What Happens when You are The Doctor on the Airplane?

[weilke]

Someone with the necessary skill and experience made a judgement call and the outcome proved him right. None of us was up there, this discussion is somewhat silly.

 

[Dave Theisen]

Anyone else read that article and think the lady is faking it? She gets on the plane and makes a big scene about how allergic she is and then, sure enough, she has an allergic reaction with out eating the shrimp. The doctor describes what the patient is complaining about, but her vital signs are normal.

I'm no doctor, and maybe too cynical, but my gut is telling me this lady is just looking for a lawsuit.

 

[Doggtyred]

Anyone else read that article and think the lady is faking it? She gets on the plane and makes a big scene about how allergic she is and then, sure enough, she has an allergic reaction with out eating the shrimp. The doctor describes what the patient is complaining about, but her vital signs are normal.

I'm no doctor, and maybe too cynical, but my gut is telling me this lady is just looking for a lawsuit.

People are stupid. Even educated ones. We had a nurse come downstairs to the ER one night for an allergic reaction. Her coworkers cooked shrimp gumbo. She was allergic to shrimp/shellfish.

She had a bowl, picking the shrimp out, then was surprised when she had a reaction.

 

[SteveinIndy]

People are stupid. Even educated ones. We had a nurse come downstairs to the ER one night for an allergic reaction. Her coworkers cooked shrimp gumbo. She was allergic to shrimp/shellfish.

She had a bowl, picking the shrimp out, then was surprised when she had a reaction.

I've got one better. As an EMS provider, we treated a lady who had a severe anaphylactic reaction to Chinese food which included shrimp (she previously had experienced an allergic reaction to crab but didn't pay attention that there was a broader implication). While we rushed her to the ED, her neighbor tried to be nice and cleaned up including putting the food into the fridge. Hours later, the lady was discharged home after the reaction faded. Now hungry, she raided the fridge and ate another serving of the food that had triggered the first reaction. She was in cardiac arrest when we arrived that second time. Darwin was right I guess....

 

[Doggtyred]

And.. Darwin for the win!

Some people you just... cant.... reach....

 

[Armageddon Aviator]

THere's also no reason to over-react, based on a stable clinical presentation because something MIGHT happen (or might not).

Its clear you guys have two different philosophies in management. Neither is necessarily wrong. I prefer to treat the patient, not the lawyers.... your mileage may vary.

Emergency care providers are confronted with that kind of dilemma on a daily basis.

Most of the time, your patients are stable, you do not need to intervene ( except maybe for O2, IV access and monitoring )...

There are times however, when you need to draw the big guns and provide aggressive care without delay in order to save somebody's life ( cardiac arrest, fulminant pulmonary edema, tension pneumothorax, etc )...

It's up to the caregiver ( based on his training, experience and clinical judgment ) to decide when the patient is stable and when he is not.

Medical emergencies are fairly common aboard airliners, if you had to divert every time somebody is ill and MIGHT require intensive care, airlines would lose many millions of dollars on a monthly basis...that's one of the reasons they're working with organizations like Medlink...

Anyone else read that article and think the lady is faking it? She gets on the plane and makes a big scene about how allergic she is and then, sure enough, she has an allergic reaction with out eating the shrimp. The doctor describes what the patient is complaining about, but her vital signs are normal.

I'm no doctor, and maybe too cynical, but my gut is telling me this lady is just looking for a lawsuit.

I tend to agree that in the mentioned case, the woman was hysterical and very apprehensive because she thought she MIGHT experience a severe allergic reaction...hard to say, I wasn't there...

There are so many clinical presentations, it's hard to generalize....but, just to give an example, I would not hesitate to ask for a diversion when treating a patient with a suspected acute MI ( it would be foolish to delay thrombolytic therapy or risk cardiogenic shock / dysrhythmias )

 

[mchesney]

A whole lot of medical squabbling for an aviation forum!! I'm at work (in a hospital) and come here to escape such foolery!

My take on it is this... Without having been there to fully appreciate her condition and the subtle clues as to which way she was progressing, there is no right answer as to what the correct course of action SHOULD have been. In the strictest sense, a severe anaphylactic reaction with an airway that is obviously swelling should make one extremely nervous but epinephrine is a wonderful drug in that context. It's difficult to armchair quarterback medical decision making without having the "whole picture" and not just the picture you draw in your mind based on the story.

 

[jonnyjetprop]

Here's how things work from the front office. The senior FA calls the cockpit and informs the captain of what is going on. Nobody goes in or out of the cockpit. The captain then gets in touch with dispatch. The dispatcher will do a phone patch with Medlink. After the medical information is passed on to Medlink, a plan is formed. Divert or no divert. If divert, where will you go? Arrangements are made for arrival for the ill passenger. So the on the ground doctor is informed about the aviation part. Yes, oceanic and Africa pose certain problems. It makes no sense to land where medical help is poor or non existent. This was one of the reasons why air carriers are required to carry an emergency medical kit.

 

[dcmoser]

Interesting article. I forwarded the article to my Dr. son and a couple of his doctor friends. I didn't realize they carried such kits on board, but it makes sense. Thanks for posting....

 

[denverpilot]

Yep...although now called "motor vehicle collisions" because "accident" implies no one is at fault. I'm sure there's a lawyer somewhere we can thank for that clarification

Still calling them MVA on all the dispatch channels around here. Or just "Two car accident with injuries, Code 10. Possible trapped victims." Most of our dispatch trainers have moved back to demanding plain English other than standard codes, which still aren't standard between agencies, of course.

The only codes used religiously are the EMS dispatchers use numbers that correspond to locations on a map that aren't published, for telling the ambulances where to park and stage, so they don't attract bad guys wanting to hurt EMS folk. But those numbers haven't changed in 20 years, and everyone knows where the common ones are.

That and the north and south "pumps" for fuel. Those haven't moved as long as I've been alive.