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altitude involved and the duration of exposure.
This chapter is intended to familiarize the designated medical examiner with some of the basic
principles of aviation physiology related to the working and environmental conditions encountered in
civil aviation; a brief description will also be made of the man-machine relationship, the physical and
mental demands imposed on aviation personnel, and the medico-biological aspects conducive to safe civil
aviation operations. However, a single chapter does not do justice to this important topic, and the
interested reader is therefore referred to one of the standard textbooks in aviation medicine for further
information. Two examples of such texts are provided at the end of this chapter.
The human being is the most important element in the aviation system, and a healthy and competent
crew is a prerequisite for safe and efficient flight. The philosophies underlying initial certification and
continuing integrity of both the man and the machine are in fact analogous.
Advances in aviation research, development and improved technology have served to minimize the
probability of human failure of the man-machine system. Being one of the vital elements in this system,
man should be properly assessed from somatic and psychological viewpoints, taking into account the
requirements for the task to be accomplished.
The rapid development of aviation during the past decades and the ever increasing number of
individuals of all ages who avail themselves of air travel, have stimulated extensive research on the
physiological effects of altitude in order to define tolerable and safe limits of exposure and to develop the
most effective protective measures. In this respect, this chapter includes a short description of some
technological necessities, e.g. cabin pressurization and oxygen systems, which permit life in otherwise
hostile environments.
Human factors specified in Annexes
ICAO regulatory documents – Annexes – make many references to human factor aspects of civil aviation
operations. Annex 1, 1.2.4.4.1 specifies that “Medical examiners shall have received training in aviation
medicine and shall receive refresher training at regular intervals. Before designation, medical examiners
shall demonstrate adequate competency in aviation medicine.” In addition, 1.2.4.4.2 requires that
“Medical examiners shall have practical knowledge and experience of the conditions in which the holders
of licences and ratings carry out their duties”, followed by a Note in which it is stated that “Examples of
practical knowledge and experience are flight experience, simulator experience, on-site observation or
any other hands-on experience deemed by the Licensing Authority to meet this requirement.”
Part I, Chapter 1 of this manual also describes the relevant provisions contained in Annex 6
concerning oxygen in flight and fitness of flight crew members, as well as limitations of flight time
intended to ensure that fatigue does not endanger the safety of a flight.
Annex 6, Part I, 6.12 describes the relevant provisions concerning radiation indicators to be carried by
ICAO Preliminary Unedited Version — October 2008 II-1-2
aeroplanes intended to be operated above 15 000 m (49 000 ft).
Figure 1.— Flight deck of an Airbus 330 (courtesy – Airbus)
Working environment
The designated medical examiner must be familiar with the design and operation of aircraft cockpits and
air traffic control towers, so as to enable an adequate assessment of licence holders. Aircraft cockpits are
designed in such a way that the flight crew member can function optimally not only under normal but also
under critical conditions such as peak workloads. The main factors to consider in this working
environment are graphically depicted in Figure 1. The major portion of information gathering is by vision;
therefore limitations of human vision with respect to both acuity, the size and shape of the peripheral
visual fields, and colour perception must be considered against the problems of access to visual
information presented from both inside and outside the cockpit.
The position and operation of controls and flight instruments are fundamental. All controls should be
within easy reach of the crew and all instruments should be easy to read. This will permit the pilot to
acquire the information without interference (sensory acquisition) and permit him to operate all the
controls efficiently (effector function).
The air traffic controller’s workload is subject to wide variation. It depends on such factors as the
number of aircraft supervised, the complexity of air traffic routes, individual aircraft speed and relative
aircraft movement comprising fast and slow aircraft, arrivals, departures and en-route traffic.
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