"Is there a doctor on board?"

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Febrifuge

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Vacation time is almost here, Chez Febrifuge*. Right by the calendar on the cube wall at day-job is an email, printed out after a patient wrote in to say nice things about our ED. Pt had chest pain on a flight that made an emergency landing in our town. Now, this will be the first time I've flown since earning EMT cert (18 months ago; I really need to take more vacations), and I wonder, what if "the question" comes over the intercom?

Actually, I know what if. All the really good stuff in the aircraft's kit is outside my scope of practice. But I can record the hell out of those vital signs, and talk to medical control more or less intelligently. The question is more for you types.

When you travel by air (or train, I guess), do you identify yourself in advance, when you book your ticket, so that the attendant can discreetly come and get you in the event of trouble?

Have you ever risen from your seat at a theater or restaurant, to gallantly render assistance?

Or do you just pray that nothing ever happens... and if it does, do you hope you're not the only MD/DO on board?


* We're going to Orlando, and I hope to check out the "program" at In N' Out Burger.

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Febrifuge said:
Vacation time is almost here, Chez Febrifuge*. Right by the calendar on the cube wall at day-job is an email, printed out after a patient wrote in to say nice things about our ED. Pt had chest pain on a flight that made an emergency landing in our town. Now, this will be the first time I've flown since earning EMT cert (18 months ago; I really need to take more vacations), and I wonder, what if "the question" comes over the intercom?

Actually, I know what if. All the really good stuff in the aircraft's kit is outside my scope of practice. But I can record the hell out of those vital signs, and talk to medical control more or less intelligently. The question is more for you types.

When you travel by air (or train, I guess), do you identify yourself in advance, when you book your ticket, so that the attendant can discreetly come and get you in the event of trouble?

Have you ever risen from your seat at a theater or restaurant, to gallantly render assistance?

Or do you just pray that nothing ever happens... and if it does, do you hope you're not the only MD/DO on board?


* We're going to Orlando, and I hope to check out the "program" at In N' Out Burger.

The one time I got involved on a plane, the stewardess asked if there were any "medically trained persons" aboard the flight...Just so happened that I was flying to the NAEMSP conference, so half the plane's passengers stood up to help this old lady w/ her nosebleed...

I would render assistance if needed...No problem there.

Also, on a side note, I am pretty sure there are no In-n-Out burgers in Orlando Fl....Pretty much a West coast thing, however they are slowly spreading East..They have a few locations in AZ and NV as well....Sorry to break the news to you...
 
Dammit. It must have been a Sonic I went to, last time I was in Orlando. (One more dream, crushed...)
 
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I have never been on a plane when 'assistance' was needed. My husband flies over 300,000 miles a year (domestic and international) and he's only heard the announcement once!

However, I live about 10 miles from Bradley International Airport in Connecticut and while its not the biggest airport, it is the largest between Boston and New York serving this area. My EMS service gets called as a back-up for medicals there if the primary town's rig is busy. Most of the calls are for emplyees or passengers having a problem in the terminal, but we do get a few of the 'flight inbound with...' calls. Having had a medical crisis while travelling, I always feel for the person getting taken off the plane in a city far from home with often no friends or family nearby.

Have a great time on your trip!
 
spyderdoc said:
The one time I got involved on a plane, the stewardess asked if there were any "medically trained persons" aboard the flight...Just so happened that I was flying to the NAEMSP conference, so half the plane's passengers stood up to help this old lady w/ her nosebleed...

:laugh: :laugh:
 
The summer before I started med school, I flew to Boston and back to Texas with my family. They asked for a doctor and my dad (General Surgeon) didn't hear them until I poked him. There was a lady with nausea and he gave her some Phenergan from their medical kit. The flight attendant asked if we needed to land the plane and my dad chuckled and said no. I don't remember any details about the patient or why they thought they needed a doctor but I think he received some vouchers or free airline miles for his "medical assistance." I've been trying to see if the flight attendants ever need help with medical care ever since then in hopes of getting some free drink coupons... ;)
 
these things used to happen to me ALL the time, before I had any medical training other than a first responder and then an EMT-B. Since medical school/internship began I dont think Ive had any outside the hospital. Prior to this though, I was the first to offer my incompetent services.
 
Febrifuge said:
Dammit. It must have been a Sonic I went to, last time I was in Orlando. (One more dream, crushed...)

Just like In-N-Out Sonic offers a wide array of training however it is not ACGME like In-N-Out is so you may run into some licensing and priveledging problems down the road.
 
What liability does an intern or resident have if he/she performs invasive skills (e.g., relieving a tension pneumo) or administers medicines without having a license?

I think there can be significant liability for this outside a supervised teaching situation, which isn't going to happen on an airplane. Any interns or residents ever done this on a plane without having a license yet?
 
I know of an internal medicine resident that trached a person with a steak knife at an Outback Steakhouse many years ago... but I think she was a 3rd year resident at the time.
 
spyderdoc said:
Also, on a side note, I am pretty sure there are no In-n-Out burgers in Orlando Fl....Pretty much a West coast thing, however they are slowly spreading East..They have a few locations in AZ and NV as well....Sorry to break the news to you...


Having loved In-n-Out and having lived in Orlando I can say without at doubt there are none there. Which is sad...but makes my trips to the west coast that much better. There is a sonic on international drive...but alas there are none here in Miami. :(
 
southerndoc said:
What liability does an intern or resident have if he/she performs invasive skills (e.g., relieving a tension pneumo) or administers medicines without having a license?

I think there can be significant liability for this outside a supervised teaching situation, which isn't going to happen on an airplane. Any interns or residents ever done this on a plane without having a license yet?

If you truely had a tension that needed relieving I don't think anyone could seriously fault you for doing it. I think it would be pretty tough to justify not doing it just based on liability concerns. I'd rather ask for forgiveness later than watch someone die.

Just what is the standard of care on an airplane at 30,000 feet? Interesting question.

What sort of goodies do they have onboard an airplane anyway? Someone mentioned phenergan. What about ASA, beta blocker, nitro? 12 lead EKG? :D

Hard to justify a cardiac cath with a drinking straw and a coat-hanger I would imagine.

In-and-Out is the shizzle.
 
Funny how I should come upon this post. Just a few days ago, I came across this article. It's a little scary what this chiropractor think he is able to do with his "activator"

EDIT: I do not want to hijack this thread and turn it into some anti-chiro thread. I just thought it would be interesting to post this as it somewhat relates to the purpose of this thread.

http://www.chiroweb.com/archives/16/07/03.html

Dynamic Chiropractic
March 23, 1998, Volume 16, Issue 07

Chiropractic at 33,000 Feet

by Bruce C. Hagen, Sr., DC
In 1991, my wife and I journeyed to England to partake in the wonders of Wimbeldon. We were joined in London by our son Eric, who was a student at Heidelberg, Germany. We then flew on to Frankfurt, where our daughter, a Pepperdine student studying in Madrid, Spain, joined us for an additional two-week tour of Europe. After touring through Europe, including the Scandinavian countries, we returned to Frankfurt to depart for London. We were supposed to stay overnight in London and then return to the U.S.

However, upon calling my office in South Dakota, I learned that my son, Dr. Mark Hagen, was about to have root canal surgery and would be unable to operate our Sioux City clinic. I decided to avoid overnighting in London and proceed directly to the US so I could take his practice. Lufthansa Airlines informed me that if I left an hour earlier for London in order to fly directly to the USA, it would cost an additional $800. I agreed, then checked with the US airline that we were scheduled to take from London back to Sioux Falls. They were accommodating and put us on a standby flight from Frankfurt to Boston, on to Minneapolis, then to Sioux Falls.

Our standby status looked precarious as the airline loaded the passengers on board. Suddenly, policemen appeared with dogs and made everyone get off the plane. After an hour-and-a-half delay to search the plane, the passengers re-boarded. My wife and I got the last two seats. Needless to say, there was a surly group of passengers concerned about missing their flight connections out of Boston.

About 90 minutes out of Frankfurt, an announcement was made over the loudspeaker: "If there is a doctor on board, please identify yourself." The announcement was urgently repeated about five minutes later. I pushed my call button, advised the head stewardess that I was a chiropractor, and asked if there was anything I could do. She took me forward to the first-class compartment, then related to me that a young lady, seven-and-a-half months pregnant, was complaining of severe headaches, nausea and back pain. She might have been experiencing premature labor. (I later found out that this young lady was a military dependent who originally had been pregnant with twins but had one of the babies aborted without her permission. She was so angry with the health care she had received that she was returning to Boston to have her baby delivered in the private sector.)

I assisted the patient to a standing position, palpated the level of the hips, and found a PD right. I adjusted the standard Activator listings in the standing position. I also adjusted the sixth thoracic area for the nausea, and found the spinous axis was projecting way out to the right. Fifteen minutes later, the adjustment was complete and she was sound asleep in her seat.

Needless to say, the head stewardess was ecstatic with the results I had achieved. She informed me that they would have been forced to land in Iceland or return to Frankfurt for emergency services. After the long delay from our original estimated time of departure, a further delay could have created a passenger mutiny on board!

To thank me, the stewardess offered to move me up to the last seat in first class. As tempted as I was, I thought it better to return to my wife. The stewardess brought us one of France's finest champagnes a little later. Being a total abstainer, I still have the bottle. Several other crew members also thanked me for my services.

In February and March of 1997, we traveled to New Zealand and Australia thanks to the generosity of our oldest daughter, who had given us business-class accommodations from LA to New Zealand, Sydney, Perth, Ayers Rock, and Cannes; then back to Sydney and home again. While in Port Douglas at the conclusion of our vacation, we were caught in a cyclone with wind speeds up to 180 knots per hour.

After a hair-raising ride from Port Douglas to Cannes that included striking a tree that had blown across the road, we flew from Cannes to Sydney, then boarded our flight from Sydney to LA. We were served a meal, and I settled back in my seat for the first sleep in three days due to the cyclone. I was abruptly awakened by the head flight steward. He asked me if I was a medical doctor, and I replied that I was a chiropractor. I asked him what the problem was, and he said a man in coach was apparently having a heart attack. I quickly asked him if there were any medical doctors on board. He said I was the only one listed as a doctor. I could see his disappointment at learning I was not a medical doctor, but I volunteered to take a look at the patient.

He escorted me to the man's seat in the mid-section of the plane. They had moved him to an aisle seat, and he was using the oxygen mask hanging down from the ceiling. He looked cyanotic and in severe distress. He was perspiring profusely. I felt his pulse and found it weak but rhythmical. I opened his shirt and listened to his heart with my ear. I found out that the man had seen his cardiologist that morning and been given the OK to travel. He was on quite a bit of medication. I did the applied kinesiology, neurovascular, and neurolymphatic procedures for heart problems. I also held pressure against his axis vertebrae, which afforded him considerable relief. After he was resting comfortably, I told him I would be back in thirty minutes to check on his status.

Thirty minutes later I returned with my Activator. An Australian nurse was checking the patient with a stethoscope and other instruments she had found in the airplane. She wanted to hook him up to a defibrillator in case his heart quit. I palpated his cervical and upper thoracic region, and adjusted the second thoracic and the axis with the Activator.

There was no place to hook him up to the defibrillator equipment except up in the galley, so we moved him there with a portable oxygen tank. We laid him on the floor, and just then the plane was caught in severe turbulence and we were ordered to take some seats in the flight-crew compartment for about twenty minutes. We left the poor patient lying on the floor. When we returned, the patient was feeling much better, and didn't want to be hooked up to the defibrillator. He returned to his seat, eventually got off the oxygen, ate his breakfast, then departed the plane on his own.

Upon returning home to Sioux Falls, my wife received a call at our residence from the overseas marketing director of the airline, commending and thanking me for my services, and especially for helping avoid an emergency landing in Hawaii. That kind of delay would have resulted in rebooking 400 passengers on different flights. He called me several weeks ago and thanked me again.

In reflecting back on this situation, I can recall how disappointed the head steward was when he discovered I was not a medical doctor. However, when one considers scientifically the capabilities of a chiropractor and a medical doctor on an airplane, who has the advantage? Does the medical doctor carry a suitcase full of cardiac meds? I think not.

I have also traveled to Jamaica on five occasions for missionary work, to the Ukraine, and to Poland twice. A chiropractor does not need an MRI -- or a CAT-scan, an x-ray or an automatic processor. Even in an emergency, your hands, an Activator, a bed, a couch, a chair or a portable table are all you need to render care to 98% of the populace.

Thinking back on my 44 years of practice and my varied experiences, I think maybe I should become a cruise-ship chiropractor in my retirement.

Bruce C. Hagen, Sr., DC
Sioux Falls, South Dakota
 
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if a chiropractor tried to treat my pregnant wife in an emergent situation with manual adjustment, i'd probably hit him.

and i'm not a violent person.
 
That chiropracter's article reads like a Christmas brag letter. Could he be any more self-congratulaltory? Not only do we read about his heroic savings of pregnant women and heart attack victims in the skies; we are also privy to the details of his worldly travels and exploits from Wimbeldon to Australia. Wasn't that charming that he gave up a first-class upgrade so he could keep his wife company!
 
Several years ago (as the now-legend tells it), a 3rd year IM resident at my institution was onboard when the call came out. She managed to diagnose a bradyarrhythmia, and used scopolamine patches until the plane made an emergency landing.

Of course, I heard it secondhand (granted, it was from an attending), but it's a cool story.

And then there was the lady flying to Florida who had some chest pain (this was sometime in the last 2 years - it made the "weird news" part of the paper.) When they asked for assistance, the 17 cardiologists on their way to a national conference volunteered their sevices.

Never happened to me... although just having completed my residency interivews, I wondered if it might.
 
friend of mine tried to stand up and convince the airline that the deficiency of their stock of "splints and bandages" shouldn't keep the flight grounded for 4 hours and that she actually knew how to make splints out of other things that could be found on the plane should the occasion arise. They wouldn't hear of it...
 
Thirty minutes later I returned with my Activator. An Australian nurse was checking the patient with a stethoscope and other instruments she had found in the airplane. She wanted to hook him up to a defibrillator in case his heart quit. I palpated his cervical and upper thoracic region, and adjusted the second thoracic and the axis with the Activator.

So, let me get this straight - the DC used his ear, while the Australian RN searched for, found and used the aircraft's stethoscope?:idea: Brilliant!!!

Then, 30 mins later, he returned with his Activator? Can someone tell me WTF is an Activator?!?

I don't want to turn this into a DC bash-fest, but I could hardly keep from falling off my chair laughing. :laugh:

Whoever said this read like a Christmas brag letter was right on the money.
 
Hey all,

Besides comforting an elderly woman who syncopized at Boston's Logan Airport gate, I've not had the privilege of saving a life in flight. Of course, I have fantasized about heroics at 30,000 feet. Besides resuscitating the pilot prior to an emergency landing or rushing to the aid of a fallen flight attendant, I've also given some thought to a proper introduction. The next time someone asks for a doctor on board, I'll offer up one of these canned responses:

"I'm almost done with medical school!"
"I'm a fourth year medical student but I DID work as a paramedic."
"I'm going into emergency medicine!"
"I've been accepted into an emergency medicine residency!"
"I'm still in school, but I stayed in a holiday inn last night..."
"I'm not a doctor, but I did see this cool thing on Baywatch.."
:Grabbing the bullhorn: "Rampart, this is squad-51.. requesting orders to defibrillate at 200 watt-seconds.."

Best wishes for a fantastic fifteen minutes of fame.

PuSh
 
pushinepi2 said:
I've not had the privilege of saving a life in flight. Of course, I have fantasized about heroics at 30,000 feet.


Herioics? Funny, I have always had fantasies of other things at 30,000 feet. :laugh:
 
Not on an airplane, but at one of the largest churches in the country (see http://www.forbes.com/2003/09/17/cz_lk_0917megachurch.html and http://hirr.hartsem.edu/org/faith_megachurches_database.html#sort) was where I noticed doctors involved in some sort of public medical emergency. It was the Easter service a few years ago. I ended up high in the balcony (it was packed more than usual as a result of it being Easter service... see http://www.second.org/virtualtour/tour_land.asp and click on "Open Virtual Tour," then "Lite Tour" under Woodway Campus, and then click "Worship Center.") so I could not see what exactly happened. The pastor (Ed Young, Sr.) was preaching and then I heard some commotion from the crowd below. Then I saw a couple of individuals running down the aisles. Then the pastor stopped his sermon and lead the congregation in prayer for someone in the crowd. Then there was silence for 10 minutes and then the pastor stated that it was fortunate that cardiologists from the Texas Medical Center and St. Lukes were regular members at the church. He also mentioned that one of the board members convinced the church to invest in AEDs a few weeks prior to this and if I remember correctly, the pastor may have indicated that the patient involved was the board member's father. I wish I could have seen what was going on. (I got there an hour late b/c apparently 2nd Baptist doesn't turn their clocks 1 hour forward for their first Sunday service after Daylight Savings.)
 
Dr. J? said:
Can someone tell me WTF is an Activator?!?



I think it has something to do with the Wonder Twins.
 
beanbean said:
That chiropracter's article reads like a Christmas brag letter. Could he be any more self-congratulaltory? Not only do we read about his heroic savings of pregnant women and heart attack victims in the skies; we are also privy to the details of his worldly travels and exploits from Wimbeldon to Australia. Wasn't that charming that he gave up a first-class upgrade so he could keep his wife company!

Christmas brag letter? I thought it seemed a lot like "Letters to Penthouse". Or at least equally fictitious.
 
I'm so glad the chiropractor saved 400 people from being diverted to such a desolate and terrible place like Hawaii with the wave of his magical activator wand. As for the guy with the presumed MI... he wins a lifetime tax break on his EF. Nice to know that the treatment for MI at 30,000 feet is laying down and waiting out the pain. :laugh: :laugh: :laugh:
 
i have a sneaking suspicion that 'the activator' is nothing more than a miniaturized pogo-stick.
 
stoic said:
i have a sneaking suspicion that 'the activator' is nothing more than a miniaturized pogo-stick.

I think that's exactly what it is. The doctor then bounces on the patients back in miniature until the heart attack or miscarriage goes away.
 
Incidentally, the reason you don't hear them ask for doctors much on plane flights is that the major airlines have contracted out their cases to private doctors for online medical control, much the same way that EPs do medical control for ems companies. I rotated briefly through the hospital that had most of the contracts for the US airlines, which was staffed with EPs. It was a cool room, with lots of plasma screens.
 
Sessamoid said:
Incidentally, the reason you don't hear them ask for doctors much on plane flights is that the major airlines have contracted out their cases to private doctors for online medical control, much the same way that EPs do medical control for ems companies. I rotated briefly through the hospital that had most of the contracts for the US airlines, which was staffed with EPs. It was a cool room, with lots of plasma screens.

But who actually is the provider? I read about those services, and one guy was saying that, if something happens onboard, and someone volunteers, they'll briefly quiz the guy/woman to make sure they're not a tool or hack or quack, and then let them do things under direction (if they're not licensed). What if there is noone - is it the flight attendant?
 
pushinepi2 said:
:Grabbing the bullhorn: "Rampart, this is squad-51.. requesting orders to defibrillate at 200 watt-seconds.."

:laugh: :laugh: :laugh: Too friggen funny!!! :laugh: :laugh: :laugh:
 
Apollyon said:
But who actually is the provider? I read about those services, and one guy was saying that, if something happens onboard, and someone volunteers, they'll briefly quiz the guy/woman to make sure they're not a tool or hack or quack, and then let them do things under direction (if they're not licensed). What if there is noone - is it the flight attendant?
It's generally the flight attendant unless something unusual is called for. All flight attendants receive at least basic first aid training and are trained in use of the AED as well.
 
Sessamoid said:
It's generally the flight attendant unless something unusual is called for. All flight attendants receive at least basic first aid training and are trained in use of the AED as well.

That sound correct. Some of our faculty (Drs. Idris and Roppolo) have been in charge of training the flight crews at DFW.
 
From this web site

67 year old Dorothy Fletcher, from Britain, is lucky to be alive after she suffered a heart attack on a flight in the US. On board her flight at the time of the heart attack were 15 heart specialists making their way to a conference in Florida.
All 15 of them stood up when the attendant asked if there was a doctor on board. Fletcher said that "I was in a very bad way and they all rushed to help. I wish I could thank them but I have no idea who they were..."
Fletcher was on her way to her daughter's wedding in November and had to spend 5 days in hospital in North Carolina, two of which were spent in intensive care. She did, however, make it to the wedding on time.
 
waterski232002 said:
I know of an internal medicine resident that trached a person with a steak knife at an Outback Steakhouse many years ago... but I think she was a 3rd year resident at the time.


You're kidding, right? Because if you're not, you're LYING (or she lied to you).
:laugh:
 
Apollyon said:
But who actually is the provider? I read about those services, and one guy was saying that, if something happens onboard, and someone volunteers, they'll briefly quiz the guy/woman to make sure they're not a tool or hack or quack, and then let them do things under direction (if they're not licensed). What if there is noone - is it the flight attendant?
The flight attendant I used to date says yep. She can run the AED and everything. (Of course, a drunken 5-year-old could run an AED, but still.)
 
Febrifuge said:
The flight attendant I used to date says yep. She can run the AED and everything. (Of course, a drunken 5-year-old could run an AED, but still.)

or a monkey
 
Hornet871 said:
You're kidding, right? Because if you're not, you're LYING (or she lied to you).
:laugh:

Nope... she was a friend of my sister's in medical school and apparently the heimlick maneuver didn't work, airway could not be established during CPR, so she made the incision and stuck an endotracheal tube inside so EMS could bag.
 
group_theory said:
Funny how I should come upon this post. Just a few days ago, I came across this article. It's a little scary what this chiropractor think he is able to do with his "activator"

EDIT: I do not want to hijack this thread and turn it into some anti-chiro thread. I just thought it would be interesting to post this as it somewhat relates to the purpose of this thread.

http://www.chiroweb.com/archives/16/07/03.html

Dynamic Chiropractic
March 23, 1998, Volume 16, Issue 07

Chiropractic at 33,000 Feet

by Bruce C. Hagen, Sr., DC
He escorted me to the man's seat in the mid-section of the plane. They had moved him to an aisle seat, and he was using the oxygen mask hanging down from the ceiling. He looked cyanotic and in severe distress.

I think this may be bogus or exagerration. I don't think you can activate a single overhead mask. Every flight I have been on had suplemental O2 in bottles with the medical kit and I never saw anyone placed on the overhead mask.

My public EMS moments.
1. NYC at a performance of M. Butterfly. Right at a really intense moment in the play an old guy in front of me seizes from what I think was a vfib arrest. Tony Randal stops the show, brings up the house lights and asks, "Is there a doctor in the house" . The entire row behind the patient is all terrified 1st and 2nd year med students. Fortunately being NYC there are dozens of real docs in the house. After EMS carts the patient off Tony Randal and BD Wong launch right back into the play.
2. Heimlich at a local restaurant. I was amazed at how hard you have to do it to get it to work. Just as the patient was going limp he coughed up half a porkchop followed shortly after by vomiting up the rest of his meal.
3. Transcontintental flight to Italy. Young guy with vasovagal syncope. By the time I get back to him there is some lady doing all kinds of weird stuff to him involving pressure points. When the dude is fine and back in his chair they ask the lady to sign some form which she refuses (won't even give her name). Turns out she is an unlicsensed naturopath. I sign the forms and collect a free bottle of wine.
4. Flight from Las Vegas young lady with too much partying and not enough hydration passes out. My wife responds and finds a dentist doing CPR on a semiawake patient.
5. As we are taxing from the gate some old guy with a million cardiac problems complains of chest pain and passes out. My wife responds and finds the patient already awake. He refuses to get off the plane and the stewardess want to know if its ok to go ahead and take off. My wife says, "like hell it is" EMS hauls the guy to the hospital.
6. While visiting distant relatives in a little town in SE Asia my wife was asked to replace the next door neighbors dobhoff. He was some sort of cancer patient getting a sort of third-world version of home hospice.

We got a bottle of wine for the Italy flight and first class upgrade vouchers which we never ended up using for the other inflight stuff. We got a very nice thank you in SE Asia.
 
Whoa. Between the unlicensed naturopath who was willing to intervene but unwilling to give her name, and the DDS doing unindicated CPR, I'm convinced. My ability to do the EMT-B "stand around, look capable, and don't do anything too stupid" maneuver might be of real benefit to someone.

Also, I'm with MudPhud on the O2 mask thing in the chiro story. Plus, how long is the tubing on those things? Don't they drop only to lap-level? And how do you activate just one? I'll check my source and get back.
 
Apollyon said:
But who actually is the provider? I read about those services, and one guy was saying that, if something happens onboard, and someone volunteers, they'll briefly quiz the guy/woman to make sure they're not a tool or hack or quack, and then let them do things under direction (if they're not licensed). What if there is noone - is it the flight attendant?

Actually here at Mayo we have a contract with Northwest Airlines (and it's "code sharing" partners) to provide medical direction to their flights. If there is a medical emergency in flight, the call is routed through to our medical control phone. We, as residents, directly communicate with the flight crew and direct the medical care. The flight attendants can provide basic care, including AED use. There is also a more "advanced" kit on board for use by a licensed physician. If someone on the flight identifies themselves as such, we do work with them. As for "are they really a doctor?", it doesn't much matter. The equipment is very limited and the chance for additional harm in the dire situation of an "in-flight arrest" is minimal.

That said, I think any of us would direct the flight crew to guide a chiropractor back to their seat if they identified themselves as a "doctor" in this setting and wanted to help, especially if they wanted to adjust the patient as opposed to providing medical treatment.

BTW - post-911, would you even be allowed to carry an "activator" on board?

- H
 
Febrifuge said:
Vacation time is almost here, Chez Febrifuge*. Right by the calendar on the cube wall at day-job is an email, printed out after a patient wrote in to say nice things about our ED. Pt had chest pain on a flight that made an emergency landing in our town. Now, this will be the first time I've flown since earning EMT cert (18 months ago; I really need to take more vacations), and I wonder, what if "the question" comes over the intercom?

Actually, I know what if. All the really good stuff in the aircraft's kit is outside my scope of practice. But I can record the hell out of those vital signs, and talk to medical control more or less intelligently. The question is more for you types.

When you travel by air (or train, I guess), do you identify yourself in advance, when you book your ticket, so that the attendant can discreetly come and get you in the event of trouble?

Have you ever risen from your seat at a theater or restaurant, to gallantly render assistance?

Or do you just pray that nothing ever happens... and if it does, do you hope you're not the only MD/DO on board?


* We're going to Orlando, and I hope to check out the "program" at In N' Out Burger.


I was flying back from STL (to LAX) once, and an elderly man was having SOB. This was before the airlines carried decent equipment, and all I had was a 'scope - I checked him out, got him on O2 (btw, the airlines bottles are not very adjustable), and determined that he was basically not very bad at all - he had COPD, had gotten up to go to the lav and walked through the smoking section (this was around 1985?) and the added insult of the smoke displacing O2 caused his SOB.

A little O2, and he was fine. SOB resolved, he was pefusing OK, had no reported chest pain or Hx of heart disease. The first officer came back and checked, we talked, and I offered my $.02 about his condition, and we decided that the flight could continue on to LAX. This was a decision based on our location, the time it would take us to land somewhere short of LAX, and the added time it would take to get to LAX: if the guy went south at any time, it would still take us 20 -30 minutes to get on the ground no matter where we were (at 40,000 feet it takes awhile to get an airliner on the ground without breaking it). We were about 40 minutes out of LAX at the time.

So, we landed at LAX, he was helped off the plane by EMS, and continued on the next day to Hawaii or whereever he was going. Turns out that he had started at like 4AM that morning to get to JFK for a cheap flight that stopped at STL and LAX before going to Hawaii. Just fatigue and the cabin altitude (normally 8,000 feet) plus the smoke (another 2,000 feet?).

BTW, the airline was so greatful that as I was leaving they offered me a tiny bottle of Champagne (actually, 'domestic sparkling wine"). Thanks, TWA! A $4 bottle for saving you $25,000+ in handling charges and costs.

As far as credentials, they were more impressed with my LA County Deputy Coroner (Reserve) badge than my EMT cert (we didn't mention the coroner to the pt). And no, I wouldn't advertise before hand. But, in probably 750 to 1000 commercial airline flights (more? less?) that I've made in my life, thats the only time something like that has happened so I don't wait, ready to spring to the rescue.
 
southerndoc said:
What liability does an intern or resident have if he/she performs invasive skills (e.g., relieving a tension pneumo) or administers medicines without having a license?

I think there can be significant liability for this outside a supervised teaching situation, which isn't going to happen on an airplane. Any interns or residents ever done this on a plane without having a license yet?

It's called practicing medicine without a license. Also, battery if you perform an invasive procedure without informed consent (like, telling the pt that you're not qualified)
 
About the chiro's story, and the detail about the O2 mask. This is from my source the former Waitress in the Sky:

"Airplanes have individual O2 tanks for people who need medical help, and the flight attendants are trained in their use.

I guess the mask situation would depend on the aircraft. While it is possible to deploy one individual mask, it would be *extremely* unlikely, as the canisters used for the emergency oxygen heat up to 500 degrees (the emergency O2 is not actually *stored* anywhere, it is more manufactured by a chemical process from the surrounding air.)"


So the BS factor appears to be elevated at least somewhat.
 
Febrifuge said:
Whoa. Between the unlicensed naturopath who was willing to intervene but unwilling to give her name, and the DDS doing unindicated CPR, I'm convinced. My ability to do the EMT-B "stand around, look capable, and don't do anything too stupid" maneuver might be of real benefit to someone.

Also, I'm with MudPhud on the O2 mask thing in the chiro story. Plus, how long is the tubing on those things? Don't they drop only to lap-level? And how do you activate just one? I'll check my source and get back.


The tubing is about 4-5 feet long (long enough for any mask to reach any seat in that side of the row). And no, you can't turn just one on.

This sounds like other reports in the chiro "literature", where a heroic DC performs an emergenct, life-saving "adjustment" and cures not only an MI but cirrhosis and AIDS.
 
flighterdoc said:
BTW, the airline was so greatful that as I was leaving they offered me a tiny bottle of Champagne (actually, 'domestic sparkling wine"). Thanks, TWA! A $4 bottle for saving you $25,000+ in handling charges and costs.

As a medic, I have been in this situation twice (on the same trip). First, while flying to South Africa (to present a paper) Miami to Johannesburg, the flight crew came overhead asking for "a doctor". I identified myself as a paramedic and they ushered me toward the front of the plane. At the same time, in the next aisle, another man was being shown to the front of the plane. He turned and asked me if I was a doctor, I replied that I was a paramedic, he said "great, because I am an OB/GYN, so unless someone is giving birth it is all you". As it turned out, it was a full arrest. The first officer told us we were three hours from land if we turned back or four hours if we diverted to the Azores (sp?). This guy was gone. AED showed no shock advised, he had a CABG scar and was about a billion years old. We coded him for an hour before the doc, along with "on-line" medical control, called the code. We landed in the Azores, and the OB/GYN and his family stayed behind "to fill out papers". We took off again, and the crew gave me a bottle of wine, and the "toiletries" package that first class got. They were very nice about it. I'm sure the OB got some other good stuff seeing as how he had to stay with the body until a local doc came out.

On the way home, flying into NYC, as we were disembarking, there was a woman in profound respiratory distress. She was diaphoretic, gray, and very short of breath. She was a large woman, hx of recent tx for Breast CA, and it was a 17 hr. flight. You do the math. Anyway, a woman who identified herself as "a doctor" was trying to convince everyone around to lay the patient supine (a move the patient was monosyballically protesting). I grabbed the O2 from a stewardess, put the patient on 15L NRB, and tried to quiet the situation. A port authority police officer showed up (he was also a medic), and he promptly escorted the "doctor" (now frantic because she was being ignored) off the scene. EMS transported the patient, still SOB, but alert, in short order. I stayed, filled out a bunch of paperwork, then went on my way.

Fast forward two weeks, I get a thick envelope in the mail from the airline (let's just say it was not a foriegn airline, so it was an American Airline). I excitedly ripped it open, expecting tickets or something. What did I get? A thank you note and $10 worth of McDonald's gift certificates! WTF!?! I mean really, skip the gift certificates, that was just demeaning! :smuggrin:

- H
 
OSUdoc08 said:
EMS services carry cricothyrotomy (both needle & surgical cric) kits. It wouldn't make sense to do a cric without pain management and sterile technique if an EMS service is right in front of you that has the equipment for such a procedure.

Like I said... she used a steak knife... what pain medicine do you need when someone is in cardiopulmonary arrest???? They don't feel pain b/c they are DEAD! Furthermore, sterile technique is the LEAST of that patients worries. The priority is ABC's....

What I'm really wondering, however, is if she attempted to use the Magill forceps that every EMS service carries as well to remove the foreign body, before attempting the "steak knife" cric.

I said I heard about it... I didn't say I watched it on TLC.

Sorry, just not believable. If it is true, however, I hope that she lost her license and was sued out the wazoo.

I'm sure they were really gonna sue her after she saved the damn guys life! No airway = Nobody alive to sue you!
 
In 1991, my wife and I journeyed to England to partake in the wonders of Wimbeldon. We were joined in London by our son Eric, who was a student at Heidelberg, Germany. We then flew on to Frankfurt, where our daughter, a Pepperdine student studying in Madrid, Spain, joined us for an additional two-week tour of Europe. After touring through Europe, including the Scandinavian countries, we returned to Frankfurt to depart for London. We were supposed to stay overnight in London and then return to the U.S.

Is this paragraph relevant?

Lufthansa Airlines informed me that if I left an hour earlier for London in order to fly directly to the USA, it would cost an additional $800. I agreed,

Yeah right. Who pays $800 to leave 60 tiny minutes earlier for an international, 9 hour flight?

She was so angry with the health care she had received that she was returning to Boston to have her baby delivered in the private sector.)

Biased...

I opened his shirt and listened to his heart with my ear. I found out that the man had seen his cardiologist that morning and been given the OK to travel.

:laugh: :laugh:


Thinking back on my 44 years of practice and my varied experiences, I think maybe I should become a cruise-ship chiropractor in my retirement.

Maybe he should!!


Bruce C. Hagen, Sr., DC
Sioux Falls, South Dakota

Is that guy for real? Seems like he paid the article as an ad. :thumbdown:
 
OSUdoc08 said:
1. I didn't realize they were pulseless & apneic, but that still doesn't explain no use of Magill.

2. This also does not explain why EMS didn't use the cric kit---even if they didn't have one, they at least had a scalpel and would be able to produce a sterile field.

3. People get sued all the time for events just like this.

4. If the priority is ABC's, and no cric kit is available, an IV catheter can be inserted into the cricothyroid membrane. This is much less invasive, and prevents risk of infection.

Apparently you know everything. That's awesome. That will serve you well on the wards and in the ED.

If this is indeed true, why on earth would you hope the doc would have her license revoked and sued? From the story she saved the guy's life. She's a licensed doc. What's the problem?

Here's to someone looking at your actions with such clear hindsight in the not so distant future. (sarcasm is hard to convey on a message board ;) )
 
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