The AMA Principles of Medical Ethics addresses this issue with the following language: “A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.”3 Of course, the emphasis here is on “except in emergencies,” which carries the implication that it is a physician’s duty/responsibility to respond.
Explore this issue:January 2016
An otolaryngologist is, first and foremost, a physician, and there is a societal expectation that physicians will respond to a need for medical rescue. To put it a different way, wouldn’t we like to think that a physician would come to our rescue, or that of a family member, in an emergent or urgent situation? Finally, altruism and a basic respect for human life and well-being compel us to respond, even if we are limited in skills or capabilities for a given emergency. If we do not respond, and the outcome is to the detriment of the victim, then we live with that knowledge.
Now, let’s address the specific scenarios.
Clinical Scenario 1
This is a difficult situation, because European laws covering “Good Samaritan” acts may vary from country to country or, depending on the country, may not even exist. Because the emergency occurred on a river cruise boat that traverses a number of countries, it would not be possible for the otolaryngologist to know the applicable laws for that location. Additionally, under the circumstances, the otolaryngologist has not only limited resources but also limited training in any definitive therapy for a stab wound to the abdomen. Still, he needs to do something, as he is bound by professional standards to do the best he can for the victim. He will likely need to apply pressure to the wound, perhaps even a makeshift compressive abdominal garment, and reduce shock, as well as administer CPR should the victim become apneic or experience cardiac arrest or severe arrhythmia. Short of basic first aid—unless IV fluids are available—the otolaryngologist must call for the boat to dock at the soonest possibility and ask for emergency medical services to meet the boat and take charge of the victim’s care. Finally, he should ascertain whether other healthcare providers are on board to conduct a team effort in first aid. As long as the otolaryngologist acts in good faith and makes his best effort, there should be little risk of liability.
Clinical Scenario 2
Many physicians, including otolaryngologists, may be called to assist on an in-flight medical emergency during their careers. Fortunately, most flights will likely have more than one healthcare provider on board, and consulting and working with other providers can benefit the victim and the otolaryngologist who responds. The implications of this scenario are potentially quite serious, with the pilot at risk of succumbing to what might be a serious medical event, such as a myocardial infarct, ruptured aortic aneurysm, or another dire condition. At this point, immediate rerouting to the nearest airport with the appropriate hospital facilities is warranted, and basic emergency care should be instituted. The primary responsibility of the otolaryngologist is to assist in life-saving care, to provide information to the co-pilot, who is now in charge of the aircraft, and to help promote calm among the passengers. She should present an air of confidence and control. The Aviation Assistance Act is designed to protect the Good Samaritan physician who acts out of altruism and in good faith, and although this act applies to U.S.-registered aircraft only and the same provisions may not be provided by other countries, this uncertainty should not be a reason in itself to not respond to an emergency if called.
Clinical Scenario 3
A head and neck surgeon is likely well qualified to perform the primary assessment of an injured patient in this scenario and will likely have a practical knowledge of the injury and its immediate care. Reassurance of the victim and his parents, prevention of shock, protection of the injured leg, provision of comfort, and the call for an immediate evacuation of the victim are priorities. This will, in all probability, be an air evacuation situation. Few physician hikers and campers pack intravenous fluids and venipuncture equipment, but a comprehensive medical kit packed for a group campout might have been included—if so, other medical equipment might be available to the otolaryngologist. There is no way for the otolaryngologist, if he is the only physician in the group, to avoid tending to the victim. It is part and parcel of his professional duty.
The decision an otolaryngologist must make regarding whether or not to respond to an urgent call for a physician outside of the medical environment is, admittedly, a personal one. Neither this author nor the profession in toto, except in three U.S. states, can mandate that he or she respond. But, because of the altruism, oaths, expectations, and medical ethics of the profession of medicine, most physicians will step forward and do what they can under the circumstances. Good Samaritan Laws and the Aviation Assistance Act are designed to protect the responding physician from liability, and this premise has been proven time and again. Otolaryngologists who are faced with medical emergencies that are generally outside their scope of practice must draw upon their basic medical knowledge and training to provide assistance in a prudent and reasonable manner, even if it is only first aid or basic CPR. The important thing is just to be willing to help in an emergency medical situation to the best of one’s abilities.