Value of preflight medical examinations - Tips from Other Journals

Date: Feb 1, 1994

Because travel by jet aircraft poses possible adverse effects for certain patients, preflight medical evaluation of patients with stable medical conditions or those who are recovering from serious illness can be valuable in the preparation for air transportation. Preflight medical screening can assure the physician and patient of air safety and prevent or minimize in-flight medical complications that may necessitate unscheduled landings and inconvenience other passengers. To help clarify the health status and flight patterns of passengers with various medical conditions, Gong and colleagues reviewed the demographic, flight and medical characteristics of a group of air passengers who underwent preflight medical screening.

The investigators evaluated the records of 1,115 passengers who were routinely referred for preflight medical screening by a major domestic airline over a 12-month period. All passengers with medical problems were interviewed by a medical advisory staff of trained medical personnel. All information was confirmed with the passenger's physician, who would then arrange for any special needs, such as medication or an oxygen tank.

Patients were classified into three groups: 892 patients who required in-flight oxygen therapy ("oxygen" group); 51 patients who did not require oxygen but had a major respiratory diagnosis and possibly needed special services such as suctioning ("pulmonary" group), and 172 patients with nonpulmonary medical conditions or needs ("nonpulmonary" group).

Of the patients in the oxygen group, 656 (78 percent) were 50 years of age or older. Chronic obstructive pulmonary disease and cardiac disorders were the most common disorders in the group requiring inflight oxygen; obstructive airways disease and cardiac disorders were the most common in the pulmonary group. At the time of screening, 313 patients were hospitalized in an acute care facility

More than 80 percent of the patients were taking prescribed medications; 416 (37 percent) were using bronchodilators, 209 (18 percent) were using corticosteroids, and 433 (38 percent) were taking cardiac medications. Patients in the non-pulmonary group used antibiotic, cardiac and antiseizure medications most frequently. The majority of patients in the oxygen group were already receiving oxygen therapy either continuously (50 percent), or intermittently (23 percent). Forty-six patients recalled flight-related dyspnea without supplemental oxygen.

At total of 1,011 (90 percent) of the patients were approved for air transportation, including 824 (92 percent) of those in the oxygen group. Subsequently, all patients in this group received in-flight oxygen therapy. The remaining 104 patients were refused transport due to an unstable medical condition, physician refusal or violation of airline policy, such as intravenous therapy or request for a stretcher. The average flight duration in the oxygen group was 323 minutes, including layover. None of the 1,011 patients who were cleared for flight were known or reported to have experienced a medically significant in-flight problem or one that caused a flight delay or an unanticipated flight diversion.

The authors conclude that large numbers of patients referred for preflight medical screening are receiving medication, have a wide range of medical disorders and have recently been hospitalized in an acute care facility. The authors believe preflight screening may reduce in-flight morbidity of patients with cardiopulmonary and nonpulmonary conditions, especially those who require oxygen treatment during the flight. Patients with cardiopulmonary diseases may be at greater risk from acute hypoxia of air travel. However, this area needs further study, since preflight arterial blood gas values were not determined in the majority of the screened population. (Chest, September 1993, vol. 104, p. 788.)

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