Are you fit to fly?

Air traveling is so common nowadays, like traveling by car. As Bali is one of a major international tourist destination with thousands of people coming and going by plane, BIMC Hospital gets plenty of requests to certify someone’s condition; fit to fly or not. You might wonder whose fit and who’s not?

Who should need a fit to fly statement?
Airlines have the right to refuse to carry passengers with conditions that may worsen, or have serious consequences, during the flight. The airline may require a medical clearance for passengers who could be suffering from any disease or physical or mental condition that:
•    May be considered a potential hazard to the safety of the aircraft.
•    Adversely affects the welfare and comfort of the other passengers and/or crew members.
•    Requires medical attention and/or special equipment during the flight.
•    May be aggravated by the flight.

What the doctor considers
Doctors who give the fit to fly statement will consider the conditions above, and also think about other additional factors, i.e.:

•    Cabin pressure. At cruising altitude the cabin air pressure is lower than air pressure at sea level. As a consequence, less oxygen is taken up by the blood and gases within the body expand.
•    Prolonged immobility and circulatory problems. Some patients need certain position during the travel. As an example, someone who has a broken leg would need a seat with enough space for leg elevation, so the recommendation would be a business class seat. Then the doctor needs to know which patient would need certain injections to prevent thrombosis.
•    Medication during flight. The doctor needs to figure out whether the patient would need medication during flight and how it is given.

Who should NOT fly
Air travel is normally contraindicated in the following cases:
•    Infants less than 7 days old.
•    Women after 36th week of pregnancy (after 32nd week for multiple pregnancies) and until seven days after delivery.
•    Those suffering from:
o    Angina pectoris or chest pain at rest
o    Any serious or acute infectious disease
o    Decompression sickness after diving
o    Increased intracranial pressure due to hemorrhage, trauma or infection
o    Infection of the sinuses or infections of the ear and nose, particularly if the Eustachian tube is blocked
o    Recent myocardial infarction and stroke (time period depending on severity of illness and duration of travel)
o    Recent surgery or injury where trapped air or gas may be present, especially abdominal trauma and gastrointestinal surgery, cranio-facial and ocular injuries, brain operations, and eye operations involving penetration of the eyeball
o    Severe chronic respiratory disease, breathlessness at rest, or unresolved pneumothorax
o    Sickle-cell disease
o    Psychotic illness, except when fully controlled
(The above list is not comprehensive and fitness for travel should be decided on a case-by-case basis.)

Other Options for Air Travel
In some cases these contraindicated patients must be transferred by air to have higher care treatment or the when treatment is not available in the current location. Usually they need to be transferred immediately, and can not wait until the airline will accept them. If they are not fit to fly by commercial flight, the next option is to fly by air ambulance. This is a special aircraft designed with medical equipment and flies at a lower altitude, with no pressure difference between the cabin and sea level pressure.

So now you know….
There is much to bear in mind for that piece of paper, the medical clearance. You should also know that medical evacuations, i.e. transfer with a medical escort, is costly while it is also necessary. In these situations you need insurance, or travel insurance if you’re on holiday. Once there are certain medical arrangements needed, the insurance company, at least most of them, would discuss it with the doctor on the best arrangement for the patient’s travel.