Planning to leave the UK for your elective? Or perhaps you're staying domestic. No matter where you are, would you and should you intervene to help in an unexpected situation? Anahita Kirkpatrick, a senior medicolegal adviser with the Medical Defence Union, says that you may have to and gives some advice on what to do in a good samaritan act

Most students first starting at medical school believe that they will be saving lives in precarious conditions as in the television soaps.

You may not think that you are battle hardened and confident enough to lash together a life saving thoracic drain using a mineral water bottle and a coat hanger. But, according to the General Medical Council's (GMC) regulations as outlined in Good Medical Practice: “In an emergency, wherever it may arise, you must offer anyone at risk the assistance you could reasonably be expected to provide.”¹

The original good Samaritan So the fact that you are not a consultant in accident and emergency medicine, or that you have never been ATLS (advanced trauma life support) trained, or that there is no fully equipped crash trolley close by, forms no barrier to helping in the best way you can. And that applies even if you are not in Britain at the time.

With that in mind, you might want to reconsider your plans to spend your elective travelling in a remote and relatively poor part of the world, where there is a higher chance that you will be called on to act in a medical emergency.

That said, emergencies can occur anywhere. Last year two doctors, a professor of orthopaedic and accident surgery and a senior house officer, who were passengers on a jumbo jet from Hong Kong to London famously saved the life of a woman with a collapsed lung. They made a Blue Peter style chest drain from a coat hanger, a biro, and mineral water bottle. The only thing that was missing was the double sided sticky tape, but they are sure to pack it in hand luggage next time.

Apocryphal stories of good samaritan medics being sued within an inch of their lives for not saving the victim of a 100 mph through the windscreen road traffic accident are just that— apocryphal. In reality the chances of your facing legal action as a result of a good deed are remote. A trawl through legal case notes by the MDU shows that even in the incredibly litigious United States there has been only one instance of a doctor being sued following a good samaritan act.

Indeed, many US states have passed legislation protecting doctors and nurses who carry out such acts. In any case your medical defence organisation should be able to offer you a policy covering such acts anywhere in the world. The MDU was the first to provide this benefit to its members in Britain.

Taking the situation to the other end of the spectrum, some countries take such a proactive approach to encouraging good samaritan acts that you could face prosecution for ignoring an emergency. In France, for example, there is a law which compels doctors to help in an emergency. Failure to do so may result in a jail term.

You should remember, however, that whatever you do can be classed as a clinical intervention, so you must make a clinical record of what you are doing, the name of the patient, and pass a note of your name and address to the cabin crew or other suitable officials. Do not forget that your duty of confidentiality to patients carries on beyond death, especially if there is media interest in the case.

On a slight tangent, always remember to take appropriate personal precautions with infectious diseases. Some students have traditionally taken needles, syringes, gloves, and other medical equipment for their own personal use. But in view of tighter airport security since 11 September, confirm permission with the airline before the day of departure if you want to take these things with you as hand luggage.

In the absence of specialist equipment and premises, the help that you can practically give is limited, and it is inadvisable to delay the transfer to hospital, merely to do more at the scene of the accident.

What if you are on a holiday flight enjoying the delights of the galley when the call for a doctor comes? You might be worried that your medical judgment could have been a little clouded by that second or third glass of wine.

Everyone has different tolerances to alcohol so any decision must be made by the individual as to whether they are in a fit state to help. And of course any decision to intervene would depend on whether the condition was life threatening or not. If you do decide to help you should inform the appropriate person. If it transpires that there is someone else on board who is in a better position to help you can happily and safely step back.

Working as a medicolegal adviser for the MDU, I have dealt with many calls from students and qualified doctors asking for advice on acting as a good samaritan. Box 2 gives a typical situation that I have come across.

One of the most frequently offered excuses for the walk on by approach is fear of litigation if something goes wrong or even if everything goes right medically speaking but the patient dies anyway (always a possibility).