Anthony McCormack

Philip Dunne MP Minister of State for Health Department of Health Richmond Our reference: PFD-1097064 79 Whitehall London SWIA 2NS Ms Fiona Borril Tel: 020 7210 4850 HM Area Coroner Manchester City Area HM Coroner S Office PO Box 532 Manchester Town Hall 2EIV E Albert Square 3 NOV 2017 M6O 2LA z N Xil 31st Ockber 24l7 Thank you for your letter of 4 September to the Secretary of State about the death of Mr Anthony William McCormack: I have been asked to respond. I was very saddened to read of the circumstances surrounding Mr McCormack'$ death: Please pass my condolences to his family and loved ones. I appreciate this must be a very difficult time for them_ Your Report raises concerns about the level of paramedic cover at the Manchester International Airport; I should explain that the provision of emergency ambulance services is a matter for the local NHS. My officials have made enquiries with the North West Ambulance Service NHS Trust and the NHS Blackpool Clinical Commissioning Group (CCG); as lead commissioner for ambulance services in the North West region. Iam advised that paramedic cover at the Manchester International Airport is by commercial arrangement with the Airport which funds the service. I understand that there is no obligation on the Manchester International Airport to provide anything more than first aid. However, I am informed that the North West Ambulance Service has provided Manchester International Airport with a paramedic service since 2008. Iam advised that staffing comprises five solo paramedics working across a shift pattern resulting in one paramedic on duty at all times, 24/7. The paramedics House being

work closely with the Airport and receive special training, including airfield driving: Manchester Airport paramedics are required to have high levels of security and regular accreditation which means that in an emergency are permitted through security checks without delay and unescorted This is not the case for any other North West Ambulance Service personnel from outside the Airport, who are required to enter security checks and be escorted their time airside. The site is exceptionally secure for obvious reasons and I am advised that the permissions have alleviate previous issues of delays to patients. Activation to incidents is initiated by direct contact between the Airport operations/communications centre and the Manchester Airport paramedic. The paramedic will speak directly to the caller and make a judgement on attendance. When it is identified that an outside resource is required, the paramedic will contact the North West Ambulance Service by radio and request the back-up require. In cases of cardiac arrest; this would be done immediately and would also include a call to the Manchester Airport communications centre for an AED Call" . This results in the mobilisation of the Manchester Airport Fire Service to assist. While this is a great asset, it should be noted that there are strict regulations in place from the Civil Aviation Authority about response from the Fire Service to an airport incident: The Fire Service has seconds to respond to a fire and has to ensure that cover is not compromised by responding to other incidents Within these considerations, I am advised that work is underway to increase the training of the Fire Service to Extended Community First Responder levels. In the case of Mr McCormack, Iam advised that the incident was not *called in as cardiac arrest. This status was only confirmed on the Manchester Airport paramedic' $ arrival at the scene The North West Ambulance Services advises that a review of 2016 cardiac arrest data for Manchester Airport shows a survival to discharge rate of 43.75 per cent, which is favourable compared to the national average of 25.6 percent: In addition, Return of Spontaneous Circulation (ROSC) rates are good, at 62.5 per cent; compared to the 50 per cent national average. Finally, as you will know, Manchester Airport is expanding: Iam advised that work is underway to understand the impact this will have on the North West Ambulance Service and whether or not a second paramedic at Manchester Airport is required: This will be reviewed as the expansion takes place, but I am advised by they during they they

Department of Health the North West Ambulance Service and its commissioners that are satisfied a sole paramedic is adequate for the current activity (an average of 9.3 incidents a in 2017). Inote the comments in your Report about evidence heard at inquest around ambulance performance. Iwould like to take this opportunity to highlight following an independent evaluation of extensive trials, we have agreed NHS England '$ recommendation to implement an improved ambulance performance framework, which: Prioritises responses to the sickest patients, while helping reduce waits for ambulance responses; Ensures patients receive the response need, first time; all patients under a national response standard; and Improves the efficiency and resiliency of the ambulance service in the face of demand. The NHS is now implementing these changes so that patients across the country can benefit from them. North West Ambulance Service has already transitioned to this framework. The Department continues to work closely with NHS England and NHS Improvement to monitor and support performance in 2017-18, and there is a range of ambulance improvement programme work underway: This includes work to improve the clinical capability and conditions for paramedics; commissioning and operating models for ambulance services; and ambulance trust productivity and efficiency. Ihope this information is helpful. Thank you for bringing the circumstances of Mr McCormack's death to our attention: Yss fx-C Dak PHILIP DUNNE they day- that, long they Brings rising

Dear Ma'am Inquest Touching the death of Mr Anthony McCormack Regulation 28: Report to Prevent Future Deaths Further to the above dated 4 September 2017, we provide our responses to the two matters of your concern below. "The adequacy of the training of Emirates staff in respect of the recognition of possible cardiac arrest and signs thereof including agonal breathing and the administration of appropriate first aid/prompt CPR First Aid and CPR training is undertaken by all Emirates cabin crew both as part of their initial training and also on an annual basis as refresher training on medical procedures The CPR training conducted by Emirates in each of these instances meets the rigorous standards set by leading international bodies, including the International Liaison Committee on Resuscitation (ILCOR), the American Heart Association (AHA) and the European Resuscitation Council; This training includes information on the recognition of abnormal breathing a5 sign of cardiac arrest and this is reflected in the Emirates Operating Manuals and training materials covering this issue_ We also note that it is widely recognised by experts in the field of resuscitation that recognition of agonal breathing is extremely problematic even for seasoned medical professionals and is not always present in all cases of cardiac arrest, Emirates also closely monitors the latest research and developments in pre-hospital emergency care and resuscitation on an ongoing basis As and when any of the recognised international resuscitation bodies report improved methodologies in handling medical emergencies, Emirates promptly assimilates these improved procedures into its crew medical training programs to ensure that any on-board medical emergency is handled by our crew to the highest possible standard of modern medicine. As such, we will continue to follow this approach and do not propose to take additional action above and beyond that which is detailed above: "The adequacy and effectiveness of the procedures followed by Emirates staff in the event that the Tempus system is unable to provide assistance which was the case here_ PO Box 686, Dubai, United Arab Emirates; jJ1iall aUJJI OILolll4u) IT.4-US Tel: +971 4 708 MII +9vi { V-^ iii :Lilol emiratescom emiratescom Ae cua

Emirates Emirates has robust procedures in place to deal with medical emergencies and all crew are trained in these procedures on an annual basis. The primary focus of these procedures is on practical, manual skills in assessing and providing care, which can be used by crew in a wide range of on- board medical emergency situations For example, crew are trained to use the "Look, Listen and Feel" method, together with assessing the level of responsiveness, to determine the adequacy of breathing of a passenger in medical difficulty: The Tempus device or other on-board medical devices are only used as an adjunct to support the crew in the use of these primary assessment methods_ These procedures have been designed and implemented in order to ensure that the crew are able to assess the medical condition of a passenger as quickly and accurately as possible, even where there are instances of communications or equipment errors_ We do not propose to take additional actions for the above reasons