Judith Murawski reports on the efforts of aviation unions to win recognition for an invisible but often serious health hazard

Cabin crew-member Debbie D has just got back from a six-day longhaul trip. One look at her skin hives and swollen eyes and her doctor said she looked just like the migrant farm workers he treats for pesticide poisoning.

Avionics worker Stephen C noticed a powerful smell after removing an interior wall panel to gain access to a computer. By the time he drove home, he had chills and stomach cramping. Three days later, his tongue was so swollen and ulcerated that he had trouble breathing. Janitorial worker Karen S. had a strikingly similar experience after removing sheets of absorbent paper that had been laid down to soak up a chemical spill in the cabin.

Pilot “John Doe’ was recently made redundant on the basis that his company could not guarantee he would not suffer repeat exposure to toxic oil fumes in-flight. The company said his “sensitivity” was the problem, not the toxic fumes.

Cabin crew and passengers recently reported a rash of unexplained dizziness, fainting, and muscle weakness on a series of A330 transatlantic flights from the US. The reports were dismissed and the source never identified.

Most people would assume that these stories must be anomalies. Surely there must be standards for the quality and quantity of air supplied to the passenger cabin and cockpit. Surely airlines would not even countenance soaking a plane with pesticides shortly before crew and passengers board without meeting strict re-entry requirements.

Aviation workers, however, understand the reality – that the airlines are essentially self-regulating when it comes to the safety and health of their employees. On the ground, an inadequate supply of outside air (or a supply of contaminated air) has been associated with “sick building syndrome” but “sick aircraft syndrome” has yet to be recognised.

Led by the aircraft manufacturers and their suppliers, the airlines have painted a picture of chemically injured or ill workers as malingerers, or at best, misled. The manufacturers’ party line cites stress, dehydration, and motion sickness as the real roots of the problems, because of course, the air supply systems are in perfect working order.

Worse, the financial woes of the industry encourage additional cutbacks, with a prevailing wisdom that the airlines are in bad enough shape as it is without workers or their unions pushing for improvements to the quality of the air on board.

Coordinating a response
During the 1990s, increased communication between ITF-affiliated safety representatives highlighted the similarity in the symptoms reported by crew-members in different parts of the world. They were not restricted to one airline or one aircraft type. To formalise this process of information exchange and activism, an ITF-sponsored international task group on aircraft air quality held its first meeting in June 1999. Participants spanned the globe, but the stories they brought to the table were strikingly similar.

A first priority for the task group was to develop and distribute a standardised reporting form that all aviation workers, as well as passengers, could easily access to report any air quality problems. The airlines and regulators have no incentive to collect such reports because if they have no data, then there is no problem. Early in 2001, the ITF reporting form was formalised and published. Since then, the ITF has also launched an online reporting system that allows users to report any type of safety, health, and security incident.

Task group members had to define the problems with aircraft air quality, as well as come up with a unified approach to working towards change. The task group published a position paper that describes and addresses inadequate ventilation, substandard oxygen supply, chemical contaminants in the air supply, and exposure to pesticides. The bottom line is that clean, abundant air is essential to our health and well being, and to achieve this, specific changes can and must be made.

Our current focus is to boost the use of the online reporting system. When there is a problem, we want to know.

To meet the specific recommendations laid out in the position paper, some task group members in the US have been participating on a non-governmental committee that is developing the first-ever aircraft air quality standard. Opposing the efforts of big industry to exert undue influence on the process is half the battle, but some gains have been made. When finished, this standard will not be enforceable, but could serve as a possible model for the regulators to adopt because it includes input from crew-members. A first draft may be issued later in 2004, but it could still take years before the final standard is issued.

Meanwhile in Europe we are monitoring the progress of industry-sponsored research into air quality – which is being conducted without input from unions or crew. The results of this research are expected to form the basis of an air quality “pre-standard” that would apply to airlines based in the European Union.

It is not easy to try to change a system that has enabled airlines, manufacturers, and their suppliers to continually cut costs and corners at the expense of the health, safety, and comfort of crews and passengers worldwide.

The regulators do not keep track of the health impact of sub-standard aircraft air quality. The airlines do not monitor the air. Airline workers have no right to access the very records that prove the air made them sick. There is little recognition of these hazards among doctors, resulting in misdiagnosis, and the cards are stacked firmly in the airlines’ favour when it comes to workers’ compensation. In these difficult circumstances aviation unions have made considerable progress in defining the problems and increasing recognition, with some help from the media and concerned legislators.

Cabin crew complaining of headaches and dizziness should not be left to assume that stress, overwork and dehydration are the only culprits. The health effects associated with cabin air quality are real, debilitating and sometimes serious. Aviation unions can support their members by joining the ITF task force, getting informed and reporting any problems – no matter how small – to the international online database.

Judith Murawski is an Industrial Hygienist for the Association of Flight Attendants, AFL-CIO based in Seattle, WA, USA. For details of how to join the international task force on aircraft air quality check the ITF website at www.itf.org.uk/aviation or telephone the ITF Civil Aviation Section on + 44 20 7403 2733.

In the air

• The cockpit gets up to 20 times more outside air than the passenger cabin, and typically, none of it is recirculated.
• On most aircraft, about half the air supply is recirculated, and the source of moisture in the air is the breath of those on board.
• Ozone gas – a strong irritant that can lower immunity to infection – occurs naturally in the air at flight altitudes and can be pulled into the aircraft air supply.
• At maximum flight altitude, the oxygen supply in the cabin is about 75 per cent of what is in the air at ground level.
• Carbon monoxide gas exposure can occur during an incident when smoke appears in the cabin, and this is especially serious in-flight because the oxygen supply is already reduced.
• Any damage done to brain or nerve tissue during exposure to tricresylphosphates (TCPs, additives in many engine oils and hydraulic fluids) may not develop until weeks after an incidence of “smoke in the cabin.”
• Some airlines soak the planes with pesticides before crew and passengers board – or even during a flight. Nobody is warned in advance and menstruating or pregnant women, babies, and people who are immunocompromised are especially at risk of toxic effects.

Aircraft air quality problem	Some effects associated problem with exposure
Inadequate supply of clean, outisde air.	Difficulty concentrating, fatigue, outside air general malaise, headaches, possible increased risk of disease transmission.
Inadequate oxygen in-flight.	Bluish lips or nails, chest tightness/pain, confusion/giddiness, difficulty concentrating, dizziness, fainting, fatigue, headache, impaired judgment, nose bleed, vomiting, weakness.
Air supply contaminated with de-icing or exhaust fumes.	Chest pain, dizziness, de-icing fluid or exhaust fumes eye/nose/throat irritation, headaches.
Air supply contaminated with ozone.	Breathlessness, eye/nose/throat ozone irritation, chest tightness/pain
Air supply contaminated with heated oils or hydraulic fluids.	Balance problems, chills, memory heated oils or hydraulic fluids loss, mouth ulcers, muscle aches/twitching, seizures, stomach cramps, tingling, tremors, vertigo, vision problems; see also inadequate oxygen symptoms.
Pesticide exposure.	Anaphylactic shock, cough, difficulty breathing, dizziness, eye/throat irritation, fatigue, headache, immune and nervous system dysfunction, lung damage, nose bleed, rash/hives.
Any combination of the above.	Unstudied and largely unknown.