RICHARD MARK WESTGATE · Prevention of Future Deaths report

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Issued 16 Feb 2015•Dorset

Published report and response evidence

This report’s concerns and statements found in recipients’ published responses. Statements are included even where no link to an individual concern is recorded. A link shows an evidence connection; it does not assign responsibility.

View original report
Concerns
5

Raised in this report

Recipients
2

Named on the report

Responses found
2

Of 2 recipients

Stated actions
5

Described in responses

Recipients and published responses

Full report text

This is the full text from the original published report.

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Concerns and recipient responses

Select any concern, action or position to view the source wording.

Concerns raised5

  1. Failure to account for genetic variation in susceptibility to exposure
  2. Lack of real-time monitoring for organo-phosphate compounds in cabin air
  3. Exposure of aircraft cabin occupants to organo-phosphate compounds causing health damage

Stated actions An action is something a recipient says it has done, is doing, or plans to do in response to a concern raised.5

  1. British Airways Plc

    Keep abreast of research concerning cabin-air quality and contamination.

  2. British Airways Plc

    Maintain a system for monitoring cabin-air contamination events.

  3. Civil Aviation Authority

    Co-operate fully with EASA’s cabin air quality work.

  4. Civil Aviation Authority

    Review its position on cabin air quality after receiving EASA’s study results.

  5. Civil Aviation Authority

    Write to the Chief Coroner inviting clarification of guidance on Prevention of Future Deaths reports.

Respondent positions A position is what a recipient says about a concern when it does not describe a specific action.4

  1. British Airways Plc

    Existing government and regulatory guidance, compliance with legislation, research monitoring and event monitoring are considered sufficient.

    Existing arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
  2. British Airways Plc

    Available evidence does not support a risk of future deaths from cabin air contamination requiring further action.

    Disputes the concernThe respondent disagreed with part of the concern or the basis for it.
  3. Civil Aviation Authority

    Expert studies found no positive evidence linking cabin-air contaminants with acute or long-term health effects, although a link cannot be excluded.

    Disputes the concernThe respondent disagreed with part of the concern or the basis for it.
  4. Civil Aviation Authority

    Existing expert studies and EASA investigations constitute a proportionate, evidence-based response to cabin-air-quality health concerns.

    Existing arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Failure to account for genetic variation in susceptibility to exposure

Wider context from the report

“(5) That no account is taken of genetic variation in the human species, such as would render individuals tolerant or intolerant of the exposure. ”

Is this part of a recurring concern?

No recurring-concern membership is currently published.

Open source report

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Lack of real-time monitoring for organo-phosphate compounds in cabin air

Wider context from the report

“(4) There is no real time monitoring to detect such compounds in cabin air. ”

Is this part of a recurring concern?

No recurring-concern membership is currently published.

Open source report

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Exposure of aircraft cabin occupants to organo-phosphate compounds causing health damage

Wider context from the report

“(2) That the occupants of aircraft cabins are exposed to organo-phosphate compounds with consequential damage to their health. ”

Is this part of a recurring concern?

No recurring-concern membership is currently published.

Open source report

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Health impairment of aircraft controllers endangering aircraft occupants

Wider context from the report

“(3) That impairment to the health of those controlling aircraft may lead to the death of occupants. ”

Is this part of a recurring concern?

Yes — Inadequate medical fitness controls for safety-critical aviation personnel.

Open source report

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Presence of organo-phosphate compounds in aircraft cabin air

Wider context from the report

“(1) That organo-phosphate compounds are present in aircraft cabin air. ”

Is this part of a recurring concern?

No recurring-concern membership is currently published.

Open source report

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Keep abreast of research concerning cabin-air quality and contamination.

Verbatim wording from the response

“Those regulatory investigations are continuing with the recently announced decision of EASA to undertake further research in the area.”

Source location

2015-0050-Response-by-British-Airways-Plc
Page 1 · response
Published 16 February 2015

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Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Maintain a system for monitoring cabin-air contamination events.

Verbatim wording from the response

“BA follows the guidance and legislation to which it is subject. BA keeps abreast of research in this area, and has in place a system of monitoring such events.”

Source location

2015-0050-Response-by-British-Airways-Plc
Page 1 · response
Published 16 February 2015

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Co-operate fully with EASA’s cabin air quality work.

Verbatim wording from the response

“The CAA will co-operate fully with EASA’s work on cabin air quality and will review its position in due course with the benefit of the results of EASA’s study.”

Source location

2015-0050-Response-by-Civil-Aviation-Authority
Page 1 · response
Published 16 February 2015

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Review its position on cabin air quality after receiving EASA’s study results.

Verbatim wording from the response

“The CAA will co-operate fully with EASA’s work on cabin air quality and will review its position in due course with the benefit of the results of EASA’s study.”

Source location

2015-0050-Response-by-Civil-Aviation-Authority
Page 1 · response
Published 16 February 2015

Open published response

Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Write to the Chief Coroner inviting clarification of guidance on Prevention of Future Deaths reports.

Verbatim wording from the response

“We shall be writing to the Chief Coroner in these terms inviting him to clarify his Guidance on PFD Reports. In our view, if a Coroner is concerned from information he has obtained that circumstances creating a risk of other deaths will occur, or will continue to exist in the future, the Coroner should first establish (a) whether those concerns are reflected by information that he has not seen and (b) what action is already being taken to prevent the occurrence or continuation of such circumstances before issuing a PFD Report. The obvious way of doing that is to invite representations from the relevant public body.”

Source location

2015-0050-Response-by-Civil-Aviation-Authority
Page 2 · response
Published 16 February 2015

Open published response

Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Existing government and regulatory guidance, compliance with legislation, research monitoring and event monitoring are considered sufficient.

Verbatim wording from the response

“The Matters of Concern in the Report to Prevent Future Deaths have been fully dealt with by official Government and regulatory bodies. They have studied the issue of cabin air contamination, and have provided guidance for airlines (including BA) to follow. The evidence does not support the conclusion that there is a risk that future deaths will occur unless action is taken. The most recent example of such advice may be found in the Committee on Toxicity’s (“COT”) Position Paper on Cabin Air in 2013.”

Source location

2015-0050-Response-by-British-Airways-Plc
Page 1 · response
Published 16 February 2015

Open published response

Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Available evidence does not support a risk of future deaths from cabin air contamination requiring further action.

Verbatim wording from the response

“The Matters of Concern in the Report to Prevent Future Deaths have been fully dealt with by official Government and regulatory bodies. They have studied the issue of cabin air contamination, and have provided guidance for airlines (including BA) to follow. The evidence does not support the conclusion that there is a risk that future deaths will occur unless action is taken. The most recent example of such advice may be found in the Committee on Toxicity’s (“COT”) Position Paper on Cabin Air in 2013.”

Source location

2015-0050-Response-by-British-Airways-Plc
Page 1 · response
Published 16 February 2015

Open published response

Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Expert studies found no positive evidence linking cabin-air contaminants with acute or long-term health effects, although a link cannot be excluded.

Verbatim wording from the response

“The CAA takes its regulatory responsibilities regarding passenger and crew health very seriously. The subject of cabin air quality has been considered by several expert studies over the years as referred to in the annex to the CAA’s letter to you dated 23 March 2015, a copy of which we attach as an annex to this response. The overall conclusion of those studies is that there is no positive evidence of a link between exposure to contaminants in cabin air and possible acute and long-term health effects, although such a link cannot be excluded.”

Source location

2015-0050-Response-by-Civil-Aviation-Authority
Page 1 · response
Published 16 February 2015

Open published response

Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Existing expert studies and EASA investigations constitute a proportionate, evidence-based response to cabin-air-quality health concerns.

Verbatim wording from the response

“In our opinion the above studies represent a proportionate, evidence-based response to the concerns that have been raised about the health implications of cabin air quality for passenger and crew. They were not taken in response to the PFD Report but have been ongoing for several years.”

Source location

2015-0050-Response-by-Civil-Aviation-Authority
Page 2 · response
Published 16 February 2015

Open published response
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Information checked against the published report and official responses · Data reviewed 7 Sep 2026 · About data quality and limitations

Data last updated 7 September 2026