1. Home
  2. INFLIGHT MEDICAL EMERGENCIES
  3. Declaring an in-flight emergency – what happens next

Declaring an in-flight emergency – what happens next

0

Direct communications between aircraft rescue fire fighting (ARFF) and flight crews


David Bjellos
Contributing Writer

Medical

Determining enroute medical diversions is extremely important during the planning phase. Here is a technique using Custom Content on ForeFlight for a typical NAT-HLA crossing. Label your medical alternates and insert your notes as necessary. When needed, just tap on the label “Lajes- or Santiago- or Bordeaux-Medical,” and all your divert data and notations populate, including bearing and distance.


The topic of in-flight emergencies and our preparations for them is as old as aviation itself. Our Part 142 training schools have done an exceptional job of teaching airmen to identify the problem, declare an emergency, and then get the airplane on the ground as expeditiously as possible. What happens when we set the parking brake remains somewhat open to (often lively) discussion.

What support is available to us? Who should we be communicating our intentions with? Is an evacuation warranted? Much of our knowledge is anecdotal, but there have been some qualitative studies which will help the reader with what is available and how to ask for assistance at a critical time.

Communicating your intentions – how to declare an emergency

Credit to Mark Zee and the team at Ops Group for a very timely and important article on in-flight emergencies. If you’re a member, see the March 22, 2023 article and links on the subject. If you’re not a member of Ops Group and fly internationally, they are an invaluable resource for this subject and many others. Ops Group efforts at addressing this area have helped FAA review its terminology and we can expect a SAFO or InFO from them in the coming months for clarification on the Aeronautical Information Manual (AIM) guidance.

AIM Chapter 6 Section 3 defines what is expected of airmen. For those situations of distress, the signal “Mayday” should be declared 3 times. For conditions of urgency, “PAN- PAN” should be declared 3 times. However, these terms are not in common use within the US. There are numerous YouTube videos (eg, the National Cargo 747 departure from NRT [Narita, Tokyo, Japan], or Shamrock 12G departing MCO [Intl, Orlando FL]) of less-than-ideal communications during a critical time (an example of each from ATC and flight crew).

Statistical studies suggest that direct ARFF to crew communications using a discrete emergency frequency (DEF) can reduce the number of potentially unnecessary evacuations, lessen the injuries incurred from evacuation or panic, and reduce overall risk to flight crews, passengers and on-scene ARFF personnel. If time and conditions permit, you can ask ATC for the DEF and they will assist you.

At present, there is no centralized repository or database for these data for US or international airports. There is no requirement to request or utilize this option – it remains another tool available to the flight crew.

Equipment failure

Regulations, OEM directives, and required Part 61/135 training have prepared us for most contingencies, and they teach us to think in the abstract when a condition doesn’t present itself in the QRH or AFM. Once we determine if the situation is of an urgent or distress nature (PAN-PAN or Mayday), we can so state to ATC and ask for their assistance.

If you are given an option for airports, do you know the distinctions between their ARFF capabilities? Depending on your airplane type, it could make a significant difference.

For US airports which have scheduled commercial traffic (certified under FAR Part 139), the ARFF categories are indices based upon aircraft length. Most corporate aircraft are Index A or B (< 90 ft for Index A and 90–126 ft for Index B).

ICAO defines them via code/number and designates the service RFF (rescue and fire fighting). For example, a G650 is RFF Code 6, an Airbus A380 is Code 10. (See ICAO/FAA format graphic.)

While it is not critical to memorize these descriptors, it is important to understand the capabilities at your destinations – and probably more importantly at those along your route of flight. The bigger the index or number, the higher the level of emergency services and capabilities. Preflight planning for diversion alternates could favor one airfield over another in this regard.

Once you declare your situation, you may state, “Request equipment on arrival,” or similar. At this point, our training providers are vague – and for good reason. This author spoke with more than a dozen airport managers, ARFF chiefs and local firefighters/first responders trained for Part 139 airport operations in the US, and to airport operations managers in the UK and Australia.

USA

Aeronautical Information Manual standardized hand signals for US NAS airports supported with ARFF.


signalsICAO differences in hand signals: (L) Emergency hand signal indicating location of a fire (right engine). (R) Fire in left engine or brake. ICAO hand signals for recommended evacuation, stop, and emergency contained are the same as FAA AIM guidance.


They all echoed the same response – each airport team (ATC and ARFF/RFF) develops their own protocols and responds according to their unique agreements. Which makes our task easier in one respect – let them deal with the problem and stay out of their way – but more demanding in another.

That other challenge is maximizing the synergy between aircrew and emergency responders when it is not clear if we should evacuate immediately. Teams were then asked if they felt that direct communications between ARFF and aircraft would be useful. They agreed unanimously, except in cases of clear danger of loss of life.

One sensible ARFF chief stated, “We both have the same goals – to save lives and cause as little injury as possible getting the passengers and crew to safety. Direct communications means that I can be your eyes and ears on the ground, and can help you assess the need to evacuate, keep them seated, and anything in between.

ICAO-FAAWe understand very clearly the responsibility of the PIC in deciding to evacuate or not – and we don’t want to interfere with that authority. We feel that synergy between aircrews and first responders can contribute to better-informed decision-making in real-time. Remember, we see more injuries in the evacuation phase than in most emergency or precautionary landing situations.”

In 2000, NTSB made a recommendation to FAA to establish a common VHF frequency for aircrew/ARFF communications, but it was never enacted. That recommendation was based upon scientific studies of accidents outside the US where direct communication benefited both parties.

mobile app

Shown here are selected airports from the MedAire mobile app showing travel and medical risks. This app can be populated with intermediary points and kept handy during flight if an emergency divert is indicated. Also, a great tool for trip planning and alternatives.


The UK has established a VHF frequency of 121.6 for BAA airports, and Australia has dedicated 131.0 for 16-plus airports in-country. Caution is advised at this point. Neither ICAO nor EASA requires ARFF or RFF to speak English. This is obviously a moot point within the US NAS, but should be kept in mind outside our borders.

Some US airports have DEF – eg, BOS (Logan, Boston MA) and CVG (Intl, Cincinnati OH) – as do DXB (Dubai, UAE), VIE (Vienna, Austria), and AMS (Schiphol, Amsterdam, Netherlands).

When talking to ARFF directly, their callsign is “Command”, eg, “Teterboro Command.” You will be talking directly with the “incident commander”, or ARFF-IC. Of interest and background, Massport (the operator of Boston area airports), FAA, and local ARFF conducted qualitative trials at BOS between 2003 and 2005 with a DEF for ARFF-to-crew communications.

The results showed that both sides benefited greatly from the dialogue. The overwhelming majority of incidents were airline-related, but the goals and protocols remain the same for GA and validated the NTSB recommendation. Here is a summary of the Massport BOS DEF trials from the participants.

Air Rescue Fire Fighting personnel (ARFF) are among the highest-trained first responders in fire rescue. They deal with the extremely limited window of time in which to evaluate/assess the emergency, and then make a determination on how to extricate the passengers and crew. They are trained in aluminum and composites, location of batteries and fuel cells and cockpit controls for shutting dow engines and APUs should the flight crew become incapacitated. The US NAS and FAA airports are populated with the most highly trained and equipped first responders worldwide.

ARFF-IC needs the following info from the flight crew:

Nature of the emergency. Conditions improving, static, or deteriorating.
Any injuries. Any non-ambulatory pax.
If smoke in cabin or cockpit, smoke increasing, decreasing, or uncertain.
Has flight crew used fire suppressing agent(s) on engine or APU?
Intent of flight crew – stop on runway, taxi off, immediate evacuation, or request ARFF external assessment.

Flight crews need the following from ARFF-IC:

Updates on the exterior of the aircraft and affected area(s).
Smoke/fire visible? Contained, increasing, decreasing?
When and where ARFF discharges fire suppressing agents.
Both groups agreed that ARFF-to-crew communications worked most effectively when the emergency landing was planned vs unplanned (time being the discriminator). They also agreed that outcome quality was significantly improved by using DEF.

Medical emergencies

These can be far more serious in many respects than equipment failure, especially for corporate operators. Most readers are familiar with MedAire services, so we won’t expand on the basics – the vast majority of corporate flight departments are subscribers. MedAire also provides a similar service for large yachts and vessels.

Owners with both can access medical databases seamlessly between airplane and boat, and MedAire can maintain – if requested – confidential medical files for specific individual passengers or crew. MedAire maintains a robust catalog of worldwide medical service providers and can offer recommendations when requested for a specific condition or ailment.

Enroute options for medical diversions

MedAire’s Digital Assessment Kit (DAK) contains a 12-point ECG hookup and provides MedAire physicians the same diagnostic tools as they have in their hospital ER environment. This, along with a pulse oximeter and digital glucometer measurements can allow doctors a greater range of metrics for recommendations on treatment, diversions or continuing care. The widespread use of inflight WiFi will enable these tools to add significant value for flight departments wishing to provide the highest levels of medical care and support to passengers..

Outside the US NAS, having a closer look at your options along your route of flight is mandatory. The number of long-range, large-cabin aircraft operating internationally is growing faster than at any time, and it is critical that we have a good idea of options and alternatives. MedAire can provide an operator with a list of options for medical alternates along a planned route.

They have 35-plus years of information and maintain an active database of hospitals best equipped to service a cardiac event, stroke, etc when needed. The most common ailments are: gastrointestinal (GI); cardiac (heart attack, arrhythmia); vascular (stroke); and loss of consciousness (LOC).

Thanks to the widespread use of inflight Wi-Fi, MedAire offers a variety of diagnostic tools. One of great interest is a device called a digital assessment kit (DAK), which has a 12-lead ECG recorder capable of providing the MedAire physicians with the same quality ECG data as found in a modern emergency room.

A trained crew member or passenger can apply the leads with an easy-to-apply torso sticker. This represents a huge advance in passenger support and care from previous devices. Like the basics of learning CPR and using AEDs decades ago, devices like the DAK (and future innovations) will be commonplace and improve acute and time-critical healthcare dramatically.

Two important takeaways

In practical terms, this article has 2 observations for your consideration. You don’t need to have Wi-Fi or a cabin attendant for success – just some foresight, planning for the unexpected, and the option of talking with highly-trained first responders once on the ground.

Equipment issues/malfunctions/emergencies. Time and workload permitting, consider asking ATC for a discrete VHF frequency for the ARFF on the field. Use the callsign “Command” after the airfield name, eg, “Teterboro Command.” ATC/Tower will be monitoring, so once you are stopped and assessing your condition and options, ARFF can provide a second set of eyes to assist in your decision-making process. They will be exceptionally helpful and supportive.

Medical issues. Without question, MedAire is the largest and most comprehensive provider of medical and security services for business aviation (and airlines, yachts, and private individuals). Consider a review of their website for MedAire 360 services and ask for a hands-on demonstration of their products. ER physicians can provide a very detailed written summary of diversions for specific medical conditions from their home base in Phoenix AZ.

Depending on your service provider, this summary can be added to your flight plan package, or added to the documents section of ForeFlight if you use this app. Many lives have been saved by this remarkable company.

For further information on ARFF DEF, see FAA Advisory Circular AC 150/5210-7D.


DavidDavid Bjellos has been writing for PP since 2004. He is an active airman flying a G650 based in south Florida, a former board of directors liaison to HAI’s UAS Committee, and a subject matter expert in VTOL ops.