air india patient travel

• Type 2 Diabetes
• Heart Disease
• Digestive Health
• Multiple Sclerosis
• COVID-19 Vaccines
• Occupational Therapy
• Healthy Aging
• Health Insurance
• Public Health
• Patient Rights
• Caregivers & Loved Ones
• End of Life Concerns
• Health News
• Thyroid Test Analyzer
• Doctor Discussion Guides
• Hemoglobin A1c Test Analyzer
• Lipid Test Analyzer
• Complete Blood Count (CBC) Analyzer
• What to Buy
• Editorial Process
• Meet Our Medical Expert Board

Guidelines for Flying With Heart Disease

Air travel is generally safe for heart patients, with appropriate precautions

• Pre-Flight Evaluation

Planning and Prevention

During your flight.

If you have heart disease, you can fly safely as a passenger on an airplane, but you need to be aware of your risks and take necessary precautions.

Heart conditions that can lead to health emergencies when flying include coronary artery disease (CAD) , cardiac arrhythmia (irregular heart rate), recent heart surgery, an implanted heart device, heart failure , and pulmonary arterial disease.

When planning air travel, anxiety about the prevention and treatment of a heart attack on a plane or worrying about questions such as "can flying cause heart attacks" may give you the jitters. You can shrink your concern about things like fear of having a heart attack after flying by planning ahead.

Air travel does not pose major risks to most people with heart disease. But there are some aspects of flying that can be problematic when you have certain heart conditions.

When you have heart disease, air flight can lead to problems due to the confined space, low oxygen concentration, dehydration, air pressure, high altitude, and the potential for increased stress.   Keep in mind some of these issues compound each other's effects on your health.

Confined Space

The prolonged lack of physical movement and dehydration on an airplane may increase your risk of blood clots, including deep vein thrombosis (DVT) or pulmonary embolism (PE) . One of the biggest risks for people with heart disease who are flying is developing venous thrombosis.

These risks are higher if you have CAD or an implanted heart device, such as an artificial heart valve or a coronary stent. And if you have an arrhythmia, a blood clot in your heart can lead to a stroke.

One of the biggest risks for people with heart disease who are flying is developing an arterial blood clot or venous thrombosis.

Low Oxygen and Air Pressure

The partial pressure of oxygen is slightly lower at high altitudes than at ground level. And, while this discrepancy on an airplane is typically inconsequential, the reduced oxygen pressure in airplane cabins can lead to less-than-optimal oxygen concentration in your body if you have heart disease.

This exacerbates the effects of pre-existing heart diseases such as CAD and pulmonary hypertension .

The changes in gas pressure in an airplane cabin can translate to changes in gas volume in the body. For some people, airplane cabin pressure causes air expansion in the lungs. This can lead to serious lung or heart damage if you are recovering from recent heart surgery.

Dehydration

Dehydration due to cabin pressure at high altitude can affect your blood pressure, causing exacerbation of heart disease. This is especially problematic if you have heart failure, CAD, or an arrhythmia.

If you experience stress due to generalized anxiety about traveling or sudden turbulence on your flight, you could have an exacerbation of your hypertension or CAD.  

Pre-Flight Health Evaluation

Before you fly, talk to your healthcare provider about whether you need any pre-flight tests or medication adjustments. If your heart disease is stable and well-controlled, it is considered safe for you to travel on an airplane.

But, if you're very concerned about your health due to recent symptoms, it might be better for you to confirm that it's safe with your healthcare provider first before you book a ticket that you may have to cancel.

Indications that your heart condition is unstable include:

• Heart surgery within three months
• Chest pain or a heart attack within three months
• A stroke within six months
• Uncontrolled hypertension
• Very low blood pressure
• An irregular heart rhythm that isn't controlled

If you've had a recent heart attack, a cardiologist may suggest a stress test prior to flying.

Your healthcare provider might also check your oxygen blood saturation. Heart disease with lower than 91% O2 saturation may be associated with an increased risk of flying.

Unstable heart disease is associated with a higher risk of adverse events due to flying, and you may need to avoid flying, at least temporarily, until your condition is well controlled.

People with  pacemakers  or  implantable defibrillators  can fly safely.

As you plan your flight, you need to make sure that you do so with your heart condition in mind so you can pre-emptively minimize problems.

While it's safe for you to fly with a pacemaker or defibrillator, security equipment might interfere with your device function. Ask your healthcare provider or check with the manufacturer to see if it's safe for you to go through security.

If you need to carry any liquid medications or supplemental oxygen through security, ask your healthcare provider or pharmacist for a document explaining that you need to carry it on the plane with you.

Carry a copy of your medication list, allergies, your healthcare providers' contact information, and family members' contact information in case you have a health emergency.

To avoid unnecessary anxiety, get to the airport in plenty of time to avoid stressful rushing.

As you plan your time in-flight, be sure to take the following steps:

• Request an aisle seat if you tend to need to make frequent trips to the bathroom (a common effect of congestive heart failure ) and so you can get up and walk around periodically.
• Make sure you pack all your prescriptions within reach so you won't miss any of your scheduled doses, even if there's a delay in your flight or connections.
• Consider wearing compression socks, especially on a long trip, to help prevent blood clots in your legs.

If you have been cleared by your healthcare provider to fly, rest assured that you are at very low risk of developing a problem. You can relax and do whatever you like to do on flights—snack, read, rest, or enjoy entertainment or games.

Stay hydrated and avoid excessive alcohol and caffeine, which are both dehydrating. And, if possible, get up and walk for a few minutes every two hours on a long flight, or do leg exercises, such as pumping your calves up and down, to prevent DVT.

If you develop any concerning issues while flying, let your flight attendant know right away.

People with heart disease are at higher risk for developing severe complications from COVID-19, so it's especially important for those with heart disease to wear a mask and practice social distancing while traveling.

Warning Signs

Complications can manifest with a variety of symptoms. Many of these might not turn out to be dangerous, but getting prompt medical attention can prevent serious consequences.

Symptoms to watch for:

• Lightheadedness
• Dyspnea (shortness of breath)
• Angina (chest pain)
• Palpitations (rapid heart rate)
• Tachypnea (rapid breathing)

To prepare for health emergencies, the U.S. Federal Aviation Administration mandates that supplemental oxygen and an automated external defibrillator (AED) is on board for passenger airplanes that carry 30 passengers or more. Flight crews receive training in the management of in-flight medical emergencies and there are protocols in place for flight diversions if necessary.  

A Word From Verywell

For most people who have heart disease , it is possible to fly safely as long as precautions are taken. Only 8% percent of medical emergencies in the air are cardiac events, but cardiac events are the most common in-flight medical cause of death.  

This means that you don't need to avoid air travel if you have stable heart disease, but you do need to take precautions and be aware of warning signs so you can get prompt attention if you start to develop any trouble.

Hammadah M, Kindya BR, Allard‐Ratick MP, et al. Navigating air travel and cardiovascular concerns: Is the sky the limit?   Clinical Cardiology . 2017;40(9):660-666. doi:10.1002/clc.22741.

Greenleaf JE, Rehrer NJ, Mohler SR, Quach DT, Evans DG. Airline chair-rest deconditioning: induction of immobilisation thromboemboli? . Sports Med. 2004;34(11):705-25.doi:10.2165/00007256-200434110-00002

American Heart Association. Travel and heart disease .

Ruskin KJ, Hernandez KA, Barash PG. Management of in-flight medical emergencies . Anesthesiology. 2008;108(4):749-55.doi:10.1097/ALN.0b013e31816725bc

Naqvi N, Doughty VL, Starling L, et al. Hypoxic challenge testing (fitness to fly) in children with complex congenital heart disease . Heart. 2018;104(16):1333-1338.doi:10.1136/heartjnl-2017-312753

By Richard N. Fogoros, MD Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology.

Air India Wheelchair Assistance – A Practical Guide To Asking & Getting Assistance With Air India

AirlinesUpdates » Blog » Air India Wheelchair Assistance – A Practical Guide To Asking & Getting Assistance With Air India

If you or someone you know has reduced mobility and requires Air India wheelchair assistance when traveling by air, it’s important to plan ahead to ensure a smooth and stress-free experience. When flying with Air India, the process of requesting wheelchair assistance is straightforward and can be done easily through their official website.

It’s recommended that you make this request as early as possible in order to give airline staff enough time to prepare for your arrival at the airport. It will also help avoid any last-minute confusion or delays. When arriving at the airport on your day of travel, be sure to inform airline staff that you’ve requested wheelchair assistance. Let’s discuss this wheelchair assistance in brief.

In this post

Air India Assistance Overview

This policy makes it easy for a passenger, be it an elderly or an ill person, to request a wheelchair from the airline. Also, knowledge about the fee charged to all the needy passengers for this service is required. So read this overview of the Wheelchair Assistance policy and gain the knowledge that will help you.

Below is significant information regarding Air India assistance for the elderly.

• When traveling by air, travelers who need Air India assistance are strongly advised to pre-book their request at the time of flight reservation. It is because last-minute requests for wheelchair assistance can also cause unnecessary delays and may result in unavailability of the service. 
• To make sure that all travelers obtain timely and efficient assistance, it is significant to make arrangements well in advance.
• It is also worth noting that Air India has some restrictions when it comes to carrying wheelchair passengers on flights. 
• This measure has been put in place primarily for security reasons in case of an emergency evacuation; other travelers must be able to exit the aircraft rapidly and safely without any issues or hindrances.
• While this restriction may seem inconvenient for certain passengers, it is ultimately a significant precaution designed to save everyone on board the flight.
• Therefore, if you need Air India wheelchair assistance when flying with Air India, kindly make sure you book your request ahead of time so that your requirements can be accommodated properly and safely during your journey.
• Old, ill, and infirm flyers will not be charged any fee for providing them with a wheelchair service.
• Air India offers different categories of wheelchairs based on your specific requirements, such as whether you require an aisle chair or a ramp for boarding/deboarding the aircraft.

Wondering How To Get Wheelchair Assistance At The Airport? Air India Has the Answer For You

If you have difficulty walking due to an injury or health condition, you may need assistance getting to and from your flights. This service can be especially helpful if you are recovering from surgery or have recently experienced a painful fall.

Below are provided tips on wheelchair assistance request when traveling through an airport.

• During peak travel seasons, such as summer and holidays, it is advisable to allow extra time between flights due to potential delays caused by busy wheelchair attendants assisting other passengers.
• When Air India assistance booking, opt for the biggest plane possible with over 60 seats and multiple aisles to have more seating and restroom options.
• To ensure wheelchair assistance during air travel, call your airline at least 48 hours before the trip and request it. The representative will add a note to your reservation record and inform all relevant airports.
• When traveling, plan ahead for meals, as it may not be possible to purchase food during flights or layovers. Wheelchair attendants are not obligated to take passengers to restaurants or fast food stands. To avoid hunger, consider packing your food from home and bringing it on the flight.
• If you’re traveling during a holiday period, it’s best to arrive early and give yourself enough time to check-in, go through security, and get Air India special assistance if necessary.
• If you use a wheelchair at the airport, it’s important to fill out the Air India wheelchair assistance form and inform your attendant of what you can and cannot do before reaching security screening.
• Passengers who use personal wheelchairs should expect to check them at the boarding gate as airlines do not allow their use during flights. It is recommended that instructions be brought if disassembly of the wheelchair is necessary.

Wondering how to book wheelchair assistance in Air India Tickets? Read More

If you require Air India wheelchair assistance on a plane, boarding early can be expected. This expectation is because Air India focuses on offering the service to you. If you arrive early, you get help getting through all the airport formalities and are seated inside the plane first. All of this comes under the special service given under the assistance service.

• Communicating your needs and abilities to the attendant and flight crew for optimal support is essential.
• Wait until other passengers have left the plane before exiting. A wheelchair attendant will be available to assist you in getting to your connecting flight.
• When traveling and in need of a restroom stop, state that you are a traveler with a disability to the wheelchair attendant who will take you to one on the way to your gate. The attendant will give Air India disability assistance.

Air India’s Exceptions To Air India Disability Assistance

Air India provides wheelchair assistance at airports and never denies special Air India senior citizen assistance to passengers who need it. If you have been wondering about a situation where there might be an exception, the airline doesn’t offer this assistance. Then Read ahead:

• Air India has the right to deny boarding to passengers with certain medical conditions or disabilities that could pose a risk to other passengers. This includes situations where the passenger’s condition may be harmful during the flight.
• Air India may refuse to allow the passenger to board their flight.
• A passenger’s medical condition could pose a risk to other passengers. In such cases, the airline may deny boarding or require additional measures to ensure the safety of all passengers on board.
• Passengers with contagious medical conditions or those traveling in an incubator or stretcher without an escort may not be allowed to travel on a flight.

What is The Air India Wheelchair Charge?

Passengers who require a wheelchair at the airport can request one from the airline without having to pay any additional charges, as per passenger civil rights.

To receive Air India wheelchair assistance and mobility assistance for your flight, request it during booking or from the reservation office.

How Is Air India Caring For The Disabled Passengers?

Air India offers facilitation services to passengers with disabilities or special needs. Read more about how Air India makes the flying process smooth and effortless for flyers who require special assistance.

• Air India prioritizes the needs of disabled passengers by boarding them first and deplaning them last while informing the crew about their medical conditions. 
• In case of a connecting flight, they will be escorted to another carrier to ensure a smooth travel experience.
• An airline is offering mobility assistance to passengers who use wheelchairs.
• Air India assists passengers with special needs, such as wheelchairs and airport check-in aids.
• Passengers can select the service that best suits their requirements, while expectant mothers and parents of unaccompanied children can review policies on Air India’s website( www.airindia.com ) before flying.
• The airline offers assistance for passengers with various disabilities and medical needs, including those using crutches or prosthetics, visually impaired individuals with certified guide dogs, hearing-impaired passengers, those needing spinal support or medical assistants, and travelers with intellectual or developmental disabilities. 
• They also accommodate passengers traveling with internal medical devices.
• The Airline will provide them quickly for those who need oxygen aid and a stretcher.

Advice To Operate At The Airport With Air India Senior Citizen Assistance

Make the most of Air India Assistance by knowing how to operate at the airport. What are the few things to ponder when arriving/boarding/ cancelling the flight ? This is what makes all the difference. This clarity of actions makes the entire operation very convenient for you as a disabled/senior/medically ill passenger.

• Passengers are advised to allocate enough time for check-in and security procedures.
• Sometimes wheelchair attendants at the airport may leave passengers in baggage claim or other areas. It is recommended to have a cell phone with important numbers programmed in case this happens so that one can call for help from family, friends, or a taxi.
• If you need a wheelchair at the airport, airlines prefer 48 to 72 hours notice, but you can still ask for one when you check-in. However, it’s best to give yourself extra time if it’s a last-minute request.

If you are someone who requires Air India wheelchair assistance at the airport, it can be quite daunting to navigate through the process. However, with Air India’s special assistance services, getting wheelchair assistance has become a lot easier. In this article, we have provided detailed information on how you can get wheelchair assistance when traveling with Air India .

Air India offers different categories of wheelchairs based on your specific requirements, such as whether you require an aisle chair or a ramp for boarding/deboarding the aircraft. It is essential to carefully read through these categories mentioned in the article and select one that best suits your needs.

Frequently Asked Questions (FAQs) – Air India Assistance

Air India offers special assistance and allows for quick and easy booking of their flights through an official website. They can easily book Air India Wheelchair assistance.

Air India allows only one cabin of baggage weighing up to 7 kg and with dimensions not exceeding 115 cm. The bag must fit under the seat or in the enclosed storage compartment inside the cabin. For more information on Air India’s baggage allowance policy and other benefits, visit their website.

To request special assistance at the airport, contact your airline after buying a ticket and use their specific codes.

The Wheelchair Agent assists airline passengers with mobility issues by safely escorting them through the airport terminal from one point to another.

To receive assistance during travel, it is recommended to request it either at the time of booking or 48 hours prior to departure. It can be done through a travel agent, tour operator, or airline, and the information will be shared with the airport and service provider.

Passengers with wheelchairs or other assistive devices can check up to two of these items for free, along with any medical equipment. However, additional charges may apply for checking more than two devices or those used for sports purposes.

You might also like:

• How to Request Icelandair Wheelchair Assistance? 
• JetBlue Wheelchair Assistance – Get Wheelchair Assistance On Your Air Journey Or Bring Your Own
• Aer Lingus Wheelchair Assistance – How to book Assistance

One thought on “ Air India Wheelchair Assistance – A Practical Guide To Asking & Getting Assistance With Air India ”

I want to book wheelchair for elderly mother aged 82 has adthma My name is Kuldip Sihota daughter in law and her son travelling with her from Birmingham on 29/10/2923 from Birmingham UK

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Save my name, email, and website in this browser for the next time I comment.

Related Post

• Southwest Airlines Wheelchair Assistance for Special Passengers
• Delta Airlines Wheelchair Assistance – All The Ins And Outs Of Assistance Service 

Need help for Booking, Changes or Cancellation? Just give us a call to get instant help! Call us at +1-866-569-0036 and get assistance 24/7.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• J Anaesthesiol Clin Pharmacol
• v.32(3); Jul-Sep 2016

Air medical transportation in India: Our experience

Himanshu khurana.

Department of Anesthesia and Critical Care, Institute of Anesthesia and Critical Care, Gurgaon, Haryana, India

Yatin Mehta

Sunil dubey.

1 Emergency and Trauma, Medanta- The Medicity Hospital, Gurgaon, Haryana, India

Background and Aims:

Long distance air travel for medical needs is on the increase worldwide. The condition of some patients necessitates specially modified aircraft, and monitoring and interventions during transport by trained medical personnel. This article presents our experience in domestic and international interhospital air medical transportation from January 2010 to January 2014.

Material and Methods:

Hospital records of all air medical transportation undertaken to the institute during the period were analyzed for demographics, primary etiology, and events during transport.

586 patients, 453 (77.3%) males and 133 (22.6%) females of ages 46.7 ± 12.6 years and 53.4 ± 9.7 years were transported by us to the institute. It took 3030 flying hours with an average of 474 ± 72 min for each mission. The most common indication for transport was cardiovascular diseases in 210 (35.8%) and central nervous system disease in 120 (20.4%) cases. The overall complication rate was 5.3% There was no transport related mortality.

Conclusion:

Cardiac and central nervous system ailments are the most common indication for air medical transportation. These patients may need attention and interventions as any critical patient in the hospital but in a difficult environment lacking space and help. Air medical transport carries no more risk than ground transportation.

Introduction

The use of air medical transportation has risen over the past two decades.[ 1 ] Air medical transportation has evolved from balloons used during the First World War to the massive evacuation exercise undertaken by the Indian forces in Uttarakhand and Kashmir in recent times. Many more patients are transported daily in need of advanced medical attention to higher centers worldwide. These are interhospital transfers of critical patients using the available air infrastructure.

Most individuals with mild to moderate medical or surgical conditions are able to travel safely in a normal cabin seat with some assistance from the airline in the form of wheelchair and oxygen in case of emergency.[ 2 ] Some patients need either a stretcher in a commercial scheduled flight or a smaller dedicated chartered flight with all medical equipment and medical staff experienced to handle the situation. This may include continuous oxygen supply, airway management, cardiac monitoring, and interventions. Many countries where large areas are served by a few tertiary care centers have very efficient air medical transportation services, e.g., Australia, South Africa. This facility is poorly developed in India.

On case basis, the cost of air medical transportation may seem expensive when compared to ground transportation and even in comparison to the actual cost of treatment. On the contrary, studies show it is cost effective due to the decrease in time to treatment,[ 3 ] survival benefits,[ 4 ] and quality of life years added.[ 5 ] Over the past decade, wide availability of air ambulance services has brought a reduction in mortality and morbidity in India.[ 6 ]

Ours is the largest private multi super specialty hospital in India with patients transported from all over India and the world. Some of these patients are in serious medical condition and require urgent transportation and life-saving intervention by our dedicated air transportation team.

We present our experience based on 4 years of activity with the domestic and international interhospital air transport. This is the first of its kind audit in India and gives an insight into the profile, interventions and the present scenario of air medical transport in India.

Material and Methods

This is a retrospective analysis of all air medical transportations undertaken by the hospital from January 2010 to January 2014. Predetermined demographic and variable parameters were accessed from medical records of the hospital after due clearance from hospital authorities and fed into an Excel sheet for analysis. The primary underlying cause identified was recorded as the underlying indication for transportation. The causes were grouped together under the organ system for ease of interpretation.

Derived data are presented as mean ± standard deviation and percentage.

Evacuation time was defined as time from actual possession of the patient at the transferee hospital to handing over to primary admitting team at the transferred hospital.

It is important to note that all transportations were carried out by our team and subsequently admitted to our hospital, after a request for the same was received from the next of kin or legal guardian. Fixed wing aircraft were used in all transportations.

Fixed wing small aircraft available to us as air ambulance included 2 single propeller engine (Pilatus 12 NG, Pilatus Aircrafts Ltd., Switzerland) and 1 double propeller engine aircraft (King Air B 200, Beechcraft Corporation, USA) in a 4 seat and 1 stretcher configuration [ Figure 1 ]. They can accommodate 2 doctors, 1 nurse, 1 accompanying person and the patient on a stretcher. These small unscheduled flights can be arranged on short notice, and can land and take off from small airstrips.

Customized arrangement of a 6 seater chartered aircraft for medical transport

Commercial flights are the routine scheduled operations of the airlines between airports. Most aircrafts can have seats customized to accommodate a stretcher on a prior request and approval by the airlines.

Standard equipment for all medical transport includes airway management devices (laryngoscope, endotracheal tubes, tracheostomy tubes etc.), patient monitors, vascular access devices, and adequate number of oxygen cylinders. Vacuum stabilizing mattresses (Ferno (UK) Limited, West Yorkshire, UK) filled with small polyvinyl granules that adapt to shape of the supine patient to prevent undesirable and dangerous movement of the patient are used to transport critical patients, especially trauma victims. Intra-aortic balloon pump (IABP), cardiac pacing device, and fracture stabilizers (cervical collar, Thomas splint etc.) are included depending on the requirement. Spare dry nonspilling batteries are carried along as there may be no charging facility on aircraft.

As per aviation standards, all equipment are compact, portable, and noninterfering with radio communication. Equipment check for safety and integrity is done more frequently as they are more prone to wear and damage.

Medical staff included 1 to 2 doctors and a nurse depending on the criticality of the case. Around 50 doctors from specialties including anesthesia and critical care, cardiology, cardiac surgery, emergency medicine, pediatrics have been trained to handle logistic and administrative issues related to air medical transport in addition to handling emergency situations. The choice of accompanying doctor depends on the specific case. The challenge in most air ambulances is constraint of space, constantly moving cabin and stressful working conditions. The main focus is thus to select highly motivated staff and training them to cope with stress in the small cabin of the aircraft with limited resources.

Procedure of air medical transport

All medical transports are under direct supervision of the Chairman, critical care and trauma of our institute. Request for transport of patients to the hospital is usually received by the hospital call center which is directed to the operations manager who acts as the coordinator between all concerned. He takes situation from the doctor where the patient is admitted, alerts the admitting specialty of our hospital, checks for availability of aircraft, applies for clearances from airport authorities and assembles the team of flight medical staff for preparations accordingly. The team is dispatched to the airport after affirmation from all concerned.

Stretcher in a routine scheduled commercial airline including international flights is available on request to the concerned airline and is subject to availability of required number of seats. The usual procedure is to get approval from the airline appointed doctor on the prescribed “Medif form” available with the airline office at least 2-3 days in advance.[ 2 ] Different aircraft need to assemble a fixed stretcher on 6-9 folded seats usually at the rear end of the aircraft with a curtain around it and an oxygen cylinder underneath. The accompanying staff is usually one doctor and one nurse. All equipment and patient responsibility have to be borne by the accompanying doctor. Visa for international transfers can be issued on an emergency basis by placing a request to the concerned embassy by the medical team.

The transport team, the patient's family and the operations manager remain in constant touch and appraise each other of the patient's condition and his/her further requirement all the time till the patient is handed over to the admitting team.

Patients are received at the transferee hospital where the first assessment is done, and any interventions necessary for safe transport are performed. Informed consent is taken, and family members are apprised of the condition.

The medical transport is complete only when the patient is handed over to admitting specialty and the family briefed.

Over the 4-year period, 586 patients were air transported to our hospital with a total 3030 flying hours and a mean evacuation time of 474 ± 72 min.

Patient demographics and mission details are presented in Table 1 . Maximum evacuation time within India was 430 min (Imphal, Manipur) and from an international location to our hospital was 1560 min (San Francisco, USA). International transfers included USA, Europe, Africa, Middle East Asia, Afghanistan, Pakistan, Nepal and South East Asia.

Demographics

The primary cause most commonly identified or diagnosed in 210 (35.8%) patients at initial admission center was of cardiovascular origin. These included angina and myocardial infarction, cardiac failure, valvular and congenital heart disease. Central nervous system disease including head injury and stroke in 120 (20.4%) was the second most common indication [ Table 2 ].

Primary identified etiology

Five patients were intubated on board by the anesthetist/critical care physician. The indication for tracheal intubation was cardiorespiratory arrest in 2 and inability to maintain oxygen saturation with noninvasive ventilation in 4 patients. One endotracheal tube change for cuff malfunction and 5 tube depth change were needed for optimal ventilation. 156 patients (26.6%) were already intubated at the hospital of origin.

Four patients needed cardio pulmonary resuscitation (CPR) during transportation out of which 2 died. One of the patients was a 72-year-old male with recent myocardial infarction on mechanical ventilation and nitroglycerine infusion. The other was a 56 year old male with multiorgan failure involving cardiovascular, respiratory and renal system on ventilator and vasopressor support and history of 10 days in hospital.

Inotropic and vasopressor infusion was used in 109 (18.6%) patients for a total of 1133 h. This included 50 (45.8%) patients on a single drug. Most commonly used single agent was noradrenaline infusion in 32 patients. 59 (54.2%) patients were on more than 2 inotropes. The most common inotropic combination used at the receiving hospital was dopamine and noradrenaline in 25 patients.

Intra-aortic balloon pump was used in 7 patients, all of which were inserted prior to transport by the cardiac surgeon from our team. 14 invasive monitoring lines were placed during transport including 8 central venous catheters and 6 arterial lines. 96 (16.4%) patients already had invasive lines in place (78 CVCs and 36 arterial catheters) at receiving hospitals.

Overall complication rate including minor event was 31 (5.3%). All handovers to the admitting team were reported to be in satisfactory condition.

Prehospital and transportation data analysis has been done earlier, and it gives an insight into the demographics and travel patterns of the particular countries.[ 7 , 8 ] There are a few commentaries on the uniqueness of air medical transport scenario in India.[ 9 ]

Cardiovascular diseases remain the most common cause for the need of transfer to a tertiary center. This may be partly due to uneven distribution of tertiary cardiac centers in India and mainly due to an increase in incidence as well as a decrease in age of cardiac diseases in India.[ 10 ] Essebag and Halabi also observed an increased frequency of medical transportation of cardiac patients due to medical, economical, and social patterns in Canada.[ 1 ] The same holds true for India.

More males are transported for treatment to another facility. This may be attributed to the cultural, social, and economical dominance of males in the Indian society. Khera et al . pointed out that there is a gender bias in medical care in India.[ 11 ]

The main patient-related concerns when air transporting a critical patient are the low atmospheric pressure and gas expansion effects of altitude, patient and family anxiety; and movement related complications. Fixed wing propeller aircrafts fly at an altitude of 15,000-30,000 feet. Barometric pressure decreases from 760 mm Hg at sea level to 226 mm Hg at 30,000 feet. The aircraft cabin is pressurized to an equivalent pressures of 5000-8000 feet which corresponds to a PO 2 (inspired) of 107 mm Hg.[ 12 ] This PiO 2 is easily tolerated by normal individuals but in critical patients with limited reserves, it causes hyperventilation and tachycardia with an increase in cardiac output. This may also alter the need of vasopressors and inotropes and can be particularly detrimental to patients with underlying respiratory or cardiac diseases.[ 13 ] In our experience, there was a need for CPR in 4 patients and 2 mortalities due to cardiac arrest. It is important to note that these were all previously sick patients in need of advanced care. The changes in the environment, however small could not be ignored and need further investigation.

Another effect of decreased atmospheric pressure is on gas expansion. All potential body spaces, especially middle ear, bowel and pathological body spaces like pneumoperitoneum, pneumocranium, pneumothorax are at risk of expansion at high altitudes and especially during rapid changes during rapid ascend and descent. Though we did not find any complication to any body cavity, there was an incidence of endotracheal tube cuff rupture which needed tube change by the accompanying anesthetist. This was reported just after take off and could be attributed to the gaseous expansion in the cuff.

The 6 endotracheal tube adjustments to optimize ventilation were needed due to the endobronchial migration of tube probably during patient transfers between beds. This was despite precautions including head stabilizers and vacuum body stabilizing stretchers.

The overall complication rate of 5.3% in our study is similar to 5-6% reported by Szem et al . in 1994.[ 14 ] This paper however evaluated interhospital road transport of patients. A review article by Waydhas reported a complication rate in the range of 6-70% during transfers rather than during actual transport.[ 15 ] Most common complications were disconnections of leads, intravenous tubing, and ventilator circuits. We can safely say that air transportation carries no more risk than ground transportation.

Ground transportation may seem cheaper than air transportation. Some emergencies are potentially life or limb threatening and require urgent care and speedy transport to an advanced care center. This has been made possible only by air medical transportation with proven benefits in survival.[ 3 , 4 , 5 ] Bruhn et al . created an economical model to compare the cost of air ambulance services and ground ambulance services. The annual budgetary cost of ground network was estimated at $3,804,000, and helicopter ambulance cost was estimated at $16,865,000. Per patient cost worked out to be $4,475 and $2,811, respectively. They concluded that the commonly held notion that condemns helicopters as an excessively expensive technology as incorrect.[ 16 ] Only two clinical situations justify the choice of air over ground interhospital transportation of sick patients. First, nonavailability of the required diagnostic and therapeutic facility at the present facility and second when factors such as time and distance render ground transportation nonfeasible.[ 17 ]

Over the past decade, many factors have contributed to the increase in interhospital air medical transport in India. There is an easier availability of small aircraft for civil use that can be customized as ambulances. Almost all districts in India have access to either a civilian or military airstrip which can be used for air ambulance services on request to competent authorities.[ 18 ] There is an inequitable distribution of tertiary care hospitals in India.[ 19 ] Further, access to internet has made it easy to locate and communicate with specialty centers worldwide.

Even after all the above catalysts, the limiting factor in the speedy air transport of critical patients has been the time required for the customization of the aircraft and shortage of specialized equipment like IABP and extra corporeal membrane oxygenation and trained personnel.

The condition of the air transported patients is the same as in any other critical area of the hospital and thus necessitates the same monitoring and interventions in a totally different environment.[ 20 ] This requires specialized equipment and trained staff. At present, there is no air medical training facility for civilians in India.[ 21 ] Norton pointed that there is a need for air medical transport curriculum for emergency medical residents.[ 22 ] We feel there is a need of a structured accreditation policy and training program to bring accountability to the mushrooming air ambulance business in India. There is a need for trained medical staff, equipment, and dedicated aircraft to fill in the gap created by the inequitable distribution of hospitals in India.

Patients who are transported with a medical escort may need invasive and advanced monitoring and interventions as in any critical care area of the hospital. Cardiovascular diseases remain the most common reason for interhospital air medical transport. Complication rate during interhospital air transportation of critical patients is similar to ground transportation.

Source of Support: Nil

Conflict of Interest: None declared.

Free Crowdfunding for India | #1 Fundraising website in India | Milaap

Travelling With Ease: Discounts And Concessions For Cancer Patients In India

Travelling can be a daunting task for cancer patients, especially when they have to travel long distances for treatment or medical check-ups. however, there are several discounts and concessions available for cancer patients in india that can make their travel easier and more affordable., published on: 10 february, 2023.

Battling cancer, one of the deadliest conditions known to man, is a daunting experience. In addition to the physical toll it takes on the body, it is also emotionally and financially taxing. 

Cancer patients deserve all the support and solidarity that individuals and organisations can offer them, during the course of their treatment which can run in lakhs at the very least. Travel concessions are offered by the following in India exclusively for cancer patients and their families – especially those who have to travel from one state to another for hospitalisation, as a way to help alleviate their financial burden significantly:

• Cancer patients are eligible for 100% concession in AC 3-Tier/sleeper; a 75% concession on second class , AC Chair Car; and a 50% concession in AC 2-Tier and AC First Class . These are allowed on the basic fares of mail and express trains. 
• The bystanders of cance r patients are also eligible for a 75% concession in second class , sleeper, AC Chair Car, AC 3-Tier and a 50% concession AC 2-Tier and AC First Class . These are allowed only on basic fares for mail and express trains.
• The concession is 50% of the basic fare for male patients and 75% of the basic fare for female patients.
• At a time, passengers can avail only one type of concession. 
• The minimum distance required to avail of the cancer concession offered by Indian Railways varies based on the class of travel.
• For AC classes (First AC, Second AC, and Third AC), there is no minimum distance requirement for availing the cancer concession.
• For non-AC classes (Sleeper Class, Second Sitting, and General Class), the minimum distance requirement is 100 kilometres.
• Concession will be applicable only on the primary charge, not for a super-fast surcharge, reservation fee etc. 
• Passengers can’t ‘promote’ their concession tickets to a higher class.
• It is important to note that to avail the cancer concession, a passenger must carry a valid medical certificate issued by a recognized Indian institution. The documents issued by persons/organisations of other countries won’t be permissible for railway concessions.
• Bookings cannot be made online.

Access the IRCTC cancer patient concession form here . 

• Cancer patients are eligible for 50% concession on the basic fare of select booking in the Economy Class between place of residence and the place of treatment where the cancer hospital/ cancer Institute is located.
• Travel permitted within India as well as on India - Nepal sectors.
• Cancer patients should fill out an application stating that he/she is proceeding for treatment supported by a certificate issued by a hospital that specializes in cancer treatment

Access more details about Air India concessions here . 

• Cancer patients can avail travel concessions for road, rail and air transport from Tata Memorial Hospital to their place of permanent residence. It is important to enter your nearest airport/railway station/bus depot correctly in the registration form to avail travel concession.
• Train - The patient can travel for free or avail 50% discount while the attendant can avail 25% concessions on rail tickets , based on the distance between their hometown and the hospital, in AC 3-Tier, Ac 2-Tier and First Class. 
• Bus - The patient can avail up to 50% discount based on the distance between their hometown and the hospital , while the attendant has to pay full fare.
• Concessions cannot be availed online.

Access more details about Tata Memorial Hospital concessions here . 

• The bystanders of cancer patients are also eligible for a 75% concession in second class , sleeper, AC Chair Car, AC 3-Tier and a 50% concession AC 2-Tier and AC First Class . These are allowed only on basic fares for mail and express trains.
• Travel concession is applicable for a maximum of 300 km of travel. 
• Passengers can’t ‘promote’ their concession tickets to a higher class. 
• Cancer patients should present the requisite medical certificate produced by hospitals based in India. The documents issued by persons/organisations of other countries won’t be permissible for railway concessions.

In times of need, support means everything, and with Milaap, you need not look any further. Milaap enables you to set up a fundraiser for any medical emergency within minutes, and you can easily raise funds for treatment expenses.

Do you know someone who could benefit from fundraising? Simply refer them to us and we’ll be happy to lend a hand. Visit  www.milaap.org  or call us on +91 9916174848 to get started now.

For more information, write to us at  [email protected] .

Do you know someone who could benefit from fundraising? Simply refer them to us and we’ll be happy to lend a hand.

Visit  www.milaap.org  or call us on +91 9916174848 to get started now.

Written by:

Aathira Ayyappan

Discover more from Free Crowdfunding for India | #1 Fundraising website in India | Milaap

Subscribe now to keep reading and get access to the full archive.

Type your email…

Continue reading

NICOLE POWELL-DUNFORD, MD, MPH, JOSEPH R. ADAMS, DO, MPH, AND CHRISTOPHER GRACE, DO, MPH

Am Fam Physician. 2021;104(4):403-410

Related Letter to the Editor: Helping Adults With Dementia Travel by Air

Author disclosure: No relevant financial affiliations.

Air travel is generally safe, but the flight environment poses unique physiologic challenges such as relative hypoxia that may trigger adverse myocardial or pulmonary outcomes. To optimize health outcomes, communication must take place between the traveler, family physician, and airline carrier when there is any doubt about fitness for air travel. Travelers should carry current medications in their original containers and a list of their medical conditions and allergies; they should adjust timing of medications as needed based on time zone changes. The Hypoxia Altitude Simulation Test can be used to determine specific in-flight oxygen requirements for patients who have pulmonary complications or for those for whom safe air travel remains in doubt. Patients with pulmonary conditions who are unable to walk 50 m or for those whose usual oxygen requirements exceed 4 L per minute should be advised not to fly. Trapped gases that expand at high altitude can cause problems for travelers with recent surgery; casting; ear, nose, and throat issues; or dental issues. Insulin requirements may change based on duration and direction of travel. Travelers can minimize risk for deep venous thrombosis by adequately hydrating, avoiding alcohol, walking for 10 to 15 minutes every two hours of travel time, and performing seated isometric exercises. Wearing compression stockings can prevent asymptomatic deep venous thrombosis and superficial venous thrombosis for flights five hours or longer in duration. Physicians and travelers can review relevant pretravel health information, including required and recommended immunizations, health concerns, and other travel resources appropriate for any destination worldwide on the Centers for Disease Control and Prevention travel website.

Air travel has become increasingly popular over time, despite decreases during the COVID-19 pandemic, with 1.1 billion total passengers in 2019 and most Americans having flown at least once in the past three years. 1 Air travel is generally safe, but especially for the aging U.S. population, the flight environment poses unique physiologic challenges, particularly relative hypoxia, which may trigger adverse myocardial or pulmonary outcomes. To optimize health outcomes, communication must take place between the traveler, family physician, and airline carrier when any doubt occurs about fitness for air travel. Travelers should carry current medications in their original containers as well as a list of their medical conditions and allergies and should adjust timing of medications as needed based on time zone changes. Travelers should also consider available medical resources at their travel destinations and layover locations. Family physicians and travelers can review relevant pretravel health information, including required and recommended immunizations, health concerns, and other travel resources appropriate for any destination worldwide at https://wwwnc.cdc.gov/travel/destinations/list .

Pulmonary Conditions

By law, U.S. commercial aircraft cannot exceed a relative cabin altitude of 8,000 feet (2,438 m) because of the potential for significant hypoxia above this altitude. 2 Most passengers exposed to this environment will have a partial pressure of arterial oxygen (Pao 2 ) of 60 to 65 mm Hg (7.98 to 8.64 kPa), corresponding to 89% to 94% peripheral oxygen saturation (Spo 2 ), which may compromise cardiovascular or pulmonary disease in affected travelers. 3 Neither reassuring pulse oximetry nor reassuring forced expiratory volume in one second has been found to predict hypoxemia or in-flight events for patients with pulmonary conditions. 3

The nonstandardized Hypoxia Altitude Simulation Test, administered and interpreted by pulmonologists, can be used to determine specific in-flight oxygen requirements for patients with pulmonary complications or those for whom safe air travel remains in doubt. Typically, the Hypoxia Altitude Simulation Test comprises breathing 15% fraction of inspired oxygen for 20 minutes, with pulse oximeter and blood gas measurements taken before and after testing. 4 – 6 Patients with a Hypoxia Altitude Simulation Test Pao 2 less than 50 mm Hg (6.65 kPa) at any point during the test require supplemental oxygen in flight, whereas those with a Pao 2 greater than 55 mm Hg (7.32 kPa) do not. Pao 2 measurements falling between 50 and 55 mm Hg are considered borderline and may necessitate further testing with activity. 5 Given that the test itself incurs some risk and may not be available to all travelers, family physicians can counsel patients who are unable to walk 50 m (164 ft) or those whose usual oxygen requirements exceed 4 L per minute not to fly. 3 , 4 , 7 , 8

Patients with oxygen requirements less than 4 L per minute can be counseled to double their usual flow rate while flying. 8

Commercial airline carriers usually permit the use of personal Federal Aviation Administration–approved portable oxygen compressors, but carriers require travelers to give from 48 hours to one month's notice before flight when they are requesting the use of compressed oxygen. 9

Table 1 lists indications for which further assessment (e.g., Hypoxia Altitude Simulation Test, ability to walk 50 m) is warranted, including previous respiratory difficulties while flying, severe lung disease, recent or active lung infections, any preexisting oxygen requirements or ventilatory support, or if less than six weeks have passed since hospital discharge for acute respiratory illness. 3 Patients who have undergone an open-chest lung procedure should defer travel for two to three weeks, must not have any recent or residual pneumothorax, and should be assessed for supplemental oxygen needs. 10

Cardiac Conditions

Travelers with underlying cardiac conditions should use airport assistance services such as wheelchairs and baggage trolleys to decrease myocardial oxygen demand. 9 Although most cardiac conditions are safe for flight, some require additional consideration. Travelers with minimally symptomatic, stable heart failure may safely fly, but medication adherence is critical. 9 , 11 Patients with stable angina should be assessed for oxygen needs if they become short of breath after walking 50 m , and they should not fly following any recent medication changes that have not demonstrated clinical stability beyond that medication's half-life. 7 , 11

Patients with unstable angina, new cardiac or pulmonary symptoms, or recent changes in medication without appropriate follow-up should not fly until stable, particularly for medication changes that could impact blood pressure or coronary reserve. 11 Travelers with recent myocardial infarction at low risk should defer air travel for three to 10 days postevent 11 – 15 ( Table 2 11 ) . Low-risk patients who required percutaneous transluminal coronary angioplasty may fly after three days as long as they are asymptomatic. 9 Travelers who have had coronary artery bypass grafting or an uncomplicated open-chest procedure should wait to fly until they are 10 days postprocedure. 7 , 11

Many implantable-cardioverter defibrillators are compatible with standard airport security. 9 The Transportation Security Administration recommends that travelers with pacemakers, defibrillators, or any other implanted metal device request pat-down screening instead of using a walk-through metal detector. 16 For travelers with pacemakers and implantable-cardioverter defibrillators, a two-day flight restriction following uncomplicated placement is appropriate. 11 It is prudent for all cardiac patients to travel with a copy of their most recent electrocardiography results and a preflight graded exercise test, which may aid in assessment and management in case of an event during flight. 9 In patients with hypertension, medication compliance is especially important because aircraft noise and other travel-related stress may provoke blood pressure elevations. 17 Travel in patients with moderately controlled hypertension is not a contraindication, but airline travel for those with uncontrolled hypertension requires shared decision-making and clinical judgment.

Ear, Nose, and Throat Conditions

Trapped gases and sinus air-fluid levels can cause significant pain for the patient with ear, nose, and/or throat conditions. Adult patients with symptomatic rhinosinusitis or allergic rhinitis may benefit from oxymetazoline (Afrin) and/or pseudoephedrine to prevent ear blockage during descent. 18 No evidence suggests that antihistamines or decongestants are beneficial in children with sinusitis, 19 and these medications should not be used to hasten an early clearance for flight in any age group. Flight within 36 hours of otitis media resolution is generally safe. 20 Equalizing pressure on descent can also be accomplished in adults with frequent swallowing, chewing gum or food, or by generating pressure against a closed mouth and glottis. In young children and infants, upright bottle feeding or pacifier use can achieve similar effects. 21

Patients who have undergone jaw fracture repair should defer flying for at least one to two weeks, and jaw wiring should be temporarily replaced with elastic bands in case of emesis. 18 Transdermal scopolamine is effective in preventing air sickness , 22 and alternatives such as first-generation antihistamines may also be useful. Patients who elect to take scopolamine should be counseled on adverse effects of drowsiness, blurry vision, dry mouth, or dizziness. 22 Individuals who are prone to air sickness should refrain from alcohol use during flight and in preflight and should eat smaller, lighter meals. 18 The expansion of trapped gas at altitude may cause severe tooth pain in patients with caries beneath fixed restorations. Travelers with hearing aids should bring extra batteries and all accessories and may need to adjust their volume levels to offset background noise.

Diabetes Mellitus

In addition to carrying all medications, travelers with diabetes requiring insulin should request appropriate meals and consider checking blood glucose levels at intervals during longer flights. 23 Bringing snacks or other food can assist those with tenuous diabetes management in the event of layovers or delays. Insulin requirements may change based on the direction of travel and crossing time zones, which may entail lost or gained hours. Even if it is not part of the patient's normal regimen, fast-acting insulin, ideally with a pen device, should be considered for all travelers during flight due to its flexibility and responsiveness. 23 When traveling east, if the day is shortened by two or more hours, it may be necessary to give less insulin on the first day at the destination. When traveling west, if the day is extended by two or more hours, it may be necessary to give more insulin on the first day at the destination. Blood glucose should be checked at least 10 hours after the first-day dose to allow for further adjustments. Travelers can return to their normal insulin regimen on day 2 at their destination. A comprehensive public access resource for medical professionals addressing insulin adjustment for the air traveler is available through the Aerospace Medical Association. 23

Gastrointestinal Conditions

For travelers with recent intra-abdominal procedures, trapped gas expansion could disrupt sutures and cause rebleeding. Travelers should wait until 24 hours have passed and any bloating has resolved following laparoscopic abdominal procedures or colonoscopy. 7 , 10 Travelers should wait one to two weeks after open abdominal surgery. 10 Patients with active gastrointestinal problems, including hematemesis, melena, or obstruction, should not fly. 24

Hematologic Conditions

A baseline anemia may predispose travelers to syncope given the relative hypoxia of the flight environment. Caution should be exercised for travelers with a hemoglobin level below 8.5 g per dL (85 g per L), and some authorities recommend not advising flight for any travelers with levels below 7.5 g per dL (75 g per L). 7 Young, otherwise healthy patients with chronic anemia may be more tolerant of relative hypoxia, especially if their hemoglobin level is greater than 7.5 g per dL. 24 For the traveler with sickle cell anemia, sickling crisis during flight is unlikely 24 ; however, flight should be delayed for 10 days following an acute crisis, and patients with sickle cell anemia who have received a recent transfusion should not fly if hemoglobin levels are less than 7.5 g per dL. 24

Although deep venous thrombosis (DVT) is not caused by the flight environment itself, DVT is a concern for people who sit for extended periods or have risk factors. 25 Incidence of DVT reaches up to 5.4% in high-risk groups flying an average of 12.4 hours. 26 Compression stockings can prevent asymptomatic DVT and superficial venous thrombosis in flights lasting five hours or longer. 27 Table 3 lists recommendations for DVT prophylaxis for travelers who are at low, moderate, and high risk for DVT. 11 The baseline recommendations for each group include staying hydrated, avoiding alcohol to prevent dehydration, walking at least 10 to 15 minutes in each two hours of travel time, and performing isometric exercises while seated. 11 When indicated for high-risk travelers, including those with reduced mobility, low-molecular-weight heparin (e.g., 40 mg of subcutaneous enoxaparin [Lovenox]) on the day of and day after travel is appropriate for anticoagulation. 28

Psychiatric and Intellectual Disability Conditions

Passengers with mental or intellectual disabilities often benefit from a traveling companion because physiologic stresses of flight and the chaotic nature of busy airports may be especially challenging aspects of travel for these groups. 9 Prescription anxiolytics may alleviate travel anxiety, but a test dose is highly encouraged before flight. 9 Service or emotional support animals can be used for a variety of mental health conditions; an article in American Family Physician provides information about considerations for documentation for emotional support animals. 29 See the U.S. Department of Transportation website for current guidelines regarding the use of these animals during air travel. 30

Neurologic Conditions

Passengers predisposed to stress-related headaches and severe migraines should always carry abortive medications. Travelers with uncontrolled vertigo are not good candidates for flight. Patients prone to syncope should remain well-hydrated and be cautioned to avoid alcohol or quickly standing from a seated position. One small study suggests that people who have epilepsy with a history of flight-related seizures and a high baseline seizure frequency are likely to have a seizure after flying. 31 The Aerospace Medical Association recommends that patients with uncontrolled or poorly controlled seizures should not fly. 32 A safe amount of time permitted before flight following a seizure has not been established, but clinical judgment and the presence of a knowledgeable chaperone should factor into any medical recommendation. Although some airline carriers allow patients to fly 72 hours after a stroke, 7 the Aerospace Medical Association recommends waiting one to two weeks. 32

Obstetric Conditions

Background radiation associated with the flight environment does not pose a special hazard for most pregnant air travelers; however, the Federal Aviation Administration recommends informing aircrew or frequent flyers about health risks of radiation exposure. 33 Because a lack of in-flight medical resources may jeopardize safety of the mother and neonate, patients with an uncomplicated singleton pregnancy should generally not fly beyond 36 weeks of estimated gestational age 7 , 24 , 33 , 34 and those with a multiple gestation not beyond 32 weeks . 7 , 34 Body imaging scanners are safe for security screening during pregnancy. 34 , 35 Postpartum travelers are at moderate risk for DVT and should wear compression stockings and perform isometric exercises during flight. 11 Travelers who have undergone an uncomplicated cesarean delivery are generally safe for flight within one to two weeks. 10

Ophthalmologic Conditions

Passengers with severe visual impairment may benefit from having a traveling companion. Xerophthalmia may be exacerbated in the low humidity of the airplane cabin, and lubricating eye drops are advisable. Cataracts and clinically stable glaucoma are not contraindications to flight; however, any retinal detachment interventions should restrict flight for at least two weeks. 36 Open-globe eye surgery should delay air travel for up to six weeks, and travel recommendations should be made in conjunction with an ophthalmologist. 36

Orthopedic Conditions

Because of expansion of trapped air at altitude, all fixed casts should be bivalved. 7 , 37 Some airlines do not permit air casts of any kind, but if they are used, a small amount of air should be released to prevent any limb compression that occurs as a result of trapped gas expansion. Elastic bandages can be added to a bivalved cast and can be loosened as tolerated. The Transportation Security Administration recommends that passengers with prosthetic limbs should avoid metal detector screening and should be screened with alternative measures. 16 Individuals with significantly decreased mobility should consider wheelchairs and the use of travel companions. Passengers with low back pain and other mobility-limiting conditions can request seating near the front to reduce walking; however, business and first-class seating is an additional cost.

Urologic Conditions

Foley catheters and other inflatable balloons are compatible with flight; however, they should be filled with liquid for air travel, given the previously described expansion of trapped gas at altitude.

Special Considerations for Children

Healthy, term neonates should not fly for at least 48 hours after birth but preferably one to two weeks. 21 Infants younger than one year with a history of chronic respiratory problems since birth should be evaluated by a pulmonologist before air travel. 3

Other Air Travel Considerations

Jet lag occurs as a result of desynchronization between an individual's internal circadian rhythm and the external environment's time zone. 38 , 39 Jet lag is worse for eastward rather than westward travel. 40 Measures for prevention include ensuring enough sleep before travel, timing light exposure using sunglasses, avoiding alcohol, and eating at appropriate times after arriving at the destination. Timed melatonin is highly effective at treating jet lag, 41 and prescription hypnotic-sedative medications may also work in controlling sleep loss. 38

Self-contained underwater breathing apparatus (SCUBA) divers should not fly within 12 hours of a dive because of the concern for decompression sickness or life-threatening arterial gas embolism. 42

The airplane cabin does not inherently pose greater risk for infection than any other close contact, but respiratory viral pathogens are the most commonly transmitted infections. 43 Because of the ongoing COVID-19 pandemic, the Centers for Disease Control and Prevention (CDC) recommends delaying travel until the individual is fully vaccinated because traveling increases the chance of getting and spreading COVID-19. For patients not fully vaccinated who must travel, it is important to follow the CDC's recommendations for unvaccinated people. Check for evolving guidelines on the CDC's website. 44

Patients with breast cancer who have had surgery may fly without risking new or worsening lymphadenopathy. 45

A comprehensive discussion of in-flight emergencies is beyond the scope of this article. See the American Family Physician article on in-flight emergencies for more details. 46

This article updates a previous article on this topic by Bettes and McKenas . 37

Data Sources: A PubMed, Cochrane database, Essential Evidence Plus, ACCESSSS, and ECRI search occurred in April and May 2020 and April and May 2021 using search terms aviation medicine, travel medicine, commercial flight, air travel, and fitness to fly. The Aerospace Medical Association's website resource, Medical Considerations for Airline Travel, was searched in its entirety. The Handbook of Aviation and Space Medicine, Fundamentals of Aerospace Medicine, and Aviation and Space Medicine were reviewed for clinically relevant chapters.

The authors acknowledge Rachel Kinsler, USAARL Research Engineer, for her thoughtful review of this manuscript.

The views, opinions, and/or findings contained in this report are those of the authors and should not be construed as an official Department of the Army position, policy, or decision, unless so designated by other official documentation. Citation of trade names in this report does not constitute an official Department of the Army endorsement or approval of the use of such commercial items.

Airlines for America. Air travelers in America: annual survey. Accessed May 1, 2021. https://www.airlines.org/dataset/air-travelers-in-america-annual-survey/#

14 Code of Federal Regulations §25.841—pressurized cabins. Accessed May 1, 2021. https://www.govinfo.gov/app/details/CFR-2012-title14-vol1/CFR-2012-title14-vol1-sec25-841

• Ahmedzai S, Balfour-Lynn IM, Bewick T, et al.; British Thoracic Society Standards of Care Committee. Managing passengers with stable respiratory disease planning air travel. Thorax. 2011;66(suppl 1):i1-i30.

Respiratory disease. In: Green N, Gaydos S, Hutchinson E, et al., eds. Handbook of Aviation and Space Medicine . CRC Press; 2019:329–333.

Dine CJ, Kreider ME. Hypoxia altitude simulation test. Chest. 2008;133(4):1002-1005.

• Matthys H. Fit for high altitude: are hypoxic challenge tests useful?  Multidiscip Respir Med. 2011;6(1):38-46.

Bagshaw M. Commercial passenger fitness to fly. In: Gradwell DP, Rainford DJ, eds. Ernsting's Aviation and Space Medicine . 5th ed. CRC Press; 2016:631–640.

Josephs LK, Coker RK, Thomas M; BTS Air Travel Working Group; British Thoracic Society; Managing patients with stable respiratory disease planning air travel. Prim Care Respir J. 2013;22(2):234-238.

Rayman RB, Williams KA. The passenger and the patient inflight. In: DeHart RL, Davis JR, eds. Fundamentals of Aerospace Medicine . 3rd ed. Lippincott Williams & Wilkins; 2002:453–469.

Aerospace Medical Association. Surgical conditions. May 2003. Accessed May 1, 2021. http://www.asma.org/asma/media/asma/Travel-Publications/Medical%20Guidelines/Surgical-Conditions.pdf

• Smith D, Toff W, Joy M, et al. Fitness to fly for passengers with cardiovascular disease. Heart. 2010;96(suppl 2):ii1-ii16.
• Thomas MD, Hinds R, Walker C, et al. Safety of aeromedical repatriation after myocardial infarction: a retrospective study. Heart. 2006;92(12):1864-1865.

Roby H, Lee A, Hopkins A. Safety of air travel following acute myocardial infarction. Aviat Space Environ Med. 2002;73(2):91-96.

• Zahger D, Leibowitz D, Tabb IK, et al. Long-distance air travel soon after an acute coronary syndrome: a prospective evaluation of a triage protocol. Am Heart J. 2000;140(2):241-242.
• Cox GR, Peterson J, Bouchel L, et al. Safety of commercial air travel following myocardial infarction. Aviat Space Environ Med. 1996;67(10):976-982.

Transportation Security Administration. Frequently asked questions. Accessed May 1, 2021. https://tsa.gov/travel/frequently-asked-questions

• Steven S, Frenis K, Kalinovic S, et al. Exacerbation of adverse cardiovascular effects of aircraft noise in an animal model of arterial hypertension. Redox Biol. 2020;34:101515.

Aerospace Medical Association. Ear, nose, and throat. May 2003. Accessed May 1, 2021. https://www.asma.org/asma/media/asma/Travel-Publications/Medical%20Guidelines/Ear-Nose-and-Throat.pdf

Shaikh N, Wald ER, Pi M. Decongestants, antihistamines and nasal irrigation for acute sinusitis in children. Cochrane Database Syst Rev. 2014;(10):CD007909.

• Pinto JA, Dos Santos Sobreira Nunes H, Soeli Dos Santos R, et al. Otitis media with effusion in aircrew members. Aerosp Med Hum Perform. 2019;90(5):462-465.

Aerospace Medical Association. Travel with children. May 2003. Accessed May 1, 2021. https://www.asma.org/asma/media/asma/Travel-Publications/Medical%20Guidelines/Travel-With-Children.pdf

Spinks A, Wasiak J. Scopolamine (hyoscine) for preventing and treating motion sickness. Cochrane Database Syst Rev. 2011;(6):CD002851.

Aerospace Medical Association. Diabetes. May 2003. Accessed May 1, 2021. http://www.asma.org/asma/media/asma/Travel-Publications/Medical%20Guidelines/Diabetes.pdf

Passenger fitness to fly. In: Green N, Gaydos S, Hutchinson E, et al., eds. Handbook of Aviation and Space Medicine . CRC Press; 2019:263–266.

Watson HG, Baglin TP. Guidelines on travel-related venous thrombosis. Br J Haematol. 2011;152(1):31-34.

Possick SE, Barry M. Evaluation and management of the cardiovascular patient embarking on air travel. Ann Intern Med. 2004;141(2):148-154.

• Clarke MJ, Broderick C, Hopewell S, et al. Compression stockings for preventing deep vein thrombosis in airline passengers. Cochrane Database Syst Rev. 2021;(4):CD004002.

Gavish I, Brenner B. Air travel and the risk of thromboembolism. Intern Emerg Med. 2011;6(2):113-116.

Tin AH, Rabinowitz P, Fowler H. Emotional support animals: considerations for documentation. Am Fam Physician. 2020;101(5):302-304. Accessed May 1, 2021. https://www.aafp.org/afp/2020/0301/p302.html

U.S. Department of Transportation. U.S. Department of Transportation announces final rule on traveling by air with service animals. December 2, 2020. Accessed May 1, 2021. https://www.transportation.gov/briefing-room/us-department-transportation-announces-final-rule-traveling-air-service-animals

Trevorrow T. Air travel and seizure frequency for individuals with epilepsy. Seizure. 2006;15(5):320-327.

Hastings, JD; Aerospace Medical Association. Medical guidelines for airline travel: air travel for passengers with neurological conditions. September 2014. Accessed May 1, 2021. http://www.asma.org/asma/media/asma/Travel-Publications/Medical%20Guidelines/Neurology-Sep-2014.pdf

ACOG Committee opinion no. 746: air travel during pregnancy. Obstet Gynecol. 2018;132(2):e64-e66.

Royal College of Obstetricians and Gynaecologists. Air travel and pregnancy: scientific impact paper no. 1. May 2013. Accessed May 1, 2021. http://www.asma.org/asma/media/asma/Travel-Publications/Medical%20Guidelines/RCOG-Pregnancy-and-Air-Travel-Scientific-Impact-Paper.pdf

Harvard Medical School. Are full-body airport scanners safe? June 2011. Accessed May 1, 2021. https://www.health.harvard.edu/diseases-and-conditions/are-full-body-airport-scanners-safe#:~:text=he%20authors%20begin%20with%20an,the%20biological%20effects%20of%20radiation

Aerospace Medical Association. Ophthalmological conditions. May 2003. Accessed May 1, 2021. http://www.asma.org/asma/media/asma/Travel-Publications/Medical%20Guidelines/Ophthalmological-Conditions.pdf

Bettes TN, McKenas DK. Medical advice for commercial air travelers. Am Fam Physician. 1999;60(3):801-808. Accessed May 1, 2021. https://www.aafp.org/afp/1999/0901/p801.html

Aerospace Medical Association. Jet lag. May 2003. Accessed May 1, 2021. https://www.asma.org/asma/media/asma/Travel-Publications/Medical%20Guidelines/Jet-Lag.pdf

Choy M, Salbu RL. Jet lag: current and potential therapies. PT. 2011;36(4):221-231.

• Waterhouse J, Reilly T, Atkinson G, et al. Jet lag: trends and coping strategies. Lancet. 2007;369(9567):1117-1129.

Herxheimer A, Petrie KJ. Melatonin for the prevention and treatment of jet lag. Cochrane Database Syst Rev. 2002;(2):CD001520.

Divers Alert Network. February 1, 2017. Accessed May 11, 2021. https://dan.org/alert-diver/article/flying-after-pool-diving-2/

Mitchell GW, Martin GJ. Chapter 19 Infectious diseases. In: Davis JR, Johnson R, Stepanek J, et al. Fundamentals of Aerospace Medicine . 4th ed. Lippincott Williams & Wilkins; 2008:432–446.

Centers for Disease Control and Prevention. Domestic travel during COVID-19. Updated April 27, 2021. Accessed April 30, 2021. https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-during-covid19.html

Co M, Ng J, Kwong A. Air travel and postoperative lymph-edema—a systematic review. Clin Breast Cancer. 2018;18(1):e151-e155.

Hu JS, Smith JK. In-flight medical emergencies. Am Fam Physician. 2021;103(9):547-552. Accessed April 30, 2021. https://www.aafp.org/afp/2021/0501/p547.html

Continue Reading

More in AFP

More in pubmed.

Copyright © 2021 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions  for copyright questions and/or permission requests.

Copyright © 2024 American Academy of Family Physicians. All Rights Reserved.

Diagnoses for Consideration in a Returning Traveler with Fever

If illness presentation is not consistent with malaria or malaria has been ruled out, other diagnoses based on specific clinical presentation and travel itinerary/place of possible exposure should be considered. Travelers can have non-travel related reasons for fever, too.

• Headache, eye pain, nausea/vomiting, myalgias, arthralgias, macular rash
• Shock, hemorrhage, organ failure, ARDS
• Clinical stabilization, may develop confluent rash
• Initial diagnosis may be established by clinical suspicion
• Serum RT-PCR or viral antigen testing within first week of illness
• See CDC Dengue Case Management Guidelines Cdc-pdf [PDF – 8 pages]
• Early clinical signs (weeks 1-2): fever, abdominal pain, “rose spots” rash overlying abdomen
• Severe/late clinical signs (week 3): hepatosplenomegaly, hematochezia, intestinal perforation, septic shock
• Blood culture remains gold standard
• Stool culture, serology, and rapid diagnostic tests have more limited utility
• Ceftriaxone or fluoroquinolone if low risk of fluoroquinolone resistance (travelers outside of South/Southeast Asia where resistance is >80%)
• Ceftriaxone for travelers from South/Southeast Asia
• Fluoroquinolone
• Azithromycin
• See Traveler’s Health Typhoid & Paratyphoid Fever
• Katayama Fever (acute schistosomiasis syndrome): acute onset of urticaria, angioedema, eosinophilia due to hypersensitivity reaction to schistosome antigens
• Severe disease: can involve liver, spleen, neurological involvement but typically seen after chronic infection
• Diagnosis: serology preferred
• Corticosteroids (prednisolone 20 to 40 mg) initially, followed by praziquantel after resolution of acute symptoms to avoid aggravation of symptoms
• Neuroschistosomiasis requires immediate corticosteroid treatment, followed by praziquantel after a few days
• See Travelers’ Health Schistosomiasis
• Initial presentation: fevers, rigors, myalgias, headache, conjunctival suffusion
• Severe complications: renal failure, pulmonary hemorrhage, ARDS, myocarditis, uveitis, optic neuritis
• Diagnosis: serology preferred; microscopic agglutination test is considered gold standard
• Pregnancy: azithromycin or amoxicillin
• Pregnancy: avoid doxycycline
• Severe disease in children: IV azithromycin; avoid doxycycline
• Jarisch-Herxheimer reaction (inflammation in response to spirochete clearance) can occur
• See Travelers’ Health Leptospirosis
• Presentation: fever, headache, myalgias, rash
• Diagnosis: may be initially established by clinical suspicion; other laboratory-based methods include serology, PCR, culture, biopsy
• Treatment: oral or intravenous doxycycline is preferred
• See Travelers’ Health Rickettsial (Spotted & Typhus Fevers) & Related Infections, including Anaplasmosis & Ehrlichiosis
• Acute infection: high-grade fever, polyarthralgia (typically bilateral/symmetric, distal>proximal joints), macular rash
• Severe complications: meningoencephalitis, respiratory failure, renal failure, hepatitis, hemorrhagic, heart failure/cardiomyopathy
• Diagnosis: RT-PCR or serology, consider testing for dengue and Zika as well
• Supportive care, fluids as appropriate
• Avoid aspirin/NSAIDS in patients with concern for dengue until patient is afebrile for 48 hours and no additional warning signs for dengue to reduce risk of hemorrhage
• See Travelers’ Health Chikungunya
• Acute infection: non-specific presentation (fever, pruritic rash, arthralgia)
• Severe complications: Guillain-Barre syndrome, other neurologic complications including encephalitis, transverse myelitis
• Diagnosis: RT-PCR or serology, consider testing for chikungunya and dengue as well
• Supportive care, fluids, acetaminophen
• See Travelers’ Health Zika
• Clinical presentation: fever, myalgias, shortness of breath, dyspnea, hepatomegaly, endocarditis
• Diagnosis: serology
• Management: doxycycline preferred
• See Travelers’ Health Q Fever
• Ulceroglandular: skin lesion with central eschar, may be accompanied by lymphadenopathy
• Glandular: tender regional lymphadenopathy without skin lesion
• Oculoglandular: ocular pain, photophobia, lymphadenopathy
• Pharyngeal: severe sore throat, oropharyngeal ulcers, tonsillitis
• Typhoidal: acute or chronic in presentation, may include abdominal pain, diarrhea, hepatosplenomegaly
• Pneumonic: similar to community-acquired pneumonia
• Management: streptomycin preferred, gentamicin is an alternative
• See Tularemia For Clinicians
• Clinical presentation: severe pneumonia, ARDS
• Diagnosis: RT-PCR of lower respiratory tract specimens (sputum, endotracheal aspirate, or bronchoalveolar lavage)
• Management: Immediate respiratory isolation; supportive care; no specific treatment is available
• See Travelers’ Health Middle East Respiratory Syndrome (MERS)
• Early infection: headache, fevers, malaise, arthralgias, lymphadenitis; trypanosomal chancre (rare);
• Late infection: progressive meningoencephalitis and other CNS involvement
• Diagnosis: trypanosome visualization on serum, CSF, chancre or lymph node aspirate
• All patients with concern for trypanosomiasis should undergo CSF evaluation to rule out CNS involvement which can be subclinical
• Infectious diseases clinical consult recommended to guide choice of antitrypanosomal therapy, which differs by species of trypanosome (T.b. gambiense vs. T.b. rhodesiense). Drugs include suramin, melarsoprol, eflornithine, and others under investigation.
• See Travelers’ Health Trypanosomiasis, African (Sleeping Sickness)
• Bubonic: rapid onset of fever, painful, tender lymphadenopathy
• Pneumonic: fever, hemoptysis
• Septicemic: fever, prostration, disseminated intravascular coagulation
• Diagnosis: culture from blood, sputum, CSF or lymph nodes is preferred
• Management: Droplet precautions if pneumonic; streptomycin or gentamicin preferred
• Wilson, Mary Elizabeth. Chapter 5: Fever in Returned Travelers . CDC Yellow Book Travelers’ Health, Centers for Disease Control and Prevention. Accessed 27 September 2017.
• Taylor, Terrie E. Treatment of severe malaria. In: UpToDate, Daily, Johanna (Ed), UpToDate, Waltham, MA, 2017.
• Hopkins, Heidi. Diagnosis of malaria. In: UpToDate, Daily, Johanna (Ed), UpToDate, Waltham, MA, 2017.
• Thomas, Stephen J. et al. Dengue virus infection: Clinical manifestation and diagnosis. In: UpToDate, Hirsch, Martin S. (Ed), UpToDate, Waltham, MA, 2017.
• Wilson, Mary Elizabeth; Lenschow, Deborah J. Chikungunya fever. In: UpToDate, Hirsch, Martin S. (Ed), UpToDate, Waltham, MA, 2017.
• LaBeaud, A. Desiree. Zika virus infection: An overview. In: UpToDate, Hirsch, Martin S. (Ed), UpToDate, Waltham, MA, 2017.
• Day, Nick. Epidemiology, microbiology, clinical manifestations, and diagnosis of leptospirosis. In: UpToDate, Calderwood, Stephen B. (Ed), UpToDate, Waltham, MA, 2017.
• Day, Nick. Treatment and prevention of leptospirosis. In: UpToDate, Calderwood, Stephen B.; Edwards, Morven S. (Eds), UpToDate, Waltham, MA, 2017.
• Soentjens, Patrick; Clerinx, Joannes. Treatment and prevention of schistosomiasis. In: UpToDate, Weller, Peter F. (Ed), UpToDate, Waltham, MA, 2017.
• Krishna, Sanjeev; Stich, August. Clinical manifestations, diagnosis, and treatment of African trypanosomiasis. In: UpToDate, Weller, Peter F. (Ed), UpToDate, Waltham, MA, 2017.
• Ryan, Edward; Andrews, Jason. Epidemiology, microbiology, clinical manifestations, and diagnosis of enteric (typhoid and paratyphoid) fever. In: UpToDate, Calderwood, Stephen B. (Ed), UpToDate, Waltham, MA, 2017.
• Ryan, Edward; Andrews, Jason. Treatment and prevention of enteric (typhoid and paratyphoid) fever. In: UpToDate, Calderwood, Stephen B. (Ed), UpToDate, Waltham, MA, 2017.
• Sexton, Daniel J; McClain, Micah T. Other spotted fever group rickettsial infections. In: UpToDate, Calderwood, Stephen B. (Ed), UpToDate, Waltham, MA, 2017.
• Sexton, Daniel J. Scrub typhus: Clinical features and diagnosis. In: UpToDate, Calderwood, Stephen B. (Ed), UpToDate, Waltham, MA, 2017.
• Sexton, Daniel J. Scrub typhus: Treatment and prevention. In: UpToDate, Calderwood, Stephen B. (Ed), UpToDate, Waltham, MA, 2017.
• Raoult, Didier. Treatment and prevention of Q fever. In: UpToDate, Sexton, Daniel J. and Edwards, Morven S. (Eds), UpToDate, Waltham, MA 2017.
• Raoult, Didier. Clinical manifestations and diagnosis of Q fever. In: UpToDate, Sexton, Daniel J (Ed), UpToDate, Waltham, MA 2017.
• Penn, Robert L. Clinical manifestation, diagnosis, and treatment of tularemia. In: UpToDate, Calderwood, Stephn B., and Edwards, Morven S. (Eds), UpToDate, Waltham, MA, 2017.
• Judd, Michael C; Mintz, Eric D. Typhoid & Paratyphoid Fever . In: CDC Yellow Book 2018: Health Information for International Travel. Oxford University Press, New York, NY, 2017.
• Montgomery, Susan. Schistosomiasis. In: CDC Yellow Book 2018: Health Information for International Travel. Oxford University Press, New York, NY, 2017. Accessed online: https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/schistosomiasis.
• Galloway, Renee L; Stoddard, Robyn A; Schafer, Ilana J. Leptospirosis. In: CDC Yellow Book 2018: Health Information for International Travel. Oxford University Press, New York, NY, 2017. Accessed online: https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/leptospirosis.
• Centers for Disease Control and Prevention. Dengue Case Management Clinician Guide Cdc-pdf [PDF – 8 pages] .
• Nicholson, William L; Paddock, Christopher D. Rickettsial (Spotted & Typhus Fevers) & Related Infections, including Anaplasmosis & Ehrlichiosis . In: CDC Yellow Book 2018: Health Information for International Travel. Oxford University Press, New York, NY, 2017.
• Staples, J. Erin; Hills, Susan L; Powers, Ann M. Chikungunya . In: CDC Yellow Book 2018: Health Information for International Travel. Oxford University Press, New York, NY, 2017.
• Chen, Tai-Ho; Staples, J. Erin; Fischer, Marc. Zika . In: CDC Yellow Book 2018: Health Information for International Travel. Oxford University Press, New York, NY, 2017.
• Kersh, Gilbert J. Q Fever . In: CDC Yellow Book 2018: Health Information for International Travel. Oxford University Press, New York, NY, 2017.
• Centers for Disease Control and Prevention. Tularemia: For Clinicians .
• Watson, John T; Gerber, Susan I. Middle East Respiratory Syndromes (MERS) . In: CDC Yellow Book 2018: Health Information for International Travel. Oxford University Press, New York, NY, 2017.
• Krishna, Sanjeev; Stitch, August. In: UpToDate, Weller, Peter F. (Ed), UpToDate, Waltham, MA, 2017.
• Abanyie, Francisca. Trypanosomiasis, Africa (Sleeping Sickness) . In: CDC Yellow Book 2018: Health Information for International Travel. Oxford University Press, New York, NY, 2017.
• Mead, Paul S. Plague (Bubonic, Pneumonic, Seticemic) . In: CDC Yellow Book 2018: Health Information for International Travel. Oxford University Press, New York, NY, 2017.
• Sexton, Daniel J. Clinical manifestation, diagnosis, and treatment of plague (Yersinia pestis infection). In: UpToDate, Calderwood, Stephen B, (Ed), UpToDate, Waltham, MA, 2017.
• About VSPB (Viral Special Pathogens Branch)

Exit Notification / Disclaimer Policy

• The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
• Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
• You will be subject to the destination website's privacy policy when you follow the link.
• CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website.

• Medevac by Ambulance Aircraft
• Medical Repatriation
• Air Medical Escort
• Domestic Ambulance Flights
• Ambulance Flight Abroad
• 24/7 Medical Flight Services
• Bed-to-Bed Service
• Sea level flight
• Service for International Patients
• VIP Patient Service
• Medical Tourism
• Commercial Airline Repatriation
• Our Airplanes
• Our Helicopters
• Helicopter Air Ambulance
• Ground Ambulance Service
• Executive Air Ambulance
• Pediatric Incubator Transports
• Organ Transport
• Coffins and Funeral Transports
• Air ambulance costs
• How to Save on your Air Ambulance Costs?
• Cheap Air Ambulance Alternatives
• Request a Free Quote
• Our Company
• What we stand for
• Memberships
• Case studies
• Regions of operation
• Medical Travel Guide
• Coronavirus
• How Do Global Air Ambulance Services Work?
• How to organize the perfect MEDEVAC mission?
• Tips to choose the right Air Ambulance Company
• A USA air ambulance guide for American travelers
• All about International Medical Flights
• Everything about Medical escorts and Transports
• Air Ambulance Australia - Life Flight Worldwide
• South East Asia Medical flights - fly worldwide
• Air Ambulance Africa - All you need to know

Can bed-bound patients fly? What is a safe traveling option?

Reading Time: 4 minutes

Table of contents

Bed-bound patients: bed-ridden or on bed rest, medical conditions causing someone to become bed-bound, flying for bed-bound patients: why is it necessary, can bed-bound persons fly, traveling on a commercial flight for a bed-bound person, air ambulance for bed-bound patients: a safer option, why is an air ambulance safer for bedbound patients, our bed-to-bed service: ground transportation for bed-bound patients before and after a medical flight., contact us if you are bed-bound and you need an air ambulance.

How can someone who cannot move from one room to another on his own fly across continents? Is life so restrictive for bed-bound patients that they cannot travel, whether short or long distances? The simple answer to this question is No. While bed-bound patients are at a disadvantage, this does not mean that they are confined to the four walls of their room.

Looking at the medical complications that may cause someone to be bedridden or on bed rest, this article will explore why it might be necessary for a bed-bound patient to travel and the options that are available to him. A bed-bound patient can fly either on a stretcher with a medical escort on a commercial flight or on air ambulances . Both options are suitable depending on the patient’s condition.

When looking at the diseases that might incapacitate someone from moving, it is important to distinguish between a bedridden patient and someone on bed rest. While both of them are bed-bound, their circumstances, medical condition and recovery chances vary greatly.

A patient on bed rest has to lie down at all times as part of medical treatment to try to cure a particular illness . It is a form of a rest cure. In this case, the patient is contained to his bed on a short-term basis only. In some cases, the bed rest is voluntary.

In the case of a bedridden patient, the medical condition of the patient is more serious. Most of the time, the patient is disabled and his movements are restricted to a severe extent . With functional mobility being strongly affected, recovery for these patients is very slow or even impossible.

What causes someone to become bedbound? What are the medical conditions that may incapacitate the mobility of an individual, either on a short-term or long-term basis?

Some of the most common conditions requiring bed rest are:

• Severe back pain
• Knee injury
• Weakness from a debilitating condition

These are temporary conditions that may get better with time, allowing you to resume your life as usual afterward.

How can you become bedridden? The following are some examples of medical emergencies that can cause a person to become bedridden:

• Severe brain damage
• Spinal cord injury
• Myasthenia Gravis- a condition causing muscle weakness
• Stage 4 acute COPD

A bed-bound patient is pretty restricted in their daily activities. It can be quite complex for them to move a few kilometers away, with their movements and functionality being limited. This implies being contained in their home, a hospice or a healthcare facility.

However, there are many cases when traveling, short or long distances, are necessary , even for bed-ridden patients. Examples of such situations are:

• Traveling abroad for treatment : The patient may have to travel to another country to obtain higher quality treatment currently not available.
• Traveling back home : In case of a medical complication while on holiday or business abroad, the patient needs to come back home.
• Transfer between hospitals and homes : Transfers between different healthcare facilities or house.
• Traveling to meet relatives : Traveling to meet relatives and loved ones,

The most important question that comes up when speaking about traveling for someone bed-ridden or on bed rest is “Can he fly safely without any complication”. Would this be possible on commercial flights? This can only be determined by a doctor. As such, the first thing to do when planning a flight for a bed-bound person is to consult your doctor so that he can assess whether the patient is fit-to-fly . Depending on the person’s conditions, there are two different flight options available for bed-bound patients: a stretcher on a commercial flight with a medical escort and air ambulances.

Patients are unaware but flying on a stretcher on a commercial plane is possible for many bedridden patients. Medical Air Service can organize such flights for you wherever you are across the globe. What does it entail exactly?

When opting for our commercial medical escort service, you will be accompanied by our medical escort on a commercial flight . For bed-bound patients, the request to install a stretcher must be made to the airline company. The latter might take a couple of days to deliberate and approve or decline the request.

A safer, faster and more reliable option of traveling for bed-bound patients is via air ambulances . These are medical flights that are equipped with state-of-the-art medical equipment and medical professionals to ensure that the patient is taken care of throughout the flight.

An air ambulance is a private plane. This means that it is dedicated to the patient only. There will be no other passengers on board the place . This offers an added level of privacy and comfort.

An air ambulance, since it is a private jet, can be deployed according to the schedule of the patient. This removes both the need to wait for a commercial airline company to give approval and the risk of the firm refusing to have the patient onboard the plane.

An air ambulance is equipped in such a way that even ICU patients can travel long distances safely , with the necessary precautions taken to cater to medical emergencies.

As it is, being on bed rest or being bedridden implies that the patient is already suffering from an existing medical condition. On top of that, there are several complications that might occur , independently of the existing medical condition.

Some medical conditions that are commonly linked to patients being bedridden for a long time are:

• Muscles weakness
• Muscle shortness
• Pressure sores (bed ulcerations)
• Respiratory problems (lung infection)
• Blood circulation problems
• Bone demineralization

To ensure that the health of a bedbound patient does not deteriorate and that the person remains fit, proper physiotherapy and care are needed.

Considering the number of medical complications that might come up for bedbound patients, an air ambulance is the safer option for patients to travel .

The air ambulances of Medical Air Service:

• Have the necessary medical equipment
• Have doctors and paramedics on board to provide treatment and care
• Are private jets
• Can be deployed according to the patient’s schedule
• Are operational worldwide

As an added benefit for bed-bound patients, Medical Air Services offers a bed-to-bed service. This means that we can collect the patient from either his home or hospital , carry him to a ground ambulance, in which he will be transferred by medical professionals.

At the airport, the air ambulance will already be waiting and the transfer to the plane will once again be done by medical professionals. The same process is reversed on landing. This means that the patient is under the care of medical professionals at every step of the way.

If you are bedridden, on bed rest or have any issue with mobility, get in touch with us. Our agents are available at all times to listen to you and advise you on the best solution for you.

Our quality management is certified by TÜV SÜD according to the DIN ISO 9001 standards.

• Can you transport patients suffering from coronavirus (Covid-19)?
• I found you online – are you the right contact for me?
• How quickly can a repatriation be arranged?
• Which countries do you collect patients from?
• How do I order an ambulance flight?

JavaScript must be enabled to fill and submit the contact form.

We are a partner company of Doctors without Borders.

• Contact form
• Data Protection
• Legal notice

• Main Menu ×
• Search Flights
• Corporate Travel Programme
• Group Booking
• Special Offers
• Travel Insurance
• Flight Schedule
• Check In Online
• Manage Booking
• Seat Selection & Upgrades
• Self-Service Re-accommodation
• Request Refund
• Flight Status
• Nonstop International Flights
• Popular Flights
• Partner Airlines

• Baggage Guidelines
• Airport Information
• Visas, Documents and Travel Tips
• First-time Travellers, Children and Pets
• Health and Medical Assistance

• At the Airport
• The Air India Fleet

• About Flying Returns
• Sign In/Sign Up
• Our Partners
• Family Pool
• Earn Points
• Spend Points
• Upgrade Cabin Class
• Points Calculator
• Customer Support

What are you looking for?

Hi, this website uses essential cookies to ensure its proper operation and tracking cookies to understand how you interact with it. The latter will be set only after consent.

Enter a new world of possibilities

Enrol Now and Earn 1000 bonus points*

Fly with A350-900 Starting 1 st Apr 2024

Travel Period: 1st Apr – 30th Jun’24 *T&C apply

Enjoy an enhanced flying experience with upgrade+

Fly Premium Economy at special fares

Starting @ INR 136,699* for IN – USA USD 1599* for USA – IN

Enjoy 10X Membership Rewards® points on booking Flights.

T&C Apply*

Your check-in window is open now!

Precipitation: | Humidity:

EARN FLYING RETURNS POINTS WITH 50 PARTNERS

A class apart. it’s the new standard..

Discover our world of exclusive offers and services that change the way you travel.

Popular: Mumbai to NYC

Experience new york, nonstop travel time: 15 hours, 15 minutes.

Loyalty Programme

One stop for all rewards. join flying returns today.

Star Alliance

Wherever you venture this season, we'll get you there seamlessly..

Complete Your Travel Pack with Insurance, Hotels, E-visa, and More

Have a question about travelling with Air India? Ask customer service—anytime, 24/7.

Prepare to travel.

Helpful hints for everything from packing to paperwork, so you are fully prepared.

BAGGAGE ESSENTIALS

Travel light on worries and heavy on information. baggage rules decoded..

Airport Adventures

Turn layovers into mini vacations—insights on terminals, lounges, amenities and more..

Before you fly

From visa essentials to medical assistance, everything you need to know., fly nonstop.

It’s time to leave layovers behind. Our nonstop routes will whisk you from India to the heart of Asia, Australia, Europe, the Middle East, North America, and beyond.

San Francisco

Air India Posts

• About Air India
• Corporate Information

BOOK & MANAGE

Where we fly.

• Nonstop Flights

PREPARE TO TRAVEL

Air india experience.

• At The Airport
• Flying Returns FAQ
• Frequently Asked Questions
• Grievance Resolution

Download the app to book and manage your flights on the go. Learn more Details

• Terms & Conditions
• Privacy Policy
• Accessibility Plan and Feedback Process
• Cookie Policy
• Cookie Settings
• Conditions of Carriage
• Domestic Fares
• Travel Agents
• Passenger Rights

Copyright © 2024 Air India Ltd.

All rights reserved. Use of this website indicates your compliance with our Privacy Policy, Conditions of Carriage, Terms and Conditions.

It seems like you're in landscape mode. For the best view, switch to portrait mode where the magic happens!

Simple Flying

Timely help saves passenger's life on an air india flight from tokyo.

A cardiovascular surgeon managed to keep the passenger stable until the aircraft landed.

A difficult medical situation was defused on an Air India flight from Tokyo to Delhi when a doctor came to the rescue of a passenger who suffered cardiac arrest. The aircraft had to be diverted to Kolkata, but thankfully, the doctor provided timely treatment until the aircraft could land.

Medical emergency

On May 26th, an Air India flight from Tokyo to Delhi had to be diverted due to a serious medical emergency onboard. Flight AI307 took off from Tokyo Narita (NRT) at 11:31 for its nine-hour journey to New Delhi ( DEL ). But not too long into the flight, a passenger suffered cardiac arrest.

Thankfully, one of the passengers on the plane was a senior cardiovascular surgeon, Dr. Deepak Puri, from Chandigarh, who was returning from Tokyo after attending a two-day ‘Cardiomersion World Heart Congress.’

Get the latest aviation news straight to your inbox: Sign up for our newsletters today.

Dr. Puri immediately came to the patient's rescue, but given the situation, it was also crucial to take the passenger to a hospital. Upon landing in Delhi, the doctor explained the tricky situation that unfolded thousands of feet in the air and said,

“We were not sure if we could get help if flight was directed to China so it was a daunting task to sustain the patient for five hours with whatever limited medical resources available on flight.”

Timely help

The patient reportedly suffered a massive heart attack on the plane, and it was a challenging task to not only save him but also to keep him stable and monitor the situation until the aircraft landed in Kolkata, which was still five hours away. Dr. Puri was quoted as saying,

“On the heart attack of the patient, I did cardiopulmonary resuscitation and revived him but we were over sea and nearest destination was Kolkata - five hours away - so we had a daunting task of keeping him stable for five hours with minimum resuscitation resources.”

The aircraft landed in Kolkata where an ambulance was arranged to take the patient to the hospital. Dr. Puri deservedly received massive applause from the passengers and crew members for his successful efforts in saving the patient. The plane left Kolkata at 16:03 and eventually landed in Delhi at 18:01.

Medical emergencies

While not a frequent occurrence, medical emergencies do happen on commercial flights . Unlike the situation with the Air India flight, not every flight has a qualified and medically trained professional onboard. Therefore, flight attendants are trained to provide first aid and emergency medical procedures until the aircraft can land.

Get all the latest aviation news right here on Simple Flying.

Cabin crew are also trained to remain calm and professional, as well as being discreet and not to cause any disruption inside the cabin. There are certain protocols and procedures to be followed in such cases, and Simple Flying has looked in great detail at how crew deal with in-flight medical emergencies .

What are your views on this? Please leave a comment below.

Source: IANS via Zee News

International:

941-536-2002

1-800-948-1220

[email protected]

Cost of Medical Evacuation from India is Skyrocketing

Difficulties of transporting patients during the covid pandemic.

While medical evacuation from India to other countries can still be done as of May 1, 2021, the cost of medevac from India is rapidly increasing. What cost from $15,000 to $150,000 a year ago to bring a patient from India to the United States, for instance, now costs from $220,000 to $350,000.

The international restrictions for medical evacuation from India are rapidly changing and have priced many patients out of reach of medevac service. For now, it is still physically possible to transport patients via air ambulance out of India to other countries. Those that can still afford rapidly increasing costs of air ambulance from India and that are anticipating the need for medevac should consider quickly repatriating their patients now before governments further restrict movements. The reasons for cost increases and diminishing window of opportunity for medical evacuation are explained below.

The least expensive option for medical evacuation from India for many patients has been airline medical escort. For those patients that were well enough to travel in business class seating with the aid of a registered nurse, medevac costs were typically less than $20,000. For those patients that needed more medical treatment, the next least expensive option was medical stretcher transport aboard commercial airlines.

However, these services, for all intents and purposes, have been effectively shut down. Nurses travelling to India to retrieve patients now require a letter of authorization from India’s Ministry of Health. That letter, as of this writing, takes at least eight weeks to receive. Nurses travelling from India then require a PCR test, now extremely hard to get in India, that takes two weeks to receive, when testing is available.

Air Ambulance Service is still available from India for both COVID and Non-COVID patients. However, the cost of air ambulance has dramatically increased because of neighboring countries’ restrictions for foreign aircraft. Many countries are now not allowing aircraft that have landed in India to then land in their country, even to simply refuel. Therefore, options for medevac’ing patients from India have been restricted to two costly options.

One option is to use a much larger aircraft with a much greater flight range. The least costly air ambulance jet to medically evacuate patients from India has historically been the Learjet 35A. Yet, the Learjet only has a flight range of about four hours. All countries within this range have restricted planes that have landed in India from landing at airports within their countries. Therefore, Learjets cannot travel from more than four hours away, land in India, and then leave with a patient.

However, planes like the Gulfstream IV have a much longer flying range. Gulfstreams can fly beyond countries that restrict planes from India to land in a country that still allows stops for refueling. The per hour flight cost of a Gulfstream medevac is much more than the cost of a Learjet medical evacuation.

The second option to medevac a patient out of India is to use the services of a few air ambulance companies neighboring India to fly into India to retrieve a patient and then fly back to their base without having to land in another country to refuel. Then companies like Global Air Ambulance can transfer the patient from the retrieving air ambulance company and continue on to the patient’s destination country. In this manner, the retrieving air ambulance company that is restricted from traveling beyond its base, having landed in India, can transfer the patient to a company, like Global Air Ambulance, that has not landed in India.

While this option is temporarily available, neighboring air ambulance companies that are positioned to retrieve patients from India have doubled or tripled their prices thus far during this surging Indian pandemic crisis. This dramatic price increase, some might call price gouging, is outside the control of air ambulance companies like Global Air Ambulance. Global Air Ambulance has not increased our pricing whatsoever, but we must pass through the rapidly increasing prices that other companies are charging for wing-to-wing transfers out of India. This is the reason that a typical price for air ambulance from India to the United States has increased from $150,000 to $220,000, as of this writing.

Countries are continuing to increase restrictions for travel from India. Australia is now not even letting its own citizens return to Australia from India. The United States, as of May 4th, is now restricting travel from India to U.S. citizens and legal residents. These are but a few of the rapidly changing restrictions. We expect that some of the few remaining options for medical evacuation from India will close due to added restrictions in the coming weeks as India continues to be ravaged by an uncontrolled spread of the virus within its borders. Therefore, if you are considering medical evacuation from India, consider expediting your medevac decision.

Call For a Free Quote

Have more questions? We're happy to answer them.

404 Not found

Petition For Air India To Begin Service At Dallas/Fort Worth Receives Nearly 4,000 Signatures

• Demand for direct flights from Dallas to India is high due to a significant Indian population in Texas.
• Air India has considered adding US destinations like Dallas in the recent past.
• With improvements in the carrier's operations, nonstop flights to Dallas may soon become a reality.

The United States continues to attract Indians for various reasons, be it economic opportunities or for higher education, among others. As such, demand for nonstop flights is present almost all year round. And while New York, San Francisco, Chicago and Washington, DC are currently served with non-stop connections, other cities in the country are also demanding direct services.

Petition for Dallas-Hyderabad flight

The significant Indian population in Texas is voicing its opinions about the lack of a convenient way to travel back to India to meet their family and friends. A resident of Frisco, Texas, Venkat Mulukutla, has started a petition to request Air India to start a non-stop service between Dallas/Fort Worth and Hyderabad in South India.

The Indian-origin communities along the East and West Coast and the Midwest have convenient non-stop options to fly back to India, with Air India serving New York-JFK, Newark, Chicago, Washington, DC, and San Francisco. But for those living in Texas, the journey back home is often more than 20 hours, with a stopover at airport hubs in the Middle East or Europe.

Mulukutla’s petition says,

“We request Air India to start a Direct Flight from Dallas to Hyderabad. India. Dallas Fort Worth metroplex and surrounding areas are considered Telugu speaking Hub. Out of 400 thousand Indians in DFW at least 50- 60% are Telugu people. Every Year lot of Telugu students coming to Dallas to study while lot of Telugu including elderly parents are traveling to live with their children.”

He further adds that instead of first flying to places like Doha or Dubai, which are around 4-5 hours away from India, it would be better if Air India offered a nonstop service. The petition has already gained more than 3,700 signatures.

There have been some developments

Air India seems to be aware of the demand for such flights from the US. Not too long ago, Simple Flying reported that the carrier added three additional US destinations to its map – Dallas, Los Angeles, and Seattle. However, those plans did not materialize, and the airline never got around to announcing the routes.

Coming Soon? Air India Adds 3 US Destinations To Its Route Map

While we don’t know the exact reasons for their removal, the development did suggest that Air India is considering expanding into the US. Clearly, there’s demand for such flights, and the carrier would want to capitalize on the opportunity as part of its growth plans.

Possibility in the near future?

Air India has been planning more US flights for the longest time, but several factors – including the lack of enough widebody airplanes – halted those plans. However, there have been significant changes within the company since the Tata Group took over its operations. Several of its grounded widebody planes have been fixed and many more have arrived on leases.

The carrier primarily operates Boeing 777s on its US routes. It has acquired several of these planes on short-term leases and doubled down on existing US airports on its network. Perhaps with the new Airbus A350s, and more arriving soon, we could see more places in the US, including Dallas, appear within its international route network.

Examined: Air India's North American Operations

What are your views on this? Please leave a comment below.

IATA/ICAO Code: AI/AIC

Airline Type: Full Service Carrier

Hub(s): Delhi Indira Gandhi International Airport

Year Founded: 1946

Alliance: Star Alliance

CEO: Campbell Wilson

Country: India

Region: Asia

Agoda to Promote Tourism in Goa Under New Deal – India Report

Bulbul Dhawan , Skift

April 8th, 2024 at 11:00 PM EDT

Goa is seeking to reinvent itself as a year-round destination. Its partnership first with MakeMyTrip and now Agoda is a step towards being known for more than just its beaches.

Bulbul Dhawan

The Skift India Newsletter is your go-to platform for all news related to travel, tourism, airlines, and hospitality in India.

Online travel platform Agoda has signed an agreement with Goa Tourism to promote the coastal state. The collaboration aims to highlight various experiences that the state can offer to different travelers. 

As part of the partnership, Agoda will be creating custom pages and travel guides that would highlight Goa and its hidden gems. It will also be using its social media platforms for the promotion of the destination. 

Goa beyond beaches: In February this year, the government of Goa partnered with online travel agency MakeMyTrip . As part of the agreement, MakeMyTrip will focus on the inland offerings of the state, promoting it as a year-round destination. 

Goa has been focusing on promoting itself beyond its beaches as part of its regenerative tourism initiative and ‘Goa Beyond Beaches’ vision. 

Ooty Most-Searched Leisure Destination for Domestic Summer Travel

Travel insights by online booking platform Booking.com has revealed that Ooty is the most-searched domestic leisure destination this year among Indian travelers. Booking.com Travel Predictions 2024 have revealed that 57% of the Indian travelers are looking to undertake long domestic trips between April 15 and July 15 this year. 

Dubai continues to be the most-favored international destination for summer, followed by Singapore, London, Paris, and Bangkok. 

Santosh Kumar, country manager for India, Sri Lanka, Maldives and Indonesia at Booking.com said that there has been a significant change in the way Indians are approaching summer travel in recent years. “While Indians are exploring both domestic and overseas destinations, we are seeing travelers gravitating towards culturally significant or leisure-oriented destinations with a growing desire for immersive experiences,” he added. 

IndiGo Announces Three Routes in Kerala, Lakshadweep

Budget airline IndiGo has announced three new routes that are set to be operational from May this year. The new routes will connect Kozhikode with Kochi in Kerala; Kochi in Kerala with Agatti in the Lakshadweep archipelago; and Kozhikode with Agatti via Kochi, the airline has said. 

Agatti is the latest destination to be added in IndiGo’s network, after the carrier began operating daily flights there from Bengaluru on March 31 . Vinay Malhotra, head of global sales, IndiGo, said that these new flights would contribute to travel, tourism, and trade in the region. 

The airline’s move is in line with the government of India’s push to tourism in Lakshadweep recently.

Jayaraj Shanmugam Appointed Head of Global Airport Operations at Air India

Air India has appointed Jayaraj Shanmugam as its head of global airport operations, and the appointment is set to come into effect on April 15. Shanmugam is set to join the carrier from Bangalore International Airport Limited (BIAL), where he is the Chief Operating Officer. 

He has previously worked with airlines such as Singapore Airlines, Qatar Airways, and Jet Airways. At Air India, he will oversee the airline’s airport operations worldwide and ensure coordination and efficiency to make the passenger journey smooth. 

RCI Launches First-Ever Cruise Exchange Program in India

Timeshare exchange company RCI has launched its first-ever cruise exchange program in India on the occasion of its 50th anniversary. The program will allow members to use their timeshare ownerships in order to access discounted rates on cruise bookings worldwide. 

As part of the program, active members of RCI would be able to book from a range of cruise options, including different destinations, cruise lengths, and cabin categories, RCI said in a statement. 

Air India Express Launches Bag Track and Protect Services

Air India Express has launched ‘Bag Track and Protect’ services that would let passengers track their baggage. The services have been launched in partnership with Blue Ribbon Bag and would need to be pre-booked by passengers as add-ons. 

This service would also facilitate expedited return of delayed baggage and allow passengers to get compensation in case of delayed baggage not being delivered within 96 hours of landing at the destination. 

Skift India Report

The Skift India Report is your go-to newsletter for all news related to travel, tourism, airlines, and hospitality in India.

Have a confidential tip for Skift? Get in touch

Tags: agoda , air india , Air India Express , airlines , aviation , aviation industry , aviation news , booking.com , cruise , domestic leisure travel , dubai , goa tourism , hotels , india , india outbound , india travel , indian airlines , indigo , indigo airlines , Leisure , leisure travel , leisure travelers , makemytrip , online , online booking , online travel , online travel agencies , online travel companies , skift india report , tourism , Travel Trends

Photo credit: Goa has been a popular Indian destination for a long time, known mostly for its beaches. Incredible India website