Chest Pain at FL360: Approach Ban Versus Medical Urgency

No, not past the final approach fix on the present report.

The operator's approach ban (CAT.OP.MPA.305) requires that, in commercial air transport, the commander does not continue an instrument approach beyond the outer marker or final approach fix, or below 1,000 ft above the aerodrome where no FAF exists, when the reported RVR or visibility is below the applicable minima.

The minima to apply here are the operator's CAT I minima for LFLC with both pilots limited to CAT I: RVR 550 m. The reported 400 m is below that figure, so the approach must not be continued past the FAF. If the RVR were reported at or above 550 m before the aircraft reaches the FAF, the approach could be flown normally.

The two traps:

• The minima are not simply the published State CAT I minima. They are the operator's minima, including any additional conditions (RVR/VIS, approach light credit, TDZ and stop-end RVR).
• Emergency authority (SERA.2010) allows the commander to deviate from the rules to the extent necessary in an emergency, but it does not create a new legal minimum. It must be exercised knowingly, with a declared emergency and the responsibility that goes with it. Here it would not be justified: LFLL is only 18 minutes further with RVR 1,400 m. The defensible decision is a diversion to LFLL, not a marginal approach in fog to save a few minutes of patient transport time.

1. Aviate. Engage the autopilot, confirm the aircraft is trimmed and stable, and allocate tasks. The diversion must not begin before somebody is definitely flying.
2. Medical care. Oxygen and, if carried, the AED; the senior cabin crew continues care and the ground medical service stays on the link.
3. Communicate. Tell ATC: 'PAN PAN, PAN PAN, medical emergency, request diversion to Lyon, request priority.' PAN is correct while the passenger is conscious and deteriorating; escalate to MAYDAY if he becomes unconscious or arrests, which brings priority handling and vectors through controlled airspace if needed.
4. Weather and fuel. Request actual LFLL weather (RVR, cloud base, wind), not just the ATIS. Recompute fuel at LFLL, holding and any second alternate. With 2,600 kg the plan is comfortable, so do not rush it.
5. Prepare. Brief the LFLL approach, minima, missed approach and taxi route; request an ambulance and medical reception on arrival.

The classic failure in this scenario is both pilots discussing the passenger while the aircraft drifts off the cleared level or an unbriefed descent begins. The medical urgency is real, but it does not remove the need for a stable, briefed approach.

Legally, holding is not prohibited: the approach ban is applied against the report current when the approach is continued, so a new report at or above 550 m would permit the approach.

Operationally it is weak:

• The forecast trend is no improvement, and VV 100 ft with fog suggests a stable shallow layer that typically improves with daytime heating, not within ten minutes.
• Each extra approach attempt costs roughly 8 to 10 minutes and 250 to 350 kg of fuel, and a go-around from the LFLC ILS puts the aircraft back at 5,000 ft with the patient no closer to hospital.
• The 45-minute advice is clinical guidance, not an operational limit. Landing at LFLL in about 50 minutes off a 1,400 m RVR approach meets the medical aim at normal risk.

What would change the decision: the passenger becoming unconscious or arresting (MAYDAY), combined with LFLL being unavailable, or an LFLC report of, say, 600 m on a clearly improving trend. In that case the commander could reasonably accept LFLC under emergency authority, with a planned go-around briefed and fuel to reach LFLL.