Fit to fly?

Illness during a flight may lead to an unscheduled landing. This is expensive for the airline and extremely inconvenient for other passengers. There are relatively few situations where travel by flight is not allowed, but the following guidance is helpful for anyone with any doubts. Fuller guidance can be obtained from aviation-health.com, a link is at the bottom of this document.

Most people are aware that the air gets thinner, providing less oxygen the higher you go. To help deal with this, commercial aircraft are pressurised to the equivalent of an altitude of 1500-2000m. This still results in a relatively small fall in oxygen saturation of the order of 3-5%, which may be significant for travellers whose oxygenation is already compromised by severe cardiac/respiratory disease. In practical terms, people with severe heart or lung disease who can walk 50m on level ground or ascend a flight of 12 domestic stairs are probably fit to fly.

In general:

  • Chronic medical conditions should be controlled as well as possible prior to travel.
  • Medication should be carried in hand baggage on the person
  • Help needed during travel must be pre-booked
Anyone who has suffered a heart attack, but who has made a good recovery will probably be fit to fly three weeks later. Flying within 2 weeks of a major cardiac or neurological crisis such as a stroke is not recommended.

If there is a history of a thrombosis (a clot of blood in the veins) frequent leg movements are recommended during the flight. Ensure an adequate fluid intake (not alcohol or caffeine drinks), and consider support stockings and the use of a preventative medicine to thin the blood before boarding and after arrival.

Flying within 2 weeks of most forms of surgery is not recommended. From the points of view of both expansion of air in body cavities and of wound healing, air travel should not be undertaken within two weeks of abdominal surgery. After gastrointestinal bleeding at least one airline recommends a wait of three weeks before travelling by air.

In the case of laparoscopy (when a camera is introduced into the abdominal cavity to look at the individual organs, commonly the ovaries) and colonoscopy (a fibre optic camera is used to look at the lining of the bowel) it is recommended to wait until 24 hours have elapsed and bloating is absent. (Gas is introduced into the abdominal cavity/colon in order that an adequate view can be obtained).

Surgery for retinal detachment with introduction of gas: seek medical advice from your eye surgeon.

Epilepsy.
There is no specific reason why travellers who suffer from epilepsy should not fly, but they must be aware that tiredness, lack of sleep, over-indulgence in alcohol and poor compliance with medication during travel may all increase the likelihood of a fit.

Asthma.
There is no specific reason for asthmatic travellers not to fly, though the dry air in the aircraft may make symptoms worse. Inhalers should be carried in your hand luggage, together with rescue courses of steroids if your asthma is severe.

Coughs and colds
Travellers with upper respiratory tract infections may experience pain in the ears and/or sinuses. Obstruction of the Eustachian tubes results in failure to equalise pressure during ascent and descent as the cabin pressure changes. The use of decongestant drops before take-off and landing may help, as may other methods such as a Valsalva manoeuvre, in which you close your nostrils and breathe down, yawning, chewing gum or sucking sweets, or, in the case of small children, crying.

After trauma
A relatively short flight from Europe with a fractured leg in plaster may not cause too many problems, although there may be practical difficulties such as access to the aircraft and room in the cabin for the injured limb. On longer flights, the possibility of swelling of the limb during the flight could cause damage to a limb in a complete plaster, and if immobilisation in plaster is necessary the plaster should be longitudinally split. You would need to speak to your doctor.

Psychiatric conditions
Severely anxious, depressed or psychotic patients should be advised against air travel. The stress of travel may exacerbate their condition and cause difficulty or danger to themselves, or to other passengers. Less severely ill patients may be able to travel, provided that they are escorted and that they have supplies of medication available should their condition deteriorate during travel. A psychiatric assessment prior to travel may be necessary.

Physical disabilities
Passengers with physical disabilities may need assistance with problems of transit through the aircraft and access to the aircraft. These facilities booked in advance, along with such additional cabin space, in-flight oxygen and special diets. it cannot always be assumed that the same facilities provided at a UK airport will be available at every destination.

Miscellaneous
  • After diving: single dives wait 12 hours; allow at least 24 hours after multiple dives or staged decompression.
  • Infections: patient with infection may be a hazard to fellow passengers eg Tuberculosis or chickenpox.
  • Delay flying after spinal anaesthetic: air may have been introduced. Severe headache has been reported seven days after spinal anaesthesia
  • Dental abscess: may be associated with gas production
  • Pregnancy after 36 weeks: the woman should consult the airline and their travel insurance.
For further information on contraindications to air travel, contact:
The Aviation Health Institute
8 King Edward St
Oxford OX1 4HL
Tel 01865 739681
Fax 01865 726583
Email aviationhealth.institute@tesco.net

The Medical Information Form (MEDIF) issued by the International Air Transport Association (IATA), which has a section for the doctor to complete, should be used to inform airlines about a patient's medical condition when booking a flight. Patients can obtain MEDIF's from their travel agent. The airline's medical officer may request further information. The captain reserves the right to refuse to carry a passenger.

Further information

Aviation Health

This article published on
28 November 2005

Next review date 01/11/2013

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