General layout of a vascular access device

This article is about communicating an air safety risk, it is NOT medical advice.

Crowding isn’t just apparent in air travel, but in matters of public health. The asset, whether it is a seat in a jet, or a bed in a ward, is constantly under pressure to be ‘more efficiently utilised’ or occupied.

In the air, that can mean being in much closer contact with your by chance travelling companions, or the fixed seating around you, which may no longer be as likely to be unoccupied as it may have been in recent years.

In a hospital, even in private rather than public ward care, there is a cost driven focus on such procedures as ERAS, early release after surgery, or periodic home or self administered periods of on-going treatment.

For this now mildly disabled reporter, who is recovering from a slowly healing back fracture, and receiving management through chemotherapy for the consequences of stage four cancers, these matters have converged in a way that makes a safety risk to flight obvious, yet it is one that none of our four main brands of air travel currently deal with in simple, unambiguous, and direct language.

THE ISSUE is passengers not being explicitly warned against flying or even using crowded trains, trams and buses, while receiving slow release cytotoxic chemotherapy drugs via vascular access devices such as subcutaneous ports, often branded Power Ports, or the likes of Hickman’s Catheters.

These devices are usually fed off reservoirs contained in bottles worn as bum bags and through a thin plastic tube that lead up to the skin covered bump over the catheter assembly housing in a large vein just above your heart.

The slow release infusion process begins typically on day one of a regular chemo regimen in hospital, then continues at home for much of the 40 hours or so set aside for the process, which ends on the third day again under strict medical supervision to disengage, flush, and lock the access port.

It is in that middle day when a user of a such a port might feel perfectly entitled to do a day return flight to another city. There is nothing in big, unambiguous lettering on any of the main airline sites that says they shouldn’t.

Yet the oncology wards and specialists quite correctly issue users with spill kits and very explicit instructions as to how to protect themselves and those around them by putting on provided protective light plastic gloves and cover-alls, similar in intent to those heavier duty copies that are so meticulously used by chemo nursing staff.

In those kits chemo patients are told to immediately head for a hospital emergency department and show their see-me-without-delay cards. Needle pop outs or other disconnection events are potentially life threatening. The sudden infusion of slow release cytotoxic drugs can kill. Jets can’t suddenly divert to a landing at an ED department. Breathing the volatile traces in a hot confined space like an airline cabin is a severe risk to the health of those within it. Aircraft cabins circulate the air efficiently, in cases like this, arguably much too efficiently. There are no good scenarios concerning cytotoxic drug spills at altitude.

A review of the web page advice to intending passengers on Jetstar, Qantas, Tigerair and Virgin, and confirmed by discussions with them, makes it clear that they are all abundantly aware of their obligations to make passenger safety the number one priority. (It isn’t optional, it is in regulatory terms, the number one priority.)

Jetstar stood out as best at being direct, although it makes no reference to this specific set of risks, and nor did any other site, except the very legalistic and detailed Qantas pages, which on repeated readings, only mentioned chemotherapy directly once a passenger with powers of endurance gets to a sub section of a Part B questionnaire.

As the written guidance to Plane Talking said: While all medical clearance forms are assessed individually, patients undergoing active chemotherapy treatment would generally fall outside the category of passengers cleared to fly.

But the Qantas guidance assumes that passengers even consider, or know about, a need to have a clearance form.

Where does a Qantas passenger, or any passenger, get asked to consider whether or not they need a medical clearance to fly subject to certain circumstances linked to their cancer treatment?

No one is being asked up front, on web sites at least, are you being treated for cancer, or receiving passive medications using an implanted device? It is far too late to do this at a terminal kiosk, or an identity check.

Although dangling a visible plastic line from an object worn on a hip to somewhere on your upper body might get noticed by security, where that medical emergency card might come in handy. Then again, in some parts of the world, you might get tackled to the ground, which would quite likely bring on an immediate cytotoxic crisis.

Nor can a user just switch off the device, except by following the very specific spill or blockage management instructions. Chemotherapy users are at elevated risk of general infections, and crowded places are a health risk to them at the very outset. If an access point pops out for any reason the sharp end just can’t be shoved back in without creating the near certainty of a massive infection, if not a potentially lethal overdose of a poison that is intended to kill or more correctly shrink or stay the progress of a cancerous lesion or tumour.

The medical risks and manifest rewards of effective chemotherapy are matters on which professional advice is critical. This post is about the need for airlines to be far more direct in preventing people who are on the day of intended travel using vascular access devices actively delivering cytotoxic drugs as part of their chemo regimens from putting themselves and others at risk in aircraft.

Don’t hide the message behind a wall of waffle. Tell the customers DON’T DO IT.

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