Can you push ALS drugs based off an AED's decision to shock?

akflightmedic

Forum Deputy Chief
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Interesting thread here.

Due to the amount of travel I do annually, I have had my fair share of experience with these scenarios. Some of you against working outside the box just do not seem to grasp the nature of air travel.

You can not just plop down anywhere as soon as an emergency on board arises. Even if flying over the US at a normal altitude of 30-35K feet, it will take 30 minutes or more to do an emergency landing. There are runway considerations, fuel issues, etc. Now with that time frame in mind and knowing the proven statistics of viability of a cardiac arrest patient outside of a hospital, what would you do?

I do a lot of international travel, meaning there are times where it could be HOURS before a landing is even possible. So go back through this scenario and ask yourself, would you provide ACLS medications without knowing what is on the screen? What if it were a family member? Would you still try?

The few times I have assisted on an IFE (In Flight Emergency), the attendants were extremely calm and quite selective in whom they allowed to assist the patient. My certs are always in my pocket and validating them (best as you can at 35K feet) is required before they even told me who the patient was. Basically they looked at them for appearance sake and checked the expiration date, which is fine because I do not imagine too many whackers travel with false credentials. I am sure it occurs but not that often.

I have worked one cardiac arrest, several syncopal episodes, abdominal pain, two chest pains and administered a patient's pain medication IM.

Except for the cardiac arrest as it was quite a few years ago, I had to show documentation of who I was and then after the flight attendant was comfortable with me, I was then allowed to assess the patient and determine if they needed any intervention and if the plane needed to divert. After my assessment, I was then placed on a phone with medical control whom I briefed on patient status and gave my opinion of whether or not we should land.

This is the tricky part!! It would be very easy for some overzealous, inexperienced or undereducated rescuer to say "we need to land now", when in all reality the patient will probably be fine. They do not want to hear those words unless it is absolutely necessary. Be prepared for medical control to question you quite extensively. If they are the attendant are dissatisfied with your answers, treatment or conduct, they will very quickly have you take a seat and make you sit on your hands. :) (Seeing who read this far)

As far as legalities, we have covered that already with links to documentation supporting us so that we may render care, however I had indeed asked the same question when I offered my services. One of the airlines had me sign a document prior to rendering care that made me a temporary employee of the airline and thereby falling under the auspices of the airline's medical control physician. Since I was an employee, they have to compensate me, so I did receive an upgrade for a future flight and some Dom Perignon.

Not sure where I was going with all this, but I think I just want to stress that there are and will be times when you have to work outside your comfort zone. Some times within reason. extreme situation may call for an extreme action. Pushing medications on a cardiac arrest while in flight with no chance for landing instantly would be one of those times.
 

reaper

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Dang Ak, that was long!!!!! j/k

But you wrapped up everything that has been discussed, perfectly.
 

Markhk

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That was a great post akflightmedic.

I would just add a caveat though, in regards to the last part of your post for anyone who might be interested . While some airlines are generous enough to provide a "thank you" (it sounds like this particular air carrier had thought it through very well), other airlines will not provide compensation whatsoever. This is the norm, particularly in the United States, as there appears to be some belief amongst some legal departments that a "thank you" gift might void the protections given in the Aviation Medical Assistance Act. (I'm not a lawyer so I can't comment on how valid this logic is.)

And then you get the psychiatrist like this one:
http://www.bmj.com/cgi/content/full/317/7160/701

:)
 

MMiz

I put the M in EMTLife
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That was a great post akflightmedic.

I would just add a caveat though, in regards to the last part of your post for anyone who might be interested . While some airlines are generous enough to provide a "thank you" (it sounds like this particular air carrier had thought it through very well), other airlines will not provide compensation whatsoever. This is the norm, particularly in the United States, as there appears to be some belief amongst some legal departments that a "thank you" gift might void the protections given in the Aviation Medical Assistance Act. (I'm not a lawyer so I can't comment on how valid this logic is.)

And then you get the psychiatrist like this one:
http://www.bmj.com/cgi/content/full/317/7160/701

:)
I got a thank you card, 5,000 frequent flyer miles, and a round of applause.
 

piranah

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interesting situation.....i am ACLS/PALS intubation certified but licensed BLS in my state does the state cert count or my certifications......i would do BLS anyway im just wondering...
 

mikie

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Great post AK!

The few times I have assisted on an IFE (In Flight Emergency), the attendants were extremely calm and quite selective in whom they allowed to assist the patient.


Can you tell us what interventions you preformed on these patients with the limited supplies the airplane had?

Thanks!
 

CH47Doc

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btw, look at the list of required gear again, this time focus on the quantities.

that amount of stuff would last long enough to get the medics there if the plane was still on the ground.


i was just going to say that. theres also only .5 of atropine available, great for a first round pedi code. I like how theres actually a sheet provided to tell the flight attendants what the drugs are for. ya think they really care? i like the 'non-narcotic pain relief' of 325mg of ASA as well.
 

mikeylikesit

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I wouldn't unless i got a readout first! Plus who am I covered by in case poo hits the fan and the drugs are bad or mislabeled?
 

reaper

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i was just going to say that. theres also only .5 of atropine available, great for a first round pedi code. I like how theres actually a sheet provided to tell the flight attendants what the drugs are for. ya think they really care? i like the 'non-narcotic pain relief' of 325mg of ASA as well.

Well, it is really 1 mg of atropine. So that is good for one round in adult code. I think the ASA is more likely for cardiac issues. They have tylenol, advil and aleve for pain. Hey, it is better then nothing!:rolleyes:
 

CH47Doc

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my bad. 2 ampules of .5mg. i never seen an 'ampule' of atropine. i seen it in prefilled 1mg syringes though.
 

lizhiniatsos

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I've got a dead guy (or gal) in front of me...good CPR in progress...no status change in the patient....and a minimal tool box at hand....am I gonna take a chance and DO something....or just leave 'em lyin?....I'm thinkin'... I sure ain't gonna make 'em any deader by tryin' a few tricks...
....is it worth the risk? Each of us can only answer that for ourselves and act within' the bounds we feel are appropriate(all legal mumbo jumbo aside)...the answer will vary from one end of the spectrum to the other...

for me, yes, the chance that I might help someone stick around to enjoy life awhile longer is one I would have to take...or live forever wondering "what if" and feeling horrible about it~
 

june125

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This is a personal choice for each and everyone. I personally couldnt sit by and do nothing, I would want someone to help my family member.
 

daedalus

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I feel confident in pushing epinephrine in an arrest situation on an airline, even without EKG tracing. Dead is dead. The epi will probably make no difference in outcome but its worth a try huh?
 

rhan101277

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Strong work... Dont worry- how do you know there's a doctor on the plane? Oh, they'll tell ya!

We have to ask for their credentials before they can begin care and once they start they are supposed to ride to the ambulance with you, since pt care is now their responsibility. I don't know how reasonable that is in the field.
 
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