A Practical Pre-flight Medical Screening Framework in the Royal Thai Army Healthcare System: A Narrative Review for Physicians and Nurses
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Abstract
Air travel has become a common activity among patients in contemporary healthcare settings, including military personnel, their families, and the general population. This is particularly relevant in the Royal Thai Army healthcare system, which comprises medical facilities of various levels and capacities, ranging from small hospitals to advanced care centers. Healthcare professionals at all levels are therefore frequently required to assess patients’ fitness for air travel under constraints of limited resources and restricted access to specialized expertise, particularly in aviation medicine.
This article aims to review the aviation medicine literature related to patient air travel by synthesizing key principles of aviation physiology, common clinical risk factors, and practical approaches to pre-flight patient screening. Emphasis is placed on a red flag–based thinking framework to support clinical decision-making by physicians and nurses across all levels of the Royal Thai Army healthcare system, even in settings without direct access to aviation medicine specialists.
This approach may help reduce the risk of in-flight medical complications, enhance patient safety, and decrease the likelihood of airline offload.
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Aerospace Medical Association. Medical guidelines for airline travel. Aviat Space Environ Med. 2003.
Ernsting J, Nicholson AN, Rainford DJ. Aviation medicine. 4th ed. CRC Press; 2016.
Muhm JM. Predicted arterial oxygenation at commercial aircraft cabin altitudes. Aviat Space Environ Med. 2004;75:905–912.
Silverman D, Gendreau MA. Medical issues associated with commercial flights. Lancet. 2009;373:2067–2077.
British Thoracic Society. Managing passengers with respiratory disease planning air travel. Thorax. 2011;66(Suppl 1):i1–i30.
Ahmedzai S, et al. Managing passengers with lung disease planning air travel. Thorax. 2011;66:i1–i30.
Philbrick JT, et al. Air travel and venous thromboembolism: a systematic review. J Gen Intern Med. 2007;22(1):107–114.
Schreijer AJM, et al. Activation of coagulation during air travel. Lancet. 2006;367:832–838.
Liew CH, Flaherty GT. Experiences and attitudes of international travelers with cardiovascular disease. Am J Trop Med Hyg. 2020;102(3):689–697.
Peterson DC, et al. Outcomes of medical emergencies on commercial airline flights. N Engl J Med. 2013;368:2075–2083.
Nable JV, et al. In-flight medical emergencies during commercial travel. N Engl J Med. 2015;373(10):939–945.
International Civil Aviation Organization. Manual of Civil Aviation Medicine. 3rd ed. Montreal: ICAO; 2012.
European Union Aviation Safety Agency. Medical considerations for air travel. Cologne: EASA; 2020.
Civil Aviation Authority (UK). Fitness to fly: guidance for health professionals. London: CAA; 2019.
World Health Organization. International travel and health. Geneva: WHO; 2022.
