Off duty RN scope of practice on an airplane.

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I recently went on vacation & was on an airplane. A person on the plane had a seizure & then went into full arrest. There was another RN on the plane with me. We are both ER nurses & ALCS certified. We used a BVM & an AED. We started an IV and gave epi. All supplies were from the plane. My license is in California. We Diverted to Nevada.

Looking back I wonder if I was covered under the good Samaritans law or did I practice outside my state & scope of practice. Technically, although we left California we landed in Nevada so I wasn't in my state. Also, there was no doctor on the flight who gave the epi order.

What are your thoughts?

ER RN

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Specializes in Critical care.

In 1998, federal law passed the Aviation Medical Assistance Act to specifically protect medics, nurses, physicians, etc. who provide emergency medical treatment while in flight.

Outside of gross negligence, such responders are "covered".

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Specializes in Telemetry, Allergy & Asthma.

Personally I would be the most worried that I gave epi without an order, even with ACLS training.

If they were carrying epi on a plane who would be the person trained in administering it?? I guess I don't understand how they would even be allowed to carry it if the flight attendants aren't trained in it- but I don't really know much about what training they get.

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Specializes in Orthopedics.
Personally I would be the most worried that I gave epi without an order, even with ACLS training.

If they were carrying epi on a plane who would be the person trained in administering it?? I guess I don't understand how they would even be allowed to carry it if the flight attendants aren't trained in it- but I don't really know much about what training they get.

I dated an airline pilot at one point, and he and I discussed this. The pilot has control over who uses the emergency kit in the plane. It's not meant for use by flight attendants, only trained medical personnel. If the pilot calls for medical volunteers in the plane, he will allow that person (or people) to use the kit, provided they have medical training and haven't been getting toasted in first class. Some airlines also have direct communication with a physician on the ground via the radio.

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Specializes in Complex pedi to LTC/SA & now a manager.

Was it cardiac epi or anaphylaxis epi (dose wise) I assumed you checked ;)

Some airlines have physician protocols that can be used by a licensed professional as standing orders

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Specializes in Critical care.

The ACLS meds and equipment are supplied FOR any responding medical professionals. The flight attendants are trained in bls and basic first aid only. Physicians are available to consult and help coordinate care while in flight and where to divert to if needed.

Edit: The above posters beat me to it...

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Specializes in NICU, ICU, PICU, Academia.

You were compassionately providing care to an unfortunate individual with ZERO other options at 30,000. The epi was likely an anaphylaxis dose. You acted as a Good Samaritan, and should be fine.

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That poses an interesting question. IM Epi is 1:1,000 where cardiac IV Epi is 1:10,000. I would think in a cardiac situation there is a lot of math that needs to be done to swap them out. I assume the emergency kits on the plane have the appropriate concentrations.

Epinephrine in the treatment of anaphylaxis

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Personally I would be the most worried that I gave epi without an order, even with ACLS training.

If they were carrying epi on a plane who would be the person trained in administering it?? I guess I don't understand how they would even be allowed to carry it if the flight attendants aren't trained in it- but I don't really know much about what training they get.

The whole point of ACLS is so that you know what to give if a provider isn't available (which happens). It is not inappropriate or outside the scope of anyone to give ACLS medication during an arrest. What was she supposed to do? Ring 30,000 feet down for an epi order?

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And kudos to you. That's an awesome feeling having those skills and knowledge to be able to respond with confidence in that situation.

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Specializes in Telemetry, Allergy & Asthma.
The whole point of ACLS is so that you know what to give if a provider isn't available (which happens). It is not inappropriate or outside the scope of anyone to give ACLS medication during an arrest. What was she supposed to do? Ring 30,000 feet down for an epi order?

When I responded I was simply letting OP know what part of that scenario would have bothered me personally. I have ACLS training myself and know what it's for. I was just saying that I would have felt slightly uncomfortable about doing that with no further direction from a physician. When I actually used my ACLS training in a hospital setting we always waited for a physician to show up before actually administering any meds- we would always start CPR, ect if needed but never actually administered meds until a physician was present or gave orders. I understand in this situation that's not really feasible (although other posters have expressed that you actually can get orders from a physician on the ground apparently).

I forgot to add to my first post that it sounds like a crazy situation and I probably would have done the same thing as OP. So kudos to you, OP, for helping that patient out of a tough spot.

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Specializes in Telemetry, Allergy & Asthma.

And just to add...

When I say "when I used my ACLS" I meant in a capacity as an RN. I'm currently an FNP but not in a hospital setting.

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