So it very much is a case by case analysis of balancing the urgency for one passenger with the damage to the environment (dumped fuel) + risk to other passengers for a heavy landing + risks to other passengers from imposing a delay (e.g. Another passenger flying to a surgery).
With due respect to a doctor, I've had an IV in my own arm and have seen an i-oss deployed on someone a few feet from me. The pain is not comparable, even when it is done by a expert. When it goes wrong and has to be repeated... The pain of i-oss needles has been much discussed in relation to the death penalty. They hurt.
My dentist told me about "pick a friend day" when they practiced injections deep into the jaw. Are there any med schools where students practice with i-oss needles on each other?
I've had a posterior shoulder dislocation, which requires one to be put under to reduce the dislocation. An on-site EMT attempted to reduce it not knowing it was posterior, and the pain (while excruciating) was nothing compared to unnecessary attempts on repeat injuries (anterior dislocations, which do not require anesthetic of any kind).
It's a great idea to introduce professionals to the experience of what their actions might feel like to patients. But they almost certainly are an approximation.
Some patients are so scared that they begin to cry even before the needle touches the skin, and they might subjectively be in great pain, but it's not due to the technique itself.
You can read a little bit more about the pain here: http://sci-hub.cc/10.1177/1460408611430175
If I were the FAA, rather than issue drills to flight attendants, I'd focus on perhaps preventing at-risk people from boarding aircraft in the first place. Or train cabin crews to identify situations before they need the in-flight crash cart.
I used to take allergy shots as a child, and was greatly surprised to discover how much less it hurt to stick myself than to have a nurse do it - obviously not because of any better technique (I was eight), but rather because, controlling for noxious stimulus, you experience less pain when you're the one applying it to yourself.
I have no real idea why this is, but would guess it might be related on the one hand to having less bandwidth free to experience pain because you need to concentrate on what you're doing, and on the other hand being in control of what's going on to a greater extent than in the case where someone else is doing it to you. I also have no real idea of how to find studies corroborating the anecdote in a more systematic way, but I strongly suspect they exist and hope someone here will do a better job digging them out of PubMed than I have.
In any case, if it's a choice between having an intraosseous needle or dying, well, bring on the drill! I still have a few things left to do in this life. But I've had broken bones, too, and the pain from such an injury is unique and astonishing in a way that leaves me in no doubt of how unpleasant an intraosseous needle would be.
I think you make a good point, but sounds like it was a tough call in this instance.
The nearest non-final destination for almost the entire flight is (a) pretty far away from the flight path anyway (b) probably not on anyones list of places they'd hope to end up in a severe medical emergency.
http://www.gcmap.com/faq/intro#definegc
Also, because it's so far from land, there are special procedures that need to be in place, see eg. ETOPS.
You can use this website to see the true flight path for the Johannessburg flight: http://dl.fltmaps.com/en [enter Atlanta and Johannesburg as the endpoints]
EDIT: Can't find an FAA source about distances to airport, but here's a related Wikipedia page. https://en.wikipedia.org/wiki/ETOPS
This is a true flight path, and it's much closer to the great circle: https://www.flightradar24.com/DAL200/ae190b1
Funny, I even have a family member who carries an epipen, I had to give her a dose of adrenaline on a plane once when the chicken curry turned out (unexpectedly) to have nuts in it: we ended up using her own supply, but you're right, it should definitely be stocked!
However, in these kind of situations, I don't think it's in the patient's best interests to avoid diversion. The algorithm should be: 1) sick vs not sick - this person was clearly sick (when an ER docs say someone is 'sick', they usually mean there is a non-trivial probability that they could die in the next 24 hours) 2) Could a delay in critical care treatment lead to a worse outcome for the patient? If so, I would argue that you have to advise diversion to the nearest airport with the required standard of medical care.
That means that it might be ok to advise taking one hour to get to a major city, rather than taking 10 minutes to land at a rural airfield with a tiny hospital nearby - that's a judgement call. The only reason not to divert that I can think of is the cost to the airline, and passenger inconvenience: both of those looks like really bad reasons if the guys gets worse again and dies on the plane, when they might easily have been saved if they had diverted to a nearer airport + hospital.
I agree with another comment regarding the difficulty of IV's, particularly in shocked patient. Ideally, the airline kits would stock intra-osseous needles (needles with a screw that are screwed into the bone of the shin or upper arm using an electric dril). It sounds brutal,but is probably not much more painful than an IV, and takes seconds to do with training. The crew could be trained to use them as part of their first-aid training - the training takes less than an hour, and it would probably make more difference to patient outcome than having adrenaline on board would.
I totally agree about speaking to the pilot in person when you have a critically ill patient - they know (or can figure out) flight times to the various possible diversion airports, you (probably) know better what kind of care the patient needs, and the chances of finding that kind of care in a given city.