Let me give you a quick course in REALISTIC first aid. I am a 12 year US Paramedic with ACLS ( Advanced Cardiac Life Support and Instructor for 8 years. You may receive basic first aid course but its almost always with a dummy ( someone from ops or scheduling lol j/k) right there in front of you and not seated in a sim or actual cockpit or in the case of a passenger, seated or found in the bathroom ( you find alot of full arrest patients there, caught with their pants down literally). In the case of a flight deck crew member: Here ya go...
Unreponsive ? Remove the little bottle from his flight bag, delete girlfriends numbers from his cell phone THEN you Call for cabin crew. Ok all kidding aside :
If unresponsive check for pulse. No pulse ? Maintain your aircraft, notify CC then ATC and if able ( aircraft is maintained) start compressions regardless if pt is still seated until CC arrive. * BAD CPR IS BETTER THAN NO CPR*
ENTER CC who take over CPR
PILOT: 1. Before notifiying ops to be moved up on the seniority list, Notify ATC your emergency, ask them to get an ER doctor from the nearest hospital that can speak English ( if you're international) If this happens IN THE US: ASK ATC TO GET MED CONTROL if you do not have MEDLINK from the nearest city your closest to especially if diverting and patch them thru to you via SAT phone radio if possible or relay thru ATC There's your doc who can standby to assist or call time of death. Advise them you have a full arrest. This notification allows documentation of the time the patient was down and when CPR was started so that a doc can determine when to call time of death.
2. After you have requested MED CONTROL, ask if there is a PARAMEDIC on board, a NURSE 2nd and 3rd a DOCTOR. Why Paramedic first ? Because as Paramedics, we do this every day in the craziest of circumstances, places, environmental issues etc. and believe it or not, some of us travel with certain equipment ( ET roll kit, for intubation) I've done it while traveling to/from conventions, training courses, responding to/from emergency disasters. Also, we work under the direction of Med Control and MEDLINK and we can call time of death in the field under what is called standing orders. US that is, not sure about other countries.
CC: 1. Assuming you took over compressions, continue compressions, Give 2 rescue breaths and put pilot 02 mask on pt. Get pt out of his seat without manipulating flight controls. Get pt on flat hard surface OUT OF THE COCKPIT, attach AED if you defibrillate the pt in the cockpit and the only pilot left winds up getting shocked too, you then become fubar. Its too tight of quarters in there to take that chance. You can also cause an arch or get shocked yourselves. As Paramedics, we're even taught that our safety comes before patient safety. If we die, the patient definitely doesn't stand a chance. Keep CPR GOING! Realizing you can't take his o2 mask with you, follow current CPR guidlines for 2 persons CPR ( which just changed by the way) continue CPR while AED is attached to pt.
2. Follow AED instructions that are verbally given. Switch up compressions between CC's every 5 or so min. It is exhausting. If you have turned on your 02 tank, turn it off, save it in case you get him back because you're giving those rescue breaths. DO NOT STOP COMPRESSIONS unless to shock or change CC administering compressions.
3. If you dont have MEDLINK and the pilot has been able to make contact with MED CONTROL ( a doc at a hospital authorized to give instructions via phone/radio and even call time of death if indicated) he will ask you what access you have to certain meds. Clue: got an epi pen ? use it. Epinepherine is a first line drug used in ACLS and it is protocol for respiratory arrest. Pt isn't breathing right ? Never know he could have went into cardiac arrest due to anaphylactic shock which has probably caused edema to the airway and you need a patent airway ( open) to deliver oxygen to the lungs. Your working with what you've got. What are the chances of a passenger having one if you don't ? Ask. Here's something else you can do under the direction of that med control doc, Get a blood sugar on this pt. Is he a diabetic ? I have worked many full arrest on pt's who were diabetics and pushing D50 brought them back. You won't have D50 capabilities but at least the family and that pilot who witnessed this will know that if he had a blood sugar of 11, or even 40, he died because of that and there was nothing anyone could do. You can do this by asking if there is a passenger on board with a glucose testing machine ( they are pocket size)
The last 2 steps are only if there is enough crew to make sure that CPR is continuous and not interrupted.
When to stop CPR: The patient tells you your hurting him. ( its happened)
You have med control on the line telling you to stop
A doctor on board ( who has shown ID) tells you to
stop. Med Control doc supercedes doc on scene.
Obvious death: Rigor Mortis prevents you from CPR
Under no circumstances do you stop CPR to check pupils. Nor do you check pupils b4 starting CPR At this point, it's irrelevant.
Please remember this. People don't die from cardiac arrest persay.. They die from an underlying cause that then caused them to go into cardiac arrest. That is NOT always a heart problem. Especially at 43 years old. So you do have to treat the cardiac arrest and what I suspect with this Captain, was a PE aka Pulmonary Embolism. If he suffered a PE, there was nothing anyone could have done as once the PE moves from the lungs to the heart, thats it.. He has now earned his golden wings and is in a much better place.
This memo or reply to thread in no way is to take place of a well taught, industry specific first aid/ cpr/ aed course but it offers some helpful hints that aren't taught in the basic course that you may get or some of you haven't been able to get. So many instructors teach text book theory without real pt placement scenarios. If your SOP contraindicates any of this, just make sure you write down what was done in accordance with your SOP
If its not in your SOP, then it needs to be.
Ahem. TOPGAS... like i stated above. Bad CPR is better than NO CPR. We are not God, it is not up to us to determine anyone's fate but I would hope you would give it a half ass chance and try. I'd rather know someone died despite ALL efforts than to know he/she died with NO efforts.