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At least 181 records · Page 10Linked to original sources
PubMedDate not supplied

Communication and teamwork in patient care: how much can we learn from aviation?

OBJECTIVE: To identify evidence on the role of assertiveness and teamwork and the application of aviation industry techniques to improve patient safety for inpatient obstetric care. DATA SOURCES: Studies limited to research with humans in English language retrieved from CINAHL, PubMed, Social Science Abstracts, and Social Sciences Citation Index, and references from reviewed articles. STUDY SELECTION: A total of 13 studies were reviewed, including 5 studies of teamwork, communication, and safety attitudes in aviation; 2 studies comparing these factors in aviation and health care; and 6 studies of assertive behavior and decision making by nurses. Studies lacking methodological rigor or focusing on medication errors and deviant behavior were excluded. DATA SYNTHESIS: Pilot attitudes regarding interpersonal interaction on the flight deck predicted effective performance and were amenable to behavior-based training to improve team performance. Nursing knowledge was inconsistently accessed in decision making. Findings regarding nurse assertiveness were mixed. CONCLUSIONS: Adaptation of training concepts and safety methods from other fields will have limited impact on perinatal safety without an examination of the contextual experiences of nurses and other health care providers in working to prevent patient harm.

Accidents, Aviation↗
PubMed1999

Human error and crew resource management failures in Naval aviation mishaps: a review of U.S. Naval Safety Center data, 1990-96.

The present study examined the role of human error and crew-resource management (CRM) failures in U.S. Naval aviation mishaps. All tactical jet (TACAIR) and rotary wing Class A flight mishaps between fiscal years 1990-1996 were reviewed. Results indicated that over 75% of both TACAIR and rotary wing mishaps were attributable, at least in part, to some form of human error of which 70% were associated with aircrew human factors. Of these aircrew-related mishaps, approximately 56% involved at least one CRM failure. These percentages are very similar to those observed prior to the implementation of aircrew coordination training (ACT) in the fleet, suggesting that the initial benefits of the program have not persisted and that CRM failures continue to plague Naval aviation. Closer examination of these CRM-related mishaps suggest that the type of flight operations (preflight, routine, emergency) do play a role in the etiology of CRM failures. A larger percentage of CRM failures occurred during non-routine or extremis flight situations when TACAIR mishaps were considered. In contrast, a larger percentage of rotary wing CRM mishaps involved failures that occurred during routine flight operations. These findings illustrate the complex etiology of CRM failures within Naval aviation and support the need for ACT programs tailored to the unique problems faced by specific communities in the fleet.

Accidents, Aviation↗
PubMed2004

A classification on human factor accident/incident of China civil aviation in recent twelve years.

OBJECTIVE: To study human factor accident/incident occurred during 1990-2001 using new classification standard. METHOD: The human factor accident/incident classification standard is developed on the basis of Reason's Model, combining with CAAC's traditional classifying method, and applied to the classified statistical analysis for 361 flying incidents and 35 flight accidents of China civil aviation, which is induced by human factors and occurred from 1990 to 2001. RESULT: 1) the incident percentage of taxi and cruise is higher than that of takeoff, climb and descent. 2) The dominating type of flight incidents is diverging of runway, overrunning, near-miss, tail/wingtip/engine strike and ground obstacle impacting. 3) The top three accidents are out of control caused by crew, mountain collision and over runway. 4) Crew's basic operating skill is lower than what we imagined, the mostly representation is poor correcting ability when flight error happened. 5) Crew errors can be represented by incorrect control, regulation and procedure violation, disorientation and diverging percentage of correct flight level. CONCLUSION: The poor CRM skill is the dominant factor impacting China civil aviation safety, this result has a coincidence with previous study, but there is much difference and distinct characteristic in top incident phase, the type of crew error and behavior performance compared with that of advanced countries. We should strengthen CRM training for all of pilots aiming at the Chinese pilot behavior characteristic in order to improve the safety level of China civil aviation.

Accidents, Aviation↗
PubMed1995

[Problems of flight safety and effectiveness of aviation specialists' activities].

In all cases reliability of aviation specialists' activities is a parameter influenced by complex of intrinsic and extrinsic matters. That proves the concept of absolutely safe flights to be inadequate, necessitates justification of the maximal safety level providing the reliability degree which is potentially available. The actual risk always exceeds the expected one, and the difference between them shows the resources and approaches to optimize aviation systems through more reliable specialists and equipment. Flight accidents have three groups of causes traced to human factor. The first group comprises social factors and peculiarities of pilots' and aviation supervisors' training. This group is in charge of nearly 50% of the accidents. The second group includes ergonomic drawbacks of the equipment and induces 25% of flight accidents. The third group covers medical and psychologic factors which show not only the pilot's health, but the functional resources tending to decrease during the activities. This group also causes about 25% of the accidents. If higher expenses for training of pilot causing the accident risk equal to 0.01, amount of flight accidents could decrease several times, and overall expenses will be optimal (nearly 2 times lower than now).

Accidents, Aviation↗
PubMed2005

Characteristics of alcohol-related fatal general aviation crashes.

BACKGROUND: The effects of alcohol on piloting performance have been studied extensively. Information describing alcohol-related aviation crashes, however, is scant. METHODS: We developed a data system for fatally injured pilots in Maryland, New Mexico, and North Carolina by linking autopsy data from the state medical examiner offices and crash investigation reports from the National Transportation Safety Board. Alcohol-related crashes are defined as those in which the pilot had a blood alcohol concentration of 20 mg/dL or greater. Differences between alcohol- and non-alcohol-related crashes were assessed with regard to pilot characteristics, crash circumstances, and human factors. RESULTS: The National Transportation Safety Board recorded 313 general aviation crashes fatal to the pilot in the three states between 1985 and 2000. Of these crashes, 255 (81%) were matched successfully with medical examiner records. Alcohol testing results were available for 233 of the fatally injured pilots. Of those tested for alcohol, 25 (11%) had blood alcohol concentrations > or =20 mg/dL (mean=75 +/- 64 mg/dL). The majority of alcohol-related crashes (52%) occurred at night (7p.m. to 6a.m.), compared with 28% of other crashes (P < 0.01). Alcohol-related crashes were significantly more likely than other crashes to have involved continued flight under visual flight rules (VFR) into instrument meteorological conditions (IMC) (32% versus 12%, P < 0.01), and flawed decisions (64% versus 41%, P = 0.03). CONCLUSIONS: Distinctive epidemiological patterns are exhibited in alcohol-related fatal general aviation crashes. Alcohol appears to play a particularly important role in crashes involving flight under VFR into IMC.

Accidents, Aviation↗
PubMed2003

Using aviation safety measures to enhance patient outcomes.

Recent media reports have put a spotlight on the increasing number of medical errors occurring in US health care institutions. In contrast to health care's increasing error rate, the aviation industry is experiencing a decreasing error rate. Could the safety techniques used in the aviation industry be applied to health care? This article explores that question. The dynamics of the surgical suite are not unlike those of the cockpit of an airplane; therefore, perioperative services was selected to pilot test the aviation model of safety training.

Attitude of Health Personnel↗
PubMed2004

Natural sunlight and its association to civil aviation accidents.

BACKGROUND: Glare is a temporary visual sensation produced by luminance within the visual field that is significantly greater than that to which the eyes are adapted. Glare from natural and artificial light sources can result in temporary visual impairment, increasing the risk of an accident. This study investigates the relationship between visual impairment from natural sunlight and aviation accidents. METHODS: The National Transportation Safety Board Aviation Accident/Incident Database was queried for the period January 1, 1988 to December 31, 1998 for terms, which included "sun," "glare," "vision," "blind ed," and "reflections." Reports annotated with one or more of these terms were reviewed to determine whether glare was considered a direct or contributing factor in the event. RESULTS: There were 130 accidents in which glare was found to be a contributing factor. The majority of these events occurred during clear weather and atmospheric conditions (85%), and were associated with approach/landing and takeoff/departure phases of flight (55%). CONCLUSIONS: Exposure to glare from natural sunlight has contributed to aviation accidents, primarily under otherwise optimal visual conditions at low altitude in congested airspace. Preventative techniques are presented that may protect a pilot's visual performance against the debilitating effects of glare from the sun.

Accidents, Aviation↗
PubMed2002

Exploratory spatial analysis of pilot fatality rates in general aviation crashes using geographic information systems.

Geographic information systems and exploratory spatial analysis were used to describe the geographic characteristics of pilot fatality rates in 1983-1998 general aviation crashes within the continental United States. The authors plotted crash sites on a digital map; rates were computed at regular grid intersections and then interpolated by using geographic information systems. A test for significance was performed by using Monte Carlo simulations. Further analysis compared low-, medium-, and high-rate areas in relation to pilot characteristics, aircraft type, and crash circumstance. Of the 14,051 general aviation crashes studied, 31% were fatal. Seventy-four geographic areas were categorized as having low fatality rates and 53 as having high fatality rates. High-fatality-rate areas tended to be mountainous, such as the Rocky Mountains and the Appalachian region, whereas low-rate areas were relatively flat, such as the Great Plains. Further analysis comparing low-, medium-, and high-fatality-rate areas revealed that crashes in high-fatality-rate areas were more likely than crashes in other areas to have occurred under instrument meteorologic conditions and to involve aircraft fire. This study demonstrates that geographic information systems are a valuable tool for injury prevention and aviation safety research.

Accidents, Aviation↗
PubMedDate not supplied

Quantitative determination of sildenafil (Viagra) and its metabolite (UK-103,320) in fluid and tissue specimens obtained from six aviation fatalities.

During the investigation of aviation accidents, postmortem samples from victims are submitted to the Federal Aviation Administration's Civil Aerospace Medical Institute for toxicological analysis. This report presents a rapid and reliable method for the identification and quantitation of sildenafil (Viagra) and its active metabolite, UK-103,320. This procedure utilizes sildenafil-d(8) as an internal standard for more accurate and reliable quantitation. The quantitation of sildenafil and UK-103,320 in postmortem fluid and tissue specimens obtained from victims from six separate aviation fatalities is described. The method incorporates solid-phase extraction and liquid chromatography-tandem mass spectrometry (LC-MS-MS) and MS-MS-MS utilizing an atmospheric pressure chemical ionization ion trap MS in the positive chemical ionization mode. Solid-phase extraction provided an efficient sample extraction yielding recoveries ranging from 79 to 88%. The limits of detection for sildenafil and UK-103,320 were 0.39 and 0.19 ng/mL, respectively. The linear dynamic range for both compounds was 0.78-800 ng/mL. The current method proved to be simple, accurate, and robust for the identification and quantitation of sildenafil and UK-103,320 in postmortem fluids and tissues.

Accidents, Aviation↗
PubMed1993

Alcohol and civil aviation.

In aviation medicine until the early 1960s the idea that pilots would fly while under the influence of alcohol was taboo. In the United States of America, the taboo was broken when it became known that 30% of fatally injured pilots in general aviation had been under the influence of alcohol. Since then the rate has declined to 10%. No fatal accidents involving alcohol have been recorded in airline passenger transport. The prevalence of pilots flying under the influence of alcohol is unknown. The lowest studied blood alcohol concentration (BAC) with impaired flying skill today is 0.025%, effectively suggesting that the permitted level should be zero, but many aviation authorities have not yet translated such findings into rules and regulations. In the early 1970s the US Federal Air Surgeon began to re-issue licences for rehabilitated alcoholic pilots. Previously alcoholism had been a reason for mandatory permanent grounding. The possibility of returning to the cockpit first opened the way to early recognition of alcoholic pilots on a larger scale. Today many airlines have their own alcohol programmes. This paper gives a brief account of the Swissair programme with its four phases: observation, intervention, treatment and follow-up.

Aerospace Medicine↗
PubMed2000

Geographic variations in crash risk of general aviation and air taxis.

INTRODUCTION: In the past decade, numerous studies have been published regarding the relationship of crash risk and mortality with respect to geographic area. METHODS: We analyzed data (United States only) regarding general aviation and air taxi crashes from 1992-94 from the National Transportation Safety Board. Data regarding 1993 flight hours and standard error were obtained from the Federal Aviation Administration (FAA) and pooled to provide a reliable estimate of crash risk for 1992-94. Calculations were determined for each state and FAA region. RESULTS: During the 3-yr period, the calculated United States crash rate is 8.9 crashes per 100,000 flight hours. The Alaskan and Northwest Mountain regions had the highest crash rates and fatal crash rates. DISCUSSION: This is the first study to report on geographical differences in rates determined as crashes per 100,000 pilot hours. It shows that even when the amount of flying is controlled for, crash rates and fatal crash rates are highest in mountainous regions. Our results indicate that aviation safety in mountainous regions deserves more attention.

Accidents, Aviation↗
PubMed2000

The incidence, nature, and severity of injuries in New Zealand civil aviation.

BACKGROUND: Strategies to improve aviation safety can be directed at the pre-crash, in-crash, or post-crash phases of aircraft crashes. For resources to be made available for in-crash interventions, and for these to be well designed, it is necessary in the first instance to have a detailed understanding of the injuries sustained in crashes. The purpose of this study was to describe the incidence, nature, and severity of injuries sustained in aircraft crashes and other related events in civil aviation in New Zealand. METHODS: National injury databases were searched for fatalities and hospitalizations sustained in aircraft crashes and related events, and cases were linked with Civil Aviation Authority accident records to identify the aircraft involved. Rates were based on estimates of total hours flown by active pilots. RESULTS: There were 104 fatalities identified for the period 1988-1992, giving a rate of 2.57 per 100,000 flight hours. There were 120 hospitalizations identified for the period 1988-1993, giving a rate of 2.45 per 100,000 flight hours. Most fatalities involved injury to multiple body regions, with at least one injury being sufficient in itself to cause death in 48% of cases. For hospitalizations, the lower extremities (23%), spine (20%), and head and face (18%) were the body regions most commonly injured, with fractures being predominant. While the majority of fatalities and hospitalizations occurred in fixed- and rotary-wing aircraft, the highest rates were for microlight and home-built aircraft. CONCLUSIONS: Different patterns of injury were evident for fixed- and rotary-wing aircraft. Reasons for these are suggested. Future research will seek to determine the relative risk associated with potentially modifiable risk factors.

Abbreviated Injury Scale↗
PubMed2001

Characteristics of general aviation crashes involving mature male and female pilots.

BACKGROUND: General aviation crashes in the United States were analyzed to identify differences between male and female pilots in the circumstances of their crashes and the types of pilot errors involved. METHODS: All 144 female pilots who were born between 1933 and 1942 and who were involved in general aviation crashes between 1983 and 1997 were matched 1:2 with 287 male pilots by age within 2 yr, medical certificate and pilot certificate, state or region of crash, and year of crash. RESULTS: Mechanical failure, gear up landings, improper IFR approaches, and collisions with wires or poles were more common in crashes of male pilots. Loss of control on landing/takeoff was more common in crashes of female pilots. Mishandling aircraft kinetics was the most common error of pilots of both genders and was noted more often in female pilots' crashes (81% vs. 48%) (p < 0.001). Males' crashes were more likely to involve flawed decisions (29% vs. 19% of females' crashes) (p = 0.027) or inattention (32% vs. 19%) (p = 0.004). Older pilots made fewer errors: among males age 55-63, 26% of crashes were without obvious pilot error compared with only 7% at age 40-49 (p = 0.003). CONCLUSION: There are large gender differences in the types of pilot error involved in general aviation crashes. Mishandling aircraft kinetics, poor decision making, and inattention are the most common pilot errors and merit increased attention in pilot training.

Accidents, Aviation↗
PubMed2000

Functional magnetic resonance imaging of mental strategy in a simulated aviation performance task.

BACKGROUND: The objective of this study was to analyze the sensory and cognitive functions associated with activated brain regions characterizing mental strategy relative to degree of expertise in aviation-related tasks. METHODS: We used echo-planar functional magnetic resonance imaging (fMRI) technique to examine brain activity in expert pilots (n = 6) compared with novice pilots (n = 6) during performance of a simulated aviation track-following task at 200 knots vs. 100 knots. RESULTS: Expert pilots showed reduced activity in visual and motor regions that contrasted with predominant activation within anterior structures including the frontal and prefrontal cortices; structures involved in visual working memory, planning, selective attention and decision making functions. Novice pilots showed widespread activation of anterior and posterior brain structures, with a rise in activity in the visual, parietal and motor cortices as task difficulty increased. CONCLUSIONS: A high level of performance in the track-following task related to a high degree of expertise in the aviation field. This corresponded to experts performing perceptual and mnemonic processing through a network of specialized functions from visual through multiple prefrontal areas. By contrast, the novice pilots predominantly show activity associated with non-specific perceptual processing and without subsequent representation of selective information in working memory.

Adult↗
PubMedDate not supplied

Sudden incapacitation: occupational aviation medicine perspectives.

Within the aviation environment, occupational medicine tends to focus on pilots, because of the very great effects pilot injury or illness can have on public safety. However, medical conditions of other aviation workers can also endanger public and personal safety. Sudden incapacitation an abrupt loss or impairment of consciousness, control, or performance is the most important occupational concern in aviation medicine. The authors discuss the neurologic causes of sudden incapacitation and syncope, and evaluate the risks of returning affected pilots to duty. Also offered is a Controversy (Single Seizure: To Treat or Not To Treat).

Aerospace Medicine↗
PubMed2002

Field experience with the FAA's Web-based medical certification system "AMCS/DIWS". Federal Aviation Administration.

The October 1, 1999, introduction in the U.S. of a Web-based medical certification process for civil aircrew opened a new era within civil aviation. The Federal Aviation Administration's (FAA) Aeromedical Certification System/Document Imaging Workflow System (AMCS/DIWS) has imposed certain new requirements on the designated Aviation Medical Examiners (AMEs), including the use of Internet systems and procedures. A number of AMEs elected to discontinue their work as the classic medical certification processes were replaced. The authors document their personal experience with respect to the new system, and cite the overall advantages that modernized medical certification procedures bring. These advantages include far fewer "mistakes of omission" by AMEs, more timely receipt by the FAA of aircrew certification data, and a developing master aircrew database for analytic studies.

Aerospace Medicine↗
PubMed2002

Prevalence of cardiovascular abnormalities in pilots involved in fatal general aviation airplane accidents.

INTRODUCTION: Cardiovascular disease in general and coronary heart disease in particular remains the leading cause of morbidity and mortality in developed countries. Coronary artery disease is of concern in aviation because of its potential to cause sudden in-flight incapacitation. The purpose of this study was to analyze the cardiovascular abnormalities in pilots involved in fatal general aviation airplane accidents. METHOD: A comprehensive review was performed of all cardiovascular abnormalities detected during autopsies conducted on pilots involved in fatal fixed-wing general aviation aircraft accidents in the U.S. from 1996-1999. Data was obtained from the database maintained at Civil Aerospace Medical Institute in Oklahoma City. RESULTS: An analysis of 534 autopsy reports revealed presence of cardiovascular abnormalities in 234 pilots (prevalence rate 43.82%). Coronary artery stenosis had a prevalence rate of 37.64%. There were 41 pilots who had evidence of severe atherosclerosis of the left coronary artery. This was significantly associated with stenosis of the right coronary and circumflex arteries. There was a statistically significant relation between coronary atherosclerosis and advancing age. DISCUSSION: Although the overall prevalence of coronary atherosclerosis is lower than previously reported, evidence of severe atherosclerosis was found in a relatively high percentage of pilots and may be a cause for concern. The findings have implications for aircrew health education and primary prevention programs. There is also a need for more standardized data collection.

Accidents, Aviation↗
PubMed2003

Characteristics and toxicological processing of postmortem pilot specimens* from fatal civil aviation accidents.

INTRODUCTION: Autopsied biosamples from civil aviation accident pilot fatalities are submitted to the Civil Aerospace Medical Institute (CAMI) for toxicological evaluation. However, such evaluation is dependent on types and amounts of submitted samples, and obtaining suitable samples is governed by the nature of the accident. Characteristics of those samples and associated toxicological processing have not been well documented in the literature. METHOD: Therefore, the CAMI Toxicology Database was searched for these aspects. RESULTS: CAMI received samples from the pilot fatalities (CAMI cases) of approximately 80% of the 1990-2000 aviation accidents reported by the National Transportation Safety Board. Accidents and cases during June-September were higher than the other months, and more than half of the received cases had multiple samples in sufficient amounts. For example, out of 1891 cases processed for the 1996-2000 accidents, 1211 had at least adequate amounts of blood, urine, and/or vitreous humor; 324 had inadequate amounts of blood and urine; and 356 had no blood or urine. Muscle, liver, lung, and/or kidney samples were submitted in 90% of the cases, while cerebrospinal fluids were submitted in only 8% of the cases. The toxicologically preferred samples, blood and urine, were available in 78% and 56% of the 1891 cases, respectively. Out of 51 cases containing only one sample type, 46 had muscle and the remaining 5 had other sample types. Samples were primarily analyzed for combustion gases, alcohol/volatiles, and drugs. Generally, the presence of analytes is demonstrated in at least two different sample types by using two different analytical techniques for reporting a particular case as "positive." An effective quality-assurance/quality-control is maintained throughout the process. CONCLUSION: In the majority of the aviation accidents, sufficient amounts and types of biological samples were submitted for toxicological evaluation.

Accidents, Aviation↗