The busiest travel days of the year are behind us now (or ahead of us, I suppose, since it’s now 2012), but countless travelers with disabilities or medical conditions will nonetheless continue to encounter difficulty when passing through security. I’ve written about this topic before, but it keeps coming up, so here are 4 FAQs on flying with a disability or medical condition, medical device screening, and the value of air medical transport.
Yes. All passengers are allowed to bring small amounts of liquid on the plane, and some types of liquids are allowed in larger amounts for passengers with disability and medical conditions, including:
However, per Transportation Security Administration (TSA) regulations, “if the liquid medications are in volumes larger than 3.4 ounces (100ml) each, they may not be placed in the quart-size bag and must be declared to the Transportation Security Officer. A declaration can be made verbally, in writing, or by a person's companion, caregiver, interpreter, or family member. Declared liquid medications and other liquids for disabilities and medical conditions must be kept separate from all other property submitted for x-ray screening.”
Yes. Passengers in wheelchairs should have a wheelchair attendant to help them through security. They’ll go to the front of the security line, or through the flight crew line. The TSA is still required to do a security check on the passenger, but instead of going through the metal detector like most of us typically do, the passenger goes directly to the side area where they will be scanned by a TSA official with a handheld scanning device.
Generally, yes. Here the rules are a bit different for getting through security than actually getting on the plane. The TSA recommends but does not require passengers to have documentation of their disability or medical condition in order to proceed through security with a medical device or the liquids listed above (though passengers should be prepared to answer questions about their disability, condition, and devices/medications for TSA personnel).
But to get on the airplane with a medical device like an oxygen concentrator or wheelchair, special documentation called a medical fit-to-fly information form (MEDIF) is required. Unfortunately, we’ve seen and heard about many passengers who were hassled or even denied boarding because they didn’t have the proper documentation.
That’s one reason why having an air medical transport escort can significantly reduce the stress of traveling with a medical condition or disability: the medical escort knows the ins and outs of all the rules and regulations, which can vary by airline and even by airport. At MedFlight911 Air Ambulance, we know the documentation that’s required, the people we need to talk to, and the steps we need to take to ensure that our patients and all of their medical supplies make it safely and comfortably onto the airplane.
This question is actually personal; my mother has cancer, and has a cancer port with metal in its construction implanted in her chest. When she flew in November to visit relatives back East, the TSA screener was unfamiliar that such a device existed and so he put my mother through an unnecessary amount of additional screening until a supervisor who was familiar with it finally stepped in.
Unfortunately, there’s not much we can do to improve the familiarity of TSA screeners with medical devices, but passengers can learn what to say to the TSA screener. And here is another case where having an air medical transport escort who knows very clearly all of the TSA regulations regarding medical devices can help a lot.
Here at MedFlight911, we believe that top-notch air ambulance service starts with having top-notch people. So I’m really happy to congratulate our Medical Director Dr. Charles A. “Chip” Finch Jr., D.O. for his recent appointment to the Des Moines University Board of Trustees. As Medical Director, Dr. Finch provides medical oversight to all patients treated and transported by MedFlight911.
In addition to serving as our Medical Director, Dr. Finch is a partner and staff physician in the department of emergency medicine at Scottsdale Emergency Associates, and in pediatric emergency medicine at Maricopa Medical Center. He has received a variety of accolades, including being named the 2011 Arizona Osteopathic Medical Association Physician of the Year and 2011 DMU College of Osteopathic Medicine Alumnus of the Year.
Dr. Finch also serves on the Board of Trustees of the Arizona Osteopathic Medical Association and the Board of Directors for the American Lung Association of Arizona. He holds faculty and committee positions at the Arizona College of Osteopathic Medicine, where he is chair of the integrative medicine department; A.T. Still University College of Osteopathic Medicine in Arizona; Midwestern University College of Osteopathic Medicine; and DMU, where he is an adjunct clinical assistant professor.
Dr. Finch also serves on the board of directors of Stepping Stones of Hope, a nonprofit organization dedicated to providing care and education to grieving children, families, adults and communities. He is the founder and camp director of Camp Paz, a Stepping Stones program in which grieving adults and children come together to heal in a safe environment (an incredible program that MedFlight911 is proud to support).
We’ve said it many times before, but we understand how stressful and scary it can be for the patient and his or her loved ones when they’re in a situation to need an air ambulance or air medical escort. It’s our job to take the fear and uncertainty out of the transport process, making the entire experience as seamless and stress-free as possible. To make that happen we rely on the best doctors, paramedics, nurses, and support staff, all of whom are passionate about patient care. People like Dr. Finch.
Many of the patients for whom we provide air ambulance service are moving into some form of care facility – so these are issues that are important to us, as they are to caregivers and patients themselves. Earlier this week we outlined the different types of care facilities available. Today we’ll offer some tips on choosing the best place for your loved one.
Making a list
Let’s begin at the beginning: you have determined your loved one’s needs and the most appropriate setting for meeting those needs. Now, you need to locate facilities that fit your criteria. But how do you even begin to find a facility? Look around for this information:
Once you have a list of facilities that might work, it’s time to make contact. Call and ask basic questions: vacancies, number of residents, cost and method of payment, if they accept Medicaid or long-term care insurance, their recreation schedule, and ability to deal with special needs and dietary restrictions. Most of the bigger facilities will have a marketing employee whose sole purpose is selling you on their facility. If they will not return your calls or answer your questions, move on.
Visit, visit, and visit again
You may want to visit facilities by yourself, with your loved one, or with a close family member or friend. Bring someone who will support you in the process; it won’t be an easy one. Caregivers generally hate the first facility they visit; guilt and anxiety usually clouds their judgment. Pick the place furthest away to visit first. Then move closer to your home as the visits get easier. They will get easier!
As you make your visits, consider:
Visit the facility once during business hours and get the “royal” treatment and tour. Then, visit the facility again on a weekend night when the administrative staff is off. This will give you an idea of how the facility runs on nights and weekends.
Weigh your needs versus your loved one’s needs
Determine what is really important in a care facility. A beautiful lobby with a crystal chandelier and a playing piano are nice features, but ultimately your loved one is there to receive care and have the best quality of life possible. Keep those two tenets in mind while visiting facilities and narrowing down your list. A longer drive for you to visit should be outweighed by the better quality of care at a facility further from your home.
Contact your local licensing agency to find any complaints filed against the facilities. Evaluate the severity and type of complaint. A complaint regarding the amount of spice used in a fajita dinner is very different than a complaint about quality of care.
Read the fine print
Obtain a copy of the contract for review. Consider discussing it with an attorney. A comprehensive contract should include:
Choose a facility
Remember that no facility can provide the one-on-one care you provided at home. That does not mean that facilities cannot provide good or even great care. Research your options. Plan ahead as good facilities often have waiting lists. Choose a place that you, your loved one and family are comfortable with and sign on the dotted line.
When patients or their family members hire MedFlight911 for air medical transport they have already figured out where the patient needs to go – whether it’s a specialized care facility or a convalescent care or end-of-life care facility. But today we wanted to skip back a step and help you address what options are available for the care of your loved one, whatever their needs.
They are many options that allow an individual to stay within their home. Home delivered meals, paid caregivers, respite services and adult day care can all be valuable tools. But sometimes care at home is simply no longer safe, comfortable, or practical. The question then becomes how to provide the level of care the individual needs and deserves outside the home.
Just as we advise our clients to consider what their air ambulance needs really are, so we can help them determine the safest and most effective form of transport, so is it important to think about the type of care your loved one needs. A checklist is helpful. Once you have an idea of what activities of daily living (ADLs) your loved one needs assistance with, then you can begin researching your options.
Assisted living homes (ALHs) are licensed to provide care for up to 10 individuals in a residential setting. Homes are licensed to provide different levels of care and there is generally a sliding scale of price based on the care required.
Assisted living facilities (ALFs) are licensed to provide care and assistance with activities of daily living for more than 11 individuals. An ALF commonly resembles a small hotel or apartment complex. Individuals live in an apartment-like setting with their own restroom and possibly their own kitchen. These facilities have medical personnel who can assist with ADLs, particularly bathing, grooming and medication reminders. Higher levels of care are available at increasing prices.
Dementia specific assisted living facilities are care facilities that are specifically designed and built with the needs of individuals with dementia in mind. The facilities most recently built resemble several cottages on a locked campus; however, there are still some locked units attached to ALFs or skilled nursing facilities that provide dementia specific care. The facility’s employees are trained to provide all levels of care. And, most individuals can live in the same facility until the end of their life.
Formerly called nursing homes, skilled nursing facilities are state-licensed, long-term care facilities that offer 24-hour medical care provided by registered nurses (RNs), licensed practical nurses (LPNs) and certified nurse assistants (CNAs). In addition, there is a house physician who visits on a regular basis. Some skilled nursing facilities provide short-term rehabilitation for people transitioning from the hospital to home, but they more typically provide care to the frailest residents who are dependent on nursing care.
These “lifestyle” campuses include facilities providing all levels of care – independent living, assisted living and skilled nursing. Individuals or couples can move onto the campus into a facility appropriate for their care needs at the time and move as their needs change. Generally, these facilities offer multiple amenities. A large buy-in or endowment fee in addition to a monthly maintenance fee is expected.
Because every individual’s care needs are different, the search for the appropriate care facility is different for every family. Begin by defining your loved one’s needs and what type of facility best suits their immediate and long-term needs. In Thursday’s blog, MedFlight911 Air Ambulance on Choosing a Care Facility for Your Loved One, we will focus on turning this knowledge into a concrete decision.
I always like to take some time during the holiday season to reflect on the year that has almost gone by, the moments shared, memories made. As providers of emergency and non-emergency air medical transport service, we meet people at particularly fragile points in their lives – and I mean that for both patients and for their families.
Most of our patients and their families are scared and stressed. When we not only transport them to where they need to go, but also provide a seamless service that relieves a lot of their fear and stress, we make friends for life. It is for these kinds of relationships that I do what I do here at MedFlight911.
So I thought today it would be appropriate to share some stories (many I’ve shared here before in the blog) that are particularly heartwarming, triumphant, or simply reflect the power of the human spirit.
The absolutely heart-wrenching story of Sophie’s Mommy, Kimberly Alvarez, who survived an amniotic fluid embolism while giving birth to her first daughter, but suffered severe brain damage as a result. We flew Kim in an air ambulance to a specialized traumatic brain injury rehab facility in July then fought to get the insurance company to cover the cost of the transport, which they finally did. Kim is still working hard to recover; our thoughts and prayers are with her, Sophie, and the entire family. Read more of Kim’s story here
The story of Aunt Frances, who we flew in an air ambulance from New York to Ohio the day after her 88th birthday. Aunt Frances’ story was graciously shared with us by her niece Elizabeth, who relayed to us how much it meant to Frances and to her family to be together during the last year of Frances’ life (she passed away in the fall). This is part of what Elizabeth had to say: “We were blessed to have the opportunity to share this part of Frances’s journey, even the hardest days, and I want to thank you once again for everything you and your colleagues did that made it possible. It really is comforting to know that help appears when you need it most, from strangers who become friends.” Read more of Frances’ story here
There there’s the story of Jim, the MedFlight911 commercial medical escort whose set Murphy’s Law in motion when, waiting in line for a flight from Florida to Omaha to meet a patient who was travelling to Bulgaria, Jim rushed to the aid of a man who was in cardiac arrest on the jet way. That caused him to miss his plane, which meant he needed a last-minute medical fit-to-fly information form (MEDIF) change because the airline sent the oxygen concentrator he was carrying for the patient to another destination. The day ended with a six hour search for an appropriate facility to take the patient in Bulgaria. Going above and beyond doesn’t begin to describe Jim’s service in this story. Read more of Jim’s story here
While some of the stories we share are in part sad, they are all at the same time uplifting, heartwarming stories of the power of family and the triumph of the human spirit. To me, that’s what the holidays are really all about. So from our family to yours, Happy Holidays.
Issues surrounding caregiving are important to us at MedFlight911 in part because many of the patients who use our worldwide air ambulance service require some form of convalescent care or end-of-life care. Last month, we wrote about hospice. Today I’d like to focus on partnering with the physician to get the best care for your loved one.
Once you have found “Dr. Right” you need to ensure that you get the most out of your time with him or her. Research has shown that on average a patient has 7 to 16 minutes with their doctor. Every minute counts. According to Strength for Caring, a resource guide for caregivers, you should leave the appointment with the following information:
Keep a journal of your loved one’s symptoms – Write down when they began, their frequency and what, if anything, reduces or eliminates them.
Make a list of your loved one’s medications – Include every medication, prescription and over-the-counter. For example, some people may not realize that a self-prescribed baby aspirin will counteract negatively with prescription blood thinners.
Make a list of your concerns – Begin jotting down notes several days before the visit. It may take time to remember everything. Prioritize your list and consider scheduling back-to-back appointments or a follow-up visit if you have more concerns than can be discussed during one visit. Consider faxing the list to the doctor ahead of time and bring an extra copy with you to the visit so he or she can follow along.
Bring a paper and pencil with you – Appointments can fly by, and it’s easy to miss important information. In fact, studies show that anxious patients forget 93% of what their doctor says to them. By writing down key terms and phrases, you can educate yourself later at home.
Speak up – Due to short appointment times issues get prioritized. You may find that your major concern is not on the top of the doctor’s list. Tell the doctor. This visit is your time.
Ask questions – If the doctor’s instructions are unclear, ask. A doctor’s recommendations are only as valuable as the patient’s interest and ability to put them into place. If the individual you are caring for will not swallow pills, for example, ask if the medication can be put into food. If a specific sleep aid causes your loved to be clumsy and at risk for falls, ask if a different medication can be prescribed. Ask if physical therapy, art therapy or music therapy will increase your loved one's quality of life and can be prescribed.
‘Tis the season for air travel delays, which can affect worldwide air ambulance transfers just as they do commercial flights. The most common cause of travel delays this time of year is, of course, weather. When there’s a blizzard at the Denver airport and visibility is too poor for airplanes to land there, that affects air travel across the country (even in Phoenix where it’s 65 degrees) – as planes are re-routed to land at other airports and prevented from departing from other locations going to Denver.
It’s easy to imagine, and it’s true, that when weather prohibits planes from landing or taking off at a commercial airport, private planes at the FBO or local private airport will also not be allowed to land or take off. The fact is that the Federal Aviation Administration (FAA), in charge of managing all commercial and private air travel in the U.S., wants to ensure that air travel is safe – and will hold planes on the ground or divert them to another airport if weather makes it unsafe to take off or land.
One of the most important reasons to use an air ambulance service for a patient with a medical condition or a patient in medical distress is because of our ability to give that patient medical care while we wait if there are delays. Think of the experience of sitting around the airport (or on the tarmac) for hours on end (pretty terrible, right?): that kind of waiting can be dangerous for a patient with medical needs if he or she doesn’t have a medical care provider along with.
But with an air ambulance, we have a number of options to keep the patient safe and comfortable. One, if we know well enough in advance of the delay, we’ll keep the patient at the discharging facility (the medical facility where he or she is currently at) until we have a good idea that we’ll be able to depart soon. If we don’t have that kind of lead time, the air ambulance is fully equipped with medical supplies and equipment to keep the patient safe and comfortable while we wait, and the medical flight crew will be with the patient at all times.
Even when a patient chooses to fly commercial (because he or she is stable enough to do so and determines in consult with his or her care provider that commercial is the right option), hiring an air medical escort is often a very wise decision. The air medical escort is a paramedic, critical care nurse, or physician who travels with the patient on the commercial flight to ensure that the patient stays safe and comfortable.
We cannot, of course, predict or prevent delays in air travel (much as we would like to!), and that’s true for commercial air travel as well as private air ambulance flights. But with an air medical transport provider like MedFlight911 Air Ambulance who is equipped and staffed to provide medical care for patients in even the most acute medical distress, you can at least be sure the patient is as safe and comfortable as possible.
As healthcare costs rise exponentially, air ambulance can be one part of the solution for controlling costs, by enabling patients to access specialized medical care consolidated regionally rather than locally. The rising cost of healthcare in the U.S. is in the news almost every day, it seems. And it’s true: healthcare costs in the U.S. have increased from about 5 percent of GDP in 1960 to about 16 percent today. At the rate we’re going, we’ll be spending 20 percent of our national income on healthcare by 2020.
In response, many medical insurance companies have increased premiums, decreased the percentage of healthcare costs they’ll cover, and eliminated some kinds of coverage altogether. In addition, many state governments, especially, have cut back on funding for state health programs and state health insurance coverage. All of those cutbacks combined have led to the decrease in medical services, even closure of medical facilities – especially in rural areas, and especially of specialized medical services.
Yet people in rural areas still need access to specialized medical services. Imagine, for example, a young person in rural Ohio gets a concussion during a football game. The local doctor is concerned about traumatic brain injury (TBI) but doesn’t have the specialized training or equipment to properly diagnose or treat it. Or imagine an elderly woman in a small town in New York who falls and breaks her hip. The local hospital has no facilities to do hip replacement surgery, and the woman’s family all live in Florida.
In any of these examples – and millions others like them – the role of an air ambulance is crucial. An air ambulance can transport those patients to the medical facilities where they can get the care they need.
A recent public policy paper by the MedEvac Foundation International explained it well: “Current financial pressures on the health care system will only increase. The mismatch between demand and resource availability is becoming more acute. These pressures will continue to erode the availability of hospital based delivery of specialty care and life-saving technologies, particularly in rural areas. The need for increased access to ever scarcer specialty care resources, and the increased need to make such care mobile will increase the need for air medical services.”
Something needs to be done to contain healthcare costs that are spiraling out of control. Consolidating specialized medical services into regional centers makes a lot of sense. Because while an air ambulance may be expensive, it’s a whole lot more cost effective than staffing a traumatic brain injury rehabilitation center, for example, in every small city across the country. In essence, air ambulances allow specialized medical centers to serve much wider regions, which is far more cost effective.
The “rise” of medical tourism has been in the news quite a bit recently, and I’ve been wanting to blog about the topic anyway, plus I just got an email from a patient we transported back to the U.S. via air ambulance last year. So, I figure, now’s the time.
To start, the term “medical tourism” broadly refers to travelling internationally for medical care. Sometimes patients go outside of the United States for health care that is less expensive in other countries; sometimes they go for procedures that they can’t get here.
That was the case for Sarah, who we transported back to the U.S. from Costa Rica after she had alternative cancer treatment there. At the time, Sarah’s health was not good enough to travel commercially, which is why she chose a worldwide air ambulance. I was thrilled to read Sarah’s update that her cancer is now in remission and she’s even back to work part time.
Medical tourism itself can be a fairly controversial topic, and I really don’t want to get into that debate here, but I do want to share a few points that are important to bear in mind for anyone with a medical condition who’s thinking about travelling internationally, or for anyone who’s thinking about travelling outside the U.S. for a medical procedure.
Might you need a worldwide air ambulance?
Point 1: If you’re travelling internationally, think about what you’d do if you had a serious medical emergency. Certainly if you’re travelling abroad to have a medical procedure done, it’s very important to consider what you’d do if the procedure went wrong. What are the hospitals like? Where/how were the doctors trained? Do you speak the language?
If you’re not comfortable with the quality of emergency medical care, if you don’t speak the language, and/or if you would need long-term medical care, then you might need to come back to the U.S.
Point 2: If you’ve had a medical emergency or a medical procedure went wrong, how will you get back to the U.S.? I’ve blogged quite a bit about when a person with a medical condition can fly on a commercial airline. Certainly I would never recommend that a patient in distress fly alone on a commercial airplane; there is simply too much that could go wrong at 35,000 feet to not have expert medical help.
Now a commercial air medical escort is certainly an option, but it’s only for patients who are relatively stable. For the vast majority of patients who have had a medical emergency, and all of those in acute medical distress, a worldwide air ambulance is the only way to get the patient back to the United States to an appropriate medical facility. Because it’s the only transport option that is fast and has the full range of life-supporting equipment.
Point 3: Consider who will cover the cost of an air ambulance should you need it. As I’ve written before, medical insurance sometimes covers international air ambulance transfers, as does travel insurance – but not always. If you elected to travel abroad for medical care and something went wrong, my guess is that neither medical insurance nor travel insurance would cover an air ambulance to bring you back to the U.S. (though that of course depends on your particular policy, and the circumstances).
So again, I’m not giving any advice on whether a person should or shouldn’t go outside of the U.S. for medical care. I’m simply offering some points on things to think about if you are considering “medical tourism.”
The November-December-January holidays are the most highly travelled times of the year. If you’re travelling – whether by plane, train, or automobile – here are four tips to keep in mind if you have a medical condition.
Tip #1: Get travel insurance. I’ve blogged before about the importance of some kind of insurance that would cover an air ambulance transfer for people with medical conditions (see Does Insurance Cover Air Ambulance Service? Part 1 – Travel Insurance). The cost of a policy from Medjet Assist or a similar provider is likely well worth it should you have a medical emergency away from home. Even for travelers without medical conditions, a travel insurance policy that would cover an air ambulance can be a very good idea (especially if you’re travelling overseas).
Tip #2: Move around. Deep vein thrombosis, or DVT, is a clot that forms (usually in the legs), breaks off, moves through the bloodstream, and ends up blocking blood flow to the lungs (pulmonary embolism). It is typically caused by prolonged periods of inactivity, most often when a person is sitting with his or her legs bent at the knee in the same position for an extended period of time – as on an airplane.
To reduce the risk of DVT, move around to whatever extent possible. Changing sitting positions can help get the blood flowing and minimize the chances of a DVT. For passengers who are mobile, that may mean short trips up and down the aisle. Even for passengers who are not mobile, shifting positions and doing leg stretches and ankle rotations can reduce the chances of DVT.
See Traveler’s Deep Vein Thrombosis: How to Stay Safe for more ideas on minimizing the risk of DVT.
Tip #3: Stay hydrated. Staying hydrated is another way to reduce the chances of deep vein thrombosis. It’s also good practice for every traveler in general, helping to reduce jet lag. Especially when travelling on a long flight, staying hydrated (with water, not alcohol or soda) is important. In most airports passengers can purchase bottles of water at the gate-side of security – which is a good idea because it can sometimes take awhile for flight attendants to get water distributed to all passengers on the plane.
Tip #4: Ensure you have the proper documentation to bring your medical supplies and equipment on board. Commercial airlines require passengers with medical conditions who need special supplies or equipment to have what’s called a medical fit-to-fly information form (MEDIF). I wrote about the story of one of our commercial air medical escorts who nearly missed a flight to Bulgaria with his patient because the airline had re-routed the patient’s oxygen concentrator, which was listed on the MEDIF.
For travelers who need to carry liquid medications, syringes, oxygen tanks, or other medical supplies, having those supplies listed on the MEDIF – which must be submitted to and approved by the airline in advance of the flight – is absolutely critical. Getting through security with those kinds of supplies also requires a MEDIF or other documentation that the supplies are medically necessary for the patient.
In the cases we’ve heard about where a patient was denied access to the flight, or even denied passage though security, it’s typically because of confusion about the proper documentation required to bring critical medical supplies past security and onto the airplane. We’ve heard stories of people denied their liquid medications, oxygen concentrators, and other medical necessities because they didn’t have the proper documentation (and rules can vary by country, airline, even airport).
With these four tips, you’ll be well on your way to safe holiday travels this year.