Aviation Health Working Group minutes: 21 April 2008

Note of Meeting held on 21 April 2008 at Department for Transport

Present

Role	Name	Organisation	Initials
Chair	Sandra Webber	DfT	SW
	Andrew Ashbourne	DfT	AA
	Abimbola Alli	DfT	BA
	Tim Williams	SRG (CAA)	TW
	Tim Bamber	BALPA	TB
	Dr Tony Goodwin	BALPA/AMS	TG
	James Fremantle	AUC	JF
	George Blundell-Pound	Thomas Cook	GBS
	Dr Elizabeth Wilkinson	BA	EW
	Christine Barringer	HSE	CB
	Ursula Wells	UW	UW
	Nikki Jones	TGWU	NJ
Secretariat	Jason Richardson	DfT	JR

Apologies

Name	Organisation
Dr Ray Johnston	SRG (CAA)
Nick Brewer	SRG (CAA)
Dr Mark Popplestone	Virgin/BATA
Roger Wiltshire	BATA
Mike Carrivick	Bar-UK

Item 1: Introductions

1.0 The Chair opened the meeting and thanked everyone for attending.

Item 2: Minutes of previous meeting (14th January 2008)

2.0 NJ requested that her comment under item 3.3 be recorded under item 5 where her comment was originally made. The meeting agreed a revised text.

Item 3: Update on work of CAA Aviation Health Unit

3.0 TW gave an update on the work of the AHU. (Please see Annex A).

3.1 Bola Alli also added that she along with TW and Dr Ray Johnston had recently met with Department for Transport officials from the Dangerous Goods Division. The meeting was to discuss the revising of the Euratom Basic Safety Standards (for radiation protection) Directive (96/29/Euratom) in particular, the requirement for controlling exposure of aircrew to cosmic radiation and the role of CAD/AHU in the delivery of a UK response to proposed amendments.. Initial indications are that there is limited support for the new proposals and that most states would prefer to adhere to existing obligations of exposure to both crew and flying passengers. However, discussions are still in the early stages; the group will be kept informed of developments as they occur.

Item 4: Cabin Air Research - Progress Report.

4.0 AA informed the group that since the last meeting in January a lot of progress had been made;

The work on the first functionality tests have been completed by Prof Muir at Cranfield University, and also peer reviewed by scientists in UK, USA, and Holland. The report was published on 21 February and is available via the DfT website at www.dft.gov.uk/pgr/aviation/hci/cabinairtest.pdf.

Work on getting the real time tests going is moving forward. A Steering Committee chaired by Helen Muir has been set up to guide the work. The first meeting took place on 14 February. A note of the meeting can be found at Annex B.

4.1 Continuing with the issue of cabin air, AA explained that prior to today's meeting, Nigel Dowdall from British Airways had contacted the Department with a suggestion of producing a 'Frequently Asked Questions' paper. It was generally thought it would be a useful resource. A draft was produced and circulated. Several comments were received on the content of the FAQ's and suggestions made. A revised version was drafted and sent to members of the group. A copy has also been placed on the DfT website at www.dft.gov.uk/pgr/aviation/hci/faq. TB added that BALPA were also producing a statement on cabin air in connection with Jim McAuslan's appearance on a Panorama programme about cabin air to be broadcast the evening of 21 April.

4.2 In relation to proposals to carry out further testing of cabin air in the cockpit. TB reported that pilots were becoming increasingly irritated with their lack of control over cockpit security. New security rules and their interpretation in the UK mean pilots have limited involvement on who can travel in the cockpit, however legislation in other countries was being interpreted differently, leading to increased frustration from UK pilots. The Chair responded that TRANSEC had been contacted about future cockpit testing; they were not unduly concerned about the security aspect. Nevertheless any scientist carrying out testing would need a letter of authorisation from the Department.

Item 5: Aviation Health Unit

5.0 The Chair circulated a paper to ascertain the Group's view on transferring the chair of the AHWG to the CAA's Aviation Health Unit (AHU) (Annex C). The Chair drew the Group's attention to the recent House of Lords Science and Technology (HoL) Report on Air Travel and Health which recommended that there was scope to raise the profile of the AHU. The Chair advised that the Government was minded to accept this recommendation and would consult colleagues about their thoughts on taking forward the recommendation and transferring the chair of the AHWG to the AHU. There were several reasons in favour of this proposal; the AHU had the required expertise, they were better placed at identifying emerging issues within aviation health, and routinely attended international conferences on health issues.

5.1 The Chair opened the floor for comments. TB said that BALPA was happy with how the group functioned and preferred to retain DfT as chair. GBP added that moving the Chair to the AHU could be perceived as aviation health receiving less Government attention but he would like to consult colleagues in BATA. AA responded by saying that the statutory duty passenger health remained with the Secretary of State under the Civil Avaition Act 2006. Rather than being seen as taking a step back, the expertise in the AHU could move the group forward.

5.2 The issue would be considered again at the next meeting.

Item 6: Defibrillators.

6.0 BA informed the group that the Aviation Minister, Jim Fitzpatrick, and officials including Dr Johnston had recently met with Paul Keetch MP who is campaigning for legislation to make the carriage of defibrillators on-board aircraft compulsory on all UK aircraft. Mr Keetch had recently collapsed on a flight from Washington to the UK with Virgin Airways and his heart was successfully re-started with an AED. On briefing the Minister, Dr Raymond Johnson advised that whilst many airlines carry defibrillators on a voluntary basis the evidence to date about their benefits is inconclusive. To enforce carriage would also require action at European level by EASA, as requirements for medical kit would require harmonisation across the EU States. A recent report by the Department of Health with the British Heart Foundation emphasised the importance of properly trained staff.

Item 7: AOB

7.0 None.

Item 8: Dates of Next AHWG Meetings

8.0 Monday 14 July 2008 in Great Minster House.
Monday 20 October 2008 in Great Minster House.

CAD 28 April 2008

Annex A: Report from the Aviation Health Unit (AHU)

Website

We continue to develop the website with an increase in FAQs and the professional guidelines for Fitness to Fly were launched on 24 March.

(Please see press notice below.) We are working with the CAA Information Department on the construction of a passenger portal to ensure that the profile of AHU continues to be raised in the public profile.

ICE Project

The data acquisition is complete and data analysis is now ongoing. The next Project meeting will discuss dissemination of the results in appropriate peer review journals.

Cabin Air Research Steering Group

The Head of AHU is a member of the Group.

Ionising Radiation European Directive

In conjunction with the Health and Safety Advisor, the Head of the AHU is contributing to the response to proposed changes to Council Directive 96/29/Euratom to ensure that an evidence based approach is used when considering the effects of cosmic radiation on aircrew and passengers.

Raising the profile of the AHU

The Head of the AHU has attended a number of meetings, both national and international, in the areas pertinent to the function of the Unit. He attend a symposium on the airliner cabin environment run by the American Society for Testing Materials (ASTM) which dealt with issues of cabin air, enhancing humidity in the cabin and potential toxic compounds in cabin air. A full report on key presentations in this symposium will follow.

18 April 2008

CAA launches fitness to fly patient assessment guide

Date: 25 March 2008

Following a rise in the number of emergency diversions of aircraft due to onboard medical incidents, the Civil Aviation Authority's Aviation Health Unit (AHU) has published a guide for medical professionals on assessing patients' fitness to fly.

There were 514 emergency calls made by UK airlines in 2007 due to medical emergencies, resulting in 58 diversions – a 26 per cent increase since 2003. Many diversions are caused by passengers who are not fit to fly or do not make their medical condition known to their airline before travelling. In-flight medical emergencies can be particulary dangerous for the patient, as it can take some time for aircraft to divert to a suitable airport for medical assistance, whilst also causing disruption to airline operations.

Medical professionals can play an important part in helping to prevent in-flight emergencies by carrying out thorough fitness to fly assessments and, in certain cases, providing full details of the passenger's medical condition to the patient's airline.

To help practitioners to make sound assessments, the AHU has launched a free guide, available from www.caa.co.uk/fitnesstofly, covering issues such as angina pectoris, asthma, respiratory infections, diabetes, deep vein thrombosis and post-surgical issues.

The increasingly ageing population of the UK means that there is an ever-increasing number of elderly passengers for whom fitness to fly is particularly important. Airline users of air-to-ground medical service MedAire reported that 59 per cent of medical diversions in 2006 were caused by passengers aged 51 years and older. The top three causes of in-flight emergencies were neurological, cardio and respiratory conditions respectively.

The Head of the CAA's Aviation Health Unit, Dr Raymond Johnston, said: "The aim in assessing fitness to fly is to allow the passenger to travel safely without any deterioration in their medical condition and to prevent the delay and distress caused by diversions.

"Passengers should declare to their physician that they intend to travel and the practitioner should be familiar with the aircraft environment and any potential interaction with the patient's condition.

"The majority of in-flight emergencies occur to those whose medical condition is unknown to the airline. It's therefore essential that the physician sends adequate details to the airline well in advance of the flight."

The Aviation Health Unit's PDF is available to download for free from www.caa.co.uk/fitnesstofly.
[ends]

Notes to editors:

For media information please contact Jason Wakeford at the CAA press office on 0207 453 6024 or jason.wakeford@caa.co.uk.

The UK Civil Aviation Authority’s Aviation Health Unit (AHU) was formed on 1 December 2003 to advise Government on passenger and aircrew health issues. In March 2007, the AHU was given an additional statutory function in safeguarding the health of all persons onboard aircraft. A recent House of Lords Inquiry (Air Travel and Health: an Update) emphasised the pivotal role of the Unit as a focus for those interested in aviation health matters.

Annex B: Cabin air steering committe

Note of Meeting held on 14 February 2008 at Department for Transport

Present

Role	Name	Organisation
Chair	Prof Helen Muir	Cranfield University
	Sandra Webber	DfT
	Andrew Ashbourne	DfT
	Abimbola Alli	DfT
	Dr Ray Johnston	Head of AHU, CAA
	Capt Tim Bamber	BALPA
	Dr Mark Popplestone	Virgin/BATA
	Capt Ian Pringle	BA/Flight Tech
	Prof Robert Maynard	HPA
	Dr John Cherrie	Institute of Occupational Medicine

Note of main points:

1. Introduction

Chair summarised COT review of evidence and recommendations leading to the first functionality test and subsequent report by Cranfield University.
A peer review of the report had been undertaken by academics in the UK, USA and Europe.
The final report of the first functionality test would be published shortly on the Department's website (note: published on 21 February).

2. Samples

Chair explained how the various devices had performed during the first phase of the functionality test.
Results from the Solid Phase Microextraction Fibres (SPME) devices were not convincing. These devices would be dropped.
It was suggested that Photoionsiation Detector Samplers (PIDS) may not be sufficiently sensitive for compounds with low concentrations (although they would probably respond to all volatiles such as perfumes, w/c and galley smells, etc.). A particle counter was suggested as an alternative. Models were already on the market which could give an instant read-out, and capture tiny concentrations of compounds.
In discussion it was agreed that particle counters, PIDs and pumped tubes were the way forward for monotoring aerosols and volatiles in real time.
After challenge, the committee accepted the complexity of the study plan, as acceptable research could not be done on the ground or using a single aircraft.

3. Swabs

It was agreed that swab samples from internal surfaces of the cabin would be valuable. These should be taken from clean, neutral surfaces (e.g. glass or metal) over a period of time.
As a control, similar swabs should be taken from similar surfaces on other transport modes (e.g. buses, trains, airport vehicles). The Chair will have a discussion with Dr. Cherrie before proceeding.

4. Questionnaires

A questionnaire would be provided to the pilot, co-pilot and researcher for completion following each test, irrespective of whether a fume event occurred. The scientist should not tell the crew whether the sampling devices had detected an irregularity as it was important to test the correlation between smell and compounds.

5. Irritancy

It was noted that all persons had some degree of sensitivity to some level of substance. Pilots were no different. The committee needed to acknowledge it would not be possible to determine levels of concentrations that affected no-one.

6. Laboratories

The committee argued for consistency and compatibility between labs involved in analysis of samples. Every test should have two samples – one to be sent to each lab. Labs should present results according to an agreed methodology. Dr Cherrie would look over this.
Labs should cooperate to collect and analyse each others’ samples.
The detailed design of the next phase of tests, including the role of the labs and the statistical design of the study, should be submitted to the ethics committee at Cranfield University.
The possibility of peer review of the project design was left open. This may be most valuable at a phase of research after functionality tests.

7. Possible American cooperation

The Chair would contact Prof Jack Spengler of Harvard about possible cooperation with the FAA.
There was potential to incorporate US kit into next phase of functionality testing, subject to agreed protocols with project manager and participating airlines being content.

8. Next meeting

Scheduled for mid June when some further tests had taken place. Exact date to be confirmed.

Annex C: Transfer of the chair of the AHWG to the AHU

We welcome your views on the proposal to transfer the chair of the AHWG to the AHU

In the recent House of Lords inquiry into air travel and health, it was recommended that the "AHU and the CAA work together with Government departments and the aviation industry in raising the profile of its work so that it becomes the focus for airlines, passengers and health care professionals in their quest for information on aviation health matters".

The Government has accepted this recommendation. In our response to the HoL (not yet published) we said we would consult colleagues about transferring the chairmanship of the inter-departmental Aviation Health Working Group (AHWG) from the DfT to the Head of the AHU. DFT considers that transferring the chair would give the AHU the higher profile the Lords recommend and enhance the complementary nature of the work of both the AHU and the AHWG. DFT would expect to remain fully engaged as the Government Department with statutory responsibility for the health of persons on board aircraft. Specifically, the Department would retain responsibility for the continuing study into the cabin air environment.

Background

The Civil Aviation Act 2006 amended existing legislation and charged the Secretary of State with "the general duty of organising, carrying out and encouraging measures for safeguarding the health of persons on board the aircraft".
When the Act entered into force, the functions of the CAA were also amended to include the health of persons on board the aircraft.
The 2007/8 House of Lords inquiry into Air Travel and Health recommend that the AHU and the CAA work together with Government departments and the aviation industry in raising the profile of its work so that it becomes the focus for airlines, passengers and health care professionals in their quest for information on aviation health matters.
In response the Government committed to consult colleagues during 2008 about transferring the chairmanship of the inter-departmental Aviation Health Working Group (AHWG) from the DfT to the Head of the AHU.
In March 2008, the AHU produced guidelines for medical professionals on assessing fitness to fly. A press release was issued by the CAA on 25 March 2008 with a link to the new guidelines (please see attached).