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Longevity in military pilots: 37-year followup of the Navy's "1000 aviators".

The 37-year nonmilitary mortality rate for initially healthy aviators was determined in a followup program on the U.S. Navy's "1000 Aviator" cohort. Of the 800 survivors of World War II and the Korean conflict, 95 were found to have died from nonmilitary causes over this followup period. This is markedly less than the 208 that would be expected from a random sample of white American men over a similar period (p less than 0.005). It is also significantly less than the 143 that would have been expected from a group of men who had passed an initial insurance physical (p less than 0.005). Lower-than-expected death rates occurred in all three major categories of cause of death in this age group: cardiovascular, neoplastic, and accidental. The generally good socioeconomic background, the positive genetic influence of long-lived parents, the above average intelligence, and the health and fitness orientation of the military aviator are all thought to be factors contributing to this increased longevity.

Accidents↗

The military aviator with renal stone disease.

Regulations currently in force governing the flight status of military aviators with urinary calculus disease are more restrictive than necessary and result in a substantial loss of aviation manpower. Those regulations and policies currently in force are reviewed, and more liberal guidelines, designed to provide for the safe return to useful flight status of aviation personnel with renal stone episodes, are proposed.

Aerospace Medicine↗

Current trends in the usage of the Adaptability Rating for Military Aviation (ARMA) among USAF flight surgeons.

The Adaptability Rating for Military Aviation (ARMA) is that portion of the initial flight physical that assesses an aviator candidate's motivation for and potential adaptability toward an aviation career. A survey was mailed to all USAF operational flight surgeons in the continental U.S. to describe the frequency and distribution of ARMA usage and attitudes. Descriptive statistics suggest that the ARMA is used suboptimally in accordance with current USAF regulation. ARMA training, flight surgeon satisfaction and lack of regulation clarity are described and discussed. More flight surgeons are dissatisfied with the ARMA than are satisfied, and the regulation is perceived as unclear in the area of final disposition for candidates with equivocal ARMA's. A post-hoc analysis to rule out the influences of rank, gender, experience and residency training was performed. Residency training in Aerospace Medicine is beneficial in terms of doing an ARMA, when required, and covering recommended areas. Females and those with less than 1 year experience perform an ARMA more frequently than males and experienced flight surgeons. Despite the limitations of the current ARMA, it should not be abandoned. Recommendations to improve it are provided. Doing better ARMA's can lead to decreased illness, injury, accidents, and attrition.

Adaptation, Psychological↗

Stroke in the young aviator.

A robustly healthy aviator experienced a sudden focal impairment in cerebral function from which he rapidly recovered in a manner consistent with the entity known as "spectacular shrinking deficit syndrome." Although brain imaging studies revealed a "lacunar" type lesion involving the caudate nucleus, the clinical picture was much more suggestive of a cardiogenic embolic event. Transthoracic echocardiography was required to demonstrate the probable cause of the stroke (an atrial septal defect). Following surgical repair of the atrial septal defect, the aviator was recommended for waiver to resume duties involving aviation as pilot in command.

Adult↗

A review of articles published in Aviation, Space, and Environmental Medicine, 1975-94.

Aviation, Space, and Environmental Medicine, the official journal of the Aerospace Medical Association, is dedicated to serving and supporting all who work to solve the problems of living and working in hazardous environments on, above, and beneath the earth and sea. This study examines and analyzes the characteristics of authors and their articles published in Aviation, Space, and Environmental Medicine over a 20-y period, from 1975-94. There were 3562 articles meeting inclusion criteria published during this period. Articles were analyzed for article length, number of authors per article, country and institution of origin, main topic, and educational preparation of authors. The majority of articles originated in the United States (68%), followed by England (7%), Canada (5%), France (3%), Israel (2%), and Russia/USSR (2%). The number of different countries contributing articles increased from 26 countries in the first 5 yr to 35 countries in the last 5 yr. The content has remained relatively uniform, with the most frequent topics being aviation medicine, aerospace physiology, environmental medicine, and space medicine. The most infrequent topics were health promotion and wellness, occupational health, and aerospace nursing. Over 85% of articles in which the educational status of authors was known were written by authors with a doctorate degree. Most primary authors possessed a doctor of medicine (38%) degree, doctor of philosophy (37%) degree, or both (5%). This analysis can provide insight into the history and future of aerospace and environmental medicine and physiology, since the contents of the Journal clearly reflect the interests of individuals working in these fields.

Aerospace Medicine↗

Spirometric assessment of potential respiratory impairment in general aviation airmen.

Chronic obstructive pulmonary disease continues to manifest an increasing prevalence in male Americans. A recent study of commercial airline pilots revealed a 12% prevalence of more-than-minor spirometric impairment. Because commensurate data were not available for general aviation pilots, in whom such impairment could also compromise flight safety, a parallel study was made. The BMRC and smoking questionnaires, chest expansion, and spirometric measurements of FEV1, FVC, FEV1%, MVV, and FFF 25-75% were assessed in 181 male general aviation pilots. All showed a general relationship to increasing age and smoking amount. Based on FEV1% and FEF 25-75% combined, minor or more-than-minor degrees of spirometric impairment were manifested by 25.4% of the pilots and moderate degrees by 12.7%. Very little impairment was reflected in the remaining spirometric parameters. Subsequent testing of such spirometrically impaired pilots for altitude, fatigue, and orthostatic tolerances related to general aviation flight safety is planned.

Adult↗

Organization and operation of civil aviation medicine in the Soviet Union.

The United States of America and the Soviet Union formalized an agreement in 1973 wherein periodic exchanges of information in civil aviation take place. During the period Aug. 21-Sept. 9, 1976, the author and an associate visited the Soviet Union as part of the exchange agreement. During the visit, the following information was covered. The civil ceviation medicine program in the Soviet Union involves preflight physical examinations for aircrew members, including flight attendants, quarterly physical examinations on pilots and flight engineers, and a special central hospital for diagnosis and treatment of problem medical cases occurring in aviation personnel. In addition, prophylactoria (special rest facilities) for flight crew are maintained at major airports. Certain other aspects of Soviet civil aviation medicine include preflight examinations on all children, and the provision at each airport of a designated medical emergency facility.

Aerospace Medicine↗

Naval aviators admitted to a Naval hospital.

This paper discusses the hospitalization of aviators at the Naval Regional Medical Center, San Diego, Ca. The areas covered include cancer, trauma, cardiac cases, alcoholics, and the effect of hospitalization on the flying status of aviators. The variety of diagnoses accumulated in 2 years was suprising. Further follow-up of cardiac cases must be pursued, especially post-coronary artery bypass. Alcoholism as a diagnosis in hospitalized patients may be a larger problem than elicited in this series. Hopefully this paper will not be just a statistical study. We should think of prevention and care to decrease the number of aviators who have their wings clipped due to medical problems.

Aerospace Medicine↗

Review of cardiac events in USAF aviators.

INTRODUCTION: The purpose of this study was to define the cardiac event rate in the U.S. Air Force (USAF) aviator population. METHODS: Several sources of information were reviewed to search for individual USAF active duty pilots and navigators who had cardiac events (defined as myocardial infarction, angina and sudden cardiac death), while on unrestricted flying duties during the years 1988-92. Source investigated included: USAF physical disability, casualty and medical evaluation board records, and records from the Aeromedical Consultation Service at Brooks AFB, TX. RESULTS: There were 38 total cardiac events, with an average of 7.6 events per year. Myocardial infarctions occurred in 23 aviators, angina in 7 and sudden death in 8. The ages ranged from 31-53 yr with an average age of 44 yr. The 5-yr average annual event rate by age group was 0.0054% (30-34 yr), 0.018% (35-39 yr), 0.038% (40-44 yr), 0.14% (45-49 yr), and 0.13% (50-54 yr). CONCLUSIONS: Although the total number of cardiac events in our aviator population is low, the cardiac event rate in the older age groups is of concern and may warrant a more intensive screening program for that population.

Adult↗

Lipid lowering therapy and military aviators.

This article discusses the role of the newer lipid lowering agents (statins and fibrates) for the treatment of hyperlipidemias in military aviators. Special emphasis will be on long-term safety and the effects of these drugs on CNS functions pertinent to aviators. We propose that these new lipid lowering agents, such as hydrophilic statins and newer fibrates are reasonably safe in aviators with restricted flying duties, subject to long-term surveillance by a specialist.

Aerospace Medicine↗

Physiological effects of thermal stress on aviators flying a UH-60 helicopter simulator.

An evaluation of the physiological effects on aviators of heat stress (90 degrees F wet bulb globe temperature [WBGT]) versus a cooler condition (70 degrees F WBGT) when wearing either a MOPP0 (Mission-Oriented Protective Posture 0) uniform or a MOPP4 ensemble encumbered with a ballistic chest plate and overwater survival gear was performed at the United States Army Aeromedical Research Laboratory. The study used a repeated-measures design with 14 aviators flying 4-hour missions in a UH-60 helicopter simulator. Average crew endurance in the MOPP4-hot condition was reduced to one-third of the fully completed mission time of 309 minutes. For the hot condition, core temperature in the simulator rose 1.4 degrees F/hour when aviators wore the encumbered MOPP4 ensemble versus 0.27 degree F/hour when they wore the MOPP0 uniform. Sweating rate in the MOPP4-hot condition was 1,523 ml/hour, resulting in 2.5% dehydration, in contrast to 183 ml/hour and 0.9% dehydration in the MOPP4-cool condition. In this study, pilots flying realistic UH-60 simulator sorties rapidly incurred significant physiological heat strain when wearing an encumbered MOPP4 flight ensemble in hot cockpit conditions.

Adult↗

Risk factors for pilot fatalities in general aviation airplane crash landings.

CONTEXT: Most pilots survive airplane crash landings in small airplanes. Factors associated with pilot death have not been well studied. OBJECTIVE: To identify factors associated with fatalities in general aviation airplane crash landings. DESIGN: Case-control study. SETTING: The United States. SUBJECTS: All pilots in general aviation crash landings of airplanes with 10 seats or fewer, from 1983 through 1992. MAIN OUTCOME MEASURE: Pilot death. RESULTS: Pilots died in 437 (5.2%) of 8411 crash landings. A fire or explosion on the ground was strongly associated with pilot death (relative risk [RR], 20.4; 95% confidence interval [CI], 15.5-26.9), adjusted for pilot age, pilot flight hours, type of landing gear, and the filing of an instrument flight plan. Pilots who failed to use both lap belt and shoulder harness were more likely to die (adjusted RR, 6.8; 95% CI, 1.8-25.5), as were those who used only the lap belt (adjusted RR, 1.7; 95% CI, 1.3-2.2), compared with pilots who used both restraints. CONCLUSION: Pilots may be able to reduce their risk of death in a crash landing by using lap and shoulder restraints.

Accidents, Aviation↗

Flying personal planes: modeling the airport choices of general aviation pilots using stated preference methodology.

This study employed stated preference (SP) models to determine why general aviation pilots choose to base and operate their aircraft at some airports and not others. Thirteen decision variables identified in pilot focus groups and in the general aviation literature were incorporated into a series of hypothetical choice tasks or scenarios. The scenarios were offered within a fractional factorial design to establish orthogonality and to preclude dominance in any combination of variables. Data from 113 pilots were analyzed for individual differences across pilots using conditional logit regression with and without controls. The results demonstrate that some airport attributes (e.g., full-range hospitality services, paved parallel taxiway, and specific types of runway lighting and landing aids) increase pilot utility. Heavy airport congestion and airport landing fees, on the other hand, decrease pilot utility. The importance of SP methodology as a vehicle for modeling choice behavior and as an input into the planning and prioritization process is discussed. Actual or potential applications include the development of structured decision-making instruments in the behavioral sciences and in human service programs.

Accidents, Aviation↗

Analysis of changes in the pilot population and general aviation accidents.

General Aviation pilots have been involved in a steadily decreasing number of accidents over the past 20 years. Changes in the age distribution, certification, and flying habits of these pilots make direct comparison of accident statistics inaccurate. This study reviews changes in the pilot population over the past 20 years to analyze their impact on accident statistics. Pilot age and certificate distributions from 1968 to 1987 were assembled from annual Federal Aviation Administration (FAA) surveys. Information about pilots involved in accidents was collected from annual National Transportation Safety Board (NTSB) reports. Trends in pilot age distribution, certification, aircraft use, flight planning, and weather were reviewed. The accident experience from the first 5 years of the study period was used to construct an adjusted plot of expected aircraft accidents. From 1968-87, the mean pilot age increased from 35 to 40 years and the number of pilots over the age of 60 increased five-fold. The number of pilots with Air Transport Pilot (ATP) certification tripled and instrument certification increased 80%. Accidents where an Instrument Flight Rules (IFR) flight plan was filed increased from 3.6% to 6.6% without a corresponding increase in the number of accidents in weather at or below instrument meteorologic conditions (IMC). The accident experience from 1968 to 1973 predicted 116,000 accidents from 1968 to 1987. The actual number of accidents was 40% less than predicted. The average pilot age has increased both due to more pilots over the age of 50 and less young student pilots.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Aviation↗

Midair collisions: limitations of the see-and-avoid concept in civil aviation.

INTRODUCTION: Midair collisions cause loss of life and property and undermine general aviation; they also represent failures of the see-and-avoid concept in air traffic control. This study identifies limitations of the see-and-avoid concept. METHODS: Analysis of National Transportation Safety Board data on 159 U.S. civil aviation midair collisions and limitations of the see-and-avoid concept. RESULTS: On average, there were 15.6 midair collisions annually from 1991 through 2000. At least one aircraft was maneuvering in 88% of collisions, and both in 70%. There were 77% that involved arrival to, departure from, or flight over an airport, with 61% in the traffic pattern. Head-tail collisions were more frequent in the traffic pattern than out (28.3%, 2.8%, p < 0.05). Other horizontal convergence angles were equally frequent in or out of the pattern: head-on (8.3%, 11.0%), obtuse (11.0%, 8.3%), and acute (13.8%, 16.6%). DISCUSSION: Because the relative bearing to each aircraft on an unaccelerated collision course is constant, pilots sometimes cannot see converging aircraft when climbing, descending, or level. Even if a converging aircraft is unobstructed, it appears small, motionless, camouflaged, and inconspicuous until imminent impact. A statistical model reveals that the probabilities of seeing and avoiding a converging 40-ft aircraft, for an optimal observer or theoretical pilot scanning 2/3 or 1/3 of the time, respectively, are less than 0.91, 0.60, 0.30 at 200 kn; 0.49, 0.32, 0.16 at 300 kn; 0.28, 0.18, 0.09 at 400 kn; and 0.15, 0.10, 0.05 at 500 kn. The see-and-avoid concept has striking physical and behavioral limitations.

Accident Prevention↗

Alcohol, aviation, and safety revisited: a historical review and a suggestion.

A 1964 study by Harper and Albers initiated a new era of alcohol, aviation, and safety interest. Studies by the author agreed with the Harper and Albers data. Educational efforts that followed, and the apparent effects, are described. A study commissioned by the author confirmed the effect of low levels of alcohol on flying performance. Impairment from other effects of alcohol, such as alcohol-induced hypoglycemia (AIH), post-alcohol impairment (PAI), and positional alcohol nystagmus (PAN) are mentioned. It is suggested that the effects of PAN may play a role in spatial disorientation. It is also suggested that the ingestion of alcohol days before an accident may be demonstrated by laboratory procedures. The feasibility and implementation of this should be established. If the association between previous alcohol ingestion, and spatial disorientation or other impairment becomes evident, it should provide a basis for extensive education regarding aviation and safety.

Accident Prevention↗

A double-blind, placebo-controlled investigation of the efficacy of modafinil for sustaining the alertness and performance of aviators: a helicopter simulator study.

RATIONALE: In 1998, the FDA approved modafinil for treating excessive daytime sleepiness in narcoleptics, and this has raised questions about the appropriateness of this compound for enhancing alertness in sleep-deprived controls. This study explored the efficacy of modafinil for maintaining the performance of volunteers required to accomplish highly demanding tasks despite sleep loss. OBJECTIVE: The principal objective was to determine whether prophylactic doses of modafinil would attenuate decrements in aviator performance and arousal throughout 2 days and 1 night without sleep. METHODS: Six pilots were exposed to two 40-h periods of continuous wakefulness. In one, three 200-mg doses of modafinil were given and in the other, matching placebos were administered. Helicopter simulator flights, resting EEGs, and Profile of Mood States (POMS) questionnaires were evaluated. RESULTS: Modafinil attenuated sleep deprivation effects on four of six flight maneuvers, reduced slow-wave EEG activity, and lessened self-reported problems with mood and alertness in comparison to placebo. The most noticeable benefits occurred between 0330 and 1130 hours, when the combined impact of sleep loss and the circadian trough was most severe. The most frequently observed drug side effects were vertigo, nausea, and dizziness. These could have been related to: 1) the motion-based testing, 2) the use of a simulator rather than an actual aircraft (i.e., "simulator sickness"), and/or 3) the administration of more than 400 mg modafinil. CONCLUSIONS: Modafinil is a promising countermeasure for sleep loss in normals; however, additional studies aimed at reducing side effects are needed before it should be used in aviators.

Adult↗

Analysis of injuries among pilots involved in fatal general aviation airplane accidents.

The purpose of this study was to analyze patterns of injuries sustained by pilots involved in fatal general aviation (GA) airplane accidents. Detailed information on the pattern and nature of injuries was retrieved from the Federal Aviation Administration's autopsy database for pilots involved in fatal GA airplane accidents from 1996 to 1999. A review of 559 autopsies revealed that blunt trauma was the primary cause of death in 86.0% (N=481) of the autopsies. The most commonly occurring bony injuries were fracture of the ribs (72.3%), skull (55.1%), facial bones (49.4%), tibia (37.9%) and pelvis (36.0%). Common organ injuries included laceration of the liver (48.1%), lung (37.6%) heart (35.6%), and spleen (30.1%), and hemorrhage of the brain (33.3%) and lung (32.9%). A fractured larynx was observed in 14.7% of the cases, a finding that has not been reported in literature until now. It was observed that individuals who sustained brain hemorrhage were also more likely to have fractures of the facial bones rather than skull fractures.

Accidents, Aviation↗