Is there a doctor on the plane?

[flyingblind]

QF93 has diverted to HNL due to a sick passenger. We are currently just sitting on the plane on the Tarmac

 

[docjames]

Bummer.

It seems to happen often enough trans-pac.

I guess the greater number of pax / aircraft the odds of a diversion must go up.

 

[RooFlyer]

To the medicos here (at least 3 I think ) would you mind if I migrated the question "who makes the call for a medical diversion" to the 'Ask the pilot' thread' ? I think jb747 has covered the topic in the past, but always an interesting topic ( for bystanders at least ... ).

Or would one of you like to put the question yourself to JB, from a practitioners point if view? For instance, what happens if you strongly disagree with a Captains decision not to divert? Would you ask to speak to QF ground support?

 

[Cynicor]

To the medicos here (at least 3 I think ) would you mind if I migrated the question "who makes the call for a medical diversion" to the 'Ask the pilot' thread' ? I think jb747 has covered the topic in the past, but always an interesting topic ( for bystanders at least ... ).

Or would one of you like to put the question yourself to JB, from a practitioners point if view? For instance, what happens if you strongly disagree with a Captains decision not to divert? Would you ask to speak to QF ground support?

It's been answered. While the pilot would always have final say re: safety, ability to land safely at airport X, QF have a ground medical assistanc eline that would determine whether diversion is required. If you disagree I'm sure you could speak to them and press your case, but you would need to be pretty convincing I reckon.
It'd take a lot for me to ask for a diversion- you need a life or organ threatening reversible cause in an otherwise salvageable pt.

Plus, docotrs don't disagree on the major stuff as much as in the movies. It's the little things like the best abx, best way to wean pred, best approach for a NOF that we can argue for year on.

 

[RooFlyer]

It's been answered. While the pilot would always have final say re: safety, ability to land safely at airport X, QF have a ground medical assistanc eline that would determine whether diversion is required. If you disagree I'm sure you could speak to them and press your case, but you would need to be pretty convincing I reckon.
It'd take a lot for me to ask for a diversion- you need a life or organ threatening reversible cause in an otherwise salvageable pt.

Plus, docotrs don't disagree on the major stuff as much as in the movies. It's the little things like the best abx, best way to wean pred, best approach for a NOF that we can argue for year on.

Yeah, thought I remembered it being discussed. As you say, a topic for long discussion, but as a layman, I find it hard to see a ground based expert over-riding the strong opinion of a doctor-with-the-patient assuming of course the captain is satisfied with the bona fixes of the doctor in the plane. If I was the patient in that case, and the ground people were saying 'fly on', I would probably suspect that there was some economic influence in that call, whereas I would suspect that the doctor with me was calling it purely on the basis of what's best for the patient.

But as you also say, the likelihood of strong disagreement is probably small.

 

[docjames]

Adding again - jb has answered that it's the pilot who has final say, and i'm sure they factor in all the advice they are getting.


Agree with Cynicor's comments (post #84).

 

[drron]

I think you will find that it depends on what the ground medics think of the advice that the medico on the plane is giving.
In my JAL example I learnt later from the CSM that the pilot had been told to divert to ORD.The passenger's problem was one best treated by a specialist physician which is what I am and at that stage 30 years experience at that level.The ground medics deferred to my decision that it was safe to continue to JFK.
Which is probably why I got a personal letter and gift from the President of JAL.

 

[Cynicor]

Thas was the other point i was going to make. The ground team will be more specialised in the area of triage, and understand the limitations of the aircraft environment, while a responding doctor may be anything from a physician to surgeon to business manager to retired golfer. Experience levels in this case differ wildly, and many would be out of their depth in certain situations.

Take my last flight to NAN. Call went out, doctor to my left shot up and did his thing. I talked to him later and assessing the situation as he told it, I would have been far less worried about the child. The difference? He retired from GP quite a few years ago and now just manages a locum business while I worked (at the time) in a paediatric ED (as a junior). I would never criticise the conservative approach, however. And I told him as he was walking back that I could assist if required, but we were only about 30 out IIRC.

 

[docjames]

Thas was the other point i was going to make. The ground team will be more specialised in the area of triage, and understand the limitations of the aircraft environment, while a responding doctor may be anything from a physician to surgeon to business manager to retired golfer. Experience levels in this case differ wildly, and many would be out of their depth in certain situations.

.

Again, agree entirely. And agree with drron - hence it's never black and white, always shades of grey.

I've made myself known when the call went out, described my qualification (at the time I was a registrar), and offered to assist. They'd actually found about half a dozen doctors on board - the one nearest the sick pax "had it under control" (according to the crew) and I was told they'd come back if required. From memory I asked them what sort of doctor and what the issue was - turns out it was a vomiting pax, and the doctor assisting was a gastroenterologist. I suggested to them he'd be more than capable of managing it!

 

[RooFlyer]

Thas was the other point i was going to make. The ground team will be more specialised in the area of triage, and understand the limitations of the aircraft environment, while a responding doctor may be anything from a physician to surgeon to business manager to retired golfer. Experience levels in this case differ wildly, and many would be out of their depth in certain situations.
<snip>
.

Which is why I qualified my comments with words to the effect that the captain needing to accept the bona fides (qualifications) of the volunteering doctor as germane. It's silly to talk about a business manager or retired golfer in the circumstances we are talking about.

Personally, I wouldn't give a rats behind what the ground based expert triage team said, if I (and more particularly!) the crew / captain was satisfied that the attending doc knew what he was talking about, and disagreed with the ground based expert triage team, then tough luck to the ground jockeys.

We all know that the Captain has ultimate call on the plane. The only point of me sticking my joe punter nose in here is to investigate the shades of grey that clearly exist.

 

[Simo]

As a non medical person would I am guessing in the case of a diversion it would be well we can land here but the medical support is limited but if we fly for an extra X amount of time we can land in a larger town who will have all the medical support we need.

My thought process would be landing in either ISA or DRW. DRW would have better medical support than ISA(My guess anyway)

 

[Shorns]

Hi everyone,

Just discovered this thread with great interest. I'm an Intensive Care Paramedic with some further qualifications also. I've answered the call a couple of times (oddly enough no MO's on board either time, maybe they didn't make the announcement in J??

Someone mentioned that the likelihood of being personally "sued" in Australia is not as much of a concern. There's a couple of interesting points to make (which probably has less relevance for the MO's). The state I practice in (and most others) actually only authorise practicing when representing your employer. The work around is if you do something elsewhere in Australia then your employer in a very basic sense puts you to work once you've told them about it. Whilst mid air between the US and Australia on a US plane would present some medico-legal challenges the overriding concept is this; If you do something that's reasonable and something that a peer of yours would reasonably do, then you're safe. It is a very interesting question though and I suspect even MO's might have issues with either their employer's or personal "insurance" and how it covers them overseas. I would, however suggest that making a phone call to your lawyer with someone in cardiac arrest in front of you would be something few of us would do.

I've never opened a qantas kit, I hear they are very good. Don't get sick on a virgin plane though, I was surprised how limited it was on both occasions, both were long haul international flights, maybe you have to pay extra for the deluxe kit? I was told by the CSM that they limited their contents so that people presenting false credentials, or just plain incompetent practitioners (of whatever flavour) had limited options in making the situation worse. I thought that was pretty interesting that VA were basically limiting the ability of good (and real) practitioners scared that someone would falsely identify themselves as one and do harm.

The question of diversion is interesting, on one VA flight from the US I was essentially asked by the captain (via the CSM) what to do; So to ask that of a paramedic demonstrates there's some different approaches to handling such a thing, as it turns out the patient was very very not sick so it was an easy decision but would be an interesting call to have to make, especially with the rest of the pax giving you death stares for the rest of it!

 

[ozbeachbabe]

I think there are an ever increasing number of passengers who know they are sick and shouldn't be travelling but do because they don't consider the consequences of an aircraft having to divert en-route to their destination so they don't bother to tell the airline they feel unwell or asked to be moved to a flight the next day.

Some friends were flying SIN/BNE a few weeks ago and were in the centre DE seats on the 744 with another couple in the FG seats next to them. They said right from the word go the bloke didn't look well at all and didn't eat the meal served. He got up several hours into the flight to go to the loo & collapsed in the aisle.

My friends got moved to PE in the middle of the night to allow the sick passenger to lie down.

I think too many people are blase about travelling when ill which is highlighted when they make comments like "the hostesses are trained for that kind of 'thing' aren't they" or "they carry oxygen onboard don't they"?

 

[Pushka]

Agree ozbeachbabe but I can also understand why someone unwell just wants to get home and they deteriorate onboard. And it isn't going to get better with the ageing population.

 

[erkpod]

If someone is sick & probably shouldn't travel, are they worried about the airline charging fees (as many of them do) to change flights?

 

[flychrisfly]

If someone is sick & probably shouldn't travel, are they worried about the airline charging fees (as many of them do) to change flights?

Plus hotel costs, plus more airport transfers plus meals plus no clean clothes plus...
If it was me and I felt ill but not too ill I'd be on board hoping to sleep all the way home then see my GP on arrival.

 

[JessicaTam]

Through work I have strong first aid skills, and have offered my services a couple of times. Not needed thankfully. As I am not a trained medical practitioner, I make it clear that I am not a doctor/nurse, but could help if needed.

In Victoria, you are not required to render assistance. Should you, and you act to the best of your abilities, you are fine. Once you have started rendering assistance, though, you are required to continue assisting as best you can - no deciding you can't be bothered anymore.

 

[kpc]

I am trained as a medical practitioner but most times I'm under the influence of alcohol / sleeping tablets to be able to render assistance:shock:

 

[DrAndyC]

I think the ideal respondent would be a rural GP....someone with gynae, anaesthetics and mental health / paeds skills. No offence to the "specialist" brigade...but an aeroplane is full of panic attacks, asthma attacks and heart attacks....a good all rounder as a dr is a better option

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!)

 

[DrAndyC]

me too......

I am trained as a medical practitioner but most times I'm under the influence of alcohol / sleeping tablets to be able to render assistance:shock: