Pilots don’t deal with emergencies nearly as much as the people in Hollywood would have you believe. The majority of flights are uneventful, and most of the ones that are eventful fall that way because of the weather, not because of an engine fire or a hijacking.

In my career, I’ve had a number of issues both mechanical and human to handle in flight. Mechanical ones are usually pretty straightforward, as there is a checklist for just about everything (“just about” being the caveat). A few of the more challenging scenarios have involved medical issues with passengers, and the most challenging have been those that occur with relatively short notice before either a descent to the destination or the landing.

Three stand out. One was a pregnant lady who went into labor as we were turning final, and two were passengers who got sick in flight (different people, different flights, same day—you can’t make this stuff up). It’s often said that the holy trinity of flying is aviate, navigate, communicate, and never is that more true than when dealing with a compressed time frame and a medical scenario that may require immediate help. No matter what it is, you need to ensure that safety of all passengers, and you can best do that by actually flying the airplane. Sounds obvious, right? But it sometimes gets lost in our innate desire to help someone.

The first task is to figure out if a diversion is even an option or necessary. The captain and the first officer may disagree on this, but the FO has an obligation to respectfully assert an opinion, and the captain has an obligation to respectfully listen and consider that input.

If a diversion is not in the cards, then it is imperative to split the workload in such a way as to ensure continued safety while addressing the problem. On the second of my two medical emergencies in one day, the passenger was deteriorating rapidly, and the captain had me take over all of the flying duties while he coordinated with the cabin crew and the folks on the ground. This particular event began below 18,000 feet on our descent, so things happened quickly.

Normally, sterile cockpit procedures would apply, but there was reason to believe that this person might not survive, and time was of the essence. While I flew, the captain got as much information as possible from the flight attendants and passed that on to our station on the ground, so that they could pass it on the EMTs on the airport. We did the checklists together, but in between, he was getting updates from the cabin.

When we checked in with the tower, they had to be told what was going on, as preparations were still coming together on the ground. ATC had some idea of what was going on, but they didn’t know the full extent of it. Once we told them, they gave us a better runway and promised us an expedited taxi to the gate. This conversation went on until just a short distance from the runway.

On the ground, the captain taxied the airplane as quickly as he safely could while I took over ATC duties, and when we got to the gate, the paramedics were on the jetway with a stretcher waiting to remove our sick passenger.

Unforeseen emergencies like this don’t happen often, but when they do, it seems to be at the worst possible time. The workload and the stress increase, but the obligation to stay professional and on task never changes. This passenger survived, and part of that was the coordination that took place to make sure that emergency personnel were in position and had the information they needed. But that would not have mattered if we had not aviated first, navigated second, and communicated third.—Chip Wright