1. Guidelines on Fitness to Fly Eppie Habashi

2. Notifying an Airline of a Medical Condition Cabin crew can administer first aid Airlines have medical advisers who when given info in advance can decided whether a passsenger is “fit to fly” –Nature of condition, stability, severity, medications, mobility Info over the phone or via MEDIF form

3. Physiological Effects of Flight Altitude – decreases alveolar partial pressure of oxygen, sats around 90%, tolerated if healthy –If resp or cardio disease or severe anaemia may need supplementary oxygen Barometric pressure changes – gas expands so problems with urti, pneumothorax, abdo/eye surgery, lung bullae, bubbles in insulin pumps etc Low humidity Jetlag – med timing

4. Cardiovascular Disease ConditionContraindicationAdvice HypertensionMeds in hand luggage AnginaUnstableStable is fine Pacemaker, ICDUncontrolled arrythmia Fine when stable Uncomplicated PCI<3 daysOk from 3 days Stroke<3 daysOk from 3-10 days Uncomplicated MI<7 daysOk after 7-10 days CABG<10 daysOk from 10-14 days Complicated MI4-6 weeks Severe symptomatic Valve disease and decompensated heart failure Can’t fly

5. Diabetes Medication in hand luggage Never put insulin in the hold as can be too cold, degrade Plan if on insulin and time difference may need more/less insulin Pump may deliver more when at high altitude and cause hypoglycaemia, reduction in delivery on descent

6. Haematology Supplementary oxygen for severe anaemia, sickle cell disease If at risk of DVT consider stockings and possibly LMWH –Risk of aspirin>benefit

7. Pregnancy Delivery or diversion for delivery not favourable –Single pregnancy can’t fly from 36 weeks –Twin pregnancy 32 weeks Most airlines require certificate after 28 weeks to say pregnancy progressing normally and EDD

8. Respiratory If a patient can walk 50 yards or climb one flight of stairs without dyspnoea, unlikely to need supplementary oxygen on flight AsthmaHand luggage. May take course of oral steroids with them COPDMay need oxygen, sometimes pay airline, sometimes can take own oxygen or concentrator Bronchiectasis and CF May need to take antibiotics, may need oxygen, med to decrease sputum viscosity InfectionsCan fly once recovered PneumothoraxPresent = contraindication. Can travel 2 weeks after successful drainage

9. Surgical Abdominal Surgery10 days Colonoscopy, laparoscopy 24 hours Neurosurgery10 days Ophthalmic1 week for most procedures 2 weeks – sulpher hexafluoride 6 weeks – perfluoropropane Trauma/OrthopadeicsPOP – 24-48 hours depends if flight >2hrs, immobility, may swell, unable to elevate

10. www.caa.co.uk (civil aviation authority)www.caa.co.uk