Can a bed-ridden person be transported by air?

Rudy de Kort / 22 June 2022

Some people have compelling reasons to travel, but can’t sit up because of severe pain, discomfort or weakness. They might be unconscious or sedated, or suffering from late stage dementia. They might even be in a palliative state, and on their way home. These are the cases where airlines team up with commercial medical escort companies and other specialty service providers to safely transport the passenger to the scheduled destination. And where air travel is not possible, there are also other options to transport a stretcher-bound patient over a long distance. I’ll explain.

Can a bed-bound person be transported on a commercial plane?

It is a question that many families face after their loved one suffers a stroke, severe injury or in the wake of major surgery. In these cases, arrangements to support daily life at home or in the community are readily available. But what happens if someone needs to travel by plane, but can’t sit up for a long time? I’ll discuss different options. Each come with a price tag, but while there are many reasons why people can be medically unfit for air travel, being immobile, alone, isn’t necessarily a reason to keep a traveler on the ground.

Flying Business Class when you can’t sit

Upgrading to Business Class can solve the problem. Sometimes. International long-haul flights and busy domestic routes are often operated by aircraft with lie-flat pods. The extra space, complimentary pillows and the option to recline to a position of comfort, can take away a lot of pain and discomfort. Lie-flat seats are in that sense more comfortable than an airline stretcher.

But you’ve got to be sure though what seat you are getting on your flight, as Business Class can also mean a wider seat, with no full recline, or even a Kurt row of Economy Class seats of which the middle seat has been left unoccupied. The same route you are familiar with could be operated by a Dreamliner with lie-flat pods on the 8 am flight, while the 10 am flight is flown by a narrow body Airbus with classic Business Class seats.

It is also important to know that every passenger who boards a commercial flight needs to be able to sit up for at least thirty minutes for take off and another thirty minutes for landing. If a passenger shows up at the gate, and is not able to sit properly in a wheelchair, the airline staff will deny boarding until a doctor can provide a fit to fly letter. So, in all cases where someone can’t sit at all due to for example severe pain, weakness or paralysis, a lie-flat pod won’t be an option either.

Book a commercial airline stretcher on your plane

Most of the larger commercial airlines in Europe, Asia, Africa, Australia and the Middle East allow a stretcher onboard. Not only can the patient travel on the stretcher for the full duration of the flight, but there are special procedures in place to board and deplane the aircraft in private, without obstructing other passengers. The stretchers are designed to fit in an airline cabin. They are usually installed in the back of the Economy cabin, after blocking off six to nine seats. Some privacy is offered by a small curtain around the stretcher, and space is always limited. A commercial airline stretcher can only be booked if the patient is accompanied by a medical travel companion or a commercial medical escort who can provide in-flight care. This service is a separate booking, with a specialized company, independent from the airline. It is often best to speak to the medical escort company first, and have them book the stretcher with the airline, as part of their service. The cost of flying on a stretcher is significantly higher than booking a Business Class seat, but also significantly lower than chartering an air ambulance, especially on ultra long-haul flights. A commercial airline stretcher is not always an option though. There are body weight restrictions. Airline stretchers are also not offered by low cost carriers, for operational and logistical reasons, and if you need to travel domestically within North America, the option is completely unavailable. None of the Canadian or American airlines offer stretcher services on their aircraft. So can a bed-ridden person fly within Canada or the US? If they are flying internationally, directly to or from North America, they can book a stretcher with any of the foreign carriers that support air stretcher service and depart or arrive at one of the major airport hubs. But on any connecting domestic flights, a commercial airline stretcher is not an option in either the USA or Canada.

How to transport a sick person to another state or province by air

People in the United States or Canada can fly in on a stretcher, if they are coming from let’s say Asia or the Middle East, but they can’t transfer to a stretcher on a connecting domestic flight within the country. If the final destination is in another state or province, there are two options left: an air ambulance or a long distance ground transfer by a long-haul ambulance service. The fastest and most practical option, is the air ambulance. It is also the most expensive option. It is after all a private charter plane, with a crew of pilots and aeromedical staff and a fully equipped cabin that supports patient transport. But even air ambulances come in different colors and flavors. Cost will depend on a number of factors like, what type of aircraft is being used? And how many fuel stops need to be made to bridge the distance? What level of care is needed? That last question is important to keep in mind. A patient who needs critical care during the transfer, will be transported by an expensive ICU-equipped air ambulance, with a critical care team onboard. But a patient needing only a basic air stretcher setup, can be safely transported by a basic air ambulance, with a single flight nurse and overall a lower price tag. So make sure the service offered is suitable for the patient’s care needs.

Long distance patient transport when flying is not an option

There are long-haul ambulance companies out there, that take interstate patient transfers across the US or from one province to another in Canada. They provide an excellent and much needed service for those who cannot fly, not only because they need to lie down, but for a broad range of reasons when someone is considered unfit to fly by an airline. Even cross-border transfers are done on a daily basis by ground ambulances between the US and Canada, with distances up to 1500 kilometers covered. Long distance ground ambulances come with entertainment screens, food and beverage services, comfortable mattresses for the patient and a family member, and extra drivers who can swap, drive or rest every so often. It’s a great resource, but whether it is a viable option needs to be evaluated by professionals, as case-specific factors are now in play, to balance out patient safety, comfort and cost. Does the itinerary include multiple stopovers? Is the distance manageable over the road or will the transfer simply take too long? Will the extra space in the back of the ambulance and the ability to make road stops add to patient safety and comfort, or will the length of the trip and the changes in road conditions cause more stress and discomfort?

Organizing the in-flight care for a traveling stretcher patient

So a very sick person who cannot sit up can travel by air, if he is otherwise fit to fly. But it’s important to realize that a stretcher on itself is not the answer to the question how to transport a bed-bound patient on a flight. The care provided in-flight needs to be solid. Lying down on a narrow stretcher for hours and hours at altitude comes with the risk of pressure sores and blood clots, and other complications. So frequent positional changes are needed, as well as professional observation and monitoring and symptom control with medication and oxygen. Also consider that toileting on a stretcher, in a confined space, will take the help of an experienced air medical escort.

Rudy de Kort is a flight paramedic and the founder of Jet Companion, a commercial medical escort company based in Canada.

EVERY MILE WE FLY IS FOR THE PURPOSE OF REUNITING PEOPLE OR BRINGING THEM TO SAFETY