A coroner is “struggling” to see why the full range of medical kit on a British Airways plane was not offered when a teenage girl suffered a fatal allergic reaction to a Pret A Manger sandwich.
Dr Sean Cummings said he did not find it “entirely logical” that there was a defibrillator at the back of the aircraft but other medical equipment at the front.
He was speaking at an inquest into the death of Natasha Ednan-Laperouse, 15, who collapsed on a BA flight from London to Nice in July 2016 after suffering a fatal reaction to a Pret sandwich.
She had been on her way to a four-day break in France with her father and best friend when she bought an artichoke, olive and tapenade baguette as they passed through Heathrow Airport’s Terminal 5.
The inquest at West London Coroner’s Court has heard that the on-board defibrillator was not used in-flight as it was situated at the back of the plane and it would have been too dangerous to get it from the other end of the aircraft when Natasha went into cardiac arrest minutes before landing.
Hearing evidence from Clare Durrant, learning and development manager in crew learning at British Airways, Cummings said: “I’m struggling a little bit with why the full range of kit wasn’t made available to Dr Pearson-Jones or why he wasn’t made aware of it.”
Thomas Pearson-Jones was a junior doctor on the flight.
The coroner added: “That sounds to me like a quantum leap in terms of the judgments that your crew are being asked to make.
“That doesn’t sound safe to me.”
The coroner asked Durrant if she was saying that, even though Natasha was “blue, not breathing, unresponsive”, the defibrillator was not fetched due to one of the crew members making a judgment.
Durrant said crew members could not move through the cabin at that stage.
The family’s lawyer, Jeremy Hyam QC, asked Durrant to describe “agonal breathing”.
She described it as “not normal breathing”, and Hyam said: “The evidence I have is that she was in severe distress … isn’t that agonal breathing?”
He later added: “How can it be a safe system to wait for cardiac arrest to arrive?”
Durrant said that until that happens, a defibrillator would not have been used, but Hyam pointed out that it would have been there for the doctor to use when the time came.
The teenager, from Fulham, south-west London, suffered from numerous allergies and reacted badly to sesame seeds “hidden” in the bread, which caused her throat to tighten and vicious red hives to flare up across her midriff, eventually triggering cardiac arrest.
Two epipens were jabbed into her legs, but the symptoms did not abate and she was declared dead the same day at a hospital in Nice.
British Airways cabin crew have already been questioned over their response after the inquest heard that the on-board defibrillator was not used in-flight.
Mario Ballestri, who helped Pearson-Jones as he performed CPR on Natasha, said it would have been too dangerous to get the device from the other end of the aircraft when she went into cardiac arrest minutes before landing.
Head of cabin crew John Harris was also asked why BA staff had not got the defibrillator.
Harris said: “Without sounding harsh, the coverage of doors takes priority.”
He explained that it was a formal requirement of his training to ensure cabin crew were in position on landing so they could get passengers off the aircraft in case of an emergency.
“There were only five cabin crew on that particular flight and the aircraft had four sets of doors, totalling eight doors, and one cabin crew member was out of action.
“So we literally had the minimum number of crew to cover those doors,” he said.
The inquest heard that a defibrillator was used on Natasha after landing when Nice paramedics arrived.
“My opinion is that Natasha died as a result of anaphylaxis triggered by something she ate in the airport.””
- Dr Alex Croom
Expert witness consultant allergist Dr Alex Croom said in a report to the coroner: “My opinion is that Natasha died as a result of anaphylaxis triggered by something she ate in the airport.”
Giving evidence, Croom said: “I think if it has been anything she ingested before she arrived at the airport she would have developed earlier symptoms.”
He added: “She had very classic symptoms.”
The inquest heard that Resuscitation Council guidelines suggest 25mm is the best needle length for an injection treating an anaphylactic reaction, and that Natasha’s epipens were just 16mm.
Asked if she thinks a standard prescription should have a 25mm length, Croom said: “Yes, really.”
On the subject of whether earlier application of a defibrillator would have helped, she said: “I think it’s unlikely that it was an abnormal (heart) rhythm that needed corrected.”
The inquest heard from Durrant that British Airways cabin crew get three days of medical training, and that they know a defibrillator is the “priority piece of equipment” to collect if someone is unconscious or not responding.
Durrant said the crew is there “primarily for safety”.
She told the inquest they would only call on the defibrillator if someone was unconscious and not breathing.
The inquest is due to last until Friday.