Thursday, November 20, 2008

Airborne Medical Emergency...behind the scenes

Something many people probably don't ever think about is...what happens if you're on board an airplane, in flight, and a medical emergency occurs? I just had one happen on one of the flights I was dispatching yesterday, and I thought discussing that topic here would make for a good blog post. (The actual airports involved have been changed, just to prevent giving out any potentially confidential information.)

The short answer is, if a life-threatening emergency is occurring, the plane you are on will in all likelihood divert to the nearest suitable airport so that the sick passenger can be taken to the hospital for medical treatment. There are several steps that are normally followed before the decision is made to divert, however, so let's go through them.

When an emergency occurs, there will be an announcement made on board to ask if there are any medical professionals on board who can assist. Normally, there is a doctor, nurse, or paramedic traveling on the flight, but not always. Next, the flight will attempt to contact its dispatcher (me, in this case) to report the emergency and request a patch with a service we use called MedLink. MedLink is not widely known outside the industry, but it's a pretty cool service to have...they have doctors on call trained to give advice on what to do in any medical situation, so even in the unusual situation of having no medical personnel on board, they can advise the flight attendants on what steps to take. They also make the call in whether a flight should divert immediately or not.

This is good for two reasons: first, we're getting advice from a doctor trained in dealing with inflight emergencies, and second, it provides legal liability for the airline. I know that second part sounds odd but think of it this way...if a doctor on board is asked to treat a patient, and they seek his opinion on whether the flight should divert or not, he will almost always say yes, for liability reasons. I am not blaming any doctor in our lawsuit-happy society for doing this, but MOST of the time, an immediate diversion is not necessary. (Not always, of course.) If a problem is serious but can be adequately treated on board the aircraft, MedLink arranges for paramedics to meet the flight in its destination city. MedLink also can help us determine if an ill passenger is fit to fly or not before the flight leaves the gate, if the crew has any concerns. Once again, this shields the airline from potential lawsuits.

Let's get back to the situation last night. The announcement was made on board requesting medical personnel, and a doctor was traveling on the flight who came forward to help. Since most of our domestic planes no longer have onboard phones (due to the manufacturer of those phones no longer supporting them) the flight contacted me through a radio service all the major airlines use called ARINC. I got some details about what was going on from the captain and contacted MedLink. In this case, a male passenger in his 60's who had just had recent coronary bypass surgery was experiencing symptoms of a heart attack, and a doctor on board was performing CPR. MedLink got information from me about the flight (flight number, aircraft type, destination, ETA) and talked briefly to the captain via the ARINC phone patch, and then briefed their physician.

The MedLink physician just had a few questions for the crew once he found out CPR was being performed...he asked if the onboard defibrillator had been used, and if the doctor treating the patient needed any advice on drugs to give the patient. Normally, my role in these calls is pretty minimal; I just monitor what is being said and make notes for later to put in my shift log. In this case, though, while we were waiting for the pilot to get back to us with some information on the ill passenger, the doctor asked me where was the nearest airport the plane could land at. I told the doctor Birmingham looked like it was closest, and the doctor said that getting the plane on the ground fast would be important.

On a side note here...sometimes the closest airport that a plane can land at is not the closest one geographically. A plane can be directly overhead an airport, but if it's up at cruising altitude, it can take longer for the plane to descend and land there than it might for an airport farther along its flight path. Also, it's important to go somewhere that the plane can get to a gate fast and have paramedics waiting. In addition to it's location last night, Birmingham was a good choice in this case because they had gate availability, on-site paramedics, and good ground support.

The captain came back on the line and said that while a defibrillator had been hooked up, it hadn't had to shock the patient's chest. (The defibrillator determines whether it has to give a shock on its own when it tries to detect a patient's heartbeat.) The MedLink doctor told the captain the plane needed to land ASAP (which the doctor on board helping the patient was also saying) so the captatin talked to me about where to land. He said next big airport along their route was Nashville, but I saw that Birmingham was slightly closer, so I passed my recommendation along to the captain. The captain agreed that Birmingham would be closer and confirmed with me he would be diverting there.

MedLink said they would take care of calling paramedics in Birmingham, and I told the captain I'd notify our station personnel there. After verifying again that we were diverting the flight to Birmingham (always good to verify things like that twice) the phone patch was ended. In situations like this, I don't call air traffic control directly unless the pilot requests me to, since he's already talking to them on the radio and can let them know he needs to divert much faster than I can.

Someone on the desk next to me offered to call Birmingham operations, and had a little trouble getting through, but finally managed to find some of our people at the ticket counter. I entered the diversion information into our reservations system, and worked up a new flight plan and flight release so the flight could continue on out of Birmingham once the ill passenger was taken care of. I then began calling everyone I needed to get in touch with in the office, which was a fairly long list of supervisor, our operations director, customer service, load planning...but it didn't take a very long time, and I had the new flight plan ready to go before the flight even landed in Birmingham.

I was kind of proud of myself about how well everything went with the flight last night. I didn't have a major role, but I may have saved the flight a few minutes in getting on the ground by suggesting Birmingham rather than Nashville, and in cases like this, every minute is important. The captain called and said thanks for my help after he landed and the ill passenger was taken off the plane. I was very impressed with how well he handled things as well...there have been cases where the first time we find out there's an emergency is when we see the flight diverting on the screen we use to track them with enroute. In some emergencies (usually mechanical ones) the crew doesn't have time to call us, but for this emergency they did, and by doing so they made the full use of all the resources available to them. I would go so far as to say that this was a textbook example of how inflight medical emergencies should be handled.

You may ask, well, that all sounds fine if you're flying over the US or some other heavily populated area, but what happens if there's a medical emergency and you're out over the middle of the ocean, or over the North Pole? The answer to that question is...pretty much the same thing, but it will probably take a lot longer for the plane to get to an airport with medical facilities available. Getting in touch with those flights is not a problem...all of our long-haul birds are equipped with satellite phones...but some of our long flights use emergency airports in Eastern Siberia (or for the Pacific ocean, Midway Island) and while we can gas up our planes in those places, they don't have much in the way of emergency medical services. Still, in any emergency, your airline will do the best it can and get you to the closest place there is with good medical care as fast as possible, wherever it is you're flying.


Anonymous said...

Once, when Twinks was a toddler, we were almost the *cause* of our flight being diverted...

We had attended a "farewell" dinner that my brother held prior to driving us to the airport. I didn't realize that Twinks had consumed some shrimp that were on the buffet; my sister-in-law had promised to keep an eye on her while my brother and finished up some family business. SIL apparently forgot that Twinks is EXTREMELY allergic to shellfish...

Long story short, Twinks was one sick little girl - and there was a lot of talk with the pilot and the FA's about diverting, but luckily there was a pediatrician aboard who moved into the seat across the aisle from us, and monitored Twinks for the duration of the flight. Luckily, we had an adequate supply of Benedryl in her diaper bag, and her Epi-Pen (which we didn't have to use) but it was the most scared I have ever been on a flight.

We had to call my SIL and brother, to see what Twinks had eaten, and then call our Pediatrician. This was probably sometime in 1995 or '96, and we racked up about $150 in Airphone charges on that flight.

Scary stuff...

Chuck said...

Thimbelle - Glad everything worked out OK. Medlink was probably involved in your situation as well, although the crew probably didn't tell you about it. Also...Airphones aren't available much anymore...due to their high cost they never became popular.

Heather Meadows said...

Great post, Chuck! I love behind-the-scenes stuff :D

Chuck said...

Heather - Thanks!