Meet new scuba divers, maintain a virtual dive log, participate in our forum, share underwater photos, research dive sites and more. Members login here.

Medical Assistance
Kemperite - 2/06/2008 10:49 AM
View Member Articles
Category: Educational
Comments: 7
Medical AssistanceSome of you on here may know me. I`m the vagrant dive bum without a home who flies First Class. It`s kind of a running joke with my friends. I`m homeless - but I hate sitting in Cattle Class on the plane. So Saturday, the 2nd of February I was flying from a non-diving city in Florida to Atlanta, Georgia. I try to go up once a quarter to check my mail. I may be homeless but try doing business in this world with just an e-mail address. So I have a Post Office Box where I have to show up every so often to empty the sales and marketing crap out of it. Anyway, this weekend "Jinx" (On DiveBuddy) and I were headed to Atlanta to check my mail, clean up my storage unit to find some dive gear that I needed for an upcoming set of trips and meet some friends. The following is told not to make fun of people but instead to educate others based on our experiences.

We caught the early morning flight - 0600h and flying high for an incredible sunrise. It was uneventful. I had managed to have my second adult beverage in First Class before the seat belt light was turned off. At which time I promptly made my way down the aisle to the Emergency Exit Row on the Starboard side of the plane to bring Jinx a pillow, a bottle of water, some Sun Chips and my presence to watch the sunrise off the tip of the wing on the horizon. My travel companion may have been in Coach Class but I was going to make sure she at least got the Sun Chips and the pillow for this flight. As for my company at 0630h she could probably take it or leave it. Eventually I made it forward to First Class to resume my seat and continue on this 73 minute scheduled time flight of uneventful early morning beauty.

At 59 minutes into our flight the call came up the aisle. An elderly man had gone down. Heart troubles, shallow breathing, color gone all wrong and general old man problems on a plane. The #2 flight attendant clears an aisle and they move the man so he can lie down across the seats. The Lead Flight Attendant hits the PA to ask for any Medical Personnel on board the plane. I think fast, Jinx has her key chain pocket mask on her belt loop. Mine is attached to my computer bag over my head. I also had two pairs of freshly liberated from the ambulance purple gloves in my bag`s outer pocket courtesy of the Fire Captain where I had just done an Instructor Class. As the Flight Attendant is making the announcement I`m unbuckling my seat belt and reaching for my black bag. Then, before I`ve had a chance to even unzip the bag she says, "Oh, never mind. He`s traveling with his doctor."

So here`s how I take this scenario. An old man is traveling in Coach Class on our little MD-88. He has "his" doctor with him. First thing that comes to mind is that this man must have plenty of medical issues to be traveling with his own doctor. Second thing that comes to my mind is that he should really fly First Class if he has the cash to keep a doctor at his side while he travels. Of course, I digress. I stand down and close the lid on my first response gear located in the overhead compartment. After all, his doctor is with him so what could I possibly do for the man?

Luckily, we are less than 15 minutes from the ground at Hartsfield-Jackson Atlanta International Airport. We`re waiting on someone else to die in the ATL so that we can add more names to the airport so it can be known not only has the busiest by both flights and passenger volume worldwide but also longest name. From my First Class seat I didn`t see much action on this old man but I figure it`s under control and hang on for what I know will be a wild landing. The kind that pilot`s who started out on military aircraft long for when they transition to being the bus drivers of the sky. We get priority clearance into Hartsfield and drop out of the sky so fast I hear the warning buzzer from the cockpit. Luckily, First Class is generally populated with frequent flyers so there is not screaming about impending doom from the passengers near me while the alarm is sounding in the cockpit. We hit the tarmac and make the hard left immediate turn to the concourse where we are met by the Ambulance with Advanced Life Support equipment (ALS), a Fire Truck with ALS gear and people, the Atlanta Police and the Airport`s Paramedic Golf Cart. I swear, I don`t know what additional gear the golf cart had that the ALS Ambulance and Fire Trucks were missing, but it came too!

So, gentle reader, about now you might be asking - how does this blog fit into the educational side of life? Well, the parts that were behind me and fit in between the above paragraphs but only learned by me *after* we landed are pretty important. This is where we communicate on the ground and put everything together as sort of an after-action review to see what could have been done differently or better.

The man himself was in fact a doctor. He was on his way home from a conference in Florida of other doctors. It just happened that he was sitting with other doctors from the conference. So in essence the first ding in the armor of our story is that he was not traveling with HIS doctor but rather a few peers from the conference. As Jinx and I are discussing this incident she said, "I was jumping up when they called but when they said he had a doctor with him I figured at my level (newly minted EMT) there was nothing I could do without my gear." Then she saw the Flight Attendant hand the doctor the plane`s medical kit which had a blood pressure cuff and stethoscope among other critical items that she would have needed but didn`t have of her own on the plane. So she learned a valuable lesson about the fact that planes do carry "stuff" for such emergencies.

Let`s look at what else this plane carried for this emergency: 3 Emergency Oxygen Kits fully assembled with a non-rebreather mask on each bottle capable of delivering Oxygen to a patient for 20 - 30 minutes per bottle; an Automated External Defibrillator (AED) for use on patients whose hearts have gone into Fibrillation to put the heart back into its proper rhythm; a full medical kit with most of what you would need for Basic Life Support (BLS) functions until the pilot can put you on the ground for an ALS crew to take over.

This is where the diving community comes in. In Scuba Diving we teach you to just add Oxygen. Is the patient breathing? Add a demand inhalator with oronasal resuscitation mask with 100% Oxygen and continue your assessment, if he is not breathing strong enough then change to a non-rebreather mask at 15 lpm flow rate. Is the patient not breathing? Put supplemental Oxygen on the inlet barb of an oronasal resuscitation mask and give rescue breaths (lay-provider) or attach supplemental Oxygen to the inlet barb of a Bag Valve Mask (DAN`s BLSPro Course) and provide rescue breaths. Oxygen can do no wrong in Recreational Scuba Diving Emergencies.

That`s pretty much the drug of the EMT in this situation (patient having difficulty breathing or not breathing). Sitting behind Jinx was an ER Nurse. She also stood down and watched from her seat when told that the patient had doctors with him. They had a much better view of the scenario unfolding in Coach then I did up front.

Jinx tells me when we landed that she watched one doctor take his blood pressure and pulse with the cuff and stethoscope. Then he checked his level of responsiveness and finished up by checking his pupils for reaction and such with the little flashlight. So clearly he is unresponsive, yet the doctor continues to go back to checking the patient`s eyes. At this point Jinx doesn`t realize that there are 3 Oxygen Bottles within 40 feet of this man`s current location. Two Forward in the First Class Cabin and one Aft in the Coach Galley, as a Flight Attendant would say when pointing out their locations to you if asked for their whereab


Madsmiley - 3/07/2008 4:36 PM
Ah,but you see the potential can of worms that could be opened here!!! Once you establish contact with the patient and begin any type of interventions,how far are you going to take it?? Agreed, O2 isn`t going to harm the patient in this case and I would most definitaly give it if avaliable..That brings up the question of the other types of meds though.Would I give those if we were outside of Texas???Not unless the aircraft was able to get me medical direction via the radio..If I was not able to confirm medical direction and then the patient crashes because I legally cannot give the meds,what type of situation is that going turn into??
Kemperite - 3/07/2008 6:41 AM
Good Samaritan laws vary widely from state to state. In Hawaii, using an AED on a patient without having received training from an MD actually puts you outside the scope of protection (unless recently changed). Some areas have Good Samaritan laws that actually instill a "duty to act" based upon the fact that every person should act within the limits of their training upon seeing an incident. Once you hit EMT though you are in a whole new ballgame. As a "professional" you are open to lawsuits. I always recommend carrying liability insurance whenever you hold a rating that pays you to do something someone could sue you for. Nature of our society.
Kemperite - 3/07/2008 6:40 AM
With regard to giving Albuterol my answer would be that it depends on your level of training. The standard for a lay provider is that they may "assist" the patient in taking prescription medication that has been specifically prescribed to them. With the exception of the magic 8 drugs, EMT`s are allowed the same assist rule. It`s not until Paramedic that you get to push drugs from a much broader spectrum (Thanks Jinx!). Nitro is one that a lay provider may give. Insulin - although no longer requiring a prescription to buy - is one that a lay provider may ASSIST with but should never GIVE on their own.
Kemperite - 3/07/2008 6:38 AM
Medical O2 both is AND is NOT a drug. Whether it is considered a drug is completely dependent on how - the situation at hand if you will. I suppose this is a topic for another blog. Technically, it does not require a prescription to get your O2 bottle filled. The Federal rules regarding Oxygen are highly sketchy as to how to treat it. Bottom line, some states require a prescription based on their interpretation of the federal statute regarding Oxygen and some do not. With regard to scuba diving, most states where diving is prevalent will allow you to fill your scuba oxygen kit so long as you provide a current certification card showing you`ve been trained. The answer becomes "Yes" I would give this guy Oxygen.
Madsmiley - 3/06/2008 11:25 PM
Medical O2 is still considered a drug since it requires a prescription to get the bottles filled..Can or would you give this guy O2?? If he still had difficulty breathing,could/would you give albuterol?? What if the guy was having chest pains??Can or would you give him nitro???There are several ways this scenerio could play out with other than a happy ending.. The point Im trying to make here is to remind everyone of the golden rule of EMS..Protect yourself first,your partner second and your patient third..
Madsmiley - 3/06/2008 11:23 PM
Heres an interesting questions some may be able to answer for me..Im and EMT-B in Texas,have been for 9 years.I was grandfathered in and not required to take the national registery..So if a situation were to happen out of Texas and I attempt to help,am I setting myself up for a potential lawsuit or would I be protected under some type of "good sameritan" clause. Please forgive me if this sounds harsh or jaded in any way,but this is a legitimate concern and leads to other points..If someone such as myself do chose to step up,it will be without a "duty to act" and therefore,will not be supported or protected under my normal protocols.Basically,I could do nothing but basic first aid legally..This is where everyone has to start weighing legal vs. moral/ethical considerations..
Kemperite - 2/07/2008 7:56 AM
I`ve had a couple of comments - I`m aware that an ophthalmologist is an MD. In fact, when I go for an eye exam I make sure it`s an ophthalmologist and not an optometrist because I`m rude and snooty like that. I realize that some doctors are already aware of what is contained on a plane for medical kit. The list of what was on the plane was directed at the divers who are lay-providers as well as the occasional medical professional traveler who did not know what was available to them on the plane. I`m well aware that the important thing is to get the plane on the ground for ALS support. However, when the plane is in the air my point is that for someone who isn`t breathing properly we should start Oxygen. Yes, if they have a pulmonary embolism it probably won`t help - but it won`t hurt either and in fact it may be able to help.

The point is: Just because someone says, "I`m a doctor" doesn`t mean you don`t step up. Starting O2 15 minutes sooner could have saved his sweater.