Meeting the needs of travelers with disabilities has never been easy. Since September 11, 2001, however, a whole new set of frustrations exist for both the travelers and the home health care companies that supply them with equipment and oxygen.

Security restrictions at airports, as well as new policies for cruise lines and other modes of travel, have forced providers to make changes to the way they offer equipment, including oxygen tanks, scooters, and manual and power wheelchairs. The current environment has also forced disabled travelers to plan their trips with greater detail.

Air Travel
Air travel unquestionably presents the most challenges for HME providers and users. “It’s always been tough getting items like oxygen tanks through security, but now it’s even more difficult since companies need to get special clearance in order to deliver equipment to the gate,” says Thom Tullis, owner of TRAVELMED, a Las Vegas-based company that offers medical equipment and services for travelers with disabilities. Some of TRAVELMED’s direct competitors have even gone out of business since September 11 due to these problems as well as a slowdown in the travel industry, Tullis says.

According to Bob Fary, director of respiratory therapy of Lake Forest, Calif-based Apria, providers as large as Apria are facing similar problems as they try to assist their clients. “Right after 9/11, all home health care companies were having trouble getting through security to make deliveries,” he says. For example, at Atlanta International Airport in the weeks immediately following September 11, some oxygen patients had to remain off oxygen from the time they disembarked the airplane to the time they left the concourse, Fary says.

After meetings with the National Council on Disabilities (NCD), Fary and other provider representatives convinced the NCD that home health care companies needed special passes that would enable them to get through security to meet their clients. “This is now being practiced throughout the country and if we come across an airport that does not comply, we show them the document from the NCD,” Fary says.

But costs and hassles still abound, which is why Ira Goldberg, owner of Medical Travel Inc, Boca Raton, Fla, has been advising clients since 9/11 to take alternative modes of transportation if at all possible. “If a patient can drive, it’s certainly a lot easier than putting up with long waits at the airport and dealing with all the arrangements for medical equipment.”

This is especially true for oxygen-dependent passengers. Some airlines do not even offer oxygen to passengers and others charge a variety of prices for the service. In addition, while requirements vary from carrier to carrier, all insist that arrangements be made in advance. Plus the Federal Aviation Administration (FAA) requires a physician’s statement of a passenger’s oxygen needs in order for that person to fly on a commercial airplane.

“The first thing I tell clients is to never try to take their own oxygen containers on board, since they could actually be arrested on felony charges,” Tullis says.

Oxygen travelers should also book their trips well in advance and make sure that oxygen is available, since some airlines limit the number of oxygen-dependent travelers to one to two per flight, he says.

Direct flights are obviously best, but if someone traveling with oxygen must make a connection, they should also be aware that airports charge different rates for oxygen for connecting passengers. Logan International Airport in Boston, Dulles International Airport in Washington, DC, and Minneapolis/St Paul International Airport are among the most expensive. Miami International Airport, Cincinnati/ Northern Kentucky International Airport, Salt Lake City International Airport, and Detroit Metropolitan Airport are among the least expensive.

Finally, international travelers requiring oxygen must make sure their prescription for oxygen is valid in the countries they are traveling to. “Many consumers don’t realize that their prescriptions cannot be used outside the United States,” Tullis says. Companies like TRAVELMED authenticate the prescriptions with consulting physicians overseas so they will be valid in a particular country.

Other Transportation
Cruise lines were also hit hard following September 11 due to sagging interest in cruise vacations, and cruise operators were forced to quickly implement security procedures, which directly affected HME providers. Fary says that in Miami, his company’s technicians had to show up 4 hours before departure time to make it through security clearance.

The annual access fee charged by ports to HME and oxygen providers has also increased. “Before, one driver would drive the truck right up to the boat, unload equipment, and then deliver it directly to the patient,” Tullis says. “Now we have to send two employees and one drives the truck in circles around the dock while the other makes the delivery.”

According to Tullis, since 9/11 many cruise ships stopped carrying extra oxygen. In the past, passengers could purchase oxygen from the cruise line, but now if passengers forget their oxygen, they are dropped off at the next port.

In addition, some cruise operators also limit the number of oxygen patients on board ship.

If there is a bright spot among the travel challenges for patients in need of oxygen or other HME, it is rail travel. Individuals are allowed on Amtrak trains with their oxygen portable equipment in either coach or sleeping car accommodations as long as they notify Amtrak in advance that oxygen will be needed on the train.

Under Department of Transportation (DOT) regulations, bus operators may permit travel with oxygen equipment; however, once again it is important to contact local bus operators for regulations.

Change in Air Travel Restrictions?
Even though air travel is still the most challenging mode of transportation for individuals dependent on oxygen, progress has been made this year in discussions with DOT regarding the easing of certain restrictions. Following these discussions, which were spearheaded by the National Council on Disabilities and the National Home Oxygen Patients Association (NHOPA), DOT approved the development of demonstration projects by various air carriers to determine the safety and effectiveness of new oxygen policies. Continental Airlines will be the first carrier to participate in one of these demonstration projects.

“Continental is anxious to become involved in this because ultimately it would allow the airline greater flexibility in meeting the needs of patients who require oxygen,” says Phillip Porte, NHOPA’s executive director. He believes the demonstration will eventually lead to regulation revisions that will allow oxygen patients to travel with their own portable equipment.

Air carriers stand to benefit from revised oxygen policies since oxygen users represent a largely untapped air travel market. As Tullis reports, an estimated 16 million Americans are diagnosed with chronic obstructive pulmonary disease (COPD), and between 1985 and 1995, the number of physician visits in the United States for COPD almost doubled.

Travel Tips
Many portable oxygen users or individuals requiring HME seek out advice from their home health care providers regarding travel. Large providers, such as Apria, often have their own travel programs. In other cases, customers are referred to companies such as TRAVELMED or Medical Travel Inc.

Porte says many individuals, especially those requiring oxygen, have heard so many horror stories of passengers’ experiences that they become intimidated by air travel. To help overcome their fears, NHOPA (www.homeoxygen.org) publishes a guide on air travel for members. “Individuals with disabilities particularly need to learn how to be advocates and when someone tells them they cannot do something related to travel, they should question that individual,” Porte says.

The variety of travel-related products and services available to individuals with disabilities also gives them many more options than in the past. Jackie Maxted, operations manager for Winnipeg, Manitoba-based ScootAround, says business has never been better for her company as more individuals are looking for scooters while they travel. “Many customers have told us they don’t want the burden of transporting their own scooters or wheelchairs and would much rather have us deliver one directly to the airport or their hotel,” she says.

Even post-9/11, there is no limit to the types of trips individuals with disabilities can make as long as they plan them adequately. “I like to tell the traveling public that if you think you shouldn’t travel because of terrorism or airport hassles, you’ve actually let the terrorists win because you have essentially lost your own freedom,” Tullis says.

Carol Daus is a contributing writer for Dealer/Provider.