An Rx for Onboard Health Concerns

We’ve previously examined emergency medical charter flights in this space. But say that instead of handling an unforeseen health crisis, you simply want to bring an infirm relative to a family function, or you recently underwent surgery, experienced a flare-up of a chronic condition, or face some other non-emergency medical issue. How do these situations affect charter plans?

That depends not only on the traveler’s medical condition and history but on the aircraft, the charter provider, the flight’s duration, and many other factors, says Dr. Paulo Alves, global medical director of aviation health at MedAire, which provides consulting services to business jet operators. Yet experts agree that one bit of advice applies universally: you should talk to a doctor who’s knowledgeable about aviation medicine, which “not every physician knows about,” says Alves.

A main concern for these specialists—and you—should be the effect of lower atmospheric and oxygen pressure within the cabin. The typical business jet is pressurized to about 8,000 feet. At that equivalent altitude, “you never know how someone’s physiology is going to respond,” says Dr. Robert Quigley, senior vice president and regional medical director for International SOS (ISOS), which assists in some 20,000 transport cases annually.

For example, surgeries and even microscopic procedures leave gas inside body cavities that, until absorbed into tissue, can expand up to 25 percent at this cabin altitude. Also, a compromised circulatory, respiratory, or pulmonary system that performs normally at sea level may decompensate, or functionally deteriorate, precipitating consequences that can include death, says Quigley. And while a medically compromised individual might be able to handle an 8,000-foot altitude, “you can have cabin depressurization in the airplane at 40,000 feet,” notes Scott Delaney, director of managed aircraft services at Mayo Aviation (no relation to the Mayo Clinic). That’s a possibility that operators like Mayo, which provides both air ambulance and standard charters, need to consider.

Involve your primary caregiver (or that of your prospective guest) in the decision process. The physician can review the travel considerations listed on the websites of the Aerospace Medical Association and the major airlines. These sites explain policies on carrying passengers with medical needs and provide primers on health conditions affected by air travel.

Concurrently, discuss the situation with your charter provider. Says Quigley of ISOS, MedAire’s parent company: “One would hope that when presented with [certain] circumstances, the charter company will say, ‘We don’t feel comfortable putting Grandma or Grandpa on the plane. Have your physician tell us whether that person is fit to fly, and if so, under what conditions.’ [But depending on the provider] they may say, ‘We’ll meet you at the FBO. Let’s go.’”

The charter company may have a relationship with a medical advisory service. If not, consider locating candidates on your own—for example, via the NBAA’s website (see Medical and Human Factors Services in the site’s Products and Services Directory). Either way, the specialist will use the primary physician’s information to recommend any necessary en route accommodations. Depending on the evaluation, you could be cleared to fly without restriction; advised to have additional support, such as supplemental oxygen, extra medication, or healthcare assistants onboard; to travel via air ambulance; or told not to fly. Alternatively, some operational adaptation may be made, as in cases where “the hypoxia of higher altitude can be so deleterious, the flight has to go at sea level [meaning maintain a sea-level-altitude equivalent in the cabin],” says Quigley.

Satisfy yourself that the charter company has experience organizing the level of medically assisted flight you require. The Commission on Air Medical Transportation Systems (CAMTS) is the primary accreditation agency for air ambulance and medical flight operators in the U.S., and some states mandate that its standards be followed. Ensure that any air ambulance provider you work with has this or an equivalent accreditation.

Size and configuration of the aircraft also play a role, and bigger isn’t always better. If the traveler has limited mobility, “from a charter standpoint, it’s easier to get them on a smaller airplane that’s low to the ground,” notes Delaney. “When you get to super-mid to large-cabin airplanes, it can be quite a job to get up the airstairs.” Kelli Roth, MedAire’s nurse manager, notes that she has “had pilots take pictures of how many steps” must be climbed to get into the airplane, to confirm accessibility with travelers.

Slings and belts are available to lift immobile travelers aboard aircraft, as are narrow wheelchairs for navigating their aisles. For the ultimate in ease, charter operator Oak Air has a Challenger 604 with a lift system that can hoist a passenger in a wheelchair into the large-cabin jet.

If the traveler has to be carried aboard supine, “to get in and out [of the cabin] on a stretcher is next to impossible,” says Quigley, even on large jets. (The Pilatus PC-12 turboprop and forthcoming PC-24 twinjet with their pallet-sized cargo doors are exceptions.) Standard air ambulances like the Learjet 31 and 36 can do the job but don’t have enough room for you to bring other travelers along comfortably. Air ambulance operator Phoenix Air’s fleet includes the world’s only two Gulfstream GIIIs that can handle a supine traveler (via cargo doors) as well as multiple companions. One of the GIIIs is outfitted in VIP configuration.

Both the NetJets and Flexjet fractional programs subscribe to MedAire, which covers members when they’re in the air or on the ground during a trip, but the assistance doesn’t extend to providing medical advisory services when planning a flight, according to the companies. Flexjet finds that “typically if an owner needs assistance, they already travel with an aide,” who “assists them in climbing the airstairs and seating them in the aircraft,” says Megan Wolf, vice president of owner experience. “If needed, we can help an owner source an air ambulance as well,” she adds.

The price of medically assisted flights depends on the number and type of onboard healthcare providers required. “That’s where the cost starts going up: paying for the medical expertise,” says Quigley. The final bill can vary widely, but expect it to fall somewhere between $20,000 and $200,000. A basic London–U.S. flight could cost up to $150,000.

Given the potential consequences, consider your current state of health before every flight. “Anything that is new—fever, shortness of breath, [seemingly] trivial chest discomfort that happens only when walking fast—needs to be carefully evaluated,” says Alves.