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Dogma 24th Sep 2018 13:26

Captains responsibility
 
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/art...-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 24th Sep 2018 14:53


Originally Posted by Dogma (Post 10257101)
...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 24th Sep 2018 19:36

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 25th Sep 2018 00:55


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 25th Sep 2018 06:45


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 25th Sep 2018 06:49

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 25th Sep 2018 09:21

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 25th Sep 2018 11:20

Pack a lunch bag?
 
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 25th Sep 2018 11:35


Originally Posted by BluSdUp (Post 10257881)
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?


Originally Posted by BluSdUp (Post 10257881)
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 25th Sep 2018 12:14

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 25th Sep 2018 13:56


Originally Posted by arketip (Post 10257893)
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 25th Sep 2018 14:58

Arketip
 
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 25th Sep 2018 15:33

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 25th Sep 2018 15:37


Originally Posted by BluSdUp (Post 10258067)
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 25th Sep 2018 16:58


Originally Posted by Kerosine (Post 10258095)
.....

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/p...-a3945466.html







172_driver 25th Sep 2018 18:24

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 25th Sep 2018 20:19

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

underfire 25th Sep 2018 21:20

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 25th Sep 2018 22:18


Originally Posted by Kerosine (Post 10258095)
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 25th Sep 2018 23:52


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

underfire 26th Sep 2018 02:20


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....d7f40f682f.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 26th Sep 2018 03:51

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 26th Sep 2018 06:22


Originally Posted by sycamore (Post 10258309)
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 26th Sep 2018 07:09

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 26th Sep 2018 08:09


Originally Posted by Cmon-PullUP (Post 10258639)
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 26th Sep 2018 08:49


Originally Posted by wiggy (Post 10257917)
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 26th Sep 2018 09:13

infrequentflyer...

Interesting, many thanks for taking time to post that.

Kerosine 26th Sep 2018 09:36


Originally Posted by TolTol (Post 10258401)
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.


Originally Posted by Kerosine (Post 10258095)
..... 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 26th Sep 2018 09:36

Thanks Wiggy....

olster 26th Sep 2018 10:00

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 26th Sep 2018 10:08


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 26th Sep 2018 10:48

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 26th Sep 2018 10:55

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

wiggy 26th Sep 2018 10:59

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 26th Sep 2018 11:28


Originally Posted by Chesty Morgan (Post 10258820)
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 26th Sep 2018 12:22

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 26th Sep 2018 12:24


Originally Posted by His dudeness (Post 10258687)
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 26th Sep 2018 14:27


Originally Posted by wiggy (Post 10258737)
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-co...rgy-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 26th Sep 2018 14:40

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

https://www.theguardian.com/society/...abelling-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 26th Sep 2018 14:53


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.


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