Aviation Health Working Group minutes: 4 August 2006
Aviation Health Working Group # 38
4 August 2006, Great Minster House
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Present |
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Chair: |
Sandra Webber |
DfT/CAD |
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Secretary: |
Grace Hansford |
DfT/CAD |
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Andrew Ashbourne |
DfT/CAD |
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Abimbola Alli |
DfT/CAD |
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Dr William Maton-Howarth |
DoH |
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Dr Raymond Johnston |
CAA/AHU |
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Tom Hamilton |
CAA/SRG |
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Cliff Barrow |
CAA/SRG |
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Helen Bennett |
CAA CPG |
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Tim Williams |
CAA |
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Cliff Barrow |
CAA/SRG |
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Helen Bennett |
CAA CPG |
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Tim Williams |
CAA |
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Simon Evans |
AUC |
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John Furlong |
HSE |
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Dr Sandy Mitchell |
BALPA |
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Dr Tony Goodwin |
BALPA |
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Tim Bamber |
BALPA |
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Roger Wiltshire |
BATA |
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Dr Mark Popplestone |
BA/BATA |
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George Blundell-Pound |
Thomas Cook Airlines |
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Apologies: |
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Dan Monnery |
CAA CPG |
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James Fremantle |
AUC |
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Andy Freeman |
HSE |
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Mike Carrivick |
BAR UK |
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Brendan Gold |
TGWU |
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Nikki Jones |
TGWU |
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Victoria Mayo |
DfT/ASCM |
Item 1: Introductions
1.1 The Chair welcomed Helen Bennett, who is attending on behalf of Dan Monnery.
Item 2: Minutes of the previous inclusive meeting (9 June 2006)
2.1 Actions listed -
- Item 3.2 - Following the discussion on the use of disinsection sprays,
Angela Tanner, of the Crawley Borough Council Environmental Services, Port Health Division advised that she would take up the issue of other forms of disinsectants with the WHO Working Group. The Chair relayed Angela's report as follows:
The Working Group has not issued an official statement as yet, but there has been general discussion on the subject. Concerns raised regarding spray disinsectants are partly to do with the timing of the spraying - either residual or pre-board spraying, or in-flight, from canisters used by the crew - and the resultant exposure levels to passengers and crew, either direct or indirect, depending on the method used. However, chemical safety experts at the WHO have repeatedly stated that the disinsectant used, in the amounts normally required, is not a health problem.
There are also drawbacks to the use of the air curtain method. Other doors than the bridge door may be open while loading, and would not have protection. Another concern is that many countries do not use bridges.
- Item 3.6 - Recent developments at the WHO - The Chair advised that Angela Tanner is awaiting further contact from the WHO Working Group and will report back to the AHWG.
2.2 During the discussion which followed, Dr Raymond Johnston asked the Group to consider the use of other types of curtain, e.g. beaded, which can be used on all doorways.
2.3 On a related issue, John Furlong reported that there was no news as yet on the progress of an application to extend the use of Methyl bromide as a fumigant in Europe, which was discussed at the previous meeting. He agreed to provide a further update at the next meeting.
Action Point
2.4 Amendments to the previous minutes requested by Dr Ray Johnston
- Item 4.2 - Defibrillators. This Para should read:
Dr Johnston advised that in deciding on the use of defibrillators, it was important to examine the nature of each event, and the likelihood of a successful outcome. To date the incidence of a potentially remedial rhythm upset ranges from10 - 40% of cases. At present there is insufficient evidence for mandatory requirement on board aircraft.
- Item 4.3 - Cabin Air Quality: The Professor's name was incorrectly spelt. It should of course be Professor Steve Hecker.
- The amended minutes will be circulated.
Item 3: Presentation on Defibrillation
3.1 As promised at the previous meeting, Dr Raymond Johnston gave a presentation on the issues surrounding the use of automated external defibrillators (AEDs). The Chair explained that there was no question of the Government or CAA discouraging the many airlines which carry AEDs; the purpose of Dr Johnston's investigation was to assess whether there was a case for mandatory carrying of AEDs.
3.2 Only two abnormalities of heart rhythm are amenable to defibrillation; these are ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT). The main factors contributing to successful defibrillation are:
i) when the subject suffers either of those two conditions without having a heart attack or a pre-existing heart disease, and
ii) the length of time elapsing between collapse and application of the electrical shock, i.e. if there is a time gap of more than three minutes, there are implications for the survival of the patient.
3.3 In 1987, Dr Peter Chapman of British Caledonian calculated the likely number of cardiac deaths onboard aircraft, and the proportion which may be resuscitated successfully. The calculations are based on the prevalence of coronary heart disease: 1500 cases of sudden death per million in a year, which equates to around 4 sudden deaths per million per day, or one in a million passengers on an average six hour flight. This correlates well with BA figures of 1.6 -1.8 deaths per million passengers. Further calculations using data provided by various airlines, conclude that defibrillator use saves, at best, one passenger per 8 million carried.
3.4 Discussion followed on whether or not a case can be made for the mandatory carriage of automated external defibrillators (AEDs) on all flights.
3.5 The Group discussed the lack of evidence from actual case studies of AED use. Current data does not use standard definitions of "survival" after onboard treatment - e.g. admission to hospital, for instance. Collecting data on the outcome of cases is difficult because issues of doctor-patient confidentiality can prevent the release of follow-up information on a patient's progress.
3.6 Concerns were raised about the practicalities of using the equipment onboard. The timing of treatment is crucial, as any delay could have a major impact on the outcome. This in turn is affected by conditions such as the passenger's seating position, weight, etc, as well as available clear floor space in which to administer treatment. However, it was argued that AEDs are not only used to administer shock but also as in-flight monitors of passengers who have collapsed, to reassure crew that the passenger has a stable heart beat. The underlying argument is that AEDs can potentially save lives.
3.7 The group discussed whether support for mandatory AEDs was primarily customer-led, i.e. passengers may choose to fly with an airline which carries the equipment. However, there was general agreement that, apart from those with a pre-diagnosed heart condition who might be directly affected, the majority of passengers were unconcerned. Those passengers for whom this was an issue would tend to contact individual airlines for information on defibrillators.
3.8 Dr Johnston reported that there are no figures available on the total number of air carriers which currently have AEDs onboard. However, Roger Wiltshire stated that they are carried by all BATA long haul carriers, though there is less consistency among short haul carriers.
3.9 With regard to the International position, Dr Sandy Mitchell reported that in the US, the Federal Aviation Administration (FAA) mandated the carriage of AEDs in 2004. Dr Johnston reported that there is movement towards this in Europe, and mandatory carriage of AEDs will be an issue for EASA to consider. However, the data available as yet cannot adequately support an argument in favour of a mandate which would satisfactorily convince the 24 other member states.
3.10 The group agreed that there is a need for more information of sufficient quantity and quality, and supported the idea of all airlines having standard reporting protocols.
3.11 In closing the discussion, the Chair thanked Dr Johnston, and advised that this was an issue to which the Group might return.
Item 4: Progress of COT
4.1 The Chair summarised the meeting of the Committee on Toxicity held on Tuesday, 11 July. Following the submission of evidence, mainly from BALPA but also requested by COT from the CAA and oil companies, the Committee had identified the two main issues as:
i) whether there is conclusive evidence of cabin air contamination; and
ii) if so, whether this contamination is enough to pose a health and/or safety problem
4.2 On the first issue, the COT examined the issue of incident reporting, noting that there was room for improvement in the quality of reporting, consistency of data, the interpretation of results and the application of the knowledge gained, but reached no conclusion on the issue of under-reporting.
4.3 On the second issue, with regard to health, the Committee was not convinced that organophosphates are the cause of reported ill-health episodes. These could be due to another chemical, or a combination of chemicals, or indeed could be due to general working stress, environment, etc. The Committee concluded that further work is necessary, and that it was important to keep an open mind about the cause of illness.
4.4 On safety, the Committee discussed the results of a small-scale study conducted by Dr Sarah Mackenzie-Ross, Consultant Neuropsychologist and Clinical Tutor at University College London, which showed that some pilots displayed cognitive weakness which could affect performance. In recognising the small scale and limited scope of the study, the Committee enquired whether further research on these lines should be considered. BALPA pointed out to the AHWG the difficulty of getting any pilots to participate once they had passed the CAA's demanding simulation test for fitness to carry out their job. Dr Johnston suggested that use could be made of the FAA's equivalent test for pilot fitness.
4.5 The Group discussed other types of testing, notably cabin air sampling - which all members were keen to see carried out - and examining the compounds emitted from super-heated engine oil. During the discussion which followed, the Group considered the merits of using manual and/or automatic forms of cabin air sampling. One view was that the method of monitoring cabin air should be automatic, i.e. without any human interface, to avoid distracting crew during a fume event and to avoid subjectivity. Dr Maton-Howarth proposed considering a mix of automated and manual types of sampler, as each has its own advantages under certain conditions.
4.6 On the issue of research, the Chair advised that the Government would want to tender for research based on the best option or combination of options. It was agreed that, following the COT meeting in September, contact should be made with the COT secretariat to begin the process of putting together the specification for research. Dr Maton-Howarth agreed to liaise with COT on an outline specification, and to schedule another meeting of the Research Sub-Group. In the meantime, suggestions from the Group would be welcome.
4.7 The Group commended COT on its work so far, and members reiterated their continuing commitment to supporting the Committee and working with each other to ensure the health concerns were properly investigated.
4.8 It is hoped that the COT will publish its conclusions by Christmas 2006.
Item 5: House of Lords Select Committee on Air Travel and Health
The House of Lords Select Committee on Science and Technology published a report on 15 November 2000 entitled 'Air Travel and Health', in which several recommendations were made. The purpose of today's discussion was to review progress on implementing those recommendations. The latest updated table of actions had already been circulated to members. The two items flagged up for specific discussion were:
5.1 Recommendation 1.25: Cabin Air Quality - the aircraft manufacturers' and airlines' provision of information to the public on cabin air quality. Whilst some information has been placed on various websites, further input had been invited from members last time the actions were discussed.
- Mark Popplestone reported that there was nothing further to add.
5.2 Recommendation 1.46: Information for passengers - it was recommended that airlines provide a pre-take-off health briefing similar to that currently provided for safety.
- Mark Popplestone reported that BA provides such advice shortly after take-off. On long haul flights there is also an in-flight video and on short haul flights there is a magazine. George Blundell-Pound said that the information was available on Thomas Cook websites, in the in-flight magazine, in-flight video, and that crews on all flights had received briefing. Of the Charter airlines, the "big five" all provide this. The group agreed that it was important to guard against information "overkill", and the risk of triggering indifference among passengers.
5.3 Other Recommendations:
- Recommendation 1.13 on Fitness to fly - Simon Evans advised that 'Flight Plan', the booklet from the Air Transport Users Council (AUC), is no longer in production and that all information is now web-based
- Recommendation 1.26 on cabin atmosphere sampling programmes -
The Chair advised that the Action table could be updated now, in light of the discussions on research at the COT meeting (see Item 4.4, above),
- Recommendation 1.29 on the fitting of ozone converters - Roger Wiltshire advised he would shortly be able to provide an update.
5.4 Dr Maton-Howarth requested some amendments to the List of Reports at the back of the document, to reflect more accurately the commissioning and funding sources.
Item 6 - AOB
6.1 6.1 Bola Alli advised the Group that Civil Aviation Division has recently taken on a new tranche of work on the issue of the rights of Persons with Reduced Mobility (PRMs) when travelling by air. DfT's Mobility and Inclusion Unit recently published a report on access to airlines, the voluntary code of practice and how airlines are complying with that and the Disability Discrimination Act (DDA). We hope to talk to stakeholders and look at the new 2006 EU legislation on the rights of disabled passengers and persons of reduced mobility (PRM) when travelling by air. Because the EU regulation was published on 26th July we are taking on this work in liaison with MIU with regard to enforcement and penalty regimes.
6.2 The Secretary advised that in future the Minutes of the AHWG meetings will be posted on the Department's website. Minutes of previous inclusive meetings are currently awaiting publication, estimated to be within the next two weeks, along with an explanatory note about the AHWG.
Item 7 -Dates of Next Meetings:
6 October 2006
1 December 2006
CAD 1
4 August2006
