# Just broke the seal on an airline jump kit



## webster44 (May 10, 2010)

Tonight as I was flying back home I had the opportunity to work on a patient and open the Delta airline "jump kit" I had always been a bit curious what they carried so I thought I'd share the story.

   As we approached for our night landing the cabin lights were turned off. Then I noticed the light in the back went on. I looked back and saw the flight attendant leaning over a seat and looking worried. I immediately knew I was about to be called into action. She asked for a medical professional on the intercom. I rushed to the back - was presented with an unresponsive pt. A doctor came too. I asked the flight attendant for their kit and O2 tank. I took the head in assessing the pt. 
   I worked well with the doctor. 
   Once landing a paramedic unit boarded and took the pt.

   Our handling of the situation was pretty good. The bumpy landing while in the aisle with the pt was rough but I held on tight to the O2 tank.

    There was a problem with the O2. Even though there was a ambu bag with O2 tubing in the kit, there was not the proper connection to hook it to the tank.(it was not a barbed connector. it was some kind of recessed female attachment)  We had to use one of those masks that drop to the seats.

    Bag specifics - It was about 20"x6"x12"  It contained:

Ambu bag with three sized face masks
IV catheters, syringes, Bag of fluid(don't remember what) 
Sharps container
BP / Stethoscope
Full bag of drugs(didn't pay attention to what they were)
There was alot of other stuff but I was focused on just what I needed. The flight attendant also brought me an A.E.D.

As I was leaving the flight attendant just asked me for my name, cert, and phone number.

Hope the info is helpful.


----------



## JPINFV (May 10, 2010)

Did it look like the connector on the left?

Also, a few quick questions. What level are you? What did the physician do?


----------



## MGary (May 10, 2010)

It won't let me paste the picture into this, but I found a list of what was contained in those medical kits. It's basically an Intermediate(85) jump kit, with some I-99 meds. 

It contains a 500cc bag of NS, line, IV caths, IM needles, Benadryl, D-50, Nitro tabs, Epi 1:1,000, Epi 1:10,000, ASA, Bronchodilator MDI (doesn't specify if Duoneb, albuterol, or what) and ampules of Lidocaine. It also contains basic airway management (BVM, OPAs,) and they must carry an AED. 

It says that it contains instructions on the use of these drugs, but does anybody besides me think that this should be limited to an I-85 at least? (And why Lido? Plan on treating arrythmias at 30,000 ft? It's not even hangable for post-resusc and I'm sure as hell not going to try and calculate the injection volume and then drip rate to put it in the NS bag) 

Thoughts? Concerns? Personally, I wouldn't want some idiot giving me or my family 20mg of Lido with no idea what the MOA of Lido even is or what it's used for and going off of a little instruction booklet. This should be limited to I-85 and above, and take out the damn lido. And replace the 1:10,000 with an Epi-pen and Epi-pen jr. Not every flight will happen to have a medic on it.


----------



## akflightmedic (May 10, 2010)

Save your typing....

http://emtlife.com/showthread.php?t=12873&highlight=emergency+airline

http://emtlife.com/showthread.php?t=10208&highlight=emergency+airline

http://emtlife.com/showthread.php?t=575&highlight=emergency+airline

http://emtlife.com/showthread.php?t=554&highlight=emergency+airline


----------



## emt_irl (May 10, 2010)

MGary said:


> It won't let me paste the picture into this, but I found a list of what was contained in those medical kits. It's basically an Intermediate(85) jump kit, with some I-99 meds.
> 
> It contains a 500cc bag of NS, line, IV caths, IM needles, Benadryl, D-50, Nitro tabs, Epi 1:1,000, Epi 1:10,000, ASA, Bronchodilator MDI (doesn't specify if Duoneb, albuterol, or what) and ampules of Lidocaine. It also contains basic airway management (BVM, OPAs,) and they must carry an AED.
> 
> ...


is that on all delta airline planes? wondeer how the legalities would work there.. as in flight takes off from dublin airport does u.s or irish law apply in regards to patient care?


----------



## Scout (May 10, 2010)

webster44 said:


> Tonight as I was flying back home.....




Well done i'm sure they appreciated it.

EMT AFAIK, you could be in international territory and just ask for a doc to be put on the phone and do as he says.

If you look back in the above threads someone has posted their experiences of using this stuff, AK maybe?


----------



## JPINFV (May 10, 2010)

MGary said:


> Thoughts? Concerns? Personally, I wouldn't want some idiot giving me or my family 20mg of Lido with no idea what the MOA of Lido even is or what it's used for and going off of a little instruction booklet. This should be limited to I-85 and above, and take out the damn lido. And replace the 1:10,000 with an Epi-pen and Epi-pen jr. Not every flight will happen to have a medic on it.



On the other hand, it's very likely that there will be some sort of medical professional around. It's not like medics are the only person who can provide emergency care. Additionally, all airplanes are going to be able to patch you through to a contracted medical control center on the ground.


----------



## Shishkabob (May 10, 2010)

Get rid of Epi 1:10?  For what reason?


----------



## medicdan (May 10, 2010)

webster44 said:


> Tonight as I was flying back home I had the opportunity to work on a patient and open the Delta airline "jump kit" I had always been a bit curious what they carried so I thought I'd share the story.
> 
> As we approached for our night landing the cabin lights were turned off. Then I noticed the light in the back went on. I looked back and saw the flight attendant leaning over a seat and looking worried. *I immediately knew I was about to be called into action.* She asked for a medical professional on the intercom. *I rushed to the back * - was presented with an unresponsive pt. A doctor came too. I asked the flight attendant for their kit and O2 tank. I took the head in assessing the pt.
> I worked well with the doctor.
> ...


Um...?


----------



## Veneficus (May 10, 2010)

the transatlantic airlines are much better stocked, they have a "doctor's medical kit" as well as a basic one for non health care providers. I had the opportunity to open one of Lufthansa's they had all kinds of stuff, including heparin and an intubation kit. Nice drug cards with english on one side and german on the other. 

Since nobody on board spoke whatever language he did, we eventually figured out he had a headache and wanted something for it. Ultimately he got 2 asparin from the kit)

The only medical people on board was myself and another medic. By some strange coincidence, we were sitting next to each other. I respectfully declined the gift, since I didn't do anything that was remotely worthy of a reward. 

When I spoke to the German medical control doc his only question was: "Do we have to make an emergency landing?" After I said "no" he thanked me and hung up.


----------



## usafmedic45 (May 10, 2010)

emt_irl said:


> is that on all delta airline planes? wondeer how the legalities would work there.. as in flight takes off from dublin airport does u.s or irish law apply in regards to patient care?



Having rendered assistance on a couple of trans-Atlantic flights, the rule is generally that if you are credentialed in the country of origin or the country of destination, you are covered (just like with interstate ground or aeromedical transports).  That said, no one else I know who has offered assistance has ever caught hell for not having a credential meeting the requirements mentioned above.



> the transatlantic airlines are much better stocked, they have a "doctor's medical kit" as well as a basic one for non health care providers. I had the opportunity to open one of Lufthansa's they had all kinds of stuff, including heparin and an intubation kit. Nice drug cards with english on one side and german on the other.



I've had to work a near-code on board a Lufthansa flight.  They are one of my favorite airlines to fly because they are so well prepared for an in-flight emergency.


----------



## usafmedic45 (May 10, 2010)

> I immediately knew I was about to be called into action. She asked for a medical professional on the intercom. I rushed to the back  - was presented with an unresponsive pt.



LOL I don't rush anywhere onboard aircraft.  The last thing I want is to meet a pissed off sky marshall.  Never intervene until asked.  If you want to be proactive, tell the flight attendants when you get on the plane that you're willing to help in an emergency. I make a point to do this.


----------



## usafmedic45 (May 10, 2010)

> Personally, I wouldn't want some idiot giving me or my family 20mg of Lido with no idea what the MOA of Lido even is or what it's used for and going off of a little instruction booklet. This should be limited to I-85 and above, and take out the damn lido. And replace the 1:10,000 with an Epi-pen and Epi-pen jr. Not every flight will happen to have a medic on it



The flight attendants are trained to not allow someone to render above BLS care unless they can prove they are a medical professional.  I've had to produce credentials on any time I've had to offer assistance.  

Besides, 1:10,000 in an Epi-Pen isn't any good in a cardiac arrest. Epi is the only drug likely to offer any appreciable benefit in cardiac arrest outcomes, so removing it from the drug bag is a really stupid thing to do.


----------



## webster44 (May 10, 2010)

JPINFV said:


> Did it look like the connector on the left?
> 
> Also, a few quick questions. What level are you? What did the physician do?




No. it didn't. There was this metal flap valve that I had to pivot, and then insert the connector.

I'm a Basic.

I took the lead in assessing the pt. The doctor told me to perform jaw thrust in order to stimulate a response. I also performed a sternum rub but he told me to stop. I set up I.V. Supplies but he declined to use it. When the medics arrived I gave the report and then the doctor disappeared. 

I was very quick to act and suggested to the doctor to put in an I.V. because I work for the dept that that responded to the call. I knew that they would put one in anyway.

   Additionally I felt comfortable in immediately responding as I am licensed specifically in the location the plane was landing.


----------



## webster44 (May 10, 2010)

usafmedic45 said:


> LOL I don't rush anywhere onboard aircraft.  The last thing I want is to meet a pissed off sky marshall.  Never intervene until asked.



I didn't leave my seat until the flight attendant asked for assistance.
Since the plane was moments away from landing I did move very quickly.


----------



## usafmedic45 (May 10, 2010)

webster44 said:


> I didn't leave my seat until the flight attendant asked for assistance.
> Since the plane was moments away from landing I did move very quickly.


If the plane was truly moments away from landing (in other words, gear down on short final), I would not have left my seat until we were on the ground.


----------



## medic417 (May 10, 2010)

webster44 said:


> She asked for a medical professional on the intercom.



We should put your response and actions in that funniest thing heard/seen discussion.  

I hope you did not come across in real life the way you did on here.  

Oh and she wanted your name and other not for a hot date with her but for the patients lawyer that will be contacting you soon.


----------



## Melclin (May 10, 2010)

webster44 said:


> I immediately knew I was about to be called into action. She asked for a medical professional on the intercom. I rushed to the back - was presented with an unresponsive pt.
> ....
> Our handling of the situation was pretty good. The bumpy landing while in the aisle with the pt was rough but I held on tight to the O2 tank.
> 
> ...





webster44 said:


> I took the lead in assessing the pt. The doctor told me to perform jaw thrust in order to stimulate a response. I also performed a sternum rub but he told me to stop. I set up I.V. Supplies but he declined to use it. When the medics arrived I gave the report and then the doctor disappeared.
> ...
> I was very quick to act and suggested to the doctor to put in an I.V. because I work for the dept that that responded to the call. I knew that they would put one in anyway.



Haha, oh mate, calm down. All this talk of rushing into action and saving the day with you jaw thrusts.... 

Its nice that you helped and that you're proud of yourself but maybe tone down the action man narrative, eh. Did you ever actually assess the patient? What was wrong with him?


----------



## Flight-LP (May 10, 2010)

webster44 said:


> I'm a Basic.
> 
> I took the lead in assessing the pt.



You = EMT-B. Physician = someone with better assessment abilities. Your statement is false.



webster44 said:


> I also performed a sternum rub but he told me to stop.



Because a sternal rub is generally not appropriate.



webster44 said:


> I set up I.V. Supplies but he declined to use it.



Good thing you gave your information. That way Delta can send you the bill for wasting their supplies.



webster44 said:


> I was very quick to act and suggested to the doctor to put in an I.V. because I work for the dept that that responded to the call. I knew that they would put one in anyway.



Again, you = EMT-B, him = physician. Let me know how your suggestion worked out for you. 



webster44 said:


> Additionally I felt comfortable in immediately responding as I am licensed specifically in the location the plane was landing.



Are you licensed? Or certified?

Sounds like Delta needs to review their policies about soliciting medical assistance from those with minimal medical education. The BVM without supplemental O2 would have provided better ventilatory support in comparison to a mask that was flowing at a max of 4LPM.


----------



## usafmedic45 (May 10, 2010)

Thank you...I wasn't about to risk getting an infraction for calling BS on this thread.  LOL


----------



## JPINFV (May 10, 2010)

Flight-LP said:


> Are you licensed? Or certified?



You know, to be honest, I'm not even sure that most politicians know the difference. As such, anything coming from the government that grants an other wise restricted practice is a license, regardless of the noun used to describe it.


----------



## the_negro_puppy (May 11, 2010)

lol action man, care to tell us what was actually wrong with the pt?


----------



## webster44 (May 11, 2010)

Ok so i want to provide some more info.

Pt:
   Unresponsive 19 year old male - Adequate breathing, slightly thready pulse, bp 80 by palp. He was with his school group(some sort of honors scholastic team) not responsive to pain. Chaperon was unable to provide any additional medical history - he had eaten earlier in the day.

    Medic checked his blood sugar and came in at 60.
    So what was wrong with him?...  I don't know - i'm just a basic <_<


Ambu bag - The reason i wanted to use the ambu was because I would prefer to have a clear face mask as opposed to the yellow airline thing - I'm not sure what the flow rate was on o2 that I did use as it was just on or off.
I never really considered assisting with ventilation.

The physician asked me to preform a jaw thrust - I thought a head tilt would have been fine - I thought that a sternum rub would be appropriate but the doctor told me to cease - Any reason why it would be inappropriate?
While I recognize that a doctor is alot higher then me on the food chain I am still going to interact with him and make my own opinions known. I don't know him or his skill level. Heck he might by an eye doctor who hasn't been in a hospital and 40 years. (and he does not know me either)
But of course I will defer to his decisions. 

I acted within my scope of practice

While I can see how my post has a certain action hero quality to it I was calm and deliberate in my actions - I have been an EMT for many years and worked in multiple major metropolitan city's- I'm used to serious medical and trauma situations alike. I don't think I over reacted or acted outside my scope 

From my understanding - I am certified by National Registry, and my state. For my individual municipality, and the location of the airport I am licensed under my medical director.

Any other questions?  B)   .....


----------



## lightsandsirens5 (May 11, 2010)

emt_irl said:


> is that on all delta airline planes? wondeer how the legalities would work there.. as in flight takes off from dublin airport does u.s or irish law apply in regards to patient care?


 
I would guess this; US airline, US flagged aircraft, US crew = US Law.

But I dunno for sure.

~~~~~~~~~~~~~~~~~~~~

And for god's sake, stop brow beating the guy. Maybe he did a few things wrong, but seriously..........some people on here actually have a heart to help others. To them medicine (however little they know) is actually about caring for people, not just a job.

Now I run like heck to avoid the coming storm.....h34r:


----------



## usafmedic45 (May 11, 2010)

> To them medicine (however little they know) is actually about caring for people, not just a job.



Actually it's a job that happens to involve providing care to people.  You don't actually have to care _for_ them or _about_ them to provide care _to_ them.  There are a lot of patients I've crossed paths with that I honestly believe the world would be better off without, but that's a topic for another discussion. 

I don't think any of us have a problem with him helping.  We have a problem with the quasi-"Trauma", quasi-Jack Bauer style description of how he really didn't do much when it comes down to it.  I really can't fault him for anything else. LOL


----------



## EMTtoBE (May 11, 2010)

I'm still an EMT-B student and we were always told never do a sternum rub...we were taught a gentle shake...never understood why


----------



## usafmedic45 (May 11, 2010)

EMTtoBE said:


> I'm still an EMT-B student and we were always told never do a sternum rub...we were taught a gentle shake...never understood why


It's overkill.  You can achieve the same end result with a lot less force and pain.  A jaw thrust for example will get the patient to respond if they are going to, plus it can provide an airway.  In my book, I'd rather be sternal rubbed than have a jaw thrust done on me, but other's mileage may vary.

There is also some who speculate that sternal rubs could pose a risk of aggravating spinal injuries.  I'm not so sure I believe that one, but I've heard it repeated a few times.


----------



## EMTtoBE (May 11, 2010)

Thanks for making it more clear..I don't see how it can affect a spinal injury..but thank you


----------



## clibb (May 11, 2010)

usafmedic45 said:


> It's overkill.  You can achieve the same end result with a lot less force and pain.  A jaw thrust for example will get the patient to respond if they are going to, plus it can provide an airway.  In my book, I'd rather be sternal rubbed than have a jaw thrust done on me, but other's mileage may vary.
> 
> There is also some who speculate that sternal rubs could pose a risk of aggravating spinal injuries.  I'm not so sure I believe that one, but I've heard it repeated a few times.



How would it aggravate a spinal injury when the spine is not moved or interfered with at all through the sternum rub? Just a questions. I've been taught to use the sternum rub as the third alternative in getting a response from an unconscious patient. 
1) Voice or gentle shake if by-standers can confirm that the patient will not have a spinal injury.
2) Pinching
3) Sternum



EMTtoBE said:


> I'm still an EMT-B student and we were always told never do a sternum rub...we were taught a gentle shake...never understood why



I performed a sternum rub on one of my buddies when he was my patient for our Critical Exams. I got a nasty verbal response from him haha.


----------



## Melclin (May 11, 2010)

*Sternal Rubs are nasty.*







This kind of damage is common, or as rare as hens teeth depending on who you talk too. Anyway you look at it, it does not appear to be the favoured method of painifying your patient. The consensus seems to be that if you use the sternal rub properly (rubbing hard for anywhere up to 30 seconds), you will do damage.

The painful stimuli of choice these days appears to be trap squeeze and supra-orbital pressure on account of the fact that they have a greatly reduced potential for causing nastiness.

I've never heard of the spinal injuries argument, though I've nothing for or against it. I have, however, always been a tad concerned about a pt's movement after a painful stimulus if I think they have a spinal injury.


----------



## emt_irl (May 11, 2010)

sternum rubs have been gone for years in ireland.. some people still use it but i reckon it could be classed as assualt. we can pinch the ear lobe(very effective ive found) or try get a pain stimulus from the back of hand or finger.


----------



## joeshmoe (May 11, 2010)

It would seem to me a jaw thrust alone would be a pretty good way to evoke a pain response. 

So what was even wrong with the patient? No real information aside from they were unresponsive. 

Were there snakes on the plane?

EDIT: oops my bad I missed the post where the OP clarified the situation a little


----------



## usafmedic45 (May 11, 2010)

> How would it aggravate a spinal injury when the spine is not moved or interfered with at all through the sternum rub?



No clue. Just a rumor I have heard several times.


----------



## Veneficus (May 11, 2010)

usafmedic45 said:


> No clue. Just a rumor I have heard several times.



I had somebody scream at me then write me up in EMS saying that testing for a Babinski reflex would so the same thing...

We really have to start a petition to make the test harder.


----------



## LondonMedic (May 11, 2010)

webster44 said:


> Additionally I felt comfortable in immediately responding as I am licensed specifically in the location the plane was landing.


I would have felt particularly uncomfortable with you responding. I think you were very lucky to have that particular doctor there, I suspect many others (myself included) would have suggested that you return to your seat if you behaved in this way.


----------



## Seaglass (May 11, 2010)

Flight-LP said:


> You = EMT-B. Physician = someone with better assessment abilities. Your statement is false.



To be fair, I've seen some doctors who aren't very comfortable outside of a clinical setting. Maybe they practice in an unrelated specialty, maybe they want to observe before getting involved... it doesn't really matter. They know more, but they still might hang back at first. So I wouldn't call the OP a liar on that alone. 

Agreeing with the rest, though. And the bit about staying in the aisle for landing strikes me as odd on a commercial airline.


----------



## LondonMedic (May 11, 2010)

Seaglass said:


> To be fair, I've seen some doctors who aren't very comfortable outside of a clinical setting. Maybe they practice in an unrelated specialty, maybe they want to observe before getting involved... it doesn't really matter. They know more, but they still might hang back at first. So I wouldn't call the OP a liar on that alone.


Agreed, but they still hold (or will hold) clinical responsibility and should at least be asked if they mind.



> Agreeing with the rest, though. And the bit about staying in the aisle for landing strikes me as odd on a commercial airline.


Absolutely, unless the patient is in extremis (and salvageable), scene safety would be my first thought. I would at the very least have thought that loose or heavy kit (like a cylinder) should be secured.


----------



## usafmedic45 (May 11, 2010)

> I had somebody scream at me then write me up in EMS saying that testing for a Babinski reflex would so the same thing...
> 
> We really have to start a petition to make the test harder.



No kidding.


----------



## Veneficus (May 11, 2010)

LondonMedic said:


> Agreed, but they still hold (or will hold) clinical responsibility and should at least be asked if they mind.



If they are playing with the O2 bottle, they are busy with something other than getting in the way of patient care right? 

You know, like a kid, give them something to occupy the hands so you can do what you need without interruption?


----------



## usafmedic45 (May 11, 2010)

Veneficus said:


> If they are playing with the O2 bottle, they are busy with something other than getting in the way of patient care right?
> 
> You know, like a kid, give them something to occupy the hands so you can do what you need without interruption?


I would always ask them to assess breath sounds or "read" an EKG for me on scene.  It makes them look good and keeps them out of my way.


----------



## MMiz (May 11, 2010)

Exciting!  I too had the opportunity to use a Delta (Northwest Airlines) jump kit, and it was loaded.

Regarding the O2 tubing on the BVM, it was not made to hook up to airline O2 cylinders, and you're limited to using the masks they provide.

Regarding the use of drugs, they only unlocked it after contacting med control (Mayo Clinic service), and as an EMT-Basic I was only allowed to administer nitroglycerin.

Even though my patient was pretty out of it (suspected MI) he was secured in a seat for landing with my seated across the aisle with the O2.  All other supplies were strapped into the seat next to me.

It was definitely an exciting experience, and it sounds like you did a great job.  Did you get a certificate/brochure with 5,000 free miles?  I still have mine.


----------



## usafmedic45 (May 11, 2010)

> Did you get a certificate/brochure with 5,000 free miles? I still have mine.



Nice. I have a card somewhere that entitles me (and one person flying with me) to an upgrade to first class on Star Alliance flights because of the case I handled on a Lufthansa flight.


----------



## clibb (May 11, 2010)

Seaglass said:


> To be fair, I've seen some doctors who aren't very comfortable outside of a clinical setting. Maybe they practice in an unrelated specialty, maybe they want to observe before getting involved... it doesn't really matter. They know more, but they still might hang back at first. So I wouldn't call the OP a liar on that alone.
> 
> Agreeing with the rest, though. And the bit about staying in the aisle for landing strikes me as odd on a commercial airline.



One of my instructors told that she had a patient collapse on a football field during a game and an OBGYN doctor told her that he is in charge of the patient. She politely asked him to step away from her patient.
She is Nurse and a EMT, though.



Melclin said:


> This kind of damage is common, or as rare as hens teeth depending on who you talk too. Anyway you look at it, it does not appear to be the favoured method of painifying your patient. The consensus seems to be that if you use the sternal rub properly (rubbing hard for anywhere up to 30 seconds), you will do damage.
> 
> The painful stimuli of choice these days appears to be trap squeeze and supra-orbital pressure on account of the fact that they have a greatly reduced potential for causing nastiness.
> 
> I've never heard of the spinal injuries argument, though I've nothing for or against it. I have, however, always been a tad concerned about a pt's movement after a painful stimulus if I think they have a spinal injury.



Holy crap! Are we even talking about the same sternum rub? I mean using your knuckles and rubbing on their sternum. Not rubbing so hard that there would be damage. Also, I wouldn't rub for 30 seconds. If you're not going to get a response within the first 5-10 sec, then why would you at 30?


----------



## mycrofft (May 11, 2010)

*What was "pulling the oxygen mask" like?*

They're very "exothermic", a unlabeled load of them started to light off in the cargo section and took down a cargo jet some years ago.

PS: I have had pt's who know how to withstand a humane sternal rub without flinching. I'm still a proponent of the prompt, reasoned, very transitory and unannounced delivery of an ammonia inhaler by the nose.


----------



## JPINFV (May 11, 2010)

clibb said:


> One of my instructors told that she had a patient collapse on a football field during a game and an OBGYN doctor told her that he is in charge of the patient. She politely asked him to step away from her patient.
> She is Nurse and a EMT, though.



Was the nurse a bystander or employed/contracted by the school to provide a medical response?


----------



## JPINFV (May 11, 2010)

mycrofft said:


> They're very "exothermic", a unlabeled load of them started to light off in the cargo section and took down a cargo jet some years ago.



ValueJet in Florida...


----------



## Veneficus (May 11, 2010)

clibb said:


> One of my instructors told that she had a patient collapse on a football field during a game and an OBGYN doctor told her that he is in charge of the patient. She politely asked him to step away from her patient.
> She is Nurse and a EMT, though.



Contracted or not, OB/GYN is still a physician, a surgical discipline at that.

It seems quite foolish to ask him to step away from the patient, much less tell him to. But I should come to expect such behavior from a nurse. Too much propaganda surrounding them.


----------



## JPINFV (May 11, 2010)

Veneficus said:


> Contracted or not, OB/GYN is still a physician, a surgical discipline at that.
> 
> It seems quite foolish to ask him to step away from the patient, much less tell him to. But I should come to expect such behavior from a nurse. Too much propaganda surrounding them.




The thing with being contracted is that if she is, then she has legitimacy to be there and in charge. To compare this to formal EMS, most EMS systems require online medical control before handing over a patient to a physician on scene, however a nurse cannot walk up and demand to care for a patient. However, if the RN was not contracted or on duty in any sense of the term, then the RN is a bystander whereas the physician, with an unrestricted license to practice medicine, is free to practice medicine whenever and wherever he feels fit to do so. That, alone, is a very serious technicality that is often overlooked in any physician on scene scenario since it's a major difference between physicians and other nursing or allied health providers.


----------



## Veneficus (May 11, 2010)

JPINFV said:


> The thing with being contracted is that if she is, then she has legitimacy to be there and in charge. To compare this to formal EMS, most EMS systems require online medical control before handing over a patient to a physician on scene, however a nurse cannot walk up and demand to care for a patient. However, if the RN was not contracted or on duty in any sense of the term, then the RN is a bystander whereas the physician, with an unrestricted license to practice medicine, is free to practice medicine whenever and wherever he feels fit to do so. That, alone, is a very serious technicality that is often overlooked in any physician on scene scenario since it's a major difference between physicians and other nursing or allied health providers.



I don't think it is a question of authority, but a question of turning away good help. Most physicians (even the ones I don't like) are rather reasonable. Pointing out you are the contracted responder will usually suffice. But to send a physisican packing because you want to clearly demontrate who is in charge, is not doing what is best for the patient.


----------



## JPINFV (May 11, 2010)

Veneficus said:


> But to send a physisican packing because you want to clearly demontrate who is in charge, is not doing what is best for the patient.



You mean that medicine is about the patient? Heck if there is a common theme between all physician on scene threads (including doctor's office calls), it's that everyone loves demonstrating how they can be superior to the dumb doctor.


----------



## EMSLaw (May 11, 2010)

JPINFV said:


> You mean that medicine is about the patient? Heck if there is a common theme between all physician on scene threads (including doctor's office calls), it's that everyone loves demonstrating how they can be superior to the dumb doctor.



I would say many things about the doctor's I've known.  Like any population, they have a whole range of positive and negative personality traits.  But I doubt any of them are dumb.

If anything, the problem I've seen with doctors at the scene of an emergency out of the hospital is that they know too much, and are paralyzed trying to sort through it all in a few seconds.  EMTs have the benefit of their ignorance.  Treat the symptoms, stabilize, and get to the hospital.  

One course I've taken discussed clarity versus precision.  At the EMS level, you need only clarity - you need to pick out which bucket of gross injury and illness types the patient falls into, and then act according to the protocol for that gross injury or illness type (difficulty breathing, trauma, possible cardiac, etc.)  Physicians, who diagnose and treat in the long term, require precision - the determination of exactly what is wrong with the patient.  You can't get precision on the side of a highway in dim light with no lab tests and traffic rushing by at fifty miles an hour.  

Anyway, just my two cents.


----------



## JPINFV (May 11, 2010)

I don't buy that argument because 10 miutes later you're going to be handing off to a physician who's going to be concerned about both the immediate (now), short term (next few hours), and long term (days/admission) needs. It's not like you hand off to a nurse or paramedic at the ER and the physician only comes when the lab results are back. This isn't to say that all phsyicians are capable at providing emergency care any more than all physicians can do open heart surgery, however I can point to numerous threads with chest beating about how the EMT or paramedic was "smarter" than the physician.


----------



## clibb (May 11, 2010)

Veneficus said:


> Contracted or not, OB/GYN is still a physician, a surgical discipline at that.
> 
> It seems quite foolish to ask him to step away from the patient, much less tell him to. But I should come to expect such behavior from a nurse. Too much propaganda surrounding them.



She did that so she could provide "on the field" care. After that the physician took care of it. Sorry for not providing that part. 

But if it was me on a plane. I would ask the physician to provide the care for the patient while I'm there to assist him.


----------



## EMSLaw (May 11, 2010)

JPINFV said:


> I don't buy that argument because 10 miutes later you're going to be handing off to a physician who's going to be concerned about both the immediate (now), short term (next few hours), and long term (days/admission) needs. It's not like you hand off to a nurse or paramedic at the ER and the physician only comes when the lab results are back. This isn't to say that all phsyicians are capable at providing emergency care any more than all physicians can do open heart surgery, however I can point to numerous threads with chest beating about how the EMT or paramedic was "smarter" than the physician.



I see your point, though an emergency physician is something of a special case.  Still, though, a hospital is a different environment than on scene.


----------



## frdude1000 (May 11, 2010)

Can you guys just chill out?!??!?!  This guy was sharing his experience of HELPING somebody that he didn't have to.  You don't have to bust his brains out over it.  People don't follow rules they learned in kindergarten; if you don't have anything nice to say, don't say it at all!!!  Some people on here need to be a bit nicer to others.  There is a lot of Paramedic bullies, who think they are the sh*t because they have an associates degree from the local CC.  Let the guy share his exciting experience; when I tried to share one of mine, everybody blew up on me too.


----------



## JPINFV (May 11, 2010)

frdude1000 said:


> Can you guys just chill out?!??!?!  This guy was sharing his experience of HELPING somebody that he didn't have to.  You don't have to bust his brains out over it.  People don't follow rules they learned in kindergarten; if you don't have anything nice to say, don't say it at all!!!  Some people on here need to be a bit nicer to others.




You know, if I tell a story and I make a mistake, I want people to call me on it. You can't fix issues that you don't know is broken. Similarly, there should be back and forth over issues because depending on the information available, multiple people might have multiple views on what should have been done. 

Also, I'll make sure to tell my attendings to be nice to me when I start clerkships. I'm sure that'll go over like a lead balloon.


----------



## frdude1000 (May 11, 2010)

Your absolutely right JPINFV.  But do we need pages and pages of posts of this?  I don;t think so.  And was one positive thing said?  I dont think so.  A critique includes POSITIVES and deltas, things that should have changed.


----------



## joeshmoe (May 11, 2010)

frdude1000 said:


> Can you guys just chill out?!??!?!  This guy was sharing his experience of HELPING somebody that he didn't have to.  You don't have to bust his brains out over it.  People don't follow rules they learned in kindergarten; if you don't have anything nice to say, don't say it at all!!!  Some people on here need to be a bit nicer to others.  There is a lot of Paramedic bullies, who think they are the sh*t because they have an associates degree from the local CC.  Let the guy share his exciting experience; when I tried to share one of mine, everybody blew up on me too.



Frdude....I dont think theres anything wrong with constructive criticism. The OP is (according to him) a professional EMS provider. It wasnt like he was just a good samaritan. Some things in the story seemed kind of immature and unprofessional, at least to me. It might just be the way he's retelling the incident, kind of embellishing his role. In reality he probably did an ok job.

Most EMT's are pretty aware of how little training and knowledge we have compared to other health care professionals, especially a physician. But there seem to be a few that arent completely aware, or maybe are in denial.  This could potentially get themselves in trouble outside of work, maybe harm a patient, or at least make themselves look foolish. 

Besides, thats just how forums like this work I think. Anyone who posts enough is eventually gonna get flamed by others, nature of the beast.


----------



## Seaglass (May 11, 2010)

The only time I'd be comfortable with a lesser authority telling a physician to back off is if there's a really good reason. Like, the doctor's drunk. 



LondonMedic said:


> Agreed, but they still hold (or will hold) clinical responsibility and should at least be asked if they mind.



I agree, but I'm giving the OP the benefit of the doubt on the details.


----------



## Melclin (May 12, 2010)

JPINFV said:


> I don't buy that argument because 10 miutes later you're going to be handing off to a physician who's going to be concerned about both the immediate (now), short term (next few hours), and long term (days/admission) needs. It's not like you hand off to a nurse or paramedic at the ER and the physician only comes when the lab results are back. This isn't to say that all phsyicians are capable at providing emergency care any more than all physicians can do open heart surgery, however I can point to numerous threads with chest beating about how the EMT or paramedic was "smarter" than the physician.



They do however, have the benefit of a controlled and familiar environment, with all the gear they need and plenty of nurses.

Certainly a lot of physicians would be perfectly capable in EMS, but I'm quite sure they would often have to take moments to absorb the differences. I'm always struck at how much clearer a pt's condition is when they have, plenty of light, a nice set of vitals appearing regularly and automatically on the screen above their bed, a proper 12 lead (instead of our stupid bloody ones all squeezed onto a rhythm strip), and history, meds, and working diagnosis laid out in front of you. 

I also completely agree about being hamstrung by their knowledge. I tripped over the knowledge I had as a paramedic student when I started doing volly first aid. It wasn't rocket science to figure out but, it takes a minute to rearrange your mind to figure out your management, when you don't have say..blood pressure...or a monitor... or people don't answer your questions honestly because you're just a first aider and not a trustworthy figure like a paramedics, nurse or doctor. I imagine doctors would have to make similar simple but significant adjustments when all of a sudden they didn't have a ED to play with. Which could prove especially difficult if they were watching the footy one moment and then all of a sudden they have to deal with an unconscious head injured seizing footballer with unfamiliar gear, little or no support, and its been 10 years since they did that because they're a GP now and haven't dealt with a seriously ill person since St Kilda won the flag (a long time ago ;-) ). Better to let the paramedics do what they're supposed to and offer helpful advice and assistance where needed, I think. This is not a "dumb doctor" argument, its just a matter of adjusting to a new working environment.


----------



## Shishkabob (May 12, 2010)

usafmedic45 said:


> If you want to be proactive, tell the flight attendants when you get on the plane that you're willing to help in an emergency. I make a point to do this.



You do?  What's the usual reaction?


I'd feel like they'd view me was a whacker if I went up and said "I'm a Paramedic if you need help".


----------



## JPINFV (May 12, 2010)

Linuss said:


> You do?  What's the usual reaction?
> 
> 
> I'd feel like they'd view me was a whacker if I went up and said "I'm a Paramedic if you need help".



This. Hell, I feel like a wacker as it is walking from my car to the clinic in my lab coat. I can't imagine getting on a ____ and telling anyone that I'm a EMT.


----------



## rescue99 (May 12, 2010)

Heck, I just sit back and enjoy the ride! Never had an incident occur on a plane but I do teach corporate pilots from time to time. Always wondered who'd fly the plane if something happened ^_^


----------



## usafmedic45 (May 12, 2010)

Linuss said:


> You do?  What's the usual reaction?
> 
> 
> I'd feel like they'd view me was a whacker if I went up and said "I'm a Paramedic if you need help".


Usually it's something to the effect of "Thank you so much. It's nice to know we have help if we have a sick passenger."  Twice, when I've said this, the flight attendants have offered me a better seat after everyone got on board.  One of these got me a seat in business class on a 757.  Given the cattle car feel of most airlines nowadays, anything to help get a more comfortable seat is fine by me.

What is nice is when I check in for Lufthansa flights, apparently my account is flagged as a result of what happened (I assume it's flagged because the counter personnel look at the screen, look up and start kissing my butt without me having to mention my upgrade card).  Pretty much I get put to the front of the boarding queue and will get an upgrade whenever a better seat is available.


----------



## Seaglass (May 12, 2010)

JPINFV said:


> This. Hell, I feel like a wacker as it is walking from my car to the clinic in my lab coat. I can't imagine getting on a ____ and telling anyone that I'm a EMT.



Same... and I don't think my opinion will change after medic school. I feel like a whacker just wearing an EMS t-shirt around.


----------



## EMTinNEPA (May 12, 2010)

When I read this, I can't help but think of the Janitor from Scrubs...



> I guess I just never realized how you pick up just from working here. I heard someone yell 'Hold that woman's legs down!' and I instinctively knew what to do.


----------



## JPINFV (May 12, 2010)

EMTinNEPA said:


> Pt. Assessment [X], IV therapy [X], Pharmacology [X], ITLS [X], Pulmonology [X], ACLS [X], Neonatal Resuscitation [X], Obstetrics and Gynecology [ ], PALS [ ], Endocrinology [ ], Hematology [ ], Infectious Disease [ ], Final Exam [ ], NREMT-P Practical [ ], NREMT-P Written Exam [ ]



:unsure:


----------



## EMTinNEPA (May 12, 2010)

JPINFV said:


> :unsure:



^_^:beerchug:


----------



## lmiller081084 (May 17, 2010)

*Here are some answers for everyone*

Delta has and has had a contract with UPMC (University of Pittsburgh Medical Center) for a while now.

New Rules:

XMK/EEMK Usage: Expands Captain’s authority by allowing Captain to authorize XMK/EEMK use by personnel who have (in the Captain’s judgment) the medical knowledge or skills necessary to use the kit. (Ref NW FOM 7.4.3 and DL FOM 7-4.3)

Albuterol (“Al-BU-ter-all”) Multi-Dose Inhaler (MDI)
Aspirin 325 mg	vs.	Acetaminophen 325 mg
Atropine (at-ro-peen)
Diphenhydramine (Dye-fen-hide-rah-mean)
Epinephrine (“Ep-ee-NEF-rin”)
Lidocaine (lye-doe-kane).
Nitroglycerine tablets


Cabin Medical Communication System Ships 7101 & Subsequent
A cabin medical communication system is installed to permit direct communication between the cabin and a ground based medical consultant using the first observer’s audio control panel.
In the cabin, six sets of communication jacks are installed on the Passenger Service Units above center seat rows 3, 12, 33, 40, 47 and 55.
A headset is provided for communication and is stored in the aft cabin overhead bin with the AED and EEMK equipment. The headset assembly includes a 12 foot cord, equipped with a Push-To-Talk switch. Once communication is established from the first observer's audio control panel, the cabin crew will have direct communication via the headset.


There are many more items included in the kit.  I will try to take some pictures and get some more items that are in the kit tomorrow at work.


----------



## CAOX3 (May 17, 2010)

What is the instances of medical emergencies in the air?  

Would it be proactive to have a paramedic on board during flights or would that be overkill?


----------



## Markhk (May 17, 2010)

Medics will love some of the weird things about the EMKs (Emergency Medical Kits) aboard US aircrafts...the Aviation Medical Assistance Act stipulates the placement of so called "enhanced" EMKs along with an AED aboard when there is at least 1 flight attendant but here are some strange things: 

- Although Dextrose 50% is required in the EMK, a glucometer is not
- Although Epi 1:10,000, Atropine and Lidocaine is required in the EMK, a cardiac monitor to let you know if you have VF/PEA/Asystole is not required. The onboard AED is not required to have an EKG screen
- Although syringes and needles are specified, IV catheters gauges are not. I have seen one airline EMK have two 16 G IV needles in their kit, and that was it.  (GO BIG OR GO HOME!) 
- As mentioned earlier, while an adult BVM is required, it is not required to have fittings that attach to the portable oxygen bottle (P.O.B.)
- Also, most of the aircraft POBs have two settings: LOW (4lpm) and HIGH (6lpm), so don't even bother about pulling out a non-rebreather. The two settings are meant for (i) first aid and (ii) decompression for the cabin crew to walk around to attend to people after the plane has leveled off from the emergency descent.   

Some airlines, thankfully, see beyond the minimum and choose to equip their fleet with more stuff. Some of the legacy airlines - such as British Airways - even carry some pretty extensive drugs, at one point even digoxin and nalbuphine was carried. It all depends on a carrier's national requirements, and then airlines can further decide to add addition stuff to the kit.


----------



## Markhk (May 17, 2010)

Linuss said:


> I'd feel like they'd view me was a whacker if I went up and said "I'm a Paramedic if you need help".



Not necessarily. Flight attendants are trained to locate "able bodied passengers" (aka ABPs) that may assist in an emergency (unplanned emergency landing, etc.). 

Amusingly enough though I've met a decent number of flight attendants who actually are EMTs, paramedics, ER nurses...I would say 90% of flight attendant training is emergency procedures related so EMS providers who become flight attendants are already used to the preparedness mindset.


----------



## MMiz (May 17, 2010)

lmiller081084,

Welcome to EMTLife and thanks for the information!  Is this going to be true on all former NWA ships too?

It was a pain having to use the interphone to relay information to the pilot, who then told me he was relaying it to the "Mayo Clinic" via radio.  Lots of details were lost, and it took some time for him to write everything down.

Again, welcome to EMTLife, and I sure would love to see those pictures!


----------



## mycrofft (May 17, 2010)

*This thread got interesting, thanks all!*

1. By law an aircraft is subject to laws of the territory it is flying over. No liquor over Nebraska on Sundays used to be funny. I suppose local EMS wold waive jurisdiction until landing.
2. Funny contents lists. I bet a committee must have taken a list then cut it down to save money space and weight, then gave their draft to a typist to make into a final product without review by medical authority.
3. If Lufthansa upgrades you, maybe SW will give me an extra pack of nut free snacklike food substance if I save someone?


----------



## LanCo EMT (May 17, 2010)

Some of the responses on this thread are the reason why I would never feel comfortable posting up anything that I do on the job. 

There is really no need to bash someone for doing the best job that they can do in the situation to try and help a Pt.


----------



## JPINFV (May 17, 2010)

LanCo EMT said:


> Some of the responses on this thread are the reason why I would never feel comfortable posting up anything that I do on the job.
> 
> There is really no need to bash someone for doing the best job that they can do in the situation to try and help a Pt.





JPINFV said:


> You know, if I tell a story and I make a mistake, I want people to call me on it. You can't fix issues that you don't know is broken. Similarly, there should be back and forth over issues because depending on the information available, multiple people might have multiple views on what should have been done.
> 
> Also, I'll make sure to tell my attendings to be nice to me when I start clerkships. I'm sure that'll go over like a lead balloon.


.


----------



## webster44 (May 17, 2010)

JPINFV said:


> .



I did feel that I was pretty bashed by certain posters. But I know that when I put something down in writing here that I am subject to that as I have seen it happen to others.

I do appreciate useful criticism.  I am always interested in improving my skills.
- Its really the only reason I read this board -

I'm proud to be an EMT and I'm proud of my performance in this incident.


----------



## usafmedic45 (May 17, 2010)

> a cardiac monitor to let you know if you have VF/PEA/Asystole is not required. The onboard AED is not required to have an EKG screen



The ones I have seen have had monitor screens.  We diverted to Iceland on one flight because the guy was in sustained VT.



> Amusingly enough though I've met a decent number of flight attendants who actually are EMTs, paramedics, ER nurses



I know one who flies (flew?) for Cathay Pacific who is trained as a physician (at the insistance of his family...he quit after completing an internal medicine residency because he hated the field).



> I have seen one airline EMK have two 16 G IV needles in their kit, and that was it. (GO BIG OR GO HOME!)


..or "Go EJ or go home!".


----------



## mycrofft (May 18, 2010)

*Original specs for "Stewardess" included a RN certificate.*

Be a beeatch if you divert and land only to find the ground EMS is no better than what you have on board.


----------



## usafmedic45 (May 18, 2010)

> Be a beeatch if you divert and land only to find the ground EMS is no better than what you have on board.



Note: do not land in Iceland.


----------



## mycrofft (May 18, 2010)

*Reyjavic General isn't as big as the Mayo Clinic, eh?*

I was thinking about Iceland, Azores, Los Angeles...


----------



## EMSLaw (May 18, 2010)

> ..or "Go EJ or go home!".



A man after my own heart.


----------



## medic417 (May 18, 2010)

Why the hard on for ej's they are just a peripheral vein.


----------



## Shishkabob (May 18, 2010)

medic417 said:


> Why the hard on for ej's they are just a peripheral vein.



Neck fetishes?


----------



## TraprMike (May 18, 2010)

linuss said:


> neck fetishes?



ez-io ftw


----------



## Shishkabob (May 18, 2010)

I love EZ-IOs.


However, in my companies infinite wisdom, we do not have IOs for anyone over 6yo...


----------



## adamjh3 (May 18, 2010)

Linuss said:


> I love EZ-IOs.
> 
> 
> However, in my companies infinite wisdom, we do not have IOs for anyone over 6yo...



Do they provide a reason as to why?


----------



## usafmedic45 (May 18, 2010)

> Reyjavic General isn't as big as the Mayo Clinic, eh?



I have no problem with the hospitals...it's the paramedics there that are, how to say it nicely, "distinctly lacking in the ability to play well with others".  



> Why the hard on for ej's they are just a peripheral vein.



It was a joke. 



> ez-io ftw



I love IOs.


----------



## MrBrown (May 18, 2010)

EMTinNEPA said:
			
		

> Pt. Assessment [X], IV therapy [X], Pharmacology [X], ITLS [X], Pulmonology [X], ACLS [X], Neonatal Resuscitation [X], Obstetrics and Gynecology [X], General Medical [ ], PALS [ ], Final Exam [ ], NREMT-P Practical [ ], NREMT-P Written Exam [ ]





JPINFV said:


> Anatomy [X] Head & Neck [X] MCBM [X] IDIT [X] Blood and Lymph [X] Neuo [X] Behavior and Psych [ ] Musculoskeletal [ ] SUMMER! [ ]



[  ] MBChB Part A (Years 1 and 2)
[  ] MBChB Part B (Years 3 and 4)
[  ] MBChB Part C (Trainee Intern Year)
[  ] PGY 1 (House Officer Year)
[  ] PGY 2 (Senior House Officer Year)
[  ] ANZCA Basic Training Year 1 
[  ] ANZCA Basic Training Year 2
[  ] ANZCA Advanced Training Year 1
[  ] ANZCA Advanced Training Year 2
[  ] ANZCA Advanced Training Year 3
[  ] ANZCA Fellow (Consultant Anaesthetist)

Medical school and fellowship.... 12 years, ~ $100,000 

[  ] Orange jumpsuit with "DOCTOR" on the back
[  ] Telling people "I am on the helicopter emergency service doctors"

PRICELESS ... FTW


----------



## usafmedic45 (May 18, 2010)

adamjh3 said:


> Do they provide a reason as to why?


You mean other than just generally having their heads in the sand?


----------



## adamjh3 (May 18, 2010)

usafmedic45 said:


> You mean other than just generally having their heads in the sand?



Well... yeah, but I suppose that will suffice. h34r:


----------



## webster44 (Jun 11, 2010)

Link to JEMS article

http://www.jems.com/article/patient-care/handling-flight-medical-emerge


----------



## usalsfyre (Jun 11, 2010)

EZ IO is expensive you know, Jamashidis are much cheaper.....


----------



## lmiller081084 (Jun 12, 2010)

No problem man.  Once all of the A/C have been updated to Delta standards (interiors, configurations), then all equipment will be modified so that all A/C have the same available equipment, and it will be easier for the crews to able to swap between aircraft.


----------



## emt_irl (Jun 13, 2010)

flying with delta myself on my u.s trip. never seen sign or any evidence of a jump kit being on the flight


----------



## FLEMTP (Jun 13, 2010)

TraprMike said:


> ez-io ftw



I like subclavian central lines 

MUCH more fun ... especially rolling down the road !


----------



## JPINFV (Jun 13, 2010)

emt_irl said:


> flying with delta myself on my u.s trip. never seen sign or any evidence of a jump kit being on the flight




The first aid equipment is normally kept in one of the off limits overhead bins. There should be a little O2 sign and first aid kit sign right underneath the bin.


----------



## MMiz (Jun 14, 2010)

emt_irl said:


> flying with delta myself on my u.s trip. never seen sign or any evidence of a jump kit being on the flight


In my case it was actually kept locked inside a locker inside an overhead bin at the back of the plane.  The lead flight attendant had to use a key to access both the AED and the drug box.  This was on a domestic U.S. flight on Northwest Airlines (now Delta).


----------



## akflightmedic (Jun 14, 2010)

emt_irl said:


> flying with delta myself on my u.s trip. never seen sign or any evidence of a jump kit being on the flight



Everytime I used it on Delta, the lead flight attendant had to be the one to retrieve it and she got it from somewhere in the rear of the plane. The kits were large, so I imagine they are in a locked rear overhead or stowed away in some compartment. These are not items you would ever pull yourself.


----------



## emt_irl (Jun 15, 2010)

ah i see, it got me thinking after reading this when i got on the plane. i just sat back and watched some movies though instead of worrying about it


----------



## MrBrown (Jun 15, 2010)

Its best not to worry mate .... unless this guy is seen entering the flight deck lol


----------

