Medical emergency = PAN?

[brockenspectre]

I am not sure if this should be posted here or in Questions but I am sure someone will move the thread if it is not appropriate.

Someone was telling me that these days, under new rules, if a pax has has a medical emergency in flight, the aircraft has to declare PAN to get an ambulance to attend the airport/aircraft? Is this the case generally, in the UK, and why??? surely a PAN is a declaration of a situation that might lead to an aviation emergency (when a full MAYDAY would be declared)?

If it is the case there is definitely something wrong, IMHO, what does anyone else think?

:)

[TwinNDB]

A medical emergencey does justify the use of a PAN call so does seeing a vessel in distress at sea etc.

Obviously wether you do declare one or not is at the discretion of the Captain since the information could be conveyed without the use of such a call

Twin

[HEATHROW DIRECTOR]

The MAYDAY and PAN calls are used to indicate to ATC that assistance is required and UK controllers respond to such calls appropriately. If a pilot simply indicates to ATC that he requires priority for medical reasons we are required to ask if he is declaring an emergency. If he does not then we are not required to take any action. In reality, if someone tells us they have a sick PAX we don't muck about; we get him in fast.

Ambulances are called as in any emergency situation, usually by the operating company but sometimes by ATC if necessary.

[Michael111]

HI

A bit of useless information:-)

I am a licenced user of Marine radio and we also use the prefix of Maday and Pan to alert the Coastguard / Harbour authority in the case of an emergency. If the emergency is of a medical nature we transmit "PAN MEDICO" 3 times before relaying the exact nature of the problem.

Regards

Michael

[DrSyn]

Actually, brockenspectre, you've raised a very pertinent point although, sadly, a small response so far. Just to recap, the CAP413 (UK RT document) states:

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

So current practice, as stated by TwinNDB and HD, is quite correct of course. However, I am fascinated by Michael111's contribution on maritime procedure.

I think it would be reasonable to suggest that the technical reliability of modern aircraft has improved rather more rapidly, in recent years, than that of its typical occupants - especially those with a high mileage! Additionally, the law of averages almost demands a probability on larger aircraft that someone will "have a turn". Although I have no idea of the statistics, I wouldn't mind betting that medical diversions or incidents outnumber the tech ones these days - or darned close.

Anyone who has done this job for a while, especially on longer trips, who has not had a medical problem on board would surely be considered to have had a charmed life. ATC mates have been nagging us for years to overcome the almost ingrained reluctance of pilots to use MAYDAY pr PAN in a timely fashion. The aero-psychos tell us it's something to do with public admission of defeat, not in full control of the situation, etc. All no doubt true.

It strikes me that the inclusion of PAN MEDICO in the aeronautical vocabulary would be a really useful improvement. One that pilots would be less averse to using, as in, "Hey, we're OK but it's this guy down the back, you see!"

More practically, it could cut down on unnecessary chat and get the medics on the move at (chosen) destination. Lets face it, they don't have a different set of specialists ready to deal with each condition that crops up on board. Anyone else feel like adding an opinion on this?

[HEATHROW DIRECTOR]

Medical emergencies far exceed those of a "mechanical" nature. Rarely a day goes by at Heathrow without one or more.

I think the thread also brings to question the need for any sort of magic code word nowadays. Given that current R/T comms are better than a telephone, a plain language message from the crew should suffice. If someone says to me "We have a sick passenger with a possible heart attack" I don't really need him to do the "PAN, PAN, PAN" bit! Equally, if he says "three of my four engines have flamed out" I don't go back and say "If you are declaring an emergency will you kindly prefix your call with 'Mayday'" Maybe in centuries to come it will all change?

[Air Bus Driver]

Very interesting topic indeed!

At SWR we were taught, that we always should use the mayday-prefix to declare an emergency, as it creates probably the most attention! Especially on crwoded frequencies, where ppl (pilots & controllers) have their finger ready to push the mic-butten, just waiting for the gap in the previous transmission, a "mayday, mayday, mayday" will let everyone shut up at once!

Also, this way atc's "station calling, say again!" can most probably be avoided, as the controller, e.g. if co-ordinating with an other sector, will be more alerted by the emergency code than by a "text-only" message...

Cheers, ABD

[brockenspectre]

Thanks for the replies so far - PAN MEDICO sounds like an idea!

I still am uncertain whether the "no ambulance will turnout if PAN is not declared" is true though?

:D

[Captain Stable]

Interesting thread. I agree whole-heartedly with Dr Syn, and with Air Bus Driver regarding the use of the phraseology.

HD, I have to disagree with your second post. You appear (correct me if I'm wrong) to have fallen into the trap of thinking that R/T transmissions from aircraft are communications to you. That's correct, but not entirely. I know that MATS (and ICAO procedures) do not assume that crews listen to the transmissions of other aircraft, but this is a bad mistake (and one into which the French fell over their failed experiment in using Aeronautical English at CDG). Aircraft crews obtain an extraordinarily high proportion of their situational awareness from transmissions to and from other aircraft.

Use of either "Pan Pan" or "Mayday" will very rapidly relax all those fingers straining to push their respective PTT switches as soon as they can get a word in edgeways.

For this reason, if for no other, I would strongly advocate the use of the term.

Furthermore, where Ops Frequencies are often congested with people ordering bar uplifts, discussing schedule changes etc. etc., it may not be easy to get handling agents to order an ambulance to meet us on arrival on the ramp. The less bright among them will often have ordered an ambilift instead. If we can't get through to them, we know we can to you. Consider it a backhanded compliment - we trust you (most of the time ;))!

PS brokenspectre - the answer to your question is no - an ambulance will turn out if requested, and the relative urgency gets through to the ambulance operators.

[PPRuNe Radar]

To add something .... all ATC really want to know is do you have a problem up there ... and if so,... how urgent is it before you require assistance ??

Most 'medical emergencies' I seem to see overfly numerous facilities with top class medical facilities before they choose to land exactly where they originally intended to............. why ?? If the pax are that seriously in danger of losing life then surely a lengthy transit ain't going to help too much :rolleyes:

Unless you tell me otherwise.

[Captain Stable]

PPRuNe Radar, in many cases it is of no time benefit to land short of destination. It can, of course, be very uncomfortable for the passengers (especially the one who's ill) to stuff the nose down to bring it in at, say, PIK instead of LHR when coming on from across the pond with a passenger who's only just been taken severely ill.

You do, however, want to be assured that you'll get priority routing to destination.

Often, there is considerable discussion going on between the cabin crew and the flight crew concerning the passenger's state, as well as between the aircraft and, say, a company doctor, monitoring the passenger, taking advice on what options are open, whether the passenger should be put on the ground at first possible opportunity or whether he can hold on for the extra 20 minutes, (generally the case), balancing all this risk against the extra cost of a diversion, etc. etc.

I have never heard of a crew declaring a spurious "passenger illness" to get in faster. If any ATCO is ever suspicious that they may have been taken for a ride, you can, of course, phone the company's ops department. Any pilot trying that on would get very short shrift indeed in any company for which I've worked (well, except one, and that's another story :D).

[Spitoon]

OK, this is the UK perspective 'cos I don't have much experience of what happens elsewhere.

DrSyn has given the book definitions. As far as I know PAN MEDICO is not aviation phraseology - that is, ICAO doesn't recognise it - so it would be unwise to start using it in just a few odd countries. You could campaign for it to be adopted by ICAO but really it doesn't offer very much extra information. A PAN call says 'I've got a fairly urgent problem' - and ATC will want to know a bit more so that they can best deal with you. A PAN MEDICO call would say 'I've got a fairly urgent problem because someone's not well' - and ATC would want to know a bit more so that they can best deal with you.

In practice HD is spot on - although a PAN call is usually going to be the textbook answer, the important thing is to tell ATC what the problem is. If you say you've got a medical emergency, whether you prefix it with PAN or not, ATC will give you priority handling - whatever you say you want, rapid descent, diversion, gentle turns, slow descent or whatever, you'll get it as soon as it's possible. In almost every case ATC will call an ambulance (or notify someone else who will), but there's no guarantee - it all depends on what the Aerodrome Emergency Orders say. If you can't get through to your handling agent or you want to be sure an ambulance has been called, ask.

If you're operating somewhere where English is not the only language used on the RT then yes, making a PAN call is both textbook and going to get attention. A MAYDAY call is probably not the correct answer because the standard respose is for ATC to impose RT silence on everyone else which is not going to be necessary in this circumstance.

[ShyTorque]

Some years back I was learning to fly the mighty Wessex at the RAF school of Air Traffic Control.

On my first night circuit I suffered a hydraulic failure so I called "*** PAN, PAN, PAN, hydraulic failure, request runway 36 for immediate landing!"etc.

The answer came back from ATC "Aircraft calling PAN - wait out. Callsign calling for rejoin - say again details?"

My instructor to ATC "We didn't say practice, you know!"

ATC: " Oh, in that case clear to land!"

Ah, yes, the school of excellence :)

Sorry, that was off topic. I think that PAN is sufficient to alert ATC, followed by an explanation of the problem when asked to pass details. An ambulance can always be requested by the crew to meet the a/c.

[bernaise]

Why not use MED 1 or MED 2 as we have in Oz?

MED 1: An aircraft proceeding to pick-up or is carrying a severely ill patient on whom life support measures are taken.

MED 2: An aircraft proceeding to pick-up medical personnel and / or equipment urgently required for the transport of a MED 1 patient, or returning urgently required medical personnel and / or equipment at the termination of a MED 1 flight.

[Fr O'Blivien]

It may be an ICAO procedure but I believe that PAN is neither used nor recognised in many, if not most countries around the world. Shout PAN in Spain or the USA and they wont know what youre on about...

We are drilled here in the UK on its use but seldon seem to acknowledge that it may not work elsewhere.

Can anyone suggest places where it does and doesnt work?

[jetfour]

By the by; the use of 'Pan Pan Medico' in maritime transmissions is to enable shore based coastguards and port operations agencies to understand that you have a medical emergency requiring that a doctor is sought to talk to you in your language, or one common to you both. Unlike the aviation world there is no standard 'language of the sea.' There are many areas of the world where 'day no speakadee inglish, de chinese, de espagnol, de francais etc... So these words get the attention of the operator (hopefully) and he/she has a standard list of actions to get you the medical advice you require. This service is essential for ships that may be many hours (days!) from helecopter or lifeboat support.

I think that aviation has a different set of problems, mostly to do with time, but if the use of this call were internationally promulgated then there are situations were it could help expedite matters.

[brockenspectre]

It hadn't occurred to me that PAN is not internationally recognised, and that some countries might think you are asking for bread!!

Surely to have an international aviation standard call for a medical emergency would obviate unnecessary chat on air like:

ATC: ABC123 descend FL260
ABC123: descending FL260 ABC123..oh..by the way...we are declaring a medical emergency
ATC: are you declaring an emergency?
ABC123: a passenger is having difficulty breathing but hanging in there so we would like to get on the ground quickly ABC123
ATC: so are you declaring an emergency, that is how you can come in ahead of everyone else
ABC123: oh in that case..yes..let's make it an official emergency ABC123
ATC: do you wish us to arrange for an ambulance ........

Instead it could have been:

ATC: ABC123 descend FL260
ABC123: descending FL260 declaring PAN MEDICO (or other phrase - any suggestions for this? )ABC123
ATC: ABC123 PAN MEDICO acknowledged, an ambulance will be arranged

Given that folks agree that the majority of PAN calls these days are for medical problems, Dr Syn quite rightly highlighted the age and potential infirmity of many travelling, how can the radio/calls be updated in line with reality?

:) :cool:

[5milesbaby]

If an aircraft calling Swanwick says it has a medical emergency, 90% will take that as read, however, there are some who will ask if you're declairing a PAN. PAN is the official word used just to make sure you're not pulling a fast one to get in first, due to both ATC and flight crew having forms to fill in. We are also trained to ask if an ambulance is required and any extras needed, we do not sort this out as a matter of course.

I do find it ironic how many aircraft wait to their first transmission with UK control, rather than declare with, in my area, the French. I except that this is purely down to that conveying the message in english to english is much easier. Thumbs up to the Speedy pilot into KK about a month ago who came in first transmission with PAN, message, and intentions, plus ambulance etc arranged, just requesting direct route. All I had to say was 'PAN acknowledged, direct 12 mile final, descend when ready FL150, no speed restriction.' and then later 'contact....' Makes it so much easier!!!

[Frequent SLF]

I hesitate to poke my nose in to a procedural area in which my professional competence is open to question, but I happened to be browsing through Annex 10 to the ICAO Convention last night (as one does to combat insomnia) and found the following in Volume II, Chapter 5. It seems that the "medical" term has already been assigned.



5.3.3.4 Action by an aircraft used for medical transports

5.3.3.4.1 The use of the signal described in 5.3.3.4.2 shall indicate that the message which follows concerns a protected medical transport pursuant to the 1949 Geneva Conventions and Additional Protocols.

5.3.3.4.2 For the purpose of announcing and identifying aircraft used for medical transports, a transmission of the radiotelephony urgency signal PAN PAN, preferably spoken three times, and each word of the group pronounced as the French word “panne”, shall be followed by the radiotelephony signal for medical transports MAY-DEE-CAL, pronounced as in the French “médical”. The use of the signals described above indicates that the message which follows concerns a protected medical transport.

I suspect that this probably originates in the ITU Radio Regulations which also cover maritime rtf. Maybe the use of PAN PAN MEDICO could cause some real confusion here

[ORAC]

Well if a pilot or a controller in the USA doen't know what PAN means, they should have their licence revoked. because they are in the FAA Aeronautical Information Manual.

FAA (http://www.faa.gov/atpubs/aim/Chap6/aim0603.html)

[Hew Jampton]

Well done to Frequent SLF for finding that information tucked away, but I would think that it refers more to Red Cross flights, air ambulances etc ("medical transports") with premeditated requirements for expeditious handling, rather than a medical emergency on a 'normal' flight.

PAN PAN MEDICO/MAY-DEE-CAL has been looked at in the UK but the feeling seems to be that the aircraft making a straight PAN PAN call and including in the first call a brief statement of the problem will do the trick, and the MEDICO etc doesn't add anything to the picture, except another (superfluous) term and category.

[HEATHROW DIRECTOR]

Very interesting... We get a fair few "ambulance" and "medical emergency" flights into Heathrow and I've yet to hear one of the ambulance variety mention the word PAN. Flight plan info states "ambulance", or something similar, but half the time they are positioning flights with just a pilot aboard! A good number of commercial airline flights are also flagged as ambulance flights but never say anything on the R/T.