Off duty RN scope of practice on an airplane.

[creativekari]

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

[JustBeachyNurse, LPN]

Several times people have mentioned showing credentials and/or certification. I am a fairly new nurse - wondering if anyone carries a business card with their license number on it?

That would not be a valid source to prove you are a currently licensed nurse. Either carry a wallet card license from your BoN, link to license verification on your phone, photo of your license or screenshot of your online verification from the BoN or Nursys on your phone. I have an app "ScannerPro" on my phone that converts photos to PDF and can email if necessary. I use it to also keep copies of important papers such as TB screen results, titers, immunization records, my son's asthma action plan, CEUs

[RNsRWe, ASN, RN]

How are you being punished? Because there's the possibility someone will ask for ID? I mean... you're protected from liability by federal law...

I was being a bit flippant in my comment, but I was thinking about how there is so much discussion here about who can have access to the medical supplies/equipment.....after what and how much proof is provided....what is "acceptable" proof.....and meantime you're a human being just doing whatever you can to help the guy on the floor. By "punishment", I'm mostly thinking about all the scenarios presented for potential pushback from airline staff that could waste time and possibly make it more difficult for a positive outcome for the patient. Or even bring on a negative one. If someone is standing between the patient and the best possible outcome (considering the circumstances, of course) it just feels a bit like punishment for the one who is trying to intervene. Was just using a common idiom to describe the frustration of that situation.

[Dogen]

Ah, I suppose I didn't recognize that sense because I figured it was the same kind of legal musing as whether we were even allowed to intervene without an MD present. In my limited experience (asking two people I know who responded in-flight), neither the absence of an MD nor a license card (OR doesn't issue them) ever occurred to them and had no effect on their ability to treat the person. So, it seems like hand-wringing to me.

I figure if I'm the only person who responds to an in-flight emergency, they're probably not worried about checking my ID while we stand over someone clutching their chest. "Yeah, so I don't know the website address off the top of my head. Just Google OSBN. It's usually the first link. ... Hold on sir, I'll be with you in a minute, just keep breathing... yeah, you can just hit license verification, wait, the wifi is slow... can everyone stop streaming Netflix for a minute?" Not going to happen. It just isn't.

[RNsRWe, ASN, RN]

LOL....you're not kidding.

[29AlmostFNP, ADN, RN, EMT-P]

Its just weird to me to have an ACLS certification at all if not to use what you are certified for? Why would there be an ACLS certification if not to use it.

My philosophy is that I have the certification as the RN or paramedic or whatever to know how to use the drugs, and that I have the ACLS certification to be able to use those medications in that capacity.

[JustBeachyNurse, LPN]

Its just weird to me to have an ACLS certification at all if not to use what you are certified for? Why would there be an ACLS certification if not to use it.

My philosophy is that I have the certification as the RN or paramedic or whatever to know how to use the drugs, and that I have the ACLS certification to be able to use those medications in that capacity.

Yes but the reason it doesn't count as "standing orders" is anyone can take the class including lay people, students, EMT-B, CNA, monitor tech none of whom can legally perform most of the skills from IV start, intubation, IV drug analysis, cardio version or defib in absence of an AED. Then there are the nurses that take the class but never use the skills,don't know the current protocols,and can no longer demonstrate competency after course completion. (People that collect certification/course completion cards but no intention to ever use the skills).

Hence why it's no longer a certification card but a course completion card that states you successfully passed the skills & written tests on the date and nothing more.

[azhiker96, BSN, RN]

US Airlines have access to ground based consultation from emergency physicians. When I was a student nurse I toured one of these in Phoenix. It was a room in the ED well endowed with computer screens, flight monitors, phones, and radios. At the time, they were tracking 5 flights, 3 international and 2 domestic.

The doctors in the room were able to give any order needed by personnel on the planes.

As someone mentioned early in this thread, we are also covered under a federal flight good Samaritan law as long as we are acting in good faith.

[icuRNmaggie, BSN, RN]

I have TSA pre check approval for expedited boarding. It required an extensive online application. TSA pre check is printed on my boarding pass which is scanned at the gate.

It seems to me that in post 9/11 America, passenger information would be readily available to the Captain and First Officer in the event of an incident or emergency. I would be curious to know if this is the case.

[doctorwhofan]

I apologize if this has been covered by previous posters. I've been enjoying this thread over the course of several days and cannot remember everything mentioned.

In response to icumaggie about the TSA preboarding ticket-while you may have filled that info out the average person doesn't. I've thought about applying for that just to cut down on wait times but haven't as of yet. When I do fly no one knows my occupation.

I took an interesting cme course on flight emergencies. Basically, nurses are covered under the Good Samaritan act, provided we act within our scope. Yes, we can start an IV and even hang fluids on a hypotensive patient because that would be within our scope. No, we cannot place a chest tube if a tall thin teenager developed a spontaneous pneumothorax because that's not within our scope. Different airlines carry different supplies. One carries an extra O2 tank and IV kit, one carries a basic first aid kit. It's also helpful to ask the patient home medications or family members if they are traveling with others. If they can't answer questions then the flight attendants can help you go through their bag since many people carry prescription medications on them. This can help in figuring out what may be wrong.

Our job in that situation is to help the patient. The flight attendant's job would be crowd control. The pilot's job would be to determine the best course of action for everyone involved. Diverting a flight isn't just finding an empty runway. It means diverting every flight at the airport you would land at, thus affecting thousands of people. It also means he would have to dump fuel so as not to land with a full tank (if I remember correctly). That's why if the patient is relatively stable and can finish the planned flight then they will.

Anyway, thanks for the interesting read!

[icuRNmaggie, BSN, RN]

I apologize if this has been covered by previous posters. I've been enjoying this thread over the course of several days and cannot remember everything mentioned.

In response to icumaggie about the TSA preboarding ticket-while you may have filled that info out the average person doesn't. I've thought about applying for that just to cut down on wait times but haven't as of yet. When I do fly no one knows my occupation.

I took an interesting cme course on flight emergencies. Basically, nurses are covered under the Good Samaritan act, provided we act within our scope. Yes, we can start an IV and even hang fluids on a hypotensive patient because that would be within our scope. No, we cannot place a chest tube if a tall thin teenager developed a spontaneous pneumothorax because that's not within our scope. Different airlines carry different supplies. One carries an extra O2 tank and IV kit, one carries a basic first aid kit. It's also helpful to ask the patient home medications or family members if they are traveling with others. If they can't answer questions then the flight

attendants can help you go through their bag since many people carry prescription medications on them. This can help in figuring out what may be wrong.

Our job in that situation is to help the patient. The flight attendant's job would be crowd control. The pilot's job would be to determine the best course of action for everyone involved. Diverting a flight isn't just finding an empty runway. It means diverting every flight at the airport you would land at, thus affecting thousands of people. It also means he would have to dump fuel so as not to land with a full tank (if I remember correctly). That's why if the patient is relatively stable and can finish the planned flight then they will.

Anyway, thanks for the interesting read!

All good points.

Precheck is only $85 and good for five years. It is worth it to get through security in a few minutes, keep my boots on and for us to have an enjoyable trip.

[nurseprnRN, BSN, RN]

Good Samaritans are at risk any time they do Good Sam acts. Check out Malpractice and Negligence insurance companies.

If they meet the criteria for the GSA, that is, not getting paid, not exceeding training and experience and scope of practice, no they aren't at risk. Sure, somebody can sue them-- anybody can sue anybody if he can get an atty to take the case (BIG if) or he want to do it pro se (for himself)-- but that doesn't mean the nurse who adheres to the GSA guidelines will be screwed by it.

Edited to add: Link to federal GSA

http://definitions.uslegal.com/g/good-samaritan-rule/

[nurseprnRN, BSN, RN]

You would not be negligent. There is, to my limited knowledge, no requirement to render aid when you are not on the job. There is no requirement to volunteer, qualified though you may be.

Not true in some states. Some states feel if you have a license from them, you do have a duty to step up. In NH, if you are an EMT or paramedic and are observed to fail to stop at the scene of an accident even if off duty, you can be in a world of trouble. This is why NH EMS never put those fancy EMS decals on their cars. In MA, if you know about child/elder/disabled abuse and don't report it, you can lose your RN license. I am sure there are more.