Fitness to FlyFitness to Fly

The ProblemThe Problem

Every year 2 billion people flyEvery year 2 billion people fly Cheap travel started 30 years agoCheap travel started 30 years ago 40-50 yr olds now 70-80 yrs40-50 yr olds now 70-80 yrs Older people have more disposable Older people have more disposable

incomeincome Families spread round globeFamilies spread round globe Sick and disabled want to fly tooSick and disabled want to fly too

Cabin environmentCabin environment

Cabin pressure decreases from Cabin pressure decreases from 100kPa to 75kPa100kPa to 75kPa

Gas expands as pressure fallGas expands as pressure fall Oxygen pressure fallsOxygen pressure falls Air drawn from outside aircraftAir drawn from outside aircraft Air is coldAir is cold Very little moisture – dry eyes etcVery little moisture – dry eyes etc

SeatingSeating

Seats tightly packedSeats tightly packed Immobility Immobility Cramped seatingCramped seating Spread of ariborne diseasesSpread of ariborne diseases

Medical facilitiesMedical facilities

Flights over large oceans nowhere to Flights over large oceans nowhere to divert todivert to

Medical kit limitedMedical kit limited No DoctorNo Doctor Difficult environment to cope with Difficult environment to cope with

medical emergencymedical emergency

AssessmentAssessment

Severe AsthmaSevere Asthma Severe COPDSevere COPD Severe restrictive lung diseasesSevere restrictive lung diseases Cystic fibrosisCystic fibrosis Co-morbidity with illnesses causing Co-morbidity with illnesses causing

hypoxaemiahypoxaemia Within 6/52 discharge for rtiWithin 6/52 discharge for rti Already requiring oxygenAlready requiring oxygen

Who requires OxygenWho requires Oxygen

Haemoglobin oxygen sats 92% or Haemoglobin oxygen sats 92% or lessless

Hb sats 95% don’tHb sats 95% don’t Hb sats 92%-95% need assessmentHb sats 92%-95% need assessment

Gas volume changesGas volume changes

Middle earMiddle ear

– Ascending pos pressure in ear forces Ascending pos pressure in ear forces

open eustachian tube no problemopen eustachian tube no problem

– Descending negative pressure in middle Descending negative pressure in middle

ear has opposite effect if eustachian ear has opposite effect if eustachian

tube dysfunctional get otic barotraumatube dysfunctional get otic barotrauma

Gas volume changesGas volume changes

SinusesSinuses

– Inability to equalise pressure in sinuses Inability to equalise pressure in sinuses

particularly frontal sinus can cause particularly frontal sinus can cause

excruciating painexcruciating pain

– Usually due to urtiUsually due to urti

– Avoid flyingAvoid flying

– Ephedrine nasal dropsEphedrine nasal drops

– Oral pseudoephedrineOral pseudoephedrine

Gas volume changesGas volume changes

Lung bullaeLung bullae

– Risk of rupture not knownRisk of rupture not known

Closed pneumothorax don’t flyClosed pneumothorax don’t fly

Don’t fly following surgical proceedures Don’t fly following surgical proceedures

that have left gas in delicate structurethat have left gas in delicate structure

Don’t dive in 24 hours before flyingDon’t dive in 24 hours before flying

Deep vein thrombosisDeep vein thrombosis

Risk not knownRisk not known

Immobility in cramped positionImmobility in cramped position

Pressure on popliteal veinPressure on popliteal vein

Mild hypoxiaMild hypoxia

Mild dehydrationMild dehydration

PreventionPrevention

Regular exercisesRegular exercises Walking around cabinWalking around cabin Avoid alcohol drink fluids ++Avoid alcohol drink fluids ++ Avoid long periods of sleepAvoid long periods of sleep Below knee compression stockingsBelow knee compression stockings ? aspirin? aspirin

High risk flyersHigh risk flyers

Flights less than 4 hoursFlights less than 4 hours– Usual adviceUsual advice– Stockings aspirinStockings aspirin

Flights more than 4 hoursFlights more than 4 hours– Clexane 40mgs on day of outward and Clexane 40mgs on day of outward and

inward flightinward flight– Pre-filled syringePre-filled syringe– Given at airportGiven at airport