Medical Emergencies On Airplanes: Should Doctors “Heed The Call”?

In a recent episode of Larry David’s hilarious HBO series,  Curb Your Enthusiasm, (“Accidental Text on Purpose”), Larry, (after giving up his aisle seat to a woman with a supposedly overactive bladder) finds himself sitting next to Dr. Nathan Winocour. When a call for medical assistance for a stricken airplane passenger is issued, Larry is perturbed that the doctor fails to “heed the call.”

Winocour justifies his inaction with two comments:

“Give it a minute. He’s gonna be fine.” and

“Have you ever been part of an emergency landing? Is that what you want, Larry? To spend the night in Lubbock, Texas, at a Days Inn with a $15 voucher from Cinnabon? Think about it.”

He’s correct that the vast majority of medical “emergencies” resolve without any specific intervention.

And if he had attended on a patient with a serious non-transient medical problem he would suddenly find himself having to make an incredibly difficult and life-deciding decision on whether or not to  divert the plane or make an emergency landing with insufficient diagnostic tools and inadequate information.

Dr. Winocour is not alone in this failure to heed the call. Many physicians are conflicted about identifying themselves as a physician in medical emergencies-on planes or elsewhere.

Last year, a British physician was described in an article as having assisted in 3 medical emergencies while on American Airlines flights in the previous year. This man is so eager to assist in in-flight emergencies that he “pre-identifies” himself as a physician as he boards the plane.

I wondered how many physicians enthusiastically pre-identify themselves as ready to heed the call, so I posted a poll in 2017 on the physician social media site, SERMO.

Most Physicians Don’t Want To Assist In Medical Emergencies In Flight

A majority of physicians indicated that they were not interested in assisting in medical emergencies in flight.

Screen Shot 2018-02-01 at 8.14.01 AM

Only 3% would pre-identify (with another 2% agreeing to pre-identify if they were upgraded to first class). Another 19% would not pre-identify but would respond it there was a call for a physician.

Medical Liability Issues

In 1998 Congress passed the Aviation Medical Assistance Act, which tries to protect medical Good Samaritans who heed an airplane call. The act protects physicians, nurses, physician assistants, state-qualified EMTs and paramedics:

“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.”

Despite this apparent protection, many physicians left comments like the one below on SERMO indicating they would not heed the call due to concerns about medical liability:

Yes, I am aware of good samaritan docs trying to come to the rescue but were sued anyway. The standard of care still applies to doctors rendering care, whether they are acting as a good samaritan or not- thus we are held to a much higher standard of care than any bystander would be rendering aid. Good samaritan laws in several states note that doctors remain bound to the physician standard of care whether charging the patient or not. Even if it is a life threatening situation involving a complete stranger, the doctors are held to a higher standard of care that permits the patient or their families to sue you. In Florida, there are no caps on malpractice, therefore you can be held personally liable for all your assets, with the exception of those held in “tenancy in entirety”. Therefore I never identify myself as a doctor when coming on a scene to help anyone outside my office, and never give my name if rendering aid.

Other Factors Limiting Heeding

Other physicians noted the lack of appropriate medical supplies on airplanes and the hassle factor.

I’ve responded several times. The last time was when the plane hit an air pocket and the drink cart came down on a flight attendant’s foot. I needed an Ace bandage. Opened the small kit–lots of stuff but no Ace. Opened the big kit to see the contents list. I could have run a code or taken out a GB–but nothing for a compression dressing. Finally wrapped her foot with her panty hose and put an ice pack on it. Then they insisted I fill out a raft of forms about opening the kits, although nothing had been touched. They had my name and address but didn’t bother to say thanks. I did hear from the flight attendant–her foot was fractured.
Never fill out those damn forms unless they agree to pay you for it. And take your own ace bandage.

One MD expressed concerns that failure to heed the call could lead to legal consequences:

I don’t think the risk is zero (in the US) if no other passenger identifies himself/herself as a physician in the event of a flight emergency. For example, if a passenger dies en route and it was later discovered you were on that flight and that had you intervened you might have saved a life, the family members could come after you.

Hm. Now I have another reason to wear ear plugs and close my eyes when flying; can’t be dinged when I did not hear/see the announcement for a physician.

This urologist’s comments are typical of those who have volunteered, but feel like they didn’t help too much and were inadequately thanked or compensated for their time and effort.

I assisted on a flight from Ireland back to the states. Woman had a vasovagal episode and passed out. Spent about 15 minutes and only thanks I got was asking me for my name and license number “just in case.” It was United Airlines. Will never offer my services again unless someone needs a foley.

Dr. Winocour’s failure to heed the call ended up costing him dearly. When he desperately needed a joke for a speech he was giving,  Larry refused to heed the comedian call.

How do you feel? Should physicians heed the call in the air?

Airobatically Yours,

-ACP

9 thoughts on “Medical Emergencies On Airplanes: Should Doctors “Heed The Call”?”

  1. Some of the airlines have instituted an in-house physician phone consult for in-flight medical emergencies; usually though they hand the phone to whomever has offered to help; works ok for those who are willing to take the consult advice — but not so much for others. As a paramedic responding in-air on occasion and transporting on the ground after some of these instances have occurred (more frequently) I dearly wish that the law would require basic first aid/cpr of flight attendants and then the in-flight consult would be for THEM. It would make far more sense, since asking random medical staff of any sort OTHER than EMS/ED staff to do emergency medicine is more than a little ridiculous, and unless it is a transient not-really-needed issue, it IS emergency medicine. With the supposed “safety first” mantra of the airlines justifying all manner of odd rules, from baggage amounts to bumping passengers of various types, you would think that “just ask for some misc. helpful person and hope they have a clue” would not be at the top of the emergency checklist. If not that most obvious solution, they ought to ask for EMT’s instead anyway — we are used to having no sleep, subsisting on Cinnabons and not being thanked or compensated. We fit the bill lol. Of course many of my colleagues will not “heed the call Samaritan style” either, because of the law suit issue.

    1. Cheryl,
      Great points. I agree with “asking random medical staff of any sort OTHER than EMS/ED staff to do emergency medicine is more than a little ridiculous.” except we should probably include cardiologists and critical care physicians as presumably capable of taking care of most life-threatening emergency situations.
      I do agree that EMTs are a better choice than most random MDs in these situations even if they have been subsisting on Cinnabons. I cannot recall what Dr. Winocour’s specialty was……?

  2. I am a pathologist. I would never render assistance because I don’t feel that I am qualified after 30 years away from clinical medicine, but I would be happy to do an autopsy on the victim later.

  3. I love “Curb” too. Doctors failing to be good Samaritans is a price society is paying for the excessive freedom to sue frivolously in the US.

  4. In my experience, it is the nurses and EMT’s that reliably respond to these events. An in- flight airplane is an austere environment and all trained providers should be adequately protected from lawsuits by statute. If not, we need to change that. They can’t be expected to perform at standards associated with medical offices or emergency departments. That being said, airlines have professional medical consultants on retainer to assist with decisions on emergency landings.

  5. So …. What if the RN or physician or EMT et al has an in flight drink? Oi vey! I never thought of this until now.

    I imagine the “emergent” voluntary caregiver could be sued to kingdom come if the outcome for the victim was less than stellar. That is a scary thought! You’re damned if you don’t and you’re damned if you do! And you’re double damned if your help doesn’t fix things perfectly. And no thank you?!?! Hey, we’re not asking for money people … Just common courtesy for putting our license on the line … It’s not like we’re asking for first class … Or monetary compensation. I think only medical people and lawyers truly get this issue. I assume Joe (or Joanna) public thinks we as medical professionals need to pony up in a heartbeat.

    And yep, flight attendants should have provider CPR and first aid at the very least!

    As a nurse I would probably step up if I needed to and there wasn’t another medical professional already handling the situation. I guess I’d bite the bullet, take it for a ride and do the best I could to help. I wonder what the stats are on medical professionals actually getting sued? I don’t carry private professional liability insurance.

    This was a thought provoking post. I googled but can’t find what Dr. Nathan Winocour’s specialty is.

    1. My thoughts: 1. Anyone can be sued for anything at any time. Winning is another story. 2. In-flight interventions most likely involve BLS skills, not advanced E.D. skills. I’d rather bet my life on a seasoned EMT/paramedic who provides those skills regularly than one of the flight crew who likely is not experienced in assessments and BLS.

  6. I am a nurse practitioner in the inpatient setting so am used to dealing with acute issues (in adults mind you). I would feel really bad not offering to help if I were on a plane and they called for someone with medical training–I think a lot of us feel a certain moral duty that way. That said, I think there should be immunity from liability for people who respond in those situations–that would make people more comfortable helping and account for the fact that one doesn’t have the same equipment and resources as they would in the hospital/office.

  7. Fascinating. I never thought that some physicians would choose to withhold the fact that they are physicians. Thanks for sharing.

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