Additional issues facing an otolaryngologist who is deciding whether or not to respond to a call for a physician include liability risk and ethical and moral obligations. There will likely not be a lot of time for the otolaryngologist to determine a course of action in an urgent or emergent situation, so it is wise to give thoughtful consideration to what one’s response would be in a range of possible circumstances.
Explore this issue:January 2016
Legislation in Place
Medical liability should usually not be a major concern for a physician who responds to an emergency call because of the “Good Samaritan Laws” in effect in all 50 states. While the details of these laws vary somewhat from state to state, their commonality is that a physician who is responding to an urgent or emergent situation and acting in good faith and reasonable prudence on behalf of the victim will be protected from any liability arising from his or her actions. These laws were passed to encourage healthcare providers to come to the assistance of victims of accidents and other emergencies.
A review of the Good Samaritan statutes in the U.S. states by Stewart and colleagues revealed a number of common elements or requirements: 1) a physician acting in good faith to render first aid or emergency care; 2) no expectation of compensation; and,
3) a victim who is not presently the physician’s patient.1 Under these conditions, a physician would not be liable for civil damages resulting from simple or ordinary negligence. All but the state of Kentucky provide immunity to physicians who hold licenses from another state. Three states—Louisiana, Minnesota, and Vermont—require a physician to provide basic emergency care, with the risk of violation of the law if the physician “walks away” from the emergency. It must be emphasized that acts of gross negligence or misconduct are not immune from liability.
Emergency care rendered by physicians and other healthcare providers during domestic air flights is protected by the Aviation Medical Assistance Act of 1998. This act, which “declares that an individual shall not be liable for damages in any such action arising from out of acts of omissions in providing, or attempting to provide, such assistance, except for gross negligence or willful misconduct,” is especially important because of the isolated and inaccessible conditions inherent to an in-flight emergency, as well as limited access to diagnostic and therapeutic equipment.2
Scope of Training
Limited scope of practice, training, and experience may be a concern for some otolaryngologists. While management of an airway emergency would fit nicely into an otolaryngologist’s capabilities, managing other medical or surgical emergencies—such as an acute hypertensive crisis/stroke, MI, diabetic crisis, or precipitating delivery—could be disconcerting or daunting. Outside of special experiences, such as military duty as a general medical officer or previous training in general or emergency medicine, some calls for a physician may stretch the scope of practice for an otolaryngologist. While all hospitals likely require basic CPR certification for staff privileges, not many otolaryngologists routinely recertify in advanced cardiac life support or advanced trauma life support, although it might be helpful for them to do so. There also may be some trepidation in an adult otolaryngologist treating a pediatric victim, and vice versa. Yet, the most common issues that prompt a call for a physician involve such “emergencies” as syncope/dehydration, nausea and vomiting, hypoglycemia, and shortness of breath, all of which are within the general scope of knowledge of an otolaryngologist.
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?
Medical kits on domestic air carriers likely will provide the necessary equipment for starting intravenous fluids; for administering intravenous glucose, sublingual nitroglycerine, and anti-nausea medications; for checking blood pressure; for listening to the heart, lungs, and abdomen; and similar interventions. Most aircraft are also equipped with an automatic external defibrillator, the proper use of which is an important part of basic CPR training for physicians. When faced with a serious or life-threatening emergency, otolaryngologists may have to rely upon their common sense and general medical training to do the best they can under the circumstances. It is also generally held that the most experienced and appropriately trained healthcare professional on the scene should take charge of the victim’s care, and that may be an emergency medical technician, combat medic, intensive care unit nurse, or other physician or surgeon. The best interests of the patient should always be the priority.
Moral and Ethical Considerations
Perhaps the most compelling arguments for a physician to respond to an urgent or emergency call are their moral and ethical duties to society—i.e., their fellow human beings. Under professional oaths and codes of ethics, a physician has a specific duty for “medical rescue,” which requires a prompt response to a call for assistance. In such emergency situations, the physician may not have the luxury of waiting until no one else responds, particularly if CPR, airway obstruction clearing, hemorrhage treatment, or defibrillation is required. Fortunately, most emergency calls are not immediately life threatening, but that determination is not certain until the physician evaluates the victim. At minimum, we should be able to stabilize the victim until more experienced and capable assistance arrives.