Fitness to Fly

Travelling abroad seeking medical treatment often involves using commercial air travel therefore some considerations regarding special individual circumstances and the flight environment should been taken into consideration.

Below are some recommendations with regards to the most common issues encountered after receiving treatment at Dr. Gilete Spine Center .

Medical Criteria for Fitness to Fly

There are a number of contraindications to flying that are absolute, and many more which are relative to the individual passenger. It is impossible to give definitive advice for every condition so discretion should be used. Please note that the information provided is for guidance only and may be altered in cases such as complications or multiple pathologies. In all instances, passengers must always carry into the cabin with them any medication that might be required in flight.

The Aerospace Medical Association has published guidelines on fitness for travel and the
International Air Transport Association (IATA) provides a recommended Medical
Information Form (MEDIF) for use by member airlines. This is available directly from the airlines or from travel agents.

The need for Medical Clearance

Medical clearance is always necessary when:
• A passenger’s fitness to travel is uncertain as a result of recent illness, injury, hospitalization, surgery or instability of an acute or chronic medical condition.
• Special services are required e.g. oxygen, a stretcher or authority necessary to carry or use accompanying medical equipment.
• A passenger is contemplating overseas diagnostic or hospital treatment in specialist hospitals. It is still necessary to conform to airline requirements for medical clearance.

Key physiological considerations when assessing fitness to fly

Aircraft cabins are pressurized, but not to sea level. The cabin pressure is typically equivalent of up to 8000ft (2438m). This results in:
1) Less available oxygen (partial pressure of oxygen drops to the sea-level equivalent of breathing about 15% oxygen, instead of 21%.
2) Gas expansion in body cavities (approximately 30% increase in volume up to 60%) – particularly applicable to middle ear, sinuses, pleural space and after certain types of surgery when opening an air free body space.
3) Mild hypoxia in high risk individuals may have a prothrombotic effect , so DVT (deep vein thrombosis) prevention should be considered in high risk patients for long-distance air travelers (>6h).

Practical Considerations

The passenger’s medical condition should be the focus of the preflight evaluation and special consideration should be given to the dosage and timing of any medication, possible infectivity, and the need for special assistance requests.

Much can be achieved simply by the physician reminding passengers to carry by hand life-line medication and by acknowledging and confirming the need for valid travel insurance which includes adequate health cover.

General Medical Guidelines

• ALWAYS Hb >9gr/dL
• Make sure no residual air in surgically opened cavities (e.g. pneumothorax, pneuno-cranium…)
• Identify high risk patients with regards to avoidance of deep vein thrombosis (DVT) and venous thromboembolism:
a-Previous DVT with known additional risk including known cancer
b-Surgery lasting >30 min within last 4 weeks.

• For long haul flights (>6h), in high risk patients, subcutaneous Enoxoparin 40mg on the morning of the flight and on the following day.

Medical Guidelines per Surgery & Pathology

Spine Surgery >7 days
Cranial Surgery >10 days. More than ≥10d after uncomplicated craniotomy. Ensure no pneumo-cranium. Escort may be required if passenger unable to care for his/herself.

DVT: more than 5d if anti-coagulation is stable (INR 2-3).
Cranial surgery: more than ≥10d after uncomplicated craniotomy. Ensure no pneumo-cranium. Escort may be required if passenger unable to care for his/herself.
Anaemia: generally fit to fly if Hb≥9,0g/dL. If due to chronic disease and compensated, consider accepting Hb ≥8,0g/dL.

More info available at
http://www.asma.org/publications/medical-publications-for-airline-travel
http://www.iata.org/whatwedo/safety/health/Documents/medical-manual-2012.pdf