Pressurisation Failure with a Passenger in Distress
You are cruising at FL350 with 48 passengers. A cabin crew member reports a loud bang and rapid fogging, and the cabin altitude is climbing through 14,000 ft. You don the oxygen mask and start an emergency descent. A passenger with a known heart condition is reported to be pale and confused. Your first officer is on oxygen but is struggling to read the checklist because of the mask and noise. The nearest suitable airport is 18 minutes away at your current speed; a closer military field is 9 minutes but has no medical services. You have 12 minutes of oxygen in the crew bottles at current flow.
1. Prioritise your actions and explain the human-factors risks in this high-workload phase.
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Priority order: fly the aircraft, then manage the pressurisation, then communicate. Set maximum descent, select 100% oxygen, and confirm the first officer is on oxygen and conscious. The human-factors risks are: task saturation (multiple simultaneous demands), communication breakdown through masks and noise, and confirmation bias (assuming the first officer is fine because they are quiet). Use closed-loop communication: point, state, and have the other crew member repeat back. Delegate the passenger problem to cabin crew with clear instructions, but do not let it distract from flying. The 12-minute oxygen limit is a hard constraint: you must be below 10,000 ft cabin altitude before it runs out, so the descent profile must be flown accurately. Do not attempt to troubleshoot the pressurisation until the descent is established.
2. Choose the destination and justify the decision, including the medical and operational trade-offs.
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Choose the closer military field only if the passenger's condition is immediately life-threatening and the 9-minute saving is likely to change the outcome. Otherwise, choose the airport 18 minutes away with medical services. The reasoning: a cardiac event needs definitive care, and landing at a field without medical services adds ground transfer time that may exceed the 9-minute airborne saving. The passenger is confused and pale, which suggests hypoxia and possibly a cardiac event; oxygen and descent are the immediate treatments, and cabin crew can administer oxygen. The 12-minute oxygen supply is a constraint but should be sufficient for the descent to 10,000 ft. Declare a medical emergency, request priority, and have the company arrange medical services at the destination. The decision should be reviewed as the passenger's condition evolves.