Examination of Witnesses (Questions 60-79)
Dr Nigel Dowdall, Dr Mark Popplestone and Mr Roger
Wiltshire
26 JUNE 2007
Q60 Lord Haskel: Coming to the matter
of a pandemic of influenza, are there any contingency plans to
deal with an outbreak? If you know that an outbreak has occurred
do you have contingency plans to deal with it so that there is
a routine which just goes into operation?
Dr Dowdall: Any airline that does not have contingency
plans is somewhat remiss for its shareholders, because for us
it is a business continuity issue. In terms of what we should
all be doing, International Civil Aviation Organisation, International
Air Transport Association and the WHO had a meeting a couple of
years ago in Singapore where they developed protocols and guidance
for airlines, for airports, and those are published and made available.
Certainly most of the major airlines have taken that on board
and have developed their plans and are clearly working in conjunction
with their other business partners, government agencies and so
on. It is certainly happening in the UK, where the CAA Aviation
Health Unit is the focal point for the liaison between airlines
and airports and the Department of Health, the Department of Transport,
etc, in pandemic planning.
Q61 Lord Haskel: Have these plans been
tested? Do we know that they work?
Dr Dowdall: There have been a number of exercises.
The Government has run exercises. My own airline is planning on
exercising our plan later this year.
Dr Popplestone: Virgin Atlantic took part in
a recent exercise run by the Department of Health and, yes, we
run regular contingency planning exercises. We have a working
group within the airline. You gain information on contingency
planning because it is a business threatening problem. But in
everything we do we try to work with the Department of Health,
to work with the Government Health Protection Agency. The other
complicating factor, of course, is that we have to interact with
the public health authorities of many different countries around
the world as well, but we do what we can to try to make sure that
all things are compatible with that.
Q62 Lord Haskel: The staff play a
part in this. They know how to deal with the passengers.
Dr Dowdall: In terms of passengers, pandemic
flu is no different from any other contagious disease, so, yes,
part of our training is for staff. Again, IATA has produced guidelines
applicable to cabin crew, to ground staff and, indeed, to cleaning
staff for how you manage an incidence of suspected communicable
disease. Of course, on board the aircraft, you just get someone
who has symptoms, so they maybe have a fever and a cough, and
there are guidelines and procedures for how you manage that, how
you alert the public health authorities on the ground. So there
are some procedures that are in place all the time and then from
the airline point of view we would make specific plans in relation
to a possible pandemic.
Q63 Earl of Selborne: When airlines
are procuring and commissioning aircraft, do the chief medical
officers of the airlines get to make a contribution on cabin configuration
or seats and such like?
Dr Popplestone: I was due to be meeting our
head of design today, but I am here instead. There are a lot of
factors that are involved in new aircraft design, new seat design,
new cabin design which will involve weight, comfort, general company
ethos and whatever. Up until recently Virgin did not have a dedicated
chief medical officer or head of medical services but they did
through very informal arrangements get involved with the design
team. With the arrival of me in the organisation, it is now something
that we are looking at building on, to try to make sure there
is a medical contribution to the design process. The driver in
putting in any sorts of seats onboard an aircraft, goes back to
what Dr Dowdall was saying earlier on, that it is comfort, and
airlines compete quite fiercely on comfort. In general terms,
if it is going to be comfortable, then there are not going to
be many adverse implications to deal with. One has to be careful
that you do not put some sort of design amendment in that you
believe may reduce the incidence of DVT but which may have an
unintended consequence of not achieving that. Certainly we do
try to work with the design team to make sure there is a medical
aspect to it.
Q64 Earl of Selborne: Would you be
able to make a contribution, for example, in the seat chosen by
the airline? Some are clearly going to have more medically adverse
pressure points than others. Would that be a view that you would
be able to take?
Dr Dowdall: We could certainly contribute to
that, yes. Absolutely. It would take all factors. As I said, it
is one of the many aspects of designing a seat or a cabin. Yes,
if we felt something was going to be detrimental to an individual's
health, then we would certainly have the opportunity to say it
and I believe within my organisation it would be taken on board.
Q65 Earl of Selborne: Is there any
evidence which shows that one airline seat is better than another
in terms of pressure points?
Dr Popplestone: There is industry-wide data
that compares passenger comfort and passenger satisfaction with,
dare I say, Virgin's economy cabin, British Airways, American
Airlines. The airlines can compare with each other to see how
they are seen compared with competitors.
Mr Wiltshire: Of course when an airline introduces
a new cabin configuration, it often tests that out with passengers
or with travellers and asks them to trial the seat. The seat manufactures
do the same thing. These are not products that have suddenly appeared
on an aircraft without being assessed in terms of their perceptions
of comfort, their real comfort and other factors as well. Airlines
obviously have a great interest in satisfying what their consumers
want and obviously seat comfort is one of those aspects.
Dr Dowdall: I think it is important to recognise
that in terms of seat design health is almost an irrelevant issue,
in that seat comfort is not an objective measure, it is subjective:
there are many different body shapes and, as you know, with any
seat design some people will find one seat comfortable and not
another, for somebody else, it is the other way around. I do not
think, in terms of health contribution, there is or should be
a major input these days from an airline medical department. I
think we can have a role, and an example I would give would be
when British Airways introduced the rearward facing seats in business
class. There were concerns about how that would affect people's
physiology and how people would react to that and what we needed
to do about the "brace position", as there is a different
position facing backwards from when you are facing forwards. Then,
yes, our department was involved, because those were issues where
it was felt that our knowledge of aviation medicine could make
a contribution.
Q66 Lord Howie of Troon: With regard
to this long-haul configuration, what consideration was given
to the problem of someone in an inside seat stepping over someone
in an aisle seat to get to wherever they wanted to go?
Dr Dowdall: From a health perspective, other
than the fact that people can get fairly irritated if they keep
getting kicked, I do not think it is a health issue. It is about
what is commercially viable, what will passengers accept, what
will make them choose one airline over the other? If you were
to give people the choice between sitting in a leading-side seat
or sitting in a seat that had much more leg room, they clearly
would choose a lot more space, but economic factors come into
it, so I think if you said: "Is the three-abreast reasonable
in terms of the space?" then yes.
Q67 Lord Howie of Troon: This configuration
was presumably tested with real people climbing over each other.
What sort of reaction came back from them about that specific
detail?
Dr Dowdall: I know those seat configurations
have been around for far longer than I have been in the industry.
I do not know if Roger can comment.
Q68 Lord Howie of Troon: For how
long have you been in this business, then?
Dr Dowdall: I have been in aviation medicine
for 30-odd years. I have been with British Airways for 11 years.
I am sorry, are you talking about the business class seat.
Q69 Lord Howie of Troon: Yes, where
you climb over each other.
Dr Dowdall: I think it is commercial trade-offs.
Our new configuration aims to reduce the number of seats where
people do have to step over.
Q70 Lord Howie of Troon: I think
of Lady Thatcher. She would put her handkerchief over.
Dr Dowdall: I think, from a customer satisfaction
point of view, our business class cabin is very highly regarded.
Q71 Baroness Finlay of Llandaff: Is
there any data on a lower number of medical emergencies, particularly
DVTs, from flatbed seats versus seats which maintain an incline
all the way through the flight?
Dr Dowdall: We do not have any data on in-flight
DVT because it is impossible to diagnose.
Q72 Baroness Finlay of Llandaff: I
was thinking about medical emergencies which occur. I wondered
if you had collected that data.
Dr Popplestone: I do not think that is broken
down. We do not get that data.
Dr Dowdall: The numbers would be so small that
it would be very difficult to draw any significant conclusions
from them.
Baroness Finlay of Llandaff: I would have expected
a health benefit, but there we are.
Q73 Chairman: At the time of the
original inquiry, most of the anecdotal evidence received was
from members of the public with regard to DVT. This time around
half of the anecdotal evidence we have received is from pilots
and cabin crew concerning fume events inside aircraft and, in
particular, in the cockpit. What action are the airlines taking
to meet concerns expressed by pilots, unions and others on this
issue?
Mr Wiltshire: There have been some fume events
on certain aircraft historically. These events have all been investigated
by the airlines and by the regulator, and, where appropriate,
technical modifications have been made if a technical issue has
been discovered. We have no evidence to suggest that there is
a serious medical problem here but we are very much involved through
the Aviation Health Working Group and the research that will now
be taken forward by the Department of Health, COT, and the sampling
of air in aircraft. We will continue to assist the authorities,
the regulator and the Government with that to see if there is
a problem here. The industry does not see any trend or a particular
issue here as far as health is concerned but we are working closely
with those who are doing further research.
Dr Dowdall: From a BA perspective, safety is
our number one priority. We have always taken fume events seriously.
If reported, these events are always investigated. The concerns
about health are relatively new, from a relatively small number
of individuals. We have looked at the evidence. From the evidence
that is currently available, I do not see anything convincing
that there is either a significant short-term or long-term impact
on health, but, having said that, we also recognise that the evidence
is incomplete. One of the particular difficulties we have had
is that, although we can sample cabin air during normal operation,
events of contamination are infrequent and unpredictable and there
has not been the opportunity, the suitable equipment, to capture
an event and analyse exactly what it is the crew may be exposed
to. I do not have any evidence that there is a health problem,
but we are interested and supporting the work of the Aviation
Health Working Group in investigating the concerns and we are
actively investigating the concerns. As Roger said, there is ongoing
work to look at that.
Q74 Chairman: It has even been suggested
that fume events are grossly underreported because pilots fear
for their jobs. Do the airlines keep records of fume events? You
have mentioned that but can you be confident of the integrity
of the figures?
Dr Dowdall: With any reporting system you will
never get 100% reporting. I think we can be very confident that
the more serious events will be reported. As they get more and
more minor, individual pilots will have a threshold both for detecting
smells and for reporting them. I am very clear that in British
Airways we have a very open reporting culture: we encourage reporting
and we take those reports serious and they are followed up and
investigated.
Q75 Chairman: Have there been cases
where there have been fumes in the passenger compartments and
the public has complained?
Dr Dowdall: I have spoken to our customer service
people and it is not an issue that customers report or complain
to us.
Mr Wiltshire: There have been one or two specific
incidents, several years ago, of aircraft where smoke appeared
in both the cabin and the cockpit. Those events, as I said earlier,
were fully investigated. They become incidents that are fully
investigated by the authorities and any technical issues resolved.
But these events were very small in number and there has been,
as far as I understand, no trend of those events increasing. In
fact, they tend to have reduced a bit recently.
Q76 Chairman: Will you or have you
made the data that you hold on aircrew health available to assist
in the AHWG-sponsored research into the health impacts of toxic
air?
Dr Dowdall: I am not sure what you mean by information
we hold on aircrew health.
Q77 Chairman: We are aware that a
number of pilots have complained. Some evidence we have heard
has suggested there have been 27 cases or something of that order,
so you must have received these complaints or concerns and the
question is whether you have reported the data you have on those
concerns to the group.
Dr Dowdall: For confidentiality reasons, we
clearly cannot talk about individual pilot's medical conditions.
We do not have any evidence that links fume events to illness.
In that respect, we have not because we do not actually have any
evidence. We are aware of particular individuals who believe that
their health has been affected but belief and reality ... We do
not say there is not a link; we just say we do not have evidence
that suggests that there definitely is a link. We are keen to
continue with the work and the research. The Committee on Toxicity
(COT) are looking at all the available evidence and there is a
whole raft of information that is available. We provide all the
information we have, the aircraft manufactures, the engine manufactures,
the oil companies, have all cooperated in providing information
and evidence to the Committee on Toxicity in their review of the
evidence and, as Roger said, we are working with the Aviation
Health Working Group on trying to put in place some research that
will answer some of the questions where we do not have the evidence.
Q78 Lord Patel: Are the fume incidents
easy to identify?
Dr Dowdall: There is a percentage of incidents
where, yes, you find an underlying fault and you are able to correct
it.
Q79 Lord Patel: If you are in the
cabin of an aircraft, are fume incidents easy to identify?
Dr Dowdall: The human nose is very sensitive
and most of these incidents involve volatile organic components.
Yes, people are able to detect very low levels of compounds.
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