I thought it might be cool to put you in my shoes when you hear that announcement on a flight “Is there a Doctor Onboard?”
The first thing you should know is that what we do is voluntary. On a trip back from Cancun Mexico this March break, I was busy resuscitating a holiday maker suffering dehydration from one to many martinis and one of my friends sitting in another row over heard the lady sitting next to her whisper fearfully, “I’m a gynecologist they won’t need my help”. I also sat out an event on the forward trip of my honeymoon when a groggy passenger collapsed in the aisle, was spotted emergency Dr. and immediately attended to by him, followed by another in the aisle ahead. We are not legally obliged to lend a hand and do so out of moral conscience.
To encourage us to put up our hand when called to serve, Good Samaritan laws were created to prevent the legal debacles of the 70′s where victim’s profited from their misfortune by suing their helpers. The good Samaritan laws in essence say that if a health professional volunteers to assist someone, unless they do something obviously stupid or incompetent, they are not liable financially.
So here’s what happens when you hear that announcement over the PA system. Any Doctor, Nurse, Paramedic, or person trained in first aid decides whether to step up or sit back. Many of us will wait a couple seconds to see if someone else more qualified steps up first. If not, we muster our courage and approach one of the cabin crew and say for example “hi I’m Dr. Ramon how can I help”. The flight attendant will then ask to see identification and records our details. We usually carry our credentials on a wallet sized card issued by our medical body. The staff onboard are also trained in first aid as a backup. And they have phone access to medical personnel on the ground.
The first thing I do is eyeball the person / patient and check my gut feeling, ‘is this person sick enough we need to land the plane or is this something that can wait until we reach our destination Airport’. So far, I’ve been lucky enough not to encounter any severe life threatening problems like a heart attack or stroke. The next step is a formal mini exam, assessment, and suggestions. Unfortunately assessment on a plane is very difficult. It’s noisy, making blood pressure hard to hear, it’s cramped and social, making exposure difficult. And there’s very little diagnostic gear or tools to intervene with, for example IV access. And worse, this scenario is not part of a doctor’s training. We have to make up an algorithm based on an abbreviation of what we would normally do in an office.
The first time I’ve helped was on a train in the “Chunnel” between Paris and London. I was very nervous and still a medical student near the end of training. Luckily, there was a seasoned neurologist there as well. But it turns out he was better as moral support as he’d long forgotten basic life support techniques as a specialist while this was still fresh in my mind. Today, I feel I’m an old hand at this, and feel no fear when called on, just fatigue.
Once the patient / person is stable we return to our seat with thanks from the flight staff and the offer of a beverage or wine from the bar. But what prompted me to blog about this is I got a letter in the mail yesterday giving me bonus air miles for helping out a sick child on the flight home from my honeymoon last month. I’ve helped on numerous trips since starting my doctor career. But this is the first time I’ve been monetarily compensated. We as a profession do this from moral conviction. Not for compensation.
On landing at the Airport medical officers then may attend to the person. And typically that is the end of the encounter for us and it quickly slips out of memory. Just another day at the office, kinda.
