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Fit to fly: well enough to fly, or not?

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Fit to fly: well enough to fly, or not?

Air travel has definite effects on the body. Healthy passengers feel this, for example, through harmless pressure or ‘popping’ in their ears during take-off and landing. However, flying can also cause more serious complications in the last few weeks of pregnancy, as well as in some serious injuries or illnesses. To rule out such problems, it may be necessary to clarify in advance whether the passenger is fit to fly.

Doctor making notes

What does ‘fitness to fly’ mean?

If a traveller is considered fit to fly, he or she can take travel aboard a plane without expecting any complications from a medical point of view. Pre-existing medical conditions are not expected to get worse because of the flight, and there is no danger for other passengers – for example, from serious infectious diseases, or mental health problems that could result in violence. For pregnant women, there must be no risk for the expectant mother or her unborn child.

In advance of a medical repatriation in an ambulance jet or scheduled airliner it is required to clarify whether the patient is healthy enough to travel. For certain diseases such as pneumothorax or pneumonia, the pressure conditions in the interior of the plane, which differ from those on the ground, can cause complications. And despite intensive care medical equipment, not every patient can be transported safely, even in an ambulance jet. That's why our medical service carefully examines the medical condition of our patients in advance of every medical repatriation.

Who decides whether a patient is fit to fly?

patient on the way to the schedules aircraft

Of course, only an expert can decide if a patient is fit to fly. On a scheduled flight, the airline always has the last word. The doctor treating the patient must complete a special form, which will then be reviewed by the airline's medical service. Based on the patient's files, the medical staff then decide whether the patient can travel with the airline. Our experience shows that the decision-making process takes at least 1 to 2 days.

But even if the patient's fitness to travel has been declared, the pilot of the scheduled aircraft has the option of refusing to take the patient on board on the day of the flight. This mainly occurs when the patient’s condition appears to be worse than indicated on the form. In the final analysis, the pilot is responsible for the wellbeing of all the passengers – including the patient – and, in case of doubt, he or she must refuse to transport the patient.

If the medical repatriation takes place in an ambulance jet, the accompanying flight doctor decides whether the patient is well enough to travel. For this purpose, in advance of the patient transport, the flight doctor communicates closely with the doctors at the hospital about the patient’s medical situation. Compared to travelling with a commercial airline, this process is much more flexible. In unambiguous situations, it is often enough for the doctors to have a brief conversation with each other and it is not necessary to fill in complicated forms.

If the flight doctor and the treating doctors disagree, the flight doctor will make the final decision as to whether the patient is fit to fly. As a specialist, he or she can better assess the options for care and treatment on board an ambulance aircraft. In addition, he or she is responsible for the health of the patient during the flight.

When is a patient fit to fly?

Of course, it is always required to decide in each individual case whether a patient is fit to fly. However, given the situation on board, some general statements can be made.

Scheduled airliner

If the patient is supposed to travel on board a scheduled airliner, there must be no acute medical condition requiring intensive care. Although a medical professional can accompany the patient, he or she will only be carrying emergency medical equipment and can therefore only provide limited treatment.

Under no circumstances should there be a risk that the patient could endanger other travellers or infect them with a serious illness. In addition, the reduced air pressure inside the cabin must not cause any complications.

If the patient can sit upright for an extended period, transport is possible in a regular Business Class seat. If the patient has to lie down while travelling, a patient stretcher bed can be installed in the cabin. As an additional complication, the airline may refuse to install a patient bed due to time constraints.

Ambulance jet

Ambulance aircraft

The medical treatment options in an ambulance aircraft are much better than in an airliner. For this reason, even intensive care patients can, in most cases, be safely transported in an ambulance jet and can be cared for using the latest medical equipment.

If necessary, the cabin air pressure can be maintained at close to ground level air pressure – a so-called Sea Level Flight – so that there are no ill effects on the patient due to changes in air pressure. Since the patient is flying with only the medical team and any accompanying persons, there are no additional passengers who could be put at risk by the patient transport.

However, sometimes the patient's condition is so critical that even the medical equipment and treatment options on board an ambulance jet is not sufficient to certify that the patient is healthy enough for flying. In this case, a risk assessment must be carried out: is the medical situation in the country in which the patient is staying so problematic that a medical repatriation is still the better option? Or is it better for the patient to stay in the local hospital until his or her condition has stabilised?

Fly back home with Medical Repatriation UK

We organise medically accompanied repatriations from almost anywhere in the world. During the initial consultation we can often assess the probability of a patient receiving a Fit to Fly Certificate by the responsible authorities. If the patient is judged to be well enough to travel, we will gladly relieve you of all the organisational effort – we will be your one-stop shop for organising a safe medical repatriation for the patient.

Contact us now for your medical repatriation

Our 24-hour service is available to assist you at any time and can advise you on your options free of charge. Please contact us:

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