Nurse fury at Ryanair as woman dies on flight from Italy
 

http://www.unison.ie/irish_independe...issue_id=14689

Airline criticised over lack of 'basic' equipment for mid-air lifesaving bid

A NURSE who had to give unprotected mouth-to-mouth resuscitation to a dying passenger on a Ryanair plane has hit out at the lack of medical equipment.

Kate Douglas, who was returning from a holiday in Venice, rushed to the aid of a 24-year-old au pair who had collapsed at the rear of the plane.

But she said the Ryanair staff were unable to provide her with any latex gloves or a resuscitation mask.

"I was basically giving that girl who I didn't know, mouth-to-mouth CPR, exchanging fluids. I wasn't not going to do it, but it's not a nice position to be placed in," she said.

The medical emergency arose on the Ryanair flight from Treviso in Italy to Dublin last Friday. The captain of the plane appealed for any medical personnel to come forward and Mrs Douglas, another Irish nurse and an Italian doctor all responded.

Mrs Douglas, from Youghal in Cork, said she could not believe the plane did not have basic medical equipment, such as an airway device or an ambu-bag which is used to force air into the lungs of people with breathing problems.

"We were in extreme difficulty doing the CPR because we didn't have that. It was very distressing anyway, but then you just get angry because there wasn't even the most basic equipment."

The 24-year-old woman was lain across three seats and given CPR for around 40 minutes while the Ryanair plane was diverted to Charleroi Airport in Belgium.

She was given further medical treatment by the emergency services when the plane landed but pronounced dead shortly afterwards.

The other Irish nurse on the flight, Suzanne Scott from Malahide in Dublin, said she had written to the Irish Aviation Authority to express her concerns.

"They didn't have any type of airway equipment although they did provide us with an oxygen bag and an oxygen cylinder. The staff did their best but they didn't seem to have much competence in first aid or CPR - one air hostess said she was only trained to take a pulse."

A Dublin family, who were due to receive the young woman as an au pair, wrote an e-mail to RTE's 'Liveline' programme to express their shock at her death. It is understood that she died from a brain haemorrhage.

Regulations

Under European aviation regulations, all planes on short-haul flights must have first-aid kits containing a list of 24 items, including one resuscitation mask and two pairs of latex gloves. However, there is no requirement to have medical equipment such as airway devices or ambu-bags.

Ryanair said all of its aircraft were stocked with two security-sealed first-aid kits, as required under the regulations. A spokeswoman said the first-aid kits on the Treviso-Dublin flight did contain four sets of latex gloves and two masks but she could not explain why the two nurses had not been provided with them.

"As the cause of death of this passenger has yet to be confirmed, it is pointless to speculate whether any piece of medical equipment could or would have averted this tragedy. All of our thoughts and prayers remain with the friends and family of the deceased."

The spokeswoman added that all Ryanair staff were trained in CPR.

The Irish Aviation Authority said it would respond to the nurses about the concerns they had raised. "But it's a medical matter and it's not really an aviation matter to be investigated," a spokesman said.

Meanwhile, a Ryanair flight from London to Derry was forced to turn back last night after the captain collapsed with suspected food poisoning.

Passengers say they were around 15 minutes from Derry when the announcement was made and the plane was turning back to Stansted Airport.

The passengers were put on another flight.

Michael Brennan

That must have been back it the dark ages then. On a recent CPR refresher course (non aviation) I was given a small pack to take away containing gloves and a barrier mask. The nurse is absolutely correct.

Reminded of the "exposé" of cabincrew training by one of the locos on UK television some time ago. If some of the crew had gone through that the fact that gloves etc. were not provided could be explained,
I'm sure there was discussion of this here but can't find it, also I don't think it was Ryanair that featured.

From memory I believe that ryr use std boeing first aid kits.Little inadequate kits that look like they were bought at woolies , tacky standard of equipment. They are a joke. This woman would have stood a better chance on a UK registered carrier with Doctors kits and extensive first aid kits theraputic oxygen and defibs, ie something for everything. This is the IAA's fault not ryr. They let them carry these mickey mouse kits and dont legislate for better equipment.Quite frankly their First aid training is a joke as well. But again the fault of the regulator for letting them do it.

Surely the sham of dublin being their head office should be addressed and the CAA make legal moves to change the situation. :mad:

Kalium,

Might be worth considering updating your first aid certificate as the aforementioned items are a must! A one-way valve and a pair of gloves are considered essential and, I would have thought, common sense!

Another example of them playing at aviation as opposed to doing it properly.

Df1,

They may be a 'must' in some eyes, but not essential in the requirments of doing CPR - they are required on courses and recommended.

They are a must to most 'sensible' first aid practitioners, but not essential. gloves and barrier do not prevent the first aider from providing the same level of cpr as they would be able to give with them.

farty flaps

depends on what her condition was whether your statement is true.

Defib machines are not the be all and end all, too many people get excited because they are allowed to use shiny pieces of kit that used to be only available to qualified medical staff. Defib machines work for what they are supposed to do, but only that.

As we do not know why the woman died, we cannot categorically state that having a fuller first aid kit would have helped her, although the basic kit that the IAA seems to allow could do with some enhancements.

Just to set the record straight:

I wasn't suggesting that you refuse to assist in the absence of these itmes in much the same way that you wouldn't refuse save someone from drowning because your didn't have you swim suit and goggles with you! I'm quite amazed that a commercial operation (especially airline) could find themselves without these basics. I agree that they are not essential to life saving itself and I wasn't suggesting that they were. They are essential in the sense that there really is no excuse not having them. It really is a matter of basics. I renewed my first aid certificate recently and there was a heck of a lot of emphasis on maintaining this personal hygene and safety standard.

My issue was with Ryanair apparently not having this most basic of eqiupment which is of trifling cost and in leaving a otherwise experienced nurse in a "not a nice position" to use her own words!

You do not need rubber gloves or the mouth valve for mouth to mouth it is advisable but not essential. How many of you have been to a night club and kissed a total stranger.
Ryanair do have first aid kits on board aproved by by IAA and in one of them I believe does have a mouth piece and gloves.
The question is now why did the crew not use them who knows state of panic we all make mistakes when we are faced with stressfull situations.

well.
1. i was told to hold the person's mouth closed and blow into the nose. so unless the face is a total mess, there should be little exchange of fluids.
2. on the street u can call an ambulance. in the air u can call it, too. but the medics' arms will be to short to get up to you. so it would be nice to have *some* usefull equipment.

From the article above...

er ....they do sport - if the victim is HIV they will increase your chances of survival no end!

What a numpty :ugh:

Just out of interest, how many people do die on planes in a year?

Well I can only comment on the time i had a seal problem on a kit for ryr. During the audit of the contents I was shocked by the poor quality of equipment. It was of no higher standard than a kit in a vw or boots off the shelf little first aid box. Compare that to the compulsory Extensive doctors kits and uk first aid kits and there is a greater chance , as i said , in any med emergency to get treated with the kit that might save you on a uk aircraft.I'm not blaming ryr , just its pet regulator and the other toothless tigers at the belgrano.

despegue - My brother's best mate is a copper. One of his pals performed CPR on a local alcoholic tramp who had collapsed.

The herpes he got that day will stay with him forever.

If this is an accurate quote then I find this lack of concern by the IAA absolutely staggering.
In the UK the CAA used to approve the extensive medical training courses which CC and Flight crew undertake, and their refresher training. They also approve the medical kits, drugs and equipment carried on board. To say that it's not an aviation matter in Ireland is staggering.
What I find equally difficult to accept is that RYR is also one of the UK's major operators, it isn't really good enough to operate within the UK to inferior standards by hiding behind another regulators lax standards.
On a final point whilst some conditions may have come on slowly it would appear that this patient was not breathing and had no pulse, and yet it took 40 minutes to land at a suitable airport whilst carrying out CPR?
Tell the cabin crew to throw all the trays etc. in the toilets and you should be able to get it on the ground in 15 minutes max from anywhere in Europe!

Irishboy

thanks for that I must really read the initial post more closely!!!

That said, a defib would, more than likely, not have helped in this sad case.

FCS

So how would you deal with a brain haemorrhage even if the A/C had the extended kit?

If it was fitted out as per IAA regulations, who is more to blame, RYR for being shoddy and trying to get away with the bare minimum (a budget airline after all - the clue is in the word 'Budget'), or the IAA??

Does anyone know what the communication was between cabin crew and pilots? I know the statement seems to be and it is cruel and morbid, but passengers traveling on a US carrier in the states never die in flight... they always die on short final.

come on now--
 

15 minutes??

a bit optimistic aren't we?

have you read reports of other emergencies recently? once you declare an emergency, you had better make sure all your "eyes" are dotted and "tees" crossed, because the multiple CAA's and JAA will go over every thing you said (recorded) and did with a fine tooth comb.

the only thing that would merit a "balls to the wall get down on the ground" event would be a fire! or loss of both engines and neither one came back!

if they didn't have the charts to their diversion airport at hand, weather, approach speeds, etc, it would take some time to get ready to do the approach.

we cannot risk the aircraft and all others on board and maybe others on the ground to possibly save one passenger.

Neither the mask/shield nor the gloves in debate here would improve a persons chances of survival or improve the quality of their treatment - I think that we all agree.

The Red Cross first aid advice is that gloves are considered as the "basic materials" and the mask as a "useful edition" in a first aid kit. Without argument then neither are vital to life saving.

They do however form part of a kit which ought to be readily available and low in cost (excluding defrib etc) in any commercial workplace especially one which accomodates a fare-paying public. All staff, particularly any nominated first-aiders, should know where the kit is located and how to access it. Putting one of these kits together isn't brain surgery and neither is checking its inventory.

As I read it, the nurse thought these elementary yet important items. she takes issue with not having or being able to access a basic set of eqiupment - including equipment to protect herself from injury or infection.

Really, this is not at all about what equipment helps or doesn't help save lives - what saves lives is a proper approach to dealing with emergencies and Ryanair, it seems, sails close to the wind. It is absolutely about the reputation of an airline that digs itself deeper and deeper into a hole that it is reluctant to climb out of. Maybe, though, when the average cost of a decent first aid kit is more than the average price of the ticket it might be worth pax reconsidering who they fly with. Next time we might not be debating rubber gloves but something more sinister! I sincerely hope not!

Sounds like this pax coned, so all the CPR in the world wouldn't have made any difference.

I hate to say this, but without suction, a laryngoscope and a cuffed tube CPR of someone who's really not breathing isn't that successful. Like as not the airway is full of vomitus or gastric contents that's hard to clear and keeps coming back. The stomach inflates and it's almost impossible to ventilate someone successfully for long, if at all.

External cardiac massage may keep a bit of circulation going, but it isn't enough. If you can't get at least some spontaneous cardiac output pretty quickly then it's sayonara.

For effective on-the-street CPR you need good ventilation, circulatory access (a drip), the right drugs, a defib, some idea of what you're doing and a lot of luck.

T-shirt, etc.

This thread is absolutely terrifying!!! Another reason why I will be advising all my friends and family to never touch Ryanair with a bargepole!!! Id the crew had been properly trained they would know where the First Aid kits were, they would know that they contain latex gloves and face shields and THEY WOULD KNOW HOW TO USE THEM!!!

Surely the crew member who can only take a pulse is not fully legal to be flying under Irish Aviation regulations???

I actually know the nurse from Malahide so next time Im home I shall be having an interesting chat with her!

There are two item of medical equipment in the bag; you can chose ONLY one, the gloves OR the mask.

Your DRABC drill shows you're gonna have to do CPR, which bit of kit would you chose?

The gloves (because the cabin floor of any Ryanair acft is seething mass of vomit, chewing gum and chocolate muffin?:yuk: No, the mask, because it gives you a greater level of protection than the gloves.

I think the Red Cross should revise which one is essential.

Yup, definately the mask!

At risk of thread digression, in the CPR context, yes the mask is more important.

But for the broad subject of "first aid" - covering any injury - then the gloves are probably more essential in preventing disease transfer both ways.

And to answer an earlier question, yes HIV can be transmitted orally if the infectee (?) has open cuts around the mouth (especially possible with bleeding gums or a mouth ulcer).

I would like to make it clear that the crew are properly trained they know where the equipment is everyday there is a briefing as with most other airlines in that briefing it discuses the day etc etc how many passengers and speicifc detail i.e. if theres going to be turbulence etc etc then at the end each crew member is asked by the supervisor safety questions these questions relate to first aid, drills, equipment location, use of equipment if they do not answer these questions they do not fly it as simple as that. Every year there is recurent training where they go through all the first aid drills procedures etc etc then at the end an exam with a very high pass rate fail that you do not fly they dont have a job.

Inescapably....... You get what you pay for

The arrogance of O'Leary will only permit the absolute minimum of equipment on board that is mandated. Anything else is a waste of money & fuel.

This is the RYR way.

first aid
 

hello gents,

the required emergency outfit onboard is regulated by the jar ops1 & there should not be any difference wether the aircraft is irish, uk ,ba, bmi, monarch, ryr,ez, high cost, low cost etc.

Please somone correct me if any of the statements below are incorrect:

• The masks and/or gloves in question cost a few pounds/euros
• The masks and/or gloves in question are provided in sealed bags - assuming the bags are not opened they are good for many months
• A new passenger plane costs $50-200 MILLION
• The marginal costs per flight (fuel / landing charges / crew wages / ....) are considerable

The cost, per flight, of providing DOZENS of these masks/gloves is fractions of a penny - compared to the tens of thousands of pounds/euros that the flight costs to lay on. I guess thats the value that MOL and RYR management put on the life of one of their passengers (guess they can't complain once they're 6 feet under).

By my standards the above statement is outrageously provocative - but, in this case, it's how I feel. I would love someone from the company to explain to me why I should change the above - I am always open to more information.

OC619

P.S. This does assume that the kit was not on board. If it was then the crew training needs looking at.

Ryanair said all of its aircraft were stocked with two security-sealed first-aid kits, as required under the regulations.

When our UK charter airline started many years ago we had a sealed first-aid kit. The restocking and resealing was done under the engineering contract and cost £150 per time plus items.
Most flights needed the kit resealing after each fkight where perhaps one paracetomol had been taken out.
After five years of this someone cottoned on and the cabin crew took on an unsealed kit of obvious pills and bits to be restocked from Boots at leisure.
Eventually a Doctor's kit was put on which was sealed as it contained drugs that could only be prescribed by a physician.
In the interim there was an obvious reluctance to break open a sealed kit with the inherent high cost and this may have been a factor in this incident.

Last year I went thru First Aid training. The teacher was a professional fireman.
Here is what he told us when asked if we should use them on the street:
"For us (pros) it is a professional mistake (liable to sanctions by management) not to use both of them" followed by "but you can do what you want". :hmm:

In this case, the problem is not to know if it would have saved the passenger or not, but more to the point, how is it possible to have cabin crew not knowing the content of the first aid kit? :confused:
Could it be due to lack of training?

I wonder if the crew are fully aware of the kit at their disposal on board :confused: it appears not in this case.

Can the MODS explain why they removed my post about possibly sending the a/c back to STN as a commercial move ??

first aid
 

hello every one
what did the italian doctor do?

>The other Irish nurse on the flight, Suzanne Scott from Malahide in Dublin, said she >had written to the Irish Aviation Authority to express her concerns.

Good luck... she'll need it.

Difficult to comment without knowing the full facts, but it's unlikely that an increase in the complexity of the basic equipment would have saved this poor girl.

I'm not sure how many unexpected deaths there are in the skies each year, but I have seen a recent article suggesting that about 200 lives per year could be saved in the UK per year if we were all proficient in CPR.

I would have thought it prudent to carry some cheap basics on board,- I'm not a first aid expert, but a one way mask/tube, and ?perhaps an assortment of airways would be useful. I'm not sure if this would help the patient that much, but from my experience, cardiac/ and respiratory arrest usually involves the airway becoming obstructed by vomuit/mucous. I'm not sure why rubber gloves are that important.

Of course, you could impact on the 120,000 premature deaths each year, and stop selling cigarettes.

sadly, and by the looks of it, not much :uhoh:

Condolences to the family involved.

Please note:

Mac The Knife (from his handle you should be able to guess what he gets up to for a living) said it all in his post. Please go back to it and read it in full.

/LH2 (who used to be a lowly EMT in a previous life)

If this is an accurate quote then I find this lack of concern by the IAA absolutely staggering.

And you are surprised!!! Have you read the thread cullen v O'leary??? The only thing the IAA care about is money. Too many people in HQ got there because they know someone and not something. Everyone should be calling them up and asking them questions because nobody seems to regulate them.They are a law on to themselves.

Not sure if you are all aware, but if you give mouth to mouth to someone, 99% of the time they will vomit if they begin breathing again . I for one would want to make sure i had gloves on to clear the airway from vomit. Why should that nurse put herself at risk when she is nopt in her work place. If she caught a virus due to not having protection, who is to blame ????

Most airlines ( shorthaul ) only carry the standard 1st aid kit and don't carry defibs, or doctors kits.

They probably didn't give it a thought. It's more important for them to land at a RYR base for commercial reasons :mad: