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      Problems with flying

Air Rage
Aircraft disinsection
Airport Security
Chest and abdominal problems
Cosmic radiation
Deep vein thrombosis
Dry skin, dry eyes
Flight phobia
Heart and lung diseases
Infectious diseases
Middle ear problems
Motion sickness
Smoking in aircraft

The vast majority of Australians travelling overseas do so by flying in commercial airlines and without any trouble. Unfortunately, the characteristics of flying may present a problem for some. If you think flying may be a hazard to you, please discuss with your travel clinic doctor and (if necessary) the airline, well in advance of your planned trip.

Airport security

Airport security around the world has tightened in recent years and the following is a selection of regulations from Australia, UK and USA.

AUSTRALIA
Carry-on baggage at International Airports
Each container of liquids, aerosols or gels in your carry-on baggage must be 100 millilitres or less. All the containers must be sealed in a transparent, one-litre plastic bag. You are only allowed one plastic bag. Any transparent resealable bag of one litre capacity or less is allowed. You may still carry on board prescription medicines. Baby products and non-prescription medicines that you need for the flight are also allowed. Proof of need may be required.
When you get to the screening point, you will have to surrender any liquids, aerosols or gels greater than 100ml that you still have with you, including duty free. The new rules also introduce random frisk searches as part of the screening process.
These restrictions do not apply to checked-in luggage or items purchased after passing the screening point.
Exemptions
Prescription medicine and prescribed medical devices are exempt from the liquis, aerosols and gels (LAGs) restrictions. Where the medication is non-prescription, you may take the amount required for the flight.
You should determine the reasonable quantity of non-prescription medication required for the duration of your flight, as it may be assessed by security screening staff. Reasonable amounts include what is required for length of the flight as well as possible delays and flight diversions.
If you have any prescription or non prescription medications, have them ready for inspection. It is also best to have any supporting documentation (ID cards, letters from doctors etc) ready for inspection should it be required.
The Australian Government controls the export of medicines subsidised through the Pharmaceutical Benefits Scheme (PBS) and travellers are urged to check the Medicare web site before carrying medications overseas.


New airport security arrangements for the UK and USA have been upgraded.

Publicly available information on airport security developments in other countries can be found at Air Security International\'s World Watch Monitor.


UNITED KINGDOM
The following arrangements apply to all passengers starting their journey at a UK airport and to those transferring between flights at a UK airport. It provides some advice designed to help passengers pass through the security search point as quickly as possible.

Key Points to remember:
Each passenger is restricted to carrying only one item of cabin baggage through the airport search point with a maximum size of 56cm x 45cm x 25cm. Other bags, such as handbags, may be carried within the single item of cabin baggage. Where possible, put all liquid items in your hold baggage. This includes water and other drinks, creams, sprays, pastes and gels.

The details below will help you and we strongly recommend that you take some time to read it before setting off for the airport.
Passenger requirements:
Liquids
Some liquids are allowed through airport security check points. There are however, restrictions on the quantity of liquids that can be taken through:
Passengers may carry small quantities of liquids, but only within separate containers each of which with a capacity not greater than 100ml.
These containers must be brought to the airport contained in a single, transparent, re-sealable plastic bag (about the size of a small freezer bag), which itself must not exceed 1 litre in capacity (approximately 20cm x 20cm). The contents of the plastic bag must fit comfortably and the bag sealed. Each passenger may carry only one such bag of liquids.
The bag must be presented separately for examination at the airport security point.
Please note:
Any containers larger than 100ml (excluding essential medicines, see section below) will NOT be allowed through the security search point. Most liquids of any amount may still be carried in hold baggage. ONE lighter per person may be carried through central search. Lighters form part of the allowance of liquid in the litre bag and can either be placed inside the litre bag or screened separately provided they would fit into the bag. It is very important that passengers do not place the lighter into their cabin bag after screening - it must be carried on the person for the duration of the flight. Lighters are NOT permitted in hold baggage.
Remember that \'Liquids\' includes:
  • All drinks, including water, soup, syrups
  • Creams, lotions, oils, perfumes, mascara etc
  • Sprays and pressurized containers including shaving foam and spray deodorants
  • Pastes, including toothpastes
  • Gels, including hair and shower gel
  • Any other solutions and items of similar consistency
    Please note that liquids can usually be purchased beyond airport security search points, in the departures area, as these liquids are subject to a separate screening process.
    Essential Medicines
    Essential Medicines for the period of the trip may be permitted in larger quantities above the 100ml limit, but will be subject to authentication. Passengers must have obtained the prior agreement of the airline with which they are travelling and their departure airport. Passengers must also bring with them supporting documentation from a relevant qualified medical professional. Essential Medical Equipment
    Passengers are permitted to carry through airport security medical equipment essential for use during the period of their trip. Where possible the equipment should be contained within the ONE item of cabin baggage and again should be accompanied by supporting documentation from a relevant qualified medical professional. For further information, see the UK Department of Transport.

    UNITED STATES
    The US has elevated its threat condition level to Red (Severe) for all commercial flights from the UK, and to Orange (High) for all other international flights and all domestic commercial aviation.
    The Transportation Security Administration is immediately implementing the following changes to airport screening procedures:
    * No liquids or gels of any kind will be permitted in carry-on baggage; such items must be packed in checked baggage. This includes all beverages, shampoo, suntan lotion, creams, tooth paste, hair gel, and other items of similar consistency.
    * Exceptions are baby formula, breast milk, or juice if a baby or small child is traveling; prescription medicine with a name that matches the passenger\'s ticket; and insulin and essential other non-prescription medicines
    * Passengers traveling from the United Kingdom to the United States will be subject to a more extensive screening process.
    Passengers are advised to pack lightly to facilitate easier screening, and to arrive earlier than usual at the airport. For further information, see the US Transportation Security Administration.

    Deep vein thrombosis(DVT) and pulmonary embolus (PE)

    Controversy still surrounds the relationship between deep vein thromboses (DVTs) and long distance air travel. The well-publicised sudden deaths or serious illness of travellers following long haul flights has attracted the attention of travellers and, of course, solicitors. Some courtroom dramas are pending, but now seem likely to be aborted following the ruling of the
    High Court of Australia (June 2005).
    The development of DVTs and pulmonary emboli (PE) - when clots break away from their holding veins deep in the legs or pelvis as emboli to clog up the heart and lungs - has been linked to prolonged immobility for many years, at least since the Second World War. DVTs may develop through long periods of immobility whether this is through long distance air travel, car or bus travel, prolonged surgery or just from hours in front of the TV. Long distance air travel has, however, certain added risks.

    Your risks of clot formation
    Some of us are more likely to develop serious clots than others. In long distance air travel, the risk of clinical DVT development is about one for every 100,000 travellers. But in higher risk groups, the rate rises to 3 or 4%. Those at high risk of DVT formation are passengers with a personal or family history of clotting, recent major surgery, stroke or people with paralysed limbs. Those affected should consult their GPs or travel medicine specialists before travelling.
    Travellers with increased risk are those older than 40, the obese, those with varicose veins and those with limb injury or recent surgery. Pregnancy, women on the pill or taking other hormones and those with recent heart disease are at increased risk.

    Symptoms and signs of DVT
    Those who develop a DVT may have swelling, pain, tenderness and redness especially involving the calf. The pain may be made worse by bending the foot upward towards the knee. This is different from the mild ankle swelling that many people get during long haul flights and DVT usually - though not always - affects only one leg. These symptoms may develop during the journey but more commonly hours or even days later.
    In some cases there are no signs or symptoms of DVT at all in the legs and problems only become obvious when a pulmonary embolus (PE) develops and lodges in the lungs. PE can cause breathlessness, chest pain and in severe cases, collapse. Fortunately PE is rare.
    Both DVT and PE, whatever the cause, are serious conditions and need urgent investigation and treatment.

    Preventing DVT formation
    Research is still needed to clarify some of the issues with DVTs, but the following is considered helpful advice, at the time of writing.

    1. Move around from your seat as often as is practicable.
    2. Exercise calf muscles while seated every half hour or so.
    3. Minimise the consumption of alcohol or caffeine-containing drinks before and during flights.
    4. Have an adequate intake of water or juice.
    5. Follow the in-flight advice given by the airline.
    6. Keep the legs uncrossed.

    On the advice of their GP, passengers at high risk should consider:

    1. The use of elastic compression stockings (such as JetSox, approved by the TGA; Scholl Anti-DVT Flight Socks; OAPL Travel Stockings or Tyco T.E.D.Stockings). In moderate risk patients graduated compression stockings are highly effective, and given that they are cheap, easy to use, and have negligible adverse effects their use should be promoted widely in these patients.
    2. The use of oral aspirin.
    3. The non-use of sleeping tablets.


    For more detailed information on DVT and its prevention, please refer to the following sites:
    QANTAS
    Australian Department of Health and Ageing
    UK Department of Health
    Jet Sox



    Problems arising from the aircraft environment

    Reduced pressure
    At a cruising altitude of 12,500 m, most modern airliners maintain cabin air pressure to levels similar to those encountered at 2,200 m (Mt Kosciusko is 2,240 m). As aircraft climb, pressures within closed cavities (eg middle ear, abdominal cavity and chest) will become higher than in the cabin and cause distension, with problems for some travellers. With descent, the reverse occurs.
    Middle ear problems
    Pressure within the middle ear must be maintained by an open eustachian tube (facilitated by swallowing, yawning, chewing), which connects the middle ear to the back of the nose. This does not happen when the tube is blocked by infection (eg a cold, middle ear infection) or allergic problems (eg hay fever) and severe pain can result as a consequence of the increased pressure. Oral decongestants of nasal sprays might clear the eustachian tubes and prevent this pain, but passengers with recent intraocular eye surgery, ear or sinus surgery or current sinusitis or middle ear infection are advised to delay their flight until recovered.
    Chest and abdominal problems
    Increased pressure in the chest may cause problems in passengers who have experienced recent chest surgery or pneumothorax and travel should be delayed until well healed. Similarly, an increased pressure within the abdomen will cause distension within the bowel. Travellers who have had recent bowel surgery should ensure full recovery before travelling. Those with colostomy or ileostomy bags will need to take extra bags for their flight.

    Reduced oxygen
    At cruising altitude oxygen levels in the blood stream of passengers is reduced. Healthy travellers easily tolerate this reduction, but those with anaemia or lung disease may be seriously affected. Modern airliners re-circulate half of their cabin air every 3 to 4 minutes, but carbon dioxide levels in the cabin may be raised and can lead to headache, light-headedness and dizziness.
    Heart and lung diseases
    People with poor lung function, uncontrolled heart failure, cardiac irregularities or requiring oxygen on the ground, should not travel.
    Generally speaking, travellers able to walk 50m or climb 15 stairs without breathlessness are able to fly without special assistance.
    Passengers requiring portable oxygen must make prior arrangements with the airline before travelling.
    Most airlines provide in-flight oxygen but usually requiring 2-3 days advance notice of requirements. A fee is commonly charged.

    Recycled air
    Cabin air is cycled through filters, usually in blocks no more than a couple of rows deep (considered along the long axis of the fuselage) and is similar to those used in operating theatres. Some 99% of particulate matter (including most germs) is removed and the resulting air is cleaner than the average public place.
    Infectious diseases
    Infectious diseases such as those caused by viruses have, very rarely, been transmitted in flight to passengers in adjacent seats.
    Transmission in a crowded departure lounge is more likely to occur. People with serious infections (eg
    TB, chickenpox, influenza) should avoid travel.

    Dry skin, dry eyes
    An unavoidable feature of the in-flight environmental control system is a low humidity, averaging around 17% relative humidity, which can fall as low as 5% in business or first class. Passengers are encouraged to avoid alcohol and caffeine and to drink regular watery drinks during the flight. They may need to use moisturisers for dry skin, nasal sprays (such as Fess or Sterimar) and ocular emollients (Refresh Tears Plus or Genteal Drops) for dry eyes and which are compatible with contact lenses. (See
    Airport Security.) Spectacles, rather than contact lens, may be more comfortable.
    (All contact lens wearers should have back up spectacles with them and carry prescriptions for both.)
    Newer aircraft will have humidity levels resembling those at ground level.

    Cosmic radiation
    Radiation (coming from the sun and outer space) is increased as aircraft fly higher and may be 6 times higher than at sea level. Travellers have not been harmed by this increased exposure, but the maximum internationally recommended ionisation limit is exceeded if they fly more than 2000 hours/year.
    Pregnant women are advised to restrict flying to 200 hours during their pregnancy.
    Natural background radiation levels and its interaction with the human body is discussed by the
    Australian Radiation Protection and Nuclear Safety Agency. The effect on the development of cancer or genetic changes to gametes caused by cosmic radiation can be found in great detail at the United Nations (UNSCEAR) website.

    Motion sickness
    Except in the case of severe turbulence, air travellers rarely suffer from motion sickness. Those who are affected might choose to sit in the mid-section of the aircraft over the wings, where movement is less pronounced. Medication prescribed by a doctor can also be helpful.

    Psychological aspects
    All forms of travel may produce stress, but the long preparation, the anxieties about security, the unavoidable delays at airports, the sleep disturbances and the cramped conditions all contribute to stress for aircraft passengers. These problems are often alleviated by careful planning and preparation, but may need medical help.
    During your flight, the following (provided by Singapore Airlines) may be helpful:
    - Put your seat in the recline position. Close your eyes.
    - Breathe in steadily, as you count slowly to three. Hold your breath momentarily, than breathe out steadily, counting to three. Practise for 10 to 15 minutes.
    - Alternatively, picture yourself in a relaxed situation, perhaps on a tropical beach. You may even be flying there on vacation! Concentrate on each part of your body in turn. Feel it gradually relax - feet, legs, thighs, tummy, chest and so on. Over several minutes, you should reduce your pulse and breathing rates and gradually tension will drain away.

    Flight phobia (fear of flying) may be a serious handicap for some and those affected should seek psychological advice and help. They should avoid alcohol, which could aggravate their problem.
    More information is available from the
    Better Health Channel and QANTAS offers courses through its Fearless Flyers organisation.
    Interesting material is provided by CASA and by HealthInsite, Australian Government bodies.

    Air rage (disruptive behaviour associated with air travel) is sometimes associated with excessive alcohol consumption and high levels of stress.
    The
    Australian Services Union (ASU) provides information on this subject.

    Other issues
    Cigarette smoking is now banned on most aircraft. This, together with long flights and smoking restrictions at stopovers, may constitute a stressful situation for smokers. Nicotine patches or chewing gum should help the smoker survive the journey.
    Travel Clinics Australia
    More information on flying at World Health Organisation

    Advice provided by:
    QANTAS
    SINGAPORE AIRLINES
    EMIRATES
    BRITISH AIRWAYS

    Guidelines for Doctors
    Aerospace Medical Association Medical Guidelines
    Medical Advice for Commercial Air Travelers


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