Comment by omegant | Hacker News Reader

Comment by omegant | Hacker News Reader

I have had several medical emergencies onboard as a pilot. One thing I constantly say to physician friends (my wife is a doctor), is that we (the crew) expect from them to make as fast assessment of the situation as possible.

For example in my company we don´t have an online doctor to ask for help, so the volunteer has to take care of the situation. Recognizing the problem as soon as possible and prescribing the necessary action (Is not going to be easy with such limited capabilities, sometimes is just impossible, but is better an overreaction), is important because commercial planes fly at 8 NM/minute, and depending where are you flying ( flying over the ocean or africa) 10 minute delays could mean another 30 extra min to land or even several hours if you have passed a no return point in the middle of the ocean.

Don´t hesitate to take control of the situation regarding the patient, stewardesses and other passengers:

- Ask for the medikit (only physicians are allowed to use it). I have seen some chief stewardess resisting to bring it, just to avoid having to write the compulsory report. - If it is necessary to lay the passenger on the ground or other seats, bring him water or any other thing, just give the needed orders and ask for help. - Ask the stewardesses to keep other passengers away if they are interfering too much. - As soon as practicable give a report to the captain and if necessary ask him to land the plane. He will be waiting for it. - If possible never declare a decease onboard , first you could be wrong!, and it is a bureaucratic mess. Is better to keep trying CPR till the emergency team can take care of the patient. We apply this in Europe although it is not a written rule, I don´t know how it works in USA. -Remember when in doubt it is better to ask the captain to land. Everybody will lose an hour or two but a live will probably be saved.

I know I'm going to get down-voted for an information-free post, but I think it's awesome that you're a commercial pilot and participating in HN. It can sometimes get too insular with valley-type techies here. Thanks for participating.

Well I am also founding my own startup..;) so maybe it doesn't count!

I wish there was a better way on HN to know someone's other disciplines. They're usually hidden out of context.

I like reddit's Askscience's method of having a short tag next to the username. This could be helpful.

It could be interesting. I wonder how it could influence bias on the reader though if it was that direct. I more would like to be able to explore a person deeper if they've said something interesting, etc..

Not for being "information-free" but for breaking the guidelines: "Please don't bait other users by inviting them to downmod you."

I don't think he was baiting users so much as apologizing in advance.

"Ask for the medikit (only physicians are allowed to use it)"? Are you sure? As a paramedic, I know of several cases where it's been used by paramedics and even EMTs. In fact, realistically (though not for a moment to denigrate physician knowledge, and training, etc), arguably most of the equipment in a commercial airplane medikit is -more- familiar to a paramedic than a family practitioner or indeed any physician whose career isn't in the emergency center or operating theater.

Perhaps it was imprecise language, I would use 'physician' more broadly. I imagine he means "trained medical personel" e.g. and not the untrained flight staff.

My apologies I was writing on the move and I wasn´t too precise. In fact is anyone with medical training, paramedic, nurse, or physician.

(Always wanted to be a commercial pilot. My wife also is a physician).

Curious, what is type procedure to verify that someone really is a physician? The OP doesn't mention if a license was checked or otherwise. He relates having to speak to a someone on the ground before he could use the kit but doesn't indicate if any check of credentials was made.

A similar thing happened to my wife (an MD). She was asked by the crew if she had any sort of hospital ID. There turned out to be ~3 other doctors on board, so she wasn't needed, but they did ask for some kind of confirmation that she was indeed a doctor.

Yes you have to ask for professional ID.

Well is not so glamourous after all. A friend of mine is currently working in Oman, he has told me that there are tons of american pilots working there as the salaries can be double than in the states. For young pilots the salary can be as low as 1000$/month. So there is lot of emigration in this profession. If you really would like to enjoy flying, just try soaring!. Much more safe than paragliding (more expensive too and less convenient). Only the plane and your ability to extract energy from the atmosphere. Awesome!. Of course being in North America you must try a flight in a warbird!

Do you have access to an on-call physician? Would a provider at some level less then 'physician' (e.g. nurse practitioner or paramedic) be able to use the kit if they're in contact with a physician?

It would be extremely frustrating to watch someone die (or at least get sicker), knowing there was equipment on board that could help them...

We don't have inmediate access to a physician via frequency(lime AA seems to have which is great), but surely the ground team would find the airport team if necessary. Mind you that even if you have access to the medical kit, you are not going to use it properly, I have some general knowledge but I can not distinguish an heart atack from a simple pass out. You could easily complicate a simple issue. I carry on my Iphone the special operations forces medical handbook. It has some gidelines on asisting a birth, and much more(from dressing a hunt piece to basic dentist instructions) but I don't think I Could dare to prescribe a drug based on things read on the fly.

I'm trained as a paramedic. I routinely make those sorts of assessments (much more frequently than most physicians, in fact). It's unlikely you carry anything in your medkit that I don't carry in my ambulance.

My question is mostly if the 'physcian' requirement could be circumvented if someone with medical training (other than a physician) were in contact with a physician on the ground. If, for example, I were to explain to a remote physician that there's someone on board who is experiencing A, B, and C, and I would like to do X, Y, and Z. If the doc concurs with the decision, would that be enough, or is there some set in stone policy that couldn't possibly be overridden?

Let me check the rules, but I certainly would give you access to the emergency kit, and control over the issue. Your experence and formation is much more related to an onboard sudden problem, than for example a dentist or any other physician who has forgoten basic ER knowledge.

I just checked and you are completely right, is any one with a medical training and a professional ID as an accreditation. It is just we call for a doctor as a generalization, but is wrong and we should be more precise.

Law and regulations vary, but essentially you can "practice" under the license of a physician (and in fact, throughout the US, that's how EMTs and Paramedics operate, through an agency or county Medical Protocol Director).

Everything in that bag is likely able to be used autonomously by a paramedic - it deals with acute care, not chronic, which unsurprisingly is what paramedics are used to dealing with:

* childbirth * airway management / ventilation, up to emergency cricothyroidotomy * ET / NG intubation, including RSI (rapid sequence induction, essentially sedation, anesthetization in preparation) * bleeding control / fluid resuscitation * pain management * seizure / neurological * cardiac events, drug administration, manual and automated defibrillation, pacing * diabetic * overdose / poisoning * less common on an aircraft, but trauma, including burns * medication administration via IV/IM/IO routes

Most paramedics work almost entirely autonomously via protocols and training, and do not require direct physician approval for drug administration (as opposed to nurses). This range of drugs is quite extensive (my county allows approximately 40, including adenosine, amiodarone, atropine, dopamine, etomidate, fentanyl, morphine, midazolam, lidocaine, furosemide, promethazine, succinylcholine, vasopressin).

Yeah, I was looking to clarify if there was some sort of medical control available.

I know for a fact that some airlines do have an on-call physician (the medical director for my paramedic program was one years ago, in addition to providing state-wide medical control for all flight based EMS services), I was just curious if the OP's airline did.

We have medical service, and they are called in an emergency if necessary(is not like they are in standby just for a plane to call them), but usually we first ask for a doctor onboard. It seems that AA first call their doctor as a procedure, it has surprised me, but it´s pretty logical if you ask me.

> never declare a decease onboard

I had a friend on a transatlantic flight that got stuck in Iceland (they tried to get the person on the ground and to a hospital but there wasn't really anything that could be done) for... a long time... because of this. And IIRC, letting them off the plane was not really an option either, so it ended up being not only depressing, but pretty miserable in other ways as well.

As a physician, thank you for this. Is there a standard medkit load out?

There is an ICAO recomended kit list, but usually is more extensive than that, I have our company list (I'll search it and post it later) but trying to find if there is a more general one. Now a days there are also automatic defribilators (spelling?) in transoceanic planes. There should be some kind of general briefing for physicians, from airlines and medical asociations.

I believe this document has the current ICAO med kit. Interestingly, I work with the guys who draw up these supply lists for naval ships, and we're chopping one now. Will definitely include this in the discussion. I really hope you can send me your company list.

http://www.asma.org/asma/media/asma/pdf-policy/2007/airline-...

Interesting - this is essentially an ALS (Advanced Life Support / Paramedic) bag.

Minus a laryngoscope and other vital airway kit items. Although I couldn't imagine trying to use one on the aisle of an aircraft, I'm sure there are many paramedics, anesthesiologists, and ER nurses and physicians who wouldn't hesitate if one were needed. All there appears to be for airway support are oropharyngeal airways. That's surprising and in my opinion (as someone with long-expired EMT training), unfortunate. The same goes for AEDs. A $2000 kit that could save someone's live from being claimed from the most common group of disease in the Western world (cardiovascular diseases) should be a no-brainer aboard a 200 million dollar aircraft. People are helpless at 30,000 feet and it's the airlines' responsibility to have the equipment available for qualified medical professionals who happen to be on board in the event of an emergency. AEDs could even be used by steward/esses who had undergone minimal training.

The aisle of an airplane would be an awesome place to intubate someone. One of my favorite intubation positions is having the patient lying supine, then lying prone 'above' them. This obviously only works of you have a fair amount of space in at least one direction (like an airplane aisle).

I found something better than my company list, this is IATA medical manual. It is much more extensive, and it covers almost everything related with health and flight. But you can find the recommended kit in the SECTION 6 passenger care, APPENDIX B. I suppose it will be of more interest for you.

I must also say that when there is a person onboard with high fiver or symptoms of a contagious disease, in the USA you have to notify to the authorities (the Federal and State Quarantine and Isolation Authority I think) immediately. I didn´t know it before I read the manual as I am not currently doing intercontinental flights.

https://www.iata.org/whatwedo/safety/health/Documents/medica...

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