Page 1 of 1

Question about in-flight medical emergencies re: CPR through approach and landing

Posted: Fri May 25, 2018 10:51 am
by flapsdown40
This is a hypothetical in-flight medical emergency, but I'm sure it's happened before, purely due to the number of people who fly these days.

Here's the scenario: A 50-something male begins to exhibit all of the classic signs of a heart attack about 30 minutes before the flight's arrival at the destination. A medical doctor just happens to be on board this flight, and determines the passenger (now a heart attack patient) needs CPR *now* for the patient to have any chance of surviving the potentially lethal condition. The MD determines the patient needs to be laid out in the aisle so CPR can begin. So the MD, along with another passenger, maybe even a nurse on holiday, begin to administer CPR as the plane starts its descent to the airport. The MD determines that the patient needs continuous CPR until paramedics can board the plane after it has landed. (Let's leave a portable AED device out of the equation for the sake of this hypothetical situation.)

So on to the question: in a case like this, would the MD and "passenger assistant" be allowed to remain with the patient through the entire approach AND landing, or would they be forced to abandon the patient and return to their seats and buckle in for the approach and landing?

Sorry if this question seems silly or totally off-the-wall, but it's just something I've been wondering about.

TIA for any responses.

Re: Question about in-flight medical emergencies re: CPR through approach and landing

Posted: Fri May 25, 2018 12:40 pm
by XAM2175
Not an expert at all, nor do I have any experience, but I believe many airlines have a last-resort procedure for crew and the like who can't make it back to their seats when otherwise required to. It's along the lines of sit down where you are and brace against seats or solid fittings, and I imagine that would the compromise used to avoid letting a patient die.

Similarly, in the event of a decompression, there are portable oxygen bottles and on many aircraft also a number of supplementary tethered masks at normal seat rows - the latter intended, I understand, to support lap infants but obviously also of use to displaced passengers and crew.

Re: Question about in-flight medical emergencies re: CPR through approach and landing

Posted: Fri May 25, 2018 2:22 pm
by mmo
If the situation was that dire, the PIC would have declared an emergency. As such, he can use his Captain's emergency authority and allow the essential people to remain where they are. However, given the time of the descent and even expediting the descent it will be at least 30 minutes until emergency services are on the ground. Most likely more.
Most of the medical kits I have had experience with have an Ambu bag onboard so that would be used instead of CPR.

Re: Question about in-flight medical emergencies re: CPR through approach and landing

Posted: Sat May 26, 2018 3:26 am
by mabadia71
mmo wrote:
Most of the medical kits I have had experience with have an Ambu bag onboard so that would be used instead of CPR.


The ambu bag is not a replacement for CPR, the ambu is for supplying oxygen in a CPR situation, but if your not doing chest compressions you can pump that ambu all you want, the patient will still be dead.

Re: Question about in-flight medical emergencies re: CPR through approach and landing

Posted: Sat May 26, 2018 9:02 am
by debonair
I can only tell for my company - CPR is never done in an aisle in front of other passengers, also the available space is not suitable. CPR will be done in the galley, also to allow paramedics on the ground straight to the patient and to "secure" the patient against the bulkhead on landing. The "active" persons will do CPR at all times, even during touch down - other assisting, non-active persons will be seated closest to the patient in the crew jump seat!

Re: Question about in-flight medical emergencies re: CPR through approach and landing

Posted: Sat May 26, 2018 12:53 pm
by flapsdown40
Thanks to all for your responses.

mabadia71- I kind of thought the same thing about the chest compressions- without any bloodflow, and therefore oxygen, to the brain, slow brain death will begin in about 4 minutes or so, from what I've heard. And the Ambu bag eliminates the need for actual physical mouth-to-mouth
(lips-to-lips) breathing for the patient.

Debonair- it never occurred to me that a CPR patient would be taken to the galley area of the plane. Sounds entirely reasonable to me.
Seeing someone being given CPR "in the open" so to speak could be traumatic for some people, especially those who are very squeamish about medical procedures in general.

Re: Question about in-flight medical emergencies re: CPR through approach and landing

Posted: Mon May 28, 2018 2:20 am
by AAlaxfan
Someone correct me if I’m wrong, but once CPR is started you don’t stop unless the patient has been revived and stabilized or declared dead.

Re: Question about in-flight medical emergencies re: CPR through approach and landing

Posted: Tue May 29, 2018 5:31 pm
by kpc777
Last year I was on UAL GUM-HNL flight (777) sitting in economy just behind business. I think we were about 60-90 min from HNL when a passenger in business started having medical problems. There were a number of medical professionals on the flight and they started performing CPR in the aisle. I don't recall how long it was going on but did notice individuals alternating (I tried not to look....it's hard to give someone privacy on a plane but I felt that was one way I could do it.)

I noticed shortly before touchdown that the individual was placed in the galley and a flight attendant was there, curtains closed. I did not notice if passengers were with the flight attendant in the galley. The individual did pass away and was quite heart breaking to see his family with several children leave the aircraft first.

Re: Question about in-flight medical emergencies re: CPR through approach and landing

Posted: Tue May 29, 2018 7:09 pm
by anstar
I guess its up to the crew on the day. ie for safety reasons they wouldn't be made to continue... but I'd say most would continue CPR during approach and landing. But they certainly wouldn't be obliged to for safety reasons. Its one of those ones where the manual says this but on the day something different might happen.

Re: Question about in-flight medical emergencies re: CPR through approach and landing

Posted: Tue May 29, 2018 7:52 pm
by jupiter2
AAlaxfan wrote:
Someone correct me if I’m wrong, but once CPR is started you don’t stop unless the patient has been revived and stabilized or declared dead.


That's it, you do not stop unless you are physicaally unable, your own life is in imminent threat/risk, or you are relieved by someone else. A normal approach and landing are not something as severe to put someone performing CPR at imminent risk of their own safety, so you keep going.

Simply put, if you stop CPR the patient is going to die.

Re: Question about in-flight medical emergencies re: CPR through approach and landing

Posted: Thu May 31, 2018 8:32 am
by VSMUT
I was very shortly with a major airline once. Their policy was to stop all CPR 15 minutes prior to landing, and also to perform it in the aisle. It was only 1 of many dubious things I saw there, so I left pretty shortly thereafter.

Re: Question about in-flight medical emergencies re: CPR through approach and landing

Posted: Thu May 31, 2018 10:03 am
by SCFirefighter
AAlaxfan wrote:
Someone correct me if I’m wrong, but once CPR is started you don’t stop unless the patient has been revived and stabilized or declared dead.


For Professional Rescuers
A) If you have formal, professional training you have a duty to act. Stopping CPR before you’re relieved by higher trained personnel can open you up to criminal and civil liability. (Abandonment) For professional rescuers and CPR Instructors like myself, when you touch the patient, the patient belongs to you, not a flight crew. Period. Ceasing medical care inflight to move a patient that’s not in imminent danger will open you up once again to legal repercussions. Convenience, and Privacy Vs Standard of Care. Here’s a Scenario: You immediately begin CPR on a male in the isle for a witnessed cardiac event, while 150 people watch in horror, only to stop CPR for 1-4 minutes to move said patient to a galley. Patient dies. Family is left saddened and angry because they and 145 people witnessed *you* stop continual care. A lawyer would absolutely eat you alive as a professional in court.

For the Layperson
B) The layperson can stop care without legal ramifications due to Good Samaratin laws. While this may seem crazy, of course having CPR Training does train you to resuscitate someone, but until you crack and snap your first rib or attempt to ventilate a patient for the first time, only to give them too much air, entirely too fast with a BVM, filling the stomach with air and have them explosively vomit bile all over you, there’s no way to know how you’d react. Any of those things could make you walk away for a myriad of reasons.

Most 911 Centers across the US have adopted “compression only” for the layperson that calls 911 and gets instructions on what to do. AHA studies have shown that there’s enough residual oxygen in the bloodstream to maintain life for 5-10 minutes of compression only CPR.

It’s important to have a lot of hands around in these events. There’s not a single person on earth that can do proper CPR for 30 straight minutes without switching off between cycles. It’s brutally physical to do it properly over an extended period of time.

Most professional rescuers from the 911 real world know this fact - Be wary of anyone saying “I’m a nurse or doctor”... Caring for a victim that’s been properly packaged by Fire/EMS in a hospital room is vastly different from crude, raw CPR in a stressful situations outside of a medical facility. My rule: No person ever takes my patient away from me until they can prove they’re higher trained than me.

While this may not be the most popular opinion among some on here, trying to drag or carry a patient up an airplane isle to a “private place” could be the exact reason they die. Early CPR saves lives. Early. Seconds matter.

Always remember this tip:
If you do more than 15-20 compressions and you haven’t felt or heard the patient’s ribs break, you’re not doing it hard enough.

Finally from my standpoint as a professional rescuer, I would not allow any patient in cardiac arrest to be drug or carried anywhere, by anyone, on any flight, unless there’s imminent danger. If that means they call law enforcement on me at the gate, so be it. I will absolutely pick and win that battle only because I can legally prove my actions give the patient the highest chances of survival. It’s hard to bring someone back. Really hard. Delaying care will make really hard, damn near impossible. It goes without saying that saving someone's life is the most noble and selfless thing that anyone could ever do.

Re: Question about in-flight medical emergencies re: CPR through approach and landing

Posted: Fri Jun 01, 2018 11:57 am
by csavel
Just a week ago, i was on a flight from PAP to JFK and this happened about 30 minutes before touchdown. Luckily there was a medical missionary team on the flight so like 20 medical professionals to assist. I didn't see everything but I was close enough to business class (where the passenger was) to see that people were walking to and from the patient until just before landing and the people attending the patient during landing weren't sitting. Assume they were switching off performing CPR. Good job by everyone. Once we landed and were at the gate and paramedics came on, there was an announcement that there was another emergency in the back of the plane! Plane was filled with a lot of old people, far more than I have seen normally on this route. Maybe going to NYC to visit the grandkids? (There is a huge Haitian diaspora in Brooklyn) Or coming back from visiting family in Haiti - I don't know why at this specific time of year. The wheelchair line on the jetway was like you see when you land at PBI.