
An account of a serious medical emergency on a transoceanic flight - bshep
https://feminem.org/2016/09/01/doctor-on-plane/
======
dr_
Similar experience, although less dramatic circumstances, on a Qatar flight. I
was asleep, when my wife awoke my and volunteered me to address the needs of a
passenger passing out in the aisle of the plane. I asked for equipment to
check his vitals. Bp was on the low side so I asked he remain supine with his
legs slightly elevated. There was a lady sitting next to us who criticized my
every move (she felt I wasn't getting an accurate pressure because he was
laying down, but I was more concerned with maintaining his pressure than
having it bottom out further). The passengers were upset he was laying in the
aisle. Turns out the lady next to me was a physician as well, but she never
volunteered this or assisted in any way. He eventually got better and I
allowed him to return to his seat. I checked on him as we landed and left the
plane. Medical services came with a wheelchair to take him off. No
appreciation from the crew on this, but I guess that doesn't matter at the end
of the day. barring the criticism I received for how I was handling it, the
situation ended well.

~~~
clort
Its interesting that the other doctor did not volunteer this information. I
did pool lifeguard training a few years ago (in the UK) and was told that as
this training is at a higher level than basic first aid training I would be
legally required to notify my status and presence in an emergency, and that
not doing so could leave me open to prosecution. Do doctors not have any
obligations such as this laid upon them?

(My lifeguard certification has expired now)

~~~
barking
Every medical student hears horror stories where a doctor acting as a good
samaritan in less than optimal conditions results in the person who was helped
suing them afterwards.

~~~
Nutomic
In Germany, every citizen is required to give first aid, as long as he doesn't
endanger himself. If you don't help, you can get sued. And the law protects
first aiders, so they can't usually get sued if they do something wrong.

Source (only in German):
[https://de.wikipedia.org/wiki/Erste_Hilfe#Rechtliche_Situati...](https://de.wikipedia.org/wiki/Erste_Hilfe#Rechtliche_Situation)

~~~
GunboatDiplomat
In the US and probably the rest of the English speaking countries, typically
only medical professionals and first responders are required to render aid,
but the law does protect "good samaritans" from legal culpability if they do
help.

~~~
dghughes
There have been recent situations here in Canada where very ill people were
literally on the doorstep of the ER asking for help but were refused any help.

In nearly all the situations the staff in the building told the sick people
outside to call 911 to get transported inside two feet inside the door.

The hospital workers and by that I mean nurses and doctors were unwilling to
help even though the people outside were very ill.

~~~
geoka9
So the problem was that those people couldn't get inside the ER by themselves
and the nurses and doctors refused to move them?

I ask because I once walked my relative into an ER and they were attended to,
no problem.

~~~
dghughes
Yes sometimes it's a person literally on the doorstep of the ER in front of
the doors. One time a news report said the person was in a passenger seat of a
car. But usually right there at the ER in some state of distress.

I can understand some concerns of staff but to flat out refuse seems to go
against the ethics of being in the medical trade.

I also suspect it's government bureaucracy and union rules, paperwork trumps
life I guess.

------
xarope
In contrast to this story, my wife (a doctor) did attend to an ailing
passenger on a transoceanic flight. The attendants were more than helpful, and
my wife expressed surprise at how well stocked their medical kit was (drugs
etc).

After the flight, the airline gave her some duty free goodies on the spot, and
a few days later, a one-way business class ticket (I guess to make up for the
fact that she sat with this ailing passenger for most of that transoceanic
flight).

The article didn't mention what airline. We were flying Singapore Airlines.
Service does make a difference.

~~~
HappyTypist
I usually fly with Singapore Airlines. The service is always exceptional. One
time (out of about a dozen trips) the flight was cancelled due to engine
issues. After explaining I had a conference to attend and the next flight
would mean missing one out of three days, they booked me an United ticket and
offered me some points as an apology for the "inferior service". It was.

~~~
SapphireSun
I'm not sure what the conditions are, but the airlines are required to do that
by law under certain circumstances. Maybe someone more knowledgable could
chime in?

~~~
kbouck
For flights to/from EU member countries, Regulation 261/2004 is applicable. I
guess Rule 240 would be the US equivalent.

It can be tricky to get the airline to comply when they deny responsibility.
So there are intermediary agencies that do the claim paperwork (and take the
legal actions if necessary), taking a small percentage of the reward only if
successful.

With the help of an intermediary, I successfully invoked Regulation 261/2004
against KLM after a flight was cancelled due to mechanical failure. The
correct reward was ultimately transferred approximately one year after the
original flight.

[https://www.airhelp.com/en/know-your-rights](https://www.airhelp.com/en/know-
your-rights)

~~~
Symbiote
I got €400 compensation from Ukraine International Airways under the EU
regulations after simply sending them a letter requesting it, after a 30 hour
delay.

------
ghufran_syed
As an emergency physician, the first thing I would say if I ever met the doc
would be 'well done' for volunteering - it's a hard thing to do. I'm also very
glad that it seems the patient did ok.

However, in these kind of situations, I don't think it's in the patient's best
interests to avoid diversion. The algorithm should be: 1) sick vs not sick -
this person was clearly sick (when an ER docs say someone is 'sick', they
usually mean there is a non-trivial probability that they could die in the
next 24 hours) 2) _Could_ a delay in critical care treatment lead to a worse
outcome for the patient? If so, I would argue that you _have_ to advise
diversion to the nearest airport with the required standard of medical care.

That means that it might be ok to advise taking one hour to get to a major
city, rather than taking 10 minutes to land at a rural airfield with a tiny
hospital nearby - that's a judgement call. The only reason not to divert that
I can think of is the cost to the airline, and passenger inconvenience: both
of those looks like really bad reasons if the guys gets worse again and dies
on the plane, when they might easily have been saved if they had diverted to a
nearer airport + hospital.

I agree with another comment regarding the difficulty of IV's, particularly in
shocked patient. Ideally, the airline kits would stock intra-osseous needles
(needles with a screw that are screwed into the bone of the shin or upper arm
using an electric dril). It sounds brutal,but is probably not much more
painful than an IV, and takes seconds to do with training. The crew could be
trained to use them as part of their first-aid training - the training takes
less than an hour, and it would probably make more difference to patient
outcome than having adrenaline on board would.

I totally agree about speaking to the pilot in person when you have a
critically ill patient - they know (or can figure out) flight times to the
various possible diversion airports, you (probably) know better what kind of
care the patient needs, and the chances of finding that kind of care in a
given city.

~~~
hueving
In a flight that long that you arent that far into, landing early for a
diversion requires dumping fuel (for up to an hour on larger aircraft) or
risking the lives of the other passengers because the plane is over maximum
landing weight.

So it very much is a case by case analysis of balancing the urgency for one
passenger with the damage to the environment (dumped fuel) + risk to other
passengers for a heavy landing + risks to other passengers from imposing a
delay (e.g. Another passenger flying to a surgery).

~~~
gizmodo59
I just read the wiki about fuel dumping. Based on that it seems less likely
that most of the passenger flights have fuel dumping capabilities. Nice read
though.

~~~
TylerE
You can always dump it the hard way... fly slow, with the aircraft in a high
drag configuration (e.g. flaps out, possibly gear down as well if the speeds
allow it) and lots of throttle.

------
eganist
With regards to the kit which was not aboard the plane, I have a few quick
questions from anyone in the know.

Missing were:

\- Aspirin

\- Nitroglycerin

\- Masks

\- Fluid cleanup kits

\- Airways

I'm assuming the latter three are one-time-use. I'm assuming the former two
have expiration dates. Does anyone have info on how often these items might be
used aboard flights and/or actually reach their expiration dates?

I'm asking specifically to see how much money is saved by not stocking up and
simply assuming that the resulting lawsuits and fines are cheaper than keeping
kit stocked. I simply can't attribute this kind of neglect to human error.
Someone has to have done the math on this.

~~~
mindslight
I doubt this is the result of any conscious optimization process. If it were,
it would have been turned into a profit center - eg aspirin billed at
$100/pill to the passenger who "requested" it. Who wouldn't want to get in on
the hospitals' racket?

~~~
groby_b
IIRC, passengers don't get to request anything. The kit stays closed, except
for medical professionals. For good reasons - handing out meds likely entails
liabilities, and no airline wants that.

~~~
mindslight
That's why I put "request" in quotes. The patient is unable to request
anything; the doctor is doing it on their behalf.

------
jewbacca
Interesting discussion on the medical particulars on /r/medicine:

[https://www.reddit.com/r/medicine/comments/50q4fa/yes_there_...](https://www.reddit.com/r/medicine/comments/50q4fa/yes_there_is_a_doctor_on_the_plane_what_i_learned/)

~~~
seizethecheese
An incredible anecdote about a different incident from that thread:

> I'm going to share this story passed on to me by an anesthesiologist. He was
> on a trip from Canada to to Europe to visit family. He doesn't enjoy flying
> very much, even less so without anyone he knows to keep him distracted. So
> he purposefully got a late flight so he could sleep through it. Before
> boarding he took a few sleeping pills and downed a shot. He's an
> anesthesiologist, please don't try this at home. He boarded the plane almost
> last, did up his seat belt, and went nearly straight to sleep. Somewhere
> over the ocean he was half awake, in a lovely daze of drugs when he heard
> over the PA. "If there is a doctor on board the plane can they please
> identify themselves to the flight crew." He thinks about it for a minute,
> debating what to do and hoping someone else will say something before he has
> to. Finally he feels like he has no choice. He hits the call button on his
> seat arm and shortly after, a flight attendant comes to his row. He explains
> he's a Doctor and he'd like to help if possible. The flight attendant looks
> at him and says, "Sir, we called the Doctor for you, We've been unable to
> wake you for the past two hours, and we had to re-seat the passenger beside
> you because you were drooling on them."

~~~
quickpost
Anesthesiologists are definitely a different breed. That approach (a few
sleeping pills and a shot) definitely jives with my encounters with a few of
them. Epic.

~~~
SomeHacker44
When I fly commercial, I fly Delta.

Once, on an SD to NYC red eye in which I take a prescription sleeping pill,
the person behind me took the same one and two shots. Scared me but I guess
not fatal for him.

------
seesomesense
My wife ( a doctor ) had to attend to a patient who had a medical episode on
Singapore Airways (might have been the a Sydney to Singapore or a Singapore to
London flight ). According to her, things went well, the air crew were
professional and helpful, equipment was available.

There was another doctor on the flight who volunteered his help. The two
doctors liased and decided that my wife's training and skills were more
relevant to the situation.

My wife was thanked and given symbolic remuneration ( which she will probably
never bother to cash in ). She felt valued and will probably be willing to
help again if in a similar situation with Singapore Airlines.

------
icinnamon
Always been curious about what occurs "behind the scenes" in situations like
this. Strange how airlines (and the flight attendants!) aren't held more
accountable. Would have assumed the FAA would want to look into any in-flight
medical emergency.

~~~
emodendroket
I'm going to guess the FAA is, like a bunch of other regulatory agencies,
struggling to meet its obligations with the insufficient funds funneled into
it.

~~~
SpacemanSpiff
This article was linked on HN last fall I believe:
[http://www.vanityfair.com/news/2015/11/airplane-
maintenance-...](http://www.vanityfair.com/news/2015/11/airplane-maintenance-
disturbing-truth) Basically the airlines are outsourcing maintenance to places
like El Salvador, Mexico, and China. The FAA has very little capacity for
providing the same level of oversight previously conducted in US-based
maintenance facilities. Scary.

~~~
emodendroket
Yikes. Horrifying stuff. If you've ever read the book "Poorly Made in China"
it's kind of frightening to imagine the same techniques being applied to
airplane maintenance.

------
alphaoverlord
I had a good experience on American Airlines. Volunteered when the
announcement was made and had flight attendants that were attentive, helpful,
and appreciative of my help. I didn't ask for anything but they thanked me as
I left the plane - to my suprise, a couple of days later I got an email saying
I was credited 25k points on my frequent flier account. I was quite far away
from my seat and didn't realize they kept track of who I was. Was very
pleasantly suprised and thought things went well.

------
imroot
My friend (who is an ER Doctor) had a medical emergency (man had a stroke) on
her flight from Pittsburg to Miami when she came to visit my family a few
months ago. She actually told me afterwards that she thought that the bag was
extremely well stocked and that she had the ability to perform whatever she
needed. They used the Airphone to validate her medical license, gave her the
med bag, and told her that if she needed anything to drink, to just call.

I've had similar experiences on US Airways (Pre-American); I'm a paramedic and
someone had an MI -- they airphoned me to a doctor on the ground and he and I
diagnosed the patient together, and he gave me orders to push drugs.

On my friend's flight, the Flight Attendant gave her many many small bottles
of bourbon to say "Thank you" and American Airlines gave her 25,000 bonus
miles as a "thanks," and they upgraded me to first class for my trip home as a
way to say thanks for me.

------
Tomte
"Don’t expect so much as a thank you from the airline."

Lufthansa at least has a formal program to identify doctors between their
passengers: [http://www.lufthansa.com/us/en/Doctor-on-
board](http://www.lufthansa.com/us/en/Doctor-on-board)

------
rdl
I'd like to know what airline this was so I can never fly them.

1) This obviously physically incapable person was sitting in exit row
initially

2) The F/A of negative utility (the physician probably should have escalated
to the pilot, or at least the purser.) That has to be a combination of
training and personal incompetence. (Actually, she sounds like the lead flight
attendant, which means she should just be fired.)

3) The medical kit. wtf.

Ah -- appears to be Delta, which I'd never fly on a 17h international flight
anyway.

~~~
yladiz
The only way for the stewardess to check if a customer can sit in the exit row
is to ask, "Are you willing and able to help passengers in the event of an
emergency?" If the customer has no obvious outward appearance that might cause
an issue, there's no way to know. The person in question in the exit row had a
syncopal episode; syncope is defined on Wikipedia as, "Syncope, also known as
fainting, is defined as a short loss of consciousness and muscle strength,
characterized by a fast onset, short duration, and spontaneous recovery."
Having diabetes doesn't disqualify you from being an in exit row.

Your other critiques are warranted; the lead FA shouldn't have acted the way
the story portrays her to, and the medical kit was woefully understocked.

As an aside, do you think that because it's Delta it makes it worse? Why would
American or United or Southwest or Allegiant or Silver or any other airline be
intrinsically better? This was a lapse in judgement for not having the medical
kit stocked, possibly a large one, but one particular organization isn't
necessarily worse than any other.

~~~
rdl
The training lapses and other personnel issues which put a flight attendant in
the lead role on a top international route (so, one of their most
senior/experienced; likely 50+ years old and with 20-30 years in the
job...international routes are pretty highly coveted) are an independent issue
from the stocking issue, and do come down on the airline as well.

------
ddalex
Experience varies - I got very sick on a short haul flight with a low-cost
airline in Europe. There was no doctor on board, but the emergency services at
the airport came to help as soon as we landed. They determined I can't be
moved from the airplane, and that I needed an ambulance to take me to the
hospital; and nobody in the crew had any problem waiting for over 2 hours for
the ambulance to arrive, even turning on the airplane engines to keep the heat
up for me, burning heaven knows how much fuel, and serving the airport
emergency staff with water and snacks.

Totally unexpected for a budget airline, but highly appreciated. Kudos on this
one, Wizz !

------
PhasmaFelis
I really want to know what was going on in the one flight attendant's head. I
mean, I'd actually like to hear it from her. It's possible that she's actually
a horrible, soulless bureaucrat by nature, but I'd like to think that
something else--fatigue, life circumstances--was messing with her and causing
her to make really stupid decisions just then.

~~~
throwanem
That latter assumption, save with the stress of the situation rather than
"something else", is pretty much encapsulated in the physician's choice of
"decompensated" to describe her. That's an interesting word! I'm glad I had
cause to look it up.

------
coldcode
Delta is either incompetent when it comes to preparation, or maybe the FAA has
no actual way to force compliance with its rules so things like this get
ignored. No matter what the rules are on an airline there is no excuse for
putting people's lives secondary to them.

------
lgleason
Given that this was a 17 hour flight I would bet that this was probably the
jnb to atl flight (Johannesburg to Atlanta). I fly that route frequently and
this does not surprise me.

~~~
smartbit
More _longest flights_ here [https://en.wikipedia.org/wiki/Non-
stop_flight#Longest_flight...](https://en.wikipedia.org/wiki/Non-
stop_flight#Longest_flights)

------
empressplay
Flying to Australia on Delta isn't advised in any circumstance. I know they're
cheaper than Qantas or Air New Zealand but you get what you pay for. Just
don't do it.

~~~
XorNot
I've given up trying to save money when flying. There's a list of airlines I
trust, and I buy at whatever price their tickets are. The trip is either worth
that much, or not worth going at all.

~~~
sobbybutter
I'm curious--which do you find good (and bad!)?

~~~
XorNot
I'm in Australia, so my good list is Qantas, Emirates and Singapore Airlines
for any flight longer then about 2 hours.

------
dankohn1
I'm writing this 2 hours into a 14.5 hour flight from Shanghai to New York
[0], and I'd just like to thank all physicians everywhere who have answered
the ding.

[0]
[https://flightaware.com/live/flight/UAL87](https://flightaware.com/live/flight/UAL87)

~~~
twosheep
I'm not sure EWR counts as New York ;-)

------
owenversteeg
I'm curious what the worst profession to hear when they ask "is there an x on
board" is. Sure, "is there a doctor on board" is scary but usually ends fine.

"Is there a herpetologist on board" could get interesting, a la Snakes on a
Plane.

"Is there an electrical engineer on board" would be scary, and "is there a
computer scientist on board" would be downright terrifying.

Maybe "is there an infectious disease specialist"?

~~~
rsync
"Is there a pilot on board ?"

~~~
neurotech1
That actually happened fairly recently with a United Airlines 737:

[http://www.af.mil/News/ArticleDisplay/tabid/223/Article/4851...](http://www.af.mil/News/ArticleDisplay/tabid/223/Article/485155/af-
pilot-helps-in-airline-emergency.aspx)

~~~
nommm-nommm
> "are there any non-revenue pilots on board, please ring your call button."

May be a stupid question but what is a "non-revenue" pilot?

~~~
CamperBob2
A pilot flying as a passenger to get to another flight they're scheduled to
work, or who's taking advantage of an employee benefit (free/cheap flights).
Why they would use language that excludes a military pilot or someone from a
different airline altogether, I don't know.

Might just be an industry-insider code phrase to keep from alarming the
passengers with the obvious request ("Uh, does anyone onboard know how to fly
a Boeing 737?")

------
zitterbewegung
What if the flight attendant did cause serious injury or death? Who would be
liable?

~~~
Cieplak
In the US, I might guess the airline could be held civilly liable for
negligence or wrongful death.

Not sure about the jurisdictional issues given that it was an international
flight.

Postscript:
[https://en.wikipedia.org/wiki/Wrongful_death_claim](https://en.wikipedia.org/wiki/Wrongful_death_claim)

------
naiv
In 2015, I was on flight EY23 that was first stranded on the the tarmac in Abu
Dhabi because of fog for 13 hours and then diverted to Vienna because a
passenger had a heart attack inflight. So a short 7 hour flight turned into 30
hours of horror. ([http://www.thenational.ae/uae/elderly-passenger-dies-on-
boar...](http://www.thenational.ae/uae/elderly-passenger-dies-on-board-
delayed-etihad-flight))

It seems that some airlines have a very strict protocol. There were at least 4
doctors on board but they were not allowed to help the crew with CPR or help
much more than with checking the blood pressure.

Interesting enough, the crew was always connected to a company that has
emergency-medicine specialists on the ground, so the crew became their remote
hands.

------
JshWright
> The AED indicated a normal cardiac rhythm.

That's not something AEDs can do... An AED can tell you whether or not the
patient is in one of two very specific rhythms or not. If the heart is in
ventricular fibrillation or ventricular tachycardia, the AED will advise a
shock is necessary, otherwise it will report "no shock advised". There are all
sorts of nasty cardiac rhythms that an AED will no shock, and there is way to
differentiate that.

~~~
PhasmaFelis
There's a thread on the r/medicine discussion where someone asserts that some
AEDs with a monitoring display can be manipulated to get at least some
indication of the cardiac rhythm. I'm definitely not qualified to say if
they're correct.
[https://www.reddit.com/r/medicine/comments/50q4fa/yes_there_...](https://www.reddit.com/r/medicine/comments/50q4fa/yes_there_is_a_doctor_on_the_plane_what_i_learned/d76f2g2)

------
post_break
Should he have been allowed to sit in an exit row with all that going on? I
mean they knew he had these conditions before hand.

~~~
jrockway
The requirements are the ability to understand English and lift 50 pounds. No
lifting required for a modern widebody anyway. Open the door and get out,
that's your only job when you're sitting in the exit row.

~~~
Symbiote
Or not open the door -- for instance, if there is water or fire on the other
side.

Hence needing to understand English.

------
nommm-nommm
Doctors are great. Always going above and beyond the call of duty.

When I was side swiped by an SUV in front of a shopping plaza a doctor was
eating dinner in the red lobster inside the plaza. Upon hearing the sound of a
car crash she left her dinner and ran to the scene to render aid if needed.
Thankfully there were no injuries.

------
MistahKoala
Watching the side discussion(s) going on between clinicians, it's surprising
to see how much disagreement/debate there is about equipment and procedures
for dealing with medical emergencies on flights. I don't know why, but I took
for granted that it would be a bit less controversial.

~~~
feminem
That's why we published the article. To help push consistency on flights, not
to flame this particular airline. All experiences are variable.

------
omegant
I think I´m able to give some perspective and tips here. I'm commercial pilot
flying long haul and I´ve had some medical incidents during my flights,
including a recent suicidal lady cutting her wrists while arriving to JFK
airport in NY, or a possible heart attack while in the middle of the Sahara.
Also my wife is a doctor who had to help in 3 flights already.

If you are a physician:

-The cabin crew MUST help you in all the things you require, that is:
    
    
           ·Providing food, liquids, blankets (for free of course).
    
           ·Providing the mandatory medical kit (that can only be opened by qualified persons never by the crew on their own).
    
           ·move the passenger wherever you find appropriate (galley, the aisle, laying in several seats, etc...). 
    
           ·Don't accept any excuse regarding the medical kit, some pursers are willing to avoid the paperwork involved after opening it (this happened to my wife in an Easy Jet flight, unfortunately I was in another row taking care of the kids and didn't know about it till the end of the flight). It must be fully stocked when opened (usually they are closed with a lock), if it's not the company was breaking the regulations. The medical kit is a no go item (it must be present and in perfect conditions for a flight to begin).
    
           ·Request the cabin crew to keep other passengers away. People loves a good show, and is able of disgusting behaviour (like taking photos of a semi-nude patient to "share", looking over the doctor's shoulder, etc..)
    
    
           ·Most cabin crew are super professional and will help to the best of their capabilities, but you can always find an idiot. Don't let them intimidate you.
    
    

-The pilots are waiting for the instructions of the experts. From the first moment we know there is a medical emergency, we are planing for a diversion to the nearest airport, usually we'll listen to their opinion regarding the need of an immediate hospitalization of the passenger. Although the captain has the last word, no pilot I know is willing to risk avoiding the recommendations of a doctor and face police charges for letting a passenger die for not following instructions.

-What I mean is if it's clear to you that it's a heart attack for example, and the patient needs an hospital, tell the pilot ASAP. We are flying at 8 Nautical Miles per minute, and 10-20 minutes flying away from an airport can mean up to an hour more than necessary till you are in the ground. We take the decision based on the instruction of the doctors and nurses onboard.

-That said, be careful to ask what city is the captain willing to land at, and what kind of medical facilities it has. If you are flying over the sea or desert, just expect up to 3-4 hours till able to land in a city with a good enough Hospital. I had a discussion with a captain cause he wanted to land in Tamanrasset, a small city in the middle of the Algerian Sahara. We had a passenger with a possible heart attack, and he wanted to land there. I told him that we needed 45 minutes to land, and then wait at 3am till we were able to disembark, an ambulance to arrive and the patient be carried to the local Hospital, that as you may imagine is less than stellar. The purser just confirmed my suspicions, as he just had the exact same case. The patient took more than 3 hours to arrive to the Tamanrasset hospital, and there was nothing there to treat him of his heart attack. So a private flight was called from Italy to evacuate him. It was much simpler and safe to wait till Malaga in Spain, just 2 and a half hours of flight away with a medialized ambulance waiting for you at the parking.

-The FAA list of mandatory medical kit onboard [http://www.faa.gov/documentLibrary/media/Advisory_Circular/A...](http://www.faa.gov/documentLibrary/media/Advisory_Circular/AC121-33B.pdf)

-You also can find that the passenger has no need of immediate hospitalization, but needs medical help once landed. The crew is able to call emergency teams to be ready once the doors open (EMTs and police)

-Some companies have a remote medical service available by radio or satellite phone, they are there to help with the diagnosis and treatment if necessary. But they are not infallible and they could recommend you to land in an airport that has a unsuitable Hospital(it has happened). Right now I'm not aware of any international list with the medical facilities available close to big airports.

-Just a recommendation, IANAL but if unfortunately a passenger dies in flight, I would not declare the decease (we are talking strictly medical causes, no aggressions, killings, etc..), keep trying to reanimate, let the EMT take care of the patient once you've landed and they come onboard. Depending the country a declared decease onboard means a judicial investigation, police reports, etc... that will surely take all day once you land (or more).

-Most usual medical emergencies onboard are faints, suffered by people with previous medical conditions. Also people drink too much or take some kind of drugs to endure the fear of flying. Also some kind of digestive problems and heart attacks happen but are less common than faints (based on my personal and friends anecdote)

------
throw7
The specific airline protocols makes all the difference... which isn't
specified in the article. Also something as simple as all the medication being
in a foreign language can be a stumblimg block on an international flight.

~~~
alasdair_
Don't all international pilots speak English as a requirement for talking with
air traffic control? I would assume that if English is standard for pilots it
would also be standard for emergency equipment (in addition to any other
languages)

~~~
tbihl
I just hope that the "English speakers" on planes are better than the ones
nominally fulfilling the same requirement on merchant vessels.

------
_pferreir_
I've been through a similar experience that unfortunately ended up quite
badly. Here's my account, I hope it helps the discussion.

I was on a 2 hour flight, we had left maybe 15 minutes before when the
passenger sitting right in front of me started feeling unwell. He was
travelling alone, so the passenger sitting next to him notified the flight
attendant. The flight attendant asked whether he had a history of diabetes,
but he was in such pain that he could barely articulate a word. He would only
say "it hurts". Believing it was an episode of hypoglycemic shock (not sure
based on what, but well, IANAD), the flight attendant brought him a glass of
soda and, maybe five minutes later, seeing no improvement, shouted the usual
"is there a doctor on board?" question. There was indeed a doctor on board
(two, actually), who immediately proceeded to examine the person (he even had
a stethoscope). He asked for the emergency kit as well, which proved to be
quite minimal. As the flight attendant debriefed the doctor (who at this
point, still believing the thesis of hypoglycemic shock, tried to measure the
heart rate in parallel), the patient collapsed. It was then clear to everyone
that he was experiencing cardiac arrest. The doctor quickly put together, with
his other colleague, a small group of people that manage to lay the person
down on the aisle floor. In the meantime, the pilot was informed of the
situation and diverted the plane to the closest airport en route. By then, at
least 20 minutes had passed since the start of episode. CPR was at first
successful, but the patient lost his senses again after a few minutes. A
second attempt at CPR proved unsuccessful. We landed maybe 30 minutes after
the pilot got to know about it. The ground medical team hopelessly tried
reanimation with a defibrillator (there was none on board, BTW), nothing. It
was pretty sad, especially because I have the feeling that if that person had
been on the ground he would have almost for sure survived (IANAD, once again,
so, it's just a feeling).

Anyway, things that went awfully wrong and are a danger to airline passengers:

* As I've said before the first aid kit was pretty basic and, according to the doctors, lacked some essential material; * Most commercial planes aren't equipped with a defibrillator. They're not mandatory, at least not in Europe. * Airline crews know nothing about first-aid. They're just not prepared. They cannot recognize the simplest symptoms of a heart-attack. * They clearly didn't know what the first aid kit had or hadn't. They couldn't name the contents. To be fair, the crew was french-speaking while the doctor was not, so maybe they just didn't know the names of things in English. Still, crews on international flights are supposed to have a good level of English. * Most flight attendants behave like robots in stressful situations. They have such a respect for protocol and rules that they will be reluctant to break them even if that means saving a life. For instance, as the doctors were applying the last round of CPR, they considered improvising a tracheotomy using a pen (desperate measure, but who knows whether it would have worked?) By then the plane had started descending and was maybe 10 minutes away from landing. As the doctors asked for a pen, the crew remained still in their seats.

Bottom line: if I ever have a heart attack (which I hope I won't), I'd better
not be on a plane.

~~~
DanBC
> because I have the feeling that if that person had been on the ground he
> would have almost for sure survived (IANAD, once again, so, it's just a
> feeling).

Sadly, most people who need CPR will die.

    
    
        How successful is resuscitation through CPR?
    
        Diagnosis                      Success Rate for CPR
        Head injury                    7.2%
        Acute renal failure            2.7%
        Survival after 24 hours        9.2%
        Survival to hospital discharge 8.3%
    

(That's from a Google instant answer).

[https://www.resus.org.uk/faqs/faqs-cpr/](https://www.resus.org.uk/faqs/faqs-
cpr/)

> 9\. How many people survive a cardiac arrest?

> In the UK fewer than 10% of all the people in whom a resuscitation attempt
> is made outside hospital survive. Improving this figure is a major priority
> for the RC (UK), the Department of Health, ambulance services and voluntary
> aid organisations.

It's a bit of a problem when films and tv shows depict CPR as almost always
being successful.

~~~
_pferreir_
Well, I guess if an ambulance manages to reach you quickly chances increase? I
don't know. Anyway, I guess they do increase dramatically if there's a
defibrillator available, right? At least that's what this suggests:

[http://www.health.harvard.edu/press_releases/aed-
cpr](http://www.health.harvard.edu/press_releases/aed-cpr)

~~~
dredmorbius
Ventricular fibrilation, (vfib) "an electrical disorder of the heart", is
among the _most_ survivable conditions, _if_ there's a defibrilator available
which can be applied _within five minutes_.

The problem is entirely within the heart's signalling, it's not a blockage,
obstruction, aneurism, or other blood-vessel defect. And the treatment isn't
counterindicated for most other possible similar conditions.

Short answer: rapid appropriate response can result in total recovery, but
it's very dependent on the underlying etiology.

~~~
fnj
The prognosis depends on the circumstances leading to the vfib. If it is a
response to a sudden 100% blockage in the left anterior descending coronary
artery, that is a widowmaker. No amount of defib will "fix" that until the
blockage is cleared, and there is only a window of a very few minutes to clear
it by going in surgically, or a hail mary measure to dissolve it fast.

If the vfib is "just" a result of chemical imbalance or a less major blockage,
the outlook with vfib is much better, and it has even been known to
spontaneously self-clear.

~~~
dredmorbius
Again: electrical problem, 100% resolvable in virtually all cases.

An arterial blockage != an electrical problem.

------
xacaxulu
Along with not stocking medical equipment, didn't Delta's data center just go
down?

~~~
dredmorbius
You're being dinged for this as I write, but that's an interesting observation
and a sign of failure-to-manage-complexity on Delta's part.

Though information-system-related service failures are generally increasing
among carriers, if I'm recalling the coverage of Delta's outage correctly.

Still remains a good flag to raise.

------
paviva
Interesting story and I can partially confirm. I have responded to a few on-
flight emergencies on international flights and experience varies according to
the airline.

Lufthansa has a _really_ great kit to deal with agitated passengers, but
nothing to deal with pain. Air Canada's kit is pretty worthless. Most airlines
fall in between.

That being said, I find the doctor's requirement a bit unrealistic.

Airways ? Common, good luck placing an airway in the cramped flight
conditions. A BVM [1] would be more useful.

IVs ... Completely useless, too. First, unless you have a good nurse on board,
you wont be able to open up a good vein. Second, you cannot expect airways
companies to store enough of IV fluids to make a difference either way. Third,
fluids don't save lives unless you have other medications coming in the next
few minutes.

The lack of nitro might be a good thing too. Rarely useful, and most likely to
result in the passenger passing out/dying than helping anyone.

~~~
ackfoo
What an odd reply. I have placed airways in helicopters and Piper twin-engine
aircraft that were serving as air ambulances. Those are far more cramped than
a commercial airliner. Control of the airway can make all the difference when
things go bad in a hurry.

IV fluids are critical in dehydration--no drugs to follow.

Oh. I wrote the foregoing and then I re-read the part about "a good
nurse...open up a good vein" and I realized you are a troll with no medical
experience or qualifications. Good one.

~~~
JshWright
> IV fluids are critical in dehydration--no drugs to follow.

If someone was able to walk on a plane, it's unlikely they are severely
dehydrated... Plenty of other reasons to carry fluids though.

~~~
neurotech1
Actually, being at 30,000+ feet the air is extremely dry. Getting severely
dehydrated during the flight is quite possible. More so if alcohol is
involved.

------
intrasight
What a sad, disheartening tale.

~~~
nraynaud
Well, the patient survived, the plane got to destination, I'd call it a shitty
situation that ended well.

~~~
intrasight
True. Still makes me sad and angry when incompetent people interfere with
competent people working to save lives.

------
Drdrdrq
Of course OP will not be able to get his emergency kit through security
check... :(

~~~
nommm-nommm
The author of this article is a woman.

------
goatherders
I am sure there are horror stories for every airline so it seems unfair to
gang up on Delta.

Actually, no. That isn't what I meant. I flew Delta a month ago and won't be
doing so again. Free TV shows and new planes don't compensate for being late
or having unfriendly staff members. Never mind this tale...

------
consto
After reading the article I am very angry at that flight attendant.

------
plg
what do they do (with the body) if someone dies on a long haul flight and it's
still many many hours to land

~~~
tacostakohashi
[https://www.theguardian.com/business/2004/may/11/theairlinei...](https://www.theguardian.com/business/2004/may/11/theairlineindustry.travelnews)

------
Waterluvian
I really hope to see a follow-up story of the FAA giving Delta a serious
scolding.

------
vacri
On a tangent, not all doctors are suitable for emergency work. I used to work
with a paediatric neurologist, who was excellent in her field and a respected
specialist, and she told the story of the call going out on a plane for a man
who was having a heart attack. She hesitated about it - she hadn't "done
hearts" since medical school twenty years earlier. Just as she was about to
volunteer, however, another doctor put his hand up... and he was a
cardiologist.

~~~
Johnny555
If it were me unconscious on the floor, I'd take a pediatric neurologist that
"hasn't done hearts" for 20 years over a flight attendant with 8 hours of
"first aid" training.

~~~
webtechgal
Heck - I'd settle even for a vet... any day...

~~~
ndespres
I fear the day I have to call upon my experience birthing livestock to help
deliver a human baby.

------
gragas
Why was this post renamed?

------
hetfeld
Oh, yeah. Delta again...

