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Author: Ali Bacharouch, MSIII
University of Michigan
AAEM/RSA Education Committee
Imagine boarding your flight to Fort Lauderdale after a hectic few months at the hospital. As the plane takes off you begin to think about how relaxing your trip is going to be. As you are trying to sleep, you hear some sounds coming from the back of the plane that give you flashbacks of the emergency department. You then hear an announcement the intercom system: “A fellow passenger needs medical attention; if you are a medical professional please identify yourself to a cabin crew member.” You quickly spring into action and attend to an elderly woman who reports new-onset lightheadedness. After ruling out life threatening conditions, you provide reassurance and head back to your seat as the woman expresses her gratitude.
If you travel somewhat frequently, you will may be called upon by a flight crew member to respond to an in-flight medical event. What are the odds of a similar event happening on your next trip? In-flight medical emergencies that require the attention of on-board medical personnel occur in approximately one in every 600 flights, involving between 30 to 50 passengers each day.[1,2] What are your responsibilities in such a scenario? Are you legally required to offer your services? Although in general, physicians do have an ethical duty to offer their expertise, some may choose not to respond for a variety of reasons, including lack of comfort in responding to situations outside of their typical professional circumstances, lack of familiarity with on-board medical kits, concern for potential liability or litigation, or even the desire to be completely “off the clock” while on vacation.
In the United States (US), there is no legal obligation for you to respond to in-flight medical emergencies. However, you are generally protected from liability should you make the decision to respond, so long as you are not grossly negligent and do not cause intentional harm. The 1998 Aviation Medical Assistance Act protects volunteer health care providers who offer assistance during in-flight emergencies from any action in state or federal court “unless the individual, while rendering such assistance, is guilty of gross negligence or willful misconduct.” These protections, however, do not apply should you accept monetary compensation for your services, and it is not common for airline companies to offer monetary compensation. Travel vouchers and seat upgrades are generally not considered to be momentary compensation, but be sure to read the fine print before accepting any travel voucher that is offered. There is a report of an Australian orthopedic surgeon who was offered a travel voucher by a US airline company after responding to an in-flight event, and that the conditions of acceptance included language absolving the airline company from any legal liability in regards to the treatment of the passenger. Since these scenarios have yet to be tested in court, it is advisable for you not to accept monetary compensation from an airline company nor from the patient, should such an offer be extended. Additionally, this law will not preclude the possibility of a lawsuit brought against you by the passenger, but it will provide a strong defense in federal court. This could still result in a financial burden for you should you be expected to fund your own defense. In the unlikely event of litigation against a physician-passenger, some airline companies will cover the physician-passenger under their own insurance policies. These extra protections, however, are not provided by most US airline companies.
It is also important to keep in mind that the Aviation Medical Assistance Act only applies within the jurisdiction of the United States government. The legal ramifications of responding, or not responding, to in-flight medical emergencies become much more convoluted in the context of international travel. Technically, under international law, the country in which an aircraft is registered holds legal jurisdiction on board the flight regardless of where the plane happens to be during a given event. Moreover, the country of citizenship of the physicians or the patient may also hold legal jurisdiction.[7,8] Australia and many European countries do impose a legal obligation for physicians to assist during in-flight medical emergencies. If, for example, you ever travel on an Australian airline and you ignore the call for assistance, you could theoretically be held accountable by Australian authorities if they are able to identify that you are a physician.
Some regulatory bodies, including the European Joint Aviation Authorities, require aircraft captains to “ensure that drugs are not administered other than by qualified doctors, nurses or similarly qualified personnel.” Thus, if you respond to a call for assistance, you may be expected to present some form of identification and basic credentials. However, in many situations, you will be trusted solely on verbal confirmation of your credentials. If another provider simultaneously offers his or her assistance, briefly discuss your credentials with each other and decide who should make the medical decisions. Ultimately, however, all final decisions on board the aircraft are made by the captain, who has the power to override any medical decision that he or she deems would compromise the safety of the passengers. If, for example, the physician believes that the flight should be diverted to the nearest airport so that the ill passenger could receive prompt hospital care, the captain is not legally obligated to oblige to that decision.
As of yet, there have not been any reported cases of legal action brought against a physician-passenger who provides assistance onboard a commercial aircraft.[6,10,11] Thus, in a general sense, concerns about potential litigation should not hold you back from responding to an in-flight medical emergency. The International Code of Medical Ethics stipulates that “a doctor must give emergency care as a humanitarian duty unless he is assured that others are willing and able to give such care.” Thus, while it is technically true that under the penal code of several countries, you would have a legal obligation to act, the ultimate decision to respond should come down to your willingness to fulfil your professional and ethical duties as a physician.
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