Travelers with Disabilities
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. Nonetheless, with proper preparation many travelers with disabilities can travel internationally. Some travelers with disabilities, including those experiencing reduced mobility, 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.
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.
Because of this 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 clinicians can learn more about these exceptions and other aspects of the act 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, which is 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 (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).
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. 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 that are adequate for that traveler’s needs.
The US 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. Travelers who have disabilities or medical conditions that may affect TSA screening may use notification cards to discreetly communicate with the officer. Notification cards are available at www.tsa.gov/sites/default/files/disability_notification_card_508.pdf. Travelers can learn more about the TSA guidelines for travelers with disabilities at www.tsa.gov/travel/special-procedures.
Assistance and Accommodations
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, 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 [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.
Patients with Respiratory Conditions
Travelers with certain respiratory conditions that cause low blood oxygen levels may need supplemental oxygen to make up for the reduced air pressure in the cabin during flight. More information about air travel for people who may need supplemental oxygen is available at www.uptodate.com/contents/supplemental-oxygen-on-commercial-airlines-beyond-the-basics.
Under the ACAA, 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. However, service animals are not exempt from compliance with quarantine regulations and 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).
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.
- 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)
- Aviation Consumer Protection and Enforcement Rules (see links under Part 382, Passengers with Disabilities) (http://airconsumer.ost.dot.gov/rules/rules.htm)
- Passengers with Disabilities (site provides a summary of the main points of the DOT rule, Title 14 CFR Part 382) (http://airconsumer.ost.dot.gov/publications/disabled.htm)
- Transportation Security Administration—Disabilities and medical conditions (www.tsa.gov/travel/special-procedures)
- MossRehab ResourceNet (www.mossrehab.com/patients-and-visitors/information-for-out-of-town-visitors/travel-resources)
- American Council of the Blind—Travel Resources(www.acb.org/node/1643)
- Society for Accessible Travel and Hospitality (www.sath.org)
- Aerospace Medical Association—Medical publications for airline travel (www.asma.org/publications/medical-publications-for-airline-travel)
- Mobility International USA (www.miusa.org)
- 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: http://www.passepartouttraining.com/uploads/2013/03/ICAO-Manual-Doc-9984-1...
- Josephs LK, Coker RK, Thomas M, British Thoracic Society Air Travel Working Group. Managing patients with stable respiratory disease planning air travel: a primary care summary of the British Thoracic Society recommendations. Prim Care Respir J. 2013 Jun;22(2):234–8. [PMID:23732637]
- Nondiscrimination on the basis of disability in air travel. 2003 [cited 2016 Sep. 27]; Available from: http://airconsumer.dot.gov/rules/382short.pdf.
Kira A. Barbre