When Do You Need a Sea Level Flight for Medical Repatriation?

When arranging an air ambulance, there’s already a lot to think about — but one question often surprises families:
“Why does my loved one need to fly at a lower altitude?”
The answer lies in a specialised service known as a Sea Level Flight.

At SkyCare, we frequently arrange sea level flights for patients whose medical conditions would be made worse by standard high-altitude flying. In this article, we’ll explain in simple terms why this matters, who benefits from it, what the process involves, and what you should know before booking. We’ll also share a few important facts about altitude and air ambulance missions, so you feel confident and informed.

What is a Sea Level Flight?

Despite the name, a Sea Level Flight doesn’t literally mean flying just above the ocean. It means the aircraft is pressurised to keep the cabin atmosphere close to what it feels like at ground level — even though the plane itself might be flying at around 10,000–15,000 feet.

Normal commercial flights cruise much higher, around 35,000–40,000 feet, with the cabin pressure equivalent to being at about 6,000–8,000 feet up a mountain. That drop in air pressure and oxygen isn’t a problem for most healthy passengers — but it can be dangerous for certain medical conditions.
In a Sea Level Flight, we maintain a higher cabin pressure, richer in oxygen, to protect vulnerable patients during their journey.

Why Would a Patient Need a Sea Level Flight?

Certain illnesses and injuries respond badly to altitude. Here’s why we might recommend flying lower and keeping cabin pressure at sea level:

1. Brain Injuries or Neurological Conditions

• Head injuries, strokes, brain surgeries or swelling (cerebral oedema) are all highly sensitive to changes in pressure.

• Air trapped inside the skull (e.g., post-surgery) can expand by up to 30% at normal flight altitudes, risking serious complications.

• Flying at a sea-level cabin pressure helps stabilise brain pressure and oxygen flow.

2. Heart Conditions

• Heart attacks, recent cardiac surgeries, or severe heart failure can worsen when the heart must pump harder to deliver oxygen in thin air.

• By flying lower, oxygen levels stay high, easing strain on the heart and circulation.

3. Respiratory Diseases

• Lung conditions like severe asthma, COPD, pneumonia, or patients needing ventilators cannot tolerate thinner air.

• Maintaining ground-level oxygen helps them breathe comfortably throughout the flight.

4. Anaemia

• Patients with low haemoglobin already struggle to transport oxygen in their blood.

• Flying at a high altitude could dangerously lower oxygen delivery to tissues — sea level flights prevent this risk.

5. Post-Surgical Cases

• Fresh surgical wounds, especially abdominal, thoracic, or cranial surgeries, are vulnerable to gas expansion inside the body.

• A lower cabin pressure reduces the risk of wound swelling, bleeding, or other pressure-related complications.

6. Pneumothorax (Collapsed Lung)

• Trapped air in the chest expands significantly at high altitudes, risking serious lung collapse.

• Sea level flights ensure the safest possible cabin conditions.

7. Decompression Sickness (After Diving)

• Scuba divers suffering from “the bends” must avoid any altitude — including commercial flights — until cleared.

• Medical flights maintain ground-level pressure to prevent nitrogen bubbles worsening.

How is a Sea Level Flight Achieved?

At SkyCare, arranging a Sea Level Flight involves careful planning:

• Aircraft Pressurisation Settings: Our air ambulances adjust their cabin pressure settings to match sea-level conditions during cruise. Special onboard systems allow pilots to maintain a steady, safe environment throughout.

• Lower Flight Altitude: To achieve sea-level pressure without overstraining the aircraft, the plane flies lower — often between 8,000 and 15,000 feet.

• Medical Clearance and Permits: Some countries require special aviation clearance for low cruising altitudes across their airspace. We handle this paperwork in advance.

• Flight Planning: Lower flights consume more fuel, so extra stops for refuelling may be needed on longer journeys. SkyCare plans routes carefully to minimise delays and ensure patient safety.

What are the Benefits of a Sea Level Flight?

For the right patient, the benefits of a Sea Level Flight are enormous:

• Higher Oxygen Levels: Helping injured lungs, hearts, and brains function normally.

• Lower Risk of Gas Expansion: Reducing swelling in surgical wounds, head injuries, and pneumothoraxes.

• Greater Comfort: Avoiding headaches, shortness of breath, or faintness caused by thin air.

• Smoother Medical Care: Ventilators, IV drips, and monitoring equipment work more effectively at lower altitudes.

In short, Sea Level Flights create the safest possible environment for vulnerable patients to travel by air.

Are There Any Downsides?

While Sea Level Flights offer clear medical advantages, it’s important to understand the trade-offs:

1. Increased Fuel Use

• Aircraft burn more fuel at lower altitudes because the air is denser.

• This adds cost to the journey, which families may see reflected in the flight price.

2. Longer Journey Times

• Flying lower can mean slightly slower speeds and the need for extra refuelling stops on longer trips.

3. Slightly More Turbulence

• Lower altitudes can mean bumpier weather, though our pilots work carefully to avoid rough air.

Despite these challenges, when a patient’s safety is on the line, sea level flight conditions are absolutely worth it.

A Quick Realistic Example

Imagine Kate, a 64-year-old lady who suffered a stroke while on holiday in Portugal. Her doctors stabilised her but advised against air travel due to the risk of brain swelling. Her family arranged a SkyCare air ambulance with a sea level cabin setting. The aircraft flew at 12,000 feet, maintaining sea-level pressure. Although the flight took a little longer and may of needed a refuelling stop in France, Kate arrived safely in London — stable, comfortable, and ready to continue her recovery. The small extra cost was a worthwhile investment in her health.

Why Choose SkyCare for Sea Level Flights?

At SkyCare, patient care always comes first. Our air ambulance service is built around safety, comfort, and expertise.
When a Sea Level Flight is needed, we:

• Conduct thorough pre-flight assessments

• Work with aviation authorities to plan routes and obtain permissions

• Provide ICU-standard equipment onboard

• Assign experienced medical teams, including specialists like consultants if required

• Offer transparent pricing, explaining all additional costs upfront

• Deliver bed-to-bed care, from collection to handover at the destination hospital

We believe families deserve clarity, honesty, and the highest level of care — at every stage of the journey.

If you’d like to learn more about how SkyCare can arrange a Sea Level Air Ambulance Flight, please visit our Air Ambulance Service Page.

Final Thoughts

If you’re arranging an air ambulance for someone you love, understanding the option of a Sea Level Flight can give you peace of mind.
It’s not just a technical detail — it can genuinely save lives and make long journeys much safer for patients with sensitive conditions.

At SkyCare, we’re proud to offer this specialist service — with compassion, skill, and 24/7 support.
Whether you’re moving a loved one across Europe or across the world, we’re here to make sure their journey is as safe and smooth as possible.

Contact SkyCare