Tuesday, May 25, 2010

Should We Divert?

Several months ago I wrote about a passenger issue concerning a child traveling with a severe peanut allergy. The flight was ultimately operated without incident and everybody seemed pleased with the outcome.

A recent flight of mine brought all that allergy business back into play.

Departure: Madrid, Spain

Destination: Dallas/Ft Worth, TX

Typically when we arrive at the aircraft, one of the first things we do is look over the logbook for any write-ups made by the inbound crew or any items that are currently inoperative and awaiting repairs. We also look back over several days or more worth of write-ups just to get a general idea of what has been going on with the maintenance on that particular aircraft.

This day our aircraft had just arrived from Miami and was one of the newer 767's. It had all the newer nav equipment and some other bonus features.
A check of the logbook revealed some nuisance cabin issues that were being corrected prior to boarding. The only cockpit item that was inoperative was the SatCom (satellite communication) radio system. It had been inop for a couple of days so we knew it wasn't going to get repaired in Madrid. A visit with the mechanic on duty confirmed this as well.

The SatCom allows us to communicate with our dispatchers and maintenance technicians from just about anywhere in the world. The quality of the communication is outstanding. It is a favorite among the pilot group. We hoped we wouldn't need it this day.
After a lengthy delay for departing traffic, we finally launched and headed west for the ten hour leg to Texas.

It was business as usual for the first hour and a half of flight.

Then the cockpit chime rang.
The purser was calling to advise us that a lady passenger was having an allergic reaction to the pesto sauce in her meal. The lady reported that she always travels with Benadryl (for this very reason), but she somehow managed to forget it this time and she inadvertently ate the pesto sauce.

The lady was asking the flight attendants if we had any Benadryl on board that she could take. Now that might be a good solution to the problem, but I couldn't possibly condone any of our cabin crew dispensing any kind of medication without the proper authorization! Not in today's society! So my answer was a definite "NO.....but Standby."

By now we were getting close to the Azores so I asked the first officer to check with Santa Maria on our HF radio for the latest Lajes weather (just in case).
It was marginal....the other options would be to turn around and land in Lisbon or return to Madrid.

So this is where the SatCom would have come in handy.

My employer has a program in place just for situations like this. There is always a physician on call available to answer any questions or to assess a passengers condition via radio voice call or phone patch. It's not perfect but it is far better than having an untrained airline crew attempting to diagnose an ailing passenger.
The only problem with this program is that we have to be able to contact them via radio! So that wasn't going to be an option this day so we had to find another solution.

I was in almost constant communication with our purser and she was reporting that the lady was beginning to have difficulty breathing.

All of our planes carry a medical kit on board with basic first aid and certain other medical supplies. But the only one authorized to dispense any of the medicine is a qualified physician.

So the next option was to make a PA announcement asking if there was a physician on board that would assist.
With over 200 passengers on board this day we were lucky to have a Spanish physician answer the call. He assessed the lady's condition and administered the equivalent of Benadryl that was in the onboard medical kit.

Her condition did not seem to be improving as we pushed westward, but it wasn't worsening either. We were now well past the Azores and our next suitable divert option was Keflavik, Iceland. However, the physician seemed to be of the opinion that she was going to be okay so we pressed on towards home.

Another hour passed and she was now improving. Her breathing was back to normal and the physician seemed happy with her condition.

We would soon have VHF radio capability and would be advising our dispatcher of our situation. By the time we passed Gander, Newfoundland, all was well in the cabin and the remaining hours passed without any further issues.

Typically an Atlantic crossing consists of a few radio position reports, some basic map plotting, a crew meal, a bathroom break, and maybe some other mundane tasks. This crossing would prove to be far different. I can't remember ever having been so busy on any given leg.

Thankfully this day we had the good fortune to have a physician on board and we were grateful for his services. I personally thanked him when we landed and he was very gracious about the entire incident. A good guy for sure!!

That SatCom would have been a great help.....Good thing that we didn't have to divert!

For a look at some more of my photos, please aviate over to Plane & Simple.


Mark Lawrence said...

Wow Len - difficult situations those and I can understand the reluctance to give anything medication wise! Thank goodness for the doctor - otherwise - would you have diverted had there not been a doctor? I can't remember is Lajes is CAT III equipped if the weather was marginal. At least it all worked out well.

Len (Barfbag) said...

Hi Mark,

I think we would only have diverted had she gone unconscious. That's more or less the guideline our company gives us when deciding whether or not to make an unscheduled landing for a medical situation.
Lajes only has a basic ILS with 300 ft minimums.
Glad we didn't have to divert...that would have made for an extra-long day!!


Michael said...

Hi Len, long time!

Glad to hear all is well on the line and everything more or less is keeping you busy!

Take care,


Sherri said...

I think you must have jinxed me... i just got back from Costa Rica and was in the middle of a 6.2 Earthquake. I read your post about the earthquake you experienced in Costa Rica right before I left for my vacation.

So I guess it's good I read you post... don't think I was as worried knowing they have them a lot. But the locals were scared by this one... said they don't usually get them that strong. Fun times! :)

5400AirportRdSouth said...

I'm curious, and I hope it doesn't come across as tacky or anything, but when a physician is called on in-flight, would they send a bill to the airline? Is there protocol for offering some kind of compensation?

I've heard of this happening so many times ( calling for a doctor on board ), I wonder if physicians colleges have come up with guidance for their members or if this simply falls under " doing the right thing, lawyers-be-darned "

I enjoy the blog, very well written, skipper.

Len (Barfbag) said...

That's an interesting question about compensation for a physicians services!
I really don't know if there is any protocol for the airline to reimburse the physician for his or her services. I would think that the physician should bill the passenger and not the airline. After all, it's not the airlines fault that the passenger was ill.


david said...

awesome, i love watching how logic exists in all animals - probably sometimes much more than we humans have!

Moving Companies said...

Love your blog great layout.

PropellerHead said...

As a doctor, air traveller and private pilot this post and comments were fascinating. A few points come to mind:
1) I have given medical assistance twice on long haul flights. One fairly innocuous but the other rather troubling (chest pain in someone with a cardiac history).
2) I personally would never dream of charging an airline or passenger for such a "Good Samaritan" act but my medical history is in the UK and New Zealand, both with "socialised" health care systems and, perhaps, a different moral perspective.
3) It seems ridiculous to have medical equipment and medications on board with no-one qualified to use them. What about paramedic training for cabin crew?
4) The medico-legal issue is a bit of sticky one - such that I would hesitate to put my hand up if I were flying in the US or on a US airline as my malpractice cover likely wouldn't be valid - I might get away with the "Good Samaritan" argument but would be unwilling to risk it without written indemnity from the airline (not likely to happen, I know). My previous acts were on Virgin and Air NZ - a good number of years ago.
Could probably discuss this at much further length.
Great post, thanks
Barry aka PropellerHead

capnaux said...

New reader here--great post!

Often have this same dilemma enroute, but thankfully, flying coast to coast across the U.S., my flight's always full of diversion alternates. Have used Medlink many times, and diverted for a few. But, fortunately, most situations tend to be innocuous.

@Prop-Head: US FA's are trained in how to use the defibrillator, but tha's about it. Originally, FA's had to be full-on nurses!