Passenger health FAQs Am I fit to fly

The key focus when considering the pregnant traveller is the health and wellbeing of the mother and the baby.

Delivery in flight, or diversion in flight to a location, which may not have high quality obstetric services, is undesirable and for this reason, most airlines do not allow travel after 36 weeks for a single pregnancy and after 32 weeks for multiple pregnancies.

Most airlines require a certificate after 28 weeks, confirming that the pregnancy is progressing normally, that there are no complications and the expected date of delivery.

The subject of air travel following a surgical operation is becoming an important issue with the increasing frequency of day surgery. The time between surgery and travel varies depending on the complexity and extent of the surgical procedure.

It is appropriate to allow one to two days following keyhole surgery and between four and five days for simple abdominal surgery. Major chest or abdominal surgery requires a period of approximately ten days. Simple cataract or corneal laser surgery do not cause major complications and therefore 24 hours is an adequate gap between surgery and flying. More complex eye surgery, for example that used for a detachment of the back of the eye (retina) require approximately one week before air travel.

It is always best, in more complex cases, to contact the airline concerned in order that their medical adviser can have as much information as possible before making a decision on fitness to fly.

In 2010 the British Cardiovascular Society published guidelines on air travel for patients who have a heart condition. The report concludes that the vast majority of people who have a stable heart condition can travel safely, although some will require some special assistance, for example in getting around the airport or in having additional oxygen supplied during the flight. However, some people who have more severe heart disease or whose condition is unstable, may have to delay travelling until their condition has improved.

If you are planning a flight, it is a good idea to check with your GP or hospital specialist before you book your flight. You should make sure that you have adequate travel medical insurance if you are going abroad, even if you are only going to Europe and already have an EHIC card.

If your doctor is not sure if you are fit to fly, contact the airline you intend to fly with for advice. Most airlines have a special assistance or medical clearance team and there will be information on how to contact them on their website. You must contact the airline before your flight if you will require help at the airport, wish to carry additional medical equipment or will need extra oxygen during the flight. Sometimes the airline will need additional medical information and will ask your doctor to fill in a medical information form (MEDIF) before they will confirm whether you are fit to fly.

Remember to carry your medication with you in your hand-baggage, in case you need to use it during the flight. It is also a good idea to take a copy of your repeat prescription, in case you need to get more medication when you are away from home.

The list below gives general guidance for some common heart conditions, but each case does have to be looked at individually and some airlines may apply different rules.

Angina

Angina is not usually a problem in flight, provided that your symptoms are stable and controlled by your medication. If you sometimes get chest pain on gentle exercise, such as climbing a flight of stairs or walking up a slight slope, you will still probably be able to fly but might need assistance at the airport and to have extra oxygen during the flight. However, if you sometimes get chest pain when you are at rest you may not be able to travel by air.

Heart attack (myocardial infarction)

If you have had a heart attack, you may be able to travel after 7 to 10 days, provided that there have not been any complications. If the blocked artery that caused the heart attack has been successfully unblocked, it may be possible for you to fly after as little as 2 to 3 days.

Heart failure

Heart failure occurs when the heart is weakened and is no longer able to pump blood around the body as effectively as it should. Most people who have heart failure are still able to fly, provided that the condition is stable and well-controlled on treatment. However, if you get breathless on gentle exercise you may need to request assistance at the airport and to have extra oxygen during the flight. However, if you sometimes become breathless when you are at rest or when you lie down, you may not be able to travel by air.

Pacemakers and Implantable Cardioverter Defibrillators (ICD)

Travelling by air should not be a problem if you have been fitted with a pacemaker or an ICD. The modern devices are designed so that they will not be affected by any of the security screening equipment at airports and will not cause any problems with the aircraft electronic systems. However, they may set off the airport security alarm and therefore you should carry a letter from your doctor to explain that you have been fitted with the equipment and, if possible, show this to the security staff before you go through the security arch.

Heart surgery

Patients are often discharged from hospital very quickly these days, even after major surgery such as coronary artery bypass grafting or replacement of a heart valve. Normally you should not fly after such surgery for at least 10 days and until you are able to manage normal daily activities. You may need to request assistance at the airport if you still need help with baggage or are not yet able to walk the sometimes long distances from check-in to the aircraft.

Hypertension (high blood pressure)

Your blood pressure should not be affected by air travel and therefore there is no reason why you should not fly if you are being treated for high blood pressure. However, your travel insurance may not cover the cost of any additional treatment or complications, so it is advisable to only travel once your blood pressure has been controlled and your treatment is stable.

You can find more useful information on the British Heart Foundation website.

Your doctor might also wish to consult the British Cardiovascular Society website for guidance.

The majority of individuals with conditions such as asthma and chronic obstructive pulmonary disease, sometimes called COPD, can travel perfectly safely on board an aircraft. It is essential however to carry all relevant medications, such as an inhaler, in cabin baggage. Contrary to popular belief, modern aircraft are not pressurised to sea level equivalent and fly with a cabin altitude of between 5,000 and 8,000 feet, causing a slight reduction in oxygen. This should not cause symptoms in the majority of individuals with mild / moderate disease. It is important that you discuss your intention to travel with your treating physician who knows all your medical details, in order that an accurate assessment can be made. In general terms, if a passenger can walk 50 yards/metres at normal pace, or climb one flight of stairs without significant breathlessness, oxygen should not be required.

If it is felt that supplementary oxygen is required, it is important that the airline is notified well in advance with a MEDIF Form in order that this service can be provided. Some carriers do make a charge for this. Recent work has shown that the majority of those with lung conditions respond well to supplementary oxygen in flight and should be able to travel worldwide.

The treatment for a broken arm or leg usually includes a plaster or fibreglass/resin cast to immobilise the broken bone. Checks are made when the cast is first put on to make sure that it isn't too tight and doesn't stop the circulation to the tissues. However, problems can still occur if the tissues around the fracture swell after the cast has been applied, either as a result of the injury itself or due to blood pooling in the immobilised limb.

Because of the risk that swelling inside a cast can affect the circulation, many airlines restrict flying during the first 24 or 48 hours after a cast has been fitted. If you need to fly before then, the airline will usually require the cast to be split along its full length before you fly, as any swelling will not then affect the circulation. This can be arranged at the hospital. You may also have to make arrangements to have the cast replaced once you reach your destination. It is helpful to carry a letter confirming the date and time of application of the cast, especially if you have not had the cast split.

If you have a broken arm or leg, you will not be allowed to sit in an emergency exit row. Also, if you have a broken leg and are unable to bend your knee to sit normally, you may be required to purchase additional seats so that you have enough space. This will also allow you to elevate the leg during flight and will reduce any swelling that would occur if you kept the leg down.

Pneumatic Splint

A pneumatic splint is a plastic sleeve or sock which can be inflated with air to form a rigid splint. They are often used by first aiders to immobilise a suspected fractured limb. However, they are not suitable for use when flying, as the pressure within the splint is affected by the changes in air pressure in the aircraft.

Passengers with a blood count of greater than 8 may travel without problems assuming there are no other conditions such as heart or lung disease. If the count is less than 7.5 special assessment should be made and consideration to the use of supplemental oxygen should be considered. If the anaemia is chronic, passengers often tolerate a slightly lower blood count without problems in flight, but in this case it is essential that the airline is informed of precise medical information via the MEDIF Form.

The fear of flying is the third most common phobia after the fear of snakes and spiders. Whilst 90% of adults are apprehensive when flying, fear only occurs in 10-25% of airline passengers.

There are various components which may cause the fear of flying - concern over heights, loss of control, claustrophobia, physiological effects, media "hype" and fear of the unknown.

To help overcome the fear, some airlines run courses which combine behavioural techniques and educational input on aspects of flying, including helpful material on aircraft noises and other area which may cause distress, such as turbulence. Many courses finish with a flight, which is carried out in carefully controlled situations.

Research has shown that the above interventions are effective and that the benefit may be sustained.

In severe cases, a GP may be able to prescribe a mild tranquiliser to assist in the process.

During the flight, it is advisable to avoid excess caffeine and alcohol.

The ultimate decision to carry a passenger is that of the airline and the more information the airline has, the better and more objective that decision can be. Information can be provided to the airline either by telephone and your treating physician can give details via the MEDIF Form.

Should I discuss my trip with my diabetes team?

Air travel should not pose significant problems for travellers with well-controlled diabetes. Pre-planning is important and discussion of the travel itinerary, four to six weeks in advance, with your GP or treating specialist team plays an important part in preparation for travel.

What should I pack?

Passengers may carry essential liquid medicines such as insulin for the period of their trip. These are permitted in larger quantities above the 100ml limit for liquids, but will be subject to authentication.

All prescription medication and dietary liquids that you have medical confirmation for are allowed. Any that are in containers of 100 ml or less may be placed in a re-sealable plastic bag as above if you wish. This can be carried in addition to a bag containing toiletry and cosmetic items and must be presented separately to cabin baggage. Any containers over 100 ml must also be taken out of cabin baggage, and will be subject to additional screening.

The security officer may ask to see your medical confirmation. This could be your name on a prescription label or a letter from your doctor. You should only carry the amount you need for your trip.

For diabetic passengers who use insulin pumps and/or continuous glucose monitoring (CGM) devices, it is essential that they speak to the airline to obtain precise advice on the use of such devices on board the aircraft.

Passengers must also take with them supporting documentation from a relevant qualified medical professional.

It is essential that diabetic passengers carry adequate equipment (glucose meters, lancets, batteries) and medication in their hand baggage. It is also important that insulin not being used in the flight is not packed in the hold baggage as this may be exposed to temperatures, which could degrade the insulin, in addition there is also the potential that luggage may be lost en-route.

It is useful to have simple carbohydrates to treat hypoglycaemia including glucose tablets or sweets. It may also be useful to pack longer lasting carbohydrates such as snack bars or biscuits in case of delayed meals.

What should I do on-board?

• Frequent blood glucose monitoring is essential.
• Avoid excess caffeine and alcohol as these can affect diabetes control including your warning of hypoglycaemia.
• If you are travelling North or South there is no need to change the timing of your insulin or other medications.
• Similarly keep to your regular regimen if you are crossing fewer than 5 time zones.
  • Travelling West means that your day will be longer - you may need more insulin;
  • Travelling East means that your day will be shorter - you may need less insulin.

As noted above, it is best to discuss this with your diabetes team in advance. If you use oral medicine, it may be easier to skip one dose rather than take two doses close together. A short period of slightly high glucose levels will not cause harm.

Insulin pumps

There have been some concerns about possible effects of airport security screening equipment on insulin pumps. Guidance from the Department for Transport is that both insulin pumps and CGMs must not be either screened by x-ray or pass through the security scanner.

At airport security passengers with insulin pumps can opt for an alternative screening method. You will need to carry a letter from your doctor confirming your situation which should be handed to the security officer. This applies to all EU airports which should be aware of the requirement

The CAA and the Airport Operators Association (AOA) have produced a Medical Device Awareness Card for passengers with an insulin pump or CGM that can assist passengers in preparing for their journey, and provide the correct documentation at the search area. The card also acts as a reminder to security officers that alternative processes to screening by security scanner and spare devices by x-ray are available.

The Awareness card can be downloaded here.

Changes in the cabin air pressure can have an effect on insulin delivery. The reduction in cabin air pressure when the aircraft climbs may lead to a slight increase in delivery of insulin as a result of the formation or expansion of air bubbles in the insulin syringe or tubing. This might be sufficient to cause symptoms of hypoglycaemia. A more severe impact could be seen in the (very rare) event of sudden decompression of the cabin at altitude. A slight reduction in insulin delivery is also possible during descent. You should discuss the best way to manage this with your doctor.

At my destination

Should you run out of insulin and need to source this locally, remember the strength may be different as many countries still use U-40 or U-80 as opposed to the U-100 used in the UK.

Some safety advice for illness

• Always continue taking your insulin, even if you're not eating.
• Test for ketones if your blood glucose levels are above 14mmol/L
• Positive ketone tests always require treatment with extra insulin
• If you are unable to eat because you are ill, you can obtain carbohydrate from sources such as high-energy drinks (e.g. Lucozade), fizzy soft drinks, squashes and milky drinks.

Most people with mobility problems have found it possible to travel by air, especially with legislation which was passed in 2008. If there are other medical issues you should check with your GP that these are taken into account.

If the conditions are complex, the use of the MEDIF Form may be required.

Useful guidance for travellers is given on the following links:

• Department for Transport Code of Practice
• Equality and Human Rights Commission Step by Step Guide
• Directgov - Advice regarding airport and airline services for disabled travellers

If you have a medical condition that is stable, e.g. a stroke which has left residual weakness which impairs movement and no further complications, you do not need a medical certificate.

If you have an unstable condition, e.g. an underlying heart condition which had led to the stroke and is ongoing, a note from the treating physician outlining the medical condition will help with the decision on fitness to fly.