nd lifeboat developed by B. F. Goodrich Company.

CONTROLLER STAFF 1967 — 1970

21,400

21,000 [
20,600 L
20,200
19,800 |

19,400 }

21,243 !

94D





2
|

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MEDICAL AND PSYCHOLOGICAL ASPECTS OF MASS TRANSPORTATION

Transportation comprises one of the most
dynamic elements in any society. The history
of civilization and the history of transportation
were always closely interrelated, since transpor-
tation assists in social development, and society,
in turn, demands transportation. Starting within
the first half of this century and accelerating
greatly within the past twenty-five years, air
transportation not only has surpassed other
types of transportation (Fig. 1), but also has
become a major element in world affairs as an
expression of national policy, economy, and in-
dividual private endeavor.

In accordance with statistical predictions, air
transportation will increase annually at some-
what more than ten percent until the end of this
decade. Hence, the air traffic volume will double
in about 714 years and it will triple in about 1114
years. This growth rate will depend on an
equilibrium of the various forces which tend to
drive it to higher levels by public demand for
transportation facilities and a favorable economic
climate, and the various forces which tend to
impede its growth by technical limitations, po-
litical reasons, or certain social objections. The
question is whether the upward trend can be
expected to continue through another decade in
spite of the possible restrictions.

The increase in air traffic does not simply
depend on the availability of more, faster, and
larger aircraft. Mass air transportation, just like
any other mass transportation, is made possible
only by the fact that a large number of people
want and can afford to use the airplane as a
means of transportation, As shown in Figure 2,
this presently seems to be the case. In accord-

Dr. Gerathewohl is Chief, Research Planning Branch,
Office of Aviation Medicine, Federal Aviation Adminis-
tration; Dr. Mohler is Chief, Aeromedical Applications
Division, Office of Aviation Medicine, Federal Aviation
Administration; Dr. Siegel is the Federal Air Surgeon,
Federal Aviation Administration, Washington, D.C.
20590.

ance with the figures published by the Interna-
tional Civil Aviation Organization, 289 million
passengers used the aircraft in 1969, traveling
349 billion kilometers. In order to sell that many
tickets, a number of requirements has to be met.
The first requirement of mass air transporta-
tion is safety. Accidents, in particular fatal
flight accidents, must be prevented. Figure 3
provides an interesting illustration of the in-
crease and present state of flight safety. The
diagrams in the center and at the bottom of
Figure 3 show that the number of fatal acci-
dents has been drastically reduced during the
time from 1952 to 1969. Depending on the
criterion used, this reduction amounts to be-
tween 50 and 60%. In contrast, the top diagram
shows that the number of fatalities increased
during the same period of time. In the future
even more passengers will be exposed to an acci-
dent. It follows that with the introduction of
the jumbo jets and even larger aircraft, the acci-
dent rate of the scheduled air carriers must be
reduced considerably below the present figure in
order to decrease the number of persons killed.
In accordance with data released by the National
Transportation Safety Board, the so-called
“pilot error” or other human factor deficiencies
substantially contribute to about 50% of the
accidents in air carrier operations and to about
85% in general aviation. The intensification of
medical and human factor efforts associated with
accident analysis and accident prevention are
therefore of high importance in regard to the
introduction of even larger airplanes: the
stretched versions of our present transport air-
craft, air buses, and jumbo jets. The increased
number and new types of aircraft taken into
operation complicate the problem further.

I. Airworthiness Aspects.
With the introduction of larger, faster, and
more complex airliners, it is obviously necessary

to consider the operational requirements of the
flight crew. A picture of the flight deck of the



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lation to follow suit. The potentially large num-
ber of patients will require an intensification
and improvement of medical facilities in flight
and at airports and the development of related
medical standards.

Although the airlines do provide to a greater
or lesser extent technical emergency evacuation
and first-aid training, the stewardess is often
considered a “hostess in the sky.” The aero-
medical experts are contemplating the assessment
of whether or not at a future date these persons
should be certificated so that the traveling public
is assured of a minimum level of competence
equivalent to that necessary to safely evacuate
the supersonic transport or other future aircraft.
This intensification of training may be necessary
in view of the increased demands on the profes-
sional skills of the flight attendants.

The Aeromedical Applications Division in the
Office of Aviation Medicine of the FAA spear-
headed a survey of 34 major airports in order
that facts could be obtained concerning the sig-
nificance of on-site occupational medicine pro-
grams. In reviewing the survey forms, airports
have been observed which have parking facilities
for passengers located at considerable distances
from the passenger terminal. These have necessi-
tated physical stresses upon’ passengers, particu-
larly the elderly, infirm, and those handicapped.
Furthermore, airports have been seen to have no
arrangement in the interior whereby these per-
sons can readily get about. In some terminals
wheel chair personnel have a particularly diffi-
cult time, especially in the toilets and getting
from the ticket counter to the flight waiting area.

The survey inquired into the nature, and the
number of airport toilets, and it has been found
that these have not kept up with the growth of
passengers and spectators, The number of toilets
must be predicated on passengers plus spectators
plus employees and adjusted upwards accord-
ingly. Food handlers should have separate toilet
facilities.

As a result of the non-standardized airport
interior-flow patterns for passengers, some con-
fusion almost inevitably occurs as the passenger
finds himself in an unfamiliar airport. This is
a particular problem for the naive, the elderly,
the handicapped, and certain others.

It has been found that many airport terminal
seating facilities and airline waiting-room seats

are inadequate in number for the passenger pop-
ulation. This is compounded by the visitors who
accompany the passengers and may be particu-
larly bothersome to pregnant women and women
with small children.

The handicapped person, whether in a wheel-
chair, one legged, blind or otherwise indisposed,
is considerably discommoded in many airports.
He cannot readily move from the check-in coun-
ter to the flight gate. If visually limited, he has
difficulty reading the flight announcements. If
readily fatigued, he often has limited seating
arrangements. Not infrequently, he cannot uti-
lize the extant toilet facilities because the local
architect who designed their features did not
give consideration to their utilization by handi-
capped persons.

Occasionally, a given flight is cancelled. This
means that its complement of passengers must
return to'the ticket counters. This will result
in increased confusion and an impairment of the
efficiency of flow of passengers scheduled for
succeeding flights. Adequate waiting-room ac-
commodations for these recurrent eventualities
will assist in the efficiency of handling the in-
creasing numbers of passengers.

The movement of large numbers of people on
international airways intensifies the danger of
carrying contagious diseases from one country to
another. Examples are the recent epidemics in
the East which could be spreading if preventive
measures are not taken. Similarly, diseases
threatening fruit, crops, and livestock must be
controlled. In 1967 the World Health Organi-
zation recommended the use of automatically-
dispensed pesticides (dichlorvos) for inflight
disinsection of passenger-carrying aircraft.

There are, however, questions about the com-
plete safety of the chemicals used under all
operational circumstances in regard to passenger
reaction, or whether toxic effects absent at sea
level might appear at higher cabin altitudes.
The FAA in cooperation with the Public Health
Service has recently conducted experiments and
answered these questions.

Passengers having contagious diseases will
flow at an increasing rate through airports. In
order that persons who might be susceptible to
various acute contagions, such as influenza, small-
pox, poliomyelitis, and other conditions depend-
ing upon geography and season (for example,


F. Our research personnel tell us that very
few restraint or flotation provisions are made for
large numbers of passengers. Although all air
transport airplanes are required to have flotation
seat cushions and seat belts by regulation, little
attention has been paid to the safety devices for
pregnant women and infants. Such protective
devices are now under development. Accord-
ingly, future aircraft will have universal restraint
flotation devices which can be applied to all age
groups in any seat and used under all conditions
(Fig. 7).

G. The FAA has started a series of experi-
ments using a new simulator for studying escape
problems and procedures associated with large
transport aircraft (Figs. 8 and 9). The simu-
lator consists of a platform which is 75 feet long
and 20 feet wide. The platform can be loaded
to capacity of 100,000 pounds, of which 45,000
pounds can be a live load. It can be tilted in
pitch and roll attitudes of plus and minus 20
degrees from the vertical and can be raised 16
feet above the ground by a hydraulic lift. A
two-story aircraft fuselage is being installed on
the platform and studies of emergency escape
will be accomplished in simulations of different
roll and pitch attitudes, Involved will be 154
passenger seats, smoke generating equipment,
and various lighting and sound effects. Of spe-
cial value will be the opportunity to evaluate
different emergency escape devices and different
types of fuselage doors. For.studying problems
associated with aircraft ditching, inflatable pools
will be positioned at appropriate locations be-
neath the simulator and occupants must escape
through the provided means into the water. One
of the most significant devices to be evaluated
with this simulator is the new slide-raft combi-
nation as shown in Figures 10 and 11. Another
is the determination of credit to be given con-
cerning the number of persons for each Type-I
door exit associated with a double-width slide.
Also, an attempt will be made to obtain a cor-
relation factor between trained vs. untrained
subjects, as well as to obtain certain information
bearing upon stewardess training levels.

H. The possibility has been suggested of the
placement in major airports of exhibits of emer-
gency escape devices together with operational
techniques. For example, the emergency exits
would be on exhibit and passengers could prac-

tice opening and closing these exits. In this way,
the passengers waiting at major airports can
familiarize themselves with standardized emer-
gency equipment and escape briefing so that this
time-consuming activity will not be placed to
such a heavy extent upon the cabin attendants.
Of course the cabin attendants of a specific air-
plane would give a short briefing on the unique
features of the airplane, but the main briefing
would already have been accomplished prior to
passenger boarding, leaving the busy cabin at-
tendant free to discharge her appropriate duties.
The airport briefing could be accomplished by
film or video tape.*

Ii. Certification of Airmen.

The increased use as a preferred means of
transportation relates the aircraft to mass trans-
portation. This concerns the air carriers (3,008
aircraft, 170 million passengers in the USA in
1969; ICAO: 289 million passengers without
China and USSR) as well as general aviation.
There is a steady increase in the number of gen-
eral aviation aircraft, flight tours, and private
pilots in the USA (Fig. 12). In 1969, 719,000
civil airmen held valid medical certificates. In
the process of making application for medical
certification (Figs. 13 and 14), they bring for-
ward all of the infirmities and medical problems
to which mankind is subject. We are confronted
not only with diversity in diagnostic entities, but
with the variable manifestations, the spectrum
of severity that each disease or combination of
diseases may depict.

The complexity of the problem is puzzling.
On the one hand, we find an increase of safety
mostly due to improved aeronautical engineer-
ing. This, on the other hand, lures a lot of per-
sons into the air who, psychologically or med-
ically, may be only marginally fit to fly. However,
unsafe pilots like unsafe drivers endanger the
highways in the sky. Hence, the problem is to
keep the unsafe persons—commercial _ pilots,
private pilots, and passengers—off the air while
at the same time opening up the airways to mass
transportation. The number of petitions denied
by the Administrator, FAA, and their medical
classification are shown in Figure 15. We will
deal with the commercial pilots first. The com-
plexity of the modern airliner, in particular the
wide-bodied jets and the SSTs, together with
the increased traffic density, novel flight pattern,



Boeing 747 is shown in Figure 4. Principles of
good management as well as human engineering
must be incorporated in the philosophy concern-
ing the pilot’s role in the modern-day airliner.
Just as the manager of a company must have
visibility of the operation and its problems and
future plans, the pilot of a modern-day airliner
must have information relative to the aircraft’s
situation, rate of progress relative to its objec-
tives, and any problems that may develop. The
requirement for clear-cut, timely information in
an easily understood format is equally necessary
for both the manager and the pilot.

The following examples are given to illustrate
the airworthiness efforts for future aircraft:

A. All instrument approach and blind flight
displays will be heads-up, or so placed that they
are conveniently ahead of the pilot. All relevant
information will be simplified and displayed in
intelligible analog form with simple digital
clarification readout.

B. All instruments will be properly lighted
with no hidden instruments which require inten-
sive study by the pilot under night IFR condi-
tions just when his attention is most urgently
needed elsewhere.

C. The current cluster of non-standard knobs,
switches, displays, and other protrusions will be
totally eliminated. A standardized cockpit based
on the building block concept will exist which
clearly provides the pilot with essential informa-
tion and enables the pilot to transition between
aircraft with negligible difficulty.

D. Vista vision cockpit windows will provide
all crewmembers with true sky-scanning capa-
bility. Live television scanning to assist landing
may be utilized, as may pictorial navigation
devices.

II. Protection of Human Lives.

In the future decades, crashworthiness struc-
tures of air transport and other aircraft will be
upgraded considerably. The following examples
may illustrate certain of these projections:

A. All instrument panel and seat structures
will be constructed of material which, within the
range of occupant impact, will not yield fatal
injury during impacts which do not demolish the
aircraft fuselage. Universal restraint systems
will be incorporated in all aircraft which can

be adjusted to all sizes of persons. In addition,
new restraints will not produce injury in preg-
nant women and will be quickly releasable fol-
lowing cessation of the impact.

B. Aircraft seats will be capable of absorbing
deceleration forces throughout the crash impact
profile, the latter limited by the loss of fuselage
integrity. Consequently, the seat occupant will
not receive deceleration forces which exceed his
tolerances unless the accident is nonsurvivable.
Moreover, all seats will be tied down to appro-
priately designed and strengthened floors in such
a fashion that. seats will not fail throughout the
range of crash forces delimited by the fuselage
integrity. Restraint systems must exceed human
tolerances if they are designed to really protect.
the passengers. The seats will have to be posi-
tioned so as to minimize the acting G-forces.

C. In order to reduce the fire hazards often
associated with aircraft accidents, the FAA is
investigating various methods of preventing fires,
including the use of thickened or gelled fuels.
Moreover, protective hoods against smoke and
radiant heat were developed for individual pas-
senger use. At the present time this smoke hood,
although felt practical for many emergencies,
provides protection for only four to five minutes
(Fig. 5). Research is underway to extend the
period of protection by a small cartridge built
into the hood containing compressed air.

D. Aeromedical scientists have evaluated cloth
escape chutes and slides for passenger use in
emergency evacuations. The next generation of
such devices suitable for jumbo jets and super-
sonic transports should represent an improve-
ment in these old-fashioned cloth structures (Fig.
6). The next generation devices should be highly
compact, lightweight, of metal “solid-state”
structures, rapidly deployable at the press of a
button, and not affected by wind. One such
device has already been reported on by the Civil
Aeromedical Institute and others are in evidence.

E. Large aircraft which exceed the jumbo jet
in size, the gigantic jets, are already on the draw-
ing board. There may be two or three levels of
passengers. We are studying the possibility of
using already deployed inside metal tubular es-
cape chutes which serve also as boarding stairs.
It is conceived that with the press of a button
the stairs fall flush, providing a smooth slide for
rapidly evacuating the occupants.




and prevent the stress effects of control work
upon the air traffic controllers.

The concept that control work is stressful—
sufficiently stressful to warrant special handling
and recognition for men in this line of work—
is not new. The recognition of the demands
which this work can generate encourages us in
seeking to develop an objective standard which
will accurately measure the effects of stress upon
the human organism generally and also more
specifically upon the controller in the working
situation, Such measurements can serve to an-
swer the question as to whether air traffic control
work warrants specialized career benefits to com-
pensate for the cumulative effects of stress that.
over the years may exact a toll in terms of de-
clining health and individual personality changes.

The Sixteen Personality Factor Test (16PF)
is used by FAA scientists to select psycho-
logically healthy controllers.° The 16PF is in-
herently perhaps the best constructed test of per-
sonality inventory now available for this purpose.
The 16PF is constructed to cover the whole
range of personality characteristics, normal and
abnormal, but we are largely interested in get-
ting at the troublesome aspects of a controller’s
personality. At the same time, it should be
realized that the 16PF, unlike many clinical
tests, does allow for the description of a normal
personality.

Experience with the test over the past five
years, with cases of many types, has convinced
us that the test is the most useful personality
inventory for predicting the success of an air
traffic controller or his possible failure. It is
obvious that this simple test is only one means
among others to be used in the ATC selection
procedure.

The incidence of stress-type illnesses among
the controller population has previously been
compared with that of the airman population
and also with figures for the total Air Force
population, Air Force officers only, and Air
Force pilots." Stress type illnesses such as coro-
nary heart disease, hypertension, diabetes, peptic
ulcer, and analogous disorders occur at signifi-
cantly higher rates in the controller population
than in these control groups with which the
controllers have been compared. Further studies
of ATCs in towers and terminals are in progress
and an attempt will be made to incorporate their

findings into a comprehensive employee health
program.

Finally, the assignment of physicians and
ancillary medical personnel to staff small med-
ical clinics to be established in each expanded.
center commencing in the early part of 1971 will
facilitate the examination of controllers under
the ATC Health Program. This measure will
establish effective medical surveillance to the
actual working ‘interface, thereby affording bet-
ter medical care for the controller population,
while at the same time enabling the medical
service to better identify and appraise the be-
ginning and development of stress effects in con-
trollers through the close observation which the
assignment of medical officers in large working
facilities will guarantee.

Vv. Airport Aeromedical Survey.

Today the nation’s airports need similar atten-
tion. Many airports are saturated at peak-hours;
terminals have become strained; and it is be-
coming increasingly difficult to reach the airports.
In about three years a considerable number of
the world’s major airports will each have to
accommodate over 20 million passengers and
about the same number of nonpassengers per
year.!?

For the non-passenger, the airport may be a
kind of “no-man’s land.” The visitor may be in a
much more precarious state than is the case with
the ticketed passenger, because the airlines will
usually take responsibility for ticketed passen-
gers who experience medical problems. The
non-passenger visitor, however, must fend largely
for himself should he become ill in an airport
with no airport medical facility.

It must be anticipated that the number of
handicapped, sick, or border-line cases—psycho-
logically and medically—will increase at least
proportionately with the increment of passengers.
There is a good possibility that the relative and
absolute number of such persons will increase
out of proportion, this being typical for most
mass phenomena. The notion that only healthy
and physically fit individuals can travel by air-
craft has long been relegated to the limbo of
false assumptions; and the introduction of the
jumbo-jets, their advertisement and catering to
the people, undoubtedly will encourage the not
quite so healthy and fit specimens of the popu-



es at the Civil Aeromedical Institute, Oklahoma City, Okla.



TECHNICAL REPORT STANDARD TITLE PAGE

~ Report No.

FAA-AM-71-10

2. Government Accession No.

3, Recipient's Catalog No,

a

Title and Subtitle

TRANSPORTATION

MEDICAL AND PSYCHOLOGICAL ASPECTS OF MASS AIR

3. Report Date

March 1971

6. Performing Organization Code

7 Author's)

P. Vi Siegel, M.D.

8. J. Gerathewoh1, Ph.D.; S. R. Mohler, M.D.; and

8. Performing Organization Report No.

- Performing Organization Name and Address
Office of Aviation Medicine

Federal Aviation Administration
800 Independence Avenue, S.W.
Washington, D.C. 20590

10. Work Unit No.

TT. Contract or Grant No.

13. Type of Report and Period Covered

12. Sponsoring Agency Name ond Address
Office of Aviation Medicine
Federal Aviation Administration
800 Independence Avenue, S.W.
Washington, D.C. 20590

Ta Sponsoring Agency Code

15. Supplementary Notes

16. Abstract

transportation,

major airports,

The increase in air transportation depends not only on the technological
progress and the availability of more and larger aircraft, but also on
the corresponding increase in flight safety.
accidents, pilot error is a contributing factor, research concerning the medical
and human factors must be expanded to include the new generation aircraft, in
particular, to the jumbo jets and air buses which are the means of mass air
Moreover, the medical aspects of airports must be adjusted to
serve the increasing number of crews, passengers and patients.
provided for first aid, quarantine and the prevention of infectious diseases
through air transportation; and a disaster plan must be established for all
Finally, the effects of mass air transportation on the
environment must be considered in order to protect the quality of life.

Since, in most of the aircraft

Means must be

17. Key Words

Mass Transportation, Human Factors in
Flight, Aviation Medicine

18. Distribution Statement

Availability is unlimited
Document may be released to the National
Technical Information Service, Springfield,
Virginia 22151, for sale to the public.

19. Security Classif. (of this report)

Unclassified

20. Security Classif. (of this page)
Unclassified 29

Ti. No. of Pages | 22, Price

$ 3.00

Form DOT F 1700.7 (8-69)



that the maximum tolerable jet noise covers the
range from. 95 to 105 PndB. A variety of ex-
periments is being used to assess the effects of
noise on individuals and communities. The re-
sults obtained so far show that, while certain
performances—in particular, fine motor coordi-
nation and related psychomotor activities—are
susceptible to impulsive noise, medical effects
produced by flyover or sonic booms are extremely
rare and difficult to prove. In comparing sub-
sonic daytime noises (100 dB) with 1.7 psf booms
at night, the reaction was more favorable toward
the boom than to the subsonic noise. With the
exception of much higher over-pressures gener-
ated close to the ground, the infrequent sonic
boom appears to be less annoying and the habit-
uation more evident than most people realize.’
Studies of human responses to impulsive noises
are presently in progress at the Civil Aeromedi-
cal Institute at Oklahoma City (Figs. 18, 19,
and 20).

At any rate, noise is still a problem and could
be one of the restrictions of mass air transport
if it cannot be solved satisfactorily. Solutions
will be even more important in the future around
V/STOL terminals and under such flight cor-
ridors. Supersonic commercial air transport
possibly will add to sideline noise the annoyance
of the sonic boom. At present, prospects are not
readily apparent for significant reductions in the
intensity of these noises. Any solution to the
aircraft noise problems must include the devel-
opment of guieter engines, the establishment of

ment, waste our reserves and national resources,
and thus add to human misery in the long run.

Some believe that it is not realistic to expect
the growth of new technologies to continue at
the present rate. Logic as well as circumstance
suggests that the various restrictions mentioned
earlier are real. Available means and tools to
advance mass air transportation are not being
used appropriately. An analysis of 61 surviv-
able aircraft crashes made by the Flight Safety
Foundation in 1967 indicated that nearly half
of the 1087 fatalities and serious injuries which
occurred could probably have been prevented by
the use of improved restraint systems. Conferees
at the December 1967 USAF-Industry Life
Support Conference held at Las Vegas, Nevada,
concluded that “human tolerance to accelerative
forces is much greater than the forces generated
during some of today’s ‘non-survivable’ accidents.
We have 40-G people riding in 20-G aircraft,
and sitting in 9-G seats and restraint systems.”
There may also be political and social restrictions
to mass air transportation which must be con-
sidered. The assumption that more and more
percent of our population want to travel by air
may be falacious. Presently only about 20 per-
cent of the U.S. population has ever traveled
by air; in order to cater to the remaining
80 percent, transportation must be inexpensive,
that is, less expensive than air transport can
afford to be. If nations and populations, in
particular the rich and highly technologized

ong. dp ngtincrease at the statistically predicted _____



typhoid fever or cholera), routine medical im-
munizations will be a significant factor in the
future.

The geo-political jurisdiction, including coro-
ner or medical examiner jurisdiction, must be
considered with respect to airport medical serv-
ices and assistance during airport air disasters.
An airport disaster plan must be developed, in-
tegrated with all elements of the airport and
surrounding community which will be concerned,
and updated annually, or as required by changing
circumstances, Some of the 34 airports surveyed
were found to have no disaster plan which in-
volved the medical support aspect. Some of the
airports had given considerable attention to the
development of a disaster plan including the in-
corporation of information involving medical
personnel, these plans not infrequently having
evolved subsequent to an on-site disaster.

Temporary morgue facilities must be ulti-
mately provided at all airports expecting mass
air transportation. These facilities must be of
an adequate capacity to handle the potential
numbers of fatalities which can result from a
full complement of fatal victims contained in
the largest aircraft utilizing the airport. The
accident investigator and victim identification
teams may require up to three or more days of
investigative time prior to their release of the
bodies. Prior planning and designation of space
for this need prevents problems at a future date.

Following this detailed survey of 34 of the
world’s major civil airports, the International
Quarantine, Airport Medical Service, and Flight
Sanitation Subcommittee of the Aerospace Med-
ical Association provides data supporting the
following conclusions:

A. Each airport should have a designated
Chief Medical Officer ;

B. When the airport employees exceed 3,000,
or when the passengers per year exceed 2,000,000,
an. on-site airport medical service is desirable;

C. Of the 34 airports surveyed, 32 are forecast
to meet the minimum standard for establishment
of an airport medical service; and

D. An “Airport Medical Design Guide” which
provides information on aeromedical and human

factors aspects of the airport operation should
be assembled and promulgated.

VI. Effects on the Environment.

The growth of civil aviation during the past
decade has been accompanied by world-wide
concern about the adverse effects upon the en-
vironment. There can be no doubt that air
transportation has brought about environmental
changes, such as changes of the scenery through
the construction of airports, supporting facili-
ties, connecting roads, highways, etc. However,
these changes generally are less dramatic than
those brought about by other means of mass
transportation, in particular, the automobile.
As a matter of fact, it has been claimed that the
aircraft is the one vehicle which spoils the en-
vironment the least (Fig. 17) and that certain
unpleasant by-products, such as engine smoke,
some air pollutants, and chemicals released
through the combustion process, will be better
controlled in the future.

It seems that the most obvious environmental
effect of aircraft operation is engine noise.

The new generation aircraft may produce even
higher noise levels under flight paths or to the
sides of runways. If more frequently operated,
they will probably bring longer periods of rela-
tively high noise to neighborhoods adjacent to
airports.

Noise is receiving increasing attention from
airframe and engine manufacturers, airport op-
erators, government agencies, and the public.
Its arousal of communities surrounding airports
will become a major obstacle to the growth of
aviation unless solved.*

Current research on human reaction to aircraft
noise is being expanded. With increased air
traffic and introduction of new kinds of aircraft,
it is of the greatest importance to have more
accurate information about human response to
different characteristics of noise and to a total
environment in which noise may be an important
negative element.

Among the various sources of noises, air-
craft noise has been the most publicized. It is
this noise source which has substantially con-
tributed to the public reaction against modern
traffic noise. It has been pointed out in this
connection that the fear of airplane crashes en-
hances the annoyance factor. Fearful people
who live in the vicinity of airports go through
a continuous tension which is closely related to
the actual noise level. There is reason to assume



and national or international peculiarities may
demand a higher degree of mental and physical
response than is needed in our current aircraft.
This would indicate the need for higher psycho-
physiological fitness and, accordingly, for high
psychological and medical standards.

At this point, we can make the case that sud-
den, partial, or total incapacitation of a crew
member is more likely to prove disastrous to the
aircraft and passengers. Therefore, questionable
or borderline findings in the vital organ systems
(under dynamic loadings) will not be acceptable.
From a medical standpoint, wishing to err on
the conservative side, this reasoning would make
a certain amount of sense, and therefore would
likely be accepted. From the operator’s and fly-
ing public’s standpoint, however, the question
might well be raised that if such a case can be
made for the jumbo-jet and SST crews, then why
not impose it on all commercial pilots as an ad-
ditional measure of flight safety? If we were
working in a completely objective aviation sys-
tem, the forces resisting such action would be
minimal; but unfortunately the one in which we
work is heavily burdened with political, eco-
nomic, and prestige.constraints, such as seniority
or merit system not based on medical facts alone.
These ever-present biases, along with the assump-
tion that the “state-of-the-art” of aviation medi-
cine is fairly imprecise, amplify the inherent
difficulties.°

However, we must look at the jumbo-jets as
another trend in air transportation leading
toward more complex and larger public vehicles
operating in environments containing potential
hazards of increasing lethality. It must be
pointed out in this connection that the science
and practice of preventive medicine hold great
promise to alleviate many of the mass transpor-
tation problems. Accepting this trend, it is our
primary responsibility to periodically review and
update our aeromedical standards and procedures
by which we can optimize the reliability of the
human component in the system and, at the same
time, maximize the safety of air operations.

One of the most pressing needs is to find im-
proved means of detecting early coronary heart
disease in pilots.’ Also, means for determining
biological dependency on alcohol should be de-
veloped and studies of intermediate vision re-
quirements by pilots are indicated. The aero-
medical community would indeed be short-sighted

if it did not incorporate any advances in this
area toward improving the health and fitness of
airmen, at the same time setting better records
for flight safety.

In addition to an adequate aircrew selection
and training program, the care of the passengers,
which will include a substantial number of handi-
capped or ill: persons, has to be considered.
Physiological indoctrination, first aid, and med-
jeal care of patients will be required by airport
personnel and the stewardesses, who will have
to work much more independently in the wide-
bodies and stretched jets than in conventional
aircraft. Attention should also be paid to the
prevention of a panic in case of unusual situa-
tions, be this a hijacking or a flight emergency,
and the aircrew personnel must be prepared for
dealing with panicking passengers under these
conditions.

IV, Air Traffic Controller Health.

The air transportation growth in the last four
years and forecasts for the future indicate that
air traffic will increase at a greater rate than the
present or programmed traffic control system can
handle. An increasing number of terminal areas
are already experiencing unusually long delays
in receiving and dispatching aircraft.

Through 1977, FAA forecasts sharply rising
demands for airspace by air carriers and general
aviation and declining use by the. military.
Total aircraft operations at airports with FAA
traffic control service will rise from 55.9 million
in fiscal year 1969 to an estimated 174.2 million
in fiscal year 1981, an increase of approximately
212 percent.’

Increased air traffic volume with a greater
proportion of larger aircraft will clearly require
new approaches to air traffic control in the future.
Present deficiencies will become progressively
worse unless strong measures are taken.

In order to cope with the air traffic problem,
the number of air traffic controllers was sharply
increased during the past three years (Fig. 16).°
Moreover, the FAA initiated a research and
health program which began to operate early in
1966.2 While affording all the advantages which
an employee health program can bring to those
who participate in its benefits, it was also de-
signed to develop experience data which would
serve to determine environmental stress levels


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27









‘ioning device.



LIST OF ILLUSTRATIONS

Figure

1

. Passenger fatalities and fatal air accidents, 1950-1969
. Cockpit of Boeing 747

. General aviation aircraft flight hours
. Airman applications for medical certification, 1940-1969 -

. Buildup of Air Traffic Controller Staff, 1967-1970
. Projected levels of world atmospheric pollution —_

Development of air traffic and sea traffic across the North Atlantic, 1951-
1969, ICAO Bulletin, May 1970
Passengers hauled and cargo and mail tonnage handled between 1947
and 1969 ___

Protective smoke hood used for evacuation of aircraft —
Evacuation slide —__.
Infant protection device
Aireraft fuselage on top of CAMI positioning device
Aircraft fuselage in nose-down position using the CAMI positioning device
Combined evacuation slide and lifeboat developed by the B. F, Goodrich
Company -.-
Combined slide/lifeboat with protecting cover developed by the B. F.
Goodrich Company -

Receipts of medical certificate applications by class ___.
Petitions denied by the Administrator, 1961-1969

Bedroom for studies of human responses to impulsive noises at the Civil
Aeromedical Institute, Oklahoma City, Okla, -_-..
Sonic boom generator at the Civil Aeromedical Institute, Oklahoma City,
Okla.
Equipment for recording human response to impulse noises at the Civil
Aeromedical Institute, Oklahoma City, Okla.

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