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Medical Emergencies Over Big Oceans  
User currently offlineKris From United Kingdom, joined Mar 2006, 51 posts, RR: 0
Posted (5 years 10 months 5 days 4 hours ago) and read 5785 times:

A hypothetical question - if for example a pax had a cardiac arrest over the middle of the Atlantic requiring full resuscitation, what would the procedure be?

Do aircraft have to be within a certain flight time of an airport when over a big patch of water, and what would the maximum time be?

Do procedures advocate an immediate descent to below a certain altitude in order that the pax will get more benefit from tissue oxygenation from CPR, or do you remain at a higher altitude to save fuel just in case?

And lastly: is there anywhere I can read the regulations for such an emergency?

Thanks in advance

48 replies: All unread, showing first 25:
 
User currently offlineFrancoflier From France, joined Oct 2001, 3735 posts, RR: 11
Reply 1, posted (5 years 10 months 5 days 3 hours ago) and read 5760 times:



Quoting Kris (Thread starter):
if for example a pax had a cardiac arrest over the middle of the Atlantic requiring full resuscitation, what would the procedure be?

The procedure varies from airline to airline, but generally speaking, the cabin crew would call a doctor on the ground through satcom and get instructions from them. If a doctor is on board he can be asked to help, and cabin crews have basic CPR training. Airlines usually carry a doctor kit with more advanced medical hardware and medications than the basic medkit (to be used by a doctor only), and a defibrilator.

Decisions regarding deviations are made jointly by the ground doctor, ops and the pilots.

Quoting Kris (Thread starter):
Do aircraft have to be within a certain flight time of an airport when over a big patch of water,

The only distance requirement from an airport I know is that of ETOPS and various fuel constraints (depressurization, engine loss...). None of these are related to health concerns for the people onboard (apart from the obvious one...).

Quoting Kris (Thread starter):
Do procedures advocate an immediate descent to below a certain altitude in order that the pax will get more benefit from tissue oxygenation from CPR

I have no medical knowledge, so I don't know whether a lower cabin altitude would actually help more than administering oxygen, but no, O2 is all they'd get, unless there are serious medical conditions in which high cabin alt would endanger the life of the patient even if he's breathing oxygen.

Quoting Kris (Thread starter):
is there anywhere I can read the regulations for such an emergency?

Civil aviation regulations regarding these events vary from country to country, but I'm sure they're mostly similar. You could look up the FAR or JAR texts.
Airlines have their own procedures approved by local authorities and they also differ from one to another.



Looks like I picked the wrong week to quit posting...
User currently offlineEMBQA From United States of America, joined Oct 2003, 9364 posts, RR: 11
Reply 2, posted (5 years 10 months 5 days 2 hours ago) and read 5725 times:



Quoting Kris (Thread starter):

There are no regulations that govern this that I know of...

What do you do...?
Hope there is a medically trained person on-board...
Get on the ground as fast as you can...

The cold reality.. If you have a cardiac in mid flight across the open ocean, your chances are very-very slim



"It's not the size of the dog in the fight, but the size of the fight in the dog"
User currently offlineKris From United Kingdom, joined Mar 2006, 51 posts, RR: 0
Reply 3, posted (5 years 10 months 4 days 23 hours ago) and read 5657 times:



Quoting Francoflier (Reply 1):

Thanks for the info - very useful

Quoting Francoflier (Reply 1):
I don't know whether a lower cabin altitude would actually help more than administering oxygen

In theory it would help in addition to giving oxygen, as the amount of oxygen available to the body would increase by about quarter by dropping the altitude from 8,000ft to sea level, but I don't know how much it would help in practice for the outcome of the patient in the event they survive. There is an altitude limit for some medical flights for this reason, I was just wondering if it was part of any airline medical procedure.

Quoting EMBQA (Reply 2):
The cold reality.. If you have a cardiac in mid flight across the open ocean, your chances are very-very slim

That's more or less what my colleagues and I concluded! Best to avoid it then...

Thanks for the replies all

Kris


User currently offlineTheGreatChecko From United States of America, joined Mar 2004, 1128 posts, RR: 2
Reply 4, posted (5 years 10 months 4 days 23 hours ago) and read 5646 times:

In the US, other than regulations requiring that certain medical equiptment is onboard the aircraft, there are no regulations specifically addressing passenger health issues onboard an aircraft.

The Emergency Medical Kit, does contain the required meds to run a full code, however, the use of such meds would require properly trained medical personnel onboard. I'm an EMT Basic, but my scope of care does not include the administration of the drugs required to resuscitate someone from a full arrest, so I would not use those meds, even if I had authorization from medical control to use them (thank lawyers for that).

So at the end of the day, hope for a doctor or critical care nurse to be onboard and you might have a shot.

Checko



"A pilot's plane she is. She will love you if you deserve it, and try to kill you if you don't...She is the Mighty Q400"
User currently offlineBlackbird From , joined Dec 1969, posts, RR:
Reply 5, posted (5 years 10 months 4 days 17 hours ago) and read 5511 times:

Could the Captain call over the P/A -- a passenger is having a heart-attack in row 15, we need anybody here who's a doctor to head over there on the double or something to that effect?


Blackbird


User currently offlineTheGreatChecko From United States of America, joined Mar 2004, 1128 posts, RR: 2
Reply 6, posted (5 years 10 months 4 days 16 hours ago) and read 5469 times:



Quoting Blackbird (Reply 5):
Could the Captain call over the P/A -- a passenger is having a heart-attack in row 15, we need anybody here who's a doctor to head over there on the double or something to that effect?

Probably be a PA from a flight attendant asking is there were any medical professionals onboard.

However, with the commotion stemming from someone in cardiac arrest, I'm sure someone would probably just step forward.

Checko



"A pilot's plane she is. She will love you if you deserve it, and try to kill you if you don't...She is the Mighty Q400"
User currently offlineStarlionblue From Greenland, joined Feb 2004, 16992 posts, RR: 67
Reply 7, posted (5 years 10 months 4 days 16 hours ago) and read 5465 times:



Quoting Kris (Reply 3):

Quoting EMBQA (Reply 2):
The cold reality.. If you have a cardiac in mid flight across the open ocean, your chances are very-very slim

That's more or less what my colleagues and I concluded! Best to avoid it then...

If you are over 50-60 or otherwise have an elevated risk of blood clots or other circulatory issues, it is a good idea to take an aspiring before take-off on a flight, especially long haul. This will dilute the blood slightly.

It you are over 60 it may be a good idea to take half an aspirin a day anyway.



"There are no stupid questions, but there are a lot of inquisitive idiots."
User currently offlineLowrider From United States of America, joined Jun 2004, 3220 posts, RR: 10
Reply 8, posted (5 years 10 months 4 days 15 hours ago) and read 5455 times:



Quoting Blackbird (Reply 5):
Could the Captain call over the P/A

In the past I have seen Flight Attendants making the call. It is usually fairly generic, along the lines of, "Will any medical professional please identify themselves by pressing their call button?". It is slightly more discrete and helps keep an audience from forming.



Proud OOTSK member
User currently offlineBhill From United States of America, joined Sep 2001, 948 posts, RR: 0
Reply 9, posted (5 years 10 months 4 days 14 hours ago) and read 5436 times:

I suspect the with the patient being administered 100% O2 @ 2L a min. most likely by mask, altitude would have a minor effect. With the newer AED's bring used and guidance from the ground, hopefully a persons' chance of survival has greatly improved. A question tho...would cruising at a lower altitude help at all? Seems to me it would be easier to treat the patient without being bumped around in the thicker air. Not easy to start an IV when the target is moving around.

Cheers



Carpe Pices
User currently offlineFrancoflier From France, joined Oct 2001, 3735 posts, RR: 11
Reply 10, posted (5 years 10 months 4 days 12 hours ago) and read 5409 times:



Quoting Kris (Reply 3):
In theory it would help in addition to giving oxygen, as the amount of oxygen available to the body would increase by about quarter by dropping the altitude from 8,000ft to sea level, but I don't know how much it would help in practice for the outcome of the patient in the event they survive. There is an altitude limit for some medical flights for this reason, I was just wondering if it was part of any airline medical procedure.

Interesting, but no, oxygen from a bottle is all they'd get until the aircraft started its descent to a landing.



Looks like I picked the wrong week to quit posting...
User currently offlineFirefly_cyhz From Canada, joined Jul 2000, 167 posts, RR: 1
Reply 11, posted (5 years 10 months 4 days 2 hours ago) and read 5304 times:

As a medic who has taken a flight medicine course (I've never worked as a flight medic, just took the course) the first thing we were told when we walked in the door was if you remember nothing else remember that when you go higher the patient gets sicker...something to do with all those gas laws I had hoped I'd never have to think about again... the outcome from a cardiac arrest is not good even in the most ideal situations, I would imagine it is much worse in an aircraft..does anyone know if there are any statistics published anywhere for this?

User currently offlineStarlionblue From Greenland, joined Feb 2004, 16992 posts, RR: 67
Reply 12, posted (5 years 10 months 4 days 1 hour ago) and read 5283 times:

If the plane goes low enough to increase pressure that would mean under 10k feet or so. This means slower speeds and more fuel burn. If you're in the middle of the ocean delaying arrival for the cardiac event victim is probably worse than exposing him/her to lower pressure.


"There are no stupid questions, but there are a lot of inquisitive idiots."
User currently offlinePoint8six From United Kingdom, joined Apr 2008, 94 posts, RR: 0
Reply 13, posted (5 years 10 months 3 days 21 hours ago) and read 5224 times:

I have had 2 medical emergencies over the Atlantic and in both cases (one eastbound, one westbound) diverted into Bermuda, with excellent medical response on arrival.
Some airlines carry defibrillators on board and their Cabin Crew are trained operatives. Not all medically qualified personnel identify themselves to cabin crew following an announcement requesting them to do so, because of fear of litigation following incorrect diagnosis and treatment -sad but true.
Just a point on descending to lower the cabin altitude, it is reckoned on the B747 that flight at 14,000ft doubles the fuel-flow and would restrict the Captain's diversion options.


User currently offlineGeorgiaAME From United States of America, joined Aug 2005, 954 posts, RR: 6
Reply 14, posted (5 years 10 months 3 days 20 hours ago) and read 5207 times:

I fly trans Atlantic about 3 times a year, and my kids take bets on how long it will be into the flight before I get called. For better or worse, I've actually had a great deal of hands on experience when it comes to in-flight Trans-Atlantic emergencies. About a year ago I was called into action for chest pains in row 30 on a Continental flight to London. I identified myself as a physician, provided a copy of my medical license to prove I really was a physician, and got to see the patient. I was less than happy with what I found. We opened the medical kit, which is basically a giant first aid kit with a few medications, and I called for the defibrillator so that I could get a rudimentary EKG tracing. Continental had to call their medical people on the ground to get authorization. I was much less than happy, and I was turned down-no go on opening the defibrillator-someone else might need it (brilliant logic). At which point I advised both the ground and the aircrew that since I was the medical "officer" in charge of a (currently) breathing patient, I was opening the gizmo with or without their permission, and they could either assist me in caring for the patient or they could interfere. ( I got browny points with his wife, and actually with the aircrew; ground crew in Houston was less than pleased with me, but that wasn't my problem). To make a long story short, the one lead tracing was abnormal, we got an IV running, spritzed 2mg of morphine, started the oxygen flowing, and I requested an immediate diversion. Here is where it gets really scary-we had just passed the legendary "point of no return"- London was closer than Halifax or Reykjavik. I had to do some steady breathing for about 3 hours, and if you think trans-Atlantic flights drag, try this for size, this took forever. It was not a fun flight. We landed in London, were met by the Gatwick EMS people who were fabulous, National Healthcare not withstanding. They did a full EKG, and sure enough, I had been treating an inferior wall myocardial infarction for 2 hours. That can be a lifetime when it comes to getting the clot busting drugs into a patient.

I got a very nice letter from Continental, along with an apology regarding the medical ground
crew. The epilogue: 9 months later, I was flying with my younger son to Rome. As we got onboard the aircraft, he said they would call me around Ireland. We were just south of the Irish coast, the call went out for an MD, the little one started laughing... but that's another story for another day. Medical crises at 35,000 feet over the Atlantic are not in the least bit fun. PLEASE: if you aren't feeling well, don't fly!



"Trust, but verify!" An old Russian proverb, quoted often by a modern American hero
User currently offlineStarlionblue From Greenland, joined Feb 2004, 16992 posts, RR: 67
Reply 15, posted (5 years 10 months 3 days 16 hours ago) and read 5146 times:

Excellent post GeorgiaAME.

Quoting GeorgiaAME (Reply 14):
We landed in London, were met by the Gatwick EMS people who were fabulous, National Healthcare not withstanding. They did a full EKG, and sure enough, I had been treating an inferior wall myocardial infarction for 2 hours. That can be a lifetime when it comes to getting the clot busting drugs into a patient.

What happens here? Do you go to the hospital as the treating physician or do you hand the patient off?

Quoting GeorgiaAME (Reply 14):
At which point I advised both the ground and the aircrew that since I was the medical "officer" in charge of a (currently) breathing patient, I was opening the gizmo with or without their permission, and they could either assist me in caring for the patient or they could interfere. ( I got browny points with his wife, and actually with the aircrew; ground crew in Houston was less than pleased with me, but that wasn't my problem).

There is a military axiom that reads, more or less: "Don't second-guess the man on the spot. You trained him to do the job. Now trust him to do it" Obviously useful for more than military operations.

Quoting GeorgiaAME (Reply 14):
PLEASE: if you aren't feeling well, don't fly!

I was once sitting in front of this guy breathing really heavily. Probably just winded but he did not look well. The F/As asked if he was ok. A doctor sitting beside me told him and the crew that the man should at least wait for the next plane (an hour later). And yet they didn't eject him. I guess a diversion is 20 minutes away when over Sweden.

My point though, is that if I had been the guy, I would have gotten off, sat down, had some water, and seen what happened. If I had been fine, next flight. If not, at least I would have been on the ground. People can be so stubbornly boneheaded about their health.



"There are no stupid questions, but there are a lot of inquisitive idiots."
User currently offlineFrancoflier From France, joined Oct 2001, 3735 posts, RR: 11
Reply 16, posted (5 years 10 months 3 days 16 hours ago) and read 5141 times:



Quoting GeorgiaAME (Reply 14):
I was much less than happy, and I was turned down-no go on opening the defibrillator-someone else might need it (brilliant logic). At which point I advised both the ground and the aircrew that since I was the medical "officer" in charge of a (currently) breathing patient, I was opening the gizmo with or without their permission, and they could either assist me in caring for the patient or they could interfere.

Standard procedure is to call the ground medics, who then become responsible for the patient and its treatment. Crews are told to do what they say over what a pax/doctor would...

I don't know exactly the reasoning that led to this procedure, although it probably has to do with the fact that these organizations on the ground have doctors of all specialities with more experience on in-flight emergencies, whereas the pax/doctor might be less 'qualified' to deal with the specific case. The ground medical company hired by the airline is also more aware of what equipment is available on board, where the aircraft can divert to and what kind of medical help the patient can expect there.

Of course, a doctor attending the patient personally will have a better idea of what's going on than a doctor sitting behind a phone 3000 miles away being told about it by a cabin attendant.
Usually, the 'inflight' doc and 'ground' doc get to talk to each other over satphone for easier communication and to better decide on what actions to take.

I can understand why this situation might lead to disagreement between all the parties involved, and it's a weird situation at times, but I suppose it's all a matter of responsability. The ground docs are hired by the airline to do just that: take responsibility if things turn for the worst. If the onboard doc decides to do something else, he then becomes responsible for the patient.



Looks like I picked the wrong week to quit posting...
User currently offlineStarlionblue From Greenland, joined Feb 2004, 16992 posts, RR: 67
Reply 17, posted (5 years 10 months 3 days 12 hours ago) and read 5110 times:



Quoting Francoflier (Reply 16):
If the onboard doc decides to do something else, he then becomes responsible for the patient.

Of course. But I suppose this is no different from what he does on the ground. In any case he is typically covered by Good Samaritan laws and so forth.



"There are no stupid questions, but there are a lot of inquisitive idiots."
User currently offlineIAirAllie From , joined Dec 1969, posts, RR:
Reply 18, posted (5 years 10 months 3 days 10 hours ago) and read 5079 times:



Quoting Francoflier (Reply 1):
Airlines usually carry a doctor kit with more advanced medical hardware and medications than the basic medkit (to be used by a doctor only), and a defibrilator.

On US carriers they all carry this equipment it is mandated.

GeorgiaAME I am shocked they didn't let you use the AED. How bizarre.

The process is pretty similar at most airlines.

The first FA on the scene assess the situation and provides immediate first aid while the other FA's communicate and gather equipment. The communicating FA lets the cockpit know and pages for medical "volunteers" (AA was very insistant you use the word volunteer) they also provide a link between the first responding FA and the flight deck. The cockpit crew contacts medical on the ground and patches them through to the FA's. the equipment FA gathers any necessary items then assists the first FA as needed. Remaining FA's attend to the other passengers and remain observant for any security irregularities in case the medical is really a diversionary tactic. Any diversion decisions are made by ground medical, assisting airborne medical professionals, the captain and operations/dispatch/flight following staff. We generally defer to the medical professional onboard when it comes to medical treatment our expertise is limited to first aid care only.


User currently offlineWILCO737 From Greenland, joined Jun 2004, 8968 posts, RR: 76
Reply 19, posted (5 years 10 months 3 days 8 hours ago) and read 5061 times:
AIRLINERS.NET CREW
HEAD MODERATOR



Quoting GeorgiaAME (Reply 14):

Let me say thank you to you. It is great that you helped that guy without any hesitation and they you used the defi! That's what it is for.
I've never heard that the F/As need the permission to use it at all. AFAIK the F/As at LH know how to use the defi and they are allowed to use it. It is not hard to use (I got a training on it myself). It is a very helpful thing to have on board.

It is a hard desicion where to divert. Flying over center Greenland you don't have many uptions. Landing a 744 with 400 passengers on board in BGSF with nasty weather, short runway etc etc... Or just continue to Halifax, Goose Bay, St. Johns, Keflavik, or whatever airport is close to you. It is a tough decision to make.

One other thought: on my cargo flights, there is only the captain and me. So if one of us gets seriously sick, no F/As to assist... e.g.: captain collapsed in the galley. I am alone in the cockpit, what to do? providing first aid to him and leave the airplane on its own? Leave the captain on its own and continue? Can be very tough if you are just 2 souls on the plane. And we don't have a defi, only a first aid kit.

WILCO737 (MD11F)
 airplane 



It it's not Boeing, I am not going.
User currently offlineStarlionblue From Greenland, joined Feb 2004, 16992 posts, RR: 67
Reply 20, posted (5 years 10 months 3 days 1 hour ago) and read 4991 times:



Quoting WILCO737 (Reply 19):

One other thought: on my cargo flights, there is only the captain and me. So if one of us gets seriously sick, no F/As to assist... e.g.: captain collapsed in the galley. I am alone in the cockpit, what to do? providing first aid to him and leave the airplane on its own? Leave the captain on its own and continue? Can be very tough if you are just 2 souls on the plane. And we don't have a defi, only a first aid kit.

That is indeed a toughie. On the bright side your yearly medical is just a tad more thorough than the average passenger's knowledge of his/her own medical history.



"There are no stupid questions, but there are a lot of inquisitive idiots."
User currently offlineTheSonntag From Germany, joined Jun 2005, 3513 posts, RR: 29
Reply 21, posted (5 years 10 months 2 days 19 hours ago) and read 4950 times:

Just to add a little bit on the legal point of view: The legislation of the country where the airplane is registered applies on board of the airplane, which actually does also mean that you need to be a physician according to the legislation of the country of registration.

This means that there is an official guidance that German doctors should not help on board of US airplanes, as German physicians are no physicians according to US legislation until they have passed an US exam (which they usually would pass quite well, as the education standard is comparable.).

So while they are fully qualified to do the job, from a legal point of view they should not help, as they lack the required US exam.

I am not completely sure if this still applies, but this is indeed an issue. I think people should help nevertheless, but there is a risk if they do to be hold liable.

Quite sad. I am not sure if it is like that the other way around, as well.

And, don't get me wrong, this is not to be supposed to bash the legislation of the US, just to point out a legal risk.


User currently offlineStarlionblue From Greenland, joined Feb 2004, 16992 posts, RR: 67
Reply 22, posted (5 years 10 months 2 days 17 hours ago) and read 4919 times:



Quoting TheSonntag (Reply 21):

This means that there is an official guidance that German doctors should not help on board of US airplanes, as German physicians are no physicians according to US legislation until they have passed an US exam (which they usually would pass quite well, as the education standard is comparable.).

So while they are fully qualified to do the job, from a legal point of view they should not help, as they lack the required US exam.

I'm pretty sure Good Samaritan laws protect the physician. By and large, legislation is not a suicide pact.



"There are no stupid questions, but there are a lot of inquisitive idiots."
User currently offlineTdscanuck From Canada, joined Jan 2006, 12709 posts, RR: 80
Reply 23, posted (5 years 10 months 2 days 10 hours ago) and read 4886 times:



Quoting Starlionblue (Reply 22):
I'm pretty sure Good Samaritan laws protect the physician.

I'm sure it varies by country, but "professionals" (doctors, EMT's, fire fighters, etc.) are explicitly exempted from Good Samaritan laws in many jurisdictions, basically because they're supposed to know what they're doing.

Tom.


User currently offlineStarlionblue From Greenland, joined Feb 2004, 16992 posts, RR: 67
Reply 24, posted (5 years 10 months 2 days 10 hours ago) and read 4885 times:



Quoting Tdscanuck (Reply 23):
I'm sure it varies by country, but "professionals" (doctors, EMT's, fire fighters, etc.) are explicitly exempted from Good Samaritan laws in many jurisdictions, basically because they're supposed to know what they're doing.

I see. But in any case if the doctor makes a best effort his/her defense against eventual legal action is presumably pretty strong. And if he/she does nothing I bet that would lead to lawsuits as well.



"There are no stupid questions, but there are a lot of inquisitive idiots."
25 TheGreatChecko : Good Samaritan laws are very thorny on the ground and I have no clue how they would apply on an aircraft over international waters because, at least i
26 Daviation : A bit off-topic, but I actually did suffer a coronary arrest (my third one) on a Celebrity cruise ship. Since I had already experienced full arrest pr
27 CrimsonNL : The most disturbing story I've heard (came from a very reliable source) On an MP TATL flight, a man got sick and suddenly dropped to the ground. There
28 CURLYHEADBOY : Back in 2002 I was on a LH flight routing JFK-FRA when a flight attendant began walking along the aisle asking for a doctor, she never went on the PA
29 Starlionblue : Scary. However, this is not really that uncommon. "Dead" people "come back" with remarkable frequency. It does surprise me that two doctors pronounce
30 Teme1976 : Major concern during a long flight is a deep vein thrombosis (blood clot). Aspirin (acetylsalicylic acid) is not a good drug to prevent that. It is u
31 Starlionblue : Good info thx. . . .
32 DocLightning : So I can probably answer this. First of all, airliners do carry medical kits aboard. According to a friend of mine who is a F/A aboard BA, a physician
33 Post contains links IAirAllie : Anyone presenting credentials regardless of what nationality they are is welcome to assist. http://www.airliners.net/aviation-forums/help.main?open=n
34 TheGreatChecko : I still don't know how. A US registered aircraft is engaged in interstate commerce and well in the federal jurisdiction and good sam laws are state l
35 Lowrider : I know a few women who might disagree. Very true. When I flew for people haulers, we were told that the cabin staff would be encouraged to make use o
36 Gulfstream650 : I was on a flight from LHR to ORD on a UA 777 about a year or so ago, about halfway across the Atlantic a call came on the tanoid: "If there is a doc
37 DocLightning : Fair enough. This reminds me of Bill Cosby's line: "Natural childbirth means that no drugs will be administered into the mother's body during the ent
38 Starlionblue : How I wish that had been true.
39 Kimberlyrj : Hi The scariest experience I have had as a CSD (cabin service director) is when I had a 13 year old American fella who was traveling on his own on a f
40 CrimsonNL : Wow, that is one amazing story! It was a thrill to just read it! Great job you did!
41 DocLightning : A word on this: I could care less. I am a physician and I took the following oath: My interpretation is that if there is a sick patient, I think abou
42 Andz : That's the whole point of an AED. We sell them and the voice prompts make it pretty difficult to screw it up.
43 Kimberlyrj : Thank you - at the time I felt like I had let the kid down, I guess you always feel you could have done more or better? I can put my hand on my heart
44 IAirAllie : I wholly agree with you. My Mom is an RN and has stepped in many times to help as has my stepmother who is a pediatrician.
45 Nomadd22 : When my company people are in the boondocks or on a ship they have a hotline number to a service at Johns Hopkins that specializes in remote emergenci
46 IAirAllie : They do most use Medlink.
47 DocLightning : They do and they're great, but just as having a pilot on the ground talking to an amateur in a cockpit about how to fly a plane is hardly an optimal
48 Lincoln : I know it's been answered elsewhere in this thread for other airlines, but just for comparison, both CO flights I've been on with medical issues the
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