Is there a doctor on board?

[LUCPM]

A silly question out of curiosity:

As an intern, are you obligated to respond to in-flight emergencies? In other words, is it illegal not to respond to such emergencies?

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[VA Hopeful Dr]

A silly question out of curiosity:

As an intern, are you obligated to respond to in-flight emergencies? In other words, is it illegal not to respond to such emergencies?

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Nope, not illegal for a fully licensed physician to not respond either.

 

[BoardingDoc]

Nope, not illegal for a fully licensed physician to not respond either.

This is true in the United States. Just to elaborate on this a little bit:

Most people cite Good Samaritan laws in these cases. The deal with good sam in the US is variable. E.g. the specifics will vary from state to state. That said, the general theme is that if you are a trained responder and you attempt to render aid, and something terrible happens to that person: you cannot be held liable provided you did not commit gross negligence. Again, the fine print will vary from state to state. That said, a universal truth about these laws is that you are NOT REQUIRED to render aid. Technically speaking, if you're an off duty doctor and you see someone have a cardiac arrest, you are not liable if you decide not to perform CPR. (again, see local statutes for minor variations. E.g. in some states you are required to at least call 911.)

As for DUTY TO RESCUE: This does not exist in the USA. There are, however, several countries where if you are a qualified professional and you are able to render aid you must do so.

 

[Raryn]

A silly question out of curiosity:

As an intern, are you obligated to respond to in-flight emergencies? In other words, is it illegal not to respond to such emergencies?

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Not in this country.

The only thing I'd add is: If you do provide aid, under no circumstances should you accept *any* form of reimbursement. Good Samaritan laws protect you from liability, if and only if you do not form a business relationship with the patient. If they offer you a gift out of gratitude, say thanks but no thanks. Opens you up to liability.

 

[GoWiththeFlo]

I have seen someone receive a complimentary bottle of wine from the flight attendant to thank the Dr. or medical person.

Actually, there is not much you can do for the person. It is noisy from the engines and I doubt you could hear pulmonary or heart sounds or hear them well enough.

The real real crunch time is if the flight crew asks the Dr. if this is an emergency and should land the plane.

 

[racerwad]

I have seen someone receive a complimentary bottle of wine from the flight attendant to thank the Dr. or medical person.

Actually, there is not much you can do for the person. It is noisy from the engines and I doubt you could hear pulmonary or heart sounds or hear them well enough.

The real real crunch time is if the flight crew asks the Dr. if this is an emergency and should land the plane.

Technically, each airline service makes the decision to divert or land internally, not at the request of a physician on board the plane. The airlines have their own medical control that you would get put in contact with in flight. A discussion is had, you present your findings, and the airline makes the decision if, where, and when they are going to divert. The costs of diverting to the airline are substantial, both in time and actual $$$ so the airlines do not take diversion lightly. All you need to do as a physician on board a plane w/ a medical emergency is render the best care you can in those circumstances and politely decline any and all gifts/compensation (to remain compliant w/ Good Samaritan laws as above).

 

[Crayola227]

not illegal to not render aid

however, I have heard of lawsuits being brought and won against physicians who stood by and did nothing

if it were me I would rather rely on Good Sam laws to protect me for trying to help than assume that a jury is going to understand my CYA move to do nothing in the other instance

it's key to make clear to all involved exactly what level of training/expertise you have and to point out that they have the option of not accepting care or advice from you

 

[Raryn]

not illegal to not render aid

however, I have heard of lawsuits being brought and won against physicians who stood by and did nothing

This is not possible unless you have some kind of duty to the patient. If you have no relationship with the patient before or after, you cannot be sued.

 

[CptCrunch]

There was a NEJM review article on this topic:
http://www.nejm.org/doi/pdf/10.1056/NEJMra1409213

 

[Sea_Bass]

If someone needs help and you ignore them, you're a pretty crappy person regardless of the laws IMHO.

Grow a pair and help someone if they need it.

 

[link2swim06]

These types of situations are pretty limited in terms of what you can do. The actual sick patient don't need a doctor on a place, they need a ER.

The amount of equipment will vary significantly based on airplane size, airline, etc. You aren't going to be placing a central line, pressors, and REBOA. Rather you will be giving maybe a Zofran and maybe an IV with IV fluids.

I guess in the rare chance of cardiac arrest you might get to do your BLS skills for awhile.

And if you did have a real emergency at full altitude, it is going to take awhile to actually find an airport, descend safely, land, and bring EMS on board to assume care of the patient.

 

[Merely]

Someone just said that if you stand by you can be sued? Why are people above saying that and is that even true? Moreover, it kind of is annoying that if you save someones life and they offer you a nice gift you have to turn it down...

 

[gutonc]

Someone just said that if you stand by you can be sued? Why are people above saying that and is that even true? Moreover, it kind of is annoying that if you save someones life and they offer you a nice gift you have to turn it down...

You don't "have" to turn it down. But if you accept it, and they later go on to have a serious complication from that event...no matter how amazingly you performed at the time...you have now established a doctor/patient relationship with them and you are potentially legally liable. Since you would be practicing 3rd world medicine in a first world (OK, fine...American) legal climate, most of us would say that they'd have to offer you a 6-7 figure "gift" to make it worth accepting it.

Now, as to whether or not you can accept a "token of appreciation" from the airline, I think that's a little more up in the air (I crack me up). But the way airlines treat their customers these days, unless you deploy a stent across a 99% occluded LAD in row 29 and prevent them from having to divert that plane to Akron for the STEMI, the most you're likely to get is a free drink and a credit for a free checked bag on your next flight.

 

[Siggy]

These types of situations are pretty limited in terms of what you can do. The actual sick patient don't need a doctor on a place, they need a ER.

The amount of equipment will vary significantly based on airplane size, airline, etc. You aren't going to be placing a central line, pressors, and REBOA. Rather you will be giving maybe a Zofran and maybe an IV with IV fluids.

There's more in those kits than one would guess. Sure, it's not a flying cath lab, but it's more than zofran and a bag of NS.
https://www.acep.org/Clinical---Practice-Management/Be-Prepared-for-In-Flight-Medical-Emergencies/

 

[styphon]

not illegal to not render aid

however, I have heard of lawsuits being brought and won against physicians who stood by and did nothing

In the United States a key part of malpractice is a "duty to act", without this there is no lawsuit. If you are eating at a restaurant and someone chokes, you literally can sit and do nothing. Sure you will be a horrible person, but you are clear in the courts. The problem is if you DO have a duty to act -> you must act, and this is were the lawsuits come in.

 

[RadOncDoc21]

Especially since we live in a world where people are already suing starbucks over too much ice in their drink. Not saying I won't help but I will be more selective.

http://www.reuters.com/article/us-starbucks-lawsuit-idUSKCN0XT1V4

 

[Mad Jack]

not illegal to not render aid

however, I have heard of lawsuits being brought and won against physicians who stood by and did nothing

if it were me I would rather rely on Good Sam laws to protect me for trying to help than assume that a jury is going to understand my CYA move to do nothing in the other instance

it's key to make clear to all involved exactly what level of training/expertise you have and to point out that they have the option of not accepting care or advice from you

I usually need to have a few drinks to fly- planes make me nervous as all hell- so while I would normally help a person in need, I'd be setting myself up for gross negligence if something were to go wrong given that Good Samaritan laws stop at that point. Hope I never have to have that dilemma sorted out in real time...

 

[link2swim06]

There's more in those kits than one would guess. Sure, it's not a flying cath lab, but it's more than zofran and a bag of NS.
https://www.acep.org/Clinical---Practice-Management/Be-Prepared-for-In-Flight-Medical-Emergencies/

I am not sure that kit is available on all planes. I have heard there is great variety depending on the flight.

 

[Mad Jack]

I am not sure that kit is available on all planes. I have heard there is great variety depending on the flight.

"Basic life support cards
Advanced life support cards"

Looks like they're ready for derm! I joke, I joke...

 

[shoal]

in minnesota there is a duty to act and you can be held liable. https://www.revisor.mn.gov/statutes/?id=604a.01

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[Siggy]

I am not sure that kit is available on all planes. I have heard there is great variety depending on the flight.

Here's the FAA's required kit. If the plane doesn't have at least these components, then it shouldn't be flying.

https://www.law.cornell.edu/cfr/text/14/part-121/appendix-A

 

[FutureInternist]

If someone needs help and you ignore them, you're a pretty crappy person regardless of the laws IMHO.

Grow a pair and help someone if they need it.

With the way people are sue happy in USA (even though it's their own fault) it may not be worth it to help (as sucky as that is, MY family comes before others)

http://upgrd.com/matthew/family-sues-us-airways-and-clt-for-death-of-son-a-wheel-well-stowaway.html

http://www.sitcomsonline.com/boards/showthread.php?t=208739

As above, whatever you decide to do (help or no help) NEVER take ANYTHING for it (even a free drink) since then you can be on the hook for the outcome

 

[Apollyon]

When I lived in Hawai'i, my hospital was the closest to HNL, and 4 times I had 5 patients (one was a two-fer), and none - all of which turned the plane around before the halfway point to the mainland) - ever needed surgery, to be admitted, or even any extensive workup. One of the two-fer was a REALLY attractive European woman with one the UGLIEST tattoos I'd ever seen, and she thought it might be infected (it was) and if she needed to be seen (in the ED, probably not). Since the plane was already turned around and on its way, she just figured to take advantage.

I figured that, if the plane got turned around, the people that needed to be rebooked (around 150 to 200 each time) would be REALLY pissed, and, if they found out how trivial was the "emergency", they might kill the person.

At the same time, I flew a friend in who is a paramedic, and, when she was flying back, there was a guy that looked like he was in cardiogenic shock. Since this didn't manifest until after the halfway point, he got off the plane at wherever it was (LA or SF or Portland or SeaTac or wherever). For a 4 year period, I flew enough on Northwest and Delta to be "platinum", and I never once was paged overhead for a doctor on board. One time, I was talking to a flight attendant, and a mother said that her son had a problem, but it was just air in his lacrimal apparatus after he sneezed.

 

[TooMuchResearch]

I have seen someone receive a complimentary bottle of wine from the flight attendant to thank the Dr. or medical person.

Actually, there is not much you can do for the person. It is noisy from the engines and I doubt you could hear pulmonary or heart sounds or hear them well enough.

The real real crunch time is if the flight crew asks the Dr. if this is an emergency and should land the plane.

But do you really need those to respond to an in flight emergency?

 

[Crayola227]

like one poster pointed out, you just want to be sure there's no "duty to act" laws or precedent in your state

even if there isn't, I think you should also see what your state licensing board's take on all of it is

you can get in trouble with the licensing board for conduct that is technically legal, so if you do stand by and watch someone choke to death and not attempt to give them the Heimlech and someone brings a complaint against you to the medical board, you might want to get a sense of how that's going to fly

nevermind if the media gets a hold of the story

for all of the above, and the Good Sam laws, I figure I'm safer offering to render some sort of aid

 

[NotAProgDirector]

If you're flying in a plane, exactly what "state" are you in? The one you started in? The one you're landing in? The one you're over? The one the airline is based in?

 

[Raryn]

If you're flying in a plane, exactly what "state" are you in? The one you started in? The one you're landing in? The one you're over? The one the airline is based in?

It's complicated. Depends on where the plane is and where it's registered. Generally speaking, if it's in the air, the laws of wherever the plane is registered apply. The relevant treaties are 50 years old at this point, but I think they apply domestically as well.

 

[calvnandhobbs68]

in minnesota there is a duty to act and you can be held liable. https://www.revisor.mn.gov/statutes/?id=604a.01

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Guilty of a petty misdemeanor, oh no. There are speeding tickets more serious than that. Shouldn't really impact your decision one way or the other.

Also remember the Good Samaritan laws almost universally include this little section:
"unless the person acts in a willful and wanton or reckless manner in providing the care, advice, or assistance."

 

[galactus]

This is why I'm a Mr. and not a Dr. on my frequent flyer miles. Not messing with it.

 

[Raryn]

This is why I'm a Mr. and not a Dr. on my frequent flyer miles. Not messing with it.

Eh, even if you're doctor, you could be a doctor of English literature. Or a pathologist. Unless they wanted a stat analysis of the themes of a piece of literature or an autopsy, both would be of roughly equal utility on a flight (unless the pathologist was still close enough to medical school to remember some basics, but even that...).

 

[SitraAchra]

I had always wanted to respond to an emergency on a plane and just a few months out of residency I got my chance. Overnight trans-atlantic flight to London, they overhead page for a doctor. I pushed my call light and the attendant showed me the patient. Some 2+ lower extremity edema in a lady who takes oral steroids for an eye condition. I took a set of vitals and had her lay all the way flat (she got a first class cabin out of this!) and elevated her legs above her heart. Basically I saved her life. I got a thank-you email from British Air.

 

[Dr Tony T. Chopper]

I had always wanted to respond to an emergency on a plane and just a few months out of residency I got my chance. Overnight trans-atlantic flight to London, they overhead page for a doctor. I pushed my call light and the attendant showed me the patient. Some 2+ lower extremity edema in a lady who takes oral steroids for an eye condition. I took a set of vitals and had her lay all the way flat (she got a first class cabin out of this!) and elevated her legs above her heart. Basically I saved her life. I got a thank-you email from British Air.

That must have been memorable. How did the passengers react?

 

[Cinclus]

I usually need to have a few drinks to fly- planes make me nervous as all hell- so while I would normally help a person in need, I'd be setting myself up for gross negligence if something were to go wrong given that Good Samaritan laws stop at that point. Hope I never have to have that dilemma sorted out in real time...

I put myself into a Dramamine coma each time I fly, because I have a tendency to become airsick. It makes me pretty drowsy and dopey. For this reason, I hope to never be asked to assist someone while onboard a plane. I am pretty sure I could still do BLS in the near-zombie state, though.

 

[SitraAchra]

That must have been memorable. How did the passengers react?

As you would expect. The captain broadcast over the PA that "a real hero is aboard today. We all know angels can fly...and sometimes *voice cracking fighting back tears* ...sometimes they fly British Airways."

Then the entire crew lined up on the Tarmac and shook my hand, while top gun theme played in the background.

 

[Dr Tony T. Chopper]

As you would expect. The captain broadcast over the PA that "a real hero is aboard today. We all know angels can fly...and sometimes *voice cracking fighting back tears* ...sometimes they fly British Airways."

Then the entire crew lined up on the Tarmac and shook my hand, while top gun theme played in the background.

Didn't even break out the confetti. Typical British Airways hooligans.

 

[DrMikeP]

Much of this problem of variation in Good Samaritan Laws could easily be fixed in the US with a Federal Law protecting doctors/other healthcare practitioners from lawsuit if the helping response is within reason, unless the state law is more protective of physicians. So why doesn't the US federal government act? Because it's filled with lawyers who oppose anything that might limit lawsuits. There is absolutely no reason such a law couldn't be passed!!!

My malpractice insurance recommends against helping anyone unless they are officially my patient. It actually excludes coverage in such situations if I provide care to someone unless the patient consents (officially becomes my patient) or if I'm functioning in professional capacity and the patient is unable to consent due to psychiatric or health issues. They basically are excluding good samaritan activities, because that is not me acting in my professional capacity.

I'm all for helping others, but help at your own risk. Would I help or stand by and not help, depends on the situation.

 

[Crayola227]

my school had provided some sort of paper on the stats about good sam cases and malpractice but I dont remember or practice EBM on SDN

basically, doctors are rarely ****ed over in these circumstances from what I recall

they cautioned us more against what can happen to us if we didn't act which in itself I sort of took as what their attitude was that I should abide by
I would talk to my institution, cuz like I said I'd be more worried what the medical board and my school/credentialing hospital would think if I did dick

who I fear in order of fear to my long term career (anyone lower on the list than someone else is lower because they have to turn someone higher on the list to screw you, unless they have independent powers to screw you, the top 5 can basically do it with minimal help from outside parties). I just made this list and I have to say I find it ironic that patients are at the bottom.
School Admin/PD
Medical Board
Attendings
Hospital
Juries
Lawyers
Nurses
Residents
Patients

 

[NickNaylor]

A few months ago I was at the dog park with my wife and dog. My dog and another dog were running around chasing each other when they bowled into an older woman that was standing around in the field. She fell, there was a loud snap, and she started screaming in pain and grabbing her ankle. Likely ankle fracture.

Other than ask her if she was ok - which she obviously was not - I didn't "out" myself nor did I mention that I was a physician. First, I'm a psychiatrist, not an orthopedist. Second, I had essentially zero orthopedics training in medical school, and other than saying, "yup, that's broken, you should go to the ER" there's absolutely nothing that I can offer this woman in that moment that I can't offer as a non-professional bystander. Third, there was a hero "physical therapy guy" who decided he was going to save the day and figure out what was going on. He very likely did know more about fractures than I did. I just didn't see the point.

If I can somehow be useful in a situation then I'm happy to volunteer myself. But as has been said you are not compelled to act, and unless you get some kind of rush from saying, "stand back, I'm a doctor!" I don't see the point if you can't meaningfully provide any care apart from "yeah, you need to go the ER" or, even better, calling 911.

 

[Merely]

A few months ago I was at the dog park with my wife and dog. My dog and another dog were running around chasing each other when they bowled into an older woman that was standing around in the field. She fell, there was a loud snap, and she started screaming in pain and grabbing her ankle. Likely ankle fracture.

Other than ask her if she was ok - which she obviously was not - I didn't "out" myself nor did I mention that I was a physician. First, I'm a psychiatrist, not an orthopedist. Second, I had essentially zero orthopedics training in medical school, and other than saying, "yup, that's broken, you should go to the ER" there's absolutely nothing that I can offer this woman in that moment that I can't offer as a non-professional bystander. Third, there was a hero "physical therapy guy" who decided he was going to save the day and figure out what was going on. He very likely did know more about fractures than I did. I just didn't see the point.

If I can somehow be useful in a situation then I'm happy to volunteer myself. But as has been said you are not compelled to act, and unless you get some kind of rush from saying, "stand back, I'm a doctor!" I don't see the point if you can't meaningfully provide any care apart from "yeah, you need to go the ER" or, even better, calling 911.

That's good that we are not required to act under the law tho

 

[alpinism]

Had one last year on a flight to Seattle.

Teenage girl who had an episode of syncope after getting up to go to the bathroom. Luckily she came around after about 30 seconds. Didn't end up doing much beyond taking vitals and doing a quick physical exam. Everything was normal so I just gave her some oxygen, water, and crackers. That being said, it would have been nice to check her glucose as well (their med kit was pretty impressive and included IV dextrose but no way to do a BGL check).

Ended up getting a free plane ticket voucher from Alaska Airlines.

As a side note, the previous posters are correct. The stethoscope is basically useless because of the engine noise. You have to take the BP by palpation.

 

[rokshana]

Had one last year on a flight to Seattle.

Teenage girl who had an episode of syncope after getting up to go to the bathroom. Luckily she came around after about 30 seconds. Didn't end up doing much beyond taking vitals and doing a quick physical exam. Everything was normal so I just gave her some oxygen, water, and crackers. That being said, it would have been nice to check her glucose as well (their med kit was pretty impressive and included IV dextrose but no way to do a BGL check).

Ended up getting a free plane ticket voucher from Alaska Airlines.

As a side note, the previous posters are correct. The stethoscope is basically useless because of the engine noise. You have to take the BP by palpation.

can always have the flight attendant ask if anyone has a glucometer...i'm sure there had to be someone on board that had one.

 

[tkim]

my school had provided some sort of paper on the stats about good sam cases and malpractice but I dont remember or practice EBM on SDN

basically, doctors are rarely ****ed over in these circumstances from what I recall

they cautioned us more against what can happen to us if we didn't act which in itself I sort of took as what their attitude was that I should abide by

this is garbage

 

[alpinism]

can always have the flight attendant ask if anyone has a glucometer...i'm sure there had to be someone on board that had one.

Very true.

 

[Siggy]

Much of this problem of variation in Good Samaritan Laws could easily be fixed in the US with a Federal Law protecting doctors/other healthcare practitioners from lawsuit if the helping response is within reason, unless the state law is more protective of physicians. So why doesn't the US federal government act? Because it's filled with lawyers who oppose anything that might limit lawsuits. There is absolutely no reason such a law couldn't be passed!!!

There's also the fact that there's no part of the Constitution that allows the Federal Government to make such a straight forward law.

 

[NotAProgDirector]

A few months ago I was at the dog park with my wife and dog. My dog and another dog were running around chasing each other when they bowled into an older woman that was standing around in the field. She fell, there was a loud snap, and she started screaming in pain and grabbing her ankle. Likely ankle fracture.

Other than ask her if she was ok - which she obviously was not - I didn't "out" myself nor did I mention that I was a physician. First, I'm a psychiatrist, not an orthopedist. Second, I had essentially zero orthopedics training in medical school, and other than saying, "yup, that's broken, you should go to the ER" there's absolutely nothing that I can offer this woman in that moment that I can't offer as a non-professional bystander. Third, there was a hero "physical therapy guy" who decided he was going to save the day and figure out what was going on. He very likely did know more about fractures than I did. I just didn't see the point.

If I can somehow be useful in a situation then I'm happy to volunteer myself. But as has been said you are not compelled to act, and unless you get some kind of rush from saying, "stand back, I'm a doctor!" I don't see the point if you can't meaningfully provide any care apart from "yeah, you need to go the ER" or, even better, calling 911.

You may be protected by the Good Sam laws for medical care, but she can sue you for her ankle fracture from your dog injuring her...

Ended up getting a free plane ticket voucher from Alaska Airlines.

This is a very bad idea. To repeat what's already been on the thread, taking ANY compensation completely voids any Good Sam protection you have. Afree flight, seat upgrade, or a free drink coupon, or a free pillow -- it doesn't matter. Once you take anything, you are no longer a Good Sam. You are being paid. And your med mal may or may not cover you.

 

[NickNaylor]

You may be protected by the Good Sam laws for medical care, but she can sue you for her ankle fracture from your dog injuring her...



This is a very bad idea. To repeat what's already been on the thread, taking ANY compensation completely voids any Good Sam protection you have. Afree flight, seat upgrade, or a free drink coupon, or a free pillow -- it doesn't matter. Once you take anything, you are no longer a Good Sam. You are being paid. And your med mal may or may not cover you.

You're absolutely right, and I did actually think of that afterward and was even more comfortable with my decision not to "out" myself...

 

[alpinism]

You may be protected by the Good Sam laws for medical care, but she can sue you for her ankle fracture from your dog injuring her...



This is a very bad idea. To repeat what's already been on the thread, taking ANY compensation completely voids any Good Sam protection you have. Afree flight, seat upgrade, or a free drink coupon, or a free pillow -- it doesn't matter. Once you take anything, you are no longer a Good Sam. You are being paid. And your med mal may or may not cover you.

Meh. You had to bring it to the ticket counter and get it signed for it to be valid (which I never did). Just thought it was a nice gesture especially since it was at 3am on a red eye flight and I ended up sitting next her the rest of the flight to make sure she was okay.

 

[DrMikeP]

There's also the fact that there's no part of the Constitution that allows the Federal Government to make such a straight forward law.

If the government can require people to purchase healthcare and give a company immunity from lawsuits then it can give drs protection for good Samaritan efforts.

Sent from my Nexus 4 using Tapatalk

 

[jthedestroyr]

I had always wanted to respond to an emergency on a plane and just a few months out of residency I got my chance. Overnight trans-atlantic flight to London, they overhead page for a doctor. I pushed my call light and the attendant showed me the patient. Some 2+ lower extremity edema in a lady who takes oral steroids for an eye condition. I took a set of vitals and had her lay all the way flat (she got a first class cabin out of this!) and elevated her legs above her heart. Basically I saved her life. I got a thank-you email from British Air.

Close to landing paged over head for a physican. Some guy is in scrubs near me and figured he's some douche that wants everybody to know he's in medicine since he's flying in scrubs. I hear him say, "I'm just a drug rep," so I actually hit my call button. Stewardess tells me the person has really bad SOB and "high bp." Wondering how do they know they've got high BP. FYI impossible to listen to anything using the crappy stethoscope they have in their kits, let alone if you had a good one with the engine noise. AA has a decent kit for medical emergency (most IVP drugs, nitro, line stuff etc) and a cool BP cuff. Turns out BP was perfectly fine. Got a thank you from American and 50$ gift card.

Someone mentioned they have in flight medical, that is not always true. They asked me if they should have an ambulance waiting, etc etc. They wanted me to make the decision whether to land now or wait the 1hr or so that we had to go.

Side note: stewardess said had a similar complaint the night before, but this guy actually had a BP >200/100, visual changes and SOB. No medical people were on abroad and they just powered through to their destination with the guy on oxygen. Hate to think what happened to that guy.

 

[Siggy]

Side note: stewardess said had a similar complaint the night before, but this guy actually had a BP >200/100, visual changes and SOB. No medical people were on abroad and they just powered through to their destination with the guy on oxygen. Hate to think what happened to that guy.

The catch is how long would it take to divert and land the plane. Does it really matter if you get on the ground 10 minutes earlier?