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Chapter 5 Travelers with Additional Considerations

Travelers with Disabilities

Cynthia F. Hinton, John Eichwald

OVERVIEW

According to the Americans with Disabilities Act, a person has a disability if he or she has a physical or mental impairment that substantially limits at least 1 major life activity. With proper preparation, many travelers with disabilities can travel internationally. Some travelers with disabilities, such as those with mobility limitations, vision or hearing loss, or cognitive disabilities may require special attention and adaptation of transportation services. The following recommendations may assist in ensuring safe, accessible travel for travelers with disabilities:

  • Assess each international itinerary on an individual basis, in consultation with specialized travel agencies or tour operators.
  • Consult travel health providers for additional recommendations.
  • Plan ahead to ensure that necessary accommodations are available throughout the entire trip.

BEFORE TRAVEL

Each country has its own standard of accessibility for people with disabilities. Several websites can help the traveler answer questions about accessibility. Visit https://travel.state.gov/content/travel/en/international-travel/International-Travel-Country-Information-Pages.html and enter a country or area to find information on accessibility for travelers with mobility limitations in the “Local Laws & Special Circumstances” section. Unlike the United States, many countries do not legally require accommodations for people with disabilities. Read section 6 of the State Department’s Human Rights Report for information of the human rights and social service framework protecting citizens with disabilities in the destination country (www.state.gov/j/drl/rls/hrrpt/index.htm).

  • Consult with travel agents, hotels, airlines or cruise ship companies to learn about services during the trip and at the destination, including for service animals. Websites such as Mobility International USA (www.miusa.org) will have links to overseas disability organizations.
  • Consult an organization that specializes in travel for people with intellectual disabilities (http://newdirectionstravel.org).
  • Consider enrolling in the Smart Traveler Enrollment Program (STEP) to receive security messages and to make it easier for the US embassy or consulate to help in an emergency (https://step.state.gov/step/).

Medical Considerations

  • If the traveler’s health insurance plan does not provide coverage overseas, the US State Department strongly recommends purchasing supplemental medical insurance and medical evacuation plans.
  • Visit the web page “Your Health Abroad” for information about international travel (https://travel.state.gov/content/travel/en/international-travel/before-you-go/your-health-abroad.html).
  • See the Travelers’ Health page of the Centers for Disease Control website for health actions before, during, and after travel (www.cdc.gov/travel).
  • Travelers should carry medical alert information and a letter from their health care provider describing medical conditions, medications, potential complications, and other pertinent medical information.
  • Travelers should carry sufficient prescription medication to last the entire trip, including extra medicine in case of delay. Always carry prescriptions in their labeled containers, not in a pill pack.
  • Some prescription medications that are legal in the United States are illegal in other countries. See https://travel.state.gov/content/travel/en/international-travel/International-Travel-Country-Information-Pages.html for the specific area where you will be traveling, and contact the foreign embassy or consulate for more information (www.usembassy.gov).

Assistive Equipment

  • Call the Transportation Security Administration’s (TSA) helpline for travelers with disabilities and medical conditions at 855-787-2227 (toll-free), federal relay 711, or check TSA’s website, (www.tsa.gov/travel/special-procedures) for answers to questions about screening policies, procedures, and the security checkpoints.
  • Find out if there are specific policies for devices such as wheelchairs, portable machines, batteries, respirators, and oxygen.
  • Consider renting wheelchairs and medical equipment at the destination. Research the availability of wheelchair and medical equipment providers. Websites such as Mobility International USA (www.miusa.org) or the European Network for Accessible Tourism (www.accessibletourism.org) will have links to overseas medical equipment providers.
  • Consider the use of manual versus power wheelchairs. The country voltage, type of electrical plug, and reliability of the electrical infrastructure at the destination country may make one type of wheelchair preferable over another.

Service Animals

  • Contact the US embassy or consulate of the destination country for information on possible restrictions and cultural norms about service animals (www.usembassy.gov).
  • Find out about any quarantine, vaccination, and documentation requirements.
  • Consult veterinarians about tips for traveling with service animals.
  • Contact destination hotels to make sure they will accommodate service animals.

AIR TRAVEL

Many non-US airlines voluntarily adhere to codes of practice that are similar to US legislation based on guidelines from the International Civil Aviation Organization. However, these guidelines are not identical to those outlined in US legislation, and the degree of implementation may vary by airline and location. Travelers planning to fly between foreign countries or within a foreign country while abroad should check with the overseas airlines to ensure that the carriers adhere to accessibility standards adequate for their needs.

Regulations and Codes

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

Flight Information and Reservation Services

If an airline carrier provides telephone reservation and information service to the public, these services must be available to people who are deaf or hard-of-hearing through a telecommunications device for the deaf (TDD), telecommunications relay services, or other technology.

Airports

As part of the ACAA, DOT rules require any airport terminal facility that receives federal financial assistance to enable or ensure high-contrast captioning. The captioning is required at all times on televisions and other audio-visual displays capable of displaying captions located in any common area of the terminal to which passengers have access, including the gate area, ticketing area, passenger lounges, and leased commercial shop and restaurant spaces.

Security

The 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. Travelers who have disabilities or medical conditions that may affect TSA screening may use notification cards to communicate with the officer. Travelers can learn more about the TSA guidelines for travelers with disabilities at www.tsa.gov/travel/special-procedures and print the card at www.tsa.gov/sites/default/files/disability_notification_card_508.pdf.

As with other people with disabilities or medical conditions, travelers who are deaf or hard-of-hearing can provide the TSA officer with a notification card or other medical documentation that describes their condition and informs the officer about the need for assistance with the screening process. Travelers are not required to remove any hearing aids or external cochlear implant devices. Additional screening, including a pat-down or device inspection, may be required if assistance devices alarm security technology.

Ticket Counter, Gate, and Customer Service Desks

Current ACAA rules require people who are deaf or hard-of-hearing to self-identify in order to ensure the receipt of accessible information. Passenger information, including information about flight schedule changes, connections, gate assignments and baggage claim must be transmitted in a timely manner through an accessible method of communication to those who have identified themselves as having hearing impairment. Passengers with impaired hearing must identify themselves to carrier personnel at the gate area or the customer service desk even if they have already done so at the ticketing area. The rule does not require a sign language interpreter to ensure that a passenger who is deaf receives all pertinent information.

In-Flight

All audio-visual displays played on aircraft for safety and informational purposes must use captioning or a sign language interpreter insert as part of the video presentation. The captioning must be in the predominant languages in which the carrier communicates with passengers on the flight. The current ACAA rule does not require the captioning of in-flight entertainment.

Boarding and Deplaning

There may be no jetway with smaller airplanes, and travelers who use wheelchairs may need to be manually lifted up or down the stairs. Some airports have adapted hoists or lifts. An aisle chair is usually required to board and deplane. Travelers should be sure to mention they need an aisle chair, both when reserving tickets and when check­ing in at the airport (http://wheelchairtraveling.com/traveling-with-medical-equipment-or-a-wheelchair-handicap-limited-mobility-or-senior-at-airports-airplanes-and-all-aboutflying-faa-tsa-air-carriers-act).

Assistance and Accommodations

Because of the ACAA, 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 clinicians can learn more about these exceptions and other aspects of the ACAA at http://airconsumer.ost.dot.gov/publications/horizons.htm.

Air carriers are also obliged to accept a declaration by a passenger that he or she is self-reliant. A medical certificate (a written statement from the passenger’s health care provider saying that the passenger is capable of completing the flight safely without requiring extraordinary medical care or endangering other passengers) can be required only in specific situations. 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, a medical certificate is typically required.

Under the guidelines of the ACAA, when a traveler with 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 (aisle chair), and personnel must help move the wheelchair from a seat to the lavatory area. 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. Without reason, however, carriers may not require a person with a disability to travel with an attendant.

Airlines may not require advance notice of a passenger with a disability. They may, however, 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 an aircraft with <60 seats
  • Provision by the airline of hazardous material packaging for batteries used in wheelchairs or other assistive devices
  • Accommodation for a group of ≥10 people with disabilities who travel as a group
  • Provision of an onboard wheelchair (aisle chair) for use on an aircraft that does not have an accessible lavatory

DOT maintains a toll-free hotline (800-778-4838 [voice] or 800-455-9880 [TTY], available 9 am to 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.

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. However, all travelers with disabilities should check with individual cruise lines regarding availability of requested or needed items before booking. Cruise operators and travel agents that cater to travelers with special needs also exist.

USEFUL LINKS

BIBLIOGRAPHY

  1. Barnett, S. Communication with deaf and hard-of-hearing people: A guide for medical education. Academic Medicine. 2002; 77(7):694–700.
  2. Bauer I. When travel is a challenge: travel medicine and the “dis-abled” traveler. Travel Medicine and Infectious Disease. 2018:22;66–72.
  3. International Civil Aviation Organization. Manual on access to air transport by persons with disabilities. Montréal: International Civil Aviation Organization; 2013 [cited 2016 Sep 27]. Available from: www.passepartouttraining.com/uploads/2013/03/ICAO-Manual-Doc-9984-1st-Edition-alltext-en_published_March-2013.pdf
  4. National Association of the Deaf. Legal rights: The guide for deaf and hard of hearing people. Washington, DC: Gallaudet University Press; 2000.
  5. Nondiscrimination on the basis of disability in air travel. 2003 [cited 2016 Sep 27]. Available from: http://airconsumer.dot.gov/rules/382short.pdf.
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