Was it just confusion or was QR's medical kit really missing a lot of crucial stuff?
Jul 20, 2015, 1:53 am
#16
Join Date: Jun 2013
Location: UK
Programs: BA GGL, BA Amex Prem, Amex Plat, Hilton Diamond, Sir Crazy8534 de l'ordres des aides de Pucci
Posts: 4,460
I understand that as the crew is taught to a first aider/ responder level that they administer oxygen to most patients. The point I was making was that there is plenty of equipment carried seemingly in case there happens to be somebody competent in its use on board (intubation/cannulation for example) so why not a pulse oximeter?
Jul 21, 2015, 7:11 am
#17
Original Poster
Join Date: Jan 2006
Location: LAX/SYD
Programs: BA GGL/CCR, AA EXP, QFF WP, HH D, SPG G, Hertz PC
Posts: 245
Hi everyone, my apologies for being away for a few days, thanks for your understanding.
It might be partially my bias because I work in medical retrieval (both helicopter rescue and international air ambulance (fixed wing) services, and I'm acutely aware of what happens to patients at altitude with regards partial pressures of various gases. However, I recognise that some people (including doctors) might find pulsoximeters at altitude confusing. However they still provide useful information, including over a period of time with regard trends, and valuable information on pulse as well, particularly if they make auditory sounds. It's also useful for picking up things like endobronchial intubations, or oesophageal intubations.
I do note that there's no method of capnography in the BA pack, being the gold standard for assessing endotracheal tube placement.
In retrieval services we carry a lot more stuff - and much of it is used. It's somewhat unnerving to deal with any unconscious patient. Not being able to determine that you can't talk to (unconscious) is diabetic and unable to talk to you because their blood gluclose level is below 3 mmol/L (that's something like 51 mg/dL, I believe).
It was a QF flight but it was somewehere a little over 15 years ago that I was able to get trace monitoring on a patient who was in ventricular fibrillation via the AED - it was an earlier model. Again, being able to look at the rhythm was useful. I'm aware that modern AEDs don't do this (much to my frustration - AEDs run slower that what I can do!)
I'm genuinely surprised that kits are not required to have some method of capnography and blood glucose monitoring equipment, and pulsoximetry though. It really did make the job of diagnosing a difficult problem much the harder.
It might be partially my bias because I work in medical retrieval (both helicopter rescue and international air ambulance (fixed wing) services, and I'm acutely aware of what happens to patients at altitude with regards partial pressures of various gases. However, I recognise that some people (including doctors) might find pulsoximeters at altitude confusing. However they still provide useful information, including over a period of time with regard trends, and valuable information on pulse as well, particularly if they make auditory sounds. It's also useful for picking up things like endobronchial intubations, or oesophageal intubations.
I do note that there's no method of capnography in the BA pack, being the gold standard for assessing endotracheal tube placement.
In retrieval services we carry a lot more stuff - and much of it is used. It's somewhat unnerving to deal with any unconscious patient. Not being able to determine that you can't talk to (unconscious) is diabetic and unable to talk to you because their blood gluclose level is below 3 mmol/L (that's something like 51 mg/dL, I believe).
It was a QF flight but it was somewehere a little over 15 years ago that I was able to get trace monitoring on a patient who was in ventricular fibrillation via the AED - it was an earlier model. Again, being able to look at the rhythm was useful. I'm aware that modern AEDs don't do this (much to my frustration - AEDs run slower that what I can do!)
I'm genuinely surprised that kits are not required to have some method of capnography and blood glucose monitoring equipment, and pulsoximetry though. It really did make the job of diagnosing a difficult problem much the harder.
Jul 21, 2015, 7:33 am
#18
Join Date: Dec 2009
Posts: 842
beardoc,
You are comparing equipment used in medical transport of patients with the emergency kit that airlines carry for use in contingencies. When airlines carry medical patients with special needs then they carry more equipment similar to what you will find in an air ambulance including stretchers, heart monitoring and so on. It doesn't make sense to carry all that equipment all the time for contingencies especially as they don't necessarily have qualified passengers on board and procedures call for diversions if the cases are serious.
The blood glucose monitor is recommended and is carried but it could be in the form of the colour changing strips and not a battery operated machine.
You are comparing equipment used in medical transport of patients with the emergency kit that airlines carry for use in contingencies. When airlines carry medical patients with special needs then they carry more equipment similar to what you will find in an air ambulance including stretchers, heart monitoring and so on. It doesn't make sense to carry all that equipment all the time for contingencies especially as they don't necessarily have qualified passengers on board and procedures call for diversions if the cases are serious.
The blood glucose monitor is recommended and is carried but it could be in the form of the colour changing strips and not a battery operated machine.
Jul 23, 2015, 5:28 am
#19
Original Poster
Join Date: Jan 2006
Location: LAX/SYD
Programs: BA GGL/CCR, AA EXP, QFF WP, HH D, SPG G, Hertz PC
Posts: 245
beardoc,
You are comparing equipment used in medical transport of patients with the emergency kit that airlines carry for use in contingencies. When airlines carry medical patients with special needs then they carry more equipment similar to what you will find in an air ambulance including stretchers, heart monitoring and so on. It doesn't make sense to carry all that equipment all the time for contingencies especially as they don't necessarily have qualified passengers on board and procedures call for diversions if the cases are serious.
The blood glucose monitor is recommended and is carried but it could be in the form of the colour changing strips and not a battery operated machine.
You are comparing equipment used in medical transport of patients with the emergency kit that airlines carry for use in contingencies. When airlines carry medical patients with special needs then they carry more equipment similar to what you will find in an air ambulance including stretchers, heart monitoring and so on. It doesn't make sense to carry all that equipment all the time for contingencies especially as they don't necessarily have qualified passengers on board and procedures call for diversions if the cases are serious.
The blood glucose monitor is recommended and is carried but it could be in the form of the colour changing strips and not a battery operated machine.
I absolutely appreciate that, and if it's okay, I don't want to start putting the details of the medical emergency online, because that would be unfair to the person that I helped.
I can assure you that particularly the lack of pulsoximeter and lack of blood glucose level monitoring made this particular patient's management much harder. I'm heartened that there is indeed a form of blood glucose monitoring on board and that in my case it might have been confusion by the staff that I was working with that meant I couldn't find it.
I think in future, given what I know now about the minimum requirements of airline medical equipment, I'm going to have to set expectations about what I could reasonably achieve with an airline medical kit. That's not bad - that's actually good to know.
Jul 29, 2015, 5:19 am
#20
Join Date: Nov 2005
Location: Fairbanks, Alaska and other places
Programs: American Airlines Platinum
Posts: 56
Oh, this is an interesting thread - and right up my alley, so to speak.
Anyway, the kit on-board the aircraft is primarily for emergencies. I've flown many "medical escorts" (medevac via commercial airlines). Typically, we carry our own equipment and supplies and do not rely on the aircraft kit at all (except, as the case may be, for the occasional backup).
The equipment on the aircraft, while ultimately up to each airline and specific regulatory bodies, is generally based on advice given in the IATA Medical Manual (https://www.iata.org/whatwedo/safety...anual-2013.pdf). It is meant to provide a short-term, life-saving resource for personnel skilled and licensed for "advanced life support" level care (e.g. Physicians, Nurses, Paramedics, etc); though, in a bind, any skilled and capable medical provider is more than welcomed...
The Aerospace Medical Association also put together a decent primer for medical providers; "Medical Emergencies: Managing In-Flight Medical Events", and this is available at: https://www.asma.org/asma/media/asma...e-document.pdf
Only once in my medical career did I encounter an emergency case while flying as a "regular" passenger; but a few times I was called upon while traveling with a medical case. Between use of the on-board kit, communications with ground medical, working with cabin or flight crew, etc., I've never had a problem arise that couldn't be overcome.
As an side anecdote, once upon a time, ground communications with the airline medical services was done exclusively from the cockpit - and made for an opportunity to sit on the flight deck for a few minutes; sometimes followed up by an invitation to come back when the time allowed. Sadly, this has necessarily changed, owning to security needs.
Jace
Anyway, the kit on-board the aircraft is primarily for emergencies. I've flown many "medical escorts" (medevac via commercial airlines). Typically, we carry our own equipment and supplies and do not rely on the aircraft kit at all (except, as the case may be, for the occasional backup).
The equipment on the aircraft, while ultimately up to each airline and specific regulatory bodies, is generally based on advice given in the IATA Medical Manual (https://www.iata.org/whatwedo/safety...anual-2013.pdf). It is meant to provide a short-term, life-saving resource for personnel skilled and licensed for "advanced life support" level care (e.g. Physicians, Nurses, Paramedics, etc); though, in a bind, any skilled and capable medical provider is more than welcomed...
The Aerospace Medical Association also put together a decent primer for medical providers; "Medical Emergencies: Managing In-Flight Medical Events", and this is available at: https://www.asma.org/asma/media/asma...e-document.pdf
Only once in my medical career did I encounter an emergency case while flying as a "regular" passenger; but a few times I was called upon while traveling with a medical case. Between use of the on-board kit, communications with ground medical, working with cabin or flight crew, etc., I've never had a problem arise that couldn't be overcome.
As an side anecdote, once upon a time, ground communications with the airline medical services was done exclusively from the cockpit - and made for an opportunity to sit on the flight deck for a few minutes; sometimes followed up by an invitation to come back when the time allowed. Sadly, this has necessarily changed, owning to security needs.
Jace