Medlink over South America

[Sidious]

So this scenario happened to me a few days ago and I'm interested in some opinions.

Just departed Santiago, Chile around 4am local time with a full load in the back. 15 mins after departure, we get a call from the back that a passenger is having trouble breathing but seems to be stabilized. FA says she'll call if it gets worse.

We break out the charts and get the HF freqs for AIRINC and me and the capt discuss the game plan. Right now we're only 20 mins out of Santiago so we said we would just return no problem.

30 mins go by and we get a another call from the back. A doctor is on board and checking her out. He fills out the on-board form we have for MEDLINK and sends it to us with all her information.

We get a phone patch to MEDLINK and give them the information. They tell us to continue to our destination which would be 6 more hours. Dispatch also tells us the same thing.

15 mins later the doctor tells us the pax condition is worse and he says we need to land ASAP. We start diverting to our enroute alternate while it takes about 15 more mins to contact MEDLINK. We tell MEDLINK the situation and they say, "Keep going to destination, we do not recommend diverting, the passenger is probably having a panic attack, give them XXX medicine and call back."

We talk to the doctor some more after he gives the medicine and she seems stable. We cease diverting and head back on route. We have now diverted to much and will need to refuel somewhere in route.

15 more mins and doctor calls and says passenger is worse. We call MEDLINK and again they say "DO NOT DIVERT, CONTINUE TO DESTINATION" We then tell them that we ARE diverting anyway for fuel and to have medical services ready at Lima, Peru. They then make the comment "We will put in our paperwork that we are not agreeing with your diversion for Medical reasons" So we tell them to put it down for fuel diversion.

I didn't expect this from Medlink at all. To me, with a doctor on board giving us that opinion, they would also err or the side of caution and have us divert as well.

What do you think? Oh, and the passenger got off in Lima and the medical personnel told us she was in the first stages of a heart attack.

 

[jtrain609]

I didn't realize they could make any decisions eh?

 

[Sidious]

I didn't realize they could make any decisions eh?

With regards to a passengers health I grant them the expert opinion yeah. If the doctor on the other line says to continue then I'm continuing. That's his area of expertise, not mine. Now what I was surprised at was that they seemed to totally discount the doctors opinion on board the airplane. The doctor that was actually with the passenger.

We were diverting because of the doctor on board however if he had not been there and nothing obvious changed with the passenger, then we would have continued.

 

[BobDDuck]

I always have used a doctor or nurse's judgment on board over Medlink's suggestion. As far as I am concerned they are their to authorize pushing drugs and that's about it. The few times I've had to call them it has always taken forever to get anything useful. The one time I actually did have a critically ill passenger on board (who ended up not making it anyway) I didn't even bother calling them before heading to the divert field.

 

[Cptnchia]

FWIW, we had a crew divert off the tracks to the nearest field because a doctor on board said they needed to land ASAP. Problem was, they didn't talk to anyone first and landed at a field where there was more medical equipment on board the aircraft. They could have overflown the field and landed at St Johns. Instead, a medical evac helicopter had to be brought in to transport the passenger. Neither the crew on board, nor any medical professional has a clue what medical services are available on the ground. That is why you are supposed to call them. If you're in the CONUS, then that shouldn't be a problem, Outside the USA, all bets are off.

 

[Kingairer]

I dont think it wouldve been out of the question to ask "Why not?". They may have a very valid reason as in the case above.

 

[LISRAREF]

Let me ask you guys this question from an ATC standpoint since I have been stuck as the third wheel in these arguments with MEDLINK a few times......

When you are going back and forth with MEDLINK do you insure the task of monitoring the ATC Frequency be it VHF or HF is handled by the flying pilot....? This way you can still receive control instructions or such from us..... I have had instances where I have not been able to get a hold of the crew during these MEDLINK patches for extended periods of time and its quite a hassle.... Just curious from your end....

 

[Kingairer]

Normally I have the FO do the flying and the normal ATC calls. I handle the FA's, Dispatch ACARS, and Dr on the radio.

 

[Sidious]

Yes, we had plenty of time to delegate who was still with ATC. I can see where both crew members could be distracted trying to listen to Medlink. Especially on HF it was impossible to make out what the doctor was saying, even changing freq. multiple times. In the end we just had AIRINC be our relay between them.

 

[Autothrust Blue]

15 more mins and doctor calls and says passenger is worse. We call MEDLINK and again they say "DO NOT DIVERT, CONTINUE TO DESTINATION" We then tell them that we ARE diverting anyway for fuel and to have medical services ready at Lima, Peru. They then make the comment "We will put in our paperwork that we are not agreeing with your diversion for Medical reasons" So we tell them to put it down for fuel diversion.

I'm quaking in my boots. MedLink is neither:
(1) The pilot-in-command,
(2) Qualified to make judgments about how much fuel is on board, and how much it'll take to get from here to there, or
(3) Actually on board the aircraft.

As stated...

I always have used a doctor or nurse's judgment on board over Medlink's suggestion. As far as I am concerned they are their to authorize pushing drugs and that's about it. The few times I've had to call them it has always taken forever to get anything useful. The one time I actually did have a critically ill passenger on board (who ended up not making it anyway) I didn't even bother calling them before heading to the divert field.

On the other hand,

FWIW, we had a crew divert off the tracks to the nearest field because a doctor on board said they needed to land ASAP. Problem was, they didn't talk to anyone first and landed at a field where there was more medical equipment on board the aircraft. They could have overflown the field and landed at St Johns. Instead, a medical evac helicopter had to be brought in to transport the passenger. Neither the crew on board, nor any medical professional has a clue what medical services are available on the ground. That is why you are supposed to call them. If you're in the CONUS, then that shouldn't be a problem, Outside the USA, all bets are off.

That would be my chief concern about diverting outside of the States — will anyone competent actually be able to meet us upon arrival?

 

[I_Money]

You have to remember what type of doctor is in the back - while they are all MDs many of the don't see emergencies outside their specialty. A radiologist (and many other doctors) might get very concerned over a patient with abdominal pain and want to land, while an emergency room physician might suggest crackers.

 

[Autothrust Blue]

Normally I have the FO do the flying and the normal ATC calls. I handle the FA's, Dispatch ACARS, and Dr on the radio.

In the situations I've experienced thus far, this has been how it's worked out. If I'm not flying the airplane, we're away from the rocks, and it's serious enough to warrant a bunch of Captainy attention (e.g., a threat with time to handle things), I'm given the airplane and the #1 Comm, and charged with keeping the shiny side up and headed in the correct direction.

 

[mshunter]

"Put down whatever you want to on the damn paperwork. I will deal with it when this is over."

And now you have a chance to focus on what the guy in the back needs, patient and the doctor. If he is not a qualified doctor to be back there (ala-radiologist), then the patients health is still in his hands, and I follow his direction. Because I'm no doctor, and the dude in back has that one on me.

The medical company can be damned! "You tell me the closest alternate, or I'll pick one."


I'm pretty sure that the medical company doesn't have operational control.

 

[UAShopeful]

You have to remember what type of doctor is in the back - while they are all MDs many of the don't see emergencies outside their specialty. A radiologist (and many other doctors) might get very concerned over a patient with abdominal pain and want to land, while an emergency room physician might suggest crackers.

I agree. For all you know, the doctor in the back could be a veterinarian. Granted, I know most have you have brought up the point that regardless, you're a pilot and he's a doctor, therefore what he says has more pull, however, you know what they say about experts... "An 'expert' is simply someone who knows more than you do about something". For the OP, did you ever consider asking MedLink to explain their reasoning (I understand that everyone in this situation is under a heavy workload and probably doesn't have time to ask "Why?", but I was wondering if they ever gave you any more than simply just "Stay the course").

Either way, this is surprising that MedLink would behave in such a way in a situation, especially when the no. 1 priority in aviation is safety.

 

[dasleben]

I would probably side with the doc onboard as well, assuming he/she is trained to deal with such issues. If the person's an ER doc, then yes, they probably know more from first-hand examination than someone being relayed information through SATCOM/Stockholm. Domestic US or other "western," first-world country, easy divert.

Cptnchia brings up a very good point about medical facilities OCONUS, too. We had a MedLink situation not too long ago over the North Pacific, and a medical diversion would have taken us to Petropavlovsk. Maybe they have a good hospital there, maybe not. Diverting to the nearest field may create more problems for the patient than continuing to the destination, which is why we use MedLink in the first place.

Sidious, I got your PM...I'll reply when I have time to sit down and write a bit more.

 

[Sidious]

For the OP, did you ever consider asking MedLink to explain their reasoning (I understand that everyone in this situation is under a heavy workload and probably doesn't have time to ask "Why?", but I was wondering if they ever gave you any more than simply just "Stay the course").

Yes, they said that based on the info that we had given to them, it was most likely a panic attack. They prescribed some meds to call them down and then said to continue. It was odd seeing as how that went directly against the doctor on board; whether he was a veterinarian or not.

 

[mastermags]

There is a question on the American Application very similar to this.

 

[Boris Badenov]

IMHO, no contest. If a medical professional (they could be a pediatrist, whatever...hell they could be an EMT) says the patient needs to be on the ground, pronto...we're getting on the ground, yesterday. If for no other reason than because if the patient croaks it, you can bet your hindquarters that I'll be deposed. Ain't nobody got time for that.

 

[Sidious]

Just a follow up. Me and the captain never heard anything about it except a short email from the Chief Pilot that said good job. Hindsight is 20/20 and I can comfortably sit in my humid Panamanian apartment and say it all worked out but its a another story when you're somewhere off shore and a service that you have always been TOLD is "supposed" to help you is contradicting what you're thinking.

 

[Deleted member 27505]

So this scenario happened to me a few days ago and I'm interested in some opinions.

Just departed Santiago, Chile around 4am local time with a full load in the back. 15 mins after departure, we get a call from the back that a passenger is having trouble breathing but seems to be stabilized. FA says she'll call if it gets worse.

We break out the charts and get the HF freqs for AIRINC and me and the capt discuss the game plan. Right now we're only 20 mins out of Santiago so we said we would just return no problem.

30 mins go by and we get a another call from the back. A doctor is on board and checking her out. He fills out the on-board form we have for MEDLINK and sends it to us with all her information.

We get a phone patch to MEDLINK and give them the information. They tell us to continue to our destination which would be 6 more hours. Dispatch also tells us the same thing.

15 mins later the doctor tells us the pax condition is worse and he says we need to land ASAP. We start diverting to our enroute alternate while it takes about 15 more mins to contact MEDLINK. We tell MEDLINK the situation and they say, "Keep going to destination, we do not recommend diverting, the passenger is probably having a panic attack, give them XXX medicine and call back."

We talk to the doctor some more after he gives the medicine and she seems stable. We cease diverting and head back on route. We have now diverted to much and will need to refuel somewhere in route.

15 more mins and doctor calls and says passenger is worse. We call MEDLINK and again they say "DO NOT DIVERT, CONTINUE TO DESTINATION" We then tell them that we ARE diverting anyway for fuel and to have medical services ready at Lima, Peru. They then make the comment "We will put in our paperwork that we are not agreeing with your diversion for Medical reasons" So we tell them to put it down for fuel diversion.

I didn't expect this from Medlink at all. To me, with a doctor on board giving us that opinion, they would also err or the side of caution and have us divert as well.

What do you think? Oh, and the passenger got off in Lima and the medical personnel told us she was in the first stages of a heart attack.

You guys sound like you were the medical version of AK261.
Medlink sounds exactly like your typical insurance company.