Medical Guidelines for Airline Travel

Introduction Each year approximately 1 billion people travel by air on the many domestic and international airlines. It has been predicted that in the coming two decades, the number of passengers will double. A global increase in travel, as well as an increasingly aged population in many countries, makes it reasonable to assume that there will be a significant increase in older passengers and passengers with illness. Patients frequently ask their physicians whether or not it is advisable for them to travel, and if so, what precautions they should take. Consequently, physicians need to be aware of the environmental and physiological stresses of flight in order to properly advise their patients. In addition, because international travelers can fly to the four corners of the world in just hours, a basic understanding of vaccinations is requisite. Two caveats are brought to the attention of the reader. First, if inflight illness or even death has occasionally been reported by the airlines, the event was not necessarily caused by airline travel or the stresses of flight. The physician must be mindful that, with so many passengers spending so many hours inflight, flying and the medical event may be coincidental rather than causal. Second, the guidelines described herein are just that– guidelines, and not rigid criteria or hard and fast rules. Like all patient management, these guidelines must be individualized and tempered by the physi-cian's clinical judgment. This publication was prepared by the Aerospace Medical Association Medical Guidelines Task Force. The information contained herein is for primary care and specialist physicians so they will be better prepared to advise patients who are contemplating air travel. (The reader is cautioned that the material applies only to passengers and not to airline crews or cabin attendants .) The authors sincerely hope that this publication will educate the physician and contribute to safe and comfortable flight for passengers. Modern commercial aircraft are very safe and, in most cases, reasonably comfortable. However, all flights, short or long haul, impose stresses on all passengers. Preflight stresses include airport tumult on the ground such as carrying baggage, walking long distances , and being delayed. Inflight stresses include lowered barometric pressure and partial pressure of oxygen , noise, vibration (including turbulence), cigarette smoke, uncomfortable temperatures and low humidity, jet lag, and cramped seating (64). Nevertheless, healthy passengers endure these stresses which, for the most part, are quickly forgotten once the destination …