There is nothing like a medical emergency at altitude to ruin your whole day. For some people with chronic lung disease, flying puts them at risk of not receiving enough oxygen while they are up in the air. Even some people who do not regularly need supplemental oxygen may need it while flying because of the lower oxygen levels in a pressurized cabin. Here are the steps you should take if you need to fly with oxygen.
Step One: Determine if you can safely fly
Work with your healthcare provider to confirm it is safe for you to fly and to determine if your oxygen flow needs to increase during flight.
If your doctor can order a High-Altitude Simulations Test (HAST) or you can find a facility, it is the simplest way for most people to determine a prescription for flying. The machine adjusts the level of oxygen in a breathing apparatus down to mimic being at 8,000 feet (which is the same atmospheric pressure as the cabin of a commercial airplane) and you get a specific prescription for being at rest at altitude. Just like being at home, you will need some additional oxygen for moving around the plane.
Step Two: Work with the airline and satisfy all their rules
Every airline has rules about flying with oxygen, and if you fail to comply, they can refuse to allow you to board. If you fail to comply with rules while in the air, they can make an emergency landing and charge you for it, and even have you arrested.
That is why it is important to do your research about the airline ahead of time. By simply searching [(airline name) flying medical oxygen] you will find the regulations you're looking for. Many airlines have a form that must be filled out by the passenger and healthcare provider. Some airlines will not accept generalized provider’s notes so if they have a specific form, use it. For foreign flights, you will often need a more elaborate form called a Medical Information Form (MEDIF) and it is not unusual for an airline to refuse a MEDIF from another airline, even if the forms are identical except in appearance.
If you are a frequent traveler, you might consider printing out and completing forms for the airlines you usually fly and asking your pulmonary doctor to sign them—most airlines are OK with forms filled out within a year, so I often get new letters each year and keep them on file.
Once you book your flight, even if you know you have and will comply with all the requirements of the airline, call the special services office at the airline so they can identify you on the manifest. Try to choose a window seat, since most airline cabin crews will insist you sit near the window so that your machine’s tubing isn’t hazardous to other travelers.
Step Three: Understand Portable Oxygen Concentrator requirements
In general, the only acceptable source of oxygen for flying is a portable oxygen concentrator—a POC. The airline website typically will list acceptable POCs that are FAA approved. It is important to obtain the POC with sufficient time to become familiar with the operation and effect of the POC prior to the trip.
POCs are 'portable' because they can run on battery power, not because they are lightweight or easy to carry. Those approved for flying range in size from 3 to 20 pounds. The first concern when choosing a POC to buy or rent for flying is that it provides sufficient oxygen. To choose correctly, it is important to understand the difference between continuous flow and pulse (on demand) delivery. Your healthcare provider can help explain the difference and suggest the best option for you.
The second characteristic of the POC that is very important for flying safety is understanding battery duration. When manufacturers say how long their batteries last, they are talking about a brand-new battery and a low setting. A model that lasts 6 hours on a pulse 1 setting may last only 1 hour on a pulse 6 setting. Most airlines require you to have enough batteries to provide duration equal to 150% of the length of your trip at the required setting. This is to allow extra battery duration to account for unexpected events like waiting for takeoff or being directed to a different airport. A few airlines alter this to a “plus 3 hours” requirement for longer flights.
In some instances, you will be able to use the AC power outlet on the plane to run your equipment. Sometimes this works, but sometimes it doesn't, so one must always plan to run the full duration of the flight on batteries.
If your flight involves more than one 'leg', consider choosing flights with long layovers. This gives you more time to recharge batteries between flights. If you have a long enough layover, you may be able to negotiate with the airline special services office to carry fewer batteries.
Step Four: Get to the airport early
Allow extra time for everything. Because you are on the manifest as a traveler with special needs, you will not be able to check-in online. When you check-in at the counter, they will confirm you are flying with oxygen and may want to go over requirements with you. Be sure you have all your paperwork with you, including your doctor-signed airline medical form.
I strongly encourage asking for a wheelchair assist at this point, if you have not already been using one. With special assistance, you and your companion can move around the line at the TSA check more efficiently. Once you are at the checkpoint, if you can walk without oxygen, I suggest walking through the detector and sending your POC through the X-ray machine. If you go around the checkpoint in the wheelchair, you will undergo a body search where they will also examine the wheelchair and all your equipment.
At the gate, plug in the POC to top off the battery. If there are no public outlets there is often power at the check in desk and I carry a short extension cord to plug in under their counter. I sit close to the check in desk—and when the check in crew arrives, I always go up and introduce myself and verify that I can board early. At that point, I may ask if I can get an empty seat next to me for the equipment if the flight isn’t full. Take advantage of early boarding so you can find storage up above for your carry on and get the POC set up.
Step 5: On the Plane
Once you are set up, use your oximeter and adjust your oxygen as necessary. You may be able to save some battery power while you are on the ground and getting to altitude. Also, remember that if you are doing fine sitting, you will likely need a higher setting for a trip to the toilet. You may be tempted to take off your oxygen just for the trip down the aisle—don't do it. Activity at altitude will challenge your oxygen intake.
Learn more about oxygen therapy.
Blog last updated: August 21, 2023
