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70 Medico-Legal J. 1 (2002)

handle is hein.journals/medlgjr70 and id is 1 raw text is: Medico-Legal Journal (2002) Vol. 70 Part 1, 1 2 © Medico-Legal Society 2002 Editorial: The Health Risks of Long Haul Flying Diana Brahams Editor Travel, it is said, broadens the mind. But it may also pose risks to your health. Since September 11, anyone who buys an air ticket (especially for the USA) will have in mind the possibility that one or more terrorist bombers may be on the same plane. Statistically, the chances of this happening are posi- tively minute, but media hype and the public's aston- ishingly poor capacity to understand risk (or the chances of winning the lottery) still keeps many Americans and others from flying both internally within the USA and abroad. However there are arguably more likely risks to health triggered by long haul flights (longer than 4-5 hours and increasing with the number of hours on the journey). Top of the list is deep vein thrombosis (DVT) and infection. It has been claimed that airlines have long been aware of what has been described as Economy class syndrome caused by inadequate leg room and conditions on board long distance flights. Key factors pointed up are cramped seating and cabin pressure. The current permitted minimum space is 26 inches from front to back (including the seat back itself) with many airlines providing only a little more even for long flights and uncomfortable shape and tilt in the seats and seat back. Cabin pres- sures are suggested as another irritant factor, though as yet there is no clear research on this point. They are frequently kept near to the maximum permitted levels of 8,000 feet (the equivalent of a high moun- tain peak). Dehydration is aggravated by caffeine intake and alcohol consumption in excess of 2-3 units. Both are served free on most flights and although water and orange juice are also offered, anyone who fears not being able to gain access down the aisle to the few toilets in the crowded economy cabin will be unlikely to drink much. Other potential sources of harm are reheated prepared foods, imported diseases carried on board, recycled air inside the plane and the stress of travel - and the list goes on. On January 21 this year I attended a Conference at the Royal Society of Medicine. It was fascinating and I picked up some useful and not so useful infor- mation. Do I feel more confident than before? I am not really sure. The airline industry denies there is any real hard data, but after years of lobbying, the first signficant research study has been fixed up with South African Airways (but the numbers look to be sub-optimum). The current vogue is for aspirin. Most people who have thought about it believe aspirin taken for a few days before each flight will reduce their chances of a deep vein thrombosis. However some medical speakers and delegates were sceptical and pointed out that supposed benefits are as yet unproven by convincing research and that aspirin may trigger other bowel-related problems. The big message to take away seemed to be that you should check the list of increased risk factors (there are lots of web sites to assist you on all aspects of travel). Nearly everyone will qualify at least on one count. If this is the case then you should seek advice from your GP (they'll be inundated if everyone does even though the numbers of long haul travellers are down). But the medics and industry hacks who pontificated both on and off the rostrum (most interestingly when huddled in groups during coffee breaks) made it clear that support stockings were a Good Thing only if the correct length and properly fitted. And stockings bought off the shelf may be neither and so counterproductive. An appar- ently sensible doctor advised me discreetly to buy a pair of ordinary support tights from Marks and Spencer in my correct size. I might do just that! How clear is the evidence that DVTs are occa- sionally triggered by long haul economy class air travel? Opinions differ. Statistics were bandied about and countered and undermined. We need research, now, and with sufficient numbers of participants and

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