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Dealing with death at 30,000 feet

In-flight fatalities are a dreadful and often traumatizing experience for family members and fellow passengers who are forced to take a close-up look at frailty and death and share their journey in close quarters with a corpse.
/ Source: The Associated Press

When Rubina Husain's husband died aboard an airliner, she shielded her 10-year-old daughter's eyes so she wouldn't see her daddy's body carried through the cabin.

Then, with the corpse covered up and tucked away in a rear galley, the passengers who had stood around and stared after the man collapsed returned to eating and chatting. The Athens-to-New York jetliner continued on to its destination for eight or nine more hours. And the in-flight movie was shown as planned.

"It felt like a never-ending flight," says Husain, whose husband died in 1998 after an asthma attack. "I felt like: Why doesn't this plane just crash and kill me? Why don't I just die?"

Abid Husain, who couldn't be saved despite CPR and an epinephrine shot from a doctor friend who was aboard, was one of hundreds of people who have died on airplanes in recent years —a dreadful and often traumatizing experience for family members and fellow passengers who are forced to take a close-up look at frailty and death and share their journey in close quarters with a corpse.

"It's one of the most overwhelmingly emotional situations possible," said Heidi MacFarlane, a spokeswoman for MedAire, a company that has doctors available on the ground to advise flight crews in a medical emergency. "When you're the one sitting next to the remains, it can be shocking and upsetting."

The macabre phenomenon has received renewed attention since a 44-year-old woman died on a flight from Haiti to New York last week, drawing complaints from her family that the airline did not do enough to respond.

Airline procedures vary
When a passenger is stricken aboard a plane, flight crews and travelers with medical training often pull out emergency medical supplies and rush to save the patient's life in full view of other passengers.

If the person dies, the crew often throws a blanket over the corpse or puts it in a body bag, an item routinely kept on some planes. The dead passenger is sometimes placed on the floor in a galley area, or kept buckled in his or her seat, since a corpse cannot be allowed to block certain emergency exits. Pilots may consider making an emergency landing, but often they keep going.

Airlines are not required to track or report the medical incidents they handle, so an exact tally of in-flight deaths is hard to find. But fatalities and serious illnesses on airplanes are rare when compared to the large number of people who fly.

MedAire is on call for about one-third of the world's commercial flights and counted 89 deaths in 2006. That means that if a similar death rate occurs on the other flights, the number of annual deaths exceeds 260.

MedAire says that each passenger boarding one of the flights monitored by the company in 2006 had at least a 1-in-7.6 million chance of dying on board in a medical incident.

People are far more likely to die in a plane crash. In 2007, 1 in 1.3 million travelers who boarded a commercial flight anywhere in the world died in an incident in which the plane was damaged, according to the International Air Transport Association. In 2006, the rate was 1 in 1.5 million.

The Federal Aviation Administration requires airlines stock certain emergency medical supplies, such as defibrillators, syringes and epinephrine, and train flight attendants in CPR and some first aid.

FAA spokesman Les Dorr said he was unaware of any policies that specifically address what should be done if someone dies in flight. The airlines make those decisions on their own.

When a passenger falls seriously ill, flight attendants often contact the pilot. The crew typically makes an announcement to the passengers, asking whether there is a doctor or other medical professional aboard. And in many cases, there is. But if there isn't, the crew can usually reach specialists on the ground for advice on such things on what treatment to give and whether to make an emergency landing.

The procedures for how to handle airplane deaths are less public. Northwest Airlines and JetBlue declined to release their policies on how crew members decide where to place the body and what they are supposed to say to family members and other passengers. Delta Air Lines did not return a call.

"When there is a death aboard a flight the general procedure is to move the deceased to an area of the cabin where they can be isolated to some extent and covered in as dignified a way as possible," said Tim Smith, a spokesman for American Airlines, which is under scrutiny over the death last week of Carine Desir.

MedAire advises crews not to place the body in a lavatory. In the past, that has made it difficult to remove the remains from the tiny space after rigor mortis has set in.

While the pilot has the option of diverting the plane after someone has died, often the flight continues on to its destination. If the flight lands in another location, the family of the dead passenger often has to make arrangements to transport the body.

In Desir's case, her body was covered with a blanket and placed on the floor in first class. Other passengers were moved to seats farther away. Friends and family of employees who were flying at a discounted rate were seated closest to the body, Smith said. The plane continued on to New York, even though it could have put down in Miami.

Decades ago, in the early days of commercial flight, all stewardesses were nurses. Now, the FAA mandates that flight attendants receive non-professional-level training in such methods as CPR, but they are not required to be able to use the syringes and intravenous drips in onboard medical kits.

Northwest said that doctors, nurses or paramedics are aboard an estimated 96 percent of its flights. MedAire said medical professionals stepped forward to help in 48 percent of the more than 17,000 medical situations it was called on to help with last year.

In Desir's case, a cousin who was with her claimed that she was initially refused access to oxygen tanks and that they weren't working. American Airlines said that she was helped swiftly and that the equipment worked.

Nevertheless, the oxygen tanks that the FAA requires aboard planes are not designed primarily for such medical emergencies. Instead, the tanks are meant to help people in case of sudden cabin decompression, according to the FAA. Oxygen at a hospital may be more concentrated and can be given directly through a nose tube.

Desir's husband and two children, ages 23 and 10, have hired a law firm to investigate the death of the Brooklyn nurse.

"My wife died on the plane," her husband, Mario Fontus, told The Associated Press. "And I want to know what happened on that plane."