Fall 2003, Vol. 17, No. 3
Judith R. Fischer, MSLS, Cypress, California
More and more ventilator users are taking advantage of improved ventilator technology and portability to travel by air, both professionally and personally. Advance planning and attention to detail involves obtaining reliable and accurate travel information. Working together with one’s physician, home health agency, respiratory therapist, and the airline is critical for successful travel.
Flying’s most serious medical concern for ventilator users is the quality (low cabin humidity and temperature) and pressure of the cabin air. Airplanes generally cruise above 30,000 feet, with the cabin or barometric pressure adjusted to between 5,000 to 8,000 feet, which is equivalent to standing on a mountain.
Because the plane’s barometric pressure is lower than at sea level, a person’s arterial oxygen can drop from 5 percent to 20 percent, decreasing oxygen availability throughout the body. With less oxygen in the bloodstream, vital organs can be deprived, and hypoxia can develop.1 Ventilator users who have access to a finger pulse oximeter may want to take it along to monitor drops in oxygen saturation in-flight.
Ventilator users who need to use their ventilators in-flight must prepare for air travel well in advance. First, they should contact the reservation agent and explain their needs so that the use of the ventilator in-flight becomes part of their passenger record. Then, to ensure that the arrangements are correct, they should contact a customer service representative and explain about the ventilator again, emphasizing that it is different from using oxygen in-flight.
The airline’s medical and engineering departments may need to approve ventilator use in-flight. The ventilator user should prepare a list including the ventilator’s name and model number, complete specifications, and the manufacturer’s name, address, phone, and website. The ventilator user also needs to determine if the ventilator will fit under the seat (unless the individual is willing to pay for an extra seat) or if he or she can hold the ventilator.2
The airline’s medical department often requires a ventilator user to obtain a letter from his or her pulmonologist stating the individual’s medical diagnosis and ability or fitness to travel. This letter should be ready to present at departure, along with the ventilator specifications and any documentation received from the engineering department, if requested by the ticket and gate agents. With strict new security regulations and screening, these documents can help to expedite passage through security checkpoints. Travelers should bring multiples copies of important papers.
If the ventilator user plans to plug the ventilator into the aircraft’s electrical system, he or she must obtain permission to do so. The Federal Aviation Administration (FAA) does not require airlines to provide this service, and it is not a universal practice. Individuals report that United and Northwest are the most flexible in allowing use of their electrical outlets.
Most airlines will allow dry or gel-cell batteries onboard if they fit under the seat. The HT50® ventilator (www.newportnmi.com) is popular with travelers because of its 10-hour internal battery. However, even when a battery is advertised to provide power for a certain length of time, the battery should be tested far in advance to ensure its performance.
Many airline personnel aren’t aware of the FAA regulations relating to technical specifications of modern portable ventilators, and some require the ventilator to be turned off during takeoffs and landings. The FAA has approved some ventilators for flight such as the LTV™ series (www.pulmonetic.com) and certified that they do not interfere with radio and other transmissions.
Individuals who do not need to use their ventilators during the flight have the options of renting a ventilator from a home health care dealer at their destination, carrying the ventilator onboard (if it meets the storage specifications), or carefully packing it for shipment as checked baggage. Each has advantages and risks.
Laura Hershey, a writer, consultant, and disability rights activist who travels frequently, always brings her bilevel positive airway pressure device with her when flying. “The only time I tried to rent one at my destination, I ended up with a different type of machine that was very uncomfortable for me to use,” Hershey said. “Also, I don’t want to mess with settings upon arriving in a hotel room late at night. So I pack my (equipment) carefully with lots of padding to protect it, and I have never had it damaged.” She recommends bringing extra tubing, filters, connectors, and masks.
Ventilators and other medical equipment and supplies do not count toward the limit on carry-on items. Ventilator user Alan Fiala relates, “I told the flight attendant that my ventilator in the carry-on bag was an assistive device for a disabled person and it was to go in a closet. This worked, except on Southwest’s planes which have no closets.”
Some ventilator users who are ambulatory may not have enough arm strength to pull carry-on items containing ventilator equipment and supplies on-board or lift them into the overhead compartment. Fellow passengers may be willing to help. Flight attendants and airline staff may or may not provide assistance, citing liability concerns or airline rules. Some airlines require
a traveler with a more severe disability to have a traveling companion to help in case of emergency evacuation. (Aviation Consumer Protection Division, Department of Transportation)
Linda Bieniek, another frequent traveler who has used nocturnal ventilation for the past 15 years, states, “When I ask for assistance, I am very specific and explain that I have weak muscles from polio. Although I can walk onto the plane and may look fine, I need assistance with my carry-on bag containing breathing equipment that I use at night and don’t want to chance checking through baggage. Although I dislike having to ask, I have learned that when I struggle, I pay a high price in terms of pain, fatigue, and possible injury.”
All airlines are required to have a Complaints Resolution Officer (CRO) immediately available – even if only by phone – to resolve disagreements that may arise between the carrier and passengers. The Federal Aviation Administration website provides the complete rules and regulations of the Air Carriers Access Act for people with disabilities.
Arrangements for arrival at the destination also require advance planning. Ventilator users should contact a home health agency there to discuss their equipment to ensure that the RTs on staff are familiar with it and can provide support in case of equipment failure or other emergency. Ventilator users also should have the names and contact information for respiratory health professionals in the area knowledgeable about neuromuscular conditions and home ventilation. These professionals can be located using the International Ventilator Users Network’s Resource Directory for Ventilator-Assisted Living.
1. Davis, R. (2001). Do passengers get enough oxygen? USA Today. March 6, 1-2.
2. Hinderer, L. (1998). Airline travel with ventilators. IVUN News. 12(1), 4,8.
Adapted with permission from an article that appeared originally in ADVANCE for Managers of Respiratory Care, April 2003.
Thanks to E.A. Oppenheimer, MD; Bruce Krieger, MD; and Joe Lewarski, RRT, for their review of this article.
Even individuals who use mechanical ventilation only at night may need supplemental oxygen in-flight. Linda Bieniek relates, “In the past, I developed respiratory infections each time I flew. But since I started using oxygen in-flight, I have not had this problem. I highly encourage people who only use a ventilator at night and even those who have neuromuscular conditions without breathing problems to explore the value of this option.”
A physician must determine and write the order for the oxygen flow, usually available in either 2 Lpm or 4 Lpm.1 The order must be presented to the airlines two to seven days in advance so that they can secure and obtain the oxygen. Although most major airlines are certified by the Federal Aviation Administration and equipped to supply oxygen for an entire flight, most economy airlines carry oxygen only for a medical emergency.
Fees for oxygen vary from airline to airline, nationally and internationally, but average about $75 for each leg of the itinerary. The cost of a roundtrip ticket with several connections can become expensive and prohibitive.2 The websites of each individual airline offer related information about oxygen in-flight; Continental’s site is the most comprehensive.
It is advisable to confirm the oxygen request with the ticketing agent at check-in so he or she can phone ahead to the gate agent to verify that the oxygen request has been filled and is on the plane.