PassatDoc

I forwarded the information about Lufthansa's Doctors On Board to American's customer service department, suggesting they implement something similar at AA. I received a cordial (not an auto reply form letter) reply stating they were sending the suggestion to their medical department for review. Maybe it won't go anywhere, but it's in AA's ballpark now. I have a friend who is an AA purser who has told horror stories of someone sick on board and no doctors stepping forward to help (or no docs on board).

I also downloaded the fax registration form for LH's program, but explained (in German) that I don't have a Miles And More account number, instead providing my United Mileage Plus number. They e-mailed back saying that an LH number was required for registration. I wrote back saying I have no use for an LH number, since I fly United domestically far more than LH internationally, and so when I book LH I use a UAL mileage plan number. I also raised the issue that there is no point having an alliance if they can't identify doctors on board whose primary program is with an alliance partner. (their computers are set up to display only doctors who have registered with them using Miles And More---i.e. doctors with an SAS or Swiss or United number will be invisible to them). I don't think they will bother to reply.

stonecrd

While not a medical emergency I did encounter and interesting medical issue on one flight. Coming to the gate I see two brother's waiting to board on scooters both are +500lbs. After boarding with F and taking my seat they start general boarding and the one brother is having a tough time, sweating profusely, moving a couple of rows then stopping to rest. He finally gets back to his seat and I notice boarding is stopped? Eventually the guys come out from the back along with the FA carrying the seat cushion. Seems like a problem with bodily fluids. They ended up having to get a cleaning crew on board and wipe all of the seats the guy had contact with. Ended up being a 30m delay.

FlightNurse

You really seem passionate about this subject, and I don't mind talking about this, but please have an open mind when reading this post.

From what I gather the EMT-B is the basic entry level of the EMT profession, this is what I got off the internet:

EMT-Basic is the entry level of EMS. The procedures and skills allowed at this level are generally non-invasive such as bleeding control, positive pressure ventilation with a bag valve mask, oropharyngeal airway, nasopharyngeal airway, supplemental oxygen administration, and splinting (including full spinal immobilization). Training requirements and treatment protocols vary from area to area.

Now if this is correct, the EMT-B does not have the training nessesary to treat a patient who is having an MI, PE or other medical emergency that might require to open the medical bag while in flight i.e inserting P,IV, pushing medication and Interpreting a ECG.

Regarding Medlink, No, but have worked for MedAire out of PHX,AZ which was the first company of its kind. I have worked for them in "the dark" (answering the phones (so to speak)) and as well as on the outside speaking to Ambulance services as well Airlines and teaching BLS, ASLC and at times, TNCC (they have since stopped this.)

The medical Kits that the airlines have are all basically the same, but each airline does customer order thier own kits. They have some cardiac drugs, ativan or valum, morphine, Benadryl, Epi (pens and IV Push), nitro paste and pills, ASA (usually childerns chewable.) the kits are mostly to "stablize" the patient until the plane can get on the ground.

Regarding non Dr's to open the kits, most kits today say, to be open by a qualified medical personal. According to airlines as well as MedAire this would be a Dr (MD or DO) Nurse Practioneer (NP), RN or Medic (paramedic.) But again, each airline has their own policy on this, of course there is a hierarchy that happens to allow who opens the Medical Kit, First a DR, then NP RN then Paramedic. Stangely most airlines do not allow Physician Assistant (PA) to open the kits (but there are exceptions to the rule.)

I think you miss read what I posted, I never stated that RNs or Paramedics can not open the med kits, but EMT-B's and EMT-I's can not open the kits. It basically comes down to scope of practice. I can't see a EMT-B having the skills of starting an IV and pushing medications, since its a entry level position. Not every RN has the skill set to handle someone with a MI or PE, but they have the skills and knowledge of inserting the P.IV and pushing the medications given the order from the ground and staying with-in thier scope of practice. One of the biggest misconception when it comes to pushing cardiac medications is, you do not have to be ACLS certified to do it. ACLS is a algorithm.

One thing people need to know, that a commerical airliner can not be flown without a intact Medical Kit. Once a kit has been opened, that kit is known as being "dead" and can't not be used again (sort of like Code Carts in hospitals) But ususally stations in which airlines fly into, they have a spare Kits on hand "just in case" a diverted plane arrives.

I hope I have answered your questions and concerns. Having been a flightnurse for 12 years, ICU Nurse for 5 I have only had to open a medical kit once. A man was having a MI, just looking at him I knew got him stablized and then we landed in Reno,Nv. Heard a week later he had quad done and was alive.

Koru Flyer

Interestingly, my wife (much to her embarassment*) has managed to clock up two medical emergencies (note she is also a 100k+ flyer).

1. After a holiday to Cairo (vegetarian at the time), suffered extremely bad food poisoning (that will teach you for eating salad!). And was hospitalised for 3 days when back in CPH. Wife vomiting, weak, and extreme pain and blood clots on the face. Was moved to F and attended to by a plastic surgeon and a trauma surgeon. All was very professional - with constant contact to a medical ground centre, until came to land in LHR where no assistance between terminals was provided.

2. Broke her foot while in car accident in the USA (car driven by mother in law - thanks!). Had to fly TVC-ORD-LAX-MEL a week later (foot stabilised in a sports cast so was cleared to fly). All OK, except on ORD-LAX flight she had extreme pain and immobility in the leg. FA called for MD on board. Along came guy and his wife who was a herbologist . So no assistance onboard - FAs in constant contact, wife in enormous pain. Have never had such a fast landing and taxi into LAX. Maybe similar to previous poster: FA went on the PA on landing to tell everyone not to dare stand up until medical staff had boarded and helped my wife off. Problem was that we had crutches, a couple of bags and a two year old! Wife much to her embarrasment at the fuss bundled down the aisle with paramedics in tow. Especially when she saw three of them run on with equipment!!!!, one clever pax realised that there was no way I would get off with a tw year old, cructhes and bagsand FA was not letting anyone up so if he helped he would be wisked off in the pandamonium. Ended up all OK was due to blood flow and QF upgraded us all to /F/ on the LAX-MEL leg ^ (and pax landed one hour early into LAX).

*Also as a private pilot she forced a 757 to a quickly decided go around as she landed her Cessna too slow at IND - but she does not like to talk about that either!)

KF

sangria

Passionate? Sure why not. You made a definitive statement and I believe your statement to be false. If it's not false I'd like to know where exactly it's coming from because it is bad policy. I also believe it to be dangerous. Yes, there are often cases where there is a practitioner that has more training than an EMT-B, thankfully. But, if there was an aircraft over the ocean and the only person with any medical training onboard happened to be an EMT-B and someone was going into anaphylaxis, I sincerely, sincerely doubt that the airline or the airline's contracted medical service would deny the EMT-B access to the medical bag for an Epi autoinjector. And they would have no reason to.

I'm being "passionate" about this because your definitive "no" means that the airline would indeed deny the EMT-B access to the medical bag. To do so would be negligent on the part of the airline and medical control.

Anyway.- Benadryl, Epi Auto-Injectors, Nitro and ASA are all part of the national curriculum for EMT-B's and all well within their scope of practice. Granted, the patient must have an Rx for the medication, but on-line medical direction could allow an EMT-B to give any of those med's even if the patient doesn't have an Rx.

Further, an EMT-I absolutely can Start an IV and interpret an ECG (which is something that most airlines don't have anyway according to the Journal of Emergency Medicine).

So, with (or without) on-line orders both EMT-I and EMT-B could stay within their scope of practice while utilizing many of the tools in the medical bag. No, they cant use all of them, but that's absolutely no reason to exclude an EMT from the bag.

KtownTraveler

Please post her future itineraries here so that we may avoid her flights.

mreed911

Considering that most hairdressers have more training than an EMT-B, I'd guess this is correct. Not a slam against basics, but let's be fair - EMT's are largely undertrained and the profession as a whole continually fights to keep the basic certification requirements at a minimum to support rural volunteers being able to afford/put the time into a program. This is why there's such a difference in EMT and Paramedic, and the gap is widening. That said...

Maybe. Not all EMT's are trained in Epi auto-injectors, and MedLink has no way to validate that a person's training likely covered this scenario. Perhaps it's cheaper to carry 1:1000 Epi, instead, so there are no auto-injectors? Or perhaps they're worried about cardiac complications alongside an injection of Epi. In some states, EMT-B's may assist patients with their OWN injector, but may not provide one (or use one not provided to the patient via prescription by a physician). There are way too many variables to be able to say they have "no reason to" when, in fact, they do.

The airline has no duty to provide an off-duty *any certification* person with access to the medical kit. They have a duty to act in the best interest of the passengers, and as such, vest the power to provide access to flight crew and cockpit crew. In most cases this means that the higher the certification/licensure of the person, the more likely they are to be able to access the contents of the kit for a given emergency.

Let me ask you this - do your protocols SPECIFICALLY allow you to practice when not on duty, especially when out of state or out of country? Mine don't. In fact, my protocols, to cover my medical director, ONLY authorize me to practice under his license when on duty for my service. On an aircraft, especially out of the country, I have no authorization to practice paramedicine. This is where MedLink can come in handy - they have doctors that can authorize me to practice, and to practice specifically in regards to an on-board emergency. I'd bet that if you look, you're not authorized to practice outside of work... and that your state law probably limits your ability to practice to your home state, as NREMT is only a certification authority and not able to provide you license or scope to practice.

Not in Texas they're not. EMT's here can ASSIST with a patient's own Nitro/Epi, but CANNOT provide it to them. They don't do Benadryl at ALL. They CAN, if their medical director approves it, but it's NOT part of the curriculum required by Texas.

You have this in the wrong order... and it's interesting that you place this last. This is what I've been saying above, and what others have been saying. This is where the discussion must start. A physician DOES NOT NEED authority to practice - their license conveys that. Nurses, paramedics and other Allied Health specialties DO. Period.

Yes, there is. Liability, and that fact that not all EMT's and Paramedics are the same, to include training, skills and abilities. Additionally, they're NOT licensed for independent practice, period. Period. Period.

JY1024

Though I've personally found this thread to be very interesting and informative, the core conversation has now drifted to a point where it's not about AA or AAdvantage. Therefore, we'll give this a new home in TravelBuzz for folks to continue the conversation/discussion there. Thanks for your cooperation. /Moderator

FlightNurse

I'm sorry you don't like the rule, I can not change it. The statement I made is not FALSE (Please prove me wrong), sorry it goes against your beliefs. I do know that most of the airlines give training to the FA to be able to give simple medications to pax when they are in contact with MedAire i.e epi pens, nitro and asa as well as O2.

FlightNurse

One thing I like about AA when it comes to inflight medical emergency is they have an in-house physican who talks to thier crew when a problem happens. But with the way the company $ problems I wonder how long they will keep him on staff!

FlightNurse

Thank you.

Scubatooth

Mrreed911 - have you checked the NREMT/DOT National Curriculum as Auto injectors were part of the training as far as i remember. It was taught in my Basic class, but thats been a few years and Im now a paramedic.

Nurses cant practice independently/autonomously either so whats the point.

mreed911

You assume all EMT's are NREMT (they're not), and that administration of an Epi-pen is allowed even when it's not prescribed to the patient, which isn't always true, either. Most places that provide ALS care don't carry Epi-pens, anyway, since they have Epi dose vials instead... so few if any services carry Epi-pens.

Utah, Wyoming, Illinois, North Carolina, New York and Massachusetts don't use NREMT certification at all. Florida uses it for EMT-B ONLY. Alaksa, Indiana, Maryland, New Jersey, New Mexico, Pennsylvania, Virginia, Washington and DC use NREMT for EMT-P ONLY. Now try to sort that out in flight, and realize that even though they may or may not use NREMT for certification, they each have vastly different approaches to scope of practice, skills, etc.

FWIW, I'm a paramedic, now in a state that requires NREMT-P for new medics, but I've never, ever been NREMT-P certified - only Texas certified (and now licensed). I maintain my licensure based on STATE requirements, not NREMT.

Huh? I mentioned that in my post above. In that regard, nurses are much like EMS personnel - each is going to need MedLink to actually do anything ALS.

The real story here is that most people DON'T need ALS care, or the delay for ALS care won't impact their morbidity or mortality. In those few cases that do, MedLink is there and/or a physician is likely to be available as well. I'd suggest that if EMS/nurses respond along with a a physician that they'll likely work together as needed as a team.

FlightNurse

Basically from what I know about EMT's the scope of practice varies greatly from state to state, some states allow EMTs to do things that other states do not allow them to. Regarding Nurses (when I say Nurses I'm talking about RN's) the scope of practice is basically the same, insert P IV"s, do IV push's, and make assessments. This is the difference why RN's are allow to open the Medical Kits with the permission of the captian on the aircraft and not EMTs-B and I's.

I hope this settles the debate, which has gotten way off base of the topic at hand. If you do not like that airlines do not allow EMTs B and or I to open the Medical Kit, then do two things. Get the rules changed at the airlines or move on to the next level of skills and become a EMT-P. But sitting here on this forum want make a difference and not believing this is just a waste of time.

pinworm

Recently I was on a WN flight (gag) SAN to HOU and some guy in the back had a seizure. The FA paged if anyone onboard was a doctor. A VERY old, retired guy put up his hand and my seatmate did too, turns out he was a nurse.

I thought we were going to divert, but we didn't. The victim walked off the flight under his own power as well. Good thing...that doctor was wayyyy too old. Probably had not practiced medicine since the early 90's.

Twice I have been on diverted flights for med emergencies. 1 heart attack and 1 child with a rupturing appendix on a TATL. We dumped fuel in both cases. In the case of the TATL we were 5 hours in and managed to get to Halifax in time to avoid the worst case scenario but it was a bit upsetting to everyone to wait that hour between being informed and getting to Halifax..because it was a kid after all. There were doctors aboard in both cases and a two nurses on the heart attack flight.