Searching for Airline Security Part Deux

Monday, November 29, 2010

Robert Gezelter

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Searching for Airline Security Part One Here

X-ray exposure and damage to human dignity are not the only potential hazards of recent changes in US Transportation Security Agency (TSA) procedures.

While I freely admit that I have not had to go through a TSA checkpoint in the last few weeks, I note that the last time I traveled, I do not recall seeing a sight that should have been obvious: a supply of disposable gloves. In many ways, this is an emblematic communications problem.

Contagion and contamination are more of a hazard to both screeners and those screened than any terrorist threat, yet straightforward steps of industrial hygiene are not obvious at checkpoints. The hazards posed by poorly-thought out procedures are contagion, contamination, and infestation.

In passing through airport security, one hears a cacophony of sounds: infants, bags opening and closing, machinery, shoes, and a host of commonplace noises. However, one sound that I do not recall hearing: the snapping of disposable gloves being removed. In health care facilities, this noise is as distinctive as it is commonplace.

Contamination is a far more immediate health hazard than low-dose X-rays. This meme has appeared in the discussion, but more as a “yuk” factor than as a serious hygiene question. More serious treatment is appropriate.

It consists of at least three questions: Are gloves changed for each person screened? Are the gloves “fresh”? Is there any security danger in a guarantee that fresh gloves will be used for each person screened?

TSA has two challenges: A technical problem and an image problem. The technical problem focuses on the safety and efficacy of “full-body” imaging and the “enhanced” pat-down procedures. Screening that produces injuries, either physical or psychological, is damaging to TSA's mission. The question of efficacy was discussed in my previous article.

The second challenge is far more commonplace: making sure that screening does not cause immediate harm. In a sense, this is a question no more complex than that faced by eating establishments that serve the public every day. Screening should at least be able to match the standards set for the airport snack bar.

When I recently visited someone in the hospital, or when I visit a physician's office, the small boxes of sterile gloves are ubiquitous. Infection control guidelines require changing gloves for each patient, and frequent washing of hands with either a disinfectant gel or ordinary soap and water (the gel dispensers have become ubiquitous in many businesses as well, due to concerns about communicating influenza and other pathogens).

Normally, when I go through a toll barrier, I use my EZ Pass, an electronic toll transponder, to pay the toll. On the rare occasions that I need to pay a cash toll, I have noticed a sensible precaution, the prevalence of gloves on toll attendants. Hundreds or thousands of dollars may pass through a station in a shift, and paper money may or may not be hygienic. Precautions to protect toll collectors are clearly appropriate.

In my previous article, I asked several questions concerning the efficacy and safety of the “full-body” imaging (referred to as “Advanced Imaging Technology”, often referred to using its acronym, “AIT”) recently deployed by the US Transportation Security Administration.

When an individual declines to be subjected to full-body imaging, the alternative is an enhanced pat down. Relating to the enhanced pat down, there is an aspect that I omitted to mention, safety for the person being screened. In all honesty, I did not consider how basic it was.

How many people have seen TSA personnel change their gloves? Is the role of the gloves to protect the TSA screener, or are the gloves to protect all from spreading contamination, whether chemical or biological? The difference is important.

Health care providers are well aware of the issues. The problems are not a mere nicety. Disease and contamination have always been a challenge to human health. The connection of germs to human health is far from news. The seminal work was done nearly two hundred years ago. One of the classic cases were so-called puerperal fever, childbirth associated infections which caused high mortality. As described by the www site discoveriesinmedicine.com:

“Attempts to understand and stop puerperal fever brought about some of the early advances in antisepsis. In 1773 Dr. Charles White (1728-1813) of England recommended antiseptic injection in some cases of childbirth. Scottish physician Alexander Gordon (1752-1799) stated that obstetricians should wash their hands and clothes before treating patients. American physician and author Oliver Wendell Holmes (1809-1894) presented his conclusions about the spread of puerperal fever by unwashed doctors in 1843, while Hungarian doctor Ignaz Semmelweiss made the same discovery in 1847. When Semmelweiss required his students to wash their hands in an antiseptic chloride solution before examining patients, maternal death rates plunged from a high of 18 percent to a low of nearly 1 percent. Semmelweiss was correct about the transmission of infectious materials, but he could not explain what those substances were. Pasteur had part of the answer. In his studies of fermentation (organic transformation), Pasteur proved the existence of airborne microorganisms.”

[From Medical Discoveries - Antisepsis [1]]

Today, our knowledge has advanced. We well know that disease can travel from person to person; we also know that those who suffer from sensitivities and allergies can suffer consequences, including life threatening reactions, from exposure.

Health care providers have realized the importance of this danger; but the dangers posed by cross-contamination are of far wider relevance. Many, if not most, municipal health codes have similar precautions; for example the common ban on the return of underwear and swimwear.

“Fresh gloves per person physically screened” is not a national security question; it is a simple question of industrial hygiene. I do not see a reason why TSA cannot simply state that it is an unquestioned and agreed right that fresh gloves will be used for each person going through a checkpoint, whenever belongings or bodies are physically searched. There should be no question about this. Germs and contaminants are ever present. This is required practice for all medical personnel. It is not simply a question of communicable diseases.

Many people are extremely sensitive to latex. When they are hospitalized, latex is clearly banned from their rooms. Are there any studies on the impact of searching a latex-sensitive persons clothing with latex-gloves? What of other allergens? Do TSA screeners change gloves for every person screened?

If this is presently TSA practice, it is possible that my recollections of security are faulty. A quick check of glove logistics (e.g.,orders, inventories) could easily demonstrate that TSA personnel frequently change gloves. When I checked TSA's www site, I found a report of a series of incidents at Boston's Logan Airport involving scabies. Interestingly enough, that precise article in the TSA blog states:

“... Keep in mind, TSOs are required to wear gloves during the screening process while handling passengers' belongings. You can always request that a TSO change gloves prior to a bag search or pat down. ...” [Emphasis mine]

[TSA WWW Site[2]]

In the online discussions that ensued however, I find numerous references in the comments to reports of TSA personnel not changing gloves. The right to a fresh pair of gloves should be unquestioned, particularly with the new, enhanced pat-down policies. The glove material is also unstated.

TSA should heed the negative example set by the New York City Department of Corrections in a recent court case. The Department of Corrections had insisted that its security searches were done with dignity, with misdemeanor detainees given disposable gowns to wear during the examinations.

After much litigation, a severe mismatch was discovered between the number of searches performed and the number of gowns purchased and in inventory. In short, as reported by The New York Times, the Department of Corrections personnel provided false information to the court as to their procedures.[3]

The answer to this question is a simple one: A statement from TSA management confirming that people being screened have an absolute and unquestioned right for TSA personnel to use a fresh pair of gloves when examining one's person or belongings together with conspicuous signage at checkpoints of this policy.

This is a simple communications problem, reassuring people in an age of communicable diseases that screening will not expose them to new contagion. This is particularly sensitive, now that there are well documented parasite outbreaks (e.g., lice, bed bugs) in major cities. The scabies episode last year at Boston's checkpoints should be viewed as a warning sign.

The question of medical apparatus is a more complex question. The simple fact is that implants, various drainage devices (e.g., urostomy, colostomy), insulin pumps, and other devices have become commonplace. This is a long- term problem. It has been with us since screening was increased following the 9/11 attacks, and has remained a problem.[4] In spring 2002, I experienced this problem firsthand, when returning from out-of-town surgery, and using a wheelchair, I was forced to stand for several minutes.

I well remember being ordered: “stand up; don't touch anything,” a definite challenge to someone recovering from ear surgery and suffering from impaired balance. I know those who cannot stand still without a cane for auxiliary support. There needs to be heightened awareness that not everyone traveling is in perfect condition, and one must expect the unexpected.

So far, we have been fortunate. None of the reported encounters between screeners and medical devices have been life threatening. However, there is no guarantee that this will continue. Travelers should carry, in their hand luggage, whatever spare components can be reasonably carried. A spare collection bag is a good idea in any case. However, requiring travelers to have a spare change of clothes to deal with a urostomy bag burst by a screener is unreasonable.[5]

More care during screening is called for. Perhaps “Are you wearing any medical devices? Are you wearing any dressings or bandages?” are appropriate additional queries before any pat down. I have seen many surgical and other bandages that are conceivably bulky enough to attack screener attention, but are not designed for searching. Dislodging such a bandage could result in a medical incident. Similarly, I have known people with uncorrected hernias and other problems who could easily be compromised by an unmodified search.

There is no disputing that TSA personnel have a challenging job. The majority of TSA personnel whom I have dealt with in my travels have been reasonable and efficient, particularly so when dealing with the frustrations of travelers faced with ever changing rules. That said, I have encountered officers who are less than reasonable, as in the episode when I was returning from surgery. Fortune smiled on me, I was able to stand long enough for the scan. What would have happened if I had stumbled?

I am sure that the overewhelming majority of TSA personnel find it an unpleasant task to perform body searches on potentially hundreds of people per shift. However, to this point, we have been fortunate: no one has has been reported as seriously injured as a result of a screening. It is well-known and acknowledged that some screeners are less than perfectly professional.[6] Practices and communication should preempt the possibility of a life-threatening incident.

Perhaps, screeners who do “enhanced pat downs” should give each person screened a screening record, with their badge number and photograph, as well as the ticket number and name (or ID information, if a non-passenger). Such records are in-expensive, and would help provide accountability in the event of a problem.

“Register” type receipts would protect both the TSA employee and the person screened; the receipt would clearly connect the TSA ID and the person screened. There would be no danger of a discarded card being used to falsely accuse a TSA screener, just as there would be an audit trail if there was an incident. Signage should clearly indicate the right to sterile gloves, the right to be escorted, and the right to the receipt.

TSA has a mission to create a safe environment in the air; at the same time, passengers, flight crew, and airport personnel have a reasonable expectation that their short-term and long-term well-being, physical and psychological, will not be sacrificed in the process.

Notes [1] “Antisepsis -- From Medical Discoveries” [2] TSA (2009, April 9) “Two Scabies Cases Reported at Boston Logan International Airport” [3] Jim Dwyer (2010, March 24) “Strip-Searches: The Truth Comes Out” The New York Times, pp A20 [4] Susan Ferraro (2010, November 24) “TSA touches the junk of millions: People with medical devices have long endured invasive patdowns” [5] Gina Damron (2010, November 21) “Metro Flier: Airport pat down too rough” [6] Aaron Smith (2010, November 22) “TSA pat downs: ‘Horrible’ screener job gets worse” References

 

Reproduced from Searching for Airline Security, Part Deux an entry in Ruminations -- An IT Blog by Robert Gezelter. Copyright (c) 2010, Robert Gezelter. Unlimited Reproduction permitted with attribution.

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