Report 5 of the Council on Scientific Affairs (I-98) Full text

Note: This report  represents information on this subject as of December 1998.

Full text

Resolution 411, introduced by the International College of Surgeons at the 1997 Interim Meeting, asked: "That the American Medical Association (AMA) endorse the White House Commission Report on Aviation Safety and Security, and that the AMA work toward the implementation of these goals and standards for air travel safety." The resolution was referred to the Board of Trustees and then the Council on Scientific Affairs (CSA) for review of the cited document.

The White House Commission Report on Aviation Safety and Security

In 1996, the crash of Trans World Airlines Flight 800 off New York raised national concern about the safety and security of civil aviation. In response, President Clinton created the White House Commission on Aviation Safety and Security, which was chaired by Vice President Gore. The Commission issued an initial report on September 9, 1996, with 20 specific recommendations for improving aviation security. On February 12, 1997, the Commission issued its Final Report with 57 recommendations pertaining to aviation safety, security, air traffic control, and disaster response.¹ The final report of the Commission included updates and additions to the initial security report, as well as detailed recommendations for improving aviation safety and air traffic management. Overall, these recommendations provide a framework for government officials and airline personnel as they develop strategies to ensure greater passenger safety and security, promote modernization and progress in aviation, and maintain global leadership of the United States in the aviation industry. 

Improving aviation safety

The Commission issued 14 recommendations to improve aviation safety. The most important of these was the establishment of a national goal to reduce the rate of fatal air crashes by fivefold within the next decade (the current fatal air crash rate in the United States is 0.3 per million departures). To achieve this goal, the Commission recommended re-evaluation of Federal Aviation Administration (FAA) regulatory and certification programs and increased support for aviation safety research and development. Also required are the combined efforts of the aviation industry and federal government to develop systems and technologies to prevent equipment malfunctions, reduce mishaps due to human error, and prevent collisions between aircraft and other air or ground hazards. The Commission further recommended expansion of the FAA s aircraft inspection program, ensured protection of individuals who report air safety violations, elimination of a federal exemption that allows passengers under two years of age to travel without child safety restraints, and installation of smoke detectors in the cargo holds of all passenger aircraft. 

Making air traffic control safer and more efficient

To maintain global leadership in civil aviation, the Commission determined that the US air traffic control system requires modernization. Recommendations call for accelerated deployment of new technologies to provide air traffic controllers and pilots with enhanced navigation, surveillance, and communications systems and better information, as well as replacement of aging and obsolete equipment.

Improving security for travelers

The Commission determined that terrorist threats against domestic and international civil aviation are changing and increasing. To combat these threats, the Commission developed 31 recommendations to enhance security in airports and aboard aircraft. An ultimate goal expressed by the Commission is the establishment of aviation security as a national security issue. Additional recommendations include the development and deployment of technologies for detecting explosives in baggage; screening of checked and carry-on baggage, mail, and cargo; deployment of an effective passenger profiling system; and the restriction of unauthorized individuals from gaining access to critical airport areas.

Responding to aviation disasters

Aviation crashes can overwhelm state and local emergency response teams. Such crashes also have considerable physical and emotional consequences for crash victims and their families. The Commission determined that aviation disaster responses in the United States need to be better coordinated and more compassionate. The Commission proposed that responsibility for coordinating national aviation disaster responses should be placed with a single entity such as the National Transportation Safety Board.

Implications of the Commission report for physicians and the AMA

While the CSA appreciates the effort of the White House Commission to address the complex issue of aviation safety and security, the CSA found that most of the recommendations in the Commission report are not clinically relevant. This finding was supported by representatives of the Aerospace Medical Association and the American College of Emergency Physicians, who were asked by the CSA to examine the Commission report. Reviewers from these societies indicated that while the Commission report thoroughly addresses current problems and concerns in aviation safety, security, and air traffic control, the focus of the report is beyond the purview of most physicians.

Because most of the Commission's recommendations deal with nonmedical issues, reviewers limited their comments to two aspects of the report that have medical implications for consideration by the AMA. The first is the need to reduce the occurrence of human error in aviation crashes. According to the Commission report, in the past decade flight crew errors accounted for more than 60 percent of all aviation crashes worldwide. Performance deficiencies also occur among ground and air traffic controllers, security personnel, and maintenance technicians. Efforts to expand research, technology and training, and sharing of safety data to reduce human error in aviation should be fully supported by the medical community.

Reviewers further recommended that the AMA support a Commission recommendation that all passengers be appropriately restrained, regardless of age, during takeoff, landing, and turbulent conditions. This is particularly a concern for children under the age of two years and requires that standard certified child safety seats be developed and used on commercial flights. AMA policy supports the use of appropriate restraint systems for all children on all commercial airline flights (Policy H-45.989,  AMA Policy Compendium). Recently, the FAA responded to the Commission recommendation by publishing an advance notice of proposed rulemaking seeking information about the technical practicality and feasibility of requiring children and infants to be restrained in child restraint seats in aircraft.²

The Commission report does not address passenger health issues, particularly the medical care and treatment of passengers during in-flight emergencies. The state of medical care of passengers aboard commercial aircraft is an issue of national interest and is currently being studied by the FAA, the airline industry, and medical specialty societies such as the Aerospace Medical Association and the American College of Emergency Physicians (Personal communication. Russell B. Rayman, MD, MPH, Executive Director, Aerospace Medical Association, July 1998).

In lieu of full or partial endorsement of the Commission report and its 57 recommendations, the CSA recommends that the AMA support the general concept of improving aviation safety and security. This is consistent with existing AMA policy (H-45.992), which urges appropriate federal agencies to review; fully enforce; and, where necessary, strengthen security measures at airports.

Recommendations

The following statements, recommended by the Council on Scientific Affairs, were adopted by the AMA House of Delegates as AMA policy at the 1998 AMA Interim Meeting.

1. The AMA encourages the appropriate federal agencies to work with the aviation industry to develop and implement a comprehensive plan to ensure greater public safety and security in airports and aboard aircraft.  
2. The AMA urges the appropriate federal agencies and the aviation industry to expand efforts to reduce the incidence and effects of human error in aviation.  
3. The AMA encourages the ongoing efforts of the Federal Aviation Administration, the airline industry, the Aerospace Medical Association, the American College of Emergency Physicians, and other appropriate organizations to study and implement regulations and practices to meet the health needs of airline passengers and crews, with particular focus on the medical care and treatment of passengers during in-flight emergencies.  
4. Existing AMA Policies H-45.989 and H-45.992 are reaffirmed. 

References

2. White House Commission on Aviation Safety and Security. Final Report to President Clinton. Washington, DC: The White House;1997. Available at: http://www.aviationcommission.dot.gov/212fin~1.html. Accessed July 24, 1998.  
3. Federal Aviation Administration. 14 CFR Parts 91, 121, 125, and 135. Child restraint systems.  Fed Register. 1998;63:8324-8328.

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