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Ten top tips on assessing fitness to fly

Aviation health specialist Dr Raymond Johnston's hints on helping patients fly safely

1. Most in-flight emergencies occur in passengers whose condition is unknown to the airline.

Ultimately it's up to airlines to decide if they will carry a passenger with a medical condition, but the more information they have, the fairer and safer that decision will be. The best way to give them this is to use a medical information form or MEDIF.

A copy at is from British Airways but can be used for other airlines.

2. There are some cardiovascular contraindications to flying.

• Uncomplicated myocardial infarction within seven days and complicated MI within four to six weeks

• Unstable angina

• Decompensated congestive heart failure

• Coronary artery bypass graft within 10 days

• Cerebrovascular accident within three days

• Uncontrolled arrhythmia

• Severe heart valve disease.

3. Patients with COPD cannot take their own oxygen on board.

Oxygen can be provided by the airline with advance warning for patients with COPD or chronic bronchitis, depending on their baseline Pa02. But COPD patients already on oxygen cannot take their own, as equipment must meet aviation standards.

4. Some patients with cardiovascular disease may also need in-flight oxygen.

This includes those with heart failure New York Heart Association class III and IV, angina class III, cyanotic congenital heart disease and primary pulmonary hypertension. Those with more severe angina should postpone their flight or arrange a medical escort.

5. There is a simple and pragmatic way to assess the need for on-board oxygen.

The most practical approach is to assess whether the patient can walk 50m at a normal pace or climb one flight of stairs without severe dyspnoea. If they can they will probably tolerate the cabin.

6. Simple allergies do not require a MEDIF.

But airlines need to know about anyone with a life-threatening food allergy that may require the use of adrenaline. This is particularly true if they react to the presence of traces of food in the air.

7. Any air trapped in the body after surgery will expand by 30%.

Patients should not fly within seven days of neurosurgery, 10 days of a simple abdominal operation or 21 days of chest or invasive eye surgery (not including laser). Also, patients with severe otitis media or sinusitis should be advised against flying.

8. Air trapped under plaster casts can also be a problem.

Most airlines restrict flying for 24 hours after application of a plaster cast on flights of less than two hours, or 48 hours for longer flights. Anyone needing to fly sooner needs a cast with valves.

9. Deep vein thrombosis prophylaxis should be targeted at those with greatest risk.

This can be as simple as compression stockings but some may need low-molecular weight heparin. Further details are available in the article on page 24.

10. Cabin crew are trained in advanced first aid, but they are not trained – or permitted – to administer medication

Most will help passengers reach the aircraft toilet but patients should not expect them to render more personal hygiene.

Dr Raymond Johnston is head of the aviation health unit at the UK Civil Aviation Authority

The CAA's free guide to assessing fitness to fly can be downloaded at


click here to download a copy of MEDIF