AIr Plane Travel - Factors which Affect Health & Safety

Travel by air is an essential method of travel in today's world. However, there are concerns that have been raised concerning how travel may affect health, especially for those individuals that use airplane travel on a regular basis. People such as frequent fliers. pilots, and flight attendants and frequent fliers are at a significantly increased risk. Even people who fly infrequently. have exposure to possible threats to their health. Research References (Air Risk Factors)

Risks to Health

(1) At the Air Terminal

• Air Pollution / Stress & Anxiety / Radiation

• FACTOR: Airport terminals are a source of harmful air pollutants from heavy car traffic as well as the  engine exhaust and wear residue from airplanes.
• AIR POLLUTION. The airport is the center of activity for vehicular traffic (cars, trucks, buses) and hundreds   of flights taking off and landing. Cars emit particulate exhaust emission, while airplanes emit turbine engine exhaust as well as particulate wear residue (from brakes and tires)¹ Quantification of air pollutants was performed in an airfield adjacent to a passenger air terminal, which showed that particulate matter corresponded to aircraft activity. Air pollutants included harmful carbon dioxide (CO(2)), nitrogen oxides (NO(x)), benzene and black carbon² This includes aircraft ground idle, thrust takeoff and in-flight.³

• General Air Pollution (Benzene) - a pervasive hydrocarbon in fuels, turbine engine emissions, cleaning solutions, and other sources. A known carcinogen with high association to the development of leukemia.¹⁷  
• Airport environments are a high source of air pollutants containing benzene (from car. truck and aircraft turbine emissions)
• Benzene is classified as a Hazardous Air Pollutant (HAP)
• Benzene is a mutagen and can cause damage to DNA.
• Primary method of intake into the body is through inhaling air with benzene as a hazardous pollutant.
• Emissions from aircraft turbine engines are a high source of benzene (in addition to other hazardous air pollutants). 
• Air pollutants from turbine engines represent a significant concern both on the ground (at the terminal) and during flight.
• AirPlane Exhaust - In a recent report, airplane emissions are reportedly responsible for 10,000 deaths a year. While previously thought that most emission pollutants occur during take-off and landings, it is now understood that MOST AIRCRAFT EMISSIONS OCCUR AT ALTITUDES OVER 3,000 feet (including sulfur dioxide and nitrogen oxides). These are very small pollutants, which are tiny enough to insert deep into the lung and into the bloodstream.¹⁸

•  Cockpit Air Pollution (Chemicals and air pollution may also enter the cockpit and cabin from internal or external sources). At times, the engine compressed air (about 50% of cabin air), may be contaminated with engine oils or fluids. Normally, this is due to a faulty engine seals⁴.  - see AEROTOXIC SYNDROME below. At high altitudes, increased ozone levels in many planes can also impact respiratory function.¹³

•  FACTOR: Stress & Anxiety. The whole experience of air travel is normally very stressful and raise anxiety levels. Standing in lines, rushing to  catch a flight, going through    security checkpoints (removing belts, shoes, computers) is stressful and not conducive to health. Stress increases cortisol (stress hormone levels), which in turn increases blood sugar levels. The result is increase in systemic inflammation, which negatively affects the body and brain.  Stress & anxiety also depresses the immune system - which can lead to greater risk of infections.

•  FACTOR: Radiation.
• Full body security scans. While the amount of radiation is very small form these devices and is believed to represent no more than 1% of total radiation exposure from a 6 hour air plane trip (99% being while at high altitude), the long term effects are unknown. Also, since radiation effects will be additive, the small amount at screening should still be considered for potential health effects.
• EMF, Cell phone and Wi-Fi usage. Large numbers of cell phone and wireless users inside the terminal radiate microwave EMFs. Key considerations for degree of exposure include power of the device(s) and distance. The closer and more powerful the microwave emission the more danger to health.

(2) In the Cabin of the Airplane

 AEROTOXIC SYNDROME

• FACTOR: Aerotoxic syndrome describes the toxic chemicals and.or odors which enter the cabin and which can have short-term and long-term health effects on the flight crew and passengers. There are many potential sources of chemicals entering plane, but the foremost and most serious, is the compressed air from the engine, which provides air to the cabin. Air in the cabin is normally a 50% mixture from compressed engine air and 50% recycled air via HEPA filters. However, all of the cabin air originates from the engines of the jet. Over time the seals that prevent the entry of engine oils may wear down, resulting in leaks that enter the air system. In addition to being in the air, the contamination fumes may also leave substantial residue inside the cabin.

               Suspected Health Incidents Relating to Air contaminants in the cabin               

• In late 2012, a coroner investigation into the death of an airline pilot reported high levels of organophosphates in the pilot's body. The coroner indicated concern about "the presence in his body of organophosphate toxins that are present in aircraft cabin air".
• Other suspected incidents of air contaminants reportedly caused severe sickness in pilots and flight attendants.  

                How can you detect if there is a compressed air contaminant leap into the cabin?

• According to a report by The Telegraph ⁴, a small leak will smell like sweaty socks, wet dog or vomit.
• Larger events (termed an "event fume") will appear as a blue haze or smoke.
• There are no sensors which will detect these chemicals in modern aircraft.

                 Why is the engine jet oil so toxic (in the compressed air)?⁵

• Jet engines operate at extremely high temperatures, requiring synthetic chemicals as the oil. 
• Also - additives include toxic organophosphates as antiwear agents and other aromatic hydrocarbons as antioxidants
• Due to the high temperatures, some of the oil constituents become partially decomposed
• The contaminant fumes which enter the cabin are a combination of the synthetic oil, additives and decomposition intermediates.
• It is believed that the additives and decomposition intermediates present the greatest hazard in terms of toxicity^.
• All planes (including turboprops) are subject to the problem of toxic fumes from engine air.
• Note: The new Boeing 787 Dreamliner does not have this problem, since air is drawn from the atmosphere not the engines.

                  Sources of air contaminants inside cabin    (UK based Committee on Toxicology (COT)) 

• Air supply system (via engines compressed air) - engine oil, hydraulic fluid an other contaminants
• Under floor hydraulic leaks / Ingestion of deicing fluid into APU inlet.
• Periodic maintenance task that is required to clean the forward galley oven.
• Inappropriate or excessive use of dry ice by caterers.
• Toilet fluid spillage, leakage and also unapproved mixing of different disinfectant fluids within the toilet.
• Leakage of the rain repellent system, or rain repellent contamination within the cabin or flightdeck.
• Spillage within baggage bays / Items stowed in overhead baggage bins

                    Frequency of events.

• According to a report from COT (2007), air "fume events" happen 1 in every 100 flights.

                    Is this a major concern?

• Note: Most airlines deny that there is a problem with cabin air contamination. However, the International Transport Workers’ Federation says there is growing evidence of the toxicity of the oil fumes .

IMMUNITY & GERM EXPOSURE

• FACTOR: The interior of airplanes are not cleaned as often as one might think. Notably, during a long flight, cleaning is not a priority, and any existing germs or acquired germs during the flight will be present. So there is the potential for picking up germs on the headrest, touching the back of the seat while walking down the aisle, or other surfaces.

• Airborne germs. While most aircraft filters the air using HEPA air filters, which can remove most germs (including viruses), the close proximity of passengers still present possible routes of airborne germ transmission (via air droplets). Therefore, while HEPA filters reduce the spread of airborne pathogens in recirculated air the threat is not totally eliminated.
• On contact germs. Most areas of the airplane are not disinfected, therefore it is possible to acquire disease causing bacteria or viruses from merely touching the affected item. For example, magazines (in the seat holder), tray tables, seat belt buckles, toilet (door handles, sink, seat). blankets and pillows (even bagged). USA Today reported that the most significant problems areas include: chair upholstery, seats, the tray table, the armrests and the toilet handle, where bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and E. coli can live for up to a week on airplanes that aren't properly cleaned.⁶
• Suggestion: Cleaning an area before touching surfaces such as the armrest, tray table and door handles (using disinfectant wipes) will help to reduce exposure. However, some areas such as the cloth seating or other fabrics can be difficult to clean.

• FACTOR: Dehydration / Low Humidity. The airplane cabin is very low humidity (normally 10-20% humidity). This tends to dry out pulmonary system which increases the risk of airborne infection. Proper hydration in the air requires adequate water intake and minimizing alcohol consumption

 (3) Preparing for take-off

 STRESS & ANXIETY

• FACTOR: Once everyone is boarded, which itself can be stressful, the plane may not take off for an extended period of time. First it must push away from the gate, then (depending on traffic) sit in line for take-off.  

• Stress. It has become more common for a plane to pull away from the gate then sit on the tarmac for what seems to be forever. Gradually the stress of everyone on the plane gets quite high.
• Anxiety. Anxiety is the result of uncertainty. Uncertainty levels can be high in air travel. Whether it involved uncertainty involving safety, turbulence in the air or delays involved with the plane, anxiety can reach high levels.
• Unsanitary & Heat. If the plane sits for hours, the situation may not only increase mental stress but create unsanitary conditions with the overflowing toilets and possible extreme heat inside the cabin. 

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