Flight Crews: Managing an Inflight Medical Emergency

June 19, 2017

Are you prepared to manage an inflight medical emergency? If a crewmember or passenger experiences a critical medical incident on a flight, would you know how to handle the event to achieve the best possible outcome?

HAVE A PLAN

“Just like you have a checklist to respond to an inflight mechanical problem, business aircraft operators need to have a standard operating procedure for an inflight [medical] emergency so it doesn’t become an imminent crisis,” says Dr. Clayton Cowl, chair of the Division of Preventive, Occupational and Aerospace Medicine at Mayo Clinic, which provides healthcare solutions for pilots.

When developing a plan for managing an inflight medical emergency, keep in mind that some business aircraft operators don’t have the resources or medical expertise in house. Since many business aircraft operations are conducted without cabin crew and some are flown single-pilot, consider developing relationships with vendors to assist in a medical emergency so pilots can focus on flying the aircraft.

“It’s not like a commercial airline flight, where you often have multiple cabin crewmembers to assist or may have a nurse or a doctor among the passengers,” said Lesley Revuelto, a flight attendant with nearly 30 years of experience in Part 91, 121 and 135 operations who is now the inflight manager for a Texas-based Part 91 flight department. “That’s where a vendor comes in.”

Just like you have a checklist to respond to an inflight mechanical problem, business aircraft operators need to have a standard operating procedure for an inflight [medical] emergency.

Dr. Paulo Alves of MedAire added, “Having the right resources and help on hand who understand the medical systems available around your destination, or at a diversion airport, and can help you coordinate with local resources is critical during an emergency.”

Vendors that specialize in aviation medical emergencies provide not only inflight medical assistance by ground-based emergency room physicians, but have processes and contacts to coordinate ground transfers and recommendations on which local hospitals to utilize.

Daily preparation is important, too. Revuelto recommends a briefing between pilots and cabin crew (if onboard) before each flight to discuss the options in the event of an emergency. This can be especially helpful for Part 91 operators that often fly the same passengers and have established relationships with them.

“For example, if you know you have a diabetic passenger, or a passenger with severe food allergies on board, you can be prepared,” said Revuelto.

TRAIN FOR AN EMERGENCY

Experts also encourage business aircraft operators to provide pilots, flight attendants and frequent passengers (for those operators not flying with a cabin crewmember) with comprehensive training in managing inflight emergencies.

“An integrated solution is needed to address the possibility of an inflight medical event,” said Dr. Alves, who recommends real-world, scenario-based flight crew training to prepare for the most frequent inflight medical emergencies, as well as the less frequent but most critical inflight situations that could occur, like a cardiac event.

Training should be specific to the type of operation – whether single pilot, two pilots or two pilots and flight attendants – and to the aircraft, including instructions on using onboard medical equipment, while observing best practices for critical phases of flight.

“Often crewmembers aren’t familiar with the medical equipment on the aircraft or with the aircraft’s configuration,” said Karl Kamps, director of Aircare Access and lead inflight medical instructor at Aircare International. “For example, the oxygen port might be behind the divan. It’s important to pull out the medical equipment routinely and become familiar with it.”

“Also, if a crewmember becomes ill, do the passengers know what to do?” said Kamps, who suggests identifying a lead passenger on each flight and providing that passenger with basic instructions on the location and use of onboard medical equipment.

Revuelto’s department provides its flight attendants with formal, third-party training every year, but also conducts training as a department, where pilots and flight attendants learn to act as a team.

“The first time we ran through scenarios as a department, we noticed a lot of inconsistencies in checklists,” said Revuelto. “You see the disconnects when you run procedures and do drills, and then you can close the gaps before an emergency occurs.”

Kamps recommends including your medical vendor in company training sessions. “We encourage flight departments to arrange a training call during in-house training or meetings. Most vendors will provide scenarios for these training calls and can even provide a demo kit. The feedback from these calls is important for both the flight department and the vendor.”

STAY HEALTHY

Finally, flight crews can help prevent an inflight medical emergency by simply minimizing the risk. Pilots often worry about a physical exam revealing a disqualifying condition. But it’s far better to identify and treat a condition before it can become an inflight emergency.

“Pilots have a culture of not telling anyone or seeing anyone about a health concern because they don’t want to jeopardize their medical certificate,” said Dr. Cowl. “When you talk about safety, you have to look at the people who are the most important part of the aircraft – meaning the mental and physical health of the pilots.”

Training should be specific to the type of operation – whether single pilot, two pilots or two pilots and flight attendants – and to the aircraft, including instructions on using onboard medical equipment.

Dr. Cowl recommends that pilots undergo a preventive medical exam, together with their typical flight physical, in a trusting, safe environment for the pilot.

Dr. Alves also focuses on crewmember health and fitness and recommends clients contact MedAire experts prior to flights to talk through the I’M SAFE (Illness, Medication, Stress, Alcohol, Fatigue, Emotion) mnemonic to determine if they’re fit for flight.

The bottom line: Have a robust plan, conduct thorough training and stay fit and healthy to minimize the potential for an inflight medical emergency.