Human Performance and Limitations

ATPL
Human
Performance
and Limitations
© Atlantic Flight Training
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ATPL Human Performance and Limitations ii 27 November 2003

CHAPTER 1
Introduction to Human Factors

Introduction ........................................................................................................................................1-1
Accidents and Incidents .....................................................................................................................1-2
Public Transport Accident Data..........................................................................................................1-2
The Meaning of Human Factors.........................................................................................................1-3
A Conceptual Model of Human Factors – The SHEL Model ..............................................................1-4
Human Error ......................................................................................................................................1-6
Pilot Error ...........................................................................................................................................1-7
James Reason Model ........................................................................................................................1-7
Confidential Human Factors Incident Reporting Programme (CHIRP) ..............................................1-8
Study and Sleep.................................................................................................................................1-9
Learning Styles ..................................................................................................................................1-9
Lecture and Revision Notes ...............................................................................................................1-9
Review of Notes...............................................................................................................................1-10
Methods of Learning ........................................................................................................................1-10
Revision Style ..................................................................................................................................1-11
Revision Method ..............................................................................................................................1-11
Relaxation ........................................................................................................................................1-12
Sleep................................................................................................................................................1-12
CHAPTER 2
Aviation Medicine - Respiration and Circulation

The Atmosphere ................................................................................................................................2-1
Measurement of Atmospheric Pressure .............................................................................................2-2
The Standard Atmosphere .................................................................................................................2-2
Standard Atmosphere Pressures and Temperatures for Different Altitudes ......................................2-2
Physical Divisions of the Atmosphere ................................................................................................2-2
Gas Laws ...........................................................................................................................................2-4
The Human Need for Oxygen ............................................................................................................2-5
Respiration.........................................................................................................................................2-6
Inspiration and Expiration...................................................................................................................2-7
Gaseous Exchange............................................................................................................................2-7
Control of Breathing ...........................................................................................................................2-8
The Circulatory System......................................................................................................................2-9
Composition of the Blood .................................................................................................................2-11
Blood Circulation..............................................................................................................................2-12
Further Uses of Blood Circulation ....................................................................................................2-13
CHAPTER 3
Aviation Medicine - The Effects Of Altitude

Introduction ........................................................................................................................................3-1
Tracheal air ........................................................................................................................................3-1
Alveolar Air.........................................................................................................................................3-1
Forms of Hypoxia...............................................................................................................................3-3
Oxygen Requirements .......................................................................................................................3-3
Alveolar Partial Pressure....................................................................................................................3-3
Summary of Oxygen Requirements ...................................................................................................3-4
Hypoxia ..............................................................................................................................................3-4
Signs and Symptoms of Hypoxia .......................................................................................................3-5
Stages of Hypoxia..............................................................................................................................3-6
Susceptibility to Hypoxia ....................................................................................................................3-6
Time of Useful Consciousness...........................................................................................................3-7
ATPL Human Performance and Limitations iii ©Atlantic Flight Training

Limitations of Time at Altitude ............................................................................................................3-7
Hyperventilation .................................................................................................................................3-8
Symptoms of Hyperventilation ...........................................................................................................3-8
Treatment of Hypoxia and Hyperventilation .......................................................................................3-8
Cabin Decompression........................................................................................................................3-9
Climb and Descent...........................................................................................................................3-10
Climb................................................................................................................................................3-10
Decompression Sickness.................................................................................................................3-10
Re-exposure ....................................................................................................................................3-11
Treatment of Decompression Sickness............................................................................................3-12
Flying and Diving .............................................................................................................................3-12
Descent............................................................................................................................................3-12
Sinuses ............................................................................................................................................3-12
The Ear ............................................................................................................................................3-13
Prevention........................................................................................................................................3-14
CHAPTER 4
Aviation Medicine – Health and Hygiene

Introduction ........................................................................................................................................4-1
Joint Aviation Requirements ..............................................................................................................4-1
JAR-FCL and ICAO Annex 1 .............................................................................................................4-1
Medical Fitness ..................................................................................................................................4-1
Fitness ...............................................................................................................................................4-1
Requirement for Medical Certificate...................................................................................................4-2
Aeromedical Disposition.....................................................................................................................4-2
Decrease in Medical Fitness ..............................................................................................................4-2
Fitness to Fly......................................................................................................................................4-3
Blood Pressure ..................................................................................................................................4-3
Hypertension......................................................................................................................................4-5
Orthostatic Hypotension.....................................................................................................................4-5
Causes of Orthostatic Hypotension....................................................................................................4-5
Coronary Heart Disease.....................................................................................................................4-6
Atherosclerosis ..................................................................................................................................4-6
Risk Factors of Coronary Heart Disease............................................................................................4-7
Reducing the Risk of Coronary Heart Disease...................................................................................4-7
Detection and Treatment of CHD.......................................................................................................4-8
Stroke ................................................................................................................................................4-8
Anaemia.............................................................................................................................................4-8
Obesity...............................................................................................................................................4-8
Body Mass Index ...............................................................................................................................4-9
Effects of Obesity...............................................................................................................................4-9
Exercise ...........................................................................................................................................4-10
Hypoglycaemia ................................................................................................................................4-10
Tropical Diseases ............................................................................................................................4-11
Water ...............................................................................................................................................4-11
Food.................................................................................................................................................4-12
Diarrhoea .........................................................................................................................................4-12
Cholera ............................................................................................................................................4-12
Amoebic Dysentery, Amoebiasis .....................................................................................................4-12
Diseases Transmitted by Insects .....................................................................................................4-12
Insects and Insect vectors................................................................................................................4-12
Mosquito-Borne diseases.................................................................................................................4-13
Malaria .............................................................................................................................................4-13
Diseases Transmitted by Flies .........................................................................................................4-13
Other Insects....................................................................................................................................4-13
Hepatitis ...........................................................................................................................................4-14
Immunisations..................................................................................................................................4-14
Rabies..............................................................................................................................................4-14
Tobacco and Smoking .....................................................................................................................4-14
ATPL Human Performance and Limitations iv 27 November 2003

Carbon Monoxide.............................................................................................................................4-15
Nicotine ............................................................................................................................................4-15
Drugs and Medication ......................................................................................................................4-16
General Health.................................................................................................................................4-16
Drugs ...............................................................................................................................................4-16
Allergic Reactions ............................................................................................................................4-16
Idiosyncrasies ..................................................................................................................................4-17
Synergistic Effects ...........................................................................................................................4-17
Effect of Drug Combinations ............................................................................................................4-17
Alcohol .............................................................................................................................................4-18
Unit of Alcohol..................................................................................................................................4-18
JAR-OPS 1.115 - Alcohol and Drugs ...............................................................................................4-19
Recommended Amounts of Alcohol.................................................................................................4-19
Alcoholism........................................................................................................................................4-19
Physical Problems ...........................................................................................................................4-20
Alcohol and Sleep ............................................................................................................................4-20
Toxic Materials.................................................................................................................................4-20
Toxicology........................................................................................................................................4-20
Aviation Gasoline (AVGAS) .............................................................................................................4-21
JP4-JP5 ...........................................................................................................................................4-21
Ethylene Glycol ................................................................................................................................4-21
Methyl Alcohol..................................................................................................................................4-21
Chlorobromo Methane (CBM) ..........................................................................................................4-21
Halon ...............................................................................................................................................4-21
Hydraulic Fluid .................................................................................................................................4-21
Plastics.............................................................................................................................................4-21
Mercury ............................................................................................................................................4-22
Incapacitation...................................................................................................................................4-22
Fits and Faints .................................................................................................................................4-22
Epilepsy ...........................................................................................................................................4-22
Faint .................................................................................................................................................4-23
Gastroenteritis..................................................................................................................................4-23
Acceleration .....................................................................................................................................4-23
Short Term Acceleration ..................................................................................................................4-23
Long Term Acceleration ...................................................................................................................4-24
Motion Sickness...............................................................................................................................4-24
CHAPTER 5
Aviation Medicine - Diet and Digestion

Introduction ........................................................................................................................................5-1
Carbohydrates and Fats.....................................................................................................................5-1
Fats ....................................................................................................................................................5-2
Proteins..............................................................................................................................................5-2
Diet ....................................................................................................................................................5-2
Mineral Salts and Vitamins.................................................................................................................5-3
Mineral Salts ......................................................................................................................................5-3
Vitamins .............................................................................................................................................5-4
Trace Elements..................................................................................................................................5-5
Digestion ............................................................................................................................................5-5
The Alimentary Canal ........................................................................................................................5-5
Mouth .................................................................................................................................................5-5
Teeth..................................................................................................................................................5-5
Salivary Glands..................................................................................................................................5-6
Digestion in the Mouth .......................................................................................................................5-6
Pharynx and Oesophagus..................................................................................................................5-6
Swallowing .........................................................................................................................................5-7
Stomach.............................................................................................................................................5-7
Digestion in the Stomach ...................................................................................................................5-7
Small Intestine ...................................................................................................................................5-8
ATPL Human Performance and Limitations v ©Atlantic Flight Training

Digestion in the Small Intestine..........................................................................................................5-8
Large Intestine ...................................................................................................................................5-8
Functions of the Large Intestine.........................................................................................................5-9
Defaecation........................................................................................................................................5-9
CHAPTER 6
Aviation Medicine - Metabolism, Excretion And Heat Regulation

The Liver ............................................................................................................................................6-1
Functions of the Liver.........................................................................................................................6-1
Pancreas............................................................................................................................................6-1
Insulin ................................................................................................................................................6-1
Excretion and Regulation of Body Fluids ...........................................................................................6-2
Functions of the Skin .........................................................................................................................6-2
The Kidneys .......................................................................................................................................6-2
Functions of the Kidneys....................................................................................................................6-3
Micturation .........................................................................................................................................6-3
Body Heat Regulation ........................................................................................................................6-3
Heat Production .................................................................................................................................6-3
Heat Loss...........................................................................................................................................6-3
Fever..................................................................................................................................................6-4
Heat Stroke ........................................................................................................................................6-4
Climate and Heat Loss.......................................................................................................................6-4
CHAPTER 7
Aviation Medicine - The Eye

Introduction ........................................................................................................................................7-1
Anatomy and Physiology of the Eye ..................................................................................................7-1
Visual Acuity ......................................................................................................................................7-2
Clarity of Vision ..................................................................................................................................7-3
Depth Perception ...............................................................................................................................7-3
Distance Estimation and Depth Perception........................................................................................7-4
Stereoscopic Vision ...........................................................................................................................7-4
Monocular Cues.................................................................................................................................7-4
Geometric Perspective.......................................................................................................................7-5
Motion Parallax ..................................................................................................................................7-5
Retinal Image Size.............................................................................................................................7-5
Known Size of Objects .......................................................................................................................7-5
Increasing or Decreasing Size of Objects ..........................................................................................7-6
Terrestrial Association .......................................................................................................................7-6
Terrestrial Distance of Objects Used to Determine Distance .............................................................7-7
Overlapping Contours or Interposition of Objects ..............................................................................7-7
Aerial Perspective ..............................................................................................................................7-8
Emmetropia........................................................................................................................................7-8
Myopia (Short Sightedness)...............................................................................................................7-8
Hypermetropia (Long Sightedness) ...................................................................................................7-9
Presbyopia .........................................................................................................................................7-9
Astigmatism .......................................................................................................................................7-9
Spectacles .........................................................................................................................................7-9
Contact Lenses ..................................................................................................................................7-9
Radial Keratotomy ...........................................................................................................................7-10
Colour Vision and Colour Blindness.................................................................................................7-10
Night Vision......................................................................................................................................7-11
Saccadic Eye Movement..................................................................................................................7-12
Sunlight and its Effect on the Eyes ..................................................................................................7-12
Empty Field Myopia .........................................................................................................................7-12
Glare ................................................................................................................................................7-12
Sunglasses ......................................................................................................................................7-13
ATPL Human Performance and Limitations vi 27 November 2003

Flickering Light.................................................................................................................................7-13
CHAPTER 8
Aviation Medicine – Visual Illusions

Introduction ........................................................................................................................................8-1
Spatial Orientation .............................................................................................................................8-1
Spatial Disorientation .........................................................................................................................8-3
Landing ..............................................................................................................................................8-4
Width of Runway................................................................................................................................8-4
Approach............................................................................................................................................8-6
Runway Gradient and Terrain ............................................................................................................8-7
Runway Slopes Up ............................................................................................................................8-7
Runway Slopes Down ........................................................................................................................8-7
Ground Sloping Down to the Runway ................................................................................................8-8
Ground Sloping Up to the Runway.....................................................................................................8-8
Visual Illusions in the Air ....................................................................................................................8-8
Lean on Cloud....................................................................................................................................8-8
Lean on Sun.......................................................................................................................................8-9
Black Hole Effect..............................................................................................................................8-10
Visual Factors at Night .....................................................................................................................8-11
Reaction Time..................................................................................................................................8-11
Visual Acuity ....................................................................................................................................8-12
Blind Spot.........................................................................................................................................8-12
CHAPTER 9
Aviation Medicine - The Ear - Hearing and the Vestibular System

Introduction ........................................................................................................................................9-1
Noise..................................................................................................................................................9-2
Effects of Noise..................................................................................................................................9-3
Conductive Deafness .........................................................................................................................9-3
Cochlea..............................................................................................................................................9-3
Noise Induced Hearing Loss (NIHL) ..................................................................................................9-4
Protection Against Noise....................................................................................................................9-4
Presbycusis........................................................................................................................................9-4
Vibration.............................................................................................................................................9-4
The Vestibular System .......................................................................................................................9-4
Semi-Circular Canals .........................................................................................................................9-5
Otoliths...............................................................................................................................................9-6
CHAPTER 10
Aviation Medicine – Vestibular Illusions

Illusions of Vestibular Origin.............................................................................................................10-1
The Leans ........................................................................................................................................10-1
Somatogravic Illusion .......................................................................................................................10-2
The Somatogravic Illusion in Yaw and Roll ......................................................................................10-2
Somatogravic Illusion in Pitch ..........................................................................................................10-4
G-Excess Illusion .............................................................................................................................10-6
The Oculogravic Illusion...................................................................................................................10-6
Elevator Illusions..............................................................................................................................10-7
False Perception of Angular Motion – Vertigo..................................................................................10-8
Somatogyral Illusion.........................................................................................................................10-8
Oculogyral Illusions ..........................................................................................................................10-9
Illusions due to Cross-Coupled (Coriolis) Canal Stimulation ............................................................10-9
Pressure Vertigo ............................................................................................................................10-10
ATPL Human Performance and Limitations vii ©Atlantic Flight Training

Summary of Disorientation.............................................................................................................10-10
Prevention......................................................................................................................................10-10
Practical Advice to Flight Crew ......................................................................................................10-11
Practical Advice on how to Cope with Spatial Disorientation when it Occurs.................................10-12
CHAPTER 11
Aviation Medicine – High Altitude Environment

Radiation..........................................................................................................................................11-1
Risk to Flight Crew...........................................................................................................................11-2
Ozone ..............................................................................................................................................11-2
Humidity ...........................................................................................................................................11-2
Water Vapour...................................................................................................................................11-2
Relative Humidity .............................................................................................................................11-2
Humidity Control ..............................................................................................................................11-3
Pressurisation ..................................................................................................................................11-3
Pressurised Cabins ..........................................................................................................................11-3
Cabin Pressurisation Advantages ....................................................................................................11-3
Disadvantages of Pressurised Cabins .............................................................................................11-4
Aircraft Oxygen Systems..................................................................................................................11-4
All Aeroplanes on High Altitude Flights ............................................................................................11-4
Oxygen Regulator ............................................................................................................................11-5
Oxygen masks .................................................................................................................................11-5
CHAPTER 12
Sleep
Introduction ......................................................................................................................................12-1
The Danger of Fatigue .....................................................................................................................12-1
Vigilance Effects ..............................................................................................................................12-1
Causes of Pilot Fatigue ....................................................................................................................12-2
Symptoms of Pilot Fatigue ...............................................................................................................12-2
Sleep and Sleep Deprivation............................................................................................................12-2
Sleep Credit/Deficit ..........................................................................................................................12-4
Sleep................................................................................................................................................12-6
Sleep Disorders ...............................................................................................................................12-7
Sleep Loss and Microsleep ..............................................................................................................12-7
Insomnia ..........................................................................................................................................12-7
Sleepwalking and Sleeptalking ........................................................................................................12-8
Sleep Apnoea ..................................................................................................................................12-8
Narcolepsy .......................................................................................................................................12-8
Sleep Hygiene..................................................................................................................................12-8
Napping............................................................................................................................................12-9
Drugs ...............................................................................................................................................12-9
Sleeping Tablets ..............................................................................................................................12-9
Melatonin .........................................................................................................................................12-9
Circadian Dysrhythmia – Jet Lag .....................................................................................................12-9
CHAPTER 13
Stress
Introduction ......................................................................................................................................13-1
Stress...............................................................................................................................................13-1
Effects of Stress...............................................................................................................................13-2
Stress is Cumulative ........................................................................................................................13-2
Psychological Stressors ...................................................................................................................13-4
Effects of Stress...............................................................................................................................13-6
ATPL Human Performance and Limitations viii 27 November 2003

Physical and Psychological Stress Reactions..................................................................................13-7
Physical Stress Reactions................................................................................................................13-7
General Adaptation Syndrome.........................................................................................................13-7
Psychological Stress Reactions .......................................................................................................13-8
Domestic Stress...............................................................................................................................13-8
Clinical Effects of Stress ..................................................................................................................13-8
Coping Skills ....................................................................................................................................13-9
Stress Management .......................................................................................................................13-10
CHAPTER 14
The Nervous System

Introduction ......................................................................................................................................14-1
The Central Nervous System ...........................................................................................................14-1
Brain ................................................................................................................................................14-2
Spinal Cord ......................................................................................................................................14-2
The Peripheral Nervous System ......................................................................................................14-3
Sensory Nerves ...............................................................................................................................14-3
Motor Nerves ...................................................................................................................................14-3
Autonomic Nervous System.............................................................................................................14-3
CHAPTER 15
Human Information Processing

Introduction ......................................................................................................................................15-1
Sense...............................................................................................................................................15-1
Perception........................................................................................................................................15-2
Confirmation Bias.............................................................................................................................15-3
Central Decision Making and Response Selection ..........................................................................15-3
Ultra-short Term Memory .................................................................................................................15-4
Cocktail Party Effect.........................................................................................................................15-4
Working Memory or Short Term Memory .........................................................................................15-4
Short Term Memory and its Limitations............................................................................................15-5
Environment Capture .......................................................................................................................15-6
Long Term Memory and its Limitations ............................................................................................15-6
Motor Memory..................................................................................................................................15-7
Action Slip ........................................................................................................................................15-8
Response Execution ........................................................................................................................15-9
Attention...........................................................................................................................................15-9
Selective Attention .........................................................................................................................15-10
Divided Attention............................................................................................................................15-10
Stress and Attention.......................................................................................................................15-10
Response Behaviour......................................................................................................................15-10
Skill Based Behaviour ....................................................................................................................15-10
Rule Based Behaviour ...................................................................................................................15-11
Knowledge Based Behaviour .........................................................................................................15-11
Feedback .......................................................................................................................................15-11
CHAPTER 16
Situational Awareness and Attention

Introduction ......................................................................................................................................16-1
Situational Awareness .....................................................................................................................16-1
Building Situational Awareness........................................................................................................16-1
Personal Factors Affecting Situational Awareness...........................................................................16-3
Three levels of Situational Awareness .............................................................................................16-3
Situational Awareness Level 1: Monitoring ......................................................................................16-3
ATPL Human Performance and Limitations ix ©Atlantic Flight Training

Situational Awareness Level 2: Evaluating ......................................................................................16-4
Situational Awareness Level 3: Anticipating.....................................................................................16-4
Pilot Considerations .........................................................................................................................16-4
Briefing/Debriefing ...........................................................................................................................16-4
Conflict Resolution ...........................................................................................................................16-5
CHAPTER 17
Communication
Communication ................................................................................................................................17-1
Effective Communication .................................................................................................................17-1
The Cost of Effectiveness ................................................................................................................17-2
Results of Poor Communication.......................................................................................................17-2
The good transmitter ........................................................................................................................17-2
The good receiver ............................................................................................................................17-2
Types of Communication .................................................................................................................17-3
Written Communication....................................................................................................................17-3
Visual and Pictorial Ambiguity..........................................................................................................17-3
Verbal Communication.....................................................................................................................17-4
Social Skills......................................................................................................................................17-4
Body Language................................................................................................................................17-4
Verbal Behaviour .............................................................................................................................17-5
Listening...........................................................................................................................................17-5
Non-verbal Response ......................................................................................................................17-7
Verbal Response .............................................................................................................................17-8
Closed Question ..............................................................................................................................17-8
Open Question.................................................................................................................................17-8
Leading Question.............................................................................................................................17-8
Limiting Question .............................................................................................................................17-9
Understanding..................................................................................................................................17-9
Active Listening................................................................................................................................17-9
The art of effective listening .............................................................................................................17-9
Status, Role and Ability ..................................................................................................................17-10
Status.............................................................................................................................................17-10
Role ...............................................................................................................................................17-10
Ability .............................................................................................................................................17-10
Atmosphere....................................................................................................................................17-10
Communication summary ..............................................................................................................17-11
CHAPTER 18
Personality and Behaviour

Introduction ......................................................................................................................................18-1
Working Relationships .....................................................................................................................18-1
Intelligence.......................................................................................................................................18-2
Personality .......................................................................................................................................18-2
Assessment .....................................................................................................................................18-3
Behaviour.........................................................................................................................................18-3
Self Opinion .....................................................................................................................................18-4
Defence Mechanisms ......................................................................................................................18-4
Denial...............................................................................................................................................18-4
Introversion and Extroversion ..........................................................................................................18-4
Behavioural Styles ...........................................................................................................................18-5
Assertive Behaviour .........................................................................................................................18-5
Case For Assertiveness ...................................................................................................................18-8
Body Language................................................................................................................................18-8
Aggressive .......................................................................................................................................18-8
Non-Assertive ..................................................................................................................................18-8
Assertive ..........................................................................................................................................18-9
ATPL Human Performance and Limitations x 27 November 2003

Assertive Behaviour .........................................................................................................................18-9
CHAPTER 19
Leadership / Followership
Introduction ......................................................................................................................................19-1
Leadership Qualities ........................................................................................................................19-1
Leadership Skills..............................................................................................................................19-1
The Person Goal (P/G) Model..........................................................................................................19-2
Leadership - The Leader..................................................................................................................19-4
Qualities Approach...........................................................................................................................19-4
Situations Approach .........................................................................................................................19-5
Effective Leadership ........................................................................................................................19-5
Attitudes to Leadership ....................................................................................................................19-6
Ineffective Leadership ......................................................................................................................19-7
CHAPTER 20
Decision Making
Decision Making Process.................................................................................................................20-1
Reaction to Decision Making............................................................................................................20-1
Making and Taking Decisions ..........................................................................................................20-1
Decision Making Models ..................................................................................................................20-2
Group Versus Individual Decision Making........................................................................................20-3
Influences on Decision Making ........................................................................................................20-4
Summary..........................................................................................................................................20-5
CHAPTER 21
Error and Error Chains

Introduction ......................................................................................................................................21-1
Levels of Human Error .....................................................................................................................21-2
Correction of Human Error ...............................................................................................................21-2
Group Attitudes ................................................................................................................................21-3
SHEL Model Interfaces ....................................................................................................................21-3
Links of the Error Chain ...................................................................................................................21-4
Breaking the “Error Chain” ...............................................................................................................21-5
CHAPTER 22
Learning and Learning Styles

Introduction ......................................................................................................................................22-1
The Learning Cycle..........................................................................................................................22-1
Honey and Mumford ........................................................................................................................22-3
Flexible Learning..............................................................................................................................22-4
Maslow.............................................................................................................................................22-4
CHAPTER 23
Automation
Introduction ......................................................................................................................................23-1
Flight Crew Functions ......................................................................................................................23-2
Human Factors Concepts in Design ................................................................................................23-3
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Common Problems with Automation ................................................................................................23-3
Industry Requirements .....................................................................................................................23-4
Flight Crew Responsibilities .............................................................................................................23-4
Automation Summary ......................................................................................................................23-5
CHAPTER 24
CRM & MCC

Introduction ......................................................................................................................................24-1
What is CRM?..................................................................................................................................24-2
Why CRM training?..........................................................................................................................24-2
CRM Loop........................................................................................................................................24-3
Multi-crew Co-operation (MCC) .......................................................................................................24-3
ATPL Human Performance and Limitations xii 27 November 2003

Chapter 1.
Introduction to Human Factors
“Errare humanum est”
Introduction
Flight safety is one of the major objectives of the ICAO and considerable progress has been
made in the past few years. However, additional improvements are needed as it has long
been known that approximately 75% of accidents result from less than optimum human
performance. This indicates that any advance in the field of Human Performance will have a
significant impact on the improvement of flight safety.
This was recognized by the ICAO Assembly which adopted a resolution on "Flight Safety and
Human Factors" in 1986. As a follow up to the Assembly Resolution, the Air Navigation
Commission formulated the following objective for the task:
"To improve safety in aviation by making States more aware and responsive to the
importance of human factors in civil aviation operations through the provision of
practical human factors material and measures developed on the basis of
experience in States"
Human behaviour and performance are cited as factors in the majority of aircraft accidents.
To decrease accident rates, Human Factors in aviation must be better understood and the
knowledge more broadly applied. The improvement of awareness in Human Factors presents
the international aviation community with the single most significant opportunity to make
aviation safer.
To introduce you to Human Performance and Limitations this chapter includes:
¾ A possible meaning and definition of Human Factors

¾ A conceptual model of Human Factors
¾ The industry need for Human Factors
¾ The application of Human Factors in flight operations
¾ The levels of expertise required for flight safety in modern day operations
The human animal has only been flying since the early 1900's. In the quest for more safety in
aviation, attention has been focused on the obvious deficiencies of man and machine. Since
the early beginnings of flight, great technological advances have been made making aircraft
much safer. But what about the human? Has he been forgotten?
This subject deals with the Human Factors that are considered the most important in aviation.
The information given should help in the understanding of the human animal and, hopefully,
help make aviation safer.
ATPL Human Performance and Limitations 1-1 ©Atlantic Flight Training

Accidents and Incidents
Human error is, by far, the most extensive cause of accidents and incidents in what is now a
technologically complex area. Some of the latest accident statistics show that 65% of all
accidents in Public Transport aviation have been attributed to flight crew error. It also
indicates that for the approach and landing phase of flight, which accounts for 6% of total
flight exposure time and 49% of all accidents, flight crew error is cited in 70% as a casual
factor.
Take Off Initial Climb Cruise Initial Initial Final Initial

Climb Descent Approach Approach Landing
Percentage Percentage Percentage Percentage Percentage Percentage Percentage Percentage
of of of of of of of of
Accidents Accidents Accidents Accidents Accidents Accidents Accidents Accidents
14.4% 10.4% 6.9% 4.4% 7.2% 11.3% 24.2% 19.2%
Percentag Percentag Percenta Percentag Percentag Percentag Percentag Percentag

e of Flight e of Flight ge of e of Flight e of Flight e of Flight e of Flight e of Flight
Time Time Flight Time Time Time Time Time
Time
1% 1%
Public Transport Accident Data
Note: Loading, Taxi and unload are allocated 2% of the flight time. No accidents
are reported in this phase.
Studies have shown that pilot disregard of rules is the most common cause of approach and
landing accidents, other causes cited are:
¾ Omission of an action/inappropriate action by a flight crew member eg descent

below DH/MDH without the appropriate visual reference
¾ Lack of positional awareness of height above terrain
¾ "Press-on-itis", a decision to continue the approach when conditions are not
suitable
The industry need for Human Factors is based on the interaction between the following:
¾ Effectiveness of the system

¾ Safety
¾ Efficiency
ATPL Human Performance and Limitations 1-2 27 November 2003

¾ Well being of crew members
Almost everyone involved in Public Transport aviation, from the design of an aircraft to its
operation, is concerned with the human element; all need some basic Human Factors
training. An Airline will continuously publish bulletins on technical subjects that are likely to be
effective because both flight crew and technical personnel realise the importance to the safety
of the operation. A similar bulletin on Human Factors topics is unlikely to generate the same
response and comprehension unless training is given to the importance of the subject. All
airline staff should be exposed to a general level of Human Factors education. Better
education means that the Human Element becomes more aware of human performance
capabilities and limitations.
Studies indicate that if all sources are included in aircraft accident statistics then 80 - 90% are
attributable to human error in one form or another
The Meaning of Human Factors
The human element in aviation can be considered in asset terms as:
¾ The most reliable

¾ The most adaptable
¾ The most valuable
Unfortunately, the pilot is also the most vulnerable to outside influences that can adversely
affect performance.
Human Factors is not a single discipline, it draws information from all of the following areas:
Psychology The science of mind and behaviour

Engineering Applying the properties of matter and the sources of energy
in nature to the uses of man
Human Physiology Deals with the processes, activities and phenomena
characteristic of living matter, particularly appropriate to
healthy or normal functioning
Medicine The science and art of preventing, alleviating or curing
disease and injuries
Sociology The study of the development, structure and function of
human groups
Anthropometry Study of human body sizes and muscle strength
The above is not a comprehensive list, other disciplines engaged in Human Factors activities
include:
¾ Education
¾ Physics

¾ Biochemistry
¾ Mathematics
¾ Biology
¾ Industrial design and operational research
A Conceptual Model of Human Factors – The SHEL Model
It is helpful to use models to aid in the understanding of Human Factors; this allows a gradual
approach in the understanding of all factors. The SHEL concept is one such model (Edwards
1972) that lends itself to the aviation environment. The name is derived from the initial letters
of the model Software, Hardware, Environment and Liveware. The idea of the model is to
establish the concept of a man/machine - environment.
H L
H
Liveware
Hardware
E Environment
S L E S Software
L
For a basic understanding of the SHEL model consider a football game. Start with the central
L, and then look at the match between interfaces:
L Your team, (Players, Coach, Trainer)

L-L Opposing team (Players, Coach, Trainer), Referee
L-H Ball, Playing surface, Goal
L-E Stadium, Fans, Weather
L-S Rules, Scoreboard, Match importance
The interfaces are not straight edged. Remember that a perfect match is never achievable in
real life – is there a perfect football team that never loses?

L - Liveware - The person - The pilot
To understand the person we need to look at the basic human characteristics:
Physical Size and Shape Design of workspace from anthropometric data

(Anthropometry).
Physical Needs The requirement for nourishment

(Physiology and Biology).
Input Characteristics The sensory systems that collect information for the
brain
(Physiology, Psychology and Biology).
Information Processing The limitations of human capability

(Psychology).
Output Characteristics Once information is processed, the way the human

sends messages to the muscles to initiate responses
(Psychology, Physiology and Biomechanics).
Environmental Tolerance The body's capability to withstand temperature,

pressure and humidity
(Physiology, Psychology and Biology).
The liveware (Pilot) is the hub of the SHEL model. The rest of the model must be adapted and
matched to this central component.
Liveware – Hardware Cockpit design – will there ever be a perfect flight deck? This
interface is the area considered when an aircraft is designed - yet why does the pilot
still have problems with the layout and use of equipment
On the BAC 1-11 flap/gear levers next to each other so that inadvertent
operation became a common occurrence.
Liveware – Software The non-physical aspects of a system - procedures, manuals

or checklists etc. Do you keep your aviation documentation up to date?
A Constellation on approach to Prestwick. An experienced pilot flying a radar

to visual pattern. The maps on the aircraft showed masts, on the approach,
up to 50 ft agl - in fact they were up to 500 ft agl. The aircraft crashed, hitting
the masts, killing all persons on board.
Liveware – Environment Errors associated with the environment - noise, heat,

lighting and vibration. The earliest interface to be recognised in flying. The challenges
of pressurisation, air conditioning, vibration and sound proofing have been

understood and dealt with in most modern aircraft. New challenges such as the
problems associated with sleep disturbance are now the major causes of concern.
Liveware – Liveware The interface between people. Poor interaction means poor
crew effectiveness. This relates to all aspects of an airline operation. Any person
dealing with a flight must be considered in this area. Flight crew human factors
training attempts to minimise the mismatches that occur with this interface.
Human Error
Mismatches occur with the interfaces of the SHEL model as no human is perfect. Even
though aircraft have developed technologically over the last 50 years the human being has
not evolved at the same rate. New equipment can surpass the human capability to effectively
operate it. All humans make mistakes - All pilots make mistakes. But remember, not all
mistakes lead to disasters. The simple error model below illustrates the effect a pilot can have
on a flight:
PILOT ⇒ ERRORn ⇒ DISASTER
Where ERRORn is a sequence of more than one error.
The F28 accident at Dryden, Ontario, in March 1989 is a good example of how this model
works. On the face of it, this was a clear cut case of pilot error. The immediate cause of the
crash was the failure of the flight crew to obtain adequate protection against wing icing prior to
departure. The inquiry yielded a 6 volume report; probably the most exhaustive air accident
report ever. The conclusion:
“The accident was not the result of one cause but of a combination of several
related factors. Had the system operated effectively, each of the factors might
have been identified and corrected before it took on significance. This accident
was the result of a failure in the air transportation system as a whole.”
Each sequence of this model needs to be attacked.
PILOT ⇒ ERRORn
Remedy
¾ Training - manuals, simulator training.

¾ Cross monitoring, 2 pilot operation.
¾ Crew fatigue and stress.
ERRORn ⇒ DISASTER
Remedy
¾ Technology - weight on wheels switches, computer control.

¾ Cockpit/aircraft design.
Pilot Error
The phrase Pilot Error is peculiar to aviation; there is no equivalent in the civilian world -
Doctor Error, Engineer Error etc. The phrase is “falling from grace” especially with the advent
of better Human Factors training. However, there is a need to evaluate the human response
to the above error progression. Crew Resource Management (CRM), Multi-Crew Co-
operation (MCC) and Human Factors training all play a role in ensuring the safety of the
aircraft, crew and passengers. CRM and MCC are discussed in a later chapter.
In aviation terminology an "incident" is a dangerous event but with no serious consequences.

According to Frank Bird, for every fatal accident there are 600 incidents with no accident
potential.
1 Disabling Injury – Fatal Accident
10 Minor Injury – Accident/Incident
30 Property Damage – Incident
600 No Injury or Damage – Errors/Near Accidents
The conventional way to represent the role of Human Factors in accidents is to count each
accident where there was clear human error involvement. Looking at fatal accidents, if we list
the human factors contributions to these fatalities, the top 4 causes are:
Controlled flight into terrain (CFIT) 2169

Maintenance and inspection 1481
ATC and Comms 1000
Approach and Landing without CFIT 910
To further explain the error model the James Reason Swiss Cheese Model is used.
James Reason Model
To explain the Frank Bird model we can break down the above diagram into a what is termed
the Swiss Cheese Model. Aviation can be broken into two failure areas:

Active Failures Errors and violations by the human element – the pilot
Latent Conditions Resident pathogens that may lie under the surface for years
We cannot prevent the latent conditions, we can only make them visible to those who manage
and operate the system. All decisions, even the good ones, will have a downside for
someone, somewhere in the system. The resident pathogens are more difficult and this is
where the model, shown below, is important.
The resident pathogens may lie dormant for years. All pilots make errors. Put this with the
immediate mental precursors of an error - distraction, preoccupation, forgetfulness --then the
sequence of the Error model is being put into place. All that is needed is for the resident
pathogens to occur together (Errorn). Then the holes in each part of the model line up and the
accident will occur (Sequence a). Where the errors occur and the holes are not matched then
the sequencing will stop - and no accident will occur (Sequence b).
Design and development
Manufacture
Acceptance into Airline Service
Development of technical
Sequence b servicing procedures
Implementation of
SOP's
Sequence a
Accident
Confidential Human Factors Incident Reporting Programme (CHIRP)
A totally confidential reporting system about Human Factors incidents that do not get
reported. CHIRP is a charitable company run from RAE Farnborough. Similar schemes are
run on behalf of the national Civil Aviation Authorities throughout the world. CHIRP is outside
the control of the CAA. Feedback, a 3 monthly magazine, is produced that covers a wide
range of Human Factors topics such as:
¾ Sleep and Fatigue

¾ Stress
¾ Communication
¾ Operating difficulties
¾ Technological problems
This system relies on the honest reporting of any incident or occurrence. Flight Crew, Cabin
Crew, Engineers and ATC controllers can make reports. For Example:

I had two early mornings on two consecutive days to do two European flights and I was
rostered for a night standby the following day at 0830L and did not sleep again that day. At
1900L crewing phoned to call me in for a UK - Europe - UK on which the crew were already
into discretion.
All went according to plan and I still felt fine as we set off from Europe for the UK (0300L).
Due to the overlap of duty times we had three pilots on the flight deck and as always there
was more stimulation and conversation than usual and I didn't start to feel jaded until the last
90 minutes of flight. With one hour to go I really started to feel tired but thought I should be
able to last the flight without falling asleep. At the top of descent my eyes closed for the first
time and I was in somewhat of a dozy state during the descent. I still felt, however, that I
could make a big final effort during the last 10 minutes of the flight when there was more
activity. Going downwind for landing, the approach checks, RT calls and then the flap setting
did increase the activity but I simply felt worse than ever. Commands/actions were followed
immediately by falling asleep again. On final approach I found myself being woken up as the
Captain was asking for gear down, flaps etc. When we finally landed I felt dreadful and
possibly the worst in many years of flying.
There are obvious safety implications from this incident not the least of which was my driving
home (0830L) afterwards. The irony of the situation was that the two pilots in discretion had
been accommodated by crewing and felt fine whereas I was still within my allowed FDP and
felt like death. I think that standby duties during late evening/early morning are almost
impossible to rest and prepare for properly but can be acceptable with good rostering. I swear
I will never accept an early morning duty followed by late evening standby on the roster again.
Study and Sleep
Learning Styles
Learning "Parrot Fashion" was once the only form of learning in most schools. Nowadays, this
system has changed to one where the student is expected to learn, understand and apply the
material taught. This is no different in ab-initio pilot training, you will be presented with
copious amounts of material to help you pass your groundschool exams. But what is essential
to pass the exams?
Lecture and Revision Notes
The following is written for a full time student but the revision techniques apply to all.
However, the means of study and revision note taking apply to Distance Learning. Students
have to develop a method of copying the information that a lecturer is trying to pass on. This
is usually done by note taking. Taking notes does help people remember what was said, and
taught, in lectures. To ensure that notes are effective takes practice; it is not an easily
acquired skill. The initial difficulty any student has is to decide what to write down. A student
cannot write down everything that is said; how do you sift out the wheat from the chaff? This
chapter is designed to help a student make notes of value such that revision is made easier.

One good way to start is to sort out what has to be learnt into:
M - What I must Memorise

U - What I must Understand
D - What I must be able to Do
Common Problems
¾ The student has no control over how fast the lecturer delivers the lesson.
¾ How much material does the student need to write down; in note taking, more is
not necessarily better.
¾ Too much detail means little time is spare for thinking about what is being taught.
Taking detailed, accurate notes, requires the student to pay attention to everything that is
said. Therefore, the time that a student needs to think about what notes to take is as
important as the time that attention is paid to what the lecturer is saying. Remember,
borrowing notes is never as effective as writing the notes during a lecture. The starting point
for any note taking must be the building of an effective framework from which to work.
Note Framework:
Subject Heading. The lecturer will always write or state the lesson
objective. This must be the starting point.
Sub Heading. The lecture will be split up into minor topics each with its own
explanations.
Calculations. Any calculation made by a lecturer must be included. Ensure

that you copy all calculations exactly as they have been written on the board.
Review of Notes
Notes should be made by making connections with all the related material (MUD). It is
important to review any notes as soon as possible after they have been taken. If this review is
done at an early stage it is possible to relate them to text book material. Remember, the notes
have to be used at a later date for revision.
Methods of Learning
As examinations approach, the student needs to be able to recall and use the information that
has been taught.
Common Problems Unsuccessful students try to read the material straight off:

¾ No allowance is made for difficult sections of text.
¾ If a portion of text is not understood, then the student ignores it.
¾ Text is skipped over, not read comprehensively.
Revision Style
Successful students monitor their performance.
¾ A study plan is made and followed.

¾ Difficult sections are re-read till understood.
¾ Periodic reviews are made of the material
Effective learners need to:
¾ Understand the material that has been taught.

¾ They must be able to relate the facts learnt to other course material.
¾ They must be able to organise this material into easily remembered, and easily
accessible, facts.
Revision Method
To help with revision the SQ3R method can be used. This method of revision is a successful
way for remembering textbook material. The SQ3R way of learning is:
SURVEY Do not begin by reading the material. Look at the subject headings,
bold type headings or italic terms. Obtain an idea of how much material is to be learnt
or discussed. Decide on how to split the text into easily learnt packages.
QUESTION Before reading each section ask yourself questions about what is to
be learnt.
READ Read the text. Think about the material as it is read. Ask questions of
understanding and complete calculations if necessary. If text is not understood - DO
NOT PROCEED. Ask for help at this stage, from other course members or staff
members. Make sure all the material is understood before progressing to the next
part of the revision package.
RECITE At the end of each major section recite the major points to yourself.
Do not skip over any areas. As you become more familiar with the information being
presented, then the temptation is to miss out large chunks of material that you think
you know.
REVIEW The most important section. Review all the material learnt by using
reciting or questioning techniques. Using other course members, in question and
answer sessions, helps to reinforce all the material learnt.

Relaxation
Make sure that you take breaks during the learning process. Revision can be tedious,
especially if there is a lot of text to be learnt. Short breaks every hour make sure that you stay
refreshed during the toil. Do not revise one subject a night, this will lead to boredom; aim to
revise 2 or more subjects.
Sleep
Individuals require differing amounts of sleep. The older you are the less sleep you require.
However, people in learning situations do require regular sleep patterns. An integrated flying
course requires a student to both fly and carry out an intensive ground school phase.
Pressures are such that students start to disrupt their sleep by late night study or worry. Sleep
is covered in more detail during the later stages of HPL, this small section is designed to help
make a student comfortable in his new environs.
¾ Make the room comfortable - pictures on walls, personal possessions. These all
make an area feel comfortable - more like home.
¾ No strenuous exercise immediately before going to bed. This means no physical
or mental exercise.
¾ A high level of study activity should be avoided immediately before trying to
sleep.
¾ Ensure that after working there is sufficient time to relax. The brain needs time to
wind down.
¾ Keep the room ventilated - not too warm, not too cold.
¾ Do not drink too much alcohol. Alcohol induces a coma like sleep where there is
no body refreshment.
¾ Try a warm milky drink - NOT COFFEE or tea.
¾ Light reading or listening to music can help relax the mind and body.
Do not jump into bed, straight after finishing studying, and expect to fall asleep immediately. If
you find that you are not sleeping well try to stay in bed where it is warm. There is some
suggestion that you will get some relaxation and body revitalisation even whilst lying down.
Finally DON'T worry.

Chapter 2.
Aviation Medicine - Respiration and Circulation
The Atmosphere
The Earth is surrounded by a mixture of gases known as the atmosphere which is held in
place by the force known as gravity. The mixture of the atmosphere remains constant and is
found to cover the earth up to 30 000 ft at the poles and 60 000 ft at the equator. The
boundary of the atmosphere is known as the tropopause.
30 000 ft
60 000 ft
Within the atmosphere there is normally a decline in temperature of approximately

1.98ºC/1000 ft. Pressure also decreases with altitude. Cold temperature increases air density;
low pressure decreases air density. Pressure change is the dominant force and as such the
air density decreases with altitude. In the atmosphere, small increases in height at low altitude
will cause a much greater change in pressure than the same height change at altitude.
Outer Space – No
Molecules
High Altitude – High

Density of Molecules
Low Altitude – Very

High Density of
Molecules

Measurement of Atmospheric Pressure
Standard atmospheric pressure, or barometric pressure, is the weight or force exerted by the
atmosphere at any given point. This pressure is expressed in different forms by the method of
measurement such as pounds per square inch (psi), millimetres of mercury (HG) and inches
of mercury. Millimetres of mercury (mm/HG) are used in these notes.
The Standard Atmosphere
Continual fluctuations of temperature and pressure in the atmosphere create problems for
engineers and meteorologists who require a fixed standard of reference for aircraft. This
standard is known as the International Standard Atmosphere (ISA). Conditions throughout the
atmosphere for all latitudes, seasons, and altitudes are averaged and published by ICAO. The
resultant standard atmosphere has specified sea level temperature and pressure and specific
rates of change of temperature and pressure with height.
Standard Atmosphere Pressures and Temperatures for Different Altitudes:
Sea level 760.0 mm/HG +15°C

10 000 ft 522.6 mm/HG -05°C
18 000 ft 379.4 mm/HG -21°C
33 700 ft 190 mm/HG -52°C
40 000 ft 140.7 mm/HG -56.5°C
Physical Divisions of the Atmosphere
The divisions of the atmosphere are primarily physical or meteorological in nature. From
meteorology we are familiar with both the troposphere and the stratosphere; both of which are
important to the aviator and aviation. To look at the Physiological Effects associated with flight
the atmosphere can be split into four zones:
Physiological Zone This area extends from sea level to approximately 12 000 ft.
It represents the area of the atmosphere to which the human body is more or less
adapted. Only minor physiological problems exist when flying within this zone. Pilots
who go higher than their acclimatized levels notice common symptoms such as
middle ear blockage and sinus blockage difficulties, shortness of breath, dizziness
and headache. Above this zone we are in an environment to which our body is
unaccustomed.
Physiological Deficient Zone Existing from 12 000 ft to 50 000 ft this zone, along
with the previous zone, is the area in which most flying takes place. Oxygen
deficiency becomes an ever increasing problem as we ascend due to the reduced
atmospheric pressure.
Partial Space Equivalent Zone This zone extends from 50 000 ft to 120 nm,
where pressure changes become very small. The problems for flight over 50 000 ft
are the same as those encountered in space. Sealed cabins, pressure suits are

necessary as problems now occur with blood and body fluids boiling over 63 000 ft.
Gravitational changes on the body make this a space equivalent zone. Only
Concorde has operated in this zone.
Total Space Equivalent Zone True space, this zone extends outwards from 120 nm.
The physiological problems of this zone are similar to the previous zone.
The air is composed of a mixture of gases of nearly constant proportions:
Oxygen 20.94%
Nitrogen 78.08%
CO2 0.03%
Other gases 1%
These proportions remain the same at all levels within the troposphere and up to an altitude
of 60 000 ft. ICAO has defined the standard atmosphere which assumes:
Pressure 1013.2mb
Temperature 15ºC
Density 1225 gm/cubic metre
The temperature lapse rate of 1.98ºC/1000 ft continues up to 36 090 ft. Above this altitude the
temperature remains constant at –56.5°C.
Pressure falls 1 hPa per 30 ft gained in the lower levels of the atmosphere (acceptable in the
first 5000 ft)
A temperature change of 3°C or a 10 hPa change in pressure will change the density by 1%.

700
600
500
PRESSURE
(mmHg) 400
300
200
100
0
0 10 20 30 40 50 60
ALTITUDE (x1000 FEET)
Gas Laws
The human body is adapted for life at sea level. If exposed to an altitude of 40 000 ft then a
person will become unconscious in a few seconds and dead a few minutes later. Knowledge
of the gas laws is essential in explaining the effects of reduced Barometric Pressure on the
body.
Boyle’s Law For a fixed mass of gas at constant temperature (T), the pressure (P)
is inversely proportional to the volume (V). If the pressure on a gas decreases, its
volume increases and vice versa. This law, when applied to the body, explains the
expansion of gases trapped within the body in areas such as the middle ear, sinuses
and gastro-intestinal tract.
PxV=C
Where: P Pressure
V Volume
C Constant.
Charles’s Law If the volume of a gas remains constant, the pressure will
vary directly with the temperature.
Algebraically PV = RT or
PV
/T = R
P Absolute pressure
V Volume
R Universal gas constant

T Temperature
Dalton’s Law In a mixture of gases, the pressure exerted by one of the gases is the
same as it would exert if it alone held the same volume. From this the partial pressure
of oxygen in the atmosphere can be derived for any altitude, since the pressure at
that altitude can be measured and the proportion of oxygen in the atmospheric air is
constant. This is of great importance to aviation especially when we discuss Hypoxia.
To determine the partial pressure of each gas in the mixture we use the following:
Ptotal = ppA + ppB + ppC….
Where Ptotal represents the total pressure of the mixtures of gases and ppA, ppB, or ppC
represents the partial pressure of each gas in the mixture.
Graham’s Law A gas of high pressure will exert a force towards a region of
lower pressure and if a membrane separating these regions of unequal pressure is
permeable or semi-permeable, the gas of higher pressure will pass through the
membrane into the region of lower pressure. This will continue until the unequal
regions are nearly equal in pressure. This law explains the transfer (diffusion) of
oxygen, CO2 and other gases from one part of the body to another.
Henry’s Law The amount of gas in solution varies directly with the pressure of that
gas over the solution. When the pressure of a gas over liquid decreases, the amount
of gas dissolved in the liquid will also decrease, or vice versa. This gas law is
applicable when Decompression Sickness is discussed when Nitrogen comes out of
the blood.
General Gas Law A combination of Boyle’s Law and Charles’s Law where P
and T signify absolute pressure and temperature, respectively.
P1V1 = P2V2
T1 T2
The general gas law applies to "ideal" gases where the molecules are assumed to be
perfectly elastic. For practical purposes we accept that the law applies to all gases.
The Human Need for Oxygen
To live, the human being must produce heat and energy from food eaten. Eaten food is
converted into simple food products and transferred to the tissues by the blood. It is then
oxidized to provide this heat and energy. To oxidize the food, oxygen has to be supplied to
the living cells in the body. The waste product, carbon dioxide, is then carried away from the
tissues and expelled from the body. This process is respiration. The definition of respiration is
given below:

“The exchange of the respiratory gases, O2 and CO2, between the organism and its
environment.”
Respiration
The breathing process consists of two phases:
Breathing In Inspiration
Breathing Out Expiration
The respiratory system is made up of the following:
¾ Mouth and nose

¾ Trachea
¾ Bronchus
¾ Bronchiole tree
¾ Alveoli.
GAS
EXCHANGE
AIR
TRACHEA
BRONCHUS ALVEOLI
CAPILLARY
NETWORK
BRONCHIOLE
When a human breathes, air is drawn in through the mouth or nose to the Pharynx. The
Pharynx, which is found at the back of the throat, warms, humidifies and filters the air before it
passes down the trachea into the two bronchi. The bronchi split into the bronchiole tree as the
air passes into the lungs. The lungs are set inside the chest cavity, or thoracic cavity,
wrapped in an airtight sac called the pleura. At the ends of each branch of the bronchiole tree
are air sacs, alveoli. These air sacs are very small and are surrounded by capillaries which
are small blood vessels. The thin walls of the alveoli and capillaries allow oxygen to diffuse
into the blood and CO2 into the alveoli. The lungs in the average man can hold approximately
6 litres of air, a woman, 4 litres.
Tidal Volume The volume of air breathed in and out in a single breath. When
resting this is approximately 500 cm3

The maximum volume that can be breathed in and out is approximately:
Men 2500 cm3

Women 1500 cm3
Inspiration and Expiration
The chest cavity is surrounded by the ribs on the sides and separated from the abdominal
cavity by the diaphragm, a large flat sheet of muscle. The chest cavity has only one opening.
Any change in volume to the chest cavity will ventilate the airspace in the lungs. The chest
size is altered by a muscular action that raises and lowers the diaphragm and by contraction
and relaxation of the muscles between the ribs.
Inspiration and expiration circulate air in and out of the lungs efficiently.
4 8
1 5
3 7
INSPIRATION EXPIRATION
1 RIBS RAISED 5 RIBS RETURN
2 DIAPHRAGM DEPRESSED 6 DIAPHRAGM RELAXES
3 LUNGS EXPAND 7 LUNGS RETURN TO ORIGINAL VOLUME
4 AIR DRAWN IN 8 AIR EXPELLED
Gaseous Exchange
The constant turnover of air provides the mechanism for both O2 to diffuse into the blood and
CO2 to diffuse into the lungs.
This gaseous exchange can be explained by looking at the partial pressure each gas exerts.
In air outside the lungs the partial pressure of O2 is 160 mmHg. Carbon Dioxide has a low
partial pressure in outside air of approximately 0.3 mmHg. The difference in pressure of these
gases between the alveoli and the blood is how the gaseous exchange between the lungs
and the bloodstream occurs.
¾ Blood entering the lungs has a lower ppO2 than the alveolar air, so oxygen
diffuses into the blood

¾ The ppCO2 is higher in the blood entering the lungs than in the alveoli, so CO2
diffuses out of the bloodstream and into the lungs
TRACHEA
(WINDPIPE)
RESPIRATORY
BRONCHIOLE
CO 2
CO 2 O2
PULMONARY O2
ARTERY LUNG
CO 2
O2
CO2 O2
BRONCHI
ALVEOLI BROCHIOLES
PULMONARY
VEIN
DEOXYGENATED BLOOD
OXYGENATED BLOOD
Most of the oxygen is taken into the blood, and carried, by the protein haemoglobin.
Haemoglobin is found within the red blood cells and is an Iron rich compound. The
Haemoglobin bond ensures that the body can receive enough Oxygen for the body’s needs. If
blood diffused directly into the blood solution only, then the body would be starved of
sufficient Oxygen necessary for the human to survive. Oxygen remains bound to the
haemoglobin until it reaches the tissues of the body, an area of low oxygen tension. This
oxygen is then released into the tissues to oxidize food. About 95% of the oxygen is
transported by haemoglobin, as an oxy-haemoglobin bond, and the remainder is diffused
directly into the blood solution. Some Carbon Dioxide binds to the haemoglobin but the
majority diffuses into the blood and is carried in solution as carbonic acid. Both Oxygen and
Carbon Dioxide bind weakly to the Haemoglobin as a strong bond would result in difficulties in
releasing the gases to either the tissues or the lungs.
Control of Breathing
Control of breathing is centred in the respiratory centre of the brain. The human requires no
conscious effort to breathe; although the rate of breathing can be altered voluntarily.
Inspiration is the active phase of breathing; expiration the passive phase. The rate and depth
of breathing can be adjusted to meet any change in the consumption of oxygen and expiration
of carbon dioxide.
Under normal conditions the body is slightly alkaline (pH7.4).
During respiration:
¾ The partial pressure of carbon dioxide elevates

¾ The acidity level increases
¾ The pH value lowers to less than 7.4
Any increase in the CO2 concentration in the blood stimulates an increase in the ventilation
rate. As blood flows through muscle capillaries the dissociation of oxy-haemoglobin to release
oxygen is increased by:
¾ Low O2 concentration in muscle tissue

¾ High CO2 concentration
¾ High temperature
Too little CO2 causes the blood to become more alkaline and the pH value to rise. The human
body maintains the equilibrium within narrow limits, any shift in the blood pH and ppCO2 levels
are sensed by the respiratory centres of the brain. When unusual levels occur, chemical
receptors trigger the respiratory process to help return the ppCO2 and pH levels to normal
limits. For the uptake of O2 by the blood and the release of that O2 to tissues the extreme
limits of the pH of the body are regarded to be 7.2 to 7.6.
The brain monitors the levels of both carbon dioxide and oxygen in order to make any
changes in the respiration rate.
Note: A healthy body is more sensitive to changes in the carbon dioxide

balance of the body than to oxygen.
The Circulatory System
The circulatory system is concerned with the transportation of blood throughout the body. The
blood has the following functions:
¾ The carriage of oxygen and the carriage of carbon dioxide

¾ The carriage of food
¾ The carriage of nitrogenous waste
¾ The carriage of hormones or chemical messengers
¾ The protection of the body against disease
¾ Regulation of body temperature
The circulatory system centres on a muscular pump - the heart. The heart is a hollow organ
with a wall made of three layers:
The Pericardium The outer layer

The Myocardium The middle layer
The Endocardium The inner lining of the heart cavities

This heart is made up of four chambers; Two atria which are thin walled, the suction
chambers, and two ventricles which are thick walled, the discharge chambers.
The Ventricles The left ventricle, which pumps blood around the body, has a
much thicker wall than the right ventricle, which only pumps blood to the lungs
Separation of the Atria and the Ventricles The atria and ventricles are
separated by the atrio-ventricular valves:
Tricuspid Valve Separates the right atrium from the right ventricle
Mitral Valve Separates the left atrium from the left ventricle
HEART AND BLOOD FLOW
Right Atrium Two veins enter the right atrium, the inferior vena cava and the
superior vena cava. These veins bring blood back to the heart from all of the body
except the lungs. Blood from the right atrium passes into the right ventricle and then
into the pulmonary artery to the lungs
Left Atrium Blood from the four pulmonary veins runs into the left atrium. This
blood is passed into the left ventricle which is connected to the main artery which
passes blood to all parts of the body except the lungs. This main artery is known as
the Aorta
The blood is circulated around the body by a network of flexible tubes, the blood vessels
Arteries Strong, muscular and elastic walled vessels, arteries carry mainly
oxygenated blood. All arteries flow away from the heart. The exception is the
pulmonary artery which carries de-oxygenated blood from the heart to the lung.

Veins Thin walled vessels, with one way valves, veins carry mainly de-oxygenated
blood back to the heart. The exception is the pulmonary vein which carries
oxygenated blood from the lungs to the heart.
Capillaries Arteries sub-divide to form a dense network of fine thin-walled blood

vessels known as capillaries. The thin capillary walls allow the exchange of gases
and other material between the cells of the body and the blood. The capillaries
eventually rejoin passing through the tissues to become veins.
Composition of the Blood
Blood is a complex tissue made of different kinds of cells, free proteins, other chemicals and
factors and water.
The average adult has about 6 litres of blood circulating in the body. Blood consists of a clear
yellow fluid (plasma) and solids. Approximately 90% of the plasma is water, in which other
substances are dissolved or suspended. The most important solids in suspension are
Red blood cells The red blood cells are formed in the bone marrow and
contain a red pigment, haemoglobin. This is also the protein that carries oxygen to
the tissues. Haemoglobin is an iron-containing compound. The iron that is in the
haemoglobin molecule is responsible for the chemical affinity of haemoglobin for
Oxygen and Carbon Monoxide.
White Blood cells Several kinds of cells found in the blood are colourless or
white in appearance. All of these cells play a role in protecting the body from disease.
The white blood cells are formed from “stem cells” found in the bone marrow. These
cells mature into the specialized forms that protect the body from infection. Although
these white cells are located in the blood, they function as part of the body’s immune
system.
Platelets Platelets help the blood clot. When a blood vessel is severed or torn
the damaged ends constrict and retract in order to minimize blood loss. Almost
immediately the blood that is escaping from the damaged vessel begins to clot.
Platelets congregate at the site of the injury and release clotting factors. These
clotting factors start to convert one of the blood substances, fibrinogen, into the
protein, fibrin. Fibrin forms a dense weblike structure that in turn traps more platelets.
This forms into a jelly like clot taking about 10 minutes. As the clot hardens it begins
to shrink, releasing a watery substance, serum. The serum carries antibodies to
combat infection and specialized cells that begin the process of repair.
Together the above cells account for 45% of the blood’s total volume the remainder is called
plasma.
Plasma Plasma is a yellow, slightly alkaline fluid consisting of 90% water and
10% solid matter. The composition of the plasma is controlled mainly by the kidneys,
these solids include:

¾ Proteins
¾ Amino acids
¾ Fats
¾ Glucose
¾ Urea and other nitrogenous waste
¾ Salts
Blood Circulation
The cycle of blood flow through the body is as follows:
¾ Blood from the right atrium is pumped into the right ventricle
¾ From the right ventricle the blood goes into the pulmonary artery which carries
blood to the lungs
¾ In the capillaries of the lungs, gaseous exchange occurs:
¾ Oxygen is taken into the blood

¾ Carbon dioxide is passed into the lungs
¾ The freshly oxygenated blood returns to the left atrium of the heart via the
pulmonary veins
¾ The left atrium empties into the left ventricle which is connected to the aorta
¾ Contraction of the left ventricle forces blood into the aorta, the major artery which
is connected to the rest of the body save the lungs
¾ The aorta divides into arteries that carry the blood to the tissues. These arteries
divide into capillaries which give off the oxygen and take up carbon dioxide before
the blood returns to the heart
¾ All blood returning to the heart collects in the superior or inferior vena cava which
feed directly into the right atrium

OXYGENATED
HEAD BLOOD
DEOXYGENATED
AND
ARMS BLOOD
DIRECTION OF
FLOW
BLOOD
AORTA
PULMONARY
ARTERY LUNG
LUNG VENAE
CAVA PULMONARY
E VEIN
LEFT
ATRIUM
RIGHT
ATRIUM
LEFT VENTRICLE
RIGHT VENTRICLE
LIVER
INTESTINE
HEPATIC PORTAL VEIN
KIDNEYS
LEGS
Further Uses of Blood Circulation
As the blood passes through the body the following organs carry out the following functions:
Stomach Nutrition from food is picked up and carried along to the tissues
Spleen Old blood cells are taken out of circulation
Liver Removes toxins and adds proteins to the blood
Kidneys Adjust the water content and remove waste products
Bone Marrow Helps renew white blood cells

Intentionally Left Blank

Chapter 3.
Aviation Medicine - The Effects Of Altitude
Introduction
The atmosphere is a mixture of gases of constant proportions up to an altitude of 60 000 ft.

The approximate figures are:
Oxygen 21%
Nitrogen 78%
Other gases 1%
As altitude increases, pressure and density decrease and the amount of Oxygen available to
the red blood cells decreases.
Two gases cause further complicating factors:
Water Vapour Ever present in the atmosphere, water vapour content varies
depending upon the climatic conditions. In the lungs, the
alveolar air is always saturated with water vapour. This
accounts for 6% of the volume of air in the lungs at sea level.
Carbon Dioxide The amount of carbon dioxide in the atmosphere is

approximately 0.03%. In the lungs, because of the respiration
process, the amount of CO2 is higher; equivalent to 5.5% of
the available volume at ground level.
These gases have to be taken into account when considering the amount of Oxygen available
to the respiration process. At sea level, because of the amount of water vapour and CO2, the
volume of Oxygen in the lungs available for the respiration process is reduced to 14.5%.
Tracheal air
When inhaled air is drawn into the respiratory passages, it becomes saturated with water
vapour and is warmed to body temperature. This water vapour has a constant pressure of 47
mmHg at normal body temperature. This is regardless of the barometric pressure. The
inspired gases available for the respiration process are reduced by the amount of water
vapour present.
Alveolar Air
The tracheal air enters the lungs and Oxygen and CO2 are exchanged in the respiration
process. The expired air has less Oxygen and more carbon dioxide content. The partial
pressure of O2 (ppO2) in the alveoli varies with the CO2 partial pressure. A constant,

ventilation rate creates a CO2 partial pressure of approximately 40 mmHg. Using these values
the ppO2 at any altitude can be calculated. Where:
P Ambient barometric pressure in mmHg

F The fractional percentage of the inspired gas
ppH2O(tr) Water vapour partial pressure constant at 47 mmHg at 37oC

ppO2(tr) Tracheal Oxygen partial pressure
ppCO2(alv) Alveolar carbon dioxide partial pressure constant at 40 mmHg with
normal ventilation rate
ppO2(alv) Alveolar Oxygen partial pressure
To calculate tracheal gas:
ppO2(tr) = (P - ppH2O(tr)) x F
In the transition from tracheal air to alveolar air, the ppO2 is reduced and ppCO2 is increased.
We assume that the ppN2 remains constant.
To calculate alveolar gas:
ppO2(alv) = ppO2(tr) - ppCO2(alv)
Example At 10 000 feet the air pressure is 523 mm Hg, using 21% as the
percentage O2. What is the alveolar partial pressure of O2?
Step 1 Calculate the tracheal gas:
ppO2(tr) = (P - ppH2O[tr]) x F
ppO2(tr) = (523-47) x 0.21 = 99.96 mm Hg
Step 2 Calculate the alveolar gas:
ppO2(alv) = ppO2(tr) - ppCO2(alv)
ppO2(alv) = 99.96 mm Hg - 40 mm Hg = 60 mm Hg
The calculated alveolar partial pressure of Oxygen in the lungs is 60

mm Hg at 10 000 ft altitude.

A pressure gradient is required to ensure that Oxygen diffuses from the alveoli into the red
blood cells. If this pressure gradient falls, Oxygen movement into the blood is impaired. Some
degree of protection is given to the body up to 10 000 ft because of the affinity of
haemoglobin for Oxygen. The body has a “surplus” of Oxygen for use to this height. Above
10 000 ft the partial pressure of Oxygen in the alveoli falls off rapidly and the over protection
is lost. The body begins to suffer from a lack of Oxygen; a process known as Hypoxia.
Forms of Hypoxia
Hypoxic Hypoxia. Caused by an insufficient partial pressure of Oxygen in the

inspired air. This reduction of Oxygen becomes apparent above an altitude of 10 000
ft. Most likely in aviation when an aircraft has a decompression.
Anaemic Hypoxia. Anaemic Hypoxia, also known as Hypaemic Hypoxia, is

caused by a reduction in the Oxygen carrying capacity of the blood. This reduction
can be caused by a lowering in the amount of circulating haemoglobin, Anaemia.
Haemoglobin forming a bond with carbon monoxide produces the same result.
Stagnant Hypoxia. Defined as an Oxygen deficiency in the body due to poor

blood circulation. Caused by a failure of the circulatory system. When flying, this type
of Hypoxia, can be caused by problems such as pressure breathing or excessive "G"
forces.
Histotoxic Hypoxia The inability of the body to utilize Oxygen. Caused by a

failure of the body tissues to use the available Oxygen efficiently because of
impairment to cellular respiration. Poisons such as drugs and alcohol are the usual
cause.
Oxygen Requirements
As altitude increases the Oxygen pressure decreases:
¾ By 8000 ft the atmospheric pressure is only ¾ of the sea level pressure

¾ At 18 000 ft the atmospheric pressure is ½ that at sea level
¾ By 33 500 the atmospheric pressure is ¼ of the sea level pressure
As altitude increases, the percentage of Oxygen that needs to be added to the gas a pilot
breathes needs to increase to ensure that the alveolar partial pressure is maintained.
Alveolar Partial Pressure:
Sea Level 103 mm Hg

10 000 ft 61 mm Hg

Above 10 000 ft extra Oxygen needs to be added. The percentage of Oxygen added
increases until 33 700 ft where 100% Oxygen is required to give the equivalent alveolar
partial pressure to that at sea level (103 mmHg). Above this height the partial pressure can
be allowed to fall to the 10 000 ft equivalent of 61mmHg - this occurs at 40 000 ft. Above
40 000 ft positive pressure breathing, the forcing of Oxygen under pressure into the lungs, is
required.
Summary of Oxygen Requirements
HEIGHT OXYGEN REQUIREMENT ALVEOLAR PARTIAL

PRESSURE
0 - 10 000 ft Air only 103 mm Hg
10 000 - 33 700 ft Increasing percentage of Oxygen required 61 mm Hg
As % of 02 increases so the
equivalent partial pressure
increases
33 700 - 40 000 ft 100% Oxygen required 103 mm Hg falling to
61 mm Hg by 40 000 ft.
40 000 ft + 100% Oxygen supplied by pressure -
breathing
The above figures refer to the actual height. Modern aircraft are pressurised to a cabin
altitude of approximately 6 - 8000 ft. The temperature is easily controlled and mental functions
can be retained. Some older people or those who suffer from respiratory disease may suffer
from Hypoxia at these levels. In an ideal world, the aircraft would be pressurised to sea level.
In reality this is impracticable because of the weight and strength parameters that would have
to be achieved.
Hypoxia
Hypoxia occurs when the Oxygen available in the blood supply is insufficient to meet body
tissues needs. The greatest risk of Hypoxia to a pilot is normally a result of a rise in altitude
associated with a fall in pressure. Early signs of Hypoxia are related to the higher mental
functions and are similar to those of alcohol. The rate of onset depends on the altitude:
15 000 ft The signs and symptoms are relatively slow in onset and difficult to
detect.
40 000 ft The signs and symptoms are so quick that an individual may not
recognise what is happening.
In 1979 a Beech Super King Air was flying westwards at FL 310 along the south coast of
England on a conversion exercise. As it approached Exeter the crew asked ATC for
permission to practise an emergency descent. This was granted and they were instructed to
execute a right hand turn and contact Exeter ATC as they initiated descent. The crew
acknowledged this instruction, adding that they 'would be out of contact for a few seconds as
they would be donning masks and things'. Shortly afterwards the aircraft entered a turn to the
left, which became a left orbit. The aircraft continued to orbit left for the next 6 hours, slowly

drifting southwards with the wind until it crashed in north east France. No further contact had
been made with the crew.
During the investigation into the accident it was discovered that the training captain had,
whilst conducting such flights with previous students, actually depressurised the aircraft and
Oxygen masks had been really necessary. Examination of the wreckage revealed that the
pilots had donned their masks but that the mask hoses had not been fully connected to the
Oxygen supply system. Further testing in an identical aircraft depressurised at FL 300, with
descent initiated as soon as the test commenced, revealed that a doctor taking his mask off at
such an altitude was rendered incapable after 15 seconds and unconscious after 30 seconds.
In this accident when the crew were breathing air these test times would have been reduced
by a significant amount, causing rapid onset of Hypoxia with death following in a few minutes.
Signs and Symptoms of Hypoxia
Mild Hypoxia may produce a state similar to drunkenness. More serious cases will result in
coma. All episodes of Hypoxia are damaging to tissues. If exposure is prolonged then
damage may be permanent; the most vulnerable area being the brain. At normal body
temperatures the brain is unable to tolerate total lack of Oxygen for more than 3 minutes
without irreversible damage. The symptoms of Hypoxia are many and individuals will differ in
their reactions to the onset. The symptoms are listed below:
Personality Change Changes in behaviour occur. The mild mannered may

become aggressive in nature. A “Laissez Faire” attitude is
also apparent at this stage.
Impaired Judgement Lack of self-criticism. The sufferer is usually the last person
to see any deterioration in performance.
Muscular Impairment The pilot begins to lose muscular co-ordination. Accurate

flying becomes difficult. Minor errors quickly turn into major
events.
Memory Impairment Short term memory is lost. Simple arithmetic problems

become difficult and accuracy in calculation is difficult. Long
term memory actions can still be accessed.
Sensory Loss Colour vision is affected very early in the onset of Hypoxia.
Touch becomes dull,hearing becomes limited and spatial
orientation problems may occur.
Cyanosis The extremities of the body become blue in colour.

Haemoglobin in the de-oxygenated state gives the capillaries
this bluish tinge.
Hyperventilation As a pilot begins to suffer from the onset of Hypoxia the need
for Oxygen results in a tendency to overbreathe.

Other sensations include tingling or warm sensations, sweating, headache and nausea. All
the above symptoms will be experienced by a person suffering from Hypoxia; however, each
person will exhibit his own symptom pattern which occurs on each exposure to Hypoxia.
Impairment of Consciousness As Hypoxia progresses so does an

individual's level of consciousness. Initial confusion is followed by semi-
consciousness and unconsciousness. Without Oxygen, DEATH will follow.
Stages of Hypoxia
There are four stages of Hypoxia which vary according to the altitude and the severity of
symptoms.
Indifferent Stage Night vision shows the effects of Hypoxia. A loss of 40% of
night vision can be experienced at altitudes as low as 4000 ft.
Compensatory Stage The circulatory and respiratory system provide a defence

against Hypoxia. Pulse rate, systolic blood pressure, circulation rate, and cardiac
output increase to offset the lack of Oxygen. Respiration will increase in rate and
depth. At 12 to 15 000 feet the effects of Hypoxia on the nervous system are
increasingly apparent. After 10 to 15 minutes, the impairment in efficiency becomes
obvious. Crewmembers start to become drowsy and frequent errors of judgement are
made. Simple tasks become difficult, especially those requiring alertness or moderate
muscular co-ordination. At these altitudes Hypoxia is slow in onset and is difficult to
detect especially in the hard working environment of the modern cockpit.
Disturbance Stage The body can no longer compensate for the Oxygen
deficiency. Occasionally, pilots become unconscious from Hypoxia without
undergoing the subjective symptoms; Fatigue, sleepiness, dizziness, headache,
breathlessness, and euphoria are the symptoms most often reported. However, the
symptoms above are all valid.
Critical Stage Within three to five minutes, judgement and co-ordination

usually deteriorate. Subsequently, mental confusion, dizziness, incapacitation, and
unconsciousness occur.
Susceptibility to Hypoxia
Susceptibility to Hypoxia can be increased by the following:
Altitude At higher altitudes Hypoxia onset can be measured in seconds not

minutes.
Time The longer the pilot is without Oxygen the greater the effect.
Exercise Exercise increases the need for the body to produce more energy.
Hence, the need for more Oxygen.

Cold When cold, the body uses energy to get warm. To warm the body
heat is generated from the oxidation of food.
Illness Illness increases the demands on the body’s need for energy..
Fatigue Tiredness and fatigue lower the body’s resistance to the onset of
Hypoxia.
Drugs/Alcohol Hypoxia impairs the body’s higher mental functions. Drugs and
alcohol have a similar effect. The combination of the two has an
obvious cumulative effect.
Smoking CO has a greater affinity for haemoglobin than Oxygen. By reducing

the amount of haemoglobin available for an Oxygen bond the body is
already part way to being Hypoxic.
Time of Useful Consciousness
The definition of the Time of Useful Consciousness is accepted as:
“The time available to a pilot to recognise the development of Hypoxia and do something
about it”
This is not a time to loss of consciousness.
ALTITUDE TIME OF USEFUL

CONSCIOUSNESS
45 000 ft 12 Seconds
40 000 ft 10 - 20 Seconds
35 000 ft 30 seconds
30 000 ft 45 - 75 Seconds
25 000 ft 2 - 3 Minutes
18 000 ft 30 Minutes
Limitations of Time at Altitude
An aircraft not equipped with Oxygen should not fly at altitudes above 10 000 feet for
extended periods of time. Specific time and altitude restrictions are stated in JAR-OPS. An
unpressurised aircraft should not exceed 14 000 ft without supplemental Oxygen being used.

Hyperventilation
The respiratory controls of the body react to the amount of CO2 in the blood. During exercise
the body uses more Oxygen and more CO2 is produced. This means that an excess of CO2
will be present in the blood. The respiratory centre, in the brain, reacts to this surplus and the
rate of breathing increases in both depth and rate. This increase in breathing rate removes
the excess CO2 from the body. Once this excess is removed the breathing rate returns to
normal.
Hyperventilation is an increase in the rate of breathing which removes carbon dioxide from
the body faster than is required. This induces a lowering of the acidity of the body.
Hyperventilation may be a side effect of Hypoxia, but the following can induce an attack:
¾ Anxiety or emotional stress

¾ Pain
¾ Motion sickness
¾ Heat
¾ Turbulence
¾ Vibration
Symptoms of Hyperventilation
¾ Dizziness and light headedness

¾ Tingling in the hands, feet and around the face
¾ Stiffening of hands and fingers and increasing stiffness of other limbs and
muscles
¾ Visual Disturbance including tunnelling or clouding of vision
¾ Hot or cold flushes
¾ Anxiety and worry causing a vicious circle of effect and cause.
¾ Impaired performance
¾ Loss of consciousness leading to collapse. In the case of collapse respiration
returns to normal and an individual recovers.
Treatment of Hypoxia and Hyperventilation
The symptoms of Hypoxia and Hyperventilation are so similar that to differentiate between
them can be difficult. Use the following guidelines:
Above 10 000 ft Assume Hypoxia, Oxygen must be given to the sufferer. A

descent below 10 000 ft is essential.
Below 10 000 ft Hypoxia should not be a problem except in those people who
are old or have respiratory problems. The rate and depth of
breathing should be slowed down. If hyperventilation is
identified as the problem then re-breathing the expired air

can help the recovery. Restricting the breathing by use of a
sick-bag or Oxygen mask are common methods used.
Cabin Decompression
Cabin pressurisation failures can occur at any time during flight. The rate of loss of pressure
can be:
¾ Very slow which allows time for a pilot to recognise and deal with the problems
promptly, or
¾ Very rapid if the decompression is due to the loss of a door or window.
For a Public Transport aircraft like the B747:
Loss of a door The pressure will equalise in approximately 12 - 20 seconds.
Loss of a window The pressure equalises in approximately 60 - 90 seconds.
In smaller aircraft the pressure will equalise in a much shorter time.
During a rapid decompression there will be a sudden explosive bang and the cabin will fill with
fog, dust and flying debris. The fog occurs due to the rapid drop in temperature and the
change in Relative Humidity. Normally the ears will clear automatically. Belching and the
passage of intestinal gas will occur. Air escapes from the lungs through the mouth and nose.
In such a case the crew are immediately exposed to the following problems;
¾ Hypoxia
¾ Cold
¾ Decompression Sickness
Oxygen is needed to avoid Hypoxia and a descent is required to a safe altitude below 10 000
ft. Where structural damage has occurred, the descent must be made at a rate that the
damage allows. Emergency descents are not normally made in Public Transport aircraft for a
rapid decompression as supplementary Oxygen is provided.
During rapid decompression the cabin altitude may rise above aircraft altitude due to a venturi
effect. Aerodynamic suction occurs where the air on the outside, passing over the defect in
the hull pulls air out of the cabin. The difference between cabin and aircraft altitude can differ
by as much as 5000 ft.
If flying in a pressurised aircraft, which has a rapid decompression, then the Time of Useful
Consciousness will be reduced. The rapid reduction of pressure in the aircraft will affect the
body. Oxygen is exhaled from the lungs due to this pressure change. The partial pressure of

Oxygen in the blood is reduced and the Time of Useful Consciousness can be reduced by up
to ½ the normal time
eg For a rapid decompression at 30 000 ft the Time of Useful Consciousness will

be 25 - 30 seconds (The time for 35 000 ft).
In the event of a decompression or suspected pressure loss the first action that the crew must
take is to ensure a sufficient oxygen supply by donning their own oxygen masks.
Climb and Descent
Any air or gas contained within the body will expand or contract with any change in pressure.
Climb
The following problems can occur when there is an increase in altitude:
Lungs and Intestine Gas collects along the gastro-intestinal tract because of:
Eating When we eat, air is swallowed with the food we eat.
Bacteria Gas is formed in the intestines by the action of bacteria on

food.
The gas in the stomach or intestines expands during a rapid decompression. If this
gas is not released to the atmosphere, severe pain can be experienced. Damage to
the lungs, or even rupturing (pneumothorax - air between the lung and chest wall) can
occur if pressure changes are extreme. Normally the rib cage will protect the
respiratory system.
Teeth Good dentistry ensures that teeth are filled correctly and the oral health of the
pilot is maintained to a high standard. Poor oral hygiene can result in abscesses, poor
dentistry can lead to air pockets being left in filled teeth; both can cause pain during a
decompression due to the expansion of gases.
Decompression Sickness
Decompression sickness is caused by inert gases, mainly nitrogen, coming out of solution
into the body's tissues due to exposure to reduced atmospheric pressure. When breathing air
at sea level, the body is normally saturated with nitrogen. When the ambient pressure is
reduced by increasing altitude, the body becomes super-saturated with nitrogen. Some of this
nitrogen can come out of solution as bubbles in joints, the skin or the chest. Depending on the
location, and the extent of bubble formation, the symptoms can vary. The common names for
Decompression Sickness and the location in the body are listed below:
Bends Painful joints such as the knees or elbows

Creeps Itching in the skin that may be accompanied by a rash.
Chokes Pain in the chest with a dry hacking cough.
Nervous System Effects Possible paralysis and a loss of vision.
Staggers Loss of balance which is similar to the actions of a drunk.
Collapse Unconsciousness, death may occur.
Certain conditions make decompression sickness more likely:
Altitude Cabin altitudes greater than 18 000 ft. Above 25 000 feet the
chances of suffering from decompression sickness are greatly
increased.
Duration The longer a person is at altitude the more likely the chance of
decompression sickness
Age Age seems to affect the onset
Weight Obese and overweight people are more susceptible.
Diving Diving allows the body to “super saturate” with Nitrogen. An

increased altitude allows this Nitrogen to come out of solution.
Rate of Climb The faster the rate of climb the faster the onset.
Exercise The parts of the body that are most used in exercise are those that
are most susceptible.
Other Factors Fatigue, Alcohol, Hypoxia and cold
Re-exposure
Flying within 24 hours of suffering from Decompression Sickness will increase a pilot’s
susceptibility of contracting the problem again. 48 hours should be the minimum time allowed
to elapse before flying again.

Treatment of Decompression Sickness
Decompression sickness can be avoided by pre-oxygenation (breathing 100% Oxygen before

flight) and then breathing 100% Oxygen during flight. This saturation of the body with Oxygen
reduces the Nitrogen saturation and reduces risk of Decompression Sickness.
If Decompression Sickness does occur:
¾ Descend immediately
¾ Land as soon as possible.
¾ Use 100% Oxygen.
¾ Keep the patient warm.
¾ Recompression in a barometric chamber may be required after landing.
¾ Do not rub affected parts.
Flying and Diving
Diving before flight increases the risk of Decompression Sickness. If compressed air is used
under pressure, the body's store of nitrogen is increased. As an ascent is made, nitrogen
comes out of solution - thus causing Decompression Sickness. Do not fly within 24 hours
of SCUBA diving.
Decompression Sickness can occur as low as 6000 ft after diving. Modern passenger jets are
pressurised to altitudes between 6 - 8000 ft.
Descent
The ear and the sinuses are parts of the body that suffer most in the descent.
Sinuses
FRONTAL SINUS
MAXILLARY SINUS

Sinuses are air filled cavities in the bones of the skull that form the upper part of the face.
They help resonate the voice and make the skull lighter.
The frontal sinuses are in the brow of the forehead above the eyes. The maxillary sinuses are
larger cavities in the cheek bones. Other sinuses are found in the deeper bones of the skull,
separating the nasal passages and the floor of the skull. The sinuses are lined with mucous
membrane and are connected to the nasal cavity by small openings. These openings, sinus
canals, allow the air pressure to be equalised to the atmosphere. The sinus canals vent air to
the atmosphere as the altitude increases. The lining of the canals is made up of a soft
mucous membrane which expands when a person is suffering from colds or flu. Air can still
vent to the atmosphere in the climb; but in the descent the inward passage of air is
impossible. During the descent, severe pain and injury can result. This is known as a sinotic
barotrauma or Barosinusitis.
The Ear
The ear has three main areas which are discussed in detail in a later chapter:
¾ Outer ear
¾ Middle ear
¾ Inner ear
Outer Ear Inner Ear

Middle Ear
The outer ear is exposed to atmospheric pressure.

The middle ear is an air filled cavity bordered by the ear drum and the Cochlea. It is
connected to the back of the throat by the Eustachian tube. The walls of the Eustachian tube
are made of soft tissues, with the opening into the throat acting as a flap valve. During ascent,
air can vent to the atmosphere. This flap valve can stop air returning into the middle ear
during a descent when the pilot suffers from an infection.
Below
Atmospheric
Pressure
Atmospheric
Pressure
Ear Drum
Eustachian
pulled inwards
Tube blocked
Colds or flu can cause the soft tissue, of the Eustachian tube, to expand. Therefore, in a
descent the ear cannot equalise the middle ear pressure to the outside pressure. Severe pain
and injury (possible rupturing of the ear drum) can occur. This is the otic barotrauma or
Barotitis Media.
Prevention
Do not fly with any of the following:
¾ Cold
¾ Flu or
¾ Hay fever.

Chapter 4.
Aviation Medicine – Health and Hygiene
Introduction
A delicate subject to all of us because once qualified, you are going to spend your working life
in close contact with other pilots. To this end the problems of body odour and bad breath have
to be discussed. Simple courteous acts such as brushing the teeth, bathing daily and using
deodorants should be first nature.
As an airline pilot you are the representative of your company and the consideration of dress
and habits must also be addressed. Appearing clean and tidy for duty give the appearance
that you are the professional pilot.
Of more importance is how you stay healthy. A pilot requires a medical certificate in order to
exercise the privileges of the licence.
Joint Aviation Requirements
The Civil Aviation Authorities of certain European States have agreed common
comprehensive and detailed aviation requirements, referred to as the Joint Aviation
Requirements (JAR).
JAR-FCL and ICAO Annex 1
Joint Aviation Requirements for Flight Crew Licensing (JAR-FCL) relate to flight crew
licensing. ICAO Annex 1 gives the standards and recommended practices for personnel
licensing and has been used to provide the structure of the JAR-FCL.
JAR-FCL and ICAO Annex 1 both require a licence applicant to demonstrate theoretical
knowledge of human performance limitations relevant to licence sought.
JAR-FCL Part 3 details the medical requirements for each licence. This document details the
requirements for obtaining and maintaining a medical certificate. ICAO documents provide the
basic structure for the JAR requirements. Additions are made where necessary by making
use of existing European regulations.
Medical Fitness
Fitness
The holder of a medical certificate shall be mentally and physically fit to exercise safely the
privileges of the applicable licence.

Requirement for Medical Certificate
In order to apply for or to exercise the privileges of a licence, the applicant or holder shall hold
a medical certificate issued in accordance with the provisions of JAR-FCL Part 3 (Medical)
and appropriate to the privileges of the licence.
Aeromedical Disposition
After completion of the examination the applicant shall be advised whether fit, unfit or referred
to the authority. The authorized medical examiner (AME) shall inform the applicant of any
condition(s) (medical, operational or otherwise) that may restrict flying training and/or the
privileges of any licence issued. In the event that a restricted medical certificate is issued
which limits the holder to exercise PIC privileges only when a safety pilot is carried; the
authority will give advisory information for use by the safety pilot in determining their function
and responsibilities.
Decrease in Medical Fitness
Licence holders or student pilots shall not exercise the privileges of their licences, related
ratings or authorizations at any time when they are aware of any decrease in their medical
fitness which might render them unable to exercise safely those privileges and they shall
without undue delay seek the advice of the authority or AME when becoming aware of:
¾ Hospital or clinic admission for more than 12 hours

¾ Surgical operation or invasive procedure
¾ The regular use of medication
¾ The need for regular use of correcting lenses
Every holder of a medical certificate issued in accordance with JAR-FCL Part 3 (Medical) who
is aware of:
¾ Any significant personal injury involving incapacity to function as a member of a

flight crew, or
¾ Any illness involving incapacity to function as a member of a flight crew, or
¾ Being pregnant
shall inform the authority in writing of such injury or pregnancy, and as soon as the period of
21 days has elapsed in the case of illness. The medical certificate shall be deemed to be
suspended upon the occurrence of such injury, or the elapse of such period of illness, or the
confirmation of the pregnancy, and
¾ In the case of injury or illness the suspension shall be lifted upon the holder being
medically examined under arrangements made by the authority and being
pronounced fit to function as a member of the flight crew, or upon the authority
exempting, subject to such conditions as it thinks fit, the holder from the
requirement of a medical examination, and

¾ In the case of pregnancy, the suspension may be lifted by the authority for such
period and subject to such conditions as it thinks fit and shall cease upon the
holder being medically examined under arrangements made by the authority after
the pregnancy has ended and being pronounced fit to resume her functions as a
member of the flight crew
Fitness to Fly
You are the judge as to whether you are fit to fly. Illnesses that are trivial on the ground can
cause that fatal accident in the air. With the availability of new “over the counter” drugs
problems such as:
¾ The power of the drug, and

¾ The side effects and symptoms
become important.
A medical certificate is the most important attachment to the licence; lose it – lose the job.
Most pilots neglect the body for many reasons, favourites are:
¾ Poor diet
¾ Lack of fitness
¾ Alcohol intake
¾ Drug Intake
¾ Smoking, and
¾ Ignorance
But these are also the cause of many accidents.
Blood Pressure
The maximum arterial pressure is achieved when the left ventricle contracts to force blood out
of the heart. Known as the Systolic Pressure, this is the pressure at which the blood leaves
the heart through the Aorta. When the heart relaxes, the pressure in the left ventricle will fall
and the valve from the heart is closed off. Elastic recoil in the Aorta and the arteries maintains
the pressure so that a steady flow of blood is achieved towards the capillaries.

Original Position
Stretched Position Aorta
Blood Flow
During the Systolic phase:
¾ The ventricles contract

¾ Pressure in the heart increases
¾ The aortic valve is forced open
¾ Blood is forced down the aorta
¾ The aorta stretches to make room for the blood
The minimum pressure in the arteries is the Diastolic Pressure. This pressure reflects the
resistance of the small arteries and capillaries to the blood flow. This resistance is the load
against which the heart must work.
During the Diastolic phase:
¾ The ventricles relax

¾ The pressure within the heart decreases
¾ The aortic valve is forced shut
¾ The elastic walls of the aorta recoil and return to their original position
¾ Even though the heart is at rest the blood is still propelled through the rest of the
body
Blood pressure is determined by using a sphygmomanometer where the blood pressure is

given in mmHg. Measurement is taken from the upper arm in a sitting position. Typically, the
values of blood pressure are given as two figures eg 120 over 80 meaning:
Systolic 120 mmHg

Diastolic 80 mmHg

The World Health Organisation (WHO) classification of blood pressures is listed below:
Category Blood Pressure mmHg

Systolic Diastolic
Below normal < 100 < 60
Normal 100 – 139 60 – 89
Borderline 140 – 159 90 – 94
Hypertension > 159 > 94
Hypertension
If the systolic and diastolic pressures are high when the body is at rest then this is an
indication that the heart is working hard at pumping blood. This high blood pressure increases
the risk of stroke and coronary heart disease especially when the blood pressure is higher
than 140/90. Long term hypertension imposes strain on the cardio-vascular system that in
turn can lead to heart failure.
The cause of high blood pressure is generally unknown but can be linked to:
¾ Moderate to excessive intake of alcohol.

¾ Smoking
¾ Obesity
¾ Salt in the diet
¾ Genetic factors
Hypertension has a reputation as the silent killer because of the lack of warning of impending
heart failure or heart attack.
Orthostatic Hypotension
Orthostasis means upright posture, and hypotension means low blood pressure. Orthostatic
hypotension consists of symptoms of dizziness, faintness or light-headedness that appear on
standing, and are caused by low blood pressure. Symptoms that often accompany orthostatic
hypotension include chest pain, trouble holding the urine, impotence, and dry skin from loss
through sweating.
Causes of Orthostatic Hypotension
Blood pressure is maintained by a combination of several factors. The heart is the central
pump, and a weak or irregular heart can cause orthostasis. Conditions such as arrhythmia
heart failure, deconditioning, and pregnancy are examples where the heart may not be able to
provide an adequate blood pressure. The heart pumps blood, and if there is too little blood
volume (anaemia, dehydration, dialysis), the pressure drops. The blood vessels in the body
also can constrict to raise blood pressure, and if this action is paralysed, blood pressure may

fall. Heat, such as a hot shower or from a fever, can also dilate blood vessels and cause
orthostasis.
Both Hypo- and Hypertension can lead to the loss of a pilot’s licence.
Coronary Heart Disease
Coronary heart disease (CHD) kills an estimated 10 000 000 people worldwide. CHD is a
general term that refers to any disease that results in a restriction or blockage of the coronary
blood supply to part of the hearts wall. Any restriction or blockage causes a partial or total
deprivation of oxygen to the affected part. This may cause death in the muscle cells. Any
sudden irreversible damage of this kind is termed a myocardial infarction. Where a large part
of the heart is affected then a person may die. If only a small region is affected then the
person may make a complete recovery.
The first two branches of the aorta are the left and right coronary arteries. These vessels
spread out over the surface of the heart and divide into a dense network of capillaries
supplying the muscle of the atria and ventricles.
Aorta
Coronary
Arteries
Atherosclerosis
The build up of a fatty material in the lining of the coronary arteries causes them to narrow.
Initially the fatty material lines the inner coat of the artery wall. As time passes, lipid and
cholesterol molecules from the blood enlarge the fatty material. Eventually, calcium deposits
harden this fatty material. The larger these deposits become, the more the restriction in the
blood vessel. The heart has to work harder to force blood through the arteries which in turn
may cause the blood pressure to rise.
Where CHD develops it normally takes one of three forms:
Angina Suffered by people who have their coronary arteries narrowed by

atherosclerosis. The main symptom is severe pain in the centre of the chest radiating

out to the left arm and up to the neck and jaws. Normally brought about by exertion or
stress, the pain goes when the sufferer relaxes. There is no death of muscle tissue
involved. During exercise or stress the heart beats faster and the demand for oxygen
by the cardiac muscle cells increases. This demand cannot be met by the reduced
flow through the narrowed coronary arteries and so angina results.
Heart Attack Also known as Myocardial Infarction or Coronary Thrombosis. The

fatty lining on the inside of an artery makes the surface uneven and this results in a
disturbance of the smooth blood flow. This provides sites where blood can clot slowly
(thrombus).
If a clot breaks loose it follows the blood flow until it reaches a narrower blood vessel.
This can severely restrict or even stop the blood flow. This blockage causes the heart
muscle to be starved of oxygen and leads to a myocardial infarction. Sudden and
severe heart pain results which may be fatal.
Heart Failure The blockage of a main coronary artery leads to gradual damage of
heart muscle with the result that the heart becomes weaker and fails to pump blood
efficiently.
Risk Factors of Coronary Heart Disease
The main risk factors in their order of importance are:
¾ Family history
¾ Smoking
¾ Raised blood pressure
¾ Raised blood cholesterol
¾ Lack of exercise
¾ Diabetes
Other conditions such as obesity are not fully understood.
Reducing the Risk of Coronary Heart Disease
By avoiding the main risk factors the risk of CHD can be minimised. You can help yourself by:
¾ Stopping smoking
¾ Leading a less stressful lifestyle
¾ Being careful with the diet, eating a low cholesterol and low fat diet
¾ Keeping your weight to a normal Body Mass Index
¾ Exercising at least three times a week for a minimum of 20 minutes. The exercise
must be vigorous enough to double the pulse rate.

Detection and Treatment of CHD
Tests do not give an accurate indication of the health of the coronary arteries. An ECG can
give some indication of the electrical activity of the heart muscle to show abnormalities such
as an infarct, or narrowing of the arteries. For partial blockages arteriography would have to
be used.
Stroke
A stroke occurs when the blood supply to an area of the brain is cut off. Two types of stroke
can occur:
Haemorrhagic An artery in the brain bursts so that blood leaks into brain
tissue – a brain haemorrhage, or
Ischemic There is a blockage due to atherosclerosis
Anaemia
A blood deficiency involving an abnormal reduction of the haemoglobin content of the red
blood cells. These are the cells that carry oxygen to the various locations of the body. Those
who are anaemic develop symptoms caused by the inadequate delivery of oxygen to their
body tissues. Symptoms include low energy, dizziness, shortness of breath, pallor and
digestive disorders.
Obesity
Any food that is eaten in excess of that required is stored as fat. Obesity is associated with a
high fat intake in the diet and lack of exercise. Obesity increases the risk of developing the
following diseases:
¾ Diabetes
¾ Hypertension
¾ Coronary heart disease
¾ Arthritis
¾ Cancer – especially of the colon, rectum, prostrate in men and uterus, cervix and
breast in women
¾ Stroke
Obesity also increases the likelihood of developing hernia, varicose veins and gallstones.
Obesity is defined as when a person:
¾ Is 20% or more above the recommended weight for height

¾ Has a Body Mass Index greater than 30

To lose weight a person must reduce their intake of food.
Body Mass Index
The Body Mass Index (BMI) is calculated as:
BMI = Body mass (Kg)

Height (m)2
BMI Category
Male Female
< 20 < 19 Underweight
20 – 25 19 - 24 Acceptable
> 25 – 30 >24 - 29 Overweight
> 30 > 29 Obese
Effects of Obesity
Diabetes Diabetes is a metabolic disorder that changes the way the body
breaks down sugars and starches. In normal people insulin, which is a hormone
produced in the pancreas, helps to convert sugar to energy. This is stored by the
body cells or used instantaneously. Diabetes is diagnosed as:
Non-Insulin Dependent Diabetes The pancreas produces insulin but

the body is not able to make use of it effectively.
Insulin Dependent Diabetes The sufferer must have insulin injections

because of a lack of insulin being produced.
Non-insulin-dependent diabetes is linked to a person’s body weight; most non-insulin

diabetics are 20% over their ideal body weight. Non-insulin diabetes can disappear
when weight is lost.
Coronary Problems A contributor to heart failure. Obesity causes changes in the

heart’s left ventricle, which raise the risk of sudden death.
Gout Gout is a disorder in where the body produces an excessive amount of uric
acid or where the kidneys are unable to eliminate the uric acid formed. The uric acid
is deposited in tissues and joints in the form of needle like crystals. This causes
inflammation, swelling and severe pain. Joints most often include the knee, ankle,
foot, hand, hip, and shoulder. Attacks can begin suddenly and the joint becomes
inflamed, swollen, red and tender. If left untreated the problem can last for weeks.
Arthritis Arthritis is an inflammation and stiffening of the joints often causing

great pain. As the joints become stiff and painful, movement is difficult. Arthritis is an

illness that progressively disables and handicaps a person. Where the sufferer is
obese, extra stress is put on the joints of the body, especially the knee and hip joints.
Exercise
Exercise does not help a person lose weight although it is an excellent way to reduce the risk
of CHD. To be effective exercise has to be regular:
¾ It must be sufficient to double the resting pulse.

¾ Be carried out for at least 20 minutes three times a week
Hypoglycaemia
A condition where the sugar content of the blood has fallen to a dangerously low level.
Symptoms include;
¾ Physical or mental tiredness

¾ Lightheadedness
¾ Collapse and unconsciousness
Initially the brain and nervous systems are affected which manifest as personality changes
such as:
¾ Anger
¾ Lack of ability to exercise judgement
¾ Poor decision making
Hypoglycaemia can occur as a result of a diabetic taking an overdose of insulin. In fit people
hypoglycaemia can occur when:
¾ No food has been eaten for a few hours

¾ Subjected to sudden mental anxiety or physical exercise
Pilot’s are their own worst enemies, so before flying:
¾ Do not skip meals

¾ Always have a meal before flying
A quick fix to hypoglycaemia is to take a sweet drink or eat sweets.

Tropical Diseases
Where public health control is poor personal protection from Tropical Diseases must rely on
preventive measures and personal hygiene.
The term tropical disease refers to diseases or conditions encountered in areas with high
temperature and humidity. This is assumed to be an area bounded by the Tropics of Cancer
and Capricorn.
Tropical diseases are well understood. They are preventable and curable by modern drugs. If
proper attention is given to personal hygiene combined with simple safeguards, there is no
reason why problems should occur. Flight crew have to be alert and must follow:
¾ Simple rules of hygiene

¾ Sanitary precautions
Water
Contaminated drinking water is one of the most frequent sources of intestinal infection such
as:
¾ Diarrhoea
¾ Dysentery
¾ Typhoid and paratyphoid fevers
¾ Cholera
¾ Schistosomiasis and worm infections.
These can develop into chronic diseases for which the cure is difficult. All can be prevented if
sensible precautions are taken with regard to water and food. Do not:
¾ Drink water straight from the tap

¾ Have drinks with ice cubes
¾ Brush the teeth with tap water
¾ Drink water from pre-opened bottles
To purify water boil it for 3 - 5 minutes. Hot tea or coffee and undiluted citrus fruit drinks are
also safe. If water cannot be boiled purify with a chemical tablet. Drinks from well-reputed
manufacturers that are bottled under strict licensing control are usually safe. Outdoor
swimming in salt water is safe, except where beaches are next to freshwater outlets.
Freshwater can be the source of serious tropical disease and bathing should be avoided.

Food
Most diseases caused by contaminated water may also be acquired from contaminated food.
This is the principal source of simple diarrhoea and food poisoning. In tropical countries it is
not unusual for human excreta to be used as fertiliser. Irrigation of crops is by the use of open
springs or sewers. Do not eat raw vegetables or fruit unless you peel them yourself. Avoid
salads as they are usually washed in the local water. Milk and milk products can also be the
cause of certain ailments.
Food poisoning is a general term applied to some gastrointestinal infections. The risk to flight
safety is by the sudden onset of incapacitating symptoms. Food poisoning does occasionally
occur on board aircraft or during flight and flight crew should not consume food from the same
source prior to or during a flight.
Diarrhoea
Diarrhoea (travellers’ diarrhoea) is a worldwide illness where the body excretes watery stools.
The rapid dehydration that occurs may cause serious flight safety problems.
Cholera
Cholera is an acute enteric infection caused by Vibrio Cholerae. Spread by the intake of water
and foods contaminated by the excrement of infected persons. Untreated, mortality may
exceed 50 per cent. Control is by purification of water supplies and proper sewage disposal.
Cholera vaccine provides some protection for a period of six months.
Amoebic Dysentery, Amoebiasis
Infection is by cysts from faeces of infected persons and is transmitted by hand to mouth,
polluted water, and contaminated raw vegetables. Severe complications can affect the liver
and lungs. The disease may be encountered anywhere in the world.
Diseases Transmitted by Insects
Insects and Insect vectors
High temperatures, humidity and long hot seasons ensure that insects flourish in tropical
environments. Exposure to insects is predominantly due to outdoor or primitive living
conditions. Insects can affect the health of a person in the following manner:
¾ By transmitting or disseminating the disease

¾ Some insects are parasitic in or on the human body, and
¾ Some are directly poisonous in that they may inject powerful, even lethal irritants
or venom.

Mosquito-Borne diseases
The most important of mosquito-borne diseases is malaria. Mosquitoes require blood in order
to reproduce. Other important mosquito-borne diseases include:
¾ Yellow fever
¾ Dengue Fever
¾ Filariasis
Malaria
Malaria is an acute recurrent, febrile disease characterised by chills followed by high fever
and sweating. The incubation period is usually eight to nine days but can be up to 12 months.
Deaths due to malaria are reported every year among international travellers. These occur
because:
¾ Travellers are unaware of, or underestimate, the danger of contracting malaria

abroad
¾ Lack of prevention measures such as taking the required medication
Malaria still kills more people than any other tropical disease.
Diseases Transmitted by Flies
Gastro-intestinal diseases are transmitted by the housefly in unhygienic or unsanitary

environmental conditions.
Biting flies are responsible for dissemination of bartonellosis, pappataci fever and
Leishmaniasis that may be prevalent in certain tropical areas.
Tsetse flies are vectors of trypanosomiasis (African sleeping sickness) in central Africa.
Other Insects
Assassin bugs (Reduviidae) are vectors of Chagas disease found in Central and South
American areas.
Fleas are vectors of plague, murine or endemic typhus and some tapeworms.
Ticks are vectors of such diseases as Rocky Mountain spotted fever, Q fever, Colorado tick
fever, encephalitis and tularaemia, and can cause tick paralysis. Soft ticks transmit relapsing
fevers.
Mites and lice are transmitters of typhus and encephalitis fevers.

Cockroaches and bedbugs are looked upon with suspicion because they usually indicate
unsanitary environments but they are not natural vectors of disease.
Hepatitis
Inflammation of the liver caused by infectious or toxic agents. Infectious agents include
viruses, spirochetes protozoa and bacteria. The incubation period is two to six weeks and the
infection can be prevented by immune serum globulin injections.
Immunisations
Medical requirements for immunisation of flight crew on international flights differ from country
to country. Requirements are usually company dependent.
Rabies
Rabies is an infectious fatal disease spread to humans by the bite of an infected animal. The
incubation period for rabies is between 3 weeks to 120 days. The disease is nearly always
fatal unless a vaccine is given. Stay away from all animals especially cats and dogs. Rabies is
a common problem in many countries around the world.
Tobacco and Smoking
In the 1950s the link between smoking and lung cancer was recognised. In the 1960’s,
smoking was found to be a risk factor in CHD. Tobacco smoke is composed of:
Mainstream Smoke Smoke from the filter or mouth end of a cigarette
Sidestream Smoke Smoke from the burning tip
Approximately 85% of smoke in a room is sidestream smoke. Most of the 4000 different
chemicals in cigarette smoke are found in a higher concentration in the sidestream smoke
than the mainstream smoke. This must put others as well as the smoker at a greater risk of
developing smoking related diseases. This is known as passive smoking.
Three main components of cigarette smoke pose a threat to the human being:
¾ Tar
¾ Carbon Monoxide
¾ Nicotine
Tar is implicated in the blocking of the bronchiole tree and tarring of the alveoli. Sufferers
experience difficulty in breathing because of the blockage of the airways and the progressive
destruction of the alveoli. The blockage of the airways is caused by chronic bronchitis. Where

a person has been smoking for a long time the chronic bronchitis can be accompanied by
emphysema:
Chronic Bronchitis The cleaning action of the lungs is inhibited by the tar in
tobacco smoke. As the tar passes through to the lungs through the airways more
mucus is secreted. This mucus accumulates in the bronchiole tree and may block the
passage of air. Any dirt, bacteria or virus will collect in the mucus – this is the cause
of what is known as “smoker’s cough”.
Emphysema Where the lung is affected by chronic bronchitis infection will become
more commonplace. Inflammation occurs and an enzyme called elastase is
produced. This enzyme destroys the elasticity of the alveoli which eventually burst.
Thus there is less surface area for any gaseous exchange. In extreme cases a
person will need continuous oxygen to stay alive.
Carbon Monoxide
Carbon monoxide (CO) is a product of the incomplete combustion of carbon compounds and
is absorbed by inhalation. The relative toxicity of CO increases with altitude. Carbon
Monoxide (CO) is absorbed by the blood in the alveoli and competes with oxygen for
haemoglobin. The haemoglobin has a greater affinity for the CO than it does oxygen
(approximately 200 times). The stable compound carboxy-haemoglobin is formed and
because of this the amount of oxygen available for absorption is reduced by as much as 10%.
CO is deadly; being colourless, odourless and tasteless. It has a four hour half-life in air.
Carbon monoxide does not naturally occur in any quantity in the atmosphere. Its effects can
be cumulative and are not easily corrected. Oxygen does not bring quick relief and several
days may be required to rid the body completely of carbon monoxide. The presence of carbon
monoxide results in hypoxia where it can have the same effect as an altitude increase of 8 to
10 000 feet.
The symptoms of carbon monoxide poisoning are headache, dizziness, weakness, nausea,
rapid heart beat, respiratory failure and death. After death a person shows a redness in the
lips and cheeks.
Nicotine
Nicotine stimulates the sympathetic nervous system by reducing the diameter of the arteries
which stimulates the release of adrenaline from the adrenal glands. Nicotine is absorbed into
the blood and will reach the brain within a few seconds. The release of adrenaline increases
the heart rate and blood pressure. The narrowing of the arteries decreases the blood supply
to the extremities such as the hands and feet. This lack of Oxygen can lead to the amputation
of limbs due to the onset of gangrene.

Drugs and Medication
The term drug is a difficult one to define; in the widest sense a drug is a chemical substance
which is taken into the body or applied to the skin. More commonly the term is used to
describe substances which interfere with some aspect of the body’s metabolism. These drugs
are taken to alter the:
¾ The progress of a disease, such as a painkiller or antibiotic

¾ The working of the nervous system such as LSD, Heroin or even Alcohol
General Health
The person who, for whatever reason, does not feel well should not fly. General discomfort is
not conducive to safe flying.
Self-medication is also hazardous and the best recommendation to flyers is not to take any
drug and fly. Drugs and flying do not mix. The side effects of most medications can be
disabling in the air. If illness or pain requires treatment then a pilot will not perform normal
flying tasks well.
Drugs
The safest rule is to take no medicine while flying, except on the advice of an authorised
medical examiner. The condition for which the drug is required may be hazardous to flying.
Specific drugs associated with aircraft accidents are:
¾ Antihistamines (widely prescribed for hay fever and other allergies)

¾ Tranquillizers (prescribed for nervous conditions, hypertension, and other
conditions)
¾ Reducing Drugs (amphetamines and other appetite suppressing drugs can
produce sensations of well being which have an adverse affect on judgement)
¾ Barbiturates, nerve tonics or pills (prescribed for digestive and other disorders,
barbiturates produce a marked suppression of mental alertness).
Legitimate medications taken for minor ailments can jeopardise safe flight by their subtle or
unpredictable effects on the pilot. This includes both prescribed medications and over-the-
counter medicines.
Allergic Reactions
Some people may experience an exaggerated or allergic reaction to a medicine. The allergic
response to a drug can arise unexpectedly and dramatically causing incapacitation.

Idiosyncrasies
An individual may react in an unusual and unexpected way to a particular medicine.
Synergistic Effects
When a drug is taken in combination with another drug the total effect may be exaggerated.
Effect of Drug Combinations
Two drugs taken at the same time can:
¾ Cancel each other out

¾ Render each other more potent, or
¾ Cause a side reaction
Drugs may have side effects which contribute to pilot error, and accidents. Some are listed
below:
Antihistamines Widely prescribed and readily available for sufferers of hay

fever, allergies and colds. Drowsiness and dizziness are a common side effect.
Decreased reaction time and orientation problems may occur.
Nasal decongestants Can cause nasal burning and stinging, sneezing and
increased nasal discharge.
Aspirin Side effects include, irregular body temperature, variation in rate and
depth of respiration, hypoxia and hyperventilation, diarrhoea, gastrointestinal
problems and decreased clotting ability of the blood.
Antacids Allow the formation of carbon dioxide at altitude that can cause acute
abdominal pain due to the distension of the stomach.
Sleeping Pills and Tranquilizers Cause sleepiness, nausea, depression,

reduced alertness, affected reaction time and concentration, visual disturbances,
severe mental disturbances and predisposition to heat stroke.
Reducing Agents and "Pep" Pills Drugs generally containing amphetamines.

They produce a feeling of high spirits and false confidence, while actually crippling
one's judgement and leading to reckless errors.
Barbiturates and Pain Killers Used to relieve anxiety or reduce pain. These drugs
suppress mental alertness.

Cough Medicine Cause central nervous system depression, reduced reaction
time and high probability of overdose.
Motion Sickness Drugs Cause drowsiness and depressed brain function,

and temporary deterioration of judgement making skills.
Diuretics Change the osmotic balance of the body.
Alcohol
Alcohol can produce subtle effects on the perception and performance abilities of a pilot.
There is no known threshold level for these effects.
Alcohol, taken even in small amounts, produces a dulling of judgement which results in:
¾ Reduction of reaction time

¾ Lack of accurate flying
¾ Lack of self criticism
¾ A decrease in spatial orientation
Unit of Alcohol
A unit of alcohol is equivalent to:
¾ A standard glass of wine

¾ A single spirit, or
¾ ½ pint of beer
Specifically it is defined as 15 ml or 9 grams pure alcohol which is equivalent to a bottle of

beer.
Alcohol is absorbed very rapidly into the blood and tissues of the body. The body metabolises
alcohol at the rate of one to one and a half units per hour. Binge drinking increases this time
drastically.
Alcohol is also absorbed into the fluid of the inner ear. The fluid metabolises alcohol much
slower than the rest of the body causing problems with the vestibular system.
The presence of alcohol in the blood interferes with the normal use of oxygen by the tissues
causing histotoxic hypoxia. Because of reduced pressure at high altitudes and the reduced
ability of the haemoglobin to absorb oxygen, the effect of alcohol in the blood during flight at
high altitudes, is much more pronounced than at sea level. The effects of one drink are
magnified 2 to 3 times over the effects the same drink would have at sea level.

Alcohol acts as a depressant and an anaesthetic. Binge drinking the night before flight is
dangerous as a pilot will still be acting under the influence of alcohol.
JAR-OPS 1.115 - Alcohol and Drugs
The operator ensures that no person enters an aeroplane when under the influence of alcohol
or drugs where the safety of the aeroplane or its occupants is likely to be endangered.
JAR OPS state that a pilot shall not:
¾ Consume alcohol less than 8 hours prior to the specified reporting time for flight
duty or the commencement of standby
¾ Commence a flight duty period with a blood alcohol level in excess of 0.2 promille
¾ Consume alcohol during the flight duty period or whilst on standby
If large amounts of alcohol are consumed then the period should be increased to over 24
hours.
Recommended Amounts of Alcohol
The following are the recommended Health Council limits for alcohol:
Men 21 units per week
Women 14 units per week
If a man’s intake is more than 6 units per day/30 units per week, women 4 units per day/20
units per week, then there is a greater than 50% chance of an alcohol related illness.
Blood Alcohol Levels commonly used as guides to impairment:
0.05% - exhilaration - loss of inhibitions.

0.11% - slurred speech and staggering gait.
0.20% - euphoria - marked gait impairment.
0.30% - confusion.
0.40% - stupor
0.50% - coma.
0.60% - respiratory paralysis and death.
Alcoholism
Alcoholism is a disease. Of the many definitions given the World Health Organisation
definition is most accepted:

Alcoholics are those excessive drinkers whose dependence upon alcohol has reached such a
degree that it results in noticeable mental disturbance or in an interference with their bodily
and mental health, their interpersonal relations, their smooth social and economic functioning,
or those who show the signs of such developments.
Physical Problems
Problems include:
¾ Digestive system disorders such as ulcers

¾ Inflammation of the pancreas
¾ Cirrhosis of the liver.
Alcohol and Sleep
The use of alcohol as a relaxant is widely used by flight crew. The odd social drink will not
affect a person’s well being. Large amounts of alcohol induce a coma like sleep where both
the slow wave and REM sleep are badly affected. Prolonged use of alcohol will induce
extreme fatigue because of the lack of proper sleep.
Toxic Materials
All pilots will be exposed to a variety of chemical agents that are toxic. A general knowledge
of the effects of these materials is required.
Toxicology
Toxicology is defined as:
The study of the nature and mechanism of toxic effects of substances on living organisms and
other biological systems.
Toxicity depends on:
¾ The amount of exposure

¾ The dose, and
¾ The duration of exposure
Toxic materials can affect any organ of the body. The major organs that can be affected are
the lungs, liver, kidney, skin, eyes, nervous system, reproductive system, heart and immune
systems.

Aviation Gasoline (AVGAS)
Exposure may occur during handling, storage, or engine maintenance. It may be inhaled or
absorbed. AVGAS fumes are an upper respiratory irritant. Rapid vaporisation of AVGAS can
cause chemical skin burns if next to the body.
JP4-JP5
JP4 and JP5 are jet engine fuels; JP4 is 65% kerosene and 35% gasoline, while JP5 is
kerosene. They may cause headache, nausea, confusion, drowsiness. Prolonged skin
exposure can lead to second degree burns.
Ethylene Glycol
Used in antifreeze, hydraulic fluids, condensers and heat exchangers. Ingestion can be fatal.
Methyl Alcohol
Methyl alcohol causes disturbances of vision, headache, vertigo, nausea and vomiting. Methyl
alcohol is found in de-icing fluid. If drunk in large amounts then blindness can occur.
Chlorobromo Methane (CBM)
A constituent chemical used fire extinguishers. Absorb by inhalation and skin absorption.
CBM is considered safe for flight crew.
Halon
Halon is a generic term meaning halogenated hydrocarbon. The gas is a CNS depressant.
Used as a flooding agent to extinguish fires in simulator buildings.
Hydraulic Fluid
Hydraulic fluid is petroleum based and inflammable. When burned, phosgene is formed. This
toxic gas affects the respiratory system. Inhalation is possible when a hydraulic line breaks
under pressure.
Plastics
Plastic burns to CO and other toxic gases. Absorption is through inhalation. Burning plastic
creates a black, choking, toxic smoke that quickly incapacitates.

Mercury
Mercury is a metal liquid at room temperature. The vapour can be absorbed by inhalation
Incapacitation
In-flight pilot incapacitation is known to have caused accidents and occurs frequently enough
for flight crew to train for the possible consequences.
Despite strict medical standards incapacitation still continues to occur. Temporary

incapacitation may be less dramatic than a total collapse but is just as much of a problem.
Most temporary collapses are caused by gastrointestinal upsets.
Incapacitation can be divided, “obvious” and “subtle” incapacitation.
Obvious Incapacitation Obvious incapacitation is immediately apparent to

other flight crew members. Occurring suddenly, attacks are usually prolonged and
normally result in that flight crew member being useless for the rest of the sortie.
Sudden incapacitation may not be preceded by any warning.
Subtle Incapacitation Subtle or insidious incapacitation is harder to identify

because it is not obvious. Subtle in its onset it is hard to predict or notice. This form of
incapacitation can be dangerous because of the time it takes for a crewmember to
notice the effects.
Fits and Faints
A sudden loss of consciousness disqualifies a pilot from holding a flight crew licence. An
explanation is given as to the difference between Fits and Faints. One may impose a
permanent loss of licence; the other suspension or restrictions.
The term fit (seizure) is usually reserved for some manifestation of epilepsy. Faint (syncope)
refers to a change of consciousness caused by disturbance of the brain’s blood supply.
Epilepsy
Epilepsy is just a collective term for a set of symptoms caused by electrical activity in the
brain and often classified as minor or major. An EEG (electroencephalogram) test, recording
routine brain activity, will often detect epilepsy. The fit is usually termed:
Grand Mals Normally a major attack accompanied by convulsions and

uncontrolled physical movement
Petit Mals A minor attack which lasts for a few seconds and is associated with
loss of attention

Epilepsy will mean a permanent withdrawal of licence.
Faint
Faints are more common because an otherwise healthy person may faint from shock, loss of
blood, stress, lack of fluid or food. The basic mechanism of a faint is a sudden reduction of
the blood's oxygen supply to the brain.
Faints can be caused by any of the following:
¾ Shock
¾ Loss of blood
¾ Hypoglycaemia
¾ Stress
Where the cause of fainting can be identified then it will not normally affect a person’s fitness
to fly. There is a possibility that restrictions may be made on the licence eg two pilot operation
only.
Gastroenteritis
Gastroenteritis is generally caused by food poisoning and is most common in travellers. The
symptoms are nausea, vomiting, diarrhoea, abdominal cramps and fever. The conditions are
usually short lived and a pilot is unfit to fly whilst he is affected. The symptoms usually settle
within 2 – 3 days. However, if the problems last longer than 72 hours a doctor must be
consulted.
Acceleration
The body is able to withstand the effects of acceleration up to certain thresholds. These
thresholds depend upon both the intensity and duration that the forces are applied. Normally,
acceleration is divided into 2 areas:
Short Term Acceleration
Impact acceleration forces that last less than one second. The forces the body can withstand
are directly related to its own strength:
¾ In the vertical axis the body can withstand 25G
¾ In the fore and aft axis 45G
¾ In the lateral (side) axis 10-15G
Any force above these levels cause injury.

Long Term Acceleration
Forces that last more than one second. As a human being we are used to the effects of
gravity. When we fly we are subject to the acceleration forces that can be applied when flying
the aircraft. The value of long term acceleration is usually given as either “positive G” or
“negative G”.
Positive G Perceived as an increase in body weight, the more the G pulled the
harder it becomes to move freely. If enough G is pulled then organs can be displaced
from their normal position. As seen earlier we measure the blood pressure in the
upper arm as this equates to the blood pressure in the heart. If we were standing it
would be fair to say that the blood pressure in the head will be less than that in the
heart and that the blood pressure in the feet will be greater than that in the heart. If G
is applied then the blood pressure in the head will be reduced because the force will
drive the blood to the lower half of the body. The blood supply can be cut off meaning
that the eyes and the brain are starved of blood. As G increases we notice the effect
on the eyes firstly by greyout (gradual greying of the vision) and followed by
unconsciousness. Greyout will appear at approximately 3.5G if the pilot is totally
relaxed. By using straining manoeuvres the delay of greyout and unconsciousness
can be up to 7-8G. The military use G-suits to help the pilot in long term acceleration.
G tolerance is reduced by many factors such as:
¾ Hypoxia
¾ Hyperventilation
¾ Heat
¾ Low blood sugar
¾ Smoking
¾ Alcohol
Negative G The effects of negative G are the opposite of those for positive G.
Negative G manoeuvres in an aircraft are much more uncomfortable than positive G
manoeuvres. Facial pain can be experienced and in extreme cases small blood
vessels can burst. Negative G is associated with the term “redout”, where the lower
eyelid is pushed up under the eye. Maximum negative G is considered as –3G and
then for short periods only.
Motion Sickness
Although motion sickness is uncommon among experienced pilots it does occur. It can
jeopardises your flying efficiency especially when concentration is needed eg Instrument
Flying. Student pilots are more susceptible to the effects of motion sickness which is caused
when the body is subjected to a real or apparent motion that is unfamiliar.
Motion sickness is caused by continued stimulation of the inner ear which controls balance.
Symptoms are progressive and include problems such as:

¾ Over salivation
¾ Perspiring heavily
¾ Feeling nauseous and disoriented
¾ A tendency to vomit
In extreme cases if the air sickness becomes severe a pilot can be incapacitated.
Do not fly if taking anti-sickness drugs. These drugs affect the central nervous system and
reduce a pilot’s efficiency. When suffering from airsickness the following may help:
¾ Open air vents

¾ Loosen clothing
¾ Use supplemental oxygen
¾ Keep the eyes outside the aircraft and try and fly straight and level for a period.
¾ Avoid unnecessary head movements
¾ Land as soon as possible.


Chapter 5.
Aviation Medicine - Diet and Digestion
Introduction
All living cells require energy. This is obtained from the digestion of food. Food has to be
eaten to provide the human body with the required energy. Foods fall into three distinct
categories:
¾ Carbohydrates
¾ Fats and oils
¾ Proteins
To form a complete diet, mineral salts, vitamins, trace elements, water and roughage (fibre)
are also required. The amount of food taken must supply enough energy to:
¾ Keep the body alive, both at rest and play

¾ Allow energy to be stored in the body for use when we are not eating
Carbohydrates and Fats
Carbohydrates are compounds that contain carbon, hydrogen and oxygen and are the most
immediate source of energy found in the body. Carbohydrates are:
¾ The main fuel used by the muscles, and

¾ The only fuel that can be used by the central nervous system
They can be sub-divided into three groups:
¾ Simple sugars
¾ Complex sugars
¾ Starch
All carbohydrates are converted to glucose by the body. If carbohydrates are not available in
the body then poisonous substances, ketones, are produced. Carbohydrates are required to
carry out the satisfactory oxidation of fats in the body. Foods high in carbohydrates include
bread, rice and potatoes. When eaten in excess, carbohydrates are converted and stored in
the body as fats.

Fats
Fats also contain carbon, hydrogen, and oxygen; but less oxygen than carbohydrates. Fats
produce energy by oxidation, however, for every 2 grams of fat it takes 1 gram of
carbohydrates to carry out this process. Fats are less bulky than carbohydrates and for the
same weight produce twice as much energy. However, fats do take much longer to digest
than carbohydrates.
Proteins
Proteins, like fats and carbohydrates, contain carbon, hydrogen and oxygen as well as
nitrogen and sulphur. They are essential for the diet as they produce amino acids which help
the body build up new protoplasm.
Protoplasm All human beings consist of microscopic units, known as cells. These
cells are made up in part by a living matter, protoplasm.
Amino Acids The acids that form the component parts of proteins.
Proteins can be sub-divided into two groups:
First Class Proteins Those proteins found in meat, fish, eggs, milk and cheese.
These foods contain all the essential amino acids.
Second Class Proteins The foods, like vegetables, that do not carry all, or are poor
in, the essential amino acids.
Diet
Our diet has to be adequate to supply all our energy needs. When planning a diet, the amount
of energy produced by different foodstuffs should be taken into account. To survive, the body
must produce:
Heat Energy To maintain the body temperature at 36.9° C.
Mechanical Energy To enable us to perform efficiently at work.
The whole energy requirement of the body could be provided by carbohydrates. This would
most probably be indigestible because of the bulk required. Proteins, as they may be used as
a source of energy, could also provide the body's total energy requirement. However, to
satisfy our needs, approximately 5 kg of meat would have to be consumed daily - quite an
expense. Fat alone will not give us our energy requirements as we also need carbohydrates
to break it down into a usable form.
Generally when people talk about a balanced diet, all three forms of food have to be eaten. A
suggested diet could include:

Intake Calorie Intake
Proteins 125 g 500
Fats 125 g 1125
Carbohydrates 400 g 1600
Total Calorie Intake 3225
Mineral Salts and Vitamins
Both mineral salts and vitamins are essential for the complete diet and a healthy body.
Mineral Salts
All of us realise that we require an intake of common salt, sodium chloride. In addition,
numerous other minerals are essential for the body to function correctly.
Calcium Important for the formation of teeth and bone and required for muscle
contraction. Nearly 30% of our bone is calcium. Calcium is present in most tissue
fluids, green vegetables and milk.
Phosphorus Phosphorus combines with calcium to form calcium phosphate, an
essential salt in the formation of healthy bones and teeth. Phosphorus is found in
certain proteins.
Magnesium Magnesium is necessary for the formation of the skeleton and

efficient cell functioning. Meat is the body's main source of magnesium.
Potassium Helps muscle function and the conduction of nerve impulses.
Sodium Helps keep the osmotic balance of the body as well as aiding muscle
function and the conduction of nerve impulses.
Sodium Chloride Taken into the body in the form of common salt. Sodium chloride
is an important constituent of our blood. The osmotic pressure and tissue fluid are
both regulated by its presence. Sodium chloride is also necessary to provide the
stomach with the material to form hydrochloric acid, an essential fluid within the
stomach. Salt can be excreted by both the kidneys and the skin, as sweat. If the body
loses a large amount of salt then it must be replaced to maintain body equilibrium.
Potassium Chloride Potassium is found in most vegetables and like sodium

chloride helps maintain intracellular osmotic pressure. The body must maintain a
sodium chloride/potassium chloride balance. If there is a lack of sodium chloride, the
potassium chloride replaces it in the blood stream. An excess of which has a harmful
effect on the heart.

Iron An important constituent of haemoglobin. Lack of iron in the diet can lead to
anaemia.
Anaemia A deficiency in the number of red blood cells or their haemoglobin

content.
Iron is present in meat, fruit and green vegetables.
Iodine Iodine is necessary for the correct function of the thyroid glands. These
glands control the body's metabolism and growth.
Zinc A constituent of some enzymes, and is involved in wound healing and the
functioning of insulin.
Vitamins
Vitamins are essential, in small quantities, for the normal functioning of the metabolism of the
body. The major vitamins are:
Vitamin A Vitamin A provides for the proper functioning of the retina in the eye.
Found in milk, fat, butter, liver, oils, egg and green vegetables. When Vitamin A is
deficient:
¾ Night blindness can occur

¾ Young people do not grow correctly
¾ Drying of the mucous membrane of the eye lids and cornea allow
Keratinisation (a coating of the surfaces by a hard film)
Vitamin B Complex A large group of water soluble vitamins found in yeast, liver,
milk, green vegetables and flour. Three of the vitamins are found to be essential in
the human diet, Vitamins B1 , B2 and Nicotinic Acid. Lack of Vitamin B1 can cause
diseases such as Beri Beri. Lack of Nicotinic Acid causes Pellagra, a disease
characterised by inflammation of the mouth and skin and mental impairment.
Vitamin C Vitamin C helps the proper functioning of the skin and mucous
membrane. Found in fresh fruits and very lightly cooked vegetables. Lack of Vitamin
C causes scurvy, a disease in which bleeding occurs in all parts of the body.
Vitamin D A fat soluble vitamin found in cod liver oil, egg, butter and cream. The
body can produce its own Vitamin D by exposure to sunlight. Lack of Vitamin D leads
to the onset of rickets in children, a disease where the bones of the body become
deformed. In adults, osteomalacia can result, or softening of the bones. Without
Vitamin D, calcium and phosphorus cannot combine to form calcium phosphate which
is essential for healthy bones and teeth.

Vitamin E Found in cereals, meat and lettuce. The effects of its absence are not
really understood, but a deficiency is thought to cause sterility.
Vitamin K Vitamin K is essential for the clotting of blood. It is seldom lacking in

the diet.
Trace Elements
Other elements fluorine, manganese, cobalt, zinc and copper are required in minute
quantities for special purposes.
For a complete diet, a person must also take in water and roughage. Water is an essential
constituent of protoplasm, and is necessary for the balance of body fluids; the body is in effect
70% water. Because water is continually lost from the body in sweat, urine and respiration,
continuous replacement is required to avoid dehydration.
Roughage is the indigestible part of food and is passed through the stomach and the gastro-
intestinal tract. If roughage is allowed to remain in the alimentary canal for any period of time
then poisonous toxins can be produced which eventually pass into the blood.
Digestion
Before food can be utilised by the body it has to be converted into soluble diffusable
substances. These substances must be able to pass through the walls of our small intestines
into our blood stream. The preparation of food for absorption, and the excretion of waste, is
the process known as digestion. This takes place in the Alimentary Canal; a long canal that
begins at the mouth and ends at the anus.
The Alimentary Canal
Mouth
The mouth is an oval cavity with an opening to the outside. It consists of two parts:
¾ The outer part which is the space outside the teeth and within the lips and cheeks
¾ The inner part or true cavity of the mouth
Teeth
Within the mouth are the teeth. Each tooth is covered by enamel, a hard substance containing
phosphate and calcium. Under this enamel is a thick layer of bony substance, Dentine. After
losing the temporary milk teeth, each jaw has:
¾ 4 incisors or cutting teeth

¾ 2 canine or eye teeth

¾ 6 molar or chewing teeth
Salivary Glands
The mouth contains three pairs of salivary glands:
¾ Parotid glands
¾ Sub-maxillary glands
¾ Sub-lingual glands
Digestion in the Mouth
Food is divided up into small pieces by the teeth and mixed with saliva, which flows out of the
salivary glands. Saliva flows as two secretions:
¾ A flow due to a mental stimulus ie the watering of the mouth due to the sight or
smell of food.
¾ A second flow when the food is in the mouth
Saliva is a colourless, slimy liquid which is slightly alkaline. Consisting mainly of water, it also
contains salts, Mucin and Ptyalin. The saliva has important digestive functions:
¾ It moistens and lubricates food, so facilitating swallowing

¾ It dissolves part of the food, making taste possible
¾ Taste stimulates
¾ The saliva glands into producing more saliva

¾ Other glands into producing other digestive juices
¾ Ptyalin digests starch by converting it into sugar
Correct chewing of food is important as:
¾ More food is subject to the action of saliva

¾ More of the food area can be subjected to other digestive juices later in the
process
Pharynx and Oesophagus
To the back of the mouth is a cone shaped cavity, 12 - 14 cm long, the pharynx. This leads
into the oesophagus which is approximately 25 cm long. The oesophagus lies between the
trachea and spinal column. Passing through the thorax, the oesophagus goes through the
diaphragm and enters the abdomen, joining the stomach at the cardiac orifice.

Swallowing
Food is passed down the oesophagus by a muscular action, peristalsis. This is a wave like
relaxation and contraction of the muscular walls of the oesophagus.
Stomach
The stomach is located in the abdomen, immediately below the diaphragm. The size of the
stomach varies with the amount of food it contains.
Digestion in the Stomach
Food arrives in the stomach from the oesophagus. The presence of the food stimulates the
gastric glands into secreting gastric juices. The gastric juices are clear, colourless and
strongly acidic, which:
¾ Digest proteins
¾ Allow the acid contents of the stomach to kill any germs
¾ Clot any milk products
The food is converted into a semi-liquid mass, acid chyme. Gradually, the acid chyme is
allowed to flow into the duodenum, the first stage of the small intestine. The gradual flow of
food is necessary as the acidity of the food needs to be made alkaline by the fluids of the
duodenum.

Small Intestine
The small intestine is approximately 6 m long and consists of the duodenum and the coiled
part. The duodenum is approximately 25 cm long and circles the pancreas. Openings into the
duodenum come from:
¾ The bile duct from the liver and gall bladder

¾ The pancreatic duct from the pancreas
The long coiled part of the small intestine lies in the central and lower part of the abdomen
Digestion in the Small Intestine
When the acid chyme enters the duodenum a hormone called secretin is produced. This
hormone pours into the blood and stimulates the pancreas to secrete its juices.
Pancreatic Juices A colourless, alkaline fluid containing solids in solution. These

solids act upon fats, proteins and starch.
At the same time, the acid chyme stimulates the intestinal glands to:
¾ Secrete intestinal juice which converts the acid chyme into a digestible form.
¾ Stimulates the gall bladder into emptying its bile. Bile is produced in the liver and
stored in the gall bladder. A yellowish-green fluid, bile is purely an excretory
substance which is produced from broken down red blood corpuscles. Bile is
important to digestion as it helps emulsify fats. Bile also acts as a weak antiseptic
lubricating the contents of the duodenum.
Large Intestine
The small intestine joins the large intestine, which is approximately 1.5 m long. The large
intestine extends from the ileum to the anus and is divided into 3 sections:
The Caecum The caecum is a large sac, from which the appendix hangs. The
appendix is important in vegetable eating animals for the digestion of cellulose. In
man it has no function.
The Colon The first part of the colon runs up the right lumbar region. Just below
the liver it turns across the front of the abdomen and then descends to the left lumbar
region of the abdomen.
The Rectum and Anus The colon becomes the rectum, a tube approximately 12 cm
long. The last 3 cm of the rectum is known as the anal canal. The opening to the
exterior is called the anus, an area protected by the sphincter muscles.

Functions of the Large Intestine
Undigested food passes, in a liquid state, from the small intestine into the large intestine. In
the large intestine, water is absorbed into the blood, faeces are formed and the mass
becomes more solid. Movement along the large intestine is by peristalsis. The faeces take
approximately 16 hours to move along the large intestine.
Defaecation
Defaecation is the act of passing faeces to the exterior.
Faeces Faeces are a semi solid mass consisting of approximately 70%

water. Coloured by a pigment stercobilin, which is formed from bile pigments. The
solid matter consists of waste products from the process of digestion.


Chapter 6.
Aviation Medicine - Metabolism, Excretion And Heat Regulation
The Liver
The liver is the largest gland in the body, weighing approximately 1.5 Kg. During respiration,
when the diaphragm is depressed, the liver is compressed. This compression aids the
circulation of blood through the organ. For this reason, exercise is important for the correct
functioning of the liver. Connected to the upper surface of the liver is the gall bladder.
Functions of the Liver
The functions of the liver are:
¾ The storage of excess carbohydrates as glycogen

¾ The regulation of the amount of glucose in the blood
¾ The preparation of fat for utilisation as a source of energy
¾ Converting nitrogenous waste into urea, which is passed through the blood to the
kidneys
¾ Production and secretion of bile
¾ Release of Vitamin B12 which stimulates red blood corpuscle production
¾ Storage of iron
¾ Body temperature regulation
Pancreas
The pancreas has two important functions:
¾ The secretion of the pancreatic juices

¾ The secretion of insulin.
Insulin circulates around the body in the blood. Without insulin, no glycogen can be stored in
the liver and glucose cannot be released to produce energy.
Insulin
Without insulin the body cannot get its energy by the oxidation of sugars. Fats and amino
acids are converted in to glucose, but this form of glucose cannot be stored, and is thus
excreted by the kidneys. In effect, the body wastes away. The disease that results from this
lack of insulin is known as diabetes.

Excretion and Regulation of Body Fluids
During the activity of the body, waste substances are produced. Accumulation of these
substances can be harmful and so they must be excreted from the body. There are three
excretory organs within the body:
The Skin The body excretes by the process of sweating out water and mineral
salts.
The Kidneys and Other Urinary Organs These organs excrete nitrogenous
waste, mineral salts and water.
The Lungs The lungs excrete CO2, water and other waste products of
respiration.
The Skin The outer covering of the body consists of two layers:
¾ The outer epidermis

¾ The inner dermis
Functions of the Skin
Sweat Glands Sweat glands continuously give out water which contains small
quantities of salts and organic matter. This sweat is not normally seen as it
evaporates as it is formed.
Protection The skin is the outer layer of the body and as such protects the inner
organs.
Regulation of Body Temperature
Sense Proprioceptive receptors are found in the skin. These nerve sensors give us
the senses of touch and temperature recognition.
The Kidneys
Urine, containing nitrogenous waste, is produced in the kidneys. These waste substances are
extracted from the blood continuously. The urine is passed to the bladder, which is emptied
through the urethra.

Functions of the Kidneys
The kidneys:
¾ Excrete waste products of the body

¾ Control the concentration of certain salts within the blood plasma
¾ Control the osmotic pressure of the blood
¾ Maintain the alkalinity of the blood
¾ Remove abnormal substances when found
Micturation
Micturation is the action of passing urine from the bladder to the exterior. Pressure is built up
within the bladder by the continuous collection of urine. Once a certain pressure is reached,
then the urge to micturate is felt.
Body Heat Regulation
Man is a warm blooded mammal, with an internal temperature of approximately 36.9° C.

Body temperature is kept stable by the balance of heat production and heat loss.
Heat Production
Heat is produced by the cells of the body, particularly the muscles and the liver. Blood leaving
the liver is warmer than that entering. It is the blood leaving the liver that distributes these
heat gains to the body.
Heat Loss
Heat is lost from the body by:
The Faeces and Urine This heat loss is constant.
Respiration This heat loss varies with temperature and humidity.
The Skin Heat loss varies dependant upon blood flow and sweat.
Heat loss from the faeces, urine and respiration cannot be controlled by the body. Heat loss
from the skin is controlled by the temperature of the body:
¾ If the body is cold, the blood vessels in the skin constrict, blood flow is reduced,
and heat loss is reduced.

¾ If the body is warm, the blood vessels dilate, more blood flows through the skin.
This allows more heat to be lost to the air.
Fever
Where a rise in body temperature occurs, a person may have become infected, and fever
may result. The symptoms of fever are:
¾ Initially, the skin becomes dry and heat production is increased. Shivering and a
chilled feeling may soon follow.
¾ As the fever advances, the skin becomes hot and flushed and profuse sweating
occurs.
¾ Headache and generalised aches and pains are experienced.
Heat Stroke
A condition that can occur suddenly when the body heat regulation mechanism fails and the
sweat glands cease to function properly. Symptoms include:
¾ Headache
¾ Confusion and restlessness
¾ Hot, flushed possibly dry skin
¾ High body temperature
Climate and Heat Loss
Climate Healthy/Unhealthy Reason

Hot and moist Unhealthy The body is not cooled by sweating
because of the humidity of the air.
Hot and dry Healthy The dry air increases the evaporation of
sweat
Cold and moist Unhealthy Moist air holds a great deal of heat, so that
heat loss from the body is relatively high.
Cold and dry Healthy Heat loss from the body is low.

Chapter 7.
Aviation Medicine - The Eye
Introduction
Vision is the most dominant sense, the eyes are approximately 25 times more sensitive than
any other organ in the body. Although good vision is essential for pilots and is tested during
the medical assessment of a pilot; perfect eyesight is not required.
Anatomy and Physiology of the Eye
The eyeball lies in a bony socket within the skull (the orbit) with two eyelids which protect and
clean the surface of the eye. The eyeball is connected to the skull by 6 muscles, which move
the eye up and down and from side to side.
PUPIL
IRIS
LENS
RETINA OPTIC
CORNEA
NERVE
Light is refracted by the transparent cornea at the front of the eye onto the lens. The lens then
focuses the remaining light onto the retina. The lens can vary its focal length by the
movement of the ciliary muscle which surrounds the lens. By using a process of contraction
and relaxation the lens’ focal length is varied. This is the process which allows the eye to
focus on both near and far objects.
¾ 70% of the focussing process is refraction as light passes through the Cornea
¾ 30% of the focussing process is carried out by the variable focus lens

Between the cornea and the lens is the iris, a circular sheet of muscle fibre; this muscle sheet
gives the eye its colour. The pupil is the opening in this muscle sheet. Contraction and dilation
of the Iris:
¾ Increases and decreases the depth of focus

¾ Controls the amount of light falling on the retina.
The retina, the light sensitive covering on the inside of the eye, contains two types of photo-
receptor cells:
Rods Sensitive to low light illumination and relative movement at the

extremes of vision.
Cones Colour sensitive the cones are associated with both vision in good
light and fine detail.
The focal point of the retina is called the fovea, this area contains cones and no rods. This is
the point of highest visual acuity. Decreasing numbers of cones and increasing numbers of
rods occur as the distance from the fovea increases. Colour discrimination is limited to small
areas around the central fovea.
Both rods and cones are connected to the brain by nerve fibres (neurones) which then
combine to form the optic nerve. Each cone has a single neurone; clusters of rods share the
same neurone. The nerve fibres combine as the optic nerve, the blind spot.
After detection of light on the cones or rods nerve impulses travel along the optic nerve to the
optic chiasma. This is where the optic nerves from both eyes meet. From the chiasma the
impulses travel to an area of the brain known as the visual cortex, where the information from
the eyes is interpreted into a usable message.
Visual Acuity
Visual acuity is the ability to perceive shape and detail. The highest visual acuity occurs when
the retinal image is focused within 2° of the fovea. Light focused on the retina away from the
fovea is less well defined and visual acuity falls rapidly towards the periphery of the eye.
Peripheral vision is sensitive to movement but in order to distinguish detail an object must be
looked at directly.

6/6
VISUAL ACUITY
6/12
6/60
60 40 20 0 20 40 60
DEGREES AWAY FROMFOVEA
Relative visual acuity is measured by the Snellen's Test. A test type card is placed at 6
metres and the test is based on what a normal eye can see at that distance:
6:6 Vision The ability to see at 6 metres what an average individual can see at 6
metres – average vision.
6:4 Vision The ability to see at 6 metres what an average individual can see at 4
metres - better than average vision.
6:20 Vision The ability to see at 6 metres what an average individual can see at
20 metres - worse than average vision.
Clarity of Vision
Clarity of vision does not fully depend on visual acuity. External factors that can affect a
persons clarity of vision include:
¾ Time of day
¾ Size, shape and contrast of an object with relation to its surroundings
¾ The distance an object is from the viewer
¾ Relative motion to the viewer
¾ Visibility – whether clear or hazy
Depth Perception
To see clearly at different distances the eye makes two adjustments:
¾ A change in the refractive power of the lens to enable the eye to focus, and
¾ A change in the convergence of the eyes - binocular vertege.
For the brain to make judgement of depth certain cues are used:

¾ Binocular vision (two eyes), people who are monocular make adjustments which
compensate for the loss of one eye
¾ The relation, size and clarity of the object.
¾ The relative movement and texture of the object.
Distance Estimation and Depth Perception
Cues to distance estimation and depth perception are easy to recognise when pilots use
vision under good illumination. As the light level decreases, the ability to judge distance
accurately is degraded and the eyes become more vulnerable to illusions. Pilots can judge
distance at night if they understand the problems in obtaining accurate cues to distance
estimation and depth perception. A pilot normally uses subconscious factors to determine
distance where either single or a variety of cues is used. Accurate estimates of distance can
be gained if the pilot is aware of the factors to be aware of. Cues to distance or depth
perception are either monocular or binocular.
Stereoscopic Vision
The human being is able to focus both eyes on a single object. This is called stereoscopic
vision. Each eye sees an object at a slightly different angle (binocular cues). The images seen
are merged together and the human being sees a three dimensional object.
Stereoscopic vision does not play a major role in depth perception over a distance of 12 m,
beyond this range other static and dynamic cues are used.
Binocular Cues
Binocular cues depend on the slightly different view each eye has of an object. Consequently,
binocular perception is of value only when the object is close enough to make a difference in
the viewing angle of both eyes. When flying, most distances outside the cockpit are so large
that the binocular cues are of little value. Binocular cues operate on a more subconscious
level than the monocular cues.
Monocular Cues
Several monocular cues aid in distance estimation and depth perception such as:
¾ Geometric perspective
¾ Motion parallax
¾ Retinal image size and
¾ Aerial perspective.

Geometric Perspective
Where an object appears to have a different shape when viewed at varying distances and
from different angles. The types of geometric perspective are explained in the following
paragraphs.
Linear Perspective Parallel lines, such as railway lines, tend to converge as

distance from the observer increases.
Apparent Foreshortening A problem where distant objects appear elliptical due

to their distance from the viewer. For example, a lake may look elliptical from a
distance but the real shape is revealed as the distance to the lake reduces.
Binocular vision is not essential for flying - there are one eyed airline pilots.
Motion Parallax
Considered the most important cue in depth perception. Motion parallax is the apparent,
relative motion of stationary objects when viewed by an observer moving across the
landscape. Near objects appear to move past; distant objects seem to move in the direction of
motion or remain fixed. The rate of apparent movement depends on the distance the observer
is from the object. For example, when driving a Go-cart the ground underneath appears to be
moving fast; when flying at altitude the ground underneath seems to move slowly. Motion
parallax can cause problems to pilots taxiing:
A pilot who changes from a low cockpit height aircraft will taxy at a specific speed. The
ground movement outside is one cue he takes his taxiing speed from. If the pilot changes to a
high cockpit aircraft he will tend to taxy too fast as he uses the relative speed of the ground as
his cue for the taxy speed.
Retinal Image Size
An image focused on the retina is perceived by the brain to be of a certain size. The factors
that aid in determining distance using the retinal image are explained below:
Known Size of Objects
The nearer an object is to the observer, the larger its retinal image. The brain adapts to
estimate the distance of familiar objects by using the size of their retinal image. The diagram

below shows how this method is used. A structure projects a specific angle on the retina,
based on its distance from the observer. If the angle is small, the observer judges the
structure to be at a greater distance. A larger angle indicates to the observer that the structure
is close. In the case below, the observer can judge the distance from the object by the relative
size. If no experience exists, an object’s distance would be determined primarily by motion
parallax.
500 metres
Eye
30 ft
10°
1000 metres
Eye
5° 30 ft
Increasing or Decreasing Size of Objects
Using common sense, if the retinal image:
¾ Increases in size - the object is moving nearer the observer

¾ If the retinal image decreases - the object is further away. If the retinal image is
constant, the object is at a fixed distance.
Terrestrial Association
Comparison of objects, such as an airport with an aircraft flying, will help to determine the
relative size and apparent distance of the object from the observer. Objects associated
together are judged to be at approximately the same distance. In the diagram below, an
aircraft that is observed near an airport is judged to be in the traffic pattern and, therefore, at
approximately the same distance as the airport.

Eye
Terrestrial Distance of Objects Used to Determine Distance
Overlapping Contours or Interposition of Objects
When objects overlap, the overlapped object is farther away as shown in the picture below.
G-FIND must be the closest of the aircraft as it obscures the aircraft behind.

Aerial Perspective
The clarity of an object and the shadow cast by it are perceived by the brain and are cues to
estimating distance. To determine distance with these aerial perspectives, most pilots use the
areas discussed below:
Fading Colours or Shades Objects viewed through haze, fog, or smoke are
less distinct and appear to be at a greater distance than they really are. If an object is
seen more distinctly in clear air it appears to be closer than it actually is.
Loss of Detail or Texture Distant objects become less discrete. If a ploughed

field is viewed from a distance it appears brown. As the observer closes, not only
does the colour appear brown but also the ruts of the ploughing become visible.
Position of Light Source and Direction of Shadow All objects cast a shadow if
lit. The direction of the shadow depends on the position of the light source. If the
shadow is toward the observer, the object is closer than the light.
Emmetropia
The healthy state of the eye when fully relaxed. Parallel rays of light are focused on the retina.
NORMAL
Myopia (Short Sightedness)
In short sightedness the eye is longer than normal and this results in an image focusing in
front of the retina. Accommodation (focusing) by the lens cannot overcome this deficiency.
SHORT SIGHTED (MYOPIA)
Distant objects will be out of focus, with close up vision being satisfactory. To correct short
sightedness a concave lens is used.

Hypermetropia (Long Sightedness)
In long sightedness a shorter than normal eye results in the image being focused behind the
retina.
LONG SIGHTED (HYPERMETROPIA)
Close up vision is blurred yet long distance vision is usually clear. To correct long sightedness
a convex lens is used.
Presbyopia
Close up vision deteriorates with increasing age. Hardening of the lens in people over 40
results in a mild form of long sightedness. This is known as presbyopia. Difficulty in reading
fine print in poor light is normally the first sign of the onset of presbyopia. Half Moon
spectacles are used to correct the defect; corrections for middle and distant vision can be
made by using bifocal, trifocal or even quadrifocal lenses.
Hardening of the lens may also result in clouding of the lens. This clouding is associated with
cataract formation. Pilots with early cataract problems may see an eye chart, but can have
difficulty in bright light. Due to the scattering of light as it enters the eye this sensitivity may be
disabling under certain circumstances. Any clouding of the eye should be investigated
immediately.
Astigmatism
An optical defect caused by abnormalities to the surface of the cornea or lens. In a healthy
state the cornea is spheroidal, like a football. The astigmatic cornea is oval shaped, like a
rugby ball. Errors caused by astigmatism can be corrected by a cylindrical lens.
Spectacles
Variable focus lenses are an alternative to bifocal or multifocal lenses. There is no clear
demarcation between upper distance vision to near vision correction in the lower portion of
the lens. Distortion also occurs near the periphery of vision. Because of these problems
varifocal lenses are not advised for use in flying.
Contact Lenses
Contact lenses provide better peripheral vision and are not subject to misting. There are a
some problems associated with flying with contact lenses. The cornea does not have its own
blood supply and obtains oxygen from the ambient air, the contact lens may starve the cornea

of the oxygen required. Mild hypoxia and dehydration, caused by the low humidity on the flight
deck also increase the potential for corneal damage. Cabin decompression can result in
bubble formation. Rubbing of the eyes may dislodge a contact lens.
Before a medical certificate can be annotated approving the wearing of contact lenses the
applicant must provide a report from an ophthalmologist or contact lens practitioner. If all
requirements are met then the use of contact lenses is approved; the certificate usually
carries an annotation stating that a pair of ordinary spectacles must be carried in flight whilst
the contact lenses are being worn.
Bifocal contact lenses, for the correction of presbyopia, are unsuitable for flying.
During a rejected take-off in a B747 the flight engineer lost visual co-ordination between the
throttles and EPR gauges and advised the captain that the number three engine was losing
thrust. The cause of the engineer’s action was attributed to his multifocus lens spectacles
which he was wearing for the first time.
The above example shows the importance of wearing the correct spectacles and the time it
takes the eye to adapt to them.
Radial Keratotomy
Radial keratotomy is a surgical procedure that creates multiple radial, spoke-like incisions on
the cornea of the eye to produce better visual acuity. Glare sensitivity can be a complication
of the procedure which may be troublesome at night. Other complications include fluctuating
visual problems because of corneal swelling and increased susceptibility to injury. Possible
long-term complications of this procedure are unknown and no pilot should undergo the
treatment.
Colour Vision and Colour Blindness
People with normal colour vision can distinguish up to 120 different colours and over 1000
differing shades of these colours. 8% of the male population and 1% of the female population
cannot distinguish between red and green. There are 4 types of red/green colour blindness:
Protanopia Blue-green appears grey; red-purple appears grey
Protanomalia Blue-green appears an indistinct grey; red-purple appears an

indistinct grey
Deuteranopia Green appears grey; purple-red appears grey
Deuteranomalia Green appears an indistinct grey; purple-red appears an

indistinct grey

Total colour blindness is rare but can be found in both males or females. Two types of total
colour blindness are known:
Typical The person has no colour discrimination and sees everything as

black or white. If a person suffers from this type of colour blindness
then they usually suffer from other types of visual impairment.
Atypical A condition where only very clear colours can be discerned.
Colour vision is affected in people who do not have colour blindess by:
¾ Yellowing of the cornea and lens due to old age.

¾ Smoking and alcohol.
Normal colour vision is not essential for flying. However, there is a need to be able to
distinguish between red, green and white lights in order to comply with:
¾ The rules of the air by night

¾ Light signals from the ground
¾ Aerodrome signs and markings
¾ The changing colours associated with glass cockpit displays
Night Vision
If the amount of light entering the eye changes then any initial coarse adjustment is made by
the iris to close or open the pupil which allows more or less light into the eye. Because the
pupil has only a limited capacity a second process is required. Chemical changes which
involve both the rods and cones take place. As light intensity decreases colour discrimination
of the cones is difficult. It is at this stage that the rods, which are sensitive to low level
illumination take over vision from the cones. The rods contain a pigment, visual purple
(Rhodopsin) which is bleached by bright light. The chemical change takes a finite time as the
light decreases. This dark adaptation time is approximately:
¾ 30 minutes for the rods

¾ 7 minutes for the cones - the fovea contains no rods so maximum visual acuity at
night is achieved by looking at objects off-centre.
Best night vision is achieved after this 30 minute adaptation period. Night vision is lost
immediately when the eye is exposed to bright light. The major factors that affect night vision
are:
Hypoxia As low as 4000 ft night vision begins to deteriorate, by 14 000 ft it is

possible that up to 40% of night vision will have been lost.

Smoking Carbon monoxide in tobacco smoke, forms a strong bond with
haemoglobin. The carboxyhaemoglobin produced reduces the amount of oxygen that
is carried by the blood. A heavy smoker can suffer from hypoxia well below 10 000 ft
with a consequent loss in night vision.
Other factors include, age, alcohol intake, illness and the use of stimulants
Saccadic Eye Movement
When the eyes are not tracking a moving target they move in a series of jerks called a
saccade. This movement takes approximately 1/3 second. As a result of saccadic eye
movements, it is not possible to make voluntary, smooth eye movements while scanning
featureless areas.
Autokinesis A problem that occurs because of the saccadic movement of the eye.
If a person stares at a single point of light such as a star then after about 5 to 10
seconds the star will appear to move. This can appear to the pilot as another aircraft
in the sky.
Sunlight and its Effect on the Eyes
Very high levels of light are encountered at high altitude, especially when an aircraft is flying
over a flat sheet of cloud. Two parts of the light spectrum can cause damage to the eye:
Blue Light Long term exposure may cause cumulative damage to the retina.
Ultra Violet (UV) Light Prolonged exposure to UV wavelengths can also

cause damage. UV rays are absorbed by the lens and cause a painful swelling,
accompanied by extreme sensitivity to light better known as snowblindness. It is
produced only after prolonged exposure to high-intensity sunlight, such as that
reflected into the eyes by cloud. Ultraviolet burns do not normally produce permanent
damage to the eye. UV wavelengths are normally filtered by the cockpit windshield.
Empty Field Myopia
When flying at altitude, at night or above cloud where there is no definite pattern of earth or
sky to focus upon, the eye adopts a resting focus of 1 - 2 metres away. Distant objects have
to be relatively large to be seen. Effort is needed to refocus the eye on infinity. In order to see
objects outside the flight deck the eyes should be focussed on objects such as the wing tips
or clouds.
Glare
Glare is caused when flying above a layer of cloud or flying into a low sun. The brightness
contrast outside and inside the cockpit can make it difficult to read the instrument panel.
Photochromatic lenses are now commonly used by pilots but these adapt to ambient light
slowly. A problem may occur when changing from bright light to relatively darker backgrounds

eg sunlight to cloud. Pilots should be aware of the possibility of ending up flying blind without
realising.
Sunglasses
Cumulative damage to the retina can occur over a number of years due to glare. Good quality
sunglasses give protection by filtering out both blue and ultra violet light.
Flickering Light
Bright flickering light can cause epileptic type fits. Helicopter passengers have suffered fits
because of the rotor blades turning in bright sunlight and causing a flicker effect. An individual
may feel uneasy or suffer discomfort in this flicker environment. Precautions can be taken by
a sufferer such as wearing sunglasses. It is possible that the warning symptoms of mental
unease or discomfort can last for a few minutes, but this cannot be relied upon. The following
suggestions are made with reference to flickering light:
Pilots If a pilot suffers from flickering light effect:
¾ Wear sunglasses.
¾ Turn away from the sun to reduce the flicker effect.
¾ Land immediately.
Passengers Affected passengers are usually on the sunny side of the aircraft. To
reduce flicker effect:
¾ Wear sunglasses.
¾ Cover adjacent windows.
¾ Cover or close the eyes.
¾ Move to a seat which is not affected by the sun.


Chapter 8.
Aviation Medicine – Visual Illusions
Introduction
This chapter discusses the problems of visual illusions. Vestibular illusions are discussed in a
later chapter.
Who needs instruments he said, with perfect eyesight like me? My approach seems just right,
he thought one black night and calmly flew into the sea.
Anon
Spatial Orientation
Changes occur as we grow from being a baby into early childhood. Gradually a baby learns
about the forces that affect our orientation in the world. From that early age we begin to
understand the force of gravity (G) and how it always acts vertically down. It is later in life that
we learn that the force of gravity exerts a force of 1G, and that our visual horizon is horizontal
with this force.
When pilots determine spatial orientation they use different senses:
¾ The eyes
¾ The vestibular system in the inner ear
¾ The proprioreceptive sensors in the skin that confirm our position with the
vestibular and vision senses – “seat of the pants”
To determine visual orientation other factors are taken into account, some of which are listed
below:
¾ The colour of an object

¾ The size and shape of the object
¾ The perspective
¾ Hue (shade) and parallax
¾ The groupings of objects
Problems with spatial orientation begin with the eye – brain interface. “Seeing is believing” is
often used, unfortunately, the eye does not always transmit enough information to the brain
for us to interpret the truth. When dealing with Human Information Processing (HIP) we shall
use the term “perception”. This part of the HIP process is built on past experience and
expectation. So we can say in some instances that the eye is confused because perception
has made its best attempt at telling us the truth.

The two pictures that follow show how easy it is to confuse the brain. The reversible goblet is
a simple example of how perception is not a static process. You see a candelabrum or two
faces looking at each other. The brain does not fix on one image, but constantly reminds you
of each picture. In reality, you are unable to concentrate on one of the interpretations; both
the candelabra and faces are continuously interpreted.
A more difficult interpretation is the Toulouse Lautrec picture shown below.
Within the picture is an old lady and a young lady. Once unlocked it is difficult to concentrate
on just one of the depictions in the diagram.
In both pictures you have been given no depth clue. The next diagrams are included for
interest and rely on you believing that the flat plane is in fact 3-dimensional.

The circles diagram uses the concept of relative size. The centre circles are the same size but
the one on the right looks larger. The tuning fork is an impossible diagram if looked at closely.
The two line diagrams are viewed as perspective drawings and the central two lines are seen
as curves. Both lines are straight and parallel.
Sight is the most powerful sense. However, in the diagrams above, you have been easily
deceived into believing what is obviously false.
In the next pages we look at how this deficiency translates into the airborne environment.
Spatial Disorientation
Since the 1920’s when the Royal Air Force designed the first blind flying panel the problems
of instrument flying have been recognised. The standard “T” of instruments that you use in
modern aircraft was in fact developed in 1927. By training and technological innovation, the
number of accidents attributed to disorientation has fallen over the past few years. It must be
remembered that if the power of vision is removed then the pilot will lose control of the
aircraft. The USAF demonstrated this by using a simple test. Three experienced pilots flew
simple manoeuvres with their visual and instrument clues removed. The results in the
diagram below show that in straight and level flight control could only be maintained for
approximately 60 seconds.

Pilot 1
80
Pilot 2
Pilot 3
Time From 60
Loss of
Visual Cues
to Loss of 40
Control
(Seconds)
20
Straight and 30° AOB

Level Turn
Landing
During training to take-off and land a pilot determines his position with reference to cues
around the airfield. These can include:
¾ The size and shape of familiar objects

¾ The speed at which these objects pass in the peripheral vision
¾ The gradient of the terrain
¾ The covering of the terrain (English Countryside, water, desert etc)
¾ The brightness of the terrain
¾ The visual angle between the horizon and the touchdown point
¾ The rate of closure of the touchdown point
No pilot will use all the cues all of the time, unconscious attention is paid to their own
individual “favourites” that are cultured during training. When one or more of the cues is
removed or altered then difficulty in landing or taking-off may occur.
Width of Runway
The pilot uses the PAPI or VASI system to judge the visual angle of approach at most
airfields. Where these aids are not available then the pilot has to revert to basic visual cues
taught in training.

Low Normal High
Approach Approach Approach
Assuming that the above diagram is for the same width runway a pilot should have no
problems in believing that:
¾ If the aircraft is low then the runway appears flat and short
¾ If the aircraft is high that the runway appears long and thin.
The considerations change when the three runways have a different width. For example, if the
first runway is very wide, the middle runway is normal and the one on the right is very narrow.
All the approaches could in fact be normal for their respective runway width.

This can compound the errors during an approach where no PAPI or VASI are fitted. If the
pilot is on an approach to a runway that is narrower than the one normally used, then the thin
runway may be interpreted as being farther away than the normal width runway or that the
aircraft is high. The aircraft may be descended early and land short.
Approach
During a 3° approach the angle between the pilot’s eye and the touchdown point must be 3°.
Visual Horizon
3°
Visual
Touchdown
Point
The pilot aims the aircraft at the touchdown point and as it approaches the runway, just before
landing the ground seems to flow away from a central visual impact point.
The visual impact point and the touchdown point are different. The aircraft will touch down on
the runway before the visual impact point. Landing cues are used as the aircraft gets nearer
the ground, these include the apparent:
¾ Speed that the ground passes the peripheral vision

¾ Size of objects on the ground

These cues are easily lost when the approach is made at night, over water, desert or snow it
is then that problems occur.
Runway Gradient and Terrain
Where the runway slopes to the threshold, or the terrain slopes into a level runway, the pilot
may misinterpret his approach height. The diagrams below give both the side view and the
view of the runway that the pilot may expect.
Normal Approach
The pilot sees the “correct” picture for the runway and the correct approach path is made.
View of
Runway
Runway Slopes Up
With a runway that has an upslope, the pilot will see the runway as long and thin and may
believe that he is too high. A possible action is to correct to what the pilot believes is the
correct approach path, which will involve the aircraft descending and possibly landing short.
View of
Runway
Runway Slopes Down
A runway with a downslope will be seen as short and fat. The pilot may believe that the
aircraft is too low and fly the aircraft high to achieve what he believes is the correct approach.
The aircraft will be high with the possibility of landing long.

View of
Runway
Ground Sloping Down to the Runway
As the aircraft approaches the runway the terrain appears to be too close to the aircraft. The
feeling is one of being too low and the aircraft is climbed.
Apparent
Height
Real Height
Ground Sloping Up to the Runway
The impression on the approach is that the aircraft is high because the terrain appears to be
too far away. The aircraft may be descended in this case.
Real Height Apparent

Height
Visual Illusions in the Air
Lean on Cloud
Clouds are not like the visual horizon that a pilot flies to. It is possible for the cloud to have
slope. Pilots who believe that the cloud is level are liable to align the aircraft with the horizon
given by the cloud and sky.

The worst possibility occurred over New York in 1965, where a B707 and L1049C collided.
The pilot of one aircraft levelled his aircraft to the visual horizon given by a flat sheet of cloud,
the other aircraft flying straight and level appeared to be turning in towards his aircraft.
Turning to take evasive action caused the aircraft to collide.
Lean on Sun
A partial visual illusion because the aircraft is in cloud. Where an aircraft is flying close to the
top of cloud it is possible to make out the position of the sun. The pilot interprets this
brightness as the sun being vertically above the aircraft. The sun is rarely directly above and
in the diagram below it is positioned to the left of the pilot. In this case the aircraft is banked
left to bring the aircraft into the perceived vertical position.

Black Hole Effect
During night flying accidents occur because the pilot’s visibility is determined by the greatest
distance that lit obstacles can be seen. Darkness degrades or eliminates most of the visual
cues so depth perception is degraded or totally removed. Lit objects are seen at a greater
distance at night than by day. When a pilot approaches a runway over terrain that does not
have any lights such as desert or water judgement becomes difficult – known as the Black
Hole Effect.
Where an approach is made over unlit terrain such as water or desert the pilot sees the
runway lights at a greater distance than the runway would be seen during the day. The
perception is that the aircraft is high on the approach to the runway. Under these conditions it
is possible to misjudge the approach and land short of the runway. At night bright lights and
good visibility lead to an under-estimation of the distance. Conversely low light and poor
visibility lead to an over-estimation of the distance.
A pilot on a “Black Hole” approach varies the descent profile by reference to the visual
perspective this can also be aggravated by other factors (Kraft and Elworth):
¾ If a long, straight approach is made to an airport located near to a small town

¾ The pilot is not familiar with the runway length/width combination
¾ The airport is at a slightly lower elevation than the surrounding terrain
¾ The airport does not have a good lighting system

¾ Small settlements are spread over an area around the airport
Visual Factors at Night
Other factors that mislead pilots flying at night:
¾ A brightly lit runway will make the runway appear closer than it really is. This may
cause the pilot to descend early.
¾ Flying in clear air at night, brightly lit objects appear closer than they really are.
¾ If the horizon is obscured scattered lights can be mistaken for stars. This can give
the pilot the sense that the aircraft is nose high and a correction nose down is
made.
¾ If the horizon is obscured then the distant lights of a city may make the horizon
seem to be lower than it actually is.
¾ Rain on the windshield can convince a pilot that he is too high due to the
refraction of light. It is possible that an error of 200 ft per nautical mile can occur.
¾ When an airport is viewed through a rain shower the runway lights bloom and
appear bigger than they really are causing the pilot to believe that the aircraft is
high.
¾ Flying over a dark sea at night when no stars are visible it is possible that the pilot
may misinterpret fishing boat lights below the aircraft as stars. The misconception
is that the aircraft is upside down and the pilot rolls the aircraft to put these “stars”
above him.
Reaction Time
Where an aircraft is approaching head on the retinal size of the approaching aircraft is small
until a short time before impact. Where a target is moving across the visual field the “pick up”
time is much shorter.
3 SEC ½°
1.5 SEC/1°
.75 SEC/2°
.38 SEC/4°
.1 SEC/ VERY BIG INDEED

Peripheral vision is good at picking up the movement across the eye by using the rods.
In the diagram below two aircraft on a collision course are on a constant bearing at a constant
speed.
If the constant bearing is maintained and there is no relative motion then aircraft B will be
stationary in aircraft A’s visual field. The movement needed to stimulate the rods is absent
and the pilot in aircraft A will not see aircraft B until shortly before the collision. The aircraft
subtends such a small angle on the retina till it is within 0.4 seconds of impact. Probably too
late for any corrective action.
Visual Acuity
Visual acuity has been described as the capacity of the eye to resolve detail. The acuity
across the eye reduces rapidly as soon as we are more than 2° away from the fovea.
Blind Spot
The eye has a Blind Spot. In normal vision a person does not notice any deterioration in
vision because of the position of the blind spot. Compensation is made by the saccadic
motion (a jerk/rest cycle of 1/3 second) of the eye. The saccadic movement can be
demonstrated by the following experiment. On a dark clear night, stand still and concentrate
on a single bright star, after 5 to 10 seconds the star will start to move. A process known as
Autokinesis.

To illustrate the blind spot look at the diagram below from about 30 cm. Then:
¾ Close the left eye

¾ Focus the right eye on the cross
¾ Move the picture slowly towards the face
As the picture gets closer the aircraft will disappear and then re-appear.


Chapter 9.
Aviation Medicine - The Ear - Hearing and the Vestibular System
Introduction
The ear has two functions:
¾ The sense of hearing.

¾ The sense of balance.
The ear is divided into three parts;
¾ The outer ear

¾ The middle ear, and
¾ The inner ear.
The outer and middle ear react to vibration and are solely involved in hearing. The inner ear is
divided into two parts:
Cochlea Responsible for the transduction of the atmospheric

vibrations into electrical energy transmission to the
brain.
Vestibular Apparatus Responsible for balance.
Semi-circular
Ossicles Canals
Otoliths
Cochlea
Tympanic
Membrane
(Ear Drum)
Eustachian Tube

Sound waves travel through the outer ear and cause the ear drum (tympanic membrane) to
vibrate. The vibrations are amplified and conducted across the middle ear (the conductive
system) by the Ossicles (Malleus, Incus and Stapes) to the inner ear. The cochlea converts
the vibrations to nerve impulses which are then relayed to the brain and interpreted as sound.
The middle ear is an air filled cavity and connected to the back of the nasal passage by the
Eustachian Tube. This tube provides the means of equalising pressure between the outer ear
and the middle ear.
Noise
Sound vibrations or pressure waves (noise) have two variable factors which directly affect any
damage to the ear:
Intensity of Sound This depends on the amplitude of the sound waves

and is registered as loudness.
Frequency The number of cycles per second, this is pitch.
The frequency range of human hearing extends from 20 - 20 000 Hertz.
50 - 100 Hz The hum from a mains voltage system.

256 Hz Middle C on the piano.
300 - 500 Hz Speech range.
8000 Hz The upper level of the speech range
Sound intensity is usually registered in decibels (dB). A list of sounds and their noise rating
are given below:
0 dB Threshold of hearing.
15 dB Whisper.
30 dB Conversation.
45 dB Conversation in a busy office.
60 dB An orchestra playing loud music.
90 dB Pneumatic drill.
120 dB Piston aircraft engine a few feet away.
125 dB Disco.
130 dB Jet aircraft noise a few feet away.
150 dB Jet aircraft with afterburner selected.

Effects of Noise
Damage to the ears depends on:
¾ The intensity of the noise

¾ The duration of the noise
If the hearing system is subjected to noises in excess of 85 dB temporary hearing loss can
occur. Where there is exposure above 85 dB for more than 8 hours a day over a long period
permanent hearing loss may occur. Excessive exposure to noises above 120 dB for several
hours a day for 3-6 months will cause Noise Induced Hearing Loss (NIHL) or deafness. With
noises above 120 dB:
¾ 120 dB Discomfort to the ears.

¾ 140 dB Pain to the ears.
Other problems associated with noise include:
¾ Where 100 dB is heard:
¾ A frequency below 100 Hz causes the body to sweat

¾ High intensity noise can affect mental and physical co-ordination, and
lead to disorientation
¾ High intensity noise below this danger level must be regarded as a stress
factor and can lead to a decrease in efficiency
Conductive Deafness
Deafness because of damage to the middle ear can be caused by:
¾ The perforation of the eardrum, or

¾ Infection to the middle ear, or
¾ Displacement of the Ossicles.
This damage can often be repaired and does not necessarily result in hearing loss; if
permanent hearing loss occurs it is known as conductive deafness.
Cochlea
Damage to the cochlea is more serious and can be irreversible. Cochleal implants are
possible and these return some of the hearing loss. The cochlea is full of sensitive
membranes connected to nerve ends which respond to vibrations. This vibration generates
movement in the nerve impulses which the brain translates as sound.

Noise Induced Hearing Loss (NIHL)
If the membranes in the cochlea are “over vibrated” then they can be permanently damaged.
These hairy membranes are bent over permanently and are unable to recover. High
frequency acuity is usually the first area of the auditory range to be lost; known as high tone
deafness.
Protection Against Noise
Hearing protection is simple and should be used by pilots. The effects of jet engines,
engineering sheds, car noise, discotheques or even personal stereos can damage the
hearing. Ear defenders (ear muffs) or ear plugs are very effective in attenuating (weakening)
noise:
Ear Plugs Protection of up to 25 dB
Headset or Ear Defenders Protection up to 45 dB
Presbycusis
Presbycusis is the loss of hearing that gradually occurs in most individuals as they grow older.
Hearing loss is a common disorder associated with aging. About 30-35% of adults between
the ages of 65 and 75 years have some hearing loss.
Age reduces the effectiveness of the auditory system; high frequency acuity is usually
affected first.
Vibration
Vibration affects both the visual and psychomotor performance. Where frequencies between
1 – 20 Hz are experienced the following physical symptoms may occur:
1 – 4 Hz Breathing problems
4 – 10 Hz Possible chest and stomach pains
8 – 12 Hz Lumbar region pains
10 – 20 Hz Headaches and possible eyestrain
The Vestibular System
The vestibular system of the ear consists of:
¾ The semi-circular canals which detect angular accelerations of the body, and
¾ The otolith organs, the utricle and saccule, which detect linear acceleration or
deceleration.

Semi-Circular Canals
There are three fluid filled semi-circular canals in each ear. The canals are set in three planes
at right angles to each other and are named the Lateral Canal, the Anterior Canal and the
Posterior Canal.
SEMICIRCULAR
CANALS
VESTIBULAR NERVE TO BRAIN

UTRICLE
AUDITORY
NERVE
SACCULE
COCHLEA
At the base of each canal is a sensory organ, the cupola. The cupola is a saucer shaped
valve anchored at one end to the semi-circular canal, detecting movements of the fluid it
contains. These movements are turned into electrical signals - since there are 3 canals at
right angles the brain can use these signals to give 3-dimensional information to help control
balance and tell us which way up we are.
With no acceleration the

cupula remains vertical
During any lateral motion the fluid in the canal begins to move. The cupula is then deflected in
the direction of fluid movement.

As a state of equilibrium is reached the cupula overcomes the movement of the fluid and
returns to a state of rest.
When rotation stops the fluid within the canals, because of the inertia, will cause a deflection
of the cupula in the opposite direction.
Since the semi-circular canals are at right angles to one another the forces of acceleration in
yaw, pitch and roll can be detected.
In the absence of visual cues, the brain will interpret these stimuli as:
¾ Acceleration as movement
¾ Simple acceleration
¾ Changes of acceleration
¾ Constant velocity
In general terms, the semi-circular canals sense any angular movement by the body.
Otoliths
The otoliths are sensitive to linear movement and the force of gravity. The two Otoliths,
positioned below the semi-circular canals in the inner ear are made of calcium carbonate.
Movement in a linear sense can give a false impression of climbing or descending.

Chapter 10.
Aviation Medicine – Vestibular Illusions
Illusions of Vestibular Origin
The Leans
A term used to describe a false sensation of bank when the aircraft is, in level flight. This
illusion can occur in both VFR and IFR flight:
The aircraft is initially flying straight

and level
The pilot allows a wing to drop at a

rate that is below that required to
stimulate the fluid in the semi-
circular canals
The pilot still believes that the

aircraft is flying straight and level
The pilot detects the error and

returns the aircraft to straight and
level.
The rate of roll is fast enough to

stimulate the fluid in the
semicircular canals
The fast roll induces the pilot to

believe that he is in a turn in the
direction of the roll

The false sensation of bank may persist for up to an hour, but this is unusual. To overcome
the sensation flying must be referenced to the instruments. This can be draining especially if
the sensation lasts for a long time. In some cases the pilot may align his body with the
apparent vertical, rather than the normal axis of the aircraft. In a two pilot aircraft control
should be always given to the other pilot.
Somatogravic Illusion
Somatogravic illusions occur when the Otoliths are stimulated by a linear acceleration. When
standing still the perception is that gravity acts vertically down. In the Somatogravic Illusion
any accelerating force can cloud this perception.
When short term linear acceleration is experienced then the pilot can easily distinguish
between that and gravity. If the acceleration is long term, as an aircraft accelerating, the brain
is unable to distinguish between the resultant acceleration and the acceleration due to gravity.
The acceleration is combined with that of gravity to give a resultant force.
Force (F)
Resultant (R)
Gravity (G)
The Somatogravic Illusion in Yaw and Roll
During a prolonged visual turn the pilot knows that the aircraft is turning because of the visual
clues given by the instruments and the visual horizon. If the visual clues are taken away, the
pilot will still sense the turn because of the stimulation of the fluid in the semi-circular canals.
As soon as a steady turn is achieved the fluid in the semi-circular canals reaches an
equilibrium and the cupola returns to the normal position. The pilot loses all sense of a turn
and the perception is that the aircraft is flying straight and level.

Perceived
Resultant
Force
R
G
Where:
F Inertial force of radial acceleration
G Gravity
R Resultant force

In a flat turn, the opposite occurs; the pilot believes that the aircraft is banking in a turn.
Perceived
Resultant
Force
R
G
Somatogravic Illusion in Pitch
Of greater importance is the somatogravic illusion in pitch.
Where the speed is linear and there is no acceleration the pilot will sense the forces below.
Up
Down
G G G

During a sustained acceleration, the pilot feels that the aircraft is in a nose-up attitude
because of the resultant force. The illusion takes approximately one minute to develop fully.
Acceleration
Up
Pitch Up
F
F F
R
R G Down R G
G
Where:
F Inertial Force due to Acceleration/Deceleration
G Gravity
R Resultant Force
Even a brief acceleration, such as a catapult launch (5g for 2-3 seconds), can give rise to an
apparent nose-up attitude of 5°, which may take a minute or more to die away.
Conversely, during a sustained deceleration such as applying airbrakes, the aircraft may
appear to pitch down.
Deceleration
Up
Pitch Down
F F
Down F
R G
G R
G R
The somatogravic illusion can occur during take-off or on a missed approach and is a
particular danger at night or in poor visibility. The natural response of any pilot is to counteract
the pitch up sensation by pitching the aircraft nose down. This increases the acceleration
because of the unloading of stick forces and the sensation becomes worse. The more the
pitch down the greater the sensation of pitch up and hence the worsening of the illusion.
Note: If an aircraft is fitted with an air driven artificial horizon, as the aircraft
accelerates, the indications given will support the somatogravic illusion ie a pitch up
indication.

The diagrams below taken from an accident report show how the aircraft was bunted into the
ground. The pilots sensed that the aircraft had pitched up and flipped onto its back.
G-Excess Illusion
A sensation of angular movement can be induced in a turning aircraft. The movement of the
head in a turn when looking down at the instrument side panel can induce a tumbling
sensation. Neither the movement, whether forward or backward, nor the rate, is consistent
between individuals. Experiments have shown that a forward head movement in pitch made
during a pull up from a dive produces a sensation of tumbling forward in pitch. The illusion
occurs because of:
¾ A cross coupled stimulation of the semi circular canals, or

¾ A transient stimulation of the Otoliths
The Oculogravic Illusion
The oculogravic illusion is regarded as a visual component of the somatogravic illusion.

During acceleration the pilot can experience a pitch up sensation. This can be accompanied
by the apparent upward movement of objects within the visual field. On deceleration, the
visual field may appear to move downwards. The mechanism is not primarily because of eye
movement, but the perception of how the brain has interpreted the sensation. If the external
visual field is well defined the illusion is not a problem.

At night, when only a few stars or isolated lights are visible, or where external visual cues are
largely inadequate, such as flight over water or desert, the oculogravic illusion can cause
spatial disorientation.
The apparent movement and transient displacement of light sources in the external visual
scene may be interpreted by the aviator as a change in aircraft attitude, Alternatively, the
apparent movement of an isolated light may be misinterpreted as the light of another aircraft.
In normal flight the lights of the runway appear to be below the aircraft.
Horizontal
As the aircraft accelerates the resultant force gives the illusory movement of the lights
upwards. The pilot may assume this is a nose down change in attitude and counteract with a
pitch up to what he believes is a safe attitude. The perception is in the opposite direction to
that of the somatogravic illusion but is produced by the same change in the direction of the
resultant force vector.
ACCELERATION
Apparent upward
motion of lights
If there are no external visual cues, the somatogravic illusion is dominant.
Elevator Illusions
Visual illusions can occur when there is a change in the magnitude of the vertical forces.
These are termed Elevator Illusions, as they were first experienced in the high speed lifts built
in America in the 1920’s. In an updraught the gravity vector increases and there is a
sensation of moving up. This is confirmed by an apparent up movement of the visual field.
The converse happens in a downdraught.

False Perception of Angular Motion – Vertigo
Vertigo is defined as an illusory sense of turning. Unfortunately, the term has now become
synonymous with spatial disorientation. Somatogravic and oculogravic refer to linear motion,
for angular or rotating motion the terms somatogyral and oculogyral are used:
Somatogyral Illusion
The semi-circular canals sense angular acceleration. During a prolonged turning manoeuvre
at constant angular speed such as:
¾ A co-ordinated turn
¾ A sustained roll, or
¾ A spin
the correct information is sensed for the first few seconds.
O 2-3 Seconds 15 Seconds
Roll Right
Cupola
Angular Cupola Returns to
Motion Starts Deflection Normal
Position
The initial sensation of a right turn will be lost after approximately 15-30 seconds. This
depends upon:
¾ The speed of rotation

¾ The axis of rotation
¾ Cues from other sensory organs, and
¾ The extent to which the pilot is familiar with the motion
Figures given by the USAF state that, for a typical spin pilots will be unable to perceive
rotation by purely vestibular means after 15-30 seconds. Spin direction can be determined
from the blurred view of the outside world or by checking cockpit instruments.

Visual cues are usually adequate to allow the appropriate recovery action. Recovery
produces an angular acceleration in the opposite direction to that on spin entry.
15 Seconds 18 Seconds 30 Seconds
Roll Left
Cupola
Recovery Cupola Returns to
Starts Deflection Normal
Position
The sensation of turn in the recovery is in the opposite direction to that of the spin. This
illusion occurs when the pilot is deciding whether the rotational component of the spin has
ceased so that the recovery can be completed. The only reliable means of detection is
reference to the visual references or instruments. If the rotation has been fast vision may
have been degraded. It normally takes a pilot several seconds after the spin has ceased, for
full visual acuity to be restored.
The presence of false sensations and impaired vision can cause problems in the spin
recovery. The pilot may sense that the spin has stopped before the full recovery is complete.
If the pilot tries to pull the aircraft out of the dive then the aircraft may be overstressed.
After recovering correctly, the pilot may make believe that the spin is now in the opposite
direction. By attempting a recovery the aircraft may re-enter the original spin. This may result
in a graveyard spin, the aircraft repeating the cycle several times.
Oculogyral Illusions
Where impairment of visual acuity is caused by rotation, the semi circular canals may pass
illusory signals to disorientate the pilot. These take the form of apparent motion and errors in
the position of visual objects.
Not a problem in well defined visual conditions, but if external cues are poor, illusions can
persist for a few minutes. When the rotational movement has stopped a light that can be seen
clearly will appear to rotate with the observer.
Illusions due to Cross-Coupled (Coriolis) Canal Stimulation
Complex motion will stimulate more than one semi-circular canal simultaneously. This can
cause interactive sensations causing spatial disorientation. Interactive illusions involving the

otolith organs may occur such as g excess illusion. Head movements made during an aircraft
manoeuvre are the main cause of this type of illusion.
Head movements made during the initial part of a turn, do not give any false sensations,
because the semi-circular canals sense the movement correctly. During this time, each canal
senses the angular velocity correctly. The imposed rotation and the angular motion of the
head are sensed correctly.
Any movement of the head after this initial period can result in the cross-coupling of the
senses and the illusion occurs. Turning the head to change a radio frequency or Squawk is a
common cause of Coriolis.
Pressure Vertigo
Pressure Vertigo is caused by pressure changes within the middle ear normally when clearing
the ears in the climb or in the descent. The vertigo sensed is intense, with blurring of vision
and apparent movement of the visual field. The duration is short and will last no longer than
10-15 seconds.
Summary of Disorientation
Prevention
This can be considered under three headings:
Aircraft Factors:
Instrumentation:
Quality of displays.
Instruments which can be read quickly and un-ambiguously by night and day.
Instruments adequate for manoeuvres and conditions expected.
Reliability.
Clear malfunction indication,
Use of head up displays to assist transfer from external to internal cues and
reduce head movements.
Display should reduce perceptual conflict when external cues are uncertain.
Flightdeck:
Position ancillary instruments and controls so that head movements are

reduced during critical flight phases.
Configuration - a lack of well-defined aircraft frame of reference, contributes
to break-off and leans.

Presence of sloping edge of canopy and instrument panel not aligned with
transverse axis of aircraft, does not assist pilot to maintain level attitude when
flying on external visual references.
Operational Factors Recognise manoeuvres and flight environments which carry a

high disorientation risk. Flight crew should fly only those aircraft, those manoeuvres
and in those flight conditions which are commensurate with training, experience and
proficiency.
Flightcrew Factors Training and experience are of paramount importance:
¾ Selection. This is important because of the large difference between

individuals in apparent susceptibility to disorientation in flight.
¾ Health. Disorders affecting vestibular and visual systems should result in
grounding.
¾ Drugs. Susceptibility to disorientation increases when drugs are used eg
hypnotics (sleeping pills) and especially barbiturates, anti-histamines (for
hay fever), anti-motion sickness tablets (hyoscine) and alcohol. Many
stay in the body for more than 24 hours.
Practical Advice to Flight Crew
Preventative Advice:
¾ You cannot fly by the seat of your pants.

¾ Don’t allow control of the aircraft to be based at any time on seat of your pants
sensations, especially when deprived temporarily of visual cues
¾ Do not mix instrument flying with flying by external visual cues unnecessarily.
¾ Make an early transition to instruments in poor visibility. Once on instruments,
stay on instruments, until external cues are unambiguous.
¾ Maintain a high proficiency at flight in IMC.
¾ Be particularly vigilant in high risk situations - night, poor visibility, etc.
Do Not Fly:
¾ With an upper respiratory tract infection (common cold, ear or sinus infection).
¾ Under the influence of drugs or alcohol.
¾ When mentally or physically debilitated for any reason.
Make your first flight after a period off flying a simple VMC sortie. Experience does not make
you immune.
CROSS CHECK YOUR INSTRUMENTS AND TRUST THEM, THEY CANNOT

ALL BE WRONG

Practical Advice on how to Cope with Spatial Disorientation when it Occurs
¾ You can dispel persistent minor illusions (eg leans) by redirecting attention to
other aspects of flying.
¾ When suddenly confronted with strong illusory sensations:
¾ Get on instruments
¾ Maintain instrument reference and correct scan pattern
¾ Control aircraft to make instruments display desired flight pattern
¾ Don’t mix external visual and instrument references
¾ Seek help if disorientation persists, from co-pilot, ground control, etc.
¾ Finally, remember that disorientation is a normal response to the unnatural

environment of flight.

Chapter 11.
Aviation Medicine – High Altitude Environment
Introduction
The effects of high altitude have already been detailed in an earlier chapter. The aim of this
chapter is to detail the effects of other high altitude problems such as:
¾ Radiation risks to flight crew

¾ Ozone
¾ Humidity in pressurized aircraft
¾ Pressurisation
¾ Oxygen and oxygen systems
Radiation
JAR OPS lays out rules with respect to Cosmic Radiation. The only aircraft affected is
Concorde.
All aeroplanes operated above 15 000 m (49 000 ft) — radiation indicator All
aeroplanes intended to be operated above 15 000 m (49 000 ft) carry equipment to
measure and indicate continuously the dose rate of total cosmic radiation being
received and the cumulative dose on each flight. The display unit of the equipment
shall be readily visible to a flight crew member.
Cosmic radiation consists of particulate radiation and photons produced when charged
particles interact with the nitrogen, oxygen and other constituents of the earth's atmosphere.
These charged particles enter the solar system and produce secondary radiation known to us
as cosmic radiation. The sun continuously ejects charged particles. In normal conditions the
charged particle from the sun is too weak to enter the atmosphere and has no effect on the
public transport flight crew. At certain times, the solar particles have enough energy to
penetrate the atmosphere and substantially increase the dose equivalent rate at these
altitudes.
The earth's magnetic field deflects a large percentage of the charged particles approaching
the earth. This protection is most effective at the geomagnetic equator near the geographic
equator. At the magnetic equator the lines of force are nearly parallel to the surface of the
earth and provide a shield which repels the charged particles. Where the magnetic lines of
force are perpendicular to the surface of the earth the shielding effect is minimum. This is
found at the magnetic poles. Tests show that the dosage rate over the poles is twice that of
the equator. Most airlines operate great circle routes over the poles.

Risk to Flight Crew
Cancer is the main risk from exposure to Cosmic Radiation. Although low, the risk for flight
crew is there. For 1000 flight crew who fly the Atlantic between London and New York for 20
years it is perceived that 6 will die because of work related cancer. In the normal population of
1000 people, approximately 250 would be expected to die of cancer.
Hereditary risk is also possible. Where a parent has been exposed to radiation it is possible
that a child will inherit any radiation induced genetic defects.
Ozone
Ozone is a highly toxic gas. In small amounts it is an irritant to the lungs. If large amounts are
inhaled then it is deadly. Stratospheric ozone is formed by the action of ultraviolet light on
oxygen. Ozone is found in large quantities around 115 000 ft. The amount of Ozone reduces
as the altitude is reduced. Below 40 000 ft there is little or no free ozone in the atmosphere.
At the altitudes that Concorde cruises it is possible, in Polar Regions, that the Ozone content
of the atmosphere can reach 1 - 2 parts per million (ppm). This Ozone still has to penetrate
the pressurized cabin. Ozone is destroyed by heat and by the catalytic action of materials
such as nickel. To totally destroy the Ozone bond the temperature required is 400°C. The air
in the cabin pressurization system is heated above this temperature thus removing the Ozone
before the air is used in the cabin.
Problems may occur when the engine power is reduced for the descent. Tests have shown
that the content of Ozone in the cabin can reach a level of no more than 0.5 ppm. The length
of exposure and the low concentration of the gas have no long lasting effect.
Humidity
Water Vapour
Water vapour is always present in the atmosphere as a gas. The concentration of this gas
varies dependent on the climate and conditions. The body needs to have a moist atmosphere
to function normally. To function correctly the lungs need to be constantly moist. The amount
of water vapour in the atmosphere is measured in terms of Relative Humidity.
Relative Humidity
Relative Humidity is the amount of water vapour present in the atmosphere and is measured
as a percentage.
Amount of Water Vapour in the Atmosphere

/ Total Amount of Water Vapour the Atmosphere can hold x 100 (%)
Temperature is the major determining factor. Warm air can hold more water vapour than cool
air. Air at high altitudes is cold and therefore holds less water vapour than air at low altitude.

For maximum comfort the water vapour should be approximately 40 – 60%. When flying long
haul it is possible for the humidity to drop to as low as 5%.
Humidity Control
Humidifiers provide a means of increasing the moisture content of the air received into the
system when operating at high altitudes. This reduces the discomfort caused by the action of
excessively dry air.
Humidifiers are normally located in the fuselage ducting just down-stream of the heating and
refrigeration equipment.
Pressurisation
Pressurised Cabins
Modern transport aircraft are pressurized to a cabin altitude of between 6000 to 8000 ft. This
gives the passenger and crew:
¾ Protection from high altitude problems such as Hypoxia and Decompression

Sickness
¾ A comfortable environment in which to exist
Most modern aircraft have a rate of climb in the order of 2000-3000 fpm, for comfort the cabin
pressure changes at a rate of about 150-300 ft/min. This allows the body to equalize pressure
slowly and comfortably as the aircraft climbs. Some people may still have problems with ears
blocking or gas expansion in the stomach and intestines. Cabin pressurisation is taken from
the engine compressor, it is then cooled and fed into the cabin. The pressure level is then set
by controlling the rate of escape of the compressed air from the cabin by means of a
barometrically operated relief valve.
Cabin Pressurisation Advantages
Advantages of pressurization are:
¾ Protection from Hypoxia and Decompression Sickness

¾ Oxygen is only needed in emergencies
¾ The pain from the expansion of stomach and intestinal
gases is reduced.
¾ Temperature can be warmer than the outside
environment.
¾ Movement is possible within the cabin.

Disadvantages of Pressurised Cabins
The advantages of pressurization outweigh the disadvantages:
¾ Contamination of the cabin is easy

¾ With rapid decompression the occupants are exposed to all the
rigours of the high altitude environment.
Aircraft Oxygen Systems
Aircraft oxygen systems provide diluted or 100 percent oxygen for breathing. JAR-OPS
determines certain criteria for aircraft on high altitude flights.
All Aeroplanes on High Altitude Flights
Approximate altitude in the Standard Atmosphere corresponding to the value of absolute

pressure used in this text is as follows.
Absolute Metres Feet

Pressure
700 hPa 3000 10 000
620 hPa 4000 13 000
376 hPa 7600 25 000
An aeroplane intended to be operated at flight altitudes where the atmospheric pressure is

less than 700 hPa in the cabin is equipped with oxygen storage and dispensing apparatus
capable of storing and dispensing the oxygen supplies required.
An aeroplane intended to be operated at flight altitudes where the atmospheric pressure is

less than 700 hPa where the cabin is pressurized above 700 hPa in personnel compartments
is provided with oxygen storage and dispensing apparatus capable of storing and dispensing
the oxygen supplies required.
Pressurized aeroplanes introduced into service on or after 1 July 1962 and intended to be
operated at flight altitudes where the atmospheric pressure is less than 376 hPa are equipped
with a device to provide positive warning to the pilot of any dangerous loss of pressurization.
An aeroplane intended to be operated at flight altitudes at which the atmospheric pressure is

less than 376 hPa, or which, if operated at flight altitudes at which the atmospheric pressure
is more than 376 hPa, cannot descend safely within four minutes to a flight altitude at which
the atmospheric pressure is equal to 620 hPa and for which the individual certificate of
airworthiness is first issued on or after 9 November 1998 is provided with automatically
deployable oxygen equipment to satisfy the requirements.

The total number of oxygen dispensing units has to exceed the number of passenger and
cabin attendant seats by at least 10 per cent.
Oxygen Regulator
Flight crew use an oxygen regulator to control the flow of oxygen into the oxygen mask. This
reduces the oxygen pressure to a breathable level. Regulators may include diluter demand for
diluting the supplemental oxygen with ambient air to extend the duration of the oxygen supply
or automatic positive pressure for flights above 30 000 feet. Continuous flow regulators are
used for portable oxygen bottles and in some passenger cabin systems.
Diluter demand regulators used by flight crew incorporate:
¾ A pressure gauge
¾ A flow indicator, and
¾ An air valve lever.
Most operate in the altitude range from 0 to 37 500 ft. Oxygen is delivered to the pilot in
response to breathing. The regulator provides either an air oxygen mixture, or 100 percent
oxygen, depending upon the mode of operation selected.
Oxygen masks
Flight crew use a full face mask which provides a seal to the outside atmosphere. In
conditions where cabins are filled with smoke this is thought to be essential. Passenger
oxygen masks are not as efficient. The mask delivers 100% oxygen continuously. There is no
seal to the outside atmosphere and as such there is no smoke protection.


Chapter 12.
Sleep
Introduction
The aviation industry is a 24-hour activity in order to meet the demands of the modern world.
Flight crew are required to support this 24 hour operation. With the demands of both long and
short haul operations fatigue in aviation is recognised as a serious safety concern. Fatigue
and lack of sleep may not be apparent to a pilot until serious errors are made. Pilots routinely
experience fatigue throughout their aviation careers and many crewmembers consider it an
occupational hazard. Commercial pressure is ever increasing and these demands with the
ever present “press on itis” quickly fatigue even the most fit pilots. Sleep is a real concern
and this section outlines:
¾ How fatigue occurs

¾ How to help combat fatigue
¾ Sleep and sleep disorders
The Danger of Fatigue
Fatigue is a danger to both the long haul and the short haul pilot. Because of its insidious
nature an individual does not initially feel the onset of fatigue. A fatigued pilot may not be
aware of the gradual and cumulative effect and consequently, may be unaware that their
performance has become degraded. Because of the slow onset the pilot may not recognize
the degradation of his performance.
A fatigued pilot loses the ability to self criticize and is more willing to accept inaccurate flying
and poor judgment. As fatigue increases, decision making skills are lost with a slowing down
of the whole thinking process. Information may have to be checked and checked again
because of these problems. Reaction time is increased, irritability and mood swings easily
block communication and hamper teamwork.
Apathy eventually sets in and the fatigued pilot becomes indifferent to the outcome of the
flight and the operational performance.
Where a person goes without sleep for up to 24 hours the effects are similar to those of
having up to 8 units of alcohol.
Vigilance Effects
Any task that requires vigilance is suspect to the effects of fatigue. Fatigue can be described
as:
Short Term Fatigue (Acute) The effects of normal everyday living. Acute fatigue
is the tiredness a person feels after physical or mental strain. Co-ordination and

alertness become dulled and performance reduced. Good rest and sleep combined
with proper nutrition and exercise prevent acute fatigue.
Long Term Fatigue (Chronic) If sufficient recovery time is not allowed between
bouts of acute fatigue then chronic fatigue may occur. The only recovery is a
prolonged period of rest. During chronic fatigue performance and judgement can
lower to a dangerous level.
Causes of Pilot Fatigue
Pilot fatigue is normally caused by:
¾ Circadian Dysrhythmia – Jet Lag.

¾ Short haul rostering – multi leg flying days
¾ Poor rostering – long standby periods, long duty periods
¾ Sleep lost because of domestic worries
Other factors do have an effect, but the above may be taken as the main causes.
Symptoms of Pilot Fatigue
We know when we are fatigued, but can we recognize it in others. A few symptoms are listed
below:
¾ Slow reaction time, both physically and mentally.

¾ Errors becomes the norm
¾ Lack of self criticism.
¾ Fixation on a single source of information or task.
¾ Short-term memory loss
¾ Impaired judgment leading to poor Decision Making.
¾ Distracted easily from the main task.
¾ Inaccurate flying
¾ Lethargic
¾ Limited Situational Awareness.
¾ Poor communication skills.
Coffee, concentration or will power do not get rid of fatigue. They may delay the onset but the
normal result is one of worsening the effect.
Sleep and Sleep Deprivation
Chronobiology is the scientific name for the study of biorhythms. The human body follows
certain biological rhythms some of which have a period of 24 hours, these are termed

Circadian Rhythms (Latin: Circa - about, dies - a day). Other biorhythms, however, display
different periods eg., the female menstrual cycle - 28 days, children's rest/activity cycles - 90
minutes.
One of the most studied of Circadian Rhythms, that is useful to pilots, is the sleep/wake
rhythm. The body's temperature is approximated at 37°C. During a 24 hour period it cycles
between 36.2°C and 36.9°. The sleep/wake cycle is bound to this change in body
temperature:
¾ When the temperature is rising the body is waking

¾ When the temperature is falling the body is ready to sleep
In the diagram below the time of minimum temperature and maximum temperature are
annotated on the body temperature cycle. Note that there is a dip in the temperature after the
lunch time period.
Body
Temperature
Minimum
36.5°C
0500 Time of Day
Maximum
1800
Post Lunch
Dip
This sleep/wake cycle is controlled by the body’s internal clock. In America deprivation tests
were carried out on an individual in a room with no time clues such as light or dark. Initially
allowed a clock the individual was asked to rise at 9 am each day. After 3 days the clock was
removed. Initially the person woke at 9 am. On subsequent days the waking time was delayed
by one hour – on day 4 waking at 10 am, day 5 at 11 am etc.

WITH A CLOCK DAYS ASLEEP AWAKE
1
2
3
WITHOUT A CLOCK 4
5
6
7
8
9
10
11
12
13
14
15
0 6 12 18 24
TIME OF DAY
The circadian rhythm of the body has adjusted to 25 hours, a condition known as free run.
The body is contracted into a 24 hour day by the constraints of our working lives. We react to
the night and day and to other time clues known as Zeitgebers (German for time giver)
The problems of the body temperature cycle and the circadian rhythms do have an affect on
the pilot.
Sleep Credit/Deficit
Using a simple system of allowing +2 points for every hour asleep and -1 point for every hour
awake we can show how easy it is for the body to go into sleep debt. The system is not
infallible, as it does not take into account:
¾ The type of sleep

¾ Whether the person is on long haul flight
During a normal night if we assume that an individual has 8 hours sleep then when they wake
they will have amassed +16 points. If that individual then stays awake for 16 hours then they
will lose –16 points. Thus finishing the day with 0 points. On subsequent days the same
occurs and the points score never goes below the 0 line – the individual is in sleep credit.

+16
+8
SLEEP
CREDIT
0
00 00 0800 1600 0000 0800 1600 0000 0800 1600 0000
SLEEP
DEFICIT
-8
-16
Now assume that the cycle is broken by a period on night shift.
Assuming a normal night’s sleep:
¾ The individual wakes with +16 sleep points (A)

¾ Assume they stay awake for 8 hours (B) and from 1600- 1800 hrs manage to get
a two-hour nap (C) before reporting for duty
¾ Duty starts at 2000 hrs through to 0600 hrs.
¾ At 0600 hrs they return home but are unable to sleep because the body
temperature is rising
¾ Finally they sleep at 1200 hrs (D). They sleep until 1800 hrs (E) when it is time to
prepare for work
¾ The cycle repeats itself and the person gets further and further into sleep deficit.
This situation is termed cumulative sleep debt.
+16
B
A
C
+8
SLEEP
CREDIT E
D
0
00 00 0800 1600 0000 0800 1600 0000 0800 1600 0000
SLEEP
DEFICIT
-8
-16
By the time the third shift is started the sleep credit is 0 before they start work. Now translate
this to the pilot on a flight in the early hours of the morning with little to do but monitor the
autopilot. Most pilots use coffee to stop sleep but this is only a short term measure.

Sleep
The precise functions of sleep are not fully understood. Experiments have shown that sleep
has a restorative function for both the body and the mind. Sleep has been investigated
extensively over the last sixty years and much is known of its nature.
In experiments three main measurements are recorded:
Brain wave activity EEG (electroencephalogram)

Eye movement EOG (electroculogram)
Muscle tension EMG (electromyogram)
The recording of these three measurements has shown scientists that the body initially goes
through four linked stages of sleep termed quiet sleep. During these 4 stages there is a
gradual slowing of the brain’s activity as the body goes into a deeper sleep. Stages 3 and 4 of
quiet sleep are known as slow-wave sleep because the EEG records little or no brain activity.
Following the Quiet Sleep is another stage of sleep called REM (rapid eye movement) sleep.
Also known as Paradoxical sleep. During this sleep:
¾ The EEG records similar brainwaves to those recorded when someone is awake
¾ The EOG records rapid eye movements (hence REM sleep) as if searching for
something
¾ The EMG records total muscle relaxation; the mind is awake but the body is
asleep – hence the term paradoxical sleep
Quiet sleep is thought to be body restorative and that REM sleep allows the brain to store
what has been learned during that day and also to check and create new neural pathways.
The evidence supporting this theory is that children (and adults who are in learning situations)
show a higher REM sleep percentage than average.
Each full cycle of sleep takes approximately 90 minutes, successive cycles showing
increasing amounts of REM sleep. In general, during a normal 8 hours sleep, the first four
hours are mainly slow-wave sleep (body-restorative) and the latter four hours mainly REM
sleep (mind-restorative). If the first four hours (slow-wave) or the second four hours (REM)
sleep are interrupted then both are made up on the next night.
CYCLE
STAGES 1-4
SLEEP
REM SLEEP
TIME OF DAY 23 24 1 2 3 4 5 6

Dreams occur mainly in REM sleep but sleepwalking and nightmares occur in slow-wave
sleep, hence, people remember dreams but not sleepwalking.
Alcohol affects both Quiet Sleep and REM sleep.
¾ Moderate amounts affect REM sleep

¾ Large amounts affect both types because of the coma like affect of alcohol
Sleep Disorders
The common sleep disorders include:
¾ Microsleep
¾ Insomnia
¾ Sleepwalking and sleeptalking
¾ Sleep Apnoea
¾ Narcolepsy
Sleep Loss and Microsleep
Any loss of sleep will begin a sleep debt. Fitful sleep overnight may also produce the same
effect. Sleep debt is only cured by sleep.
Sleep debt and fatigue may lead to what is termed a microsleep.
Microsleeps are uncontrolled spontaneous episodes of sleep that last for a few seconds up to
a few minutes. During a microsleep a person becomes detached from reality and will be
unresponsive to outside influences.
Insomnia
Insomnia can be divided into two types:
Clinical Insomnia Clinical Insomnia is suffered by people who are unable to

sleep even in the most favourable conditions.
Symptoms include:
¾ Difficulty in falling asleep

¾ Difficulty in maintaining sleep
¾ Waking unrefreshed
¾ Daytime fatigue

¾ Irritability
¾ Lack of concentration
Situational Insomnia Aircrew can suffer situational insomnia; it is an inability to

sleep due to irregular work/rest patterns. Jet lag being the most common cause.
Sleepwalking and Sleeptalking
Common in childhood and less common but present in some adults are sleepwalking
(somnambulism) and sleeptalking (somniloquism). Neither are a health hazard but excessive
cases need investigation.
Sleep Apnoea
A condition which affects people who snore excessively, especially those who are overweight.
During sleep the snoring affects the back passages of the throat and air can be cut off from
the lungs for a short period. The person effectively stops breathing. In extreme cases a
person could die. The condition is treated by the use of a mask which the sufferer wears
during the night. Air is passed through the mask by a compressor which ensures a positive
pressure in the throat at all times.
Narcolepsy
The inability to stay awake. Sufferers have the tendency to fall asleep at any time whether
they are tired or not.
Sleep Hygiene
Individuals require differing amounts of sleep. The older you are the less sleep you require.
People in learning situations do require a regular sleep pattern. When studying the pressures
are such that late night study or worry can disrupt the sleep pattern. But a few helpful hints
are given below:
¾ No strenuous exercise immediately before going to bed. This means no physical

or mental exercise.
¾ A high level of study activity should be avoided immediately before trying to
sleep, rest for at least 30 minutes before going to bed
¾ Keep the room ventilated - not too warm, not too cold.
¾ Do not drink too much alcohol. Alcohol induces a coma like sleep where there is
no body refreshment.
¾ Try a warm milky drink - NOT COFFEE OR TEA.
¾ Light reading or listening to music can help relax the mind and body.

Napping
Most people feel tired during their waking hours. Napping is a way of refreshing the body
quickly and efficiently. In experiments it has been shown that a short nap can be as
restorative as a longer period of sleep.
Drugs
To sleep or to stay awake some pilots will resort to drugs. To stay awake the most common
drug used is Caffeine; the antidote for sleepiness being a strong, black coffee. To relax and
sleep alcohol is used.
Caffeine The harmful and addictive effects of excessive caffeine should be

noted and are well-documented.
Alcohol Alcohol is a central nervous system depressant which interferes with

sleep, particularly REM sleep. In small amounts alcohol does promote well-being and
can relieve stress and promote relaxation. But like all drugs addiction can bring
problems.
Sleeping Tablets
With normal medication, cold and flu remedies induce drowsiness because of their nervous
system depressant action. Some drugs can remain in the system for hours and affect
performance the next day. The half-life of a drug is an important factor that pilots must take
account of. The half-life of a drug is the time it takes for a drug to decay to one half of its peak
concentration. Half-life figures are not available publicly. In order to ensure that any drug you
are using is safe always consult a GP before use. Sleeping tablets have a long half-life and
can affect a waking person for a few hours after rising out of bed. Newer sleeping drugs are
always coming onto the market and before use a doctor should be consulted. Contrary to a lot
of opinion, sleeping tablets are only meant as a short term sleeping problem fix.
Melatonin
Melatonin is a depressant currently being promoted in some countries as a natural hormone,

which allegedly induces sleep in shift workers or elderly people. The drug is now marketed as
an aid to combat Jet-Lag. Melatonin is not legal in several countries and is certainly not
recommended for use by pilots. There are problems with quality control, potency and
monitoring of this supplement. The biological effects and the long-term use of Melatonin are
not known.
Circadian Dysrhythmia – Jet Lag
Abnormal shift work can result in a cumulative sleep debt. Longhaul pilots have the added
problem of their body adjusting to new time zones. New Zeitgebers confuse the body ie new
light/dark, new meal cues as time zones are crossed. For the long haul pilot it is better to be
travelling westwards than eastwards. Westwards travel involves a lengthening of the day and

the Circadian Rhythm is better at lengthening its cycle than shortening it. Remember that the
body rhythms free-run at 25 hours.
The body’s Circadian Rhythms adjust at different rates at between 1 – 1½ hours per day for
every hour’s difference in time zone. The result of this slow resynchronization is that you may
find yourself beginning the next leg of your flight before your biorhythms have resynchronized.
It is estimated that some long haul pilots spend their entire flying careers suffering from
Circadian Dysrhythmia and only adjust fully when on extended periods of leave or illness.
Two methods are suggested to combat Jet Lag.
Method 1 Stay awake for 2 hours after landing; then rest/sleep for 4 hours; then
sleep for 8 hours before reporting for duty.
Method 2 If the lay over is less than 24 hours then remain on the original time
zone cues.
The effects of Circadian Dysrhythmia are well known and include:
¾ A general lack of well-being.

¾ Below par performance.
¾ Stomach disorders.

Chapter 13.
Stress
Introduction
Stress affects all human beings. It is the perception of what the stress is that determines
whether the human copes. Overstress a person and their ability to reason and function
correctly is reduced. Not enough stress will cause boredom and complacency. The right
amount of stress and optimum performance levels are achieved.
Stress
Stress can be defined as:
Excessive and aversive environmental factors that produce physiological responses in an

individual
The strain and pressure that is exerted on a human can be related to the scientific use of the
term where effectively a body is bent and eventually breaks if overstressed.
Stress is present in all humans. It is important to accept that in all walks of life that we all
suffer some stress whether good or bad. The pilot needs to be aware of the problems of
stress and how to cope with the rigours it puts the body through. This helps the person
recognise the negative impact on performance caused by overstress such as:
¾ Fatigue
¾ Personal problems, and
¾ High workload
Remember, the pilot is his own worst enemy. Peer pressure over the years has instilled in
most pilots a fear that admission of overload is a weakness.
The stress that the body is subjected to can be broken down into three areas. Remember that
these problems may be singular or cumulative, for simplicity we look at each separately.
Physical Environment we live in; conditions such as, noise, vibration and
stages of hypoxia
Physiological Fatigue, physical fitness, poor diet
Emotional The domestic, social and emotional factors related to living. Work
related activity such as leadership or decision making.

Stress can be defined as either:
Chronic Stress The long term demands of a person’s lifestyle such as work,
health or domestic security
Acute Stress Short term stress caused by the issues of the day.
Effects of Stress
Acute stress is dealt with by the body immediately. Adrenaline is released into the
bloodstream and charges the body:
¾ Raising the heart rate

¾ Increasing the blood pressure
¾ Increasing the breathing rate, and
¾ Increasing the blood sugar level
A condition known as the "fight or flight" syndrome. This allows the person to react quickly to
a given situation.
Chronic stress is different, the body has to take a long term view of the stress that it is being
put under. Chronic stress can make a situation that we normally cope with difficult. Chronic
stress will exaggerate the effects of acute stress and in the long term threatens a person’s
health.
Stress is Cumulative
Long term stress over a period of time can affect the individual’s ability to perform in stressful
situations. In a pilot this can result in:
¾ Inaccurate flying
¾ Communication difficulties
¾ Leadership and command problems
A simple model like the one shown below can help describe the effects of stress.
Stress
Stressor Stress Mediation
Reaction
Where:
Stressor A situation or event that causes a stress

Stress Reaction The physical, physchological or emotional response of the
body
The interaction of stressors and the resultant stress reactions are not straightforward. We all
react differently to different stresses in life. What seems minor to one person may be a life
crisis in another.
To misquote Kipling:
“if you can keep your head when all around you are losing theirs, you don't understand the
problem!”
Any stress reaction is related directly to the evaluation of the stress and the perceived ability a
person has in coping. Solely psychological these are our stress mediators and can be good
or bad depending on our perception of the problem.
To extend the simple stress model used before.
Stress
Stressor Stress Mediation
Reaction
Change Physical
Coping Skills
Frustration Psychological
Perception of Stress
Conflict Emotional
Predictability
Pressure
Boredom
Trauma
Listed are some of the major stressors in life. These pass through a mediation phase that
then is felt by the body as a stress reaction.
Mediation should lessen the effect of stress. As we learn to cope with the R/T and flying the
aircraft at the same time both become inbuilt into our sub-conscious and are no longer
worried about.
However mediation may not work:
Example Assume that you are on an approach to London Heathrow. The weather is
poor. The cloud base is on the ground, the crosswind is on limits.
There are two possibilities.

One You cope with the approach and do a good job
Two You “cock it up”
One week later you are flying into London Heathrow in exactly the same
conditions.
If you succeeded last time stress mediation will have taken place and you will
not be so worried about the approach and most probably you will make a
good approach again.
If you failed last time your brain will be telling you that you failed last time and
that you can’t do it. In this case mediation is worse and you will most likely
fail.
Psychological Stressors
The stressors that are related in the simple stress model can be experienced as shown
below.
Frustration Where obstacles stand in the way of our progress such as

holding because of problems on the ground
Pressure Whether self inflicted or external we all get the feeling
so much to do and so little time to do it
Last minute cramming for the examinations?
Boredom A problem in that a bored person does not work at peak

performance and can be left wanting in an emergency
Trauma A physical or emotional experience that leaves the body in

shock
Conflict Domestic or work, conflict can make the life of the sufferer
miserable.
Change Change is related in this chapter by the use of Life Change

Units. The events listed are measured relative to each other
for a Northern European adult. If you accumulate more than
120 LCU's/12 months or 200 LCU's/2 years, then you may
suffer a minor life crisis.

STRESS
EVENT VALUE IN LCU's
DEATH OF A SPOUSE 100

DIVORCE 73
MARITAL SEPARATION 65
IMPRISONMENT 63
DEATH OF CLOSE FAMILY MEMBER 63
PERSONAL INJURY OR ILLNESS 53
MARRIAGE 50
DISMISSAL FROM WORK 47
MARITAL RECONCILIATION 45
RETIREMENT 45
CHANGE IN HEALTH OF FAMILY MEMBER 44
PREGNANCY 40
SEX DIFFICULTIES 39
GAIN OF NEW FAMILY MEMBER 39
BUSINESS READJUSTMENT 39
CHANGE IN FINANCIAL STATE 38
CHANGE IN NUMBER OF ARGUMENTS WITH SPOUSE 35
MAJOR MORTGAGE 32
FORECLOSURE OF MORTGAGE LOAN 30
CHANGE IN RESPONSIBILITIES AT WORK 29
SON OR DAUGHTER LEAVING HOME 29
TROUBLE WITH IN-LAWS 29
OUTSTANDING PERSONAL ACHIEVEMENT 28
WIFE BEGINS OR STOPS WORK 26
BEGIN OR END SCHOOL 26
CHANGE IN LIVING CONDITIONS 25
REVISION OF PERSONAL HABITS 24
TROUBLE WITH BOSS 23
CHANGE IN WORK HOURS OR CONDITIONS 20
CHANGE IN RESIDENCE 20
CHANGE IN SCHOOLS 20
CHANGE IN RECREATION 19
CHANGE IN CHURCH ACTIVITIES 19
CHANGE IN SOCIAL ACTIVITIES 18
MINOR MORTGAGE OR LOAN 17
CHANGE IN SLEEPING HABITS 16
CHANGE IN NUMBER OF FAMILY REUNIONS 15
CHANGE IN EATING HABITS 15
HOLIDAY 13
CHRISTMAS 12
MINOR VIOLATIONS OF THE LAW 11

For the pilot, as well as the domestic changes that are listed above there are certain events
specific to the job in hand:
¾ Medicals
¾ Training and line checks
¾ Time schedules and late passengers
¾ Other crew members
¾ Company pressure
¾ Fatigue etc
There are many more, these are but a few.
Effects of Stress
Stress affects our motivation and performance. Small amounts of stress are needed to make
the body move. This can be related in a simple performance/ arousal graph. As the amount
of stress increases we are initially:
Optimum
Arousal
Performance
Loss
Performance
Low
Arousal
Arousal
¾ In a low arousal state. This can be thought of as just waking up or being over
fatigued. The central nervous system is not functioning fully and any information
processing is slow and inaccurate. Motivation to react to stimuli is low and the
body is inattentive. Think about what your actions are when you wake to the
alarm clock. Get up straight away or press the snooze button?
¾ As the day progresses the arousal increases as does the performance. Under
optimum conditions the central nervous system is functioning correctly. To carry
out complicated tasks the body needs to be in this state of optimum arousal:
¾ One where a task will stimulate and interest the brain but not be so
complicated so as to push us into an overload situation.

¾ Once the limit of capacity is reached then the performance falls rapidly.
Physical and Psychological Stress Reactions
Stress reactions are the physical, psychological or emotional response to the stressor. The
reactions are not independent of each other but can be interrelated. For simplicity each is
discussed separately.
Physical Stress Reactions
Think of what happens to you when you have a sudden shock. Pulse and breathing become
rapid, possible sweating and trembling. The fight or flight syndrome is an animal reaction to
danger and results in the release of certain hormones (Adrenaline and Nor-adrenaline) into
the bloodstream. The commands to release these hormones come from the Sympathetic
Branch of the Autonomic Nervous System. As the danger passes, the Parasympathetic
Branch calms the body down.
The long term effects of stress are better explained by the General Adaptation Syndrome.
General Adaptation Syndrome
Resistance
Alarm Exhaustion
Three stages occur:
The Alarm Stage A stressor causes a fall in our resistance. Defensive

measures are taken by the body and it starts to act against the stress.
The Resistance Stage Once mediation has taken place the body prepares a
resistance phase. This is a time limited phase as the body can only cope with so
much.

The Exhaustion Stage Eventually resistance will fail if the mediation has not
been successful. Prolonged exhaustion can be fatal. More common are ailments
such as hypertension, organ failure, cardiac arrest, ulcers, or renal failure.
Psychological Stress Reactions
Stress is related as the way that a person feels and responds to a situation. These feelings
are divided into three simple categories:
Emotional Responses Common emotional reactions to stress include

anger, anxiety, fear, depression etc.
In extreme cases emotional responses can be come uncontrollable and cause

such problems as anxiety attacks.
Cognitive Responses Stress affects the ability to concentrate on the task in

hand. To think clearly and logically defence mechanisms are used to cope with the
stressors.
Behavioural Responses The changes in the way a person acts when

stressed. Fidgeting or shaking when worried is just one example. In the pilot the
most common response to stress is the use of alcohol.
Domestic Stress
The one stress we all suffer from at some stage in life. By using the LCU table you can
determine how life is affecting you. Domestic stress does affect the workplace no matter who
you are.
Clinical Effects of Stress
The body reacts in differing ways to cope with stressors. Both psychological and physiological
responses are made:
Physical Effects The “Fight or Flight” syndrome where the

Sympathetic Branch of the Autonomic Central Nervous System is activated.
Health Effects Increased heart rates and the release of adrenaline

will cause hypertension.
Behavioural Effects The problems of the over use of drugs or alcohol.
Cognitive Effects Lack of concentration and lack of attention to detail

lead to the inability to deal with problems clearly and logically.

Emotional Effects The body releases tension in many ways which may
include aggression or moodiness etc.
Coping Skills
To cope with stress the person needs to accept that a stress is causing problems. The next
stage is to choose a coping strategy that best helps. Some coping is carried out
subconsciously. If the sub-conscious does not work then there are strategies that can be
adopted. To cope with a stress the person must accept that they are under stress and want
to do something about it.
These conscious coping strategies are:
Action Coping The reduction of stress by direct action. Implementation usually

includes some or all of the following:
Assessment Find the sources and effects of the stress
Set Goals Find the stressors and stress reactions that need to be
attacked
Plan Make a plan of action on how to cope
Action Carry out the plan
Evaluation Check to see if the plan is working. If not, try again or revise
the plan.
Cognitive Coping Cognitive coping is a method in changing the way we think

about a problem. Methods used include:
Distraction Concentrate on other tasks to take away the pressure of the

stressor
Redefining the Situation Try to make the stress more acceptable
Direct Action By thought the decision may be to use action planning
Catharsis An emotional outburst to release the stress
Acceptance Decide to accept the problem and do nothing about it
Symptom-Directed Coping The use of external coping skills:

Physical Exercise A healthy person copes with stress better than an
unfit person. Stress can be released in the aggression of sport – is that golf
ball your bosses’ head?
Relaxation Techniques Use of areas such as meditation or hypnosis

to counteract the ravages of life.
Other Coping Strategies include:
Religion The help of the church and someone to talk to is a good way of
helping with stress
Counselling Not only professional counselling but talking with a friend can help.
Stress Management
The way that a person decides to cope with a stress. To carry out stress management the
person must first accept that stress is causing a problem.
It is easy to recognize the signs of stress in oneself, but what about others?
If a person does not manage stress, stress will manage the person. Life events do not create
stress; the perception of the stress is created in our minds. The source must be identified
before it can be addressed and reduced or eliminated.
Make a plan and stick to it. The aim is to control or to eliminate the effects of stress. Be
realistic and practical. This may call for you to be flexible and willing to adapt. Rest is
essential as a tired mind and body give quickly. Humour and perseverance help.

Chapter 14.
The Nervous System
Introduction
The nervous system is a communication system which allows the body to adapt itself to an
ever changing environment. It includes:
¾ The spinal cord with the spinal nerves

¾ The brain and its cranial nerves
¾ The autonomic nervous system
¾ The sense organs
¾ The eye
¾ The ear
¾ The organs of taste in the mouth
¾ The epithelium in the nose which is sensitive to smell
¾ The sense organs of the skin and muscles which are sensitive to touch
The Central Nervous System
Cell Body
Axon
The basic unit of the nervous system is the neurone (nerve). The neurone consists of:
¾ A cell body
¾ Dendrites which conduct nerve messages to the cell body
¾ The axon, a slender thread which conducts nerve messages away from the cell to
the central nervous system
The brain and spinal cord make up the central nervous system, a collection of neurones
connected to each other by dendrites and axons.

Brain
The brain is the master controller of the body, more complex than any computer. Consisting
of a mass of nervous tissue the brain is responsible for:
¾ Our senses
¾ How we learn
¾ Our memory
Specific areas of the brain monitor and control the different areas of the body. The Cerebrum,
the largest division of the brain, is where information processing occurs. The Cerebellum is
the structure of the brain that helps a person maintain their balance while standing. Below the
cerebrum and cerebellum lies the brain stem; this connects the brain to the spinal cord.
Spinal Cord
The spinal cord is nearly cylindrical and runs down the middle of the vertebrae of the spine.
The spinal cord contains billions of

nerve fibres which transmit signals to
and from the brain. Branching out from
the spinal cord are the spinal nerves.
Each nerve leaves the spinal cord as
two roots which join once clear of the
vertebrae. These nerves connect all of
the body's areas and tissues below the
head to the central nervous system.
Some of these nerves are connected

to each other, as well as to the brain.
These connections allow a loop to be
formed which does not depend on the
brain for a response. Known as a
"reflex" the loops allow for a faster and
simple reaction in critical situations eg
placing a hand on an electric hot plate,
the hand is automatically pulled away
such that the response is completed
before the brain has had time to think
about it.

The Peripheral Nervous System
Peripheral nerves emerge in pairs from the spinal cord and pass to all parts of the body. Like
telephone cables they are capable of relaying both incoming and outgoing signals. These
nerves can be grouped into three divisions:
¾ Sensory nerves
¾ Motor nerves
¾ Autonomic nervous system
Sensory Nerves
Sensory nerve fibres carry information received by the senses to the brain. Sensory nerves
are designed to detect stimuli from:
¾ Touch
¾ Pressure
¾ Pain
¾ Temperature
¾ Position
Motor Nerves
Motor nerves carry the orders sent by the brain to the muscles. The motor system controls the
body's motor functions or more simply, movement. Motor nerves are attached to the muscles
of the body, impulses are sent from the brain which signal the muscle to contract or extend,
placing the skeleton into the position required. If more control is needed then more motor
nerves are required eg in finger control. The majority of the motor nerves are voluntary. This
means that a person must think about moving a muscle.
Autonomic Nervous System
The autonomic nervous system supplies those organs of the body that are not under the
control of the will eg contraction of intestinal muscles to push food along. There are two
divisions of the autonomic system:
¾ Sympathetic system
¾ Parasympathetic system
The two systems effectively work against each other sending opposite signals to the organs:
¾ If the heart is beating too slowly the sympathetic system will send signals to
increase the heart rate

¾ When the heart is beating too fast the parasympathetic system will send signals
to slow the heart down

Chapter 15.
Human Information Processing
Introduction
During the day a person makes hundreds of decisions. Flying an aircraft is no different, the
pilot must use his decision making skills continuously. An American diplomat once said:
Only total inactivity will cause no errors
Edward Phelps – US Diplomat
The pilot, unfortunately, cannot follow this course of action as the aircraft will eventually run
out of fuel. The use of information and decision making is a complicated process. The neural
pathway through the brain where information is received, a decision taken and a response
executed are too complicated for this course. A simple model of what is called Human
Information Processing (HIP) follows.
Sense
A physical stimulus has to be received by the receptors.
Stimulus Receptor
Sight Eyes
Sound Ears
Taste Tongue
Touch Proprioreceptive System
This raw energy is unusable to the brain and needs to be converted (transduced) into
electrical impulses.
Transduction
Stimulus Receptor Sensory

Memory

Initially the information is sent to the Short Term Semsory Memory. The time that the
information is stored is limited and depends upon the attention that can be paid. Information
from the two main senses are held in:
Iconic Memory Visual sensory store which lasts for 0.5 to 1 second
Echoic Memory Auditory sensory store which lasts for 2 to 8 seconds
Once there is enough processing capacity in the brain then the information is passed on to
the area of perception.
Attention is paid during each of the following processes. The amount of attention that can be
paid to each piece of information is limited as will be seen later in this chapter.
Perception
An interpretation or impression based on one’s understanding of something
Perception is the process by which the brain recognises and interprets the transduced
stimulus which has been held in the short term sensory memory. In the perceptive stage the
mind starts to build up a mental model.
This entails building a 3-D model which builds pictures in our minds of:
¾ Where we are
¾ Where we are going
¾ Where we have been
It is true to say that our mental model is our conceptual way of understanding:
¾ What an object is
¾ How that object works
¾ What effect that object is going to have in our life
Transduction
Receptor Sensory Perception

Stimulus
Memory

Perception is based on the information we sense and our expectations of the world.
Perception is based on the following inputs:
¾ The processing capacity of the brain

¾ Past experience
¾ Expectation
Unfortunately, once we have reached the perceptive process it is difficult for us to change our
minds. It is at this stage that the human being is most likely to fall into the problem of
Confirmation Bias.
Confirmation Bias
Confirmation Bias is part of the human error process that occurs when a false perception is
made. It is a situation where a person has made a decision and only believes information that
confirms that decision. Any contradictory information is ignored.
For example:
In a two engined aircraft where there is a burning smell in the cockpit. If one engine is
shut down and the burning smell goes then it might be fair to assume that the correct
engine has been shut down.
If in the above case the conditioning system is taking air from both engines then the
burning smell might have gone for another reason and the incorrect engine shut
down. In this case the pilot may be tempted to believe that he has shut the correct
engine down and Confirmation Bias has been started.
Central Decision Making and Response Selection
Once perception is completed then a decision has to be made. Impulsive or immediate

response can be made or the HIP continues with the brain using:
¾ The working memory and long term memory, or

¾ The motor memory system

Transduction

Stimulus
Memory
Decision and
Response
Ultra-short Term Memory
If an immediate response is required then the brain replies on impulse using the “ultra short
memory”. This memory can retain sensory inputs for about a second. This does depend on
external factors such as strength of impression.
In the ultra-short term memory, material is processed very quickly according to its current
importance. Importance or priorities will vary from person to person and with the situation.
Cocktail Party Effect
Cocktail party effect is one way that the brain uses this ultra short memory. A crowded Friday
night bar where you are in conversation with friends. You are concentrating on your group
when a person behind you says your name. Without altering expression you immediately
change your attention to the other group.
Working Memory or Short Term Memory
Both terms are frequently used. Consider the following. If a pilot hears a warning bell on a
flight deck then they will probably react in one of two ways:
¾ Switch off the sound in which case an immediate response has been made.
¾ Hold the information in memory whilst a search is made in order to identify the
problem.

The above uses a continuous process where information is constantly entered and recalled
from memory. During this period a decision has to be made where the information is stored –
the short term memory or retrieval from the long term system. The central decision and
response channel can only work one problem at a time and is thus a choke point within the
brain.
Transduction

Stimulus
Memory
Decision and
Response
Long Term Short Term

Memory Memory
Short Term Memory and its Limitations
When the brain accesses the short or long term memory system the short term memory will
store information for a short time.
Used to retain information that is not needed in the long term memory, the short term memory
only retains information for a limited period and its capacity is limited to:
¾ 7± 2 unrelated items of information that can be held for approximately 10-20 seconds
unless active rehearsal is used to retain the information.
¾ A process called “chunking” can increase the number of items.

eg the use of telephone numbers
¾ A telephone code 041 is held as one item not three
¾ An area code 01455 is held as one item not 5
¾ 01455 477686 would be retained as 2 items not 11 which would overload the
short term memory
Short term memory is prone to interference and any interruption can and will cause the loss of
information.
For example:
You need to phone a person but do not know the number. You look it up in the phone
book and start rehearsing it as you go to the phone. Before getting to the phone you
are interrupted for about 30 seconds by something. The short term memory loses the
phone number and you have to start all over again.
Environment Capture
The short term memory is prone to a problem known as environment capture. A frequently
operated skill in the same environment (a habit) where the pilot has not made a conscious
decision to operate the skill.
For example:
When flying in the traffic pattern. Pilots who delay undercarriage selection somehow
have this information dislodged from the working memory especially if the delay is by
some form of interruption like ATC instructions. The event will generate a standard
response from what becomes a boring activity, flying several uneventful circuits. The
pilot may make the final gear down call because he always makes it at this time. The
mental model is completed and the pilot believes he has selected gear down. Only
when the aircraft scrapes down the runway does the pilot realise that he has failed to
select the gear.
Long Term Memory and its Limitations
Long term memory has two distinct parts:
Semantic Memory This is the store associated with what we know and do: the
understanding of a word; how to fly an aircraft; facts - London is the capital of
England.
This area of the brain stores all the information that is learnt, including that
information we will never use. If a word or fact is forgotten it is because the neural
pathways are forgotten, not that the information is lost. The information is stored in an
area of the brain that has not been accessed for a long time.

Episodic Memory Episodic memory is a fluid memory that remembers events
that have been experienced. It is coloured by our desires and expectations. Stories
are not remembered factually but reviewed and changed to suit the teller’s needs.
In eye witness reports episodic memory can have problems. Think about the
reporting of aircraft crashes:
¾ All aircraft burst into flames before they crash

¾ All pilots fly the aircraft away from schools, hospitals and houses before
they crash
Other problems occur with the “expert” witness. A pilot witnessing an aircraft crash
has expectations of what was happening in the cockpit and will relate these as what
he saw. A non-expert witness is more likely to give a better account. Children give the
best eye witness reports as their episodic memory has not yet developed.
Motor Memory
When a new action is learnt then it initially seems difficult. Like riding a two wheel bike for the
first time. Piloting is exactly the same, initial impressions of flying, ATC etc seem to make the
task impossible when training is started. Like most actions which are well practised flying is
eventually executed by a motor programme. Non conscious actions are used to fly the aircraft
whilst talking on the radio uses conscious thought through the decision and response
channel. The motor programme is by-passing the central decision and response channel.

Transduction
Stimulus Receptor Sensory Perception

Memory
Decision and
Response
Response
Execution
Long Term Short Term Motor Memory

Memory Memory
A motor programme can be used when an action has been well practised and is repetitive.
The performance of this action becomes automatic and no conscious thought need be
applied. The process by which motor programmes operate is complex but as soon as the
flying becomes difficult eg landing, the central decision and response channel has to be used
to fly the aircraft.
Action Slip
The advantages of using motor memory is obvious, as it extends our capabilities. Action slip
is an error process that is caused by the brain using motor memory.
For example:
Pouring a cup of tea, whilst watching TV, and then adding sugar to the cup. If there is
some distraction on the TV we can find ourselves pouring tea into the sugar bowl.
The action of pouring the tea is being carried out by a motor programme, with no
conscious thought being applied. With the distraction the process of pouring the tea
carries on and we start pouring the tea into the sugar bowl because the brain thinks it
has progressed to the sugar stage, or:
BAC 1-11; My first officer was flying the leg. After T/O I carried out the usual checks. Brakes,
U/C up, PAX notices off etc. Weather lovely, blue sky. W/V 270/18, temp +30C! At 1500 ft I

noticed the flaps were retracted. I thought the F/O had retracted them early. Usually the flap is
retracted at 200 ft plus in VFR or 3000 ft noise abatement. Almost immediately he mentioned
that the flaps were retracted. "Oh, I see you have brought the flaps in" he said. "No", I replied,
"I haven't touched them". He said that he hadn't either. Shortly after this he noticed the U/C
was still extended. I raised it. There can be no doubt I raised the flap instead of the U/C after
take-off. I had no memory of this. Why would I do this potentially dangerous thing on an
aircraft with which I was completely familiar? I have no idea; no sickness, no stress, nothing
dramatic personally.
Response Execution
Once the memory has been used the brain has to make a response. How appropriate the
response depends upon the pressure that a person perceives that he is under. The following
apply to decision making in all walks of life:
¾ If a delay is dangerous then a person will feel that they are under pressure to
make a quick decision
¾ Quick decisions are usually made before all information is processed
¾ Where there is stress then a fast but less accurate response is made
¾ Sound stimulates the mind better than sight
¾ Where a person plans for the expected then it is possible that if there is any
change then pressure will make the brain reply with the planned response
A crew planning for runway 13 from take off to landing. Only when they
contact tower is runway 31 given as the landing runway yet they still land on
runway 13.
¾ An old person may react more slowly than a young person yet the response is
usually more accurate
Attention
Attention is a limit to HIP, it depends upon certain factors:
¾ The limit to the number of items working memory can hold.

¾ The rate at which information can be passed through the central processing
system.
Whether attention is paid to a stimulus depends upon:
¾ The importance of the stimulus

¾ The available attention

Attention can be described in two ways.
Selective Attention
Selective attention is where inputs are sampled and given a priority. Detailed processing can
only be carried out on one complex task. If there are too many demands on the attention then
information will be lost.
In 1972, a Tristar on approach to Miami experienced a minor undercarriage malfunction. The

crew selected the auto-pilot and looked into the undercarriage problem. Unfortunately, the
auto-pilot setting was such that the aircraft entered a shallow descent. As the aircraft
approached the ground, ATC, other aircraft, visual and audio warnings tried to attract the
crew's attention to their danger. The crew's attention was focused on their undercarriage
problem and were filtering out all other warnings, until it was too late to do so. The aircraft
crashed killing all on board.
Divided Attention
Divided attention can be used to carry out two tasks that do not overload the HIP.
Motor programmes, which are run with no conscious thought, can be consciously checked by
a pilot who diverts his attention away from the major task in order to check a sequence of
operation.
Stress and Attention
Stress focuses the attention processes. Thus to complete a task, under stress, we focus
entirely on that task in hand. This is always to the detriment of other problems.
Response Behaviour
Once a response has to be made the brain will use one of the three response behaviours.
Skill Based Behaviour
Skill based behaviours are procedures acquired through practice and that are executed
without conscious thought. Skill based behaviour is obtained in two distinct manners:
¾ Concentration on the individual parts of a skill, giving them attention, until practice
makes the individual processes second nature.
¾ Practising the whole skill with concentration on the final product. Eventually a
motor programme is made which carries out the skill based response.

Once these skills are acquired then they seem to possess certain characteristics:
¾ The skill is not easily explained to others. This may cause difficulties if a pilot
wishes to pass on the skill.
¾ If the skill needs to be modified then the component parts must be broken down
and re-learnt.
Because of the uses of motor programmes in skill based response a pilot operating a skill
makes the decision to do so and then has the attention to monitor the task. But if a distraction
is introduced then the pilot may make an inadvertent operation. Environment Capture can
also occur in skill based response.
All actions need to be consciously checked, especially those that are using sub-conscious
thought.
The errors of skill do not normally happen to the student pilot; they happen to a pilot with
experience.
Rule Based Behaviour
Rule based behaviour uses the short and long term memory to carry out actions. Rule based
behaviour is stored in the long term memory and involves the use of the central decision and
response channel. By using conscious thought the error problems that occur with motor
memory skills are bypassed.
Simulator, procedural training or similar work that involves the use of Flight Reference Cards
and checklists or plates are examples of this type of behaviour. The only problem relates to
the well known saying:
Garbage in – Garbage out
Knowledge Based Behaviour
Knowledge based behaviour is based on the reasoning powers that a person can use to
arrive at a decision. The pilot is able to use his own thinking processes to evaluate and then
reach a decision.
Feedback
When carrying out a task then we must continuously monitor the consequences of our
actions. To enable the information to be processed, both internal and external feedback
mechanisms are used.


Chapter 16.
Situational Awareness and Attention
Introduction
“Stay ahead of the Aircraft”. How many flight instructors have used this term to tell a student
to think about his flying? Does he mean that the student’s Situational Awareness is lacking?
When we look at aircraft accidents we have to ask ourselves this question:
Why does a well motivated crew, in an aircraft fitted with all the latest equipment, fail to
perform at a critical point during a flight?
Situational Awareness
It is difficult to define personal or crew situational awareness. Below are some definitions that
other people have used:
¾ Situational awareness is the perception of the elements in the environment within

a volume of time and space, the comprehension of their meaning and the
projection of their status in the near future (Endsley 1987)
¾ Situational awareness refers to the up to the minute cognisance required to
operate or maintain a system (Adams, Tenney and Pew 1995)
¾ Situational awareness is adaptive, externally directed consciousness. At a very
simple level, situational awareness is an appropriate awareness of a situation
(Smith and Hancock 1995)
The above definitions are really definitions for the single crew. For the crew:
¾ Team situational awareness involves two critical but poorly understood

abstractions; individual situational awareness and team processes in a highly
interactive relationship (Salas, Prince, Baker and Shrestha 1995)
¾ Team situational awareness is the crew’s understanding of flight factors that
affect (or could affect) the crew and aircraft at any given time (Wagner and Simon
1990)
Building Situational Awareness
To help build situational awareness we need to build a 3 D model which pictures in our mind:
¾ Where we are
¾ Where we are going, and
¾ Where we have been

This mental model is our conceptual way of understanding:
¾ How or why something is working

¾ Why something is happening
¾ Why a person is behaving in the way they are
There are numerous factors that affect Situational Awareness. The diagram below lists but a
few:
Task Crew
Aircraft
Intent
Dynamics of Goals
Standard Behaviour
the Situation Constraints Individual Behaviour
Performance
Resources
System Status
Sensors
Avionics
Situational
Awareness
Air Traffic Control Active Monitoring Environment

Clearances Cockpit Navigation Data
Instructions Senses Weather
Information ATC Other Traffic
Other Flight Crew
The mental model that a pilot prepares is created by both experience and expectation. It is
therefore, a perception of events. The problem with perception – has the pilot picked up the
reality of the situation or is it imagination?
To ensure that the crew situational awareness is equal all crewmembers must remember that:
¾ In the modern flight desk “knowledge is not power”

¾ All information must be shared
¾ Effective communication ensures that the correct message is sent
There is a need for an accurate perception of the factors and conditions that affect the aircraft
and flight crew before, during and after the flight.

Personal Factors Affecting Situational Awareness
Vigilance Most tasks require constant monitoring without lapses in attention.

Vigilance can be defined as attention to the task in hand such as continuously
scanning for other aircraft during a long flight. Vigilance is decreased by factors such
as:
¾ Fatigue
¾ Loss of sleep
¾ Boredom
Arousal Defined as “to awaken from sleep”. In the aviation sense it can be
taken as maintaining preparedness for a task. As seen in the chapter on stress a high
level of arousal is needed for optimum performance. It is fair to state that a high
arousal state requires a high vigilance state. Low arousal leads to low vigilance and
very poor performance.
Hypervigilance A state of panic. This worrying state can manifest itself

quickly and for no apparent reason. The sufferer becomes illogical in the way that
attention is paid to all tasks. Minor problems may take a disproportionate amount of a
pilot’s attention leading to major problems being missed.
Three levels of Situational Awareness
The pilot requires the skills of not only coping with what is happening now but with the skills of
anticipating what is going to happen in the near future. This can be broken down into three
Situational Awareness Levels:
Situational Awareness Level 1 Monitoring

Situational Awareness Level 2 Evaluating
Situational Awareness Level 3 Anticipating
Situational Awareness Level 1: Monitoring
There are limits to how much a pilot can see and hear at the same time. Monitoring is an art
where the pilot needs to be aware of the present needs and be able to ignore the unwanted.
Easy to say – difficult to act upon.
Let us look at some techniques that can move us towards this goal.
Attention is like a searchlight. It can be focussed in one direction. Attention can become so
narrow that a pilot can ignore all outside influences to ensure that he concentrates on the task
in hand. Narrowly focused attention is useful when solving difficult problems. But who is flying
the aircraft?

If the attention is widened too far the pilot will be aware of all aspects of the flight and its
environs. The pilot’s job requires the ability to focus on a problem and to keep the big picture.
Too wide a span and overload is a possibility. In two crew aircraft, redundancy allows for one
crewmember to focus on a problem whilst the other is “flying the aircraft”.
It is easy to fall into the problem of being sidetracked. These distractions have to be sorted
into those that matter and those that don’t. Distraction is an easy way to fall into the first
stages of an error chain.
As a pilot you need to be able to:
¾ Keep the big picture.

¾ Pay attention to detail.
¾ Not get sidetracked or distracted.
Situational Awareness Level 2: Evaluating
To fall behind the task in hand is one of a pilot’s worst nightmares. In this level the pilot needs
to evaluate and comprehend the numerous inputs associated with the flying job in hand. In
addition to monitoring inputs there must be comprehension as well. This allows the pilot to
have a Situational Awareness of the task in hand.
The majority of problems in this category come from difficulties with automation. To stay on
top of the situation we must utilise all sources of information.
Situational Awareness Level 3: Anticipating
The pilot not only needs the awareness of what is happening now but needs to be able to
anticipate what is going to happen in the future.
This stage ensures that crews have the same awareness of a problem and can both work to
the same goal. The crew that anticipates usually stays away from the problems that high
workload situation brings.
Pilot Considerations
“What if” is the question a pilot should continuously ask. This question can help in the
management of the cockpit environment which includes Situational Awareness. Both pilots
need the knowledge of “what”, “where”, “when”, and “who” during any portion of a flight.
Briefing/Debriefing
A NASA study showed that those crews that brief and debrief a flight are much more effective
than those who don’t. Both briefing and debriefing allow pilot’s to plan the sortie. This plan is
the initial basis on which Situational Awareness is built. The brief is the initial sharing of
knowledge.

Conflict Resolution
By monitoring, another crewmember’s mistakes can be quickly recognised and dealt with.
SOPs help by designating the responsibilities of both the pilot flying and the pilot non-flying.
Each pilot will have certain responsibilities but must also monitor the situation with the other
pilot.


Chapter 17.
Communication
Introduction
Communication can be defines as a process where:
Information, thoughts and feelings are exchanged in a readily and clearly understood manner
Communication is essential in the modern day transport aircraft in order to maintain

Situational Awareness.
Karl Marx wrote:
he who communicates, leads
Communication
Effective Communication
Why should we communicate effectively? Consider the words below:
Captain: Take-off power

Engineer: Responds by pulling the power back on all four engines. Good thing it
was at the take-off point
On the flight deck the pilots need to communicate ideas, concerns and information effectively.
How effectively this is done depends not only on the sender but the receptiveness of the
receiver. Do not assume that everything you say is clearly and immediately understood. The
opposite is often true. Hearing is not synonymous with understanding and without
understanding there is no effective communication.
Effective communication is vital for the safe conduct of flight operations, but, what is effective
communication? How can we define it?
Consider other words beginning with the same 6 letters, ie., community, communism,
communion, communal etc, all imply sharing. Communication could be defined as the sharing
of information. We are concerned, however, with effective communication. Is the sharing of
information, therefore, enough for us to have communicated effectively?
Any message starts with a sender. It is eventually received by the receiver. To be effective
this message must be sent and received with the minimum of change to its meaning.

The Cost of Effectiveness
All communications have a price. To ensure that the message has been correctly received a
check of understanding must be carried out.
Results of Poor Communication
Look at the Company angle rather than the flight deck, what are the results of poor
communication?
Low Production By poor rostering you fail to fly an economic number of hours
for the company. Such as missing a flight to Inverness
because the company failed to ring you.
Apathy "Well they didn't tell me about the 0630 Inverness shuttle last
week, who knows if they will bother this week".
Mistakes Occur "I thought I was on the 0730 to Heathrow".
Non-Cooperation "Well if they can't be bothered to tell me anything, then they

can get stuffed".
Grapevine Abounds "I hear Captain Bloggs is for the chop for missing the
0630 to Inverness ".
We have all experienced something similar in life at some stage.
The key to good communication is whether the sender is a good transmitter and the message
is sent to a good receiver.
The good transmitter
¾ Passes clear and easy to understand instructions

¾ Has a clear voice
¾ Transmits when the receiver is ready
¾ Ensures that the message is understood and that a feedback system is in
operation
The good receiver
¾ Pays attention to the whole message

¾ Tells the transmitter if they are not ready
¾ Acknowledges the receipt and understanding of a message

Types of Communication
Communication comes in many forms: verbal, written, pictorial etc. Each type of
communication needs to be looked at separately to discover the positive and negative
aspects.
Written Communication
Written communication is provided to the pilot in many forms such as; checklists; JAR-FCL
OPS; UKAIP; Ops Manuals; letters; memo's etc. The advantages of written communication
is obvious; letters and memos can be distributed quickly; checklists and publications can be
amended quickly if mistakes occur. Negative aspects are that the communication is
impersonal; it is one-way and subject, therefore, to ambiguity and misinterpretation; no
check of understanding can be carried out; is the document up to date? Written
communications have to be well structured and simple to use to be effective.
Think of an insurance policy and all the small print. The length of sentence and the legalese
used may mean that you have forgotten what you first read before you get to the end of the
sentence. Survey has shown how the number of words in a sentence affect understanding:
The Number of Words % Who Understand

in a Sentence After the First Reading
27 4
15 70
12 86
8 94
Shortening the sentence does not mean that the sentence is any easier to understand. Think
of the double meaning of both the sentences below:
If you find any of our goods unsatisfactory you should see our Manager!
The Area Manager has passed all water used in our batteries.
Visual and Pictorial Ambiguity
Pictures tell a thousand words. Yet in the chapter on visual illusion we can see how easy it is
to become confused.
In 1979, an Air New Zealand DC10 flew inexplicably (seemingly) into the side of a
13 000 ft active volcano in Antarctica. The weather in the area was declared
VMC; the aircraft was in controlled flight; there was no alarm expressed by the
crew recorded on the cockpit voice recorder, so why did the DC10 crash? Visual
ambiguity in true whiteout conditions was a major causal factor.

Verbal Communication
Verbal communication is face to face and with body language aids the interpretation of a
message. Most verbal communication is two-way, allowing questions to be asked to achieve
clarity. Verbal communication can be ambiguous and because there is no written record may
be difficult to refer to.
Social Skills
Social skills refers to the basic behavioural mechanisms that we use between each other.
One of the main areas is body language.
Body Language
There has been a lot written on the term body language. Below are listed some of the
general principles that help to maintain good relations on the flight deck.
In the diagram below the way that we carry out normal communication is shown in a pie-
graph. Note how little attention is paid to the words and how much is paid to the body
language.
Normal Communication
7% The words
The way the words are

38% said
55%
Body language
The main methods by which we communicate using body language are:
Eye Contact Do you believe someone who constantly looks away from
you while you are talking to them? Not only does it show a lack of interest in the
conversation but is rude. Staring on the other hand can be used as a form of
aggression.
Facial Expression We all show happiness, sadness, content etc with our facial
expression. On the flight deck it is easy to show contempt, disgust etc.

Touch Touch is an important means of communication. In the Arab states the
handshake is a long protracted affair which if not carried out shows lack of interest. In
the UK, the handshake is little more than a grasp of hands. It is easy to forget the
importance of touch to some cultures.
Body Orientation and Posture The way that you sit, the way that you place
your body in respect to others communicates your feelings towards them. Crossed
arms, crossed legs all give different messages.
Physical Separation There is an approximate 50 cm space around the body that

is sacrosanct. Any invasion in this space is usually countered by a movement away.
Verbal Behaviour
The way in which words are said holds nearly as much importance as body language. The
emotions are easily betrayed by the speed, pitch and tone of the voice. Suffice to say that the
words themselves mean little in a general conversation.
As soon as the crew are on a flight deck then there is a block to the normal communication
state. As soon as the flight crew enter high workload areas of flight then the communications
are forced and the body language takes on a much lesser importance.
Forced Communication
10% The words
The way the words are

35% 55% said
Body language
It is at the high workload times that most communications errors that cause accidents are
made. It is important that the pilot realises that:
¾ There is a change in the preferred means of communication

¾ 75% of accidents occur in the take-off/landing phase of any flight (high workload)
¾ The words and the way they are used are critical at this stage of flight
Listening
40% of our day is spent listening and is a most vital area of communication. We all think that
we are good listeners but do we listen or do we hear? All too often the “noise” does not

penetrate into the brain and accuracy and meaning are lost. Problems in effective listening
are:
¾ We speak at approximately 125 words per minute, maximum 180 words per
minute
¾ We have the capacity to listen at 500 words per minute
The person uses the excess brain capacity for:
Planning Preoccupation with formulating a response and not listening to what

the sender is saying
Wandering Waiting for a key word and when it comes up, taking the
conversation into another area of interest
Debating Taking the opposite point of view.
Turning Off The receiver does not listen because it is felt that the message is not
important.
Listening is a skill. How many times have you been accused of hearing only those things that
you wish to hear?
I know you thought you understood what I said; but what bothers me is that what you heard is
not what I meant
The reasons behind poor listening lie in the Human Information Processing system itself. The
only way that we can converse quickly is by our perception process playing a guessing game
as we will see below. The brain attempts to guess what the other person is about to say, in
order that an answer can be prepared.
The two processes below are often confused:
Hearing The physical comprehension of a sound
Listening The process of interpreting physical, emotional and intellectual inputs
Look at the diagram below.
Reply
Person 1
Level of
Attention
Listening Planning
Person 2
Evaluating

This is a simple representation of an everyday conversation. Person 1 is speaking, Person 2
initially listens but soon wishes to become the centre of attention. As soon as the evaluation
starts the level of attention drops and no notice is paid to the conversation. Evaluation is
being carried out on the small portion of the conversation heard. Eventually Person 2 has his
reply formed and they interrupt to have their say.
To be a good listener then active listening needs to be practised. The process of active
listening can be split into 4 stages:
Stage 1
¾ Awareness of the sound

¾ Making sense of the sound
¾ The ability to distinguish words
Stage 2
¾ Understanding begins
¾ The listener starts to concentrate
Stage 3
¾ The distinguishing of fact from fantasy

¾ True analysis of information
¾ Dependence on knowledge and past experience
Stage 4
¾ Stage 3 plus the added dimension of empathy
To help the above consider the following:
Non-verbal Response
¾ Face the speaker, smile, look relaxed.

¾ Maintain eye contact.
¾ Encourage the other to speak.

Verbal Response
Use questions to check the understanding:
¾ Restrict the range of possible responses.

¾ Useful in getting specific information quickly.
¾ Improper use can make a person feel like they are being interrogated.
Questions are asked for many reasons such as:
¾ To obtain information
¾ To obtain information or views
¾ To show interest
¾ To check understanding
There are four types of popular question. Two are acceptable in an aviation environment, two
are not.
Closed Question
A question that invites a simple yes or no answer. This question is good for:
¾ Obtaining information
¾ Giving information
¾ Checking understanding
What is the capital of France?
Open Question
A question that allows another person to give their views.
What do you think about the approach into Heathrow?
Leading Question
Where the question gives the answer.
I think Luton’s our best diversion, don’t you?

Limiting Question
Similar to the above yet gives a limit to the answers.
Where shall we divert, Luton or Coventry?
Understanding
Once a question has been asked then there must be a degree of understanding. Remember,
that compliance is the norm in the human. Compliance is the psychological term which
describes a person's tendency to prefer to agree rather than disagree. The answer to our
question will invariably be yes, even if there is no understanding of the subject.
By use of the first two questions above there is the chance that effective communications can
be maintained. Remember the following that Rudyard Kipling wrote:
I have six faithful serving men

They taught me all I know
Their names are what and why and when
And how and where and who.
Use them to phrase your question and you are part of the way there.
Active Listening
Active listening is:
¾ The genuine desire to understand another person's perception

¾ Listening and expressing understanding of what another person has said
¾ Sensitivity to another's thoughts and feelings
Active listening is not:
¾ Passive
¾ Giving agreement or disagreement
¾ Judgmental
¾ Argumentative
The art of effective listening
Being an effective listener takes practice and a sincere effort on behalf of the listener.

The effective listener is:
¾ Trustworthy and caring

¾ Accepting
¾ Allows others to talk
¾ Focuses on thoughts and feelings
¾ Is constructive
¾ An active listener
Status, Role and Ability
Status
Status on the flight deck usually depends on two variables:
¾ Who is the captain

¾ Who is the first officer
The relationship between the two can be defined as leadership/followership. In status, the
captain has no difficulty in questioning the first officer; can the same be said about the
transfer of information the other way? The problem can be exacerbated when the captain is a
training captain and the first officer is just starting his career.
When crew are of an equal status, such as two Captains flying together or two Flying
Instructors, even two students. Those of equal status are reluctant to question the ability of
the other; there is a reluctance to appear to be taking over.
Role
The role of a pilot changes continually dependent on whether he is the handling or non-
handling pilot. Pilots are reluctant to take control in situations that appear to be dangerous
because they do not wish to show a lack of faith in the other.
Ability
We consider other pilots by our judgement of their ability. The Captain may well be a good
commander, but if we consider him a poor pilot then our relationship with him will be coloured.
Atmosphere
A good flight deck is one that has the right atmosphere created by both crewmembers. This
leads to effective 2-way communications. The atmosphere is created by:
¾ Correct attitudes for the Leadership/Teamwork job

¾ Interest is shown in the opinions of other crewmembers as much as the
completion of the task
¾ Open and frank discussion is encouraged
¾ Active listening is used and consideration given to an answer before the reply is
made
¾ Empathy is given to other crewmembers
¾ An explanation of answers and decisions is given to encourage an open cockpit
Communication summary
As the phrase says:
You cannot not communicate
To be an effective communicator the sender or receiver must be:
¾ An active listener
¾ A good questioner
¾ A clear and concise orator


Chapter 18.
Personality and Behaviour
Introduction
All people are different. Unfortunately, this can and does complicate our working life. We
begin to notice differences from an early age:
¾ Initially, the physical differences are those that are obvious

¾ Psychological differences are then noticed, areas such as:
¾ Personality
¾ Behaviour
¾ Intelligence
The differences in personality and behaviour that we show in everyday life are important in
aviation. Especially important are the behavioural traits we show when first meeting someone.
We all want a pleasant flight deck atmosphere. We all want to be sympathetic to other
peoples needs. A friendly relaxed flight deck atmosphere helps to:
¾ Foster good communications, which

¾ Helps Situational Awareness, which
¾ Leads to a safer flight
A lot is said about personality and behaviour, in simple terms:
Personality Is what we are

Behaviour Is what we exhibit
Working Relationships
The most important aspect of flightdeck operations is the relationship built up between the
pilots. As a human we constantly:
¾ Build relationships with people

¾ Break relationships
¾ Adapt ourselves to the change in our environment.
A pilot though is not only concerned with the building of relationships with other pilots. From
the minute they are at work, the process of building relationships start with:

¾ Car park attendants
¾ Operations personnel
¾ Cabin crew
¾ Dispatch
¾ Engineering
¾ ATC
In communications it was shown how important the way that words are said and body
language are. The importance of the following cannot be underestimated as well:
¾ First impressions
¾ Personality clash
¾ Cultural or religious differences
It is important that the pilot recognises the following traits to help flight deck communications:
¾ A person's personality
¾ A person’s style and their attitude to life
By recognising the above traits there is the chance to respond positively and enhance the
flight deck relationship.
Intelligence
There are no selection criteria for a person to train to be a pilot. There may be a selection
procedure within a company when sponsorship is involved but most pilots self improve and
hence are not selected.
Intelligence does not affect whether you can become a pilot or not. But, what is intelligence?
A great deal of work has gone into defining and quantifying the subject. Intelligence Quota
(IQ) tests are the benchmark most people think of when assessing intelligence. Unfortunately,
intelligence is sometimes mixed with the general world wise traits of the human.
Personality
Personality can be described as the inner person. It is personality that makes you the
individual that you are. Personality is:
¾ What you are born with, and

¾ What you acquire over your formative years from:
¾ Family
¾ Friends

¾ Education
Once the formative years have passed personality is fixed. However, it can be changed by a
traumatic influence such as brain damage after a car crash.
Assessment
There are times when it is necessary to assess a person's suitability for a task. This is
normally achieved in three ways:
Interview A subjective way of assessing a person. This is a person’s

view of another. Most people judge and assess on the first
impression and appearance. It is difficult to modify these
thoughts even with the passage of time.
Questionnaire Where a questionnaire is used techniques such as factor

analysis help with the construction of the document.
Questions may seem repetitive but the findings are linked
and give an assessment of the person.
By using the factor analysis technique, a valid questionnaire for assessing personality traits is
constructed and this builds a profile of that individual. One such questionnaire being the
Myers-Briggs profile which is widely used within the aviation industry.
Behaviour
Behaviour is similar to the clothes we choose to wear. Think of the clothes you would wear at
the following two occasions:
¾ A funeral
¾ A barbecue
Behaviour is very much the same. You choose your behaviour to a particular situation like the
clothes you wear. If you choose your behaviour, then you are responsible for your behaviour.
Unfortunately, you are judged on the way that others see you.
In reality the two statements below dictate behaviour:
First Impressions Last You never get a second chance to make a first
impression
Behaviour Breeds Behaviour If you shout at someone, they will normally shout
back

Self Opinion
We all have a picture of what we think we are. This picture is composed of certain values
such as:
¾ Thoughts
¾ Attitudes
¾ Moral values, and
¾ Commitments
These values are influenced by our past experiences and expectations on life. These can
include events that are both successes and failures. This includes the way that others have
reacted to these events especially during our formative years. We live to these values and
more importantly judge others with these values.
Defence Mechanisms
To help in our self opinion we employ inbuilt defence mechanisms. These also help us in our
coping strategies against stress.
The defence mechanisms are set to disguise the presence of a weak or undesirable quality
by the emphasis of a more positive quality. In stress coping they may reduce tension by
accepting and developing a less preferred but more attainable lifestyle.
These defence mechanisms can also relegate the blame for such problems as shortcomings
or mistakes by attributing them to others. The student pilot who fails a test blames the
instructor for not teaching the correct techniques.
Denial
We are all guilty of turning our back on the unpleasant side of life. With pilots it is the
embarassment of watching our own errors when played back on a video screen. Remember
“Errare Humanum Est”. No pilot has ever flown a perfect sortie, flying is a continuous
correction of errors.
Introversion and Extroversion
Introversion and extroversion are diametrically opposite. The prefix ‘intro’ means into or
toward, and ‘extro’ means from or away. Introverts turn inwards to their own thoughts and
can be viewed as shy or being socially reserved. Extroverts turn their thoughts outwards,
demonstrating gregarious behaviour and confidence.
Introversion and extroversion are personality traits formed by deeply held beliefs. Behaviour
is affected by introversion and extroversion, and although it is possible to alter ones behaviour
through activity and training, the effects are generally short lived, with deep rooted personality
traits emerging when fatigued or under pressure. Most of us fall somewhere into the middle
ground of introversion and extroversion with a slight preference one way or the other. In

order to study grades of introversion and extroversion it is simpler to look at extreme
examples.
An extreme introvert would try to avoid unnecessary contact with others, preferring to be left
to their own devices, not being challenged by those around them. The true introvert would be
happy with his or her lot, enjoying solitude and rarely seeking self improvement. Extreme
introversion is usually coupled with a lack of confidence and self-empathy.
An extreme extrovert requires constant attention from others, needing interpersonal

stimulation and often adulation from those around them. Extroversion usually requires a high
level of self confidence, but conversely, a strong extrovert may also not enjoy being
challenged by colleagues or work related tasks. This may manifest itself as overconfidence,
and occasionally arrogance.
To enable a person to change their behaviour by choice, first they must alter their beliefs.
This can be more difficult than it sounds. Rarely can an individual change their beliefs to alter
their behaviour over a long term. The first step is to become aware of the behaviour that they
feel requires changing. This must then be linked to the relevant belief that causes the
behaviour. Once the belief and behaviour have been identified, the individual must accept the
required change, and this may involve a period of denial followed by anger. Only then can an
individual change their personality.
Beliefs, personality traits and behaviour can be altered by external circumstances. Indeed, an
individual’s beliefs and personality traits will change with time as they experience life, and it is
these experiences that will alter behaviour. The most obvious changes occur following life
threatening or near death experiences and can be very dramatic, but every thing that one
sees hears and does will have an impact on behaviour no matter how small.
Behavioural Styles
Past experience and expectation can have an influence on our behaviour. Behaviour is
influenced not only by the accumulation of these experiences but also by the attitudes and
awareness of maintaining a friendly relaxed attitude within the flight deck
Psychologists divide behavioural styles into two basic categories
Relationship Oriented The first consideration is the feelings of others, which rank
high in the Decision Making process. A person who is high relationship oriented and
low task oriented is considered to have a caring or nurturing style of behaviour.
Task Oriented The first consideration is given to the task or goal in the Decision
Making process. A person who is high task oriented and low relationship oriented is
considered to have an aggressive style of behaviour.
Assertive Behaviour
Assertive behaviour has a bad reputation mainly because of its association with aggression.
In some ways aggression is a hostile act. It can be argued that an assertive person intends to
hurt or injure, maybe even destroy another. In truth, assertion is a device used to ensure that
the maximum potential for reaching a goal has been attained. In some ways the following
define assertiveness:

¾ The ability to use words positively and with conviction
¾ The ability to defend one’s own rights
Personal assertiveness is required to ensure that:
¾ A person can take the initiative in any task

¾ They can translate this initiative into an action
¾ No implication of aggression is perceived
Over-assertion is regarded as:
¾ Improper
¾ Provocative
¾ Unusual in certain cases
The above feelings are felt by people who are subject to over-assertive action. Their reactions
can be categorised into three areas:
¾ Discomfort
¾ Resentment
¾ Retaliation
In its most vulgar form assertiveness can be used as an unscrupulous device to extract total
obedience. To achieve “the norm” a person must ask certain questions of themselves. The
most important being “What do I understand as the meaning of assertiveness?”. We can split
assertive behaviour into three categories:
Non-Assertion Where a problem is taken up and a person fails to say

anything about the difficulties that it may create
Lack of self respect
Aggression Doing things in such a way that other peoples rights are violated
Lack of respect for others
Assertion Doing things in such a way that other peoples rights are not violated
Respect for both oneself and others
Following are listed a few advantages and disadvantages of each behavioural style.

Non Assertiveness
Advantages Disadvantages
The appearance of being virtuous Eventually others lose their respect.
The non assertive may feel more comfortable Resentment may take its place
being used People take advantage of the situation
The idea that non assertiveness leads to a The non assertive gets what they want; but
quiet life not what they need
Self respect is eventually lost
Aggressive
The less aggressive do what the aggressive Others resent the aggressive
wants Retaliation is always likely after aggressive
The aggressive can get the admiration of behaviour
other people In the long term people revolt against the
The aggressive feels all powerful aggressive

Assertive
Others understand what the assertive wants The assertive risks being given the answer
There is never a feeling of being manipulated “NO”
Both long and short term goals are Confrontation is sometimes inevitable
achievable
Self respect is always maintained
It is fair to say that a lack of confidence in oneself will usually lead to non-assertive behaviour.
The pilot must be able the express an opinion and be able to influence others without
aggression.
Case For Assertiveness
Suppression of an aggressive is essential to ensure that conflict is kept to a minimum.

Assertive action leads to an inward belief and awareness of one’s own abilities.
Non assertive action combined with low confidence lead to misunderstanding and
resentment.
Body Language
The importance of body language and assertiveness is summarised in the next few
paragraphs:
Aggressive
General Exaggerated show of strength, flippant and sarcastic

style, air of superiority.
Voice Tense, shrill, loud, shaky, cold, deadly quiet, demanding,
superior, authoritarian.
Eyes Expressionless, narrowed, cold, staring, not really
seeing you.
Stance Hands on hips, feet apart, stiff and rigid, rude,
imperious.
Hands Clenched, abrupt gestures, finger pointing, fist pounding.
Non-Assertive
General Actions instead of words, hoping someone will guess

what you want, looking as if you do not mean what you say.
Voice Weak, hesitant, soft, sometimes wavering.

Eyes Averted, downcast, pleading.
Stance Lean for support, stooped, excessive head nodding.
Hands Fidgety, flutter, clammy.
Assertive
General Attentive listening, assured manner, communicating,

caring, strong.
Voice Firm, warm, well modulated, relaxed.
Eyes Open, frank, direct, eye contact without staring.
Stance Well-balanced, straight on, erect, relaxed.
Hands Relaxed motions.
Assertive Behaviour
Assertive behaviour, takes the best of aggressiveness (without the put-down negatives) and
the best of non-assertiveness (without loss-of-self.). Assertive action is a genuine direct
communication of ideas, wants and needs. Put with conviction a position can be expressed
strongly without domination.
Assertive behaviour becomes easier the more it is used. When we respect these rights in
ourselves, we are also more likely to act in a manner that respects these rights in others.
Aggressive behaviour denies the rights of others and non-assertive behaviour overlooks
these rights in ourselves.

Chapter 19.
Leadership / Followership
Introduction
Leadership is a term which applies to the whole flight deck. For there to be a leader there
must also be a follower. True leadership and command must not be confused; command is
normally assigned where as leadership is an acquired art. All flight crew must recognise their
own leadership responsibility in the decision making process.
Leadership is a way of focussing and motivating a group in order to achieve the task. On the
flight deck the commander, as the designated leader, has the authority and responsibility for
the flight. In modern public transport operations the pilot flying can be termed a functional
leader; one who carries out a specialised task on a temporary basis.
Leadership Qualities
A leader should be able to:
¾ Provide continuity and motivation

¾ Remain flexible at all times
Normally a leader should be one step ahead of his team; too far ahead and the team can be
lost.
The effective leader has to use the ideas and actions in such a way that they influence the
thoughts and behaviours of the team. The leader is the pivot through which change and
influence are implemented.
Leadership Skills
Leadership skills begin developing as soon as a pilot sits on a flight deck for the first time.
These skills are determined by certain factors which can be good or bad depending upon the
formative years on the flight deck.
Most leaders perform 4 primary functions:
Regulation of the flow of Information The leader must be able to regulate the flow
of information, ideas and suggestions. The leader can either be the commander or
the pilot flying in this case.
¾ Communication of flight information

¾ Asking for opinions, suggestions

¾ Giving opinions, suggestions
¾ Clarifying communication
¾ Providing feedback
¾ Regulating participation
Directing and Coordination of Crew Activities The commander usually

processes the information below.
¾ Direction and coordination of crew activities.

¾ Monitoring and assessing of the crew performance as a whole. This may
include self criticism
¾ Providing planning and orientation
¾ Setting of priorities, whether task or people orientated
Motivation of Crewmembers A positive climate generated by the reasoning below

helps in keeping performance standards high.
¾ Creation of a happy working environment

¾ Maintenance of an "open" cockpit atmosphere
¾ Good conflict resolution through assertive actions
¾ Maintenance of positive relations
¾ Providing non-punitive critique and feedback at all times. Accepting
critique and feedback from other crewmembers
Decision Making
¾ The leader is ultimately responsible for decisions

¾ Assuming responsibility for Decision Making
¾ Gathering and evaluating information from all sources
¾ Formulating decisions
¾ Implementing decisions and relating why the particular action has been
chosen
¾ Gathering feedback on all actions
The Person Goal (P/G) Model
One way of depicting interaction is to construct a model where the dimensions are people-
orientation (P) and goal-orientation (G).

Person
P+G- P+G+
Goal
Acceptable Behaviour
P-G- P-G+
Unacceptable Behaviour
In this model we are looking at the balance between the concern for achieving the goal (G)
and the concern for people (P).
P+G- Democratic Leader The friendly leader who has little concern for the
task. Conflict resolution is kept to a minimum where others are left to have their
own way. The types of word that describe the democrat are:
¾ Reactive
¾ Understanding
¾ Sensitive
¾ Nice
¾ Protective
All are commendable but in extreme can lead to a dysfunctional flight deck.
P-G- Timeserver Other names applied to this type of leader are laissez-faire or
autonomous leader. This type of leader cares little for the job or for the people in
it. This style of leadership generates the poorest team performance because of
the willingness to accept poor leadership styles by:
¾ Rule bending
¾ Failure to achieve or trying to achieve objectives
¾ Low morale within the team
The negative traits shown are:
¾ Indifference
¾ Apathy
¾ Passiveness

P-G+ Autocratic Leader The aggressive leader. Task orientated to the extent
that the feelings of others are ignored. The over-bearing nature of this type of
leader ensures that the experience of others is ignored. In extreme cases those in
the team become disinclined to offer any help at all. The autocrat gives directions,
expects unquestioning obedience from juniors and is abrasive and demeaning.
The unacceptable traits shown are:
¾ Overbearing
¾ Autocratic
¾ Dictatorial
¾ Tyrannical
¾ Ruthless
P+G+ Ideal Leader By definition this person must be assertive. Concerned for
both the goal and the person this leader will earn the respect and commitment of
the team. The atmosphere enables all to contribute ideas which are recognised
and considered. Traits observed are:
¾ Constructive
¾ Straightforward
¾ Direct
¾ Expressive
¾ Assertive
Leadership - The Leader
Wherever a group of people are found certain expectations exist of the person in charge of
that group. What makes an effective leader? The old saying:
Leaders are born, not made!
Some people are born with the aptitude for leadership, but they are few in number. But how
is leadership taught?
Qualities Approach
By examining the personal qualities (PQ's) of born-leaders it is possible to define the qualities
that made them effective. The result is a list of those qualities that give both a positive and a
negative relationship. Below is a table summarising the percentage of positive and negative
relationships between personality traits and leadership. Adapted from Mann (1959)

Traits Number % Giving A % Giving A % Yielding
Of Positive Negative No
Findings Relationship Relationship Relationship
Intelligence 196 46 1 53
Adjustment 164 30 2 68
Extroversion 119 31 5 64
Dominance 39 38 15 46
Masculinity 70 16 1 83
Conservatism 62 5 27 68
Sensitivity 101 15 1 84
From all the qualities seen there is no positive way of teaching which combinations are
effective and those which are not.
Situations Approach
Following the failure of the PQ's theory, an alternative, the situations approach, was fielded.
It stated that leaders were born for situations; people like Winston Churchill.
In all leadership programmes where a situations approach to leadership was adapted it was
found that, where a person was appointed at random to be the leader, after a short period the
others in the group started to behave as if the appointed leader was the natural leader. If, the
leader is appointed such as on the flight deck then the foundations for leadership have been
laid; the leader still needs to be effective.
Effective Leadership
The following characteristics are generally accepted as those recognised in an effective

leader:
Competence Professional competence is required by the leader on the

flight deck. The technical skills shown along with the piloting
skills should be good and inspire confidence in the rest of the
crew.
Communication Communication should be clear and concise interspersed

with good listening skills so that interpretation and evaluation
is possible. Personal emotion is kept out of transactions.
Decision Making Decisions are based on the situation at that time. All
information is used and a logical decision making sequence
is used to form the solution (DECIDE).

Perseverance A leader who sticks to the task in hand regardless of the
difficulties encountered. The effective leader is always
confident that a solution can and will be found.
Emotional Stability Self control is maintained in the most trying conditions.

Personal emotions never cloud decision making.
Enthusiasm Where the leader is committed then the follower will usually
give their best.
Ethics The highest standard of professional conduct is expected at

all times.
Recognition Acknowledgement is given to the help of others.
Sensitivity Stress and fatigue should be recognised in both self and

others to ensure overload situations are not allowed to
develop.
Flexibility Adaptation of styles to the problem in hand must be possible.

No two emergencies are the same.
Humour One man’s humour is another’s sarcasm. Well directed

humour is an effective tool in the management of the flight
deck. Badly directed humour is hurtful and can destroy
effective teamwork.
Attitudes to Leadership
The likes and dislikes of a human being that can destroy the effective team at any time. Most
are formed from personal belief about situations or events. Most attitudes are from the
subconscious and are apparent in the behaviour that we show.
Extremes of attitude are dangerous in the flight deck environment:
Anti Authority The person who hates anybody telling them what to do.
Where this person regards rules and regulations as stupid or
unnecessary then an unsafe cockpit atmosphere can be
engendered. All pilots have the prerogative to question
authority if they think it necessary.
Impulsive The flying “arms in the cockpit” type. The person who has to
react to any problem immediately. The lack of thought can in
extreme cases cause Confirmation Bias.

Invulnerable The “it’ll never happen to me” brigade. Accidents happen to
others but not me. The pilot who has this attitude is more
likely to take risks and chances that are unsafe.
Macho Thought to be a male problem only but in fact females are

just as susceptible. The type who has to prove that they are
better than anyone else.
Resignation The “Who cares” or “What’s the use” pilot. The pilot who
does not believe that they make any difference to the
situation. This type will follow the more assertive pilot which
may lead to the acceptance of unreasonable risks.
Complacency With high levels of automation crews are beginning to accept

what the computer does as the norm. Monitoring and
checking is left because the “computer is always right”.
Ineffective Leadership
Ineffective leaders will tend to:
¾ Over control all situations

¾ Focus on the task only and ignore the person
¾ Avoid conflict
¾ Distance themselves from the other crew
¾ Behave inconsistently
¾ Ignore inputs from other crewmembers, by either demeaning or totally ignoring
them
¾ Be sarcastic or belittling
¾ Be devious or indirect
Most captains do not use this style of leadership. Most will develop a very shallow cross flight
deck gradient which encourages the assertiveness of others.


Chapter 20.
Decision Making
Decision Making Process
Decision Making can be broken down into a series of steps or actions that the pilot follows:
¾ The recognition that there is a problem. Note that no action is taken at this stage
¾ The gathering of information in order to assess the situation. This is undertaken
by all crewmembers
¾ The information required and where that information can be located needs to be
established. How this information can be verified is set at this stage
¾ The options that are identified and the alternative solutions are now risk
evaluated. Advantages and disadvantages are weighed to give the best solution
¾ Decision implementation and any actions are executed. Remember, doing
nothing can be an action
¾ Review the consequences by use of feedback. Evaluation and revision may be
necessary
Reaction to Decision Making
The following actions are not a comprehensive list of addressing the decision making
problem. The intent is to give a logical safe progression to a problem:
¾ Fly the aircraft

¾ Never assume that you do not have the time
¾ Identify the problem
¾ Assess the situation using all resources
¾ Select and carry out the correct procedure
¾ Continue evaluating the situation
¾ Inform the cabin crew
¾ Inform the passengers? Good idea or bad – will it cause panic.
Making and Taking Decisions
There are very few situations in an aircraft that require an immediate decision. There is not
an infinite time period in which a problem can be solved; the aircraft will eventually run out of
fuel. Therefore, certain principles need to be applied to decision making. They can be
described as below:
Inquiry What is wanted. Priorities and timescale need to be defined

Advocacy Consultation of all participants
Conflict Resolution Commitment to a plan of action and being able to resolve this
with other members of the crew
Decision Making All decisions must be explained. At this stage, why there was
rejection of any plans must also be explained
Critique A review of the situation is needed to ensure that the plan is

working. At this stage checks for Confirmation Bias should be
made.
Decision Making Models
Most airlines use simple acronyms to ensure that a logical process, like the above, is
followed. British Airways use DODAR.
¾ Diagnosis
¾ Options
¾ Decide
¾ Assign
¾ Review
It does not matter what model is used, all have the same intent and format. All are closed loop
situations which allow a continuous evaluation of the problem and its consequences.
Atlantic Airlines use DECIDE:
Detect
Estimate
Choose
Identify
Evaluate Do

Detect The pilot detects the fact that a change has occurred that requires
attention
The emergency occurs
Estimate The decision making team have to estimate the significance of the
change to the flight
What is the problem
Choose The team now choose a safe outcome
What are the options
Identify The team identifies actions that will control the change
What is the best course of action
Do The team do action on the best option
Carry out the action
Evaluate Evaluation of the effect of the change is monitored continuously
Review of the situation
Group Versus Individual Decision Making
A crew as opposed to an individual will usually make a better decision. It is one reason why
committees are formed. A crew working as a team, where knowledge and experience are
combined, can be very effective. To be effective all must be confident and comfortable in
raising doubts or opinions. Each crewmember must be confident that their opinion is a valued
one.
In team decision making the following guidelines can be used:
¾ Use all the available resources.

¾ Differences of opinion can be expected. This must be regarded as helpful not a
hindrance.
¾ Avoid arguing. All problems must be approached logically.
¾ Majority voting is acceptable in committees. In the aircraft there is one Captain.
The final decision must rest with him.
¾ All inputs have to considered as important.

¾ Why a solution has been taken has to be explained to all.
Influences on Decision Making
Certain factors have to be taken into account where group or individual pressure can
influence pre-decision thinking. These factors are listed below.
Compliance Most people will tend to comply with decisions rather than question
them.This is true when the decision is made by someone of a perceived higher
status. Compliance can also occur when a person has disagreed with a previous
decision and does not wish to seem obstructive.
Conformity Peer pressure. A person will tend to conform with the group's
decision because they wish to be the same as the rest of the team. If 2 or more
people have given an answer to a problem then it is likely that a third will give the
same answer. Status affects conformity. Differences must be voiced at this time.
Confirmation Bias Confirmation Bias is the natural tendency for a person to accept
information which agrees with their ideas about what is happening and to reject that
information which does not agree, as spurious.
Group Polarisation (Risky Shift) The tendency for a particular attitude to

prevail within a group. A group decision reflects an extreme rather than a norm. The
problem is worst when a pilot who likes taking risks flies with a pilot who is similar in
attitude. The tendency for the pair is to take greater risks. A phenomenon known as
“Risky Shift”. Conversely, cautious pilots would make a more cautious decision.
Other factors affect the decision making processes of a pilot. These are more social
influences than the effects of the above:
Vigilance With a normal person as workload increases so does vigilance.

Vigilance is a degree of activation of the body. It is different from
attention which depends upon the capacity of the brain to deal with
problems. Where boredom or monotony occur, hypovigilance can
lead to a state of near sleep where decision making is difficult.
Judgement Where a pilot is vigilant then judgement is usually sound. Good

judgement is learnt through the flying processes and can be said to
be based upon experience.
What matters with judgement is the outcome. Judgement depends

upon the decision to act and the response given. Judgement in a pilot
is the recognition of all the variables that effect decision making and
their outcome.
Attitude What does the term “Safe Pilot” mean. Is it someone who is over
cautious or someone who weighs up all eventualities and their
outcome. Attitude is a part of the mind you as a pilot put to all

processes of flying. Hence its affect on decision making. A good
attitude does not necessarily mean good decision making but it does
help.
Summary
Decision making depends upon evidence given to us by certain senses, it is based upon:
¾ Our expectations and desires which can distort the perceived information
¾ Any erroneous mental modelling in building our situational awareness
No matter how we perceive a problem it is essential that in the decision making process we
always hold an open mind. We must:
Hope for the best; but plan for the worst


Chapter 21.
Error and Error Chains
Introduction
We have all experienced part of another person’s accident
For example:
¾ How many readers have had an accident when driving a car?

¾ How many readers have nearly had an accident when driving a car?
Human error is attributed as the main cause factor in 65 – 75% of all aviation accidents. Each
accident can be said to be the activation of an error chain being activated.
The knowledge of how an error chain works or how to mitigate the effects of human error are
essential to the modern pilot.
No pilot flies a perfect sortie. It could be said that a flight is a sequence of errors occurring
one after another. Each error being linked like a chain. In most cases the links of the chain
are broken by the pilot correcting each or most errors which leads to a safe flight. Where the
links of the chain are not severed then the error progression is followed and an accident is
possible.
The Chain is broken
SAFE FLIGHT
The Chain is intact
POSSIBLE ACCIDENT

Levels of Human Error
Because of the nature of flying there is always the possibility of errors occurring. The error
chain is a result of human error and should not be linked with flying alone. Three levels of
human error can be classified:
Slip Slips occur when the incorrect information is sent or poor

communication is used. A slip is often a response to a well formed
habit. Normally a slip is seen as a visual or auditory response which
can also be an indication of a raised stress level.
Mistake Planning failures. Mistakes generally occur because of the perceived

time an individual thinks they have to complete a task. Rushing
causes the pilot to misread simple tasks such as track and time etc.
Error Errors occur because of incorrect actions. The incorrect action can
be based on either correct or incorrect information flow. Because the
error is an action it is classed as the most dangerous form of human
error.
Correction of Human Error
Each of the above levels can be corrected as they occur:
Slip By letting the person who made the slip know that the error has been
made.
Mistake By questioning the plan at the time the misconception is announced.

This can be during the planning, briefing or execution stage.
Error By using two flight crew who are alert to the possibility of errors
occurring. However, each pilot must be capable of using assertive
action to alert others that an error has been made.
To ensure that the above are carried out some form of error management process is required.
James Reason suggested that to be effective that any error management system would have
to cover the following:
The Operator Any person who is involved with the operation of the aircraft
The Task What the aircraft is doing
The Flight Deck The pilots and their interaction with the aircraft
The Organisation The company and its peripheral services

Human error can occur at any time. Most airlines train to what they think may happen or has
happened in the past. The airline SOPs are written to cover most eventualities in an attempt
to eliminate the possibility of human error. SOPs do not cover every eventuality and the pilot
may have to revert to a knowledge based response in order to deal with occurrences.
Group Attitudes
Errors are induced by any of the following:
Peer Pressure Doubts are suppressed because of the need to be part of the group
and the pressure of wanting to be “one of the boys”
Vulnerability Risky Shift, where team members agree to the more adventurous
approach
Knowledge “Knowledge is power”. Members of the team withhold information

because they feel that to have more knowledge is to have more
power
Rationalisation“It’ll be alright on the night”
SHEL Model Interfaces
In Chapter 1 the SHEL Model was introduced as a conceptual model of human interaction.
H L
H
Liveware
Hardware
E Environment
S L E S Software
L
The interfaces are frequent sources of error because of the mismatch between the central
Liveware and the outer components of the model:

¾ The Liveware-Hardware interface where switches and levers are poorly located
or improperly coded
¾ The Liveware-Software interface where delays and errors may occur while
seeking vital information from confusing, misleading or excessively cluttered
documentation and charts. Problems can also be related to information
presentation and computer software design.
¾ The Liveware-Environment interface related to factors like noise, heat, lighting, air
quality and vibration. This area also covers fatigue caused by the disturbance of
the body’s biological rhythms.
¾ The Liveware-Liveware interface where the interaction between people is
investigated
Links of the Error Chain
Certain clues can be used to identify and break the links of any error chain. For simplicity the
error chain can be broken into two areas:
Operational Errors
Failure to Meet Failure to meet the flight targets such as ETA,

Targets airspeeds, approach minima etc. The operational
procedures required by the company are ignored or
missed.
Non-Standard Whether intentional or not, deviation from the SOPs

Operations can lead the aircraft into a dangerous situation. The
SOPs are developed to lead the flight crew through a
logical approach to any problem solving. The SOPs
may not cover all aspects of flight but they offer the
pilot an effective means of problem solving during
periods where time may be critical.
Violation of Whether intentional or unintentional any violation of

Minima minima or operating standards can lead the aircraft
into a dangerous situation.
No One Flying the During all stages of flight the aircraft’s progress needs
Aircraft to be monitored. If the aircraft is left to its own devices
then accidents can and will happen.
Human Errors
Poor Whether the problem involves incomplete messages

Communication or the lack of communicating information poor
communication is an area that still causes concern.
As soon as there is a difference in knowledge level
then there will be a difference in situational

awareness.
Ambiguity in Where sources of information do not agree there is

Instructions the possibility of the crew falling into Confirmation
Bias. Sometimes it is better to check the negative in
order to find out what is happening.
Discrepancy in Where information is constantly changing it is

Situational important that all flight crew members are kept up to
Awareness date with all changes.
Distraction and Once attention is focused on one problem the brain

Attention focuses and deals with this problem alone. Because
of the attentional capacity in HIP there is the
possibility that information will be lost.
Distraction can be the result of outside influence and

inattention is paid to the process of flying the aircraft.
Confusion Where confusion reigns it is important that the flight

crew do not seek solace in each other. It is at this
time that the problems of leading questions and the
need for confirmation come to the fore.
There will be other component parts to the operational and human errors outlined above. The
ones shown are the main areas of the error chain that need to be broken.
Breaking the “Error Chain”
To break the Error Chain the crew first has to detect the presence of a problem. Action needs
to be taken in order to ensure a safe flight:
¾ Identify the problem

¾ Communicate what the problem is
¾ Achieve agreement as to what the problem is
¾ Decide on an action to solve the problem and break the chain of events
¾ Evaluate the action to ensure that the problem does not reappear


Chapter 22.
Learning and Learning Styles
Introduction
As a learner you have probably never thought about the principles that may affect your
learning. In general there are certain principles that guide us in how we learn. These can be
split into two areas:
¾ The material presented to us for the course, and

¾ How we learn it
The Learning Cycle
A training programme is usually devised to suit a training need. In this case Human
Performance and Limitations as part of the JAR-FCL theoretical knowledge course. Most of
our learning process is either theoretical or practical:
¾ We are given a subject to learn and then apply the knowledge practically
We use these notes to pass the Human Performance Examination
¾ We get the practical knowledge by the result of an action

We learn by experience that on a cooker that when the ring is red it is hot,
black means cold
Kolb (1984) further expanded this process into a learning cycle. This is just a simplified model
which represents a person’s process of learning.

What has to be learnt
Individual Training Plan

learner
Evaluation Delivery of
of the training
programme
Assessment of the
individual
This model is not as complicated as it looks. The learning cycle can be joined at any point and
the circle completed.
The Kolb cycle can be further simplified by cutting down to four elements.
Experience
Preparation Reflection
Theory
The four areas can be expanded in the following way:
Experience A learning process that can happen by chance. It is our process of

everyday learning. The experience can be by a formal teaching method. This is an
active stage where information for a task is fed to our sensors.

Reflection The point in the cycle where a learner starts to think about what has
been experienced. This is a passive stage. A person will reflect on the subject that
has been learned. In some way this is the stage where a person begins an inner
discussion with themselves. Effectively “the wheat is sorted from the chaff”.
Theory Not many people are natural theorists. In most cases we all use other
peoples ideas to help with our own instruction. This is a stage where new information
is taken in and compared with what we already know.
Preparation A planning stage. When a new piece of information has been learnt
then the information is normally reflected upon. Once this reflection has occurred then
it is time to move on to the next point in the cycle.
Honey and Mumford (1982)
Honey and Mumford redesigned the Kolb Learning Cycle to produce a model of learning
styles.
Experience
Activist
Preparation Reflection
Pragmatist Reflector
Theory
Theorist
The Kolb cycle is modified by linking it to the 4 types of person who are happiest working at a
particular stage of learning.
Activist The type of person who enjoys things as they happen and look
forward to an experience with enthusiasm. The activist will rush into
things without thinking of any drawbacks. The people who use this
learning style prefer to be centre stage where the action is. Once the
activity is completed they become bored. This type of person likes to
learn through games, teamwork etc.
Reflector A person who takes a cautious, thoughtful approach to learning. This

person is a listener who will tend to take a back seat in any
discussions. The reflector only acts once all information has been
gathered. Kelly (1955) described this stage in the following
statement:

When new information is received, if it fits in with our beliefs
then we confirm what we already know.
The problem arises when we receive information that is

contra to our beliefs. At this stage we have two choices,
rejection or reflection to accommodate or disregard this new
information
The more mature learner is normally found in this stage. In summary

the reflector is a person who likes learning by observation or by self-
instruction by investigation.
Theorist A person who learns by rote. The theorist is very much a vertical
learner with little lateral thinking. Most of us are not born as logical
thinkers and the process of theory has to be learned in itself. The
theorist learns by rules, using the rules. This is a very effective way of
learning because this style leads to learning accuracy.
Pragmatist The person who is happy putting an idea into practice. This learning
style describes the person who gets on with the job and is only
interested if it works. This is the practical down to earth workman who
enjoys learning from life’s experiences.
Flexible Learning
By looking at the above styles it is easy to categorize yourself or others. In most cases we all
use a mixture of the styles to get “our balanced form of learning style”. The knowledge of your
or other peoples learning styles can help on the flight deck in the understanding necessary to
achieve an effective team.
Maslow (1943)
To satisfy the human needs there is an order of priority. Maslow introduced a triangle of
human needs. The lower order motives are aroused first and must be satisfied first. Once a
need is satisfied then the next level in the hierarchy can be satisfied. The triangle of needs
starts with basic physiological needs up to those related to ego. Eventually the person
reaches self-fulfilment. The hierarchy of needs is shown in the diagram below.

1 Self Fulfilment (expression of capacities and talents)
2 Self Esteem Needs (prestige, status, achievement

and domination)
3
Belonging and Affection Needs (friendship and
love)
4 Safety and Security Needs (freedom from

pain and danger)
5 Physiological Needs (hunger, thirst,

oxygen
requirements)
Reference: The Manual of Learning Styles, Peter Honey and Alan Mumford
Peter Honey
Ardingly House
10 Linden Avenue
Maidenhead
Berkshire
SL6 6HB


Chapter 23.
Automation
Introduction
Since the introduction of the basic instrument flying T designed by the Royal Air Force in
1927, manufacturers have been developing systems that reduce pilot workload.
Air
Attitude Altimeter
Speed
Director
Indicator
Horizontal Rate of
Machmeter Situation Climb
Indicator
The above instrument panel has now been developed into the glass cockpit designs that
pilots in modern aircraft have become accustomed to. A simple design is shown below. Note
that the basic T is still adhered to.
ATTITUDE
ATTITUDE
ALTITUDE
AIRSPEED
AIRSPEED
VERTICAL SPEED
17 18 19
16 20
15 21
HEADING 180

Operating an aircraft has changed as automation has increased. Automation provides the
pilot with:
¾ Alternate methods of accomplishing tasks

¾ Having more capacity to spare for the job in hand
With the increased use of automation it is essential that:
¾ The automatics work reliably and in a predictable manner

¾ The instruments are easy to read with little or no chance of misunderstanding
¾ The pilots understand the operating limits and limitations of the system
Part of the problem of difficulty in reading and understanding instruments can be shown with
the three pointer altimeter below:
100
0 FEET
9 1000 FEET 1
10000 FEET FEET
8 2
7 3
6 60000FT
1013 4
¾ The instrument is difficult to read

¾ Making an error in reading the altitude is easy
¾ However, the instrument is accurate
Flight Crew Functions
Flight crew perform 4 primary functions during flight (Abbott1993):
Flight Management Flying the aircraft

Communications Management Monitoring and response to internal and
external communications during the flight
Systems Management Monitoring and actioning of all systems

during flight
Task Management The management of tasks and resources

needed in the conduct of the flight
Human Factors Concepts in Design
The primary functions of the flight crew must be taken into account. Most designers and
manufacturers take into account the following when designing aircraft automatics:
¾ Integration of fail safe concepts for the flight crew

¾ Adapting the automatics for minimal workload for the crew
¾ Easy to understand systems which allow easy monitoring
¾ Better Liveware – Hardware interfacing
¾ Comprehensive information flow
¾ Easy to correct instruments and systems
¾ Sensible error tolerance factors
Automation has to be seen as a partial, or even total replacement, of the pilot. Obviously, the
amount of pilot – machine interface depends upon the level of automation required.
Common Problems with Automation
The advance in computer technology has meant a rapid advance in cockpit automation.
There are obvious benefits in the new technology but there are still serious accidents where
flight crew management of the systems is inadequate. Corrections are made for these
deficiencies, as a problem is uncovered. The most significant areas where there is a
breakdown are:
Training Training can cover the essentials of operating the system in normal
flight; but is the training sufficient to operate the system in a degraded mode. Over
use of the computer can result in a degradation of the pilot’s flying skills, especially on
NDB approaches.
Design Philosophy There is still the perennial problem of the designer not
consulting the pilot. There must be consultation to ensure that problem areas can be
dealt with before manufacture. Radical changes have occurred over the last few
years with the introduction of concepts such as side stick control.
Situational Awareness and Complacency To maintain situational awareness is

essential in all flights. The reliability and accuracy of modern systems lead pilots into

an over-reliance on what they think is a no fail system. Boredom results and the pilot
becomes inattentive. Reaction times to an emergency when a pilot is in this low—
aroused state are slow and prone to errors.
Design Protection Different manufacturers take different approaches to this

problem. Some design systems which are intolerant of human error, others allow
margins for human error. In either system there must be a crew warning system to
ensure that the computer and pilot work together and not against each other.
Manual Override If the situation deteriorates there must be a method of

manual reversion for the pilot. Accidents have occurred where the pilot has not been
able to revert to manual control and the aircraft has continued on its computer flight
path.
Information Management Too much information can confuse and overload the
pilot. The time taken to input information means less time to the tasks of lookout and
communications. In some aircraft deciding what to display can distract from the task
in hand.
Automation Management The computer is always right!
Communication Lack of awareness leads to breakdowns in communications

and procedures.
Industry Requirements
To ensure that the implementation of new systems meets the performance standards required
industry must follow certain guidelines:
¾ Design reviews and evaluation of automation must be carried out before

manufacture
¾ Some form of human factors certification of automation must be possible
¾ Validity of all designs must be proven
¾ The role of the pilot must be specified including his task management
responsibilities
¾ Training courses have to be developed to ensure that both normal and degraded
operations are covered in depth
¾ Standards should be developed for all displays and the colours to be used
Flight Crew Responsibilities
To ensure that the operation remains safe and that for both normal and emergency
procedures the pilots carry out the required task:
Normal Operations All selections and actions are checked by both pilots. One
pilot actions the other pilot checks. It must always be remembered:

¾ The autopilot is not a pilot but an aid to help workload and situational
awareness
¾ Flight parameters must be continuously monitored
Emergency Procedures The aircraft must be flown and the following

actioned:
¾ Time should be taken in identifying the problem

¾ ECAM actions should be followed
¾ Where an irreversible action has to be completed then there must be a
positive check by both pilots
Automation Summary
There are both advantages and disadvantages to automation. Whether you are for or against
the automation of the flight deck it must always be remembered that both the computer and
the human being are not infallible. Listed below are some of the advantages and
disadvantages:
Advantages
¾ Performs most of the control tasks allowing the pilot to perform other
higher mental functions
¾ Removes the human element from day to day performance
¾ Can reduce the crew size
¾ Better control of systems making the aircraft more economic
Disadvantages
¾ Is the pilot reduced to a button pusher?

¾ Does the pilot lose interest in the job?
¾ Removes the most flexible asset who can resolve non-SOP problems
¾ Automation does cause accidents
¾ Increases the mental workload with the need to monitor the system
carefully
¾ Handling skills are infrequently practiced
¾ Complacency and boredom set in
A recent FAA survey listed the main contributory factors in automated aircraft accidents:
¾ Pilot’s who have an insufficient knowledge of the systems they are using
¾ Confusion involved when not knowing the mode of flight

¾ Liveware – Software design mismatches
¾ Systems behaviour when modes are changed – what information is being shown
¾ Over reliance on the computer
¾ Non SOP operations
Note that most of the above are problems with the human element. Automation at its best
should help the pilot; at its worst it kills. To make the best of the systems provided the pilot
needs to be both trained and motivated to operate at a high performance level.

Chapter 24.
CRM & MCC
Introduction
From the beginning of flying to the present day the majority of accidents have been attributed
to the pilot. The term “pilot error” has been used to categorise all accidents possible. In the
last few years this term is becoming less predominant and the term “human error” is
becoming more common.
Using the statistics for the First World War it is not surprising that so many pilots crashed
because of human error
World War 1 Statistics
8% 2%
Pilot Error
Technical Defect
Enemy Action
90%
When the statistics are brought up to date.
Air Transport Accidents 1994
4% 7%
16% Human Error
Technical Defect
Weather
ATC
73%
We can see that the largest proportion of blame is to human error.

Studies have shown that there is a real need for effective crew training. Hence the advent of
Cockpit Resource Management (CRM).
What is CRM?
We have been flying for over 90 years, why CRM now? The concept of CRM is not new but it
remains a fact that accidents related to external sources have decreased, whilst accidents
attributed to human weaknesses have increased.
Why CRM training?
Crew Resource Management represents one approach to improving aviation safety.

Technical skills alone are not enough to manage the modern public transport aircraft. CRM
programmes have gone into widespread use since the early 1990’s.
The value of these programmes can be shown by using real incidents. One of the best
examples is the Sioux City DC-10 accident. Captain Al Haynes and his team were faced with
a hopeless situation when his United Airlines DC-10 suffered a loss of all three hydraulic
systems at FL 370. The crew used all resources available in the air and on the ground while
manoeuvring the DC-10 by differential thrust from the two remaining engines. A crash landing
was done at Sioux City airport saving 186 of the 296 passengers. Commander Haynes
commented:
"United started something called CRM in 1980. It really helped us. We would not have made it
without it".
The list of critical situations where good human performance and teamwork saved the day is
lengthy. There have been many accidents where the cockpit and cabin crew’s hard efforts
have saved many lives. CRM training has already proved its value many times.
CRM training can only be considered fully effective when it comes to light as improved
everyday behaviour through practical actions.
CRM and Human Factors training for airline crew members is now mandatory.
ICAO detailed certain markers that define what CRM is and is not. CRM Training is:
¾ A comprehensive system for improving crew performance

¾ It addresses the entire crew population
¾ It is a system that can be extended to all forms of flight crew training
¾ It concentrates on attitudes and behaviours and their impact on safety
¾ It is an opportunity for individuals to examine their behaviour and make individual
decisions on how to improve cockpit teamwork
¾ It uses the crew as the unit of training

CRM Training is not:
¾ A quick fix that can be implemented overnight

¾ A training programme administered to only a specialised few or "fix-it" cases
¾ A system that occurs independently of other on-going training activities
¾ A system where crews are given a specific prescription on how to work with
others on the flight deck
¾ Another form of individually centred crew training
¾ A passive lecture style classroom course
¾ An attempt by management to dictate cockpit behaviour
A pilot should remember that:
CRM is not, and never will be, a substitute for the mechanical skills of flying. It is here to help
you understand what is required in the modern day airliner
CRM Loop
Approximately 70% of air accidents are caused by human error and problems occur because
of four main failings.
¾ Poor decision making

¾ Ineffective communication
¾ Inadequate leadership
¾ Poor management
CRM training was further reduced into 7 major training areas:
¾ Communications
¾ Situational Awareness
¾ Problem Solving/Decision making
¾ Leadership/Followership
¾ Stress Management
¾ Interpersonal Skills
¾ Critique
Multi-crew Co-operation (MCC)
JAR-FCL now requires a pilot to undergo MCC training before the first type is annotated to an
licence. The MCC skills required to work together in a multi-crew environment are difficult to
distinguish between those required for CRM. The regulations however, do make a clear
distinction between CRM and MCC. JAR-FCL requires MCC training before the first type
rating is issued. JAR-OPS requires CRM training on a continuous yearly training basis. CRM
training is often given to both pilots and other personnel.

The objectives of MCC training are:
¾ Optimum decision making

¾ Communication
¾ Division of tasks
¾ Use of checklists
¾ Mutual supervision
¾ Teamwork, and support throughout all phases of flight
Listed below are some of the advantages of multi-crew operations versus single pilot
operations, MCC helps to enhance these skills:
¾ There will be another pilot to fly if one should be incapacitated

¾ Reduced workload and hence better situational awareness
¾ Monitoring of other’s reactions
¾ Correct use of checklists
¾ More efficient operation
Disadvantages are usually the fault of the crew not because of the deficiencies in the system:
The use of the multi-crew concept is required by regulations for many aircraft and it has
proved itself as a fundamental tool in achieving safe and efficient operations of aircraft.

Human Performance and Limitations

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ATPL

ATPL Human Performance and Limitations ii 27 November 2003

Introduction to Human Factors

Aviation Medicine - Respiration and Circulation

Aviation Medicine - The Effects Of Altitude

ATPL Human Performance and Limitations iii ©Atlantic Flight Training

Aviation Medicine – Health and Hygiene

ATPL Human Performance and Limitations iv 27 November 2003

Aviation Medicine - Diet and Digestion

ATPL Human Performance and Limitations v ©Atlantic Flight Training

Aviation Medicine - Metabolism, Excretion And Heat Regulation

Aviation Medicine - The Eye

ATPL Human Performance and Limitations vi 27 November 2003

Aviation Medicine – Visual Illusions

Aviation Medicine - The Ear - Hearing and the Vestibular System

Aviation Medicine – Vestibular Illusions

ATPL Human Performance and Limitations vii ©Atlantic Flight Training

Aviation Medicine – High Altitude Environment

ATPL Human Performance and Limitations viii 27 November 2003

The Nervous System

Human Information Processing

Situational Awareness and Attention

ATPL Human Performance and Limitations ix ©Atlantic Flight Training

Personality and Behaviour

ATPL Human Performance and Limitations x 27 November 2003

Error and Error Chains

Learning and Learning Styles

ATPL Human Performance and Limitations xi ©Atlantic Flight Training

CRM & MCC

ATPL Human Performance and Limitations xii 27 November 2003

Introduction to Human Factors

“Errare humanum est”

To introduce you to Human Performance and Limitations this chapter includes:

¾ A possible meaning and definition of Human Factors

ATPL Human Performance and Limitations 1-1 ©Atlantic Flight Training

Take Off Initial Climb Cruise Initial Initial Final Initial

Percentag Percentag Percenta Percentag Percentag Percentag Percentag Percentag

Public Transport Accident Data

¾ Omission of an action/inappropriate action by a flight crew member eg descent

¾ Effectiveness of the system

ATPL Human Performance and Limitations 1-2 27 November 2003

The Meaning of Human Factors

The human element in aviation can be considered in asset terms as:

¾ The most reliable

Psychology The science of mind and behaviour

ATPL Human Performance and Limitations 1-3 ©Atlantic Flight Training

A Conceptual Model of Human Factors – The SHEL Model

L Your team, (Players, Coach, Trainer)

ATPL Human Performance and Limitations 1-4 27 November 2003

To understand the person we need to look at the basic human characteristics:

Physical Size and Shape Design of workspace from anthropometric data

Physical Needs The requirement for nourishment

Information Processing The limitations of human capability

Output Characteristics Once information is processed, the way the human

Environmental Tolerance The body's capability to withstand temperature,

Liveware – Software The non-physical aspects of a system - procedures, manuals

A Constellation on approach to Prestwick. An experienced pilot flying a radar

Liveware – Environment Errors associated with the environment - noise, heat,

ATPL Human Performance and Limitations 1-5 ©Atlantic Flight Training

PILOT ⇒ ERRORn ⇒ DISASTER

Where ERRORn is a sequence of more than one error.

Each sequence of this model needs to be attacked.

¾ Training - manuals, simulator training.