Inflight Medical Emergency

[Farma]

I’m curious to know what the situation is if a passenger falls sick during a flight and the aircraft is diverted to make an emergency landing.

Does the airline charge the sick passenger for the costs incurred from the emergency landing or is it classed as part of airline operating costs?

The reason I ask is I’ve just been on a flight from Bangkok which was diverted an hour out.

A medical emergency landing was made. The aircraft had to dump most of its fuel to lighten up for landing. The other fees would have included airport landing charges and the costs to refuel the plane. This could easily add up to a very expensive bill.

[solent01]

Difficult question to answer as many country's have different laws regarding this, but be preparred for the harsh reality that it could well end up being the person having the emergency, I will have to hit the books again, but I'm sure all ICAO compliant airlines have to cover against this through their insurance, smaller airlines (third world, who are not members of ICAO), may not cover this through insurance, so it falls on you to check it out before you fly...

Good question by the way.

I will post back the ICAO standards for you.

[flightcrew1]

Good question...

In my nearly 20 plus years of flying I've had countless emergencies both in the air and on the ground which caused the aircraft to be either delayed or diverted to another airport. I've asked this question a few times and have been told that it is incurred as costs and the airline insurance carrier picks up the cost.

Though I would not be at all surprised if this has changed as we now charge for everything and getting worse all the time!

[Farma]

Thanks for the replies. Being a regular traveller for more years than I care to admit it was the first time I’ve been on a flight where this occurred.

After watching fuel dumping from the wings for nearly 30 minutes it got me thinking about who pays for all this. I couldn’t recall seeing it covered in the travel insurance I’ve taken out in the past.

If the lady concerned last night reads this, I wish you a full and speedy recovery.

[geriatrickid]

I've noticed that on all of the flights I have been on where there is an "emergency", the "crises" almost always occur in the cheap seats section of the plane. People that fly in F/J and premium economy seem to take the matter of flying when unfit seriously. Thing is, the person sitting in that deep discount seat most likely doesn't have the cash to reimburse the airline, so even if the airline sent a bill, chances are the PAX would say, hey sorry no money teeheee.

[britmaveric]

Most likely the airline has insurance to cover this sort of emergency.

Now I have seen airlines go after people when the flight has been diverted because of trouble. (disrupting the flight ect)

[Tywais]

After watching fuel dumping from the wings for nearly 30 minutes it got me thinking about who pays for all this.

Would indeed be an expensive charge. 747-400 holds about 57285 gallons (depending on configuration), price per gallon for jet fuel is around $2.60 so around 4.6 million baht to top it off. And here I complain when I get my car filled up.

[cgjtt]

To my knowledge, a divert due to a medical emergency is covered by the airline.

But diverting due to a abusive pax or someone that might compromise the safety of the flight is a different ball game. That pax will probably see himself in court, if not, some kind of punitive action against him or her, my company usually went after them.

As for the medical, a lot of companies have a system where they call through radio telephone to a medical consulting company that specializes in inflight medical emergencies. When all fails, dump and land. Mind you no one chucks a whole 57285 gal out the door. What scares me the most is when the sick pax has to wait 3 hours before landing cause you're so far from a suitable landing place.

[Zpete]

I've noticed that on all of the flights I have been on where there is an "emergency", the "crises" almost always occur in the cheap seats section of the plane. People that fly in F/J and premium economy seem to take the matter of flying when unfit seriously. Thing is, the person sitting in that deep discount seat most likely doesn't have the cash to reimburse the airline, so even if the airline sent a bill, chances are the PAX would say, hey sorry no money teeheee.

What a pompous old <deleted> you are.

The average number of, so called, cheap seats on any large aircraft, far outnumbers the 1st class,(If any) or business class.

I have been flying since 1948 and only emergencies I have seen were both in business class. Heart attacks both.

No doubt bought upon the victim, himself and herself, by excessive use of the airlines' hospitality.

Most probably should never have been flying in their condition, if heart problem was know, heart attacks could strike anyone, anytime.

Thai. 747-400, 1st class..............12

.....................Bus class.............44

.....................Economy..............300 + approx.

Count taken from <www seatguru com>, put in the dots.

On the law of averages, what would one expect.

Go back to your gilded castle, get a life.

Gee, some people get my gander up.....!!!!!!!

[flightcrew1]

As much as I tend to always agree with "geriatrickid" posts I feel he was off the mark here, though I don't think he intended to come off as a snob.

Again with my 20 plus years of flying and working all cabins (First, Business, Economy) I can say yes that most of the emergencies do happen in the back of the cabin but as "Zpete" said that is because there is 300 plus passengers sitting back there. Over the years I've had heart attacks in all cabins and deaths in all cabins and I would say that on average it works about the same as far as an emergency goes.

[Ricardo]

If it was a Low Cost Carrier, would they charge the other passengers again, for their 2nd flight, or am I only being cynical ?

[stoneman]

And do you get mileage credit for the extra miles traveled as a result of the diversion caused by the medical emergency landing?

[peter991]

Inflight Medical Emergency: Who Pays?

For air travelers, the classic theater usher''s cry, "Is there a doctor in the house?", has morphed into, "Is there a doctor on the plane?" Often there is, and we tend to assume that a physician will attend to a stricken fellow passenger, with the assistance of first aid-trained flight attendants, until the plane is on the ground. We think that it's part of the Hippocratic Oath for doctors to do so. In some people's eyes, Hippocratic came too close to hypocritical on a recent flight.

According to reports in the Asian media disseminated to the travel industry worldwide by eTurboNews, an Australian doctor, sent a bill for "services rendered" to Malaysia Airlines, for attending to three sick passengers on a flight from Melbourne to Kuala Lumpur. "I left my young family to attend to three sick passengers," Dr. Matilda Metledge was quoted as saying. Her unanticipated patients were two elderly travelers and "another passenger who was causing a disturbance," according to eTNews.

John Gullotta, chairman of the Australian Medical Association (AMA) public health committee, was quoted as saying, "Doctors whose travels are ruined by fellow passengers should be compensated. I myself had three recent flights ruined because I had to treat passengers. The airlines are taking doctors for granted." The AMA has suggested that doctors who declare themselves available on call during a flight be given an upgrade or be paid for their time while on call. By offering an incentive upfront everyone else can relax. It is a bit unfair to expect doctors trying to get away on holiday to be always available and render assistance. Obviously we have to do that as part of our Hippocratic Oath and sense of well-being, but the airlines have to take a bit more responsibility."

Again according to eTN, the airline reportedly had turned down the doctor's request for an upgrade but compensated her for her trouble with some toiletries and a pair of pajamas. I have no idea whether she requested an upgrade just for herself or for her whole family or whether the carrier paid the doctor's bill.

The eTN report also quoted Lorraine Long from the Medical Error Action Group, an Australian patient-advocacy group (acronym: MESSUP), who believes that treating sick people is a doctor's professional obligation: "Shouldn't a 'thank you' be sufficient?" Long reportedly asked.

An unnamed airline industry observer was quoted on the other side of the discussion, which seems as if it could also have been said by someone from the AMA. "The doctor's obligation is to the passenger, not to the airline. If there is any bill to be paid, it should be paid by the patient, just like going to the clinic back on the ground."

Another LINK

Peter

Edit: Found some more info on the Management of inflight medical emergencies on commercial airlines

Edited April 27, 2008 by peter991

[geriatrickid]

Ut oh, I offended someone My posts are usually so long that my attempt at brevity caused distress. Scuzi, cuz on short haul flights 3hrs and less I too fly cheap seats.

I have only read the summaries of inflight emergencies for flights to and from the USA since they are tracked and made available for study. Many of the most serious situations on long haul flights are associated with two types of PAX - the elderly and those already in poor health.

My comment about the cheap seats reflects medical care and self care characteristics of the PAX in those seats. In the USA, (Canada, AUS and the UK as well) there is a direct co-relation between general health condition and those with greater disposable income. This is especially pronounced in Canada, despite the presence of a socialized medical care. Simply put, poorer people generally have poorer health and are more likely to be morbidly obese which brings on health complications. The people that occupy the "cheap seats" the U,V, W, X fares vs the Y, B M G type fares on long haul flights will most likely be those with limited budgets and less likely to maintain attention to general health. Obviously there are exceptions such as younger people. However, those young people do not usually have medical emergencies unless it falls into drug or metabolic category and even then their conditions are generally manageable.

There are indeed medical emergencies in the higher fare categories but even if one takes into account the fewer seats in F/P/C/J the incidence is still less than those observed in the lower fare seats. Again the reason is most likely attributable to the fact that these passengers are more likely to have proper medical maintenance. The health conditions likely to cause an inflight emergency will therefore be managed so as to avoid such an event.

Couple points about these medical emergencies, that may or may not surprise you;

1st thing they do on the plane after the FA assessment, is that they page for medical assistance. If you pay attention, they are now having to page 2-3X because many physicians are fed up with the hassle of responding since it ruins their trip and they do not receive any form of compensation for the services rendered. The medical consultant that is online with the aircraft will rely in good part on that physician's opinion before recommending a diversion. A physician's opinion can be the difference between continuing or diverting and this in turn acts to save the airline alot of money. A flight where a PAX is attended to by a medical practioner is less likely to be diverted than one that is not.

Heart attacks usually occur 1-2 hrs after food service, which is why the flights will be subject to diversion rather than an an IFTB. Food service on most long haul flights start 1-2 hours into the flight. If you are 4 hours into a transpacific flight it's a tough call and usually there is nowhere to divert to for awhile. Turning back doesn't make sense. If its transatlantic you either head to Gander or Shannon and make your descent fast.

Events attributed to a "heart attack" are often not coronary crises but are symptoms of another ailment and are usually not fatal.

The most recent case of a PAX that died on a US flight illustrates my point. Flight from Haiti to JFK. Morbidly obese female complains of breathing problems and is attended to by FAs and 2 physicians. Plane is about to divert to Miami but PAX dies, so plane continues on to JFK. Medical examiner rules death by natural causes attributable to deceased's heart disease. Guess what type of ticket she was flying with? I'll give you a hint - I don't think it was F or Y

BTW I rather like the sound of pompous old &lt;deleted&gt;. Thanks And I don't live in a gilded castle yet. If you bump off me dad, I might get my inheritance faster and be able to buy one in Isaan before I'm 50 or sumthin and have serious ED.

[lomatopo]

Who pays, and for what, can be really complex and will vary by carrier, circumstances, origin, destination, diversion point if any. For U.S. carriers on flights operating within the U.S., the airlines absorb the costs associated with medical diversions. In some cases, airlines can deny boarding if a passenger seems unfit to fly, or can require medical certification prior to allowing boarding. Many airlines have a Contract of Carriage, which might contain sections on medical emergencies. Civil Aviation authorities, in each country, might also have requirements for medical diversions.

farma, can you share any more details re: your recent diversion? It sounds like to departed BKK (Suvarnabhumi?) and diverted one hour out. What was the carrier? Destination? Diversion point?

I have flown a lot, ~ 2.5 million flight miles, and have never had a medical-emergency diversion. I have been on a few flights when there has been a call for a Physician, but never so bad as to have to divert.

Nowadays I assume someone with ultimate responsibility for flight operations (management, on the ground) makes the call to divert, based on input from the Captain, Flight Officers and medical personnel (both volunteer on the aircraft, and on staff for the airlines). In many cases a diversion may represent more problems (ETOPS runway, snowed in without sufficient medical treatment), than the immediate one on board.

I haven't thought about who, by class of service, might be more likely to cause a medical diversion. It seems more likely to be equally spread across the CoS's equally based on the number of pax in each cabin. Given that most aircraft have ~ 80+% of the seats in Economy, I'd expect 80% of medical emergency diversion to come from Y pax. Drilling down to socio-economic levels, income and health of the flying public seems absurd at best. Upon reflection age might be more of an indicator that ticketed cabin or fare bucket?

Edited April 28, 2008 by lomatopo

[Farma]

Lomatopo the flight was out of swampy on Gulf, diverted into Dhaka. A crew member mentioned the diversion was due to a lady 3 months pregnant suffering a miscarriage.

Another crew member was overheard saying they didn’t return to swampy as they couldn't take off again. I presume this would have been due to crew hours expiring and no replacement crew readily available. I can see where flight ops would have counted the beans to see what the cheapest option was.

Curiosity got the better of me when I started thinking of all the costs involved.