1. LESSONS TO BE CONSIDERED (Panagiotis V. Stathopoulos)
THE HELIOS ACCIDENT
&
LESSONS TO BE CONSIDERED
April 29, 2010
“Panos”
(Panagiotis V. Stathopoulos)
Major HAF/F16 Pilot, MSc

2. An investigation into appropriate actions to be
taken in the event of pilot incapacitation in a
commercial aircraft, and whether cabin crew would
be able to fulfill these actions
In 1972 at Staines a British European Airways (BEA) Trident I, crashed shortly after takeoff and all 118 passengers and crew on board were injured fatally (Macarthur,
1994a). The aircraft went into a deep stall after takeoff; a silent heart attack in the handling pilot might have been a contributing factor. It is possible that sudden
pilot flying (PF) incapacitation3 in a critical phase of flight did not give the inexperienced pilot monitoring (PM) time to take over the controls and prevent the
imminent accident.
A year later, Anderson’s (a Senior Consultant to the Civil Aviation Medicine Service of Canada) experience both on airworthiness requirements of airliners and aviation
medicine, suggested that pilot medical fitness could be assessed by a pilot ”failure” risk rate similar to the corresponding risk rates of mechanical failure (Evans,
2006, p. 554). In 1982 the United Kingdom (UK) Civil Aviation Authority (CAA) adopted Anderson’s concept to assess the mortality rates of cardiovascular disease
in pilots. However, the western developed countries’ mortality rate due to cardiovascular disease was not in the desired target range of 1 in 109 hours at any age for
European males. Therefore, a low level of pilot ”failure” risk could be attainable, if commercial aircraft are always manned by two pilots. Consequently, the 1% rule
framework was established, based on medical risks of pilots’ incapacitation in proportion to the annual flight hours, and an incapacitation rate of 1 in 106 hours is
approximately equivalent to a failure rate of 1% per year. Nowadays, this concept has been adopted by the regulators and all commercial aircraft are imposed to be
manned by two pilots, in order to achieve a low pilot incapacitation rate.
Although the 1% rule has been established for the last 40 years, many fatal accidents have been recorded in general aviation or in single crew aircraft operations as a
result of pilot incapacitation. In Australia from 1976 to the first term of 2006, ten fatal accidents have been recorded due to pilot incapacitation in single flight
crew operations (Newman, 2007). However, in the last eight years two fatal airline accidents, one in the United States of America (USA) and the unprecedented Helios
Airlines accident in Europe, have depicted the possible gaps in the 1% rule for commercial aircraft.
Even though complete pilot incapacitation4 was the main causal factor of these accidents, the flight crew were not incapacitated by medical reasons but by other
contributing factors such as hypoxia or terrorist attacks. Precautions have only been taken both by regulators and airlines for single pilot incapacitation in the case of two
pilot operations. Nobody has taken precautions in the event of total pilot incapacitation in commercial aircraft. In the United Airlines flight 93 accident is believed
that pilot incapacitation occurred due to terrorist attack, and in the Helios Airlines accident (AAIASB , 2006) somebody was still alive on board up to the fatal crash
point. Even if a flight attendant was able to control the Helios Airlines Boeing 737, he did not manage to prevent the impending accident. However, he succeeded
in avoiding collateral damage and making a belly landing based on his Private Pilot License (PPL) training experience. These two fatal accidents might have been
prevented, if procedures had been developed in the event of pilot incapacitation.
The International Civil Aviation Organisation (ICAO, 1996, p. E1-11) manual for Cabin Crew Safety Training recommends that the latter is required to know some
basic flight deck equipment including weather radar, and basic flight instruments, but there is no reference to pilot incapacitation procedures. Additionally, the ICAO
(2006, p ) Safety Management Manual recommends that commercial airlines should train cabin crew in assisting an incapacitated flight crew in two pilot
operations. Furthermore, single flight crew incapacitation procedures are cited in the Transport Canada (TC, 2005) Flight Attendant Training Standard Manual, but
there are no references to flight attendants’ knowledge of flight deck switches or equipment.
Additionally, a recent survey (by Panos, 2008) into eight European Union (EU) airlines revealed that after the unprecedented Helios Airlines flight 522 accident, airlines
have slightly improved the procedures in Crew Resource Management (CRM) in the event of cabin pressurisation problems, which might contribute to total pilot
incapacitation. Furthermore, the survey illustrated that these EU airlines have developedprocedures on how to provide medical assistance to a single flight crew in
the event of incapacitation.
Rationale of relevant research
Nobody could have imagined the two accidents of Helios and United Airlines. Consequently, the purpose of this research is to develop a further safety barrier in commercial
aircraft in the event of total pilot incapacitation, towards the improvement of global aviation safety. In the event of pilot incapacitation common sense necessitates
the following options to prevent the impending accident:
1. Pilots’ recovery assisted by cabin attendants.
2. Search for a doctor to assist the pilots and/or for a pilot as on board passenger
to take the aircraft controls.
3. And if nothing was practicable from the above, the flight attendants’ training
in some reasonable knowledge in the flight deck may let them take some reasonable
actions to control the aircraft and land it safely, if external assistance
is provided.
Therefore, the research was conducted along the third option, so that a safety barrier could be developed. The study is also required since the appropriate knowledge
of cabin crew on flight deck equipment will be illustrated more specifically than in the ICAO (1996, p. E1-11) cabin crew training manual. ICAO recommends
that cabin crew should be able to identify and know the basic function of the flight deck equipment without being specific on which equipment and why it is required.
The manual does not quote any particular knowledge regarding the flight deck. Consequently, the study will provide a better insight into what is required by the cabin
crew to deal with total pilot incapacitation.
The research neither aimed to depict instruction of cabin crew on aviation and handling aircraft theories nor focused on designing training for cabin crew to fly the
aircraft manually. The study aimed to illustrate the minimum reasonable knowledge that cabin crew should have on flight deck switches and equipment for an emergency.
This reasonable knowledge might enable cabin crew to manage the aircraft automation and direct aircraft for an auto land, if external assistance and instructions
are provided through radio. In other words, reasonable cabin crew knowledge of cockpit automation and certain levers or switches could contribute to the prevention
of an accident in the event of pilot incapacitation. To be more specific, theword ”reasonable” advocates seeking simple tasks and actions in the cockpit which
do not require demanding attendant training such as pilot instruction.
Even though Unmanned Air Vehicles (UAV) technology is robust enough to be applied on commercial aircraft control to recover it in the event of pilot incapacitation,
some passengers may not trust it to fly a commercial aircraft (McIntosh, 2007, p ). On the other hand, the expensive fees of an Air Transport License (ATPL)
and the expected air traffic average growth of 3.4% annually (Eurocontrol, 2008) might contribute to a shortage of commercial pilots in the near future. Even if
airline funds allow a pilot to be paid as a third flight crew on the flight deck, so that risks of total pilot incapacitation are reduced, the possible future shortage of
professional pilots may necessitate that cabin crew should have some reasonable knowledge of the flight deck, which could be obtained by using the bare minimum
resources.

3. 1972, Staines, BEA 548, 118 Fatalities
Introduction Departure – Intercept Final Descent Causes Pilot incapacitation Research
Accident Analysis Accident common points Incapacitation factors Safety barriers Research Concept
Analysis of similar accidents
1955, Wyoming, UA 406, 66 Fatalities
1972, Staines, BEA 548, 118 Fatalities
2001, Shanksville, UA93, 44 Fatalities
2005, Grammatiko, HCY522, 121 Fatalities
Near miss due to aircraft systems design
Ten years after the end of the Second World War on 6 October 1955, a Douglas DC-4 from the United Airlines crashed on the summit of Medicine Bow Peak near
to Wyoming, in the United States (Gero, 2006, p. 21). Sixty three passengers and a crew of three were killed. After an assiduous investigation, evidence illustrated
that pilot incapacitation probably occurred due to a carbon monoxide leak from the engines. Also, debris dispersion advocated that somebody was probably attempting
to recover the aircraft at the time of its crash.
Similarly, the accident of BEA at Staines in 1972 (Macarthur, 1994a) probably occurred due to insidious pilot incapacitation. An insidious heart attack in the handling
pilot contributed to a subsequent deep stall shortly after take-off, which caused the fatal accident. The pilot incapacitation happened in a critical phase of the flight,
even though the percentage of aircraft flying in the critical phases, the take-off and landing, is much less than the non-critical phase, the cruise.
Apart from the Staines accident, similar accidents have occurred during the last 40 years in non-critical phases of flight where pilot incapacitation was involved. In the
most recent unprecedented accident of Helios Airlines, pilot incapacitation occurred in the en route phase due to hypoxia since some safety measures
were omitted after take-off (AAIASB , 2006). Two similar accidents had occurred previously in the USA and Australia respectively. In 1999 a business jet crashed
and killed everyone on board in Aberdeen, USA, due to pilot incapacitation, and in2000 a Beech King Air 200 crashed similarly in Burketown, Australia. In all the
above accidents hypoxia was the primary contributing factor to pilot incapacitation (AAIASB , 2006, p ).
Not only could medical reasons contribute to pilot incapacitation, but also fatal injuries from terrorist attacks. In the United Airlines flight 93 accident, which was related to the 9/11 terrorist attacks, it is believed that pilot incapacitation had been caused by fatal injuries in the terrorists’ attempts to take over the aircraft controls.
However, the National Transportation Safety Board (NTSB, 2001) did not publish an open report since the investigation was under the jurisdiction of the Federal Bureau
of Investigation (FBI).
Research using the Irish Air Accident Investigation Unit database (AAIU, 2001a, 2001b, 2003, 2005), and research of AAIASB (2006, p ) into National
Aeronautics and Space Administration (NASA) Aviation Safety Reporting System (ASRS), Transportation Safety Board of Canada (TSB) and Australian Transport
Safety Bureau (ATSB) revealed that pilot incapacitation might be caused by human factors that are involved with various aircraft systems design. In particular, the
hostile high altitude environment, which contributes to hypoxia and a subsequent human incapacitation, is counterbalanced by a cabin environmental and pressurisation
system. However, the above reports illustrated that the pressurisation system in many cases, and in specific aircraft type, are not designed to be in accordance with
human factors principles; this may contribute indirectly to pilot incapacitation due to induced human factors problems like errors, lapses, confusion, misjudgement
and other factors.
Another research into NASA ASRS reports between January 1, 1986 and December 1992 revealed that passengers are subjected more to incapacitation than the crew,
and the pilots are involved more with incapacitation than the flight attendants (Mortimer, 1995). The medical standards of the aircrew could explain the contrast in the
first finding among crew and passenger incapacitation; and the disproportion among pilots and flight attendants population during the flight might have contributed to
the difference in the incapacitation incidents. The second finding is evident since it could be supported by the probability theory, if the addition and multiplication
laws of probability are considered (Stroud and Booth, 2007, p ); and it could be also supported by the lower mortality rates of females than males (Evans,
2006; UK National Statistics Authority, 2008) since flight attendants are usually female. In large commercial jets there are commonly two pilots and flight attendant
numbers could vary from three to fifteen according to the regulator, the aircraft cabin size and airline policies. Therefore, the risks of pilot incapacitation could be
deemed higher for flight attendants since the latter are always more in number compared to pilots. It is self evident that incapacitation rate of all flight attendants may
be much less than pilots incapacitation rate and the incapacitation rate of all crew might be extremely improbable.
Additionally, Mortimer’s (1995, p. 231) findings show that pilot incapacitation happened mainly in the cruise (46%) and approach (30%) flight sub-phases (paragraph
3.1.1) than in the critical phases of flight. Furthermore, more than half of incapacitation incidents (73%) occurred at altitudes above 10,000 feet. The main factors for
commercial pilots’ incapacitation were cardiopulmonary and gastrointestinal diseases. Fatigue was also recorded as a factor which had contributed partially or
slightly to incapacitation. One important finding is that crew members were sometimes forced to be on duty despite their medical problems.
A later study in the USA among United States (US) airlines between 1993 and 1998 recorded 39 incidents of incapacitation during 47 flights of commercial aircraft (De-
John et al, 2004). All incapacitated pilots were male and the risk was increased in regard to age since the recorded mortality rates of males are usually higher than
females (UK National Statistics Authority, 2008). The major four recorded medical factors for incapacitation were the loss of consciousness (LOC), cardiac, neurological
and gastrointestinal. During this period of time, two non-fatal accidents occurred due to pilot incapacitation. Similarly, the study shows that accidents are very rare
due to pilot incapacitation since 86 million flight hours were covered during this five year period and the accident rate was estimated at 0.04 per 100,000 flight hours. It
is believed that the presence of the second pilot was responsible for this very low accident rate in the event of pilot incapacitation.
In the southern hemisphere, the ATSB has recorded ten fatal accidents in Australia caused by pilot incapacitation between January 1, 1975 and March 31, 2006 (Newman,
2007). Nine accidents involved general aviation (either aircraft or helicopter operations), but the tenth accident involved a commercial business flight and it was
caused due to hypoxia. In this study, the major medical factors of pilot incapacitation were 21.43% gastrointestinal disease and 8.16% heart attack (Newman, 2007,
p. 8). Newman’s research (2007, p. 5-6) revealed that pilot incapacitation mainly occurred in aircraft which were involved in airlines or charter flights; and the majority
of incapacitated pilots held either ATPL or Commercial Pilot License (CPL).
This further illustrates that the most experienced and professional pilots, who fly in the hostile environment of high altitude, are more susceptible to incapacitation. It
is also apparent in this study that the majority of incapacitation incidents occurred in the en route phase of flight rather than the critical phases, either take-off or landing.
However, the incapacitation incidents account for only 0.19% of all aviation accidents in Australia, and the ten fatal accidents only involved with single pilot
operations. The majority of incapacitation incidents occurred due to acute or insidious medical factors rather than chronic medical reasons. Therefore, this Australian
study depicts a low risk of accident due to pilot incapacitation since the majority of commercial aircraft are manned by two pilots.

4. Common points during incapacitation
Introduction Departure – Intercept Final Descent Causes Pilot incapacitation Research
Accident Analysis Accident common points Incapacitation factors Safety barriers Research Concept
Common points during incapacitation
Non critical phase of flight
High altitude
Aircraft was flying uncontrollable
Interceptors
Somebody was alive before impact/crash
Medical factors and terrorism
The above analysis concluded that professional pilots might be more susceptible to incapacitation than flight attendants and the majority of incapacitation incidents
occur in non-critical phases of flight, and usually at high altitude. The risk of incapacitation is still in the foreground and it is increased in proportion to age due
to a subsequent increase to the cardiovascular risk (Cooke, 2006, p. 786).

5. Pilot Incapacitation factors
Introduction Departure – Intercept Final Descent Causes Pilot incapacitation Research
Accident Analysis Accident common points Incapacitation factors Safety barriers Research Concept
Pilot Incapacitation factors
Hypoxia
Terrorism
Cardiovascular
Gastrointestinal
The major factors for medical incapacitation are hypoxia, cardiovascular and gastrointestinal
diseases, with the last two factors being dominant among commercial pilots (Evans, 2006). In most cases, pilots might be unaware of the impending incapacitation
due to insidious and acute medical factors. However, pilot incapacitation could be caused by terrorist attacks as well. As a consequence, the regulators and airlines
have developed some safety barriers to prevent pilot incapacitation, and indeed the recorded accident rates have been very low over the last 40 years.

6. Measures against Pilot Incapacitation
Introduction Departure – Intercept Final Descent Causes Pilot incapacitation Research
Accident Analysis Accident common points Incapacitation factors Safety barriers Research Concept
Measures against Pilot Incapacitation
Proactive
1% rule, two pilot operations
Medical screening
Hypoxia theory training
Meals policy
Cockpit locked door
CRM training
Flight deck regular checks
Reactive
Cabin crew for Single pilot incapacitation
Technical knowledge
Proactive protection against pilot incapacitation
A study in 1989 (Tunstall-Pedoe, 1992, cited in Evans and Rainford, 1999, p. 225) presents the cardiovascular mortality rates per 100,000 males or females in five EU
countries, which are higher than the required risk rate 1 per 100,000 annually for incapacitation. Therefore, the theory of the 1% rule, which was developed in 1973
to determine an acceptable level of incapacitation risk, provides a safety barrier in order for this very low risk to be achieved. This rule, which was adopted and
applied by the regulators, is based on medical risks for incapacitation in order to ensure that no individual has a failure risk over 1% per year. This is equivalent
to an incapacitation rate of 1 in 106 hours annually. This rule necessitates that all commercial aircraft should be manned by two pilots to provide a fail safe system in
the event of pilot incapacitation (Evans and Rainford, 1999, p. 224).
Additionally, the regulators impose that airline pilots should have an annual medical screening which is doubled after the age of 40, so as to identify any risk of imminent
incapacitation due to medical reasons (Evans, 2006). Indeed, the big killer of pilots, cardiovascular illness, could be diagnosed and treated in time since long – term
unfitness due to cardiovascular reasons in UK professional pilots has reduced from 63.1% in 1975 to 36.1% in Needless to say, cardiovascular disease was the
top rated factor of long – term unfit assessments in the UK pilots (UK Civil Aviation Authority Medical Department, cited in Evans, 2006, p. 228).
Even with medical screenings and the 1% rule protecting pilots from incapacitation proactively, the insidious enemy of high altitude, hypoxia, is still a significant
factor. Although aircraft designers have developed the pressurised cabin to protect crew and passengers from the hostile high altitude environment, hypoxia is still an
insidious factor since in many cases the pressurisation system has suspended without warnings and people on board have suffered from hypoxia symptoms. Although
the Joint Aviation Authorities (JAA, 2007, p. 1-O-12) and ICAO (1996, p. E1-12; 2006, p ) recommend that pilots and flight attendants should have theoretical
background of hypoxia symptoms, hypoxia unconsciousness may follow before many of the symptoms appear. To put it simply, crew incapacitation may occur
without warning of hypoxia symptoms such as dizziness, light headache and many others, which are related to visual, psychomotor and cognitive functions (Gradwell,
2006, p ). On the one hand the hypoxic crew recovery could be rapid and complete if oxygen is administered. However, the hypoxic subject may not be recovered
rapidly and completely by the oxygen supply. It is the oxygen paradox phenomenon in which its responsible mechanism is still undetermined (Gradwell,
2006, p. 54). Hence, hypoxia is one of the important contributing factors of pilot incapacitation and its insidious nature may overcome the proactive protection of
hypoxia theory training.
Moreover, gastrointestinal diseases are also a significant factor in pilot incapacitation. Two studies in 1967 (Buley, 1969, cited in Evans, 2006, p. 553) and 1987
(Green and James, cited in Evans, 2006, p. 553) among airline pilots revealed that 20 year period. Therefore, many airlines have adopted a different meals policies.
They provide different meals to pilots who have to eat at different times. Even though these policies may protect pilots proactively, gastrointestinal disease is still
recognised as a significant factor in more recent studies (Newman, 2007).
Additionally, other potential factors such as terrorist attacks could contribute to pilot incapacitation. The 9/11 terrorist attacks prompted the cockpit locked door
implementation in order to protect pilots from terrorists and subsequent incapacitation. Instead, the locked door and the sterile cockpit regulation (FAR /FAR
) of the Federal Aviation Administration (FAA) in 1981 have impeded the communication between the two teams of crew (Chute and Wiener, 1996; Tabary,
2006, p. 66). A possible link of communication, the flight engineer has also disappeared due to the cockpit automation evolution (Wiener, 1988). These factors
could obstruct the communication between cabin and flight crew, which might be crucial during the emergencies, whereas effective communication could be the salutary
reminder of impending incapacitation. Furthermore, communication between the cabin and the cockpit is deterred by the manifestations of every airline environment
since flight attendants and pilots are considered as independent groups within an airline, and even during the flight (Chute and Wiener, 1995). In other words, the
erected obstacles between cockpit and cabin communication may contribute to pilot incapacitation indirectly. The cabin crew might not be able to keep pilots informed
about a situation which might contribute to incapacitation such as the pilot incapacitation in the Helios Airlines accident. It is worth quoting the following comment
of a UK major airline flight attendant, which depicts the concern for safety implications due to cockpit locked door, ”If things go wrong, if you’ve got a pilot
incapacitated then that can be a problem” (Tabary, 2006, p. 34). Similarly, in another serious cabin pressurisation incident the Senior Flight Attendant continued to
urge pilots about the cabin situation and indications and this persistence ensured the safe outcome of this incident (AAIU, 2001a).
At the same time the communication barriers that are erected during the development of pilot protection against incapacitation have already been identified by the
regulators and airlines. These issues have been integrated into CRM training which is an integral part of pilots’ and flight attendants’ training (ICAO , 1996; JAA ,
2007), in order that effective crew communication and coordination is achieved during emergency situations, where pilot incapacitation might be in the foreground.
Also, many airlines have adopted the policy of regular checks of pilots during flight. Cabin crew should check every half an hour that pilots are conscious and that no
problem exists in the flight deck (by the author, 2008).
All of the above, the medical screenings, the hypoxia training in theory, the locked cockpit door, the different meals policy, the regular pilot checks and the 1% rule
application, are some basic methods against pilot incapacitation. On the other hand, some rules or procedures might have an impact on communication and coordination
between cabin and cockpit since the effective communication, which is an integral element of good CRM, could be the salutary reminder of imminent pilot incapacitation.
It could be also confirmed by the Irish AAIU reports of incidents (AAIU, 2001a, 2001b, 2003, 2005), where effective communication between flight attendants
and pilots averted the disaster due to the imminent pilot incapacitation.
Reactive protection against pilot incapacitation
The ICAO (1996, p. E1-11) manual for Cabin Crew Safety Training recommends that a flight attendant is required to have knowledge of some basic equipment of
the flight deck, including weather radar and basic flight instruments, but there is no reference related to pilot incapacitation procedures. However, the manual suggests
that cabin crew are required to have knowledge of emergency equipment applications, physiology of flight and assistance in flight medical emergencies, but
no special guidelines for pilot incapacitation are provided. Even the ICAO (2003) Manual for Human Factors in Cabin Safety has no relevant considerations to pilot
incapacitation. However, the ICAO (2006, p ) Safety Management Manual recommends that commercial airlines should train cabin crew in assisting an incapacitated
flight crew during two pilot operations without providing any further guidelines or procedures. Also, single flight crew incapacitation procedures are
cited in the Transport Canada (2005) Flight Attendant Training Standard Manual but there is no reference to flight attendants knowledge on flight deck switches or
equipment. This manual particularly covers relevant topics on how the incapacitated pilot would be secured into the seat and how (s)he would be recovered from
incapacity. These skills are required to be instructed both in initial and recurrent training of cabin crew. Also the cabin crew training manuals of eight major EU
airlines cover the single pilot incapacitation procedures similarly with the same objectives.
Additionally, the ICAO (1996) cabin crew training manual recommends that flight attendants are required to have some basic knowledge of flight deck equipment,
so that the cabin crew will be able to communicate effectively without delay during emergencies. This knowledge will increase the accuracy and the effectiveness of
procedures during emergencies since cabin crew familiarisation with cockpit technical terminology may contribute to more effective communication with pilots. However,
a study in US airlines (Dunbar et al, 1997) illustrated that cabin crew could not deal with technical terms even in the cabin. From a sample of 177 female and
male flight attendants only 20 (11%) of them were able to identify correctly some basics aerodynamic surfaces of aircraft which are visible from cabin windows. It is
apparent that cabin crew face communication problems during an emergency since they might not be able to describe their concerns effectively to pilots regarding aircraft
systems or parts. Additionally, this research shows that flight attendants may not be able to speak in technical terms such as aviation terminology. This low level
of cabin crew technical knowledge may no converse the situation during a cabin emergency which might indirectly contribute to pilot incapacitation, such as a cabin
pressurisation emergency.
Although the ICAO and TC cabin crew training manuals provide partial guidelines for single pilot incapacitation, it is apparent that cabin crew may lack knowledge
of aviation or aircraft technical terms. This is reasonable since pilots and flight attendants are considered as two separate cultures in the airline environment; cabin
attendants are usually part of the marketing department of an airline despite the fact that they are required on board to ensure passenger safety (Chute andWiener, 1995).
Even if Dunbar, Chute and Jordan’s study (1997) showed the flight attendant’s level of aircraft cabin technical knowledge, no research has been conducted on flight
attendant’s technical knowledge of the aircraft cockpit, where the appropriate and reasonable knowledge of flight attendants on the flight deck may be required to
prevent or mitigate an accident in the event of pilot incapacitation.

7. Concept of research based on a model
Introduction Departure – Intercept Final Descent Causes Pilot incapacitation Research
Accident Analysis Accident common points Incapacitation factors Safety barriers Research Concept
Concept of research based on a model
Concept and research model of incapacitation
The review on human skills acquisition has depicted that a pilot should have developed cognitive, perceptual and motor skills for aircraft flying (Proctor and Dutta,
1995). Many sub-categories of skills could be allocated in these three domains such us decision making, problem solving and many other skills. These obtained
skills interact each other in order that pilot can fly the aircraft. However, interaction links would be broken during the pilot incapacitation. Therefore,
certain cabin crew’s skills may be required to bridge a broken link between pilot and automation. Motor skills could be never substituted, unless cabin crew were
trained as pilot. On the other hand, automation could substitute the motor skills, and external pilot assistance could support the majority of cognitive and perceptual
skills. Therefore, this concept suggests that flight attendant should have developed simple skills in order to control the aircraft with an external pilot assistance.
According to pilot incapacitation concept, a research model could be designed in respect of what literature review has illustrated. This model describes that pilots can fly a commercial aircraft manually or can control it with automation. It is self evident that pilot incapacitation factors will break automation and manual control links with aircraft flying. However, cabin crew might control aircraft with automation contribution, supported mutually by an external pilot guidance (link b). This model suggests that cabin crew should
acquire certain perceptual skills, based on pilot’s training, in order to manage aircraft automation, supported by the cognitive skills of an external pilot. Therefore,
current research aims to identify the reasonable and simple tasks or skills of pilotsthat a flight attendant should acquire, so as to bridge the link (b). To further illustrate
that, the acquired skills of cabin crew may contribute to an effective flow and communication at links (a), (b) and (c), so as to prevent the impending accident due
to pilot incapacitation.
According to this model of research cabin crew may be able to capture which switch should be activated with an external assistance (perceptual skills). Though (s)he
would not have the knowledge when and why it is required to be activated the corresponding controls (cognitive skills). For instance, a cabin crew may be able
to set the appropriate altitude on autopilot panel if they are instructed to do that in time, whereas cabin crew are not needed to know when, where and why altitude is
required to be set.
Many research issues could be derived by the proposed model of pilot incapacitation. However, the following research questions were decided according to the
literature review to investigate in depth some issues on the links (a), (b) and (c):
• What are the current airlines procedures in the event of pilot incapacitation?
• Which reasonable tasks and actions in the flight deck are required to be known
by the cabin crew in the event of pilot incapacitation (link a)?
• What would cabin crew do in the event of pilot incapacitation (link c and b)?
• Do cabin crew have the technical knowledge in the flight deck to take the
reasonable actions?
Model considerations
External Pilot Guidance
Automation Contribution
Weather & ILS minima CAT III (auto land feature)
Airbus & Boeing Families due to cockpit similarities
En route phase due to more available time of reaction
Simple & reasonable tasks so that cabin crew need minimum training
Interceptors may be taken off since past similar accidents depicted that.

8. Introduction Departure – Intercept Final Descent Causes Pilot incapacitation Research
Cabin crew need to do Cabin crew would do Findings Research recommendations
Cabin crew need to do
Pilots
The sample consisted of eight active commercial pilots, all of them males. Their piloting experience ranged 16 to 30 years and 4,000 to 16,000 flight hours in commercial aircrafts correspondingly. One of them has military background of further 4000 flight hours, which was not included in the above descriptive analysis. Pilots were also employed by six EU airlines. The pilots’ sample consisted of six Captains and two First Officers. Also, five of them were qualified as instructors. Pilots were rated in five different aircraft
types which were mainly consisted of Airbus, Boeing and ATR types.
Method: Interviews focus group/individually
Top four categories of template analysis were generated:
• Category 1 - Deal with situation. Cabin crew should know to operate the pilot’s seat adjustment and the emergency equipment of cockpit such as the pilot’s oxygen mask.
It is obvious that cabin crew would be able to set his/herself in the pilot seat and fasten it.
• Category 2 - Establish communication. A flight attendant should know at least where the push to talk switches of radio are. As a further instruction, the radio frequency tuning
may be provided. It sounds more complicated, whereas the push to talk switches activation appeared as the most simple action for establishing communication.
• Category 3 - Aircraft direction and preparation
• Category 4 - Approach and auto land
Conclusion
To sum up, flight attendants might not have the appropriate mental models to control the aircraft in the event of pilot incapacitation. Cabin crew may follow the procedures for single pilot incapacitation, when they discover that aircraft is not manned by pilots. However, the study showed that the most important link in this analysis is
the communication. The research proposed model requires that cabin crew should establish communication by themselves, in order that an external assistance can
provide them guidance. If cabin crew are not able to establish communication, no solution may exist in the event of pilot incapacitation. It is obviously expected that
cabin crew would not have the appropriate perceptual, motor and cognitive skills in order to control the aircraft. However, if (s)he has certain knowledge in the cockpit,
it is possible that the imminent accident due to pilot incapacitation could be prevented; since automation and an external pilot could contribute to guide cabin crew
to take appropriate actions.
This part of the research presents reasonable actions on cockpit controls. It is self evident that these actions require pilot training. However, the training
to use the radio push to talk switch appears to be the most simple training for a flight attendant since only one switch is involved. Also, the perception process,
the bottom up versus top down approach of every human being, may let cabin crew identify all the appropriate switches that the pilots suggested. All modern cockpits
are designed according to human factors principles in order to facilitate the information processing system of the operator. To put it simply, the labelled controls of
cockpits may drive flight attendants to perceive and capture the required target in the cockpit. Also, the design of switches is similar to every day man-made objects
and flight attendants’ mental models may let them perceive the function of the control.
For instance, the flap lever is located into a rail which dictates that this lever could be only moved either forward or backward.
In conclusion, the flight attendant should know at least how to establish communication with ground control provided that external assistance and automation are
involved as well.

9. Introduction Departure – Intercept Final Descent Causes Pilot incapacitation Research
Cabin crew need to do Cabin crew would do Findings Research recommendations
Cabin crew would do
Cabin Crew
31 Cabin crew / 16 males & 15 females
Experience years
26 Long haul / 5 short haul
The sample consisted of thirty one active flight attendants, 16 males and 15 females. Their experience ranged 4.58 to 31 years. Eighteen of them were instructors. Four of them had a small amount of piloting experience from a number of flying lessons without having any pilot license. Also, this airline has divided their cabin crew according to haul sector distance and 26 of the sample were flying in long haul, whereas 5 cabin crew were involved with short haul.
Method:
Interview individually in a real cockpit environment without assistance on unexpected given scenario of pilot incapacitation
questions - on certain cockpit controls that recognised from first study
Results
Deal with situation: Every cabin crew would set different priorities in this unexpected event of pilot incapacitation, and they would respond
according to their priorities. It is self evident that some filters have been established between pilot incapacitation event and procedures. These filters on the cabin crew
judgement pattern are, crew’s co-ordination, and the assessment of situation severity. Cabin crew would request support by other cabin members in order to remove
pilots and/or manage the aircraft. On the other hand, some cabin crew may assess the severity of aircraft situation, and if the aircraft flying is safe under autopilot operation,
they would only take further actions. Statements also illustrated, that every cabin crew choice of action could follow any different pattern when they deal with
the situation of this event. Therefore, cabin crew would develop CRM skills (ICAO, 1996, 2003; TC, 2005; CAA, 2006; JAA, 2007) in order to deal with situation such
as team work, leadership and communication.
Establish communication: All the participants of sample identified that communication with ground should be established after they have been dealt with the situation.
However, many of them knew how to operate the radio or even just to press any push to talk switch in order to speak. On the other hand, some of them did not know how
to employ the radio and they applied back up methods that they might have acquired by the working environment. Even they might be co-ordinated with other cabin crew
members in order to find a way how to employ the radio. In general, all of them would explain the situation if they had established communication. However, a few
of them might have worsened the situation since they might have employed switches which disengage the aircraft automation protection such as the autopilots disengage
switch on the yoke. Also, cabin crew with small piloting experience might not be able to establish communication. Similarly, the quantitative results provided a
picture of medium level of radio operation knowledge. Up to this point of analysis, cabin crew presented a reasonable way of thinking. The majority of them would
deal with the situation initially and they would attempt to establish communication as a second step.
Waiting for instructions from ground: It is self evident that cabin crew would not be able to decide what to do after establishing contact. Their decision making is poor due to lack of motor skills in LTM. They have followed the certain tasks that they have trained, such as pilot incapacitation procedures, but they might have no idea of piloting tasks. Indeed, pilots’
analysis recognised that cabin crew should establish communication for further actions and decision making. Also, the proposed model of research necessitated the
communication link, in order that an external pilot provides direction and guidance for managing cabin crew the uncontrollable aircraft.
Cockpit knowledge: Cabin crew statements revealed that some of them might have basic knowledge on certain aircraft controls. Some of them also they knew the basic flying skills.
Also, some of them have acquired the knowledge by watching what pilots are doing. Some of them know that aircraft could be directed by the MCP panel, but many
of them might not know the technical term. Also, some of them were aware of autopilot’s safety, but a few of sample were aware of how autopilot could be activated
or disengaged. A few of the participants would have a look on the aircraft flight manuals for getting information of cockpit controls. It became apparent the lack of
technical knowledge of cabin crew. Even though they might have acquired basic knowledge of basic flying skills, they were not so familiar with technical terms in
the cockpit. Similarly, Dunbar, Chute and Jordan (1997) described that cabin crew could not deal greatly with technical terms even in aircraft cabin.
Conclusion
Cabin crew would deal with situation by executing the single pilot incapacitation procedures. In sequence, they
would attempt to establish communication with the ground and they might not take any further action. They would wait for instructions. Indeed, Wickens and Hollands
(2000, p. 294) describe that decision making is influenced by the factors of familiarity and expertise. Meanwhile, they might assess the aircraft flying safety
and situation severity, and they might be ready to take certain actions to alleviate any impending dangerous situation. Also, they might request team co-ordination,
if they are not able to communicate or to deal with aircraft flying. In addition, they might employ back up methods to establish communication. These methods might
have been developed by watching pilots’ actions. In general, they have identified to deal with situation by following the pilot incapacitation procedures, and they would
make efforts to establish communication for further instructions. It is apparent that cabin crew would do a certain task (single pilot incapacitation procedures) in which
they were trained. On the contrary, the lack of familiarity and motor programmes in the LTM do not let them take any further decisions on piloting tasks.

10. Cabin crew technical knowledge…
Introduction Departure – Intercept Final Descent Causes Pilot incapacitation Research
Cabin crew need to do Cabin crew would do Findings Research recommendations
Cabin crew technical knowledge…

11. Communication is mandatory
Introduction Departure – Intercept Final Descent Causes Pilot incapacitation Research
Cabin crew need to do Cabin crew would do Findings Research recommendations
Research findings
Cabin crew would…
…deal with situation, but communication uncertainty…
…wait for guidance – instructions…
…develop CRM skills…
…consider any impending danger…
…be unaware for Autopilot Disengage SW…
…would not be able to tune ILS frequency…
Cabin Crew may…
…recognise cockpit controls with an external guidance…
1. Cabin crew would deal with the situation, would follow single pilot incapacitation procedures and would attempt to establish communication. However,
they would not be certain how to operate the radio.
2. Cabin crew would wait for instructions when communication is established.
3. Cabin crew may take some actions to alleviate any impending danger while
they are dealing with situation.
4. Cabin crew may recognise the appropriate cockpit controls but communication should be established with an external pilot for aircraft management.
5. ILS tuning is an important task for automation contribution and it could be a difficult task for a layperson such as flight attendant.
6. First study with pilots revealed that communication and ILS tuning are the most important links in the event of pilot incapacitation. Communication
should be established for decision making and guidance contribution of anexternal pilot. ILS tuning is not just a button that should be pressed. It is a sequence
of actions that should be taught. This was not be able to be addressed in the second study due to equipment, but should be focused upon for future
research.
7. Cabin crew may do not know how to establish communication with a safe procedure and avoid disengaging the autopilots in the event of pilot incapacitation.
8. Cabin crew would develop CRM skills, such as leadership and team work, in order to deal with situation of total pilot incapacitation due to lack of technical
knowledge.
Communication is mandatory

12. Research recommendations
Introduction Departure – Intercept Final Descent Causes Pilot incapacitation Research
Cabin crew need to do Cabin crew would do Findings Research recommendations
Research recommendations
Recommendations
Regulators
1. The cabin crew training manuals should be updated in order to provide accurate guidance on what knowledge a flight attendant should have on the flight
deck.
2. Double pilot incapacitation procedures should be developed and standardised as an emergency, because pilot incapacitation factors are significant despite
the fact that incapacitation accident rates are low.
Airlines
The following recommendations are developed in regards to employing the minimum resources of an airline for cabin crew training in the event of total pilot incapacitation.
1. Airlines should integrate into the cabin crew training some simple tasks or procedures for a double pilot incapacitation. Cabin crew should know where
exactly the push to talk switches are in the cockpit and the autopilot disengage switches after they have dealt with single pilot incapacitation procedures.
2. Cabin crew could be taught to know the specific technical term of certain reference points in the cockpit such as the MCP panel, forward panel and
pedestal. These reference points could achieve an efficient guidance of cabin crew on the cockpit description by an external pilot, and contributing to an
efficient communication in the event of pilot incapacitation. Also, a description of major controls of aircraft could be taught without significant resource
involvement.
3. Cabin crew flight check lists should have an integrated reference annotated picture of a cockpit outline of the controls and switches that pilots described
in order to be included. These pictures may be employed in the event of pilot incapacitation for cabin crew guidance in the cockpit.
4. Also, topics relevant to speaking on current radio frequency, autopilot disengage switches awareness and basic controls of cockpit could be reviewed
briefly during the crew briefings before aircraft departure. This brief review, as many authors have described (Dunbar et al, 1997; Chute andWiener, 1995,
1996), may generate an effective communication and improve crew performance during the emergencies such as the total pilot incapacitation.

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14. …his girlfriend, Haris… Thank you for your attention!!!
Dedicated to…
the heroic flight attendant of the Helios
HCY 522 last flight …
Andreas Prodromou…
…his girlfriend, Haris…
Thank you for your attention!!!