Flying with Oxygen: Air Ambulance vs. Commercial Airline
If you or a loved one has breathing difficulties and needs to travel with supplemental oxygen, you face special hurdles when planning a trip. Not only can factors such as the change in elevation and cabin pressure make breathing more difficult, but airlines also have strict rules about bringing oxygen on board. Depending on your health and the amount of oxygen you need, you may need to travel via ground ambulance or air ambulance rather than a commercial flight.
There are a number of restrictions regarding oxygen on commercial flights. Only "Airline Approved" oxygen concentrators are permitted on commercial flights; you will need to check with airline's reservations or the airline's website for a list of their approved concentrators. Most airline approved concentrators are capable of a maximum of 3 liters/per minute constant flow or 5 liters "pulse" (intermittent) flow. If the patient is already on oxygen at 2-3 liters/minute at home, once at an altitude of 30,000-40,000 feet, there will not be enough reserve to meet any additional oxygen demand and possibly resulting in discomfort for the patient or trouble breathing. You also must bring 1.5 times the battery requirements for your flight time and oxygen rate. If your concentrator batteries are capable of providing power for 2 liters/min for an hour and your total flight time is four (4) hours, you will need 6 batteries. If you need more oxygen or your flight is longer than that, you'll have to find another way to travel. But that's not all.
Airlines require passengers who need supplemental oxygen to produce a letter or document from their doctor verifying the need for oxygen, and to notify the airline in advance of their trip. Typically, you must have your physician complete and submit to the airline's medical department (up to 72 hours in advance of your flight), a "MEDIF" or "fit-to-fly" form, and have a confirmation from the airline of acceptance. (This form can usually be found on the airlines website).
In some cases, you can't bring your own oxygen unit on board and will need to make arrangements for oxygen delivery at the airport. An airline may even charge an additional fee to passengers who require oxygen while in-flight. Because the restrictions vary based on airline and destination, we strongly recommend checking with your carrier well in advance of your trip to make sure you understand what you need to do to prepare. (You can see the guidelines from American Airlines here, and the guidelines from United Airlines here.) Fortunately, you don't necessarily have to manage all this on your own. A commercial medical escort can help you manage travel when you need supplemental oxygen, providing valuable support on the day of travel.
If travel via commercial airline is impossible (which may be the case for patients with conditions like advanced lung cancer or cystic fibrosis), there are still options. While commercial airlines only allow small portable oxygen concentrators on board, an air ambulance can accommodate a large "M" cylinder oxygen tank, which can provide 15 liters of oxygen per minute for nearly five hours. But because the canisters are so large – about the size of a 10-year-old child – the air ambulance can't accommodate more than one, and a stop may be scheduled to refill the canister during a longer flight. For example, MedFlight911 recently arranged an international medical transport from South America to the U.S. for a patient who needed supplemental oxygen. The flight time was nearly 10 hours, so we had to schedule a stop to both refuel and refill the oxygen.
Another option for patients who need oxygen may be ground transport via medical motor coach. Like an air ambulance, a motor coach carries the oxygen concentrators capable of up to 20 liters/minute that some patients need..
The bottom line: Even patients who need large amounts of supplemental oxygen can travel, though they will probably need to make special arrangements. And if you need oxygen and are planning a commercial flight, make sure you check in with your airline in advance. There could be restrictions that make it difficult – or even impossible – for you to fly. In that case, an air ambulance or medical motor coach could be your best option.