A/C Medical Question.

[SCT]

We recently had a medical situation during an overseas trip on our company aircraft. A guest of our CEO had a mild allergic reaction to some pistachio nuts that was served by the F/A. The CEO went to the onboard medical kit and did not find anything useful to help the guest. He has asked the flight department to find a medicine for the a/c for any future events. Has anyone else had a similiar medical problem? What do you have on board? Benadryl? Do you need a perscription for a Epipen for an airplane? Thanks for any input.

 

[Cat3C]

We use Med Aire for our medical kit and AED/CPR training. I believe that for certain medicines (Epipen, Nitro, etc) you do have a need for a prescription but again, they handle that for us. They also moniter the meds for epiration dates etc.

 

[Pilot Doc]

We recently had a medical situation during an overseas trip on our company aircraft. A guest of our CEO had a mild allergic reaction to some pistachio nuts that was served by the F/A. The CEO went to the onboard medical kit and did not find anything useful to help the guest. He has asked the flight department to find a medicine for the a/c for any future events. Has anyone else had a similiar medical problem? What do you have on board? Benadryl? Do you need a perscription for a Epipen for an airplane? Thanks for any input.

Any medicine that would be more than a convenience item will require a prescription. That would include an epi-pen. Over the counter benadryl would help with mild allergic symptoms - hives, itching, etc. It would be of little use in a life-threatening allergic reaction.

If your CEO is in a mood to spend money, what you should get is an automated external defibrilator (AED) It's a device around the size of small shoebox that very effectively treats many cardiac arrests. You won't find anything better to quickly and easily fix a (relatively) common life threatening medical problem. In particular, it makes the diagnosis for you - it won't defibrillate someone who doesn't need it. The trouble with epipens is that you need to know when to use them - it won't help (and might hurt) someone who's having a seizure or stroke, etc.

 

[G100driver]

We have an AED but to be honest with you we should have Epinephrin on board. If someone on board has a severe allergic reaction you will not have time to land.

I am sure there is a way to get a generic perscription as I know several outdoor services carry them in the event that a client gets stung by a bee.

 

[Rxflyer]

I think it would be a good idea to carry an Epi-Pen in the kit. One thing to be aware of is that if the plane spends a lot of time in the sun on the ramp, the hot cabin temps can destroy the epinephrine. Never use a pen that has become brown/discolored.

There's probably a lot of prescription meds that would be handy to carry, such as sublingual nitro, an albuterol inhaler, etc, but as mentioned above, you have to know when and how to administer them.

 

[avbug]

Even if you have epinepherine on board, do you know how and when to use it? What if the condition wasn't actually an allergic reaction? Suppose the patient had a cardiac condition and you administered epinepherine? Suppose it was something entirely different? Is the CEO qualified to make that diagnosis? Forget technical qualifications and legalities...does he have the experience and training, or the knowledge to make the decision?

If the patient is subject to severe reactions, why does the patient not have his or her own prescription?

If the person administering the drug were an emergency medical technician, especially at the basic level, unless the patient brought his or her own, it's still not a drug that the EMT could administer, and generally then only under medical direction or control...in other words, unless a docor on the other end of the line ordered it.

Administer the wrong drug at the wrong time, however well meaning, and one might end up harming or killing the patient.

Setting that aside, what of the legal ramifications? An AED is straightforward; it's designed to protect the patient and the user. But drugs are not. If your drugs are used inappropriately, you're liable in a very big way. If your drugs are out of date, contaminated, or otherswise cause harm in that respect, then you're liable. Does your CEO want to make himself, you, and the company liable for untrained and unqualified people making untrained and unqualified decisions that affect someone's life and the financial future of everyone involved...potentially for the rest of your lives?

Conversely, if that patient does have a reaction as described and dies, you are not at fault for failing to have drugs on board which you are not qualifed or allowed to administer...see the difference?

If instead you counter that you're qualified or the CEO is qualified and able to prescribe these meds on the spot (or yourself, or someone else onboard, or associated with the company, or you have a medical director to handle it, etc), then have a ball, stock up, and the question has a silent, or mute point.

I believe your question was specifically if others carry this on board. Presently I don't. I have been involved in ambulance operations where we did carry such supplies (and a whole lot more) on board. In the event we had our regular contingent of nurses and medical technicians on board, of course any of the drugs could be used according to the established protocols for the medical direction for that company. I'm also an EMT, far from a doctor and far from any particular significant level of qualification. However, absent any specific approval from the doctor who provided the medical control for that operator, I couldn't merely decide to administer those drugs by myself, to a patient or passenger on board.

I experienced a flight one night in which a passenger in a small twin lost consciousness in a rural/remote area at night. I didn't have a nurse on board. I was transporting two passengers from a hospital to their home in a remote location, and was told only that the passenger was being returned home following "tests." The passenger was seated next to me in the right seat, at his request. The other passenger was seated at the back of the airplane. My ability to administer help to the passenger/patient was limted, of course, by my responsibility to fly the airplane.

Within reach, I did what I could, which was put a nonrebreather mask on the passenger and apply oxygen at 30 litres/min, and slip a pulse oximeter on his finger. At the same time I executed a rapid descent to the nearest field and landed. Drugs were on board. I didn't use them. I did not know for certain at the time that the patient was experiencing a cardiac condition. He could have been stung by a scorpion (common there), he could have had any number of problems, including an allergic reaction. Had I attempted to administer epinepherine (an inappropriate reaction in that case), I could have killed him. Most likely, I would have.

My point is that even if the drugs are available, chances are that using them is an inappropriate reaction...especially if one doesn't hold the qualifications to use them.

When I was spraying full time, many operators carried Atropine to counteract oranophosphate poisoning. Organophosphates are typically sprayed pesticides, but act as nerve agents on people and are very hazardous. Their effect with continued use is cumulative, so that poisoning may take place over time, and smaller and smaller doses may be necessary to cause a reaction or kill a person. When you're working with Parathion and other such chemicals daily, this is an important consideration.

The problem is that Atropine shouldn't be administered by non-medical personnel. It does counter the organophosphate, but it is also a deadly poison. The proceedure then was in a nutshell to poison the victim of organophosphate poisoning with Atropine. Then treat the atropine poisoning with Protopam Chloride (2Pam). Then treat for the effects of the 2-Pam. An operator who began self-administering Atropine following a poisoning was in effect, killing himself with the Atropine, though he might be saving himself from Organophosphate poisoning. Perhaps you see my point.

Securing an Epi-pen or similiar product to put on board isn't difficult, or is the use difficult...but the big question is should you? The ramifiations of carriage and use are very serious for you, your company, and the patient. Something to think very carefully about before proceeding.

 

[Hawker rider]

You know what would be the easiest and best solution?

Make sure that one of the flightcrew has an MD. Or better yet.. one isn't considered redundancy, make that at least two on each crew.

You are expected to be able to minister First Aid. If you are not schooled and qualified to use medicine like that, stay away from it, that's pretty serious stuff.

 

[Diesel]

Call the mayo clinic they have a mayo aviation services. Its who nj uses. They provide you with everything you need and also a 800 number for 24hr calls on how to use the stuff and they talk you through it over the atlantic. They will also coordinate mayo only approved hospitals and transport.

We've had a lot of pilots and passengers use the service and they are well worth the money. One call gets you everything you need plus you have use of the mayo clinic out in Rochester if you yourself ever get sick.

They will also come and train you at your flight department on how to use all the stuff and the procedures to use them.

I can't say enough good things about them. They are really great.

If you are going to do it do it right. One day you might save your owners own life. An eppi pen isn't crap unless you have everything and the training you need.

 

[SCT]

Thanks for all the input and information, guys. We've been doing some research the last couple of days and pretty much came to the same conclusions. The only thing we can legally carry on board would be over the counter Benedryl. This would be better then nothing and help out w/ mild allergic reactions on our overseas flights. (We also have AEDs/ First Aid and train yearly on CPR).

We just origionally thought that there might be an EpiPen available for our situation. But as we soon found, 1- You need a perscription in someone's name. 2- They will probably not store well on an a/c. 3- All of our flight personel would have to be trained. 4- And the biggest problem be the liability on the flight crew administering medicine onboard. (This would probably go beyond the Good Samaritan Law.)

Thanks, again for the input.

 

[Diesel]

Actually SCT when you get the mayo training you can then carry an eppi pen in one of their sacks of stuff they give you. Its a days worth of training and well worth it.

They have you carry a whole host of stuff that is all sealed. When you have a problem they will talk you through in how to use it if necessary.