AIRBORNE CHEMICALS in-aircraft cabins   A presentation to Aerospace Medical Association, Air Transport Medicine Symposium, Houston, May 7, 2000   By Jean Christophe BALOUET and Chris WINDER   Introduction Q  Airborne chemicals - all chemical contaminants in vapor and particle (aerosol) phases (Environmental Tobacco Smoke ETS not included in this presentation). Q  Includes: VOCs, semi-VOCs and non-Volatile compounds Q  Same contaminant may be in gas and particulate phase. Q  Over 1000 contaminants have been identified in buildings. Q  Over 500 in cabin air. Q  Contamination sources and sinks. Q  Normal Commercial Practice (CP) and Failure Conditions (FC), maintenance procedures, the use of more or less toxic compounds,  do certainly influence contamination level and toxicity issues. Q  Data from Air Quality Investigations.   Q     application of de-icing fluids; Q     hydraulic fluid leaks from landing gear and other hydraulic systems and their ingestion by Air Conditioning Systems (ACS); Q     preservatives of aircraft skin and structure; Q     accumulations of fluids in belly, dirt and brake dust build up by APU inlet or ingestion by rear engines; Q     ingestion of oil and hydraulic fluid at sealing interfaces, around oil cooling fan gaskets and in worn transitions; Q     engine combustion products (for example, defective fuel manifolds, seal failures, engine leaks); Q     on ground contamination sources; ingestion of exhaust from other aircraft; Q     cleaning and maintenance operations; Q     passenger services and passengers metabolites. Q      SAE panels on air quality and airborne chemicals   General Toxicity Concerns Q   Flight safety and incapacitation of flight crew. Q   Emergency situations (with flight crew in control of airplane and cabin crew in directing emergency evacuation). Q   Occupational health of airline employees. Q   Health of passengers - in exposure situations (most notably frequent fliers). Q   Health of passengers - susceptibility, sensitive individuals and children. Q   Individual chemicals , intensity and duration of exposure. Q   Interaction of hypoxia of altitude and toxicity (for example, CO 46% more toxic at cabin altitude). Q   Interactions of combined exposures (blends), whereby exposure to different chemicals can have additive, potentiation or synergistic effects.  Q   Summation approaches in mixed exposures should remain < 1:   C1/AEL1 + C2/AEL2 + C3/TLV3 + … Cn/AELn > 1 to be prevented Where C = Concentration in air, AEL = “Acceptable” Exposure Level Q   Availability of control measures that can reduce exposure, risks.     Use of TLVs at Altitude Threshold limit values are used for: Q  inhalational exposures to single exposures in the working environment; Q  must be reduced if exposure occurs to more than one chemical; Q  do not take into account skin exposure; Q  DO NOT APPLY TO ALTITUDE SITUATIONS     Aviation Requirements Q FAA/JAA: CO, CO2, O3, NOx, SOx, Particulates, Pressure, Airflow  (O3 not yet covered by JAA). Q FAR/JAR 25.831:  “Under normal operating conditions and in the event of any probable failure conditions of any system which would adversely affect the ventilating air, the ventilation systems must be designed to provide a sufficient amount of uncontaminated air to enable the crewmembers to perform their duties without undue discomfort or fatigue and to provide reasonable passenger comfort.” Q FAR 23.831: “For pressurized airplanes, the ventilating air in the flight crew and passenger compartments must be free of harmful or hazardous concentrations of gases and vapors in normal operations and in the event of reasonably probably failures or malfunctioning of the ventilating, heating, pressurization, or other systems and equipment”.    Implementation      Principal Air Quality Investigations (1983-1998) Q     1983:       -      US Air Force study on years 1970/79 smoke/fumes in the cockpit;       -      US NTSB: investigating unexplained crashes/supposed             incapacitation related to engine oil contamination;       -      Tashkin et al: Respiratory symptoms of flight attendants             during high altitude flights. Q     1989: US DoT Airliner Cabin Environment Q     1996: US Congress, continuing in 2000. (ICAO , Air Transport Medicine  proposal to investigate Cabin Air Quality) Q     1998: NIOSH/FAA : ongoing until 2002.   Principal Air Quality Investigations (1999-2000) •       1999 : –    Australian Senate started 1999, ending June 2000, Air Quality on BAe 146. –    Sweden BASI (with reference to Malmo incident dated November 12, 1999) –    FAA/JAA: Terms of Reference TOR 1 (TOR #2 draft to be released in June 2000).                                                                •       Starting 2000: –    House of Lords, –    FAA, US National Academy of Sciences, –    European Air Transport Commission : passengers rights –    ASICA: Simulation and management of cabin-air, industry consortium supported by EU.   Pending Investigations USA   FAA / NAS : Sect. 725 of Bill Number H. R. 1000 : Dated April 5, 2000. It will instigate a year long study by the US National Academy of Sciences, in conjunction with the FAA:                  …”including the collection of new data” …”to identify contaminants in the aircraft air and develop recommendations for means of reducing such contaminants.” … “Assessment and quantitative study of: Contaminants of concern…, the systems of air supply, including the identification of means by which contaminants may enter such systems, … the toxicological and health effects of the contaminants of concern, their byproducts, and the products of their degradation; … Any contaminant used in the maintenance, operation or treatment of the aircraft…; Actual measurements of the contaminants of concern in the air of passenger cabins… Pending Investigations UK House of Lords, Technical Sub-com. No. 2 : Airline Cabin Environment Enquiry, Released March 29, 2000, comments to be received by May 2. 1    Which features of the aircraft cabin environment have an adverse effect on the health of passengers and crew? What are these effects? 3    To what extent does the health of passengers and crew influence national and international regulators, manufacturers, and airlines when considering civil aircraft designs and changes in practice? Will projected developments in the design and use of civil aircraft affect the health hazards of air travel? 4    Is the enforcement of the regulations governing the aircraft cabin environment adequate throughout the lifetime of an aircraft’s operation? … Are the minimum standards adequate to ensure that the health of passengers and crew is not compromised in the competition to reduce air fares? 5    To reduce the risks of adverse health effects for passengers and crew, what changes might be made…? Pending Action EU Air Passenger rights in the European Union        A Consultation Document on Consumer Protection in Air Transport Issued by Air Transport Directorate (comments by March 1 2000). Section D : Conditions in the aircraft cabin, D . Air Quality/radiation      “Incontestable research results in this areas are, however, often not available”. Before drawing conclusions, it is necessary to make an independent evaluation of research that has already been carried out and assess the need for further research.”        Possible Action: Scrutiny of existing work and some further research appears to be needed on all these health related issues.   ASICA : Air simulation and Management of cabin air   Pending Action: FAA / JAA •       TOR # 1  : FAA/JAA Harmonization on Occupational Health & Safety: “The FAA believes that a comprehensive review and development of harmonized cabin environment regulations should be accomplished to address passengers, crewmember and industry concerns.” Task A. (1) :  JAR. 25.831 does not have similar requirement regarding “probable failure”, “uncontaminated air”, “undue discomfort or fatigue”, and “reasonable passenger comfort” whereas FAR 25.831 has. Definition of above terms. Review current airplane capabilities (e.g. under normal operating and in the event of any probable failure does the ventilation system provide sufficient uncontaminated air into the cabin, etc) and airline practices…” •       TOR # 2 to be released in June 2000                           Note: the previous three actions cover cabin environment, not just the airborne chemicals     Aerotoxic Syndrome Features: 1    Associated with air crew exposure at altitude to atmospheric contaminants from engine oil or hydraulic fluids. 2      Chronologically juxtaposed by the development of a consistent symptomology of irritancy, toxicity, and neurotoxicity/sensitivity. 3    Short term effects, but long term syndrome apparent. Clusters of Symptoms Q      Irritation of eyes, nose and throat         Q      Neurotoxicity Q      Neuropsychological symptoms Q      Skin problems Q      Respiratory problems Q      Cardiovascular symptoms Q      Gastrointestinal symptoms Q      Chronic fatigue, chemical sensitivity     Symptoms in Aerotoxic Syndrome (short term exposure) Symptoms from single or short-term exposures include: Q   Irritation of eyes, nose and upper airways. Q   Neurotoxic symptoms:  blurred or tunnel vision, nystagmus, disorientation, shaking and tremors, loss of balance and vertigo, seizures, loss of consciousness, parathesias. Q   Neuropsychological symptoms: memory impairment, headache, light-headedness, dizziness, confusion and feeling intoxicated. Q   Gastro-intestinal symptoms: nausea, vomiting, abdominal cramps. Q   Respiratory symptoms:  cough, breathing difficulties (shortness of breath), tightness in chest, respiratory failure requiring oxygen. Q   Cardiovascular symptoms:  increased heart rate and palpitations.      Neurotoxicity is a major flight safety concern, especially where exposures are intense. Symptoms in Aerotoxic Syndrome (long term exposure) Symptoms from long term low-level exposure include: Q   Irritation of eyes, nose and upper airways. Q   Neurotoxic symptoms: numbness (fingers, lips, limbs), parathesias. Q   Neuropsychological: memory impairment, forgetfulness, lack of co-ordination, severe headaches, dizziness, sleep disorders. Q   Gastro-intestinal symptoms: salivation, nausea, vomiting, diarrhoea; Q   Respiratory symptoms:  breathing difficulties, tightness in chest, respiratory failure, susceptibility to upper respiratory tract infections; Q   Cardiovascular symptoms:  increased heart rate and palpitations; Q   Skin symptoms: skin itching and rashes, skin blisters, hair loss; Q   Sensitivity: signs of immunosupression, food and alcohol intolerances, chemical sensitivity leading to multiple chemical sensitivity Q   General: weakness and fatigue (leading to chronic fatigue), exhaustion, hot flashes, joint pain, muscle weakness and pain, glandular problems.   Conclusions What will hopefully be addressed:   Q  List of Airborne Chemicals: still confidential at this stage although over 500 individual chemical identified . Q  Crew symptoms worked out: earlier publications and case studies   (> 100 with severe long term adverse health effects). Short term and Long term. Neurotoxicity (and flight safety), health and comfort . Q  Logs: maintenance, top up, flight deck and cabin crew symptoms and  correlation with documented leak/contamination events, statistics suggest (< 1/160 flights). Q  International Coordination: increased benefits in sharing data, arranging agendas to ensure data availability, international database. Q  US NAS, FAA / JAA -TOR-, EU, House of Lords, AsMA