Enabling air travel with oxygen in Europe

Relevant EU Regulations for travel are:

  • Regulation (EC) No 1107/2006

  • Regulation (EC) No 965/2012.

These two regulations concern technical requirements and administrative procedures concerning air operations. We will also go deeper into relevant rules and resolutions from authorities:

  • European aviation authority “EASA” (The European Aviation Safety Agency)

  • International regulation body for aviation “IATA” (The International Air Transport Association)

EU Regulation 1107/2006, concerning the rights of disabled persons and persons with reduced mobility when travelling by air

Regulation (EC) No 1107/2006 is there to protect the rights of disabled persons or persons with reduced mobility (PRM) who travel from, to (or in transit) at airports situated in an EU

Member State and applies to:

  • All European air carriers whose flights depart from and arrive at a European airport;

  • All European air carriers departing to and arriving from airports located outside of the European Union;

  • All airports situated in an EU Member State.

All assistance needed to meet the particular requirements of PRMs should be provided on the ground and on board of the airline.

Passengers with reduced mobility can expect assistance at the airport to:

  1. communicate the arrival at an airport and request for assistance;

  2. move about the airport; from a designated point to the check-in counter, proceed from the check-in counter to the aircraft, board the aircraft, proceed from the aircraft door to the passenger’s seat and vice versa, proceed from the aircraft to the baggage hall and retrieve baggage, with completion of immigration and customs procedures, proceed from the baggage hall to a designated point;

  3. Board and disembark the aircraft with lifts, wheelchairs, other assistance needed;

  4. Store and retrieve baggage on the aircraft;

  5. Reach connecting flights when in transit, with assistance on the air and land sides and within and between terminals as needed;

  6. Move to the toilet facilities if required.

Assistance you can expect from the air carrier:

  1. Carriage of recognised assistance dogs in the cabin, subject to national regulations;

  2. In addition to medical equipment, transport of up to two pieces of mobility equipment per disabled person or person with reduced mobility, including electric wheelchairs (subject to advance warning of 48 hours and to possible limitations of space on board the aircraft, and subject to the application of relevant legislation concerning dangerous goods);

  3. Communication of essential information concerning a flight in accessible formats;

  4. The making of all reasonable eorts to arrange seating to meet the needs of individuals with disability or reduced mobility on request and subject to safety requirements and availability;

  5. Assistance in moving to toilet facilities if required;

  6. Where a disabled person or person with reduced mobility is assisted by an accompanying person, the air carrier will make all reasonable eorts to give such person a seat next to the disabled person or person with reduced mobility.

The provision of medical assistance, such as oxygen therapy, is not covered by this legislation.

Some articles in the regulation do apply, as a person who needs oxygen may have impaired mobility, if oxygen is needed to remain active or to function.

Those articles most relevant to people who need medical oxygen are articles 4, 7 and 10.

To make sure your information needs are met, the regulation states that an airline or its agent need to make the applicable safety rules as well as any restrictions related to the carriage of PRMs publicly available and accessible (Art 4(3)). All costs imposed for special assistance on board of the aircraft should be published and easy to find.

According to the Regulation (Art 10), the assistance that the airline should provide includes the transportation of medical equipment, subject to dangerous goods legislation, without charging a cost. You are allowed to transport your medical equipment (POC, empty oxygen cylinder) in the cargo, without additional charge.

This is of course subject to relevant legislation concerning dangerous goods.

It is the responsibility of the airport managing body to provide assistance to persons with disabilities or reduced mobility, so they are able to take their flight. As it may require a serious eort to walk around the airport without oxygen service, you have the right to receive assistance at the airport if required by using e.g. lifts, wheelchairs, subject to pre-notification of your particular need to the air carrier or its agent or the tour operator at least 48 hours before the published time of departure of the flight51 (Art 7).

Airports are not required under the Regulation to provide medical services on the ground. However, should the airline allow you to use and transport your own oxygen bottle, as hand luggage, you can move around the airport with this medical equipment and embark and disembark. If you need help with your oxygen service, and are assisted by a person accompanying you on the flight, this person must be allowed by the airport to provide the necessary assistance in the airport and with embarking and disembarking of the plane. An accompanying person always needs to take the same flight as you. If they do not take the same flight, but only provide assistance on the ground and with embarking and disembarking, the airport may refuse to allow them access.

This is of course subject to the applicable national legislation.

Why EFA highly values the Commission’s guidelines to protect the rights of persons with reduced mobility.

These interpretative guidelines, were launched by the European Commission to support good implementation of Regulation (EC) No 1107/2006 by EU Member States. Unlike the regulation, they are not legally binding.

The guidelines are written in the form of 22 question-answers. One of those questions (Q4) takes up the issue of the transport of dangerous goods (e.g. medical oxygen), use of on-board company oxygen and travelling with medical equipment.

The guidelines:

  1. Recognise that persons with disabilities or reduced mobility need additional support to be able to travel by air. The regulation does not provide any definition of medical equipment or the quantity of such items that may be carried (subject to limitations of space on board and applicable rules on the carriage of dangerous goods).

  2. Clarify that medical oxygen is among the types of medical equipment specifically mentioned in Annex II of Regulation (EC) No 1107/2006.

  3. Stipulate that, subject to pre-notification, persons who need medical oxygen can carry it free of charge, as long as the equipment meets any dangerous goods requirements applied by the air carrier (according to ICAO rules).

  4. Remind airlines that when they charge for the provision of medical oxygen, they can offer it at a discounted rate.

  5. Emphasise that carriers need to make the cost of this service publicly available, as part of the rules and restrictions.

As the Regulation doesn’t specify what is meant by the term medical equipment, EFA welcomes this initiative from the European Commission and calls upon Member states and European airlines to follow these guidelines.

EU Regulation 965/2012, laying down technical requirements and administrative procedures related to air operations pursuant to Regulation (EC) No 216/2008 of the European Parliament and of the Council.

According to this regulation oxygen/compressed air cylinders are considered dangerous goods. If passengers intend to carry these items on board, they fall under Annex 18 of the Chicago convention and need to respect the ICAO Technical Instructions. They stipulate that gaseous oxygen/air cylinders for medical use of no more than 5 kg gross weight are allowed in checked and carry-on baggage or used by the person, with approval of the operator.

The cylinders, valves and regulators have to be protected from damage that could cause an inadvertent release of the contents.

When approved, the operator must then inform the pilot-in-command of the quantity and the passenger’s location on board. Spare oxygen cylinders of a similar size are also allowed to ensure an adequate supply for the duration of the journey.

There are no specific requirements, regarding the technical instructions of on-board use of oxygen bottles. However, the operator’s Operations Manual, which has been approved by the National Authority, will contain procedures on the use of oxygen bottles.

Flight Standards – Dangerous Goods

Regulation 965/2012, refers to the ICAO Technical Instruction for the Safe Transport of Dangerous Goods by Air (2015-2016) and the latest edition (n°56) of the IATA Dangerous Goods Regulation (DGR).

Under the above, oxygen bottles are defined as “hazardous material” and a security/safety risk.

Security: Its highly inflammable nature, make it a potentially harmful good with a security risk that can hurt other passengers.

Safety: As it cannot be guaranteed that bottles/valves have been maintained properly, there is also the incidental risk of damage, which may impede on the passenger’s safety. The valves have to be maintained correctly and it has to be ensured that the bottle and the valves do not contain any grease. A fire can even start without any sparks.

Nevertheless, there are some restrictions:

  • National authorities may decide to prohibit all oxygen bottles from being carried on board, despite their size.

  • Where national authorities do allow that small gaseous oxygen bottles (≤5 kg) are taken on board, the operator has the right to accept them or not, also due to safety reasons.

Personal medical oxygen systems with liquid oxygen are forbidden for transport on a commercial aircraft, both as carry-on or checked baggage.

For these reasons, passengers who need oxygen service and/or to transport (and use) medical equipment, should request more information from the airline at the time of booking.

European Aviation Safety Authority (EASA)

EASA is the EU Authority for aviation safety and the body with the technical financial and legal autonomy to ensure the highest level of safety protection for EU citizens. The following decision published by EASA, are the acceptable means of compliance or guidance material to EU regulations regarding air safety. Acceptable means of compliance are non-binding and the operator (airline) may deviate from the EASA Decision. However, the operator can only deviate from the EASA Decision, if it has demonstrated that an alternative means of compliance ensures an equivalent level of safety.

ED Decision 2012/018/R Acceptable Means of Compliance and Guidance Material to EU 965/2012 pursuant to EU Regulation 2016/2008

As a general rule Portable Electronic Devices have to be turned-o for the entire duration of the flight, to prevent any negative eects they may have on the performance of the aircraft’s systems and equipment.

However medical equipment necessary to support physiological functions does not necessarily need to be switched-o during any phases of the flight.54 POCs under EU safety rules do not require an authorisation. If the passenger carries a POC inside the cabin then the acceptable means of compliance ensures that the operator should have a procedure to ensure that medical equipment that supports physiological functions should be exempted from the general principle to switched-o portable electronic devices during flight.

International Air Transport Association (IATA)

IATA stands for the International Air Transport Association, which acts as the global trade association for the airline industry. The organisation represents 83% of the total air trac, with its membership of 250 airlines.

The IATA standards are very important, however they are not legal documents. Only 83% of all airlines is an IATA members, so these standards will only apply to them and not to all airlines. In addition, IATA standards cannot supersede EU air safety rules.

Acceptance and carriage of incapacitated passengers (IATA Resolution 700)

The IATA Resolution 700 concerns the “acceptance and carriage of incapacitated passengers”.

Special assistance can be arranged when it is requested by:

  • the passenger

  • family

  • a medical authority

  • airline personnel / travel agents (in case they observe an abnormal physical condition)

Incapacitated passengers are categorised in various groups and identified by air trac abbreviations. For people who need oxygen the combined categories MEDA (Medical Case) and OXYG (Oxygen) apply.

For people who need medical attention, or to transport and/or use medical equipment, prior medical clearance is required, especially if their condition may worsen because of or during the flight. Therefore a medical information form needs to be completed by all passengers who need oxygen, well in time.

See practical advice for people travelling with medical oxygen.

When oxygen service is provided by IATA members or their handling agents, this has to be done in accordance with the airline’s own policies (including applicable rates and charges) and subjected to the relevant dierent regulations, depending on the destination of the flight.

On the ground, it is the responsibility of the airline to advise the ground sta about the passenger and their specific needs for special assistance.

However, as several countries have stricter requirements than is laid down in the EU regulations when it comes to the acceptance of dangerous goods, this is subjected to national legislation.

IATA Lithium Battery Guidance Document

This document was created to guide IATA members, in complying with the provisions outlined in the most recent edition of the ICAO Technical Instruction for the Safe Transport of Dangerous

Goods by Air (2015-2016) and the latest edition (n°56) of the IATA Dangerous Goods Regulation (DGR).

Portable Medical Electronic Devices, e.g. a POC, containing either lithium metal or ion cells or batteries may be carried by passengers for medical use as follows:

  • For lithium metal or lithium alloy batteries, a lithium content ≥2 g; ≤8g;

  • For lithium ion batteries, a watt-hour rating ≤100 Wh.; ≥160 Wh;

  • Batteries must be of a type that meets the requirements of the UN Manual of Tests and Criteria, Part III, subsection 38.3.

Technical instructions for the safe transport of dangerous goods by air, ICAO, part 8

According to part 8 of the ICAO Technical Instructions, spare gaseous oxygen cylinders (of no more than 5kg gross weight and never containing liquid oxygen) are allowed on-board by ICAO when required for medical use.57 However, this does not mean that passengers can bring their own bottles into the aircraft due to the safety risks associated with bottles that are not properly maintained.

The Safe Transport of Dangerous Goods by Air, Chicago Convention, Annex 18

Gaseous Oxygen falls under class 5 of the nine “hazard classes” determined by the United Nations Committee of Experts. Class 5 covers all oxidizing material, organic peroxides (both oxygen carriers) and poisonous or toxic substances.