Passenger Family Sues American Airlines After In-flight Death
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Passenger Family Sues American Airlines After In-flight Death
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
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.
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
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.
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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.
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.
I won't go into details for obvious reasons but I (a paramedic), got involved with a patient from LAX to LHR.
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.
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.
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.
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.
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.
I know from experience that, in the case of HF radio, it is not easy for an unfamiliar operator.
We ended up with one of us operating the radio as the onboard doc (newly qualified) listened in.
Diverted to Boston, lady dropped off, happy ending.
We ended up with one of us operating the radio as the onboard doc (newly qualified) listened in.
Diverted to Boston, lady dropped off, happy ending.
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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
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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.
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.
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
Paxing All Over The World
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.
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):
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.
I searched the general question: what percentage survive heart attack?
Here is the first answer listed and it is from the US Science Daily.
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.
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.
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 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.
Please for the love of god can people stop using the terms “heart attack” and “cardiac arrest” interchangeably
they are not the some condition!!
they are not the some condition!!
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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?
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
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
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
Last edited by Buswinker; 29th Apr 2018 at 06:49.
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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.
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