Preflight medical clearance of ill and incapacitated passengers: 3-year retrospective study of experience with a European airline.

BACKGROUND: Cabin environment in commercial airline flights may pose specific risks for the ill or incapacitated. International regulations provide a framework for the transportation of passengers for whom specific in-flight equipment or services are needed to minimize possible adverse effects and incidents on board. Little has been published on the characteristics of cases requiring preflight medical clearance for commercial airlines. METHODS: Requests to our medical center for clearance of ill or incapacitated passengers for a medium-sized European airline, within a 3-year period, were systematically reviewed and characterized. RESULTS: For the period of 1999 to 2001, 1,387 requests for medical clearance were made (1 for every 10,935 passengers), 32 (2.3%) of which were denied and 25 (1.8%) of which were deemed unnecessary. Over half (53.6%) of the requests were on behalf of male passengers, and the most common age group ranged from 61 to 70 years (13.3%). Musculoskeletal conditions and limb fractures in particular were the conditions that accounted for the greater number of cases (24.2%), followed by neuropsychiatric (17.6%), cardiovascular (14.5%), respiratory (12.6%), and neoplastic (10.0%) conditions. The most frequent reasons for denial of clearance were recent myocardial infarction and insufficient clinical data. A significant proportion of passengers needed a qualified escort (38.9%) or travel companion (36.7%). Wheelchairs for displacement during boarding or transit (30.4%), in-flight oxygen (28.1%), and stretchers (27.3%) were also frequent requirements. A total of 1,119 passengers (80.7%) required a mean of 2.3 extra needs on board. CONCLUSIONS: The results of this study may help one to better know the nature of medical cases actually requesting clearance for flying. The characteristics of the conditions found suggest that preflight medical clearance may have the potential to prevent the occurrence of disruptive in-flight medical incidents and complications.

Permanent medical disqualification in airline cabin crew: causes in 136 cases, 1993-2002.

INTRODUCTION: Pronouncing cabin crew permanently unfit to fly is a difficult decision involving personal, professional, ethical, and corporate aspects. We analyzed the causes of permanent medical disqualification in cabin crew in a medium-sized European commercial airline for the period 1993-2002. METHODS: The minutes of the official Medical Assessment Board of UCS for TAP Air Portugal were systematically reviewed and yielded a total of 136 cases of permanent medical disqualifications. RESULTS: The medical conditions most frequently responsible for grounding were otorhinolaryngological (30.1%), followed by musculoskeletal (21.3%), and psychiatric (12.5%). The remaining cases resulted from cardiovascular, malignant neoplastic, ophthalmologic, respiratory, neurological, infectious, urinary, digestive, and metabolic conditions. The disqualification rate was 9.2 for every 1000 cabin crewmembers per year. More than half of all cases (53.6%) were in the age range 41-50 yr (median 46 yr) and 66.1% were women. More than 85% had been with the company for 16 yr or more. The early retirement of these patients resulted in the loss of approximately 2364 person-years of work as cabin crew, although many patients were reassigned to ground duties with the airline. DISCUSSION: The annual disqualification rates found in this study were higher than those for airline pilots; we could find no comparable studies of rates for cabin crew. The results indicate the relevance of early detection as well as clinical and occupational follow up.