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Dealing with In-Flight Medical Emergencies

In-flight medical emergencies in commercial aviation are common. There are a range of considerations you should be aware of when suddenly a passenger or crewmember suddenly is hit with an illness or injury onboard a flight.

Doctors on flight often hear screams like, “Is there a doctor on board?” They may hear in-flight announcements such as “If there is a doctor on board, please make yourself known to cabin crew”. What happens when an emergency occurs onboard?

One of the first significant studies of more serious emergencies was published in 1988 relating to deaths on board. The study collected data from 42 airline members of IATA from the 1977 to 1984 period. The study found that 570 deaths were recorded, for a mean of 72 per year and a rate of 0.31 per million passengers.

A 2013 study by the University of Pittsburgh found there was one medical emergency in every 604 flights on an international basis.

Very common in-flight medical emergencies include cardiac arrest (responsible 86% of all in-flight deaths), heart attacks, strokes, fainting and breathing difficulties.

Where a crewmember is suffering

If there is a medical emergency onboard where the crewmember is suffering, the plane should really land as soon as possible. Landing at the next suitable airport would arguably be the best option.

An aircraft with two pilots and no flight attendant (carrying 19 passengers or less) will experience a less complex situation if they are faced with this scenario. A larger commercial transport operation (such as a B737) will have much more complicated issues to deal with.

If if it is the co-pilot incapacitated on a single pilot certificated aircraft, it will be less of a safety or operational concern.

Where a passenger is suffering

Suffering in-flight medical emergencies can be a traumatising experience. Nevertheless, the safety of the flight must always take precedence over passenger wellbeing.

Generally, the cabin crew are responsible for managing medical emergencies whilst in the air. If they are trained properly, they will be equipped with knowledge to recognise common medical problems and administer first aid. They should assess the passenger and inform the captain of the aircraft.

Some airlines have gone the extra mile. Emirates has a 24/7 satellite medical advisory service that connects crew to aviation medical consultants on the ground who can help patients as the emergency is ongoing, i.e. in real time.

The crew may also request assistance from any doctors or nurses onboard. A range of ‘Good Samaritan’ laws protect doctors from legal liability if they administer care in good faith. There is also generally no obligation for passenger doctors to help in the first place.

Pilots may make a ‘pan’ call to air traffic control to alert controllers. A ‘pan’ call is less urgent than a ‘may day’ call but still requires air traffic control attention.

If the pilot believes the medical emergency is urgent enough, and may involve breaching regulations in order to get the passenger to safety, they could exercise their discretion and declare a mercy flight (link to a draft Advisory Circular).

In CASA’s Draft Advisory Circular 91-170(0), mercy flight is defined as:

a flight which will involve contravening one or more of these regulations, made for the purpose of relieving a person from grave and imminent danger arising out of an urgent medical, flood, fire relief or similar situation, at a time where failure to make the flight is likely to result in serious or permanent disability or loss of life.

Clause 5.1 and 5.2 emphasise that mercy flights can really only be declared in exceptional circumstances:

5.1 A mercy flight may only be declared when a pilot is unable to conduct a compliant flight within the time available, or lacks the time to seek an exemption from relevant provisions of the regulations. Notwithstanding the declaration of a mercy flight, normal flight rules apply to the maximum extent possible in the circumstances.

5.2 Pilots should be aware that stress generated by the urgency of a mercy flight may compromise their decision making ability. Coupled with a contravention of normal flight rules, poor risk analysis may result in poor quality decisions.

Note that this is only a draft. However, it indicates how exceptional the circumstances must be. Mercy flights simply must not be declared when the flight can comply with relevant regulations and orders. They also shouldn’t be taken when alternative means of achieving the objective is available.

A scenario where declaring a mercy flight might be called for is if a noxious gas has broken out inside the aircraft and all the passengers are at the risk of becoming asphyxiated.

For more information, please contact Avlaw Aviation Consulting.