What Really Happens If An Airline Pilot Falls Ill During A Flight?

We've all seen the movie. A flight is experiencing turbulent weather as lightning flashes outside, the camera pans over a cabin full of worried passengers, and then an announcement comes over the intercom. "Are there any experienced pilots on the plane?" We then see the pilot hunched over in the cockpit, as panic ensues on the plane.

Fortunately, this nightmare scenario is only a Hollywood fever dream. When a pilot becomes sick during flight, to the degree that the ailment affects their ability to operate the plane, it's called pilot incapacitation — and it does happen. 

However, the airline industry implements plenty of regulations and protocols to protect passengers if a pilot does get sick while flying. Pilots must continually pass medical evaluations, and if a pilot does become incapacitated during flight, your flight may be diverted, but that's about it. So, no, there's not a scenario in which your flight-simulator prowess translates to real-world heroics.

First, you've probably noticed that two pilots always fly commercial flights (and private jets): a pilot and a co-pilot. Two pilots help improve a flight's safety and efficiency, including safeguarding against pilot incapacitation. Although both pilots are fully trained to fly the aircraft themselves, commercial pilots work in pairs, as dictated by the Federal Aviation Authority.

Normally, one pilot — whether it's the captain or first officer — serves as the "flying pilot." This pilot sets the autopilot, handles the controls, and steers the plane when necessary. The other pilot acts as the "pilot monitoring," and their responsibilities include communicating with air control, monitoring instruments, and cross-checking the actions of the flying pilot.

While these duties are clearly defined before the flight, both pilots are trained and capable to operate the plane themselves. So, if one pilot falls ill, the other pilot may divert the flight to the nearest airport, but they can do so safely.

But what happens if both pilots fall ill? In theory, if both pilots become sick, we'd get closer to the aforementioned nightmare scenario. However, there are also contingencies to prevent this situation. Federal Aviation Regulations require commercial pilots to receive regular medical certifications to fly. These regular screenings assess vision and physical health, as well as ensure mental health and neurological standards. These certifications are renewed yearly or every six months for pilots over a certain age, helping to ensure pilots remain in optimal health.

Lastly, many airlines also implement their own best practices to prevent illness. For example, it's common for pilots to eat different meals before and during the flight to prevent both pilots from succumbing to any food-related issues. Although there's no industry-wide requirement, one pilot may eat a first-class meal, while the other eats an economy meal. Or, one pilot may bring their own food from home. While not exactly the most nuanced idea, this industry practice is another way to ensure your pilots stay healthy during the flight.