01 January 2012
EU, Europe
Asthma , COPD
- Inequalities


The EFA Oxygen Harmonization Project was a project officially completed in 2013 and focused on the inequalities which exist in relation to the availability of oxygen during travel on commercial airlines. The project worked as a parallel action working with MEP Keith Taylor at the European Parliament, who has requested an own-initiative report (OIR) in the Transportation and Tourism (TRAN) Committee of the European Parliament on “The functioning and application of established rights of people traveling by air.” EFA and the European Lung Foundation (ELF) identified the current situation of air travel with oxygen as challenging and we want to give insight to all stakeholders about the experiences of what chronic patients requiring oxygen to travel demands, what needs to be done prior to a air travel booking as well as what the airlines and authorities need to change to enable air travel with oxygen without creating cases of discrimination and exploitation.  

EFA's position

At the present, many airlines in Europe are competitors who use oxygen as a commodity for profit, making air travel a luxury for patients in need of oxygen, as it can at times require a similar fee to the original price of the ticket. In 2012, the project worked on the harmonization of conditions for patients with respiratory illness and a need for oxygen during travel, making oxygen available at all times and free of charge to people in need on airlines. EFA believes that airlines should complement the needed oxygen with the patients’ own supply free of charge for flights where more than one tank is necessary and that airlines should additionally offer transport of the additional tanks free of charge. As a long term objective, EFA envisions the creation of oxygen tank refill stations at major airports, much like those already existing in the Zurich Train Station.  

EFA's Booklet 'Enabling Air Travel with Oxygen in Europe' and Past Actions

As a result of the inconsistencies of rules among different commercial airlines, patients who wish to travel, always come up with a series of questions regarding their possibilities to use oxygen with safety for their health and their trip. In the framework of Oxygen Harmonization Project, EFA collected questions from patients addressed to the European stakeholders influencing safety guidelines with the aim of demonstrating the need for harmonization of the oxygen use on board of aircraft in Europe. In order to clearly demonstrate the need for a harmonization of different practices among airlines, EFA prepared a booklet Enabling Air Travel with Oxygen in Europe:  An EFA Booklet for Patients with Chronic Respiratory Disease which analyses the different policies of European airlines for using oxygen during air travel, includes patients’ stories from all around Europe and presents discriminatory practices ongoing among certain airlines. The booklet will includes EFA’s position together with testimonies from patients with respiratory problems gathered from across Europe. The patients’ stories recall their travel experiences by airplane with oxygen and highlight any trouble they have faced with different rules and procedures of European airlines.  EFA stressed the need to harmonize those rules and enable the travel of patients who need to use oxygen during flights. The booklet was endorsed by MEP Taylor, whom also EFA kindly thanks for agreeing to include a foreword in the booklet, and was presented to the European Commission, International Civil Aviation Organization (ICAO) and European Aviation Safety Agency (EASA). At the European Health Forum 2014 at Badgastein, Austria EFA also presented the booklet to Commissioner Tonio Borg, who has worked tirelessly on discrimination and led a session on the topic at the event, receiving his support and acknowledgement of these discriminatory practice as unacceptable. The findings were presented at the European Respiratory Society Congress (ERS) 2014 during a poster discussion on COPD.

Findings of EFA's Booklet

Discriminatory practices are persistent among many of the major European commercial airlines which opt to charge for the use of oxygen

  • People requiring the use of oxygen when they travel can be charged up to 7x the price of the same round trip airfare for a normal passenger
  • The same flat rates are usually charged for intercontinental and continental flights
  • A minority of airlines do not charge for the use of oxygen and even offer it free (e.g.  British Airways, Air Baltic, Air Malta and Tarom)

European airlines each have different Medical Information for Fitness to Travel (MEDIF) forms

  • Different approval periods for completing MEDIF forms make it confusing and difficult for people requiring oxygen to confidently make travel reservations in a timely manner
  • The lack of a single European MEDIF form causes extra work for healthcare professionals as different forms may request different information or have different approval periods

Some cabin crews of European airlines are inadequately trained on how to assist passengers requiring the use of oxygen

  • Patient testimonials revealed unacceptable requests from cabin crews to passengers requiring oxygen were made (e.g. “Can you turn off your oxygen for take off and landing?”)
  • Without one properly trained cabin crew member, misunderstandings and mistakes are more likely to occur resulting in stressful and unnecessary costs for passengers

Most airlines permit the use of  personal Portable Oxygen Concentrators (POCs) onboard aircraft during the entirety of the flight; approved devices are normally listed

EFA's follow up actions in 2014

Following the release and dissemination of the 'Enabling Air Travel with Oxygen in Europe' booklet and the official end of the Oxygen Harmonization Project, EFA has planned for follow-up actions within the 2014 COPD Project to continue building momentum on this issue. EFA has identified the need for direct meetings with representatives of the European airlines to discuss further the policies associated with the use of oxygen during air travel. In addition to building a case against European airlines continuing their discriminatory practices, the booklet also highlights other airlines which already have best practices in place.  These include Air Baltic, Air Malta and Tarom, three airlines that provide oxygen to passengers free of charge already, as well as British Airways, which permits one passenger per flight to have free oxygen during their travels. As a consequence, EFA approached the European Disability Forum (EDF) and Rare Diseases Europe (EURORDIS), where agreement was reached to partner in ending the ongoing discriminatory practices by airlines that affect a broader range of patients and people with disabilities. With its partners, EFA has invited the CEOs of European airlines to meet in Brussels to discuss their policies further and pinpoint potential possibilities to transition away from discriminatory practices.

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