Off duty RN scope of practice on an airplane.

Nurses General Nursing

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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

Specializes in ICU + Infection Prevention.
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.

Not anymore. Pre lines are frequently longer than standard lines... If they are open...

Specializes in MICU, SICU, CICU.

We have not had that experience but we travel very early in the morning.

Specializes in Med-Surg, Ortho, Subacute, Homecare, LTC.

Is it strange that the OP hasn't responded with anymore details? There's quite a few logical posts regarding some things that probably need some clarification... and yet nothing.

This is very useful to know since my last flight was to Europe and then in mid-Atlantic came the overhead "any medical person on board please come to the front of the plane"...

Specializes in L & D; Postpartum.

Interesting thread: My husband is a retired airline captain with 38 years experience and has related many post-trip medical emergency stories to me.

First of all,the crew doesn't make medical decisions unless they are very simple problems, such as a passenger who is hyperventilating. The cockpit crew is immediately notified of any serious problem and the cabin crew makes an announcement for any medical personnel to ring their call light. I have done this many times, had a FA quietly come to my seat, I tell them my credentials and experience (for me: RN: Labor and Delivery, OB, peds) and they decide later if I am needed or not.

For serious problems, the flight crew contacts their medical advise folks, Docs at Med-Link I think it is. Those docs will give orders depending on what information is fed to them from those in the back. The captain is called the Pilot in Command for a reason and he or she will make a decision to request a diversion or to press on, with all the information being taken into account.

One on occasion, my husband was mid-Pacific,half-way between the West Coast and Hawaii, when an old man coded. Not knowing at the time that he was DNR and going home to die, the crew started CPR and my husband contacted Med-link. Mind you, this guy was gone and there was 3 hours left in the flight regardless of pressing on or turning back. After talking to his wife, finding out he was DNR. my husband told the crew to dc CPR and do what they could to cover him reseated next to his wife. The wife sat with him holding his hand for the remainder of the flight. Med-link wanted them to continue CPR for the remainder of the flight. The PIC said "that's not happening." Med Link then said to restart CPR on approach (I guess to make a show of having done it according to the book) and again the PIC said, "and that's not going to happen either."

Med-link will be notified for all serious medical problems.

Years ago, before the Med-Link thing, he told me of a situation where 5 docs of different persuasions responded and my husband did a quick interview and he decided which one of them would be in charge.

I told my husband that if I were ever on one of his flights and someone went into labor, I, the experienced L and D nurse, would be in charge. He knew I was serious. I am only about 1/4 joking about that, because unless there's a veterinarian, or an actual midwife or OB also on board, I can guarantee I would have had more recent experience and would have "caught"more babies than anybody else who might show.....

I have made my presence known several times in flight...I have never actually had to help. But I would.

Personally, going through an entire ACLS procedure mid-flight anywhere, without having any kind of facility for transport within 15-30 minutes from door to door seems like overreach to me.

Seriously? You waited on a physician? I code people all the time for 18 years. Never have I waited on an md. More than once We've finished epi x3, defibrillated, RT'S have intubated and we're done. That only takes less than 8mins. If its 2am and the ED has a code or two of their own or a multi pt trauma it takes a bit for a MD to respond. The patient would be dead if we waited on a MD.

I can tell you what happened to an MD on a flight that I am friends with...

Pt. had a syncopal episode and chest pain. They called for medical personal and he responded with another physician. He was given a hard time about doing anything even though he produced his business card and even then they gave him difficulty in obtaining the medical kit, all decisions had to go through medical control on the ground including diverting the flight (which they ended up doing, thanks to the physician's on board insistence). So I think it is VERY dependent on the airline you're flying how easily you will be able to render assistance, but I would not worry about providing care in the air no matter where I was.

Oh and as a critical care RN waiting for a physician for ACLS orders is insanity. We code people all the time with no doc present...

Meanwhile my son was 15 when a guy fell in his lap with a pulse of 30 & fading. The crew tried to tell my son just to buckle up and wait because they'd be landing in 15mins. He refused, put the guy on the floor and insisted the crew alert the pilot. Pilot told the crew to take him oxygen, made a call to ground control & had an ambulance meet them. Guy was a beta blocker overdose on accident because he was drinking and forgot he took his meds..so he took them again and again. He lived but just barely.

Specializes in Critical Care, Emergency, Education, Informatics.

Waiting on the Doc if your a nurse and don't work in a critical care or ED setting is not insanity. You do what your trained to do. If your training is limited to BLS, then BLS and Auto Defibrillator is what you do. If your trained, and you have the tools, you do more.

Waiting on the Doc if your a nurse and don't work in a critical care or ED setting is not insanity. You do what your trained to do. If your training is limited to BLS, then BLS and Auto Defibrillator is what you do. If your trained, and you have the tools, you do more.

We have been discussing trained ACLS nurses having to wait for doctor's orders to follow protocol, not merely BLS trained nurses. At least one ACLS certified nurse has said they don't give emergency drugs in her hospital during a code until a doctor is present and gives the order. That is what has been debated, in addition to the airplane scenario.

Specializes in Complex pedi to LTC/SA & now a manager.
Waiting on the Doc if your a nurse and don't work in a critical care or ED setting is not insanity. You do what your trained to do. If your training is limited to BLS, then BLS and Auto Defibrillator is what you do. If your trained, and you have the tools, you do more.

Most facilities have standing order protocols for credentialed nurses & therapists to initiate ACLS, PALS, NRP. Medics (EMT-P) in the field don't work independently they work under physician created treatment protocols. Some airlines have written medical protocols for credentialed nurses & medics to initiate ACLS others have telephonic physician consultation.

An individual who has an ACLS card does not have carte blanche to initiate ACLS protocol simply by completing the course---mostly because ANYONE can take and complete the course. EMT-B, CNA, basic first aider, ECG monitor tech all can take the class but neither have the training not the credential to initiate the protocols and administer the drugs.

A nurse who works 1:1 private duty pediatrics with non high tech children with an ACLS card and never once participated in a code is not exactly qualified to initiate ACLS protocol.

If there are no drugs or supplies (IV etc) what do you do? BLS--assess, CPR, positioning, possibly O2, AED

The epi is there to be used by trained medical professionals. If a person had anaphylaxis I would have given the IM dose. That said, my training as an RN includes ACLS and BLS/CPR. IV medication administration is all by protocol, which is overseen and approved by a physician. In this case I would have performed BLS/CPR and used the AED as there is no requirement except for training. Pushing IV medications without a physician is what I would consider outside of my nursing scope of practice. It would have been possible for the pilot to contact the emergency medical team on the ground. In that case, I would have been comfortable taking orders from a licensed independent medical provider via phone/radio and would have administered the epi IV as/if directed.

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