Who Should Step Up to Help in an In-flight Medical Emergency?

Who Should Step Up to Help in an In-flight Medical Emergency? Posted By:
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Recently I got an email from Medscape that detailed three articles, and one piqued my curiosity: "Who Should Step Up to Help in an In-flight Medical Emergency?" I fly a lot for work and have visibly cringed when I heard that chime and overhead page asking, "Anyone who is a healthcare provider, please ring your overhead call button!" My response universally has been to reach up and do so. I did this for the first time before I was a PA, and was a paramedic, and there was some comedy involved. I saw a middle-aged man a few rows in front of me get up and he literally collapsed next to my seat. I got up and was quickly joined by two older gentlemen. I identified myself to them as an EMT, which was mis-heard by both of the other men as "I'm an ENT," and they said in turn, "Thank goodness because I'm a dermatologist," immediately followed by the other saying, "I'm a psychiatrist and haven't taken CPR in over 20 years!" I was a bit taken aback and repeated myself more slowly—"No, I'm an EMT—you know, a paramedic?" They looked at each other and both agreed I was better qualified to care for our patient. Regardless, we immediately discovered that the man had simply tripped and was embarrassed and didn't know what to do. He was regaining his composure, then much to our surprise rolled over and got up to return to his seat. Not exactly life-saving.

I have a decade of experience in emergency medicine and more than that in family medicine with urgent care. While never comfortable providing "ectopic care," I have run codes in the hallways of homes and the CT scanner. And that isn't too different than 35,000 feet at Mach .80. Since that first episode on American Airlines I've worked alongside physicians, residents, medical students, NPs, PAs, nurses, and prehospital personnel at medical emergencies. The common thread was that everyone had a desire to help, some more than others. I've never experienced a turf war.

So, when I saw this Medscape link, I clicked on it. It was a survey done in the Spring of last year that focused on what different medical provider groups think about the ability of different providers to respond to a medical emergency, such as on a flight, and which healthcare group is qualified to do so. Now, this this online poll was not exactly New England Journal of Medicine-worthy and there were a tremendous number of inherent flaws, but it is still telling. What immediately struck me about this was that virtually every group thought that their own peers were capable of responding, while physicians and medical students downgraded other groups significantly.

The poll was available online from March 21 through April 10, 2018 and had over 1578 respondents (872 or 55% physicians; 459 or 29% medical students of all years; 183 or 12% RNs/APNs lumped together; and 64 or 4% PAs), plus medical assistants. There was no information provided as to practice specialty or experience of any of the groups.

The vast majority of both providers and students agreed that off-duty physicians were qualified to help in a medical emergency. I found one significant flaw in the poll in that there was no distinction between a PGY1 resident and a Board-certified emergency physician. Nor was there a distinction between that ED physician and either of the two physicians whom I encountered (dermatologist and psychiatrist) when I was a paramedic, neither of whom had touched a stethoscope in over 25 years. Most medical students (92%) said physicians were qualified, and almost all in the RN/APRN, PA, and physician groups (96%, 97%, and 95%, respectively) agreed. That level of agreement did not hold true with respect to whether RNs/NPs and PAs were qualified to help in such situations. RNs/APRNs and PAs gave themselves a vote of confidence (96% and 95%, respectively). But among the 872 physicians, 83% said nurses/NPs were qualified, and 73% said PAs were qualified. Striking to me was that among medical student respondents, substantially fewer felt groups other than physicians qualified to respond: 76% said nurses/NPs were qualified, and 61% said PAs were qualified.

Another survey indicated that medical students had lower ratings of their own competencies to respond than did physicians, RNs, APNs, and PAs. Clearly the issue is at what point in their education and training is that student in medical school. But the percentages of those who said yes, regardless of year, were still low overall: 23% of medical students, 52% of RNs/APRNs, 40% of physicians, and 55% of PAs.

I'm clearly biased on multiple levels. While flight attendants are exceptionally well-trained for a number of things, I suspect that they would openly admit that their ability to treat complex medical emergencies is limited. Any of the categories of healthcare providers is better suited to treating a patient with a medical emergency, which is one of the reasons they request help. So I'm a bit puzzled why any healthcare provider would ostensibly opt for the flight attendant to provide emergency care when there is a RN or advanced practice provider available.

And I would rather have a PA or NP with emergency medicine or urgent care experience taking care of me during a medical emergency as opposed to a well-qualified dermatologist. A good RN has saved my bacon in practice more than once. So why the low responses from physicians and lower still numbers from medical students?

Does this speak to a lack of interprofessional education? Are these folks who have simply never worked side-by-side with us? Or is this how people feel and can vocalize those thoughts unimpeded because they are doing so anonymously? Perhaps I'm overreacting—and we will never know the reason—but these numbers are extremely disconcerting to me.

Reference
  • Frellick M. Who should step up to help in a medical emergency? www.medscape.com/viewarticle/896256. Accessed January 21, 2019.

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