Are You a Good Samaritan?

Karl Neumann, MD, FAAP

Health care professionals have moral and ethical obligations to give medical assistance to travelers and those obligations supersede any legal ramifications of their actions. This is the near unanimous opinion of the eighty ISTM members responding to a questionnaire asking for their thoughts on this subject.

Virtually all respondents have offered medical assistance and would do so again, but about half of them would not do so unconditionally, with many giving inconsistent answers to different questions. Typically: "I would rather be sued than deal with my conscience." But, "I help if it appears that my assistance will make a difference."

No respondent has experienced legal complications from providing medical help but many had "heard" or "read" of such cases. Only one respondent cited an example: a South African doctor driving in Mozambique hit a child who ran into the road. He stopped, rendered assistance, and took the child to hospital. The child died. The doctor was arrested at the hospital and spent three days in jail. (However, as wrongful the arrest may have been, this physician was not merely a Good Samaritan. Ed.)

Here are some interesting responses to our questions:

Should health care professionals be Good Samaritans?

"I often assisted trekkers in Nepal but not local people unless it is absolutely necessary. Assisting locals undermines local health systems - which tourists are often unaware even exist."

"In the U.S., each state has Good Samaritan laws, and they vary considerably. All the laws are listed at: http://www.aedhelp.com/legal/downloads/aed_legislation_summary.pdf ... "

"Some Canadian provinces have Good Samaritan laws. See http://www.canadianlawsite.com/goodsamaritan.htm... Quebec is unique in requiring people to help a person in peril…."

"Generally, I think one should respond - perhaps make it clear to the patient what level of competence they have, and get a verbal OK with a witness…"

"I would be careful in offering help if it involves the jurisdiction of the U.S."

"Morally, absolutely. But sometimes it's hard to know if you are exceeding your range of competency, especially in a "foreign" environment, often with inadequate resources."

"In Portugal, medical professionals must respond, if only to say there's nothing they can do."

"As a fellow human being I try to help where I feel I am the best (or the only) one available. But traveling medical professionals should avoid going overboard in dispensing unofficial medical care which circumvents the established health care system."

"I can recall six occasions when I have done so: two aboard aircraft and four on the road. Not once was I thanked. One roadside case resulted in my being required, without remuneration, to take time from my practice to testify in court. One party sued another, not me. These incidences have increased my cynicism regarding society, and contempt of lawyers. Nonetheless, I would assist again. Not because I'm a physician, but because I'm a human being. Rendering aid is casting a vote for a kinder, more humane society; refusing is voting for a society in which every one is condemned to suffer alone." 

"Physicians are fortunate that we - often through the efforts of others - have our professions. We have an obligation to use our skills…"

"I've volunteered three times in airplanes: for fainting, nose bleed, and hyperventilation.  It's my moral duty…. It beats just sitting for long periods, might lead to something exciting, makes one feel part of "the team," meet nice people, and get special attention (like a bottle of champagne). Mostly, I like being a doctor."

Should health care professionals carry medical equipment/medication when they travel?

"I carry a gadget for CPR mouth-to-mouth protection." 

"For Africa, I carry a medical kit, for myself and my travelling companions. …whole countries have no EMS services."

"I carry a mini trauma kit in my hand luggage."

"A uniform kit for all medical professionals would be a great idea."

"I give medicines from my personal supplies when the airlines do not have them."

"I keep my ACLS/BLS certificates up to date."

"I carry a stethoscope, diagnostic set and sphygmomanometer in my laptop bag."

"I used to carry a medical emergency box in my automobile's trunk but found that the drugs were usually out of date and/or damaged by the heat so I no longer do so." 

"All airlines should carry the same equipment and same medication."

"I have ceased doing so.  To carry them in my car is an invitation to thieves, and to carry them in my luggage aboard an aircraft causes too much inconvenience with security personnel."

"I always carry a stethoscope and usually an otoscope and Z-pak."

"On a key ring I carry nitro and a beta blocker. In my shaving kit I have epinephrine, Benadryl and a straight catheter."

"My small first aid kit with basic medications came in handy once when someone had an allergic reaction."

"I have gloves and a one-way valve CPR mask in my car trunk."

"Health care professionals should NOT have to carry medical supplies, airlines should. And they should be standardized."

"I don't feel obligated to carry equipment other than our own first aid supplies."

Anecdotal Experiences

"Using a stethoscope, you can't hear heart sounds over the noise of the jets. I thought that an unresponsive, pale and pasty guy was dead. I was getting ready to shock him. Then he groaned and moved. It was a case of syncope."

"…stethoscopes are helpful on planes even if you can't hear. Placing it on the patient's chest gives you time to think what in hell you do next."

"I medically assisted a traveler with sleeping sickness flying from Tanzania to Amsterdam. I would do it again. I carry lots of medications, but not for all eventualities."

"In the Athens departure lounge a man in our group developed renal colic. To leave the area would have caused him to miss his flight.  We scrounged enough opioids and other pain meds from other travelers (including physicians) to keep him reasonably comfortable during the flight to the U.S."

"I'm a nurse. I have done CPR on a plane, beach, subway platform, and in a city park. Unfortunately 2 of the 4 patients died, but in the hospital, not while I was assisting. I have stopped for road-side accidents, positioned patients, "prevented" inappropriate care of seizure patients, helped dehydrated travelers and escorted people to ERs (broken ankle, head laceration). I was never alone for long - other nurses and doctors responded - sometimes too many!"

"Flying from Milan to Madrid a lady had a panic attack but the steward thought she had a heart attack. I talked the lady down a bit and gave her diazepam from the aircraft's medical kit. She was asleep when we arrived in Madrid. …I may have prevented an unscheduled landing or other unnecessary actions by the crew. …responding should be automatic for physicians. The intromission of government and business on physicians has damaged respect for physicians and has caused irreparable damage to the profession."

"… In an airport, I was moved aside when paramedics arrived, which was fine.  However, they misinterpreted the cardiac monitor and were going to shock a 3rd degree block until I helped them with the rhythm. They wouldn't believe me until their ER-based doc confirmed my reading.  Yes, I would do it again."

"I pulled a passenger out of acute pulmonary edema at 3:30 AM over the South Pacific using nothing but 10 mg of furosemide, a single vial of digitalis, rotating tourniquets, and all the oxygen bottles aboard. As we landed I had to stand wedged between the rows of seats in front of him while holding him supine on the row of seats."   

"In flight, I had to provide proof of my MD credentials. Then I was offered a medical bag including a wide assortment of medications, including morphine. The passenger vomited on me. He turned out to be o.k.  The flight attendant handed me a long form to complete, but did not offer to clean my clothes. I received a thank-you letter from the airline's medical director. While I still believe we must assist I feel no obligation to complete forms for airlines for free, especially if they won't even help me after being vomited on. Next time I help, I will write a detailed note and retain it for my records. But I will not provide it to the airlines for free. (I understand that most airlines now offer appropriate recognition of a doctor's help with either frequent flyer points or free tickets."

"Most airlines now have links to emergency doctors on the ground. … I was treating a lady in heart failure. The flight attendant placed the call. The line was continuously busy and we never got through. I did receive two free tickets to anywhere the airline flies in North America."

"In Ethiopia I assisted at a road accident. I had an Advanced Life Support paramedics "jump bag." I resuscitated a severely head injured patient; transported him on the back of our Toyota to the local hospital where there was no comprehension of managing an intubated patient. Did I do him a favour?"

"I am retired. I have assisted, and probably will continue to so. So far (fortunately for all concerned) I have encountered only air sickness and vaso-vagal reactions.  If I thought it was something cardiac I'd tell the flight crew that I am retired and would encourage them to get advice from ER docs on the ground. I would help them by being the crew's eyes, ears, and hands."

"… Generally, I avoid dispensing medical care to guides, taxi drivers, etc. when traveling as a tourist. I try to avoid interfering with local care, even when it isn't the best."

"Many doctors are in specialties with little knowledge of emergency medicine. Is it a crime for them not to assist?"

"India rewards physicians with lower fares if they say that they will assist in emergencies…"

" …have assisted four or five times at airports/aircraft.  Once found a man collapsed/cyanotic on the floor, having a seizure. I was able to open his airway until paramedics arrived. I almost missed my flight. Would the airline help if that occurred? (The victim was an attorney. He sent me a wonderful letter of thanks.)" 

"… a passenger collapsed with a vaso-vagal episode.  As I and another physician assisted him, we were essentially elbowed aside by four or five extraordinarily aggressive crew members who insisted that they knew best what to do.  I'm glad he didn't have something more serious." 

"I'm a nurse - and if there's no doctor around, that's who they yell for next.  Calls I've responded to have been first-aid in nature, or stabilizing someone immediately post accident until EMS arrives.  Have done CPR at accident scenes twice, in the early 70's and mid-80's.  Did mouth to mouth each time...would I do it now?  Not sure..."