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The Perils Of Air Travellers' Thrombosis
The following article pertains to a subject matter that has been of great concern to me (and many others) for quite some time now. What the airline industry does NOT wish for the travelling public to know is the fact that more pax (passengers) suffer from Thrombosis than is generally known. In addition to this, many pax themselves suffer varying degrees of Thrombosis, post-flight, yet many do not make the connection between their condition and the horrific tight seating configurations in Economy/Coach class cabins of many carriers the world over.

Unless the FAA and their equivalent counterparts in nations the world over step in and implement rigid guidlines/policies re aircraft seating configurations, the problem is going to worsen.
This, in my opinion, is a clear example of corporate greed vs the health and safety of the passenger.

This is why it is absolutely IMPERATIVE that the travelling public should be educated and made fully aware of the dangers posed by Thrombosis.
On long-haul sectors, pax should stand and move around the cabin at regular/semi-regular intervals, and consume non-dehydrating beverages
(see article below).

J.O. - YYZ

The Perils Of Air Travellers' Thrombosis
Martin O'Malley & Robin Rowland, CBC News Online

It has been called "economy-class syndrome," but that's a misnomer as even people who fly first-class have been killed by it. A better name is "travellers' thrombosis" though the correct name is "deep-vein thrombosis" or DVT.
It's caused by sitting rigidly for too long � usually on lengthy intercontinental flights � so that a blood clot forms and makes a lethal journey to the lungs or heart. It was first noted more than 50 years ago in London when people crowded into air-raid shelters to escape bomb attacks during the Second World War.

It's front-page news because of the death last September of Emma Christoffersen, a 28-year-old Briton who returned to London from Australia where she had attended the Olympic Games. After completing the 19,000-kilometre, 20-hour trip, Christoffersen collapsed at Heathrow airport and died before she reached hospital. She developed a clot in her leg on the Qantas flight, the clot dislodged and made its way to her heart.

Estimates of the number of deaths from travellers' thrombosis vary widely. A conservative estimate is about 100 a year, though David Derbyshire, medical writer for The Daily Telegraph, says that doctors who carried out a study at Ashford Hospital in Surrey believe more than 2,000 people a year die from travellers' thrombosis in Britain. What made Christoffersen's case more noteworthy was that she was young, in good health and about to be married.

Travellers' thrombosis is regarded as such a new condition that it has not properly been tracked and many deaths may not be recorded as caused by long-haul flights. The Science and Technology Committee of Britain's House of Lords has issued a report demanding that the air travel industry do "urgent" research into deep-vein thrombosis among fliers. (The committee also recommended an end to the phrase "economy-class syndrome" on the basis that it is not accurate.)

Blood clots, thrombosis and embolisms are not new, but there appears to be a sharp increase in their occurrence among long-haul air travellers over the past 10 years. Many speculate one of the contributing factors is the decrease in leg room on passenger planes � the distance between seats, known as "pitch" in aviation language.

To cite an example, British Airways over 10 years decreased the pitch of their seats from 91 centimetres to 79 today. The pitch of Qantas seats is about 81 cm, the pitch of Air Canada seats about 83 cm. Pitches are not all identical even on the same plane. Exit and bulkhead seats have much more leg room, making them safer for potential travellers' thrombosis victims.

Farrol Kahn, director of the Health Aviation Institute, told Reuters News Agency that travellers' thrombosis is a much more common problem on long-haul flights than is believed or admitted by international airlines.

A hospital study in England says at least 30 people have died in the past three years of massive blood clots after arriving at Heathrow airport on long-haul flights. An Australian surgeon has been quoted as saying 400 people a year landing at Sydney airport suffer blood clots.

The condition is not always fatal. A story in The New York Times in October, 2000, estimated that five million Americans a year experience a blood-clotting thrombosis caused by prolonged immobility. The story said this results in some 800,000 hospitalizations a year. DuPont Pharmaceuticals Company has responded to the situation by selling a blood-thinning drug called Innopehn, designed to prevent and treat the condition.

Remedies suggested include taking Aspirin as a blood-thinner before long flights, maintaining one's liquids (but avoiding alcoholic beverages), wearing knee-length elastic stockings, and getting up from one's seat at regular intervals. Critics have also drawn attention to increasingly smaller, cramped seating arrangements in economy sections, especially on charter flights.

The problem has more to do with immobility than with cramped conditions on planes. Travellers' thrombosis has been known to affect passengers in buses, trains, cars, trucks � even theatres. Deadly blood clots also tend to be more of a risk to the elderly, smokers, pregnant women, diabetics, cancer patients and overweight people.

The risk is exacerbated when these people are confined in a cramped, immobile position for long periods. Something as innocent as a kick in the leg a week before a flight can add to the risk of an in-flight blood clot.

A class action suit in Australia targets several major airlines, including Air Canada, on behalf of 800 alleged victims of travellers' thrombosis. Eleven of the 800 people say they were flying Air Canada when they developed blood clots.

Laura Cook, a spokesperson for Air Canada, says the airline is aware of the Australian lawsuit, but has not yet been served with legal papers. She told CBC News Online that Air Canada's position is that there is "insufficient evidence" that travellers' thrombosis is the result of conditions on airplanes.

Having said this, however, Cook explained that Air Canada offers an in-flight video that includes exercises designed to protect against travellers' thrombosis. The video is shown on all long-haul flights.

As for the Australian lawsuit, Cook says Air Canada only began flights to Australia in June, 2000.

Deep Vein Thrombosis FAQ

What is Deep Vein Thrombosis?

Deep vein thrombosis is the formation of a blood clot in a deep vein, usually in the calf or the thigh.

What is the cause?

If the vein becomes narrowed or blocked, a blood clot can form at that point. The problem is not only poor circulation from sitting too long in cramped conditions. (Patients confined to bed as a result of a heart condition may also suffer from deep vein thrombosis.) It can also be caused by injury to the vein, or be a side effect of radiation therapy or surgery, or during pregnancy.

What are symptoms of DVT?

Pain or soreness in the joint
Tenderness and redness in the area
Rapid heartbeat
Sudden unexpected cough
Pain and swelling in the "path" (the area drained by the vein) that is blocked
The vein feels hard, like a cord
Some people do not display symptoms if the thromobosis forms in an area other than the leg or arm.
Note: for travellers, the symptoms may not appear immediately. They could occur sometime after the traveller leaves the aircraft, bus or other vehicle.

Danger signs

Deep vein thrombosis can develop into pulmonary thrombosis where the clot breaks away from the vein and travels to the lungs. Danger signs include:

Chest pain
Coughing up blood
New symptoms of pain or swelling which could indicate that treatment is not working
If you have symptoms of Deep Vein Thrombosis, you should call your doctor immediately. If you have the symptoms plus chest pain or coughing up blood call 911.
How to do doctors diagnose deep vein thrombosis?

Tests for blood clots
How is Deep Vein Thrombosis treated?
Preventing the clot from travelling to other parts of the body is the most important part of the treatment. Doctors may prescribe anticoagulant or anti-platelet medication or in some cases, medication called thrombolytics that dissolve blood clots.

Do not rub the affected area, that may dislodge the clot. Keep the limb elevated.

If deep vein thrombosis is detected early, treatment is usually successful. If untreated, the condition can be fatal.

In some cases, deep vein thrombosis becomes a chronic condition, where patients continue to have pain and swelling of the leg because the thrombosis has damaged the blood valves in that vein. The pain and swelling then decrease the activity of the patient.
Posts: 27 | Location: Toronto, Canada | Registered: Tue September 02 2003Reply With QuoteReport This Post
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Note: I myself experienced symptoms of Thrombosis after flying AMS-YYZ on KLM 4 months ago. After speaking to my physician about it (thank God the symptoms went away), I spoke with health and safety officers (former flying colleagues of mine) from both Air Transat and Air Canada, both of whom stated that while the tight seating configurations alone may not be the primary factor in the cause of Thrombosis, it is indeed a
moderate to high contributing factor.

I have also noticed that whenever I fly Business Class, the symptoms have never appeared. I also asked several work colleagues and friends who fly on a regular basis both Economy and Business Class for their input. Almost all stated that, like myself, Business/First seating appears to be a very low risk re Thrombosis.

In relation to this, another concern of mine re dense Economy/Coach seating - cramped legroom on aircraft is the factor of fast and effective land/water evacuation timelines of the cabin in the event of an emergency.

I will source a British Airways emergency evacuation article, where pax and cew stated the dense seating played a huge factor in the over-long evacuation of the B737 cabin.

Normally, an aircraft evacuation of a cabin on most aircraft types has been given a timeline of 90 seconds. On the British Airways B737, in 1985,
evacuation took 1 minute, 30 seconds. This particular aircraft was a BA charter, with approximately 35-40 more seats than the regular aircraft type.

The Economy seating configuration on many carriers
I have flown
Posts: 27 | Location: Toronto, Canada | Registered: Tue September 02 2003Reply With QuoteReport This Post
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Note to self: When posting, ensure spelling/grammar and text is complete!!
Posts: 27 | Location: Toronto, Canada | Registered: Tue September 02 2003Reply With QuoteReport This Post
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J.O. Thanks for your comments. I feel that the airlines really underplay the perils of thrombosis particularly when passengers are jammed into coach. I think the problems overcrowding causes have far more serious implications to passenger safety than airlines are willing to acknowledge. Glad to hear that your symptoms resolved themselves without treatment. I guess you will need to be very careful in the future to try and stretch or maybe even to go for more space particularly on a long flight.

You brought up another excellent point and that is that overcrowding can lead to major problems in the event of necessary quick evacuation of an aircraft.

I thought you might be interested in an interview with John Nance that I posted on the site sometime ago.;f=1;t=000252

It never fails to amaze me how passengers are packed into commercial jets in recent years. Thankfully I am pretty small but I must say I still feel pretty claustrophobic on today's commercial jets and when I try to mentally plan an escape route (in case of an emergency) I see myself tripping over people to evacuate.

As J.O has suggested if you have the symptoms of thrombosis following a flight be sure to tell your medical provider because to ignore it could have some very serious consequences. At a time when airline revenue is down I doubt we will see improvements in this area anytime soon.
Posts: 2572 | Location: USA | Registered: Sun April 07 2002Reply With QuoteReport This Post
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Here is a link to more information on Thrombosis:

Deep Vein Thrombosis
Posts: 142 | Location: Ottawa, Ontario, Canada | Registered: Mon April 08 2002Reply With QuoteReport This Post
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BF and CD, thank you for the links to the John Nance interview and Transport Canada article. Hopefully, members and viewers of this site will absorb some imperative information in regards to DVT.

BF, I agree with you, commercial carriers have gone way over the line in terms of aircraft economy/coach class capacity. Charter carriers, as some of you may know, are the biggest culprits.
One day there is going to be (yet another) incident where the cabin has to be evacuated. I shudder to think, given the factors of the accident, what the number of lives lost will be re the impedement of rapid evac due to too many rows, too many seats.

Eg: Skyservice Airlines, a Canadian - Toronto (YYZ) based carrier, operates Airbus A319, A320 and A330 aircraft. On their A320 equipment, for example, the pax configuration is for 180. One Hundred and Eighty passengers in a 3-3 configuration. Unbelievable. The A320 aircraft is of a size that could/should seat around 130 - 145 passengers in reasonable comfort with a generous seat pitch. A few of my ex-flying colleagues are Pursers and Flight Attendants with this carrier, and they tell me the horror stories of pax who can barely fit into these seats; male pax especially are "tortured" for the duration of the flight.

I fly for business and pleasure frequently, and initially I rather enjoyed it. In the past few years, I must say that it has become a "chore", and if I am scheduled to fly economy (which is more often than not the case), then I dread the flight, especially the long-haul overseas sectors.
Another one of my pet-peeves is the poor quality of cabin air, due to cost-saving methods implemented by many carriers, where 75% to 85% of the cabin air is recycled. But that's another post topic altogether.

In my opinion, one of the worst offenders for legroom (seat pitch) in Economy has to be KLM Royal Dutch Airlines. British Airways "World Traveller" (Economy) Class is a close runner-up.
Air France, surprisingly, offers the pax fairly good seat pitch in their economy "Tempo" Class, although there's always "room for improvement", pardon the pun. In regards to the worst offenders, I cannot even imagine HOW a person who is 5'2", let alone 6'0" would be comfortable in these seats. Whenever I fly KLM-Economy, you'll find me, in-flight, standing by the rear lavs at doors 5L/R. I grab a book, stand and read. It is the only way to endure the flight. Am I am not alone in doing this.

In short, when you fly, STAND and walk around the cabin (if possible on single aisled aircraft) and listen to the experts and avoid coffee, tea and above all, alcohol (Although I know more than a few people who rely on the latter to get them through a long-hauler).

Kind regards,
Posts: 27 | Location: Toronto, Canada | Registered: Tue September 02 2003Reply With QuoteReport This Post
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