Qatar Airways Pilot dies mid-flight
Join Date: May 2010
Location: UK
Age: 79
Posts: 1,086
Likes: 0
Received 0 Likes
on
0 Posts
As an ex First Responder with a little experience, leaving him in his seat is not an option. There is ALWAYS a possibility that efficient CPR may have the right effect, and all large passenger aircraft have an automatic defibrillator on board.?? To leave him in his seat would be unforgiveable. No pulse or breathing does not necessarily mean dead, though if you leave him there, he soon would be!!.
No pulse or breathing leaves a chance of revival if treated very quickly.
If you shine a bright light in the patient's eye and the iris does not contract there is only one diagnosis - the patient is either brain dead or totally blind in that eye. An airline captain would not be totally blind in both eyes. In more general terms, if both eyes fail to respond and there is no white stick or guide dog the patient must be dead.
If the pilot is dead and there is no replacement pilot to take his place then it is safer to leave him. If there is a chance of resusitation then it is worth moving him and giving all available appropriate treatment.
Geek:
Should the day ever come for you, I hope that those who are in attendance when you are in need will have more compassion than you seem to be able to muster. Sheesh!
Should the day ever come for you, I hope that those who are in attendance when you are in need will have more compassion than you seem to be able to muster. Sheesh!
Join Date: Nov 2008
Location: Oz
Posts: 148
Likes: 0
Received 0 Likes
on
0 Posts
Fair point but cabin crew are not doctors, we cannot make a diagnosis and in that case would make any and all attempts to provide first response.
Of course, in a cardiac arrest situation the chances of being of any help whatsoever are slim- but we cannot tell that standing behind a cockpit seat looking at the back of his head.
Much easier to assess the situation with the pilot in the galley or other suitable area, not to mention not being a distraction to the remaining pilot (and also a lack of room to do so in any flight deck other than possibly the 380- it's still be a tight squeeze)
Of course, in a cardiac arrest situation the chances of being of any help whatsoever are slim- but we cannot tell that standing behind a cockpit seat looking at the back of his head.
Much easier to assess the situation with the pilot in the galley or other suitable area, not to mention not being a distraction to the remaining pilot (and also a lack of room to do so in any flight deck other than possibly the 380- it's still be a tight squeeze)
Thread Starter
Join Date: Feb 2002
Location: st. louis
Posts: 16
Likes: 0
Received 0 Likes
on
0 Posts
Boomerang, thanks for the sensible input.
Geek, I really don't know which planet you are from. This is civilian flying we are talking about and though trained, we certainly aren't exposed to dealing with "dead" persons in any state, let alone at 35000ft with 300 pax at the back. It's a scary situation to say the least. Maybe not so in military flying?
Obviously the way to go is pretty much what Boomerang said. We all get trained to ask the c/c to assist in such situations in the very way he has explained.
What need to be explained here is why the poor captain went the way he did.
Was he sick? fatigued? overworked? or simply a course of fate?
And is there anything that could be learned from this? Did he enough l/o period in MNL and was he truly rested?
The airline I flew with in 747 classic, though three crewed had an extended layover policy on long haul trips like these. From what I understand the money making oriented gulf airlines squeeze every minute out of the layover time to bare legality. I can only speculate, but if enough of long haul short layover trips are made, it's only a matter time before the poor motor packs up!
Geek, I really don't know which planet you are from. This is civilian flying we are talking about and though trained, we certainly aren't exposed to dealing with "dead" persons in any state, let alone at 35000ft with 300 pax at the back. It's a scary situation to say the least. Maybe not so in military flying?
Obviously the way to go is pretty much what Boomerang said. We all get trained to ask the c/c to assist in such situations in the very way he has explained.
What need to be explained here is why the poor captain went the way he did.
Was he sick? fatigued? overworked? or simply a course of fate?
And is there anything that could be learned from this? Did he enough l/o period in MNL and was he truly rested?
The airline I flew with in 747 classic, though three crewed had an extended layover policy on long haul trips like these. From what I understand the money making oriented gulf airlines squeeze every minute out of the layover time to bare legality. I can only speculate, but if enough of long haul short layover trips are made, it's only a matter time before the poor motor packs up!
Join Date: Sep 2004
Location: SLF, living somewhere East in the West
Posts: 235
Likes: 0
Received 0 Likes
on
0 Posts
if you shine light in one eye and it does not react he also could be under Atropin which widens the pupil and you may not get a reaction. Other options come to mind as well such as focal brain lesions such as abscess, hemorrhage etc. Diagnosis of death is by US law and German law and many other countries ONLY to be made by a licensed physician, which I assume based on your comment you are not. And your comments show the very reason why these laws are in place to start with...
Join Date: Sep 2010
Location: Singapore
Age: 61
Posts: 89
Likes: 0
Received 0 Likes
on
0 Posts
The Ancient Greek
Not only are you totally out of order, if you conducted yourself as you describe in a real life situation say with a member of my family who was flying upfront with you, I would haul your ass through every court in the land until I had the very shirt off your back. Pilots are Pilots, we are not Doctors, no matter how many documentaries you have watched or web pages you have read to make you an \'expert\' ... Not!
The completely correct action was taken by the FO. Divert the aircraft immediately, hoping the poor guy is not dead and that onboard assistance and expert medical help on the ground can save his life.
Condolence to the family
Not only are you totally out of order, if you conducted yourself as you describe in a real life situation say with a member of my family who was flying upfront with you, I would haul your ass through every court in the land until I had the very shirt off your back. Pilots are Pilots, we are not Doctors, no matter how many documentaries you have watched or web pages you have read to make you an \'expert\' ... Not!
The completely correct action was taken by the FO. Divert the aircraft immediately, hoping the poor guy is not dead and that onboard assistance and expert medical help on the ground can save his life.
Condolence to the family
Join Date: Sep 2000
Location: Bielefeld, Germany
Posts: 955
Likes: 0
Received 0 Likes
on
0 Posts
Folks,
this is an important thread on an important issue, which thankfully occurs very rarely. A few points.
1. Dealing with an incapacitated flight crew member is something that should be in every airline's SOPs. I am rather taken aback by the lack of a single contribution which starts "our airline's SOPs are to do ...." There are a bunch of decisions to be made; about when, how and where, and by whom, to try resuscitation, which are not trivial and should not have to be made on the fly. And these SOPs should be regularly reviewed.
2. Many of the contributors to this thread have obviously not had to deal with medical emergencies and their main corollary, dead people, on a regular basis. The question: what do I do if my crew dies on me? is valid and requires an answer a little more grounded than expressing condolences and sending a card.
3. Ancient Geek has done nothing more than relate an experience and make a triage suggestion. In doing so, he has contributed more in terms of points 1 and 2 above than any of those contributors who criticise him for it (and, in contrast to those who berate him for his contribution, he has been neither impolite nor inappropriate).
I didn't know whether he is right or wrong about iris response as an appropriate way of deciding whether resuscitation is worthwhile. So I asked my partner, who is a dialysis nurse; they quasi-regularly have such emergencies.
She says check pulse, breathing, maybe eyes (iris contraction), but that there is no single indication that someone is dead. Lack of iris contraction indicates brain damage of some sort, but one cannot thereby conclude that the victim is dead. She says that resuscitation must always be tried. But of course she operates in a relatively unconstrained situation.
They perfom CPR, on a special board, because almost everything else is too flexible to perform it properly. The defibrillators may only be used by a doctor (they don't have a "layperson's defibrillator"). I asked what one would do if it happened to a captain in-flight. It is obviously not possible to perform CPR on someone in a seat, but she doesn't know if one could effectively apply a lay defibrillator on a sitting person.
There are other people I could ask; for example, an acquaintance who is a full-time emergency-response doctor. But I think this is enough for now. This commentary just goes to support point 1 above.
It looks as if iris-response is just one of a constellation of things to try, none of which, either alone or all together, forms a universally valid decision criterion for death.
4. Concerning the trope that only a registered medical doctor may determine death in England and Wales and the US and other countries, prima facie it rather misses the interesting point, which is: what do you do if it happens in your presence? It is a question which most people who put themselves out of quick access to medical services (for example, most people who go sailing, backpacking, trecking, rock-climbing, mountaineering, cross-country skiing, even hunting and angling) are wise to ask themselves, and indeed such guidance is available.
However, there is a point here for aircrew. Crew may be wise first to ask whether there is a doctor on board and solicit hisher help without delay. If there is, and heshe is willing, then heshe can perform the relevant determinations and guide response. (There may be the problem of persuading a doctor to undertake the responsibility.) If not, then the legal issue is irrelevant and the crew must do what they think best. The very best is that they follow established guidance in their SOPs, because if they improvise, and someone disagrees later with what was done, they might have a liability problem which they would not necessarily have (although their airline might have) if it's in SOPs.
5. There is obviously a tension between the necessity to revive someone suffering from cardiac arrest, and the risk to flight involved in removing them to a place in which this may be attempted. This risk should be mitigated through a proper risk analysis and determination of appropriate procedures to mitigate risk, and we are back to point 1 above.
PBL
this is an important thread on an important issue, which thankfully occurs very rarely. A few points.
1. Dealing with an incapacitated flight crew member is something that should be in every airline's SOPs. I am rather taken aback by the lack of a single contribution which starts "our airline's SOPs are to do ...." There are a bunch of decisions to be made; about when, how and where, and by whom, to try resuscitation, which are not trivial and should not have to be made on the fly. And these SOPs should be regularly reviewed.
2. Many of the contributors to this thread have obviously not had to deal with medical emergencies and their main corollary, dead people, on a regular basis. The question: what do I do if my crew dies on me? is valid and requires an answer a little more grounded than expressing condolences and sending a card.
3. Ancient Geek has done nothing more than relate an experience and make a triage suggestion. In doing so, he has contributed more in terms of points 1 and 2 above than any of those contributors who criticise him for it (and, in contrast to those who berate him for his contribution, he has been neither impolite nor inappropriate).
I didn't know whether he is right or wrong about iris response as an appropriate way of deciding whether resuscitation is worthwhile. So I asked my partner, who is a dialysis nurse; they quasi-regularly have such emergencies.
She says check pulse, breathing, maybe eyes (iris contraction), but that there is no single indication that someone is dead. Lack of iris contraction indicates brain damage of some sort, but one cannot thereby conclude that the victim is dead. She says that resuscitation must always be tried. But of course she operates in a relatively unconstrained situation.
They perfom CPR, on a special board, because almost everything else is too flexible to perform it properly. The defibrillators may only be used by a doctor (they don't have a "layperson's defibrillator"). I asked what one would do if it happened to a captain in-flight. It is obviously not possible to perform CPR on someone in a seat, but she doesn't know if one could effectively apply a lay defibrillator on a sitting person.
There are other people I could ask; for example, an acquaintance who is a full-time emergency-response doctor. But I think this is enough for now. This commentary just goes to support point 1 above.
It looks as if iris-response is just one of a constellation of things to try, none of which, either alone or all together, forms a universally valid decision criterion for death.
4. Concerning the trope that only a registered medical doctor may determine death in England and Wales and the US and other countries, prima facie it rather misses the interesting point, which is: what do you do if it happens in your presence? It is a question which most people who put themselves out of quick access to medical services (for example, most people who go sailing, backpacking, trecking, rock-climbing, mountaineering, cross-country skiing, even hunting and angling) are wise to ask themselves, and indeed such guidance is available.
However, there is a point here for aircrew. Crew may be wise first to ask whether there is a doctor on board and solicit hisher help without delay. If there is, and heshe is willing, then heshe can perform the relevant determinations and guide response. (There may be the problem of persuading a doctor to undertake the responsibility.) If not, then the legal issue is irrelevant and the crew must do what they think best. The very best is that they follow established guidance in their SOPs, because if they improvise, and someone disagrees later with what was done, they might have a liability problem which they would not necessarily have (although their airline might have) if it's in SOPs.
5. There is obviously a tension between the necessity to revive someone suffering from cardiac arrest, and the risk to flight involved in removing them to a place in which this may be attempted. This risk should be mitigated through a proper risk analysis and determination of appropriate procedures to mitigate risk, and we are back to point 1 above.
PBL
Join Date: Oct 2009
Location: The Rainforest
Age: 63
Posts: 7
Likes: 0
Received 0 Likes
on
0 Posts
Re: Doctor on board; it may well be worth extending the call for outside assistance to include ambulance service paramedic. In fact it may be the better first option as they'll have far more experience of dealing with heart attacks 'in the field' than most doctors.
Thread Starter
Join Date: Feb 2002
Location: st. louis
Posts: 16
Likes: 0
Received 0 Likes
on
0 Posts
It is mandated that passenger aircraft carry defibrillators, which crew can operate.
I have had at least three passengers die in some of my flights. The last one the defibrillator was on board and though used, he couldn't be saved.
It was mentioned the captain was a 45 yr old man.
That's sadly rather young.
I wish someone was able to fill us in on the exact circumstances sorrounding this gentleman's demise.
What we are doing here is totally misdirected speculation.
I have had at least three passengers die in some of my flights. The last one the defibrillator was on board and though used, he couldn't be saved.
It was mentioned the captain was a 45 yr old man.
That's sadly rather young.
I wish someone was able to fill us in on the exact circumstances sorrounding this gentleman's demise.
What we are doing here is totally misdirected speculation.
Thread Starter
Join Date: Feb 2002
Location: st. louis
Posts: 16
Likes: 0
Received 0 Likes
on
0 Posts
Join Date: Aug 2007
Location: @ some hotel far away from everything
Posts: 734
Likes: 0
Received 0 Likes
on
0 Posts
What a terrible situation to get stuck in! Your colleague`s main engine (heart) fails when at cruising altitude, and suddenly you`re in charge of the way things are going to happen in the very near future 
. You`ve probably been drillied in the sim and through company SOPs on what to do and how to do it, but these things happen rarely (you`re more likely to encounter an engine failure) and they are never the same.
Aviate, navigate, communicate... These things have been correctly mentioned. But it is also very important to assess your new world before doing anything. No contact with the guy next to you? He`s not sleeping? Unconscious? Maybe/maybe not...
. First thing to do, just to get things started, is call "my controls". If you can secure your colleague by the seatbelt/harness lock then you should have him slumping down/forwards on the control column - which you now are in control of. Then, call the CC for assistance. While he/she/they are coming, call ATC and divert to nearest possible airport for a priority landing. Now you`ve effectively used very many of your options for help and can focus on flying the bird you`re in charge of
. Unless you`re a doctor or have sufficient medical training, there is really no way of finding out exactly what is wrong with your colleague, but if you`re doing nothing (or your best) to help him then you`re doing something wrong.
But this is why air transport aircraft have a minimum of 2 flight deck crew onboard. Also, those who fly single pilot commerciallly over a certain age are required to have their medical at shorter intervals than those flying multipilot.
Also, this is where an FO with experience is preferable
. You`ve probably been drillied in the sim and through company SOPs on what to do and how to do it, but these things happen rarely (you`re more likely to encounter an engine failure) and they are never the same. Aviate, navigate, communicate... These things have been correctly mentioned. But it is also very important to assess your new world before doing anything. No contact with the guy next to you? He`s not sleeping? Unconscious? Maybe/maybe not...
. First thing to do, just to get things started, is call "my controls". If you can secure your colleague by the seatbelt/harness lock then you should have him slumping down/forwards on the control column - which you now are in control of. Then, call the CC for assistance. While he/she/they are coming, call ATC and divert to nearest possible airport for a priority landing. Now you`ve effectively used very many of your options for help and can focus on flying the bird you`re in charge of. Unless you`re a doctor or have sufficient medical training, there is really no way of finding out exactly what is wrong with your colleague, but if you`re doing nothing (or your best) to help him then you`re doing something wrong. But this is why air transport aircraft have a minimum of 2 flight deck crew onboard. Also, those who fly single pilot commerciallly over a certain age are required to have their medical at shorter intervals than those flying multipilot.
Also, this is where an FO with experience is preferable
Join Date: Aug 2007
Location: Chedburgh, Bury St.Edmunds
Age: 81
Posts: 1,175
Likes: 0
Received 7 Likes
on
5 Posts
Automatic defibrillators can be used in a seating position, BUT the use of them is generally supplemented by CPR. which cannot be given in this position. Automatic defibs are simple to use, the instructions are verbal when the lid is opened, and the voice is very clear and easy for anyone to follow. It is not good enough on it's own, however, and if it gives instruction,after auto assessment, 'shock not advised, continue with CPR', then there is a problem if the victim is still in the seat. Clever piece of kit tho'.
Join Date: May 2010
Location: UK
Age: 79
Posts: 1,086
Likes: 0
Received 0 Likes
on
0 Posts
2. Many of the contributors to this thread have obviously not had to deal with medical emergencies and their main corollary, dead people, on a regular basis. The question: what do I do if my crew dies on me? is valid and requires an answer a little more grounded than expressing condolences and sending a card.
The instructor and the FO both survived but neither flew again.
3. Ancient Geek has done nothing more than relate an experience and make a triage suggestion. In doing so, he has contributed more in terms of points 1 and 2 above than any of those contributors who criticise him for it (and, in contrast to those who berate him for his contribution, he has been neither impolite nor inappropriate).
As others have said, the first priority is to fly the aircraft safely. Then assess the risks and get whatever appropriate help is available. SOPs and prior training are a great help but the best hope will always be the professional medics on the ground.
Last edited by The Ancient Geek; 14th Oct 2010 at 11:21. Reason: spilling mistrakes
Hi all. I'm just a SLF normally found lurking and keeping myself to myself because I haven't got any aviation experience or knowledge to share, but I did used to be a Paramedic so have a little relevant information with regards to this thread.
Just to make the point that fixed dilated pupils aren't a sign of brain death, and there is every chance that with prompt defibrillation someone in cardiac arrest and dilated pupils might well be saved. Its been a few years since I've been in the job, but they used to say that for every minute that passes from arresting to defibbing the chances of survival go down by 10%, so even allowing for the time to remove the pilot from the seat in theory you might stand more chance of getting someone back than we did, bearing in mind our sometimes lengthy response times.
Obviously it all depends on why someone arrests and the cardiac arrest rhythm they go into, and they're probably more likely not to survive than be saved, but a younger patient just suddenly dying from nowhere I reakon would probably be the most likely to respond to a defib.
Don't want to sound like I'm saying that this poor guy could have been saved, not talking about him in particular. I've been to dozens of cardiac arrests and only got about 5 back. Just that without trying, you'll never know. Fixed dilated pupils aren't diagnostic of death.
Just to make the point that fixed dilated pupils aren't a sign of brain death, and there is every chance that with prompt defibrillation someone in cardiac arrest and dilated pupils might well be saved. Its been a few years since I've been in the job, but they used to say that for every minute that passes from arresting to defibbing the chances of survival go down by 10%, so even allowing for the time to remove the pilot from the seat in theory you might stand more chance of getting someone back than we did, bearing in mind our sometimes lengthy response times.
Obviously it all depends on why someone arrests and the cardiac arrest rhythm they go into, and they're probably more likely not to survive than be saved, but a younger patient just suddenly dying from nowhere I reakon would probably be the most likely to respond to a defib.
Don't want to sound like I'm saying that this poor guy could have been saved, not talking about him in particular. I've been to dozens of cardiac arrests and only got about 5 back. Just that without trying, you'll never know. Fixed dilated pupils aren't diagnostic of death.
Join Date: May 2002
Location: Middle East
Posts: 806
Likes: 0
Received 0 Likes
on
0 Posts
As far as summoning a crew to continue the journey, there would have already been a QR crew in KUL anyway on their regular KUL layover (KUL is also an A330 destination for QR, with an extension now to Phuket, so there are mixed layover durations of 24 hours up to 48 hours). My guess is that the diversion to KUL was selected to take this into account (other nearby QR destinations of SIN and BKK are now 77W ports, so there would not have been a suitable crew at either of those locations to allow the flight to continue onwards.)
Of course, the airline would ONLY have made this decision to proceed onwards to KUL (even if BKK or SIN were closer for medical emergency) with the onboard knowledge that the Commander was already deceased, and therefore, immaterial where the aircraft diverted to.
Horrible thought, but probably a sad fact.
Of course, the airline would ONLY have made this decision to proceed onwards to KUL (even if BKK or SIN were closer for medical emergency) with the onboard knowledge that the Commander was already deceased, and therefore, immaterial where the aircraft diverted to.
Horrible thought, but probably a sad fact.