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Medical emergency at 35,000 feet — what you should know

 

It’s mid-afternoon, July 13, 2005, and this reporter is catnapping 35,000 feet above Canada’s unforgiving Northwest Territories, en route from Atlanta to Tokyo Narita International. Aboard Delta Air Lines Flight 55, a sleek 777-200ER, a quiet drama is about to play out, one that

will intimately illuminate how airlines, crew members, ground-bound physicians and, yes, even some passengers can work in concert to pull people through a serious medical emergency.

A flight attendant has been hit in the head by a heavy serving tray in the rear galley. She’s showing signs of moderate concussion, a condition that demands close scrutiny.

The call goes out on the cabin public address system for a doctor. No one responds. Another summons, this time for a nurse. No one answers. Finally, the voice of the chief flight attendant pleads for anyone with medical experience to help. I pause, then push the flight attendant call button on my seat console. It’s been three decades since I was a U.S. Army combat medic. I just hope I remember enough to help

On board the Triple-Seven is a medical kit. I grab the blood pressure cuff and stethoscope and try to take a reading, the noise of the air rushing over the fuselage all but masking the telltale initial “tap-tap” systolic sound, as well as the fading “thump-thump” that signals the diastolic reading. It takes two tries to get a clear blood pressure, and it’s lower than it should be.

The chief flight attendant calls the captain, who initiates a call to the University of Pittsburgh Medical Center’s Stat-MD operation in the U.S. state of Pennsylvania, where emergency physicians are on call 24/7. He puts me on the line with a specially-trained doctor. I relay the vital signs, my overall impression of the patient’s condition.

It’s time to make a decision. If Flight 55 is going to divert, the nearest airport close to appropriate medical help is Anchorage. And if we’re going to make ANC we need to start descending shortly. The diversion will cost Delta upwards of $100,000. The captain, in whose hands the final decision lies, asks the doc what he thinks. The three of us – passenger, physician and pilot – converse one more time. The patient’s pupils are equal and responsive to pulses from my penlight. Her blood pressure is coming back up. There’s no blood in the ears. Best get her to the crew rest area in the upper “attic” of the Triple-Seven and have me monitor her for the rest of the flight.

No diversion, not this time. The rest of the flight is blessedly uneventful.

A Decidedly Delicate Balancing Act

According to the International Air Transport Association (IATA) airlines worldwide flew some 3.3-billion passengers in 2014, the last full year for which statistics are available. On the basis of data gathered between January 1, 2008 and October 31, 2010 authors of the May 2013 article Outcomes of Emergencies on Commercial Airline Flights in the prestigious publication The New England Journal of Medicine estimate “44,000 in-flight medical emergencies occur worldwide each year. Medical emergencies during commercial airline travel, although rare on a per-passenger basis, occur daily.”

Let’s sharpen that per passenger statistic a bit. U.S.-based MedAire’s air-to-ground MedLink service, based out of the Emergency Department of Banner Medical Center in Phoenix, Arizona in the US “receives an average of 37.5 calls for medical advice from aircraft in flight per 1 million passengers carried by the [airlines] that use our service,” says Dr. Paulo Alves, MedAire’s global medical director for Aviation Health. Some 70 airlines worldwide employ the MedLink.

“Taking care of passengers is something unique to the transportation industry and, in particular, to air transportation,” says Alves. In his paper The Challenges of Medical Events in Flight, he goes on to say, “Once a flight is airborne, there is no possible access to any established health care system.” That creates a dilemma, how to strike a good balance “between the immediate risk and cost of a diversion, vs. the implied risk – or even liability—when deciding to continue a flight with an ill or injured passenger.”

MedLink stats reflect one aircraft diversion per one million passengers flown. A diversion means a flight lands at an airport other than its intended destination.

Air-to-ground doctor-to-aircraft systems, endorsed by the International Civil Aviation Organization (ICAO), “can help in significantly reducing unnecessary diversions,” says Alves.

But what airlines want to prevent, at all costs, is an in-flight passenger death. While reported statistics are scarce, Dr. Alves says, “it’s estimated that one IFD (in-flight death) occurs for every 7.6 million passengers traveling. In addition to the human toll IFDs wreak, he says they can ignite “litigation and bad publicity for the airline.”

What Ails You

Most in-flight medical emergencies, or IFMEs, says The New England Journal of Medicine’s (NEJM) study, have to do with lightheadedness, fainting, respiratory symptoms or gastrointestinal symptoms. Just about 30 percent of those situations got better while the flight was still in the air, so much better that emergency medical personnel weren’t needed upon landing. When things did not get better, and the pilot asked for EMS help upon touchdown, just over 37 percent of those passengers were taken to a hospital emergency room.

“In addition to cardiac arrest,” says the NEJM report, “medical problems that were associated with the highest rates of hospital admission were stroke-like symptoms (23.5%), obstetrical or gynecologic symptoms (23.4%) and cardiac symptoms (21%).”

Drilling a bit deeper into data, the report found obstetrical symptoms rarely cause medical emergencies, “a finding that supports existing recommendations that air travel is safe up to the 36th week of gestation [pregnancy].” The majority of obstetrical or gynecologic symptoms—just under 61 percent of them—“occurred in pregnant women at less than 24 weeks.” As for the popular belief that pregnancy begets bunches of flight diversions, the study tallied just “three cases involving pregnant women in labor beyond 24 weeks which resulted in diversion.”

Tool Kits to Combat What Ails You

AEDs, automatic external defibrillators, those wondrous machines that can shock a heart back to beating, are mandated for passenger aircraft by US Federal Aviation Administration regulations. So is a well, and specifically, stocked Emergency medical kit, or EMK. A number of other worldwide regulatory bodies recommend or require the same.

No mere first aid kit, EMKs are mini-pharmacies. They’re fitted with oral drugs such as Nitroglycerine tablets for heart pain. There’s injectable Epinephrine, to counter life-threatening anaphylactic shock, which can be triggered by severe allergies to things as simple (and potentially deadly) as peanuts.

How to Avoid an IFME in the First Place

The best way to handle a medical emergency, in the air or the ground, is to avoid it altogether. Dr. T.J. Doyle is medical director of the University of Pittsburgh Medical Center’s Stat-MD program, which serves some 17 airlines throughout the globe. He says the most important role passengers can play in protecting their health aloft is to make sure they understand their own medical issues, particularly chronic conditions.

Included in the chronic category is COPD, chronic obstructive pulmonary disease, where supplemental oxygen may be necessary. “It’s important to remember that even if you don’t need oxygen on the ground, the cabin altitude is [usually] the equivalent of being on a six- to eight-thousand-foot mountain,” says Dr. Doyle. “So, even if you don’t need it at sea level there may be a possibility you may require oxygen at altitude.”

If you have a chronic pulmonary problem, Doyle suggests checking with your physician before flying, as well as the airline. That’s because “The solution now on the commercial airline side is portable oxygen concentrators.” Problem is “Most US commercial airlines either no longer provide, or give you the opportunity to purchase, on-board oxygen. Some of the Canadian airlines do.”

There are a number oxygen concentrators approved by various governmental regulatory agencies such as FAA and EASA, the European Aviation Safety Agency.

So, how about those cylindrical oxygen bottles with the masks attached that you may have seen stowed on board? Why not use those? “The onboard [portable] oxygen is technically not for passenger use,” says Stat-MD’s medical director. “It’s really for the flight attendants in the case of a decompression emergency so they can walk around the cabin…[Passengers] shouldn’t have an expectation it’s available for them.”

Another IFE-avoidance tip is a bit of a no brainier: “Make sure that if you take medications that you don’t put them in checked baggage,” says Dr. Doyle. “Have them with you in your carry-on.”

More than a few flyers forget. “We get calls from people on transoceanic flights,” he says. “A classic [example] is they have forgotten their Insulin is in their checked baggage and that their blood pressure is going to be out of control.”

Is There a Doctor On Board?

MedAire doesn’t track the percentage of time on-board professional medical help is at hand, but Dr. Alves estimates it ranges from 60 to 80 percent – physicians, nurses, emergency medical technicians and other first responders. As sort of a force-multiplier measure, MedAire runs training programs “designed to give cabin crew [flight attendants] the knowledge and skill to recognize and manage in-flight medical emergencies.”

Still, Alves says the fact remains “Many airlines rely on the kindness of stranger by paging for a medical volunteer.” Problem is, “A medical professional doesn’t board a flight expecting to go to work—he [or she] is a passenger first,” a passenger who “may not have the skills necessary” to handle the situation they face.

Hovering over the situation, providing presumed cover for those strangers, is the Good Samaritan angel. In general, Good Samaritan laws offer legal protection to people who give reasonable assistance to those injured, ill, or in peril. But, as with everything involving the law, there are nooks and nuances you need to know about.

Alves says, “Good Samaritan regulations that may cover those assisting during a medical situation could be negated if any form of compensation is offered. Someone who is compensated is not generally regarded as a volunteer.”

Back to Delta Flight 55 for a second. After I tended to the flight attendant and got her settled in the crew rest area, the captain upgraded me to business class. I took him up on it, every few minutes checking on the condition of “my patient.” But—and here’s the irony of it—the moment I settled into that BusinessElite seat I may have stripped myself of legal cover, the Good Samaritan angel fluttering away outside the window.

Even if I had declined the upgrade, Good Samaritan might not have applied. That’s because a week after I returned home from Tokyo I found a delivery driver at the front door with a goody basket of crackers and confections and a thank you note from Delta.

Be compassionate, but play it safe. Assuming you’re qualified, volunteer to render aid. Remember, the physician, pilot, qualified passenger partnership really can save lives. But don’t expect anything aside from satisfaction in return. Decline anything that even hints of a gift.

The greatest gift in all is human life. Ground-bound physicians such as Paulo Alves and T.J. Doyle understand that. They also understand, says Doyle, while an in-flight medical emergency “may be a once-in-a-career [event] for the cabin crew, the pilot, and…the on-board volunteer,” it’s virtually a daily occurrence at companies such as MedAire and Stat-MD. That’s why having an experienced, aviation-savvy ground-bound ER doc at the crew’s beck and call can be critical, even when medically-trained personnel are on board.

“We do this all the time,” says Doyle. “We understand how [IFMEs] work…how they usually play out. It’s important that the flight crew trusts us.”

Whether to divert or not remains the captain’s call. Doyle says pilots sometimes disagree with the ground doctor’s recommendations.

But physicians thousands of miles away still have considerable sway as they help crew and on-board caregivers navigate the IFME storm, working to “take some of the fear and uncertainty out of the situation and, hopefully,” says Dr. Doyle, “help everyone onboard get through it.”

See something? Say something – The perils of holding one’s tongue

When aviation safety is at issue, silence is anything but golden. In recent years airlines and civil aviation authorities have developed reporting systems to speed the flow of critical safety information among pilots, mechanics, airlines and regulators. The motto of all those efforts is straightforward: ‘See Something, Say Something.’

Absent from the process, at least formally, are airline passengers, the people upon whom the health of the industry ultimately pivots. In this post-9/11 society we live in security officials encourage flyers to report anything that looks out of the ordinary be it person or package. But the industry is all but mum when it comes to speaking up when something mechanical or weather-related looks strange.

“They haven’t taken it to the next step,” says
former U.S. National Transportation Safety Board Member John Goglia, “which would be [creating] a process by which passenger information would also be plugged in.”

Goglia says he understands airlines could get “a lot of passenger comments that mean nothing. But…every once and a while you’re going to get a comment that has significance to it.”

Once, as a cabin crewmember on a flight awaiting departure from the wintry U.S. city of Denver, Colorado, Sara Nelson, now international president of the Association of Flight Attendants, responded to a passenger’s call button. “He said he thought he saw some ice build up on the wing,” she remembers. She took a look out the window and headed for the flight deck. “The first officer (co-pilot) came back… and, indeed, there was concern.” The aircraft was de-iced again.

Goglia recounts a somewhat similar scenario when he was on an aircraft awaiting takeoff from the snowy Midwestern city Indianapolis, Indiana in the U.S.: “I was sitting over the wing and saw the snow build up pretty good and could see where it was at the point that it was [concerning]. I actually got up. I was in a window seat. So I climbed over two people and…and was making my way towards the cockpit when one of the pilots came back. And I said, ‘I was just coming up and let the flight attendant know you need to go back and be de-iced.’”

The pilot responded, ‘I was coming back to look. Thanks.’”
The aircraft took an hour’s delay while ground crews de-iced it.

But oft-times passengers don’t speak up.

Hell Over Hawaii
April 28, 1988, Aloha Airlines Flight 243 is 24,000 feet above the Pacific en route from the U.S. city of Hilo, Hawaii to Honolulu when the unthinkable happens: explosive decompression rips 18 feet of fuselage from the top of the 737-200. Ninety-five souls are on board. One of them, a flight attendant, is swept overboard to her death.

The craft makes a miraculous emergency landing at Maui. No one else dies.

The United States National Transportation Safety Board says the probable cause was Aloha’s failure “to detect the presence of significant [structural] disbanding and fatigue.”

In the wake of Flight 243, this revelation emerges: “After the accident, a passenger stated that as she was boarding the airplane through the jet bridge at Hilo, she observed a longitudinal fuselage crack,” says the accident report. That crack lurked in an upper row of rivets, along what’s called a lap joint, about half way between the cabin door and the edge of the jet bridge hood. The report notes, “She made no mention of the observation to the airline ground personnel or flight crew.”

Why Passengers Don’t Speak Up
Marc Berman is a 100,000-mile frequent flyer, CEO and managing partner of The Mallett Group, a U.S.-based loyalty and relationship marketing firm. What makes his insights particularly penetrating, however, is that as a licensed independent clinical social worker he has a grounding in psychology.

Berman believes passengers often don’t speak up when they spot something unusual because many of them “have become very passive and don not question an airline’s [safe] operations.” Ironically, this passivity is pegged to the industry’s “fantastic safety records. People put their faith [in the airline]. I think there’s some denial there. Everyone wants to believe they’re going to be okay.”

That warm, fuzzy blanket believes Berman is ripped apart only when “an egregious sort of problem…makes someone speak up.”

BA’s Close Call
May 24, 2013, London Heathrow International. A British Airways A319 with 80 souls on board is taking off on a flight to Oslo when the cowl doors covering both engines are wrenched from the twin-engine Airbus. According to a recently-released report by the United Kingdom’s Air Accidents Investigation Branch (AAIB), the crew turned back to LHR. On approach to Runway 27R leaking fuel from a damaged fuel pipe on the starboard, or right side, engine ignited.

Here’s where passenger input comes into play. According to the AAIB report, “Several passengers reported that they had attempted to inform a member of cabin crew about the leaking fluid from the right engine. It is unclear when or how the passengers attempted to draw this to the attention of the cabin crew, or indeed which cabin crew member(s) were involved, but it is evident from photographs and passenger reports that the fuel leak was clearly visible through the cabin windows. Despite these cues, information regarding the fuel leak was not assimilated by the cabin crew and not passed to the flight crew as required by the operator’s SOPs (standard operating procedures).

“Information not acquired cannot be passed onto the decision maker and the pilots remained unaware of the fuel leak until the ECAM (Electronic Centralized Aircraft Monitor) fuel imbalance alert was triggered. Had the flight crew been made aware of the fluid leak from the right engine at an earlier stage, they might have been able to identify the fuel leak more quickly and could have taken appropriate action to mitigate the severity of the event.
“The operator (British Airways) has…a procedure for cabin crew to report cabin emergencies to the flight crew and provides new entrant cabin crew with basic aircraft knowledge in accordance with EASA (European Aviation Safety Agency) practices. However, on this occasion, the training and procedure were unsuccessful in ensuring that vital information on the state of the aircraft was acquired by the cabin crew and made available to the commander.”

Thanks to some superb airmanship on the part of the cockpit crew the Airbus landed safely back at Heathrow. No one died; there were no injuries.

In the wake of the incident, Air Accidents Investigation Branch recommended British Airways amend its pilot and cabin crew “training, policies and procedures regarding in-flight damage assessments and reporting by cabin crew.”

Passenger Input In The Digital Age
One particularly pointed lesson learned from the BA incident is that in this digital age we inhabit potentially every passenger is a reporter, a chronicler of obvious, the outlandishly out-of-the-ordinary.

Peter Goelz is a prime position to know. He’s former managing director of the U.S. National Transportation Safety Board, and current senior vice president of the Boston-based crisis communications consulting firm O’Neill and Associates. “The world has changed dramatically, particularly over the last ten years,” he says. “The ubiquity of recording devices,” has altered the informal rules of the game when it comes to passenger input. Consider the BA incident and the photos passengers took of fuel erupting from the right side of the aircraft. “In terms of safety…that sort of crowd-sourcing puts considerable pressure on aircraft crewmembers to take these kind of inquiries seriously.”

Where once upon a time Goelz says the flight attendant might have simply said, “‘Ma’am (or sir), I understand. We’ll get to it. Everything is under control,’” now the passenger may have a digital photo or tape of the offending problem.

Goelz further argues since 9/11, “the whole issue of how you respond to passenger concerns has changed.” Passengers are encouraged to be part of the security effort by suspicious people or packages. Goelz sees scant difference between reporting potential safety issues and reporting suspected security lapses. “You don’t want people to sit on [potential safety information].” While conceding a sudden fountain of passenger-generated information could be a “pain in the neck” for airlines, the former NTSB official asserts something fundamental: Passengers “have a right to ask questions.”

Virtually all the experts AirlineRatings interviewed for this story agree that ‘See Something, Say Something’ needs to be something more than a slogan. AFA’s Sara Nelson says, “In terms of what we can do to get [passengers] engaged, perhaps the safety briefing, those initial safety instructions” about seat belts, oxygen masks and exit locations should add a more general admonition: ‘See Something, Say Something.’

Marc Berman contends the concept could be seen by particularly passive passengers as “permission” to speak up.

Permission or not, indications are we may well be entering a brave new era, one where it no longer pays for passengers to hold their tongues.

Disturbing data: Just how effective is airport security?

Sixty-seven out of seventy isn’t a bad score, unless it concerns the success rate in cracking airport security. That puts the data in a decidedly different light.

According to a report by the American Broadcasting Company, based on leaked data, that’s the number of times auditors dispatched by the inspector general of the U.S. Department of Homeland Security (DHS) were able to penetrate airport security: 67 times out of 70 tries. According to ABC, DHS was able to secret fake explosives and weapons through the system unnoticed some 96 percent of the time.

In the days that followed the ABC report we discovered gaps in the vetting of people who work at U.S. airports. According to a release from DHS’s Office of Inspector General, the OIG “identified 73 individuals with possible terrorism-related information that [were] not reported to TSA. TSA acknowledged that these individuals were cleared for access to secure airport areas despite representing a security threat.”

In prepared testimony before the U.S. Senate’s Committee on Homeland Security and Governmental Affairs DHS Inspector General John Roth said, “We believe there are vulnerabilities in TSA’s screening operations, caused by a combination of technology failures and human error.”

Even before Roth’s testimony, the Transportation Security Administration’s acting administrator, Melvin Carraway, was reassigned. He’d occupied one of the hottest of hot seats in Washington, DC. He’d been in the position just since January.

The leaked data, and resulting bureaucratic response, beg the question: just how concerned should airline passengers be?
“Every American should have reason to be concerned,” asserts Mike Boyd, president of Boyd Group International, a noted aviation consultancy. “TSA is a misfire. We need to shut it down and start a real security organization.”

Boyd believes any organization taking the place of TSA “should be accountable and they should be professional. These [airport screeners] in blue shirts are very, very nice people…the nicest people in the airport.” But, he goes on to maintain, “they’re not a security team. They’re there to look for pointy objects, not [spot] security failures.”

Then there’s this assessment: “We are not any safer than [before] 9/11.”

In the immediate wake of September 11, Kevin Mitchell says he did “one of the dumbest things I’ve ever done.” Mitchell is chairman of the Business Travel Coalition, a U.S.-based consumer group. Some 15 years ago he called for a federal takeover of airport security. Now, he wants to give that job back to the airlines, with some stringent upgrades in standards. His reasoning? “The airlines are the entity with the most to lose, and therefore they should logically do it right this time.”

Mitchell says any such handover should be accompanied by high standards that an oversight body “would police the hell out of.”

He likens the resultant oversight to the model the U.S. Federal Aviation Administration now employs when it comes to aircraft maintenance. “The airlines do the maintenance, and they’re ultimately accountable.” Is it perfect? No. “But,” contends the BTC chief, it’s “far better a model than…TSA.” He maintains the Transportation Security Administration is “out of control. It does things for political reasons often instead of security reasons.”

So, is the sky really about to fall? Not at all, contends Jack Riley, vice president of the RAND Corporation’s national security division. RAND is a major international think tank.

Asked if he agrees with ABC News’ report, he answers, “Do I believe that we’re actually missing 67 out of 70…contraband [articles] coming through [security]? I think the answer to that is ‘no.’”

Riley says part of the security probing process, via which tests are carried out, “is artificial. The people conducting the test may know better than the average person about how to conceal something.” That, he asserts, “probably tends to over-inflate the failure rate.”

As for the portrait recent (and not so recent) revelations paint of TSA as a bumbling, lax organization populated by people who are neither well trained nor properly managed he counters, “That’s just patently not true.”

So, once again, how safe are we? Decently safe, believes Riley, even though he concedes there’s work still to do. The RAND security chief cites TSA’s layered approach to security as providing extra protection. “There are multiple other elements to defense the civil aviation system. It starts with locked cockpit doors that make it very difficult for a 9/11-style hijacking to occur again.”

Then there’s the legacy of United Flight 93 that frightful Tuesday morning a decade-and-a-half ago, when the 757’s passengers took matters into their own hands and tried to save the aircraft from hijackers. The notion now is “that if something like that occurs, everybody has a responsibility to put an end to the event,” says Riley.

There’s another level of protection: Federal Air Marshals. They travel incognito on many flights, especially international ones. Other even stealthier security exists too, layers passengers don’t notice, layers that remain intentionally invisible.

In Jack Riley’s estimation the revelations of the past couple of weeks are opportunities for TSA to transform itself. They “didn’t disagree with any of the [inspector general’s] findings. I think that’s a very important signal that they understand there were gaps.” That’s why he’s inclined to look at the present situation “as a learning moment rather than a moment of panic.”

Don’t look for this debate to end any time soon.

Lessons from on high: Staying safe and sane while flying with kids

Seasoned travelers with few fears of flying can go catatonic at the idea of having to spend time cooped up with kids in an aircraft cabin. You’ve seen the look as they suddenly realize they’re seated next to a mother with child. “I’ve certainly experienced my fair share of stink eye,” says Corinne McDermott, mother of two, frequent flyer and founder of the popular blog HaveBabyWillTravel.com. For some flyers “the very idea of sharing airspace with children” sparks quiet hostility. On go the noise-canceling headsets, down come the eyeshades.

Looking for strategies to defuse the situation, to set the tone for the flight so that frequent flyers and families alike have a better shot at comfortable co-existence? Read on.

The Power of Sleep
When traveling with daughter Megan and son Riley, McDermott tries to make sure departure time coincides with nap or bedtime, the better to fall asleep when onboard. This is a natural for families traveling from the U.S. East Coast to Europe, where departures dovetail nicely with bedtime.

If you can’t manage the clock the way you’d like, try getting the kids some vigorous pre-board exercise. Ditch the dead zone of the gate hold area. Have them stow the video game, unplug their headphones and take them on a brisk trek down the length of one those never-ending concourses. A treat at the end of the trek helps, perhaps a cup of sleep-inducing hot chocolate. It’s a sensational soporific.

Increasingly airports around the world are fitted with in-concourse playgrounds, places where kids can burn off energy before boarding or between connections. Take advantage of them.

At airports such as Dallas/Fort Worth International, American Airlines’ prime hub, some playgrounds mimic actual airports, complete with terminal, air traffic control tower and aircraft. It’s the sort of setting that gives free rein to kid’s imaginations, and tires them out at the same time.

This sort of natural approach works best. Medication well may not. “Most pediatric medicine specialists do not recommend sedatives for traveling children,” say Doctors Philip R. Fischer and M. Rizwan Sohail of the world-renowned Mayo Clinic. Their comments come from the June 2011 edition of Minnesota Medicine in the paper Children and Airplanes: Are We Having Fun Yet?

They say that while commonly used over-the-counter diphenhydramine (Benadryl) “is usually safe…parents should be warned that some infants…may become hyperactive or agitated after receiving a dose.” Fischer and Sohail suggest if you do intend to sedate your child they fly the best approach is “to try a test dose at home” just to make sure they aren’t prone to a bad reaction.

It all boils down to parental philosophy. If you do give a mild sedative to a wee one when traveling across multiple time zones make sure “at least one adult care provider…remains unsedated in order to be available to the children traveling with them.” It’s okay if you zone out while traveling alone. Flying with a child for whom you’re responsible is another matter entirely.

HaveBabyWillTravel.com’s McDermott says, “Gravol and Benadryl can make some kids drowsy.” But when she gave it to her children for the prescribed reason “it made them hyper.” She now flatly states: “Drugging my kids for a flight is not an option.”

Natural sleep is the best sort of sleep. The flight passes faster and the side effects are fewer.

Oh My Aching Ear
Ear pain is no joke, especially among small children. We hesitate to call it an ache, because the pain can prove excruciating. It usually comes on during descent, that long slow approach to the airport. That’s when first whimpers break out, whimpers that can quickly turn to screams among the very small. Doctors Fischer and Sohail write, “There is no known medication that can help.” While adults may benefit a bit by taking pseudoephedrine nasal decongestant half an hour before takeoff, kids who take the medication appear neither better nor worse for having taken it.

Both the good doctors, as well as Corinne McDermott, recommend packing finger food and drinks for the flight. A sippy cup half full of a child’s favorite juice helps somewhat in taking off that sharp edge associated with descent. That’s because kids have to swallow. “Children (especially young infants) can suck and swallow in ways that manipulate the Eustachian tubes and facilitate pressure equalization,” concludes Children and Airplanes: Are We Having Fun Yet?

This author’s first-born son had exceptionally narrow Eustachian tubes when born, and our family flew a lot. On a flight ‘twixt Birmingham, Alabama and Dallas/Fort Worth a Delta Air Lines flight attendant demonstrated a trick that seemed to work. She got a paper towel, soaked it in warm water, wrung out the excess water and then stuffed the towel in the far end of a plastic cup. She then said we should hold the cup to our son’s ear for a short time. After a few moments, he stopped crying. A cautionary note: be sure the temperature of the water is merely warm, not hot, and that any excess moisture doesn’t trickle into the ear. Some doctors don’t support this “cure,” counseling parents to avoid it altogether because it could lead to infection.

Don’t assume just because they’re flying that the yowls emanating from your child are pegged to pressure on the ear. “Children have a difficult time expressing when [and, more importantly, where] they hurt,” says Sara Nelson, international president of the Association of Flight Attendants (AFA). “Many times children are crying because they’re actually teething,” says the lady who heads the union representing some 50,000 flight attendants.

She says there are devices to be had that, when filled with ice, kids can suck on. They numb the gums, and can lower the cabin stress level considerably.

Let Me Entertain You
Keeping children placid on airplanes involves a bit of practice, and a decent degree of trial and error. Lots of parents opt to roll out a pack of in-flight entertainment: toys, books, videos. HaveBabyWillTravel.com founder McDermott is a true believer in the inspiration the iPad affords kids. Instead of toting along books, crayons and games simply consolidate the diversions virtually, via a tablet computer. As for the really wee ones the chore is much easier. “They’re easily distracted by the in-flight safety card, an airsickness bag, your cell phone or your watch.”

Older children, of course, demand a lot more. You can plug them into the IFE (in-flight entertainment system) and let them be or you can take the opportunity to interact with them, and render each flight a real journey of discovery.

Never underestimate the entertainment value that awaits just outside the window. Do a bit of reading up in AirlineRatings.com’s Did You Know? section and discover how wings work. How slats and flaps work to sculpt the air, producing the miracle that is lift; how ailerons operate bank and to turn the airplane. Each flight, indeed each phase of flight, can be a fascinating learning experience. All your kid has to do is look out the window.

Then there are clouds, in all their majestic shapes and hues. Before you travel, purchase a book on clouds suitable for young readers. Make it a contest to see which child can spot what kind. Kids love to compete.

Take along a map, either embedded in your digital device or folded out on your tray table. Work with your child as they trace the route across country. Many airlines have flight tracking software linked to seatback video monitors. Ask your child to match virtual cities, rivers and mountains with the real, live thing down below. It’s a great lesson in geography.

The point is you don’t have to “set and forget” your kid as they lose themselves in the world of pulse-pounding video games or music videos. Consider flight attendant Sara Nelson’s sometime solution. She’s gone so far on an overnight flight as to cradle a babe in her arms and sing to them against a backdrop of a darkened cabin and sleeping passengers. Such airborne lullabies, of course, aren’t always possible, “because there’s typically more workload than flight attendants can handle.”

But, before you can work any of this in-flight magic, you’ve first got to determine if it’s right for your child to fly. Most of the time it’s fine; sometimes it’s not.

Is It Okay for My Child to Fly?
Otherwise healthy (and that’s the key here) newborns aren’t too young to travel by air. Fischer and Sohail say once conventional wisdom was that infant alveoli (air sacs within the lungs where the exchange of oxygen and carbon dioxide takes place) took six weeks of post-pregnancy development before they could handle the low air pressure in an aircraft cabin. Not so. “No evidence supports this hypothesis,” they say. “Age is not in any way a predictor of one’s ability to tolerate low-pressure environments.”

More myth-busting revelations about cabin air and infants: the concern is that relative hypoxia in a commercial airliner (the equivalent of breathing air with 15 percent oxygen vs. the normal 21 percent at sea level) might be risky for babies. The conclusion: they had neither significantly longer instances of hypoxia (reduced oxygen) nor apnea (pauses in breathing or shallow or infrequent breathing during sleep). Moreover, say Fischer and Sohail, “There is little evidence that high altitude is associated with increased risk of sudden infant death syndrome,” or SIDS.

That said, parents should proper precautions when they do decide to fly. Among Fischer and Sohail’s recommendations:

– If your baby was born prematurely and had neonatal lung disease avoid taking the child on an aircraft for first year of life.

– If your child has been diagnosed with a peanut allergy always have an epinephrine pen on hand. That means when you’re flying too.

Seat of the Pants
Where your child sits matters. Ensure that it’s not on the aisle. Children sitting on the aisle not only have an unimpeded straight shot to the rest of the airplane should they become restive, they also run the risk of trauma from falling objects and burns from the meal and beverage carts. This is especially true for infants. A yet-to-be-published report by MedAire’s Dr. Paulo Alves finds lap infants much more likely to suffer in-flight injury from turbulence, material falling from overhead bins and amputation of fingers from food trolley carts.

Then there’s the issue of reserving a separate airline seat for your child and using an approved child restraint system to strap into that seat. Not everyone can afford to do that. As for holding a child in your lap or attaching them to you with a belly belt, rules vary from country to country. The International Civil Aviation Organization (ICAO) and International Air Transport Association (IATA) are working together to harmonize regulations.

There’s no doubt kids are safer in an approved child restraint system, one secured to their own seat. But, contends AFA’s Nelson, such seats “help soothe and calm” kids. It’s a matter of flying amidst familiar immediate surroundings, “because they travel all the time in the car, usually in that very seat.”

How to Pack that Carry-on
Corinne McDermott believes in being over-prepared before setting out to the airport. When children Meagan and Riley were very young she packed one diaper for every hour of her journey, not just the time spent aloft. “If you’re trapped in an airport, purchasing baby items is not the easiest thing to do,” she says. Another essential is wipes. They’re good not just for baby’s bottom but for sanitizing seat tray tables, armrests, even laminated safety cards.

Perhaps topping the must-have list is the child’s ‘Wobbie,’ thats special blanket or toy. She admonishes readers to “Guard this with your life!” If at all possible carry a back up. Otherwise, should the one, ‘irreplaceable’ comfort item be lost you’re doomed. To see McDermott’s phenomenally complete carry-on packing list go to http://www.havebabywilltravel.com.

To counter the evil eye some passengers inflict on infant flyers, their families, and their Wobbies, some of McDermott’s readers go so far as to bring peace offerings on board to hand out amongst nearby fellow travelers, things such as drink coupons. Personally, she doesn’t go for the idea. She contends it distracts from the task at hand: taking care your child with every fiber in you. “If you are 100 percent focused on your child, in keeping them engaged, comfortable and safe” one side effect is a pleasant plane ride for all.

Getting buy-in by older children is part of the prescription for a pleasant flight. AFA International President Sara Nelson finds siblings “can be very helpful,” in helping parents cope. “If you have two or three children and one’s a bit older, giving that older child the job of trying to keep the younger child quiet,” can work both to entertain the younger while occupying the older.

Neslon has been flying with her five-and-a-half-year-old son since he was two months. Before they board, Nelson “has a little discussion about airline etiquette,” about not kicking the seat in front of him, continually opening and closing the tray table, things like that. She’s a real advocate in “enrolling” children as part of the travel process, of “helping them understand that they’re part of the larger community.”

Among lessons learned aloft, this might be the most important, and the most lasting.

Geremanwings Flight 9525 has ample precedent: a recent history of pilot murder-suicides

The words spoken by Marseille prosecutor Brice Robin were chilling. In the wake of the March 24 crash of Germanwings Flight 9525, which killed all 150 on board, the French legal official says it appears First Officer Andreas Lubitz’s “intention [was] to destroy this plane,” by locking the captain out of the cockpit and commanding the aircraft to descend on a bee-line into the Alps.

If this proves out it may well mark at the fourth instance in the past 21 years that a commercial airline pilot has purportedly purposely crashed his aircraft. The toll for the four crashes (although some label a few of these occurences “accidents”) is 504 souls on board.

Consider:

– November 29, 2013: LAM Mozambique Airlines Flight 470, with 33 on board, takes off from Maputo to Quatro de Fevereio Airport in Angola. The Embraer 190 regional jet crashes en route into a Namibian national park.

Although the weather was poor, a preliminary report by the Mozambican Civil Aviation Institute finds Captain Herminio do Santos Fernandes had (here’s that word again) a clear “intention” of crashing the aircraft, by changing the autopilot settings. More eerily, the Cockpit Voice Recorder (CVR) discloses successive loud bangs as the first officer tries to break down the locked cockpit door.

– October 31, 1999: EgyptAir Flight 990, with 217 aboard, crashes some 60 miles south of Nantucket, Massachusetts on a nonstop flight from New York JFK to Cairo. All on board die when the 767-366ER plummets into the North Atlantic. The U.S. National Transportation Safety Board rules the probable cause for the crash was “the airplane’s departure from normal cruise flight and subsequent impact with the Atlantic Ocean as the result of the relief first officer’s (second co-pilot’s) control inputs. The reason for the first officer’s actions was not determined.”

No, but we do know that that the CVR recorded relief first officer, Gameel Al-Batouti, twice calling out “Tawkalt ala Allah” (“I rely on God”) before pulling back the craft’s power levers and pointing the nose of the big Boeing towards the chilly North Atlantic.

The captain had been in the lavatory, returning aghast to the cockpit to ask, “What’s happening?”

The Egyptian Civil Aviation Authority, the (ECAA) didn’t agree with the NTSB’s conclusion. The ECAA pegged the crash to mechanical failure of the 767’s elevator system. The elevators are located on the horizontal stabilizers, on the tail of the aircraft. They control ascent and descent.

– December 19, 1997: SilkAir Flight 185. One-hundred-four souls are aboard the 737 as it lifts off from Jakarta, Indonesia. It crashes in a river in southern Sumatra.

Because the aircraft was built by Boeing, the U.S. NTSB participates in the investigation. It does not issue a probable cause, that’s up to the Indonesian National Transportation Safety Committee. But the NTSC was stumped. Because of inconclusive evidence it doesn’t determine the cause of the crash.

However, in a December 11, 2000 letter to the Indonesian NTSC the NTSB said, “The examination of all of the factual evidence is consistent with the conclusions that: 1) no airplane-related mechanical malfunctions or failures caused or contributed to the accident, and 2) the accident can be explained by intentional pilot action. Specifically, a) the accident airplane’s flight profile is consistent with sustained manual nose-down flight control inputs; b) the evidence suggests that the cockpit voice recorder (CVR) was intentionally disconnected; c) recovery of the airplane was possible but not attempted; and d) it is more likely that the nose-down flight control inputs were made by the captain than by the first officer.”

To this day, the cause of SilkAir 185’s demise remains controversial.

Psychological Autopsies
In the wake of an airline crash, authorities often perform so-called “psychological autopsies,” on the cockpit crew – especially if there are indications human factors are involved. Germanwings First Officer Andreas Lubitz’s life is coming in for minute scrutiny just now, this in an effort to determine why, if indeed that’s the case, he chose to lock that cockpit door and fly the A320 into the Alps.

Is there an effective way to cull out potential bad apples before they wreak havoc, a way that transcends the existing airline and regulatory scrutiny?

A noted former safety investigator once told this author that Aeroflot psychologists, back in the bad old days of the Soviet Union, used to examine crewmembers before each flight. The idea was to ferret out potential defectors, but psychologists were also out to determine who was fit to fly that day.

No one is suggesting that sort of approach today. The operational pace of today’s commercial airlines is just too fast, and the pilot’s unions might well object to the intrusiveness of such scrutiny.

But with a possible quartet of pilot murder-suicides in the past two decades it’s safe to say the problem is getting the industry’s attention as never before.

Lithium-ion battery battle: Pilot’s union backs ban

The lithium-ion battery battle is heating up, literally and figuratively. The issue: whether these controversial power-producers should be allowed to be carried, in bulk, in the bellies of passenger aircraft.

According to a story by the Associated Press two influential groups want the ban. One of them is the International Coordination Council of Aerospace Industry Associations (ICCAIA), which represents, among others, aircraft manufactures such as Boeing and Airbus. The other is the International Federation of Air Line Pilots Associations (IFALPA).

In a paper obtained by AP the ICCAIA contends the threat of lithium-ion battery fires poses “an unacceptable risk.”

Underpinning the call for a ban are tests conducted on lithium-ion rechargeable batteries in the spring of 2014 by the U.S. Federal Aviation Administration’s Fire Safety Branch. Results were dramatic. FAA was testing the effectiveness of cargo compartment fire-resistant (FRCs) containers and fire-containment covers (FCCs) in combatting large lithium battery fires. According to FAA, two FRC tests took place. Those containers were fitted with a dry powder fire suppression agent. According to an FAA document, “An explosion occurred inside the [container] during both tests. The overpressure and subsequent fire destroyed the FRCs in both of these tests.” The fire suppression agent didn’t discharge in the first test. It did in the second, but that made scant difference. “The discharge of suppression system did occur prior to the [second] explosion but did not prevent it,” says the document.

In perhaps the most chilling passage FAA says, “The cause of these explosions was ignition of flammable gasses that were vented by the batteries in thermal runaway that had collected within the FRC.”

The tests employed some 5,000 batteries.

The response
International Civil Aviation Organization (ICAO) Communications Chief Anthony Philbin says, “The ban being proposed by IFALPA (the pilots’ group) is currently awaiting discussion at the ICAO Dangerous Goods Panel Working Group.” That body convenes April 27. Philbin notes, however, “subsequent recommendations…will still require Council review and adoption to be construed as an ‘ICAO position.’” In other words, this may take a while.

It’s important to note that Philbin says ICAO already “bans shipments of lithium metal batteries (author’s emphasis) on passenger aircraft.” These metal batteries power, among other things, cameras.

The U.S. Pipeline and Hazardous Materials Safety Administration (PHMSA) banned shipment of lithium metal batteries back in in December 2004.

Where the regulations stand today
It’s the meaning of the term “bulk” that could play the pivotal role in deciding whether international regulators eventually end up prohibiting lithium-ion battery shipments in the cargo holds of passenger airliners.

There is already regulation of lithium-ion batteries stowed in the bellies of passenger aircraft. For airliners, the U.S. revised rule went into effect in August 2014. It focuses on proper packaging and labeling of the batteries, “harmonizing” the rule with stricter ICAO regulations.

The Rechargeable Battery Association, an industry lobbying group, supports those revised PHMSA rules, thinks harmonization is critical. “Dual standards create a fog of confusion that undermines compliance and enforcement efforts, says George Kerchner, the group’s executive director. “And reduced compliance jeopardizes safety.”

An outright ban, of course, is decidedly different than mere mitigation of risk via stricter packaging, handling and labeling procedures. In response to calls to prohibit bulk lithium-ion batteries altogether in the bellies of commercial passenger aircraft, Kerchner says his group “remains fully committed to the safe transport (author’s emphasis added) of lithium batteries.”

Therein lies the rub: how to effectively enforce rules already on the books. In a letter to ICAO’s Secretary General, Kerchner said recent “disregard” of regulations on the part of some battery manufacturers and distributors “was both revealing and worrisome.” Kerchner says some “who have their products shipped out of Hong Kong continue to offer their batteries for transport without complying with ICAO’s dangerous goods requirements.” More damning is his contention that “in many of these cases, circumstances suggest that they may have knowingly violated ICAO requirements.”

Yet another world aviation body, the International Air Transport Association wants governments to criminalize the shipping of dangerous goods. James Woodrow, who heads IATA’s Cargo Committee, is also chief of Cathay Pacific Cargo. He recently told delegates to the World Cargo Symposium in Shanghai, “Flagrant abuses of dangerous goods shipping regulations, which place aircraft safety at risk, must be criminalized.”

At the same time IATA, at least as of this writing, is not ready to endorse an outright ban of bulk shipments of lithium-ions on passenger aircraft. “We don’t believe that a total prohibition is the correct approach,” says Perry Flint, IATA’s head of corporate communications for The Americas. He says IATA has seen no incidents “involving correctly manufactured and properly compliant shipments.”

As the bureaucratic back and forth continues, some carriers have taken matters into their own hands, and unambiguously prohibited bulk shipments of the batteries on their aircraft. United Airlines and Delta Air Lines are two of them. United spokesman Charles Hobart, citing safety concerns, says, “While the risk is minimal, United has chosen to eliminate this potential risk by no longer accepting or loading any bulk shipments of UN3480 lithium ion batteries.”

How many other airlines follow suit remains to be seen. That could become clearer as IACO prepares to tackle the topic.

None of this means you can’t still take that lithium-ion-powered computer of yours into the passenger cabin in your carry-on hand luggage. However, you can’t pack any lithium-powered devices, including laptops, in a checked bag. As for spare lithium-ion batteries, they’re also limited to carry-on only, and they should be individually protected from short-circuits by taping the terminals or putting them in a sealable plastic bag.

Tough questions after AirAsia 8501: Changing climate will affect the way you fly

There’s a lot we don’t know yet about AirAsia Flight 8501. What we do know is that there’s a convective weather connection: thunderstorms are becoming nastier and more numerous.

Something’s happening here, and what it is is increasingly clear: the climate of this fragile blue orb we cling to is changing, mutating much faster than many had imagined. By the end of the 21st Century, the Intergovernmental Panel on Climate Change estimates Earth’s average temperature will balloon by 2.8 degrees C. The fate of the Polar Bear aside for a moment, that’s going to affect the way we fly.

Best buckle up.

“Rising concentrations of heat-trapping greenhouse gasses are changing our climate,” says Michel Jarraud, Secretary-General of the United Nations’ World Meteorological Organization. Implications are “far reaching, and in some instances, immediate.” Already impacted by wild weather, according to the WMO’s report The Global Climate 2001 – 2010, A Decade of Extremes are places such as Eastern Europe, India, Africa and Australia. Down under, they hold the distinction of being blasted by drought and swept by floods during the same decade.

How will all of this play out for airlines, airports and the flyers that depend upon them? “I’d be very cautious about any detailed [metric] modeling of these sorts of changes,” says Dr. Michael Bennett, a teacher and researcher at the Centre for Aviation Transport and the Environment in the United Kingdom. “The only thing we can predict is there are going to be some nasty surprises out there.”

Surprises such as stronger and more frequent thunderstorms, the kind that trigger seat-gripping turbulence.

Storms, Turbulence and Weird Winds

According to the study The Impacts of Extreme Weather and Climate Events on Aviation penned by Idowu Innocent Abbas, James Kayode Ojo and P.A. Igbru and presented in Nigeria in 2009, 777 people died between 1979 and 2005 worldwide in commercial aviation accidents associated in some fashion with thunderstorm turbulence.

Expect such storms to “become more frequent and more violent,” says Bennett. “There’s more energy there; there’s more latent heat.” So, should you order a second Scotch and water and cinch your seatbelt a bit tighter for the ride ahead? He says with improved technology “We should be able to predict, detect and avoid [storm-triggered] turbulence,” but cautions such avoidance “comes at a cost.” Aircraft have to fly farther in order to circumnavigate bad weather.

Looking out his window of the World Meteorological Organization headquarters in Geneva at the parking lot that holds his hail-dented car, Dr. Herbert Peumpel says unexpectedly stormy weather is already a fait accompli on the European continent. “Geneva is not known for hail storms,” muses the WMO’s aeronautical chief. But “probably the biggest [such storm] I’ve ever observed happened in in Geneva.” Switzerland has never been considered a hotbed of convective thunderstorm activity. That sort of thing is traditionally the province of places such as the U.S., Southeast Asia or the Brazilian rain forest. No longer.

As a result of all this convective weather, a report by the air traffic control entity Eurocontrol, Challenges of Growth 2013 – Climate Change Risk and Resilience, envisions “Disruption and delay” as well as “potential safety issues if frequency and severity increases” or the ability to predict dangerous weather declines.

Disruption and delay come in assorted flavors. Mess up the traditional west-to-east flow of the jet stream – the purveyor of cooler, milder weather to Europe – and bad things happen. Such interruptions allow “bad weather to persist for weeks,” says Herbert Peumpel. He links the interrupted flow to “melting of the Arctic ice sheets.”

Wretched weather need not be destructively convective to wreak havoc. Ironically, Eurocontrol says a warming world could spawn “snow-heavy weather events” in Europe. The rationale, again, is pegged to air flow. Because the North Atlantic and Artic are warming, there will be longer periods when whether patterns are blocked. That would prevent warmer weather from spreading across the continent, setting up a scenario of more snow. Frozen precipitation and on-time airline operations are mutually exclusive.

Then there’s the little matter of that tail wind you get hurtling across the Atlantic from New York to London. A diminished jet stream could lengthen the journey and cause airlines to rejigger schedules.

Zip, zap, zoom. As climate changes, weather wrenches around in fast fashion. Consider, Peumpel says during he late winter and early spring of 2013 the Hungarian Army was rescuing people stuck in snowdrifts on the flat highway linking Vienna and Budapest. Scant weeks later the temperature had catapulted 30 degrees Celsius. “The extremes are changing more rapidly,” he says, and those extremes are “lasting longer.”

Airports

Superstorm Sandy played hell along the Eastern Seaboard of the United States in October 2012, and airports were not immune. A gradually rising sea and surging tides coupled calamitously to flood portions of New York LaGuardia Airport. Waters from Flushing Bay lapped at the tarmac. New York Kennedy International and Newark Liberty International were less severely hit.

This could be a mere foretaste of what’s to come. In the report Climate Variability and Change with Implications for Transportation, the U.S. National Oceanic and Atmospheric Administration lists a number of airports in the United States that could be in harm’s way. Among them are Louis Armstrong New Orleans International, San Francisco International, Reagan Washington National, and Boston Logan. Interestingly, New York LaGuardia was ostensibly best positioned among all these airports to withstand storm surge. It sits some 22 feet, or 6.7 m, above mean sea level.

Dr. Bennett says the immediate threat is not so much from sea level rise per se as from storm surge. “Let’s be clear, sea level rise is a gradual process. Over the last ten years we’ve been looking at about three millimeters per year.” Bennett believes this could add up to an increase of some “six inches by mid-century, perhaps more than that.”

But couple that rise with walls of water emanating from storms such as Sandy and the equation suddenly becomes soggy. He says together storm surge and sea level rise pose a real problem at “about 150 airports [airports] worldwide. “

By mid-century, such “storms will become more intense,” asserts the WMO’s Peumpel. They derive their punch from the energy extant in the atmosphere – and the best storage medium for that energy is atmospheric moisture, moisture stemming from what Peumpel says are “increased sea surface temperatures.”

Especially vulnerable are airports built on artificial islands, airports such as Osaka’s Kansai International. At KIX, Peumpel says, “there’s the problem of [ground] subsidence.” In short, the airport is sinking, even as the seas rise.

Europe has its share of low-lying airports. Consider Amsterdam. Schiphol rests 11 feet below sea level. In its report, Eurocontrol asserts one implication is “loss of airport availability” at more than 30 “at risk” European aerodromes. Echoing Bennett and Peumpel, the report cautions, “the impacts of sea-level rise [affecting Europe] are expected to be experienced over the longer term.” More ominously, “the impacts of an increase in storm surges may be more immediate.”

Immediate, as in right now.

You don’t have to fly out of a seaside airport for climate change to spoil your day. Just ask flyers who frequent Phoenix Sky Harbor International, a major hub for US Airways and a busy “focus city” for Southwest Airlines.

How Heat Affects Aircraft Performance

This past summer was a scorcher in the aptly-named Valley of the Sun in the Southwestern U.S., so much so that on a deadening 119 F-degree summer day US Airways had to ax 18 flights out of PHX. It was simply too hot to fly.

Here’s why. Warm air is less dense than cooler air. As the temperature rises, molecules of air spread out. That results in less lift, and longer takeoff rolls. The wings just can’t get the bite out of the air they need to produce sufficient lift.

“The length of a takeoff run is directly proportional to the absolute temperature of the air,” says Michael Bennett. Via this “density effect” for every three-degree increase in temperature you need a one percent increase in runway length. Most of the time, a few additional “tens of meters” will do the trick. But when temperatures soar to the significant triple-digits it could be “your existing runway is simply not long enough.”

Assuming the flying machine lifts off at all, its ability to climb can be radically reduced. If there are mountains around, as there are in the hot, western reaches of the U.S., watch out. The density effect is universal. As the Civil Aviation Authority of New Zealand puts it, “Rate-of-climb and angle-of-climb are noticeably reduced, as is obstacle clearance after takeoff” when temperature and altitude rise.

And when mountain and airplane meet, the latter is always the loser.

One way to operate in these kinds of temperatures is to limit the weight the aircraft has to carry. That may mean less fuel, equating to less range. A nonstop becomes a one-stop. Another option is to load-limit passengers and baggage. Either way, airline profit tumbles.

Performance degradation is just one issue. Bennett says the flashpoint for Jet A1 fuel is 100 degrees F, “which is fine in England. Normally, you could just throw a match into the tank and it wouldn’t burn.” Ah, but on a sizzling tarmac where the temperature is significantly higher it’s another matter. Temperatures such as those experienced in the desert Southwest of the United States, the Middle East, and other hot, arid areas can produce what Bennett calls “a highly flammable liquid.” While getting aircraft ready for flight is “doable” under such circumstances, “it just makes it more difficult.” You’ve got to be “very, very careful.”

He believes market forces may adjust automatically to increasing heat. “Clearly, this will affect European holiday-makers.” Will they continue to fly to the Greek Islands in August, “when [they] can hardly go outside…or fly in February of September, when it might be relatively pleasant?”

The World Meteorological Organization’s Herbert Peumpel says coping will become largely a matter of mitigation. No need to cancel a flight when you can adjust the schedule. It’s already happening. He says Middle Eastern airlines which fly regularly to hubs such as Dubai and Doha already hub after sunset. “If you look at their peak hours of operation, it’s nighttime. That may be the answer,” he says. “In areas that are getting extremely hot, you may have to switch mostly to nighttime operations.”

Options

The old adage “everyone talks about the weather, but nobody does anything about it” is a tad shop-worn. We’ve all but conquered wind shear though pilot training, air- and ground-based detection. Infinitely more capable radar systems, as well as laser-based LIDAR (Light Detection and Ranging), have enabled us to ferret out weather dangers as never before.

We may not be able to avoid the weather extremes brought on by rapid climate change, but we can mitigate their impact. Airports can prepare for the shift of prevailing wind by building more crosswind runways. They can get for rising waters by elevating generators and electrical systems. Carriers can shift hot weather hub operations from day to night during the warmest times of year.

“We need to look [at] better mitigation and better planning so that we can handle a series of unusual events without a major breakdown,” says the WMO’s Herbert Peumpel. “I think aviation has always been extremely good at that.”

And it’s going to have to get even better yet before too terribly long.