What are the hidden medical risks on long-haul flights?

Long-haul flights over 8 hours pose hidden medical risks like deep vein thrombosis (DVT), dehydration, hypoxia, and cardiac events due to immobility, low humidity, and cabin pressure changes. Travel insurance mitigates these by covering emergency medical care, evacuations, and hospital bills that can exceed R1.5 million.

Key Insights

• Long-haul flights carry real and often hidden medical risks
• Pre-existing conditions increase the chance of in-flight or post-flight complications
• Medical events mid-air often lead to expensive emergency landings and treatment
• Comprehensive travel insurance is essential for both treatment and evacuation
• Prevention is key: pre-travel check-up, hydrate, move regularly.

Table of contents

• What medical risks do long-haul flights pose?
• Who is at the highest risk for health issues on a long-haul flight?
• What happens during a medical emergency on a long-haul flight?
• How travel insurance protects you during long-haul emergencies?
• Tips to stay healthy on long flights
• FAQs: Medical emergencies during flights
• Additional resources for long-haul health and safety

What medical risks do long-haul flights pose?

Spending hours in a pressurised cabin with limited movement, recycled air, and low humidity can affect your body in unexpected ways. Even healthy passengers can experience symptoms, while those with underlying conditions face elevated risk.

The most common issues include:

• Deep vein thrombosis (DVT): Blood clots in the legs due to immobility
• Pulmonary embolism: What happens when a clot travels to the lungs
• Dehydration and electrolyte imbalance
• Lower oxygen levels (hypoxia): Especially risky for people with heart or lung conditions
• Cardiac arrhythmias or chest pain triggered by dehydration and hypoxia
• Fainting or blood pressure drops due to dehydration or blood pooling due to prolonged immobility
• Abdominal discomfort from gas expansion due to lower cabin pressure
• Respiratory infections from proximity to other passengers and contaminated surfaces
• Jet lag, noise, vibration, and psychological stress all increase the risk of cardiac and neurological events

Who is at the highest risk for health issues on long-distance flights?

While anyone can experience discomfort during long or very frequent shorter flights, certain groups are more vulnerable to serious complications:

• Travellers with pre-existing conditions (e.g., diabetes, hypertension, asthma, heart disease)
• Pregnant travellers (especially beyond 28 weeks)
• Elderly passengers
• People recovering from recent surgery or injury
• Those with a history of blood clots or varicose veins
• Smokers, obese, very tall and very short persons
• Travellers on medications like hormonal therapy or birth control (DVT risk)

Quick tip: Always consult a doctor before flying if you fall into one of these categories, especially on long-haul or multi-leg journeys.

What happens during a medical emergency on a long-haul flight?

When a medical emergency happens at 38,000 feet, options are limited. Flights may divert, or they may not. Here’s what typically happens:

In-flight emergency response:

• Cabin crew perform basic first aid
• Crew or onboard doctor assesses the situation
• The pilot may request permission to divert to the nearest airport
• Paramedics meet the aircraft upon landing
• The traveller is taken to a local hospital, often a private facility

If you don’t have travel insurance, what could be the reality?

• Emergency landings cost airlines R400,000-R1 million+, so diversions aren’t automatic
• If you land in a country without reciprocal healthcare, you pay full price upfront
• Long haul flights to and from South Africa occur over water where diversion is not possible or over Africa where diversion airports may have sub-optimal medical care
• ICU care, diagnostics, and evacuation costs may reach R1.5-R3 million+

How travel insurance protects you during long-haul emergencies?

Travel insurance isn’t just about trip cancellations; it’s your lifeline in a medical crisis. On long-haul flights, this cover becomes especially important.

Hence, a high-quality travel policy should include:

• Cover emergency medical care on arrival, including ICU and specialist fees
• Pay for emergency medical evacuation or an air ambulance back to SA if needed
• Provide 24/7 assistance for decision-making
• Offer direct billing to hospitals so you’re not stuck paying upfront
• Support repatriation if travel plans are cancelled due to hospitalisation

Without insurance, you (or your company) may face massive out-of-pocket costs and limited medical options abroad.

Tips to stay healthy on long flights

Prevention is powerful. These steps can reduce your risk of medical issues during long-haul travel:

Before your flight:

• Visit your doctor if you have a pre-existing condition
• Visit a travel clinic for pre-travel advice, fitted compression stockings and vaccines that may help prevent in-flight infections
• Request a fit-to-fly letter if you’ve recently been unwell or hospitalised
• Book an aisle seat to encourage movement
• Request wheelchair assistance if you have mobility issues, heart or lung disease
• Wear fitted compression socks and consider anti-coagulants to prevent DVT
• Avoid or limit alcohol and caffeine for 24 hours before and during flying
• Stay hydrated and eat light, low-sodium meals
• Arrive at the airport well ahead of time so as not to have to rush and make sure connecting flights are well spaced.

During the flight:

• Move or stretch every 2-3 hours
• Drink water frequently (aim for 1 litre per 5 hours)
• Avoid sleeping in tight or unnatural positions
• Keep essential medication in your carry-on
• Use hand sanitiser and sanitise surfaces
• Wear a mask if you are immune-suppressed in any way

FAQs: Medical emergencies during flights

1. What happens if I need medical attention while flying?

If you experience a medical emergency mid-flight, the airline will follow strict safety protocols, but your access to care will be limited until you land.
Flight attendants are trained in first aid and CPR, but they are not medical professionals.

Most commercial aircraft are equipped with a basic emergency medical kit that may include a defibrillator (AED), but they lack diagnostic equipment or the ability to provide advanced treatment. Diversion airports may be two or three hours away.

Here’s what typically happens:

• Assessment by crew:
  Cabin crew will respond immediately and assess your condition. If you are conscious, they may ask about symptoms, medical history, and medication.
• Call for assistance:
  A call will go out to any medically qualified passengers onboard (e.g. doctors, nurses, paramedics) to assist. They will use the onboard kit and monitor your condition.
• Pilot notification:
  The captain is notified and consults with the crew and, in some cases, a ground-based medical advisory service through radio or satellite link.
• Diversion decision:
  If your condition is life-threatening or requires urgent intervention, the pilot may request to divert the aircraft to the nearest airport with medical facilities. This decision balances your health needs with operational and airspace considerations.
• Emergency response on landing:
  Paramedics will meet the aircraft on the runway or at the gate and transfer you to the nearest hospital. In many countries, this will be a private hospital, which means you may need proof of insurance or a deposit before receiving treatment.

2. Does travel insurance cover emergencies that start mid-flight?

Yes, in most cases, a comprehensive travel insurance policy will cover medical emergencies that begin while you’re flying, as long as the incident isn’t excluded under your policy.

Medical events that happen mid-air are typically treated the same as any other medical emergency during your trip, provided:

• Your policy was active before boarding
• You did not travel against medical advice
• The condition is not excluded from cover
• Once the flight lands and you’re handed over to medical services on the ground, your insurance kicks in to cover:
  • Emergency medical transport from the airport to hospital
  • Diagnostic tests, hospitalisation, treatment, and specialist care
  • Medical evacuation if care at your current location is inadequate
  • 24/7 support from your insurer’s medical assistance team
  • Claims and documentation processing directly with the hospital

Important:

• If your insurer requires pre-authorisation, make sure someone contacts them on your behalf ASAP

Tip: Keep your travel insurance documents and emergency contact details printed and stored in your hand luggage. In a crisis, your medical team, flight crew, or fellow passengers may need access to them.

Article reference source: Dr Albie de Frey – The Travel Doctor