dimanche 29 novembre 2015

Doctor on-board?

Based on what I recall from a lecture in residency:

1) Most important resource is that all airlines contract with telemedicine services that are on call to assist with medical decision making. The crew can patch you through to whatever service the airline is contracted with, you can describe the situation and your findings, and really it's on them to make decisions if you don't feel comfortable or are not sure what needs to be done. In this way, even a physician not used to dealing with emergencies (or even a medical student) can be very helpful because they can describe what is actually going on (i.e.: he is aphasic vs "he is out of it").

2) Medico-legally it's totally not clear which laws apply. Some sources say source country, some say destination, or maybe the stop over (if that's your situation) or the airline's country... Either way, it is probably a reasonable assumption that some sort of "good samaritan" logic applies, and you shouldn't have the medico-legal stuff hold you back from helping. If anything, a number of countries have laws obligating physicians to help in emergencies! Either way, you won't be able to figure it out in the midst of the situation, so just do what seems the most reasonable at the time. Keep in mind that usually "good samaritan" only applies if you do not receive compensation. I am not saying you would ever bill the passenger you assisted for your services, but receiving upgrades from the very grateful airline (even later) may be seen as compensation and likely void your good sam protection.

3) You will have access to oxygen at the very least, as well as the passenger's own medications. You will probably have access to a stethoscope, sphingomanometer, and some basic meds. If you are lucky you may have more advanced equipment (including AED, intubation equipment), but this is not standardized the world over. You will probably have access to other passengers' medications if you ask the crew to make an announcement, but this is likely to be useful in only a few situations (asthma attack, lost inhaler at the airport).

4) Biggest decision is likely to be is should we divert to nearest airport or can the crew continue to planned destination. Bear in mind that sometimes diverting to nearest airport may have a small increased risk that applies to a whole plane full of people and DEFINITELY has a huge cost associated with it. This will often be a moot point except on the longer flights.

5) Let the local EMTs take over once you land.

6) Seats in business/first class often go completely flat, so if your patient is pale, bleeding, syncopyzing, or just looks like crap, tell the airline staff they need to move his to business class seating so he can be flat. They should be able to arrange that. Also ask them for oxygen. It will at the very least make you look professional while you are figuring things out.

7) They will probably ask for your credentials.

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Doctor on-board?

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