Doctor on Board, Are you ready?

"Is there a doctor on this flight?" Those words can strike fear in the hearts of a passenger--even one who is a physician. What about liability? What equipment is available?

 Such instances are rare but occasionally passengers get ill during a flight, sometimes seriously so. An estimated medical emergencies occur in roughly 1 out of 600 commercial flights and 44,000 in-flight medical emergencies occurring worldwide every year, according to a 2013 study published in the New England Journal of Medicine.

Actually, no requirement to record such incidents, no-one can be sure exactly. Especially as the most common illness on-board is fainting, which is likely to go unreported.

the top five events on board Frontier aircraft are vasovagal events, respiratory distress (usually from changes in altitude and cabin pressurization), cardiac events, neurological events, and gastrointestinal events.

 Cabin crew must dread having to make the announcement requesting emergency medical assistance but at times it is necessary. Should there be a doctor among the passengers on a flight, they can be called on to deal with anything from minor incidents, including panic attacks, and back pain, to strokes and heart attacks. Some doctors don't like entering territory beyond their immediate realm of expertise.

Liability protections exist for medical personnel who volunteer to provide assistance on aircraft in the event of an emergency. According to the Aviation Medical Assistance Act of 1998,1 "An individual shall not be liable for damages in any action brought in a Federal or State court arising out of the acts or omissions of the individual in providing or attempting to provide assistance in the case of an in-flight medical emergency unless the individual, while rendering such assistance, is guilty of gross negligence or willful misconduct."

 While some countries have duty-to-respond regulations that will apply to their airline carriers, US carriers depend on volunteers. A physician needn't be trained in emergency medicine to provide valuable assistance.

Some countries obliged the cabin crew to carry a minimum requirements of medical kits. This will enable doctors on-board to act in a right and easy way. The emergency medical kit and other medical equipment is provided in order to respond to an unplanned medical emergency (not for medical needs that can be anticipated pre-flight, i.e. passengers with known medical conditions should bring their own medical supplies in their carry-on luggage and not rely on aircraft emergency equipment) 

 Here is a Guidance (Produced by: Aerospace Medical Association Air Transport Medicine Committee)

 Summary Checklist for volunteer medical professionals

This checklist is provided to assist volunteer medical professionals that consider responding to a request for medical assistance.

1.  Before flight, consider the possibility that you may be asked to provide on board medical assistance.
2.  Decide if you are in a proper condition to respond to a medical emergency (e.g. if you have consumed a significant amount of alcohol, it may be inappropriate to respond to an emergency).
3. Ask to see information provided by the airline to volunteer medical professionals (if available) e.g. information on liability
4. Identify yourself and offer proof of credentials if you have them.
5. If the situation appears to be serious, inquire if the airline has a contract with a medical ground support company. If so, ask that they be contacted to bring them into the loop as early as possible. Even if you are an emergency qualified physician the support of the ground company may become very helpful - in case of diversion for instance - since they are familiar with the availability of ground based medical facilities.

 MEDICAL EMERGENCIES: MANAGING IN-FLIGHT MEDICAL EVENTS

1. Request the emergency medical kit if one is available (small aircraft or those flying short-haul routes may not have an emergency medical kit). Inquire if telemedicine equipment is available (although most aircraft do not have such facilities). If the ill traveler has arrested, the cabin crew will normally provide an AED when one is available. If not provided, ask if one is available.
2. Request that at least one cabin crew member remain available to answer your questions, to help with procedures, to communicate with the pilots, etc. If necessary, ask for an interpreter.
3. When possible and if appropriate, treat the traveler whilst seated. If he needs to be horizontal, request that he be transported to where the intervention will interfere the least with mobility of the other cabin crew and the passengers.
4. If resuscitation is required and you are presented with a "Do Not Resuscitate" order by the accompanying family member or friend, first decide if that is acceptable to you; note that if it is, the cabin crew may decide to continue resuscitation on their own if it is their company policy and/or ask for another volunteer medical professional.
5. Document your findings and treatment, preferably on the airline form if one is available. Keep your own personal copy.
6. Do not attempt to practice beyond your level of expertise, but remember that whatever your level of expertise is, it is better than any non-health professional and your help may be very valuable.

 Here is some experiences of many doctors and nurses who found themselves in this situation

https://www.abc.net.au/news/health/2017-07-31/is-there-a-doctor-on-the-plane/8650044

 Bottom Line

As the rate of air travel increases, emergency medical providers are increasingly likely to encounter an in-flight emergency. Providers have extensive legal protection when helping with these cases and should not hesitate to offer assistance when they are able.

 References

1. https://www.medscape.com/viewarticle/849853
2. https://www.telegraph.co.uk/travel/travel-truths/what-happens-in-the-case-of-a-medical-emergency-in-the-air/
3. https://www.acep.org/Clinical---Practice-Management/Emergency-at-30,000-Feet---What-You-Can-Do/
4. https://www.congress.gov/105/crpt/hrpt456/CRPT-105hrpt456.pdf