Captains responsibility
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....
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....
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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.
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.
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.
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.
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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.
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.
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.
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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.
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.
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”
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”
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/
also:
https://www.dailymail.co.uk/wires/pa...-baguette.html
And also:
https://www.theguardian.com/uk-news/...dnan-laperouse
From the Guardian Report, in part: .
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...-baguette.html
And also:
https://www.theguardian.com/uk-news/...dnan-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.
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.
Last edited by wiggy; 28th Sep 2018 at 11:21.
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
PDR
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.
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.
Last edited by wiggy; 1st Oct 2018 at 11:19.
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
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I asked about Medaire previously as it could always have been their decision for the flight to continue to the destination.
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
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.
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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.
Last edited by wiggy; 1st Oct 2018 at 12:56.
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.
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.
