Who Should Step Up to Help in a Medical Emergency?

Marcia Frellick

May 07, 2018

Physicians, nurses, advanced practice providers, and medical students have different ideas about who should volunteer to help in a medical emergency — such as on a flight — and who is qualified to do so, according to a Medscape poll.

The poll was available online from March 21 through April 10. Respondents included 459 medical students, 183 registered nurses/advanced practice registered nurses (RN/APRN), 872 physicians, and 64 physician assistants (PAs).

Most providers and students agreed that physicians were qualified to help in a medical emergency when they were off duty. Most medical students (92%) said physicians were qualified, and almost all in the RN/APRN, PA, and physicians groups (96%, 97%, and 95%, respectively) agreed.

That broad agreement did not hold with respect to whether nurses/nurse practitioners and physician assistants were qualified to help in such situations. RNs/APRNs and PAs gave themselves a vote of confidence (96% and 95%, respectively). But among physicians, 83% said nurses/NPs were qualified, and 73% said PAs were qualified. Among medical students, 76% said nurses/NPs were qualified, and 61% said PAs were qualified.

Should Medical Students Help?

The question of whether medical students should help is difficult. In a recent Medscape blog, medical student Vincent Migliaccio Michaelson noted that most medical students are eager to help but that they differ in levels of knowledge and experience.

In this poll, answers as to whether med students should volunteer differed by providers and students and by consideration of the student's year in medical school (generally, higher percentages reflected more years in school). Providers were much more likely than medical students to say that medical students should volunteer regardless of year in school. But the percentages of those who said yes regardless of year were still low overall: 23% of medical students, 52% of RNs/APRNs, 40% of physicians, and 55% of PAs.

Table. Should a Medical Student Volunteer to Help in an Emergency?

Answer Medical Students (%) Nurses/Advanced Practice Nurses (%) Physicians (%) Physician Assistants (%)
Yes, regardless of year in school 23 52 40 55
Yes, if at least a second-year student 4 5 3 0
Yes, if a third-year student or above 25 9 15 5
Yes, if a fourth-year student or above 32 7 19 16
No, medical students are not qualified to assist in medical emergencies 8 11 14 14
Unsure 8 16 9 11

Across the board, fewer poll respondents said that certified medical assistants (MAs) are qualified to help. Of those who said MAs were qualified, 50% were physicians, 58% were RNs/APRNs; 41% were PAs; and 47% were medical students.

Feelings of Moral Obligation

When asked about feeling a moral obligation to help in a medical emergency when off duty, medical students had the strongest pull, at 85%, followed by physicians (83%), then PAs (78%) and RNs/APRNs (77%).

Comfort levels were low among providers and medical students in acting in such situations. APs represented the largest percentage among those who said they were comfortable responding, at 65%, followed by RNs/APRNs (63%), physicians (53%), and medical students (49%).

There are many reasons for hesitation, experts say. The provider may think someone else on board a plane, for instance, may be more qualified, or they may feel impaired by lack of sleep or by use of alcohol. They may not feel comfortable working with few supplies on board or working in such cramped space, or they may worry about missing a connecting flight.

Some who commented on the poll pointed to the possibility of legal repercussions.

An ophthalmologist commented that he was encouraged that so many respondents said they would help.

"I never understood how someone with (or without) training could avoid helping someone else," he said. "Have done it many [times] over the years and never thought about medical-legal [implications]. We are people first, which would imply stepping in to help. I would feel horrible if I didn't step in and the patient died or had terrible complications."

As previously reported by Medscape Medical News, medically qualified professionals who volunteer without monetary compensation have so-called Good Samaritan liability protection under the Air Carrier Access Act of 1998.

According to that act, "An individual shall not be liable for damages in any action brought in a federal or state court arising out of the acts or omissions of the individual in providing or attempting to provide assistance in the case of an in-flight medical emergency unless the individual, while rendering such assistance, is guilty of gross negligence or willful misconduct."

A nurse practitioner who commented on the poll said it all comes down to common sense.

She wrote, "Common sense dictates that the most capable and most experienced person on site must take command until relieved by a more or equally capable person."

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