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Chapter 8 Advising Travelers With Specific Needs

Travelers with Disabilities

Megan Crawley O’Sullivan


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 essentially differ from that of any other traveler. The following recommendations may assist in 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.


Regulations and Codes

In 1986, Congress passed the Air Carrier Access Act to ensure that people with disabilities are treated without discrimination in a way consistent with the safe carriage of all passengers. The regulations established by the Department of Transportation (DOT) apply to all flights of US airlines, as well as flights to or from the United States by foreign carriers.

Because of the act, carriers may not refuse transportation on the basis of a disability. However, there are a few exceptions; for example, the carrier may refuse transportation if the person with a disability would endanger the health or safety of other passengers or if transporting the person would be a violation of Federal Aviation Administration safety rules. (Travelers and their physicians can learn more about these exceptions and other aspects of the act at Air carriers are also obliged to accept a declaration by a passenger that he or she is self-reliant. A medical certificate, which is a written statement from the passenger’s physician saying that the passenger is capable of completing the flight safely without requiring extraordinary medical care, 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 the person’s medical condition can be reasonably expected to affect the operation of the flight).

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. If a traveler’s plans include flying between foreign countries while abroad, one must check with the overseas airlines to ensure that the carriers adhere to accessibility standards for disabled passengers.

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.

Assistance and Accommodations

When a traveler with a disability requests assistance, the airline is obliged to meet certain accessibility requirements. For example, carriers must provide access to the aircraft door (preferably by a level entry bridge), an aisle seat, and a seat with removable armrests. However, aircraft with <30 seats are generally exempt from these requirements. Any aircraft with >60 seats must have an onboard wheelchair, and personnel must help move the wheelchair from a seat to the lavatory area. However, airline personnel are not required to transfer passengers from wheelchair to wheelchair, wheelchair to aircraft seat, or wheelchair to lavatory seat. In addition, airline personnel are not obliged to assist with feeding, visiting the lavatory, or dispensing medication to travelers. Only wide-body aircraft with ≥2 aisles are required to have fully accessible lavatories. Travelers with disabilities who require assistance should travel with a companion or attendant. However, carriers may not, without reason, require a person with a disability to travel with an attendant.

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 services (if they are available on the flight):

  • Medical oxygen for use on board the aircraft
  • Carriage of an incubator
  • Hook-up for a respirator to the aircraft electrical power supply
  • Accommodation for a passenger who must travel in a stretcher
  • Transportation of an electric wheelchair on a flight scheduled on an aircraft with <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 people with disabilities who travel as a group
  • Provision of an onboard wheelchair to be used on an aircraft that does not have an accessible lavatory

DOT maintains a toll-free hotline (800-778-4838, available 9 am–5 pm, Eastern Time, Monday through Friday, except federal holidays) to provide general information to consumers about the rights of air travelers with disabilities and to assist air travelers with time-sensitive disability-related issues.

Assessment and Preparation

With the high incidence of cardiopulmonary disease and millions of people traveling by air, many people are at risk for hypoxia and respiratory symptoms while flying. Generally, patients with an oxygen saturation >95% by pulse oximetry 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 92%–95% by pulse oximetry) who may benefit from oxygen supplementation during air travel, decreasing their risk for 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 codes and interairline messages are sequentially entered for all flights. The delivering carrier is always responsible for a traveler with a disability until a subsequent carrier physically accepts responsibility for that passenger.


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 & Animal Products across International Borders). However, carriers must permit guide dogs or other service animals with 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 assigned seat, 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.


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. 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.



  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. Dine CJ, Kreider ME. Hypoxia altitude simulation test. Chest. 2008 Apr;133(4):1002–5.