Medical Emergiencies aboard an Airplane, what to do differen

[ghurty]

For the second time in the past year I have been on an airplane that had to make an emergency landing do to a medical emergency on board. Last time there was a medic on board as well, but this time I was the only one.

Is there anything different that I have to know about, or that I should be doing on board an airplane (in regards to oxygen, AED, etc..) I guess perhaps due to pressure differences?

Is there a course/document (on-line) outlining the differences (if any)?

Thankx

[Just Plain Ruff]

Nothing much to do differently.

I travel every week for work and have been involved in at least 4 different instances. From the very minor diabetic who needed some sugar in their orange juice all the way to a patient with a pulse of 24 and getting ready to code. Which she did a little after they got her in the back of the ambulance.

What you do not ever do is interfere with the flight attendants - no matter how right you think you are. They are always in CONTROL.

Many airlines policies require that the flight attendants operate the AED and you can assist but they operate the aed.

If there is a physician on board - defer to them unless they have no clue which most of them on the airplanes do not or do not want to have a clue as this makes them liable and responsible.

One other thing, do not ever take any monetary or extra perks from the airline such as a free ticket or free drinks or whatever because in effect you have just become an employee of the airline (per a attorney who was on the flight that the lady coded on). Once you take any recompense from the airline then you become an employee of the airline and are no longer subject to the Good Samaritan allowances.

So my advice to you is this -- do what you feel comfortable doing and no more. Remember you are actually not practicing under anyone's license and thus you need to follow accepted treatment guidelines. When in doubt, the airlines have in place communication plans that allow you to discuss the patients condition with physicians on the ground. they will make the determination if the patient can make it to their original destination or if an emergency landing needs to be done.

I've been on transconinental flights and always identify my self to the flight attendants that' I'm a medic so if something happens they can always call on me to help, it doesn't hurt and sometimes the flight attendants give me more soda and peanuts if they know I'm willing to help out.

[Doczilla]

Airlines contract with services that provide online medical direction from a ground-based ER in situations like this. The system is in place to hook you up with a doc on the phone that can do medical control just like you would in the field. And ultimately, that doc is in control just like your medical director is, and can authorize advanced care as needed. The medical control physician on the ground can override orders by a doc on the plane as well. The point is, you're never on your own up there, no matter what your skill level or what airline you're on. Virgin Atlantic has been installing telemetry modules on their planes to transmit vitals and other data (the module takes vitals for you, which is probably the key advantage of having it).

The point was made here that the flight crew, and ultimately the captain, has the final say on what happens on that plane. No matter what kind of emergency it is, they may elect not to divert to another airport. You can provide some input, but don't really have any legal authority, so don't make a stink if they don't take your advice.

The real question is whether or not to land the plane early. In a lot of situations, it won't make too much sense. On the little data that's available, most in-flight emergencies are anxiety-related. A few points to consider:

1) Planes take off loaded with fuel, but aren't built to land loaded with fuel. This means that if an emergency occurs just after take-off, the plane will have to circle to burn off fuel or dump it. Think about how much time that saves, and you may be better off just continuing the flight.

2) The airline loses about $250,000 each time it diverts a plane like that. This is important to consider in the grand scheme of things: will it really matter to get the patient to the hospital that much sooner? In the aforementioned example of the patient with a HR of 24, it might. For abdominal pain, even a ruptured appendix, probably not.

3) If a patient codes on a flight, there is no way to get them on the ground in time to make a difference. The captain will often just opt to complete the flight, since it won't make a difference anyway.

4) Planes are generally pressurized at 8000 feet. This may lead to some gasseous expanse problems (not a big deal for most unless they have a serious bowel condition), which can be a REAL problem if they have a pneumo or decompression sickness because they just HAD to go scuba diving one last time on their vacation. For this reason, oxygen is always a good idea. The pilot does have the capability to pressurize the plane to about sea level in cases like this. This can buy you time.

5) Plane first aid kits are commercially manufactured and vary by supplier. AEDs are pretty standard now by federal law. A lot have IV meds, benadryl, epi, lido.

'zilla

[Timmy]

What happens if your country doesn’t have medical control?

If I was in this situation I probably wouldn’t do anything, the attendants are more than capable of handing the situation. In Australia my organisation has just trained a heap of airline people in advanced first aid, medical emergencies, AED and 02. So unless the health care professional brings the ambulance with them, there’s not much more they could do.

[akroeze]

Who here does/doesn't make themselves known to the flight attendants?

I fly atleast twice per month but I have never really considered going to the attendants and telling them I'm a medic. I dunno, I guess to me it would feel like I was bragging :oops:

[somedic]

Its interesting to arrive back in the states and find this subject! Im on a flight to Edinburgh, Scotland. I get up to go stretch my legs and talk with the flight attendants in the back of the plane. They start asking general questions like where Im from and what I do....and they seem pleased that I am a Paramedic. they make a note of where Im sitting.

I then tell them that I am familiar with the flight medical kit and its contents but that I hope for no dramas on during the flight. The Flight attendants were great to talk to and a short while later a man in civilian clothes comes to where Im sitting and asks if Im "ACLS trained".Thinking to myself "aren't all paramedics?" I reply Is someone sick? He replies "no but the flight attendants told me you were a paramedic".

I realize quickly what this person probably is and why he is asking me questions.

I agree with previous posts on here The flight crew and any potential security officers are in charge at all times. I did not know that accepting free Gin and tonics from the flight attendants made me an "employee" of the airline...I guess I made a good drunk employee on that flight!

SOMEDIC

[Dustdevil]

The main difference is that, at no time should you tell the pilot to stop while you start an IV. :wink:

I have never identified myself to the flight crew as a medic. If they were to make an announcement asking for medical assistance, I would go. But I am with Akroeze... I never really thought about identifying myself ahead of time. Sounds sort of cheesey to me. But hey, if flight crews want us to do that, I don't mind. I obviously fly a LOT, so I would like to know how crews feel about this. But I am betting they get tired of all the volunteer EMTs with their FD t-shirts, track-suit wearing wives, and feral kids coming up and trying to impress them with the badge they bought from Gall's.

So, who was the dude in the civilian clothes, SO?

[somedic]

Dust: excellent post! I have seen the words "feral children" used some where on this forum before :wink:

The man in civilian clothes was probably an air marshal. I never asked and he never told. I thought I could make out the out line of a side arm under his jacket.

I agree with you so much about prewarning the flight crew that you are a emt or Paramedic. I have never done it before and wont ever do it in the future(although the free alcohol was nice!). I fly often and have never been on a plane when a medical porblem came up. Im sure there are glory loving nurses, chiropractors, proctologists, and emt-basics on possibly every flight that can jump to the call of duty.

The bottom line for me here is this: Flight crews just like EMS put up with a lot of crap. I see no glamour in their job. I think we have it worse than them but we have common gripes. I always try to speak with the crew when time allows.

Somedic

[akroeze]

It just occured to me that I tend to use my OASIS card (ID proving you work in EMS) as photo ID when boarding because it's in the windowed area of my wallet. So I suppose that is the most I do to identify myself, and it's only from laziness

[somedic]

Oasis card???? That smacks a bit as being a poser. Do you get free drinks because you do that?