Inflight Medical Emergency

[ea200]

A friend of mine traveling on a THY flight from Turkey to London responded to an 'is there a doctor on board?' announcement recently. She is qualified in both Turkey and the UK and is currently working as a GP in the UK. She was asked if she had proof that she was a doctor. She was traveling on holiday and did not have any such proof with her. Her offer was declined due to 'company policy'. She was understandably upset.

Does any body know if this policy is common or is it just some THY thing. Good news is that the passenger concerned recovered sufficiently to leave the aircraft on foot into the care of the LAS. I do not know if a medical emergency was declared.

I wonder how many doctors traveling by air have the means to prove their qualification.

[Blues&twos]

Interesting. So does the airline believe that their 'policy' can overrule the potential wishes of the casualty (assuming conscious)? This would also lead to the ridiculous scenario of airline staff attempting to prevent family members assisting each other without proof.

[Hotel Tango]

Makes sense really. I would guess that if the crew take the initiative to request a doctor over the P/A they must then be satisfied that any responder is indeed a qualified doctor.

[MarcK]

I imagine that 'proof' could be as easy as a business card or wallet id from a hospital. I carry my EMT card with me, and have been asked to produce it.

[ExXB]

I can't imagine a Dr., not being able to 'prove' they are such. On the other hand someone who says that s/he is a Dr, but can't prove it....

While there are Drs, other than medical ones I can't imagine an economist wanting to do a frontal lobotomy. (Paul Krugman excepted)

[PAXboy]

So the airline lets a 'Dr' have full access to their passenger. If that is NOT a Dr and does anything from steal their wallet or the pax dies? Ask your local friendly lawyer who would get the blame!

[Heathrow Harry]

I thought all medics carried a stethoscope everywhere so they could leave it on their car seats when they park on double yellow lines...................

[Hotel Tango]

:) Oh what a cynic you are HH :ok:

[alserire]

Surely all airlines should be doing something like this?

The ?Doctor on board? programme - Lufthansa ® Ireland (http://www.lufthansa.com/online/portal/lh/ie/info_and_services/on_board?nodeid=1907351&l=en)

[obgraham]

I've responded to these calls 2-3 times. Never been asked for anything more -- crew just want some help, appreciate who they get.
But if they did ask, sh!t outta luck -- I don't travel with any credentials.

Besides, almost all airlines now are working with ground based medical assist agencies.

[wiggy]

Besides, almost all airlines now are working with ground based medical assist agencies.

We certainly do, and those agencies can sometimes verify the bona thingies of anyone claiming to be a doc.

As far as the original question goes the cabin crew will obviously happily accept help but if there is any doubt in their minds about the competence of the medical professional they have to decline the assistance.

I'm guessing medical "Walts" are rare but they do exist.

[Basil]

Besides, almost all airlines now are working with ground based medical assist agencies.
Years ago, trans-Atlantic, recently qualified young lady volunteered.
We were using HF to UK Ops with 'phone patch to US medic advice provider.
Initially put Doc in direct contact but then realised that HF radio is a bit difficult for the un-initiated so she asked the Qs and I relayed.
We dived into Boston and offloaded our suspected heart attack which turned out not to be and lady was eventually discharged.

[herman the crab]

I have responded to the requests on several occasions, mostly on Virgin Atlantic, have always been asked if I have proof (I always do), but always the patient came first before paperwork.

On the last occasion the ground based doctor got fed up with me disagreeing with their suggested treatment (it's much easier to treat a patient that you can see that one who can be described), told me to just treat as best as possible with what I had and for the flight crew to just give them updates. Involved a diversion, patient had 2 weeks in hospital and major surgery to survive albeit minus a useful but not essential body part).

Given the recommended treatment based on what the crew had been able to relay prior to my involvement he would have died somewhere mid Atlantic track. This is in NO way discrediting the crew who had done extremely well in managing him but as non medics weren't looking for the same things, nor phrasing questions as I was and also not able to realize that the signs and symptoms didn't add up to what the patient and ground doctor thought was the diagnosis.

One big issue I found was thanks to the post 911 rules I could not enter the cockpit to speak directly with the doctor and had to relay everything through the purser.

I still have the picture of the fuel dumping prior to diverting, I think we were only about 3 or 4 hours out of LAX for LHR.

HTC

[PAXboy]

(genuine question from an ignoramus) Can the R/T not be connected to the Interphone to allow direct comms?

[rjtjrt]

Post 6 Paxboy wrote So the airline lets a 'Dr' have full access to their passenger. If that is NOT a Dr and does anything from steal their wallet or the pax dies? Ask your local friendly lawyer who would get the blame!
The other side of that is what if patient had died with a Dr there but not allowed to offer treatment or advice? Ask your local friendly lawyer who would get sued then?
Common sense surely must apply.

[PAXboy]

Absolutely rjtjrt! I agree, I was putting the stock mgmt attitude and should have prefaced it as such. The LH programme looks to be very good indeed.

[DaveReidUK]

(genuine question from an ignoramus) Can the R/T not be connected to the Interphone to allow direct comms?

The issue here is the nature of HF/SSB comms. Unless you're a long-haul pilot or a radio ham, it can be very difficult to interpret the squeaky voice that you're hearing over the airwaves, hence the OP's need to relay what was being said.

[Gibon2]

minus a useful but not essential body part

A MEL item then? I feel like I've been operating without an APU for years now.

[wiggy]

Can the R/T not be connected to the Interphone to allow direct comms?

Might be a regulatory/cost issue involved but in any event it's not been a possibility on any comms I've seen.

FWIW these days on many types (especially long haul) the communications with the medics on the ground will be done by the crew via satellite phone ( which in our case is part of the Flight Deck communications fit) rather than by using noisy, scratchy etc HF.

[Piltdown Man]

Our thread starter has told us of an interesting scenario. But I just wonder what the crew would have done had the passenger's condition worsened. Also you have ask what would have happened if the passenger's condition was such that a medic would advice an immediate diversion. It would be very difficult to explain after your passenger dies as to why you didn't take medical advuce when it was standing right in front of you. That would possibly lead to an even more interesting case in court. Lots of 'ifs' I know but it is important to know how 'being safe' can sometimes backfire and hurt you or others.

PM

[wiggy]

what would have happened if the passenger's condition was such that a medic would advice an immediate diversion. It would be very difficult to explain after your passenger dies as to why you didn't take medical advuce when it was standing right in front of you.

Well in the contect of diverting for medical reasons may I make a general point that the volunteer medic on-board will almost certainly not have the big picture, and the crew and most especially the captain has to weigh up the risks of continuing the flight for the ill pax against the possible risks of diverting ASAP because that is what the on-board medic is advising..for example:

The nearest "obvious" airport on the map may not be the best option from a medical POV. Often flying another 15-30 minutes or more to airport B rather than landing ASAP at airport A might mean the patient gets better medical attention quicker.. this is where the ground based medical advisors on the sat phone come into their own because they know where the best facilities are.

The nearest obvious airport(s) on the map may be a very poor or even illegal option from a weather/equipment point of view and a diversion may place everybody on board at serious risk ( northern canada/Russia in winter are classic examples).

It can be a difficult decision to make and is the sort of scenario often discussed during command upgrades, especially on Long Haul fleets...

[Piltdown Man]

I totally agree with you Wiggy. Dealing with a broken aircraft is easy when compared with dealing with 'broken' pax.

PM

[Paracab]

I've answered one of these calls and it turned out to be a 'nothing job' as we say in the ambulance service. I wasn't asked to provide credentials at that stage; I guess the way the conversation went following the announcement was enough. I left full details of both myself and my then employer, then was very well looked after for the rest of the flight and received a thank you letter to boot. The captain asking me if we needed to divert tempted the mischievous side in me but I remained sensible ;)

As for the other call on a different flight, my mate (Paramedic) and I shrunk into out seats as we'd had a beer and left it to someone else.

[oldpax]

Do all the cabin crew have to do a first aid course?CPR etc?

[wiggy]

Do all the cabin crew have to do a first aid course?CPR etc?

They do where I work and are checked/tested on it annually. In the context of CPR FWIW the long haul aircraft also carry "automated" defibrillators. I suspect most airlines these days do the same.

[HeartyMeatballs]

Defribulators are carried on easyJet flights. I'm not sure of the training the crew go through but I believe they're of the type where it talks you through each and every step of the process, should it be needed. All cabin crew are trained and tested in CPR anually and also cover such topics in their regular safety quiz/tests which are done throughout the year.

[wiggy]

and also cover such topics in their regular safety quiz/tests which are done throughout the year.

Good point - our crew are often quizzed on medical procedures as part of the start of trip brief.

The other side of airlines having this (relatively low level) medical capability is that some of the public can have unrealistic expectations of the same. There needs to be an understanding that whilst the cabin crew are medically trained to deal with problems arising in flight they are not there to facilitate an unofficial casevac...turning up in a wheel chair with a fresh plaster cast due to a fall during a bike ride earlier in the day causes questions to be asked..........

We all understand why individuals sometimes want to "get out of Dodge" and back home, but the denial of boarding in these circumstances is not a pleasant process for anybody involved .

[Paracab]

I'm not sure of the training the crew go through but I believe they're of the type where it talks you through each and every step of the process, should it be needed

Automated External Defibrillators (AED) do indeed give you explicit instructions as to what to do; the ones you see in public places are for anyone to use in a cardiac arrest scenario. I never used an AED when I was in the ambulance service (they are carried but just to get around the requirement to carry a defib to every patient's side from a elf n safety point of view, the manual machines are heavy) just the manual machines for professionals as you'd expect, many hundreds of times.

The first time I used AED was when mid-way through a First Aid course I was teaching at a golf course... not on a delegate but an elderly member of the club. So having never seen the machine, as we teach in First Aid, I switched it on and did as I was told! Sadly we didn't get the outcome we wanted, but not for not trying.

If someone is collapsed and not breathing and a public access AED is nearby please get it involved, if its in a case the 999 operator will release the keysafe code to you. Do as you're told by the machine and there won't be anything to worry about from a legal point of view. Every minute defibrillation is delayed the survival chance decreases by 10%.

[herman the crab]

An interesting point (that may well have changed now), was the first call I ever answered was on Virgin Atlantic for a woman with chest pains. No ECG (EKG) available but an AED, the abnormality was SOP only allowed the crew to actually defib a patient but I could give all the drugs, etc.!

If you know Prof. Chamberlain Paracab, I was heavily quizzed by him a few weeks later about the suitability of the on board supplies - the only issue was the size of the sharps container didn't allow for cannula needles! I later found out that he was the advisor for their medical kits.

HTC

[easyflyer83]

To my knowledge, there is a legal requirement for all cabin crew to be first aid trained. They are generally trained to treat signs and symptoms but to not diagnose. That is a bit of a paradox as the training is to recognise and treat the signs and symptoms of various conditions from heart attacks and stroke through to DVT to renal colic (kidney stones) and emergency child birth.

In a general form, a serious medical scenario is dealt with through a drill which brings together treatment and communication. The most serious and critical scenario being a passenger in cardiac arrest with CPR being performed and the defib (AED) used.

First Aid (or AVMED) actually has an equal weighting to a crew member proficiency to fly as safety and emergency procedures (SEP).

We really appreciate medical assistance, it can be quite daunting dealing with serious "medicals". However, as crew you have to be very aware when a medical professional offers help. There has been a couple of times on my flights when someone with or equivalent of a St.Johns first aid qualification trying to takeover, not realising that actually, the crew are just as well trained.......if not more so.

There has also been instances where a medical professional has assisted but has done something that totally goes against cabin crew training and the crew have had to step in. Case in point is to remember that not all medically trained personnel are specialists and so a General Practitioner (GP) may not be used to dealing with someone having a heart attack. Just an example.

If a medically trained professional advised us to divert, it would be unlikely that crew would decide not to. By the same token, if the cabin crew specifically advised the flight crew to divert, chances are they would. At my carrier we are trained to not specifically ask the medical professional whether we should divert but instead advise them of how long we have until we arrive at our destination. This is to avoid putting pressure on the doctor about whether a diversion is necessary but also there has been instances (albeit rare) where a medic has advised to continue simply because they want to get to where they are going.

I once read a case study at a previous airline where two professionals assisted. A doctor and a nurse. The doctor, whatever their reasons were, advised against diversion but the nurse did. In the end, a diversion was made and it became apparent that was absolutely the right call to make.

Medically trained passengers assist crew thousands of times a year and crew absolutely appreciate their assistance....they can be a lifesaver both in reality and metaphorically. However, we cannot totally handover responsibility to the medical professional for the reasons I have covered.

[Heathrow Harry]

you may also want to consider where you are diverting to.......... I think you'd probably continue to Hawai (for example) than stop in one of the islands.............

[air pig]

I actually work as a flight nurse for an international air ambulance company, as part of the morning pre flight brief, diversions are always discussed. The usual plan is that we divert to the nearest biggest airport as they normally have hospitals in the area capable of dealing with most emergencies. This means we will possibly pass smaller airports.

A flight from anywhere in Europe, a major airport is usually reachable quite easily, from the Canary Islands which are a frequent run, after departure if closer to land and carrying on is a shorter time, you have as you come north places like Lisbon, Porto etc. Even across Asia the same generally applies.

Africa is a case all on its own for medical facilities and the option if stability is achieved is to continue until you can get to a facility that has the required equipment. Nairobi is about the best, followed by Cairo.

[S.o.S.]

Thank you air pig. It's always helpful to have information 'from the pigs mouth', if you'll allow! ;)

[air pig]

SoS:

Oink oink, must be some truffles around.

Not a problem, just glad to be able to put a different perspective to the conversation.

[abgd]

I have heard a few stories about people who weren't allowed to help and were quite distressed by this. On the other hand a first aider the other day described themselves to me as 'a fellow medic' which I'm afraid I felt was a bit of a stretch - even more so after I'd talked to him for a bit*. I can't reference it but I've heard that something like 1/10 people who respond to a call for a medic aren't medically trained by any reasonable definition.

Interestingly when I renewed my UK passport a few months ago I got a call out of the blue asking whether I wanted it to state that I was a medical doctor. Of course, if I were to admit to being a British medical doctor I wouldn't be allowed to post to this forum anonymously so I had to say 'no', obviously**.

Attending a medical emergency on a flight really isn't something I would relish doing. Working in a hospital you get used to having a range of diagnostic tests available to guide you, familiar equipment and lots of well trained help. You have reasonably quiet rooms where you can take a history in peace and privacy ('When was your last period? Was it normal for you? Are they usually that irregular? Have you had any sexually transmitted infections in the past? - all important questions if you're suspecting an ectopic pregnancy - do airlines stock pregnancy testing kits?) What of a suspected testicular torsion? Do you huddle patient, (presumed) doctor and one of the airline hostesses (chaperone) in the toilets together for an examination? Or do you draw the curtains to the galley? Do you undress women in the aisle in order to apply defibrillator pads?

I have a confession: even though I don't work in an emergency department I feel I'm not as slick as I should be when it comes to cardiac arrest calls. Medicine has moved towards predicting who is about to die and either doing something about it before their heart has stopped, or giving up in advance. Older medics will have attended many, many arrests. Newer doctors may only attend one or two a year.

Medicolegal concerns do weigh in. I know nothing about air law as it pertains to medicine, but I do know that in various countries in the Middle East everyone even peripherally involved in a clinical incident is liable to lose their passport until the inquest is completed - i.e. years. On the other hand, in France you can be prosecuted for 'non-assistance a personnes en danger'. Personally I would find it hard to not assist if I felt I could but I completely understand the advice I've heard to 'get tipsy before you board the flight, and endeavour to stay drunk until it lands'.

Incidentally I've also heard a few stories of doctors who've been left in the lurch (e.g. in an emergency divert airport if they've accompanied the ambulance crew to the hospital) or not even thanked after preventing an expensive diversion by diagnosing renal stones.

* but then again, he might well be a lot better than me in some aspects of out-of-hospital first aid.

** something of a digression: the British medical regulator has said that doctors should not mention online that they are doctors without being willing to give their contact details. Many in the profession feel that they are over-reaching themselves somewhat. I'm actually a dogtor.