The following NASA ASRS report is from an EMB145 First Officer (#1291779) of a medical diversion that went poorly due to the Captain trying to rush their descent and landing. The first approach resulted in a go around and the second was an unstabilized approach continued for a landing.
While working this leg in cruise at FL300 about an hour out from our scheduled landing, me and the Captain could clearly hear a scuffle going on in the cabin. We looked at each other and were going to call back to the flight attendant but just before we could she called up to us and informed us that she had a medical emergency with a passenger having a seizure in row 5. The Captain (PF) said we will get the plane on the ground and hung up the phone and we got working on an alternate. Captain advised a landing in ZZZ as that was only about 40 miles ahead at 12 o’clock. I gave a quick thought as to whether that would be a suitable alternate and being that we have scheduled service into there and it was nearest practical I agreed and immediately informed ATC, they then immediately issued a descent. On the way down we were very saturated with calls from ATC and from the cabin passing back and forth information regarding the sick passenger and services required upon landing on top of the instructions given to us by ATC in regards to just flying the aircraft. The Captain was able to complete a diversion report and I was able to get enough time off frequency to get the ATIS, runway landing, landing speeds, determine that we would be underweight, and attempted to contact operations. In all of this scuffle we had been in a steep descent into ZZZ with the Captain unnecessarily taking his attention away from flying the aircraft. This led to us being very fast descending through 10,000 feet which triggered the high speed master warning multiple times. I gave a stern call for correction once and then again I said more abruptly that he needs to slow the plane down again of which he made a less than sufficient correction but we eventually were able to get down to a correct airspeed by about 8,500 feet.
It was about this time we had a break and I could read and complete the in-range checklist. We were all caught up by about this time although still in a steep descent we did a 360 to help get down with the help of ATC. But calls from the cabin started to come back again from both the flight attendant and a physician who was tending to the passenger when we were entering a very critical phase of flight and also with the sterile light illuminated. Again despite my best attempts to help alleviate workload for the Captain, he was task saturating himself and taking his attention away from flying the aircraft. I could sense his manic pace that he was attempting to use to get the aircraft on the ground and tried to alert him to slow down and relax but it did not seem to have effect. As we soon approached ZZZ airport I and the Captain lost situational awareness due to task saturation and unfortunately marginal conditions at the airport. Which were reported as very VMC but due to a large amount of glare from landing into the sun made it difficult to see the field of which we were attempting a visual approach backed up with and ILS NAVAID as had been briefed. The approach checklist had been completed but due to us loosing situational awareness we were a lot closer to the airport than we thought and despite the captains attempts at some steep S-turns there was just no way to make that approach happen and we did get a sink rate aural warning on approach. So we broke off to the right and the Captain asked me to request a visual approach to Runway XX, of which I obliged and the tower advised that it was closed. So I said how about left traffic for runway 9, tower said that’s just fine and cleared us to maneuver as necessary and cleared to land runway 9. I checked the winds to make sure the tailwinds were not excessive (which it was a 6 knot tailwind component) and made sure the Captain was comfortable with making that maneuver which he said he was.
From this point we made a left visual traffic pattern for runway 9 at about 1,000 AGL. I quickly gave the Captain a the ILS course and frequency for backup and hoped the approach would work out better for us. Unfortunately, the Captain again overcome by his emotion to get the aircraft on the ground tried to rush too quickly and cut the turn to base way to short. We rolled final at about 400 feet and received and aural sink rate and bank angle warning on short final. We touched down relatively on speed and in the touchdown zone but the approach was far from stable. We turned off the runway and were met by paramedics who pushed stairs up to the aircraft and tended to the stricken passenger. Both the Captain and myself were visibly shaken by the event. The passenger was taken off along with another passenger who had a slight injury while helping the man suffering from the seizure but he was able to get fixed right up and boarded the plane again. We did what we could to try to block out what happened and concentrate for our next leg to continue on to destination which happened without incident. The Captain told me later on that he had never had a medical emergency on one of his flights before.
There were a lot of threats on this flight but as I see it the overwhelming factor that led to the undesired aircraft state was just the Captain’s inability to slow down and take his time. I tried to explain to him at one point that risking 50 lives is not beneficial to helping one life but it did not seem to take effect. Also the basic division of attention which allowed himself to get far too task saturated and stop flying the aircraft of which I was guilty of as well. Other threats were that: the Captain had never had a medical emergency before, the multiple and unnecessary calls coming from the cabin in a critical phase of flight, Marginal weather at our airport of intended landing, and lack of leadership in the cockpit. There were a couple undesired aircraft states that occurred during this emergency diversion due to factors listed above but the most prominent undesired aircraft state that I observed was the airplane landing from a very unstable approach. The go-around was on the tip of my tongue during that whole approach, but being the fashion the aircraft had been operated up to that point I feel it was probably safer that we were on the ground, but landing from an approach like that is something I hope to never do again and I think the Captain would agree with me we were both very disappointed in ourselves in how we handled this emergency.
In the future I will be much more vocal and assertive in taking our time and making sure there is one level of safety in an event like this to prevent undesired aircraft states like this one. I have had a few of these types of emergencies before and frankly have gotten mixed assessments from pilots in prominent positions in this company some saying to do everything you can to get that aircraft on the ground quickly and some saying the opposite. This may just be a position that is just left up to people and their opinions but after this event I realize just how bad things can go if you do not take your time and lose focus on the bigger picture.
There is quite a bit to unpack here. Let’s examine some of the main points:
Division of tasks during high task loading: Immediately after learning about the medical emergency, the Captain selected a divert airport that was very close. They had some 30,000 feet to lose within 40 miles. They also had a large number of tasks to complete before landing. The FO’s report indicates that they divided the task load to accomplish everything before landing. They don’t report on how they communicated dividing those tasks. When we don’t coordinate division of tasks, we default to dividing them quickly and spontaneously. Perhaps the Captain assigned some tasks to the FO while he chose to complete others himself. This is a commonly used technique among proficient airline crews. Each pilot completes their tasks independently and then the crew realigns their efforts as the workload eases. While this is a useful process for handling task overload, it relies on each pilot’s accuracy and thoroughness. A resilient practice is to verify each other’s task accomplishment after workload subsides. Often this doesn’t happen because the crew never reaches a low-workload phase. Most crews rely on checklists to capture the major items and hope that everything else was handled accurately, that missed items will prove inconsequential, or that anything missed will be discovered before it becomes consequential.
Continuous interruptions from the cabin: The FO expressed frustration with continued “multiple and unnecessary calls coming from the cabin.” This highlights the conflict between cabin procedures and flightdeck workload. The Flight Attendants don’t know how busy we are or how much their calls disrupt our workflow. They only know that their procedures direct them to keep the pilots informed. In the end, the pilots turned on the sterile environment indicator to stop the cabin interruptions.
Captain’s rushing: The FO expresses frustration with being unable to get the Captain to ease his sense of urgency and fly a safer profile. They made “stern” callouts to get the Captain to comply with safe aircraft operation. This problem persisted through landing. The FO vows to “be much more vocal and assertive” in the future. While this is important, every PM needs to prepare which responses they will use across the full range from simple callouts through interventions including assuming aircraft control. This FO’s indecision set the stage for the next point.
FO’s acceptance of the unstabilized approach and landing: The FO made a conscious decision to allow the second (unstabilized) approach to continue. This is a common feature of events like this. PMs make a “safety” determination when they judge that a profile can be guided to a safe conclusion even though it violates procedures. We don’t talk about this flightdeck dynamic enough – the gap between procedural compliance and “safe operation”. (See my book for an in depth discussion of the types of safety margins.) As pilots, we perceive that we have discretionary space to manage this gap. With most crews, we only apply this in exceptional situations (like this one). With other crews, these excursions into the discretionary gap safety margin becomes common, even routine, depending on the pilot personalities and company’s line culture. Notice how the FO reported, “The go-around was on the tip of my tongue during that whole approach…”
Practice and rehearsal: Notice how the Captain attributed their choices to the situation’s novelty (first time they had ever experienced a medical emergency). This is a defining aspect of the Master Class path. Master Class pilots study, imagine, and practice situations like this regularly. This improves the accuracy and speed of their actions and choices during the event and reduces the adrenaline factor (startle and surprise). In line flying, we have a lot of quiet time in cruise flight. Imagine if these pilots had imagined this kind of scenario and discussed the sequence of actions, the defining conditions, the division of roles, and the descent and landing process. This practice and rehearsal would have reduced the sense of urgency and guided a more appropriate response.
The big picture: A passenger seizure is a serious medical event, but it is rarely deadly – especially when the patient is attended by a qualified physician and Flight Attendants. There was every reason to make an expeditious descent and landing, but not one that warranted extreme measures. While I acknowledge that I make this assessment in hindsight, we generally know what constitutes the need for extreme speed – heart failure or severe bleeding. Baring these factors with a medical emergency, we should declare the emergency, gain priority handing, and make reasonable efforts to get the aircraft on the ground at an airport with capable medical facilities.
Please follow this post with your comments on the event and my analysis.
