Date: 201910
Local time of day: 0601-1200
Location: ZZZ.Airport, US
Aircraft: A319
Operator: Air Carrier
Operating under: Part 121
Flight plan: IFR
Mission: Passenger
Flight phase: Other Preflight at Gate
Reporter organization: Air Carrier
Reporter function: Flight Attendant In Charge
Reporter qualification: Flight Attendant Current
Human factors: Situational Awareness; Physiological - Other
Second reporter function: Flight Attendant (On Duty)
Anomaly: Aircraft Equipment Problem Less Severe; Deviation / Discrepancy - Procedural Published Material / Policy; Flight Deck / Cabin / Aircraft Event Smoke / Fire / Fumes / Odor; Flight Deck / Cabin / Aircraft Event Illness / Injury
Detector: Person Flight Attendant
When detected: Pre-flight
Result: General Flight Cancelled / Delayed; General Maintenance Action; General Physical Injury / Incapacitation
Contributing factors: Aircraft
Primary problem: Aircraft

Narrative: As we got on the plane; I noticed a smell in the cabin. I was near the cockpit door and kept getting hints of a greasy/rotten smell. It went away for a little; but when I walked towards the back of the aircraft; the smell got stronger. The pilots asked if I wanted cleaners to come on; but the smell was something I recognized. It smelled like dirty socks. The pilots started the APU to see if it would clear it up. The aft door was open for catering reasons. I stayed on the aircraft in the front galley talking to the mechanics about another issue while the B and C Flight Attendants went into the jet bridge because the smell was so strong in the aft. After a few minutes; the smell seemed to dissipate and so we gave the okay to board. I noticed a slight headache; but thought it would go away. We started boarding and finished in about 30 minutes or so. During that time I was getting the galley ready for the flight. Once I stood still; I felt a little fuzzy headed and confused. The headache turned into a dull pain at the base of my neck that started to almost make me nauseous. There were supervisors who showed up to the aircraft; since we reported an odor earlier. The call was made to deplane after all three of us were feeling the same symptoms. I was still confused and my head hurt; so I wanted to get checked out by a doctor. As I was speaking to people; I noticed that my speech was very broken and slurred and I couldn't find any words or make any sense. The captain made an announcement to deplane and (supervisor who showed up to the gate) said I should get off the aircraft; since it was a safety situation; so I sat in the jet bridge as the rest of the guests deplaned. We then started the process to get checked at the hospital and run tests. We called [medical company] and gave them our information and symptoms. We ended up being seen almost four hours later at hospital near the ZZZ airport. There should be a more concise checklist to follow when an odor/air quality incident occurs. Also; I felt like we were not taken seriously at first and our symptoms got worse; being exposed to possible contamination for a longer period of time. Especially when we all had similar symptoms at the same time. I understand that there are false alarms; but if there's a way to get more information to crews; hospitals and clinics about these incidents; we can all learn more and be more informed about being safe in the workplace.


Second narrative: We took over the aircraft from the inbound flight. My crew and I entered the aircraft. I proceeded to the aft cabin and upon reaching the last two rows; I smelled dirty socks. I knew what the odor meant since I had an air quality issue on a MD80 aircraft XX years ago. At that moment; the APU was just turned on as I heard the air conditioning blowing; the L2 door was opened because the two caterers were still catering the flight's provisions; and there was one fleet service personnel who just finished cleaning the lavatories.After I put my flight bags away; I immediately grabbed a safety card and started fanning my face. I proceeded towards the forward door to get fresh air when the B Flight Attendant asked me if I smelled the odor. I told her that I am aware of it and it is an air quality issue. I also told her that I'm getting off the aircraft to get fresh air and she should do the same. The A Flight Attendant also mentioned about the odor as I reached the forward galley. Before I got off the aircraft; I told the flight deck crew that I smelled dirty socks in the aft cabin and mentioned that it is an air quality issue.I was on the jet way when I heard the captain mention; 'Call fleet service and tell them to spray the aft lavatories.' The mechanic arrived to check on a separate issue when I heard the flight deck mentioned to the mechanic about the odor in the aft cabin. The mechanic checked the cabin for the said odor; but he told us that he did not smell anything. I went back inside the aircraft to see if I could still smell the dirty socks; but the odor dissipated. We started boarding. I was in the aft galley organizing the beverage and food carts when the A Flight Attendant old me that an In flight Supervisor is going to speak to me. He made his way to the aft galley and asked me several questions: what happened; how was I feeling; do I want to continue on with the trip or get off. I told In flight Supervisor about the dirty socks odor and mentioned to him that I felt out of it like I was drugged and I have a scratchy throat with a bitter aftertaste. I hesitantly told him that I think I'm okay to continue with the trip. I told him to speak to the B Flight Attendant because she was not feeling well. All the passengers were boarded and seated. A Fleet Service Personnel came to the aft galley and asked me which lavatory needs to be sprayed. I told her that both lavatories don't need to be serviced. An announcement was made that all passengers need to deplane because the mechanic found an issue with the aircraft. The B Flight Attendant and I were in the aft galley while the passengers began deplaning. The In flight Supervisor notified us via interphone to get off the aircraft because the paramedics are coming to assess us. We told him that we could wait until the passengers have deplaned; but he insisted us to come forward. The B Flight Attendant and I reached the first class cabin while the A Flight Attendant was in the jetway. In flight Supervisor told us to get off the aircraft and I told him that we need to have a minimum crew onboard since the passengers are still deplaning. He insisted that 'It's okay.' I was hesitant and I told the B Flight Attendant that she could get off first since we still have a minimum crew (i.e. In flight Supervisor; a non-revenue Flight Attendant; and me). However; In flight Supervisor insisted that both B Flight Attendant and I should get off the aircraft since the paramedics are arriving soon. He reassured us that; 'It's okay' to get off the aircraft and he mentioned that the non-revenue Flight Attendant; was on medical leave so she couldn't substitute as a working crew. Both the B Flight Attendant and I deplaned and waited for the paramedics to arrive at the jetway.The paramedics arrived and took the oxygen saturation of the A and B Flight Attendants; but none of our other vital signs were taken. They said that they couldn't really do anything for us; but they offered to transport us to the ER. I declined the ambulance ride because I thought that I would have to pay for it. In flight Supervisor told us to call [medical company] to report our incident. I contacted [medical company] and spoke to a nurse about my symptoms. The [medical company] representative told me that she would call me back within an hour for an authorization and health care facility information. It is also worthwhile to mention that none of the crew received individual case reference numbers. We waited for over an hour for the call from [medical company]; but no call back was made. Hence; I called them back to follow up on our status; but the representative told me that there were a few cases in queue and she assured me that she would call me back soon and send me an email about the health care facility information. I called [medical company] again and told them that time is of the essence for the blood test to be drawn and we need to know the facility ASAP. We finally received our respective emails containing the health care facility information.My crew and I arrived at the Emergency Department. The front desk mentioned that they were expecting us. We gave our urine samples to the ER tech. Nurse ushered us to the treatment room; notified the lab for blood draw; and began our individual assessments. Approximately four hours post exposure; the A and B Flight Attendants Carboxyhemoglobin levels were drawn then they were put on high flow oxygen while I was administered 10 liters of oxygen before the lab technician drew my blood. The ER physician assessed our lung sounds and spoke with us individually. When our Carboxyhemoglobin results became available; the physician told us that all three of us have a 'slightly elevated level'. I asked if our urine samples would be tested for TCP metabolites; but he dismissed that ER techs usually collect urine samples as expected and no further testing is required. I also asked the physician if he would order a serum cholinesterase test for us; but he said it wasn't necessary unless each one of us or one of us had a cardiac medical condition.1) Install air quality sensors in all aircraft.2) Create an air quality algorithm for the flight deck if there is nothing in place yet.3) Provide more education to all flight attendants about air quality awareness: what to look for; what symptoms could occur; and post exposure procedure (notifying [medical company]; pertinent lab tests; etc).4) Improve post exposure algorithm (e.g. expedite approval from [medical company]; educate affected crew to go to a health care facility immediately while waiting for the insurance approval).


Synopsis: A319 Flight Attendant crew reported  persistent 'dirty socks' odor in passenger cabin during boarding. Maintenance had passengers deplaned. Flight attendants received medical treatment for physiological symptoms.