IATA - CABIN HEALTH CONFERENCE OCTOBER 2008 Captain Susan Michaelis Aviation Contaminated Air Reference Manual An overv

1. IATA - CABIN HEALTH CONFERENCE OCTOBER 2008Captain Susan MichaelisAviation Contaminated Air Reference ManualAn overview

3. Susan Michaelis - • Former Australian Airline Pilot.(1986-1997) –Ill health retired • Winner 1987 CASA Sir Donald Anderson award - Best academic merit • Commenced research 1997 (MSc 2002) • Head of Research - Global Cabin Air Quality Executive (GCAQE). • PhD research student at the University of New South Wales in Sydney, Australia. • Author of the Aviation Contaminated Air Reference Manual (2007). (ACARM)

4. Aviation Contaminated Air Reference Manual (ACARM)ISBN:9780955567209 • Published in 2007. • 1st time data has been collated. • 844 pages of key information. • Aviation industry data from 1953 – 2007 • Data is fully referenced / widely sourced • Covers all main issues from incidents, monitoring, health effects and flight safety

5. Industry documents -wide variety Published papers Surveys Union reports Defect reports Regulator reports Medical reports Legal / insurance reports Government data Scientists & doctors Aircrew & passengers Media Bureaus of air safety Industry meetings & conferences Military Academic reports ACARM data taken from:

6. RAAF Review:2008 • “…first-ever comprehensive and definitive attempt to document and encapsulate the problem of aircraft cabin air quality in one book.” • “..ground-breaking and seminal work.” • “A notable and distressing element of the data is the widespread prevalence of denial of the existence of the problem, particularly among the aircraft operators and aviation regulators.”

7. ACARM – Key Facts • Flight safety is being compromised. • Passengers and crews suffering short and long term health effects. • Data confirms FAA position of under reporting of events is significant. • Fume events are NOT rare. • Aviation ald OH&S regulations not being met. • Oil and hydraulic fluid contaminants are being found in various studies.

8. Chapter Breakdown….. 1/2 • Chapters1. Understanding the Problem.2. Flight Safety Aspects of Contaminated Air.3. What is in Contaminated Air.4. The Toxicology Debate.5. The Mislabelling of Engine Oils.6. Effects On Crews and Passengers - Symptoms Seen and Reported.7. Medical Side - Doctors and Scientists.8. The Kolvar & other Australian Incidents - Findings of the Australian ATSB.9. The Malmo BAe 146 Incident of 12 November 1999 and a Swedish Perspective.10. UK AAIB Report into the BAe 146 G-JEAK Incident of 05 Nov 2000.11. UK AAIB Report into the Boeing 757 G-CPER Incident of 07 Sept 2003.12. Frequency of Events and Under Reporting.13. ASHRAE.14. The ITF and the International Task Group on Aircraft Air Quality15. Regulations to Protect Us.16. The Exposure Standard Debate.

9. Chapter Breakdown….. 2/2 • Chapters17. What They Knew and What They Did: a BAe 146 Analysis.18. The Inquiries.19. The Public Conferences Including the 2005 BALPA Conference.20. The UK Civil Aviation Authority Report - Cabin Air Quality 2004.21. US Perspective.22. The Airline Industry Misinformation Campaign.23. Occupational Health Research Consortium in Aviation (OHRCA) Project.24. SAE.25. UK Committee On Toxicity (COT)26. Filtration.27. Canadian Perspective..28. Important Dates in the Chronology of the Contaminated Air Debate.29. Solutions and the Future.

10. Appendices Breakdown 1/2 • AppendicesA01: Typical Aircraft Air System.A02: Incidents on the UK database as of 1 August 2006.A03: Chemicals reported found in aircraft cabins and cockpits.A04: MSDS extracts data of chemicals found in commercial aircraft.A05: BAe 146 Service Bulletins, Service Information Leaflets and Data confirming CAQ problem.A06: BAe 146 Contaminated air events given to the Australian Senate by the FAAA.

11. Appendices Breakdown 2/2 • AppendicesA07: USA Contaminated air events as of 18 August 1997 listed in a NIOSH HHE application.A08: AOPIS COT Committee report 'AOPISCOT024' dated 3 July 2006.A09: ASRS data: 'Smoke/fire/odor related incidents involving ATR 42, B757 & BAe 146 aircraft.'A10: Air monitoring research summary.A11: AOPIS COT Committee report 'AOPISCOT025' dated 26 February 2007.A12: AOPIS response to COT - TOX 2006/39 and TOX 2007/10 dated 16 March 2007.

12. Chapter 2: Flight Safety aspects of contaminated air • Flight Safety is definitely being compromised • Global issue • Impairment is occuring in flight: Cabin crew & Pilots • Regulations are not being met • Airline industry is not treating contaminated air adequately as a flight safety issue: Often dismissing as an OH&S issue

13. Chapter 3: What is in Contaminated air? Appx 3,4,10 • Extensive mixture of contaminants • Hazardous substances • Organophosphate, TCP (antiwear additive) at 3% - (ortho isomers >0.3% [Mobil 2000] - hazardous / toxic levels • PAN, skin sensitizer (antioxidant) - 1% - Hazardous levels • BNA – Cat 1 known & prohibited human bladder carcinogen • Synergistic mix of contaminants • Adequate testing has not been done • TCP is being found in aircraft swab samples, air monitoring & pilots blood

14. Where Has TCP been identified? • TCP found in crew blood tests and on crew clothing. • TCP found in swab tests from the surface of the flight deck & cabin walls and in cockpit roof top filters, HEPA filters. (2005-2007) • Australia, UK, USA, Europe • B747,B777,B767,B757,B737,A330,BAe146,MD80,DCH8: 85% positive • TCP found in aircraft ducting. (CAA 2004) • TCP found in air sampling by RAAF (1988, 2005) and Honeywell (1997,2000), Qantaslink(1998) • Allied Signal 1997: TCP detected 4 times greater than allowed (Australian Senate, 2007) • TCP identified in Cranfield University DfT testing 2007 • CO detected in flight on the BAe 146 in 83% of surveyed flights. (ACARM 2007)

15. Contaminated air is predominantly related to oil fumes • Rolls Royce 1990:‘The approach adopted some years ago by Rolls Royce was to recognize the fact that in the majority of instances where cabin air contamination was a problem, it was mostly associated with small leakages of synthetic lubricant from bearing seals etc.’ • ATSB:‘Failure of oil seals has been a common factor in the majority of cabin fume incidents.’ • CASA:‘All aircraft from time to time suffer fumes within the aircraft… that is a feature of the basic design of air-conditioning systems in aircraft, being bleed air from engines.’ • CAA, Ansett, BAe…‘Oil leakage is primary cause of fumes.’

16. Chapter 4: The toxicology debate • TCP : Neurotoxin , OPICN , Other Ortho isomers: Increased toxicity known since 1958 • PAN: sensitizer • Synergistic mix • Inhalation toxicity testing for exposure to heated jet engine oils has never been done. • CASA- ‘Mobil Jet oil 2 – Known to be harmful’ -2007

17. TCP • TCP for synthetic jet engine oils manufactured only in two plants in the world and has a unique chemical signature. • TCP has several isomers which fall into 3 families: ORTHO, META and PARA. • ORTHO isomer neurotoxicity (TOCP) has been known since before the first car! • META and PARA chronic toxicity (OPICN)now emerging.

18. Ortho isomer misunderstandings • ORTHO isomers divided into: TOCP, DOCP and MOCP. • Focus has been on TOCP with UK House of Lords and CAA reports of 2000 and 2004 failing to ever mention DOCP or MOCP. TOCP 0.006 ppm Toxicity factor x 1 DOCP 6 ppm Toxicity factor x 5 MOCP 3070 ppm Toxicity factor x 10 • In ignoring DOCP and MOCP you underestimate the total ORTHO toxicity by a factor of 6.14 million which has been known since 1958 (Henschler) • Must not refer to TOCP alone – (Henschler 1958) • Exposure standards used incorrectly (Mobil 1999).

19. Chapter 5: Mislabelling of the oils • MSDSs minimize risk • Hazards are not adequately advised on labels & MSDS • Operators uncritcally accept MSDS findings & use this to minimize risk. • Suitable risk assessments not being done

20. Chapter 6: Effects on crews & passengers: Symptoms seen & Reported • Various surveys show similar pattern of effects • discrete occupational Syndrome: Aerotoxic Syndrome • Aerotoxic Syndrome (AS): Short & long-term effects • Following Aerotoxic slides: Courtesy of Prof C Winder UNSW

21. Aerotoxic Syndrome

22. 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, neurotoxicity and chemical sensitivity • Obvious short term effects, but a long term syndrome apparent

23. Aerotoxic Syndrome Clusters of Symptoms • Loss of consciousness/Inability to function • Symptoms of direct irritation to eye, airways or skin • Respiratory symptoms secondary to irritation • Skin symptoms secondary to irritation • Gastrointestinal symptoms • Neurotoxic symptoms • Neurological/neuropsychological symptoms • Nonspecific general symptoms such as chronic fatigue, chemical sensitivity

24. 2007 BAe 146 UK Pilot survey • Results • 86% smelt contaminated air • 57% report short-long term AS effects • 25% report medium – long-term AS effects • >8% appear to have lost medical certificate related to AS

25. Chapter 7: Medical Side: Doctors & Scientists • Short term These may include some or all of the effects listed: • Nausea, vomiting Headaches • Disorientation Sore nose, eyes, throat • Skin Rashes Chest pains • Tingling or numbness Breathing difficulty • Stupor Lethargy • Tunnel vision Difficulty concentrating • Tremor Short term memory problems • Vertigo Light headedness etc….

26. Chapter 7: Medical Side: Doctors & Scientists • Long-term effects include: • Neurological effects: CNS,PNS: Jamal 1997, Jamal, Julu… 2002, 2005 • Autonomic nervous system effects: Jamal, Julu… 2002, 2005 • Working memory / cognitive problems. (neuropsychological), Coxon 2002 / Mackenzie Ross 2006 • Chronic neurotoxicity (OPICN): Abou-Donia 2004, 2005 • Neuronal brain cell death: Abou-Donia • Respiratory disorders: Burdon, Glanville 2005 • Immune system effects, fatigue, chemical sensitivity etc.. • Blood pathology disorders • Strong occupational link: Cone 1983,1999 / Harper 2005 • Individual susceptibility: Furlong • TCP Blood test: 6 of 10 TCP isomers are converted into the highly toxic metabolite – psp: that inhibits the activity of a number of important enzymes. • Gene expression: Gene expression effected by TCP at levels found in UK pilots’ blood.

27. Passenger on major US Airline

28. European Pilot: Courtesy of Welcome Aboard Toxic Airlines

29. Chapter 12: Frequency of events • Refer Appendix 2, 6, 7, 9 • Less than 4% of events are reported • COT- 1% of flights - • US – ~1 documented event per day in the US – underestimate over 18 months/ >50% involved diversions (Murawaski/Supplee(2008)) • Wide range of data available , often inconsistent or incomplete • Events are increasing • Fume events are NOT rare • FAA (2006): • ‘FAA’s growing concern over numerous reports of smoke/ fumes in cockpit/cabin’; • FAA data analysis indicates numerous events not being reported.’ • Source of fumes is predominantly oil

30. Chapter 12 – Frequency of events • Global issue: Example of UK data • Number of events increasing over the years. • Events occur on many aircraft types. • Less than 4% of events ever reported to airlines of which only 48% of these events are reported to the regulator. • 32% of reported CA events involved some degree of crew adverse impairment. • 20% of CA events involve at least 1 pilot impairment. • 9% of CA events involved 2 pilot impairment

31. Chapter 12 – Frequency of events • Oxygen used by 1 pilot only 4% of the time and both pilots 12% of the time and usually temporarily only. • Engineering is often not finding source of the problem on first inspection. • Crew errors are being made. • Crews continue flight duty after exposure events. • Fume events often seen as normal or a nuisance only.

32. Chapter 15: Regulations to protects crews & passengers • Aviation Regulations exist • OH&S regulations exist • REGULATIONS ARE NOT WORKING OR BEING ENFORCED BY AIRLINE INDUSTRY OR GOVERNMENT BODIES

33. Airworthiness Ventilation Regulation: 25.831 • (a) …. the ventilation system 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. (b) Crew and passenger compartment air must be free from harmful or hazardous concentrations of gases or vapors.

34. Chapter 16: The exposure standard debate • An aircraft is a discrete occupational environment • Exposure standards do NOT apply: RAAF & • ‘It should be noted that that current safety standards differ from air quality levels that will provide a perceived acceptable level of customer and crew satisfaction. Contaminant levels may be well below recommended levels in currently accepted safety standards yet generate complaints, because they act in synergy with other contaminants or because some standards may be outdated and not have incorporated more recent scientific and medical evidence. In addition, extenuating circumstances on board aircraft (including humidity and cabin pressure) have not been studied to the extent that a new standard can be proposed - that incorporates these factors or identifies interactions between factors.’ - Honeywell 1997 • ‘OSHA standards (and others throughout the world) are not applicable to aircraft cabin air. Rather, they were designed by regulatory agencies for the industrial workplace and based on the assumption that the worker will be on the job 8 h per day,……... Can such terrestrial standards be applied to workers in the air (cockpit and cabin crew) and passengers with rationde-a rhetorical question to which the answer is, probably not.’ – R. Rayman, ASMa 2002 • …………………….

35. How long have we known about these problems ? • There is a very extensive database of information showing how long this issue has been known. (ACARM 2007) • 1953 -‘Concerns about toxicity of various aviation products including oils & hydraulic fluids.’AMA CAT (1953) Aviation Toxicology: an Introduction to the Subject and a Handbook of Data.

36. 1977: Air National Guard C-130 Hercules • ‘This report documents the incapacitation of an aircraft navigator during flight. This situation resulted from an inhalation exposure to aerosolized or vaporized synthetic lubricating oil.’ • ‘Further investigation into the potential hazards from inhalation of synthetic oil fumes… is definitely warranted.’ Montgomery, M.R., Wier, G.T., Zieve, F.J., Anders, M.W. Human Intoxication Following Inhalation Exposure To Synthetic Jet Lubricating Oil. Clinical Toxicology 1977; 11: 423-426.

37. Chapter 17: What they knew & what they did – BAe 146 case study • See appx 5 • Long history of oil fumes • Service Bulletins, service Information leaflets, All Operator Messages, Airworthiness Directives…… • There is NO secret

38. Committee of Toxicity (COT) • COT review is seriously flawed – • Fume events occuring in 1% of flights: While significant, was based on 3 UK airlines / primarily BA data : Ignored real under-reporting & evidence • Ignored chronic health effects data • Causal link between fumes and effects denied: Data ignored • epidemiological research for any other acute or chronic health effects denied as available data ignored or significantly downplayed • Ignored TCP findings in aircraft, consequently advising against focus on TCP • ……… • Cranfield/DfT research based on COT studies

39. Chapter 29: Solutions 1/2 • Contaminated air detection systems must be fitted. • Bleed air filtration or bleed free supplies needed. • Crew education to ensure 100% emergency oxygen always used. • Enforcement and education of the reporting system. • Regulations such as 25.831 enforced. As well as all aviation & OH&S regulations (HSE, NOHSC) • Full scale epidemiological survey of crews. • Less toxic oils and hydraulic fluids……… • NYCO - Tubonycoil 600

40. Chapter 29: Solutions 2/2 • Address design issues • TCP Biomarker blood test & gene toxicity studies - occuring • Inhalation studies of breathing oils & hydraulic fluids • B787 • Regulators must become independent & regulate • Appropriate Inquiries & studies: US FAA funded OHRCA;CASA 2008 EPAAQ, NIOH…. • OHRCA- "Exposure to Aircraft Bleed Air Contaminants Among Airline Workers: A Guide for Health Care Providers". & Cabin crew survey • CASA EPAAQ(2008) • GCAQE – Funding Furlong blood test

41. Thank you for your attention.Do not ignore the evidenceAviation Contaminated Air Reference ManualISBN9780955567209 www.susanmichaelis.comsusan@susanmichaelis.com