Transcript Guidelines on Fitness to Fly

Guidelines on Fitness to Fly
Eppie Habashi
Notifying an Airline of a Medical
Condition
• Cabin crew can administer first aid
• Airlines have medical advisers who when
given info in advance can decided whether
a passsenger is “fit to fly”
– Nature of condition, stability, severity,
medications, mobility
• Info over the phone or via MEDIF form
Physiological Effects of Flight
• Altitude – decreases alveolar partial pressure of
oxygen, sats around 90%, tolerated if healthy
– If resp or cardio disease or severe anaemia may need
supplementary oxygen
• Barometric pressure changes – gas expands so
problems with urti, pneumothorax, abdo/eye
surgery, lung bullae, bubbles in insulin pumps
etc
• Low humidity
• Jetlag – med timing
Cardiovascular Disease
Condition
Contraindication
Hypertension
Advice
Meds in hand
luggage
Angina
Unstable
Stable is fine
Pacemaker, ICD
Uncontrolled
arrythmia
Fine when stable
Uncomplicated PCI
<3 days
Ok from 3 days
Stroke
<3 days
Ok from 3-10 days
Uncomplicated MI
<7 days
Ok after 7-10 days
CABG
<10 days
Ok from 10-14 days
Complicated MI
4-6 weeks
Severe symptomatic Valve disease
and decompensated heart failure
Can’t fly
Diabetes
• Medication in hand luggage
• Never put insulin in the hold as can be too cold,
degrade
• Plan if on insulin and time difference may need
more/less insulin
• Pump may deliver more when at high altitude
and cause hypoglycaemia, reduction in delivery
on descent
Haematology
• Supplementary oxygen for severe
anaemia, sickle cell disease
• If at risk of DVT consider stockings and
possibly LMWH
– Risk of aspirin>benefit
Pregnancy
• Delivery or diversion for delivery
not favourable
– Single pregnancy can’t fly from 36
weeks
– Twin pregnancy 32 weeks
• Most airlines require certificate
after 28 weeks to say pregnancy
progressing normally and EDD
Respiratory
If a patient can walk 50 yards or climb one flight of stairs without dyspnoea,
unlikely to need supplementary oxygen on flight
Asthma
Hand luggage. May take course of oral
steroids with them
COPD
May need oxygen, sometimes pay airline,
sometimes can take own oxygen or
concentrator
Bronchiectasis
and CF
May need to take antibiotics, may need
oxygen, med to decrease sputum viscosity
Infections
Can fly once recovered
Pneumothorax
Present = contraindication.
Can travel 2 weeks after successful drainage
Surgical
Abdominal Surgery
10 days
Colonoscopy,
laparoscopy
Neurosurgery
24 hours
Ophthalmic
1 week for most procedures
2 weeks – sulpher hexafluoride
6 weeks – perfluoropropane
Trauma/Orthopadeics
POP – 24-48 hours depends if
flight >2hrs, immobility, may swell,
unable to elevate
10 days
• www.caa.co.uk (civil aviation authority)