Minor medical emergency on my airplane trip today!

Published

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?

Specializes in Clinical Research, Outpt Women's Health.

I am not an acute care nurse. I would do the basics - oxygen, CPR, etc..... I would give meds if the ground doc ordered them, but really, what are my chances of getting in an IV in this situation? So, if it has to be given IV it will probably not happen.

I am curious about what other air emergencies people have encountered and responded to?

Every time i see toddlers chewing on popcorn and hot dog pieces I just duck down in my seat and hope someone else more qualified is present. If not though I would just go back to the basics, CPR as indicated and stop any overt bleeding......

Up Vote Up Vote ×
Specializes in L & D; Postpartum.

You can't always count on the "phone docs" to give great advice. One a flight from the West Coast to Hawaii (and right smack in the middle of the "pond") my pilot DH's flight had a code. The FA's starts CPR and it was pretty clear the man was not going to survive. They found out soon after that (his wife was there with him) that he was terminal, knew that, and was going to HI to die. The captain (my husband) called the required people and told them what was happening, that the guy was dead, that he'd gone to HI to die. And he also told them that CPR was unnecessary since the guy was already dead. They weren't too happy that the CPR had been halted. And here's what they said, "well, start it again just before you get ready to land." I kid you not.

As if appearances are everything. The Captain of that ship, told them, "that isn't going to happen." And it didn't. It was 2 1/2 hours to anywhere. Did they really think CPR could be continued for that amount of time? And did they really think that stopping it and then resuming 2 hours later was going to prove anything? There were times when he just could not wait to tell me what happened at work that day!

Personally, when I fly, I don't tell anybody what I do. And if they call for help, I watch to see how much other help they get. If it's an OB related need, then I will tell them to get outta my way and I'll tell them what I need them to do.

Up Vote Up Vote ×

Hey, I am a flight attendant (and nursing student). Our airline procedure is that NO ONE can open the enhanced emergency medical kit other than a medical doctor--and we are supposed to see ID before turning it over. Even when MedLink is called (and they are called for everything), that's the policy. We recently had an incident on board with a paramedic who volunteered to help us, he was not authorized to open the kit and we had to divert. I was under the impression that this was standard airline/FAA protocol...

Up Vote Up Vote ×
Hey, I am a flight attendant (and nursing student). Our airline procedure is that NO ONE can open the enhanced emergency medical kit other than a medical doctor--and we are supposed to see ID before turning it over. Even when MedLink is called (and they are called for everything), that's the policy. We recently had an incident on board with a paramedic who volunteered to help us, he was not authorized to open the kit and we had to divert. I was under the impression that this was standard airline/FAA protocol...

As an ER nurse in a super busy ER and frequent flyer in the travel sense, I have often thought about what I would do if I was called to help out in a code situation on a plane. This saddens me. I would hope that with an up to date ACLS card, prove of nursing licensure, and MD orders via phone that I would be able to initiate ACLS. I would hate to think that someone had to die because an MD wasn't on the plane!!!

Up Vote Up Vote ×
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.

I am ACLS certified. As an RN, that only gives me the ability and certification to recognize, suggest and execute orders from a provider, not to independently initiate it. I wouldn't personally mess with those drugs even if I had the formula card in front of me unless someone else was running the code. Although maybe that would be different if I was experienced with codes and was sure I would be covered, I'd be interested to know if in an emergency an RN would be ok to act that far outside their legal scope of practice.

Up Vote Up Vote ×
Specializes in L & D; Postpartum.
As an ER nurse in a super busy ER and frequent flyer in the travel sense, I have often thought about what I would do if I was called to help out in a code situation on a plane. This saddens me. I would hope that with an up to date ACLS card, prove of nursing licensure, and MD orders via phone that I would be able to initiate ACLS. I would hate to think that someone had to die because an MD wasn't on the plane!!!

I just retook ACLS in May and the visual they paint of an actual code requiring ACLS measures is not pretty. Is it really reasonable to think that this could be done on an aircraft? Is it something other passengers will understand or appreciate in its urgency? The first thing that comes to mind is space. Is there the space available to manage a full-on code? And personnel? Just how many people at the lowest number are required to properly run a code? My vision is a group at the very least.

Up Vote Up Vote ×
Specializes in Intermediate care.

In that case i would hope to get a doctor/ACLS trained RN on the phone at least. To tell you what drugs to give and how much. I would hate to just NOT give life saving drugs to someone who needed it. But i would still want to practice safely because if you don't know what your doing, you could cause more harm than good.

Hope im never in that situation that serious. Only had to came upon 1 medical emergency seconds after a 4 year old was hit by a car. Thank god she was ok, just some broken bones and a little cut up, but it too made me nervous.

Up Vote Up Vote ×
I just retook ACLS in May and the visual they paint of an actual code requiring ACLS measures is not pretty. Is it really reasonable to think that this could be done on an aircraft? Is it something other passengers will understand or appreciate in its urgency? The first thing that comes to mind is space. Is there the space available to manage a full-on code? And personnel? Just how many people at the lowest number are required to properly run a code? My vision is a group at the very least.

I see your point and also realize that the possibilty of coming back from asystole is very low. However, I would hate to think that someone died because I wasn't able to access the emergency equipment that might have saved their life. At the same tme, I could also see an unqualified person jumping at the chance just because they work at hospital thinking they have the skills necessary to help in a code situation. Even someone who is ACLS certified may not have the code experience of an ER nurse who sees at least 3-5 codes a month. I don't know. I've thought about this several times and see both sides, yet would hate to think someone died because no one pushed some epi that might have saved a life!!!!

Up Vote Up Vote ×
Specializes in L & D; Postpartum.

The other thing is that the coding person probably won't be in first class, more likely much farther back in the aircraft. The captain, of course, is in the front (and won't be coming back anymore after 9-11 to check on things) and will stay there. That's where the phone is. Just getting the information from Medlink to the person "running" the code could take a lot of time.

Up Vote Up Vote ×
Specializes in Trauma Surgery, Nursing Management.

If I was called to help in an emergency situation, I would do it. I am ACLS certified and am also involved heavily with disaster/trauma medicine. My first priority would be to have the captain alert the nearest hospital, and get the trauma doc on the line. Then I would assess the pt. Should I need to intervene, I would do the very basics: start an IV, get some 02 on, position the pt in semi-fowlers and wait for orders. Normally, the docs come on the line quickly and ask the pertinent questions. I then would follow orders, using the ACLS algorithm.

If the doc does not come on line in a timely manner, there is nothing that I can do; my hands are tied. I have not seen this happen, however. More times than not, when I have traveled there has been an MD on board. I volunteer to assist, and we both work as a team. Thankfully, the few times that I have been in this situation, an anethesiologist is on the flight with me.

Up Vote Up Vote ×
Specializes in ICU.

As an ACLS certified nurse, I would really hate not giving treatment in the absence of a Dr's order. Working nights in a hospital with one hospitalist in the ICU, we have had to run some codes.

I think I would take my chance on a lawsuit. It's my human nature, I can't know how to help and just standy by. With a cardiac monitor, IV access, Epi and Atropine and Asystole on the monitor, I would want to do something!

Up Vote Up Vote ×
Specializes in Emergency Department.
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.

If you're unable to access the tools necessary, you will not be held to that standard. In some cases, you can be an excellent RN and be legally disallowed to assist. For instance, in California, most RN's are allowed to provide BLS (EMT-B) only level care in the field.

Hey, I am a flight attendant (and nursing student). Our airline procedure is that NO ONE can open the enhanced emergency medical kit other than a medical doctor--and we are supposed to see ID before turning it over. Even when MedLink is called (and they are called for everything), that's the policy. We recently had an incident on board with a paramedic who volunteered to help us, he was not authorized to open the kit and we had to divert. I was under the impression that this was standard airline/FAA protocol...

I would suspect that this is an airline policy, not necessarily an FAA order/protocol.

I am ACLS certified. As an RN, that only gives me the ability and certification to recognize, suggest and execute orders from a provider, not to independently initiate it. I wouldn't personally mess with those drugs even if I had the formula card in front of me unless someone else was running the code. Although maybe that would be different if I was experienced with codes and was sure I would be covered, I'd be interested to know if in an emergency an RN would be ok to act that far outside their legal scope of practice.

ACLS in and of itself does not authorize anyone to do anything... it is evidence of having taken the ACLS course which is just formal education in running a code in a standardized way.

I just retook ACLS in May and the visual they paint of an actual code requiring ACLS measures is not pretty. Is it really reasonable to think that this could be done on an aircraft? Is it something other passengers will understand or appreciate in its urgency? The first thing that comes to mind is space. Is there the space available to manage a full-on code? And personnel? Just how many people at the lowest number are required to properly run a code? My vision is a group at the very least.

There is often not enough room to properly run a code... but then again, if you have enough room to place an AED, enough room to be able to place an IV line, and perhaps drop an ET tube or place an LMA or other such device, you can run a code. Think about it this way... flight crews run codes in the back of small helicopters such as a BO-105... they can do the job in that small of an area. It's not easy, but they can do it. Those flight crews often number just 2...

Some people are used to independently initiating care... and some are not. I've seen nurses in ACLS classes just not being all that comfortable in the team-lead position of running the megacode. It's not that they're not capable of doing it, they're just not comfortable at it. If you choose to help in flight, do the best you can within the limits of the equipment on hand that's accessible. You will be flying over various states, counties/parishes and subject to just Fed law, not individual state law. Once you're on the ground, let the EMS on the ground take over and continue care. As long as you're NOT expecting to get anything out of your care, you'll generally be covered by the various good sam laws (all states have them) and probably the analog you'll find in the FARs.

Up Vote Up Vote ×
+ Join the Discussion