Diversion Scenario:

[reddituser8901]

Hey guys,

Scenario I want to pose to y'all. I've heard various answers. Let's say you just departed KDAB. ATC has told you to climb and maintain 3,000 and fly a heading of 360. You are here (the white circle).



Your passenger tells you he is starting to feel hypoxic (I know it's quite low, but it's just a hypothetical). You decide that it's in his best interest to divert. You are still under ATC instruction at this point but have a choice to make. Will you turn immediately to the airport you will be diverting to (likely OMN) without getting an amended clearance first or will you get an amended clearance first before making that turn?

Some people have argued that it's not an emergency so they'll get the amended first but I have also heard others say that it's in the interest of safety so they will make that turn first and then get the amended later.

What you would guys do? Curious to hear your thoughts.​

 

[rk911]

Declare the emergency and go from there.

 

[TCABM]

Pax having a medical event? Declare and land at nearest suitable facility, which may or may not be the nearest airport if EMS is immediately needed.

 

[Fearless Tower]

If the PIC feels it is a potential medical emergency, agree with the above - declare the emergency and tell ATC what you need.

But also keep in mind - in an emergency, keep it as simple as you can - too many emergencies have turned into accidents because the PIC overreacted and/or rushed the situation.

In the example you have, I'm returning to DAB not going to OMN.

OMN is only slightly closer, but why complicate the situation by having to make a rapid descent and entry into the traffic patter while changing frequencies?

Just say you are declaring an emergency and need to return. You likely still have DAB tower in the standby window on the comm radio. You have more time/room to make your descent/approach and a controlled landing and you are familiar with the field since you just launched from there.

 

[dbahn]

When you have any emergency you are free to do anything that reduces its risks. Keep ATC advised and realize that your decision making may be reviewed by the local FSDO. That's never a problem when your actions are reasonable.

 

[Half Fast]

Declare the emergency and get on the ground. My choice of Daytona or Ormond might depend upon the traffic situation, as Daytona can get quite busy. If Daytona isn’t swarming it would be my preference due to having more help available.

 

[asicer]

Your passenger tells you he is starting to feel hypoxic (I know it's quite low, but it's just a hypothetical). You decide that it's in his best interest to divert. You are still under ATC instruction at this point but have a choice to make. Will you turn immediately to the airport you will be diverting to (likely OMN) without getting an amended clearance first or will you get an amended clearance first before making that turn?

Well FAR91 says:
"In an in-flight emergency requiring immediate action, the pilot in command may deviate from any rule of this part to the extent required to meet that emergency."

To what extent is necessary for dealing with a hypoxic passenger? What if instead of hypoxia it was a heart attack?

 

[Roger Wilco]

Hey guys,

Scenario I want to pose to y'all. I've heard various answers. Let's say you just departed KDAB. ATC has told you to climb and maintain 3,000 and fly a heading of 360. You are here (the white circle).

...

Your passenger tells you he is starting to feel hypoxic (I know it's quite low, but it's just a hypothetical). You decide that it's in his best interest to divert. You are still under ATC instruction at this point but have a choice to make. Will you turn immediately to the airport you will be diverting to (likely OMN) without getting an amended clearance first or will you get an amended clearance first before making that turn?

Some people have argued that it's not an emergency so they'll get the amended first but I have also heard others say that it's in the interest of safety so they will make that turn first and then get the amended later.
What you would guys do? Curious to hear your thoughts.​

My perspective is that a passenger who reports feeling hypoxic does not constitute a dire situation in which immediate action is necessary. Therefore, in the scenario that you describe, I recommend:

1. Maintain control of the aircraft​

​

2. State your intentions​

​

3. Obtain an amended clearance​

​

4. Comply with the clearance​

Any deviation from an ATC cleared route and/or altitude creates the risk of collision with other aircraft, terrain, or obstructions. Now, a heart attack or stroke are medically urgent and declaring a Mayday is appropriate, but I would still obtain an amended clearance before changing course—as much as I may be concerned for my passenger’s life, a catastrophic collision with another aircraft would be a far worse outcome. Consider that, in the heat of the moment, your situational awareness may become temporarily compromised along with your ability to accurately assess the risks involved. Fly the airplane first.

... Keep ATC advised and realize that your decision making may be reviewed by the local FSDO. That's never a problem when your actions are reasonable.

In any abnormal (the industry term is “non-normal”) situation, you as the PIC must assess the situation, consider all available information, and take the best course of action to ensure a safe outcome. Only you can make the call. Only you can save the day. So I strongly disagree with dbahn here--when faced with an actual or potential emergency situation, NEVER NEVER NEVER allow yourself to consider the local FSDO, or anyone else for that matter. You are the PIC and you have the legal authority, the obligation, and the responsibility to take any action that YOU deem necessary to achieve a safe outcome. The FSDO has nothing to do with the safe conduct of your flight. Allowing yourself, even for a moment, to consider the effin' FSDO may seriously compromise your decisionmaking ability just when you least need that kind of distraction. So forget about the Feds and focus on the immediate task of contending with the emergency and getting the airplane and passengers safely on the ground.

 

[Racerx]

What type of hypoxia? Was asked to name the 4 types for my oral. Dont know anyone that could tell me they're feeling hypoxic.

If you look at the symptoms, it could be something more dire. Rapid breathing, shortness of breath, change of skin color, confusion, rapid heart rate. All symptoms of hypoxia....or not. Declare. Figure it out on the ground.

 

[Clip4]

Situational awareness. A diversion is made to a suitable airport. Your scenario is you are currently under DAB departure control. Declare a medical emergency and 180 back to DAB. You will get priority handling back into DAB and they have ARFF, which means medical assistance immediately when you land.

 

[cowman]

Passenger hypoxia is to me a minor emergency and I'd be inclined to coordinate with ATC before doing anything. However, if someone says they're getting hypoxia at 3000' I'm going to have a strong suspicion that it's not hypoxia. At that altitude I'm thinking something along the lines of a stroke which greatly increases the urgency of getting medical attention.

The thing about scenarios is they're all different and the details matter. Are we VFR or are we in IMC? How busy is the radio? Are we creating a potential hazard by making an immediate turn without ATC support? I've flown through that area when center was so busy you could hardly find a chance to check in. If it's not too busy and it's under visual conditions I might initiate an immediate turn towards OMN while making a radio call declaring what I'm doing and why. If it is busy or I'm in IMC I may opt to inform them first and then get cleared- I think that's a situational judgement call. If you can't raise them right away squawk 7700 and they'll be calling you pretty quick. You're in an emergency now, you tell ATC what you need to do and their job is to assist and advise not give permission.

On the subject of whether to go to OMN or back to DAB I see that as a toss-up. From that position I'm sure you're talking to approach and they control the airspace over both fields. They won't have any trouble coordinating with either tower or getting an ambulance dispatched, you're going to be getting priority handling and switching to tower in either case. I'd guess there would be an ambulance pulling up at OMN by the time you taxi in but knowing they have services on field at DAB might tweak the decision in that direction.

 

[MikeNY]

a choice to make. Will you turn immediately …

For a decision on how best to manage emergency, remember … don’t rush.

 

[Skip Miller]

For a decision on how best to manage emergency, remember … don’t rush.

First, wind your watch….

 

[TCABM]

Re: hypoxia as the pax condition is a bit if a red herring for the discussion and probably why there’s a variety of answers.

If, for any reason, a pax is no longer in the same condition or better than when they boarded the flight, it’s time to do PIC things, not EMT/MD things. If the pax condition has deteriorated such that the planned flight is no longer executable, the only question is whether you need priority handling by ATC to get on the ground or resources for the pax. If yes, the answer is declare and tell ATC what you need. Let the bodies in a 1G/zero airspeed environment do their thing to so you can do your thing and get the pax the resources they need.

Everything else is academic.

 

[midlifeflyer]

Re: hypoxia as the pax condition is a bit if a red herring for the discussion and probably why there’s a variety of answers.

If, for any reason, a pax is no longer in the same condition or better than when they boarded the flight, it’s time to do PIC things, not EMT/MD things. If the pax condition has deteriorated such that the planned flight is no longer executable, the only question is whether you need priority handling by ATC to get on the ground or resources for the pax. If yes, the answer is declare and tell ATC what you need. Let the bodies in a 1G/zero airspeed environment do their thing to so you can do your thing and get the pax the resources they need.

Everything else is academic.

Actually that struck me too. Apparently, @reddituser8901 connects with people who think an ill passenger is not an emergency.

The other thing that struck me funny was the two choices:

Will you turn immediately to the airport you will be diverting to (likely OMN) without getting an amended clearance first or will you get an amended clearance first before making that turn?

It comes across as (1) violate your clearance or (2) wait for an amended clearance. Sure, ATC may well toss in a new "cleared to" whatever you ask for, but it's not like you're going to hear, "I have an amended clearance. Advise when ready to copy."

Really @Fearless Tower gave the 100% Take-It-To-The-Bank answer. Even if the choice is to do go to OMN rather than the simpler return to DAB, it's really just a matter of:

"Dayton Departure. [Callsign]. Declaring an emergency. Sick passenger. Need vectors to..." You will get what you need without causing a traffic conflict.

 

[asicer]

If the pax condition has deteriorated such that the planned flight is no longer executable, the only question is whether you need priority handling by ATC to get on the ground or resources for the pax.

That's why the hypoxia thing is a red herring. If you passenger tells you he is starting to feel hypoxic, what does that mean? "My toes are starting to tingle"? "My fingernails are looking a little blue"? Or is it "I'm nauseous and feel like I'm going to pass out"?

 

[midlifeflyer]

That's why the hypoxia thing is a red herring. If you passenger tells you he is starting to feel hypoxic, what does that mean? "My toes are starting to tingle"? "My fingernails are looking a little blue"? Or is it "I'm nauseous and feel like I'm going to pass out"?

I'm taking a decision to divert because of it at face value. That puts it into the emergency category in my book.

 

[Initial Fix]

Like everyone has said. Declare and tell ATC what you need. They are there to help.

I think far too many have heard myths about declaring.

 

[dmspilot]

Actually that struck me too. Apparently, @reddituser8901 connects with people who think an ill passenger is not an emergency.

You got that from this thread? I didn't see that.

 

[RussR]

This whole discussion is actually hampered by the OP's selection of "hypoxia at 3000" as the reason for the diversion. Because that's a weird condition. I mean, if somehow I could actually diagnose that it's hypoxia, then the first solution is to descend, right? But how would I know it's hypoxia? Especially at 3000, that's highly unlikely, so if the person is showing similar signs I'm not going to think "hypoxia", I'm going to think heart attack or stroke or something. And obviously that is an automatic emergency declaration. I'd assume DAB has better immediate medical care than OMN, so I'm headed there immediately, squawk if necessary, and declare.

 

[Half Fast]

I’m not qualified to diagnose the ill person on the ground, much less in the air while busy flying. I’m going to declare and get him down and handed off to those who are qualified.

 

[asicer]

I'm taking a decision to divert because of it at face value. That puts it into the emergency category in my book.

Is the passenger your dear 22 year old brother who is the Paragon of good health, all your ancestors have lived to 100 and he mentioned his toes are tingling? ("maybe you should not be sitting on my water bottle") Or is it an 81 year old with slurred speech on his way to a presidential debate?

 

[RussR]

I’m not qualified to diagnose the ill person on the ground, much less in the air while busy flying. I’m going to declare and get him down and handed off to those who are qualified.

To be fair, hypoxia is a condition that we should be able to "diagnose" (word used loosely) if we're flying an aircraft where it's a possible condition.

If you're flying along at 12,500 (without using oxygen) and the passenger starts showing the classic signs of hypoxia, you descend. Preferably fairly rapidly. If you get down to 8000 and the passenger is obviously much improved, that reasonably affects the decision-making process. You may still land early and seek medical attention, or you may proceed to your destination, but likely there's no need to make an emergency descent into the nearest field.

 

[Roger Wilco]

This whole discussion is actually hampered by the OP's selection of "hypoxia at 3000" as the reason for the diversion.

I agree--the dubious choice of hypoxia as a medical emergency seems to have thrown some of us off the scent.

As I understand the OP's post, the question is not about how to diagnose and respond to a case of hypoxia, or which airport represents the better diversion choice. The nature of the hypothetical medical condition is not the point: the OP could just as easily have supposed a heart attack or stroke or explosive diarrhea. The crux of the OP's scenario seems to be this, and only this: in the case of an inflight medical emergency, "will you turn immediately to the airport you will be diverting to (likely OMN) without getting an amended clearance first or will you get an amended clearance first before making that turn?"

 

[RussR]

I agree--the dubious choice of hypoxia as a medical emergency seems to have thrown some of us off the scent.

As I understand the OP's post, the question is not about how to diagnose and respond to a case of hypoxia, or which airport represents the better diversion choice. The nature of the hypothetical medical condition is not the point: the OP could just as easily have supposed a heart attack or stroke or explosive diarrhea. The crux of the OP's scenario seems to be this, and only this: in the case of an inflight medical emergency, "will you turn immediately to the airport you will be diverting to (likely OMN) without getting an amended clearance first or will you get an amended clearance first before making that turn?"

I hope the OP comes back to clarify, because if that's all the question is, then the answer (I think) is obvious - you do what you have to do and exercise your emergency PIC authority. Head to the airport and advise ATC of what you're doing, don't wait. Squawk if necessary.

But as with any scenario, the details are important and change the response. Because of the inclusion of the hypoxia diagnosis, that changes the question and may not have the same answer.

 

[TCABM]

To be fair, hypoxia is a condition that we should be able to "diagnose" (word used loosely) ….

Depends. There’s the traditional hypoxic hypoxia we’re likely most used to, but there’s also histotoxic, stagnant, and hypemic hopoxia, all of which can display with similar symptoms. But improving O2 conditions through altitude or supplemental O2 may not solve the problem.

 

[bflynn]

Declare the emergency and get on the ground. My choice of Daytona or Ormond might depend upon the traffic situation, as Daytona can get quite busy. If Daytona isn’t swarming it would be my preference due to having more help available.

When you declare, the traffic worries go away. ATC will move everyone out of the way.

From there, I would choose Daytona, because I'm already talking to them, they will have medical personnel to meet us, and my radios are probably still set up for tower and ground.

Runway and taxiway will depend, but if possible I'd choose 7L and ask medical to meet us on P around P3/4. Keeping the runway cleared so they can reopen quickly is a minor concern, but let's try to be nice about it.

Best speed to about a mile out, then reconfigure for landing because draggy airplanes slow down well.

 

[midlifeflyer]

You got that from this thread? I didn't see that.

Some people have argued that it's not an emergency

 

[midlifeflyer]

Is the passenger your dear 22 year old brother who is the Paragon of good health, all your ancestors have lived to 100 and he mentioned his toes are tingling? ("maybe you should not be sitting on my water bottle") Or is it an 81 year old with slurred speech on his way to a presidential debate?

Maybe you misunderstand? I'm not making a diagnosis. In the scenario, the pilot has already made a decision to divert. I'm taking the pilot's decision that it's important enough to divert at face value.

IOW. I'm reading the post as "what do you do when you have an ill passenger and decide you need to divert because of it" rather than as an EMT "how sick is he?" exam.

 

[Salty]

Maybe you misunderstand? I'm not making a diagnosis. In the scenario, the pilot has already made a decision to divert. I'm taking the pilot's decision that it's important enough to divert at face value.

I've diverted plenty of times where it wasn't an emergency. Not the same thing IMO.

 

[midlifeflyer]

I've diverted plenty of times where it wasn't an emergency. Not the same thing IMO.

Well, I edited is slightly, but you'll probably quibble anyway

 

[Salty]

Well, I edited is slightly, but you'll probably quibble anyway

I don't think I am, but maybe.

I think there's still an emergency divert and a non-emergency divert even with your limits. If my passenger is just queasy, I'm going to stay within the rules and ask for a clearance first, if it's a real emergency, I'm not necessarily going to wait for that.

 

[Roger Wilco]

I hope the OP comes back to clarify, because if that's all the question is, then the answer (I think) is obvious...

That, I think, is all the question is. But if the answer were obvious, why ask the question?

I tried to address the OP from that perspective in post #8.

When a passenger suffers a medical emergency, that situation in-and-of-itself does not impact the aircraft, but it does affect the crew by creating a distraction and increasing stress, both of which can lead to errors, procedural and judgemental, if not carefully managed. And therein lies the real danger.

Many years ago I was presented with the following scenario (as best as I can recollect) during an airline interview: Shortly after takeoff you receive a call from the lead flight attendant. A passenger has suffered a heart attack, and the attending physician says that we have to turn around and land right away or the guy won’t make it. Meanwhile, the weather at the departure airport has just gone below landing minimums and the nearest available diversion airport is an hour away. The guy is in bad shape and probably won’t survive to the diversion airport. What’s your decision, Captain?

Nearly four decades and many emergencies later, the answer is still the same: Operating the aircraft with the highest possible degree of safety is always the first and foremost priority. Never risk the lives of many to save the life of one. As this philosophy applies to the OP, obtain an amended clearance before diverting.

 

[Hang 4]

If we set aside the hypoxia thing, I think the real question was "talk first" or "turn first"? Assuming an onboard medical emergency, I'd declare with intentions. So basically talk and turn. I'd go to DAB for reasons others have stated. That's a crazy busy class C and I would not want to have to waste time with them yelling at me for an unannounced turn. PAN PAN PAN, bugsmasher 123 returning Daytona for medical emergency. Request vectors for immediate landing.

 

[RussR]

PAN PAN PAN, bugsmasher 123 returning Daytona for medical emergency. Request vectors for immediate landing.

Minor nit, I believe it's PAN-PAN PAN-PAN PAN-PAN, not that it's going to make any difference (especially in the US).

 

[dbahn]

Don't try to diagnosis anything from the pilot's seat. It's simply a MEDICAL emergency. ATC may or may not ask further questions, but the priority is to land as quickly as possible where medical services can be made available quickly. So what if it turns out to be nothing serious? That's better than quickly having a much more serious problem on your hands.

 

[asicer]

Maybe you misunderstand? I'm not making a diagnosis. In the scenario, the pilot has already made a decision to divert. I'm taking the pilot's decision that it's important enough to divert at face value.

IOW. I'm reading the post as "what do you do when you have an ill passenger and decide you need to divert because of it" rather than as an EMT "how sick is he?" exam.

If the scenario has been modified to say that "the PIC has determined that the passenger needs medical assistance", then yes I agree.

 

[Half Fast]

If you can't raise them right away squawk 7700 and they'll be calling you pretty quick.

Yep. Alternatively, if the frequency is crowded and you can't get through, switch to 121.5. IIRC from listening to OB, all the ATC facilities have 121.5 on a speaker in the room, so it's pretty much guaranteed a controller will hear you and respond. Be sure to state which facility you need ("Daytona Approach, N123AB, emergency return....") as everyone within radio range will hear your call.

 

[cowman]

I've diverted plenty of times where it wasn't an emergency. Not the same thing IMO.

I diverted about 2 weeks ago because I was still an hour from my destination and had desperately needed a toilet for the previous hour. Did not declare

 

[midlifeflyer]

If the scenario has been modified to say that "the PIC has determined that the passenger needs medical assistance", then yes I agree.

I guess we read

You decide that it's in his best interest to divert

differently. I read it as

the pilot has already made a decision to divert

IOW, the only question I am working with is, “having decided to divert and treat it as an emergency, what do I do?”

If you are working with “should I treat it as an emergency?” we are working with two different questions. You are welcome to argue about yours, but I don’t care because that's his PIC decision even if it might not be mine.