SQ Pilot 'refused sick passenger's plea to land'

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If you’ll re-read above, it can land after a fuel dump, but it then means a longer than usual turnaround for the aircraft as extra checks will need to be performed. I hardly see that being a design issue if you had to land for one sick pax… turn that around and look at the QF incident and they managed to land, though that aircraft isn’t in service yet for other reasons.

Someone has unrealistically high expectations.

I think what JohnPhelan was alluding to was that if an incident like this were to happen again, the next passenger with a heart attack may not be able to be stablised over the 14 hour flight. So if a 388 won't be able to land safely after dumping most of its fuel and do that within, say, the same time frame as a 744, then he thinks that's a failure in the design and subsequently a failure in the people who approved the certification.

Of course, if the life of someone really depended on landing within a very short timeframe, the plane could always land, although there are measurable safety risks and the plane will need to be taken away for inspections afterwards. Again - could this be a failure in the design (i.e. not designing for safety or extreme yet important scenarios).

Now I don't have the technical expertise to comment on whether that comment he made is technically reasonable or unreasonable (viz. compared to other aircraft that may fly in place of a 388, e.g. the 744).
 
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Based on JB's comments earlier, a 747 can dump fuel and always then be under max landing weight, so it can land pretty much immediately. Whereas an A380 can only dump some of its fuel and will therefore still be well above max landing weight, especially if the dump occurs early in the flight.

So, if the situation is:
* 747 can dump fuel and land straight away
* 380 can dump fuel and still need to fly for up to 4 hours before being under max landing weight
- then I think it's pretty clear which is the better-designed and safer aircraft!!

I certainly would prefer to be on an aircraft which can dump fuel and land straight away if needed, rather than dump fuel and have to continue flying for 4 hours to get below max landing weight!
 
You are more likely to die on the way to the airport, at the airport, than on a plane.
Things like allergy reactions (peanuts, seafood), asthma, and even old age.
If you live in NSW, you public health system has problems.

You missed the point being more than 1 hour away from a cardiac treating hospital to make a difference. Forget about being in a plane. Even 1 hour is too generous.Then you make a bet that ER treats you in a timely and professional manner.

Even a traffic jam would be life threatening. The public/heart attack patients would be more upset to know what really happens when Hospitals go into 'bypass mode' or pass-the-buck mode - 97% of NSW people not getting optimum treatment.
Stroke patients to attend specialist care units
Tissue plasminogen activator - Wikipedia, the free encyclopedia
Royal North Shore Hospital Heart Surgery - 25/09/1991 - PRIV - NSW Parliament
Hospitals shun bypass, yet turn away ambulances

Based on the second article - window of 3 hours. Someone can list the price of a Streptokinase needle and the price of pca, where this latter could be A$800 or so for a single injection.
 
Based on JB's comments earlier, a 747 can dump fuel and always then be under max landing weight, so it can land pretty much immediately. Whereas an A380 can only dump some of its fuel and will therefore still be well above max landing weight, especially if the dump occurs early in the flight.

So, if the situation is:
* 747 can dump fuel and land straight away
* 380 can dump fuel and still need to fly for up to 4 hours before being under max landing weight
- then I think it's pretty clear which is the better-designed and safer aircraft!!

I certainly would prefer to be on an aircraft which can dump fuel and land straight away if needed, rather than dump fuel and have to continue flying for 4 hours to get below max landing weight!
I think that the only true person who can judge which aircraft is safer would be jb747
 
I am hesitant to reply, but there is a lot of ill-informed speculation in this thread about heart attacks.

Just a few facts, not specifically replying to any one poster:

1. Cardiac arrest is very different from a heart attack. Cardiac arrest is cessation of pumping activity of the heart, and can result from many different disease processes. A 'heart attack', or MI as it more accurately known, is the result of ischaemic hypoxic injury to the heart muscle ie a lack of blood flow - very likely to be due to a clot from atherosclerosis or 'ischaemic heart disease'. A heart attack predisposes to cardiac arrest, especially in the first 24 hours.

2. It is impossible to determine when/if a heart attack has occurred without investigations, which may be quite extensive and invasive. Many other diseases mimic the signs & symptoms. History and examination alone is insufficient.

3. Minutes and hours matter. It is not correct to assert that if it takes longer than an hour to get to hospital, there is no rush. Primary PCI is performed routinely up to six hours post onset of symptoms. And following an MI, the risk of cardiac arrest is much much higher than normal - hence admission for observation.

4. Chest pain is always an emergency and will be seen as such when you call the ambulance and go to ED. It is automatically triaged at cat 2 (should be seen in <10 min).

5. There being a doctor and a medical kit on board is totally irrelevant to the need for urgent hospitalisation in the event of an MI. Doing CPR on a plane is NOT a substitute for avoiding the cardiac arrest in the first place.

6. None of this means that the captain was necessarily in the wrong in this case. There are too many other factors to consider. I would not want to pass judgement on this particular incident - it smells a bit off to me, and I am sure some very relevant information has been left out.



And DrRon - that looks terrifying! When I helped with an evacuation off the Norwegian coast, we used a chopper, which was precarious but the stretcher was always strapped in nice and tight. Now that was a scary night :(
 
Based on JB's comments earlier, a 747 can dump fuel and always then be under max landing weight, so it can land pretty much immediately. Whereas an A380 can only dump some of its fuel and will therefore still be well above max landing weight, especially if the dump occurs early in the flight.

So, if the situation is:
* 747 can dump fuel and land straight away
* 380 can dump fuel and still need to fly for up to 4 hours before being under max landing weight
- then I think it's pretty clear which is the better-designed and safer aircraft!!

I certainly would prefer to be on an aircraft which can dump fuel and land straight away if needed, rather than dump fuel and have to continue flying for 4 hours to get below max landing weight!
John, you're going to have to start picking your aircraft carefully. Many of the smaller aircraft cannot dump fuel at all, and not just Airbus....

A fuel dump takes time. In a 747 you'll be looking at about an hour for the dump to get you from max take off weight, to max landing weight. Add some time for the initial problem to become evident, and then time for the approach and landing ('cos you can't normally just turn the dump off as you arrive on the ILS .... although that has been done in serious cases), and you're looking at a minimum flight time of 2 hours. Bear in mind too, that in some cases you cannot return to the place you took off from (because take off mimina is often better than landing minima). Of course, it's also quite possible that you'll really need to dump to well below max landing weight (wet runway). For instance, not a medical emergency, but QF30 was dumped to 40 tonnes BELOW max landing weight. As a general rule though, the 747s are not landed above max landing weight....unless there is an overwhelming emergency. That does not include medical at all....

Airbus on the other hand do treat it differently. Their treatment of 'max landing weight' is less rigid. They allow a dump to a point at which the weight is 'reasonable', even though above the max, and are not too fussed if you then land. There may be other issues that preclude you doing so, but generally, you can. With a smooth touchdown, and low levels of braking, there may be no inspections required at all. Autoland is mandatory for this though, which may be a limit in its own right.

The civil aviation authorities then step into the act, with their own interpretation of how max weights are to be handled. For Australian registered aircraft, you MUST declare an emergency to allow an overweight landing. Rather timely perhaps, but they have, in the last few days, released an exemption to this requirement for the A330 and A380.

With regards to certification, returns for an ill passenger simply are not considered. You can always come up with scenarios that you may think should have been looked at, but honestly, if certification considered everything that could ever happen, nothing would ever fly.

All of these aircraft can take off, turn around and land again immediately. Without any fuel dump, at vast weights above the maximum. And old rule of thumb is that any runway you can take off from, you can immediately return to. You will, of course, blow tyres, but you will stop. But, if you then want to add system failures on top of that, it's very easy to build a scenario on which you'll need Edwards AFB to be able to land.

The question it all comes to in the end though, is what level of risk the captain will accept to get your sick passenger onto the ground. In the right weather conditions, even if weight were not an issue, there will be innumerable airports that you would fly past. Go to Europe in winter, and a large number of the diversion airports are available only for major aircraft problems. They will not be considered at all for medical issues...and this applies to the 747/777 as well.

As I said near the start of this thread, the answers to this sort of problem are not black and white. They will vary dramatically depending upon a whole range of factors, most of which, none of the passengers are even slightly aware of.

So, I guess the $64,000 answer is 'what would I have done'? Well, recognise straight away that this is conjecture, and I have no knowledge other than what the media printed as to the actual facts. Initially I would have continued along the flight planned track (away from Singapore). Medical advice on board would have been solicited (as it was), but also Medlink would have been called on the satphone. Medlink's decision with regard to the desirability of getting the passenger on the ground or not, and where, would have been taken as being the 'medical position'. If their call was to land with Singapore being the best medical choice (as it surely would have been), then the dump would have been commenced, and the aircraft simultaneously would have been descended to the lowest level within the controlled airspace. Speed brake would have been selected against power (and even the landing gear later on) to increase the fuel consumption to the maximum possible. The aircraft would have been landed overweight at the end of the dump. Crew would be out of hours to continue, so pax and crew go to hotels.

If it happened a bit later, the options are actually a little better. Dubai is a LONG way from the planned route, but if you had the problem come up around the Indian coastline, you would have sufficient time to arrange to track via the gulf. Because no backtracking is involved, and you still have about 4 hours to run (in either direction), you could dump and probably get close to max landing weight. If you can get below it, there would be no inspections, and you would be able to continue the flight (hours would most likely not become an issue) to Europe.

If Medlink did not agree with the passenger's assessment, the flight would have continued to destination.
 
This is an interesting scenario, as I'd have thought that they would have landed in Dubai.
Whilst Dubai is the best A380 option between Singapore and Europe, bear in mind that it is actually nowhere near the tracks that are mostly used to get there, and may involve going right around one particularly large country, which virtually everyone is now banned from overflying.

I've been on a 747 in the past when an engine failed during takeoff from Heathrow and we had to fly for 4-5 hours before landing again, and as I say that was a 747.
That is very unusual, and would indicate that there was a problem beyond a simple engine failure.

I also would have thought that an AED would have an ECG trace on it, so they may well have been able to detect a heart attack (not absolutely but quite possibly). And anyone having a heart attack - well as previous posters have said, there is a window of opportunity where the damage can be reversed / prevented. And also a risk of death if untreated.
They don't let pilots play with it. Probably on the perfectly reasonable assumption that we'd find someone (hopefully with a lower seniority number) and test it on them.

So is the verdict that it is because it is an A380 that it would be harder (are A380's to be avoided if one is of a "heart attack" age?).
There is no doubt that the flexibility of aircraft reduces as they get bigger. There are options between Singapore and London, but many more in a 747, and presumably more again in a 777. Of course, if you seriously think that's an issue, I guess the Pacific and Indian Ocean crossings are totally ruled out.
 
jb747, thank you for all the information you have patiently posted in such a clear way. Its been an interesting read.

The reason I mentioned AED's and ECG traces is because I wondered whether the ECG trace might give sufficient information to detect a (severe) MI. A significant issue in this particular case / news story is whether the patient was actually felt to be having an MI or not. In making that diagnosis you would normally need a 12 lead ECG and blood test, obviously impossible on a plane, but if you could get even a 1 line trace on an AED that you could detect changes suggestive of an MI then that would obviously be helpful in coming to a provisional diagnosis. All speculation of course.

I'd love to know how they would weigh up whether to divert / make an early landing or not in this sort of situation. Chest pain is such a common problem and difficult to diagnose without access to the right tests.

Sue
 
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I'd love to know how they would weigh up whether to divert / make an early landing or not in this sort of situation. Chest pain is such a common problem and difficult to diagnose without access to the right tests.
As I said, the call from the medical perspective is made by Medlink. They are specialist providers of medical information to airborne aircraft... If we need to divert they also take care of arranging everything that is needed medically, as well as giving us advice on just where is best suited to a passengers needs. How they do their doctor stuff, I don't know, but then they don't know how I do my pilot stuff....

But, from my perspective, it is largely about risk. A quick drop into Dubai to offload somebody entails no risk, and is simply inconvenient and expensive....two factors that pilots are pretty good at disregarding. A diversion to a snow bound airfield in the middle of nowhere, may be something I'd do if the aircraft were falling apart around me, but is unlikely to be a choice for any other reason. In that case the good of the one does not outweigh the risk to all others. So, that's a sliding scale from white to black, and depending upon a whole bunch of largely aviation factors, I'll choose where, and how much, risk I'm prepared to accept. It probably isn't the definite answer you were after, but it's about as good as I can give.
 
and again another interesting comparison here from SQ - this time a 50 minute return to LHR after an electrical fault.

Incident: Singapore A388 near Amsterdam on May 20th 2011, electrical problems

some interesting discussion around airbus aircraft being able to handle maximum take-off weight landings

Passenger Nick reported the lights on the right hand side of the cabin extinguished and the inflight entertainment system ceased. No unusual sounds, vibrations, jolts or smells were observed (although ground personnel the next day hinted there may have been an engine failure involved, Nick however rated the ground staff as unreliable source of information). The crew announced they had an electrical power failure and were returning to Heathrow as a precaution. Landing was smooth, the airplane taxied to a gate where the passengers disembarked normally through the L1 door.


Love the comment by 'Passenger Nick' about rating the ground staff as an unreliable source of information. Unless he's a LAME or tech crew I wonder what his level of experience is that makes him an expert?
 
On my first VA flight from LAX to BNE, we diverted to Apia to let a sick passenger and his wife get off the plane.

He was walking around the cabin, and crew had been hovering around him when he was seated during the flight from LAX; but he was not showing signs of extreme pain or being in crisis. The pilot just explained that we were diverting to Apia because it was a better hospital choice than whatever else was along the route; so he couldn't wait until Brisbane.

I was lucky that I wasn't connecting after BNE; so it was a very interesting 5-hour diversion. I did wonder what the health crisis was, though.
 
Fairly hefty load of gibberish in there actually....

Not unusual for an internet bulletin board!

On that note, thankyou, sincerely, for your contributions. It's always a pleasant relief to have a source posting that is reliable, sensible, and professional.
 
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