Scared of the "E" word

[NEDude]

Last night I heard something that made me cringe, and wonder why some pilots are so scared of the "E" word - Emergency. Last night I heard a flight (I will not state the airline so I cannot be accused of xxxxx airline bashing) request immediate direct to a nearby airport due to a "medical issue". The pilot emphasized that they were not declaring an emergency, but needed "direct and immediate routing" and requested that "paramedics or medical personnel" be on hand to meet the flight.

So you are changing the destination, requesting "direct and immediate routing" and asking for emergency medical personnel to meet the aircraft. But you aren't declariing an emergency? Why?

Guess what, the paperwork isn't that bad. At most airlines it is simply an irregularity report. I had an inflight emergency just over a year ago (thankfully all ended well) and other than five minutes of filling out my irregularity report, and telling the CFR folks my name and address, there was nothing more to it.

 

[dash8driver]

well then you gotta go and add up all the fuel you have on the plane and try to remember how many souls are on board.

if you really want to know why using the E word is for lesser men, PM avbug.




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[stage]

In most cases, a passenger being sick isnt an emergency. Sick crewmember? Yes. Passenger? No.

It might be wise to divert so the guy doesnt die on you, but the sick guy doesnt jeopardize the safe operation of your aircraft. Sounds kinda cold, doesnt it?

 

[D.sanchez]

Stage--- How does declaring an emergency jeopardize by itself the safe operation of the aircraft???

 

[dollacrackho]

yeah people are way too uptight about declaring emergencies. i almost declared one last week cause i sharted.

 

[wmuflyguy]

Sick passenger = Medical emergency (you'll get priority handling and the such)

 

[stage]

Stage--- How does declaring an emergency jeopardize by itself the safe operation of the aircraft???

No...the situation (i.e. sick passenger) doesnt jeopardize the safe operation of the aircraft. Therefore, the situation isnt serious enough to declare an emergency.

 

[stage]

yeah people are way too uptight about declaring emergencies. i almost declared one last week cause i sharted.

I might declare for that too....depending on how violently explosive the shart was.

 

[NEDude]

In most cases, a passenger being sick isnt an emergency. Sick crewmember? Yes. Passenger? No.

It might be wise to divert so the guy doesnt die on you, but the sick guy doesnt jeopardize the safe operation of your aircraft. Sounds kinda cold, doesnt it?

This wasn't simply a case of simply changing a destination. They were requesting immediate and direct, and asking for emergency medical personnel. There was a definate sense of urgency in his voice as well.

The simple fact is, even though they insisted very clearly that they weren't decalaring an emergency, ATC obviously treated it as such. Requesting emergency medical personnel is going to require paperwork. In other words, even though they insisted they didn't want to declare an emergency, they were treated as such, and the end result - as far as paperwork, will most likely be the same. It really seemed as if the crew was trying to make it clear they were declaring an emergency, but were afraid to say the "E" word for fear of paperwork. I could be wrong on what was going on, but it seemed very clear to the two of us in our aircraft as to what was going on.

 

[upndsky]

A little known fact, but ATC can declare an emergency for you, even though you may not even know it. If I remember right, there are four levels of emergency, ranging from an unsafe gear indication to a full-blown Sioux City-type event. The level will dictacte the type of handling and emergency response you'll get. The pilot in this case may not have declared an emergency, but he was probably treated as one by ATC.

Also, declaring an emergency does not always mean you have to fill out paperwork. I've declared 4 emergencies in my flying career. Three were in piston aircraft (partial engine failure in a C-182, unsafe gear in a Baron and a near-complete radio failure in a PA32 in IFR). The other was in an EMB145, when the anti-ice system failed in icing conditions as we were approaching the airport. The captain declared an emergency, we got immediately cleared to a lower altitude in VMC and when it looked like we'd stay out of icing, the captain cancelled the emergency. In none of these cases did the FAA ask us to fill out a report. I'd call them once I was on the ground as a courtesy and all they'd say was that they were glad we were alright and that was it. With the icing incident, we did fill out an ASAP report, but that was voluntary.

Don't be afraid to declare. I'd rather explain why I did than why I didn't.

 

[Ben Dover]

we did fill out an ASAP report, but that was voluntary.

Why did you fill out an ASAP report? Not being critical, just trying to follow the thought process.

 

[Workin'Stiff]

Don't be afraid to declare. I'd rather explain why I did than why I didn't.

Well said.

 

[upndsky]

Why did you fill out an ASAP report? Not being critical, just trying to follow the thought process.

It was partly a CYA, in case someone did come back later to ask questions. By declaring, we did deviate from normal procedures. Now there's a record saying why.

Primarily, though, it's an excellent way to keep the airline in the loop about potential problems with an aircraft or operation. If they suddenly get a bunch of ASAPs about the anti-ice system failing, then this is something they might want to investigate further. It's just another communications tool to let the desk jockeys know what's going on out on the line. Fortunately, at XJT they look at these ASAP reports seriously and the company continuously revised policy and procedure based on information they get from these ASAP reports. In my book, ASAP is a great program.

 

[upndsky]

No...the situation (i.e. sick passenger) doesnt jeopardize the safe operation of the aircraft. Therefore, the situation isnt serious enough to declare an emergency.

Well, I hope you're not the captain when I or one of my loved ones becomes sick on one of your aircraft. What are you going to do? Keep flying for another 2 hours because a potential heart attack victim isn't jeopardizing the safe operation of the aircraft?

Anytime medical attention is warranted, time is of the essence. For instance, a stroke caused by a clot can be completely reversible if the patient is administred TPA (an clot-busting drug) within an hour of the incident. After that, the damage by the stroke may be irreversible.

Hidding behind the cockpit door, you have no way to assess a passenger's medical condition. You don't know if he's having indigestion or a heart attack (they can present with similar symptoms), or if he's diabetic or stroking out. BTW, I spent 6 years as a paramedic.

Get the plane on the ground and let EMS determine if it was an emergency or not. Luckily, ATC controllers know that. But apparently you don't.

 

[Ganja60Heavy]

Which is worse, a heart attack in the back, or a shart attack up front?

 

[wmuflyguy]

Get as much info from the FA's as to what the person is experiencing, Declare a Medical Emergency, relay it to ATC and your company, divert(if conditions warrant) to nearest suitable airport that has CFR on field (pretty much any airport for a 121 carrier).

 

[stage]

Well, I hope you're not the captain when I or one of my loved ones becomes sick on one of your aircraft. What are you going to do? Keep flying for another 2 hours because a potential heart attack victim isn't jeopardizing the safe operation of the aircraft?

Anytime medical attention is warranted, time is of the essence. For instance, a stroke caused by a clot can be completely reversible if the patient is administred TPA (an clot-busting drug) within an hour of the incident. After that, the damage by the stroke may be irreversible.

Hidding behind the cockpit door, you have no way to assess a passenger's medical condition. You don't know if he's having indigestion or a heart attack (they can present with similar symptoms), or if he's diabetic or stroking out. BTW, I spent 6 years as a paramedic.

Get the plane on the ground and let EMS determine if it was an emergency or not. Luckily, ATC controllers know that. But apparently you don't.

I am not saying that I would ignore the situation and continue on the flight as if nothing is happening. Exactly opposite of what I would do.

I think the crew in the example did the right thing by having emergency personnel stand by and requesting immediate and direct routing, but they were also right in not declaring an emergency since the aircraft and crew werent degraded in some form or fashion.

But if you want to declare an emergency, that's fine. No one would fault you for it. I just think it's unnecessary if the crew and aircraft are fine.

 

[Quiet Flight]

Which is worse, a heart attack in the back, or a shart attack up front?

A shart up front. Because you can give a heart attack victim a couple of aspirin and it might prolong his life. But there is nothing you can do for a shart at cruise!!

 

[NEDude]

No...the situation (i.e. sick passenger) doesnt jeopardize the safe operation of the aircraft. Therefore, the situation isnt serious enough to declare an emergency.

Declaring an emergency does not mean the aircraft is operating in an unsafe manner! All it means is that ATC gives you priority to do what you need to do to meet the demands of the situation. It also means that on the ground resources (such as CFR, law enforcement, or medical personnel) are now at your disposal.

Where on earth do you come up with the connection that a declared emergency = unsafe operation?! In fact nothing could be further from the truth.

but they were also right in not declaring an emergency since the aircraft and crew werent degraded in some form or fashion.

The pilot/controller glossary defines emergency as: "A distress or an urgency situation" (BTW that is the entire definition - I omit nothing).

The glossary defines distress as: "A condition of being threatened by serious and/or imminent danger and of requiring immediate assistance."

Urgency is defined as: "A condition of being concerned about safety and of requiring timely but not immediate assistance: a potential distress condition (see ICAO term Urgency)
Urgency (ICAO)- A condition concerning the safety of an aircraft or other vehicle, or of person on board or in sight, but does not require immediate assistance"

Under no definition of emergency or the related terms does it state that the aircraft has to be in danger for an emergency to be declared. A medical involving a passenger is a full blown emergency and should be declared. You are saving nothing by being not using the "E" word.

 

[Flyerjosh]

One other thought... declaring an emergency allows you to bypass certain restrictions that otherwise exist if you don't (for example 250<10000'). IMHO, anytime that you have questions about the safe completion of the flight for the aircraft OR any of the passengers onboard said aircraft, you have an EMERGENCY.

You can better f'ing believe that if my passenger has a heart attack or other medical issue, we're declaring an emergency and coming down in a hurry. I owe the best I can do to my passengers (especially the ones that authorize my paychecks and salary increases).

I've declared 5 times, and never had to do more than any paperwork I would have filled out anyway (company incident forms, NASA/ASAP, or just a couple of questions from the tower).

 

[Ganja60Heavy]

Shart!

I'd be afraid to declare....the controller, and everyone on the freak, would know that I had a shart in my pants.

In such case, "roll the equipment" means a portable laundromat with a heavy-duty chip-cycle to handle the load.....right there at taxiway B4....

Personally, I'd lie and say it was a heart patient in the back, or an engine oil problem, or something else......less severe, obviously...

 

[Nindiri]

Stage is correct.

A passenger medical emergency does not permit you to violate FARs. It may sound cold, but having a pax with a heartattack does not allow you to bust minimums on the approach, for example. You can get priority like the above mentioned crew did, but you still can't deviate from the rules.

 

[stage]

For you 121 guys, I invite you to take a look at your ops manuals to see if there is any guidance on this subject. Ultimately, it is up to the aircrew to make the final decision on how to handle each situation.

There is a gray area (no fine line) when it comes to dealing with passenger issues. Do you declare for a heart attack? Seizure? Severe motion sickness? Headaches? Hiccups? Bad hair day? Where do you all draw the line?

I save the "E-word" for situations that could cause the plane to crash (system degradation, smoke, fire, engine failure, crewmember incapacitation, left wing falling off, etc)

 

[Ganja60Heavy]

There is a brown area (no fine line) when it comes to dealing with sharts

Dang right! no fine line....a wide friggin' line! From leghole-to-leghole!

 

[Flyerjosh]

Stage is correct.

A passenger medical emergency does not permit you to violate FARs. It may sound cold, but having a pax with a heartattack does not allow you to bust minimums on the approach, for example. You can get priority like the above mentioned crew did, but you still can't deviate from the rules.

I disagree. The AIM defines Emergency as "a distress or an urgency condition." A medical emergency definately is a condition that requires urgent action.

Further more, 91.3 states that during an inflight emergency requiring immediate action, the PIC may deviate to the extent required to meet that emergency.

There is a difference between prudent and reckless. Violating an MDA probably isn't prudent in the case of a medical emergency. However, violating the 250 below 10000 rule to arrive in a more expedient manner IMO is certainly justified (and I have done as such in a medical emergency). Likewise we opted to taxi clear and meet CFR crews right off the runway, in order to provide prompt assistance.

Like I said before, I have declared several emergencies, and exercised my rights as PIC to deviate from FARs, and never had to do any more than fill out in-house incident reports. In fact, one of those reports resulted in a letter of commendation from the FSDO/ASAP evaluation team.

Just realize that if you do decide to deviate, you need to be able to explain and justify your actions.

 

[Flyerjosh]

There is a gray area (no fine line) when it comes to dealing with passenger issues. Do you declare for a heart attack? Seizure? Severe motion sickness? Headaches? Hiccups? Bad hair day? Where do you all draw the line?

You're correct here and each crew needs to assess the situation with a bit of rational judgement. Fortunately for me, our company requires that at least one member of each crew (either a pilot or FA/CSA) be EMT certified.

As a general rule, I won't declare a medical emergency unless life or limb is at risk of loss, or the emergency has the potential to negatively impact the life or limb of any other crewmember or passenger.

 

[NEDude]

I save the "E-word" for situations that could cause the plane to crash (system degradation, smoke, fire, engine failure, crewmember incapacitation, left wing falling off, etc)

Again, what is it you are saving? Do you have a limited supply of "emergencies"?! Why save it? Look at what I posted from the AIM. Very clearly a passenger becoming ill and requiring medical attention is an emergency. I really have a hard time comprehending what you think you are saving by not declaring an emergency.

You declare an emergency, get priority handling with no questions asked, get the passenger on the ground and spend a few minutes filling out some paperwork.

You don't declare an emergency, waste time explaining to ATC why you need priority handling, maybe get the airplane on the ground quickly and at best spend a few minutes filling out some paperwork. At worst you'll have to explain why you didn't declare an emergency and endangered one of your passengers. Just because you declare an emergency doesn't mean you are required to operate the aircraft in an unsafe manner.

I guess I am thick headed here. I just can't understand why you would save "emergency" for only a handful of situations when it very clear it is to be used so many other situations - including a passenger medical issue. What is it you think you are saving by not declaring?

I guess this is why I posted this thread, I really want to understand this mindset.

 

[Nindiri]

I agree with you in general about not being afraid to declare an emergency, but in the case of a passenger medical emergency the correct procedure is to declare lifeguard status and request priority handling.

 

[stage]

I guess you have to draw the line somewhere. I wont declare for a passenger hangnail, even though I have an unlimited supply.

Flyerjosh quoted the AIM and also part 91, but I would limit the term "medical emergency" to a medical situation involving the crew. If a flight attendant is sick, then a plane full of healthy people is potentially in danger in the event of another emergency (evacuation, rapid D, etc). One passenger getting sick is a situation that requires immediate attention, but doesnt put the entire aircraft in danger (unless the dude has SARS or ebola or something). You handle it appropriately, and you will be getting on the ground as soon as practicable, but you dont have to declare.

 

[Quillpig]

For you 121 guys, I invite you to take a look at your ops manuals to see if there is any guidance on this subject. Ultimately, it is up to the aircrew to make the final decision on how to handle each situation.

Not a bad idea. Here's what my airline thinks about it.

First of all, the sections PASSENGER ILLNESS, INJURY IN-FLIGHT and DEATH OF A PASSENGER OR CREWMEMBER both occur in the EMERGENCY section of our GOM. Further, and I quote, "A passenger becoming unconsious or seriously ill is an emergency situation and usually warrants an unscheduled landing, unless doing so would otherwise comprimise the safety of flight."

If I'm in the back of your airplane having a heart attack, I hope you'd be willing to fly as fast as safely possible to get me to medical treatment. Because that's what I'd do for you.

QP