Qatar Airways Pilot dies mid-flight

[djeskine]

It's in the Aljazeera TV breaking news that a Qatar airways flight en-route from Manila to Doha Qatar had to make an emergency landing in Kuala Lumpur, due to inflight death of the pilot. They didn't specify the rank and whether he was operating then or not. I would think such a flight would be augmented crewed and there would have been no real situation where the flight was flown solo for any period at all.
Anybody with the latest could you please update us here on the forum?

[DRM1973]

Very sad if true and my best wishes and condolences to all concerned, I have friends working for them and I'm trying to find this story for more details but it is not being reporting anywhere that I can see at the moment.

[Jetstar2Pilot]

Good ammunition to keep at LEAST two pilots in a cockpit on any airline.

[Hotel Tango]

It's a fact of life that thousands of people die prematurely every day. Even pilots.

[Airclues]

A question for QR pilots;

Manila to Doha must be about 9 hours. Would this flight have an augmented crew, or just the standard two-pilot crew?

Dave

[The Ancient Geek]

Would an augmented crew have made much difference ?.

Trying to remove a dead captain from the LH seat would be fraught with accidental control hazards, it would be safer to leave well alone and fly
a diversion from the RH seat. Just make sure that the seat belt is secure and that hands & feet are safely out ouf the way.

[Airclues]

Would an augmented crew have made much difference ?.


That would depend on whether the pilot who died was in the seat at the time.

Dave

[Yo767]

The Ancient Geek said:
Trying to remove a dead captain from the LH seat would be fraught with accidental control hazards, it would be safer to leave well alone and fly

What about taking him out of his seat and administer CPR to try to save his life instead? :ugh:

I hope you are not my FO the day my main hydraulic pump fails in flight.

[Daermon ATC]

Ok, sorry in advance for bringing this up and I plead guilty to bad taste, but I would really enjoy to read Mr. O'Leary's comments on this incident...
or perhaps Ryanair pilots are forbidden by contract to die while on duty? :ugh:

[non0]

Don't want to come to wrong conclusion but that poor co-pilot is still under a train!

I would like to see your face when your left/right seat collapse and you aren't capable of doing nothing (also if you are the best CPRest in the world)!

Performing a pilot incapacitation landing can be a piece of cake (especially because trained in the sim), compare to timely handle such a psychological strong event like seen someone dying close to you!

[Airclues]

i agree with Yo767. All of the cabin crew that I have met have been trained to safely remove a pilot from the seat and administer CPR. I cannot believe that Mr Geek would really leave a guy having a heart attack to die rather than getting assistance from the cabin crew.

Dave

PS......Are there any QR guys here? How many pilots are on this flight?

[MelbPilot85]

3 crew on the way back....

[non0]

... I really doubt they left the poor guy in the seat!

[The Ancient Geek]

i agree with Yo767. All of the cabin crew that I have met have been trained to safely remove a pilot from the seat and administer CPR. I cannot believe that Mr Geek would really leave a guy having a heart attack to die rather than getting assistance from the cabin crew.


It depends.

There are degrees of severity in heart attacks. A mild attack can be as simple as a sudden chest pain. My only personal experience was with a neighbour, we were standing next to his garage chatting about car problems when he grabbed at his chest and said "I've never had a pain like that before". Within a few seconds he collapsed to the ground. Not breathing, no iris response, nothing. He was stone dead and nothing we did would have helped. We tried but it was futile.

So yes, it MIGHT be possible to help the captain out of his seat and administer CPR if his condition was recoverable but dead is dead.
I am sure that the crew would have done their best to save him if there was any hope.

[Dreezy]

Unbelievable

[moggiee]

Even with a conventional yoke, two cabin crew should be able to remove a pilot from his seat without causing too much grief. With an Airbus it will be nice and easy.

Condolences to all involved - friends, family and the crew of the aeroplane who had to deal with a traumatic experience and still operate safely.

[JEM60]

As an ex First Responder with a little experience, leaving him in his seat is not an option. There is ALWAYS a possibility that efficient CPR may have the right effect, and all large passenger aircraft have an automatic defibrillator on board.?? To leave him in his seat would be unforgiveable. No pulse or breathing does not necessarily mean dead, though if you leave him there, he soon would be!!.

[Mr.Bloggs]

The key issue here is not how to remove the incapacitated pilot from the controls, it is why such events should take place. Admittedly a fatal incapacitation can always happen, albeit rarely.

With the prevailing exhaustion levels amongst EY/EK/QR long-haul crew, I wonder what consideration the airline management give to the increased risks of in-flight problems. The East-West rostering is at times inhumane, according to my contacts in all 3 companies. I also wonder how much the airlines are concerned about staff health....

And why all the widespread condolences and commiserations to all and sundry? What if the guy was an unpleasant s.o.b? It has been written many times before, but there is no need for half the contributors to send condolences to people they do not have the slightest connection with. Perhaps pprune should have a Condolences section for those that feel the need to express themselves.

[moggiee]

Even if he was the nastiest pilot in the world, it's still a traumatic event for the rest of the crew to deal with.

[Boomerang_Butt]

As a cabin crew who has dealt with this issue (happily, our pilot survived) the first thing the F/O did was establish control of the aircraft. He then called us to come and get the captain out of the seat to administer first aid.

His instruction to us was first to avoid hitting the controls and then secondly attend to the poor guy. (one outfit I used to fly for got us to actually practise this on ground with one of the flight deck crew as part of initial training. It was bloody hard to a) get a good enough grip on the guy and b) get enough lifting force to bring him out, clear of hitting anything. Airbus is definitely easier to deal with in this respect)

I'm sure you're all familiar with aviate, navigate. communicate. As soon as the first two were taken care of, we came into it.

I can only imagine how the poor crew felt and while single pilot approach/landing is a high stress/workload, imagine how it is when you've just witnessed your colleage dying/dead!!! Have a little sympathy!!

It was bad enough for us and ours lived to fly another day.

If fatigue is an issue, then it should be looked at.

Just wanted to add in from the CC point of view.

[The Ancient Geek]

As an ex First Responder with a little experience, leaving him in his seat is not an option. There is ALWAYS a possibility that efficient CPR may have the right effect, and all large passenger aircraft have an automatic defibrillator on board.?? To leave him in his seat would be unforgiveable. No pulse or breathing does not necessarily mean dead, though if you leave him there, he soon would be!!.


Yes but .....
No pulse or breathing leaves a chance of revival if treated very quickly.
If you shine a bright light in the patient's eye and the iris does not contract there is only one diagnosis - the patient is either brain dead or totally blind in that eye. An airline captain would not be totally blind in both eyes. In more general terms, if both eyes fail to respond and there is no white stick or guide dog the patient must be dead.

If the pilot is dead and there is no replacement pilot to take his place then it is safer to leave him. If there is a chance of resusitation then it is worth moving him and giving all available appropriate treatment.

[J.O.]

Geek:

Should the day ever come for you, I hope that those who are in attendance when you are in need will have more compassion than you seem to be able to muster. Sheesh! :ugh:

[Boomerang_Butt]

Fair point but cabin crew are not doctors, we cannot make a diagnosis and in that case would make any and all attempts to provide first response.

Of course, in a cardiac arrest situation the chances of being of any help whatsoever are slim- but we cannot tell that standing behind a cockpit seat looking at the back of his head.

Much easier to assess the situation with the pilot in the galley or other suitable area, not to mention not being a distraction to the remaining pilot (and also a lack of room to do so in any flight deck other than possibly the 380- it's still be a tight squeeze)

[DownIn3Green]

Geek...Give it a rest...

[djeskine]

Boomerang, thanks for the sensible input.

Geek, I really don't know which planet you are from. This is civilian flying we are talking about and though trained, we certainly aren't exposed to dealing with "dead" persons in any state, let alone at 35000ft with 300 pax at the back. It's a scary situation to say the least. Maybe not so in military flying?

Obviously the way to go is pretty much what Boomerang said. We all get trained to ask the c/c to assist in such situations in the very way he has explained.

What need to be explained here is why the poor captain went the way he did.
Was he sick? fatigued? overworked? or simply a course of fate?
And is there anything that could be learned from this? Did he enough l/o period in MNL and was he truly rested?
The airline I flew with in 747 classic, though three crewed had an extended layover policy on long haul trips like these. From what I understand the money making oriented gulf airlines squeeze every minute out of the layover time to bare legality. I can only speculate, but if enough of long haul short layover trips are made, it's only a matter time before the poor motor packs up!

[grimmrad]

if you shine light in one eye and it does not react he also could be under Atropin which widens the pupil and you may not get a reaction. Other options come to mind as well such as focal brain lesions such as abscess, hemorrhage etc. Diagnosis of death is by US law and German law and many other countries ONLY to be made by a licensed physician, which I assume based on your comment you are not. And your comments show the very reason why these laws are in place to start with...

[Henry09]

The Ancient Greek

Not only are you totally out of order, if you conducted yourself as you describe in a real life situation say with a member of my family who was flying upfront with you, I would haul your ass through every court in the land until I had the very shirt off your back. Pilots are Pilots, we are not Doctors, no matter how many documentaries you have watched or web pages you have read to make you an \'expert\' ... Not!

The completely correct action was taken by the FO. Divert the aircraft immediately, hoping the poor guy is not dead and that onboard assistance and expert medical help on the ground can save his life.

Condolence to the family

[costamaia]

Aviate, Navigate, Resuscitate, Communicate!:ok:

[A300Man]

Only 43 years old. Very sad indeed. Know the crew and the route well. My regards to all involved.

[skol]

Long haul aircraft should have body bags - that's what you do with a dead person.

[PBL]

Folks,

this is an important thread on an important issue, which thankfully occurs very rarely. A few points.

1. Dealing with an incapacitated flight crew member is something that should be in every airline's SOPs. I am rather taken aback by the lack of a single contribution which starts "our airline's SOPs are to do ...." There are a bunch of decisions to be made; about when, how and where, and by whom, to try resuscitation, which are not trivial and should not have to be made on the fly. And these SOPs should be regularly reviewed.

2. Many of the contributors to this thread have obviously not had to deal with medical emergencies and their main corollary, dead people, on a regular basis. The question: what do I do if my crew dies on me? is valid and requires an answer a little more grounded than expressing condolences and sending a card.

3. Ancient Geek has done nothing more than relate an experience and make a triage suggestion. In doing so, he has contributed more in terms of points 1 and 2 above than any of those contributors who criticise him for it (and, in contrast to those who berate him for his contribution, he has been neither impolite nor inappropriate).

I didn't know whether he is right or wrong about iris response as an appropriate way of deciding whether resuscitation is worthwhile. So I asked my partner, who is a dialysis nurse; they quasi-regularly have such emergencies.

She says check pulse, breathing, maybe eyes (iris contraction), but that there is no single indication that someone is dead. Lack of iris contraction indicates brain damage of some sort, but one cannot thereby conclude that the victim is dead. She says that resuscitation must always be tried. But of course she operates in a relatively unconstrained situation.

They perfom CPR, on a special board, because almost everything else is too flexible to perform it properly. The defibrillators may only be used by a doctor (they don't have a "layperson's defibrillator"). I asked what one would do if it happened to a captain in-flight. It is obviously not possible to perform CPR on someone in a seat, but she doesn't know if one could effectively apply a lay defibrillator on a sitting person.

There are other people I could ask; for example, an acquaintance who is a full-time emergency-response doctor. But I think this is enough for now. This commentary just goes to support point 1 above.

It looks as if iris-response is just one of a constellation of things to try, none of which, either alone or all together, forms a universally valid decision criterion for death.

4. Concerning the trope that only a registered medical doctor may determine death in England and Wales and the US and other countries, prima facie it rather misses the interesting point, which is: what do you do if it happens in your presence? It is a question which most people who put themselves out of quick access to medical services (for example, most people who go sailing, backpacking, trecking, rock-climbing, mountaineering, cross-country skiing, even hunting and angling) are wise to ask themselves, and indeed such guidance is available.

However, there is a point here for aircrew. Crew may be wise first to ask whether there is a doctor on board and solicit hisher help without delay. If there is, and heshe is willing, then heshe can perform the relevant determinations and guide response. (There may be the problem of persuading a doctor to undertake the responsibility.) If not, then the legal issue is irrelevant and the crew must do what they think best. The very best is that they follow established guidance in their SOPs, because if they improvise, and someone disagrees later with what was done, they might have a liability problem which they would not necessarily have (although their airline might have) if it's in SOPs.

5. There is obviously a tension between the necessity to revive someone suffering from cardiac arrest, and the risk to flight involved in removing them to a place in which this may be attempted. This risk should be mitigated through a proper risk analysis and determination of appropriate procedures to mitigate risk, and we are back to point 1 above.

PBL

[Expect to walk]

Re: Doctor on board; it may well be worth extending the call for outside assistance to include ambulance service paramedic. In fact it may be the better first option as they'll have far more experience of dealing with heart attacks 'in the field' than most doctors.

[djeskine]

It is mandated that passenger aircraft carry defibrillators, which crew can operate.
I have had at least three passengers die in some of my flights. The last one the defibrillator was on board and though used, he couldn't be saved.

It was mentioned the captain was a 45 yr old man.
That's sadly rather young.
I wish someone was able to fill us in on the exact circumstances sorrounding this gentleman's demise.
What we are doing here is totally misdirected speculation.

[djeskine]

Qatar Airways pilot dies mid-flight (http://www.thepeninsulaqatar.com/qatar/129158-qatar-airways-pilot-dies-mid-flight-.html)

[Guttn]

What a terrible situation to get stuck in! Your colleague`s main engine (heart) fails when at cruising altitude, and suddenly you`re in charge of the way things are going to happen in the very near future :eek:. You`ve probably been drillied in the sim and through company SOPs on what to do and how to do it, but these things happen rarely (you`re more likely to encounter an engine failure) and they are never the same.

Aviate, navigate, communicate... These things have been correctly mentioned. But it is also very important to assess your new world before doing anything. No contact with the guy next to you? He`s not sleeping? Unconscious? Maybe/maybe not...:confused:. First thing to do, just to get things started, is call "my controls". If you can secure your colleague by the seatbelt/harness lock then you should have him slumping down/forwards on the control column - which you now are in control of. Then, call the CC for assistance. While he/she/they are coming, call ATC and divert to nearest possible airport for a priority landing. Now you`ve effectively used very many of your options for help and can focus on flying the bird you`re in charge of:ok:. Unless you`re a doctor or have sufficient medical training, there is really no way of finding out exactly what is wrong with your colleague, but if you`re doing nothing (or your best) to help him then you`re doing something wrong.

But this is why air transport aircraft have a minimum of 2 flight deck crew onboard. Also, those who fly single pilot commerciallly over a certain age are required to have their medical at shorter intervals than those flying multipilot.

Also, this is where an FO with experience is preferable:D

[JEM60]

Automatic defibrillators can be used in a seating position, BUT the use of them is generally supplemented by CPR. which cannot be given in this position. Automatic defibs are simple to use, the instructions are verbal when the lid is opened, and the voice is very clear and easy for anyone to follow. It is not good enough on it's own, however, and if it gives instruction,after auto assessment, 'shock not advised, continue with CPR', then there is a problem if the victim is still in the seat. Clever piece of kit tho'.

[Airclues]

Well done to QR for being able to summon an entire crew in KL and achieve a turn-round in under two hours.

[The Ancient Geek]

2. Many of the contributors to this thread have obviously not had to deal with medical emergencies and their main corollary, dead people, on a regular basis. The question: what do I do if my crew dies on me? is valid and requires an answer a little more grounded than expressing condolences and sending a card.


Such incidents are very rare, my 2 non-fatal incapacitation events are probably more than most will experience in their career. The first was in basic training in a Chipmunk and the second hauling freight in a DC3 so there was nothing that could be done in either case other than to get to help on the ground ASAP.
The instructor and the FO both survived but neither flew again.

3. Ancient Geek has done nothing more than relate an experience and make a triage suggestion. In doing so, he has contributed more in terms of points 1 and 2 above than any of those contributors who criticise him for it (and, in contrast to those who berate him for his contribution, he has been neither impolite nor inappropriate).


Maybe I have been a tad insensitive to the religious and cultural values of some contributors, my apologies to any who have been offended.

As others have said, the first priority is to fly the aircraft safely. Then assess the risks and get whatever appropriate help is available. SOPs and prior training are a great help but the best hope will always be the professional medics on the ground.

[telster]

Hi all. I'm just a SLF normally found lurking and keeping myself to myself because I haven't got any aviation experience or knowledge to share, but I did used to be a Paramedic so have a little relevant information with regards to this thread.

Just to make the point that fixed dilated pupils aren't a sign of brain death, and there is every chance that with prompt defibrillation someone in cardiac arrest and dilated pupils might well be saved. Its been a few years since I've been in the job, but they used to say that for every minute that passes from arresting to defibbing the chances of survival go down by 10%, so even allowing for the time to remove the pilot from the seat in theory you might stand more chance of getting someone back than we did, bearing in mind our sometimes lengthy response times.

Obviously it all depends on why someone arrests and the cardiac arrest rhythm they go into, and they're probably more likely not to survive than be saved, but a younger patient just suddenly dying from nowhere I reakon would probably be the most likely to respond to a defib.

Don't want to sound like I'm saying that this poor guy could have been saved, not talking about him in particular. I've been to dozens of cardiac arrests and only got about 5 back. Just that without trying, you'll never know. Fixed dilated pupils aren't diagnostic of death.

[A300Man]

As far as summoning a crew to continue the journey, there would have already been a QR crew in KUL anyway on their regular KUL layover (KUL is also an A330 destination for QR, with an extension now to Phuket, so there are mixed layover durations of 24 hours up to 48 hours). My guess is that the diversion to KUL was selected to take this into account (other nearby QR destinations of SIN and BKK are now 77W ports, so there would not have been a suitable crew at either of those locations to allow the flight to continue onwards.)

Of course, the airline would ONLY have made this decision to proceed onwards to KUL (even if BKK or SIN were closer for medical emergency) with the onboard knowledge that the Commander was already deceased, and therefore, immaterial where the aircraft diverted to.

Horrible thought, but probably a sad fact.

[Boomerang_Butt]

Dealing with an incapacitated flight crew member is something that should be in every airline's SOPs. I am rather taken aback by the lack of a single contribution which starts "our airline's SOPs are to do ...."

It is. I briefly described mine, sorry I didn't specifically say it was the SOP.

4. Concerning the trope that only a registered medical doctor may determine death in England and Wales and the US and other countries, prima facie it rather misses the interesting point, which is: what do you do if it happens in your presence? It is a question which most people who put themselves out of quick access to medical services (for example, most people who go sailing, backpacking, trecking, rock-climbing, mountaineering, cross-country skiing, even hunting and angling) are wise to ask themselves, and indeed such guidance is available.

Generally, it's:

1. Secure incapacitated pilot away from controls.
2. If possible, remove pilot to other suitable area (usually the galley)
3. Page for onboard medical assistance while commencing first response
4. Purser or other crew to remain in flight deck to assist remaining pilot if only 2 crew operating
5. Contact outside assistance (for airlines that use Medlink)
6. Continue first response in consultation with outside advice & any onboard professionals
7. Assist travelling companions/family of the patient (if applicable)

CPR if conducted may only cease when:

a) Definbrillator advises to discontinue
b) Doctor onboard pronounces death
c) extreme danger to the crew performing CPR
d) On flights with only a few crew, the crew become too tired to continue
e) The flight lands and ground medical services take over
f) signs of life return

She says check pulse, breathing, maybe eyes (iris contraction), but that there is no single indication that someone is dead. Lack of iris contraction indicates brain damage of some sort, but one cannot thereby conclude that the victim is dead. She says that resuscitation must always be tried. But of course she operates in a relatively unconstrained situation.

As pointed out earlier we are legally unable to pronounce someone dead, even a doctor onboard can only pronounce death and not certify death. For this reason in my current outfit it's called "presumed death" and we are not allowed to fully cover the face of the deceased in case they are in fact under some other condition but not clinically dead.

Most large airlines do have equipment onboard to deal with a presumed death in flight (clean-up equipment, body bags, places to stow a deceased person, etc etc)
There are also procedures which deal with this but I won't go into them here; suffice to say we are going to treat the person with as much dignity as possible given the situation.

[SeenItAll]

While this was certainly an unfortunate event, one issue that has not been addressed fully is: why was the flight diverted to KUL? Examination of Great Circle Mapper suggests that the likely track would have been substantially to the north, and BKK, HAN or other airports would have been much closer.. See:
Great Circle Mapper (http://gc.kls2.com/cgi-bin/gc?PATH=kul-mnl-doh&RANGE=&PATH-COLOR=&PATH-UNITS=mi&PATH-MINIMUM=&SPEED-GROUND=&SPEED-UNITS=kts&RANGE-STYLE=best&RANGE-COLOR=&MAP-STYLE=)

If the diversion was to KUL for ops convenience reasons (as suggested by A300Man), this would seem to imply that there was no question but that the pilot was verified to be completely dead.

[justforfun]

Well done to QR for being able to summon an entire crew in KL and achieve a turn-round in under two hours.

A fellow crew member dies in flight and this is the BS that people post?

Having read the thread I am disgusted at the comments and all the BS about "operating the airplane" and so on...

What is more important, a colleague dying in flight... with all the "what if's"... because of "you know what"... the "what if's" just happened!

And there are people are on here talking about what can only be described as "crap"... your colleague just died in flight!!!! It IS a significant event.



JFF :*

[justforfun]

"SeenItAll" ... "Great circle mapper..."

Wow, this is a great piece of software... free to anyone in the world.

Amazing to think Jeppesen, Navtech etc went to all that trouble to develop bespoke software as opposed to what is is free on the internet.

KUL is and was the most beneficial / logical Intl Airport for them... given the fact the 330 comes in here, and pretty much always there is a crew here.

Get a grip!

JFF :yuk:

[SeenItAll]

Justforfun: If you read my post, I did not suggest that QR made an incorrect decision. I only suggested that because KUL did not appear to be the closest airport to general flight track, QR's decision to go there suggests that it did not think that the shortened flight time would afford the pilot a greater chance of survival.

Now of course if you happen to know the actual flight track of that day's flight, or know that it is QR's procedure to think of operational convenience over the health of a still-living captain with a severe heart attack, please enlighten us.

[DownIn3Green]

Justfor "fun" or whatever you care to call yourself...Your profile does not state any pilot quals...and from your posts on this thread I understand why...

I don't know about training at other airlines other than where I have been, but in my experience NO ONE!!! ever "dies" onboard the A/C...Period...

They are deemed "seriously ill" or "medically inpaired" but never DEAD...

Reason being, what country are you over???...or "who" pronounced this "seriously ill" pax or crew passed into the ever for ever land??? Insurance, wills, liabelity concerns, etc...These are all things to think about...

Also, as has been stated on this thread...Who actually knows the person is "dead"...

[skol]

You certainly are wet behind the ears, you should stick to seafaring.
There's nothing in our SOP's about 'do not resuscitate'.

Is your ship 'dry'?

LOL

[telster]

Wetbehindear

I'm aware that this is an aviation forum, not a medical one, so don't want to go too far off topic.

Agree with what you've written about the limitations of CPR and agree that its main benefit is to keep the patient 'alive' until he can be defibbed. I've been to a few collapses where bystanders claim that CPR alone had revived the patient before our arrival but I'd be pretty certain they'd never arrested in the first place. Probably had to hold them down to do it!

Just bear in mind though, that sometimes defibbing does work and a 'do not resusc' policy will ensure that the arrested patient has no chance at all. I know of somebody who arrested mid sentence, was succesfully defibbed, and carried on talking where they left off with nothing more than 'wtf was that?!'.

I'd have thought that an aircraft with easy access to defibrillation would be one of the more likely places to have a successful outcome.

[Airclues]

justforfun

Thanks for biting. This is a forum for professional pilots not a condolences forum. I think that we are entitled to discuss "operating the airplane".

If, as has been reported, the incident took place an hour out of Manila and the aircraft then diverted to an airport where a crew was available rather than a closer destination, this would imply that the captain was declared dead with no hope of revival. It would be interesting to know who made this diagnosis.
Unfortunately these incidents will continue to happen and it is important that we learn as much as possible from the medical experts amongst us.

[A37575]

As a matter of interest was the first officer the only remaining pilot on the aircraft and what was his experience level.

[telster]

Think this is getting off topic now, so this'll be my last post.

I can only speak for the UK, and I've been out of the ambulance service a few years now, but Do Not Resuscitate orders have no place in the pre-hospital environment. If you go into cardiac arrest, and an ambulance crew attends you, they will resuscitate despite the medallion, tattoo across your chest, wife begging you not to, whatever.

Legally, and morally, there is too much to lose by not resuscitating someone who might have benefited, and the legal minefield of ensuring that the patients wishes not to be resuscitated were made in sound mind, really were their wishes etc, is one to be picked across in a less time-critical situation than a cardiac arrest.

As for cockpit crew, realistically what are you going to do? Add your resusc preference to your pre-flight briefing, or have "DNR" embroidered onto your epaulettes??

[Boomerang_Butt]

Airclues,

On your mention of a decision to divert.... services such as Medlink, using qualified doctors, will advise for or against a diversion given the facts known at the time and available to them. In certain cases I believe they can pronounce death in which case they would probably advise continuing to a company port so that the affected crew can be stood down and supported by their colleagues and company personnel.

Of course, the captain/PIC always has the last decision but Medlink will give any and all necessary advice. They have legal liability to make decision on behalf of the cabin crew and cabin crew if following directions of Medlink are absolved of liability, given they follow said instructions to the letter.

Hope this helps clear it up a bit.

[topgas]

There is increasing evidence that the most important factor in the early stages of a cardiac arrest in adults is continuous chest compressions, to the extent that non trained personnel should not waste time trying to give "kiss of life". Even paramedics are not always very good at continuous compressions - they get distracted with airway, vascular access, etc. It would be nice if someone could lift the chin to open the airway so that there is air movement with the compressions, and of course the chances of survival also rely on rapid defibrillation using the Automatic External Defibrillator if it is a shockable rhythm. There's nothing to lose by trying, particularly in the pilot age group. Someone mentioned up to 10% survival - one in ten doesn't sound bad when the alternative - doing nothing - is pretty close to 0%

[SassyPilotsWife]

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.

[lomapaseo]

Please remember this. People don't die from cardiac arrest persay

I would love to believe this since my heart and arteries, like many healty folks are in good shape except for V-tach possibly leading to V-Fib. or throwing a clot to lungs or brain. To me that is cardiac arrest and lights out.

[olster]

SPW -thank you for taking the time to post -very interesting and very good info.

[JEM60]

SPW
Excellent post. Whilst no longer involved as a First Responder, I believe that there is a lot of discussion in UK as to whether or not the two rescue breaths are worth while, and that continous CPR is the answer. No decision yet, but I think the breaths will go.

[riverfish]

Hello.
I have no aviation knowledge specifically. I have dropped in as a doctor, doing a repat flight yesterday, to see if there was anything to cause the go around and hold at DUB yesterday due to a blocked runway.!!


If I may just make a few points.

1) The real thing is very different from 'training' No matter how well you train..you are never completely prepared, though to think through what you need to do will help you work more efficiently and safely through the situation. Though of course in the aviation industry, lots of your training is for situations that you hope will not occur in real life.
2) If the pilot has arrested, his chance of survival outside a hospital setting is very small. Effective management and treatment will increase his survival odds, but they are still small.
It is therefore imperative that the other healthy individuals on the plane are not jeapordised by trying to extracate from the seat. Do not underestimate how awkward heavy and difficult corpses/unconscious people are to move. You will need one person to protect the head/neck, and others to move the trunk. They will need lying somewhere eg the galley.If there is any risk whatsoever of risking the safety of the others on the plane DO NOT DO IT!!!

I have never had to do rescussitation on a plane, but my impression is that it would be very difficult because of the cramped conditions and noise.They would need lying down on a firm surface, I suppose in the galley.

3) You need to get effective cpr (cardiac massage ) as soon as possible, and if you have an automatic defib on the plane get it connected, and get a reading as quickly as possible to see if there is something that would benefit from a shock. These things are really good and idiot proof these days, and you cannot do any damage with them!!
worth a couple of mins of your time having a look at it if you havnt.

4) \You are right that the guidelines have changed recently...or they are doing in 2011.. http://www.resus.org.uk/pages/guidesum.pdf


5) In the resuscitation council guidelines, 'call for help' is number one on the list...even for people who supposedly know what they are doing....so you should too.
Nurse doctor paramedic, ask for them all. An ER nurse is going to be more use than an ophthalmologist, but find out who you have on board. You might have someone like me going to do a medical retrieval, with a defib in my hand luggage!!!! If you dont ask you may never know.

6) Speed in getting effective cpr under way is crucial.
We had a lady in the er a couple of weeks ago all monitored, with something completely different , when all of a sudden she had a cardiac arrest!!!! Defibbed within 10 seconds, and virtually carried on with the conversation where she left off!!!
I was at a concert, and an old guy became ill and was led outside, I and a collegue, a consultant anaesthetist administered effective cpr for half an hour from the moment he collapsed. By the time the ambulance appeared 45 mins later, he had come round. Though we will never know what happened for sure, the likelihood is that the guy must have developed an abnormal heart rhythm that did not give him a pulse. we kept him going till his heart clicked back into a rhythm with a pulse. ...so it is worth giving it a good go, but he was lucky to be right by two experienced docs.



7) I wouldnt get too involved in discussions about pupil size any more than I would get involved in discussions about wind shear!!

I hope this is useful, and I hope it never happens!!

[topgas]

SPW - great post
I would only take issue with you about Pulmonary Embolus, clot which moves from the legs(usually) through the heart and lodges in the lung vessels, blocking the blood flow. Chest compressions can break up the clot and distribute it to the smaller vessels, allowing more blood to flow through the lungs and pick up oxygen. No disrepect intended on paramedic CPR - they are still better than most, and the good are very good. I've had the honour to fly missions with some of the best.

WBE
latest changes are
1. When obtaining help, ask for an automated external defibrillator (AED), if one is available.
2. Compress the chest to a depth of 5-6 cm and at a rate of 100-120 min-1.
3. Give each rescue breath over 1 s rather than 2 s.
4. Do not stop to check the victim or discontinue CPR unless the victim starts to
show signs of regaining consciousness, such as coughing, opening his eyes, speaking, or moving purposefully AND starts to breathe normally.
5. Teach CPR to laypeople with an emphasis on chest compression, but include ventilation as the standard, particularly for those with a duty of care.
In addition, advice has been added on the use of oxygen, and how to manage a victim who regurgitates stomach contents during resuscitation.

The whole lot are here (http://www.resus.org.uk/pages/guide.htm)

Just remember the five Ps

[BRE]

Riverfish: "By the time the ambulance appeared 45 mins later, he had come round."

What kind of concert was that? All concerts I'm familiar with (not counting local bands in a pub that accomodates 50 guests) have an ambulance on the premises. The only exception to this are opera houses / concert halls, which will have staff paramedics and are in a central urban setting where you can reasonably expect an ambulance or helicopter to arrive within 5 minutes.

[BRE]

LH flight magazine this June ran a story on how they prepare for medical emergencies. Unfortunately, it does not seem to be available online. Two points of interest to me were that they have their own 24 h medical service available via sat phone, which they were looking to expand into in flight telemetry and video capability, and that they had had a doctor preregistration service in place since 2006. It allowed doctors to register and have advance briefing on the kit available in exchange for some frequent flyer card with special previleges, and the boon for the airline was that c/c would know in advance what kind of doctor was seated where.

There was also a recent article by LH doctors on in flight emergencies in a state physicians' association magazine, unfortunately only in German:
http://www.laekh.de/upload/Hess._Aerzteblatt/2010/2010_06/2010_06_08.pdf