https://www.cnn.com/2018/04/27/us/american-airlines-wrongful-death-suit/index.html

my latest  encounter with a medical situation was on a phenom 100 1 hour and 37 mins away from destination 3 passengers,  1 doctor with a patient an a  family member . we are a small ant compared to a mayor airline but our owners are 180% strict on safety of everyone . a landing on a smaller field near by took care of the situation and 6 hours later we were back on the air with everyone on board kicking and screaming ... .I cant for the life of me wake up for the rest of my life knowing that a landing could of save someones life ,  I rather get fired and hand over my career as a pilot . on the other hand a lost of a life and a lawsuit would be the end of the company and our jobs . 

What I would like to know is what the doctor passenger told the crew during the second episode. When a mefical situation arises inflight, the procedure is to contact Medlink, a company that contracts in flight medical guidance to a lot of airlines. If the crew follows Medlink guidance, Medlink is supposed to assume liability. The determination of whether to land or not is provided by Medlink, if the captain decides to land against Medlink recommendation, it’s on him. So my question is did Medlink recommend they continue the 1.5 hours and if so why? What information were they given to come to that comclusion? I’m sure the initial diagnosis of a ‘panic attack’ probably didn’t help Medlink to grasp the seriousness of the situation. 

That’s right, medlink can and do override medical staff onboard, the reason being they are specialists in aviation medicine and know in great detail how altitude can distort the symptoms that an onboard doctor may observe, and make a much more accurate assessment.

i would agree the airline industry nowadays isn’t the experience it used to be, but I can 100% guarantee that once a safety or medical issue raises its head in flight the financial aspect goes out the window and isn’t considered for a moment.

Not wanting to comment about this situation as I know nothing about it, other than to say I’d be very surprised if the decisions made on the day were not  done with great care and with good reason,but I don’t know.

Souless pilots? Yes, I’m afraid in situations like this as a captain you simply have to be, you simply must concentrate on the safe operation of the aircraft and not allow what is happening in the cabin to get a hold of you and cloud your judgement and decision one way or another. It’s not pleasant, and it’s hard, but it is what must be done.

Edited April 28, 20188 yr by jon b

Wonder if the captain decision would have been the same (given the same external conditions, of course) if the sick person were his daughter.

Read about this on Airliners.net, and a couple of points were brought up.

• Where exactly was the flight when the decision was made whether to continue or not.
• What were the weather conditions like in Albuquerque. Terrain considerations?
• What facilities were available once the flight got on the ground. In other words, how far was the nearest hospital.

Those are the only ones I can think of off the top of my head, as it's 06:57 AM. Depending on her condition, another point made was that it's possible that making a rapid descent could have made her condition worse. In any event, you certainly wouldn't want to get the flight on the ground only to find out there aren't medical facilities nearby.

Ultimately, it will come down to, did the crew follow procedures? If they did, the crew are fine, if they didn't it's going to be a bun fight to decide if they acted negligently.

Then... are the procedures reasonable? As a major western carrier I would have thought that American's in flight medical emergency procedures are both legally watertight and eminently sensible and tested, they wouldn't be in business now if it wasn't.

5 hours ago, KevinAu said:

What I would like to know is what the doctor passenger told the crew during the second episode.

Indeed, as useful as they are who know if (s)he was really a Dr or of what. Medlink offer medical guidance and, as far as I'm told, take medical responsibility, ultimately the decision to divert remains with the Capt, Medlink know nothing of operating an aircraft and killing everyone trying to get into an inappropriate airport with a hospital would not be considered a good outcome.

1 hour ago, jon b said:

Souless pilots? Yes, I’m afraid in situations like this as a captain you simply have to be, you simply must concentrate on the safe operation of the aircraft and not allow what is happening in the cabin to get a hold of you and cloud your judgement and decision one way or another. It’s not pleasant, and it’s hard, but it is what must be done.

Spot on, fly the plane, follow the procedure and let the lawyers fight it out on the ground, that's the job.

In my experience Medlink are quite conservative (and rightly so) but with only 1hr 30 to go, by the time a diversion was set up with Ops and ATC and the descent and approach made you would probably only be on the ground 20 minutes or so quicker (with an increased risk of incident/go around due to unfamiliar airport and rushed crew doing something non normal). Declaring a medical emergency and getting priority landing into DFW (not that I've ever been delayed in there) with all it's resources sounds pretty reasonable to me.

1 hour ago, Murmur said:

Wonder if the captain decision would have been the same (given the same external conditions, of course) if the sick person were his daughter.

I expect so, if he didn't follow the procedure and his daughter died he would never forgive himself, if he follows the procedure and she still dies he knows he did everything he could, as devastating as it would be.

HTH

Ian

Welcome to the 21st Century.

Noel

After reading several articles on this it's reported the woman died after suffering a pulmonary embolism and cardiac arrest. A blood clot. Probably a result from sitting too long on the long flight. According to the doctor onboard the medical equipment a blood pressure cuff and defibrillator were not working. Wether a working defibrillator would have saved her or not we'll never know. If the investigation has determined the equipment was faulty I can see the airline being held liable in this case. Such a tragedy that maybe could have been avoided.

https://health.howstuffworks.com/diseases-conditions/cardiovascular/heart/plane-travel-heart-attack.htm

https://www.nytimes.com/2018/04/27/travel/american-airlines-brittany-oswell-death.html

 

2 hours ago, bills511 said:

After reading several articles on this it's reported the woman died after suffering a pulmonary embolism and cardiac arrest. A blood clot. Probably a result from sitting too long on the long flight. According to the doctor onboard the medical equipment a blood pressure cuff and defibrillator were not working. Wether a working defibrillator would have saved her or not we'll never know. If the investigation has determined the equipment was faulty I can see the airline being held liable in this case. Such a tragedy that maybe could have been avoided.

https://health.howstuffworks.com/diseases-conditions/cardiovascular/heart/plane-travel-heart-attack.htm

https://www.nytimes.com/2018/04/27/travel/american-airlines-brittany-oswell-death.html

 

Perhaps, but pulmonary embolisms and associated blood clots can be fatal even if the very best medical care is immediately available. A friend of the family died of an embolism. He was already in the hospital, and in intensive care (for a different problem) at the time it happened. A whole team of doctors and nurses responded within seconds, but there was nothing that could be done to save him. 

I agree though, that there is potential liability on general principles if the AED on the aircraft was not in working condition. 

I for one take exception to your title for this topic.  You don't know why the crew chose to head for Dallas or why they didn't land in ABQ. I'm quite sure it wasn't the sole decision of the pilot unless there were extenuating circumstances.

Pilots are doing their jobs and sometimes they have to make very hard decisions and generally there is someone else involved in the decision making process.

1 hour ago, 188AHC said:

I for one take exception to your title for this topic.  You don't know why the crew chose to head for Dallas or why they didn't land in ABQ. I'm quite sure it wasn't the sole decision of the pilot unless there were extenuating circumstances.

Pilots are doing their jobs and sometimes they have to make very hard decisions and generally there is someone else involved in the decision making process.

It was pointed out somewhere that this flight was a red-eye flight, so that may have limited diversion options. You certainly wouldn't want to land at an airport that doesn't have any ground staff available.

1 minute ago, Captain Kevin said:

It was pointed out somewhere that this flight was a red-eye flight, so that may have limited diversion options. You certainly wouldn't want to land at an airport that doesn't have any ground staff available.

think in a emergency a pilot would land at any airport that was available for  his  type  of  aircraft and  than worry  about  ground  staff,  besides  ground  staff can quite simply  be  ferried  to where ever  he  decided  to land

As mentioned above - airline captains are not medical experts and this is why Medlink exist.

16 minutes ago, pete_auau said:

think in a emergency a pilot would land at any airport that was available for  his  type  of  aircraft and  than worry  about  ground  staff,  besides  ground  staff can quite simply  be  ferried  to where ever  he  decided  to land

And this is where the precise nature of the emergency makes a big difference to where one might choose to land. 

If you're on fire then clearly the priority is to get the aeroplane on the grounds ASAP and worry about how you're going to accommodate the pax etc later. 

But in a medical emergency just putting the aeroplane on the ground at the nearest airport is not necessarily going to result in the best outcome. What if there are no steps suitable for the aircraft type available? How will you get your sick pax off/paramedics on?

I know nothing of Albuquerque but I know in very general terms that Dallas/Fort Worth is a much bigger place, potentially with much better medical facilities, and it is my understanding that Medlink will recommend options based on the quality and availability of facilities on the ground as much as anything.

To take it to the extreme - if you're over northern Greenland on a transatlantic flight, dumping the aircraft in Sondestrom is probably not going to get your sick passenger the quickest or most effective medical assistance compared to flying a bit longer and landing in civilisation.

Another favourite real-world example: B777 on a transatlantic, UK-USA west coast. Potable water runs out over the Atlantic.

Crew divert to Iqaluit to uplift additional potable water. All very well, but on arrival it emerges no potable water is available - it was all frozen! Result: complete waste of time, money and fuel and the solution to the problem significantly delayed.

13 hours ago, bills511 said:

According to the doctor onboard the medical equipment a blood pressure cuff and defibrillator were not working.

If this is true then AA's bigger issue is likely to be the non-functioning first aid equipment rather than the captain's decision assuming Medlink's advice was followed.

Yes, in an emergency, you would land wherever if necessary. But it may not be quite so simple to get your ground support. Ground station personnel may have to be roused out of bed and then have to drive to the airport. Which may take as much time if not more than landing somewhere else. So you sit there on the tarmac with the ill person stuck on the plane for some time. More sensibly in a situation like that, you would end up using whatever fbo or maybe another airline’s ops that happen to be available. Not impossible, but not quite as simple either. 

Again, I doubt this happened because of the captain’s greediness. But rather a situation of miscommunication, inadequate information, and misdiagnose. If this was Medlink’s decision to have them continue, they are liable. But that that doesn’t mean they won’t push it off themselves by questioning whether the flight attendants and the involved passenger doctor provided them the proper information. The quality of the decision is only as good as the information used, and the information used by Medlink is based off a simple questionnaire that the FAs fill out during the situation. The quality of the information on that questionnaire is only as good as FA’s ability to make medical observations. And these people are neither doctors nor nurses and don’t get any medical training as far as I know. The failure of the on board medical equipment is a whole other issue that will see the airline’s maintenance or the device manufacturer brought into the mix.