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crew workloads, and to make it possible fully to integrate the flight crew members into a flight crew team
so as to establish a crew in which there is always at least one fully competent pilot at the controls. Ideally
the actions of each crew member should continuously be monitored by his fellow crew member(s). The
concept aims at achieving maximum safety in the operation of the aircraft and equitable distribution of
cockpit workload so as to ensure the crew can cope with all requirements including peak demands in
adverse weather or under emergency conditions – such as in-flight pilot incapacitation.
The “fail-safe crew” concept is the key ingredient for successfully dealing with any form of pilot
incapacitation. Support at all levels of management and pilot representation is needed for the “fail-safe
crew” to, in practice, do justice to the concept. Meaningful simulator training, reinforced with a suitable
education programme, is a requirement.
The story of controlling the incapacitation risk in air transport is the story of a progress made in a series of
small but important steps. Learning to manage the cognitive incapacitation risk remains an important
goal.
Crew resource management
In modern flight operations, line-oriented flight training (LOFT) emphasizes that resource management is
making a substantial contribution to flight safety.
A captain representing a pilots association explained the concept as follows:
“. . . One of the basic fundamentals of this philosophy is that it is the inherent responsibility of every crew
member, if he be unsure, unhappy or whatever, to question the pilot in command as to the nature of his
concern. Indeed, it would not be going too far to say that if a pilot in command were to create an
atmosphere whereby one of his crew members would be hesitant to comment on any action, then he would
be failing in his duty as pilot in command . . .”
ICAO Preliminary Unedited Version — October 2008 I-3-8
Training in crew cooperation, called crew resource management (CRM), is now provided by most major
airlines but frequently not to the same extent by smaller operators. In smaller companies, procedures are
less standardized and a greater degree of individuality is tolerated, so behavioural problems can be
expected to be more common, and experience has shown that this is the case. In recent years CRM has
been expanded to include the interaction between flight and cabin crew in recognition of the fact that
cabin crew members can sometimes have operationally relevant knowledge that flight crew do not have.
This was dramatically demonstrated in the United Kingdom in 1989 when a flight crew shut down the
wrong engine of a Boeing 737. Although the pilots believed their action was correct, the cabin crew had
seen flames issuing from the other engine, but unfortunately this information was not communicated to
the flight crew. In the ensuing crash several passengers and crew members were killed or severely injured.
While most would agree that CRM training is helpful in promoting flight safety, its assessment is more
controversial. Interpersonal relationships are not particularly amenable to measurement and there is much
suspicion among pilots about any process which attempts, or seems to attempt, to measure personality.
Medical standards and prevention
of pilot incapacitation
One of the major purposes of medical examinations and determination of medical fitness of an applicant
is to assess the probability of a medical condition resulting in in-flight incapacitation. Based only on such
an assessment can the authority objectively consider certification that is compatible with generally
accepted flight safety standards. In this context a discussion of the 1% rule can be found above.
The medical examiner is in many cases handicapped in making such an assessment, because adequate
predictive epidemiological data are not available for the condition itself or, if they are, they cannot be
readily applied to the flight environment. This situation is, however, improving. Figures for the risk of a
future cardiac event in an individual recovering from a common cardiac problem such as myocardial
infarction are available. Figures may also be available for certain other relatively common diseases, such
as the risk of a cerebral metastasis from a recurrence of a surgically removed malignant melanoma, or the
recurrence of an epileptic seizure after a first fit. It should be remembered that a medical condition in a
pilot that might potentially result in only a loss of efficiency or a moderate decrease in safety in a multipilot
aircraft might incur great risk in single-pilot operations.
However, more demanding medical requirements cannot alone adequately control the flight safety risk
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Manual of Civil Aviation Medicine 1(53)
