Date: 201505
Local time of day: 1801-2400
Location: ZZZ.Airport, US
Flight conditions: VMC
Light: Daylight
Aircraft: Small Transport; Low Wing; 2 Turboprop Eng
Operator: Air Taxi
Operating under: Part 135
Flight plan: VFR
Mission: Ambulance
Flight phase: Descent
Airspace: Class E ZZZ
ATC / advisory: Center ZZZ
Reporter organization: Air Taxi
Reporter function: Pilot Not Flying; Captain
Reporter qualification: Flight Crew Air Transport Pilot (ATP)
Human factors: Situational Awareness
Anomaly: Flight Deck / Cabin / Aircraft Event Illness / Injury
Detector: Person Other Person
When detected: In-flight
Result: Air Traffic Control Provided Assistance; Air Traffic Control Issued New Clearance; Flight Crew Diverted
Contributing factors: Human Factors
Primary problem: Human Factors

Narrative: We accepted a transport request and were informed by our medical crew that the patient was severely sick.  This was evidenced by the fact that the departure was delayed for over an hour while the patient was stabilized for transport before leaving the hospital.  During our initial descent from cruise we were informed by the medical crew leader that the patient's condition had deteriorated and we needed to get him on the ground as soon as possible.  We quickly considered our options and elected to divert to an airport that was close; had good emergency facilities on the field and which the First Officer and I had recently flown into and were familiar with. We informed Center of the situation and requested that an ambulance meet us. We were cleared direct.  About five minutes later; the medical crew leader informed us that the patient had improved slightly and the best option for him now would be to continue to destination.  We informed Center of this change and were cleared direct.  A few minutes later; the medical crew leader informed us that the patient had gone into cardiac arrest and again requested that we divert.  From this point on the medical crew were fully engaged in CPR and attempts to resuscitate the patient.  We informed ATC and received a clearance direct to the diversion airport; which we were now in visual contact with.  We once again requested an ambulance meet us; and informed them of the patient's condition and age as requested.  We switched to tower frequency and were cleared for a visual approach and to land.  We had planned to taxi to the FBO to meet the ambulance.  However; on landing the fire and rescue services were waiting for us.  We exited the runway and were cleared to shutdown on the taxiway to allow the emergency services onto the airplane.  Our medical crew were still performing CPR so I instructed a fireman to open the cabin door in order that they could assist.  CPR was eventually discontinued.  We remained shutdown on the taxiway for an estimated 45 minutes.  In general; the events; although stressful; went smoothly.  I was thoroughly impressed by the efficiency and helpfulness of the controllers; and by the response of the emergency services.  My First Officer; was the pilot flying and; although new to the aircraft and air ambulance operations; he did a wonderful job of remaining focused on flying the aircraft; despite the distractions of the medical crew's activities.  However; some issues did arise that deserve some thought.First; I did not declare an emergency.  It did not occur to me to do so as; being medevac; we already had priority status.  However; I learned afterwards that ATC did treat us as an emergency aircraft; clearing other traffic away from us.  Whether they declared an emergency on our behalf; I do not know.  Although it did not affect our handling in this instance; given a similar situation in the future; I will declare an emergency to ensure that the seriousness of our situation is communicated.Second; the airport fire and rescue services were somewhat surprised when; on opening the cabin door; they realized we were a Lifeguard flight.  They had the impression we were a non-medevac aircraft with a sick passenger.  It appears that all the details of our situation did not get communicated to them.  However; given the short time span between the beginning of our divert and our landing; and that the airport had not been expecting a medevac flight; this perhaps is understandable.Third; after resuscitation attempts were abandoned; a problem arose of what to do with the body. The fire and rescue services could not take it off our aircraft; I believe; initially the ambulance was reluctant to do so.  It took an estimated 20 minutes to resolve this issue (the ambulance eventually took it to the fire station). While this problem is perhaps more an issue for the medical crew; I believe it would be prudent for medevac pilots to receive training that covers these kinds of medical issues; just so we know what to expect. Just as we train new medical crewmembers on the aircraft; it would be useful for us to receive some training on what they do in the back of our aircraft so their activities are not a surprise to us.  (At one point; the medical crew leader alerted us to watch for an electrical interruption because of a procedure they were about to perform.  I did not understand what they were doing and it was only when I turned around I realized they were using the AED.) Such training would; I believe; help us recognize critical times for them; understand their needs at these times and; by learning some of their terminology; be better able to communicate with them and relay their needs to ATC.




Synopsis: A medevac Captain describes the events surrounding the transport of a seriously ill passenger that results in a diversion when the patient goes into cardiac arrest.