(1) handling problem cases in pilot medical certification; (2) selecting
and supervising Aviation Medical Examiners; (3) providing for the medical
investigation of aircraft accidents which occur in their areas; and, (4)
making personal presentations on the medical aspects of aviation safety
to groups of pilots. These Assistant Regional Flight Surgeons are looked
upon as FAA's field medical managers and its practitioners of aviation

medicine.

12

GPO 907-497



Among the results of these instructional efforts are improvements in the
quality of AME decisions as to which pilots are certified as fit to fly.
An equally important benefit is the improvement in the quality and com-
pleteness of medical reporting on pilot applicants. This contributes
greatly to the value of the data which are taken from the reports and
stored for future analytical studies.

When the AME has finished his examination, he sends his report to the
Aeromedical Certification Branch at the FAA Aeronautical Center in
Oklahoma City. There, all significant information relating to the exam-
ination is entered on computer tape. By using a set of preprogrammed re-
viewing criteria, the computer then proceeds to check on the quality and
completeness of the AME's case report and the appropriateness of any
action taken. Between five and six percent of the cases require some
further action to bring them to proper completion.

The stored information provides a valuable data bank describing the status
of medical fitness of all active civil airmen. Many special tabulations
can be made periodically such as the number of active pilots by age, the
number who wear glasses or contact lenses, the number who have no useful
vision in one eye or who have had an amputation of one or more extremity.

From the preceding, it can be seen that some pilots with significant
medical defects are permitted to fly. In many of these instances, certain
limitations are placed on their certificates, restricting them to flying
under certain specified conditions designed to protect the public as well
as the airman.

MEDICAL

NDARDS

Three classes of medical standards have been established and are applied
according to the level of airman responsibility.

These standards and related policies and procedures have been developed
with reference to certain basic certification philosophies. For example,
in FAA medical certification matters, concern for medical fitness extends
only over the period during which an issued certificate will be valid --
six months for duties requiring an airline transport pilot certificate, one
year for duties requiring a commercial pilot certificate, and two years for
duties requiring a student or private pilot certificate. This contrasts
with the concern of employers such as airlines, other private corporations
and the military services, to measure and attempt to predict pilot fitness
for extended periods -- the anticipated duration of employment of the
individual.

Another basic consideration is that if at all possible, applicants should be
permitted to fly if they can demonstrate an ability to perform airman duties
safely, regardless of the presence of a physical defect. For the most part,
This policy of special issuances applies to fixed or "static" defects such
as those that are visual, auditory, or musculoskeletal. It does not apply



industry. As previously discussed, a training program has been established
for the AMEs. They are required to participate in three-day seminars--
one every five years. In addition to the benefits previously discussed,
these seminars present an opportunity for the agency medical staff to make
personal contact with the AMEs. There is considerable benefit to the
agency in obtaining the point of view of people who administer the certi-
fication, accident investigation and education programs in the field.

AMEs gain from such firsthand exchanges a clearer understanding of their
role as agency representatives.

An example of the apparent effect of specifically focused educational
campaigns was the result of a letter from the Federal Air Surgeon to fly-
ing physicians. In anticipation of the ordinarily high accident rate

over Labor Day weekends, the Federal Air Surgeon sent a letter to physicians
who fly. He called their attention to the fact that the accident record
for physicians appears to be significantly worse than that for pilots in
general, flying similar aircraft. He listed certain precautions that

might be taken and urged physicians to exercise the same sort of care in
preparing for flying and in flying as they would in caring for patients

in their respective practices. Analysis of data subsequently indicated
that the number of accidents in this group over the next Labor Day weekend
was approximately half that which was expected from prior years' experience.

OCCUPATIONAL HEALTH

Maintenance of good health among the Federal Aviation Administration
employee population serves three principal objectives. First, the
individual employees should be able to continue to work productively,

be afforded the opportunity to progress in their careers and to provide
for themselves and their families. Second, the investment made by the
public in training and the experience gained by the employees are not
wasted by the untimely loss of personnel due to health deterioration.
Third, performance of duties by certain specific employees has direct and
critical impact or influence upon the personal safety of large numbers of
the public, and the presence of poor health among these employees could
seriously compromise public safety.

Health maintenance efforts within FAA are directed toward the general
employee work force in the form of on-the-job diagnostic and emergency
treatment services; providing care prescribed by private physicians,
such as allergy injections; providing selected immunizations; offering
disease detection services, such as screening for diabetes, glaucoma,
hypertension; and, counseling regarding possible alcohol or drug abuse.
All of the above efforts, when available, are strictly voluntary on the
part of the employee.

FAA now employs approximately 56,000 people with about half of the work
force assigned duties as air traffic control specialists. The majority
of air traffic controllers and large numbers of other employees are
assigned to special facilities identified as terminals (airport towers),
centers (Air Route Traffic Control Centers), and Flight Service Stations.


objectives have been established: identifying and eliminating insofar as
possible, those factors which cause or contribute to aircraft accidents;
updating the medical certification procedures of airmen, increasing the
health and physical fitness of aviation personnel, and improving the working
and safety conditions of all persons who are engaged in, or use the National
Aviation System.

The work is done in several subject areas (Task Areas):
a. Aeromedical Factors in Systems and Operations
b. Aircrew and Passenger Protection
c. Personnel Performance and Efficiency
dad. Aeromedical Factors in Flight’ Management
e. Public Acceptance of Aircraft Operations

The program operates on a budget of about $3 million.

MEDICAL INVESTIGATION OF AIRCRAFT ACCIDENTS

Since late 1959, there has been a complete medical investigation of all fatal
air carrier (airline) accidents. In addition, beginning in 1960, fatal general
aviation (non-air carrier) accidents have been medically investigated with
increasing frequency. At the present time, approximately 60 percent of the
general aviation fatal accidents receive some form of medical investigation.

Medical investigations are conducted for three basic reasons. First, the
possibility of physical incapacity as the cause of the accident must be con-
sidered. Second, the mechanisms by which impact forces produce death and
injury are studied for the determination of possible survivability factors.
Third, medical evidence which is accumulated is added to the other evidence
obtained during the investigation in order to attempt a reconstruction of the
events leading to an accident.

Primary responsibility for accident investigation and determination of
probable causes of aircraft accidents rests with the National Transportation
Safety Board (NTSB), an agency separate from the FAA. However, the FAA
Office of Aviation Medicine assists the NTSB in the medical aspects of the
investigation.

In numerous air carrier accidents, a study of injury patterns, evacuation
sequence, and the concentration of inhaled combustion products in the bodies
of accident victims has led to a fuller understanding of factors which affect
survival or escape following the occurrence of accidents. Information ob-
tained from these investigations is used in the design of specific research
studies to develop equipment or procedures which will increase the probability
of survival and escape.

In general aviation (non-air carrier) flying, there are about 650 fatal
accidents per year and approximately 1,300 fatalities. As previously
stated, there is some form of medical investigation in about 60 percent
of these accidents. For these investigations, the FAA Regional Flight
Surgeons are assisted by AMEs. AMEs, because of their geographic distri-
bution and acquaintance with local authorities and resources, are ideally

5



equally to organic or functional disorders that have a potential for sudden
incapacitation, progression, or recurrence, or for which some form of con-
tinuing medical treatment is required. However, in certain circumstances
where organic or functional disorders are present that would be otherwise
disqualifying, certification of many individuals has been possible through

the application of operational limitations and/or special medical surveillance.
For example, because of the nature of the underlying medical condition, an
applicant may be found eligible to perform the duties of a flight engineer,
but not those of a required pilot flight crewmember.

Among the organic or functional disturbances that are specifically disquali-
fying for any class medical certificate is an established medical history or
clinical diagnosis of (1) a myocardial infarction, (2) angina pectoris or
other evidence of coronary heart disease that the Federal Air Surgeon finds
may reasonably be expected to lead to myocardial infarction, (3) diabetes
mellitus that requires insulin or any other hypoglycemic drug for control,

(4) a personality disorder that is severe enough to have repeatedly manifested
itself by overt acts, (5) a psychosis, (6) alcoholism, (7) drug dependence,
(8) ‘epilepsy, and (9) a disturbance of consciousness without satisfactory
medical explanation of the cause. While individuals with such histories or
conditions are not eligible for certification under the established medical
standards, they may be considered for exemptions to the regulations. Exemptions
are granted if it can be determined that the condition involved does not pose
a threat to aviation safety and that the grant of exemption would be in the
public interest. Many exemptions granted are subject to operational limita-
tions and special followup medical evaluations.

In the development of medical regulations, procedures provide for public notice
and opportunity for public comment on proposals for amendments. Due considera-
tion of all comments, suggestions, and recommendations, as well as the oppor-
tunity to request the initiation of rule making, allows for full public
participation in regulatory efforts.

Over the years, the medical regulations (Part 67 of the Federal Aviation Regu-
lations) have undergone several changes. The last major revision of the ex-
plicit medical standards was in 1959. Since that time, several amendments
have been issued that are principally of an organizational and procedural
nature. Among others, these include authority for special issuances to
applicants who do not meet the established medical standards, delegation of
authority within the FAA to representatives of the Federal Air Surgeon to
issue final denials in certain cases, and revision of the psychiatric termi-
nology and definition of alcoholism and drug dependence. In addition, Part ll
of the Federal Aviation Regulations has been amended, delegating authority

to the Federal Air Surgeon to grant or deny petitions for exemptions.

AEROMEDICAL RESEARCH

FAA medical research is conducted at the Civil Aeromedical Institute (CAMI)
at the FAA Aeronautical Center, Oklahoma City, Oklahoma. It is supplemented
by contract research let to other government or private institutions.

The program provides objective information regarding current and anticipated
safety problems in civil aviation. The need for continuing research arises
from the changing technological and environmental conditions which place
different, and in many instances higher, demands on the airmen and other in-
dividuals involved in aviation activities. Specifically, the following


small groups of pilots in a manner which provides relatively close day~
to-day contact. The large number of civilian pilots, their geographic
distribution, and the unavailability of adequate numbers of medical
officers make this approach impractical in civil aviation. Therefore,
it is necessary to use other means of getting the word to the pilot.

Whenever it is possible, FAA medical officers meet with pilots and pro-
vide firsthand information in answer to questions at such pilot meetings
as safety seminars, "hangar flying" sessions, and other gatherings. In
order to extend the coverage which can be given by agency medical officers,
a second program utilizes the services of designated AMEs, who are pro-
vided with prepared material such as films, slide presentations, or
leaflets. AMEs address groups in local areas and make themselves avail~
able for answering questions on aviation medical matters, during visits
to local airports or at local meetings of pilot groups. This kind of
communication is enhanced, of course, if the AME is himself a pilot. The
FAA is particularly grateful for this service from AMEs since the agency
is not in a position to reimburse they Jor the time spent. This service
is possible only because of the d-'.vation and enthusiasm of individual
AMEs. <

A number of leaflets have been prepared for distribution to pilots through
the offices of AMEs Among them have been such titles as "Rx to Keep You
Healthy in Flight," "IFR/VFR-~Either Way Disorientation Can Be Fatal!" and
"Disorientation." Since the AME is the only agency representative with
whom all active pilots are required to make contact on a periodic basis
(for their physical examinations), they are an ideal distribution point
for such literature.

The Office of Aviation Medicine has also prepared slides and films dealing
with the effects of a number of medical conditions on flight proficiency
and flight safety. These films are available to FAA Safety Inspectors,
Regional Flight Surgeons, AMEs, and other personnel for presentation to
pilot groups. Pilots trained in the military are exposed to physiological
training and chamber indoctrination. Civilian trainees also have the
opportunity for this valuable training and experience at Oklahoma City
and at several military bases scattered about the country. The Aero-
medical Education Branch of the Civil Aeromedical Institute supports
flight instructor revalidation clinics and also the Flight Standards Ser~
vice in their accident prevention clinics through lectures dealing with
aeromedical topics (medical facts for pilots, psychological aspects of
flying, etc.).

The Office of Aviation Medicine also communicates with the aeromedical
community and the aviation industry by means of technical reports based
on research efforts. In addition, a Medical Handbook for Pilots is
available containing key information on medical factors critical to
flight. ‘his handbook, publication number AC 67-2, is available from
the Superintendent of Documents, U. S. Government Printing Office,
Washington, D. C.

Medical education efforts do not stop with the airman or the aviation

7



Technical Report Documentation Page

T. Report No. 2. Government Accession No.

FAA-AM-76-8

3. Recipient's Cotelog No.

~ Title and Subtitle
AVIATION MEDICINE - FAA

5. Report Date
August 1976

7. Author's)

H. L. Reighard, M.D.

6. Performing Organization Code

AAM=1

Performing Organization Report No.

2

Performing Organization Name and Address
Office of Aviation Medicine
Federal Aviation Administration
Washington, D. C. 20591

10. Work Unit No. (TRAIS)

11. Contract or Grant No.

12. Sponsoring Agency Name and Address
Office of Aviation Medicine

Federal Aviation Administration
Washington, D. C. 20591

13. Type of Report and Period Covered

OAM Report

14. Sponsoring Agency Code

15. Supplementary Notes

16. Abstract

Review and status of civil aviation medicine.

17. Key Words

18. Distribution Statement
Document is available to the public through
the National Technical Information Service,
Springfield, Virginia 22151

19. Security Classif, (of this report)

Unclassified

20. Security Classif. (of this page)

Unclassified

21. No, of Pages | 22, Price
12 $3.00 PC

-95 MF

Form DOT F 1700.7 (8-72)

Reproduction of completed page authorized



the controllers, and some not previously known, including hypertension, \
diabetes, peptic ulcer, coronary artery disease, hearing loss, and \
pulmonary pathology.

An early positive action was the use of the individual special considera-~
tion provision which allowed returning controllers to duty despite the
existence of medical problems. FAA, having knowledge of a problem, could
medically monitor each individual and when it was determined that neither
public safety nor employee health was jeopardized, could approve continued
duty for such controllers. The individual thus continues a career and FAA
retains a valuable resource.

There is growing medical evidence that many illnesses or disorders are
related to the stresses and strains faced by human beings in our modern
world. Stress may result from excessive or sustained mental or physical
demands, or may be found in circumstances of pure boredom. Many occu-
pations routinely involve alternating periods of intense activity and
periods of almost no activity, such as firefighters, police officers,
pilots and some ATC duties. Although there is no pure evidence that ATC
duty, per se, causes illness, scientific in-depth studies are continuing.
Regardless of the etiology or presence or absence of job relationships,
the facts are that illnesses and disorders which are unacceptable within
the air traffic system do occur among controllers.

The leading major diagnostic groups forming the basis for medical dis-
qualification were found to be: psychiatric-psychological disorders,
cardiovascular, and gastrointestinal, with medication a requirement in
almost every case in each group. The presence of these conditions is

not unusual in any population group, but the presence of these conditions
in controllers results in termination of careers. In contrast, in most
other careers, although complicated or altered by these illnesses, careers
could continue because the safety of others was not threatened.

Medical data derived from the ATCS Health Program are maintained by the
Office of Aviation Medicine, Regional Flight Surgeons, and in a computer
bank at CAMI. Disease incidence, trends and comparative studies are
planned, utilizing these data.

Changes in the operation and equipment used in the Air Traffic System,
and experience gained since the implementation of the ATCS Health Program,
have resulted in the need for revision and updating of the medical
standards utilized in the program. In addition, new laws and administra-
tive changes have resulted in the need for revision and updating of the
basic order covering the conduct of the program.

ENVIRONMENTAL HEALTH

The Occupational Safety and Health Act of 1970 and Executive Order No.
11807 are aimed at providing a safe and healthful working environment
for Federal employees.

The Environmental Health Program is designed to preserve the health and

10



Occupational health clinics are provided by the FAA at the Headquarters,
Washington, D. C.; Civil Aeromedical Institute, Oklahoma City, Oklahoma;
National Aviation Facilities Experimental Center, Atlantic City, N. J.;
nine of eleven Regional Headquarters, and the 20 major Air Route Traffic
Control Centers (ARTCC). Unless terminals and flight service stations
are physically located near one of the above, FAA medical care resources
are not available. However, medical examinations required for continued
employment, if not provided at FAA facilities, are provided at FAA expense
and are accomplished by certain AMEs or by selected clinical specialty
consultants. In addition, health units staffed by nurses are established
at Washington National Airport and Dulles International Airport.

Special health and examination programs have been established for the
following employee groups: Air traffic control specialists, FAA pilots,
firefighters, police officers, mobile lounge operators, and certain motor
vehicle operators.

The most extensive occupational health effort within FAA is the Air Traffic
Controller Health Program. This program was initiated in December 1965
after several years of study. Air Traffic Control Specialists (ATCS) are
responsible for the control, safe separation, and expeditious flow of both
civilian and military air traffic. This critical responsibility requires
that controllers be mentally and physically fit, be intelligent, display
good judgment, and be minimally affected by the unique and peculiar aspects
of these duties.

The initial program included a complete medical examination conducted by
selected AMEs. In addition, certain ancillary examinations including EKG,
chest X-ray, and audiogram were required. Initially, most of the
ancillaries were obtained at other government facilities, such as the
Department of Defense, U. S. Public Health Service, and the Veterans Ad-
ministration. Due to the nature of the duties and responsibilities of
controllers, a psychological screening test was administered to all ATCSs
already employed, and since then, is administered to all applicants prior
to employment.

A major effort completed in the early 1970's was the construction,
equipping and staffing of 20 clinics in FAA's ARTCCs. Capability
established included occupational health care, emergency care, and com—
plete physical examinations, including exercise EKG, X-ray, audiogram

and complete visual testing tonometry. A small laboratory was planned;
however, almost all specimens are forwarded to local automated laboratories
for analysis and reports. The medical officer at each center clinic is

an Assistant Regional Flight Surgeon and is in direct line of authority

to the Regional Flight Surgeon of each region.

The basis for the ATC Health Program is a set of standards developed by
FAA and published by the Civil Service Commission as the medical require-

ments for employment and retention on duty in the GS-2152 series.

An immediate product of the program was the identification and documenta-
tion of existing medical problems among controllers, which were known to

9



situated for the purpose of participating in the early phases of accident
investigations. They are in a position to arrange for autopsies to be
performed and toxicological studies to be conducted. In addition, the
AME, where possible, visits the scene and documents the evidence of im-
portance to the medical phase of the investigation.

From these investigations, case histories have been accumulated in which
the probable cause of the accident was some medical deficiency on the part
of the pilot. In others, it has often been determined that the accident
could have been survivable had the pilot or passengers been properly re-
strained at the time of impact (by a shoulder harness, for example).

In addition, a new approach to the investigation of aviation accidents
has been initiated, utilizing the psychological autopsy. This approach,
the psychosocial reconstruction inventory, enables the development of a
dynamic, retrospective portrait of the pilot-in-command subsequent to an
accident. When routine accident investigation data are supplemented by
a psychosocial or "lifestyle" reconstruction, a much deeper understanding
of the cause of the accident often emerges. In addition to the traditional
detailed explanation of what happened, it is often possible to determine
why the pilot-in-command behaved in a fashion to produce the accident.

By increasing pilot insight into the role of emotions and situational
stress in accident causation, more effective accident prevention programs
should result.

Prior to the initiation of the medical investigation program, very little
information existed as to the magnitude of such problems as physical in-
capacity, fatalities in potentially survivable accidents, or the effects
of alcohol consumption by pilots.

Studies will be made in an effort to determine if certain medical de~
ficiencies, now considered disqualifying, are compatible with safe air-
craft operation, perhaps under special conditions.

Where relationships of a type which indicate the need to alter present
standards of medical fitness are found, changes in the standards will be
made.

The findings of these investigations and studies should also help in
identifying areas where improvements in the safety record could be
attained through educating pilots on steps they can take to protect
themselves against the possibility of accident or injury.

AEROMEDICAL EDUCATION
The FAA has a duty to inform airmen by educational means rather than by
the regulatory approach, where its safety goals can be achieved by this

mechanism.

The medical education of pilots is perhaps ideally provided in the
military setting by the assignment of a flight surgeon to relatively


a significant beneficial change in the condition which caused his prior
denial.

Basically, any qualified physician may apply for designation as an AME.
However, the agency requires that he demonstrate an interest in the
program and agree to participate periodically in training seminars
designed to enhance his effectiveness as an AME. Need for an AME in an
area in which the physician is located is also a factor in the designation.
In addition, the agency gives weight to current or prior familiarity with
aviation or aviation medicine. Actual experience in aviation medicine,
such as service as a former military flight surgeon, is given considerable
weight. FAA likes to have AMEs who are themselves qualified pilots.
There is also a preference for physicians whose type of practice is such
that they would ordinarily be equipped to conduct a complete and compre~
hensive examination. Representation by specialties is approximately as
follows: general practice, 58 percent; internal medicine, 15 percent;
general surgery, 11 percent; aviation medicine, 3 percent; industrial
medicine, 2 percent; psychiatry, 1 percent; ophthalmology, 5 percent;
miscellaneous, 5 percent. Former flight surgeons are somewhat more
likely to be ophthalmologists or to have had some post-graduate ophthal-
mological training. Examination of the eyes is still an important part
of the pilot examination, and for this reason most general practitioners,
internists, and general surgeons, upon accepting a designation as an AME,
are required to purchase certain eye examination equipment which they
ordinarily would not use in their practice.

To keep AMEs abreast on matters of importance to their service as FAA
representatives, the Federal Air Surgeon uses a variety of instructional
media. Each AME is given a set of the Federal Aviation Regulations which
contains the medical standards by which he makes judgments of medical
fitness. In addition, the Federal Air Surgeon has published a "Guide"
which elaborates on the standards and informs the AME of the various
procedural and administrative practices relating to his work. Periodically,
the Federal Air Surgeon also issues a Medical Bulletin on the most recent
developments of interest to AMEs in the field of aviation medicine.

Perhaps the most effective means of keeping AMEs informed is by training
seminars. Each AME is required to attend a three-day seminar every five
years.

When first established in 1961, the seminars were conducted at medical
schools, using a combination of the post-graduate training faculties and
FAA personnel. There has been a transition to seminars which are con-
ducted wholly by the Office of Aviation Medicine with lecturers about
equally divided among FAA staff, aviation industry medical specialists,
and a select group of lecturers from a number of medical teaching
institutions. Considering the fact that AMEs, in order to attend, must
be absent from their practices for at least three days (for which they
are not compensated), their response and enthusiastic participation in
these seminars indicate their keen interest in aviation and making a
contribution to its further safety. Seminars have been scheduled annually
at metropolitan centers such as San Francisco, Dallas, Chicago, and
Washington, D. C.



AVIATION MEDICINE

The health and safety of more than 200,000,000 aircraft passengers,
approximately 700,000 active civilian pilots and other civil aviation
personnel are the concern of the Federal Aviation Administration's
Office of Aviation Medicine.

In the civil aviation system, involving 155,000 aircraft, which accumu-
late 36,000,000 flying hours per year, there are numerous and varied
opportunities to apply the principles of preventive medicine.

The Federal Air Surgeon, as Director of the Office of Aviation Medicine,
manages the nationwide program which: establishes the standards of
medical fitness for pilots, coordinates to the CSC on standards for air
traffic controllers, and other personnel connected with civil aviation;
provides a certification program which involves the periodic medical
examination of these personnel; provides medical investigation for air-
craft accidents; conducts medical research on a variety of subjects of
importance to civil aviation safety; operates an occupational health
program for the agency's 56,000 employees; and provides for the education
of civil airmen on medical subjects of importance to safe flying.

Civil aviation activity has grown at a more rapid rate than predictions
had indicated. Among other things, this has meant an estimated 7 percent
average annual increase in the number of pilots medically examined over
the most recent ten years.

MEDICAL CERTIFICATION

The key element of the program for periodic medical examinations and ,
issuance of medical certificates to airmen is a group of private
practicing physicians. These are the 8,000 designated Aviation Medical
Examiners (AMEs). Each calendar year they are expected to examine over

a half million airmen, including new applicants as well as renewal appli-
cants. Fees for these examinations are paid directly to the physician by
the airman. The AME has authority, delegated by the Federal Aviation
Administration, to issue a medical certificate on completion of an
examination. The AME also has authority to make a preliminary deter-
mination that the airman applicant is not qualified under the existing
medical standards and to issue an official notice to this effect to the
applicant, who then has the right of appeal. It is expected that approxi-
mately 1-1/2 percent of the airmen examined ultimately will be found
medically disqualified. Denied airmen have several avenues of appeal.
They may be reconsidered by the Federal Air Surgeon to determine if they
clearly are not qualified under the medical standards of Federal Aviation
Regulations Part 67, to see if a "waiver" or a grant of "exemption" is
possible in the public interest and under certain operational or other
limitations. Once the airman has exhausted his appeals within the FAA,
he may petition the National Transportation Safety Board for a “rules-of-
evidence" type of hearing. Airmen may use the U. S. Court of Appeals for
further legal review of their rights. Lastly, any airman will be recon-
sidered at any future time when he is able to submit medical evidence of





well-being of agency employees through the continuing evaluation and
control of health hazards in specific areas.

Industrial Hygienists, assigned to FAA Headquarters in Washington, D. C.,
and the Civil Aeromedical Institute in Oklahoma City, Oklahoma, provide
the technical competence necessary to recognize health hazards in agency
facilities and work places. Using as a guide standards promulgated or
approved by the U. S. Department of Labor, these personnel survey agency
facilities for the following specific problems:
1. Environmental health hazard evaluations.

a. Noise, lighting, temperature, space, and humidity control.

b. Radiation, vibration, contaminants (non-toxic and dust).

c. Sanitation and pollution problems.

d. Medical aspects of agency housing problems.
2. Medical consideration in:

a. Disposal of garbage and industrial wastes.

b. Water supply.

c. Insect and rodent control (pesticides).

d. Weed and foliage control (herbicides).

e. Food supply and dispensing.

3. Toxicological problems - gases, liquids, fumes, dust, and biological,
chemical and radiological control.

a. In aircraft.
b. In ground installations.

REGIONAL MEDICAL ACTIVITIES

To carry out the various aspects of the agency's medical programs, which
are developed and supervised from the Washington Headquarters, there are
eleven Regional Flight Surgeons and their staffs located in Boston, New
York City, Atlanta, Ft. Worth, Kansas City, Chicago, Denver, Los Angeles,
Seattle, Anchorage and Honolulu. There are Assistant Regional Flight
Surgeons, each with a small staff, located in the 20 major air route
traffic control centers, who provide medical services to center employees
and personnel in other nearby agency field facilities. These clinics
are extensions of the Regional Medical Divisions. The work of these
field elements is predominantly in occupational health, involving air
traffic controllers, with the balance of their efforts devoted to

il