A doctor trying to save the life of a plane passenger who was choking on a bread roll found the emergency medical kit "largely empty", an inquest heard.

Brighton doctor Tim Sales was also forced to use a knife which had been confiscated at Gatwick when he asked for a blade and pen to carry out an emergency tracheotomy on the patient.

But the blade was too blunt to cut through Raffaele Falzon's skin to create a new airway in his throat and he later died.

The 74-year-old retired labourer from south-east London had just left Gatwick with his family for a holiday in Tunisia.

His family and a member of the crew tried to use the Heimlich manoeuvre when he became pale and his eyes did not focus. Then an announcement was made calling for a doctor.

Dr Sales tried to revive Mr Falzon using heart massage, back slaps and more Heimlich manoeuvres in the aisle of the plane.

Dr Sales told the inquest at Southwark Coroners Court the medical kit he was given did not contain many supplies.

He said: "I was very surprised how little was there."

Deputy assistant coroner Doctor Adele Williams asked whether the box was largely empty. He replied: "Pretty much, yes. Possibly there was another box and this was the overflow from it."

He also told the hearing two oxygen cylinders brought to help the ailing grandfather could not be used.

He said the first was empty or the gauge was faulty. When a different one was brought, he said the airline crew did not seem familiar with it at all.

In a statement, firefighter Chris Tuthill, who helped Dr Sales, said: "The crew could not operate the oxygen equipment provided. Tim tried a tracheotomy but there was insufficient equipment on the plane. We tried to explain the first aid provision was not up to standard."

A legal notice from the Tunisian Ministry of Transport contains details of the recommended composition of both first aid kits which can be used by crew and also emergency kits for use by medically qualified personnel.

Emergency kit items should include a single-use syringe, stethoscope, forceps, and other medication and equipment. Guidance from the Convention on International Civil Aviation recommends medical kits should contain disposable syringes and a disposable scalpel handle and blade.

The plane was diverted to Lyons in France, and Mr Falzon was then treated and taken off the flight by a French team of paramedics.

But Dr Sales said by then the Libya-born father of 11 had no pulse. The inquest heard the crew on board were trained in the use of oxygen, and the medical kit contained all that was required.

There was no record of the oxygen equipment having been found to be defective prior to this incident.

Lofti Ayadi, cabin crew chief, said: "There was no panic on board the aircraft. The crew performed well and in accordance with training.

"I'm not aware of any irregularity in either the conduct or knowledge of the cabin crew."

A post-mortem examination in France found Mr Falzon had died of asphyxia as a result of a mechanical event.

Dr Williams apologised to the family for the "shameful" length of time it had taken to hold the inquest since the flight on August 14, 1998.

She said it seemed clear to her the oxygen was not functioning properly on the plane and there was limited equipment in the first aid kit.

She said two items that might have made a difference to Dr Sales' efforts were a scalpel and syringe.

She said: "I think we have to bear in mind the inevitable difficulties of resuscitating anybody onboard an airplane and I don't know whether a tracheotomy, carried out by Dr Sales, would have been successful.

"However, I think it is very notable the absence of this equipment prevented there being any real chance of saving Mr Falzon."

She recorded a narrative verdict "that Mr Falzon ingested some food on board flight 987 from Gatwick on August 14 1998, as a result of which he choked".