31 minutes after taking off from Taiwan’s CKS International Airport at 0746 local time on May 8, 2000, and during cruising level flight and heading for Ho-chiming City, Vietnam, the first officer of China Airlines flight CI681, an Airbus A300-600R with registered number B-18503 and carrying 265 passengers found out that the captain had suddenly showed no response to the flight. Following the incapacitation procedures, the first officer called the cabin chief flight attendant and a flight attendant to help him to move the captain to the main cabin (galley) to do the first aid. At the same time, through the passenger address system the cabin chief announced for the help of a doctor on board, if any. Then the first officer decided to turn back to CKS International Airport. Eventually, the aircraft landed safely via autopilot system on Runway 05-Left.

At 0816, before landing, a request was issued for ambulance and towing vehicle to stand by.

The aircraft landed at 0850 and stopped on the taxiway at 0852.

As China Airlines allows no first officer taxi, China Airlines flight CI681 waited to be towed to the parking bay.

After towing to the parking bay, medical personnel embarked the aircraft to carry out first aid. At 0936, the captain was carried to Mingsheng Hospital in Tao Yuan County. After unsuccessful operations, the captain was announced dead at 1020 in that hospital.

• The captain held a physical certificate and a certificate of the aircraft rating issued by Civil Aeronautics Administration (CAA). The physical certificate showed no specific restrictions or any record of waiver.
• According to the data of his heavy weight, age, hyper lipidemia and smoking habit in his physical examination record, the pilot was grouping to a high potential cardiac patient.
• The incapacitated pilot made no remarkable improvement to the suggestions of the physical examination doctors.
• There was no pilot’s medical history dated before his coming to work in Taiwan.
• The track cardiograph of the pilot physical examination record showed no symptoms of myocardial infarct. The Aviation Medical Center did not have to conduct the follow-ups in accordance with the Procedures of Physical Examination of CAA.
• The pilot’s working hours, flying hours, and Rest time were totally in accordance with CAA laws. The flight crew who flew with the said pilot in one or two days before the incident said that he did not exhibit any irregularity at work.
• The medication the captain carried with him showed no toxic ingredients or any cardiac-healing medicaments.
• The cause of death of the pilot was coronary artery occlusion, i.e., a natural death.
• The first officer conducted the flight with autopilot. The weather of the day was fair and the aircraft was in airworthiness condition. Before the incident, no flight crew had extra workload and the captain was under regular pressure of work.
• When the pilot incapacitation happened, the first officer proceeded with the airlines’ incapacitation procedures and landed the aircraft safely with auto-land system at CKS International Airport. However, the first officer failed to use emergency phraseology to report the serious incident.

As the captain experienced the incapacitation, the flight attendants that entered into the cockpit had good cooperation with one another and kept performing cardiopulmonary resuscitation (CPR) to the captain of China Airlines flight CI681.

• The doctor on board performed first aid to the captain and found that the captain had incontinence of urine, mydriasis, no heartbeat and pulse reaction.
• The CKS International Airport provided medical personnel and facilities and maintained a medical cooperative contract with MinShen Hospital. The CKS Airport also provided procedures for seriously ill passengers to quickly pass the immigration. However, there were no medical treatment operation procedures established in CKS Airport.
• In the “Civil Aircraft Accident Procedure Highlights” of the CKS International Airport, it stipulated that medical service in airport was the responsibility of the contracted Mingsheng Hospital. However, the said Highlights failed to describe the duties and detailed procedures of the medical service team.
• The air traffic controllers at Taipei Area Control Center failed to understand the message of incapacitation sent by the first officer of the aircraft. They relayed a wrong message of a seriously ill passenger to the airport authority. Again, the first officer made requests twice to land on Runway 05-Left, however, the air traffic controllers answered runway in use 06. It was observed that the air traffic controllers failed to comprehend the message sent by the first officer and that severely affecting the following emergency operations on ground.
• The airport authority failed to offer the nearest parking bay available for the emergency response servicing.
• CAL’s Asian Dispatch Center personnel failed to fully communicate with the first officer and keep close contact with the CKS International Airport authority. CAL’s Asian Dispatch Center personnel failed to response properly for saving the time to comply the request of the officer to call towing vehicles to stand by the runway. It made the aircraft wait for towing vehicles for as long as 9 minutes (0852-0901) on the runway.
• The commanding vehicle at the scene had no two-way radio for communications with the aircraft that made it impossible to know immediately of those emergency responses such as that the first officer was not authorized to taxi, the condition of the sick person and the intention of the aircraft commander.
• CKS Airport had the “Implementation Highlights of CKS Airport Accident and Incident Handling Procedure”, the “Civil Aviation Accident Notification Procedures,” the “CKS Airport Transit Procedure for Emergency Sick Passengers,” and the” Firefighting Operation Handbook”. However, there was no such “ Full Emergency Operation Procedures” as recommended by International Civil Aviation Organization.

The aircraft landed and came to a completely stop at 0852. The incapacitated pilot was carried to the ambulance at 0936. The whole emergency process took 44 minutes.

The pilot’s natural death was caused by heart rhythm disorder that was triggered by acute cardiac artery occlusion.

• There were no follow-up actions to further remind the pilot who belonged to the hig group.
• According to the pilot’s physical examination records, the pilot made no signs of substantial improvements to his health.