DriveByDoc

Sorry to chime in late, but given the gamut of reactions in this thread, let me preface my comments by saying that I am a board certified emergency physician with 15+ years clinical experience and have responded to a number of in-flight emergencies over the years.

We don't know what really happened in this particular case, but I'd like to address some of the issues brought up.

Resuscitation in general:

There comes a point in a resucitation when efforts become futile. We don't know how long the resusciation effort took, but if you have patient with no palpable pulse, no blood pressure, no spontaneous respiration, no functional cardiac rhythm and no response to rescitation efforts, then there comes the point when any continued efforts are medically futile.

As painful as it may be for the family, sometimes you just have to stop.

Pronouncing patients dead:

I've done this hundreds of times - in the field, in private residences, at the hospital and in an ambulance - and it always depends on where you are and what the circumstances are.

Example 1: Man with known heart disease collapses on a plane. After 30 minutes of CPR, AED, resuscitation drugs (depending on the airline kit), etc. there is no response, and the physician on board pronounces him. Reasonable? Yes.

Example 2: Child falls into icy pond and is dragged out after ten minutes. No pulse or breathing so bystander CPR is started. 20 minutes until EMS unit arrives and another 15 to get him to the hospital. Still no response to resucitation efforts. Stop and pronounce him? No, because the child is hypothermic and in this situation, this child has a chance for survival.

If they tried to resuscitate this woman and could not despite their best efforts, and she showed no response to those efforts, then after whatever time deemed medically appropriate given the patient's condition and the surrounding circumstances, declaring her dead is a reasonable option.

About Good Samaritan laws:

The Aviation Medical Assistance Act of 1998 gives protection for those responding to in-flight emergencies, but sadly, anybody can sue anybody. My conscience dictates that I will always try to help out in an emergency. If someone decides to sue, I can't stop them, and it'll take time and effort to get it dismissed, but at least I'll be able to sleep at night knowing I did the right thing.

This mostly reiterating what others have already posted, but I just wanted to put in my perspective from an emergency medicine standpoint.

oklAAhoma

^^

fanch26

Not pbz, but as a NR EMT for 20 years, this is has been the standard of US prehospital care both in the National Registry Curriculum and the protocols of both states in which I work and have worked for over 10 years.

Never thought my first FT posting would be this....

drron

Protocols can be wrong.I repeat if a patient has high carbon dioxide levels in their bloodstream chronically then uncontrolled oxygen therapy can kill them.
There used to be a protocol to give 100% oxygen to premature babies until someone realised it caused blindness.Oxygen is not benign.

fanch26

Technically, it can knock out their hypoxic drive, which if left untreated could kill them. The Prehospital treatment, should this occur, is to provide positive ventilation (Bag ''em) on O2. The hypoxic drive is restored by in-hospital respiratory therapy.

The reason behind the US prehospital protocol change is that the old Deny-O2-to-COPD protocol was killing patients by hypoxia, which was not reversible by any therapy.

AAFA

This thread needs to be put into the AAMD section. The relevance to AA has become tenuous in the last 2-3 pages.

mojorisin'

Carry a waiver with you and have the ill person or family member sign it before you help ....

srouyuptf

Complete horse$hit when used for short term treatment and extremely rare for long term use. Very few COPD pts have become true hypoxic breathers. The same is true for DKA and the use of oxygen causing harm. Both are outdated and not supported by any peer review studies in the last 5 years.

It's forgotten knowledge because it was flawed treatment (or more accurately, failure to treat) that resulted in many deaths from the withholding of oxygen.

EricJay

I've been an EMT for nearly 15 years (state cert. EMT-A, state cert. EMT-B, and NREMT-B over the years), and currently work in medical research focused specifically on COPD.

The risks drron mentions aren't news to me. I learned about them in my first EMT class, and they have come up in refresher and continuing ed courses more recently. As pbz and fanch26 pointed out, though, EMS protocols almost never allow withholding oxygen based on a history of COPD since much of the literature suggests that the risk of too little oxygen outweighs the risk of too much of it (easier to artificially ventilate than it is to repair oxygen-starved cells).

I found an article in the American Journal of Emergency Medicine (Volume 15, Issue 7, November 1997, Pages 648-651). The study "examined whether emergency medical technicians withhold oxygen from hypothetical patients whom emergency physicians would treat with high-flow oxygen, particularly COPD patients."

Here's what the investigators found:

Just to try to bring this back to the matter at hand... unless I've missed a major release of info, all we know about what happened with the oxygen tanks on that flight come from AA (who says they were used and they provided oxygen), and the patient's family member (who says they were used and they were empty).

Ok, I now realize just how off-topic this was. My apologies... I'm off to post about AAdvantage upgrades in another threat to redeem myself.

JDiver

Hmmm. Law, Oxygen, medical infromation... very little that is AA travel- or miles- related

I'm a certified Rescue Diver, Medic / First Aid and Oxygen Provider - and a Moderator. This thread will now take a well-deserved breather.

-Moderator