Fit to fly?

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In the case of acute illness, chronic conditions, or during pregnancy, the question arises whether a patient is "fit to fly". Before certifying the fitness for travel, the medical condition of the passenger has to be assessed carefully for medical clearance. But who is in charge of making the final decision? Is your GP's decision final? And which illnesses are known to cause problems while flying?

What should you know about being fit to fly when planning a trip? 

  • Some patients cannot fly because they have an existing medical condition that may worsen because of the conditions related to the flight. 
  • The change in cabin pressure, lack of medical equipment and other factors can cause a medical condition to worsen mid-air
  • Your doctor determines whether you are fit to fly but the final decision lies with the airline company
  • In most cases, an air ambulance can transport patients who are not fit to fly commercially, enabling flying when sick

Flying when sick: what does ‘fit to fly’ mean? 

Fit to fly is a term commonly used in the medical and aviation sectors to show that a passenger can board a plane without risking his health. There is no medical condition that prevents him from flying. 

Usually, doctors would not issue a fit to fly certificate in case the patient has a medical condition that might worsen mid-air due to the act of flying and the environmental condition in the plane cabin. This deterioration can be extremely dangerous, even fatal in some cases, since it is difficult to obtain proper and timely medical treatment and care on a scheduled flight. Another reason which might affect your fit to fly status could be that you have an infectious disease that would put other passengers and the airline staff at risk.

Medical conditions for not being able to fly 

What are certain medical conditions that affect your fit to fly status? 

  • A recent stroke or heart attack 
  • Breathing difficulties at rest
  • Chronic obstructive pulmonary disease (COPD) 
  • A recent surgery
  • Terminal diseases such as last-stage cancer
  • Infectious diseases such as chickenpox or COVID-19
  • And others 

Fit to fly:  why is flying on a scheduled flight dangerous?

In most cases, a scheduled airliner reaches a height of more than 12 kilometers. At this altitude, the air is quite thin. Inside the passenger aircraft cabin, oxygen levels are adjusted so that they are comparable in flight to the conditions at an outside altitude of 2,4 kilometers. For healthy travellers, this cabin altitude does not cause any symptom as they fly and no complications are caused by the cabin pressure to those with no pre-existing conditions.

If the passenger is sick, however, health complications can occur due to the lack of oxygen. The lower oxygen levels can have negative effects if the passenger suffers from pre-existing medical conditions, a lung disease, for example, may require additional oxygen being readily available throughout the flight. Furthermore, infectious diseases (including COVID-19), severe psychiatric problems, or recent surgical wounds can result in the patient not being fit to fly. 

In case of acute illness, one also has to keep in mind that the medical equipment and medication that can be carried onboard a scheduled airliner might not be sufficient. The patient can travel with a medical escort carrying medication and emergency medical equipment. A stretcher can also be installed in order to enable the patient to lie down. 

Flying when sick: who makes the decision about your fit to fly status? 

The airline has the final say about whether a patient is fit to fly. The treating physician or GP can provide his opinion by filling out a medical information form or providing a written assessment of the patient. But the airline has no obligation to follow his assessment despite any medical certificate.

That's why it is very important to contact the airline before the flight. The medical team of the airline will request written information about the patient's health. Most of the time, a special form has to be filled out. Within 1-2 days, the airline will make its decision adhering to their own guidelines. 

However, this decision and health clearance is not binding, even with a "fit to fly certificate." If the patient presents himself in worse medical condition during checking-in than described, the flight captain and cabin crew can still refuse to transport him. The captain's job is to protect the well-being of the patient and the other passengers and he will make his decision accordingly. Moreover, many patients may now be required to provide a Covid test before being granted to a foreign or his home country. 

Medical Escort for flying when sick

In some cases, a patient can only fly in a scheduled aircraft if a medical escort accompanies him. In this case, a doctor or a paramedic can travel with him. If the passenger can sit upright, he will travel in business class in order to give the health professional who takes care of him more room to work.

If the passenger's health condition indicates that they can only travel lying down, a stretcher is installed inside the passenger cabin, where he can rest comfortably. Usually, this option is only available on long-haul flights because most airlines shy away from the necessary reconfiguration of the cabin on shorter flights.

Fit to fly on an ambulance flight

In case of a medical condition that prevents flying commercially, patients can be transported by ambulance aircraft. Still, it is important to make sure that the patient is well enough to travel. Many patients do not know who is qualified to answer such a question. For that reason, many patients rely on the opinion of doctors at the hospital where they are currently being treated.

If you fall ill abroad, you may not speak the local language. This can lead to communication problems and makes the experience of going to the hospital even more stressful. Medical opinions diverge greatly on the subject of whether patients are fit to travel. Often, hospital staff feel responsible for the patient’s well-being while they are in the hospital – and also on their trip home.

What to do when you are not fit to fly? 

Whether or not a patient is fit to travel is often asked in the following cases:

  1. When local doctors question it.
  2. When family members want to have a patient transferred but are unsure that it is safe to do so.
  3. When the health insurance provider refuses to organise transport home for the patient.
  4. When we prefer to assess a patient’s health ourselves.

The first situation often occurs when a patient’s family want to have them transferred, but local doctors don’t think the patient is fit to fly. In the second, we would assess the patient and let their family know what we think. In the third situation, health insurance providers rely on us to prove that the transfer is medically advisable. Please get in touch with us to discuss any of the above situations: our doctors have years of experience and can accurately assess a patient’s fitness and travel requirements for transport. It is only the doctor accompanying the patient on the plane who is responsible for the patient’s well-being. We consult with the patient’s family before the flight, as there is always a small risk of a patient taking ill during a flight, but we are equipped to deal with medical emergencies in the air.

We are here to help!

Even in borderline cases, we assess the patient and consult with their doctors and the patient’s family to discuss whether the flight is a risk worth taking – that is, if the risk to the patient of travelling is lower than the risk to the patient of staying at their current location.

Air ambulances are fitted with equipment to care for patients who require intensive care during their medical flight alongside beyond the air travel. The decision of whether or not a patient is fit to fly is not made by the hospital doctor, but by the doctor who will accompany the flight. You can rely on their judgement, even if it diverges from that of the hospital doctor. If a hospital doctor tells you the patient is not fit to fly, do not accept their opinion as gospel; ask for a second opinion. Medical Air Service offers this service free of charge. Moreover, should you be wondering about any specific requirements throughout the COVID-19 pandemic (including covid-19 testing requirements) we will be glad to help. 

Do you have any questions? 

If you would like to have more information about how to know if a patient is fit to travel, please see our list of FAQs.

Contact us

Our team members are available 24/7 to provide advice. We can arrange quick medical flights worldwide.

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