Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Clearing the air on air travel medicine
- Osman A Dar (15 March 2008)
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Being used and abused
- liam farrell (17 March 2008)
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Beware incorrect translation of medicine labels
- Cheri M John, Deepa E Mathew (17 March 2008)
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Least heroic and most disruptive
- Lauren E Young (19 March 2008)
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Raising standards for rising demand.
- James Austin (20 March 2008)
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Beware those sallying forth to your aid....
- Anthony G Cummins (20 March 2008)
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Call for mandatory, standardised medical equioment
- Adrian Mondry (21 March 2008)
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First Class help on Budget Airline
- Katie S Hoogewerf (26 April 2008)
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Osman A Dar, Clinical Fellow in Diabetes and Endocrinology Addenbrooke's Hospital, Cambridge, CB2 0QQ
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I fully appreciate the need of editors to make final adjustments to articles submitted for publication in the interests of staying within the bounds of allowed word counts and what constitutes appropriate use of the English language but I feel that a couple of important points were omitted from my recently published submission. I would like to highlight that the main point of my Personal View article was to emphasize that self-regulation of an increasingly profit driven industry in an era of rising oil prices is not the best mechanism for ensuring adequate healthcare provision on international flights. Airlines know which routes and sectors are more likely to yield dissatisfied customers that have recourse to legal action. This probably already has, lead to a two-tiered system where different health standards are applied by the same airline depending on where flights are originating from and flying to. As disciples of a profession that aims to promote equity and equality of access to healthcare for all peoples this is an unacceptable state of affairs that we find ourselves in and we are duty bound to oppose it. On a slighlty more lighthearted note my last point about the airlines providing 'longer aisles and stockings for everyone' was meant as sarcasm but came across as a serious suggestion after editing. Working in a Diabetes ward where neuroischaemic lower limb ulcers and patients with severe peripheral vascular disease abound aplenty and where stockings are a relative contraindication, I fear being lynched by my colleagues on my return to the ward! Competing interests: None declared |
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liam farrell, gp crossmaglen health centre bt35 9hd
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Dr Dar's experience reminds me of my own, having to catheterise a patient in retention, sans gloves, sans lubricant, sans courtesy from crew, sans gratitude from airline and then being asked to sign a form which read; "I would confirm that I have treated the above named passenger and accept full responsibility in respect of such treatment. I further confirm that that I will indemnify and hold harmless the airline and its employees and/or subsidiary companies against any claims arising from my treatment of the said passenger." I trust these forms are now history. Competing interests: None declared |
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Cheri M John, Consultant paediatrician Whiston hospital, Prescot L35 5DR, Deepa E Mathew
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Sir, As a paediatrician couple, we had to deal with a febrile eighty year old gentleman on an inter-continental flight. The chief flight purser asked for a doctor and we offered our services as there did not seem to be any other volunteers. The chief flight purser opened up the 'medical bag' which contained a wide array of medicines. We flipped through all the drugs which were labelled in French and the 'list of contents' looking carefully for Paracetamol or any similar sounding version of its spelling. The chief flight purser helped us identify the drug we needed. We questioned the flight purser twice as we had our doubts about the route of administration for this particular preparation based on it's shape! The French word 'suppositaire' certainly sounded like it should not be swallowed. Our minds went back to medical school where we were taught that in France, suppositories are the route of choice.It is unusual for any course of treatment not to include suppositories. Anecdotally, this always seems to come as a surprise to visiting Brits who fall ill in France. Their embarrassed reaction is a source of endless amusement among the French. The same orifice is preferred for the taking of temperatures. French people are horrified at the idea of putting a thermometer in their mouths - they assume that all thermometers will previously have been inserted elsewhere. Fortunately, my wife had a supply of Paracetamol tablets in her handbag which duly brought the patient's temperature down. The moral of the story - Make sure that someone translates the medicine labels for you when you travel in this ever shrinking global village. Competing interests: None declared |
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Lauren E Young, Final year medical student Royal Free & University College Medical School, London
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Sir, Although in-flight emergencies may be rare, I'm sure many medical students envisage heroic life-saving maneuvers and subsequent free flights should any passengers fall ill in their vicinity. However, this was definitely not the experience I had. The plane had taxied to the start of the runway when the crew put out repeated calls for a doctor. After a few calls I decided that although I was a 4th year medical student I may be able to help, a little. The patient was an elderly lady who had managed to board the plane and had since lost her passport and all knowledge of her personal details or medical history. She was confused, disorientated and had a resting tremor. On further questioning she produced an empty blister packet of medication which had no generic name on it and stated that she had taken them recently but she couldn't remember what for. She became more and more agitated and was unable to tell me if she had any medical conditions. The crew were growing more and more impatient by this stage, as were the hundreds of other passengers listening intently to my fumbling efforts at a clerking after being awake for 36 hours. One stewardess declared the patient had diabetes after taking her pulse and said the flight would be just 2 hours so we should get on and take off. Although I felt awkward as a mere medical student, I knew that flying 2 hours with a confused patient who may or may not have taken some medication was not a good idea for any of us. I watched as the stewardess gave the patient a sugary drink and decided that although I wasn't qualified I still had to act in the patient's best interests. I stated that in my non-professional opinion the plane should return to the terminal and the passenger should be assessed by a fully qualified doctor. As the hundreds of passengers groaned and glared at me I slunk back into my seat and sighed with relief as the terminal building drew closer. Choosing the least heroic and seemingly most disruptive option is often the safest. Competing interests: None declared |
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James Austin, Anaesthetist / Intensivist Wagga Wagga, Australia
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Dr(-to-be) Young: well done! Kudos to you, both for your excellent medical judgement, and for having the courage to enforce it in the face of a hostile multitude! For what it's worth, my experience of an in-flight 'emergency' was very positive. Nothing very life-threatening (dehydration from acute gastro), but I was tremendously impressed with Air Singapore. Their equipment was wide-ranging, relevant and in good condition; their attitude was both friendly and professional; and their nursing training seemed excellent (how many doctors are capable of taking a manual BP fluently?). While I was engaged with the patient, a stewardess helped my wife with our three-month-old baby; and at the end of it we were warmly thanked, and given a voucher for the duty-free trolley, from which my wife got a very nice pearl necklace. I agree wholeheartedly with Dr Dar's point: left to their own devices, some airlines will provide excellent medical support, and some will be lousy. Either this must be regulated from above, with route licenses dependent on compliance; or it must be encouraged via the free market, with consumer-standards organisations able to assess and report on airlines' medical facilities. With the increasing number and age of air passengers, this is bound to be an expanding epidemiology. Competing interests: None declared |
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Anthony G Cummins, Lecturer Department of General Practice Royal College of Surgeons in Ireland (RCSI) Dublin 2 Ireland
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My hairs bristled and my antennae extended when I heard: "Is there a doctor on board the train?" The poor victim in need of assistance was eleven carriages away from me. Arriving in her compartment I noted she was losing consciousness and sweating profusely. I assumed this was a hypo. However, she was being "attended" by an inebriated man who was conducting his idiosyncratic notion of "resuscitation." Because of his actions, bystanders assumed he was a doctor. The woman became unconscious and ultimately had to be taken off the train and admitted to hospital where an intravenous dextrose infusion was needed to counteract her confirmed hypo. When someone rushes forth to offer assistance in such a crisis many others feel inhibited about getting involved and often may be only too relieved that someone else is providing assistance. Oh, and how did the train company reward my intervention? Well, having helped transfer the woman to an ambulance I then proceeded to walk down the platform to enter my compartment, some eleven carriages further on. I was stopped abruptly by staff on grounds of health & safety. But they weren't all bad: a staff member was sent round after I had returned to my seat with a can of Coca Cola with the management's compliments. Competing interests: None declared |
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Adrian Mondry, Consultant in Acute Medicine Hammersmith Hospital, London, W12 0HS
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In 2004/ 2005, I did an intercontinental flight every month of the year. Not surprisingly, I got my fair share of emergencies to deal with, ranging from "drunk and disorderly" to "sudden loss of consciousness". I can only repeat the previous correspondent's praise for the high level of paramedical training Singapore Airlines' staff are able to demonstrate, as well as the range of drugs and technical apparatus available on board their planes. Flying on cheaper competitors, I found this sadly lacking and very much concur with Dr. Dar's impression that self- regulation is not ideal in assuring that in flight medical emergencies will be dealt with appropriately. Relative to the huge financial turnover airlines generate, the cost for standardised equipment and its maintenance is rather low. The price for a fully equipped emergency box is around the £1000 mark; in view of recent reports of "Ghost flights" (i.e. intercontinental flights without passengers aboard) abounding, such a contribution to passenger saftey should be both standardised and mandatory for all airlines. Competing interests: None declared |
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Katie S Hoogewerf, General practice Shanghai 200040
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I too have ben called up on a flight and my experience was almost totally opposite to that which Osman Dar describes. I was on a short haul budget flight, when the call went out "Is there as doctor on board?" In this respect, my experience was similar to Osman's- reluctant admission that as a doctor I may be able to help, and a feeling of impending gloom. The rest of the story differs markedly from his. Firstly, I was immediately asked to provide proof of my status (a bank card ensured this). The patient, I was fairly confident after assessment, had simply fainted. I stopped the oxygen which the crew had already started to administer.The patient recovered and I remained with her. Within about 5 minutes I was asked by the steward, "The captain would like to know if you need an emergency landing?" "No, definitely not" I replied. "What about a rapid descent into Gatwick?" Again I replied no. With no prompting by me, I was asked if an ambulance would be needed on arrival. No, I felt, but a medical review would be nice at the airport - it would be nice to have your diagnosis at 30000 feet reconfirmed at ground level. This actually, did not seem to be possible, so we elected for a single paramedic to attend at the gate. On arrival, the Captain announced the emergency, the passengers were asked to remain seated, and the paramedic boarded the aircraft. The patient had an on board ecg which was fine, and was then "discharged" from the flight. Seemingly the only reluctance on the part of the airline? To provide a free bottle of orange juice to the patient....in fairness even this was done eventually. Competing interests: None declared |
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