lincoln
Posts: 3133
Joined: Mon Nov 01, 2004 11:22 pm

When Is The Decision Made To Divert For A Medical?

Mon Dec 26, 2005 7:14 am

Hi All,

I was flying today (12/25, Christmas), and on the IAH-ONT segment, about an hour before we were scheduled to arrive at Ontario all of a sudden "[Ding] At this time we need to ask that any licensed medical professionals on board, such as a M.D., R.N., or E.M.T. please ring your flight attendant call button immediately, again, any licensed medical professionals..."

There was a gentleman on board who was a paramedic (coincidentally, we had been talking about that in the gate area prior to boarding), who went to the rear galley (738) and did his thing... From what one of the flight attendants was telling us, a defibrillator was involved, and there was quite a bit of interphone dinging and flight attendants running from front to rear and viceversa. The gentleman continued working in the back of the aircraft until just prior to landing.

We continued on to Ontario, landed and taxied to the gate normally, where we were met by quite an assortment of equipment (3 airport police vehicles, 2 ambulances, 1 non-airport fire vehicle, 1 airport CFR vehicle, and a few trucks just labeled ONT), and paramedics came on board before anyone was let out of their seats (understandably)

Anyways, this event I was wondering (a) what drives the decision to divert or continue to the original destination, (b) who makes that decision (I guess ultimately it's the captain's, but does the 'medical professional' have input?) (c) what would have happened had there not been anyone with a medical background on board?

Also, just as a side note, the cabin crew on this flight was one of the best I've ever had (and that's saying something for CO!) -- and their reaction when I gave them Merry Christmas/Thank You cards was quite unexpected (made the effort feel very worthwhile).

Lincoln
CO Is My Airline of Choice || Baggage Claim is an airline's last chance to disappoint a customer || Next flts in profile
 
werdywerd
Posts: 557
Joined: Wed Aug 17, 2005 1:40 am

RE: When Is The Decision Made To Divert For A Medical?

Mon Dec 26, 2005 7:36 am

Here at jetblue we have "Medlink" where FA's can contact a doctor on duty on the ground to tell him/her the situation on board. The doctor will give their recommendation as to whether divert immediately and land or continue on to the final destination. If the recommend a diversion the FA will notify the Captain and the captain will make the final decision which 99.9% along with whatever the doctor says to do.
If they are close enough to the final destination and the final destination is closer than a diversion, the Capitan will obviously land at whatever destination will get them to the ground quicker. Also I believe with a situation like this that the aircraft gets priority landing wherever they are headed.
 
CO767FA
Posts: 388
Joined: Mon Aug 08, 2005 1:45 am

RE: When Is The Decision Made To Divert For A Medical?

Mon Dec 26, 2005 7:45 am

At CO, we also have "Medlink", but we also ask for additional assistance from any qualified Nurses, Doctors and/or EMT's. In the OP message it appears s/he was traveling aboard one of our flights.

The customers health and well being is paramount, but we try to avoid unnecessary diversions because of the expense and inconvenience; but sometimes that just can't be avoided.
 
EMBQA
Posts: 7798
Joined: Sat Oct 25, 2003 3:52 am

RE: When Is The Decision Made To Divert For A Medical?

Mon Dec 26, 2005 7:46 am

Quoting Lincoln (Thread starter):
Anyways, this event I was wondering (a) what drives the decision to divert or continue to the original destination, (b) who makes that decision (I guess ultimately it's the captain's, but does the 'medical professional' have input?) (c) what would have happened had there not been anyone with a medical background on board?

A) The Captain...
B) The Captain...
C) The Captain would land the plane at the closest airport...
"It's not the size of the dog in the fight, but the size of the fight in the dog"
 
ChiGB1973
Posts: 1394
Joined: Mon Mar 22, 2004 6:39 am

RE: When Is The Decision Made To Divert For A Medical?

Mon Dec 26, 2005 7:58 am

I guess ultimately it is up to the captain, but Medlink is the decision maker. The captain can choose not to, but it is highly doubtful that this would ever happen. If the medical is obvious as to what the captain should do, of course, he is going to do it. Most of these guys are very smart. I do not recall any I did not trust, obviously, with my life. Some had personalities that left a little to be desired, but that is a moot point.

One of the last trips I flew was out of Bangor and just short of half way to SNN, we had a medical and had to return to YQX. I believe that was the routing. The cool thing is I did get to talk to Medlink on the radio. There were so many things to consider. This guy would have been in SNN vs Gander, which was a lot closer to home, there was weather, communication problems, overweight problems. It was a mess. He wound up being fine on the trip back to Gander. As far as follow-up, I have no clue. I wish I knew.

What a long day that was!

M
 
Go3Team
Posts: 3156
Joined: Sun Mar 14, 2004 1:19 am

RE: When Is The Decision Made To Divert For A Medical?

Mon Dec 26, 2005 8:52 am

As heartless as it may sound, has any airline ever tried to recoup the expenses incurred during a divert? Say if a passenger was feeling ill, and thru a fit about needing medical attention, the plane diverted, and all it was, was a case of gas. In that situation, I can see no problem with the airline wanting its lost money back. On the other hand, someone feeling ill before a flight, they have a heart attack, and a diversion is necessary for them to get the medical attention they need. Should the airline try to get their money back then?
Yay Pudding!
 
AR385
Posts: 6763
Joined: Fri Nov 07, 2003 8:25 am

RE: When Is The Decision Made To Divert For A Medical?

Mon Dec 26, 2005 9:25 am

Today, most airlines have "Medlink" Some airlines as SOP will try to get someone trained in medicine alongside Medlink. Some don't. Defibrillators are very nice, but, as far as I know, they are useless in a heart attack. They are used for cardiac arrest, which might be a consequence of a heart attack. You'd be surprised however how many airlines carry "first aid kits" that actually look like operating room kits, and the amount of training in medical emergencies that the F/A's have.

If the airline has access to Medlink, the captain will follow their reccommendation. If they don't, but have a doctor or other medically trained person reccommend the diversion, the captain will also follow that advice. If no medlink, and no medical trained passengers on board, the captain will require constant updates on the passenger's condition. If it is obviously worsening a diversion will be the likely result.
 
MAS777
Posts: 2757
Joined: Sun Jul 11, 1999 7:40 am

RE: When Is The Decision Made To Divert For A Medical?

Mon Dec 26, 2005 9:32 am

I was called to an emergency on a flight once - this was probably in the infancy of Medlink and other medical link-ups now in operation. I saw this chap and figured he might have been having a coronary.

There was a nurse on board too who came to see what was happening but she was very odd and I found her to be rather useless. The captain basically gave me the decision to make. He came back to the rear of the plane where the passenger was and advised me of 'our' options and he asked 'do you think we should turn back?'. I remember replying (in a slightly nervous state) - 'you're the captain' and he smiled and replied 'you're the doctor!'.

It was a fairly easy decision to make (as I failed to agree with the 'nurse' (?) who seemed more bothered about her connection and suggested we gave him some soup (???)) as we had a long flight ahead.

We turned straight back to KUL as I scoured through the medical kit (looking for a coat-hanger and bottle of whiskey... I remember thinking... - lol - as that incident had just happened) having just crossed over Sumatra and the passenger was off-loaded to an awaiting medical team at KUL.

I wish I could find out what happened to the passenger. I will always remember his wife being so distraught and as I spoke to the medical team at KUL - it turned out that her husband was in a rush to get back to the UK to see his cardiologist and she was concerned that he would now miss his appt...

...good call I thought to myself when I heard her say that...


btw - post-script and disclaimer - to anyone who might want to try this - there is absolutely NO use for a coat-hanger and a bottle of whiskey in treating a possible myocardial infarction - apart from hanging up your coat and drinking that bottle of whiskey perhaps.  Smile
 
RDUDDJI
Posts: 1717
Joined: Fri Jun 04, 2004 4:42 am

RE: When Is The Decision Made To Divert For A Medical?

Mon Dec 26, 2005 9:34 am

Here at UA, we have our own medical department who is generally involved with these type of situations. When I started with UA, I had to get a physical at ORDEX and while I was there I heard a flight call in with a medical emergency (it was relayed from the flight deck onto their speakerphone). One of the Nurses went to get a Doctor who took the call and went through everything with the crew. I thought it was pretty cool that UA had their own medical team.
Sometimes we don't realize the good times when we're in them
 
shlomoz
Posts: 90
Joined: Wed Jun 21, 2000 9:36 pm

RE: When Is The Decision Made To Divert For A Medical?

Mon Dec 26, 2005 9:41 am

I was on an El Al flight last week from TLV to JFK that diverted to Rome for a medical emergency. The call, ultimately, was made by the captain, but it was a doctor among the passengers who was asked to give medical attention that told the captain what to do.

We landed and were diverted to what seemed like a remote part of the airport - no jetway - just stairs. El Al security (not Rome police) appeared out of nowhere and secured the perimeter of the aircraft and even checked-over the paramedics who came onboard to take the passenger off.
 
3201
Posts: 813
Joined: Sun Oct 10, 2004 4:16 pm

RE: When Is The Decision Made To Divert For A Medi

Mon Dec 26, 2005 10:49 am

Dr. Rumack:
Captain, how soon can you land?
Capt. Clarence Oveur:
I can't tell.
Dr. Rumack:
You can tell me, I'm a doctor.
Capt. Clarence Oveur:
No, I mean, I'm just not sure.
Dr. Rumack:
Well, can't you take a guess?
Capt. Clarence Oveur:
Well, not for another two hours.
Dr. Rumack:
You can't take a guess "for another two hours"?

Quoting Lincoln (Thread starter):
(a) what drives the decision to divert or continue to the original destination,

Usually if there's a MD on board the captain asks their opinion, just like in Mas777's story... and of course,

Quoting Mas777 (Reply 7):
the 'nurse' (?) who seemed more bothered about her connection

the folks on board want to get where they're attempting to go, not to divert!  Smile But obviously if it really is life-threatening, they'll advise, as did Mas777, to divert.

I know a physician who has been called to help at least 2 times, I think actually more (he flew a lot), and always advised to continue to planned destination. This was a while ago, but he reported signing something saying that he was opening the sealed first-aid kit, and got thank-you letters from the airlines in question afterwards.

Quoting Mas777 (Reply 7):
apart from... drinking that bottle of whiskey perhaps

yeah I think he got offered some of that from the FA's as well.  Silly
7 hours aint long-haul
 
Airlinerfreak
Posts: 1246
Joined: Tue Jan 18, 2005 4:16 am

RE: When Is The Decision Made To Divert For A Medical?

Mon Dec 26, 2005 10:54 am

A question here, is the person who is ill held financially responsible for the diversion?
 
ChiGB1973
Posts: 1394
Joined: Mon Mar 22, 2004 6:39 am

RE: When Is The Decision Made To Divert For A Medical?

Mon Dec 26, 2005 11:06 am

There is a "cocktail" for heart attack that includes aspirin, nitroglycerine and oxygen, all of which are available on the plane. The fourth ingredient is a clot-busting medication that is not available on the plane, nor in most pre-hospital settings. So, the ingredients are there, it is a matter of training that makes the difference.

In 1/2 of heart attacks, the heart does go into a ventricular rhythm with the only treatment, except in very, very few cases, is defibrillation.

As a flight attendant, I attended one chest pain customer in 2 1/2 years. There were a few other medicals, but nothing like this poor guy. He insisted on not diverting as he was going to see his dying sister in PIT. Medlink was contacted and agreed to the continuation of the flight to Chicago. I doubt he was allowed on to PIT, but I do not know. I am also a paramedic. The training was helpful with this and one other case, but otherwise I was fairly lucky not having sick people on the plane.

M
 
thegreatchecko
Posts: 689
Joined: Sat Mar 06, 2004 3:34 pm

RE: When Is The Decision Made To Divert For A Medical?

Mon Dec 26, 2005 11:35 am

In my experiences, the captain, FA, and dispatcher are all on the "phone" with Medlink. If the doctor recommends a diversion, he will also recommend a city, and the dispatcher and captain must concur (obviously). The doctor doesn't have all the airport info on hand (weather, etc.) so if it doesn't work, the Captain would then ask for another option.

Quoting AR385 (Reply 6):
Defibrillators are very nice, but, as far as I know, they are useless in a heart attack. They are used for cardiac arrest, which might be a consequence of a heart attack.

Actually, its the other way around.  Smile

A defibrillator converts an irregular rhythm to a normal rhythm by momentarily stopping the heart and allowing it to "reset" itself. It will not do a thing if the heart has completely stopped and is in asystole (aka flat line). Medications would be needed to assist the heart in that situation.

Automatic External Defibrillators are very useful and will save the life of someone that has recently experiences a sudden cardiac arrest, especially if applied in the first two minutes.

GreatChecko
EMT-B
"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"
 
OPNLguy
Posts: 11191
Joined: Tue Jun 15, 1999 11:29 am

RE: When Is The Decision Made To Divert For A Medical?

Mon Dec 26, 2005 11:37 am

The Medlink doctor makes the decision to continue or divert, and while the doctor may suggest a certain airport, it's up to the captain and dispatcher to determine if the airport the doctor mentions is suitable. For example, the doctor may suggest AMA, but the doctor has no way of knowing that AMA is 1/8 mile in fog with RVR below minimums. The captain and dispatcher hash that out, and if another close-by airport has good weather, say, LBB, we'll divert there, or someplace else that's suitable.
ALL views, opinions expressed are mine ONLY and are NOT representative of those shared by Southwest Airlines Co.
 
APFPilot1985
Posts: 1840
Joined: Fri Nov 26, 2004 12:51 pm

RE: When Is The Decision Made To Divert For A Medical?

Mon Dec 26, 2005 11:41 am

In the days before medlink, I was on a flight with my mother from RSW to BUF and they asked for medical professionals to please press the button. My mom was the only one on board who called. She is a nurse and a former FA. A gentleman on-board was having angina attacks. Basically she just got him on 02 and the captain called her up to the flight deck and asked her if we should divert.
Stand Up and Be Counted Visit Site Related to Voice your opinion
 
lincoln
Posts: 3133
Joined: Mon Nov 01, 2004 11:22 pm

RE: When Is The Decision Made To Divert For A Medical?

Mon Dec 26, 2005 12:17 pm

Thanks for all the replies, it's interesting to know what goes on when something like this happens (and that I'm in good hands if something unforseen were to happen).

Quoting CO767FA (Reply 2):
At CO, we also have "Medlink", but we also ask for additional assistance from any qualified Nurses, Doctors and/or EMT's. In the OP message it appears s/he was traveling aboard one of our flights.

Yep... I love you guys I (a he) was on CO1723 IAH-ONT. Your colleagues were great (as always) on that flight. (On a selfish note, after my trip home I will finally have enough miles to qualify for silver elite status)

Quoting EMBQA (Reply 3):
A) The Captain...
B) The Captain...
C) The Captain would land the plane at the closest airport...

Wow...It's even more clear-cut than I thought.

Quoting Airlinerfreak (Reply 11):
A question here, is the person who is ill held financially responsible for the diversion?

I'm curious about this, too, and would appreciate it if an authority on the subject could speak. I would imagine costs of diversion could, depending on circumstances, be tens of thousands of dollars. On one hand, I beleive it's common (at least in some areas of the US) for paramedics to bill for their services [but luckily, I have not needed paramedics [knock on wood] so I can't speak from first hand knowledge], so it would make sense to charge the pax for essentially the same service; on the other hand, if the pax knew that they were going to be billed, insisted that the flight not divert because they were 'feeling fine now', and later died the airline may be involved in a wrongful death suit, so they may just view diversions as a cost of doing business.

Also, for anyone curious, the ill pax did walk off the aircraft under his own power (though closely followed by paramedics) and was then brought down to the ambulance where (I assume) he was given a full checkup.

Lincoln
CO Is My Airline of Choice || Baggage Claim is an airline's last chance to disappoint a customer || Next flts in profile
 
OPNLguy
Posts: 11191
Joined: Tue Jun 15, 1999 11:29 am

RE: When Is The Decision Made To Divert For A Medical?

Mon Dec 26, 2005 12:54 pm

Quoting EMBQA (Reply 3):
Anyways, this event I was wondering (a) what drives the decision to divert or continue to the original destination, (b) who makes that decision (I guess ultimately it's the captain's, but does the 'medical professional' have input?) (c) what would have happened had there not been anyone with a medical background on board?



Quoting EMBQA (Reply 3):

A) The Captain...
B) The Captain...
C) The Captain would land the plane at the closest airport...



Quoting Lincoln (Reply 16):
Wow...It's even more clear-cut than I thought.

Well, actually, no it's not. In reality (IMHO), it's:
A) What drives the decision is what's in the best medical interest of the passenger...
B) The Medlink doctor makes the decision to continue or divert (in concert with captain and dispatcher as mentioned above in reply #14)...
C) If no Medlink, and no doctor/nurses/EMTs aboard, the captain makes his/her own decision and that's usually to land at the nearest suitable airport.

In the years before Medlink, you'd be confronted by all sorts of medical situations that you had to deal with:

1/ PHX-AUS, over ELP captain calls up and says there's a 13 year old kid traveling by himself and he managaed to stick a marble in his ear and it was now causing him alot of pain. Captain wanted to know if we needed to land in ELP, or could he make a long shallow descent into AUS for a more gradual pressure change. My spouse at the time was an ICU nurse, so I called her and we had a 3-way call with an ER doc. Before a concensus could be reached the marble popped out on its own, and the situation solved itself.

2/ Enroute somewhere to somewhere else, 30 year old female complains of typical heart attack symptoms. Not the typical age patient for such a malady, but we divert, EMS meets flight, and pax (and her boyfriend) get off the aircraft. No room in the ambulance for boyfriend, so he catches a cab to hospital. In the ambulance, after boyfriend leaves in cab, and just before ambulance is to leave the airport, female patient announces she faked the whole thing to get away from her abusive boyfriend, gets up, and bails from ambulance. Poof, she's gone.
ALL views, opinions expressed are mine ONLY and are NOT representative of those shared by Southwest Airlines Co.
 
Grbld
Posts: 349
Joined: Tue Dec 06, 2005 9:25 pm

RE: When Is The Decision Made To Divert For A Medical?

Mon Dec 26, 2005 6:38 pm

It is really a difficult subject, as we discovered over some hostile territory not too long ago. A passenger was passed out and had sympthoms that could've been a severe heart problem but could also be hypoerventilation. The airports around us were all place that you didn't want to land, let alone put someone in the hospital. The thing is that medical personnel (as passengers) on board was not willing to make a decision, let alone advise one. So either it was life threatening or not. In the end we flew on and the passenger was greeted by an ambulance, but improved his condition during the remainder of the flight (which, according to the medical personnel, still did not exclude a heart problem!).

I talked to some family members of mine who are also in the medical field about the chance that you're taking and they said that it's normal to allow for a 4% margin of error. So in fact, when someone complains about chest pains and you tell them to just wait it out for another day, it's more or less acceptable if 4% turns out to be a problem after all.

This shocked me, but it's understandable on the other hand. If you had to commit everyone with chest pains to the emergency room, 96% would go home again with nothing serious, but they would take up the staff's time and cost a lot of money (see your insurance premiums quadrouple if they have to perform scans and checks on everybody, let alone where they'd find the capacity and personnel) and in the end, some people who are in trouble die in the waiting room because the hospital is so backed up and cannot deal with the number of patients.

It's a raw deal, to know that in healthcare, you may be faced with a doctor's decision based upon a chance that things may be okay. And just as a comparison, where it is okay in healthcare to be wrong 4% of the time (that's one in 25), in the cockpit we train emergencies that on average may occur one in a billion times. Quite the difference, isn't it?

But it does put the diversion scenario into perspective. Should you divert any time, just to be safe? Perhaps not, doctors don't work that way either. But it remains difficult.

Grbld
 
Mir
Posts: 19108
Joined: Mon Jan 05, 2004 3:55 am

RE: When Is The Decision Made To Divert For A Medical?

Mon Dec 26, 2005 6:55 pm

Quoting OPNLguy (Reply 17):
1/ PHX-AUS, over ELP captain calls up and says there's a 13 year old kid traveling by himself and he managaed to stick a marble in his ear and it was now causing him alot of pain. Captain wanted to know if we needed to land in ELP, or could he make a long shallow descent into AUS for a more gradual pressure change. My spouse at the time was an ICU nurse, so I called her and we had a 3-way call with an ER doc. Before a concensus could be reached the marble popped out on its own, and the situation solved itself.

 rotfl 

Oh, what kids do these days....

-Mir
7 billion, one nation, imagination...it's a beautiful day
 
ultrapig
Posts: 570
Joined: Fri Dec 12, 2003 11:38 pm

RE: When Is The Decision Made To Divert For A Medical?

Tue Dec 27, 2005 1:03 am

Are pasengers for who a me is declared then blacklisted for that airline--if not balcklisted is there a list prepared for lets saymulti diversion people?
 
RobertS975
Posts: 760
Joined: Sun Aug 14, 2005 2:17 am

RE: When Is The Decision Made To Divert For A Medical?

Tue Dec 27, 2005 2:12 am

Lufthansa was successfully sued by the family of a passenger who died aboard a trans-Atlantic flight when the flight crew ignored recommendations from medical folks on board to divert.

But care must be taken to divert to an airport that has proper facilities. Recall the Virgin 747 London-LAX that put down at Iritusk (?spelling) in the Canadian arctic for an onboard medical emergency. Successful landing but wingtip hit a building while taxiing. The whole planeload had to be transferred to smaller planes and flown out. Of course, the sick passenger was also airlifted out to a better facility. So in reality, the 747 landed at an airport that was a proper diversion point if it were on fire, but not suitable for a medical diversion.
 
User avatar
EA CO AS
Posts: 13636
Joined: Wed Nov 14, 2001 8:54 am

RE: When Is The Decision Made To Divert For A Medical?

Tue Dec 27, 2005 2:40 am

Quoting Go3Team (Reply 5):
As heartless as it may sound, has any airline ever tried to recoup the expenses incurred during a divert?

In former Eastern Air Lines CEO Col. Frank Borman's autobiography "Countdown," he recalled an incident where he and his wife were on an EA flight in First Class where a passenger got up, staggered into the aisle, and collapsed. He and the crew tended to the man's needs while they diverted and the customer was taken away by ambulance.

A few days later his secretary says there's a very irate man on the phone, threatening to sue. Turns out it's the SAME GUY - claiming that he was sleeping and that the crew mistook his sleeping for a medical problem and that he woke up in a strange hospital. Col. Borman didn't miss a beat and told him that he was on the same flight, and personally held an oxygen mask over the man's face while they made a costly emergency landing in a different city - and that EA was prepared to countersue for their costs!

The guy gulped and said, "You were on that flight?"

Borman replied, "I sure as hell was."

And the guy hung up.
"In this present crisis, government is not the solution to our problem - government IS the problem." - Ronald Reagan

Comments made here are my own and are not intended to represent the official position of Alaska Air Group
 
OPNLguy
Posts: 11191
Joined: Tue Jun 15, 1999 11:29 am

RE: When Is The Decision Made To Divert For A Medical?

Tue Dec 27, 2005 2:59 am

Quoting EA CO AS (Reply 22):
The guy gulped and said, "You were on that flight?"

Borman replied, "I sure as hell was."

And the guy hung up.

Great story!

Quoting Go3Team (Reply 5):
As heartless as it may sound, has any airline ever tried to recoup the expenses incurred during a divert?

I see where BA is trying to fet $58,000 USD out of the boffing couple that forced their LHR-MBJ flight to divert to BDA, but, of course, that wasn't a medical diversion.

I don't know of any airline that has tried to re-coup the costs of a medical diversion, and as far as I'm concerned, such diversions (if for confirmed or truly suspected medical issues) are just the cost of doing business. If someone intentionally fakes it for other purposes (as I mentioned in an earlier post), that's a different story and an airline should go after them.

I would think that one of the downsides of an airline going after recompense after a diversion (one for a true/suspected medical problem) is that you run the great PR risk of looking live an evil corporate monster that's trying to take advantage of the poor helpless passenger. Pretty soon, the media starts writing stories to that effect, and before you know it, the general populace thinks that Airline-X is charging people to administer oxygen, or charging folks to use the defibrillator. Better to just quietly consider the diversion cost as an normal, yet unexpected cost.
ALL views, opinions expressed are mine ONLY and are NOT representative of those shared by Southwest Airlines Co.
 
letsgetwet
Posts: 490
Joined: Tue Jul 26, 2005 12:08 pm

RE: When Is The Decision Made To Divert For A Medical?

Tue Dec 27, 2005 3:05 am

Quoting Lincoln (Thread starter):
There was a gentleman on board who was a paramedic (coincidentally, we had been talking about that in the gate area prior to boarding), who went to the rear galley (738) and did his thing... From what one of the flight attendants was telling us, a defibrillator was involved, and there was quite a bit of interphone dinging and flight attendants running from front to rear and viceversa. The gentleman continued working in the back of the aircraft until just prior to landing.

Just a side note, if a medical professional such as an RN or even an EMT responds to such an emergency, that person has no choice but to stay with his patient until he is relieved by a higher medical authority. He can't just return to his seat because could be held liable for deserting his patient.
 
firiko
Posts: 132
Joined: Mon Nov 21, 2005 4:05 am

RE: When Is The Decision Made To Divert For A Medical?

Tue Dec 27, 2005 4:19 am

I was once on a Turkish Airlines flight from LHR to Ist Just after take off one of the passenger's got up shouted for help and collapsed. The first thing I remember is the purser rushing into the cockpit. Then came the announcments asking for a doctor or anyone with a medical profession.(3 times- recorded both in Turkish and English ) Everybody was in shock cause we were still climbing to reach our cruising altitude. The aircraft started landing while 4 cabin crew members including the purser was trying to give first aid. When we landed we taxied to the nearest gate in a less then a minute. Paramedics rushed in. We took off again after a 45 min delay due to an ill passenger. I thought Tk was very professional in handling the situation.
 
MarkATL
Posts: 486
Joined: Sat Jul 03, 2004 10:07 am

RE: When Is The Decision Made To Divert For A Medical?

Tue Dec 27, 2005 4:26 am

I would think that the costs of diversions, Medlink, defibulators, sealed medical kits, etc. are a nominal fraction of what the liability expenses of offering common carrier services without them would be. One guy's family sues because he dies of a heart attack on board and no action, contingency planes or procedures are in place. The verdict alone would cost more than twenty diversions. It's as much a cost of doing business as fuel.
"...left my home in Georgia, 'n headed for the "Frisco" Bay...
 
RIXrat
Posts: 674
Joined: Sun Nov 27, 2005 10:20 am

RE: When Is The Decision Made To Divert For A Medical?

Tue Dec 27, 2005 4:46 am

I thought that I posted a reply to this thread, but it seems to have vanished into the ether above us.

I'll try to repeat what I said. I recently read that passengers aboard an aircraft with a medical education, especially doctors, are becoming more and more reluctant to answer the call for assistance in case of a medical emergency.

They would rather remain anonymous than to face a possible law suit from the ill passenger later. What a pity on both sides of the fence. There are many ramifications. You do your best and the patient dies and you get sued. You don't do anything and some lawyer sues you for abandoning your Hippocratic Oath by not doing anything. A no win situation.
 
lincoln
Posts: 3133
Joined: Mon Nov 01, 2004 11:22 pm

RE: When Is The Decision Made To Divert For A Medical?

Tue Dec 27, 2005 4:53 pm

Quoting RIXrat (Reply 27):
They would rather remain anonymous than to face a possible law suit from the ill passenger later. What a pity on both sides of the fence. There are many ramifications. You do your best and the patient dies and you get sued. You don't do anything and some lawyer sues you for abandoning your Hippocratic Oath by not doing anything. A no win situation.

I'm not suprised by that at all, especially in the US, but... I thought that "Good Samaritan" laws in many states would protect off-duty medical professionals (and especially lay people) who offer aid in the case of an emergency from all liability unless the person was grosly neglegiant. But I guess that would open a whole 'nother can of worms about what state's (if any, given the Airline Deregulation Act's provisions) laws would apply and if that particular state even had the Good Samaritan protections. I hate to say it, but if I were placed in the situation I almost certainly wouldn't do anything-- it's just too easy (especially for a layperson like myself) to cause further injury rather than helping the original problem.

Lincoln
CO Is My Airline of Choice || Baggage Claim is an airline's last chance to disappoint a customer || Next flts in profile
 
3201
Posts: 813
Joined: Sun Oct 10, 2004 4:16 pm

RE: When Is The Decision Made To Divert For A Medi

Wed Dec 28, 2005 1:54 am

Quoting Lincoln (Reply 28):
unless the person was grosly neglegiant.

Yeah, but it's too easy to find 12 high-school-dropouts who can be convinced that *anything* is "grosly neglegiant" -- we have subjective laws and let idiots interpret them. *sigh*
7 hours aint long-haul
 
letsgetwet
Posts: 490
Joined: Tue Jul 26, 2005 12:08 pm

RE: When Is The Decision Made To Divert For A Medical?

Wed Dec 28, 2005 4:02 am

Quoting Lincoln (Reply 28):
I thought that "Good Samaritan" laws in many states would protect off-duty medical professionals (and especially lay people) who offer aid in the case of an emergency from all liability unless the person was grosly neglegiant.

The "Good Samaritan Laws" will protect a lay person, but not a trained medical professional (off-duty or not)
 
RobertS975
Posts: 760
Joined: Sun Aug 14, 2005 2:17 am

RE: When Is The Decision Made To Divert For A Medical?

Wed Dec 28, 2005 4:46 am

That's why any medical professional will recommend diversion... why would the professional want to keep responsibility for the situation when more likely than not, he/she is without proper history, equipment, medical backup (labs etc.) and is often completely outside their true specialty.
 
AsstChiefMark
Posts: 10465
Joined: Thu Feb 05, 2004 2:14 pm

RE: When Is The Decision Made To Divert For A Medical?

Wed Dec 28, 2005 4:57 am

Whenever I board a flight, I tell the lead FA that I'm an RN/medic. In case they need help, it could save time and avoid an announcement that would draw attention.

One of my fears is a cardiac arrest halfway across the Atlantic Ocean. That would make a long flight feel a lot longer.

Mark
Red tail...Red tail...Red tail...Red tail...Red tail...Red tail...Red tail...Red tail...Damned MSP...Red tail...Red tail
 
Ken777
Posts: 9102
Joined: Thu Mar 11, 2004 5:39 am

RE: When Is The Decision Made To Divert For A Medical?

Wed Dec 28, 2005 5:11 am

I was on a BA HKG-LHR flight several years ago when a FA got rather sick and a local (HK) Dr cared for him. Four hours into the flight the decision was made to return, primarily because there were few medical facilities on the route ahead. No one was upset about the decision, but I was rather surprised when some uniformed "officials" came on board in HKG and seemingly challenged the doctor about his recommendations.

We had to spend the night at the airport hotel and have another day in HK at BA's expense, which wasn't a problem for me, and when we took off the next night the Captain advised us that the FA was still in the hospital and doing well.

The issue with medical diversions simply works down to the issue of taking care of the pax.
 
debonair
Posts: 2749
Joined: Sat Jan 03, 2004 10:50 pm

RE: When Is The Decision Made To Divert For A Medical?

Wed Dec 28, 2005 5:37 am

Hi, very difficult...

but I can give u some inside information in european aviation, it is very different...

1.some airlines have a list with "check-boxes", you have to cross the questions and at the end, you will get a score. depending on the score, an emergency landing is necessary...
2.well, not every airline is linked to an "emergency-call-center" like MEDLINK
3.it is not an obligation to have defibrillator onboard or any doctor-equipment,as we in europe have a "20-minute"-rule, that means, that any aircraft will find a suitable airport within a 20-Minute-range (enough for CPR)- so most airline have only a first-aid-kit onboard!!!

I had once the case, that we had an infant with breathing problems on take off from Cuba. The pilot decision was, to fly straight to Europe, as he was afraid of the medicial-standards in Cuba...
 
thegreatchecko
Posts: 689
Joined: Sat Mar 06, 2004 3:34 pm

RE: When Is The Decision Made To Divert For A Medical?

Wed Dec 28, 2005 3:17 pm

Quoting Debonair (Reply 34):
as we in europe have a "20-minute"-rule, that means, that any aircraft will find a suitable airport within a 20-Minute-range (enough for CPR)- so most airline have only a first-aid-kit onboard!!!

I'm thinking this may not be the smartest idea.
20 minutes to the airport, 5 minute taxi.

That's at least 25 minutes if an IMMEDIATE diversion was made to the nearest suitable airport before advanced life support could be initiated (IF the medics meeting the plane were properly equipped).

Personally, that's a long time for a heart to be stopped. I think the chances of survival would probably be quite low.

And 20 minutes doing CPR... have you ever actually done chest compressions, its a lot harder than you think!  Wink

Quoting Debonair (Reply 34):

I had once the case, that we had an infant with breathing problems on take off from Cuba. The pilot decision was, to fly straight to Europe, as he was afraid of the medicial-standards in Cuba...

I don't mean to be picky, but what about the US? I know we aren't perfect, but its an emergency! What would have happened if the kid had died on the 8 hour flight to Europe?

As a pilot I wouldn't want that on my mind just because I felt the medical standards may be sub par (which I probably don't have much of a basis to make my opinion upon, I am a pilot not a doctor, right?).

GreatChecko
"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"
 
BA380
Posts: 1441
Joined: Mon May 17, 2004 9:59 pm

RE: When Is The Decision Made To Divert For A Medical?

Wed Dec 28, 2005 11:19 pm

Quoting TheGreatChecko (Reply 35):

Quoting Debonair (Reply 34):

I had once the case, that we had an infant with breathing problems on take off from Cuba. The pilot decision was, to fly straight to Europe, as he was afraid of the medicial-standards in Cuba...

IIRC, Cuba is famous for having one of the best health care systems in the world!!!!!
cabin crew: doors to automatic and cross-check...
 
don81603
Posts: 1105
Joined: Sun Jul 24, 2005 12:07 am

RE: When Is The Decision Made To Divert For A Medical?

Wed Dec 28, 2005 11:41 pm

Quoting EA CO AS (Reply 22):
The guy gulped and said, "You were on that flight?"

Borman replied, "I sure as hell was."

And the guy hung up.

Man, talk about nerve!

Does anyone know the final outcome of this? Sounds interesting.
Eagles may soar, but weasels don't get sucked into jet engines.
 
ltbewr
Posts: 12502
Joined: Thu Jan 29, 2004 1:24 pm

RE: When Is The Decision Made To Divert For A Medical?

Thu Dec 29, 2005 12:40 am

Two issues - although very rare - I would be concerned with as to a medical emergency would be where a fake situation is part of a hijacking/terror act or when a person has a personal or mental health issue. That is probably why some evaluation of the distressed person must be made at the time to consider emergency diversions, especially over certain areas of the world.
One poster above noted on an El AL TLV-JFK flight that was diverted to Rome, El Al security went out first rather than airport security, noting the particular target that El Al is and probably due to possibility of a terror attack. Another problem as also noted above, is when a person fakes a medical condition due to personal or mental health issues (in that case to get away from an abusive boyfriend/husband).
I would also suggest that if the person is not revivable and apparently died during the flight, it is a long flight with few diversion airports available, that the flight will continue on it's way to it's destination. We have had threads before of a dead person being moved to a quiet place on the aircraft and covered up, or where some Singapore Airlines aircraft that have a storage compartment for dead pax.
 
georgiaame
Posts: 955
Joined: Sat Aug 13, 2005 7:55 am

RE: When Is The Decision Made To Divert For A Medical?

Thu Dec 29, 2005 4:45 am

I've dealt with several medical emergencies, including one diversion.

I made the decision to divert, and it was the captain who specifically asked a) if diversion would be necessary, and b) when would I be making the decision to divert. This was a Delta international flight heading westbound, rapidly approaching the Atlantic with one very sick passenger. I requested a diversion to London first, Belfast second, Shannon as a last resort.

We landed in Shannon within 30 very long minutes. The ultimate insults, we were not allowed into the Duty Free Shops (all that Waterford, so close, so close...), and not a word of thanks from the airline for helping to save the life of a crew member.

In all, one very, very humbling experience, and scary as poop.
"Trust, but verify!" An old Russian proverb, quoted often by a modern American hero
 
boeingfanyyz
Posts: 970
Joined: Sat Jul 23, 2005 12:12 pm

RE: When Is The Decision Made To Divert For A Medical?

Thu Dec 29, 2005 10:17 am

I was reading something a while back that states that many carriers who offer non-stop service between continental US and Asia are to use the wine cellar for storage of deceased passengers, instead of diverting. And, yes, it has happened!

I'd just hate to be on one of those planes that does not offer that added "service" and be sat beside the poor soul!

Cheers,
Boeingfanyyz  airplane 
"If it aint boeing, it aint going!", "Friends are like condoms...they protect you when things get hard!"
 
itsjustme
Posts: 2727
Joined: Sun Apr 25, 2004 6:58 pm

RE: When Is The Decision Made To Divert For A Medical?

Thu Dec 29, 2005 2:57 pm

Quoting ChiGB1973 (Reply 12):
There is a "cocktail" for heart attack that includes aspirin, nitroglycerine and oxygen, all of which are available on the plane.

Seriously? Nitroglycerin is carried on a commercial aircraft? If that is true, the obvious question would be, is there always someone on board who is licensed to administer it being that it is a medication that can have serious and sometimes fatal side effects if given when contraindicated.
 
ChiGB1973
Posts: 1394
Joined: Mon Mar 22, 2004 6:39 am

RE: When Is The Decision Made To Divert For A Medical?

Thu Dec 29, 2005 3:59 pm

So can Aspirin and Tylenol if given to someone allergic.

There is stuff in the medical kit that made me cringe to think someone untrained has assess to it. NTG is the least of your worries. Most of the ACLS meds are on there not-to-mention the SZ treatment meds. It really amazed me, and actually still does a little what is on the plane. There is ET equipment too. Have you ever seen doctors take ACLS. Some of them you have to walk through every step. Some are top notch. Remember, podiatrists and psychiatrists have "Dr" in front of their names.

In the case of NTG, it can be provided to the customer if directed by Medlink and the customer/patient can self-administer it.

M
 
itsjustme
Posts: 2727
Joined: Sun Apr 25, 2004 6:58 pm

RE: When Is The Decision Made To Divert For A Medical?

Thu Dec 29, 2005 6:16 pm

Quoting ChiGB1973 (Reply 42):
Have you ever seen doctors take ACLS.

Yep and you're right, it's not a pretty sight. Actually, medics sometimes get a kick out of seeing the Docs (and nurses as well) sweat prior to being tested on things we do on a daily basis (intubation, EKG intrepretiation, IV therapy, and of course the much dreaded megacode just to name a few).

Quoting ChiGB1973 (Reply 42):
In the case of NTG, it can be provided to the customer if directed by Medlink and the customer/patient can self-administer it.

OK, now you have me curious. Even if the patient is able to self administer it (I assume you are referring to pt's who are already on it), does Medlink at least ask for a pressure to be taken prior to ordering that NTG be given?

As for the szr meds...you're not referring to valium, dilantin, phenobarb, etc... are you?
 
ChiGB1973
Posts: 1394
Joined: Mon Mar 22, 2004 6:39 am

RE: When Is The Decision Made To Divert For A Medical?

Fri Dec 30, 2005 9:30 am

Quoting Itsjustme (Reply 43):
OK, now you have me curious. Even if the patient is able to self administer it (I assume you are referring to pt's who are already on it), does Medlink at least ask for a pressure to be taken prior to ordering that NTG be given?

We had automatic B/P machines and that was part of the work sheet to be filled out prior to contacting MedLink.

Quoting Itsjustme (Reply 43):
As for the szr meds...you're not referring to valium, dilantin, phenobarb, etc... are you?

I wish I could find the list. It was strange in the fact that F/As had to "work" the code until landing and medical personnel took over, but there was one of each. When I worked codes in the field, I liked high dose Epi. One pre-filled doesn't get you too far.

M
 
MAS777
Posts: 2757
Joined: Sun Jul 11, 1999 7:40 am

RE: When Is The Decision Made To Divert For A Medical?

Sat Dec 31, 2005 3:34 am

Quoting GeorgiaAME (Reply 39):
and not a word of thanks from the airline for helping to save the life of a crew member.

In all, one very, very humbling experience, and scary as poop.

On my flight - British Airways was superb and I did get quite a few 'perks' on the remaining flight back to London.

I second that 'scary as poop' remark... hence my (?bad) advice of downing that bottle of whiskey should you find one first!

Not sure what the problem is with GTN (as we call it here) on an aircraft - I have one in the boot of my car along with everything else I hope I never need (like ET tubes).

Popular Searches On Airliners.net

Top Photos of Last:   24 Hours  •  48 Hours  •  7 Days  •  30 Days  •  180 Days  •  365 Days  •  All Time

Military Aircraft Every type from fighters to helicopters from air forces around the globe

Classic Airliners Props and jets from the good old days

Flight Decks Views from inside the cockpit

Aircraft Cabins Passenger cabin shots showing seat arrangements as well as cargo aircraft interior

Cargo Aircraft Pictures of great freighter aircraft

Government Aircraft Aircraft flying government officials

Helicopters Our large helicopter section. Both military and civil versions

Blimps / Airships Everything from the Goodyear blimp to the Zeppelin

Night Photos Beautiful shots taken while the sun is below the horizon

Accidents Accident, incident and crash related photos

Air to Air Photos taken by airborne photographers of airborne aircraft

Special Paint Schemes Aircraft painted in beautiful and original liveries

Airport Overviews Airport overviews from the air or ground

Tails and Winglets Tail and Winglet closeups with beautiful airline logos