Osler Case Reviews - Is there a doctor on board?

Summary

In an engaging Osler case review, hosted by Todd Fraser, an intriguing scenario of a mid-flight medical emergency is presented. The session explores the ethical obligations and practical challenges faced by medical professionals when a passenger suffers a cardiac arrest in-flight. Through an interactive panel discussion, experts share insights into managing such emergencies, emphasizing the importance of teamwork, communication, and understanding the unique aviation environment. The review also touches upon medico-legal aspects, the role of ground-based support, and the psychological impact on responders.

Highlights

• Medical professionals have an ethical obligation to assist during in-flight emergencies, despite legal complexities. 🌍
• The challenge of providing medical care in the limited space and resources of an airplane cabin. 🚑
• Importance of communication with flight crew and ground support in managing an in-flight medical crisis. 📞
• Legal protections are generally in place for those rendering aid in good faith, though international laws vary. 🛡️
• The psychological toll on responders can be significant, necessitating support and recognition of 'second victim' effects. 💔

Key Takeaways

• A doctor on board a flight has an ethical, but not always legal, obligation to assist in emergencies. 🌐
• Working in an unfamiliar, constrained environment like an airplane requires adaptability and quick thinking. ✈️
• Communication with the flight crew and understanding aviation protocols are crucial in medical interventions on flights. 📡
• Medical kits on airplanes are limited; knowing how to utilize available resources creatively is essential. 💼
• Dealing with an in-flight emergency can have significant psychological impacts on all involved, highlighting the need for post-event support. 🧠

Overview

In this Osler case review, the challenges of managing a medical emergency during a flight are explored extensively. Todd Fraser and a panel of experts discuss a scenario where a doctor is called upon to assist a passenger experiencing a cardiac arrest. With input from various professionals, the discussion covers the technical, ethical, and logistical aspects of handling such situations in the air.

A significant part of the dialogue revolves around the practical difficulties encountered when rendering assistance with limited medical resources and equipment availability on board. The experts highlight the importance of effective teamwork, clear communication with flight crew, and the integration of ground-based medical support to ensure the best possible outcome for the patient.

Beyond the immediate medical actions, the review delves into the ethical and legal responsibilities of healthcare providers in these situations, and it recognizes the potential psychological impact on the responders, emphasizing the need for adequate post-event counseling and support. The session is a comprehensive exploration of the complexities involved in airborne medical emergencies.

Chapters

• 00:00 - 02:30: Introduction and Acknowledgments The chapter begins with an introduction and acknowledgment from Todd Fraser, a founder of Osa and the chief medical officer. He expresses his excitement about the upcoming Osa case review session. The session is described as a fantastic opportunity for discussion, with many questions arising during the planning stages. Fraser anticipates a terrific session due to the engaging nature of the topic.
• 02:30 - 05:30: Panel Introductions and Scenario Setup The chapter begins with the panel introductions where the speaker emphasizes that the scenario being discussed is relatable to almost anyone in clinical practice. The speaker acknowledges the Gabby Gabby people, the traditional custodians of the land where the event is taking place, and pays respect to their Elders past and present. The introduction sets the stage for the discussion by highlighting the universal applicability of the forthcoming scenario. It also introduces CH Gilbert as a medical professional participating in the event.
• 05:30 - 09:30: The In-flight Emergency Scenario The chapter titled "The In-flight Emergency Scenario" introduces the speakers, including an education officer for Osa, an experienced senior medical officer, and Nicholas Seas, an intensive care nurse who will manage the chat. The narrative encourages attendees to utilize the chat function for questions. Additionally, Whitney Oxford, a registered paramedic, is introduced. The focus is on presenting and discussing an in-flight emergency medical case.
• 09:30 - 13:00: Legal Obligations and Considerations The chapter titled 'Legal Obligations and Considerations' introduces two experts with extensive experience in their respective fields. The first is a veteran with 30 years of experience in the aviation industry, specializing in advising airlines on health and onboard emergencies. She is the founder of both the Aviation Health Group and Fit to Fly, which will be detailed further by her towards the end of the presentation. The second expert is Anthony Mino, a senior solicitor and head of migas claims and legal service, who will also be contributing to the discussion.
• 13:00 - 18:00: Prehospital Environment Challenges In the discussion, Anthony is recognized for his extensive knowledge and past contributions to Osa case reviews, while Brad Roberts is introduced as an experienced intensive care paramedic with years of service in various remote and rural settings in Victoria and WA. The speakers express their gratitude for the participation of these experts in the session.
• 18:00 - 23:00: Medical Equipment and Support The chapter begins with a brief introduction by Todd, followed by Chris, who presents a medical scenario for discussion. Participants are encouraged to envision themselves as a 40-year-old GP who has been practicing for several years. The scenario highlights the importance of regular Basic Life Support (BLS) recertification, which the fictional doctor last completed three years ago, to set the stage for discussions on medical equipment and support in such settings.
• 23:00 - 28:00: Resuscitation Protocols and Challenges The chapter titled 'Resuscitation Protocols and Challenges' discusses the reality of medical professionals who may have outdated training and experience in advanced life support. It sets the scene with a scenario of medical personnel on annual leave, flying on a long-haul flight from Melbourne to destinations like Dubai or Los Angeles. Despite having past medical experience as a medical hospital officer, the professional reflects on their current state of readiness and confidence to handle emergency situations given the passage of time since their last practical involvement in such protocols.
• 28:00 - 34:00: Medico-Legal Concerns The chapter titled 'Medico-Legal Concerns' begins with an anecdote about being unexpectedly upgraded to business class on a flight. The narrator engages in a casual conversation with a flight attendant who curiously inquires about their profession. Upon discovering that the narrator is a General Practitioner (GP), the attendant expresses a warm welcome, addressing them as 'Doctor.' Enjoying the perks of business class, such as complimentary drinks and quality snacks, the narrator settles in with a light-hearted novel, reflecting on their fortunate circumstances.
• 34:00 - 41:00: Post-Resuscitation Decisions The chapter titled 'Post-Resuscitation Decisions' opens with an evocative scene, asking the reader to imagine being on a flight en route to a destination like Dubai when an in-flight emergency occurs. A call is made seeking a medical professional to assist in an unspecified emergency, setting the stage for potential scenarios that might unfold post-resuscitation.
• 41:00 - 46:45: Psychological Impact and Support The chapter explores decision-making in emergency situations, particularly for individuals like a GP whose Basic Life Support (BLS) and Advanced Life Support (ALS) skills might be outdated. It presents a scenario prompting the reader to reflect on what actions they would take during an unspecified emergency. It considers psychological and social factors influencing whether one would immediately offer help, wait to see if others step in, or feel unsure about intervening at all.
• 46:45 - 55:00: Crisis Management Tips The chapter discusses the obligations of Australian doctors in attending medical emergencies. It clarifies that there is no legal obligation for doctors to respond, an inquiry doctors receive frequently. The dialogue sets the context for exploring the broader theme of crisis management, questioning what is expected ethically and practically from professionals in emergency situations.
• 55:00 - 74:00: Conclusion and Additional Resources The chapter discusses the responsibilities of medical practitioners during emergencies on international flights, specifically when over international waters. While there is no legal obligation to assist, Australian medical practitioners have an ethical obligation to help in emergencies, keeping in mind their own safety and well-being.

Osler Case Reviews - Is there a doctor on board? Transcription

• 00:00 - 00:30 welcome everyone um my name is Todd Fraser I'm one of uh the founders of Osa and I'm the chief medical officer and I'm delighted to be able to welcome you back to another Osa case review uh so this is a fantastic uh presentation and case review I think I'm really excited about this and when we were planning this session we uh every time we seem to talk about it we came up with new questions to be answered and I think it will be a terrific session because it
• 00:30 - 01:00 does relate to almost all of us in clinical practice uh something like this could potentially happen to you no matter where you are and who you are um so firstly I'd just like to acknowledge the Gabby Gabby people uh whose land uh also is on um and we'd like to recognize the continuing connection to land waterways and community and pay our respects to Elders past and present with us tonight our usual suspects CH Gilbert is the uh medical
• 01:00 - 01:30 education officer for Osa and an experienced emergency senior medical officer and she'll be presenting the case and also with us is os's CPD home manager Nicholas Seas who's a very experienced intensive care nurse uh Nicola will be monitoring the chat and feeding through questions that are burning everybody's brain uh as we go along so please feel free to use the chat function to ask any questions in addition we've got Whitney Oxford Whitney is a registered paramedic
• 01:30 - 02:00 who got 30 years of experience working in the aviation industry providing advice to various Airlines about health um and online sorry on board emergencies she's also the founder of Aviation health group and uh fit to fly and Britney will be able to fill you in in a little uh little while or towards the end of the presentation on on those companies we also have Anthony Mino who's a senior solicitor and head of migas claims and legal service um
• 02:00 - 02:30 Anthony is a wealth of knowledge and has been a part of our uh Osa case reviews in the past and we're delighted to have him back thanks very much Anthony and finally we have uh Brad Roberts who is a highly experienced intensive care and paramedic uh with many many years of experience working across a wide variety of uh remote and Rural settings in both Victoria and wa and we're really uh delighted and very grateful to everyone for coming along
• 02:30 - 03:00 tonight so without further Ado I'll hand over to Chris who will present the case right thanks Todd um so we've created a doctor I want you all to try and think of yourself as this particular doctor and what you would do in this setting so um so picture yourself you're 40 years old you've been at GP for many years um the last time you actually did your BLS recertification was about 3
• 03:00 - 03:30 years ago and it's a little bit out of date now um and the last time you actually did Advanced life support on a patient was when you were a Medical Hospital medical officer many years ago in the hospital so you're pretty happy uh it's day three of annual leave and you're flying well it doesn't really matter where you're flying Melbourne to Dubai or Melbourne to uh La somewhere a long way away and you're in a great big quantis Airbus and we sort of get on to
• 03:30 - 04:00 the details of that you were very fortunate there was a couple of seats vacant up in business class and you sit down you start having a chat with the flight attendant you know she asks oh what are you doing oh you know I'm on leave or what do you do oh I'm a GP welcome doctor welcome aboard so you grab your glass of bubbles you got a trashy novel and because you've been upgraded to business class you've got some decent snacks and you're thinking
• 04:00 - 04:30 wow could this be any better Heaven you're on your way somewhere somewhere a long way away so we've got here that you're going to Dubai but it could be anywhere so you hear a call and the call is is there a doctor on board or I'll get Whitney to give us the exact wording of how that actually is said these days but is there somewhere someone on board who is a medical professional that could help in an emergency
• 04:30 - 05:00 so this is our first Poll for you to have a think about and to answer so as this GP whose BLS is a little bit out of date you haven't done ALS for a while you don't know what the emergency is what are you going to do what would you do would you press the call button to help would you wait to see if someone else does first and then only if no one else puts their hands up would you press the call button or I really don't feel
• 05:00 - 05:30 comfortable I might just pretend to be asleep thanks Chris so Anthony we'll start with you in terms of obligations to uh attend a medical emergency what are Australian doctor uh obligations uh it's something that we asked fairly frequently Todd and um there's no legal obligation if we're
• 05:30 - 06:00 talking about this scenario of an international flight and you're over international waters there's no legal obligation to assist in an emergency but as as practitioners registered with the Medical Board of Australia there is an ethical obligation um and the ethical obligation I'm paraphrasing but the ethical obligation is to assist an emergency having a regard for your own uh safety and well-being um your own
• 06:00 - 06:30 skills um and I would include in skills um whether you're affected by alcohol and how how to to what extent you're affected by alcohol um so essentially there is an ethical obligation uh to to assist um there are some states if if there's emergency situation in a in a particular state in South Australia sorry particular States in Australia some of those States New South Wales and Northern Territory in particular create a legal obligation to assist an emergency but that only applies in those
• 06:30 - 07:00 States so we're talking about international waters international flight Chris um is obviously kicking back and enjoying herself and has had a couple of glasses of bubbles by this stage what implications does that have for her in terms of her legal obligations and and the risk that she's in yeah I think um you know obviously anyone affected by significantly affected by alcohol might may have a poor Judgment of their ability and and
• 07:00 - 07:30 and sometimes they might feel they got more ability um having consumed alcohol than they really have and hopefully there's um enough objective stand um you know Witnesses staff that can actually make an assessment say no thank you we don't need your help but ordinarily I I'd like to think that any any person practitioner or otherwise would be able to assess to say I shouldn't be helping here and it would only be if they're significantly affected they might not have that judgment but others others would Whitney what does this mean I mean
• 07:30 - 08:00 clearly there is a lot of different professionals and abilities that would be potentially exposed to this scenario um should everyone feel that they have a responsibility to act and and where does your skill mix come into what your obligations might be so thanks Todd I think um it's really important to remember that the crew are only trained at a first level they they don't do um
• 08:00 - 08:30 Advanced life support um they do follow obviously um they're trained through the doctor's ABCD um you know BLS sort of level um and so they are not able to administer any drugs unless they're um um advised or under the guise of the groundbased medical provider which airlines quite often use um and there's only a couple of those in the world um and then generally it's you know it's very
• 08:30 - 09:00 limited in the medical kits what they can give because if we're wanting um IV access or we need to give something um IM um or subcut obviously they can't do that so they don't have the skills but I think the really important thing to remember is that from a medical perspective what we're really looking for is the eyes the ears and the hands of the clinician um and I think it's you know in a very big event obviously it's all Hands-On deck um but the crew will
• 09:00 - 09:30 going back to the drinking piece the crew will be right across how much you've drunk if you've put your hand up I can I can guarantee you of that because they have to do RSA um and if you have been knocking back those drinks in business class um and you do put your hand up they they will probably ask you to sit down um especially if there is someone else to help and then the other point is the groundbased medical provider um also is running a lot of the backend information about what they want to happen so it's really important I
• 09:30 - 10:00 often have had doctors say to me um throughout my career at quis and virgin there was the crew kept telling me about this other doctor that was giving instructions and but there was no one there but me it's because they're talking through the flight deck and the airline pays for that service Chris I might throw back to you so I just thought at this point um because I'm going to get Whitney and Brad to sort of talk about the logistics of what you do and where you send it you know where do you take the patient so this is the
• 10:00 - 10:30 the uh the plane that you're on it's the Airbus 38800 I I'm not very okay with planes but as you can see it's enormous it's the double decker one it's got over I think it's about 500 people on that count um and you're sitting up in the top deck in the upper deck in business class which looks all very nice um and the uh flight attendant so all of you end up having to go because you've either pressed the button or no one's actually responded and then you press the button or because the uh flight
• 10:30 - 11:00 attendant knows that you're a doctor they've come and tapped you on the shoulder and said can you please help so the flight attendant escorts you downstairs um we chose this particular scenario because I had I was fortunate enough to have a chat with Whitney prior to tonight and this is the one of the most common reasons why um there is a significant Medical Emergency on board a plane and also a reason to divert or even the discussion around diversion so this is possibly for a lot
• 11:00 - 11:30 of people their worst nightmare you're out in the middle of the ocean there's no real place in sight you've got this chap he's sitting in that starred seat down in economy sitting next to the window Peter so he's a 60-year old male he's um essentially a very high risk for an es schic event he's got all the risk factors he's had a stent three years ago and he's had some chest pain so he self aditt mined two sprays of gtn and it was
• 11:30 - 12:00 initially 8 out of 10 but it's gone down a little bit but still looks gray and diaphoretic so you've got a high-risk chest pain sitting in a window seat in economy so Todd I'll just throw it back to you for the minute thanks Chris so time for our second poll so this question is uh one that we'll get um Brad to talk about in just a moment but you've got a patient who's stuck up against the window in a crowded
• 12:00 - 12:30 environment what are you going to do are you going to move the patient out of their current location or are you going to do something else so one of the the key things that came up for us when we were talking about this case was that most of us do not ever work in a prehospital environment uh there's a few a handful of doctors who have got some exposure to
• 12:30 - 13:00 doing that but most of us practice in an environment where we know the staff around us or at least mostly we know the equipment that's around us at least mostly we uh know the environment and what we can do and so on and so forth but working in a prehospital environment is a completely different kettle of fish and something that one of our panelists um Brad will be able to talk to um with 30 or 40 years of experience behind him in that environment so Brad if you're um approaching this
• 13:00 - 13:30 patient what would you do would you move the patient and if so how would you go about doing that all right well good evening everyone um the main thing you need to consider here besides your ongoing clinical assessment and treatment of your patient from a prehospital perspective and environment like this if you've got someone like this pinned up against the window and the wall of the plane and something
• 13:30 - 14:00 happens you've got real trouble um now I think Whitney's got a bit more experience from that Airline perspective but what I would consider doing he's already had his first gtn Pains come down this is the time to coordinate with staff and say right I wanted this patient moved to a place where if he does collapse or deteriorate we can get better access to him ideally that would probably be towards the back of the
• 14:00 - 14:30 aircraft the reason for that is if we get to an airport with this patient on well there are number of ways we can get them off the aircraft um there are air stairs um lifts that um the airport can utilize and we've done this plenty of times at Melbourne Airport where I've uh responded to that you don't normally go by the airbridge there are other ways to get the patient out um if the patient deteriorates if we got enough spare seats towards the back you can actually
• 14:30 - 15:00 put the armrest up a little bit and lie down on the chairs um but again you need to be mindful of thinking well if he does deteriorate to the point of being unconscious enough to do something else there's still not much room anywhere so you need to have an available space where you might be able to do things so from my perspective without fully um knowing too much more about the patient apart from getting a blood pressure on the patient than initial observations is is while the going is good get the
• 15:00 - 15:30 patient going is basically my my my Mantra in this situation Whitney what sort of locations within the um the aircraft would be suitable for that sort of um process yes it's um a great question and it's um it is every uh inflight medical event nightmare because there are a lot of rules and regulations around um exits on aircraft and do not
• 15:30 - 16:00 go and put somebody where you're going to have to then move them so if you're going to move them make sure you're moving them to a place that they can stay um you can see on this aircraft on the bottom there for economy it actually has four seats in the middle across um and those armrests all do come up um as opposed to where the passenger sitting on that window seat where there's only three seats which is not really long enough to lie somebody if you did um if you were able to put them in the row of four seats I agree totally with Brad as
• 16:00 - 16:30 far back as you could um because you can actually get an airway you could lean over them and do um CPR from the aisle um quite quite effectively and you've also got access at the other end you're not going to be able to access them from the side that well um because the seats are quite close together but as opposed to putting them at a door so if um you look forward of that star um you'll see there's like a bit of a gap um there's
• 16:30 - 17:00 doors there um so it's quite a large area there's usually there's a toilet there as well um but that is also has crew seats where the crew have to go and sit for landing so I saw someone right before there's seats in the galley yes there are but they are for the cabin crew and what you need to remember is we're still flying an airplane it's still fully operational and we still can encounter an emergency of some other kind such as turbulence where the crew
• 17:00 - 17:30 will be told to S take your seat immediately um so you need to be thinking about if we're going to move someone can we leave them there we can't impact on anybody else's safety because we're not going to um uh risk the safety of many for the sake of one and I hate to be really brutal about that but ultimately that's what the captain's thinking he's responsible for All Souls on board um and the other point is um uh where where you put them you want to be
• 17:30 - 18:00 able to be able to to get access and work on them so fortunately this aircraft at the back there are stairs and you might think there's a lot of room there but there's actually not because there's a um cabinet there shelf system where you can go and you can get snacks um you might be lucky enough on this aerplane that there is a spare first class seat and they might allow you to have access to that at the rear um I've been on aircraft where I've helped and and we've taken some on into business because they needed to be
• 18:00 - 18:30 supine they had um we need to run some fluids they had low blood pressure so just bear in mind that you gleys are probably the best place because they can work around not serving people um and they are at an exit but they're they're kind of um adjacent to an exit so they're not going to stop free flowing um egress in the event of a um an emergency Brad what are the sorts of things that are going through your head in terms of preparing to be able to deal
• 18:30 - 19:00 with whatever's going to come your way so um from from a prehospital perspective we we look at things like um like Whitney was saying accessibility to Patient um where where we are currently at the STA location the patient seat we we can't do much um and if the patient deteriorates nothing's nothing is useful um I've had to resar a patient on a um on a on a
• 19:00 - 19:30 coach a bus coach unconscious unresponsive middle um of the bus up against the window and that took us literally a crew of um four five paramedics three police officers it took us a good half hour just to get this person out of the seat and out the front door so these complications we Face from a prehospital perspective it's just not treating the patient it's everything
• 19:30 - 20:00 else and that's where we need to adopt a real team approach and look at uh utilizing Airline staff and getting their input as where we can place this patient um ideally I'd like to try and get an IV if I can if it's available in the first aid kit you need to find out what's on the first aid kit on the aircraft because you don't normally carry a full first aid gear that I'm used to carrying on a domestic flight in
• 20:00 - 20:30 my own time so everything is limited by what is around you what resources you have and you start you need to start making a team around you Whitney with the other question that came up around this is the people who you might have at your disposal who can be of use to you in this situation um so obviously you've got cabin crew um on an A380 you've got cabin crew who work upstairs and you've got crew who work down sters and there's in excess of 22 odd crew on that
• 20:30 - 21:00 aircraft um they also work in their section so generally you don't have everybody from the whole downstairs or the whole upstairs helping you it'll it'll be a defined um part of um the team um but it is really important to identify who is the lead crew member in that um cabin and if you need um for additional sort of escalation of things um in terms of information you would ask for the most senior um crew member which is generally the cabin um service
• 21:00 - 21:30 manager um and they generally would come for a significant medical event the other thing is um other medically trained passengers so often when you press that call Button you might get a the crew might get a group of different respondents and they're going to be all over that airplane which is massive so you may not know who else is around and they might often they say well we've got one person everybody else can sit down but what they're not processing is well what is the medical situation we've got
• 21:30 - 22:00 and what is the overall experience or skill set that we've got available to us so that is something to be considered so if you feel like you're the only person ask did anybody else respond can you make another call if you think this is going to be a deteriorating patient um paramedics and nurses so paramedics I find being a paramedic is that um I I always get called but I've worked in Airline medical team so I know what to do but paramedics often say to me me I'm really reluctant because I'm not working
• 22:00 - 22:30 as part of my ambulance service now now we've got registration and a lot of us are private paramedics and carry our own um Indemnity insurance we can absolutely stand up and help but as um I'm sure Anthony will speak about later around um the legal liability they should be getting up because I think as Brad would agree with me um we're trained from a prehospital we're used to prehospital environment um we're used to envir en Ms that are cramped and you know there's
• 22:30 - 23:00 nothing that our our normal workplace has um and so we're often very good in um making decisions around what else we might need um and nurses I mean even if you've got an enrolled nurse you know they can do CPR they can get you things out of the kit if you need it other people um army Medics or Army personnel and defense are often very good especially if you're needing to move the person um they can help with that um and then there's the groundbased medical
• 23:00 - 23:30 provider I talked about them briefly before so the main one is called medlink um which is part of international SOS it's based in the states um they also have a call center in Johannesburg and they follow follow the sun model and the captain will um call via the operation center of the airline we'll speak to um a doctor on the ground who will get the basic information and then often they will say call us you know we're going to agree on a plan call us back in 30 minutes if anything's changed um or
• 23:30 - 24:00 before if if you need us um and they are the ones that will guide in terms of decision making around diversion Etc can I just add one more thing there Todd um don't be scared to challenge often what what the information is that's coming back to you um I have had situations because they are us-based they're not all always um willing to have a medication administered and often we've had to intervene at at the airline
• 24:00 - 24:30 level um so just you know ask questions is is my advice um to this most senior crew member and if you need to go and speak to the captain um often they'll let you do that thanks Whitney Chris I'll hand back to you um yeah so we'll say that you have managed to move the patient to the most appropriate spot at this point they're still sort of semi-recumbent in a in a seat but with much easier your access and then I guess if you're in a hospital
• 24:30 - 25:00 or a usual environment that most of us work in a hospital you'd probably want to give some aspirin have some access to further gtn then you'd probably want to put on monitoring if they were hypoxic deliver oxygen get IV access maybe give some fluids if they're hypotensive and maybe provide some morphine so I thought this is a good juncture for Whitney in terms of this initial management we'll talk about sort of advanced life support later what what is actually available in
• 25:00 - 25:30 terms of monitoring like can you get an ECG um heart rate blood pressure set monitoring or even a temperature if you worried someone's septic and then what sort of uh basic stuff like oxygen IV access fluids morphine aspirin are they available on flights and are they only available on some you know some aircraft and not others um yeah thanks Chris so from a monitoring persp perspective um
• 25:30 - 26:00 this could be a topping in s um so there used to be a really great um Telemetry device called Tempest IC which had bells and whistles it had 12 lead ECG ECG it had both audio and video capability and photographic capability to send to the ground um and it also had um uh pulo symmetry um Tim Panic um thermometer and um blood pressure um and it connected to the communications of the aircraft and
• 26:00 - 26:30 could send it real time down to the groundbased medical provider so they could give you advice and obviously by having a 12 12 lead ECG they can actually see what is going on with the heart and is it an actual um infa and do we need to divert or something of concern that we can't deal with on the flight um Tempest I see unfortunately got bought by Phillips and is really only they're only focusing in using it in the um Defense Forces now so it
• 26:30 - 27:00 hasn't been commercially supported um on the airlines any longer um Emirates was the last aircraft that I knew was still running it um but there are a couple of other alternative ECG devices we were trialing them at quantis before I left um one is cardio Seco which is a German um 12 12 lead ECG that comes with an iPad that's excellent the other one is QT which medling um utilize you won't
• 27:00 - 27:30 find them on every aircraft so quis doesn't currently have an ECG device they are um working towards getting the QT I believe um so therefore you're not going to have that you'll most often have a manual blood pressure cuff you might have a very small um spo2 monitor um deliberately we don't have one on quantis and that is because your oxygen saturations at altitude are going to be different to what they are on the ground and that often causes a lot of people
• 27:30 - 28:00 who don't understand altitude physiology to um overreact um and stethoscopes are commonly complained about because we don't invest money in them because you can't hear anything anyway so you're going to have to palpate um you know and have a look at your um spe mometer in terms of oxygen maximum that is carried is 4 lers a minute that can be delivered um it can be delivered at a continuous or an meant flow rate there are some
• 28:00 - 28:30 like on the 787 a pulse um oxygen so as you breathe that that's when the Oxygen's released um so when the 787 came into the quis operation I said well that's ridiculous if you've got someone that you need to have free flowing oxygen for and who isn't breathing you can't um cause that that pulse to release that oxygen so we had to load some Continuous Flow oxygen um most kits have very good IV access so generally your International carriers um there are
• 28:30 - 29:00 requirements from um iata and I over what is generally carried but it's very broad um fluids from a fluid perspective um we carry two leaders in internationally um but on an A380 there's two kits so you'd have four liters in total domestically they they only carry one liter um and there are two giving sets um and yes they do carry morphine um particularly Australian carriers do carry morphine um there's
• 29:00 - 29:30 only a limited number of vials um but there is that and and all your other you gtn your aspirin Etc that's that's all readily available in the kit Brad you mentioned when we were talking talking about this prior to the uh the webinar that uh you may be able to Source some equipment and medications from other people on board yeah so what what you need to consider is what do I need for this patient and and I was talking earlier about let's change the
• 29:30 - 30:00 the context the patient and say they might be having an asthma attack um you might be able to utilize some other gear that other uh passengers might be carrying um to utilize on the patient so some people might be carrying an EpiPen some people might have cbol inhalers you don't know what you don't have until you ask um Whitney just a quick one I I was thinking when I mentioned it to Christine for does the medical kits on
• 30:00 - 30:30 some of these aircraft carry anti rythmics or they just the basic type medications um it's not a standard on the I or I list that I can remember um I think we we do we do it Corners um but it's it's going to be hit and miss with the kit so what I really advise is low light always in a cabin ask them to turn the lights up ask someone for a torch and actually get the list out some
• 30:30 - 31:00 Airlines will give you the list first and not let you have access to the kit until you can identify there something in it you're actually requiring to use and then some Airlines will then have to go back to medlink and ask if you can give it um so you just have to follow the bouncing ball as frustrating as it is you just have to remember that you're there assisting the airline um it's not like you're in your normal place of practice excellent points
• 31:00 - 31:30 Chris um so you were lucky enough to be able to hear with the dodgy stethoscope so you got a proper blood pressure of 100 on 60 um on the little sat monitor it said 90 and it's sounded kind of regular you only had one sort of single lead ECG so you don't know if this patient is infecting or not and you've got a set which may or may not be real you managed to get IV access and then the patient suddenly says I don't feel
• 31:30 - 32:00 well so then suddenly your patient becomes unconscious so I might throw it back to Todd and Brad and Whitney here as to what happens now when your patient is well in this case has arrested so Brad your patient has now arrested they're sitting up in the the seat at the time what are the issues in ter terms of a seated patient who goes into cardiac
• 32:00 - 32:30 arrest well um the effectiveness of any potential CPR is going to be diminished um long have gone the days of what we used to call the erotic CPR um which is just trying to do chest compressions on someone in a sitting position and this reinforces what I was saying before that we need to think about getting to a patient where if they deteriorate we can lay them down um um good effective out of Hospital CPR
• 32:30 - 33:00 needs up a firm back rest um and preferably uh a small team to do CPR because um as we have found in our current Ambulance Service that we adopt the high performance CPR model which is only one person maximum 2 minutes compression time because the fatigue sets in so quickly if you're doing it
• 33:00 - 33:30 right um there's a lovely uh EMR response capability in Melbourne where the uh fire rescue Victoria the FES Co respond I'm not sure if that's available in other states uh out of hospital and we basically have a congol line of firefighters lined up to do CPR it's the best CPR machine you're ever going to find anywhere um in an aircraft situation though you need to think about okay how many more people can I get to do the
• 33:30 - 34:00 CPR um and we've always said that the worst kind of CPR is no CPR um ideally obviously we we're talking about a sudden kadak arrest most likely in this circumstance we're thinking about lethal or dangerous arhythmia so uh hopefully there's an AED available on the aircraft uh Whitney might clarify that uh whether that's a standard uh with aircraft or not um bag valve mask so the good ABCs it's
• 34:00 - 34:30 always the good ABCs every time um secure the airway if it was me in that situation I'd be up on the airway end of the patient because it gives me a couple of advantages I can see down the whole length of the patient I can control the airway and I can act as a team leader from that perspective um monitoring get one person just to sit with the AED and then telling people get off the chest on the chest and so on so forth um
• 34:30 - 35:00 adrenaline um every four minutes as per current um guidelines out there from the resuscitation Council um LMA fantastic if we got it don't know if every Airline carries them and that's the question I asked about any the anti rythmics as well before if you've got them but if you don't know what Rhythm you are trying to
• 35:00 - 35:30 treat electric is the best option if it's a shockable rhythm Whitney um Brad asked about defibrillators what can you tell us about what's carried on the aircraft yeah so I'm very proud to say that I've ensured that all aircraft in Australia both virgin and quantis domestic International and Regional are all fitted now with defibrillators um they are fitted with either the z a plus that is in this image or the Z
• 35:30 - 36:00 A3 but please please please remember they don't act the same way as your defibrillator in your Ed where you can switch between automatic and manual they are completely automatic they often in most cases will not show you what the rhythm is and that is deliberate on behalf of the airline medical team's decision um because we don't want doctors of all varying kinds or clinical people making a decision on an aircraft
• 36:00 - 36:30 where there's vibration there's movement um and may not quite be at the Skool level that's needed to interpret is this a shockable rhythm or not at that time we also have to remember that if there's no medical person there to help we're relying on the crew so that is why we have automatic um automatic external defibrillators in saying that these defibs are pretty pretty good in terms of they do recognize when you um you're
• 36:30 - 37:00 fatiguing with your compression so they often give prompts to push harder and if you hear that um and you are at the head and you're running the the um arrest then that often is a really clear indicator if you've forgotten the two-minute change over is to change change the CPR person um cabin crew are trained in CPR and um whilst they only train once a year on on it um giving them feedback as they're doing it they will absolutely listen to what you're
• 37:00 - 37:30 saying um and the other thing is that we often have doctors saying the defib didn't work because I couldn't see what the Rhythm was it wouldn't switch to manual I couldn't shock when I wanted to none of those things will be able to occur with an AED with an automatic external um defibrillator um and in terms of lmas um so I don't know if quas did change over to ey gels but that's what we were planning on on doing um there are some issues with your standard ET tubes um
• 37:30 - 38:00 with cuffs inflating at altitude um either overinflating or not inflating enough or reducing an inflation and then you can obviously get um aspiration um and there are BVM um bags at different sizes with the appropriate attachments but do remember also there's no way you're running 100% oxygen you're running 4 lers a minute um continuously and that's all you've got better than nothing but just be aware of
• 38:00 - 38:30 that um so one of the big issues here is about Medico legal uh responsibility we've already had plenty of questions coming up in the chat uh about that um I thought at this point we might throw to Anthony one of the the key features of this case is that the doctor involved uh felt that their ALS was a little bit out of date there are guidelines around now for example in terms of your uh your CPD
• 38:30 - 39:00 as a GP you're required to do basic life support every 3 years what implications does this have for doctors who may have let that slip for example um probably very little I should say I was uh fascinated by the discussion I forgot I was a panelist there for a second I was in enjoying that conversation um but in terms of um um skills obviously you do your best to keep up the date um that's really
• 39:00 - 39:30 important um if it's if it's out of date it's not a reason to you know put your hand down or not press the call button and not not not assist you're going to be as we heard from Whitney and Brad you're going to be assisted by and guided by um lots of people with experience um and um all hands more hands are better than no hands so um I would not um discourage anyone from assisting
• 39:30 - 40:00 purely on medical legal grounds because they they feel they're not up to dat with their uh ALS just by extension then there's a lot of people who will feel extremely uncomfortable about this environment yeah um if they make a mistake clearly people will be worried about the issue of litigation and so on so where do they stand in that sense yeah it's a it's a good question and I should say like in all I've been doing this sort of work helping medical practitioners with
• 40:00 - 40:30 claims and complaints for over 25 years now and I've never had one one matter that involves a a midair emergency and I and I you know for the purpose of this webinar I was trying to find some cases internationally I couldn't find anything so it is so exceedingly rare I mean not the instance obviously midair emergencies medical emergencies happen you know probably more often than I than I know about but um and probably Whitney can say how often they occur but it's pretty fre frequent but litigation in
• 40:30 - 41:00 that in that space against Health practitioners is so rare that it I couldn't find anything so let's we put it in that context to say put your hand up help where you can um work within you know the limits of your abilities Guided by those around you Guided by the the uh on ground uh medical staff um and not be so concerned about getting it wrong now I should say you you know you're if
• 41:00 - 41:30 you're a GP um and this person's needs open heart surgery you're not going to go and grab the you know dinner knife and and open up the patient's chest I wouldn't recommend that because that would expose you to litigation but you know working within the skills that you do have uh offering assistance the standard of care of a doctor in that situation of any health practitioner in that situation is judged by the circumstances in which they find themselves in um and all the limitations
• 41:30 - 42:00 that we heard Brad and Whitney talk about are all the circumstances in which the practitioner standard if ever called into question will be judged against Anthony in terms of whose rules apply in these sorts of situations does it matter that we're in international waters or we're Landing in Dubai or Los Angeles wherever it might be uh it it it does matter in terms of of the Good Samaritan legislation I know the ref can see the reference there on the slide but
• 42:00 - 42:30 um in terms of my understanding Whitney hopefully will be better equipped to answer this question but the legal liability from a on an international flight is determined by the um the Civil liability um legislation and sorry a the carriers liability so the air um uh the flight litigation um legislation my IES and so that is determined by which
• 42:30 - 43:00 aircraft carrier you're on so if you're on a quantis the the jurisdiction will be the Australian jurisdiction the Good Samaritan legislation which is state-based legislation only applies to incidents in those States so it doesn't apply to flights internationally that does protect the Good Samaritan legislation protects any Good Samaritan um medically qualified or not um to uh render assistance so they can't be Su sued they've got an immunity from being sued
• 43:00 - 43:30 if they act in good faith we're not we're talking about an international flight so it doesn't apply but it's important that you know our audience knows that they they can and should render assistance in any emergency um on the ground in any state and they'll be protected from liability as a health practitioner you're also protected from giving from from liability if you're giving um advice medical advice rather than medical treatment in an emergency situation the only Proviso to that is if
• 43:30 - 44:00 you're um there's no immunity from suit if you if you're heavily affected by drugs and or alcohol while giving that assistance and and advice but that's the legislation that applies um I should say despite the fact There's No Good Samaritan legislation that I'm aware of that applies for international flights from an insurance perspective all all doctors are covered certainly under our policy migas policy for um any Good
• 44:00 - 44:30 Samaritan act um that they perform here overseas or anywhere but it's important that I come back to the point I first made is that it is so rare that I've not not heard of it happening so um it's you know it's nice to know yes I'm covered for it I should be able to you know provide assistance without fear of litigation um um and um yeah hope hopefully that's clarified the legal
• 44:30 - 45:00 position Chris um so we're coming to our third poll now for our audience members to get involved so at this point in the case the patient is now on the floor in an area that you can access wealth you've got your team um there's good CPR in progress you know things are going along fairly well but there's flight turbulence um so then the pilot in instructs all staff and all passengers to return to their seats and put their
• 45:00 - 45:30 seat belt on so what do you do do you continue CPR and tell everyone to keep going how can we stop do you return to your seat or do you just sort of well I'll do what I feel like I need to do and let others return to their seat just a quick question off the C Anthony well people are putting their answers in where does documentation fall
• 45:30 - 46:00 into all of this if you're a volunteer a Good Samaritan what's your obligations in terms of documenting what's happened um another another very good question I think the this the standard would at that point in a medical emergency uh you wouldn't expected to make a fullen um a fullsome note at you know contemporaneous note um I've often had um calls from doctors when they've landed from overseas saying you know
• 46:00 - 46:30 this has happened while I was on the flight uh what should I do and I I generally my general advice is when you get a chance just make a note sometimes most of the phones these days have a dictation facility available I would recommend just making some brief notes about it um send it through you know to their personal email you know email address sometimes I say look just send it through to me we keep it on record if anything comes of it which again is never Happ happens but I I I would always recommend you know keeping some
• 46:30 - 47:00 brief notes just for your own recollection if you're ever called upon to come and ask if there's you know if a patient dies on on flight or you know you know and there's a cor's investigation there is a chance that you will be asked to you know recollect or give a statement about um what you did didn't do um your involvement and having some brief notes is just there to refresh your memory so I'd certainly recommend it I wouldn't make it a priority to to do it on the plane um in a medical emergency but certainly when
• 47:00 - 47:30 you get a chance next available time just make some notes as uh the lawyers say he with the best notes wins isn't that true Anthony good notes good defense no notes no defense so 50% said they would return to ceas um and a smattering across the other two groups we need this would seem pretty obvious of course as doctors we are all going to stay with the patient and continue doing CPR that would be the right outcome wouldn't it well it's
• 47:30 - 48:00 interesting Todd it's not your normal environment we're not on the ground and remember what I said the pilot in command is absolutely 100% legally responsible for every soul on board so this goes back to commu early communication and teamwork one thing that I my heartfelt guidance is that I've seen this happen too many times and and we've had great CPR underway and we've ended up with terrible turbulence and people have had
• 48:00 - 48:30 to sit down and we know that what's the point of starting if you're going to stop um so communicating this really early on when you're starting CPR or CPR is underway is to communicate it to that senior cabin crew member and have them relay this to the captain and work out early what the plan is going to be um making sure the captain is 100 now this might sound stupid St but the captain's not MediCal making sure the captain
• 48:30 - 49:00 knows we've commenced CPR it's not like we can start and stop if we are doing CPR do you want us to keep going in a turbulence event I'm happy to if I'm safe enough but we have seen terrible turbulence events Mo in most recent times where there have been mass casualty events and people have been extremely injured and this is where that you know kind of for sake one for the greater greater number is that kind of case the other thing you need to remember is that piloting command is um
• 49:00 - 49:30 is a legislated um legal uh position and there are international and you know Australian intern um regul regulations Aviation regulations that are legislated through Parliament and part of the criminal code so if you've seen people before dragged off aeroplanes by the AFP in Australia for just not sitting down and doing as they're told you can be prosecuted you can be arrested and you can be prosecuted so you need to follow
• 49:30 - 50:00 the captain's um instructions and that is why I say communicate early to have a plan because there are very um different levels of turbulence and they can see on the weather some turbulence but there is clear air turbulence where they can never predict it and often you know that's you know you might be in the middle of that so just make sure that you communicate early if you're doing CPR to the crew and to the captain so everybody knows exactly what the expectations going to
• 50:00 - 50:30 be Brad you've worked in remote and Rural positions in the past uh where transport times might be quite significant not unlike this particular scenario if CPR is ongoing do uh Paramedic Services have guidelines or a process for determining where the CPR should stop um yes it depends which service you're with um um but we do follow specific
• 50:30 - 51:00 guidelines um generally uh against the myth that happens out there uh we don't normally do CPR in the back of an ambulance that's moving it's just unsafe um it's probably the best to categorize to this scenario where there's flight turbulence um you drive down certain highways or freeways um in Victoria and it's worse than probably clear air turbulence encountered by
• 51:00 - 51:30 aircraft um so what we would normally do in this environment is resuscitate at the scene with the patient and only we would load and head towards a hospital with certain priso so um we're very close to a major Hospital like in Melbourne we're just basically two streets away from the Alfred Hospital which is the major Trauma Center in Melbourne uh and that's normally due to traumatic cardiac ARIS uh medical cardiac arrest in Victoria we would uh make the decision based on
• 51:30 - 52:00 presentation of the patient um resources available likely outcomes cause of the arrest all the factors that every other medical person would um would absorb uh and we would normally resuscitate a person through to a conclusion and these days we look at around about 45 minutes as the maximum we probably do unless there's circumstances in indicating that we do it do something else um but normally 45
• 52:00 - 52:30 minutes and if we don't have Ros uh by that point uh normally we would consider Ros to be futile and probably not carry on further um obviously the aim is with good defib and good CPR in this circumstance we've got a high chance of resuscitating our patient because it's a witness to rest and they're the ones that we have most success with Whitney what um what would your thoughts be on that yes so I was just going to
• 52:30 - 53:00 add to that um if you are on an airline that is using a groundbased medical provider um and you haven't been able to successfully um get any shocks in and you've been continuing CPR for um it does vary somewhere between 30 to 60 minutes just depending on what's gone on um you know have you been able to get adrenaline in amot own in or have you not had any IV access Etc whether it was a witnessed arrest or not obviously all
• 53:00 - 53:30 those things come into place um they will often um they'll advise to to cease CPR um so if you find a situation where you only have cabin crew for example and no medical personnel um they'll definitely do that if diversion time is too extended um or you've got those other factors into play so um there is it look each case is is its own obviously um but you may find that
• 53:30 - 54:00 someone is someone else is telling you to to ccpr um so this webinar isn't about uh ALS protocol so we're keeping it very simple um so a single AED shock is given and you do have return of uh spontaneous circulation for your patient um um so you've got the patient who now has rosk so what are you going to do so should
• 54:00 - 54:30 it's not necessarily what you should do but do you think that the plane should be diverted to the closest airport um closest main city that has facilities that may be able to do a PCI or should they just continue on to whether it's Dubai or La we say it's a good four or five hours at least in the flight until you're reaching your Destin
• 54:30 - 55:00 ation so regardless of the scenario it's likely that you're going to be still traveling for an hour before you can get on the ground in this sort of situation is that right Whitney uh so eops can be anything up to 180 minutes so 3 hours is there a role for descending in any way we talked a little bit earlier about
• 55:00 - 55:30 uh altitude physiology um and many people might not be aware that uh the concentration of sorry the uh the partial pressure of oxygen is not sea level when you're at altitude even if the the aircraft is pressurized what can be done in that sense so um an airline that I worked for a baby was delivered and one of the things that Captain actually did of his own valtion was descend to um a sea
• 55:30 - 56:00 level cabin um they were diverting they were on their way to LA and they were diverting into Hawaii um and they were not that far out so he was obviously that burns more fuel so he has to take that into consideration um but that is something that could be considered but it would be very much dependent on where you are and where you're going to and I would just add in that some s might take a little bit of offence at a doctor trying to tell them how to fly the plane
• 56:00 - 56:30 but look it's worth it's worth adding it in um you know most of them are pretty good if you don't ask you won't know no and it might not be something they've thought about because they're thinking of so much at the time so a range of things Whitney would affect the uh decision to divert can you talk us through what those might be yes so obviously we talked about before um number one is safety of the aircraft and everybody on board so what is the appropriate airport to land in um also
• 56:30 - 57:00 the appropriate airport for the aircraft cuz I have seen an A380 go into a Pacific Island airport where that aircraft could not leave fully loaded so all those people had to get off including the patient the patient didn't survive and that aircraft was parked there for days while the airline had to fly in um other aircraft to get that out so that was that that diversion alone went into millions and millions of dollars not to mention the um you know disruption to everybody um ground
• 57:00 - 57:30 support So can they refuel that aircraft um have they got stairs do they normally receive an A380 do they actually have even ground equipment to get someone off an A380 because not every set of stairs or a bridge can be for that particular aircraft type um patient transfers obviously another thing um Brad talked about it so yes you don't have to take them down the stairs you don't have to take them through the airbridge um there is a high lift which is like your catering truck that comes up to the
• 57:30 - 58:00 aircraft you can pull a stretcher but you can't get an ambulance stretcher in any way shape or form navigate it around into an aisle so you need to use um either a carry sheet or something similar to to get them off um we talked about the hospital with definitive care crew hours is a big one so there are crew hour limitations for both flight crew and cabin crew and if you are on the ground for an extended period of time and the crew go out of hours or will go out of hours and can't be
• 58:00 - 58:30 extended sometimes they will seek a dispensation from the regulator but often they won't be given it especially for this type of length of Journey um that means everybody's staying so that means then we have to accommodate our crew we have to accommodate our customers um and then obviously you know your your patient goes off I have seen instances where we've diverted for a chest pain and everybody got stuck on the ground and by the time everything was done to get that plane off the ground that customer had gone to the
• 58:30 - 59:00 hospital been checked been cleared and came back and was waiting to get to get on that next aircraft out of there so we didn't put them on the same aircraft we made them wait for the next one because we didn't think um anyone would be too happy about that but just things to consider the other thing is if they are deceased I see you've got that question there Todd is um if you are flying somewhere and you've actually um you know we've called this and we're saying that that person um is is deceased what is the point of
• 59:00 - 59:30 diverting because it's likely that that person either resides in the country of destination that you're going to or there is someone there waiting for them um or the fact that you're just going to fly into some random country and drop off um a deceased person doesn't really go down well um and what is the point of doing that um there are the crew are trained what to do with a deceased body on board the aircraft it's not at all comfortable for everybody around
• 59:30 - 60:00 unfortunately but really when you weigh up the options it's just better to continue to destination um that is if um also your crew are coping with the situation as well and nine times out of 10 they generally are um one of the other issues with a patient who's now survived to cardoc rest is um restraining them and being able to keep them in in position for landing What would the approach be to that so if I go back to our baby born on
• 60:00 - 60:30 board we were on a 787 it's got a large Galley uh the crew brought a um a crew uh rest mattress down for Mom to deliver the paramedic delivered the baby um the paramedic and the mom stayed in the back Galley on the floor for landing um the captain used his appropriate Landing um tools including flaps so max flaps from the beginning rather than a graduated bringing flaps on so it slowed that aircraft down in in a more um controlled
• 60:30 - 61:00 Manner and the other thing was the infant was with an emergency doctor and a GP in the last row of seats with oxygen Etc um so there are different things you can do you can brace yourself like put your legs out and brace yourself if it's a smaller aircraft um hang on you know the everything's tied down and locked down in the galley so if you're in a galley area um especially if you were in one of those middle gys which talked about the distance between one side to the other you could actually sit there and I'm short but my legs
• 61:00 - 61:30 still reach across so I could brace myself against um the the carts in the galley or the cupboards that are locked and closed so um there are a few different options um obviously you're not going to have a seat belt um and you will probably be told about from a legal liability perspective um and duty of care that you know we prefer you to be in your seat but if there's an instance where you can't um then you know you work that out with the crew and the captain and as long as the captain's
• 61:30 - 62:00 giving permission for that to happen that can occur now one of the uh inevitable outcomes of something like this particularly for people who aren't dealing with this as a routine is the the issue of the second victim the experience of the resuscitators um Nicola you just wanted to mention that I think yeah I've had a um personal experience with this idea resuscitation on the beach down 500 M from home one Saturday morning when I was down there
• 62:00 - 62:30 for a walk and we worked on the lady she was a German tourist she'd just come for her son's wedding the night before and she'd gone for a swim the next morning and drowned and we were sated her for 25 minutes on the beach and got Ros and then she died in the ambulance on the way down to sko because they couldn't do further resuscitation so it probably took me about a year to get over it really so it does take a toll and when
• 62:30 - 63:00 you're outside your own clinical situation you just need to be aware of your own self when you're dealing with something like this yeah thanks Nick it does highlight um that many people will be witnessing something that's very graphic um what sort of support can be given to to lay people and people who participate in the resuscitation there there are good psychologists actually a couple around Australia but there's not enough of them
• 63:00 - 63:30 really yeah would need do the companies the aircraft companies have any sort of resources that are available to their passengers obviously they've got EAP but they can have um a a trauma pite team um attend an airport and that's generally um around the world for any incident or event um you know by all means you can um uh communicate with the airline and they would provide support for you if
• 63:30 - 64:00 you needed it um we are finding that a lot of the crew since um Co are kind of a brand new lot um they they've got less experience um they're a little bit younger um than what we've seen over our you know 20 30 year sort of career spans of previous crew and from a psychosocial perspective we are seeing a lot of um crew issues and not necessarily from a cardiac arrest from quite minor events so if they did have a cardiac arrest I can imagine that that would be um for
• 64:00 - 64:30 them quite confronting and difficult so um the airlines are you know they've got well entrenched um some of them even have internal psychologists as well um but definitely from a volunteer perspective if you are struggling um I really encourage you to reach out to the airline and the airline should accommodate and help through probably through their EAP where you would get some assistance one of the questions that's come up in the chat is tips for how you manage a
• 64:30 - 65:00 crisis situation Chris you've got a lot of experience as a an experienced Ed um Smo what are the sorts of things that you would recommend to people who aren't familiar with this type of experience um look and I I think Brad can attest to this as well that um it's about communication and making sure that you're communicating with the people how who are within your team um and then you
• 65:00 - 65:30 know in terms of delegating roles a as the doctor you may not be the best person to be leading that crisis whatever it happens to be so working out who is best place to to do which role within that crisis um and therefore being aware of what's going around what's going on um and I I've always found even you know and Brad can attest to this is well when you're team leading that you're sort of talking through and using your team in guiding those
• 65:30 - 66:00 decisions and making sure everyone um particularly if you don't know them they might have way more experience than you um to be communicating with everyone who's actually involved um to make sure that they're okay with it as well and I think that will also lead to people who are involved to feeling better about that crisis afterwards if they felt heard and felt involved um and then as Brad sort of suggested that you know planning so uh I can't
• 66:00 - 66:30 remember your exact word spread but hope for the best but plan for the worst so you know making sure that you've sort of thought about your plan A B and C if you've got that experience it may be that you say look I am 100% out of my depth here I'm happy to help I can do chess compressions but I don't feel comfortable team leading or being in charge of drugs because I can't remember that so that people can appropriately you know then go oh hang on well actually I I do know that or you know
• 66:30 - 67:00 you've never drawn up drugs before most doctors don't know how to draw up drugs unless you're doing anesthetics or procedural sedation so you know maybe the nurse or the paramedic who's way better equipped to be giving drugs or adrenaline and those sorts of things um so yeah I guess just making sure you're communicating you're delegating roles and then you know talking about it making sure that um you know there the other thing to remember in this role is you're not actually at work you're
• 67:00 - 67:30 helping um so you don't have to feel as though everything all the weight is on your shoulders because you're actually assisting in a voluntary capacity here so keeping that in mind as well that that it's not you're helping because you feel you can help in that situation rather than feeling the obligation that you know it's my fault if something goes wrong or it's up to me to make all of these decisions so that would probably be a couple of things to think about
• 67:30 - 68:00 yeah I think definitely um recognizing that volunteer position helps you feel safer in that moment because you don't know the people around you so it's a very very isolating situation to find yourself in because nobody's familiar to you that you're with unless you're traveling with people who are trained but that's very often when you're heading off on a holiday you go to get away from those people and I'd absolutely back up that
• 68:00 - 68:30 too I think the person I'd want most is a paramedic I think it's um it's can't be overstated how difficult it is to operate in an environment that you're unfamiliar with and that's the Wheelhouse of paramedics um they understand scene control and utilization of resources and all of those sorts of things way better than we will ever ever have uh knowledge of Chris I might throw back to you for the conclusion I guess once again it's not
• 68:30 - 69:00 about uh interpreting angiograms and pcrs and and all of that but um we we'll just say that the you the pilot and ground crew and yourself all had a unanimous decision uh to land at a major airport nearby and the patient had a good outcome and you managed to have another glass of champers and enjoy the rest of your holiday so um yeah the the case details in this particular case review are less important than the you
• 69:00 - 69:30 know the logistics around how you as a doctor are going to be able to navigate a difficult situation for medical professionals um this is an activity that you can claim on alsoa for measuring outcomes uh points and you can claim that for 1.5 hours there is a worksheet in the resources tab of your Zoom browser um if you can't access that for any reason then please email us at support community.com if you fill that
• 69:30 - 70:00 out and upload it that will count as evidence of your attendance here to make it easy for you so we'd strongly encourage you to do so Chris do you want to talk to the uh event that you've got hatching in your mind you know coming up later this year yeah look we thought there has been some interest in people actually being involved in presenting and wanting to do sort of a number of sort of short V clinical vignettes um so we thought what
• 70:00 - 70:30 we might try we'll continue with this format for for a number of case reviews but we thought we're aiming to maybe do six of these this year in total but we thought maybe two of those we might see if Osa members want to actually get involved we'll see how we go so we thought the the the main sort of carrot in all of this is that you would get measuring outcome out hours for all of your um time involved so that includes
• 70:30 - 71:00 putting the presentation together as well as attending the case so you'd get lots of measuring outcome hours but we also thought it'd be good to to get you as you know we've we described as osla Community we want you involved um so if you are interested we'll send out an email um with more details but basically we'd be looking for people who would be interested in doing a 15 minute presentation um with a obviously a measuring outcomes Focus so we thought
• 71:00 - 71:30 maybe in August if we had a respiratory focus in a September we might do some cardiac cases so just to get you on board and hopefully um get you involved sounds very exciting Chris I'm looking forward to seeing what uh what comes down the pipeline with that one Whitney finally I'll throw to you about an opportunity that you've got for uh people attending this webinar yes thanks thanks Todd um so Todd mentioned in the beginning I um am the CEO and founder of
• 71:30 - 72:00 two two companies Aviation health group and fit toly um so Aviation Health Group has a course which is called the medically qualified volunteer course um it covers altitude physiology um a lot about the different types of aircraft environments we've only talked about one the at 380 tonight um what the type of kits and equipment that is carried it talks more again about the legal liability the the C Captain um and the training of the crew um and a whole lot of other information around the groundbased medical provider so um it's
• 72:00 - 72:30 ASM and Aram um accredited and I'm um offering uh all the webinar participants tonight um $100 off that course so if you put in that code Med 2025 if you just go to Aviation healthgroup docomo it and the other one to look forward to which we've just almost completed is one called is your patient fit to fly so um our other company fit
• 72:30 - 73:00 to fly is a software program that has been developed with clinical logic to automate the medical clearance process for passengers um who need a medical clearance in order to travel commercially um and I would love every doctor to do this course because it teaches you everything you need to know about who needs a medical clearance how to fill it out why you filling it out what's the process behind um and so that course excuse me will be available later this year um so I really
• 73:00 - 73:30 encourage you to to look out for that one so we'll send out some links to all people who registered for this uh session around that later date uh so we've reached the end it's getting close to our time frame uh thank you all for attending uh in particular thank you very much to Whitney luxford Anthony manilo and Brad Roberts for uh for sharing their insights and their expertise tonight Chris for another excellent job presenting the case and Nicola on the bass drum and also looking
• 73:30 - 74:00 at the chat and keeping things coming through so thank you all for your participation and we look forward to seeing you again next time