October 2024 President’s Message

October 2024 President’s Message

Answer the call during an in-flight emergency

by Howard Chang, MD —

Have you ever heard the dreaded announcement: “Is there a doctor on board? If so, please hit your call light!” It’s a call that many physicians both anticipate and fear.

A few months ago, while I was returning home from an emergency medicine conference, an elderly individual suffered a syncopal episode and became unresponsive in the aisle. The flight crew made the announcement, and I responded. Fortuitously, there were two other board-certified emergency medicine physicians on this flight who also responded, including my colleague and fellow MSSC member Dr. Matthew Sinnwell. That day, the odds were in our favor.

The passenger eventually regained consciousness and was fine. However, I was left frustrated. In today’s day and age, one would expect that something as basic as a pulse oximeter would be available on an airplane. While we all learned how to take a manual blood pressure, trying to obtain an accurate reading in the cacophony of airplane engines combined with a crying infant, using a plastic “Mattel-grade” stethoscope proved nearly impossible.

This experience brought to mind another in-flight emergency I once managed. On a flight from Kuala Lumpur to Los Angeles, somewhere in the middle of the Pacific, I was “summoned” to assist a passenger with uncontrollable nose bleeding. The airplane lacked the necessary supplies, so I improvised by coating some 2-by-2-gauze with topical antibiotic ointment, then used a flimsy plastic coffee stirrer to pack his right nasal passage. Remarkably, it worked, but the experience left much to be desired.

If you’re interested in what Southwest Airlines had in its medical kit, I’ve included in this column a photo we took.

It’s no surprise that many physicians are hesitant to volunteer for in-flight medical emergencies (IMEs). According to a 2013 New England Journal of Medicine review of nearly 12,000 ground consultations from five large domestic and international airlines, IMEs occur on 1 in 600 flights. Also, it turns out about 50% of these IMEs are responded to by physicians.

If you find yourself in this situation, it’s important to understand the legal considerations. The Aviation Medical Assistance Act (AMAA) of 1998 protects medical professionals who provide good-faith care during in-flight emergencies. The AMAA mandates that all aircraft be equipped with basic medical supplies, though it seems to vary.

In the United States, physicians are protected from damages in federal or state courts unless gross negligence or willful misconduct is proven. To date, no case has been won against a physician responding to an IME. In fact, only one lawsuit has ever been filed, and it was dismissed before trial.

The AMAA also protects Good Samaritans who are medically qualified, act voluntarily and in good faith, and do not receive monetary compensation. While nonmonetary tokens of gratitude ó such as miles, alcohol, chocolates or seat upgrades ó are not explicitly covered in the AMAA, they are generally viewed as gestures of appreciation rather than compensation. To avoid any ambiguity, you might choose to decline such gifts.

As a side note, before responding to an IME, the first person you must assess is yourself. Assess whether you have the capability and wherewithal to practice medicine at 30,000 feet. Did you just have a drink at the airport lounge? Did you just take an Ambien to get some shut-eye? Are you gravely jet-lagged? If you’ve taken something, you may not have the alertness and judgment necessary to provide medical care, so it may be best to refrain from offering your assistance.

When responding to an IME, follow standard medical practices. Obtain permission and consent from the passenger, document the consent, and also document the entire encounter. Do it on a napkin if you have to.

Also, don’t forget that many airlines have Ground-Based Medical Support (GBMS) available for consultation. If you need extra hands, you can request help from the flight crew or any other passengers with medical training, such as a nurse or paramedic. The decision to divert the flight rests with the captain or GBMS. You can make a recommendation for diversion, but the ultimate decision is theirs. Lastly, be aware that airlines may not reimburse you if you miss a connection or incur additional travel expenses when you spend time helping a fellow passenger.

All flights these days will stock an automated external defibrillator, a first aid kit and a few medications; however, it is fairly limited. I’ve responded to four IMEs now, and those may be the only times I’ve taken a manual blood pressure since graduating from medical school. I am far more used to the automated BP machines we see in our offices and hospitals.

After working the IME on my recent flight, both Dr. Sinnwell and I wrote to the airline asking it to please include a pulse oximeter in its medical kits. After all, your oxygen saturation level is a vital sign. In the meantime, I’ve been flying with my COVID-purchased pulse oximeter and a nasal clamp in my carry-on, just in case.

Lastly, I’d like to reiterate that it’s highly unlikely that you will be sued (especially successfully sued) if you volunteer to help during an IME. As long as you provide reasonable care, you will be safe. And I can assure you, the passengers, their family and the airline are very appreciative of your medical assistance.

So, please consider lending your expertise in times of need. It is simply the compassionate and right thing to do.

Happy travels!