What Happens When Someone Dies Mid-Flight

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Traveler editor Lale Arikoglu was flying through the night from New York to Istanbul last summer when a group of flight attendants rushed down the aisle and stopped next to a woman two rows behind her. The passenger had been unresponsive when her seatmate tried to wake her so he could use the bathroom. The crew called for a doctor, and the pilot got on the PA system to let passengers know they would be making an emergency landing in Zurich.

“We all sat in silence, listening to the flight attendants yell at each other in Turkish as they tried to resuscitate the woman while we descended,” says Arikoglu. On arrival, the plane sat on the tarmac; you could see the flashing lights of the police and ambulance waiting outside, she says. The emergency officials boarded the plane and carried the woman down the aisle past bleary-eyed passengers. The Swiss police, struggling to find the woman’s bag—she was traveling alone—asked passengers to claim their own as the police used process of elimination to recover it. The remaining passengers stayed on the plane; an hour went by, maybe two. Without further explanation, the pilot said they were clear to leave and the plane continued on its journey to Istanbul. “Even a year on, I think about that woman a lot,” says Arikoglu. “We never found out what happened. She was only around 30.”

It’s not surprising that in-flight deaths regularly grab the headlines—the experience can be traumatic, to say the least. In September, a British man traveling from Manchester to Ibiza died after needing medical attention on the flight. The inquest into another Briton’s death just concluded: Schoolgirl Natasha Ednan-Laperouse died of an allergic reaction to a sandwich she’d bought at Heathrow and brought on a British Airways flight to Nice two years ago. Stateside, 25-year-old Brittany Oswell died two years ago after having a pulmonary embolism on a flight from Hawaii to Texas; her family is suing American Airlines because the pilot failed to divert for the medical emergency. Other recent cases have included a 70-year old woman who died while flying to New Delhi from London, and an American Airlines pilot who had a medical emergency in 2017 during the final phase of landing in Albuquerque, New Mexico. The captain managed to land the plane successfully, but attempts to revive the other pilot failed.

Despite the media fascination with in-flight deaths, “death onboard a commercial aircraft is actually quite rare,” says Dr. Claudia Zagan, associate medical director of Global Rescue, which focuses on medical emergencies while traveling. “Medical emergencies occur in approximately 1 in 600 flights, which represents 16 medical emergencies per one million passengers.” A New England Journal of Medicine study from 2013 found that just 0.3 percent of in-flight emergencies over a two-year period involved passenger death.

It may not be as rare as a baby born in the sky, but in a tight space where nerves are already high, experiencing a death can leave its mark.

Yet the intensity of the experience, in such constrained quarters, magnifies the effect for passengers and staff involved, says Dr. Paulo Alves, MedAire’s global medical director, who previously worked as the medical director of Brazil’s Varig Airlines. It may not be as rare as a baby born in the sky, but in a tight space where nerves are already high, experiencing a death can leave its mark—even a year on, as it did for Arikoglu. Airlines, for their part, plan as well as they can: Many carriers have traditionally carried stretchers on board, he says, though the chiller cabinet in the now-retired long-range Airbus A340-500 operated by Singapore Airlines—dubbed a “corpse cupboard” in media reports—was an outlier.

Alves says Arikoglu’s story was also atypical, and per his experience, most in-flight fatalities are not unexpected. When a terminally ill patient wishes to visit a country for the last time—usually to see family—airlines allow them onboard as a humanitarian gesture, even though the low oxygen environment of a pressurized cabin might cause distress. “If you don’t accommodate the passenger, they wouldn’t have their very last wish,” he says, “So airlines might enter into some accord with the family, agreeing in advance that the flight will not divert. Sometimes the person carries a formal DNR certificate, too.”

Procedures in the event of a life-threatening medical emergency or death vary by airline, and there are no formal rules via industry bodies like the International Air Transport Association (IATA) or the Federal Aviation Administration (FAA). Attempted resuscitation is recommended—there are Automated External Defibrillators available on most planes—and staff will ask if there’s a doctor on board. The request isn’t solely about help with revival; only a physician can legally declare a patient dead, so if the doctor does make this call, it falls to the pilot to decide next steps. If there isn’t a doctor on board, airlines will connect with someone on the ground: MedAire operates a service called MedLink, for example, which acts as an on-call doctor for pilots in this scenario.

“We have satellite communications with MedLink, whose doctors take primacy in the decision-making process,” says a Virgin Atlantic cockpit veteran who asked to remain nameless as most commercial pilots aren’t allowed to comment on the record. ”To assist them we have a piece of kit called Tempus, which is a diagnostic device. In essence, you can connect it to the casualty and it monitors a whole range of bodily functions: heartbeat/rhythm, blood pressure, temperature, glucose levels. It will then livestream these to MedLink.”

It’s an urban myth that deaths require an emergency diversion or landing, says Zagan. “There is no mandate to alter the flight path in the event of a death in flight. The pilot must follow certain notification regulations, depending on the country and jurisdiction of the destination airport, as well as company protocol.” Typically, the pilot won’t specify that there’s been a death, but rather a medical emergency; if pilots decide not to divert, the cabin crew will be tasked with handling the body in the interim. The focus is always on dignity: The corpse might be moved to a crew rest area, or even to first class, where there’s likely to be more space, in the form of a spare seat, where the body can be discreetly placed. IATA spokesperson Perry Flint says that tales of corpses left in their own seat, perhaps covered with a blanket with oxygen mask in place to suggest sleep, are commonplace; there is no data, however, to suggest it as widespread practice, nor would a body ever be hidden in the bathroom—another misconception.

As for costs and logistics involved with post-landing repatriation, it again falls to the individual airline. “There are protocols for transport of bodies and if international borders are crossed. These are complex and may require specialist agencies to facilitate, rather than simply putting the body on board,” says Flint. “The cost may or may not be covered by travel or medical insurance policies.”

MedAire’s Alves, though, provides some context to it all. “At this very moment, probably around one million people are flying across the world—it’s like a virtual city suspended in the air. So over a period of 12 hours, people will be born, and people will die.”

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