WATCH | Doctor sucks out urine of passenger's bladder on plane + what you should know about in-flight emergency protocols

2019-11-22 06:30 - Saara Mowlana
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Emergencies are unavoidable by nature, but what happens when you're mid flight to your dream vacay in the Maldives and an unforeseen medical emergency arises?

Luckily for one passenger with a bladder dilemma, a doctor was onboard that went to extremes to save his life.

READ: The ANC of how to fly a plane in an emergency

On a China Southern Airlines from Guangzhou to New York, an elderly man started complaining about extreme pain and swollen stomach about 10 hours into the flight, reports South China Morning Post.

Two surgeons on the flight were asked to help by the cabin crew, who ascertained that the man had about a litre of urine trapped in his bladder - and if it didn't come out his life would be in serious danger.

In the middle of nowhere, there was still six hours to go before the flight could land, and the patient was already showing signs of shock. The doctors ended up devising a system to pump the urine out of the bladder made up of oxygen mask tubing, straws and a syringe.

And the only way to pump it out in a controlled fashion was by sucking out the urine with someone's mouth - which Dr Zhang Hong did, spitting it out into an empty wine bottle.

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“It was an emergency situation. I couldn’t figure out another way,” Zhang was quoted as saying.

“When I saw that the man could hardly bear the pain any more, my only thought was how to get the urine out of his bladder.”

He did this for just over half-an-hour, and afterwards the patient laid down until landing to seek treatment from a hospital.

What you should know about in-flight emergencies

But what if there isn't a doctor on a flight with a medical emergency?

We got in touch with four of SA's top airline carriers and asked each of these airlines three questions regarding their in-flight safety protocols:

  1. What procedures are in place for medical emergencies during flights?
  2. What should people do when faced with an inflight emergency situation? 
  3. What does it take for a flight to turn around or be diverted should a medical emergency arise? 


South African Airways's Chief Medical Officer, Dr Nonhlanhla Sishaba, had this to say regarding our questions:

1. What procedures are in place for medical emergencies during flights? 

SAA ensures that their cabin crew are well trained, by trainers who belong to the Resuscitation Council of South Africa and American Heart Association, in level 2 First Aid, which entails that they can identify and stabilise unwell passengers suffering from any of the following conditions:

  • Minor ailments
  • Heart attacks
  • Fractures
  • Low blood sugar
  • And they can even deliver babies - during uncomplicated pregnancy. The airline does not encourage heavily pregnant women to travel – particularly without proper consultation with their OBGYN or medical practitioner first. The general rule is not after 

Sishaba said that SAA crews are also well as trained in the use of Automated External Defibrillator (AED) among other equipment. He added that the cabin crew are the first port of call in case of on-board medical emergencies.

The nearest available cabin crew member, once notified by the passengers about unwell passenger, is then trained to inform the senior purser (a leader of the cabin crew on board), who will in turn then inform the commander of the aircraft (the Captain).

A call or an announcement is then made requesting assistance from any current practicing medical practitioner (medical doctor, nurse or paramedic) that might be aboard the flight and able to offer assistance.

A call is also made to SAA doctors on the ground who are on call who are on standby 24-7 to offer assistance telephonically to whoever is assisting on board, be it a cabin crew member or any current practicing medical practitioner.

On all SAA aircraft operating, Sishaba added, there are also  three medical emergency bags on-board, namely a First Aid Kit, a Grab bag and a Doctor's bag with scheduled medicines (this is securely stored and access to it is through specific protocols). 

 2. What should people do when faced with an in-flight emergency situation?  

Sishaba said that in the event of an emergency, the passengers should promptly alert the nearest cabin crew member. And since the crew has the level 2 first aid training, they will know which steps to take based on the nature of the medical emergency.

Some of these steps include those outlined in the first answer in case a current practicing medical practitioner is required and aboard the flight. In the event no medical practitioner is available on board, other steps will be followed as part of our operating procedures under such circumstances.

SAA doctors on the ground, who are on standby at all times, will also be contacted to provide the required guidance. A value judgement will always be made based on individual the circumstances of each case and the severity of the emergency.

3. What does it take for a flight to turn around or be diverted should a medical emergency arise?  

For a flight to turn around (return to base) or to be diverted in a medical emergency, Sishaba explained, depends on the outcome of the clinical condition of the unwell passenger during the stabilisation process.

A determination is made to see if is it more feasible to make an air-turn back, continue to fly to the destination or to divert. If the clinical outcome is so urgent that it requires immediate attention, a diversion - which is informed by a number of other considerations - will then be authorised to save the life of unwell passenger.

In addition to saving the life of an unwell passenger, Sishaba concluded, the decision to authorise diversion to any point or destination takes into account the following factors:

  • the size of the airport
  • the size and weight of the aircraft
  • and the type of health or medical facilities available at the diversion site or country.  


As an overarching answer to the questions, Kulula told us that they encourage passengers to immediately alert cabin-crew of any in-flight emergency.

They also said that they ensure that all of their cabin-crew are highly trained to handle emergencies and will duly advise passengers on any appropriate action if needed. 

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Mango's Head of Safety, Tamzin Strauss, had this to say regarding our questions:

1. What procedures are in place for medical emergencies during flights? 

Mango ensures that their cabin crew are first and foremost trained as safety representatives of the company. Strauss added that as such their first point of call is always to reach out for assistance in the event of in-flight emergencies - even though basic first aid is a pre-requisite of their licenses.

Mango Cabin Crew also have access to a detailed manual that is kept on-board, that covers various procedures and provides an extra level of assistance to the crew on how to react in the event of various medical emergencies.

All of their aircraft also feature a first aid kit and a doctors bag available on-board should a doctor or medical professional be on-board a flight to assist in the situation. And, of course, the aircraft is also equipped with oxygen available on-board to assist with the affected passenger.

2. What should people do when faced with an in-flight emergency situation?  

Regarding what the passenger ought to do in these situations, Strauss said that it is dependent on the situation. A number of options are available to the Mango crew.

Firstly, if possible, a Senior Cabin attendee would need to ask the passenger questions and discuss all relevant information particular to their problem, medical emergency or situation.

This way the relevant information can be then used to determine the best course of action and, where applicable, the Captain of the flight can assist to make a judgement call.

3. What does it take for a flight to turn around or be diverted should a medical emergency arise?   

Should a serious medical emergency arise, Strauss said that the Captain of the flight will call in an emergency to radar or ATNS (Air Traffic Navigation Services) and ensure that the flight is diverted accordingly to the closest airport where adequate emergency services are available for the affected passenger.

Strauss added that the airline has found that most medical emergencies arise as a result of passengers being rushed in the day to make their flights and neglect taking prescribed medication as consequence; or they neglect to take it on-board as hand luggage and it is out of immediate reach for the duration of the flight.

They've also found it common among passengers who forget to eat and experience low blood sugar levels in the air and nausea.

It is very important for passengers to plan ahead when making any journey, regardless of the duration, and ensure that they have their medication, if they have prescibed medication, within immediate reach in the event of a medical emergency.


FlySafair Head of Sales & Distribution, Kirby Gordon, had this to say about FlySafair's protocols:

1. What procedures are in place for medical emergencies during flights?  

FlySafair said that they ensure their Cabin Crew is trained accordingly as one of the basic requirements for a Cabin Crew License is to complete an Aviation Medicine certification.

This equips the crew team members with basic medical aid knowledge to face medical emergency situations that are likely to occur on board and arms them with the skills needed to provide aid within the space constraints of the aircraft.

There is also an on-board first aid kit with basic equipment, which the crew are trained to use.

2. What should people do when faced with an inflight emergency situation?  

Regarding what passengers should do in the situation, FlySafair highlighted that the most important things to do are to alert the cabin crew of the emergency and then follow their instructions. It's important to keep out of their way while they perform their duties.

The only instance in which you should intervene is if you are a trained medical doctor, paramedic, nurse or First Aid practitioner, in which case you should make your skill set known to the crew.

FlySafair also pointed out that should the crew require assistance from a passenger they will request it.

3. What does it take for a flight to turn around or be diverted should a medical emergency arise?  

Turnbacks or diversions can and do happen for a multitude of reasons.

FlySafair explained that the Captain will always act in the interest of passenger safety and if the Captain understands and sees that need urgent medical attention is needed they will ensure that the quickest route to the nearest destination with the necessary facilities is plotted.

This can happen for any medical emergency. The only situations that Gordon said he has ever personally been privy to have been heart attacks - which doesn't happen often, but it has happened before. 

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