MEDA Part 3: Medical Guidelines for Doctors completing MEDA Part 2

Thank-you for submitting a MEDA for your patient. We are committed to facilitating travel for
passengers with medical conditions and improving passenger medical safety. The Air New Zealand
MEDA is based on the International Air Transport Association (IATA) approved form. Your application
will be reviewed by our experienced Paxcare and Aviation Medicine Unit teams, who will make the
final determination of fitness to fly. To ensure rapid approval for your patient, we need to understand
clearly their clinical condition and how they may be affected by air transport.

Paxcare: MEDA and Special Handling Desk E. [email protected] T. +64-9-255-7757 F. +64-9-336-2856

Key Physiological Considerations when assessing Fitness to Fly

Aircraft cabins are pressurized, but not to sea level. The cabin pressure is typically equivalent of up to
8000ft. This results in:
1) Less available oxygen (PaO2 drops from 21% to a sea-level equivalent of around 15%)
2) Gas expansion in body cavities (approximately one-third increase in volume) – particularly
relevant to trapped gas in the middle ear, sinuses, pleural space and after surgery.

Air travel also results in low humidity, motion, turbulence, immobility and increased stress for some
passengers. Civil Aviation Rules require all passengers to be able to use the aircraft seat with the
seatback in the upright position. Exit row seats are only permitted for able bodied passengers.

When to Submit a MEDA

Submit a MEDA if your patient has any of the following:
1) An injury, illness or medical condition that may cause a significant problem for them or others
in flight (see table below)
- E.g. active heart disease/angina, severe mobility problems, psychiatric problems, injury
and unable to bend at knee
2) A medical condition that may be made worse by the flight itself
- E.g. significant lung disease, ear and sinus problems, recent surgery
3) An infectious disease that could be contagious at the time of travel
- E.g. chicken pox, TB, measles, mumps, influenza
4) A requirement for special medical equipment
- E.g. nebulisers, syringe pumps, CPAP, oxygen
- Wheelchair to aircraft door alone does not require a MEDA if requested at time of
booking

Consider a MEDA for passengers with an obvious medical condition that may cause difficulties or
challenges during boarding (e.g. new limb casts, resolving chicken pox).

Consider continence, mobility and comfort of other passengers. Please advise about recent
exacerbations or complications of chronic conditions. See the table below for further details on specific
conditions.

There is no need to complete a MEDA for mobility problems requiring only a wheelchair to the aircraft
door, visually impaired, hearing impaired or for uncomplicated singleton pregnancy travelling before
the 36th week (see below for further details).

MEDA forms should be submitted 3-14 days prior to travel. For complicated medical situations, a
MEDA may be submitted further in advance in order to gain Air New Zealand Medical Travel Approval
prior to a firm booking. MEDA forms may need to be completed for travel on other airlines.

Confidentiality

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All information contained in MEDAs is treated in confidence and is used only by appropriate Air New
Zealand personnel (or their agents) for the purpose for which it was provided – namely to facilitate
medical clearance and special handling arrangements.

Special medical equipment

All equipment requiring power supply must be approved a minimum of 48 hours but preferably two
weeks prior to travel. Battery powered devices may be used in flight (except take-off and landing) if
they have self-contained batteries and are no larger than standard cabin baggage items.

Oxygen
If your patient requires oxygen during flight this must be pre-arranged a minimum of 72 hours but
preferably 4 days prior to travel and will be subject to fees. Onboard oxygen supplies are for use in the
event of a major aircraft emergency only and should never be relied upon for passengers who ‘may’
need oxygen. If unsure, refer to the recommendations for specific medical conditions below and/or
discuss with the Air New Zealand Aviation Medicine Unit (+64 9 256 3924).

Patient Condition on Room Air General Advice on Supplementary In-Flight O2

Can walk 50m without dyspnoea Unlikely to require (unless other medical
or Sea-level SAO2 ≥93% considerations, see table below)
Sea-level SAO2 89-92% May require
Sea-level SAO2 ≤88% Will require

- For international flights, an “Airsep Lifestyle” oxygen concentrator is provided. Note this is an
on demand pulse flow system so only operates when the patient breathes in. It is usually
provided via nasal cannulae at 2L/minute. In the uncommon event where continuous flow
oxygen is necessary, oxygen bottles will be provided on request.
- For domestic flights, you will be referred to an authorized provider who can provide the
oxygen directly to you. Approval must still be obtained via a MEDA for each journey.
- Air New Zealand can only supply oxygen in-flight. If oxygen is required on the ground (e.g.
during transit) it is the passengers responsibility to arrange supply.
- Personal oxygen bottles may not be used in-flight, but may be carried if packaged and
transported per “Dangerous Goods” carriage regulations. Some personal Portable Oxygen
Concentrators (POCs) may be permitted if pre-approved via MEDA.
- While Air New Zealand will make every effort to have oxygen available on the flight requested,
due to operational matters this may not be possible. In these instances Air New Zealand
reserves the right to request that travel is completed on a flight where oxygen can be supplied.

Liquid, Aerosols or Gels on International Flights: Doctor’s Letter for Medications

Aviation Security measures for international flights include that no liquids, aerosols or gels in
containers over 100ml are permitted into the aircraft with the exception of essential prescriptions,
non-prescribed medications, dietary supplements/foods and other medical items.
• It is recommended that passengers carry a doctor’s letter supporting the need to take any
essential medical items or dietary supplements/foods on board in carry-on baggage for
presentation to Aviation Security. The letter should include the passengers full name (as on the
passport), diagnosis, medication needed, quantities of medication required, and the doctor’s
full name and contact details.
• Carry-on baggage should only contain what is reasonably required for the flight(s) plus
unexpected delays, missed connections, and lost baggage.
• Medication must be dispensed in reasonable quantities and carried in the original packaging
with a clear printed prescription label including the name of the medicine, the passengers full
legal name, doctor and pharmacy details.
• Pills and capsules are not restricted under the liquid, aerosols and gels policy.
• Countries have different custom regulations, which may be determined by contacting the
relevant Embassy or High Commission.

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 Medical Conditions and Recommendations on Fitness to Travel

The following are guidelines to assist you in advising your patients on when they are likely to be fit for travel.
A MEDA is still required even if your patient meets the guidelines. For patients who do not meet the
guidelines, a case-by-case approach in consultation with the Air NZ Aviation Medicine Unit may be
warranted in some circumstances.

Cardiovascular and other Circulatory Disorders Blood disorders

Respiratory Conditions Gastrointestinal
Endocrine Renal disorders
Pregnancy ENT disorders and Dental
Neonates Eye disorders
Orthopaedic Terminal illness
Psychological/ Mental health illness Other conditions/circumstances
Neurological Conditions Organ Transplant

Cardiovascular and other Circulatory Disorders

No MEDA MEDA for PAXCARE MEDA for MO Review
required (if all assistance (if not cleared
apply) without MEDA)
Anginaviii If no angina at rest, Angina with minor Unstable or severe angina (i.e. Angina at
can walk 50m at exertion, need to travel rest or cannot carry out any activity without
moderate pace with in-flight with oxygen discomfort) will require AVMED unit
without SOB or and medications in cabin clearance. Should only travel if essential,
chest pain, and and with supplementary oxygen and
bag.
symptoms well wheelchair. In all cases, must bring
controlled with medication in hand luggage.
medication, may
travel without
supplementary
oxygen.
Myocardial Any passenger with
infarctionviii MI over 2 weeks Moderate risk = no High risk = EF<40% with signs and
ago and evidence heart failure or symptoms of heart failure or requiring
asymptomatic. inducible ischaemia or further investigation/revascularization or
arrhythmia, EF>40% device therapy should be discussed with
Low risk = 1st delay travel ≥10d. AvMed Unit and travel delayed until stable.
cardiac event,
age<65, successful Patients should not fly within 3d of MI,
reperfusion, unless with medical escort, oxygen and
EF>45%, AvMed Unit clearance e.g. emergency
uncomplicated and repatriation.
no further
investigations or
interventions
planned may fly
≥3d.

Cardiac failureviii May travel with controlled and stable

chronic heart failure. Adequate control =
can walk 50m and up 1 flight stairs without
SOB or chest pain, on room air. Borderline
cases may require in-flight O2 and/or

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 medical escort. Patients with SOB/chest
pain at rest or unable to carry out any
physical activity without discomfort or
symptoms should not fly. Advisable to
delay travel 6 weeks after an episode of
acute heart failure.
DVTvii If stable, N/A If significant complications, ongoing
uncomplicated and symptoms or not adequately anti-
on adequate anti- coagulated.
coagulation.

Pulmonary If > 2 weeks ≥ 5 days if anticoagulation Less than 5 days, symptomatic-

embolismvii stable, stable, oxygen saturations shortness of breath with minimal
asymptomatic, normal on room air and no exertion and with complications/co-
uncomplicated and shortness of breath on morbidity.
on adequate anti- minimal exertion. (walking
coagulation 50m).
Pacemaker or ICD ≥ 48 hours if uncomplicated,
insertion no pneumothorax
Angiography/ ≥ 24 hours if uncomplicated
Angioplasty with or and original condition stable.
without stent
Cardiac surgery ≥ 10 days if asymptomatic,
(major) e.g. CABG, uncomplicated recovery and
valve surgery, CXR excludes
transpositions, pneumothorax. Post CABG,
ASD/VSD repairs Hb ≥ 90g/L
Cyanotic congenital If has symptoms at rest or
heart disease with any activity – only
essential flying, with O2
2L/min.
Hypertension Should not fly if
severe and
uncontrolled.

Syncope See neurological

section.

Respiratory Conditions
No MEDA MEDA for PAXCARE MEDA for MO Review
required (if all assistance (if not cleared
apply) without MEDA)
Pneumonia Should not fly until fully
resolved (no SOB, minimal
or no cough).
COPD, emphysema, Mild COPD, Moderate COPDs, Oxygen Severe COPD. Significant respiratory
pulmonary fibrosis, OXYGEN SAT SAT at 88-93%, successful impairment and function, Oxygen Sats
Cystic fibrosis, >93% and able to travel last year with less than 88%. Recent unresolved
pleural effusion, walk 2 flight of supplemental oxygen and no exacerbation/infection, cyanosis on
haemothoraxvii stairs/50m OR Hx other significant cardiac or ground despite supplementary O2 or PaO2 <
of recent travel in other co-morbidities. In- 55mmHg. Inflight Hypoxic event with or
the 1ast year not flight oxygen required 2l/min without supplemental oxygen. History of
requiring oxygen, pulsed delivery generally

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 And no cardiac or sufficient for most people. Pulmonary Hypertension and Right Heart
other significant Please indicate patient’s Failure. Additional information that will be
events. current SaO2 on MEDA useful will include HAST, 6 minute walk
form. test, respiratory physician report and echo
measuring mean pulmonary arterial
pressures.

Asthma Can fly if mild or moderate Severe/brittle asthma – discuss with AvMed
asthma, currently Unit. Note, most common cause for asthma
asymptomatic, travelling attack in aviation setting is rushing to board
with medication in hand flight and forgetting to have inhaler in
luggage. carry-on bag. Consider a spacer.
Pneumothorax – Contra-indicated Rib fractures are not a Earlier travel may be considered in
spontaneous or for flight if lung not contraindication to flight but discussion with AvMed Unit. If Heimlich
traumaticv fully inflated. there should be a CXR type drain and medical escort early
reported by a Specialist transportation is acceptable.
Radiologist excluding
pneumothorax
Chest surgery Thoracoscopic Open procedures, may fly ≥
(pulmonary) e.g. procedures > 48 11days post-op if
lobectomy, hours post- uncomplicated recovery, no
pleurectomy, open procedure and with pneumothorax.
lung biopsyvii no pneumothorax
or other clinically
significant
complications
Lung cancer Recent If respiratory symptoms Not fit to fly if clinical stability in question.
diagnosis of small are minimal and stable and Correct severe or symptomatic anaemia +
lesions with no Hb is > 90 g/L and does significant electrolyte disturbances. If does
clinical symptoms, not need oxygen, recent not meet criteria in column two the case
electrolyte CXR/imaging does not must be discussed with AvMed unit.
disturbance or
associated clinical
show any large pleural
respiratory disease. effusions, and no brain
Or past history of metastases then ok for
lobectomy without approval if specialists
recurrence of letters considers patient fit.
disease and Consider DVT risk to be
asymptomatic. discussed with the
passenger by the treating
specialist.
Major haemoptysis Contraindicated for air travel until clinically
stable. Please indicate Hb on MEDA form.
DVT/Pulmonary See section on
embolismvii ‘Cardiovascular
and other
Circulatory
Disorders’

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Endocrine
No MEDA MEDA for PAXCARE MEDA for MO Review
required (if all assistance (if not cleared
apply) without MEDA)
Diabetes Should not travel if Passenger must carry
unstable, including medication(s) on board and
hypoglycemic administer own medications
attack requiring or have someone with them
assistance of other who can administer. Aim to
in the last 24hours. avoid hypoglycaemia in
Brittle diabetes – flight. Note insulin should
see GP or not be stored in aircraft hold
endocrinologist as too cold. Insulin cannot be
before travel. stored in aircraft fridge –
consider purchase of small
cooling storage wallet. Useful
patient information websites
re diabetes and air travel:
www.diabetes.org.nz;
www.diabetes.org.uk

Pregnancy
No MEDA MEDA for PAXCARE MEDA for MO Review
required (if all assistance (if not cleared
apply) without MEDA)
Singleton, May fly without Pregnancies with Will be considered on an individual basis.
uncomplicated medical clearance complications or beyond the
pregnancy up to the start of allocated timeframes at time
38th week for of travel.
domestic flights or
short international
flights (i.e. up to
5h duration).

For flights >5h

duration, travel
acceptable up to
the start of the 36th
week. Should
carry a letter from
GP/midwife
confirming dates
and that pregnancy
is
uncomplicated/fit
for travel.
Multiple, Travel up to the start of the
uncomplicated 33rd week permitted with
letter confirming dates and
that pregnancy is
uncomplicated/fit for travel.

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Complicated On an individual basis. For fetal problems
pregnancies, or in which baby will need tertiary care travel
history of premature up to term may be acceptable if escorted by
labour midwife with delivery pack and no signs
active labour prior to flight.
Miscarriage Must be stable, no May not travel with active
bleeding or pain bleeding and/or pain.
for 24 hours. Must MEDAs required if bleeding
be in the last 7 days.
haemodynamically
stable. Hb >90 g/L

Neonates
No MEDA MEDA for PAXCARE MEDA for MO Review
required (if all assistance (if not cleared
apply) without MEDA)
Newborns and May travel ≥ 48h <48 h All MEDAs need to be reviewed by MO.
infants after birth if born <37/40 gestation
at term and Complicated birth or requires
otherwise well/no ventilator/incubator.
complications. Complicated neonatal
medical hx. e.g. premature
lung disease or congenital
cardiac disease.

Orthopaedic

No MEDA MEDA for PAXCARE MEDA for MO Review

required (if all assistance (if not cleared
apply) without MEDA)
Lower limb Travel >24 Requiring mobility Major fracture including pelvis/femur
encircling plaster hours post cast assistance Co-morbidities
cast, (Domestic application, no Hb < 90 g/L
flights within New mobility Travel < 24 hrs
Zealand). assistance rqd
Lower limb plaster Travel > 48 Requiring mobility Major fracture including pelvis/femur.
cast, (All flights hours post cast assistance Co-morbidities
outside of New application, with Hb < 90 g/L
Zealand) cast bivalved Travel < 24 hrs
along length, no Risk DVT for flights> 8 hours consider
mobility anticoagulation
assistance rqd.
Upper limb Travel > 24 Requiring mobility Neurovascular compromise
fractures hours post cast assistance Co-morbidities
application, with
no
neurovascular
compromise, no
requirement to
split cast

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Joint Arthroscopy Uncomplicated Requiring mobility Only if complications or significant co-
Procedure procedure. No assistance morbidities
mobility
assistance
required,
Analgesia in
hand luggage
Spinal surgery (e.g. Uncomplicated, Domestic flights under 2 Surgery with complications e.g. dural
Discectomy) adequate pain days and international tear, complex, multi-level procedure.
relief and no under 3 days after surgery
mobility issues. with analgesia in hand
Can travel after luggage, wheelchair assist
2 days domestic as required.
and 3 days
international.
Joint replacement Domestic flights > 3 days International flights at 7-10 days
(e.g. Hip, knee) if uncomplicated, pain consider Hb > 90 g/L, anticoagulation
well controlled, mobility for flights > 8 hours if no contra-
and VTE prophylaxis indication
considered.i
Burns Small, Localised Burn > 10 %, medically Large burns > 10%
area (< 10%) stable and well in other Oral, facial or chest burn, if unstable e.g.
respects, may travel with in shock/ widespread infection or hospital
appropriate wound dressings, to hospital transfer, must be discussed with
hospital with treatment AvMed Unit.
plan,
Analgesia in hand luggage
Mobile without assistance
Ventilators Advice must be sought from Seriously ill cases will require detailed
the airline as to the discussion.
compatibility of any
ventilator with aircraft power
and oxygen supplies.
Head Injuries See ‘neurological’ section.
Wired Jaw See ‘ENT and Dental’
section.

Psychological/ Mental health illness

No MEDA MEDA for PAXCARE MEDA for MO Review
required (if all assistance (if not cleared
apply) without MEDA)
Mental Health Fit for travel if Providing stable for 7days When the mental health disorder is
disorders including condition stable may travel with a doctor unstable, including hospital to hospital
psychosis and for 14 days or and/or psychiatric nurse transfers of unstable patients.
complex psychiatric more AND escort. Consider stress of air Transfer of people under the NZ Mental
disorders. regular travel and length of journey – Health Act.
medication use/ in some cases 2 Where there is a medium to high risk of
management. Fit escorts/security escort may deterioration in flight, risk of harm to crew
if living be required for safety or other passengers, need for medical
independently in reasons. intervention in flight, sedation resulting in
the community, inability to provide self-cares

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 self-managing
personal cares
including any
required
medication.
Fit if condition
unlikely to
deteriorate in
flight.
Consider travel
related anxiety,
alcohol and other
substance use, use
of sedative
medication,
length of travel,
and need for
active medical
support during
flight.

Travel related Fit to travel if If travel related anxiety Where high risk of significant inflight
anxiety including management causing significant pre-travel symptoms/distress, problems with
fear of flying strategies for symptoms OR has caused alcohol or medication misuse, or risk to
anxiety are significant symptoms inflight crew and other passengers.
effective, in the past OR issues with
including alcohol or medication misuse
successful use AND/OR management
during previous strategies only partially
travel. If effective. May require a
prescribed travel companion to assist
anxiolytic with inflight anxiety.
medication ensure
ground trial
before flight and
advice about
avoiding co-use
of alcohol.

Neurological Conditions
No MEDA required MEDA for PAXCARE MEDA for MO Review
(if all apply) assistance (if not cleared
without MEDA)
CVA/TIA ≤ 48 hours should not Minor CVAs including TIAs Travel may be considered after 5 days
fly. fit for travel ≥ 72 hours if with AvMed Unit clearance.
stable and improving. Supplementary oxygen required within 2
Major CVA can travel after 10 weeks of major CVA. Nursing escort may
days if stable. be required dependent upon deficits.
Seizures Should not fly if May travel if ≥ 24hours since First-time seizure requires medical
seizure < 24 hours seizure and control stable. assessment & clearance. Note that relative
before departure or hypoxia at cabin altitude can lower
uncontrolled epilepsy. seizure threshold – encourage compliance
with medication and avoid alcohol.

9
Syncope Acceptable for travel if If age > 70yrs age or syncope Passengers with frequent fainting or
< 70 yrs age with within 24 hours must be suspected underlying CAD, arrhythmias
classic vasovagal cleared by a medical or seizure disorders should be discussed
symptoms, no history practitioner. with AvMed unit.
of CAD, significant
heart arrhythmia, or
suspected seizure
disorders.
Closed head Mild concussion (headache Severe concussion (headache + other
injury only) - travel > 48 hours. symptoms e.g. dizziness, memory loss,
impaired concentration) – delay travel
until symptoms resolved; requires AvMed
Unit clearance.
Skull fractures Depressed skull fractures require
clearance from treating neurosurgeon and
AvMed Unit. Basilar skull fractures – no
flying until CSF otorrhoea, rhinorhoea has
stopped and intracranial air has resolved.
Travel > 3 days if clinically stable & CT
scan shows no intracranial bleed or air. If
scanning unavailable, can fly > 10days if
clinically stable. Urgent emergency
transfers require AvMed Unit clearance.
Subarachnoid / Should not fly < 10 days from
Subdural haemorrhage unless with AvMed Unit
haemorrhage clearance. Travel ≥ 10 days if stable. May
require medical escort depending on
deficits.
Hydrocephalus Travel if clinically stable.

Increased Travel when clinically stable and

intracranial neurologically intact.
pressure
Dementias Very mild dementias Moderate dementia AND If severe e.g. significant risk of acute
without behavioural dependent upon support of behavioural problems that would be
issues. Independent others to live in the difficult to manage in-flight even with
living in the community. escort.
community. Ability to OR living in hospital/rest- Consider provision of oxygen if co-
understand and follow home may travel providing existing heart or lung disease.
crew safety directions. stable behaviour &
May require meet and management with a nurse
greet services at escort.
airports. If stable (calm and co-
No continence issues. operative) may be able to
travel with a non-medical
family/friend escort, but
consider the stressors of travel
and continence issues.
Brain tumour Not fit for travel if significant symptoms
e.g. uncontrolled seizures. Consider need
for escort if significant deficits.
Cerebral Palsy Can travel if clinically
stable.

10
Cranial surgery ≤ 7 days since surgery should May travel ≥ 10 days after uncomplicated
not fly. craniotomy. If considering travel 7-
10days post-op need CT or MRI scan to
ensure no pneumo-cranium. Escort may
be needed if passenger unable to self-care.
Aneurysm ≥ 3days can travel if uncomplicated.
coiling Escort may be needed if passenger unable
to self care.
Spinal Surgery See Orthopaedic
section
Autism

Blood disorders
No MEDA MEDA for PAXCARE MEDA for MO Review
required (if all assistance (if not cleared
apply) without MEDA)
Anaemia Generally fit to fly if Hb ≥ If lower or if concurrent lung or cardiac
90g/L. If due to chronic disease, consider transfusion +/-
disease and compensated, supplementary O2. If acute anaemia, check
consider accepting Hb Hb > 24hours after last blood loss, which
≥80g/L. must have ceased.
Sickle cell disease ≥ 10 days after a sickling crisis. Must travel
with pre-arranged supplementary oxygen.
Bleeding disorders Contraindicated if active
bleeding.
Clotting disorders/ Anticoagulation stabilized
Thrombophilias and therapeutic.
Leukaemias In stable If not in stable remission If Hb , < 60 g/L or clinical concern from
remission with Hb however Hb > 90 g/L and treating Dr regarding fitness to fly, or if
> 90 g/L letter from specialist stating significant comorbid disease
passenger is fit for travel,
may travel without oxygen.

If Hb is between 60 and 90
g/L and the passenger is
otherwise well (e.g. no
significant cardiac or
pulmonary comorbid
disease) may travel with
supplemental oxygen 2 LPM
pulse delivery

Communicable Disease
No MEDA MEDA for PAXCARE MEDA for MO Review
required (if all assistance (if not cleared
apply) without MEDA)
Varicella May travel once all lesions .
(Chickenpox) have formed scabs - generally
around 7 days after start of
rash. Drs note required

11
Measles (English) Travel 5 days from the start
of the rash.
Rubella (German Travel 5 days from the start
measles) of rash.
Dengue Fever Travel if clinically stable.
Transmission Aedes
mosquito. Not transmissible
from person to person
contact.
Hepatitis A,B,C Travel if clinically stable.
HIV Travel if clinically stable.
Lice May not travel if active head
or body lice present.
Meningitis (bacterial May not travel if ill or had recent close
- meningococcal) contact to a person with meningococcal
disease.
Meningitis (Viral) Travel if clinically stable.
Mumps Travel > 4 days from start of swelling if
stable
Shingles Travel if otherwise well and
all lesions crusted over
generally around 7 days (and
covered where practicable).
Tuberculosis (Tb) MEDA required from treating physician
stating passenger is not infectious.
Cholera > 6 days after onset as long as diarrhoea
settled and clinically stable.
Yellow fever May travel > 7 days if clinically stable.
Viral haemorrhagic Absolutely contraindicated for travel
fevers during acute illness.
Mosquito borne No MEDA N/A N/A
viruses such required however
Zika/Dengue/Chikun if acutely
gunya symptomatic
should not fly
until symptoms
resolve

Gastrointestinal
No MEDA MEDA for PAXCARE MEDA for MO Review
required (if all assistance (if not cleared
apply) without MEDA)
Gastrointestinal No travel < 24hours May travel ≥10days if stable. After 1-9days
bleed following bleed. travel may be considered if stable and clear
evidence that bleeding has stopped e.g.
endoscopic confirmation or serial Hb rising
as expected over time.
Major abdominal Usual is travel ≥10 days AvMed unit may consider travel at 7-9days
surgery e.g. bowel post-op if uncomplicated if excellent recovery.
resection, open recovery.
hysterectomy, renal
surgery etc

12
Appendicectomy > 5 days with > 3 days post surgery and
(open) procedure and must have passed bowel
recovery motion and eating and
uncomplicated drinking. Domestic, Trans-
Tasman and International
differs. Hb ≥ 90 g/L and
stable
Laparoscopic surgery Consider travel For less complex procedures More complex laparoscopic procedures
e.g. cholecystectomy, after 3 days if can be cleared with MEDA such as hemicolectomy and less than 10
appendicectomy, uncomplicated after > 2 days if days post surgery, provide MEDA and
tubal surgery procedure and uncomplicated recovery and discharge documentation for review by
excellent must have passed bowel
aviation medical officer
recovery-. motion and eating and
For more complex drinking.
procedures such
as hemicolectomy
OK to travel after
10 days if
uncomplicated
procedure and
excellent
recovery.
Investigative ≥ 24h if N/A Provide MEDA and discharge
laparoscopy uncomplicated documentation for review by aviation
procedure, gas medical officer if criteria in column one not
resorbed (no met.
abdominal
bloating/
distension
present), and no
other clinical
concerns.
Colostomy ≥ 5 days if simple 10 days if also had major abdominal
uncomplicated colostomy. surgery i.e. bowel resection with colostomy.
Colostomy must be working,
patient tolerating oral intake,
no abdominal distension,
nausea or vomiting.
Passenger or an escort able to
care for the colostomy.
Nausea/vomiting or Contra-indicated 24 hours post vomiting or
diarrhoea if actively diarrhoea and
vomiting and/or asymptomatic.
profuse or bloody
diarrhoea; or
symptoms of
dehydration
(weakness,
lightheaded).
Diverticulitis Flying If still being treated with antibiotics or if
contraindicated if still acutely symptomatic, provide MEDA
acutely with results of Hb, WBC and CRP.
symptomatic

13
 especially if
febrile.
If antibiotic
course completed
and symptoms
fully resolved
then no MEDA
required.
Stable chronic
diverticular
disease not
requiring
antibiotic
treatment

Incontinence Urinary: Advise on

incontinence pads and
consider IDUC.
Faecal: Ensure bowel
evacuation prior to departure.

Renal disorders
No MEDA MEDA for PAXCARE MEDA for MO Review
required (if all assistance (if not cleared
apply) without MEDA)
Renal disease Stable and no Required with Check Hb and consider need for transfusion
associated heart complications. E.g. acute or supplementary oxygen if Hb <80g/L
failure on chronic failure with (assuming patient is chronically anaemic
heart failure. Hb>80 g/L. and compensated to this level of anaemia).
CAPD (Continuous May travel if
Ambulatory clinically stable
Peritoneal Dialysis) and Hb > 80g/L
(see note above).
Should travel with
additional CAPD
bags in case of
delays. Due to
large volumes of
liquid being
carried passenger
will need to seek
advice from
airport authorities.
Renal calculus May travel with Travelling with acute renal Travelling with symptoms, on
history of current colic, renal tract international flight.
asymptomatic obstruction. For domestic,
stones or has must travel with health
passed stone/been
professional escort.
treated and now
asymptomatic.
Advise travel with
analgesia.

14
ENT disorders and Dental
No MEDA MEDA for PAXCARE MEDA for MO Review
required (if all assistance (if not cleared
apply) without MEDA)
Ear pain, otitis media Contraindicated May travel if able to clear
& sinusitis for travel if ears, illness is improving,
persistent ear pain pain controlled.
and unable to
clear ear.
Middle ear surgery ≥ 10 days with MEDA from Stapedectomy – as advised by surgeon –
ENT specialist, may require longer on ground
uncomplicated.
Cochlear implant MEDA form not
required unless
complications or
ENT surgeon has
concerns e.g. re
early travel post-
op
Tonsillectomy Due to bleeding For urgent domestic travel, For earlier urgent domestic travel, clearance
risk, avoid non- may fly after 10 days, must be sought from AvMed Unit.
essential air travel assuming no post-op
for 3 weeks post- complications.
operatively.
Wired jaw Must have escort with cutters
and knowledge of how to use
in emergency or if
unescorted, self quick-release
wiring.
Epistaxis (nose bleed) Contraindicated for travel if
active bleeding or has nasal
packing in situ.
May travel if bleeding
controlled > 24hours.

Check Hb if hospitalised.
Nasal surgery e.g. ≥ 10 days if uncomplicated. Earlier travel may be considered if MEDA
rhinoplasty, from ENT specialist.
septoplasty
Dental procedures ≥24h if symptoms
e.g. root canal, controlled and
extractions with analgesia on
hand.

Eye disorders
No MEDA MEDA for PAXCARE MEDA for MO Review
required (if all assistance (if not cleared
apply) without MEDA)
Penetrating eye ≥ 7days – any gas in globe must be resorbed
injury – confirm with ophthalmologist.
Intra-ocular surgery Depends on gas used – ophthalmologist
must confirm. Varies 7-42 days
Cataract surgery ≥24h

15
Corneal laser surgery ≥24h
Retinal detachment If treated with injected oil or If gas injection must wait up to 6 weeks
laser surgery can fly within depending on gas used. If unrepaired retinal
24 hours. detachment may fly as unlikely to worsen
during flight.

Terminal illnessii
No MEDA MEDA for PAXCARE MEDA for MO Review
required (if all assistance (if not cleared
apply) without MEDA)
Consideration must be given If clinical stability in question must be
to mobility, lung function, discussed with AvMed Unit doctor.
bowel and urinary function, Stretcher, oxygen and nurse escort may be
analgesia in flight. required.

Cancer
No MEDA MEDA for PAXCARE MEDA for MO Review
required (if all assistance (if not cleared
apply) without MEDA)
Cytotoxic drugs Customers carrying cytotoxic/cancer
drugs delivered via subcutaneous ports
(power ports) or Hickman Catheters
are unable to fly.

The relevant flight and personal safety

reasons relate to potential spills of
cytotoxic drugs in the cabin
environment and the risks for
customers using these devices having
no rapid access to emergency care in
the event of device disconnection or
sudden drug infusion.

Other conditions/circumstances
No MEDA MEDA for PAXCARE MEDA for MO Review
required (if all assistance (if not cleared
apply) without MEDA)
Allergies We are unable to Food may be brought onto the
guarantee aircraft but is unable to be
allergen-free refrigerated, stored or warmed
meals or aircraft during flight. Food is subject to
cabins. quarantine regulations
overseas.

16
Anaphylaxisiii,iv Allergen-free Recommend travel with Requests for allergen-free environment
environment adrenalin auto-injector in hand in-flight
(including meals) luggage and passenger must be
cannot be capable of self-administration
guaranteed – or travelling with escort who
passengers can can administer adrenaline auto-
bring their own injector.
food but this
cannot be Unaccompanied minor < 16
refrigerated, years not possible. Needs
stored or warmed adult travel companion able to
due to food manage case in the event of
hygiene inadvertent exposure to
regulations. allergen.
.
Scuba diving >24h following uncomplicated scuba
diving. Flying should be further delayed if
multiple dives in the 3days before travel.
Decompression In discussion with treating physician
illness (hyperbaric medicine) and AvMed Unit –
generally 3-7days after treatment.

Organ Transplant/Biopsy
No MEDA MEDA for PAXCARE MEDA for MO Review
required (if all assistance (if not cleared
apply) without MEDA)
Kidney Transplantvi Stable pre- Any other pre-transplant If acutely unwell or criteria in column two
transplant status patients with supporting not met
with Hb >80g/L MEDA from the treating
specialist specifying no
clinical concerns for flying
Liver/Kidney Stable post Stable post procedure > 24 If acutely unwell or criteria in column two
Biopsyvi procedure hours, Hb > 90 g/L and not met
>72hours, Hb > INR considered suitable
90 g/L and INR for domestic air travel by
considered treating specialist
suitable for
domestic air
travel by
treating
specialist.

Other info:
HEPA air filters and frequent air exchange make for minimal air re-circulation during a flight however it is
not possible to guarantee that there will be no exposure in the close confines of an aircraft with surface
touching being another possible exposure point
i
Cooper H J - Air Travel during early post-operative period after TJR – American Academy of Orthopaedics Annual
Meeting March 2013.
ii
Foreign travel for advanced cancer patients: a guide for healthcare professionals – Perdue and Noble Postgrad Med J
2007;83:437–444. doi: 10.1136/pgmj.2006.054593

17
iii
http://www.anaphylaxis.org.uk/living-with-anaphylaxis/travelling/booking-your-flight/
iv
http://www.anaphylaxis.org.uk/living-with-anaphylaxis/travelling/holiday-top-tips/
v
Sacco, F., & Calero, K. R. (2014). Safety of early air travel after treatment of traumatic pneumothorax. International
Journal of Circumpolar Health, 73(1).v73.24178
vi
. Email correspondence with Vascular/Renal transplant surgeon- Dr Carl Muthu, ADHB.
vii.
Shrikrishna, D., & Coker, R. K. (2011). Managing passengers with stable respiratory disease planning air travel: British
Thoracic Society recommendations. Thorax, 66(9), 831–3. ISSN: 14683296 .
viii. Smith, D., Toff, W., Joy, M., Dowdall, N., Johnston, R., Clark, L Cleland, J. (2010). Fitness to fly for passengers with
cardiovascular disease. Heart, 96 Suppl 2, ISSN: 1468201X
Rose D M, Fleck B, Thews O, et al. Blood Gas-Analyses in patients with cystic fibrosis to estimate hypoxaemia during exposure to high
altitude in a hypobaric chamber. Eur J Res 2000; 5, 9-12
J Cyst Fibros. 2002 Dec;1(4):281-6. Predictors of desaturation during formal hypoxic challenge in adult patients with cystic
fibrosis. Peckham D1, Watson A, Pollard K, Etherington C, Conway SP.

Fitness to fly for passengers with cardiovascular disease – the report of a working group of the British Cardiovascular Society – Heart
2010;96:ii1-1116. Doi:10.1136

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