Tag: medical emergency

Medical Events

Medical emergencies in flight are pretty rare, but when you consider the numbers, it is inevitable that some will happen.

With 50 to 350 people on an airplane, some of whom already have underlying health issues and may be experience more stress than normal because of the travel experience, someone will eventually get sick. Hopefully, it is relatively minor and not a life-threatening event, and better still if there is a medical professional of some sort on board.

In my days at the regionals, the decision to execute a diversion was almost entirely in the hands of the crew. As you can imagine, this led to a lot of second-guessing, but pilots are pilots, and not doctors. Given the choice, they will act in a conservative fashion and land so as not to risk the burden of a serious illness or death on one of their flights.

At the majors, the carriers utilize more resources. Almost every airline has a contract with a medical service that has a team of doctors on call 24/7/365 to help evaluate a situation. The pilot is expected to gather as much information as possible—passenger name, gender, age, symptoms, pertinent medical history/current medications—and relay that to the folks on the ground. During this conversation, the flight dispatcher is usually listening in. The dispatcher will coordinate with a diversion airport if necessary, and will also have EMTs and paramedics meet the airplane when necessary.

Diversions can be major disruptors to the schedule, and they are expensive. Making one unnecessarily doesn’t do anyone any good, so it’s important to make the right decision. Taking the decision out of the hands of the crew and putting it in the hands of the medical professionals takes the pressure off the crew—if not off the airline—and allows the experts to call the shots.

I’ve had a handful of medical events over the years, and the last several years it has averaged about one per year. Usually, it is someone who is just sick or doesn’t feel well. There was only one where I disagreed with the decision to press on versus a diversion, but it wasn’t my call to make. One memorable day I had medical emergencies on back-to-back flights. That was fun. The second one was on a relatively short flight, and the destination was the only real option, but it was a compressed time frame, and we were incredibly busy trying to coordinate things with ATC, the station, and the cabin crew.

International flights pose their own challenge because of Customs and Immigration procedures. Incidents over water are challenging because the ability to communicate with the company and medical folks may be limited, and the time to an airport may be longer than you’d like. I’ve experienced more than one event coming in from the Caribbean, which always leads one to hope that someone just had a bit too much fun on vacation.

Every company has their own procedures in place for dealing with and properly reporting an event. It behooves even new-hire pilots to be as familiar as possible with those procedures early on, because once the cabin crew calls with an event, the workload—and stress—can rapidly escalate. Knowing where to find your help and what to do with it will go a long way toward ensuring a favorable outcome.—Chip Wright 

What are your most common emergencies?

It’s an unusual question, but it isn’t. And I’m sure that somewhere, someone actually keeps track of this sort of stuff. It just doesn’t happen to be me. I’ve been asked this several times, and the question came to mind the other day when I had to declare an emergency.

First of all, one has to define what an emergency is. My company manual says that a flight emergency is “any situation, such as a malfunction of the aircraft, that requires immediate decision and action for the safety of flight…[and] requires special procedures to be taken beyond those normally utilized in flight operations.” Note that none of this includes various other emergencies, such as medical emergencies. Basically, what it says, is that…well, it’s so clearly written that it’s pretty obvious what it says.

Still, there is room for interpretation. For instance, we would all probably agree that an issue with a failed elevator would constitute an emergency, which would justify declaring the same. What about a flap failure—specifically, one in which the flaps simply failed to deploy? This was a not-uncommon issue on the CRJ for several years. If flaps fail to move, is that really an emergency? It depends on your definition. Some operations will dictate that if a flight control of any form is involved, then it is an emergency, no matter how minor or severe the situation. The no-flap landing speed on the CRJ is 172 knots indicated. The max groundspeed for the tires is 182 knots. If this scenario were to occur at a high- elevation landing, those two numbers could wind up eyeball-to-eyeball with each other. Besides, 172 knots on final is fast–real fast. Almost 200-miles-an-hour fast. That’s approaching space-shuttle-on-final fast.

But when it comes to “common” emergencies, I’m not sure that there really is a one-sized-fits-all approach. At least, there doesn’t appear to be one for me. I’ve had the flap failure. I’ve had gear issues (this, to me, is the ideal emergency if there is one). I once had a hydraulic failure that forced a diversion. One flight required an engine to be shut down because of improper maintenance done on the airplane after a bird strike the day before. My most recent one was a spoiler that did an uncommanded deployment in flight. An uncontrollable fuel transfer system once caused two emergencies in one day. I used to joke that the tower would just declare an emergency on my behalf every time I took off.

As you can see, there really isn’t a pattern, and that is a testament to how well airplanes are designed and built these days. The redundancy alone is a lifesaver. In fact, sometimes, a redundant system can save the day automatically, and the crew doesn’t even know there was a problem until the airplane says, “Hey, I had this issue, but chill, because I already fixed it.” If I had to pin down the most common issue, it wouldn’t be the airplane. It would the carbon-based units being transported on said airplane. Medical emergencies take place every day. In fact, at least three times a week, I hear a crew calling either ATC or the company about a passenger having a problem.

Of those, my own unscientific analysis seems to indicate that losing consciousness or having what appears to be a heart attack or a stroke top the list. I don’t know this, of course, but I hear an awful lot of discussion about those symptoms (it’s pretty hard to misdiagnose someone as passed out when they are out cold). Some of these get interesting too. Seizures can be dangerous not just for the victim, but also for those around them. They can be messy as well (use your imagination). Ladies going into labor get everyone’s attention. Guess how I know that?

Some emergencies you can practice for, and some you can’t. Some you shouldn’t just because it isn’t very safe to do so. But in your own mind, you should have a definition that suits your equipment and your experience. Should you find yourself within the bounds of that definition, then declare an emergency. As for the rumored “mountains” of paperwork? There is no such thing. ATC may ask for your contact info, but nobody is going to fault you, and nobody is going to be having you filling out piles of forms in triplicate or even in double-icate. Honestly, it’s no big deal. As a matter of fact, if an emergency situation clears itself (say your landing gear had a gremlin, but then acted normally and went to the commanded position), you can “undeclare” your emergency. If you want to, you can fill out a NASA ASRS form, but you are not required to fill anything out, so long as the airplane is not damaged.

Just don’t do what one crew did, and declare an emergency because the FMS/GPS quit and they didn’t think about navigating from VOR to VOR. I won’t say which airline it was for, but yes, it did happen. Once.—Chip Wright