B757-200
Communication Breakdown; Workload
Deviation / Discrepancy - Procedural Published Material / Policy; Flight Deck / Cabin / Aircraft Event Illness / Injury
General None Reported / Taken
Company Policy; Human Factors
Just as we were about to lose VHF contact with Canadian Air Traffic Control (and I was about to take my break) the aft flight attendant called up and said that there was a 16 year old autistic boy in row 12 that had become agitated and was screaming and crying.  His parents were barely able to restrain him.  His medication was evidently not working.  There was a doctor onboard who said that the medication that he was taking would not do much for this sort of anxiety.  The parents reported that this was the worst they had ever seen him.The parents reported that the boy had suffered a seizure two days prior and had vomited a few minutes ago.  The doctor was requesting access to the onboard medical kit; which contained a couple of drugs that should help.In order to get more help in the cockpit; I had the flight attendants wake up the other pilot so that there were now three of us to handle the radios and the flying duties.The main problem for us was we were about to lose VHF radio contact and begin the Oceanic portion of the flight.  Thus began an hour long struggle to get a phone patch to the doctor network and our dispatch office.  The HF was not working very well due to atmospheric conditions affecting all the phone patch frequencies we tried.  We talked to an A-330 up north of us that had a SAT phone and he relayed some of the information to dispatch; but we really needed to speak directly to dispatch and the doctor network.  In the meantime; the patient was beginning to get out of control and causing some havoc in the back of the airplane.  The doctor waited as long as she could; but as we were unable to get through to dispatch; she went ahead and administered what was basically Super [antihistamine].By now we were within 45 minutes of our Equal Time Point.  Tonight; because of the weather in the Azores and turbulence to the north; we had only two alternates--Goose Bay in Newfoundland and [our destination]; both the Azores and Iceland were out.  Thus; we were fast approaching a point where we would be unable to turn back and it would be quicker to proceed to [our destination]. We finally found a frequency; after looking through several manuals and at the useless Quick Reference Card; that would allow us to talk directly to dispatch and the doctors and made contact with them although the conditions were very difficult.  They authorized what the doctor had already done and we began to discuss diverting back to Goose Bay or even somewhere closer like St. John.Finally; just before the Equal Time Point; the flight attendants reported that the patient had started to calm down as the [antihistamine] kicked in and the decision was made to proceed.  Dispatch would call ahead and alert [our destination] that we were requesting non-emergency priority handling on our approach and that we were requesting medics; but no ambulance; to meet the plane.So things finally settled down a little.  My break time was almost over; so the remaining pilot and I split the time of the next break and I went back for a short 30-minute nap.  While in the back; I spoke with the doctor and checked on the patient and things seemed quiet.After my break and as we were passing the Azores; we again got word that the patient was becoming agitated again.  The doctor reported that he was also having what appeared to be an allergic reaction to the [antihistamine].  This brought up a new set of problems as now his airway was in question.After trying unsuccessfully (language barrier) to explain to Santa Maria Oceanic Control what was going on; we were switched to [our destination's] Control as we neared Europe.  We were now requesting an ambulance meet the plane so as to get him to a hospital immediately.The situation in the back continued to deteriorate with the patient becoming more agitated and the doctor worrying about his airway as we began our descent into [destination].  I had the airplane going as fast as it would go despite the restrictions on speed that we would normally observe.When Approach Control asked our speed and told us that we were overtaking aircraft in front of us; I [stated the nature of our situation].  [ATC] immediately cleared us direct to the outer marker and for the ILS approach into the airport.  I held the speed as high as I could until I had to slow it down to hit the FAF at the proper speed and configuration.After landing; we kept the passengers in their seats until we could get the boy and his folks off the airplane and into the terminal where the medics were waiting to give him something to counter his reaction.  People do not realize how far from help and the physical problems of transoceanic flight and put us all in situations that cannot be easily resolved.I am sure that this is not the sort of thing that you want to read; but I would be derelict if I did not state my opinion on how needlessly hard this incident was and the unnecessary stress we endured because of the way the company has transitioned discarding best practices in favor of the old; 'We've always done it this way' approach.I am really disappointed that [this merger has taken us] back 15 years.  The information we needed; which was once in one handy place; is now scattered between the Pilot Handbook; [Flight Manual]; and the [other manual].  The hour we spent looking for suitable frequencies and establishing contact might have been the difference between life and death for that young man.  Shame on you for refusing to see a better way and insisting that we use procedures and manuals that are less safe than ones that worked so well for the end users.  And shame on you FAA for not seeing better procedures and manuals and forcing [airline management] to change to the better way.If this young man had really gone into anaphylactic shock and his airway closed how would we explain this to the stricken parents?  The underlying ancestor worship of the powers in the flight department that refuse to recognize better procedures; manuals; and training methods just because they were 'Not Invented Here' is not the way to [best handle the situation].
An air carrier Captain on an overwater international flight reported difficulty dealing effectively with a sick passenger in large part because of what he feels are less effective manuals that stem from bad decisions following a merger.