Memorandum by British Airways Plc
INTRODUCTION
1. British Airways welcomes the opportunity
to submit evidence to the follow-up Science and Technology Committee
inquiry into air travel and health. The airline was a contributor
of both written and oral evidence to the original inquiry in 2000,
and was pleased to facilitate a visit by the Committee to the
British Airways Maintenance base at Cardiff Airport as part of
its research.
2. The health, safety and security of passengers
and employees are the primary concerns of British Airways. In
the year to 31 March 2007, the airline carried 33 million passengers
and employed 43,000 staff, including 18,000 pilots and cabin crew.
Over the same period the airline recorded 1,700 in-flight medical
incidents for which the crew sought the assistance of the MedLink
ground-to-air medical advisory service.
3. British Airways has always taken its
responsibilities very seriously in matters of health and safety
and provides active support to a number of independent and international
aviation medical organisations. We also work closely with industry
groups, medical professionals and regulatory agencies to ensure
we deliver the highest levels of care to our customers and employees.
The airline has long been a leader in innovation in areas to enhance
the health and safety of passengers and crew.
4. As we stated in 2000, we believe there
is little independent scientific evidence to support any view
that there is adverse effect on the health of passengers or crew
members from travelling in a pressurised aircraft cabin. The cabin
is the normal place of work of the 15,000 cabin crew members employed
by British Airways and we see no trends in sickness rates or causes
which would indicate a link.
SPECIFIC ISSUES
5. The information submitted by British
Airways to the original inquiry in 2000 remains relevant. We believe
the information given by HM Government in response to the same
inquiry also remains relevant.
6. We offer the following comments in response
to the specific questions posed in the Call for Evidence of the
Committee's Inquiry
What progress has been made in research into the
priority areas?
7. Deep Vein Thrombosis (DVT). Since
the Committee's original report, the World Health Organisation
(WHO) conducted a major study into the effects of air travel and
DVT. The WRIGHT study confirmed the belief that the risk of DVT
in air travel is due to prolonged seated immobility and that this
is no different to that found for other causes of prolonged immobility.
There is not a risk specifically attributable to air travel.
Research commissioned by the UK Aviation Health
Working Group (AHWG) also examined population attitudes to DVT
risk and the sources of information used. This led to recommendations
on consistent sources of information and use of terminology by
those providing information to passengers.
8. Cabin Air. Several recent studies
have been conducted into cabin air quality, including the European
Union's Cabin Air project and the United States' ASHRAE study.
Both have confirmed the results of previous studies that cabin
air quality is generally at least as good as, and often better
than, that found in domestic or office environments, other than
the known issues of low humidity and reduced level of air pressure.
The UK CAA is a participant in the EU Ideal
Cabin Environment (ICE) project which aims to build on the previous
research and deliver final outcomes and recommendations.
9. Contamination of cabin air. The
AHWG is addressing the concerns of a small number of individuals
and organisations about the possible acute and long term health
effects of contamination of the cabin air supply, particularly
on flying crew. The Committee on Toxicity (COT) is undertaking
a review of the existing evidence and the AHWG Research Sub-Group
is commissioning research this year to sample cabin air. The research
will also use new technology to try to capture data on an actual
contamination incident.
10. We consider this a very good example
of the collaborative work taking place within the UK of the AHWG,
with input from the aviation industry, the Trade Unions and several
Government Departments.
11. Evidence base. It will always
be possible to identify areas where further research would be
interesting and/or useful. However, there is little evidence that
air travel leads to adverse health effects and, therefore, little
evidence that research in this area should necessarily be a priority
for funding.
Have any new health concerns emerged?
12. Infectious disease. The SARS
outbreak in 2003 highlighted the potential role of air travel
in the global spread of infectious disease, in that those who
appear well but are incubating an infection can travel large distances
in a short time. In response to the outbreak, effective relationships
were developed at that time between the WHO, the International
Civil Aviation Organisation (ICAO) and International Air Transport
Association (IATA) to address the issues and provide guidance
on management of communicable disease in air travel.
There have been notable outcomes as a result
of the continued collaboration between WHO, ICAO and IATA. These
include recommendations for airlines and airports on planning
for pandemic flu; guidance for cabin crew, ground staff and cleaning
staff on the management of an incident involving a person with
a suspected communicable disease; revision of the WHO guidance
on "Air Travel and TB" and relevant aspects of the International
Health Regulations.
With regard to the retention of passenger's
information, British Airways has policy and procedures in place
to facilitate the provision of data and other support to the public
health authorities, based on the processes advocated by the WHO.
Cabin air contamination. See above
EFFECTIVENESS OF
AHWG
13. The AHWG has proved effective in bringing
together representatives of Government, the aviation industry,
airline staff and passengers in a forum in which issues relating
to air travel and health can be raised and discussed. The main
outputs have included the provision and exchange of information;
evidence reviews, the prime example being the COT involvement
in the contaminated cabin air issue; and the commissioning of
research.
14. The UK commercial aviation industry
is represented at the AHWG by two representatives, Dr Nigel Dowdall,
Head of Health Services for British Airways, and Dr Mark Popplestone,
Head of Medical Services for Virgin Atlantic. Both are also members
of the AHWG research sub-group.
International awareness
15. Since 2000, there has been a considerable
expansion in interest in air travel and health and also in collaboration
between the various groups. Examples of these include the establishment
of the European Civil Aviation Conference (ECAC) Airline Passenger
Health Issues Working Group, which brings together representatives
of the European Aviation Authorities with representatives of industry
(Association of European Airlines—AEA, IATA), flying crew
(European Transport Workers Federation—ETF, IFALPA), other
regulators (US FAA, Transport Canada, ICAO), and aviation medicine
(Aerospace Medical Association—AsMA); and the ICAO Air Passenger
Health Multi-Disciplinary Working Group.
16. Dr Nigel Dowdall of British Airways
is a member of the IATA Medical Advisers Group. In this capacity,
he was one of two industry representatives who contributed to
the revision of two WHO publications, namely `Tuberculosis and
Air Travel' and the air travel chapter in "International
Travel and Health".
Aircraft cabin environment improvements
17. The progressive replacement of ageing
aircraft with newer aircraft has led to incremental improvements
in cabin environment. For example, the highest efficiency HEPA
filters are the standard fit on all new commercial aircraft.
Aircraft manufacturers are continually seeking
improvements for their products. At this time, both Boeing and
Airbus are evaluating strategies—and any associated benefit—to
improve humidity levels. They are also exploring alternative sources
to engine bleed air for the cabin air supply and the potential
benefits of a reduction in the maximum operating cabin altitude.
In-flight medical emergencies
18. There is no evidence to suggest that
the JAA regulatory requirements for aircraft medical equipment
and cabin crew medical training are inadequate. Nevertheless,
British Airways and other airlines are continually working to
develop their equipment and training in light of medical advances.
Together with Virgin Atlantic, British Airways has jointly sponsored
research to confirm the efficacy of cardiac resuscitation using
an "astride" technique more suited than traditional
methods for use in the aisle of an aircraft.
19. Defibrillators have been installed on
all British Airways aircraft since April 2000, and are still carried
on all aircraft, together with crew trained in how to use them.
20. British Airways has used the MedLink
service since 1998 as the provider of advice on the management
of in-flight emergencies and also of "gate clearance"
before passengers embark. In the year to the end of March 2007,
we consulted MedLink on 1,700 in-flight medical incidents, out
of some 33 million passengers carried. During this period there
were 50 flight diversions for medical reasons, which is fewer
than 1 in 5,400 of the more than 270,000 services operated by
British Airways.
Information to Travellers
21. Most airlines provide health information
for passengers, particularly on their websites. Collaboration
between IATA and WHO in revising the WHO information on "Air
Travel and Health" and use of common sources of information
such as that on the AsMA website have helped to ensure consistency
of information and advice. In the UK, the Aviation Health Unit
of the CAA provides a focal point for passengers, media and other
interested parties.
22. British Airways has published health
information on its website since 2000. The comprehensive information
is found under the "Health and Well Being" page of the
information section of our website. This is complemented on-board
by our video and audio presentations and by well-being guidance
in the in-flight magazine High Life.
23. The website provides links to other
organisations and sources of information where relevant, and also
offers guidance on a range of medical conditions and compatibility
with flying. Our website advises customers with specific queries
about their fitness to fly to contact the British Airways Passenger
Medical Clearance Unit and for those with special needs to contact
our reservations team. Full contact details are given.
24. British Airways also provides information
to medical professionals through its Your Patient and Air Travel
publication. This is reviewed and updated regularly to ensure
it reflects the latest medical advice and information. In addition,
our in-house team of doctors and occupational health nurses frequently
contribute at conferences and post-graduate meetings. Dr Dowdall
was the co-author of the British Medical Association Board of
Science and Education publication The Impact of Flying on Health:
A Guide for Health Professionals published in May 2004.
Information for Crew and Employees
25. British Airways has conducted and/or
participated in several research projects in recent years, including
a flight crew mortality study. We have various means of identifying
and responding to issues of concern raised by our crew, through
staff forums; safety data collection and monitoring; and our in-house
occupational health service.
26. As with all commercial pilots of UK
airlines, our flight crew regularly undergo CAA medical examinations
with approved medical examiners to ensure they are fit to fly.
27. Detailed information on a range of health
issues is available to all employees on the airline's intranet
website, which also includes links to the main British Airways
health pages.
SUMMARY
28. British Airways believes there have
been significant advances in the area of air travel and health
in the years since the House of Lords Science and Technology Committee
published its report into the subject in 2000. The establishment
of the Aviation Health Working Group was a major factor in the
improving understanding of the issues and informing the industry,
consumers and Government public policy. It has led to the creation
of the Aviation Health Unit which provides timely and accurate
advice to Government on a wide range of health issues.
29. Several studies have been undertaken
into various aspects of air travel, in particular into DVT, and
these have helped to allay public and travellers' fears and misconceptions
about aviation. Information is more widely available and the medical
profession is better informed about the impact of flying on passenger
and patient health.
30. The safety and health of customers and
employees are vital to British Airways and to the wider aviation
industry. We welcomed the Committee's report in 2000 following
a thorough and extensive inquiry that sought evidence and comment
from acknowledged medical experts and aviation health professionals.
We hope and expect the follow-up inquiry to be of a similar standard.
June 2007
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