# Flying as an EMR?



## busmonkey (Dec 16, 2010)

Hi there,

I was curious, do you guys tell Flight Attendants prior to boarding the aircraft, or do you wait and if there is an emergency, announce yourself? I am flying for the first time as an EMR (I have flown before, but not since my cert.) and I am curious if I should announce myself prior to boarding or what?

What do you guys think?

Thanks everyone

JB


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## skivail (Dec 16, 2010)

I wouldn't be surpirsed if the flight attendants had a very similar level of training.


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## jjesusfreak01 (Dec 16, 2010)

Is that a first responder level? If so, then yes, the attendants probably have a similar level of training, at least as far as the types of emergencies you can have on a plane go. If you tell them ahead of time, you will probably look like a whacker...

If they really need someone, they will ask, or you can offer when the emergency occurs. If you are an actual doctor on a larger plane, maybe on a transatlantic flight, it might be more appropriate to tell an attendant, as you are more likely to have a simple "sick" person on a long flight than a life-threatening emergency.


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## busmonkey (Dec 16, 2010)

Yes. Emergency Medical Responder will be one level above them, as they will have First Responder versus EMR which is an actual Paramedic level (as in I can work on Ambulances)... Yes I suppose if there is an emergency I will announce myself  Thanks for your help guys!!!

JB


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## Flight-LP (Dec 16, 2010)

Actually, most flight attendants receive specialized education on frequently encountered issues in flight. I place a lot more confidence in their abilities to assist vs. that of an EMT who has no knowledge of flight physiology or the nature of the aviation industry. Honestly, outside of CPR (which on an aircraft is frequently futile), what does the EMT / EMR level truly have to offer in flight?


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## jjesusfreak01 (Dec 16, 2010)

Flight-LP said:


> Actually, most flight attendants receive specialized education on frequently encountered issues in flight. I place a lot more confidence in their abilities to assist vs. that of an EMT who has no knowledge of flight physiology or the nature of the aviation industry. Honestly, outside of CPR (which on an aircraft is frequently futile), what does the EMT / EMR level truly have to offer in flight?



Totally depends on the injury. Commercial jets are pressurized to the equivalent of 8000ft or less, a lower altitude than say, Vail ski resort, so generally, pressure shouldn't be a huge issue unless someone has a sinus/ear infection or general airsickness (the two biggest medical problems unique to flying). You could hit a pocket of turbulent air and end up with 5 traumatic injuries. Someone could have a heart attack and need aspirin and calming down, speaking of which, someone could just be having a panic attack and need a talkdown. There are as many possible injuries in a plane as there are any other one place. An EMT could help with any one of these things, and although its possible the flight attendants would be perfectly capable of handling these situations, in some cases they might now be.


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## AnthonyM83 (Dec 16, 2010)

Don't announce yourself. On any given flight there will probably be other people aboard with equal and higher level of training (I'd bet money none announce themselves). 

Medical people are everywhere. One time I pulled out an intro to EKGs book. The person next to me smiled and pulled out an advanced EKG book for EMS that he was editing on his way to write test items for NREMT. Flight emergencies are relatively rare even for frequent fliers.


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## Flight-LP (Dec 16, 2010)

jjesusfreak01 said:


> Totally depends on the injury. Commercial jets are pressurized to the equivalent of 8000ft or less, a lower altitude than say, Vail ski resort, so generally, pressure shouldn't be a huge issue unless someone has a sinus/ear infection or general airsickness (the two biggest medical problems unique to flying). You could hit a pocket of turbulent air and end up with 5 traumatic injuries. Someone could have a heart attack and need aspirin and calming down, speaking of which, someone could just be having a panic attack and need a talkdown. There are as many possible injuries in a plane as there are any other one place. An EMT could help with any one of these things, and although its possible the flight attendants would be perfectly capable of handling these situations, in some cases they might now be.



O.k., I'll bite.................

1. So you have 5 traumatic injuries from turbulence, that is actually a quite rare occurance. Every commercial flight plan includes an up to date check of current weather and pilot reports. In other words, turbulence is very rarely an acute unknown issue. If clear air turbulence is reported or observed greater than light-moderate, the seat belt sign is going to go on. So that aside, what you going to be able to contribute that will improve the injured persons outcome that could not be provided by any other passenger on the plane or the flight crew?

2. The heart attack scenerio. Are you carrying the Aspirin? If not, how are you going to administer it? Are you appropriately credentialed to do so?

3. Same with the panic attack, others can offer the same level of assistance.

4. You are correct, pressure shouldn't be an issue, but in an emergency, it is a huge issue! The flight crew is well versed in the understanding of the physiology associated with flight. Much more so than an EMT-B and in many cases, an EMT-P. Case in point, i am interested in hearing your explanation as to where you came up with the 8,000ft. figure?

Yes, an EMT can be as assisting as anyone else, but the key here is dependent on if your help will be requested, accepted, or even allowed. That decision is made by the Captain and the decision he makes is the final word and law on that flight.

Your enthusiasm is admirable, just understand your limitations and look at the whole picture before flying down the aisle.


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## JPINFV (Dec 16, 2010)

Flight-LP said:


> Case in point, i am interested in hearing your explanation as to where you came up with the 8,000ft. figure?



Since I'm not sure if you're challenging the actual figure or the source for the figure, 8,000 was what we were told in lecture with the slide figure being sourced from _Respiratory Physiology – the essentials_, 8th ed.


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## JJR512 (Dec 17, 2010)

Here's what you do.

Wait until the steward/stewardess has just finished the pre-flight safety announcements and demonstrations, then stand up, and proclaim loudly for all to hear that you are a Trained Medical Professional so everyone can rest assured that they are Perfectly Safe. Then thank the steward/stewardess and remind him or her that if there are any problems, you're in seat # <whatever>.


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## JPINFV (Dec 17, 2010)

JJR512 said:


> Here's what you do.
> 
> Wait until the steward/stewardess has just finished the pre-flight safety announcements and demonstrations, then stand up, and proclaim loudly for all to hear that you are a Trained Medical Professional so everyone can rest assured that they are Perfectly Safe. Then thank the steward/stewardess and remind him or her that if there are any problems, you're in seat # <whatever>.



...and ignore the laughter from the physicians on the flight, because there's probably at least 1 on board.


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## Aidey (Dec 17, 2010)

I wouldn't volunteer the information unless there was some sort of in flight emergency and they were doing the whole "Is there a doctor on the plane" and it didn't appear that anyone was responding. 

I think JP is probably right, that there is usually at least one physician on board. The only question is what type they are. There was an story in JEMS or on one of the EMS websites about in flight emergencies, and in one of the cases there was a doctor on board, but it was someone who had been practicing Dermatology for the last 40 years and they deferred to the Paramedic.


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## ffemt8978 (Dec 17, 2010)

AnthonyM83 said:


> Don't announce yourself. On any given flight there will probably be other people aboard with equal and higher level of training (I'd bet money none announce themselves).
> 
> Medical people are everywhere. One time I pulled out an intro to EKGs book. The person next to me smiled and pulled out an advanced EKG book for EMS that he was editing on his way to write test items for NREMT. Flight emergencies are relatively rare even for frequent fliers.



I'll bet you didn't know you were seated next to RidRyder911.  h34r:


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## AnthonyM83 (Dec 17, 2010)

Haha.
I would be quite mad if he skipped the Dayton EMS cadaver workshop with the EMTCity crew to go write test questions! (That's why I was one the plane)


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## WTEngel (Dec 17, 2010)

I was on a flight from Chicago to DFW with my wife and mother in law last year when they asked if there were any nurse on board (they specifically asked for a nurse for whatever reason.)

My wife AND my MIL are both nurses (yes it was a ridiculously long weekend to say the least!)

Anyway, my MIL decides she wants to volunteer, which is hilarious, because she has not been in the clinical setting for at least 20 years (my father in law is a physician, so she was able to retire a long time ago.) At this point, my wife, who is a pediatric ICU nurse with 9 years of experience decided she better accompany the MIL and help.

Now don't get me wrong, when it comes to incredibly sick kids, my wife is second to none! Heart defects, cardiac surgeries, ECMO, you name it, she even has CCRN and all the alphabet soup... But even she will admit she doesn't like adults, and really doesn't care to have much to do with them.

So all this is to say that they get up and volunteer, I kind of linger in the background, and within about 30 seconds they decided they wanted a paramedic consult from me, apparently they really didn't know where to start.

Luckily, we hadn't pushed back from the gate yet, the patient was weak with a low blood pressure blah blah blah, so her family decided to take her off and not fly. Southwest upgraded us to business class and comped all of our drinks (alcohol included) and treated us like royalty.

Needless to say, I got a lot of mileage out of the fact that the flight attendant specifically asked for a nurse. My wife, who is easily the smartest person I know, and excellent clinician, just finished her masters, and has years of ICU experience decided she would rather have me deal with it...which to this day I don't let her forget! Probably the only time I will ever have a leg up on her clinically..

Thought of this funny story when I read this thread...I would not announce yourself.

"Better to remain silent and have others think you are a fool, than to speak up and remove all doubt" I forget who said it, but it rings true...


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## JPINFV (Dec 17, 2010)

AnthonyM83 said:


> Haha.
> I would be quite mad if he skipped the Dayton EMS cadaver workshop with the EMTCity crew to go write test questions! (That's why I was one the plane)



They need to stop having that right in the middle of the week right before exams. Grr...


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## JPINFV (Dec 17, 2010)

Aidey said:


> I think JP is probably right, that there is usually at least one physician on board. The only question is what type they are. There was an story in JEMS or on one of the EMS websites about in flight emergencies, and in one of the cases there was a doctor on board, but it was someone who had been practicing Dermatology for the last 40 years and they deferred to the Paramedic.



I can see it happening, but I think it's a little more complicated than that.

Physician vs EMT is different than physician vs paramedic, regardless of the physician's specialty. 

Specialties outside of emergency medicine can easily surpass the abilities of a paramedic, especially anesthesiology, intensivests, urgent care, and a handful of others. This is also before matching up specialty to complaint. 

There's only a handful of tools and drugs available. Yes, a paramedic should be better at intubation than the family physician, but does it matter if you don't have the tools available to intubate?

Finally, the physician has the ultimate trump card. S/He's a physician. If the paramedic wants to do the entire, "I'm the paramedic, this is an emergency, I'M IN CHARGE HERE" routine (and, admittedly, there are plenty of physicians who are willing to do that), fine, what ever. I guarantee you that even if the physician is deferring to the paramedic, they're still analyzing the patient and the treatment conditions and that trump card is going to be played if the paramedic wants to do something that the physician considers unreasonable.


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## MrBrown (Dec 17, 2010)

All commercial jets carry an AED and a physicians kit which is basically an IV roll with standard advanced airway supplies and drugs.  Most airlines allow the Captain to release it for use to a doctor upon sighting credentials however this may not extend to ambulance Paramedics, Brown knows of one or two airlines where this is the case.

Brown, CPL-C


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## medicRob (Dec 17, 2010)

It has been my general experience that there is usually either an RN or a Physician on the plane, especially on large flights. I wouldn't really worry about announcing myself, it just seems a little over the top and showy.


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## JJR512 (Dec 17, 2010)

JPINFV said:


> ...and ignore the laughter from the physicians on the flight, because there's probably at least 1 on board.



No...Just tell the physicians that you will ask for their help if you need it.


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## Bosco578 (Dec 17, 2010)

I'd bring one of those kids helmets with siren and the rotating light on top,slap that bad boy on. Just in case. But seriously, I would not just offer up my status, EMR,EMT,PARAMEDIC,however if your a fireman,anounce that over the loud speaker, I'm sure they will roll out the red carpet for ya.


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## Hockey (Dec 17, 2010)

I get up once we take off, go toward the cockpit and announce loudly so everyone can hear: ATTENTION EVERYBODY, THIS WILL ONLY TAKE A MINUTE AND I DON'T WANT ANYONE TO GET HURT BY DOING SOMETHING STUPID.

Then you can let em all know what you do


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## Shishkabob (Dec 17, 2010)

Flight-LP said:


> Actually, most flight attendants receive specialized education on frequently encountered issues in flight. I place a lot more confidence in their abilities to assist vs. that of an EMT who has no knowledge of flight physiology or the nature of the aviation industry.



You're honestly giving too much credit to flight attendants.  My mom was one for 6 years and she has told me countless times the 'training' they go through on first aid.  It IS below even the first responder level, and has nothing on flight physiology or anything of that nature.

Essentially CPR, AED and use the intercom to get a medical professional.


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## emt_irl (Dec 17, 2010)

i personally wouldnt tell them, unless something happened mid flight, then if i hadnt already had a few drinks, and was bored of all the movies, id consider making myself known.


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## JJR512 (Dec 17, 2010)

Personally, the in-flight emergency I'm looking forward to is when the pilot, co-pilot, and anyone else up in that little room at the front of the plane all get sick and incapacitated. Then they'll ask if there's a pilot on board and I'll raise my hand and proudly proclaim, "NO, but I've played a lot of flight-sim video games so we're in Perfectly Safe hands!"


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## emt_irl (Dec 17, 2010)

JJR512 said:


> Personally, the in-flight emergency I'm looking forward to is when the pilot, co-pilot, and anyone else up in that little room at the front of the plane all get sick and incapacitated. Then they'll ask if there's a pilot on board and I'll raise my hand and proudly proclaim, "NO, but I've played a lot of flight-sim video games so we're in Perfectly Safe hands!"



hahaha epic!! just like the movies...

imagine the ammount of free travel miles you'd get after that one!
free travel for life


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## bigbaldguy (Dec 22, 2010)

As a 15 year light attendant and a brand new EMT my advice is this. Feel free to introduce yourself to the flight attendnt at the front of the plain. Over the years I've had doctors and nurses jump to the rescue on the plane and be of no use at all. I will take one decent paramedic over any 5 doctors. As Flight attendants we have a decent amount of training in handling the basic stuff but there is nothing that makes us hapier then when a paramedic steps in and saves the day. And jst a little FYI the o2 masks on the plane blow 2 liters on low and 4 on high


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## Madmedic780 (Dec 22, 2010)

JJR512 said:


> Here's what you do.
> 
> Wait until the steward/stewardess has just finished the pre-flight safety announcements and demonstrations, then stand up, and proclaim loudly for all to hear that you are a Trained Medical Professional so everyone can rest assured that they are Perfectly Safe. Then thank the steward/stewardess and remind him or her that if there are any problems, you're in seat # <whatever>.



Also it's very important to wave around a improvised weapon while doing this. It establishes dominance over the other medical personnel on board so that they know their place.


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## jjesusfreak01 (Dec 22, 2010)

MrBrown said:


> All commercial jets carry an AED and a physicians kit which is basically an IV roll with standard advanced airway supplies and drugs.  Most airlines allow the Captain to release it for use to a doctor upon sighting credentials however this may not extend to ambulance Paramedics, Brown knows of one or two airlines where this is the case.
> 
> Brown, CPL-C



Only an actual doc can start an IV in the field without online medical control. Its possible they might be able to authorize a paramedic to do it with them watching (well, its probably still not legal but you likely wouldn't get in trouble for it), but still unlikely. I guess this may not apply in countries where paramedics are independently licensed to practice without physicians oversight, but it holds in the US.


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## rook901 (Dec 22, 2010)

bigbaldguy said:


> I will take one decent paramedic over any 5 doctors.



I'll take the five guys with four years of pre-med, four years of medical school, and two to three years of residency over the guy with at best two years of EMS education. Surely, between those five physicians' combined fifty years of training, they can figure something out. 

Now, if you make me choose between one decent gynecologist and one decent paramedic, give me the medic.


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## Flight-LP (Dec 22, 2010)

jjesusfreak01 said:


> Only an actual doc can start an IV in the field without online medical control. Its possible they might be able to authorize a paramedic to do it with them watching (well, its probably still not legal but you likely wouldn't get in trouble for it), but still unlikely. I guess this may not apply in countries where paramedics are independently licensed to practice without physicians oversight, but it holds in the US.



While I think I see where you are coming from, there are some Paramedics that have standing orders that are applicable throughout the country (and even internationally in some cases depending on their service area). Thats not really an accurate blanket statement.


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## jjesusfreak01 (Dec 22, 2010)

rook901 said:


> I'll take the five guys with four years of pre-med, four years of medical school, and two to three years of residency over the guy with at best two years of EMS education. Surely, between those five physicians' combined fifty years of training, they can figure something out.
> 
> Now, if you make me choose between one decent gynecologist and one decent paramedic, give me the medic.



I'll take the medic with 5 years of emergency medicine EXPERIENCE over any doc who's been practicing in a barely related field. Internal medicine? Sure, i'm maybe ok with that, maybe surgery or anesthesiology too, but you could have a psychiatrist, a gynecologist, or a pediatrician with absolutely no emergency experience besides a few weeks during their clinicals. 

The purpose of a residency is to give a doctor experience in their field before they are allowed to practice independently. This is why you have board exams, to show competency in the field. While we may have no equivalent to board exams and residencies, we do have the badge of experience to show. 

In any real emergency, you want someone with real experience dealing with these emergencies. This could be an experienced EMT, a medic, an ER nurse, or an emergency medicine physician . . . it could even be a firefighter or a CNA working on a code team.

@Flight-LP...yeah, that's why I put in the qualifier about this being for the US. After I started writing that, I remembered that other countries are not like the US. Most don't have states, and some don't require physicians oversight for practice.


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## rook901 (Dec 22, 2010)

Thank you for the information on what a residency is. 

I was poking fun at the foolishness of making the statement that one "decent paramedic" is better than five doctors. I really don't care what their specialty is. I'm quite certain that the experience of five physicians, regardless of specialty, would be more useful than the experience of one "decent" paramedic (decent is the quoted poster's word, not mine). Now, if we throw egos into the mix between the five physicians, there may be a problem.

I also clearly stated that I would rather have one medic working on me than one gynecologist.

Try not to be so defensive next time. Perhaps I'll have to call that gynecologist after all. Seems like there's a case of MPH floating around. 



jjesusfreak01 said:


> I'll take the medic with 5 years of emergency medicine EXPERIENCE over any doc who's been practicing in a barely related field. Internal medicine? Sure, i'm maybe ok with that, maybe surgery or anesthesiology too, but you could have a psychiatrist, a gynecologist, or a pediatrician with absolutely no emergency experience besides a few weeks during their clinicals.
> 
> The purpose of a residency is to give a doctor experience in their field before they are allowed to practice independently. This is why you have board exams, to show competency in the field. While we may have no equivalent to board exams and residencies, we do have the badge of experience to show.
> 
> ...


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## jjesusfreak01 (Dec 23, 2010)

rook901 said:


> Try not to be so defensive next time. Perhaps I'll have to call that gynecologist after all. Seems like there's a case of MPH floating around.



I have been considering a masters in public health.


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## rook901 (Dec 23, 2010)

jjesusfreak01 said:


> I have been considering a masters in public health.



Different MPH, but I'll allow it. ^_^


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## Jay (Dec 23, 2010)

busmonkey said:


> Yes. Emergency Medical Responder will be one level above them, as they will have First Responder versus EMR which is an actual Paramedic level (as in I can work on Ambulances)... Yes I suppose if there is an emergency I will announce myself  Thanks for your help guys!!!
> 
> JB



JB,

A couple of points, first Paramedic level in the states is different from the same title in Canada. EMR and First Responder are more or less synonymous though. In most states there are three basic levels starting with EMR, EMT and concluding with EMT-P or Paramedic level with the highest level of training. Flight attendants will have some level of training but not usually an EMS level cert, more than likely CPR on or up to BLS level along with advanced first aid such as ASHI's Emergency Responder (which is 14 hours as opposed to ASHI's First Responder which is 40+), they also will probably have some basic flight physiology training as well as one other responder pointed out that O2 apparatus is different on-board commercial aircraft (in part due to cabin pressure considerations). FYI, the tubing on commercial aircraft is different than O2 tubing that we use on the street and a bag-valve will almost never attach but think about it, with 4 or so LPM your not going to push that much more than 21% O2 to begin with.

More info on the equipment and differences between "street" EMS and the kits and capabilities found on commercial passenger aircraft can be found in a fairly recent article on JEMS, here's the link:

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

You will be amazed at what is on board that fits into many scopes of training.

As for announcing yourself before the flight, I have to agree that it does in fact sound a bit whackerish, the odds of someone on the flight having equal or higher training is likely and even if a doc is on-board you will be amazed how often they will want you around if you step in, act professional and know what you are talking about. The same goes for in hospital codes as everyone is an integral part to the ACLS team and anyone who disregards any individuals input is ignorant, absolute poppycock. My advice to you is have your credentials ready, perhaps keep a set of gloves in your wallet or carry on and if it looks like a mess, then step in.

Cheers!

Jay


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## wyoskibum (Dec 23, 2010)

jjesusfreak01 said:


> Only an actual doc can start an IV in the field without online medical control. Its possible they might be able to authorize a paramedic to do it with them watching (well, its probably still not legal but you likely wouldn't get in trouble for it), but still unlikely. I guess this may not apply in countries where paramedics are independently licensed to practice without physicians oversight, but it holds in the US.



There are different rules while in flight.  You are allowed to practice to your scope during an in flight emergency.  Also, the Airlines have medical control available which you can consult with, especially if you need to redirect the flight to a closer airport.


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## Jay (Dec 23, 2010)

*U.S. DOT vs. State-Level Protocols for In-Flight Service*



wyoskibum said:


> There are different rules while in flight.  You are allowed to practice to your scope during an in flight emergency.



It should be noteworthy to comment that national EMS standards are set by the DOT and each state bases their specific protocols around this national framework. Practicing within the state means that in a hospital or ground ambulance that you are required to keep with the state protocols. I recently was speaking with a medic instructor here in Philly that is on a lot of state-level programs and he said it to me best that once you are off the ground, in an aircraft, all rules are off when it comes to state protocol and the larger national-level scope applies, which is set by the DOT. The EMS practitioner falls under the national scope for his or her level until they land and then is bound to the rules of the state that they land in. I am not sure if this applies as soon as they are an inch off of the ground with takeoff or if there is a set footage when the transition applies but he did make it sound like it was as soon as the aircraft is airborne.


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## jjesusfreak01 (Dec 23, 2010)

Jay said:


> It should be noteworthy to comment that national EMS standards are set by the DOT and each state bases their specific protocols around this national framework. Practicing within the state means that in a hospital or ground ambulance that you are required to keep with the state protocols. I recently was speaking with a medic instructor here in Philly that is on a lot of state-level programs and he said it to me best that once you are off the ground, in an aircraft, all rules are off when it comes to state protocol and the larger national-level scope applies, which is set by the DOT. The EMS practitioner falls under the national scope for his or her level until they land and then is bound to the rules of the state that they land in. I am not sure if this applies as soon as they are an inch off of the ground with takeoff or if there is a set footage when the transition applies but he did make it sound like it was as soon as the aircraft is airborne.



The problem with this is that even if you are held to national scope in the air,  the second you hit the ground you no longer have a certification to do anything if you don't practice in that state, am I right?


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## JJR512 (Dec 24, 2010)

jjesusfreak01 said:


> The problem with this is that even if you are held to national scope in the air,  the second you hit the ground you no longer have a certification to do anything if you don't practice in that state, am I right?



My understanding is that no matter where you go, you continue to function under the rules of the jurisdiction in which you started functioning. So if you start in the air, under national scope, you continue to function under the national scope until care is transferred.


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## Markhk (Dec 24, 2010)

Just to echo the previous point, in regards to scope of practice, the safest policy is "to do what only what you are currently trained to do" . If there is something that you think might be even slightly out of scope - or if you would normally ask for base contact - inform the flight attendant to get a patch to MedLink or the another ground physician service they subscribe to. Virtually all US airlines I've come across utilize a service like this. The ground physician can guide treatment and take responsibility for you to provide treatments. (For example, a Medlink MD might authorize a flight attendant to use an Epipen if it's equipped on board...an Epipen is actually optional equipment, the FAA only mandates 1:1000 epi ampoules to be carried, but that's another story...). 

The sky is certainly not an excuse to provide cowboy medicine, even if the Good Samaritan protections afforded in the Aviation Medical Assistance Act is very generous. 

Something to consider also is that the flight attendants may have another job...in healthcare. I've come across flight attendants who were ED nurses, retired physicians and paramedics/firefighters. In fact, JetBlue was featured in the news a couple months ago for specifically hiring retired NY firefighters, cops and medics, because of their emergency response background. If anyone of you see cabin crew doing their emergency drills in a cabin simulator, you'd be amazed how much they have to perform like we do when we do our NREMT skills. 

Bottom line: if they need you, they'll call for you.



> More info on the equipment and differences between "street" EMS and the kits and capabilities found on commercial passenger aircraft can be found in a fairly recent article on JEMS, here's the link:



I happen to be the person that wrote that article, so if anyone has any particular questions, feel free to PM me and I'll try my best to answer any specific questions about the topic.


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## Phlipper (Dec 24, 2010)

When I fly commercial, or fly as an FO on corporate and charter flights, I stick my chest out as far as possible and say, in my best US Army voice "I ... am a NC certificated Emergency Medical Technician Basic.  Should an emergency arise while in flight, I will need to be notified immediately, and then everyone should stand back out of my way and let the professional handle it."

At that point people usually start rolling their eyes, especially the MDs and RNs, and walk off muttering to themselves.  And my Captain will generally say something like "Shut the h@ll up and get the checklists ready!".

Doesn't bother me.  I know in my heart that I am a BLS God.


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## bigbaldguy (Jan 8, 2011)

*Flight attendants 2 cents*

I had to work on New years day (as a flight attendant). Sure enough on my last flight into Houston a guy goes down in the aisle. We do our usual "are there any doctors, nurses or other medical personel on board". Older guy walks up and says "I'm a doctor" I ask "what kind of doctor" the guy looks kinda embarrassed for a minute then says "gynecologist". I ask him if he could get the guys blood pressure while I talk to StatMD our online medical folks. He leans in and says "I haven't taken a manual blood pressure in over 15 years". 
Again if you are an EMT let the Flight Attendants know. The first thing StatMD asks for is a blood pressure and they don't teach us how to take BP's, they should but they don't. Once someone goes down we sometimes get so involved we forget that we are supposed to page for medical assistance so don't be afraid to come tell us "I'm a paramedic or I'm an EMT". Before we let you do anything beyond taking a blood pressure we run your info by StatMD. We had one situation recently involving a cardiac arrest in which we had NO medical personel on board. StatMD tried to get one of the flight attendants to attempt an injection of some sort but none of them felt comfortable doing it. The flight attendants continued cpr through landing but the patient didn't make it. My understanding of the situation was that StatMD would have let anyone attempt that injection because at that point it was the guys only chance (AED detected no shockable rythm). But no one felt comfortable trying it even with a headset on and a doctor walking them through it. I know of a few situations in which scope of practice went out the window and StatMD (used to be medlink) allowed people to do something well beyond their training because the plane was 20 or 30 minutes out and there just wasn't anyone else. Anaphylaxis is a good example. I've heard of StatMD walking folks through the epipen.


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## bigbaldguy (Jan 8, 2011)

bigbaldguy said:


> As a 15 year light attendant and a brand new EMT my advice is this. Feel free to introduce yourself to the flight attendnt at the front of the plain. Over the years I've had doctors and nurses jump to the rescue on the plane and be of no use at all. I will take one decent paramedic over any 5 doctors. As Flight attendants we have a decent amount of training in handling the basic stuff but there is nothing that makes us hapier then when a paramedic steps in and saves the day. And jst a little FYI the o2 masks on the plane blow 2 liters on low and 4 on high



Ok maybe I exagerated a bit about taking one paramedic over 5 doctors but seriously in my experience the usefullness of med personel on the plane is as follows from most helpful to least helpful

Paramedics
Nurse/Emt
Doctor

Yes I imagine upon occasion an ER doctor might happen to jump up and save the day but in my experience this hasn't been the case.


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## jjesusfreak01 (Jan 8, 2011)

bigbaldguy said:


> Anaphylaxis is a good example. I've heard of StatMD walking folks through the epipen.



Epipens are hardly an advanced medical device. "Press firmly into the outer thigh and under no circumstances put fingers over either side"

I think I would feel relatively comfortable with StatMD walking through code management on a plane. If they'd let me, i'd start an IV and give drugs. It would be fun, imho.


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## Jay (Jan 8, 2011)

jjesusfreak01 said:


> The problem with this is that even if you are held to national scope in the air,  the second you hit the ground you no longer have a certification to do anything if you don't practice in that state, am I right?



After revisiting this thread I realized that you would need to continue practicing in the scope that you were last utilizing, e.g. national standards in the air otherwise one may be looking at a potential case of patient abandonment. You can't simply stop working on a patient. Any thoughts on this?


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## Jay (Jan 8, 2011)

Markhk said:


> I happen to be the person that wrote that article, so if anyone has any particular questions, feel free to PM me and I'll try my best to answer any specific questions about the topic.



Awesome article Mark! I found it rather informative and put together very professionally. There was obviously a reason that I remembered to refer back to it specifically months after reading it. Keep up the great work!


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## Veneficus (Jan 8, 2011)

jjesusfreak01 said:


> Sure, i'm maybe ok with that, maybe surgery or anesthesiology too, but you could have a psychiatrist, a gynecologist, or a pediatrician with absolutely no emergency experience besides a few weeks during their clinicals.



Without getting into all the variables of the various experiences and fnctions of physicians, I would just like to point out that a gynecologist is a surgical discipline.


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## JJR512 (Jan 8, 2011)

I've actually just come up with the perfect solution.

Every EMT (-B, -I, or -P) license or certification card should come with an RFID tag built in which broadcasts a signal identifying the presence of the provider. All public buildings and spaces shall be required to have receivers that will detect the presence of these tags. The receivers will be tied in to the phone system, so if anyone calls 911, the caller will be alerted that there is already an EMS provider nearby. The paging system in the building will automatically request the EMS provider to please present his or her self to a designated spot in the building, and the person who called 911 will have already been directed to go meet the provider at that spot so the caller can escort the provider to the scene of the emergency. Also, all cell phones will need an RFID receiver as well, so anyone calling 911 from a cell phone can also be alerted to the fact that there is an EMS provider nearby. Obviously, in places where calling 911 isn't really appropriate, other routines will need to be devised, such as what this thread is about, being on an airplane. For airplanes, the flight crew will have some kind of indicator light added to the instrument panel that indicates if an EMS provider RFID tag has been detected onboard, and if that light is on, in the event of an emergency the pilot only has to request that the EMS provider calls the flight attendant so he or she can take the provider to the patient needing help.

Obviously there are some further details to work out but I think this is a pretty good beginning...


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## Phlipper (Jan 9, 2011)

jjr512 said:


> i've actually just come up with the perfect solution.
> 
> Every emt (-b, -i, or -p) license or certification card should come with an rfid tag built in which broadcasts a signal identifying the presence of the provider. All public buildings and spaces shall be required to have receivers that will detect the presence of these tags. The receivers will be tied in to the phone system, so if anyone calls 911, the caller will be alerted that there is already an ems provider nearby. The paging system in the building will automatically request the ems provider to please present his or her self to a designated spot in the building, and the person who called 911 will have already been directed to go meet the provider at that spot so the caller can escort the provider to the scene of the emergency. Also, all cell phones will need an rfid receiver as well, so anyone calling 911 from a cell phone can also be alerted to the fact that there is an ems provider nearby. Obviously, in places where calling 911 isn't really appropriate, other routines will need to be devised, such as what this thread is about, being on an airplane. For airplanes, the flight crew will have some kind of indicator light added to the instrument panel that indicates if an ems provider rfid tag has been detected onboard, and if that light is on, in the event of an emergency the pilot only has to request that the ems provider calls the flight attendant so he or she can take the provider to the patient needing help.
> 
> Obviously there are some further details to work out but i think this is a pretty good beginning... :d



roflmmfao!


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## djm0219 (Jan 9, 2011)

JJR512 said:


> Every EMT (-B, -I, or -P) license or certification card should come with an RFID tag built in which broadcasts a signal identifying the presence of the provider. All public buildings and spaces shall be required to have receivers that will detect the presence of these tags.



ROTFL ... now you've done it, the government will start working on that and spend a bazillion of our tax dollars to make it a reality.  Be careful what you think of/wish for


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## jjesusfreak01 (Jan 9, 2011)

My ID already has an RFID tag to allow me station access, so we can work from there...

Flights are a possibility. They could simply have you register your medical certification when you buy your ticket, at which point the flight attendants would simply be able to look at the manifest to find the most appropriate provider/s, then tap them on the shoulder when they were needed.


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## Markhk (Jan 9, 2011)

jjesusfreak01 said:


> Flights are a possibility. They could simply have you register your medical certification when you buy your ticket.



Lufthansa already has a program for physicians specifically for that purpose. They even give free miles for physicians who sign up and are trying to offer CEs to them as well.

http://www.lufthansa.com/online/portal/lh/de/info_and_services/partner?nodeid=1907351&l=en&cid=18002


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