Fasten Those (Inflight) Seatbelts!

"Airports like London Heathrow deem that the person hasn't died [while a passenger on a flight] until the port authority doctor certifies the death. Only a licensed physician can pronounce death; otherwise it is deemed 'apparent'."

"If possible, passengers are displaced, but remember, most flights are full. Or, if possible, the body is relocated."

"The body is covered with a blanket up to the neck, the seat is reclined, eye shades are used, the seat belt is fastened, and pillows are used for padding."

Flight Captain Doug Morris, Air Canada Pilot

An airplane passes in front of the setting sun in London. A flight does not always divert if someone expires onboard (Press Association)

There were thousands of medical emergencies (that emanated from millions of passenger flights) in three years of which 0.3 percent culminated in death during a flight, according to a 2013 report in the New England Journal of Medicine on "Outcomes of Medical Emergencies on Commercial Airline Flights". That 0.3 percent was broken down to specify that out of 36 identified 'airline' deaths, 30 occurred during flight, capturing people ranging in age from a one-month-old baby to a 92-year-old.

Air Canada Captain Doug Morris published a book titled This Is Your Captain Speaking: Stories From The Flight Deck. He pointed out, among other things, that people travel for many reasons, the most common among which is for leisure and for business. But there are also people for whom a flight can represent issues of health and mortality. Those who fly somewhere in search of medical care, or who return home to spend their final days where they plan to breathe their last.

People live, people die, and occasionally they die while flying somewhere on a commercial flight that is shared by hundreds of other people. People who are suddenly confronted by a dire medical emergency among the passengers that results in death. The reaction is horror, fear and sometimes panic. People take death very seriously; their own, and that of others in proximity to themselves in particular. Flight crews are not completely unaware of the risks involved in their positions that can call upon them to administer defibrillators.

Abstract:  In-flight Deaths During Commercial Air Travel  How Big Is the Problem?

"Do passenger deaths occur during commercial air travel? If so, how often and from what causes? We reviewed information reported to the International Air Transport Association on in-flight deaths that occurred during commercial air travel for the eight years between 1977 and 1984. Of the 120 airlines in the International Air Transport Association, 42 carriers reported deaths during these eight years. A total of 577 in-flight deaths were recorded, for a reported average of 72 deaths per year. Deaths occurred at average rates of 0.31 per million passengers, 125 per billion passenger-kilometers, and 25.1 per million departures. The majority of those who died were men (66%, 382/577) and middle-aged (mean age, 53.8 years). Most of the individuals (77%, 399/515) reported no health problems prior to travel. Physicians aboard the aircrafts offered medical assistance for 43% (247/577) of the deaths. More than half of the deaths (56%, 326/577) seemed to be related to cardiac problems. Sudden unexpected cardiac death was the cause of death in 63% (253/399) of the apparently healthy people and seems to be the major cause of death during air travel. These observations support the initiation of programs to train cabin personnel in the skills of basic cardiopulmonary resuscitation and in the use of automatic external defibrillators."

JAMA Network   April 1, 1988

In one instance, a 62-year-old man died on a flight from Los Angeles to Albuquerque in 2014. The reaction of the flight crew was less than noble, in refusing to use a defibrillator in reflection of the man's hairy chest. More recently a woman in her 60s died en route to Manchester from Tenerife. Such events, though rare, are morbid events causing no lack of consternation from all involved.

Even though it might seem obvious from close inspection by a member of a flight crew that someone has suddenly died on board, legally and medically the expired are not held to be technically dead unless and until an authorized medical practitioner examines the person and confirms death has occurred. In such unlikely events as an onboard, inflight death, often passengers who happen to be medical doctors can intervene. 

The International Air Transport Association's non-binding protocols anticipate that cabin crew may be prepared to perform cardiopulmonary resuscitation for 30 minutes at the least when circumstances such as turbulence allow the opportunity for the deceased to be placed on the floor. Everyone must wear seat belts however, during periods of severe turbulence, including the dead, and for obvious reasons; a body left unsecured has the potential to bang about the interior of a plane, becoming a potentially lethal flying object itself.

When these situations arise, the plane becomes unlikely to reach a scheduled destination on time. Captain Morris, in writing of his experiences with an in-flight live consultation service helping to determine whether an on-board medical emergency requires flight diversion, indicates that presumed deaths do qualify for flight diversion.

"I have diverted to a few places under their recommendation, but I've also kept the flight going most times, based on their expert findings."

"The service is a saviour for everyone because there is nothing easy about 'pulling over to the side of the road', in an airliner."

Air Canada Captain Doug Morris