Survivability of occupants in commercial passenger aircraft accidents

•The average survival rate is 86.3%, casualty rate 20.1% and RSF 0.16.•Survival rate increases to 95.6% when accidents with a 100% fatal rate are excluded.•Accidents in approach phase, smaller or destroyed aircrafts decrease survivability.•Accidents in approach phase, smaller or destroyed aircrafts increase casualty rate and RSF.•About two-thirds of the accidents occurred at the airport or its immediate vicinity. Globally, the risk of a commercial aircraft accident is low. The fatal accident rate of about 0.65 per million flights at the start of the 1990 s decreased to an average of one per 2.75 million flights for the five-year period 2010–2015. Research related to factors that can impact the health outcomes of occupants and the preparedness and response to aviation mass casualty accidents is rather limited. The aim of the study was to expand this knowledge and to determine the impact of maximum take-off weight (MTOW), flight phases and aircraft damage on the survivability of occupants in commercial passenger aircraft accidents. Two thousand one hundred accidents from the period 1990–2014, included in the accident database of the International Civil Aviation Organization (ICAO), met the inclusion criteria of the study. Results of the study showed that the survivability was lower and the casualty rate and the rate of seriously and fatally injured was higher in accidents that occurred during the approach phase, involving smaller aircrafts and in which the aircraft was destroyed. Approximately two-thirds of the accidents happened at the airport or in its immediate vicinity. Empirical data on the casualty rate, the rate of seriously and fatally injured and the survivability of occupants involved in commercial passenger aircraft accidents can help to optimize the preparedness and response of emergency medical services and hospitals in the accident area.