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Dr Mark Popplestone.
Onboard, apart from crew training and basic
supplies that may be stipulated by regulators, how
airlines respond to a passenger’s illness is up to
them. When the crew does not feel they can handle
an incident alone, a call is put out for a `Good
Samaritan’ – a doctor or nurse who may happen to
be onboard and who may offer to help. Such
passengers may fear subsequent legal problems,
although airlines like BA indemnify their Good
Samaritans against any legal proceedings that may
arise following the assistance of a passenger.
Many airlines now use the services of telemedicine
companies, which provide immediate advice by
satellite telephone or high frequency radio from
doctors who are particularly knowledgeable of
airborne conditions. One of the most renowned is
Phoenix-based MedAire, which provides a range of
support through its MedLink service – from first aid
and medical kits, staff and crew training, airport and
in-flight medical advice – for around 90 airlines
including Aer Lingus, Air Canada, British Airways,
Cathay Pacfic, Delta Airlines, Qantas Airways,
Thomas Cook Airlines and Virgin Atlantic Airways.
“All of our doctors are active practitioners and also
undergo specific training in altitude physiology,” says
Sullivan Garrett. MedLink’s medical advice, she says,
can be given in over 140 languages through
interpreters: “Most pilots and crew speak English but
their proficiency varies. Also, not only do crew and
anyone else helping onboard sometimes need
interpreters, but the interpreters must be familiar
with medical terminology.”
One dilemma that can arise, points out Sullivan-
Garrett, is that an airline may be carrying equipment
that only medical professionals can use, but no such
professional may be onboard, or those that are may
not want to use it. Before taking on clients,
therefore, telemedicine companies generally discuss
with airlines what they are confident and
comfortable about doing in medical emergency
cases. If telemedicine doctors believe an ill
passenger needs to be hospitalized or needs urgent
medical attention, it identifies the closest hospital in
case the plane needs to be diverted, though in
some more isolated parts of the world, finding
adequate medical facilities nearby can be a challenge.
Cost-effectiveness
Not all airlines have telemedicine services that
require expensive onboard satellite communications
systems. Easyjet, the UK-based low-cost airline, is
one airline that sees no need presently to have such
facilities. “We’re a short haul airline,” says an Easyjet
spokesperson. “We don’t have equipment like
defribullators onboard, though we do have standard
first aid kits. And we don’t use a telemedicine service
as our planes are usually very close to airports
where we can land if we have a medical
emergency.”
This may be reasonable in the case of a short haul
airline and it remains the decision of the airline as to
what it will carry onboard. “It’s up to the airline
what kind of backup they need and want but a lot of
airlines use telemedicine services and a lot are
looking at them,” says the CAA’s Dr Johnston. But
should telemedicine services be compulsory? “It’s
like any other new treatment or procedure,” he
says. “You have to consider the accumulated
evidence before you make anything mandatory or
decide whether something is an effective – and a
cost-effective – way to intervene.”
Some insurers, too, it seems, are not so concerned
about telemedicine services. “We only expect
people to receive minimal treatment onboard
anyway,” says a spokesperson for BUPA’s travel
insurance arm. “Our policies cover people for being
hospitalized after a diversion, and in cases where
they can’t get proper treatment we can send a
doctor or nurse or an air ambulance.” Norwich
Union – also a travel insurer – has a similar
approach: “Our experience is that airlines take the
safety of their passengers seriously so they will make
the decision that is right for them,” says the
company’s David Ross.
Flight diversion
However minor most onboard illnesses may be,
there may well come a time when a passenger may
need immediate treatment not available onboard.
Around one in every 1,000 BA flights is diverted for
a medical emergency. “Ultimately, the decision on
　
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