almost immediately dropped from what I understand; I can't really speak for what exacting happened there but it was a none issue very quickly. The company, the captain and myself had a few more issues. They claimed negligence of the crew for passing up an airport but we were able to prove that landing there would have taken longer than continuing to our final destination and it would have been unsafe. It was eventually dropped but that didn't stop us from getting harassed by the FAA for eternity. You have to love the government; when the Feds smell blood them come running!!!
 
marinehrnt said:
This sounds like the talk of a pilot with an instrument rating? Do you fly? When ever I here someone talk about alternates they have to have some aviation experience.
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Yeah, IFR single. I was going for my twin cert when I had to give up for med school. So it's been a long time. I plan to strat up again when the kids are older but I have to get a notation on my cert that says I was a pilot before I was a doc. And I'll never fly a Bonanza 'cause that's just to cliche.
 
Good timing, I just heard the request for an MD today on a train from Paris to London. I wonder what kind of supplies they have on a high-speed train...probably the same as an airliner, I would imagine.
 
leviathan said:
Good timing, I just heard the request for an MD today on a train from Paris to London. I wonder what kind of supplies they have on a high-speed train...probably the same as an airliner, I would imagine.
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Having been in this situation when I lived in London, I can tell you they have nada onboard the trains. Seriously, they had a few bandages, but nothing else. Trains can stop quickly at a station whereas a plane might take an hour to get to the nearest airport.
 
docB said:
Yeah, IFR single. I was going for my twin cert when I had to give up for med school. So it's been a long time. I plan to strat up again when the kids are older but I have to get a notation on my cert that says I was a pilot before I was a doc. And I'll never fly a Bonanza 'cause that's just to cliche.
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I thought that only applied to dentists...
 
docB said:
Yeah, IFR single. I was going for my twin cert when I had to give up for med school. So it's been a long time. I plan to strat up again when the kids are older but I have to get a notation on my cert that says I was a pilot before I was a doc. And I'll never fly a Bonanza 'cause that's just to cliche.
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I had to laugh about the Bonanza comment, it's funny because it's true! When I was an instructor I taught several docs and more than one ended up in a Bonanza. Don't think getting a mutli-engine rating is worth it today, no one wants a twin that burns 50 gallon an hour when 100LL is $6.00 per gallon. You should get back into it, just like riding a bike you know but very addicting.
 
Twice I've been called to help on the plane, and both times I ended up having to sit next to people that should never have flown (literally, the people told me "I've had x disease for x years, and my Dr. told me not to fly yada yada yada..."....and then "yada yada yada" for the next 4+ hours.

The crappy part is that both times the flight crew wanted me to sit next to the "patient" for the rest of the flight (goodbye reading, goodbye sleep, and hello obnoxious lady in a sweatsuit from florida, who wants a lot more medical advice than is pertinant).

The next crappy part, paperwork, (3 pages of forms).

The next crappy part, neither time did I get a "thank you", or here's a food voucher (missed the food/drink as I was "helping" a patient and she couldn't eat either), I'm not a freebie snob, I just wanted a little drink on my 4 hour flight.

The next crappy part, they wanted me to wait for medical personel to arrive before leaving the gate, making me late for my next flight.

The next crappy part, legal liability. While I know i wont be "successfully sued", I still can be sued, which we all know is expensive, regardless of outcome. If those patients were actually having MI's, had massive myocardial damage, I'm pretty sure that both would've TRIED to sue me.

and the last crappy part, after all that x 2, I still got treated like a$$ by the airline on the flights back (both times got bumped, cancelled flights, "no room" for two days, sitting in the airport, lost my luggage, etc)

No, I didn't get anything from either airline (no drinks, no coupons, no vouchers, no comps, not evan a thank you card). While I certainly don't expect it, I do think that we should have a payment option of sorts (i rendered care, made a medical decision, and gave medical advice)....

Seriously, if the toilet breaks on the airplane, we don't ask the plumber in seat 11a to go fix it, or if the plane is delayed, we don't ask the off duty pilot in seat 2b to go fly the plane, but you could bet your a$$ that if we did, they would send us a bill for cost + inconvience.

I realize that the airline industry and society in general "appreciates" our help, but I am at the point where I may not volunteer to help. I'm not saying they need to pay me, or I wan't x y and z. I'm saying that as a "Graying" US society, more and more people are going to fly that shouldn't, and more and more often I'm going to get asked to "help out". Frankly, after my previous experiences with "helping', and the airline greed, I'm not sure that I'm going to be the first to offer. 👎
 
TysonCook said:
Twice I've been called to help on the plane, and both times I ended up having to sit next to people that should never have flown (literally, the people told me "I've had x disease for x years, and my Dr. told me not to fly yada yada yada..."....and then "yada yada yada" for the next 4+ hours.

The crappy part is that both times the flight crew wanted me to sit next to the "patient" for the rest of the flight (goodbye reading, goodbye sleep, and hello obnoxious lady in a sweatsuit from florida, who wants a lot more medical advice than is pertinant).

The next crappy part, paperwork, (3 pages of forms).

The next crappy part, neither time did I get a "thank you", or here's a food voucher (missed the food/drink as I was "helping" a patient and she couldn't eat either), I'm not a freebie snob, I just wanted a little drink on my 4 hour flight.

The next crappy part, they wanted me to wait for medical personel to arrive before leaving the gate, making me late for my next flight.

The next crappy part, legal liability. While I know i wont be "successfully sued", I still can be sued, which we all know is expensive, regardless of outcome. If those patients were actually having MI's, had massive myocardial damage, I'm pretty sure that both would've TRIED to sue me.

and the last crappy part, after all that x 2, I still got treated like a$$ by the airline on the flights back (both times got bumped, cancelled flights, "no room" for two days, sitting in the airport, lost my luggage, etc)

No, I didn't get anything from either airline (no drinks, no coupons, no vouchers, no comps, not evan a thank you card). While I certainly don't expect it, I do think that we should have a payment option of sorts (i rendered care, made a medical decision, and gave medical advice)....

Seriously, if the toilet breaks on the airplane, we don't ask the plumber in seat 11a to go fix it, or if the plane is delayed, we don't ask the off duty pilot in seat 2b to go fly the plane, but you could bet your a$$ that if we did, they would send us a bill for cost + inconvience.

I realize that the airline industry and society in general "appreciates" our help, but I am at the point where I may not volunteer to help. I'm not saying they need to pay me, or I wan't x y and z. I'm saying that as a "Graying" US society, more and more people are going to fly that shouldn't, and more and more often I'm going to get asked to "help out". Frankly, after my previous experiences with "helping', and the airline greed, I'm not sure that I'm going to be the first to offer. 👎
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Which airline was this with? Your treatment sounds very unusual based on what others have been saying.
 
leviathan said:
Which airline was this with? Your treatment sounds very unusual based on what others have been saying.
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In all honesty, I would have written a complaint letter or talked to someone higher up because that is complete BS to help out and be treated like that! I'm sure if you voiced your complaint a bit you could get a little something. Like first class on the next flight rather than being bumped!
 
crewmaster1 said:
In all honesty, I would have written a complaint letter or talked to someone higher up because that is complete BS to help out and be treated like that! I'm sure if you voiced your complaint a bit you could get a little something. Like first class on the next flight rather than being bumped!
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That gets tricky. As soon as you send off a letter that reads anything like "I did this for you so you owe me." even if all you say they owe you is to not screw you over on subsequent flights you may have in essence demanded compensation and nullified what ever good sam protection you had. I'd say that Tyson is doing exactly what I would have in that situation. I'd be silent, annoyed and unlikely to help out in the future.

Frankly I think that airlines asking for docs on flights is a bad move on thier part. They have med command, they have flight attendents who can follow directions in theory. They're lucky if they get a doc who is appropriate to deal with any of this stuff and not a retired political science PhD. I think that they are just trying to spread the liability around and asking for "volunteers" to do it.
 
docB said:
That would have gone better with a 😀 after it (unless you weren't kidding which would be frightening).
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Seriously, i am not kidding. That's why i did not use the smilies.:scared::hardy:
 
Resurrecting a 3 year-old thread, but with a new twist -

What if the patient involved is an unaccompanied minor? Does the UM paperwork that the family signs give the flight crew the power to consent to tx for the child?

I had my first call for a doctor on board the other day. Patient ended up being a child, probably about 10 y/o, complaining of abdominal discomfort. We were about 6 hours into an 8-hour international flight. Kid looked good, seemed to describe more nausea than true abdominal pain. Flight attendants said he hadn't eaten at all on the plane. Interestingly they also said that because he was traveling unaccompanied and complained of feeling ill, they had to have him checked out. Not sure what they would have done if there was no doc on the plane. I pressed on his abdomen, which was benign, and ultimately pronounced him probably just airsick, and recommended pretzels and water.

But what do you do with an unaccompanied minor?
 
Good bump, and I don't know the answer, but I have some logical opinions. Where I work now is the closest hospital to HNL, so, when a flight is diverted for medical reasons, the patients are brought to us (and we are on divert less than any other ED on O'ahu that has inpatient beds - there is one standalone ED here that is on divert less often).

Just like being in school, when an unaccompanied minor flies, the flight crew works in loco parentis - "in place of the parents". If a nonadult was critically ill/injured, and I was on the plane, I would examine the child (do your "medical screening exam"), and then determine if more was needed.

On another tack, I've had several patients on flights that were turned around before making it halfway to the mainland (interestingly, I've never had a patient from a plane going to Japan). Once I had two separate patients from one flight. How many have I admitted? Zero. One guy was a psychiatrist - he had been here for the APA convention. His flight was full of doctors. He had taken his Proscar and got a little dizzy - as he knows. He just needed to lie down. He told them all this. Still, someone made the call to divert.

Personally, if I was on a plane that was diverted, part of me would be royally pissed, knowing what I know. First, there is my personal inconvenience. Then, there is the total inconvenience of 200 to 300 other passengers. Then, to think about it, it's about a $100K cost to the airline.

I mean, emergencies happen, sure. However, if you were told not to fly, and were feeling ill before you got on-board, do you have the right to screw other people?

My specific experience, though, on-board, was a kid that probably blew some air into his canaliculus while trying to clear his ears. Otherwise, I got nada.
 
Apollyon said:
GThen, to think about it, it's about a $100K cost to the airline.
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We are also a tourist destination and have a lot of people who get sick trying to board planes, on planes or they miss a flight. Once the airlines become aware that a patient is ill they demand a "clearance to fly" form from us before they will allow the person on a plane.

I am scared to death to sign these. If the patient has a relapse of their illness (asthma for example) and the plane has to divert am I personally liable for the airline's expenses? Is that covered under my insurance? They're not alleging malpractice, it's a simple tort. They would be alleging that I certified the patient for flight and they didn't make it so pay our expenses. Is that covered?
 
See, I think you're in a worse place than I am - you have those chronically ill, should be dead COPDers and CHFers that have to gamble, and, although they don't need to be admitted, as I said, they should be dead anyhow.

I don't get those - I don't worry (as much) with the "clearance to fly" forms, because the people I've had have all been dischargeable.

At the same time, I work nights, and early morning for me is early to mid-day on the mainland. As such, for one person that needed an outpatient stress test, I was able to speak with her doctor's office in Sacramento to arrange for it. I haven't had, yet, to call a doc in Atlanta or NY for their patient here.
 
Hey - I'm a visitor from the Anesthesiology forum, currently ending my intern year. There was a similar thread there about a year or two ago about what to do, expect, etc on board an aircraft during a medical emergency. Someone then posted a link to an article published in Anesthesiology back in 2008 from the Department of Anesthesiology at Yale. It goes over some stuff unique to the airplane environment: changes in physiology, air quality on board, hypoxia, what to expect from in-flight kits, and some more. I thought I'd just post a link to the article here, too.

Management of in-flight emergencies. Anesthesiology 2008; 108: 749-755.
 
EM_Rebuilder said:
I think your wrong on that. The air is United States air space, and the water is United States Waters.... there is no Texas airspace or Texas waters (as much as we wished there was) (by waters I mean the sea).

In other words, if I wish to fly my plane ONLY around my town, I still have to follow ALL FAA rules and regulations. With water, I think its within 2 miles of shore state reigstration and such cross covers, outside of that, its US coast guard....
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Yes, there are state waters. All inland waters, and federal navigable waters out to three miles, are state waters.

I don't know about the air space issue though.

Edited - Just realized I responded to a 3 year old post 😳
 
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