Legalities in Flight Emergencies

[MNRNBSN]

Let's say you are an RN passenger on an airplane and an announcement is made asking all medical professionals to assist in a medical emergency. What if your experience as a nurse is not in critical or emergency care and have not run a code. My thoughts are I could at least help to the best of my ability and it may or may not save the persons life but at least I tried. If I didn't at least try and that person perished I would have to live with guilt the rest of my life. Since following ZDoggMD on Facebook he has brought to light all the legalities involved in assisting a flight emergency. He states you should know you are competent before responding, get written consent from the person (verbal if that's not possible), document everything, and communicate with the flight crew at all times. He said that the Good Samaritans law may not apply if you commit gross negligence. How do I know if I am competent in that situation until I know what the situation is? Can I legally back out and say I do not know how to handle it? How do I get consent and document in that setting? Can I simply assess the situation and allow the on-call doctor to advise me based on my assessment? What if I don't catch something? What if something goes wrong and it turns into their word against mine? I don't want to end up in legal trouble. You'd think this is a rare occurrence but I was surprised to find out how often this happens and how often the medical equipment in the plane's malfunction or are not up to par. I want to be prepared and be able to protect myself from legal trouble. This short video is what triggered this question

A Young Nurse Dies On A Plane; What Could Have Been Done?

[video=youtube_share;TIHQIvSUXiA]

If you have any knowledge or experience in the legal side of this please share. Thank you.

[verene, MSN]

I feel like in-flight emergencies are d*mned if you do d*mned if you don't kind of situation. As medical professionals we have a ethical duty to respond, but aren't necessarily provided any legal protection for operating in far less than ideal circumstances. I've pondered more and more what I might do if I end up in that kind of situation, as by virtue of being a psych RN I feel like my skills for common in-flight medical issues are likely limited (cardiovascular and pulmonary emergencies are not my comfort zone), but still higher than that of an average lay-person.

I think I'd likely step up but make known my competencies (and lack thereof) and step out of the way if there is someone more competent on the flight.

[Sour Lemon]

I haven't watched the video, but my interpretation of what you wrote is:

Do - Come forward, give your credentials, and state ways you might be able to help, "I'm a new nurse. I have no critical care experience, but I can take vital signs and I know CPR." If someone more competent arrives, step aside and let them take the lead.

Don't - Come barreling down the isle screaming, "I'm an RN and this person needs an airway! Does anyone have a pocket knife so I can make one?"

[KelRN215, BSN, RN]

It IS incredibly rare. I fly 1-2x/month (usually with layovers so many, many flights) and have only ever been on one flight where they asked for help from medical personnel. That was a transatlantic flight when I'd been a nurse for just over a year and a half. By the time I got to the back of the plane, a doctor had already responded.

Also, in the case in question, based on other articles I've read, the family is claiming that the AED was faulty because it didn't shock the woman. AEDs only shock shockable rhythms. She had a pulmonary embolism, on another discussion I saw on this post somewhere, someone pointed out that PEA is the most common rhythm found in a patient with PEs and AEDs do not shock PEA.

[MNRNBSN]

I think your right that it's a good idea to explain your limitations. I just hope that I'm able to keep my mind clear enough to communicate that. I can only imagine how nervous I'd be with all those people staring at me expecting me to fix the problem. Thankfully I did some research and found that there was a law enacted in 1998 that protects us when helping in flight medical emergencies as long as we do not commit gross negligence. The example they gave was for an MD who was intoxicated but responded to the situation anyways. Thanks for your input. I'm glad I'm not alone. I think the reason this prompted me to worry was because I recently just attended a medical emergency at a restaraunt and felt very helpless when the staff just left me to deal with it on my own.

[That Guy, BSN, RN, EMT-B]

Just help to your ability and what you are comfortable with. Know your limits and dont go doing any ball point pen crics on people.

[Guest374845]

Most major domestic carriers contract with companies that give the pilots near-instant radio contact with an emergency medicine physician for guidance. In the rare instance where you respond to an in-flight code, respiratory distress, syncope, etc, you can be their eyes and ears as well as (if comfortable) take orders from the physician for something like a round of ACLS drugs.

[mbrae]

Former flight attendant here for a major US airline. I have dealt with many an emergency in the air alongside many nurses, docs and EMTs that came forward to help. When you offer to help at 32,000 feet, you're protected by the Good Samaritan law. My airline actually had a card, with all the legalese on that protection, that we could provide incase this question came up. But it never did, people just spring into action. At my airline, and I imagine most other major US carriers, we contracted with a company called StatMD that kept MDs, familiar with flight medicine, on call. They direct all care and they assume full legal responsibility for the patient. Domestically, you're talking to a doctor within a minute of calling.

Every time I've had a medical onboard, I was so grateful for volunteers. And so were the families. You don't have to volunteer, but if you do, know it's appreciated! And not that we do any of this for the miles, but many airlines will "thank you" with some miles for your assistance.

[akulahawkRN, ADN, RN, EMT-P]

As long as you're volunteering to help (and you're not being compensated for the work) you will be covered by Good Sam laws, you just have to basically avoid gross negligence. In short, don't do something stupid because you saw it on TV, do what you you have been trained to do and you'll be OK. As others have stated, most major US carriers (if not all of them) have the ability to contact a physician that can provide you with medical control. You can act as their eyes, ears, and hands. You also have to remember that you are NOT usually obligated to respond and you should NEVER do something that you are not familiar with doing. If you're not familiar with doing IV's, don't do it.

Now I am certainly very comfortable in a first responder role, I've done that for years as a Paramedic. I have voluntarily responded to incidents while "off-duty." Just because I am comfortable doing this, it doesn't mean that you should be. Most nurses aren't first-responders. That's OK. You don't have to take the lead. Just do what you can. If someone that is a first responder comes along, give control of the situation over to that person. They'll be far more comfortable being the lead and you do what you can.

If you're with a patient already, don't abandon your current patient to help someone else. You may or may not "enjoy" Good Sam protection in that instance and you could have a patient abandonment issue on your hands...

[PeakRN]

I've responded to a handful of in flight emergencies and countless emergencies while driving, at events, or what ever else in my off time. At least in the US the good samaritan laws are pretty robust and you are at very little legal risk as long as are doing what would be reasonable for another bystander who had the same experience as you. Certainly if there is a more experience provider for the situation then you should let them lead, but we should be working as a team when attending an emergency. We work with medics and physicians, not above or below them.

As a nurse (or really any clinician) I would always recommend that the patient who presents with an emergency (of course not someone like asking for a cold pack because they stubbed their toe) to immediately be evaluated in an receiving facility with the tools and resources to adequately assess the patient. It is not your responsibility to determine if the flight can keep going to its destination or land immediately, I would leave that on the hands of the pilot/airlines. The same goes for things like traffic accidents, don't try to figure out if the patient can see their PCP for their neck pain but rather leave that on the ED or responding EMS agency.

Personal feelings aside (though as a disclosure they are not complementary) I think Dr Damania is not particularly well versed in emergency medicine nor the legal implications of emergency treatments. We do not gain written consent prior to treating patients in the ED or the field, if they have called for help or presented to the ED they have already (with rare exception) implied consent for evaluation. I would still explain any procedures prior to doing them but I'm not going to make a patient with crushing chest pain write me a legal consent for treatment. Some patients cannot consent, or refuse for that matter, treatment and yet we still see and care for them.

As far as equipment not being up to par or having limited resources, that does not hurt you legally. It is not your responsibility to make sure that some 3rd party has equipment or resources. If your assessment isn't perfect that is okay, you are in an austere environment with limited resources but try your best. I do think that as nurses we have a ethical responsibility to provide care when someone asks for it.

[Amethya]

I always wanted to ask, what if I'm just a CMA? Can I help the doctor or do I just pretend I'm just a normal passenger? Because I do want to help, but I'm not sure if I'm allowed to or not.

[Flatline, BSN, RN]

Depends on your state and the license you hold. Some states have laws known as "Duty to Act" or similar which mandate that if you are educated, trained, and licensed you must take action in the case of an emergency. It is similar to the mandatory reporting laws that many teachers and healthcare providers have requiring they report suspected cases of abuse or neglect.

It is within everyone's ethical responsibility to act, especially if you have any training whatsoever. Even if your BLS is not active, you have more training and education than most.