Chest pain at FL380 with a mass above MLW
Two hours fifty minutes into a four-hour-twenty flight at FL380, a 58-year-old passenger reports severe chest pain. A doctor on board suspects acute coronary syndrome and asks for a landing within the hour. The nearest suitable aerodrome is 35 min away with a 3,000 m runway, an ILS and full medical services; the destination is 1 h 40 min ahead. Current mass is 68.5 t, MLW 66.0 t. Fuel on board is 9.2 t; cruise burn 2.4 t/h, and the descent plus diversion below FL200 burns 2.8 t/h. Fuel jettison is not installed. The overweight-landing procedure requires a maintenance inspection afterwards plus a conservative approach speed and a longer landing distance. Cabin crew report the passenger is pale, sweating, but conscious and talking.
1. Compare going direct with holding to burn down to MLW. Show the numbers.
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Excess over MLW = 68.5 − 66.0 = 2.5 t.
Direct diversion (35 min below FL200 at 2.8 t/h):
- Burn = 2.8 × 35/60 = 1.63 t
- Landing mass = 68.5 − 1.63 = 66.87 t - still 0.87 t over MLW.
Hold first, then divert: fuel needed = 2.5 t. If 25 min of holding at 2.4 t/h is flown:
- Hold burn = 2.4 × 25/60 = 1.00 t
- Then diversion burn = 1.63 t; total = 2.63 t
- Landing mass = 68.5 − 2.63 = 65.87 t - at or below MLW, a normal landing.
So the choice is 35 min to the diversion aerodrome with an overweight landing, or 60 min with a normal one. Holding alone direct to MLW would take about 62 min, which is worse than the hold-then-divert combination because the diversion burns fuel faster. Remaining fuel after the direct diversion is 9.2 − 1.63 ≈ 7.6 t, so fuel is not the constraint; time is.
2. Who decides, who must be told, and what does the overweight landing actually cost?
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The commander decides. He has authority over the aircraft and the final say on diversion and on accepting an overweight landing; the doctor advises on medical urgency, the company advises on handling, but neither can direct the aircraft.
Notifications: declare an emergency (or at least request priority) to ATC with the nature of the problem and the number of persons on board requiring medical services; request ambulance/paramedic attendance on arrival and passengers' disembarkation arrangements; inform the operator's duty office so the maintenance inspection and onward flight planning are prepared; advise the destination of the diversion so ground arrangements follow.
Cost of the overweight landing: it is a maintenance and inspection burden, not a structural prohibition - a heavy landing check, possible borescope/inspection of the gear and airframe, and the aircraft may be out of service for a period. It also carries operational costs: higher approach speed, longer landing distance (which is why the 3,000 m runway matters), higher brake and tyre energy, and a firmer touchdown technique. Against a possible heart attack, that is a small price - but it is not zero, so it should be a considered decision rather than a reflex.
3. Halfway through the hold the doctor says the passenger is deteriorating and now wants an immediate landing. What is the decision and what goes into the approach brief?
Read the worked answer
Land now, overweight. The calculation above was a trade of 25 min against a maintenance inspection; once the clinical picture deteriorates, the trade is a possible myocardial infarction against an inspection, and the medical risk dominates. The 0.87 t over MLW is handled by procedure, not by delay.
Brief should include:
- Performance: landing distance recomputed at 66.87 t with the actual wind, runway condition and any contamination, using the overweight figures and a conservative flap setting; confirm the 3,000 m runway still gives a comfortable margin; note the higher Vref and the extra energy to be dissipated.
- Technique: avoid a long float; a firm, positive touchdown to get the wheels spinning and the spoilers out; be ready to use maximum braking only when necessary given brake energy limits.
- After landing: clear the runway and stop where medical services can reach the aircraft; do not block the runway if a taxiway is available; keep the passenger comfortable and do not let cabin crew delay disembarkation of medical personnel.
- Crew resource management: assign the PM to run the checklists and communications, confirm the go-around decision is still available at any point, and record the commander's decision, times and reasoning for the report that will follow.