Sep 10, 2010

REPORT: Flight Attendants as First Responders

U.S. Department of Homeland Security & Department of Labor have yet to include Flight Attendants in the category of Essential Employees. It's up to US to push for recognition and change.

[02.23.07] -- On the same day AFA-CWA Council 12, Los Angeles released the article on our LAXSW AED save, Heather Healy, our AFA-CWA International Director of EAP, delivered the same message to the International Critical Incident Stress Foundation (ICISF) Ninth World Congress on trauma, stress, and coping. Audience members included firefighters, police, medical professionals, and mental health practitioners.

The purpose of her presentation was to reinforce to the emergency mental health response community (which consists of peers and mental health professionals) to recognize that Flight Attendants are also First Responders.

It is AFA-CWA's goal that Flight Attendants be recognized as critical First Responders, and should also have access to job training, various support services, and stress management interventions that are currently available to those clearly recognized as First Responders in the United States.

How many times have you been on a flight and encountered a situation that required immediate action and quick-thinking? Every Flight Attendant is a First Responder, and it is important to ensure we receive that recognition.

Flight Attendant involvement is crucial in all levels of our Union - we must all work collectively to ensure that our voices are heard, and our jobs as Safety & Security Professionals are clearly identified. Public awareness and education about our career starts with you. Our AFA-CWA Government Affairs Committees take the same message to Capitol Hill. Every Committee is vital to our success - Get involved & make a difference!

"You are Safety Professionals.." -- John Woodring, FAA Inspector for United, '07-'08 RET e-Learning

"You are expected to be a First Responder.." -- United '07-'08 RET e-Learning

Copyright © February 2007 AFA-CWA, Council 12 Los Angeles. All Rights Reserved.
 

By Heather Healy, AFA-CWA EAP Director  |  Edited by Darren Shiroma

As our world changes, so does our vocabulary. Every year, new words are added to our speech. Some of these terms become entries in dictionaries if they gain enough popularity. These are called neologisms.

Neologisms are words, terms or phrases that have been created to apply to a new concept, or to reshape an older term in newer language form. Neologisms are especially useful in identifying inventions, new phenomena, or old ideas that have taken on a new cultural context. 

In current times, many of these words relate to electronics, and high-tech consumer products like iPod, hard drive, software, and flat screens. Neologisms can also relate to actions like: IMing, posting, surfing the net, blogging, and googling. They can relate to incidents or events such as DWIs, a drive-by, suicide bombings, and 9/11.

They can even describe organizations and job functions - whether new or old, that better reflect our emerging culture of preparedness like TSA, Homeland Security, Sky Marshal, and First Responders.

We are here today to tell you that Flight Attendants are First Responders. Every workday in America, the equivalent of the entire population of Chicago steps aboard an airplane. What happens on the ground that requires the immediate protective response of law enforcement, firefighters, and emergency medical technicians also happens in our nation’s skies.

At 39,000 feet, Flight Attendants are the first and in many cases, the only responders for health, safety and security threats that occur in the air - just as they do on the ground. One could argue, moreover, that within the confines of a high-speed flying metal tube that any medical emergency, fire, or acting out behavior can have permanent and exponential results not just for those on the plane, but, for those on the ground. One could point to Sept 11th, 2001 to prove this.

For Flight Attendants, however, the reality of their First Responder duties is not substantiated by just this one historical event. It's experienced before, during and after every departure, every day, and whether the threat of an emergency does or doesn't occur. September 11th represented the possibility that the profession would finally be recognized for their safety and security role - and that they would get the respect, training and resources consistent with the recognition that they are a key component of our Nation's emergency response system.

Today, we'd like to share with you some research on the term "First Responder" including: What is the definition of a first responder? What occupational groups do they typically include? What characteristics do first responders share? And where do Flight Attendants end up in this classification scheme?
 

We're here to share with you some of the problems that have been created because the term "First Responder" has yet to be extended to Flight Attendants, despite the events of September 11th. Finally, we'll share with you some simple ways that each of us here today can help reshape the perception and treatment of Flight Attendants to better match their reality and their needs as a First Responder group. Where better to begin this change process than in the community of other First Responders and other stakeholders in the emergency response continuum?

The term "First Responder" has multiple definitions. If you were to Google the term, you'd find 58 pages of cited references. Let's look at a few of the regulated definitions and the criteria used to distinguish who first responders are. Let's also see where Flight Attendants fit into this scheme.

The Department of Homeland Security, the lead federal agency responsible for ensuring that First Responders are prepared, equipped and trained for any man-made or natural disaster says, "First Responders are those individuals who in the early stages of an incident are responsible for the protection and preservation of life, property, evidence and the environment."

Initially, their definition included law enforcement, emergency medical services, and fire fighting personnel. It has since been expanded to include emergency management, public health, clinical care, public works, and other skilled public and private personnel that provide immediate support services during prevention, response, and recovery operations." The Department's abbreviated definition of a First Responder is "America's first line of security and the first line of defense in a terrorist attack."

Is a Flight Attendant one of them?

According to an affidavit filed against shoe bomber Reid, a Flight Attendant smelled what she thought was a burnt match after American Airlines Flight 63 had been airborne for about 90 minutes. The Boeing 767 left Charles de Gaulle International airport around noon. After the Flight Attendant determined that the smell came from Reid, the attendant confronted him. Reid also lit another match and appeared to be trying to set fire to the inner tongue of one sneaker. The Flight Attendant noticed a wire protruding from the sneaker and attempted to grab the shoe. Reid who is 6'4" and weighs more than 200 pounds, pushed her into the bulkhead. She tried again and Reid pushed her to the floor. The Flight Attendant called for help and another Flight Attendant joined in the struggle with Reid.

Flight Attendants are trained in basic bomb components and identification with outlined procedures in their operations manual.

Under the security section of the Flight Attendants' operations manual, if a passenger commits or threatens to commit any act which is detrimental to the safety of the flight and/or its passengers, it is the duty and responsibility of Flight Attendants to use whatever means reasonable - including restraint if necessary - to ensure the safety of the flight and their passengers. In the event of an in-flight misconduct incident, the airline and the FAA strongly encourage pilots not to leave the flight deck during flight.

In the fall of 2003, Congress incorporated a Flight Attendant certification requirement under the Vision 100 Century of Aviation Reauthorization Act. Although Flight Attendants perform safety and security related functions, they previously had never been certified like pilots, mechanics, and aircraft dispatchers. When Congress required Flight Attendant certification, they acknowledged; "Flight Attendants perform vital crewmember functions onboard the aircraft, including emergency functions for aircraft evacuations, firefighting, first aid, and response to security threats."

The Department of Homeland Security has yet to include Flight Attendants in their definition of First Responders.

The US Department of Transportation, in its First Responder National Standard Curriculum states that a "First Responder is one who works with a limited amount of equipment to provide initial and immediate care to the ill or injured using entry level techniques of emergency medical care."

According to this definition, First Responders include those workgroups whose jobs require them to be trained in basic emergency medical care, usually as the first to arrive at a scene or the first to initiate care.

Under this definition, is a Flight Attendant a first responder?

A major Airline reported 3,386 in-flight medical incidents or about 1 per 11,000 passengers for a one-year period. Three out of every four in-flight medical emergencies were managed directly by cabin crew without the assistance of on-board medical personnel. The most reported conditions included chest pain, sudden collapse, breathing difficulties, head injury, psychiatric problems, abdominal problems, diabetes, allergic reactions, obstetric and gynecological emergencies.

According to the F.A.A., the time required for an airline aircraft to make an unscheduled landing due to a life-threatening medical emergency can be in the range of an hour or more, especially for wide-body jet aircraft. Therefore, immediate emergency care, including first-aid and cardiopulmonary resuscitation must be available if a high level of occupant safety is to be assured.

EMS personnel, firefighters and police are the only listed reference group under DOT's definition. Even though flight attendants are tasked, trained and equipped to respond to illness and injury as well as to support life, they are not considered by DOT to be a first responder.
 

According to the U.S. Department of Labor, First Responders include the following occupational groups:

Police Officers Detectives Deputy sheriffs State troopers Highway patrol officers

Investigators / Inspectors Correctional officers Parole and probation officers Park rangers Hazardous materials workers

Firefighters Paramedics Ambulance personnel Rescue workers Emergency room technicians

 

Note -- Flight attendants aren't listed. So - what characteristics do these work groups share but Flight Attendants don't?

According to the Employments Standards Administration of the Department of Labor, First Responders have identifiable job functions, as well as qualifications, training, and working conditions that set them apart. Let's look at these and compare them to those of Flight Attendants. According to the DOL, a First Responder's job functions include one or more of the following.

Preventing, controlling or extinguishing fires of any type:

If a fire is discovered, one Flight Attendant is responsible for fighting the fire while another acts as a phone liaison with the flight crew to advise of the type and progress made in fighting the fire.

According to a reported incident, a passenger smoked in the lavatory and threw the cigarette in the trash. The cigarette was not completely out. A Flight Attendant discovered the fire and safely extinguished it.

On another flight, Smoke entered the cabin. The Flight Attendant notified the cockpit and the cabin was prepared for emergency landing. On landing, an electrical fire was discovered. 

Rescuing victims of fire, crime or accidents:

In January of 2007, United Flight Attendants were recognized for the 27 defibrillator saves that have occurred at United Airlines.

Preventing or detecting crimes:

Two hours out, a Flight Attendant found a white substance in the first class lavatory. Authorities were alerted to meet the flight.

In a second incident, a passenger became intoxicated and irate, tried to open the aircraft door in flight, Flight Attendants subdued and restrained the passenger. Authorities met the flight.

On another flight, a crazed passenger became totally disoriented and tried to break into the cockpit. Flight Attendants subdued and restrained the passenger.

Conducting investigations or inspections for violations of law performing surveillance:

Crewmembers pay special attention during pre-flight inspections to ensure unauthorized persons, including stowaways, are not on-board. Any person found in a secure area without proper documentation or authorization must be challenged by the crewmember.

Pursuing, restraining and apprehending suspects:

On a US air carrier, from Buenos Aires to JFK, a Flight Attendant was assaulted by a passenger in the aft galley of a 767 and suffered a broken vertebrae. The assaulting passenger was subdued and restrained by other Flight Attendants. The plane diverted to Puerto Rico where the passenger was removed.

Preparing investigative reports:
 

After an incident, the Flight Attendant completes a Passenger Disturbance Report. This report aids law enforcement officials in the prosecution of any passengers that violate Federal Law. A Flight Attendant also completes and submits additional reports such as a Flight Attendant Report, an Aviation Accident Report, Witness Card, etc. as appropriate.

According to U.S. Department of Labor, First Responder job qualifications typically include:

- Minimum age requirement - Minimum education requirement - The wearing of a uniform - Requirement to adhere to performance regulations/policies - Ability to communicate effectively - to use good judgment, remain calm in high stress situations. - to be unaffected by loud noises and flashing lights

- to function without supervision - to speak, read and document in English - Possess good manual dexterity - withstand varied environmental conditions such as extreme heat, cold, moisture - Ability to work in low light situations and confined spaces; - and to work with others to make care decisions.

           

First Responder training usually includes the following:

1. Completing a formal course of training;  which also includes classroom and hands on practice sessions. 2. Earning a passing score on competency tests. 3. Completing mandatory re-current (annual) trainings 4. Participate (be subject to) in safety sensitive alcohol and drug testing 5. Clearing a background check                        6. Mandatory rest periods                                                                  7. Limitations on duty time

First Responders are also subject to unique work environments or conditions:
 

- Work in all types of weather - Have irregular hours - Are on-call for long periods of time - Do considerable kneeling, bending, and lifting - May be exposed to infection and diseases from body fluids

- Exposure to violence from intoxicated/drugged persons - Work is physically strenuous - Function in uncommon situations - May encounter many stressful situations - Actions are subject to regulated inspection and review

By Federal Air Regulation, training, and job expectation, Flight Attendants are directly involved in and around emergency, security, and medical events that occur on board the aircraft. They possess a necessary level of preparedness to help secure the safety of passengers in-flight and on the ground. 

According to their job description, Flight Attendants:

- Must attend training classes and recurrent (annual) emergency procedure training - Their work environment is subject to frequent changes in climate and locals, and; - Involves variable hours, working conditions and changes in cabin altitude - A duty period may be scheduled up to 16 hours and duty in-flight may be scheduled  up to ten (10) continuous hours - Perform their safety sensitive duties without supervision or oversight - Work in the confined spaces of aircraft aisles and galleys - Stand, walk, kneel, bend, stoop, stretch, reach, lift moderately heavy objects - In continuous contact with the public, they must handle all types of passengers - Address problems with unaccompanied minors and handicapped passengers to disorderly, intoxicated, or irate passengers. - Tends to ill, injured, and incapacitated passengers and administers first aid

In the event of an emergency, a Flight Attendant must be prepared to rapidly evacuate passengers from an aircraft, provide leadership, direction and assistance to passengers in accordance with FAA and corporate regulations.

Flight Attendants must adhere to the following:

- Operate mechanical equipment: airstairs, open aircraft doors, remove window exits, and; - Respond with fire, first aid, defibrillator & oxygen equipment. - Be prepared to provide leadership, direction, and assistance to passengers in unusual incidents. - Be prepared to immediately respond to incidents such as bomb threats and hijacking. - During recurrent (annual) emergency training, a Flight Attendant is required to actively participate with proficiency in simulated emergencies and physically operate aircraft emergency equipment with 100% proficiency.

    

So - if this doesn't sound like a Flight Attendant and the U.S. Department of Labor doesn't recognize Flight Attendants as First Responders, where are they categorized?

The Department of Labor has 23 categories where they list all occupational groups. Let's look at that list.

11-0000 Management 13-0000 Business & Financial Operations 15-0000 Computer & Mathematical 17-0000 Architecture & Engineering 19-0000 Life, Physical, & Social Science 21-0000 Community & Social Services 23-0000 Legal Services 25-0000 Education, Training, & Library 27-0000 Arts, Design, Entertainment, Sports, & Media 29-0000 Healthcare Practitioners & Technical 31-0000 Healthcare Support 33-0000 Protective Service

35-0000 Food Preparation & Serving Related 37-0000 Building, Grounds Cleaning & Maintenance 39-0000 Personal Care & Service 41-0000 Sales & Related 43-0000 Office & Administrative Support 45-0000 Farming, Fishing, & Forestry 47-0000 Construction & Extraction 49-0000 Installation, Maintenance, & Repair 51-0000 Production 53-0000 Transportation & Material Moving 55-0000 Military Specific

 

Where do you think Flight Attendants are listed? You might think they're under “Transportation and Material Moving Occupations” with other air transportation workers. But they aren't.

Air transport workers fall under "Transportation and Material Moving Occupations" (53-0000):

53-2010 Aircraft Pilots and Flight Engineers 53-2011 Airline Pilots, Copilots, and Flight Engineers 53-2012 Commercial Pilots 53-2020 Air Traffic Controllers and Airfield Operations Specialists 53-2021 Air Traffic Controllers 53-2022 Airfield Operations Specialists

Flight Attendants are listed under “Personal Care and Service Occupations” (39-0000) along with:

Barbers/hairdressers Manicurists Coat Check Personnel Ushers/Lobby Attendants Tour Guides Baggage Porters/Bellhops Amusement Park Attendants

 

When we examine how the field of emergency mental health defines and characterize "First Responders", we find omissions and misperceptions similar to those we just saw and talked about.

In our review of behavioral health literature on the term First Responder, we found no clear definition for this term. What we were able to surmise was that a first responder was both synonymous with as well as a subset of a larger group of workers sometimes described as "emergency service workers".

But when we looked for a clear definition of "the emergency service worker" (even in research that was specifically designed to study their exposures, their vulnerabilities and mental health needs) we only found varying assumptions that the study group included fire fighters sometimes, it included police officers other times, and most always included emergency medical workers. There was one consistency though. Almost 100% of the time, emergency responders didn't include Flight Attendants.

To date, one research article describes Flight Attendants as First Responders - the study that the Association of Flight Attendants conducted post 9-11.

What we did find in our review of emergency mental health research is an attempt to "back into" the definition of who a First Responder is by identifying the occupational stress incidents that could prove impactful.

Stressors that were identified to be unique to First Responders were:

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