Flying Safe - Medics Onboard Qantas

[artemis]

I suspect that regardless of the mode of transport, bonafides should be requested and provided to remove any doubt of credentials. If the episode of care occurred on the ground, then it is highly likely that those details would be requested/required from the practitioner by a police service (within Australia). The same could occur/has occurred on board at the request of cabin crew, or at the end of a journey by the AFP, or a similar agency if travelling internationally.

And I've never been required to prove my credentials if I've been a first responder. I've even rung up the hospital where the patient was transferred to follow up on care and all I've ever had to say is "this is Dr Artemis and I'm the specialist at xyz and I was wondering if..." Maybe we're too trusting.

But I think it's pretty apparent when people know what they are doing in these sort of serious accidents. Thank god for the emergency services - they absolutely know what they are doing and I am so grateful to hand the patient over for extrication etc etc. I think these non-medical types do a brilliant job getting people out of the most terrible messes... Must be so traumatic to do it day in, day out!

 

[puppysparkes]

That is my point. In the situation I've mentioned (Australia doctor, Qantas) it might very well be the case that bonafides have been checked! In this modern age asking the person to see a bit of paper may not be required to check on them. This isn't comparable to something on the ground where the backup system are unlikely to be in place.

On land, having regard to medical practitioners, the legislation applies to the practitioners principle place of practice. I have nil knowledge of what legislation applies while transiting through an airspace/ocean, domestically or otherwise.

 

[puppysparkes]

And I've never been required to prove my credentials if I've been a first responder. I've even rung up the hospital where the patient was transferred to follow up on care and all I've ever had to say is "this is Dr Artemis and I'm the specialist at xyz and I was wondering if..." Maybe we're too trusting.

But I think it's pretty apparent when people know what they are doing in these sort of serious accidents. Thank god for the emergency services - they absolutely know what they are doing and I am so grateful to hand the patient over for extrication etc etc. I think these non-medical types do a brilliant job getting people out of the most terrible messes... Must be so traumatic to do it day in, day out!

Ten million likes

 

[mattm199]

Very interesting thread; and nice to see so many medical colleagues in the neighbourhood!

The discussion of whether Qantas might look for a Dr from the manifest reminded me of a flight last year (CBR-BNE). The booking included my middle initial of "C", and the title DR on the boarding pass.
I found I was greeted on boarding as "Commander", because of the CDR after my name. Lucky no Naval (or medical) emergencies arose during the flight.....

 

[Anna]

My Daughter is a Doctor, and books as such. She have been called on twice to attend people on a QF Plane, one was a panic attack, and the other a Cardiac arrest (Very Serious). She has only once been upgrades to J, and never F. But they are quick to call on her services. After the Cardiac arrest she was upgraded to J, but that is the only time it has happened.

There is a possibility that you may put yourself outside the application of 'good samaritan' legislation if you accept something that looks like payment for services. Grey area.

As to the longrunning 'Qantas asking for ID' concept in this thread, my view is that QF would not be liable for failing to ask for ID if some lunatic falsely answered a call for a doctor and caused some harm through purported treatment. The cause of the harm is the lunatic's actions, not QF's. QF would much more likely be liable if they said 'there is an emergency but we refuse to allow you to look at the pax because you aren't carrying the right ID'.

 

[RooFlyer]

There is a possibility that you may put yourself outside the application of 'good samaritan' legislation if you accept something that looks like payment for services. Grey area.

As to the longrunning 'Qantas asking for ID' concept in this thread, my view is that QF would not be liable for failing to ask for ID if some lunatic falsely answered a call for a doctor and caused some harm through purported treatment. The cause of the harm is the lunatic's actions, not QF's. QF would much more likely be liable if they said 'there is an emergency but we refuse to allow you to look at the pax because you aren't carrying the right ID'.

Playing devil's advocate a bit, just say a call for a 'doctor' went out on an Australian domestic flight, and someone responded, who happened to be a 5th year med student (ie so appeared competent to lay people). They weren't asked by the FAs in any way to confirm that they were, in fact, a doctor. Harm was caused to the patient, easily identifiable in retrospect to what the med student did or didn't do.

Wouldn't there be some liability accruing to the airline for failing to find out, or attempting to find out, the level of qualification of the person allowed to attend the patient / their passenger? The patient's action might mention the fact that, had the airline ascertained that the person attending was only a med student, or couldn't easily ascertain the standing of the person attending, then the ground based medical assistance lot would have taken control and the med student would have been used in an advisory capacity or to administer things? There's a zillion permutations and combinations of what may or may not transpire in such a situation, but hopefully you get my drift.

I'm not keen on the vastly over-used phrase 'duty of care', but wouldn't it have some application in these sorts of cases?

 

[artemis]

There is a possibility that you may put yourself outside the application of 'good samaritan' legislation if you accept something that looks like payment for services. Grey area.

As to the longrunning 'Qantas asking for ID' concept in this thread, my view is that QF would not be liable for failing to ask for ID if some lunatic falsely answered a call for a doctor and caused some harm through purported treatment. The cause of the harm is the lunatic's actions, not QF's. QF would much more likely be liable if they said 'there is an emergency but we refuse to allow you to look at the pax because you aren't carrying the right ID'.

I doubt accepting an upgrade or a bottle of wine constitutes payment for services given that I have to provide informed financial consent to each of my patients for every clinic visit and operation. And the Good Samaritan laws are pretty vigorously defended, because otherwise no one would get out of their comfy flat bed to assist other pax.

Again I think most doctors volunteer to help because it's the right thing to do, and not because they're expecting an upgrade or a bottle of wine.

 

[legroom]

I doubt accepting an upgrade or a bottle of wine constitutes payment for services ....

Again I think most doctors volunteer to help because it's the right thing to do, and not because they're expecting an upgrade or a bottle of wine.

Agree

It's a stretch to label thank-you compliments as 'payment in kind'.

No self respecting medico would seek, expect or demand such 'compliments'.

I doubt if airlines have a written policy of 'compliments'.

Those who entertains such a thought obviously has never gone through medical training / practice where you do thousands of things unprompted / beyond the 'letters of the job description' WITHOUT any thought of compensation (unlike the billings I received from my lawyers).

If you carry the 9 to 5 mentality, you won't last long in the medical professions.

From the NEJM article I quoted earlier, here is another quote which accurately reflects the thinking of the medical professions:

".... 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...."

http://www.nejm.org/doi/full/10.1056/NEJMoa1212052#discussion

The legal obligation to intervene was in reference to a NSW land-based case where the GP was specifically requested to come to the aid of the patient and he refused IIRC.

Whether that principle of NSW law applies when you are out of state / country, did not declare to be a medico, was not in your 'place of employment' would be open to interpretation by the courts IMO.

 

[N860CR]

The ground controllers should (and I believe they do) have final say in diversion of aircraft. I might put my case forward as a strong recommendation, but I wouldn't be the one demanding a flight diversion. I might suggest going lower altitude though, if the situation warrants

Just to be pedantic (and I'm not sure what you mean by ground controllers), the person with the final say in any diversion is the Captain.

 

[Anna]

Playing devil's advocate a bit, just say a call for a 'doctor' went out on an Australian domestic flight, and someone responded, who happened to be a 5th year med student (ie so appeared competent to lay people). They weren't asked by the FAs in any way to confirm that they were, in fact, a doctor. Harm was caused to the patient, easily identifiable in retrospect to what the med student did or didn't do.

Wouldn't there be some liability accruing to the airline for failing to find out, or attempting to find out, the level of qualification of the person allowed to attend the patient / their passenger? The patient's action might mention the fact that, had the airline ascertained that the person attending was only a med student, or couldn't easily ascertain the standing of the person attending, then the ground based medical assistance lot would have taken control and the med student would have been used in an advisory capacity or to administer things? There's a zillion permutations and combinations of what may or may not transpire in such a situation, but hopefully you get my drift.

I'm not keen on the vastly over-used phrase 'duty of care', but wouldn't it have some application in these sorts of cases?

I don't think the airline has breached its duty of care, because its actions weren't the proximate cause of the damage. In legal terms the analysis goes: duty of care - breach of duty - causation - damage. It's only if you have all 4 that you get to liability.

 

[Anna]

I doubt accepting an upgrade or a bottle of wine constitutes payment for services given that I have to provide informed financial consent to each of my patients for every clinic visit and operation. And the Good Samaritan laws are pretty vigorously defended, because otherwise no one would get out of their comfy flat bed to assist other pax.

Again I think most doctors volunteer to help because it's the right thing to do, and not because they're expecting an upgrade or a bottle of wine.

The good samaritan legislation in my state refers to "payment or other consideration", so it's not limited to money.

I'm glad to read your last sentence. The poster that I was responding to appeared to take a different view from yours.

 

[RooFlyer]

I don't think the airline has breached its duty of care, because its actions weren't the proximate cause of the damage. In legal terms the analysis goes: duty of care - breach of duty - causation - damage. It's only if you have all 4 that you get to liability.

I'm very glad to hear that, although it surprises me. Going back to my hypothetical, so you have an airline passenger who suffers some event requiring some form of medical inspection or intervention. I'm now saying he or she went unconscious and that resulted in the call for a doctor. It goes pear shaped an the passenger suffers some bad thing as a result of the med student making a mistake.

The med student is OK as a Good Samaritan. Prima facie, the airline hasn't breached its duty of care. Yet the passenger boards the plane intact, simply faints, but ends up with [some form of injury] as a result of the medical attention they didn't ask for, performed by someone not qualified, instigated by the airline's staff

A case of 'suck it up, princess'?

 

[puppysparkes]

Agree

It's a stretch to label thank-you compliments as 'payment in kind'.

No self respecting medico would seek, expect or demand such 'compliments'.

I doubt if airlines have a written policy of 'compliments'.

Those who entertains such a thought obviously has never gone through medical training / practice where you do thousands of things unprompted / beyond the 'letters of the job description' WITHOUT any thought of compensation (unlike the billings I received from my lawyers).

If you carry the 9 to 5 mentality, you won't last long in the medical professions.

From the NEJM article I quoted earlier, here is another quote which accurately reflects the thinking of the medical professions:

".... 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...."

http://www.nejm.org/doi/full/10.1056/NEJMoa1212052#discussion

The legal obligation to intervene was in reference to a NSW land-based case where the GP was specifically requested to come to the aid of the patient and he refused IIRC.

Whether that principle of NSW law applies when you are out of state / country, did not declare to be a medico, was not in your 'place of employment' would be open to interpretation by the courts IMO.

Regarding your last paragraph, in QLD it comes down to the practitioners principle place of practice, and not physical location where the care was provided. I believe this is also the view of AHPRA under the national law. I'll clarify next week and update the thread accordingly.

 

[Anna]

The med student is OK as a Good Samaritan.

I would say not, as you are not covered by good samaritan legislation if you act recklessly (at least in my state). Jumping up and pretending to be a doctor when you're not would be reckless in my view.

 

[Dalescott]

I don't think my daughter expects an upgrade, she now flies J now anyway. I would have thought that QF or any airline for that matter, would have upgraded as a thank you.

 

[legroom]

I would say not, as you are not covered by good samaritan legislation if you act recklessly (at least in my state). Jumping up and pretending to be a doctor when you're not would be reckless in my view.

Firstly, any pretender is reckless regardless of their qualifications or lack thereof.

Secondly, the best 5th year med student would be hard pressed to deal with any emergency. It would be an exceptional student who can do anything of substance.

Thirdly, Rooflyer's scenario presumed that he put up his hand declaring that he was a med student so there was no attempted fraud there. Whether he could help or whether anyone accepts his offer is another story.

 

[straitman]

The ground controllers should (and I believe they do) have final say in diversion of aircraft. I might put my case forward as a strong recommendation, but I wouldn't be the one demanding a flight diversion. I might suggest going lower altitude though, if the situation warrants

I am also very circumspect about the legal protections one might have in an in-flight situation. The Good Samaritan law is only applicable in an Australian sense, and different countries have their own medico-legal culture that can be quite foreign and counter-intuitive to our own

..and here lies the problem with all of this.

Everyone has a little knowledge about their part of the situation but no one has all of the picture as that's not how we work. jb747 has posted what he knows and it's from a pilots perspective. Others have posted what they know and it's from a medicos or insurance perspective but most/all are not understanding things from the other persons position.

An example is why recommend flying lower? Why not first see if the crew can lower the cabin altitude or have oxygen available. These may achieve the same outcomes and at the same time assist in maintaining a safer and more effective[SUP]1[/SUP] flight path.

[SUP]1 [/SUP]effective as in getting the aircraft to a suitable destination at the earliest possible time.

 

[artemis]

I would say not, as you are not covered by good samaritan legislation if you act recklessly (at least in my state). Jumping up and pretending to be a doctor when you're not would be reckless in my view.

I don't think acting at the level of a 5th year med student is reckless, providing the med student has stated they are med student. I believe the standard of care is based on experience with an intern allowed to make more mistakes than a senior specialist.

The good samaritan legislation in my state refers to "payment or other consideration", so it's not limited to money.

I'm glad to read your last sentence. The poster that I was responding to appeared to take a different view from yours.

I think it's one thing to offer your services with no expectation of upgrade or wine (one can only hope!); deliver services and then accept a gift. It's quite another to demand an upgrade or wine prior to offering service - that is the expectation of payment.

Good luck to the lawyers trying to prove what goes on in a doctor's mind when called to assist. I think you'll find the few bad eggs out there who would rather be paid aren't going to be the first to volunteer.

I have to say the aircraft that I requested turn back to CHC my main motivation was not having to sit next to a recently deceased pax with their sobbing spouse on a 3 hour skip across the ditch. It really would have been unpleasant. I did weigh that up against returning to NZ with all its aftershocks (unpleasant) plus the annoyance of delay to me, and the financial consideration to the airline. I didn't really want to be looking after someone for 3 hours - I'm not an Intensivist and then have them deteriorate. I wanted a decision before we were too far away to divert. (Where does one divert - I didn't think there was anywhere!). That was my motivation. Not the few small bottles of wine the CSM threw at me. (I was already in PE on a Virgin flight).

 

[artemis]

I don't think my daughter expects an upgrade, she now flies J now anyway. I would have thought that QF or any airline for that matter, would have upgraded as a thank you.

I hope QF has filled the J cabin thereby preventing upgrades on that flight, but provides it on the next equivalent flight!

 

[AVC]

Firstly, any pretender is reckless regardless of their qualifications or lack thereof.

Secondly, the best 5th year med student would be hard pressed to deal with any emergency. It would be an exceptional student who can do anything of substance.

At the end of the day, a 5th yr med student may be more use than a "proper" doctor (and I use the term loosely). What if said Dr specialised in looking down a microscope at skin cells (I have a Dr colleague who does just that), and 5th yr med student spent years as an Army medic/St Johnnie/whatever? It's about your skill set more that the letters before of after your name.

..and here lies the problem with all of this.

An example is why recommend flying lower? Why not first see if the crew can lower the cabin altitude or have oxygen available. These may achieve the same outcomes and at the same time assist in maintaining a safer and more effective[SUP]1[/SUP] flight path.

There is always supplemental O2 on board. Any medico who knows (or more accurately remembers) about partial pressures would know that administration of O2 vs altitude is proportional anyway. RFDS or combat agency aircraft don't fly nap of the earth every time a patient has a compromised respiratory system.

edit- I wonder if the onboard kit includes O2 SAT monitor?