Flying the deadly skies

Recently I’ve seen a number of reports of women who are denied the ability to help in a plane emergency because they are not believed to be doctors. While most of the denied women are of color, since this became public a large number of women of all races have come forward because of similar racial and gender discrimination.

I am an emergency physician, and I was once called to duty on a flight. I was believed instantly and put into service. So why am I writing? Because the treatment of emergencies in the air is flawed and is a massive problem.

A lot of people doubt that this could happen. I believe it because I experience doubt frequently, even with my coat on. As an example, one night shift, I walked into a room (wearing my white coat), introduced myself as Dr. B and proceeded to do a full history and exam. Since the patient was bleeding, I checked on him frequently to see improvement.

After two hours, the patient started howling, “Where is the f—ing doctor? I demand to see a doctor! I’ve been here two hours without seeing anybody!”

The nurse gently replied, “You have seen one. Dr. B has been in and out of here five times. The short woman with the white coat on.”

His response: “That little girl? That’s my doctor?”

In the real world (outside of the hospital), I do not wear a coat. I shed the doctor persona for other ones: wife, mother, writer. Even my kids don’t always believe me when I give them medical advice. Sometimes I have to go to the pediatrician just to have my kids realize that I know what I am talking about.

So I can understand, in a hectic, stressed environment like an in-air health emergency, that the already biased general population might reflexively express them at the most inappropriate time.

However, If someone goes out of their way to put down their book and offer assistance, it seems that it would quickly become obvious if their skills were not real. It just doesn’t make sense that you would reject a doctor volunteer based on appearances. On our off days, we might be wearing ripped jeans and look pretty scrubby. We might be getting off call or a night shift before hopping on that plane. Regardless, the concept that there are any people in any location who need emergent help and ask for it, who then reject people based on looks, is absurd. And yet, it is happening.

To solve this, we as a population need to drop the adjective. I’m not a lady doctor. I’m a doctor. I’m not xyz race. I’m a person. Drop your preconceived notions on how what a person looks like means for the help they can provide. That woman wearing the hijab who scares you might just be saving your life someday. If you just take a few seconds and listen, it will be glaringly obvious that what comes out of our mouths is somewhat unintelligible medical-nerd-speak. There’s a language to medicine. Even if you do not understand it, you can recognize it by just listening.

Second, there is a larger problem with flying the deadly skies. Airlines as cost savings measure are ill equipped to help people with medical problems. They also do not restrict those who probably should not be flying. Sure, if you look like you have the plague they will screen you out. Or if appears as if you will deliver a baby soon. However, people who have serious medical problems are allowed to fly. Some of them will have a problem mid-flight, and require assistance. Hoping and praying that there are qualified medical personnel on board as passengers does not represent the best way to prepare for these emergencies.

In my experience, the medical kit was a joke. The flight attendants had not been trained to know what they had and what it did. The oxygen tubing connector did not fit the oxygen tank! It was impossible to do anything other than basic CPR. We had an emergency physician and an EMT helping out, and this person still died. Proper equipment is key to saving a life. Plus, after all the stress of losing my passenger status and getting conscripted into service as an airline medical assistant, without any useful tools to help, I got nothing but an offer for a drink (I declined as I was pregnant at the time, though I miscarried soon after this event). When I made a formal complaint to the airline about the inadequate training on medical equipment and lack of proper fitting resources, I was given 1,000 miles and a $25 piece of luggage, but the important issues were brushed off. The airlines create an unsafe environment for the treatment of medical emergencies, and do not seem to care.

Frankly, the problems regarding racial and gender bias and inadequate medical resources are worthy of a congressional hearing. But nothing ever happens because it will cost too much.

What do we need?

I think on every flight, one flight attendant should be trained as an EMT and all the equipment on the plane must be functional. All doctors, nurses, and EMTs should voluntarily register with the airline (with proper credentials) and be flagged for potential use in an emergency. In exchange, all registered people should get 10 percent off their ticket and automatic pre-check for security. If called into service, they should get an equivalent value ticket credit for a future flight.

In summary, we need to listen to those who wish to help. Also, have an improved system to allow better health care in the skies. If not, fly at your own risk. Because that doctor who could be there to help you might just keep drinking their wine and reading their book rather than risk being degraded, harassed, or be put in a no-win situation without proper life-saving materials.

Ilene Benator is an emergency physician and author of Schizo: Hidden in Plain Sight.  She can be reached at Ilene B. Benator: The Schizo Series.

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