Long night and you finally start the push.....


Well-Known Member
...and learn of an ill passenger.

Here is a "hypothetical" situation...tell me you would've done. Its been a long day of weather delays and crowded terminals and oversold flights at a popular NY metro airport. The crew working the only flight that night to this particular Canadian destination finally gets its airplane and the paperwork, and learns that they are weight restricted. They had been dispatched in the version of the fleet that usually is NEVER wt restricted. The reason for the wt rest was the fact that dispatch was making very sure they had a suitable alternate since the weather in the NE of Canada is and was terrible all day. Dispatch wanted an alt airport with company services. In the wake of RST the crew didn't blame them and was happy to see the initiative.

Well, as the crew called ops for more water and food in case of a divert ops advises of a new flt plan and a fuel stop in order to take all 50 people since the flight the night before had canceled. The crew is now almost 2 hours past the scheduled departure time and is somewhat fatiqued. But still fit enough to fly if they could get going. Things finally get worked out and they begin taxi. As they taxi ramp tells them to return to the gate for more gas and new paperwork direct to the destination, with no fuel stop. HMMM. OK. Back to the gate and almost another 30 minutes pass. The captain hops in, the door closes and calls for the checklist.

Now for the real interesting part.

The flight attendant calls and say,"ready for taxi, but the woman in seat ## is puking....alot. Kind of a sudden onset. Do you as captain demand her off the flight. Do you as captain talk to her and make your own decision? Do you as captain seek advise from higher ups? Or a combination of all of the above? Keep in mind this woman has been traveling for 24 hours and just wants to go home. She is with her teenage daughter who is taking care of her. And on the gen dec there is a statement of known illness.
The crew is tired and ready to be at the overnight. They still had a long taxi ahead of them. And the rest of the passengers have already sustained a really long delay.
What would you do?

You speak with the F/A's and ? the specific pax. After questioning the two of them you make your own PIC decision not the PAX decision. Fatigue and Duty times should play 0 factor into your decision.
Nothing operationally, schedule or otherwise, should take priority over a sick passenger. Get her off the plane while you're still on the ground and get her medical care. Seems straightforward to me.
Good CRM means consult and utilize all sources of information. I'd question the FA to about the condition of the passenger including the specifics of the previously reported illness then find out if there are any medical personnel on-board. I'd report all of this info to Ops with a request for an expert opinion (i.e. either upper management or a medical expert). In the end, it always comes down to 91.3.

I'm not a medical expert although I'm married to one (an RN). What little I do know says the greatest hazard of repeated puking (and diarrhea) is dehydration which, if prolonged, can kill you. How long had this passenger been puking their guts out? 24 hours? 48? I know they really, really want to go home, but I really, really don't want anybody dying on my watch.

There's a good safety maxim: "When in doubt, there is no doubt. Do the safest thing."

Depending upon the answers from the back and over the company radio, this may mean returning to the gate and handing over the passenger to the paramedics.
Call Medlink +1 602 239 3627. Let them make the decision. We had this a couple of weeks ago with a woman that was 5 months pregnant, pale and sweating. Her husband, who said he was a physician and she was under his care, had to help her walk on the airplane. Medlink said take her off, husband threatened to sue. Turns out he was a quackopracter. We pushed without them.
And if she dies enroute because of a medical problem? People are funny. Some will want off at the first sign of a cloud in the sky, but another will threaten to sue because you won't fly through a hurricane so they can make a business meeting.

Like pilots, some people have gethomeitis even if they are deadly ill. The FA(s) might be able to answer most of the questions, but it still boils down to protecting the safety of the passenger even if it means having them removed until their condition can be verified.

One way I decide what to do when faced with two possibilities is to consider the worst possible outcome of each decision. In this case it's being called on the carpet by the CP for returning to the gate and dumping a passenger for eating a bad canoli or answering questions from the FAA why I didn't dump a now-dead passenger who was obviously very sick but pushed on to my overnight anyway even though they said they wanted to go.
I would do whatever it takes to get that sick lady off the plane.

An RJ is not very big, a fact I'm sure your passengers remind you of every day. The odor from "a lot of puke" is not going to be pleasant for the other passengers for 3 hours, not to mention the health considerations of the lady herself. I'm going back to the gate, getting medical assitance for the lady, making sure she doesn't get back on my flight, calling for a cleaning crew, and thoroughly correcting the situation before i depart again.

I really wouldn't care if the flight got cancelled at that point, but I'm not leaving with someone puking their guts out in the back, and I don't care if the sick person still wants to go or not. An extended stay at 8000 ft cabin altitude is generally not going to improve a person's medical condition, it's going to exacerbate it.

A few years back I had a guy have a "seizure" on the taxi out. We did a gate return, paramedics checked him and they wanted to put him back o the plane. I said no way! Turns out, I did the guy a favor since we timed out on the ensuing taxi. Unfortunately that guy's seizure and the resulting gate return caused a bunch of folks to spend an unscheduled night at the hub.
If there's any doubt about the medical condition of one of your passengers, do not hesitate to delay the flight to get the passenger medical attention.

I had a passenger slip and fall on the ice in Madison. Hit her head pretty good and boarded the airplane.

When I was in the back of the plane (beech 1900) doing the manual passenger brief, her eyes were spiraling in her head like a cartoon.

I told the captain, called CFR and a couple of paramedics took a peek at her, I see two big exclamation points about their heads and they carted her off the airplane.

Turns out she had a massive concussion and spent a few days in the hospital thereafter.
Like pilots, some people have gethomeitis even if they are deadly ill. The

Umm...kinda off topic, but I thought I'd share my epic fail with you guys. I saw this, thought it sounded like an interesting medical issue with us talking about chronic puking/illness etc, and googled it only to find out that it was get home itis.

Get her off the plane. Try to let her understand that it's not just her health on the line here, but everyone on aircraft. And if something were to happen, like a cisk opens in her stomach and she starts choking blood, then there won't be any help that can be immediately called upon in the air.