Medical diversion out of the USA

[timster]

I'm going to have a look at that one too

The one I was talking about is titled: "is there a doctor on the plane"

OK. I'm now confused.

Here is "In-flight medical emergencies (IFMEs): epidemiology and management" by Qantas' medical director, to the ICN (the details you originally mentioned) in 2014:
ICN Victoria: Hosegood on In-Flight Medical Emergencies

Here is "Is there a doctor on the plane", on the same site, by an MD from UCSF.
Is There A Doctor On The Plane? Dealing With In-Flight Medical Emerge…
However that is presumably a common title (that could well have been used by Qantas elsewhere too). Indeed the ABC ran a story with a similar title, previously talked about on AFF:
http://www.australianfrequentflyer....discussion/is-there-a-doctor-plane-51901.html

All interesting reading.

 

[ICUDr]

This is great stuff!
There isn't much information available on this topic.

I'm on nights this weekend and will go through all of them (again) to keep me awake.

Cheers
Kenny

 

[Quickstatus]

Well QF93 today was about 2 hours into flight and diverted back to SYD to offload an ill elderly pax.

It would be interesting to get an idea of point of time in flight when cabin crew is notified of problem. Seems to me it (recently at least) occurs within 2-3 hours of departure. Cynically this suggests a predeparture illness.

 

[Mrmaxwell]

Well QF93 today was about 2 hours into flight and diverted back to SYD to offload an ill elderly pax.

It would be interesting to get an idea of point of time in flight when cabin crew is notified of problem. Seems to me it (recently at least) occurs within 2-3 hours of departure. Cynically this suggests a predeparture illness.

Certainly many times a PAX may not feel well but they will almost never decide not to board a flight in the hope they will just get over it.

Once the flight commences and they reach altitude within the pressurised cabin they start to deteriorate and wish they had never boarded in the first place. I am assuming all the loops QF93 did before landing were to burn fuel or wait for a slot?

 

[Quickstatus]

Certainly many times a PAX may not feel well but they will almost never decide not to board a flight in the hope they will just get over it.

Once the flight commences and they reach altitude within the pressurised cabin they start to deteriorate and wish they had never boarded in the first place. I am assuming all the loops QF93 did before landing were to burn fuel or wait for a slot?

i suspect its fuel. I think if they were Ok with landing weight they would ask for a priority clearance in to SYD due to the medical situation

I have no evidence to back it up but human nature suggests the "hope they will just get over it" is similar to the "it wont happen to me" logic pertaining to travel insurance

 

[ICUDr]

Certainly many times a PAX may not feel well but they will almost never decide not to board a flight in the hope they will just get over it.

Once the flight commences and they reach altitude within the pressurised cabin they start to deteriorate and wish they had never boarded in the first place. I am assuming all the loops QF93 did before landing were to burn fuel or wait for a slot?

To prevent issues with the lower than usual Oxygen concentrations, Airplanes have to pressurise the cabins but still fail to achieve normal conditions.

The higher the altitude, the lower the atmospheric pressure and therefor the lower the concentration of Oxygen or the "thinner" the air is (for the geeks out there, its called Dalton's law on partial pressure of gases) same as when you go up to Machu Pichu or the Everest.

This doesn't affect us -the healthy ones- but does affect people with health issues. I.e hearth problems (as your heart muscles require oxygen to work and now is working with lower amounts of Oxygen) or people with lung illness (as they now "filter" lower concentrations of Oxygen to the body)

Few hours into a flight, at low oxygen levels and with predisposing medical conditions the PAX decompensate and the AF has to call for help.

 

[jb747]

To prevent issues with the lower than usual Oxygen concentrations, Airplanes have to pressurise the cabins but still fail to achieve normal conditions.

They don't fail to achieve 'normal conditions'...it isn't even attempted. The cabin will be at altitudes of between 4,000 to about 6,500 feet. The newer aircraft will have peak altitudes that are slightly lower than the older, but not dramatically so.

 

[UP4014]

Would be curious if a airline would seek compensation if they had to divert and a passenger intentionally deceived the airline about sickness

Another question is: if I bought a cheap non flexible ticket and wasn't feeling well in say LAX and went to the QF counter and self declared of sorts asking if I could go a day later as wasn't feeling up to it would they say yes. It would help me and help the airline.

The answer to the above is probably another reason why people get on anyway.

Matt

 

[ICUDr]

They don't fail to achieve 'normal conditions'...it isn't even attempted. The cabin will be at altitudes of between 4,000 to about 6,500 feet. The newer aircraft will have peak altitudes that are slightly lower than the older, but not dramatically so.

I give you that I shouldn't have said "normal conditions" but there is so many variables in this situations that is impossible to put them all here without sound too technical.

Airplanes do attempt to achieve more "physiologically tolerable" conditions for passengers. It is necessary to do so otherwise more than the usual number of passengers could get sick.

At sea level (we, who live in Australia) breathe 21% of oxygen. At 4000 feet this drops to roughly to 17% and at a 747's cruising altitude of say 8000 feet? to 13%

At cruising altitudes, with lower atmospheric pressures -and therefor lower fraction of inspirited oxygen-, breathing dryer air (water vapor pressure is another variable that affects us), this numbers could be even lower.

I was doing a helicopter retrieval trip, in a non pressurized cabin and my oxygen levels were down to 94% (normal up to 100%, normal for me 99%)

We fit and healthier, non smokers (cough, cough) people can tolerate this without issues but a PAX with certain medical contains may not.

 

[jb747]

I give you that I shouldn't have said "normal conditions" but there is so many variables in this situations that is impossible to put them all here without sound too technical.

What's wrong with technical? There's plenty of that here (on AFF), and some is even correct.

Airplanes do attempt to achieve more "physiologically tolerable" conditions for passengers. It is necessary to do so otherwise more than the usual number of passengers could get sick.

Well, if you define getting sick as dying, then I agree. The reality is that aircraft fly at levels at are totally hostile to life, and they are in those conditions for about 99% of any given flight. Outside that perspex window, the temperature is likely in the order of -50ºC, and the air pressure about 230 mb instead of the sea level 1013 mb...i.e. about 25% of the air density. And of course, the oxygen component is just about negligible. Time of useful consciousness at those altitudes is measured in seconds. At the other end of the scale, I've seen people in pressure chambers start being affected mentally at not much over 10,000 ft.

At sea level (we, who live in Australia) breathe 21% of oxygen. At 4000 feet this drops to roughly to 17% and at a 747's cruising altitude of say 8000 feet? to 13%

The cabin altitudes are as I quoted. 8,000 ft is an extremely high cabin. Having said that, I've seen one at almost 30,000 ft, but that was an unusual day.

Cabin altitudes in airliners are limited by structural issues. Differential pressure in the cruise is in the 8.5-9psi range. As a contrast, the military, in particular fighter aircraft, may operate with very low differential, only pressurising to about half the actual height, so taking the mask off (Tom Cruise style) might be a very bad idea.

 

[NZ_Flyer]

You'd need to differentiate between those passengers who deteriorated from an illness that existed pre-flight vs those who suffered an acute medical emergency (heart attack, anaphylaxis, seizure, stroke etc) that just happened to occur earlier in the flight than later. Also - as someone has pointed out syncope's can be quite common (fainting) and are generally benign but look quite serious when they occur.

And then even within the group of patients who were unwell pre-flight and deteriorated you'd need to have more details as to what was wrong with them and the patients level of self-care. For example, some people with a bad case of gastro or some type of influenza like illness will just deal with it and have a horrible flight going to the toilet constantly. While others will ask for assistance from the crew which then requires "medical emergency" protocols to be started despite the fact they may just need rehydration. And then they may end up having a severe infection which does require diversion.

Basically without more details as to what the problem was in each individual case it's hard to say whether people got on the plane knowing they shouldn't fly, or legitimately thought they would be fine.

 

[marki]

Couple of flights ago bloke took ill with chest pain and Shortness of breath. He was a male 27 yrs old.
Required diversion into Honolulu airport. Offloading. Then flying into Nadi for refuelling and crew change.
Turned out this bloke had pulmonary Embolism and was discharged the next day either he had no insurance or was given appropriate medication and managing on pure room air.

 

[Quickstatus]

At sea level (we, who live in Australia) breathe 21% of oxygen. At 4000 feet this drops to roughly to 17% and at a 747's cruising altitude of say 8000 feet? to 13%

Assuming oxygen is 21% of all gases at every point in the earths atmosphere, the % you quoted are the equivalent % at sea level pressures???

here is a ready reckoner for effects of altitude on physiological oxygel levels

http://www.altitude.org/oxygen_levels.php

 

[Quickstatus]

Turned out this bloke had pulmonary Embolism and was discharged the next day either he had no insurance or was given appropriate medication and managing on pure room air.

As pure as the partially recirculated air on an aircraft

 

[timster]

Assuming oxygen is 21% of all gases at every point in the earths atmosphere, the % you quoted are the equivalent % at sea level pressures???

here is a ready reckoner for effects of altitude on physiological oxygel levels

Altitude.org | Oxygen Levels

Slides 9-13 of the QF medical director's presentation here has a nice summary of the relevant physics and physiology:
ICN Victoria: Hosegood on In-Flight Medical Emergencies

Bottom line: a significant proportion of otherwise-healthy 50+ year old pax will be significantly O2-desaturated at typical cabin pressures.

 

[Quickstatus]

Slides 9-13 of the QF medical director's presentation here has a nice summary of the relevant physics and physiology:
ICN Victoria: Hosegood on In-Flight Medical Emergencies

Bottom line: a significant proportion of otherwise-healthy 50+ year old pax will be significantly O2-desaturated at typical cabin pressures.

yes everyone will be "desaturating" at typical cabin pressures and also if skiing in Colorado, khow that translates into significant medical problems is the question.

I was baetween 9000-12500 feet for about 4 weeks in December January. headaches mainly, and shortness of breath. (Translating to between 89% and 76% oxygen saturation) normal at sea level 97%. Of course this is a simplistic as acclimitisation would have occured to some extent

 

[marki]

As pure as the partially recirculated air on an aircraft

I thought that was purer ?

Oh and ICU doc 21% Oxygen. In all areas of the Atmosphere !!! But not the last ( Exosphere) that's just space and international space station territory.

Usually DRY air at altitude.

Oh Mass Oxygen Flow is not the same as Volume flow of oxygen at Altitude. The difference increases with altitude. Follows Boyle's Law. ( I.e. Pressure and volume are inversely proportional)

 

[marki]

yes everyone will be "desaturating" at typical cabin pressures and also if skiing in Colorado, khow that translates into significant medical problems is the question.

I was baetween 9000-12500 feet for about 4 weeks in December January. headaches mainly, and shortness of breath. (Translating to between 89% and 76% oxygen saturation) normal at sea level 97%. Of course this is a simplistic as acclimitisation would have occured to some extent

If your a smoker your already at a disadvantage being 94% at sea-level.