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The authors suggest a conceptual approach justifying major directions in prophylaxis, correction and rehabilitation of eye in aviation operators of electronic display means. Necessity of multifarious attitude to the medical management.
Carbon monoxide exposure is an important public health issue that poses a significant, albeit uncommon risk in aviation. Exposure is most common in single engine piston-driven aircraft where air is passed over the exhaust manifold to serve as cabin heat. Effective primary prevention of this exposure is the regular inspection and maintenance of aircraft exhaust systems, as required by law. For situations at special risk should exposure occur, and where there is concern for the public safety, installation of active warning devices for CO intrusion into cockpits may improve secondary prevention. Modern studies should be performed of occupation-specific abilities to support the 50 ppm FAA CO exposure standard and 50-70 ppm FAA Technical Standard Order (TSO) for CO monitors alerting pilots to the possibility of exhaust gas intrusion into their cockpits.
A complex of measures for prevention, correction and rehabilitation of ground aviation personnel revealing symptoms of vision fatigue due to the work with electronic information display systems is proposed. Yet, the author point to the need to apply these measures as a part of an integral approach.
BACKGROUND: Periodic medical examinations are the daily work of the flight surgeon. Their immediate impact on flight safety, however, has not been evaluated. This case-control study was done to ascertain whether, among German military pilots, differences exist in the results of periodic medical examinations that were associated with a higher odds of being involved in a fatal aircraft mishap. METHODS: Participants were 146 German military pilots who died in air crashes and 292 controls. Cases and controls were matched 1:2 by aeronautical confounders (age, type of aircraft aeronautical experience, and membership in the air force, army, or navy). Data source was the central register of the German Air Force Institute of Aviation Medicine; data were obtained from periodic medical examinations and included physical examination and laboratory data. Odds ratios were calculated by conditional logistic regression analysis. RESULTS: Descriptive statistics showed no distinct difference between cases and controls in most of the parameters considered except for total serum bilirubin, but multiple conditional logistic regression showed no remarkably different odds for any of the parameters tested. CONCLUSION: In aircrew who pass all the criteria for fitness to fly there are no important medical risk factors for fatal air crashes that can be detected by periodic medical examinations.
U.S. military aviators are currently restricted to the use of chloroquine or doxycycline for malaria prophylaxis. Ground forces are allowed the additional option of taking mefloquine. These medications are begun before deployment, must be taken for 4 weeks after leaving the malarious area, and primaquine must be added to the regimen the last 2 of those 4 weeks. Compliance with this regimen is often poor, especially in populations who travel abroad frequently for short periods of time. Causal malaria prophylaxis offers potential benefits of decreased length of postdeployment regimens and obviates the need for a second medication for terminal prophylaxis. Potential obstacles include adverse drug reactions, cost, and rapid development of resistance to new medications by Plasmodium species, which should be weighed against the risks to health and mission success in each deployment.
Doctors of the medical aviation service were consulted in 774 cases of gastrointestinal bleeding of various genesis in 1985-1989. Chronic gastroduodenal ulcer (peptic ulcer of the anastomosis among others) was the source of the bleeding in 473 (64.88%) patients. In the first period of observation (1985-1986) active surgical tactics was applied in 103 patients with chronic bleeding ulcer. Fifty-one patients (49.5%) underwent operation, with a fatal outcome in 12 cases (23.5%). Active individualized tactics was accepted in the second period (1987-1989). In a group of 370 patients 185 (50%) were operated on, 20 with fatal outcomes (10.8%). Active surgical tactics was individualized by strict comparison of the amount of blood loss and the degree of activity of the bleeding. Clinico-endoscopic and laboratory interpretation of the degree of activity of the bleeding is described and the expediency of indicating this criterion along with the amount of blood loss in establishing the diagnosis in a patient with bleeding from the ulcer is pointed out.
According to the author, preventive medical issues of providing human safety in aviation are related to the fundamental biomedical and socio-psychological problems of human beings in the present-day world. Factual material for analysis was compiled in the study performed at the State Research and Test Institute of Military Medicine. Outlined are main vectors of the future attack on the problem.
During the past 15 years fewer than 1% of those treated in the National Spinal Cord Injury Center were injured as a result of aviation accidents. In addition to 9 such patients treated at the center since 1973, another 6 were found among the many hundreds receiving ambulatory care in our clinics. 3 patients had survived a helicopter crash, 2 were injured while ejecting from combat aircraft, 3 were injured in crashes of light aircraft, 1 fell from a hand glider and 6 were injured in parachute drops. Of the 15 reviewed, 6 use wheelchairs, 3 walk assisted by orthopedic devices, while 6 ambulate freely. Although initial hospitalization was not substantially longer than in other patients with spinal cord injuries, extended ambulatory psychological intervention was necessary.
RISK MANAGEMENT: The large proportion of human errors in aviation accidents suggested the solution--at first sight brilliant--to replace the fallible human being by an "infallible" digitally-operating computer. However, even after the introduction of the so-called HITEC-airplanes, the factor human error still accounts for 75% of all accidents. Thus, if the computer is ruled out as the ultimate safety system, how else can complex operations involving quick and difficult decisions be controlled? OPTIMIZED TEAM INTERACTION/PARALLEL CONNECTION OF THOUGHT MACHINES: Since a single person is always "highly error-prone", support and control have to be guaranteed by a second person. The independent work of mind results in a safety network that more efficiently cushions human errors. NON-PUNITIVE ERROR MANAGEMENT: To be able to tackle the actual problems, the open discussion of intervened errors must not be endangered by the threat of punishment. It has been shown in the past that progress is primarily achieved by investigating and following up mistakes, failures and catastrophes shortly after they happened. HUMAN FACTOR RESEARCH PROJECT: A comprehensive survey showed the following result: By far the most frequent safety-critical situation (37.8% of all events) consists of the following combination of risk factors: 1. A complication develops. 2. In this situation of increased stress a human error occurs. 3. The negative effects of the error cannot be corrected or eased because there are deficiencies in team interaction on the flight deck. This means, for example, that a negative social climate has the effect of a "turbocharger" when a human error occurs. It needs to be pointed out that a negative social climate is not identical with a dispute. In many cases the working climate is burdened without the responsible person even noticing it: A first negative impression, too much or too little respect, contempt, misunderstandings, not expressing unclear concern, etc. can considerably reduce the efficiency of a team.
Cryogenic fuels are viewed as an alternative to the commonly used hydrocarbonic fuels. The existing national and international guidelines set limits to the emission of unburned carbohydrates (CnHm), carbon monoxide (CO), nitrogen oxides (NO(x)), and soot (SN); there is also prohibition against premeditated fuel discharge in atmosphere of airports. Whereas the international regulations are constantly revised toward toughening, more than 80% of the plane engines in the Russian civil aviation do not meet both national and international harmful emission limits. One of the ways to resolve the problem is substitution of the liquid carbohydrate fuel (kerosene) by natural gas.
INTRODUCTION: The Colour Vision Study Group of Transport Canada undertook a prevalence review to ascertain the degree and type of color vision deficiency (CVD) common in different populations. This was performed as a first step toward establishing whether a bone fide occupational requirement for color vision in aviation can be determined. LITERATURE SEARCH: Peer-reviewed articles with large populations and appropriate methodology for measuring CVD were assessed. Those pertaining to congenital CVD were cross-sectional prevalence studies with greater than 100 subjects assessed with a combination of pseudoisochromatic plates (PIPs) and Farnsworth D15 and/or an anomaloscope. Of 162 papers reviewed, 36 met these criteria for inclusion in the congenital CVD section. Acquired CVD papers were included based on the quality of color vision tests employed. CONGENITAL CVD: Data on congenital and acquired CVD are presented separately in parts 1 and 2. Part 1 demonstrates that although the prevalence numbers for North American and European populations are consistent with those reported in reference texts, congenital CVD is actually less prevalent in Asian, African, and Native populations. Therefore, the reported overall 8% prevalence of CVD in men applies only to Euro-Caucasians and is significantly lower in other racial groups. Possible evolutionary implications of dichromatism in humans are explored. ACQUIRED CVD: In this section the current understanding of acquired color vision deficiency, with an estimated prevalence ranging from 5 to 15% (51,95), is reviewed. Acquired CVD is frequently associated with significant impairment of visual acuity and/or visual field. However, many ocular diseases and drugs do primarily affect color vision, independent of other visual function, and one must remain vigilant to their presence. CONCLUSION: Congenital CVD is present in a consequential percentage of men, but considerable variability exists in different populations (2-8%). Acquired CVD may elude detection, but if severe is also associated with loss of visual acuity and/or visual field. Senescence remains the most common and increasingly prevalent cause for acquired CVD.
Psoriatic arthritis is a chronic spondyloarthropathy whose pathogenesis is unknown. We present a case of a naval flight officer who presented with chronic psoriatic arthritis, which ultimately became well controlled with etanercept treatment. The naval flight officer was granted military aeromedical waivers for psoriatic arthritis, cutaneous psoriasis, and chronic medication use. We also review the medical literature on psoriatic arthritis disease and etanercept and discuss their aeromedical implications in military aviation.
Two methods of ejection from tactical aircraft are commonly used: jettisoning the canopy prior to seat travel, and ejecting through a closed canopy. This report compares the ejection injury experience of Naval Aviation in each mode during January 1977-August 1990. During that period, 336 through-canopy and 580 canopy-jettison ejections were accomplished. The former group sustained 10.7% fatal injuries, and only 17.0% egressed injury-free. By comparison, the latter cohort incurred only 4.7% fatalities and fully 31.9% egressed without injury. Analysis of patterns of injuries confirms higher G-forces in through-canopy ejections, resulting in not only more injuries, but more severe injuries. In spite of these findings, we discuss the compelling tactical and financial reasons to consider through-canopy systems.
Testicular tumor is an uncommon cancer mainly affecting males between 20 and 54 yr of age. In the United States, approximately 2 to 3 new testicular cancer cases per 100,000 males occur each year. Testicular cancer is disqualifying for all classes of Federal Aviation Administration medical certificates, and consideration must be deferred to the FAA for Special Issuance (waiver) consideration. This article presents a case report of testicular cancer in an airline pilot, a brief discussion of testicular cancer, and the aeromedical implications of the diagnosis.
This paper discusses theoretical aspects of aviation psychophysiology, specifically the problem of image control of objective actions of a pilot. The general concept representing a system of psychic control of pilot's actions is an image of the flight. Its structural components include: an image of spatial position, an image of an instrumental panel, and the feeling of an aircraft. It is shown that these three information-cognitive components are insufficient to use the flight image for controlling objective actions. It is important to supplement it with object-activity components. Using the flight image concept and experimental observations, a model of controlling objective actions of a pilot is discussed. Components of the model form a closed self-regulating system with direct and feedback control loops. It is underlined that the knowledge of functional patterns of mental images of a pilot is required not only to explain his actions at work but also to solve problems of designing his professional activities and to develop means and methods of his training.
The values of vital capacity (VC), forced expiratory volume in the first second (FEV1) and Tiffeneau index (100xFEV1/VC) were determined in 14,234 examinees in the period 1977-1987. Examinations were performed using the Godart expirometer. After the statistical analysis of the results being performed, the unique table was made according to height and age of examinees. The examinees came from all regions of Yugoslavia. The results of the study can be used for establishment of standard values of pulmonary ventilation for candidates for aviation schools, i.e. for youngsters aging from 14 to 20 years.
This study considered NTSB data and post-crash medical data received by the Medical Statistical Section of the Civil Aeromedical Institute (CAMI), Oklahoma City, OK from 1975-82, and other related literature to estimate the probability of incapacitation in general aviation. Data for the years studied indicate that approximately 3 accidents per 1,000 (15 per 1,000 fatal accidents) are known to result from the incapacitation of the pilot for all causes. Results suggest that the likelihood of incapacitation increases with age. The occurrence of incapacitation for obvious medical reasons is less than would be expected based on general population morbidity/mortality data; however, the need for continued vigilance in certification, and education regarding flying with known or suspected medical problems, is emphasized.
The autopsy reports of 710 pilots involved in fatal general aviation accidents were received by the FAA for the years 1980-82; they were reviewed to appraise the age-specific prevalence of coronary atherosclerosis among the autopsied group and to compare findings with those of an earlier study. Of the autopsies on pilots killed in aircraft accidents, 69% indicated some degree of coronary atherosclerosis, ranging from minimal to severe. This finding is higher than for a similar group of pilots studied for the years 1975-77. However, only about 2.5% of the 1980-82 study group were found to have severe coronary atherosclerosis, compared with 5% in the previous study. Prevalence of severe coronary atherosclerosis increased with age from 5.8 per 1,000 for ages less than 40 years to 73.9 for age 50 years and above, also reflecting lower age-specific rates for severe coronary atherosclerosis than were found in the previous study.