What requirements must a patient meet to be medically fit to fly?

Medical Fitness to Fly: Requirements and Assessment

A patient is generally considered medically fit to fly if they can walk 50 meters on level ground or climb one flight of stairs without severe shortness of breath or chest pain, maintain oxygen saturation >90% at ground level, have a stable medical condition, and do not pose a contagion risk or safety hazard to other passengers. 1, 2

Core Assessment Criteria

Functional Capacity Threshold

• The "50-meter walk test" is the fundamental screening tool: patients who cannot walk 50 meters on level ground or climb one flight of stairs without severe dyspnea or chest pain should not fly without further evaluation 1, 2
• This simple bedside assessment identifies those at risk for hypoxia-related complications during flight 3

Oxygen Saturation Requirements

• Ground-level oxygen saturation >90% is the critical threshold: patients meeting this criterion typically do not require supplemental oxygen during flight 4
• Patients with oxygen saturation ≤90% at ground level will likely need in-flight medical oxygen 4
• For patients with borderline values or uncertainty, the Hypoxia Altitude Simulation Test can determine specific in-flight oxygen requirements 3

Medical Stability Assessment

• Patients with unstable medical conditions should not fly: stability is defined as no recent hospitalization, no acute exacerbation of chronic disease, and controlled symptoms 1, 5
• Specific timing considerations include waiting at least 6 weeks after major thoracic surgery before flying 1

Absolute Contraindications to Air Travel

The following conditions prohibit air travel entirely:

• Active infectious tuberculosis (contagion risk to other passengers) 1
• Current closed pneumothorax (risk of tension pneumothorax with cabin pressure changes) 1
• Severe uncontrolled psychiatric conditions with risk of agitation (safety risk to passengers and crew) 1
• Major thoracic surgery within 6 weeks (unless essential travel with formal medical assessment) 1

Condition-Specific Requirements

Heart Failure Patients

• NYHA Class I-II: Can travel safely when stable 4
• NYHA Class III: Can travel but should arrange on-board medical oxygen support 4
• NYHA Class IV: Should not travel; if unavoidable, requires on-board oxygen and medical assistance 4
• Pre-travel specialist consultation 4-6 weeks before departure is recommended for all heart failure patients 4

Respiratory Disease Patients

• Patients requiring >4 L/min oxygen at baseline should not fly 3
• Those with recent pneumothorax, recent hospitalization for acute respiratory illness, or severe COPD/asthma require pre-flight assessment 1
• Cabin pressurization to equivalent altitudes of 2,438 meters reduces oxygen partial pressure, potentially causing significant hypoxemia 1

Cognitive Impairment

• Patients with dementia or cognitive impairment can fly if they have adequate caregiver support and no history of severe agitation in unfamiliar environments 4, 1
• Risk factors requiring special consideration include history of delirium, behavioral disturbances, and inability to follow instructions 4

Airline Medical Clearance Process

When Medical Clearance is Required

According to IATA guidelines, medical clearance must be requested if the passenger: 4

1. Suffers from a contagious disease
2. Is likely to be a hazard or discomfort to other passengers due to physical or behavioral condition
3. Is considered a potential risk to flight safety
4. Is incapable of self-care and requires special assistance
5. Has a medical condition that may be adversely affected by the flight environment

Required Documentation

• Special Assistance Form (SAF) and Medical Information Form (MEDIF) must be submitted to the airline's medical department for clearance 4, 1
• Frequent Traveller's Medical Card (FREMEC) can be obtained for passengers with stable conditions to avoid repeated clearance requests 4

Pre-Flight Preparation Requirements

Medication Management

• All medications must be carried in original containers in carry-on luggage (not checked baggage) 4
• Bring sufficient medication for the entire journey plus extra for unforeseen delays 4
• Carry a photocopy of the last prescription 4
• Adjust medication timing based on time zone changes, particularly for drugs requiring specific timing 4, 3

Documentation to Carry

• List of medical conditions and allergies 3
• Contact information for treating physicians 3
• Medical device documentation (for pacemakers, defibrillators, etc.) 4

Common Pitfalls to Avoid

• Underestimating the combined effects of hypoxia, dehydration, and immobility: these factors synergistically worsen existing conditions 1
• Failing to account for cabin altitude effects: even "mild" respiratory or cardiac disease can decompensate at equivalent altitudes of 2,438 meters 1
• Not obtaining airline medical clearance when required: this results in denied boarding at the gate 1
• Inadequate hydration planning: patients on diuretics need careful fluid balance strategies, while all passengers should maintain adequate hydration to prevent venous thromboembolism 4, 3

Special Considerations for Long-Haul Flights

Venous Thromboembolism Prevention

• Walk for 10-15 minutes every 2 hours during flight 3
• Perform seated isometric exercises regularly 4
• Wear compression stockings (15-30 mmHg) for flights ≥5 hours to prevent asymptomatic deep venous thrombosis 4, 3
• Avoid alcohol and maintain adequate hydration 3
• Heart failure patients have 1.57 times higher risk of VTE and require particular attention to these measures 4