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Patients don't want super-surgeries

What is the legal and ethical position when a doctor is confronted with a medical emergency on a plane, in the street or anywhere outside the surgery? Dr Anahita Kirkpatrick explains

With peak holiday season approaching, GPs will be looking forward to the moment they can wave goodbye to their responsibilities as they board a plane bound for somewhere sunny. But with around 500 incidents requiring medical assistance occurring on board aircraft each week1, your clinical skills may be called on even at 30,000 feet.

If you are unlucky enough to hear the dreaded call of 'Is there a doctor on board?' call, you may wish to know your ethical and legal position in advance.

While there is no duty under UK law for a doctor to volunteer as a Good Samaritan, there is an ethical duty to help in an emergency. The GMC in Good Medical Practice says 'In an emergency you must offer anyone at risk the treatment you could reasonably be expected to provide'.

Thankfully medical emergencies on board planes are rare. British Airways points out that most medical incidents in flight are minor and only about one flight in 1,000 is diverted.

The commonest in-flight medical incidents are fainting, diarrhoea and vomiting, and bruises or sprains. The major reason for diversion is chest pain or other suspected heart problems. ('Medical care in the air' www.ba.com)

Of course when midair emergencies do happen they tend to hit the headlines. Readers will doubtless remember the occasion in 2001 when two doctors, a professor of orthopaedic and accident surgery and a senior house officer, famously saved the life of a woman with whom they were travelling on a jumbo jet from Hong Kong to London.

The woman had a collapsed lung and the doctors improvised a chest drain from a coat hanger, biro and mineral water bottle.

It goes without saying that Good Samaritan acts are not limited to air travel. You could be asked to help out anytime, any place, anywhere. One of the most common scenarios doctors face is when they witness a road traffic accident and stop to help.

If an emergency happens in your practice area, you have a contractual duty to 'provide treatment owing to an accident or emergency at any place in its practice area' within 'core hours' according to the standard GMS contract (paragraph 47.3). The ethical duty to assist, however, applies wherever or whenever the emergency arises.

Although Good Samaritan acts may be common, being sued as a result of them is thankfully rarer than a first-class upgrade. The MDU is not aware of any UK cases of doctors being sued after acting as a Good Samaritan.

Your medical defence organisation may in any event indemnify you for Good Samaritan acts. MDU members are covered by an insurance policy for claims arising out of Good Samaritan acts worldwide, subject only to the terms and conditions of the policy. In addition, some airlines say they will indemnify doctors who assist in an emergency.

So the chances of being sued are remote and your medical defence organisation can help you if you are. But if push came to shove, by what yardstick would a Good Samaritan doctor be judged?

The GMC say you must offer anyone at risk the treatment you could be 'reasonably expected to provide'. A GP would not be expected to have the expertise of a consultant in A&E, for example.

The GMC also requires all doctors to recognise and work within the limits of their competence. So if by chance there is someone more appropriately trained to deal with the emergency than you, such as a paramedic, you may wish to step back and allow them to take over.

The same is true if you feel your ability is impeded because you have had a drink or are very tired. If you have no choice but to treat the patient in these circumstances, it would be wise to explain the situation to him or her beforehand, if possible.

If you are in a situation where you've answered a call for a doctor ­ such as on board a plane, in a supermarket, etc ­ and your A&E skills are a bit rusty, you may wish to ask for another announcement to be made asking for 'all available health professionals' to come forward as someone more appropriately qualified may volunteer.

In any case, it is always useful to have another pair of hands. If the patient

doesn't speak your language, you may also have to ask for a call to go out for an interpreter.

Whatever you do can be classed as a clinical intervention, so you must make a clinical record of what you are doing, the name of the patient, and if on board a plane or at the scene of an accident you may wish to pass a note of your name and address to the cabin crew, paramedics or police.

But do remember that your duty of confidentiality to patients prevents you from passing on information about them to third parties without their consent, except in rare circumstances. It's also advisable to give a full handover to whoever is taking over the care of the patient.

In the absence of specialist equipment and premises, the help you can practically give as a Good Samaritan will often be limited, but at least you can rest easy in the knowledge that you have done all you can to help.

Reference

1 DeJohn C et al (2000). Evaluation of in-flight medical care aboard selected US carriers: 1996 to 1997. Flight Safety Foundation, Cabin Crew Safety 35(2): 1-20

Case study

A GP was out for the night at the local cinema when he noticed a woman in front of him in the foyer who was bent double and seemed to be showing signs of respiratory distress. She collapsed and the GP went to her assistance.

Her boyfriend explained that she was asthmatic but had forgotten her inhaler. The GP asked cinema staff to call an ambulance and to cordon off the area to try to give the patient some privacy.

By chance, the couple lived a few doors down from the cinema and so the boyfriend was able to run home and get the inhaler. The woman

was able to take the inhaler and shortly afterwards the ambulance arrived. The GP left his details with cinema staff in case of any repercussions.

A week later he received a bottle of champagne and a letter of thanks from the woman, who explained she had made a full recovery.

The cases mentioned are fictitious, but based on cases from MDU files ­ doctors with specific concerns are advised to contact their medical defence organisation for advice

Anahita Kirkpatrick is an MDU medicolegal adviser

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