Air Travel Advice

Pregnant women can normally travel safely by air, but most airlines restrict travel in late pregnancy. Typical guidelines for a woman with an uncomplicated pregnancy are:

• after the 28th week of pregnancy, a letter from a doctor or midwife should be carried, confirming the expected date of delivery and that the pregnancy is normal;
• for single pregnancies, flying is permitted up to the end of the 36th week;
• for multiple pregnancies, flying is permitted up to the end of the 32nd week.

Any case of a complicated pregnancy requires medical clearance.

A fit and healthy baby can travel by air 48 hours after birth, but it is preferable to wait until the age of 7 days. Until their organs have developed properly and stabilized, premature babies should always undergo a medical clearance before travelling by air. Changes in cabin air pressure may upset infants, and this can be helped by feeding or giving a pacifier to stimulate swallowing.

The contraction of muscles is an important factor in helping to keep blood flowing through the veins, particularly in the legs. Prolonged immobility, especially when seated, can lead to pooling of blood in the legs, which in turn may cause swelling, stiffness and discomfort.

It is known that immobility is one of the factors that may lead to the development of a blood clot in a deep vein, known as deep vein thrombosis (DVT). Research has shown that DVT can occur as a result of prolonged immobility, for instance during long-distance travel, whether by car, bus, train or air. A WHO study showed that the risk of DVT increased 2- to 3-fold after long-haul flights of more than 4 hours and similar forms of travel.

In most cases of DVT, the body is able to gradually break down the clots and there are no long-term effects. Larger clots may cause symptoms such as swelling of the leg, tenderness, soreness and pain. Occasionally a piece of a clot may break off and travel with the bloodstream, to become lodged in the lungs. This is known as pulmonary embolism and may cause chest pain, shortness of breath and, in severe cases, sudden death. This can occur many hours or even days after the formation of the clot in the leg.

The risk of developing DVT when travelling is increased in the presence of other risk factors, including:

• previous DVT or pulmonary embolism
• history of DVT or pulmonary embolism in a close family member
• use of oestrogen therapy – oral contraceptives (known as the pill) or hormone replacement therapy (HRT)
• pregnancy
• recent surgery or trauma, particularly to the abdomen, pelvic region or legs
• cancer
• obesity
• some inherited blood-clotting abnormalities.

DVT occurs more commonly in older people. Some researchers have suggested that there may be a risk from smoking and from varicose veins.

It is advisable for people with one or more of these risk factors to seek specific medical advice from their doctor or a travel medicine clinic in good time before embarking on a flight of 4 or more hours.

WHO suggests moving around the cabin during long flights to reduce prolonged immobility, although this may not always be possible. A regular trip to the bathroom, for example every 2–3 hours, is a reasonable measure. Many airlines provide helpful advice on exercises that can be carried out in the seat during flight. Exercise of the calf muscles can stimulate the circulation, alleviate discomfort, fatigue and stiffness, and may reduce the risk of developing DVT. WHO also suggests that hand luggage should not be placed where it restricts movement of the legs and feet, and clothing should be loose and comfortable.In view of the clear risk of significant side effects and absence of clear evidence of benefit, passengers are advised not to use aspirin specifically for the prevention of travel related DVT. Travellers at greatest risk of developing DVT may be prescribed specific treatments and should consult their doctor for further advice.

Airlines are required to provide minimum levels of medical equipment on aircraft and to train all cabin crew in first aid. The equipment carried varies, with many airlines carrying more than the minimum level of equipment required by regulations. Equipment carried on a typical international flight would include:

• one or more first-aid kits, to be used by the crew;
• a medical kit, normally to be used by a doctor or other qualified person, to treat in-flight medical emergencies.

An automated external defibrillator (AED), to be used by the crew in case of cardiac arrest, is also carried by several airlines.

Cabin crew are trained in the use of first-aid equipment and in carrying out first-aid and resuscitation procedures. They are usually also trained to recognize a range of medical conditions that may cause emergencies on board and to act appropriately to manage these.In addition, many airlines have facilities to enable crew to contact a medical expert at a ground-based response centre for advice on how to manage in-flight medical emergencies.

Airlines have the right to refuse to carry passengers with conditions that may worsen, or have serious consequences, during the flight. They may require medical clearance from their doctor if there is an indication that a passenger could be suffering from any disease or physical or mental condition that could be a hazard to the safety of the aircraft, reduce the welfare and comfort of the other passengers and crew members, require medical attention during the flight, or may be aggravated by the flight.

If cabin crew suspect before departure that a passenger may be ill, the aircraft’s captain will be informed and a decision taken as to whether the passenger is fit to travel, needs medical attention or presents a danger to other passengers and crew or to the safety of the aircraft.Airline policies vary and requirements should always be checked at the time of, or before, booking the flight. A good place to find information is often the airline’s own web site.

Most people with medical conditions are able to travel safely by air, provided that necessary precautions, such as the need for additional oxygen supply, are considered in advance.

Those who have underlying health problems such as cancer, heart or lung disease, anaemia and diabetes, who are on any form of regular medication or treatment, who have recently had surgery or been in hospital, or who are concerned about their fitness to travel for any other reason should consult their doctor or a travel medicine clinic before deciding to travel by air.

Medication that may be required during the journey, or soon after arrival, should be carried in the hand luggage. It is also advisable to carry a copy of the prescription in case the medication is lost, additional supplies are needed or security checks require proof of purpose.A frequent traveller who has a permanent and stable underlying health problem may obtain a frequent traveller’s medical card (or equivalent) from the medical or reservation department of many airlines. This card is accepted, under specified conditions, as proof of medical clearance and for identification of the holder’s medical condition.

Dental/oral surgery

Recent dental procedures such as fillings are not usually a problem when flying. However, unfinished root canal treatment and dental abscesses are reasons for caution, and it is recommended that individuals seek advice from their dental practitioner before making travel plans.

Security issues

Security checks can cause concerns for travellers who have been fitted with metal devices such as artificial joints, pacemakers or internal automatic defibrillators. Some pacemakers may be affected by modern security screening equipment and any traveller with a pacemaker should carry a letter from their doctor.

Smokers

Almost all airlines now ban smoking on board. Some smokers may find this stressful, particularly during long flights, and should discuss the issue with a doctor before travelling. Nicotine replacement patches or chewing gum containing nicotine may be helpful during the flight and the use of other medication or techniques may also be considered.