HEALTH PROBLEM IN LONGFLIGHT

dr. Taufik Pasya Litaay, MM, Sp.KP

ONE DAY SYMPOSIUM"BASIC AVIATION MEDICINE IN DAILY PRACTICE“

LAKESPRA,13 desember 2014JAKARTA

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What health risks are associated with longflight air travel?

Potential Health Risks :

• Acute Exposures

• Chronic Exposures

Potential Health Risks

• From Acute Exposures• Deep Vein Thrombosis

• Infection

• Injury

• Adverse events in the medically vulnerable

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D V TDeep Vein Thrombosis

• Economy Class Syndrome• Traveler Trombosis• Prolonged immobility, discomfort and

dehydration may contribute to an increased risk of deep venous thrombosis (DVT) and its significant complication venous thromboembolism (VTE).

Definition

•Deep vein thrombosis is the formation of a blood clot in one of the deep veins of the body, usually in the leg.

Epidemiology

Venous ThromboEmbolism related deaths 3,00,000/anum

7% diagnosed and treated 34% sudden pulmonary embolism59% as undected CDC estimates that each year between 350,000

and 900,000 Americans develop blood clots for the first time

DVT Blood Clots: A Potentially Fatal Health Problem

• Up to 2 million people in the United States suffer from DVT blood clots every year

• Approximately 600,000 experience pulmonary embolism (PE)

• In the US, complications from DVT blood clots kill almost 300,000 people a year — more than AIDS and breast cancer combined

Incidence • An annual incidence of symptomatic Venous

ThromboEmbolism as 117 per 100,000 persons .

• Venous ThromboEmbolism in hospitalized patients has increased from 0.8% to 1.3% over a period of 20 years.

• The absolute risk of VTE in a fit person was calculated at 1/6000 for a flight of 4 h.

Presentation and Physical Examination

• Calf pain or tenderness, or both • Swelling with pitting oedema • Increased skin temperature and fever • Superficial venous dilatation • Cyanosis can occur with severe obstruction

The risk of developing DVT when travelling is very small unless one or more other risk factors are present. These include:

— Previous DVT or pulmonary embolism

— History of DVT or pulmonary embolism in a close family member

— Use of oestrogen therapy–oral contraceptives (“the Pill”) or hormone replacement therapy (HRT)

— Pregnancy

— Recent surgery or trauma, particularly to the abdomen, pelvic region orlegs

— Cancer

— Some inherited blood-clotting abnormalities

• DVT occurs more commonly in older people. Some researchers have suggested that there may be a risk from smoking and from varicose veins.

• It is advisable for people with one or more of these risk factors to seek specific medical advice from their doctor or a travel medicine clinic in good time before embarking on a flight of four or more hours

Prevention of DVT1. People who have serious risk factors and are more than 40 years of age should consult their doctors ahead of the trip.

2. Passengers with the tendency of edema on the leg or who have serious risk factors should wear compression stocking.

3. Exercise the legs while sitting, if possible get up from the seat and walk along the aisle, particularly during long haul flight.

4. Drink enough water and eat snacks, avoid alcoholic drink in preventing dehydration.

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Fatigue

• Long haul flight of 8-10 hours coupled with noises and vibrations may cause fatigue.

• Symptoms or signs of fatigue usually are stiffness (muscle and joint) and mental symptoms such as becoming nervous, irritable, decreased capacity of thinking, sleep difficulty, headache, slower response to react, forgetful, less attentive, weaken condition, decreased ability to make judgement, tired eyes, digestive tract problem, decreased appetite, etc.

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• Prevention

Preventing efforts are conducted through the elimination or by reducing factors that caused fatigue (including mental, physical and body function factors), for instance by having enough sleep that is around 8 hours a day, take a good resting time, eat well based on nutritional needs (enough amount of food and nutrition, not too stimulating/hot/spicy, etc.), and avoiding works that cause tiredness.

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JET LAG during Long Haul Flight

Other problem that may occur during long haul flight is psychophysiological disturbance known as JET LAG,

• The symptoms of jet lag disorder (JLD) are generated by circadian misalignment, the inevitable consequence of crossing time zones too rapidly for the circadian system to keep pace.

• Depending on the number and direction of time zones crossed, it may take days for the circadian system to resynchronize.

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TRAPPED GAS DCS

• EAR BLOCK

• SINUS BLOCK

• G.I. TRACT

• TOOTH BLOCK

• Ear pressure pain, worsens with

descent, can

cause dizziness

• Intense cheekbone upper teeth pain, eye area

• Abdominal pain worsening with increasing altitude

• Tooth pain worsening with increasing altitude

• Level off, Valsalva, swallow, yawn, ascend and try ear-clearing again; land ASAP if no relief, decongestants

• Level off Valsalva, ascend and try sinus-clearing again; land ASAP if no relief

• Try to pass gas through flatulation or belching, immediate descent if no relief

• Level off, see dentist, land ASAP if no relief

Potential Health Risks

• From Chronic Exposures• cancers/leukemia from

•cosmic radiation

•cabin air exposures

Cosmic Radiation

• Altitude

• Latitude

• Solar Activity

Doses are affected by ….

Kendall 2000

• The short-term and long-term health hazards of air travel are of interest

• There is little scientific evidence to quantify the association between air travel and DVT

• There is inconsistent evidence of a link between cancer and cosmic radiation

The information reviewed suggests that ..

ThankThank you for youryou for yourkind attention!kind attention!