Air ambulance or stretcher on a scheduled flight: how the choice is made
A patient who needs to travel by air can fly in a dedicated air ambulance, lie on a stretcher on a scheduled flight, or sit in an ordinary seat with a doctor or nurse alongside. This guide explains what separates the three options and who decides between them.
Medical review: [name and qualification of the referring doctor]
Three ways to fly a patient
Each option offers a different level of care on board. The right one depends on the patient’s condition, not on preference alone.
Dedicated air ambulance
A medically equipped aircraft flies for one patient, with a medical team on board. It leaves when the mission is ready, not to a timetable, and is usually organised as a bed-to-bed transfer, from the hospital bed at departure to the bed at destination.
Stretcher on a scheduled flight
The airline installs a stretcher in the passenger cabin, over several seats taken out of sale. The patient lies flat throughout and travels with a medical escort. Whether it is possible depends on the airline, the route and the aircraft.
Seated with a medical escort
The patient travels in an ordinary seat on a scheduled flight, accompanied by a doctor or nurse who monitors them and provides care during the journey.
How airlines handle stretcher passengers
A stretcher on a scheduled flight is a special request, never a standard booking. Each airline sets its own conditions, but the same points recur.
- Medical clearance. The airline’s medical service must accept the patient beforehand. The request usually goes through a MEDIF, a form based on the IATA Medical Manual and partly completed by the treating doctor.
- A qualified escort. On their medical forms, Brussels Airlines and Lufthansa state that a stretcher passenger needs assistance from a nurse, paramedic or doctor, and that family members are not accepted as medical escorts. Cabin crew do not give nursing care.
- Advance notice. Ask as early as possible. IATA’s recommended practice is to request special assistance at least 48 hours before departure, and Royal Air Maroc, for example, requires advance notice and a medical certificate for a stretcher.
- Every flight counts. With a connection, each airline and each flight must accept the stretcher, so a direct flight is usually simpler.
- Ground transport. The airline does not usually supply ambulances: the family, the assistance company or the insurer arranges them.
Airlines charge for the stretcher on top of the escort’s tickets, and conditions must be checked for each specific flight.
Who decides which option is suitable
The choice is a medical decision, made case by case. It starts with the treating doctor, who knows the patient’s condition, treatment and stability. Their recent medical report is the basis for everything that follows.
Our medical team reviews that report with the treating doctor and looks at the whole journey: care needed on board, flight time, ground transfers and the consequences of a delay. For a scheduled flight, the airline’s medical service has the final word. When an insurer or assistance company is paying, its doctors take part in the decision too.
Airline forms ask, for example, whether the patient can sit upright, whether oxygen is needed, and how the condition may react to the lower oxygen pressure in the cabin. We do not publish a list of conditions that are fit or unfit to fly: each situation is assessed on its own facts.
Comparing the three options
A general overview: for each patient, the medical assessment decides.
| Criterion | Air ambulance | Stretcher on a scheduled flight | Seated with a medical escort |
|---|---|---|---|
| Care in flight | Team and equipment dedicated to one patient, up to intensive care if needed | Escort’s care while lying flat, with airline-approved equipment | Escort’s monitoring and care in a standard seat |
| Availability and lead time | Organised around the mission: [usual time from agreement to take-off] | Airline clearance, notice period and a stretcher place on the flight | Seats available and, where required, airline clearance |
| Departure time | Flexible, set around the patient and hospitals | Airline timetable | Airline timetable |
| Routing | Direct, with refuelling stops if the distance requires | Airline network; connections add complexity | Airline network; connections if the patient can manage them |
| Privacy | Patient alone with the medical team | Passenger cabin, among other travellers | Passenger cabin, among other travellers |
| Equipment and oxygen | Carried on board as part of the medical set-up | Airline rules: oxygen booked ahead, limits on personal cylinders, devices approved | Same airline rules |
| Accompanying relatives | Depends on cabin space and the medical team | Usually possible with their own ticket, but not as medical escort | Usually possible with their own ticket |
| Ground transfers | Usually part of the same mission | Ambulances booked separately at both ends | Arranged according to mobility |
| Relative cost level | Highest: aircraft and crew for one patient | Intermediate: stretcher charge plus escort tickets | Usually the lowest |
For what drives the price of each option, see medical repatriation costs.
When each option tends to be considered
An air ambulance is usually preferred when
- the medical assessment calls for continuous monitoring or intensive care in flight;
- the transfer is urgent and cannot wait for airline clearance or a suitable flight;
- no scheduled flight on the route can take a stretcher, or the connections would be difficult;
- the airline’s medical service declines the patient, or the patient must be kept apart from other passengers.
A stretcher or a medical escort may be enough when
- the treating doctor and the medical team consider the patient stable enough for a scheduled flight;
- one doctor or nurse can provide the care needed, with equipment the airline accepts;
- a suitable flight exists and the timing allows for the airline’s clearance.
These are general patterns, not rules: the decision always depends on the medical assessment of the individual patient.
Practical steps
- Gather the medical documents. Ask the treating doctor for a recent report and direct contact details. Our guide to the documents for a medical repatriation explains the MEDIF.
- Check the insurance first. If a travel insurance or assistance contract may apply, call the insurer before booking: it may have to approve the transport. See travel insurance and medical repatriation.
- Ask for a quote. Send the departure, destination, preferred date and a few words on the patient’s mobility through our quote request form. We review the case with our medical team and explain which options are realistic.
- Confirm the whole chain. Flight, escort, ground transfers and receiving hospital are confirmed together, as described in how a medical repatriation works.
Important
This guide gives general information only. It does not replace the advice of the treating doctor and does not say whether a particular patient can fly: that decision belongs to the doctors in charge, the medical team organising the transfer and, on a scheduled flight, the airline’s medical service. In an emergency, call the local emergency number (112 in the European Union).
Frequently asked questions
Can the family choose the option it prefers?
Its wishes are heard, but the means of transport must match the care the patient needs. The final choice rests with the doctors and, on a scheduled flight, with the airline.
Why can an air ambulance sometimes leave sooner?
It does not depend on a timetable or on an airline’s clearance. It still needs flight permits, an open airport and a confirmed bed at the receiving hospital.
Can a stretcher patient take a connecting flight?
In principle, yes, but every airline and flight on the journey must accept the stretcher, and the transfer between aircraft must be organised. On complex routes, a direct flight or an air ambulance is often considered instead.
Is an air ambulance always the safer choice?
Not automatically. The suitable option is the one that matches the care needed during the whole journey. Some patients can travel on a scheduled flight with an escort; others need a dedicated aircraft. The medical assessment decides.
What if the airline refuses the stretcher?
Another airline or flight, or an air ambulance, may be considered, depending on the medical assessment. A recent medical report helps react faster.
Related guides
Documents for a repatriation
MEDIF, fit to fly and medical report: what to prepare and who completes it.
Insurance and repatriation
What travel insurance usually covers and how a guarantee of payment works.
Choosing a provider
The questions to ask before entrusting a repatriation to an organiser.
Not sure which option suits the patient?
Tell us where the patient is, where they need to go and whether they can sit, must lie flat or need close monitoring. We will review the options with our medical team and send you a quote.