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Aerospace medicine 

Aerospace medicine

Aerospace medicine

D.M. Denison

and M. Bagshaw

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date: 25 April 2017

Travel by air is a safe means of transport, but puts people at various physiological risks and is a potential means of spreading infectious disease.

Physiological risks associated with flying include hypoxia—atmospheric pressure falls with altitude. The minimum cabin pressure in commercial passenger aircraft (565 mmHg, 75.1 kPa) brings a healthy individual’s arterial Po2 along the plateau of the oxyhaemoglobin dissociation curve until just at the top of the steep part, but does not cause desaturation. By contrast, people with respiratory disease and a low arterial oxygen pressure may desaturate, which can be overcome by administering 30% oxygen, this being equivalent to breathing air at ground level. Guidance for assessing a passenger’s fitness to fly is provided by the websites of the Aerospace Medical Association and the British Thoracic Society. A second physiological risk is increased exposure to cosmic radiation, although there is no evidence that this leads to abnormality or disease.

Other medical problems associated with flying include (1) venous thromboembolism—the relative risk is significant, but the absolute risk is very low. Medical practitioners need to be circumspect in advising preventive measures, taking account of the efficacy and risk profile of any intervention, but compression stockings and/or a single prophylactic dose of low molecular weight heparin may be recommended in high risk cases. (2) Jet lag—there is no simple solution for combating the effects of jet lag: the individual must evolve strategies to suit their particular needs.

Transmission of disease—there is no evidence that the pressurized aircraft cabin itself encourages transmission of disease, and recirculation of cabin air is not a risk factor for contracting symptoms of upper respiratory tract infection. It is important that individuals with a febrile illness should not travel on commercial aircraft. Restricting air travel will not prevent global spread of pandemic influenza, but might delay the spread sufficiently to allow countries time to prepare.

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