Preflight medical clearance of ill and incapacitated passengers: 3-Year retrospective study of experience with a European airline

Abstract

Background: Cabin environment in commercial airline flights may pose specific risks for the ill or incapacitated. International regulations provide a framework for the transportation of passengers for whom specific in-flight equipment or services are needed to minimize possible adverse effects and incidents on board. Little has been published on the characteristics of cases requiring preflight medical clearance for commercial airlines. Methods: Requests to our medical center for clearance of ill or incapacitated passengers for a medium-sized European airline, within a 3-year period, were systematically reviewed and characterized. Results: For the period of 1999 to 2001, 1,387 requests for medical clearance were made (1 for every 10,935 passengers), 32 (2.3%) of which were denied and 25 (1.8%) of which were deemed unnecessary. Over half (53.6%) of the requests were on behalf of male passengers, and the most common age group ranged from 61 to 70 years (13.3%). Musculoskeletal conditions and limb fractures in particular were the conditions that accounted for the greater number of cases (24.2%), followed by neuropsychiatric (17.6%), cardiovascular (14.5%), respiratory (12.6%), and neoplastic (10.0%) conditions. The most frequent reasons for denial of clearance were recent myocardial infarction and insufficient clinical data. A significant proportion of passengers needed a qualified escort (38.9%) or travel companion (36.7%). Wheelchairs for displacement during boarding or transit (30.4%), in-flight oxygen (28.1%), and stretchers (27.3%) were also frequent requirements. A total of 1,119 passengers (80.7%) required a mean of 2.3 extra needs on board. Conclusions. The results of this study may help one to better know the nature of medical cases actually requesting clearance for flying. The characteristics of the conditions found suggest that preflight medical clearance may have the potential to prevent the occurrence of disruptive in-flight medical incidents and complications.