What happens if your pilot falls ill or unconscious during your flight?

Dec 4, 2021

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It’s the announcement most passengers pray they never hear: “If there is a trained pilot on board the aircraft, please let a member of the crew know by pressing your call bell.” The thought of the pilot slumped over the controls, the aircraft hurtling through the sky at 550mph with no one in control is enough to make anyone nervous.

However, at risk of upsetting all you avid flight simmers who dream of being the hero one day, this kind of situation only ever happens in the movies.

Every so often pilots do fall ill during a flight. In some circumstances, this can be so severe that they are unable to continue with their duties and in rare events, pilots have even been known to die while at the controls.

So what happens in these situations? Is it really down to one plucky passenger stepping forward and saving the day or is there a system in place to safeguard against this?

Causes of Incapcitaion

Pilot incapacitation, the official term given to a situation where a pilot is no longer able to perform their duties, is a very rare event. In over 15 years of airline flying, I have never become incapacitated myself nor has a fellow crew member succumbed to the same fate.

Official data on the incapacitation rate on aircrew is hard to come by, but a 2012 study by Sally Evans and Sally-Ann Radcliffe found that of 16,145 professional UK pilots in 2004, 36 cases of incapacitation were identified. Of these, half were due to a heart attack or stroke.

The chances of getting sick from an inflight meal are extremely low (Photo by Dan Ross/The Points Guy)

Other causes of incapacitation can be attributed to hypoxia, where a lack of oxygen from a loss of cabin pressurisation leads to a deterioration of consciousness; smoke or fumes, where gasses enter the pilot’s lungs and inhibit their ability to focus on the task at hand; and gastrointestinal problems such as food poisoning and food allergies.

Heart Attacks and Strokes

Despite the overall numbers being extremely low, heart attacks and strokes are a very real threat to the safety of a flight should a pilot suffer from one while at the controls. While they can not be prevented from happening, the best form of defence of these situations is to take preventative measures.

Not only do pilots have to hold a valid flying licence to take to the air, but they must also hold a valid medical certificate. To fly a commercial aircraft in the UK, a pilot must hold a Class 1 medical.

As part of the process of being awarded a Class 1 medical, pilots must undergo a series of tests and examinations to ensure that they are fit and healthy enough to fly passengers safely. This includes tests of the eyes, hearing, cardiovascular system and blood sugar levels amongst other things.

Heart Attack. Photo courtesy of Shutterstock
Pilots health is closely monitored to reduce the chances of them getting ill during a flight Photo courtesy of Shutterstock

If awarded, an airline pilot must then go through this process annually until they are 60, at which point the timeframe is shortened even further and a medical must be renewed every 6 months. Simply put, without a valid medical certificate a pilot is not allowed to fly.

Every year, hundreds of pilots have their medicals suspended for anomalies found during their medical. Most are minor and the certificate is reinstated after further investigation. But a handful of them may never get their medical back and for those unlucky few it means losing their job and finding a new life away from the flight deck.

Gastrointestinal problems

A pilot taken ill in this way is the premise to countless air disaster movies, most famously in ‘Airplane’. However, the reality of these situations is much less exciting, or dare we say it: comical. Incapacitation from food poisoning or food allergies can set in extremely quickly. In as quickly as just 20 minutes a pilot can go from being completely fine to being unable to fly the aircraft.

To reduce the chances of this happening it used to be mandated that the pilots were not allowed to eat the same meal (especially the fish!) as each other onboard the aircraft. At some airlines, this is still the case. However, with high levels of modern-day food hygiene, many airlines have reviewed their policy on this.

If the pilots (and cabin crew) are provided with an inflight meal, this will come from the same catering facility as the passenger meals. These huge kitchens create thousands of meals a day and, as a result, have to ensure that their standards of food hygiene are perfect. This means that the chances of getting sick from an inflight meal are thankfully quite low. The real threat lies in what and where the crew members eat before the flight.

One of the best parts of travel is getting to experience the local cuisine wherever we go. However, consuming different types of food and drink on a daily basis can play havoc with our digestive systems. As a result, we must take care to ensure that we don’t put ourselves at risk of in-flight incapacitation because of something we ate the morning before a flight.

Fumes and smoke

Fumes and smoke in the flight deck is a threat that we must also be prepared for. Smoke in the cockpit is an obvious source of why someone may become incapacitated but what causes the fumes may not always be immediately obvious.

During times of high workload, like take-off and landing, there is an almost constant flow of conversation between the pilots. Any breakdown in this flow becomes very obvious and would alert us to a potential problem with the other person. However, in the calm of the cruise, we can go some time without saying anything to each other, especially on long haul flights.

In these situations, looking over at your colleague to find them passed out would come as quite a shock. Initially, you’d be forgiven for thinking that they had fallen asleep. Long nights out of bed, after all, can be difficult.

But what if instead of them being simply asleep they had succumbed to a gas which, until this point, you have not noticed? Very quickly the situation could become critical if you too are affected.

As a result, if we are in any doubt, the first thing we will do is don our oxygen mask. This gives us complete protection from the cockpit environment with a clear screen covering our face while being provided with 100% oxygen from the aircraft’s emergency oxygen system.

Ensuring that we are protected and able to fly the aircraft safely, we can then begin to work out what is wrong with the other pilot.

What happens next?

All major systems on an airliner have a backup. For the really important systems, there’s a backup to the backup. It’s all to ensure that even though the chances of a system failure is incredibly low, flight safety is never compromised. This is exactly the same principle with the pilots.

A modern airliner is operated by a minimum of two pilots. On longer flights, there will be an extra 1 or 2 pilots to ensure that we are as alert as possible for landing. Like a system failure, the chances of a pilot ‘failing’ is also extremely low but by having a second pilot we have an extra level of safety built into the system.

Continuing to fly the aircraft safely is the number one priority if a pilot falls sick. (Image Getty Images)

Contrary to common belief, both pilots are as qualified and capable of flying the aircraft as each other. The terms ‘captain’ and ‘co-pilot’ are just used to indicate the roles within the flight deck. The key here is in the ‘co’ of ‘co-pilot’.

If one pilot was rendered incapable of flying the number one priority of the other pilot is to fly the aircraft. This may sound blindingly obvious but with all the distraction of a colleague suddenly taken ill, it’s very easy for attention to be taken away from the safe path of the aircraft.

What the remaining pilot decides to do next very much depends on the stage of flight.

On The Ground

If the aircraft is on the ground, either before departure or after landing, things are a lot easier. While there is no set way of doing things, the most likely strategy would be to bring the aircraft to a safe stop on a taxiway and set the parking brake. With the safety of the aircraft assured, the remaining pilot can then look to deal with the problem at hand.

With engines running, getting out of the seat isn’t an option so we would most likely call the cabin crew for assistance. As part of their safety and emergency training, in addition to learning how to evacuate an aircraft, fighting fires and dealing with a whole range of other scenarios, they also learn what to do in the case of pilot incapacitation.

Bringing the aircraft to a safe stop is key before dealing with an incapacitated pilot. (Photograph provided courtesy of Denver International Airport)

Hauling a pilot out of their seat is fraught with challenges. Not only may the pilot be considerably heavy, but they are also likely to interfere with the flight controls and switches in the process. Conversely, leaving them in their seat runs the risk of them collapsing forwards onto the flight controls.

As a safe medium, the crew are trained to move the pilot’s seat backwards, moving their body and limbs away from the controls as they lock the safety harness in place. This ensures that the sick or unconscious pilot is unable to impede the aircraft from being flown safely from the other seat.

The remaining pilot can then declare an emergency to ATC and taxi to a parking stand so that urgent care from paramedics can reach the sick pilot as soon as possible.

In the cruise

If a pilot becomes incapacitated mid-flight, there’s a lot more to think about. After ensuring that the aircraft is flying safely, depending on the severity of the situation, the remaining pilot will most likely declare an emergency to ATC. This can always be cancelled at a later time but it’s good for ATC to know what is going on sooner rather than later. They can then take steps to reduce the pilot’s workload from their point of view, such as reducing the number of radio calls that they have to make.

The next priority is to get the incapacitated pilot some help and this will most likely require the help of the cabin crew. They are able to administer first aid but if the problem is more serious, a call to Medlink may be required. Using satellite communications, pilots are able to contact doctors in Arizona, USA who can better diagnose the problem. They can then advise what course of action they deem best for the sick pilot.

The big decision is then whether to continue to the destination or divert to a nearby airfield and this is by no means a black and white scenario. A whole range of factors will be taken into account during the decision-making process.

Firstly how many fit pilots are left? Even if the captain has been taken ill, on an ultra long haul flight there may still be another captain and 2 first officers remaining. If the ill crew member does not require immediate help, the flight may be able to continue to its destination.

There is no black and white way to decide whether the flight should continue or divert. Image courtesy of Slattery.

However, if there were just two pilots from the start and the captain was taken ill, even if they do not require urgent help, it may be prudent for the first officer to divert to a suitable nearby airfield instead of continuing on for several hours single pilot.

You would then need to also consider where in the world you are. The closest suitable airport could be 3 hours flying time away. Do you land somewhere closer that you’ve never been to before, or carry on a little further to an airport where you’ve been many times before?

There is no right or wrong answer, you just have to use your training and experience to make the best series of decisions possible given the information and options available to you.

On final approach

Despite seeming to be the worst time for a pilot to become incapacitated, doing so a short time before landing is probably the best scenario after it occurring when the plane is grounded.

While it may come as quite a shock to the remaining pilot, most of the variables have already been taken care of. They know which runway and approach they will be flying, they will know the weather and will have confirmed that it is safe to land.

The safest course of action in this situation is normally just to continue with the approach and land.

To reduce the workload and minimise the chances of having to go around, they might consider carrying out an automatic landing. While not as smooth as a manual landing, the reduced workload means that the single pilot will have a greater capacity to assess other factors, making sure that they haven’t missed anything in the heat of the moment.

Once again, there is no set procedure of what to do in this situation. What the remaining pilot does will very much depend on their training and experience. They may choose to call the cabin crew in order to move the other pilot back from their seat. Equally, being so close to the ground they may deem this a distraction and thus a bigger threat to the safety of the aircraft.

Bottom Line

There’s always a chance of any occupant on an aircraft getting ill, including the pilots. However, a number of precautions are taken to reduce the chances of this happening. Due to the extremely high food hygiene standards of airline catering facilities, not all airlines mandate that their pilots must eat separate meals on board. Risk assessments concluded that a pilot was more likely to get sick from food that they ate before the flight than anything on board.

If the worst does happen midflight, all is not lost. All airliners have a minimum of 2 pilots for good reason – despite some suggestions that they could safely operate with just 1. Both pilots are as qualified as each other to fly the aircraft and so it would be up to the remaining crew member to use their training and experience and the need to consider not just whether they may need to get their colleague urgent medical assistance, they also have to take the safety of all the other occupants of the aircraft into consideration.

There is no set way to deal with pilot incapacitation but what is certain is that there is no substitute for two well-trained, experienced pilots sitting in the front of every passenger-carrying aircraft.

Featured Image – Getty Images


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