kris
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Medical Emergencies Over Big Oceans

Tue Sep 23, 2008 11:59 am

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
 
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Francoflier
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RE: Medical Emergencies Over Big Oceans

Tue Sep 23, 2008 1:01 pm



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.
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EMBQA
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RE: Medical Emergencies Over Big Oceans

Tue Sep 23, 2008 2:17 pm



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"
 
kris
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RE: Medical Emergencies Over Big Oceans

Tue Sep 23, 2008 4:43 pm



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
 
thegreatchecko
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RE: Medical Emergencies Over Big Oceans

Tue Sep 23, 2008 4:59 pm

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
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Blackbird
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RE: Medical Emergencies Over Big Oceans

Tue Sep 23, 2008 10:38 pm

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
 
thegreatchecko
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RE: Medical Emergencies Over Big Oceans

Wed Sep 24, 2008 12:06 am



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
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Starlionblue
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RE: Medical Emergencies Over Big Oceans

Wed Sep 24, 2008 12:14 am



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." - John Ringo
 
lowrider
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RE: Medical Emergencies Over Big Oceans

Wed Sep 24, 2008 12:51 am



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.
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bhill
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RE: Medical Emergencies Over Big Oceans

Wed Sep 24, 2008 2:06 am

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
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Francoflier
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RE: Medical Emergencies Over Big Oceans

Wed Sep 24, 2008 3:43 am



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.
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firefly_cyhz
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RE: Medical Emergencies Over Big Oceans

Wed Sep 24, 2008 2:14 pm

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?
 
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Starlionblue
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RE: Medical Emergencies Over Big Oceans

Wed Sep 24, 2008 3:16 pm

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." - John Ringo
 
point8six
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RE: Medical Emergencies Over Big Oceans

Wed Sep 24, 2008 7:22 pm

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.
 
georgiaame
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RE: Medical Emergencies Over Big Oceans

Wed Sep 24, 2008 8:16 pm

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!
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Starlionblue
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RE: Medical Emergencies Over Big Oceans

Thu Sep 25, 2008 12:06 am

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." - John Ringo
 
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Francoflier
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RE: Medical Emergencies Over Big Oceans

Thu Sep 25, 2008 12:26 am



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.
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Starlionblue
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RE: Medical Emergencies Over Big Oceans

Thu Sep 25, 2008 4:09 am



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." - John Ringo
 
iairallie
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RE: Medical Emergencies Over Big Oceans

Thu Sep 25, 2008 6:29 am



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.
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wilco737
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RE: Medical Emergencies Over Big Oceans

Thu Sep 25, 2008 7:42 am



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.

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Starlionblue
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RE: Medical Emergencies Over Big Oceans

Thu Sep 25, 2008 2:30 pm



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." - John Ringo
 
TheSonntag
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RE: Medical Emergencies Over Big Oceans

Thu Sep 25, 2008 8:34 pm

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.
 
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Starlionblue
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RE: Medical Emergencies Over Big Oceans

Thu Sep 25, 2008 11:04 pm



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." - John Ringo
 
tdscanuck
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RE: Medical Emergencies Over Big Oceans

Fri Sep 26, 2008 6:10 am



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.
 
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Starlionblue
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RE: Medical Emergencies Over Big Oceans

Fri Sep 26, 2008 6:17 am



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." - John Ringo
 
thegreatchecko
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RE: Medical Emergencies Over Big Oceans

Fri Sep 26, 2008 7:23 am

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 in the US, they are state laws. There are no federal laws addressing this issue.

Quoting Starlionblue (Reply 24):
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.

True. But the concern is the lawsuit and the expenses associated with it, not whether or not they are right. Like I said earlier, thank lawyers that its better to just do nothing.

Also, in the story related above, had something gone wrong don't you think lawyers would have a field day with the fact the doctor overrode the directives of the airline's online medical direction? Seems like a pretty strong case for the plaintiffs to me.

Not every doctor has the expertise and experience required to handle an airborne medical emergency. Thus the existence of companies like MedLink and Stat MD that provide access to medical professionals (ER doctors, paramedics, critical care nurses) with the expertise and resources to properly advise crews on what to do in the event of a medical emergency. They even provide the added benefit of assuming liability from the airline and crew as long as their orders are followed.

Checko
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daviation
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RE: Medical Emergencies Over Big Oceans

Fri Sep 26, 2008 4:13 pm

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 previously, I knew what was happening and although I was very frightened, I was not in a complete panic. Of course, I owe my life to my implanted ICD. If I didn't have an implanted defibrillator, I'd be six feet under the sod by now. Anyway, we were docked in Hamilton Bermuda, and the on-board medical team -- I don't know how to say this charitably -- but they were probably recruited from the beauty salon. They were more frightened than I was, so they shipped me off to King George (or Edward?) Hospital immediately. Unfortunately, my experience with the medical care in Bermuda was not positive. It took 17 hours for a cardiologist to see me, the physician and nursing staff had never even heard of my ahrythmia syndrome, and it was National Cricket Day, so there was no public transportation on the island. Obviously I recovered, but I had to demand to be discharged from the hospital, and they wouldn't release me until I handed over my American Express Card! I then hitched on the back of a motorbike to rejoin the cruise in St George. What an experience!

A year later, I was on a US Air flight when the man in front of me keeled over out of his seat. The flight attendants didn't make a general announcement, but since the entire drama was taking place in front of me, I offered my medications of nitroglycerin, beta blockers, aspirin, and Xanax (to steady his nerves, if necessary). The flight crew was very appreciative, and I'm glad to say that the patient recovered quickly.
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CrimsonNL
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RE: Medical Emergencies Over Big Oceans

Fri Sep 26, 2008 6:49 pm

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 were 2 medical doctors that both checked on the man and declared him dead. So they put a blanket over the guy and his wife was very upset of course. So 15 minutes later the deceased suddenly stands up and feels oke! I believe as the story goes they immediately diverted.

I myself was on a NW flight and after we docked in MSP the FA announced there was a medical emergency, and that medics would board to get the passenger off. Turned out to be a TSA officer checking some guy's bag and then left again...
Always comparing your flown types list with mine
 
curlyheadboy
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RE: Medical Emergencies Over Big Oceans

Fri Sep 26, 2008 8:35 pm

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 but just kept asking quietly row after row. I was travelling with my dad who is an experienced surgeon, and when she asked us, my dad answered he was in fact a doctor.
She asked very politely if he could check on a passenger travelling in business (we were flying Y) that was "not doing very well".
So my dad went with her and when he came back a few minutes after, he told me there was one guy that complained about having difficulties in breathing, so he visited him but he believed he just had a few drinks too much and was ok.
Then he told me the F/A asked him if, in his opinion, they should continue to our destination or divert, he told her he believed the passenger was ok and didn't need any immediate medical care.
About an hour later the same F/A came back to us to inform my dad that the passenger was actually doing a lot better and presented us with two small bottles of champagne "on behalf of the crew".
That was very nice of them (I would have dreamed of an upgrade in first, but I guess I'd been asking for too much  Wink )
If God had wanted men to fly he would have given them more money...
 
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Starlionblue
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RE: Medical Emergencies Over Big Oceans

Fri Sep 26, 2008 11:20 pm



Quoting CrimsonNL (Reply 27):
On an MP TATL flight, a man got sick and suddenly dropped to the ground. There were 2 medical doctors that both checked on the man and declared him dead. So they put a blanket over the guy and his wife was very upset of course. So 15 minutes later the deceased suddenly stands up and feels oke! I believe as the story goes they immediately diverted.

Scary. However, this is not really that uncommon. "Dead" people "come back" with remarkable frequency.

It does surprise me that two doctors pronounced him dead, though.
"There are no stupid questions, but there are a lot of inquisitive idiots." - John Ringo
 
teme1976
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RE: Medical Emergencies Over Big Oceans

Sat Sep 27, 2008 7:02 pm



Quoting Starlionblue (Reply 7):
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.

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 useful to prevent arterial clots. If you are in a risk group for deep vein thrombosis mini heparin is the drug that can be considered.
 
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Starlionblue
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RE: Medical Emergencies Over Big Oceans

Sun Sep 28, 2008 5:40 am

Good info thx.
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"There are no stupid questions, but there are a lot of inquisitive idiots." - John Ringo
 
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DocLightning
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RE: Medical Emergencies Over Big Oceans

Sun Sep 28, 2008 6:24 am

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 on board is not permitted to assist as the flight attendants are trained in CPR and are put in contact with a physician on the ground. This policy varies from airline to airline, however.

This is the talk I give to medical students:

If you are a physician called to a medical emergency in an inconvenient location (a plane, a high-speed train miles from civilization, etc.) your job is:
1) Assume control of the situation
2) Appear calm and in control
3) Assess the patient's AIRWAY and secure it if not secured
4) Assess the patient's BREATHING and establish respiration if not established
5) Assess the patient's CIRCULATION and establish it if not already done.
6) Fix anything else that you can quickly fix (apply pressure to the gushing wound, splint the broken limb, etc.)
7) Do what is necessary to get the patient to a medical facility ASAP.

In other words, your job is to ensure that the air is going in and out and the blood is going round and round ad that it keeps doing that until the patient is no longer under your care. If the patient is breathing then I just sit there with the patient. Any more fooling around and I could hurt the patient and expose myself to liability.

The only exception to this rule is if there's a delivery in which case... you have to deliver the baby. You first guide the baby's head down, then up, while applying pressure to the perineum (just posterior to the vaginal opening). Clamp the cord, suction, stimulate, warm, and dry the baby, and voila! It's easy, really.
-Doc Lightning-

"The sky calls to us. If we do not destroy ourselves, we will one day venture to the stars."
-Carl Sagan
 
iairallie
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RE: Medical Emergencies Over Big Oceans

Wed Oct 01, 2008 7:58 pm



Quoting TheSonntag (Reply 21):
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.

Anyone presenting credentials regardless of what nationality they are is welcome to assist.

http://www.airliners.net/aviation-forums/help.main?open=new

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

Not in an US registered airplane. They are protected.

Quoting DocLightning (Reply 32):
This policy varies from airline to airline, however.

That policy may be unique to BA. None of the American carriers I've worked for have anything like that trained medical assistance is always welcome.
Enough about flying lets talk about me!
 
thegreatchecko
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RE: Medical Emergencies Over Big Oceans

Thu Oct 02, 2008 1:05 am



Quoting IAirAllie (Reply 33):
Not in an US registered airplane. They are protected.

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 laws. Unless the incident occurs on the ground, there is no way a state law could apply.

Furthermore, Good Sam laws only protect someone if they do everything right. How often does that happen, especially in an airplane, with an unfamiliar medical kit, far from any true medical interventions.

Thus why it is best to just follow the directions of the people on the ground and simply question anything you don't think is right. Disregarding them opens a responder to a whole bunch of legal issues and liabilities, especially if something happens to the patient.

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"
 
lowrider
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RE: Medical Emergencies Over Big Oceans

Thu Oct 02, 2008 2:42 am



Quoting DocLightning (Reply 32):
It's easy, really.

I know a few women who might disagree.

Quoting DocLightning (Reply 32):
This policy varies from airline to airline, however.

Very true. When I flew for people haulers, we were told that the cabin staff would be encouraged to make use of any medical personnel on board to meet the needs of an emergency. Even a vet if that is all you have (no disrespect, to vets, especially the large animal ones). Pilot were supposed to assist by making PA's if requested, and start evaluating diversions as soon as we were advised of the situation.
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gulfstream650
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RE: Medical Emergencies Over Big Oceans

Thu Oct 02, 2008 3:15 am



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?

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 doctor on board would he or she please make themselves known to the cabin crew"

Incidently, I was in the Business Class cabin and about 5 doctors all stood up. Turned out they were on the way to some sort of medical conference. Anyway, to cut a long story short I don't know what was wrong with the pax but we didn't divert and just carried on to ORD and the doctors took turns to monitor the pax throughout the rest of the flight.

Here is an inflight video of an American carrier returning to London due to an onboard medical emergency:

I don't proclaim to be the best pilot in the world but I'm safe
 
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DocLightning
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RE: Medical Emergencies Over Big Oceans

Thu Oct 02, 2008 12:00 pm



Quoting Lowrider (Reply 35):
Quoting DocLightning (Reply 32):
It's easy, really.

I know a few women who might disagree.

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 entire birth. The father can have all he likes."
-Doc Lightning-

"The sky calls to us. If we do not destroy ourselves, we will one day venture to the stars."
-Carl Sagan
 
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Starlionblue
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RE: Medical Emergencies Over Big Oceans

Thu Oct 02, 2008 3:05 pm



Quoting DocLightning (Reply 37):
"Natural childbirth means that no drugs will be administered into the mother's body during the entire birth. The father can have all he likes."

How I wish that had been true.  Wink
"There are no stupid questions, but there are a lot of inquisitive idiots." - John Ringo
 
kimberlyRJ
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RE: Medical Emergencies Over Big Oceans

Thu Oct 02, 2008 11:13 pm

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 flight from Miami to London Heathrow.

He was sat in Club class (we upgraded him from World Traveler (economy class) so we could keep a close eye on him, I know what you boys/men are like lol

After serving drinks, dinner and more drinks the cabin started to settle down for the snooze while we cruised over the Atlantic.

That night we were taking a quite southerly NAT (North Atlantic Track) which put our pond crossing time at just over five hours.

Two hours into the crossing I was reading a book in the crew rest area when I heard the dreaded three calls (in the case of a medical emergency the responding crew member pressing the flight attendant call bell by the passengers seat three times, which alerts all the cabin crew members to get to there ‘medical stations’.

As a fully trained paramedic I shot out of the crew rest area and was told it was a “male passenger in club traveling on their own and he seemed to be fitting and was finding it hard to breath”.

Normally I should take a look at a passenger before taking the next step, but I had a feeling things were going to get worse so I engaged what we call at BA ‘Medical Response Protocol’ hit the lights on to wake everyone up and announced “Attention please – if there is a person of medicine on this flight please make yourself known to the crew as soon as possible” – this is also the code for the flight crew to switch on the seat belt signs so the cabin crew can have a clear run of the aisles. It was also the code for my fellow crew members to get the first aid kits and medical gases from where they were stowed and take them to the exit nearest the medical emergency, in this case exits L/R 2 (where the stairs take you to the upper deck.)

Making my way forward I listened out for any responses to my announcement, I heard nothing. Passing the galley area by exits L/R 2 the two cabin crew who get the first aid kits and medi gases confirmed they were ready.

On arrival to the passenger (the young man) there where passengers all turned around looking and two cabin crew members trying to help him. The young man had blood coming out of his mouth, blood pouring out of his arm he was fitting heavily and was a shade of white from were he could not breathe.

As he was fitting we needed to protect him from the surrounding seats etc which he was hitting with some force due to his seizure. We got blankets and pillows and surrounded him them with, got him into the recovery position and gave oxygen.

As the seizure continued for more then four minutes, and we could find no medicine in his bag (and no medical information given to the airline) I decided to inject a drug called Diazepam (10mg IV). With in a minute the seizure had mostly stopped however he was still finding it hard to breath, even with 100% oxygen his saturation rate was only 89%, very low for someone on oxygen!

At this point we moved him to the galley where my fellow crew members had got plastic sheeting on the floor (we do this so it’s cleaner for the medical emergency and then later cleaner for the galley!) Laying the young man on the floor it was obvious that the kid was having an asthma attack by the way he was trying to inhale and exhale.

At this point MediLink was finally on the phone and after explaining what was happening the Doctor granted me permission to open the first aid kit containing the drugs (which was lucky as I had already done it. Remember, I am legally allowed to open the first aid kit containing drugs and administer all but of few of the drugs to a passenger even with out speaking to a Doctor or MediLink – something that’s back up by BA policy.)

From the information shown MediLink agreed that the young man was having a severe asthma attack and we needed to land. Lucky for me the Captain had come to see what was going on and I told him we needed to land as soon as possible and then some.

On our planned route we were over an hour and a half from Heathrow, however the Captain spoke with ATC and he was permitted to go as fast as he needed, the Captain also elected to land at Cardiff airport, which would save us landing at a very busy Heathrow and would cut off at least 30 minutes flying time plus at least 10 minutes taxi time.

The young man was at this time fully awake after the seizure however was now panicking due to not being able to breath. I gave the young man an inhaler to use, which seemed to slow down the progress of the attack, but in no way stop it.

Keeping the young man calm was one of the most important things to do, so I sat with him, half covered with a blanket sat up with our backs to exit L2. The lights had been totally dimmed in that area to try and calm him down and noise was kept to a minimum, as was the crews movement in that area.

The Captain did an excellent job flooring it (English term for putting your foot down, going as fast as you can) and he reported they were only just shy of going into over speed.

Just as aircraft started its descent the young mans saturation rate went through the floor, from what I remember around 10 seconds later the young man arrested, I and one of my crew started CPR and I administered an EpiPen (which contains adrenaline), I picked up the intercom to the Captain and told him I was going to be using the defibrillator and how long did we have until finals (this is when we must stop using this equipment), he said around 20/25 minutes but he would see what he could do.

We used the defibrillator and shocked the young man three times – nothing. I decided to administer more adrenaline while the crew continued CPR, the young mans airways were open enough to get oxygen in and out, so we knew we had to press on.

I remember the Captain must have been going for it, the aircraft seemed to be pitching down at a steep angle and I could feel the vibrations of the speed breaks having been deployed.

We continued to do another three cycles of CPR and shocks and as quickly as the young man arrested he was back with us, barely but he was breathing for himself. I quickly filled in a form, explaining in detail what the young fella’s condition was at that stage, what drugs we had given him etc for one of my crew to take it to the Captain, so he could let the ground agents know (so they could in turn pass it onto the ambulance crews, so they are totally ready and waiting).

Minutes after the Captain asked for crew to be seated, however I and another cabin crew member stayed with the young fellow on the floor, he was hooked up to equipment and three drips there was no way he was going to move!

The Captain performed an excelling landing, a little hard but I am sure he just wanted to get us down and off the runway. Minutes after landing and a very fast taxi to the ramp exits were disarmed. The ambulance crews were on in minutes along with a rapid response Doctor.

The young lad was taken off the aircraft and rushed to hospital, leaving my crew to clean up the cabin and for me to be sick in the bathroom, think the shock of what was going on only caught up with me once it was over.

I met the young man and his parents a week later at our head office, the cheeky fella gave me a large bunch of flowers and I have him a model Boeing 747 and a get well card from the crew of that flight.

It just shows that you can never relax on any flight, you must always be ready to help and take control of a situation and always think on your feet. What I always feel my crew is fear is like a virus, the minute you show it, it spreads uncontrollably!

Airlines need to have excellent training, teach good communication and crew always need to trust each other – trust the information your given and to know each crew member are doing everything they can to assist.

I guess the most important part of being a crew member is to have total confidence in what your doing – that comes with time!

Kimberly.
 
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CrimsonNL
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RE: Medical Emergencies Over Big Oceans

Fri Oct 03, 2008 11:11 am



Quoting Kimberlyrj (Reply 39):

Wow, that is one amazing story! It was a thrill to just read it! Great job you did!
Always comparing your flown types list with mine
 
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DocLightning
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RE: Medical Emergencies Over Big Oceans

Fri Oct 03, 2008 11:12 am



Quoting IAirAllie (Reply 33):
Not in an US registered airplane. They are protected.

A word on this:

I could care less. I am a physician and I took the following oath:

Quote:
That into whatsoever house I shall enter, it shall be for the good of the sick to
the utmost of my power; I holding myself aloof from wrong, from corruption,
from the tempting of others to vice;

That I will exercise my art solely for the good of my patients, and will give
no drug, perform no operation for a criminal purpose, even if solicited, far less
suggest it;

My interpretation is that if there is a sick patient, I think about the patient before I think about myself. This whole medico-legal bullcrap ticks me off because doctors start to think about themselves before they think about the patients. If you want to operate that way, quit and get a job in which you're less likely to get sued. You knew the stakes when you applied to medical school.

So stop worrying about getting sued. If you take care of the patient, the patient won't sue you. Lawsuits happen when you do things wrong.

HOWEVER, this is why in such a situation I stick to ensuring that the patient is still alive and then I stop there. Trying to fool around any further in a limited environment like an aircraft is begging for a lawsuit. You do what the patient NEEDS and no more.
-Doc Lightning-

"The sky calls to us. If we do not destroy ourselves, we will one day venture to the stars."
-Carl Sagan
 
andz
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RE: Medical Emergencies Over Big Oceans

Fri Oct 03, 2008 11:52 am



Quoting WILCO737 (Reply 19):
It is not hard to use

That's the whole point of an AED. We sell them and the voice prompts make it pretty difficult to screw it up.
After Monday and Tuesday even the calendar says WTF...
 
kimberlyRJ
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RE: Medical Emergencies Over Big Oceans

Fri Oct 03, 2008 9:25 pm



Quoting CrimsonNL (Reply 41):
Wow, that is one amazing story! It was a thrill to just read it! Great job you did!

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 and say any cabin crew member I have worked with at BA would have and will do the same in the future - I mean the best they can.

Still, I think there is more airlines could do on longer haul flights!

Is it true that Singapore's A345's have a area to put a dead body in the cabin, I mean apart from the WC which is what we do.

Kimberly.
 
iairallie
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RE: Medical Emergencies Over Big Oceans

Sat Oct 04, 2008 12:35 am



Quoting DocLightning (Reply 41):
My interpretation is that if there is a sick patient, I think about the patient before I think about myself. This whole medico-legal bullcrap ticks me off because doctors start to think about themselves before they think about the patients. If you want to operate that way, quit and get a job in which you're less likely to get sued. You knew the stakes when you applied to medical school.

So stop worrying about getting sued. If you take care of the patient, the patient won't sue you. Lawsuits happen when you do things wrong.

HOWEVER, this is why in such a situation I stick to ensuring that the patient is still alive and then I stop there. Trying to fool around any further in a limited environment like an aircraft is begging for a lawsuit. You do what the patient NEEDS and no more.

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.
Enough about flying lets talk about me!
 
nomadd22
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RE: Medical Emergencies Over Big Oceans

Sat Oct 04, 2008 2:37 am

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 emergencies. It seems like airlines would subscribe to a similar service.
Anon
 
iairallie
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RE: Medical Emergencies Over Big Oceans

Sat Oct 04, 2008 11:21 pm



Quoting Nomadd22 (Reply 45):
It seems like airlines would subscribe to a similar service.

They do most use Medlink.
Enough about flying lets talk about me!
 
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DocLightning
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RE: Medical Emergencies Over Big Oceans

Wed Oct 08, 2008 10:37 pm



Quoting Nomadd22 (Reply 45):
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 emergencies. It seems like airlines would subscribe to a similar service.

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 situation, having a doctor on the ground talking to an amateur on the plane about how to treat a sick patient is also a sub-optimal situation.

One quick glance at the patient can give me thousands of times more information than a five minute conversation with someone who has seen the patient. Especially in an emergency.
-Doc Lightning-

"The sky calls to us. If we do not destroy ourselves, we will one day venture to the stars."
-Carl Sagan
 
lincoln
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RE: Medical Emergencies Over Big Oceans

Wed Oct 22, 2008 10:43 pm



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?

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 announcement (from a FA) has been

"May I have your attention please. At this time if there are any licensed medical professionals onboard, pease ring your flight attendant call button. May I have your attention please. If there are any licensed medical professionals, such as a doctor, nurse, or paramedic, on board please ring your flight attendant call button."

Both times multiple dings have been heard within seconds.

(Come to think about it -- both were around the holidays [one was on Christmas day] and both were on flights to or from Houston)
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