Medical emergencies on commercial flights

[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]

Originally Posted by fincastle84

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........

I agree.....suspend judgement.

[Globaliser]

Originally Posted by lowcostdolly

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

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]

Response and a couple more questions

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]

Heart attack on board

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...

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