There are plenty of unpleasant odors in the cabin. Most are harmless, but some are toxic, so it is important to be informed. Two types of fumes (unpleasant, odorous, and potentially toxic compounds) that can contaminate the air supply are engine oil and hydraulic fluid. It’s important to pay attention to the presence of unusual, unpleasant odors, especially if they are coming from the air supply vents, because those odors may be oil or hydraulic fumes, which are toxic and can make you sick. You need to report the fumes and minimize your exposure. This is true even if there‘s no visible smoke or haze. On some aircraft, because of the design, the air coming out of the cabin vents can be contaminated, while the flight deck airis just fine (or vice-versa). So, it’s important to let the pilots know about any irregular conditions in the cabin. This is what you need to know:

1. If oil or hydraulic fumes contaminate the cabin air supply, then you will notice an unpleasant smell coming from the air supply vents. Typically, there is no haze or smoke – “just” a smell. Know that other types of fumes can come from the vents, too, like exhaust, fuel, and deicing fluid.

• Oil fumes don’t usually smell like oil. Many people think they smell like dirty socks. Others say “chemicals,” “old cheese,” “wet dog,” “heated garbage,” etc. One aircraft manufacturer says that engine oil fumes can smell electrical. Hydraulic fumes have a distinctive acrid smell. The odors associated with exhaust, fuel, and deicing fluid fumes tend to be easier to recognize.

• If you smell what could be oil or hydraulic fumes and are already onboard, quickly try to determine the source of the odor (fumes). Are they coming from an onboard item? Or are they coming from the air supply vents? Verify that nobody is cooking anything smelly, that the coffee pots are not burning, that the cabin lights are working and not burned out, and that the galley chiller lights are not indicating malfunction (red). (Not all of these possible sources will apply to all aircraft types.) Oil/hydraulic fumes come from the air supply vents, not from an in-cabin source. Sometimes, the source isn’t totally obvious.

• Report the fumes to the pilots. Describe the WHAT (smell, intensity), WHERE (coming from air supply vents or something in the cabin, and forward, mid, aft, or combination), WHEN (phase of flight when noticeable), and WHY (whether anyone is sick/needs first aid, including oxygen).

• If you are sick while the aircraft is at the gate, deplane and get medical attention. If you are sick inflight, use oxygen for first aid purposes (per your airline procedures), ask the pilots to call Medlink (if available at your carrier), and get medical attention after landing.

• Post-flight debriefing? You have the right to an AFA union representative present.

• More questions? Contact your AFA-CWA MEC Safety, Health, and Security Chair, Lori Kordosky: lori.kordosky@qxafa.org or XXX  Backup option is Judith Anderson, AFA-CWA Air Safety, Health, & Security Dept.: judith@AFAnet.org or 206-932-6237.

SICK FROM POOR AIRCRAFT AIR QUALITY?

REPORT IT – EVEN IF YOU THINK YOU’LL BE BETTER SOON

AND CALL AFA-CWA FOR HELP

Many different types of chemicals can contaminate the cabin air, including exhaust fumes, deicing fluid, electrical fumes, and jet fuel. All of these can make you sick. AFA-CWA is especially concerned if the air was contaminated with heated oil or hydraulic fluid. Oil fumes are often described as smelling like dirty socks. In some cases, crewmembers do not remember seeing or smelling anything unusual during a flight, although they report symptoms consistent with exposure to carbon monoxide gas and neurotoxic chemicals, and aircraft records confirm that oil or hydraulic fluid entered the air supply. Many symptoms that you may experience are not specific to contaminated bleed air. For example, you may have difficulty breathing due to insufficient oxygen or exposure to ozone gas.

If you feel that you may be suffering from symptoms due to exposure to chemical fumes supplied to the aircraft cabin through the air supply vents, the best thing you can do for yourself is document it. Don’t just figure you’ll likely feel better soon so there is no need to report anything. If your health problems persist or return after another incident, the paper trail will be critical. Start by contacting your AFA-CWA MEC Safety, Health, and Security Chair, Lori Kordosky (lori.kordosky@qxafa.org or XXX). As backup, call XX

If you have symptoms that are visible, have somebody take photos or video as soon as possible. It will help to establish the cause-effect relationship that you want to prove. Symptoms such as stomach cramping, fatigue, muscle pain, and confusion are not visible, but can be documented by a doctor. Video may be helpful for recording some symptoms, such as tremors or speech issues. In some cases, neurological symptoms may develop during the weeks after an exposure.

It is very important that you see a doctor as soon as possible to document your symptoms. Do not just go home. Get medical attention. It is especially important to have everything documented to protect yourself if your symptoms get worse. If you think that you were exposed to heated oil or hydraulic fluids on board the aircraft, read and print the informationfrom the AFA-CWA Air Safety, Health, & Security website: http://ashsd.afacwa.org/docs/practical.htm. Describe to your doctor the cabin conditions and your symptoms, both during the flight and since the flight. Bring the relevant product safety data sheet and Health Care Providers’ Guide (posted on that same AFA-CWA webpage) to all medical appointments.

Whenever possible, have your doctor perform objective tests to document your condition There is currently no blood test that will confirm that you breathed engine oil or hydraulic fumes, so your description of the cabin conditions and your symptoms are especially important. Some medical tests may be useful for assessing symptoms. For example, if you have respiratory complaints, a lung function test may document any reduced breathing capacity. Nerve conduction velocity tests may be used to confirm nerve damage. If you are dizzy or faint, you may have been exposed to carbon monoxide and a blood oxygen hemoglobin test may be appropriate, although blood must be drawn within a few hours of exposure, and within one hour of exposure if you went on oxygen during the flight. Also, oil and hydraulic fluid fumes don’t always contain carbon monoxide; it will depend on the temperature to which the oil/hydraulic fluid was heated in the engine/APU.

File a report with the company promptly.  Note the date, flight number and plane number. Describe the working conditions. Did you notice an odor or visible mist/haze/smoke? Were you aware of any mechanical problems? During what phase of flight did you develop symptoms? Was this the first time? Send a copy to your AFA-CWA LEC Safety, Health, & Security Chair.

Keep a copy of everything – every medical record, report, photo, and a record of all phone conversations (names, dates, and a short summary). If you have to mail anything, send it by certified mail with a return receipt. Reporting to the company is a priority, but to advocate on your behalf, AFA-CWA also needs to know about your incident. For more information, contact Judith Anderson at AFA-CWA’s Air Safety, Health & Security Dept. Seattle field office (206-932-6237 or judith@AFAnet.org).

Fumes onboard?

Overview and practical advice for AFA-CWA members  

Have you read the recent high-profile media reports about crews getting sick from breathing toxic fumes (unpleasant, unexplained odors) inflight? AFA-CWA has long been a leader among unions in working to address this complex and difficult problem of fumes onboard, which the industry has tried to keep quiet since the 1950s. Our research confirms that the most serious types of fume events (involving exposure to engine oil or hydraulic fluid fumes) happen on a daily basis on US airlines alone. Clearly, not all types of onboard fumes make crews sick- some are just unpleasant. But it’s important to be able to recognize the difference, so read on…

With the exception of the B787, the cabin and flight deck are supplied with ventilation air that is first compressed in the aircraft engines or the APU (a small engine in the tail). Engines are known to leak oil, sometimes, and aviation oils contain some extremely toxic chemicals, such as TCPs which are known to be toxic to the brain.  Also, carbon monoxide gas can be generated when the oils are heated in the engines, which can give you a nasty headache and make you feel woozy, or even pass out. Despite these facts, aircraft systems aren’t equipped with suitable filters, so when oil leaks or spills, you breathe the toxic fumes in the cabin.

For decades, crews have reported symptoms consistent with breathing oil fumes during and after flights with confirmed exposure to oil fumes; symptoms that they didn’t report before the exposure. Manufacturers and airlines know all about this problem. They know that oil fumes often smell pungent – like dirty socks or a wet dog – while hydraulic fluid fumes often smell acrid. They know what’s in the fumes. And they know about the many illness reports. Still, the industry – including the FAA – continues to deny that these fumes are anything they need to address. A 2015 FAA report included bogus claims about oil fume events being “extremely rare” and the TCPs in the fumes not being very toxic. Airlines and their workers’ comp carriers routinely try to discredit and harass crews who get legitimately and seriously sick.

Calling AFA members! Remember to review the AFA-wide practical advice for onboard fumes on this page: http://ashsd.afacwa.org/docs/practical.htm.  Print these documents and carry them with you.

AFA-CWA is fighting for your rights. The solutions are obvious: we need suitable filters to prevent exposure to oil fumes. We need chemical sensors to give early warning of contamination to pilots and enable prompt troubleshooting by maintenance staff. We need education and training to ensure that flight attendants, pilots, and maintenance workers know how to recognize and respond to fumes coming from the vents, and to distinguish fumes that matter from fumes that likely don’t. Know your workplace, ask questions, report fumes, and visit the AFA-CWA webpage, posted above. More questions? Contact AFA’s Judith Anderson at judith@afanet.org or 206-932-6237.

Answers to frequently asked questions:
Onboard Exposure to Smoke/Fumes

Prepared by: Judith Anderson
AFA-CWA Air Safety, Health, & Security Dept.
judith@AFAnet.org — 206-932-6237

What are the possible sources of smoke and fumes in the cabin?

There are many sources of smoke, haze, fog, and odors (fumes) in the cabin and flight deck. In-cabin sources include galleys, people (perfume, smokers, etc.), uniforms, carpets, electronics, and carry-ons. Most cabin air quality issues may be smelly and unpleasant, but they typically do not make you sick. What many people don’t realize is that the air supply system can also be a source of smoke/haze/fumes because it can sometimes get contaminated with engine oil, hydraulic fluid, engine exhaust, ground service vehicles, fuel, deicing fluid, and ozone. It is especially important for crewmembers to be able to recognize and respond to the presence of engine oil or hydraulic fluid smoke/fumes in the air supply system because of the toxicity of those compounds. Just like you get trained to act in an overwater landing, so too it is helpful to understand how oil can get into the supply air and what that can mean. If you do notice an unusual odor (fumes) onboard, especially if you experience unexplained symptoms, it is important to quickly try to identify the source; that is, are the fumes coming from the air supply system, or from either a person or item inside the cabin?

How can engine oil leak into my breathing air?

Unless you are hooked up to a ground cart, the air you breathe in the cabin is first compressed in the engines (inflight) or the APU (typically used on the ground). The APU is basically a small aircraft engine used for electrical power and air conditioning. The compressors in the engines and APU are lubricated with oil. The oil is supposed to stay on the “wet side” of each compressor, and not contact the “dry side” which comes into contact with the air that ventilates the cabin and flight deck. But if an oil seal leaks or a maintenance worker overfills an oil reservoir, for example, your breathing air can get contaminated. Knowing what phase of flight you were exposed to fumes, and whether or not fumes were also reported in the flight deck, can help to determine the location of the source.

How do people describe the smell of oil fumes?

Most commonly, oil fumes are described as smelling like dirty socks or having a musty/moldy quality. Other descriptions include: wet dog, electrical, foul, vomit, chemical, oily, noxious, old cheese, and pungent. AFA has received reports from multiple crewmembers on the same aircraft who all describe the smell differently because sense of smell varies between individuals. Also, be aware that if you are continuously exposed to fumes, you can develop olfactory fatigue, such that you won’t notice the smell.

Isn’t exposure to contaminated air only a problem if I can see smoke or haze?

No. AFA systematically documented the characteristics and health/safety impact of smoke/fume events at one US airline over a two-year period. Only three of 87 events had any smoke/haze; the rest were “just” reports of cabin fumes (odor), but the reported health impact of exposure to “just fumes” is listed below:
Number of flights with 1+ crewmember who needed urgent medical care 27 of 87 flights
Number of flights with 1+ crewmember who lost work time 37 of 87 flights
Number of flights with 1+ crewmember who required follow up medical care 43 of 87 flights

“Just” oil/hydraulic fumes can still cause significant short- and long-term symptoms. See this AFA bulletin for some suggestions on ways to recognize and limit your exposure, when possible: http://ashsd.afacwa.org/docs/prevent.pdf And again, keep in mind that only a minority of air quality events involve oil/hydraulic fluid, so be sure to first quickly check for the presence of any in-cabin sources of unusual odors.

I know that the air I breathe onboard is first processed in the aircraft engines or APU, but isn’t it filtered before I breathe it?

No. It has been known within industry circles since at least the 1950s that oil from the aircraft engines/APU can contaminate the onboard ventilation air, and get supplied directly to the cabin and flight deck. It is also well-known that aviation engine oil fumes are very toxic. Still, the outside air you breathe onboard is not filtered before you breathe it.

When oil or hydraulic fluid fumes enter the cabin, can I be exposed to carbon monoxide?

Yes. Oil fumes, hydraulic fluid fumes, fuel fumes, and exhaust fumes can all contain carbon monoxide gas if they get heated to high enough temperatures in the engine/APU. The operating temperatures in those systems range from 250 to 950°F, depending on the phase of flight and air supply source. Carbon monoxide forms starting at temperatures around 450°F. The cabin air supply is not filtered for carbon monoxide before you breathe it. Immediate symptoms of carbon monoxide exposure include: headache, dizziness, fatigue, disorientation/mental confusion, giddiness, and fainting.

Is it true that some symptoms may be delayed after exposure to oil fumes?

Yes. Even some of the compounds that get into the air supply system, such as engine exhaust and fuel fumes, may make you feel sick temporarily, but you should recover quickly. Aviation engine oil fumes, on the other hand, contain some very toxic additives called tricresyl phosphates (TCPs) which, in addition to causing acute symptoms such as stomach cramping, weakness, and sinus congestion, can sometimes cause neurological symptoms which can be delayed and may not manifest days (or even weeks) after an exposure. Potential delayed-onset, chronic neurological symptoms may include speech/memory deficits, abnormal gait/balance, fatigue, neuropathy (pins and needles), headache, and poor concentration. Some oils also contain trixylyl phosphate (TXP), another neurotoxin. In addition to delayed symptoms, acute neurological symptoms like dizziness, headache, and disorientation may also manifest during a fume event, likely caused by exposure to carbon monoxide which can be a constituent of oil/hydraulic/fuel/exhaust fumes.

If I was exposed to fumes during my flight, how do I find out what I exposed to?

Make sure you have reported the incident to AFA and file a report with the company. The exact company paperwork and even the “chain of command” will vary somewhat by airline, but there is generally an airline injury/illness reporting form and workers’ compensation paperwork (if applicable) to complete. At AFA, contact your LEC safety representative first. Your LEC/MEC benefits representative and EAP representative may also be good resources. And you can also contact AFA’s Judith Anderson (206-932-6237, judith@AFAnet.org), the staff member in the AFA-CWA Air Safety, Health & Security Department who works on chemical exposure issues.

Should I see a doctor?

For air quality issues that don’t cause symptoms, seeing a doctor isn’t necessary. But if you do have symptoms, see a doctor because you need to document the symptoms and seek relief. Typically, crews are first examined at either an emergency room or urgent care clinic. It is very helpful to bring the following two documents to any appointment:

1. Two-page Health Care Providers’ Guide which was written by an occupational physician, funded by the FAA, and intended to educate other physicians on the health implications of aircraft air supply contamination; and
2. The safety data sheet (SDS) for the product that likely/definitely contaminated the air supply system.

AFA also recommends that you print and bring a copy of the “What Your Doctor Needs to Know” bulletin, available at http://ashsd.afacwa.org/docs/docinfo.pdf.

Under workers’ comp rules, what doctor(s) can I see?

This will vary by airline. Most airlines require that, if you need emergency medical care, you go to a company clinic, or to an ER if there is no local company clinic or if the local clinic is closed. But again, this varies by airline, so check first! If you have questions about insurance issues/whether a doctor is covered, contact the AFA Benefits Committee member at your base. If you have questions about what type of doctor you should see for follow-up care, contact AFA’s Judith Anderson (206-932-6237; judith@AFAnet.org).

Can the doctors test my blood to identify/confirm what I was exposed to?

AFA is not qualified to give medical advice, but does provide information for you to discuss with your doctor. Regarding oil fumes, AFA is unaware of a specific blood test to definitively determine if you have been exposed. However, available blood tests that may be helpful include carboxyhemoglobin (blood marker of exposure to carbon monoxide), butyl/serum cholinesterase (blood enzyme influenced by TCPs), and serum c-reactive protein (blood marker of inflammation which can be increased after exposure to organophosphate chemicals). Scientists at the Univ. of Washington and Univ. of Nebraska have, independently, published papers on the preliminary stages of their work to develop blood tests specific to some of the TCP additives in aviation engine oils, but no test is yet finalized. The Univ. of Washington researchers have stored hundreds of archived blood samples, drawn largely from crews shortly after onboard exposure to oil fumes. Once the blood test development is finalized, the researchers will test those samples and communicate the results to each individual.

Paramedics met my flight and examined me. How can I get a copy of those records?

You have the right to a copy of your medical record from paramedics who may have met the aircraft. Typically, you can access those with a written request via the Emergency Medical Services branch of the relevant airport authority. AFA cannot request the paramedic records on your behalf because they are your private medical records. You can find the general phone number for the relevant airport authority online and ask to be transferred to the fire/emergency medical services department. Alternatively, the necessary paperwork you need to file may be online. Try using the following online search terms: [name of city], airport authority, fire department, EMS, records. For example of necessary form to request a copy of Seatac airport paramedic records, click HERE.

Firefighters met my flight with an air sampling device. How can I get a copy of their air testing data?

You have the right to any air quality testing data, if firefighters met the aircraft, for example. You can file a records request with the relevant airport authority to obtain that information. Again, the necessary form(s), or at least the general phone number for the relevant airport authority so that you can ask to be transferred to the appropriate department for a records request, should be posted online. As an example, the form for this type of request at Seatac airport is posted HERE. Because air sampling data are not medical records, AFA should have the right to request a copy of air quality test data on your behalf, and can then share those data with you and the other members of the flight attendant crew.

When should I expect to feel better?

Recovery after exposure to oil/hydraulic fluid smoke/fumes is highly variable. It typically takes longer to recover from exposure to oil fumes than hydraulic fluid fumes, all other things being equal. Your recovery will be influenced by the degree of your exposure (concentration, duration), whether you have a history of exposure to such fumes, your liver function, genetic makeup, and other physiological factors, known and unknown. Everyone is different, but recovery from these types of chemical exposures can be slow.

What can I do to feel better?

AFA is not qualified to give medical advice. However, researchers, doctors, and affected crewmembers have shared their expertise, so AFA is passing this information to you because we recognize how little information is available. Again, this is not medical advice and some of it is still in experimental stages, so be sure to seek treatment from a qualified doctor!

(1) It’s important to stay well hydrated by drinking lots of water. There is also some evidence in the medical literature that a high-fiber diet may help with absorbing and excreting toxins from the digestive system.

(2) “Olestra” and similar synthetic fats that pass through the gastrointestinal tract without being absorbed appear to “pull out” highly fat-soluble chemicals, enabling them to be excreted in the stool. Thus, ingesting olestra can speed the excretion of dioxin and some other fat soluble toxins (See: http://www.ncbi.nlm.nih.gov/pubmed/15776770;http://www.ncbi.nlm.nih.gov/pubmed/10520643; http://healthnews.uc.edu/publications/findings/?/466/1576/). The neurotoxic TCPs in aviation engine oils are fat-soluble, so there is reason to think that olestra may help to facilitate the elimination of TCPs (and chemically similar toxins) after an exposure to oil fumes. One study (http://www.ncbi.nlm.nih.gov/pubmed/10481251) estimates that ingesting 25 gram per day of olestra would more than double the overall rate of elimination of a particular dioxin compound from the body. To put this dose in context (assuming it translates to other fat soluble toxins), one serving of Pringles Fat-Free Pringles Super Stack contains 9 grams of Olestra, and one serving of Lays Original Light Potato Chips contains 11 grams of Olestra. So, a daily dose of 25 grams is equivalent to between two and three servings of these types of foods, per day. Such foods may be hard to find in the grocery aisle, but you can purchase them online. Be aware that Olestra can cause diarrhea and cramping, and can dissolve fat-soluble vitamins (D, E, K, A) and carotenoids, so vitamin supplementation may be necessary. Ask your doctor if this may be a suitable option for you.

(3) A small 2012 study (http://www.ncbi.nlm.nih.gov/pubmed/22790946) reported that taking three grams of chitosan (“kī-to-san”) for three consecutive days a week for four weeks increased the rate that the subjects excreted dioxin from their bodies. TCPs, like dioxin, are fat-soluble toxins. Chitosan is an over-the-counter supplement extracted from the shells of shrimp, lobster, and crabs, available at many health food stores and also online. It is a fibrous substance that might block absorption of dietary fat and cholesterol. People with shellfish allergies may be allergic to chitosan. Ask your doctor if this may be a suitable option for you.

(4) There is preliminary evidence that drinking grapefruit juice immediately after an exposure to oil fumes may offer some protective effect from the subsequent neurological symptoms (http://www.ncbi.nlm.nih.gov/pubmed/23085349). It is known that the TCP neurotoxins in oil fumes must be “bioactivated” in your liver before they do damage to your nervous system. Some key liver enzymes that convert TCPs into the toxic metabolite are the same enzymes that metabolize the active ingredient in grapefruit juice. So, in theory, if you drink grapefruit juice, you may be able to “distract” your liver from bioactivating the TCPs in your system, or at least slow down the TCP bioactivation so that the production of the neurotoxic metabolite(s) is slowed, which may offer some protection from damage. This theory is grounded in science, but has not been formally tested and is only speculative, so is shared for informational purposes only. Be aware that if you take medications that are also metabolized by these p450 liver enzymes (whether to bioactive the medicine or excrete it), drinking grapefruit juice may interfere with the efficacy of such medications. Presumably, the bioactivation of TCPs is not delayed once it enters the bloodstream, although it is unknown how long the bioactivation process takes. So, presumably, grapefruit juice would need to be ingested without delay, although this has not been tested. Grapefruit can negatively interact with the metabolism of many medications, so it is very important to first talk to your doctor about whether this is a suitable option for you.

(5) The 2008 Health Care Provider’s Guide (http://ashsd.afacwa.org/docs/HCPquick.pdf) references patient reports that nebulized glutathione may be helpful. Glutathione is an antioxidant produced in your liver, but your stores can be depleted. You can take glutathione orally, but absorption through the gut is poor. An alternative option is to inhale glutathione mist generated by a nebulizer. The mist enters the bloodstream through your lungs, and bypasses the gut, so absorption is better. You require a doctor’s prescription that you fill at a compounding pharmacy. If you don’t have a nebulizer, you will need to purchase one. They cost approximately $75 and may be covered by insurance. Ask your doctor if this may be a suitable option for you.

(6) Some people have reported that a daily Epsom salt bath can be helpful. Run a hot bath and add two cups of Epsom salts (cheap to buy from your local pharmacy). You can also add a box of baking soda. Soak for 30+ minutes.

(7) Some people have reported daily saunas are helpful. IR saunas are an option, but are expensive. You may first want to try a sauna at your local YMCA or community center. Take a friend/family member, as a safety measure, in case you find the high temperatures unsuitable. Ask your doctor if this is a suitable option for you.

Final words of advice?

Get a notebook/dayplanner and keep a written record with the date of any symptoms (whether improved or worsened), medical appointments, and anybody you talk to by phone, whether from the company, doctor’s office, workers’ compensation carrier, or union. This is especially if your memory is impaired or if you are very tired. Ask a family member or friend to accompany you to medical appointments. Involve your significant other or a close friend in the management of your medical care. Keep a file with copies of all medical records, documents and correspondence related to your illness.

AFA is here to help!