AIR MEDICINE

Scheduled air travel

Factors to consider when taking an airliner.
Many airlines offer advice to passengers who are in doubt about taking a flight in case of disability, for general travel medical information, international prophylactic indications and for general health and hygiene advice.
Air Medical also offers a free consultation service.
Our Medical and Nursing Staff is present at the Operations Centre 24 hours a day and is able to provide information on the feasibility of a flight in case of illness.
Our Air Ambulance service comes to the rescue in all those cases in which it is not possible to make a trip on scheduled airplanes with Assisted Medical Transport, and in all those cases where an Air Medicine Service is indispensable.

How come flying can be dangerous?

When you fly, you reach altitudes that would not allow the survival of the body, where there are very cold outside temperatures (-57 degrees Celsius) and a partial pressure of oxygen really very low.
In addition, there are ionizing radiations of the sun (UV rays, X rays, etc.). Although these conditions are not the best, there is no need to worry or be afraid, because the interior of the aircraft has a hypobaric environment, with normal temperatures and a partial pressure of oxygen corresponding to 2000-25000 meters above sea level.
It must be said, however, that although a healthy person does not suffer from this pressure surge, a person with cardiovascular or pulmonary problems, for example, may suffer. Given the conditions, there is a very low percentage of humidity which favours phenomena of dehydration of the body tissues.
In short, although it is not risky for most people, it is still stressful for the body. Moreover, especially if you travel in economy class, you are forced to sit for the entire duration of the flight, bringing the arteries and veins mainly of the legs to a compression that can generate ischemic phenomena, venous states and formation of edema or swelling, usually in the ankles and feet.

When to avoid flying

For the reasons mentioned above, there are categories of diseases that could be risky for those affected.

Cardiovascular diseases

• Ischemic heart disease with recent angina attacks.
• Coronary bypass for less than 10 days, without prior cardiological evaluation.
• Heart failure.
• Uncontrolled hypertension.
• Uncontrolled arrhythmia.
• Primary pulmonary hypertension.
• Congenital heart disease.
• Patients with unstabilised pacemakers.
• Obese or high body mass index (BMI) elderly patients with coagulation disorders, polycythemia, thrombophilic states or recent surgery

Respiratory diseases

• Moderate or severe respiratory failure.
• Patients with pneumonia, bronchopneumonia, alveolitis, tracheitis, acute infectious bronchitis or TB in progress.
• Pneumothorax for less than 2 weeks.
• Asthmatic patients, no bronchodilators at hand.
• Pulmonary capacity less than 50%.

Haematological diseases

• Moderate or severe anemic states.
• Recent Hemorrhages
• Severe haemoglobinopathies, severe thalassemia and sickle cell anemia.

Psychiatric and neurological diseases

• Epilepsy or epileptic states, without medication.
• Psychotic or agitated patients.
• Dementia, Parkinson's disease or confusion, if not adequately accompanied.

Also, you should avoid flying:
• After abdominal surgery and up to 24 hours after colonoscopy.
• Before 10 days of neurosurgery and 48 hours after orthopaedic surgery.
• 2 weeks after ophthalmic surgery for retinal detachment.
• When you have an ear infection or nasal polyposis (also immediately after a nose and throat operation).

For reasons of common sense and possible contagion, it is not advisable to fly with any acute infectious or parasitic condition in place, as infections or epidemics can easily spread rapidly in the aircraft, causing contagion.
Moreover, premature infants up to six months after birth and healthy infants only after the first week are strongly discouraged from flying. Pregnant women, on the other hand, are not allowed to fly after 36 weeks of gestation, as the flight puts the foetus at risk.
In any case, for all cardiological patients or those with heart failure, oxygen therapy must be provided.

Tips for a more comfortable journey

Flying by plane, especially if long duration, exposes you to small but sometimes annoying problems. Some small devices can allow a more comfortable journey.

Dryness of the air

To avoid disturbances caused by dryness of the air in the cabin of the aircraft is advisable to follow the following advice:
• Use a nasal decongestant
• Remove contact lenses during flight
• Drink plenty of water
• Avoid caffeine and alcohol

Immobility

One of the major health risks during air travel is immobility; you can do isometric exercises while staying in place (e.g. press your feet on the floor with force, alternate contractions and release of calves and thighs); when possible it is useful to take short walks in the hallway. These movements allow for better blood circulation and prevent thrombosis.
Those at risk of venous thrombosis (e.g. pregnant women, elderly people, recently operated individuals, patients under hormonal treatment, people with cancer) should wear elastic stockings suitable for the purpose and possibly, if there are no risks and only under medical prescription, may take a small dose of aspirin or receive an administration of heparin before the flight.

Pressure variation during flight

The pressure inside the aircraft cabin is maintained at between 2,000 and 2,400 metres above sea level.
The most common problem is ear discomfort.
Nasal decongestion can be achieved through abundant hydration and the use of spray and fluid decongestants. Chewing American gum can also help unlock the fallopian tubes and thus reduce discomfort.
It is advisable to stay awake during take-off and landing maneuvers to minimize these inconveniences.

Jet Lag (time zone syndrome)

During long air journeys to the east or west there is a change in the time zone which can have consequences especially on sleep cycles; the loss of the synchrony of the sleep-wake rhythm causes a reduction in the ability to control actions and mood alterations; other disorders may be loss of appetite, nausea, constipation, irritability.
The disturbance is proportional to the number of time zones (in particular it occurs after 4 hours).
On average, travellers need one day to recalibrate their biological clock for each hour of time zone change. The sleep-wake rhythm is generally restored in a short time while the other rhythms (execution of fluids, bowel movements, melatonin) require up to 6 and even 18 days to recover.
Adaptation is easier on journeys to the west (with a reduction in the day) than on journeys to the east.

Minimizing the effects of jet lag

The main factors influencing adaptation to the new time zone are meal times and exposure to sunlight.
Rest before you leave. Organize your trip well: a peaceful trip is important to adopt as soon as possible the rhythm of the country of destination (unless your stay lasts less than 48 hours, in which case you should not change your habits). To minimize the impact of the Jet Lag start the adaptation by moving one or two hours a day, in the days before the trip, the hours of meals and sleep.
Transoceanic trips sometimes make adaptation more difficult by not allowing sleep as the meals served by the companies do not agree with the arrival time. In these cases it is advisable to eat before departure and then try to rest on the plane and alternate rest with short physical exercises.
Do not drink alcohol
Do not drink coffee or beverages containing caffeine
Melatonin: this substance can help you synchronize your internal clock to circadian rhythms. A dose of 2 mg taken at the first evening can anticipate the circadian rhythm by about 3 hours and reduce the discomfort from Jet Lag by 50%.
However, a recent work by Spitzer RL et al. (Am J Psychiatry 1999; 156:1932) has not demonstrated its effectiveness either at a dose of 5 mg or at a dose of 0.5 mg. A diet based on carbohydrates during the flight (for those who can afford it), can facilitate sleep and a more energetic meal (meat, cheese) after disposing of the fatigue of the trip, can help alleviate the disorders of Jet Lag.

Also, you should avoid flying:
• After abdominal surgery and up to 24 hours after colonoscopy.
• Before 10 days of neurosurgery and 48 hours after orthopaedic surgery.
• 2 weeks after ophthalmic surgery for retinal detachment.
• QWhen you have an ear infection or nasal polyposis (also immediately after a nose and throat operation).

For reasons of common sense and possible contagion, it is not advisable to fly with any acute infectious or parasitic condition in place, as infections or epidemics can easily spread rapidly in the aircraft, causing contagion.
Premature infants up to six months after birth and healthy infants only after the first week are strongly discouraged from flying. Pregnant women, on the other hand, are not allowed to fly after 36 weeks of gestation, as the flight puts the foetus at risk.
In any case, for all cardiological patients or those with heart failure, oxygen therapy must be provided.

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