Preflight Medical Screenings of Patients: Analysis

Over 80 percent (911) of the patients were using prescribed medications (Table 2). Approximately 40 percent of the patients were using one or two bron-chodilators (aerosol or tablet), ranging from one to four types in all groups, except for the nonpulmonary group (range, none to one). Oral corticosteroids were used by 192 (21.5 percent) patients in the oxygen group and 7 (13.7 percent) patients in the other pulmonary group. Cardiac medications (especially for congestive heart failure) were used frequently in both pulmonary groups. The patients in the nonpulmonary group used antibiotic, cardiac, and antiseizure medications most frequently. The majority of patients (655 or 73.4 percent) in the oxygen group already were receiving oxygen therapy either continuously (50.1 percent) or intermittently (23.2 percent), such as during exercise or sleep. Twenty-eight patients (21 in the oxygen group) had a permanent tracheostomy, and 11 patients used a transtracheal catheter. Two thirds of the screened patients had flown previously (Table 3). Most patients (650 or 72.8 percent) in the oxygen group had flown previously and within the prior 2 years (59.4 percent), although only 224 patients (25.1 percent) had done so with supplemental oxygen. Forty-six patients recalled flight-related dyspnea without supplemental oxygen. Approximately 90 percent (1,011) of all screened patients were “cleared” for transport, including 92.4 percent (824) of patients in the oxygen group (all of whom received in-flight oxygen therapy). The remaining 104 screened patients were refused transport due to an unstable medical condition, physician refusal, or policy violations (eg, requests for in-flight stretcher use or intravenous therapy). In-flight oxygen therapy was determined by review of ground-level oxygen requirements, resulting in in-flight flow rates which were generally increased by at least 33 percent. Oxygen was supplied by nasal cannulas (88.7 percent), face mask, or trach collar at the mean (and median) flow rate of 3 L/min (range, 0.06 to 8.0 L/min). Most patients (62.2 percent) were traveling with a relative, and 37.8 percent had booked return flights.
Patients in all groups had two (mean and median values) flight segments (range, one to four), requiring a median number of one plane change per patient (range, one to three). The durations of individual flight segments and of the entire flight per patient were comparable across the three groups. The total duration of flights in the oxygen group averaged 236 min (median, 211 min), with a wide range (35 to 955 min) (Fig 4). A second, third, and fourth flight segment was present in 436, 89, and 10 flights, respectively. The layover time in 430 flights averaged 87 min (median, 63 min; range, 22 to 1,440 min). The layover time in 130 flights without aircraft change averaged 54 min (median, 45 min; range, 20 to 224 min). Twelve patients in the oxygen group flew to a destination which was at an elevation of more than 5,000 ft (more than 1,529 m) above sea level, whereas 78 patients flew from a departure city which was at an elevation of more than 5,000 ft above sea level to a destination which was less than 5,000 ft above sea level.
The medical outcomes of the patients who were cleared for flight were not wholly available. However, randomly selected respiratory patients using in-flight oxygen (41 patients) or no supplemental oxygen (3 patients) were informally surveyed shortly following their flights. Adverse health sequelae during and after flight or technical problems with the on-board oxygen units were not reported. Four patients, however, reported that oxygen was initially not available despite preflight arrangements, and another patient was apparently unable to use her oxygen while in the lavatory. In addition, 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 diversion (S. Whitehead, oral communication, August, 1992).

Table 2—Medication Use of Patients Undergoing Preflight Medical Screening

Oxygen Group (n = 892), No. (%) Other Pulmonary (n=51), No. (%) Nonpulmonary (n = 172), No. (%) Total (n= 1,115), No. (%)
Patients using medications* 755 (84.6) 37 (72.5) 119 (69.2) 911 (81.7)
Bronchodilators 388 (43.4) 22 (43.1) 6 (3.4) 416 (37.3)
Corticosteroids
Oral 192 (21.5) 7 (13.7) 10 (5.8) 209 (18.7)
Inhaled 79 (8.8) 4 (7.8) 2 (1.2) 85 (7.6)
Cardiac medications 404 (45.3) 9 (17.6) 20 (11.6) 433 (38.8)
For angina 71 (7.9) 4 (7.8) 6 (3.4) 81 (7.2)
For congestive heart failure 266 (29.8) 4 (7.8) 6 (3.4) 276 (24.8)
For arrhythmia 48 (5.4) 4 (7.8) 3 (1.7) 55 (4.9)
Anticoagulants 55 (6.2) 1 (1.9) 4 (2.3) 60 (5.4)
Antibiotics 120 (13.4) 4 (…) 21 (12.2) 145 (13.0)
Antiseizure medications 26 (2.9) 3 (5.8) 20 (11.6) 49 (4.4)
Preflight oxygen therapy 655 (73.4) 2 (3.9) 0 657 (58.9)
Continuous 447 (50.1) 0 0 447 (40.1)
Intermittent 206 (23.3) 2 (3.9) 0 210 (18.8)

Table 3—Prior and Upcoming Flights in Patients Undergoing Preflight Medical Screening

Flight History Oxygen Croup (n = 892), No. (%) Other Pulmonary (n = 51), No. (%) Nonpulmonary (n = 172), No. (%) Total (n = 1,115), No. (%)
Prior commercial flight 650 (72.8) 31 (60.8) 80 (46.5) 761 (68.2)
Flight within 2 yr 530 (59.4) 23 (45.1) 66 (38.4) 619 (55.5)
With supplemental oxygen 224 (25.1) 1 (1.9) 3 (1.7) 228 (20.4)
Upcoming flight
Cleared 824 (92.4)* 40 (78.4)t 147 (85.4)t 1,011 (90.6)
Traveling alone 213 (23.8) 12 (23.5) 55 (32.0) 280 (25.1)
With relative 577 (64.6) 35 (68.6) 82 (47.6) 694 (62.2)
With health provider 62 (6.9) 2 (3.9) 19 (11.0) 83 (7.4)
Return flight booked 365 (40.9) 20 (39.2) 37 (21.5) 422 (37.8)

Figure-4

Figure 4. Frequency distribution of total flight times in the oxygen group (n = 892). Median value was 211 min and range, 35 to 955 min; 770 (86.3 percent) patients had flights lasting 2 or more hours.

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