Medical emergency

If the plane happens to be above in the middle of the Atlantic, the pilot doesn't have a lot of options. It may be a few hours before the plane can reach an airport that can handle jumbo jets. But three of the most frequently used airports for medical emergencies is (because of their locations) Gander New Newfoundland, Reykjavik Iceland, and Dublin Ireland. But a lot depends on the exact route the aircraft is taking.

As a nurse, I'm really hoping you don't think you're going to have a medical emergency! I've rendered pt care on a plane, and while the medical kit was quite complete, and I felt comfortable doing what I did, I wouldn't feel comfortable running a code etc.

Make certain that you have plenty of travel insurance that includes an upper level of medical coverage. One that not only takes care of all of your medical needs, but will also pay for your transport back to the U.S. if necessary.

richard, I believe the normal protocol in case of medical emergency is to put-down at the nearest airport that is able to accommodate that type of aircraft. As Michael mentioned, that's often Gander, Reyjavik or Dublin, depending on where they are at the time an emergency occurs. I'm a retired Paramedic, but hopefully I won't have to provide care as Elaine did. I'm assuming that flight crews have some emergency medical training, but not sure how extensive this is? If you have a medical condition that may require Medivac on short notice, you may want to have a look at the plans offered by MedJet Assist.

The usual procedure is that the flight crew asks if there are any physicians, nurses or other health professionals currently on the flight. If one of these people volunteers, they assess the patient and make a recommendation to the flight crew. I have heard of flights being diverted for on-board medical emergencies, but never witnessed this personally (THANK GOD!). The most I've seen is that an EMT team escorts the patient off the plane immediately after it arrives at its scheduled destination. Not sure either what exactly are the legal responsibilities of the pilot to act on the medical professionals' recommendations. For life-and-death cardiovascular emergencies that require immediate intervention, planes are equiped to perform modified ACLS (Advanced Cardiovascular Life Support). However, ACLS would have to be performed by qualified medical professionals who just happen to be on the plane, as flight crews are not trained in this discipline. The very nature of transoceanic air travel means that there is no perfect solution. The ultimate responsibility should lie with the traveler to take care of their own health and to make informed decisions on their ability to travel.

Flights take planned routes to stay close to land for as long as they can. When I flew Chicago to London, I noticed that we went up along the coast of Canada until the tip, and kept north around Iceland etc. Depending on how far off the coast you are, they may turn around. My mother's flight from Moscow to the US had a person on it who had a medical emergency. They were over the Atlantic ocean but turned around and stopped in Scotland.

If a heart attack isn't an extreme medical emergency - then what is?

The FAA requires that all U.S. commercial airliners be equipped with emergency medical kits, including automated external defibrillators, and that all aircrew receive initial and ongoing training in their use. But I don't know what the regulations might be for non-U.S. carriers. http://rgl.faa.gov/Regulatory_and_Guidance_Library/rgAdvisoryCircular.nsf/list/AC%20121-34B/$FILE/AC121-34B.pdf

And the captain always makes the final decision as to whether or not a flight will be diverted for a medical emergency. He/she is considering the recommendations of health care professionals on board, his/her operations center, company guidelines, etc. There are significant costs and liabilities, so I'm sure it's not a decision taken lightly. The captain isn't required to divert and would do it only in an extreme circumstance...I wouldn't count on it for a heart attack.

'...I wouldn't count on it for a heart attack' I wonder what the corporate liability would be if the dude with a heart attack croaked?

I've been on two flights where the crew has asked for assistance from medical personnel. In the first case, a person in business class collapsed in the front of the plane. As it was only about 10 days after 9/11, the loud noise from the front of the plane caused quite a commotion and many passengers who were already on edge jumped up from their seats. The crew ran to the front of the plane and then made an announcement requesting any medical personnel on board to ring their call button. There were two doctors in the front of the plane. I could not see what medical treatment was provided. When we landed at Dulles (the destination), there was an ambulance on the tarmac and paramedics boarded to take the passenger off the plane on a stretcher. In the second case, a small child had an allergic reaction to something she ate. She was seated in the row behind me so I saw the whole event. We were over the Atlantic en route to London. Once again the crew asked for medical personnel and there was a pediatrician on the plane. The crew had a bag with some medications, but stated that doctor needed to look to see if there was anything appropriate. The doctor looked through the bag and the child was given benadryl (although I am not sure if the benadryl was from the airline's medical bag or from the passenger's own supply). This was effective and the swelling in the child's face went down. We landed in London as normal.

'Flights take planned routes to stay close to land for as long as they can.' Nope. Routes are based on minimal fuel consumption: prevailing winds, jet stream, etc. North America to Europe is often, but not always as described. The return route is generally further south and at a lower altitude. Fuel on board is what's need to reach the destination, shoot an approach, and make a run to the alternate, plus an additional allowance. Turning around into prevailing winds might be impossible.

A captain may or may not deem it a medical emergency for a single heart attack victim...there are many variables he/she would need to consider, but you could probably count on a medical emergency if 20 passengers suddenly developed flu-like symptoms and were turning blue. Ed's right...it's all about efficiency. But there are ratings for aircraft (esp. 2 engine) that govern distance/time from a diversion airfield that play into it, too.

'Ratings' apply to drivers, regulations apply to use of the machines. The fuel regs are not specific to two engines, they break down into single and multi-engine. Further specifics are for turbin and non-turbin, fixed and rotary wing, type of use, etc. It gets more complicated with explosive decompression possibilities, apu use, and a zillion other things. Time and distance are not factors; it's all stated essentially as 'fuel required to'. It's all covered in FAR Part 121 if anybody except an airplane driver cares to memorize it.