Etihad A332 over Iran on Jun 29th 2015, first officer incapacitated after blowing his nose

Last Update: November 21, 2016 / 16:12:19 GMT/Zulu time

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Photo of Etihad Airways A6-EYN, Airbus A330-200 — Etihad Airways A6-EYN, Airbus A330-200 (Photo credit: m-takagi / Flickr / License: CC by)

Incident Facts

Date of incident
Jun 29, 2015

Classification
Incident

Cause
First officer incapacitated

Airline
Etihad Airways

Flight number
EY-45

Departure
Abu Dhabi, United Arab Emirates

Destination
Dublin, Ireland

Aircraft Registration
A6-EYN

Aircraft Type
Airbus A330-200

ICAO Type Designator
A332

An Etihad Airbus A330-200, registration A6-EYN performing flight EY-45 from Abu Dhabi (United Arab Emirates) to Dublin (Ireland) with 212 people on board, was enroute at FL380 about 450nm northwest of Abu Dhabi and about 70nm southeast of Ahwaz (Iran) in Iranian Airspace when the first officer, pilot monitoring, blew his nose and noticed blood mixed with mucus coming down the nose. Subsequently the first officer advised he was not feeling well and became unconscious. The captain declared PAN with Tehran Center and decided to return to Abu Dhabi. The first officer regained consciousness but was taken out of the cockpit. The aircraft landed safely back in Abu Dhabi about 2.5 hours after departure.

The aircraft departed again as flight EY-45D after about 4:45 hours on the ground and reached Dublin with a delay of 6.5 hours.

The French BEA reported in their weekly bulletin that another off duty captain on board assisted with communications, the overweight check list and overweight performance calculations were conducted for the landing. United Arab Emirates GCAA rated the occurrence a serious incident and opened an investigation.

On Nov 21st 2016 the GCAA released their final report concluding the probable causes of the occurrence were:

The Air Accident Investigation Sector could not determine the cause of the Copilot fainting after he saw blood upon blowing his nose as the Investigation was informed that all post-incident medical test results had not identified any medical condition.

Contributing Factors

Possible contributory factors that may have affected the Copilot’s medical fitness included performing flying duties whilst he suffered from nasal congestion, the possible effects of the use of the over-the-counter nasal spray, medical fitness being affected by his biological clock, the effect of flying in a pressurized aircraft, and the psychological effect of seeing blood after he blew his nose, a condition that is known as vasovagal syncope.

The GCAA described the events on board:

The Commander of the flight was the pilot flying and was seated on the left hand seat.

Approximately 58 minutes into the flight, with the Aircraft in cruise at FL380 in Iranian airspace, the Copilot asked for a box of tissues from the Commander as he wanted to clear his nasal congestion. He blew his nose hard into the tissue and then saw a mixture of blood and mucus. The same occurred several more times. The Copilot informed the Commander that he was not feeling well. Soon after, he started to feel strange, suffering a tingling sensation in his fingers and body. He then partially reclined his seat. At this point the Copilot fainted and collapsed backwards into his seat with his eyes open. The Commander tried to revive the Copilot by calling his name and physically shaking him. Receiving no response, the Commander reclined the Copilot’s seat further and pushed it backward thus preventing the Copilot from obstructing the flight controls while incapacitated.

An emergency alert passenger announcement was made in order to have the Cabin Manager go to the cockpit. The Cabin Manager attended to the Copilot by administering wet towels and oxygen with the help of another crew member. The Copilot revived after approximately one minute, but he was not fully conscious.

The Commander declared PAN-PAN, to Tehran air traffic control (ATC) and he informed ATC of the Copilot’s incapacitation and of his decision to return to Abu Dhabi. He instructed the Cabin Manager to assist the Copilot out of the cockpit.

A medical doctor, travelling on the flight as a passenger, attended to the Copilot and checked his vital signs. The Copilot’s blood pressure was reported to be low and the doctor indicated to him that his blood pressure was low possibly as a result of the action of blowing his nose forcefully. The Copilot stated that after about 20 minutes he was feeling normal again. He then occupied a business class seat next to the doctor, and remained there for the rest of the flight.

The Cabin Manager informed the Commander that an off-duty company Boeing 777 captain was travelling as a passenger on the flight. The Commander requested the captain’s assistance to help with ATC communications and checklist completion. The Commander then briefed the Cabin Manager and an announcement was made advising the passengers that the Aircraft would return to the departure airport.

Abu Dhabi ATC provided priority clearance and an uneventful overweight landing was performed at 0454 LT, one hour and 18 minutes after the Copilot’s incapacitation. The total flight time was two hours and 16 minutes.

Airport paramedics met the Copilot at the Aircraft parking stand and medical checks were performed, including an electrocardiogram. The results of the medical tests were considered normal. The Copilot was then transferred to the airport on-duty doctor and no additional tests were performed. Blood tests for drugs and alcohol were not carried out. The doctor released the Copilot as the medical results were satisfactory.

The GCAA analysed:

The departure of the Incident flight from Abu Dhabi International Airport was uneventful with the Commander as the pilot flying. While the flight was in Iranian airspace, at FL380 and 58 minutes into the flight, the Copilot, who had started the flight with symptoms of nasal congestion, informed the Commander that he was not feeling well after he had seen blood mixed with mucus upon blowing his nose. Shortly after, the Copilot fainted in his seat and was unconscious for approximately one minute.

The incapacitation of the Copilot was immediately apparent to the Commander who verified his physical status by calling out his name and trying to physically shake him. The Cabin Manager was summoned and after the Copilot was removed from the cockpit, assistance with radio communication and checklist completion was accomplished with the assistance of an off-duty Boeing 777 captain, who was an employee of the Operator travelling on the flight as a passenger.

Even though the Operators’ reference states that as a result of a pilot incapacitation the aircraft should be landed as soon as possible, the Commander initiated a return to the departure airport of Abu Dhabi which was 400 NM away. The closest airport at the time of the Incident was Kuwait International Airport which was a distance of 105 NM away.

An uneventful overweight landing was performed at Abu Dhabi Airport 78 minutes after the incapacitation.

Upon arrival, the Copilot was allowed to leave the airport medical clinic without a drug and alcohol blood test being performed.

The Investigation believes that most of the actions taken by the Commander were in line with the Operator’s standard operating procedures. However, due to inconsistencies with the flight crew operation manuals, the Commander should have landed the Aircraft as soon as possible and not allowed the Boeing 777 captain into the cockpit, as he was not type qualified, and instead, obtained the assistance of a cabin crewmember. Therefore, the Operator should standardize and align its procedures following a flight crew incapacitation so that flight crews are better guided.

With respect to the medical fitness of the first officer the GCAA analysed:

Even though it was not medically substantiated, the Investigation believes that the symptoms experienced by the Copilot prior to his fainting are similar to vasovagal attack. These included the triggering effect of seeing blood when he blew his nose, his description of feeling strange with a tingling sensation in his fingers and body, his actual fainting, confirmation of low blood pressure as measured during the flight, and subsequent nil-findings during the post-incident medical testing. In addition, he had suffered a similar experience of fainting when blood was drawn during a medical test before he joined the Operator.

...

A vasovagal attack itself is not serious. However, injury is possible during a fainting episode as the person may fall if standing and the attack poses a potential danger if episodes occur during a critical activity such as driving, or operating machinery, including piloting an aircraft. Single pilot aircraft are at greater risk if a vasovagal attack occurs during flight.

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Suspension of piloting privileges after a vasovagal syncopal episode is not covered under the UAE Civil Aviation Regulations. This is an area that requires further research and data analysis.