PlaneHunter
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Nursing College: A380 Will Need Full-time Medic

Thu Mar 23, 2006 4:01 pm

Article on scotsman.com:

http://news.scotsman.com/scitech.cfm?id=450062006


THE next generation of super jumbo jets will need a full-time medic on board, the Royal College of Nurses said today.

Rita Mody, a committee member of the college's In-flight Nurses Association, said the move is needed to make sure people who fall ill can get care immediately.

Ms Mody said the high numbers of passengers that can be carried on Airbus A380s will lead to a "high probability that someone will fall ill".



PH
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ikramerica
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RE: Nursing College: A380 Will Need Full-time Medic

Thu Mar 23, 2006 4:06 pm

I guess nobody has really scheduled 12 hour flights with 500 pax before, but there are 747 configurations with over 400, so why does the extra <100 make it so critical? 747s occasionally stop to get people help, so do other jets.

Sounds more like a vested interest trying to force airlines into hiring their profession.
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alaskaqantas
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RE: Nursing College: A380 Will Need Full-time Medic

Thu Mar 23, 2006 4:09 pm

why not train certain Flight attendants. I mean they would be on the aircraft doing the job of a flight attendant, but if something happened then they would be qualified to be a medic.
This way the airlines save money. Cause we all know that the planes don't fly with out  dollarsign   dollarsign   dollarsign   dollarsign   dollarsign  !!!!!!!
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alexchao
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RE: Nursing College: A380 Will Need Full-time Medic

Thu Mar 23, 2006 4:16 pm

It's an interesting point. Most airports are capable of handling the 747, but will all airports be able to handle the A380?

Then again, we have planes flying across hours of ocean without any problems.
 
Ken777
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RE: Nursing College: A380 Will Need Full-time Medic

Thu Mar 23, 2006 4:17 pm

It is probably a good time to have some one sit down and work the numbers for the various long haul flights. The frequency is one factor, the other is the severity of conditions encountered. EMTs or Nurses might be attractive to the airlines if the stats show risks. The one time I was on a flight with a medical problem the flight (BA's HKG - LHR) returned after 5 hours of flying, had to overnight and put everyone up at the Airport Regal Hotel. Throw in all of the extra costs of that and medical experience on board can be very handy.

The other option is to provide large discounts to EMTs and Nurse (especially ICU nurses) if they agree to be available if needed. Docs would fly free under the same conditions.
 
AeroWesty
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RE: Nursing College: A380 Will Need Full-time Medic

Thu Mar 23, 2006 4:34 pm

Quoting Ikramerica (Reply 1):
Sounds more like a vested interest trying to force airlines into hiring their profession.

Or just returning to their roots.

http://www.united.com/page/article/0,6722,3211,00.html
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AOMlover
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RE: Nursing College: A380 Will Need Full-time Medi

Thu Mar 23, 2006 4:35 pm

Corsair sends 747-400s with 590 pax on board for 11+ hours flights to La Réunion island. Corsair 747-300s with more than 580 seats also used to fly from Paris Orly to Tahiti via Oakland. It was a pretty long stretch.
 
emiratesa345
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RE: Nursing College: A380 Will Need Full-time Medic

Thu Mar 23, 2006 5:50 pm

Quoting Ken777 (Reply 4):
The other option is to provide large discounts to EMTs and Nurse (especially ICU nurses) if they agree to be available if needed. Docs would fly free under the same conditions.

I don't think so. When there is a crisis onboard the crew will generally call out to ask for the assistance of any medically trained professionals.

If I was a doctor and someone was ill on the flight that I had been travelling on, and the cabin was paged for medically trained professionals, I would feel pretty damn shitty about myself for not offering my services.

I'm not certain but I think you can even get in trouble with the law if you fail to provide assistance. I heard from a nurse here in Ontario, Canada that if you see a car crash or someone in need in public and you don't offer your assitance, that decission can cause you trouble.

Mark
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manni
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RE: Nursing College: A380 Will Need Full-time Medic

Thu Mar 23, 2006 5:53 pm

Quoting Ikramerica (Reply 1):
Sounds more like a vested interest trying to force airlines into hiring their profession.

 yes 

Once I was travelling together with my wife on an SQ flight from CDG to SIN. A few hours inflight she felt really ill. I called a flight attendant, who wasn't able to help nor any of her collegeaus. She then made a general call over the PA system, asking if anyone onboard has a medical education. Minutes later, a french docter showed up together with the flightattendant. The doctor asked the flight attendant to get the medical equipment available onboard, and helped my wife.


If you're travelling onboard an A380 mathematically the risk of being encountered with a passenger getting ill is higher, put in similar fashion, chances that a doctor, medic, nurse will be onboard will be higher aswell. If the flightattendant asks for assistance over the PA, I can't imagine that someone who'd qualify to provide assistance would not make her/himself known. And a compensation scheme shouldn't be obligatory...
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gkirk
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RE: Nursing College: A380 Will Need Full-time Medic

Thu Mar 23, 2006 5:54 pm

Quoting Manni (Reply 8):
If you're travelling onboard an A380 mathematically the risk of being encountered with a passenger getting ill is higher, put in similar fashion, chances that a doctor, medic, nurse will be onboard will be higher aswell. If the flightattendant asks for assistance over the PA, I can't imagine that someone who'd qualify to provide assistance would not make her/himself known. And a compensation scheme shouldn't be obligatory...

Aye, the chances are quite good that there is a Doctor onboard anyway
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ILOVEA340
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RE: Nursing College: A380 Will Need Full-time Medic

Thu Mar 23, 2006 5:58 pm

Quoting Manni (Reply 8):
that a doctor, medic, nurse will be onboard will be higher aswell.

I completely agree. There is a MUCH higher likelyhood that there is a doctor (and many at that) on the plane than someone falling so incredibly ill that only immediate attention will save them.

In fact. I bet you can fin a doctor or at least trained professional for virtually every possible problem out of a group of 500 (relatively well educated, as this is the group doing the most flying in A380 countries) people.
 
GBan
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RE: Nursing College: A380 Will Need Full-time Medic

Thu Mar 23, 2006 5:59 pm

Quoting Manni (Reply 8):
If you're travelling onboard an A380 mathematically the risk of being encountered with a passenger getting ill is higher, put in similar fashion, chances that a doctor, medic, nurse will be onboard will be higher aswell. If the flightattendant asks for assistance over the PA, I can't imagine that someone who'd qualify to provide assistance would not make her/himself known. And a compensation scheme shouldn't be obligatory...

That's exactly the point. Statistically there is no difference from the perspective of the airline. As a passenger I should feel more comfortable in a 380 since my chance of having a doctor on board if I'm in trouble are higher with more people on board.
 
cha747
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RE: Nursing College: A380 Will Need Full-time Medic

Thu Mar 23, 2006 7:19 pm

It may be nice to have a nurse or doctor on board, but in reality, there is not much they can do without having a hospital around that a properly trained FA can't do. The new AED's (automatic external defibrillators) "speak" the instructions for advanced cardiac life support and at 35000 feet, there's very little you can do in addition to that. They tell you to connect the electrodes, they analyze the rhythm, they advise shock, tell you when to check for a pulse, and tell you to continue CPR. That's about all I as an Emergency Physician could ask anybody to do and now we put machines on planes that do a great deal of the thinking for you.

Many times physicians on board don't do much, but they provide re-assurance and can make some simple suggestions that alleviate the pt's pain and/or anxiety.

Sure, there have been anecdotal cases of chest decompressions and airway management with the tube of an ink pen, but nurses and basic EMT's won't be doing that kind of stuff on a regular basis (many general doctors and specialists [read: non ER doctors]) would crap their pants if they had to do emergent airway or cardiac management at 35000 feet with minimal equipment.
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madairdrie
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RE: Nursing College: A380 Will Need Full-time Medic

Thu Mar 23, 2006 7:29 pm

A number of years ago late 90's I was flying Laker (silly me) from LGW to Florida (the whole flight was another very long story) anyway we had to make a fuel stop after the fuel stop a passenger collapsed (which later I discovered was dehydration) and the Flight Crew made an appeal for anyone with medical knowledge to come forward we ended up with 3 doctors and 6 nurses, who looked after the man very well until the FA decided they needed the Medical teams credentials - which ended up causing all sorts of problems. As did the Paramedics when we landed who would not accepts a British Doctors summing up of the events and they got very annoyed when a British Nurse injected the patient with what he needed, then finally to take the biscuit they would not let him go to hospital as he had not filled out his landing and immigrations cards!

My point in reference to this is to agree with everyone above that the more passengers you have the more chance you have of having a medic on board, and so I am unsure if there is a real need to have a specific nurse on board.

However if the Royal College of Nurses want to try and work out some facts and figures that might suggest to the airlines that it will be worthwhile as they wont be making as many diversions then I am sure they will take this on board. You could end up with a high qualified nurse on board with various things that handle the common medical requirements onboard and then if someone does take ill they will be able to get to their destination which keeps their fellow passengers happy and also might be even more beneficial for the ill person as well as there is more chance they will have family or at least some form of arrangements for their destination rather than end up at a diversion point that is unknown to them. Basically I think it is up to the Royal College of Nurses to prove the need and if they do I am sure the Airlines will take it on board.

Kenneth
 
Markhkg
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RE: Nursing College: A380 Will Need Full-time Medi

Thu Mar 23, 2006 8:24 pm

I am curious to what the article means to as "medic"...

In the United States, "medic" usually refers to a paramedic or flight nurse that are able to utilize and interpret EKGs, start IV or IO lines, administer advanced medications, defibrillate manually, intubate (put tube in throat)...some states even allow paramedics to administer thrombolytics to dissolve clots in heart attacks.

But in the EU, the term "medic" is sometimes used to discuss a wider array of healthcare professionals from a GP doctor to an Accident and Emergency Nurse.

The difference between a doctor and paramedic are actually quite far apart, so I am curious to what the In-flight Nurses Association is actually suggesting?

I have looked through some of the medical training flight attendants do, and rather sadly, it is rather lacking. Someone taking a 5-day advanced first aid course will probably cover the same material. (However, some F/As have the additional training with how to use medical direction programs like MedAire which boosts their capacity as emergency responders!)

Additionally, you can never be certain that healthcare professionals will volunteer on the flight. I know of quite a few HCPs who refuse to participate because of liability concerns, founded or unfounded...
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tjc2
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RE: Nursing College: A380 Will Need Full-time Medic

Thu Mar 23, 2006 8:55 pm

Quoting AOMlover (Reply 6):
Corsair sends 747-400s with 590 pax on board for 11+ hours flights to La Réunion island. Corsair 747-300s with more than 580 seats also used to fly from Paris Orly to Tahiti via Oakland. It was a pretty long stretch.

Isn't a 747 with 590 pax on board filled to capacity in Economy? So If an A380 is fitted entirely Economy then isn't it around 800 pax?

Hiring a Nurse just to be a nurse on a flight is a good idea. However, what I think people should take into consideration is the fact that for the many cases, flights go over thousand miles of ocean with ~400 pax many times a day, everyday. The large majority of these flights are completed with out medical incident. When there is such an incident the chances are high that there is a medically qualified person on board who can assist.

What I'm trying to say is that although Air safety records are quite high in today's world, could it be a risk to have a highly qualified nurse on board who for most of time is not being put to the best of use, when he/she could be practising his/her profession in an area where they are more likely to get more frequent opportunities? Then of course, if you have ~150 A380 (with hopefully more to come in the future) flying around the skies, that is ~150 nurses who could be doing better things with most of this time?

I think training FA's would be better use of time and money...

just my  twocents 
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AMSSpotter
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RE: Nursing College: A380 Will Need Full-time Medic

Thu Mar 23, 2006 9:04 pm

Quoting PlaneHunter (Thread starter):
Ms Mody said the high numbers of passengers that can be carried on Airbus A380s will lead to a "high probability that someone will fall ill".

There seems to be this human tendency, some sort of conservatism I guess (no pun intended), to draw a certain, imaginery, line and everything that crosses that line (usually in terms of size) is considered a reason to significantly change current regulations.
In this case, the line is the B747 and through the years, we've become used to and grown comfortable with it's dimensions and the number of passengers it can carry. Now that something even bigger (in terms of passenger-potential) is on the horizon, some people almost seem to "freak out" just because of that. The line they've drawn has been crossed and this almost seems to mean "total psychological chaos" to them. What they don't realize is that, in case of the A380:
the newcomer still fits in the 80x80 meter box,
that not every 747 carries the same amount of seats and
that the debute version of the A380 will not carry that many more passengers than the current 747's.
I guess people equally "freaked out" when Boeing introduced it's Queen of the Skies since in those days, they were used to the B707.

Besides "freaking out", a lot of people have all kinds of hidden agenda's that make it very convenient to freak out (as was mentioned earlier in this thread).  Wink
 
boeingguy1
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RE: Nursing College: A380 Will Need Full-time Medic

Thu Mar 23, 2006 9:27 pm

Quoting Tjc2 (Reply 15):
Isn't a 747 with 590 pax on board filled to capacity in Economy? So If an A380 is fitted entirely Economy then isn't it around 800 pax?

...Just dont let Corsair get a hold of one of these things... because you would see it!
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TGV
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RE: Nursing College: A380 Will Need Full-time Medi

Thu Mar 23, 2006 9:43 pm

As mentioned above the chance of having a doctor (or a nurse) on-board goes up with the number of passengers on the flight.
On all my travels I have been on 4 flights during which the call for a doctor was made. In each and every case there was, at least, one doctor. In one case I was seated just behind the person with a chest pain, and they even had to select the more appropriate doctor, as they were 3 on-board (and it was an A340 with around 250 passengers).

I spoke once with an AF FA who told me that they usually had not any problem to find a doctor. The flights to/from the US being the most problematic due to the fear of some doctors to be sued after their intervention !
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MEA-707
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 1:41 am

Still I think airlines should offer some compensation for doctors who help out.
I heared about a doctor on board a BA flight who planned to sleep during the flight, lost 8 hours of rest due to assisting a sick passenger, and was so tired he had to cancel a day of paying patients after arrival. But he didn't even receive a thank you card or flowers from the airline, let alone payment or travel/upgrade credits! BA came with the excuse they didn't want people just cash in on passengers mysery.
I can understand if a doctor doesn't identify himself next time, for him it's a job.
nobody has ever died from hard work, but why take the risk?
 
Markhkg
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RE: Nursing College: A380 Will Need Full-time Medi

Fri Mar 24, 2006 1:52 am

Perhaps you should read this story about another doctor and see if your feelings about compensation don't change just a little...  Sad


BMJ 1998;317:701 ( 12 September )
News


Doctor demands payment for helping airline passenger

Clare Dyer, legal correspondent, BMJ

A doctor who answered an emergency call on a transatlantic flight will break new legal ground next month when he goes to court in a bid to force the airline to pay for his services.

John Stevens, a consultant psychiatrist and psychotherapist, was returning with his family from a holiday in California in January 1997 when the call for a doctor went out over the American Airlines jet's public address system.

Dr Stevens, who divides his time between Springfield Hospital in south London and Surrey Oaklands Hospital in Redhill, said that he was initially reluctant to respond to the call, which came just 20 minutes into the flight. "I sat on my hands because I felt the best doctor would be one who deals with emergency medicine all the time. Then I heard a kerfuffle a few rows behind, so I couldn't ignore it. The second call went out, and I felt impelled to act."

He said that the passenger, a former nurse from the Republic of Ireland, "looked grim [and] had chest pains and breathlessness." She had a history of repeated leg thromboses and had been taking anticoagulants, but the treatment had been stopped.

Dr Stevens believed she had had a pulmonary embolism as she was boarding the aircraft. She was given oxygen and initially rallied, but when she had a further attack, he advised an emergency landing for hospital treatment in Chicago, rather than risk a long flight over the north Atlantic, where landing would have been impossible.

At the end of the flight, Dr Stevens was presented with a bottle of "cheap champagne" by the crew, and he said that a $50 (�30) travel voucher, excluding all the main holiday periods, arrived a month later. The airline says that the voucher was for $250, but Dr Stevens, who took a photocopy before returning it to the company's solicitor, insists it was for only $50.

In the meantime, he sent the airline a bill for �540, charging for four and a half hours of his time at �120 an hour. The airline refused to pay, claiming that it was not company policy, so Dr Stevens, with advice from legal friends, brought a small claims action in Central London County Court.

The airline tried to have the claim struck out, but a judge ruled that it could go ahead. The hearing is set for 7 October. Under the small claims rules, Dr Stevens will not be liable for the airline's costs if he loses.

A spokeswoman for American Airlines said: "We have a strict company policy that we don't pay doctors in circumstances such as this. Our position is that it's a matter between the doctor and the patient, and the fact that treatment was on our aircraft is incidental."

But Dr Stevens points out that his services were sought by the crew rather than the patient, who told him she was not consulted before the call for a doctor was broadcast. He says that had anything gone wrong, he could have faced a large malpractice claim for which he had since learned he would not have been covered.

The BMA, which wants to clarify the position of doctors who give in-flight help, has had informal discussions with several airlines and hopes to raise the issue with an international aviation advisory body, a spokeswoman said.
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BoomBoom
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 2:33 am

Quoting MEA-707 (Reply 19):
BA came with the excuse they didn't want people just cash in on passengers mysery.

Funny, considering airlines have been cashing in on passengers misery for years...
Our eyes are open, our eyes are open--wide, wide, wide...
 
B6JFKH81
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 2:49 am

Quoting Alexchao (Reply 3):
It's an interesting point. Most airports are capable of handling the 747, but will all airports be able to handle the A380?

Then again, we have planes flying across hours of ocean without any problems.

This is an interesting point Alexchao. This may be why they have to do this. If there is a Medical Emergency onboard, how many airports can the A380 divert to at this point in time? JFK isn't even finished prepping for it.
"If you do not learn from history, you are doomed to repeat it"
 
A319114
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 3:34 am

Quoting B6JFKH81 (Reply 22):

This is an interesting point Alexchao. This may be why they have to do this. If there is a Medical Emergency onboard, how many airports can the A380 divert to at this point in time? JFK isn't even finished prepping for it.

*sigh* The a380 can land at EVERY airport which can support a 747, it just will have a hard time taxiing here and there.
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CRJ900
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 3:40 am

Quoting Cha747 (Reply 12):
Sure, there have been anecdotal cases of chest decompressions and airway management with the tube of an ink pen, but nurses and basic EMT's won't be doing that kind of stuff on a regular basis (many general doctors and specialists [read: non ER doctors]) would crap their pants if they had to do emergent airway or cardiac management at 35000 feet with minimal equipment.

Exactly. I am studying to become a nurse and work in a hospital. We have had several discussions in class about what to do if people need help on a plane, train or bus etc... many lecturers (MDs and nurses) said that they avoided saying they were health care pros, as they hadn't been in contact with ER situations for years. Many MDs and senior nurses do office work only. Me, working at the gastro surgery division, would be hesitant if someone has a heart attack, because I haven't dealt with any patients that have had one and would be unsure of what to do...

Quoting MarkHKG (Reply 14):
Additionally, you can never be certain that healthcare professionals will volunteer on the flight. I know of quite a few HCPs who refuse to participate because of liability concerns, founded or unfounded...

I think we'll se more of this. We hear so many horror stories from the US where patients scream "I'll sue your ass off if I don't get well again!" and it's coming to the rest of the world too... HCPs are simply scared of helping, as it may cost them their career (and everything else that matter)...

I support ER-experienced crew onboard, if there are to be any HCPs employed.
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richm
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 3:44 am

I think the logical answer would be to make F/A's do first aid training, training specifically designed for offering in-flight first aid. Perhaps they could have senior F/A's do higher levels in First Aid. After all, they are there for the passengers safety and not just to be a trolly dolly.

[Edited 2006-03-23 19:47:50]
 
SCEagle
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 4:03 am

Offer incentive pay to FA's who qualify for medical certification.

Simple.
 
BoomBoom
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 4:10 am

Quoting CRJ900 (Reply 24):
I support ER-experienced crew onboard, if there are to be any HCPs employed.

A very expensive proposition...
Our eyes are open, our eyes are open--wide, wide, wide...
 
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lightsaber
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 4:24 am

Quoting Ikramerica (Reply 1):

Sounds more like a vested interest trying to force airlines into hiring their profession.

 checkmark 


But maybe this will be a return to the days when F/A's were certified nurses.  Wink Naa... Won't happen.

Quoting TGV (Reply 18):
I spoke once with an AF FA who told me that they usually had not any problem to find a doctor. The flights to/from the US being the most problematic due to the fear of some doctors to be sued after their intervention !

By US law, a doctor (or anyone) performing "good intention" pro-bono emergency care cannot be sued. If there have been exceptions (due to doctors standing by doing nothing because they knew their malpractice didn't cover the event) then the law needs to be changed again.

Lightsaber
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pa201
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 4:31 am

Putting medical professionals on-board long haul flights doesn't seem a practical use of thier skills nor the airlines money. Think about it - what could these professionals really do in an emergency other than provide basic first aid and confirm to the captain that "we need to put down as soon as possible" ? A flight attendant can do that. You don't need a crew of medical professionals added to airlines ranks just for the small, incremental improvement in the on-board rendering of basic first aid/CPR these folks could provide without the benefit of the equipment/drugs/assistants that I think is being envisioned in this thread, and that could never be realistically put onto a commercial airliner. Again, all I see from having these pro's on-board is confirmation that the condition is serious and that the airplane needs to land at once. You don't need doctors to tell you that in most circumstances. Trained FA's are definatly the answer here.
 
ChiGB1973
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 4:56 am

Quoting TGV (Reply 18):
The flights to/from the US being the most problematic due to the fear of some doctors to be sued after their intervention

It is probably fear of not knowing what to do. As Cha747 said, most doctors (no ER's docs  wink  ) would crap themselves if something serious were to arise and require intervention. Granted, the equipment is limited, but quite impressive, at least the ones I have seen.

Quoting MEA-707 (Reply 19):
Still I think airlines should offer some compensation for doctors who help out.
I heard about a doctor on board a BA flight who planned to sleep during the flight, lost 8 hours of rest due to assisting a sick passenger, and was so tired he had to cancel a day of paying patients after arrival. But he didn't even receive a thank you card or flowers from the airline, let alone payment or travel/upgrade credits! BA came with the excuse they didn't want people just cash in on passengers misery.
I can understand if a doctor doesn't identify himself next time, for him it's a job

He should have planned his schedule better. He would have to cancel if the flight were delayed or anything else happened. Honestly, it is about helping someone, not free flights or champagne. This is an ethical argument. One could also argue that receiving any compensation deems him liable for his actions (see below).

Quoting MarkHKG (Reply 20):
Doctor demands payment for helping airline passenger



Quoting MarkHKG (Reply 20):
But Dr Stevens points out that his services were sought by the crew rather than the patient, who told him she was not consulted before the call for a doctor was broadcast. He says that had anything gone wrong, he could have faced a large malpractice claim for which he had since learned he would not have been covered.

He should have stayed sitting on his hands. What an idiot! If anything went wrong? What did he do for the patient, counsel them on dying? He is a shrink. He is already guilty of malpractice and him getting paid for it is going to land him in court. Apparently she looked:

""looked grim [and] had chest pains and breathlessness." She had a history of repeated leg thromboses and had been taking anticoagulants, but the treatment had been stopped."

this only 20 minutes in to the flight. Any doctor with any common sense would have had this plane return immediately. He suspected a pulmonary embolism when boarding and he did not insist on landing immediately for her treatment. He caused harm to that patient if he suggested going on to Chicago - at least 3.5 hours. So, rather than hope the Good Samaritan law would protect him, he wants to get paid so that he is fully liable.

M
 
positiveetco2
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 4:59 am

I am an anesthesiologist. I often wonder what exactly is onboard as far as emergency drugs, IV and airway equipment. The Defib. is great, but what else is available if I am called? Any airline professionals care to comment?

As an aside, as a teenager I watched my father struggle to give chin lift to a German girl onboard an Alaska 727 over Mexico. She was having an anaphylactic reaction to antibiotics she had received just prior to our departure from Puerto Vallarta. As we perfomed this dramatic descent into Mazatlan my father, a dentist, asked for the emergency kit to give the girl epinephrine. He was denied because he wasn't a physician. Then the flight attendant wanted him to put the girl back into her seat for landing. I was never so proud of my father when he told her colorfully that this was not going to happen.
 
Markhkg
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RE: Nursing College: A380 Will Need Full-time Medi

Fri Mar 24, 2006 5:12 am

PositiveETCO2 (are you a colormetric or digital capnometer? Well regardless I've sure you verify that you got into the trachea... )

Emergency Medical Kit contents (Medaire)
http://www.medaire.com/comm_emk_card.pdf

Enhanced Emergency medical kit contents (Medaire)
http://www.medaire.com/comm_eemk_card.pdf

From the Mayo Clinic
http://www.mayoclinic.com/health/heart/WL00027

"If you do experience an emergency related to these or other conditions, know that plans exist to respond to such emergencies. The Federal Aviation Administration requires that major U.S. air carriers have an enhanced emergency medical kit and basic first-aid kit on board. The medical kit includes a stethoscope, a blood pressure device, syringes, needles, a CPR mask, breathing tubes, a self-inflating manual resuscitation device and a few medications. The kit may be opened only when authorized by a doctor, either on board or by telephone.

Commercial air carriers participating in scheduled passenger-carrying activities with more than one flight attendant on board must carry an automated external defibrillator (AED). This portable, computerized device treats sudden cardiac arrest or heart rhythm abnormalities, which may cause inadequate blood flow to your brain and other vital organs."

[Edited 2006-03-23 21:13:15]
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Mudboy
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 5:41 am

Quoting PA201 (Reply 29):
a crew of medical professionals added to airlines ranks just for the small, incremental improvement in the on-board rendering of basic first aid/CPR these folks could provide without the benefit of the equipment/drugs/assistants that I think is being envisioned in this thread, and that could never be realistically put onto a commercial airliner.

Although I have no idea what is currently carried on airliners in the form of an Emergency Medical Kit, given the right advanced medical training of one FA on board, you could greatly increase the survival of someone in a true medical emergency, given they had the proper meds and equipment. Paramedics however, carry with them the right gear to enable them to immediatly treat patients experiencing medical emergencies, and most of the time, initiate the same treatment the patient would recieve at the ER. This is most noted in cases of cardiac arrest, myocardial infarction, and severe allergic reactions, just to name a few. Yes a current FA, or HCP could do CPR or use an AED, but if a person is having an MI(heart attack) and goes into cardiac arrest CPR alone is not going to keep that person alive until the plane gets on the ground. If the person is in V-fib(when the heart stops beating is not pumping and is just quivering,which is shockable heart rhythm treated by an AED),you may get the person's heart back beating, but until you give the person an antiarrhythmic(Lidocaine,Amiodarone),which Paramedics carry in thier bag, the patient will probably keep going into Cardiac Arrest. Given this type of situation, without immediate inervention the chance of survival for this patient is very slim. In a perfect world putting a FA with Advanced Emergency Medical training on flights would make sense and could easily be done with the only equip being a Medic kit and a cardiac mon/defib. But, the obvious problem would be, would this be worth the added cost to airlines, and would we be willing to pay extra money per ticket for this service to be provided? I for one would pay extra per ticket for this service to be provided, knowing what I know being Emergency Medicine is my profession. But, I in no way claim to be expert in the aviation industry and have no idea as to what something like this would cost, or if people would be willing foot this added cost. And we haven't even started to cover the legal aspects of this. Just my thoughts.
 
georgiaame
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RE: Nursing College: A380 Will Need Full-time Medi

Fri Mar 24, 2006 5:50 am

Quoting PlaneHunter (Thread starter):
I bet you can fin a doctor or at least trained professional for virtually every possible problem out of a group of 500

Um, yes, but...

My first in flight call, and I have had several, was above the Atlantic on a packed Swissair 747. 4 others responded, 2 psychiatrists, and 2 gynecologists. I was the only internist, so the others very quickly deferred to me. I was just out of training, so I got the kidney infection. They would not allow us into the almost empty First Class cabin to allow me to do an even rudimentary physical exam. You think flying in a 17" wide seat is difficult? Try playing doctor in one! And the medical kit, I swear, contained enough bandage material to cover most of the passengers in case of a crash. No antibiotics, no real medications at the time other than some pain killers, and really rudimentary equipment. Things have changed a bit, but not too much.

I think that once planes routinely fly with 1000 passengers on board, having a multi-lingual MD is not a bad idea. (And I'm putting in a vote for a lounge area, especially in steerage) For 500 or fewer, if they want to pay me, sure, I'll do it, but I really don't think it is either cost effective or necessary.
"Trust, but verify!" An old Russian proverb, quoted often by a modern American hero
 
positiveetco2
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RE: Nursing College: A380 Will Need Full-time Medi

Fri Mar 24, 2006 6:12 am

Quoting MarkHKG (Reply 32):
(are you a colormetric or digital capnometer? Well regardless I've sure you verify that you got into the trachea... )

Digital of couse! EBBS (equal bilateral breath sounds)

Thanks for the interesting list of equip/meds. I'd like even more. BTW I always tell my wife how impressed I have been with most paramedics and flight nurses I have encountered. Very professional.
 
ikramerica
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 6:18 am

Quoting Tjc2 (Reply 15):
Then of course, if you have ~150 A380 (with hopefully more to come in the future) flying around the skies, that is ~150 nurses who could be doing better things with most of this time?

Best point made. Not just 150 nurses, try 1200 at least. One would assume that 1 plane would need at least 8 nurses available to have 1 able to cover each flight, maybe more.

With the shortage of nurses and other medical care workers, seems awfully wasteful to allocate them to such a situation. Risk management would say their services would be more valuable in hospital ERs...

Quoting MarkHKG (Reply 20):
Then I heard a kerfuffle

I didn't know kerfuffles were allowed on American carriers. We usually only permit a ruckus here and there.

Quoting A319114 (Reply 23):
*sigh* The a380 can land at EVERY airport which can support a 747, it just will have a hard time taxiing here and there.

Mostly true, and really not a big issue. It's an emergency situation, not just a diversion, and one would assume that even if they had to close the runways for a few minutes while you taxied to a remote tarmac, then again when they cleared you for departure, it's worth it to save a life.

Quoting GeorgiaAME (Reply 34):
And the medical kit, I swear, contained enough bandage material to cover most of the passengers in case of a crash. No antibiotics, no real medications at the time other than some pain killers, and really rudimentary equipment.

Sounds like they should invest in better medical kits on flights then.
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CcrlR
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 6:19 am

Quoting Manni (Reply 8):
If you're travelling onboard an A380 mathematically the risk of being encountered with a passenger getting ill is higher, put in similar fashion, chances that a doctor, medic, nurse will be onboard will be higher aswell. If the flightattendant asks for assistance over the PA, I can't imagine that someone who'd qualify to provide assistance would not make her/himself known. And a compensation scheme shouldn't be obligatory...

mabye SQ could try it out with their A340-500's and see if it works and they could be able to use it on the A380 once they start using it. How long has it been since they stopped using nurses on aircraft?
"He was right, it is a screaming metal deathtrap!"-Cosmo (from the Fairly Oddparents)
 
ChiGB1973
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 6:37 am

The one I saw had endotracheal intubation equipment. Meds have expiration dates. Most of the stuff never gets used, except for the occasional band-aid or ibuprofen. That stuff is generally available otherwise as not to break the seal on the enhanced emergency medical kit.

No more than it is used, it would be ridiculous to carry more than what's there. It is more than many ambulances I have seen. Sure, there will be a need for just about any medication in the world on the plane at one time or another, just does not mean it is feasible to have it.

My personal thoughts were that there should be more resuscitation meds on the aircraft. 2 1:10,000 epis is not enough for a cardiac arrest. Of course you can use the 2 1:1,000 epis and that gets you 9 minutes into the arrest once medications starts. Granted, there are 2 atropine getting you 15 minutes into the arrest in the event of asystole or PEA and 2 lidocaines in the event of v-fib or v-tach, still only 15 minutes. Regardless of this, 15 minutes is barely enough time to call the flight deck, much less get Med-Link on the horn, ops, find a diversion airport, descent and land and get an ambulance to the plane. I think there should be an hours worth of these type medications.

There is probably not much hope for the poor soul, but we were required to work the arrest until we turned them over the ambulance personnel. I figure we should give them our all. I know a doctor that arrested when he was in his early forties and it took 45 minutes to resuscitate him, but he was live and well.

M
 
pmg1704
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 6:50 am

Quoting Ikramerica (Reply 1):
Sounds more like a vested interest trying to force airlines into hiring their profession.

I think you are wrong. Considering the extreme shortage of nurses, they don't need more places to find extra vacancies.

See: Nursing shortage fact sheet.
 
okelleynyc
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 6:51 am

Here's my two cents worth.....

I get approached all of the time on international flights whenever a passenger gets sick, but unfortunately for them, I'm an administrator and not and MD. I suppose they look at the flight manifest and see that I'm from an academic medical center and just assume? If they wanted to renegotiate a third party payor agreement, then I'm their man....  Smile

However, I'm usually travelling with an entourage of some of our top clinicians and they are sometimes hesitant to respond because of all of the reasons listed above, i.e. litigation, incomplete equipment/pharmaceuticals, or it's outside of their super specialty.

In my opinion, there is another potential option. Since it seems that everyone here agrees that a generalist/emergency medicine specialist/internist is probably the most appropriate individual, why not do this via telemedicine? The Johns Hopkins Emergency Department did this for a while in support of cruise ships. If a modified crash cart was on board, the ground based physician could, in concert with the other medicos on the flight, administer stablizing aid. The airlines could contract with one or more academic medical centers to provide 24/7 coverage - all done via satellite.

I've been involved in telerobotic surgeries (Hopkins) between Baltimore and Bangkok and this was eight years ago. At New York Presbyterian, we provide remote ICU monitoring and centralized monitoring of all telemetered patients for Columbia and Cornell.

Just a thought.......
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AirTranTUS
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 7:08 am

I think the A345 and 772LR qualify for this more than an A380. 747's have never needed an onboard medic. The A380 can't fly that much farther so IMO it's unnecessary. With more pax, there is an even higher chance of a doctor or two being onboard.
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ltbewr
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 7:09 am

Many workplaces in the USA are now required to have some people trained in first aid, including CPR training. To me at least one f/a with such training should be on each flight. As to medical care and equipment, airlines and the regularatory agencies will do a cost-benefit analysis. You don't need a EMT or = on each flight. Often you have someone on the a/c whom can do some emergency care and many airlines have varying levels of emergency care equipment with some levels of it only accessable with a Doctor's OK. You also have to be concerned with the kit containing items that a hijacker or terrorists could use (sharp surgical knifes, etc). Most of the time the on-board kits and a medically trained pax can give prompt care that will help until one can land to take the stricken pax off and live, but with some flight routes and lengths of flights, that is becoming more difficult.
 
redngold
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 7:11 am

I haven't read any of the other responses, but here's my take on it:

The A380 was originally envisioned as an airliner that could provide luxury service to a smaller-than-capacity group of passengers. It makes sense that any airline which might follow through on the original plan would want to include medical personnel.

I know, I know... everyone here thinks that the A380 will be packed full in the usual sense... I'm just saying...  Smile
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vv701
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 7:27 am

Quoting Ikramerica (Reply 1):
Sounds more like a vested interest trying to force airlines into hiring their profession.

Otherwise why would a professional body,whose raison d'etre is to promote the profession, even think of such a thing?

Quoting Alaskaqantas (Reply 2):
why not train certain Flight attendants

When I was young I knew a young lady who wanted to be an FA and had been trained as a nurse and was welcomed with open arms to work for BOAC on their DC7C fleet. At that time the airline tried to recruit such people (probably because in the much smaller aircraft of those days the chances of a doctor or nurse being amongst the passengers was more remote).

Quoting Pmg1704 (Reply 39):
think you are wrong. Considering the extreme shortage of nurses, they don't need more places to find extra vacancies.

They may be scarce but there is the law of supply and demand. If the number of posts for nurses increase and there is no equivalent growth in the number of nurses available the relative scarcity of this resource will tend to increase the pay of ALL nurses compared to the rest of the community. They may not need more places but I am sure they are interested in a salary increase.
 
Mudboy
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 9:16 am

Quoting Pmg1704 (Reply 39):
I think you are wrong. Considering the extreme shortage of nurses, they don't need more places to find extra vacancies.

I would like to make something clear to those out there that are misinformed about nurses. NURSES ARE NOT TRAINED TO WORK IN SITUATIONS LIKE THIS!! Before I make any fellow RNs mad, let me say, I am a Paramedic and RN. Nurses are trained First, in long term clinical care of a patient. They are taught very little about Emergency Medical Care. When they get out of school and go to work in areas like ER, OB, etc. they take classes like ACLS(Advanced Cardiac Life Support), PALS( Pediatric Advanced Life Support) and so on, where they learn more in depth emergency care. Paramedics on the other hand, are taught to multi-task and maintain focus in a total chaotic environment. They are taught to perform skills that nurses cannot do such as, Airway Intubation,Chest Decompression, Surgical Airways, Giving Meds, just to name a few, all WITHOUT the direct supervision of an MD. As MarkHKG stated, In some states Paramedics give Thrombolytics, start central IV lines and insert Chest tubes, all of which could only be performed by MDs and DOs. This is no way a knock on nurses, for I am one, they serve an important purpose, just in a different environment.
 
madairdrie
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 9:44 am

Just a little question that I have just thought of from reading the above - maybe I should start another thread but if someone Can answer it here then there is no need.
A few people have mentioned a reason for carrying a medic on board the A380 is that there are a limited number of airports that it can land at - so it will not be able to do medical emergencies everywhere. The example stated was that JFK is not A380 ready yet. What I was wondering was - the airports that are not 380 ready yet like JFK, would they be able to take a 380 in an emergency situation? For example I know Glasgow is not 747 certified (unless not fully laden) but I also know there have been a few 747's over the years that have put down in Glasgow due to emergencies - the one that springs to mind was a BA 747 that had left LHR and there was some bomb scare which ultimately proved to be unfounded and for the investiagation it landed at Glasgow.
Clearly some airports will always be unable to take the A380 just like some are always going to be unable to take the 747 but are airports like JFK able to take the A380 in emergency circumstances, even if maneuvering around taxi ways would be complicated?
I think the above makes sense!
Kenneth
 
aa757first
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 9:52 am

Quoting CRJ900 (Reply 24):
Me, working at the gastronsurgery division, would be hesitant if someone has a heart attack, because I haven't dealt with any patients that have had one and would be unsure of what to do...

If you don't know basic First Aid for a heart attack, you should not be a nurse.

Quoting RichM (Reply 25):
I nthink the logical answer would be to make F/A's do first aid training, training specifically designed for offering in-flight first aid.

Already done.

Quoting GeorgiaAME (Reply 34):
I think that once planes routinely fly with 1000 passengers on board, having a multi-lingual MD is not a bad idea. (And I'm putting in a vote for a lounge area, especially in steerage)

A doctor? No way, that would be too expensive. A nurse? Maybe. But I don't think it's necessary. All a flight attendant really needs to be able to do is to perform CPR and use the AED, which is FAA required.

AAndrew
 
manni
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 9:59 am

Any airport that can take the 747 should be able to take the A380, atleast as far as landing and take off goes, aswell as tarmac strenght. When an airport is said to be not "A380 ready", it's often a terminal with jetbridges, capable of loading/unloading an A380 that is missing. Mobile stairs and remote stands solve that problem, wich are being used just about everywhere. JFK not being able to take in an A380, absolutely ridiculous...
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centrair
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RE: Nursing College: A380 Will Need Full-time Medic

Fri Mar 24, 2006 10:22 am

My father is a doctor (specialist) and my mother is a nurse (now teaching).

My father even though he is 66 years old, responds to what his hospital terms a Doctor 6...serious emergency. With Air Force Training, special training at Cook County, and intern at Cleveland, he was ready for anything thrown at him. I flew with him on a flight to Europe once when he responded to a call. Without even thinking, he was up and out of his seat ready to do his job. He can sleep anywhere, go deep and come right out at the sound of a phone or the word "Doctor". He always says, "I am a doctor, if someone needs a doctor I will do my job." He never got huge amounts of money but got something he valued more, respect.

My mother was trained in Cook County and worked in the projects as a public health nurse. She left nursing when she had kids but maintained studies and her license. I witnessed her stop at a car accident to do preliminary assessment and assistance. One a flight to Paris once, she actually answered a call for a doctor. Though she is not a doctor, she felt that it is her job to lend a hand in the situation. Now she is 63 and does health training but still believes that it is the job of medical professionals to do their job regardless of money. They are to give assistance and do what they can in what ever situation. When she travels, she wears her University of Illinois School of Nursing pin. The Caduceus as the mark of a medical professional helps her to be identified quickly.

Be it a CRJ or an A380, doctors on board should give help no matter what. My father would say, if the airline and the patient said, "thank you", it would be enough for him. He is proud to be a doctor and to do his job. All doctors should remember the oath they took and follow it.

Should their be Flight Attendants with medical training? YES. Basic EMS or Advanced First Aid. But the best they can do is assit.
Should Doctors get money or discounts for saying they are a doctor and will give service if asked? NO. They should do it no matter what. But if they do give assistance, they should be thanked for public service and if they choose to escort the patient to the hospital, the airline should reschedule his/her ticket and offer an upgrade for the rescheduled flight.
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