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Flight paramedics practice under medical direction and approved protocols. When requested to perform an intervention outside those protocols, the appropriate action is to consult online medical control or your medical director for authorization. This maintains legal and professional accountability, ensures patient safety, and preserves the integrity of your scope of practice. Declining outright without seeking guidance may delay necessary care; accepting a non-authorized order exposes both crew and agency to legal risk and undermines clinical governance. “Consensus” with a partner does not confer authority to deviate. Clear communication, situational awareness, and documentation of the request, assessment, and the guidance received are key components of professional conduct. In air medical transport, where resources are limited and risk is elevated, adherence to medical oversight structures safeguards patients and crews, aligns with accrediting expectations, and ensures continuity of care between sending and receiving facilities across jurisdictional boundaries.

Falsifying documentation undermines patient safety and legal integrity. Reporting through established systems ensures investigation under just-culture principles, distinguishing mistakes from misconduct. Ignoring or altering records perpetuates unsafe practices. Private correction without reporting fails to address systemic risk. Transparency and reporting protect the patient, the provider, and the organization.

Positive FAST with shock indicates internal hemorrhage. Definitive management is surgical control. Air medical teams should begin balanced blood product transfusion (PRBCs, plasma, platelets), maintain permissive hypotension (unless TBI), and expedite transport to an OR. Thrombolytics or anticoagulants worsen bleeding. Maintenance crystalloid alone is inadequate. Communication with trauma surgery, activating massive transfusion, and ensuring rapid access to blood in flight are critical for survival. Damage control resuscitation principles should be followed.

Amiodarone 300 mg IV is recommended after defibrillation and CPR in refractory VF/pulseless VT. Lidocaine is an alternative if amiodarone unavailable. Adenosine is for stable SVT, not VF. Digoxin treats atrial fibrillation and heart failure, not cardiac arrest. In-flight, drug administration must follow ACLS with precise documentation and coordination with medical control.

Neurogenic shock results from loss of sympathetic tone after high spinal cord injury, causing vasodilation, hypotension, and bradycardia with warm, dry skin. Hypovolemia causes tachycardia. Sepsis typically causes fever and tachycardia. Cardiogenic shock causes cool extremities and pulmonary edema. Treatment includes fluids, vasopressors (norepinephrine), and atropine or pacing if bradycardia severe.