Fit-to-Fly Certificates: What They Are & Why Medical Flights Need Them

If you’re planning a medical flight, missing just one piece of paperwork–your Fit-to-Fly certificate–can delay the entire process.

In this article, we’ll explain what “fit to fly” really means and why it’s essential for international medical transport. You’ll learn when and how to obtain this clearance, what’s included in the certificate, and why commercial flights and air ambulances have different requirements.

If you’re planning a medical flight, REVA’s operations team will guide you through every step to ensure a seamless transfer. Contact us today to arrange an air ambulance flight to a hospital in 90+ countries– we’ll provide continuous care in the air to keep you safe.

What Does it Mean to be “Fit to Fly”?

A “fit-to-fly” determination confirms that a patient—or anyone on board a medical flight—is safe to travel. For medical transports, this means the patient has been medically cleared by:

• Their treating physician or care team at the sending facility
  
• The medical direction team overseeing the air ambulance or commercial medical escort

This clearance ensures the patient’s current condition is stable enough for travel, whether by commercial airline or medical aircraft.

Who Needs to Be Fit to Fly?

In nearly all situations, every person on a medical flight must be declared fit to fly. This includes:

• The patient
• Accompanying family members or companions
• Medical crew members
• Flight crew (pilots)

This is especially critical for high-risk patients, like those who are critically ill, on ventilators, or on medications that require close monitoring.

When Is a Fit-to-Fly Certificate Required?

A fit-to-fly certificate is mandatory in several scenarios:

• When departing certain countries that require medical clearance for international medical repatriation
  
• At airport checkpoints, especially when immigration or customs officials request documentation
  
• For commercial medical escorts, where airlines need proof that the patient is safe to fly
  
• For international patients entering the U.S., especially non-citizens who need additional customs documentation

Failure to secure this certificate in advance can result in denied boarding or major travel delays.

What is Included in a Fit-to-Fly Certificate

The certificate is usually a short, formal letter issued by the treating physician or hospital. It confirms that the patient is:

• Medically stable and cleared for transport
• Safe to leave the treating facility
• Eligible to travel by air (either commercial or air ambulance)

Some certificates may include extra notes, such as whether the patient needs oxygen, must fly at sea-level cabin pressure, or should be accompanied by medical personnel. Requirements and formatting may vary by country, facility, or regulatory body.

How to Obtain a Fit-to-Fly Certificate

When you contact an air ambulance provider, their operations team coordinates directly with the treating hospital and physicians to make sure your fit-to-fly documentation is in place before takeoff. Here’s how it works:

• Air ambulance operations specialists communicate with the hospital and any local medical teams.
  
• The treating physician writes and signs the certificate once the patient is deemed stable.
  
• The air ambulance team verifies that all required documentation is completed and ready before departure.

Although most certificates don’t have an expiration date, REVA maintains regular contact (every 4–6 hours) with the treating facility to confirm there have been no changes in the patient’s condition prior to transport.

How Is Fit-to-Fly Clearance Different for Air Ambulances?

Air ambulances provide much more flexibility than commercial medical escorts when it comes to fit-to-fly approvals. Here’s why:

• Air ambulances are fully equipped flying ICUs with advanced life-support equipment and critical care teams.
  
• Patients who are not stable enough for commercial flights—those on ventilators, IV drips, or cardiac monitors—may still be deemed fit to fly on an air ambulance.
  
• Air ambulances can operate with sea-level cabin pressure when necessary for patients with altitude-sensitive conditions.
  
• In-flight medical crews respond to medical emergencies that commercial crews are not equipped to handle.

While commercial carriers may deny boarding for ill or injured patients, an air ambulance team can often proceed safely.

Why a Fit-to-Fly Certificate May Be Denied or Delayed

Even with preemptive planning, some patients are not immediately stable enough for transport. Fit-to-fly certificates are commonly denied or delayed based on the patient’s clinical condition.

A certificate may be withheld for:

• Patients who are too unstable to be moved within the hospital, let alone flown internationally
  
• Patients experiencing active organ failure, uncontrolled bleeding, or those who need emergency intervention
  
• Situations where even an ICU-level air ambulance cannot safely transport the patient without risk

In these cases, REVA works closely with the treating facility to stabilize the patient and revisit fit-to-fly approval once their condition improves.

Arrange an Air Ambulance Flight With REVA

When you or a loved one need an air ambulance flight, REVA gathers all necessary documentation to prevent travel delays and provide a safe transfer as quickly as possible. Our operations team works with hospitals, physicians, and ground handlers to secure fit-to-fly clearance and coordinate every detail of your flight.

Contact us today to arrange a medically supervised flight with REVA’s world-class air ambulance team.