This guide is intended for you to help make your holiday as organised and problem free as possible. It can be a daunting experience when flying for the first time as a wheelchair user so the following advice is aimed at ensuring that your holiday is a good one.
The information has been collected from colleagues working with patients with spinal cord injury and by asking our out-patients about their first hand experiences. It is not a definitive guide; therefore there may be other information available that is not included here.
It is worth trying to plan as best as you can and as early as possible to avoid any annoying complications. Much of the information is common sense but it does not hurt to have a guide that can be used as a reminder to make sure you have covered everything you need to make your holiday an enjoyable experience. The value of good planning will inevitably reduce the amount of stress.
Booking your holiday.
Decide on the type of holiday and where you want to go. Take into account, weather conditions, activities, transport, care needs.
Your travel agent or tour operator can help with advising you about accessible
accommodation. The Internet may also help in your search for a suitable holiday,
providing useful information on travel to your chosen destination and accessible
accommodation. The following websites have useful information.
www.accessibletravel.co.uk
www.spinal.co.uk (Spinal Injuries Association)
Various travel agents have their own websites with specific sections for
the disabled traveller. Some of the sites allow you to ask questions via e-mail.
Ensure that you have comprehensive travel insurance to include cover for
possible complications relating to your spinal cord lesion.
E.g.
- Medical treatment for an infection
- Pressure area problems (skin problems).
- Repairs to your wheelchair if it becomes damaged.
The Spinal Injuries Association (SIA) can advise on appropriate insurers with experience in providing cover for persons with a spinal cord injury.
Airline Forms.
Ensure the airline and travel tour operator is aware of your disability and any individual requirements. (Some airlines have disability help-lines to assist with your enquiries and specific needs). If you need any assistance you will probably have to fill in an Incapacitated Passengers Handling Advice form (INCAD). You can get this form from the airline or some travel agents. It will tell the airline about any services, facilities or assistance that you will need during the flight.
Some airlines require medical clearance using a MEDIF (Standard Medical Form)
of which Part 2 needs to be completed by your own doctor. (Especially if
you have internal fixations, baclofen pumps, sacral anterior root stimulator,
ventilator etc). These forms are available from the airline and should be
requested well in advance of travelling. The MEDIF form only lasts for one
journey and on the dates stated on your ticket. If you alter your journey
you will require a new form.
A FREMEC (Frequent Travellers Medical Form) is
often available from the airlines and can be used for frequent travellers.
This can avoid the need
for separate
medical clearance for each journey. Some airlines use their own equivalent
to a MEDIF or FREMEC card. Check when making a booking.
You can get more details of health care and advice for travellers abroad
from a free booklet "Health Advice for Travellers" from the Post
Office and the Department of Health. This leaflet also contains an E111 application
form, which will entitle you to emergency treatment in European Union Countries.
For further information go to the links below
www.dptac.gov.uk/pubs/aviation/access/04.htm
www.dh.gov.uk/PolicyAndGuidance/HealthAdviceForTravellers/fs/en
Facilities.
Ask the airline about the disabled facilities for the flight and your accommodation if appropriate. (Some airlines do have “accessible” toilets although in reality they can be difficult to access).
Plan your travel arrangements to the airport including parking. You want to be sure that the journey to the airport is a smooth one and getting to the check in desk is as easy as possible.
At the check-in desk, ask for an aisle seat with arm raise facility.
Make sure that your wheelchair is tagged on the main frame as this will go
into the baggage hold.
Take wheelchair footplates and arms into the cabin for storage.
At the
airport and having checked in, you should arrange to remain in your wheelchair
until the time to board the plane. At the gate, ask for any courtesy
first-class seats that might be open. If there is any problem when
you are at the gate, ask for a complaints resolution officer (CRO). All airlines
are required to have one at the airport. This person is empowered
to
act
on behalf of the airlines, and may or may not be overruled by the
pilot for safety reasons.
At the entrance to the plane you should be assisted into a narrow
aisle chair, carried on this and helped into your seat on the plane. You
will usually board
first and disembark last.
Take your cushion with you onto the plane to sit on throughout the
flight,
especially if you are travelling long haul. Do not have it stowed away in
the baggage hold. If it were to become damaged or lost it may be difficult
to replace in a hurry. Your cushion has been assessed to meet your pressure
requirements.
You may need to check if the plane seat is wide enough to accommodate your
cushion.If it does not fit, stow it away with the hand baggage and if possible
try to relieve the pressure as best you can either by pressure lifting in
the seat or leaning forward and side to side.
Roho cushions will need the air pressure adjusted due to the cabin pressure
at high altitude. Air will need to be removed as the plane reaches high altitude
and re-inflated on arrival.
Be very careful if using a Vicair cushion. There is little allowance for
the changes in pressure within the individual air pockets. (Take advice from
your Wheelchair Services or Pressure Clinic if you want to consider removing
some of the air pockets while at altitude).
Deep Vein Thrombosis/Pulmonary Embolism (DVT/PE).
Much has been publicised about DVT/PE and it is not my intention to worry
you unnecessarily but to raise awareness of the condition.
“
You may also need to discuss treatment with blood-thinning drugs or the use
of elastic stockings if you are in a high-risk group. While there is some
evidence that elastic stockings may be useful there is no evidence that aspirin
is effective in preventing travel-related DVT or PE. Elastic stockings are
widely available from pharmacies and pharmacists can provide advice on use
and fitting. Because aspirin can have serious side effects like bruising,
bleeding from the gut and allergies you should consult your doctor before
deciding to take this drug. People taking aspirin already should not increase
the dose”. (Department of Health 2005)
For further information go to the Department of Health link below.
http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/BloodSafety/DVT/...
Fluid input and output.
Ensure fluid intake is sufficient while onboard the flight to avoid dehydration.
This does not mean lots of alcohol!!
If on a long flight, consider attaching a night bag to your leg bag. This
can be easily hidden inside a carrier bag and placed under your seat. Be aware
that cabin staff may not necessarily dispose of urine for you.
If you usually pass intermittent catheters, consider a urethral indwelling
catheter for the journey. Some airlines may insist on this if the toilets
are not accessible so check first.
You may want to practice passing/removing an indwelling catheter and inflating/deflating
the balloon before you go.
Once aboard the plane, request that the cabin staff radio ahead to your destination to ensure your wheelchair is ready immediately on disembarking.
At your destination.
Check that the transport from the airport to your destination is accessible for you.
Your accommodation.
It may be necessary to perform bowel care on the bed if the toilets are not
accessible or adapted equipment is not available. Consider practising this
before you go.
Drink more (again, not alcohol) if visiting a hot country to reduce the risk
of dehydration, constipation or urinary infection.
Be aware of Poiklothermia. This is the reduced ability to regulate your body
temperature below the level of your spinal cord lesion. Air conditioning may
be a factor as well as extremes in the temperature of the country you are
visiting. If you are in a hot country try to keep cool so that you do not
overheat. Alternatively if you are in a cold country try to keep warm so that
you do not get too cold (hypothermic).
Cushion care.
Consider the effects of hot or cold on your cushion. (Gel in cushions may
become more fluid in hot conditions and firmer in cold conditions).
Roho cushions may need the air to be adjusted. Some air may need to be taken
out in hot conditions and some air may need to be added in cold conditions.
Both will affect your seating pressures. Check your skin for pressure marks
regularly.
If you need advice on how to check the correct amount of air in the cushion
or just general cushion care advice, contact either your local Wheelchair
Services, Spinal Unit Pressure Clinic.
Eating & Drinking In Developing Countries.
Traveller’s diarrhoea is the most common health problem affecting those
travelling to developing countries.
It can affect anyone but is more serious in the elderly and young children,
it is therefore important to think the issue through BEFORE you go.
- Boil any drinking water you are unsure about - or drink bottled water - but always ask to open the bottle yourself in restaurants, checking the seal is in place - if in doubt stick to carbonated water - and make sure it fizzes!
- Use bottled or boiled water for cleaning your teeth, don’t open your mouth and drink water when in the shower.
- In developing countries order drinks without ice, avoid roadside food vendors selling ice cream and unwashed fruit.
- Eat early if you have a buffet that has been sitting out for long periods during the day - food kept warm under food lamps can be a source of infection.
- Avoid - unpasturised milk, shellfish, soft cheeses, lukewarm food and empty restaurants.
- Boil it, cook it, peel it or forget it.
- Apply strict hygiene while away especially after using the bathroom and before you eat food - never use communal, damp towels in public conveniences! Use disposable paper towels or hot air. If you get diarrhoea - drink plenty of clear, clean fluids and consider a hydrating solution such as Dioralyte.
- If it continues for more than 48 hours and you are unable to drink, or are passing blood - SEEK IMMEDIATE MEDICAL ATTENTION.
Equipment to take with you.
Do you need certain equipment at your destination i.e., a particular mattress
(an overlay mattress can be brought with you if you are not sure of the mattress
at your destination) You may need to turn in bed more frequently if you are
on an unfamiliar mattress or become dehydrated or too hot.
Do you need a hoist, shower chair or sliding board etc?
Plan ahead. Certain hotels have access to certain equipment. Check first
to ensure they can meet your requirements and that the equipment is suitable
for you personally.
Community Liaison can advise you.
Bladder management and equipment to take with you.
Pack a couple of spare indwelling catheters; even if you currently perform
self-intermittent catheterisation. Take the necessary equipment for
a catheter change. 10 mls sterile water and a 10 ml. syringe to inflate/deflate
the
catheter balloon.
Catheter bags (leg and night drainage bags).
Extra intermittent catheters if you are drinking more fluids.
Consider 2 types of antibiotics in case you develop an infection.
A weak and a stronger type, i.e., Trimethoprim and Ciprofloxacin.
Discuss this with
your G.P. first.
Bowel care and equipment to take with you.
Suppositories if required.
- KY or Lignocaine gel if used.
- Gloves etc.
- Imodium may prove useful if you develop an upset stomach.
- Dioralyte may also help if diarrhoea persists. It will help to hydrate you and restore some of the sodium, potassium and glucose that may have been depleted.
Take into account the time differences when travelling abroad. This may have an affect on the timing of your regular bowel care routine.
Wheelchair.
- Puncture repair kit
- Spare inner-tube
- Pump
- Roho pump if applicable
- Box spanner and allen keys for any minor adjustments to your chair.
Other equipment.
List of any current medication (including nifedipine if susceptible to autonomic
dysreflexia).
Autonomic Dysreflexia alert card.
Sunblock / sun hat, aftersun lotion, mosquito repellent, water spray.
Insect bites and minor cuts and grazes may take longer to heal in a hot climate.
Take a small first aid kit to ensure you can keep a wound clean and dry whilst
away. Seek medical advice if you are concerned.
If you are planning to drive abroad take your full driving licence (paper and plastic parts) Don’t forget to take your blue badge with you if driving within the EU. Arrange a vehicle with hand controls if required. Remember, these could be on the opposite side
As mentioned before, most of this is common sense so don’t be put off. It may seem like a lot of hassle but it needn’t be with good planning. Hopefully this guide will make it easier. Relax, enjoy the experiences and have fun!
Useful contact telephone numbers for further advice.
Spinal Injuries Association advice line 0800 9800501
Community Liaison -spinal unit 01722 429130
Pressure Clinic-spinal unit 01722 429291
