Physicians News Health news for doctors and patients.
By Brad Broker
If you’re on a plane, chances are good that one of the other passengers is a doctor. In almost half of all on-board medical emergencies, physician passengers have been there to save the day.
In a new study published in the New England Journal of Medicine, researchers examined in-flight emergency records from 2008 – 2010 and found an incidence of 1 in-flight medical emergency per 604 flights. Of the 11,920 total medical emergencies, researchers found that 37.4 percent of all cases were syncope or presyncope, followed by respiratory symptoms (12.1%) and nausea/vomiting (9.5%).
According to the study, “airlines partner with health care institutions to deliver real-time medical advice from an emergency call center to airline personnel, in an effort to improve the quality of care provided to passengers.” However, in most cases, care is provided by on-board passengers. Physician passengers account for 48.1% of care provided on board, followed by nurses (20.1%), EMS providers (4.4%), or other health care professionals (3.7%). The most commonly used medications and medical therapies were oxygen (in 49.9% of cases), intravenous 0.9% saline solution (in 5.2%), and aspirin (in 5.0%).
“We believe that airline passengers who are health care professionals should be aware of their potential role as volunteer responders to in-flight medical emergencies,” the authors said. But in such cases, it’s not uncommon for physicians to be concerned about overly-litigious people looking for a payday. So what about medical liability? The authors wrote:
The 1998 Aviation Medical Assistance Act includes a Good Samaritan provision, protecting passengers who offer medical assistance from liability, other than liability for gross negligence or willful misconduct. Although there is no legal obligation to intervene, we believe that physicians and other health care providers have a moral and professional obligation to act as Good Samaritans.
For doctors and other health care providers, the relevant passage of the Aviation Medical Assistance Act reads:
An individual shall not be liable for damages in any action brought in a Federal or State court arising out of the acts or omissions of the individual in providing or attempting to provide assistance in the case of an in-flight medical emergency unless the individual, while rendering such assistance, is guilty of gross negligence or willful misconduct.
The Aviation Medical Assistance Act affords the physician more protection from liability than some state Good Samaritan laws. Three states — Louisiana, Minnesota and Vermont — have “failure-to-act” laws. According to an article in Family Practice Management, “In these states, if a physician is known to have walked away from a scene at which an individual required emergency medical treatment, then he or she can be in violation of the law.”
Back to the airplane emergencies — it’s important to keep in mind that the physician or health care provider must be asked for their assistance. The authors of the current study reference a Journal of Royal Society of Medicine article that states “it does not apply if you spontaneously offer assistance, and you should therefore wait for a request to be issued. If assistance is requested directly by the passenger, as could occasionally happen, it is pertinent to inform airline staff of the situation and clarify that indemnity will be provided.”
As for the patient outcomes in the current study:
For 3402 passengers (31.2%), the situation resolved sufficiently before landing so that emergency-medical-service (EMS) personnel were not requested. Of the 7508 patients for whom EMS personnel were requested to meet the aircraft on landing, 2804 (37.3%) were transported to a hospital emergency department. Subsequently, 901 patients (8.6% of those for whom follow-up data were available) were admitted to the hospital or left the emergency department against medical advice. In addition to cardiac arrest, medical problems that were associated with the highest rates of hospital admission were strokelike symptoms (23.5%), obstetrical or gynecologic symptoms (23.4%), and cardiac symptoms (21.0%).
Read the full text of the study.
As a physician, I always react and try to assist patients during air travel. That said, I am not alone with the concept that we as physicians are not as protected as the law states. As quoted from the law, “…unless the individual, while rendering such assistance, is guilty of gross negligence or willful misconduct.” This statement can be interpreted in numerous ways in the court of law. After all, what is gross negligence? A greedy lawyer could certainly twist this into an advantage.
What if the physician had taken a drink at the beginning of flight (hours before)? What if the physician’s specialty focused on adults and the patient was a child? Gross negligence can be applicable in a multitude of real-world situations on the airplane. I would recommend that this aspect of the law be written with stronger legal language to further protect the practitioner trying to aid the patient.
Nevertheless, I will continue to treat fellow passengers to the best of my ability, hope that things go smoothly and hope that opportunistic lawyers fully understand the spirit of this law.
This just happened on my recent Aer Lingus flight from NYC to Dublin. The passenger was flying business class and the poor physician in tourist. I hope she got at least a voucher for a free flight.
My late husband answered the call for a physician years ago. He was a psychiatrist and diagnosed the individual with an anxiety attack, using breathing exercises he learned in our Lamaze class to calm him down. You just never know how knowledge and techniques will come in handy.