Is there a doctor on the plane?

[medhead]

On the question of being a calling. I think all doctors/new doctors are mostly motivated by caring. But I also think their greatest strength in constantly thinking about patients medical care can also be a weakness.

IIRC, by the time they pick up the degrees - fresh graduates before the internship - they already know how to do a POP (Plaster of Paris) for a fracture, have helped to deliver 5-7 babies and fully aware that Aspirin saves lives in a heart attack plus knowing the normal heart / breathing rates (i.e. what is abnormal)......

So, you are 100% free to choose a member of the public.

We live in a free country after all.

So I just have 3 to 5 babies to go then.

Seriously I have no idea why you feel you need to change my opinion or why you feel the need to defend medical grads. I am not attacking them, I understand why they can do stupid things, I understand the pressures they're under once they graduate. But that doesn't change the fact that I'd rather a more senior doctor to care for me. In the case of an emergency on an airplane that means first aid trained FAs, in contact back to senior medical advice provided by qantas. Sorry if you can't handle that, but the airline will most likely have very good medical resources at their disposal.

 

[legroom]

On the question of being a calling. I think all doctors/new doctors are mostly motivated by caring. But I also think their greatest strength in constantly thinking about patients medical care can also be a weakness.



So I just have 3 to 5 babies to go then.

Seriously I have no idea why you feel you need to change my opinion or why you feel the need to defend medical grads. I am not attacking them, I understand why they can do stupid things, I understand the pressures they're under once they graduate. But that doesn't change the fact that is rather a more senior doctor to care for me. In the case if an emergency on an airplane that means first aid trained FAs, in contact back to senior medical advice provided by qantas. Sorry if you can't handle that, but the airline will most likely have very good medical resources at their disposal.

My comments referred to the subject matter at hand - the choice between "a member of the public" vs "a recent graduate".

 

[medhead]

My comments referred to the subject matter at hand - the choice between "a member of the public" vs "a recent graduate".

Actually the subject also includes "on a plane".

 

[Pinktommy]

KC2, we travel to Fiji every year too and have had to consult a pediatrician with one of the kids.....who by the way was excellent, but I really would hate to be stuck in Fiji needing urgent medical treatment!!!!! I would rather the plane go on to Australia!

 

[k_sheep]

If you can substantiate that, then his tenure is over.

I've no interest in bringing someone down. Med law people are, by and large, slime anyway, so I figure their miserable life is punishment enough! I just wryly smile and immediately ignore their advice. Perhaps at my own peril, but at least I can sleep at night.

Probably sound advice. Last thing I'd want is a recent graduate if I was sick.

I'd 100x rather a recent graduate than a pathologist, radiologist, psychiatrist etc, heck even a surgeon who hasn't done their ALS/BLS for 20 years! What's an orthopod going to do, just order 1g keflex for anything/everything? At least junior doctors have spent time recently in acute/critical care, and are up to date with their ALS/BLS.

 

[Milboo]

Interesting that the med students get told thing in their Med Law lectures and the Law students learn the opposite! It's been at least 10 years since my med law lectures and I remember learning that there is no legal obligation (at law) to render assistance in an emergency. However a failure to do so may be a professional conduct issue.

Obviously if they do assist then a doctor does establish/ create a duty of care to the patient. Therefore they have to act with due care and skill i.e. not be negligent.

I have not stayed across the area of law so don't know if there is recent cases but I'd highly doubt it. And if there were then professional indemnity insurance would be available surely?

 

[k_sheep]

I have not stayed across the area of law so don't know if there is recent cases but I'd highly doubt it. And if there were then professional indemnity insurance would be available surely?

Depends on your insurance; some of them blanket refuse cover when you practice in the USA, which can extend to US aircraft, airspace etc. I don't know the specifics but I remember many people saying they won't help out if there's any hint the USA might be involved - which is incredibly sad. But I see their point, yes doctors will generally want to help, but they don't want to destroy their own life and career if something goes wrong.

 

[Will]

I speak as an anaesthetic registrar, and my ideal team for dealing with an on-board medical emergency would include a MICA paramedic. The skills that are required - managing sick patients in an unfamiliar environment with limited resources, and co-opting a team of lay rescuers - are practiced by MICA paramedics on a weekly basis. I am training to be an expert in airway management and life support, but there is a massive difference between an operating heatre with my anaesthetic machine and a trained assistant etc, and a free-for-all pre-hospital arrest. I don't pretend to be an expert in pre-hospital resuscitation, and I agree with the earlier statements that we should respect the skills and not the title.

I have a few on-board medical emergency stories which I am happy to share if people are interested (not particularly exciting though!)

 

[Will]

Interesting that the med students get told thing in their Med Law lectures and the Law students learn the opposite! It's been at least 10 years since my med law lectures and I remember learning that there is no legal obligation (at law) to render assistance in an emergency. ...

Law is evolving, and you are extremely unlikely to be liable for failing to render assistance, but there is precedent - have a read of Lown v Woods NSW SC 1995 (as previously mentioned in this thread). Liability was established for failure to leave a GP practice and render assistance to a fitting child.

 

[Will]

Relevant Article: Refusing to treat - Medical Observer

 

[drron]

You are covered by the US Aviation Medical assistance act in LOTFAP so no concerns-
Text of H.R. 2843 (105th): Aviation Medical Assistance Act of 1998 (Passed Congress/Enrolled Bill version) - GovTrack.us

The real problem is France which I learnt from a lawyer I met on a trip.The Civil code makes it an offence not to offer help but then holds you liable for any harm caused.
So note to medicos-avoid Air France.

 

[k_sheep]

So note to <medicos> everyone -avoid Air France.

Fixed for you

 

[bosox76]

As a medico who has attended a few "calls for help", i am saddened to hear that medical students are being "taught" to not respond. Especially for litigation reasons. I can however state from personal experience that the medical kit onboard the QF A380's is very well stocked. In fact it comes in 3 large separate bags. I also agree with some of my colleagues above that having a paramedic around would be very useful. Having spent an entire flight from MEL to LAX looking after a sick crew member and having to put in iv lines and giving meds in non-hospital setting is something that we don't usually do. Lastly, having to make a call as to whether or not to divert a flight halfway over the pacific with 400 people onboard is not something that is easily done. And from my experience it was not the captains call to make but mine. Not sure if that is always the case but it was on my flight.

 

[stewiejp]

As a medico who has attended a few "calls for help", i am saddened to hear that medical students are being "taught" to not respond. Especially for litigation reasons. .

It is a sad state of affairs certainly, and while I'm fairly certain in Australia one cannot be sued for rendering assistance, unfortunately in other countries (U$A most famously) - a medical student/paramedic etc could be sued, possibly charged even if patient was 100% "fixed". If the person unknown to them administered something that person was allergic to, or didn't want for religious beliefs, the compensation could run into the millions.

Unfortunately in some parts of the world, the common sense approach has gone out the window...

 

[legroom]

As a medico who has attended a few "calls for help", i am saddened to hear that medical students are being "taught" to not respond. Especially for litigation reasons. I can however state from personal experience that the medical kit onboard the QF A380's is very well stocked. In fact it comes in 3 large separate bags. I also agree with some of my colleagues above that having a paramedic around would be very useful. Having spent an entire flight from MEL to LAX looking after a sick crew member and having to put in iv lines and giving meds in non-hospital setting is something that we don't usually do. Lastly, having to make a call as to whether or not to divert a flight halfway over the pacific with 400 people onboard is not something that is easily done. And from my experience it was not the captains call to make but mine. Not sure if that is always the case but it was on my flight.

The recent NEJM article claimed that every major airlines (I assume QF is the same) has access to ground based experts in the event of the need for further consultation if you think diversion is needed.

Further, diversion for medical reason, according to NEJM, is a rare event.

Should that be NOT available, I agree it could be a relative burden to wear.

 

[bosox76]

The recent NEJM article claimed that every major airlines (I assume QF is the same) has access to ground based experts in the event of the need for further consultation if you think diversion is needed.

Yes there is access to ground based experts, in the case I was involved in it was an emergency physician based in Dallas Texas, however they weren't about to make the call as I was the one with the "patient" in front of me. Maybe it was because I was "senior enough". Again I stress that this was my experience only and not necessarily company policy. It is also my understanding that for Trans-Pac crossings there is a certain point of no return when it comes to diversions (somewhere just beyond fiji??). Perhaps someone else can confirm or correct this for me. Although not an easy decision, if i needed to make the call to divert, I would do it 100% of the time. Yes there would be many upset passengers with missed connections etc (probably me included) but if it's the right thing to do, then so be it.

Despite all the drama, I would still urge any people with medical training to respond to the call for help. We are in a privileged position of being able to help people no matter where we are and no matter how inconvenient you may personally find the situation to be.

 

[docjames]

bosox76 - what specialty are you in (if you are happy to disclose)? Or "stream" (crit care / physician / surgeon / gp etc)?

Certainly the further out I get from my Critical Care experience, the less "comfortable" I am in an unfamiliar environment (reflecting my agreement that in many situations a doctor is useful for "big picture" stuff but a paramedic can be invaluable).


My understanding is that it is ALWAYS the decision of the captain to divert, but he/she will assess the information being given from the ground and the onboard medico and weigh up what he/she believes (ie. how convincing / how clear you are re: diagnosis / likely outcome for the patient).


I would certainly factor in "likely diversion site" - landing in NAN from mid-pacific when LAX or HNL might only be an extra 15 minutes flying time would in many cases be "worth it" depending on the patients circumstances (I know of one intensivist who had this discussion with q QF 744 Captain mid pacific and was given "10 more minutes" to assess the situation - by which time LAX was the closest suitable airfield.....)

 

[bosox76]

My understanding is that it is ALWAYS the decision of the captain to divert, but he/she will assess the information being given from the ground and the onboard medico and weigh up what he/she believes (ie. how convincing / how clear you are re: diagnosis / likely outcome for the patient).

I am a physician by trade but much of my clinical time is spent in ICU/HDU/CCU. I take your point that it is up to the Captain to ultimately make the call, but (again this is only my own personal experience) based on my conversations with the Captain, via the CSM, it definitely felt like the decision was mine to make. I also agree that if it is borderline timing wise between diverting back to NAN and proceeding to LAX I would choose LAX for sure.

 

[Rox]

I have a few on-board medical emergency stories which I am happy to share if people are interested (not particularly exciting though!)

Always love a good medical story!

 

[drron]

It is a sad state of affairs certainly, and while I'm fairly certain in Australia one cannot be sued for rendering assistance, unfortunately in other countries (U$A most famously) - a medical student/paramedic etc could be sued, possibly charged even if patient was 100% "fixed". If the person unknown to them administered something that person was allergic to, or didn't want for religious beliefs, the compensation could run into the millions.

Unfortunately in some parts of the world, the common sense approach has gone out the window...

The USA does have a Good Samaritan Law passed by Congress in 1998-I quoted it earlier in this thread.So you are not going to be sued for millions on an American airline.The country to be really scared in is France.