Date: 201910
Local time of day: 0601-1200
Location: ZZZ.Airport, US
Light: Daylight
Aircraft: Commercial Fixed Wing
Operator: Air Carrier
Operating under: Part 121
Flight plan: IFR
Mission: Passenger
Flight phase: Parked
Reporter organization: Air Carrier
Reporter function: Flight Attendant (On Duty)
Reporter qualification: Flight Attendant Current
Human factors: 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
Detector: Person Flight Attendant
When detected: Pre-flight
Result: General Flight Cancelled / Delayed; General Physical Injury / Incapacitation
Contributing factors: Aircraft
Primary problem: Aircraft

Narrative: We boarded the plane before passengers boarded. I stopped at the first set of overhead bins to check the equipment. Then I walked to row 6 to check additional equipment. As I stood at row 6; I began to smell a strong odor. It didn't last very long; and quickly dissipated. So; I said to the 'A' Flight Attendant; 'What was that smell?'  At the same time; she was asking the pilots if they noticed the smell. She said that it smelled like burnt oil. As I proceed to walk towards the back of the plane; I noticed that the smell was getting stronger. As I was walked back; the 'C' Flight Attendant walked towards me. I said to her; 'What is that smell?' She answered; 'Dirty socks. It smells like dirty socks; and I know that smell; it is bad air quality. I had an issue like this when I first started working for [Company]. I am getting off of this plane; and so should you.' I told her that I had to put my bags away first; and then I would follow. As I stood in the back of the aircraft putting my bags away; the smell made my stomach queasy and I began to feel light headed. So; I quickly walked to the front of the plane to get off.Before getting off; I witnessed the 'C' Flight Attendant talking to the Captain; telling him the same 'dirty socks' incident she shared with me. I can't remember if he went to the back to smell the odor; but I do remember him stating that he would call and request the cleaners to come back to spray something to help the smell. Then; the 'C' Flight Attendant and I proceed to step out into the jet way to get some 'fresher air.'  We only stood in the jetway about five minutes and then she and I returned to the plane to start passenger boarding. I and the 'A' Flight Attendant stood in the front of the plane; and the 'C' in the aft of the plane.I stood at the L1 door greeting passengers and about a third of the way into the boarding process; a Maintenance man came onto the aircraft. I am not sure if he came onto the aircraft to check the air quality. Next; a cleaning lady came on and as the Captain suggested; we sent her to the back to take care of the odor.' She told me she checked the lavs and there was not a problem and she left.About half way into the boarding process; a ZZZ Supervisor boarded and informed us that he had received a call regarding air quality. He said that he called Maintenance to come as well. I informed him that Maintenance had already been on the plane and the Captain requested cleaners as well. He said because there was a second call; Maintenance would come out again. Because the odor was coming from the back; I suggested that he talk to the 'C' Flight attendant in the aft of the plane regarding the issue. So; he followed the boarding passengers to the back to talk to the 'C' Flight Attendant. The boarding process was almost finished; so I to walk toward the aft of the plane to start closing bins and brief the exit rows. ZZZ Supervisor was going to the front of the aircraft. By the time I got to the back of the plane; my symptoms began to worsen. Now; I was feeling pressure in the back of my head and neck; in addition to feeling 'foggy' (not being able to think clearly); and my stomach was even more queasy. I told the 'C' Flight and she suggested that I go to the front to talk to ZZZ Supervisor. She told me that she had informed him that I was not feeling well.  So; I walked to the front of the aircraft to talk to the supervisor. I informed ZZZ Supervisor that I was not feeling well and I wanted to get off of the plane. He said; 'Ok; I will call Crew Scheduling to send a replacement for you.' I said; 'Wait can I just have five minutes; and then I will let you know if I want to get off or not.' He said; 'Let me see how much time we have.' Then he went into the flight deck to talk to the Captain. He returned; and said; 'Okay we have a few minutes; Maintenance is here.' I said; 'Are they here because of the air quality? He said no. They are here for a fan belt. I believe those were his words.  As I stood in front of the L1 Doorway; feeling sick to my stomach; and foggy in the head; trying to get 'fresh air' I asked ZZZ Supervisor to call Crew Scheduling. I told him I would make the decision when the replacement got to the plane. I was not thinking clearly. I could not even make the decision to stay on the plane; or to get off the plane even though I was clearly not feeling well.After talking to ZZZ Supervisor; I went to the back of the plane again to wait for my replacement. I informed the 'C' Flight Attendant that I was getting off the flight and at that time she told me that she was not feeling well either. She wanted to get off too. So; she went to the front to talk to ZZZ Supervisor.  I stayed at the back of the aircraft.  She returned shortly after speaking to ZZZ Supervisor and as she made it to the back of the aircraft; we received a phone call telling us to get off the plane immediately and paramedics would be waiting outside. So; we made our way through the deplaning passengers and we met ZZZ Supervisor in first class. He asked us to get off the plane. We did so reluctantly because there were passengers still on the plane. He said don't worry about that we will handle it. He said; you need to get off now.After we got off the plane; paramedics met us in the jet way. They asked us how we felt and about our symptoms. [Both of our] oxygen levels were checked. They told us that there was not much they could do. They had no equipment to test us for CO exposure. They asked if we wanted to go to the hospital in an ambulance. We declined and said we would take a ride to the hospital and ZZZ Supervisor offered to follow us there. None of us were thinking clearly. We should have gone to the hospital immediately (we did not receive medical attention until almost four hours later).After we left the paramedics; ZZZ Supervisor instructed us to contact [medical company] to get the paperwork started for us to get medical attention. After the case worker received my information; she informed me that I would receive a call or an email within an hour. I was never given my case number; and I did not receive a call or an email. After two hours; [coworker] called [medical company] and we all finally received the necessary information to go to the hospital via email. We arrived at the hospital; and we were admitted seen by a physician. Blood was drawn urine samples taken; and we were given oxygen. After about an hour the doctor came back with the test results. My CO level was 3.9. We were released; and instructed to drink lots of liquids; and get lots of fresh air.After I was discharged; we sat in the waiting room waiting for a ride back to the airport to go home. I began to feel light-headed and foggy again.  So; I went back to talk to the nurse. I told her that I was not feeling well again. And I asked if I could have a bit more oxygen. She allowed me to sit with the oxygen for 10 more minutes; but she informed me that if I did not feel better after the 10 minutes; she would have to readmit me to the hospital to find the reason why I was not feeling better. After the 10 minutes of extra oxygen; I felt better. But I decided to stay a night at a hotel; instead of going home.  The nurse instructed me to get rest and call for help at the hotel if I should have any more problems. I stayed a night at a hotel; and I took an early flight home the next day. This was a terrible ordeal that could have been avoided. The pilots did not take us seriously!


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 information 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 information 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: Flight attendants reported noxious odor throughout the passenger cabin during preflight. Passengers deplaned and flight attendants received medical treatment for physiological symptoms.