Understanding ‘Fit to Fly’ in Medical Air Travel

Air travel can be daunting when you or a loved one is unwell. The term “Fit to Fly” refers to a medical clearance required by airlines to confirm that a passenger’s condition is stable enough for air travel. It’s like a “passport of health” that signals to the airline and crew that the journey is safe based on recent medical information. This certification is especially important for people recovering from surgery or those with serious illnesses. Without it, most airlines will refuse boarding. Obtaining a Fit to Fly certificate involves gathering medical records, GP or consultant letters, and sometimes specific tests like oxygen saturation or blood work.

What Does a Fit to Fly Certificate Mean?

When an airline says a person is “fit to fly,” it means their medical team has reviewed the required documentation and found no reason to deny travel. This usually involves completing a medical form (commonly called a MEDIF), listing all conditions, medications, and care needs. The reviewing doctor may write something like “I know of no reason this patient should not fly,” which is not a guarantee of safety, but a confirmation based on the available medical facts. Even with a certificate, the captain has final authority to deny boarding if the passenger appears worse than expected at the airport.

Who Decides and What Documentation Is Needed?

The airline always makes the final decision. Even if a personal doctor approves the flight, the airline’s medical team has to agree. This requires a health questionnaire, consultant letters, discharge notes, and sometimes imaging or test results. SkyCare can assist by gathering records, liaising with hospitals, and submitting documents on your behalf. We recommend doing this at least 48–72 hours before departure. Pilots can still overrule the medical clearance on the day if the patient seems unfit.

Common Reasons a Fit to Fly Certificate Is Denied

• Need for supplemental oxygen: If oxygen needs exceed what the airline can provide (typically 2 L/min), the patient may be refused. See Flying with a Lung Condition.
• Recent surgery or acute illness: Airlines often require recovery time after operations or serious illnesses due to the risk of in-flight complications.
• High risk of deterioration: Unstable patients (e.g. ICU cases, unstable heart rate, breathing difficulties) will not be cleared to fly.
• Contagious infection: Passengers with infections like flu, TB, or chickenpox are denied to protect others onboard.
• Pregnancy near term: Most airlines require a certificate from 28 weeks and refuse boarding after 36 weeks (or earlier for twins).
• Other safety risks: Issues like uncontrolled seizures, mental health crises, or inability to wear a seatbelt can also lead to refusal.

Fit to Fly with Restrictions vs. Not Fit to Fly

Some passengers are cleared to fly under certain conditions—this is known as being “fit to fly with restrictions.” For example, the airline may require the passenger to be accompanied by a medical escort, use a wheelchair, or fly business class with a stretcher installation. In contrast, a “not fit to fly” decision means the airline deems the flight unsafe even with support. This is where SkyCare steps in with alternatives such as air ambulances or road repatriation.

Alternatives When a Commercial Flight Is Denied

If an airline refuses clearance, all is not lost. SkyCare can arrange an air ambulance—a medically equipped aircraft staffed by ICU doctors and nurses. Because these are private charters, airline rules do not apply. We also offer road ambulance repatriation for stable patients across Europe. If appropriate, we may advise waiting a few days for the patient to stabilise, then arranging a commercial medical escort once safe.

Mental Capacity and Informed Consent

Most airlines assume adult passengers have mental capacity to understand and accept risk. If a patient is advised not to fly but insists, airlines often permit travel with a signed waiver. SkyCare always ensures true informed consent is obtained. If the patient lacks capacity, decisions must be made by a legal guardian or someone with power of attorney. However, any decision to transport the patient must still be a best interest decision, in accordance with the Mental Capacity Act. We work closely with families, legal representatives, and hospitals to ensure all actions taken are clinically appropriate, legally valid, and always prioritise the patient’s well-being and dignity.

SkyCare’s Approach and Services

When a Fit to Fly certificate is denied, SkyCare steps in. We assign a dedicated case manager to gather all clinical data and communicate with doctors, hospitals, insurers, and airlines. If a commercial flight is not possible, we arrange a safe alternative—air ambulance, stretcher flight, or medical escort. Our CQC-regulated services cover everything from paperwork to bedside handover, including stretchers, oxygen, mobility, medication, and visas. Whether flying from Europe, Asia, or the Middle East, we tailor every journey to the patient’s needs.

Key Takeaways

• Airlines require a Fit to Fly certificate for unwell passengers—but air ambulances do not.
• The airline’s medical team, not your personal doctor, makes the final decision.
• Common reasons for refusal include oxygen needs, recent surgery, instability, and infection.
• “Fit with restrictions” allows flight under strict conditions; “not fit” requires medical transport.
• SkyCare offers air ambulances, medical escorts, or road repatriation as needed.
• We always confirm mental capacity and informed consent or secure proper authorisation if needed.
• All journeys are medically managed, bed-to-bed, and regulated by the UK Care Quality Commission.

Contact SkyCare for Repatriation Assistance

A Fit to Fly refusal doesn’t mean you’re stranded. SkyCare offers 24/7 advice and medical repatriation services tailored to your needs. Visit our Medical Repatriation and Air Ambulance pages, or contact us now to speak with a medical operations specialist.