This is for those that work on the gate - are you allowed to refuse boarding to passengers that don't look well enough to fly (disregarding those that have taken advantage of the departure lounge bar).

What's the criteria for your decision, and what do you do with regard to a qualified opinion, ie is there a doctor/medical officer on permanent duty at the airport who has the final say, or is it ultimately up to the captain who gets on his aircraft?

I work with people with illnesses that require pre-flight physiological assessment to ensure they don't come to harm during flight - if they're OK we give them a doctor's signed letter just in case, but it is obvious that there are a lot of people that don't come through us or are just taking the chance and getting on anyway!

Quoting Kris (Thread starter): This is for those that work on the gate - are you allowed to refuse boarding to passengers that don't look well enough to fly (disregarding those that have taken advantage of the departure lounge bar).

Yes. The airport bar qualifies too but I see what you mean.   For the rest I'll let the agents and F/As answer.

In case the staff supervising the boarding,observes something out of place,the concerned authority is informed to follow up on it.

regds
MEL

We frequently see patients who are quite disabled with their breathing but who are perfectly fine under flight conditions - we give them a letter that reads something like "this person looks like death but won't die on your airplane from his disease" just in case they are stopped at the gate. I was wondering how often it actually happens and is it worth us doing it.

Quoting Kris (Reply 3): We frequently

When you say "We" which Dept/profession are you reffering to.
regds
MEL

I've boarded AA transcon with bronchitis and fever about 38C (100.5 F), I bet I looked sick.
They couldn't care less..
Just to clarify: that was a return flight, I got sick away from home

Quoting Kris (Thread starter): are you allowed to refuse boarding to passengers that don't look well enough to fly

Yes. This tends to happen with elderly passengers more than any other group, as probably can be expected. Usually this will not be for coughing and spurting but for things like not being able to walk, becoming ill in the terminal area then 'recovering' (but not really).

The TV program "Airline" - whilst being very low level, has some examples of this.

I've turned a family away who's little girl was ill and apparently had been vomiting etc. There had been an outbreak of Norwalk virus (horrible, highly infectious, can kill older people if they don't get treatment) in the area recently so that was of concern.

I spoke to the captain who rung the airlines medical advice service (Medlink??) and they said that she shouldn't fly due risk to other pax and so I offloaded them.

I felt awful; all the little girl wanted to do was go home (they were on holiday) and I stopped them!

Quoting Kalvado (Reply 5): I've boarded AA transcon with bronchitis and fever about 38C (100.5 F), I bet I looked sick. They couldn't care less.. Just to clarify: that was a return flight, I got sick away from home

That's a bit ill. That's not sick. Sick is when you are concerned that the patient might stop breathing.

A low-grade fever and a cough is not an indication to recommend that a patient not fly. Being obtunded and non-responsive with labored respirations is sick.

As operations manager I got a call from one of our captains. They were on the ground at a small-town airport for the return leg of a charter flight. One of the passengers identified herself as an RN and said that one of the other passenges, a person unknown to her, "needs to see a doctor RIGHT NOW" The flight attendants had no medical training but it was obvious this person was not well. They did not want to take the responsibility. The captain came back and talked to the passenger who gasped that he was fine. He took the RN aside and talked to her for a few minutes then called me on his cell phone. I took the heat off the captain and instructed him to remove this passenger, with our apologies, and get someone in the ground party to take charge of him.

The results:

1. The plane departed for a 1500 mile flight home without the passenger or his wife aboard.
2. The passenger got a two-hour ambulance ride to the nearest hospital.
3. The passenger was admitted for a 24 hour stay in that hospital.
4. Two days later the passenger and his wife flew home on another airline.
5. Two days after that I got a call from his attorney. He was suing.

I told the lawyer I could save his staff a little research. Our authority to refuse transportation came from 14 CFR Chapter 1, Part 121 §121.133 and §121.135 and our FAA-accepted operations manual which complied with those rules. Then I quoted him the pertinent paragraph from our ops manual, the language of which very clearly gave our crew sufficient latitude in such a case. It even mentioned that they were not to second-guess a person with any medical training or professional standing. When I mentioned the ambulance and hospital stay the attorney said that his client hadn't covered that part of the story very well.

I said: counselor, it appears to me that we might have saved your client's life. He said: "I'm inclined to agree." That was the last we heard of it.

I have talked a passenger out of taking the flight from Cozumel back to the States with a fairly graphic description of what he might expect on the descent. The other pilot later told me that I should never be a doctor because I have a terrible bedside manner. It's okay, I still think I did the guy a favor.

Quoting JER757 (Reply 7): I've turned a family away who's little girl was ill and apparently had been vomiting etc. There had been an outbreak of Norwalk virus (horrible, highly infectious, can kill older people if they don't get treatment) in the area recently so that was of concern.

That can kill a kid, too. I'll explain the pathophysiology:

You start to vomit and get diarrhea. Now you are dehydrated, which means that you have decreased circulating blood volume due to the fluid loss (not blood loss, but fluid loss). Without the circulating blood, the kidneys don't get enough blood and can't do their work.

Now one of the jobs of the kidneys is to regulate the acid-base balance of the body. Left to its own devices, the body will crank out acid. So as you get more and more dehydrated you get more and more acid building up in your body. This makes you feel sicker and more nauseated, which makes you more dehydrated, which makes you more nauseated... vicious circle.

The way around the problem is by giving IV fluids. That way you don't have to orally rehydrate the child. It can be done orally with a solution made of one teaspoon of salt and 8 teaspoons of sugar to liter of clean water, but it has to be done slowly, laboriously, and over the child fighting the effort. Since planes don't carry IV fluids (not that I know of) and nobody wants to be trying to orally re-hydrate a child for a flight of who-knows-how-many hours' duration, you were right not to board that family.

Quoting DocLightning (Reply 10):

Cheers, good stuff! I'm a 4th year medical student so you're kinda preaching to the converted though!

It was only a 1 hour flight though so it wasn't hydration that immediately concerned us, mainly the transmission to other pax.

Incidentally I saw them fly out a few days later (I let them on that time!). Turns out it wasn't norovirus but food poisoning... probably just as unpleasant but non-transmissible!! I spoke to them and they understood why we made the decision. We didn't want to take any chances!

[Edited 2008-06-15 17:09:11]

Quoting DocLightning (Reply 8): A low-grade fever and a cough is not an indication to recommend that a patient not fly.

I'd be mighty pissed if I had to sit next to a coughing and sneezing contagious person for a flight.

Quoting HAWK21M (Reply 4): When you say "We" which Dept/profession are you reffering to

I'm a clinical physiologist with a background in aviation medicine/physiology.

Quoting Swiftski (Reply 6): Yes. This tends to happen with elderly passengers more than any other group, as probably can be expected. Usually this will not be for coughing and spurting but for things like not being able to walk, becoming ill in the terminal area then 'recovering' (but not really).

Would you take notice of a slip of paper signed by a doctor that states that the patient has had relevant tests and is fit to fly, despite looking that ill?

Quoting ArmitageShanks (Reply 12): I'd be mighty pissed if I had to sit next to a coughing and sneezing contagious person for a flight.

I'd be mighty pissed to be denied carriage for a 38C "fever" and a mild cough or sneezing. It's hard to tell if a cough or sneezing is contagious.

Think about how your employer would treat someone who stayed home from work every time they technically had a fever and/or had a cough or sneezing fit?

Quoting Analog (Reply 15): It's hard to tell if a cough or sneezing is contagious.

Indeed. A lot of times when you're at the coughing and sneezing phase you're not that contagious anyway.

Quoting SlamClick (Reply 9): a fairly graphic description of what he might expect on the descent.

What might that have been? Inquiring minds want to know.

Quoting HangarRat (Reply 17): What might that have been?

In non-medical terms, I explained the eustachian tubes and how the sea level pressure he had trapped behind his eardrums might very well escape in bubbles through the mucus and/or pus to vent out into cabin pressure, but during the descent, trying to re-establish the higher pressure of lower altitudes in the space behind his eardrums, the increasing air pressure would simply pack pus and mucus up into his middle ear at best, or block the pressure transfer causing his eardrums to press inward, easily reaching the point of rupture. The pain would travel along some very short nerve pathways to the brain a mere inch or so away and no pain reliever on board the airplane would do a thing for him - nor could we delay the descent just because his ears were bleeding.

For some reason he elected to stay and dry his head out for another couple of days.

I think I gave him sound advice. Not a PR triumph but I do believe I spared him something I would not wish on anyone.

Quoting Kris (Reply 14):

A lot of carriers I have work for have a form of Medical Guidelines, for example they note requirements for pregnant pax, timelines for travelling after diving, sinus congestion etc. In one CS manual, it gave these guidelines and then noted when it was advised to get further advice. This caused issues when even passengers travelling on Department of Health accounts would arrive without the correct form, as a letter from the doctor would not suffice, it required the specific medical clearance form as defined on the website.

For example for australian carriers:
Jetstar
http://www.jetstar.com/au/travel-inf...-the-airport/health.html#clearance

Qantas/Jetstar
http://www.jetstar.com/~/media/files...ealth/jqtravelclearancepackage.pdf

Virgin Blue's are almost exactly the same.

As many of the CS/Gate agents here will hopefully agree, there are quite a few times where you ask the questions at check-in leading for the correct answer, as you can tell the passenger is fine and want them to travel! F/A's of course are notorious for thinking that the extra couple of days of First Aid they recieve make them more qualified than any of the lowly Ground Staff, and offload people with perfectly good medical clearance all the time!

I have personally offloaded people who have accidentally mentioned, in particular, diving, a lot of times which leads to fairly heated situations, as well as pax who are straight out of post op and still on oxygen with no paperwork. Of course the saddest are those pax who have been discharged and are 'going home for their final days' - it breaks your heart to offload them!!

Hope this helps,

Thanks,

Ozzy

That's very helpful - I think in addition to our doctor's note I'll instigate a policy of looking on individual airlines' websites or calling them up just in case there are additional documents to fill in once the patient is cleared. We do that with British Airways at the moment (to download the INCAD and MEDIF forms), but I'd never seen documents required by any other airlines (Thanks Ozzy).

(Should be fun when working in an organisation that blocks websites concerning 'travel'... they even blocked A.net until I complained that I needed it for work purposes! A heated discussion with our IT department to follow I think!)

Quoting Kris (Reply 14): Would you take notice of a slip of paper signed by a doctor that states that the patient has had relevant tests and is fit to fly, despite looking that ill?

The Person on duty will take a desicion on his view of the Pax at that time irrespective of any note.

Quoting Kris (Reply 13): I'm a clinical physiologist with a background in aviation medicine/physiology.

Interesting.Thanks.

regds
MEL

Quoting Kris (Reply 20): (Should be fun when working in an organisation that blocks websites concerning 'travel'... they even blocked A.net until I complained that I needed it for work purposes! A heated discussion with our IT department to follow I think!)

You can always use a proxy website like: http://orzin.com/ or http://www.proxyweb.net/ to spoof your company's proxy server rules. All your IT department will see is that you are surfing on the proxy website.  

Quoting SlamClick (Reply 18): Not a PR triumph

Aw, that's bull puckey. Too many people walk around with a sense of entitlement and expect the rest of the world to act like their butler.

Even if this particular individual tried to bring proceedings against you, he must know deep down that you'd have a good reason to reject a paying customer.

In fact, the legal proceedings were probably because of his hurt feelings and his realisation that your actions had saved him an unpleasant experience. People hate being told that they're being stupid and they like to lash out because of it.

Quoting BAe146QT (Reply 23): People hate being told that they're being stupid and they like to lash out because of it

Even though rules are made for the best reason.Its getting an individual to accept them which is the problem.
regds
MEL

As a F/A I have to say it is relatively rare we denied boarding for a medical case, more often we deny boarding due to disruptive behaviour due to the lounge bar...

Most of the captains and pursers say "whoever we take on board, we have to deal with him/her and be responsible of them until the door goes open at the other end" so if we suspect anything we have to act.
Also on the ground we have professionals and more equipment available as well.

Quoting Kris (Reply 3): We frequently see patients who are quite disabled with their breathing but who are perfectly fine under flight conditions - we give them a letter that reads something like "this person looks like death but won't die on your airplane from his disease" just in case they are stopped at the gate. I was wondering how often it actually happens and is it worth us doing it.

A lot really!
a PAX carrying a medical certificate is a lot of information to us on his condition, and the captain will accept it most of the time. If a professional from your end can approve his/her condition we can be certain from our side not to cool down 300 furious PAX because we had to divert or worse because of it.

Quoting BAe146QT (Reply 23): Even if this particular individual tried to bring proceedings against you, he must know deep down that you'd have a good reason to reject a paying

Actually we didn't deny boarding to this guy. We invited him up to the cockpit and I briefed him on what he might experience and he made the decision to stay on the ground.

My point on the other person, up in reply #9 was that we felt that our crew and the company were on pretty safe ground so long as we made a conscientious effort to apply the rules of operation. The language of those rules gave us authority to make operational judgements where we were utterly unqualified to make medical or legal ones.

Quoting Ozzy738 (Reply 19): I have personally offloaded people who have accidentally mentioned, in particular, diving, a lot of times which leads to fairly heated situations,

What's the problem with diving?

Quoting BuyantUkhaa (Reply 27): What's the problem with diving?

From http://www.scuba-doc.com/flyngaft.htm

A minimum surface interval of 12 hours is required before ascent in a commercial aircraft (8000 foot (2438 m.) cabin).

Wait an extended surface interval beyond twelve hours after daily, multiple dives for several days or dives that require decompression stops

The greater the diving the longer the duration recommended before flying.

Quoting BuyantUkhaa (Reply 27): What's the problem with diving?

It has to do with decompression sickness (AKA "the bends" or archaically "caisson disease"). When you dive (or your body is in another compressed environment) inert gases you breathe in (mostly nitrogen) are absorbed by your fluids and tissues due to compression. The deeper and longer you dive the more gases. As you rise to lower pressure at the end of the dive, the gases are released again. If you rise too fast bubbles will form, particularly around joints.

The symptoms range from mild pain to permanent joint damage and even death.

It is a cumulative effect, which is why for sport divers the second or third dives of the day are typically shallower than the first.

To avoid this, divers keep track of dive depth and length, as well as rising slowly and often pausing before surfacing. Commercial divers ending long, deep dives often need to stay in compression chambers where the pressure can be released slowly, over days or even weeks, to give the gases time to release without issues.

How is flying involved? Well, decompression (rising to the surface) brings on the problems. If you get to the surface and then get on an airliner, the ambient pressure is reduced even further, exacerbating the problem.

[Edited 2008-06-22 18:03:10]

Quoting Kris (Reply 20): (Should be fun when working in an organisation that blocks websites concerning 'travel'... they even blocked A.net until I complained that I needed it for work purposes! A heated discussion with our IT department to follow I think!)

I run the filter at my employer. A.net? Needed for business?? I would have laughed at your request!  

(that being said we don't block a.net...it's under the category "Message Boards and Clubs" in Websense. Personal Internet usage is allowed so long as it is "brief and incidental", per policy)

Quoting Starlionblue (Reply 22): You can always use a proxy website like: http://orzin.com/ or http://www.proxyweb.net/ to spoof your company's proxy server rules. All your IT department will see is that you are surfing on the proxy website.

This is a far more serious transgression. I block all proxy avoidance sites in Websense and I'm watching for it on my 2 IDS's, one open source and one commercial. I'm also watching for any encrypted channels I'm not expecting, so don't get cute and try to SSH to your home box where you've got a proxy running on your cable modem connection. If I catch you...internal audit will be notfiied and at the bare minimum you will receive a warning and be put on a performance improvement plan. One person was, uh, shall we say, re-fired to put it politely, for violations of this nature. He proxied 3 gigs of porn onto his box. dumb, dumb, dumb.

Quoting Brons2 (Reply 30): This is a far more serious transgression.

Only the company regs specify it as forbidden. Having said that, any non work surfing is typically verboten so that's that. Hey I didn't say you were allowed to do it, just that you could do it.  

Quoting Brons2 (Reply 30): One person was, uh, shall we say, re-fired to put it politely, for violations of this nature. He proxied 3 gigs of porn onto his box. dumb, dumb, dumb.

What kind of person does that anyway? Seems particularly stupid...

Quoting Starlionblue (Reply 31): Quoting Brons2 (Reply 30): One person was, uh, shall we say, re-fired to put it politely, for violations of this nature. He proxied 3 gigs of porn onto his box. dumb, dumb, dumb. What kind of person does that anyway? Seems particularly stupid...

Different strokes for different folks (no pun intended). Do you think there's anyone on this website who hasn't said something along the lines of "Oh yeah baby... show me those GE-90s!" at least once when they thought no-one was listening?

Quoting TSS (Reply 32): Different strokes for different folks (no pun intended). Do you think there's anyone on this website who hasn't said something along the lines of "Oh yeah baby... show me those GE-90s!" at least once when they thought no-one was listening?

I didn't say there is anything wrong with downloading porn or watching it. Downloading it to company kit is a stupid thing to do.

Quoting Starlionblue (Reply 29): How is flying involved? Well, decompression (rising to the surface) brings on the problems. If you get to the surface and then get on an airliner, the ambient pressure is reduced even further, exacerbating the problem

I knew about caisson disease and yes, coming to think about it, it makes perfect sense now. When a diver rises to a few thousand feet above sea level, that's got to have an effect, even if air density is much lower than water density.

Quoting BuyantUkhaa (Reply 34): When a diver rises to a few thousand feet above sea level, that's got to have an effect, even if air density is much lower than water density.

Air density gradient is lower than water density gradient, but indeed as you say.

Quoting Brons2 (Reply 30): I run the filter at my employer. A.net? Needed for business?? I would have laughed at your request!

A lot of forums and mesage boards are filtered out, but I argued that it was the only way I could find out the necessary information regarding the aviation-related part of my job. I bet the message boards for IT professionals weren't blocked on their PCs! Either that, or I'd be ringing every single airline in the phone book and they could pick up the bill at the end of the month!

EDIT: some very helpful replies here, thanks.

[Edited 2008-06-23 06:57:53]

Quoting Kris (Reply 14): Would you take notice of a slip of paper signed by a doctor that states that the patient has had relevant tests and is fit to fly, despite looking that ill?

There are two issues: 1) Unless the slip was issued 5 minutes ago, the patient's clinical condition could have deteriorated. 2) The physician, in writing such a note, is theoretically assuming responsibility for the patient, but can always fall back on (1).

Quoting SlamClick (Reply 26): Actually we didn't deny boarding to this guy. We invited him up to the cockpit and I briefed him on what he might experience and he made the decision to stay on the ground.

Apologies, chap. I got the two incidents in your post mixed up. I thought you were referring to the incident where lawyers were involved, not this;

Quoting SlamClick: I have talked a passenger out of taking the flight from Cozumel back to the States with a fairly graphic description of what he might expect on the descent. The other pilot later told me that I should never be a doctor because I have a terrible bedside manner. It's okay, I still think I did the guy a favor.

I get it now - thank you for being gentle with the hard of thinking.

Quoting Starlionblue (Reply 31): What kind of person does that anyway? Seems particularly stupid...

Well, he was 3 months from retirement and was allowed to keep his pension at least. But he was definitely shown the door.

Quoting TSS (Reply 32): "Oh yeah baby... show me those GE-90s!"

I can honestly say I have not only never said anything like that, I have never even contemplated it.

However, I did once mention to my then girlfriend at the airport that the A300 we were standing in front of was very phallic. Unbeknownst to me at the time, we ended up flying on it too, CO IAH-SFO, A300B4.

Quoting SlamClick (Reply 18): In non-medical terms, I explained the eustachian tubes and how the sea level pressure he had trapped behind his eardrums might very well escape in bubbles through the mucus and/or pus to vent out into cabin pressure, but during the descent, trying to re-establish the higher pressure of lower altitudes in the space behind his eardrums, the increasing air pressure would simply pack pus and mucus up into his middle ear at best, or block the pressure transfer causing his eardrums to press inward, easily reaching the point of rupture. The pain would travel along some very short nerve pathways to the brain a mere inch or so away and no pain reliever on board the airplane would do a thing for him - nor could we delay the descent just because his ears were bleeding.

I've had something similar to this happen to me. I had no idea I was sick. In fact, I never did figure out what happened. I was on a flight into Cairns, I think. On descent, I suddenly experienced a horrible, sharp pain in my right maxillary sinus (that's the sinus on either side of your nose, below the eye). It just came out of nowhere. I was about 16 or 17 at the time and I just sank my face into the seat next to me (which was thankfully unoccupied at the time or I would have been in someone's lap). The pain was horrible. I thought my face was going to explode...and I was actually kind of hoping it would because at least it would release the pressure. It may well be the worst pain I've ever felt in my life, and I've felt some pretty awful pain.

The F/A was wonderfully nice (this was Ansett Australia) and gave me this little paper towelette soaked in eucalyptus, which helped somewhat, but it wasn't until the next day that I felt better.

It's *exactly* the sort of experience you would wish on your worst enemy.

I do wish that airlines allowed pax a bit of leeway in changing their flights due to being sick...earlier this year, I felt rather ill (but am great at hiding it) so I emailed jetBlue (my voice wasn't exactly in working order, however)...they said that I can change it for $75 or whatever, and the difference in fare, bringing the total extra cost to $150+..so I just thought..whatever, and flew as scheduled. I feel bad for the person next to me who had to put up with the mountain of used Kleenex but oh well...every pax for him/herself I guess!

Quoting Luv2cattlecall (Reply 41): I do wish that airlines allowed pax a bit of leeway in changing their flights due to being sick..

They do if you have a doctor's note stating that you are unfit to fly. They will also do it if a doctor writes a note stating that a family member is sick/dying.

They don't if you just call in and claim to be sick or everyone would use that excuse.

Quoting BuyantUkhaa (Reply 34): When a diver rises to a few thousand feet above sea level, that's got to have an effect, even if air density is much lower than water density.

It's not so much the change as the short amount of time in which that change takes place. Climbing to a cabin altitude of 7,000 feet in thirty minutes is pretty quick.

Going from 7,000 feet to 35,000 feet in a matter of moments should the airplane have a sudden decompression is going to leave you in all sorts of trouble if you were diving that day.

-Mir

Quoting Mir (Reply 43): Going from 7,000 feet to 35,000 feet in a matter of moments should the airplane have a sudden decompression is going to leave you in all sorts of trouble if you were diving that day.

Indeed - though I imagine it wouldn't be all rainbows and bunny rabbits for the non-diving passengers either  

The procedure at our airline is to contact medical direction (StatMD or MedLink) to clear the passenger. Their decision is final and they accept all liability. Thus why we contract with them.

Quoting DocLightning (Reply 10): Since planes don't carry IV fluids (not that I know of) and nobody wants to be trying to orally re-hydrate a child for a flight of who-knows-how-many hours' duration, you were right not to board that family.

Doc, I think you'd be quite surprised what the FAA requires to be contained in an EMK. There is a 500cc bag of NS in there amongst things. This is only to be opened under orders of the captain or medical control to a licensed medical professional, of course.

From AC 121-33B:

Part 121, appendix A, specifies that the following items must be carried in EMKs:

Sphygmomanometer - 1
Stethoscope - 1
Airways, oropharyngeal (3 sizes): 1 pediatric, 1 small adult, 1 large adult or equivalent - 3
Self-inflating manual resuscitation device with 3 masks (1 pediatric, 1 small adult, 1 large adult or equivalent) - 1: 3 masks
CPR mask (3 sizes), 1 pediatric, 1 small adult, 1 large adult, or equivalent - 3
IV Admin Set: Tubing w/ 2 Y connectors - 1
Alcohol sponges - 2
Adhesive tape, 1-inch standard roll adhesive - 1
Tape scissors - 1 pair
Tourniquet - 1
Saline solution, 500 cc - 1
Protective nonpermeable gloves or equivalent - 1 pair
Needles (2-18 ga., 2-20 ga., 2-22 ga., or sizes necessary to administer required medications) - 6
Syringes (1-5 cc, 2-10 cc, or sizes necessary to administer required medications) - 4
Analgesic, non-narcotic, tablets, 325 mg - 4
Antihistamine tablets, 25 mg - 4
Antihistamine injectable, 50 mg, (single dose ampule or equivalent) - 2
Atropine, 0.5 mg, 5 cc (single dose ampule or equivalent) - 2
Aspirin tablets, 325 mg - 4
Bronchodilator, inhaled (metered dose inhaler or equivalent) - 1
Dextrose, 50%/50 cc injectable, (single dose ampule or equivalent) - 1
Epinephrine 1:1000, 1 cc, injectable, (single dose ampule or equivalent) - 2
Epinephrine 1:10,000, 2 cc, injectable, (single dose ampule or equivalent) - 2
Lidocaine, 5 cc, 20 mg/ml, injectable (single dose ampule or equivalent) - 2
Nitroglycerine tablets, 0.4 mg - 10
Basic instructions for use of the drugs in the kit

IV access would probably be the first thing I'd establish (with an order, of course) on a patient that was sick enough to need it.

Quoting Warren84 (Reply 44): Indeed - though I imagine it wouldn't be all rainbows and bunny rabbits for the non-diving passengers either

True, but they would probably be okay once the aircraft reaches 10K ft or so, while the guy with decompression sickness would be in excruciating pain or dead

Checko

Quoting TheGreatChecko (Reply 45): Doc, I think you'd be quite surprised what the FAA requires to be contained in an EMK. There is a 500cc bag of NS in there amongst things. This is only to be opened under orders of the captain or medical control to a licensed medical professional, of course.

Well I'll be damned...

However, while I see needles on the list, I don't see angiocaths. You don't want to administer an IV medication through a needle, especially not to a child. You want to use an angiocath, which is the plastic tube that sits in the patient's vein after you insert an IV.

Quoting TheGreatChecko (Reply 45): IV access would probably be the first thing I'd establish (with an order, of course) on a patient that was sick enough to need it.

Do you know how to? It's REALLY hard. I could suture, deliver a baby, draw blood, staple, and do many other procedures before I became a true master of the IV. And in a child who is fighting the attempt, especially a dehydrated kid with collapsing veins, it can be almost impossible.

Took me over a year of pediatrics residency before I got good at IV's. Now I'm a Jedi IV placer. But the learning curve is loooong and very steep.

Quoting DocLightning (Reply 46): Quoting TheGreatChecko (Reply 45): IV access would probably be the first thing I'd establish (with an order, of course) on a patient that was sick enough to need it. Do you know how to? It's REALLY hard. I could suture, deliver a baby, draw blood, staple, and do many other procedures before I became a true master of the IV. And in a child who is fighting the attempt, especially a dehydrated kid with collapsing veins, it can be almost impossible. Took me over a year of pediatrics residency before I got good at IV's. Now I'm a Jedi IV placer. But the learning curve is loooong and very steep.

I hear ya. My daughter of 19 months had to get an IV last week. Our doctor, a guy with a lot of experience and who has taught pediatrics, says it is tricky on toddlers. Earlier the same day some bozo in the ER tried to draw blood, and failed! We were trying to explain to him that if he could just let her sit in mummy's lap she would be nice and calm. She has done this before and sits very still. But nooo, he had to have her lie down. She was screaming and afraid. And so he missed. Twice. Idiot...

But I digress...

Quoting DocLightning (Reply 46): Do you know how to? It's REALLY hard.

I don't think I'd ever say I was perfect at them, but it wouldn't be my first rodeo. I am a man of many hats...

 

Quoting DocLightning (Reply 46): However, while I see needles on the list, I don't see angiocaths.

Its right above the syringes, 18, 20, and 22 gauge, two each (its poorly written and described, this is the FAA we are talking about). I wouldn't be pushing any meds unless I was authorized to already do so under my license. (D50 is pretty much the only one on the list).

Quoting DocLightning (Reply 46): a dehydrated kid with collapsing veins, it can be almost impossible.

Been there, seen that, would never want to really try it unless I had to. If I was the only one in the back who could, of course I'd give it a go, but still, I'd hate to be there...

Quoting Starlionblue (Reply 47): Earlier the same day some bozo in the ER tried to draw blood, and failed!

As Doc says, its as much an art as it is a science, especially in peds. The guy should have listened to you, sitting with mom is a very basic part of dealing with peds, but still that wouldn't have guaranteed a successful "stick".

He's a bozo for not listening, but I don't think I'd call him a bozo for missing, even the most experienced miss from time to time.

Checko

[Edited 2008-11-21 13:04:35]

[Edited 2008-11-21 13:05:19]

Quoting TSS (Reply 32): Do you think there's anyone on this website who hasn't said something along the lines of "Oh yeah baby... show me those GE-90s!" at least once when they thought no-one was listening?

Guilty 
However, I was quite aware that my boss was listening.