What Happens If You Get Ill on a Flight?

In most developed countries, we take health care for granted. Not feeling well? You go to see your local doctor. If it's an emergency, you call an ambulance and within minutes you'll have professional help at your door. If it's really serious, they can whisk you off to the nearest hospital.

But what if you start to feel unwell on a flight? When you're in a pressurized metal tube seven miles above the ocean in the middle of the night. The only source of help seems to be your cabin crew, but they just serve food and drinks, right? All of a sudden, that ambulance on the end of a 911 call seems a millions miles away.

However, there's help at hand. And it's closer and more advanced than you may think.

First Aid

Your first port of call if you start feel even the slightest bit unwell is your cabin crew. A major part of their training is in first aid, and crew are tested and retrained on this every year. Even if it's something as simple as feeling sick, they crew know how to diagnose and treat certain ailments. If you're feeling a touch light-headed, they can administer oxygen to help you feel better. For a headache, they can access the aircraft first aid kit and give you medicine to help ease your pains.

However, if it's a bit more serious than this, your crew's training extends beyond giving out ibuprofen. Most, if not all, commercial aircraft will carry an Automated External Defibrillator, or an AED. If a passenger is showing signs of a heart attack, cabin crew are trained to use the AED. Stats show that if a defibrillator is used within three to five minutes of a cardiac arrest, the survival rate jumps from 6% to 74%.

Some Crew Are Qualified Nurses

You may also be surprised at the qualifications of some of your cabin crew. Back in the heyday of aviation, a requirement of being a 'flight attendant' was to be a qualified nurse. Even in the 1930s, airlines knew that once up in the air, passengers would often be a long time from medical assistance. By having a medically trained crew member on board, it provided a level of care that would otherwise be unavailable. Today, airlines still look positively on crew who have come from a medical background. You never know when the training may come in handy.

This is all well and good if you've got a minor problem. But what if it's something a bit more serious? When it seems like all hope is lost, fear not, help is at hand. Enter, Medlink.

Medlink — Ground-Based Flying Doctors

Banner University Medical Center in Tuscon, Arizona, is not your average hospital. At the center of the emergency room, a level 1 trauma center, sits the Medlink operations hub. Here, specially trained Communications Special Executives (CSEs) take 400 to 500 calls a day from aircraft around the world. From this high-tech center, specialist doctors are able to take passenger information passed by the crew and suggest treatment depending on the facilities available on board. So how does the process work?

You're 38,000 feet over the Atlantic Ocean trying to get some sleep on your overnight flight from Orlando to London. You're were catching some good Z's until you're woken up by the guy next to you grabbing at your arm. Your initial annoyance turns to concern as you open your eyes and see that he is not well. Looking around you, everyone else is asleep. There are no cabin crew in sight. You're stuck by the window so the only thing you can do is press your call bell. Repeatedly.

Within a few seconds, a crew member is with you and assisting the passenger. After making a brief assessment, she summons the help of other crew who then asses the situation further. He's experiencing chest pains, shortness of breath and dizziness — all classic symptoms of a heart attack. While one crew member hurries off to fetch some portable oxygen, another grabs the nearest inter-phone to inform the pilots.

Meanwhile, in the dark of the flight deck, all is calm. Nearly halfway across the Atlantic, the flight is going according to plan. The aircraft is tracking accurately along its route, the estimated fuel on arrival is greater than planned and the 150mph tailwind is whipping the aircraft along at nearly seven miles a minute. Then, the call from the cabin comes.

"I have control of the aircraft, my comms", says one pilot, allowing the other to answer the call. As the cabin crew member relays the situation to the the pilot, they calmly write down all the information the crew have taken from the passenger. Symptoms, age, sex, medical history and seat number are all noted down to make sure that they have as much information about the situation as possible. When the call from the cabin crew has been completed, the pilots will discuss the situation and then decide to call Medlink.

Traditional communications over the Atlantic are notoriously unreliable. High frequency radio transmissions can be weak and suffer from strong interference, making clear conversation impossible at times. As a result, a better form of communication was required and this comes in the form of a satellite phone — The SatCom.

Pilots can make a call directly to Medlink's control room in Arizona using the SatCom. Here, one of the CSEs answers the call and speaks to the pilot. After taking a few details of the flight, the CSE is able to see on a screen where exactly in the world the aircraft is. They are also able to see what medical equipment is on board the aircraft. When the patient details have been relayed to Medlink, the CSE calls a doctor from the emergency room whose speciality best suits the situation.

Once the doctor is on the phone and talking to the pilot, quite often the best way to get the most accurate and up-to-date information is to speak directly to the crew dealing with the situation. But how do you connect a doctor in the USA, via a satellite, to the flight deck of an airliner and to a seat 40 rows back?

Well, aircraft manufacturers have thought of this exact problem. On modern aircraft, like the Boeing 787 Dreamliner, the pilot is able to transfer the call from the flight deck directly to the nearest cabin phone. This not only enables the cabin crew to talk directly to the doctor but also negates the need to constantly open the flight deck door — an important aspect for today's security-conscious aviation world.

The doctor is then able to get realtime information from the cabin crew and suggest a course of treatment. In addition to a basic first aid kit, most aircraft will have a more advanced medical kit. If there is a medical professional on board, Medlink may also suggest that they assist.

The video below shows how a conversation between the doctor in Arizona and the cabin crew would go. It starts from when the call has been transferred from the pilot to the cabin inter-phone.

The Medlink doctors will provide their expert medical recommendations for the pilots' consideration. Should the crew decide to divert the aircraft to a nearby airport based on Medlink's advice, the team in Arizona will assist them to determine the most medically appropriate diversion location based on the passenger's needs. However, what may be best for the sick passenger may not be best for the flight.

Always Have a Plan

While medical situations like this don't happen on every flight and at every stage of a flight, pilots will always have a 'what if?' plan. "What if we lose cabin pressurization? What if we have a medical emergency?" A non-normal situation should not catch a good crew on the hop.

Before every flight, the pilots check not only the weather at their destination, but also at various airports along the way. This increases the crew's situational awareness for the flight and gives them a good idea of where they might be able to divert to should the need arise. Once airborne and underway, the crew constantly update their 'what if' plan. Maybe an airport that was forecast good weather now has fog. Maybe the route has changed slightly putting them farther away from one airport and closer to another. No two flights are ever the same, and it's for this reason that pilots never stop thinking during a flight.

By having a current 'what if' plan, when the call comes from the cabin alerting the pilots to the medical situation, they will already know which nearby airfields are usable. The weather will have been checked and deemed suitable, and the airport passenger handling facilities will have been assessed.

A landing distance calculation will also have been performed. This isn't such a problem on short-haul aircraft but long-haul aircraft can use around 80 tons of fuel during a flight. This can make a big difference to the weight of the aircraft when landing earlier than planned, so a calculation is made to ensure the proposed runway is long enough.

The decision to divert the aircraft and where to ultimately lies with the captain. In this example, Medlink may suggest diverting to Gander in eastern Canada. This may be because they know it has a good hospital to deal with patients suffering with cardiac problems. However, the crew may have deemed Gander unsuitable due to weather. Trying to land at an unsuitable airport to save one passenger's life may put the other 200 lives at risk.

The pilots may decide that, even though it is farther away, diverting to Keflavik, Iceland would be a better decision. The sick passenger will receive the care that they require while the other 200 passengers will also be well looked after.

Once this decision has been made by the flight crew, Medlink's assistance doesn't end here. After ending the call with the pilots, the CSE is able to access a database of more than 5,000 airports served by its clients. From this, they are able to coordinate with airport operations and local emergency services to ensure that the best medical care is waiting when the aircraft lands.

Back on the Flight Deck

Meanwhile, the diversion is underway. The pilots have contacted Gander Oceanic Control and asked for a clearance to divert to Keflavik. They descend the aircraft below the North Atlantic Track system and make a left turn to head straight for Iceland. In the flight management computer, the arrival and approach is changed from those at London Gatwick to the ones in use at Keflavik. The approach charts, often in electronic form, are selected for Keflavik. The crew independently check that what's in the computer is what's depicted on the charts.

Based on previous calculations, the aircraft may still be too heavy to land with the runway conditions in Keflavik. To rapidly reduce the aircraft weight, fuel will need to be jettisoned. In other words, released into the air. One pilot selects the fuel jettison checklist while the other meticulously flies the aircraft.

Only when all of the flying tasks have been completed and the diversion is underway will one of the pilots make an announcement to the passengers explaining what's going on. If you've been following the moving map display in another part of the aircraft, this may be the first time you know what's going on. This is normal and may take some time. The safe flightpath of the aircraft always takes priority over talking to people.

Once safely on the ground and the sick passenger has been transferred to the medical team on the ground can Medlink continue to provide assistance for the patients care and return home.

You're in Safe Hands

So, next time you're on an aircraft, looking out of the window and miles of nothing, remember that help is always on hand. Your cabin crew are well trained in dealing with minor medical problems and Medlink are always just a phone call away. Your pilots are constantly updating their 'what if' plan, so should the worst happen, you and all around you are in safe hands.

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