Redcordes From United States of America, joined Jan 2006, 245 posts, RR: 0 Posted (4 years 10 months 3 weeks 4 days 2 hours ago) and read 3014 times:
What training does the crew of an airliner typically have to deal with in-flight, medical emergencies? Also, what equipment/supplies are carried? I suppose the Captain has discretion as to if, where and when to divert, but this must be a difficult decision to make. Also, I assume the larger the aircraft the more likely it is to be confronted with these decisions, and the more costly the diversions.
"The only source of knowledge is experience." A. Einstein "Science w/o religion is lame. Religion w/o science is blind."
MarkHKG From United States of America, joined Dec 2005, 954 posts, RR: 2 Reply 1, posted (4 years 10 months 3 weeks 3 days 23 hours ago) and read 2980 times:
Most carriers will provide emergency first aid training for their cabin crew. Typically, the following topics are discussed:
- Cardiac Emergencies (Heart Attack)
- CPR, Choking first aid and use of Automated External Defibrillators (if equipped)
- Medical Oxygen administration
- Sudden illness (Diabetic emergency, stroke, allergic reaction)
- Injuries (Severe bleeding, broken bones, etc)
- Familiarization with on board first aid kit
- Procedures to handle Emergency Medical Kit and requests for medical assistance
- Telemedicine procedure (i.e. MedLink)
- Bloodborne Pathogens training
On US Carrier (Part 121 Operations), typically if there is 1 flight attendant on board, an Automated External Defibrillator is required. Basic first aid kits are required in the cabin. Certain carriers may also be required to carry an Enhanced Medical Kit (EMK) (sometimes called a Doctor's Kit) that includes things such as medications (Epi Pen, etc.) for doctors/nurses/paramedics to use. The EMK also typically has a BP cuff and a stethoscopes, among other things. Flight attendants are not permitted to use the EMK.
Other airlines, such as VS, may carry advance telemedicine equipment that can wirelessly transmit ECG and other vital sign data to a offsite medical center.
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Zeke From Hong Kong, joined Dec 2006, 6561 posts, RR: 72 Reply 2, posted (4 years 10 months 3 weeks 3 days 21 hours ago) and read 2962 times:
Quoting Redcordes (Thread starter): I suppose the Captain has discretion as to if, where and when to divert, but this must be a difficult decision to make. Also, I assume the larger the aircraft the more likely it is to be confronted with these decisions, and the more costly the diversions.
We only divert when MedAire (http://www.medaire.com/comm_air.asp) has recommended to our ops people to divert, and they have a plan in place for the diversion. Once we have been told to divert by ops, MedAire picks up all the costs, it is like an insurance policy and 24/7 medical help line in one. The have all the enroute airport capabilities, the hospitals, doctors on hand etc. Also carry a number of medical kits on-board some of which can only be used by a doctor, also carry defibrillator etc.
The flight crew can also say no to a diversion for operational reasons which may put more passengers at risk than one ill passenger.
Gkirk From UK - Scotland, joined Jun 2000, 24519 posts, RR: 62 Reply 3, posted (4 years 10 months 3 weeks 3 days 14 hours ago) and read 2914 times:
Quoting Zeke (Reply 2): The flight crew can also say no to a diversion for operational reasons which may put more passengers at risk than one ill passenger.
I'm guessing that would only be a last resort, if the nearest airport suitable was in a hostile environment?
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Sean1234 From United States of America, joined Aug 2000, 411 posts, RR: 0 Reply 4, posted (4 years 10 months 3 weeks 3 days 4 hours ago) and read 2846 times:
MarkHKG From United States of America, joined Dec 2005, 954 posts, RR: 2 Reply 6, posted (4 years 9 months 4 weeks 1 day 19 hours ago) and read 2513 times:
There are kit contents from one company for the EMK (Emergency Medical Kit) and EEMK (Enhanced Emergency Medical Kit).
RNOcommctr From United States of America, joined Jan 2001, 815 posts, RR: 4 Reply 7, posted (4 years 9 months 4 weeks 1 day 3 hours ago) and read 2452 times:
We get a LOT of medical diversions into RNO. Some are out of SFO, SEA, and others. Many times we get a call from Medlink. Other times we get the call from the ATCT and never hear from Medlink. Occasionally we get a call from the local airline ops (depending on whether the diverted a/c has operations in RNO). And because we get medical calls from so many sources, we have to make sure the local airline ops is aware (sometimes they are the last to know) and sometimes we have to let the ATCT know so they can give the emergency a/c priority handling.
We try to get the seat/row number of the patient to assist paramedics in getting to the patient.
OPNLguy From , joined Dec 1969, posts, RR: Reply 8, posted (4 years 9 months 4 weeks 1 day 3 hours ago) and read 2448 times:
Quoting Gkirk (Reply 3): I'm guessing that would only be a last resort, if the nearest airport suitable was in a hostile environment?
Quoting Sean1234 (Reply 4): ...or maybe due to weather, runway length, etc.
Just a point of clarification, but Medlink makes the general divert decision, and may even recommend the closest airport, but it's up to the flight's PIC and dispatcher to determine whether the closest airport is suitable. If a flight is overhead AMA at 35,000 and they recommend diverting there, there's no way for the medical folks can know that AMA is 1/4SM in snow with a 40 knot crosswind, in which case I'll look at LBB, ABQ, ROW, GCK or someplace else.
If I had to take I wild guess, it'd be that we end up diverting somewhere 10%-15% of the time. Having access to medical personnel really cut down on the unnecessary diversions...
A380US From United States of America, joined Mar 2007, 2357 posts, RR: 1 Reply 9, posted (4 years 9 months 3 weeks 5 days ago) and read 2331 times:
but honostly who decides if the doctor is qualified also in a case if something (g-d-forbid) something happens to the pilot lets say a 747 is the copilot supposed to land it himself or how is it done its pretty hard todo that (i imagine)
Practice makes perfect but no ones perfect so why practice?
Bellerophon From United Kingdom, joined May 2002, 556 posts, RR: 62 Reply 10, posted (4 years 9 months 3 weeks 4 days 22 hours ago) and read 2316 times:
Redcordes
...I suppose the Captain has discretion as to if, where and when to divert...
Yes.
However, like all decisions, it must be made with the safety of all the passengers in mind, not just the invalid requiring attention.
...but this must be a difficult decision to make...
No, on most occasions, it isn't a difficult decision, as you will receive, first hand, expert medical advice, given by doctors who have a reasonable understanding of airline operations. Whether that advice is to divert or, as it is in the majority of cases, not to divert, you will generally have no reason to disregard it.
On some, hopefully very rare, occasions it may be a difficult decision, because you might decide you have to ignore sound medical advice, which would undoubtedly benefit the invalid, because the proposed course of action would pose too high a risk to the rest of the passengers; perhaps as a result of information you've received from someone like OPNLguy.
Remember, distressing as it may be for the invalid, just because one life may be in danger, that is no justification for taking any undue risks with all the other lives on board.
...I assume the larger the aircraft the more likely it is to be confronted with these decisions...
Yes, broadly speaking, although more correctly, probably, the number of passengers carried, rather than the size of the aircraft.
However, the duration of flight, type of route and time of year are also very relevant, because, perhaps much more so than you might think, they can determine the type of passenger travelling.
An aircraft carrying fifty retired, elderly passengers, travelling LHR-SIN-SYD, taking advantage of cheaper air fares during off-peak times of the year, will, statistically, present a greater risk of a medical incident than an aircraft carrying fifty college football players from JFK-MIA for a football match.
...and the more costly the diversions...
Yes, but irrelevant.
I might just ignore MedLink on the grounds of safety, but never on the grounds of cost.
MedLink have saved the airlines money because, as OPNLguy has already said, they have prevented countless precautionary diversions that would probably otherwise have been made.
Finally, let me say I have lost count of the times I have phoned MedLink for advice - I did so on my flight last week - and they are, quite simply, excellent.
OPNLguy From , joined Dec 1969, posts, RR: Reply 11, posted (4 years 9 months 3 weeks 4 days 5 hours ago) and read 2261 times:
Quoting Bellerophon (Reply 10): I might just ignore MedLink on the grounds of safety, but never on the grounds of cost.
I'd never ignore them on the basis of cost either, nor a divert recommendation (unless "A" was unsuitable but the next closest "B" was suitable), but I did ignore one of their "continue" recommendations once. A pax in their mid-70s was complaining of sudden, severe eye pain in one eye, which he'd surgery on about a week earlier. The destination was about 1:15 away, but the flight would have overflown one of our major stations just :20 min ahead. After they dropped off the patch, I asked the PIC if he was copacetic with that decision to continue (I wasn't) and he wasn't either, so I dropped the flight into our major station just ahead. Our reasoning was that it just wasn't humane to keep the pax in severe pain any longer than necessary. (I've had eye surgery in the past, and could readily imagine what the gent must have been going through). The pax ended up making the final segment of his journey by train.
They are a great service, and provide excellent service. Before we had them, we'd usually divert for anything and everything. I had a PHX-AUS flight over ELP one night radio in with an odd one. They said the had a 14-year old boy traveling by himself and he'd somehow managed (bored, I guess) to stick a small marble in his ear, and now couldn't get it out, and was in some pain. The PIC wanted to know if he should land in ELP (33,000 feet below) or continue to AUS and make a long gradual descent to keep the pressure changes bearable for him. My wife at the time was an ICU nurse, so I rang her up, and she put me on hold while she consulted their ER department. While I was waiting, I had a fleeting thought about telling the PIC to send the F/O back to the cabin with the crash axe to "offer" to get it out and scare the snot out of the kid, but she returned to the line just as the PIC was radioing back that the marble had popped out on its own.
OPNLguy From , joined Dec 1969, posts, RR: Reply 13, posted (4 years 9 months 3 weeks 3 days 12 hours ago) and read 2211 times:
Quoting MarkHKG (Reply 12): OPNLguy, your story is absolutely priceless.
The truth can be funny sometimes. Sad too. There was a case on a ABQ-SAN flight where a troubled soul went into the forward lav and attempted suicide by slashing their wrists. No need to evaluate a divert decision there--they screamed into PHX at Warp Factor 10. I don't recall whether they survived or not, but it was a major clean-up job.
Those types don't (fortunately) happen too often. In other bizarre ones, I had another one where a young woman (25-30, IIRC) traveling with her boyfriend was showing symptoms of an apparent heart attack. We ended up diverting, and the ambulance took her away, but there wasn't room for the boyfriend, who was to take a cab to the hospital. We found out later that the female bolted from the ambulance at some point, and it turns out she was trying to get away from the boyfriend.
IAHFLYR From United States of America, joined Jun 2005, 4063 posts, RR: 29 Reply 14, posted (4 years 9 months 3 weeks 3 days 9 hours ago) and read 2191 times:
Quoting OPNLguy (Reply 13): We found out later that the female bolted from the ambulance at some point, and it turns out she was trying to get away from the boyfriend.
That is brilliant, right up to the point the airline sends her the divert cost!!!!!
S5FA170 From United States of America, joined Sep 2005, 534 posts, RR: 5 Reply 15, posted (4 years 9 months 3 weeks 3 days 8 hours ago) and read 2173 times:
To answer the question about the qualifications of someone offering medical assistance:
Somewhere in the Aviation Medical Act is a statement that basically instructs flight crews that if a passenger presents themselves as a Medical Doctor, and we have no reason to doubt that statement (you're basically going off of their look and what information they communicate to you verbally), we are not required to see any proof of certification.
Both times that I have had medical diversions, MedLink was never called. The first one we had a nurse on board who informed us our passenger was having a stroke - easy decision.
The second one, we had no qualified medical personel on board and we were only 25 minutes out of our departure destination. Also an easy decision. We couldn't pinpoint what was wrong with him, only try to treat select symptoms, so it was better to get him to paramedics ASAP.
At my airline, our medical training is minimal, so as to avoid us being liable in the event we mess something up. Charming, eh?
MarkHKG From United States of America, joined Dec 2005, 954 posts, RR: 2 Reply 16, posted (4 years 9 months 3 weeks 2 days 23 hours ago) and read 2109 times:
Quoting S5FA170 (Reply 15): At my airline, our medical training is minimal, so as to avoid us being liable in the event we mess something up. Charming, eh?
Great, that means you can resort to the medical training you see on television!
Defibrillator = thump the chest with a fist (ER), For blocked airway = use a pen into the trachea (ER), For a drug overdose = inject the heart (Pulp Fiction), Suck out snake bite poison (John Wayne), Use a tourniquet on bleeding wounds (John Wayne)
All of the above are wrong things to do, by the way! Seems to me that television, not first aid training, will get you in trouble.
Release your seat-belts and get out! Leave everything!
OPNLguy From , joined Dec 1969, posts, RR: Reply 17, posted (4 years 9 months 3 weeks 2 days 22 hours ago) and read 2106 times:
Quoting MarkHKG (Reply 16):
All of the above are wrong things to do, by the way! Seems to me that television, not first aid training, will get you in trouble.
One of the other benefits of using Medlink is that they assume all the liability, and that's a major factor. Conversely, if they're not used (when they should be), the PIC and/or F/As are accepting liability on behalf of the company, and that's alot of potential exposure.
I heard of a case from a friend at another airline, that one of their PICs called in about 1 hour into a 4 hour flight to request a replacement portable oxygen bottle (POB) on arrival at the destination (XYZ), which was 3 hours ahead. Their inevitable question then was "why do you need one?" and it turned out a pax wasn't feeling well. The F/As and PIC hadn't gone through Medlink, and had to be reminded of the liability aspect, rather than rely on their (or the pax's) opinion that the pax looked/felt "better". Medlink got involved, and since they suspected an intestinal blockage, they recommended a divert to ZZZ which they did. The pax was taken to a hospital where they underwent surgery for, you guessed it, an intestinal blockage. Would the pax have survived another 2-3 hours until they reached their intended destination XYZ? Who knows, but had the pax succumbed, there undoubtedly would been a wrongful death lawsuit and a check with a great many zeroes in it...
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