Fatalities Above 30,000 Feet: Characterizing Pediatric Deaths on Commercial Airline Flights Worldwide

Objectives: We conducted this study to characterize in-flight pediatric fatalities onboard commercial airline flights worldwide and identify patterns that would have been unnoticed through single case analysis of these relative rare events. Design: Retrospective cohort study of pediatric in-flight medical emergencies resulting in fatalities between January 2010 and June 2013. Setting: A ground-based medical support center providing remote medical support to commercial airlines worldwide. Patients: Children (age 0-18 yr) who experienced a medical emergency resulting in death during a commercial airline flight. Interventions: None. Measurements and Main Results: There were a total of 7,573 in-flight medical emergencies involving children reported to the ground-based medical support center, resulting in 10 deaths (0.13% of all pediatric in-flight emergencies). The median subject age was 3.5 months with 90% being younger than 2 years, the age until which children are allowed to travel sharing a seat with an adult passenger, also known as lap infants. Six patients had no previous medical history, with one suffering cardiorespiratory arrest after developing acute respiratory distress during flight and five found asystolic (including four lap infants). Four subjects had preflight medical conditions, including two children traveling for the purpose of accessing advanced medical care. Conclusions: Pediatric in-flight fatalities are rare, but death occurs most commonly in infants and in subjects with a preexisting medical condition. The number of fatalities involving seemingly previously healthy children under the age of 2 years (lap infants) is intriguing and could indicate a vulnerable population at increased risk of death related to in-flight environmental factors, sleeping arrangements, or yet another unrecognized factor.