Table 46.1.
Guidelines for medical clearance
| Category | Do not accept | Remarks |
|---|---|---|
| Cardiovascular disorders |
Uncomplicated myocardial infarction within 7 days | Myocardial infarction < 21 days requires MEDIF assessment |
| Uncontrolled heart failure | ||
| Open heart surgery within 10 days | This includes CABG and valve surgery. MEDIF assessment required up to 21 days postoperatively | |
| Angioplasty – No stenting 3 days; with stenting 5 days | Transpositions, ASD/VSD, transplants, etc. will require discussion with airline medical advisor | |
| Circulatory disorders |
Active thrombophlebitis of lower limbs | |
| Bleeding/clotting conditions | Recently commenced anti-coagulation therapy requires assessment | |
| Blood disorders | ||
| Hb <7.5 g/dL | MEDIF assessment required for Hb < 10 g/dL | |
| History of sickle cell crisis within 10 days | ||
| Respiratory disorders |
Pneumothorax which is not fully inflated, or within 14 days after full inflation |
|
| Major chest surgery within 10 days | MEDIF assessment required up to 21 days postoperatively | |
| If breathless after walking 50 m on ground or on continuous oxygen therapy on ground | Consider mobility and all aspects of total journey | |
| Gastrointestinal disorders |
General surgery within 10 days | Laparoscopic investigation may travel after 24 h if all gas absorbed. Laparoscopic surgery requires MEDIF up to 10 days |
| GI tract bleeding within 24 h | MEDIF required up to 10 days | |
| CNS disorders |
Stroke including subarachnoid hemorrhage within 3 days | Consider mobility/oxygenation aspects.MEDIF up to 10 days |
| Generalized seizures within 24 h | Petit mal or minor twitching – common sense prevails | |
| Brain surgery within 10 days | Cranium must be free from air | |
| ENT disorders |
Otitis media and sinusitis | |
| Middle ear surgery within 10 days | ||
| Tonsillectomy within 1 week | ||
| Wired jaw, unless escorted and with wire cutters | If fitted with self quick release wiring may be acceptable without escort | |
| Eye disorders | Penetrating eye injury/intraocular surgery within 1 week | If gas in globe, total absorption necessary – may be up to 6 weeks, specialist check necessary |
| Acute psychiatric disorders | Unless escorted, with appropriate medication carried by escort, competent to administer such | MEDIF required. Medical, nursing or highly competent companion/relative escort |
| Pregnancy | After end of 36th week for single, uncomplicated | Passenger advised to carry medical certificate |
| After end of 32nd week for multiple, uncomplicated | ||
| Neonates | Within 48 h | Accept after 48 h if no complications present |
| Infectious disease | If in infectious stage | As defined by the American Public Health Association (Benenson) |
| Terminal illness | Until individual case assessed by airline medical advisor | Individual case assessment |
| Decompression | Symptomatic cases (bends, staggers, etc.) within 10 days | May need diving or aviation physician advice |
| Scuba diving | Within 24 h | |
| Fractures in plaster | Within 48 h unless splint bi-valved | Extent, site, and type of plaster may allow relaxation of guidelines. Exercise caution with fiberglass casts |
| Burns | Consult airline medical advisor | |