CRM: Desarrollo de Aspectos Críticos Pendientes / CRM: Development of Pending Critical Aspects

La evolución de los programas de CRM ha supuesto para la aviación un enorme progreso en cuanto al estudio de los factores humanos y su relación con la reducción de los accidentes aéreos. Si bien es cierto que los programas de CRM han sufrido una exitosa evolución desde su aparición en 1979, no lo es menos, que los avances en la ciencia psicológica de las últimas décadas hacen necesario revisar y profundizar en aspectos ya abordados en etapas anteriores por dichos programas. Uno de estos aspectos es la importancia que presentan los Tripulantes de Cabina de Pasajeros (TCP) como integrantes del equipo de vuelo. Retrotrayéndose a los programas de CRM de tercera generación, el presente artículo analiza las actuaciones que han tenido los TCP en diferentes accidentes aéreos, poniendo de manifiesto la importancia que tiene su ejecución y la coordinación de la misma con la del resto de la tripulación de cara al éxito en la resolución de la emergencia aérea.(AU)

The evolution of CRM programs has meant enormous progress for aviation in terms of the study of human factors and their relationship with the reduction of air accidents. Although it is true that CRM programs have undergone a successful evolution since their appearance in 1979, it is no less true that the advances in psychological science in recent decades make it necessary to review and expand on aspects already addressed in previous stages by these programs. One of these aspects is the importance of the cabin crew members (CCM) as members of the flight team. Going back to the third generation programs, this paper analyzes the actions that the CCM have taken in different air accidents, highlighting the importance of their performance and their coordination with the rest of the crew in order to achieve success in resolving the air emergency.(AU)

The potential stickiness of pandemic-induced behavior changes in the United States.

Human behavior is notoriously difficult to change, but a disruption of the magnitude of the COVID-19 pandemic has the potential to bring about long-term behavioral changes. During the pandemic, people have been forced to experience new ways of interacting, working, learning, shopping, traveling, and eating meals. A critical question going forward is how these experiences have actually changed preferences and habits in ways that might persist after the pandemic ends. Many observers have suggested theories about what the future will bring, but concrete evidence has been lacking. We present evidence on how much US adults expect their own postpandemic choices to differ from their prepandemic lifestyles in the areas of telecommuting, restaurant patronage, air travel, online shopping, transit use, car commuting, uptake of walking and biking, and home location. The analysis is based on a nationally representative survey dataset collected between July and October 2020. Key findings include that the "new normal" will feature a doubling of telecommuting, reduced air travel, and improved quality of life for some.

Commercial Air Travel for Passengers With Cardiovascular Disease: Recommendations for Common Conditions.

The exponential growth of commercial flights has resulted in an explosion of air travelers over the last few decades, including passengers with a wide range of cardiovascular conditions. Notwithstanding the ongoing COVID-19 pandemic that had set back the aviation industry for the next 1-2 years, air travel is expected to rebound fully by 2024. Guidelines and evidence-based recommendations for safe air travel in this group vary, and physicians often encounter situations where opinions and assessments on fitness for flights are sought. This article aims to provide an updated suite of recommendations for the aeromedical disposition of passenger with common cardiovascular conditions, such as ischemic heart disease, congestive heart failure, valvular heart disease, cardiomyopathies, and common arrhythmias.

Air travel in a COVID-19 world: Commercial airline passengers' health concerns and attitudes towards infection prevention and disease control measures.

BACKGROUND: COVID-19 and its associated travel bans have reduced international passenger traffic by over 80% below 2019 levels. If airlines are to resume flying at commercially sustainable levels, they must work to restore passengers confidence and sense of security. This study examined commercial airline passengers' health concerns and attitudes towards infection prevention and control measures for travel health and safety in the current COVID-19 global pandemic. METHODS: A cross-sectional study was conducted inviting adult members of 39 frequent flyer groups across three social media platforms to participate in an online survey. RESULTS: A total of 205 respondents completed the survey. The majority (75.6%) reported feeling 'somewhat' to 'extremely concerned' about contracting an infectious disease while flying, particularly respiratory-related. Few (9.8%) reported perceiving their health as an 'essential priority' for their preferred airline. Most respondents agreed airlines should provide complimentary hand sanitisers (86.8%), sanitary wipes (82.9%) and masks (64.4%) for passengers to use while flying as well as more information about preventing the spread of infections (90.7%), which would make the majority feel safer to fly. CONCLUSION: COVID-19 has extensively challenged the air travel industry. Passengers have signalled that they expect more from airlines, and that they would actively engage in additional infection prevention and disease control measures while flying. Airlines must ensure passengers about the steps taken to minimize travel-associated risks, and their commitment towards passengers' health and wellbeing, in order to rebuild consumers' confidence in the recovery of the air travel industry.

Commercial airline protocol during COVID-19 pandemic: An experience of Thai Airways International.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) pandemic has affected the aviation industry. Existing protocols have relied on scientifically questionable evidence and might not lead to the optimal balance between public health safety and airlines' financial viability. OBJECTIVE: To explore the implementation feasibility of Thai Airways International protocol from the perspectives of passengers and aircrews. DESIGN: An online questionnaire survey of passengers and an in-depth interview with aircrews. SETTING: Two randomly selected repatriation flights operated by Thai Airways International using Boeing 777 aircraft (TG476 from Sydney and TG492 from Auckland to Bangkok). PARTICIPANTS: 377 Thai passengers and 35 aircrews. RESULTS: The mean age of passengers was 28.14 (95%CI 26.72 to 29.55) years old; 57.03% were female. TG492 passengers were mostly students and significantly younger than that of TG476 (p<0.0001) with comparable flying experience (p = 0.1192). The average body temperature was 36.52 (95%CI 36.48 to 36.55) degrees Celsius. Passengers estimated average physical distances of 1.59 (95%CI 1.48 to 1.70), 1.41 (95%CI 1.29 to 1.53), and 1.26 (95%CI 1.12 to 1.41) meters at check-in, boarding, and in-flight, respectively. Passengers were checked for body temperature during the flight 1.97 (95%CI 1.77 to 2.18) times on average which is significantly more frequent in longer than shorter flight (p<0.0001). Passengers moved around or went to the toilet during the flight 2.00 (95%CI 1.63 to 2.37) and 2.08 (95%CI 1.73 to 2.43) times which are significantly more frequent in longer than shorter flight (p = 0.0186 and 0.0049, respectively). The aircrews were satisfied with the protocol and provided several practical suggestions. CONCLUSION: The protocol was well received by the passengers and aircrews of the repatriation flights with some suggestions for improvement.

Impact of perceived distances on international tourism.

Worldwide tourism revenues have tripled in the last decade. Yet, there is a gap in our understanding of how distances shape peoples' travel choices. To understand global tourism patterns we map the flow of tourists around the world onto a complex network and study the impact of two types of distances, geographical and through the World Airline Network, a major infrastructure for tourism. We find that although the World Airline Network serves as infrastructural support for the International Tourism Network, the flow of tourism does not correlate strongly with the extent of flight connections available worldwide. Instead, unidirectional flows appear locally forming communities that shed light on global travelling behaviour since there is only a 15% probability of finding bidirectional tourism between a pair of countries. We find that most tourists travel to neighbouring countries and mainly cover larger distances when there is a direct flight, irrespective of the time it takes. This may be a consequence of one-way cyclic tourism that we uncover by analysing the triangles that are formed by the network of flows in the International Tourism Network.

[CME: Fear of Flying and Flying Phobia]. / CME: Flugangst und Flugphobie.

CME: Fear of Flying and Flying Phobia Abstract. Fear of flying and flying phobia are very common in the general population and can lead to substantial distress. Symptoms and diagnosis of fear of flying and flying phobia will be described. Severe fear of flying can be diagnosed as specific phobia or alternatively as agoraphobia. Cognitive behavioral therapy with exposure in vivo has been shown to be the most effective treatment. The treatment with benzodiazepines is the main priority for the general practitioner and will be subsequently discussed. The treatment of flying phobia and agoraphobia will be described based on two examples.

Perspectives on Long-Distance Air Travel with Type 1 Diabetes.

We sought to determine the real-life experiences of individuals traveling long distance (across five or more time-zones) with type 1 diabetes (T1D). Five hundred three members of the T1D Exchange online community ( www.myglu.org ) completed a 45-question survey about their travel experiences flying long distance. The cohort was stratified by duration of T1D and whether or not participants used continuous subcutaneous insulin infusion (CSII) therapy and/or a continuous glucose monitor (CGM). In the last 5 years, 71% of participants had flown long distance. When asked about their perceived "fear of flying," CSII users (with and without a CGM) reported their primary anxiety was "losing supplies," while non-CSII users described concerns over "unstable blood glucose (highs and lows)" (P < 0.05). In addition, 74% of participants reported more hypoglycemia and/or hyperglycemia while traveling overseas and 9% had avoided international travel altogether because of problems related to diabetes management. Furthermore, 22% of participants had run out of insulin at some point during a trip and 37% reported inadequate attention in current sources of information to the unpredictability of self-management needs while traveling. Especially problematic for individuals traveling with T1D are a lack of resources adequately addressing (1) protocols for emergencies while abroad, (2) how to navigate airport security, and (3) managing basal insulin rates when crossing time zones. A strong need exists for easily accessible, free resources for traveling with T1D that is tailored to both device use and duration of the disease.

Predicting passenger seat comfort and discomfort on the basis of human, context and seat characteristics: a literature review.

This literature review focused on passenger seat comfort and discomfort in a human-product-context interaction. The relationships between anthropometric variables (human level), activities (context level), seat characteristics (product level) and the perception of comfort and discomfort were studied through mediating variables, such as body posture, movement and interface pressure. It is concluded that there are correlations between anthropometric variables and interface pressure variables, and that this relationship is affected by body posture. The results of studies on the correlation between pressure variables and passenger comfort and discomfort are not in line with each other. Only associations were found between the other variables (e.g. activities and seat characteristics). A conceptual model illustrates the results of the review, but relationships could not be quantified due to a lack of statistical evidence and large differences in research set-ups between the reviewed papers. Practitioner Summary: This literature review set out to quantify the relationships between human, context and seat characteristics, and comfort and discomfort experience of passenger seats, in order to build a predictive model that can support seat designers and purchasers to make informed decisions. However, statistical evidence is lacking from existing literature.

Detection of Total Knee Arthroplasties at Airport Security Checkpoints: How Do Updated Security Measures Affect Patients?

Airport security measures continue to be updated with the incorporation of the new body scanners and automatic target recognition software. The purpose of this study was analyze the incidence of: (1) triggering the security alarm; (2) extra security searches; (3) perceived inconvenience; and (4) presence of other surgical hardware in those who underwent total knee arthroplasty (TKA) and passed through airport security. A questionnaire was given to 125 consecutive patients with a TKA. Those who passed through airport security after January 2014 were considered for inclusion. A questionnaire was administered that addressed the number of encounters with airport security, metal detector activation, additional screening procedures, and perceived inconvenience. Out of the 125 patients, 53 met inclusion criteria. Out of the 53 patients, 20 (38%) reported that their prosthesis triggered a metal detector. Out of the 20 patients, 8 (40%) who reported triggering of metal detectors also reported the presence of surgical hardware elsewhere in the body. Eighteen of the 53 patients (34%) believed having a TKA was inconvenient for airplane travel. Compared with the historical cohort, alarms were triggered in 70 of 97 patients (p = 0.0001) and 50 of 97 reported inconvenience when traveling (n = 50 of 97 patients; p = 0.04). The incidences of those who underwent TKA triggering alarms and perceiving inconvenience when passing through airport security have decreased from previously published studies. This is most likely due to the recent updates and modifications to screening. As these security measures are modified and implant designs continue to evolve, this is an area of investigation that should continue.

A Novel Treatment of Fear of Flying Using a Large Virtual Reality System.

BACKGROUND: Fear of flying (FoF), a common phobia in the developed world, is usually treated with cognitive behavioral therapy, most efficiently when combined with exposure methods, e.g., virtual reality exposure therapy (VRET). We evaluated FoF treatment using VRET in a large motion-based VR system. The treated subjects were seated on a moving platform. The virtual scenery included the interior of an aircraft and a window view to the outside world accompanied by platform movements simulating, e.g., takeoff, landing, and air turbulence. Relevant auditory stimuli were also incorporated. CASE REPORT: Three male patients with FoF underwent a clinical interview followed by three VRETs in the presence and with the guidance of a therapist. Scores on the Flight Anxiety Situation (FAS) and Flight Anxiety Modality (FAM) questionnaires were obtained on the first and fourth visits. Anxiety levels were assessed using the subjective units of distress (SUDs) scale during the exposure. All three subjects expressed satisfaction regarding the procedure and did not skip or avoid any of its stages. Consistent improvement was seen in the SUDs throughout the VRET session and across sessions, while patients' scores on the FAS and FAM showed inconsistent trends. Two patients participated in actual flights in the months following the treatment, bringing 12 and 16 yr of avoidance to an end. DISCUSSION: This VR-based treatment includes critical elements for exposure of flying experience beyond visual and auditory stimuli. The current case reports suggest VRET sessions may have a meaningful impact on anxiety levels, yet additional research seems warranted.

Pre-flight safety briefings, mood and information retention.

Mood is a moderating factor that is known to affect performance. For airlines, the delivery of the pre-flight safety briefing prior to a commercial flight is not only an opportunity to inform passengers about the safety features on-board the aircraft they are flying, but an opportunity to positively influence their mood, and hence performance in the unlikely event of an emergency. The present research examined whether indeed the pre-flight safety briefing could be used to positively impact passengers' mood. In addition, the present research examined whether the recall of key safety messages contained within the pre-flight safety briefing was influenced by the style of briefing. Eighty-two participants were recruited for the research and divided into three groups; each group exposed to a different pre-flight cabin safety briefing video (standard, humorous, movie theme). Mood was measured prior and post safety briefing. The results revealed that pre-flight safety briefing videos can be used to manipulate passengers' mood. Safety briefings that are humorous or use movie themes to model their briefing were found to positively affect mood. However, there was a trade-off between entertainment and education, the greater the entertainment value, the poorer the retention of key safety messages. The results of the research are discussed from both an applied and theoretical perspective.

Effects of sleep/wake history and circadian phase on proposed pilot fatigue safety performance indicators.

The Karolinska Sleepiness Scale and Samn-Perelli fatigue ratings, and psychomotor vigilance task performance are proposed as measures for monitoring commercial pilot fatigue. In laboratory studies, they are sensitive to sleep/wake history and circadian phase. The present analyses examined whether they reliably reflect sleep/wake history and circadian phase during transmeridian flight operations. Data were combined from four studies (237 pilots, 730 out-and-back flights between 13 city pairs, 1-3-day layovers). Sleep was monitored (wrist actigraphy, logbooks) before, during and after trips. On duty days, sleepiness, fatigue and mean response speed were measured pre-flight and at the top of the descent. Mixed-model analysis of variance examined associations between these measures and sleep/wake history, after controlling for operational factors. Circadian phase was approximated by local (domicile) time in the city where each trip began and ended. More sleep in the 24 h prior to duty was associated with lower pre-flight sleepiness and fatigue and faster response speed. Sleepiness and fatigue were greater before flights departing during the domicile night and early morning. At the top of the descent, pilots felt less sleepy and fatigued after more in-flight sleep and less time awake. Flights arriving in the early-mid-morning (domicile time) had greater sleepiness and fatigue and slower response speeds than flights arriving later. Subjective ratings showed expected associations with sleep/wake history and circadian phase. The response speed showed expected circadian variation but was not associated with sleep/wake history at the top of the descent. This may reflect moderate levels of fatigue at this time and/or atypically fast responses among pilots.

Effects of simulated domestic and international air travel on sleep, performance, and recovery for team sports.

The present study examined effects of simulated air travel on physical performance. In a randomized crossover design, 10 physically active males completed a simulated 5-h domestic flight (DOM), 24-h simulated international travel (INT), and a control trial (CON). The mild hypoxia, seating arrangements, and activity levels typically encountered during air travel were simulated in a normobaric, hypoxic altitude room. Physical performance was assessed in the afternoon of the day before (D - 1 PM) and in the morning (D + 1 AM) and afternoon (D + 1 PM) of the day following each trial. Mood states and physiological and perceptual responses to exercise were also examined at these time points, while sleep quantity and quality were monitored throughout each condition. Sleep quantity and quality were significantly reduced during INT compared with CON and DOM (P < 0.01). Yo-Yo Intermittent Recovery level 1 test performance was significantly reduced at D + 1 PM following INT compared with CON and DOM (P < 0.01), where performance remained unchanged (P > 0.05). Compared with baseline, physiological and perceptual responses to exercise, and mood states were exacerbated following the INT trial (P < 0.05). Attenuated intermittent-sprint performance following simulated international air travel may be due to sleep disruption during travel and the subsequent exacerbated physiological and perceptual markers of fatigue.

Childhood headache attributed to airplane travel: a case report.

Headache attributed to airplane flights is a rare form of headache disorder. This case study describes an 11-year-old girl with recurrent, severe, frontal headaches occurring during airplane travel. The episodes were associated with dizziness and facial pallor but no additional symptoms and showed spontaneous resolution on landing. Blood tests and imaging revealed no abnormalities. The present case fulfils the criteria for airplane headache recently included in the revised edition of the International Classification of Headache Disorders (ICHD-III Beta). Only a few cases of airplane headache have been reported in children. To our knowledge, this is the fourth case. We review the current literature on this rare syndrome and discuss various proposed pathophysiological mechanisms.

Significance of time awake for predicting pilots' fatigue on short-haul flights: implications for flight duty time regulations.

European regulations restrict the duration of the maximum daily flight duty period for pilots as a function of the duty start time and the number of scheduled flights. However, late duty end times that may include long times awake are not specifically regulated. In this study, fatigue levels in pilots finishing their duty late at night (00:00-01:59 hour) were analysed and compared with pilots starting their duty early (05:00-06:59 hour). Fatigue levels of 40 commercial short-haul pilots were studied during a total of 188 flight duty periods, of which 87 started early and 22 finished late. Pilots used a small handheld computer to maintain a duty and sleep log, and to indicate fatigue levels immediately after each flight. Sleep logs were checked with actigraphy. Pilots on late-finishing flight duty periods were more fatigued at the end of their duty than pilots on early-starting flight duty periods, despite the fact that preceding sleep duration was longer by 1.1 h. Linear mixed-model regression identified time awake as a preeminent factor predicting fatigue. Workload had a minor effect. Pilots on late-finishing flight duty periods were awake longer by an average of 5.5 h (6.6 versus 1.1 h) before commencing their duty than pilots who started early in the morning. Late-finishing flights were associated with long times awake at a time when the circadian system stops promoting alertness, and an increased, previously underestimated fatigue risk. Based on these findings, flight duty limitations should consider not only duty start time, but also the time of the final landing.

Norwegian airline passengers are not more afraid of flying after the terror act of September 11. The flight anxiety, however, is significantly attributed to acts of terrorism.

The aim of this paper is to study: (1) the prevalence of flight anxiety among Norwegian airline passengers; (2) situations that may be of concern during flights and situations not related to flying; (3) whether passengers feel more afraid after the terror act of September 11, 2001; and (4) whether passengers were more afraid in 2002 than in 1986.A questionnaire was distributed during domestic flights in Norway in 1986 and 2002. To asses flight anxiety, a six point scale was used, from 0 = not afraid at all, to 5 = always very afraid, and sometimes avoid flying because of that. A 10-cm visual analogue scale (VAS) was used to measure the degree of anxiety. There were 50.8% who were not afraid at all. There were 12 women (5.2%) and one man (0.4%) with flight phobia. However, 22 (4.5%) had cancelled flights because of anxiety during the last two years. Situations that caused most concern during flights were turbulence and fear of terrorism and highjacking. After September 11, 48% were not more afraid, 38% a little more, 10% moderately, 3% rather much and 2% very much. The passengers, however, were not more afraid of flying in 2002 than in 1986. About 3% of Norwegian airline passengers have a flight phobia. Women are significantly more concerned than men. The impact of the terror act September 11, 2001 was rather moderate. The level of flight anxiety among Norwegian airline passengers was not significantly different in 2002 and 1986.