[Air transport, aeronautic medicine, health]

There were 3.2 billion airline passengers in 2006, compared to only 30 million in 1950. Intercontinental health disparities create a risk of pandemics such as SARS and so-called bird flu. Precautions are now being implemented both in airports and in aircraft, in addition to measures intended to prevent the spread of malaria and arboviral diseases, such as vector eradication, elimination of stagnant water, malaria prophylaxis, vaccination, and use of repellents. These measures are dealt with in international health regulations, which have existed since 1851 and were last updated on 15 June 2007. Flying on an airliner also carries a risk of hypobaria (cabin pressure at 2000 m), which can aggravate respiratory problems. Other problems include relative hypoxia, gas expansion, air dryness, ozone, cosmic rays, airsickness, jet lag, the effects of alcohol and tobacco, and, more recently, deep vein thrombosis (DVT) and pulmonary embolism (PE), collectively known as "coach class syndrome". A new type of medicine has appeared, in the form of on-board medical assistance. The European Civil Aviation Committee has recommended first-aid training for cabin crews and onboard medical equipment such as first-aid kits and defibrillators. Airline statistics show that one in-flight medical incident occurs per 20 000 passengers, as well as one death per 5 million passengers and one medical reroute per 20 000 flights (40% of reroutes turn out to be unjustified). More than 80% of long-haul flights have a physician travelling on board. However, depending on his or her specialty, problems of competence and legal responsibility may arise. Ground-based medical centers can provide help via satellite telephone, but this implies the need for airline staff training. International cooperation is the only way to minimize the health risks associated with the growth in global air travel.