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PubMed1985

Teaching and training in aviation medicine in the United Kingdom.

In the United Kingdom, training in aerospace medicine is provided by a range of post-graduate courses at the Royal Air Force Institute of Aviation Medicine. An Introductory Medical Officers' (IMO) course lasts for two weeks and is attended by all RAF doctors within the first few months of their entry to the Service. Its objective is to teach the elements of aviation physiology and medicine that they will need in the care of aircrew at a flying station. Four courses are held each year. A General Aviation Medicine (GAM) course is available to civilian doctors who wish to gain recognition as Authorized Medical Examiners of commercial aircrew, or who merely have an interest in the subject. It runs concurrently with the IMO course, and much of the material is common to both. Greater emphasis is, however, given to clinical teaching and to civil aviation. The GAM course also occupies two weeks of teaching. A course leading to the Diploma in Aviation Medicine is held once each year, and lasts for six months. It is open to all who have at least one year of previous experience, and has been attended by 244 military and civilian doctors from 25 countries. The D Av Med course covers every aspect of aerospace medicine at an advanced level, and its standard is at least as high as that of a M Sc degree. The Diploma is a recognised academic qualification awarded by the Royal College of Physicians. Royal Air Force medical officers receive an extra three weeks of training immediately following the D Av Med course, to educate them in procedures and policies specific to the RAF. This Advanced Course is essentially practical, and those who complete it are designated as Flight Medical Officers. They receive refresher training given at regular intervals thereafter. Aircrew are taught the basic principles of aviation medicine when they attend the RAF Aviation Medicine Training Centre for training in the use of their personal protective equipment assemblies. These courses are specific to the type of aircraft to be flown, and a pilot will undergo at least four during his flying career. Short courses of a specialised nature are also offered to clinical consultants, medical students, senior Air Force officers, nurses and others. It is now recognised in the United Kingdom that aviation medicine is a component of occupational medicine, and the Royal College of Physicians accepts the D Av Med as evidence of formal education in that branch of medicine.(ABSTRACT TRUNCATED AT 400 WORDS)

Aerospace Medicine↗
PubMed2000

Spinal symptoms in aviators and their relationship to G-exposure and aircraft seating angle.

BACKGROUND: Aviator spinal symptoms related to G-exposure such as neck pain may limit flying performance and result in an increase in acute and chronic spinal disease. METHODS: An anonymous survey was conducted to better establish the nature and degree of G-related spinal symptoms. HP (high-performance) aviators were compared with a control group of non-high-performance (NHP) aviators. RESULTS: Of 161 surveys distributed, 79 were returned for a return rate of 49%. No greater incidence of chronic spinal symptoms or disease in the neck or lower back were reported in the HP group as compared with the NHP group. However, a majority of HP aviators (54%) did report acute spinal symptoms, especially neck pain, temporally associated with pulling Gz, occurring either during or shortly after sorties. Some 20% of the total number of HP aviators responding reported that neck symptoms limited their flying performance, including pulling Gz, checking 6, and air combat maneuvers. Despite the increased seat angle slant in the F-16 as compared with the F-15, no significant difference in neck symptoms or performance limitations were reported as a result. Both HP and NHP aviators were noted in general to have good exercise habits with minimal use of tobacco. However, moderate use of alcohol was noted in both groups. CONCLUSIONS: Spinal symptoms, especially neck pain, are a common problem associated with HP flying and frequently limit flying performance though do not appear to result in any increase in long-term morbidity in this relatively young, predominantly male, group of aviators. (Survey form included as an appendix for reference and future research.) KEYWORDS: aerospace medicine, aircraft, aviation, health surveys, military personnel, questionnaires, risk factors, spinal diseases.

Adult↗
PubMed2001

Incidence and outcomes of total hip arthroplasty among U.S. Army aviators.

Among Army aviators, the incidence of total hip arthroplasty (THA) is unknown. This study analyzes the incidence and aeromedical disposition of THA among Army aviators. The U.S. Army Epidemiology Data Register was queried for a 10-year period from calendar year 1987 to 1996. The aviators selected for this study cohort were all qualified and on active flight status before undergoing THA. Data collected included age, gender, diagnoses, and aeromedical dispositions. There were 214,003 aviator-years of observation. Eleven aviators underwent 14 THAs. The overall incidence of THA was 0.05 per 1,000 aviator-years of observation. Of the 11 aviators who underwent THA during the study period, 4 received aeromedical suspension from flying duties (36%). THA is a rare medical event among Army aircrew members. Most are able to return to full flying duties with a waiver. Aircrew members younger than 50 years with THA are more likely to be suspended from aviation duties.

Absenteeism↗
PubMed2002

Assessment of personality and crew interaction skills in successful naval aviators.

PURPOSE: We were interested in studying a full range of successful aviators to discern which personality factors were present and whether these factors correlate with age, rank, and accumulated flight time. METHOD: The Armstrong Laboratory Aviator Personality Survey (ALAPS) was administered to 312 designated naval aviators and flight officers from a variety of aircraft communities. The sample included O-3/O-4 elite aviators who were selected for their squadron billets based on superior performance, O-5/O-6 aviators selected for command positions, and 59 flag officers. RESULTS: The junior aviators scored higher on the factor associated with Dogmatism and lower on the factor associated with Team Orientation and Socialness. This pattern was reversed for the flag officers, while O-5/O-6 aviators received intermediate scores on each of these factors. CONCLUSIONS: The present study demonstrates a correlation between specific ALAPS factors and experience, rank, age, and flight time. The combination of high Dogmatism, low Team Orientation, and low Socialness in junior aviators could suggest lower openness to crew input and increased risk for mishaps.

Adult↗
PubMed1989

U.S. Army anthropometric standards for rotary-wing aviators in the light observation helicopter.

U.S. Army anthropometric standards for rotary-wing aviators were examined to determine if the standards allowed an adequate fit of the aviator to the cockpit of the OH-58A "Kiowa" light observation helicopter, which now comprises the overwhelming majority of light helicopters in the active army and reserve forces. Thirty rated aviators with heights less than or equal to 70 in. were examined, and standard anthropometric measurements were made. Army regulations require these measurements on all initial-entry aviation students with heights less than or equal to 68 in. The aviators were then placed in a representative OH-58A cockpit to determine their ability to reach all control surfaces and panel switches. Several aviators greater than 68 in. tall and, therefore, not subject to anthropometric testing upon entry into army aviation, could not perform all cockpit tasks without cockpit changes beyond the limited adjustments in the OH-58A. Several had developed aid devices, especially pads to support forearm-to-thigh "spot welds" to ensure right arm stability on the cyclic control. The same problem was seen with some aviators less than 68 in. in height, who had been anthropometrically evaluated. The present standards do not adequately address functional ability in the OH-58A cockpit, which is the least adjustable cockpit in the combat inventory. Design modifications to accommodate these factors exist and should be used to retrofit existing aircraft and to design future aircrafts.

Aerospace Medicine↗
PubMed1995

Waivers for disqualifying medical conditions in U.S. Naval aviation personnel.

In the United States Navy, many diagnoses are considered disqualifying for aviation duty, but aircrew may be "waived" to return to flight duties after resolution of the disease or appropriate treatment of the condition. Personnel with waivers are usually subject to more frequent physical examinations and/or special diagnostic procedures. Although the Naval Aerospace and Operational Medical Institute promulgates written aeromedical guidelines as to which diseases may be waived and which may not, waivers are granted on a case-by-case basis considering not only the diagnosis, but the age, experience, and type of aviation duty of the individual in question. This study was undertaken to determine which conditions were most and least likely to be waived. We reviewed all records of aviators entered into the Naval Aviation Medical Data Retrieval System who had been diagnosed with a condition considered disqualifying for aviation duty, totaling over 39,000 records. Cases were stratified by diagnosis and aviation duty, and the percentage waived was calculated for major diagnostic groups. Among designated aviation personnel, approximately 68% of all aviators with a disqualifying diagnosis were recommended for a waiver. Otolaryngologic, musculoskeletal, and cardiovascular disorders accounted for nearly 50% of diagnoses in personnel recommended for a waiver. Fear of flying, personality disorders, and adjustment disorders were the three diagnoses least likely to be granted a waiver. The most frequently occurring disqualifying diagnoses were allergic rhinitis, obesity, disorders of refraction and accommodation, urolithiasis, and alcohol dependence.

Adolescent↗
PubMed2001

General aviation crashes involving military personnel as pilots.

BACKGROUND: Injuries sustained in off-duty activities are a major cause of mortality and morbidity among military personnel. Reducing these off-duty fatalities is a continuing priority of the military. METHODS: General aviation crashes recorded by the National Transportation Safety Board between 1983 and 1998 were analyzed for military pilots (n = 205) and other military personnel (n = 185), and compared with all other general aviation crashes (n = 32,807) to identify differences in the crash circumstances and sustained injury severities. RESULTS: During the 16-yr study period, a total of 45 military pilots and 52 other military personnel were fatally injured while flying general aviation flights. Military pilots who were involved in general aviation crashes were more likely to have advanced licenses and higher total flight times when compared with other military personnel and civilian pilots (p < 0.05). Among the three groups of pilots, other military personnel had the least flying time and the largest percentage of student/private licenses. Military personnel had significantly less time in type in the 90-d and 30-d periods preceding the crash compared with civilians (p < 0.05). Shoulder restraint usage was associated with less severe injuries for all groups. We estimate that general aviation deaths have cost the military at least $405 million since 1983. CONCLUSIONS: General aviation crashes are a costly source of mortality and morbidity for military personnel, particularly military pilots. Interventions aimed at improving safety of military personnel in the general aviation setting warrant special consideration.

Accidents, Aviation↗
PubMed2003

Proteinuria in aviation personnel: waiver policy in the U.S. Navy.

BACKGROUND: Proteinuria is a condition occasionally detected both in applicants for military pilot training and in experienced pilots. Medical personnel involved in the care of either group require a standardized policy for the evaluation and aeromedical disposition of proteinuria for these personnel. METHODS: A literature search was conducted to obtain current information and prognostic data on proteinuria in the general medical literature. Generally accepted waiver principles were then examined to determine if proteinuria should be waivered in aviation personnel. Other agency policies regarding proteinuria in aviation personnel were examined. The biomedical database records at the Naval Aerospace Medical Institute (NAMI) were searched to discover the U.S. Navy's experience in the evaluation and disposition of aviation personnel with proteinuria. RESULTS: A review of the general medical literature revealed general categories of proteinuria (dependent on protein excretion amount and symptomatology) and the presence or absence of systemic disease that correlated well with prognostic data. These categories provided useful criteria to develop an aeromedical policy that was consistent with previous (informal) NAMI policies, generally accepted waiver principles, and the existing policies of other agencies. Using the above results, a recommended policy for aviation personnel with proteinuria was presented. CONCLUSIONS: A recommended policy for the evaluation and aeromedical disposition of aviation personnel with proteinuria was developed for both applicants for U.S. Navy aviation duty as well as in those already serving within the U.S. Navy aviation community.

Aerospace Medicine↗
PubMed1992

Disease prevention strategies for Army aviators: clues from a descriptive analysis of the flying duty medical examination.

The U.S. government spends approximately $300,000 to train an Army aviator. Maintaining a healthy aviator population is important not only to the completion of the aviation mission, but also for budgetary reasons. We reviewed Army aviator physical examinations and self-reported risk behavior questionnaires from the Aeromedical Epidemiological Data Repository at Fort Rucker, Alabama, to assess aviator health. Overall, aviators are healthy adults; however, the health status of aviators can be improved by reducing tobacco use, limiting cholesterol and fat intake, and wearing hearing protection devices both during and off duty.

Adult↗
PubMed1998

Alcohol in aviation-related fatalities: North Carolina, 1985-1994.

BACKGROUND: Previous studies examining the role of alcohol in aviation safety have been limited to pilots and the estimated degree of alcohol involvement in fatal aviation crashes was susceptible to selection bias because alcohol testing was not conducted on a routine basis. This study examines the magnitude of and factors related to alcohol involvement in both pilot and non-pilot aviation fatalities. METHODS: We analyzed medical examiner data on all victims who died in civilian aircraft crashes in North Carolina during 1985-94, complemented by crash investigation data from the National Transportation Safety Board. RESULTS: During the 10-yr study period, the North Carolina Medical Examiner Information System recorded 337 aviation-related fatalities including 111 pilots. Alcohol testing was performed on 91% of the pilots and 72% of the non-pilot occupants. Of the victims who were tested for alcohol, 12% (7% of the pilots and 15% of non-pilot occupants) had positive blood alcohol concentrations (BACs), ranging from 0.02 to 0.14%. All four victims with BACs greater than 0.10% were pilots aged 20-29 yr who were fatally injured in nighttime general aviation crashes. In crashes of commercial flights, none of the pilots tested positive for alcohol, whereas 20% of the non-pilot occupants had positive BACs. CONCLUSIONS: Intoxicated flying, particularly among young general aviation pilots, is still a valid concern. The aviation safety implications of alcohol use by passengers of commercial flights should be further examined.

Accidents, Aviation↗
PubMed1999

Case report of an aviator with a single episode of altered consciousness due to Hymenoptera hypersensitivity.

This case is presented to: a) emphasize the importance of a careful history, including interviewing witnesses and considering a complete differential diagnosis when evaluating aviators with a history of an episode of altered consciousness; and b) demonstrate an appropriate use of literature review, subspecialty consultations, and U.S. Air Force Aeromedical Guidelines to arrive at an aeromedical disposition for an unusual case. A military aviator experienced an episode of syncope/near syncope, initially felt to be caused by a primary seizure or an arrhythmia. Subsequent thorough evaluation included careful history taking, extensive interviewing of witnesses, subspecialty consultations, review of appropriate literature and deliberation by a board of experienced military aeromedical physicians. Cardiac and neurologic diagnoses were considered but careful history and witness interviews revealed that the aviator had sustained an insect sting just minutes before the episode. Evaluation by allergy specialists, including skin testing, identified him as being hypersensitive to Hymenoptera stings. A diagnosis of hypersensitivity reaction to a Hymenoptera sting was determined to be the cause of the altered consciousness episode. Review of the literature revealed that immunotherapy for Hymenoptera sensitivity reduces the risk of future anaphylaxis to only 1-2% after maintenance dose is achieved. Consideration of the risk of future events and the success of rush immunotherapy resulted in a recommendation for a waiver to return the aviator to unrestricted flying duties. The importance of diligent history taking must never be forgotten. In this aviator it led to the correct diagnosis and definitive therapy. In addition, appropriate consideration of the literature and knowledge of outcome rates allowed a return to unrestricted flying for this aviator. If the original diagnosis of seizure or arrhythmia had been accepted, this aviator would have been disqualified without waiver and a valuable flying asset would have been lost.

Adult↗
PubMed2001

Blood carbon monoxide and hydrogen cyanide concentrations in the fatalities of fire and non-fire associated civil aviation accidents, 1991-1998.

Blood samples submitted to the Civil Aeromedical Institute (CAMI) from aviation accident fatalities are analyzed for carbon monoxide (CO), as carboxyhemoglobin (COHb), and hydrogen cyanide, as cyanide (CN(-)). These analyses are performed to establish possible exposure of victims to smoke from in-flight/post-crash fires or to CO from faulty exhaust/heating systems. The presence of both gases in blood would suggest that the victim was alive and inhaled smoke. If only COHb is elevated, the accident (or a death) could be the result of CO contamination of the interior. Information pertaining to blood levels of these gases in aviation fatalities, in relation to the associated accidents, is scattered or not available, particularly with regard to toxicity. Therefore, considering that COHb> or =10% and CN(-)> or =0.25 microg/ml are sufficient to produce some degree of toxicological effects, the necessary information was extracted from the CAMI database. Samples from 3857 fatalities of 2837 aviation accidents, occurring during 1991-1998, were received; 1012 accidents, encompassing 1571 (41%) fatalities, were fire associated, whereas 1820 accidents were non-fire related. The remaining five accidents were of unknown fire status. There were fewer fire related fatalities and associated accidents in the (COHb> or =10% and CN(-)> or =0.25 microg/ml) category than that in the (COHb<10% and CN(-)<0.25 microg/ml) category. No in-flight fire was documented in the former category, but in-flight fires were reported in 14 accidents (18 fatalities) in the latter category. No non-fire accident fatality was found wherein levels of both gases were determined to be at or above the stated levels. There were 15 non-fire accidents with 17 fatalities wherein only COHb (10-69%) was elevated. The present study suggests that aviation fire accidents/fatalities were fewer than aviation non-fire accidents/fatalities and confirms that aviation accidents related to in-flight fires and CO-contaminated interiors are rare.

Accidents, Aviation↗
PubMed2006

[The clinical significance of cosmic radiation in aviation].

UNLABELLED: The possible adverse health effects of cosmic radiation remains an important topic in the consultation of aviators and frequent flyers. A good number of articles, dealing with this questions have been published recently but produced controversial results. METHODS: We performed a Medline database search and identified 20 relevant articles that were published between 1990 and 2003. There were one retro-/prospective, 13 retrospective, 3 prospective cohort studies and 3 metaanalysis reviewed. Sixteen studies were set in the civil aviation environment, two studies in the military aviation environment and two studies were set in both environments. RESULTS: Seven out of nine studies found an identical or decreased over-all-risk for aviators to develop cancer of any kind compared to the general population. In re- gards to skin cancer, seven out of eight studies found an increased risk for aviators to develop malignant melanoma, basalioma or other kinds of skin cancer. Three studies found an increased risk for the development of prostate cancer and two studies were able to demonstrate a higher risk for the appearance of leukaemia. CONCLUSIONS: Although our review found some studies, that identified higher risks for pilots to develop cancer of the skin, prostate cancer or leukaemia, there is not enough scientific evidence to support the hypothesis, that cosmic radiation is the cause for these findings. It shows to be important to include other factors in the interpretation of the results, since some of the findings may be well explained by life-style factors of the aviation community.

Aerospace Medicine↗
PubMed2005

Hearing loss in Turkish aviators.

OBJECTIVE: Hearing loss among aviators is often reported but it still remains unclear whether this hearing loss occurs as a consequence of the surrounding noise or aging. The effect of flight noise on hearing loss in Turkish aviators is evaluated. METHODS: Audiometric tests were performed in 300 cadets assessed for entry to the Air Force Academy, 107 experienced aviators undergoing periodic health examination, and 100 people for control group. Audiometric test results were compared between the Academy cadets and the experienced aviators and between the Academy cadets and the control group. The effects of flight hours, aircraft type, and age on hearing loss were investigated. RESULTS: Hearing loss in higher frequencies was found to be significantly associated with flight hours. The age and aircraft types were not related to this problem. CONCLUSION: Hearing loss among the Turkish aviators occurs as a result of exposure to noise during flight. The use of appropriate hearing-protection equipment should be considered and should be obligatory as a preventive measure for Turkish aviators.

Adolescent↗
PubMed1999

Correlates of pilot fatality in general aviation crashes.

BACKGROUND: General aviation accounts for the majority of aviation crashes and casualties in the United States, and general aviation safety has not improved in the past decade. OBJECTIVE: This study identifies factors associated with pilot fatality in general aviation crashes. METHODS: We analyzed the National Transportation Safety Board's Factual Reports for all airplane and helicopter crashes of general aviation flights that occurred in North Carolina and Maryland during 1985 through 1994. Surviving pilots were compared with fatally injured pilots in relation to crash circumstances, and pilot and aircraft characteristics, at bivariate level and multivariate level. RESULTS: A total of 667 crashes resulted in 276 deaths and 368 injuries during the 10-yr period in the two states. Of the pilots-in-command involved in these crashes, 146 (22%) died. The case fatality rate for pilots was significantly higher in crashes that occurred between 6 p.m. and 5 a.m. (34%), away from airports (36%), with aircraft fire (69%), or in instrument meteorological weather conditions (IMC) (71%). Multivariate logistic regression revealed that the significant correlates of pilot fatality were aircraft fire [odds ratio (OR) 13.7, 95% confidence interval (CI) 6.9-27.2], off-airport location (OR 9.9, 95% CI 5.0-19.6), IMC (OR 9.1, 95% CI 4.3-19.6), nighttime (OR 2.2, 95% CI 1.3-3.7), and pilot age > or = 50 yr (OR 1.7, 95% CI 1.0-3.0). Pilot gender, flight experience, principal profession, and type of aircraft (airplane vs. helicopter) were not significantly associated with the likelihood of survival. CONCLUSIONS: The most important correlates of pilot fatality are variables likely related to increased impact forces. Better occupant protection equipment, such as air bag and crashworthy fuel system, are needed for general aviation aircraft.

Accidents, Aviation↗
PubMed2002

Direct and indirect cost of general aviation crashes.

BACKGROUND: There have been few well-designed studies which estimate the costs inflicted on society from injuries, fatalities, and property damage caused by aviation crashes. Furthermore, indirect cost estimates from the human capital (HC) approach tend to be substantially smaller than those obtained from the willingness-to-pay (WTP) approach. OBJECTIVES: To estimate the direct and indirect costs of general aviation crashes in New Zealand, and to contrast the HC and WTP approaches used to estimate indirect costs. METHODS: The incidence, morbidity, and mortality from aviation crashes between 1988 and 1997 were estimated from national health and aviation records. Direct costs included medical treatment, damage to aircraft and property, and the cost of crash investigation. For the HC approach, we valued losses to society as the value of lost production from both employed work and household activity. For the WTP approach, we used the Land Transport Safety Authority's estimated values of society's willingness to pay to avoid a fatality or injury. RESULTS: The annual average direct cost of aviation crashes was $9.1 m (range: $8.0 m to $11.4 m). The annual average indirect cost using the HC approach was $13.6 m ($5.6 m to $32.2 m). Using the WTP approach the annual average indirect costs was $49.3 m ($20.6 m to $106.5 m). Indirect costs from premature deaths were the key cost drivers. A sensitivity analysis showed that these values were relatively robust to changes in parameters. CONCLUSION: The annual average cost of general aviation crashes in New Zealand was between $22.6 m and $58.4 m. Indirect costs using the WTP approach were 3.5 times greater than those estimated using the HC approach.

Accidents, Aviation↗
PubMed1985

Will they fly again? The probability of wounded military aviators returning to flying duty: a study of 70 cases.

In this study, 70 Israeli Air Force aviators, most of them suffering from severe or moderately-severe injuries, were evaluated as to their potential to return to active flying duty. Of these, 59 (84%) were able to return to flying and 11 (16%) were permanently grounded. While 44 of 51 fighter aviators (86%) returned to flying, only 30 of them (59%) returned to fly fighters, and the rest were transferred to another type of aircraft. The roles of age and severity of injury were studied in detail and it was concluded that higher age and severe injuries prolong the convalescence period but do not prevent the aviator from returning to flying. Nine aviators were permanently grounded because of medical reasons. In each case a single injury could be demonstrated as the direct cause of their permanent grounding. All aviators were followed-up for 3 years after having returned to flying. It was concluded that an evaluation period of 2 years is sufficient to determine the long-term success of military aviators returning to flying.

Accidents, Aviation↗
PubMed2000

Brigadier General Theodore C Lyster [correction of Lister], MD: father of American aviation medicine.

Aviation medicine came into existence as a recognized entity when certain standards were established during and shortly after World War I. During this time, accident rates were high. In fact, a larger number of pilots were dying in accidents than in combat. Figures from Great Britain's casualty list at the close of the first year of World War I indicated that for every 100 aviators killed, 60 died as a result of some individual physical defect, 30 from some form of recklessness or careless behavior, 8 as a result of some mechanical defect in the airplane, and only 2 at the hands of the enemy. Aviators were found to be in poor physical condition. Because there were no established regulations with regard to workloads, aviators were frequently found to have been flying to a point beyond exhaustion. Because of workload, chronic fatigue, and emotional stress, aviators were constantly called upon to perform superhuman feats when not in peak physical condition. Errors in judgement were common. The majority of pilots lost weight as a somatic sign of stress. This was recognized by Theodore Lyster [corrected] who had recently been appointed as the Chief Surgeon, Aviation Section of the U.S. Army. Such problems were not diagnosed by medical officers because they were not trained to recognize them. Theodore Charles Lyster [corrected] was the son of Captain William J. and Martha Doughty Lyster [corrected]. He was an Army "brat" who entered the world on July 10, 1875. His childhood was spent in various posts around the country. At the age of 7, Lyster [corrected] contracted yellow fever while living in Fort Brown, TX. The boy was treated by William Gorgas, a young post surgeon. Gorgas was credited with the young boy's recovery. Later, Gorgas was to marry Lyster's [corrected] aunt making Lyster [corrected] his nephew by marriage. Having survived the yellow fever infection, young Lyster [corrected] had a lifelong immunity to the disease.

Aerospace Medicine↗