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By Jane M. Orient, M.Dhttp://www.aapsonline.org/

The bizarre disappearance of Malaysian Airlines flight MH370 might sound like an episode from the Twilight Zone, when an aircraft Airlinervanishes into a different dimension and emerges in an earlier time.

But of course the airplane is somewhere on earth, intact or in pieces, and we have evidence that it was in flight for hours — under the control of somebody who evidently knew a lot about it.

Air transportation is a wonderful boon, and many of us have to fly to be able to do our jobs. Engineers, weather forecasters, pilots, air traffic controllers, and many others have made flight very safe, but perils remain. Is there anything we as passengers can do to help ourselves?

Airplanes remain an attractive target for people who don’t mind killing innocent people (“collateral damage”) to achieve an agenda. They might want to cause terror, to wreak revenge, to kidnap hostages, or to assassinate someone. Jihadists might see merit in simply killing infidels. MH 370 raises additional possibilities: stealing the airplane itself for future use, capturing a contingent of experts needed to develop military technology, or perhaps simply creating a diversion at a time of crisis as in Ukraine.

The TSA does not make us perfectly safe. I don’t care much about being x-rayed and patted down, but it is not much more helpful than the old, discarded “security” question about whether I packed my own bag. The U.S. could learn from the Israelis and focus on behavior and likely terrorists.

Passengers need not be burdened by fear of the political correctness police. They can observe the people in the boarding area. Are people making unusual demands of gate personnel, as on 9/11? Do they look out of place, or unusually nervous? You could ask a few polite questions: “Excuse me, sir, are you taking this flight? Where are you planning to stay tonight?” If you don’t like the reaction, you don’t have to board the flight. Many of us, unfortunately, are more afraid of looking stupid than of real threats.

Is there someone on your flight who is a serious threat to powerful interests? When the plane carrying Homi Bhabha, father of the Indian nuclear program, ran into Mont Blanc in 1966, it might have been an accident — or an assassination. In 2011, there were calls for re-opening the investigation of the 1961 crash that took the life of UN Secretary General Dag Hammarskjold. Was his plane shot down? Was KAL 007 deliberately diverted into Russian airspace in 1983 because of Congressman Larry MacDonald? If you have any choice, fly with ordinary folk.

imagesIf the goal is to seize the airplane, MH 370 suggests an efficient way to prevent passengers from interfering or from sending a message by satellite phone or wifi if they notice the plane turning off course.

Flyers may not realize it, but they are sitting comfortably in a pressure chamber. That’s why there’s a little hole in the window — it allows the pressure of the air between the two panes of glass to equalize with cabin pressure.

Only the windows and a thin shell of aluminum are between the passengers and the lethal conditions in the atmosphere at cruising altitude. The cabin must be pressurized to about 8,000-10,000 feet (10-11 psi). Even at that altitude, people with serious heart or lung conditions may not be able to get enough oxygen into their blood.

In the safety briefing, passengers are told to put their oxygen mask on immediately if it drops down, before trying to assist others. That’s because the time of useful consciousness (TUC) may be measured in seconds. At 40,000 feet (2.7 psi), that would be 15 to 20 seconds.

A rapid decompression is lethal for other reasons, being comparable to bolting for the surface from a deep dive: ruptured eardrums, bubbles blocking circulation, exploded lungs. But with a controlled rate of decompression, the bad guys could do just fine with oxygen, while everyone else lost consciousness and quietly died.

Who is piloting your aircraft? Who has control of its life support and communications systems? In a time of total war, it matters.

Jane M. Orient, M.D., is the executive director of the Association of American Physicians and Surgeons, and author of Sapira’s Art and Science of Bedside Diagnosis; and YOUR Doctor Is Not In: Healthy Skepticism about National Health Care. Additional information on health-related issues can be found at: http://takebackmedicine.com/