Kris From United Kingdom, joined Mar 2006, 49 posts, RR: 0 Posted (5 months 3 weeks 3 days 15 hours ago) and read 3336 times:
This is for those that work on the gate - are you allowed to refuse boarding to passengers that don't look well enough to fly (disregarding those that have taken advantage of the departure lounge bar).
What's the criteria for your decision, and what do you do with regard to a qualified opinion, ie is there a doctor/medical officer on permanent duty at the airport who has the final say, or is it ultimately up to the captain who gets on his aircraft?
I work with people with illnesses that require pre-flight physiological assessment to ensure they don't come to harm during flight - if they're OK we give them a doctor's signed letter just in case, but it is obvious that there are a lot of people that don't come through us or are just taking the chance and getting on anyway!
Starlionblue From Greenland, joined Feb 2004, 12935 posts, RR: 57 Reply 1, posted (5 months 3 weeks 3 days 15 hours ago) and read 3336 times:
Quoting Kris (Thread starter): This is for those that work on the gate - are you allowed to refuse boarding to passengers that don't look well enough to fly (disregarding those that have taken advantage of the departure lounge bar).
Yes. The airport bar qualifies too but I see what you mean. For the rest I'll let the agents and F/As answer.
My real self is a Blood Elf Mage in Azeroth. Meet him on Boulderfist.
Kris From United Kingdom, joined Mar 2006, 49 posts, RR: 0 Reply 3, posted (5 months 3 weeks 2 days 12 hours ago) and read 3164 times:
We frequently see patients who are quite disabled with their breathing but who are perfectly fine under flight conditions - we give them a letter that reads something like "this person looks like death but won't die on your airplane from his disease" just in case they are stopped at the gate. I was wondering how often it actually happens and is it worth us doing it.
Kalvado From United States, joined Feb 2006, 151 posts, RR: 0 Reply 5, posted (5 months 3 weeks 1 day 10 hours ago) and read 3034 times:
I've boarded AA transcon with bronchitis and fever about 38C (100.5 F), I bet I looked sick.
They couldn't care less..
Just to clarify: that was a return flight, I got sick away from home
Swiftski From Hong Kong SAR, PRC, joined Dec 2006, 2091 posts, RR: 2 Reply 6, posted (5 months 3 weeks 1 day 2 hours ago) and read 2995 times:
Quoting Kris (Thread starter): are you allowed to refuse boarding to passengers that don't look well enough to fly
Yes. This tends to happen with elderly passengers more than any other group, as probably can be expected. Usually this will not be for coughing and spurting but for things like not being able to walk, becoming ill in the terminal area then 'recovering' (but not really).
The TV program "Airline" - whilst being very low level, has some examples of this.
Cathay Pacific or Virgin Atlantic. Win Win situation.
JER757 From United Kingdom, joined Jun 2006, 117 posts, RR: 0 Reply 7, posted (5 months 3 weeks 11 hours ago) and read 2964 times:
I've turned a family away who's little girl was ill and apparently had been vomiting etc. There had been an outbreak of Norwalk virus (horrible, highly infectious, can kill older people if they don't get treatment) in the area recently so that was of concern.
I spoke to the captain who rung the airlines medical advice service (Medlink??) and they said that she shouldn't fly due risk to other pax and so I offloaded them.
I felt awful; all the little girl wanted to do was go home (they were on holiday) and I stopped them!
DocLightning From United States, joined Nov 2005, 3258 posts, RR: 13 Reply 8, posted (5 months 3 weeks 9 hours ago) and read 2947 times:
Quoting Kalvado (Reply 5): I've boarded AA transcon with bronchitis and fever about 38C (100.5 F), I bet I looked sick.
They couldn't care less..
Just to clarify: that was a return flight, I got sick away from home
That's a bit ill. That's not sick. Sick is when you are concerned that the patient might stop breathing.
A low-grade fever and a cough is not an indication to recommend that a patient not fly. Being obtunded and non-responsive with labored respirations is sick.
SlamClick From United States, joined Nov 2003, 9953 posts, RR: 72 Reply 9, posted (5 months 3 weeks 8 hours ago) and read 2940 times:
As operations manager I got a call from one of our captains. They were on the ground at a small-town airport for the return leg of a charter flight. One of the passengers identified herself as an RN and said that one of the other passenges, a person unknown to her, "needs to see a doctor RIGHT NOW" The flight attendants had no medical training but it was obvious this person was not well. They did not want to take the responsibility. The captain came back and talked to the passenger who gasped that he was fine. He took the RN aside and talked to her for a few minutes then called me on his cell phone. I took the heat off the captain and instructed him to remove this passenger, with our apologies, and get someone in the ground party to take charge of him.
The results:
1. The plane departed for a 1500 mile flight home without the passenger or his wife aboard.
2. The passenger got a two-hour ambulance ride to the nearest hospital.
3. The passenger was admitted for a 24 hour stay in that hospital.
4. Two days later the passenger and his wife flew home on another airline.
5. Two days after that I got a call from his attorney. He was suing.
I told the lawyer I could save his staff a little research. Our authority to refuse transportation came from 14 CFR Chapter 1, Part 121 §121.133 and §121.135 and our FAA-accepted operations manual which complied with those rules. Then I quoted him the pertinent paragraph from our ops manual, the language of which very clearly gave our crew sufficient latitude in such a case. It even mentioned that they were not to second-guess a person with any medical training or professional standing. When I mentioned the ambulance and hospital stay the attorney said that his client hadn't covered that part of the story very well.
I said: counselor, it appears to me that we might have saved your client's life. He said: "I'm inclined to agree." That was the last we heard of it.
I have talked a passenger out of taking the flight from Cozumel back to the States with a fairly graphic description of what he might expect on the descent. The other pilot later told me that I should never be a doctor because I have a terrible bedside manner. It's okay, I still think I did the guy a favor.
DocLightning From United States, joined Nov 2005, 3258 posts, RR: 13 Reply 10, posted (5 months 3 weeks 5 hours ago) and read 2921 times:
Quoting JER757 (Reply 7): I've turned a family away who's little girl was ill and apparently had been vomiting etc. There had been an outbreak of Norwalk virus (horrible, highly infectious, can kill older people if they don't get treatment) in the area recently so that was of concern.
That can kill a kid, too. I'll explain the pathophysiology:
You start to vomit and get diarrhea. Now you are dehydrated, which means that you have decreased circulating blood volume due to the fluid loss (not blood loss, but fluid loss). Without the circulating blood, the kidneys don't get enough blood and can't do their work.
Now one of the jobs of the kidneys is to regulate the acid-base balance of the body. Left to its own devices, the body will crank out acid. So as you get more and more dehydrated you get more and more acid building up in your body. This makes you feel sicker and more nauseated, which makes you more dehydrated, which makes you more nauseated... vicious circle.
The way around the problem is by giving IV fluids. That way you don't have to orally rehydrate the child. It can be done orally with a solution made of one teaspoon of salt and 8 teaspoons of sugar to liter of clean water, but it has to be done slowly, laboriously, and over the child fighting the effort. Since planes don't carry IV fluids (not that I know of) and nobody wants to be trying to orally re-hydrate a child for a flight of who-knows-how-many hours' duration, you were right not to board that family.
Cheers, good stuff! I'm a 4th year medical student so you're kinda preaching to the converted though!
It was only a 1 hour flight though so it wasn't hydration that immediately concerned us, mainly the transmission to other pax.
Incidentally I saw them fly out a few days later (I let them on that time!). Turns out it wasn't norovirus but food poisoning... probably just as unpleasant but non-transmissible!! I spoke to them and they understood why we made the decision. We didn't want to take any chances!
ArmitageShanks From United Kingdom (England), joined Dec 2003, 2906 posts, RR: 14 Reply 12, posted (5 months 2 weeks 6 days 21 hours ago) and read 2836 times:
Quoting DocLightning (Reply 8): A low-grade fever and a cough is not an indication to recommend that a patient not fly.
I'd be mighty pissed if I had to sit next to a coughing and sneezing contagious person for a flight.
Kris From United Kingdom, joined Mar 2006, 49 posts, RR: 0 Reply 14, posted (5 months 2 weeks 6 days 15 hours ago) and read 2810 times:
Quoting Swiftski (Reply 6): Yes. This tends to happen with elderly passengers more than any other group, as probably can be expected. Usually this will not be for coughing and spurting but for things like not being able to walk, becoming ill in the terminal area then 'recovering' (but not really).
Would you take notice of a slip of paper signed by a doctor that states that the patient has had relevant tests and is fit to fly, despite looking that ill?
Analog From United States, joined Jul 2006, 1900 posts, RR: 1 Reply 15, posted (5 months 2 weeks 5 days 23 hours ago) and read 2734 times:
Quoting ArmitageShanks (Reply 12): I'd be mighty pissed if I had to sit next to a coughing and sneezing contagious person for a flight.
I'd be mighty pissed to be denied carriage for a 38C "fever" and a mild cough or sneezing. It's hard to tell if a cough or sneezing is contagious.
Think about how your employer would treat someone who stayed home from work every time they technically had a fever and/or had a cough or sneezing fit?
In non-medical terms, I explained the eustachian tubes and how the sea level pressure he had trapped behind his eardrums might very well escape in bubbles through the mucus and/or pus to vent out into cabin pressure, but during the descent, trying to re-establish the higher pressure of lower altitudes in the space behind his eardrums, the increasing air pressure would simply pack pus and mucus up into his middle ear at best, or block the pressure transfer causing his eardrums to press inward, easily reaching the point of rupture. The pain would travel along some very short nerve pathways to the brain a mere inch or so away and no pain reliever on board the airplane would do a thing for him - nor could we delay the descent just because his ears were bleeding.
For some reason he elected to stay and dry his head out for another couple of days.
I think I gave him sound advice. Not a PR triumph but I do believe I spared him something I would not wish on anyone.
A lot of carriers I have work for have a form of Medical Guidelines, for example they note requirements for pregnant pax, timelines for travelling after diving, sinus congestion etc. In one CS manual, it gave these guidelines and then noted when it was advised to get further advice. This caused issues when even passengers travelling on Department of Health accounts would arrive without the correct form, as a letter from the doctor would not suffice, it required the specific medical clearance form as defined on the website.
As many of the CS/Gate agents here will hopefully agree, there are quite a few times where you ask the questions at check-in leading for the correct answer, as you can tell the passenger is fine and want them to travel! F/A's of course are notorious for thinking that the extra couple of days of First Aid they recieve make them more qualified than any of the lowly Ground Staff, and offload people with perfectly good medical clearance all the time!
I have personally offloaded people who have accidentally mentioned, in particular, diving, a lot of times which leads to fairly heated situations, as well as pax who are straight out of post op and still on oxygen with no paperwork. Of course the saddest are those pax who have been discharged and are 'going home for their final days' - it breaks your heart to offload them!!
Kris From United Kingdom, joined Mar 2006, 49 posts, RR: 0 Reply 20, posted (5 months 2 weeks 5 days 16 hours ago) and read 2689 times:
That's very helpful - I think in addition to our doctor's note I'll instigate a policy of looking on individual airlines' websites or calling them up just in case there are additional documents to fill in once the patient is cleared. We do that with British Airways at the moment (to download the INCAD and MEDIF forms), but I'd never seen documents required by any other airlines (Thanks Ozzy).
(Should be fun when working in an organisation that blocks websites concerning 'travel'... they even blocked A.net until I complained that I needed it for work purposes! A heated discussion with our IT department to follow I think!)
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