Passenger seriously ill.

[sudden Winds]

Just departed from an airport below minimums for CAT 1 landings (about CAT II conditions) for a 40 minute flight toward an IMC destination, but ok for CAT I. Aircraft capable of conducting autolands, but crew not certified.
10 minutes after takeoff..passenger gets a heart attack, he´s critical. No other nearby alternate airports. Try to land back at origin airport or continue to destination?

Regards,
SW.

[Ashling]

Carry on to destination or divert to a closer airfield that is inside your limits. Obviously you would declare a mayday with a medical emergency go max chat etc in order to cut the journey time down. I'm afraid if your not certified to do autolands its rather irrelevant whether the aircraft is up for it or not. Autolands can go wrong and there is a reason for crews being specificaly trained and certified to do them. Its simply not worth risking everyone on board in order to perhaps save one.

If you have an uncontained fire or some other drama that immediately threatened the safety of flight then by all means do what you have to to get on the ground bending whatever rules you need to but not in this scenario.

[Tight Slot]

Would have thought a Pan Pan rather than a Mayday...

[christn]

'Mayday' gets everyone's attention and can always be downgraded.

[Notso Fantastic]

Without doubt, continue to destination. You are hazarding everybody else on the aeroplane attempting to conduct an autoland outside your operating parameters. I believe Mayday is the correct call as human life is in grave and imminent danger.

You should not ever hazard the safety of the aeroplane unless a greater danger threatens. Thus an 'on fire' overweight landing is a correct decision, but choosing to operate outside your skills is definitely forbidden.

[stiffwing]

Notso,
"Mayday" is to be used when the aircraft is is imminent or immediate danger, not a passenger. Unless a doctor is on board and can verify the passengers medical condition ("I'm a pilot, not a doctor") then, the PIC should proceed to the nearest suitable aerodrome, i.e. one that meets the physical characteristics for the intended operation.
Be very careful in making a laymans diagnosis of a condition for which one is not qualified.
If the illness puts the a/c into a situation that threatens the rest of the crew and pax then its a different matter.
Notwithstanding the above, "PAN" has little meaning or influence in some countries.

[ITCZ]

Are your cabin crew not First Aid and CPR current? Unusual. I thought it was a requirement.

If you were foolish enough to turn back when you were 10 min out, you are also at least 15 minutes away from parking the aeroplane and opening the door to let the paramedic in.

Clean up aircraft, climb to planned cruise level, complete all normal checklists, proceed to destination. Advise ATC that you have a pax needing urgent medical assistance on arrival. Details to follow.

Keep seatbelt sign on. Not all pax will be aware that something unusual is taking place in the cabin, so best not have them bumbling their way to the lavatory.

Let your cabin crew do the job they are trained to do. Give them permission to make a PA asking any medically qualified persons on board to come forward and assist.

If you have more than 50 pax on board, there will be at least one doctor or one nurse on board (I had one heart surgeon, one emergency room doctor, and three nurses out of 65 pax respond to such a request when a young woman had a grand mal seizure aboard last year).

Your hypothetical heart attack victim will need immediate attention. If respiration and circulation are not restored within 3 minutes, that person is in a grave situation.

Dont sit his/her rescuers down for 15 minutes while you attempt an autoland at a below minimums aerodrome. Use your crew and passenger resources.

[JimGreen]

....Safety is top priority...Limitations and minimas are always respected..your OWN (professional and otherwise), Aircraft limitations, Limitations of the 'field' of intended landing.

The only situation that drifts into mind, where Safety may not be top priority is if you are a fighter pilot in the WAR ZONE !!! :ok:

JG

[ITCZ]

I find it interesting the number of airline pilots that rate themselves 'above average' in their CRM skills, but freely admit they have never opened a copy of their airline's Cabin Crew policy and procedures manual ("FCOM" for cabin crew).

How can you be a good Crew Resource Management practitioner, if you have scant idea what skills, knowledge and abilities are present in the other half of your airborne team?

Food for thought!

[PENKO]

Nah, the focus of safety always shifts IMHO. If you are on fire as someone already mentioned, then of course you do not go on for 40 minutes to your destination. Clouds slightly below your minima are now suddenly not your greatest safety hazard.

For one sick passenger you go on to destination. For two...you go on. Should however more pax start keeling one after the other over due to lets say, toxic fumes in the cabin, then the safety focus starts shifting. Judgement call..

[Notso Fantastic]

Read the question. It is simple! People are throwing all sorts of complications in! Cabin Crew, fighter pilots? It is a simple question requiring a simple answer. People are changing the question then answering their own additions!

[Denti]

I find it interesting the number of airline pilots that rate themselves 'above average' in their CRM skills, but freely admit they have never opened a copy of their airline's Cabin Crew policy and procedures manual ("FCOM" for cabin crew).


Interesting. Our manuals (pilot ones) contain all the information that is in the cabin crew manual so we do not need to open them (although they are available online as well), they are basicly just an abbreviated version of the pilot manuals restricted to what the cabin crew needs to know. Wasn't aware that some companies keep all the cabin crew stuff outta their pilots manuals.

[SNS3Guppy]

In a light twin many moons ago, a passenger in my right seat experienced a heart attack at night, in a remote area. He collapsed, became unresponsive. Over the years since, I've had numerous passengers go critical in flight...some of whom started that way, when flying air ambulance.

Regardless of the situation, you're not on board to panic, you're not on board to be an EMT or doctor. You're a pilot You fly the airplane. Do you try to be a hero and make decisions that compromise the safety of flight because you' feel like your temperature just went up a little? A passenger has collapsed. You don't know why, you're not a doctor, you don't know that it's a heart attack. You don't know.

What you do know is that you are able to perform within certain parameters as a pilot. You know what the weather is, you know what the minimums are. You hopefully are aware of places to which you can divert.

The question appears to be crafted to see if one is willing to act illegally and unsafely in order to handle a perceived emergency. That is, does one's perception of an emergency justify acting outside the scope of a normal operation?

Any operation, abnormal or emergency, should be rehearsed and enacted such that it doesn't raise your blood pressure, doesn't quicken your pulse, doesn't break a sweat. You're there as a professional, after all. Do things routinely, make the situation as routine as possible. You didn't cause the passener to lose consciousness, you can't be expected to know why he's lost unconsciousness, but you can be expected to fly the airplane.

Mayday? One can't be serious.

"Boston, Scramby356. We have a report of an unresponsive passenger, requesting priority, direct to XXX. Request medical be notified."

Simple. No screaming, no panic, no need to formally declare the day an emergency or an impending disaster, no need to get excited. You have an unresponsive passenger. You can't go back. If your destination is the nearest choice, then it's the nearest choice. Period. If there's something closer and your weight and circumstance will allow you to use it, then do that.

[mini-jumbo]

Mayday? One can't be serious.Yes, absolutely. Remember, you might not be able to assist the pax, but the cabin crew most certainly can, and they will report to you regarding the pax condition. If it is life and death, then yes, I would declare a Mayday. I would at the very least declare a PAN (or a MAYDAY in a country which doesn't recognise a PAN).

"request priority" dosen't exist in europe (in terms of standard RT) where as there is no confusion over MAYDAY.

[cats_five]

Said passenger needs medical help ASAP. Go to the nearest destination (in *time* terms) that meets all the relevent regs, make sure ATC are aware of the medical emergency and hope he's OK in the end.

If you are 10 minutes into a 40 minute flight, you are only 25% of the way through it. Will it really be faster to continue? If I was a passenger returning for a medical emergency (if that was the fastest way of providing qualified & equipped assistance) would be comforting, as it's what I would want for myself if I was ever so unlucky.

[Stuck_in_an_ATR]

I'd rather go back and land below mins... I'd rather have "no tea and biscuts" meeting with my boss, than having to live with thought that I might have saved the guy's life and didn't (even being perfectly within regs)... Of course the final decision would depend on the actual weather. I wouldn't try a VOR app to a CAT II minima, but with ILS and autoland... I think I would

[mini-jumbo]

but with ILS and autoland... I think I wouldAnd lets assume that because you're not cat 3 autoland certified, that you didn't read the notam stating that the ILS has been downgraded. That would result in more than no tea and biscuits I would imagine.

[Notso Fantastic]

These dramatic statements to ATC of 'Unresponsive passenger, request priority approach!!' blah blah- I'm unimpressed. We had it drummed into us that UK ATC does NOT recognise even 'low fuel state' or 'low fuel emergency'. What they want to hear is either 'Pan-Pan......' or 'Mayday....' as per the correct fuel parameters of those conditions (for example the BA747 ex-LAX of recent history- correctly given). Now, if a fuel state hazarding the aeroplane (and occupants) is not recognised officially unless given the correct monicker, is a 'medical emergency....' call likely to be recognised? Stiffwing,thank you for the lesson on Maydays, but, I would rather stick my neck out and give this solution a 'Mayday...' and apologise later that although the aircraft was not in grave and imminent danger, one of the occupants (a human life) was, 'so please go easy on me Guv!'

The object of the exercise is evidently to probe how easily one would be persuaded to go outside one's SOPs and regulations. NOT a safe option, in this exercise, to return! The Cabin Crew were not a factor in the question!

[SNS3Guppy]

Actually, that was kind of the point. Crying "mayday, mayday" is an overblown, ridiculously overdramatized act which isn't necessary. Merely tell ATC what you intend to do. Period. No declaring the day an emergency, no dramatic announcements of mayday, no reqests for diversions; tell ATC what you intend to do and what you need, then do it. Simple.

Your job is not the passenger; your job is safe operation of the airplane, and you have all the passenger's interests to consider when you do that.

[PENKO]

So ATC tells you 'SNS3Guppy, enter the hold at XYZ, you're number three for approach'.

You say what? 'Request priority?'
I bet you that ATC will ask you then: 'SNS3Guppy, are you declaring an emergencey?'

What will your answer be?



On the other topic, just to make myself chrystal clear regarding my previous post: in my opinion the life of one passenger can never be the reason to bust your minima, risking the lives of everyone else on board. I honestly cannot believe that someone would return to land below minima for one sick passenger. You only disregard minima if you know that not doing so will be more dangerous on the whole. Minima are there for a very good reason. IMHO, once again.

[Ashling]

I think the vast majority of us agree whole heartedly that the correct thing to do is land at the nearest avaiable airfield that meets the operating limits.

Stuck In An ATR you may wish to consider how you might feel if instead of saving one you killed many by making an ill considered return into below limits conditions for which you have not been trained.

I can see both sides of the Mayday/Pan debate. What you have to do is use a recognised distress call and then clarify what the nature of your problem is and what you wish to do. In some areas Pan is not recognised so a Mayday would be more appropriate and it will certainly get you attention and you can always downgrade it. Snag being, I am told, is that in some places the airfield you are arriving at is obliged to put its crash plan into operation so you may have a whole fleet of ambulances etc waiting for you rather than just the one. On the flip in the UK if you declare a Pan you could land with a medical emergency and still have to wait 30 mins for an ambulance to pitch up. What you will get is the airports paramedic who will then decide if an ambulance is required. This is because an airport is deemed a place of safety in the NHS's eyes as it has a paramedic. A Mayday will probably obtain you the ambulance that you, your crew and the doctor onboard deem necessary.

Personaly after experience of the above when we had a doctor on board desperate for an ambulance to get the patient away quickly (and communicating it effectively to all who would listen Pan medical emergency request direct ambulance to meet etc) all we got was a paramedic and a 30 min wait for the ambulance when the paramedic agreed with the doctor.

So Pan is I guess the correct call, were it is recognised, but after personal experience if I get the impression things really are life threatening it will be a Mayday for me initially and I'll eat humble pie after the dust settles.

SN3GUPPY all your example call in the UK would achieve is a question from ATC, "are you declaring an emergency?", declare the emergency then ask for what you want not the other way round. While a Mayday call may be a touch overblown, and your first priority is safety of flight which you must not compromise, I can assure you that your pax and his relatives will definately consider it a mayday. So I can live with being a touch over dramatic if it saves a life.

[SNS3Guppy]

So ATC tells you 'SNS3Guppy, enter the hold at XYZ, you're number three for approach'.

You say what? 'Request priority?'
I bet you that ATC will ask you then: 'SNS3Guppy, are you declaring an emergencey?'

What will your answer be?


Negative...not "declaring an emergency."

You see, as the PIC, I don't have an emergency. I don't even know if the passenger is alive. Asleep. Having a siezure, stroke, or religious experience. I have a fully functioning airplane with no problems, and am going to do what I can in the interest of the passenger without any willingness to compromise the safety of the flight.

As soon as you let emotions into it, you just became the wrong man for the job.

Some years ago I was enroute to Mountain Home, ID, to retrieve a heart. I had a surgical team on board to harvest the heart, and a patient waiting for that heart. Conditions deteriorated such that both of us flying the airplane determined we would not continue, and returned with the crew on board. We did not harvest the heart. If the heart was lost, if the patient died, I don't know. I don't make those decisions. I did decide, based on the criteria set before me as a pilot, what I could and couldn't do based ONLY on those criteria. The need for the heart, the condition of the patient, and whatever else is riding on that flight are NOT pilot considerations.

Over my career I have flown many, many emergency medical missions. I've turned down flights due to weather, mechanical, and other reasons, even though a critical patient needed transport. I've spent many years flying firefighting missions in which I've refused, cut short, or changed the mission due to my own safety-driven assessments. This is crucial. You can make the scenario in the back of the airplane anything you want. A woman is giving birth. A man just had a heart attack. A poltergeist is loose and stealing everybody's spare change. There's a bloodbath in progress and someone's using the blood to paint uncouth religious grafitti on the lav walls. Take your pick. All irrelevant.

Someone forgot their wallet? Still not an emergency. Still not my problem. I'm there to fly the airplane.

What do you think is going to happen when you grip that microphone with white knuckles, crackle hoarsly as squeak as you clear your throat to say "Control, I hereby declare this day a day of emergency and mayhem, mayday, mayday, mayday?" You think the sky will light up and the heavens and waters part for you, and something will magically change? No. Do you think ATC will respond with "Understand Baybridge Four Three Niner. You are cleared immediately to do whatever you want to do, disregard safety and throw caution to the wind. All regulations are hereby repealed, and you are free to act as you wish. You're number one in our book."

I was in Riyadh last year, preparing for departure, when a Saudia flight called in an emergency. He was very clear to state over and over again his maydays and that he had an emergency. He was clearly distraught, so we listened with interest as ATC tried to determine the nature of the emergency.

"Riyadh, I say, we have an EMERGENCY! We must have the police meet us at the gate. Bring as many as you can. Do you hear me, Riyadh! We have an emergency. I say, Mayday, Mayday. We have an emergency. You must bring the police!"

"What is the nature of your emergency?"

"I tell you, we have an emergency. We must land right away, and we must have the police. Have them meet the airplane the moment we land. I say again, it is an EMERGENCY!"

"We must know the nature of your emergency, Captain. What is your emergency?"

Then, in a hoarse whisper, fraught with emotion and fear, the captain replied, "We have a passenger on board who is consuming ALCOHOL!" I say, we have an emergency, we have ALCOHOL on board, and must have the police right away."

Wow.

The use of Mayday and Pan Pan is meant to draw immediate attention to the radio call,and it serves to tell all other listeners that radio traffic is to stop, to draw attention to this particular traffic, and is a final call of desperation. Often made into the blind. Hardly warranted while in the ATC system, talking to ATC, when there is no threat to the safety of the flight.

Simply telling ATC what you have, what your intentions are, and then getting it done will suffice. So far as getting excited and attempting to return to land in conditions below minimums...if you're more concerned about the life of the passenger in a situation where you aren't qualified to know what's going on behind the cockpit door, if you're emotional enough to get excited about this, then you're the wrong one for the job. You already have a job; flying the airplane, legally and safely.

Each passenger climbs aboard knowing he or she will be more than a few feet from a surgeon, more than a few feet from a firefighter, more than a few feet from a beautician. The passenger knows he or she is climbing into an airplane which moves away from the earth, isolated from help, isolated from all the conveniences of the ground. The passenger has made this decision by climbing on board. It's not your decision to worry about. You didn't create the "emergency." Your ONLY concern is flying safely. Period. That the passenger lives or dies is also not your concern, not your responsibility; you have a bigger duty and that's to fly the airplane safely. You can do that by picking an alternate, pressing on to the destination, making a cabin anouncement for assistance by cabin crew or other passengers for the cabin victim, or other means within the scope of your job. Turning back to fly an approach for which you are not qualified nor trained, in conditions less than you are legal and less than which you're experienced in is not in the purview of your duty; it's a breach of confidence placed in you by your employer, your certificating agency (CAA, FAA, etc), and the passengers. You don't have that right. Fly the airplane, don't get excited, end up on the ground when you can. Again...you did NOT create the problem, you're only handling it. Do it methodically and safely.

[Rod Eddington]

"Negative...not "declaring an emergency." "

In which case, in the UK at least, you would get not get any priority. I'm sure your sick pax will be delighted at your decision.

"As soon as you let emotions into it, you just became the wrong man for the job"

Declaring a mayday has nothing whatsoever to do with emotions. What a wierd thing to say.

[Notso Fantastic]

Guppy, that is long and passionate, and raised far more issues than are in the question. You were presented with a simple medical emergency scenario with a weather problem. Everybody has been making far more of it than the problem presented. The lesson to those trying to learn is forget about heart transplant issues when they don't exist in this problem, handle the immediate problem, remember what limitations are for and always consider the safety of all those on board. It leads to one answer! With UK ATC (at least), unless you declare an emergency, you will get no preferential treatment whatsoever. You may expect few, if any, countries outside the UK will even recognise the term 'pan-pan' or know what you are talking about. Therefore to have a severe medical condition on board, the only option is to declare an emergency.

In practice, I had such a transatlantic condition this year. With proper communication, I received full co-operation from ATC without having to declare an emergency, and was fully satisfied with the handling.

[PENKO]

SNS3Guppy, I know there are 'real' pilots around who probably have landed aircraft without any wings attached, flown through flack, and rescue little orphans from burning rooftops on a weekly basis. Won't stop any mortals for yelling mayday the moment their engine surges. I can see the point you make, it is a valid one in the grand scheme of things. But every pilot has to make his own decisions I think, based on the situation at hand, experience, co-operation of ATC etc. etc.

If you have the means available to be on the ground ASAP, and one of those means is a mayday call, then that's what you should use. (And again, of course you do not bust minima for one pax).

[Ashling]

Guppy

I think you are losing the plot somewhat here.

The scenario asked you to choose between the immediate needs of a seriously ill passenger and safety of flight. Overwhelmingly people have chosen safety of flight and quite right too. So I fail to see why you feel the need to keep banging on about safety of flight having primacy when virtualy everyone has made the same point by chosing to continue and not return into conditions which are below limits.

Also I think you will find that legaly you have a responsibility to each individual passenger as well as the collective whole. You may well know exactly what is wrong with the passenger as your crew will have told you as will the almost inevitable Doctor/Nurse on board. If you have a patient with a heart attack you most certainly do have a medical emergency and you have a professional and legal responsibility to deal with it appropriately.

How do you deal with it? Well when you are made aware there is a medical issue you review your options with your flight deck colleagues while the cabin crew deal with the immediate issue and gain medical help if any is available. You then make a decision based on the information you recieve from your cabin crew and the information you have gathered ref diversion airfields eg weather and notams. Your company may have a medical hotline so that can be consulted too. Taking all these factors into account you make a reasoned decision whether to continue or to divert. If you need priority you declare an emergency. Pan would be correct but as we have observed this is not recognised everywhere. The key is to get priority if you need it.

Throwing caution and flight safety to the wind in the interests of one ill passenger is an extreme and inappropriate response but so is casually and coldly ignoring it and denying any emergency exists. There are such things as coroners courts were people are held to account for their actions you might wish to consider that especially as you may be legaly liable.

[mixture]

Not really wishing to be drawn into the general debate about turning back vs proceeding to destination that's going on here.....

Suggest some of you re-read CAP 413.

A PAN would probably be justified and appropriate in order to try to get you priority routing and medical assistance on the ground. (ref: definition of "urgency" in CAP413).

Use of MAYDAY for pax emergencies is less clear and probably would be less justified in this scenario.

P.S. I believe you'll also find that PAN and MAYDAY are internationally recognised and should always initiate ICAO prescribed procedures.

[ITCZ]

they are basicly just an abbreviated version of the pilot manuals restricted to what the cabin crew needs to know.

The Boeing FAM might be loosely classified in that way. But the checking and training manual, the company policies and procedures manuals etc can tell you a lot about who you have back there, what their capabilities and their limits might be.

Not my idea. Passed on by a couple of the great operators that I respect. One put it thus: "I have to answer for everything that happens on my watch. I don't have to know everybody's job, I just like to know what I have at my disposal."

[SNS3Guppy]

In which case, in the UK at least, you would get not get any priority.


Well, that's the UK for you, isn't it? Don't worry, it's just a scratch. Only a flesh wound. In the land of understatement, only a declaration of war rouses enough attention to bat an eyelash.

[Skylion]

Don't forget that many airports do not have serious medical services on site. LHR only has a paramedic (on a bike) available in each terminal. Ambulances have to be summoned from the London Ambulance Service at Hillingdon to take passengers, crew or airport staff involved in industrial accidents to the hospitals A & E. Ashford A & E was nearer but I understand that has now closed.

[Ashling]

Mixture,

I agree with you however, sadly not all countries respond to a Pan at least not all controllers. A colleague of mine declared a Pan in France, the controller refused to recognise his call. In the end he was forced to use a Mayday.

Skylion

I made the same observation earlier and the worrying thing is that you may well only get the paramedic initially even if you request an ambulance as thats the way the NHS works. Thats why, after bitter experience, I would consider going Nuclear and useing a Mayday even though it is incorrect to do so as Mixture has observed.

Guppy

The reason the UK is so particular about getting you to declare an emergency is because we've found over the years Pilots can be a touch trigger happy and make calls such as "we have a minor problem request direct routeing and a priority approach" When asked the nature of the problem the reply would go something like "a minor technical issue". This left ATC unsure what level of assistance was required and as ASRs were often not filed the rather unpleasent possibility arose that some crews were pulling a fast one to get in ahead of others eg the famous "we're running short of fuel" So ATC quite rightly insisted on a formal declaration of an emergency. That way we all know were we stand and the incident has to be reported and looked at which means we all learn from it and it prevents the bogus calls. As an example, we now know a Pan with low fuel means that an aircraft MAY have to dip into final reserve fuel and a Mayday means it WILL dip into final reserve fuel. Much clearer for all concerned. Certainly better than "request priority due low fuel" "are you declaring an emergency" "er no but request priority approach" So it all prevents the careless and unecessary declaration of emergencies something I gather you are keen to prevent as well.

Although I often take their name in vain Brit ATC are, in my view, the best there is. `

[mixture]

Ashling,

If I were somwhere outside UK airspace where a PAN was not being recognised, I too would probably resort to a MAYDAY, especially, in the case of this scenario, if a doctor on board confirmed that it was indeed a heart attack.

Also, in the case of somewhere like France, I would also seriously consider filing a report against an ATC unit that refused to recognise a PAN.

I made the same observation earlier and the worrying thing is that you may well only get the paramedic initially even if you request an ambulance as thats the way the NHS works.

Indeed.

I believe the practice (particularly for the larger NHS wards, such as London) is that if the phone operator is satisfied that your situation is serious enough (as would be the case with a heart attack), they will send out a FRU with an ambulance to follow.

So yes, you will get your ambulance, but the FRU system is the NHS's way to buy themselves more time to find an available ambulance and/or allow the ambulance to fight through traffic (because FRUs are generally just converted cars, they are smaller and more agile than an ambulance).

[Ashling]

Mixture

My understanding of the system is the same. My bitter experience was with a diabetic who went into shock and they refused to send an ambulance until the paramedic had assessed the patient even though we had a qualified doctor on board pleading for an ambulance. My other half, who is a GP, tells me its because the NHS view the airport as a place of safety due to it having a paramedic there. I do appreciate its in order to avoid the unecessary dispatch of an ambulance which may be needed more urgently elsewhere but you would have thought that when a qualified doctor asks for the ambulance they would relent and send it. Not so apparently. I filed an MOR in the above case.

I also agree that filing a report against ATC if they do not recognise a Pan would be the right thing to do. Certainly upgrading to a Mayday will get it looked at.

[Rananim]

Aircraft capable of conducting autolands, but crew not certified.

Do you mean that their certification has lapsed or that they've never received training?If the former then a return to destination would be an option.Captain's discretion.A crew should do all they feasibly can to avoid a death on board.It IS a big deal.Would depend if there was a doc on board and what he said..would fifteen minutes make the difference to fifty?

[mixture]

would fifteen minutes make the difference to fifty?

In the case of a heart attack, yes. I believe the commonly stated figure is five minutes left untreated will lead to long term effects (brain damage etc.) ... with good quality first aid and/or basic medical attention, you can probably delay this for twenty minutes or so. But a heart attack is something that really needs access to a lot more resources (equipment, pharmaceuticals) than will generally be available on-board.

[SNS3Guppy]

As an example, we now know a Pan with low fuel means that an aircraft MAY have to dip into final reserve fuel and a Mayday means it WILL dip into final reserve fuel. Much clearer for all concerned. Certainly better than "request priority due low fuel" "are you declaring an emergency" "er no but request priority approach" So it all prevents the careless and unecessary declaration of emergencies something I gather you are keen to prevent as well.


Safety of flight is one thing, but we're talking about a sick or unresponsive passenger here. In the US, the standard call for minimum fuel when an emergency condition does not exist but may with any undue delays, is strangely enough, "minimum fuel." A sick passenger is not a threat to the safety of flight. Fuel is a threat to the safety of flight. You see the difference.

Would depend if there was a doc on board and what he said..would fifteen minutes make the difference to fifty?


A doctor is no more capable than any first responder in the absence of oxygen, respiratory equipment, a defibrilator, monitoring equipment, and stabilizing drugs. A doctor could do what you could do; provide forced ventillation and chest compressions. And take a pulse.

Fortunately, many aircraft today are equipped with semi-automatic or automatic electronic defibrilators. Whereas CPR is 80-90% ineffective, a defibrilator brings the chance of survival into the 40% percentile range in the case of a heart attack. In the scenario we're given, however, we don't really have any way of determining what the passenger has; food poisoning, an allergic reaction, a stroke, a heart attack...who knows? We have an unresponsive passenger. Absent the equipment and means to treat the passenger, it's all largely superfluous. The pilot actions remain the same; get somewhere and land in a safe, orderly manner.

A few critics here have spoken their deep offense at my comments regarding panic. Much of my flying career has been in emergency services of one kind or another, and I've seen a lot of pilots take on an "attitude" or sense or urgency when they know an emergency or passenger risk is involved. Sometimes people really do feel as though they should toss the rules to the wind and fly differently because of this new development. I've' seen it time and time again. Many of us wouldn't act differently, and shouldn't. However, I brought it up with good reason.

The drive to turn and land at the departure airport when it's below minimums and the crew isn't trained to fly the approach would be such an example, and therefore is directly relevant.

I believe the commonly stated figure is five minutes ...


Four minutes.

The passenger has three basic life requirements; airway clear, breathing/respiration, and circulation That's the purpose of CPR. However, CPR addresses only the basics of ventillating the patient and circulating blood at a greatly reduced rate. If a heart attack has occured, generally it's because of an incorrect electrical rhythem, and this needs to be evaluated and electrically corrected...hence the need for an AED...which many aircraft have on board now. Todays AED will evaluate the patient's rhythem, determine the course of action and even the value of the shock to be delivered and give aural instructions and warnings, and tell when to shock. Nearly anyone can operate one with minimal training.

[Ashling]

Guppy

I was explaining to you why the UK has gone down the path of getting you to declare an emergency. I fully appreciate the difference between a sick passenger and a fuel emergency. Both however require a calm and reasoned response.

In earlier posts you seemed to allude to a serious medical problem being of no greater consequence than a lost wallet in terms of the attention it would get from you. I do hope I misunderstood you or that you were merely stating something for dramatic impact. A serios medical condition is an emergency a lost wallet is not I hope you appreciate the difference.

[belongins]

I'm no pilot (hopefully CTC training soon though :)) but i have some emergency first responder training specialising in AED of heart patients and i agree with the guy below.
Besides dont ac no carry AEDs on board?


<SNIP>
Are your cabin crew not First Aid and CPR current? Unusual. I thought it was a requirement.

If you were foolish enough to turn back when you were 10 min out, you are also at least 15 minutes away from parking the aeroplane and opening the door to let the paramedic in.

Clean up aircraft, climb to planned cruise level, complete all normal checklists, proceed to destination. Advise ATC that you have a pax needing urgent medical assistance on arrival. Details to follow.

Keep seatbelt sign on. Not all pax will be aware that something unusual is taking place in the cabin, so best not have them bumbling their way to the lavatory.

Let your cabin crew do the job they are trained to do. Give them permission to make a PA asking any medically qualified persons on board to come forward and assist.

If you have more than 50 pax on board, there will be at least one doctor or one nurse on board (I had one heart surgeon, one emergency room doctor, and three nurses out of 65 pax respond to such a request when a young woman had a grand mal seizure aboard last year).

Your hypothetical heart attack victim will need immediate attention. If respiration and circulation are not restored within 3 minutes, that person is in a grave situation.

Dont sit his/her rescuers down for 15 minutes while you attempt an autoland at a below minimums aerodrome. Use your crew and passenger resources.
<SNIP>

[Notso Fantastic]

Mixture, you appear to have a clear reference to what the rule books state, and a lot of computer experience, but you are seriously misled as to what happens in real life out there in practice.
Not really wishing to be drawn into the general debate about turning back vs proceeding to destination that's going on here.....

Suggest some of you re-read CAP 413.

A PAN would probably be justified and appropriate in order to try to get you priority routing and medical assistance on the ground. (ref: definition of "urgency" in CAP413).

Use of MAYDAY for pax emergencies is less clear and probably would be less justified in this scenario.

P.S. I believe you'll also find that PAN and MAYDAY are internationally recognised and should always initiate ICAO prescribed procedures.

You need to understand very few parts of the world have any recognition or knowledge of Pan.

I believe the practice (particularly for the larger NHS wards, such as London) is that if the phone operator is satisfied that your situation is serious enough (as would be the case with a heart attack), they will send out a FRU with an ambulance to follow.

So yes, you will get your ambulance, but the FRU system is the NHS's way to buy themselves more time to find an available ambulance and/or allow the ambulance to fight through traffic (because FRUs are generally just converted cars, they are smaller and more agile than an ambulance).
You are wrong. We were repeatedly told not to request an ambulance 'to meet the aircraft on arrival at London' because we wouldn't get one. I'm not sure where you get your references for such positive statements, but you are seriously misled if you think that is how it is out there in practice! Reading and quoting CAP 413 or the whole Air Navigation Order will get you precisely nowhere. I wouldn't want to sit in Court being sued by relatives and being asked by Learned Counsel 'so Mr. Smith was mortally suffering whilst you were airborne.....and you chose not to even declare an emergency?' What exactly is one to do when Pan is not recognised or known?

Guppy,
Simply telling ATC what you have, what your intentions are, and then getting it done will suffice. Wrong! Maybe in the US in your type of ops. Maybe some other parts of the world. I believe the UK response (and Aus as well from what I have seen) will be simply 'are you declaring an emergency?' Airline ops are different to yours.

[SNS3Guppy]

In earlier posts you seemed to allude to a serious medical problem being of no greater consequence than a lost wallet in terms of the attention it would get from you.


I am not on board as a finder of lost wallets, nor as an EMT...though I've certainly done both. Many years spent as a firefighter and medic, in fact. However, that's not my job...I'm there to fly. No spilt tears for the victim, only thoughts for the airplane and the flight. If you can't operate like that, then you've no business being on board.

Airline ops are different to yours.


Are they? What sort of operation do you suppose it is for which I fly?

Hate to burst your bubble, but it's an airline, operating internationally.

[low n' slow]

Interesting. This is actually a question asked for the Scandinavian Air Ambulance interview if I remember correctly. If you decide to bust minima because of a life threatening medical condition onboard and all other parameters regarding the flight are normal, you're busted and won't get the job.

As for Mayday, PanPan or a request for priority, I'd go with Mayday. That will give you priority and it can allways be downgraded. Nothing in the manual says that a Maday call has to be given in panic, so no reason to make a big thing of it. But it will give you a direct routing as well as a quiet frequency for you to pass your message.

LnS

[Ashling]

Guppy

Sorry cannot agree.

Safety of flight is clearly paramount and you are correct in saying that you must not allow any feelings you may or may not have for a seriously ill passenger to interfere with that. However if you have a medical emergency you cannot simply ignore it or pretend it isn't happening. You deal with it just like any other non normal situation. If you can't handle that then I would say it is you who has no business in the profession if you really want to bandy those less than constructive terms about.

[SNS3Guppy]

However if you have a medical emergency you cannot simply ignore it or pretend it isn't happening.


No one, least of all myself, has spoke of ignoring the situation. Quite the contrary. Perhaps you should re-read.

[Ashling]

Re read. I might say the same to you.

Nowhere have I or almost anyone else suggested you would compromise safety of flight to save the passenger.

[JimGreen]

Any operation, abnormal or emergency, should be rehearsed and enacted such that it doesn't raise your blood pressure, doesn't quicken your pulse, doesn't break a sweat. You're there as a professional, after all. Do things routinely, make the situation as routine as possible. You didn't cause the passener to lose consciousness, you can't be expected to know why he's lost unconsciousness, but you can be expected to fly the airplane.



Guppy....Nicely put..Very Nicely put....

[Capt Pit Bull]

Hmm, this is a balance of probabilities and risks isn't it?

If you've got a very seriously ill passenger, then that extra time to reach medical attention is very likely to substantially reduce their outlook.

I have to say though, my inclination would probably be to continue, for all the reasons other have listed. But I can't go with the 'automatic not even considering my options' method that many are advocating.

Flying airliners has never been about avoiding risks, its about managing them.

Clearly one would never subject the rest of the passengers and crew to a large risk in order to return to the departure airfield.

e.g., lets say you have a 50% chance of spearing in by so doing. Clearly a 50% risk to 100 people is unjustifiable to give the casualty a significantly increased chance.

But what about 1 in a million? Would that be reasonable? In airline terms, 1 in a million would still be radically unsafe (1 in 10^9 being our target.)

What about if both you and your copilot have thousands of hours on type and have flown hundreds of AWOPS approaches, but sadly the last time you were in the sim it went tech 10 minutes before the end of the detail, so you missed the last low vis RTO and therefore are not certified. What about if the other guy has thousands of hours on type with another company, but hasn't got the tick in the box with yours? Such situations are not uncommon.

I take issue with the position that the safety of the flight can not be compromised at all.

You are responsible for the safety of ALL the passengers, not just the healthy ones. Your task is to balance the risks to all involved, and if you can decrease one risk without significantly increasing another you should do so.

Nothwithstanding all that I've just said, unless the lack of qualification is 'administrative' in nature as described above, I *would* certainly be continuing.

As a matter of practicality, and experience (having had passengers keel over several times), as the skipper you are *really* unlikely to get any meaningful diagnosis in the time frame of the scenario listed.

So, in essence, I agree with the majority view, but not for the same reasons.

pb

[SNS3Guppy]

But I can't go with the 'automatic not even considering my options' method that many are advocating.


Nobody, not a soul has advocated not considering one's options. In fact, everyone (myself included) appears in general agreement that if a diversion to a closer field that's above minimums can safely be made, then by all means, do so.

Flying airliners has never been about avoiding risks, its about managing them.


Most absolutely not. Flying, and not just airliners, is about eliminating risks by either opening the back door to make them save, or choosing another route. We go around thunderstorms, rather than picking the lesser of two evils. We carry reserve fuel. We plan for the ability to continue a takeoff or stop safely with powerplant or system failures. We train in simulators because many of the things for which we train can't be done safely in the airplane; we don't accept that risk. We train so that we can safely handle them ultimately in the airplane. We perform preventative inspections and maintenance. We time and life limit components in order to prevent having to wait until they fail or break. We strive to find risk, and eliminate it. It's what we do, and we're paid for our judgement in so doing.

[Capt Pit Bull]

The key word there is 'strive'. You can't eliminate all risks, all you can do is make them safer.

The trouble is that many people consider that 'safety' is a binary condition, with something either being 'safe' or 'unsafe'. In fact, most of the time in aviation or any other safety critical activity we are dealing with very low probability events at the extreme limits of the probability curves.

This is whats meant by managing risks. You often need to elect to take a greater risk in one area in order to reduce a risk in another area. If you always choose the less risk option whenever you have an option, you may 'paint yourself into a corner' vis-a-vis a far riskier situation later.

In order to manage risks you need to have a solid appreciation of the probability of something going wrong compared to the likely severity if it does. If you simply blindly 'follow the book' without understanding why then you're going to be in deep trouble if you ever find yourself in a 'double bind' i.e. a situation where you have no choice but to break a rule, the only choice being which one you break.

None of which is directly relevant to the scenario raised, but rather to point out that flying is inherently 'risky'. The only way to avoid the risks is to not fly.

The logical extension of that is that it is OK to subject your passengers to risk. Clearly this does not mean it is should be done recklessly, but rather in a considered manner based upon sound decision making processes backed up by knowledge and skills.

If you can't accept that, don't let the passengers on the aircraft.

The simple fact is there are many areas of human activity where it is deemed perfectly acceptable to subject a large number of people to a small risk in order to reduce a large risk to a small number of people.

I'm interested in the fact that one poster talks of 'compromising the safety of the flight to save one passenger'.

What do we mean by 'safety of the flight'?

Its about the safety of ALL the people on board.

By pressing on you are *definitely* increasing the risk to one of those passengers. OK, I accept that by turning back you are also incurring a risk (to all of them). There is no 'safe' option, so people shouldn't fool themselves that there is.

As it happens, I agree that almost certainly if you assessed those risks you would correctly decide that the risk of a return was unnacceptable, do to the severe potential consequences.

But I did put forwards what I thought was a perfectly plausable scenario where a crew could be as likely as a qualified crew to be able to complete a low vis approach, even if not certified to do so. I'd like to think that in those circumstances if an administrative 'rule' needed to be broken the crew would have the balls to get on and do it. Don't forget the law explicitly permits such actions.

pb

[Ashling]

Well she is insured for rather a-lot and the weather is below minima's......

You have to take the same action regardless of who it is. That is your professional responsibility.

I always thought you could only bend the rules if safety of flight was compromised or could be. I don't really think a medical emergency would fall into that category. That said I believe Capt Pit Bull has a valid point when he mentions the technicality. Personaly, in this case, I think I'd probably still end up at destination as it would take time for the crew to deal with the problem get assistance from the any medics on board and communicate to me what the outcome was. By that stage the approach to destination would be set up so that would still be quicker than a diversion or airborne return.

Tweak the scenario a bit more so that destination is 2 hours away and by the time the crew have done their bit (you are advised by the heart specialist on board that the passenger will undoubtably expire should he not reach a hospital in the next 40 mins) you are now close to an airfield that is in LVPs and its the only airfield for ages. Bring in Pit Bulls technicality issue (ie I'm LVO qualed in current recent line practise but could not complete my LVP recurrant purely due to a broken sim) and I think that would tip it for me if my F/O agreed.

Blimey I'll now have to go and ask training standards if that decision would have cost me my job.

Would make a very interesting Command Sim Scenario.

[Angels 60]

Assuming everyone here is qualified and or experienced to shoot an approach below SOPS/Legal Minimum, would you take a chance of losing your job to save some anonymous person in back?

[SNS3Guppy]

If one is qualified to fly the approach, then one isn't going to lose one's job; the point is mute.

Regardless, one has no concept of the condition of the person in back, whether they are asleep, dead, unconscious, having an epileptic seizure....why would one jeopardize safety? You don't get to do any "saving." Not even the patient assessment. You don't know that there's anything to save. You have an airplane to fly. You're not there to play here.

Whether your wife is on board or not is irrelevant.

You can dangle all the carrots you like; doesn't change the propriety of good judgement. What if it's your wife? What if you're offered a million dollars? What if? What if?

What if you only consider the safety of flight and accept that no amount of carrot dangling changes a decision made in the interest of safety of flight. Everything else takes a back seat.

[Pugilistic Animus]

Assuming everyone here is qualified and or experienced to shoot an approach below SOPS/Legal Minimum, would you take a chance of losing your job to save some anonymous person in back?

good question--[I feel the hint of sarcasm]---NO!--not necessarily because I'm afraid to lose my job though!

More pilots should read the IAP criteria in TERPs [or PAN-OPS]--to see that DA/DH means exactly that:\

[Angels 60]

Not sure if we technicaly assumed that we had 100 passengers in back, or could we consider just one passenger in the plane having a heart attack.? Maybe this is a reposition flight with someone deadheading, or just flying alone with someone. The issue of weighing the safety of the many vs the one, might not apply at that point.

I have found many times these questions of safety come down to ability as well..we might see someone dangling from a cliff and call him, crazy and unsafe, only to find he's a world class rock climber...and this rock is an easy climb for him.

Pilots experienced with IMC weather and routinely excecuting low approaches might be better qualified to consider this scenario then the crew that is based in Phoenix and just flies regionaly for instance.

[Pugilistic Animus]

Not sure if we technicaly assumed that we had 100 passengers in back, or could we consider just one passenger in the plane having a heart attack.? Maybe this is a reposition flight with someone deadheading, or just flying alone with someone. The issue of weighing the safety of the many vs the one, might not apply at that point.

I have found many times these questions of safety come down to ability as well..we might see someone dangling from a cliff and call him, crazy and unsafe, only to find he's a world class rock climber...and this rock is an easy climb for him.

Pilots experienced with IMC weather and routinely excecuting low approaches might be better qualified to consider this scenario then the crew that is based in Phoenix and just flies regionaly for instance.


Come again:confused::confused::confused:?

[Ashling]

Guppy

You are of course correct re safety of flight however I do think you may well know more about the condition of the patient than you allow for. Certainly I have had medical emergencies with specialist Doctors in the relevant field just happening to be on board so we had an accurate diagnosis. I'd also say that if you are able to get the chap/chapess to help speedily and the medics subsequently say that made a difference then you have indeed done some saveing. Semantics perhaps but the pressure to bend the rules in this situation comes from the crews percieved potential to save a life.

It won't change the decision in this case of course. If your not qualified you can't do it.

[SNS3Guppy]

Semantics perhaps but the pressure to bend the rules in this situation comes from the crews percieved potential to save a life.


No doubt, hence my emphasis in previous posts in this thread that the matter is not one over which to get emotional or excited. One must divorce once's self from any such emotional response, and fly strictly on the basis of what is right for the flight.

One need not weight one against many, nor start number crunching to come to that decision. One should take the same action regardless if no one, one person, or a hundred are sitting in back.

[Angels 60]

Pug- Sorry...let me be more clear...I think if the pilot was very comfortable shooting low approaches, hypotheiticaly that's where he lived, he made his bones in bad weather, he might be more comfortable not feeling this is a safety issue and just shoot the approach...someone from Arizona who hasn't seen a real ILS down to minimums in ten years might be more reluctant to make that choice...

Certainly how safe a flight is, is almost wholy dependent upon the pilot's ability, judgement and actual choices he makes.

[SNS3Guppy]

If the weather is below minimums and below the legal limits for the pilot, then it really doesn't matter how comfortable he feels, or from whence he hails.

Again, leave the emotion and the dangling carrots on the side.

Just departed from an airport below minimums for CAT 1 landings (about CAT II conditions) for a 40 minute flight toward an IMC destination, but ok for CAT I. Aircraft capable of conducting autolands, but crew not certified.


From the original post, we have weather below minimums, and a crew (that's CREW, as in plural) not qualified. That doesn't provide an option to return.

[Ashling]

Guppy

Agreed.

If Angels60 is indeed SSG under cover I rather suspect no amount of rational reasoning will ever convince him.

Now what was it Viper said to Maverick in Top Gun? Something along the lines of "Top Gun rules are there for your safety and the safety of others, they are not flexable and neither am I"

Angels60 if your aircraft is about to fall out of the sky do what you need to bending whatever rule you need to bend to ensure the best outcome but never ever bust minima simply because some people are ill or you have a minor snag.

[Right Way Up]

These grey areas of command are what you ultimately get paid for. I tend to look at it as a balancing of risk. Would I risk the whole aircraft for the life of one person, who may incidentally be suffering from indigestion. No. I don't know the exact figures but I remember seeing some stats which proved that only a small percentage of suspected heart attacks were genuine.

[Angels 60]

Sorry Guppy, I have to respecfully disagree...it's very clear in the FARs that the pilot can deviate from the rules should he deem it neccessary.

For instance: An experienced CAT II pilot who missed his CAT II sim ride by a week might not be 'qualified' but we all know he can excecute the low approach. That condition wouldn't by any strech be considered unsafe, as a week later he would be doing those approaches on a regular basis.

So if he lands the aircraft, having the experience and ability to do so, but some little reg, rule, expiration date doesn't apply to him that day...sure he may be called on the carpet, but someone might live.

It's a judgement call and all SOPS and Rules can't fit all possible aviation scenarios.

[Rananim]

SNS3Guppy,
I am happy that its you and not me that gets to work with SAS ambulance services.Each to his own.If you're experienced in low vis ops but the paperwork isnt in order,then IMO,you are free to make whatever decision you think is best without regard to SOP.It may be that the doc on board advises that a return would be futile,in which case you continue.It is an emergency,albeit a medical one.Judgement over SOP.WE're paid to think like that.

[SNS3Guppy]

SAS ambulance services.


What's a SAS ambulance service?

[Ashling]

I may be corrected by him but I don't think Guppy has any great issue if its a technical breach of the regs such as Pit Bull, 60 etc have mentioned.

A technical breach is clearly very different from doing something for which you are not trained or busting approach minima deliberately even if it is by a foot (eg we do a VOR/DME with a cloudbase 50' below MDA but because its a high MDA and we know the area, GPS etc and the bloke will most likely die if we don't we decide to bust it we decide in this case we can).

I suspect what Guppy is, quite rightly, getting at is that you must not let your natural human concern for the patient cloud your professional judgement and allow yourself to be led into a situation beyond your training, experience and the regs. Our first responsibilty is always to fly the aircraft safely.

[Pugilistic Animus]

C....F....I....T.....1STPL:D:D:D:ok:

A60---did I answer your question?

PA

[SNS3Guppy]

I suspect what Guppy is, quite rightly, getting at is that you must not let your natural human concern for the patient cloud your professional judgement and allow yourself to be led into a situation beyond your training, experience and the regs. Our first responsibilty is always to fly the aircraft safely.


Summed up quite nicely and succinctly, thank you.

[Angels 60]

Couldn't agree more Ashling...one person's 'danger danger Will Robinson' is another person's cake walk.

We have to know our limits and capabilities and judge accordingly. It's nice to see once is a while people put thier egos in check and say ' I don't know' or ' I am not qualified to do that, but I will point you to a guy that is' or ' I wont fly that approach, haven't done a low approach in years'

I have hired guys with this attitude, knowing they are the type to figure out what they don't know vs the guys that think they know everything...the latter usualy get caught at some time unprepared ofcourse...'student's' like myself tend to always seek the truth and be prepared with the answer...

Simply put, I agree with you guys that recognizing, a situation that could be beyond your capabilities, and avoiding it ahead of time is just good judgment. Your putting your ego in check, looking at the big picture, thinking what's best for the passengers, equipment, company...

Very altruistic and profesional.

With regard to going against the group, and saving the day...taking that low approach for instance...99 pilots might not be able to do what one pilot can...as evidenced by some posters in here about certain exceptional pilots in the sim, or accidents that were averted by departing from SOPs and making a non-typical solution to an non-typical problem.

I suspect this makes the other 99 pilots nervous, authorities nervous: With that said one pilot called on the carpet, even after saving the day...get's the dressing down, but get's off, because ultimately he saved lives through outstanding performance....not luck. Too bad the group tends to want to knock him down to thier level, when the end result is he averted a catastrophe...bruised group egos, culture issues, politics vs outstanding individual talent...

[Pugilistic Animus]

and what if the little 'home field doesn't have a hospital nearby for you below min apch??---look up the 'DECIDE model of aeronautical decision making and remake the scenario in a safe rational fashion---there are multiple safe option beside maintaining 250 to 5 to shoot an unstabilized below minimum aprch:=

PA

[pithblot]

A collation of SNS3Guppy’s posts on this thread would be a seriously good primer for a wannabe aeromedical pilot.

I thought that my company’s practice of telling the pilot (single pilot) the distressing nature of a retrieval contributed to unnecessary and unjustified panic among some aircrew.

Ring ring…

”We’ve got a (MED3, MED2), MED1 to Bloggsville a two year old girl has been run over by her father in the family car.” This sort of welcome to night shift never did anything for air safety.


PITHBLOT

[Rananim]

Ashling,
Thank you for helping me interpret what SNS3Guppy is advocating.:cool:
You say:
I may be corrected by him but I don't think Guppy has any great issue if its a technical breach of the regs
But re-read what he actually said:
If the weather is below minimums and below the legal limits for the pilot, then it really doesn't matter how comfortable he feels,

To me that indicates that even in an emergency situation,SNS3Guppy most certainly has an issue with a technical breach of the regs...

You go on to say:
you must not let your natural human concern for the patient cloud your professional judgement and allow yourself to be led into a situation beyond your training, experience and the regs.

If a pilots judgement leads him into a situation that is beyond his training and experience,then it would indeed be poor judgement.If his judgement entails a technical breach of the regs,the same corollary is not necessarily so.As someone said,FAR's entitle the skipper to take what action he deems appropiate in an emergency situation.

Our first responsibilty is always to fly the aircraft safely.
Thank you for clearing that up.Are you implying that a technical breach of the regs in an emergency situation is unsafe?

[SNS3Guppy]

FAR's entitle the skipper to take what action he deems appropiate in an emergency situation.


No, the regulation entitles the PIC to deviate from the regulation only so far as necessary to meet the needs of the emergency. Pilots have been subject to successful enforcement action on numerous occasions for doing exceeding the requirements to meet that emergency. Bear in mind that what takes you moments to decide in flight, the relevant authorities have ample time to review and prosecute later.

Simply because one thinks it's appropriate is not an adequate defense. You had better be right. And those reviewing your actions had better agree with you. You specifically cited the "FAR's," invoking the US regulation. Under US administrative law, you are guilty until proven innocent...your opportunity to explain and defend yourself comes during the appeal process after you have already been violated.

An action may be perfectly legal, but unsafe. An action may be perfectly safe, but not legal.

Unless it is legal AND safe, don't do it.

[Angels 60]

Guppy,

If your worried more about busting a reg then saving a lives, I suggest you reconsider the profession your in.

[SNS3Guppy]

I've spent much of my career in air ambulance and aerial firefighting, as well as other types of emergency services flying, and flying upon which lives and resources depend. Most of the time when I've flown, the call to fly hasn't been put out until a state of emergency exists. I've been called to pick up and move gunshot victims, chainsaw victims, car accident victims. I've been called out of the airplane and into the ambulance to put pressure on spurting blood, to ventilate victims, to administer CPR. I've worked for years on the ground as a firefighter and EMT. My flying back ground is varied, ranging from corporate to airline to agricultural to government.

In that time, I've flown into canyons burning out of control with explosions, fire, severe turbulence, nil visibility, numerous aircraft, a heavy load, minimal performance, and about as much pressure as you can get from those on the ground and in the air to deliver retardant to crews about to be burned over, houses about to be lost, you name it. I've been pressured to pick up patients in unimaginable conditions, and refused when I didn't deem it safe or legal, despite direct threats against my job, my career. I've even been told by an employer that the employer didn't care if I returned, only that I launched in order to show dispatch reliability.

Much of the time I've been on standby, it's been ready to go, sitting under the wing of the airplane with only a few minutes notice to be airborne and enroute. For years and years, with lives depending on the actions and decisions made on a daily, hourly, and minute-by-minute basis.

Something I learned long ago is that when things seem most critical, it's time to sit on your hands, count to ten, and evaluate what you're doing. I learned long ago that someone else's emergency isn't my emergency; if I wouldn't bust minimums without someone being sick, I won't do it with someone sick. If I wouldn't exceed other limitations or regulations without the perceived "emergency," then I wouldn't do it with the emergency. Unless you can divorce yourself from the perceived pressure of the "emergency," then you have no place operating the aircraft for that evolution.

Many moons ago I responded to a secondary school to a report of a student with a seizure. I crewed the ambulance with two women who lived in the small community to which we responded. Both seemed slightly flustered during the call, and were less than decisive or proactive in their treatment and assessment. During the debriefing, they both allowed that they found the situation uncomfortable, as they both knew the boy. They admitted they were unable to function effectively with this emotional attachment. Clearly their own emotional attachment to the situation was a liability to the patient and to the call; if one can't be objective and handle a situation on it's own merits, emergency or not, then one has no business being there.

Legal technicality? Hardly.

Suppose you return to make the approach. You're going to place the patient's alleged safety ahead of the "technicalities" of the regulation. You feel justified because you believe the regulation excuses you from following the regulation, due to your perception of this "emergency." You take the time to return, and fly the approach. Unfortunately, the weather has further deteriorated, and you're unable to complete the approach. Now you've cost the patient more time that could have been spent diverting to a useful alternate, you've placed the flight at risk as well as all the other passengers, you've used up additional fuel that might later be needed (remember, weather is below minimums), and you've broken the regulation...all for naught.

Have you acted professionally? No.

Youv'e acted impetuously, making an emotional judgment when you're paid to be better than that. You've acted foolishly.

I've flown for several companies in which the operations manual specifically addressed patient medical situations and stated flatly that they didn't constitute a safety of flight emergency, nor justify taking emergency action. I agree. One should certainly do what one can within the confines of safety and legality, but a patient's problem doesn't mean all bets are off or anything goes. People see a little blood and panic. People hear a patient is sick and feel pressured. What has changed? A little blood and someone's sick. Not justification making an emotional excursion from professional discretion. Stick to the plan, fly the airplane. Period.

Now, what would you know about someone's life depending on the outcome of your flight?

[Ashling]

Rananim

I agree that if an emergency is serious enough you can deviate from SOP, Regs etc in order to effect a safe outcome. I have said exactly that in an earlier post. However your response must be proportinate to the emergency. I don't have the FAR in front of me but I would be very surprised if you can suddenly do whatever the hell you like just because a fuel pump/generator/passenger has a problem.

A medical emergency does not threaten the safety of the aircraft so it is important that in your response to it you do not allow yourself to compromise safety of flight. So if the "technical breach" is in the order of missed item in the sim due to no fault of yours and you are in current line practise then I see no problem. However if you define a "technical breach" as busting MDA/DA then I do see a very big problem as this situation does not warrent it. Other situations may warrent it but not this one.

[Rananim]

Guppy,
If the chances of survival are not greatly increased by the return option,then the justification(to break the reg) isnt there.Just how you ascertain that in 5 minutes is the problem and in this regard,your argument carries more favor.I never said it was an easy decision to make.All I said was that the decision isnt automatically made for you if the crew are cat 3 experienced but only cat 1 certified.I'm not a doctor but as I understand it,if the patient can be kept alive,the effectiveness of clot-busting drugs is very much time-dependent.
Where is Sudden Winds..he started all this anyways.

[Pugilistic Animus]

Longflights ---

Why do planes use less fuel with aft CoG?


PA

[Brian Abraham]

Pugilistic Animus - I think you will find that Longflights is the latest pseudonym for our old friend ssg, Angels 60, tankdriver45 et al. The folks over at http://www.pprune.org/forums/showthread.php?t=328287 had this to say of him. I wouldn't take any notice of any nonsense he comes up with.
I don't actually believe he's for real. Surely, no-one's that stupid.

Seldom have I heard anyone display the depths of their ignorance with such total conviction. The only downside is that there are others who might believe what he says through their own inexperience. The reasoning behind some of his statements would have made the Monty Python crowd very proud of him. He certainly sounds like he believes them himself and thats scary!

[Pace]

SNS3Guppy

I have never been involved in the sort of work that you have ie ambulance work.

What springs to mind here is the comparison with Doctors or surgeons. They are professionals to and have to be emotionally detached from their patients.
The same goes for the police attending road accidents.

I am sure at the start they are emotionally involved and the sights they see must give them nightmares for days, but then they become more desencitised and more able to get on with their job in the way that they are trained to.

Your work must be the same to a certain extent. Emotional descisions are rarely the correct descisions and the most satisfactory outcome for all is to do your job with a clear head and not muddled by emotional concerns.

Regretfully some you loose but that is life ? and I am sure you will agree with that.

Pace

[Capt Pit Bull]

I infer that there is a body of thought that says a 'return' in this scenario represents a clouded / emotional decision wherein concern for the casualty causes a failure of judgement and the aircraft is put at risk.

What I can't figure out is the apparent viewpoint that the casualties safety is a null factor. We have the viewpoint that you shouldn't even think about a rule violation, even if its safe. Well to my mind thats not 'good' judgement, but rather its an absence of judgement. If anything, its an emotional fear of breaking a rule that is preventing any judgement from being exercised.

I also find it rather difficult to believe that any experienced pilot can honestly say they've never had to choose which of a pair of mutually contradictory rules/SOPs etc they have to break.

Let me restate (as I did in my earlier response) that for almost all circumstances the considered decision in the scenario above would be to continue. But rather, I'm more interested in the general principle, and in any case I'm sure that one could come up with any number of scenarios where the decision was much less clear cut.

My contention is the following:

"It is acceptable to expose a larger number of people to a small risk in order to reduce the risk to a smaller number of people."

In other words I'm saying that the safest course of action is the one that reduces the expected number of fatalities. As such I believe that the well being of the casualty should form a consideration.

Lets take it to extremes. If it genuinely is not acceptable to increase the risk to the flight even slightly, then you shouldn't consider a return even if its CAVOK, on the grounds that the remaining passengers will be subject to 2 takeoffs and 2 landings for a single journey. Take offs and landing accounting for the most accidents, its apparent that we've doubled the risk to the rest of the passengers...

What about if was a 2 hour flight, but with a convenient regional airport 60 miles on the nose. Only snag is it would be a non precision approach. Which of course are statistically far more risky that an ILS....

My point is that there is NO course of action that is less risky than just continuing to the original destination. So, even if there is no need to break any rule, or any minimum, the 'no risk' adherents shouldn't be medically diverting under any circumstance.

We're paid to exercise judgement, not abdicate responsibility.

pb

[SNS3Guppy]

My contention is the following:

"It is acceptable to expose a larger number of people to a small risk in order to reduce the risk to a smaller number of people."


One's purpose in the cockpit is to exercise the judgment necessary to eliminate risk by finding it, identifying it, taking other courses of action, opening a back door to nullify the risk by making it safe, etc. Not accept risk or balance or manage risk. Acceptance of risk is a fallacy that's far too pervasive.

In other words I'm saying that the safest course of action is the one that reduces the expected number of fatalities. As such I believe that the well being of the casualty should form a consideration.


Fatalities?

when one undertakes a flight as a passenger, one knowingly accepts the fact that the flight takes place above the surface of the earth, where access to medical personnel, armed police, friendly bank tellers, and the expectation of religious counseling for personal issues is somewhat removed, nigh impossible in most cases. This is a given. One knows that one may indeed experience a heart attack, or a pulled groin muscle, or a chipped fingernail, and have no way of dealing with it. This is what the passenger accepts with the purchase of a ticket to ride.

One does not undertake a flight as a pilot, nor as a passenger, with the expectation of fatalities, and one does not make a decision based on the number of expected fatalities I do not elect to take an ILS vs. a VOR because one might produce more fatalities than another, and I do not accept a flight to an airport which is illegal or unsafe (such as one below minimums) on the basis of the number of fatalities.

If one would not make that decision without a sick passener one board, one must NOT make that decision with a sick passenger on board. The sick passenger has changed nothing; your mission is to make a professional judgement based on both what is legal and what is safe. An act may be safe, but not legal, and an act may be legal, but not safe. Unless the act is both legal and safe, it's unacceptable. Period.

[Capt Pit Bull]

One's purpose in the cockpit is to exercise the judgment necessary to eliminate risk by finding it, identifying it, taking other courses of action, opening a back door to nullify the risk by making it safe, etc.

I'm not saying that one should accept risks if they are avoidable. What I'm saying is that some risks are unavoidable. In aviation often they are very small, but we are in the business of managing them not pretending they don't exist.

Not accept risk or balance or manage risk. Acceptance of risk is a fallacy that's far too pervasive

Well, apparently not as pervasive as the idea that risks can be totally eliminated.

One does not undertake a flight as a pilot, nor as a passenger, with the expectation of fatalities,

Thats correct - but only because we have made the industry relatively safe, so if you multiply the probability of an accident on your flight by the number of passengers on the aircraft you get an expected number of fatalities that is very small, but not zero.

Although many are purely ticket price driven, there's a sizeable number of people who consider an airlines safety culture when deciding who to fly with. There are certain operators I wouldn't fly with.

In other words, I'm prepared to accept risk (and so is everyone else) but given the choice I'll choose less risky.

Certainly, when procedures are considered, the suggested plans of action are usually based on expert opinion of the balance of risks.

and one does not make a decision based on the number of expected fatalities I do not elect to take an ILS vs. a VOR because one might produce more fatalities than another,

Well, thats exactly my point.

In general, not specific to the original scenario: If the alternative to flying a non precision approach is that a diversion is required, then clearly it would be expected that a professional crew would fly a non precision approach. Statistically, non precision approaches are riskier. But assuming they are properly trained and in current practice, there is no reason why such a course of action should introduce an unnacceptable degree of risk.

What we're saying is that we are prepared to accept slightly more risk (note the risk wasn't zero to start with!) in the name of expediency (i.e. actually getting the passengers to their destination.)

Every aspect of transport safety is about that balance.

when one undertakes a flight as a passenger, one knowingly accepts the fact that the flight takes place above the surface of the earth, where access to medical personnel, armed police, friendly bank tellers, and the expectation of religious counseling for personal issues is somewhat removed, nigh impossible in most cases. This is a given. One knows that one may indeed experience a heart attack, or a pulled groin muscle, or a chipped fingernail, and have no way of dealing with it. This is what the passenger accepts with the purchase of a ticket to ride.

Actually, I think you'll find that passengers accept that there is some risk, but expect you to consider every available option. Please remember I originally said that the course of action was probably to continue, but that I wouldn't rule out a return without considering it. There's no doubt in my mind that personal injury lawyers would have a field day if you assessed a return as have no additional risk but necessitating a breach of CAT3 recency requirements.

Unless the act is both legal and safe, it's unacceptable

In my opinion this is a somewhat naive mindset. It hinges around the idea that the 'rules' cover every eventuality. Well they don't.

What about the situation where the ONLY choices are:

a) riskier but doesn't break a rule.
b) safer but requires a rule is broken.

or worse still:

a) Breaks one rule.
b) Breaks a different rule.

If you aren't in the habit of thinking about risks, and aware of the risk assessments that were considered when making the rules in the first place, then the whole shooting match can come unglued. IMHO those who are not prepared to even consider that they might at some point have to break a rule are more likely to completely lose the plot if they find themselves in a double bind.

Sometimes you just have to go for the lesser of two weevils.

pb

[herman the crab]

May have missed parts as scanned though thread, but...

1. Define heart attack - are we talking cardiac arrest, myocardial infarction or maybe even angina.

2. Things may have changed in past few years but at one time Gatwick had a dedicated paramedic on site, Heathrow had an ambulance and crew satationed there as did Luton and I believe Stanstead were looking at the same system as LGW. I believe most BAA fire crews are also EMT trained...

HTC