Correspondence

Requests for a Physician's Help during Airline Flights

N Engl J Med 1998; 339:928September 24, 1998

Article

To the Editor:

I recently received promotional material from the frequent-flyer program of American Airlines touting the fact that all its passenger jets are now equipped with cardiac defibrillators and other materials that will enable medically qualified passengers to administer what is, in effect, advanced cardiac life support. I often fly from Boston to London, and I have now responded to five requests for “any physician to make himself known to a member of the cabin staff.” In two instances I assessed passengers who were intoxicated from alcohol served to them during the flight, one of whom had sustained a laceration after falling in the lavatory. I have also assessed a passenger with substernal pain that was relieved by antacids, a young passenger with severe abdominal pain that was relieved by several bouts of diarrhea, and a passenger with renal colic that subsided without treatment.

On each occasion, I had to give my opinion as to whether there was a need to land at the nearest airport because of a medical emergency. The crew supervisor made it clear that this recommendation was mine alone to make. This decision would clearly have considerable legal and financial implications for the airline. On each occasion, I was obliged to conduct an examination in cramped conditions with poor lighting and limited tools, make a rapid diagnosis where possible, and advise whether to divert the aircraft. On each occasion, I was obliged to spend several hours out of my assigned seat and away from my traveling companion, sitting next to and keeping an anxious eye on my patient.

It would now appear that American Airlines and other airlines as well not only count on having a physician on their passenger lists, but also expect that he or she will be ready, willing, and competent to administer advanced cardiac life support and to make decisions regarding the need to divert the aircraft. Not all physicians are so qualified. Some may be seeing resuscitation equipment for the first time in decades in semidarkness over the Atlantic Ocean. There are accounts of well-intentioned but quite inappropriate and dangerous medical maneuvers being performed in flight by physicians working outside their field of expertise.1

I really must protest the increasingly unrealistic and burdensome expectations that we physicians now face whenever we board an aircraft. Perhaps the airlines should make clear to physician passengers in advance that they are expected to be available and on duty throughout the flight, to abstain from alcohol, and to be prepared to administer advanced cardiac life support. The industry should certainly indemnify against malpractice any physician from whom in-flight help is requested, regardless of the nationality of the sick passenger or the location of the aircraft.

Incidentally, I have yet to hear any word of appreciation from the airlines for the five anxious and ruined flights that I have had. A suitable token might be a free first-class ticket in return for one's services and exposure to liability.

Of course, every physician will be ready to come to the aid of a passenger in the case of a bona fide emergency, and in such circumstances, the availability of resuscitation equipment would be welcomed. Nonetheless, one does get the feeling of being taken for granted and even of being used as a form of hidden advertisement for the airlines that are widely promoting the fact that they carry advanced cardiac life-support equipment.

Paul D. Buisseret, M.B., F.R.C.P.
18 Briarwood Cir., North Easton, MA 02356

1 References

1. 1

   Buisseret PD. Managing in flight emergencies: plane should not have left the ground. BMJ 1995;311:1507-1508
   CrossRef | Web of Science | Medline

Author/Editor Response

A spokesperson for American Airlines replies:

To the Editor: It is not clear whether the experiences Dr. Buisseret describes happened on American Airlines flights or those of one of our competitors, and we regret any insensitivity or ingratitude on our part if American was involved. Frankly, we were surprised by his letter, since we make every effort to recognize physicians who voluntarily assist on flights, both with a thank-you letter and, if the incident was severe, through our mileage program.

As Dr. Buisseret notes, American Airlines has equipped its entire fleet with both automatic external defibrillators and enhanced medical kits, and other carriers are following suit. Since the initiation of our program, the defibrillator has been used more than 65 times, primarily as a monitor, and one life has been saved thus far with the equipment.

The response of all physicians on American Airlines flights is completely voluntary, and our flight attendants are trained to use the defibrillators without the involvement of a physician. Physicians are under no obligation to respond, contrary to Dr. Buisseret's suggestion. We are very grateful when they do, since it can mean the difference between life and death for one of our passengers.

We are deeply appreciative of the support shown by the medical profession.

David K. McKenas, M.D., M.P.H.
American Airlines, Dallas–Fort Worth Airport, TX 75261-9616