The Real Reason to Fear Flying

New Scientist | 7 June 1997


Forget terrorists. You are more likely to die from a heart attack or other medical emergency while travelling on an airplane than from almost anything else, says Wilson da Silva.



MORE AIRLINE passengers are dying from heart attacks and other medical emergencies than in plane crashes. The latest figures from the U.S. Federal Aviation Administration (FAA) suggest that the number of in-flight medical emergencies has doubled in the past decade.


The most detailed study yet, using figures collected between 1990 and 1993, shows that there were 14,000 incidents a year on the country’s nine major airlines.

Applied across the whole country and all airlines, this suggests at least 21,000 emergencies occur annually in the United States alone, or an average of 15 a day. Of these, an estimated 350 to 360 passengers die. This compares with an average of 118 U.S. passenger deaths a year from air crashes.

“It’s probably under-reported. Nobody wants to draw attention to the fact that people die on board.”

Other countries report similar figures: in the year to March 1997, British Airways had one medical emergency for every 11,000 passengers. The British medical journal, The Lancet, estimated in 1995 that between 500 and 1,000 people die annually aboard aircraft of heart attacks alone.


“It’s probably under-reported,” says Michael O’Rourke, an Australian cardiologist at the University of New South Wales in Sydney, an expert in aviation medicine. Despite the high figures in the American study, he said many U.S. airlines register the place of death as the terminal. “Nobody wants to draw attention to the fact that people die on board.”


Air crew undergoing training in in-flight medical emergencies

Experts believe much the same occurs in Australia, but thy are hampered in that Australia’s Civil Aviation Safety Authority does not consider it an air safety issue. No data on emergencies or fatalities is collected, and the agency has never studied the issue, say the airlines. Australia’s flag carrier, Qantas Airways, reports an average of three in-flight emergencies a week, and about five passengers a year die on international flights. This equals about one death per million international passengers; on a bad year, the airline has had 11 on-board fatalities. 


Most airlines have a standard procedure to deal with airborne deaths: place bodies in the toilet and mark the cubicles 'out of order', or put cushions and a blanket around the corpse in order to feign sleep and not draw the attention of other passengers.


What is worrying about the FAA study is that the number on-board emergencies is at least five times higher than in the last study, from 1986 to 1988; it found an average of two to three emergencies a day on U.S. airlines. 

Qantas was one of the first airlines in the world to introduce defibrillators on its long-haul international flights. In the first five years since their introduction in 1992, the defibrillators were used 109 times.

Although the problem has increasingly been discussed among aviation physicians – most of them employed by airlines and much of the discussion behind closed doors – the FAA study has forced the issue into the open. 


The aviation subcommittee of the U.S. House of Representatives in May 1997 began hearings into the adequacy of in-flight medical care in the United States, where aircraft generally carry fewer emergency medical supplies than in other countries. 


Eric Donaldson, the former president of the international Airline Medical Directors Association and general manager of aviation health at Qantas, testified at the hearings that heart defibrillators are an important part of the emergency equipment aboard airlines. Defibrillators send powerful electric shocks into the heart muscles to restore their beating. Not only do they save lives, he said, they also reduce the number of diversions in response to medical emergencies. 

Qantas was one of the first airlines in the world to introduce defibrillators on its long-haul international flights, as well as medical kits with a range of hospital-grade drugs and medical tools. All of its 345 flight service directors, or chief stewards, are trained to operate the defibrillators.


In the first five years since their introduction in 1992, the defibrillators were used 109 times. On 24 occasions, passengers had their heart rhythm restored while in another 63 cases the machines were used to monitor sick passengers while heart drugs were administered. In at least 17 cases, the machines were used in terminals. 


“Defibrillators will not save every victim of a heart attack, but it will give them a chance that would not otherwise be available,” Donaldson says. “If you’re travelling at 30,000 feet and someone has a heart attack, it would take at the very least 20 minutes to get back to the gate. After 16 minutes, the chances of resuscitating someone who’s gone into cardiac arrest are virtually nil.” 

“If you’re travelling at 30,000 feet and someone has a heart attack, it would take at the very least 20 minutes to get back to the gate. After 16 minutes, the chances of resuscitating someone are virtually nil.” 

American carriers are reluctant to discuss the issue. “People don’t die on our airline,” an unnamed airline official was recently quoted in an American newspaper . “They may stop breathing and their hearts may stop beating, but they just don’t die on our airline.”

For years, many have maintained that fatalities largely involve elderly people who would have died anyway, and that aircraft can be diverted to ground for medical assistance within 30 minutes. 


These arguments were tested in 1996 with the tragic death of a 37-year-old businessman on an United Airlines flight from Boston to Salt Lake City, a case that triggered a series of damning newspaper articles on airline safety. The victim, an avid sportsman and father of three, died at 37,000 feet – flat on his back in the first class aisle and being tended by three doctors, a nurse and a paramedic. Despite the assembled medical firepower, they could do little without the drugs or the defibrillator that might have saved his life.

Some U.S. carriers have been convinced. American Airlines, which experiences 50 to 60 on-board heart attacks a year, began to introduce defibrillators and enhanced medical kits in 1997. 


Only two other airlines in the world carry defibrillators: Virgin Atlantic and Air Zimbabwe. Hong Kong’s Cathay Pacific recently has said it intends to introduce defibrillators, while British Airways and Scandinavian Airlines are considering the move. 


While no one knows why the rate of medical emergencies aboard passenger aircraft has doubled since 1988 – in the United States at least – there are a number of theories: most of the deaths occur on long-haul flights, and the number of passengers taking these has doubled in the past decade. The number of Americans flying international routes – many of them long-haul flights – has also doubled.


Additionally, the population is growing older, and many more of the elderly are flying. Some doctors speculate that the added exertion of carrying baggage before a flight, and the excitement of holiday travel, may help trigger episodes. 

Wilson da Silva is the Sydney correspondent  for New Scientist.

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