Key points

  • Fitness to fly is decided by the treating doctor, often with the transfer medical team and, for scheduled flights, the airline's medical department.
  • Doctors consider the patient's stability, breathing, recent surgery and the length of the whole journey.
  • The decision can change, so families should expect it to be reconfirmed close to departure.

“Is the patient fit to fly?” is the question that decides whether a transfer happens, what kind of transfer it is, and when. It is answered by doctors, never by a coordinator, an airline booking agent or a family member. This guide explains what goes into that answer so that families understand the conversation.

It is general information. The treating doctor’s assessment of an individual patient always takes precedence.

Who makes the decision

  • The treating doctor at the sending hospital knows the patient’s condition and makes the primary assessment.
  • The transfer medical team reviews the medical summary and agrees what care and equipment the journey needs.
  • The airline’s medical department, for scheduled flights, decides whether it will carry the patient, usually based on a form completed by the treating doctor.

What doctors usually consider

Stability. Whether the patient’s condition has been stable recently, and how likely it is to change during the journey.

Breathing and oxygen. Aircraft cabins are pressurised to a lower pressure than at ground level, so there is less oxygen available with each breath. Patients with breathing or heart conditions may need supplemental oxygen, or may need a dedicated aircraft where more support is available.

Recent surgery or procedures. Air in body cavities expands at lower cabin pressure, so after certain operations or procedures doctors may advise waiting before flying.

Position and mobility. Whether the patient can sit upright for take-off and landing, or must lie flat on a stretcher.

The whole journey, not just the flight. Ward to ambulance, ambulance to airport, waiting time, flight, airport to hospital. For a long journey the total time matters more than the flight time alone.

What happens if something changes. What equipment, medicines and skills the medical team needs to respond during the journey.

Why the answer can change

A patient who is fit to travel on Monday may not be on Tuesday, and the reverse. Doctors usually reconfirm fitness to fly close to departure, and transfer plans should allow for that. A coordinator who promises a fixed departure time before the clinical picture is clear is promising something no one can guarantee.

What families can do

  • Ask the treating doctor directly whether they consider the patient fit to travel, and by what means.
  • Make sure the medical summary is current. Old reports slow everything down.
  • Tell the coordinator about any recent change in the patient’s condition, however small.

The fitness to fly assessment often decides between a dedicated air ambulance and a commercial flight with an escort. It also determines what the documents for the transfer must include.

For a patient travelling home after treatment in India, see returning home after treatment.