Aviation Health Working Group minutes: 18 November 2005
Aviation Health Working Group # 34
18 November 2005, Great Minster House
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Present |
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Chair |
Sandra Webber |
DfT/ACCD |
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Secretary |
Grace Hansford |
DfT/ACCD |
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Peter Smith |
DfT/ACCD |
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Abimbola Alli |
DfT/ACCD |
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Andy Freeman |
HSE |
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Dr Annette Ruge |
CAA/AHU |
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Tim Williams |
CAA/SRG |
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Steve James |
CAA/SRG |
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Cliff Barrow |
CAA/SRG |
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James Fremantle |
AUC |
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Dr Tony Goodwin |
BALPA |
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Carolyn Evans |
BALPA |
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Captain Tristan Loraine |
BALPA/CAQTG |
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Dr Mark Popplestone |
BATA |
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Roger Wiltshire |
BATA |
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George Blundell - Pound |
Thomas Cook Airlines |
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Apologies |
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Dr Bill Maton-Howarth |
DoH |
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John Furlong |
HSE |
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Tom Hamilton |
CAA/SRG |
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Nikki Jones |
TGWU |
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Victoria Mayo |
DfT/ASCM |
Item 1: Minutes of the previous inclusive meeting (4th August 2005)
1.1 Minutes agreed.
Item 2: CAA Bill: Progress of Bill through House of Lords
2.1 The Second Reading of the CA Bill took place in the House of Lords on
1st November. The Countess of Mar, who has also asked a number of Parliamentary Questions, raised the issue of cabin air.
2.2 Another debate is due to take place over two Sessions during the week
commencing Monday 5th December. Lord Hanningfield has tabled an amendment to Clause 7 of the Bill, extending its scope to give the CAA responsibility for health of residents living near airports (we assume in respect of the environmental effects of noise and emissions). We expect the Government to resist the amendment.
Item 3: Research Sub-group
Cabin Air Quality
3.1 Dr Maton-Howarth had provided an update which the Chair relayed. The issues under consideration fall into two categories: research and protocol.
Research
3.2 There are currently two strands of research. Following the submission of further information by BALPA, the DoH funded Toxicology Group at Imperial College has asked the independent Committee on Toxicity to conduct a scientific review of the evidence. Alongside this, the FAA-sponsored feasibility study to measure Cabin Air Quality has begun. The study will be conducted nationally at first, but researchers have indicated their expectation of widening the study internationally, and of seeking support from the UK and other countries.
3.3 Discussion followed regarding the timescales involved in both strands of research, particularly the FAA study. It was suggested that, if the group felt that a speedier result were required, the UK might consider conducting its own study once we had pointers from the Committee on Toxicity review. BALPA advised that the American study's feasibility stage should be completed by Spring 2007.
3.4 The Group acknowledged BALPA's keenness for the UK to join the American research and agreed that the UK may do so at a later date. Bill Maton-Howarth had already had a discussion with the researchers and would keep in touch with them as their work progressed. Meanwhile, the Group wished to be guided by the outcome of the Committee on Toxicity review, on which we had now embarked, as to the best way forward.
Protocol
3.5 Professor Robert Maynard CBE, a toxicology expert and colleague of Dr Maton-Howarth, has agreed to look at Dr Goodwin's draft protocol for dealing with patients who present with symptoms of fume events at hospitals. This is important as affected persons are not necessarily at hospitals near major airports.
3.6 BALPA advised that one of its pilots had conducted a breath test study which had revealed the presence of certain chemicals, and offered to provide a list of those found. It was agreed that this was more relevant to the Committee on Toxicity review than the protocol. BALPA confirmed that the list was in the material submitted to the review. Dr Tony Goodwin suggested that as further research results became available, they could be used to inform and update the protocol.
Item 4: Update of the work of the Aviation Health Unit
4.1 Dr Ruge represented the UK Aviation Health Unit at the ICASM (International Civil Aviation and Space Medicine) in Warsaw. During the Conference she met Dr Antuñano who is the Chief Medical Officer of CAMI (Civil Aviation Medical Institute, attached to FAA). In his presentation he gave an overview of FAA research projects. Dr Ruge also attended the annual German Congress of Angiology where she was able to hear about the newest research results regarding deep vein thrombosis.
4.2 ECAC called in a small group of experts to discuss the eventual need for a harmonised European approach in the event of an outbreak of an Influenza Pandemic. Doctors from the Italian, French, Irish and UK CAAs and from AEA/IATA and ACI attended the meeting. They developed recommendations, based on the WHO recommendations and IATA guidelines, which Dr Ruge will present to the DGs at their next meeting on 7 December. The recommendations are very general but provide a good basis to work on. Continuation of the work on behalf of the UK will be done by DoH and DfT.
4.3 EASA asked for comments on issues closely related to, but not within, the EASA remit, such as security and passenger health, and mentioned cabin air quality, seat pitch, passenger fainting, overhead bin safety precautions, turbulence, cabin layout to accommodate a sick passenger, regulations for toilets and diversions because of medical emergencies. Dr Ruge has been asked by the CAA to provide input.
4.4 Passenger concerns
Oxygen levels in cabin air: There was significant interest among both media and passengers in this issue following the publication in the Irish Journal "Anaesthesiology" of an article about a decrease in blood oxygen saturation. The article was rather flawed and did not communicate any new facts. Nevertheless, the AHU continues to receive questions on oxygen.
Drinking water: This continues to attract questions from passengers. It should be noted that EPA (Environmental Protection Agency in the US) is considering regulations with regard to cleanliness of water in aircraft. At the moment several US operators have submitted to voluntary controls of their water supplies and some UK airlines have tasked a research institute in Farnborough to check the condition of water on board aircraft.
4.5 Crew issues
Meals: Several complaints have been received from flight crew members regarding non provision of crew meals, meals not cooled or crews having insufficient time to eat. One complaint came in via CHIRP, and one as a MOR. Dr Ruge responded with the help of Tim Williams. BALPA indicated that concerns about nutrition as a health and safety issue had been raised by crews, particularly those on airlines which don't provide free passenger food. BALPA asked that the AHWG consider the issue; however, it was pointed out that this was about occupational health and safety and was being addressed by the Occupational Health & Safety Steering Group in CAA.
Action: Tim Williams to provide feedback.
Temperatures: As a follow-up on the last meeting, Dr Ruge contacted Tony Evans of the ICAO, who advised that ICAO does not intend to look into this issue at the moment. Tim Williams provided a paper by the Health and Safety Commission on maximum working temperatures.
Action: Dr Ruge to include the issue of temperature in her comments to EASA (see 4.4)
4.6 Website information - Dr Ruge is co-ordinating the advice on DVT on AHU and DoH websites. She will also be providing advice on respiratory issues.
4.7 Dr Ruge was asked if she could share the original paper on passenger health and security, but she advised that the document concerned contained merely a list of issues rather than providing any detailed information.
4.8 Dr Ruge was asked how much AHU time is spent on passenger complaints and concerns. She replied that AHU has dealt with around 100 queries in the past year. Sandra Webber added that Dr Ruge also inputs into DfT queries from passengers.
Item 5: Other research
Wright Project Phase 1
5.1 Peter Smith reported that a summary of the results of the WRIGHT project will be published on the Department's website in the next month or so, and that the DH website advice to travellers would be updated in the light of the results. A press release may be issued to co-incide with this. The basic message will be that journeys of more than four to five hours in length by all forms of travel involving prolonged immobility increase the relative risk of DVT three to four-fold.
5.2 Discussion followed regarding the location of the information to be published i.e. should it be on the Aviation part of the DfT website given that it covered travel in general? DfT agreed to consider this.
Regarding the level of detail available, the Department of Health website already describes high-risk categories of people. It was intended that, if there were a press release, in order to give some perspective to the actual risk, an example such as DVT during pregnancy could be used, where the risk is increased but the actual incidence is rare. The press release might also say that in only one per cent of cases was DVT fatal
Wright Project Phase 2
5.3 Peter Smith reported that discussions with researchers are ongoing regarding risk reduction of DVT and the high cost of research into methods of prevention. The group discussed the use of Aspirin as one method of intervention. The concensus of the various data received was that was that there is no evidence that Aspirin is effective, but, it may have some influence as a placebo.
Use of Aspirin in the prevention of DVT
5.4 The report was nearly ready to go onto DfT website.
Action: DoH and DfT.
Item 6 - AOB
Aviation Health Unit
6.1 The Chair reported that the AHU website has accumulated a large database of information which it is hoped could be made available to the public.
The Group discussed the forthcoming vacancy for Head of the AHU.
6.2 The Chair reported that Dr Ruge's post has not yet been advertised publicly. There is likely to be a delay between Dr Ruge's departure and her successor taking up the post. One option that had been suggested was that, rather than recruit a new head, the post be contracted out to an academic institution, as occurs at the Department of Health. The Group discussed the issue of qualifications for the post, and whether or not medical qualification would over-ride industry knowledge. The Chair responded that this would depend on the future remit and functions of the post. The Chair welcomed feedback on this issue.
6.3 The aviation industry members re-iterated concerns regarding the international aspect of Dr Ruge's work, and also that the industry was funding a post which was considered essentially as a provider of research and advice to Government.
Workplace experience guidelines
6.1 Tim Williams reported that he was aware of correspondence between HSE and BALPA on the applicability of workplace exposure limits in the aircraft environment.. He commented that the occupational exposure limits in EH40 are evidence based standards and cannot automatically be transposed, due to the different conditions experienced within the aircraft, particularly pressure differences and exposure times. Further research would be required before determining whether EH40 could be adopted. The CAA will to talk to the Health and Safety Executive on this issue as they have the expertise in this area. Dr Ruge pointed out that the exposure limits are aimed at a normal 40 hour working week pattern.
Departures
6.2 Steve James announced his forthcoming departure from the CAA at the end of this year, and said that Cliff Barrow would be will taking over the technical side of his work. Steve's last attendance at the AHWG will be at the Exclusive meeting on 2 December.
Dr Annette Ruge confirmed her forthcoming departure from the AHU early next year.
6.3 Peter Smith, Head of the Aviation Consumer Protection Branch in DfT announced his forthcoming retirement in December.
6.4 The Group joined the Chair in expressing their gratitude for the hard work and effort of all three members and wishing each of them every success for the future.
Dates of Next Meetings:
Inclusive - 18 November 2005
Exclusive - 2 December 2005
Inclusive - 10 February 2006
Exclusive - 7 April 2006
Inclusive - 28 April 2006
Exclusive - 9 June 2006
Inclusive - 4 August 2006
Exclusive - 1 September 2006
Inclusive - 17 November 2006
Exclusive - 1 December 2006
ACCD 18 November 2005
