Making a Smooth Landing for Employee Health and Safety at Airports and Airlines

Michelle Hopkins

“Frontline dedication” in the skies and on the ground

Airline and airport employees make it possible for 926 million passengers on U.S. flights1 to create the future for companies through business travel and to build a store of personal memories through leisure travel – all while potentially putting themselves in harm’s way – perhaps dozens of times each day. Cockpit and cabin crew members, gate crew ticket counter and ramp agents, ground crew ramp, baggage, and cargo handlers, service equipment operators, maintenance and repair, and cleaners and caterers confront so many possible hazards to their safety and health that a complete list is impossible. Here are several of the main ones that are vital to address:

  • Musculoskeletal and associated health effects: Prolonged standing/sitting, confined spaces, awkward positions, neck and back pain, heavy lifting, falling objects, falling from heights, slips, trips, and falls, and lifting baggage that exceeds weight limits
  • Other physical/health effects and exposures: Flight-associated venous thromboembolism; noise, vibration, sun and radiation, extreme temperatures, biological agents, diesel exhaust, pesticides, hazardous chemicals, bloodborne pathogens, rapid and adverse weather changes, de-icing chemicals, fires, burns, explosions, and turbulence. Concentra offers a comprehensive travel vaccinations and medicine program, including the latest guidance on local health-related considerations for all international destinations.
  • Endurance and mental health: Fatigue, aggressive passengers, irregular working hours, shift work, interrupted circadian rhythms/sleep patterns, adaptations to long flights, extended periods away from home, intense deadlines and turnaround times, and demanding tasks
  • General well-being: Extreme responsibility continually protecting self and thousands of others

Raising awareness and becoming mindful

Oftentimes, to passengers processing through the gate and boarding a plane, airline and airport employees are practically invisible, just gatekeepers of different stages in a process. Passengers are immersed in their electronic devices and other personal belongings as they make their way through checkpoints. Once on board, their attention turns to in-flight creature comforts. Wrapping up a flight, they are focused on gate and ground connections or reclaiming baggage and then, they rush off to the reason for their trip.

How often do passengers or business leaders reflect that air travel success isn’t just about filling every seat on the plane and a smooth departure and arrival – although those things, admittedly, are nice. Successful air travel is also about protecting the health and safety of airline and airport employees who, as a trained and smoothly functioning team, are a critical lifeline for the passengers they serve, as well as business and leisure.

Raising awareness about the occupational environment of airline and airport employees is good. But becoming mindful and present to them as they perform their functions may go even further to improve their world and our own. Mindfulness – the state of being genuinely conscious of something or someone – was studied by Swiss researchers. They found that an individual who was mindful cultivated internal character traits of creativity, bravery, perseverance, love, social intelligence, self-regulation, and gratitude.2 In other research, mindfulness promoted more empathy and compassion for others.3 These are valuable traits in 2021 and in air travel, with 200-300 people in a 100-to-200 foot fuselage moving at 500 to 600 miles an hour.4

Four occupational health and safety solutions

This article suggests four solutions for the health and safety of airline and airport employees, all ably supported by best-in-class occupational health providers. Best-in-class occupational health providers may start with the same “runway” of services as other providers – injury care, primary care, urgent care, travel health and vaccinations – but they reach greater heights through in-depth understanding of how to effectively engage employers and employees, communicate clearly, and skillfully apply performance data and analytics to achieve quality medical outcomes, injury prevention, and workforce health and safety protection.

These four solutions align with the four areas of hazards described above. They are:

  1. Proactive musculoskeletal health through physical therapy interventions that foster healthy physical movements, follow ergonomic guidelines, and prevent injury – or after an injury does occur, promote optimal functional recovery and return to work. Among the physical therapy interventions supported by research are pre-employment functional testing, musculoskeletal screening, early reporting programs5, exercise, stretching, conditioning, and weight training.6 Best-in-class therapists have abundant expertise and experience, maintain clear communication with employers, employees, and payors, and immediately consult with the medical doctor on the case (located at the same facility) to consider adjustments in treatment or other strategies to accelerate progress when an employee’s functional recovery is slower than expected. Representing Concentra®, Chris Studebaker, DPT, PT, OCS, national director of onsite therapy and athletic trainers, and Shelby Mendez, DPT, PT, FAAOMPT, CSCS, director of therapy operations in east Florida, presented strategies to take musculoskeletal health mainstream and to the next level in a digital session April 21, 2021 for the National Workers' Compensation and Disability Conference.
  2. Medical surveillance exams, respirator clearance and fit testing, and recommendations on the proper use and maintenance of personal protective equipment (PPE). In numerous airline and airport job functions, exposures to hazardous chemicals, noise, vibration, extreme hot and cold temperatures, exhaust, and fumes cannot be avoided. Best-in-class clinicians are well-versed in relevant regulatory standards that apply to airline and airport employees. Expertise in respirator requirements and use, as well as other PPE is essential to protecting employees from exposure hazards. Medical surveillance services establish a baseline of health and monitor for any possible adverse health effects over time. In addition to medical surveillance, physical exams with a best-in-class approach are thorough. They also enable a knowledgeable medical clinician to raise the awareness of airline and airport employees about possible health risks posed by the physical requirements of their work. Here’s an example. Flight-associated venous thromboembolism (deep vein thrombosis and pulmonary embolism) involves the formation of a clot that can cause serious illness, disability or, in some cases, death. Research and news coverage about extended sedentary time on a flight and the risk of venous thromboembolism have typically focused on passengers. Many pilots and crewmembers may not know that venous thromboembolism is a risk for them, too. According to a study published in April 2020, about two-thirds of airline pilots are unaware of flight-associated venous thromboembolism as a health threat. Pilots between the ages of 20 and 40 were much less knowledgeable – but not less at risk – than older pilots.7
  3. Best-in-class expertise that is continually updated on how to handle highly complex stressors, such as fatigue, sleep deprivation, mental health, aggressive people, and intense deadlines. The research on each is constantly evolving. Best-in-class occupational health providers help employers incorporate new research findings into employee health and safety programs because, as the term implies, being best in class means staying on top of your game. Concentra has developed a novel approach, called medical expert panels. These panels, composed of leading Concentra experts, support clinicians enterprise-wide, as well as employers, to ensure up-to-date, effective, patient-centric medical care, physical therapy, regulatory testing/examinations, transportation, pharmacy and therapeutics. Concentra Medical Expert Panels also are a leading-edge force for occupational health and workers’ compensation nationwide. Transportation Medical Expert Panel Chair Anne-Marie Puricelli, MD, JD, national medical director of transportation and clinical director of strategic accounts, and Michael Berneking, MD, FACOEM, FAAFP, FAASM, medical director and transportation medical expert panel member, are sought-out experts for industry conferences and interviews. They addressed the serious threat of fatigue in the transportation industry in a June 17, 2021 article for Risk&Insurance.
  4. Onsite centers to support the general well-being of airline and airport employees who daily shoulder extreme levels of responsibility for thousands of air travelers. Look for best-in-class occupational health providers who offer an onsite center or program with flexible staffing and services, supported by pricing scalability and strategies for program longevity.

As an example of the benefits, a major U.S. airport hosting a Concentra onsite clinic over several years, has significantly lowered direct cost and improved employee satisfaction and health.


More than 700,000 airline employees in all carrier groups8 and 96,000 airport operations employees9 dedicate themselves to giving business and leisure passengers safe and pleasant travel. Best-in-class occupational health solutions can enhance their health, safety, and satisfaction. How much? The sky’s the limit.

Are you ready to upgrade to best-in-class occupational health care for your employees?


  1. Passengers on US Airlines in 2019. Bureau of Transportation Statistics. April 30, 2020.
  2. Pang D, Ruch W. The Mutual Support Model of Mindfulness and Character Strengths. Mindfulness. 2019; 10(8):1545-1559.
  3. Does Mindfulness Meditation Really Make You Kinder? Greater Good Magazine: Science-based Insights for a Meaningful Life. July 17, 2018.
  4. United Airlines Fleet Information. February 2021.
  5. Are We Driving the Model of Employee Health Without A Locomotor? It’s Time to Take Musculoskeletal Health Mainstream. Presentation by Concentra and Dominion Energy. 2020 National Workers’ Compensation and Disability Conference. Digital Session.
  6. O’Connor DK, Dalal S, Ramachandran V, Shivers B, Shender BS, Jones JA. Crew-friendly Countermeasures Against Musculoskeletal Injuries in Aviation and Spaceflight. Frontiers in Physiology. July 2020; doi: 10.3389/fphys.2020.00837.
  7. Kilic B, Soran S. Awareness Level of Airline Pilots on Flight-Associated Venous Thromboembolism. Aerospace Medicine and Human Performance. April 2020; 91(4):343-347.
  8. Search Airline Employment Data by Month. Bureau of Transportation Statistics. April 2021.
  9. Airport Operations in the US – Employment Statistics 2002-2027. IBISWorld. March 26, 2021.