In January 2015 the National Transportation Safety Board (NTSB) released its Most Wanted List. These 10 items highlight critical changes needed to reduce transportation accidents and save lives. Two in particular—“Prevent Loss of Control in Flight” and “Disconnect from Deadly Distractions”—attracted attention from the aviation community. Yet the item “Require Medical Fitness for Duty” (FFD), remarkably, has gone unnoticed. For the MRO contingent, this item is critical for flight safety.
Most U.S. MRO providers are familiar with the medical surveillance examination mandated under the Occupational Safety and Health Act (OSHA) of 1970. But the risks identified 45 years ago are not the top concerns of today. The current urgency pertains to the age of the maintenance technician. In the U.S. a technician’s average age is 54 years, in Australia 59, and in Europe a relatively youthful 46. As of 2009, 19% of all workers were 55 years or older. By 2018 this demographic will comprise 25% of the workforce.
The baby-boomer surge in older workers highlights the concept of latent medical and environmental conditions (LMEC)—red links in a chain of events that may lead to an unanticipated consequence. LMEC include signposts of aging such as loss of near vision and reduced hearing, chronic diseases like arthritis, and workplace-exposure hazards—such as from bonding agents—that can affect lungs and other organs.
The potential of LMEC to affect aviation safety is worrisome. More than 50% of work on aircraft involves visual inspection; yet by age 52, workers have lost nearly all ability for unaided focus on near objects. One in five individuals older than 60 has diabetes, a condition that destroys the nerves for tactile sensation. In addition, 47% of workers over the age of 55 have arthritis, which can affect manual dexterity. Composite repair is becoming common, yet refractory exposures reduce hearing and tactile sensation. Diminished human senses contribute to risk.
Given the aging workforce and the demands of aircraft repair, aviation safety requires some means to detect LMEC. A workforce with the basic medical function to complete an FFD check has the physical capability to safely repair aircraft. A properly constructed FFD exam provides reassurance to the MRO that its workforce can maintain aircraft.
To paraphrase the problem: Worker health is flight safety. MROs must be the guardians of the worker health mantra. The FAA last reported on medical surveillance for maintenance personnel in a 2005 report, but the agency has not dedicated any recent funds to explore the link of aging to flight safety. Public health agencies, such as the National Institutes of Occupational Safety and Health (Niosh), have provided general warnings about the aging workforce.
Public health disciples, arising from the management of mass casualties in wars and epidemics, focus their resources on the largest work groups. Construction trades with 6 million workers and health care with 3 million workers receive considerable attention. The workforce of 140,000 U.S.-certified A&P (airframe and/or powerplant) mechanics is simply too small for resource allocation. Private medical companies, which provide MROs with surveillance exams at the worksite, are competing for contracts and are not equipped to evaluate effects of aging.
Developing an FFD protocol for aviation mechanics and ground-support personnel is a challenge MROs can undertake themselves. Components of the FFD exam should include vision, hearing, dexterity and toxicology evaluation. MROs should not retreat from this challenge simply because they do not have the same initials behind their names as physicians and researchers. Follow the lead of volunteer firemen; their fledgling effort to screen volunteers before undertaking community fire duties eventually resulted in an FFD exam protocol under the research direction of Niosh.
My suggestion starts with MROs recognizing that LMEC are real and worker health potentially presents an unmanaged risk for aviation safety. Next, form a task force to develop a standard FFD exam for aviation workers. The first draft will be cumbersome but it will generate and help guide discussion. More important, the focus on aviation safety will attract the attention of the unfunded FAA researchers and large-industry-oriented public health professionals. The second draft will be a document that all MROs can use to manage the worker-health risk among mechanics and ground-support personnel.
Medical societies have joined together to develop standard treatment protocols for common diseases such as arthritis and hypertension. A task force of MRO providers offers the same opportunity for development of a uniform FFD exam for mechanics. Such an exam is consistent with NTSB recommendations. It provides the opportunity to manage the LMEC component of risk that will only increase as the workforce ages. c
Dr. James Allen is an environmental medicine specialist, safety counselor and aviation medical examiner. He is a retired U.S. Navy physician.