Experts Advocate for AEDs on All Commercial Flights to Save Lives

In a significant call to action, experts are advocating for the mandatory placement of automated external defibrillators (AEDs) on every commercial aircraft to enhance survival rates for passengers experiencing in-flight cardiac arrests. A comprehensive literature review published in the Canadian Journal of Cardiology indicates that while in-flight cardiac arrest is rare, it accounts for up to 86% of all deaths occurring in the air, highlighting serious gaps in current aviation safety standards.

The study identifies critical systemic and policy shortcomings and urges global alignment in aviation health protocols. The authors recommend implementing regulated AEDs on all flights, standardizing cardiopulmonary resuscitation (CPR) training for crew members, and integrating telemedicine capabilities onboard. These measures aim to bolster the preparedness and response to medical emergencies during flights, a growing concern given that nearly four billion passengers travel by air each year.

Risk Factors and Challenges

The review notes that the primary risk factors for in-flight cardiac arrest include male gender, advanced age, pre-existing cardiac conditions, and the duration of the flight. As the global passenger demographic ages and flight times increase due to advancements in aircraft technology, the frequency of such emergencies is expected to rise.

Dr. Adrian Baranchuk, a senior author from Queens University, emphasizes the unique challenges posed by the cabin environment. “The confined space of the fuselage and limitations in equipment accessibility, coupled with inconsistent training for crew members in CPR and AED usage, complicate emergency responses,” he states. Currently, only the United States mandates AEDs on commercial flights, while Canada merely recommends their use, leaving implementation decisions to individual airlines.

The critical nature of prompt defibrillation cannot be overstated. Data indicates that the likelihood of survival from a shockable cardiac arrest decreases by 7–10% for each minute that passes without defibrillation. Given that a diversion for an emergency landing typically takes longer than 20 minutes from cruising altitude, time is of the essence when addressing these emergencies.

Potential Lives Saved and Recommendations

Without an onboard AED, the survival rate for in-flight cardiac arrest patients plummets to approximately 6%. However, projections suggest that equipping all commercial aircraft with AEDs could potentially save between 35 and 93 lives each year worldwide.

First author Dr. Mario D. Bassi from the University of Ottawa notes that “AEDs are reliable and sensitive for detecting and treating in-flight cardiac arrest. They are also cost-effective for airlines.” Importantly, there is no evidence to suggest that AEDs lose functionality in the challenging conditions of an aircraft cabin.

Dr. Baranchuk concludes, “The primary determinant impacting sudden cardiac arrest survival is the time to defibrillation. We believe that our recommendations must be seriously considered by policymakers and airlines to enhance passenger safety and improve survival rates.”

For more information, 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).