Flying passengers with special medical needs

Maybe you'd like to fly a wheelchair-bound relative to a family function. Or perhaps a member of your management team has contracted a bad case of the flu during a business trip. Flights with passengers like these-or anyone with a significant health issue-necessitate special planning.

"Many medical conditions require people to think before they travel," said Jennifer Garr, manager of medical operations for Tempe, Ariz.-based MedAire, which provides medical information to flight departments and charter companies. "We assess everything from a cough to someone who just had a cast put on," Garr said.

The demand for MedAire's services underscores the need to consult a doctor or other health professional if a medical issue could affect a passenger's flight. Make sure the physician understands that cabin altitudes can affect some medical conditions. If the doctor green lights the flight, consider the basic rules governing fitness to fly without an attendant: "The individual has to be able to follow commands, sit on a seat and [wear] a seat belt," said George Martinez, director of flight programs at Fort Lauderdale, Fla.-based National Jets and National Air Ambulance.

Assuming the passenger can do that, you need to determine what accommodations might be necessary to address any en route health care needs. The answer may dictate the choice of aircraft, whether any cabin reconfiguration is required and what ground-support services and equipment you need.

Alert the operator of the flight to the passenger's condition as far in advance as possible and provide contact information for his or her physician. It's also advisable to arrange for in-flight contact with medical professionals if you anticipate the need for any assistance en route. (Fractional provider NetJets touts its affiliation with the Mayo Clinic, a perk that includes in-flight advice from the clinic's aviation medical experts.)

Wheelchairs and Oxygen
One of the most basic questions in determining flight suitability concerns whether a prospective passenger is ambulatory. Wheelchair use doesn't preclude flying, but you have to address the issue of how to get on and off the aircraft. Can the passenger walk at least enough to enter and exit the airplane on foot? If not, talk to the flight provider about the availability of assistance at departure and arrival. A non-ambulatory traveler can be carried aboard, seated on a small chair. Some flight operators and FBOs have stair chairs, which can lift an individual in a wheelchair on or off an aircraft-if the cabin door is wide enough. Once on board, the traveler can be transferred to a seat. Consider where to store the wheelchair during the flight, as well.

Individuals who use supplemental oxygen on the ground because of compromised respiratory systems present special challenges. "Anytime somebody requires oxygen on the ground, the first question should be, 'Is it safe for me to get on an aircraft?'" advised Sam Cimone, who directs the air ambulance program at SkyService in Etobicoke, Ontario. "Any condition that can affect respiratory function or the way someone breathes-chronic obstructive pulmonary disease, for example-will amplify itself in the air."

Typically, a passenger with a longstanding respiratory problem will handle cabin altitudes better than someone whose condition was recently diagnosed, as the latter's body hasn't had as long to adapt to the condition.

Regulatory issues apply to onboard supplemental oxygen use. Both aircraft and crews need certification to bring supplemental oxygen tanks or oxygen-generating canisters onboard. These devices rely on compressed, flammable gas or potentially flammable chemicals, and are hazardous. The aircraft must be licensed to carry them; flight crews must be trained and certified; and paperwork must be completed when they are brought on a flight. Issues of explosive or flammable substances aside, a poorly secured oxygen tank could do plenty of damage in a turbulent flight.

Consider the length of the trip, as well. "An hour or two on a jet might not be a problem, but if it's hours and hours, that can make a difference if you have a medical condition," Martinez said. Be sure to bring extra oxygen, medications and other medical supplies in case the flight takes longer than expected or must divert to an alternative airport, which may not have the medical services the passenger requires. And as a general rule on any aircraft, carry all medications and medical supplies required in the cabin, not stowed in a baggage compartment that's inaccessible during the flight.

In-Flight Assistance
For some conditions-if a passenger is on a ventilator, taking intravenous fluids or unable to sit up and follow commands, for example-you'll need an onboard nurse or paramedic. Several companies provide such escorts. For those who need to lay supine, devices such as a LifePort can provide an FAA-certified method for carrying them in the cabin on a gurney. In some cases, a cabin may have to be temporarily reconfigured to accommodate the passenger. Remember that weight and balance will have to be recalculated for the flight if seats are removed.

If the traveler needs ongoing attention because the condition could deteriorate or he might need CPR en route, an air ambulance may be necessary. An air ambulance may also be required if the only alternative is a small aircraft that won't accommodate a supine passenger. "We operate a Challenger 600," said Scott Morris, director of client services for Mayo Aviation (not associated with the Mayo Clinic) in Englewood, Colo., which provides both regular charter and air ambulance transportation. "It's a great airplane [for medical transport] because it's got three couch-style bench seats."

Not only physical ailments can require an onboard medical attendant. "Someone could be very anxious about flying," MedAire's Garr said. "If it is debilitating, we would recommend an escort with medications to relieve anxiety."

Patients who simply shouldn't fly

Fortunately, they aren't many medical conditions that absolutely preclude air travel. Those that do include some cardiovascular and respiratory conditions and severe anemia. Post-surgical patients and individuals with some forms of tumors, such as brain tumors, also should not fly. "A tumor could start expanding, press against the brain and cause a stroke," said Ed Sells, mission coordinator of Angel Flight, Inc. of Tulsa, Okla., a charity that provides flights for individuals needing noncritical medical transportation.