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October 30, 2019

Death at 30,000 feet: What really happens during an inflight medical emergency

Daily Briefing
    Editor's note: This popular story from the Daily Briefing's archives was republished on Nov. 21, 2022.

    It's rare for airplane passengers to experience a fatal medical emergency midflight, but that's what happened onboard medical journalist Kate Johnson's flight. In the New York Times' "Well," Johnson recalls the harrowing effort by medical professionals on the plane to revive the passenger—and the crew's "calm" response. 

    Johnson recalls that the man was "already dead" when medical professionals on the plane—a firefighter, a few nurses, and Johnson's daughter, a medical student—begin CPR.

    "The monotony of the counting, the silence of the other passengers, the lack of response, the futility—the nothingness is building into something," Johnson writes. "The defibrillator beeps, again and again. No response," Johnson notes. The man's "lips are a violent blue," Johnson writes, calling the experience "obscene" to witness.  

    The rescue group takes turns trying to resuscitate the man, "[t]heir breaths, sometimes misdirected, bloat his stomach," leading it to "eventually regurgitate[e]," Johnson writes. "They are emptying themselves into and onto him."

    But despite the team's efforts, after a period of time, a flight attendant tells them, "There is no response. It's been 15 minutes. OK to stop."

    As the rescue team returns to their seats, the flight crew carries the patient "to a seat near the back where he is propped up, with an eye mask, blue lips displayed for all to see," Johnson writes.

    While this "was terribly unsettling," Johnson later learned the International Air Transport Association recommends that passengers who die midflight be given a seat with a blanket covering them from the neck down. Johnson discovered the reason the patient was seated is because "he was not 'officially' dead yet, only presumed so until a doctor could declare it." She writes, "We lay dead bodies down. We cover their faces so they may rest in peace."

    With four hours left of flight time, Johnson writes the pilot makes a brief announcement, "There was a medical emergency—it's been dealt with." So much went unsaid in that message, Johnson writes. "On a lonely flight, 30,000 feet in the air, the pilot failed to announce The Departure."

    Could things have gone differently?

    Recalling the flight crews response, Johnson asks, "Could the process of his attempted resuscitation have been handled better?"

    She notes that an in-flight medical emergency happens 16 times for every one million passengers. A death happens once in every 7.74 million passengers. "So it's unlikely the crew on my flight had much experience with an in-flight death," Johnson writes.

    "One flight attendant had seemed to take charge of the initial response," Johnson notes. "But his instructions floated aimlessly in the air as his colleagues fumbled," Johnson explains, as they searched for items essential to the rescue, without a clear idea of "where to look or what to look for." But despite the confusion, Johnson writes, "The man could not have been revived."

    In the immediate aftermath, Johnson's daughter, the medical student, "wants more," Johnson writes. "She needs to know the cause of death [and] the preceding symptoms" for closure, but the crew says they cannot share this information with her, Johnson writes.

    Upon landing, Johnson's daughter tells an officer the family may contact here if they wish. "One officer shrugs and says that won't be necessary," Johnson writes. "But it is important. She talks to another, who takes note of her offer."

    As the passengers leave, "the healers straggle off, no words exchanged," Johnson writes. "They dissipate, like his spirit" (Johnson, "Well," New York Times, 10/18).

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