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Medical Emergency Diversions/ No Doctor On Board  
User currently offlineJulesmusician From , joined Dec 1969, posts, RR:
Posted (8 years 9 months 4 weeks 5 hours ago) and read 2694 times:

When an airliner has to consider diverting because of a medical emergency of a passenger, and there are no skilled medical practitioners on board then who makes the call for the diversion? - is the captain obliged to get medical advice through the radio before diverting? - also is the captain obliged to call the company he flies for and talk to them before making the decision or would it be "this sounds bad I am diverting" and just do it? - this assumes there is no medical person on board to give qualified advice..

J

[Edited 2005-10-30 00:05:49]

14 replies: All unread, jump to last
 
User currently offlineOPNLguy From , joined Dec 1969, posts, RR:
Reply 1, posted (8 years 9 months 4 weeks 5 hours ago) and read 2682 times:

Can't speak for all locales in the world, but here in the USA, many airlines use the services of Medlink, who are associated with a major hospital ER in Phoenix.

The flight initiates the call to its dispatch office via ARINC, and the flight, the dispatcher, and Medlink are all on the phone/radio patch. The flight gives the ER folks the situation, and the ER Doc recommends treatment or diversion accordingly. Actual diversions happen maybe 10% of the time, and the dispatcher is involved to ensure (along with the captain) that any diversion point that the ER Doc recommends is operationally suitable (above weather minimums, for exampe).

Other airlines may have similar arrangements, but use their own internal medical staffs.


User currently offlineHAWK21M From India, joined Jan 2001, 31679 posts, RR: 56
Reply 2, posted (8 years 9 months 3 weeks 6 days 23 hours ago) and read 2617 times:

Out here Normally theres always a Doc on board amongst the Pax.However on not having a Doc to Advice on the Situation.The Capt takes the Decision to divert.
regds
MEL



Think of the brighter side!
User currently offlineCX flyboy From Hong Kong, joined Dec 1999, 6597 posts, RR: 55
Reply 3, posted (8 years 9 months 3 weeks 6 days 21 hours ago) and read 2604 times:

We use Medlink, which is fine for us as it takes the responsibility out of our hands. We will tell them where we can divert (If thats what they want) and they then pick the best place out of the options we have given them.

At the same time, the medlink people can give advice to the cabin crew, or a doctor on how to treat the passenger.


User currently offlinePhilSquares From , joined Dec 1969, posts, RR:
Reply 4, posted (8 years 9 months 3 weeks 6 days 21 hours ago) and read 2606 times:

No matter what the situation is, the Captain always has the responsibility to make the decision.

At my company we use a third party for inflight medical advice. Even if there is a physician onboard we still contact the third party. Normally, the captain, dispatch and the medical experts come to an agreement on where the best divert location is.

As a captain, the more information I have the easier it is for me to make any decision. Dispatch has a much better idea of facilities for the party involved and the other passengers too.


User currently offlineOPNLguy From , joined Dec 1969, posts, RR:
Reply 5, posted (8 years 9 months 3 weeks 6 days 21 hours ago) and read 2602 times:

Quoting PhilSquares (Reply 4):
No matter what the situation is, the Captain always has the responsibility to make the decision.

With respect to the medical divert, i.e. Doc says divert and PIC says no?


User currently offlineCX flyboy From Hong Kong, joined Dec 1999, 6597 posts, RR: 55
Reply 6, posted (8 years 9 months 3 weeks 6 days 21 hours ago) and read 2599 times:

Obviously everything to do with the aircraft and passengers is ultimately the captains responsibility...however it would take a real good reason and guts on the captains part to ignore a recommended diversion and continue only to have a passenger die.

User currently offlineKevinl1011 From United States of America, joined Mar 2005, 2964 posts, RR: 48
Reply 7, posted (8 years 9 months 3 weeks 6 days 20 hours ago) and read 2591 times:

On a related note. Recently, my sister who is a PA (Physicians Assistant) was on a WN flight, PHX-CLE. An elderly woman began to experience a heart attack and the FA called for asst. My sister, who worked many years in the Trauma center at Mission Hospital (Mission Viejo, CA.) and knows her stuff was very impressed with the FA's handling of the situation. The FA relayed medical terms and info proficiently to Medlink. Additionally, she was very impressed with the medical kit and supplies WN had on board their 737-700. You could do emergency surgery if you had to. The only crappy part was that she saved them from a diversion and got nothing in return.

All said, Not enough respect is given to the FA's up there. Joe Pax views them as servants and not as the potential life savers that they are.
KevinL



474218, Carl, You will be missed.
User currently offlineHAWK21M From India, joined Jan 2001, 31679 posts, RR: 56
Reply 8, posted (8 years 9 months 3 weeks 6 days 13 hours ago) and read 2546 times:

Quoting Kevinl1011 (Reply 7):
The only crappy part was that she saved them from a diversion and got nothing in return.

 Smile

Quoting Kevinl1011 (Reply 7):
The FA relayed medical terms and info proficiently to Medlink

Is Medilink Available for most countries.Is there an Area coverage.Any Info/link on Medilink.
regds
MEL



Think of the brighter side!
User currently offlineSlamClick From United States of America, joined Nov 2003, 10062 posts, RR: 68
Reply 9, posted (8 years 9 months 3 weeks 6 days 12 hours ago) and read 2539 times:

Medlink is a great system and a real asset in such circumstances. The crew has enough to think about without having to make medical decisions. We also carry medical kits with some common drugs used by emergency medicine folks and a defibrillator.

Quoting OPNLguy (Reply 5):
With respect to the medical divert, i.e. Doc says divert and PIC says no?

I can't imagine a pilot overruling a doctor on a medical matter but I am certainly going to make the call on operational matters. I don't care if we are right smack over a city with the best hospital in the world for this person, if they are having a level-5 thunderstorm over the airport at the moment I am going to the second-best.

Divert? Get them on the ground? Absolutely, no problem. Land on the hospital helipad - I don't think so.

But then I doubt there are any medical professionals who would quarrel with a captain's or aircraft dispatcher's operational decision.



Happiness is not seeing another trite Ste. Maarten photo all week long.
User currently offlinePhilSquares From , joined Dec 1969, posts, RR:
Reply 10, posted (8 years 9 months 3 weeks 6 days 11 hours ago) and read 2522 times:

Quoting OPNLguy (Reply 5):
With respect to the medical divert, i.e. Doc says divert and PIC says no?

At SQ we always have a third party, so I'm not worried about that. I think flying domestically vs. International puts things in a very different perspective.

Internationally, it can be a very clear cut decision. Domestically, it's much more convoluted.


User currently offlineOPNLguy From , joined Dec 1969, posts, RR:
Reply 11, posted (8 years 9 months 3 weeks 6 days 10 hours ago) and read 2513 times:

Quoting SlamClick (Reply 9):
I can't imagine a pilot overruling a doctor on a medical matter but I am certainly going to make the call on operational matters. I don't care if we are right smack over a city with the best hospital in the world for this person, if they are having a level-5 thunderstorm over the airport at the moment I am going to the second-best.

Divert? Get them on the ground? Absolutely, no problem. Land on the hospital helipad - I don't think so.

But then I doubt there are any medical professionals who would quarrel with a captain's or aircraft dispatcher's operational decision.

I was just wondering, because PhilSquares' statement seemed a bit of a disconnect and otherwise not in the context of a medical decision versus a purely operational one, thus my question to him to clarify.

I once did have a Medlink Doc advise us to divert said AMA was the closest place. AMA had been MVFR when the flight had departed hours earlier ABC-PHX to go over the top of AMA, but it had since gone 1/4 mile in fog with RVR below mins, so I jumped right in and said nearby LBB was the best place to go.

Although I don't know of any situations where the Doc said "divert" and the PIC declined, a dispatcher I know at another airline once related a story that's close.

About :30 into a 4:30 flight, the PIC radioed in to request a replacement POB at his destination (a MX base) 4:00 ahead. The dispatcher asked the inevitable question "Why do you need one?" and it turned out there was a passenger aboard with abdominal pain. Although the F/As wanted the PIC to hook them up with Medlink, the PIC didn't think it was serious, and didn't want to get Medlink involved. (It should be noted that this was the PIC's last leg of his sequence, back to his domicile). The dispatcher was mindful of the liability aspect, and Medlink was finally brought into the loop. Medlink's diagnosis (based on the passenger's symptoms and recent medical history) was that he had a serious bowel obstruction, and the Doc recommended diverting, which they did. The passenger went to the local ER, and did indeed have an obstruction, and they operated immediately. Would the passenger had succumbed in during the remaining flight time, had they continued? Impossible to say, but having procedures in place only to be ignored by a "rogue" for apparently personal reasons isn't a good thing. My buddy never said what happened to the PIC involved, but I would imagine he at least had a sit-down with his Chief Pilot.


User currently offlineSlamClick From United States of America, joined Nov 2003, 10062 posts, RR: 68
Reply 12, posted (8 years 9 months 3 weeks 6 days 9 hours ago) and read 2502 times:

Quoting OPNLguy (Reply 11):
the PIC didn't think it was serious, and didn't want to get Medlink involved.

Wow! Wow! It always astounds me when someone makes a judgement like that. Hard for me to imagine someone wanting to get home so bad that they would actually let it affect their judgement.

I've had every motivation you could imagine for getting home on time (and some you might not imagine) but to interfere in a medical issue? Wow! I mean, you say a bad word or two then you do what has to be done.

Quoting OPNLguy (Reply 11):
My buddy never said what happened to the PIC involved, but I would imagine he at least had a sit-down with his Chief Pilot.

If I was chief pilot I'm afraid I'd have to hand this one off to someone more even-tempered than myself.



Happiness is not seeing another trite Ste. Maarten photo all week long.
User currently offlineOPNLguy From , joined Dec 1969, posts, RR:
Reply 13, posted (8 years 9 months 3 weeks 6 days 8 hours ago) and read 2500 times:

Quoting SlamClick (Reply 12):
Wow! Wow! It always astounds me when someone makes a judgement like that. Hard for me to imagine someone wanting to get home so bad that they would actually let it affect their judgement.

I've had every motivation you could imagine for getting home on time (and some you might not imagine) but to interfere in a medical issue? Wow! I mean, you say a bad word or two then you do what has to be done.

Another example, also heard from an industry counterpart, and heavily sanitized for obvious reasons:

Narrow-bodied flight off an east coast airport to a hub (also a crew domicile and MX base) in VMC weather, no destination alternate required. About 2/3 of the way enroute, the PIC calls a MX controller on the radio (not the dispatcher) and mentions that they've been unable to get to normal cruise altitude and normal speed. MX suspects a MLG door(s) hanging down.

Dispatcher is within earshot, hears it all, and queries the PIC as to the flight's current fuel quantity. Answer given. Dispatcher then asks flight's DME distance from airports AAA, BBB, and CCC, as well as from the scheduled destination. The scheduled destination is furthest, and AAA is the shortest. Dispatcher changes flights destination to AAA and tells them to proceed there ASAP. PIC replies that AAA not in Ops Specs. Dispatcher says it doesn't matter and then declares emergency. Flight lands uneventfully at AAA, but with only a few hundred pounds of fuel left. Flight never would have made the scheduled destination, due, of course, to the additional fuel consumption from the drag of the gear door(s). PIC was getting off at the destination, and was to make a quick connection to another flight so he could DH home. He seems to have been distracted...


User currently offlineBa299 From United Kingdom, joined Jun 2003, 173 posts, RR: 1
Reply 14, posted (8 years 9 months 1 week 6 days 18 hours ago) and read 2239 times:

At BA we use the assistance of a London Trauma centre. When we have this issue the team work are essential. The CSD talk with the doctor to give all the medical information, the captain contact the OPS-control to make the arrangement for a diversion, the F/O check for a suitable alternate.
When the decision to divert is made (by the doctor). The captain and the F/O decide where to divert and declare PAN-PAN.
Normally than we send a diversion message to the OPS control via ACARS with the new destination.


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