BEFORE THE FEDERAL AVIATION ADMINISTRATION

WASHINGTON D.C.

Docket FAA

- 2011
- 0618

REPLY TO FEDERAL AVIATION ADMINISTRATION REQUEST FOR ADDITIONAL INFORMATION

November 22 , 2011

**Background:**

By e
- mail and later published to Docket FAA 2011
- 0618, Mr. Charles M. Schramek, General Manager Qu ality Assurance and Compliance, was request ed by Aviation Safety Inspector Leo Hollis to provide additional information so the FAA may complete its technical analysis of Delta’s exemption request. Inspector Hollis stated the following:

“ We requested the FAA’s Civil Aerospace Medical Institute (CAMI) to review and evaluate your request for an exemption to certain requirements in 14 CFR part 121 § 121.333. We have received the results of that evaluation. CAMI stated that the requirements in § 121.333 recognize a difference between 

### Petition of
DELTA AIR LI NES, INC. OPERATING CERTIFICATE DALA026A For exemption of certain requirements of 14 C.F.R. §§121.333(e)(2)Delta Air Lines, Inc. Response Docket 2011

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non - emergency flight between 10,000 and 14,000 feet as addressed in § 121.329 and flight at these altitudes following a decompressi on and subsequent rapid descent. In the latter situation, pulmonary sequelae of barotraumas such as arterial gas embolisms and alveolar rupture may be present in some passengers. The standard of care for such emergencies still inc ludes the provision of con tinuous supplemental oxygen.
We recognize that decompression is an extremely rare event and that a decompression over a mountainous area requiring that the flight stay above 10,000 ft is even more remote. Nonetheless, an increasingly older flying populat ion will predictably have more medical conditions that are affected by hypoxia at 14,000 feet.
In order to complete our technical analysis of your petition for exemption, the FAA is requesting the submission of additional data to the docket. Please prov ide analysis of the potential passenger population and the passenger health issues on the affected routes including consideration for additional portable emergency oxygen systems, medical supplies, flight attendant training and operational plans. Additiona lly, a plan should be proposed that addresses how additional medical support will be provided to passengers with barotraumatic injuries or compromised cardiopulmonary function in the event of a decompression. ”

**Delta Response**

**Introduction :** 

The concern represented by the FAA’s request stem s from the need for undiluted oxygen after a decompression due to possible respiratory injury as a result of the rapid change in differential pressure

. A passenger who is compromised by a condition such as arterial gas embolisms or alveolar rup ture should be treated withDelta Air Lines, Inc. Response Docket 2011

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the higher oxygen flow rate prescribe d by 121.333(e)(3) rather tha n the flow rate prescribe d under 121.335(b) , which through rule change now requires compliance with §25.1443(c)(1)

. It is important t o note that the mass flow oxygen requirement at 14,000 feet as prescribe d by §25.1443 (c)(1) is a mean tracheal oxygen partial pressure of 100 mm Hg when breathing 15 liters per minute, BTPS, and with a tidal volume of 700 cc. with a constant time interval between respirations. Breathing ambient air at 14,000 feet has a mean tracheal oxygen partial pressure of 94 mm Hg with all other parameters constant. The additional supply of a mean tracheal oxygen partial pressure of 6 mm Hg would not be appropriate fo r the treatment of a passenger who has a sever e respiratory injury or other condition that requires first aid oxygen.
The issue the FAA is asking Delta to address is actual ly germane to any rapid decompression event regardless of whether the initial des cent is to 14,000 feet or 10,000 feet. For this reason Delta considers this to be more of a question of whether current data and first aid procedures support the adequacy of the required oxygen supply carried under the requirements of §121.333(e)(3)

. The following information and analysis supports that this regulatory requirement is currently serving the actual need.

**Data Analysis:** 

I n research conducted by Dr. Parmet , A ppendix 1, there has not been any reported significant respiratory injury attribute d to a rapid decompression. There have only been two cases of air embolism in the scientific literature. Neither was associated with a decompression event. There have been literally billions of passengers flown with an extremely low rate of significant respiratory injuries. The typical ailments experienced during a rapid decompression are related to barotraumas to ears and sinus. This condition is not typically treated with undiluted oxygen. Even in the most significant cas es in NTSB history, the on bo ard oxygen was not cited as an issue
or concern.Delta Air Lines, Inc. Response Docket 2011

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November 22 , 2011 Page 4

Delta ’s research of the last 10 years of our internal reports revealed there have been
no reported cases of an ill passenger , regardless of the reason or cause , where the onboard supply of oxygen require d under §121.333(e)(3) was depleted before the passenger was transferred to the care of ground medical personnel. Delta also researched to see how many cases in the past 10 years where there was more than one passenger on an individual flight who required first aid oxygen, §121.333(e)(3)

. We found only one incident on a B

- 767. One passenger was having a respiratory issue and another passenger fainted. This flight was diverted for medical attention and was on the ground within 45 minutes. In this case o nly two oxygen bottles were partially used.

B ecause this event occurred on an ETOPS aircraft approved for 180 minute operations with a 209 passenger configuration , the aircraft was equipped with 11
ox ygen bottles capable of supplying five passengers wit h oxygen in excess of 180 minutes

. Actual required oxygen bottles to meet the requirement of the rule for a 180 minutes ETOPS flight is 10 oxygen bottles and if operating in non

- ETOPS the aircraft requires 5 oxygen bottles. Delta purposely configures the aircraft to carry one additional oxygen bottle over the minimum required for the maximum route authority (207, 180, 120 or 60 minute routes from an enroute airport)

. By MEL authority, Delta will operate at the minimum oxygen requirement if the add itional bottle(s) were consumed , e.g., medical divert to an off

- line airport where replace ment bottles are not available . The vast majority of the time , Delta aircraft are operating with at least one oxygen bottle above regulatory requirements.

T o address the FAA’s concern with respect to the aging population , Delta has studied approximately four years of re ported medical incidents though Delta’s airborne medical consultant service regardless of the cause

. The resultant data was broken down by rate pe r passen ger carried and rate per flight leg , A ppendix 2

. We have also examined the rates of typical events where oxygen would most likely be administered to the patient. Highlights of that data analysis are as follows:Delta Air Lines, Inc. Response Docket 2011

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 Events where oxygen would typically be adm inistered ( Syncope, Respiratory, Cardiac, Seizures, Diabetes, Stroke, and Pregnancy) is currently averaging between 2 to 3 events per day based on approximately 2300 flights per day. This is an averag e rate of approximately 7 passengers per 1,000,000

.

 The rate of events where oxygen would typical ly be administered remained relatively constant between 2009, 2010 and year

- to
- date 2011. There was an increase between 2008 and 2009 . 2008 was the first full year this data was collected and reported to our s ervice provider for analysis.

 Across a ll categories collected, Delta currently averages 4 to 5 medical events per day. Most of these are minor medical issues where oxygen is not needed.

 Overall rates and specific category rates between 2010 and 2011 remain relatively constant to a slight decrease

.

 The overall rate increase between 2 009 and 2010 was mainly driven in the categories of s yncope (fainting), i njury (generally slip fall), and p ai n.

Delta has reviewed 2010 US Census Bureau data and compare d the age demographics to that of passengers currently fl y ing on our aircraft. Delta utilized “Secure Flight” data for our analysis from this current year. Due to the volume of data , two sections of the data were pulled which represented a data set of ap proximately 5 million passengers.

The charts contained in Appendix 3 represent the age demogr aphics from the 2010 US Census Bureau and Delta passenger age demographics from Secure Flight and contain:

 All Delta passengers compared to US Census data

 Pass enger demographics of those who typically transit the high terrain of South America compared to US Census dataDelta Air Lines, Inc. Response Docket 2011

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 Passenger demographics of those who typically transit the high terrain of Greenland , compared to US Census data

 Passenger demographics of those w ho typically transit the high terrain of the Middle East compared to US Census data
Delta’s analysis of the Delta passenger v. US Census data is as follows:

 Approximately 80 % of Delta passenger s fall in the age range of 25 to 64 years old

 Approximately 53 % of the US 2010 Census population fall s in the age range of 25 to 64 years old

 Approximately 11% of Delta passengers are between infant age and 24 years old

 Approximately 34% of the US 2010 Census population is between infant age and 24 years old

 Appr oximately 9% of Delta passengers are over 65 years old

 Approximately 13% of the US 2010 Census population is over 65 years old

 Less than 2.3% of D elta passengers are over 75 years old

 Approximately 6.1% of the US 2010 Census population is over 75 years ol d

 Flights operating from South American cities , European Cities and flights transiting the Mid dle East high terrain areas tend to skew slightly left/younger age profile than the total Delta passenger profile

.
T his data is favorable since the age demograph ics trend younger than the overall US Census Bureau data

. With the passenger demographics skewed younger than the US Census data, it is reasonable to conclude the associated health issues with the aging population would also be skewed to a less likely pos ition. Delta certainly acknowledges the population in general is living longer but it is not directly correlated to the age demographics of the flying public.Delta Air Lines, Inc. Response Docket 2011

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**Flight Attendant First Aid Training and Guidance :** 

While historical data has not shown an ar terial gas embolisms or alveolar rupture to be even a remotely common passenger issue, the symptoms of this condition mirror those of cardiac or respiratory distress. The initial treatment would follow the same protocol as these conditions. The ability t o completely diagnose these extremely rare conditions is best conducted by an appropriately qualified physician with specialized equipment. The advanced treatment would also require equipment associated with a medical trauma unit. The ideal recommended m ethod to assist someone with an arterial gas embolisms or alveolar rupture is to get the passenger to an appropriately equipped trauma unit as soon as practic al

. As shown in Appendix 2 , Delta experiences approximately 4 to 5 medical issues per day durin g the conduct of 2300 flights per day. In four years of data collection and research, Delta has not identified issues where the training or guidance provided to the Flight Attendants has been inadequate to initially treat the passenger. Appendix 4 is a c opy of the first aid treatment section of the Delta Flight Attendant manual along with the latest updates to recommended cardiac care based on recent guidance from the American Heart Association. Delta provides FAA

- approved initial and recurrent training to each Flight Attendant for this subject matter. Additionally, Delta subscribes to a 24 hour a day 7 day a week medical consultant service. This service provides expert medical advice for the treatment and care of a passenger. All aircraft are equipped with the capability to contact this service throughout Delta’s route structure.
With respect to any procedural changes to accommodate the granting of Delta ’s exemption request, Delta believes it would be appropriate to add certain step s to the Flight A ttendant procedures for decompression inc idents with respect to passengers using oxygen concentrators. This is part of Dr Parmet’s position paper, Appendix 1. The following guidance would be considered:Delta Air Lines, Inc. Response Docket 2011

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1. Preflight

– Take note of passenger locations for t hose who are traveling with oxygen concentrators . Brief the passenger in the event of a decompression to use the overhead oxygen system as primary and they may use their concentrator if the apparatus allows the combined use. Instruct the passenger to tur n the unit to maximum flow after they resume use of the device

. 2. Decompression event
- After the Captain has indicated it is safe to move within the cabin, assess the passenger s for those who may show signs of hypoxia or other trauma . Administer first aid oxygen as appropriate. Ensure passengers traveling with oxygen concentrators are advised to use the unit in a max flow rate mode.
Because of the current depth of training and guidance in place today, Delta does not advocate any additional change to tra ining or guidance for the Flight Attendants.

**Conclusion:**
Delta appreciates the concerns expressed by the FAA. It is our contention that the analysis of data available from historical NTSB files, scientific literature , and the Delta data supports the very low risk to passenger health associated with our exemption request. Delta has carefully considered the balance between avoiding terrain
- challenged situations and the 30 minutes of flight time at 14,000 feet that might be required in certain circumsta nces . Considering there is no documented trend or events of arterial gas embolisms or alveolar rupture on US operated aircraft , this should be evidence that the relative concern is not present in the system. Indeed, we conclude that the risk of the operat ional complexities and potential for loss of situational awareness presented by a terrain

- challenged scenario far exceeds the slight risk introduced by additional flight time at 14,000 feet.
When we study actual medical events regardless of cause, the rat e of occurrence is such that the oxygen supply required by 121.333(e)(3) has never been depleted inDelta Air Lines, Inc. Response Docket 2011

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ten year period. Also, within this same period we have only seen one flight where more than one passenger was administered first aid oxygen. The FAA has s tated in their last request to Delta, “We recognize that decompression is an extremely rare event and that a decompression over a mountainous area requiring that the flight stay above 10,000 ft is even more remote.” When we factor in the very low rate of passengers who have medical issues on board the aircraft this exponentially moves the probability/risk even lower.

While we are convinced that the cur rent regulatory requirements for oxygen supply under 1 21.333(e)(3) is at least adequate , Delta would conc ur that the need to evaluate the adequacy of first aid oxygen under 121.333(e)(3) does warrant monitoring. Additionally , Delta believe s as a proper mitigation for passengers who could experience any medical condition during flight, provisioning the aircra ft with an additional oxygen bottle of the same type and capacity currently employed would be a proper consideration. Delta proposes the following additional conditions and limitations to those previously stated as part of this exemption request:

1. Delta w ill supply a report of medical events on a yearly basis to the Principal Operations Inspector in similar manner as presented in A ppendix 2 , maintaining at least 5 years of historical data. 2. Delta will continue to provision the aircraft with a minimum of one additional oxygen bottle above that required by 121,333(e)(3). Delta retains the authority to dispatch under the minimum FAR requirements when the bottle (s) become unserviceable provided they are replaced within 10 days. 3. Delta will modify its pre - fligh t and after decompression procedures to account for passenger who may be using oxygen concentrators. 4. Delta will provide the Princ ipal Operations Inspector a demographic analysis in a similar manner as presented in Appendix 3 once every 5 years.

Delta Air Lines sincerely appreciates the time and effort the Federal Aviation Administration has put forth in the evaluation of this exemption request. Delta would not be so passionate around this exemption request unless we we re convincedDelta Air Lines, Inc. Response Docket 2011

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the traveling pubic would be best served by avoiding terrain

- challenged situations after a decompression event. When we consider the vast majority of passenger s will have no ill effect breathing ambient air at 14,000 feet and the maximum time exposure will be 18 minutes , we cannot find a justifiable reason why this exemption request would not be in the best interest of the traveling public.
Delta thanks you in advance of your thoughtful consideration of this exemption request.

Respectfully submitted,

Charles M. Schrame k General Manager Quality Assurance and Compliance Delta Air Lines, Inc.

cc: Stephen M. Dickson

– Senior Vice President Flight Operations Ken Hylander

– Senior Vice President Corporate Safety Security and Compliance Thomas Stachiw

– Office Manager Delta CMO Jim Giles

– Principal Operations Inspector Delta CMO Richard Pauly Chairman Delta ALPA Air Safety Committee

### Appendix I Dr. Allen J. Parmet position paper to Delta Air Lines

RESPONSE TO FAA REGARDING LOSS OF CABIN PRESSURE

We recognize that decom pression is an extremely rare event and that a decompression over a mountainous area requiring that the flight stay above 10,000 ft is even more remote. Nonetheless, an increasingly older flying population will predictably have more medical conditions that are affected by hypoxia at 14,000 feet.
In order to complete our technical analysis of your petition for exemption, the FAA is requesting the submission of additional data to the docket. Please provide analysis of the potential passenger population and the passenger health issues on the affected routes including consideration for additional portable emergency oxygen systems, medical supplies, flight attendant training and operational plans. Additionally, a plan should be proposed that addresses how addit

ional medical support will be provided to passengers with barotraumatic injuries or compromised cardiopulmonary function in the event of a decompression.

Leo Hollis Aviation Safety Inspector Aircraft Dispatcher Air Transportation Division

- AFS

220(202) 4 93

- 5508


### Loss of cabin pressurization is indeed a rare event. The NTSB database has 62 mishaps relating to loss of cabin pressure, from beginning with the 10/19/1962 incident and up through the 10/26/2010 AA 757 flight from Miami and a 12/18/2010 Piper PA

- 46. The worst cases were United 811, on 6/25/1990 over the Pacific where explosive decompression occurred following the loss of an improperly latched cargo door and ejection of 8 passengers; T WA 840 (B727) on 4/02/1986 when a bomb killed 4 passengers as t he aircraft approached Athens; Aloha Air 243 (B737) on 4/28/1988 over Maui lost the roof of the forward cabin ejecting a flight attendant. There are no reports of pulmonary barotraumas or air embolism.

Minor barotraumas to ears and sinus are common and oc cur on routine flights when the crew or passenger flies with a cold. Loss of pressurization eventsDelta Air Lines, Inc. Response Docket 2011

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November 22 , 2011 Page 12 

### would be more likely to result in barotraumas, but the lower the post

depressurization altitude, the greater the risk of barotraumas due to greater pressure differential. Thus the proposal actually decreases this theoretical risk slightly.
Alveolar rupture is incredibly rare. Alveolar rupture involves the gas in the small cells of the lungs not escaping up and out of the airways. Instead, the air sacs expand as the air is trapped. Eventually they rupture, allowing the air to enter the blood stream and flow into the pulmonary veins, back to the heart and then onto the rest of the body. The bubbles that travel through the bloodstream are termed air emboli (singu lar

- embolus). The bubbles follow the blood flow until the blood vessel narrows and the bubble jams and blocks the vessel. In all my years at Brooks AFB, doing about 200 people per week or more, we had one case of alveolar rupture with air embolism . I t was someone intentionally holding their breath. Air embolism resulted . Air embolism re quires prompt compression treatment and specifically hyperbaric treatment for therapy, although 100% oxygen would be used until that was available.

There are two cases of air embolism in the scientific literature. One (fatal) from Russia in 1998 and the other (survived) from Switzerland in 2007 . Both occurred during ascent under normal operations. No decompression occurred. Both cases were caused by congenital cysts in the lungs that expanded and ruptured. (Am. J. Respir. Crit. Care Med., Volume 157, Number 5, May 1998, 1686

- 1689 Fatal Air Embolism in an Airplane Passenger with a Giant Intrapulmonary Bronchogenic Cyst MICHAEL ZAUGG, VLADIMIR KAPLAN, URS WIDMER, PETER CARL BA UMANN, and ERICH WALTER RUSSI Department of Internal Medicine, Divisions of Intensive Care Medicine and Pulmonary Medicine, University Hospital Zurich, Zurich, Switz erland. AND Congenital cystic adenomatoid malformation presenting as in

- flight systemic air embolisation E.Delta Air Lines, Inc. Response Docket 2011

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### Belcher1, M. H. Lawson2, A. G. Nicholson1, A. Davison2 and P. Goldstraw 09031936.00153906 ERJ October 1, 2007 vol. 30 no. 4 801

- 804).
There have literally been tens of billions of passenger exposures to the risk of alveolar rupture given th at world wide , over two billion passengers are carried yearly. The risk is not significant.
This is not ebullism, where gas bubbles evolve, because we are not flying over 63,000 feet.
Decompression sickness can occur with any decompression event, but the treatment is to descend. No cases of decompression sickness are in the NTSB database due to loss of cabin pressurization. One case of decompression sickness occurred when a DC

- 8 on a ferry flight could not hold cabin pressure and the captain electivel y flew at FL330 for two hours. This single event is not representational of any commercial operation.
The only condition s we are concerned about are passengers with pre

- existing pulmonary compromise from their lung disease . These can be treated with supp lemental oxygen . Flight attendants can instruct anyone using supplemental oxygen to not remove their mask in the event of loss of pressure. The passenger should be directed to turn their oxygen flow to maximum. The aircraft are equipped with oxygen bottles that can be used to replace the supplemental oxygen supplies if the passenger’s oxygen generator fails.

A. J. Parmet, MD

### Appendix II Delta Historical Medical Event Data
**2008 Per Leg**  **Per Pax 2009**  **Per Leg Per Pax**  **2010 Per Leg**  **Per Pax 2011**  **Per Leg Per Pax**  **Yearly T otals**  1 Syncope (Fainting) 168 0.0001814429 0. 0000013898 248 0.0002961332 0.0000022719 349 0.0004158564 0.0000031308 268 0.0004178464 0.0000027811 1033.0009 2 Abdom inal Distress 128 0.0001382422 0. 0000010589 182 0.0002173236 0.0000016673 214 0.0002549950 0.0000019198 163 0.0002541379 0.0000016915 687.0006152 3 Respiratory 253 0.0002732444 0. 0000020930 255 0.0003044918 0.0000023360 224 0.0002669107 0.0000020095 140 0.0002182780 0.0000014528 872.0008511 4 Ca rdi ac 98 0.0001058417 0. 0000008107 126 0.0001504548 0.0000011543 128 0.0001525204 0.0000011483 120 0.0001870954 0.0000012453 472.0004119 5 Injury 31 0.0000334805 0. 0000002565 21 0.0000250758 0.0000001924 48 0.0000571951 0.0000004306 35 0.0000545695 0.0000003632 135.0001166 6 Seiz ures 66 0.0000712811 0. 0000005460 69 0.0000823919 0.0000006321 101 0.0001203481 0.0000009061 66 0.0001029025 0.0000006849 302.0002761 7 Altered LOC 41 0.0000442807 0. 0000003392 63 0.0000752274 0.0000005771 70 0.0000834096 0.0000006280 71 0.0001106981 0.0000007368 245.0002045 8 Pain 29 0.0000313205 0. 0000002399 30 0.0000358226 0.0000002748 67 0.0000798349 0.0000006010 49 0.0000763973 0.0000005085 175.0001481 9 Il l (Illness) 28 0.0000302405 0. 0000002316 107 0.0001277671 0.0000009802 74 0.0000881759 0.0000006638 52 0.0000810747 0.0000005396 261.0002481 10 Allergic Reaction 37 0.0000399606 0. 0000003061 30 0.0000358226 0.0000002748 36 0.0000428964 0.0000003229 24 0.0000374191 0.0000002491 127.0001196 11 Behavioral 24 0.0000259204 0. 0000001985 36 0.0000429871 0.0000003298 47 0.0000560036 0.0000004216 26 0.0000405373 0.0000002698 133.0001259 12 Diabetes 21 0.0000226804 0. 0000001737 21 0.0000250758 0.0000001924 28 0.0000333638 0.0000002512 32 0.0000498921 0.0000003321 102.0000817 13 Strok e 17 0.0000183603 0. 0000001406 27 0.0000322403 0.0000002473 28 0.0000333638 0.0000002512 26 0.0000405373 0.0000002698 98.0000846 14 Com municable Diseases 46 0.0000496808 0. 0000003806 50 0.0000597043 0.0000004580 35 0.0000417048 0.0000003140 20 0.0000311826 0.0000002075 151.0001522 15 Nose Bleed 1 0.0000010800 0. 0000000083 3 0.0000035823 0.0000000275 6 0.0000071494 0.0000000538 9 0.0000140322 0.0000000934 19.0000119 16 Ear Distress 6 0.0000064801 0. 0000000496 5 0.0000059704 0.0000000458 1 0.0000011916 0.0000000090 5 0.0000077956 0.0000000519 17.00001375 17 Pregnancy 13 0.0000140402 0. 0000001075 8 0.0000095527 0.0000000733 19 0.0000226397 0.0000001704 16 0.0000249461 0.0000001660 56.00004658 18 Unclassified 105 0.0001134018 0. 0000008687 97 0.0001158263 0.0000008886 105 0.0001251144 0.0000009419 73 0.0001138164 0.0000007575 380.000357

Totals 1112 0.0012009794 0. 0000091995 1378 0.0016454498 0.0000126236 1580 0.0018826737 0.0000141739 1195 0.0018631584 0.0000124009 5265.004765

Percent cases of Sy ncope, Respiratory, Cardiac, Seizures, Diabetes, Stroke, Pregnancy 0.0006868911 0. 0000052616 0.0009003404 0.0000069072 0.0010450031 0.0000078674 0.0010414978 0.0000069320 2008 2009 2010 2011 YTD-Dec YTD-Dec YT D-Dec YT D- Oct Actual Actual Actual Ac tu al Total Carried Total Passenger 120,876,747 109,160,997 111,472,408 96,364,279

Total legs flown 925,911 837,461 839,232 641,384
*NOTE - Totals are from Jan 2008 to Sept 2011

### Appendix III US Census V. Delta passenger Demog raphics
All Delta Passengers v. US Census
**Passenger Age Di stri**  **buti on V**  **s Census**

0 100000 200000 300000 400000 500000 600000 700000

0-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51=55 56-60 61-65 66-70 71-75 76-80 81-85 86-90 91-95 96-99**P a** **s s** **e n** **g e** **r C** **o u** **n t** 

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0%**P a** **s s** **e n** **g e** **r a** **n d** **C e** **n s** **u s** **P e** **r c** **e n** **t**

Count Ps gr % Census %



### South American Cities GIG/GRU/LIM/UIO v. US Census

**Passenger Age Di stri**  **buti on V**  **s Census**

0 200 400 600 800 1000 1200 1400 1600 1800

0-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51= 55 56-60 61-65 66-70 71-75 76-80 81-85 86-90 91-95 96-99**P a** **s s** **e n** **g e** **r C** **o u** **n t** 

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0%**P a** **s s** **e n** **g e** **r a** **n d** **C e** **n s** **u s** **P e** **r c** **e n** **t**

Count Psg r % Census %

### European Cities AMS/CDG/FRA/LGW
**Passenger Age Di stri**  **buti on V**  **s Census**

0 1000 2000 3000 4000 5000 6000 7000

0-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51= 55 56-60 61-65 66-70 71-75 76-80 81-85 86-90 91-95 96-99**P a** **s s** **e n** **g e** **r C** **o u** **n t** 

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0%**P a** **s s** **e n** **g e** **r a** **n d** **C e** **n s** **u s** **P e** **r c** **e n** **t**

Count Ps gr % Ce ns us %



### Middle Eastern/Western Asia Cities BOM/DXB

**Passenger Age Di stri**  **buti on V**  **s Census**

0 100 200 300 400 500 600 700

0-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51=55 56-60 61-65 66-70 71-75 76-80 81-85 86-90 91-95 96-99**P a** **s s** **e n** **g e** **r C** **o u** **n t** 

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0%**P a** **s s** **e n** **g e** **r a** **n d** **C e** **n s** **u s** **P e** **r c** **e n** **t**

Count Psgr % Cens us %

### Appendix IV Delta Flight Attendant First Aid Guidance Double click to see complete contentsDouble click to see complete contents