Dr Handford's Travel Tips Am I ‘Fit to Fly’?
How do you know if you are fit to fly?
Your airline will ask you to confirm that you are prior to booking or boarding the aircraft – but what does it really mean?
Cabin crew are trained to provide advanced first aid, but most cases of in-flight medical emergencies occur when the airline and cabin crew have not been made aware of a pre-existing condition.
Thus, details of any pre-existing conditions and their current management is vital for the airline to be able to look after you safely.
What information do I need to provide to an airline?
The airline essentially want to know three things:
- The nature of the condition and its severity and stability
- Details of any medication being taken
- Any relevant impact it may have on mobility.
Each airline will have its own medical clearance procedure, so check each time you fly.
A comprehensive and accurate way to provide this information is via a form called IATA MEDIF, which is available online or through your travel agent.
Your GP should be able to fill this in with you, or on your behalf, although they may charge you for this as it is not an NHS service and can be time consuming.
If you are a frequent traveller, there is a form called FREMEC (frequent traveller medical card) which is worth completing.
When do I need to obtain medical clearance to fly?
Essentially, the airline requires medical clearance for you to fly if you fall into one of 5 main categories:
- suffering from a disease which is contagious
- likely to be a ‘hazard’ to other passengers
- considered to be a risk to the safety or punctuality of the flight
- incapable of caring for yourself
- have a medical condition likely to be adversely affected by the flight environment.
This last category is the one we will focus on.
The ‘Flight Environment’: How flying affects your health
So how does being in a plane affect your health? Well, in several ways actually!
Because aeroplanes fly at altitude, the air pressure is lower. This essentially means less oxygen is being pushed into the blood stream. As a result, EVERYONE flying in a plane has less oxygen in their blood than they would do in normal day to day life.
This is absolutely fine for healthy people with no underlying medical conditions, but if you have an underlying lung or heart problem, or significantly low blood count (anaemia), this can cause serious health problems in-flight.
The changes in air pressure also have an effect on gas – and we have all got gas inside us (in our lungs and our gut, primarily). This gas expands at altitude and needs to take up more space – which can cause problems if the gas is trapped.
For example, the sinuses behind our nose are air spaces – if they are infected and full of discharge as a result, the air may not be able to escape, and will build up, causing pressure and pain.
This effect can be very serious if you have recently had surgery which may lead to air inside the body in an unusual place – for example inside the abdomen after a bowel operation.
As a result, if you have recently had surgery, or been diagnosed with a pneumothorax (an air leak from the lung), you MUST check with your GP or specialist before travelling by plane.
In patients with reduced heart function, the use of supplemental oxygen may be required during a flight, even if it is not needed in everyday life.
Most commercial airlines will supply this when requested in advance, although this may incur a charge. Some airlines may allow passengers to carry and use their own oxygen cylinders but you should contact your airline in advance and check their policy around this.
If you have a heart condition such as angina, it is important that you carry a supply of your medication with you in your hand luggage, and make sure your travel companions know where it is.
If you have recently had a pacemaker fitted, a heart attack, or a procedure like a bypass or an angiogram, please check with your specialist or GP about when it is safe to travel by air as there are specific guidelines about this.
When you should consult your GP
There are several other situations where you should definitely check with your GP before you travel. These include:
- If you have a plaster cast on (for example, for a broken bone)
- If you have had an operation requiring an overnight stay in hospital, within the last 2 months
- If you have had a stroke or a mini stroke in the last 4 weeks
Certainly, there are lots of conditions which are very stable, and well managed. It is less likely that you need to check with your doctor before you travel if this applies to you.
However, if you have a condition which is a bit variable – like poorly controlled diabetes, or brittle asthma, then please speak to your GP or practice nurse before you go away.
Ensure you speak to them well in advance – 6-8 weeks ideally. This will allow them to make any changes that you may need to help you whilst you are away.
Always consult your own doctor before travelling
These travel tips are intended to provide general information to those travelling with medical conditions. They do not replace a visit to your doctor . If you are planning a holiday you should consult your doctor to ensure that you are fit to travel and discuss any specific health requirements you may have.
About Dr Ruth Handford
Dr Ruth Handford is a GP with over 10 years' experience of working in both hospital and primary care. She is particularly interested in caring for the elderly in the community, child health, and family planning. Ruth lives and works in a rural community, and is kept very busy by her job and young family.
Travel Insurance for Medical Conditions
The Foreign and Commonwealth Office recommend that you have travel insurance in place every time you travel abroad. Make sure that your insurers are aware that you have existing medical conditions and ensure that your travel insurance provides cover for them.