General medical emergency advice

[mikecweb]

So, I'm gonna stop you right here for a second.

First, while you want to make sure that the sick passenger is provided any medical services they need in the most expedient manner possible, the reality is that you've got 50-500 other people strapped into that tin can you're flying. Making sure everyone gets on the ground SAFELY is your FIRST priority, not having every minute count.

Second, in any emergency, the best way you can solve the problem is to WORK. SLOWLY. By slowing down and doing the job right the first time, you'll give yourself the best chance at a successful outcome.

 

[Gundam]

@Gundam. Nice name!
View attachment 42298

I had that one...lost an arm and wing though.

So, I'm gonna stop you right here for a second.

First, while you want to make sure that the sick passenger is provided any medical services they need in the most expedient manner possible, the reality is that you've got 50-500 other people strapped into that tin can you're flying. Making sure everyone gets on the ground SAFELY is your FIRST priority, not having every minute count.

Second, in any emergency, the best way you can solve the problem is to WORK. SLOWLY. By slowing down and doing the job right the first time, you'll give yourself the best chance at a successful outcome.

I agree.

 

[USMCmech]

So, I'm gonna stop you right here for a second.
...Making sure everyone gets on the ground SAFELY is your FIRST priority, not having every minute count.

Second, in any emergency, the best way you can solve the problem is to WORK. SLOWLY. By slowing down and doing the job right the first time, you'll give yourself the best chance at a successful outcome.

The vast majority of medical "emergencies" are not time critical. In EMS we WALK not run.

If the patient can breathe and isn't gushing blood, then saving 5 minutes isn't going to make a bit of difference. If those two situations are present, they probably weren't going to make it anyway. It's harsh but true.

To answer the OP's question, just about any city with domestic airline service can handle any medical emergency you are likely to encounter in flight. The guidance in the FOM is vague because every situation is different and you need to use your best judgment. Don't pass up Tulsa thinking DFW will have better medical facilities, but don't rush to land at the nearest GA airport either.

The same logic applies to international ops. Major cities in Mexico have excellent hospitals that can take care of emergencies just as well as any US hospital. However, if it were a toss up between diverting to Monterey or HRL I would try to stay stateside.

 

[Toobdrvr]

So, I'm gonna stop you right here for a second.

First, while you want to make sure that the sick passenger is provided any medical services they need in the most expedient manner possible, the reality is that you've got 50-500 other people strapped into that tin can you're flying. Making sure everyone gets on the ground SAFELY is your FIRST priority, not having every minute count.

Second, in any emergency, the best way you can solve the problem is to WORK. SLOWLY. By slowing down and doing the job right the first time, you'll give yourself the best chance at a successful outcome.

Boom.

Me:

1. Figure out who’s gonna fly the airplane. I prefer to have the FO do that and talk to ATC so the CA can quarterback.

2. Coordinate with FAs, StatMD, and Dispatch to figure out the plan.

3. After that, it’s basically a divert.

4. Determine who’s buying...

 

[Maximilian_Jenius]

I had that one...lost an arm and wing though.

I agree.

I think that my next "man-doll", as @Derg likes to call them. Will be the Strike Freedom Gundam.

 

[Box hauler]

Do you guys not use medlink?
I've had to chat with them a few times. They provide the best advice; working in conjunction with dispatch and medical services. They provide services outside the US as well.

A few weeks ago a passenger went from dead (user error from the FA's) to ambulatory. The ambulance met us at the pudunk Caribbean airport we were flying too.

FA's first call: hey captain a passenger has died. FA's second call: hey captain, on further inspection it turns out he was just sleeping. Due to our mistake we offered him a free Buzz-ball and cup of noodles. Ops check good

 

[gotWXdagain]

For the love of all that is holy don’t just assume that because the runway is long enough, that the town has the appropriate medical facilities capabilities to deal with your passenger once they become a patient.

O.k...wasn't going off runway length, but I think we're on the same page?

The issue is an airplane isn't an ambulance and if you only have the flight attendants that aren't trained EMTs and don't have that tool kit, that person might be losing a chance at recovery since every minute can count.

I think having medically trained able bodied pax would make me go for the larger metro adjacent airport, especially if they thought it was worth the time.

Right now I am leaning toward nearest suitable to accommdate a patient, since at least they will have the EMTs ready and a hospital somewhere, possibly an air ambulance. Going for larger metro area if we have medically trained pax that think the patient could make it the 20min or so it may take. This a bigger issue flying further west passing Colorado, Utah, Idaho, etc.

If you're at a commuter the resources are lacking at least in my expeirence.

Any larger airport will have a hospital. Don't overthink it.

At larger carriers like mine we have diversion airports that include that sort of info. We actually use a phone on board to talk to a medical team on the ground, who knows our position and will recommend diversion airports based on facilities and time. They will also call ahead to those facilities to ensure transport is set up and ready to go.

Having a phone to just pick up and get all that information would be awesome but it isn't an option sadly. Communication is a big unknown since I've never used dispatch like that and exactly what they are likely to know and what ATC might know is not certain. Add to that getting information to land normally and that is a lot to juggle. Half the battle is just knowing options in terms of airports.

EMTs at small-town airstrip that happened to have a 737 land there once aren’t going to be able to do much beyond what your onboard AED is capable of.

 

[wheelsup]

EMTs at small-town airstrip that happened to have a 737 land there once aren’t going to be able to do much beyond what your onboard AED is capable of.

I don't know of many airports with on site hospitals???

Closest hospital to that small town airstrip you cited is a nine minute drive and that's without sirens on.

 

[gotWXdagain]

EMTs at small-town airstrip that happened to have a 737 land there once aren’t going to be able to do much beyond what your onboard AED is capable of.

I don't know of many airports with on site hospitals???

Closest hospital to that small town airstrip you cited is a nine minute drive and that's without sirens on.

Do I have to type everything literally or can we use context?

 

[wheelsup]

Do I have to type everything literally or can we use context?

I guess I don't know what your point was. It inferred taking people to a smaller (ie not major) airport was not smart because there would be no one on the ground to help.

What area of the country we talking about here? North Dakota or North Caolina? For example passing Greensboro to land at Charlotte would add 10-15 minutes but both have hospitals.

 

[thevideographer]

How small of a town are we talking about? Even Grand Forks has a hospital 10 minutes from the airport that could handle just about anything.

 

[gotWXdagain]

How small of a town are we talking about? Even Grand Forks has a hospital 10 minutes from the airport that could handle just about anything.

Realistically speaking you’re good with a GFK or GSO or MOT. But plopping your jet in a place like Sheridan isn’t going to do anyone any favors.

 

[wheelsup]

Realistically speaking you’re good with a GFK or GSO or MOT. But plopping your jet in a place like Sheridan isn’t going to do anyone any favors.

I don't think we are even debating that. Well, I don't know where Sheridan is but it sounds small. Grass strip?

 

[gotWXdagain]

Realistically speaking you’re good with a GFK or GSO or MOT. But plopping your jet in a place like Sheridan isn’t going to do anyone any favors.

I don't think we are even debating that. Well, I don't know where Sheridan is but it sounds small. Grass strip?

Small town in northern Wyoming that used to get 737 service, back in the good ole days.

 

[Gundam]

I guess I don't know what your point was. It inferred taking people to a smaller (ie not major) airport was not smart because there would be no one on the ground to help.

What area of the country we talking about here? North Dakota or North Caolina? For example passing Greensboro to land at Charlotte would add 10-15 minutes but both have hospitals.

Good question. North Dakota. N. Carolina is dense enough that there are quite a few decent options. I would also include western Oklahoma, the panhandle. For example AMA is really all I recall being nearby out thar way and that is kind of dinky, but acceptable to me. I am contemplating going somewhere airstairs or some other means might be needed to deplane the person if an Amarillo isn't an option. I think last I was looking Colorado and Idaho had me wondering what the options would be.

How small of a town are we talking about? Even Grand Forks has a hospital 10 minutes from the airport that could handle just about anything.

I am reticent to use towns supported only by a class D airport, but if that is the only choice in a 40-100 mile radius that is where I will go, unless there is reason to think the person could make it to a further "big" city, most of which seem to be served by a class C airport. And assuming landing/take off there will not instantly kill all of us, as some people are assuming is on the table for me.

 

[NovemberEcho]

I'll just chime in from an ATC pov but unless we can ask the sup to google closest hospital or we are familiar with the area chances are we don't know chit

 

[BobDDuck]

Most rural airports aren't going to have much in the way of medical services on the field and even if you call a few minutes out and get stuff rolling, the time it may take to round up a rig for transport, get it to the airport might mean you are waiting a bit once you get there. Add to that the fact that it's very possible that the EMTs on board are no more than Basics or Intermediates, your patient may not get much in the way of high level care until they get to a hospital. Finally, depending on where you are in the country, the local hospital may not provide much more than basic life support care and if there is a need for specialization or immediate surgery of some kind, they may get loaded back on to a medical transport (ground or air) and shipped somewhere else... somewhere you probably could have flown to in an additional 20 - 30 minutes.

These are the sorts of calls that MedAir or MedLink or the equivalent can make. They know what resources are going to be available at a specific airport or metro area and will weigh that against the potential extra time in the air with just very basic onboard care being provided. That said it can be really difficult to set up a VHF phone patch at lower altitudes, especially in certain parts of the country. The few times I've needed MedLink domestically, we ended up losing them halfway through the conversation. Also, they are very methodical about getting data from the cabin and it can, at times, feel like it takes forever to get a recommendation from them.

I suppose if you are directly over a major metropolitan area you could just throw out the boards and drop in to land and expect a paramedic rig to meet you at the gate, but if you are anywhere else, a strategic and thought out approach, supported by dispatch and MedLink (or similar) is probably going to be way more beneficial.

 

[MikeD]

EMTs at small-town airstrip that happened to have a 737 land there once aren’t going to be able to do much beyond what your onboard AED is capable of.

Depends. They could very well have necessary paramedic-level meds, and other equipment for certain conditions, far more than what would be onboard. However, weighted against other factors such as completely suitable field, etc, it may or may not be any kind of net gain to the overall situation.

 

[Gundam]

Depends. They could very well have necessary paramedic-level meds, and other equipment for certain conditions, far more than what would be onboard. However, weighted against other factors such as completely suitable field, etc, it may or may not be any kind of net gain to the overall situation.

Damnit...

I'll just chime in from an ATC pov but unless we can ask the sup to google closest hospital or we are familiar with the area chances are we don't know chit

This is what I wanted to know. Thank you.

 

[gotWXdagain]

I guess I don't know what your point was. It inferred taking people to a smaller (ie not major) airport was not smart because there would be no one on the ground to help.

What area of the country we talking about here? North Dakota or North Caolina? For example passing Greensboro to land at Charlotte would add 10-15 minutes but both have hospitals.

Good question. North Dakota. N. Carolina is dense enough that there are quite a few decent options. I would also include western Oklahoma, the panhandle. For example AMA is really all I recall being nearby out thar way and that is kind of dinky, but acceptable to me. I am contemplating going somewhere airstairs or some other means might be needed to deplane the person if an Amarillo isn't an option. I think last I was looking Colorado and Idaho had me wondering what the options would be.

How small of a town are we talking about? Even Grand Forks has a hospital 10 minutes from the airport that could handle just about anything.

I am reticent to use towns supported only by a class D airport, but if that is the only choice in a 40-100 mile radius that is where I will go, unless there is reason to think the person could make it to a further "big" city, most of which seem to be served by a class C airport. And assuming landing/take off there will not instantly kill all of us, as some people are assuming is on the table for me.

FSD and FAR both have local hospitals with (nearly) Level 1 Trauma capabilities. FSD could justifiably be a class C airport during the morning and evening pushes.

Hell, you could land at GRK and be within 30 minutes drive of Scott and White (But your airliner probably shouldn’t land at the closer airport, TPL).