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Heart
and lung patients need to know that commercial airlines require
advance notice to arrange oxygen in-flight. FAA regulations
do not allow use of personal systems on board commercial flights.
Usually 48 to 72 hours minimum notice is necessary. Some airlines
require a specific form to be filled out by your physician
and reviewed by their medical director to approve transport.
The more notice given the airlines, the better they can meet
your needs. Oxygen is an additional charge of $50.00 to $75.00
per flight segment. Nonstop flights are more convenient and
less expensive in relation to oxygen therapy. International
flights may require more advance notification and may have
higher fees (as much as $175.00 per flight segment). If you
are also planning layovers, oxygen needed on the ground will
need to be arranged from a local durable medical equipment
company. Also, ground wheeled transport must be pre-arranged
(i.e. wheelchair or motorized cart). Patients must remember
that portable oxygen canisters (such as liquid O2 strollers)
must be leaked to less than 20 PSI and checked in the cargo
area. When booking your seat, request a seat on the aisle
near the lavatory. Many airports have medical facilities;
be sure to identify the name and location of these at the
airports you will be using. For example, at Pittsburgh International
Airport, the University of Pittsburgh Medical Center has medical
facilities in C wing of the air-side terminal. If you are
planning to travel internationally, it is recommended that
you obtain a Frequent Traveler’s Medical Card (FREMEC). These
may be available from Auto Clubs, travel agents or other organizations
such as those listed below.
Finally,
you should carry 5 to 7 copies of a letter from your doctor
with the stated O2 prescription for flight, a statement related
to your fitness to travel, your diagnosis, and a list of your
current medications. For pulmonary patients, your most recent
PFTs, O2 saturation, and arterial blood gas results should
also be included.
In-flight
Oxygen Systems
For the most recent guidelines on airlines and oxygen use, visit here.
FAA
regulations require that airlines supply oxygen to passengers
requiring oxygen during flight. The airlines do retain the
right to refuse passage to patients who would be unsafe to
travel by air. The medical director for each airline determines
this.
All
airlines carry at least one oxygen cylinder for emergency
use on board. No airline permits the passenger to use his
or her own oxygen supply. It must be remembered that there
are a limited number of seats available for persons requiring
oxygen. In-flight, aviator’s oxygen is used. In comparison
to regular medical oxygen, aviator’s oxygen is drier to avoid
line freeze-up if decompression should occur.
Oxygen
cylinders using compressed oxygen are used in-flight. There
are three sizes of oxygen cylinders. The smallest holds four
cubic feet and runs at a fixed flow of 2 liters per minute
and lasts about 45 minutes. It is only available with a mask.
The second size holds 11 cubic feet and can be set to two
or four liters per minute. This tank lasts 2.6 hours (2L)
or 1.3 hours (4L). The largest tank holds 76.5 cubic feet
of oxygen. Liter flow can be set from one to eight liters
per minute. At two liters, this tank will last 18 hours.
Currently,
there are two different types of oxygen connectors used with
in-flight systems. The first is a demand-type, similar to
a pulse-air unit, which releases oxygen into the line when
triggered by inspiration. The limitation of this system is
that it may be poorly tolerated by patients with a small tidal
volume due to their large dead space, which increases the
work of drawing the oxygen. The second type of connector is
a continuous type with a preset liter flow. This type of system
cannot be self-regulated as the patient may “turn up” the
oxygen and potentially run out before the flight is completed.
Many
airlines use masks for oxygen delivery. These may be either
a regular mask or the yellow dome-type mask. United Airlines
can provide nasal cannulas for use. If using a nasal cannula,
the patient needs to cut off the mask tubing so the female
end of the nasal cannula tubing can be fitted into the tubing
remnant. Missouri It is important to remember that oxygen
is an added cost to air travel and the patient will be responsible
for oxygen charges from the airline.
It
is not included in the normal airline ticket price. If a patient
has oxygen available on an as-needed basis during flight,
the patient will be charged for that oxygen.
Equipment
and Medications Management
Patients
need to hand carry all medications on board with them. It
is important that copies of all prescriptions also be carried.
This is especially important when traveling outside the United
States. Customs inspectors will confiscate medications without
accompanying prescriptions even if in labeled bottles. For
travel, patients may wish to miniaturize equipment to reduce
weight. There are currently battery-powered nebulizers on
the market. The DeVilbiss product line has an ultrasonic nebulizer
called “Portasonic.” “Pulmo-aide Traveler” is a portable nebulizer
one-fourth the size of the regular pulmo-aide and the patient
can use his or her own nebulizer tubing. Travelers need to
remember to investigate electrical current used in their destinations
and plan for adapters or adapted equipment.
The
use of portable mechanical ventilators requires special arrangements
long prior to travel. If flying, the ventilator must fit under
the seat, so the exact dimensions of the equipment must be
discussed with the airline to assure that a proper seat is
available. A back-up battery must be with the equipment and
the traveling companion of the patient must carry spare parts.
Using suction equipment may not be allowed in flight as it
may interfere with navigational equipment. Patients should
not self-medicate for flight. The use of antihistamines can
be especially troublesome as it can cause drowsiness and increase
sputum viscosity.
Travel
Day Planning
Traveling
with an informed companion is strongly recommended. Remember
to use the restroom prior to boarding. Use pre-boarding to
avoid the crowds during boarding. Avoid overeating, alcohol,
sedatives or caffeinated beverages that may cause increased
urination or bloating. Remember to exercise your leg muscles
at least every hour. Get a good night’s sleep before starting
your journey. Carry with you a copy of your advanced directive
(i.e. living will).
In-flight
Oxygen System Development
New oxygen systems are being investigated by airlines. The
LOX is a non-pressurized system being trailed by Air Australia
and KLM. The LOX is an oxygen concentrator, which fits under
the airline seat. It weighs 41 pounds and uses the aircraft
power system. It provides 95% pure oxygen. It can provide
oxygen up to five liters per minute for an infinite duration.
The drawback to this system is its cost, which is approximately
$15,000 per unit.
Traveling
Over Land or Sea
Sea Travel:
It
has been only recently that cruise lines have allowed supplemental
oxygen. Portable oxygen systems allow many patients to enjoy
cruising. Most cruise lines require at least four weeks notice
but allow patients to provide their own oxygen source. Oxygen
concentrators provide the most convenient source, but if continuous
O2 is needed, a portable system may be more advantageous.
Prior planning, as with air travel, is the key to successful
sea travel. The patient will be responsible for arranging
refilling of portable systems during the cruise by pre-arranging
for this at ports of call. Room preference would be in a non-smoking
part of the ship, near the elevators.
Ground
Transportation:
Bus
lines allow passengers to carry their own oxygen on board
and to check empty tanks as baggage.
Railroads
allow passengers with portable O2 containers or oxygen concentrators
on board. If using a concentrator, a 12-hour battery back
up is required, with seating and accommodations in the non-smoking
part of the train.
As
with any travel, all arrangements should be made as far in
advance as possible with documentation of contact names.
Travel
by private car or RV is often the mode of choice. Compressed
oxygen can be secured in the back seat. Patients must be careful
to not allow the tanks to overheat (do not leave them in the
car in warm temperatures or in direct sunlight. Portable oxygen
concentrators are becoming available which can be plugged
into a car cigarette lighter.
Further
Information
Federal
regulations through the Access Act have lead to the improved
ability for patients with disabilities to travel. A booklet
is available with further information called “New Horizons
for Air Travelers with Disabilities.” It is available from
the Department of Transportation at (202) 366-2220 or (202)
366-4220. Other sources of information include:
Centers
for Disease Control (404) 332-4555 Provides health status
of regions of the world, including inoculation requirements.
International
Association for Medical Assistance to Travelers (716)
754-4883 417 Center Street, Lewiston, NY 14092
International
SOS Assistance (800) 523-8930 In PA: (215) 244 1500, Fax:
(215) 244 2227 Eight Neshaminy Interplex, Suite 207, Trevose, PA 19053-6956
In TX: (713) 521 7611, Fax: (713) 521 7655 2211 Norfolk, Suite
624, Houston, Texas, USA 77098
Travel
Assistance International (Worldwide Assistance Services,
Inc.) (800) 821-2828 E-mail: wassist@aol.com 1133 15th St
NW, Suite 400, Washington, DC 20005 (202) 331-1609, (202)
347-7113, fax (202) 331-1530
TravMed,
International Travelers Assistance Association (800) 732-5309,
in MD (301) 296-5225 PO Box 10623, Towson, MD 21204
WorldCare
Travel Assistance Association (800) 521-4822 2000 Pennsylvania
Avenue, NW, Suite 7600, Washington, D.C. 20006
Access
America (800) 851-2800 PO Box 807, New York, NY 10163
(Also through AAA)
International
Society of Travel Medicine PO Box 15060, Atlanta, GA 30333
($20.00 fee)
Traveler’s
Pharmacist: Travel Health Care Quick Reference3272 Darracq
Circle, Columbus, OH 43223 Loose-leaf binder for travel agents
Final
Note – Helpful Hints Some helpful hints for safer and
more comfortable flying:
- Don’t
smoke before, during or after your flight.
- Ask
for an aisle seat near the lavatory.
- Ask
for pre-boarding to simplify getting situated on board.
- Carry
your nebulizer on board and use in the lavatory if necessary.
- Hand
carry all medicines with you.
- Know
more about airline oxygen than the flight attendants!!
PHA
would like to thank the author, Gerene Bauldoff, RN, MSN,
and Air Supply: A Newsletter for Lung Transplant Candidates
for permission to reprint this article.
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