medical emergency !

[gas_man]

as a doctor , i would like to know what happens if a passenger gets very ill soon after take off. if medically, the patient needs attention soon , would you dump fuel and land? are there company policies? or are economics more important ?. .. .prasanna

[TR4A]

We use a company called Med Link. First the F/A's would see if there are any medical personnel on-board (Doctor, nurse, EMT) and would also contact Med Link. They would make the call if we needed to divert or continue. Use of this service has reduced the number of unscheduled landings.

[DontSink]

Had some time ago a passanger who had asmatic problems on board and fainthed (is that correct?) The wife said, the medication was on the cargo hold bagage (had forgot!!!). We declared medical emergency and landed as soon as possible. The guy left the airplane unconcious, I don`t know what happened to him! One hour later we resumed flight!

[no sig]

GasMan. .. .The chances are that the crew would indeed land at the first opportunity if it were obviously a serious case, fuel dumping and all. Enroute medical diversions do happen. The assistance of any medically qualified persons on board will almost always be sought. If needed, most aircraft can obtain medical advice in flight via HF radio, if an airport is not close to hand, however, rather than risk someones life the crew will land at the nearest suitable airfield.

[eyeinthesky]

Interesting... Many is the time I've had a phone call from a neighbouring ATCC telling me that such and such a flight is a medical emergency requesting straight in approaches etc. This is often some 30 mins (so +/- 250 miles) before they enter UK airspace, so some 400+ miles before their destination. On one occasion we were told on the phone that the pax had stopped breathing. Some 15 mins later the a/c called requesting a priority approach at LL. When told that 09 was in use (he was coming from the East) and 27 was offered he declined. One can only assume by this stage that it was all too late for this pax. <img border="0" title="" alt="[Frown]" src="frown.gif" /> . .. .My point is that it seems common for some airlines to continue on past many suitable diversion airfields in the interest of getting to the destination airfield ASAP. I accept that the arrangement of the necessary medical assistance is easier there than at an unscheduled stop, but I wonder whether or not cost might also be a factor. Any comments?. . . . <small>[ 25 March 2002, 10:15: Message edited by: eyeinthesky ]</small>

[no sig]

That is interesting eyeinthesky, in my experience if it is an emergency our crews do indeed land at the first opportunity. We have had, for example, medical diversions in to Nantes and Bournemouth destination London. On the other hand we have had near diversions but cancelled after the passenger rallied a bit.. .. .In Europe you would be hard pressed to justify the overflight of an airfield on the grounds that better medical treatment would be available at a larger airport.

[eyeinthesky]

I'm afraid to say it happens more often than you might think, and with some very major airlines. My feeling that is if they come through COA and call a PAN on first contact then they should have landed in Brussels! I can't name names for obvious reasons, but you would be surprised quite how far some will go with a sick pax.

[Carnage Matey!]

If you've come through COA at FL300 or above its probably quicker to continue on to the UK and land expeditously rather than do a 180 and try to weave your way down through the traffic over Belgium. In that situation I would almost certainly elect to continue to a UK airport as we'd need about 90 miles to lose the height anyway. By all means show a sense of urgency, but there's no point rushing things and creating another 150 casualties.

[eyeinthesky]

CM: Sorry, I didn't make myself very clear. What I meant was that if you have experienced the medical emergency some considerable time before entering UK airspace and then call a PAN on first contact with UK ATC then you should have landed elsewhere. Of course it is difficult to generalise about ALL situations, but in my experience we do get a surprising amount of notice of medical emergencies and I wonder whether a landing earlier might have been skipped for some other reason.

[Thunderbug]

At LHR, the only way to get an ambulance to meet the aircraft is to declare a medical emergency.. .. .The patient may be stable and not need the "land at nearest suitable", but does require medical assistance and transportation to Hospital on arrival; so the call is made.

[Scando]

Is there a definition of a medical emergency somewhere then? Surely, if you request an ambulance for whatever reason, they will supply you one, even at LHR?. .Only diverted once with a sick passenger, we put down at the nearest airport ASAP. Everything ready for us upon arrival (thanks ATC). Thats where I'll be heading if the situation develops again. Ok, I may give Ulan Bator a miss, but that place is not on my agenda. Yet.. . . . <small>[ 28 March 2002, 22:01: Message edited by: Scando ]</small>

[sanket_patel]

Just hold on a sec., now why would you dump the fuel!?!? No need!

[Northern Chique]

In Aus, many flights over the years have been diverted to to medical emergencies. A medical emergency could be generally constituted as a situation not able to be controlled on board an aircraft in this case.. .. .For example, a mild asthma attack in most cases can be controlled and relieved by medication self administered by inhaler. If the trigger is still present and the medication not available, a minor attack can quickly become a life threatening emergency. . .. .For the most part, a medical oriented person by sheer statistics will be on board a large aircraft but on a small aircraft, those odds are significantly reduced. In most cases I am aware of most airlines train their cabin crew in first aid, resusitation and Oxygen therapy.. .. .Oxygen used early in many medical conditions can slow the shock process whatever the cause. Some medical conditions have a zero survivability rate. But how do you know the difference, well, you dont. . .. .In Aus you dont have to declare a medical emergency to have an ambulance meet the plane. Many sick patients are tranferred interhospital on commercial flights both pre and post surgery. Many of these passengers are conditionally stable for flight but are stretcherbound, unable to sit or walk. . .. .The folks require non emergency transfers by ambulance, but if the same patient suddenly deteriorates and the same destination is intended, then the ambulance is advised of the patients condition prior to the aircraft landing to ensure priority transport to hospital.. .. .Another example of forward thinking and reduction was the fitting of biphasic "heart start" machines and crew trained in their use. The survival chain consists of early contact, early cpr, early defibrillation and early medical intervention.. .. .So I guess in summary, if you cant handle the medical situation on board your aircraft, or you have the situation under control but it has the potential to escalate, land. Early medical intervention saves lives.

[SEA&ski]

As a doc I'd like to offer my perspectives and thoughts. Flying about 500,000 miles I've been involved in 5 in flight medical emergencies, none of which required a diversion. Medlink is a very valuable consultation service--another medical mind can be helpful when the diagnosis is unclear. I think it may also be protective of the health care provider if a decision to not divert is made, a poor outcome (or not) resulted, and the Medlink doc was involved in the decision making process. (US legal system <img border="0" title="" alt="[Roll Eyes]" src="rolleyes.gif" /> ). .. .As far as to where to divert, getting down ASAP may well not be in the best interest of the patient. If I was confident that a passenger was having a myocardial infarcation, and I was flying over North Dakota, it would be in the patient's best interest to fly an extra 20-30 minutes so they could be taken to a hospital upon landing that could provide definitive therapy (e.g,. thrombolysis or angioplasty/stenting) rather than to a small community hospital that would just end up transferring him, at the cost of several hours and more dead heart muscle. Obviously, the advantages (and risks) for continuing on needs to be communicated to all involved.. .. .I must say that in the medical emergencies I've been involved in the pursars have all been exceptional in the handling of the situation. (Some variation among regular FA's.) More so than I would expect from individuals who don't interact with sick people daily in a chaotic environment. A criticism I have is that the selection of drugs and dressing in the aid kits I've used tend to be 10 to 20 years behind the times. However, the inclusion of AED's on many planes is very helpful--in addition to defibrillation the monitor function is extremely helpful.. . . . <small>[ 29 March 2002, 05:05: Message edited by: SEA&ski ]</small>

[gas_man]

a big fear amoung many docs is the fear of liability. if a mistake is made or for that matter if the decision is challenged in court, who will foot the legal bills?. .it may sound like a cold attitude, but for someone dealing with life and death regularily, it becomes an important issue. i wonder if the airline helps out?

[Scando]

We have a liability form aboard all our aircraft. Standard procedure to hand this over to the doctor assisting the crew.

[OXOGEKAS]

Land ASAP!. .Humanitarian reasons, as well as "company policy", order our pilots to land ASAP, in order to "save" a life.