Date: 201406
Local time of day: 0601-1200
Location: ZZZZ.Airport, FO
Aircraft: B737-900
Operator: Air Carrier
Operating under: Part 121
Mission: Passenger
Reporter organization: Air Carrier
Reporter function: Dispatcher
Reporter qualification: Dispatch Dispatcher
Human factors: Situational Awareness; Time Pressure
Second reporter function: Pilot Not Flying; Captain
Anomaly: Deviation / Discrepancy - Procedural FAR; Deviation / Discrepancy - Procedural Published Material / Policy; Flight Deck / Cabin / Aircraft Event Illness / Injury
Detector: Person Dispatch
When detected: In-flight
Result: Air Traffic Control Provided Assistance; Flight Crew Diverted
Contributing factors: Human Factors
Primary problem: Human Factors

Narrative: After an unscheduled landing due to a medical emergency; I released the continuation flight using domestic fuel reserves. There were so many different issues that I was dealing with associated with this diversion that I missed making the change to reserves in the flight plan request. I did have an additional 1;763 LBS of fuel on board for any contingencies which was more than adequate to cover the approximately 830 LBS difference between domestic and flag.


Second narrative: The A Flight Attendant called and told us a 5 year old boy was having stomach pain and that they'd keep us posted. About 5 minutes later she called again and told us the boy was screaming from pain and they needed Medlink. My First Officer had already looked up the frequencies and at that point sent an ACARS with the request for a Medlink patch. For some reason the frequencies weren't working. We couldn't hear anything but static; even when breaking squelch. We kept trying Medlink and at the same time started asking ATC for the closest suitable airport with a good hospital. The Flight Attendant was calling frequently wanting to know why we didn't have Medlink on the line and wanted to know that we were in fact diverting. She said there were no doctors on board; but they had a nurse and the nurse suspected the boy was suffering from appendicitis. All indications from the flight attendants were that this was extremely urgent. We could not communicate with Medlink at all. Communication with Dispatch was slow and only via ACARS. I asked my First Officer to handle ATC and flying the aircraft while I went between ATC (for hospital information); the flight attendants; and Dispatch via ACARS. ATC told us the name of the closest and best hospital. I looked up nearest airports in the FMC and the next closest suitable airport in the US with a good hospital was 20 minutes further flying time away. The flight attendants called again saying it was urgent and they wanted to know why we hadn't got Medlink yet. I explained we had no comm. available and they again said 'we're diverting right?' By now almost 10 minutes had passed since the first Medlink request and we weren't getting anywhere with that; so I made the decision to get the plane on the ground as soon as possible somewhere that had a good hospital close by. We got a turn to our new destination; which was almost directly behind us and started down. We determined that we would be landing overweight so we declared an emergency and looked up our performance data for our weight. We had a 10;000 foot runway available to us; good weather; and light winds; now about 15 minutes away. I was concerned about the medical facilities there and ATC was our only quick method of communication so I asked them repeatedly about the medical capabilities there. Every time I asked I was assured that they had 2 good hospitals close to the airport and that an ambulance was already on its way. I wanted Dispatch input on the decision so I was sending ACARS messages as fast as I could; all while trying to keep the flight attendants in the loop with their frequent calls to the flight deck and trying to run all the checklists. The flight attendants were doing a great job with the minimal resources they had. I once again asked ATC about the hospital and this time a Supervisor came on and said he had had major surgery right there in one of those hospitals and that they were excellent. By this time we were about 40 miles away and we got an ACARS message saying Dispatch recommended an airport with better medical facilities. I was really torn at this point. I was very concerned about the boy. The flight attendants were telling me they and the nurse considered the situation urgent and the boy was screaming with pain; but the last thing I wanted was to put a child on the ground in a place with inadequate medical facilities. Just then an airborne Medivac aircraft that had been listening in came on and said [that Hospital] is where they take all their Medivac patients and that the facilities were excellent. Now I had 3 very reliable; separate sources (2 ATC individuals and the Medivac aircraft) with local knowledge and personal experience telling me the hospitals were excellent and capable. Based on this information and the urgency of the situation; my First Officer and I thought it would be unwise to fly; at this point; an additional 30 minutes to the next nearest medical facility. We had a 10;000 foot runway close by with good weather and good hospitals and an ambulance standing by; so I made the decision to land. I then told Dispatch of my decision and concentrated on flying (monitoring) the aircraft. My First Officer landed shortly thereafter doing a great job of landing smooth while at the same time not burning up too much runway. We then spent the next 3 hours getting all the paperwork and authorization and logbook sign offs required to depart. After multiple phone international calls with Dispatch; Maintenance Control; and Operations; and finally a conference call with most of these at the end to confirm everything was taken care of safely and legally; we departed. Our original flight was a domestic flight. About an hour after getting airborne after the divert; we got an ACARS message from Dispatch saying we all forgot the flight was now an international flight because we had diverted into Canada and we had departed with domestic fuel planning instead of flag rules. Coincidently; we had sufficient flag fuel reserves; we just hadn't planned it that way. An unplanned divert into a foreign country for a Medical Emergency into an airport not suited for this size of aircraft caused multiple issues. We spoke with multiple departments within the airline to address all concerns and in the end forgot that we now had an international flight planned to continue to our destination that was originally a domestic flight. This caused us to depart with domestic fuel planning instead of flag.


Synopsis: A Dispatcher and the flight crew involved describe a medical diversion to a Canadian airport. After the ill passenger is removed from the aircraft the flight is re-dispatched to the original destination; but international fuel reserves are omitted from the flight plan.