>> that should be foundation. i know it's a bit of an eye chart. wanted to expand some of parts of it and i know boeing has evolved a bit with the 787 from that, and we thank them for it.

so, the airlines need a much more salient automation philosophy, or flight path management policy. manufacturers, design. it doesn't talk about the operation and it provides little guidance for training, procedures, division of labor, working with management. and many of us operate both airbus and boeing on property, and others as well. so really important to go back to the foundation before we jump in to create new procedure. i have a couple of examples just to kind of illustrate some of my points. so airline a, if you want to read it, the philosophy, basically this is how they operated for 30 years.

their philosophy and procedural operation guidance pretty clear. don't do it. so then they realized potential savings in both time and feel in using automation productively. and whole policy have to be written. it wasn't just about rewriting some procedures. it was an entire paradigm shift and their philosophy and culture. it was a significant change. be cautious in just changing the order or flow of the things you need to actually back it up and support it with policy. so expectations for the pilot is clear. another example, and the specific point here is, airline b and aspects of their philosophy and their more rigid culture required restrictive dissent. and we have airline c much more

flexible and they understood the open dissent at 500 feet on the 8330. so to airlines operating the same aircraft, significantly different philosophical difference in the automation policy. all right. so back to the site. -- this slide. biggest emphasis, i feel the need to make at this point is the necessity of increased, more appropriate customized training for the pilots in the automation we are expected to operate. in the near-term future we will be working with tighter tolerances, self separation, 4d trajectory. we need to maintain some manual flying skills more than anything, manual flying skills.

automated systems are tools to the pilot, not a replacement of us as operators or as monitors. and we need to consider the role of the automation in the overall system. we've been seeing way too many issues in recent years. we need to reverse that trend, and it's time to do that at these thresholds of nextgen. it's an opportunity. thank you very much. [applause] >> thank you for showing us the importance of defining and implementing proper policy, automation policies and procedures in order to maintain our safe operations. we have now time for questions. we have a microphone set up on both sides of the room if you want to make your way forward.

we could ask our analysts some questions. to begin, let me just start out and i would just ask this general to the panel immediately, as we talked about, since most of us are in the pilots in rome, the pilots in the role with all the complexity is -- actually i will let one speaker. i will hold my question. >> i appear to be the professional questioner. the question is addressed to dr. woods and the panel in general. with regard to your discussion on brittleness and resilience in your model that you've created, what recommendations would you consider for brutal? what is a brittle operational practice wax this is the setup

for the operational practice. our current expectation pilot is that they will intervene during any or all malfunctions with the aircraft system through the use of manual flying skills. and basically that's keeping the shiny side up for 30 seconds to a minute while the figure out what went wrong. most operators and many airspace areas require the pilot or aircraft to utilize all of the automation of available from basically the time to get on the runway and the takeoff, thrust, and a pretty close to landing. there's little or no process, no procedures provided for pilot minutes of manual flying skills. and how would you model this? solution to this particular situation that i think we find ourselves in? >> so, very quickly this is an

old problem. i learned 30 years ago from some wonderful engineers, right, called a bumpy transfer of control. we talked about this in past incidents. it was part of findings from the 1996 faa human factors and cockpit automation report that i was privileged to work on with many others. and we pointed out that an erosion of pilot skills which contribute to difficulties in this plan, this model of safety that you just described, that that was was brittle, wasn't as effective as we thought. and it was going to be, less effective because the automation worked so well, pilots are not learning about how to handle nonroutine situations. the recommendation we made back in the middle 90s was you have to practice more nonroutine situations. you have to practice handling a cascade of events.

as you increase the autonomy, these are the kind of trade-offs we did for the defense science board, as you increase this aspect of autonomy they are predictable changes that will happen. just like you can anticipate various conditions as you look at a flight plan and look at the weather, and in of some of the risks involved any particular route. for a particular approach. we can see these. we still have not taken this seriously. we have new cases of problems in this area and it's time we move forward. no notice, the catch, the catch is it takes resources. but it takes time with allied pilots. the number of pilots and the cost of turn. oh, my gosh, it's down to $30,000 each way? wait a minute. doesn't that set off a lightbulb? this is what we said in the middle 90s with the initial c proficiency was given each year

in asia, the long-term growth of expertise, the new forms of airmanship that are necessary were lagging behind. and you're not the only ones dealing with this problem. the military deals with this problem as they become more and more automated as well, and have to manage these resources. we can talk about it. we can react to it. we can play back an incident or we can get proactive. [applause] >> thank you. >> this is kind of funding a spectator rather than being up there. how do you like it? so, this one is kind of direct and broadly towards the whole panel, but terry, you left your presentation on a little bit of a provocative note. we've interacted a couple times.

in talking a little bit about recovery situations of what the appropriate use of rubber and no tie and all these different kind of things, and that discussion kind of went towards the on the procedures and equipment much in about development of the so-called big red bud and recovery but. and that has obvious implications for uas dealt out. i guess the question is, do you see in terms of automation development and automation evolution us ever getting to the point where there will be a fully automated recovery system integrated into these airplanes? because if you take the case of the qantas 38 accident there would be no such a system that could possibly have existed it would have saved the airplane, but for the very, very superb analysis and also triage that was performed on the part of the air crew, and basically dealing with something the books clearly didn't speak to.

that was the slide with a circle way on the outside of the ring. so kind of a pretty broad question, but i figure i would throw it out to the panel because you guys look like you need some softball stone voucher, maybe a little bit of a hardball. and i apologize ahead of time. >> thanks, very good question and very thought-provoking. i think that from both the airbus and boeing standpoint what we're going to see any future come in future designs is even integrated modes, either degraded hydraulics or degrade electric, degraded flight control modes you're going to have some basic protections in the airplane that will keep you from exiting the flight envelope, the normal flight envelope and i think you'll also find the ability to use the autopilot and a lot of degraded situation. michael alluded to that in his presentation earlier and i know on the a3 80 which is a combination of a hydraulically

controlled and electro- hydrostatic controlled airplane we can switch off a hydraulic pumps because there are two per engine. we can switch of eight hydraulic pumps and stood by the airplane normally and choose auto politics i think you're going to see that. as far as the other part of your question which i thought was very interesting and whether you would have a recovery but could hit and everyone automatically recover itself. it's a great concept, when you think about let's think about it but to actually flight test it and make it happen in the situations where you want it to happen and then go to all the fringe cases is very, very difficult. we have discussed, for example, a system where if you had a terrain in counter and the pilot was not properly reacting to a gpws, would you have the autopilot come on and recover the airplane? and try to have the airplane

itself getting the terrain. there again think about all the fringe cases, what is be does it occur at, what separate doesn't occur at, what do you do about the thrust setting? do you do that as automatically as will? it is something that needs to be considered for the future. >> you just made my case for resilience. right? we can improve, as we understand different kinds of problem areas. but the kinds of problems we face will continue to emerge. new variations will emerge as we get better at handling certain uncertainties and difficulties. that's guaranteed to actually that's part of the complexity science results. you can't escape that in this universe. maybe you've got a different universe we're going to start flying in, but in this one we can't completely escape the trade-offs. and in the end, the ultimate safe haven is that you can

demonstrate the ability to behave resilient late when these surprises happen and cascade. that's what you have to prove. my responsibility to do is that i can come up with the measures and demonstrations of how to do that. and that's my commitment to you that the sciences will do that, and that we're trying to do that right now. >> good morning. a question for the whole panel, and even you, dave. we heard from our representatives was that maybe we can think of a piloting skill. years ago maybe it was a pyramid where the pilot was at the top of the pyramid and the kind of worked down through it. what demented is maybe now it's more linear with the pilot is just a system that is on the line, but as helena alluded to there are maybe black swan events that suddenly the pilot has to perform in the higher level. would also heard research where

piloting skills were degraded. a lot of us in your fly nine on a made up and is our are degrading, what skills ways new pilots who are learning an airplane, sometimes more complex than the airbus they 320 that i'm flying, what kind of train or what kind of skills will they need or what kind of tools with you present to them to help them with those events that are totally outside the room up with the airplane into? >> is a fascinating question, as dr. woods pointed out. so we try really hard at boeing to apple legal -- especially for normal operations when you go from one command path to in the event that, to have that transient between the, not change state. our partner break is one example. after the brake pedals fully depressed either said or released the parking brake so, therefore, you can't let the

parking brake come off when airplane is not stopped and you can't put the parking brake on when it's just a. we shortly try to transient free switches between modes of your plan. it's one of the demonstration points. there's no bumps, no phones, no nothing. but as we make this isn't better and better and better, the failure, as we welcome we want to have amazingly reliable airplanes, we push off the transit until it's a more dramatic point. so we are now required, normally in your procedures, you're right procedures for 10 to the mine is fifth this. sometimes you write to the mine is seventh due to a hydraulic system. we don't right procedures 10 to the minus nine philly. -- failure. that's what he calls it the black swan. as we push these things out, the experience goes to i was giving a presentation one time at a southeast asian carrier come and

part of my presentation was to talk about flying an avatar i said how we people, and they give the same presentation at this airline down in his one time. of the five other people in a meeting in houston i asked him how may people in this room have spun an airplane, two or three times? great. i would love to see the. i gave that same question to a southeast asian carrier, and not one hand went up. and i so doubt i thought my god, i've got to change the presentation because it doesn't work. heck with that, we have people who have never out showed been in an airplane. but that's what we do in this business. so as we go through these systems, it's very difficult as an airplane designer, because you want to push off, you want to wonderful reliability, wonderful systems, but then when we get it back to the pilot we're going to give it back a lot worse than after a single

false. and i don't know what to do about that. honestly. >> and now i will say one comment since you asked me all of it, manufacturers can build awesome airframes that are safe and reliable, our research community can provide is how we measure the brittleness, and resilience of our system and we develop procedures and policies down to the pilot. but the key is who is sitting out here, you, the pilots but you're the ones who want to know what skills, which you've maintain and which have maintained and what you need to practice to move forward safety. that's the key of the policies and procedures that we're getting to allow us to do that, we need to be asking our country still allows that opportunity or take the opportunities on the line to practice on the skills, especially the ones you don't use every day. thank you. >> just a quick comment. and thank you for an excellent

presentation. i think the focus on the pilot interface is good. but i would recall that that is a vacuum. no one in here today flies an airplane in a nice giant piece of airspace all by themselves. the coming changes to nextgen sesar airspace and the efficiencies editing attempted to be designed into that airspace in order to increase the density of operations are going to force us, it seems to me, to use, to rely on automation to the exclusion of allowing either human pilot for human controller to intervene. and isn't that the most brittle system you can imagine? because here we're talking about manual flying schools, manual reversion, getting the pilot back in the loop. but if the pilot can't turn the airplane safely within the

constraints of airspace that is operating in, it seems that we have a looming huge problem and i wonder if anybody would care to comment on how exactly we're going to address that. thank you all. [applause] >> well, first of all, thanks, paul, for the comment because it is true that as the airspace becomes more and more dense, pilots have to build operate in that high density if i'm and they have to be able to do it with manual skill sets. i think in our case at airbus with our sites to control and with boeing with their wheel controller, modern flight control systems to compensate for a lot of the aerodynamic characteristics of airplanes that the pilots never see in them or because they are so well masked. and i think that the ability to control the airplane in terms of pitch and roll and bank, in the

case of our airplanes with automatic triing systems. and boeing, the trim systems are very well designed. with a minimal amount of effort you can retrieve the airplane to where you want it to be. to me it suggests that in manual flight we can meet those challenges in the future, but i think that it has to be that develop and has to be continued, and we also have to provide it on the training site so that pilots can see that they can affect fly the airplane in those environments. and if they can't, if manual control is not possible than other measures have to be taken, if traffic becomes truly that dense in nextgen. >> the point that developing and designing autonomous systems as if there's no larger role to maintain resilience in the face of inevitable surprises and complications in real world operations has been studied many times, and answer is always the same. when you over rely on the automation, it's going to be

brittle. people will adapt. we will tell you exactly what will happen. responsible people in some roles will adapt to make the system continue to work. we call that how the operator at the sharp end makes up the holes in the designer's work. the designers get better and better, but they can have simplifications and limited resources as well. so the issue that you brought up is a systems designs that is perfect this is the stuff that is covered and the defense science board report for the dod's ability to take advantage of autonomy. now i doubt there are to me people here who are pro-drone but there are certainly audiences out there that are seen drones as remotely piloted vehicle. we don't call them uass because of the defense science board report. we said it's way too much of an emphasis on the platforms to changing the title doesn't mean you're doing systems engineering probably. and we run through these factors in order to avoid the otherwise

too low score on brittleness. >> helaine? >> well, i agree very realistically. it's a looming problem, and they don't necessarily have a solution, but i do think that the training aspect of it, the millennials, they'll have far less manual flying skills coming in turn environment than anybody has in the past. so we do have to take our experience and mentor our younger generations. i think that's a huge part of it. as far as the over all, with facing a pilot shortage issue i think we all have to take a huge responsibility in that moving forward. >> i guess i'd like to say we could have the system, because boeing also announced, i don't know quite what the coveted but airplanes are running about 85%

efficient. and best estimates in the operations were not using these key assets, this multimillion, 100 our assets to the greatest efficiency possible. and one way to do that is just take out all the slot and all the margins. instead of having four miles, put them at three miles. but that means that you don't get to flight 150 knots because you want to that day because you're not very come true of the assigned 140 knots. that's the difference is that goes into. but i'd like to think that we can devise a system and make an airplane that the pilots want to fly, that flies the same guidance that the autoplay system would produce to the autopilot. if you are a 737 person you know that the autopilot and actual flight for longer time. the autopilot can actually fly, you know, it was limitation in the autoplay system that kept down the navigation performance of the 737. the system was good enough but the limitation was how fast the autopilot could react to the

system. so i think is a capability in industry and there's a desire in the industry to fly the systems and then what i think of this as flying through the flight director. you know, you know the airplane on approach flies at two degrees at angle. they are two degrees nose up. you are on speed. if you're two degrees nose up in a boeing airplane, a lighter lined up and they're not change. you are on speaker just the way it works. across the board on an airplane. take off his this and take off is the. i know the boeing company we are having these conversations about what doesn't up and do. procedures that are developed are developed for a plans that oregon city delivery and build process. at airbus, and bombarded air and they fly the first flights were procedures actually are not valid yet. because the airplanes never flown. they are valid, right, but you don't know what the fault is because they've never flown

before. i think there's a capability. i think that so you don't resilience in the system is you give the pilot the same capabilities as the automatic system does. and then you try to encourage the pilots to fly that manual system and understand what the airplane just did on the automatic system so when automatic system drops they go, i've been here before, i know the power settings, i know the pitch attitude. not necessary the power settings. i know how this airplane flies. >> thank you, mike. we're out of time now for this down so i apologize but we will take questions during the break, after lunch. want to thank your distinguished panel for coming, and then turned over to captain hogeman. >> one of the featured speakers at the airline pilots associations air safety forum was acting faa administrator michael huerta. he spoke to the group about aviation safety and the future of the faa. this is just under 20 minutes.

>> all right, so crowded, i like that. so right now i'm pleased to introduce the honorable michael huerta, acting administrator of the federal aviation administration. since joining the faa in 2010, he has demonstrated professionalism, leadership, and expertise. he also has a very impressive background in transportation and public service, including leading large international organizations. for these reasons, and on behalf of all airline pilots association members, i have urged the senate to confirm mr. where's as the next faa administrator. we believe that the agency needs to study long-term leadership that he can provide, so we're pleased to send has started the process and we would encourage them to expedite its completion.

he assumed his current role as the faa -- at the faa in december 2011, and administrator huerta is responsible for safety, efficiency of the largest aerospace system in the world. he oversees a $15.9 billion budget, and more than 47,000 employees. he also oversees the faa is multibillion-dollar nextgen air traffic control modernization program at the united states shifts from ground raised radar to state-of-the-art satellite technology. mr. huerta is an experienced transportation official who was held key positions across the country. his reputation for managing complex transportation challenges led him to the international stage when mr. huerta was tapped as managing director of the 2002 olympic

winter games in salt lake city. he was instrumental in the planning and construction of a variety of olympic transportation facilities, as well as the development of a highly successful travel demand management system that ensured that the transportation system operated safely and efficiently. before joining the faa he held senior positions at affiliated computer services from 2002-2009, rising to the position of president of the transportation solutions group. and from 1993-1998, he held senior positions at the u.s. transportation department in washington, d.c. serving under secretary federico pena and secretary rodney slater. he served as the executive

director of 1989-1993 and also served as the commission of newark city department of ports, international trade and commerce from 1986-1989. ladies and gentlemen, please give a warm welcome to the faa acting administrator, michael huerta. [applause] >> good afternoon. and thank you, lee, for the opportunity to be here today, and to share with you my thoughts about aviation safety and on the future of the federal aviation administration. you know, i really appreciate the opportunity to speak with alpa at various forms and have done a couple throughout the year, and i can't tell you how much i value the relationship that we have with alpa and how much i appreciate the support that alpa has for me and for the faa. by working together on safety

issues in a proactive way, it really makes a significant difference. and the future of aviation is very, very dependent on this sort of collaboration. you know, john f. kennedy put it very eloquently when he said, when he made a comment like this. for time in the world do not stand still. changes the law of life, and those who look only to the past or the present are certain to miss the future. this is especially true in aviation. it's always been a very spirited, a very forward thinking and the very innovative industry. kennedy's statement could not be more applicable than it is today. we are in the midst of a change that i would characterize as a revolutionary change. you have heard from many today

about new developments in safety and airline crew health, fatigue management, and most recently on -- another fundamental change that is occurring in aviation now is our nextgen air transportation system. it's a major transformation which will increase our efficiency and our safety, reduce delays and reduce fuel consumption. as you can imagine, it is an incredibly complex transition. but we are making steady headway. we also continue to see rapid technological transformation in today's aircraft, and to maintain pace with these changes, our train must keep pilots up to speed with new and sophisticated technology. it must also stress the fundamental aspects of flying. despite the sophistication of aircraft, we are really focused on providing pilots with more and better training on how to do

things like recognize and recover from stalls and aircraft upsets. we'll be able able to do this, in fact we are able to do this today with the advanced flight simulators that we have today and propels this in aviation. new training is conducted as pilots are actually on a flight rather than in highly controlled scenarios. we've seen recently that inappropriate stall recovery can be a major contributing factor in recent accident, and we can't lose sight of the importance of training on the core aspects of flying, such as crew management and stall recovery and other events that might occur when there's a change or a loss and automation systems. we believe that scenario-based training will enhance safety for the kind of emergencies that happen very, very rarely, but we won't pilots who have sufficient knowledge, experience and confidence so that they can

appropriate handle any situation. ultimately, it's the pilots today that must be the system managers of their aircraft. would also want the crew to be well rested. as you know, to support this we completed the flight and duty time rule late last year. be all the responsibility responsibility of combating fatigue in the pit. the new rule provides pilots, enough time to get needed rest based on different operations, long haul or shortfall, day or night. the rule covers all passenger operations but as you know, were not able to apply it to all cargo operations. however, all cargo operators are encouraged voluntary to comply with the new regulations and secretary ray lahood and i consistently and constantly about this option to them. i also want to recognize that some cargo operators are addressing the issue of rest for the pilots, and the doing some innovative things. unmanned aircraft systems are

also changing the face of aviation, these systems offer unique operations on a multitude of different efforts. however, they must be integrated into our airspace with the highest degree of safety. this into everyone's concerns and appreciating different points of view is the first step in action in a new technology and successfully integrating it into our international airspace system. in a sense building the technology is one thing, some might say well it's a very complicated, it's simpler than the twin challenge you have in bringing new technology into the system. and that is building human consensus on a path forward for our aviation system, which is equally important. now, we're not going to do anything to compromise his safety when it comes to the integration of unmanned aircraft into the national airspace

system. and in order to do that, what we need is good, consolidated. earlier this spring, we asked republican put into establishing six test sites for civil unmanned aircraft systems. we got a lot of comments, 200 plus comments. we had two webinars, each which had more than 400 people attending. we are evaluating all this information, and we expect to ask for specific proposals to manage these test sites very soon. we are also studying training requirements, operator experience and uses of their space, all in the context of how do we integrate them into the national airspace system. this year, we establish within the faa the uas immigration office which is in our safety organization. the purpose of doing this is to offer one-stop shopping for matters related to civil and public use of all unmanned aircraft issues and systems, and

the systems that operate within the u.s. airspace. this office is responsible for developing a comprehensive plan to integrate unmanned aircraft systems, to establish operational and certification requirements. it will also oversee coordinate research and development on unmanned systems. as you can imagine the new office has a lot of work underway already. earlier this week there's been a conference on unmanned aircraft systems taking place in las vegas. i understand that there were 8000 people who had registered and were in attendance in the conference. so that's indicative of the amount of attention that this area is getting. the staff is working on able to integrate small uas and/or national airspace. they're working on the solicitation of proposals for the six test sites, and just recently the faa received the first application for a type

certificate for a commercial unmanned aircraft. safety remains our cornerstone, it's our primary focus and it's our foundation. we have the biggest and we have the safest aviation system in the world, and we want to make it even safer and smarter. and we must continue to serve as a model for other aviation authorities all around the world. we are moving from a system of accident investigation and forensic study to a proactive analysis of data. this helps us understand what might happen in order to make changes to address the safety risks that might exist anywhere in the system. we want operators to establish safety management systems. this proactively helps to improve safety for everyone. at the faa, are already using sms and our air traffic organization, and will extend to other areas within the agency. this is all in the context of

type budgets. we all know these are lean financial times, and we expect that our funding will remain flat or the foreseeable future. the faa's fiscal year 2013 budget request is for $15.2 billion, and we see this as a sound investment in support of our mission. it would allow us to maintain appropriate levels of staffing for air traffic control, for aviation safety, as well as for research and development, with capital investment in the airport infrastructure and faa facilities and equipment. the success of all these programs and goals, of course, rests on our workforce of today and in the future. and ultimately, it rests on effective collaboration between government and industry, between the faa, with alpa, and other industry groups. and what about the faa itself? i've heard from many of you, what is my vision for the agency

in these transformational times. and as i think about that, the thing that first comes to mind is that we must embrace the fundamental technological change that is unfolding before our eyes. nextgen is truly a revolutionary change, and it moves us from aviation technology that was first developed in the 1950s to that of the future. and that's one program. there are many others, and a technology that is developed in aircraft, the technology that supports how we manage our businesses, all of that is continue to evolve at a very rapid rate. second, i want to promote a shared responsibility for safety oversight. both industry and government are responsible for ensuring that safety measures are fully met. it's not one parties responsible or the others. we can't do it if we don't do it

together. and we can't do it without the active for dissipation of one another. third, we will face major changes within the faa and our workforce in the coming years. a little more than 30% of faa employees will be eligible to retire starting in 2014. so for us, succession planning remains the crucial aspect of our focus as an agency. and we must realize that we begin to lose a vast amount of corporate knowledge in the coming years. to prepare for that what we need to do is impart that knowledge to today's emerging leaders and experts to ensure that we have a successful agency in the 21st century. but at the same time we need to capture the innovation and creativity of the younger members that are joining our

workforce, and to embrace innovation and figure out how we can continue to operate more and more efficiently. we must move forward full force and think -- in tandem with one another, with government and with industry. it's not just the faa, but it's also other government agencies and also aspects of industry, from airlines to association groups to unions. what we need to do is embrace the opportunity that we have before us to make long lasting changes together. when i think about the technology and where we stand and how our industry is evolving, the generational change were going through at the agency, i really truly and believe we're at a critical point in aviation. the decisions we will make in the coming years are really going to shape what aviation is going to look like for decades ahead. so thank you again for inviting me to speak with you today. i look forward to our continued

collaboration in the years ahead. thank you. [applause] >> the administrator still has a few minutes for questions. if you have a question, if you approached a microphone, that would be great. anyone. >> funny watching the teleprompter. the answers are not there. [laughter] so ask away. >> seeing none, i want to thank you again. thank you for all the support and looking forward to your confirmation. [applause] >> the federal aviation administration's top medical official spoke of the airline pilot associations safety forum wednesday in washington, d.c. he discussed the certification process for pilots, health

issues and the problems pilots face with prolonged lifetimes. this is about an hour 20 minutes. >> okay, welcome back. some people have the luxury of being able to take good health for granted. as airline pilots, we do. the faa makes us undergo medical examinations on a regular basis. and while many medical issues don't have much effect on a persons ability to be productive in the workplace, for an airline pilot those same conditions can end their flying career. we operate in an extreme environment with high altitudes, cosmic radiation, and ever changing time zones. we fly day and night, and have widely varying sleep habits. and don't forget stress stress from flight operations,

family concerns, or even the economic fortunes of our particular airline. they can all add up to a major impact on a pilots health and well being. we will now hear from a very distinguished group of aviation aeromedical experts about the most pressing medical issues facing today's pilots. moderating this panel is captain chip debt truck it was -- captain john dettra. [applause] >> good afternoon, ladies and gentlemen. the air line pilots association chairman of the national aeromedical group. air medical group makes up one of the five components of alpa's pilot assistance structure. in the air medical group, we take a multifaceted approach to helping members maintain good health with information and individual interactions.

our group works the medical industry and federal regulators to ensure the latest information and standards, not only get to the pilot, that they receive information but it's also applied to the medical certificate. now on to our panel. very honored that such distinguished guests today. dr. quay snyder is alpa's aeromedical advisor, and dr. fred tilton is faa's federal air surgeon. bob winger presentation there will be ample time for questions, and i encourage you to engage dr. tilton and dr. snyder, some major way to the microphones with your questions. dr. snyder is the president and ceo of the aviation medical advisory service. we often refer to it as a mass. alpa and ms have a critical ongoing relationship that started in the late '60s. every airline pilot must pass a

regular medical examinations to determine his general health and fitness for duty. amas assistance is invaluable, not only in helping pilots maintain their medical certificate, but in helping pilots regained their medical certificate with the least amount of hassle and the reasonable amount of time, if it were ever to be denied. they also provide proactive information and assistance that ensures pilots maintain the best possible health throughout their airline career. dr. snyder, i'd like for you to talk about the scope of your operations over there and how amas supports alpa. >> thank you very much, chip. pressure to be here. the alpa aeromedical office was formed in denver in 1969, and since that time we have been

providing services for alpa from its members and its leadership. we've also been interacting with the faa and with international organizations, the military and the ntsb with the goal of promoting private health and pilot safety. we have two primary functions that we work with. one is the consultation, which is advice to the union leadership on issues such as what you'll find out in the white papers that have been distributed in the backroom. please pick one up and take a look at that as they cover some very important issues. the other part of our services are to the individual pilots. we assess them with maintaining their health, providing them advice about how to best do that while simultaneously helping to maintain their medical certification, and be compliant with the faa rules for reporting medical conditions.

we work closely with the pilot assistance committee, which captain dettra alluded to has five components to the aeromedical, but would also work with the hims, a program where a pilots with the disease of addiction or abuse are successfully treated and returned to the cockpit in very, very successful program. we work closely with the professional standard and critical incident response teams from alpa, with patterson may have problems in different areas, and many times we find overlap from all of those areas. the canadians also work closely with us, although they have some autonomy and some different regulations, apply to them. the common theme of health and safety is universal for all pilots. we also spent a considerable amount of time interacting with

the alpa engineering and safety department to take a look at areas where pilot health might be improved through broad areas with suggested changes in technology and regulation. our other interactions include the legal department and retirement insurance major pilots are encouraged to get the appropriate medical care and have the ability to do so. a big part of our efforts also are working to do with the communications department at alpa. we write monthly articles, healthwatch, to inform pilots about evolving technologies, current medical conditions, and how best to care for themselves. we also produce short segments for tv. captain dettra produces the aeromedical flyer, informational handout the goes to all pilots. and we have other opportunities to communicate health and safety information to the pilots.

we also participate in a number of conferences, premier conference being our hims conference which is hosted in denver every year, with about 300-350 attendees. our international -- cooperation and ordination within unions and the certification authority such as ac on the country. would have a relationship with the icao medical office and doctor tony evans there, and are hims outrage also includes educating our international brothers and sisters regarding programs to better treat the drug and alcohol problems. most recently been in hong kong and brazil to assist them in setting up programs. for us, the most satisfying portion of what we do is collaborate with the federal air surgeon's office and a host of

areas. dr. tilton has been very gracious in working with alpa as you've seen all day with the theme of cooperation between industry and regulators. we also work very close with aeromedical certification division in oklahoma city, primary on behalf of individual pilots but also to initiate an effective policy changes. some of the areas that alpa is pushing for changes in policies that have been great successes are, number one, the hims program with over 4000 pilots who have been successful returned to the cockpit. back in the seventh, coronary artery disease was a disqualify condition, and what that did was drove highest underground cannot report conditions, or dangerous to the health, not seek evaluation for treatment. but with the evolution policy changes in that area, now pilots routinely our return to flight after being successfully

retreated -- being treated with the disease. other examples would be the hiv positive the dr. tilton's office has worked very closely and announced policies that allow pilots to use of sleep medicine to better prepare to make them safer when they are faced with these trans-meridian flights and are facing the jet lag. a very, very important change in april of 2010 was a policy allowing pilots with the disease of depression to fly on certain medications, with aggressive monitoring and testing prior to doing so. when the sars epidemic broke out and we have h1n1 to questions about whether pilots were at risk for the disease is and whether they could prophylactically used medication to reduce the risk of disease, particularly if they had

symptoms. federal air surgeon's office was instrumental in announcing policy that allowed our pilots to fly with the protection of medication, and that was done in a matter of several days. flight time to the time has been an ongoing discussion. i think we are making significant progress, medical aspect primarily not only as a science but then so well-defined is also a way that we might augment the. i would also provide education to pilots about other areas that might help, such as the use of nutritional supplements and lou of medication and also discouraging the use of alcohol and over-the-counter antihistamine which many pilots have used in the past. some of the current issues we have are the evolving technology and products in medicine. there's a continuous evolution of medications that are coming up but also now we are looking at pace makers that have

interesting capabilities now, automatic internal defibrillator to perhaps artificial pancreas or individuals afflicted with diabetes requiring insulin. on october 1, the faa's implementing universal web-based medical application for pilots. we have been able to work jointly to understand some substantial problems, with the ultra long range flight, again with worked with issues and the medication your a laser hazard exposure, the vision research department within the civil aeromedical institute was instrumental in providing us information that allowed us to educate the public at a laser hazard conference that alpa hosted last year. we are continually interested in streamlining the certification process for our pilots so there is less reluctance to get

treatment, report conditions to the faa, and know that once they are medically sound, they can also be certified. and, indeed, very, very near future, i think we will be wrestling with commercial spaceflight, medical standards, not only for the crews but possibly for the passengers as well. i earlier mentioned that alpa white papers. i would encourage you to pick up a copy in the back near our sponsors. one of the importance is, encourages safety partnership program with the faa, with industry, with osha, and with pilot groups. there's also another white paper on unmanned aircraft systems. the medical certification of the operators of those systems will be a key issue for discussion in the very near future. we are very, very fortunate to have dr. fred tilton, federal

air surgeon, without speaking today. after graduating from the air force academy, i'm sorry, from west point, i'm an air force guy, so -- [laughter] he did come to the bright side and joined the air force. and had 4000 hours as a command pilot and a senior flight surgeon and a host of aircraft between the b. 47, c-141, trainers, transport aircraft with c-12 and in his last assignment in the f-15. is a graduate of the university of new mexico with his masters of science and has his masters of public health from the university of texas. after retiring from the air force, he had a career in the regional medical director for boeing aircraft corporation and became their corporate flight department. he took his initial position with the faa and he has been the

federal earned air surgeon and currently flies the -- dr. tilton is a friend and colleague, and he is a pilot doctor, or a doctor's pilot. he understands aviation. is an advocate for the public and it's a great privilege to have him speaking with us today. thank you, fred. [applause] >> hello, everyone. i usually tell people when i get in, just proves i'm really old. so you're fortunate that dr. quay snyder working with you. we work within every quarter. he comes to washington with one of his staff members, and we spend a significant amount of time discussing policy and then we look at individual cases so that, that he represents you and your constituents and make sure that you were having problems with certifying certain individuals that they just --

they get the best shot. so he doesn't outstanding job for you and you are fortunate. i'm only going to take a couple minutes to give remarks because i want to give you most other time to ask questions. at the first thing i want to talk about is the certification policy that we have at the faa. as you heard i was a pilot before i was a doctor, and i used to tremble a lot when i used to think i would see my flight surgeon think in the best thing i can do was break even. so if i could get into and get out of there and didn't do anything to me, that was a good thing. so i felt that way until i was flying be 57th when i flew a special squadron. they flew with us. they went td why would this. they went to the club with us but they did everything and i learned the best flight surgeon i want to integrate with the puck were close with them, party with them, socialize with them and realize that flying is extremely important.

and i always tell people that a flight surgeon can make a big mistake if he unnecessarily disqualify somebody, which we hate to do. so that leads to our certification policy, which is as you well know, i work at avs, aviation safety and faa. i worked with peggy gilliland. and the primary reason we're there, the reason you're here, a safety and airspace space if i tell everyone that they work with, the reason we're here is to make sure the airspace is safe, and i go to seminars and to talk to them all the time, the there there is to do the same thing. and, in fact, you probably see them more than any other faa person. and so the ame has a great opportunity to talk with you about your history and to make sure that you are safe and to learn new things that we are finding out in aerospace medicine. but if you take for granted the primary reason we are there for safety, the second reason we're there is to make sure that

everyone we can get in the air, we do. and if you look at history the faa over the years, 40 years ago you had hypertension being treated like i do, and a lot of other things, you are disqualified, not just for a month or year, but forever. so we have gone a long way. if you look at the list of things we certify now, 40 years ago they never would consider doing that, and we do that based on evidence-based medicine. .. >> you may or may not be aware of it because it was just passed recently, and i'm not really sure, nor is the rest of the

faa, exactly how that's going to impact us. now we're going to have a requirement to notify pilots when they come many from their medical exams that they're having an examination that is, according to the law, an investigation. what does that mean? they used to be able to appeal beyond me to the national transportation safety board. now they can appeal into the u.s. district court which means they can get a jury trial. all of these things, and there are several aspects of the pilots' bill of rights that we're not clear exactly how they're going to effect us, but they will effect us. in the coming months, you'll learn more about that from flight standards and probably from your legal advisers at alpa. so be aware that that's coming. and with those comments, i'd be happy to sit town and answer questions or -- sit down and answer questions or stand up and answer questions. thanks a lot. [applause]

>> dr. tilton, really appreciate you coming today. my question has to do with attendance and reliability policies, specifically at regional airlines. i was at -- [inaudible] air before i left a few months ago for my current job, and in 2008 they implemented this policy where a pilot who called in sick could be disciplined. then we had our accident in 2009, and the company suspended the policy. a couple months ago before i left they continued once again to implement the attendance and reliability policy which is in direct conflict to our medical standards. it's a policy that really conflicts with the faa guidance about flying sick, and i know my

airline isn't the only one that has this policy. what are your thoughts on that, and is the faa looking into these individual airlines that do have these attendance and reliability policies? >> well, first of all, if you have issues like that, medical probably is not the correct organization. it would be flight standards that would be looking at the management of an airline. i certainly do not think that it is a good with the for people not to be able to tell their airline their sick. at the outset my primary reason for being here is aviation safety. and if someone is telling you they're sick and you have to fly an airplane, it's counter to the philosophy for many reason. in effect, we don't make policy for the airlines, they do that. and so if you feel there's a conflict with your airline that they're causing a safety issue, you should report it probably to flight standards and not medical, although they might talk to us about the consequences. >> i appreciate that, thank you.

>> referring to the illustrious -- [inaudible] good afternoon, defendant tilton . -- dr. tilton. i had, actually, a couple questions. from your perspective we have some emerging technologies coming our way. uas is one that was brought up on the slide, and i wonder if you could elaborate on thoughts of air medical issues that might be unique to uas, that's one. and then the same kind of question with ultra long haul operations. in particular i've had a couple bouts with kidney stones, and i don't know if there's an airline pilot out here that hasn't had a kidney stone. i didn't know if there was any more information. i know my ame has joked often about wanting to start a research project and why that's

such an issue with pilots. but just those two questions about air medical challenges faced by, perhaps, uas and ultra long operations. >> well, i'll start off, first of all, by saying i hope there's at least one airline pilot out there that hasn't had a kidney stone. and i don't know if there really is an increased incident of kidney stones in pilots, but i do know that one of the reasons people have didny stones -- kidney stones is because they get dehydrated, and sitting in an airliner at 7% humidity for 18 hours, even longer, there's a possibility today get dehydrated, and if they have a potential already to have a kidney stone, that might exacerbate the problem. i don't think anybody's really done a study that says pilots have kidney stones because of that or that they have increased incidences of kidney stones, but certainly it's significant because if you have a kidney stone, those of you that have

had it, will tell you it's not something you want to have if an airplane. they're extremely painful, and they're something that we watch, and certainly we have lots of people that have waivers with kidney stones, but we're concerned you might have one in flight that might pass and create problems. now, i'll get back to your first question which is what are we doing about uas? we are actually looking to develop standards for people that operate uas. the problem is there are so many different kinds of those airplanes that are flying. some of them are the size of a bumblebee and some of them getting up to size of almost a 737 or bigger, and how do you deal with those individuals that operate those? some are actually doing them by line of sight where they're watching these, and they have an observer that watches them. they may be inspecting a building. some of them are flying on computer programs. and so we have all kinds of issues associated with vision, associated with hearing, associated with cognitive

functions of programming, and as you're well aware, some of them are flying completely programmed, and they take off and land, and you don't do anything else. some of them are flying like model airplanes like visual control, and there are other ways you can control these airplanes. so we are going to look at, and the faa is actively trying to figure out how we will develop medical standards, and we're working on rules to do that. right now we have no authority to regulate those with respect to medical conditions, but i think eventually -- and i don't think eventually means a long time, but it's going to take us months or maybe a year or two to figure out how we develop a standard that covers this whole gamut of uas from very small things to huge things. how do we deal with them in the air space? how does air traffic control do it the way we used to manage airplanes which is see and be seen? because there's no one in a global hawk to see outside. so it's an issue for us in medicine, it's an issue for air

traffic control, it's an issue for pilots. very complicated, so i expect that you'll see in the coming months some standards associated with those people that operate them, but how we'll end up completely and finally at the end of the day i'm not completely sure. >> thank you very much. >> oh, boy, i'm the last guy standing, i get to ask the big question. first of all, i'd like to say as a recipient of a special issuance medical, thank you very much. that was a wonderful thing, to get that medical back. um, and i'd like to congratulate you folks for the speed at which the process moved. i was quite surprised. pleasantly surprised. my question has more to do with as we in the aircraft design operations look forward, we hear manufacturers talking about

constructing single-pilot transport category airplanes, things like this. and i just wondered what you look at in medical standards as you would consider that type of development. this is much -- way down the road type of a project, but as we look at the potential looming pilot shortage, there's two things i see coming. one is single-pilot transport airplanes, and the other is perhaps pilots flying well past the age of 65. >> okay. single pilot is an interesting issue. and, actually, pilots in the united states have less of an issue than they do in the united kingdom, in europe and even in canada. and the reason i say that is we do not certify individuals that we feel may have some kind of medical problem that will create a problem, a safety problem in the air. the europeans and the canadians and i'm not sure about the rest of the countries in the world,

have programs where they will certify one only for participation in a multipilot cockpit with a fully qualified co-pilot. we don't do that. so we certify people so that we believe that they're just as safe to fly an airplane as someone who might not have a special issuance or a waiver. so as a result of that from the medical perspective, i don't think that having a single-pilot transport airplane is as big an issue as i do think maybe from the flying public who wonders about one pilot up this and what happens if that -- up there and what happens if that person has some kind of medical problem. and as you're aware, we frequently see pilots get incapacitated because they may have a gastrointestinal problem or something that effects them temporarily where two days from now they're ready to go fit and fiddle. yet if they'd been alone in the airplane, what would that have accomplished, and how would that effect the safety of the air

space? i've actually heard of some manufacturers that were developing single-cockpit airplanes and decides that the public wasn't -- decided that the public wasn't ready for those kind of airplanes, and tsa anecdotal. i'm not sure if that's true or not. but i think with respect to your question how's it going to effect medical? not so much in the united states, more so in europe because of the way they certify people. does that answer your question? >> it sure did. thank you againment. >> you're welcome. >> thank you. good afternoon. my name is bob perkins, i do not have a kidney stone. [laughter] i'm your safety coordinator for canada, and i'm more interested in the international certification. the idea, of course, of trying to globally harmonize as much as possible the certification standards. through icao and other bodies. i'm just wondering how the faa

is cooperating with, which venues they're using to work with transport canada, to work with icao on that harmization of medical standards or if there is, in fact, harmization. >> it used to be better than now. the reason i say that, the jaa came over and visited with us and said couldn't someone there the faa please come and help them develop their medical policy. and at that time the jaa or joint aviation authority, was struggling through how were they going to create their medical standards in europe so that they could then input that to iasa. and that committee met quarterly, and i went over there as the participant in that committee, and i sat through those meetings. i learned a lot.

and i learned a lot about their philosophy verse is us our philosophy. and, essentially, the standards in europe are not that much different from the standards in the united states. the differences in how they employ those standards. so now that the jaa has gone away and now iasa is the legal body managing the medical certification issues i don't participate so much. i participate more now with icao than i do with the easa folks, and they also come to the meetings. so there is a committee called the medical programs study group, and we go up there and discuss standards, look at the icao standards and try to develop a uniform standard which then we hope will get deployed across the world. so rather than working directly with easa, i'm working more close hi with icao to develop the standards. and as a matter of fact, related

to that, you may be aware that on the 20th of july a rule was finalized that pilots who have a special issuance no longer have to carry their authorization letter along with them. and the reason we got that requirement was in 2007 icao audited us -- not the medical part of icao, but they audited the faa, and they actually forced us to write a rule that said if you have a waiver, you must carry your letter of authorization with you detailing the reasons you have that waiver. at first they wanted us to put that directly on the medical certificate, and we said there is no way we're going to do that. so they allowed us as an accommodation to carry the authorization letter on with them. shortly thereafter the icao doctor called me and said why did you do such a dumb thing ask

ask -- dumb thing? and i said because the auditors told us we needed to do that. and can we finally got an agreement from icao that it wasn't necessary to do that. so pilots, whether they're private or commercial, no longer have to carry that letter with them. it had private, privacy information on it; what their diagnosis was, etc. and so having to show that to an inspector was not necessary, we believed, because all they needed was a medical certificate that they're medically certified to fly. so i think that's a good thing, and that's one way we're working with the international folks to make flying safer, healthier and easier for you. >> thank you. >> dr. tilton, linda orrlady now working for boeing as a flight check and safety pilot. talking with an airline pilot about a month ago who'd received an e-mail, i believe, from your

office with your signature about a survey about ames. and i was curious, i assume you're familiar with it, but i was curious in terms of its objective if you have the results back, are we looking to change any standards, or what are we hoping to gain? >> we don't have the results back yet and, yes, i'm aware of that. it's actually run out of our office in oklahoma city. they do that every two years, and they're looking to get a consensus of what ames are thinking, do they have suggestions about how we can do our business better. so not necessarily changing the ames business, much more how we can make them effective and where can we change policies so that it'll make it easier for them to do their job and as a consequence, easy for them to help you get your medical certificate. >> is there one particular challenge that seems to be, one area ha seems to be the largest challenge for them getting pilots back recertified? >> i wouldn't say there's one

particular challenge other than what your earlier speaker said was he was thankful that he got his clearance so quickly. >> yeah. >> we work, we worry about that a lot. in fact, we just lost the person who's run the certification division for over 15 years, warren silverman, who's been now replaced by another individual named courtney scott. but he and his staff look at that closely. one thing we've done to enhance our abilities to do certification quickly is we've now expanded certification to the regions as well. so a pilot can talk to their regional medical director, so can an ame. and, hopefully, that business of looking the way we do certification, making more expeditious and enhancing our ability to do that quickly yet safely is one of our primary goals. >> but, quay, i know certainly your group and the resources are superb with that. have you noticed much change in

the process? the impression i get from talking to folks is that i don't know if i'd say easier, but more clear andless ambiguous, so i think somebody's doing some good things. >> i will make one other comment. and one of the things that we're doing is looking at a way we maybe can do away with special issuances. if a person has a particular issue which is stable, some kind of cancer, for instance, although they've had cancer, it's now been, quote, secured although people are now saying if you have cancer, you're not cured, you're just living in some kind of state where it's possible it could come back in 30 or 50 years. but if you're stable and we believe a person is stable and we're asking for the doctor to give us a report every year and the report come back and essentially said, i told you he was okay last year, why are you bugging me, there's no good reason for us to do that, les no good reason for you to have to get that report. perhaps if you're being followed by your oncologist or cancer

doctor, he sure can do that and give that to your ame, or perhaps your ame can make that decision, and we'll just issue them a regular issuance saying you have this history, and if you have a recurrence, you need to let us know. so hopefully that will, again, help streamline the process that we have for certification. >> appreciate it. thank you. >> if i may comment, this is numerous examples of -- there's numerous examples of the office of aerospace medicine streamlining the process, reducing the requirements for observation periods or the documentation. most recently we've seen a substantial reduction in the processing time for pilots diagnosed with sleep apnea which may effect 4-6% of the u.s. population. it's a very dangerous condition and certainly has adverse effects on aviation safety. yet the initial certification process required a series of tests that were both expensive and required a long period,

relatively long period in between getting the test and getting the day and getting it -- data and getting it to the faa. so it discouraged pilots from obtaining evaluations for a possible serious medical condition. now that the faa has shortened the process to allow technology to take advantage of getting data quickly, the process ha gone from -- the process has gone from what used to take three months to no sometimes under two weeks. so it works synergistically with the pilots to improve health, and as dr. tilton said, the safety of the aerospace system because pilots are encouraged to get treatments for diseases they might have. >> hi. i'm colin wilson with mesa airlines. i'm alpha safety volunteer, and i've got kind of a three-tiered question here. first of all, we hear all sorts of wild accusations or claims as to the amount of radiation that we are exposed to on certain

stage l. of flights. so, one, could you give us some idea of what it may be equivalent to in other aspects of our lives. and then kind of go into possibly if the solar flares that we're seeing so much on the news these days is adding to that exposure, and that kind of segways into my final part, could you discuss the interactions that you have with other aviation safety and health organizations such as the cdc, ntsb, maybe even nasa? >> i'm not an expert on those, the first two questions, but we actually, unfortunately, the person who used to run that organization named wally freeberg just passed away last week. he was an internationally-recognized expert, and he actually looked at things like solar flares to determine whether or not an airplane should be diverted based on the proton, the probability that a proton storm

might occur, cause some problem. so we actually have an algorithm that you can use to look at those to see if airplanes need to be diverted, and we actually have done some studies looking at certain kinds of cancer to see if they are caused by exposure in the cockpit. there's one particular kind of cancer called melanoma which there may be some relationship with, but i don't have the data. and it's, right now it's anecdotal. certainly, if you're at altitude, there's a possibility that you're exposed because the higher you go, the less atmosphere you have protecting yourself, so there's a probability that you'll be exposed. you are protected somewhat by the cockpit windows, and there are some issues that we don't have all the answers for. i haven't seen any significant increased risk with respect to the numbers saying that if a person's exposed in an airliner, he or she has a much greater risk of having a particular kind of cancer. there is a relationship to mel melanoma, and quay may have some

more data on that, i don't know. but i don't finish i have no more day a than that. the last part, and then i'll let quay answer the question if he wants to is that we interact with some of the other safety organizations. i'm on an oversight board at nasa, actually, for their medical committee. so when they have significant issues, they will call this board together, and we meet to discuss their policies and, hopefully, help them develop their safety standards that then they implement at the faa. there are members on that from the military and from the private community. there was a member on there from the national transportation airty board. other than that -- safety board. other than that, with respect to interactions with individuals like quay, we do interact with eaa and aopa, and today, in fact be, i was at oshkosh a couple weeks ago and met with their medical oversight committee that helps them. and they're a group of ames

that help them deal with pilots that have significant medical issues to help them deal with their problems. so i frequently get calls from the chairman of their medical committee, and i also get called from gary crump who's the aopa medical director whenever they have issues to deal with us. and those individuals also interact with regional night surgeons and with -- flight surgeons and with the medical certification division in oklahoma city to deal with particularly difficult medical, medical certification issues. now, if quay has a comment with respect to the cancer issue, i certainly welcome -- >> be happy to. there are three studies that i'm aware of. we've looked at a study from the medical university of south carolina that looked at cancer deaths, and essentially pilots were a healthier cohort than the general population in that. there was an increased incidence of melanoma, but it wasn't clear that that was caused by radiation received in flight.

it may be that pilots have easier access and more leisure time to get to warm climates where they might be exposed to that. so the cause and effect was impossible to determine. there was one study where there was indiana creased incidence of a rare -- increased incidence of a rare type of brain tumor if pilots in canada, but it lacked the power because of the low numbers to really make an association of that. and there was another study of flight attendants in scandinavia, i forget which country, which may have shown a slight increased risk if or breast cancer. but we really don't have any hard evidence for that at this point in time. there are two issues. dr. tilton mentioned the resources that the faa has to calculate out radiation doses that wally did. that's available on the web site, and i know alpa and the

allied pilots' association have folks who are looking at radiation issues. also the white paper that i mentioned earlier looks at possibly tasking the airlines with monitoring radiation dosages much like a radiation, radiation type worker would wear a doe semier the. it's, for the individual pilot, though, those answers are not satisfactory. so we're confronted with a situation where people may ask us about what to do. the person who's at highest risk is the pregnant pilot in her first trimester. and that that's an individual decision about whether she should fly or not. but there are certain strategies that we recommend that people would take if they elect to continue to flow. ha -- that woman should probably fly at the lower latitudes because of the greater shielding from the ozone and also fly at lower altitudes to get more

protection. so the short duration flights in the southern latitudes if they can get those would be a significantly lower radiation exposure than someone doing a transpolar route. so on an individual basis, that's the information we can give now. hopefully, at some point in the future there'll be actual ratings, and we can compare those to radiation workers. >> good afternoon, gentlemen. i'm kevin hyatt, the coo with the flight airty foundation. in the opening remarks, dr. tilton, you had talked about evidence-based medicine, and that piqued my interest because in the safety world we're all interested in evidence-based training, those types of things. i was wondering if you might be able to go into it just for a few minutes about what that means as far as evidence-based medicine, who's collecting that data and how are you using that data to help us as pilots?

>> the way we collect that data is getting information from just general studies on various kinds of cancers or various kinds of medical issues. efectively, if you could look at heart disease, for instance, and as i said in my earlier remark, 30 or 40 years ago if someone had high blood pressure, they got disqualified f they had a heart attack, they got disqualified, if they had a heart transplant, they got disof requested because we felt the risk -- and our primary concern is looking at catastrophic risk. i tell people if i could figure out if somebody has a particular problem, and i could safely certify them for six months and then they were going to fall over dead on six months and one day, i would certify that person for six months. the problem is there's a lot of art in the business, and it's not all science. but what we can to is we can look at particular kinds of cancer and say that the most likely problem with that will be maybe a spread to the bone

rather than to the brain. and that's, that's the big problem because if a cancer spreads to the brain, sometimes the first time we know it's there is when they have a seizure which is not a very good thing to have in an airplane. so we look at the data, we try to determine what kind of problem a particular person might have, and we do this based on looking at the literature. wal look at our, we also look at our cohort, our people, our pilots to see what they have and see if we can gather any experience. now, you asked who's collecting the information. we have millions of records that people we've been certifying over the years. the problem is that our database is not what's called a relational database, so it's difficult for us in some ways to go through that database and pick out particular issues. although we're getting better at it. there's a medical information system in the faa which is a really collection of medical

information systems -- not medical, information systems. it's collecting over 90 databases concern -- and putting that together to see if there's a way we can look at accidents. we have a similardatabase in med ca which takes the database i told you about it and looks at it to determine whether or not a particular medical condition could create an accident. and the first clear data we did that with was with acentral fiblylation -- fibrillation and then determine that a perp treated a specific way was cleared to fly. and we're looking at doing that with other conditions to make sure that when we certify someone, we can do it safely, but also to allow us to certify more people that we might have disqualified in the past. >> very interesting. thank you for your comments.

>> hi. i was wondering if you would promote a policy which instead of having an arbitrary age 65 retirement would instead depend on an individual examination as one got older, past the age of 65? >> excuse me. the reason i coughed not because of your question. [laughter] i cough because i've been coughing for several weeks. in fact, when i told quay, he said, you should see your doctor. i said, i did see my doctor, n., he's my ame, and he told me to take antibiotics, which i'm doing right now, but still coughing. i apologize for that. but refresh me again what you asked? >> 65. >> 65, yes. [laughter] working on my brain too. so we had a big problem with age 60, and the reason we had that is there is a specific ruling in

the faa that says if you have a airty rule -- safety rule, in order to change that safety rule, you must prove that it's as safe as or safer than it was before. so we had a difficulty trying to get to age 65 for that very iraq. very reason. while it looked like people were living longer and aging slower and you look at long jeffty, then people could safely fly an airplane up to age 65. and i think as we go beyond, i think we demonstrated that it was safe to do so. but it was done so by congress passing a law. now, if you ask me should we change from 65 to 70, the problem is that people have two different kinds of age. they have a chronological age which means they go from 1 to 2 to 10 to 50 to 90, and they also have a physiological age, and

there's some people that could be safely flying up into their 80s. in fact, we have lots of people that are certified over 80 that are flying privately. in canada, i mean, australia actually doesn't have an age restriction, although their pilots that can't fly internationally unless they fly into a country that allows them to do that because they don't meet icao standards which also has age 65. so if i could figure out a way to measure someone's physiological age, then i would certainly say i would support them flying beyond age 65 commercially. the problem is that i might also be finding somebody that over the age of 35 shouldn't be flying physiologically which also would create a problem. so it's, again, from our arrangement to science, and i don't know how to do that to support, to support it other than the fact that possibly in the future when we're looking at people looking at their longevity, looking at what kind of medical conditions they get, picking sure that

physiologically they're okay to fly beyond that, then we could, again, figure out a way to maybe go beyond age 65. but right now we don't know how to do that. >> at the time of the age 65 debate, i know alpa formed a blue ribbon panel to take a look at it. leadership that came out to our -- linda came out to our office, and we had some discussions there. there were two issues. one was the risk of sudden incapacitation such as a heart attack, a stroke, a seizure, and the other was the reason of subtle incapacitation. when you look at the data, flight safety foundation in arrow safety world published the most recent paper that i saw, you find that the risk of sudden incapacitation really for the most part is age-independent. the largest group of incapacitations would be, as fred said, could be ear, nose and throat or gi. the seizures can happen with any

age. heart attacks, sure, they happen in older folks. those are -- you're able to test for them medically, but from a public health perspective the number of false positives you get in an asymptomatic population doesn't justify testing that group of people. the bigger worry was the subtle incapacitation. there's a per tseng that there's cognitive decline -- actually, it's a fact -- that there is cognitive decline with aging, and you gave me a good study, a good paper on that from a gentleman from the naval air medical institute who had done that. the question is, where do you draw the line, and do you do testing, and does the testing that's available give you relevant aero medical information? and our information was that the training process was a better

proxy than doing testing on individuals because of the variability. and as fred said, if you instituted that as a requirement, you would have some 35-year-olds that wouldn't qualify. they wouldn't meet the standards where you couldn't have people who were 75 or 80 years old exceed those standards. so it was a very difficult situation, and i was very pleased to see that the faa essentially kept the standards identical to what they are, and there are airmen who are 80 and even in their 90s who hold a first class medical certificate. the age 65 restriction is a safety restriction based on operations rather than on a medical issue. >> thank you. >> good afternoon. mark -- [inaudible] the delta ped call chairman. i work closely with dr. snyder, and i just wanted to pass along my sincere thanks for, um, much as predicted the success of the

ssri ruling. it's changed lives. i take phone calls on a regular basis. um, i wanted to point out the raw of unintended consequences -- the law of unintended consequences. and while i know of two at delta who are flying on the ssri, i can think of at least a dozen others who have entered treatment and not had to go on it for life, yet because that was available, were willing to go and seek counseling, seek help that needed. so i want to thank you. it really does make a difference. the question i have, though, that goes with it is nimh, national institute of mental health data, suggests that the numbers should be significantly higher than we're seeing. we're seeing the numbers in, you know, double digits, and it should be more for a large pilot

group. what can you do to help us help identify those people so that they get the help that they need, so that they can return? because everyone who does seek it out eventually does return, virtually in our experience. >> that problem worries me. it's one of the things people say keeps me up at night. and the reason it keeps me up at night is i think we are probably more conservative than we need to be. if you aware of the standard that we have, we require a person who have been on the medications for over a year to be stable for over a year, and that's the biggest concern. and the reason we did that is because we want to make sure that we don't certify someone and then find out down the road that that was a mistake. and probably the best example of that is a medication called chan six that was used and -- chan six and still is used to prevent smoking. and we actually certified people

on it for a while, and then we started finding out, in fact, the fda put out a black label notice that said those people were having a significant increase in suicidal tendencies, in some cases actual suicide, and we had to go back and uncertify all those people because we were concerned that suicidal ideation or, actually, suicidal acts was not a thing that we should safely certify people for. so when we went from not certifying people with depression and certifying people on antidepressants, we were concerned that we wanted to sure we did it right. although we think that in the long run we will reduce the year to a shorter period of time, and also even our regulations now, we only certify four different drugs. although we have said that if we find other medications, and i'm certain that as medical science

improves medications and improves the research that we'll find other, even better drugs and medications than the ones we're using now that are increase the number of medications that individuals can use and be safely certificated. the other thing is the yearlong period it makes people wait some say, well, i know that other people are certified, so it's probably okay for me to continue to do this and not report it because i know i'm going to lose my longevity for some period of time. so that's kind of a disip-in to have that we have that -- inhibitor that we have that convinces people that they shouldn't be acknowledging those. some other people might say i understand that i have to wait a year, i'm depressed, but i can't afford it, or i don't want to be disqualified for some period of time. and so they're flying in a depressed state which is also not good. so i'm looking at better ways to certificate people, to give more people an opportunity to getter

certificated as they need it, to retuesday the time they -- reduce the time they need to be on the medications so we can offer this to more individuals. because i agree with you, the data of the number of people that are certificated probably are not equal to what the number are in the normal, in the noncertified, nonflying population. and so i think there are people that need to get an opportunity, and we're working on ways to do that. >> again, i just wanted to say thank you because it has made a difference in many, many lives of people that we've worked with. so thank you. >> you're welcomement -- welcome. >> afternoon, gentlemen. ray, investigation board member and line captain for jazz. this question for dr. snyder. as you know, we represent pilots in the canada and the u.s.

i'm wondering if you could elaborate on your relationship with our regulator in canada, transport canada, and you could elaborate on any appeals to the transportation appeals tribunal in canada and any denials you may have seen there that might have been certified in the u.s. or virus versa if you're aware of any differences. >> sure, i'd be happy to comment. our canadian brothers and sisters are very, very independent. the calls that we get from canadian pilots usually relate to the effective medication -- effect of medications, surgical options available, different types of treatments or policies with respect to the faa. in canada you have a much closer relationship with your cammieses, what we would call medical examiners here and the ramos which are our e question leapt of regional flight surgeons. there seems to be a collegial interchange of information. also mr. dave noble from toronto

does an absolutely fantastic job in coordinating the resources that our canadian alpa pilots use and has been very successful. we don't have direct interactions with dr. david salisbury who's the gentleman who heads up, who's fred's equivalent up in canada on individual cases. we do communicate with him on policy issues, but i can't give you any data on individual cases where denials have been appealed to him. done through our office. mr. noble and murray monroe are the gentlemen who coordinate that. >> thank you. >> hello, gentlemen. aso communications, just p want to briefly ask to you, i know we touched on the risk of not knowing -- [inaudible] just talking with other line

pilots the thought out there is that the windows in the cockpit of our aircraft should be protecting us from sun damage, and i wanted to see if you had any guidance for us or opinion among the ame community that perhaps those windows are not protecting us, and we should be seeking actual protection using sunblock, that sort of thing to protect us from not only sun taj, but perhaps melanoma as well -- sun damage but perhaps melanoma as well. >> i don't think this is so much a an ame question as it is a general health question. probably if you walked around with black clothes under an um perella from the time you were age six months or when you could start walking, you'd be better off than if you didn't to that. and what dr. snyder said earlier was that we're not sure whether the risk that pilots have is attributable to being in an airplane or the fact that they may have more leisure time, and thai lying on the beach

somewhere sunning themselves. i know when i was young which is when they were wearing blue and gray uniforms, i used to go out every day in the sun, and i didn't want wear sunblock, and we'd get baked, and by the end of the summer i'd be brown and tanned, and the sun didn't seem the bother me, but i was still cook myself in the sun. and people in my generation grew up that way. i strongly recommend that people wear sunblock when they go out in the sun, even if they're there for a shot period of time. i recommend that people wear hats regardless of their occupation. so i wouldn't say so much that i would recommend for pilots necessarily that they wear sunblock other than i would recommend that everybody wear sunblock and protect themselves from the sun. now, that doesn't mean i think you should be a monk and live in a cave and never go out in the sun because you even need the sun for vitamin d production. so the sun is not a bad thing, but you need to do, like you

need to do everything else, you need to moderate what you do. and when you go out in the sun, you should wear clothing if you -- unless you're bathing, obviously, and you should wear sunblock to protect yourself. >> i think, also, the physics are that the uva, uvb is adequately screened through the cockpit windshield. we worry a little bit about what penetrates the heavy particles that penetrate such as pro tons when -- protons when there are solar flares. but if we were successful in getting some sort of responsibility either through osha, the faa, the companies in doing studies of pilots, we would have a much better idea of what the true radiation exposure is. and then we could compare that to known data to try to make an estimate as to the risk for certain types of cancer. but at this point we just don't have that data. >> are is there an interest in -- is there an interest in collecting that data soon, or

has there been kind of a pushback from the industry? >> there's an interest, and i would encourage you to pick up a copy of the alpa white paper that i alluded to in my opening remarks regarding occupational safety and health for pilots. with the proposal from alpa to create a partnership between the faa, osha, industry and labor to see if we could get that both instituted and then monitored and then, perhaps, action based on the results of that. at this point it doesn't exist. >> thank you, gentlemen. >> i'm bill on the alpa air safety staff. first of all, dr. tilton, i'm really sorry to hear about wally freeberg's passing. he was always a very knowledgeable individual and a go-to person for any questions we had on radiation, radiation issues and we appreciated his expertise being available to us.

the faa and alpa and the industry have had a long history of collaboration on a number of issues. dr. snyder mentioned the hims program which goes back over 35 years to help people or pilots with issues in regard to, um, alcohol, substance abuse. dr. tilton, i'm wondering if you could share with us any thoughts you may have on collaborative efforts that the faa and alpa could enter into to assure and improve pilot health and safety? >> i guess the best collaborative effort that i'm aware of right now is what we have with dr. snyder is and his group. he represents not only alpa, he represents other organization as well. and their philosophy, in fact, he may or may not be aware that none of his doctors are ames,

aviation medical examiner, because they want to have no idea if there's a conflict between them as designees versus people that actually support the organizations they work with. not to say that that doesn't mean that they're fully qualified and competent to do that if they wanted to be. they certainly know all of our regulations, and they understand why we do things. but as i said earlier, we meet with them quarterly. and frequently we get calls from them. i talk to quay not weekly, but quite frequently about specific cases, specific issues, specific concerns that he and his group might come up. i also do that with eaa and, as i said, aopa as well. so the collaboration that i see is having people with medical knowledge that understand what's going on in the community working together to find whatever science we can to make sure that what we're doing is safe and what we're doing is the right thing for the safety of the community and also the

pilots that operate in it. so so i actually don't have a better answer than that because there aren't a lot of individuals that have not only the the expertise in the science, but also the expertise in aerospace medicine. if you look at our doctors in the faa, we have over 15 individuals who are board certified in aerospace medicine. dr. snyder's group are all that way. so we understand not only the science of the medicine, but also the science of the way that the particular issues sewer act with someone -- interact with someone when they're in a cockpit or in a cabin or maintaining airplanes on the ground so that using that expertise and that information we do the best we can to certify as many people as we can but do it safely at the same time. >> thank you. >> i think the great example that you brought up, bill, was the hims program. it's been in place intermitt tently since 1974. the faa funds the program.

they provide the funds which is administered through alpa to educate the entire airline industry as to the disease process of alcoholism and substance dependence. and define a way to readily identify, intervene, treat, rehabilitate, return to flying status under a rigorous monitoring program. but without the faa's support, we would go nowhere in that. and what we're seeing is that other international organizations really want what the faa has established with alpa. they want information on how do we do this because before the problem was underground. as fred said, be you had hypertension -- if you had hypertension when he was wearing his blue and gray uniform -- i don't know if he was a blue or a gray guy -- but when he was wearing that uniform, you were disqualified. certainly, the name hims comes

from back in the '70s when you say airline pilot and alcohol in the same paragraph or even in the same paper. the name has stuck the. the effectiveness has just increased, and it's spread. but it's done in close collaboration with the faaw the airlines -- with the airlines and support from their management and from the pie hot unions and then also the aerospace medical community. the faa trains a very limited number of physicians through our hims program who are qualified to serve as sponsors with that. and those same physicians who are qualified to seven as independent medical sponsors in recovery are the same ones that provide the scrutiny that the faa requires for the people on the ssris as well. it's a great program. it's tremendously successful, and it's probably the premier example of cooperation and collaboration between the faa and industry. >> great. thank you.

>> hello. dr. tilton, i'm jesse, i'm the psa chairman. earlier you alluded to other countries certifying pilots with medical conditions such that they would only be able to fly with another crew member which i'd never heard of before. i was interested to know if, one, there are any studies in the number of instances of incapacitation on that basis versus the sort of single-pilot basis that you said that we're using and, further, if the faa has considered using that standard going forward, maybe based on shortage of pilots and things that we'll need to cover that. >> i don't think there are any specific studies that have done to show that. i really, frankly, believe that the -- i'm not sure how it would help if we, well, let me say it differently. when i used to go over to europe every quarter and talk the these

people, i would argue about the fact they were unnecessarily disqualifying people, people that we felt were certainly safe to fly, people that we would qualify on a special issuance. for instance, with stents or with a bipass surgery. they were very conservative, and they would not let those people fly unless they had another person in the cockpit. i can't think of an instance where there was someone that they qualified that we wouldn't have qualified to be in a two-person cock fit pit. so what -- cockpit. so what i think is they were unnecessarily restricting people so they couldn't fly by themselves. and by that i mean by themselves without someone else in the cockpit who was fully qualified in case they had a medical condition. so i can't think of a situation that would cover the question you have which is could we get more pilots in the cockpit if we made a decision to certify people restricting them. we also, actually, years ago in the '90s were prevented from

putting restrictions on first class pilots because we lost a lawsuit in which we were restricting flight engineers that they could only fly -- they needed a first class certificate, but they could only fly as flight engineers, and we lost the lawsuit. and now it says we can't restrict a first class certificate. is so there's legal precedence to say we can't do it. plus, i really believe when i talk to my counterparts in europe, they were overly restrictive and didn't need to do what they were doing. >> thank you. >> i would say that the faa -- you have a better chance of having a medical certificate in the united states than any other country in the world. there are few exceptions as the ssris before or perhaps with insulin requiring diabetes in canada. but the evidence-based medicine policy has allowed the liberalization of the standards and the waivers that pilots get, and and we're just thrilled with

the spectrum of that. there have been some studies about in-flight incapacitation, but it didn't discriminate between two-pilot crews and one--pilot crews. but i believe that there's never a reported accident in the united states, aircraft accident in the united states as a result of incapacitation in flight in a commercial situation with a two-pilot crew. but the aerospace medicine association has published two studies over the last 12 or 13 years, i believe, on reported in-flight incapacitation that gets called into the faa as crew member incapacitation and then goes through the normal investigative process. >> and just one other comment. i really believe today, and i tell people when i was flying c-143s, we didn't have an fms, essentially we were flying a big airplane. but i felt pretty confident that if something happened to my co-pilot, i could go ahead and take over and land that airplane and talk on the radio and do all

the stuff i needed to do. but in today's world as you're well aware with flight management systems and programming and the way we fly airplanes now in our air space, if you take -- if you take a 777 and flew it into heathrow, that's really a two-pilot operation. the second pilot is not there to make sure if first pilot's incapacitated he can land the airplane, he's there, and he or she has a specific responsibility, and they are necessary in order to safely operate. now, i know airlines do incapacitation training, and i support that. i think it's great because we do have cases where people are incapacitated. but that's not optimal, and i'd much prefer to have of a situation where both pilots are fully qualified and medically competent when i'm fly anything situations such as i just described. >> any more questions out there?

is everybody satisfied and happy? [laughter] or asleep? >> all right. then i guess we'll wrap it up. i want to thank my distinguished guests. thank you, dr. snyder and dr. tilton. and, again, thank you for all your questions. thank you and have a good day. [applause] >> thank you, gentlemen. excellent panel. very, very, very interesting subject matter to all of us out there flying airplanes. okay. well, cha concludes our business for today. before we break for the evening and retire to a reception sponsored by boeing just out here in the foyer, allow me just a moment to take care of some housekeeping items and go over the schedule for tomorrow. by the way, you will see at each of your seats a evaluation form printed on blue paper. before you leave the room, please, fill it out and place it in one of the baskets at the

back of the room or return it to the registration table in the hall. your comments are very important to us. as for tomorrow, we'll start with a continue innocental breakfast with our ex-- continent aal breakfast from 7:30 to 8:30 in the morning. it's a good chance to look over the booths you may not have visited yet, and we encourage everyone to take advantage of that. we'll begin our presentations at 8:30 starting with a talk on risk-based security. so we have a lot going on tomorrow, and you won't want to miss it. thanks for being with us today, and thanks for sponsoring the audio/visual in the ballroom and the forum webcast. see you at the boeing reception at 5:30. we stand adjourned until 8:30 tomorrow morning. thank you. [applause] [inaudible conversations] >> this weekend on booktv's "after words,". >> i think we have this myth that it's two guys in a dorm room, they crack the code, and it all just falls into place and, eureka,