Sydney ophthalmologist Dr Tanya Trinh was one of three doctors on board Qantas Flight 2 from London to Singapore when a fellow passenger suffered a life-threatening cardiac emergency. Within 30 minutes, the specialists made the critical call to land the plane in Azerbaijan's capital city of Baku, in an effort to save the patient’s life. In this article, Dr Trinh writes about her experience and shares the lifelong lessons she learned.

WRITER Dr Tanya Trinh

Managing an inflight emergency was definitely not on my growing list of “To Dos” when I left London on 10 June 2025, having spent a productive three days at the American-European Congress of Ophthalmic Surgery... and visiting Azerbaijan was also never on my list of “Places To Visit”.

But what I experienced over just 72 hours was an example of crisis management done exceptionally well by the Qantas team and a testament to the Australian spirit from all of the 400 or so passengers who underwent this ordeal with us.

Six hours into the 13 hour flight from London to Singapore, we were sleeping soundly when we were awoken by the loudspeaker requesting a doctor’s assistance on the plane. I arrived first on scene with a fair amount of apprehension – it’s been a little while since I have had to attend a Medical Emergency Team (MET) call – and doing it quietly, so as not to disturb or alarm the sleeping nearby passengers in cramped and dimly lit conditions, was itself another challenge. I was swiftly joined by two lovely colorectal surgeons: Drs Hamish Urquhart and Stephen Tobin – who were excellent colleagues to work alongside and to whom I am so grateful to have shared this experience with.

The other challenge was realising that we were a mere 20 to 25 minutes from entering the airspace over Afghanistan, a region where we were told that, once within, there was no possibility of turning back nor landing – and the nearest place of safety was Mumbai, some three hours away. So we needed to make a decision, and promptly.

FIRST MOVES

We made the call to move the patient to the back of the plane, where we could at least perform a better assessment and stabilise her, and establish whether we needed to divert the plane. Having now been through the experience, I have a newfound respect for those operating within foreign environments (i.e. our paramedics and on scene emergency workers).

One of the marvels about operating within foreign environments is appreciating that necessity is the mother of invention. Where do you stash a used needle when you’ve just established intravenous access on a patient? Sharps bins are present for diabetic patients on the plane, but are static and located within the airplane toilets. One of the Qantas staff came forward with an empty wine bottle and sealed it afterwards, thereby making it safe for disposal and not a danger to anyone getting a needlestick injury during the madness and chaos of an emergency situation.

Where do you hang an intravenous (IV) line when you don’t have access to an IV pole? Bags of saline must be hung at a height to drive fluid by means of gravity into the veins of a patient, with the rate of flow being controlled by the bag height and various valves along the way. No pole? No problem – the staff rapidly innovated with a coat hanger that we hung off the latch of one of the cupboards in the galley.

And what happens when there is no bed for you to lie a patient on? We created a makeshift one, by lining the floor of the aircraft with blankets and a pillow. This not only gave us ample space to work on the patient’s arms (taking her blood pressure and establishing IV access), but also enabled us to use the airline seats as a platform to raise the patient’s legs when she felt faint. Trying to do all of this within the confines of a window-facing premium economy seat would have been impossible to do safely.

BACK TO BASICS

Simple things can trip you up in a medical emergency and sometimes we have to turn back to the basics. For one thing, listening to the heart sounds (Korotkoff sounds) through a disposable stethoscope on a flight is almost impossible, therefore making an accurate blood pressure assessment very challenging.

Instead, to get a hold of the blood pressure, we assessed how warm the patient’s peripheral limbs were, what the capillary refill time was (by watching blood rush into the fingers after firm pressure), and we watched the patient’s mental status like hawks for signs of deterioration or delirium. If you don’t have much of a blood pressure, you won’t perfuse your brain with the necessary blood supply needed to stay alert.

DOCTOR CAMARADERIE

One of the things that I appreciated most was the camaraderie shown by the two medical colleagues who joined me. Drs Urquhart and Tobin are such beautiful and gentle souls, and I am positive their patients benefit not only from their expertise but above all, their genuine care and kindness. I would certainly send my own family to them, having now worked alongside them (under pressured circumstances, which always tells you so much about a person).

It has been a while since I have had to attend to a medical emergency and every doctor knows that managing one alone is a huge mental load, especially within an everchanging and complex scenario. In a resuscitation situation in a hospital, the MET will break up into components, where a single doctor will be assigned to airway, another to breathing, another to circulation, etc. This is because tunnel vision is a very real thing – when you feel enormous pressure to get that one job right (such as rapidly establishing intravenous access to get fluids into a patient urgently), you may miss the fact that the patient has stopped breathing. Having more than one doctor present was therapeutic – not only for the patient, but for each of us.

Another thing that I didn’t expect to appreciate was the utility of smartwatches, which not only record your heart rate but also keep a track record of your usual baseline cardiac activity – inclusive of cardiac rhythms. While our patient was only wearing a simple smartwatch, it did allow me to understand that (a) she was usually very fit and (b) what we were seeing at the time on her watch was highly unusual for this patient and a sign of true distress. Taking photos on my mobile phone as a way to ‘time stamp’ each change in her stability or intervention was also incredibly helpful because we had so few hands on deck. Those watches are now on my Christmas list to get for my parents this year.

Some of the things I would add to the “on plane” arsenal would be an automated blood pressure cuff, or at least a better quality stethoscope, and a defibrillator that provides a visible rhythm at the same time to help doctors decide the best path forward.

On their way home. From left, Drs Hamish Urquhart, Tanya Trinh, and Stephen Tobin.

The patient’s smartwatch provided crucial information.

MAKING THE CALL

Making the call to divert an Airbus 380 and disrupt 400 passengers is a big, big deal and if I am completely honest, I do not think we truly appreciated at the time just how big a call this was for us to make, on behalf of Qantas. Given that the patient deteriorated at one point during our assessment, we did not feel confident that we would be able to last the distance to Mumbai – three hours was simply too risky to be without assistance if she deteriorated – and resources and supplies on the plane were very limited. And so the decision was made to land at Heydar Aliyev International Airport in Baku, Azerbaijan, which is situated between Russia and Iran.

This region of the world is known for its geopolitical instability and so the criteria for landing was to:

(1) find a safe territory that was friendly,

(2) that also had a large enough runway to safely land an A380, and

(3) that had a reasonable hospital system to look after our patient.

Our options were very limited – our aircraft was massive, and not many airports have the capabilities or capacities to handle an Airbus A380. This was especially driven home to me when we landed and I saw the stark contrast of the size of our aircraft next to the local airplanes at the airport – our beloved Qantas Airbus was some four to five times larger!

THE COMPLICATIONS CONTINUE

Of course when it rains, it pours, and this event was no exception. Once landed, we were able to perform a clinical handover to the incoming medical team and the patient was safely loaded onto a stretcher and whisked away to the safety of the nearby hospital. But... we weren’t to take offimmediately, as expected.

A routine maintenance check had to be performed for a warning indicator that had popped up on one of the engines during our flight, and there was no appropriately licensed engineer at Baku airport. Of course, safety is everything and so this meant that the correctly licensed engineer had to be flown out from London – which would mean a six hour flight for them – to inspect. It was reassuring to know that Qantas would go to that extent to ensure the highest level of safety. And if there was something truly wrong with the engine that would not pass inspection, a plane would have to be flown out from Australia because neither London nor Singapore carries ‘spare’ A380 Qantas planes.

This meant that all passengers had to be offloaded and within the space of a few minutes our Qantas crew had a new logistical nightmare on their hands – trying to find food, transport, and accommodation within a few hours for all of the 400 or so passengers on board. To rub salt into wounds, entry to Azerbaijan requires a visa, which would normally take three days – so the Department of Foreign Affairs and Trade (DFAT) needed to be involved to expedite this to three hours. Reliable internet access was extremely troublesome to establish, which hampered communications and visa applications. It was also Eid, a public holiday for Azerbaijan, so immigration officials were reduced to two individuals to process all 400 visas, and airport staffing was low. And, at that stage, we were also close to breaching the work hour safety limits for staff – without appropriate rest, the Qantas staff and pilots would not be able to fly us out the next day as anticipated – so they couldn’t be the ones on the ground to help direct ‘flow’ and assist with logistics. I must say a huge thankyou to the few Qantas staff who were flying with us (on their annual leave) who came out of the woodwork to lend their assistance.

OVER, ABOVE BEYOND

On that note, when I speak about the Qantas team members, I cannot tell you just how much I appreciated their efforts that day. Nothing was too much trouble. A plane isn’t a hospital obviously, and neither should it be, but the way they prioritised safety and efficiency above all else was exemplary. While in the depths of managing the patient, I saw out of the corner of my eye how they went out of their way to comfort the concerned partner of the patient and get them organised for the next phase of their medical journey, replete with snacks and drinks to take with them, and a blanket in case they were cold in the hospital waiting room. In healthcare this is so very, very important. The innovations and improvisations they came up with to sort out solutions were little touches of inspiration and ingenuity. And always, the service was provided with a smile and affability that underscored the fact that the Qantas team really does truly try to go above and beyond to provide for its passengers, despite extremely challenging circumstances.

And we were also really lucky that, for the most part, Australians are pretty seasoned, tough, and relaxed travellers and prepared to make lemonade. I say this cognisant of the fact that all of us had been seated within a parked plane on the tarmac for four hours, then another four to six hours in the airport awaiting visas, then another hour on the shuttle buses, then long lines to check into hotels that were on public holiday level staffing – and then back again the next day while the airport figured out how to process all of us and get us back onto the plane.

It was genuinely comforting to close the loop upon boarding with the news that we had made the right call for the patient and that she was safely receiving the serious and urgent care that she needed. Receiving that news – and knowing it was no false alarm – honestly made everything worthwhile.

As doctors, we were acutely aware that this disruption affected families with young children, elderly passengers, and travellers with pets and disabilities. We were so grateful that the good-natured Australian spirit we are renowned for prevailed and allowed what was needed to happen.

We truly appreciated everyone on board who either assisted or graciously took everything in their stride. And of course we were tremendously appreciative of the team at Qantas who took an enormous role in coordinating the care of not only that patient, but all 400 of us.