In Flight Medical Emergencies: This Doctor Is Now Ready To Heed The Call

In a previous post the skeptical cardiologist wrote about the reluctance  of doctors to “heed the call” , i.e., to respond to an in-flight medical emergency (IME) when the flight crew requests assistance from qualified medical professionals.

Only 20% of physicians in my (very unscientific) poll would respond to such requests.

I pointed out that:

“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.”

but I and other physicians  had concerns beyond medical liability, as I detailed in my post.

Physicians Who Prefer Not To Head The Call

At the time I wrote that piece, to be honest, I was in the camp of physicians who would prefer not to heed the call.

I tended to agree with Dr. Winocour on Larry David’s  Curb Your Enthusiasm who justifies his failure to respond in flight 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.”

Although Winocour was correct that the vast majority of in-flight medical “emergencies” resolve without any specific intervention it is still helpful for a physician to attend on such patients and assess the situation.

And it is true that 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.

But somebody has to make that call and the physician heeding the call will have the assistance of experts in the field on the ground.

Qualified Physicians Should Be Prepared To Heed The Call!

After pondering the issue for a few years and reading an excellent review on the topic in a recent JAMA I have changed my stance and am now completely ready (almost eager)  to heed the call.

Leslie Nielsen as Dr. Rumack in Airplane! He heeded the call.

In fact, I am currently writing this while en route from frigid and
snowy St. Louis to sunny and warm San Diego on a Southwest Airlines flight and I’m considering pre-identifying myself as a physician in case an IME develops. (The only thing stopping me is that it seems a little pretentious and likely unnecessary, perhaps if I just put wear my stethoscope constantly that will be enough.)

I have in my backpack several items that will assist me in handling cardiovascular emergencies should they arise:

  1. AliveCor Mobile ECG-With this and my iPhone I will be able to rapidly ascertain the stricken passengers heart rate and rhythm-crucial information to help diagnosis and proper treatment. (I also have my Apple Watch 4 for the same purpose.)
  2. Qardioarm BP cuff-Rapid, efficient assessment of BP without tubes, or wires.
  3. Stethoscope-a good one with which I can hear heart murmurs and lung sounds. Although the FAA-mandated emergency medical kit on board should have both a BP cuff and a stethoscope , I have no confidence they will be either accurate or functional.
  4. Sublingual nitroglycerin. The kit on the plane should have these  along with 325 mg aspirin tablets, IV atropine, and injectable glucose, epinephrine and lidocaine.
  5. An epinephrine auto-injector. For the stricken passenger who is suffering anaphylaxis from the mixed nuts being served across the aisle.

Should there actually be a cardiac arrest I’m completely up to date on Advanced Cardiac Life Support (ACLS) and CPR training and there should be an AED on board to defibrillate if appropriate.

I’ve also decided that despite my reluctance to bring attention to myself, it is highly likely that I will be the most qualified person to rapidly diagnose and treat any serious cardiovascular condition that arises on my flight.  As a doctor, I believe, I should be striving to provide assistance to those suffering whenever and wherever I can, be that in the air, on the sea, in the hospital or in the office.

Call-heedingly Yours,

-ACP

N.B. One (of many) of the newly-minted wife’s favorite Airplane! lines  comes from the doctor who heeded the call.

  • Rumack : You’d better tell the Captain we’ve got to land as soon as we can. This woman has to be gotten to a hospital.

    Elaine Dickinson : A hospital? What is it?

    Rumack : It’s a big building with patients, but that’s not important right now.

19 thoughts on “In Flight Medical Emergencies: This Doctor Is Now Ready To Heed The Call”

  1. Glad to hear you have changed your mind. Hope your stay in San Diago was warm. We actually had snow in Tucson. The sun is out and this morning and Ian ready for my walk and to take pictures of all the snow up on the Catalina mountains and Mt. Lemon.

  2. It’s good to hear someone who truly is both prepared and ready to respond, and willing to do so. As a paramedic I as well as frequent traveler I have seen aid rendered by medical professionals who were probably quite competent in their own specialty but very lost with even ACLS never mind the broader range of medical emergencies and who frankly did more harm than good. The first necessary piece is to have a solid and realistic assessment of what you have recent training and/or experience in, so that you don’t offer to step beyond it. I won’t tell tales here but let me just say that if you have a team of sorts with experience or a phone consult available—take it! 😎

    1. Even with my cardiology training and recent ACLS certification I tend to defer to paramedics because they deal with these situations on a daily basis and I do not. I would definitely defer to EMT if I were a pathologist or radiologist.

  3. Wow! I missed your first post but I’m horrified by the 20% figure. I’ve been called on a few times all for minor issues but would always respond. Basically, if the patient was one of my my bearer and dearest I would hope they’d benefit from a similar response.

    I once helped a person who’d dislocated their knee (fractured?) playing soccer on a remote sandy beach on the Great Barrier Reef. I was on my honeymoon. Once I’d organised a helicopter retrieval I was joined by three orthopaedic surgeons in a small tin boat (one Australian, two French) who had been following proceedings on their boats radio. They’d enjoyed a bit too much fine Australian wine that afternoon but had thought I was doing okay and so decided to leave me to it. That seemed fair enough.

    I still have great photos of the chopper landing on Whitehaven Beach…

    https://goo.gl/images/pCHPZK

    1. Amazing story. Makes me want to climb in a small tin boat with some French orthopedic surgeons right now!
      It’s interesting that the issue of alcohol consumption came up. I’m now eager and ready to help when on vacation but if I’m drinking alcohol am I still the most qualified person to be leading rescue efforts? Should I pack a device to check my alcohol level before volunteering? Will this invalidate my Good Samaritan protection.?

      1. Yes I agree. It’s an important consideration.
        It’s another good reason not to drink alcohol in flight I suppose.
        I can’t say I always adhere to this but I usually do (not for this reason but because long-haul I find it makes huge difference to how you feel on arrival).

  4. Glad to hear you are willing to try to save someone’s life on a flight and hope if I am ever in medical trouble on a plane, it’s you who’s also there to help and not, say, a podiatrist. Nice you are in San Diego, home of the American Gut Project (americangut.org) in which I am a participant. I found the following relating to the microbiome and heart disease: https://www.sciencedaily.com/releases/2018/04/180423190553.htm and https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.116.024251. I spent about a month in San Diego a number of years ago and still remember one notable thing from the anthropological museum in Balboa Park: that we share about 50% of our dna with bananas. Don’t know if this is true, but it is certainly curious.

    1. The effect of gut motility on composition of microbiome is news to me, but is a logical proposition. Musing on the implications lead to the realisation that opioids decrease gut motility, with possible changes in gut microbiome. It is thought that some food cravings may be influenced by the microbiome, so I wonder if opioid addiction may be influenced by the microbiome. Would be an interesting field of study.

    2. Briefly looked at the American Gut Project. Seems fascinating. Do you have a framed certificate reflecting your gut microbiome on the wall?
      On many days I feel like the banana portion of my genome has taken over!

      1. Gut Microbiome by Microba is not a framed certificate but an extraordinarily comprehensive report, with what foods to eat more of to encourage the good bugs, and what foods to avoid so the bad bugs die. Seems to be helping so just signed up for 3 monthly monitoring. What gets measured gets managed.

  5. Glad you have changed your mind, Dr. Pearson. Although, I hope you don’t ever have to attend to someone in distress on a plane…you deserve some time away from “work” also..but it is reassuring to know you are prepared and eager to help out if needed…Life is precious. If I had an event I would be glad you were on the plane.

  6. Very interesting reading. I’d never given any thought to the issues, and had subconsciously assumed that any doctor around would just step into the breach… It’s clearly a lot more complicated than that.

    Thanks for the article.

  7. I was giving a talk to the year 4 students today about on-call duties. I wanted to get them to not underestimate their skills whilst maintaining modesty and a keen appreciation of their own limits. I used your survey result as a discussion point. Somewhat to my surprise a straw poll of the room (I asked them to imagine they were qualified) looked like about 20% as well!

    It also reminded me of a most extraordinary tale of the professor of orthopaedics at my alma mater. You can read about it here

    https://en.m.wikipedia.org/wiki/Angus_Wallace

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