Occurrence
On 17 January 2011, an Air France Boeing 777-228, registration F-GSPM, departed Paris Charles de Gaulle at 08:48 UTC for a scheduled passenger flight to New York JFK. The first officer was the pilot flying. At approximately 10:00 UTC, the captain experienced discomfort. A passenger who was a doctor conducted a preliminary assessment. The captain remained at his station and decided to continue the flight. The aircraft was then about 80 nautical miles from Shannon, Ireland.
At 10:27 UTC, the aircraft entered oceanic airspace. The crew received updates on weather at Shannon, Gander, and Keflavik. Around 11:30 UTC, the captain developed abdominal pain. The doctor was called again. The aircraft was 760 nautical miles from Shannon and 585 nautical miles south of Keflavik. At 11:42 UTC, the crew decided to divert to Keflavik, the nearest suitable airport. The first officer contacted Gander ATC via HF radio and declared a medical emergency. At 11:50 UTC, the first officer informed the airline's Operations Coordination Center (CCO). The captain remained in the cockpit, assisted by the purser and the doctor.
During the descent, the captain's condition improved, and he resumed duties as pilot not flying. The first officer landed at Keflavik on runway 02 at 13:13 UTC. Upon parking, medical personnel evacuated the captain. The cabin crew conducted a normal passenger disembarkation.
Medical Aspects
The doctor, a cardiologist, initially suspected gastroenteritis and administered antispasmodic medication, which improved the captain's condition, leading to the decision to continue the flight. On the second assessment, the captain was pale, rigid, trembling, and experiencing severe abdominal pain. The doctor feared internal bleeding, prompting the diversion. The doctor used the onboard medical kit and injected an anti-inflammatory to relieve pain. The captain remained conscious, with his seat reclined, and could communicate with the first officer and purser. The exact cause of the pain was not determined. The captain was released from hospital that evening after a short observation period. The investigation could not establish whether the captain had any relevant medical history.
Operator Procedures
The airline's operations manual and safety manual addressed pilot incapacitation regarding cockpit reorganization, crew announcements, and medical assistance. However, the procedure for handling a passenger medical emergency (which included consultation with ground medical services) had not been adapted for a pilot medical event. The cabin crew informed the cockpit that passengers had noticed the change in trajectory. The captain instructed them to announce a diversion for medical reasons. The first officer did not contact the CCO because a doctor was on board, and thus did not benefit from advice from the ground medical service. The documentation was imprecise regarding transfer of command responsibilities, and the "sick on board" procedure was geared more toward passengers than flight crew.
Conclusion
The serious incident resulted from the inflight onset of abdominal pain in the captain, the symptoms of which were not detected before the flight. The investigation could not determine the exact nature of the pain. The diversion was initiated based on the doctor's fear of internal bleeding. The crew decided on the diversion but did not inform the CCO, who could have assisted with diversion strategy or medical coordination. There was no explicit transfer of command responsibility; it was unclear whether the captain was partially or fully incapacitated during his episodes. The operator's documentation lacked clarity on responsibility transfer, favoring situations like this incident.