Can an airline offload ill passengers?

If you are in any doubt about your fitness to fly, you should consult your doctor

Forty-seven passengers were offloaded from their Tui Airways flight home from Cape Verde because the airline was worried they might cause a medical diversion.

What are the rules on offloading travellers – and what happens in a medical diversion?

These are the answers you need.

Why would an airline offload passengers because of worries about their health?

Airlines want to take their customers safely and punctually to their destination. They do not want to risk the delay, inconvenience and cost of a diversion on medical grounds. To try to avoid it, they make many stipulations about passengers’ health.

Concerns over the risk of medical diversions is rising, as the ageing population becomes more susceptible to inflight emergencies.

Conditions that are mild at sea level can be exacerbated by altitude, stress and fatigue. With the added risk that infectious diseases could be transmitted within the confined space of an aircraft, airlines are very sensitive to their passengers’ state of health.

What medical conditions, current or previous, can be a concern?

Almost any. If you are in any doubt about your fitness to fly, you should consult your doctor.

Airlines generally insist on medical clearance in cases of recent illness, hospitalisation, injury or surgery.

On any airline, anyone with a long-term condition such as angina, chronic obstructive pulmonary disease (COPD) or cystic fibrosis should get a “fit to fly” letter from their consultant.

British Airways says anyone with a “recent illness, hospitalisation, injury or surgery” or who is “travelling for medical reasons or treatment” must fill out a medical information form which is then assessed before the passenger is allowed to travel.

BA, easyJet and Ryanair have their own “menus” of conditions and the rules that pertain.

The earliest you can fly on easyJet after having tonsils removed is two weeks, and for chest surgery six weeks. For British Airways, it is 10 days for either. Ryanair lets tonsillectomy passengers travel after six days.

After a “minor or uncomplicated” heart attack, you can fly on easyJet after a week. People who have suffered a stroke must wait at least 11 days, and if it is less than three weeks then a medical certificate is required.

Travellers with epilepsy can fly 24 hours after a seizure on British Airways or Ryanair.

Those with chronic anaemia are not permitted to fly on easyJet. The airline also says: “Passengers showing a shortness of breath will not be able to fly.”

Diabetics are advised by easyJet to take extra carbohydrates in their hand luggage “and remain on ‘home-time’ throughout the flight”.

Divers should not dive for 24 hours prior to flying in order to minimise the risk of decompression sickness.

I have a plaster cast because of a broken bone. What are the issues?

The lower air pressure in flight can cause the limb to expand, which is a problem when it is encased in plaster.

On British Airways, you cannot fly within 48 hours of the cast being fitted (except for flights of two hours or less).

If you know you are going to be flying at the time the cast is fitted, then ask for it to be split (cut along the length of the cast) to allow room for expansion. Ryanair allows passengers with recent casts to travel if this has happened, but says after 48 hours there is no need for this – though it may be more comfortable.

Ryanair also requires anyone with a full leg in plaster to buy three seats.

What are the rules about contagious diseases?

Ryanair has a one-week rule for measles and chicken pox; easyJet says passengers with measles must not travel for a week after the appearance of a rash, and for viral infections such as seasonal flu, “when no longer contagious”. The airline stresses: “Our crew will prevent anyone travelling, regardless of condition, if they consider them a safety risk.”

British Airways says you can fly after cholera “when your symptoms have settled, you feel well enough to travel and the public heath authority in your destination country agrees you are fit to travel".

What about pregnancy?

Each airline makes its own rules in order to minimise the risk of an onboard delivery or diversion. British Airways says you cannot fly after the end of the 36th week if you are pregnant with one baby, or the end of the 32nd week if you are pregnant with more than one baby. BA also recommends carrying a letter from your doctor or midwife confirming whether the pregnancy is single or multiple, the expected due date and that there are no complications.

“The letter should be dated as close to your travel date as possible and covers you for your entire journey (outbound and return),” says the airline.

What if I suffer a medical episode between booking and travelling?

Contact the carrier and explain your situation. Airlines will be flexible because they want to encourage passengers to do the right thing – rather than encouraging people to conceal symptoms.

If you are advised not to travel by a medical professional, there is a good chance that the airline will give you a credit note to the value of your original trip – allowing you to book an alternative flight within a certain amount of time, or sometimes pass it on to someone else.

What else can I be removed from an aircraft for?

Excess alcohol is a prime reason. The Air Navigation Order states: “A person must not enter any aircraft when drunk, or be drunk in any aircraft,” but does not define what constitutes “drunk”.

And easyJet says: “Our crew will prevent anyone travelling, regardless of condition, if they consider them a safety risk.”

Is it usual for passengers to be asked to leave an aircraft?

No, but it happens. Dr Rob Hunter, a commercial pilot and head of flight safety for the British Airline Pilots’ Association (Balpa) says: “If there is a concern about the fitness of passengers before flight then the captain may ask the ill or potentially ill passengers to leave the aircraft.

“Captains take account of as much information as they can in the very compressed time that these decisions may have to be taken.

“Their information sources include cabin crew, port health officials, airport medical staff and medical advice that they source through their own company.”

What happens when a medical emergency takes place?

Dr Hunter says: “First, the captain will take advice from company medical advisors by radio, data link or satellite phone, and any medically qualified passengers onboard.

“If the captain decides to divert, the captain and co-pilot will select a suitable airport. Long-haul aircraft, even when flying over land, can in extreme cases be up to three hours away from a suitable airport that has a sufficiently long runway. The pilots will request the diversion to air traffic control stating the reason, then reprogramme the flight management computer so that best use of the automatic systems on the aircraft can be achieved en route.”

Once the aircraft has landed, it will be met by a medical team and other officials, and the passenger will be taken to hospital.

But the operational consequences can be considerable. Earlier this year a United Airlines flight from New York to Hong Kong diverted to Goose Bay in Labrador, northern Canada. A door used for the patient to be moved could not be closed, apparently because it jammed in the extreme cold. The outside temperature was as low as -45C.

As Dr Hunter says: “All sorts of environmental and facility challenges might present themselves once a crew has landed at a diversion airport.

“After the sick passenger has been transferred to local medical services the crew of the aircraft may have a challenging task in ensuring the welfare of the passengers.

How often do they happen?

“Our captains report medical diversions around once every 10,000 hours of flying,” says Dr Hunter. “So a typical captain might undertake two medical diversions in their career.”