Are BA for real?

[A330driver]

Am I missing something here?

http://www.aaib.dft.gov.uk/cms_resources/Boeing%20777-236,%20G-VIIO%208-05.pdf


A passenger suffers a broken limb. That constitutes serious injury. Yet they continue onwards for another seven hours across the Atlantic and then declare a medical emergency so they bypass the Mayfield stack.

Cynical queue jumping at it's best?

[easyprison]

"and consultation with the injured persons, it was agreed to continue to the planned destination".

That tells me that the injured person was happy to travel to London.

[airborne_artist]

But easyprison, the medical "event" was not an emergency for 390 minutes, yet it "became" one when Mayfield (and 30 minutes in the stack) hove into view.

Unless it suddenly got worse (not mentioned in the report), why not divert into Shannon an hour before?

[sixmilehighclub]

That constitutes serious injury
Yes but it's not life threatening. The crew would have assessed the injury with the help of medical assistance, and if the injury is not life threatening, they continue. If the injured is able to physically talk, they can consent to continue. They are not unconcious, suffering from hypovolaemic shock or cardiac arrest for example which would constitiue a diversion without question.

A burn, laceration, compound fracture or even childbirth is considered serious but the persons life is not at risk, therefore there is no need to divert. Declaring a medical emergency later may have been due to the injureds condition worsening? Or declare a medical emergency to be met by a paramedic team on the tarmac?

An onboard medical kit contains almost everything to deal with all manner of injuries and medical problems. It is down to the crew and their medical support which make the decision along with the injured party and their companions.

Besides, ever hear of people breaking bones then 7 hours on a hospital trolley before being seen?

SO I suggest A330Driver, you go back to your own airline and request Aviation Medicine training to appreciate the situation before flaming other airlines. After all from relatives of those who have fallen ill onboard British Airways aircraft the crew cannot be praised enough for the way they deal with casualties. The crew are constantly tested on their medical abilities and knowledge also.

[Charly]

Well, flying is strategic risk management. You decide to continue, but not to accept any more delay...

Also you don´t know, if the situation has escalated in the last hour (i´m not a doctor but maybe accute trombose risk developed).

[GW76]

The injured party would probably have been treated better in the air than hours waiting to be seen in A+E. The cabin staff would have immobilised the fracture and given adequate analgesia. In what sounds like a relatively simple ankle fracture , these are the mainstays of management. :)

[Jordan D]

It is also quite possible that after consultation the paax was content to continue on, and nearing the destination the pilot requested medical assitance on arrival, which then transpired ...

I don't know, and I'm guessing most of the posters here don't know ... these are but suggestions.

Jordan

[niknak]

The emergency was declared to ATC straight away, the crew then advised that, after consulting with the injured parties, the best course of action was to continue onward to the UK.

As the Oceanic track was almost a direct routing anyway it had little bearing on other traffic over the Atlantic.

ATC in the UK were aware of the problem well in advance, and in their usual professional manner, afforded the aircraft the most expeditious routing available, which is no more than I or any other ATCO would do, or be expected to do under the circumstances.

The captain made his decision in conjunction with those who were injured and after taking medical advice from those who are qualified, via BA Ops.

A very unpleasant experience for all involved, but as with everything at the sharp end of aviation, decisions are made utilising your training, experience and information available, all of happened in this instance.

I hope I never have to work or fly as passenger with A330driver in any capacity.

[Carnage Matey!]

In BA the only way to get any medical assistance to meet you at the aircraft is to declare a medical emergency. I suspect that had something to do with the emergency being declared close to London.

[Del Prado]

Carnage Matey, declaring a 'medical emergency' won't get you any special treatment from ATC in the UK. I suspect the crew called a PAN if they jumped the queue at the WILLO stack.

A330driver, I don't remember ever holding at Mayfield.

(good grief I'm in a pedantic mood tonight!:ok: )

[Juan Tugoh]

As CM said, the only way to be met by an ambulance and or paramedics is to declare a medical emergency. This has less to do with queue jumping and more to do with procedure. When you declare a medical emergency ATC are bound by their procedures to ensure an expeditious approach. An ASR is always going to be filed and any abuse will be dealt with by the CAA. Still A330 Driver would know that if he had a little experience.

[beernice]

Sixmilehighclub, I think you are very wrong and even dangerous. As someone that came to the airlines from a medical background I think that the BA's crews action was quite cynical. Bar few exceptions flight crew are not medically trained. Therefore with the exception of minor superficial injury flight crew are not in a position the make a call on what is a serious injury and what is not. And for your information a break can be life threatening, ever heard of a fatty embolus? Furthermore you or the flight crew did not know what other injuries if any, were sustained in the original incident. This is another examlpe of BA carring on across the Atlantic regardless. In my opinion the company really does have poor SOP's.

[L337]

Flight crew are not in a position the make a call on what is a serious injury and what is not

The flight crew would not have made the medical decision. It would have been discussed with a "medlink" doctor, via Sat Phone.

Medlink and those Doctors are paid by BA to make medical decisions. 24/7.

Having made a decision it would then be constantly reviewed with the Doctors, via Sat Phone.

Almost certainly there would be someone on board with medical qualifications, and they tend to act as a go between. Medlink ask the question, you ask the doctor on board the question, you relay the answer.

beernice: This is another example of the ignorant condemning BA at every opportunity.

[BEagle]

In simple terms, is a 'fatty embolus' something akin to bone marrow getting into the bloodstream?

Also, how did the passenger sustain the injury? Were there other lingering possibilities such as concussion to worry about? Whilst stumbling and breaking an ankle in the loo-queue following this severe turbulence (the maximum vertical accelerations experienced were +2.367g and -0.352g), did the passenger bang his/her head?

Presumably the flight crew were in contact with some duty doctor or other at Heathrow when they made their decision?

I note that 5 crew members also sustained minor injuries....

Hmmm........

[CosmosSchwartz]

Minor injuries I would imagine includes small cuts and bruises, you're not going to suggest that requires a div, are you?

As for the broken ankle pax, is it not true that you can't fly for a number of days after a cast is fitted due to the possibilty of the limb swelling? I'd reckon the pax wanted to get home and if they were going to require hospital treatment they wanted that to be in a hospital at home, rather than being stuck in a canadian hospital for a few days.

Funny how people are so quick to criticise, especially BA, on this forum. The simple fact is, I haven't heard any reports of the pax or crew criticising the decision to continue, so why should anyone here criticise?

[behind_the_second_midland]

If there is a medical problem we contact Medlink in Phoenix by HF via ops, Sat phone or acars.

We give all the symptoms and we are passed to a specialist in that field and how it relates to flying.

We are then advised by Medlink on the action to be taken.

By following their advice we are indemnified against any legal action from the passenger.

I'm not sure about LGW but at LHR to get paramedics to meet the aircraft you are obliged to declare an emergency.This has to be a PAN as the words "Medical Emergency" alone are no longer recognised, or so I'm told.

BA's FCO's dictate that "when medical assistance is required on arrival, a medical emergency (PAN) should be declared.

[martinidoc]

As a BA frequent flyer I have never been afraid of criticising BA.
However on this occassion I think A330 has been somewhat unfair.

As a surgeon, I should point out the the captain took this decision following professional medical advice, and in consultation with the passengers.

Had I or A330 been the poor individual with the fractured ankle 2+ hours out of Orlando, and faced with the choice of returning to blighty for safe and affordable NHS care (Emergency care in the UK is still as good as anywhere in the world, even if elective care leaves someting to be desired!), or returning to the USA being lumbered with a bill for 10s of thousands of dollars, and being treated away from family and friends, I know which I would choose!.

Pain relief with analgesia and immobilisation is entirely appropriate (and hopefully the odd brandy).

Fat embolus is a rare complication in which fat from the marrow is thought to embolise to the lungs and cause a serious inflammation of the lungs with fluid accumulation, and has a high mortality rate. It is extremely unlikey that the patient had any increased risk of developing this as a result of completing the 390 minutes of the planned flight against returning to the USA which presumably would have taken about half that time.

Again I really do not think that calling this a Pan was unreasonable, particularly as it appears that SOPs require this in order to obtain appropairate medical support at the arrival airfield, and in the circumstances I would do the same thing, to try and ensure that any pain and suffering was minimsed.

For once I would applaud the actions of the crew which seem to have been carefully considered, after appropriate advice and consultation, and without making an unecessary drama, in order to minimse the inconvenience to as many people as possible.

[A330driver]

Either one of two things happened here - they passenger and crew were aware that a limb was broken or they were not. If they were, then I am absoloutely appaled that they would continue across the ocean with a passenger in that state.
Continuing onwards with a passenger in such a state cannot be in the interest of the passenger concerned - commercial considerations would appear to be the overriding issue here.

The second possiblity - that they were unaware of the extent of the injury would appear to be, and I hope, the case, but given that a number of crew members were also injured, prudence would dictate that a passenger with a serious injury be attend to ASAP as opposed to continuing across the ocean where compications might set in, and the aircraft be a long way from any help for the passenger. I

What I find cynical is that having continued onwards without any "emergency" for several hours, passing numerous suitable airfields, that when they arrive at their destination, they then declare a medical emergency - "the aircraft was given an expeditious routing".

I'm not slating BA, I'm questioning that commander's priorities. From reading the report, the welfare of the passenger really only seemed to matter in the Gatwick zone.

martinidoc,


Some attitude for a so called doc. Any expense that the passenger would incur in treatment in the US would have to borne by BA - not the individual. And don't tell me a fat embolus is not rare - I attended a funeral a week ago where a relative of mine died from a broken leg received in a car accident.

[PAXboy]

Passenger speaking (not on that flight)
A330 Any expense that the passenger would incur in treatment in the US would have to borne by BA - not the individual. How so? Do you have details of the insurance arrangements for this patient and that of BA?

I attended a funeral a week ago where a relative of mine died from a broken leg received in a car accident. Ah, understood that this will set your point of view and understandable, of course. But you were not on the a/c. You did not hear the medical advice. You did not speak to the patient.

[ETOPS]

A330driver

Some attitude for a so called doc

That's exactly the sort of quote that so upsets the rest of us here. Just read what martinidoc has written. Intelligent and concise. You may disagree but insulting comments do not make an argument...........

[52049er]

330 driver. What a load of nonsense you speak.

they passenger and crew were aware that a limb was broken or they were not

I broke my ankle once and only found out 18 hrs later, my wife broke her leg and that took 3 days to be diagnosed. Unless the bone is visibly disjointed they could never be sure. Do you think BA should turn a 300 pax, 300 ton a/c around for every person who twists their ankle nastily on board?

No? OK, perhaps in that case BA should seek the finest medical advice available. Oh, they did.

Hmmm. Maybe they should ask the passenger what they would like to do. Oh, they did.

So far some appalling decision making. OK, look what they did to really rile 330 - they also followed company rules as they approached destination to ensure their passenger had medical care on the ground. Tut tut tut.

I am sorry to hear about your relative, but that does not make fatty embolisms any less rare. A Greek airliner crashed last week - doesnt mean crashes are common though, does it?

[You Gimboid]

It might help A330 driver if you actually read the replies to your post and had the humility to acknowledge that you have no idea of BA SOPs, the consultations that took place via the excellent satphone link, the nature of the injury, what treatment was received on the flight nor any idea of the BA SOP to declare a PAN into LHR (LGW? not sure) in order to have paramedics meet the airplane. (They are not actually based at the airport, so an emergency must be declared to get them to come airside)

You have in front of you the explanations of the SOPs, a surgeons opinion no less, and yet you keep bleating on about how heartless and horrible the Capt was to continue with an injured pax on board just to save a few shekels for the company.

Grow up, bud!

[Jerricho]

had the humility to acknowledge that you have no idea of BA SOPs

Or the holds for Gatwick :rolleyes:

[FatFlyer]

Maybe there should be a procedure for A/c to arrange to be met by an ambulance for a passenger who needs to go to hospital for an injury or illness but which is not a medical emergency without declaring a PAN?

[A330driver]

Getting medical assistance airside here in Heathrow or in Gatwick does not require a medical emergency being declared to ATC. That's what the company frequency is for.

Despite passing numerous enroute airfields the commander never deemed a situation to exist that warranted getting on the
ground early, except for when he reached his destination.

The only apparant upshot of declaring this emergency appears to be bypassing a holding stack.

[Del Prado]

There's still no such thing in the UK as a 'medical emergency' (or a 'fuel emergency').
If you want priority tis a PAN or MAYDAY you must declare.

Out of interest, anyone know what the delays were into Gatwick at the time?

[behind_the_second_midland]

330

With as much repsect as I can muster.

You are talking crap.

Last time I had a medical problem I was ordered by Director to declare a PAN so as to get an ambulance.

[cargo boy]

Hang on a minute. If the crew were able to talk with MedLink and they advised that there was no emergency and it was considered that they should carry on to destination which was at least another 6 or 7 hours away then there was no 'EMERGENCY'. If there was a deterioration in the patients condition as they approached LGW then that is a different matter.

Why wouldn't the crew wait another 10-20 minutes in the hold? It's not as though they couldn't have called Ops on the Sat Phone any time in the previous 6 or 7 hours to advise them that they would need an ambulance to meet the aircraft but there was no 'EMERGENCY'. Even a simple call to Ops on the VHF whilst approaching london and they could have had the ambulance ordered and waiting for them by the time they arrived on stand.

Nope, this one does sound as though an emergency was declared when there wasn't one in order to get an expeditious arrival. Just because btsm doesn't believe it doesn't matter. Unless the patient was indeed in serious danger of deteriorating with a life threatening condition, declaring an emergency just to make sure an ambulance would be waiting when they have had many hours to make a call to their ops using Sat Phone, HF or VHF (within range) is an abuse of the system.

[touchedrunway?]

As a slight aside from the underlying topic here. About two weeks ago, talking to London, approaching from the Akiki direction, a United States Airline (No Names) told ATC that they had a medical emergency on board. On further questioning from London it was disclosed that it was a pax with a blood clot, spreading!!! London asked did they want to declare an emergency. "No" was the answer, yet they still became priority traffic into London. As (non priority) traffic on the way inbound, we saw holding as no hardship at all, and would have offered too, if necessary. Surley, professional pilots with any airline, can see the urgency in a "medical emergency". If a fellow collegue decides that he or she deems they have a "medical emergency" on thier flight, and they don't declare a "PAN", then that's their choice. They have the facts to hand about their circumstances. The least we can do is allow them a jump on a 5 minute hold, right? No? Maybe I'm too soft......call me considerate?

[Infadel]

With all this wonderful state of the art medical diagnosis perhaps BA should think about pulling out of catering and aviation.
The NHS perhaps?;)

[Speedpig]

Even a simple call to Ops on the VHF whilst approaching london and they could have had the ambulance ordered and waiting for them by the time they arrived on stand.

And then we'd get out one of the dozen or so ambulances that we have on standby at the airport, along with 24 (or so) driver/technicians...... just like all the other carriers have.

There are two ways to get an ambulance onto the ramp at Gatwick. The first is to book it in advance through an insurance company... usually a minimum of 24 hours in advance, or you request Surrey Ambulance Service to attend... "Is it an emergency?" asks the nice controller. "No" say we, "we just thought it would be nice to get this chappie off with a suspected broken ankle, and he can't wait the 24 hours for the insurance company to arrange it, so if you wouldn't mind popping along......."

The only way to get an un-prearranged casualty off an airport is to request an emergency ambulance.... and the airline pays for it. The BA aircraft will request it through ops (who will make the call) and the crew will advise ATC that an emergency ambulance has been requested and they (ATC) may well decide to expedite the arrival if possible.

Why would A330 driver have a problem with that?

This is just BA bashing. Are you inferring that if Virgin had a similar scenario that ATC would not expedite their arrival also?

On a lighter note, I had the pleasure of speaking with a gentleman who's life had almost certainly been saved by an expeditious diversion into Shannon where he was hospitalised for a week.
This chap lived in Oxford and about a month after the event came down to Gatwick by coach to speak to someone. I listened with great interest to his story of how the crew had discussed his condition with Medlink and him and then on Medlink doctor's advice, had made the decision to divert to Shannon.
I was quite taken aback when I discovered the reason for his visit to Gatwick.........
it took a while to sink in when he said he had come to get compensation for the inconvenience of having to find his own way back to Oxford from Shannon once he had been released from hospital.
I agreed to go through some figures with him, and once we had assertained that by the time all connecting pax had been rebooked and replacement crew sent to Shannon (crew exceeded hours), the 4 hour delay to the next flight operated by that aircraft, the screwing up of rosters etc etc, the cost of the diversion would be in excess of £35000 that we would indeed compensate him once he had done the same for the airline.

[PAXboy]

A330: If you are taken ill on board a flight (I doubt that you will on BA but that's you're tough luck) then do, by all means, SHOUT as loud as you can that you want to go BACK to the originating field. Do not accept any cockamamie excuse - you stand up for your rights.

I expect that the Cpt will be only too pleased to offload you. :hmm:

[apaddyinuk]

If this is the MCO-LGW incident that were talking about then as a crewmember based on this fleet I was under the impression it was a crew member that was injured (infact I trained with the lady in question and she was back flying pretty quickly after the incident) and she told the captain that she was able to continue.
We must remember here that this was not some BA policy the made the aircraft continue. Dozens of BA flights make emergency diversions for illness each year without the company questioning it. Its always the crews first priority to ensure that they are doing the right thing for the sick/injured person. Infact, usually it is Medlink, a company BA subscribe to who offer inflight medical advise to crew from their base in Phoenix ( or is it houston, i cant quite remember) and they usually advice whether a diversion is strongly advised or if the condition should be ok for the flight to continue. They will then take charge of arranging medical assistance to meet the aircraft should it divert or continue and that also includes advising the hospitals!

[martinidoc]

From CAP 413

Types of emergency

"b) Urgency A condition concerning the safety of an aircraft or other vehicle, or of some person on board or within sight, but does not require immediate assistance."

A330 Sorry about your friend's death due to fat embolism, however, as I previously said this syndrome is rare, and death from from all fractures (any cause) is rare (approx 1:2500). Fat embolus syndrome does not usually manifest itself for several days following fracture.

I can understand why this personal tradgic anectdote has coloured your views, but sadly I think you are mistaken.

Continuing the flight after consultation, and dcelaring a medical emergency pre-fixed with a Pan in the situation described seems to me to have been entirely appropriate, as specified in CAP 413.

[beernice]

L337 I've got a medical degree and an ATPL. Ignorant I'm not. Every company has its faults, the only danger is when its employees are too stupid to see them.

[Slim20]

In my opinion the company really does have poor SOP's.

Really? What, in your extensive experience, leads you to think that?

I've got a medical degree and an ATPL

Eminently qualified to comment then! What would you have done then, Dr beernice ATPL? (or should that be Capt beernice MD?)

[matkat]

Looks like a good call to Me.

[Flying Torquewrench]

It is a normal MEDLINK procedure that when you require a ambulance to meet the aircraft on arrival it will be arranged by MEDLINK. Offcourse only when you have been in touch with them to advice them of the medical problem you have on board the aircraft.

Yesterday we had a passenger who became ill during the flight so we contacted MEDLINK. Their advice was to continue to destination (major UK airport) and MEDLINK would arrange a ambulance to meet the aircraft. No need at all to declare a PAN or MAYDAY.

Can't comment on the BA story because we don't have enough information.

FT

[Hotel Mode]

From BA Flying crew orders : When medical assistance is required on arrival a medical emergency (PAN) should be declared.

Pretty clear i think.

[BEagle]

Not really. 'Should' is merely a strong recommendation in modern parlance. Mandatory action would require the Crew Orders to use the words 'shall' or 'must'.

However, it is extremely good to know about the way 'Medlink' works and that such medical advice is available 24/7.

Thanks to you all for your clarification.

[Hotel Mode]

Should in the FCO's means you better have a damn good reason not to. For example: [a wheels up/partial gear landing] SHOULD always be made on the paved surface rather than on grass or other soft surface.

You'd want a pretty good reason lined up for that one

[normal_nigel]

Not the should/must argument again :rolleyes:

[Complex_Type]

I've not heard anything about any untowards consequences for the pax, so well done that Capt. good decision.

[Cosmo]

PAXboy raises the question of the potential liability of a carrier for medical expenses.


quote:
--------------------------------------------------------------------------------
Any expense that the passenger would incur in treatment in the US would have to borne by BA - not the individual.
--------------------------------------------------------------------------------

How so? Do you have details of the insurance arrangements for this patient and that of BA?


In general, the Warsaw system would apply. By the "Warsaw system" I mean the Warsaw Convention and its numerous amendments.

Article 17 of the Convention (as amended by the Guatemala City Protocol) states that:
1. The carrier is liable for damage sustained in case of death or
personal injury of a passenger upon condition only that the event which
caused the death or injury took place on board the aircraft or in the course
of any of the operations of embarking or disembarking. However, the
carrier is not liable if the death or injury resulted solely from the state of
health of the passenger.


So it is entirely possible that a carrier would have to bear the costs of treatment of the kind of injury that apparrently took place in this case.

[GrahamCurry]

>So it is entirely possible that a carrier would have to bear the costs of treatment of the kind of injury that apparrently took place in this case.

So it was in BA's financial interest to continue to the UK . . .

[Hotel Mode]

What part of we call medlink they advise a course of action dont you understand? BA wont even normally be aware we've called Medlink until a course of action has been decided upon, and they certainly wouldnt interfere with any decision. Theres not a conspiricy everywhere.

[Jerricho]

I would give up people.

Our thread starter doesn't seem to want to play anymore.

[EasyBaby]

Well traveling back from SIN i developed renal colic (Kidney stones). I have never been in so much pain ever! Im cabin crew and i know that kidney stones is a diversionary medical complaint, its in bold: Diversion and seek medical help on arrival.

Well the crew and nurse that was onboard (thank f**k) explained the best they could, i was away with the fairies, that the nearest airport they would divert to was Mumbai. Now im sure they have very good medical care, but there was no way on Gods Earth that i was going to be left on my own far from home, in a county i know very little about, dont speak the lingo etc to have medical care. And i knew that with Kidney stones flying home would be out of the question for some time afterward.

The crew, nurse and i all agreed that they would continue to Europe, but if my condition was to get worse (i was not in good shape) they would have no option but to divert.

Now i knew the risk, as did the nurse, but i was the ill one, i was the one they consulted with, and it was my wish to continue the 12 hours to Europe. Should we be critising the airline and crew of the airline i flew with?

God knows how but we made it to Europe, and all i can say is thank you to the crew/airline and nurse that we did not divert. That was my wish and they carried it out. Im sure the BA crew consulted with the pax/crew with their ankle.

And so they jumped the queue, landed before anyone else, wether they should or shouldnt have declared an emergency, they still had someone onboard who was injured. And if that ment they got on the ground earlier and got the person seen to quicker then great. Perhaps it was a little bit of compassion that we so lack these days.

[Bart O'Lynn]

Why are you all bothering with this numpty. He sounds like an emi rat wide body driver and if so obviously the holes in his mickey mouse licence validation and real experience of the industry are starting to show thru. All shiney jet and no substance.

Beernice, atpl you may have but your ignorance of the pretty common medilink type services indicates that you are indeed ignorant. Ignorant of the industry norms that is. Something you wouldnt be if you had any real exposure to it.

By comparison i called medical assistance recently at a spanish airport while still on stand. Got a bollocking for not calling medilink and for using the local quack (and boy he was) as we lost our liability cover and after care from medilink. Great action by the crew, instinctive by me , bollockings all round and the pax moaned that we had left him behind. Thats because a first epi fit is normal where he comes from...you cant win.