rootsair
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Medical Emergencies: Should There Be A Doc Onboard?

Thu Mar 10, 2005 4:49 pm

As a med student, this is the opportunity to combine my future job with my greatest passion that aviation represents.

I have heard many a times that medical emergencies occur on board. For example, I heard about this woman a couple of years ago who got a heart(?) problem on a BA flight from LHR-HKG or vice versa and that a surgeon that was on board actually opened her with the knives that were to be used for passengers' meals
1) Can anybody tell me more about that story?

Second of all, it takes time between the moment where the passenger's state becomes an emergency and the time an airplane is cleared for the emergency landing....even worst when its over an ocean.

2)Has anybody ever experienced that type of situation while they were on board and if yes could you explain me how the procedure was?

3) How often does this happen?

4) Do you think its necessary to have a doctor on long haul flights (in case this is more common than we think)?
A man without the knowledge of his past history,culture and origins is like a tree without roots
 
ua777222
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Medical Emergencies: Should There Be A Doc Onboard?

Thu Mar 10, 2005 5:07 pm

1) I have not heard of such a story. Seems to be far fetched seeing how such knives shouldn't be on board an a/c regardless of pre/post 9/11. The day a doctor chooses to open someone with a steak knife is the day I'm asking my parents to change their insurance.

2) On SFO-HKG an elderly man in F had trouble dealing with taking meds at a high alt. and having a bad response to them. The a/c advised HKG of their issue and after we landed we were all instructed to sit to allow the medics arrive and assist the man. After about 30min. the a/c was de-planed and while passing through first the number 1, pilot, and medics were dealing with the passenger and assessing their options with dealing with customs, family, and bags. I thought the airline and the medics handled the situation very well.

3) I would say its hard to get an exact idea. It's not enough to be a common thing at every airport. It's hard to judge how the man in XXX is going to respond to his med's after taking them with a glass of wine. Works well at home but home isn't 39,000. Just hard to tell.

4) It took 4 planes to crash for airlines to put air guards on a/c so I highly doubt we'll see on board medics any time soon. F/a's are trained to deal with emergencies to a degree. SQ, as many know, have "death beds" where dead body's can be stored when on ultra-long-haul flights. I would say that there is no real need for a medic on each and every flight. And putting them on a few isn't going to work b/c you can assess the risk of an in flight emergency..

To sum it up there is no need to have an in-flight doctor hired and paid by the airlines to prevent in-flight deaths. What a f/a can't do in the sky there are people and proceedures on the ground to deal with such events. That's really all airlines can do at this point unless there are advances in medical scanning that can say when, how, or why you are going to have say a heart attack or stroke.

Thanks,

Matt
"It wasn't raining when Noah built the ark."
 
lincoln
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Medical Emergencies: Should There Be A Doc Onboard?

Thu Mar 10, 2005 5:11 pm



Quoting RootsAir (Thread starter):
4) Do you think its necessary to have a doctor on long haul flights (in case this is more common than we think)?

Probably not. I don't think (in the current market) the number of times such a service is needed actually justifies cost of providing a doctor.

Remember, in the old days flight attendants were all registered nurses and that requirement seems to have faded years ago, so it seems that providing a doctor would be an evolutionary step backwards.

Maybe with something huge like the A380 there will be enough pax that you can get the DRCPSM (Doctor Cost Per Seat Mile  Smile) down far enough that it would be viable.

Lincoln
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rootsair
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Medical Emergencies: Should There Be A Doc Onboard?

Thu Mar 10, 2005 7:57 pm



Quoting UA777222 (Reply 1):
1) I have not heard of such a story. Seems to be far fetched seeing how such knives shouldn't be on board an a/c regardless of pre/post 9/11. The day a doctor chooses to open someone with a steak knife is the day I'm asking my parents to change their insurance.

This was before 9/11

Quoting Lincoln (Reply 2):
Remember, in the old days flight attendants were all registered nurses and that requirement seems to have faded years ago, so it seems that providing a doctor would be an evolutionary step backwards.

that's a shame !!!!
A man without the knowledge of his past history,culture and origins is like a tree without roots
 
VHXLR8
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Medical Emergencies: Should There Be A Doc Onboard?

Thu Mar 10, 2005 8:17 pm



Quoting Lincoln (Reply 2):
Remember, in the old days flight attendants were all registered nurses and that requirement seems to have faded years ago, so it seems that providing a doctor would be an evolutionary step backwards.

This is true dude; but one must remember that nowadays, flight attendants must be qualified with a particular level of first aid training (varies from country to country). Combined with the medical equipment onboard these days, it really makes you wonder what's preferable; a registered nurse aboard an aircraft with little to no medical equipment, or a crew of highly first-aid trained flight attendants with modern medical technology at hand
 
cragley
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Medical Emergencies: Should There Be A Doc Onboard?

Thu Mar 10, 2005 8:39 pm

Can you just imagine the legalities of the situation and how the Dr would be exposed to any litigation.

If someone had a heart attack on board and you saved their life, they could turn around and say they were fine and that you physically harmed them.

No airline would expose themselves to legal action.
 
mrniji
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Medical Emergencies: Should There Be A Doc Onboard?

Thu Mar 10, 2005 9:06 pm

4.) Considering, that on virtually every long-hau flight of mine a doc is called (mostly minor things, though), the question you asked is a very good one and needs to be seriously debated. I think having a doc on every flight is too much, rather is the present system of calling a doc sufficient. But maybe it would be worth training the captains on evaluating when to do an emergency landing. another possibility is to require a doc tb on board on flights which are over seas, as transatlantic or transpcific... good question, will think about this and come back later eventually  Wink
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TGV
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Medical Emergencies: Should There Be A Doc Onboard?

Thu Mar 10, 2005 9:25 pm



Quoting RootsAir (Thread starter):
3) How often does this happen?

On my 200+ long-haul flights there have been 5 or 6 flights where the cabin crew asked for a doctor on the PA system.

In all cases more than one doctor was on-board and, when needed, handled the situation using medical supplies that are part of the aircraft equipment (no knives here, on AF at least !). Additionally some members of the cabin crew appeared to be trained in first aid.
Avoid 777 with 3-4-3 config in Y ! They are real sardine cans
 
cragley
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Medical Emergencies: Should There Be A Doc Onboard?

Thu Mar 10, 2005 9:58 pm

From my experience at RES, when Doctors are travelling on leisure, the majority actually called to ask to be listed as a standard passenger (Mr or Mrs) as they did not want to be identified as a Dr in case there was an inflight emergency.

It would show on the flight manifest if there was a Doctor on board and what seat number they were sitting in.

Imagine being on a flight for 12 hours and being woken in the middle of your holiday to perform duties.
 
ZRH
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Medical Emergencies: Should There Be A Doc Onboard?

Thu Mar 10, 2005 10:37 pm

My father is a Doctor. He had at least three flights were he was needed because a passenger became seriously ill. But, as already somebody mentioned, on most long-haul flights there is probably a Doctor amongst the passengers. BTW I know that all Swiss flight attendants are trained on defibrillators (I don't know if this is the right word in English) in case of heart attacks.
 
johnboy
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Medical Emergencies: Should There Be A Doc Onboard?

Thu Mar 10, 2005 10:46 pm

It seems I remember reading an article some years back (within the past 5-7 years IIRC), where someone developed a pneumo while traveling on a flight out of Hong Kong, and an MD on board rigged a chest tube/water seal out of either a straw or pen, and jug of water.

I tried to do a search, and was unsuccessful. However, I did find some studies out of the journal, "Thorax," which might be interesting to you.

http://thorax.bmjjournals.com/cgi/content/full/57/4/289
 
supa7E7
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Medical Emergencies: Should There Be A Doc Onboard?

Thu Mar 10, 2005 10:51 pm

Probably a doctor would cost more than a pilot. A pilot is extremely expensive. We might as well have waterfalls and fairy lands on A380s, if we're going to double our costs like that.
"Who's to say spaceships aren't fine art?" - Phil Lesh
 
atco2b
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Medical Emergencies: Should There Be A Doc Onboard?

Thu Mar 10, 2005 10:58 pm

Would Paramedics or Nurses be more sufficient? Probably a bit cheaper too Big grin
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trident3
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Medical Emergencies: Should There Be A Doc Onboard?

Thu Mar 10, 2005 11:09 pm

The Hong Kong story is true.
A woman was in a motorcycle accident on her way to the airport and managed to get on the flight with a broken arm and a punctured lung. There were two doctors on board the flight ,one a med student from Hong Kong and the other an A&E consultant from Nottingham, together they inserted a chest drain using a knife, a wire coathanger, a tube from an oxygen mask and a duty free bottle.
There were a number of coincidences that conspired to put all the right people on the flight
The woman was originaly booked on an earlier flight but changed to the later one because it was a smoking flight and her companion was a smoker
The consultant had been on duty at a hospital in Nottingham the night of the kegworth air crash. Because of this he had developed new trauma and triage systems for use in major disasters. He had been in Hong Kong lecturing on the new systems.
"We are the warrior race-Tough men in the toughest sport." Brian Noble, Head Coach, Great Britain Rugby League.
 
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drerx7
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Medical Emergencies: Should There Be A Doc Onboard?

Thu Mar 10, 2005 11:17 pm

We had a medical emergency on my flight from San Juan. It was a Continental 737-800 from SJU to IAH; we were about 100 or so miles southeast of New Orleans when a lady a 2 rows behind me on the right side of the plane lost all color in her face and began breathing rough. For some strange reason the flight attendant came on and said "This is a reminder this is a non-smoking flight--it is against FAA regulations ....." People looked bewildered because there was no one visibly smoking--so we assumed that maybe someone lit up in the lav. Then they came on the PA and "Are there any medical personnel on board, we have a medical situation, please ring your call button if you are medical personnel or a physician" There happened to be a couple of doctors on board. The lady's face at this point was completely flushe--it looked like a live cadaver. Everyone was restless and looking at her. They brought out the oxygen tank for her and put the mask on her face; they got as much information from her and her husband and determined that we would need to make an emergency landing. By the time that decision was made we were over New Orleans but at 30,000+ feet. The captain came on at this point "Ladies and Gentlemen, as you may know we have a medical emergency on board and we have declared an emergency with air traffic control. We will be making a rapid decent and emergency landing into Houston" We were about 20mins from IAH at that point--we came in over Galveston Bay and the ship channel and landed on runway 27--he barely applied reverse thrust and spoilers--we shot right into our gate at Terminal E--time from touchdown to gate was under 2 mins no b.s. The plane was met by ambulance and personnel. By this time color had restored to the ladies face and they let passengers deplane before emergency personnel boarded.
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trident3
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Medical Emergencies: Should There Be A Doc Onboard?

Thu Mar 10, 2005 11:23 pm

There was a couple of years ago a woman who collapsed on a flight (details unknown) Whem the cabin crew asked if there was a doctor on board half the plane stood up, they were heart specialists returning from a conference!
"We are the warrior race-Tough men in the toughest sport." Brian Noble, Head Coach, Great Britain Rugby League.
 
TimRees
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Fri Mar 11, 2005 12:13 am

Trident 3. I think you have the HKG story almost right...didn't the lady concerned fall off her horse I few days before the flight and had fractured a rib. As the aircraft climbed this lead to a tension pneumothorax which the doctors concerned treated by inserting a chest drain using make shift equipment including a biro and a coat hanger. Can't rememeber a steak knife being used. The other thing about this was that the procedure was performed mainly by the junior doctor yet the consultant took all the praise!

I am a GP and have helped on a medical emergency on a VS flight from LHR to LAX. It was 1996. We were somewhere over Greenland and there was a PA anouncement asking for a doctor. As I'd booked my ticket as Dr on this flight I felt obliged to make myself know to the flight crew. I was travelling with a junior surgeon. A few seats behind us an elderly man with a heart history (previous heart by-pass surgery and heart attack) was pretty unwell...sweating profusely, short of breath, pale and clamy. Looked pretty awful. We managed to get him onto the floor near a galley area and give oxygen, and start monitoring him. The VS 744's are equiped with a wide array of emergency drugs and a defibrillator (thankfully didn't need that). He didn't make a huge improvement to the first aid measures and we still had 6 hours (I suppose) to LAX. My colleague had to go up to speak with the captain (missed opportunity for me!) and the captain advised that we either had to divert then to Baffin Island or we would have to wait a further 3-4 hours before we could divert. It was our decision....what a responsibility. We decided with 3-4 hours to the next diversion airfield we couldn't chance this man's health incase he deteriorated. (Essentially, at FL390 there isn't a huge amount you can do to keep someone alive for hours on end without a medical team as you would have in an emergency room/cardiac department).
We decided we should divert to Iqaluit (Baffin Island). We had to dump fuel and secure the patient for landing. Apparently, diversions into Baffin Island are not that uncommon on medical emergencies.
My colleague spoke on the RT to the medics at Iqaluit so they knew what to expect. The passenger was stable.
All would have been uneventful and we would have off loaded the passengers, refuelled and been on our way, except on taxiing onto the ramp the ground crew misdirected the aircraft the the outer engine hit a refueling hydrant on the ramp leaving the aircraft (Lady Penelope - about 3 months old at the time!) grounded. Apparently, we nearly had to use the slides due to spilling JetA1 on the apron. We were made very welcome by the locals and accommodated in a closed curling rink (?) for 12 hours until Delta Airlines sent a Tristar to rescue us and fly us down to JFK to eventually connect with an AA flight to LAX the next day......it was a long, eventful journey which I would not want to repeat.
I believe this diversion cost VS several million pounds. The ground crew at Iqaluit took full responsibility and compensated VS. I believe as a direct result of this emergency VS invested in air-ground communications with a medical centre in Atlanta (?) for future such occurences.....a very good idea. The passenger was fine and may not have suffered a cardiac event at all ironically- just the effects of the reduced cabin pressure compromising his cardiac status!
On talking to the VS cabin crew on that 744 there were about 8 doctors. The odds are that in any 350 people there will be several doctors and hence there has never been a necessity to carry doctors specifically. Of course there will probably be nurses/paramedics as well. US doctors are often reluctant to volunteer due to worry about litigation (this was the case on our flight....about an hour into the emergency a cabin attendent asked if we wanted help as a US cardiologist had eventually come forward....by that time we were practically on final approach to Iqaluit so pretty unhelpful). In the UK our medical insurance will cover us for good samaritan acts anywhere in the world. I believe in France, doctors are obliged by law to volunteer in such situations.

I hope my experience has perhaps reduced the chance of doctors being called upon midflight (especially if flying VS) and of course will improve the care of ill passengers aboard. Airlines will certainly improve facilities if it ultimately saves them money.
 
EMBQA
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Fri Mar 11, 2005 12:13 am

Do you think its necessary to have a doctor on long haul flights

..and you think ticket prices are expensive now..!! That would drive up the cost of a ticket significantly, let alone open the airline up for liability. Due to the very low number of actual in flight medical emergencies, you stand a much better chance of already having a Doctor, Nurse or EMT / Paramedic onboard then you would paying the extra cost to have on standing by.
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tcfc424
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Fri Mar 11, 2005 12:32 am

I don't think that having a separate Dr., RN, or EMT on a flight would be beneficial, however I do not see why there shouldn't be a cabin crew member trained to at least EMT on the long-haul flights. No disrespect to the doctors and physicians on this board, but unless they are an ER doctor or have had extensive training in ER, they are not always as useful as a pre-hospital car provider, usually EMT's (paramedics) and RN's. An EMT would be well equipped to manage basic life support services in the air and in a pre-hospital environment, and is more inclined to correctly gauge the patients condition and the necessity to divert...almost all EMS systems have a method for classifying the severity of patients...level I, Level II, Level III...Alpha, Bravo, Charlie, Delta...etc.

The problem with relying on PAX doctors is 1) you may have doctors, but they could be chemists, educators, podiatrists, etc. 2) they may be reluctant to expose themselves to liability and 3) most would rather leave the situation to those who know best how to handle the situation...I.e. ER Docs and prehospital care providers.

In short, perhaps seeing an EMT or RN as a dedicated cabin crew member to flights flying under ETOP 180 restrictions or even 120 restrictions may not be such a bad idea. Most airlines have an international and a domestic flight crew and thus only a small amount of personnel would need training to become EMT's.

Mike S. in AUS
 
jeffrysky
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Fri Mar 11, 2005 12:47 am

a tension pneumothorax is when air is trapped within the pleural envelope surrounding the lung , restricting lung expansion. it's a standard emergency procedure to make an incision between the 4th/5th ribs if that happens.

in the HKG incident, i also recall a steak knife being used , and brandy was used to sterilise the incision site. the air was allowed to bubble out into a bottle of water ; the doctor was really worried to see blood bubbling out instead of air bubbles. fortunately for him, it was successful and the pneumothorax subsided.

Quoting UA777222 (Reply 1):

.. and we'll see whether you will be in that position to comment as such , when you are stricken with a tension pneumothorax at 33,000 ft and gasping for every breath of oxygen you can get.
 
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EA CO AS
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Fri Mar 11, 2005 12:56 am

.. and we'll see whether you will be in that position to comment as such , when you are stricken with a tension pneumothorax at 33,000 ft and gasping for every breath of oxygen you can get.



So tell me Jeffry, are you willing to pay an extra $25.00 per roundtrip to ensure there's a doctor onboard in the event that something MIGHT happen to him, then?

And are you also willing to volunteer that EVERYONE cough up this extra money as well on each and every ticket they purchase, too?

Mighty big of you to make decisions for everyone....  sarcastic 

[Edited 2005-03-10 16:58:00]
"In this present crisis, government is not the solution to our problem - government IS the problem." - Ronald Reagan

Comments made here are my own and are not intended to represent the official position of Alaska Air Group
 
lincoln
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Fri Mar 11, 2005 1:15 am



Quoting EA CO AS (Reply 20):
tell me Jeffry, are you willing to pay an extra $25.00 per roundtrip to ensure there's a doctor onboard in the event that something MIGHT happen to him, then?

...and that that Doctor MIGHT be able to do something...

This is why I said in reply #2 that it just isn't a financially viable prospect at the moment, especially with FAs that have some medical training and can contact a doctor on the ground if the need arrises

Lincoln
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cha747
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Fri Mar 11, 2005 1:21 am

Fascinating thread...a few comments:

1. Commercial airplanes should have access to some sort of ground-based medical command (most airlines do). F/A's who are trained in first aid should be able to use the onboard equipment in conjunction with medical command. If a physician (or EMT, paramedic, nurse, PA, or CRNP) is onboard, that's a plus but shouldn't be necessary. If the patient suddenly becomes so sick that they need critical care, the chances of a successful rescucitation decrease with every minute that they're not in a critical care setting (Emergency Department or Intensive Care Unit).

2. Back when F/A's were RN's, there were only 3-4 drugs to treat hypertension...currently we have several hundred. The point is that the scope of a nurse's job has changed over the years and they really need to know a lot more than before. IMO, it would be a poor allocation of resources to require F/A's to be nurses.

3. People seem to have a notion that a defibrillator (or AED...there are a million names for it) can treat a heart attack. Here's the deal...a defibrillator can shock the heart out of an abnormal rhythm, period end of story. Some heart attacks can cause an abnormal rhythm but an abnormal rhythm (arrythmia) can develop for a variety of reasons (a blood clot in the lungs, an electrolyte imbalance, from prescription or illegal drugs, etc). In addition, not all arrythmias are necessarily shockable...some respond better to medicines rather than electricity. So the point is, if somebody is having chest pain or becomes unresponsive on the plane, hook them up to the AED. Most new AED's will do all the work for you after that (shock the shockable rhythms) and get the plane on the ground.
You land a million planes safely, then you have one little mid-air and you never hear the end of it - Pushing Tin
 
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RE: Medical Emergencies: Should There Be A Doc Onb

Fri Mar 11, 2005 1:49 am

This must be one of the most sensible threads on here in a while. Kudos to RootsAir for breaking the monotony of A vs B, NW DC9, AF dirty planes, the worst one yet: "Where is Peter Max today?", and the list goes on and on...
“Once you have tasted flight, you will forever walk the earth with your eyes turned skyward, for there you have been, an
 
kith
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Fri Mar 11, 2005 2:00 am

My uncle is a Dr. and has had three or four medical emergency's over the ladt four years on flights JFK-LHR/JFK-AMS etc. Usually its nothing serious. Funny, when the F/A calls for Doctor on the JFK-AMS on KLM none raised their hands, 2nd time, none did, third time he did and he helped the woman so they didn't have to divert. KLM gave him a two first class tickets because of this! Not bad compensation for some gas! Less than having to divert/refuel though-Matt in KITH
 
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Fri Mar 11, 2005 2:08 am

Don't forget, many airlines (over 70, IIRC) contract with PHX-based MedAire, a company whose MedLink services does air-to-ground patches directly between crewmembers and emergency medical staff at Phoenix St. Joseph's Hospital for inflight medical emergencies.

http://www.medaire.com/comm_medlink.html


While it's not the same as having a doctor right there on the plane, it's a viable and economical safety net for air carriers to have.
"In this present crisis, government is not the solution to our problem - government IS the problem." - Ronald Reagan

Comments made here are my own and are not intended to represent the official position of Alaska Air Group
 
ltbewr
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Fri Mar 11, 2005 2:09 am

Poster KITH noted that his Uncle whom is a Medical Doctor and assited an ill pax was compensated with free flight tickets for his assitance. Is this a common practice for airlines to give a 'thank you' to a medical Doctor for their in-flight assistance? What about an EMT or Nurse whom might assist with treating an ill pax?
 
jeffrysky
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Fri Mar 11, 2005 2:20 am



Quoting EA CO AS (Reply 20):

I see no relevance of your statement to my post.

The point i am making in reference to UA777222 is that in light of a medical emergency mid-flight, you do not have a choice of medical instruments and you have to make do with ANY suitable equipment to overcome the medical emergency, be it as crude as a steak knife or cheap alcohol to substitute for sterilisation.

I have certainly not suggested any need for a doctor to be stationed onboard every flight, which is precisely why there is a need to improvise because there's probably no one onboard with proper medical equipment.
 
khenleydia
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Fri Mar 11, 2005 2:22 am

1. Coming from an EMS background, the only thing someone would do on a plane that would be worth while, cutting them open, would be a crich. In other words, cutting a small hole in the throat and trachea so that they can breath.

2. Probably 15+ years ago I remember someone complaining of chest pain on the flight. They gave him the portable O2, but it was happening as we were landing. Once we were on the ground, everyone stayed seated while the person was checked out and removed.

3. Wish I knew. But considering I have flown a few million of miles of the years and have never seen another incident, I imagine it isn't all the often.

4. Hate to break it to you, but I am not sure Doctors could handle an emergency in the air that well. Don't get me wrong, most doctors are GREAT, but they don't have experience working on the fly, outside of a hospital and with limited supplies. Throw a EMT-P (Paramedic) on a flight with experience, that would be a different story. We are used to working with limited help, equipment and treating for the worst without needing all sorts of tests that you can only get at a hospital. Personally, I would LOVE that job!!

Reality is, it happens so little that most airlines would probably not like the idea of giving up space on a flight for someone that would just basically be along for the ride, unless something happened. Of course, they could train F/As, but that would be a whole other deal.

KhenleyDIA
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jeffrysky
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Fri Mar 11, 2005 2:34 am

it's true that some doctors may not be prepared to handle such an emergency with such limited equipment onboard. hence, it's really many thanks to the medical personnel who managed to improvise and perform life-saving actions in face of limited equipment. and of course the BA crew , who facilitated the job of these doctors.

it's not economically feasible to have a doctor on each flight, because the incidence of such a emergency is rare. even if an medical emergency were to happen, it's not all the time a doctor onboard can intervene e.g. acute myocardial infarction ( heart attack ) , which happens to be one of the commonest emergencies to occur.

in medical school, we all take an emergency medicine module , but of course we take that module with the luxury of all that sophisticated equipment around us !
 
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Fri Mar 11, 2005 2:38 am

Sorry Jeffry - I misinterpreted your post. My apologies.
"In this present crisis, government is not the solution to our problem - government IS the problem." - Ronald Reagan

Comments made here are my own and are not intended to represent the official position of Alaska Air Group
 
TimRees
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Fri Mar 11, 2005 3:03 am

Ahh...I remember being a medical student...we thought everything just ran like clockwork and we'd all be able to save the world!

In the real world most doctors aren't ER doctors. I'm a general medical practitioner and despite keeping up-to-date with CPR, find treating medical emergencies (even in my surgery) anxiety-provoking to say the least. That's because in my field they don't happen that often even on the ground , you have limited equipement of much use (It's not like being in an ER surrounded by monitors, blood gas machines, ECG's, expert nurses, anaesthetists...etc), and you're out of practice. Even in medicine 'practice makes perfect'. Most psychiatrists, for instance, will hardly remember what an ECG looks like never mind interpret them.

IMO it would be totally impractical carrying doctors on aircraft. Also, it would be totally BORING and not a good use of your medical skills. Everyone on this forum probably loves flying, but sitting there for hours just in case something happened would be so tedious....seeing very little you would soon deskill and be no better than that psychiatrist or GP who just happens to be already on the flight. The air-ground medical communication is probably the best way forward with cabin crew trained to be competent at all essential supportative measures (Perhaps have a ALS type training) and then if necessary get that plane on the deck as soon as possible. VS crew are trained to use the defibs once instructed by the ground station now. I suspect their chance of getting a heart going again in a cardiac arrest/arrythmia would be as good as anyone's.
 
mrniji
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Fri Mar 11, 2005 3:06 am



Quoting Cragley (Reply 8):
From my experience at RES, when Doctors are travelling on leisure, the majority actually called to ask to be listed as a standard passenger (Mr or Mrs) as they did not want to be identified as a Dr in case there was an inflight emergency.

Yeah, but my dad always travels Surname/FIrstname Dr., though he is NOT a medical doctor but has his dortrade (phD) in engineering.. he was never requested specifically to give medical assistance, though they called for doctors on mutual flights.. got my point?  Wink
"The earth provides enough resources for everyone's need, but not for some people's greed." (Gandhi)
 
ckfred
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Fri Mar 11, 2005 5:42 am

A friend of mine was the F/O on an AA 767 flight from SFO to ORD. Over Nevada, a passenger noticed that the woman next to him had passed out.

So, here's the basic procedure that the crew followed:

1. F/A notifies the captain of a possible medical emergency.
2. F/A asks over the P.A. if there are any medical personnel on board. There happened to be 3 cardiologists returning from a medical conference.
3. Captain radios dispatch of a possible need to divert and to get a company doctor on the line.
4. The doctor is connected to the nearest phone on the cabin, so that the doctors on board don't have to run back to the cockpit.
5. ATC is notified of possible need to divert to SLC.
6. The F/As go through the woman's carry-ons. They found medication with the woman's doctor listed.
7. Company docter calls the passenger's doctor and conferences him in.
8. The doctors agree that passenger needs to be hospitalized ASAP.
9. Dispatch gives the OK to divert to SLC.
10. Captain declares a medical emergency and asks for vector to SLC.
11. Crew starts to prepare the aircraft for arrival in SLC.
12. Captain confirms with dispatch that he will taxi to the gate.

At this point, the plane was northwest of SLC. Since the wind at SLC was from the north at 2 kts, the captain asked to land with the wind, just to save the 5 to 10 minutes needed to make an approach from the south.

I think the elapsed time from the gentleman pulling the call button until the plane was at the gate and the paramedics came aboard was just over 30 minutes.
 
mrniji
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Fri Mar 11, 2005 1:27 pm

Quoting Ckfred (Reply 33):

ckfred, outstanding description! Super

Maybe the question is a little inappropriate, but who pays for the following costs of the diversion?
"The earth provides enough resources for everyone's need, but not for some people's greed." (Gandhi)
 
cha747
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Fri Mar 11, 2005 1:44 pm

Quoting TimRees (Reply 31):
in the real world most doctors aren't ER doctors. I'm a general medical practitioner and despite keeping up-to-date with CPR, find treating medical emergencies (even in my surgery) anxiety-provoking to say the least. That's because in my field they don't happen that often even on the ground , you have limited equipement of much use (It's not like being in an ER surrounded by monitors, blood gas machines, ECG's, expert nurses, anaesthetists...etc),

Hi TimRees - welcome to my respected users list. You hit the nail on the head. I'm a physician in a tertiary care Emergency Department and we have patients referred from offices all the time. I remember one case in particular where a 78 year old lady was upstairs in the operating room holding area getting prepped for an elective operation. She had some chest pain. The surgeons had no clue what to do with her. A brilliant surgical intern said, "Let's wheel her down to the ER!" So they did just that. In front of our eyes she went into vfib arrest, she was shocked back to sinus rhythm, we intubated her, stabilized her, and sent her to the cardiac cath lab. She died a few hours later and would have died instantly had her rhythm not change before our eyes.

The point is that even in a teaching hospital, nobody could have saved this lady's life....she was way too sick. Secondly, the general surgeons were useless for this particular case, and I'd be scared if they ever wanted to come near me with a knife. Finally, what makes people think at 39,000 feet a doctor is going to make THAT much difference in patient outcome? I routinely work as the stadium doctor at Philadelphia Phillies (baseball) games and Philadelphia Eagles (football) games and we have just as much equipment there as there would be on an ambulance. The paramedics do their thing and they consult me from time to time. People who we "code" are dead and they remain dead...we've never brought anybody back because they were just way too sick. I'm really just there because of city ordinances and to advise people whether or not they should go to the hospital depending on how sick or well they look...probably the exact same thing I'd do in the sky should the need ever arise. The question then becomes, does the cost of having a physician (or RN, PA, CRNP, etc) outweigh the cost of potentially having to divert for a medical emergency?

Emergency physicians in the US earn on average US$100/hour for their work (it ranges anywhere from US$40-200 depending on location, job, and a variety of other factors). I doubt that in this day and age of "Less Room Throughout Coach" an airline is going to want to cough-up, say, US$1000 per flight in addition to giving up a revenue seat for the off chance they might save tens of thousands in case they have to divert.
You land a million planes safely, then you have one little mid-air and you never hear the end of it - Pushing Tin
 
TimRees
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Fri Mar 11, 2005 6:09 pm

Cha747..
Thanks for the complement...
I really hope the flights I fly on are medical emergency free following my limited experiences. Following the diversion of the VS flight to Iqaluit, we were verbally abused by quite a few passengers for causing their delay by diverting the plane despite the delay being due to the ground incident. It was not the most enjoyable 12 hours of my life. Many other passengers became stressed due to the delay and on the flight down from Iqaluit to JFK was asked twice more to help out with distressed passengers...an elderly man with COPD who'd forgotten to take his inhalers due to the time differences/delay, and a young woman with painful ears due barotrauma.
Interestingly, in the case of the old man I was asked if he was fit to fly onto LAX. I advised he should rest in JFK and that in my opinion he probably wasn't fit to fly again that day and should see a doctor in NY. To my amazement, who should walk onto our AA flight to LAX but that man! I thought it negligent that he could be allowed to board and perhaps cause another diversion. I suspect he didn't want to bear the costs of medical care in NY (of course in the UK it's free!!) and his wife was keen to get home. I was disappointed that my advice had fallen on deaf ears but I suspect there was no communication between VS and AA on this occasion. As it was it was chaos on arriving at JFK with very little help available to redirect a few hundred people to connecting flights....
 
ua777222
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Tue Mar 15, 2005 7:21 am

Quoting EA CO AS (Reply 20):
So tell me Jeffry, are you willing to pay an extra $25.00 per roundtrip to ensure there's a doctor onboard in the event that something MIGHT happen to him, then?

And are you also willing to volunteer that EVERYONE cough up this extra money as well on each and every ticket they purchase, too?

Mighty big of you to make decisions for everyone.... %A0%A0

Too add to the already correct ideas, what are you going to do when the flight is overbooked and they need to remove you from your flight in order to allow the doctor that might be used to have a seat on your flight. If you think about it the airlines have done the best they can that makes sense ($$ wise) and with the consumer in mind. Trainiproceduresures, and overall awareness is all an airline can do without affecting the other passengers (More $$ per flight) and I don't think many doctors would be willing to get the certificates to have spermissionsion to work at such alt.

Like meds, the doses change at such a high alt. so there will probably need to be a check that the doctor goes through with both the FAA and the airline. The airline will probablyresponsibleable for that doctor and will need to pay for their training and other such requirements to be set by the FAA. I don't think its something that would make any real sense for an airline to invest so much time and money in something that's a "what if". I can see this happening for some airlines that are more $$ stable but right now no chance in hell...

Thanks,

Matt
"It wasn't raining when Noah built the ark."
 
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tavong
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Tue Mar 15, 2005 11:19 am

In a Medical point of view
- There aren't studies that demostrate that the survival chance is different if you have a permanent doctor on board than if you take the "normal" procedure being made by the airlines at this time, has said before is not only to have a Doctor, is also to have special equipment,

-Has stated before there are things that can't be managed into an Airplane no matter if you have a doctor or a "super-surgeon" is not practical to have a doctor on-board permanently, for example a cardiac arrest ther will be little different that can be done for a Doctor with the equipment on an Airplane than whas can be made by the F/A trained in RCP-Defibrilation, if it's a Surgical emergency, you can't do a Surgery on a plane, (no matter if is an A380 Big grin) So the result is the same, in fact if a real "emergency" happens there is little to do in an Airplane, the result will be the same.

Gus
SKBO

P.D. Hope i could make my point clear.
Just put me on any modern airliner and i will be happy, give me more star alliance miles and i will be a lot more happy.
 
avek00
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Tue Mar 15, 2005 12:45 pm

At the end of the day, many airborne medical emergenices can be averted altogether if people just used some brain power in determining whether they are fit to fly in a cramped metal tube for 1/2/12+ hours. For the non-foreseeable emergencies, the infrequency of their occasion simply do not justify the added expense and marginal benefit of having doctors permanently stationed aboard.
Live life to the fullest.
 
manu
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Tue Mar 15, 2005 12:50 pm

Quoting Ckfred (Reply 33):
the elapsed time from the gentleman pulling the call button until the plane was at the gate and the paramedics came aboard was just over 30 minutes

That is well within the "golden hour" for hospital treatment. Providing O2 and starting to treat the individual on the fight as soon as something was wrong also helps prolong that mythical golden hour.

For those who don't know, they say people need to be in hospital within an hour of trauma. For some injuries it may actually be better to be on a flight, as you can be flown directly into a major city centre compared to it happening out in the middle of no where.

Most of these flights get the "lifeguard" tag with ATC, giving them priority on arrival without having to explain the situation. I'm not sure how many actually "declare an emergency" beyond this.

FYI:

"The (golden) hour itself appears to have come from a study of splenic artery injury in rats, where the death curve peaked at something like 63 minutes" (1995, misc.emerg-services newsgroup).
 
cha747
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Tue Mar 15, 2005 1:07 pm

Hey Gus,

Good to hear you chime-in on this as well. Perhaps if an airline let a few of us "ride-along" we could get a case-series going for the NEJM or something like that.

Check this link out....now if airlines were serious about holding-off on diversion and they had medical personnel available, this would be indispensible:

http://www.lufthansa-technik.com/app...7d77b3827570c66797e3b1034ee59dcb88

Imagine...intubating, shocking, starting central lines, and placing chest tubes at 39,000 ft. Now that's what us sick ER guys call joining the mile-high club  kiss 
You land a million planes safely, then you have one little mid-air and you never hear the end of it - Pushing Tin
 
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tavong
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RE: Medical Emergencies: Should There Be A Doc Onboard?

Wed Mar 16, 2005 12:00 am

Quoting Cha747 (Reply 41):
Imagine...intubating, shocking, starting central lines, and placing chest tubes at 39,000 ft. Now that's what us sick ER guys call joining the mile-high club

HAHAHAHAHAHAHAHAHAHA, you make my day Cha Big grinD I really can't imagine doing that at 39.000 feet, on other hands i really can't imagine while you're intubating and shocking to see a F/A saying "the equipment interferes with the navigation instruments HAHAHAHAHAHAHA sorry i'm just kidding. (anyway can't be worst thant here where you sometimes need to wait for the nurse to finish off her coffee break to carry you the RCP unit.  Yeah sure


Quoting Avek00 (Reply 39):
At the end of the day, many airborne medical emergenices can be averted altogether if people just used some brain power in determining whether they are fit to fly in a cramped metal tube for 1/2/12+ hours.

Usually that's the problem people insist to fly even if they're no fit to fly, it's a cultural thing very difficult to change.

Quoting Cha747 (Reply 41):
Check this link out....now if airlines were serious about holding-off on diversion and they had medical personnel available, this would be indispensible:

http://www.lufthansa-technik.com/app...dcb88

Yes it's an interesting concept but the size of that thing would also increase costs and the space needed if you ask my opinion i really don't see that thing happening soon (even in an A380 HEHE)

Gus
SKBO
Just put me on any modern airliner and i will be happy, give me more star alliance miles and i will be a lot more happy.