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PubMed1977

Joint Committee on Aviation Pathology: XII. Sarcoidosis: a review of some features of importance in aviation medicine.

Sarcoidosis is defined in terms of its histology and natural history. Emphasis is placed upon its insidious nature and potentially pronounced pathophysiological effects. The use of lung function studies as an index of disability in the three described phases is discussed. Though we have only found the disease coincidentally in aircraft accidents, stress is placed upon the need for careful monitoring of affected aircrew and the necessity for respiratory function tests.

Adult↗
PubMed2002

Aeromedical waiver status in U.S. Naval aviators involved in Class A mishaps.

PURPOSE: U.S. Naval aviators are subject to stringent aeromedical standards. Aeromedic waivers are considered when a naval aviator develops a medical condition that is deemed safe for flight, allowing that aviator to continue in a flying status. No Class A (serious) mishap to date has been directly attributable to an aviator's waivered condition. However, to date no study has been conducted to review the overall mishap rate among aviators who are flying with a waiver. This study evaluated the aeromedical waiver status of naval aviators involved in Class A mishaps from 1992-1999. METHOD: Aviation mishaps in the U.S. Navy are investigated by trained personnel, who report their detailed findings to the U.S. Naval Safety Center (NSC). The Navy Operational Medicine Institute (NOMI) maintains a database of all aviation physicals, including the waiver status of individual aviators. A collaborative NSC/NOMI study was done to investigate the prevalence of waivers in mishap and non-mishap aviators. Records were retrieved on 234 naval aviators who were the "pilot at the controls" of Class A mishaps occurring from 1992-1999. This mishap waiver rate was compared with the baseline waiver rate for all pilots in 1994 (midpoint). Odds Ratios were calculated of having a Class A mishap if the aviator had a waiver. RESULTS AND CONCLUSIONS: Analysis failed to find a statistical difference in waiver rates between mishap aviators and the general naval aviator population indicating that the U.S. Naval Aeromedical Service is providing aeromedically safe naval aviators to the fleet.

Accidents, Aviation↗
PubMed1999

Incidence and outcomes of anterior cruciate ligament reconstruction among U.S. Army aviators.

BACKGROUND: The incidence, injury history and aeromedical disposition of anterior cruciate ligament (ACL) reconstruction among Army aviators is unknown. METHODS: The U.S. Army Aviation Epidemiology Data Register was queried for the study period of calendar years 1988-95. Factors considered included age, gender, type and mechanism of injury, prior history of ACL reconstruction, and final aeromedical disposition. The population was divided into two groups: Group I aviators had no history of ACL injury before entering aviation service, while Group II aviators had ACL reconstructions prior to entering aviation service. The data set was analyzed to determine the incidence of ACL reconstruction, to characterize the type and mechanism of injury and to determine the risk of aeromedical termination from service. RESULTS: The ACL reconstruction rate (ACL reconstructions/1000 aviators per year) was 0.52 overall, 0.50 for males and 1.39 for females. Sports accounted for 76% of the injuries requiring ACL reconstruction. The ACL reconstruction rate in Group I was 0.050%, while that of Group II was 63.3%. Among Group I aviators requiring ACL reconstruction, 94.3% returned to aviation service, 2.3% were aeromedically terminated and 3.4% were lost to follow-up. Among Group II aviators requiring revision ACL reconstruction, 60% returned to aviation service and 40% were aeromedically terminated. CONCLUSION: Female aviators and Group II aviators had the greatest risk of requiring ACL surgery. Group II aviators had a greater likelihood of undergoing a revision ACL reconstruction and subsequent aeromedical termination compared with an initial ACL reconstruction for Group I aviators.

Adolescent↗
PubMed2002

Clinical outcomes of naval aviation personnel with cholelithiasis.

BACKGROUND: This study examines the aeromedical outcomes of aviation personnel with asymptomatic cholelithiasis or those treated successfully with conventional (open) cholecystectomy (CC), laparoscopic cholecystectomy (LC), or extracorporeal shock wave lithotripsy (ESWL) for previous symptomatic cholecystitis. METHODS: The Biomedical Database of the Naval Aerospace Medical Institute was searched for waiver requests for asymptomatic gallstones, acute cholecystitis, and cholecystectomy. Microfiche records were then reviewed. The rates of development of symptomatic disease and need for cholecystectomy or ESWL were noted in aircrew granted waivers for asymptomatic cholelithiasis. The aeromedical outcomes of aircrew who underwent treatment for symptomatic disease by cholecystectomy (CC or LC) or ESWL were reviewed. RESULTS: A search of the Biomedical Database revealed waiver requests for cholelithiasis for 79 naval aviation personnel from April 1988 to August 2000. Waiver requests were for previous cholecystectomy in 56 (70.9%) and cholelithiasis in 23 (29.1%). No aviators had undergone ESWL. Of the 56 aviators with previous cholecystectomy, waivers were granted in 51 (91.1%) cases. Waivers were denied to five individuals, primarily for other medical problems. Of the 23 aviators with cholelithiasis, 11 (47.8%) were granted waivers. Waivers were denied in 12 aviators because of symptomatic cholelithiasis (5), asymptomatic cholelithiasis (1), common bile duct stone (1), other medical problems (3), or no explanation (2). The aviator with asymptomatic cholelithiasis and two of the aviators with symptomatic cholelithiasis were subsequently granted waivers after cholecystectomy (LC). The aviator with a symptomatic common bile duct stone received a waiver after cholecystectomy (CC). A total of 66 (83.5%) aviators received waivers. None were revoked during the study period because of symptomatic cholelithiasis or retained common bile duct stones. CONCLUSIONS: Aviation personnel who receive waivers for asymptomatic cholelithiasis or cholecystectomy rarely present with symptomatic biliary disease.

Absenteeism↗
PubMed2003

Hepatitis in aviation personnel.

BACKGROUND: This study examines the specific etiologies and aeromedical outcomes of naval aviation personnel with hepatitis. METHODS: We searched the Biomedical Database of the Naval Aerospace Medical Institute for waiver requests for hepatitis. We reviewed the records for specific etiologies, possible risk factors, and the aeromedical outcomes of aviators who received waivers for chronic hepatitis. RESULTS: We examined 48 initial and 95 follow-up waiver requests for hepatitis for naval aviation personnel from July 1988 to May 2001. Initial waiver requests were for chronic hepatitis C (HCV) in 23 (47.9%), chronic hepatitis B in 17 (35.4%), and other etiologies in 8 (16.7%). Asian Americans, who comprise 2% of the aviator population in the Biomedical Database, accounted for a disproportionate number of waiver requests for hepatitis: 7 (14.6%) of the total and 6 (35.3%) of the aviators with HBV. Of the 48 aviators with hepatitis, waivers were granted in 32 (66.7%) cases, all of whom were asymptomatic. Waivers were denied to 16 (33.3%) aviators. One aviator with Hodgkin's disease in remission and one aviator with chronic HCV who became asymptomatic after treatment with interferon later received waivers for a total of 34 (70.8%) waivers. Two waivers were later revoked because of symptomatic HCV requiring interferon in one and incomplete physical exam in another. CONCLUSIONS: Aviation personnel who receive waivers for asymptomatic hepatitis occasionally present with symptomatic hepatitis, but most waiver recipients remain asymptomatic during their aviation careers.

Adolescent↗
PubMed2006

Asthma in military aviators: safe flying is possible.

INTRODUCTION: Asthma is considered relatively incompatible with aviation. Firstly, due to the risk of sudden incapacitation, and secondly, due to cold and dry air and other asthmogenic factors characteristic of the aviation environment. The medical requirements for flying fitness of asthmatic aviators are inconsistent between different air services, and many flight surgeons are unfamiliar with the recent developments in asthma management. This study aims to describe our experience with asthmatic aviators and to discuss the medical standards required for flying fitness in chronic asthma. METHODS: The records of all aviators diagnosed with asthma between January 1988 and September 2005 were reviewed. Pulmonary function tests and examination by a pulmonary disease specialist and flight surgeon were performed at least annually. RESULTS: Nineteen Israeli Air Force aviators with asthma were studied. Most were treated with inhaled long-acting beta agonists and corticosteroids. Disease control was satisfactory in more then 90%, with significant worsening in only one case. We had no cases of sudden incapacitation or any other safety breach. One aviator was grounded 23 yr after diagnosis due to deterioration in the severity of the disease, and another aviator was permanently grounded 1 yr after diagnosis. CONCLUSIONS: Adequate asthma control is readily feasible, even in the aviation environment. Long-term inhaled corticosteroids are effective and have few side effects in aviators. Our management approach to aviators with asthma appears to be safe and effective.

Adult↗
PubMed2001

Incidence, epidemiology, and occupational outcomes of thoracolumbar fractures among U.S. Army aviators.

BACKGROUND: The routine occupational hazards of flying and parachute jumping place U.S. Army aviators at risk for sustaining high-energy traumatic injuries, such as thoracolumbar fractures. METHODS: A longitudinal, prospective, epidemiologic database was used to determine the incidence, injury history, and aeromedical disposition of U.S. Army aviators who sustained thoracolumbar fractures for calendar years 1987 to 1997. RESULTS: The overall incidence rate of thoracolumbar fracture was 12.8 per 100,000 aviators per year. Thirty aviators with thoracolumbar fractures were identified, and the average age at time of injury was 35.9 years (range, 25-59 years). Mean follow-up after injury was 6.5 years (range, 2-12 years). Helicopter crashes and parachuting accidents accounted for 73% of fractures. Neurologic injury occurred in 10% of aviators. Seventy-seven percent of injured aviators recovered sufficiently to return to aviation service. There was no association between type of treatment and eventual termination from aviation duties (relative risk, 1.1; 95% confidence interval, 0.7-1.6). CONCLUSION: Occupational hazards of Army aviators place them at risk for sustaining thoracolumbar fractures. These data are relevant to future decisions for research and resource allocation for aviation safety and policy.

Adult↗
PubMed1996

Herniated nucleus pulposus: rates and outcomes among U.S. Army aviators.

The incidence and age-specific rates, and aeromedical dispositions of herniated nucleus pulposus (HNP) are unknown among U.S. Army aviators. The U.S. Army Aviation Epidemiology Data Register (AEDR) was queried for Army aviators with the finding of HNP for the period 1987 to 1992. This study tabulated the incidence, age-specific annual rates of HNP, and the distribution of aeromedical dispositions for aircrew with HNP. The U.S. Army aviation medicine community can expect an annual incidence rate about 1 case of HNP per 1,000 aviator-years. However, the annual incidence rate per 1,000 aviator-years increased significantly by fivefold from 0.49 in 1987 to 2.60 in 1992 (p < 0.001). Aviators who were 40-44 years old were at the greatest risk, with an annual rate of 1.6 cases per 1,000 aviator-years. Among 132 aviators, 25.8% had cervical HNPs, 74.2% had lumbar HNPs, and none had thoracic HNPs. Operative management was required in 66.6% of cases. Those with cervical HNPs were not at increased risk for operative management compared to those with lumbar HNPs (RR = 0.961, CI0.95 = 0.723, 1.28). About 7.4% of the aviators with HNP were permanently removed from Army flying duties due to HNP complications.

Adult↗
PubMed2002

Aviation accidents and incidents associated with the use of ophthalmic devices by civilian airmen.

INTRODUCTION: Approximately 54% of civilian pilots rely on ophthalmic lenses to correct defective vision in order to maintain a valid airman medical certificate. This report reviews aviation accidents and incidents where the use or misuse of ophthalmic devices was considered to have been a contributing factor in the mishap. METHODS: The NTSB's Aviation Accident/Incident Database and the FAA's Incident Data System were queried for terms related to ophthalmic devices. All reports were reviewed to determine whether an ophthalmic device was a factor in the mishap and then stratified based on the type of ophthalmic correction involved. Additionally, the Aviation Safety Reporting System (ASRS), which allows aviation personnel to report actual or perceived safety-related problems was similarly queried and reviewed. RESULTS: The NTSB and FAA databases included 19 mishaps with contributing factors such as lost and/or broken eyeglasses, problems with sunglasses, incompatibility with personal protective breathing equipment adaptation difficulties, or inappropriate ophthalmic prescriptions and contact lenses. Aviation personnel voluntarily submitted 26 ASRS reports describing operational problems involving ophthalmic devices that adversely affected aviation safety. CONCLUSIONS: Ophthalmic devices used by pilots have contributed to aviation accidents and incidents. The review and reporting of these events provides important information that can be used to educate flight crewmembers, Aviation Medical Examiners, and eyecare practitioners about the potential hazards of using inappropriate ophthalmic devices. Recommendations in this report may assist pilots in avoiding similar hazardous situations and enhance aviation safety.

Accidents, Aviation↗
PubMed1997

Injury patterns in aviation-related fatalities. Implications for preventive strategies.

Autopsy data from individual aviation crashes have long been used in aviation safety research in the form of case reports and case series studies. Injuries sustained from aviation crashes, however, have not been well documented at a national level. This study examines the injury patterns for persons who died in aviation crashes in the United States and the implications for preventive strategies. Death certificate data for all aviation-related fatalities for the years 1980 (n = 1,543) and 1990 (n = 1.011) were obtained from the National Center for Health Statistics. The immediate cause of death and all injury diagnoses recorded on the death certificates were analyzed in relation to year of injury, crash category, and type of victim. Despite a 34% reduction in the number of aviation-related fatalities between 1980 and 1990, injury patterns were fairly stable. Multiple injuries were listed as the immediate cause of death in 42% of the fatalities, followed by head injury (22%); internal injury of thorax, abdomen, or pelvis (12%); burns (4%); and drowning (3%). Head injuries were most common among children. The majority (86%) died at the scene or were dead on arrival at the hospital. Eighteen percent of the victims were reported to have sustained a single injury, with head injury being the cause of death in nearly a third of these fatalities. Blunt injuries resulting from deceleration forces, in particular head injury, are still the most important hazard threatening occupants' survival in aviation crashes. To further reduce aviation-related fatalities requires more effective restraint systems and other improvements in aircraft design.

Accidents, Aviation↗
PubMed1998

Occupational aviation deaths in Alaska, 1990-1995.

PURPOSE: In Alaska, aviation was the leading cause of work-related death in 1995 and the second leading cause for the period 1990-95. A descriptive study of aviation crashes was completed to characterize occupational aviation crashes and fatalities in Alaska. METHODS: Aviation-related incidents were abstracted from the Alaska Occupational Injury Surveillance System and National Transportation Safety Board preliminary reports. RESULTS: Records for a total of 1065 aviation crashes were abstracted. There were 285 aviation-related fatalities (8.5/100,000/yr) for all Alaskans; 135 (47%) of the fatalities (7.3/100,000/yr for Alaskan workers) were occupationally related. Helicopters accounted for 55 (17%) of the total occupational aviation crashes and 14 (10%) of the fatalities. The most common phase of flight cited in all crashes was takeoff (59 [18%]) and landing (136 [41%]); in contrast, only 9 (13%) of the fatal crashes occurred during takeoff and landing combined. In fatal crashes, the cruise phase (27 [38%]), followed by maneuvering (16 [23%]), were the most frequent phases of flight cited. Thirty-one percent (n = 22) of aircraft involved in fatal occupational incidents were not completely destroyed, allowing for potential survivors. Shoulder harnesses and helmet use, improved cockpit design, and energy-absorbing seats could reduce aviation-related injury and death.

Accidents, Occupational↗
PubMed2001

Factors associated with pilot error in aviation crashes.

BACKGROUND: The importance of pilot error in aviation crashes has long been recognized. However, understanding and preventing pilot error remains the foremost challenge in aviation safety. OBJECTIVE: This study aims to identify pilot characteristics and crash circumstances that are associated with the presence of pilot error in a large sample of aviation crashes. METHODS: Different data files compiled by the National Transportation Safety Board for 329 major airline crashes, 1,627 commuter/air taxi crashes, and 27,935 general aviation crashes for the years 1983-96 were merged; and the presence of pilot error was analyzed in relation to variables indicating the characteristics of the pilot-in-command, crash circumstance, and aircraft. Multivariate logistic regression modeling was performed to assess the associations of individual variables with the likelihood of pilot error given a crash. RESULTS: Pilot error was a probable cause in 38% of the major airline crashes, 74% of the commuter/air taxi crashes, and 85% of the general aviation crashes. Among the factors examined, instrument meteorological condition and on-airport location were each associated with a significantly increased odds of pilot error. The likelihood of pilot error decreased as pilot certificate rating increased in commuter/air taxi and general aviation crashes. Neither pilot age nor gender was independently associated with the odds of pilot error. With adjustment for pilot characteristics and crash circumstances, flight experience as measured in total flight time showed a significant protective effect on pilot error in general aviation crashes. CONCLUSIONS: The prevalence and correlates of pilot error in aviation crashes vary with the type of flight operations. Adverse weather is consistently associated with a significantly elevated likelihood of pilot error, possibly due to increased performance demand.

Accidents, Aviation↗
PubMed2007

Alcohol screening instruments and psychiatric evaluation outcomes in military aviation personnel.

INTRODUCTION: Alcohol-related disorders are the most prevalent psychiatric conditions in the aviation population. Efforts to effectively screen aviators for these disorders are continually sought, as underdiagnosis may negatively impact aviation safety. This study evaluates screening tools that have been validated in non-aviators in terms of their utility for aviator patients. METHODS: There were 111 male aviation patients (27 +/- 7 yr) referred for psychiatric evaluation at the Naval Aerospace Medicine Institute who completed the Self-Administered Alcohol Screening Test (SAAST), the Alcohol-Use Disorders Identification Test (AUDIT), and the Common Alcohol Logistical Scale-Revised (CAL-R) prior to evaluation by a staff psychiatrist or psychologist. RESULTS: There were 40 patients who were qualified psychiatrically with no diagnosis and 49 patients who were disqualified for psychiatric reasons due to a non alcohol-related diagnosis. The remaining 22 patients were disqualified for psychiatric reasons with an alcohol-related diagnosis. The optimal aviator cut-off scores were consistent with those of the general population, although the cut-off score used for the SAAST was set at the published sub-threshold level to provide greater sensitivity. The sensitivity/specificity values for the SAAST, AUDIT, and CAL-R were 59%/94%, 46%/96%, and 68%/81%, respectively. CONCLUSION: The psychometrically sophisticated CAL-R is sensitive, specific, and has good negative predictive value, although its use requires a psychologist and its availability is limited. The SAAST and AUDIT can be administered by a flight surgeon or aviation medical examiner (AME). Given the higher sensitivity of the SAAST it may be the most beneficial if administered first. The AUDIT can be used as a follow-up diagnostic test given its higher specificity.

Adult↗
PubMed2006

Effect of G-force on bicuspid aortic valve in aviators.

BACKGROUND AND AIMS: Bicuspid aortic valve (BAV) is a common congenital cardiac malformation. The major complications are aortic stenosis (AS), aortic regurgitation (AR), infectious endocarditis and aortic dissection. This paper aims to assess the hemodynamic importance of incidentally-found BAV in military aviators and evaluate the effect of high G-force on disease progression. METHODS: Aviators with BAV were detected by reviewing all cardiac assessment records between 1987 and 2005. All aviators underwent annual flight surgeon examination. Echocardiography was performed as recommended by our cardiologists and flight surgeons. RESULTS: Eight newly diagnosed cases of BAV were found. All of the aviators continued active aviation throughout the study period. Repeat echocardiography demonstrated progressive widening of the aortic diameter in five of the eight aviators. No worsening of valve dysfunction was seen in those with mild aortic regurgitation at diagnosis. Left ventricular dimensions and function did not deteriorate. No new valve complications, including infectious endocarditis, were seen. The age at diagnosis strongly correlated with the root diameter change; both total (r = 0.74, p = 0.02) and annualized (r = 0.78, p = 0.02) change. Over a mean follow-up period of 12.1 years, no difference was seen in the progression of BAV in high-performance as compared to low-performance aviators. CONCLUSIONS: Exposure to G-force and anti-G maneuvers does not appear to worsen cardiac and valve function in aviators with BAV.

Adolescent↗