Lately it seems that I keep inheriting passengers that have severe medical issues that seem to get exacerbated by flight conditions. For whatever reason, I’ve had several in flight medicals in the last couple months. So much so that the last one had seemed almost routine, although in hind sight it seems like it was the most time critical.

So my question to you in the professional aviation community is this- if the passenger has indicators of flatlining how much does that impress upon your sense of urgency to get to a suitable airport?

I’ve had other pilots tell me they will race at +300 knots below 10,000 until they can slow up and get configured to make the approach. Guys have told me they will taxi at +40 knots to get the passenger to the EMTs as quickly as possible. Both of these practices have me considering how I come in given the urgency of the passenger in distress. While I know you are allowed to deviate from any FAR to meet the nature of the emergency I have always tried to remain consistent with the FARs as they are written. I.E. I’ll race to the airport at +10,000 as fast as I can but slow to 250 below. I don’t ever taxi above my company’s approved speeds and so forth. I feel that normally this is consistent with safe airmanship and that going outside this approved method might inject the possibility of enhancing the risk to the safety of the flight. However, with this last emergency there was a tremendous amount of urgency associated the nature of it. As such, it’s has led me to re-examine my methods of getting to an airport when a passenger is in distress.

What do you guys think?

The one I had was back when I was flying a 207, I firewalled the throttle till final.

In my jet I don’t think I’d do anymore than 250 till the OM, I’m also not likely to taxi with the airspeed alive.

Should you damage an airplane your career is over and the patient dies. Doesn’t seem worth it to gain 35 extra seconds.

Had a lady crashing in the back (air ambulance) in a learjet. We were over the gulf headed to TPA.  Declared, requested straight in rwy 9 had the ambulance meet us at the runway...250 to the marker, that is all you can safely do and maintain a reasonably stabilized approach.  Found out after dinner that evening we all got exposed to swine flu....yay! good thing the outflow valves are up front for a double dose of exposure

Doing air ambulance medical emergencies happened quite frequently

Under normal 121 operations, I'd declare, but certainly follow things like stabilized approach criteria and other good operating practice.

Your aggressive flying likely won't have a significant impact on the passenger's outcome, and potentially jeopardizes the ship.

An immediate divert is likely more influential than the minute or so you save slamming it in.

I wouldn't risk my career and the safety of my aircraft (including all the other passengers) to save a minute or two at most.

That said, there's plenty you can do if you declare and work with ATC.  Direct to the numbers, stay at 10k until you absolutely have to start down, maybe fly a "Southwest 250ish" until you get where you need to slow.

I'm not going to taxi like I'm a Nascar driver though.

Personally, none.

I'll declare, and be as speedy as I can be, but not busting FARs unless by accident.

As the saying goes, you're no good to the patient if you're also dead or injured.

Have to care for all of the souls on board, so nothing too risky, please.  (Says the non-commercial pilot who works for an airline)

Not a pilot.... but long time EMT and current doc.

I think it's rare that an extra few minutes make a big difference if they're actively dying.  Best case scenario, someone codes as your wheels touch down.  It's still 3-5 minutes before EMS gets on the plane.  That one might be saved, especially if CPR starts immediately.

On approach, add... 5 minutes more?   So 10 minutes to EMS.  Probably going to stay dead.

Now if you're far out and can fly faster or divert, and save more than about 10 minutes,  while they're alive still, probably worth gassing it.

I have had several medical diverts, and at Northwest we taught our Captains how to get to the airport as quickly as possible. The profile was about the same, it just varied a bit on actual slowdown point but essentially went like this;

Barberpole/redline to 2-3000 feet height above the airport.
Slow down as rapidly as possible but still be able to do a stabilized approach the last 500 feet.
Taxi as quickly as you can to the assigned gate

As a Captain on the DC9, I did it once for real and we went redline till ten miles out. The doctor on board and a flight attendant were doing CPR and only stopped for about 15 seconds to buckle up for landing in Moline. The passenger made a full recovery.

Once as an F/O on the 757, same profile, we had to go to idle at 20 miles out to get slowed down. That passenger did not survive.

Both times we were on the ground within ten minutes of the initial call. You most likely can't do that west of the front range of the Rockies or east of the Sierra Nevadas. Obviously if you are over the oceans somewhere the passenger is just screwed.

Also you never want to divert someplace you can't depart from, think mountain airports, Siberia in winter, and remote islands with no facilities.

If you think of the profile above, it's exactly the same one you would fly with an inflight fire.

Had a retired NWA captain tell me he kicked a sick passenger off his plane before takeoff. I believe the route was LAX to Singapore and the woman was so sick she couldn’t sit up and that people book flights to go home to die.

He said he wasn’t going to put his passengers in a position to divert to Hawaii for her emergency and that NWA was not an air ambulance service. Told her to fly United.

The numbers were canned. The DC9/B727 could go from barber pole to configuration speed at idle with the boards in level flight in about 3-4 miles. The 757 took one mile in level flight at idle to loose ten knots with the boards out. The landing weight would affect that a little.

My advice to any pilot of a turbine powered airplane is to really know and understand your pitch-power charts. In the DC9-10 when you're 15 degrees nose up at full thrust the airplane will climb, regardless of the stick shaker and mach clacker going off at the same time, both artificial horizon indicators rolling in opposite directions and multiple false warning flags/lights going off. I lived that event in Allentown and did a no gyro approach back to the airport on standby instruments. After Air France 447 hit the water, at about the same time an NWA A330 had the same problem over the Pacific Ocean while cruising in the Flight Levels. That Captain kept the nose on the horizon, cruise power set, and in a few minutes the air data instruments came back on line. Bet you didn't hear about that.

Absolutely This.   And there probably isn’t going to be any divert, unless someone is Giving Birth, Confirmed heart attack, or gushing blood profusely. (Or all three simultaneously).

The F/A make an announcement asking for medical professionals.   It usually takes a couple requests before someone steps up.
Then, they give sugar and oxygen.  Then, there’s an on call Dr. which can be called.    All of this has the effect of playing out the clock, so finally, you get close to destination and the divert isn’t needed.
I wish the passengers understood how it works, but I really doubt it would prevent sick people from flying.   People are complacent.  They live in denial.    I’ve already two this month, and I’m pretty sick of it.

Flying corporate, I would have done some fancy pilot shit to get the boss on the ground quick.   Flying airlines, everything has to be routine.

As I used to tell EMS driver trainees - it accomplishes nothing to get half way there really fast.

There is an argument to made that once someone says “medical” you say “emergency” and start thinking about a divert unless you’re within 200 nm of your destination or still on the departure (return to departure field.)

I want no liability for myself or airline, in that order.

Unless onboard medical or MEDLINK says continue, I don’t want that person onboard, anymore.

ETA: international flying may be different. YMMV.

How many times did domestics operating 737MAX aircraft have issues that didn’t result in fatalities?

This.

When doing line MX for all the majors at an Intntl airport, I saw numerous medical diverts.  Even with advanced warning, it still took 10+ minutes from engine shutdown to get the EMS folks into the aircraft to treat the patient.  Drag an airstair out to a remote piece of ramp instead of using a jetway, to avoid interrupting scheduled operations, escort the ambulance out to the jet, wait for the flight attendant to open the cabin door, secure the airstair, escort the med crew up into the aircraft, etc.   NO ONE moved with any sense of speed, just another day at the office, except for the guy with the medical problem.

And usually, the captain kicked the patient off the aircraft even if the med guys said he was okay to continue the flight.   His checked luggage went ahead without him, and sometimes he'd have his shirt or pants mostly cut off him, and then get dumped into the terminal to try arranging the remainder of his flight.  I always felt bad for people going through that experience, surviving a medical emergency and then being treated like a leper in a foreign city.