Aircraft cabin air quality: an overview [correction of overvier].

In recent years, there have been increasing complaints from cockpit crew, cabin crew, and passengers that the cabin air quality of commercial aircraft is deficient. A myriad of complaints including headache, fatigue, fever, and respiratory difficulties among many others have been registered, particularly by flight attendants on long haul routes. There is also much concern today regarding the transmission of contagious disease inflight, particularly tuberculosis. The unanswered question is whether these complaints are really due to poor cabin air quality or to other factors inherent inflight such as lowered barometric pressure, hypoxia, low humidity, circadian dysynchrony, work/rest cycles, vibration etc. This paper will review some aspects relevant to cabin air quality such as carbon dioxide (CO2), carbon monoxide (CO), ozone (O3), particulates, and microorganisms as well as the cabin ventilation system to discern if there is a possible cause and effect of illness contracted inflight. The paper will conclude with recommendations on how the issue of cabin air quality may be resolved.

Operation Homecoming: 25 years later.

Following an end to U.S. involvement in the Vietnam War in early 1973, approximately 600 Army, Navy, Air Force, and Marine personnel, the great majority aviators, were released from captivity in North and South Vietnam and Laos. Their initial medical evaluation was performed at USAF Hospital, Clark Air Base, Republic of the Philippines, between February and April 1973. The author describes the events of those memorable days.

Inflight medical kits.

Great controversy surrounds the issue of United States (US) air carrier inflight medical kits. Although there are four medications mandated by the Federal Aviation Administration (FAA) that appeared to be adequate as determined by a 1988 survey, there is now a renewed call to review the medical kit contents with an eye toward making them more robust. This has been prompted by several well publicized inflight medical events and the fact that overseas airlines have a very wide array of pharmaceuticals and supplies. Consequently, the Aerospace Medical Association (AsMA) convened a Task Force of physicians across the major specialties to put forward recommendations regarding medication, medical supplies, and automatic external defibrillators (AEDs). These deliberations were based upon a survey of AsMA physician members.

Passenger safety, health, and comfort: a review.

Since the birth of aviation medicine approximately 80 yrs ago, practitioners and scientists have given their attention primarily to flight deck crew, cabin crew, and ground support personnel. However, in more recent years we have broadened our horizons to include the safety, health, and comfort of passengers flying commercial aircraft. This will be even more compelling as more passengers take to the air in larger aircraft and flying longer hours to more distant destinations. Further, we can expect to see more older passengers because people in many countries are living longer, healthier lives. The author first discusses the stresses imposed by ordinary commercial flight upon travelers such as airport tumult, barometric pressure changes, immobility, jet lag, noise/ vibration, and radiation. Medical considerations are next addressed describing inflight illness and medical care capability aboard U.S. air carriers. Passenger safety, cabin air quality, and the preventive medicine aspects of air travel are next reviewed in the context of passenger safety, health, and comfort. Recommendations are addressed to regulator agencies, airlines aircraft manufacturers, and the aerospace medicine community.

Aerospace air pollution issues.

Practitioners of aerospace medicine are mindful of the environmental effects, particularly air pollution, caused by aviation and spaceflight operations. To an aerospace medicine specialist, the environment includes not only the air, water, and soil of the earth, but also the cabin milieu of aircraft and space vehicles where crews must work, sleep, and in some cases, live. Consequently, this article will address the following areas of concern: cabin air quality of aircraft, cabin air quality of space vehicles, noise, air pollution, and aerial spraying.

Aviation medicine.

There is debate about whether pilots infected with the human immunodeficiency virus should be permitted to pilot an aircraft. Approximately three in-flight medical emergencies occur each day, with physicians, flying as passengers, responding to 85% of them. There is no evidence that tuberculosis is any more likely to be contracted on a commercial airliner than on any other public conveyance.

Telemedicine and international disaster response: medical consultation to Armenia and Russia via a Telemedicine Spacebridge.

UNLABELLED: The Telemedicine Spacebridge, a satellite-mediated, audio-video-fax link between four United States and two Armenian and Russian medical centers, permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa. METHODS: During 12 weeks of operations, 247 Armenian and Russian and 175 American medical professionals participated in 34 half-day clinical conferences. A total of 209 patients were discussed, requiring expertise in 20 specialty areas. RESULTS: Telemedicine consultations resulted in altered diagnoses for 54, new diagnostic studies for 70, altered diagnostic processes for 47, and modified treatment plans for 47 of 185 Armenian patients presented. Simultaneous participation of several US medical centers was judged beneficial; quality of data transmission was judged excellent. CONCLUSION: These results suggest that interactive consultation by remote specialists can provide valuable assistance to on-site physicians and favorably influence clinical decisions in the aftermath of major disasters.

Telemedicine and international disaster response. Medical consultation to Armenia and Russia via a Telemedicine Spacebridge.

UNLABELLED: The Telemedicine Spacebridge, a satellite-mediated, audio-video-fax link between four United States and two Armenian and Russian medical centers, permitted remote American consultants to assist Armenian and Russian physicians in the management of medical problems following the December 1988 earthquake in Armenia and the June 1989 gas explosion near Ufa. METHODS: During 12 weeks of operations, 247 Armenian and Russian and 175 American medical professionals participated in 34 half-day clinical conferences. A total of 209 patients were discussed, requiring expertise in 20 specialty areas. RESULTS: Telemedicine consultations resulted in altered diagnoses for 54, new diagnostic studies for 70, altered diagnostic processes for 47, and modified treatment plans for 47 of 185 Armenian patients presented. Simultaneous participation of several US medical centers was judged beneficial; quality of data transmission was judged excellent. CONCLUSION: These results suggest that interactive consultation by remote specialists can provide valuable assistance to on-site physicians and favorably influence clinical decisions in the aftermath of major disasters.

Telemedicine: military applications.

Communications technology has enjoyed enormous growth in recent years and should be fully exploited by the medical community. Its application as part of disaster response was well demonstrated in the aftermath of the tragic earthquake in Soviet Armenia in 1988. Besides disaster response, telemedicine also has application for patient care, diagnostic imaging, and training and education. This capability would be particularly beneficial to the armed forces of many nations. If the communications equipment were portable, it could be well employed during peacetime, yet easily deployed to the battlefield. Therefore, armed forces should fully exploit telecommunications technology for the practice of military medicine.

Health promotion: a perspective.

Although absolute proofs are sometimes lacking, advocates of health promotion tout physical fitness, proper nutrition, abstinence from smoking, and lower blood lipid levels, among others, as essential for a longer, healthier life. USAF implemented a Coronary Artery Risk Evaluation Program (CARE) several years ago and is now considering expanding it in scope in order to provide its beneficiaries with a comprehensive health promotion program. Although noncompliance, as well as philosophical/ethical issues, appears at times to be an obstacle, physicians should not be discouraged nor deterred.

Polycystic kidney disease and the flyer.

Polycystic kidney disease (PKD) is a disorder occasionally detected in aircrew members. Complications associated with PKD include hypertension, urinary tract infections and calculi, and cerebral or abdominal aneurysms with the most frequent cause of death, uremia and renal failure. The prognosis for PKD is variable in that it is a benign disorder for some patients whereas others are fraught with these complications. Many airmen with PKD can continue with cockpit duties as long as there are no potentially incapacitating symptoms. Of particular importance is good blood pressure control for those with hypertension.

Percutaneous nephrolithotomy and the flyer.

Percutaneous nephrolithotomy (PN) is a relatively new procedure that is coming in vogue for the removal of upper urinary tract stones. Although there are possible complications from the procedure--bleeding being the most common one--its advantages make it a desirable treatment modality vis-a-vis conventional surgery. This article describes the case of a pilot who underwent PN, but remained disqualified from flying status for 6 months because of an unfortunate complication.