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MIMS HostedThe passenger must notify the airline of any medical condition that could affect their fitness to fly.
The passenger’s doctor should send adequate information to the airline well in advance of the flight including: the nature of the passenger’s condition and its severity/stability; medication being taken; and any pertinent information regarding mobility.
Information can be submitted by telephone or by using the MEDIF form, available from the CAA or individual airlines.
The final decision on whether or not to carry a passenger is that of the airline.
| CARDIOVASCULAR DISORDERS | |
|---|---|
| Most patients with cardiac conditions can travel safely as long as they are cautioned to carry their medications in their hand baggage. | |
| CONDITION | GUIDANCE |
| Angina | - Stable, not usually a problem in flight - Unstable, air travel contraindicated |
| Arrhythmia | - Uncontrolled, air travel contraindicated |
| CABG, other chest or thoracic surgery | Wait 10–14 days before air travel (contraindicated within 10 days of CABG) |
| Cerebrovascular accident | Wait 10 days before air travel; air travel contraindicated within 3 days In cases of cerebral arterial insufficiency, supplementary oxygen may be advisable to prevent hypoxia |
| CHF | - Decompensated, air travel contraindicated |
| Hypertension | - Uncontrolled, air travel contraindicated - Controlled, air travel permitted |
| MI | - Uncomplicated, air travel permitted after 7–10 days - Complicated, air travel contraindicated for 4–6 weeks |
| Pacemakers, implantable cardioverter defibrillators | Air travel permitted once patient medically stable |
| PCI | May be fit to travel within 3 days; individual assessment essential |
| Symptomatic valvular heart disease | Relative contraindication for air travel (contraindicated if severe) Individual assessment by treating physician essential |
| Cardiovascular indications for medical oxygen during commercial airline flights: - CHF (NYHA class III–IV or baseline PaO2 <70mmHg) - Angina (Canadian Cardiovascular Society class III–IV) - Cyanotic congenital heart disease - Primary pulmonary hypertension - Other cardiovascular diseases associated with known baseline hypoxaemia | |
| DIABETES | |
| Air travel should not pose significant problems for patients with well-controlled diabetes. | |
| Type I diabetes | Ensure adequate equipment and medication in hand luggage (do not pack insulin in the hold as it may be degraded by the temperatures) - Insulin pumps - changes in cabin air pressure may affect insulin delivery - Travelling east - if >2 hrs lost it may be necessary to take fewer units with intermediate or long-acting insulin - Travelling west - if >2 hrs gained it may be necessary to supplement with additional injections of short-acting insulin or an increased dose of intermediate-acting insulin |
| Type II diabetes | No issues for patients controlled on diet, medication or insulin |
| HAEMATOLOGICAL DISORDERS | |
| Anaemia | - Hb >8g/dL - patients may travel without problems provided no co-existing conditions such as cardiovascular or respiratory disease - Hb <7.5g/dL - specialist assessment required; consider use of supplemental oxygen - Sickle cell anaemia - defer travel for approx 10 days after a crisis; supplemental oxygen required |
| DVT | Risk increased by flight time >4 hrs duration Risk factors: - Thrombophilia enhancing clotting activity - Recent major surgery - Trauma or surgery of lower limbs - Family history of DVT - Age >40 years - Oral contraceptive use Prophylactic measures should be undertaken according to degree of risk. Note: Use of aspirin is not recommended as the risk of side-effects outweighs any potential antithrombotic effect |
| PREGNANCY | |
| >28 weeks | Most airlines require a certificate confirming the expected date of delivery and that the pregnancy is progressing normally without complications |
| >32 weeks | Most airlines do not allow travel after 32 weeks in multiple pregnancies |
| >36 weeks | Most airlines do not allow travel after 36 weeks in single pregnancies |
| PSYCHIATRIC CONDITIONS | |
| Air travel should not be a problem for most individuals. However, it is essential that the condition is stable and if medication is required it is taken regularly. | |
| General | Key consideration: will the condition interfere with the safe conduct of the flight or will the flight exacerbate the condition? |
| Psychotic conditions | - Passengers whose behaviour may be unpredictable, aggressive, disorganised or disruptive - air travel contraindicated - Well-managed conditions - passengers may require an escort (a reliable companion, or in more difficult cases a qualified health professional) to ensure regular medication and assist in case of problems Close liaison with airline is important. |
| RESPIRATORY DISEASE | |
| If the patient can walk 50m at a normal pace or climb one flight of stairs without severe dyspnoea. it is likely they will tolerate the normal aircraft environment. In patients with significant disease the relative hypoxia encountered in the aircraft may be easily correctable with therapeutic oxygen. | |
| Asthma | Ensure all medication carried in hand luggage. Advise carrying a course of oral steroids to enable early intervention if any deterioration. |
| Bronchiectasis and cystic fibrosis |
Appropriate antibiotic therapy, adequate hydration and medical oxygen may be required. Medication to decrease sputum viscosity (eg, deoxyribonuclease) is helpful in the low humidity of the cabin |
| COPD | Walking test and/or hypoxic challenge may be appropriate to determine the patient’s requirement for supplemental oxygen in flight |
| Pneumothorax | Air travel contraindicated In general, air travel is permitted 2 weeks after successful drainage of pneumothorax with full expansion of the lung |
| Respiratory infection | - Active or contagious infection - air travel contraindicated until there is documented control of infection and the patient is no longer infectious - Recovering from acute bacterial infection, eg, pneumonia - patient should be clinically improved with no residual infection and satisfactory exercise tolerance before flying - Viral infections, eg, influenza - flying should be postponed until the infection has resolved |
| SURGICAL CONDITIONS | |
| General considerations: | |
| Abdominal surgery or procedures | Avoid air travel for: - 10 days after abdominal surgery - 24 hrs after colonoscopy or laparascopic intervention |
| Neurosurgical intervention | Avoid air travel for approx 7 days |
| Ophthalmological procedures | - Procedures for retinal detachment - avoid air travel for approx 2 weeks if sulphur hexafluoride used or 6 weeks if perfluoropropane used - Other intra-ocular procedures and penetrating eye injuries - avoid air travel for 1 week |
| Trauma/orthopaedics | Following application of a plaster cast most airlines restrict flying for 24 hrs for flights less than 2 hrs duration or for 48 hrs for longer flights |
Source: Civil Aviation Authority. Assessing fitness to fly: guidance for health professionals (accessed November 2019). Available at www.caa.co.uk
Further guidance available from:
International Air Transport Association (IATA) Medical Manual
Aerospace Medical Association
Aviation Health Unit (tel: 01293 573674 / email ahu@caa.co.uk)