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ICAO Preliminary Unedited Version — October 2008
PART I
Chapter 3. FLIGHT CREW INCAPACITATION
Page
INTRODUCTION........................................................................................... I-3-1
Controlling the risk of pilot incapacitation ................................................. I-3-1
The “1% Rule”............................................................................................ I-3-2
Causes of incapacitation ............................................................................. I-3-3
Pilot incapacitation training ........................................................................ I-3-3
“Two communication” rule.........................................................................I-3-5
Cognitive incapacitation .............................................................................I-3-5
“Fail-safe crew” ......................................................................................... I-3-6
Crew resource management........................................................................ I-3-6
Medical standards and prevention of pilot incapacitation........................... I-3-7
Evidence-based decision making................................................................ I-3-7
CONCLUSIONS.............................................................................................. I-3-9
REFERENCES ................................................................................................ I-3-9
ICAO Preliminary Unedited Version — October 2008 I-3-1
Chapter 3. FLIGHT CREW INCAPACITATION
INTRODUCTION
The impressive growth of international civil aviation during the past decades has been accompanied by a
continued concern for safety in air travel. The number of air carrier accidents per year will increase if
industry growth continues and accident rates remain unchanged. It is, therefore, essential to continue
to examine all areas which have an impact on flight safety. One such area is that of in-flight pilot
incapacitation, which can be defined as any reduction in medical fitness to a degree or of a nature
that is likely to jeopardize flight safety.
This might be regarded as a “medical definition” focusing as it does on medical fitness. Note however,
that incapacitation can also occur in a medically fit individual, e.g. smoke inhalation or effects of a laser
beam on vision. A doctor practicing aviation medicine should be familiar with the relevant operational
environment and of the wide variety of possible causes of incapacitation.
Minor degrees of reduced medical fitness may go undetected by other crew members during normal flight
operations and lowered levels of proficiency may be rationalized, e.g. poor handling may be attributed to
turbulence or lack of recent handling experience. However, when abnormal conditions or an emergency
occurs, flight crew may have to perform complex physical and mental tasks under time constraints, and in
such circumstances even a minor deficiency in performance could be operationally significant.
Some effects of mild incapacitation include a reduced state of alertness, a mental preoccupation which
may result in a lack of appreciation of significant factors, increased reaction time, and impaired
judgement.
Controlling the risk of pilot incapacitation
Pilot incapacitation has been of concern for as long as powered flight has existed. It represents an
operational risk, and it can therefore be defined operationally as “any physiological or psychological state
or situation that adversely affects performance.”
There are sound reasons for considering an operational definition. From the operational standpoint, it is
irrelevant whether degraded performance is caused by a petit mal episode, preoccupation with a serious
personal problem, fatigue, problematic use of psychoactive substances or a disordered cardiac function.
The effects may be similar, and often other crew members will not know the difference.
A great deal about pilot incapacitation has been learned over the past decades. One of the most important
things is that the risk to aviation safety in situations where a pilot is incapacitated can be virtually
eliminated in air transport (multi-crew) operations by training the pilots to cope with such events.
In 1984 the medical director of a major British airline reported the results of a study of pilot
incapacitation that remains the most comprehensive to date (see Chapman, 1984). It included over 1300
“subtle” incapacitations which were simulated to occur at critical phases of flight during routine
competency checks in a simulator.
Five hundred of these incapacitations were deliberately planned to occur with other major failures in a
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Manual of Civil Aviation Medicine 1(48)
