Medical emergencies on commercial flights

[Babaleka]

Quite recently I boarded a flight from the Middle East to LHR. I had (now sorted out) an existing medical condition that I thought might cause a problem on the flight so I got clearance from a Doctor who assured me that everything would be OK and I could take the flight . Fortunately the Doctor was right but I must confess to having one or two anxious moments . But that and previous events I have witnessed on commercial flights got me thinking and thus the following questions which I will be grateful for a response to :

1. What circumstances / conditions constitute a medical emergency ?
2. Who makes the decision to either divert to a place where suitable medical care can be given or continue with the flight?
3. Much as I know pilots have places they can divert to in the case of technical emergencies do they have similar locations for medical emergencies.
4. Are there medical conditions passengers have that they should inform the CC of ?

Thanks in advance

[Airbus Girl]

1. What circumstances / conditions constitute a medical emergency ?
If someone's life is in danger then it would be a medical emergency. It is no different in the air or on the ground.

2. Who makes the decision to either divert to a place where suitable medical care can be given or continue with the flight?
Ultimately of course it is the Captain. However many airlines now have contracts with medical providers who they can contact whilst in flight. We can call up on HF and speak to a Dr/ Consultant who can advise us based on the medical information we give to them about the condition of the person on board. They will then advise us as to whether they think it is best to continue or divert, which then guides us the pilots.

3. Much as I know pilots have places they can divert to in the case of technical emergencies do they have similar locations for medical emergencies.
Technical or medical or any other emergency makes no difference. We always have en route and destination alternates available. If we had a choice of a few airports (perhaps whilst in Europe) then if there was time we may be guided to a specific one - never had it happen, but I guess that if there was a passenger with heart problems and we had a choice of landing at an airport near a heart hospital or one further away, and both were suitable airports, then we'd land at the most appropriate one. We would also be guided by company - sometimes an airport is better from a company point of view - for example if in Portugal and we had the choice of Faro or Lisbon we'd go to Faro because we fly there regularly and so handling etc. is all in place should the crew go out of hours etc. plus we would be familiar with the airport, whereas we don't fly to Lisbon.

4. Are there medical conditions passengers have that they should inform the CC of ?
If any passenger has a medical condition that requires a Doctors letter then this should be given to the cabin crew on boarding. It makes sense to tell the cabin crew anyway, because otherwise if you were taken ill during the flight and no-one knew you had a pre-existing condition then you may not get the appropriate treatment.

[wiggy]

3. Much as I know pilots have places they can divert to in the case of technical emergencies do they have similar locations for medical emergencies.

If I may add to Airbus Girl's comprehensive answer, and adding a Longhaul perspective.

The Medical provider will provide guidance as to where to go, and on a longhaul flight that may not be where you would choose to go with a technical problem. For example whilst over the Western Atlantic if you had a technical problem the nearest suitable runway might be at Gander, but the best hospital (as I understand it) might be at St. Johns, so the medical provider may well suggest overflying Gander and going direct to St. John's.

[fincastle84]

I read today of the recent case of a Singapore Airlines pax having a heart attack shortly after take off from SIN-LHR. There was a doctor on board in attendance but the crew refused an en route diversion.

After landing he was rushed to Harefield & although he has survived he has suffered serious permanent damage to his heart muscle, hardly surprising after a 14 hour flight without specialist intensive care.

He is considering legal action.

[PAXboy]

He should consider that he is alive. Many, many people who heart attacks on the ground, within easy reach of medical assistance - do not make it. The movies and TV promote the idea that the team can 'save him' and 'bring him back from the almost dead'. Not as often as people like to think.

[parabellum]

fincastle84 - I have put a post in Jet Blast on the SIN-LHR incident with the BBC reporter. It will have been the medical profession that would have said a diversion was not recommended, there was a doctor in attendance and almost certainly communication to other medical specialists on the ground, the captain would have been guided accordingly. Been in a similar situation myself, as a pilot.

[gatbusdriver]

Many companies use Medlink.

Takes the ball out of the Captains court. It is in some ways a form of insurance We call them with details of the pax medical condition, these details are passed onto a doctor/consultant, and hey presto, they tell you whether you need to divert.

if they get it wrong, it was their call, and as such the company/captain are not held accountable. This generally results in fewer unnecessary diversions, but what they also do is if you need to divert to somewhere with specialist equipment they can tell you where to go. They are also very good for gate screening, because although you may have a fit to fly certificate, they are on occasion, not worth the paper they are written on.

I have had one occasion where we could not contact medlink for whatever reason, but chose to divert anyway as the paddles were out.

[Airbus Girl]

I know nothing about medical things but I keep reading that this person suffered permanent heart muscle damage. Surely everyone who has a heart attack suffers from permanent heart muscle damage, even if they were able to get to a hospital a bit quicker? Even if a diversion had been started as soon as the passenger was diagnosed, it would probably have been at least an hour before he got specialist medical help. Would that have made a difference to his outcome? There was a Dr on board, and I can't believe that the Captain disregarded his opinion if he said a diversion was necessary. Although it looks like in the end it wasn't a life threatening situation, which is usually what we divert for.

[gatbusdriver]

If the airline uses Medlink, whatever they say goes. It doesn't matter what the doc says.

The doc may be a GP, when you speak to medlink you will be in touch with a specialist.

[fincastle84]

The first hour of treatment after a heart attack is critical. Such treatment requires a variety of drugs which wouldn't have been available on the flight. That's why a diversion would probably be advisable. I am in no way attempting to be judgmental of the decision making process both in the aircraft & on the ground.

Obviously I wasn't there & was only reporting what I read. My wife however, works in a major cardiac unit & is horrified by this case.

PS Whilst it's true that in any heart attack there is damage to the heart muscle, the longer that the patient has to wait for specialist treatment, the greater the damage.

[Betty girl]

Babaleka,
To answer your question 4.

Here is a link to a list of conditions, when you do need to inform my airline but if they feel it necessary, they themselves will have already briefed the cabin crew.

Link.... British Airways - Medical information (http://www.britishairways.com/travel/healthmedinfo/public/en_gb)

Click on top option - passenger medical clearance unit and then click on-
Flying after an illness or an operation

I once had a passenger tell me that he was very sore because he had had an operation in his stomach, the day before!!He was wanting some sympathy, which of course I gave him!

However I immediately informed the Captain, for obvious reasons and he was off loaded. Not only was he putting his own life at risk, he could have caused a diversion and unnecessary problems for ALL the other passengers.

[etrang]

Surely everyone who has a heart attack suffers from permanent heart muscle damage,
Not necessarily, and the degree of damage can vary very widely depending on how quickly they get proper treatment.


it would probably have been at least an hour before he got specialist medical help. Would that have made a difference to his outcome?
Its quite possible. Treatment given 1 or 2 hours after a heart attack may well save heart tissue which would otherwise have died 6 or 8 hours later.

[Nicholas49]

Out of pure interest, if there is a doctor on board and the flight crew wish to speak to him/her about a passenger's medical situation, are the rules prohibiting passengers from accessing the flight deck temporarily waived so that s/he can go on the flight deck, speak to the pilots and liaise via Medlink if necessary? Or does the captain have to leave the flight deck to speak to him/her?

I am, obviously, talking about UK-registered airlines to whom those rules apply

[Betty girl]

No, I doubt the rules would be waived because the medical emergency could be a sham, with the entry of the flight deck as the end game.

[TFlyguy]

If the flight crew wished to talk to the doctor it would be via the interphone

[A2QFI]

I understand that the first hour is critical, as I know from events involving a close relative. One could be lucky to get to a suitable medical facility from anywhere in the world during a flight and within an hour, even short finals at LHR.

[parabellum]

requires a variety of drugs which wouldn't have been available on the flight.


I think you will find that the Doctors kit, carried on SIA aircraft, does contain everything necessary to stabilise a patient. This kit can only be opened with the captains authority when he/she is satisfied that there is a doctor/nurse/para medic on board who would know how to use it.

[fincastle84]

It would be interesting to know if that happened in this event. Thanks for the update, that's very reassuring in the event I ever fly SIA.

Does this apply to all airlines?

[wiggy]

fincastle

BA use a similar system.

[Betty girl]

The BA medical kit carries a lot of injections, drugs and equipment that you would usually only find in a hospital.

As mentioned above, if any passenger is a medical practitioner, they will be allowed to use these drugs and talk to Medlink, via the pilots, for their expert advise.

This system saves many lives but please let me assure you, that most airlines would definitely divert if that was in the best interests of the passenger.

[lowcostdolly]

Morning all :)

I wonder if I could offer up an opinion here as a former CC (soon to be again CC) and a currently practicing Registered Nurse with a coronary care/emergency care specialist qualification.



First of all the management of a heart attack. The patients survival (and the quality of it) depends on 4 main factors;

Early recognition
Early basic life support
Early defibrilation (if required)
Early advanced life support (i.e hospital admission)
Medics often refer to the first hour following the onset of a cardiac event as the "golden hour". Get all of the above within that hour and your chances not only of survival but also a good quality of life are increased dramatically.

Many airlines do carry drug kits only used by medical professionals. They do not contain clot busters which are the drugs (amoung others) that save lives in a heart attack. There is a reason for this. The administration of these drugs well really beneficial is also extremely risky and needs specialist monitoring in order to correct the side effects which often occur.....some of these in themselves are lifethreatening. Paramedics are not even allowed to give clot busters on the way to hospital.

With regard to diversions

I worked for a carrier who had no AED on board, a very basic first aid kit no drugs kit at all and no medlink. Even though I am a highly qualified RN my usefulness in medical situationis was limited to advising the flight crew of the need (or not) in my professional opinion of the need for a diversion however the decision ultimately rests with the Captain.

Never in all my time flying have I ever met a Captain who would ignore the advice of a medical professional given in the best interests of a patient whether that advice was given by me or an onboard Doctor.

And diversions don't just happen for the obviously lifethreatening in my experience.......somebody in acute pain due to kidney stones for instance would necessiate a diversion if that pain could not be controlled on board with the resources avilable.

Hope this adds another perspective and clarifies the situation in relation to heart attacks.

[wiggy]

Can I just add the very important caveat that the captain also has to consider his/her duty of care to everybody on board the aircraft, not just the interests of the ill passenger. There are going to be occasions e.g. over Siberia/Northern Canada on a winter's night with perhaps very inclement conditions on the ground, where the safest course of action for the majority of the people on board might be divert to somewhere other than the nearest airport, even if that action delays getting the ill patient on the ground...

[fincastle84]

Agreed Wiggy. However, in this case it was SIN-LHR & the heart attack occurrred shortly after take off.

[Globaliser]

However, in this case it was SIN-LHR & the heart attack occurrred shortly after take off.Or so the press have said. In the absence of comment from either the passenger or the airline. Where have the press got this assertion from, and how reliable is it?

Personally, I'm suspending judgment about all of the facts until much more is known and published (if it ever is).

[lowcostdolly]

Fincastle......I agreed with your wife when I first read this thread. I was horrified that a Captain had apparently acted in this way although I did find it hard to believe given my experiences of flight crew as posted when I have been involved in medical emergencies on board.

I have a professional interest here both as cabin crew and a registered nurse so have done a bit of digging.


Globaliser the passenger has commented. He states the following

The cabin crew "refused to divert"......not their decision whatever the event
That he spent "14 hours in cardiac arrest". He must have been really cold and stiff on arrival at LHR then!!
That he then recieved "life saving surgery" at Harefield. Harefield are mavellous but even their expertise cannot raise the dead!!
And given the fact this passenger is a BBC reporter and the story is covered by the Daily Wail........:suspect:

I agree.....suspend judgement.

[Globaliser]

Globaliser the passenger has commented.Although I know we're agreeing to suspend judgement, the Daily Mail article actually says:-Speaking from his £750,000 home near East Grinstead, West Sussex, where he is resting, Mr Pearson said: ‘I don’t want to talk about it yet. It’s a very delicate situation.’

A BBC source said: ...Obviously, much of the information in the article, both before and after this bit, must have come from the pax himself. But the absence of direct comment from him, quoted verbatim, leaves me unsure about the reliability of the remote reporting which constitutes the bulk of the article.

I can't claim to have followed up every other news channel on this, but most seem to quote the Mail's approach. So we will have to see.

[wiggy]

fincastle.

Agreed wiggy. However, in this case it was SIN-LHR & the heart attack occurrred shortly after take off.

The OP for this thread was asking for information about medical emergencies/diversions in general, I was answering in that context...I must admit I thought the SIA case had been more than adequately covered in Jetblast.

[herman the crab]

Unless things have changed over the past 6 or 7 years suitably trained (UK) paramedics CAN give the clot busters.

HTC

[HEATHROW DIRECTOR]

<<Speaking from his £750,000 home near East Grinstead>>

Aahhh... at least the Daily Wail got the really important information in this case..

[lowcostdolly]

Thank you Herman.....a reminder to me not to be so insular!! ;)

In my county and those surrounding it Paramedics give asprin and GTN only before they blue light a casualty to CCU/A&E.

I've just done a google search and some authorities do train their paramedics to give IV clot busters and I was not aware of this. Staffordshire did a trial on it and it's happening now In Scotland......good thing to IMHO due to the remoteness of some area's up there.

Hopefully there are others although I didn't find them

All paramedics should be trained on this IMHO as they carry monitoring equiptment and drugs which could deal with the reperfusion arrythmia's that frequently occur prior to arrival at a specialised unit.....

I've learnt something today so thank you :ok:

Aplogies Mods for the bit of thread drift on my part! To try and vaguely get back to it I don't ever see clot busters being given onboard an aircraft.....even by a trained Paramedic/Cardiologist.

[Babaleka]

Airbus Girl : Many thanks for your comprehensive response.

Betty Girl : The link is very useful but is does raise one question . It states that "Medical clearance is required"........ What will suffice as Medical Clearance? In my case I saw a Specialist who said that he was "absolutely sure" I would not have any problems but obviously no guarantees. Should Passengers get a letter from a GP / Specialist stating that clearance has been given to fly - by way of proof , and should they declare this to the CC or just keep quiet and hope for the best.

The passenger who told you he had an Op the day before and was very sore was offloaded with good reason as confirmed in the guideline provided in the Link.The Passive Medical Clearance Unit (PMCU) contact details are very useful and there for all of use to use but as a frequent traveller I had never heard of it . With this in mind : I have no idea how often Medical Emergencies occur on flights but if the amount is significant would it be an idea to create an awareness of the PMCU within BA and do other airlines have a similar advice Unit ?

[Nicholas49]

I read someone say on another thread that the cabin must be checked for security reasons if a passenger leaves the aircraft following a diversion before you can depart again for your original destination. Makes perfect sense. But I wanted to ask:

When you divert and park up at the stand, do you have to disembark all the passengers, carry out the security search, then re-embark them? Or can you do it with them on the plane to minimise disruption / the delay?

[Betty girl]

Babalaka,

You just have to advise BA about any condition, as mentioned in the lists, and they advise you what they require from your Doctor or Specialist.

If you have a condition that worries you, waiting until you check-in or get to the aircraft is too late. You need to contact BA prior to travel or your travel agent and they will guide you to the right people in BA, or any other airline, to talk to. I am sure that all our customer service telephone operators are very used to dealing with these enquiries.

Nicholas,

If you diverted because a passenger was critically ill, it is unlikely that all the passengers would have to disembark.

A baggage identification could be done, where cabin crew move through the aircraft asking passengers to identify their own bags and any that are unidentified could be removed but I feel that if it was an unplanned condition such as a heart attack, this would probably be unnecessary. People don't normally plan to have a heart attack or another life threatening illness and it would therefore probably be the Captain who would decide if a check was required or not.

[wowzz]

Having been on a BA flight that had to be diverted to Shannon, due to an medical emergency, I can say that in that particular case the pax were not off-loaded, and our cabin baggage was not screened.

[grimmrad]

If there was a doctor on board he would have advised to divert the plane, believe me - or he made a wrong diagnosis, I have to look that case up. Especially with light of a very long flight I would have asked for an immediate diversion. Even if the patient is fine during a long haul flight complications can come later in the flight and than at a time when you cannot land any more - then what. And, as already has ben pointed out, you want to get everybody with a cardiac problem to the unit asap for further testing and if needed appropriate therapy. I have accompanied patients with unstable angina in a fully equipped ambulance and even there it was not fun.

I attended to several emergencies on BA and LH as a physician (with licenses in the US and Europe), and in the case of BA the captain followed my colleague and my advise to land asap (unfortunately we were in the middle of the atlantic, the next hours were not pleasant). And I was allowed into the flight deck to talk with the pilots and to medlink (who concurred with all our doings), who accidentally called me captain... :E

BTW, LH has a list of doctors who are registered via Miles and More and knows in advance if there is a physician on board - can be pediatrician, cardiologist or obstetrician, who knows. But any of these will have more medical knowledge than the crew and can judge the situation better.

[ThatRedHatGirl]

In addition to the other informationa already raised, for the person asking about equipment onboard...

Emirates also have a monitoring device onboard called a Tempus, basically it will give the CC all relevant information like heart rate, blood oxygen, temperature, etc etc AND this can be relayed to Medlink and appear on a screen in front of them so they can see exactly what is going on with a patient. It has the ability to send video and/or photo so you could take pictures of any injury or what is going on to allow them to better analyse the situation.

Apparently it has saved them millions in unnecessary diversions for suspected heart attacks which were other things. Basically, it takes the "guesswork" out of it and assists them to make the decision to divert or not based on the information gained from the unit. (It is portable and can be used in the cabin without the need for cables, also uses the phone system so they can patch in the dr, the captain etc...) very good system in my opinion, have seen it in use.

Along with this you also obviously have the defibrillator and the medical kit, which has everything needed including the same cardiac medication trays & IV equipment used in hospital. These are meant for qualified professionals only (decided by Medlink of course) who then provide coverage for the professional and the crew should anyone decide to sue later on. If necessary crew can give certain medications ONLY if advised by the Medlink doctors - who are trauma/specialists surgeons etc- but they have to follow instructions exactly and be willing to do it, to be covered.

In many cases, you would probably have more chance of surviving onboard than you would at your lovely yet remote holiday destination!!!!

With regard to medical conditions, it is always best to check with the airline (most large ones have their own doctors/medical departments) as your GP might not be fully aware of possible complications due to air travel. Airline doctors know all of the potential issues that may arise and have seen from their experience so they are probably better equipped to make a final decision on whether you should travel or not. Also, some people get the letter a long time before they travel and anything can happen just prior to the flight. Better to get offloaded and be a few flights behind than to have a diversion right?? :)

Hope this helps to reassure you that you really are looked after on board :)

[herman the crab]

The only downside I saw to Tempus (only had one experience with it) was for anything longish time use was the lack of being able to recharge it or plug it into the aircraft power. And that was only using it for basic BP and pulse oximetery.

HTC