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AmericanFlyer
27th Apr 2018, 05:43
American Airlines sued after passenger who suffered midflight emergency dies - ABC News (http://abcnews.go.com/US/american-airlines-sued-passenger-suffered-midflight-emergency-dies/story?id=54759312)

Buswinker
27th Apr 2018, 06:15
Can’t comment on the rights and wrongs of not diverting but a neither defibrillator that won’t deliver a shock, nor a blood pressure cuff that won’t record a blood pressure, are necessarily faulty. Airlines generally carry AEDs which are only programmed to shock if a shockable rhythm is detected. Pulmonary embolisms generally result in pulseless electrical activity (PEA aka EMD) which is a non shockable rhythm. Ergo the defibrillator quite possibly functioned perfectly in this instance. Similarly a blood pressure cuff will generally not record a blood pressure if the patient does not have a cardiac output

DaveReidUK
27th Apr 2018, 07:38
Can’t comment on the rights and wrongs of not diverting

Regardless of the outcome (which the crew couldn't have been expected to predict at the time), it's going to be difficult to defend a decision to fly on for 90 minutes after a doctor on board has recommended an immediate diversion.

Buswinker
27th Apr 2018, 09:24
Regardless of the outcome (which the crew couldn't have been expected to predict at the time), it's going to be difficult to defend a decision to fly on for 90 minutes after a doctor on board has recommended an immediate diversion.

However...

there’s a reason airlines seem to prefer their ground based medical teams, and in this case I suppose part of the question is what information was being passed on?

i’ve been in a similar situation where there was a doctor on board (hurrah!) unfortunately it rapidly became apparent he was a consultant psychiatrist who hadn’t actually looked after an acutely unwell (medically) patient for 30+ years. Even a good physician will likely not have any aeromedical training and the differences between “down here” and “up there” are not to be sniffed at

i think the way forward is the Lufthansa model, myself. Always strikes me as a bit of leaving it to chance at the moment

wiggy
27th Apr 2018, 10:35
There’s a reason airlines seem to prefer their ground based medical teams...

Agreed, but it will be interesting to see where this case goes (if anywhere).

Our ( and several other) company's medical advisors are specialist ER docs working in a major trauma unit ( they get called to into the mission control side office if we "ring") . They are obviously highly trained in emergency medicine, very experienced, and have at their finger tips access to a breadth of real time info that will not be available to crew or a professional medic on the arcraft. As a result we are cautioned about automatically assuming a doctor on-board is best placed to make a medical decision.

....and like you buswinker we've had instances of well meaning docs voluntering their services and then finding themselves well outside their area of expertise.

herman the crab
28th Apr 2018, 00:43
I won't go into details for obvious reasons but I (a paramedic), got involved with a patient from LAX to LHR. The diagnosis of the ground medic was completely wrong. After consultation with the Captain he chose to accept the view of the person on scene and I understand that the doctor on the ground was rather rude when informed of that decision.

Had I or someone else similarly trained not been there the flight would not have diverted and the passenger would have died somewhere off the eastern seaboard of the USA. We were on the ground and he was in an ambulance in under an hour and in surgery within another hour. Doctors gave him maybe that time plus a little had I not been there and started emergency treatment.

The crew could not be faulted in what they did or passed to the ground Doctor. But they weren't nor is there any reason to expect them to, be asking the right differential questions to determine the miss diagnosis. Seeing a patient tells so much.

As for defrubilators... Great for what they're designed for if used early. As stated above not every cardiac arrest is a suitable use. In almost 15 years on the road operationally I can count on 1 hand the number of patients who left hospital to return to normal life..

HTC.

wiggy
28th Apr 2018, 07:50
I won't go into details for obvious reasons but I (a paramedic), got involved with a patient from LAX to LHR.

The fact you were a paramedic was probably pivotal.....not everybody that offers their services has those specific skills.

That’s why I think it would be unwise to rush to criticise a crew simply on the basis they ignored a onboard doctor’s advice.

ExXB
28th Apr 2018, 12:56
Would not the onboard doctor have talked to the onground doctor?

DaveReidUK
28th Apr 2018, 14:09
Would not the onboard doctor have talked to the onground doctor?

There's no mention of that in the reports.

According to the lawsuit, about 30 minutes after the doctor had told the flight attendants that in her view an emergency landing was required, she was asked to come to the flight deck to talk to the captain. At that point they were about 90 minutes out from DFW. The captain again declined to divert. Five minutes later, the patient's heart and breathing stopped.

GrahamO
28th Apr 2018, 15:58
Defibrillators will not deliver a shock if the patient has no heartbeat.

Not a lot of people evidently appear tp know that. You use CPR to get the heart moving and the defib unit decides itself, based upon the electrical signals it gets from the pads, whether a shock is appropriate.

Its not something that the user decides unless they are in a hospital.

herman the crab
28th Apr 2018, 22:35
The fact you were a paramedic was probably pivotal.....not everybody that offers their services has those specific skills.

That’s why I think it would be unwise to rush to criticise a crew simply on the basis they ignored a onboard doctor’s advice.

Indeed, the fact the airline involved had excellent onboard medical equipment helped. It was the second time I'd treated someone on one of their flights so knew what to expect. The crew had passed the information asked for accurately but the dr not seeing the patient didn't push for a better history or get that "oh f&[email protected] this guy is going to die" feeling as they met him!

Sh1t happens wherever you are, same could have happened on a river boat trip... We also aren't party to what the onboard dr actual explained to the crew. In my case I was told that the responsibility to divert wasn't mine to worry about but did I think we should continue. I explained my reasons why I thought we needed to be on the ground ASAP and was told that's all we need to hear.

HTC

herman the crab
28th Apr 2018, 22:37
Would not the onboard doctor have talked to the onground doctor?

In my case, 9/11 was still fairly recent and I was told I couldn't enter the cockpit to do that (UK airline), but they would ask or pass on anything I wanted..

HTC

herman the crab
28th Apr 2018, 22:49
Defibrillators will not deliver a shock if the patient has no heartbeat.

Not a lot of people evidently appear tp know that. You use CPR to get the heart moving and the defib unit decides itself, based upon the electrical signals it gets from the pads, whether a shock is appropriate.

Its not something that the user decides unless they are in a hospital.

No!

The the idea of a defibrillator is to stun the heart from an electrical rhythm that is not allowing the heart to contract rhythmically to pump blood, in the hope the heart will restore its normal pumping function. A person with a heartbeat does not need defibrillating. (Excepting in hospital treatment used to correct rythmn errors).

CPR is an attempt to keep (predominantly), the brain supplied with oxygen. There are rare occasions that the physical force of CPR could get things started, Google 'precordial thump'. It's to give the patient a better chance of survival when a defib arrives.

There are plenty of first responders, paramedics, EMT, nurses, doctors, etc. that can make the decision to defribrilate based on experience, training and the incident. The public access automatic defibrillators are designed to remove that despise on making away from the user so that anyone who can follow simple instructions can use them.

HTC

PAXboy
28th Apr 2018, 23:49
It is never possible to know how it was when we were not there but, it is possible that, the family naturally think that 'had something been done' then the person would be alive. It has been stated in the UK that modern TV medical 'dramas' over emphasise the possibility of recovering from heart attack. The scenes of a person receiving multiple 'shocks' leading to the triumphant "We got him back" are at crushing variance with real life. As others have pointed out, "You cannot shock a flat-line" Other conditions such as pulmonary embolism (and other embolism) are also very hard to detact under such difficult conditions as this case.

I searched the general question: what percentage survive heart attack?
Here is the first answer listed and it is from the US Science Daily. (https://www.sciencedaily.com/releases/2015/06/150630135103.htm)
Date: June 30, 2015
Source: National Academy of Sciences
[headline] Cardiac survival rates around 6 percent for those occurring outside of a hospital

Summary: Cardiac arrest strikes almost 600,000 people each year, killing the vast majority of those individuals, says a new report. Following a cardiac arrest, each minute without treatment decreases the likelihood of surviving without disability, and survival rates depend greatly on where the cardiac arrest occurs, said the committee that carried out the study and wrote the report.
Please search for more.

So, the fact that the event took place in the air already makes a good outcome much less likely. herman the crab summed it up when discussing heart attack (please correct me if I have misunderstood): In almost 15 years on the road operationally I can count on 1 hand the number of patients who left hospital to return to normal life..

I have worked in a specialised part of the funeral trade for 27 years (part time now full time) and I have heard stories of death across all those years ranging from Stillbirth to aged 104. Most people who experience a cardiac arrest - do not make it. There can be mild attacks that are sufficient to get the person to a hospital and then they are OK. Some survive the first attack but have a second one within 48/72 hours that then kills them - even if in hospital. (Notably, Ms Carrie Fisher who died four days after a cardiac event whilst trans-Atlantic)

I shall not diverge into commenting on the many other ways that people can be (apparently) fine one minute and very much not fine within minutes and, often dead within the hour. Usually, the post mortem will reveal whether the outcome was always likely to be death by seeing the damage that was done. However, families that have suffered unexpected death (from whatever cause) often flail around for any scrap of hope or other cause. I have known families who are raging about medical incompetance but the PM reveals a condition that had advanced to a considerable degree - without materially affecting the person's life - until it reached a critical moment.

I was once talking with a mature woman shop assistant - at the very moment that (I learnt later) a slowly growing brain tumour impinged on her and she was unable to speak or move within the blink of an eye. I helped carry her to the sick bay. She did not live many weeks longer.

Humans need to know certainties and if one is not to hand, they will seek them wherever they can. But death is often accompanied by wide un-certitued and questions that do not have answer.

Buswinker
29th Apr 2018, 01:33
Please for the love of god can people stop using the terms “heart attack” and “cardiac arrest” interchangeably

they are not the some condition!!

S.o.S.
29th Apr 2018, 03:44
Buswinker Rather than harangue people for not knowing what you know, perhaps you could share your knowledge and help those who visit this 'cabin' to be as clever as you?

MarcK
29th Apr 2018, 05:37
No!

The the idea of a defibrillator is to stun the heart from an electrical rhythm that is not allowing the heart to contract rhythmically to pump blood, in the hope the heart will restore its normal pumping function. A person with a heartbeat does not need defibrillating. (Excepting in hospital treatment used to correct rythmn errors).
...
There are plenty of first responders, paramedics, EMT, nurses, doctors, etc. that can make the decision to defribrilate based on experience, training and the incident. The public access automatic defibrillators are designed to remove that despise on making away from the user so that anyone who can follow simple instructions can use them.

HTC
And here I was, thinking you are a real paramedic. You don't shock if there is no heart activity at all (flatline). Just VFib and VTach.

Buswinker
29th Apr 2018, 06:38
Sorry it’s a long term whinge of mine primarily driven by the press using the terms interchangeably...

but in the same way that aviation terms (conflating Trent engine issues with “all dreamliners” being a current prime example) are misused, terms ARE important and go some way to explaining why the general public has such a lack of understanding of what we all do

Now that I can post links this one explains it a lot better than I can!!

Cardiac Arrest vs. Heart Attack (http://cpr.heart.org/AHAECC/CPRAndECC/AboutCPRFirstAid/CardiacArrestvsHeartAttack/UCM_473213_Cardiac-Arrest-vs-Heart-Attack.jsp)

Piltdown Man
29th Apr 2018, 08:43
It is very easy to critise the crew after the event and take the side of the plaintiffs which in essence appears to be “If only the plane had diverted then this lady would have lived”. A rough look at the facts suggests if they took a direct route, the aircraft was in the vicinity of Abilene, some 300 miles from Dallas, possibly 20 minutes closer to the destination when the decision to continue was made. Abilene has a population of 120,000 and presumably a medical care system appropriate for a city of that size. The doctor onboard is unlikely to have known where they were. Therefore they would have been unaware of the time it would take to reach any alternate or the level of support that could be offered once on the ground. It is quite possible that a more southerly route over Mexico could also have been flown. We do not know how the doctor on onboard was qualified. We also do not know what conversations took place between the aircraft and medical advice centre on the ground. We also do not know what part if any, the locked cockpit door policy played in the death. Then the big question, assuming the aircraft landed possibly 20 minutes earlier, would this lady have had a better outcome? So providing at least all of these items are discussed in court, justice will not be served.

PM

wiggy
29th Apr 2018, 09:01
Well said PM.

Sometimes the moving map has a lot to answer for - the obvious nearest airport on the map might be closed ( I’ve had that one...closed due snow) or it might not offer suitable facilities for the casualty and a better option might be overflight to a more distant airport (Gander vs. St Johns is a classic case ) and that is something the medics on the ground are far better equipped to assess than anybody on the aircraft.

DaveReidUK
29th Apr 2018, 09:19
A rough look at the facts suggests if they took a direct route, the aircraft was in the vicinity of Abilene, some 300 miles from Dallas, possibly 20 minutes closer to the destination when the decision to continue was made.

What is your source ?

You may be right, but the lawsuit appear to be based on the doctor's first request for a diversion being about two hours before landing at DFW.

herman the crab
29th Apr 2018, 11:14
And here I was, thinking you are a real paramedic. You don't shock if there is no heart activity at all (flatline). Just VFib and VTach.

i am a real paramedic and you may check the HPC register if you are polite enough to PM for my details. I would suggest you erred what I wrote too.

I am aware that you do not shock asystole (rarely flat-line in the true sense of the words - but you know that of course?), but given the poster's gross misunderstanding already I didn't think going into specific cardiac rhythms was appropriate.

HTC.

GrahamO
29th Apr 2018, 11:33
I am aware that you do not shock asystole (rarely flat-line in the true sense of the words - but you know that of course?), but given the poster's gross misunderstanding already I didn't think going into specific cardiac rhythms was appropriate.

So when you shouted NO, to my post, you in fact mean YES !

A defib will not shock a non-moving heart back into life.

Given the report said that the uninformed passenger said the the defib 'did not work' can you not understand that it is more likely the defib was working but had made the informed choice to not shock what was already not working ? Its entirely appropriate to go into specific cardiac rhythms as its entirely appropriate - by reading your post you come across as if stating that a defib will always fire - it will not. I know you know the right answer but your reponse was factually incorrect.

I asked a local A&E Nurse who was in the office for doing training for our aircraft maintenance guys and they confirmed exactly what I posted - a defib unit will choose not to fire unless there is something there to correct. You as a professional will have access and are trusted with the full version of the units but us mere untrained mortals will be relying on commercial units which again, will diagnose and if not finding electrical activity will not fire.

PAXboy
29th Apr 2018, 12:29
The Automated External Defibrillator (AED) has indicator LEDs to give status. So that, it will report if it does not need to fire as there is no shockable rythem. In the heat of things, the untrained may not have read the indicators correctly and so thought it was not working. Again, I suggest, TV medical dramas have something to answer for.

PAXboy
30th Apr 2018, 17:22
I plead this as related thread drift.

Today I was sent an article link by my sister in law, who is a professional swimming coach and runs a swimming school. The title is: Drowning Doesn't Look Like Drowning. It carries the specific criticism:
Drowning is almost always a deceptively quiet event. The waving, splashing and yelling that dramatic conditioning (television) prepares us to look for is rarely seen in real life.
I commend the article to you for safety in the sea/water. It is short and to the point about how people, mostly, drown silently - but television and films have told us the polar opposite. Soundings On Line (https://www.soundingsonline.com/voices/drowning-doesnt-look-like-drowning)

Piltdown Man
30th Apr 2018, 18:56
DR - Fair comment. I was working with the quote from the ABC article where it said "The flight crew, after again consulting the on-call physician not on board, decided to continue to Dallas with about 45 minutes left until arrival..." and an assumption of a groundspeed close to 500 kts. But on second thoughts this would place them (assuming a route inside US airspace) in the area of the Texas/New Mexico boarder. Again, using this article, this unpleasant episode started over Arizona in the region of Phoenix. But if the flight went through Mexican airspace, their options were even fewer. What I had not realised is the how little there is in this part of the world. There's a lot of and not much else.

PM