Tuesday, February 26, 2008
Surviving an airline flight
By Dr. Sanjay Gupta
Chief Medical Correspondent

The recent story of Carine Desir, a 44-year-old woman who died on an American Airlines flight from Haiti to New York, has a lot of people thinking: Could that happen to me? Well, it could. But it's not likely and there's no reason to panic.

What happened to Desir? She reportedly complained of not being able to breathe and received oxygen, although a family member has complained that the oxygen was delayed. Doctors and nurses aboard the flight stepped in to try to help, including using an automated external defibrillator, but their efforts were not successful. The medical examiner's office said Desir died of complications from heart disease and diabetes.

But what should you be thinking about before you get on an airplane? There are times when you should rethink flying, but it's not always a simple decision. Here's how flying is most likely to affect your health and some things to think about when you're deciding to fly or not to fly.

First off, it is worth noting that two important things happen on a plane shortly after takeoff. One has to do with pressure. If you are on a small plane that flies below 10,000 feet, the plane may not be pressurized. Larger planes that fly 30,000 to 40,000 feet above the earth will be pressurized, but because of the differential, the cabin altitude will still feel like you are about 8,000 feet in the air. Most people can tolerate this just fine. The oxygenation is also slightly lower in airline cabins, again not a noticeable difference for most people.

Still, there are people who are at most risk from these changes. People who have sinusitis, pneumonia, other respiratory illnesses as well as ear problems probably shouldn't fly and will feel pretty miserable if they do, because of those pressure changes. The cavities will expand and may cause pressure and pain.

Also, if you have had recent abdominal surgery, eye, ear or face surgery, dental work such as an abscess repair, you should stay grounded. Anyone who's had a recent concussion or colonoscopy should also wait at least a day before taking to the air. Obviously, a communicable disease such as TB (like Andrew Speaker had) should preclude you from flying. Another tip: Let's say you're out skiing and break an ankle or leg. Tell your doctor you want a soft cast or splint if you are going to be on a plane. The swelling can be awful.

There are some things you should always do on planes. Drink plenty of water and lay off the alcoholic drinks. While blood clots in the legs have not been shown to be caused by cabin conditions, they can be caused by simply sitting for long periods of time, especially with your legs crossed. Get up and walk around.

You know, I was most curious about the everyday cold. How about waking up the day of a flight with the sniffles? What do you do then? There are no absolute rules here. If you are really feeling miserable, the flight will probably make you even worse. However, actually catching a virus on a plane is no more likely than catching it at sea level in crowded conditions like a bus or office space.

As things stand now, it is up to the consumer to disclose whether he or she is too sick to fly or have a communicable disease that could put other passengers at risk. Do you think the airlines should have more specific rules about people flying with an illness?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

Do you think the airlines should have more specific rules about people flying with an illness?

Sure, as long as airlines are willing to let someone with a communicable illness change their flight without penalty. Till then, I'm going to keep flying when I'm sick.
This is a comment and question for Dr. Guphta...A person with COPD of the bullus variety, should they fly without oxygen?
Upon reading about this tragic case, two points come to mind that the public should realize. Number one, defribrillators, as great as they are, are only effective for very specific heart rhythm abnormalities. Secondly, as an internist, I cannot stress enough the dangers of diabetes on coronary artery disease. America needs to become aware of heart disease and major risk factors like diabets, smoking, untreated hypertention,etc. More people die of heart disease each year than any other illness.
I think it is very important for every individual to not only take responsibility for their own health, but make responsible decisions regarding their health. This would mean divulging information about their health before traveling. However, even with this information, it should not be an airline's responsibility to monitor or become caregivers for the sick. If my relative had a heart condition and died while driving a rental car, would I blame the rental car company? It is the same with airlines. They are there to provide transportation, not give emergency room assistance. If that were the case, all flight attendants would be required to be RNs.
As a regular business traveler and former military flyer, I understand that people need to travel, but worry that we've become somewhat "pampered" in our expectations. I regularly see people flying who should not be. They are in obvious forms of frail health, injury, or are sick. Your recent experience in the jet fighter reminded us all that no matter how comfortable the inside cabin can be, the flight environment can be extremely hostile. If a medical emergency occurs, precious time will pass descending and negotiating an uncheduled landing, in addition to slightly higher risk to the aircraft. I worry that our culture of entitlement and luxury places some additional price in this respect. If you are not healthy, you should not be flying.
Simply imagine if it were not Desir, but a Senator, Governer or a celebrity? Would Dr. Gupta still write the very same blog? I doubt.
The airlines already have rules about specific illnesses. Some require a physician's certification that a passenger is fit to fly. But the airline has to know aobut the illnesses first. Privacy didtates that they cannot force someone to disclose a health condition. So the responsibility for deciding to fly or not to fly must rest with the passenger, not the airline. Moreover, the airline cannot and should not be held accountable whould a passenger have adverse reactions to flying. Flight attendants get first aid training, but they are not medical professionals. They are reluctant to administer oxyen because to do so improperly for a passenger suffering from advanced COPD can cause CO2 narcosis and death.
I was just wondering about shingles. I am currently in a very painful bout of shingles in the eye region. I have to fly, my daughter is competing in Miss Canada in Toronto and I have to fly on the 8th of March. Will that give me enough time for the nerve to settle down. I do know you can have residual pain that can last for months or years will this be exasperated also? As to the question about rules, I believe that anyone with a communicable disease that such as TB should be flagged somehow. Although I do not know how they could possibly enforce it. Colleen Hannah
An episode of "House" featured a man having pressure problems on an airplane because he'd been scuba diving the day before. Obviously a TV show is likely to overdramatize things, so how dangerous is that really?
Great information---you probably saved many lives and much pain and suffering by pointing out what should be COMMON SENSE. Thanks.
You forget to mention the risk that when you are flying, you are often at least 30 to 45 minutes away from being able to land and get hospital or emergency room care immdiately. On a trans-oceanic flight, the time to reach an emergency medical facility is going to perhaps be measured in hours.

I was on a flight once that made an emergency descent and landing for a passenger in medical distress. Even though we heppened to be near a large city, it still took 25 minutes from the time they announced the descent until the door was open and the paramedics took the person off the plane.

I am not sure what conditions might make a person know in advance that they want to stay closer to medical help (maybe 9-month pregnant women?), but it is something to think about.

- Rick
Dr. Sanjay,
What about high blood presure, is that an issue while flying? Please let us know,
thanks,
Dr. Gupta:

"However, actually catching a virus on a plane is no more likely than catching it at sea level in crowded conditions like a bus or office space."

This is blatant follishness.

Name a bus that recirculates air for 2 or 3 hours through a undercapacity system that blows air directly on the passengers head.

(On our last flight the system had not been serviced for weeks -- the pilot confirmed -- and it was spitting grey gunk on passengers for the whole 2.5 hour trip.)

Find a "bus" or "office" that has the same volume of space per person. The only thing close is an elevator and few ride them for two hours.

Find a bus seat or chair that is as uncomfortable as a "small plane" airline seat, especially for someone over 6 feet tall.

MCF
I've heard that some airlines allow passengers to bring aboard portable oxygen concentrators (not tanks), though this practice is not mandated by the FAA. In any case, should these patients be flying?
I've flown with a minor cold where all the symptoms mostly under control with OTC medicines. The flight was fine, but when we landed my ears didn't "pop" for two days. Two days of unrelenting dull earache. Ow.

My advice is to know your body and listen to it. Being a Road Warrior and traveling for my job whenever asked -- because I was "one of the team" -- didn't actually get my job done better, and made me miserable on more than one occasion.
Dr. Gupta says, "actually catching a virus on a plane is no more likely than catching it at sea level in crowded conditions like a bus or office space." It seems from my commercial flying experiences (several times a year) and those of my frequent-flyer spouse and coworkers that catching a cold a couple of days after a flight is more common than Dr. Gupta's comment would indicate. Admittedly this evidence is anecdotal, but consider this. The volume of air in an airliner is smaller than in a bus or office and that air is recirculated for several hours during the flight, both of which would give it a higher density of airborne pathogens than in the terrestrial cases.
My 7 year old son has a lot of pain/pressure in his ears whenever we fly and I remember having the same feeling as a kid and it can last for hours after the flight is over. Does anyone know of any remedies for this situation? Chewing gum has never really worked for me so I haven't tried it yet with my son. Thanks in advance.
I had a terrible sinus cold on a flight from San Francisco to Philadelphia. When we started our descent for landing the pressure in my ears was so great that pain started shooting down my neck and jaw. Once we landed I still wasn't able to pop my ears to relieve the pressure. I couldn't hear a thing either. After about an hour or so things finally got better but I definitely learned a lesson about flying when ill that day. It's not very pleasant.
Hi Sanjay,

Thanks for the article. I am a diabetic, blood pressure patient who is 31 years old. I was diagnosed about 5 years back. After reading this article on CNN about Desir's death, I am really scared to fly. I visit India once in two years. I have two questions
a) In the flight I feel that taking a deep breath which a person normally takes (natural cycle) is a little difficult for me. As of now I don't have any heart conditions. Any suggestions on how I can make myself feel more confortable.
b) In case if something happens in the flight, does really all airlines (singapore airlines, cathay pacific) carry all these oxygen and defibrillators etc?

Can I fly without any fear?
I am clastrophobic too, but somehow luckily I haven't got any anxiety attacks on flights so far.
I am really looking forward for your response.

Thanks,
SJK
Most certainly there should be rules about people flying with illness. Probably would be very difficult to enforce but there should be rules, especially if passengers raise reasonable concerns about another passenger. I am curious to know how are airlines currently going to resolve a case if several passenger think another passenger is a health risk if allowed to fly? Are the airlines going to side with the possibly sick passenger and possibly endanger everyone or the people expressing the concern?
I just had an angioplasty over three weeks ago and I plan to fly within the next two weeks. My stress test indicate I'm fine but is it safe to for me to fly so soon?

FYI I also have Atrial Fibrillation.

Thank you.
Also, if you are pregnant, even if only in your first trimester, your feet could swell severely.

I was just 3 months pregnant and on a long flight I had taken my shoes off because my feet hurt.

Five hours later on the ground, I could barely squeeze back into them.
The day before I was scheduled to leave Miami to fly back to San Francisco, I got a cold. In retrospect I should have just stayed in Miami a few days longer. The flight back was horrible and painful.
Folks also need to remember that there is no emergency room on a plane and that airline staff are trained in BASIC first aid. They are not and should not be expected to be EMTs.
What about flying during the various stages of pregnancy i.e. first, second, or third trimester?
Thanks,
Anubha
I am so excited to see something about medical conditions and flying. My 21 year old daughter is wanting to fly and she has a VP Shunt. She had a hemispherectomy at the age of 7 and has had no problems since until three years ago and she had the shunt inserted. We have replaced it twice, but this one seems to be doing the best and has functioned for a year. I have tried to get information throught the surgeons office and no one returns calls due to the fact it is not an emergency. Anyone have anything to offer? She is a college student and highly functional. She recently spent time in the mountains and had no problems.
should a boarding pass supervisor (after talking to a "doctor") over a phone have authority to reject boarding pass??
Sanjay, on your morning show several days ago, a lady cardiologist said taking fish oil was essentially worthless. I checked Medscape and there are a lot of studies showing its value. Some people don't like eating fish, but will take the capsules.
I enjoy your programs. JAS,M.D.
You would have difficulty convincing me that the airlines do not already have specific rules arbitrarily applied by flight attendants. Demands that crying babies be given Benedryl, passengers who are far from home and not allowed to board connecting flights due to neckline or skirt lengths, an asthmatic child on her way to a medical center for special treatment not being allowed to board because her breathing was 'funny' - all these stories have been in the news.
A bit of advice: If you have to fly with severe nasal congestion, whether from a cold or sinusitis, take along a SPRAY nasal decongestant. When the plane begins to descend, you will need it to relieve the pressure that will invariably build-up in your head. Without the immediate relief a spray decongestant affords, the pain from the pressure differential can be unbearable and last for days afterward. (I, unfortunately, had to learn the hard way. I flew with a cold and severe nasal congestion. On the descent I felt excrutiating pain: I burst a blood vessel in my eye and I felt like all the fillings in my teeth were being pulled out.) I always carry a spray decongestant in my carry-on.
I'm not sure I want a flight attendant telling me I'm too sick to fly. Such a determination should, ideally, be made by a physician -- even if it means going to a clinic when you can't see your regular doctor.

I've flown while sick and I don't recommend it. However, when I had to get home once, a flight attendant immediately recognized I had bronchitis; she put me in a seat at the very back of the plane, got me a couple of blankets and brought me tea -- kindnesses which have never been forgotten.
I disagree that "catching a virus on a plane is no more likely than catching it at sea level". The air int he cabin has much less humidity than sea level air, on longer flights it can lead to mild dehydration and dry mucous membranes which make you more susceptible to catching a virus.
I found the commentary very practical and professional.

I would also say that it is advisable to bandage a cut or open wound before flying.

I was an airline engineer before and when I was flying I have noticed that the cabin pressure sometimes takes finite time to recover from a sudden drop. I had noticed that the vessels in my eye were enlarged for that instance.

For the good of our eardrums, I recommend to ‘'refresh' the air pressure inside our mouse to balance it with the changing pressure in the cabin.

A veteran flight attendant once told me that,to bring the above effect, chewing gums during landing and take-off was recommended in the past days before a smooth cabin pressure control was possible with modern jet aircraft.
You gave some great advice Dr.Gupta, but I am not following you on how your advice relate to Ms.Desir. AA did a great disservice to the Haitian community, and this is just a fact.

I think the airlines should start thinking about having at least a medical technician team on every flight, or make sure at least one of their crew member is a certified MT. And most importantly, they should have working oxygen tanks on board.

Once again, they show how little they care about the Haitian people. Something like that would not happen on a flight going to or coming from Europe. It's sad.
i dont think that is really the right of the airline to decide whether you can fly or not. But a courteous person should know what to do. However, in rare cases like TB, it should not be allowed whatsoever.

davi,
saint louis
I don't think it's practical for airlines to implement restrictions on carrying passengers with an illness. Airline employees are not medical professionals, and it is unreasonable to expect them to make such assessments and enforce health policies in addition to their other duties. In addition, the enforcement of such restrictions could be seen as discriminatory and fodder for a lawsuit.

However, it would be helpful if airlines offered masks for passengers who are sick, or if you find yourself surrounded by other passengers who are sneezing or coughing, you should be able to request a mask to protect yourself.
People who fly with communicable diseases should be held open to liability, should a tort-suit ensue. The individual should be held to the reasonable person standard (i.e., would a reasonable person in the position of the passenger have known that they had the disease at the time they boarded the flight?). If a person knowingly and/or negligently boards a flight, and does in fact have a disease that spreads to other people, they should be held liable for the damages. A reasonable person carrying a communicable disease would not normally board a plane, knowing it could be passed to others, unless they were either being: 1. indifferent, or 2. careless/negligent.
Dr. Gupta,

People with lymphedema, or who are at risk of developing lymphedema, should also make sure to wear compresssion garmets whenever flying.
I don't think airlines setting specific rules for people flying with an illness would be very effective.

Many people are going to fly anyway, regardless of how sick they are. If they don't feel it's life-threatening, they will risk flying as scheduled instead of paying extra money to delay their flight. Also, people may not be willing to admit they are sick or not feeling well.
I know from experience that the airlines will charge you for changing your flight even if you have a communicable disease like the flu. The airlines do not care about the safety of their passengers enough to allow a person to delay their trip until they are not contagious.
Dr. Gupta et al.,

Thank you for your analysis of health related issues while flying. I think by imposing more regulations on people choosing to fly would be too overwhelming. We already have enough to deal with when trying to fly. Flying is similar to being in a tight Greyhound bus. You take risks by flying just like you take them before going out in public. The best thing is to follow health guidelines, be smart about your health, and understand the risks. If one could prove that certain illnesses spread under pressurized conditions then we could make a case to begin to regulate that illness when up in the air, but until that time we should not impose more regulation on passengers who already spend an inordinate amount of money to fly by placing on health restrictions.

Justin Davis
In today's cost-cutting climate, even those of us who fly frequently for business are traveling on tickets that are non-refundable or have stiff penalties for changes. I have spent many miserable hours at 35,000 feet with a raging sinus infection because, last I heard, the airlines don't accept sick notes and issue refunds!
SCUBA is a real consideration. Decompression sickness (DCS) is much more likely when flying shortly after diving.

The prudent *trained* diver will wait 24 hours. The person who did a couple of resort dives at the end of their trip could find themselves in a world of hurt.
Most major airlines DO have specific rules, and they are centered around Federal regulations pertaining to customers with disabilities -- specifically the section on "communicable diseases." I spent 18 years with a major airline, much of which was spent overseeing these regulations. It's sort of an example of "be careful what you ask for." Time was, airlines could do what they wanted, and policies in a lot of cases were customer-friendly. Then, some consumer rights folks got hold of the subject and lobbied Congress, and they passed all sorts of laws. The result was that airlines said, in essence, "Fine, if you're going to regulate us, we're going to follow the letter of the law." In some cases, like this, the customer may have wound up with the short stick.

Airlines are required to allow customers to reschedule nonrefundable fare tickets for up to 90 days without charge, or to obtain refunds, if they have certain communicable conditions, like TB, SARS, Measels, or Chicken Pox. They are NOT required to do so for conditions like the flu, mono, strep or the common cold.
Thank you for the thought-provoking article, Dr. Gupta.

After four, miserable, practically sleepless months, my wife has finally (almost) recovered from a full-blown case of pertussis (whooping cough). Unfortunately, the positive confirmation of the disease was too late for her to have benefitted from antibiotics. She suffered through the disease, breaking several ribs from the persistent, severe coughing. I also caught the bug, but managed much better.

After several days of trying to tract down where she may have contracted the disease, the answer became all too apparent--it was on a small commuter flight where she was sitting next to a woman who was coughing almost uncontrollably. With an incubation phase of (usually) 3-12 days, it is the only place that she had been within that time frame where she was around an obviously sick person--or in any large group whatsoever (she works out of our home). Furthermore, although she did not realize it at the time, the woman's cough was the eerie cough of a pertussis patient--a cough with which she and I have become all too familiar.

As responsible adults in our early 40's, we take extra care to minimize the chance of spreading communicable diseases to others. We have rebooked air flights on several occasions when we thought one of us may still be contagious from a disease. I never go into work when I think that I may pass an illness on to my colleagues (and, hence, indirectly to their families). This woman's behavior was reprehensible. It was irresponsible for her to put other people's lives in jeopardy.

If mature, adult passengers who are obviously sick cannot take others' health into consideration when traveling, then the airlines will have to do it for us. That woman should not have been let on the plane. How many other passengers on that flight have suffered? Hopefully none of them had newborn babies.
Yes, Dr Gupta, you said absolutely nothing regarding flying for those of us with emphysema or C.O.P.D. I realize that if we are along pretty well with this we would need prescription for oxygen on the plane and that can be expensive. my doctor wants me to use oxygen at 1000 ft at if in a car but said nothing about in a plane - please elaborate. Thank you
ON a recent work trip, I had sudden onset of fever and headache at the airport. I asked a pilot friend if he had any suggestions on flying while feeling awful and he said that there is actually a Dr. on site in some airports and that there was possibly a pharmacy/ CVS type store with an on call Dr. in others. I couldn't find a Dr. or clinic at the airport where I was...do you know if such Drs./ clinics exist at airports?
It made me a little uncomfortable to read that the crew (of the flight the woman who died took) were "following the airline's policies". I would rather they used their heads and acted more quickly instead of thinking that they "don't usually need oxygen for diabetics". It would be a smart move to have an RN on every flight, who could quickly evaluate a situation and not go by a company rule book.
I think a few things need to change. First, airlines or the FAA needs to define when a passenger can and can't fly and publish that. Second, if the passenger can't fly and a doctor has verified it, the airline should return the passengers money or rebook them. If they don't, people will not be truthful.

And third, airlines should do much more in terms of training and supply for people that do get sick. Not everyone can predict when they will be ill, and since you are cutoff from other help, the airline should step in.
I have Diabetes and I take blood pressure medicine. I am a retied military pilot and I would not fly aboard a commercial plane, because of the altitude/low volume of air psi. Looks like a Law Suit 101 in progress!!!!
I think airline should specify some rules. The inconvenience of a sick passenger unable to catch a flight is a small price to pay for the well-being of the other passengers around her.

I recently caught a virus from a passenger who was not at all considerate about covering her mouth when sneezing and coughing. And was bent on making her distress over the slight delay known throughout the cabin by deliberate long and loud sighs that propelled more of her germs into the surrounding air.

As a result I have been unproductive for the past week trying to recover - which is probably what a few other passengers are doing too.

I had such a horrid experience with that airline, everytime I see its logo, I cringe. I'm definitely avoiding their planes as far as possible even though I know it's not their fault.
If most passengers feel the same way, I think its wise and economical thing for airlines to be clear about its rules about illnesses.
I don't think it should or practically could be the airline's responsibility to determine if a passenger is fit to fly dues to illness. People should be smart enough to know that they should not fly if they will be in need of emergency medical assistance. Of course, no one knows WHEN they will need it, but if one has a pre-existing condition that greatly increases their risk, it seems like common sense not to put his or herself in a situation where they will be without proper care. Expecting the flight to have a medical team is impractical and to put it frankly, the plane is not a hospital. They should not be required to give care in an emergency. They are trained in BASIC first aid and I think that is sufficient.

I agree with the statement that our society has become spoiled and more inconsiderate than ever. You don't HAVE to fly. It is not your right. This is ESPECIALLY true if you will be putting others at risk because of your selfish want to travel. Personally, if you miss Christmas with the relatives and I and other passengers don't die from TB, I'm OK with that. Once again, it is the passengers responsibility to protect themselves and others from any sort of dangerous situation that is well within their control.

The previous comment that the airline did the Haitian community a disservice is pure ludicrous. I HIGHLY doubt she was not helped immediately because she was Haitian. If it was white person, I would not have seen this situation as a disservice to all white people. I'll bet last time anyone checked, AA did not have a policy saying Haitian Passengers are second class people.

One last point. Airlines should make it easier to change flights due to illness. With a note from a medical professional confirming illness, a flight should be refunded or re-scheduled without charge. This would show the airlines really do care about the people they transport.
While I beleive that it is selfish and mean-spirited to fly while sick with a communicable disease, it is equally selfish and mean-spirited for the airlines to care so little about their passengers and their staff that they would allow it. Since you cannot rely on anyone else to make the proper decision, just do what you can to be as healthy as possible and avoid flying during cold and flu season.
Dr. Gupta's commentary is responsible and appropriate. To those who comment that it is disrespectful to Haitians or it happened because she was not a politician, get the chip off your shoulder and educate yourself. His commentary is self-explanatory in simply saying this awful tragedy has started people asking questions about whether they should fly or not. His repsonse was to the latter only. He simply offered tips for knowing when to fly and in no way disparages any race or culture, or says this lady deserved this. Her death was the result of health issues and not the lack of care from airline personnel, who are not doctors and shouldn't be expected to save lives. The problem with those of you commenting otherwise is lack of accountability. While it is a tragedy she passed on, it is not AA's fault. If you want flights with doctors aboard, be prepared to pay dearly! Better yet, maybe you can talk AA into taking that Medicaid Gold Card next! And the rst of us will work and pay our taxes so you can get welfare for not working. And you can fly free!
I fly with an FAA approved portable oxygen concentrator and have flown from the US to the Netherlands, Switzerland and Guatemala. I'm flying to Ireland this Spring. I have also flown a lot within the US. There is an FAA required form that must be filled out by a physician before anyone can fly with an FAA approved portable oxygen concentrator.

I think I am less at risk than many passengers because I know my physical condition and take steps to assure that I am safe to travel by air.

A portable oxygen concentrator has given me the ability to have the freedom to live my life to it's fullest potential. I hope more airlines will permit the use of portable oxygen concentrators.
The airlines (at least the one I work for) has definite guidelines about flying while ill. However, as someone else has said, the passengers have to be willing to admit when there is a problem. I have had several easily avoidable medical situations while working due to people refusing to wait one more day to fly. The captain has the right to deny boarding to anyone he determines is not well enough to fly. But in such a litigious society, it's hard to do so without extremely obvious symptoms. Bottom line is, don't fly if you are sick! It's bad for you, the other passengers, and worse the crews that have to deal with groups of sick people all day every day, and then have to face a very very strict attendance policy that threatens their job.
There is no reason for airlines to have an illness policy. However, I do feel that airlines need to be equipped with proper functioning medical equipment and trained personnel. What if there are no doctors or nurses present on a flight? Are passengers stuck with hesitant flight attendents with minimal training in emergency medicine? I remember reading the first press release on the tragedy in which it spoke of two empty oxygen tanks and a malfunctioning AED. It seems as though the leak this information might scare the public, hence the reason its no longer available on your website. Only cover ups from the airlines saying their personnel are well trained and that the equipment was in good order. Instead of showing integrity they decided it would be easier to find a few well-known professionals and advise the public to not travel if they are sick, because we are incapable of helping you mid-flight.
To All,

from a flight crew's point of view.. Everybody certainly has to be responsible about their own health. Airplanes are cramped spaces and inflight emergencies, which are often health-, are difficult to deal with. When airlines started in the 1920's, stewardesses were actually nurses, to help passengers deal with air sickness. These days, Flight attendants get basic first aid training, and we as a crew will rely on healthspecialists on board, when they identify themselves.

When a crewmember discovers a sick individual on board, who they think should not be flying, the decision is up to the captain to remove this person.

Feng, your point about the celeb-person.. as a crew we will not differentiate. I as a captain will use all means to make a decision about where we will land, pitstop or intended destination. This does take at least 25 minutes, AFTER the decision is made (not from discovery)

Scuba diving before flying can be a dangerous thing, the pressure differences will create "the Bends" and can kill you.

E M Risse wrote about recirculating air. Most mediumsized airliners actually refresh air constantly, by taking air from the outside and pump it into the cabin. Bigger airliners do recirculate, but in the future planes will be built so air is refreshed constantly.

Catching more airborne diseases while flying : if that's the case then crews should be constantly sick, or be super(wo-)men. Since we are not the latter, I believe it all depends on proximity to a person with such a bug.

Colleen mentioned a few examples of rejected passengers. While these all sounded silly, sometimes as a captain you are asked to make "medical" decisions. You do so with all available tools, like operations, dispatch, common sense, and a service called Medlink, where doctors can advise us inflight or on the ground how to best handle the medical situation. The captain will always lean towards a conservative choice, since safety comes first in our line of work.

Hope it helped.
To the person that wondered what to do to help a child with ear pressure, a very good trick is the valsalva method. To do this hold your nose shut and try to exhale forcefully out of your nose at the same time. This is a great way to get the "pop" ears make if your ears do not do it naturally. It is more commonly a problem for children because their eustachian tubes that run into the ears are more narrow. This is also a great technique whenever congestion leads to that annoying fullness in your ears- that is why it is great also for people with colds--especially on a plane.
I personally think that airlines should be required to have a nurse on every flight who can make medical decisions in the event of an emergency. You never know what's going to happen up there and having an in flight nurse could save a lot of lives, especially if they are going to have a difficult time getting someone to a hospital.
Just a nitpick on the article: It may be that some airliners are pressurized to the equivalent of 8000 feet, but it seems to me that it's probably pretty rare. I've been told that the number varies near 6000 feet, and on the few occasions that I've taken my GPS (it has a barometric altimeter) on a plane, the pressure in the cabin at cruising altitude usually settles around the equivalent of 5500 ft.
The day before a co-pilot on some other airline died inflight in the cockpit. Fact is we all die and die someplace, if you get on a plane while sick and you die, you die,,and you hope you dont have relatives that think they can blame an airline and cash in on it,
Yes, the airlines should adopt a criteria for who can and cannot fly due to a medical condition. I’m a paramedic at an international airport I respond to call for passengers who should have stayed home, the altitude made their condition worse. The passenger cannot get the medical help they need because the aircraft can’t pull over at the nearest cloud and let them off. It will take at least 30 – 45 minuets to get the aircraft safely on the ground. My solution (take a train)and stay off the aircraft.
Not all passengers needing medical help have chronic illnesses or know they are sick before boarding a flight. My brother had a stomach ache on a trip to Hawaii, which became a full blown appendicitis on his flight home. The flight attendant ignored his requests for help, and he literally crawled off the plane to an airport payphone where he dialed 911. His appendix burst just as it was being removed during emergency surgery. The delay in getting him to a hospital was the inexcusable fault of the airline. I hear more and more similar stories all the time. When an airline takes your money for a flight, they are responsible for helping with any medical emergencies that happen during the flight. Its not like you are home and can call a doctor or 911 for help.
As an occasional flier, and a congestive heart failure patient, I have a different perspective. A person who has a KNOWN illness bears the responsibility to consult their physician about the risks of flying in a high-altitude flight. If your doctor does not give approval, and you fly anyway, what happens does become your own responsibility. An airplane is not a hospital. Your health is your own problem, not the airline staff's.
Maybe because I'm a flight attendant, or maybe because I'm just more realistic, but no one should fly when they are sick. There are actually other modes of transportation that could be safer if someone is sick. Fligh attendants aren't nurses or doctors. And I would like to add to the discussion about everyone ALWAYS getting sick after flying...I fly up to 4 international (6+ hrs) per week and I'm never sick. And people try to hand me their nasty kleenex all the time. Why not try washing your hands like I do? Apparently all the research is right because I'm never sick.
The vast majority of air travel I do is for business meetings that I would much rather be handling over email or telecon.

Imagine how much suffering, money, energy, and productivity could be saved if the average executive were half as tech-savvy as the average teenage World of Warcraft player.

Face-to-face contact is overrated (and a health hazard too).
To the person questioning flying after SCUBA diving-
That is extremely dangerous. The pressure problems Dr. Gupta was explaining you encounter while on an airplane apply to diving as well. Your body needs about 24 hours to adjust, technically decompress, from the pressurized air inhaled during a dive, especially a deep dive. For the same reason you should never ascend from a dive quickly, you should never fly immediately.
There is reference to staying grounded as a result of recent surgery. How long after cataract surgery should I avoid flying?
In response to those who experienced pain in their ears from flying, here was my solution. The first time I flew commercial, I was an adult and as soon as we began the initial descent, I experienced shooting pain in my sinus, jawline and base of my neck. Chewing gum at this point did not help and I was nearly doubled over in pain. Since that trip, I take 2 OTC non-drosey sinus relief medications before takeoff and depending on the length of the flight, 2 more while en route. This combined with forced yawning during the descent makes flying tolerable for me.
It is untrue that the air inside of the pressurized cabin of a commercial aircraft is recycled over and over during a flight. This is something that people have somehow picked up and believe to be true. It's outside air drawn from the engines, cooled, filtered, and then blown into the cabin. It is very clean, but unfortunately it is also very dry, a lot like climate-controlled office space, doing a number to the moisture in the membranes that are your first line of defense against viruses. This is one reason why it is very important to try to stay hydrated on a flight.
The dry recycled air plays havoc with my sinus problems. With my doctors suggestion, I finally resolved this with extra doses of Sudafed. This decongestant also helps those whose ears will not "pop" from chewing gum and such.

I take a dose an hour before my flight and another dose when I get on the plane. I take another dose every 2 to 3 hours of flight time. This has put an end to my sinus and ear issues. It will however give you dry mouth, so drink plenty of water on board.
For those wondering about traveling while pregnant, this I have experience with. No matter what trimester you are in you should always and I mean always discuss with your Dr about the flight before hnd. Also scope out emergency rooms where you are going and ask you dr if there is anyone in the city you are going to that they would recomend. If not then contanct a Dr there, especially if you are staying for longer than a few days, so that shoudl anything occur you know where to go and who to contact to get the best care. Especially if you are in your third trimester this is extremly important in fact some Dr's will not recomend a woman in her third trimester flying at all the closer to the delivery date the less comfortable they will feel about flying in general. Even in the begining stages of pregnancy you could experience feet swelling, more than usual t times mildly painful, discomfort in your legs and possibly even feel as though you are having very mild cramps emphasis on very mild. It should feel similiar to having a belt pulled one notch too tight. Some airlines will not even let a woman who is very close to her delivery date, this is especially true on long flights, unless she has approval of a Dr and even then they can be reluctant. The best advise that anyone who is questioning if they should fly whether it's because of pregnancy or illness, is to call your DR! There is no single standard that excludes people from flying, however your Dr may feel that with your medical history, current condition, or anything else you should stay away from flying for x amount of time. Dr Gupta's blog while highly informative and great that it brings issues to the minds of the average person is not a replacement for a Dr's advise who is familiar with your particular medical history.
Airlines could easily ensure there is a medical technician on the crew of every flight, IF we're willing to pay significantly more for our tickets. However, we want the cheapest tickets possible, so we have no reason to expect that we will receive emergency medical service. Either way, there were doctors on board this flight who assisted the dying individual, but unfortunately, they were unable to save her.
It's silly to think airplanes should carry advanced medical equipment - do you carry those items in your car when you go on a long trip? If you don't, then you can't expect them to be provided for you by an airline.
If you have heart problem, pulmonary, as(h)thma or weight problem you should start insisting on you oxygen saturation being tested everytime your blood pressure, and weight is checked at your MD's office.

I survived an on-air pulmonary crisis ONLY because I have my own Pulse/Oxygen meter and permission to carry my own oxygen convertor.

My heart goes out to this woman because I know she was in pain and terrified.

You can NOT assume anyone will assist you if this happens to you. The woman in the isle seat next to me shoved face and eyes with a magezine while I struggled to turn my machine high enough to bring my o2 sat back up from 70. She did not look at me for the rest of my flight.

As far as the medical community, my pulmo chastised me for even ASKING for permission to take my convertor on the plane with me.

Refused to give me the letter, while still guaranteeing my safety. If I had know the danger, I would have brought an extra battery. My battery died quickly after changing my ltr flow from the 1.5 he instructed me to use to the 5 ltrs it took to get my o2 up to 82 for the rest of the flight.

I have never in my life been so terrified. Or have ever felt so alone. I knew that I was ON MY OWN!!! If I didn't act quick I was going to die. Very painfully.


If I hadn't brought my own o2 concentrator I would have died.

I wonder if Ms. Desir would have died if she had offered to pay the $100 dollars per tank the airplanes charge.

I wonder what the media response to this would have been if she been anyone onther than a middle aged woman of color?

Peace & Thank you for keeping us informed Dr. Gupta. The world is a much better place for having you in it.
The Captain of an airliner has the final authority as to the acceptance of any passenger on his or her airplane. Evaluating a passenger's health condition may be necessary and is done by consulting with medical professionals, however the ultimate decision still lies with the Captain.

Passengers using oxygen concentrators or in the last week of pregnancy are required to possess a letter from a doctor authorizing them to travel. Those with contagious diseases are dealt with on an individual basis and may be denied boarding.

Finally, the myths about recirculated air contained in other comments here are at the very least half-truths. Recirculation systems utilize fans to move some existing air (usually up to 50% of total flow) through the ventilation system. This air is not trapped, but rather still continues to flow out of the aircraft as new air is introduced from the engine bleeds.
I'm a medical professional, and have been called upon several times to help people who had no business flying. One gentleman had a tracheostomy but neither he nor his companion knew how to care for it or clear secretions from it. Once a lady took her husband who had a brain tumor on the flight. The gentleman's brain swelled and he became very ill. In both circumstances the passengers and their travel partners were quite indignant that the medical equipment they needed wasn't available. The bottom line is this: when you fly, YOU are responsible for your health. You may luck out and have medical professionals on the flight, or you may not. The plane has basic first aid supplies and a defibrillator (that only works in certain heart rhythms). Be smart about your health when you travel, and stay home if you shouldn't be flying. Your life may depend on it.
The only problem with starting to screen passengers for illness based upon an airline employee's assessment or the discomfort of another passenger is the potential for it turning into a witch hunt. I am HIV+ and bipolar and take a number of prescription drugs. If someone saw my medications they could draw some unwarranted conclusions and I would be escorted off a flight unjustly. For that matter, if someone found out that I am HIV+, I have run into a LOT of people who had NO idea how it was transmitted and would think they were at risk for breathing the same air as me! Slippery slope folks!
I flew recently with what turned out to be the Flu. I was OK when I arrived at the airport on my return trip home. I had a cough that day which escalated to chills and fever by the time the delayed flight arrived in Atlanta. I felt bad and tried to minimize my spread of germs, but it is not possible given the tight quarters and shared blankets, etc. I would have at least liked to have had a surgical mask to wear and dispose of instead of coughing into a used blanket I had wrapped up in. I pity the next person who used that blanket!

Mike
Atlanta, GA
Although flying while ill is inconvenient and uncomfortable, oftentimes it seems that the illness may necessitate the travel. I once came down with an extended case of bronchitis, sinusitis, and whooping cough (simultaneously) while at college and then on spring break. Although I felt completely miserable on the flight home, I truly needed to fly home to my family to get the care I needed.

However, one must make the tricky distinction between feeling miserable and flying anyway--possibly to get the care they need, and recognizing a potentially life-threatening condition and staying off the plane.
A well-written article, but it did not address the issue of babies. At what age are babies immune systems sufficiently developed for travel on planes? I see very young infants on planes and wonder if it is harmful to their health to be on crowded planes.
Just looking at the woman's picture, I would have diagnosed metabolic syndrome: diabetes with cholesterol problems. Assuming acute myocardial infarction, so there was nothing that could have been done by anyone on board that plane to save this lady. Prayers to the family.
I have heard that air quality in airplanes is worse now than when they let people smoke because the airlines changed how the system circulated the air, probably to save money. Another thing--my 8-month pregnant daughter had to get doctor's permission to fly to her grandfather's funeral. A late pregnancy is pretty obvious. People, like Mr. Speaker, can get on a plane with anything that doesn't show. Well, just wear a face mask, I suppose, to be safe.
I recently flew back to the US on extremely short notice - my grandmother had died. Not being independently wealthy, I bought the least-expensive round trip I could find (cheaper than any of the "bereavment fares" offered by several airlines, by the way) - no changes allowed.

I got sick while home - sinusitis. However, it was going to be tremendously expensive to change the ticket, so I decided to suck it up, use saline rinse every few hours, and hope for the best. It wasn't as bad as I thought it would be.

Yep, selfish of me, but selfish of the airline, too. I did not expect to be permitted to change for free, but think that just having to pay the normal (ridiculous) change fee of $200 plus show a doctor's letter would have been in everyone's interest.
"I recently caught a virus from a passenger who was not at all considerate about covering her mouth when sneezing and coughing."

There is absolutely no way to determine if you, in fact, "caught a virus" from this person. The virus that causes the common cold is ubiquitous. Your chances of catching it from your seat mate are as likely as catching it from the slob who sat in your airplane seat before you and didn't use proper hygeine before unlatching his or her seatback tray after sneezing into his or her hand.

And how is the airline to blame for a fellow customer having a cold? Air travel is akin to a bus with wings. Would the MTA be responsible because you got a cold after riding the NYC subway?
this is directed to collen, the woman who has shingles and whose daughter is competing in a beauty contest, and wants to know about flying while ill... it is the absolute height of arrogance and borders on criminal to insert yourself into a closed group while sick with any infectious disease. shingles is more than 'just' a painful situation... for anyone whose immune system is at all compromised, it can be a death sentance. and, for pregnant women, it's a horror. if the woman is exposed, in her first trimester, the baby WILL have birth defects. if she's exposed in the third trimester, she is very likely to develop the disease in her lungs, which can, and frequently DOES, kill.

we frequently balance our needs over that of society... however, to risk killing and/or maiming people so you can see your daughter compete in a beauty contest is the height of ugliness.

if you must go while, drive. it contains the infection to your own space, in your own car.
The other day I flew back home from Colorado and the passenger beside me, at the end of the flight, goes " Oh and not to worry you or anything... But I've had pneumonia since December but I've been on antibiotics. I was actually rejected from a flight earlier in the day." And I sat there thinking to myself... OH MY GOD who let this fellow on? They should put them in a quarantined section together. Yuck! :(
Interesting, but how does this differ for children, and infants?
I have a question regarding recent abdominal surgery and flying. I had a partial hysterectomy (tubes & ovaries removed) and am thinking about flying. It will be 3 weeks post-surgery, is that a good/safe amount of time? I asked my Dr this question 6 days post-surgery and he did not have any concerns. Let me know your thoughts please. Thanks
People are going to fly even when they're sick. Business people especially, can't let a cold get in their way. What would be very smart for the airlines though would be for them to offer inexpensive masks to those that 1. are getting sick or are sick and 2. For those that are well and wish to decrease their chances of catching something because of the close-quarters found on an aircraft.
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