An MI: My Experience at 30,000 Ft.

[SafetyPro2]

Way to go Matt! (sorry for not responding sooner, just finished reading the post today) Good thing you were on board.

Up until a few months ago, we used to be able to do ET tubes as Basics. That is, those who went through the seperate Advanced Airway class and quarterly skills review. About a quarter of our EMTs were AA certified when the State decided to take that away from BLS (we were apparently the only BLS agency in the county doing it).

 

[Chimpie]

Hate to bring this post back from the dead but I was thinking about you guys and this post on my trip to Florida last week. My seat was near the back of the plane :angry: and I was watching everyone put their bags in the overhead compartments. I looked up at the one above the row across from me and saw the symbol for the first aid bag and AED. I just smiled and grinned from ear to ear and said, "I swear, if I have to grab that AED on this flight Matt is never going to hear the end of it."

 

[emt/fr]

Great job Matt. Here in WI we are taught combi and glucagon in the emt-b class. Adds about another ten hours to the class.

 

[MMiz]

Originally posted by Chimpie@Apr 29 2005, 12:41 PM
Hate to bring this post back from the dead but I was thinking about you guys and this post on my trip to Florida last week. My seat was near the back of the plane :angry: and I was watching everyone put their bags in the overhead compartments. I looked up at the one above the row across from me and saw the symbol for the first aid bag and AED. I just smiled and grinned from ear to ear and said, "I swear, if I have to grab that AED on this flight Matt is never going to hear the end of it."

LOL.

I probably think about the incident once every couple of weeks, and wonder what I could have done differently. Maybe have the ICU nurse start an IV? Have him take four baby aspirin? Oh the options.

Nice to see you're thinking of me Chimp, how's Florida?

 

[Chimpie]

Florida was great. I'll send you an email.

 

[daemonicusxx]

Originally posted by emtbuff@Jan 10 2005, 03:42 PM
daemonicusxx
Did I read that right that you can't push the little button that says shock when directed by the defib. Or do you use a different type of defib. If I remember right our is a life pack 12. And yes we are allowed to shock if the defib indicates it.
Where I run we don't have any medics and only have 3 I's which really can't do much different than a B. Sure they can start IV's but we always think and say that We will save the veins for the hospital staff. We also only have a couple minute ETA for the most part.

we can use a fully automatic AED, one that uses the sticky pads. if its got the AED function, i know the 12 has that "analyze" button. im guessin that i would be able to push the analyze button and get a shock advised, and be able to shock. not sure though. its not really gonna matter cause i just passed my P test. really just waitin on the patch to come in the mail.

 

[emt3225]

Originally posted by ffemt8978@Jan 8 2005, 11:38 AM


Did you ever notice that the higher someone is in the medical food chain, the less likely they are to volunteer to assist at an emergency?

Good job Matt.....

 

[TTLWHKR]

I'd be absolutely useless anywhere over 100' off the ground. In fact if I ever have to fly again, I plan to bring sedation along. :blink:

 

[usafmedic45]

I had a very similar incident on a Lufthansa flight from Munich to Chicago. We had been at cruising altitude for about 30 minutes when the flight attendant came back and tapped me on the shoulder (I was wearing a coat with a EMS patch on it when I got on the plane and apparently she remembered seeing the patch). "Are you a paramedic?". "No, I'm an Intermediate EMT. Do you need something?" "Yes, can you come look at another passenger? He doesn't look well at all." I agreed and followed her to the back of the plane. We were about 10 rows away when I notice this guy who is pale, sweaty, and gray. Apparently he was having 6/10 chest pain, breathing difficulty and felt like his heart was racing. I asked the flight attendant to page for any other medical personnel and to get me the AED, O2 and medical bag. I checked the guy's vitals where were something along the lines of HR 194, BP 86/52, RR 36 and labored, breath sounds were rales and rhonchi 1/3 of the way up the lungs. :blink:

They get me the O2, and it also only went to 4 L ( ) but I figured that that is better than nothing. I put the AED on him, just for a check of his rhythm and guess what I found: V-Tach. I would have just cardioverted him, but I couldn't figure out how to get the AED into manual mode. So I started setting up for an IV when I hear someone walk up behind me. Come to find out the guy was an Austrian dentist who spoke minimal English (and I at the time spoke minimal German) so he was going to be of little help. They also got a doctor on the phone (I think he was English judging by the accent), but I'm not sure and I basically asked if I could follow ACLS guidelines medication wise in treating this guy and the doctor stated I could.) I told the flight attendant that I needed to speak to the crew because this guy needed a hospital ASAP. She scurried off and I went back to starting the IV. TY I got the IV established and gave 100 mg lidocaine to try to control the VT. Luckily, it slowed the VT a little and he would have moments where he would go into what looked a sinus rhythm with multifocal PVC's so I gave another 50 of lido and started to set up for a lidocaine drip when the second officer came back and he asked how bad it was. My response was "Bad. How quickly can we get on the ground?" He goes "The closest airport at the moment is Keflavik Iceland." My response was "I don't care. He needs a hospital, and he needs it now." He acknowledged that he agreed with me and proceeded back to the cockpit.

The rest of the flight went as uneventfully as could be expected when you are stuck on a plane with an unstable cardiac patient and only an effectively non-Anglophonic Austrian dentist as your partner (basically the patient got no better but no worse). But the real fun started once we got on the ground in Iceland. The medics came on board to get the patient and they looked at me after I reported what I had done and go "Are you a doctor?" "No." "Please come with us." So I get off the plane and find myself being questioned by a couple of very grumpy Icelandic cops. Apparently the medics thought I violated some sort of rule by giving the lidocaine (they didn't seem to grasp that I had been talking to a doc prior to doing it). Needless to say I wound up being questioned for the better part of two hours- during which time my flight left :angry: - until they got in touch with the medical control doc that Lufthansa. So I was a little pissed when the cops told me that I was free to go. I had no idea how I was going to get home. So I walk to the information desk and the lady made a phone call and then two IcelandAir employees came up to me and proceeded to explain that they were terribly sorry for my inconvenience and that Lufthansa had arranged for me to catch a flight to Frankfurt on board an IcelandAir plane that was leaving in a few minutes. So I was hustled aboard that aircraft and went back to Frankfurt where I was put aboard a Lufthansa aircraft bound for Chicago. The nice thing was I got upgraded to first class on board both those flights. I also received a letter from Lufthansa a few days later thanking me for my assistance and apologizing again for any inconvenience and letting me know that the man lived. All in all it wasn't a bad experience and I would have to say I would not hesitate to offer assistance again.

So I have to say by far if you have to help out on board an overseas flight, two things: Try to do it aboard a Lufthansa flight and don't agree to a divert to Iceland. :lol:

 

[Chimpie]

Your flight left? I would have been so irrate that I would have been arrested.

 

[usafmedic45]

I can't say I blame them for leaving.....there's no reason to delay that many people because of one person. I wasn't irate, I was just concerned about how I was going to get home.

 

[Chimpie]

Originally posted by usafmedic45@May 6 2005, 11:06 AM
I was just concerned about how I was going to get home.

I would be too. LOL

 

[Jon]

That is a cool story. did you get free tickets?


Jon

 

[usafmedic45]

Originally posted by MedicStudentJon@May 6 2005, 08:57 PM
That is a cool story. did you get free tickets?


Jon

Nah, just the ones for a flight home. But I can show that letter I received and get an upgrade to first class if there is space available. :lol:

 

[TTLWHKR]

Apparently the medics thought I violated some sort of rule

I rcv'd an official reprimand by mail for putting a pressure dressing & splint on the leg of a guy who was in an auto accident in NYS. Didn't tell anyone I was w/ EMS; I just had a large first aid box. I have to give the state trooper my name, he asked how I knew to apply the dressing, all I said was "I have some training". He took my license plate #, and it's an EMS plate. So I get a letter in the mail two months later stating that I was on probation for acting as an EMT outside of the commonwealth of PA.

Since when is it illegal to provide first aid? :angry: Ba%$@rds

 

[ffemt8978]

usafmedic45,

I have a question for you about your scope of practice. You stated you were an EMT-I, but you're obviously familiar with the ACLS protocols for cardioinversion and first line cardiac drugs. Aren't both of these things outside of your scope of practice?

I realize that you got the doc to sign off on it, but I was just wondering what made you ask in the first place.

Good job on the save, BTW.

 

[MMiz]

Originally posted by ffemt8978@May 7 2005, 10:48 AM
usafmedic45,

I have a question for you about your scope of practice. You stated you were an EMT-I, but you're obviously familiar with the ACLS protocols for cardioinversion and first line cardiac drugs. Aren't both of these things outside of your scope of practice?

I realize that you got the doc to sign off on it, but I was just wondering what made you ask in the first place.

Good job on the save, BTW.

That's exactly what I was thinking.

I was actually signed up to take a summer-long ACLS course for Basics, but had to cancel due to time constraints. After my experience, I wondered how having that knowledge would have impacted my experience at 30,000 feet.

Also, I didn't even think about placing the AED on the live patient, as it's not in our protocols. I still don't think I would have done it.

What made you think of putting the AED on the patient? Is that common practice? (That goes out to everyone)

I got a booklet thanking me for my service, some frequent flyer miles, and a coupon for a sandwich at the airport... and a round of applause

 

[MedicPrincess]

Originally posted by MMiz@May 7 2005, 04:28 PM
Also, I didn't even think about placing the AED on the live patient, as it's not in our protocols. I still don't think I would have done it.

What made you think of putting the AED on the patient? Is that common practice? (That goes out to everyone)

On my test for AED check off I was asked contraindications for the AED:

1. Use on a Trauma Patient
2. Use on a child under 8, or if you have adapters under 1
and
3. A conscious patient.

 

[Jon]

Originally posted by EMTPrincess+May 7 2005, 06:26 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (EMTPrincess @ May 7 2005, 06:26 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-MMiz@May 7 2005, 04:28 PM
Also, I didn't even think about placing the AED on the live patient, as it's not in our protocols. I still don't think I would have done it.

What made you think of putting the AED on the patient? Is that common practice? (That goes out to everyone)

On my test for AED check off I was asked contraindications for the AED:

1. Use on a Trauma Patient
2. Use on a child under 8, or if you have adapters under 1
and
3. A conscious patient. [/b][/quote]
To make a point about #2 - Use of an adult AED on a child less than 8is actually allowed and discussed by AHA in BLS courses.... If you can shock the kid with an AED, the kid is dead before, might not be afterwards.

Also, everyone loves to use the "8 year old" dividing line.

I belive the divinding line technically is 45-50 kgs - as EVERYTHING in medicine goes by weight.

Jon

 

[usafmedic45]

Lidocaine is within my scope of practice as an EMT-I (as is atropine and epinephrine and manual defibrillation) and cardioversion is included in my training as a respiratory therapist (and some services allow EMT-I's to cardiovert- we were taught to do this at a service I used to work for as well as to pace patients but the protocols had not been fully approved at the time I left).

As for putting the AED on a conscious patient that's a relative contraindication- in this case I felt that it was better to be able to see his rhythm than to not. (Also the trauma issue is also a relative contraindication (only to be used if you think a medical event caused the incident that caused the traumatic injury)). But to answer the question about placing defib pads on conscious patients, no it's not common practice, unless you feel that you are going to be needing them shortly. :lol: