Onboard emergency

[LowObservable]

Twice in the last few months Mrs Observable and I have been on long-distance flights where passengers have become ill. In one case the pax had a possible heart attack and the flight (Dubai-Amsterdam) diverted to Prague. Yesterday a pax was doubled over with a kidney stone between Gatwick and Minneapolis. My wife is a nurse and volunteered to help with the first case - a doctor (hesitantly) came forward on the second case.
The question is this - there doesn't seem to be any protocol or standards in this area. I don't think any of the crew (even on a long overwater flight) is required to have any medical training, such as "first responder", and the medical kit is there but nobody understands what is in there - for example, on the DXB-AMS flight the medical people who volunteered had to read the manual for the brand-new blood-pressure monitor that had never been opened. (It was a new type that none of them had worked with.)
What eventually happened in that case, too, was that it was up to four medical volunteers to decide to divert - I know it was the captain's decision in theory but he had nothing to go on except their advice.
Is there some kind of policy in place to deal with this - in any country or in any airline?
Is there any emergency medical training available to the crew, even in terms of knowing what to do with the kit that is on the aircraft?
Should there be?

[skytrax]

The cabin crew has medical training for first response. It depends on the company how long is this training. Can be 2 days or 2 weeks.

Most of the big airlines use Medlink. Medlink staff will advice the crew what to do and when to divert in serious cases.
I know a few companies that have defibrilators on board and crew trained how to use them.

[niknak]

The fact is that whilst its very rare for cabin crew to be trained to deal with every medical problem, for the most part they do very well to cope with them when they happen.
Nearly every major airline carry defiblerators on their aircraft, but more importantly, at least two of the crew members are trained to use them.
As has been alluded to, when such a situation occurs, the crew are in close liason with Medlink and their advice is very closely followed.

Obviously you (the Observables) are medically trained and know what services should be provided by a fully trained paramedic and hospital trauma team, but on an aeroplane you can't expect miracles.

[Loose rivets]

Comments from a layman.

This is a subject that I have thought about a lot. Despite a life long interest in medicine, the chances of me having clambered out of my drivers seat to help a passenger successfully, are fairly remote. Crews are given quite intense training in first aid, but the human body, being orders of magnitude more complex than the aircraft they're in, is not something that can be given a quick fix in a real emergency...well, not without a lot of luck.

An example might be the difference in treating a patient suffering with what might be anaphylactic shock v a heart attack. The symptoms to the layman can be strikingly similar, but I would guess that the first aid treatment is about as different as it comes.

In the first case, it is vital to get blood to the brain...much of what is happening is because of the bodies own crisis management doing just this. In the second case, although blood to the brain is still of paramount importance, the heart must be given all possible help to have the load taken off.

Adrenalin or nitroglycerin? How could a layman make such a decision? I have read about it in detail, but I have no experience...and that's what counts. A quick overview from Wiki...

http://en.wikipedia.org/wiki/Adrenalin

http://en.wikipedia.org/wiki/Nitroglycerin#Medical_use

The possibility of a gall stone blocking the exit to the gall bladder is something that would be dreadful in mid Atlantic. This could present the crew with a grown man lying on the floor screaming with pain. All their training could lead them to think that it was a heart attack. It is conceivable, that with a large single stone, it would be possible to manipulate this out of the bag's exit port so to speak. The ensuing bucket-full (well, it looks like that much) of bile that the patient will part with, will bring the crisis to an end. Again, a lot of luck, because a small stone can be pushed too far to be persuaded out. But if you could pull such a manoeuver off, the patient would thank you forever, especially if as mentioned, you were hours from a possible touchdown.

I know that accident first aid is not the actual issue, but crews are also trained in physical trauma first aid.

When I was a young fo I happened across a terrible road accident involving one car with 5 pax. They seemed to have come out of every hole possible in the car, and there was so much blood about that I just didn't know where to start...apart from stopping other cars (at pub closing time) hitting the people on the poorly lit road. Mrs R positioned in the middle of the road and flashed the headlights at every car.

It was the longest 25 mins of my life, and I managed to give some help, but I made a serious mistake, which I have mentioned before on this forum. I assumed death on one young man. This was because of the huge puddle of blood surrounding him. But it was a fundamental mistake.

However, when finally a local doctor turned up, he taped wadding on the wound and pressed on to the next ‘body'. One girl's neck had such a severe wound that it looked like a picture from Gray's. I tried to stop the debris from passing cars going into the gaping hole with my jacket.

The only victim that was making a noise was hanging half out of the car. She seemed to be held by her hips and I was concerned that her writhing would further damage her spine, if indeed there had been such an injury. I got several helpers to make a cradle with their arms and lower her to a grass verge. It was a tough call, all the books say don't move injured people, but the rules just didn't fit, and the other folk were willing, but more or less inert without direction.

I know that in a survivable air crash, the odds are that there will be little to do but distance passengers from the aircraft. But we have to assume that there will be an hiatus period that will allow some emergency treatment. The average crew member can only steel themselves to use their very basic training, and a lot of initiative.

[skytrax]

The signs of anaphilactic shock are slightly diffrent from the heart attack.
-difficulty in breathing
-swelling of the face, tongue and airway
-itchy, rash
-possible signs and symptoms of Shock
-possble unconsciousness

If the guy is still conscious you can ask him about any history, and if you have the confirmation, you know what tot do. If not you just base on the signs ans symptoms.

Heart attack
-the chest pain makes the difference.

[obgraham]

I find it upsetting, but altogether believable that the original poster said the docs on board came out "hesitantly". As far as I'm concerned, any doc who does not respond to that call for onboard assistance should be lashed to the yardarm of the aircraft till landing.
I've responded perhaps three times over the last few years. Two were anxiety attacks, one a pregnant woman in distress. In the latter case, my input allowed the pilot to decide to press on.
The pilot deserves all the help available to him. I'm sure now with the availability of Medlink, the doc at base, onboard crew, and any available professionals should work together, use whatever skills are available, and do their best. Isn't that all we can ask?

[LowObservable]

It seems that there is a lot of room for improvement on the medical training that a flight crew receives, in our experience. This is not a criticism, it is an observation for improvement in the system.
The concern is that on long-distance flights that are over areas that it is not easy or realistic to land the plane in an emergency, there could be better procedures for handling a medical issue, using the crew and volunteers.
When a group of us responded to an emergency from Dubai, the cabin crew let us take over completely and did not contact Medlink for several hours into the problem. They never indicated whether they were trained to handle any aspect of the situation, nor did they indicate that there was Medlink to contact or we would have told them to do that for our support.
We were a group of 2 nurses, a first responder and a veterinarian. The job got done and we had to decide if the plane should be landed and it was really frustrating and personally, pretty scary.
You really need three people to handle a situation with Medlink involved. One to make the call and be the liaison, the second gathering data from the situation and someone else pulling whatever you need out of the bag of medical supplies.
Perhaps we just saw a bad example in action - but it does seem that there could be better procedures and training to provide a more consistent response to this kind of situation, particularly on flights over oceans or countries where medical help on the ground may not always be the best.

[got caught]

I find it upsetting, but altogether believable that the original poster said the docs on board came out "hesitantly".

Clarify their liability cover whilst travelling as a pax, and most would jump to the rescue. Unfortunately, recent bad press in the doctors rags, would put some off coming to the aid of a stricken passenger. Sad but true.

Having said that, well done for helping- I don't think I could just stand back.


A basic understanding of basic life support would probably save about 200 lives across the UK per year, and the use of those all singing/dancing defibs would probably increase that number.

So go and get a refresher fellow ppruners.

[QDMQDMQDM]

As far as I'm concerned, any doc who does not respond to that call for onboard assistance should be lashed to the yardarm of the aircraft till landing.


First rule of intervening in medical emergencies as a doc: wait and see if anyone more qualified and enthusiastic than you steps forward.

This is a variant on a well-known police rule, told to me by a Brummie ex-copper of more than 30 years who was my driver one night when I was doing an out of hours shift. We had had a call from our control centre at about midnight to say the police had advised us of a stabbing near our base and there were two injured, possibly one dead and the situation was still very unclear. I was running around like a mad thing getting together IV fluids etc and he looked at me and said, very slowly and deliberately in a Brummie accent you could cut with a knife: "Dave, never run to a foight."

How right he was!

QDM

[obgraham]

Clarify their liability cover whilst travelling as a pax, and most would jump to the rescue. Unfortunately, recent bad press in the doctors rags, would put some off coming to the aid of a stricken passenger. Do you have an example at hand? Over here where we have a lawyer on every corner, docs are pretty well protected by the "Good Samaritan" laws. That said, you can sue anyone for anything you want. Collecting cash is a different matter. I prefer to act prudently, and I'll be happy to tussle with some jerk who tries to sue over it. I have a moral problem with sitting still while someone is in distress if I have the knowledge to assist.

[LowObservable]

His reaction was very similar to what you are talking about and I have to be the first to admit that I was hoping that there was an MD on board the plane rather than me having to make the decisions, being the RN. Luckily, as I put my hand up to volunteer, he came forward at the same time and said he was a doctor. To say the least, I was relieved but like anyone that has posted, was willing to do what needed doing at the time. It is a tough one and a time of panic that the knowledge you need right then is not lodged in the cobwebs someplace.

[got caught]

Do you have an example at hand?

No sorry, don't have a direct example, but if you searched the rags you'll probably find some case studies. I tend not to take much notice of these journals, for reasons I'm sure you can work out yourself.

Personally, whenever I've witnessed incidents outside of work, I've usually stepped back and let those more qualified step in- I'm not, after all, an expert on first aid, unlike the paramedics, who do a pretty good job usually.

On the few occasions that I have stepped in, I've not found it necessary to announce my position to all around. A cool, calm firm approach usually speaks volumes to those around.

Unfortunately the poor ******* have usually ended up dying anyhow.

[slim_slag]

The fact is that whilst its very rare for cabin crew to be trained to deal with every medical problem, for the most part they do very well to cope with them when they happen.I've only seen an actual event once on a plane (elderly gentleman on the way to the toilet collapsed in the aisle) and the cabin crew ran and hid in the galley. Several passengers went over and I thought splendid as one of them might know what they were doing and I could continue with my G&T, but the best they could do was hold his hand, so I thought I should really get up. By the time I got to him the gent was on his feet and told me it happened all the time. So fair enough, makes life easy for everybody. He continued to the toilet, the plane continued to its destination, and I went back to my G&T. So on this occasion the cabin crew would not have been of much use, but there again neither was I :)

[got caught]

but the best they could do was hold his hand

Probably safer than amateur emergency medical interventions. Well done slim, you've probably saved his life.:)

[slim_slag]

And one cannot claim that happens very often :) But rolling him on his front would have been a good start, don't need 5 years of med school to do that :ok:

[Northern Chique]

I know on most work sites, mining and construction they have requirements for first aiders / occupational first aiders / paramedics / nurse clinicians / doctors per number of personel working. The exact minimum number is dependent on work type and proximity to definitive medical care.

Given the number of folks on todays international jets, it may just be worth putting a nurse clinician or paramedic on these flights. It takes the stress out of the job for the flight crew and provides the basis for qualified emergency medical care.

[got caught]

Given the number of folks on todays international jets, it may just be worth putting a nurse clinician or paramedic on these flights.

Point taken Northern, but would it justify the resultant increase in cost?

(PS I'd be the first to volunteer, I'm just on my 13th sore throat)

[mckrll]

"At EBACE2006 in Geneva Wednesday, AirCell, Inc. and MedAire, Inc. announced the new MedLink Powered by AirCell, a new program that gives business aircraft operators access to in-flight, on-demand medical assistance worldwide."

For more info:

http://www.aero-news.net/index.cfm?ContentBlockID=8af0c382-4a5d-43eb-846c-b0d6f5649bc8&

One would hope that the airlines would take this up - assuming that they don't already have this type of capability.

Andrew

[Northern Chique]

Having access to this information still doesnt qualify people to use skills they have never been trained for.

In most cases, such medical information services utilise whatever personel and skills that may be available on each flight. I know what measures have to be undertaken to attempt to treat some accute conditions, and with quick treatment, those conditions are recoverable. The trouble is, if you dont have trained personel, the potential for a good outcome is significantly reduced.

[mckrll]

I totally accept that point - and it would be difficult to train personnel to a high enough standard to be really effective in most situations I guess.

I just thought it was an interesting development in terms of the business a/c market - though unless the a/c is large enough to carry a flight attendant, there's not much either of the two up front could do with the information.

Andrew

[Roadtrip]

Despite the modern manta that everything should be provided for everyone, it is not the airline's responsibility to provide passenger medical care. However, many passengers today with serious medical problems that have NO business doing any kind of airplane travel, think nothing of buying a ticket and going. Then when something happens on-board, they think, because they get acutely sick in the airplane, that the airline should provide medical care.

I had a passenger one time (a physician no less) start a new blood pressure medication the morning of his transatlantic flight. Half way across, his blood pressure drops through the floor and we almost have to divert an aircraft with 200 people because of the stupidity of one individual. I've had people show up at the door wrapped up in bandages and in a wheelchairs . . obviously severely injured, yet wanting to use a commericial aircraft as their personal air ambulance.

Unfortunately, cowardly government agencies and spineless airline managements let this go on and on.

[Loose rivets]

The trouble is, that if you are going about your lawful business...and are suddenly struck by a 39 bus, when you are patched up there is nothing more important in the world, than getting home.

The strange Egyptian mummy replicas that we used to bring home from Innsbruck, were a bl00dy nuisance, but I wouldn't have had the heart to leave any of them behind.