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Another in flight emergency…

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  • Avatar westcoastdoc 
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    Here is an interesting JAMA article regarding in flight emergencies.

    They list the common complaints and the medical items stocked on board.

     

    https://jamanetwork.com/journals/jama/fullarticle/2719313

    #209904 Reply
    Zaphod Zaphod 
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    You’re a better person than I am. Once they started questioning the credentials, I probably would have went back to my salmon tartare.

    Click to expand…

    I am with you. In my case, I likely would not have heard the call, likely sleeping with the noise cancelling headphones in place. Not that a radiologist can do much up there, anyway.

    Click to expand…

    that’s very true. Radiologists, Dermatologists, Ophthalmologists, Allergists, Pathologists can probably safely disregard these types of calls without any feelings of guilt..

    Click to expand…

    Dont forget the plastic surgeons. Also not very useful in air. I used to have wallet cards but lost them with my wallet a few weeks ago.

     

    #209907 Reply
    Avatar Urojet 
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    This thread makes me a bit sad. I’ve responded to a few in-flight emergencies, which I’ve felt a bit more comfortable doing as an EMT-turned-urology resident. For those anywhere near training, I really don’t think your specialty matters. It’s all been intern-level troubleshooting. Even the dermatologists and plastic surgeons have done an intern medicine/surgery year somewhere and learned this stuff.

    One of these times, a woman with likely undiagnosed asthma was having an exacerbation. I was the only physician on the flight and volunteered to help out. The kit had some albuterol inhalers – and even a nebulizer, I think – but we got by with the former. Sure, anyone could have showed her how to use it, but the flight attendants were quite honestly frantic and I can’t imagine them calming a patient down effectively. In another situation, an elderly woman essentially just overheated. The flight attendants had moved her somewhere more comfortable and she was feeling fine by the time I got to her, but it was again nice to help reassure her. Again, everyone else was freaking out.

    The previously quoted article about unclear malpractice exposure is sobering. And of course I could have been wrong about either of the patients in my example and there could have been a bad outcome that would have exposed me. But have we really gotten to a place where we’d all let someone have an asthma attack nearby, but not get up to help, all because we’re not sure what the potential legal protections would be if they sued? I’m plenty risk averse, but it feels a bit inhumane.

    #209918 Reply
    NaOH NaOH 
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    Crap, who carries their work ID on a flight anyway?!

    The only time this has happened to us, me (4th year pharmacy student) and my then-girlfriend (path fellow) just looked at each other with ‘WTF should we do?’ faces. Thankfully, there were several other physicians on the flight who promptly jumped up to volunteer.

    "Don't fear failure - not failure, but low aim, is the crime.
    In great attempts it is glorious even to fail."

    #209934 Reply
    Avatar jbmitt 
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    My spouse is a doc and I’m a pilot so I understand both perspectives. Most of the airlines rely on MedAire for in air medical consultations between the flight crew, dispatchers and decisions to divert. When medical professionals are onboard, they will take their advice in mind, but there are lots of other operational considerations that come into play.

    We were on a flight to San Juan when we got the PA announcement and I woke her up and she helped an older passenger who had passed out and was light headed. I was surprised that we continued to P.R. rather than turning back to somewhere in Florida. It allowed us to make our cruise, and presumably why they discourage you from flying in the same day. ATC did vector us straight in and we were met by paramedics. The passenger ended up being ok and was on another cruise ship that was in port with us.

    Interestingly, USAir did not keep any record of the event nor ask for her credentials, contact information etc. She did provide it to the family who wanted to provide us with an update. As others have mentioned, on long haul aircraft the med kits are pretty robust, on domestic and regional aircraft they’re very basic because diversion points are much closer.

    On a side note, she trained with a female physician who had a very unpleasant, and well documented interaction with Delta on a flight to Africa. At the time of the events, her colleague was an attending who had completed a fellowship and my spouse was a 3rd year resident. Some of the flight crews have received justifiable criticism for their profiling of age, gender, race of physicians when asking for help.

    When we fly she has a wallet card of her medical license and her badge. I carry proof of my FAA licenses/endorsements/ratings and current medical.

    #209951 Reply
    Liked by G
    fatlittlepig fatlittlepig 
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    Status: Physician
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    Joined: 01/26/2017

    Crap, who carries their work ID on a flight anyway?!

    The only time this has happened to us, me (4th year pharmacy student) and my then-girlfriend (path fellow) just looked at each other with ‘WTF should we do?’ faces. Thankfully, there were several other physicians on the flight who promptly jumped up to volunteer.

    Click to expand…

    Any real doctors on board?? Looks nervously around, ooh thank god Fatlittlepig is here.

    #209953 Reply
    Liked by Olórin
    Zaphod Zaphod 
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    This thread makes me a bit sad. I’ve responded to a few in-flight emergencies, which I’ve felt a bit more comfortable doing as an EMT-turned-urology resident. For those anywhere near training, I really don’t think your specialty matters. It’s all been intern-level troubleshooting. Even the dermatologists and plastic surgeons have done an intern medicine/surgery year somewhere and learned this stuff.

    One of these times, a woman with likely undiagnosed asthma was having an exacerbation. I was the only physician on the flight and volunteered to help out. The kit had some albuterol inhalers – and even a nebulizer, I think – but we got by with the former. Sure, anyone could have showed her how to use it, but the flight attendants were quite honestly frantic and I can’t imagine them calming a patient down effectively. In another situation, an elderly woman essentially just overheated. The flight attendants had moved her somewhere more comfortable and she was feeling fine by the time I got to her, but it was again nice to help reassure her. Again, everyone else was freaking out.

    The previously quoted article about unclear malpractice exposure is sobering. And of course I could have been wrong about either of the patients in my example and there could have been a bad outcome that would have exposed me. But have we really gotten to a place where we’d all let someone have an asthma attack nearby, but not get up to help, all because we’re not sure what the potential legal protections would be if they sued? I’m plenty risk averse, but it feels a bit inhumane.

    Click to expand…

    Agree you can handle most anything as a resident. Very different shortly thereafter depending on your practice. And no, frankly, it isnt worth it. Everyone is basing the worth on the likelihood that its nothing and nothing will come of the event. Thats a bad decision making process. The reality is the bad situation will arise some time and be trouble for someone and they will not feel it was worth it. When pts are truly yours in the real world, you’ll also have a different take as the difference is palpable.

    If we’re being really real, it doesnt even matter. For most things that can be handled on a plane with what little resources you have (yes I’ve responded before), it doesnt matter if you’re there or not. They’ve either got a non emergency or something serious. If non emergency than you arent necessary anyway as its nothing requiring a doctor, if emergent, you cant do much about it anyway and they need to land, etc…If no one responds they’ll take it up with their own risk management/doctors and the same thing will occur. Just typing it out makes the situation super obvious, they are just using docs on board as first responders since its cheaper, aka, less diverted flights with the responsibility not on them.

    #209981 Reply
    Avatar G 
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    But have we really gotten to a place where we’d all let someone have an asthma attack nearby, but not get up to help, all because we’re not sure what the potential legal protections would be if they sued? I’m plenty risk averse, but it feels a bit inhumane.

    Click to expand…

    We had a lengthy thread about this before.  In my residency, someone got sued for being a good samaritan (although not on an airplane)…don’t know how it ended up, but it was a ton of hassle/time/indigestion.  Of course we all know that “not liable” or “getting dropped” from a suit is a secret code for “put through hell”….

    Anyway, I have responded to several calls over the years.

    But I will also say that since I graduated from residency, two things have happened: one, I now have something to lose; and two, more importantly, I swear the biochemistry of my brain changed when I had a baby, a hardwired transformation in the paleocortex.  Risk aversion has a whole new meaning!

    #209996 Reply
    Liked by Zaphod
    eyecandy eyecandy 
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    G – The CBP story is amazing! I’m glad I’m not the only sassy American to have been harassed by the Canadian Border Patrol. Driving up to ski in Whistler, driving my friend’s car and stupidly was honest that it wasn’t my car. (PS she’s a hand surgeon, was absolutely confident there weren’t kilos of coke hidden in the bumper) The jerks thought I was carrying drugs from the US. I was warned, “I’ve searched and arrested plenty of bankers, doctors, lawyers”. Hours later, they found nothing mostly I was pissed because I was late to my hot tub time machine time! grrr – now I just keep my mouth shut

    Some of us peripheral medicine folks still respond to emergencies. My inflight emergency experience was a decade ago, somewhere over the Atlantic. As an ophthalmologist I still respond to the call, but my strategy has been to wait for the second overhead page. By then I was feeling guilty & made it back to the patient, there was already a nurse, paramedic, and nearly retired senior endocrine surgeon. I knew him immediately. No ID asked for (nor do I carry a badge), after talking with the RN and paramedic the passenger’s syncopal episode was improving, vital signs stable – they had it under control. Surgeon and I chatted for a while, later he laughed and admitted he wouldn’t know what to do and that I was closer to the action after having more recently finished a year of internal medicine 🙂

     

    #210016 Reply
    Liked by G
    Avatar Eye3md 
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    Joined: 12/01/2017

    Zaphod, so true.

     

    Ive responded to in flight “emergencies” twice, but both were either when I was in residency or working as an ER doc so I felt pretty comfortable with the encounter.  Delta was thankful both times and sent me a gift basket for one of them.

     

    In my own office, I’ve had people go in to cardiac arrest, and it has taught me how precarious it could be to intervene with a “medical emergency” on a plane (even though an encounter in my office involves MY patients and I will always intervene). A lady in my waiting room had the classic chest pain complaint and couldn’t breathe. Next thing I know, she’s gone with blue lips. No pulse. We immediately called 911 and I did CPR.  By the time the paramedics arrived, I had her pulse back, and she ends up surviving. A few days later, her daughter called raising bloody hell with us because I broke some of her mom’s ribs and now they were going to sue me for abuse. No “thanks for saving my mom’s life”. I worry about the same thing on a plane. I really hope we are protected by Good Samaritan laws in those cicumstances

    #210041 Reply
    Avatar Panscan 
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    Jesus what a moron, broken ribs during cpr is abuse. Okie doke well then guess she can die and have her ribs intact

    #210054 Reply
    Liked by Hank
    Lordosis Lordosis 
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    Status: Physician
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    Joined: 02/11/2019

    This thread makes me a bit sad. I’ve responded to a few in-flight emergencies, which I’ve felt a bit more comfortable doing as an EMT-turned-urology resident. For those anywhere near training, I really don’t think your specialty matters. It’s all been intern-level troubleshooting. Even the dermatologists and plastic surgeons have done an intern medicine/surgery year somewhere and learned this stuff.

    One of these times, a woman with likely undiagnosed asthma was having an exacerbation. I was the only physician on the flight and volunteered to help out. The kit had some albuterol inhalers – and even a nebulizer, I think – but we got by with the former. Sure, anyone could have showed her how to use it, but the flight attendants were quite honestly frantic and I can’t imagine them calming a patient down effectively. In another situation, an elderly woman essentially just overheated. The flight attendants had moved her somewhere more comfortable and she was feeling fine by the time I got to her, but it was again nice to help reassure her. Again, everyone else was freaking out.

    The previously quoted article about unclear malpractice exposure is sobering. And of course I could have been wrong about either of the patients in my example and there could have been a bad outcome that would have exposed me. But have we really gotten to a place where we’d all let someone have an asthma attack nearby, but not get up to help, all because we’re not sure what the potential legal protections would be if they sued? I’m plenty risk averse, but it feels a bit inhumane.

    Click to expand…

    I remember when I was a resident doing a rotation with ortho.  The orthopedist thought Lisinopril was for depression.  I would not want him responding to a medical emergency on a plane unless it was a broken bone.

     

    “Never let your sense of morals prevent you from doing what is right.”

    #210112 Reply
    Liked by SLC OB
    Avatar RollieStrummer 
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    Joined: 11/07/2018

    Here’s the flip side of responding:

     

    https://www.nytimes.com/2018/04/27/travel/american-airlines-brittany-oswell-death.html

     

    The doctor was not named, presumably because she is an ally in the fight against the airline, and also because the “gross negligence or willful misconduct” standard in the AMAA is a pretty high bar.  It’s not a stretch to see how an in-flight misdiagnosis leading to death could lead to a claim in another case.  This doctor will certainly be deposed, and called to testify if the case goes to trial.  Even though she won’t suffer a financial judgement, certainly the defense lawyer will make her initial misdiagnosis a central part of the case and paint her as responsible.  That’s not a pleasant thing to go through.

     

     

    #210145 Reply
    Liked by Zaphod
    Avatar Urojet 
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    Here’s the flip side of responding:

     

    https://www.nytimes.com/2018/04/27/travel/american-airlines-brittany-oswell-death.html

     

    The doctor was not named, presumably because she is an ally in the fight against the airline, and also because the “gross negligence or willful misconduct” standard in the AMAA is a pretty high bar.  It’s not a stretch to see how an in-flight misdiagnosis leading to death could lead to a claim in another case.  This doctor will certainly be deposed, and called to testify if the case goes to trial.  Even though she won’t suffer a financial judgement, certainly the defense lawyer will make her initial misdiagnosis a central part of the case and paint her as responsible.  That’s not a pleasant thing to go through.

     

     

    Click to expand…

    Another sobering example; thanks for sharing. Ironically, I’m writing this reply at 30k feet in the air.

    Read another way, though, I think the article isn’t as clear in the conclusions one could draw. Let’s say a similar situation played out, and the flight attendants were struggling to get a defibrillator to work. If you were sitting within sight and watching that unfold, would you all really not get out of your seat to try to help them troubleshoot?

    #210149 Reply
    Dreamgiver Dreamgiver 
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    I helped a couple times when I was a resident and young attending. Now when I fly I am on vacation and either enjoying cocktails or sleepy on doxylamine so don’t answer anymore. The simple fact I was asked to file a report and “chart” the event last time I helped was enough to turn me off. While this is not optimal on a human level, I feel that we have big enough targets on our backs as it is, we don’t need further exposure by trying to make an important decision with little if any equipment and with no med mal coverage in a situation with dubious good samaritan protection.

    #210151 Reply

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