Minor medical emergency on my airplane trip today!

xtxrn, ASN, RN · Jul 27, 2011

Hi all--I don't make a lot of posts on this site but something happened today that gave me good cause to post. I was on an international flight from Mexico to the US today on the way back from a wonderful vacation. There was some commotion with a passenger a few rows up from me then an announcement went over the intercom asking for help from any doctor, nurse or EMT on the plane. I am a pretty new nurse so I waited for a doctor or experienced nurse to volunteer to help but no one did. Finally, myself and an EMT volunteered to help. The man ended up being fine, just a little dehydrated and not feeling well from a bug he caught in Mexico.
While helping the passenger, I took a look at the medical kit the airplane had on board and saw a pretty well stocked supply of meds, IV supplies, etc in order to help in the case of cardiac arrest. Meds used in code situations were on board. My question is, how far could I have gone to help this man if there is no doctor on board the plane? Can I administer these meds (epi, atropine, etc) without a doctor order in an emergency situation? I personally would not have because I am not ACLS trained and wouldn't know the proper time to use the drugs but just wondered what the legalities are in this situation. Luckily the passenger was fine and no CPR was needed but I just wonder what we could do in that situation. Anyone know?

Good question...international air space, no doc.... not sure. But I'm with you, without ACLS, I'd stay away from the code drugs.

DayDreamin ER CRNP · Jul 27, 2011

Good question...international air space, no doc.... not sure. But I'm with you, without ACLS, I'd stay away from the code drugs.

I totally agree. I AM ACLS certified, albeit recently, and I would not know which ones to push in which order. I mean, I know which ones to give but in a stressful situation and thinking about my license....I think I'd play it safe.

I do think situations like these definitely make you really stop to think and consider your own limitations and how to improve on them. Maybe you will be inspired to get ACLS certified and learn more about treating emergencies in the field.

m

core0 · Jul 27, 2011

Hi all--I don't make a lot of posts on this site but something happened today that gave me good cause to post. I was on an international flight from Mexico to the US today on the way back from a wonderful vacation. There was some commotion with a passenger a few rows up from me then an announcement went over the intercom asking for help from any doctor, nurse or EMT on the plane. I am a pretty new nurse so I waited for a doctor or experienced nurse to volunteer to help but no one did. Finally, myself and an EMT volunteered to help. The man ended up being fine, just a little dehydrated and not feeling well from a bug he caught in Mexico.
While helping the passenger, I took a look at the medical kit the airplane had on board and saw a pretty well stocked supply of meds, IV supplies, etc in order to help in the case of cardiac arrest. Meds used in code situations were on board. My question is, how far could I have gone to help this man if there is no doctor on board the plane? Can I administer these meds (epi, atropine, etc) without a doctor order in an emergency situation? I personally would not have because I am not ACLS trained and wouldn't know the proper time to use the drugs but just wondered what the legalities are in this situation. Luckily the passenger was fine and no CPR was needed but I just wonder what we could do in that situation. Anyone know?

If you need to provide medical care and need to get into the medical kit they will hook you up with a physician usually in the states. Here is an article on the process:

http://consumerist.com/2008/02/what-airlines-do-in-the-event-of-a-medical-emergency.html

BSNgrad2010 · Jul 27, 2011

Thanks coreO. It's good to know we could get a hold of a doctor although it still sounds like a nightmare to do it over the phone!

cbc1147 · Jul 27, 2011

Hi, I did some research for you because I thought it was a great question as well. Here is what I found:

Liability protections exist for medical personnel who volunteer to provide assistance on aircraft in the event of an emergency. According to the Aviation Medical Assistance Act of 1998,1 "An individual shall not be liable for damages in any action brought in a Federal or State court arising out of the acts or omissions of the individual in providing or attempting to provide assistance in the case of an in-flight medical emergency unless the individual, while rendering such assistance, is guilty of gross negligence or willful misconduct."2

According to the federal statute, a medically qualified individual "includes any person who is licensed, certified, or otherwise qualified to provide medical care in a State, including a physician, nurse, physician assistant, paramedic, and emergency medical technician."3

As for the other question can an RN give a med without a doctors order, it looks like the answer is no, however the airlines have a resource that the Captain of the aircraft can you to get an emergency room MD on the line for the medical professional to talk to, who can then give you the order verbally if required.

Airlines utilizes STAT Medevac at the University of Pittsburgh for in-flight physician consultations.

"The pilot will place a call to the communication center at STAT Medevac, and in less than 1 minute be online with an emergency physician," Mr. Barr said, adding that out of the fleet of 56 aircraft, there are on average 1.25 calls per day utilizing the service.

Hope this helps and answers your question. I was glad you had the opportunity to help and not want to sink into your chair and act invisible.

3xmom · Jul 27, 2011

As a former 8 year flight attendant, I can answer this one for you. In a medical emergency on the aircraft although we ask for and appreciate your help tremendously unless you are a licensed MD all we can do is basically utilize your medical knowledge and allow you to work with us. They should of immediately contacted the Captain who in turn calls a company on the ground called, if I remember correctly med-stat. This company has MD's that get all of the details about what is going on with the passenger and will instruct us what to do step by step. They have the authority to authorize any form of care that the aircraft is supplied for, this is where we really appreciate any sort of medical personnel, because although we are trained for medical emergencies and with the supplies we have, medical emergencies are definitely not the best part of the job and when it isn't something we deal with all the time, it is pretty stressful! Medical emergencies happen quite often on aircraft. My first emergency was a heart attack--the passengers 33rd one, and he was only 32!! He had a medical condition from birth and was rather knowledgeable about how to handle it, so he himself pretty much walked me thru his own treatment, lol. I will never forget him, his name was Oscar and he told me he himself knew when he boarded the plane he was having one but wanted to get home. We got him to Hartford, Conn where he lived and an ambulance took him to the hospital. He was doing great the following day when I checked up on him and told him next time please just don't board the plane while having a heart attack, and he laughed at me and said "your probably right, it wasn't nice of me to give you a heart attack because of mine".

BSNgrad2010 · Jul 27, 2011

As a former 8 year flight attendant, I can answer this one for you. In a medical emergency on the aircraft although we ask for and appreciate your help tremendously unless you are a licensed MD all we can do is basically utilize your medical knowledge and allow you to work with us. They should of immediately contacted the Captain who in turn calls a company on the ground called, if I remember correctly med-stat. This company has MD's that get all of the details about what is going on with the passenger and will instruct us what to do step by step. Medical emergencies happen quite often on aircraft. My first emergency was a heart attack--the passengers 33rd one, and he was only 32!! He had a medical condition from birth and was rather knowledgeable about how to handle it, so he himself pretty much walked me thru his own treatment, lol. I will never forget him, his name was Oscar and he told me he himself knew when he boarded the plane he was having one but wanted to get home. We got him to Hartford, Conn where he lived and an ambulance took him to the hospital. He was doing great the following day when I checked up on him and told him next time please just don't board the plane while having a heart attack, and he laughed at me and said "your probably right, it wasn't nice of me to give you a heart attack because of mine".

I don't know if they called the med-stat people but the captain did offer to divert the flight. The passenger was feeling much better by then so we ended up not needing to do anything, luckily!

3xmom · Jul 27, 2011

I don't know if they called the med-stat people but the captain did offer to divert the flight. The passenger was feeling much better by then so we ended up not needing to do anything, luckily!

Yes, depending on the emergency and the location of the aircraft, many flights are diverted for medical emergencies, in the case of Oscar we were closer to Hartford then any other airport, if I remember correctly we were 21 minutes out when he informed me ever so calmly that he was having a heart attack. If we would of been closer to another airport we would have diverted due to the seriousness of the situation. People get sick all the time on aircraft so diverting is saved for major emergencies of all types not just medical.

akulahawkRN, ADN, RN, EMT-P · Jul 27, 2011

It depends upon the situation and what I have at hand. On a commercial flight, I won't have time to ask for orders during a code, though I'll get the doc on the line asap. I'll likely have already begun the appropriate interventions in the meantime. In situations outside of a code, I'll do the patch to MD first and go from there. Why would I not hesitate in the code? Simple. It would be grossly unsafe if the flight crew had to suddenly dump 33k feet and land in less than 5 minutes. From cruising altitude, it will still take a good 10-15 minutes to descend and land if an appropriate airport is close by.

I certainly wouldn't step outside my scope of practice though. That would constitute gross negligence (especially if harm occurred because of it) and I'd lose any protection that's in the FAR's...

ukstudent · Jul 27, 2011

I totally agree. I AM ACLS certified, albeit recently, and I would not know which ones to push in which order. I mean, I know which ones to give but in a stressful situation and thinking about my license....I think I'd play it safe.
I do think situations like these definitely make you really stop to think and consider your own limitations and how to improve on them. Maybe you will be inspired to get ACLS certified and learn more about treating emergencies in the field.
m

Not totally sure about this but i would think that if you are ACLS certified and chose not to use ACLS protocol (because you really don't know it) and the person died, it might be grounds for a gross negligence charge. :uhoh3:

You are held to the standard of care of your license and possibly your certifications, if you volunteer to help. In other words, what should you, as an ACLS RN know and do.

blondy2061h, MSN, RN · Jul 27, 2011

We stash a neat little card with just the basic ACLS algorithms on it on our crash cart. I'm ACLS certified and decent as far as knowing what to do when, but I would want that card. ACLS is pretty simple now that they ditched atropine in code situations.