MARCO Grand Rounds for April 27, 2008

From Warren, KD4GUA:

You are on an airplane and a passenger is having chest pain. They call for a doctor...should you respond? Will you respond? Do Good Samaritan laws go into effect when you are passing over different states in rapid succession? What state law would ensue if something went wrong?

This Sunday we will discuss the "Good Samaritan" laws and how they effect you. Should be fun...10 a.m. eastern time...CW on at 9:30 a.m. Eastern.

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This grand rounds generated some interesting commentary:

From Bob, K4RLC

I missed the net on Good Samaritan laws, and wonder if you will write it up for the newsletter?

I'm interested not because of air travel, but because both our kids play several high school sports. Fortunately, they haven't been hurt yet, but some of the parents in the stands are pretty out of shape, and I've had to work on one who collapsed during a basketball game. We all tailgate at the football games, and food is copious and tasty, and that situation is ripe for a coronary or diabetic event.

A rare event happened here a few weeks ago at a high school Lacrosse game. A player was hit in the chest by the lacrosse ball, and collapsed from Commotio Cordis. He was fortunate in that a teammate's Dad is Director of Rehab Medicine here, and had read up on this rare condition beforehand. There were a total of 3 physicians and 6 nurses among the spectators, and all helped. But what saved this young man's life was the AED, as he went into V Fib. He had to be shocked three times.

He survived but suffered a hypoxic event, so I'll probably see him. I'm the neuropsychologist for our professional hockey team (Carolina Hurricanes) and see them all after concussions, as well as high school and some college kids with concussive type injuries.

Thanks for your input about out of shape parents in the stands, hi.

From Mary Kaye, AE4BX:

had something to add about being a pseudo-team doctor. When my son was in 8th grade he played football for a small private school, It was his first year playing (over many of Mom's objections). I was the unofficial team doctor by default. My husband who was a first-aid trained pharmacist, sat down on the bench with the players. I had every possible piece of equipment in my station wagon, head board etc etc etc.

The routine was that when anyone was down, my son should step aside and show me his numbers (so I could walk). Well the feared incident happened, and one of our team members went down on the ground after a tackle, held his neck saying "my neck, my neck, my neck!!!!!!" After inspecting my son's number of course, I rushed down on the field, saw that the boy could move his legs, stopped the game and called EMS. Expected chaos. Well as the sirens were heard from afar, the boy's father came down on the field, a rough an tumble redneck also smelling of spirits if I were to render an opinion. He looked at the kid, shouted. (EXPLETIVE DELETED) SCOTT, GET YOUR RED LAZY A-- UP OFFA THE GROUND AND GO PLAY BALL!!!!!!!!!!!"

Well as the EMS guys were running the stretcher on the field, the kid got a red face and said "Uh, OK Dad", and jumped up and ran to the bench". Leaving me there red-faced and about to punch out that redneck myself.

I inquired from an orthopedist later how I could tell - and he said always ask the player to raise his head up himself, and of course don't help him or yank the helmet off etc. If he had either a bad whiplash or a structural damage of any kind to the neck he can't raise his head. I saw this done many times on the field in later football games when I became an armchair expert.

My son's football career was over that year by the way. I said he could grow tall and play basketball or find himself a foster home. He took the advice, grew to 6'3" and played basketball nicely according to plan. That was also the end of my team doctor career.

And Warren KD4GUA's reply

Bob RLC in Raleigh asked about the specifics concerning the Good Samaritan Laws as he missed the lecture. Basically you are covered if you act in good faith, do not perform gross neglect, do not accept money for your deeds and do not leave the patient until someone else can take over with equal or more experience. You do not have to perform a good samaritan act unless you live in Vermont, Minnesota or Louisiana, France or Germany and then it is mandatory to help. Benign neglect is acceptable, i.e., if you do 15 instead of 30 chest thrusts for each mouth to mouth (which is now not required) that is benign neglect because you simply missed the last Red Cross course in CPR. The individual or next of kin must give consent unless the patient is unconscious or not able to give good judgment. In most jurisdictions Good Samaritan laws only protect those that have had basic first aid training and are certified by the AHA, Red Cross, or other heal th organizations. In other jurisdictions, any rescuer is protected from liability, granted he acted rationally. Congress passed a bill about 1994 enabling good samaritan laws in flight regardless of which state the plane is flying over. In international flight the rules go by the carrier's home country.

PS: The requirements as you walk through the hospital and there is a cry for help from someone else's patient--that is another story and perhaps another Sunday lecture.