APPENDIX 4: SEMINAR |
Thursday 21 June 2007
Members of the Committee present were: Lord Broers
(Chairman), Lord Colwyn, Baroness Finlay of Llandaff, Lord Haskel,
Lord Paul, Baroness Perry of Southwark, Baroness Platt of Writtle,
Baroness Sharp of Guildford, Baroness Wilcox. In attendance were
Christopher Johnson (Clerk), Elisa Rubio (Clerk), Dr Cathleen
Schulte (Committee Specialist), Dr Michael Glanfield (Specialist
Developments and Progress in Research Since 2000an
Overview: Professor Michael Bagshaw
The Committee's report in 2000 stimulated a number
of research projects. The WRIGHT Project was commissioned by the
World Health Organisation (WHO) and partially funded by the Department
for Transport. Through epidemiological studies, pathophysiological
studies and interventional studies the project aimed to confirm
the association between air travel and venous thromboembolism
(VTE), quantify the strength of the association, identify culpable
factors in flight environments and identify and evaluate preventive
The main conclusions of the WRIGHT Project were:
- for healthy passengers the increase
in relative risk when flying was in fact lower than when travelling
on other forms of transport;
- "hyper-responders" seemed to react
to something in airplanes: if an individual had a risk factor
the likelihood of him developing VTE increased dramatically after
an 8 hour flight;
- the longer the flight, including multiple trips,
the greater the risk of developing VTE;
- travelling by air accentuated other VTE risks;
- immobility was an important factor;
- there was no difference in the relative risk
of VTE if the cabin pressure was reduced; and
- those who were very short, tall or overweight
were at slightly greater risk.
Fifteen organisations from seven European countries
participated in the CabinAir project. Questionnaires were sent
to the crew of 50 commercial flights and environmental measurements
were takensuch as cabin pressure, air and globe temperatures,
relative humidity and air velocity. The publication of the full
results was imminent but it was suggested that levels of measured
air pollutants were similar to other published studies and all
levels were below the recommended occupational health limits.
There were other research projects such as the Health
Effects of Aircraft Cabin Environment (HEACE), which studied the
impact on crew members working in the aircraft environment; the
Future Aircraft Cabin Environment (FACE), which focused on comfort
parameters inside the aircraft; the Ideal Cabin Environment (ICE),
which studied the combined health effects of cabin environmental
The Committee on Toxicity was reviewing the health
effects associated with contaminated cabin air.
Fitness to Fly: Dr Michael Glanfield
The change in passenger demographics meant that the
passenger age profile had changed and with it the level of fitness.
It was suggested that a significant proportion of serious in-flight
medical emergencies were related to existing medical conditions
and in most cases the flight environment was an aggravating factor.
The question was raised of whether if was reasonable
to allow everybody to fly and whether this was fair on passengers,
the airlines or travel insurers. Also, who should take responsibility
for the decision on who should be allowed to travel. Perhaps for
those passengers with existing medical conditions a separate cabin
class or separate flights altogether with a lower cabin altitude
could be made available with extra oxygen provided.
It was suggested that at present no single authority
was in charge of fitness to fly. Greater liaison should exist
between airlines, travel insurers, doctors and passenger interests
New Health Concerns: Raymond Johnston
Three health concerns were highlighted: cabin air,
infection and defibrillators. The ICE projectwhich had
completed all its measurements and was analysing datawas
unique in that it addressed health and well being. Early results
indicated that there was no cause for concern. The Committee on
Toxicity was also looking at the health effects of cabin air.
Their final statement was expected to be published on 3 July.
With regards to the spread of infection the major
concern at present was over pandemic influenza. The world currently
stood at stage 3 of the WHO pandemic phases, with sporadic cases
of H5N1 in humans, but no confirmed human-to-human transmission.
Should the virus mutate, and sustained human-to-human transmission,
the precursor to a global pandemic, be identified, there were
already national contingency plans in place, which covered aviation.
Anonymous statistics were presented from three airlines,
including a charter airline, which showed that the number of survivors
of cardiac arrests when defibrillators were used was very low.
An airline which carried an average of 4 million passengers a
year had 6 cardiac arrests in a four year period. On 3 of those
occasions shocks were given using defibrillators. None of the
passengers survived. However pooled data and standard protocols
were needed from all airlines.
Aviation Psychology: Professor Helen Muir
The longest current direct flights were between 15
to 18 hours covering around 8,000 miles (e.g. New York to Singapore).
The question was raised whether on very long journeys (e.g. London
to Australia) a quick stop over was enough.
A number of factors should be taken into consideration
with the design and configuration of very large transport airframes
(VLTA) such as the A380, B747 and the blended wing Boeing (which
was at the prototype stage):
- Seat design and space: it was
difficult for one seat to fit all passengers;
- Location and size of exits;
- Aisle width: this was largely a comfort issue
as it had not been shown to be a factor in emergencies;
- Distance to toilets;
- Stairs: in particular internal stairs and how
they are not supposed to be used in emergencies;
- Cabin atmosphere; and
- Emergency evacuation slides: the height of the
upper decks of VLTAs meant there was a risk of vertigo at the
top and injury and congestion at the bottom of the slides.
A number of passenger stress factors were mentioned
such as claustrophobia and the behaviour of other passengers.
Also highlighted as concerns on VLTAs were precautionary evacuations,
the spread of fire, cabin crew communications and terrorism.
The Regulatory Framework: Dr Sally Evans
The International Civil Aviation Organisation (ICAO)
was a UN organisation based in Montreal. It was charged with coordinating
and regulating international air travel by establishing rules
of airspace, airplane registration and safety. It had 190 contracting
states. ICAO's current interests were cabin air quality, water
and food hygiene on board, contingency planning to prevent the
spread of disease and medical supplies on board.
The European Aviation Safety Agency (EASA), based
in Cologne, was gradually absorbing all functions and activities
of the Joint Aviation Authorities (JAA) and would assume competence
for pilot licensing (including medicals) and operations and safety
of third country aircraft in 2010.
The Civil Aviation Act 2006 gave the CAA the new
function of safeguarding the health of persons on board aircraft
and therefore the Aviation Health Unit (AHU) had been set up.
It provided reference data on aviation health matters and encouraged
and monitored research.
A lot of new research had been and was being carried
out on VTE, most of which was stimulated by the Committee's original
inquiry. Incidence of VTE appeared to be the same in 2007 as it
was in 2000. Phase 2 of the WRIGHT project would address the unknowns
of phase 1 and would also look at effective interventions. All
major airlines had introduced information in their flight magazines
and some offered advice on health to passengers over the tannoy
system as part of the security briefing before take off. It was
noted that 25,000 people died of VTE each year, mainly in hospitals
for example following surgery, and the numbers of deaths during
or following a flight were tiny in comparison.
Most aircraft accidents were unreported in the media
and occurred during take off or landing. The most frequent type
of accident occurred when an aircraft overran the runway. Effective
evacuation measures were imperative. Some 95 percent of aircraft
accidents had survivors.
The UK was at the forefront of the world in dealing
with health issues and should be proud of the way the Aviation
Health Working Group (AHWG) had brought together the Government,
the airlines, manufacturers, unions and health professionals.
It provided an interface with the air transport industry and other
interested parties on issues relating to aviation health.
The number of UK registered aircraft with HEPA filters
had increased as a direct result of the 2000 report. The CAA had
responsibility for checking that the filters were maintained regularly
as part of the general maintenance schedule. There were regular
Nine pilots out of 1,500 members of the Independent
Pilots Association had either lost their licenses due to health
problems or were under investigation. There were no protocols
when dealing with crew who complained of having suffered a contaminated
air event. There was agreement that such events did happen, but
whether they produced long term ill effects needed to be studied.
Symptoms reported were non specific and covered broad spectrum;
therefore it would be very difficult to undertake an epidemiological
study. Some research projects had measured background cabin air,
new studies were needed to measure cabin air during a "fume
event", which to date had not yet been achieved. The AHWG
was testing measuring devices in conjunction with the Federal
Aviation Administration, but the technical challenges of capturing
a short-lived "fume event" were still to be solved.
It was noted that during the SARS outbreak the infection
was not spread by droplets. It was transferred by people touching
infected surfaces. Cross-infection was more likely to occur through
direct passenger to passenger contact, either at the airport terminal
or during the flight, than as a result of air travel generally.
With regards to emergency medical equipment on board,
it was noted that the standards had not changed since 2000. IATA
was the body responsible for making recommendations about the
equipment on board. Such recommendations were regularly updated.
In general, low cost airlines carried only the statutory minimum
equipment while big airlines exceeded the minimum requirements.
Andrew Ashbourne, Civil Aviation Division, Department
Professor Michael Bagshaw, Professor of
Aviation Medicine, King's College London
Tim Bamber, NEC Member, British Air Line Pilots Association
Dr Sally Evans, Chief Medical Officer, Civil
Peter Jackson, Director, Independent Pilots Association
Dr Ray Johnston, Aviation Health Unit, Civil
Hanna Madalski, Government Advisor, Airbus
Captain Sandy Mitchell, Chairman of Flight Safety
Group, British Air Line Pilots Association
Professor Helen Muir, Professor of Aerospace
Psychology, Cranfield University
Dr Mark Popplestone, Head of Medical Services,
Virgin Atlantic Airways
Sandra Webber, Head of Civil Aviation Division, Department
Dr Ursula Wells, Policy Research Programme,
Department of Health