Medical emergency on flight - discussion and experiences
Mar 29, 2011, 1:07 pm
#31
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Mar 29, 2011, 1:14 pm
#32
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Thank you!!!
FlightNurse clearly wrote that an EMT will not be allowed to open the kit while a paramedic will be permitted to use it.
The two terms are not synonymous.
The two terms are not synonymous.
What's the Difference Between an EMT and a Paramedic?
Both EMTs and paramedics have the knowledge and skills to transport patients and provide them with emergency care. The biggest difference between them is the amount of education they receive and what they are allowed to do for patients (scope of practice).
EMTs usually complete a course that is about 120-150 hours in length. Paramedic courses can be between 1,200 to 1,800 hours. EMT and paramedic courses consist of lectures, hands-on skills training, and clinical and/or field internships. EMTs are educated in many skills including CPR, giving patients oxygen, administering glucose for diabetics, and helping others with treatments for asthma attacks or allergic reactions. With very few exceptions, such as in the case of auto-injectors for allergic reactions, EMTs are not allowed to provide treatments that requiring breaking the skin: that means no needles. Paramedics are advanced providers of emergency medical care and are highly educated in topics such as anatomy and physiology, cardiology, medications, and medical procedures. They build on their EMT education and learn more skills such as administering medications, starting intravenous lines, providing advanced airway management for patients, and learning to resuscitate and support patients with significant problems such as heart attacks and traumas.
Both EMTs and paramedics have the knowledge and skills to transport patients and provide them with emergency care. The biggest difference between them is the amount of education they receive and what they are allowed to do for patients (scope of practice).
EMTs usually complete a course that is about 120-150 hours in length. Paramedic courses can be between 1,200 to 1,800 hours. EMT and paramedic courses consist of lectures, hands-on skills training, and clinical and/or field internships. EMTs are educated in many skills including CPR, giving patients oxygen, administering glucose for diabetics, and helping others with treatments for asthma attacks or allergic reactions. With very few exceptions, such as in the case of auto-injectors for allergic reactions, EMTs are not allowed to provide treatments that requiring breaking the skin: that means no needles. Paramedics are advanced providers of emergency medical care and are highly educated in topics such as anatomy and physiology, cardiology, medications, and medical procedures. They build on their EMT education and learn more skills such as administering medications, starting intravenous lines, providing advanced airway management for patients, and learning to resuscitate and support patients with significant problems such as heart attacks and traumas.
Mar 29, 2011, 1:24 pm
#33
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In some areas, critical care transport can be done with a paramedic on board. I live in OC, California, and in our county there must be an ACLS*-certified RN when transporting a critical patient in an ambulance. In Los Angeles County, they are allowed to use either an ACLS RN or a paramedic. I have a neighbor who is a paramedic and he works in LA County doing patient transport.
Internists who do a lot of hospital work, as well as ER physicians and pulmonologists, should be comfortable providing care to unstable patients. An orthopaedist friend of mine and his Nurse Practitioner wife were aboard CO EWR-SNA which had to divert to Albuquerque to a patient having a heart attack. They gave him oxygen, aspirin, nitroglycerine and applied the AED (never went off), and got him off the plane alive in NM. They learned he later died in a hospital there. They were both practicing WAY outside their field of expertise but there was no one else who could help on a 737-700 with a small passenger roster.
*Advanced Cardiac Life Support
Internists who do a lot of hospital work, as well as ER physicians and pulmonologists, should be comfortable providing care to unstable patients. An orthopaedist friend of mine and his Nurse Practitioner wife were aboard CO EWR-SNA which had to divert to Albuquerque to a patient having a heart attack. They gave him oxygen, aspirin, nitroglycerine and applied the AED (never went off), and got him off the plane alive in NM. They learned he later died in a hospital there. They were both practicing WAY outside their field of expertise but there was no one else who could help on a 737-700 with a small passenger roster.
*Advanced Cardiac Life Support
Mar 29, 2011, 1:24 pm
#34
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Mar 29, 2011, 1:37 pm
#35
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The Scope of practice between a RN and a Paramedic is a wide one, the RN scope is greater.
In the flight ambulance world (I have 10 years experience) in there is a the scoop and run flights (helo's) there is a RN and a Paramedic. The RN is the lead person of the transport.
In fix wing transport (long distance transport), depending on the severity of the patient, it usually is a RN and Respiratory Therapist (RT). Paramedics are not usually used on the long flights on a couple of long haul transport (PHX-YYZ) I had a paramedic who was a RT so it made it nice to have an extra pair of hands and eyes.
Most fire department who have a paramedic rig use Paramedics, some do have RN's that are fire fighters. Paramedics are usually great at the scene to stablize the patient to get them the hospital. They do not have the training as a RN when it comes to medical training. One would think they would, but its not so.
BTW, I would be interested in know if your friends wife was the one who took over on the emergency on the plane, since your friend was out of his scope of pracitce.
In the flight ambulance world (I have 10 years experience) in there is a the scoop and run flights (helo's) there is a RN and a Paramedic. The RN is the lead person of the transport.
In fix wing transport (long distance transport), depending on the severity of the patient, it usually is a RN and Respiratory Therapist (RT). Paramedics are not usually used on the long flights on a couple of long haul transport (PHX-YYZ) I had a paramedic who was a RT so it made it nice to have an extra pair of hands and eyes.
Most fire department who have a paramedic rig use Paramedics, some do have RN's that are fire fighters. Paramedics are usually great at the scene to stablize the patient to get them the hospital. They do not have the training as a RN when it comes to medical training. One would think they would, but its not so.
BTW, I would be interested in know if your friends wife was the one who took over on the emergency on the plane, since your friend was out of his scope of pracitce.
In some areas, critical care transport can be done with a paramedic on board. I live in OC, California, and in our county there must be an ACLS*-certified RN when transporting a critical patient in an ambulance. In Los Angeles County, they are allowed to use either an ACLS RN or a paramedic. I have a neighbor who is a paramedic and he works in LA County doing patient transport.
Internists who do a lot of hospital work, as well as ER physicians and pulmonologists, should be comfortable providing care to unstable patients. An orthopaedist friend of mine and his Nurse Practitioner wife were aboard CO EWR-SNA which had to divert to Albuquerque to a patient having a heart attack. They gave him oxygen, aspirin, nitroglycerine and applied the AED (never went off), and got him off the plane alive in NM. They learned he later died in a hospital there. They were both practicing WAY outside their field of expertise but there was no one else who could help on a 737-700 with a small passenger roster.
*Advanced Cardiac Life Support
Internists who do a lot of hospital work, as well as ER physicians and pulmonologists, should be comfortable providing care to unstable patients. An orthopaedist friend of mine and his Nurse Practitioner wife were aboard CO EWR-SNA which had to divert to Albuquerque to a patient having a heart attack. They gave him oxygen, aspirin, nitroglycerine and applied the AED (never went off), and got him off the plane alive in NM. They learned he later died in a hospital there. They were both practicing WAY outside their field of expertise but there was no one else who could help on a 737-700 with a small passenger roster.
*Advanced Cardiac Life Support
Mar 29, 2011, 2:58 pm
#36
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The Scope of practice between a RN and a Paramedic is a wide one, the RN scope is greater. <snip>
Paramedics are usually great at the scene to stablize the patient to get them the hospital. They do not have the training as a RN when it comes to medical training. One would think they would, but its not so.
BTW, I would be interested in know if your friends wife was the one who took over on the emergency on the plane, since your friend was out of his scope of pracitce.
Paramedics are usually great at the scene to stablize the patient to get them the hospital. They do not have the training as a RN when it comes to medical training. One would think they would, but its not so.
BTW, I would be interested in know if your friends wife was the one who took over on the emergency on the plane, since your friend was out of his scope of pracitce.
As a paramedic in Texas, my scope is unlimited. Yes, unlimited. I can quite literally do anything my medical director (a doctor) authorizes provided that I'm trained and competent. Given a set of protocols that explains what I'm allowed to do (in many places this is, unfortunately, presented as a set of limitations on what paramedics can do - for me, in my service, this is not the case save some very explicit limitations that require a consult for those procedures that are very, very high risk) I can do them ad nauseum at my discretion. The ambulance I work in is certified as a mobile intensive care unit (MICU), designating that as our level of care we are equipped to provide. For me, in my practice as a street-level paramedic, it includes:
- administering any of the more than 80 medicines we carry including narcotic analgesics, sedative hypnotics, paralytics, anti-psychotics
- implementing invasive and surgical procedures (breathing tubes, cricothyrotomies, chest tubes, needle decompression, pericardiocentesis, etc.)
- providing electrical therapy for cardiac conditions (defibrillation, cardioversion and transcutaneous pacing)
- using mechanical ventilation and managing vent settings, including monitoring capnography/oximetry and adjusting as needed
The problem is that even in Texas there are paramedic-level services that don't approach the level of care we provide - they provide a much smaller subset of these capabilities, yet they're still paramedics. Apply this to other states who DO restrict what paramedics can do, or other countries which define the role of the paramedic differently, and it becomes a complete mishmash. That's why it's so much easier to identify doctors - they're GENERALLY more uniformly trained, and I think it's fair to say they've ALWAYS received more medical training than paramedics... even ones like me who work in aggressive, high-capability EMS systems.
Sorry for the off-topic post, but it seems germane, especially given that you're MUCH more likely to encounter a paramedic on a flight than a doctor, and the paramedics are likely more used to treating acute medical conditions (vs. a doctor, unless they happen to be an ER doc, emergency medicine specialist, or rural healthcare provider).
Mar 29, 2011, 3:02 pm
#37
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She is an adult family practice RNP and thus had not done hospital work involving seriously ill patients in 25+ years. I would speculate that BOTH of them were way outside of their field. This was c. 1999 and as far as I know the plane was not served by Medair or similar service where they could be walked through what to do by a cardiologist, internist, or ER MD. However, they were the only people on board with even a small amount of knowledge, and they did step forward to help.
When I had my LH incident, I too was out of my field but there was no contact with the outside world with the technology then extant (1995) and thus I could not be patched through to an obstetrician to help me. Yes, I can manage hypotension due to blood loss, but normally I am not allowed to care for seriously ill pregnant women beyond the first trimester. I'm not sure what the person who added terbutaline to the LH medical kit was thinking (i.e. was it for asthma? for premature labor?) but I was certainly glad it was on board. I didn't know the OB dose so I just gave the asthma dose and it worked. Later learned that the asthma and OB doses (when not given as a Pitocin drip) are roughly the same.
My OB colleagues' only suggestion was that I could have give her a slug of alcohol for its tocolytic effect. However, I was worried maybe they were going to do a D&C, in which case they would want her to have an empty stomach, so I deferred on the alcohol. We had no sterile gloves on board but I used FA gloves and dipped them in an Absolut vodka alcohol bath. They agreed with the Foley catheter as well as placing her perpendicular to the axis of motion of the plane. LH had a crew break room behind the last Economy lavatories with two narrow bunks. The top bunk was hinged to the wall and could be lowered to form a "sofa" for use by ill patients (the FAs said it was designed to be an alternate sick room). The aisle in front of the sofa was only a foot wide, and the sofa was so low that I had to insert catheter and IVs on my knees, as well as take vitals on my knees. The paramedics have to take care of people on the ground....we in hospitals are spoiled, we get to take care of people already on gurney stretchers.
When I had my LH incident, I too was out of my field but there was no contact with the outside world with the technology then extant (1995) and thus I could not be patched through to an obstetrician to help me. Yes, I can manage hypotension due to blood loss, but normally I am not allowed to care for seriously ill pregnant women beyond the first trimester. I'm not sure what the person who added terbutaline to the LH medical kit was thinking (i.e. was it for asthma? for premature labor?) but I was certainly glad it was on board. I didn't know the OB dose so I just gave the asthma dose and it worked. Later learned that the asthma and OB doses (when not given as a Pitocin drip) are roughly the same.
My OB colleagues' only suggestion was that I could have give her a slug of alcohol for its tocolytic effect. However, I was worried maybe they were going to do a D&C, in which case they would want her to have an empty stomach, so I deferred on the alcohol. We had no sterile gloves on board but I used FA gloves and dipped them in an Absolut vodka alcohol bath. They agreed with the Foley catheter as well as placing her perpendicular to the axis of motion of the plane. LH had a crew break room behind the last Economy lavatories with two narrow bunks. The top bunk was hinged to the wall and could be lowered to form a "sofa" for use by ill patients (the FAs said it was designed to be an alternate sick room). The aisle in front of the sofa was only a foot wide, and the sofa was so low that I had to insert catheter and IVs on my knees, as well as take vitals on my knees. The paramedics have to take care of people on the ground....we in hospitals are spoiled, we get to take care of people already on gurney stretchers.
Last edited by PassatDoc; Mar 29, 2011 at 3:10 pm
Mar 29, 2011, 3:23 pm
#38
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PassatDoc-- That is an amazing story--I am sure the mother is profoundly grateful that you were on board. I can't imagine that most doctors would do so well outside their area with such limited supplies. Bravo.
Mar 29, 2011, 3:37 pm
#39
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Check this out - Lufthansa Doctors On-Board. LH has a program to register as a doctor and receive miles, legal protection, etc.
Mar 29, 2011, 3:56 pm
#40
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That may be true, but the qualifications to become a licensed paramedic are far from standardized. I think where I'm from, in Alaska, two or three classes are required. Would you rather have a guy who barely passed his classes while training to become a licensed paramedic, or the guy who barely passed his classes for 14 years to become a licensed doctor?
I can certainly understand the airlines viewpoint. For the record, I'd rather have a licensed paramedic. I think the skills that they are taught are far better at stabilizing someone in transit.
I can certainly understand the airlines viewpoint. For the record, I'd rather have a licensed paramedic. I think the skills that they are taught are far better at stabilizing someone in transit.
Mar 29, 2011, 4:24 pm
#41
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For what it's worth, the Alaska paramedic students are often the best I've worked with, student-wise. Good enough that we've convinced several to stay and hired them on full time - and I can't think of ANYONE else we'd hire "straight out of school."
Like another poster said, you're probably confusing EMT (the basic training) with the longer, more involved, more rigorous Paramedic level training. Easy to do... we're all "ambulance drivers" to the public (and most hospital staff) anyway.
Mar 29, 2011, 10:08 pm
#42
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I've attended 3 or 4 medical emergencies, and was only asked for my credentials once (on a BA flight). On that occasion, it was actually my gf of the time who was unwell, so it was especially stressful, especially since the whole thing was rather protracted. The CSD offered to move us up to F, but that became (medically) impractical for various reasons. Was given half a case of wine by BA as a thank you, which was appreciated, but since I'm teetotal, I didn't benefit personally.
On NW, attended a man who collapsed, but I'm pretty sure it was a vaso-vagal. Monitored him a few times, and he was fine, but I advised him against driving on arrival at LHR. I was given a cert for 5k miles, which I couldn't redeem, since European residents couldn't join NW at the time.
Most recent case was about 6 months ago -- I was in F from BOS to ORD on AA, a sweet old lady lost conciousness -- not diabetic, but revived after a few minutes after being given some orange juice and I don't think it was anything serious. I monitored her regularly throughout the flight to make sure she was OK, which she was. She said that what brought her round was my 'unusual accent', which she couldn't place -- given that I speak Standard English, I found this rather bemusing! The FA took my details, but I heard nothing back.
I agree with one of the posters above: the CC/FAs are very professional, which is just as well, since it is extremely stressful attending an emergency mid-flight, taking BPs is v. difficult etc. An acknowledgement letter would be a very nice and classy thing to do -- BA was the only one to have done that in my experience.
Most difficult scenario I heard of was a friend who (when an intern) diagnosed a ruptured ectopic pregnancy in a woman, and asked for an emergency diversion. Pilot told him later that his diagnosis had been spot on, and the patient was recovering well.
tb
On NW, attended a man who collapsed, but I'm pretty sure it was a vaso-vagal. Monitored him a few times, and he was fine, but I advised him against driving on arrival at LHR. I was given a cert for 5k miles, which I couldn't redeem, since European residents couldn't join NW at the time.
Most recent case was about 6 months ago -- I was in F from BOS to ORD on AA, a sweet old lady lost conciousness -- not diabetic, but revived after a few minutes after being given some orange juice and I don't think it was anything serious. I monitored her regularly throughout the flight to make sure she was OK, which she was. She said that what brought her round was my 'unusual accent', which she couldn't place -- given that I speak Standard English, I found this rather bemusing! The FA took my details, but I heard nothing back.
I agree with one of the posters above: the CC/FAs are very professional, which is just as well, since it is extremely stressful attending an emergency mid-flight, taking BPs is v. difficult etc. An acknowledgement letter would be a very nice and classy thing to do -- BA was the only one to have done that in my experience.
Most difficult scenario I heard of was a friend who (when an intern) diagnosed a ruptured ectopic pregnancy in a woman, and asked for an emergency diversion. Pilot told him later that his diagnosis had been spot on, and the patient was recovering well.
tb
Mar 29, 2011, 10:39 pm
#43
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Interesting that FAs require inspection of credentials before allowing access to the medical kit. I'm an ED doc (30 yrs+/-), and don't think I have my license in my possession most of the time. (I'll have to check--might have the pocket card stuck somewhere.) Would a script pad with your name on it do? It'd be really hard to watch someone struggle, maybe die, because you hadn't thought to bring your creds to Cancun.
Mar 29, 2011, 11:52 pm
#44
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However, once stabilized, Canada didn't want her to remain there due to potential medical expenses (she was covered under Germany's health insurance, but probably not for another five months). She was not cleared to fly. Her husband flew to Canada and they drove three hours to Minneapolis, where they rented an apartment (family were wealthy newspaper publishers in Germany)and she remained there for five months until the baby was born normally. Rotating shifts of relatives came over from Germany to care for her. I was invited to the baby's baptism later that year but was unable to attend. It is not uncommon for Germany males (especially from Catholic families) to have two middles names. They stuck the baby with my first name as his second middle name.
Mar 29, 2011, 11:53 pm
#45
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Interesting that FAs require inspection of credentials before allowing access to the medical kit. I'm an ED doc (30 yrs+/-), and don't think I have my license in my possession most of the time. (I'll have to check--might have the pocket card stuck somewhere.) Would a script pad with your name on it do? It'd be really hard to watch someone struggle, maybe die, because you hadn't thought to bring your creds to Cancun.