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					Refer to: Chesbro WP: The role of medicine in aviation safety
          (In the Forefront). West J. Med 122:181-182, Feb 1975                                 In the Forefront

The Role of Medicine in                                                         Aviation                Safety
                                         WAYNE P. CHESBRO, MD, Berkeley

THE JULY 1969 issue of CALIFORNIA MEDICINE                           mental council on aviation safety. In February
(Vol. 111:55-56) carried an article entitled "The                    1970, initial meetings were held with over 20
Role of Medicine in Aviation Safety." Since that                     representatives of all aspects of aviation concerned
initial statement, significant progress has been                     with safety. In 1971 a constitution and bylaws
made and continues to be made. The following is                      were accepted, and the California Aviation Safety
a report of that progress.                                           Council was formed. Active members were:
                                                                       Air Line Pilots and Stewardesses Association
The California Aviation Safety Council                                 California Medical Association
    In April 1968, while participating as a panel                      California Fire Service
                                                                       Air Traffic Control Association
member at a Congressional hearing in San Fran-                         Aircraft Pilots of Metropolitan Oakland
cisco on the subject of aviation safety at carrier                     Airport Executives Representatives
airports, I was appalled at the lack of basic emer-                    The Ninety-Nines, Inc.
                                                                       The Sierra Academy School of Aviation Instruction
gency equipment as well as the inadequacy of                           California Crop Dusters Association
disaster planning for mass casualty care. Of the                       California State Department of Aeronautics
37 major carrier airports in the United States,                        California Highway Patrol
                                                                       Office of Emergency Services
only two had a 24-hour emergency medical facility,                     Armed Forces Representatives
and none had held a test exercise to demonstrate                       California Peace Officers Association
the adequacy of their disaster plans.                                  Federal Aviation Administration, Western Regional
   Further discussion showed that no coordinating                         Representatives, Los Angeles
body existed in the state of California to deal with                    Changes and additions have been made in the
the problem of aviation safety. To explore the                       foregoing according to interest expressed by these
need for such a body, two symposia on the medi-                      professional organizations.
cal aspects of aviation safety were held under
California Medical Association auspices in 1968                      Purpose and Objectives
and 1969, with approximately 100 people attend-                         The purpose of this council is to promote,
ing in each instance. Participants were carrier                      among its members, all measures devoted to pas-
pilots, physician pilots, aviation medical exami-                    senger safety in aviation.
ners, cabin attendants, airport executives, airport                     The most immediate deficiency found was the
fire and police components and personnel con-                        lack of adequate disaster planning in the event of
cerned with disaster planning on a governmental                      mass casualties from aircraft accidents at carrier
level. The enthusiastic interest of the participants                 airports, and action to remedy this problem was
in the medical aspects of aviation safety was suffi-                 our first objective.
cient to warrant the formation of a nongovern-
  The author is chairman of the California Aviation Safety Council
                                                                     Carrier Airport Disaster Planning
and consultant to the California Medical Association Committee
on Disaster Medical Care.                                               Four years ago there were no significant disaster
  Submitted revised July 25, 1974.                                   plans for mass casualty care at any carrier airport
  Reprint requests to: W. P. Chesbro, MD, California Aviation
Safety Council, 731 Market Street, San Francisco, CA 94103.          in California. One of the smaller carrier airports

                                                                     THE WESTERN JOURNAL OF MEDICINE             181
                                              AVIATION SAFETY

had held a test exercise. In May 1971, the first         Airport during the past year has established an
simulated mass casualty disaster test exercise was       excellent daytime emergency medical facility
held at Oakland International Airport. Using 110         whose coverage will extend as necessary. The
simulated casualties evacuated from an aircraft,         situation is different, however, in some other air-
supportive care was given in all phases from the         ports. It is interesting to note, for example, that
collection site 500 feet upwind of the aircraft to       Chicago's O'Hare International Airport, with one
transportation and care at the airport casualty          of the largest passenger and employee levels in the
collection center, with further air and ground           world, has no physician-staffed emergency medi-
transportation to the peripheral receiving hospitals     cal facility.
for final definitive care. Problems in removal of
casualties from a crowded aircraft cabin interior,       National and International Goals
the adequate means of casualty transportation to            The California Aviation Safety Council has
the airport stabilization casualty support facility,     urged, through its members representing national
the jam-up of casualties because of poor "flow           organizations, the establishment of state councils
through" patterns at the facility, the proper coor-      of aviation safety. This would allow greater recog-
dination of transport, and the medical channel           nition of deficiencies in airport safety and would
communications from disaster site to final hospital      present a united front for their correction to both
facility-all were present, well-illustrated and re-      private and governmental interests.
corded. In August 1972, San Francisco Interna-              On the international level, the California Avia-
tional Airport held the second large test exercise.      tion Safety Council has already established through
The same problems appeared, as well as some new          its members, excellent liaison and exchange of
ones. In October 1972, Los Angeles International         knowledge on mutual safety and airport disaster
Airport held the third large-scale test exercise,        medical care planning with South Adelaide
with some of the errors found in the two previous        (Australia), the airports of Paris, Athens Airport
exercises appearing again.                               and Zurich International Airport.
   Changes in plans and equipment used for dis-
asters are being made at all three airports based        Current Interests
on knowledge gained from actual demonstration
of their worth. Members of the California Avia-             The council has a decided interest in a number
tion Safety Council either directed or participated      of subjects involving aviation safety and is explor-
in all three exercises.                                  ing them in depth with presentations by specialists.
   The most active support organization to the           The following is a list of these subjects.
council has been the Air Line Pilots Association,           1. Toxicity problems of spray materials used
represented by Captain John X. Stefanki, Vice            by crop dusting pilots.
Chairman of the Council. Captain Stefanki,                  2. The proper containerization, labeling and
through his national contacts, has urged other           designation of appropriate neutralizing procedures
states to form similar councils. During the past         for dangerous chemicals shipped by air.
year he has also acted as an advisor to many large          3. The use of fire-resistant and nontoxic ma-
carrier airports in the United States holding test       terial for cabin decor and insulation.
exercises of their disaster plans.
                                                            4. Research in the field to establish more effec-
Emergency Medical Facilities                             tive means of passenger cabin evacuation in event
   It is the feeling of the California Aviation Safety
                                                         of crash landing on land or sea.
Council that any carrier airport used by more than          5. Instruction in advanced first aid training for
two million passengers annually and with at least        cabin attendants and annual certification.
three thousand employees should have an estab-              6. Revision and improvement of basic first aid
lished emergency medical facility. At present, a         equipment aboard carrier aircraft.
study is underway toward classifying the staffing           7. Inclusion of annual test exercises for demon-
of airport emergency medical facilities based on         stration of the adequacy of airport disaster plan-
the number of passengers using the airport and the       ning as one of the requirements of airport certifi-
number of employees. San Francisco International         cation by the Federal Aviation Administration.

    182     FEBRUARY 1975 *       122 * 2

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