Assessing Fitness to Fly (CAA Guidance)

Key advice from the Civil Aviation Authority (CAA) on fitness to fly

The 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.
CONDITIONGUIDANCE
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:
  • Patients are in a state of increased oxygen consumption due to the trauma of surgery, increased adrenergic outflow and the possible presence of sepsis.
  • Oxygen levels may be fixed or decreased in patients who are elderly, volume depleted, anaemic or who have cardiopulmonary disease
  • It is wise to delay air travel for several days or request provision of oxygen.
  • 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)


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