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.
Keep in mind that no one has ever died on an airplane. Why? Because a doctor must be present to pronounce, therefore, the passenger isn't dead until you find one.
There has never once been a patient declared dead on an airplane......ever? There has never once been a doctor present to make this pronouncement? Seems odd to me, given how often physicians fly for business or pleasure. Have to assume it's not just nurses who respond to these emergencies......yes?
Keep in mind that no one has ever died on an airplane. Why? Because a doctor must be present to pronounce, therefore, the passenger isn't dead until you find one. So I would think it would be more risk of you start CPR then decide to stop CPR.
Ummm, actually registered nurses can pronounce death in at least Arizona. We cannot sign the death certificate or assign a cause of death but we certainly can pronounce death.
I have personally had that unfortunate task many, many times.
As everyone gets caught up in medical lawyering keep in mind that nurses are judged by what is reasonable and what is prudent. What may be reasonable and prudent is not the same as following the established rules, they align most of the time but not always.
As an RN with over 17 years experience, and a former first responder, I would feel moral obligation to assist that person on the airplane, As a nurse you should have professional Liability Insurance. My policy has a clause protecting me should I provide treatment within my scope of practice in am emergency.
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
You are covered. I have assisted on several emergencies on flight. Southwest airlines carries a medical bag that has ACLS drugs available, including cardiac epi. Frontier has a medical bag that you can access only if their medical control okays it. One thing to note though before using the medical bag make sure you know what's in it and how much. I had a situation where I had 1 500 CC bag of saline and no flushes and no way to chase my meds in after I had given the 500cc bolus for hypotensive patient with bradycardia. It all turned out well but I would have done differently had I known I was limited that much.
My policy has a clause protecting me should I provide treatment within my scope of practice in am emergency.
ANYONE responding in an emergency situation, who provides treatment with his/her scope of practice is protected under the Good Samaritan law....whether they have insurance or not. Your policy provides for the cost of defense, not for coverage of the act performed.
Unfortunately, while someone would not be allowed to sue you and PREVAIL (if you acted completely within the scope of your practice and to the limits of your abilities), they most definitely CAN sue you. That would be a handy time to have Liability Insurance in place, for the defense costs....actually, the only time I happen to think it's worthwhile....but that's another discussion, on another thread. :)
My biggest concern was at the beginning of the thread. If you do not know the difference between 1:10,000 and 1:1000 epi by quickly looking at it... and know that they are 1 MG just 1 to 10000 is diluted in 10cc ns . I would rather you just do cpr. You should just do cpr/aed. If you pushed 1 to 1000 iv and my family member died...
First off- if someone is needing epi in a code situation, they're ALREADY dead. Nothing is going to make them more dead. Everything being discussed is what's being done to try and resuscitate them.
Secondly, I can't imagine if a plane is stocking anaphylaxis/IM epi it wouldn't be in pre-dosed auto injector form.
I have been an RN for 38 years. I have taken ACLS every 2 years. NEVER have they said anything about ACLS certification authorizing an RN to use any of the drugs/procedures taught. An exception might be if you are an advanced Practice RN or working in an environment that recognizes the algorithms as approved protocols. The original question as I recall was that the RN might be out of their scope if they administered Epi. without a valid order. There is a strong possibility they might if there is not a physician present. The best and most prudent course would be to follow BLS and utilize the AED, moving up the ACLS scale if medical direction is available. In my present job, we are all ACLS certified, but we are not allowed to even interpret/treat a rhythm if a physician is not physically present. We leave the patient on the AED and do BLS until the arrival of either EMS or the physician.
No class can authorize you to give meds. You need standing orders, written or oral..etc. Medics can give these meds without a docs knowledge due to standing orders from their med director (doc) in written protocols for the meds. Even if someone is pulseless...let's take a ped for example... and you do not do everything right, you can and probably will be held accountable. Yes they are dead but you just possible decreased their chance for ROSC. Debatable but I have seen it.
I'm a licensed RN in California as well and I believe that if you are ACLS certified, then you would be covered to give epi as well as to provide any other life support measures in that situation as it was medically necessary. This would be, of course, unless you were grossly negligent and/or unable to support your actions by solid rationale and that could be proven in a court of law. If you are employed in a hospital situation under the same circumstance, then you must abide by their protocols for providing ACLS and giving medications. FYI...If you are an RN or MD who is ACLS/ATLS/TNCC certified and happen to stop at a ground scene where FIRE/EMS are (or will be) present then technically you can override them BUT IT IS VERY UNWISE TO DO SO because: 1) in high volume areas, they often know it better than you, unless you're also a medic, 2) they function under written and pre-approved protocols which covers them and many have physicians they can radio at any time, 3) you will be held accountable for any interventions and will be asked to accompany them to the nearest ER or Trauma center if you do so, and 4) you may not be covered by your private malpractice insurance if anything does go wrong. I know its our nature to want to help and I would have likely done exactly the same thing in this specific situation, but be cautious. Any attorney would tell you: "The dead don't sue, but the living do."
In regards to the epi concentration, there is no math to be done: regardless of how it might have been labeled... it was likely still the same pre-packaged 1 mg epinephrine dose so giving either one IVP would not have made any difference except the volume that it is diluted in. You would have had a choice between giving 1 cc or 10 cc of volume.
The epinephrine 1 mg IV dose generally comes in a 10 ml syringe (1:10,000). The anaphylaxis epinephrine dose is packaged in a 1 ml glass vial (1:1,000) and you give 0.3 ml IM = 300 mcg in starting dose.
Either way its packaged, its still the same 1 mg of epinephrine.
RNsRWe, ASN, RN
3 Articles; 10,428 Posts
There has never once been a patient declared dead on an airplane......ever? There has never once been a doctor present to make this pronouncement? Seems odd to me, given how often physicians fly for business or pleasure. Have to assume it's not just nurses who respond to these emergencies......yes?