Flying Safe - Medics Onboard Qantas

[coolkid101]

In the case of qantas with significant on ground medical background, probably worth mentioned that Ahpra details are available online. They know the pax info, probably not a stretch to think they don't need proof from the doctor because they've already checked.

i've never actually booked my tickets under "dr". always just "mr" and "mrs" for the partner who's a medico as well. we've helped on 2 flights now (small cases) and both times never asked for any identification or proof. we volunteered our help, did our thing and the FA's didn't question a thing.

last time we helped on a qantas domestic we got a cheap bottle of wine and 2 lounge passes.

 

[artemis]

I've helped on a flight which I requested be turned back to CHC. This was post-earthquake and I was not happy to be going back! I was told by the CSM who had was on my flight there the day before that if we had to go back I would have to speak to the Captain. I felt that we did need to return . The guy was very sick and we hadn't even levelled out yet. I didn't want to have to sit with a freshly deceased body across the ditch. I was trying to manage an airway and do some basic obs with the silly plastic stethoscope they gave me (the type that I can barely hear anything through on the ground, let alone in an aircraft).

Anyway, next thing I heard was the announcement we were returning to CHC. We landed overweight, had an inspection, I got the patient off the aircraft. I got a lot of death stares from passengers too. There was a big aftershock (5.7) as we were being inspected, and the Captain's wife told him to come home or else. So we very nearly spent another night in CHC, except there was an off duty pilot flying, so up he went to the flight deck and flew us home in his board shorts. I kid you not. I was so grateful - after being in the earthquake and having to go back to retrieve luggage, I did not want to spend another night in CHC. Everyone missed their connecting flights and it must have been a huge financial imposition to the airline.

The CSM then offered me some extra bottles of wine. I never heard what happened to this guy. But my advice is: if you're 80 and feeling unwell, don't board an aircraft.


My only other story was boarding EK DXB-GLA last year where the CSM actually asked me as I was settling in what sort of doctor I was. I explained my surgical specialty and he asked whether it would be ok if he could call on me in event of an emergency. He told me there were a number of other doctors on the plane, but he liked to know who he could ask in advance.

I've certainly had CSMs/FAs ask me what sort of doctor I am, but never follow through with the question "would you be willing to help?"...so thought that was an interesting approach from EK.

 

[coolkid101]

pray tell, what sort of doctor are you

I've helped on a flight which I requested be turned back to CHC. This was post-earthquake and I was not happy to be going back! I was told by the CSM who had was on my flight there the day before that if we had to go back I would have to speak to the Captain. I felt that we did need to return . The guy was very sick and we hadn't even levelled out yet. I didn't want to have to sit with a freshly deceased body across the ditch. I was trying to manage an airway and do some basic obs with the silly plastic stethoscope they gave me (the type that I can barely hear anything through on the ground, let alone in an aircraft).

Anyway, next thing I heard was the announcement we were returning to CHC. We landed overweight, had an inspection, I got the patient off the aircraft. I got a lot of death stares from passengers too. There was a big aftershock (5.7) as we were being inspected, and the Captain's wife told him to come home or else. So we very nearly spent another night in CHC, except there was an off duty pilot flying, so up he went to the flight deck and flew us home in his board shorts. I kid you not. I was so grateful - after being in the earthquake and having to go back to retrieve luggage, I did not want to spend another night in CHC. Everyone missed their connecting flights and it must have been a huge financial imposition to the airline.

The CSM then offered me some extra bottles of wine. I never heard what happened to this guy. But my advice is: if you're 80 and feeling unwell, don't board an aircraft.


My only other story was boarding EK DXB-GLA last year where the CSM actually asked me as I was settling in what sort of doctor I was. I explained my surgical specialty and he asked whether it would be ok if he could call on me in event of an emergency. He told me there were a number of other doctors on the plane, but he liked to know who he could ask in advance.

I've certainly had CSMs/FAs ask me what sort of doctor I am, but never follow through with the question "would you be willing to help?"...so thought that was an interesting approach from EK.

 

[PaulST]

I've helped on a flight which I requested be turned back to CHC. This was post-earthquake and I was not happy to be going back! I was told by the CSM who had was on my flight there the day before that if we had to go back I would have to speak to the Captain. I felt that we did need to return . The guy was very sick and we hadn't even levelled out yet. I didn't want to have to sit with a freshly deceased body across the ditch. I was trying to manage an airway and do some basic obs with the silly plastic stethoscope they gave me (the type that I can barely hear anything through on the ground, let alone in an aircraft).

Anyway, next thing I heard was the announcement we were returning to CHC. We landed overweight, had an inspection, I got the patient off the aircraft. I got a lot of death stares from passengers too. There was a big aftershock (5.7) as we were being inspected, and the Captain's wife told him to come home or else. So we very nearly spent another night in CHC, except there was an off duty pilot flying, so up he went to the flight deck and flew us home in his board shorts. I kid you not. I was so grateful - after being in the earthquake and having to go back to retrieve luggage, I did not want to spend another night in CHC. Everyone missed their connecting flights and it must have been a huge financial imposition to the airline.

The CSM then offered me some extra bottles of wine. I never heard what happened to this guy. But my advice is: if you're 80 and feeling unwell, don't board an aircraft.


My only other story was boarding EK DXB-GLA last year where the CSM actually asked me as I was settling in what sort of doctor I was. I explained my surgical specialty and he asked whether it would be ok if he could call on me in event of an emergency. He told me there were a number of other doctors on the plane, but he liked to know who he could ask in advance.

I've certainly had CSMs/FAs ask me what sort of doctor I am, but never follow through with the question "would you be willing to help?"...so thought that was an interesting approach from EK.

A surgeon managing an airway? No wonder you were keen to land! haha

 

[ozkid]

A surgeon managing an airway? No wonder you were keen to land! haha

Touche. One of the most important things to learn is what you don't know. Far and away more safe than someone who thinks they know.

 

[coolkid101]

A surgeon managing an airway? No wonder you were keen to land! haha

just a guedel airway and bag and mask till the medics get there? lol

 

[ozkid]

Which would be zero, unless for some inexplicable reason you decided not to take reasonable care with what you were doing (and "reasonable" would be judged according to the circumstances of trying to provide medical assistance on a flight).

Honestly, some of the ludicrous comments in this thread about "liability" are beyond hilarious. (Not you PF).

A somewhat uneducated remark.
In the US, Canada, and UK there is no obligation to render help if there is no previous patient-doctor relationship
In Aust and Europe, there is an obligation to help even if a previous relationship did not exist
Lufthansa was successfully sued >2million for following the on board doctor's advice of not diverting, when the passenger ultimately suffered a life threatening heart attack

There are naunces with medico-legal law across different countries. Assuming that you will always be seen as the knight in shining armour can bring you unstuck. Coming forward to volunteer your services whilst under the influence is definitely not on, in any country. This question is asked as an ethics question in every job interview for a doctor, and the medico-legal environment is such that the answer is now black and white.

For those interested, some background info that might clear up some questions raised in this thread

Passenger doctors in civil airliners--obligations, duties and standards of care. - PubMed - NCBI
"Passenger doctor in civil airliners — Obligations, duties and standards of care"

 

[ozkid]

To balance the discussion, a more positive write up in an Australasian journal

Commercial aviation in-flight emergencies and the physician. - PubMed - NCBI

 

[vetrade]

Can I book a ringside seat? No punching below the belt now kiddies!

 

[coolkid101]

not quite related but reminds me of this
Doctor refused to help fall victim outside surgery because he 'wasn
not sure what happened to the doctor in the end but think he escaped any punishment? legally he was free of blame, though morally and ethically you would question his action.

A somewhat uneducated remark.
In the US, Canada, and UK there is no obligation to render help if there is no previous patient-doctor relationship
In Aust and Europe, there is an obligation to help even if a previous relationship did not exist
Lufthansa was successfully sued >2million for following the on board doctor's advice of not diverting, when the passenger ultimately suffered a life threatening heart attack

There are naunces with medico-legal law across different countries. Assuming that you will always be seen as the knight in shining armour can bring you unstuck. Coming forward to volunteer your services whilst under the influence is definitely not on, in any country. This question is asked as an ethics question in every job interview for a doctor, and the medico-legal environment is such that the answer is now black and white.

For those interested, some background info that might clear up some questions raised in this thread

Passenger doctors in civil airliners--obligations, duties and standards of care. - PubMed - NCBI
"Passenger doctor in civil airliners — Obligations, duties and standards of care"

 

[medhead]

Hopefully there are no additional fees. That would be an insult! Registrants should question how their fees are being used. My personal opinion, I'm yet to be convinced that AHPRA has been/is an efficient administration entity for registrants. They have been woefully resourced since the introduction of the Act in 2009. 7 years is more than adequate to refine processes, policies and procedures. All Commissioners and Ombudsman's in Australia and NZ are watching qld with interest. I won't bang on because well OT now.

Significant extra fees, maybe upto 3 times the existing "registration" fee, so 4 times the previous cost. But no ticket, no work. Wonderful experience to comment on their draft documents.

i've never actually booked my tickets under "dr". always just "mr" and "mrs" for the partner who's a medico as well. we've helped on 2 flights now (small cases) and both times never asked for any identification or proof. we volunteered our help, did our thing and the FA's didn't question a thing.

last time we helped on a qantas domestic we got a cheap bottle of wine and 2 lounge passes.

As per my subsequent post, the on the ground medical support people know you're name, they know you've volunteered as a Dr to help and they can search the online records. That is all entirely independent of any box that you tick. As I wrote, they don't need to ask for proof because they have probably checked already (that already being before the plane lands and you go on your merry way)

A somewhat uneducated remark.

Oh the irony. If only you knew the person making that remark, then you'd understand why this applies to your remark.

In the US, Canada, and UK there is no obligation to render help if there is no previous patient-doctor relationship
In Aust and Europe, there is an obligation to help even if a previous relationship did not exist
Lufthansa was successfully sued >2million for following the on board doctor's advice of not diverting, when the passenger ultimately suffered a life threatening heart attack

There are naunces with medico-legal law across different countries. Assuming that you will always be seen as the knight in shining armour can bring you unstuck. Coming forward to volunteer your services whilst under the influence is definitely not on, in any country. This question is asked as an ethics question in every job interview for a doctor, and the medico-legal environment is such that the answer is now black and white.

In case you've missed it this thread is about medical support available to Qantas flights. I don't see any suggestion of being seen as a knight in shining armour in the post you've attacked. There is no apparent relevance in an airline being sued wrt the question of liability of the doctor as per the post you attacked. The airline got sued, not the doctor.

 

[Anna]

A somewhat uneducated remark.

I agree with your remark about giving treatment after consuming alcohol.

But I'll hazard a guess that I am somewhat more educated than you in the question of how all these other countries that you mention in terrorem would, in practical terms, get jurisdiction over an Aust medic in order for any legal action to be successfully brought against him/her.

Don't go outside today, you might get hit by a meteor. There was one landed in Russia recently. I saw it on the internet. So we must all stay under cover at all times, to be safe.

 

[Anna]

It is instructive to consider the facts of the Lufthansa case that you mention, and to ponder whether that doctor's determination was reasonable that the passenger in that case was not having a heart attack.

From Krys v Lufthansa 119 F.3d 1515 11th Circuit 1997 - Mr. Krys testified that he went to the lavatory "about an hour and a half" into the flight because his stomach was upset and he felt nauseous and that he returned to the lavatory thirty minutes later because he was feeling nauseous and dizzy. There, he began to feel a "crashing, excruciating pain in [his] chest."[SUP] [/SUP]Krys also testified that he noticed his clothes were wet from perspiration. Josie Curry, a fellow passenger sitting in the row with Mr. Krys, testified that she observed him making these two trips and noticed that he was perspiring. Jan Holloway, another passenger, testified that she noticed the plaintiff returning from the lavatory:The first thing I really noticed was just glancing up and seeing someone coming back from like the restroom area, the galley area, just looking like he was airsick, you know, just that flushed kind of white pasty look you-hope-you-never-get-it type.... [K]ind of washed out is what I really meant, just where you just are gray and you just don't feel good.

Holloway also noticed that Krys was perspiring.

After returning from the lavatory, Mr. Krys contacted the flight attendant, who made an announcement asking any doctors on board to identify themselves to the crew. Dr. Fischmann responded to the call. In the estimation of both Josie Curry and Jan Holloway, the flight attendant was contacted between an hour and an hour and a half into the flight; by Krys's calculation, this happened approximately two hours into the flight. Krys, Curry, and Fischmann all testified that Krys told the doctor at this time that he was suffering chest pains. Krys's testimony reflects that he told Dr. Fischmann that he had pain in his chest radiating into his arms, pain in his jaw, difficulty breathing, dizziness, nausea, and sweating. Josie Curry described the plaintiff's state this way:

He appeared to have difficulty breathing. He started to get pale. He appeared to be very uncomfortable, you know, with the movement within his seat. Made me notice that he was very uncomfortable. It was like this man is miserable.

Jan Holloway echoed this description: "The man just was, I don't want to say in agony, but he was uncomfortable, couldn't sit still, couldn't stand, couldn't--just whatever position he tried to get into to get comfortable, it didn't last long."

In treating Krys, Dr. Fischmann administered two separate doses of nitroglycerin.[SUP] [/SUP]Curry testified that after the nitroglycerin was administered, "it didn't appear [Krys] was getting better...." Even after the second administration of nitroglycerin, according to Josie Curry, "He seemed miserable. He was pale-colored.... He looked ... about the same as he did before...."

I do not have any medical expertise but perhaps the medics here can comment upon whether that doctor's actions were reasonable (remembering that the doctor was not the defendant - Lufthansa was). I'm not a doctor but those symptoms sure sound like a possible heart attack to me. Which takes me to my original view that doctors who act reasonably needn't fear the L word ("liability").

 

[ozkid]

But I'll hazard a guess that I am somewhat more educated than you in the question of how all these other countries that you mention in terrorem would, in practical terms, get jurisdiction over an Aust medic in order for any legal action to be successfully brought against him/her.

Don't go outside today, you might get hit by a meteor. There was one landed in Russia recently. I saw it on the internet. So we must all stay under cover at all times, to be safe.

I'll accept your assertion at face value and move on. No point being sarcastic though.
I provided some references to balance an adult conversation. If you have any links for your own I'd be happy to read them and make up my own mind

cheers

thanks for above background on LH case

 

[ozkid]

In case you've missed it this thread is about medical support available to Qantas flights.

And I think the conversation had moved on from QF flights.

As I mentioned there is no problem in QF. Good Samaritan legislation will protect you, if you were asked by cabin crew for assistance, and that assistance was given in good faith and at the best of your ability. No one should feel uncomfortable in this situation.

The point I am making is that other countries have different views on this. You cannot generalise from QF.

There are enough scholarly articles in print concerning this situation, due to the relative frequency of in-flight episodes and the likelihood that a suitably trained medico/nurse/paramedic will also be on the flight. All cite the legal ambiguity and acknowledge that there are steps that you should take to protect yourself from risk.

 

[artemis]

pray tell, what sort of doctor are you

I'm a surgeon.

A surgeon managing an airway? No wonder you were keen to land! haha

I actually do practice my airway maintenance skills regularly with my anaesthetist. And I am trained in surgical airway management. Despite the adage that there is nothing that can't be fixed with a cut, the thing I really should practice more is putting in drips...! (I think femoral access cutdowns at 30,000ft would not be a good look.)


I should add - that if there was a doctor more suited to the emergency at hand, I'd always be happy to hand over care and return to my comfy J seat and champagne. Unless they needed another pair of hands. And I'd also be happy to take advice from ground medical staff, but it's my impression that people who work for medilink and the like, are generalists who may have little-to-no emergency/trauma training. Judging by the people I know who do this sort of work...

 

[RooFlyer]

Can I book a ringside seat? No punching below the belt now kiddies!

After the call "Is there a doctor on board" (for my benefit), can I request one be made "Is there a lawyer on board, specialising in trans-national law in respect of what's going to happen next" ?

 

[artemis]

After the call "Is there a doctor on board", for my benefit, can I request one be made "Is there a lawyer on board, specialising in trans-national law in respect of what's going to happen next" ?

Actually the discussion on this topic probably reflects the culture of the professions. The doctors blithely go to assist thinking "if I do my best, it will be ok" and the non-doctors are somewhat more sceptical.

On another aside - I've had a number of patients who have requested treatment for a problem that could be managed conservatively because they want to travel. (The issue they see me for would ground a pilot until it's treated but can be managed conservatively for the general population). It's not the holiday that is the issue, but the 24 hr flight to Europe that is the issue. And the possible countries to which they would be diverted and treated if there was an issue raises concerns and therefore they have to be treated before they leave!


So I do try and reduce the likelihood that my patients will require inflight care!

 

[ozkid]

Actually the discussion on this topic probably reflects the culture of the professions. The doctors blithely go to assist thinking "if I do my best, it will be ok" and the non-doctors are somewhat more sceptical.

I'm a medico and unfortunately I have learnt to temper my training/natural inclination with pragmatism whenever I am out of my normal working environment. Sometimes it is not strictly the law that applies.

I recount a story from an American surgeon (obstetrician) who, after rendering assistance, reached his middle east destination. His passport was confiscated at immigration, led into an interrogation area, refused contact with the outside world, and curiously could not find an English speaking person to communicate with. After several uncomfortable hours, the penny dropped when he was asked about his medical credentials. It appeared the person he treated is a relative of a connected family. He was then released, finished his conference, and left the country vowing never to return. When describing the clinical management, I can't see where any problem was - we assume it was either personality clash, social mores broken unknowingly, who knows (admittedly the story is only from his perspective).

No laws broken. No charges laid. No official case law or medical write up, just anedoctal.

 

[ozkid]

Here is an interesting article

http://www.bmj.com/content/317/7160/701.1
"Doctor demands payment for helping airline passenger"

The full article is behind a paywall (or at least you have to sign up to the British Med Journal first), but the abstract is enough to tell the story. Apart from the story itself, if anyone is interested read the commentary. It is dated 1999 but as far as I can tell still relevant to today.