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    Special Assistance

    Contra-indication and Advice for Sick Passengers Traveling by Plane

    Advice for Sick Passenger

    Sick passengers are sensitive to minor changes, therefore medical consultation before travelling is necessary to minimize health risks.  Medications must be kept in the hand luggage. Travelers with metallic prosthesis, cardiac pacemaker, internal defibrillator or those who have to carry medical equipment on board must travel with a medical certificate.  
    Disabled passengers who need assistance during flight must be accompanied and notify in advance for special arrangements by cabin crew.

    Passengers with medical conditions not treated and stabilized, or passengers which conditions that can be aggravated during flight, must have medical clearance before flight reservation.

    Note: A MEDIF (medical information form) must be filled by treating doctor to inform the details of the medical conditions, and if special equipment such as oxygen, a wheelchair or stretcher is needed. THAI has the right to refuse, delay or ask for changing travel conditions. Travelling by plane is permitted only for treated and stabilized patients.

    The following conditions are contra-indicated for air travel :

    • Infant less than 7 days of age,  the cabin atmosphere can cause problem for newborns. MEDIF is needed for premature babies.
    • Pregnant women : non complicated pregnancy is accepted on board; the conditions depend on the airlines to prevent premature labor on board; caution should be exercised about frequent flying during early weeks because of hypoxia. The conditions for pregnant women are as follows :
    • Pregnancy more than 28 weeks must have a medical certificate confirming the date of delivery and conditions of pregnancy
    • Single pregnancy can travel until 36th week for the flight less than 4 hours and 34th weeks for the flight more than 4 hours. The medical certificate with estimate date of delivery and confirmation of a normal pregnancy is needed. 3. Multiple or complicated pregnancy (placenta previa, past history of premature delivery etc.) are relatively contra-indicated for travelling long distance by air, the medical approval from the company is absolutely needed. 4. Pregnancy more than 36 weeks is an absolute contra-indication for travelling by air.


    • Patient with cardiovascular and pulmonary diseases

    Assure sufficient quantities of cardiac medications for the entire trip, including sublingual nitroglycerin, and keep in carry-on luggage. Keep a separate list of medications including dosing intervals and tablet size in the event that medications are lost. Limit unnecessary ambulation, particularly inflight. The following conditions are not safe for air travel :

    • Unstable chest pain - Recent myocardial infarction (MI) and congestive heart failure should not fly until at least 6 weeks have passed and they are back to usual daily activities no more chest pain
    • Coronary artery bypass grafting (CABG) and other chest surgeries should wait until the air is resorbed 2 weeks before air travel because air is transiently introduced into the chest cavity, there is a risk for barotrauma at decreased atmospheric pressure
    • Uncontrolled heart failure
    • Untreated hypertension with systolic blood pressure higher than 160 mmHg. No contra-indication to air travel for patients with hypertension as long as it is under reasonable control. Such patients should be reminded to carry their medications onboard
    • Untreated arrhythmia (heart rhythm must be controlled and on anti coagulant for travelling)
    • Decompensated valvular diseases
    • Scuba diving less than 24 hours or decompression sickness
    • Untreated or unstable pneumothorax
    • Undrainaged pleural effusion
    • Asthma, air travel is contra-indicated for those with asthma that is labile, severe, or that has required recent hospitalization. For asthmatics of less severity who are fit to fly, it is imperative that they are reminded to hand-carry on board any vital medication, particularly inhalers for rapid relief of symptoms
    • Chronic obstructive pulmonary disease (COPD). Patients with chronic bronchitis, interstitial lung disease and emphysema are susceptible to significant inflight hypoxemia, depending on their baseline PaO2. Preflight evaluation of these patients is ability to walk 50 meters  or climb stairs without dyspnea and shortness of breath
    • Uncontrolled respiratory failure
    • Patient under mechanical ventilation or with the unstable condition for the trip
    • Active pulmonary infection
    • Neuromuscular diseases with hypoventilation and require a mechanical ventilation
    • Pulmonary tuberculosis especially in immunodeficients treated less than 2 weeks
    • Thoracic surgery less than 3 weeks
    • Special precaution for the patients with tracheostomy  because of low humidity in the cabin


    • Central Nervous System Disorders

    • Uncontrolled epilepsy or the patients undergone for brain surgery with no complications less than 2 weeks. Normally, the passengers with stable epilepsy or after brain surgery may be more prone to seizures during a long flight, mild hypoxia and hyperventilation are known precipitating factors, in addition to the aggravation of fatigue, anxiety and irregular medication. Whilst it would not be appropriate to change medication immediately prior to a trip, consideration should be given to providing extra anti-convulsive medication. If nothing else, the passengers with epilepsy must ensure that they have sufficient medication in their hand baggage for the duration of the flight and also for any unexpected delays
    • Following a stroke or cerebrovascular accident passengers usually have to wait at least 2 weeks before travel if stable or recovering. For those with cerebral artery insufficiency, hypoxia may lead to problems and supplementary oxygen may be advisable
    • Patients with accident and brain injury less than 15 days
    • Untreated brain edema or lumbar puncture less than 1 week
    • Patients who have recent brain scan with use of contrast media less than 3 days
    • Psychiatric patients need medical clearance in advance of intended travel. Patients with psychotic disorders who are stabilized on medication and are accompanied by a knowledgeable companion plus suitable sedation may be able to fly


    • Gastro-Intestinal Disease :

      Passengers may experience abdominal discomfort because of gas expansion in fight.

    • Patients who have abdominal surgery in which hollow viscus has been sutured are at risk of perforation or hemorrhage as a result of gas expansion at altitude. Air travel should be discouraged for 2 weeks following any abdominal surgical procedure
    • Travelers with colostomies are not at increased risk during air travel although intestinal distension may increase fecal output. The use of a large colostomy bag is recommended. More frequent changes may be necessary for smaller bags and extra supplies should be carried in the cabin hand baggage
    • Patients with intestinal occlusion or with hemorrhage from ulcer sites or rupture of esophageal varices. For hemorrhage, travel may be permitted if there is clear endoscopic evidence of healing or wait for 3 weeks and hemoglobin level more than 10 g/dl
    • Severe gastroenteritis with dehydration
    • Patients who have gastric or intestinal surgery in the past 7 days
    • Patients who have a colonoscopy in the past 24 hours


    • Deep Vein Thrombosis (DVT):

    Passengers are at risk of developing economic class syndrome from cramped seating, inactivity, prolonged immobilization, depletion of body fluids causing increased blood viscosity, poor blood circulation and swelling of feet and legs then a thrombus develops in the deep veins. To reduce the risk while traveling it is recommended to wear comfortable shoes or take shoes off, exercise the calves, mobilize, stretch arms and legs every couple of hours, walk around the cabin, avoid sleeping pills, remain adequately hydrated and avoid excess alcohol.

    • Others medical problems

    • Ophtalmological conditions such as retinal detachment less than 3 weeks, acute glaucoma or recently operations (in the past 1 month), recent cataract surgery, unhealed keratitis, ocular surgery in the past 3 months
    • Acute sinusitis or acute otitis
    • Ear surgery in the past 3 months
    • Severe anemia with hemoglobin less than 10 g/dl. At low oxygen levels in cabin, passengers may experience lightheadedness or even lose consciousness during flight and hemoglobin less than 8.5 g/dl is contra-indicated for air travel
    • Diseases that need medical equipments forbidden by airline regulation
    • Transmitted infections : chicken pox, measles, mumps, pertussis, herpes zoster etc.
    • Immunodeficient patients with severe complications
    • Unstable diabetes must not travel by air. For well controlled diabetes, the first step is to order from the airline, in advance, the appropriate diabetic meal. Diabetic travelers should carry all medications (as well as needles, syringes, blood glucose monitors, sugared snacks, and a device to store needles/lances) in carry-on luggage and not in checked luggage. Journeys may across several time zones. It is recommended to remain on departure time during the flight and attempt to readjust to local time on arrival at destinations
    • All recent surgery or recent injury, gas trapped within the body will cause problems at altitude
    • Recent fracture under plaster cast (cast must be split for traveling to avoid compartment syndrome or harmful swelling on long flight)
    • Severe burn or infected large wounds
    • Terminal stage of illness which can deteriorate during trip
    • Precaution for the patients with urinary catheter, balloon must be filled with water, the catheter changed before departure with no sign of  urinary tract infection by direct examination and by urine culture


    If you require the use of wheelchairs, please click here for more information.


    Nut Allergy

    Due to the number of passengers on THAI flights, the company cannot guarantee a 100% nut-free environment in its lounges nor aircraft cabins. Nevertheless, if THAI is informed well in advance of a passenger’s medical condition, the company will strive to ensure that each touch point is aware of passenger requirements.
    We also highly recommend that you carry your medication and/or medical ID bracelets at all times, as well as alert THAI staff in cases of allergic reaction.