Interview question - part II

[Resume Writer]

Our aircraft are equiped with the defibulator (sp?) kits, so my answer would be go to the takeoff alternate, use the defibulator, and contact medlink.

I think this answer is closest to correct. However, I would add a few things that are probably common sense. Ensure the FA's ascertain whether there is an MD onboard the a/c to assist. Declare an emergency landing if that is the company policy (I am not sure what pilots do since I am not one).

Have dispatch (I presume) contact the Emergency Response team to meet the aircraft. Make an announcement for all the passengers to remain seated until EMS personnel got to the passenger and transported the individual off the aircraft. (of course, this comes from an FA perspective, having been through this situation before)

I actually had this problem in reverse. We were on final in SAN at 3 am; cabin was pitch black. I would estimate that we were about 2-3k off the ground. Passenger hits a call button and hits it again turning it off. Didn't think twice about it until the 3rd FA called me and said we had a pax who was unconscious with no pulse.

First thing I asked her was whether there was a doctor back in her part of the cabin. There was. I told her to hold on, as now we were about 300-500 feet off the ground. She landed in a passenger's lap.

Once on the ground, I had the 2nd FA go back to assist her. I contacted the FD and told them to have Paramedics meet us at the gate. I went back to where the passenger was, took a look at him and about died!

There he was, turning gray, blue lips and his head slouched forward. Weird thing was, the doctor put oxygen on him and he snapped back to life. After that, I thought I had seen enough for one day! I went back up to the front and opened the aircraft door.

The EMS personnel took the man to the jetway and the guy refused medical transport. No problem; we were covered legally. I will never forget this day. It was January 1, 1997.

I have had more medicals than I care to mention and have spoken several hundred times to Medlink. Flying a lot of nite flites, you get the geriatric crowd, usually all on high blood pressure meds. It truly got to the point where I would have the Flight Deck set me up with a pair of headsets and let me talk directly to the Medlink physicians.

After one such incident, the FD was just staring at me in awe. They said, "Man, you did that so well!" I just laughed and said that I had watched too much of the television show "ER" and that I was not really a doctor, I just played one on the plane!

Just my two cents...

Kathy

 

[Youneek28]

Wow

Dumb Question.

If the guy is having a heart attack on takeoff and you have no Defib onboard. He is dead. plain and simple. Take the body to the safe alternate so it dont stink up first class on the way to Hawaii.

If it is a heart attack a defib is his only chance, and a stretch at that...it has to be ON him within a few minutes or forget it...who's going to react that quick on takeoff? ...

Hopefully the F/A's?

I would hate for you to be the person to give me medical advise.

 

[TIS]

Some things to consider

I think this answer is closest to correct. However, I would add a few things that are probably common sense. Ensure the FA's ascertain whether there is an MD onboard the a/c to assist. Declare an emergency landing if that is the company policy (I am not sure what pilots do since I am not one).

First, let me say that the above quote is but the beginning paragraph of an important post because it tells us pilots how things will look to the folks in back - to the passengers and the crew. It points out that logistics can be complicated by the ordinary as well as the extraordinary when a situation like this arises.

What I'm going to add here is quite lengthy - it'll take two parts. You needn't read it if you're turned off by long posts, no matter how informative. Understand also that I do not advocate a degree of focus on the many and diverse issues that will paralyze you into inaction.

That said, here goes. I'm going to adjust this question a bit to add drama.

"You've just made captain, the plane is full including your father. The airport you just left went below minimums. The nearest airport with landing minimums is two hours away, and your father is having a heart attack; what would you do?"

The seemingly simplistic nature of this question belies its true depth and complexity. To begin with what you must recognize is that when you are asked a question like this it is probing for far more than just the answer to the question itself. It’s also going to reveal your command and asset utilization techniques as a Pilot In Command.

For anyone to suggest that diverting to an alternate that’s two hours away as flatly as has been suggested here, simply because it’s against the rules to land out of an approach you might attempt, is just plain ludicrous. It’s ill considered and reveals a great deal about the level of professional acumen thus far attained by a person who would answer this way.

Let me try to demonstrate why this is so.

First of all, whenever you are asked a question that places you in an abnormal crew situation, whether it be in a cockpit or not, you need to recognize that the question ALMOST NEVER contains enough information to adequately addresses the issues involved as a PIC. You MUST ask questions to gather as much information as possible so that you may make the most educated and reasonable decision applicable to the circumstances as you believe them to be. In short, what you are not told and hence, what you don’t know, is generally far more important than the core information contained in the original question.

By asking additional questions in response to the initial query, you will demonstrate to the interviewer(s) how you will think about your situation and utilize you resources as a Captain. That’s what they really need to see. Remember, you’re sitting in a tiny little room in the front of the airplane with no real contact with what’s going on in back. You need someone to be your eyes and ears so that you have the best picture possible before you go making decisions.

Let’s take a look at just how much you don’t know based on your phrasing of the question, which I have referenced again below.

“You've just made captain, the plane is full including your father. The airport you just left went below minimums. The nearest airport with landing minimums is two hours away, and your father is having a heart attack; what would you do?

What you don’t know is as follows:

With regard to the departure airport:
- WHY is the airport IFR? What is the obscuring phenomenon that has shut the place down?
- Did the weather require a takeoff alternate?
- What are the lighting and markings available for the runway you’d be returning to?
- What is the best approach that airport has to offer and what are the lowest minimums you could get there? In other words, what exactly does “below minimums” mean?
- Is a Category II or III approach available?
- What is the weather forecast at the departure airport? Will it be getting better soon?

With regard to potential alternates:
- Is the alternate mentioned closer or further than the destination airport for your flight?
- What is the weather forecast at the alternate mentioned? Can you reasonably expect to get in there if you proceed there?
- Do you have a takeoff alternate?

With regard to the aircraft:
- What kind of airplane is it?
- Is it Category II/III certified?
- Does it have an autopilot?
- How much fuel do you have?
- Are you over max landing weight?

With regard to the crew:
- You know the experience level of the Captain (you), or do you? Is this a NEW upgrade or a transition to a new aircraft as a Captain? In other words, are you an experienced command pilot?
- If you’re a brand new Captain, do you have 100 PIC in type yet?
- What is the experience level of the FO? In type?
- If the aircraft is Category II certified are the crewmembers also properly certified and qualified to conduct Category II operations?
- Do you have any other crewmembers either assigned to the flight, or deadheading on it who might be of some assistance to you?

With regard to the medical situation:
- Are there any medical professionals of ANY kind aboard who can examine the patient and provide you with better information than simple speculation?
- Is portable oxygen available?
- Does anyone know CPR? Can anyone be taught on the fly?
- Is there a defibrillator on board?

The original question contains 41 words. As you can see, there are at least 19 questions that are not addressed by the original question that can be probed that will help a Captain to make INFORMED decision.

Before we move on to an analysis of some of the questions it is also worth noting that the FAA does NOT consider medical emergencies to be the kind of emergency that warrants the exercise of PIC emergency authority as outlined in FAR 91.3. In other words, a medical emergency does not in itself justify deviating from FARs to meet the extent of that emergency. While declaring an emergency with ATC will indeed get you the priority you need to get back to the ground, it will not open the door to do anything you feel you need to in order to get the job done.

Continued in Part II

 

[TIS]

Some things to consider (Part II)

I won’t cover all the questions raised here but I’ll take a look at a few of the really important ones.

Q: WHY is the airport IFR? What is the obscuring phenomenon that has shut the place down?

This is important not so much because of what you might decide to attempt to do but rather because it might lead you NOT to attempt a return to the airport of departure.

If the IFR condition that you departed under was fog that would imply that winds were calm and that the condition of the runway was quite good. It might be a little slippery because it’s damp but that’s about it.

On the other hand if you were taking off in a snowstorm this would tend to imply that he wind is blowing, perhaps quite hard, and perhaps across the runway. It also implies that there is frozen contamination on the runway that could make control and braking of the aircraft difficult all on its own, let alone with a strong crosswind, once touchdown has occurred.

In the latter circumstance, it seems clear that a decision NOT to return is far more easily derived than if the weather problem were fog.


Q: What are the lighting and markings available for the runway you’d be returning to?

If the runway you’re returning to has snow on it the next question is how deep and can it be kept off the runway by plow equipment? If centerline lighting is NOT available, how will you know whether you are drifting from centerline? And what about edge lights? Are they above the snow enough to see them?

Finally, what will you see first as you break out if you attempt an approach? Does the marking and lighting of the airport assist you enough to even consider a return to the departure airport?


Q: If you’re a brand new Captain, do you have 100 PIC in type yet?

This one’s a real show stopper because, as I mentioned previously, a medical emergency does not constitute an emergency that justifies the exercise of PIC emergency authority. This means that of the high minimum Captain rules in the FARs and the Ops. Specs still apply, even if you declare an emergency. The way the question is phrased, you have no idea what the terminology “below minimums” really means. Whose minimums are we talking about here? If the Captain is still a baby Captain then he or she has to add 100’ and 1/2 mile to the applicable minimums for whatever approach is conducted.

So, the question is whether the minimums described in the original question are those that result from altering the published approach minimums for the high minimum Captain, or if they’re the actual published minimums for the approach.

If the minimums we’re talking about here are those that a baby Captain must adhere to then it’s entirely possible that an approach could be attempted and be successful. The crew is trained to handle at least Category I minimums, which could be as low as 1800 RVR. That the Captain is unable to USE those minimums is simply a regulatory issue meant to ensure that inexperienced Captains get a little savvy before they attempt more difficult procedures. The Captain has ALREADY demonstrated at least the minimum level of skill required to conduct the approach regardless of artificial adjustments that might need to be made according to the FARs.


Q: Are there any medical professionals of ANY kind aboard who can examine the patient and provide you with better information than simple speculation?

This is really important because of the nature of the proposed medical problem. Heart attack, when serious, can KILL the patient in FOUR minutes. If you can get a large turbine powered aircraft back on the ground and to a waiting ambulance in under four minutes, you’ve REALLY accomplished something, especially if you have to fly an approach.

You need expert advice before you can know whether ANY risk to everyone else on the plane is warranted. If the condition is deemed to be minor, delaying treatment could lead to an untreatable condition. However, if the attack is massive, the patient might already be dead, for all intents and purposes.

Getting someone to do CPR or field training someone to do it can buy you some time. What you really need to know though is whether it will be enough time. If there’s a defibrillator on board, use it. They have a save rate of over 90% because they render appropriate treatment earlier in the event than even paramedics might be able to, if they were there.

Hopefully you can see that this question is much more complicated than it appears to be on the surface of it. Quick, pat answers do not do this question justice and they don’t demonstrate what the question is designed to elicit from you: your command style and ability. Remember this as you answer questions that put you in tough operational scenarios that have serious up and downside consequences depending on how you choose to proceed.

There are numerous questions like this one floating round every flying club and FBO. Try taking them apart a little bit as I have here and you’ll see that there is always a better answer if you just think things through a little.

Be sure to think too about what I mentioned at the beginning of all this. You, as the pilot have to get he plane back down - somewhere - safely. The rest of your crew will be stuck dealing with the cabin situation PLUS the way you choose to handle it. Try to recognize the burden you place on them for what it is and let that help you to better decisions.

Hope this helps you out a bit!

TIS

 

[Resume Writer]

Tis,

Just so you know, the FA crew is trained in CPR, First Aid and, if the airline has them, AEDs. I said the word, "doctor" because that is what I would have preferred. (I am not talking a PhD here, i.e., Dr. Phil ) However, it can be any "trained" medical professional, such as an MD, DO, RN, or a Paramedic, (only those can use the EMK in the cockpit) or even an EMT. Medical license needs to be asked for to use the EMK. This is important in real life, not necessarily this scenario, as I had a woman who said she was an RN, when she really was just drunk and wanting to feel important!

I think the whole reason for this question is not just to address technical skills, but also CRM. They want to see if you can work as a team with everyone onboard; not just your fellow pilot.
Kathy

 

[TIS]

Tis,

Just so you know, the FA crew is trained in CPR, First Aid and, if the airline has them, AEDs. I said the word, "doctor" because that is what I would have preferred. (I am not talking a PhD here, i.e., Dr. Phil ) However, it can be any "trained" medical professional, such as an MD, DO, RN, or a Paramedic, (only those can use the EMK in the cockpit) or even an EMT. Medical license needs to be asked for to use the EMK. This is important in real life, not necessarily this scenario, as I had a woman who said she was an RN, when she really was just drunk and wanting to feel important!

I think the whole reason for this question is not just to address technical skills, but also CRM. They want to see if you can work as a team with everyone onboard; not just your fellow pilot.
Kathy

In order –

I know that the FAs are trained in CPR (as are the pilots) - on an airliner. This is not necessarily the case aboard a corporate aircraft and people have heart attacks on those too. In addition, aboard aircraft that only have one FA, that FA’s most pressing duty is safety and can be far better addressed if another individual can be drafted to help – as you well know from your experiences.

The contents of EMKs vary quite a bit too. What’s in them, as I understand it, depends on the liability (cost and otherwise) the company chooses to assume. Also, an EMK wouldn’t even be required on a Part 135 charter.

You are correct when you say that this question is about CRM as much as the nature of the situation itself. In a situation like this, if it comes down to it, the pilots will have to ignore what’s going on in the back in favor of the safe operation of the plane. Getting a sick passenger to medical aid may well take some fancy footwork and interruptions and distractions on the flightdeck won’t help. I think it’s important to understand that from a pilot’s perspective CRM in this scenario is about marshalling resources so that the front end of the plane can be separated – not insulated, mind you - as much as possible from the back end as quickly as possible.

The captain is in charge of orchestrating all of this. My points are not so much a pathway to follow as they are some things to think about before you ever have to deal with a real live problem. I raise them to illustrate things that will be inherently obvious to a crew in a real-life situation that would alter thinking and decision making in some dramatic ways.

There is much to be gained by thinking hypothetical problems through but it is important also to understand that hypothetical problems by their very nature do not immerse the one questioned in the full context of the question. They will have to dig - even if only a little – to get to a more accurate picture of what’s going on to know how to proceed.

Technical skill and technicalities do indeed play a role in the way a pilot has to address this scenario. In some ways, those issues have to be addressed before other CRM issues can be addressed. The medical nature of this problem alters this just a bit in that the top CRM priority is in getting the victim’s needs met by people in the cabin so that the flight crew is free to do the rest.

TIS

 

[Visceral]

All that being said TIS, what would you do? I've got to assume they won't give you 20 minutes to query them on one scenario.

 

[Resume Writer]

Tis,


I assumed my answer since this is posted on a regional board, not corporate or Part 135. The main things they are looking for in this question, or any other, is your ability to think on your feet, take control of the situation, and give the best possible answer given the scenario. Everything has to be taken into account.

Let me tell you a story about POOR CRM. We had a lady who went unconscious in the cabin. I told the 2nd FA to stay with her, called the 3rd FA to get O2, and I notified the FD. I asked the Captain to get me a patch to Medlink. I left the cockpit with the Medical Information form to fill out vitals, age, etc.

When I got back to the woman, a paramedic noticed the 3rd FA bringing the O2 bottle up and assisted us. It was great, because he did all the vital assessment for us.

After getting all the information, I went back to the cockpit to speak to Medlink. The Captain never made the patch. I was stunned! He said that since his wife was a Nurse, he had a good knowledge of these situations and the woman would probably be fine.

I reminded him that company policy dictated that we contact Medlink. He still would not do it. So, I asked him to at least have the EMS people meet us on the ground. He actually put us in a bad situation legally by his failure to follow company policy and could have caused damage to this woman by not letting a medical professional make that assessment. (in addition to the paramedic that helped us.)

He never came out of the cockpit on the ground to see about the woman.

When we got downstairs for the hotel van, he asked what happened to the woman. I said, "She died."

Kathy

 

[Mel Sharples]

I think TIS makes some good points. Very well thought out.

However, do you really think most HR types at regional airlines are looking for that kind of depth, or have the knowledge to understand that?

I'm not arguing the method. I think asking for more info is good because ultimately they want to see CRM, using resources, not jumping to conclusions, etc. while always keeping the most people safe you can. My problem is that if you get overly technical with some HR rep you might lose him/her along the way and scare them. At our company, most of the HR reps doing interviews are not long out of college. They are intelligent but not as up to speed on aviation terms or the latest and greatest CRM methods. They are looking for personality, teamwork, committment to safety, etc.

I agree with TIS in principle. But I caution that if you get too in depth, you may lose the interviewer along the way. NONE of these questions have a easy, clear cut solution and that is the point. They want you to think, and they want you to have to pick between the lesser of two evils. These aren't meant to be the kind of thing where you say, "Oh, that's easy. Land below mins and start CPR on the taxi in. What's next?" They want to see you think, reflect, but ultimately consider safety for the masses. TIS is correct in saying you don't have enough info and that asking a few questions is good. However, like another poster said, you won't get forever to gather info and make a decision. If you take too long, the HR rep might think you are a whack job or an indecisive pilot. Doesn't mean they are right, but remember who is conducting the interview.

Now if this is a pilot interviewing you, then it is a different story...



.

 

[TIS]

All that being said TIS, what would you do? I've got to assume they won't give you 20 minutes to query them on one scenario.

I can only say what I’d do in the absence of a company SOP and and the intricacies of dealing with a particular operating dispatch department. That said, I don't need 20 minutes but I do need some additional information as follows in the order I would want to know:

- Doctor or other medical professional on board?
- Defibrillator on board?
- Portable oxygen readied for victim?
- Anyone besides FA trained and willing to perform CPR?

I’d start by having the FO inform ATC of the medical problem and to begin the process of finding the best weather, enlisting ATC’s help find it. That puts the workload on them and he is free to continue to monitor the autopilot or hand-fly the plane. I’d have him let me know when he has some alternatives.

Next, assuming the answer to the first three questions above is “yes” I’d have the doctor hook up the defibrillator and set up the oxygen. I’d ask, but would not wait for, a medical briefing and updates from the doctor either in person or relayed through the FA. If there's no doctor/nurse I’d have the FA do it and try to enlist the help of another passenger. Defibrillators don’t require training to use. They’ll tell you what to do so anyone can be easily pressed into service so that the FA is free to monitor the cabin situation at large and report to the captain.

As what I have directed is implemented, communications with dispatch will be an essential next step. They will have their finger on the pulse of operations at that moment and may well have some good suggestions to consider. Ultimately the decision will be mine as to where the airplane goes so assuming that a viable course of action, considering fuel and weather requirements, is divined from the communications with dispatch, I’d direct the FO to declare an emergency and obtain a clearance to the chosen location. I’d ask dispatch to handle all the EMT details for our arrival. I'd back that up by having ATC do the same thing but dispatch has the advantage of mobilizing the internal resources of the company directly so I think dispatch is arguably the more potent initiative to take.

With those things accomplished, where you stand is as follows: You’ve placed yourself in a supervisory position with respect to the situation in the back and you have trained professionals acting in the best interest of the victim. You have involved ATC and dispatch and enlisted their assistance. You have determined the best place to proceed to, have placed yourself at the head of the line, and have begun the business of getting there. You have mobilized the resources of your company, ATC and the new destination airport to assist you all the way through your arrival. In short, you have done all you can. Your job now is to get the plane on the ground and the victim into the waiting care of those who will take him to more advanced medical care.

How it turns out depends on many factors, not the least of which is the gravity of the medical problem that precipitated the events we’re discussing.

TIS