Medical emergencies on commercial flights
 

Quite recently I boarded a flight from the Middle East to LHR. I had (now sorted out) an existing medical condition that I thought might cause a problem on the flight so I got clearance from a Doctor who assured me that everything would be OK and I could take the flight . Fortunately the Doctor was right but I must confess to having one or two anxious moments . But that and previous events I have witnessed on commercial flights got me thinking and thus the following questions which I will be grateful for a response to :

1. What circumstances / conditions constitute a medical emergency ?
2. Who makes the decision to either divert to a place where suitable medical care can be given or continue with the flight?
3. Much as I know pilots have places they can divert to in the case of technical emergencies do they have similar locations for medical emergencies.
4. Are there medical conditions passengers have that they should inform the CC of ?

Thanks in advance

1. What circumstances / conditions constitute a medical emergency ?
If someone's life is in danger then it would be a medical emergency. It is no different in the air or on the ground.

2. Who makes the decision to either divert to a place where suitable medical care can be given or continue with the flight?
Ultimately of course it is the Captain. However many airlines now have contracts with medical providers who they can contact whilst in flight. We can call up on HF and speak to a Dr/ Consultant who can advise us based on the medical information we give to them about the condition of the person on board. They will then advise us as to whether they think it is best to continue or divert, which then guides us the pilots.

3. Much as I know pilots have places they can divert to in the case of technical emergencies do they have similar locations for medical emergencies.
Technical or medical or any other emergency makes no difference. We always have en route and destination alternates available. If we had a choice of a few airports (perhaps whilst in Europe) then if there was time we may be guided to a specific one - never had it happen, but I guess that if there was a passenger with heart problems and we had a choice of landing at an airport near a heart hospital or one further away, and both were suitable airports, then we'd land at the most appropriate one. We would also be guided by company - sometimes an airport is better from a company point of view - for example if in Portugal and we had the choice of Faro or Lisbon we'd go to Faro because we fly there regularly and so handling etc. is all in place should the crew go out of hours etc. plus we would be familiar with the airport, whereas we don't fly to Lisbon.

4. Are there medical conditions passengers have that they should inform the CC of ?
If any passenger has a medical condition that requires a Doctors letter then this should be given to the cabin crew on boarding. It makes sense to tell the cabin crew anyway, because otherwise if you were taken ill during the flight and no-one knew you had a pre-existing condition then you may not get the appropriate treatment.

If I may add to Airbus Girl's comprehensive answer, and adding a Longhaul perspective.

The Medical provider will provide guidance as to where to go, and on a longhaul flight that may not be where you would choose to go with a technical problem. For example whilst over the Western Atlantic if you had a technical problem the nearest suitable runway might be at Gander, but the best hospital (as I understand it) might be at St. Johns, so the medical provider may well suggest overflying Gander and going direct to St. John's.

Singapore Airlines
 

I read today of the recent case of a Singapore Airlines pax having a heart attack shortly after take off from SIN-LHR. There was a doctor on board in attendance but the crew refused an en route diversion.

After landing he was rushed to Harefield & although he has survived he has suffered serious permanent damage to his heart muscle, hardly surprising after a 14 hour flight without specialist intensive care.

He is considering legal action.

He should consider that he is alive. Many, many people who heart attacks on the ground, within easy reach of medical assistance - do not make it. The movies and TV promote the idea that the team can 'save him' and 'bring him back from the almost dead'. Not as often as people like to think.

Singapore Airlines SIN-LHR
 

fincastle84 - I have put a post in Jet Blast on the SIN-LHR incident with the BBC reporter. It will have been the medical profession that would have said a diversion was not recommended, there was a doctor in attendance and almost certainly communication to other medical specialists on the ground, the captain would have been guided accordingly. Been in a similar situation myself, as a pilot.

Many companies use Medlink.

Takes the ball out of the Captains court. It is in some ways a form of insurance We call them with details of the pax medical condition, these details are passed onto a doctor/consultant, and hey presto, they tell you whether you need to divert.

if they get it wrong, it was their call, and as such the company/captain are not held accountable. This generally results in fewer unnecessary diversions, but what they also do is if you need to divert to somewhere with specialist equipment they can tell you where to go. They are also very good for gate screening, because although you may have a fit to fly certificate, they are on occasion, not worth the paper they are written on.

I have had one occasion where we could not contact medlink for whatever reason, but chose to divert anyway as the paddles were out.

I know nothing about medical things but I keep reading that this person suffered permanent heart muscle damage. Surely everyone who has a heart attack suffers from permanent heart muscle damage, even if they were able to get to a hospital a bit quicker? Even if a diversion had been started as soon as the passenger was diagnosed, it would probably have been at least an hour before he got specialist medical help. Would that have made a difference to his outcome? There was a Dr on board, and I can't believe that the Captain disregarded his opinion if he said a diversion was necessary. Although it looks like in the end it wasn't a life threatening situation, which is usually what we divert for.

If the airline uses Medlink, whatever they say goes. It doesn't matter what the doc says.

The doc may be a GP, when you speak to medlink you will be in touch with a specialist.

The first hour of treatment after a heart attack is critical. Such treatment requires a variety of drugs which wouldn't have been available on the flight. That's why a diversion would probably be advisable. I am in no way attempting to be judgmental of the decision making process both in the aircraft & on the ground.

Obviously I wasn't there & was only reporting what I read. My wife however, works in a major cardiac unit & is horrified by this case.

PS Whilst it's true that in any heart attack there is damage to the heart muscle, the longer that the patient has to wait for specialist treatment, the greater the damage.

Babaleka,
To answer your question 4.

Here is a link to a list of conditions, when you do need to inform my airline but if they feel it necessary, they themselves will have already briefed the cabin crew.

Link.... British Airways - Medical information

Click on top option - passenger medical clearance unit and then click on-
Flying after an illness or an operation

I once had a passenger tell me that he was very sore because he had had an operation in his stomach, the day before!!He was wanting some sympathy, which of course I gave him!

However I immediately informed the Captain, for obvious reasons and he was off loaded. Not only was he putting his own life at risk, he could have caused a diversion and unnecessary problems for ALL the other passengers.

Not necessarily, and the degree of damage can vary very widely depending on how quickly they get proper treatment.


Its quite possible. Treatment given 1 or 2 hours after a heart attack may well save heart tissue which would otherwise have died 6 or 8 hours later.

Out of pure interest, if there is a doctor on board and the flight crew wish to speak to him/her about a passenger's medical situation, are the rules prohibiting passengers from accessing the flight deck temporarily waived so that s/he can go on the flight deck, speak to the pilots and liaise via Medlink if necessary? Or does the captain have to leave the flight deck to speak to him/her?

I am, obviously, talking about UK-registered airlines to whom those rules apply

No, I doubt the rules would be waived because the medical emergency could be a sham, with the entry of the flight deck as the end game.

If the flight crew wished to talk to the doctor it would be via the interphone

I understand that the first hour is critical, as I know from events involving a close relative. One could be lucky to get to a suitable medical facility from anywhere in the world during a flight and within an hour, even short finals at LHR.

I think you will find that the Doctors kit, carried on SIA aircraft, does contain everything necessary to stabilise a patient. This kit can only be opened with the captains authority when he/she is satisfied that there is a doctor/nurse/para medic on board who would know how to use it.

Parabellum
 

It would be interesting to know if that happened in this event. Thanks for the update, that's very reassuring in the event I ever fly SIA.

Does this apply to all airlines?

fincastle

BA use a similar system.

The BA medical kit carries a lot of injections, drugs and equipment that you would usually only find in a hospital.

As mentioned above, if any passenger is a medical practitioner, they will be allowed to use these drugs and talk to Medlink, via the pilots, for their expert advise.

This system saves many lives but please let me assure you, that most airlines would definitely divert if that was in the best interests of the passenger.