In-flight problems
Dehydration
The circulating air in aircraft cabins is kept dry to protect equipment and this can mean passengers may become significantly dehydrated. Alcohol (especially spirits) and caffeine containing drinks can make this problem worse. Drinking adequate fluids (sufficient to keep the urine pale) is necessary and skin moisturisers can help dry skin.
Poor circulation and venous thrombosis
Sitting still for long periods in the inevitably cramped positions in aircraft frequently leads to swollen ankles and sometimes muscle cramps. Venous thrombosis in the legs and occasionally pulmonary emboli can occur but this is not unique to air travel and can occur whenever people are immobile for prolonged periods. Preventive measures should include general advice to all passengers. Regular stretching and mobility exercises should be encouraged and walking around the cabin if practical.
Those with risk factors (especially if 3 or more are present) such as those over 60 years of age, previous deep vein thrombosis, recent surgery or injury, pregnancy or those less than 2 months post-partum, malignancy, cardio-respiratory disease, other chronic illnesses, oestrogen medication
(contraceptive and hormone replacement), varicose veins and thrombophilia should discuss additional protective measures with their doctors.
Advice for those thought to be a special risk may include the use of graded compression stockings, a small dose of aspirin for its anti-adhesive effect on blood platelets or a single injection of low molecular weight heparin, given shortly before departure and for the period of risk. Similar advice is appropriate for travellers by bus or train who spend many hours immobile in cramped conditions.
Respiratory tract infections
There is no convincing evidence that re-circulation of air in aircraft cabins increases the risk of transmitting infections since very effective filters are used to remove bacteria and viruses. However sitting in close proximity for long periods next to passengers who are suffering, for example, from common colds or influenza clearly may increase the chances of a passenger becoming infected. This is why airlines discourage passengers from travelling while unwell with infectious conditions.
Tuberculosis
The World Health Organization advises that, with tuberculosis increasing worldwide, there is a small but real risk of catching the disease during air flights. Transmission has only been recorded in flights lasting over eight hours. The risk is clearly greater when many of those on board are from countries with a high incidence of the disease.
Skin Parasite infections
Occasionally head lice and other skin parasites have been passed through contact with aircraft seats when a previous passenger has been infested. Itching and a papular rash, for example, around the neck and occiput can result.
Fear of flying
In Britain an estimated nine million people suffer anxiety about flying and may miss out on professional and personal opportunities. There is no single personality-type prone to fear of flying and there may be a link with problems at work or home.
Fear may develop from a bad experience - a rough flight, or after a news report of a high jacking or crash. Panic attacks are common (sudden, intense anxiety, sweating and trembling). The sensation is often so frightening that the sufferer may from then on refuse to fly.
Advice for the traveller who is afraid of flying
- Explain that fear of flying is common and emphasize that flying is safer than road or rail travel in most developed countries.
- Try distraction by talking with other passengers, watching in-flight films, eating or reading.
- Tell the cabin crew. Reassurance about strange sounds can help.
- A visit to the doctor prior to travel can provide reassurance about general fitness for air travel.
- Consider a tranquillizer before departure. It should be stressed that these drugs do not mix well with alcohol.
Cognitive Behaviour Therapy: Recent research has indicated that "cognitive behaviour therapy" can be helpful for more severe cases. The person identifies what they actually fear, and then learns different ways of overcoming it.
Courses and counselling on fear of flying: Aviatours provide courses at Heathrow and Manchester airports (Tel: 01252 793 250).
Air rage
This term has recently been introduced to describe psychological or physical violence occurring within aircraft. It is of particular concern because of the cramped conditions inside an aircraft and the inevitable involvement of not only the cabin crew but also other passengers. There have been instances where aircraft have had to land prematurely to offload disruptive passengers and legal action taken against those involved.
What is air rage?
There is often a developing cycle of events, which may include delays, exhaustion due to lack of sleep, excessive use of alcohol sometimes to compensate fear of flying, minor irritations due to behaviour of fellow passengers which elsewhere would largely go unnoticed and sometimes anoxia causing irritability in those with pre-existing hypoxic illnesses.
Smoking and alcohol: It has recently been recognised that a common cause of air rage is nicotine withdrawal in heavy smokers on long-distance 'no smoking' flights. This has now been introduced by many airlines. Alcohol intoxication can also contribute.
Prevention
Nicotine gum or a mild tranquilliser may be useful 'prophylaxis'. Passengers should avoid excessive alcohol consumption and discouraging heavy drinking by their travelling companions. Airlines have the right to refuse to carry those who have previously caused disruption on a flight - warnings may be issued (the equivalent of 'yellow/red card system as used at football matches).
Jet lag
Changes to circadian rhythms
These regulate our sleep patterns, need time to adjust to changes in local time (usually about one day per time zone crossed). Westward travel may be better tolerated than eastward travel but problems occur when travelling in both directions. The effects of jet lag include - sleep disturbance, loss of appetite, nausea and sometimes vomiting, bowel changes (e.g. constipation), general malaise, tiredness and poor concentration.
- A relaxed flight is important.
- Avoid travelling when you are already tired and take rest before departure.
- Remember the actual home to destination travelling time will usually be at least twice the actual time spent in the air since it will include waiting in airports and often unexpected delays.
- Breaking very long journeys halfway with a stopover can be helpful.
- On the flight get maximum sleep aided by a mild hypnotic if necessary.
- Stretch and exercise as much as possible to aid circulation and prevent swollen ankles.
- Drink plenty of water or soft drinks to counteract the dry cabin atmosphere and remember alcohol in spirits and wine and also caffeine increase dehydration (caffeine is present in coffee, tea, chocolate, Coca (and Pepsi) Cola).
- Jet lag is made worse by a hangover!
- Avoid heavy commitments on the first day. Be prepared for tiredness in the evenings and early waking which can last up to 5 or more days.
- Hypnotics (sleeping tablets) such as temazepam have been shown to help sleep and correspondingly alertness during the following day. They do not speed up adjustment the new time zone and therefore may need to be used for several nights.
- Some travellers find taking regular melatonin helpful. It may help the body to adjust its circadian rhythms but its effect is scientifically unproven. It is not readily available in Britain but can be purchased in some countries such as USA and Hong Kong from health food shops or pharmacies.
Airline restrictions on flying
Airlines may not allow passengers with the following conditions to fly:
- Pregnancy beyond 36 weeks.
- Neonates during the first few days after birth (longer after premature births).
- Recent or current middle ear infections or sinusitis.
- Unstable psychiatric illness.
- Unstable epilepsy.
- Previously documented air rage or a record of previously causing disruption during flights (some airlines use a 'yellow card' warning system).
- Recent myocardial infarction.
- Moderate/severe heart failure.
- Moderate/severe hypoxic pulmonary disease.
- Recent chest, intracranial or abdominal surgery.
- Recent pnuemothorax.
- The presence of a communicable disease.
Airlines' regulations may vary so if in doubt advice should be sought from the medical department of the airline concerned.
Security in aircraft
None of the following are allowed in British Airways aircraft cabins (similar regulations are likely to be introduced by other airlines):
- Toy or replica guns (plastic or metal)
- Household cutlery
- Knives with blades of any length (including steel nail files)
- Paper knives
- Razor blades
- Tradesmen’s tools
- Darts
- Scissors of any size
- Hypodermic syringes *
- Knitting needles
- Sporting bats (including rackets, cricket bats and golf clubs)
- Billiard, snooker, or pool cues
- Catapults
- Corkscrews with blades attached
* Customers who require the use of hypodermic needles for medical reasons (for example, diabetics and customers with allergies), will be asked for proof of medical need. Please be advised that customers carrying any of the above items (with the exception of hypodermic needles) will be asked to place it in their hold baggage. Customers carrying hand baggage only will be asked to surrender the item for disposal by British Airways.
Altitude sickness on arrival
Healthy people may travel rapidly to 3500m above sea level but develop symptoms of acute mountain sickness after arrival (headache, nausea, breathing difficulty, mental confusion). Those with respiratory of cardiac problems may experience symptoms on arrival at even lower levels. A few airports are sited above this level, for example, in the Andes and Himalayas, which can mean symptoms, may present after disembarking.
An awareness of the symptoms can be helpful and care to avoid dehydration, aggravated by the dry aircraft cabin atmosphere, is important. Dehydration may worsen symptoms. Rest after arrival with only light activity is recommended because strenuous activity will worsen symptoms. Those with serious pre-existing hypoxic respiratory disease can seek advice prior to departure when an estimate of the degree of hypoxia occurring on exercise may be able to predict whether they will have problems
The above advice is appropriate for the majority of travellers. If you are at all unsure as to what measures are suitable for you, (eg if you are pregnant, or are suffering from a condition requiring special medication), it is recommended that you talk to your health advisor. This page is produced by the Scottish Centre for infection and Environmental Health.
