Travelling with health concerns

Our top priority at WestJet is the health, safety, and comfort of our guests and crew. Guests are advised that air travel may negatively affect their overall medical condition. If a medical emergency occurs onboard an aircraft, coordinating an unplanned landing to access high-quality ground medical care can take additional time to coordinate. 

If you are affected by any of the medical conditions listed below, we recommend you review your plans and this information with your physician to ensure you are safe to fly before confirming your travel.

Please click on the buttons below to access a printable version of our Air Travel Requirements Assessment form and our Information for Health Care Providers Document. We recommend submitting medical documentation 10 business days prior to departure to ensure sufficient time to review. Without advance notice, we will make every reasonable effort to accommodate your request. 

Any charges incurred for the completion of this form will be at your expense. WestJet will not provide you with compensation if you are not approved for accommodation.  Please note: Air Travel Requirements Assessment forms will be retained for a minimum of three years and handled in accordance with the WestJet Privacy Policy.

Follow up with your physician to discuss whether you should travel if you are sick or unwell before departure. All guests who appear sick or unwell at the airport may be subject to medical screening at the discretion of our WestJet agents or cabin crew. 

If you have one or more of the following medical conditions, please review your health status with your physician to determine if you need to submit our Air Travel Requirements Assessment form.

  • Medical uncertainty that you can complete the flight safely without needing extraordinary assistance.
  • Active infectious conditions such as, but not limited to, tuberculosis, chicken pox and measles 
  • Blood conditions:
    • Clotting disorders where your condition and treatment require monitoring by your physician
    • Leukemia
    • Severe anemia
  • Broken bones/fractures:
    • Casted limb within 48 hours of departure
  • Cancer with active treatment
  • Cognitive, behavioral and psychological conditions: 
    • History of condition deteriorating during previous flights
    • Not orientated x3 (to person/place/time)
    • Cognitive impairment and are unable to travel independently. (e.g. Down Syndrome, Alzheimer’s disease)
    • Unstable/unpredictable or aggressive behavior/agitation
  • Ear, nose, sinus or throat disorders:
    • Current ear infection with the inability to clear ears 
    • Eye surgery where gas has been instilled and not absorbed 
    • Post-operative middle ear or nasal surgery within 10 days of departure 
    • Recent jaw surgery within a week of departure 
    • Tonsillectomy within 3 weeks of departure
  • Gastrointestinal issues:
    • Abdominal surgery within 14 days of departure 
    • Bleeding within 10 days of departure 
    • Laparoscopic surgery within 5 days of departure
  • Heart conditions and lung conditions:
    • Currently symptomatic or unstable 
    • Inability to walk 50m without significant shortness of breath or chest pain 
    • Oxygen is required during the flight please submit a Air Travel Requirements Assessment form. WestJet does not supply oxygen for purchase therefore, you must bring your own personal portable oxygen concentrator with enough battery power to last 1.5 times the duration of your flight.
    • Recent deterioration 
  • Infant:
    • 7 days old or less 
    • Complex medical needs
    • Premature
  • Medical procedures and surgeries:
    • Surgery within 14 days of departure
  • Neurological conditions:
    • Head trauma less than 48 hours of departure 
    • Seizures within a month of departure 
    • Stroke within 14 days of departure 
    • Transient ischemic attack within 72 hours of departure 
  • Pregnancy:
    • Singleton equal to or greater than 36 weeks gestation
    • Multiple equal to or greater than 32 weeks gestation
  • Previous medical event on board a commercial aircraft or at the airport requiring medical attention.

Access our Air Travel Requirements Assessment form to fill out with your physician. The WestJet’s Information for Health Care Providers Document contains information your doctor will need to consider regarding your safety to fly. Any charges incurred for the completion of this form will be at your expense. WestJet will not provide you with compensation if you are not approved for accommodation. Please note: Air Travel Requirements Assessment forms will be retained for a minimum of three years and handled in accordance with the WestJet Privacy Policy.

Refunds of any fare type will not be provided for flights taken before an approval has been granted.

WestJet accepts Air Travel Requirements Assessment Forms from Air Canada or Air Transat as long as the form is fully completed and dated within the last 90 days of when it is submitted to our Medical Desk.

If your travel itinerary includes a flight operated by another airline, please contact them to ensure you are meeting their requirements as it relates to your medical condition. Completed forms can be emailed to MedDesk@WestJet.com or sent in via fax to 1-866-737-1202. 

A medical certificate from your physician, dated within 10 days of the departing flight, will be accepted as an alternative to the WestJet Air Travel Requirements Assessment form. The medical certificate must indicate your prognosis for a safe flight with no extraordinary medical assistance required on board, and confirm there is no indication of a contagious disease that would pose a risk to the safety of others on board.

We encourage all guests to review WestJet's Information for Health Care Providers Document with their physician.  

Information for health care providers

Air travel with medical conditions

There are numerous factors to consider when determining if your patient is medically fit to fly. Air travel can have low humidity, turbulence, prolonged periods of immobility, and requires a patient to sit upright in an aircraft seat. Several other factors can lead to deterioration of a medical condition on board, including: 

  • Gas expansion at altitude - As an aircraft ascends to cruising altitude, any gas trapped in the body will expand. In fact, the volume of gas can expand up to 30%, causing significant issues in specific instances. It may be important for your patient to consider delaying air travel if they have had recent surgery (especially in a small space such as the eye or ear) or recent pneumothorax (collapsed lung).
  • Altitude and its effect on oxygen levels - Our aircraft are pressurized to altitudes equivalent to 5000-8000 ft above sea level. At this altitude, there is less oxygen available. Healthy individuals will not notice this change, but those suffering from severe anemia, cardiac or pulmonary conditions could be at risk of severe hypoxia. Some individuals may require a Personal Oxygen Concentrator (POC) on board an aircraft to supplement their oxygen needs, even if they do not require oxygen on the ground. In these instances, consider delaying air travel until their condition is stable. To learn more information about oxygen needs, click here. 
  • Limited access to medical care on board -  In the event of a medical issue on board, our crews are trained in first aid and cardiopulmonary resuscitation (CPR). However, access to higher level medical care can take a prolonged amount of time, depending on many factors.

 

When should an Air Travel Requirements Assessment form be completed (ATRAF)?

Please consider filling out a Air Travel Requirements Assessment form for your patient if they have any of the following conditions or illnesses:

a) Any medical condition or illness that may deteriorate while on board the aircraft and potentially impact other guests. Examples may include severe heart disease, active infectious diseases, neurological issues, or unstable psychiatric illnesses. 

b) Any medical condition or illness that may worsen because of conditions on board the aircraft at cruising altitude. Examples may include a recent surgery where air is introduced into a body cavity, recent epistaxis, severe respiratory disease, or recent pneumothorax. 

c) Any potentially contagious infectious diseases such as tuberculosis, chicken pox, or influenza.

A completed Air Travel Requirements Assessment form confirms that your patient has been assessed prior to travel. The type of medical information gathered complies with international air travel guidelines. The information provided is retained in accordance with WestJet’s Privacy Policy and the requirements of the Canadian Transportation Agency's Accessible Transportation for Persons with Disabilities Regulations. 

The guidance provided is in accordance with the International Air Transport Association’s guidelines. 

  1. Any cancer undergoing chemotherapy treatment

    ATRAF is not required if all criteria are met

    • No recent chemotherapy has been administered
    • Symptoms are controlled
    • Hgb >90g/L and electrolytes are in the normal range

     

    Considerations

    Patient should not fly during active administration of a cytotoxic medicine, especially when this involves slow-release cytotoxic drugs via vascular access

  1. Ablation therapy

    ATRAF is not required if all criteria are met

    >48 hours with stable rhythm

     

    Considerations

    Patients flying within a week of the procedure are considered high risk for DVT

  2. Angina

    ATRAF is not required if all criteria are met

    • No symptoms at rest 
    • Can walk 50m without significant shortness of breath or chest pain
    • Symptoms controlled with medication

     

    Considerations

    • Angina with minor exertion may require O2 in flight (CCS III)
    • Individuals with symptoms at rest should defer travel (CCS IV)

  3. Angiography

    ATRAF is not required if all criteria are met

    >24 hours with original condition judged as stable

  4. Angioplasty with or without stent

    ATRAF is not required if all criteria are met

    >3 days, asymptomatic and stable underlying health issues

  5. Cardiac surgery

    ATRAF is not required if all criteria are met

    • 4 weeks post procedure without complicating factors 
    • Stable medications
    • CXR excluding pneumothorax 
    • Hgb >90 g/L

  6. Congestive heart failure

    ATRAF is not required if all criteria are met

    • Controlled and stable chronic heart failure
    • No exacerbations in the past 6 weeks
    • Able to walk 50m or one flight of stairs without shortness of breath or chest pain

     

    Considerations

    • Symptoms with exertion (NYHA class 3) may require O2 in flight 
    • NYHA class 4 should defer all non-essential travel and must fly with inflight O2

  7. Cyanotic congenital heart disease

    Considerations

    • ATRAF form recommended for all patients
    • Consideration of inflight O2 in all cases

  8. Deep venous thrombosis

    ATRAF is not required if all criteria are met

    Asymptomatic and stable on anticoagulant therapy

  9. Hypertension

    ATRAF is not required if all criteria are met

    Not required for isolated hypertension

     

    Considerations

    Travel should be deferred for those with severe and uncontrolled hypertension

  10. Myocardial infarction (STEMI and NSTEMI)

    ATRAF is not required if all criteria are met

    MI >2 weeks ago and is asymptomatic with stabilization of medications

     

    Considerations

    • Low risk-<65 years of age, first event, successful reperfusion, EF >45%, no complications, no investigations or interventions planned may fly earlier with approval 
    • High Risk-EF<40%, heart failure, pending investigation, revascularization, or device therapy should have travel deferred until stabilization of the condition

  11. Pacemaker or defibrillator implantation

    ATRAF is not required if all criteria are met

    • >2 days if rhythm is stable
    • CXR has ruled out pneumothorax

  12. Pulmonary edema

    ATRAF is not required if all criteria are met

    • Resolved pulmonary edema 
    • Resolution of the precipitating condition

  13. Pulmonary embolism

    ATRAF is not required if all criteria are met

    >2 weeks since onset 

    Adequate anticoagulation 

    Asymptomatic

     

    Considerations

    Consideration can be given to those requiring essential travel after 5 days if adequately anticoagulated, asymptomatic and PaO2 normal on room air

  1. Cognitive impairment (e.g. Dementia, Down syndrome, and/or Alzheimer’s disease)

    ATRAF is not required if all criteria are met

    • Mild impairment
    • Functions independently in the community
    • No paranoia, aggressive behaviour, or agitation.
    • No history of deterioration in flight.
    • Patient is alert and orientated x3 (person/place/time)

     

    Considerations

    Consider support of an attendant

  2. CVA (stroke)

    ATRAF is not required if all criteria are met

    • 14-28 days since event
    • Stable condition

     

    Considerations

    Flights under 14 days may require supplemental oxygen.

  3. Head trauma

    ATRAF is not required if all criteria are met

    • Mild concussion
    • Minimal symptoms (headache only)
    • Injury >48 hours

     

    Considerations

    Recent (<4weeks), skull fractures, subarachnoid or subdural bleeds an ATRAF is recommended

  4. Seizures

    ATRAF is not required if all criteria are met

    Stable control with no seizures in the past 30 days

     

    Considerations

    • Flight is contraindicated if unstable seizure disorder or grand mal seizure in the past 24 hours
    • Relative hypoxia onboard can lower the seizure threshold in some individuals

  5. Syncope

    ATRAF is not required if all criteria are met

    • Age <70 with classic vasovagal syncope
    • Age >70 and non-vasovagal syncope investigated, and underlying condition stabilized
    • >24 hours since episode

     

  6. TIA

    ATRAF is not required if all criteria are met

    • >72 hours since event
    • Asymptomatic
    • Investigations completed

     

    Considerations

    Crescendo TIAs should avoid travel

  7. Cranial surgery

    ATRAF is not required if all criteria are met

    • Surgery ≥ 10 days
    • Cranium free of air
    • Adequate general condition

  1. Dental procedures

    ATRAF is not required if all criteria are met

    • >24 hours since procedure
    • Pain controlled

     

    Considerations

    Recommend all patients with recent dental procedures bring their own prescribed or over the counter pain medication for travel

  2. Epistaxis (nosebleed)

    ATRAF is not required if all criteria are met

    • Bleeding has stopped for more than 24 hours
    • No packing is in place
    • Hgb >90 g/L

  3. Middle ear surgery

    ATRAF is not required if all criteria are met

    • >10 days since surgery
    • Uncomplicated surgery
    • Clearance from ENT surgeon

  4. Nasal surgery

    ATRAF is not required if all criteria are met

    • >10 days postoperative
    • Uncomplicated surgery
    • ENT clearance to fly

  5. Otitis media or sinusitis

    ATRAF is not required if all criteria are met

    • Able to clear ears
    • Illness is improving
    • No additional infectious disease concerns (e.g., COVID-19)

  6. Tonsillectomy

    ATRAF is not required if all criteria are met

    • >3 weeks since surgery
    • Hgb >90 g/L

     

    Considerations

    Due to bleeding risk, travel prior to 3 weeks will require an ATRAF with ENT surgeon consultation

  7. Wired jaw

    ATRAF is not required if all criteria are met

    • Escorted travel with knowledge of how to use cutters to remove in an emergency
    • Unescorted quick release wiring

  1. Diverticulitis

    ATRAF is not required if all criteria are met

    • Symptom resolution
    • Antibiotics completed
    • Chronic disease not requiring antibiotics

     

    Considerations

    Travel is contraindicated with acute symptoms (pain/fever)

  2. Gastrointestinal bleed

    ATRAF is not required if all criteria are met

    • No bleeding in > 10 days
    • Hgb > 90g/L

     

    Considerations

    1-9 days may consider travel if endoscopic confirmation and rising Hgb levels

  3. Major abdominal surgery (bowel resection, open hysterectomy, renal surgery)

    ATRAF is not required if all criteria are met

    • Uncomplicated surgery >14 days ago
    • Hgb >90 g/L
    • Pain controlled

     

    Considerations

    Time can be reduced to 7 days if the intestinal lumen was not opened

  4. Nausea/vomiting/diarrhea

    ATRAF is not required if all criteria are met

    24 hours past the last episode of vomiting and diarrhea and is currently asymptomatic

     

    Considerations

    Travel is contraindicated with active symptoms or symptoms of dehydration

  5. Uncomplicated laparoscopic surgery (appendectomy, tubal ligation, gall bladder removal)

    ATRAF is not required if all criteria are met

    >5 days if uncomplicated recovery

     

    Considerations

    • More complex laparoscopic procedures such as a hemicolectomy would follow major abdominal surgery requirements
    • Flight prior to 5 days will be considered if bloating symptoms are absent

  1. Acute leukemia

    ATRAF is not required if all criteria are met

    • Stable remission
    • Hgb >90g/L

  2. Anemia

    ATRAF is not required if all criteria are met

    Hgb > 90g/L and underlying health conditions are stable

     

    Considerations

    • If acute anemia, repeat Hgb should be completed 24 hours after last blood loss
    • Supplemental O2 should be considered for significant anemia or those with concurrent lung or cardiac disease

     

  3. Bleeding disorder

    Considerations

    Air travel is contraindicated if active bleeding is occurring

     

  4. Clotting disorder

    ATRAF is not required if all criteria are met

    Anticoagulation is stable

     

    Considerations

    Air travel is contraindicated if deep vein thrombosis or pulmonary embolism within 2 weeks of air travel.

     

  5. Sickle cell disease

    Considerations

    Always require supplemental O2

     

  1. Cataract surgery

    ATRAF is not required if all criteria are met

    >24 hours and uncomplicated surgery

     

  2. Corneal laser surgery

    ATRAF is not required if all criteria are met

    >24 hours and uncomplicated surgery

     

  3. Intra-ocular surgery

    Considerations

    • Depending on the gas injected in the globe, travel may be required to be delayed for 2-6 weeks
    • Prior to travel, ophthalmologist will need to confirm fitness to fly and confirm gas used

  4. Penetrating eye injury

    ATRAF is not required if all criteria are met

    • >7 days since injury
    • Any gas in the globe must be resorbed
    • Confirmation with ophthalmologist prior to travel

     

  1. Arthroscopic joint surgery

    ATRAF is not required if all criteria are met

    • Able to mobilize with a walking aid
    • Able to sit fully upright for take-off and landing
    • Pain controlled

     

  2. Full plaster cast flight >2 hours

    ATRAF is not required if all criteria are met

    • >48 hours since cast placed
    • Hgb >90g/L
    • No other injuries of significance
    • Able to mobilize with a walking aid
    • Able to sit fully upright for take-off and landing

     

    Considerations

    Risk of DVT on longer flights so consideration for anticoagulation should be considered

  3. Major hip, knee, or ankle surgery

    ATRAF is not required if all criteria are met

    • Surgery >14 days prior
    • Able to mobilize with a walking aid
    • Able to sit fully upright for take-off and landing
    • Pain controlled
    • Post-operative Hgb > 90 g/L
    • DVT prophylaxis is important and should be assessed if surgery was in the past 6 weeks

     

    Considerations

    If DVT prophylaxis is not utilized, longer travel in the first six weeks travel should only be taken if essential

  4. Spinal surgery

    ATRAF is not required if all criteria are met

    • Uncomplicated surgery >14 days ago
    • Pain controlled
    • Must be able to sit upright for take-off and landing
    • Must be able to tolerate unexpected turbulence and vibration

     

    Considerations

    Attendant would be required if unable to provide self-care

  1. Complicated Pregnancy or history of preterm labour

    Considerations

    Consideration will be given on an individual basis in consultation with treating obstetrician

     

  2. Miscarriage

    ATRAF is not required if all criteria are met

    • No active bleeding or pain for at least 24 hours
    • Hgb >90 g/L

  3. Singleton pregnancy

    ATRAF is not required if all criteria are met

    • <36 weeks gestation
    • Uncomplicated pregnancy
    • No history of preterm labour

  4. Multiple pregnancy

    ATRAF is not required if all criteria are met

    • <32 weeks gestation
    • Uncomplicated pregnancy
    • No history of preterm labour

  5. Newborn

    ATRAF is not required if all criteria are met

    Fit and healthy babies after 7 days

  1. Chronic psychiatric disorders

    ATRAF is not required if all criteria are met

    • Medical condition is stable and risk of deterioration inflight is judged to be low
    • Individual is living in the community independently
    • No episodes of acute psychosis (mania, schizophrenia, drug induced) in the past 30 days
    • Patient is alert and orientated x3 (person/place/time)

     

    Considerations

    • Medication should be carried onboard
    • Attendant should be considered if any risk of deterioration with the stress of travel
    • Alcohol avoidance should be encouraged

  1. Asthma

    ATRAF is not required if all criteria are met

    • Mild asymptomatic asthma
    • No recent hospitalizations for asthma
    • Travel with medications in carry-on

  2. Chest surgery (lobectomy, pleurectomy, open lung biopsy)

    ATRAF is not required if all criteria are met

    • ≥11 days after surgery without complication
    • No pneumothorax on x-ray

  3. COPD, emphysema, pulmonary fibrosis, pleural effusion or hemothorax

    ATRAF is not required if all criteria are met

    • O2 sats >93%
    • Able to walk >50m or 2 flights of stairs with minimal symptoms
    • No other cardiac or remarkable health issues

     

    Considerations

    Moderate COPD may require inflight O2

  4. Lung cancer

    ATRAF is not required if all criteria are met

    • Asymptomatic
    • Hgb >90g/L
    • No large effusions on CXR

     

    Considerations

    Large hemoptysis, regardless of diagnosis, is contraindicated for flight

  5. Oxygen

    Considerations

    For patient whose O2 requirement is ≤4 L/minute at rest, guidelines advise increasing the O2 flow by 1 to 2 L/minute while in flight

  6. Pneumonia

    ATRAF is not required if all criteria are met

    Fully resolved and symptom free

     

    Considerations

    Consider supplemental O2 in cases of recent episode, elderly passengers, or longer flights

  7. Pneumothorax

    ATRAF is not required if all criteria are met

    14 days after full inflation confirmed by CXR

     

    Considerations

    Consideration may be given to those with a non-traumatic pneumothorax 7 days after inflation confirmed by CXR

  8. Pulmonary Hypertension

    ATRAF is not required if all criteria are met

    • NYHA Class I
    • Stable Medications

    Considerations

    For all other cases, an ATRAF is recommended

  9. Ventilators

    ATRAF is not required if all criteria are met

    Stable requiring ventilation only with air

  1. Allergies and anaphylaxis

    ATRAF is not required if all criteria are met

    • Submit ATRAF if a buffer zone is required.

     

    Considerations

    • We are unable to guarantee an allergen-free environment as our aircraft are open to the public
    • Recommend travel with medications including epinephrine autoinjector (for anaphylaxis) in carry-on.  Patient must be able to self-administer or an attendant must accompany the patient.

  2. Communicable diseases

    Considerations

    Travel during contagious stage of the illness is contraindicated

  3. Patients treated with radionuclides or permanent brachytherapy

    Considerations

    • Travel plans should be reviewed by nuclear medicine department
    • Individual risk assessments may be required including dose rate estimate in microSV per hour at 0.5m
    • All cases need documentation for security radiation detection purposes

  4. Scuba diving

    ATRAF is not required if all criteria are met

    • >24 hours following uncomplicated scuba diving
    • >72 hours if multiple dives in the three days prior to travel

     

    Considerations

    Decompression illness will generally require 3-7 days after treatment after consultation with treating physician

  5. Terminal illness

    Considerations

    • Individual assessment of cases must occur
    • Consideration must be given to mobility, lung function, bowel and urinary function, pain control
    • Attendant may be required

References:

Fitness to fly for passengers with cardiovascular disease, The report of the working group of the British Cardiovascular Society, Heart 2010;ii1-ii16. doi:10.1136/hrt.2010.203091

Coker, R. K., Armstrong, A., Church, A. C., Holmes, S., Naylor, J., Pike, K., Saunders, P., Spurling, K., & Vaughn, P. (2022). BTS Clinical Statement on air travel for passengers with respiratory disease. Thorax, 10(1136), 1-22.

Medical manual. IATA. https://www.iata.org/en/publications/medical-manual/. Published July 12, 2020. Accessed September 8, 2022.

Managing passengers with stable respiratory disease planning air travel: British Thoracic Society recommendations. Thorax, Sept. 2011, Vol 66, Supplement 1.

Thibeault C, Evans AD, Dowdall NP. Asma Medical Guidelines for air travel: Fitness to fly and Medical Clearances. Aerospace Medicine and Human Performance. 2015;86(7):656-656. doi:10.3357/amhp.4222.2015.

NYHA: New York Heart Association NYHA Class Symptoms

I No symptoms and no limitation in ordinary physical activity, e.g. no shortness of breath when walking, climbing stairs etc.

II Mild symptoms (mild shortness of breath) and slight limitation during ordinary activity.

Ill Marked limitation in activity due to symptoms, even during less-than-ordinary activity, e.g. walking short distances (20-100 m).  Comfortable only at rest.

IV Severe limitations. Experiences symptoms even while at rest. Mostly bedbound patients.

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