Should airlines pay for services they request a medical professional to perform?

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Trauma literature is moving against crystalloids (I don't think they have been pro-colloids for years) - the old adage of 2 large bore cannulas giving rapid doses of normal saline is going out the window, thanks to the resultant coagulopathy and other secondary insults. The evidence is favouring blood (especially fresh whole blood, although most of us don't have access to that) and a degree of permissive hypotension. That said, ATLS hasn't been updated yet, so if you are sitting the exams for ATLS go with the old school, just appreciate that the literature base has moved on...

Getting back on topic, I think attempting a transfusion on a plane may be difficult and should not be recommended!
 
Trauma literature is moving against crystalloids (I don't think they have been pro-colloids for years) - the old adage of 2 large bore cannulas giving rapid doses of normal saline is going out the window, thanks to the resultant coagulopathy and other secondary insults. The evidence is favouring blood (especially fresh whole blood, although most of us don't have access to that) and a degree of permissive hypotension. That said, ATLS hasn't been updated yet, so if you are sitting the exams for ATLS go with the old school, just appreciate that the literature base has moved on...

Getting back on topic, I think attempting a transfusion on a plane may be difficult and should not be recommended!

On that we can all agree!

Speaking of trauma resuscitation fluid choice, I heard a fascinating lecture by one of the anaesthetists at the mobile trauma hospital in Tarin Kowt. He said they use deep frozen red cells, all O-, and just thaw and pour into everyone who comes through the door shocked.

I have no doubt that will be shown to be superior to the normal 2L NS followed by balanced transfusion.

And drmikki - thanks for the great advice on creating the flapvalve with the latex gloves. I'm going to give that a go next time in ED (rather than trying to work it out at 40,000 feet!)
 
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Oooh, that was going to be my next question, if anyone knows what is in the medical kits both drugs and equipment wise?

Its not the bore but the length of the cannula in the case of pneumothorax; studies in "Injury" (from memory) showed that most standard cannulae failed to reach the chest cavity in about 50% of people. In volume resuscitation, you want a large bore cannula but short length to increase flow rate (although the literature is starting to move against high volume rapid resus with crystalloids, at least in trauma).

Wow, this sounds like a whole lot of work for a Sunday... time to go do something else I think! Thanks for the interesting and wideranging opinions from medical legal and other backgrounds - yet another reason I love this forum!

And the other consideration would be the rigidity of the cannula. It's in danger of collapsing along the route from the skin to the pleura, not to mention getting blocked.
 
Trauma literature is moving against crystalloids (I don't think they have been pro-colloids for years) - the old adage of 2 large bore cannulas giving rapid doses of normal saline is going out the window, thanks to the resultant coagulopathy and other secondary insults. The evidence is favouring blood (especially fresh whole blood, although most of us don't have access to that) and a degree of permissive hypotension. That said, ATLS hasn't been updated yet, so if you are sitting the exams for ATLS go with the old school, just appreciate that the literature base has moved on...

Getting back on topic, I think attempting a transfusion on a plane may be difficult and should not be recommended!

The 8th Edition of the ATLS manual (2008) does discuss the role of minimal volume resuscitation in penetrating trauma and it always comes up at every course I have instructed on.
I cannot see it's advantage on an aircraft in a shocked patient from any cause likely to be encountered at 37000 feet.
 
Just a thought re: potential liability if one were to receive payment for a service they render on a plane assisting another unwell pax.

I agree if one were to receive monetary reward in exchange for attending to a pax, it could lead to potential legal liability which may not be covered by the Good Samaritan legislations.

Is compensation acceptable then?

Clearly different from a remuneration, because compensation, according to my own interpretation of course, is replacement for a loss. If i paid to travel in J, but spent half the time attending to a patient somewhere in the plane, would it not be reasonable for the airline to offer another set of J flights for furture use? i.e. replace what was lost with something identical? Surely this cannot be considered remuneration hence subject the practitioner to legal liability?

Surely a return ticket for future use in the class of travel of the attending doctor would be cheaper than for them to have to detour and land somewhere to offload?

Of course there is then the issue of what constitues reasonable time spent attending in order to justify any compensation. 5% of travel time? 10% of travel time? 50%?
 
Just a thought re: potential liability if one were to receive payment for a service they render on a plane assisting another unwell pax.

I agree if one were to receive monetary reward in exchange for attending to a pax, it could lead to potential legal liability which may not be covered by the Good Samaritan legislations.

Is compensation acceptable then?
Compensation in any form would be considered ex post gratia.

As covered earlier, if the receipt of or disbursement of same was codified in any form by the carrier, this could be seen to create expectation, and encourage those unqualified or not in sound mental/physical state to assist where they shouldn't.

It would essentially create a liability disaster, hence why it should only be an impromptu offering by the carrier thus allowing as much protection under various GSP legislation to remain in force.
 
Compensation in any form would be considered ex post gratia.

I think your mixing up your Latin there, you probably mean ex post facto - after the fact. Something that will happened after the service is provided.
Whereas ex gratia is done or given as a favour and not under any compulsion. So an ex gratia payment (of any kind) would indeed be what is needed to address the liability issues you mentioned.
 
Hmm...

So one is expected to give up something one paid for because the carrier requested one's services. At no cost to the carrier. Or the unwell pax. Imaging if one paid, for example, $6k on a J return to US, and spends half the time attending to an unwell pax somewhere else.

Sounds mighty unfair to me to be honest.

And one is not expected to get compensated for what was lost. I am going on the asusmption that compensation does not necessarily mean one is better off in the end, because one had originally lost what one had paid for due to no fault of theirs.

Lets turn things around. If the healthcare professional gets a needlestick injury from an unwell pax who has HIV, or some commhnicable disease, who's liable? Or are you on your own?
 
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I think your mixing up your Latin there, you probably mean ex post facto - after the fact. Something that will happened after the service is provided.
Yep, mixing my latin. That's what I get for reading AFF late at night after a whole day writing brain sapping project plans.
 
Yep, mixing my latin. That's what I get for reading AFF late at night after a whole day writing brain sapping project plans.

Actually I'm sure it would make sense in conversational Latin* just that they are more used these days as phrases with specific meanings.

*My sister in law can do this. it can be fun but best via SMS as I need to use google.
 
What a fascinating topic. I often wondered what the policy (if any) for compensation was for Australian carriers. Now that I work for an Insurance Brokers (in HR, definitely not one of them!) I see the issue being more complex.

But of course, I have my own experience...

A few years back, I was flying a domestic flight on a European carrier on the continent. I suffered from a medical 'emergency' and an on-board Doctor attended to me for almost the entire 3 hour flight. He moved to the seat next to me (he was originally in J) too.

A week later, I asked the airline formally (my roommates worked at the airline so I spoke with a senior rep) what compensation the Doctor had received. They advised me that it was not 'their' policy to offer any, and as a medical practitioner, it was his responsibility to serve. Well that's right bollocks if you ask me. When I am on annual leave, I am not going to run a mediation session, write a policy or fire someone (except perhaps that particular airline rep). It was also their policy to not provide me with the Doctor's details. I respect his privacy, but also believe in sending a thank you and recognising someone's efforts.

To cut a long story short (a shocker for me - hopefully you will get used to my long posts!), I managed to convince the gentleman to provide me with the Doctor's details; thankfully he too lived in Madrid. As well as a nice bottle of Australian (of course) red, I paid the Doctor for his J fare. He sent me the cheque back. I sent him a credit with the airline - which he graciously accepted on the provision that I allow he and his wife to take me to dinner (I think we were both out to out-impress the other). That was a nice way to end it - though I feel I made him lose more of his personal time, though we all honestly enjoyed the evening.

He told me that he too had a high strike rate on flights, and that I was the first pax that had sought to thank him. I think though, they probably didn't get the opportunity to from the airline. Moral of the story - I suggested to the airline that they send a formal thank you note at the very least. I also told Doc to leave a business card in the pockets of those patients who are still alive and kicking after the flight. The point made about Doctor's being human too is important. This kind samaritan had a wife who for the duration of the flight wondered what her husband was doing... Doctor's are like every other passenger on board and should have no special expectations upon them - and if they do step up, recognition is essential. At the very least it is good PR for the airline to a demographic that have the facility to travel more than say a Retail Assistant, and more likely than not in J, or at least not a web-deal once a year. Karma people, it goes around :)
 
The timing of this thread could not be any better...

Radio National: The Health Report - "Is there a doctor on the plane?"

"A consumer's guide to medical kits on long haul flights. What's available if a passenger becomes seriously ill during a long commercial flight?"

Monday 28/3/2011 0830HR (Tomorrow AM!!)

Is there a doctor on the plane? - Health Report - 28 March 2011
 
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