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Always Know Where Your Alternate Airports Are

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The physician on call was conferenced in and briefed. The tone of the physician’s analysis indicated that our medical problem might not be dire. This analysis conflicted with that of the onboard doctor. I took a deep breath and sighed inwardly. It was time to put on the proverbial captain’s hat. I looked at my copilot, shook my head, unsnapped the intercom handset from its cradle and pressed the code that would chime the first-class cabin. Liz answered almost immediately. I explained that I… (www.flyingmag.com) 기타...

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preacher1
preacher1 13
Good story. Refreshing to hear something real life rather than all the new flight schedules and political bitching.
canuck44
canuck44 5
Good story and a real life lesson in decision making. A captain is damned either course he chooses when the prospect of losing a passenger vs the ire of the company for not taking the most economical course. He has to act on the sparse information at hand and his own conscience.

On one hand he has a company doctor (contracted likely) who cannot actually examine the patient and the other a volunteer "doctor" from the passengers who is actually in contact with the patient. He is lucky if the latter is an Anesthesiologist, Intensivist, Cardiologist or Internist, but it could well be a psychiatrist, a proctologist or the worst of all possibilities a government healthcare "policy" administrator...in charge of rationing.

I have been that doctor twice while crossing the Atlantic, once on what turned to be a correct call to divert and once fortunately we were close enough to destination to remove the need for alternates. In both instances (before monitors and defibrillators) there was little to assist in the diagnosis complicated by the passenger not speaking English. It was all worthwhile when I received a thank you card from the surviving "divert" patient and a hand written note from the airline in the other.
JshWright
I've always wondered why crews ask for physicians. Aside from maybe an ER doctor, someone trained as a paramedic would be far better equipped to handle the austere medical environment aboard an airplane.
yakc130
You are exactly right. Most people are still used to the call of, "Is there a doctor in the house?" But not every doctor is trained to the current standards of emergency medicine. The last time that they handled an emergency may have been years ago while in med school. Not a great time or place for a non-ER doc to try and remember stuff from med school.

Paramedics and EMT's are much better trained to handle emergencies like this. We have training to deal with situations while using minimal, or basic equipment. Normally, we work using standing orders from our department's Medical Director, the doctor whose license we practice under. Some orders are standard that are used almost everywhere in the world (like giving oxygen) and don't need a doctor's order/permission.

On a situation like this, the pilot would need to establish medical control with a physician so that the medic could identify himself and confer with the doc. He would then need to give the doc a patient status report, and then advise him of what equipment he has available on board to use. From there, they can figure out a treatment regimen using what's available.

In the over twenty years that I have been involved in 911 EMS as an EMT and medic, I've only been needed one time, and that was at the gate fortunately. I have to admit that now that I am working overseas, and all of my flights are international, the flight attendants seemed to get a little pissy when I let them know that I'm willing to help if there is an emergency. I don't understand why. The Cathay F/A's really did. Maybe they were superstitious about me even bringing it up. LOL.
preacher1
That story I told about OKC yesterday; the Captain's decision to go on into OKC rather than divert on to TUL. The USAF doc that was working with the FO told him that if we had to go to TUL, the FO probably would not make it. In those days there was no company doc and it was all on the Captain, but had it not been for that I kinda figure TUL would have been an easy choice
Pilot009
Good article and a very good reminder to us G/A pilots that there doesn't have to be "dead time" on any flight, no matter how often we have flown the route. Every flight is an opportunity to practice something!
akayemm
Fore warned is fore armed. An age old axiom.
Valid for all reasons and all seasons.
So said the elders over time and again.

waynebayley
I assume that this is a piece of fiction? A mid Atlantic diversion across 3 tracks at 38500 ft would be a illegal contravention and dangerous violation of the published emergency procedures.
Aircraft are separated by 1000ft, altimeters are allowed a 75ft error each ( combined 150ft) a 777 is 100ft tall giving a potential 100ft separation! Why would a Captain take such a risk?
Diverting at 27500ft (as required) to an alternate half as far as the destination will not present any fuel issues so why be cavalier and ignore the procedure? 15 years Transfer Atlantic experience seems to have been wasted. Expect a call from the FAA.
Wayne Bayley
MikeMohle
Mike Mohle -8
I never understand how people that should not be on planes still get on them. What a selfish act to the 200+ people inconvenienced, not to mention the cost. Given her symptoms the previous day per her husband, she should have stayed put!
tyketto
seeing how they didn't know what exactly those symptoms were, nor if the passenger was flying home from EGLL (read: they were tourists; they did not have a doctor to go to besides a hospital), nor if they had left home, they would never have known how severe the condition is. Heart attacks can happen without the patient even knowing they've suffered one.

Regardless, anyone's health is just cause to divert. Would you want to be sued for negligence if you went against doctor's orders to land the plane because you didn't want others to be inconvenienced? Great way to lose your license, while causing your employer to pay out millions in a wrongful death lawsuit.

Either way, you miss the point: The pilot was on his game in knowing what he needed to do, what his options were, and regardless of not knowing the area he was going, selected the closest alternate airport to divert to, landed everyone safely, and got the passenger off the flight to where she could receive medical treatment. It's easy for us to do this over land, but to do it half way across the ocean and into a country they have never seen before is a damn good job at the least, and short of miraculous at the most.
preacher1
Not to mention it was after dark by the time they got down. Kudos to the Captain. Mike had it been you, I am sure you would not have worried about inconveniencing the other pax

[This poster has been suspended.]

joelwiley
Check your health insurance policy regarding preauthorization approval policies...
akayemm
Me ditto.
I/m a heart patient too, with two major blockages !

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