Other Air Travel Issues Beyond Wheelchairs


People approach me with questions like these all the time. Admittedly, there are no pat answers to these questions. In fact, the answers usually depend on the individual circumstances of the traveler. These topics all fall into what I call the “beyond wheelchairs” category of air travel. In some instances, such as stretcher travel, special medical clearance is required. In other instances, such as travel with a service animal, travelers merely need to learn the rules and regulations, so they know what to expect. In all instances, in-depth research is usually required. So let’s take a look at some of these special cases. To be quite honest, I really dislike the word special, as it carries such bad connotations. It implies segregation, in this era of inclusion. Years ago, people were segregated into special programs, whereas today the goal is to include everybody in the same accessible program. Personal feelings aside, many airlines insist on using this archaic term to describe certain services or departments. For example, when you need information about travel with therapeutic oxygen, you usually contact the special services or special needs department. So I hesitantly use the term special and use it only to direct you to the most appropriate airline department.


travel with therapeutic oxygen is not specifically covered under the Air Carrier Access Act (ACAA). By this I mean that U.S. airlines are not required to provide therapeutic oxygen services to their passengers. Each airline sets its own policy regarding therapeutic oxygen services. Currently, America West and Southwest Airlines do not accept passengers who travel with therapeutic oxygen. This exclusion is well within their legal rights, because travel with therapeutic oxygen is considered a safety issue and, as such, it is regulated by the Federal Aviation Administration (FAA). Of course, this statement usually prompts a lively discourse from therapeutic oxygen users. The usual argument presented by therapeutic oxygen users is that their equipment is very safe and, as such, it should be allowed on all commercial aircraft. The FAA considers therapeutic oxygen a safety issue for two reasons. First, even though most people maintain their equipment in excellent working order, you never know when somebody could unintentionally bring damaged equipment on board. And second, an oxygen cylinder is an excellent place to conceal an explosive device; a device that could potentially go undetected by security. Plus, to be honest, some airlines just don’t want to take the time to train their personnel or to make the proper arrangements. Either way, the airlines are allowed to set their own policies on this matter, so your only choice is to deal with an airline that does provide therapeutic oxygen services. Before you decide which airline to travel with, call around and ask them all about their specific policies and procedures regarding therapeutic oxygen. Procedures vary between carriers, and they can change at any time. Please note that many non-U.S. carriers also accept passengers who use therapeutic oxygen. Although different airlines have different procedures regarding therapeutic oxygen, they all prohibit passengers from using their own equipment on board. Passengers must use airline-supplied oxygen. The charge for this service usually runs between $50 and $150 per flight leg on most U.S. air carriers. It should be noted however that some non-U.S. airlines charge well over $1,000 for this service, so it pays to find out the price before your book your flight. Oxygen services are charged per flight leg. A flight leg is defined as the time between one takeoff and one landing, so try to book a nonstop direct flight whenever possible. Most insurance policies do not cover in-flight oxygen, so check with your insurance carrier in advance. Even if your insurance carrier does cover in-flight oxygen, the airlines require payment in advance, and they won’t accept an insurance assignment. You must pay the cost up front and seek reimbursement from your insurance company. All U.S. airlines require a doctor’s statement from passengers who intend to travel with therapeutic oxygen. Some airlines require the doctor to fill out specific forms, while others ask for a prescription. When making your travel arrangements, make sure to ask what kind of oxygen equipment is provided. Some airlines provide flow meters that can be adjusted from 2 to 8 liters, while others have flow meters with a low (2l) and a high (4l) setting. Ask the airline if you need to bring your own mask or cannula. Some airlines provide them and some don’t. It’s also a good idea to take some empty tanks with you, so you can have them refilled at your destination. Airlines will allow you to carry empty tanks, but you must check them with your baggage. You cannot carry them on board the aircraft with you. You will also need to make arrangements for oxygen services at your destination. Check with the airport to make sure they allow oxygen use in the terminal. Then check with your local oxygen supplier to see if they are affiliated with a national chain that can provide service to you at your destination. You must have the oxygen delivered to the airport, because you cannot use the in-flight oxygen in the terminal. Alternatively, you can have a friend or relative meet you at the airport with your oxygen supplies. The price for airport delivery of oxygen varies, however since it’s a labor-intensive service, it’s cheaper during regular business hours. You will pay a premium price for this service on weekends and in the evenings, so try to time your arrival accordingly. Location also makes a difference, because oxygen services are cheaper at certain airports. For example, you will pay bargain prices for oxygen at Philadelphia, Denver, and Miami airports, but oxygen services at Boston, Washington D.C. (Dulles), and Minneapolis airports are among the most expensive in the nation. In any case, it never hurts to call more than one supplier to get a competitive price. Many oxygen suppliers will not accept an insurance assignment for oxygen delivered to the airport, so be prepared to pay cash. You will also have to arrange for airport oxygen at your connecting airport, if you cannot arrange a direct flight. It’s extremely important to confirm and reconfirm all airline oxygen arrangements. This letter from a traveler explains what can happen if you don’t: “My husband has emphysema and needs to have oxygen on hand at all times,” she writes. “We made arrangements with our travel agent to fly on Air France from Washington D.C. to Paris. I told the travel agent that my husband would need his own supply of oxygen on board, and she informed me my husband’s doctor would have to contact the Air France physician. This was done. “When we boarded the plane, there was no oxygen at our seat,” she continues. “When I questioned the flight attendant, he asked to see my ticket. Several minutes later he informed me that our travel agent failed to follow up and order the oxygen after it was cleared by the Air France physician. We had to reschedule our trip because of this mistake. “In retrospect, I should have followed up with my travel agent,” she adds. “I thought it was a bit strange that we were not charged extra for our oxygen, but I just figured somebody forgot to enter the charge.” So be forewarned, if an extra charge for oxygen does not appear on your credit card statement, there is a good chance the oxygen hasn’t actually been ordered. It never hurts to follow up, and in many cases it can even save a trip. Finding an oxygen provider outside of the United States may be a little more difficult. Oxygen prescriptions written by U.S. doctors are not valid outside of the United States. Check with a foreign oxygen supplier to see if you need a prescription. If you do, sometimes the best bet is to work with a U.S. provider that has contracts with foreign oxygen providers. Your local oxygen supplier should be able to give you some good resources. Another good resource for all therapeutic oxygen users is Breathin’ Easy, by Jerry Gorby. Published annually, this handy guide includes over 2,500 updated listings for oxygen outlets in more than 100 countries. It also includes helpful tips for traveling by air, sea, or land with therapeutic oxygen. The Breathin’ Easy website (breathineasy.com) also features a chart that lists therapeutic oxygen policies for airlines around the world. This information includes advance notice requirements, charges, and flow-rates. Airlines that do not permit therapeutic oxygen are also listed. Another good Internet resource is the All Go Here Airline Directory (everybody.co.uk/airindex.htm), a U.K.-based website that contains access information (including the availability of therapeutic oxygen services) for most major airlines around the world. Details are also included about the type of equipment provided and the amount of advance notice required. The American Lung Association of San Diego and Imperial Counties publishes a good travel guide for people with chronic breathing problems. Filled with checklists, travel tips, and worldwide resources, the Better Breathers Traveler offers travel strategies for people with asthma, allergies, chronic obstructive pulmonary disease (COPD), or other breathing difficulties. Contact the American Lung Association of San Diego and Imperial Counties for pricing and ordering information.


is an allergy considered a disability? To be honest, there is no easy answer to that question. The Canadian Transportation Agency (CTA) has at least addressed it, however. The conclusion? A definite maybe. This 2002 CTA ruling stems from seven complaints filed against Air Canada by passengers who had allergic reactions to dogs, cats, flowers, and paint. The allergic reactions in the individual cases were all different, and they ranged from sneezing and hives to respiratory distress and hearing loss. The CTA concluded that an allergy, per se, is not a disability for the purposes of Part V of the Canadian Transportation Act. This jurisdictional ruling held that, while an allergy is not automatically considered a disability; some people with allergies may be considered disabled. So what exactly does that mean? In short, it depends on the severity and intensity of the allergic reaction. The more intense the reaction, the greater likelihood the allergy will be considered a disability. This is something that will be decided on a case-by-case basis. If the allergy is considered a disability, then the accessibility provisions under the Canadian Transportation Act apply to that passenger. The bottom line is, unless you have a severe life-threatening allergic reaction, your allergy is not considered a disability, and no special accommodations are warranted. And of course, this ruling only applies to Canadian airlines.


Most u.s. air carriers accept vent-users as passengers, although only a few airlines provide onboard electricity for medical equipment. As you may have guessed, policies and procedures vary from airline to airline. Additionally, the availability of onboard electricity also depends on the aircraft type. A lot of restrictions are associated with the use of onboard electricity for medical equipment. Airline policies on this subject change frequently, so even if you travel often, check around with the different carriers for policy updates. Here’s what a few U.S. carriers recently had to say about their current policies. M Northwest Airlines. Generally speaking, ventilators can be plugged into the onboard electrical system, provided they are compatible and do not interfere with the aircraft’s communication and navigation systems. M Delta Air Lines. Ventilators may be used on flights that have onboard electrical outlets. These outlets are only at certain seat locations on some aircraft types, and the customer is responsible for providing any adapters. M United Airlines. A number of the more common battery-powered devices are pre-approved for acceptance. All others must be cleared by United’s medical and engineering staff. Passengers cannot plug in their equipment to the onboard power, but United can provide a special electrical hook up for some devices. It goes without saying that you need to make your arrangements well in advance and reconfirm all arrangements at least 48 hours prior to travel. Always carry a backup battery and charger with you, because even if onboard power is available it can be dependent on the operational needs of the aircraft. Additionally, onboard electrical power is subject to power surges during hookup and disconnection from ground power. Check around with the various carriers to see if they can provide onboard electricity for your equipment. If not, you might want to consider traveling under battery power. This option obviously depends on your equipment and on the length of your flight. It’s not a possibility for everyone, but it may be worth your consideration. If you do travel under battery power, take a backup battery and a charger with you on board the aircraft. That way, if you run low on battery power (and happen to be on the ground), you can have somebody get off the plane and recharge one battery for you. This method is especially useful if a delay in deplaning occurs. Above all, know the limitations of your equipment and don’t plan things too tightly. Always allow for delays when making your calculations. Make sure your equipment has gel cell batteries and that they are clearly marked. Wet cell (spillable) batteries are not allowed on board the aircraft. Your equipment must fit under the seat in front of you. If your equipment does not fit in this area, you may strap it to an adjoining seat, but you have to purchase the adjoining seat if you go this route. No additional or special seating options are available for passengers who travel with a ventilator. You can always request an upgrade, but in this day and age, upgrades usually go to the top echelon of frequent flyers. It never hurts to ask, but don’t depend on it. I know some vent-users who insist that they need to be seated in the first row of first class (when traveling on an economy class ticket). After a heated argument with ground personnel, they usually end up in coach. The airlines are not required by law to upgrade you, so if you request an upgrade, keep in mind that it’s a request not a demand. While in the terminal, keep your ventilator plugged into a wall receptacle until the last possible moment, so that your battery will have a 100% charge when you board the aircraft. Take along a 25- to 50-foot extension cord and an adapter to convert a three-pronged plug into a two-pronged plug. The control panels at the end of most jetways have an AC plug, so keep this in mind for emergency situations. Keep an eye open for these AC plugs when you board the plane, just in case a lengthy delay in boarding occurs. Speaking of delays, what do you do if you experience a long delay on the tarmac? First, if you give yourself some extra time, you won’t have this problem under usual circumstances. But unusual circumstances do occur, which are either weather- or traffic-related. So, what do you do if you end up sitting on the tarmac for an hour or more? Experienced vent-users say the best thing to do is to calmly explain the situation to the flight attendant. You need to stress that it is a matter of life and death, not merely a comfort issue. As silly as this sounds, some people just don’t understand the concept of a ventilator. Be patient, and if your efforts fail, ask to speak to the CRO by radio. Although it’s not travel specific, a good resource for vent-users is the International Ventilator Users Network (IVUN). IVUN is a worldwide network of ventilator users and health professionals experienced in and committed to home care and long-term mechanical ventilation. IVUN publishes Ventilator-Assisted Living, a quarterly newsletter, offering articles on family adjustments, equipment, techniques, medical topics, ethical issues, travel, and resources.


Although most people consider stretcher travel a medical necessity rather than a vacation option, it may be the ideal solution if you are not able to sit upright or if you require additional head and neck support. To be clear here, I’m not talking about travel by a private air ambulance, but stretcher travel on a commercial air carrier. Many people don’t even know this option is available and, although it’s more costly than standard airfare, it’s still much cheaper than an air ambulance. Before you decide to travel by stretcher on a commercial airline, you should first rule out the possibility of first-class travel. Although seat comfort varies from carrier to carrier, a first-class seat might do the trick. The drawback to a first-class seat is that it may not offer the needed head and neck support. No airline equipment offers additional neck support, but I’ve seen some homemade devices created by a few enterprising folks that all center around a neck pillow and chest straps. Additionally, even though first class seating offers more reclining room, all seats must be in an upright position for takeoff and landing. So, depending on your needs, this may work for you. It is the cheaper option, so it is worth ruling out before you decide to go the stretcher route. Currently, Northwest Airlines is the only U.S. airline that provides stretcher service for people who must remain in a reclining position during the flight. Stretcher service is only available on select aircraft, including the Airbus 320; Boeing 757, 727-200, 747- 200, and 747-400; and McDonnell Douglas D.C.-10-30 and D.C.- 10-40 aircraft. The stretcher can hold up to 250 pounds and can accommodate a person up to 6’2’’. It is carried in the coach passenger compartment, and placement depends on the aircraft configuration. Existing seats are folded down and a stretcher frame is installed.

Service Animals

by now, i’m sure you’ve heard the tale about the two ladies who boarded a U.S. Airways flight with their 350-pound pig in tow. They claimed porky was a service animal, and U.S. Airways employees bought their story and allowed the pig to ride in the first class cabin. Although much confusion surrounds the exact events that transpired during the flight, everybody agrees that the pig defecated on the jetway. So, was the pig a service animal as defined under the ACAA? No, it wasn’t. And not because it was a pig, or because it reportedly took four people to wheel it aboard the aircraft. It’s not considered a service animal because it did not behave appropriately on board the aircraft. What is appropriate behavior? Well, it isn’t (as one passenger reported) “running loose through the aircraft, and squealing loudly.” Enough of the fairy tales. Let’s look at what the ACAA has to say regarding real service animals. Under the ACAA, U.S. airlines must allow service animals to accompany on board the aircraft any qualified person with a disability. This applies to any guide dog, signal dog, or any other animal trained to provide assistance to a person with a disability. This rule only applies to service animals while they are traveling with a person with a disability. For example, if a nondisabled animal trainer needed to transport a service animal by air, the service animal would be subject to the airline’s general regulations regarding the carriage of animals. In other words, the service animal would not necessarily have the right to accompany the trainer in the cabin. On May 9, 2003, the Department of Transportation (DOT) amended the ACAA to expand the definition of a service animal to also include emotional support animals. Airline employees are permitted to require documentation from passengers traveling with emotional support animals. The required documentation includes a letter from a mental health professional stating that the passenger has a mental health-related disability. The letter must state that the emotional support animal must accompany the passenger to ensure the passenger’s mental health or to physically assist the passenger. The letter must be less than 1 year old, and be on letterhead from a mental health professional who is currently treating the passenger. The emotional support animal must behave appropriately to be considered a service animal. According the DOT, these revisions were necessary to stop passengers from using the service animal provision to bring pets into the passenger cabin. The new guidelines were published in the Federal Register on May 9, 2003. Assuming that a qualified service animal is traveling with a person with a disability, the service animal is allowed to accompany that individual everywhere on the aircraft. People who travel with a service animal are entitled to bulkhead seating if they desire, but they are not required to sit in the bulkhead section. They may choose a non-bulkhead seat if they prefer. In order to protect the service animal from obstructing the driveway or other place that is required the FAA’s safety rules. If no space in the cabin can accommodate the animal without causing such an obstruction, the animal is not permitted to travel in the cabin. Most of the time, service animals have no problems traveling on commercial air carriers. The exception might be on some smaller aircraft, where there may not be enough room for the animal to sit at the owner’s feet without protruding out into the aisle. If a small aircraft is your only choice, ask for the seating dimensions (before you make your reservations) so that you can determine if enough room exists for your service animal to sit at your feet. Of course, it is the owner’s responsibility to make sure that her animal acts appropriately while on the aircraft. This is usually not much of a problem, because service animals are highly trained to act appropriately in public situations. If the service animal exhibits inappropriate behavior such as growling, barking, or running up and down the aisle, the airlines are not required to treat it as a service animal. Airline personnel are trained to mitigate the effects of such behavior. For example, if a service animal barks, they might first suggest a muzzle to try to solve the problem. If mitigation doesn’t work, they do have the right to require that the service animal travel in the cargo bin. Generally speaking, a properly trained service animal should have no problems traveling on a commercial air carrier. One subject that comes up a lot when talking about service animals and air travel is cleaning and damage fees. Are they legal? The ACAA prohibits special charges such as deposits or surcharges for accommodations made for passengers with a disability. However, an airline can charge a passenger with a disability for damage done by their service animal, as long as it’s the policy of the airline to charge nondisabled passengers for the same type of damage. For example, if the airline regularly charges nondisabled passengers for cleaning and repair to damaged seats, they can also charge a person traveling with a service animal for similar damages. Again, a properly trained service animal should have no problems, but it’s always a good idea to know your rights. Of course, bathroom facilities are always a matter of concern, and the obvious question is how do you handle this situation while you are en route with your service animal? According to my well-traveled friend Connie, a definite procedure applies. “Basically, you have to take connecting flights, and leave enough time in between flights for a doggy pit stop,” says Connie. “The airline needs to be advised that you are traveling with a service animal and that you will need assistance at the connecting airport to walk your dog,” she explains. “There are computer codes the airlines use for passengers traveling with service animals. There isn’t a specific code that addresses the doggy potty stop issue, so you need to ask the reservation clerk to note this in the remarks section. Of course, you also need to check back to make sure this has been done. Even after all that hassle, sometimes they still don’t get it right. Don’t panic, just ask to be guided to the appropriate area when you disembark.” Another issue of concern to people who travel with a service animal is the whole security screening process. What is the best way to train or prepare your service animal for the wanding procedure at the security checkpoint? One traveler suggests this method: “I familiarized Oscar (my service animal) with the screening procedure by using a cordless telephone as a practice wand,” she says. “After he was comfortable with it, I got a friend to do it. Then I got several strangers to go through the same procedure until Oscar was totally desensitized to it. When it finally came time for us to go through airport security, we didn’t have any problems at all. Oscar was so used to the procedure, he didn’t even bat an eye. He’s an old pro at it now.” Finally, be sure to inquire in advance about any restrictions or special procedures for importing animals at your destination. Some countries impose strict quarantines on incoming animals, and most of these quarantines do not exclude service animals. As of December 11, 2002, the United Kingdom lifted quarantine restrictions on dogs and cats entering the United Kingdom from the United States and Canada. It should be noted however, that a number of restrictions still apply to animals entering the United Kingdom from the United States. Some of these restrictions make it difficult or impossible for service animals to accompany their owners. To bypass the 6-month U.K. quarantine, animals must have a microchip implanted, be tested and vaccinated for rabies, arrive on an approved air route, and travel in an approved container in the hold of the aircraft. The container is required to be sealed with a special seal, and the animal is not allowed to leave the container until it clears customs. There is no exemption for service animals. All animals must travel in the hold of the aircraft. For more information about approved procedures and routes visit www.defra.gov.uk/animalh/quarantine/index.htm or call the PETS Travel Scheme Helpline at +44 (0) 870-241-1710. The United States is not free from restrictions either. Hawaii lifted their strict quarantine in 1998 (actually it’s a settlement to a lawsuit); however, Hawaii-bound service animals still face some entry restrictions. The terms of the settlement apply only to residents of the United States who have guide dogs trained at schools belonging to the U.S. Council Guide Dog Schools. The settlement allows these animals to enter Hawaii without quarantine, providing they adhere to a required program of vaccinations, exams, titers, and microchip identification. For details on the procedures, contact Guide Dog Users Inc. The Pets Welcome Database (petswelcome.com/milkbone /quarmap.html) is another helpful resource for service animal travel. Even though this online database is geared towards pets, some of the information may also be useful to people who have service animals. This worldwide database includes information about a number of animal quarantines, embargoes, restrictions, and policies. It’s important to note that some countries have restrictions on pets, but not on working dogs, and the Pets Welcome Database only applies to pets. It’s best to use this database as a general guide. Contact the consulate of your destination country for the most accurate and updated information regarding service animal quarantines and policies.