Caron Jander * / Lisa Anne Martin
Citation Information : Journal of the Australasian Society of Aerospace Medicine. Volume 10, Pages 22-25, DOI: https://doi.org/10.21307/asam-2015-008
License : (CC-BY-4.0)
Published Online: 27-June-2018
When travelling long distances with passengers with a disability, a key aim for staff should be ensuring that each individual is as comfortable as possible and not exposed to any undue stress.
Long-haul travel sees the individual exposed to a range of uncontrollable physiological and psychological stressors which can have a deleterious impact upon an individual’s health and general well-being1,2.
The stress involved with travelling may be exacerbated for passengers with a disability as they go about adjusting to the usual stressors associated with travel, along with a range of other factors that are less considered by more able-bodied passengers. For instance, for wheel-chair bound passengers, reliance on others may be necessary to enable them to carry out simple activities such as being able to take their seat and/or visit the toilet on the plane. Such experiences may impact upon the individual’s overall stress and/or energy levels due to the increased amount of cognitive effort that may be required.
Staff members on board the flight can seek to relieve some of this pressure by checking in with relevant passengers to see if they have any questions, or by simply ensuring that they feel comfortable in their surroundings. In addition to this, many times certain individuals may not want to “make a fuss”, leading to their needs not being met and physical or psychological discomfort ensuing.
It is important for staff who will be supporting passengers with a disability during the flight to have a clear understanding of each individual’s level of impairment relevant to the impact this may have upon their functioning while on the flight.
For example, for visually-impaired individuals, the level of impairment can vary considerably, ranging from those passengers who are blind to those who are partially-sighted. For those individuals with more severe impairments, finding the way to the bathroom facilities and back on a long-haul flight in a darkened cabin can present a significant challenge.
Similarly, for passengers with intellectual disabilities, the different levels of independence when it comes to day-to-day functioning will vary greatly from person to person. It is important not to avoid asking these passengers about their disability. Passengers with intellectual disabilities may be capable of explaining their abilities and limitations when asked. Many times their disability can be a source of frustration for them, therefore, asking them about the activities they find challenging and/or require assistance with can help to relieve them of unnecessary stress.
As with any traveller undertaking a long-haul flight, the opportunity for passengers with a disability to get good quality sleep where possible, to keep hydrated, to eat, to get access to a bathroom, and to engage in activities to reduce the negative impact of the flight upon their musculoskeletal system are of key importance. However, in order to decrease the amount of stress on the individual it is important for staff to be aware of the particular needs of each person and to plan accordingly. Some individuals may be very able to assist themselves when it comes to such activities, whereas others may need additional assistance.
It is important that the staff member assisting is aware of the needs of each individual and that rapport is sufficiently established. Communicating to ascertain what assistance they may or may not require and explaining how you can assist them with each of the key areas mentioned previously, along with the best way to contact you if required, should also be a priority. Such actions will help to reduce uncertainty through increasing each passengers perceptions of control. Research has found that informing an individual about what to expect, thereby providing more predictability to a situation, can significantly decrease their anxiety/arousal levels and enhance their emotional experience3.
Some assistance that might be required in each of the five areas highlighted above may include, but are not limited to, the following.
Passengers with intellectual impairment, particularly if they are new to travel, may need to be educated about time changes and/or periods of the flight that are considered good times to get some sleep (e.g. after dinner).
Some passengers with upper limb disability may have limited use of their arms, and may require assistance to put on a sleep mask or headphones.
Passengers with mobility issues and/or visual impairments should be provided with extra bottles of water to avoid them having to search for water when thirsty.
Passengers with intellectual impairments should be checked frequently to offer water, with this opportunity useful to educate them about the importance of keeping hydrated and encouraging them to continue to drink water throughout the flights.
Passengers with mobility issues and/or visual impairments should be offered snacks frequently throughout the flight, in order to assist them to stave off hunger and keep their blood sugar levels stable.
Many times, the snacks are located at the back of the plane or around each of the food preparation areas. These locations can prove difficult for some passengers with disabilities to access.
Passengers with intellectual impairments may need to be reminded where the snacks are located.
Passengers with physical and visual impairments should be allocated a seat that allows them to easily access toilet facilities. Passengers with intellectual disabilities should be provided clear instructions about the location of the closest bathroom facilities.
A person with vision impairment should be advised of the direction and number of rows to the closest bathroom. They may also need assistance when the cabin is darkened.
For individuals who need assistance getting to the bathroom, a plan should be developed to contact a staff member to help them when required.
For people who self catheterise, it is important that they are placed near a toilet facility that is clean so that ‘as sterile as possible’ self-catheterisation can take place. It is common for these people to dehydrate themselves so as to prevent having to self catheterise while in flight.
It is important for passengers to move around the cabin every few hours to help the body to avoid issues developing like Deep Vein Thrombosis (DVT) and other issues like muscle tension and/or soreness. Obviously this is not possible for some passengers in a wheelchair. However, it is important to communicate with such passengers to see if they have any requests related to ways that staff can help to relieve them of any pressures upon their bodies to avoid pressure sores or any other related issues.
Passengers with vision impairment should be provided with the opportunity to be guided around the cabin throughout the flight by a staff member so that they are able to stretch their legs and move their bodies.
If passengers with intellectual impairment are noticeably inactive over a significant length of time, staff could ask/invite them to get up and move around the cabin, or provide them with the TV channel that provides a demonstration of good exercises to do on long haul flights. There may also be other opportunities throughout the flight to educate them about the necessity or benefits of stretching and moving around, or encourage them to engage in such activities.
Apart from these key areas, it is also important to ensure equipment for passengers with physical and/or visual impairments is stowed somewhere they are aware of and can access comfortably where possible.
Passengers who have short statures may not be able to reach the overhead call buttons as found on most domestic flights, therefore an alternate means of attracting flight staff for assistance should be implemented.
It is important that passengers obtain relevant supporting medical documentation from their treating practitioners regarding medication that are required during the flight and/or medication that will be used while overseas. Different countries have different regulations regarding these and therefore it is imperative that the passengers are aware of, and respect, these laws.
Depending on the travel destination, passengers may also need to check the voltages of all medical equipment they require while abroad as different countries have different voltages and plugs. This may require passengers to purchase a Voltage converter and/or a different plug. It may also be important to check with the planes to see what the voltage is while on board and whether the equipment can be used in flight.
The airline will also need to know of any special dietary requirements. Those passengers with severe allergies should ensure that they inform the airline staff and also carry an Epi-Pen if required.
Passengers should be made aware of the fact that even though the cabin is pressurised, there are still some pressure effects on the body and caution should be taken when flying post-surgery, even minor wounds may bleed. It is also possible that if a passenger has stitches, these may swell and cause discomfort. It is therefore advisable to wear compression clothing if this is the case.
Assistance required by passengers to check in to his/her flight may vary. Many times, however, a parent/guardian/carer has the capacity to help them with this aspect of their travel because this occurs prior to them going through to the “passenger only” sections of the airport.
Some vision-impaired passengers may need to be guided through the check-in line-up and assistance with transporting/loading of luggage on arrival at the check-in counter.
Passengers with intellectual disabilities may require assistance communicating with the check-in staff to ensure that all required documents (e.g. passport; itinerary) are presented and then kept secure once returned.
It would be helpful if the individual was queried as to what assistance they may or may not require at this point of the journey so that relevant help can be provided from the security and immigration checkpoints onwards. This may come in the form of a passport stamp, or by the creation of a coloured “special needs” form being created, with different colours related to different impairments. Such cards could alert the staff throughout the airport, including the flight staff, to the particular types of impairment this individual faces. This could then prompt them to be more mindful as to what limitations they may or may not face.
Assistance may be required for vision-impaired passengers and/or passengers with intellectual disabilities to navigate through the airport in general, as well as through security and immigration checkpoints. Depending on the level of impairment, and the amount of carer assistance they have, transport through the airport to the flight gate may be required from the airline.
Depending on the level of disability, it may be necessary to assist passengers with visual or intellectual disabilities through customs. Care should also be taken with passengers with latex allergies as some countries still use latex gloves for security checks. Passengers are reminded to have documentation regarding prosthesis and may require physical examination rather x-ray screen.
Some people with disability may require assistance to complete legal and administrative forms (e.g. immigration; arrival forms) prior to and/or during the flight. Once a passenger with a disability has been identified, flight staff should ask the individual what assistance they require at the start of the journey so they can plan time for assisting with these aspects of support later in the flight.
Depending on the type of disability and level of impairment, assistance may be required to:
find their seat, stow luggage, and locate the toilet facilities when boarding the plane.
gather personal belongings/luggage,
navigate stairs when boarding or disembarking the aircraft.
Passengers who have prosthetic limbs may require overhead locker space to store their limbs during the flight. They may also require assistance with reaching the overhead lockers. It is also advisable to place the prosthetic limbs in an accessible overhead locker which will not cause distress to fellow passengers when they open the overhead locker and see a prosthetic limb.
It is recommended that passengers who take off their prosthetic limbs use a compression garment on their stump as it may swell making application of the prosthetic limb tender post-flight. It may also result in blister formation in the area. This can be disastrous when travelling abroad. In saying this, many passengers with physical impairments have their own methods of stump care that they are comfortable with. At times, this may also include not using such garments. Staff must respect each individual’s decision.
There are many potential obstacles that may need to be overcome when an individual with a disability is in transit. If they are travelling without a carer, some passengers may need additional assistance to transfer from gate to gate, to navigate their way through security checks, or to find bathroom or restaurant facilities.
While it is the responsibility of the individual travelling to have a carer, many times there is a carer at each end of the journey rather than when the passenger is in transit.
Passengers who have physical limitations may require assistance. It is always a balance between maintaining the individual’s independence and giving them assistance. Sometimes passengers who have prostheses will require wheelchair assistance while in transit. Transit buggies are frequently used to transfer passengers with physical or visual impairments from gate to gate, which can be helpful.
Timing of medication will need to be pre-planned so that there is no gap or decrease in the hours for specific medication that need to be taken at a certain time of the day/hours apart.
Passengers with intellectual disabilities may need to be helped, as they may not have the capabilities to understand the security questions or navigate the change in currency.
It is imperative that the traveller’s specific needs are transferred to the staff on the next flight. Procedures on how to best do this should be considered by each airline. Organisations may develop a slip that can be attached to the passenger’s boarding pass for the next flight that specifies the type of assistance required. For example, there may be options printed on the slip to enable the form to be completed easily and promptly, indicating the type and level of assistance required. For instance, these options may include an advisory notice such as ‘Requires assistance with completing forms’ or ‘Requires assistance stowing luggage’.
It may also be possible to provide passengers with disability with a ‘stamp’ that could be added to their passport or airline ticket, which specifies the passenger’s requirements in a simplistic manner. With travel being a global phenomenon, an international initiative would be of great benefit to passengers with disabilities.
Many people with disability travel by air each year. The types of physical disabilities, as well as the different degrees of intellectual impairment and impairment of vision, are vast. Each type of disability or impairment can impose difficulty with certain aspects of flying. However, proper care and attention, and adequate planning, can offset much of the stress experienced by people with disabilities when they travel by air. In addition, preparation and planning can lessen the stress experienced by airline staff called to support and assist these passengers.
The suggestions developed for this paper are the result of many years experience preparing to travel with people with disability. This paper can serve as guidance for others involved in preparing to travel with passengers with disabilities, to make sure air travel is undertaken as comfortably and stress-free as possible. This paper will be useful for the passengers themselves, their carers, and airline and airport staff involved in organising and facilitating the travel. It will also serve to prompt aeromedical organisations and airlines to consider advocating for a more-streamlined approach to pre-travel arrangements to reduce the stress of travel, especially in communicating the requirements when transferring between airlines or navigating through transit airports.
Disclaimer: The views expressed in this article are those of the author, and do not reflect a position of the Editor or Committee of the Australasian Society of Aerospace Medicine.
Provide extra bottles of water to avoid passengers having to leave their seat to ask for water when thirsty.
Check more frequently with passengers with intellectual impairments to see if they would like a glass of water
Encourage passengers with intellectual disabilities to keep hydrated throughout the flight.
Ensure seat allocation allows passengers with physical and visual impairments to easily access toilet facilities.
Provide clear instructions about the location of the closest bathroom facilities, including counting the number of rows if necessary.
Be prepared to assist a passenger to reach the bathroom if the cabin is darkened.
Develop a plan for the passenger to contact a staff member if they need assistance reaching the bathroom.
For people who self catheterise, placed them near a toilet facility that is clean so that ‘as sterile as possible’ self-catheterisation can take place.
If passengers are unable to reach the overhead call buttons, an alternate means of attracting flight staff for assistance should be implemented.
Ask for ways that staff can help to passengers avoid pressure sores.
Offer an opportunity to assist passengers around the cabin during the flight so that they are able to stretch their legs.
Educate passengers about the benefits of stretching and moving around the cabin during flight, if possible.
Passengers who take off their prosthetic limbs during flight should use a compression garment on their stump.
Some vision-impaired passengers may need to be guided through the check-in line-up, and assisted with loading luggage at the check-in counter.
Some passengers may require assistance communicating with the check-in staff.
Check-in staff should enquire about what assistance may be required during the journey.
Assistance may be required to navigate through the airport, including security, immigration, and customs checkpoints.
Care should be taken with passengers with latex allergies as some countries still use latex gloves for security checks.
Passengers with prostheses may require physical examination rather than conventional metal detection or x-ray screen.
Some passengers may require assistance to complete legal and administrative forms, both in the airport as well as in flight.
Airline staff should enquire about any assistance that may be required at the start of the journey so they can plan time to assist with these aspects of support later in the flight.
Provide whatever assistance is required to transfer from gate to gate, and to navigate their way through security checks.
Assist passengers locate bathroom and eating facilities.
Time medication so that dosing is not interrupted.
Passengers with intellectual disabilities may need to be assisted through the security questions.
Passengers with intellectual disabilities may need assistance with changes currency.
It is imperative that the traveller’s specific needs are transferred to the staff on the next flight.