Description

On 27 September 2017, a Boeing 777-200LRF (A6-DDE) being operated by Etihad Airways on an international cargo flight from Abu Dhabi to Amsterdam as ETD927 was in the cruise over international airspace controlled from Bahrain in day VMC when the Captain, who had just left the flight deck to get his crew meal from the galley collapsed and died despite immediate assistance being rendered by the Security Officer and Loadmaster on board and nearby. On being informed, the remaining pilot declared a MAYDAY and diverted the flight to Kuwait without further event.

Investigation

A comprehensive Investigation was carried out by the UAE GCAA Air Accident Investigation Sector. Relevant data in respect of the operation of the aircraft were obtained from downloaded data from both the CVR and FDR. 

It was noted that the 51 year-old Captain had a total of 16,547 hours flying experience which included 2,809 hours on type and the 46 year-old Co-Pilot (rank not stated) had a total of 13,205 hours flying experience which included 3,777 hours on type

What Happened

The flight was operated by two pilots and with the Captain as PF for the sector and although such freighter flights do not always have any other personnel on board, on this occasion, a loadmaster and a “corporate security officer”. Some 42 minutes into the flight which had reached its initial cruise level of FL320, the Captain handed control to the other pilot and left the flight deck in order to retrieve his crew meal from the galley. On arriving there, as he was removing his meal tray from its stowage, he lost consciousness and collapsed. The corporate security officer was close by and immediately began providing cardiopulmonary resuscitation (CPR). The loadmaster communicated with the other pilot and an immediate decision was made to divert to Kuwait, the nearest available airport. Despite the continuing attempts by the security officer to revive the Captain, his medical condition was severe and the efforts to resuscitate him were not successful. The annotated ground track of the flight is shown on the illustration below. 

The annotated trajectory of the complete flight. [Reproduced from the Official Report]

Discussion

•  In the six year period 2012-2017, reports made to the GCAA in respect of all degrees of pilot incapacitation in flight affecting all UAE departures were noted to have totalled 48. However given the total number of such departures, this figure was equivalent to one such event occurring every 50,525 flights.
• The Operator’s OM Part A did not include pilot incapacitation procedures for freighter flights.
• The Captain had passed his annual medical examination on the day before his final flight. It was noted that he had been a non smoker with a recently normal blood pressure, pulse rate and body mass index with no electrocardiogram (ECG) abnormalities. He was also understood to have been “only a social drinker, eaten a healthy diet and followed a regular exercise routine”. However there was evidence from his aviation medical examinations since 2015 of abnormal blood lipid levels which had been subject to additional monitoring and lifestyle changes. These had appeared to have been beneficial but had also been accompanied by a somewhat erratic pattern of blood lipid test results with the key relevant measurement still outside the “reference range” at his most recent annual medical. During the course of the Investigation, it became apparent that the Captain “had in his personal belongings vitamins, painkillers, various types of aspirin, and statins” which had not been declared to the aeromedical examiner, an operator requirement, particularly in respect of any use of statins which under the applicable regulations was only permitted under the supervision of an aeromedical examiner. However, it was “not possible to determine whether the self-medicated statin use had contributed to the incapacitation” or indeed whether the concealed use of them might have misled aeromedical examiner assessments given that they are generally recognised as often beneficial under appropriately prescribed use. 

The Causes of the Captains incapacitation and subsequent death were recorded as a cardiopulmonary system collapse, caused by a stenosis in the coronary artery. His high cholesterol level caused the coronary artery disease and contributed to the stenosis in the coronary artery. His undeclared use of “over the counter” medication probably contributed to a reduction in his lipid levels.This treatment was not managed by (or known to) the aeromedical examiners involved and it was therefore determined that it was not possible for the aeromedical examiner seen the day before to predict the imminent incapacitation of the Captain.

Safety Action taken as a result of the findings of the Investigation were noted as including the following: 

▪    The GCAA Medical Section provided an update to aeromedical examiners on the latest international findings on lipid management and amended the guidelines for lipid management to provide examiners with additional information when high lipid levels are encountered.

▪    Etihad Airways arranged for all additional onboard crewmembers, particularly but not only all Loadmasters, to receive the training needed to be able to assist in a situation where a pilot or other crewmember is incapacitated with corresponding changes to the OM made. 

The Final Report was issued on 25 September 2019. Based on the recorded Safety Action taken, no Safety Recommendations were considered necessary. 

Related Articles

• Pilot Incapacitation
• Medical Emergencies - Guidance for Flight Crew
• Prescription
• The Effects of Alcohol and Drugs on Pilot Performance

Further Reading

• Drug Use Trends in Aviation: Assessing the Risk of Pilot Impairment, NTSB USA, September 2014