In September, we reported on the death of Robert Rippingale, a 31-year-old Jetstar passenger who passed away on a flight from Singapore to Auckland.
choked to death while eating dinner, and although a doctor and two nurses
were onboard, they were unable to resuscitate him.
Although such tragedies are very rare, in-flight
deaths are eventualities that airlines have to be prepared for. “It’s one of those things that's very
unusual but that doesn’t make it any less difficult to deal with,” said Heidi Macfarlane, a protocol expert and vice president of strategic
development for MedAire, a company that provides airlines with on-the-ground medical
support. “Whether you're the person who dies
or a family member or crew member, it's a difficult situation.”
MedAire provides 24-hour support to more than 60
commercial airlines worldwide. In 2010, the company received more than 19,000
calls about in-flight medical emergencies. Of those cases, 94 people
In order to understand how airlines and MedAire
doctors respond to deaths, it is important to understand why deaths occur in
the first place. “There are three categories of people who could die onboard,” said
Dr Paulo Alves, vice president of aviation and maritime health for MedAire. The
first is someone for whom a medical emergency is completely unexpected. The
second is someone who is terminally ill and is travelling specifically for
medical purposes. The third is someone who knows he or she is sick, but wants
to travel anyway, often without consulting a doctor.
Unexpected medical emergencies include heart
attacks, strokes or accidents such as choking. In 2009, for example, the
captain of a Continental Airlines flight died of a heart
attack mid-flight. There is always at least one co-pilot in the cockpit
in addition to the captain, and in this case there were two co-pilots who
continued flying the plane and landed it safely at Newark Liberty
International. In order to avoid panic, the crew did not tell passengers what
Terminally ill patients are usually on stretchers and may be travelling
for the express purpose of dying in a particular location. Airlines are made
aware of such passengers and can try to make space on larger planes to
“The most important category for me is the third one,” Dr Alves said.
“Many times [these patients] are not aware of the possible consequences of [being
in] an aircraft [environment]. Sometimes, they never checked with any doctor
whether it is appropriate or not [to fly].” These are “determined travellers” –
people who may be desperate to get back home or who have made non-refundable
travel arrangements and don’t want to miss their trip. “We see this very often,
actually,” said Dr Alves. “Those are typically tragic circumstances [because
they] can be avoided by better education.”
MedAire had a recent case in which a couple asking for extra air
sickness bags was discovered to have norovirus, commonly called “the cruise ship virus”. Since the plane hadn’t yet taken
off, the two sick passengers were taken off the flight. The next day, the
couple realized they would be able to fly as long as they didn’t say anything
to the flight attendants. “We received another in-flight medical call from the
airline saying the passenger was still vomiting and was dehydrated,” recalled Macfarlane. In 2010,
MedAire received more than 12,000 calls for similar cases.
So, how does an airline respond when one of these cases results in a
death? Depending on the airline, flight crews may receive instructions from
on-the-ground medical professionals on how to proceed. “It’s not automatic that
a flight would divert if someone expires onboard,” said Macfarlane.
“Sometimes in the end, individuals with the deceased would rather carry
on to their destination,” explained Dr. Alves. For family members or friends of
the victim, dealing with human remains becomes more complicated in an
There can be reasons for diverting a flight, though. “Let's say they're travelling
from the east coast to the west coast of the US, and they’re only an hour into
the flight, and it's a small aircraft and every seat is occupied,” Macfarlane described.
“[The crew] may make a decision that travelling four more hours with human remains
onboard is too much emotionally for the crew or the family.”
Then there’s the issue of how flight attendants handle the body of
someone who has passed away. Sometimes flight attendants strap the person back
into his or her seat, which is often the safest option for nearby passengers. Putting
a body in a lavatory or in the aisle would be a violation of safety
regulations. And there may not be a row with enough free seats to lay the body
If there is not a proper space elsewhere on the plane, Singapore
Airlines actually has a compartment on its A340-500 aircraft that can hold the body of someone who has
died. The A340-500 flies the longest duration and distance flight in the world,
a nonstop 18-hour flight from Newark to Singapore. “So that creates a whole host of new
realities in terms of how you manage the flight process,” said spokesman James Boyd.
This flight also has two full sets of cockpit crew and two full sets of cabin
crew to help plan ahead for emergencies.
Airlines flight attendants are trained to perform resuscitation until the
airline’s medical consultant advises them to stop, but they do not have staff members
onboard who are qualified to call a time of death. “We technically don’t have
any mid-flight deaths,” said spokeswoman Katie McDonald. Cruise ships, on the other hand, do have
medical professionals onboard. They also often have morgues to preserve a body
in case of death.
About 10 to 12 million people go on cruises each year, many of them
elderly, so deaths are bound to occasionally occur. Just this fall, two
separate, unrelated deaths occurred on a Norwegian Dawn cruise to Bermuda, both stemming from
Since cruise ships can hold thousands of passengers who eat together,
drink together and sometimes engage in risky behaviours, there can be safety concerns. Foodborne illnesses, such as norovirus, are common on cruise ships, so experts recommend being diligent
about washing your hands regularly. Substance-fuelled accidents can also take
place, such as falling overboard. Deaths on cruises are most commonly the
result of natural causes, though, often due to old age.
Whether a death occurs during air travel or sea travel, almost every
case is different. “Each situation is unique,” said Ed Martelle, a spokesman for
American Airlines, “so we do not have a ‘one-size-fits-all’
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