Good Samaritan experiences
Authors: Kathy Oxtoby
Publication date: 21 十二月 2012
Kathy Oxtoby talks to doctors who have carried out Good Samaritan acts about their experiences and why they believe in the value of answering the call “Is there a doctor who can help?” outside working hours
Angus Wallace, professor of orthopaedic and accident surgery, Queen’s Medical Centre and the University of Nottingham
Angus Wallace used a coat hanger to save a patient’s life during a long haul flight.
I’d always wanted to become a surgeon, ever since medical school, and I’d always had a strong engineering interest, so orthopaedic surgery seemed the natural choice since it involves engineering skills, such as working with metals and plastic to carry out joint replacements.
Throughout my career I’ve enjoyed being inventive and have looked at different ways to treat conditions, such as in-growing toenails and dislocated and arthritic joints, with surgery.
This experience proved useful in 1995 when I was called to a medical emergency while travelling back to London on a long haul flight from Hong Kong, where I had been working as an examiner of medical students on behalf of the Royal College of Surgeons of Edinburgh.
I was tired after a heavy week’s work and was just starting to relax in my seat when a call went out, before we’d even taken off to say that one of the passengers had a sore arm and to ask if someone could help assess the injury. I volunteered and assessed the passenger, who explained that she had fallen off a motorbike on her way to the airport. She had a bruised arm, and it looked as if she had a minor crack fracture. Her condition seemed manageable, so I applied a splint from the medical kit, padded with a Chinese newspaper; I thought she was fit to fly.
An hour and half into the flight the same woman bent down to take off her shoes and suddenly developed severe left sided chest pain and breathlessness. I was again called by the cabin crew to assess her and my examination revealed that her windpipe had moved to the right side, which indicated she had a potentially lethal pneumothorax.
I was planning to give her a pain killing injection, such as morphine, but when I went back to the patient she was looking much worse and seemed to be in respiratory distress. Another doctor on the plane, who was one year out of medical school, volunteered to help me. It was great to have his support, and he agreed with my diagnosis that the patient had a collapsed lung.
I then went to see the captain on the flight deck to discuss the problem. By that time we were approaching the north of India and radio contact was impossible, so the captain asked me to proceed with whatever medical care I believed the passenger needed.
I knew I needed to put in a proper chest drain—the correct treatment for a tension pneumothorax—but there was only basic equipment in the airline’s medical kit, including a scalpel and a 14-gauge urinary catheter. I created a chest drain by using a coat hanger, as suggested by one of the cabin crew, which I made into a trocar for the catheter. I also used a bottle of Evian water, with two holes punched in the cap for an underwater seal drain, oxygen tubing to attach the catheter to the drain, and Sellotape to seal the catheter to the drain. Xylocard (100 mg of lignocaine in 10 ml) was the local anaesthetic provided in the airline’s emergency kit, and to disinfect my equipment I used a bottle of five star brandy provided by the cabin crew.
The cabin crew then set up an operating theatre on the back row of the plane out of the way of passengers and I inserted the chest drain. While the procedure was obviously painful for the patient, she seemed better within about five minutes and went on to make a good recovery.
When I got home my wife was keen for me to do the gardening but I explained I was “tired as I’d had to do a bit of an operation on the plane.” Within 48 hours my hospital, Queen’s Medical Centre, received about 400 calls from the media asking me for my comments about the incident.
I can recall two other important episodes when I have been called to deal with a medical emergency outside work. One was again on a flight, when a passenger collapsed and I had to persuade the cabin crew to use the last cylinder of oxygen, which was reserved for an emergency, to help revive the passenger. The other was early on in my career as a young registrar. I stopped my car to attend to a severe road crash, where there were bodies on the road. I used first aid, putting patients in the recovery position and keeping them alive until the ambulance came.
No one could have prepared me for the wave of publicity I received after the coat hanger incident. But looking back on my experience of Good Samaritan acts and my work as a surgeon I had been well prepared to deal with unusual and unexpected incidents.
Some clinicians might want to turn away from an incident because they don’t feel confident to help, but it’s important for doctors to help in emergency situations when they have the skills to do so. I would never take the attitude that just because I’ve finished work there isn’t time to help people. And I know there are a lot of caring doctors out there who feel the same way.
Mike Dixon, chairman of the NHS Alliance, chairman of the College of Medicine, interim president, NHS Clinical Commissioners, and general practitioner in Cullompton, Devon
Mike Dixon believes being a doctor means you are never off duty.
When I was younger being a Good Samaritan was a common occurrence. It seemed as if at every event I went to someone would keel over and I would need to help them, or I would always be the first at the scene of an incident outside surgery hours. I’d go to the theatre and the woman in front would collapse, or I’d be at a party when someone would fall ill. I used to ask my trainer, “Why am I always around when someone could be breathing their last?’ He would joke it was because I had a very fast sports car that I got there too soon.
Some years ago I was at a wedding when I noticed one of the guests had collapsed. I immediately went to help. It quickly became clear that the guest had had a heart attack. I had to stop the wedding and call for an ambulance. When the ambulance arrived, I helped put the patient on a trolley, which was then wheeled down the aisle. After the ambulance left, the wedding carried on. The patient made a good recovery, and the bride was relieved I’d been a guest.
Another time I was at an event where a choir was performing. I noticed one of the choir members had collapsed. It was clear the patient had fainted but was not suffering from anything more serious, so with the help of a first aider who was on hand I took them to a room elsewhere in the venue and provided oxygen. This was an occasion where the skill was to diagnose, but not to interrupt the main proceedings.
Sometimes you’re not the only doctor responding to a Good Samaritan call. I remember travelling to a party when I came across an incident where a car had collided with a bicycle. I stopped my car and waded through a mass of people who were crowded around the patient, and said: “I’m a doctor, let me through.” The patient was clearly sick and bleeding but I couldn’t get through as someone was blocking the way and seemed to be trying to help. I said, “Excuse me, I’m a doctor do you mind if I take over now?” That person I’d asked to get out of the way turned out to be a colleague who was doing a far better job than I could have done.
Trains are a common place for doctors to be called on to do Good Samaritan acts, and I’ve had my fair share of these incidents. I travel by train from Devon to London twice a week for work, and now have a reputation for helping out if anyone has a health problem. I know most of the people who work on the train line and they tend to come to me if there are any medical emergencies.
Once I had to stop the train when someone needed attention right away. The train made an unscheduled stop and an ambulance was there to meet us to take the patient to hospital for attention. The staff gave me a bottle of wine to say thank you, which was not that useful at 10 am in morning but came in handy the following evening.
My worst experience of being a Good Samaritan was early on in my career. My wife was scheduled for a major medical procedure in hospital. Meanwhile, I was attending to a medical emergency where someone had arrested and I had to stay and wait before the ambulance came. I couldn’t leave the patient but it did mean I was unable to take my wife to hospital. My wife was understandably upset and felt very vulnerable. That’s the downside of being a Good Samaritan—you may be a bit of a hero to the outside world, but your family can sometimes feel neglected. All medics who have a partner should come with a health warning that they may be absent at any moment.
As a general practitioner I believe it is my duty to be a Good Samaritan. Being a doctor is a great privilege and, as with the story of the Good Samaritan, you cannot pass by. If someone needs medical attention and you’re the only one around it is right that you should think you should help. That duty does create a background pressure in your life—a feeling that you’re always on call—but you do get used to it.
Alys Cole-King, consultant liaison psychiatrist in north Wales
Alys Cole-King says psychiatrists may well be called on to be Good Samaritans and should be prepared to deal with medical problems and mental health issues outside the workplace
Good Samaritan experiences are not normally associated with psychiatry, but I have been involved with a few incidents over the years that have had an impact on the way I practise.
Several years ago I was at a party when someone began choking on a piece of meat. It quickly became apparent that the situation was serious and potentially life threatening, but I was able to intervene by clearing the airway..
Fortunately, just that week I had attended mandatory resuscitation training. And at the end of the formal session, when the trainer asked if there were any questions, I asked if we could quickly cover what to do when a child is choking. I wanted to be equipped with those skills because I have two children, and knew of cases where children had died from choking but their lives could have been saved if someone had known what to do.
That training showed me how important it is to keep up to date with medical knowledge, not only for patients but also for the wider community. Thanks to my earlier posts in general medicine and that “top-up” training I was able to stay calm and knew exactly what to do. This experience reminded me of my days as a junior doctor when I went into “deep focus” mode when assisting during cardiac arrests. To have that refresher course in basic life support training was helpful and, as it proved, essential, and I would urge other doctors to do the same.
Working in liaison psychiatry in general hospitals, on surgical and medical wards, and in emergency departments, I often assess and support people in extreme distress after they have tried to end their lives or following episodes of self harm. Many of these people had not told anyone how they were feeling and were too fearful to seek help until they reached crisis point. Occasionally healthcare professionals find it hard to understand how someone could feel this way.
Sometimes people, such as those who are feeling suicidal, pick up on my experience in this field and ask me for help even when I’m not working.
I have been in situations as a patient when doctors have told me they are feeling under pressure and I have said that I understood how hard it was to be on call as I am also a doctor.
I think other doctors then feel they can talk to me as it seems like they are talking to a colleague.
I know I am not in a position to make any kind of decisions about the care of someone who was not my patient. But in potentially life threatening situations, I have managed to persuade doctors to seek professional help.
My experiences have shown me that sometimes medical professionals are in desperate need of help but don’t know where to go when they are feeling stressed. They have also highlighted how junior doctors may not have access to healthcare. Trainees are often doing placements in different parts of the country, and this particular doctor wasn’t registered with a local general practitioner. And, because of the stigma associated with stress and depression, doctors often feel too embarrassed to look for help.
On another occasion a doctor I knew contacted me by email requesting advice and support because someone she knew was feeling suicidal. I thought it was inappropriate to give advice about someone who was not my patient, but I was concerned that it might be a medical emergency, particularly given that the email mentioned that the person had taken previous overdoses. With the support of my medical defence union, I was able to tell this doctor that, although I could not give medical advice, this person should seek immediate medical attention.
Since then, numerous individuals have contacted me outside work about how they, or others close to them, have experienced suicidal thoughts or self harm. This showed me that there was a real need for accessible, practical, and compassionate resources to support people and their families when they are dealing with those who are feeling suicidal, and an increased awareness generally within our society about this issue.
As doctors we see people at their most vulnerable times, and it’s a privilege to be able to help them. But it’s hard to switch off from the caring work we do, and just because we’re off duty doesn’t mean that we can’t or wouldn’t want to intervene when someone is troubled. I would never undertake a Good Samaritan act if I didn’t think I had the competence to do so, but it’s the same if you see someone who may be drowning and you are a strong swimmer—it is in your gift to try to save a life and you would always do so if you could.
The priority of a doctor is to save a life or to relieve suffering. Whether you’re saving a life by carrying out a complex procedure or by preventing a suicide it’s just as valuable.
Richard Marks, consultant anaesthetist in London
Richard Marks says doing Good Samaritan acts has made him mindful that incidents he has been involved with could easily have happened to him and that even if doctors cannot always make a difference, they can always do something.
Good Samaritan acts tend to take you by surprise, often on an ordinary day when you’re doing ordinary things. One Saturday morning, when I was driving to the supermarket I saw a big crowd of people standing around a fire engine. I stopped the car and said, “Stand back, I’m a doctor.” The patient was in cardiac arrest. A passing fire engine had stopped and had oxygen, but no one seemed to be administering it to the patient. As an anaesthetist I volunteered to help with resuscitating the patient.
The call to be a Good Samaritan can happen at any time and in any place, sometimes when you’re in another country. But wherever you are, as a doctor it’s an instinct that you feel you have to help, more so if you’re the first person on the scene of an incident.
While in India on holiday with my family, where the roads were insane—full of cars, lorries, motorbikes, and elephants—I heard a crash outside our hotel. A car had knocked into a motorbike and both the rider and passenger were lying in the road; the passenger was unconscious. I didn’t even think to consider the consequences and rushed into the road to try to help and nearly got killed by the traffic. I moved the passenger from the road, covered her in a blanket from the hotel, and put her in the recovery position, and kept her comfortable until the ambulance eventually arrived.
Sometimes it’s a case of too many doctors trying to help, such as the time I was with a group of anaesthetists on a skiing trip. Two people had collided with each other and were lying on the slope, one of them unconscious. All of us tried to take charge and we argued about what to do, but we then did our best to help ensure the patients were comfortable until the ambulance came.
These experiences have made me realise how dependent I am on the equipment I use in hospital as an anaesthetist. We rely on this kit, which can make it challenging to carry out Good Samaritan acts. When you’re faced with an emergency on the street you become very aware of what you need and what you don’t have access to. It’s as if you are naked, and you feel very vulnerable without your usual access to equipment. However, our specific range of skills means that we can often help when dealing with medical emergencies.
Once you’ve declared yourself “the Good Samaritan doctor,” there’s no going back. You can’t back out of the situation even if you’re not the right person for the job and might feel out of your depth, because everyone looks to you to do something. Your priority in these situations is to take action, then think about the repercussions. Even though we’re working in litigious times, when you see someone in distress you have no option but to get involved because as a doctor you may be able to help.
When you’re working in a hospital environment and people arrive in casualty it’s almost as if they’ve come from another world. But when you’re outside work, whether you’re on the street or on a ski slope, these Good Samaritan situations bring home to you how incidents can happen at any time, how this person could have been you. And while you can’t always make a difference, you can always do something.
John Heyworth, formerly consultant in the emergency department at Southampton General Hospital and past president of the College of Emergency Medicine
John Heyworth says carrying out a Good Samaritan act is not about being a super hero but about trying to do good in difficult circumstances.
My most memorable Good Samaritan experience was during a flight to a conference when the call came to ask if there was a doctor on board. After nine hours listening to the Bee Gees’ greatest hits, it was almost a relief to respond. Another doctor and I attended to a petite woman who was complaining of abdominal pain. Following the somewhat limited assessment possible in a middle seat, we confidently diagnosed non-specific abdominal pain and returned to our seats. Thirty minutes later a stewardess nudged me to say that the woman’s waters had broken. The diagnosis was clear—and imminent. The stewardess and I assisted the woman down the cabin to the back of the economy section and we prepared the narrow floor space. The purser handed me the emergency delivery kit, which was relatively unsophisticated —it contained a pair of rubber gloves (small) and an assortment of non-obstetric kit.
I had only one glove on when it became clear the birth was already under way. My entire practical obstetric experience was limited to my time as a medical student in Wrexham some decades previously. Up to that point I’d delivered 10 babies during the course of my career, all in planned, midwife supported, well lit, spacious, and turbulence-free settings. My recent obstetric portfolio was largely passive observation of my three children’s arrivals, so in-flight obstetrics was not my forte. Fortunately, there was no time to dwell on what could possibly go wrong. It was only later that I thought about the long list of possible complications and how I might or, distinctly more scarily, might not have coped. Able assistance and encouragement to the entire team was provided throughout by the stewardess, who maintained admirable British sangfroid throughout while the purser mopped collective brows. The birth was relatively straightforward and within a few minutes, though it seemed much longer, a healthy and noisy baby was delivered.
Even though the first phase had been relatively uneventful, dealing with the aftermath of childbirth at 38 000 feet presents particular challenges, such as how to cut the umbilical cord. I found some suture material in the airline’s first aid kit so was able to do this. Then of course you have to deal with the placenta. Then the announcement came on the tannoy system that mother and baby were doing well, and there was a ripple of applause from the passengers. I was served a first class breakfast—it had an extra sausage—courtesy of the airline. We landed and the new family headed off to hospital. My in-flight portfolio also includes managing a vasovagal episode in a middle aged passenger, who was much too large for the no frills airline seat and became unresponsive after hours fixed in the cramped upright position. I corrected this by freeing the passenger and adopting the supine mode.
On another occasion, I was asked to help an elderly person who was profoundly breathless. I was given a stethoscope, which was challenging when all auscultation revealed was the rampant and deafening engine noise. I nodded sagely as expected. Fortunately, oxygen and reassurance managed the situation until we landed.
The recurrent theme is that relatively basic medical care in such isolated situations can make a real difference. A background in emergency medicine is helpful, as every day we expect the unexpected. And of course, colleagues from other acute specialties will also recognise this perspective.
Timothy Evans, medical director at the Royal Brompton and Harefield NHS Foundation Trust, and physician and intensive care specialist
Timothy Evans says that, even when faced with a medical emergency and no kit, doctors can still support patients.
I enjoy being a physician because of the patient contact. When I’m not doing intensive care medicine I practise chest medicine, mainly at an outpatient clinic. This work offers variety, but sometimes involves dealing with life threatening situations.
Recently I was faced with such a situation outside my usual practice when I came across a multiple car crash while driving with my family in heavy rain. I immediately pulled over by the crash site, put on my car’s hazard lights so that no more vehicles would go near the wreckage, and went to see if I could help. Four people were involved—two were trapped in their cars and two were near the scene of the incident lying by the side of the road. Because I am an intensive care specialist and have done advanced life support, although that was a long time ago, I dredged up the required knowledge to offer assistance; someone was already calling the emergency services.
I did a quick triage to establish the severity of the injuries and then examined the casualties who were lying on the road to check their airways, breathing, and circulation. Both clearly had bone fractures—in one case a compound fracture—but they didn’t seem to be in immediate danger so I thought they could hold on for a few minutes while I examined the people who were trapped in the cars. When I went back to the crash site I found someone trapped by a steering wheel. The motor was still running, smoke was coming out of the engine, and fuel was coming out of the ruptured tank. I turned the engine off.
I established that the patient’s airway was clear but that there was a severe injury to the lower limbs and pelvis. I supported the patient as much as I could and asked a bystander to stay with the patient. I then ran over to the other car, where a passenger was trapped in the back seat complaining of chest pain and gasping for breath. I tried to offer reassurance while waiting for the emergency services to arrive.
Fifteen minutes later a fire crew, along with a paramedic, arrived on the scene. I said I was a doctor and provided my basic diagnoses of those involved in the incident. I also stressed that, if the paramedic wanted me to assist, I would do everything I could to help. In these situations, even though you’re a doctor you don’t put yourself in command—you put yourself in the hands of those who have the authority to take charge. The paramedic said he would be grateful if I would help as he felt I had technical knowledge.
I stressed that the person trapped by a steering wheel should be released as soon as possible as I thought the car was unsafe. The fire brigade cut the car by taking off the roof and doors while I gave the victim gas and air and pain relief. I then went back to the person trapped in the back of the other car and did an electrocardiogram using equipment provided by the emergency services. The electrocardiogram proved to be fine, and the person was then removed from the vehicle.
Then the ambulance service arrived, thanked me for my help, and took my name, and I went back to my car and my family, with my jumper covered in blood. My family weren’t phased by the experience because, being a doctor, they assume that’s what I do. Faced with this situation with no kit, there was little that I could do. But, rather like my children’s assumptions, just being there as a doctor and trying to help meant I could give people a sense of reassurance. When I was attending to patients in the crash they seemed visibly better when I told them I was a doctor.
As a clinician you have to be prepared for the public assuming that you will know what to do in an emergency. But when faced with a Good Samaritan situation it’s not even about being a doctor, it is about how you can help. You have to show compassion, use your expertise, and support people the best you can. And if you have specialist knowledge in dealing with these situations, that is a bonus.
Carol Chu, medicolegal adviser for the Medical Defence Union, gives advice to doctors about being a Good Samaritan
Although there is no legal obligation in the United Kingdom for doctors to volunteer as Good Samaritans, they do have an ethical obligation to help in an emergency, even if they are off duty and wherever they are in the world.
Guidance from the General Medical Council states: “In an emergency, wherever it arises, you must offer assistance, taking account of your own safety, your competence, and the availability of other options for care.”
It is important to remember that in some countries there is a legal obligation to provide help and that a doctor who does not provide help could be prosecuted. In France, for example, there is a Good Samaritan law which compels doctors to help in an emergency.
Although most doctors will be only too happy to help, it can be a cause of a great deal of anxiety and can raise a number of questions about whether doctors will be held accountable if the outcome is not positive and what the legal position is if they do help.
Often there is little that you can do other than to assess the situation and condition of the patient, call for help or back-up, and try to keep the patient stable. Sometimes the doctor may be able to keep the patient safe and prevent further damage.
Doctors often worry that they will be asked to provide treatment that they do not feel qualified to provide. The General Medical Council expects doctors to recognise their own limitations and provide treatment only if they feel competent to do so. Doctors may be asked to act as Good Samaritans when they are feeling unwell, tired, or, for example, after a couple of glasses of wine. If this is the case, it is important that doctors assess whether they are competent to help in these circumstances. If any other doctors are at the scene, it may be more appropriate for them to help instead.
Doctors who find themselves in a situation where a Good Samaritan is needed should make a clinical record of the help given, which should include details of the patient’s name (if known), the treatment provided, and the doctor’s contact details.
Doctors who are members of the Medical Defence Union have indemnity for claims arising from Good Samaritan acts worldwide. Fortunately, the chances of a claim are rare, but members can seek help and advice from the defence union for medicolegal issues arising out of a Good Samaritan act, such as police interviews and coroners’ inquiries.
Competing interests: None declared.
Patient consent not required (patients anonymised, dead, or hypothetical).
Kathy Oxtoby freelance journalist