Avoiding important carry-on luggage being taken away

The other answers provide excellent advice, so I will add only one additional, albeit important, piece of information.

In some jurisdictions, airlines are required by regulation to allow passengers to have access to medically essential items. Some jurisdictions even require security to hand-inspect such items instead of putting them through X-ray with everyone’s shoes.

Many years ago, I had to travel with a piece of essential medical equipment. I found the applicable laws/regulations and printed them out. I laminated them and brought them with me.

I contacted the airline well in advance and notified them I would be traveling with this equipment. I performed this advanced notification both in writing and verbally.

I also met with a medical specialist to learn how to fully disassemble the equipment so it could be thoroughly inspected by security. Medical equipment is not exempt from inspection, but does often require special handling (and if security is good, it will actually involve a more thorough inspection).

When I arrived at the airport, I was prepared to politely, but firmly assert my legal rights if needed. I also a backup plan if I was unable to board with my equipment. To my pleasant surprise, security and the airline were both familiar with the laws, and I didn’t have to do anything special.

I showed security my equipment and asked for a clean table so I could perform the equipment disassembly. I brought clean gloves for myself and security. Security and I spent about 10 minutes performing disassembly and completing their thorough inspection. They then affixed a special tag (with a tracking number) that indicated the device was authorized medical equipment.

The plane was full, but the flight crew saw the special tag. They verified the tag’s validity and then ensured the equipment would be close by at all times. They also informed me to press the "attendant" button if I needed any help.

In summary, it took a significant amount of effort and preparation, but everything went well. Of course, I was quite fortunate to encounter well trained, courteous, and respectful staff members.

I live in the US and travel to the Philippines quite often. I try to travel light taking my clothing in a small suitcase which is carry on size. I put everything I need, like my medications, in a backpack. I also put things I do not wish stolen in the backpack also. Just be prepared to remove laptops and cameras from the backpack when going through security. Sometimes I need to gate check the small suitcase, but have never been asked to gate check the back pack.

Whenever I travel I use a 2-bag system.

This corresponds to the rule at most airlines, which allows a small and medium size carry-on.

• The small bag is well within the standard for the smallest carry-on they allow (sometimes called a "hand bag" or "personal item"). They generally expect you to put this under your seat. This gets anything that CANNOT be lost: iPad, medicines, papers, USB sticks, etc.
• The medium bag complies with the full carry-on bag size. They generally expect this will go in the overhead bins. It contains the more routine stuff that I am willing to lose. Just common traveler stuff – clothing, toiletries, etc.

So you seem to be asking "how do I force them to let me keep my medium bag in the cabin?" And my answer is, "You can’t. That’s why you have a small bag".

They are vanishingly unlikely to force you to gate-check such a small bag. If you have a seat that is not first-row or exit-row, you have a guaranteed place for it "under your seat" (really: under the seat ahead of you). If you foolishly booked a front-row or exit-row seat (don’t), it’s a small bag, and people load overhead bins sloppily, so there’ll be no trouble finding a space for it. (they know that).

Any valuable medical equipment I need the night I land, that goes in the small bag. Period.

As far as medicines, always carry your medicines through security and Customs in their original pharmacy-issued bottles, because that helps a lot if you are inspected. But, right after inspection, here’s a trick you can do to let you carry the bulky bottles in the medium bag. How many days would it take to get to a clinic/hospital and get new prescriptions if you lost your meds? X days? OK… while waiting, move X days’ supply of pills into Ziploc bags that you brought (1 per pill type). Put the Ziploc’s in the small bag.

Now, a word on that tag in your photo.

If you look closely at the tag, you can barely see it is perforated just above the second "Lufthansa". It’s meant to be broken at that perforation. The outer one is the "stub" or "chit" you hold to claim it. If you leave both halves on the bag, then you have no proof of ownership. You should have taken that, or they should have given it to you.

My wife was disabled and had lung cancer, but we traveled none the less. As you can imagine, medical emergency kit and mobility kit got relatively big. What worked for us was:

1. Split the kit into a smaller bags so if big bag was too big, we could just take out smaller ones and fit them into places, like emergency painkillers and anti inflammatory here, stuff to fix her prosthesis there.

2. Set some things as "lower priority emergency", like crutches, and ask cabin personnel to keep it with them if we couldn’t fit it near us,

3. Always contact an airline first to make sure they know about it. Airlines were always OK with us when we let them know beforehand.

4. Go to the gate staff as soon as they appear on the gate to remind them that airline told us it was OK with them.

My better-3/4 has essential medication, so for a situation like this will have the bare-minimum in a tiny pill container in a pocket or attached to a key ring.

This could be difficult if your minimum is physically large, in which case I’d suggest a "belt-bag" or "fanny pack" trying to keep it as small as possible. Ideally it would be "clothing" rather than something classed as a separate bag.

You might choose to have a specific comfortable "travelling shirt" which has a large pocket for your must-have essential next-dose, but nothing more.

If the medication has a best-before or use-by date, remember to regularly rotate it.

I have similar needs. What I always do is pack my medication in a smaller bag (a tote bag, a purse, even a plastic bag will do), which I can quickly take out of my carry on luggage. It’s small enough that it will fit under the seat in front of me (while keeping enough space for my feet), or even in some free corner in overhead bins. I could even keep it on my lap if necessary (not the most comfortable, but better than not having it with me).

I also often pay to upgrade my seat — this often comes with the perk of earlier boarding which means the overhead bins aren’t full yet. (Of course, this doesn’t help if all carry on luggage is checked in, even before the bins fill up).

The main reason for gate checking with delivery at aircraft is simple: It’s a small plane and standard carry on sizes don’t fit in the overhead. There isn’t a whole lot the crew can do about it: if it doesn’t fit, it doesn’t fit.

What can I do to ensure that I am allowed to carry my carry-on luggage into the cabin?

1. Pack the medical items in the smallest container possible
2. Make sure this container meets the carry on size requirements for this specific aircraft
3. Avoid aircrafts that don’t accommodate your medical items.
4. Buy extra baggage allowance for your other stuff, if you have to.
5. Consider buying early boarding privileges to make sure there is overhead space available.
6. Have a doctor’s note that clearly states that you need access to these items at all times.

There are multiple possible reasons for cabin luggage to be gate-checked.

• The most common is that the aircraft is full and they know they won’t be able to store all hand luggage in the overhead lockers or under the seat in front of each passenger. Some airlines make it quite explicit, giving two size limits, a smaller one (matching the under-seat space) which are guaranteed to be able to taken on board with you, and a larger one which will be allowed space permitting.

  This case happens mostly on the larger single-aisle planes, such as the A320 family and the B737 family.

• The other common reason is that you are flying one of the smaller aircraft types, where overhead space is even more limited than usual, and none of the larger roll-aboard type bags will ever fit. In that case they will gate-check bags which won’t fit under a seat in all cases (usually happens at the foot of the aircraft, on the apron).

  This applies on smaller planes usually called “regional” airliners, such as BAe 146, Avro RJ70/85/100 and similar types. Probably the same for Embraer 190/195 and Bombardier CRJ900 used by Lufthansa regional partners, but I’m not familiar with them. Don’t remember the situation on the ATR 42/72, haven’t flown one of those in a while.

There’s also the case of some airlines which will allow the larger type only if you pay extra.

In all cases, if your bag fits under the seat in front of you, it will be allowed in the cabin. So the easy answer is simply to make sure that your bag is the right (smaller) size.

If you need a larger carry-on for non-essentials (clothes etc.), check airline policies:

• Some will allow two bags (or one bag and one "personal item", which has the smaller size limit), so you can have the smaller one with essentials which you’ll be able to have in the cabin, and a larger one which may or may not be allowed, depending on circumstances (aircraft type, how full the flight is…).

• Others only allow a single bag. In that case, make sure inside your larger bag you have all your essentials in a smaller bag you can easily take out if your bag is gate-checked.

In situations where it’s a matter of available space, boarding early will often help. Some airlines will proactively gate-check any large bags from start of boarding if they know they won’t be able to fit everything, but most will let you board until the overhead lockers are full. Boarding early will often require paying extra to be in one of the earlier boarding groups, but even within each group, being the first to board can help a lot.

Note that hand luggage allowances (number and size) vary not only from one airline to another, but also sometimes depending on the fare or options purchased.

If your medical equipment is too large to fit in the smaller size, then you should contact the airline at time of booking.

When they try to take your in flight case away from you, do NOT let it go and say ‘medical’ and ’emergency’ and words like that.
If you know the staff understand a language you speak, use it in whole sentences, explaining your need to have the stuff with you.

I might pack a thin foldable bag inside and when they insist on taking the case, open it up and stuff all you need into that bag, and go on till all, really all, you might need is in that small bag. And as you can not pack that bag as carefully, it may well end up bigger than the carry-on case.
That is your inflight needs and medication for the time after you land, for about 2 weeks or so.

It is your right to have needed medical items with you on the flight.

It helps if you are early at the gate and tell the gate staff when you first can that you need most (or all) in your carry-on case in case of medical emergencies.

And if you do see the check-in staff, ask if they have a tag for ‘needed medical equipment’ to add to the bag, or an ‘allowed on board’ tag, as sometimes they have something like that.