After a lengthy treatment abroad, it is very important to get back to work as soon as possible. Going for a treatment, patients usually travel abroad by plane as it is the most comfortable and fastest means of transport for long distances. In the meantime, travelling by air has some specifics. When a plane is twelve kilometers up in the air, a certain level of pressure is maintained on board which is higher than the pressure on earth; at height, the concentration of oxygen is also lower. Moreover, onboard seats limit the ability to change the body position. Altogether, this can affect the patient’s condition.
Sometimes oxygen concentration falls up to 90% or even lower (compared to the standard 92% concentration) which may affect some people’s breathing. While healthy people can cope with this easily and some will not even notice it, those who have recently undergone a heart or lung surgery might face troubles and even suffer from hypoxia – a condition when the quantity of oxygen penetrating into the tissues falls dramatically and may lead to a temporary loss of memory, inability to move or think.
When a person is on their way home after the surgery, because of lowered immunity, their body is in the condition of severe stress by default. Therefore, any influence of bacteria and viruses during the flight may become a source of danger.
Thrombus formation and expansion of gas volumes in the organism are the two other problems that post-surgery patients may encounter when travelling by air. In view of these problems, doctors in Switzerland pay special attention to foreign patients who have stayed in a hospital and are planning to return home by air. As a rule, such patients are prescribed daily anti-thrombosis injections. On the day of the return flight, the injection is made immediately prior to the patient’s departure for the airport.
1. Formation of blood clots
Deep-vein thrombosis (DVT) is a condition when a thrombus (blood clot) is formed in a leg. As a rule, this happens when a wound is healing and blood coagulates or when blood circulation is poor. DVT may have a negative impact on venous valves leading to a poor bloodstream. A detached thrombus may cause a serious damage to the whole organism – up to a fatal outcome. A separated blood clot may appear in the lungs and lead to a consequence known as pulmonary embolism.
Reasons for DVT occurrence during air travel
- Blood clots may be formed due to limited movement as blood circulates slower. Patients under rehabilitation after surgeries abroad are more likely to have thrombus formed during air travel due to limited ability to move on board.
- Dehydration of the organism may be a reason, because vessels are constricted and blood becomes thicker.
- During surgeries which are may be a part of treatment abroad, it is required that the blood is thick to reduce bloodloss. Blood thickening in legs may result in blood clot formation.
The risk zone
Some types of treatment abroad have a higher risk of thrombus formation:
- Operations below the abdominal region
- Cancer treatment
- Treatment of heart diseases
- Any disease or operation with a resulting lengthy immobilization
2. Expansion of gas volume in the body
The gas that expands in various parts of the body during air travel may cause pain, discomfort and possible tissue damage. This condition may lead to serious difficulties during the patient’s rehabilitation after a treatment abroad.
- According to Boyle’s law, pressure and gas levels are inversely proportional to each other. Gas in your organism expands due to declined pressure on board.
- There are several areas in human body where gas is concentrated and may be blocked: for example, middle ear, gastrointestinal tract or lungs. The level of blocked gas rises during the flight, bringing pain, discomfort and a potential threat of adjacent tissues’ damage.
The risk zone
Patients having undergone the following types of treatment abroad fall within the risk zone:
- Colonoscopy or any other procedure resulted in large quantities of gas moving to straight intestine or duodenum.
- Neurosurgical treatments. The flights less than 7 days after a surgery may lead to gas concentration in the braincase.
- Treatment of retinal detachment. The doctor’s permit is required to travel by air in this case as such procedures may cause increased eye pressure increase which may possibly lead even to vision loss in the worst case scenario.
- Operations in the abdominal area. Travel by air is recommended not earlier than 10 days after the surgery because gastrointestinal tract is most sensitive to gas volumes expansion during this period of time.
Which preventive measures can be taken?
First of all, before planning travel home, you should consult with your doctor.
Some airlines have introduced new rules for transportation of clients, and require a notice certifying that the patient’s condition after the treatment abroad is stable and they are allowed to travel by air. In turn, the doctors are urged to thoroughly select words for certificates of this kind and clearly state the patient’s condition, thus confirming a person’s ability to travel by air based on such a notice and not simply on an assumption that they can fly. This means that the doctor should focus on listing the reasons to confirm that the patient is in a sufficiently good physical condition and not only indicate that they can travel by air. In Switzerland, doctors always carefully consult the patients who have undergone treatment in this country in terms of the date and means of travel back home. In some cases, they recommend to choose other means of transport rather than plane.
Patients can also do some things individually to prevent complications during their flight:
- It is recommended to stand up, walk and warm yourself up on board as frequently as possible
- Put on compression clothes for better blood circulation
- It is very important to avoid dehydration. However, you should also avoid caffeinated, sweet and alcoholic drinks, because they have diuretic effect resulting in dehydration
- After treatment abroad, doctors often prescribe blood-thinning medications. Ensure that you use them with care.
- It is recommended to avoid travel after the surgery for as long as possible. If a person needs to travel, they must consult with a doctor.
Medical assistance on board
Nowadays, airlines take care of their passengers’ needs through new norms and rules which ensure that the travel is more comfortable.
Most airlines nowadays have accepted rules that require a defibrillator and a medical kit with extended range of medicaments available on board. Flight attendants must know the rules of providing cardiopulmonary resuscitation and be able to use a defibrillator.
As a rule, a medical kit available on board includes a stethoscope, an Ambu-bag for artificial pulmonary ventilation, syringes and intravenous catheters of different sizes, as well as the most frequently used medical drugs. Flight attendants have learned how to use the content of the kit that must be checked before each flight.
Many airlines all over the world cooperate with onboard medical hotlines. In an emergency, the pilot contacts a hotline and specialists on earth give instructions on required actions. Should an emergency get out of control, the plane will be landed in order to provide qualified medical aid. However, a decision to land the plane can only be made by the captain. If there is a person with medical education among passengers, the crew would usually resort to their help.
Many private companies offer ‘air ambulance’ services. Their job is to make it possible for a person to undergo a surgery in another country or another emergency treatment abroad and then get to their own bed at home in the evening. Patients can travel safely and be sure that they will receive medical aid of the same level as in any hospital.
It is highly recommended to choose a licensed and certified carrier only. In Switzerland, such carrier is REGA. Among the staff of REGA and similar airlines are doctors and junior medical staff with the required education and practice: they know how to deliver medical assistance to a patient and cope with emergencies on board of a plane or a helicopter. There are always pulmonary ventilators, monitors, heart equipment, medical drugs and other equipment onboard to make the flight as safe and comfortable as possible.