In the Arena: Thanks for Flying

ACEP News
January 2011
 

By David F. Baehren, MD 

Before the Thanksgiving holiday, there was quite a stir about passenger screening by the Transportation Security Administration (TSA) in airports. Much of the debate surrounded ensuring air safety versus possible radiation exposure and the pseudo-nude images that result from full body scanning. Passengers who decline the body scan are subject to a physical search. After a few well-publicized physical search mishaps with the TSA, people started to raise an eyebrow to the whole process.

The consensus is that the scanning is safe. Any radiation exposure is a fraction of the radiation exposure passengers receive on the flight.

Some claim there needs to be more study about the long-term effects of scanning.

Unfortunately, for those who want more study, hundreds of these scanners are already in use in U.S. airports, with more on the way.

It seems that the main objection to both scanning and physical searching has to do with the Fourth Amendment to the Constitution. It's that pesky search and seizure language that's hard to get around. The government essentially claims that flying is not a right and that one gives up these Fourth Amendment rights when preparing to board a plane.

I have a full appreciation of both sides of this issue. We all have to make accommodations when flying. It's not 1965 anymore, and there is no shortage of people from various cultures who claim moral ground below the human spectrum.

With all this in mind, my wife and daughter and I boarded a flight at Detroit Metro the morning before Thanksgiving. Detroit used to have the most inefficient and depressing airport this side of Baghdad. Now flying out of Detroit is a nice experience, but that's sort of like saying your root canal went well. We were pleased to see that the security line was short, and we moved through in about 10 minutes. There was no protesting.

Everyone seemed intent on making their flight on time and moved obediently through security, partly undressing along the way.

Whenever I am asked to remove my shoes at the airport, I always think of the moronic dirtbag who tried to light the bomb in his shoe. He is serving a life term. For me, that's not good enough. For every passenger who must remove his shoes to get on a plane, this guy should get a firm whack on the head with the business end of a shoe with stiletto heels.

Maybe there could be a way to decide who needs more intense screening and who does not.

While walking through the Louis Armstrong New Orleans International Airport, it came to me that we do our own kind of burdensome screening in the emergency department, except we do it after the flight.

Imagine a 25-year-old guy on his way to work in the body shop who has flipped his Ford F150 into a wheat field on a snowy morning. When EMS arrives at the scene, they feel that he should take the fancy air taxi to the trauma center.

Really, guys, I'm fine. Just pry the door open and I'll walk out of here.  

No, I haven't been drinking. It's 7 AM and I'm on my way to work.  

Really, these straps and the collar and the board are not necessary. I'm fine.  

Could you cover my face? The snow is blowing everywhere. Look, I'll go to the hospital, but I'm fine. I really don't need to fly. Isn't the county hospital 2 miles from here? 

Life/Med/Rescue/Metroflight arrives and whisks the patient off to the nearest affiliated trauma center, and the patient is met by the obligatory gaggle of gowned gropers.

No, I'm not allergic to anything. I had an English muffin and coffee for breakfast.  

No, I stayed awake. ... Hey, those are new coveralls you're cutting. Really, is all this necessary? 

Yikes, that's cold. I'm certain that nothing happened down there during the accident ... uuuggghhh.  

Whew, I'm glad that's over.  

Hey, who's got ahold of my thing? Really, I peed before I left this morning. Give me a minute and I'll just pee for you ... uuuggghhh.  

CT scan, huh? Really, nothing hurts, except maybe my neck from being in this collar. Head to pelvis, huh? Isn't that a lot of radiation? I think I heard something about that on the John Tesh radio show. OK, if you say so.  

Everything is normal? Great. Can you take the catheter out? I need to check on my truck.  

Admit? No, thanks. You guys have been very thorough, and I mean VERY. I think I'll just go now.  

Maybe there could be a way to decide who needs more intense screening and who does not.

Dr. Baehren lives in Ottawa Hills, Ohio. He practices emergency medicine and is an assistant professor at the University of Toledo (Ohio) Medical Center. Your feedback is welcome.

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