Fit to Fly for Sick passenger

Dr.Anyarit Sangcharaswichai

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 Topic

• Overview concept
• Fit to fly
• IATA Medical manual
• Commercial flight, HAA, AA
• Fit to fly? VS Beyond Fit to fly case

2
 Overview concept
• Will stress of flight, Time of travel or progression of
disease affect to patient? Risk anticipation
• Will Air Transport is benefit to patient and Family
compare with risk?
• Dynamic process (normal validation is 7 days)
• Not only for flying process, but from Bed to Bed
planning
• Airline individual (more limitation), Arrangement
process

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 FIT TO FLY ? Yes
Stable ?
Non Critical? No
O2 <4 LPM
Benefit from
Commercial Flight transport?
Clear medical condition and Infectivity Yes No
with IATA
Oxygen needed ? Medical care
Hypoxic challenge test? capability? ?
1.5 times of ground oxygen

escort needed? Exceed patient condition Under patient condition

Yes Sit > 60 min? No

Commercial Commercial FW AA or
Beyond FTF Not fit to fly
Sitting seat Stretcher HAA
FC, BC, EC

Walk ?
Up stair No
WCHR WCHS WCHC 4
IATA Medical manual

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 Cardiovascular and other Circulatory
Disorders

* Low risk: age <65, first event, successful reperfusion, EF >45%, no

complications, no planned investigations or interventions
** Medium risk: EF >40%, no evidence of inducible ischemia or arrhythmia,
no planned investigations or interventions
*** High risk: EF<40%, signs and symptoms of heart failure, those pending
investigation, revascularisation or device therapy

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Gastro-Intestinal

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Incubation and Infectivity

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 • Recommended for journeys over 150 miles
• Advantage
• Compared to helicopter
Commercial • Faster and Cheapest
flight • Less noise, vibration
• Less weather dependent
• Can fly far away might need change aircraft at transit
point
• Cabin altitude 6,000-8,000 ft
• Disadvantage
• Many uncontrolled process
• Requires ground ambulances and airport process
 Commercial
flight Seat
Economic or Regular

Business or Reclining

First class or flat bed

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 Type of seat Detail

1.Economic Patient can sit upright along flight, no need too

(Regular seat) much space to rest, extend and elevate their leg

Commercial 2.Business Patient can sit upright along flight during take off
(Reclining and landing but can recline their seat. This mode
flight seat) has more space to rest, extend and elevate their
(Flat bed) leg. Long haul flight show more difference
between economic seat.
Oxygen and some Disturb to another passenger need to be
medical concerned.
equipment are 3.First class Patient can sit upright during take off and landing.
limit in some sub- (Flat bed) Patient that need to lie flat along the flight is
preferred
mode depend on Disturb to another passenger need to be
airline policy concerned.
4.Stretcher Patient need to lie down since get in and get off
the aircraft
 Type of escort Indication

No escort needed Patient is rarely need for all support or

help
Non-medical escort Patient is mostly need for non medical
Type of Escort support or some of medical support with
trained non medical escort

Medical escort Patient need medical support

Nurse Nursing care eg. Suction, parenteral

drug administration except high alert
drug.
No risk of ABCD support.
Doctor Patient has high risk of clinical
deterioration and need for ABCD
support.
Need to administration of high alert drug.
Commercial
Airline
Oxygen tank
 Commercial
Airline
Inside tarmac
Boarding
 • Recommended Less than 150 miles
• Advantage
Rotor wing Air
• Compared to Fixed wing
Ambulance • Might not requires ground ambulances
• Faster to mobilize

• Disadvantage
• Sea level is not available
• Slower
• More noise, vibration
• More weather dependent
 • Recommended for journeys over 150 miles
• Advantage
Fixed wing Air • Compared to helicopter
Ambulance • Faster and less cost
• Less noise, vibration
• Less weather dependent
• 24 hours services
• Sea level might be available
• Disadvantage
• Slow to mobilize
• Requires ground ambulances
Fixed wing Air
Ambulance Citation
bravo
Fixed wing Air
Ambulance
King Air
 Hawker

Fixed wing Air

Ambulance
 Mustang

Fixed wing Air

Ambulance
 Fly or Die

• Beyond Fit to fly

• No others choice due to treating hospital
does not have proper facility care to patient
should immediately transfer for higher chance
of survival.
• Greater risk of transportation VS Benefit of
further treatment

Acute SDH
60 yrs, Chinese American,
At 15:20 pm: Patient fell to
the ground cause ear and
nose bleeding, Vomiting,
weak of Lt side and Loss
consciousness few minutes
Aviation consultation 17:40
• BP 140/80 mmHg, HR 80/min, RR 18/min, O2
saturation 100% with 3 LPM cannular
• NS: Look confused, E5V4M4, Pupil 2 mm BR
• Motor power: Lt grade I/V, Rt grade IV/V
Preflight Fit to fly assessment 21:50
• Patient is comatose, Stridor
• BP 134/73 mmHg, HR 102/min, RR 18/min, O2 saturation
97% with 3 LPM canular
• NS: E1V4M1, Pupil Rt 3 mm Reactive, Lt 6 mm SR
• Treatment
• ET with RSI and Manual in line with Cervical collar
• Manitol and Retained Urine Catheter
• Discussed with Attending Neuro-surgeon
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 Humanitarian case

• Some patient that beyond medicine, any

treatment is not more longer important issue,
while their dignity and happiness are.

• Some patients desire to rest in peace back

home.

• Beyond Fit to fly

 Center 1724
BES สายด่ วน ช่ วยชีวติ

“NETWO RKO F LIFE,

CO NTINUITYO F CARE”
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