Friday October 16, 2009
Should Health Professionals be Good Samaritans?
As movie clichés go, it's right up there with Ronald Reagan's deathbed challenge to Knute Rockne to "win one for the Gipper." Someone falls ill in a theatre or a banquet hall; suddenly, the lights go up and the host asks if there's a doctor in the house.
This week on WCBA, we salute those white coats in shining armour who act as good Samaritans at everything from roadside accidents to transatlantic flights. The show airs this Saturday October 17 at 10 am (1030 in Newfoundland) and Monday October 19 at 1130 am (3:30 pm in Newfoundland).
In 2006, family doctor Henry Coopersmith was flying from his hometown of Montreal to Paris via Air Canada with his wife when he was awakened to assist a passenger in distress. He ended up being awakened three times in total for reasons he thought to be anything but emergent. Coopersmith took Air Canada to small claims court, where he won an unprecedented judgment of $1000 for providing assistance in what was determined by the judge to be a non-urgent situation. The matter is far from over; the airline has applied to the Quebec Superior Court for a judicial review.
I've been a Good Samaritan on many occasions during my career. I can remember tearing up the street when I heard the sound of a car crash. I had just finished a jog and was still in my shorts when the collision took place. I ended up staying by the side of one of the accident victims until an ambulance arrived. Another time, I saw an elderly woman collapse on the street.
One of my favourite TV characters of all time is the ultimate Good Samaritan. On the TV series Lost, Dr. Jack Shephard, a dedicated and very troubled neurosurgeon played by Matthew Fox, was one of 71 survivors of the crash of Oceanic Flight 815, which fell from the sky en route from Sydney, Australia to Los Angeles. From the moment the plane crashed in the 2-hour pilot, Shephard began providing emergency medical care to his fellow passengers. Later on in the series, he was even forced to remove a tumour from the back of the deliciously evil Benjamin Linus, played by actor Michael Emerson.
Clearly, once it became clear that the survivors of Oceanic 815 weren't going to be rescued anytime soon, Jack's Good Samaritan turn became his job. That he became the reluctant leader of the survivors is no surprise to me. Many MDs I know are attracted to power. Frankly, as a leader, Jack Shephard makes a fine physician!
When it's an emergency, I think people like me should offer help without reservation. Where Dr. Coopersmith and I draw the line is when there's a request for help in a clearly non-urgent situation. Don't get me wrong. If a flight attendant asked me to see a fellow passenger who was complaining of a rash, I'd probably say yes in a heartbeat.
But I think doctors, nurses, paramedics and other health professionals should have the right to say no to non-urgent requests for medical help without criticism or second-guessing. Most health professionals work hard. When they're on vacation, they should have the right to take off their stethoscopes and be off duty in every sense of the word.
Unless of course they end up on a deserted tropical island. Which makes me wonder...if you had a choice, which kind of health professional would you like to be deserted with?
Previous Comments (14)
Hi Dr. Goldman,
am listening to your show right now about the good samaritans. It think it's crazy that air canada expects passengers to volunteer and help with medical emergencies. it's nutty. they don't know what kind of expertise or experience these doctors have. I just think it's crazy to expect there to be someone on the plane who will have the expertise to help. surely there are flights where there is no doctor on board. what do they do in those situations? I agree that air canada is taking advantage of docs as volunteers on flights, but also they are putting their passengers at risk by not having a system in place for dealing with medical emergencies.
love your show.
In todays show you mention the fact that Air Canada makes use of the good samaritan doctors to provide their health related assistance to their passengers.
Something that perhaps was missed in the discussion was the fact that passenger manifests are doubling and tripling to the point where the liklihood of a health professional is going to be called upon rises.
It seems to me that the air lines are going to have to provide or have a responsibility to provide emergency health care for their passengers.
I was just listening to the program and was thinking how the good samaritan coat was worn by my father, a Police Officer. He didn't stop being a cop at the end of his shift. There were times when I was with him he saw something wrong and called in or personally stopped a crime.
I believe that there are certain professionals who don't stop being what they are because of the clock and because of who they are. Can you imagine a firefighter who sees a fire and stands by and says i'm off shift? Or a doctor, or a cop, or a soldier, or anyone of noble professions turning a head because they are not being paid for this so just stay out of it?! You don't become any of these just because it's something to do! It is in your heart! How can your passion for what you do be turned off and on by the clock?!
I myself have only emergency first-aid and have used it a few times. I can't imagine anyone standing by and watching another person suffer in pain and/or fear. I'm sure what prevents people from helping is the fear they experience of reprisals for anything gone wrong. Which brings us to another topic of discussion for another day the problem that today's world is all about liability and who to blame. Caring for each other shouldn't have a clock and price tag attached!Christine Chomyn, October 17, 2009 10:47 AM
Hello, as a long haul pilot for a carrier based in Hong Kong, I am happy to tell you that many airlines do have on call medical services contactable at any point in any flight.
In our case we use a service called Medlink, based in the United States. Even if there is a doctor on board they will be put in touch with Medlink and work together. The idea is that Medlink would have the legal responsibility while the doctor on the plane merely actions medlinks decisions. If there is no Doctor on board then the Cabin crew will do what Medlink advises, although that will not be as in depth as if a physician was present. Medlink will also advise the flight crew on whether a diversion is needed and how soon.
This system, I am, sure is pricey, but works very well for everything from anxiety to heart attacks and strokes.
As a pilot it was interesting to hear the doctor's side of the issue. However I feel you have not done the airline industry in general any favours. Perhaps a mention that there are many airlines around the world that do employ medical services for every flight, would shame those that don't, and put the traveling public at ease. It may even make who to fly with an easier decision !
Thanks love the show.
MartinMartin Richard, October 17, 2009 1:42 PM
Just listened to this morning's broadcast of WCBA, and enjoyed it as always. Today's episode particularly interested me as I am an airline pilot, currently flying the B-777 for Air Canada, an aircraft used primarily for ultra long range flights.
I must respond to your closing comments in which you said something to the effect of "if they're not going to have medical staff on the aircraft, they should at least have communication with same on the ground."
You might be interested to know that all of Air Canada's overseas aircraft can if necessary, be in immediate communication with a team of trained medical professionals, including Doctors, who specialize in dealing with onboard medical emergencies. In fact, when an aircraft diverts due to a medical emergency, it is at the direction of these folks.Brian Gartshore, October 17, 2009 4:12 PM
Please God if I get sick on an Air Canada airplane make sure Henry is not on board! If he is, make sure that the flight attendants do not disturb him in his first class seat.Frank Marchioni, October 17, 2009 6:25 PM
I just listened to the podcast about good samaritans and I have 3 comments.
First, although I am not a doctor nor ever aspired to be one, I think that we all should feel the need to help or find adequate help in emergencies. Everyone should learn basic first aid training and for sure not simply ignore an emergency situation. However, I do not think we should make individuals feel obliged to help others. I have never been in a situation where I was in a public place and needing medical attention but I hope that if I am ever in such a situation, someone would come to my assistance. Thank you to all the good samaritans out there, you make me feel safe.
I also want to say that I agree that airlines should not expect to rely on the generosity of physicians or off duty emergency personnel. Airlines are a business and they have an obligation to ensure they are adequately prepared to assist individuals in the event of an emergency. That being said, I am really grateful for physicians who offer their time and expertise to individuals in need while inflight.
Finally my last point is about the tendency to react less when in a group as opposed when alone. While in a group individuals often expect someone else to take the lead and then when no one does, they assume that they may have misinterpreted the situation. Perhaps this maybe an issue sometimes?Larissa Fulawka, October 17, 2009 11:41 PM
Hi Dr. Goldman,
I was listening to your interview with Dr.Henry Coppersmith,and how he has tried to recover monies for services rendered on an Air Canada flight whereby he was encouraged, by an Air Canada representative, (namely the Airline Stewardess), to tend to sick passengers.
Personally, I believe that Air Canada should give Dr. Coppersmith a couple of FREE tickets (one for his spouse and another for himself),for his (and his spouse's) inconvenience and because Dr. Coppersmith assisted the sick passengers upon request from the Airline Stewardess. To do otherwise, is simply very petty on the part of Air Canada because they have often given FREE seats to passengers who disembark an airplane voluntarily because Air Canada over-booked a flight but when a Doctor is called upon during an airline flight to assist ailing passengers, Air Canada plays the Scrooge. Why would any Doctor volunteer to help in future, if Air Canada refuses to acknowledge the 'Good Deeds' by at least giving the Doctor concerned a couple of Freebies.
It appears that Air Canada is more concerned about 'taking' (namely the services of Doctors on flights) rather than 'giving' (a couple of airline tickets for services rendered.
It wasn't that long ago when Air Canada wanted monies from the Canadian taxpayer because they were a little "sick", now that the 'shoe is on the other foot', it is altogether different.
C'mon Air Canada, give Dr.Coppersmith his free tickets just to demonstrate your generosity toward him and for the service that he provided.D. Thompson, October 18, 2009 8:20 PM
I was listening with great interest to today's show. As a flight attendant, I feel that a bit more research could have been done by your team.
At Air Canada, we do have a ground based medical expert team that can be reached at almost anytime during flight. We are also trained in basic first aid. Supplies are limited in flight therefore we use what we have at our disposal.
There is a protocol to follow and one of the steps is to call for medical assistance. I believe the doctors, RN's and peramedics that do assist us, do it out of kindness. They truely want to help... Believe me, when I page for a doctor, there is a need for one! It may be incovenient, but so is pit-stop in Reykjavik to off-load a passenger.Tad Samson, October 19, 2009 11:29 AM
The airlines should look after the insurance of doctors who are asked for assistance by airline staff. They should also be forthcoming in doing something realistic in return because the doctor's trip has been disturbed. A brief talk with another passenger would not merit much in return but repeated interruptions, being awakened, looking after someone quite ill do deserve perhaps 1/2 the value of the trip and done in a way which does not lead to more paperwork, tax or burden of responsibility. The airlines should provide much more clarity to their own staff and to physicians who assistance is sought.Rowena Julian, October 19, 2009 1:38 PM
A Doctor is no different than any other responder regardless of the situation that he or she may find themselves in outside of their office/practice.
As a First Aider (which by definition you are in the scenario given) one must follow the principles of a good Samaritan. You must use whatever training and knowledge within reason and pass your patient off to better equipped medical authority at the soonest available moment, EMS or an on duty medical facilitator (a doctor in uniform). If there was a person in distress the minimum amount of aid a person should give is at least comfort. (in my training I was even given directive to protect the dignity of VSA casualties)
To assume that the airlines is going to give you some sort of kickback because you are a "paid professional" during an emergency is ludicrous. To sit on your hands and do nothing is more ridiculous . One of your guests mentioned that if a policeman is out of uniform does this mean he is off duty? The same could be said about soldiers, who by the way are on duty 24/7 regardless of their outward appearance. A doctor or other medical professional out of "uniform" better assume that they are always the same, on duty.
The airlines have measures, practices and procedures to try and alleviate panic, remember you are in a unique situation where full blown medical facilities are not readily available. To call your assistance a "generosity" is an insult to your craft, you are providing in some cases life sustaining aid.Stuart MacDonald, October 19, 2009 1:43 PM
I am not affiliated with any airline nor medical community. I am simply a CBC listen who indeed does not agree with everything that Dr. Brian Goldman avows!!
Regarding Good Samaritans, family doctor Henry Coopersmith was entirely right in requesting compensation from his airline carrier for essentially "making a House Call, twice."
In his specific circumstances, he was volun-told to return to the back of the plane where a passenger was already being handled by other competent care.
In this non-emergency, Dr. Henry Coopersmith was not obliged to provide care.
Airline carriers have there own issues to resolve regarding the question of 'What is an appropriate protocol for providing in-flight medical care?' The existence of this airline concern does not oblige any passenger to intervene in a non-emergency situation.
Of course, I believe that every doctor, and likely many un-qualified rescuers alike, would jump to the aid of survivors were an aircraft to catch fire or crash, or if a passenger suffers a life-threathening event! A panic attack doesn't constitute a potentially life-threatening emergency.
By the way: A relative of mine survived a horific automobile accident because a medical doctor happen to be travelling the same highway within mere minutes of the crash. I hope that no medically trained person would shirk administration of emergency care: she was already dead without a physician's immediate intervention, yet she survived. Liability ought not enter the equation whenever life-saving care is attempted.Mick, October 19, 2009 2:47 PM
Hi there. When I was an Anesthesiology resident a few (ok maybe 10 or so!) years ago, I was driving on a small street (post call and almost comatose on the way home) and witnessed an elderly woman who collapsed right there on the sidewalk (that woke me up in a hurry!).
I pulled right over, put on my hazard lights, called another pedestrian for help. She was unresponsive and pulseless. The other man called on his cell (I didn't have one- not on a resident's budget!:D) for 911 and we started the best darn CPR within seconds of her collapse.
An ambulance arrived very soon, and the paramedics hooked her up to a portable (not an automatic) monitor/defibrillator which showed bradycardia and they shocked her! (not the recommended treatment)
I told them who I was and that they weren't doing appropriate therapy and they laughed in my face and said "there there, we'll take over now". It's a good thing I was so tired, but I followed up with the hospital ER where she was sent and thankfully she made a full recovery despite being zapped. I would just like to say to that ambulance driver that day that sometimes some Good Samaritans CAN help!! Since then, I don't stop at accidents if I see an ambulance there already because, well, I could be getting in their way. Is this right? (well, I've only passed by two accidents, thankfully, since, but I still recall the incident)
I would always venture to help someone out, anytime, anywhere though. Emergency or not. The fact that I have skills in a certain time and place, if you're a fatalist or not, means you do the best you can in that moment. Two scotches in.....STILL do the best you can!!Amy Thiele-Kuntz, October 19, 2009 3:07 PM
One thing jumped out at me when I was listening to the show. Back in the early days of airline travel a flight attendant was required to be a registered nurse. Perhaps we could alleviate some of the problem by re-instating that job requirement. The airlines will complain that the attendants will then want higher pay, so that will probably kill any chance of it, but it's a thought.David Bailey, October 21, 2009 11:03 AM