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

[Horseshoe, BSN, RN]

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.

I don't think that this is actually a likely scenario. Being realistic, that nurse most likely would NOT want to begin pushing drugs and shouting out that she didn't need doctor's orders if she didn't feel competent and would simply initiate BLS protocols. I know that the Good Samaritan law protects me only if I am operating under established standard of care. If I blindly push the wrong drug at the wrong time and the wrong dose, I know that I'm not necessarily going to be protected if I kill the guy with my negligence.

I think the nurse who doesn't know how to run a code is not going to suddenly think she's superman and start willy nilly acting like the experienced ER doc she knows she is not.

[SunCityInsPhysical, BSN, RN]

Having worked as a Nurse for 38 years ten of them doing travel contracts, some offshore and some in the bush, I've criscrossed the country and have had many oportunities to make the decissIon to make known my training as a Nurse and decide whether or not to render aide, very scary, especially if there is no MD aboard or available or there are extreme obstacles, weather conditions or distances to be taken into consideration. Even scarier if the MD has no cardiac arrest training, or the situation may require surgery.

I salute you both for coming forward. I Discussed this scenario with coleagues whom I frequently consult with as experts in their field. One is an AHA certified ACLS Trainer, another is the Chief of Trauma at a large Level One Trauma Hospital, another a Board Certified Cardiologist, and finally with Certified Legal Nurse Consultants. We hope to reassure you so you can breathe a little easier. You did not say whether the patient/victim survived or not, we'll assume that he did.

The consensus was that your actions whether comfortable or not were absolutely acceptable practice and we would be very surprised and saddened if any legal action were to be brought against you, and shame on them. Had you been in house, an MD familiar with leading a code may have been available with in a short time frame, you would be expected to continue to follow the protocol until a) the victim becomes stable (with or without AED assisted pacing ) b) you are relieved of leading the code by a superiorly trained provider or c) the patient expires, flat lines, bleeds out.

In your situation, once you responded, assessed the tools and drugs available and your training kicked in, I got the impression that you followed the current AHA logarithm of AED ASSISTED assesment, airway, breathing, compressions, defibrillation, and drugs according to AHA Protocol. This protocol is the same one followed by EMT's and hunting guides, etc in the AK Bush when out of range of cell/ radio service. In most if not all states and Federal Air space you should be covered by good Samaritan Laws.

Again, my kudos to you for stepping up. I hope this will spur action by the FAA to address this issue, They missed the plane with regard to addressing it pre-emptively and publicly. Perhaps the ANA &AMA will step up to the plate to join the discussion and decision making process.

Will follow this link for update.

[JustBeachyNurse, LPN]

I don't think that this is actually a likely scenario. Being realistic, that nurse most likely would NOT want to begin pushing drugs and shouting out that she didn't need doctor's orders if she didn't feel competent and would simply initiate BLS protocols. I know that the Good Samaritan law protects me only if I am operating under established standard of care. If I blindly push the wrong drug at the wrong time and the wrong dose, I know that I'm not necessarily going to be protected if I kill the guy with my negligence.

I think the nurse who doesn't know how to run a code is not going to suddenly think she's superman and start willy nilly acting like the experienced ER doc she knows she is not.

Sadly I know more than one nurse with exactly this experience that has the ego to attempt ACLS with no clinical experience hence why I mentioned this scenario.

[Horseshoe, BSN, RN]

Sadly I know more than one nurse with exactly this experience that has the ego to attempt ACLS with no clinical experience hence why I mentioned this scenario.

Yeah, I guess there does tend to be "one in every crowd."

[tntrn, ASN, RN]

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.

I worked 35 years in Labor and Delivery and the only chest compressions I ever did was on an infant. In all those years of nursing, there was never once a code called on an adult in my department.

So even though I took ACLS, (talk about a fish out of water....the acronyms alone were a mystery the first time) I would hardly consider myself qualified to run a code.....or give the meds....maybe act as scribe, but nothing more.

[icuRNmaggie, BSN, RN]

It is helpful to hear in that the pilot will quickly evaluate the people who respond and appoint a leader. Thx tntrn

[tntrn, ASN, RN]

It is helpful to hear in that the pilot will quickly evaluate the people who respond and appoint a leader. Thx tntrn

When he first started describing it to me, I said, "let me guess...it was like the keystone cops." I am sure we've all seen it.

I should add that this was pre-911 and now the pilots do not leave the cockpit except to use the loo. Another pilot deadheading might do that now.

But the cabin crew relays information to the Captain and he/she contacts Med-Link for the serious cases.

[nurseactivist]

Flying to Hawaii many years ago. My 8 year old son was sitting several rows behind me with his Grandma. A flight attendant comes up to me and says, "Are you are registered nurse?" I said,yessss? Your son told us. Flight attendant said she was an RN and there was a medical emergency a couple of rows behind my son. If she needed me, she would find me. Even a child knows the right thing to do. I was proud of his pointed little head:) I stayed in my seat, RN/flight attendant didn't need me, perfect.

[CraigB-RN, MSN, RN]

Medscape: Medscape Access

[AZSunn]

Several of the students I graduated with took ACLS while they were still in school. I don't see how you could infer someone is licensed from taking an ACLS course.

[SENSUALBLISSINFL, BSN, RN]

Exactly. Just the other day an RN friend of mine were chatting about this. She heard a guy in human resources tell of an event he experienced on a flight. A flight attendant called for a doctor or RN, he saw a guy running to where the commotion (did not see exactly what the guy did), He wondered how does the pilot or flight attendant know that he is actually a doctor or RN?

She and I, are not ER or trauma nurses, in our scope the only thing we can do we chatted was BLS, and check vitals, but we cannot do ACLS or anything more complex. She has been a public health nurse since she graduated, and my experience is in the private practice and now public health. This is why working bedside for a little bit comes in so handy, experience that neither my friend nor I got.

Reading this, I think I should review or take a course. I feel so incompetent

Way to go OP on saving a life. AWESOME.

If so...What then is the point of being ACLS certified? Pretty much the protocol is to follow the American Heart Association guidelines for ACLS...right? Every algorithm is pretty well spelled out.

I think of it as I would when someone's about to access a mediport, are they competent and have education/experience with properly accessing mediports? If not, go get someone that does, damn it! (Pet Peeve, I don't know how to competently access a mediport but plenty of people in my hospital think they're competent when they are clearly not! Can't we all just respect our limitations/comfort zones/egos for the sake of our patients?)

ACLS went over advanced airways but I know I'm not competent in that area, I would look to the many wonderful RT's for help there...but I would be expecting them to want me to return the favor by IVP the drugs for them. It would be my problem if I did not follow the specific guidelines...

[SENSUALBLISSINFL, BSN, RN]

Quote from icuRNmaggie

"Even if a nurse is uncomfortable with giving ACLS meds there other meds in the kit that can save a person's life.

I would get VS and give the aspirin, and nitro in the kit and 02 to the person with chest pain.

I would give the 1/2 amp of D50 to the unconscious hypoglycemic person after checking for a medicalert bracelet.

The kit has an albuterol MDI and I would give it and supplemental 02 to an asthmatic person who is wheezing.

There is an epi pen to treat anaphylaxis and po and IV Benadryl for allergic reactions.

I would give the fluid bolus to a very hypotensive person unable to take po.

I really don't think anyone would fault a nurse for using common sense and providing any of these interventions"

Awesome reply - I like your list!

Me toooo!!!