Good Samaritan actions and laws

"Is there a doctor on board this flight? Please press your call button if you're a physician."

Most of us have heard that request on at least one of our flights during our careers as physicians. After the AMA House of Delegates meeting in Hawaii ended on Nov. 13, many AMA delegates were on a Northwest flight from Honolulu to Minneapolis when a flight attendant requested medical assistance.

Toward the front of the plane, two AMA delegates and I attended to a middle-aged male passenger who complained of nausea, epigastric pain, and shortness of breath, and who appeared to have had a brief episode of syncope. An emergency medicine physician from Hawaii quickly joined us and assumed a primary role in examining the patient. An onboard automatic external defibrillator was used to assess the patient's cardiac rhythm, and he was given oxygen. His symptoms diminished, his vital signs were monitored and stable during the remainder of the flight, and he was transported by EMS personnel to a local hospital immediately upon arrival in Minneapolis.

During the same flight, in the back of the plane, a physician member of an AMA committee attended to a passenger who was light-headed and short of breath, and had an irregular pulse (which the passenger later reported to be a chronic condition). The physician believed that the passenger was having a panic attack, and guided the passenger in practicing relaxation techniques. The passenger's symptoms abated.

At the end of the flight, a flight attendant spoke on the PA system and gave special thanks to "the AMA doctors" who rendered care to these passengers.

Good Samaritan actions by physicians are part of our devotion to service, our professionalism, our ethics. The term "Good Samaritan" refers to a parable told by Jesus in the New Testament (Luke 10:33-35) about a "Samaritan traveler" who cared for a man who had been beaten by robbers.

Calls for medical assistance aboard commercial aircraft raise two issues specific to airlines–the training of airline personnel and the availability of medical equipment aboard the aircraft. AMA policy urges the Federal Aviation Administration to 1) require safety training programs for commercial airline cabin crews, including instructions in first aid, CPR, the Heimlich maneuver, and the use of emergency medical equipment (Policy H-45.991); 2) require U.S. air carriers to report data on in-flight medical emergencies (H-45.981); and 3) work with appropriate medical specialty societies and the airline industry to develop and implement comprehensive in-flight emergency medical systems that ensure, among other things, rapid 24-hour access to qualified emergency medical personnel on the ground; written protocols, guidelines, algorithms, and procedures for responding to in-flight medical emergencies; and adequate medical supplies and equipment aboard aircraft (H-45.978).

Because we live in a highly litigious society, physicians are understandably concerned about liability exposure when providing Good Samaritan care, whether on airplanes, alongside highways, or elsewhere. Most states have enacted Good Samaritan laws to protect health care providers and others from being sued for providing emergency help to a victim.

To trigger the protection of such a law, two conditions must be satisfied: It must be a volunteer act, and the actions must be a good faith effort to help. In the medical sense, a Good Samaritan is a health care professional who volunteers to help someone in need of emergency medical care. The act must be done without there being any duty to care for the patient and without any expectation of compensation.

Unfortunately, physicians who provide medical care at a sporting or community event aren't necessarily covered under Good Samaritan laws, which vary by state. Generally, if a physician comes upon an emergency situation and provides assistance, that would be considered a Good Samaritan act. It's important to note that if a physician who provides a Good Samaritan act is a team physician, that might not qualify as being a Good Samaritan situation. If you're looking for clarification, I suggest you consult with your attorney or state medical society.

Many states also have charitable care state laws, which exempt physicians from liability for negligent treatment of patients who lack health insurance. Because protections vary by state, I encourage physicians to become familiar with the extent of available immunity in their state of practice.

The AMA has created a document (Word, 540KB) that provides information on the Good Samaritan laws and charitable care statutes of the 50 states and the District of Columbia. Additionally, the AMA Young Physicians Section has developed a comprehensive explanation of Good Samaritan issues as they relate to emergency care.

The AMA supports legislative provisions that grant any physician, other medical professional, or airline employee, acting in the role of a Good Samaritan during an in-flight medical emergency, an umbrella of immunity against legal or personal redress by the airline, the passengers, or the persons involved in the medical emergency. To that end, the AMA works with state medical societies to educate physicians about the Good Samaritan laws in their states, and the extent of liability immunity for physicians when they act as Good Samaritans. The AMA also encourages state medical societies in states without Good Samaritan laws to develop and support such legislation.

The AMA urges the International Civil Aviation Organization to make explicit recommendations to its member countries for the enactment of regulations providing Good Samaritan relief for those rendering emergency medical assistance aboard air carriers and in the immediate vicinity of air carrier operations.

The idea of helping others tends to come into focus more during the holiday season. For physicians, though, helping others is part of our profession and our devotion to service. It's what we do–and, in many respects, who we are. If your state doesn't have a Good Samaritan law on the books, I encourage you to work with your state medical society to develop one. And contact your legislators and express your support for such a law.

If you have interesting Good Samaritan stories you'd be willing to share, please send them to me at the e-mail address shown below. I may devote a future column to them.

The lighter side

My most memorable Good Samaritan role occurred on a trans-Atlantic flight to London many years ago. A flight attendant asked if there was a doctor on board, and when I responded, she brought me to the ill passenger. He was lethargic but arousable, and his wife said he had had a seizure many years previously. I thought he was postictal, and I monitored his vital signs, which were stable for the rest of the overnight flight. EMS personnel met him on arrival in London.

In appreciation for the care I had provided, the flight attendants gave me an expensive bottle of champagne from the plane's duty-free shop. I was taken aback, however, when they delivered this gift to me in a Marlboro duty-free bag. I've made tobacco control the major focus of my career in preventive medicine and public health, and I've had many bouts of nausea from exposure to Marlboro ads in duty-free stores. Let's make sure there is no Good Samaritan care for the Marlboro Man.

Please send comments, questions, and replies to amaprez@ama-assn.org.