On average, in-flight medical emergencies occur about 15 times per day. When asked by flight crews to help in a medical emergency, providers have fairly extensive legal protection, and in some cases have a legal obligation to help [1]. In the U.S., all 50 states have some form of a “good Samaritan” law, which provides legal protection to medical providers who perform their services in response to medical emergencies outside the hospital. While these laws typically apply broadly to most out of hospital emergencies, in 1998 Congress specifically passed the Aviation Medical Assistance Act (AMAA) which offers legal protection to providers, who give assistance in the case of an in-flight emergency [2].
1. You should help if asked.
From an ethical standpoint, providers have an obligation to provide assistance when possible. In terms of in-flight emergencies, two conditions need to be met in order for the provider to be considered a volunteer under the AMAA.
- The flight crew must ask for assistance. Responding to an overhead page of “Is there a doctor on board” meets this qualification. Providers who respond to an emergency without being asked to do so by the airline are covered under the AMAA, but are not typically protected by the airline.
- The flight crew must make an effort to determine if the provider is a “medically qualified individual.” The AMAA defines “medically qualified individuals” as anyone who is licensed or otherwise qualified to provide assistance including physicians, nurses, physician’s assistants, and paramedics. The flight crew is asked to make a good-faith effort to verify credentials, which can include asking for proof of licensure. Airline policy will dictate what type of proof is required. Providing this documentation does not mean that you are acting in a formal medical capacity and does not compromise legal protections that are provided for volunteer responders [3].
2. You may be required to help.
The AMAA covers airlines that are registered in the U.S. Airlines registered in other countries may have broader coverage for providers. For example, airlines registered in the European Union and Australia go beyond providing protection and include a legal obligation for physicians to respond to in-flight emergencies. Generally the laws from an airline’s home country apply while in flight.
3. You are protected if you help.
Typical medical malpractice cases refer to the concept of simple negligence, which means that a provider’s actions departed from good and accepted medical practice. This is typically known as a deviation from a particular standard of care. The AMAA offers broad legal coverage to providers that respond to in-flight emergencies and protects them from instances of simple negligence. When responding to in-flight emergencies, providers are not held to any particular standards and are simply expected to avoid gross negligence and willful misconduct which refers to a “conscious voluntary act or omission in reckless disregard of a legal duty and of the consequences to another party.” [4]
For example, if you are asked to perform a vaginal birth delivery on a flight to Hawaii, you are expected to make your best attempt to treat the patient, but you are not held to the same standard that you would be if the same situation occurred in your Emergency Department.
4. You can be thanked for your services.
In general, providers should not ask for financial compensation or submit a bill for their services; however, accepting a gift such as an upgraded seat in business class or even a voucher for a free flight should not compromise their legal protection.
5. You don’t determine the ultimate disposition.
Most airlines partner with a health care agency that provides on-line medical assistance. When responding to an in-flight emergency, providers should work in conjunction with the airlines medical team. Decisions such as the need to divert the plane are complex as they involve logistics, which includes weather, fuel supply, and availability of a suitable landing area. A recent study of about 15,000 in-flight emergencies found that the aircraft was diverted in only 7% of the cases. In the event of a critically ill patient, providers should provide their best medical opinion in terms of need for immediate care, but ultimately the decision to divert the plane lies with the pilot and the airline [5].
Bottom Line
As the rate of air travel increases, emergency medical providers are increasingly likely to encounter an in-flight emergency. Providers have extensive legal protection when helping with these cases and should not hesitate to offer assistance when they are able.
References
- Stewart PH, Agin WS, Douglas SP. What does the law say to Good Samaritans?: A review of Good Samaritan statutes in 50 states and on US airlines. Chest. 2013;143 (6): 1774-83. PMID 23732588
- Aviation Medical Assistance Act of 1998, Pub. L. 105-170, Apr.24, 1998, 112 stat. 47, Sec. 5. Washington DC: National Archives and Records Administration, 1998.
- Dachs RJ, Elias JM. What you need to know when called upon to be a Good Samaritan. Fam Pract Manag. 2008;15 (4): 37-40. PMID 18444315
- Gardner BA. Black’s Law Dictionary. 9th Ed. Wellington, NZ: Thompson Reuters; 2009:1084, 1133-1135.
- Peterson DC, Martin-gill C, Guyette FX et-al. Outcomes of medical emergencies on commercial airline flights. N. Engl. J. Med. 2013;368 (22): 2075-83. PMID 23718164
This post belong’s to Dr. Matthew DeLaney’s series on Everyday Risk in Emergency Medicine (EREM).
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