Published in "Panorama"
Flying Safe … As much the passengers’ responsibility
Almost one billion people travel by air every year and this is likely to double over the next decade. Greater numbers of people are traveling today, not only for business purposes, but for tourism and medical treatment. Air travel, says Dr.Alasdair Beatton, Group Medical Officer, Emirates Airlines, Dubai, “is the safest mode of any form of transport. This has been proved statistically over the years. When you consider the number of people who fly, crash accidents apart, the problems that occur with flying per se, are exceedingly small.”
Much controversy has been sparked off with the death last year of 28 year old Emma Christofferson from Deep Vein Thrombosis (DVT) following a 20 hour economy flight from Australia to London. Even as the debate rages unabated with studies yielding conflicting results, Dr.T.N.Paliwal, Specialist in Aviation Medicine,Dubai, states, “In one study about 200 cases of DVT were discovered over 10 years while in another study which was done in a Honolulu Hospital, 44 cases were reported with DVT over a period of 6 years due to a long haul flight. Of these 44 cases, 16 were pulmonary embolism.”
What is DVT? Do only economy class passengers face risk from it? Will it happen only when on air? Is it always fatal?
Explains Dr. Paliwal, “To term DVT as economy class syndrome itself is a misnomer. The cramped leg space associated with the economy class does aggravate symptoms that could be potential fatal. But anyone who suffers a DVT in aircraft may not necessarily have developed the initial symptoms while on air. Also, the symptoms could take upto 30 days to become manifested, well after a journey has been completed.
Elucidating on risk factors of DVT, Dr.Nasser ……Specialist, Aviation Medicine with the U.A.E Airforce, says, “The dry environment in the aircraft can lead to dehydration; further, the cramped upright position of many economy class seats can compress the veins in the legs, reducing blood circulation back to the heart. Being inactive for long periods during the flight can also mean that blood pools in the lower leg and in your feet, increasing the chance of clotting. The most common, serious complication of DVT is a pulmonary embolism where the blood clot breaks free from a vein wall, travels to the lungs and blocks an artery. This can be life threatening and needs immediate medical attention.”
Continues Dr.Nasser, “Other risk factors include people over the age of 40 years, pregnancy, personal or family history of DVT, recent major surgery or injury, especially to the lower limbs or abdomen, oestrogen hormone therapy including oral contraceptives, obesity and being overweight, smoking, alcohol and particular medications.”
“The common symptoms of DVT include tenderness and redness in the affected area, pain and swelling in regions drained by the vein where the blood clot is located and fever.”
Elaborates Dr.Nasser, “The consensus of advice to minimize the risk of DVT includes:
1. Keeping your body well hydrated by drinking plenty of water throughout the flight;
2. Avoiding alcohol and caffeinated drinks such as coffee and colas.
3. Wearing loose-fitting clothes; avoid wearing tight socks and trousers
4. Not sleeping for long periods on a flight.
5. Performing simple exercises while sitting, wriggling your toes and raising your feet onto your toes.
6. Walking up and down the aisle for a few minutes at least twice an hour.
7. Taking an aspirin before the flight to reduce the ability of the blood to form clots. If you are already taking medication, please check with your physician. Aspirin should never to given to children under 12.”
However, while DVT is not exclusive to air travel and may occur in people exposed to prolonged cramped postures and attending risk factors, it is equally true, that DVT alone is not the health problem faced by air travelers. “The stresses of flight itself,” opine Drs. Paliwal and Beatton, “may bring on their own problems of aggravating existing symptoms, besides airsickness, jet lags, eye irritation, ear pains and premature births.”
The stresses of flight – short or long haul, include the airport hassles of long wait for check-in, long distance walks within the airport and delayed flights, apart from passenger-created problems of lugging heavy hand baggages, rushing to check-in late, et al. “The aircraft factors,” explains Dr.Paliwal, “include lower pressure in the cabin which is kept at between 5000 feet to 8000 feet altitude (most healthy people can tolerate this for long periods of travel), active and passive smoking hazards and low humidity due to dry air entering the cabin at high altitudes.”
Who then are the people whose symptoms may be aggravated on flight? Once again these are people with cardio vascular conditions, diabetics, women who are beyond the 36th week of pregnancy, anaemic people whose haemoglobin count is below 8.5 gms and if their anaemia is of recent origin or they have bled recently.
“Most airlines”, says Dr.Paliwal, “allow ladies to fly till 36 weeks pregnancy. But air travel should be avoided if vaginal bleeding is present during pregnancy, particularly during the first three or last three months. Besides, all pregnant women should take certain precautions while traveling on air which include wearing seatbelts with the lap belt going over the upper thighs or pelvis to avoid injury to the foetus, sit in the aisle seats having more leg room, walk and stretch every two hours during long haul flights.”
For those suffering from hypoxia(low oxygen in blood), asthma, bronchitis, should refrain from smoking and keep out of areas exposed to cigarettes, because the cigarette smoke further reduces the level of oxygen in the blood, aggravating the existing condition, according to Dr.Paliwal.
Airsickness is the commonest problem faced by most passengers, particularly infants and young children. Symptoms of airsickness include heavy feeling in the stomach, sweating especially over the forehead, increased salivation and feeling of nausea. And the best way to cope with this says Dr.Paliwal “would be to sit close to the wing of the aircraft since the effects of turbulence are felt least in this region, to gaze at the horizon through the window since this gives you a sense of direction, avoid excess intake of fluids, direct the cool air vent towards the face and avoid reading or closing the eyes.”
The take-off and more specifically, descent, may be particularly stressful for infants and young children since their ear clearing function is not well developed, claims Dr.Paliwal. “It’s best to keep infants and young children awake during this phase because this is the time when it can be a most painful condition for him if he doesn't equalise the pressure in the ears. This is the time when a feed should be given to a child. By sucking in motion inside the mouth, he is opening the tube. Also there is a process called valsalva which you can do: close the mouth and nose and try to push air through the ears. Even a swallowing procedure is good enough to open the ears. This is one reason why sweets are served during take-off. Should children be having a cold, they should be given nasal decongestant 30 minutes before the flight and prior to landing.”
Another problem commonly associated with flying is dryness of eyes. Clarifies, Dr.Paliwal, “People who use contact lenses may have insufficient tear formation to keep the lenses lubricated. So it’s better for these people to carry artificial tears.”
Though we may not attach much importance to problems associated with jet lags, these could have long reaching consequences, particularly for those persons who are out for only 2-3 days on business. They need to be functioning at their optimum efficiency to clinch deals, which means quick recovery from jetlags! Dr.Paliwal explains, “The body’s internal clock controls sleep, wakefulness, moods and hormone secretion. After flying over some time zones, a passenger may feel tired, have sleeping difficulty and drowsiness during the day. These symptoms occur due to desynchronisation between inner body clock and the outer environment. The factors affecting severity of jetlag include the number of time zones crossed, the direction of air travel- westward travel is better tolerated than eastward, amount of disturbance during the travel, cumulative sleep loss experienced, excessive smoking or alcohol during flights. Depending on the number of time zones involved, wearing off from jetlag may take between a day to a week.”
The solution says Dr.Paliwal “lies in earliest adjustment to the new time zone. Some airlines have started serving meals according to the meal times of the destination. Exposure to natural light and involvement in social activities at destination are some other things that can help. Judicious use of sleep, caffeine and mild hypnotic is required. A recent research strategy suggests using of melatonin capsules to combat the fatigue from jetlag.
However, to make air travel safe and comfortable, passenger co-operation is a must, emphasizes Dr.Beatton, “for there is a lot that airlines do to ensure this. The worst that can happen to a passenger on air is to become progressively ill should he be already suffering from cardiac ailments, diabetes or be in an advanced stage of pregnancy. This may include precipitation of labour to cardio-respiratory problems or even heart attacks. Diverting the flight to a foreign country, not the destination, may not always be possible and where possible, it may not be the ideal solution. We, at the Emirates Airlines, at least, carry an extensive emergency medical kit which is reviewed and improved every few years. This kit exceeds the minimum requirement very significantly and includes aids for burns, fractures, sprains and strains, epilepsy, cardiac drugs, steroids, anti allergics, anti diabetics, intravenous and childbirth equipment, besides defibrillators and extra oxygen supplies if notified of a problem.”
In addition, airlines crew are trained in first aid and also know to use the equipment in the medical kit. “Besides,” explains Dr.Beatton, “Our crew are trained in both theory and practice of first aid, are examined and certified in all aspects of it; it is also incumbent that they pass these exams successfully failing to do which, they are re-tested. Further, they undergo an annual follow-up programme involving revision and updation of knowledge and techniques. In addition our crew have a special telemedicine link through a specialist hospital, Medlink on ground to tackle problems of a serious nature.”
“But to avail of these excellent facilities while on board,” clarified Dr.Beatton, “we rely entirely on passengers to furnish health details regarding themselves, prior to their departure. Passengers have to take the responsibility to make sure they’re fit enough to travel and if they have concerns about that, they should discuss the matter with their family physician and also with the airlines personnel. If more people did that, we would have fewer medical problems arising on flight.