Captains responsibility

[Dogma]

Being a Captain is a particularly challenging job on too many an occasion these days. I note the following story:

https://www.dailymail.co.uk/news/article-6201245/Family-arrive-inquest-girl-15-died-eating-Pret-baguette.html

A horrible situation for all involved and traumatic for the whole crew. I see the court is to take evidence from the Pilots and airline to establish whether a different course of action should have been taken by the Commander. Communications, weather, aircraft weight & position, etc, etc. all a factor but it serves to remind Pilots and Crew of the responsibility they undertake in the line of work. The Commander has to justify difficult decisions based on the safety and security of the whole aircraft and her passengers. Hope they are BALPA members

[wiggy]

...Hope they are BALPA members

This is obviously a tragic story but it strikes me the young lady was the victim of a chain of events and to some degree the crew were put in a difficult situation because of the decisions and actions of others. As I understand it ATM we are talking about a coroner’s court and I don’t yet see the need for a call of arms to the Union.

In defence of the crew, if they need one: if the cabin crew acted iaw with their medical training (which would have included dealing with the victim of anaphylactic shock) and the captain had time to obtain, consider, and if it was safe to do so, act upon whatever professional medical advice was available I’d expect the airline management (even at BA) to back them up.

That said it would have been a horrible situation to try and manage.

[Rouretan]

I have been following this in The Sunday Times and The Times.

From the reports in the newspapers the incident occurred shortly after take-off. The articles state that a junior doctor was giving CPR. It is is difficult to understand why the commander continued on a 1h50 minute flight and did not divert to an en route airport of which there are many.

Isn't a Mayday, medical emergency, with medical assistance on arrival, normal procedure in such circumstances?

[megan]

incident occurred shortly after take-off The time line is important before anyone tries to stick it to the crew. She started feeling effects three minutes after eating the roll, which was prior to boarding, and took some allergy medication. They then boarded and thirty five minutes after take off they went to the toilet to use an epipen. It was at that point the cabin crew were alerted, after the lasses condition worsened. That is forty minutes after take off, not shortly after take. How long did it take for the doctor to assess the patient and what advice did he give the crew re a diversion? The coroner will assess all. The lesson to take from this is, if you are allergy prone and suspect you are having the beginnings of an attack, don't place yourself in a position where medical assistance may be difficult to access. It's a great pity that such lessons come at such great cost, a young lass with the world at her feet cut down.

[wiggy]

The time line is important before anyone tries to stick it to the crew.

Agreed megan..for example the LHR-NCE sector is typically around 90 minutes (runway to runway) so without knowing exactly what was said and exactly when it was said I think it is wrong to start drawing conclusions about decisions to return/divert/continue to destination.

[Dct_Mopas]

The article states that the flight landed 50 minutes after CPR was started. 50 minutes! Over mainland Europe.

If that is accurate then some big questions will be asked at the he inquest regarding what information/ when the flight crew were informed, and the decisions made during this period.

[wiggy]

So far a lot of what has been reported in the UK press has come from the family, either by way of press releases or statements to the coroner. I don't know if anybody from the crew or BA has been called to give their account to the coroner yet but I've yet to see any account in the media from any of the crew or details such as what time any calls (if any) were made to the airline''s medical advisors..

If I may hark back in part to a point megan made earlier..behind all this there is the whole issue that the chain of events that led to this poor girls death seems to have been precipitated by decisions and actions made on the ground by individuals not involved with the airline....maybe that needs to be kept in mind...

[BluSdUp]

Sorry to say , but a girl with known SEVERE allergy to banana, milk products, nutts and sesame seeds should under no circumstances trust any food purchased at an airport terminal before boarding a flight shorter then , say 25 minutes.
Every second month I have someone faint or become ill. Always ready to be on the ground within 15 to 25 minutes if needed. Except on the Canary flights were at times 40 to 50 minutes is needed.
I suspect this flight was close to its destination when thing got critical.
A sad thing this is for all involved.
But like all the 1000s crash reports I have read, always something to learn.
Regards
Cpt B

[arketip]

Sorry to say , but a girl with known SEVERE allergy to banana, milk products, nutts and sesame seeds should under no circumstances trust any food purchased at an airport terminal before boarding a flight shorter then , say 25 minutes

Are trying to say that she somehow deserved it?

Always ready to be on the ground within 15 to 25 minutes if needed. Except on the Canary flights were at times 40 to 50 minutes is needed.
I suspect this flight was close to its destination when thing got critical.

Not always possible

[wiggy]

Of course she didn’t ”deserve it,” but TBH as a parent I am really genuinely puzzled that anyone would go into an airport sandwich shop and buy an off the shelf product, regardless of labelling, when this applies to themselves or one of their family..(from the DM) :

“Her father detailed for the hearing how he and his wife had trained Natasha from a young age to study ingredients and allergens and how they had changed their lifestyle to protect her from allergic reactions.
Natasha was severely allergic to dairy, banana, sesame seeds and nuts, the court heard.”

I wonder if anyone here with family experience of this sort of level of allergy to food products is able to comment on how they manage dietary requirements when travelling by air?

[His dudeness]

Are trying to say that she somehow deserved it?

I think its rather unfair to deduct this from BSU's statement.

Q: why did the piriton and the 2 pens and adrenaline not work ? If an allergy is this strong and life threatening, then I think BSU has a point. What kind of info the commander did get at what time would probably have changed the landing site and thus time to hospital, but if the poor girl would have survived is another question.

What a nightmare for all involved...

[BluSdUp]

So , were in Europe would You , as Commander need more then 50 minutes to reach an emergency airport.
I help you out a bit .
The flightdeck just filled up with electric smoke.
With the exception of Greenland , Iceland and Svalbard I can always reach an airport in 50 minutes in Europe!
49 min to go!!

[Kerosine]

I have to agree. As soon as I know there's a severe medical condition that could result in permanent injury or death, subject to wx/airport suitability, I'm diverting. High speed, mayday, ambulance on arrival please.

The captain must have had some very strong reasoning not to divert into Chateauroux, Dijon, Lyon, St Etienne, Clermont Ferrand etc etc. Perhaps he wasn't told of the severity of her condition? Perhaps there were TS/CBs elsewhere?

I don't suspect we'll see all the details.

[Skyjob]

So , were in Europe would You , as Commander need more then 50 minutes to reach an emergency airport.
...
With the exception of Greenland , Iceland and Svalbard I can always reach an airport in 50 minutes in Europe!
London - Nice route: Paris, Lyon, Geneva, take your pick, all able to assist and with excellent facilities.

[wiggy]

.....

The captain must have had some very strong reasoning not to divert into Chateauroux, Dijon, Lyon, St Etienne, Clermont Ferrand etc etc. Perhaps he wasn't told of the severity of her condition? Perhaps there were TS/CBs elsewhere?

I don't suspect we'll see all the details.

I suspect we’ll get enough eventually. With reference why he/she didn’t divert into XXX or YYY we as yet only have one account of timings and no evidence yet from the crew as to what they perceived and how communications were handled so maybe it would be wise to hang fire on questioning why the captain didn’t immediately divert into somewhere enroute. I guess one possibility is that by the time the captain was made fully aware of the gravity of the situation it is possible they were approaching TOD for NCE anyway, but that is just speculation on my part. I suspect all will become more clear when he/she gives evidence to the coroner...and as you say we haven’t even had the METARs or TAFs or NOTAMs yet...

(I’ll just add and state the blindingly obvious - having seen something serious and life threatening on a Longhaul Flight these situations aren’t always as straight forward as some Monday morning quarterbacks like to think..We were strongly advised by medics to overfly the nearest alternate to get to somewhere else with much better facilities that were much more likely to save life.....now that would have looked like an odd one in the press or to a coroner until explained).

edit to add update from The Evening Standard here:

https://www.standard.co.uk/news/uk/pret-inquest-chain-logged-six-cases-of-sesame-seed-allergic-reactions-before-teens-death-a3945466.html

[172_driver]

Not sure about you,

But in circumstances like these (medical, or other), I as a pilot would much prefer an open flight deck where I can go out and see for myself, talk to the people involved (cabin crew, doctor, passenger) and judge it from there. All too often I feel the communication through the intercom is slow and not always clear.

[sycamore]

Don`t the cabin crew have `walk-around` oxygen sets` for such emergencies...?

[underfire]

Not making excuses, but...

Not sure how one could miss sesame seeds on the crust....

Piriton, adrenaline, and 2 pens ?..you OD after 2 AND adrenaline (in reality, the 2 pens may have caused the heart attack)....it is unlikely that a diversion would have mattered.

[TolTol]

I have to agree. As soon as I know there's a severe medical condition that could result in permanent injury or death, subject to wx/airport suitability, I'm diverting. High speed, mayday, ambulance on arrival please.



That’s an easy decision to make if your told right away there’s a severe medical condition onboard, so I don’t see your point.

[megan]

Not sure how one could miss sesame seeds on the crust They were not on the crust, they were embedded within the bread.

[underfire]

They were not on the crust, they were embedded within the bread.

Embedded in the crust? I have seen bread before.

These are embedded
https://cimg4.ibsrv.net/gimg/pprune.org-vbulletin/643x589/sesame_seed_bread_2_5e79185b3015b69a2bbc293c150e83d7f40f682f .jpg


There is bread with sesame seeds and there is bread without. It is easy to tell no? trained to spot allergens? Pull it apart, eat a piece....ingredients are ingredients.

Let me ask you this, when you go to a seafood market, when you look at a piece of Cod, do you look for a sign that says "may contain fish" ?

"Allergen Warning: May contain Allergens" (you sort it out)

personal responsibility

[megan]

I thought the link given by the OP was quite plain on the matter. Seems the other side of the ocean is not familiar with the use of the word "within", or its meaning. In a statement read to court, the grieving father said: 'The sandwich was impregnated with sesame seeds, not even on top of the baguette and visible to the consumer but hidden inside the dough.'

[wiggy]

Don`t the cabin crew have `walk-around` oxygen sets` for such emergencies...?

Yes, bottles and also on some aircraft plug in access to an oxygen “ring main”, all done for medical emergencies and other reasons. Some reports do mention attempts were made to administer oxygen to the girl in this case.

After talking about this case last night with somebody who has nursed in a U.K. A&E (“E.R.” In some parts of the world) I now understand that given what might happen to the body in a case of very severe anaphylactic shock getting an oxygen cylinder plus mask on the victim and/or simple CPR might not be enough. The measures that are then necessary to try and sustain life need to be done quickly and are not part of cabin crew training, certainly not where I work.

[Cmon-PullUP]

As a Captain, this is - unlike many other cases - a very black and white case.
Over mainland Europe with someone slumping away, family on board who can tell about her general health and inform of her allergi, a diversion is called for.
Unless it is severe weather or Low Vis all over, or the area infested with hurricanes, it is possible to be on the ground within 20 min anywhere overhead Europe's mainland.

This is absolutely tragic on all accounts, and a diversion might not have changed anything, but not trying while flying where they were, is poor decision making.
Safety first.

[His dudeness]

As a Captain, this is - unlike many other cases - a very black and white case.
Over mainland Europe with someone slumping away, family on board who can tell about her general health and inform of her allergi, a diversion is called for.
Unless it is severe weather or Low Vis all over, or the area infested with hurricanes, it is possible to be on the ground within 20 min anywhere overhead Europe's mainland.

This is absolutely tragic on all accounts, and a diversion might not have changed anything, but not trying while flying where they were, is poor decision making.
Safety first.

So YOU do know when the Captain was notified and what exactly he was told ? Granted IF the father right away would have told cabin crew "she will die within
minutes" on the onset of her problems, and this info would have gotten to the cockpit crew right away, then it would have been a poor decision. But we don´t know that (yet). Given the self treatment first and the fact that a MD was on board will have had an impact on the decision making at the point WHEN the cockpit was informed.

Hindsight is 20/20

[infrequentflyer789]

Of course she didn’t ”deserve it,” but TBH as a parent I am really genuinely puzzled that anyone would go into an airport sandwich shop and buy an off the shelf product, regardless of labelling, when this applies to themselves or one of their family..(from the DM) :

“Her father detailed for the hearing how he and his wife had trained Natasha from a young age to study ingredients and allergens and how they had changed their lifestyle to protect her from allergic reactions.
Natasha was severely allergic to dairy, banana, sesame seeds and nuts, the court heard.”

I wonder if anyone here with family experience of this sort of level of allergy to food products is able to comment on how they manage dietary requirements when travelling by air?


Not a family member, but I know of a relative of a friend of the family with this sort of life threatening nut allergy. My understanding of their dietary management is that this person eats nothing that isn't self-prepared in their own kitchen with their own equipment. Ever. I don't think they get out much, do they travel by air? - unlikely I think, at all.

That approach is fairly life-limiting - but on the other hand that person is, as far as I know, still alive.

At some point you have to choose between merely staying alive and actually living. The balance of risk is very different when you have a serious medical condition. A "normal" person may pick a balance somewhere between "not getting on any type of aircraft that doesn't have 10yrs of in service safety stats" and "if you haven't flown a wingsuit you haven't lived". For other people, just getting on a plane to go on a "normal" holiday is the risk equivalent of jumping out of the plane wearing a wingsuit.

There are a bunch of dead wingsuiters, mostly young, what a waste - maybe we should ban wingsuiting... or maybe we should accept that they died because they lived.

[wiggy]

infrequentflyer...

Interesting, many thanks for taking time to post that.

[Kerosine]

That’s an easy decision to make if your told right away there’s a severe medical condition onboard, so I don’t see your point.

You stopped reading before my second paragraph. See below.

..... The captain must have had some very strong reasoning not to divert into Chateauroux, Dijon, Lyon, St Etienne, Clermont Ferrand etc etc. Perhaps he wasn't told of the severity of her condition? Perhaps there were TS/CBs elsewhere?I don't suspect we'll see all the details.
​​​​​​
That being said as soon as I receive a call of a medical situation developing I'm already setting up a diversion ready to pull the trigger. If it's looking like airways, breathing or circulation are involved, playing it safe, get on the bloody ground.

​​​​​​​Again, we don't know if much/anything was passed on to captain, and if not there's an explanation required by the CM.

[sycamore]

Thanks Wiggy....

[olster]

I read this report with horror. With cpr being performed a catastrophic situation has developed. Whether the communication was flawed or the captain did not have the dm skill set to initiate an immediate diversion....With the time frame you have ory, gva, lys etc. You have to try. It should be obvious to point at the nearest concrete runway. You could not argue that the aforementioned airports are not in close proximity to top level hospitals. Tragic.

[wiggy]

I read this report with horror.

For the n'h time.....the "reports" so far are daily updates from the likes of the Press Association who are reporting on an ongoing case in a UK coroner's court. AFAIK we have yet to hear the whole story from all those involved. According to the media proceedings are supposed to be completed by late Friday, by which point everybody ( family, medic, crew and perhaps others) will have been able to give their version of events to the Coroner and we may at last be able to get a more complete picture....

So we could wait for the full story (which is what the Coroner will do) ...or we could simply rush to cast judgement and possibly look pretty stupid.

Your choice.

[olster]

This is a rumour network, so what makes you the expletive deleted expert? A person has died, possibly preventable, conjecture is not unreasonable. I have actually been in this situation ( as captain ) and we were on the ground within 20 minutes - Paris Orly. If I were this girl’s parent I would want a few questions answered. Pompous bollox straight out of the pprune handbook. You were right about stupidity.

[Chesty Morgan]

Wiggy, does BA use Medlink/Medaire or whatever you want to call it?

[wiggy]

Conjecture having heard the whole story is not unreasonable.. I’m not sure dropping hints that the crew were deficient in the dm process or comms skills given what we know at lunchtime on Wednesday half way through the hearing is particularly helpful but as you say it is a rumour site....and if in the fullness of time we found it wasn’t optimal handled by the crew I’ll not be defending them...but TBH I don’t like lynchings on the basis of incomplete data..

Like you I’ve been “there” and had to handle similar in the real world so I guess even I am entitled to opinions on other people’s opinions......

[wiggy]

Wiggy, does BA use Medlink/Medaire or whatever you want to call it?



Yes, "BA" in general does..........( and before anyone asks the obvious follow up of "did the crew have the means or time to get their advice"... I guess that is another unknown that might perhaps become a known in the next few days).

[TopBunk]

When I was in BA, and I flew both Longhaul and shorthaul, MedLink was available, but was ronly really of any practical use in LH, using satcom, when you could actually speak to someone.

In SH, on the A320 aircraft, iirc, most did not even have hf radio, so to contact Medlink you had to use acars. It was just like trying to have a conversation via sms - ie absolutely pointless in an emergency. Indeed, I recall diverting in an emergency and being on the ground in 15 minutes in Europe with a very sick child. How did we decide to do that? By me as Captain and the Cabin Crew deciding that the situation warranted it - n outside or other on-board assistance. Were we right to do it - absolutely, the child survived after a lengthy stay in hospital.

Does this translate to this case, we don't know. Do BA SH still have the same facilities, or better, I don't know.

As others have said, it all comes down to the timeline and the quality of the information made available to the Captain from the cabin.

[Cmon-PullUP]

So YOU do know when the Captain was notified and what exactly he was told ? Granted IF the father right away would have told cabin crew "she will die within
minutes" on the onset of her problems, and this info would have gotten to the cockpit crew right away, then it would have been a poor decision. But we don´t know that (yet). Given the self treatment first and the fact that a MD was on board will have had an impact on the decision making at the point WHEN the cockpit was informed.

Hindsight is 20/20

Few people would be able to state that "she will die within minutes", and this is not the point. Having had to take the decision to divert for medical reasons a few times myself, this has nothing to do with hindsight. Having a MD on board is good, but they do not decide weather to divert or continue. Their advice is very valuable, but just because a MD (or someone claiming to be MD(?)) say it is safe to continue, doesn't mean you as Cpt should blindly follow that advise. Any doubt = divert.

If the CC hasn't told the flight deck at all about the situation, then they (CC) have failed to do their job, however it would be a very bad day for none of the 4+ crew to think about informing the pilots.
When a pilot is informed about someone going unconscious with an allergic reaction, then it won't take a lot of life experience to work out this is a potential deathly situation = get on the ground asap.

[infrequentflyer789]

infrequentflyer...

Interesting, many thanks for taking time to post that.

This may be of interest too - I did a quick search on sesame allergy for my own curiosity and found this (without much effort):

https://www.anaphylaxis.org.uk/wp-content/uploads/2015/06/Sesame-Allergy-2016v2.pdf

And in the "avoiding sesame" section we have:

In-store bakery products must be viewed as particularly suspect because these may be contaminated by sesame seeds from other bread. The seeds may not be obvious – they may be in the dough or on the bottom.

All I'll say is that I don't think Pret are particularly quiet about their stuff being baked in store.

[wiggy]

An account of today's (Wednesday's) proceedings (at least in part) here:

https://www.theguardian.com/society/2018/sep/26/coroner-teen-natasha-ednan-laperouse-allergy-inquest-concerns-food-pret-a-manger-labelling-rules

Towards the end of the piece there is some comment about the cabin crew response and within that narrative just perhaps one or two more clues as to the timescale.

[akindofmagic]

John Harris, the head of the cabin crew, now retired, said he could not get the defibrillator because his responsibility at that stage of the flight was to cover the plane’s front door in case of an emergency.
Natasha’s mother, Tanya, and 14-year-old brother, Alex, held their heads in their hands as Harris said: “Without wishing to sound harsh, covering the front door is a priority.”


Mario Ballestri, crew manager, said the defibrillator was not offered because by the time Natasha was in cardiac arrest, it was time for crew to take their seats for landing.

From the grauniad article posted above.

Covering the front door is "a" priority, certainly. However, in this case you have a girl who is clearly at imminent risk of death. A quick risk assessment should surely have been able to determine that the risk of an emergency requiring an evacuation was extremely low, whereas the risk of the girl dying without continued medical intervention was extremely high.

As a captain, I wouldn't expect the cabin to be "secure for landing" as per SOP, as this was clearly not a "standard" situation. I'd expect the cabin crew to carry on their resuscitation efforts throughout landing and taxi in.

I'm afraid I don't think that the BA crew in question are coming out of this very well at all.

[wiggy]

Classic command course discussion stuff...do you elevate even slightly the risk to the many to reduce risk/save the life of one?

The patient was receiving attention from a medic and was going to do so throughout the landing..

I'm not sure what the crew/door config was on this flight but it is possible on BA Airbuses that the Cabin manager would be the only cabin crew member covering the forward doors, the rest of the cabin crew are elsewhere.

As you say it requires a careful risk assesment....

[nicolai]

There's a well known human tendency to stop thinking about a problem and go along with someone else's leadership if they assume an attitude of leadership.

So in this case a fully qualified medical doctor was attending to the patient and the CSM may well have felt that he did not have to provide initiative any longer for the patient treatment. Therefore he was no longer in a mindset of proposing solutions and equipment for the "sick passenger" problem, and not in a mindset to mention the on board epi-pen and similar things. He was probably concentrating on managing the cabin in the aircraft, including such things as the strongly-trained need for security and safety management of outside and cabin doors.

Given the passenger had been given two epi-pen shots by then, I also have to ask how much a third would have helped. I'm not sure the inquest has addressed that question yet.

The doctor was clearly in a bad position as well - probably not entirely aware of the extent of the patient's active and severe allergies, minimal and unfamiliar emergency kit, trained in general medicine but not to a high level of emergency medicine which is a specialty in its own right, and so on.

Serious breathing problems can also be insidious in emergency situations. The patient is breathing, but clearly insufficiently, and is (in retrospect) in immediate danger of death because their condition is rapidly and inexorably deteriorating. However, second by second, the situation does not get very much worse and so the patient may appear to be in a serious yet stabilised condition, until they die. This is also how people die of serious asthma attacks despite active medical attention unless someone follows immediate procedures for very active intervention and has the right equipment to hand.

[megan]

Just thinking aloud, if you are in the process of having an obvious allergic reaction (the lass had taken medication shortly prior to boarding, so she obviously was aware) does she not hold some responsibility? A friend will go into shock if she comes into contact with kiwi fruit. Pavlova traditionally has kiwi fruit, dining out she asked for the sweet without the kiwi fruit. The staff just removed the kiwi fruit in the kitchen prior to serving, but of course the remaining traces was enough to send her into a state requiring the epipen. I know it must be hard for suffers to be so eternally vigilant, but.

Flying out of Dubai on a trip a young lass in front of us on the jetway looked as though she was under the influence of something, or otherwise not well. Taxiing out we came to a stop and spent 20 minutes burning and turning before returning to the gate. The young lass was off loaded and trip resumed.

A work colleague had heart issues and his doctor advised against overseas travel. He went anyway, and while in the US had symptoms that required medical attention. Rather than access the USA medical system and its attendant financial costs, he thought he'd fly home where costs would be much, much lower. Didn't make it, died on board the aircraft enroute. Hard job you guys/gals have to do at times.

[Shiny side down]

As a Captain, this is - unlike many other cases - a very black and white case.
Over mainland Europe with someone slumping away, family on board who can tell about her general health and inform of her allergi, a diversion is called for.
Unless it is severe weather or Low Vis all over, or the area infested with hurricanes, it is possible to be on the ground within 20 min anywhere overhead Europe's mainland.

This is absolutely tragic on all accounts, and a diversion might not have changed anything, but not trying while flying where they were, is poor decision making.
Safety first.

I'm so glad it is a clear case, black and white. I'll relate a tale from a few years back.

We had a passenger on board who was asthmatic, and was having difficulties breathing. The passenger in question was travelling home as part of a football team. The senior contacted the flight deck, expressed concerns about the passenger's health, and demanded a diversion.
We were expected by SOP to contact the company's medical service first (albeit we still had the choice to divert immediately if we deemed it necessary). We asked for some basic information about the patient/pax to pass along to the medical folks on the end of our HF patch.
The senior grew more and more anxious, as 'the passenger was turning blue, and they (cc) were giving oxygen'.
The time to diversion was about the same as reaching destination at this point.
The senior continued to demand a diversion.
We landed at destination ultimately, after getting a 'direct to'.
The ambulance met the aircraft, and the paramedics came on board to see to the patient.

The senior was furious.
The plane was offloaded.
The senior was then presented with a clear view of his previously 'terminal passenger' attempting to light up a cigarette, while hoisting one heavy kit bag over her shoulder, and disagreeing with ramp staff about smoking on the apron.

I then asked the senior if he still thought that we should have diverted for that passenger?

I'd hestitate to call the BA/anaphylaxis case black and white, as we simply weren't there, and we likely do not have all of the information that was available to the crew, the doctor on board, or the family.

[Cmon-PullUP]

I'm so glad it is a clear case, black and white. I'll relate a tale from a few years back.

We had a passenger on board who was asthmatic, and was having difficulties breathing. The passenger in question was travelling home as part of a football team. The senior contacted the flight deck, expressed concerns about the passenger's health, and demanded a diversion.
We were expected by SOP to contact the company's medical service first (albeit we still had the choice to divert immediately if we deemed it necessary). We asked for some basic information about the patient/pax to pass along to the medical folks on the end of our HF patch.
The senior grew more and more anxious, as 'the passenger was turning blue, and they (cc) were giving oxygen'.
The time to diversion was about the same as reaching destination at this point.
The senior continued to demand a diversion.
We landed at destination ultimately, after getting a 'direct to'.
The ambulance met the aircraft, and the paramedics came on board to see to the patient.

The senior was furious.
The plane was offloaded.
The senior was then presented with a clear view of his previously 'terminal passenger' attempting to light up a cigarette, while hoisting one heavy kit bag over her shoulder, and disagreeing with ramp staff about smoking on the apron.

I then asked the senior if he still thought that we should have diverted for that passenger?

I'd hestitate to call the BA/anaphylaxis case black and white, as we simply weren't there, and we likely do not have all of the information that was available to the crew, the doctor on board, or the family.





- So you will rather be "Sorry than safe"???
Having said that, as I read your post above, you actually wanted to divert(?) but decided it was the same time to destination as to a diversion alternate. (??) If that is the case, it will normally be faster to get a high speed straight-in to the destination, as all should already be set up and prepared for that.

But for me, yes, if someone cannot breathe and the crew is unable to improve the situation, I divert. My company is 100% behind this as well, so not really a difficult decision. LH is a different kettle of fish.

[wiggy]

Inquest adjourned lunchtime today, Coroner’s conclusions due tomorrow (Friday) at 10 AM U.K. time.

According to a Sky News reporter (and I paraphrase in part) the solicitor for the family wants more than a simple conclusion of accidental death and is effectively also asking for the “..coroner to issue a narrative conclusion with phrasing that highlights 2 key issues surrounding the case - was the baguette labelled correctly & should the cabin crew have acted differently during medical treatment mid flight”

[wiggy]

Coroner’s conclusions now starting to be reported in MSM:

https://www.thesun.co.uk/news/7369132/pret-a-manger-natasha-ednan-laperouse-anaphylactic-shock-ba-flight (https://www.thesun.co.uk/news/7369132/pret-a-manger-natasha-ednan-laperouse-anaphylactic-shock-ba-flight/)/

also:

https://www.dailymail.co.uk/wires/pa/article-6218293/Coroner-write-Government-death-allergic-girl-ate-Pret-baguette.html

And also:

https://www.theguardian.com/uk-news/2018/sep/28/pret-a-manger-gove-tighten-up-food-labelling-rules-teenagers-death-natasha-ednan-laperouse

From the Guardian Report, in part: ......Recording that Natasha died as a result of a “catastrophic anaphlyactic reaction from which she could not be saved”, Dr Sean Cummings, the acting senior coroner for west London said on Friday he would write a recommendation letter to Gove, the secretary for environment, food and rural affairs, that food information regulations should be changed.

He also criticised Pret for not taking allergen monitoring seriously.

Dr Thomas Pearson-Jones attended to Natasha after BA staff put out a request for medical help but the cabin crew did not tell him a defibrillator was on board. Cummings described this as an “omission” but said he did not think it made a material difference to the outcome.

Cummings also made recommendations with respect to the length of EpiPens.

[PDR1]

I heard on the news this morning that the problem was more complex than initially dexribed. Specifrically - the girl hadn't had any intention of eating at the airport because of the risks involved, but her flight was delayed for six hours which essentially left her little choice but to find SOMETHING to eat.

PDR

[wiggy]

If a flight lands an hour late at destination and then a passenger on that flight driving home hits a school bus and gets killed should the airline take the blame for that, because if the flight had been in time the school bus wouldn’t have been running?

BTW it’s interesting you say you heard a report this morning, it does seem that even post the coroner’s conclusions on Friday somebody is managing to make sure this case stays high profile in the media, especially in at least one Daily paper, though the target of those articles continues to be Pret and the UK’s rules regarding food labelling, not the airline.

[olster]

Wiggy, you should try to stop defending the indefensible. I agree that 'inept monkeys' is ridiculous and many airlines run late through ineptitude or other. However, there are serious issues here and not just speculation. Did the cabin crew inform the flight deck of the seriousness of the situation? Was Mayday called? At what the stage was the catastrophic and deteriorating situation known and if it was within range of a diversion airport why was an immediate diversion not initiated. I have a horrible feeling that the elephant in the room might have been the lateness of the flight and that may have influenced the flight crew (captain) DM. I hope that I am wrong

[Chesty Morgan]

I asked about Medaire previously as it could always have been their decision for the flight to continue to the destination.

[wiggy]

Wiggy, you should try to stop defending the indefensible. I agree that 'inept monkeys' is ridiculous and many airlines run late through ineptitude or other. However, there are serious issues here and not just speculation. Did the cabin crew inform the flight deck of the seriousness of the situation? Was Mayday called? At what the stage was the catastrophic and deteriorating situation known and if it was within range of a diversion airport why was an immediate diversion not initiated. I have a horrible feeling that the elephant in the room might have been the lateness of the flight and that may have influenced the flight crew (captain) DM. I hope that I am wrong

The decision to divert or not, cabin crew/flight crew comms were covered at the inquest where the crew were put through the ringer by the famiy’s QC, and for example the captain explained to the coroner why he didn’t divert, a reason which presumably the coroner accepted as valid or at very least not effecting the outcome.

As a result of hearing all of that the coroner reached his conclusions ....in which he actually commended the efforts of the Cabin manager...we are aware of that aspect of the conclusions..aren’t we?

Some here, having only read selected extracts, still insist that despite what the coroner (the legal official who heard all the evidence) decided this girl’s death is partially or wholly is BA’s fault. IMHO that probably says as much about some people’s attitudes and prejudices rather then me defending the supposedly indefensible.

I get it, I really do, it is the standard default for many here that if it involves BA in any small way it’s all BA’s fault.

[Derfred]

... there are serious issues here and not just speculation...
I have a horrible feeling that the elephant in the room might have been the lateness of the flight and that may have influenced the flight crew (captain) DM. I hope that I am wrong

Do you realise what you just wrote?

[wiggy]

I asked about Medaire previously as it could always have been their decision for the flight to continue to the destination.





Chesty..sorry missed coming back to you on that.

As I understand it (from MSM) the court was told that Medlink couldn’t be contacted quickly because the satcom on the aircraft was either inop or not even fitted, so getting hold of them would therefore either have involved an HF phone patch or really by some other means. By the time it became clear that external advice was needed the aircraft was close to Top of Descent for Nice and the captain wanted to concentrate on getting the aircraft on the ground, rather than risk getting distracted with what would probably have been very problematic comms via HF or relay.

BTW today is the first time I’ve heard the claims that the flight was 6 hours late.

[Chesty Morgan]

Cheers Wiggy, no worries. Hadn’t realised it had been discussed in court. HF can be a massive faff.

[WhatsaLizad?]

I've probably had 10+ events as Skipper on 737/757/767 aircraft regarding passengers reporting breathing difficulties. Fortunately I had great Cabin Crew and medical professionals present for all events and of those sick did not deteriorate further.

All did occur at cruise altitude, generally with cabin altitudes of around 8000'. One thing I did with all of these events was to descend to FL240 or slightly below to get the cabin altitude down to 3000' or lower. Maybe I got lucky or the portable oxygen had a bigger effect, but in all cases the reports from the cabin generally indicated that the sick passenger began to breath easier around the same time the cabin altitude stabilized at a lower altitude. Generally I didn't inform the cabin crew of the action until later.

This action of course depends on sufficient fuel available for the remainder of the flight. One descent required a climb back to the original cruise altitude to proceed to the destination or divert for fuel. Fortunately the passenger had no further difficulties.

Of course in most events, after arriving, most passengers were cleared as "OK" by the EMT's and were not going to be stopped from continuing onto their connecting flights. :ugh: