What's up Doc ? Divert flight or watchful waiting ?

[Doc Alan]

Like all reputable airlines, Cathay Pacific requires passengers to ensure they are medically fit to travel prior to starting their journey. They deny passage to any person suffering from a potential infectious disease or who is assessed by frontline staff as being medically unfit to fly. Cabin crew are trained in first aid and infection control measures. First aid and medical kits are provided on board. A US based telephonic aeromedical service ( emergency call centre ) is also available. Other good airlines partner with specific healthcare delivery groups to provide consistent availability of medical expertise. Air quality and hygiene are maintained to " international standards ".


• It is vital, in my opinion, for ALL members to read the advice in this Health section before and after travel. It also appears – after a month away from the Forum – that some may not have done so, and / or give advice which may not always be accurate.


• Worldwide, up to 2.75 billion passengers fly on commercial airlines annually. In flight medical emergencies inevitably affect a significant minority of passengers, usually just requiring first aid, less commonly of a more serious nature. One estimate is for 44,000 such emergencies each year. They seem likely to increase with the trend towards more long haul flights and an increasing number of older passengers with pre-existing medical conditions.


• Basic considerations when assessing someone’s fitness to fly include

- Decreased air pressure ( and low oxygen ) in the cabin.

- Immobility

- Timing of regular medication

- Ability to cope mentally and physically with travel

- Adequacy of health insurance

- Comfort and safety of other passengers

- Operation of the aircraft



• Comprehensive lists of conditions which may worsen, or have serious consequences, during - or after - the flight are available ( see http://www.fitfortravel.nhs.uk/advic...ir-travel.aspx and http://www.patient.co.uk/doctor/flyi...cal-conditions ).



• The ultimate sanction to refuse travel lies with the airline and captain of the flight – if there is considered to be a risk to that passenger, other passengers, and / or the aircraft.



• It’s not known how many flights have a doctor-passenger ( or other healthcare worker ) on board, as understandably a proportion choose not to make themselves known for fear of litigation. They may worry about their responsibility and liability in an unfamiliar environment. There may be space constraints, lack of privacy, cultural and language barriers, lack of resources, noise, and physiological as well as logistical problems. They may themselves have taken sedatives to help them sleep and / or consumed alcoholic drinks.



• Despite that, many healthcare workers would be prepared to help in an unexpected emergency situation – providing advice and medical treatment in good faith as a " Good Samaritan Act ", even when they are not obliged to do so. They should still act within the limits of experience and qualifications, and at least liaise both with the cabin crew and the ground-based medical advisers. Such acts are unlikely to lead to litigation – more commonly volunteering to help in difficult circumstances will be appreciated by the passenger-patient as well as cabin crew.


• A Cathay Pacific flight last week between Hong Kong and London Heathrow resulted in a request for help if there was a " doctor on board ". Not only was the announcement made, but the cabin crew identified me and requested my assistance. No other healthcare workers declared themselves. I explained that I was laboratory-based and not a family doctor, but agreed to help. The passenger-patient was in her early thirties, British, no past significant travel history or fever, and symptoms of feeling faint, with some abdominal pain ( her period had just begun ). As always, taking a careful history ( in this case mainly from her business partner ) and essential examination was vital.



• Flight diversion, with unscheduled landing, in northwest China or Kazakhstan, is thankfully one which was NOT required - this didn’t appear to be a serious cardiac, neurological or respiratory event. Such diversions are not only undesirable for obvious reasons, but are subsequently not always shown – with hindsight - to have been necessary. Fortunately in this case, after liaising with cabin crew, and the ground-based medics, the patient improved with simple medication ( paracetamol, and stemetil for motion sickness ). " Watchful waiting " on my part meant returning to the passenger-patient at intervals thereafter to ensure the diagnoses ( motion sickness, period pain ) were correct.



• I’ve had time since the flight to reflect on these events. It’s a heavy responsibility, but I would do the same again if the occasion arose. I didn’t expect – nor did I receive – financial reward or upgrade to First Class !



http://www.nejm.org/doi/full/10.1056/NEJMoa1212052


http://www.hkcem.com/html/publicatio...3/p191-196.pdf

[stevewool]

We should all have basic first aid training, but it's the fear of being alone and everyone depending on what you may do.

This is nothing to do with flying, but many many years ago we were first on the scene of a bad accident between two cars. One person was trapped in his car and I had to help him. I had no idea what to do, but I managed to support him and comfort him until the emergency services got there. Lots of this could have happened. I was so relieved when I was taken over by this fire person.

I think someone has to take charge but you are hoping for lots of advice from others too.

Well done Alan, you never know, your next flight may upgraded!

[Dedworth]

Well done Doc - welcome back I hope CP "mark your card" for a future upgrade

[Michael Parnham]

Welcome back Alan, an excellent post, well done!

[SimonH]

Nice to see you back Alan

[bigmarco]

Welcome back Doc and another interesting post. I'll give you a rep on behalf of the lady, as I'm sure she was grateful for your assistance.
I recently had to put out a call for a healthcare professional on my train at Camden Town - with the added request for getting a Spanish speaker if possible.

Step forward a Spanish-speaking Florence Nightingale who was able to communicate help and wait with the lady until paramedics arrived.

[cheekee]

I had this happen to me last January on a Cathay flight.

A woman had collapsed and the crew asked over the tannoy if there was a doctor or nurse on the flight.

I did get 75 dollars in vouchers to say thanks though

Welcome back Doc

[Doc Alan]

Thank you to all members who have responded welcoming me back to the Forum, and for sharing your own experiences .

Whether it’s agreeing to assist in an unexpected emergency situation or offering online advice, I always try to do my best and accept the limits of my expertise.


Of course with hindsight the passenger-patient on the Cathay Pacific flight was NOT seriously ill – but she and the cabin crew were worried until the diagnosis became clear. I’ve subsequently received an appreciative letter from the airline, and consider the incident resolved … until the next time !

[Rosie1958]

Welcome back and well done Doc! I'm sure that the young lady would have been most comforted by your willingness to help and your subsequent diagnosis

Like Steve, I was one of the first on the scene of a three car pile up a few years ago whilst driving to a meeting. Fortunately, I'm first aid trained and so were two other car drivers so we took one car each. My casualty suffered internal injuries caused by her seat belt, lacerations to her face and shock. Fortunately, second aid was on the scene within 10 minutes and having given first aid, I was able to do a welcomed handover

[Arthur Little]

back to the fold, Alan ... your presence here on the forum has been greatly missed over the past four weeks by myself and - I'm sure - by many of our other regulars, besides.

Once again, thank you so much for ANOTHER informative and enlightening thread ... that, in my honest opinion, ought to be compulsory reading for ALL prospective long distance travellers.

Whilst I should imagine, most cabin crew would be likely to undergo at least some form of training in First Aid, I am also pretty certain the majority are bound to heave a sigh of relief whenever there's either a doctor or other healthcare worker on board during long haul flights in the event of an emergency ... whether real or thankfully (as in the case of the incident you happened to encounter) non life-threatening.

[Michael Parnham]

back to the fold, Alan ... your presence here on the forum has been greatly missed over the past four weeks by myself and - I'm sure - by many of our other regulars, besides.

Once again, thank you so much for ANOTHER informative and enlightening thread ... that, in my honest opinion, ought to be compulsory reading for ALL prospective long distance travellers.

Whilst I should imagine, most cabin crew would be likely to undergo at least some form of training in First Aid, I'm also pretty certain the majority are bound to heave a sigh of relief whenever there's either a doctor or other healthcare worker on board during long haul flights in the event of an emergency ... whether real or thankfully (as in the case of the incident you happened to encounter) non life-threatening.

Well said Arthur!