Passenger seriously ill.

[Ashling]

I think the vast majority of us agree whole heartedly that the correct thing to do is land at the nearest avaiable airfield that meets the operating limits.

Stuck In An ATR you may wish to consider how you might feel if instead of saving one you killed many by making an ill considered return into below limits conditions for which you have not been trained.

I can see both sides of the Mayday/Pan debate. What you have to do is use a recognised distress call and then clarify what the nature of your problem is and what you wish to do. In some areas Pan is not recognised so a Mayday would be more appropriate and it will certainly get you attention and you can always downgrade it. Snag being, I am told, is that in some places the airfield you are arriving at is obliged to put its crash plan into operation so you may have a whole fleet of ambulances etc waiting for you rather than just the one. On the flip in the UK if you declare a Pan you could land with a medical emergency and still have to wait 30 mins for an ambulance to pitch up. What you will get is the airports paramedic who will then decide if an ambulance is required. This is because an airport is deemed a place of safety in the NHS's eyes as it has a paramedic. A Mayday will probably obtain you the ambulance that you, your crew and the doctor onboard deem necessary.

Personaly after experience of the above when we had a doctor on board desperate for an ambulance to get the patient away quickly (and communicating it effectively to all who would listen Pan medical emergency request direct ambulance to meet etc) all we got was a paramedic and a 30 min wait for the ambulance when the paramedic agreed with the doctor.

So Pan is I guess the correct call, were it is recognised, but after personal experience if I get the impression things really are life threatening it will be a Mayday for me initially and I'll eat humble pie after the dust settles.

SN3GUPPY all your example call in the UK would achieve is a question from ATC, "are you declaring an emergency?", declare the emergency then ask for what you want not the other way round. While a Mayday call may be a touch overblown, and your first priority is safety of flight which you must not compromise, I can assure you that your pax and his relatives will definately consider it a mayday. So I can live with being a touch over dramatic if it saves a life.

[SNS3Guppy]

So ATC tells you 'SNS3Guppy, enter the hold at XYZ, you're number three for approach'.

You say what? 'Request priority?'
I bet you that ATC will ask you then: 'SNS3Guppy, are you declaring an emergencey?'

What will your answer be?

Negative...not "declaring an emergency."

You see, as the PIC, I don't have an emergency. I don't even know if the passenger is alive. Asleep. Having a siezure, stroke, or religious experience. I have a fully functioning airplane with no problems, and am going to do what I can in the interest of the passenger without any willingness to compromise the safety of the flight.

As soon as you let emotions into it, you just became the wrong man for the job.

Some years ago I was enroute to Mountain Home, ID, to retrieve a heart. I had a surgical team on board to harvest the heart, and a patient waiting for that heart. Conditions deteriorated such that both of us flying the airplane determined we would not continue, and returned with the crew on board. We did not harvest the heart. If the heart was lost, if the patient died, I don't know. I don't make those decisions. I did decide, based on the criteria set before me as a pilot, what I could and couldn't do based ONLY on those criteria. The need for the heart, the condition of the patient, and whatever else is riding on that flight are NOT pilot considerations.

Over my career I have flown many, many emergency medical missions. I've turned down flights due to weather, mechanical, and other reasons, even though a critical patient needed transport. I've spent many years flying firefighting missions in which I've refused, cut short, or changed the mission due to my own safety-driven assessments. This is crucial. You can make the scenario in the back of the airplane anything you want. A woman is giving birth. A man just had a heart attack. A poltergeist is loose and stealing everybody's spare change. There's a bloodbath in progress and someone's using the blood to paint uncouth religious grafitti on the lav walls. Take your pick. All irrelevant.

Someone forgot their wallet? Still not an emergency. Still not my problem. I'm there to fly the airplane.

What do you think is going to happen when you grip that microphone with white knuckles, crackle hoarsly as squeak as you clear your throat to say "Control, I hereby declare this day a day of emergency and mayhem, mayday, mayday, mayday?" You think the sky will light up and the heavens and waters part for you, and something will magically change? No. Do you think ATC will respond with "Understand Baybridge Four Three Niner. You are cleared immediately to do whatever you want to do, disregard safety and throw caution to the wind. All regulations are hereby repealed, and you are free to act as you wish. You're number one in our book."

I was in Riyadh last year, preparing for departure, when a Saudia flight called in an emergency. He was very clear to state over and over again his maydays and that he had an emergency. He was clearly distraught, so we listened with interest as ATC tried to determine the nature of the emergency.

"Riyadh, I say, we have an EMERGENCY! We must have the police meet us at the gate. Bring as many as you can. Do you hear me, Riyadh! We have an emergency. I say, Mayday, Mayday. We have an emergency. You must bring the police!"

"What is the nature of your emergency?"

"I tell you, we have an emergency. We must land right away, and we must have the police. Have them meet the airplane the moment we land. I say again, it is an EMERGENCY!"

"We must know the nature of your emergency, Captain. What is your emergency?"

Then, in a hoarse whisper, fraught with emotion and fear, the captain replied, "We have a passenger on board who is consuming ALCOHOL!" I say, we have an emergency, we have ALCOHOL on board, and must have the police right away."

Wow.

The use of Mayday and Pan Pan is meant to draw immediate attention to the radio call,and it serves to tell all other listeners that radio traffic is to stop, to draw attention to this particular traffic, and is a final call of desperation. Often made into the blind. Hardly warranted while in the ATC system, talking to ATC, when there is no threat to the safety of the flight.

Simply telling ATC what you have, what your intentions are, and then getting it done will suffice. So far as getting excited and attempting to return to land in conditions below minimums...if you're more concerned about the life of the passenger in a situation where you aren't qualified to know what's going on behind the cockpit door, if you're emotional enough to get excited about this, then you're the wrong one for the job. You already have a job; flying the airplane, legally and safely.

Each passenger climbs aboard knowing he or she will be more than a few feet from a surgeon, more than a few feet from a firefighter, more than a few feet from a beautician. The passenger knows he or she is climbing into an airplane which moves away from the earth, isolated from help, isolated from all the conveniences of the ground. The passenger has made this decision by climbing on board. It's not your decision to worry about. You didn't create the "emergency." Your ONLY concern is flying safely. Period. That the passenger lives or dies is also not your concern, not your responsibility; you have a bigger duty and that's to fly the airplane safely. You can do that by picking an alternate, pressing on to the destination, making a cabin anouncement for assistance by cabin crew or other passengers for the cabin victim, or other means within the scope of your job. Turning back to fly an approach for which you are not qualified nor trained, in conditions less than you are legal and less than which you're experienced in is not in the purview of your duty; it's a breach of confidence placed in you by your employer, your certificating agency (CAA, FAA, etc), and the passengers. You don't have that right. Fly the airplane, don't get excited, end up on the ground when you can. Again...you did NOT create the problem, you're only handling it. Do it methodically and safely.

[Rod Eddington]

"Negative...not "declaring an emergency." "

In which case, in the UK at least, you would get not get any priority. I'm sure your sick pax will be delighted at your decision.

"As soon as you let emotions into it, you just became the wrong man for the job"

Declaring a mayday has nothing whatsoever to do with emotions. What a wierd thing to say.

[Notso Fantastic]

Guppy, that is long and passionate, and raised far more issues than are in the question. You were presented with a simple medical emergency scenario with a weather problem. Everybody has been making far more of it than the problem presented. The lesson to those trying to learn is forget about heart transplant issues when they don't exist in this problem, handle the immediate problem, remember what limitations are for and always consider the safety of all those on board. It leads to one answer! With UK ATC (at least), unless you declare an emergency, you will get no preferential treatment whatsoever. You may expect few, if any, countries outside the UK will even recognise the term 'pan-pan' or know what you are talking about. Therefore to have a severe medical condition on board, the only option is to declare an emergency.

In practice, I had such a transatlantic condition this year. With proper communication, I received full co-operation from ATC without having to declare an emergency, and was fully satisfied with the handling.

[PENKO]

SNS3Guppy, I know there are 'real' pilots around who probably have landed aircraft without any wings attached, flown through flack, and rescue little orphans from burning rooftops on a weekly basis. Won't stop any mortals for yelling mayday the moment their engine surges. I can see the point you make, it is a valid one in the grand scheme of things. But every pilot has to make his own decisions I think, based on the situation at hand, experience, co-operation of ATC etc. etc.

If you have the means available to be on the ground ASAP, and one of those means is a mayday call, then that's what you should use. (And again, of course you do not bust minima for one pax).

[Ashling]

Guppy

I think you are losing the plot somewhat here.

The scenario asked you to choose between the immediate needs of a seriously ill passenger and safety of flight. Overwhelmingly people have chosen safety of flight and quite right too. So I fail to see why you feel the need to keep banging on about safety of flight having primacy when virtualy everyone has made the same point by chosing to continue and not return into conditions which are below limits.

Also I think you will find that legaly you have a responsibility to each individual passenger as well as the collective whole. You may well know exactly what is wrong with the passenger as your crew will have told you as will the almost inevitable Doctor/Nurse on board. If you have a patient with a heart attack you most certainly do have a medical emergency and you have a professional and legal responsibility to deal with it appropriately.

How do you deal with it? Well when you are made aware there is a medical issue you review your options with your flight deck colleagues while the cabin crew deal with the immediate issue and gain medical help if any is available. You then make a decision based on the information you recieve from your cabin crew and the information you have gathered ref diversion airfields eg weather and notams. Your company may have a medical hotline so that can be consulted too. Taking all these factors into account you make a reasoned decision whether to continue or to divert. If you need priority you declare an emergency. Pan would be correct but as we have observed this is not recognised everywhere. The key is to get priority if you need it.

Throwing caution and flight safety to the wind in the interests of one ill passenger is an extreme and inappropriate response but so is casually and coldly ignoring it and denying any emergency exists. There are such things as coroners courts were people are held to account for their actions you might wish to consider that especially as you may be legaly liable.

[mixture]

Not really wishing to be drawn into the general debate about turning back vs proceeding to destination that's going on here.....

Suggest some of you re-read CAP 413.

A PAN would probably be justified and appropriate in order to try to get you priority routing and medical assistance on the ground. (ref: definition of "urgency" in CAP413).

Use of MAYDAY for pax emergencies is less clear and probably would be less justified in this scenario.

P.S. I believe you'll also find that PAN and MAYDAY are internationally recognised and should always initiate ICAO prescribed procedures.

[ITCZ]

Originally Posted by Denti

they are basicly just an abbreviated version of the pilot manuals restricted to what the cabin crew needs to know.

The Boeing FAM might be loosely classified in that way. But the checking and training manual, the company policies and procedures manuals etc can tell you a lot about who you have back there, what their capabilities and their limits might be.

Not my idea. Passed on by a couple of the great operators that I respect. One put it thus: "I have to answer for everything that happens on my watch. I don't have to know everybody's job, I just like to know what I have at my disposal."

[SNS3Guppy]

In which case, in the UK at least, you would get not get any priority.

Well, that's the UK for you, isn't it? Don't worry, it's just a scratch. Only a flesh wound. In the land of understatement, only a declaration of war rouses enough attention to bat an eyelash.

[Skylion]

Don't forget that many airports do not have serious medical services on site. LHR only has a paramedic (on a bike) available in each terminal. Ambulances have to be summoned from the London Ambulance Service at Hillingdon to take passengers, crew or airport staff involved in industrial accidents to the hospitals A & E. Ashford A & E was nearer but I understand that has now closed.

[Ashling]

Mixture,

I agree with you however, sadly not all countries respond to a Pan at least not all controllers. A colleague of mine declared a Pan in France, the controller refused to recognise his call. In the end he was forced to use a Mayday.

Skylion

I made the same observation earlier and the worrying thing is that you may well only get the paramedic initially even if you request an ambulance as thats the way the NHS works. Thats why, after bitter experience, I would consider going Nuclear and useing a Mayday even though it is incorrect to do so as Mixture has observed.

Guppy

The reason the UK is so particular about getting you to declare an emergency is because we've found over the years Pilots can be a touch trigger happy and make calls such as "we have a minor problem request direct routeing and a priority approach" When asked the nature of the problem the reply would go something like "a minor technical issue". This left ATC unsure what level of assistance was required and as ASRs were often not filed the rather unpleasent possibility arose that some crews were pulling a fast one to get in ahead of others eg the famous "we're running short of fuel" So ATC quite rightly insisted on a formal declaration of an emergency. That way we all know were we stand and the incident has to be reported and looked at which means we all learn from it and it prevents the bogus calls. As an example, we now know a Pan with low fuel means that an aircraft MAY have to dip into final reserve fuel and a Mayday means it WILL dip into final reserve fuel. Much clearer for all concerned. Certainly better than "request priority due low fuel" "are you declaring an emergency" "er no but request priority approach" So it all prevents the careless and unecessary declaration of emergencies something I gather you are keen to prevent as well.

Although I often take their name in vain Brit ATC are, in my view, the best there is. `

[mixture]

Ashling,

If I were somwhere outside UK airspace where a PAN was not being recognised, I too would probably resort to a MAYDAY, especially, in the case of this scenario, if a doctor on board confirmed that it was indeed a heart attack.

Also, in the case of somewhere like France, I would also seriously consider filing a report against an ATC unit that refused to recognise a PAN.

I made the same observation earlier and the worrying thing is that you may well only get the paramedic initially even if you request an ambulance as thats the way the NHS works.

Indeed.

I believe the practice (particularly for the larger NHS wards, such as London) is that if the phone operator is satisfied that your situation is serious enough (as would be the case with a heart attack), they will send out a FRU with an ambulance to follow.

So yes, you will get your ambulance, but the FRU system is the NHS's way to buy themselves more time to find an available ambulance and/or allow the ambulance to fight through traffic (because FRUs are generally just converted cars, they are smaller and more agile than an ambulance).

[Ashling]

Mixture

My understanding of the system is the same. My bitter experience was with a diabetic who went into shock and they refused to send an ambulance until the paramedic had assessed the patient even though we had a qualified doctor on board pleading for an ambulance. My other half, who is a GP, tells me its because the NHS view the airport as a place of safety due to it having a paramedic there. I do appreciate its in order to avoid the unecessary dispatch of an ambulance which may be needed more urgently elsewhere but you would have thought that when a qualified doctor asks for the ambulance they would relent and send it. Not so apparently. I filed an MOR in the above case.

I also agree that filing a report against ATC if they do not recognise a Pan would be the right thing to do. Certainly upgrading to a Mayday will get it looked at.

[Rananim]

Aircraft capable of conducting autolands, but crew not certified.

Do you mean that their certification has lapsed or that they've never received training?If the former then a return to destination would be an option.Captain's discretion.A crew should do all they feasibly can to avoid a death on board.It IS a big deal.Would depend if there was a doc on board and what he said..would fifteen minutes make the difference to fifty?

[mixture]

would fifteen minutes make the difference to fifty?

In the case of a heart attack, yes. I believe the commonly stated figure is five minutes left untreated will lead to long term effects (brain damage etc.) ... with good quality first aid and/or basic medical attention, you can probably delay this for twenty minutes or so. But a heart attack is something that really needs access to a lot more resources (equipment, pharmaceuticals) than will generally be available on-board.

[SNS3Guppy]

As an example, we now know a Pan with low fuel means that an aircraft MAY have to dip into final reserve fuel and a Mayday means it WILL dip into final reserve fuel. Much clearer for all concerned. Certainly better than "request priority due low fuel" "are you declaring an emergency" "er no but request priority approach" So it all prevents the careless and unecessary declaration of emergencies something I gather you are keen to prevent as well.

Safety of flight is one thing, but we're talking about a sick or unresponsive passenger here. In the US, the standard call for minimum fuel when an emergency condition does not exist but may with any undue delays, is strangely enough, "minimum fuel." A sick passenger is not a threat to the safety of flight. Fuel is a threat to the safety of flight. You see the difference.

Would depend if there was a doc on board and what he said..would fifteen minutes make the difference to fifty?

A doctor is no more capable than any first responder in the absence of oxygen, respiratory equipment, a defibrilator, monitoring equipment, and stabilizing drugs. A doctor could do what you could do; provide forced ventillation and chest compressions. And take a pulse.

Fortunately, many aircraft today are equipped with semi-automatic or automatic electronic defibrilators. Whereas CPR is 80-90% ineffective, a defibrilator brings the chance of survival into the 40% percentile range in the case of a heart attack. In the scenario we're given, however, we don't really have any way of determining what the passenger has; food poisoning, an allergic reaction, a stroke, a heart attack...who knows? We have an unresponsive passenger. Absent the equipment and means to treat the passenger, it's all largely superfluous. The pilot actions remain the same; get somewhere and land in a safe, orderly manner.

A few critics here have spoken their deep offense at my comments regarding panic. Much of my flying career has been in emergency services of one kind or another, and I've seen a lot of pilots take on an "attitude" or sense or urgency when they know an emergency or passenger risk is involved. Sometimes people really do feel as though they should toss the rules to the wind and fly differently because of this new development. I've' seen it time and time again. Many of us wouldn't act differently, and shouldn't. However, I brought it up with good reason.

The drive to turn and land at the departure airport when it's below minimums and the crew isn't trained to fly the approach would be such an example, and therefore is directly relevant.

I believe the commonly stated figure is five minutes ...

Four minutes.

The passenger has three basic life requirements; airway clear, breathing/respiration, and circulation That's the purpose of CPR. However, CPR addresses only the basics of ventillating the patient and circulating blood at a greatly reduced rate. If a heart attack has occured, generally it's because of an incorrect electrical rhythem, and this needs to be evaluated and electrically corrected...hence the need for an AED...which many aircraft have on board now. Todays AED will evaluate the patient's rhythem, determine the course of action and even the value of the shock to be delivered and give aural instructions and warnings, and tell when to shock. Nearly anyone can operate one with minimal training.

[Ashling]

Guppy

I was explaining to you why the UK has gone down the path of getting you to declare an emergency. I fully appreciate the difference between a sick passenger and a fuel emergency. Both however require a calm and reasoned response.

In earlier posts you seemed to allude to a serious medical problem being of no greater consequence than a lost wallet in terms of the attention it would get from you. I do hope I misunderstood you or that you were merely stating something for dramatic impact. A serios medical condition is an emergency a lost wallet is not I hope you appreciate the difference.

[belongins]

I'm no pilot (hopefully CTC training soon though ) but i have some emergency first responder training specialising in AED of heart patients and i agree with the guy below.
Besides dont ac no carry AEDs on board?


<SNIP>
Are your cabin crew not First Aid and CPR current? Unusual. I thought it was a requirement.

If you were foolish enough to turn back when you were 10 min out, you are also at least 15 minutes away from parking the aeroplane and opening the door to let the paramedic in.

Clean up aircraft, climb to planned cruise level, complete all normal checklists, proceed to destination. Advise ATC that you have a pax needing urgent medical assistance on arrival. Details to follow.

Keep seatbelt sign on. Not all pax will be aware that something unusual is taking place in the cabin, so best not have them bumbling their way to the lavatory.

Let your cabin crew do the job they are trained to do. Give them permission to make a PA asking any medically qualified persons on board to come forward and assist.

If you have more than 50 pax on board, there will be at least one doctor or one nurse on board (I had one heart surgeon, one emergency room doctor, and three nurses out of 65 pax respond to such a request when a young woman had a grand mal seizure aboard last year).

Your hypothetical heart attack victim will need immediate attention. If respiration and circulation are not restored within 3 minutes, that person is in a grave situation.

Dont sit his/her rescuers down for 15 minutes while you attempt an autoland at a below minimums aerodrome. Use your crew and passenger resources.
<SNIP>

[Notso Fantastic]

Mixture, you appear to have a clear reference to what the rule books state, and a lot of computer experience, but you are seriously misled as to what happens in real life out there in practice.

Not really wishing to be drawn into the general debate about turning back vs proceeding to destination that's going on here.....

Suggest some of you re-read CAP 413.

A PAN would probably be justified and appropriate in order to try to get you priority routing and medical assistance on the ground. (ref: definition of "urgency" in CAP413).

Use of MAYDAY for pax emergencies is less clear and probably would be less justified in this scenario.

P.S. I believe you'll also find that PAN and MAYDAY are internationally recognised and should always initiate ICAO prescribed procedures.

You need to understand very few parts of the world have any recognition or knowledge of Pan.

I believe the practice (particularly for the larger NHS wards, such as London) is that if the phone operator is satisfied that your situation is serious enough (as would be the case with a heart attack), they will send out a FRU with an ambulance to follow.

So yes, you will get your ambulance, but the FRU system is the NHS's way to buy themselves more time to find an available ambulance and/or allow the ambulance to fight through traffic (because FRUs are generally just converted cars, they are smaller and more agile than an ambulance).

You are wrong. We were repeatedly told not to request an ambulance 'to meet the aircraft on arrival at London' because we wouldn't get one. I'm not sure where you get your references for such positive statements, but you are seriously misled if you think that is how it is out there in practice! Reading and quoting CAP 413 or the whole Air Navigation Order will get you precisely nowhere. I wouldn't want to sit in Court being sued by relatives and being asked by Learned Counsel 'so Mr. Smith was mortally suffering whilst you were airborne.....and you chose not to even declare an emergency?' What exactly is one to do when Pan is not recognised or known?

Guppy,

Simply telling ATC what you have, what your intentions are, and then getting it done will suffice.

Wrong! Maybe in the US in your type of ops. Maybe some other parts of the world. I believe the UK response (and Aus as well from what I have seen) will be simply 'are you declaring an emergency?' Airline ops are different to yours.

[SNS3Guppy]

In earlier posts you seemed to allude to a serious medical problem being of no greater consequence than a lost wallet in terms of the attention it would get from you.

I am not on board as a finder of lost wallets, nor as an EMT...though I've certainly done both. Many years spent as a firefighter and medic, in fact. However, that's not my job...I'm there to fly. No spilt tears for the victim, only thoughts for the airplane and the flight. If you can't operate like that, then you've no business being on board.

Airline ops are different to yours.

Are they? What sort of operation do you suppose it is for which I fly?

Hate to burst your bubble, but it's an airline, operating internationally.