I'm a Dr. & base this reply on the information that I learned on a medical emergencies in flight course (hosted at Virgin, run by an anaesthetic from Winchester -
http://www.ccat-training.org.uk/mef.htm) which I went to a couple of years ago.
I wish I could find the course handout.. it had these stats in...
(a) there are hundred deaths in flight annually.
not especially surprising given the global volume of air/pax traffic. Clearly, the airlines medical criteria to fly is their attempt to sieve out the folks who are likely to predictably become unwell in-flight, but it’s not fool-proof and relies on self disclosure [excepting those who clearly are too unwell to even make it too board and can be detected by non-medically trained ground staff].
From a UK perspective don't forget that certifying someone as dead is not the same as issuing a death certificate, for which several criteria must be met before a certificate can be issued. all unexpected deaths require referral to a coroner, who can then decide if a post-mortem is indicated to determine the cause of death
Anyway, the outcome of the course was that there is no obvious agreement on "where" a person dies if they are in-flight at the time of their death. The consensus was that a number of factors are likely to influence the decision:
- laws specific to the country of the flight's origin
- laws specific to the country of residence of the deceased
- "where" the death is considered to have occurred (i.e. the sovereign state in whose airspace the aircraft was at the time)
- where the aircraft lands (planned or diversion)
- how difficult it may be for all concerned to deal with the complications arising from the death - anecdotally a lot of deaths seem to occur once in the airspace of the intended destination...
b) this is operator specific and will depend on factors such as:
- operating procedures of that carrier
- availability of medical equipment on board
- availability of suitably qualified medical staff on board
- availability of a suitable airfield within sufficient proximity that a diversion is likely to effect the outcome of the illness
At the time (2005) Virgin were introducing on-board telemetry equipment so that basic objective measurements could be relayed to their contractor in the US. e.g.
- temp
- blood pressure
- pulse oximetry
- single-lead ECG
Their contract employed consultants from the local area to do shifts, were they would use information from cabin staff and the telemetry equipment to advise Virgin on the ‘best’ way of handing each medical problem. I recall their kit had no “company channel” for 2-way VHF comms, so all messages to the medical centre had to be relayed via the flight deck.
Their logic to this decision is that medically trained pax are very risk-adverse and will usually indicate a diversion is needed when their medical centre would suggest continuation.
I believe ICAO lay down minimum standards on the levels of medical equipment needed on board depending on the expected duration of flight (but others may know better)