A Practical Pre-flight Medical Screening Framework in the Royal Thai Army Healthcare System: A Narrative Review for Physicians and Nurses
Main Article Content
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 offloading.
Downloads
Article Details

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles in this journal are copyrighted by the Royal Thai Army Medical Department and published under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) license.
may be read and used for academic purposes, such as teaching, research, or citation, with proper credit given to the author and the journal.
Use or modification of the articles is prohibited without permission.
Statements expressed in the articles are solely the opinions of the authors.
Authors are fully responsible for the content and accuracy of their articles.
Any other republication of the articles requires permission from the journal.
References
International Air Transport Association. IATA medical manual. 11th ed. Montreal: IATA; 2018.
Aerospace Medical Association Medical Guidelines Task Force. Medical guidelines for airline travel. 2nd ed. Aviat Space Environ Med. 2003;74(5 Suppl):A1-19.
Ernsting J, Nicholson AN, Rainford DJ. Aviation medicine. 4th ed. Boca Raton (FL): CRC Press; 2016.
Muhm JM. Predicted arterial oxygenation at commercial aircraft cabin altitudes. Aviat Space Environ Med. 2004;75(10):905-12. Erratum in: Aviat Space Environ Med. 2010;81(5):532.
Silverman D, Gendreau M. Medical issues associated with commercial flights. Lancet. 2009;373(9680):2067-77. doi:10.1016/S0140-6736(09)60209-9
British Thoracic Society. Managing passengers with respiratory disease planning air travel. Thorax. 2011;66 Suppl 1:i1-30. doi:10.1136/thoraxjnl-2011-200295
Philbrick JT, Shumate R, Siadaty MS, Becker DM. Air travel and venous thromboembolism: a systematic review. J Gen Intern Med. 2007;22(1):107-14. doi:10.1007/s11606-006-0016-0
Schreijer AJ, Cannegieter SC, Meijers JC, Middeldorp S, Büller HR, Rosendaal FR. Activation of coagulation system during air travel: a crossover study. Lancet. 2006;367(9513):832-8. doi:10.1016/S0140-6736(06)68339-6
Liew CH, Flaherty GT. Experiences and attitudes of international travelers with cardiovascular disease. Am J Trop Med Hyg. 2020;102(3):689-97. doi:10.4269/ajtmh.19-0793
Peterson DC, Martin-Gill C, Guyette FX, Tobias AZ, McCarthy CE, Harrington ST, et al. Outcomes of medical emergencies on commercial airline flights. N Engl J Med. 2013;368(22):2075-83. doi:10.1056/NEJMoa1212052
Nable JV, Tupe CL, Gehle BD, Brady WJ. In-flight medical emergencies during commercial travel. N Engl J Med. 2015;373(10):939-45. doi:10.1056/NEJMra1409213
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.