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Select Committee on Science and Technology First Report

CHAPTER 5: summary of recommendations

Regulatory arrangements

5.1. We welcome the establishment of the AHU within the CAA. However, we 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. The AHU should become the body responsible for handling queries and complaints from passengers on health issues and should publish guidelines on how those queries will be handled.

5.2. We agree with the House of Commons Transport Committee that the United Kingdom cannot and must not transfer any further responsibilities from the CAA to EASA until it is clear that EASA is competent to exercise such responsibilities. We recommend that the Government make the strongest possible representations to the European Commission and EASA that the high priority afforded to aviation health in the United Kingdom as a result of the work of the AHWG, the CAA and the AHU must be replicated within EASA.

5.3. We applaud the Government for having taken the steps necessary to make aviation health a priority. The United Kingdom has always been at the forefront in aviation issues and our regulatory arrangements continue to be seen as a model by other countries. However, we recommend:

that the Memorandum of Understanding between the HSE and the CAA, and in particular its Annex 8, should spell out who has specific responsibilities for the health and safety of passengers;

that the HSE and CAA review the interpretation of "occupational health" as it applies to air crew, to ensure that emerging health issues are adequately reflected in regulatory arrangements.

Research

5.4. We recommend that the Government fully support Phase II of the WRIGHT Project including investigations on flight-related factors which may increase the risk of VTE, the relationship between seating and VTE, and effective preventive measures.

5.5. We recommend that the Government bring forward an amendment to Section 23 of the Civil Aviation Act 1982 which regulates the use of information from air crew medical records, so that anonymised data can be extracted and used to carry out epidemiological research projects.

5.6. We recommend that jet lag should be studied as a confounding effect of DVT as part of Phase II of the WRIGHT Project. Other research projects, such as FACE should include jet lag in their studies. We also recommend that the CAA, as the body responsible for the health and safety of air crew while on board an aircraft, commission a study into the possible long-term health effects that jet lag may have on air crew.

5.7. We recommend that in addition to contributing to international research projects, the Government and the Research Councils explore ways to increase the research capacity in aviation health that exists within the United Kingdom. A strong research base in this country is essential if awareness and understanding of aviation health are to be increased across the wider medical profession.

5.8. We find surprising and frustrating the number of EU-led research projects that have not published their reports. We recommend the Government should take an interest in these projects and if possible expedite the publication of their results.

The cabin environment

5.9. We recommend that the CAA implement the recommendations of its own research into aircraft seating standards, and increase the regulatory minimum distance between seats to at least 28.2 inches. The Government should also make the strongest possible representations to EASA on this subject when they take over responsibility on this issue.

5.10. We recommend that the Government urgently review the level of air passenger duty levied on "premium economy" seating. We further recommend that they explore ways in which the airlines can be encouraged to offer extra space to passengers for a modest premium.

Deep vein thrombosis

5.11. We recommend that the Government and the AHU work together with airlines and others in providing consistent travel advice to passengers on the risks associated with self-medicating with the intention of preventing DVT.

Infectious diseases

5.12. We recommend that the Government and the airlines advise passengers on the proven benefits of good hand hygiene in the reduction of disease transmission and in particular that passenger clean their hands before eating on board an aircraft. In the event of a disease outbreak that could lead to a pandemic, we recommend that as part of their contingency plans airlines flying from affected regions should provide bactericidal wipes and alcohol gels to limit the spread of disease in-flight.

5.13. We recommend that the Government and the regulators limit the amount of time that passengers can remain in an aircraft when the ventilation systems are non-operational to 30 minutes.

Air crew occupational health

5.14. We are reluctant to recommend the modification of CAP 371 until more evidence is presented. We recommend, however, that the Government together with the CAA (including the AHU), the unions and airlines work together to find a way of ensuring that pilots have appropriate rest periods and to monitor fatigue complaints by pilots. We also recommend that the CAA, as the body responsible for the health and safety of air crew while on board an aircraft, commission a study into the long-term effects of fatigue in air crew.

5.15. We welcome the fact that the Aviation Occupational Health and Safety Working Group, chaired by the CAA, is looking into noise-induced hearing loss. However, pending the outcome of this work, we recommend that the CAA work with airlines to review the availability of personal protection equipment so that pilots will be better able to protect their hearing.

Contaminated air events

5.16. We recommend that the CAA carries out an awareness campaign aimed at airlines and pilots to highlight the importance of reporting contaminated air events and encourages airlines to follow the spirit as well as the letter of the rules on reporting these events.

5.17. We recommend that the AHWG-sponsored research to identify the substances produced during a fume event be completed urgently. It should be followed up by an epidemiological study on pilots to ascertain the incidence and prevalence of ill health in air crew and any association there might be with exposure to the chemicals identified in the AHWG-sponsored study, paying particular attention to the synergistic effect of these chemicals.

5.18. We recommend that the Government works with manufacturers, airlines and the regulator to take effective action in preventing oil and hydraulic fluid leakages into the aircraft cabin.

5.19. We recommend that a protocol should be made available to health professionals, in particular Authorised Medical Examiners, on how to deal with air crew who suffer contaminated air events. We recommend that airlines, the regulators and the Government work together to improve the support given to pilots claiming to suffer ill health following a contaminated air event.

Information and education

5.20. We recommend that the Government and the regulators review the manner in which information on fitness to fly is offered, giving due consideration to their target audience. As the authoritative provider of information for passengers on air travel and health, the Government must ensure that information is available to all, not just people who have Internet access.

5.21. We recommend that the general practitioner postgraduate curriculum should include a basic overview of aviation medicine. Continuing professional development in the form of specialised courses should be made available for healthcare professionals with an interest in this area.

5.22. We further recommend that various specialties such as cardiology, orthopaedics and psychiatry follow the lead of the British Thoracic Society in producing guidelines on fitness to fly with the intention of informing GPs and other healthcare professionals; and that these publications should be made available in electronic form and hard copy to all GPs. In the course of time the collection of these guidelines would form a valuable (paper) reference manual.