Author(s): Jasmine Owens, Eric Cahill

The Americans with Disabilities Act defines an individual with a disability as a person who has a physical or mental impairment that substantially limits ≥1 major life activity, has a record of such an impairment, or is regarded as having such an impairment.

According to the World Health Organization, an activity limitation can include difficulty seeing, hearing, walking, or problem-solving. With proper preparation, many travelers with disabilities can travel internationally. The following guidelines can help support safe, accessible travel for people with various disabilities:

Assess. Assess each international itinerary individually, in consultation with travel agencies or tour operators that provide services to people with disabilities.

Review. Review (and refer travelers to) online resources for additional information (Table 3-05).

Suggest. Suggest that travelers ensure necessary accommodations are available throughout the entire trip.

Recommend. Recommend travelers enroll in the US Department of State’s Smart Traveler Enrollment Program to receive security messages and to make it easier for the US embassy or consulate to assist in an emergency.

Human Rights

Each country has its own standard of accessibility for people with disabilities. Unlike the United States, many countries do not legally require accommodations for people with disabilities. Several websites can help the traveler answer questions about accessibility for a specific destination or provide support if an emergency occurs. Travel agents, hotels, airlines, or cruise ship companies can also serve as sources for information about services available during the trip and at the destination, including for service animals. Table 3-06 includes resources for travelers with disabilities to help them gather information about accommodations and human rights frameworks at their destination.

Air Travel Regulations & Standards

Air Carrier Access Act

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. These regulations were established by the US Department of Transportation (DOT) and apply to all flights provided by US airlines and flights to or from the United States by foreign carriers.

ACAA ensures carriers cannot refuse transportation based on a disability. The ACAA has a few exceptions, however; for example, the carrier can 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 exceptions and other aspects of the ACAA by reviewing What Airline Employees, Airline Contractors, and Air Travelers with Disabilities Need to Know about Access to Air Travel for Persons with Disabilities (see Table 3-05 for link). Air carriers are also obliged to accept a declaration by travelers with disabilities that they are self-reliant. A medical certificate (a written statement from the traveler’s health care provider saying that the traveler can complete the flight safely without requiring extraordinary medical care or endangering other travelers) might be required in specific situations. Examples of specific situations include a person intending to travel with a possible communicable disease, a person requiring a stretcher or oxygen, or a person whose medical condition can be reasonably expected to affect the operation of the flight. 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 generally are exempt from these requirements. Any aircraft with >60 seats must have an onboard wheelchair, and personnel must help move the onboard wheelchair from a seat to the lavatory area upon request. Only wide-body aircraft with ≥2 aisles are required to have fully accessible lavatories.

Airline personnel are not required to assist with feeding, visiting the lavatory, or dispensing medication to travelers. Travelers with disabilities who require this type of assistance should travel with a companion or attendant. DOT maintains a toll-free hotline (800-778-4838 [voice] or 800-455-9880 [TTY]), available 9 a.m. to 5 p.m. Eastern Time, Monday–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.

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 (ICAO; see Table 3-05). These guidelines are not identical to those outlined in US legislation, however, and the degree of implementation can 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. ICAO (see Table 3-05) also provides accessibility scores for airports across the world that can aid in travel planning.

Assistive Devices

Assistive devices can make traveling more accessible for people with disabilities. Travelers and their health care providers can consult the DOT and Transportation Security Administration (TSA) websites (see Table 3-05) for information on traveling with an assistive device. Travelers should check for specific policies for assistive devices, including wheelchairs, portable machines, batteries, respirators, and portable oxygen concentrators.

In-Flight Services

Airlines are not permitted to require travelers to provide advance notice of a disability. Airlines might require up to 48 hours advance notice and 1-hour advance check-in, however, for certain accommodations that require preparation time for services (if they are available on the flight), such as 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, transport of a battery-powered 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 ≥10 people with disabilities who travel as a group, or provision of an onboard wheelchair for use on an aircraft that does not have an accessible lavatory.

All audiovisual displays played on aircraft for safety and informational purposes must use captioning or a sign language interpreter 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.

Airport Accommodations

Security Screening

The TSA has established a program for screening travelers with disabilities and their equipment, mobility aids, and devices. TSA permits prescription liquid medications and other liquids needed by people with disabilities and medical conditions. Travelers with disabilities or medical conditions that affect TSA screening might use a TSA Notification Card to communicate with screening officers; they can also learn more about TSA guidelines for disabilities and medical conditions online (see Table 3-05).

As with other people with disabilities or medical conditions, travelers with hearing loss (i.e., individuals who are deaf or who are 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, might be required if assistive devices alarm security technology.

Travelers with disabilities or medical conditions can call the TSA helpline toll free at 855-787-2227, federal relay 711, or check TSA's website for answers to questions about screening policies, procedures, and the security checkpoints.

Closed Captioning

As part of the ACAA, DOT rules require any airport terminal facility that receives federal financial assistance to enable or ensure high-contrast captioning at all times on televisions and other audiovisual displays. Captioning is required on televisions and other audiovisual displays 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.

Telecommunication Devices

Current ACAA rules require people with hearing loss to self-identify to airline carrier personnel to ensure their 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 loss.

Passengers with hearing loss 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 ACAA rules do not require a sign language interpreter to ensure that a passenger with hearing loss receives all pertinent information. If an airline carrier provides telephone reservation and information service to the public, these services must be available to people with hearing loss through a telecommunications device for the deaf (TDD), telecommunications relay services, or other technology.

Wheelchairs

Travelers can decide to rent wheelchairs and medical equipment at their destination. Research on renting wheelchairs might include checking the availability of wheelchair and medical equipment providers. In addition, organizations such as Mobility International USA have information about overseas medical equipment providers. The country voltage, type of electrical plug, and reliability of the electrical infrastructure at the destination country might make one type of wheelchair preferable over another. In some cases, a manual instead of a power wheelchair is the preferred assistive device.

Boarding & Deplaning with a Wheelchair

Smaller airplanes might not have a jetway, and travelers who use wheelchairs might need to be manually lifted or carried down the stairs. Some airports have adapted hoists or lifts. An aisle chair is usually required to board and deplane an airplane. Travelers should be sure to mention they need an aisle chair, both when reserving tickets and when checking in at the airport. Additional wheelchair traveling tips are available through Wheelchair Travel’s Wheelchair Users’ Guide to Air Travel.

Service Animals

Some travelers require a service animal for travel support. Travelers who require service animals, including emotional support animals, should check with the airline and the destination country to ensure that both will permit the animal and that the traveler obtains all required documentation (see Sec. 7, Ch. 6, Traveling with Pets & Service Animals). Clinicians can use the following recommendations to assist travelers with service animals. Travelers can contact the foreign embassy or consulate of the destination country for information on possible restrictions and cultural norms about service animals. Travelers should find out about any required quarantine, vaccination, and documentation for the service animal; consult their veterinarian for tips about traveling with service animals; and contact destination hotels to make certain they will accommodate service animals.

Cruise Ships

Companies or entities conducting programs or tours on cruise ships that dock at US ports have obligations regarding access for travelers with disabilities, even if the ship itself is of foreign registry, as outlined in Title III of the Americans with Disabilities Act. All travelers with disabilities should check with cruise lines regarding availability of requested or needed items before booking. Cruise ship operators and travel agents that cater to travelers with special needs also exist.

Medical Considerations

Some travelers can have both a disability and an underlying health condition. Box 3-02 provides a list of suggestions the travel health provider can use to help the traveler plan to manage their condition while abroad. For more details, refer to Sec. 3, Ch. 3, Travelers with Chronic Illnesses.