Commercial Flight Travel
Patient Transfer

Commercial flight travel entails a number of physiological effects on passengers.
It is important to be aware of the changes happening especially in cases of patient so as to adjust the oxygen and medications to compensate for the changes happening during travel in Commercial flights.

Our Medical escorts are aviation trained and understand these changes and are trained to take steps to keep the patient stable and comfortable during travel.

Pressure changes
During take off and when the aircraft is climbing, a reduction in cabin air pressure causes gases to expand. Trapped gases can expand more than 25% compared to sea level. When the aircraft descends, the volume of gas decreases. Trapped air in areas of the body such as the sinuses, ear and bowel can cause discomfort.
To lessen the effects of this pressure change on your body, avoid carbonated beverages and gas-producing foods like beans and cabbage, and avoid sleeping during the last hour or so of your flight so that you can yawn, swallow, or 'pop your ears' to equalise the pressure as the aircraft descends.
The risk of problems with ears and sinuses greatly increases if you are congested or ‘blocked up’ due to a cold. You should consider delaying your flight if you are sick or discussing with your healthcare provider as decongestant medication may also help.

Digestion
Digestion slows down when the body is inactive, so eating lightly will make for a more comfortable flight. It is also best to avoid excessive alcohol and caffeinated drinks such as coffee and tea, as these drinks act as diuretics which increases the need to visit the toilet. Instead, drink juices and water frequently to maintain proper hydration.

Mobility

To stay refreshed during and after a long flight, try performing these in-seat exercises—which can also be found in your inflight magazine—every few hours:

• Feet circling: circle your feet at the ankles, 20 times each foot.
• Bottom lifts: lift one buttock off the seat, tightening the muscles on that side. Hold to the count of 5. Repeat each side 5 times.
• Knee presses: press the knees and thighs together and tighten buttock muscles. Hold to the count of 5. Repeat 5 times.
• Back presses: press the small of your back into the seat, letting your shoulders come forward. Alternate with pressing your shoulders into the seat. Repeat 5 times.
• Shoulder circles: with arms at sides, circle shoulders forwards 10 times and then backwards 10 times.
• Head circles: slowly circle your head in one direction and then the other. Repeat 10 times.
• Foot presses: lift heels and press toes into the floor, then lift your toes and press heels into the floor. Do this 10 times for each foot.

Motion sickness

Motion sickness is caused when a body’s sense of balance doesn’t match what is being seen, and may worsen during air turbulence. If you are prone to motion sickness, we recommend that you:

• Request a window seat over the wings
• Avoid alcohol before and during the flight
• Avoid dehydration by making sure you drink enough water before and during the flight
• Eat small, non-spicy meals
• Wear loose fitting comfortable, cool clothing 
• Keep your eyes fixed on the ground, sea or horizon if the weather is clear
• Concentrating on an activity and keeping your brain active (but avoid reading if this tends to make your symptoms worse) 
• Locate the air sickness bag when you take your seat and keep it close at hand
• Discuss the use of appropriate medications with your doctor. There are also many over-the-counter preparations that can be used.

Ventilation and Humidity
Our modern aircraft are quiet and comfortable, with excellent levels of ventilation. The rate of air change in the aircraft cabin has been shown to be better than office buildings and trains and is comparable to that seen in hospital operating theatres.
In addition, all Emirates flights are non-smoking, so the level of airborne pollutants is far lower than on most city streets or buildings. Fresh air is constantly added to recycled air through very fine filters (HEPA) to remove 99.997% of all dust, viruses, fungi and bacteria.
However, the air in the cabin has low humidity levels, which can cause mild drying of the skin, nose, throat, and eyes. To minimise the drying effects, you should:

• Avoid alcohol and caffeine drinks
• Remove contact lenses and wear glasses instead during your flight
• Use a moisturiser to hydrate your skin.

Deep Vein Thrombosis (DVT) occurs when a blood clot forms in the lower leg. It is not dangerous unless the clot breaks off and travels to the lungs. Immobility is the biggest risk factor for DVT and it can occur after car, bus, rail, or air travel or even after sitting in a cinema.
In fact an international report by the World Health Organisation (the WRIGHT report) showed that there is no increased risk for healthy travellers from flying compared to immobility of the same duration from other forms of transport. Follow this general advice for inflight comfort and reduce the risk of developing DVT:

• Wear loose and comfortable clothing.
• Place your luggage in the overhead bins rather than under the seat in front of you. This will allow you to stretch and periodically exercise your feet and ankles.
• As immobility is a major risk factor in DVT formation, it is advisable to do the recommended in-seat exercises regularly and, if safe to do so, to walk around in the cabin every 2-3 hours.
• Keep well hydrated with regular intake of juices or water and avoid alcohol and caffeinated drinks.

Deep Venous Thrombosis
Deep Vein Thrombosis (DVT) occurs when a blood clot forms in the lower leg. It is not dangerous unless the clot breaks off and travels to the lungs. Immobility is the biggest risk factor for DVT and it can occur after car, bus, rail, or air travel or even after sitting in a cinema.
In fact an international report by the World Health Organisation (the WRIGHT report) showed that there is no increased risk for healthy travellers from flying compared to immobility of the same duration from other forms of transport. Follow this general advice for inflight comfort and reduce the risk of developing DVT:

• Wear loose and comfortable clothing.
• Place your luggage in the overhead bins rather than under the seat in front of you. This will allow you to stretch and periodically exercise your feet and ankles.
• As immobility is a major risk factor in DVT formation, it is advisable to do the recommended in-seat exercises regularly and, if safe to do so, to walk around in the cabin every 2-3 hours.
• Keep well hydrated with regular intake of juices or water and avoid alcohol and caffeinated drinks.

Some people are more likely than others to develop DVT. Known risk factors associated with DVT are as follows:

• Age greater than 40
• Recent major surgery or injury, particularly affecting the lower limbs or abdomen
• Recent immobilisation for a day or more
• Previous personal or family history of DVT
• Blood-clotting disorders
• Certain forms of heart disease
• Previous history or current history of malignant disease
• Hormonal treatment including the oral contraceptive pill and hormone replacement therapy
• Pregnancy
• Smoking
• Obesity
• Varicose veins

If you have any of these risk factors, you should seek advice from your doctor before travelling and discuss the following possible medical precautions:

• Use of anti-embolic stockings or flight socks 
• Anti-coagulant medication or other prophylactic measures before flight.

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Guidelines for Medical Travel on Emirates

Allergies: passengers don’t need to complete this form to request a special meal for their flight. (Please note we can’t guarantee peanut-free meals.) However if the passenger has a life threatening food allergy that may require treatment in-flight – particularly if they react to the presence of traces of food in the air – this form should be completed.
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Asthma: medication for asthma must be carried in cabin baggage. As nebulisers require their own power source, spacer devices used with an inhaler are an effective onboard alternative.

Escorts: medical escorts should ensure that they have all appropriate items for the proper care of their patient, and are responsible for attending to all aspects of their patient’s needs. Due to food handling regulations, cabin staff can’t assist with these needs.

Fractures: all new long bone fractures and full leg casts require a medical certificate. Casts must be at least 48 hours old. Plasters should be split for fresh injuries (48 hours or less), which could swell inside the cast on a long flight. Unfortunately extra legroom for leg elevation isn’t possible in Economy Class; however, an aisle seat can be reserved. Please state whether the injury is on the passenger’s left or right.

Inflight care: please note we don’t provide nursing attendants; our cabin crew are only trained in first aid.

Lung or heart disease: cardiopulmonary disease which causes dyspnoea on walking more than 100m on a flat surface, or has required oxygen in hospital or at home (or in flight previously) may require supplementary oxygen. The aircraft oxygen is for emergency use only. Serious cardiopulmonary cases as well as those requesting continuous oxygen, a stretcher, or an incubator should enclose a recent detailed medical report with the medical certificate. (A copy of a specialist or hospital referral should be sufficient.)

Physical disabilities: if the passenger only requires a wheelchair as far as the aircraft door there is no need to complete this form. Note: Civil Aviation Rules require all passengers to be able to use the aircraft seat with the seatback in the upright position.

Terminal illnesses: passengers in the advanced stages of terminal illness will normally require a medical or nursing escort.