Chapter 8Advising Travelers with Specific Needs

Emad A. Yanni, Amanda Cantor

OVERVIEW

Travelers with disabilities are defined as travelers whose mobility is reduced because of a physical incapacity (sensory or locomotor), an intellectual deficiency, age, illness, or another cause, and who may require special attention and adaptation of the transportation services that are available to all passengers. The medical preparation of a traveler with a stable, ongoing disability does not differ from that of any other traveler. The following recommendations are key to ensuring safe, accessible travel:

• Assess each international itinerary on an individual basis, in consultation with specialized travel agencies or tour operators.
• Consult travel health providers for additional recommendations.
• Use print and internet resources.

AIR TRAVEL

Regulations and Codes

Carriers may not refuse transportation on the basis of disability. By law, US air carriers must comply with highly detailed regulations that affect people with disabilities. These do not cover foreign carriers serving the United States.

All US and non-US carriers are required to file annual reports of disability-related complaints with the Department of Transportation (DOT). The DOT maintains a toll-free hotline (800-778-4838, available 7 am–11 pm, Eastern Time) to provide real-time assistance in facilitating compliance with DOT rules and to suggest customer-service solutions to the airlines. The Transportation Security Administration (TSA) has established a program for screening travelers with disabilities and their equipment, mobility aids, and devices. TSA permits prescriptions, liquid medications, and other liquids needed by people with disabilities and medical conditions. International Air Transport Association (IATA) member airlines voluntarily adhere to codes of practice that are similar to US legislation based on guidance from the International Civil Aviation Organization. However, smaller airlines overseas may not be IATA members.

Airlines are obliged to accept a declaration by a passenger that he or she is self-­reliant. Medical certificates can be required only in specific situations (for example, if a person intends to travel with a possible communicable disease, will require a stretcher or oxygen, or if unusual behavior is anticipated that may affect the operation of the flight).

Assistance and Accommodations

When a traveler with a disability requests assistance, the airline is obliged to provide access to the aircraft door (preferably by a level entry bridge), an aisle wheelchair, and a seat with removable armrests. Aircraft with fewer than 30 seats are generally exempt. Airline personnel are not required to transfer passengers from wheelchair to wheelchair, wheelchair to aircraft seat, or wheelchair to lavatory seat. Travelers with disabilities who cannot transfer themselves should travel with a companion or attendant, but carriers may not, without reason, require a person with a disability to travel with an attendant.

Only wide-body aircraft with 2 aisles are required to have fully accessible lavatories, although any aircraft with more than 60 seats must have an onboard wheelchair, and personnel must help move the wheelchair from a seat to the lavatory area. Airline personnel are not obliged to assist with feeding, visiting the lavatory, or dispensing medication to travelers.

Airlines may not require advance notice of a passenger with a disability; however, they may require up to 48 hours’ advance notice and 1-hour advance check-in for certain accommodations that require preparation time, such as the following:

• Medical oxygen for use on board the aircraft, if the service is available on the flight
• Carriage of an incubator, if the service is available on the flight
• Hook-up for a respirator to the aircraft electrical power supply, if the service is available on the flight
• Accommodation for a passenger who must travel in a stretcher, if the service is available on the flight
• Transportation of an electric wheelchair on a flight scheduled on an aircraft with fewer than 60 seats
• Provision by the airline of hazardous material packaging for a battery used in a wheelchair or other assistive devices
• Accommodation for a group of 10 or more people with disabilities who make a reservation and travel as a group
• Provision of an onboard wheelchair to be used on an aircraft that does not have an accessible lavatory

Assessment and Preparation

With high incidence of cardiopulmonary disease and millions of people traveling by air, many people are at risk for significant hypoxia and respiratory symptoms while flying. Generally, patients with an oxygen saturation by pulse oximetry >95% do not require supplemental oxygen, and those with a saturation <92% will require it during air travel. The hypoxia altitude simulation test can identify those patients (with an oxygen saturation by pulse oximetry between 92% and 95%) who may benefit from oxygen supplementation during air travel, decreasing their risk for significant cardiopulmonary effects of induced hypoxia at higher altitudes.

Internationally standardized codes for classifying disabled passengers and their needs are available in all computerized reservations systems. Passengers with disabilities should use travel agents experienced in the use of the disability coding; it is critical that appropriate codes and interairline messages are sequentially entered for all flights. The delivering carrier is always responsible for a traveler with disabilities until a subsequent carrier physically accepts responsibility for that passenger.

SERVICE ANIMALS

Service animals are not exempt from compliance with quarantine regulations and so may not be allowed to travel to all international destinations. They are also subject to US animal import regulations on return (see Chapter 6, Taking Animals and Animal Products across International Borders). However, carriers must permit guide dogs or other service animals with appropriate identification to accompany a person with a disability on a flight. Carriers must permit a service animal to accompany a traveler with a disability to any seat in which the person sits, unless the animal obstructs an aisle or other area that must remain clear to facilitate an emergency evacuation, in which case the passenger will be assigned another seat.

CRUISE SHIPS

US companies or entities conducting programs or tours on cruise ships have obligations regarding access for travelers with disabilities, even if the ship itself is of foreign registry (see Chapter 6, Cruise Ship Travel). However, all travelers with disabilities should check with individual cruise lines regarding availability of requested or needed items before booking. Cruises are available that cater to travelers with special needs, such as dialysis patients.

USEFUL LINKS

• MossRehab ResourceNet (http://www.mossresourcenet.org/travel.htm)
• Department of Transportation, Aviation Consumer Protection Division
  • New Horizons Information for the Air Traveler with a Disability (http://airconsumer.ost.dot.gov/publications/horizons.htm#NewEnvironment)
  • Nondiscrimination on the Basis of Disability in Air Travel: 14 CFR Part 382, Federal Rules (http://airconsumer.ost.dot.gov/rules/rules.htm)
• American Council of the Blind—lists cruises, books, useful telephone numbers, and links to products for purchase (www.acb.org/)
• Access-Able—resource for mature travelers and those with special needs (www.access-able.com)
• Transportation Security Administration—travelers with disabilities and medical conditions (www.tsa.gov/travelers/airtravel/specialneeds)
• Society for Accessible Travel and Hospitality (www.sath.org)
• Aerospace Medical Association—medical guidelines for airline travel (www.asma.org/publications/medicalguideline.php)
• Mobility International USA (www.miusa.org)
  • Preparing for Departure (www.miusa.org/ncde/goingabroad/survivalsteps/preparingtodepart)
  • Equipment and Tools that Make Traveling with a Disability Easy (www.miusa.org/ncde/tipsheets/tools)

BIBLIOGRAPHY

1. Bucks C. A World of Options: a Guide to International Exchange, Community Service and Travel for Persons with Disabilities. 3rd ed. Eugene, OR: ILR Press; 1997.
2. Convention on International Civil Aviation. ICAO-recommended practices relating to persons with disabilities. International Civil Aviation Organization. Available from: http://www.icao.int/icao/en/atb/sgm/disabilities.htm.
3. Dine CJ, Kreider ME. Hypoxia altitude simulation test. Chest. 2008 Apr;133(4):1002–5.