Airport Security Screening

Security screening Will my assistive aids be packed down by the security screening staff so that it does not have to be done several times due to security rules? If you have booked disability assistance, an assistant from Falck will pack down your assistive aids. May I bring medicine in my carry-on baggage, and are there any quantity limits? You are allowed to bring medicine for use during your entire journey, and there are no quantity limits. However, you may be asked to show a proof of the genuineness of the products, for instance that the medicine is in original, unbroken packaging, or a prescription or receipt from the pharmacy. It is a good idea to bring a travel letter from your own physician or hospital in Danish and English from which it appears which types of medicine you are bringing. Should I take any precautions if I have a pacemaker? No, you do not need to take any special precautions to go through security screening if you have a pacemaker. If you do not feel comfortable about going through a metal detector, you can ask not to go through it and instead have a manual body search afterwards. You just have to inform the screening staff that you have a pacemaker and would prefer not to go through the detector frame and would like to have a manual body search. Can I bring my guide dog through security? Yes, you are allowed to bring along your guide dog. You must have a valid ticket for your guide dog. Can I bring my electric wheelchair through security? Electric wheelchairs and other battery-powered aids must be approved by the airline you will be travelling on. The wheelchair will also be security screened. The wheelchair will be packed down at the gate when you check in there and be transported in the aircraft hold during the flight.

Can I be screened by a security screener of the same gender? Yes, you can always ask to be screened by a security screener of the same gender. Can I ask to be screened in a separate room if I have to be subjected to additional screening? Yes, you can ask to be screened in a security room specially designated for that kind of purpose. Is there any kind of equipment that could be damaged by the X-ray equipment used for security screening? No, the equipment will not be damaged by being X-rayed. Is there any kind of equipment which I am not allowed to bring on the flight? Some special equipment may require a permit either from your airline or the aviation authorities. If you are in doubt, it is always a good idea to contact your airline well before departure. Can I get help to go through security, and do I have to take off my belt or braces, even if I cannot put them back on? If you have booked disability assistance, the assistant from Falck will help you with these things.

Pregnancy and Security Screening I have a concern about the full-body scanners that are popping up at airports everywhere. I'm concerned about the kind where you plant your feet and raise your arms above your body for about five seconds. I'm newly pregnant with my first child and am trying to find some solid research on these things. I can find a decent amount of literature in terms of general health safety, but hardly anything trustworthy about the potential effects on a pregnancy (at any stage). I admit to being hormonal right now, but I started to cry today when I realized I went through a full-body scanner at an airport early this

month without even a second thought. Pregnancy message boards online are filled with paranoid women, I realize, but reading through them made me scared that I might have unknowingly/unnecessarily caused harm to my unborn child. Should I have opted for a pat-down? Or should I opt for pat-downs in the future? I would love to see some information on your site about these new machines with regard to pregnancy, especially since I will be flying quite a few more times before giving birth. The technology seems relatively new, which makes me even more uncertain about which advice to follow. Has there even been time to do significant studies on the effects to a fetus during pregnancy? There are two kinds of scanners. The radiofrequency scanner does not use ionizing radiation, so neither you nor your unborn child would be exposed to any radiation that is hazardous. The "full-body" x-ray scanner uses a very low-energy and low-intensity radiation, so that the unborn child is not exposed to any radiation that could possibly increase the developmental risks of radiation to the embryo. The energy of the x-ray beam is so low that it does not penetrate the skin and just makes a picture of the outline of your external torso. Your internal organs receive almost no dose. For more information on these devices, see "Safety for Security Screening Using Devices That Expose Individuals to Ionizing Radiation." Remember that radiation is all around us. These very low exposures represent no increased risk to the unborn child. If you are healthy and have no personal or family history of reproductive or developmental problems, then you began your pregnancy with a 3 percent risk for birth defects and a 15 percent risk for miscarriage. These are background risks which all pregnant women face. I am pregnant and operate an x-ray machine at a courthouse, the type that scans items people carry in with them. Should I have any concerns? Should I continue working? Baggage x-ray machines emit x rays just like medical x-ray machines except at much, much lower levels. The location of the operator is very well shielded and, really, exposes no one. It is safe to continue working while you're pregnant.

As a pregnant woman, does passing through airport security pose a risk to my baby? Passing through an airport security portal does not pose a risk to a pregnant woman or her unborn child. The metal detector is not known to pose any health risk to individuals. The devices used to scan your carry-ons are very well shielded so there is no risk from passing by those, either. I reached into an airport x-ray screener that is used to see in to our carry-on items. How much radiation exposure did I get? There is nothing for you to worry about. Airport x-ray machines and similar x-ray machines used by federal and state agencies to screen briefcases and packages give much lower doses than x-ray machines in hospitals and medical clinics-almost immeasurable. They are designed this way because they do not have to see as much detail, are not designed for looking into very large objects, and are usually looking for things that really "stand out" on images (like metal). In all likelihood, your hand was not in the actual beam, which would have made your exposure much lower. Furthermore, the hands and feet are very radiation tolerant relative to the rest of the body. Does radiation from a security screening device, like those used in airports, affect the items that pass through them such as baby bottles, food items, plants, electronic devices (cell phone), or drug products (like injectable nitroglycerin for a heart condition)? The radiation exposure from these devices is too low to affect any items passing through (other than certain types of camera film which can darken), even from repeated exposures. Additionally, in case you were wondering, there isn't any residual radiation in exposed materials after the exposure is complete either. Does radiation from a security screening device, like those used in airports, affect clothing if it passes through the screening a lot? I have a Gore-Tex® jacket that gets screened quite a bit. The amount of radiation to which the clothing, even the Gore-Tex® jacket, is exposed is too small to degrade the materials. The manufacturers of these scanners indicate the radiation exposure to an item from one scan is about

one-tenth the exposure we receive every day from naturally occurring radiation (commonly called background radiation). I travel a lot (at least once or twice a week) and will continue to do so in the foreseeable future. Obviously, I have to go through the metal detector at least twice for each trip. What effect does this radiation exposure have on me in the long run? The metal detector does not expose you to ionizing radiation, e.g., x rays; neither do the wands that are used for individual screening. Metal detectors operate by generating a low-intensity magnetic field that passes from one side of the detector to the other. If metal objects pass through that field, the magnetic field will induce a second field in the metal object. Since that second field is a disruption of the first field, the detector senses the change and sets off an alarm. Magnetic fields are a form of radiation, but they are called "nonionizing" radiation. This means that magnetic fields do not generate additional, damaging radiation the way that ionizing radiation (such as x rays) does. Magnetic fields below a certain intensity are considered to be safe in that they will not cause any biological damage to an individual. As a reference, MRI (magnetic resonance imaging) is considered safe and uses much higher magnetic field intensity than a metal detector. In summary, because of its nonionizing properties, the magnetic field generated in a metal detector will not cause harm to persons even with routine and/or repeated scanning. Pregnancy & Prolonged Exposure to Metal Detectors If you are pregnant and your work or travel exposes you to frequent metal detector radiation, you are likely worried about the possible long term effects of exposure on your baby. Most metal detectors used on people in airports and courthouses only give off safer, non-ionizing radiation and long term exposure to them does not increase the risk of birth defects, miscarriage, or fetal abnormalities. According to the Health Physics Society, the radiation you get from traveling on a flight from New York to Los Angeles is in excess of the radiation you get from going through the metal detectors in the airport and both are at low levels. Function According to the Health Physics Society in "Pregnancy and Security Screening" metal detectors emit a type of safe non-ionizing radiation that bounces its beams off of objects to see their outline. The radiation used in

hand held metal detectors and in walk through security screeners is considered safe for pregnant women. X-rays in the baggage handler machine do give off ionizing radiation, but the devices are well shielded from employees and others who work closely with them. Considerations Radiation is present in the background every day so levels are usually matched up against what they would be as a result of day to day living. According to the Health Physics Society the radiation given off when you pass through an airport screener is safe, and even accidental one-time exposure to the rays inside the baggage handler is unlikely to do much harm. There are no long term effects on food, medicine, baby bottles or clothing that pass through a metal detector, even for those items that are packed frequently. Significance Ionizing radiation that is sometimes used in medical equipment can increase the risks of birth defects, miscarriage and other reproductive harm, but the level given off from metal detectors is much lower. According to the Health Physics Society, radiation is measured in units called rad, rem or roentgen, or in the international equivalent called the gray and sievert. Limits According to the Office of Radiation Safety, pregnant women should not be exposed to more than 500 millirems, or 0.5 rem, during their entire pregnancy or less than 50 mrem (0.05 rem) in a single month. A round-trip flight from New York to Los Angeles can expose a woman to 5 mrem (0.005 rem), while the effect of metal detectors is considered negligible. Some medical x-rays may expose a woman to 60 mrem of radiation, but they may still be done in cases where the benefits clearly outweigh the risks to the the mother and fetus. Prevention/Solution Although long term metal detector exposure is not believed to harm the fetus, be prudent if you work around such equipment every day. Try to stay farther away from the radiation source, and make sure that the device is blocked or shielded. Have someone measure the radiation exposure

frequently to make sure that the level does not rise. If you are still concerned about long term exposure, consider wearing a badge that measures the radiation levels that you confront. Wash your hands with soap and water if you feel they have come into contact with radiation.

The Pregnant Traveler If you are pregnant and considering international travel, you should evaluate the availability of quality care during travel and at your destination. You should also investigate issues of insurance exclusions, medical evacuation costs, etc with your medical insurance carrier and have assurances in writing. This is of special importance if traveling to developing countries. If your pregnancy is complicated for any reason, whether it be high blood pressure, diabetes, anemia or specific obstetrical issues you need to obtain permission from your OB/GYN physician. The second trimester of pregnancy (weeks 18-24) is the safest for travel. Any special precautions to take for air travel? Avoid air travel: 

From 32 weeks of gestation onward for multiple pregnancies (twins or more)



From 36 weeks of gestation onward for single pregnancy



Within 7 days of delivery



With complicated pregnancy

Prevent blood clots by frequently exercising the feet and legs, by walking in the cabin of the aircraft, and bending/straightening your feet and knees for 2 minutes every 10 minutes. Properly fitted graduated compression stockings may be appropriate for some. Pregnancy increases the risk of blood clots and preventive measure are crucial. Go to our economy class syndrome section for further details. Avoid dehydration by drinking plenty of water or juice. Drink plenty and you will have to exercise the legs by going to the bathroom!!!

Wear seat belts at all times while seated, keep them at the level of your pelvis for a measure of comfort. Any special advice for vaccinations during pregnancy? Live bacterial and live viral vaccines are contra-indicated during pregnancy. These are: Bacille-Calamette-Guerin, Live Intra Nasal Influenza, Mumpsmeasles-rubella, oral typhoid –Ty 21a, Oral polio, Varicella and Yellow Fever. In general, avoid vaccinations in the first trimester of pregnancy The following vaccine preparations can be used form the 2nd trimester onward. 

Immune globulin



Hepatitis B



Inactivated Influenza



Pneumovacc



Inactivated Polio



Rabies



Typhoid Vi

Data on safety in pregnancy is not available for Hepatitis – A and Japanese Encephalitis Which antibiotics are safer during pregnancy? 

Traveler’s diarrhea: Azithromycin (Zithromax) and Cefixime (Suprax) are safe



Malaria prophylaxis: Mefloquine (Larium) and Atovaquone/Proguanil (Malarone) are CDC recommended after the 1st trimester. Chloroquine is safe, but should only be used in areas where Malaria parasite is known to be sensitive to it.

Avoid 

Doxycycline



Primaquine



Pyremethamine



Trimethoprim-Sulfamethoxazole



Erythromycin



Quinolone class of antibiotics like Ciprofloxacin, Levofloxacin, Gatifloxacin and antifungal agents like fluconazole, itraconazole.

What do I do about water safety during my pregnancy and travel? Boiling water for 3 minutes is the most safe and effective method to assure clean water. Bottled juices, soft drinks and bottled water should be safe, make sure the cap is sealed when you buy it. Avoid iodine tablets and iodine based water purification tablets due to risk of goiter in the fetus. Since water filters do not filter viruses and one cannot use iodine to kill viruses, water filters are not of much use. Brush your teeth with safe water. Avoid ice. See our water safety section for more details. What do I do about food safety during pregnanacy and travel? Always wash hands with soap and safe water Strictly avoid all milk and dairy products. In the developing world pasteurization is not reliable. Risk of listeria, brucella etc are too great without this precaution Avoid raw or undercooked meats, eggs and fish. Risk of Toxoplasmosis, salmonella etc are too great without this precaution. Avoid salads, pre-cut vegetables and fruits for reasons of contamination. If you must have a fruit, make sure the skin is undamaged and you peel the skin off yourself.

See our food safety section for more details. What do I do if I develop traveler’s diarrhea while pregnant? Dehydration can decrease placental blood flow; therefore one should aggressively drink fluids. Hot tea, 7-up, Ginger ale, Sports drinks or oral rehydration packets mixed in safe water are recommended. Azithromycin(Zithromax) 500 mg once a day for 3 days or Cefixime(Suprax) 400 mg once a day for 3 days are safe antibiotics to use in pregnancy. Combinations of Kaolin-Pectin and Imodium are safe if needed for symptom relief. Avoid Pepto-Bismol or Bismuth salicylate products due to risk of birth defects and bleeding in the fetus. See our traveler’s diarrhea section for more details. What about malaria prevention while traveling and pregnant? Wear long sleeve shirts and long pants. Avoid outdoor activities at dusk and dawn. Stay in accommodations with screens, fans or air-conditioning. Use mosquito nets tucked into the mattress. Use repellant containing DEET; use it directly onto clothing and only sparingly on skin exposed beyond long sleeve clothing. Medications: 

Mefloquine(Larium) is CDC recommended after the 1st trimester



Atovaquone/Proguanil is also considered safe after the 1st trimester



Chloroquine is safe, but ONLY use for areas where malaria parasites are known to be sensitive to it.



Avoid Doxycycline, Primaquine, Pyremethamine.

What do I do for motion sickness while pregnant? 

Meclizine (Antivert) 25 mg three times a day is considered safe



Dimenhydrinate(Dramamine) 50 mg four times a day as needed is considered safe

What can I do about nausea while pregnant? 

Promethazine (Phenergan) 25 mg three times a day as needed is considered safe

What can I take for pain while pregnant? Acetaminophen (Tylenol) as directed is the safest Avoid Aspirin and Nonsteroidal agents like Ibuprofen

Security Screening Is it true that some walk-through scanners actually use x rays to screen people? Yes, some of these are now being used in large international airports, such as Heathrow in London. There is very little radiation dose for a person passing through the scanner because they are not trying to see the detail of our "soft" tissues as is done in medicine. They are looking for items that will stand out pretty easily. According to the American National Standards Institute, in its standard N43.17-2002 "Radiation Safety for Personnel Security Screening Systems Using X-rays," the maximum effective dose an individual could receive when walking through this scanner is 0.01 millirem (a unit of radiation dose commonly abbreviated mrem). For some perspective on the level of this dose, the annual effective dose each of us receives from background radiation is about 360 mrem; the effective dose from one chest x ray is about 10 mrem. Is it safe for someone with a medical implant to go through the airport (or office building) metal detectors? There are two papers published in literature that discuss this. The more recent article published by Niehaus, et al., in 2001discusses pacemakers and states: "In 103 patients who were monitored as they passed through typical metal detectors, security alarms invariably were activated. In none of the patients was the pacemaker function affected. It is therefore accepted practice to advise patients that while airport screening devices may detect

the pacemaker, the device will not be adversely affected. Patients should carry their device identification card for the purpose of obtaining security clearance." According to the articles' conclusions, patients can go through metal detectors without causing a pacemaker or cardioverter-defibrillator malfunction. For other types of implants, it may be best to ask your physician. References Niehaus M, Tebbenhohanns J. Electromagnetic interference in patients with implanted pacemakers or cardioverter-defibrillators. Heart 86: 246-248; 2001. Copperman Y, Zarfati D, Laniado S. The effect of metal detector gates on implanted permanent pacemakers. Pacing Clin Electrophysiol. 11: 13861387; 1988.

I travel a lot (at least once or twice a week) and will continue to do so in the foreseeable future. Obviously, I have to go through the metal detector at least twice for each trip. What effect does this radiation exposure have on me in the long run? The metal detector does not expose you to ionizing radiation, e.g., x rays; neither do the wands that are used for individual screening. Metal detectors operate by generating a low-intensity magnetic field that passes from one side of the detector to the other. If metal objects pass through that field, the magnetic field will induce a second field in the metal object. Since that second field is a disruption of the first field, the detector senses the change and sets off an alarm. Magnetic fields are a form of radiation, but they are called "nonionizing" radiation. This means that magnetic fields do not generate additional, damaging radiation the way that ionizing radiation (such as x rays) does. Magnetic fields below a certain intensity are considered to be safe in that they will not cause any biological damage to an individual. As a reference, MRI (magnetic resonance imaging) is considered safe and uses much higher magnetic field intensity than a metal detector. In summary, because of its nonionizing properties, the magnetic

field generated in a metal detector will not cause harm to persons even with routine and/or repeated scanning. I work for a major airline and will be required to spend eight hours a day near the new baggage x-ray machines (the big ones that I think are CT machines) that TSA (Transportation Security Administration) uses. We have been given a handout saying that TSA has determined that the machines are not dangerous and that we do not need film badges. How can anyone say working near radiation is not dangerous if it is not monitored in any way? Some of the newer x-ray machines used to scan checked luggage use computerized tomography (CT) technology—just like those used in medicine. The main difference between the two types of use (security at airports and medical diagnosis) is that the machines used in airports have more shielding to stop the scattered radiation—nearly the entire luggage belt is shielded where, in medicine, the patient table is not shielded—and they subject the baggage to lower doses because the image does not need to be as clear as it does for a patient. Someone standing next to the unit in airports would receive little, if any, radiation exposure. Radiation emitted around a piece of equipment when it is operating is determined at the manufacturer and, sometimes, checked by the purchaser. A manufacturer must assure the equipment is operating within Federal regulations that govern x-ray equipment which in this case is 0.5 mR/h at 5 cm from the unit (mR or milliroentgen is a unit of radiation exposure) though performance studies of the equipment indicate that the average exposure rate was about 0.08 mR (microroentgen, one-one thousandth of a milliroentgen) per scan (NCRP Report 95). Purchasers can use the manufacturer's assurance and/or can perform their own surveys on the equipment. The dose to the luggage is very low and there is no detectable radiation outside the machines according to one manufacturer. What does it mean when my employer says the machines are safe because no "leakage" was found? What is leakage? I work about those big checked luggage scanners, so what does leakage mean to me in terms of radiation exposure? When we say "leakage," that simply means when the x-ray beam is on, the tube housing has some radiation coming through it. Actually, it always does

and x-ray machine regulations limit the amount that can come through. So, in this case, "leakage" means someone was able to detect radiation being emitted through the tube housing at levels higher than what the regulations allow. With that in mind, though, it does not mean that radiation was coming through the shielding around the unit. The scanners have shielding around them to make sure the x-ray beam cannot escape and expose people to unnecessary radiation. So, even if radiation was leaking through the tube housing when the unit was on, it is unlikely it also went through the unit's shielding. There are a couple of ways to find out if a machine is "leaking" when people are not wearing radiation dosimeters. One way is the recognition that the images are not of the same quality as they should be. If the images are deteriorating significantly, it could mean many things—one of which is that not all of the radiation is getting to the luggage. Additionally, the manufacturer or contracted workers will do regular preventive maintenance on the unit and if they work on the x-ray production portion of the unit, new surveys around the unit must be done to show that radiation protection controls still provide the necessary protection. Would you recommend the frequency of radiation leakage measurement surveys in an airport environment for the screening equipment? Every two to three years would be adequate if the machine is not opened for repair. After it is serviced, a radiation survey is a must to ensure shielding and barriers have been repositioned correctly. What type of instrument can I purchase to do radiation leakage checks on baggage x-ray screening machines? It is likely you will need two types of equipment to do a leakage survey. The first is a Geiger-Mueller probe with a mica window (i.e., a pancake probe) because it would be the most sensitive to actually find the leakage radiation if there is any. The second is an x-ray calibrated (calibrated for the energy emitted by the baggage-screening equipment) ion chamber to measure actual dose or dose rate. In the United States, the Food and Drug Administration has regulatory authority over the manufacturers of radiation-

producing equipment and have specified a leakage limit of 0.5 mR/h at a distance of 5 cm from the surface of the equipment (mR, or milliroentgen, is a unit of radiation exposure). With an airport baggage-screening machine, is it safe to line up bags in a continuous row which doesn't allow the lead protection to be completely down when a bag is in the x-ray beam? Judging by the experience of those who have measured radiation exposures around modern narrow scanning beam baggage security screening systems while they are continuously in operation, there is very little scatter from the piece of baggage being screened, so little, if any, radiation even makes it to the lead protection barrier. I am pregnant and operate an x-ray machine at a courthouse—the type that scans items people carry in with them. Should I have any concerns? Should I continue working? Baggage x-ray machines emit x rays just like medical x-ray machines except at much, much lower levels. The location of the operator is very well shielded and, really, exposes no one. It is safe to continue working while you're pregnant. As a pregnant woman, does passing through airport security pose a risk to my baby? Passing through an airport security portal does not pose a risk to a pregnant woman or her unborn child. The metal detector is not known to pose any health risk to individuals. The devices used to scan your carry-ons are very well shielded so there is no risk from passing by those, either. I reached into an airport x-ray screener that is used to see in to our carry-on items. How much radiation exposure did I get? There is nothing for you to worry about. Airport x-ray machines and similar x-ray machines used by federal and state agencies to screen briefcases and packages give much lower doses than x-ray machines in hospitals and medical clinics—almost immeasurable. They are designed this way because they do not have to see as much detail, are not designed for looking into very large objects, and are usually looking for things that really "stand out" on images (like metal).

In all likelihood, your hand was not in the actual beam, making your exposure much lower. Furthermore, the hands and feet are very radiation Does radiation from a security screening device, like those used in airports, affect the items that pass through them such as baby bottles, food items, plants, electronic devices (cell phone), or drug products (like injectable nitroglycerin for a heart condition)? The radiation exposure from these devices is too low to affect any items passing through (other than certain types of camera film which can darken) even from repeated exposures. Additionally, in case you were wondering, there isn't any residual radiation in exposed materials after the exposure is complete either.

Does airport security x-ray screening have any effect for my pet? The radiation exposure from these devices is too low to affect cats, dogs, birds, or other animals that need to be security-screened. If it is just the pet carrier that needs to be screened, you can put the carrier on the conveyor belt and walk or carry your pet through the metal detector portal instead of having the animal go through the x-ray unit. Does radiation from a security screening device, like those used in airports, affect clothing if it passes through the screening a lot? I have a Gore-Tex jacket that gets screened quite a bit. The amount of radiation to which the clothing, even the Gore Tex jacket, is exposed is too small to degrade the materials. The manufacturers of these scanners indicate the radiation exposure to an item from one scan is about one-tenth the exposure we receive every day from naturally occurring radiation (commonly called background radiation). Can I put my hand inside a screening x-ray machine to get an x ray to look for injury? No, absolutely not. These systems are not designed for medical diagnosis and will not provide appropriate image detail or contract. I would suspect that in most States, this would be illegal. X rays of people should only be done with a doctor's order to do so.

If the airport security screener stops the conveyor to observe the xray image for a longer time, does that mean the item on the conveyer gets more radiation? The scanners used for hand luggage at most airports take short single-shot images of items. The radiation is turned on for the same fixed amount of time for each item. The images are digital and held on the screen until the next coat, purse, or other item is processed. Thus, if the screeners choose to look at the images for an extended visual analysis, no additional radiation is used. If the item is removed from the scanner and put back onto the belt for a second time, however, it will then receive additional irradiation. In other words, these x-ray scanners are not "fluoroscopic" in nature like the old machines from the mid-20th century which were used to fit shoes, nor are they like angiographic or surgical x-ray machines. They are more similar to simple chest x rays, only performed using less radiation.

Effects and Security Screening I reached into an airport x-ray screener that is used to see in to our carry-on items. How much radiation exposure did I get? There is nothing for you to worry about. Airport x-ray machines and similar x-ray machines used by federal and state agencies to screen briefcases and packages give much lower doses than x-ray machines in hospitals and medical clinics—almost immeasurable. They are designed this way because they do not have to see as much detail, are not designed for looking into very large objects, and are usually looking for things that really "stand out" on images (like metal). In all likelihood, your hand was not in the actual beam, making your exposure much lower. Furthermore, the hands and feet are very radiation tolerant relative to the rest of the body. Does radiation from a security screening device, like those used in airports, affect the items that pass through them such as baby bottles, food items, plants, electronic devices (cell phone), or drug products (like injectable nitroglycerin for a heart condition)?

The radiation exposure from these devices is too low to affect any items passing through (other than certain types of camera film which can darken) even from repeated exposures. Additionally, in case you were wondering, there isn't any residual radiation in exposed materials after the exposure is complete either. Does airport security x-ray screening have any effect for my pet? The radiation exposure from these devices is too low to affect cats, dogs, birds, or other animals that need to be security screened. If it is just the pet carrier that needs to be screened, you can put the carrier on the conveyor belt and walk or carry your pet through the metal detector portal instead of having the animal go through the x-ray unit if that would make you more comfortable. Does radiation from a security screening device, like those used in airports, affect clothing if it passes through the screening a lot? I have a Gore-Tex® jacket that gets screened quite a bit. The amount of radiation to which the clothing, even the Gore-Tex® jacket, is exposed is too small to degrade the materials. The manufacturers of these scanners indicate the radiation exposure to an item from one scan is about one-tenth the exposure we receive every day from naturally occurring radiation (commonly called background radiation). Can I put my hand inside a screening x-ray machine to get an x ray to look for injury? No, absolutely not. These systems are not designed for medical diagnosis and will not provide appropriate image detail or contrast. I would suspect that in most states, this would be illegal. X rays of people should only be done with a doctor's order to do so. If the airport security screener stops the conveyer to observe the x-ray image for a longer time, does that mean the item on the conveyer gets more radiation? The scanners used for hand luggage at most airports take short single-shot images of items. The radiation is turned on for the same fixed amount of time for each item. The images are digital and held on the screen until the next coat, purse, or other item is processed. Thus, if the screeners choose

to look at the images for an extended visual analysis, no additional radiation is used. If the item is removed from the scanner and put back onto the belt for a second time, however, it will then receive additional irradiation. In other words, these x-ray scanners are not "fluoroscopic" in nature like the old machines from the mid-20th century which were used to fit shoes, nor are they like angiographic or surgical x-ray machines. The scans are more similar to simple chest x rays, only performed using less radiation. Is it true that some walk-through scanners actually use x rays to screen people? Yes, some of these are now being used in large international airports, such as Heathrow in London. There is very little radiation dose for a person passing through the scanner because they are not trying to see the detail of our "soft" tissues as is done in medicine. They are looking for items that will stand out pretty easily. According to the American National Standards Institute, in its standard N43.17-2002 "Radiation Safety for Personnel Security Screening Systems Using X-Rays," the maximum effective dose an individual could receive when walking through this scanner is 0.01 millirem (a unit of radiation dose commonly abbreviated mrem). For some perspective on the level of this dose, the annual effective dose each of us receives from background radiation is about 360 mrem; the effective dose from one chest x ray is about 10 mrem. I travel a lot (at least once or twice a week) and will continue to do so in the foreseeable future. Obviously, I have to go through the metal detector at least twice for each trip. What effect does this radiation exposure have on me in the long run? The metal detector does not expose you to ionizing radiation, e.g., x rays; neither do the wands that are used for individual screening. Metal detectors operate by generating a low-intensity magnetic field that passes from one side of the detector to the other. If metal objects pass through that field, the magnetic field will induce a second field in the metal object. Since that second field is a disruption of the first field, the detector senses the change and sets off an alarm. Magnetic fields are a form of radiation, but they are called "nonionizing" radiation. This means that magnetic fields do not generate additional, damaging radiation the way that ionizing radiation

(such as x rays) does. Magnetic fields below a certain intensity are considered to be safe in that they will not cause any biological damage to an individual. As a reference, MRI (magnetic resonance imaging) is considered safe and uses much higher magnetic field intensity than a metal detector. In summary, because of its nonionizing properties, the magnetic field generated in a metal detector will not cause harm to persons even with routine and/or repeated scanning. I work for a major airline and will be required to spend eight hours a day near the new baggage x-ray machines (the big ones that I think are CT machines) that TSA (Transportation Security Administration) uses. We have been given a handout saying that TSA has determined that the machines are not dangerous and that we do not need film badges. How can anyone say working near radiation is not dangerous if it is not monitored in any way? Some of the newer x-ray machines used to scan checked luggage use computerized tomography (CT) technology—just like those used in medicine. The main difference between the two types of use (security at airports and medical diagnosis) is that the machines used in airports have more shielding to stop the scattered radiation—nearly the entire luggage belt is shielded where, in medicine, the patient table is not shielded—and they subject the baggage to lower doses because the image does not need to be as clear as it does for a patient. Someone standing next to the unit in airports would receive little, if any, radiation exposure. Radiation emitted around a piece of equipment when it is operating is determined at the manufacturer and, sometimes, checked by the purchaser. A manufacturer must assure the equipment is operating within federal regulations that govern x-ray equipment, which in this case is 0.5 mR/h at 5 cm from the unit (mR or milliroentgen is a unit of radiation exposure) though performance studies of the equipment indicate that the average exposure rate was about 0.08 μR (microroentgen, one-one thousandth of a milliroentgen) per scan (NCRP Report 95). Purchasers can use the manufacturer's assurance and/or can perform their own surveys on the equipment. The dose to the luggage is very low and there is no detectable radiation outside the machines according to one manufacturer.

Workers and Security Screening I work for a major airline and will be required to spend eight hours a day near the new baggage x-ray machines (the big ones that I think are CT machines) that TSA (Transportation Security Administration) uses. We have been given a handout saying that TSA has determined that the machines are not dangerous and that we do not need film badges. How can anyone say working near radiation is not dangerous if it is not monitored in any way? Some of the newer x-ray machines used to scan checked luggage use computerized tomography (CT) technology—just like those used in medicine. The main difference between the two types of use (security at airports and medical diagnosis) is that the machines used in airports have more shielding to stop the scattered radiation—nearly the entire luggage belt is shielded—where, in medicine, the patient table is not shielded and they subject the baggage to lower doses because the image does not need to be as clear as it does for a patient. Someone standing next to the unit in airports would receive little, if any, radiation exposure. Radiation emitted around a piece of equipment when it is operating is determined at the manufacturer and, sometimes, checked by the purchaser. A manufacturer must assure the equipment is operating within federal regulations that govern x-ray equipment, which in this case is 0.5 mR/h at 5 cm from the unit (mR or milliroentgen is a unit of radiation exposure) though performance studies of the equipment indicate that the average exposure rate was about 0.08 μR (microroentgen, one-one thousandth of a milliroentgen) per scan (NCRP Report 95). Purchasers can use the manufacturer's assurance and/or can perform their own surveys on the equipment. The dose to the luggage is very low and there is no detectable radiation outside the machines according to one manufacturer. What does it mean when my employer says the machines are safe because no "leakage" was found? What is leakage? I work about those big checked luggage scanners, so what does leakage mean to me in terms of radiation exposure? When we say "leakage," that simply means when the x-ray beam is on, the tube housing has some radiation coming through it. Actually, it always does

and x-ray machine regulations limit the amount that can come through. So, in this case, "leakage" means someone was able to detect radiation being emitted through the tube housing at levels higher than what the regulations allow. With that in mind, though, it does not mean that radiation was coming through the shielding around the unit. The scanners have shielding around them to make sure the x-ray beam cannot escape and expose people to unnecessary radiation. So, even if radiation was leaking through the tube housing when the unit was on, it is unlikely it also went through the unit's shielding. There are a couple of ways to find out if a machine is "leaking" when people are not wearing radiation dosimeters. One way is the recognition that the images are not of the same quality as they should be. If the images are deteriorating significantly, it could mean many things—one of which is that not all of the radiation is getting to the luggage. Additionally, the manufacturer or contracted workers will do regular preventive maintenance on the unit and if they work on the x-ray production portion of the unit, new surveys around the unit must be done to show that radiation protection controls still provide the necessary protection. Would you recommend the frequency of radiation leakage measurement surveys in an airport environment for the screening equipment? Every two to three years would be adequate if the machine is not opened for repair. After it is serviced, a radiation survey is a must to ensure shielding and barriers have been repositioned correctly. What type of instrument can I purchase to do radiation leakage checks on baggage x-ray screening machines? It is likely you will need two types of equipment to do a leakage survey. The first is a Geiger-Mueller probe with a mica window (i.e., a pancake probe) because it would be the most sensitive to actually find the leakage radiation if there is any. The second is an x-ray calibrated (calibrated for the energy emitted by the baggage-screening equipment) ion chamber to measure actual dose or dose rate. In the United States, the Food and Drug Administration has regulatory authority over the manufacturers of radiation-

producing equipment and have specified a leakage limit of 0.5 mR/h at a distance of 5 cm from the surface of the equipment (mR, or milliroentgen, is a unit of radiation exposure). With an airport baggage-screening machine, is it safe to line up bags in a continuous row which doesn't allow the lead protection to be completely down when a bag is in the x-ray beam? Judging by the experience of those who have measured radiation exposures around modern narrow scanning beam baggage security screening systems while they are continuously in operation, there is very little scatter from the piece of baggage being screened so little, if any, radiation even makes it to the lead protection barrier. I am pregnant and operate an x-ray machine at a courthouse—the type that scans items people carry in with them. Should I have any concerns? Should I continue working? Baggage x-ray machines emit x rays just like medical x-ray machines except at much, much lower levels. The location of the operator is very well shielded and, really, exposes no one. It is safe to continue working while you're pregnant. Can I put my hand inside a screening x-ray machine to get an x ray to look for injury? No, absolutely not. These systems are not designed for medical diagnosis and will not provide appropriate image detail or contrast. I would suspect that in most states, this would be illegal. X rays of people should only be done with a doctor's order to do so. Is it safe for someone with a medical implant to go through the airport (or office building) metal detectors? There are two papers published in literature that discuss this. The more recent article published by Niehaus, et al., in 2001discusses pacemakers and states: "In 103 patients who were monitored as they passed through typical metal detectors, security alarms invariably were activated. In none of the patients was the pacemaker function affected. It is therefore accepted practice to advise patients that while airport screening devices may detect the pacemaker, the device will not be adversely affected. Patients should

carry their device identification card for the purpose of obtaining security clearance." According to the articles' conclusions, patients can go through metal detectors without causing a pacemaker or cardioverter-defibrillator malfunction. For other types of implants, it may be best to ask your physician. References Niehaus M, Tebbenhohanns J. Electromagnetic interference in patients with implanted pacemakers or cardioverter-defibrillators. Heart 86: 246-248; 2001. Copperman Y, Zarfati D, Laniado S. The effect of metal detector gates on implanted permanent pacemakers. Pacing Clin Electrophysiol. 11: 13861387; 1988.

Safety for Security Screening Using Devices That Expose Individuals to Ionizing Radiation What are these devices? Does this include the general walk-through magnetic screeners? What this FAQ refers to are the devices often seen in airports or courthouses that expose people to ionizing radiation (x rays) when a person walks through them. These x-ray-emitting devices are more commonly called "backscatter screeners," although they have been called "people scanners" and "security screeners." We won't be talking about the magnetic screening units or another type of device called a millimeter wave unit—those use nonionizing forms of radiation. To how much radiation am I being exposed? Is this something I need to be concerned about as a frequent flier (I fly twice a month)?

There is an American National Standards Institute/Health Physics Society (ANSI/HPS) consensus standard (listed in the reference information at the end of this document) stating that people-scanning devices should expose an individual to no more than 0.25 microsievert per screening (one screening procedure generally consists of two scans). The two primary companies who sell people screeners say that their devices expose people to half that amount of radiation. For perspective, 0.25 microsievert is also received by flying about a minute and a half (cosmic radiation during commercial flight exposes fliers to about 10 microsievert per hour). It is also received by living for 40 minutes (natural background radiation exposes people to about 0.35 microsievert per hour). Frequent fliers will be exposed to more radiation because they will go through the people scanners more often, plus they will be receiving more cosmic radiation while they are flying. The consensus standard took into account extra scans for frequent fliers and put a recommended limitation on the total radiation dose from this activity. That limit is 250 microsieverts per year, which would be 1,000 scans per year if the scanner is operating at the per scan limit. Is it safe to take my children through this device? What if I am pregnant? The American National Standards Institute/Health Physics Society (ANSI/HPS) consensus standard took into account the varying sensitivity of different groups of people who might be scanned. The authors first looked at a number of reports and published studies on the health effects of radiation. They then chose the 0.25 microsievert dose level to ensure that children and pregnant individuals can be safely scanned with these devices. The x-ray scanner uses a very low-energy and low-intensity radiation, so that an embryo/fetus is not exposed to any radiation that could possibly increase the developmental risks of radiation to the embryo. Who decided that it is okay to use radiation on so many people? The final decision was made by the Department of Homeland Security (DHS). This was made, however, only after experts gave their input on the safety of the devices. DHS needed to weigh the potential risk of exposing people to ionizing radiation versus the overall societal benefit of detecting

terrorist threats. Because the amount of radiation someone receives from being screened is so low, the benefit was determined to far outweigh the risk (if any). What about concerns that people have raised regarding the skin dose from these devices? Some have said that the skin dose must be high if most of the x rays only come in contact with the skin. The American National Standards Institute/Health Physics Society (ANSI/HPS) consensus standard addresses this issue. The 0.25 microsievert limit is an overall whole-body effective dose. To calculate that dose, measurements of the entrance exposure at the skin was taken first. The standard indicates that the associated skin absorbed dose is even less than the overall whole-body effective dose. What about concerns people have raised about the possible radiation dose to organs that sit just under the skin—like the thyroid? Or what about the eyes? Some organs do get a radiation dose—a higher dose if they are close to the skin and a lower dose if they are deeper inside the body. They won't, however, get a dose higher than the skin dose because the x rays all come in contact with the skin while only a few penetrate deeper into the body. As a result of that, even the organs that are close to the skin surface receive less than 0.087 microgray. This is a dose that is considered to have negligible risk for harmful effects. Aren't all radiation doses cumulative—doesn't all this radiation add up? It isn't as simple as saying we can add up all of the radiation to which we've been exposed in our lifetime to determine what the effect might be. When radiation interacts with a cell in the body, several things can occur: 

The cell might have some minor damage that is repaired.



The cell might have some minor damage that remains inactive until another agent interacts with the cell again.



The cell might have damage that causes it to become cancerous.



The cell may simply stop functioning.



The cell may die.

So, radiation doses aren't necessarily cumulative. Who measured these doses, anyway? How do they really know that is the dose to a person? The radiation measurements from these devices were performed by some independent researchers along with the manufacturers. The American National Standards Institute/Health Physics Society (ANSI/HPS) standard indicates how these measurements are to be performed, with what types of measuring instruments, and from the resulting data, how the dose is to be determined.

The following questions was answered by an expert in the appropriate field: If I place my breakfast, lunch, snacks, and water into the xray screening machine at work, is this safe when I will need to do this five times a week, times 52 weeks a year, for the next 25 years? What long-term effects could this have? Thank you for your question. Sending food items through a screening machine, whether at the airport or in your workplace, will not do anything to the food and the food will not contain radioactivity after it passes through the x rays. There are no shortterm or long-term effects on the food or for you.

I work at a job that makes us x ray all items that we have (food, water, clothing, keys) on a daily basis. There are no maintenance records or any calibration of these machines. Are any health risks associated with this type of daily use? Thank you for your question. Your use of anything (e.g., clothing) that has gone through the scanner or your intake of anything (e.g., food, water) that has gone through the scanner is not associated with any health risks.

The items being scanned are exposed to a very low level of radiation that won't do anything to the clothing or food items and the items do not stay radioactive. Thus, there are no health risks from using or eating/drinking these items.

There is an x-ray screener at work and recently after a superior's order we're being forced to introduce even our lunch totes into the machine. It wouldn't be worrisome if it happened every now and then, but we have to do it on a weekly basis. I was just wondering if doing it for an extended period of time would be harmful, considering the health risks of radiation exposure? There is no harm to you from handling the tote or eating the food after it has gone through an x-ray screening unit. There are two reasons for this answer. The first is that the amount of radiation to which the food and tote are being exposed, even on a daily basis, isn't enough to cause those items to be changed in any way that would be harmful if you touched them or ate the food. Second, there is no radiation "left over," so neither the tote nor the food is radioactive after being through the scanner, so you won't be exposed to any radiation as a result. Kelly Classic Certified Medical Health Physicist

What do I need to do if I have an electric/battery-powered wheelchair? You must state that you use a wheelchair when you book your ticket. In addition, you must state the weight and size of your wheelchair when you book your ticket. Electric wheelchairs are not allowed in the cabin and must

therefore be checked in with the rest of your baggage and be carried in the aircraft hold. In order to reduce the risk of damage, we recommend that you remove all loose parts from your wheelchair before leaving it with your airline. Wheelchairs with dry batteries and gel batteries are approved for air transport. However, the battery cables must be removable and must be joined in order to avoid short circuiting. You can sit in your own wheelchair right up to the gate, and help to prepare the chair for loading onto the aircraft. Falck will be at your assistance. Who assembles my wheelchair? When your wheelchair is re-assembled, it is important that you give clear instructions on how this should be done. If the assembly is complicated, you must arrange in advance for the assistance you need. Will I be separated from my helper from check-in to the gate? You will be accompanied by your helper if at all possible, but you may be separated for a short period of time for various reasons. Is it possible to get assistance for instance for duty- and tax-free shopping? No, that is not included in the service. Is there any kind of equipment which I am not allowed to bring on the flight? The airlines may have different rules on what you are allowed to bring. We therefore recommend that you check this with your airline. Is there any kind of equipment that could be damaged by the pressure in the cabin? We recommend that you check this with the supplier of your equipment before departure. Can a person who is unable to read get help to find the right gate? Yes, an assistant will be available if this service has been booked via Falck. Otherwise, you can always ask at the airport’s service information desks.

What can I do if the announcements on the loudspeakers etc. are too fast and not clear enough for me to understand what they say? If you have booked assistance, Falck will help you. Otherwise, you can always ask at the airport’s service information desks. What should I do if I hear my name on the loudspeaker and do not understand why? Ask Falck or at one of the airport’s service information desks. Can I be accompanied by a social worker/helper all the way to the gate even if the person will not be accompanying me on the flight? A companion would need to have a valid ticket to be allowed to accompany you all the way to the gate. Falck will assist you all the way to the gate if you have pre-booked disability assistance. Can I get help to go through security, and do I have to take off belt and braces, even if I cannot put them back on? If you have booked assistance with Falck, you will get help for this as well. I am going to bring a guide dog. What should I do? It is important that you state that you will be travelling with a guide dog already when you book your flight. The rules on accompanying dogs differ from airline to airline. However, in most cases, a guide dog will be allowed to accompany you in the cabin and does not have to be in a cage. Normally there is no extra charge for bringing a guide dog. And the guide dog usually does not count as part of your baggage allowance. As for all other animal transport, it is the owner’s responsibility to check which rules apply in the country of destination. In addition, you must check in advance which vaccinations the dog must have and what quarantine rules apply in the relevant countries. Passengers with an accompanying dog will usually be allowed to board before the other passengers.

Medical Devices - Defibrillators and pacemakers What is the most appropriate approach to go through airport security? 

If you have an implanted cardiac defibrillator or pacemaker it is prudent to carry a pacemaker or medical device ID card that documents the presence, make and model of your defibrillator or pacemaker and the telephone number for the manufacturer.



Inform the airport security officer that you have an implanted medical device and give them the pacemaker or medical device ID card.



Request a pat - down inspection rather than walking through the arched metal detector. Do not have the hand held security wand used to screen you, since it can interfere with the workings of your medical device.

Will my defibrillator or pacemaker set off the metal detector? Yes, implanted cardiac defibrillators and pacemakers can trigger the alarm of metal detectors. Will metal detectors harm my defibrillator or pacemaker? Hand held security wands can interfere with implanted cardiac defibrillators. Travelers should carry a letter from your physician and request a physical pat down. Walk through metal detectors will not interfere with your device but will set off an alarm. What else should I consider? You should also carry a copy of your EKG with you, so physicians who are not familiar with you can compare EKG’s if an emergency situation developed while traveling. You should also consider having your cardiologist’s contact information (telephone/fax/email) with you for others to communicate with them. For any questions regarding your defibrillator, pacemaker or stent please consult your cardiologist or the company that manufactured it.

Medical Devices - Artificial Joints and other Orthopedic Issues Will artificial joints set off the walk through metal detector? Yes, artificial joints will set off the alarm in walk through metal detectors. As a general experience total hip joints set off alarms 100% of the time, total knee joints 90% of the time, plates and screw 25 % of the time, spinal implants 14 % of the time. Artificial shoulders, wrists, screws, wires and rods by themselves may not set off alarms depending on how sensitive the machines are. Does having a Medical Device Patient Travel Card, Doctor’s letter or Xray make it easier to go through airport screening? NO it does not, these documents can obviously be forged and cannot be relied upon by airport security officers as a substitute for individual screening. What is the most appropriate approach to go through airport security screening? 

You can inform the security officer that you have an artificial joint, prosthetic device or plates & screws; they may tell you to walk through anyway or screen you privately with a hand wand.



If you walk through the metal detector and the alarm goes off, let the officer know that you have an artificial joint, prosthetic device or plates & screws etc.



You will be taken to a private area and screened with a hand wand to confirm the presence of your artificial joint, prosthesis or other device. At this point a Medical Device Patient Travel Card may help to confirm the location of your device and correlate to where the hand wand should alarm.

What about Prosthesis, Braces and Casts?

Security officers will need to see, touch and perhaps do explosive trace sampling on your artificial limb, brace or cast. These do not need to be removed for screening. What about canes, crutches and walkers? Canes, crutches and walkers must undergo x-ray screening. If they do not fit the machine, a manual inspection and explosive trace sampling may be conducted. What about TENS units, Bone growth stimulators, Orthopedic shoes etc? Inform the security officer of your device and its location. You should request a private screening with pat down and visual inspection as the calibration of devices will be interfered with by x-ray screening equipment.

Medical Devices - Cardiac stents and metal heart valves Will a stent in my heart set off metal detectors? A single metal stent will not set off alarms, however if you have multiple stents the metal detector could possibly be set off. At approximately 3-4 weeks after stents have been placed, tissue builds up around them and it should no longer set off metal detector alarms. If alarms go off and you feel it is due to your stents, show security officers your medical device ID card and request a physical pat – down screen. Will my artificial metal heart valve or ring set off metal detectors? As a general rule it should not, since the amount of metal in a valve or valve ring is small. However if the sensitivity of the machines are set extremely high it is a possibility. If alarms go off and you feel it is due to your valve or valve ring, show security officers your medical device ID card and request a physical pat – down screen.

Medical Devices - CPAP Travelers with Obstructive Sleep Apnea who use CPAP at night can travel by air these days without many hassles with their CPAP machines. This ability to transport and use the devices at their vacation or business destinations ensures their well being and health. What is the most appropriate approach to go through airport security? 

Have the CPAP machine in its original bag if possible, with bubble wrap for protection.



International plug adaptor kit and electric current converter or surge protector if needed for your device.



Bring a copy of your CPAP prescription and statement of need by your physician.



Bring a copy of TSA’a statement on CPAP devices, in case the screeners are not familiar with procedures; available at www.tsa.gov/travelers/airtravel/specialneeds/index.shtm

Should I have the CPAP machine in my carry-on or check it? Ideally you should have the CPAP machine in your carry-on luggage to assure that it does not get lost or damaged. CPAP machines cost $1000’s while checked luggage is only insured for $200, replacement will be expensive. Will I be allowed to take the CPAP machine in my carry-on? Theoretically, you should be able to take the CPAP machine in your carryon luggage according to the Department of Transportation and Security Administration (TSA) guidelines and most TSA screeners are familiar with these devices. The machines obviously have to go through x-ray screening, explosive and chemical tests prior to being allowed to board. So what is the catch? According to reports from CPAP users, your ability to take the machine in your carry-on is not guaranteed and many are forced to check it in because

they did not “pass” the x-ray test. TSA guidelines come with an exception; respiratory equipment that the Security officers are not able to clear by inspection will not be allowed on board in your carry-on luggage. If you are not allowed to take it in your carry-on; be polite, patient, understanding and check it. Wrap it well in bubble wrap to avoid any damage. Bon voyage! Can I use the CPAP machine onboard the airplane? You should be able to use the CPAP machine on board if your seat has a power port to connect the CPAP machine. You can carry a power port to 12 V adapter and connect the CPAP via its own 12 V adapter cable. Alternatively carry an inverter that will attach to the airplane power port and hook up the CPAP with its power cord to the inverter. Seats in first and business class usually come with a power port, check with seatguru.com to see if your seat comes with a power port. If you don’t want to mess with cables and power ports, there are battery powered CPAP machines with a battery life of approximately 11 hrs that can be used. How can I use the CPAP machine overseas? First of all, carry a copy of your prescription and certificate of need from your physician to clear customs smoothly. Newer CPAP machines have universal power supplies and adjust for different voltages (120 or 240) automatically without worrying about damaging the unit. Older machines may have a switch that you need to flip or may have to carry a converter or surge protector; check out the specifications of your machine. However as electric surges occur in some developing countries surge protection is vital even if a converter is built in. Wall outlets will be varied and so it is prudent to carry a multipack international plug adapter kit. Don’t forget to carry an extension cord, to assure that you actually get to sleep on the bed and not by the lamp or door.

Medical Devices Diabetes medications, equipment & supplies What is the most appropriate approach to go through security screening? 

Pack your insulin and all diabetes testing supplies in a clear separate pouch or bag.



Medications and supplies are safe to go through x-ray testing and you can place them on the x-ray machine.



However, if you prefer a visual inspection, inform the security officer that you have diabetes, have your medications & supplies with you and request a visual inspection. They may do this as a courtesy but make the request early before you go through regular screening.



If you have an insulin pump, notify the security officer that you have an insulin pump and that it cannot be removed; since it is attached with a needle under the skin. Ask the officer for a physical pat – down and visual inspection of the pump.

What all diabetes medications and supplies are allowed to be carried in your carry on luggage? 

Insulin and insulin loaded syringes that are clearly marked as such.



Unlimited number of unused syringes if accompanied by insulin.



Unlimited number of used syringes if they are in sharps disposal containers.



Blood glucose meters, lancets, test strips, alcohol swabs & meter testing solutions.



Insulin pumps and pump supplies like cleaning agents, batteries, catheter, needles, tubing, infusion kit etc, when accompanied by insulin.



Glucagon emergency kit.

Medications and Supplies What is the most appropriate approach to go through security screening? 

Pack all your medications and supplies in a separate pouch or bag from the rest of your belongings to quickly give to security officers.



Medications and supplies are safe to go through x-ray testing and are normally screened this way.



If you wish to have your medications and supplies inspected visually rather than through x-ray testing, you maybe granted this wish but you need to request it prior to going through screening.



If any of the medications or supplies cannot be adequately screened visually, it will have to go through x-ray screening.

What medications and supplies are allowed to be carried in your carry on luggage? 

As a general statement the Transportation Security Agency states that all medications and supplies are allowed as long they pass screening.



These include: Pills and liquids like insulin, inhalers and their refills, atropens, epipens, insulin syringes, pre-loaded syringes, jet injectiors, infusers etc.



Medications in pill form need not be labeled, however liquids like insulin need to be clearly identifiable with labels.



Medications in pill boxes (daily dosage containers) are allowed.

Oxygen Do I need supplemental oxygen when I fly? If you are currently on oxygen treatment at home, you will need supplemental oxygen during your flight and you will most likely need to increase the flow rate by 1-2 L/min more than your usual requirements. Consult with your physician. If you are currently not on oxygen, you may still need supplemental oxygen during flight: 

If your blood oxygen level at rest while breathing room air is less than 70mmHg. Blood oxygen level is measured by obtaining blood from your arm - arterial blood gas test. This is the best test to determine need for supplemental oxygen during flight.



If your blood oxygen saturation at rest while breathing room air is less than 92% or if it drops below 85% by walking 150 feet . This is done non-invasively by placing a probe on your fingertip – pulse oximeter test. This is the second best test to determine need for supplemental oxygen during flight.



if you are unable to walk 150 feet or climb a flight of 15 steps without becoming severely short of breath. Please consult your physician to determine need for supplemental oxygen

There are other sophisticated tests including placement in an altitude chamber, breathing mixed nitrogen/oxygen etc to determine need for supplemental oxygen. However, these tests are cumbersome and not readily available everywhere. Should I consult with my doctor before flying? Individuals with chronic respiratory conditions like asthma, bronchitis and emphysema, congestive heart failure, angina, sickle cell disease, severe anemia etc. should consult with their physician regarding supplemental oxygen during flight. If you are unable to walk 150 feet or climb a flight of 15 steps without becoming short of breath you need to consult your physician prior to flying.

When should I tell the airline regarding my need for oxygen? You should notify the airline regarding your need for in-flight oxygen as far in advance as possible, preferably when you make the booking, but a minimum of 48 hours prior to flying. Can I carry my own oxygen equipment onto the airplane? NO airline will not allow you to take your own compressed or liquid oxygen. The Airline Oxygen Council of America has helped pass legislation now requiring all airlines to allow Department of Transportation (DOT) approved Portable Oxygen Concentrators (POC) on flights in the United States. However not all foreign airlines abide by this legislation; please check with the airline you are flying. The DOT approved portable oxygen concentrators are as follows – AirSep Freestyle, AirSep Lifestyle, Inogen One, Respironics EverGo, SeQual Eclipse. What about oxygen at the terminal and during layovers? You are solely responsible for arranging your oxygen while on the ground in the terminals, during layovers and during transport at arrival and departure. Use your home oxygen company, friends and relatives etc for this. The passenger is also responsible for arranging the removal of oxygen canisters from the gate area upon your departure. The airline is only responsible for oxygen while you are on the airplane. You should never forget to make separate arrangements for oxygen at your destination as well; the airline will not do this for you. Well, who can arrange all this? Your home oxygen supplier should be able to help you make these arrangements. If you are not currently on oxygen, contact your medical insurance company for a list of contracted home oxygen providers. Your physician should be able to guide you on this as well. You can also visit www.homeoxygen.org for assistance in these matters. What is the most appropriate approach to go through security screening?



Inform the security officer that you or the person you are escorting is on oxygen therapy.



If it is safe to be disconnected from your oxygen and respiratory equipment, do so and have yourself and the oxygen equipment screened separately.



If your doctor has indicated that you cannot be disconnected from your oxygen and respiratory equipment, inform the security officer and ask for an alternative method of screening (physical pat – down, inspection and explosive trace detection etc.)

What equipment is allowed to go through security? Oxygen canisters, nebulizers, respirators and concentrators are all allowed into the terminals once they have been screened by security officers. However again, your own oxygen cannisters will not be allowed on the airplane - only POC (portable oxygen concentrators).

Elderly Traveler The elderly are more prone to effects of jet lag, temperature change, motion sickness and dehydration. To minimize these symptoms: 

Get plenty of rest prior to travel.



Carry extra layers of clothing to keep warm on the plane and while on the ground during layovers or transfers.



Drink plenty of fluids.



Carry extra snacks for unforeseen delays.

Plan ahead and always allow extra time: 

To get to the airport, transfer to different terminals, counters and baggage claim areas.



Make use of available help by asking for wheelchairs and carts.

Should I avoid travel at this time?

Contraindications to air travel include but are not limited to: 

Chest pain that is new, occurs at rest or with minimal effort



Had a heart attack in the past 6 weeks



Uncontrolled high blood pressure



Uncontrolled heart failure – breathless at rest



Had a collapsed lung in the past 3 weeks



Uncontrolled Asthma/COPD – breathless at rest



Active infection of the ear, nose, & throat



Surgery within the past 2 weeks



Had a stroke in the past 2 weeks



Been diving in the past 24 hours

Consult with your physician for your specific situation and any other contraindications to air travel. What if I have a chronic medical illness? If you have chronic medical conditions like diabetes, asthma or heart disease, there is specific advice for each illness, please go to any or all of those sections as needed with this link: traveler with diabetes, traveler with asthma and traveler with heart disease. Will I need oxygen for flying? Lists of conditions requiring supplemental oxygen while flying include, but not limited to, are: 

You are currently on oxygen at home



Your blood oxygen level while breathing room air is less than 70 mmHg



Your finger probe oxygen saturation is less than 92% while at rest or less than 85% with exertion



if you are unable to walk 150 feet or climb a flight of 15 steps without becoming severely short of breath.

Consult with your physician regarding whether you require oxygen during flight. What is the risk of blood clots from travel or flying? Factors that increase the risk of blood clots include but are not limited to: 

Age > 75,



Previous history of blood clots,



Cancer,



Kidney failure,



Immobility,



Recent surgery,



Genetic susceptibility to clotting,



Prolonged air travel (> than 4 hours) etc.

Consult with your physician regarding your specific risk for developing blood clots. Simple measures to prevent blood clots include but are not limited to: 

Avoid dehydration by drinking plenty of fluids



Wear loose fitting clothes



Exercise in your seat by bending and straightening your feet and knees 15 times every 15 minutes.



Walk around the cabin every 30 minutes if safe and feasible



Wear properly fitted graduated compression stockings.



Consult your physician to see if you require medications to prevent blood clots.

Please go to our section on economy class syndrome for further details. What about medical devices/records/drugs/supplies?

If you have implanted medical devices like defibrillators, medication infusion pumps, pace makers or artificial joints carry a letter and your medical device ID card from your physician to ease matters with security clearance. Please go to our section on traveling with medical devices. Carry a copy of your EKG and a legible list of all your medical problems and medications with you in your carry on baggage or wallet/purse. Carry all your medications, supplies and any blood sugar testing kits etc. with you in your carry on baggage. DO NOT put them in your checked luggage. If you are gone for a prolonged length of time, consider carrying a set of new prescriptions with you in your wallet or purse, in case you loose your luggage, so that you can have them refilled without problems. How about travel vaccines and antibiotics? Make sure you have received appropriate travel related and booster vaccines for the country you are traveling to and have necessary antibiotics for the prevention of malaria and treatment of diarrhea. Be aware of the potential for newly prescribed medications like antibiotics, motion sickness pills etc to interact with your usual daily medications. Check with your physician or pharmacist about the need to adjust doses or alternatives. If possible take a dose or two of the new medications prior to departure to make sure it will not cause any problems. Should I wear a medical alert bracelet? Wear a medical alert bracelet if you have diabetes, asthma, heart problems, seizures or psychiatric problems.

Travel with Children If children are traveling without their parents, the accompanying responsible adult or guardian should carry a notarized letter authorizing their travel, permission for any and all necessary medical treatment for them and evacuation if needed.

If children are traveling with a solo parent, a signed letter by the nontraveling parent, while not absolutely necessary, may speed up health care and services in countries with a legalistic bend. Children with chronic heart, lung, blood or ear, nose and throat problems should be evaluated by their pediatrician prior to air travel. Are there any special immunization requirements for children prior to travel? Update all recommended age appropriate vaccinations. Accelerated vaccine administration schedules are available for special travel circumstances if the child is younger than recommended age, check with your pediatrician Children should have at least 3 doses of tetanus toxoid and pertussis vaccine prior to travel. Mumps-measles-rubella vaccine or monovalent measles vaccine (if the child is less than 12 months old) should also be given prior to travel. Check with your pediatrician for specific recommendations for the country you are traveling to. Your child may need vaccines for Hepatitis A, Hepatitis B, Japanese encephalitis, Meningococcus, Rabies, Typhoid, and Yellow fever etc. What should be done for malaria prevention in children during travel? Stay in accommodations with screened windows and doors. Use permethrin impregnated mosquito nets. Avoid outdoor activities at dawn or dusk when mosquitoes are most active. Wear long sleeve clothing. Apply DEET (N, N-diethylmeta-toluamide) repellant on exposed skin and clothing as directed on the label for children. Check with your pediatrician for specific weight based recommendation for medications like Atovaquone-proguanil, chloroquine, mefloquine etc. See our malaria prevention section for further details.

How do I treat traveler’s diarrhea in children? Follow general food safety and water safety recommendations. Prepare formulas with safe water only. Use oral rehydration solutions aggressively. If you are unable to find them or don’t have it, just mix 6 teaspoons of sugar and 1 teaspoon of salt in 1 liter of bottled, boiled or purified water. Children should avoid lomotil, Pepto-Bismol or other anti-diarrhea medications, which could potentially cause blockage. Take appropriate weight based antibiotics as directed by your pediatrician.

Traveler on Dialysis Dialysispatients no longer need to be hooked to their hometowns. You can withsome advance planning and preparation enjoy vacations, out of townbusiness or pleasure engagements and even go on cruises or wildernessadventures. Who should consider travel? Any hemodialysis or peritoneal dialysis patients who are medically stable and on a stable dialysis regimen can travel. Who should avoid travel? Youshould avoid travel if you are new to dialysis, your regimen andfrequency are still being determined or your medical condition isunstable. How should a hemodialysis patient start planning for a trip? Oneshould start planning at least 6-8 weeks in advance, perhaps longer forpopular vacation destinations or during holidays. Discuss your planswith your kidney specialist (nephrologist) and obtain his approval from amedical standpoint. Your local dialysis centers will sometimehave a social worker or nurse who is familiar with arranging dialysisaway from your home town and can assist

you in finding a localhemodialysis center in the town you are visiting(travel dialysiscenter). If your center is not able to do this, find out whichnational company is involved in your dialysis care and call their tollfree number. The 2 largest companies are: DaVita(1-800-244-0680 ordavita.com) and Fresenius(1-866-889-6019 or fresinius.com). Theycan help you find a dialysis center in the town you are visiting. You can also go to www.globaldialysis.com to find local dialysis centers all over the world. What if one has to travel in an emergency or short notice? Mostdialysis centers will be sympathetic and try to accommodate yourneeds. Use your dialysis center staff, the above phone numbers andwebsites to make arrangements. What adjustments will have to be made? Youmay not always get into your first choice for dialysis center, you mayhave to drive a bit longer or take a different shift than you are usedto. If you plan ahead none of the above may be an issue, but be preparedto be flexible, especially if on short notice. What information will be needed at the travel dialysis center? Youwill need to provide them with your name, address, contact information,your hometown dialysis center contact number, the dates you needdialysis, your vascular access type and dialysis prescription. Inaddition they will need a copy of your medical history & physical,list of medications, laboratory results, EKG, CXR, 4-6 recent treatmentrecords and any special dialysis requirements. They will also needyour insurance information, along with the name and contact number ofyour physician. Give them the address and local telephone number for theplace you are staying at. Are there extra costs out of my pocket for this? Medicarewill pay for 80% of the costs within the United States and itsterritories, but the patient is responsible for 20%. Your

secondaryinsurance may cover this 20%, but travel dialysis centers may requireyou to pay this upfront and bill your insurance later. Medicaid by and large will not pay for treatment outside your home state and you will be responsible for the costs. Ifyou have private insurance, it is best to have a letter in writing thatthey will pay for your treatment at the travel dialysis center. Always inquire if the physician fee is your own responsibility or billed to the insurance. What about peritoneal dialysis and travel? Travelis usually quite a bit simpler since you don’t need a fixedappointment, but make sure to call the peritoneal dialysis center atyour destination and see if they would be able to assist you if problemsarose. Provide them with a copy of your pertinent medical records:history & physical, labs, EKG, CXR, dialysis prescription, list ofmedications etc. You should carry enough supplies for the entire trip and some extra in case of problems. Ifyou are traveling for a prolonged period of time, have suppliesdelivered to your destination and make sure they have arrived prior todeparture. What if I get sick while traveling? Thetravel dialysis center at your destination will be able to handle yourneeds through their physicians. Carry a complete legible copy of yourpertinent medical records including medical problems, surgeries done,list of allergies, list of medications and contact information for yourphysician and family. What about home hemodialysis and travel? Mosthome hemodialysis patients get dialyzed in a local travel dialysiscenter at their destination, however some do travel in motor homes or goto campsites with electrical hook ups and are able to performhemodialysis. Information can be found at travelingdialysisRVassociation.com. What if I am on a transplant list?

Ifyou are on a transplant list kindly inform your transplant coordinatorabout your travel plans and give contact information. If you wish to be“on hold” during the trip, please do so if you cannot get back in areasonable amount of time.