Medical emergency in the skies

After a rash of in-flight medical incidents, Bess Manson asks just what happens when things go awry at 30,000ft.

Heart attack, allergic reaction, stroke – there’s never a good time to fall ill, particularly when you’re 30,000ft up, flying over the open ocean, thousands of miles from anywhere. Up here, dialling 111 for help is not on the cards. But life is unpredictable, and crises do not adhere to a schedule. With several recent reports of in-flight medical emergencies, you wonder, just what happens when things go awry midair? It’s reassuring to know airlines have a robust system set up for an in-flight medical drama. Such events are a relatively common occurrence, according to Tim Robinson, pilot and president of the New Zealand Air Line Pilots’ Association (NZALPA).

Robinson, a first officer, who has been an international airline pilot for 26 years, says he has had around 30 in-flight emergencies during his career, dealing with anything from heart attacks and allergic reactions to serious cases of meningitis.

It can cost airlines in the millions to divert a plane, so much will be done to avoid this.

HELP ON THE GROUND

Most airlines have access to specialist medical advice on the ground, both in-house and from on-call medical services that can be reached any time from anywhere, using satellite phones.

Air New Zealand uses MedLink, part of MedAire, a USbased service that offers medical advice to more than 100 airlines in 140 languages with a database of emergency medical response teams at more than 5000 airports.

When a medical emergency happens, it is the flight crew that start the chain of action.

After alerting the captain, a call will go out asking if there is a doctor or someone with medical training among the passengers.

With the help of crew, who all have first aid training, and possibly a medically trained passenger, symptoms are relayed to the medical expert on the ground, who then works on a diagnosis. With new technology it’s possible to send photos or videos of the patient back to the ground-based personnel to help them assess their condition.

The MedLink ground staff will have full details of the flight, so are able to make an assessment on the next course of action based on the condition of the patient, where the aircraft is and how far it has to go.

Should the pilot decide to divert, the MedLink team would determine the most appropriate airport and organise onthe-ground local emergency services to meet the aircraft.

But in any situation the responsibility and the safety of the aircraft and its passengers rests with the pilot in command.

Air New Zealand’s policy is that you have to have a very good reason to stray from the advice given by MedLink, says Robinson.

‘‘Under the New Zealand Civil Aviation Act the ultimate responsibility rests with the captain, who is in situ with all the information. When considering a diversion, the captain will look at factors such as how close the diverted airport is, what the weather is like, the length of the runway, what medical facilities are available at the divert destination.

‘‘It’s very rare for the captain to [act] outside the medical advice, but they may have compelling reasons to do so.’’

COUNTING THE COST

The life of the patient is of the highest priority and everything will be done to save that person, says Robinson.

‘‘Commercial factors are a secondary priority. When we talk about life and limb, commercial factors such as whether you can refuel at the unscheduled stop, if passengers are going to be inconvenienced