But what exactly is pneumonia?
The name of the disease says it all: pneumonia is an inflammation of the lung tissue, either unilaterally – only in one lung – or bilaterally, in both lungs. In practice, human beings have two lungs because each lung works independently of the other. However, both lungs are supplied with oxygen (generated by breathing) only via a single tube, the trachea. The trachea can also act as the gateway for bacteria and viruses, which in turn can trigger pneumonia.
In fact, bacteria play a major role in pneumonia, especially the so-called pneumococcus, which causes about half of all lung infections. Viruses, including the currently active Coronavirus, are only involved in the development of about 25% of pneumonia cases. It is almost always bacteria that trigger a super-infection in conjunction with viruses such as the influenza virus.
The inflamed parts of the lung tissue are only partially able to absorb the oxygen generated by breathing and transfer it to the red blood cells to supply the internal organs. The oxygen saturation in the blood decreases, which has particularly serious consequences in an aircraft.
Why is flying with pneumonia a problem?
When we are flying towards our destination in a jet at an altitude of around 10,000 metres at a cruising speed of almost 1,000 km/h, we find ourselves in an artificial atmosphere. A modern passenger jet is in effect an airborne pressurised cabin that is simultaneously enriched with oxygen. But the atmosphere in the pressurised cabin does not quite match what most people are used to, living at altitudes of 0 metres, right by the sea, to maybe up to 800 metres above sea level. In those areas, where about 95% of the entire human population lives, the air pressure is between 1013 hPa (hectopascal) and 914 hPa.
This air pressure ensures that a person can absorb enough oxygen via the lungs to ensure a supply of around 100%. The higher a person climbs, the lower the air pressure becomes and the more difficult it becomes for the lungs, as well as the heart, to absorb enough oxygen from the air, simply because the air pressure is not at the level they are used to. People can train their bodies to adapt to low air pressure, like Reinhold Messner, who conquered Mount Everest, the world's highest mountain (8848 metres), without oxygen apparatus, but the ordinary traveller does not normally have these capabilities.
Thanks to the pressurised cabin, the air pressure in a passenger jet corresponds to an altitude of about 2,500 metres. But the air pressure at this altitude is only 735 hPa. For most people, this means that the oxygen saturation in their blood decreases to about 90%. This is not a problem for healthy people, especially since oxygen consumption is quite low while sitting down. The flight crew, on the other hand, is accustomed to it.
However, for a person with pneumonia, this means that the oxygen saturation, which has already been reduced by the disease, falls to a critical level below 90%. The fact that the pressurised cabin in a passenger aircraft is not designed to correspond to the air pressure of 0 to 800 metres is related to the weight of the aircraft. In order to be able to increase the internal air pressure to that extent, the hull of the aircraft would have to be thicker and heavier, but this would be at the expense of the take-off weight and, of course, fuel consumption. But there is a good solution for flying with pneumonia and for medical repatriations from abroad.
Sea Level Flight – flying with pneumonia
Anyone who falls ill with pneumonia while on holiday or on a business trip abroad, is usually classified by the doctors treating them as unfit to fly. This means that the patient must recover sufficiently in the host country for their ‘fit to fly’ status to be restored. But that can be a double-edged sword. Pneumonia is a serious illness that requires very intensive medical treatment, which is not necessarily available to the same high standard in every country. On the one hand, there is a risk that the patient will experience oxygen deficiency during the flight home, and on the other hand, medical care may be inadequate where the patient is staying.
The way out of this dilemma is for the patient to take a so-called Sea Level Flight. Once again, this term is self-explanatory, but rather in the figurative sense. For this specialised form of air travel, a special ambulance aircraft is used, which has a pressurised cabin that can achieve air pressure corresponding to sea level, even at cruising altitudes of 9,000 metres.
Although some fluctuations in air pressure will still occur in an ambulance aircraft with a special pressurised cabin, especially during the ascent and descent, these can be compensated for by giving the patient additional oxygen. Here at the Medical Air Service, our experienced team is well-versed in the process of organising and providing ambulance aircraft with ‘sea level air pressure’ cabins, in order to bring home patients with pneumonia quickly and safely, even from very distant countries.
How much does a Sea Level Flight cost?
Health is our most precious asset and therefore is actually priceless. Nevertheless, cost certainly counts and, for a sea level flight it is made up of many factors. For example, what is the exact location of the patient who needs to be flown home on a sea level flight? The answer to this question determines, on the one hand, the organisation of transport to the nearest suitable airport and, on the other, the type of aircraft to be deployed.
The type of aircraft we use also depends on the medical care the patient needs during the flight. It is even possible to provide care at a level otherwise only available in intensive care units, including specially trained flight doctors. Finally, the aim at the destination in your home country is always to ensure that the patient has the smoothest possible journey from the airport to the destination hospital, even using a helicopter in certain cases, where the patient's condition requires it. As can be seen, such complex requirements regarding pricing cannot be met at a flat-rate cost but require an individual calculation to be made for each case. Through our experience and our large network, we at the Medical Air Service can ensure that the costs of transporting the patient do not get out of control.
Flying with pneumonia: when does the insurance company cover the costs?
The medical repatriation of people suffering from pneumonia abroad is not one of the standard services provided by health insurers, whether private or statutory. Nevertheless, if the patient has taken out a travel insurance policy with medical cover that specifically includes medical repatriation, it should be possible to have both the hospital costs abroad and the cost of the medical repatriation reimbursed by the insurance company.
However, insurance companies always check very carefully whether a medical repatriation is really necessary and there may be a shock in store for the insured person. Some insurers have built a get-out clause into their General Terms and Conditions, which enables them to refuse to pay for medical repatriation even for patients with the most serious illnesses. This get-out clause lies in the words: ‘medically necessary’. This definition is a legal grey area. However, if the phrase ‘medically reasonable’ is included in the policy, the insurer cannot refuse to accept the costs of a medically recommended repatriation.
With us, here at the Medical Air Service, you have found the right team to organise the medical repatriation. With our extensive knowledge and many years of experience gained from carrying out hundreds of patient transports from all corners of the globe, we will ensure that you or your family member with pneumonia will be safely transported back home from abroad, from hospital to hospital, and from bed to bed.
Any further questions?
If you would like to know more about ambulance flights, we recommend that you take a look at our FAQ.
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