"They wouldn't send their patient with a serious pulmonary problem to Denver, and they wouldn't send them on an aircraft if they knew that the oxygen level in the blood decreases at 8,000 feet," Garrett says. "The body may or may not be able to compensate, depending on the severity of the disease."
Claude Thibeault, a doctor and aviation medicine expert, agrees that most doctors aren't well-versed with cabin altitude issues. It's a "legitimate concern" whether a person with a pulmonary disorder should fly, he says.
Frederick Tilton, the FAA's federal air surgeon, declined a request for an interview, but provided written responses to questions. He says individuals with medical conditions that require oxygen "should consult with their personal physician to determine fitness to fly before contemplating air travel." Individuals shouldn't fly "if they are medically unstable, and physicians should advise them against doing so," he says.
But Paul Billings, vice president at American Lung Association, says he's not aware of any data that show a traveler with lung disease is at any greater risk in-flight than someone with another disease. New technology "holds promise to open the skies" to those with respiratory problems and should be celebrated, he says.
Garrett predicts that an increase in oxygen-assisted passengers will lead to more in-flight medical emergencies and more flights diverted for emergency landings.
MedAire's statistics show that it responded worldwide to about 100 in-flight medical emergencies each day last year. More than 2,700 were for respiratory problems, including 182 for COPD. The company consulted on 62 flights last year that made an emergency landing because of a respiratory problem.
Airlines aren't equipped to handle many types of in-flight medical emergencies. Flight crews can administer first aid and assist choking victims, Garrett says, but they aren't trained and don't have the equipment to deal with more complex illnesses.
The airlines agree that they can provide "only emergency first aid," says David Castelveter, spokesman for the Air Transport Association, which represents most big carriers.
Flight crews are given basic emergency medical training, Tilton says, and flight attendants receive instruction in cardiopulmonary resuscitation and use of an automated external defibrillator.
Air of freedom, concern
Betsy Blake, 52, of Opelika, Ala., flew about three times a month as vice president of sales for a plastics manufacturer until she was diagnosed with chronic pulmonary disease about six years ago. "It's a shock when you find out you can't live without supplemental oxygen," she says.
Last January, she took her first flight with a portable oxygen concentrator, lugging extra batteries just in case. Her trip from Atlanta to Tel Aviv, via Frankfurt, Germany, went so smoothly, she flew to Honduras last month. The trip went off without a hitch. "I'm passionate about my oxygen concentrator," says Blake. "It's restored my vibrancy and enthusiasm toward life."
Though not required to do so, some airlines began allowing oxygen concentrators on planes after the FAA approved two manufacturers' units last year. Among other conditions, the FAA requires those airlines to ensure that the concentrators do not interfere with a plane's electrical, navigation and communications equipment, and that no smoking or open flame is permitted near a passenger with a concentrator.
In comments submitted in January regarding the Department of Transportation's proposed medical oxygen rules, the Air Transport Association said safety experts have expressed concern that oxygen concentrators' batteries could short-circuit and cause a fire. The group called on the agency to adopt the FAA's stowage and packaging rules for the batteries. New technology has incorporated safeguards that prevent a fire, says Daryl Risinger, vice president of Inogen, one of the approved manufacturers. Concentrators "use the same battery technology as laptop computers," he says.
Airlines have established a hodgepodge of conflicting policies, and some airport security screeners seem unaware of the new rules.
Portable oxygen concentrators are small, portable devices that separate oxygen from nitrogen and other gases in the air and provide oxygen to users at greater than 90 percent concentration.
Major airlines provide oxygen but typically charge $75 to $100 for each leg of a flight. That increases the cost of a direct round-trip ticket by as much as $200.
An Expanding Horizon MedAire's business grows as airlines realize the advantages of inflight medical emergency support BY Monica L. Rausch, Associate Editor July 1999...