What really happens when pilots fall ill at 35,000ft

It’s one of those questions that most passengers try not to think about: what happens if your pilot falls ill in the middle of the flight?

For those travellers heading home from Hurghada in Egypt to Manchester earlier this month, that terrifying hypothetical became an equally scary reality, as their easyJet flight was forced to make an emergency landing in Greece after a pilot needed urgent medical assistance.

Some passengers on the flight have already told their dramatic story to newspapers, explaining how the cabin crew rushed to the front of the plane before calling for anyone with medical training to help them. Originally passengers assumed it was one of their own who had fallen sick, only to find out – via an announcement – that it was actually the pilot.

In their own statement, easyJet has clarified to any nervous flyers that the plane was landed in accordance with routine safety procedures, with the first officer taking over the captain’s duties. They also confirmed that the captain was met by paramedics on the ground in Athens where he went to receive medical assistance.

Needless to say, such situations are extremely rare. Yet the most recent available estimates from the Civil Aviation Authority (which date back to 2010) suggest that around 30 to 50 pilots become incapacitated each year on flights to or from the UK.

Pressure to perform

“It’s a crucial part of a pilot’s licence that we must report for a flight rested and in good health,” says veteran 747 captain Nick Eades. “It’s the pilot’s responsibility to ensure that this rule is never compromised.” Naturally, that means informing the airline if they have any signs of illness in the run-up to their flight, even if it’s just a sniffle.

For their part, the airlines should have procedures in place to ensure they can call on additional pilots rather than cancelling flights. But Mr Eades says that there has historically been tension between airlines’ commercial needs and their willingness to let staff take paid sick days at short notice.

“There have been examples of airlines pressuring pilots to report for duty even when they felt unwell,” he says. “A major airline even introduced an absence management system.” Pilots who called in sick more than once within a set timeframe could be given a formal warning. Three such warnings and they risked losing their job entirely.

“On one occasion, my co-pilot checked in when suffering from the flu. When I asked him why he was not home in bed, he informed me he couldn’t risk another absence,” he says. “I took the decision to send him home and delay the flight until a replacement could be found.”

Making a meal of it

Not all illnesses will be picked up before take-off, of course. Therefore airlines also need to have procedures in case their pilots become unwell during the flight. That usually means starting with what the CAA regards as the most common cause of pilot sickness: food poisoning.

Most passengers will be aware of the requirement to have at least two pilots (a captain and a first officer) on a commercial flight. But what about the rule that pilots are forbidden from eating the same meal option as each other, in order to ensure they don’t end up catching the same stomach bug? The “separate meals” policy has been around since the 1970s and is now codified in the safety procedures of most airlines.

“The captain is responsible for ensuring that, wherever possible, the operating pilots eat different in-flight meals,” said a Virgin Atlantic spokesperson, outlining the carrier’s policy. “If both pilots request the same meal, the cabin crew must bring this to the attention of the captain who will approve or deny the request.”

And what happens when a pilot is struck down with sickness? “Incapacitation rarely occurs instantly,” says Eades. “The most common scenario is that a pilot slowly, and sometimes almost imperceptibly, loses the ability to operate.” If they then fail to respond to questions from their co-pilot, their colleague will initiate the emergency protocols.

Typically, that means alerting the cabin crew, who are trained in what to do next. “It’s something that gets drilled into you in initial training and then usually once a year in refresher sessions,” says Paula Gahan, cabin crew with a major carrier, host of the Bad Air Hostess Podcast, and regular contributor to Telegraph Travel.

The most important requirement, she adds, is to get the incapacitated pilot away from the controls. That eliminates the risk of them inadvertently pressing buttons (if they are having convulsions, for example) and, hopefully, enables their co-pilot to take over and pull off a safe and swift landing.

“We’re trained on how to pull the incapacitated pilot’s seat back from the controls and to fasten them in place with their seatbelt,” Ms Gahan explains. “It isn’t something I’ve had to do in real life, thankfully, but I’ve practised lots of times with a dummy during training.”

Creating a diversion

As soon as the immediate danger has been dealt with, the upright pilot is under a duty to declare a “Mayday” situation and divert the plane to the nearest airport – not least given the risk that they could be about to come down with the same symptoms. Cabin crew may decide to put out a call to see if there are doctors on board, but the main focus will be on landing the plane.

“I have experienced this situation on several occasions, the most serious being when we diverted into Gander – a small Canadian town in the province of Newfoundland – on our way to New York,” says Eades. “The colleague was seriously sick with acute food poisoning and ended up spending a month in intensive care.”

As thorough as the procedures and protocols may be, they still leave questions over one particularly horrifying scenario. What happens if both pilots fall ill at the same time?

On long-haul flights, it’s already standard procedure to have back-up pilots on hand, so that the captain and first officer can take a rest. But while that might minimise the already small risk of all-out incapacitation – at least on longer flights – it doesn’t eliminate it entirely.

“It’s not a situation I’ve ever heard of happening,” he adds. Indeed there isn’t any record in modern aviation history of such a situation occurring (thank goodness). Perhaps it’s best, then, to consign that particular thought to the dustbin, with the other statistically miniscule scenarios that crop up in the imagination of nervous flyers.