Jumpseat: Medical Emergency

As I shuffled charts and pages of the latest Jeppesen revision into various binders and folders, my copilot introduced herself. Lisa had recently returned from medical leave and was glad to be back at work. Upon reflection, perhaps the medical leave aspect was a foreshadowing of what was about to come.

Our flight planning review proceeded as normal, with nothing out of the ordinary except for a WSI weather chart depicting various blobs of green, indicating that most of the North Atlantic was forecast for turbulence. Turbulence is a common winter characteristic, caused mostly by the high winds of the jet stream dipping farther south. Undaunted, Lisa and I marched to our gate and our 777-300.

I completed a briefing with all 12 of our flight attendants in the first-class cabin, presenting the not-so-great news about turbulence. Meanwhile, Lisa performed the walk-around inspection. She re-entered the cockpit and presented me with paperwork indicating hazardous material (hazmat) had been loaded in the aft cargo compartment. For this flight, lithium batteries were listed as the hazmat.

After reading about recent FAA tests of thermal runaways in cargo containers, I'm not especially fond of lithium batteries. Apparently containers can become pressure vessels, having the potential to create an impromptu explosive enclosure. The airborne fire suppression system would be unable to initially reach the flames until the container had burned through. Not good.

Via the radio, I requested a meeting with our crew chief. Within a short period of time, he appeared in the cockpit. In addition to his lively irreverence typical of our New York ground crews, I also got a good-natured, professional attitude. The crew chief appreciated my concern and without resistance accommodated the request to have the batteries removed. Cool.

Nearing the departure time of 19:35, we completed our cockpit preparations. Having never flown together, Lisa and I took a moment to become acquainted.

Although delayed because of a baggage loading issue, we began our pushback from the gate with a gentle nudge from the tug. As the push progressed to the disconnect point on the ramp, raindrops began to speckle the windscreen. The 777-300 requires an adjustment to the takeoff performance with respect to V-speeds when wet runway conditions exist. The FMC (flight management computer) recalculates the data with the appropriate entries. Lisa was already in that thought process before I asked. Her fingers danced around the FMC keypad.

As the headlights of the tug backed away and melted into the glow of the terminal, we completed our taxi checklist. With clearance to depart the ramp received, Lisa transferred the frequency to JFK ground control. I eased the thrust levers forward. The airplane lumbered ahead. As Lisa acknowledged our taxi clearance, the flight attendant chime sounded in the cockpit. Instinctively, I applied the brakes. It was an awkward time for a call.

I unsnapped the intercom headset from the back of the center pedestal. Our purser, the lead flight attendant, was on the line. She reported that a passenger had been observed with his eyes rolling into the back of his head. The passenger had become unconscious — not a pleasant way to start a trip.

A nod from Lisa, and within seconds she had conveyed the medical emergency to JFK ground control. Shortly thereafter, company ramp control was advised of the situation. Our best option was a return to the gate from which we had just departed. But the return required a short circuitous excursion onto the taxiways. While Lisa coordinated with the flight attendants and ramp operations, I obtained an immediate clearance with JFK ground control. Paramedics were called. I taxied.

An additional call from our purser yielded some interesting information. Our ill passenger had been watching the cabin video monitors when some unidentified scene had displayed blood. He claimed that this had caused his loss of consciousness. It happened to him all the time. Not a big deal. (I recalled a scene from The Andromeda Strain in which the doctor went into a mild epileptic trance when she saw the color red. Truth stranger than fiction?)

In addition to the seat number and name, the purser indicated that the passenger's pallor was an interesting shade of gray despite his assertion that he was cured of the unknown affliction. By the time we arrived back at the gate, he was refusing medical attention. The passenger also deemed it unnecessary to leave the airplane.

After a brief conversation with the purser in the cockpit, it became apparent that none of the flight attendants were comfortable with the risk of having the passenger remain on board. I nodded and trotted down the aisle toward the back of the airplane.

As I approached the sick passenger's row, expecting to find a small entourage of paramedics, only one rather indifferent New York Port Authority cop was present. His function was to assess the situation before paramedics arrived. Apparently he had determined that a conscious passenger did not warrant medical attention.

The passenger appeared to be in his late 20s to early 30s. Considering the attention he had garnered, he was understandably nervous and still rather pale.

The young man immediately began to insist he was in good working order. The episode he experienced was not unusual. He claimed to have never actually lost consciousness. He made this emphatic statement while gesturing toward a female passenger seated next to him, apparently in an attempt to garner support. I assumed the female passenger was a wife or girlfriend. Her subtle roll of the eyes didn't quite reaffirm his personal assessment. I would discover later that the female passenger simply had the misfortune of sitting next to a medical emergency.

I attempted to impress upon the passenger that our rapid return to the gate was on his behalf and that, for his safety, if he required medical assistance once airborne, a diversionary airport could potentially be two hours away. In addition, we had to consider the other 309 passengers.

Despite my diplomatic oratory, he remained anchored to his aisle seat. I offered a compromise, suggesting that paramedics get his vitals. If all was normal, he could stay on board. (I was hoping that the impromptu examination might also indicate due diligence in my potential criminal negligence trial.) He agreed. Unfortunately, it was not to be.

Our lackluster Port Authority cop indicated that the EMTs were too busy to perform mundane tasks requiring only the use of blood pressure cuffs and stethoscopes. Paramedics were for emergencies only.

The bottom line? The medical assessment was now my responsibility, according to the officer. Great. I didn't recall having "general practitioner" listed on my license underneath ATP and 777 type rating.

I conferred with the gate agent supervisor: What doth the airline say? Once again, I was told that it was my call. I grinned with the absurdity of the situation, thinking I'd have to review my job description.

Using the tools of crew resource management, I convened a quick conference with the purser and the flight attendants who had witnessed the symptoms of our ill passenger. None of the flight attendants felt comfortable enough that we could avoid an unscheduled landing in Gander, Newfoundland, or Keflavík, Iceland. End of story: The passenger would deplane.

I conveyed the decision to the gate agents. Their expressions indicated a resignation to the inevitable. With further coaxing, our ill passenger accepted his fate. He deplaned without complaint and was rebooked for the next day. It is my hope that he received the appropriate medical treatment and that his affliction is not serious.

Unfortunately, the story did not end well for the remaining passengers. As per FAA rules for international flights, the young man's bags had to be removed, a task that required a pallet location search via the computer. Once the pallet was confirmed, the bag had to be physically located. Combine this tedious chore with the fact that ground crews were unavailable while they serviced scheduled departures, and a perfect delay storm occurred.

Additionally, our short jaunt around the taxiways burned a few hundred pounds of kerosene. The airplane had to be refueled back to the original dispatch amount. A mere two hours later we again departed the gate.

Although our company provides guidelines and airborne advice for handling medical emergencies, ultimately it becomes the decision of the captain. Every scenario is different. In this particular circumstance, I was just grateful the event occurred while on terra firma. Despite the painful delay, it was a relatively happy ending.

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Les Abend
Les AbendAuthor
Les Abend is a retired, 34-year veteran of American Airlines, attempting to readjust his passion for flying airplanes in the lower flight levels—without the assistance of a copilot.

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