Death on EK flight 5th June 2010
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Very good points four golds, the TRI should be ashamed. What happened to common sense... think if it were you having a jammer or passed out in the cabin during pushback? Time for a phone call and fill out some paperwork?
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The TRI is wrong--where does it say, in writing, that we should stop EVRYTHING else and call medlink??? Medlink is a tool to be used and, as always, if life is at stake the commander can use all the tools at his disposal.
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Absolutely agree that the TRI is an @rse.... Had a heart attack passenger last year on push back in Dubai. Easily dealt with by taxiing straight back onto stand and the paramedics were there waiting having been requested through ATC.... He survived...
On your point 411a I fully agree....
On your point 411a I fully agree....
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Agreed in triplicate!
TRI's that come out with drivel like that should be treated with "O.I.C", and then completely ignored!
Airmanship AND common sense should always prevail!
I wander if it was the same one that said to me before my upgrade that ONLY the dispatcher has the authority to off load a PAX while the doors are open....
Talk about a major misinterpretation of the Commanders' duties, responsibilities and AUTHORITY.
I do dispare with some of the inexperienced 'Rocket Scientists' hiding behind the FOM in our training department at times.
TRI's that come out with drivel like that should be treated with "O.I.C", and then completely ignored!
Airmanship AND common sense should always prevail!
I wander if it was the same one that said to me before my upgrade that ONLY the dispatcher has the authority to off load a PAX while the doors are open....
Talk about a major misinterpretation of the Commanders' duties, responsibilities and AUTHORITY.I do dispare with some of the inexperienced 'Rocket Scientists' hiding behind the FOM in our training department at times.
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I don't know about the specific incident in question, but it's not the first time someone has died on board, nor will it be the last.
If a PA was made for a medical pro to step forward, be it on a plane or anywhere else, I'd have my Paramedic ID in my hand and ready to show before I got anywhere near the scene.
Any MD on board who comes forward has to identify themselves, just as they would in any other incident, especially if they are going to take over from someone already tasked with providing first aid. A business card will do, a passport with a work visa (like the UAE) in it will also identify someone as a medical pro. (In a pinch medlink can be used to identify someone, but this takes far too long).
Any doctor or other pro who takes over without providing ID is leaving themselves wide open for all sorts of litigation, and they know it. These days, most medical pros will keep their heads down and try and avoid any impromptu medical work because of this.
On the other hand, I've seen Walter Mittys stepping in to the breach, loudly declaring their expertise, while trying to insist that the cabin crew force a stick down the patients throat to prevent them from "swallowing their tongue." (Gawd save us). It's because of these guys specifically, that some form of ID is required.
Many Docs haven't performed any kind of resuscitation in years. Unless they are working in an ER/A&E, they probably don't have to do so too frequently. Some 60 year old dermatologist may have gone decades without even checking for a pulse, so they aren't always that current or well practiced when it comes to CPR and ALS.
Regarding the crew: The training SUCKS. The first aid training covers the requisite topics, but the whole thing is geared towards passing a written test. Way too many crew treat it like a purely hypothetical exercise rather than something they might need to know some day. Most crew with prior medical qualifications have left these days, as there is little to keep them at EK, so more and more you get minimally trained crew who will only revise this stuff once every year before their recurrent training. When the **** hits the fan, you tend to see a massive rush of blood to the head (crew, not the patient), and they tend to focus on one thing only, the classic tunnel vision while under stress. Add in some passenger coming in claiming to be a doctor and the crew will likely focus on the ID component, as it is something easier or them to control.
At the same time, the other crew should be able to perform adequate CPR and get the defibrillator set up, but this is entirely dependent on which crew are present. Some would do a fantastic job, others would be cringeworthy.
The best help a Doctor would be at this point would be with epinephrine, basically injecting a load of adrenalin into the patient, or inserting an OP airway (no ET intubation kit or laryngoscope on board) to assist with artificial respiration.
The epinephrine and OP airways are kept in the EMK, a large briefcase style medical kit which contains a lot of stuff you'd hope to find on an ALS ambulance (except the ETintubation stuff), but is poorly laid out and is a bitch to find stuff in, especially when crew only get to have a look at it once a year generally, and pay little attention even then.
The suction unit is kept separately and takes a little practice to use. A Doc resident in a hospital may never have been near the portable hand pump EK uses, and may struggle to use it properly. Crew are not trained on it.
O2 flows at a max of 4lpm, which is pathetic in a resuscitation. Ideally a medical tank with 16-25lpm max should be on board.
Bottom line:
Any medical pro should be prepared to ID themselves at an incident, but it is incumbent on crew to do so quickly and without getting too officious.
The crew are trained to perform CPR and use an AED, but not all crew take the training to heart or understand why they need to know this.
The medical kit contains all the life saving drugs you'd hope for, but could do with a few more pieces of kit, as well as a much more user friendly layout. The resusc kits carried in first world ambulances would be ideal.
If a PA was made for a medical pro to step forward, be it on a plane or anywhere else, I'd have my Paramedic ID in my hand and ready to show before I got anywhere near the scene.
Any MD on board who comes forward has to identify themselves, just as they would in any other incident, especially if they are going to take over from someone already tasked with providing first aid. A business card will do, a passport with a work visa (like the UAE) in it will also identify someone as a medical pro. (In a pinch medlink can be used to identify someone, but this takes far too long).
Any doctor or other pro who takes over without providing ID is leaving themselves wide open for all sorts of litigation, and they know it. These days, most medical pros will keep their heads down and try and avoid any impromptu medical work because of this.
On the other hand, I've seen Walter Mittys stepping in to the breach, loudly declaring their expertise, while trying to insist that the cabin crew force a stick down the patients throat to prevent them from "swallowing their tongue." (Gawd save us). It's because of these guys specifically, that some form of ID is required.
Many Docs haven't performed any kind of resuscitation in years. Unless they are working in an ER/A&E, they probably don't have to do so too frequently. Some 60 year old dermatologist may have gone decades without even checking for a pulse, so they aren't always that current or well practiced when it comes to CPR and ALS.
Regarding the crew: The training SUCKS. The first aid training covers the requisite topics, but the whole thing is geared towards passing a written test. Way too many crew treat it like a purely hypothetical exercise rather than something they might need to know some day. Most crew with prior medical qualifications have left these days, as there is little to keep them at EK, so more and more you get minimally trained crew who will only revise this stuff once every year before their recurrent training. When the **** hits the fan, you tend to see a massive rush of blood to the head (crew, not the patient), and they tend to focus on one thing only, the classic tunnel vision while under stress. Add in some passenger coming in claiming to be a doctor and the crew will likely focus on the ID component, as it is something easier or them to control.
At the same time, the other crew should be able to perform adequate CPR and get the defibrillator set up, but this is entirely dependent on which crew are present. Some would do a fantastic job, others would be cringeworthy.
The best help a Doctor would be at this point would be with epinephrine, basically injecting a load of adrenalin into the patient, or inserting an OP airway (no ET intubation kit or laryngoscope on board) to assist with artificial respiration.
The epinephrine and OP airways are kept in the EMK, a large briefcase style medical kit which contains a lot of stuff you'd hope to find on an ALS ambulance (except the ETintubation stuff), but is poorly laid out and is a bitch to find stuff in, especially when crew only get to have a look at it once a year generally, and pay little attention even then.
The suction unit is kept separately and takes a little practice to use. A Doc resident in a hospital may never have been near the portable hand pump EK uses, and may struggle to use it properly. Crew are not trained on it.
O2 flows at a max of 4lpm, which is pathetic in a resuscitation. Ideally a medical tank with 16-25lpm max should be on board.
Bottom line:
Any medical pro should be prepared to ID themselves at an incident, but it is incumbent on crew to do so quickly and without getting too officious.
The crew are trained to perform CPR and use an AED, but not all crew take the training to heart or understand why they need to know this.
The medical kit contains all the life saving drugs you'd hope for, but could do with a few more pieces of kit, as well as a much more user friendly layout. The resusc kits carried in first world ambulances would be ideal.
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There is not a court that would hold you responsible provided you did this
In most parts of the world if you attempt to save a life in good faith then you are safe legally
I'm no legal expert, but I take it you don't live in these parts! These are not most parts of the world, Sharia law is a big unknown and most expats here would not take the risk. A very sad indictment of the society.
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Not sure why everyones jumping up and down on the TRI.
As we DON'T have all the facts, it may well have been a case of selective hearing on the part of the upgrading candidate! Often happens when people are marked down.
Personally, getting the crew to call medlink is the first instruction i'd give, followed by another to make a PA for a doctor onboard. Now that they're busy with that, declare a medical emergency to ATC and request immediate return to stand or nearest available. My own experience of Dubai and many airports is that it will take at least 10 minutes before a Paramedic crew can get to the aircraft AND get onboard. Why not in the meantime have 2 other sources of medical expertise assisting?
CRM. The use of ALL available resources.
Oblaaspop. If they are hiding behind the FOM, they really do need shooting. It changed to the OM-A several months ago! Try to keep up old chap
May the resource be with you!
Harry
As we DON'T have all the facts, it may well have been a case of selective hearing on the part of the upgrading candidate! Often happens when people are marked down.
Personally, getting the crew to call medlink is the first instruction i'd give, followed by another to make a PA for a doctor onboard. Now that they're busy with that, declare a medical emergency to ATC and request immediate return to stand or nearest available. My own experience of Dubai and many airports is that it will take at least 10 minutes before a Paramedic crew can get to the aircraft AND get onboard. Why not in the meantime have 2 other sources of medical expertise assisting?
CRM. The use of ALL available resources.
Oblaaspop. If they are hiding behind the FOM, they really do need shooting. It changed to the OM-A several months ago! Try to keep up old chap
May the resource be with you!
Harry
Last edited by harry the cod; 20th Jun 2010 at 22:11.
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Sounds like a training book response harry but lacking common sense, I repectfully disagree. I do agree that in most situations this is the first go to resource and i agree with the rest of your actions, but I would call med link last. How are you going to talk to med link while talking to ATC, make a PA and get back to the gate? Talking to med link will be a time consuming conversation, the other actions will take seconds. Get ATC help and request immediate medical assistance and clearance back to the gate, PA for doctor or nurse on board, crew to use the defib and then call med link when you've done all you can do and tick the boxes....time is critical for that scenario.
Last edited by Saltaire; 21st Jun 2010 at 02:46.
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Guys, a useful hint for this scenario I have used before in real life is that in most western countries the airport firemen have paramedic training and will respond the quickest to the aeroplane.
Happened to me going onto stand in the UK, and a diabetic went down, passed out, ambulance with paramedics would have taken 15-20 to get airside, the firemen were there in 2, grateful for the exercise.
Happened to me going onto stand in the UK, and a diabetic went down, passed out, ambulance with paramedics would have taken 15-20 to get airside, the firemen were there in 2, grateful for the exercise.
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The point the TRI was probably trying to make is that MEDLINK is a useful tool that you can use at any time, not just in the air. It came up as a discussion point during my upgrade training and the argument was that it does no harm to get the cabin crew to call MEDLINK while you are returning to stand. You don't know how long it will take the emergency services to get to the aircraft especially at some of the less developed airports we fly to and while you are waiting for them you (or the cabin crew as the case may be) are doing something useful. If the medics get to the aircraft before you get through on the satphone then great.
The point was also made that if you want medical advice about offloading a sick passenger before departure you can use MEDLINK for that as well.
The point was also made that if you want medical advice about offloading a sick passenger before departure you can use MEDLINK for that as well.
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If the patient is a UAE National, PA for doctor, return to gate, call MEDLINK, ATC, the Fire brigade, the company and any other entity you can think of.
If it's an Indian, stand by and see if he will recover. Consider a normal departure.
This is more about the risk to yourself and your job, than the risk to the passenger. No instructor will tell you this, but it's a part of flying in the ME.
I almost forgot, if you are at the gate and the passenger dies outside the aircraft, it will save you a lot of trouble.
Hypothetically speaking, of course.
If it's an Indian, stand by and see if he will recover. Consider a normal departure.
This is more about the risk to yourself and your job, than the risk to the passenger. No instructor will tell you this, but it's a part of flying in the ME.
I almost forgot, if you are at the gate and the passenger dies outside the aircraft, it will save you a lot of trouble.
Hypothetically speaking, of course.
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If the patient is a UAE National, PA for doctor, return to gate, call MEDLINK, ATC, the Fire brigade, the company and any other entity you can think of.
If it's an Indian, stand by and see if he will recover. Consider a normal departure.
This is more about the risk to yourself and your job, than the risk to the passenger. No instructor will tell you this, but it's a part of flying in the ME.
I almost forgot, if you are at the gate and the passenger dies outside the aircraft, it will save you a lot of trouble.
Hypothetically speaking, of course.
If it's an Indian, stand by and see if he will recover. Consider a normal departure.
This is more about the risk to yourself and your job, than the risk to the passenger. No instructor will tell you this, but it's a part of flying in the ME.
I almost forgot, if you are at the gate and the passenger dies outside the aircraft, it will save you a lot of trouble.
Hypothetically speaking, of course.
Ridiculous Post. What if the dying passenger was an friend/relative of yours. You dont realise the value of life. As long as a joker like you is in the flight deck aviation is never bound to be trustworthy or safe.
You re an looser.
F'Off.
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Of course it was a ridiculous post, but in the ME the value of life is not the same for all nationalities. You could substitute "Indian" with "non UAE", but as even expats are graded differently, that would not be completely correct.
If, for instance, you were to drive over and kill an Indian/Bangladeshi/Pakistani, the reaction would be different from running over and killing a UAE national.
That's just the way it is. Nobody likes to talk about it, but it doesn't change anything.
If I get any looser now, bits and pieces will start to fall off me!
Sorry for the tread drift.
If, for instance, you were to drive over and kill an Indian/Bangladeshi/Pakistani, the reaction would be different from running over and killing a UAE national.
That's just the way it is. Nobody likes to talk about it, but it doesn't change anything.
If I get any looser now, bits and pieces will start to fall off me!
Sorry for the tread drift.
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Lack of intubation eguipment on ek flights ?
From time to time i fly with Emirates. I work as a nurse anesthesist in Europe. I was surprised when i read mr. Gadgetman who stated that there was no intubations eqiupment ombord in planes from EK.
If a cardiac arrest situation should happend onbord on a long haul flight
CPR and use of a defibrilator in combination with i.v. medications sutch as Adrenalin, Amiodaron, Atropine etc. are essentials.
But equipment to take care of airway management is needed as well. Laryngoscope and endothraceal tubes i different sizes should be on every long haul flights.
I for sure would have missed it if I was invold in a cardiac arrest situasion onboard.
By the way, if shock is indicated ( say 200 joules ) is it ok for the pilots
that the defibrillator will be used ? ( Thinking of interference with the flight computers etc )
As you guys has stated several times, there are "always" doctors onboard.
If a cardiac arrest situation should happend onbord on a long haul flight
CPR and use of a defibrilator in combination with i.v. medications sutch as Adrenalin, Amiodaron, Atropine etc. are essentials.
But equipment to take care of airway management is needed as well. Laryngoscope and endothraceal tubes i different sizes should be on every long haul flights.
I for sure would have missed it if I was invold in a cardiac arrest situasion onboard.
By the way, if shock is indicated ( say 200 joules ) is it ok for the pilots
that the defibrillator will be used ? ( Thinking of interference with the flight computers etc )
As you guys has stated several times, there are "always" doctors onboard.
