"I've decided NOT to contact Medlink"

[Shadowpurser]

This is something that disturbed me while I was doing a briefing a few months ago. But also it came up in conversation with a good friend a few days ago.

Both times the crew had a medical incident on board during the cruise where they wanted medlink contacted for assitance, both times the captain decided NOT to contact Medlink.

As far as I am aware unless we are landing (which in neither situation was happening and no decision to divert had been made yet) it is the cabin crews decision to ask for medlink assistance and the captain should do as they ask. It may be a while before the captain is fully aware of all the facts because the assessor on the scene may be in the process of saving someones life.

In a serious medical incident time is the number one most important factor and the quicker things happen the more likely things will turn out ok. If we have asked for Medlink assistance it is not something we do lightly and you can be sure that we think things are looking pretty bad.

It can take up to an hour to contact Medlink so again any delay can be the difference between life and death.

The thing to think about in any medical situation is to have as much help and assistance as possible, not hinderance. If it was a loved one of yours being treated by a crew member you'd want them to have every possible chance of survival - Medlink is one more chance!!

I'd hate to be the one to tell the family that everything possible was NOT done. I'd also hate to be the person who hadn't acted on the cabin crews request for medlink assistance and it all going wrong - a lifetime of guilt?

Scary stuff!! Think about it.....

[captchunder]

The only negative thing I've come across using Medlink is that they are very keen to get you on the ground to investigate further. This may sound sensible most of the time, but that little nerdy accountant part of the pilots brain starts to ring up the dollar signs, and you know that you are talking to medics, not ops.

Having said that, if a doc says to me 'you need to land' then I can stand quite happily in front of my boss when I have to explain why I diverted at vast expense to the company, because I have done the right thing.

Not sure if this answers your point, but it might show a different light on the subject for you.

[Ballymoss]

Shadowpurser

It can take up to an hour to contact Medlink so again any delay can be the difference between life and death.

Surely the only delay can be in establishing HF comms in order
to phone patch to Medlink. In my experience this has taken
minutes I can count on the fingers of one hand.

There is then however, once details of symptoms etc are passed,
the inevitable delay "Standby, while I get the Medlink Physician"

A superb service which we couldn't do without!

Rgds
The Moss

[Right Way Up]

Hard to believe that a Captain would turn down a request to contact Medlink. Is one of the best "cover your own behind" decisions you can make! In my experience with Medlink they are more likely to make you continue. On a couple of occasions with people suffering suspected heart attacks, we were given advice to continue!

[fadec_primary_channel]

Get your company to invest in Tempus2000 bmi have it on the A330 it has been an invaluable tool that the Pilot medical officer sorted out.

It uses sat phone jack points in the cabin, so you can call them yourself and the other line sends all the telemetry to them for them to make their decision.

All you do is let 'em know up the pointy end you are using it to help diagnose a patient.

Correct decision making can then flow from there!

FPC

Any other Q's send me a pm.!:)

[Hand Solo]

Two points to consider Shadow:

1) If your friends were on one of our shiny new Airbusses then they don't have HF fitted.

2) If they weren't on an Airbus then the HF fitted may not actually have been serviceable.

Without HF comms none of our shorthaul fleet have a quick or easy way of contacting Medlink - VHF frequencies change every few minutes and the ACARS system is both very user unfriendly and totally dependent on info from the Assessor, who is course busy saving some ones life. To be quite honest if the situation is so serious that no time can be spared to speak to the flight crew then we need to be tolds. That means if people aren't breathing, or are bleeding uncontrollably, or are in agonising pain, or are turning blue in the face then we need to know. Over 90% of our short haul network we can get the aircraft on the ground within 15 minutes, faster than we can establish useful two-way comms with Medlink. If the situation is serious they're going to ask us to divert anyway and we'd rather get on with the work than mess about with ACARS. If the passenger looks like they're going to live then it's safer overall for us both to be flying the aircraft as fast as possible to destination than disregard all normal checks and procedures whilst one pilot is completely out of the loop.

In summary, for short haul Medlink is a useful tool, but only if you've got lots of time spare to wait for a response. If the situation is time critical then tell us and we'll land the thing without waiting for Medlink.

Of course, disregard the above if your friends were on a long haul flight over the middle of the ocean!

[pilotwolf]

Frequently being on the receiving end of Medlink's patients - my thoughts....

It is very difficult to diagnose a patient over a radio/phone link. Non medical personnel are notoriously bad at describing signs and symptoms and even relatively simple tasks such as taking pulses, blood pressures and recording respiratory rates require regular practise to be confident of an accurate result.

Many of the patients I/we see have completely different signs and symptoms and ultimately different illnesses/injuries to the Medlink diagnosis. This can result in avoidable diversions if a proper diagnosis is not made. However as has been said an un-necessary diversion is probably better for business than a dead passenger and the ensuing legal/pr issues! No medical staff are going to ridicule you or complain about the call if you geninuely thought the pax was (dangerously/seriously) ill. (Call us out at 0400 for a crap job - Delhi belly for 3 days before boarding etc.... take your chance!)

I would say first ASK if there are any medically trained pax on board, who are willing to help - (varies between country again, but), most medical staff have a duty to treat a patient within their own skill level, to avoid negilgence claims.

Second choice has to be telemetry - if properly connected to the pax then its as good as a nurse/doctor/paramedic taking the observations.

Third would of course be Medlink.

Finally don't forget to ask the pax - they may actually know what's wrong with them, as may the travelling companions. Too often people call ambulances without asking the patient if they are actually ill!

PS. If you call an emergency ambulance to meet your flight PLEASE keep all the pax sat down in their seats until the ambulance crew are on board - its very difficult fighting your way through 300 people all trying to go the opposite way to you! Those of us who work at the airports regularly are aware of turnaround times and customer service issues particular to airlines and will make every effort to let you carry on as normal asap.

PW

[Warlock2000]

It is the cabin crews decision to ask for medlink assistance and the captain should do as they ask.
Really? :uhoh: Sounds like the tail trying to wag the dog again!

It's hard to pass fair judgement without all the facts, but I find it hard to believe that anyone would deny contact with Medlink unless they had GOOD cause.

[Psr777]

Having used medlink a number of times myself in the same company as Shadowpurser, indeed many of the flight crew were unwilling to use the facility provided by medlink and asked us repeatedly to pa for a Dr on board first.

However the correct procedure taught to the crew was, at the time, to contact medlink first who would then advise if a Dr on board was a necessity or there was something the crew could do, depending on the nature of the incident of course.

Warlock2000 re your comments. When was the last time a flight crew member came out of the flight deck to assess a medical situation that has arisen on board and suggested a course of action? I can't recall it ever happening, that is one of the reasons cabin crew are on board.

If through our rigorous avmed training, we as cabin crew consider that contacting medlink is a neccessity, then the flight crew should contact medlink where possible, without discussion. We are not trying to tell them what to do, simply asking them to connect us to people on the ground for advice we feel is necessary.

If during the flight the Capt or FO asked us to take a look outside D3L and see if everything was okay, we would do it because we have faith in their abilities and believe they know what they are talking about. We wouldn't suggest they pa to see if we have an engineer on board first would we?
;) ;)

[kinsman]

I also find it hard to believe any Captain would deny a request from the CS to contact Medlink unless there are good operational reasons for not doing so. I have found Medlink very useful on several occasions and they have most certainly saved me from at least one diversion.

However, it would seem prudent to see if there are any medically qualified personnel on board who would be better able to communicate symptoms to Medlink. I certainly would insist on the crew exploring this avenue before contacting Medlink, it does not take more than a few seconds to establish if you have a willing qualified individual on board and it just seems to me to be a common sense first port of call. You then may have access to the Doctors kit and it could end up saving a life, which is after all the object of the exercise!

Having said all of the above the Captain is the line manager and if in his/her judgment it is not feasible to contact Medlink then that is the Captains call not the Cabin Supervisors. I would hope the Captain would communicate the reasons to the CS of course.

Prs777 the reason you would look out the window if asked by your Captain is because he is your boss for the day. You are required to obey all his/her lawful commands by law! That said airline operations are a team sport and we should be working together to resolve these sorts of problems. There may have been a good operational reason for Captain to deny such a request but as I have already said one would hope the Captain would have communicated his/her reasons to the CS.

[Psr777]

Kinsman, yup your right, the captain is my boss for the day, but you missed the point I was trying to make.

If our SOP's state that Medlink must be contacted first, then why does the captain feel it necessary to change that? What other SOP's does he feel like changing?

Not all cabin crew are under the delusion that they are in command of the aircraft, but I wish that the flight crew would stop being so bloody paranoid about cabin crew.

By reiterating in your post that basically cabin crew should do as we are told goes against everything that CRM has been trying to get around for years and I feel it has no place in todays airlines. Captains are part of the team on board, we all work together and those that don't work in the team stand out a mile and IMHO should be managed out the business.

Oh and by the way, I would do as the Captain or FO asked, because he asked me to do it ...

[tilos]

If a pap is having a suspected heart attack then trying to call for help using HF as a medium would only hasten their demise.
However a cardiac surgeon in seat 3C would, in my view, be an excellent (C) resource (M).

[Hand Solo]

Psr777 - unfortunately many cabin crew SOPs in BA have been developed entirely without flight crew input, which in a number of instances has led to false expectations about what can and can't be done in flight. The example of contacting Medlink from one of our short haul aircraft is a case in point. This shortcoming has been identified by the CAA and currently there's something of a shake-up going in in cabin crew training to produce a co-ordinated approach to events on the aircraft. From an entirely personal point of view I would suggest you call for a doctor immediately that a passenger is taken ill, rather than follow the dogma of contacting Medlink first. We can call Medlink whilst you're doing that, but its far better to have a doctor on the scene than a one at the end of a radio.

[maxy101]

Handsolo, I gather that the "corporate strategy" is to offload as much liability as possible hence the decision to always call Medlink. I gather you are expected to call them if a pax is taken ill before boarding too.

[Warlock2000]

Psr777.

You seem to be missing the point. I say again, I find it hard to believe that any Captain would deny the crew contacting Medlink unless he/she had good cause.

Comments and attitudes like "it is the cabin crews decision to ask for medlink assistance and the captain should do as they ask" certainly do nothing for CRM as at times things up front are not always as easy as they might appear. Instead of getting your t!ts in a tangle, have you ever taken the time after the flight to ask the Captain the reason for his/her decision?
Oh and by the way, I would do as the Captain or FO asked, because he asked me to do it ...
Great, now run along and get me that cup-a-tea!;)

[Hand Solo]

Maxy - if a passenger is taken ill before boarding then I shall be offloading as much liability as possible by not allowing them to come anywhere near the aircraft! If they've not crossed the threshold then they're the ground staffs responsibility, not mine. They can phone Medlink!

[maxy101]

Very true Handsolo, I understand that Medlink assume all liability once you contact them, hence BA´s insistence on calling them first.

[Psr777]

Warlock2000 :

"and how do you take that..... orally?":p :p

I do get your point, seriously. The unfortunate thing is that the SOP's are devised without proper input from the people they affect, hopefully it will improve.

However,

Comments and attitudes like "it is the cabin crews decision to ask for medlink assistance and the captain should do as they ask" certainly do nothing for CRM as at times things up front are not always as easy as they might appear. Instead of getting your t!ts in a tangle, have you ever taken the time after the flight to ask the Captain the reason for his/her decision?

In so far as things up front not being as easy as they might appear, granted, I would not presume to think any different. I have first hand experience and have great respect for the guys and gals in charge of the plane.

I rarely get my "t!its in a tangle" and regularly ask my line managers (whoever they are on the day) for feedback so I can greater understand the situation, its outcome and how to do it better next time. I also give feedback on situations to let line managers (whoever they are on the day) know how they can greater assist next time. I know my limitations, but I also know what I am good at.

Not all medical situations need the attention of a qualified Dr or Nurse. Some can be solved by simply using Medlink. Quite rightly maxy101 pointed out that they assume all liability once they are contacted, which is probably why BA insist you contact them first.

I only have experience using Medlink on East -West Long Haul services, not on short haul, so cannot comment on that.

And whilst you may find it hard to believe that any Captain would deny contacting Medlink unless they had good cause, it HAS happened. One Captain refused to use Medlink as he thought it was a waste of company money......he thought BA paid every time a call was put through, he did not know it was a yearly rate.

I asked him his reasons during the flight, didn't bother to wait until we landed.

If any medical situation arises that needs urgent medical attention, of course we would PA for a doctor immediately, it is the times when we are unsure that we tend to use Medlink....which is why it is there surely?

[kinsman]

Psr777

If you were on one of my flights you would get my full support, as you are my eyes and ears in the cabin. However, SOP’s are there to be followed to avoid the need to brief, circumstances often dictate that a different course of action is more appropriate.

If your company SOP is to contact Medlink before a PA for medical assistance then I would suggest it has been written by someone with little or no practical experience. I can think of no occasion when a qualified medical eye is going to be less able to pass accurate information to Medlink.

CRM is not always about being warm and cuddly sometimes CRM means when in command take all available information into account and command!

[TopBunk]

Working for the same company as Shadowpurser etc, my experience of Medlink is very positive - if only for reassurance etc.

On the shorthaul fleet though, a lot of aircraft have no HF comms so all you are left with is ACARS, with about 120 characters of message space which makes it very difficult to compose meaningfully. Then it takes up to 45 mins for a reply. I literally spent about half a flight from LHR to IST on ACARS to Medlink - waste of time, much better to throw it at the deck it the problem deteriorates.

On longhaul aircraft most have Satcom facilities (or at least twin HF with Speedbird London on call to patch through). The satcom facility is excellent (albeit v expensive) and you're straight through to Medlink. I have used it several times and never have I seen it refused when the cc decide it is necessary - it costs nothing (fixed annual subscription). Have also got the cc member to do the talking to complete the loop - also very useful experience for them. Recognise however on a flight from NRT to LHR (for example) that even a life threatening scenario on board will probably not result in a diversion - EVER. In certain parts of the world there aren't satisfactory ground facilities to help the patient, and you're better of in the air travelling at 600mph towards somewhere better equipped.

So my take is that on LH Medlink should never be denied when requested, just beware of our often limited options. On SH it is of much less use.

BTW, don't expect any on-board doctor to be allowed on the FD to speak directly to Medlink!

[Psr777]

kinsman,

Totally agree with you.
:ok:

[BOAC]

Psr777 - slightly off topic, but may I say how impressed I am at your demeanour in the face of such provocation?

BOAC
S/Haul BA LGW

[Captain Stable]

I have to agree fully with kinsman.

Comments that appear to imply that the Captain has no choice but to do as the CC ask (or tell) him are not helpful and demonstrate a poor understanding of human interaction.

Any member of the crew is entitled to challenge a decision if he/she disagrees strongly enough with it (remember the PACE mnemonic) but they still have to remember that the captain is in command - end of story.

In any one given airline, if SOP's are not being followed, then enquiries need to be made. If the SOP's are daft, then they need to be challenged. And if a captain appears to make a strange decision given the circumstances, then anyone can ask him later the reasons for it. As Psr777 points out, his actions may be based on a misunderstanding. Clearing up such misunderstandings can be helpful. Confrontation by saying "You have to do what I'm asking you" cannot.

[Warlock2000]

"slightly off topic..."
Way off topic! :hmm:

kinsman :ok:

For the record, used Medlink on several occasions. Works VERY well (especially on the satalite phone).

[BOAC]

For those of you who have your 'tits in a tangle' over PSR777 trying to get the f/deck to call Medlink BEFORE calling for on-board assistance, and following Kinsman's comment on the irrelevance of some orders, the person to have a go at is the Head of Tech and Training, BA, who certified the order, nor PSR777, and the relevant order (in the c/crew order book) is FCO 4260b. NB Crew are told in this order that Medlink will advise whether to PA for a doctor, and the wording is "the Flight Crew will call Medlink ......" (my italics) which is understandably read by some as an imperative?

Continued after an unexpected and hurried call off standby!

[kinsman]

BOAC

I guess the person who wrote that instruction has never tried to get a phone patch on HF mid Atlantic! Minutes may count and if there is a qualified person on board who may be able to help while I am trying to get Medlink then that will be my call and I would hope yours!

Such instructions are for guidance; only a fool would follow such instructions to the letter at the risk of a passenger’s life. What happened to common sense?

By the way if you are going to quote me I did not use the phrase irrelevant, I inferred the procedure as written was misguided in some circumstances. For information I have used Medlink to good effect on several occasions. I have also had the good fortune to have professional cabin crew who have used their heads and good old common sense and made a PA for help.

So I refer you to my earlier assertion, SOP’s are there to avoid the need to brief but are not set in stone, they cannot cover every eventuality and not all of them are very well thought out. The fact this instruction comes from the BA safety department does not alter that!

[Psr777]

Right then........back to the original discussion!!

Captain Stable, the captain is most definitely in command of the aircraft and 99.9% of the crew understand and respect that. As far as I am understand what we are talking about, that isn't the point being made.

I am unsure as to the extent of the medical training that flight crew undertake, so I cannot comment. However, cabin crew aviation medicine training is quite in depth, and we are given strict guidelines, that we are told, we must adhere to.

Notwithstanding the use of common sense for life threatening situations, when you will always PA for a doctor of medicine at the same time as trying to organise contact with Medlink, it is poor judgement of the Commander of the aircraft to refuse to contact Medlink, simply because he/she thinks it unnecessary. THAT is the issue being discussed and it has happened.

Good practice dictates that everyone works together, which means communicating with each other and not being afraid to question decisions, to fully understand the situation facing you.

Whilst I am sure it is not the intention of any of the posters here, the sentiment that the Captain is in Command, so deal with it, is not helpful, and, I reiterate, goes against everything CRM tries to accomplish.

The working relationship between cabin crew and flight crew has been damaged by the locked door policy, everyone dislikes it, but we work with what we have. If the Flight Crew community feel that the SOP's for the cabin crew, with regard to Medlink are incorrect, they need to deal with the source of those SOP's. They should not berate the cabin crew for trying to follow them.

Every time a medical situation occurs, the assessor does just that. That person has a responsibility to assess the situation and proceed accordingly. Common sense and training will dictate whether we feel it necessary to PA for immediate medical attention or to simply try to contact Medlink to get some back up. If the connection to Medlink is not possible due to technical difficulties the the Commander of the aircraft should inform the cabin crew. To refuse to contact Medlink because they don't think it necessary is, in my opinion, unreasonable.

Warlock2000: I take it you didn't like the tea?:bored:
I'll get a pretty blond to bring it in next time......I think his name is Hans! :E :E

[Captain Stable]

Psr777 - I don't disagree at all with what you've written.

It is quite possible that the Flight Deck crews' briefings in use of Medlink is insufficient. It is also quite possible that their training in First Aid is different from yours - I couldn't comment on that (which is a shame, because if yours is far in excess of FD training, then it would be sensible for everyone to do the same courses - a help in building understanding between the Cabn and the Flight Deck).

Poor SOPs, misunderstood SOPs and poor communication can all be quite easily addressed if the problem is brought to the notice of the relevant authorities.

My only real worry in all that has gone before on this thread is that some cabin crew appear to want to stamp their little feet and shout "But you must call Medlink - I've told you to" when the captain refuses. This is not good CRM and is not so easily addressed. Should the captain (for whatever reason) refuse to call Medlink, a CC member can always point out where the SOPs are documented, and challenge the captain's decision (with care) using the PACE procedure, which is very non-threatening and non-confrontational.

[Psr777]

Captain Stable:

Totally understand where you are coming from, to a certain degree.

To Quote:
"My only real worry in all that has gone before on this thread is that some cabin crew appear to want to stamp their little feet and shout "But you must call Medlink - I've told you to" when the captain refuses. This is not good CRM and is not so easily addressed. Should the captain (for whatever reason) refuse to call Medlink, a CC member can always point out where the SOPs are documented, and challenge the captain's decision (with care) using the PACE procedure, which is very non-threatening and non-confrontational. "

It can be argued that for every cabin crew member that stamps their feet etc., there is an equal number of flight crew who do the same...........To quote a captain I met recently, " I don't care what happens behind that door, I am the most important person on this aircraft" (we were chatting about crew food at the time).

The real point here is, Commanders of the aircraft should be willing and able use all avenues of information available to them, ALL the time.

None of us are perfect, the majority of us are able to do the above, the few cabin crew and flight crew who aren't, damage the working relationship we have and should be managed out of the business. The inability to work as a team is its downfall. The era of "I am pilot, therefore I am God" is gone......as is the era of "I am the In Charge Crew Member, therefore I am god".

The "Old School" Flight Crew and Cabin Crew seem to have a real problem with this, and I cannot understand why. As an "old school" trainee, I get it somewhat. What I don't understand is the neccessity of these crews to make the job difficult for everyone concered, To all those who are stuck in the timewarp, wake up, smell the coffe etc., get on with the job at hand, which is working together to provide a safe, secure environment for our customers to travel in. This will not happen if the team is divided.

The crux of the problem is communication. The understanding of it and the delivery of it.

End of the day, we all rely on each other when we fly, so why do we all "fight" so much?

Flight Crew put in an extreme amount of hours of training, not to mentin cost and expect to be afforded the respect a Captain "deserves". Cabin Crew Seniors feel that they have also put their time in and expect to be afforded respect aLso.



:sad: :sad: :sad:

[pilotwolf]

Recent experience of Medlink... (details sketchy for obvious reasons)

Pax injures himself in the toilet, early in the flight, causing severe back pain. One of CC is an ex-nurse and takes responsibility for looking after the pax. Medlink is contacted and permission is given for medical kit to be opened and pain killers to be given. Ex-nurse makes decision to stick with paracetomol and not open kit.

Usual procedures are instigated and ambulance is requested to meet the flight, unfortunately - possibly due to the Chinese whispers syndrome - the call was passed as a head injury. Decision was made by the receiving paramedic as to the resourses required. This resulted in the pax/patient waiting 20 minutes for an ambulance for transport to hospital, (accept that this is partly a failing on the responding ambulance service), also means the aircraft turn around is delayed and the operating crew are delayed from disembarking due to company SOPs.

Crew appeared to do all the right things - indeed their judgement and treatment of the pax was spot on but it seems that here Medlink was the weak(est) link as the crew decided to use their own experience and judgement above Medlink's and the details of the pax's injury was incorrectly reported by Medlink.

Maybe a common sense approach is more appropiate than Medlink sometimes?

[Captain Stable]

Psr777 - agree 100%.

I trust my cabin crew - particularly the more experienced ones. I know captains who don't. And that's not good CRM, either.