The Assessment of Fitness to Travel

Abstract

The majority of health problems encountered in association with travel stem from pre-existing, perhaps latent, illness in the individual which may be exacerbated by the rigours and hazards of travel. It is essential that the advising physician understands the hazards that are likely to be encountered during travel in order that they may develop informed decisions regarding fitness for travel and give appropriate advice. In an occupational health setting, the employer has a responsibility to safeguard the health of their employees whilst travelling on behalf of the organisation and will also have to fund any treatment abroad or the cost of repatriation. The dictating factor in determining fitness to travel will often be fitness to travel by air, consequent to the reduced partial pressure of oxygen and pressure changes in-flight. The majority of significant health problems encountered during travel are attributable to coronary heart disease and detailed guidance exists to determine fitness for travel. For many health problems little if any evidence based guidance exists and decisions will therefore have to be based on an understanding of the hazards likely to be encountered during travel. Access to appropriate standards of medical care abroad and the difficulties and expense of repatriation, should this be necessary, are also important factors to consider in addition to the basic determination of fitness for travel itself. This paper outlines the main factors to be considered when assessing fitness to travel and also examines available guidance for some of the more commonly encountered conditions.

How do you get there with Diabetes? Results of a Survey of Diabetic Travelers

“…Additional travel-related issues that need to be considered are co-morbidity control, travelrelated infections, problems carrying injection material through travel security checkpoints, and unanticipated problems with their glucose meters, insulin pumps, or continuous glucose monitors. Furthermore, the risk for complications varies with the patient's physical fitness level, method of glucose control (insulin vs. oral medications), and the patient's long-term disease control [27]. Although it is impossible to prevent all problems during travel, health care providers and patients should recognize the need to ask travel-specific questions during clinic appointments [28].…”

Management of Diabetes During Air Travel: A Systematic Literature Review of Current Recommendations and their Supporting Evidence

“…The advice varied in breadth, but common themes arose and are paraphrased into composite recommendations in Table 2. There was a consensus that patients with diabetes could travel safely by air, provided they prepared well, although caution or a delay in travel plans was advised for patients with newly-diagnosed or poorly-controlled diabetes (31). Possible contraindications to air travel were "unstable retinopathy" (31) or recent argon photocoagulation for diabetic retinopathy (32,33) due to the relative hypoxia of the cabin environment.…”

“…There was a consensus that patients with diabetes could travel safely by air, provided they prepared well, although caution or a delay in travel plans was advised for patients with newly-diagnosed or poorly-controlled diabetes (31). Possible contraindications to air travel were "unstable retinopathy" (31) or recent argon photocoagulation for diabetic retinopathy (32,33) due to the relative hypoxia of the cabin environment. These 2 recommendations appear to be based on a single case report of a patient who, in the setting of recent laser therapy for diabetic retinopathy, developed recurrent acute macular edema following a prolonged flight (28).…”

“…1) based on expert opinion. Eleven publications recommended the continuation of (unspecified) oral medications at their usual prescribed doses without specific modifications for travel (11,12,(34)(35)(36)(37)(38)(39)(40)(41), although 1 cautioned patients not to miss meals while taking sulfonylureas (42), and another stated that travelers should be aware of the risk of dehydration (31). In contrast, 7 publications suggested adjustments to oral regimens for travel (10,32,(43)(44)(45)(46)(47), which included the use of rapid-acting oral agents (repaglinide or nateglinide) with meals to cover gaps during westward travel (10,43,45); making slight but nonspecified dose modifications depending on direction of travel (44,47); or foregoing 1 dose of an oral hypoglycemic when traveling east or if missing meals (32,43,46).…”

“…The minimum number of time zones crossed before travelers need to adjust their insulin schedule or dose was not specified (6,14,(29)(30)(31)35,39,44,48) or was not consistent, varying from 2 (15,43), 3 (51-53), 5 (10,45,47,54,55), 6 (11,12,32,34,37,(40)(41)(42)46), to 7 time zones (16,36,38,56,57). One author (52) cited the American Diabetes Association's 2004 Insulin Administration Practice Guideline, which recommends travelers receive advice on insulin adjustment when crossing 3 or more time zones (7).…”