Thank you everybody for such excellent commentary and participating in our first ever asynchronous portion of Grand Rounds—it has been a huge success! This post recaps the first post in the "Out on a Limb" Case Series. If you missed the case or the discussion check it out here.
As Dr. Winders initially points out, airlines have contracts with groups for medical ground control that are available to help make the decision to divert or not. Ultimately, the decision to divert a plane will take into account many factors including cost and the medical ground crew’s opinion. We can take comfort (or issue) with the fact that we, despite proximity and years of training, are only a consultant when it comes to the big question of whether or not to divert. In influencing this decision, all we really may be able to do is offer our expert medical opinion to the ground crew. They, in turn, are going to be making their recommendation to the person with whom the final decision rests: the pilot.
In terms of in-flight action on our part, as many people pointed out, most would agree that our number one responsibility is doing what we can for the patient. Personally, I am not one who carries medical supplies with me wherever I go, though one of those pocket masks for CPR has always seemed pretty reasonable. Whereas there are recommendations for in-flight medical kits, be aware that these kits may vary widely from robust to practically non-existent. The FAA does have a requirement that all flights with one or more flight attendants and weighing more than 7,500 lbs must have a an AED.
I too agree with Dr. Loftus in that our primary utility is our experience and ability to lead in these situations. Strong leadership will be particularly important in code situations as a palpable sense of direction and a stated plan will likely go far in controlling the reactions of the rest of the passengers, even if it has little effect on the state of the actual patient. In terms of landing and continuing CPR, I think we have to have a discussion with medical control, the flight crew, and those willing to participate in CPR as landing will make them vulnerable from a safety standpoint.
Dr. Curry brings up The Aviation Medical Assistance Act of 1998 which indeed is broader and likely more protective than the Good Samaritan Laws. Ultimately the chance of being sued for rendering services on-board are low. As for accepting “tokens of appreciation” for these services, I have to agree with Dr. Ostro, the first-class upgrade to get away from the sweaty neighbor who is spilling into your seat sounds pretty lovely. However, be aware that, at least with the Good Samaritan Laws, such tokens have implied reimbursement and thus exempted practitioners from their protection. I am not sure how this would come into play with The Aviation Medical Assistance Act.
There are a lot of great links imbedded in the discussion and I will add one more: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789915/
This is a 2013 paper from the Western Journal of Emergency Medicine that details the types of emergencies commonly encountered in-flight, the types of resources available, medico-legal issues, and recommendations for approaching the patient.
Thanks again everyone! Happy Flying!