For someone who is ill or suffers from a serious medical condition, the act of preparing for surgery or treatment can be debilitating both mentally and physically. In the best of cases the person may face multiple doctor appointments, medical exams, financial burdens, and perhaps even doubts about the ultimate success of the treatment, all while attempting to balance work and family commitments.
When we talk about medical travelers, one must also add the stress and anxiety of travel to the mix. We know that healthcare providers are experts at supporting patients while they are within the walls of the hospital or clinic, however, not all are prepared to do the same while patients are traveling to and from their facility. Airports and flying can be especially challenging for any patient, particularly those with special needs or who have never travelled before. What can healthcare providers do to promote safety, increase comfort and ultimately ease the stress of travel?
Patients with special needs
Some of the individuals traveling to your hospital or clinic will be patients with special needs. They may have to travel with wheelchairs or oxygen tanks, or possibly require the assistance of a nurse or family member. While most persons with special needs do not require medical clearance before travelling, some airlines may ask for evidence of fitness to travel in order to ensure the patient is able to attend to his or her personal needs. In these cases, it is helpful for healthcare providers to provide patients with a ‘travelling letter’ that gives a brief description of their condition, disability or physical limitations and what type of assistance they might need.
Important information to convey to patients with special needs
Prior to travel, inform patients that they should inquire with their airline about:
- Available assistance at check-in, while moving around the terminal, during boarding and disembarking. Most airlines will provide assistance to passengers during these three phases including providing wheelchair assistance, mobility assistance – getting in and out of the plane, and assistance with battery-powered medical devices. Patients who require a wheelchair or other mobility assistance should advise the airline of their need during booking and no later than 48 hours prior to the flight.
- Airline policy on taking equipment such as wheelchairs, portable machines, batteries, respirators or oxygen. Some carriers require that travellers contact the airline to confirm if a given medical device is approved for travel. In the U.S., for example, passengers can only board with portable oxygen concentrators (POC’s) that are approved by the Federal Aviation Administration (FAA). Restrictions for other devices can vary depending on the airline. Patients should advise the airline in advance if they plan to take their own wheelchair or other mobility aid as most commercial airplanes only have room in the cargo hold for one folding wheelchair. 
- Special meals. Most airlines can provide a wide variety of meals including vegetarian, Kosher, Muslim, diabetic, and low sodium. However, these should be requested at least 24 hours prior to take-off.
Traveling patients are apt to carry medications to and/or from the medical travel destination. However, patients may not be aware that medications are subject to special screening protocols or that some types of medications may even be restricted in certain countries.
Drugs available as a prescription in one country may be illegal or highly regulated in other countries. It goes without saying that the patient experience will be seriously compromised if the patient faces drug charges on your watch.
- Patients should be advised to inform the destination healthcare provider of the names of any medications they will be bringing into the country.
- Additionally, healthcare providers should ensure that any medications prescribed to the patient after treatment (prior to departure) are legal in the patient’s country of origin and the countries they may pass through in transit.
- It is also recommended that the treating physician provide each patient with a letter stating what medical conditions he or she has and what medications were prescribed, including their generic names.
Packing and security screening
Flight delays and lost luggage are not an uncommon occurrence. Patients should be advised to stow their medications and prescriptions in their carry-on luggage to ensure quick access and reduce the possibility of losing items. Medications should also be labeled and placed in a separate zip lock bag for security screening.
Passing through airport security can be daunting even for seasoned travelers. There are the seemingly interminable lines, the shouts and instructions from stone-faced security personnel, the frantic struggle to pull off shoes and discard water bottles, and finally the hulking machines that scan our bodies. To make this process less intimidating for patients, let them know in advance what to expect and what actions they can take to reduce chances for delays or additional screenings. This includes:
- Informing security officers prior to screening if they have metal implants, such as artificial knees or hips.
- Informing security officers prior to screening if they using a prosthetic limb or other medical device such as an insulin pump or ostomy bag.
- Packing medications separately in a zip lock bag and declaring them prior to screening. Note that medically necessary liquids are allowed through a checkpoint in any amount once they have been screened.
Does it seem like your legs have grown several inches every time you settle into a seat in economy class? Actually you are not that far off. Airlines are continually looking for ways to squeeze more passengers onto each aircraft. One way to do this is to shorten the space between rows. According to reports, over the last several years the space between seats (between your seat and the seat in front of you) has decreased on average from 35 inches to 31 inches and on some airlines even to 28 inches.  For patients with limited mobility or who have just undergone surgery, this phenomenon is not only uncomfortable but potentially dangerous. Conditions such Deep Vein Thrombosis (DVT) – a potentially fatal condition where a blood clot forms in one or more of the deep veins in your body, can occur if passengers sit too long without moving their legs. To reduce these risks and increase passenger comfort, high risk patients should be advised to book one of the following options (in addition to taking any medications prescribed by their physician):
- Business or premium economy class
- Bulkhead seats
- Aisle seats with lifting arm rests
The first two options offer more leg room and ease of mobility, while the third option offers patients more opportunities for stretching their legs and ease of access and exit. Note that morbidly obese patients should be informed that they may require two seats.
Arrival at destination
These days some large airports almost resemble small cities with their array of restaurants, shops and even hotels. Patients disembarking from their flights can easily get lost or disoriented as they attempt to navigate the ongoing rush of passengers heading to immigration and customs. Late night and early morning arrivals can be especially challenging as information kiosks and other services may be closed. It is also important to keep in mind that traveling patients may not be familiar with the language and culture of the destination; this, couple with exhaustion from the flight can make patients feel even more disoriented. What can you as a hospital do to help?
- Depending on the size and complexity of your city’s airport, it can be helpful to provide patients in advance with a map and detailed wayfinding information to help expedite their exit from the airport and ensure they quickly locate appropriate transportation options or the prescribed meet and greet location.
- Ask an employee from your organization who is already traveling, to pay careful attention to the airport arrival process and to watch out for any challenges patients may experience.
- Ask traveling patients if they are experiencing any challenges.
Remember, it’s all about reducing obstacles and making the process easier for your patients. The more data you gather, the better decisions you can make to improve the traveling patient’s arrival experience.
Don’t let what you can’t control become a barrier to achieving patient satisfaction
GHA advocates for improving the patient experience at all stages of the medical travel care continuum both within and outside the clinical environment. And while it is acknowledged that healthcare providers cannot control all activities or interactions that occur during the travel process, they do have the ability and responsibility to 1. Identify situations that have the potential to negatively impact patient safety and the patient experience and 2. Proactively educate traveling patients to better prepare and deal with these situations. Ultimately the travel process is an important component of the medical traveler’s experience and, as such, should be rigorously monitored to ensure it does not become a barrier to achieving patient satisfaction with a hospital’s medical travel services.
 Wattles, J,. Judges Order FAA to Review Airplane Seat Sizes. CNN Money 2017. Retrieved from http://money.cnn.com/2017/07/29/news/companies/faa-airline-seat-sizes/index.html on January 23, 2018.
 Mayo Clinic Retrieved from https://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/symptoms-causes/syc-20352557 on January 23, 2018.
 USA Today, Rules for Flying with Prescription Drugs. Retrieved at http://traveltips.usatoday.com/rules-flying-prescription-drugs-63212.html on January 23, 2018.
 American Airlines – Mobility and Medical Devices. Retrieved from https://www.aa.com/i18n/travel-info/special-assistance/mobility-and-medical-devices.jsp on January 23, 2018.
*Medical travel is also known as medical tourism or health tourism.