An account of a serious medical emergency on a transoceanic flight
I think I´m able to give some perspective and tips here. I&#x27;m commercial pilot flying long haul and I´ve had some medical incidents during my flights, including a recent suicidal lady cutting her wrists while arriving to JFK airport in NY, or a possible heart attack while in the middle of the Sahara. Also my wife is a doctor who had to help in 3 flights already.<p>If you are a physician:<p>-The cabin crew MUST help you in all the things you require, that is:<p><pre><code>       ·Providing food, liquids, blankets (for free of course).

       ·Providing the mandatory medical kit (that can only be opened by qualified persons never by the crew on their own).

       ·move the passenger wherever you find appropriate (galley, the aisle, laying in several seats, etc...). 

       ·Don&#x27;t accept any excuse regarding the medical kit, some pursers are willing to avoid the paperwork involved after opening it (this happened to my wife in an Easy Jet flight, unfortunately I was in another row taking care of the kids and didn&#x27;t know about it till the end of the flight). It must be fully stocked when opened (usually they are closed with a lock), if it&#x27;s not the company was breaking the regulations. The medical kit is a no go item (it must be present and in perfect conditions for a flight to begin).

       ·Request the cabin crew to keep other passengers away. People loves a good show, and is able of disgusting behaviour (like taking photos of a semi-nude patient to &quot;share&quot;, looking over the doctor&#x27;s shoulder, etc..)


       ·Most cabin crew are super professional and will help to the best of their capabilities, but you can always find an idiot. Don&#x27;t let them intimidate you.

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-The pilots are waiting for the instructions of the experts. From the first moment we know there is a medical emergency, we are planing for a diversion to the nearest airport, usually we&#x27;ll listen to their opinion regarding the need of an immediate hospitalization of the passenger. Although the captain has the last word, no pilot I know is willing to risk avoiding the recommendations of a doctor and face police charges for letting a passenger die for not following instructions.<p>-What I mean is if it&#x27;s clear to you that it&#x27;s a heart attack for example, and the patient needs an hospital, tell the pilot ASAP. We are flying at 8 Nautical Miles per minute, and 10-20 minutes flying away from an airport can mean up to an hour more than necessary till you are in the ground. We take the decision based on the instruction of the doctors and nurses onboard.<p>-That said, be careful to ask what city is the captain willing to land at, and what kind of medical facilities it has. If you are flying over the sea or desert, just expect up to 3-4 hours till able to land in a city with a good enough Hospital. I had a discussion with a captain cause he wanted to land in Tamanrasset, a small city in the middle of the Algerian Sahara. We had a passenger with a possible heart attack, and he wanted to land there. I told him that we needed 45 minutes to land, and then wait at 3am till we were able to disembark, an ambulance to arrive and the patient be carried to the local Hospital, that as you may imagine is less than stellar. The purser just confirmed my suspicions, as he just had the exact same case. The patient took more than 3 hours to arrive to the Tamanrasset hospital, and there was nothing there to treat him of his heart attack. So a private flight was called from Italy to evacuate him. It was much simpler and safe to wait till Malaga in Spain, just 2 and a half hours of flight away with a medialized ambulance waiting for you at the parking.<p>-The FAA list of mandatory medical kit onboard <a href="http:&#x2F;&#x2F;www.faa.gov&#x2F;documentLibrary&#x2F;media&#x2F;Advisory_Circular&#x2F;AC121-33B.pdf" rel="nofollow">http:&#x2F;&#x2F;www.faa.gov&#x2F;documentLibrary&#x2F;media&#x2F;Advisory_Circular&#x2F;A...</a><p>-You also can find that the passenger has no need of immediate hospitalization, but needs medical help once landed. The crew is able to call emergency teams to be ready once the doors open (EMTs and police)<p>-Some companies have a remote medical service available by radio or satellite phone, they are there to help with the diagnosis and treatment if necessary. But they are not infallible and they could recommend you to land in an airport that has a unsuitable Hospital(it has happened). Right now I&#x27;m not aware of any international list with the medical facilities available close to big airports.<p>-Just a recommendation, IANAL  but if unfortunately a passenger dies in flight, I would not declare the decease (we are talking strictly medical causes, no aggressions, killings, etc..), keep trying to reanimate, let the EMT take care of the patient once you&#x27;ve landed and they come onboard. Depending the country a declared decease onboard means a judicial investigation, police reports, etc... that will surely take all day once you land (or more).<p>-Most usual medical emergencies onboard are faints, suffered by people with previous medical conditions. Also people drink too much or take some kind of drugs to endure the fear of flying. Also some kind of digestive problems and heart attacks happen but are less common than faints (based on my personal and friends anecdote)