painful experience in-flight
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painful experience in-flight
Thought you guys might be interested in this, from todays British Medical Journal.
Cannot understand why this guy thinks an aircraft
should be as well equipped as the local ER.
A painful experience
I was on an Airtours flight from Florida recently
when medical assistance was called for. The
patient had benign
prostatic hyperplasia and was in retention. Since we had another seven hours to fly,
holding on was not an
option. He needed a catheter, so I was reassured that the plane's
inventory of medical equipment included catheters and collecting bags.
But I then found
that there was no lignocaine gel, no lubricating jelly, and no gloves.
Performing a catheterisation without gloves or anaesthetic was not pleasant,
but the lack of lubricating jelly proved a bridge too far, so when the patient
started screaming I deputised
some antiseptic cream as an ersatz lubricant.
As the catheter was non-retaining, I advised the greatly relieved patient
not to drink any fluids for the rest of the flight and to attend accident and
emergency on his way home.
I then had to remain on alert for the next seven hours. Before disembarking I was asked to sign a form indemnifying
Airtours against any claim arising from the procedure and was
offered a bottle of wine as a gesture of appreciation.
I had expressed my concerns to the steward, but having heard nothing after a
few weeks I contacted Airtours. The company's flight officer explained that
Airtours
usually received inflight medical advice from an institute in the United States and the airline's medical officer assured me that
gloves had been
present in the equipment boxI just hadn't found them. He said that he had done hundreds of catheterisations and had never
used lignocaine gel. In a
subsequent letter, he insisted that the company's equipment was standard to all airlines, and that "the catheters are self lubricating, and being small and
atraumatic do not need lubrication or local anaesthetic." Really?
As a doctor, I had no choice but to respond to the patient's needs,
and without that choice I was forced to perform a difficult procedure with inadequate
equipment.
The poverty of the Airtours response was depressing, especially considering how much money I had saved the company;
if a doctor hadn't just
happened to be on board, the plane would have had to return to Florida.
Maybe in future Airtours should take one fewer passenger and a bit more
equipment, and maybe omit those magical self lubricating catheters.
I won't be travelling with Airtours againnot without taking my own lubricating jelly.
Liam Farrell, general practitioner.
Crossmaglen, County Armagh
Cannot understand why this guy thinks an aircraft
should be as well equipped as the local ER.
A painful experience
I was on an Airtours flight from Florida recently
when medical assistance was called for. The
patient had benign
prostatic hyperplasia and was in retention. Since we had another seven hours to fly,
holding on was not an
option. He needed a catheter, so I was reassured that the plane's
inventory of medical equipment included catheters and collecting bags.
But I then found
that there was no lignocaine gel, no lubricating jelly, and no gloves.
Performing a catheterisation without gloves or anaesthetic was not pleasant,
but the lack of lubricating jelly proved a bridge too far, so when the patient
started screaming I deputised
some antiseptic cream as an ersatz lubricant.
As the catheter was non-retaining, I advised the greatly relieved patient
not to drink any fluids for the rest of the flight and to attend accident and
emergency on his way home.
I then had to remain on alert for the next seven hours. Before disembarking I was asked to sign a form indemnifying
Airtours against any claim arising from the procedure and was
offered a bottle of wine as a gesture of appreciation.
I had expressed my concerns to the steward, but having heard nothing after a
few weeks I contacted Airtours. The company's flight officer explained that
Airtours
usually received inflight medical advice from an institute in the United States and the airline's medical officer assured me that
gloves had been
present in the equipment boxI just hadn't found them. He said that he had done hundreds of catheterisations and had never
used lignocaine gel. In a
subsequent letter, he insisted that the company's equipment was standard to all airlines, and that "the catheters are self lubricating, and being small and
atraumatic do not need lubrication or local anaesthetic." Really?
As a doctor, I had no choice but to respond to the patient's needs,
and without that choice I was forced to perform a difficult procedure with inadequate
equipment.
The poverty of the Airtours response was depressing, especially considering how much money I had saved the company;
if a doctor hadn't just
happened to be on board, the plane would have had to return to Florida.
Maybe in future Airtours should take one fewer passenger and a bit more
equipment, and maybe omit those magical self lubricating catheters.
I won't be travelling with Airtours againnot without taking my own lubricating jelly.
Liam Farrell, general practitioner.
Crossmaglen, County Armagh
Last edited by non-newtonian; 5th Apr 2002 at 11:02.
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I am typing this with my legs crossed.
If you are ill on a plane it's a bit of luck to have a doctor on board, but if he is going to poke things up the end of such a treasured and delicate item, I for one, would find some anaesthetic welcome!
If you are ill on a plane it's a bit of luck to have a doctor on board, but if he is going to poke things up the end of such a treasured and delicate item, I for one, would find some anaesthetic welcome!
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Not only that, but this also raises the serious issue that, as a Doctor, you are morally obliged to assist a passenger in distress.
Although medicine is your chosen profession, you receive no payment for your professional act. You would never refuse treatment to someone just because you're not being paid for it...but suppose there's a complication a few days later? Are you liable?
There was an article in the papers about this a couple of years ago.......possibly James leFanu in the Telegraph, but don't quote me on that.
Whatever the outcome, you are to be praised for volunteering your services, and making the best of a poor situation.
It's a real conundrum, and I've no idea of a way round it.
Although medicine is your chosen profession, you receive no payment for your professional act. You would never refuse treatment to someone just because you're not being paid for it...but suppose there's a complication a few days later? Are you liable?
There was an article in the papers about this a couple of years ago.......possibly James leFanu in the Telegraph, but don't quote me on that.
Whatever the outcome, you are to be praised for volunteering your services, and making the best of a poor situation.
It's a real conundrum, and I've no idea of a way round it.
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As the Doctor would be morally obliged to assist, surely any rational (!) court would take into account that the pax had a choice of no help at all, or assistance from the only qualified person on board. That moral dilemma should be taken into account if any litigation ensued from a Doctors well meaning actions. Also, the ramifications if a complaint was upheld ie. a sudden (apparant) drop in the number of Doctors travelling by air.
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Nopax, thanx, I'm not sure that would ever really be an issue. In very simple terms, a doctor has a duty of care to anyone he or she treats, with the level of that obligation being determined by an assumption that they are as reasonably competent as a hypothetical professional that does what they do at the level of experience that they have.
In other words, if the treatment that they give to a passenger is questioned at a later date, a court would look at how experienced the doctor was, what it is he or she had to do, what materials he or she had to work with, and any other circumstances particular to the case. The court would then attempt to compare what that doctor did, in that situation, with what a presumed hypothetical doctor with the same experience would have done in a similar situation.
I'm not sure there is an obligation (legal at least) on doctors to assist passengers in distress, but I imagine that the doctor's professional body might have something to say if they didn't, and personally I think that there should, of course, at least be a moral obligation to assist. For what it's worth there is absolutely no obligation on anyone to come to someone's aid - if you're walking past a river and see someone drowning, there is not obligation on you to dive in and rescue them, even if you are an olympic swimmer or if the water is only knee high. Beware, however, if you do. If you attempt to rescue someone but are so cack-handed at it that you in fact make things worse, there is every possibility of you being sued for negilgence...
Funny old world, eh?
In other words, if the treatment that they give to a passenger is questioned at a later date, a court would look at how experienced the doctor was, what it is he or she had to do, what materials he or she had to work with, and any other circumstances particular to the case. The court would then attempt to compare what that doctor did, in that situation, with what a presumed hypothetical doctor with the same experience would have done in a similar situation.
I'm not sure there is an obligation (legal at least) on doctors to assist passengers in distress, but I imagine that the doctor's professional body might have something to say if they didn't, and personally I think that there should, of course, at least be a moral obligation to assist. For what it's worth there is absolutely no obligation on anyone to come to someone's aid - if you're walking past a river and see someone drowning, there is not obligation on you to dive in and rescue them, even if you are an olympic swimmer or if the water is only knee high. Beware, however, if you do. If you attempt to rescue someone but are so cack-handed at it that you in fact make things worse, there is every possibility of you being sued for negilgence...
Funny old world, eh?
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You're dead right there, Lawyerboy.
I believe that the obligation is only moral (as in the Hippocratic Oath) rather than legal. The story just struck a chord as I remember reading about it in the papers; as I said, I couldn't exactly remember when.
From your reply it looks as though Doctors would be safe from litigation as long as they had acted professionally - and no doctor would ever insist on payment before treating a patient, except perhaps Dr. Nick Riviera, eh??
I believe that the obligation is only moral (as in the Hippocratic Oath) rather than legal. The story just struck a chord as I remember reading about it in the papers; as I said, I couldn't exactly remember when.
From your reply it looks as though Doctors would be safe from litigation as long as they had acted professionally - and no doctor would ever insist on payment before treating a patient, except perhaps Dr. Nick Riviera, eh??
Paxing All Over The World
There is no legal obligation on a doctor to assist on an aeroplane, anymore than their next door neighbour.
In the past I have discussed this with a doctor friend of mine. He said that he always does repond if such a call is made but he know of many doctors who do not.
Some, when travelling, ensure that 'Dr' is NOT on their tickets and will not 'make themselves know to the staff'.
That is their free choice. NOW should we move it to Jet Blast??
In the past I have discussed this with a doctor friend of mine. He said that he always does repond if such a call is made but he know of many doctors who do not.
Some, when travelling, ensure that 'Dr' is NOT on their tickets and will not 'make themselves know to the staff'.
That is their free choice. NOW should we move it to Jet Blast??
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As a passenger (and i am not a Doctor) what i find most disturbing is the fact that this
Doctor "was asked to sign a form indemnifying Airtours against any claim ....".
This guy was not on call, was not being paid, and true to his professional ethos came to
assist a human being in distress. It may even be that any insurance covering mal-practice
would be void in that situation, yet he came forward.
Not only that, he also solved an operational problem. Imagine, a passenger solving an
operational problem, saving the company quite some $/£/€ ....
Reward, a pat-in-the-back and basicaly being told "If there is any fallout, you are on your own..."
As for operational problems, what would you think of instructing the F/A to call for an
IT professional the next time some on-board computer acts-up ?
Ridiculos, right ?
Just my 3 cent (0.3 EURO)
Doctor "was asked to sign a form indemnifying Airtours against any claim ....".
This guy was not on call, was not being paid, and true to his professional ethos came to
assist a human being in distress. It may even be that any insurance covering mal-practice
would be void in that situation, yet he came forward.
Not only that, he also solved an operational problem. Imagine, a passenger solving an
operational problem, saving the company quite some $/£/€ ....
Reward, a pat-in-the-back and basicaly being told "If there is any fallout, you are on your own..."
As for operational problems, what would you think of instructing the F/A to call for an
IT professional the next time some on-board computer acts-up ?
Ridiculos, right ?
Just my 3 cent (0.3 EURO)
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The patient was lucky indeed that he had the medical problem on a British registered aircraft (and a Doctor was on on board) because generally speaking, many non-US airlines carry a much better medical kit than US carriers.
As the airline I fly for carries in terms of 40 million pax a year, medical problems like this happen quite frequently.
The co-ordinated response from the various departments that has been put in place works well - I have had occasion to use it twice recently.
On board medical kit and defib machine are well up to spec and constantly reviewed with the medical profession. BA indemnifies those doctors who come forward and offers in flight support through " Medlink" an Aeromedicine organisation based in PHX. In fact I fly with their number predialled up in the cockpit Satphone.
If all that fails we have no problem diverting - we even have special procedures for unplanned arrivals at non-gateway US airfields.
I wouldn't be too harsh on Airtours, at least they had something for the Doc to work with.
The co-ordinated response from the various departments that has been put in place works well - I have had occasion to use it twice recently.
On board medical kit and defib machine are well up to spec and constantly reviewed with the medical profession. BA indemnifies those doctors who come forward and offers in flight support through " Medlink" an Aeromedicine organisation based in PHX. In fact I fly with their number predialled up in the cockpit Satphone.
If all that fails we have no problem diverting - we even have special procedures for unplanned arrivals at non-gateway US airfields.
I wouldn't be too harsh on Airtours, at least they had something for the Doc to work with.
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Why not make every airline carry indemnity forms which a patient must sign before the doctor gives treatment. That way, the patient agrees not to sue at a later date, if he/she decides that they didn't like the service. After all, if there is no legal reason why a doctor has to treat someone, only a moral one, I wouldn't blame a doctor if they didn't identify themselves on the flight.
Personally, if I really needed a doctor, and one was found, I'd be so grateful I'd sign almost anything just to get treated.
Personally, if I really needed a doctor, and one was found, I'd be so grateful I'd sign almost anything just to get treated.
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Just to put the record straight, I fly for Airtours, and whilst I can't comment on that particular flight/incident, I can say that whilst we don't carry KY jelly! (should have asked one of the stewards), we do carry over £3000 worth of other medical eqiupment/drugs in the doctors kit, in fact it is the same kit used by just about every other airline including BA. It has drips, hyperdermics, sedatives, adrenalin and god knows what else, plus there is a defib on board. So would the learned doctor please remember that they are not in a general hospital operating theatre, but 6 miles above the Atlantic.
Also the indemnity form that was signed, was to indemnify the doctor, not the company!!!!!!! Airtours also use Medilink in Arizona via a phone patch and having used it recently, I would say it is absolutly brilliant, they make the medical descisions whether or not a Doc is on board, and they provide the indemnity even if they talk a crew member through giving an injection!
A standard form is filled in with the doctors details etc so it can be varified if they are actually a medical professional or not.
I hope that clears up that one!
Also the indemnity form that was signed, was to indemnify the doctor, not the company!!!!!!! Airtours also use Medilink in Arizona via a phone patch and having used it recently, I would say it is absolutly brilliant, they make the medical descisions whether or not a Doc is on board, and they provide the indemnity even if they talk a crew member through giving an injection!
A standard form is filled in with the doctors details etc so it can be varified if they are actually a medical professional or not.
I hope that clears up that one!
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Oblaaspop,
If, as you say, the Doctor is legally protected then i guess my earlier post is
absolute non-sense, and i stand corrected.
As for the lack of some items (the lubricant, the gloves and the other jelly),
the Doctor did make the best of what was available, and it is a matter of
logistics, easily solved if judged necessary.
You do have to agree that a catheterisation without lubricant sounds quite painfull.
I guess the exact condition of a "self-lubricating-catheter" is not one of the things
usually checked before each flight (it surelly would not cross my mind).
Thanks for settling the issue .
If, as you say, the Doctor is legally protected then i guess my earlier post is
absolute non-sense, and i stand corrected.
As for the lack of some items (the lubricant, the gloves and the other jelly),
the Doctor did make the best of what was available, and it is a matter of
logistics, easily solved if judged necessary.
You do have to agree that a catheterisation without lubricant sounds quite painfull.
I guess the exact condition of a "self-lubricating-catheter" is not one of the things
usually checked before each flight (it surelly would not cross my mind).
Thanks for settling the issue .
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ETOPS,
Satphone perhaps, but isn't your employer one of the ones to cease ACARS use as a cost-cutting measure after 110901? A great leap forwards.....
Returning to the main thrust of the argument, as the aircraft commander, I must say that in the majority of cases, the presence of a doctor on board who presumes to treat a sick passenger only increases the exposure to risk. Better, perhaps, to divert straight away that the cabin crew say the passenger needs serious attention, rather than involving individuals who may or may not be who and what they say they are and may or may not expose the commander, crew, and airline, to risk of claims.
The decision to divert in these circumstances is a very difficult one, not least on account of the paucity of accurate information available.
Satphone perhaps, but isn't your employer one of the ones to cease ACARS use as a cost-cutting measure after 110901? A great leap forwards.....
Returning to the main thrust of the argument, as the aircraft commander, I must say that in the majority of cases, the presence of a doctor on board who presumes to treat a sick passenger only increases the exposure to risk. Better, perhaps, to divert straight away that the cabin crew say the passenger needs serious attention, rather than involving individuals who may or may not be who and what they say they are and may or may not expose the commander, crew, and airline, to risk of claims.
The decision to divert in these circumstances is a very difficult one, not least on account of the paucity of accurate information available.
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Well if Airtours use the same medical kit as BA then the catheters are sealed, self-lubricating types and if they don't work as advertised then take it up with the manufacturer! I only remember this because of the initial safety training (courtesy of the cabin services dept.) where they asked 'Why are the male catheters longer than the female catheters?'.'Because they deserve it!'.