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Brie Aim Cal Imp AIR QUALll Y AND SAFEI Y Committee on Airliner Cabin Air Quality Board on Environmental Studies and Toxicology Commission on Life Sciences National Research Council NATIONAL ACADEMY PRESS Washington, D.C. 1986

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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The National Research Council was established by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and of advising the federal government. The Council operates in accordance with general policies determined by the Academy under the authority of its congressional charter of 1863, which establishes the Academy as a private, nonprofit, self-governing membership corporation. The Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in the conduct of their services to the government, the public, and the scientific and engineering communities. It is administered jointly by both Academies and the Institute of Medicine. The National Academy of Engineering and the Institute of Medicine were established in 1964 and 1970, respectively, under the charter of the National Academy of Sciences. This project was prepared under Contract No. DTFA01-85-C-00013 between the National Academy of Sciences and the U.S. Department of Transportation. Available from: National Academy Press, 2101 Constitution Avenue, NW, Washington, D.C. 20418 International Standard Book Number 0-309-03690-9 Printed in the United States of America First Printing, August 1986 Second Printing, November 1986 Third Printing, March 1987 Fourth Printing, March 1988

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COMMITTEE ON AIRLINER CABIN AIR QUALITY Thomas C. Charmers (Chairman), Mount Sinai Medical Center, New York, New York Paul F. Halfpenny (Vice-Chairman), Van Nuys, California John D. Spengler (Vice-Chairman), Harvard School of Public Health, Boston, Massachusetts Harriet A. Surge, University of Michigan, Ann Arbor, Michigan Edward J. Calabrese, University of Massachusetts Amherst, Massachusetts Stephen M. Horvath, University of California, Santa Barbara, California Nan M. Laird, Harvard School of Public Health, Boston, Massachusetts * Genevieve Matanoski, Johns Hopkins University, Baltimore, Maryland me, James M. Melius, National Institute for Occupational Safety and Health, Cincinnati, Ohio Matthew I. Radnofsky, Seabrook, Texas Donald H. Stedman, University of Denver, Denver, Colorado National Research Council Staff James A. Frazier, ProJect Director Devra Lee Davis, Acting Director, BEST Andrew M. Pope, Staff Officer Rob Coppock, Staff Officer Alison Kamat, Information Specialist Judy Tiger, Administrative Secretary Jean Perrin, Administrative Secretary Norman Grossblatt, Editor * Until February 1986. Until December 1985. iii

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BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY Donald Hornig (Chairman), Harvard University, Boston, Massachus et to Alvin L. Aim, Thermal Analytical, Inc., Waltham, Massachusetts Richard N. L. Andrews, University of North Carolina, Chapel Hill, North Carolina William E. Cooper, Michigan State University, East Lansing, Michigan John Doull, University of Kansas Medical Center, Kansas City, Kansas Emmanuel Farber, University of Toronto, Toronto, Ontario, Canada John W. Farrington, Woods Hole Oceanographic Institution, Woods Hole, Massachusetts BenJamin G. Ferris, Harvard School of Public Health, Boston, Massachusetts Philip Landrigan, Mt. Sinai Medical Center, New York, New York Raymond C. Loehr, University of Texas, Austin, Texas Roger Minear, University of Illinois, Urbana, Illinois Philip A. Palmer, E. I. DuPont de Nemours & Co., Wilmington, Delaware Emil Pfitzer, Hoffman-La Roche, Inc., Nutley, New Jersey Paul Portney, Resources for the Future, Washington, D.C. Paul Risser, Illinois Natural History Survey, Champaign, Illinois William H. Rodgers, University of Washington, Seattle, Washington F. Sherwood Rowland, University of California, Irvine, California Liane B. Russell, Oak Ridge National Laboratory, Oak Ridge, Tennessee Ellen Silbergeld, Environmental Defense Fund, Washington, D.C. Peter Spencer, Albert Einstein College of Medicine, Bronx, New York Gerald Wogan, Massachusetts Institute of Technology, Cambridge, Massachusetts iv

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Ex Officio Gary P. Carlson, Purdue University, Lafayette, Indiana Thomas Chalmers, Mount Sinai Medical Center, New York, New York Arthur B. DuBois, John 8. Pierce Foundation Laboratory, New Haven, Connecticut Alan M. Goldberg, Johns Hopkins University, Baltimore, Maryland Bernard D. Goldstein, Robert Wood Johnson Medical School, Piscataway, New Jersey David Jollow, Medical University of South Carolina Charleston, South Carolina Roger O. McClellan, Lovelace Inhalation Toxicology Research Institute, Albuquerque, New Mexico Norton Nelson, New York University Medical Center, New York, New York Duncan T. Patten, Arizona State University, Tempe, Arizona National Research Council Staff Devra Lee Davis, Acting Director, BEST Jacqueline Prince, Staff Associate v

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PREFACE This study came about because a series of Congressional hearings in 1983 and 1984 revealed that the available data on airliner cabin air quality were contradictory. Concern was expressed about the absence of standards for many aspects of cabin air quality that annoyed passengers and crew. The regulatory community and the airline industry asserted that present standards and practices were adequate and that the aircraft environment endangered the health and safety of neither passengers nor crew. As a result of the hearings, Congress, in Public Law 98-466, mandated that the National Academy of Sciences conduct a study to determine whether air quality and standards aboard commercial aircraft are adequate for the health and safety of all who fly. The Academy was asked to determine whether such aspects of cabin air as the quantity of outside air, the quality of onboard air, the extent of pressurization, the characteristics of humidification, the presence of cosmic radiation, contaminants (such as bacteria, fungi, and other microorganisms), and pollutants (such as environmental tobacco smoke, carbon monoxide, carbon dioxide, and ozone) could be responsible for health problems in the long or short run; to recommend remedies for problems discovered; and to outline the safety precautions necessary to protect passengers in event of in-flight fires, which produce smoke and fumes. Accordingly, the Committee on Airliner Cabin Air Quality was established in the National Research Council's Commission on Life Sciences. Issues the Committee addressed included the following: Are there problems with the air quality in commercial airliners? If no, what is the potential public health significance for those exposed over the vi

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short or long term? Are the problems solely those of brief discomfort, or are the health and safety of crew and passengers threatened? How well established is the threat? What can be done to alleviate it? The Committee has reviewed the available pertinent information to reach an independent scientific consensus on these issues. Unfortunately, evidence on these questions is sparse, especially on health effects. Carefully designed epidemiologic studies of health effects associated with air travel are virtually nonexistent, and most of the relevant published reports deal only with specific incidents. Hence, it is difficult to evaluate the risk to the exposed population. Indeed, the dearth of pertinent data limits conclusions about the potential for adverse health effects to no more than estimates. Much more research must be conducted before risks can be accurately assessed. The words "health" and "safety" are emphasized throughout. The Committee found it difficult to pigeonhole problems neatly as related to health, safety, comfort, or combinations of these. For example, the time required to evacuate a plane if fire occurs is certainly a safety issue, but it is also a health matter, in that evacuees will be subject to toxic fumes for a longer or shorter time. Cigarette smoking might be primarily a comfort issue for both nonsmokers exposed to smoke and smokers deprived of their stimulant; it might also be a health issue for nonsmokers, as well as smokers; it is certainly a safety issue if cigarettes are improperly disposed. The importance of these distinctions is that the Federal Aviation Administration (FAA), for which this study wan prepared, might not have the statutory authority to deal with some issues the Committee identifies. Distributed authority for the management of a situation is not unusual. For example, whether a radiation hazard is managed under the mandates of the Environmental Protection Agency, the Department of Transportation, or the Nuclear Regulatory Commission will depend on whether the radiation source is in a nuclear-energy producing facility, is in transit, or is being disposed of. vii

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As scientists and engineers, we cannot determine whether FAA alone can address the questions we raise, nor can we easily say whether they are questions of health, safety, or comfort. The legislative branch (if law must be clarified or written) and the executive branch (if, for example, coordination among agencies is required) must sort out responsibilities in appropriate ways. The Committee has gathered for the first time much important information about a complex environment. As a result of the study, we make one recommendation that clearly will be controversial. It is unanimously and forcefully proposing that smoking be banned on all commercial flights within the United States. The reasons are presented and elaborated in the text and executive summary, but the process by which the decision was reached belongs here. First, it should be emphasized that the makeup of the Committee was diverse, and only three of the 11 members were physicians with experience in the care of patients crippled or dying as a result of cigarette- smoking. Most of the members are ax-smokers who are admittedly annoyed by cigarette smoke in airliner cabins, as well as other public environments. However, most began the study with the assumption that addicted smokers could not be deprived of their habit over long flights, and therefore smoking could not be prohibited, especially on longer flights. Development of support for a complete ban was gradual, as the evidence of contamination and the impossibility of adequate cleansing of the cabin air became more and more apparent. The coup de grace to smoking in airliners was the realization that diminished ventilation with outside air and increased recirculation of air, a characteristic of almost all new airliner models, will increase previous levels of toxic products of cigarette-nmoking in nonsmoking sections of the cabin. When smoking is permitted, the result of these changes places cabin air ventilation in violation of the building coder for most other indoor environments. We recognize that prohibition of smoking on airplanes will cause discomfort and annoyance among inveterate smokers and the tobacco industry, but it is also likely to be supported by the majority of the flying public and cabin crew members. We hope that the controversies viii

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likely to arise regarding this recommendation will not divert deserved attention from the other notable proposals of the report, especially the call for much more research on other aspects of cabin air quality. To conduct its study, the Committee reviewed the available scientific and technical literature, including characteristics of various models of modern aircraft. It conducted a series of technical meetings and briefings with experts in relevant fields. In addition, members made a number of site visits to evaluate specific aspects of the issues before the Committee. The sites included: National Airport, to examine the cabin air circulation machinery of a TWA MD-80; the FAA Technical Center in New Jersey, to review procedures for testing flammability of cabin materials; the United Airlines flight attendant training Center in Chicago, to gather information about emergency training procedures; and the Boeing Commercial Airplane Company in Seattle, to explore developments in aircraft design. We are grateful to all those who educated and informed us during these visits. The Committee also thanks FAA for its support in supplying the information and assistance we requested. The Committee is unanimous in its praise of National Research Council staff, who worked prodigiously to make our job easier and more effective. Equally important, I thank the Committee members for their hard work in individually reviewing data and writing the text and for their good humor and substantive contributions to our many meetings. r Thomas C. Chalmers, Chairman Committee on Airliner Cabin Air Quality ix

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ACKNOWLEDGMENTS The preparation of this report by the Committee on Airliner Cabin Air Quality would not have been possible without assistance from a large number of people and organizations. We especially wish to thank the Federal Aviation Administration (FAA), the sponsoring agency, for responding to our numerous requests for help in locating and gathering information. In particular, we are grateful to Philip J. Akers, the project officer, and to the following other FAA staff members: Louis C. Bicknese, Charles R. Crane, Edward R. Graves, Andrew F. Home, Leroy A. Keith, Thomas E. McSweeny, Joseph A. Pontecorvo, William T. Shepherd, Robert N. Thompson, BenJamin H. Tollison, Jr., and the FAR library staff. Flight attendants have direct experience with airliner cabin environments, and they helped focus attention on issues of air quality, health, and safety. We express our special thanks to Margaret Brennan and Lynne Egge, representing the Joint Council of Flight Attendant Unions, to flight attendants Phyllis W. Conrad, Nancy Garcia, Janna F. Harkrider, Lana Holmes, and Betsy Murtaugh; and to all flight attendants who wrote letters to the Committee. The Committee visited several facilities to obtain information and observe operations and practices. We wish to thank David J. Shearer, supervisor of airport services for TWA at National Airport, for explaining the ventilation system of an MD-80 aircraft; Constantine P. (Gus) Sarkos and the technical staff at the FAA Technical Center in Atlantic City, for demonstrations of fire testing procedures and full-scale simulation tests; United Airlines personnel Paul Smith, emergency procedures training manager, Janice Northcott, inflight x

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safety manager, and Robert A. McGuffin, regional flight surgeon, for providing information and an opporunity to participate in training exercises; and Boeing Commercial Airplane Company personnel M. E. Kirchner, director of technology, B. C. Mainline, chief engineer, and their colleagues J. N. Bigford, E. E. Campbell, M. T. Katsumoto, G. Veryioglou, and A. S. Yorozu for discussing a variety of topics and demonstrating their planning techniques. The Committee consulted with a number of experts about various topics. We would like to thank John C. Bailar, William Cain, Frederick 8. Clarke, III, Arthur B. DuBois, and Ralph Goldman for their contributions. The Committee gives special thanks to Barry Ryan of Harvard University for developing the mathematical model used in this report. An open meeting was held to receive comments from the public. We are indebted to Senator Daniel K. Inonye for giving the keynote address. Several people made presentations at the meeting; they are included in the list below. The Committee thanks all the peer reviewers of the report. Their constructive remarks contributed to the improvement of presentations of technical information and its readability. So many other individuals and organizations assisted the Committee in various ways that it is difficult to mention them all. Nevertheless, with apologies for whatever inadvertent omissions occur, we shall try: John F. Banzhaf, III, Action on Smoking and Health Richard Beckham, American Association for Respiratory Therapy William M. Beckner, National Council on Radiation Protection and Measurements Merritt M. Birky, National Transportation Safety Board Cecil Brownlow, Flight Safety Foundation, Inc. Phyllis Cleveland, National Aeronautics and Space Administration J. Donald Collier, Air Transport Association of America Elliot C. Dick, University of Wisconsin xi

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Pascal Dranitsaris, Ontario Research Foundation Matthew H. Finucane, Association of Flight Attendants Hugh B. Fulton, Jr., airline pilot Sam Giordano, American Association for Respirato In Therapy Ruth M. Heron, Transport Canada Rufus R. Hessberg, Aerospace Medical Association Verena E. Klemm, Independent Union of Flight Attendants Jane Larkin, American Medical Association Richard E. Macdonald, Aerospace Industries Association of America, Inc. Samuel C. Marcus, National Center for Health Statistics Nora Marshall, National Transportation Safety Board Robert Millenburg, Smiley, Olson, Gilman and Pangla, Attorneys Stanley R. Mohler, Wright State University Philip R. Morey, National Institute for Occupational Safety and Health Matthew L. Myers, Coalition on Smoking OR Health Malcolm B. Reddoch, Food and Drug Administration John P. Reese, Aeorospace Industries Ansociation of America, Inc. James L. Repace, U.S. Environmental Protection Agency Harold Schaitberger, International Association of Fire Fighters Allen Schanot, National Center for Atmospheric Research Sorrell L. Schwartz, Georgetown University Medical Center Joseph M. Schwind, Air Line Pilots Association Donald R. Shopland, Office on Smoking and Health Jim Spahn, National Council on Radiation Protection and Measurements Martin Speiser, National Transportation Safety Board Dick Tobiason, National Aeronautics and Space Administration Jacques Vuille, Transport Canada Judy A. Weidemeier, The Tobacco Institute Bertil WerJefelt, Xenex Corporation Wayne E. Williams, National Transportation Safety Association P. Wilson, The Guild of Air Pilots and Air Navigators Edward C. Wood, Flight Safety Foundation, Inc. Mark Young, The British Air Line Pilots Association. xii

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We would like to express our thanks to the NRC staff for their work in supporting the Committee. Alvin G. Lazen, executive director of the Commission on Life Sciences, provided valuable advice concerning the intricacies of HRC activities. Devra Lee Davis, acting director of the Board on Environmental Studies and Toxicology, gave unstinting attention and support to the study. Edna W. Paulson and the staff of the Toxicology Information Center were of great assistance. Other NRC staff members contributed information and reviewed drafts of various documents for the Committee, among them Stanley M. Barkin, Committee on Toxic Hazards of Materials Used in Rail Transit Vehicles; Henry Borger Advisory Board on the Built Environment; Stephen L. Brown, Board on Radiation Effects Research; Karen L. Huleb~k, Committee on Fire Toxicology; and Diane K. Wagener, Committee on Passive Smoking. Our thanks to Norman Grossblatt for editing the entire report. Finally, we wish to express our gratitude to the following NRC staff who directly supported the study. James A. Frazier, the project director, was tenacious and persevering in shepherding us through the study. Andrew M. Pope provided valuable assistance during the formative stages of the study, and Rob Coppock contributed considerably toward the end of our task. Alison Kamat provided invaluable service not only in documenting, locating, and obtaining the large amounts of literature required in the Committee's deliberations, but also in producing the manuscript of the report. We especially thank Judy Tiger for holding us to deadlines, putting together many report drafts, and coordinating a multitude of details. xiii

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CONTENTS EXECUTIVE SUMMARY INTRODUCTION 1 PROFILE OF COMMERCIAL AIR TRAVEL Passengers, 24 Flight Attendants and Flight Crew, 28 The U.S. Airline Industry, 28 FAA Data on Selected Incidents, 33 ENVIRONMENTAL CONTROL SYSTEMS ON COMMERCIAL PASSENGER AIRCRAFT Description of Environmental Control Systems, 39 Performance of Environmental Control Systems, 48 Effect of Ventilation on Total Cabin Environment, 54 STANDARDS, REGULATIONS, AND INDUSTRY PRACTICES ... 64 U.S. Regulations and Standards, 67 Foreign Regulations, 73 Industry Operating Procedures, 74 FAA Investigation and Enforcement, 75 Adequacy and Efficacy of Passenger Safety Information, 79 Overview, 84 xiv

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4 AIR QUALITY IN EMERGENCY SITUATIONS Onboard Fires, 91 Depressurization, 106 Conclusions and Recommendations, 108 5 CABIN AIR POLLUTANTS: SOURCES AND EXPOSURES 113 Ozone, 113 Cosmic Radiation, 119 Ground Fumes, 130 Environmental Tobacco Smoke, 131 Biologic Aerosols, 152 Relative Humidity, 160 Pressurization, 165 Carbon Dioxide, 167 Other Potential Exposures, 168 6 HEALTH EFFECTS ASSOCIATED WITH EXPOSURE TO AIRLINER CABIN AIR . e e e e e e e e e e e e e e e e e e e e e e - Health Effects of Concern, 191 Monitoring and Surveillance of Crew and Passenger Health, 203 Groups at Increased Risk, 207 7 DESIRABILITY AND FEASIBILITY OF ADDITIONAL DATA COLLECTION .............................. General Concepts and Approaches, 215 Measures of Airliner Cabin Air Quality, 217 Measures of Health Effects, 220 Other SubJects, 222 APPENDIX A A Computer Model for Assessing Airliner Cabin Air Quality ~ 190 ... 214 225 APPENDIX B: Selected Material from the FAA Accident/Incident Data System 244 APPENDIX C: Airliner Cabin Safety Regulations and Standards 278 GLOSSARY xv 293

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