Experts Urge Mandatory AEDs on Commercial Flights to Save Lives

A comprehensive review published in the Canadian Journal of Cardiology advocates for the mandatory installation of automated external defibrillators (AEDs) on all commercial aircraft. This recommendation aims to enhance survival rates for passengers experiencing cardiac arrest during flights. While in-flight cardiac arrest occurs infrequently, it accounts for up to 86% of all in-flight fatalities, underscoring the urgent need for improved emergency medical protocols.

The study highlights current gaps in aviation safety standards and calls for a global alignment of policies. Key recommendations include the regulation of AED placement on aircraft, standardized training for cardiopulmonary resuscitation (CPR), and the integration of telemedicine capabilities to support in-flight medical emergencies. With nearly four billion passengers traveling by air each year, the potential for medical incidents remains significant.

Understanding In-Flight Cardiac Arrest Risks

Factors contributing to in-flight cardiac arrest include male sex, older age, pre-existing cardiac conditions, and extended flight durations. As the global passenger population ages and flight times increase due to advancements in aviation technology, the incidence of these emergencies is likely to rise.

Adrian Baranchuk, MD, a senior author from Queens University, Canada, emphasizes the unique challenges posed by the cabin environment. “The confined space, limited access to equipment, and inconsistent training in CPR and AED use among crew members complicate emergency responses,” he states. Currently, only the United States mandates AEDs on commercial flights, while Canada recommends their use at the discretion of individual airlines.

Timely defibrillation is critical for survival. Research indicates that the chance of survival for someone experiencing sudden cardiac arrest decreases by 7–10% for every minute that passes without defibrillation. Given that diverting a plane for an emergency landing often takes longer than 20 minutes, having an AED on board can be lifesaving. Without one, the survival rate drops to a mere 6% of patients who suffer cardiac arrest in-flight.

Potential Impact of AED Availability

The authors of the study estimate that equipping commercial aircraft with AEDs could save between 35 and 93 lives each year worldwide. First author Mario D. Bassi, MD, from the University of Ottawa, points out that “AEDs are consistently reliable and sensitive in detecting and treating cardiac arrest, and they are cost-effective for airlines.” He notes that there is no evidence of diminished efficacy or safety of AEDs in the challenging conditions of an aircraft cabin, including turbulence.

Research shows that survival rates improve significantly with AED use. The likelihood of survival can escalate from 6% to as high as 70% when an AED is utilized promptly. Alarmingly, the study found that up to one-third of aircraft within the European Union lack AEDs on board.

In conclusion, Dr. Baranchuk asserts, “The primary determinant impacting sudden cardiac arrest survival is the time to defibrillation.” He urges policymakers and airlines to prioritize these recommendations to enhance passenger safety and improve survival outcomes for those who suffer cardiac emergencies in the air.

For further details, refer to the article titled “Is There a Doctor on Board?: In-Flight Sudden Cardiac Arrest and Automated External Defibrillator Use,” published in the Canadian Journal of Cardiology in 2025. DOI: 10.1016/j.cjca.2025.10.010