After an accident or surgery, flying overseas may be more complicated than you think

“You won’t be able to fly back to the States,” said one doctor.

“The airlines aren’t going to want to go near you,” added another.

Neither considered me “fit to fly.”

You’d have thought I had some exotic disease. But the problem was a punctured lung, or pneumothorax, which had occurred when I broke several ribs in a riding accident. The bigger problem was that it had happened in England, on the day I was meant to take a transatlantic flight back to Washington.

The risk, the doctors explained, was that as the plane went up and the cabin air pressure went down, the air trapped between my lung and my chest wall would expand, further squashing my lung — with potentially dire consequences. Do a little online reading and the stories of emergency in-flight interventions could scare you onto an ocean liner. There’s one particularly gripping tale of a resourceful orthopedic surgeon who improvised an OR in the back row of a plane and used a coat hanger, a bottle of Evian water, some oxygen tubing and a roll of tape to save the life of a woman whose damaged lung collapsed somewhere over northern India. He disinfected it all with a bottle of five-star brandy and noted later that “while the procedure was obviously painful for the patient, she seemed better within about five minutes and went on to make a good recovery.”

Phew.

For her, that is. But it wasn’t the way I hoped to travel back to the States.

The question I needed to answer was how long I should wait before launching my lung on a long-haul flight. And more broadly, what about flying after breaking a bone, after a bout of angina or even after minor surgery? With more than a billion people traveling by air every year, these are becoming increasingly important questions. And as it turns out, the science isn’t settled, and airlines in different parts of the world manage “fitness to fly” issues quite differently.

The Alexandria-based Aerospace Medical Association issues health tips for passengers, as well as guidelines for health-care professionals to help them advise patients about the safety of air travel with certain medical conditions.

Executive director Jeff Sventek says that the nonprofit organization is in the process of updating its 2003 guidelines in coordination with various professional bodies, such as the American College of Emergency Physicians and the British Thoracic Society, to create a living document that will reflect the science as it evolves.

It’s not as if there are large randomized controlled trials, after all, of people with recently punctured lungs who’ve been sent off on flights just to see what happens. As Michael D. McGonigal, director of trauma services at Regions Hospital in St. Paul, Minn., and author of the Trauma Professional’s Blog, says: “Like a lot of what we do in medicine, there are small reports, but very few definitive answers.”

Generally speaking, though, professional organizations and airlines agree that the physical and psychological stresses of flight — such as changes in air pressure, low humidity and oxygen levels, cramped quarters and jet lag — can have an adverse effect on anything from an ear infection to a recently treated detached retina or a person’s mental state. And concerns extend beyond the well-being of the individual, to whether his or her condition could affect the safety of fellow passengers or even the operation of the flight.

In the United States, Sventek says, “the effort is to allow passengers to make decisions in coordination with their personal physicians, rather than ­­a government-regulated approach.” Hence his organization’s guidelines.

But many airlines ask passengers with medical conditions listed on their Web sites to get doctors to complete fitness-to-fly forms, which are then reviewed by the airline’s own medical department before the passenger boards.

The International Air Transport Association, which represents 240 airlines, publishes a medical manual advocating a clearance procedure for every airline but also says that uniformity isn’t possible because of the need to adapt to local laws. It singles out U.S. legislation, designed to protect the rights of the individual, as “a good example” of an approach “that constrains medical clearance. This in turn . . . makes it virtually impossible to harmonise the individual airline rules and forms.”

Some international airlines state on their Web sites that when they’re operating flights in and out of the United States, they don’t ask for the same clearance that they require in other parts of the world.

So the rule of thumb, particularly for passengers traveling internationally, is to do your own research, as I learned.

Check the IATA manual under “respiratory disorders,” and the first condition listed there is “pneumothorax.” Passengers can be accepted for flight, it says, “14 days after inflation for traumatic pneumothorax.”

A couple of weeks after I broke my ribs, an X-ray showed that my lung had reinflated, so I looked for a flight for a little more than 14 days after that as far Dublin. Aer Lingus asked me to complete an “Incapacitated Passengers Handling Advice Form” with questions for my “attending physician,” which were then reviewed by the airline’s medical department. My medical clearance came through a day before my flight.

I also called United to confirm a flight from Dublin on to Washington and, based on my experience with Aer Lingus, asked whether I’d need medical clearance.

“No,” came the ticket agent’s reply. “The only medical forms we require are from women in their ninth month of pregnancy.”

“We rely on our customers to determine whether or not flying is in the best interest of their health,” explained Jennifer Dohm, a United spokeswoman. “In a case where a customer is clearly unwell, we will discuss with the customer if it is in their best interest to fly.”

Sellers is a senior writer with The Washington Post Magazine.

Frances Stead Sellers is senior writer at The Washington Post magazine. She joined the magazine in 2014 after spending two years as the editor of the daily Style section, with a focus on profiles, personalities, arts and ideas.
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