uglyEMT Posted October 13, 2010 Share Posted October 13, 2010 Several people keep talking about their protocols. There are no protocols in these situations. You are not in your jurisdiction so your protocols have no bearing on anything. You should be following your education (training?) to provide the standard of care. Just to add a few random thoughts, there is very little presidence in the legal papers in regards to air travel. Who's juridiction does a case get brought up in? Is it a federal court, the court for the state/county/city that the incident occured over or a court in the departure city or arrival city? Excellent points ERDoc. I did not realize that once I leave my jurisdiction my protocols no longer apply and it reverts to highest level of training. I always assumed that I follow the protocols of my state liscensure no matter where I go. Thanks for the heads up! as for the law. Under article 28 of the Warsaw Convention 1929, the passenger can choose one of four jurisdictions to sue, namely: - The place of incorporation of the carrier - The place where the carrier has its principal place of business - The place of destination - The place where the carrier maintains an establishment through which the contract was made. the following link is all about inflight air emergencies as related to medical personel. It is a very good read and covers all the topics discussed for both national and international travel. No more guess work now hehehe http://www.hkcem.com/html/publications/Journal/2003-3/p191-196.pdf Link to comment Share on other sites More sharing options...
spenac Posted October 13, 2010 Share Posted October 13, 2010 If the airline wants to divert that is their choice. If they want to continue CPR that is their choice. Am I so calloused as to refuse to rotate with those that are doing CPR? No, if they are not allowed to stop I will offer to be in the rotation because it is unfair to them that because of the PR nightmare of stopping that they get stuck working so hard. My point is I am going to advise no need to divert and that I recommend based on accepted standards discontinuing life saving efforts. Plus, you have offered to help as the top medical person on the plane. Medical control has told you not to stop and continue. You refuse to continue based on your reasoning. . Several people keep talking about their protocols. There are no protocols in these situations. You are not in your jurisdiction so your protocols have no bearing on anything. You should be following your education (training?) to provide the standard of care. As quoted above I said I would continue assisting if they required it to continue. Standard of care in EMS is ACLS. That standard of care says consider discontinuing w/o pulling my book out I think it was 15 minutes with no ROSC. As to protocols they are only valid in the area the medical director signs them off for. But again I am willing to help continue cpr as above. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted October 13, 2010 Author Share Posted October 13, 2010 As quoted above I said I would continue assisting if they required it to continue. Standard of care in EMS is ACLS. That standard of care says consider discontinuing w/o pulling my book out I think it was 15 minutes with no ROSC. As to protocols they are only valid in the area the medical director signs them off for. But again I am willing to help continue cpr as above. Spenac I'm not busting your chops or anything like that, you know me better than that but playing devils advocate here You have already rendered care. NO ROSC yet the plane is diverting. Medical control is saying to continue the code including giving any additional medications that are in the bag. (some bags are better stocked than others). You say to medical control that there is no ROSC and you are requesting to cease efforts based on your ACLS knowledge. Are you telling me that you will refuse to continue the code because after 10 or so minutes there is no ROSC? How would you defend yourself in court when you had a physician on the other end of the radio telling you to continue? Just asking. Link to comment Share on other sites More sharing options...
akflightmedic Posted October 13, 2010 Share Posted October 13, 2010 Spenac I'm not busting your chops or anything like that, you know me better than that but playing devils advocate here You have already rendered care. NO ROSC yet the plane is diverting. Medical control is saying to continue the code including giving any additional medications that are in the bag. (some bags are better stocked than others). You say to medical control that there is no ROSC and you are requesting to cease efforts based on your ACLS knowledge. Are you telling me that you will refuse to continue the code because after 10 or so minutes there is no ROSC? How would you defend yourself in court when you had a physician on the other end of the radio telling you to continue? Just asking. \ To play devil's advocate, you must have me confused with someone who works for the airline or is licensed under that medical director. Since neither of those two are the case and if I decide to cease efforts yet the MD disagrees...well then I guess the stewardess needs to get on the microphone and ask if anyone else would like to assist. Easy cheesy... Link to comment Share on other sites More sharing options...
spenac Posted October 13, 2010 Share Posted October 13, 2010 Spenac I'm not busting your chops or anything like that, you know me better than that but playing devils advocate here You have already rendered care. NO ROSC yet the plane is diverting. Medical control is saying to continue the code including giving any additional medications that are in the bag. (some bags are better stocked than others). You say to medical control that there is no ROSC and you are requesting to cease efforts based on your ACLS knowledge. Are you telling me that you will refuse to continue the code because after 10 or so minutes there is no ROSC? How would you defend yourself in court when you had a physician on the other end of the radio telling you to continue? Just asking. I like when people play devils advocate makes us think outside our comfort zones. Again if they continue as I mentioned I will help. If they need me to push drugs no problem much easier than doing chest compressions. My answer is if I am final say. My point is if there is no contact with anyone because radios dead and the pilot leaves it to me I will work the code with what we have but will not hesitate to call it when no doubt they are dead and I have at least met if not exceeded standard of care which for EMS is ACLS. Same goes if I'm in my fully equipped MICU ambulance I work them on scene until ROSC or until there is no doubts they are dead and we have met or exceeded the standard. I am not a fan of show codes. Now as someone mentioned the other passengers start to get angry causing trouble then my safety would dictate a show code to keep them calm so I and perhaps all on board don't die from the mob actions that could develop. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted October 13, 2010 Author Share Posted October 13, 2010 \ To play devil's advocate, you must have me confused with someone who works for the airline or is licensed under that medical director. Since neither of those two are the case and if I decide to cease efforts yet the MD disagrees...well then I guess the stewardess needs to get on the microphone and ask if anyone else would like to assist. Easy cheesy... Those were my thoughts exactly, I was just asking more questions. listen, we all know how these things end. No ROSC, no family reunion. I think we've gone far enough on this topic. Just tried to get everyone thinking that it's never cut and dried and extraordinary circumstances often come up. What I found surprising in the article posted earlier is that I've always been under the impression that our good samaritan protection ended if the airline comped you free drinks or a free ticket which the article seemed to indicate that stuff like that is not considered compensation. Thanks for playing Ruff Link to comment Share on other sites More sharing options...
CBEMT Posted October 13, 2010 Share Posted October 13, 2010 (edited) Diverting and not calling the code may be in the best interest of the airline but also the best interest of the patient. So before we blanket statement that 2 rounds without ROSC and I'm done, period might need to be revisited. How the hell is 45+ minutes of CPR in the best interests of the patient? Plus we need to add in roll-out, taxiing, gate hookup, time to get the ground crew to the back of the plane, start ALS care, package, remove from the plane (good luck doing CPR up the aisle), time to the truck, transport.... Get where I'm going with this? 45 minutes to wheels-down probably means 50+ to additional ALS care, and maybe 70 or better to the ER. Best interests? Really? Edited October 13, 2010 by CBEMT Link to comment Share on other sites More sharing options...
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