When should I avoid Air travel?

With the rapid development of technologies, air Travel has increased. But most travellers are unaware of the conditions when the air travel should be avoided and morbidities that can be caused if ignored.

The medical safety of air travel depends on

1. the nature and severity of the traveler’s illness
2. duration of flight,
3. pressurization,
4. the availability of supplementary oxygen and other medical supplies,
5. the presence of health care professionals
6. and other special considerations.

The medical hazard most likely to be realized is hypoxia.

The most common in-flight emergencies are

• cardiovascular,
• respiratory,
• syncopal,
• neuropsychiatric,
• metabolic, and substance related.

The Air Transport Association of America defines an incapacitated passenger as “one who is suffering from a physical or mental disability and who, because of such disability or the effect of the flight on the disability, is incapable of self-care; would endanger the health or safety of such person or other passengers or airline employees; or would cause discomfort or annoyance of other passengers.”

• Patients subject to motion sickness can be given sedatives or antihistamines (eg, dimenhydrinate, 50 mg orally every 4–6 hours; promethazine, 25 mg orally every 6 hours; or meclizine, 25–50 mg orally every 24 hours) before and during the flight.
• Small meals of easily digested food before and during the flight may reduce the tendency to nausea and vomiting. Table 37–1 lists the more common contraindications to air travel.

Frequent contraindications to air travel.

1. Congestive heart failure1
2. Uncomplicated myocardial infarction within 3 weeks; complicated myocardial infarction within 6 weeks
3. Post CABG within 2 weeks
4. CVA within 2 weeks
5. Uncontrolled hypertension
6. Uncontrolled ventricular or supraventricular tachycardia
7. Severe symptomatic valvular heart disease
8. New or unstable angina
9. Deep venous thrombosis unless the person is stable, receiving anticoagulant therapy, and has no pulmonary complications2
10. Nasal congestion unresponsive to therapy
11. Pulmonary cysts
12. Pneumothorax
13. Active communicable tuberculosis or other communicable virulent infection (eg, measles, chickenpox)
14. Breathlessness or hypoxemia
15. Anemia (hemoglobin < 8.5 g/dL), sickle cell disease
16. Postsurgery (eye, thorax, abdomen) within 2–3 weeks unless surgeon approves
17. Emotionally unstable, agitated, or psychotic
18. Pregnancy unless low risk, without complications, and less than 8 months

1Oxygen should be made available for persons with cardiovascular, respiratory, or hematologic illness.
2Susceptible patients should wear support hose, perform leg exercises, and walk during flight. Preflight low-molecular-weight heparin may also be indicated.
CABG, coronary artery bypass grafting; CVA, cerebrovascular accident.

Flying with illness

Source : CMDT 2008