# What would a pilot do if a medical emergency occurs slightly further from the destination than the nearest diversion?

Imagine a long-haul flight and that a passenger on board starts suffering from a heart attack.

At that very moment, they notice that they are 3 hours away from where they came and 3.$m$ hours, such that $m$ is some positive number, away from their destination. Also, assume that there is no other place that pilots can land other than the airports located at where they go and they came.

What are the pilots supposed to do?

• $m<1$ go on, $m>1$ return. What exactly is the question? Why are you doubting that a pilot will not go to the closest suitable airport in case of a life threatening emergency? – Sanchises Mar 2 '18 at 20:23
• @Sabschises Firstly, thank you for your answer. Secondly, I am in fact not doubting, but just trying to figure out whether pilots take the likelihood of survivability of the passenger experiencing a health problem necessitating immediate attention into account while making a decision. Now, another question is even though $m$ can be less then one it is still positive and I do not see why its being less than 1 matters. – Larx Mar 2 '18 at 20:27
• Welcome to aviation.SE! I'm not sure what you're asking here, because the pilots and crew aren't doctors and may not be able to determine accurately what's wrong with the passenger and therefore what the "survivability" is. Are you just asking if pilots always divert to the nearest airport, all other things being equal? – Pondlife Mar 2 '18 at 20:39
• @ Pondlife. Well, let me rephrase and generalize a bit. We are going to B from A and we are in such a situation that we are, say, 2 hours away from both A and B. Suppose that there are only two options. We can either go back to A or proceed B; the only difference is that we well know that it would take,say, 1 fewer minute to reach back to A than B. What should we do? In fact, the question is, if we will gain 1 hour by returning home, then it is clear that home is where we are going to divert. But, what if gain is minimal and still exists.So, basically, I am curious about the threshold, if any. – Larx Mar 2 '18 at 20:49
• Rephrased, short: "When approximately equidistant between two airports, how do pilots decide where to divert?" – abelenky Mar 2 '18 at 21:02

There is no hard-and-fast rule for what to do in an emergency, including a medical emergency involving a passenger.

The decision also is not an instantaneous one; while the flight crew evaluates and works on the medical emergency, the plane is constantly getting closer to the destination.

I suspect that when 3 hours from help, an extra 10, 20, or 30 minutes is unlikely to definitively change the outcome, and the pilots would likely choose to continue to the destination. If returning is 45 minutes or more closer than continuing, then returning to the origin starts to look pretty good.

The facilities available at each destination might factor into the decision as well: If they left Chicago OHare, and are enroute Port-a-Prince, Haiti, then its very likely that there are better medical services at Chicago.

Ultimately, its a judgement call dependent on many, many factors.

• BTW: There are relatively few places in the world where an aircraft can truly be 3+ hours from any airport. It could happen in the South Pacific and southern Indian Ocean, but not many other places. – abelenky Mar 2 '18 at 20:35
• @ abelenky As I said that was just a hypothetical question but you just taught me something I did not know, so many thanks! cheers. – Larx Mar 2 '18 at 20:40
• It’s also likely that in that scenario, crew will contact a station such as medlink who will be able to give medical advice. On longer flights with several hours flying time to nearest alternate, the aircraft will be equipped with resuscitation kits, and cabin crew will have some medical training, too. – Cpt Reynolds Mar 2 '18 at 22:10

Just as a supplement to @abelenky's good answer, there are some things to be taken into account that haven't yet been mentioned.

First, if you've been flying with a tailwind for 3.0 hours and the winds would be roughly the same, it's going to take you more than 3.0 hours to fly back along the same route, possibly a lot more than 3 hours.

Second, technically you can't just reverse course without getting a clearance to do so. You have to contact ATC and negotiate the course reversal. That could take several minutes, possibly a lot more depending on communications. The captain could, of course, decide to reverse immediately and negotiate the clearance later, but he would be risking a possibly dangerous reduction in separation from other traffic, and I doubt whatever the governing authority was would take kindly to risking a couple of plane loads of people for the sake of one individual.

Then, there can be special circumstances. For example, if you were flying Indonesian Muslim pilgrims to Mecca on a Hajj charter. I can't speak to current policy as I retired in 1999, but back then the practice was that once you were in the air, you did not turn back or divert for medical emergencies. There was always a doctor on board, and technically he could request a captain to divert to the nearest suitable, but in practice that was never done. It was expected that there would be occasional deaths, and we carried body bags for that contingency.

• Can you explain the reason behind this policy ? – Antzi Mar 3 '18 at 20:04
• @Antzi You can't get 200,000 pilgrims from Indonesia to Mecca in a matter of days if you accommodate diversions, and since the typical Indonesian pilgrim is elderly, there will be health problems. Plus, the belief is, as I understand it, that if you die while performing the Hajj, that's a direct entry to heaven. That apparently makes a death less problematical. I'm an atheist, not a Muslim, so I'm just parroting what I was told when I asked the same question you have. – Terry Mar 4 '18 at 2:15