When dealing with health emergencies while traveling, particularly cases involving stroke or transient ischemic attack (TIA), the protocols and measures taken can significantly influence patient outcomes. It was reported that some airlines may not accept passengers if they have had a stroke in the last few days.

According to the AHA, 1 in 4 stroke survivors have a second stroke, and the risk is higher in the weeks after the initial stroke. According to a 2018 study, the risk of a stroke recurring is highest in the 30 days following a stroke or transient ischemic attack (TIA).

These neurological events demand prompt and proficient medical attention to ensure safe and effective management, especially when the patient needs to travel. As such, medical assistance providers face unique challenges in handling such complex cases.

We caught up with Medical Director Stuart Phillips to explain the MedResQ approach. 

“Firstly, all cases of stroke and mini-stroke (TIA) should be assessed by a medical assistance provider’s medical team with experience in assessing these types of cases. Assessment of the case will include assessment of the medical records, the assessment and treatment in hospital, and the current clinical condition of the traveller. The medical assistance providers medical team’s view will be guided by the quality of the report, treatment and investigations and the capability of the hospital.

Also, the medical assistance provider’s medical team should assess the past medical history and comorbidities, the age of the traveller, any companions, any additional or new diagnoses, such as a new cardiac arrhythmia and the treatment of it, any physical or neurological deficits, and the flight routing.

The definition of a TIA requires its complete resolution in under 24 hours, otherwise it is classified as a stroke. The international air transport association guidelines that most airlines follow or adopt permit travel after 2 days provided that there has been adequate investigation, however, if there is a secondary disease, such as Atrial Fibrillation, a heart arrhythmia which can result in clot formation which can lead to strokes, may still warrant a medical escort or greater time for observing stability.

Patients with confirmed strokes will still require the same degree of detailed case analysis by a specialist assistance company’s medical team, but in many cases, a nurse escort will be the minimum recommendation as oxygen is usually advised for travel. This can take place from 5 days after stroke, and usually a nurse is still advocated up to 14 days after stroke if there are at least mild to moderate symptoms.

After 14 days, depending on the condition of the patient, the location and destination, and the companion, unescorted travel with a friend or family member may be appropriate, however, airline medical clearance will still be needed and the patient would require a recent fit to fly letter.

Some patients may have such significant strokes that the develop significant neurological and other deficits and complications in which travel is very challenging. Such examples include confusion, respiratory infections, severe one-sided weakness and an inability to sit or stand, seizure activity, swallowing limitations, and so on. in such cases, medical assistance provider’s medical teams need to assess whether 2 medical escorts can safely manage the care needs on a commercial flight, either in a business class seat or on a stretcher.

Some patient’s have such a dense stroke , in which there support needs are advanced and require intensive care support, that only an air ambulance is appropriate, or certainly a suitable option for the short to middle term.

Finally, some stroke treatment can only be delivered in specialised neurological centres, and there may be occasions in which a patient will require an evacuation from a hospital or country in which the required treatment is not possible, and they may need airlifting to the nearest centre to receive treatment.”