According to IATA’s guidelines, cabin crew should perform CPR until one of the following conditions is met: breathing and circulation resumes, it becomes unsafe to continue (for example, due to severe turbulence or difficulty landing), all rescuers are too exhausted to continue, the aircraft has landed and care is transferred to emergency medical services, or if the person is presumed dead. “If CPR has been continued for 30 minutes or longer with no signs of life within this period, and no shocks advised by an on board Automated External Defibrillator (AED), the person may be presumed dead and resuscitation ceased,” the IATA guidelines say.
During a medical emergency, crew will always 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 (as opposed to presumed 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,” a Virgin Atlantic cockpit veteran, who asked to remain nameless as most commercial pilots aren’t allowed to comment on the record, told Traveler in 2018. ”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.” A spokesperson for Virgin Atlantic declined to comment when asked if these procedures remain current today.
It’s an urban myth that deaths require an emergency diversion or landing, says Global Rescue’s Dr. Seid. “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.
According to the suggested IATA protocol, this may mean moving the deceased to a seat with few other passengers nearby. If the aircraft is full, the body may be returned to the passenger’s original seat or moved to another area that doesn’t obstruct an aisle or exit. Crew are advised to “take extra care when moving the person and be aware of the difficulty of the situation for companions and onlookers.” If a body bag is not available, crew should cover the body with a blanket and close the person’s eyes, IATA says.
In situations like this, the focus is always on dignity: The person 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, provided 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.”
This article has been updated with new information since its original publish date in 2018.
