Air Travel and Health: A Systems Perspective

About the Authors xv

Preface xvii

Series Preface xix

Acknowledgements xxi

Acronyms and Abbreviations xxiii

1 Introduction 1

1.1 Factors Affecting Health 2

1.2 The System of Interest 2

1.2.1 The Operating Environment 2

1.2.2 The Atmosphere 3

1.2.3 The Aircraft Inhabitants 4

1.2.4 Sources of Environmental Stimuli 5

1.3 The Aircraft 6

1.3.1 Military Aircraft 6

1.3.2 Commercial Aircraft 8

1.4 Design Considerations 10

1.5 Summary 14

References 16

Further Reading 16

Useful Web Sites 16

2 Some ‘Minor’ Ailments 17

2.1 Introduction 17

2.1.1 Health Information 17

2.1.2 Considering the Whole Trip 18

2.1.3 Some Symptoms Reported by Travellers 18

2.1.4 Health Risks 19

2.2 Some Common Conditions of Air Travel 20

2.2.1 General Discomfort 20

2.2.2 Jet Lag (Circadian Dysrhythmia) 21

2.2.3 Fear of Flying (Aerophobia) 23

2.2.4 Discomfort of the Ears 23

References 25

Further Reading 25

Useful Web Sites 26

3 Air Quality 27

3.1 The Environment 28

3.1.1 The Atmosphere 28

3.1.2 Air Quality 28

3.1.3 Cabin Air Supply 29

3.1.4 Sources of Contamination 29

3.2 Aircraft Environments 31

3.2.1 Commercial Aircraft 31

3.2.2 Military Aircraft 33

3.3 Environmental Control Systems 36

3.3.1 Air Cooling 36

3.3.2 Air Distribution 36

3.4 Health Issues 40

3.4.1 Effects of Contamination 41

3.4.2 Aerotoxic Syndrome 41

3.4.3 At Risk on the Ground? 47

3.4.4 Spreading Illness 47

3.5 System Implications 48

3.5.1 Contaminants 48

3.5.2 Future Systems 51

3.6 Request for Further Information 55

References 56

Further Reading 57

Useful Web Sites 58

4 Deep Vein Thrombosis 59

4.1 Introduction 59

4.1.1 How Common Is It? 61

4.1.2 How Long Is a Long Flight? 62

4.2 The Environment 62

4.3 Aircraft Environments 63

4.3.1 Commercial Aircraft 63

4.3.2 Large Military Aircraft 64

4.3.3 Fast-Jet Military Aircraft 67

4.4 The System 67

4.4.1 Commercial Aircraft 67

4.4.2 Military Aircraft 68

4.5 Health Issues 69

4.5.1 Cabin Altitude and Pressure 70

4.5.2 SoWho Is at Risk? 71

4.5.3 Summary of Risks 72

4.6 System Implications 73

4.6.1 Litigation 73

4.6.2 Preventative Measures 74

4.6.3 Advice to Passengers 74

4.6.4 Continuing Work 76

References 77

Further Reading 78

Useful Web Sites 78

5 Noise and Vibration 79

5.1 The Environment 81

5.2 Aircraft Environment 82

5.2.1 Commercial Aircraft 82

5.2.2 Military Aircraft 83

5.3 Health Issues 85

5.3.1 Hearing 85

5.3.2 Vibration 85

5.4 System Implications 86

5.4.1 Limiting Flying Hours 86

5.4.2 Active Noise Cancellation 87

5.4.3 Microphone Disabling 87

5.4.4 Personal Noise Management 87

5.4.5 Risk Assessment 88

References 88

Further Reading 88

Useful Web Sites 88

6 Exposure to Radiation 89

6.1 The Environment 89

6.1.1 Cosmic Radiation 90

6.1.2 Radiation in Space 92

6.1.3 Non-ionising Radiation 92

6.2 The Aircraft Environment 93

6.2.1 Ionising Radiation from Space 93

6.2.2 Non-ionising RF Radiation 94

6.2.3 Understanding the Risk in Commercial Aircraft 97

6.2.4 Understanding the Risk in Military Aircraft 99

6.3 Aircraft Systems 100

6.4 Health Issues 101

6.4.1 Risk of Cancer 101

6.4.2 Risks to Female Crew Members 103

6.4.3 Risks to Passengers 103

6.4.4 Eye Damage 104

6.4.5 Damage to Life Support Equipment 104

6.5 System Implications 104

6.5.1 Legislation 104

6.5.2 Mitigating Action 108

6.6 Future Developments 109

References 110

Further Reading 112

Useful Web Sites 112

7 Back and Neck Pain 113

7.1 Back Pain 113

7.1.1 Lower Back Pain 113

7.1.2 Posture 114

7.1.3 Back Pain and Military Aircraft 114

7.1.4 Helicopter Pilots 115

7.1.5 Posture and Pain 117

7.2 Neck Strain 120

7.3 Commercial Aircraft Issues 122

7.3.1 Flight Attendants 122

7.3.2 Passengers 123

7.4 Lumbar Support 123

7.5 Advice for Passengers 125

References 126

Further Reading 127

8 Military Issues 129

8.1 The Cockpit Environment 130

8.2 Effects of Acceleration 133

8.3 Pressure Oxygen Breathing and Hypoxia 136

8.3.1 Hypoxia 136

8.3.2 Decompression Sickness 137

References 137

Further Reading 138

Useful Web Sites 138

9 Workstation Use 139

9.1 The Environment 140

9.2 Aircraft Environments 141

9.2.1 Commercial Aircraft 141

9.2.2 Military Aircraft 142

9.3 The System 143

9.4 Health Issues 146

9.4.1 Sight 146

9.4.2 Posture 147

9.4.3 Back and Neck Pain 147

9.4.4 Vibration 148

9.5 System Implications 148

Reference 150

Further Reading 150

Useful Web Sites 150

10 Regulation and Control of Risks to Health 151

10.1 General 151

10.2 Legislative Framework 152

10.2.1 Health and Safety 153

10.2.2 EU Legislation 154

10.2.3 Environmental Legislation 156

10.2.4 Air Navigation Order 157

10.2.5 Duty of Care 157

10.3 Summary of Legal Threats 157

10.3.1 Criminal Prosecution 157

10.3.2 Civil Lawsuits 158

10.3.3 Customer/Public Relations 158

10.4 Issues Arising 158

11 The Design Process 161

11.1 Control of Risk 161

11.1.1 Governance 161

11.1.2 Company Policy 162

11.1.3 Company Procedures 162

11.2 Design 162

11.2.1 Standards 162

11.2.2 Good Practice 163

11.2.3 Design and Qualification Process 163

11.3 Application 174

11.3.1 Incorporation 175

11.3.2 Operations 175

11.4 Feedback 175

11.4.1 Public Comment 176

11.4.2 Complaints 176

11.4.3 Litigation 176

Reference 177

12 Summary and Conclusions 179

12.1 Integration Effects 180

12.2 Predisposition 182

12.2.1 The Travel Experience 183

12.2.2 Genetic Factors 183

12.2.3 Public Health 183

12.3 Domestic Circumstances 183

12.3.1 Carrying and Lifting 184

12.3.2 Do-It-Yourself (DIY) 184

12.3.3 Noisy Pursuits 184

12.3.4 Lifestyle Factors 184

12.3.5 Water Sports 185

12.3.6 Obesity 185

12.4 Comparison with General Public Health Conditions 185

12.4.1 Sick Building Syndrome 185

12.4.2 Myalgic Encephalomyletis (ME) or Chronic Fatigue Syndrome (CFS) 186

12.4.3 WiFi Sensitivity 187

12.4.4 Electrical Power Line Sensitivity 188

12.4.5 New Car Syndrome 189

12.4.6 Household and Industrial Cleaning Products 190

12.4.7 Discussion 191

12.5 Serious Conditions 191

12.6 Advice to Industry 191

12.6.1 Processes and Procedures 192

12.6.2 Independent Medical Advice 193

12.6.3 Research 193

12.6.4 Seeing the ‘Big Picture’ 193

12.7 Advice to Operators 195

12.7.1 Promote Awareness 195

12.7.2 Independent Medical Advice 195

12.7.3 Research 195

12.8 Advice to Travellers 195

12.8.1 Obtain Medical Advice 196

12.8.2 Improve Awareness 196

12.9 What Can Be Done? 199

12.10 Finally 204

References 204

Further Reading 205

Useful Web Sites 205

Bibliography 207

Index 217