Patient Transport Via Commercial Airlines
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Patient Transport Because the frequency of patient transport from one via Commercial hospital to another is increasing and the popularity of air travel continues to rise, physidans should be aware of Airlines the procedures for patient transport by commercial airlines. Major airlines in Canada have experienced personnel and established procedures that facilitate the ANDREW JOHN MACNAB, MD, FRCPC transportation of patients with special medkol needs. By working with the aidine medicol health officers and using up-to-date equipment, physicians can achieve sofe, cost-effective transport of NY PHYSICIAN CAN BE CALLED bulance, while more stable patients can be appropriate patients via A *upon to determine a pa- transported by commercial airlines. Trans- commercial aircraft. tient's fitness for air travel: port by air ambulance is necessary when it might be necessary to transit time must be minimal, when a pa- organize commercial air tient requires special equipment or atten- Puisque l'on assiste a une transport for a seriously ill or injured dants, or when there is a high risk of dis- augmentation de la frequence du transport interhospitalier patient; a patient with a significant medical rupting commercial airline service for an des potients et a un condition might want to undertake a trip unscheduled landing to obtain emergency occroissement de la popularite involving air travel; a seriously ill patient medical care. des voyages aeriens, les might need treatment or ongoing manage- When the patient's condition is stable medecins se doivent d'etre ment at a different center and need to be and no longer requires the special facilities bien sensibiises oux transported to that center via air; or a air ambulances provide, commercial air protocoles appliques par les patient might need to be transported to an transport is often the preferable alternative compagnies commerciales organ transplant facility for assessment or because the cost is substantially less than a d'aviction pour le transport for a transplant procedure. As patient charter flight. This is particularly true for des patients. Au Canada, la when plupart des grandes transport from one hospital to another be- long-distance transfers: for example, compagnies aeriennes ont a comes more frequent, practitioners should repatriating a patient who becomes ill or in- leur emploi un personnel be aware of the procedures that must be jured while visiting a foreign country or experimente et des followed when planning for patient trans- when a patient requires assessment at a dis- protocoles etablis pour port on commercial airlines; practitioners tant transplant center. Recent advances in fadliter le transport des should also understand how the flight envi- the design of medical eqtipment make it patients necessitant des soins ronment can affect their patients when possible to administer relatively complex medicaux spedoux. C'est en elective travel is planned. care during a commercial flight, provided collaborant avec le personnel In Canada, most emergency air medical there is appropriate preflight planning. As m6dical des compagnies are air ambulance, although technology continues to improve and as ef- aeriennes et grace a un transports by equipment moderne que les commercial flights are occasionally used. forts to contain health care costs intensify, mWecins pourront determiner The condition of the patient usually deter- commercial aircraft will likely play an in- quels patients peuvent etre mines the mode oftransport; seriously ill or creasing role in medical transports. transportes de facon injured patients are transported by air am- securitaire et rentable dans Passengers with special les appareils de l'aviation Dr Macnab is Medial Dictor of the Paediati medical needs commerciale. Transpw Pmrogramme at Britsh Colnbiafs Child=nIs The information in this article pertains only 6on Famn P1y.dn 1992;38:1441-1447. Hospita4 Vancouver. to Canadian commercial flights; airlines in Canadian Family Physician VOL 38: June 1992 1441 other countries have different practices and lines have forms that attending physicians procedures: for example, many commer- must complete and sign before medical cial airlines in the United States will not clearance can be granted. These forms re- transport patients confined to stretchers.' quest information such as the diagnosis, Questions about specific patients should be prognosis for the intended trip, level ofam- directed to the medical department of the bulation, and need for oxygen and for an appropriate airline. attendant. Once these forms are completed Only two large commercial airlines op- and received by the airline medical health erate within Canada: Air Canada and officer, the officer consults with the attend- Canadian Airlines International. A number ing physician and the airline's reservation of smaller regional airlines operate under desk to ensure that the needs ofthe patient the umbrella of one or the other of these will be met appropriately. two larger companies; NWT Air, Air BC, Air Ontario, Air Toronto, Air Alliance, and Supplementary oxygen. Supplementa- Air Nova are all affiliated with Air Canada. ry oxygen is provided by both major air- Time Air, Calm Air, Canadian Partner, Air lines. Air Canada requires 48 hours' ad- Quebec Metro, and Air Atlantic are affili- vance notice when oxygen is needed and ated with Canadian Airlines International. can provide oxygen requirements up to 8 L/min. Air Canada charges for supple- Obtaining medical clearance. Passen- mentary oxygen and prefers either that pa- gers with serious medical conditions requir- tients be capable of regulating their own ing special consideration or assistance must oxygen intake or that patients be accompa- be approved for air travel by the airline's nied by an attendant qualified to adminis- medical health officer. Patients wishing to ter the oxygen. The charge for supplemen- travel on one ofthe smaller regional airlines tary oxygen is a flat fee. For flights within must receive clearance through the medical Canada, the fee is $60; for flights to and health officer ofthe parent affiliate. The de- from the United States, the fee is $75; for cision to permit sick or injured people to European flights, the fee is $85; and for travel depends on the circumstances of Asian flights, the fee is $105. Canadian Air- each case. lines also requires 48 hours' notice if In addition to the patient's medical con- supplementary oxygen is needed. The air- dition, the medical health officer also con- line provides supplementary oxygen to a siders the type of aircraft and its facilities maximum requirement of 4 L/min for a and the need for and availability ofa quali- flat fee of $60 within Canada and of $85 fied attendant to accompany the patient. for international flights. Passengers requir- Airlines must be notified of patients who ing supplementary oxygen on Canadian might be at risk in the flight environment, Airlines ffights do not have to be accompa- so that airline personnel are prepared and nied by an attendant. crises can be avoided. The need to work co-operatively with the airline for seriously Patients requiring a stretcher. Both ill or injured patients is obvious. Medical Air Canada and Canadian Airlines accom- clearance, however, should also be ob- modate stretcher cases whenever possible. tained in less serious cases. The process of However, Canadian's 767 aircraft cannot obtaining medical clearance ensures that accommodate stretchers because of their the patient is adequately cared for during narrow aisles. Both airlines use three seat the trip and prevents disruptions to the air- spaces for stretchers and two for portable line's operations or to other passengers. incubators. Incubators need an indepen- When arranging a flight for a patient, dent power source. Both airlines charge for the airline's reservation desk must be con- the number of seat spaces used by the tacted first. The reservation clerk will initi- stretcher or Incubator. Both airlines also re- ate the medical clearance process by ob- quire that stretcher cases be accompanied taining basic information about the patient by a qualified attendant and offer a 50% and the intended flight and forwarding the fare reduction for the attendant. Air Cana- information to the airline medical depart- da needs 48 hours' notice when stretcher ment. Both Air Canada and Canadian Air- cases are to be transported; stretchers and 1442 Canadian Family Physician VOL 38: June 1992 incubators are generally placed near the versely, the presence of the patient should bulkhead, although placement can vary, not affect the safety or comfort of the pas- depending on the class of tickets purchased sengers. To this end, airlines often place pa- and the type of aircraft. Canadian Airlines tients near a bulkhead and away from any needs as much notice as possible when areas where smoking is permitted. The stretcher cases are to be transported. Place- need for unpleasant interventions, such as ment ofthe stretcher or incubator depends suctioning, should be taken into consider- on the type of aircraft. ation when planning the transport. Arranging ground transportation. Patient care and For patients travelling on Air Canada, the the flight environment attending physician must arrange ground Atmospheric pressure. Air transport is ambulance transportation if the patient re- distinguished from other forms of patient quires it. It is important to make these ar- transportation primarily by the change in at- rangements at the patient's destination as mospheric pressure encountered with ascent well as at his or her point oforigin. Ambu- to altitude. Although some small aircraft lance access to the aircraft varies depend- used as air ambulances, such as the Lear 35, ing on the airport used; access is coordi- can maintain ground-level atmospheric nated with the aircraft ground crew pressure,2 most large commercial jets have through either the medical officer or the limited pressurization capabilities. While reservations desk. Patients on Canadian they are all pressurized, the atmospheric Airlines who require ground ambulance pressure in the cabin is not usually equal to service can have the airline make the am- the atmospheric pressure at ground level.