Travelling with additional needs and/or disability

This factsheet provides an overview and advice on the points to consider when travelling with additional needs and/or disability

With thanks to the authors Karen Ross and Dr David Ross

Key messages

• Preparation – travellers should thoroughly research the country or geographical area they are travelling to.

• Protection – travellers should ensure they have all the appropriate vaccinations and antimalarials to protect their health and that they are able to take any medication they are on to the destination. They should also be aware that a number of countries do not provide equivalent healthcare to the NHS.

• Plan the trip – mode of transport, accessibility to accommodation, venues and local environment, medical requirements and equipment, and travel or medical insurance should be researched before leaving.

• Emergency planning – travellers should ensure they have a back up plan if they become seriously ill, or their journey is delayed, or cancelled or their luggage, medication or equipment is lost.

Overview

Most people can just book a flight, chuck a few clothes into a suitcase and set off on their travelling adventure. However when additional needs and/or disability are added to the mix it isn't quite so simple. This is because it is important to ensure that the mode of transport and destination are suitable and can cater for their needs. Also that the traveller's health needs and medical requirements are met and understood. Travellers with additional needs and/or disability are recommended to have a back up plan for an emergency, whether that is medical, logistical or environmental.

Pre-travel preparation

Transport

Travellers should be encouraged to thoroughly research their mode of transport to their destination and consider the following:

• What transport best suits their needs and gets them to their destination in the most time effective way.
• What extra support do they require for their specific medical condition, additional need or disability.
• What support the airline or other transport provider will provide.
• Informing the airport/airline of their requirements well before they travel.
• Some airports in the UK have written specific guidance for people with Autism or Autism Spectrum Disorder (ASD) about the process they will have to follow in the airport to get on their flight.
• If the traveller's medication is in bulky liquid form, encourage them to speak to their pharmacist about other options, for example whether tablets can be crushed up and administered instead of the liquid formulation.

The following resources are useful for travellers with additional needs or disability:

• There is a Frequent Traveller's Medical Card (FREMEC), if the traveller has an impairment or stable condition. Further details can be found in the International Air Transport Association (IATA) Medical Manual, pg 61-2 and 78.
• If they have a medical condition, they may need to complete a Medical Information Form (MEDIF) with their GP. This is valid for one trip. See pages 61-63 and 74-77 in the IATA link above for further details.
• Civil Aviation Authority passengers with disabilities and reduced mobility.

Accommodation

Travellers should be encouraged to research their accommodation and venue and check the following:

• Is there ramped or level access?
• Are there suitable working lifts to access all areas of the hotel or other accommodation?
• Does the bathroom suit their needs, i.e. wet room rather than just grab rails?
• Are the doors wide enough for a wheelchair?
• Is the bed at the right height and in a good position?
• Are guide dogs or dogs for the disabled welcome?

Insurance

Travel medical insurance is really important for those with additional needs and /or disability

• If visiting European Union (EU) countries, travellers should carry an European Health Insurance Card (EHIC) or a Global Health Insurance Card (GHIC) as this will allow access to state-provided healthcare in some countries, at a reduced cost, or sometimes for free. The EHIC or GHIC, however, is not an alternative to travel insurance. Check the GOV.UK website for guidance.
• There are a number of companies that provide specific cover for travellers with additional needs and/or disability, it is important that insurance meets their needs and covers their equipment.
• There is useful information on covering healthcare whilst abroad on the NHS Choices website including country guides.

Journey risks

These are some of the risks travellers should be encouraged to consider when travelling:

• Safe transport of essential equipment – wheelchairs, oxygen, hoists, guide dogs etc.
• Access to the toilet and accessibility to carry out personal hygiene.
• Safe storage of medication and easy access to it.
• Movement and handling on to and off the aircraft.
• Long haul flights and how to decrease the impact of immobility – and potential risk of deep vein thrombosis (DVT).
• Roads may be less maintained in underdeveloped countries and there may be limited or no wheelchair access to public transport, taxis or hire cars.
• Signage and hearing loops for sight or hearing impaired may be limited or unavailable.

Food and water-borne risks

Contaminated food and water can transmit a number of different infectious diseases; the risk is higher in low-income regions [1]. Vaccinations can prevent only a small number of these diseases (such as cholera, hepatitis A, polio and typhoid). Certain travellers are at increased risk from contaminated food and water including older travellers, those with a weak immune system, young children and those taking medication to reduce stomach acid. For those with certain special needs or disabilities, travellers' diarrhoea could create added difficulties.

Care should be taken with food and water hygiene, and travellers should be prepared to manage the symptoms of travellers' diarrhoea during their travels.

Those with a known allergy or intolerance should consider if it is necessary to take adequate supplies of their own food with them.

They should also ensure they carry an Epipen if prescribed and enough to last for the duration of their trip. It may also be necessary for some travellers to carry dietary requirements and supplements.

Vector-borne risks

It is important for travellers with additional needs and disability to research the country they will be visiting. The Country Information pages on TravelHealthPro provide information on key vector-borne risks in the location. Insect bite avoidance measures should be taken and bites should be kept clean and not scratched. An antihistamine cream and/or tablet may be useful to reduce itching. Travellers should seek early advice if there are signs of infection around a bite, the wound is not healing or other worrying symptoms like high fever appear.

Malaria

Travellers should consider the following points when visiting areas where there is malaria or a risk of contracting malaria:

• Ensure that the anti-malarial chemoprophylaxis they have been prescribed do not have any contraindications with their usual prescribed medication or medical conditions. Information and advice can be provided by their GP or travel health clinic.
• It is important that any prescription for anti-malarial chemoprophylaxis is understood such as the frequency and time they should take it and the dosage. Also advice should be provided about what they should do if they have side-effects.
• It is important for travellers to be aware of the common symptoms of malaria and when and how they should seek in-country medical treatment and care.

COVID-19

Some people are at higher risk of severe infection from COVID-19. This mainly relates to age and any existing medical conditions and includes those prioritised for COVID-19 vaccination (see Table 2 and 3 in Immunisation against Infectious Disease).

All individuals should follow current UK recommendations to reduce their risk of catching COVID-19 and passing it on to others.

All individuals, but particularly those who are at higher risk of severe COVID-19 disease, should assess their individual circumstances, including medical facilities at their destination, and consider whether postponing travel would be appropriate.

General guidance regarding risk assessment for travel during the COVID-19 pandemic and information about the COVID-19 vaccination programme is available.

Vaccinations

• Travellers or their carers should be encouraged to research the recommended vaccinations for their intended destination with sufficient time to arrange an appointment at a travel clinic or GP practice.
• If the traveller has an additional need, such as Autism or ASD they may need a more detailed explanation about the vaccinations they require. They may be more comfortable with a health professional that they know administering their vaccination.
• Health professionals should check for interactions and contraindications with any prescribed medication and medical conditions.

Other health risks

This will depend on the traveller's medical condition or their disability. Therefore they should ensure that they consider and check the following:

• Does the country of destination allow the traveller to enter with their medication? Some substances in certain medications are illegal in some countries, so it is important to research this before travelling, see our factsheet on travelling with medicines.
• If travellers are unable to take their prescribed medication they should ask their GP or Consultant if there is an alternative, well before they intend to travel.
• Some countries do not have the equivalent women's health provision i.e. contraceptive pill, morning after pill, so it is important to check and to ensure adequate supplies are available for the length of the trip.

General advice and advice for those who get sick abroad

Travellers should carry a basic first aid kit that will help them manage common issues affecting travellers such as travellers' diarrhoea, constipation, insect bites, minor cuts and grazes.

The travel medical insurance company should be contacted early if a traveller is unwell and needs medical assistance.

Resources

Autism

• Autism Speaks: A guide for children on the airport experience
• Autism Speaks: Travelling tips for individuals with autism and their families
• National Autistic Society: Holidays preparation and practicalities
• National Autistic Society: Guidelines to make air travel more accessible

Blind and visually impaired travellers

• The Blind Guide: Travelling for the visually impaired
• Guide dogs: travel guide
• RNIB: Tips for travelling when blind or partially sighted
• RNIB: Holidays

Deaf and hearing impaired travellers

• American Academy of Otolaryngology Head and Neck Surgery: Travel tips for the hearing impaired
• National Deaf Children's Society: Travelling tips for deaf young people

Insurance

• Foreign and Commonwealth Office: Foreign travel insurance

Transport / Travel

• Age UK: Top tips for limited mobility holiday
• Civil Aviation Authority: Passengers with disabilities and reduced mobility
• Disabled Travel Advice
• Equality and Human Rights Commission: Top tips for disabled and less mobile air passengers
• Gov.uk: Transport if you're disabled
• International Air Transport Association: Medical manual (contains MEDIF and FREMEC certificate information)
• Spinal Injury Network: Disabled flying guide
• Wheel Chair Travel.org: Wheel Chair travel blog

Travel with a stoma

• Canadian Society of Intestinal Research: Travel with an ostomy
• Ileostomy and internal pouch support group: Travel tips
• Urostomy association: Travel and insurance