How to Handle In-Flight Death in International Patient Repatriation and Air Ambulance Operations

In-flight cardiac arrest is a rare event that occurs at a rate of approximately 1 event in 3.8 to 4.7 million commercial airline passengers and at a rate of approximately 1 event in 1,500 to 3,000 patients transported by fixed wing international air medical transport. Only 13% to 19% of victims of in-flight cardiac arrest can be successfully resuscitated. The arrival of an aircraft with a deceased patient/passenger on board triggers a country-specific procedure that focuses on public health and medicolegal considerations. In most jurisdictions, these procedures are detailed in the respective national Aeronautical Information Publication, which are commonly based on the International Civil Aviation Organization International Standards and Recommended Practices, Annex 9 to the Convention on International Civil Aviation. Awareness among medical and flight crews on such procedures will support appropriate documentation of the event and enable effective cooperation with the relevant local authorities.