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PubMed1995

Visual performance effects and user acceptance of the M43A1 aviation protective mask frontserts.

BACKGROUND: The initial M43 aviation protective mask was fielded without provisions for optical corrective devices. Contact lenses, an interim solution, were not entirely acceptable since a small segment of the population could not be fitted adequately with contacts. This study evaluated visual performance affects and user acceptance of the M43A1 mask with frontsert correction modifications. METHODS: The investigation was divided into three phases: 1) a helicopter simulator evaluation designed to experimentally test the suitability of the M43A1 frontserts, both in single vision and bifocal forms, for use in the aviation environment; 2) a static cockpit evaluation, designed to identify aircraft-specific problems with the frontsert system; and 3) an inflight evaluation to examine the stability and usability of the frontserts under actual flight conditions. The subjects were 30 U.S. Army aviators (28 men and 2 women). RESULTS: Objective data from flight simulation evaluations suggested there were no significant differences between flight performance with and without the mask, despite refractive status. Subjective data from static and flight evaluations reflected positive user acceptance of the new mask and frontserts. Problems may exist in smaller cockpits (OH-58 A/C, D), but evidence suggested that this may have been an artifact resulting from testing the mask while wearing protective body armor. CONCLUSIONS: Within the range of flight conditions and profiles examined, the M43A1 frontsert system meets U.S. Army aviation needs for optical correction when mission requirements dictate flying with chemical-biological protective masks.

Adult↗

PubMed1996

Occupational outcome in military aviators after psychiatric hospitalization.

OBJECTIVE: To determine if psychiatric hospitalization precluded a return to occupational status in United States Air Force aviators. DESIGN: A 7-yr retrospective review that joined hospitalization and occupational databases using individual identifiers. SUBJECTS: From a population of over 35,000 USAF rated aviation officers present between January 1986 and December 1990, 214 were both psychiatrically hospitalized and on flying status the quarter prior. PRIMARY OUTCOME MEASURE: Return to flying duties during a minimum follow-up period of 2 yr. RESULTS: Within 2 yr from psychiatric admission, 138 (64.5%) aviators returned to flying status; 141 (65.9%) returned over 7 yr. In this patient population, an affective disorder diagnosis predicted poor outcome (chi 2 = 12.86; df = 1; p = 0.0003), independent of length of hospitalization. CONCLUSION: Psychiatric hospitalization did not prevent a return to flying status for a majority of these high functioning aviators. Although an affective disorder diagnosis negatively affected occupational outcome, it is unclear whether institutional policy or poor prognosis was etiologic.

Adjustment Disorders↗

PubMed1996

[Visual tests and their score for selection of candidates to higher aviation schools].

In the majority of countries the requirements to refraction and visual acuity into the distance of candidates to aviation schools are extremely high. However, despite rigorous selection the number of students expelled from aviation schools for the reason of myopia remains impressive and even tends to rise. Aside from high incidence of myopia, this is the consequence of considerable visual loading of students and low-informative methods of examination. Simple and easy accommodation tests, the so-called visual loading tests, were applied to 628 candidates to aviation students. Analysis of results showed high informative merits of two procedures, i.e. Evaluation of stability of the visual acuity into the distance (VAD), and Determination of VAD recovery time following preliminary accommodation loading. Subjects with hypermetropia of up to 2.0 dioptres had the best VAD stability. This index was slightly lower in emmetrops; the least VAD stability margin was found in myopathic subjects. After accommodation loading, the VAD recovery time increased by more than 0.75 dioptres in the myopathic subjects and 2.0 dioptres in the hypermetropic subjects. Hence, the visual loading tests show promise as procedures worthy to be included into the program of medical selection of candidates to aviation students.

Adolescent↗

PubMed1998

Primary idiopathic optic neuritis in U.S. Air Force Aviators.

The records of 31 male aviators seen at the Ophthalmology Branch of the USAF Aeromedical Consultation Service (formerly the USAF School of Aerospace Medicine) for a diagnosis of primary idiopathic optic neuritis (PION) were reviewed. Each subject received comprehensive ophthalmologic and neurologic examinations. The long-term follow-up data were collected through repeat examinations and by survey. Despite 39% of aviators being grounded due to complications of their PION or multiple sclerosis (MS), many aviators diagnosed with PION may be safely returned to flying duties. However, any aviator diagnosed with PION has a risk of recurrence or a potential to develop systemic MS and must be carefully reevaluated and followed to ensure they remain a viable asset and do not compromise flight safety or mission completion.

Adult↗

PubMed1998

Epidemiology of work-related aviation fatalities in Alaska, 1990-94.

Alaska, with less than one-half of 1% of the United States workforce, accounts for 9% of all occupational aviation fatalities nationally; 30% of all occupational fatalities in Alaska are related to aviation. To understand this high mortality, we investigated occupational aviation crashes to identify risk factors. Occupational aviation fatalities in Alaska during 1990-94 were examined using National Transportation Safety Board reports and merged with records from the Alaska Occupational Injury Surveillance System. There were 876 aircraft crashes; 407 (46%) were work-related. Occupational crashes were 2.2 times (CI: 1.5, 3.2) more likely to result in fatalities than non-occupational crashes. Risk factors identified included poor weather conditions defined as Instrument Meteorological Conditions (IMC). A crash during IMC was 5.3 times (CI: 3.5, 7.9) more likely to result in fatalities than crashes in other conditions. Of aircraft involved in fatal occupational incidents, 33% were not completely destroyed, allowing the potential for survivors. An estimated 30% reduction in fatalities could have occurred if current technology in occupant protection had been used.

Accidents, Aviation↗

PubMed1993

Relating cognitive function to military aviator performance in early HIV infection.

There has been controversy about whether cognitive changes occur in early human immunodeficiency virus (HIV) disease. In those studies reporting cognitive changes, these are typically subclinical, and their relationship to daily and/or occupational functioning has not been addressed. The potential effects of changes may vary as a function of occupational demands. This is germane to military performance, where occupational demands cover a wide spectrum of complexity. In particular, such effects are important to consider in the many cognitively demanding specialties associated with military aviation. This paper will explore ways in which possible HIV-related military performance decrements in aviators may be measured empirically. First, studies from Walter Reed Army Medical Center (WRAMC), which have shown cognitive changes in early HIV disease, will be described. This will be followed by a summary of presentations and discussions at a conference in November 1990, entitled 'HIV and Military Performance: Assessment Methodologies' held at WRAMC. The third section of the paper will describe a programme of research, which is developing measures to detect cognitive difficulties in civilian aviators. The application of measures from this research to research on HIV will be discussed. Finally, a research programme being developed to examine the possible impact of HIV-related cognitive changes on military aviator performance will be described.

Aerospace Medicine↗

PubMed2005

Driving-while-intoxicated history as a risk marker for general aviation pilots.

The Federal Aviation Administration conducts background checking for driving-while-intoxicated (DWI) convictions on all pilots. This study examined the association between DWI history and crash risk in a cohort of 335,672 general aviation pilots. These pilots were followed up from 1994 to 2000 through the aviation crash surveillance system of the National Transportation Safety Board. At baseline, 3.4% of the pilots had a DWI history. DWI history was associated with a 43% increased risk of crash involvement (adjusted relative risk: 1.43; 95% confidence interval: 1.15-1.77). The population-attributable risk fraction for DWI history was estimated as 1.4%. In addition to DWI history, male gender, older age, and inexperience were associated with significantly increased risk of crash involvement. The results of this study support DWI history as a valid risk marker for general aviation pilots. The safety benefit of background checking for DWI history needs to be further evaluated.

Adolescent↗

PubMed2006

Aviation noise does not impair the reproductive success of farmed blue foxes.

The aim of our study was to assess the effects of aviation noise on reproduction and cub mortality in farmed blue foxes. Eighty artificially inseminated blue fox vixens (45 primiparous and 35 multiparous) were exposed to aviation noise on 5 days when they were pregnant or had cubs. The noise during the exposures varied from 85 to 121 dB (L(AFmax)). Vixens (45 primiparous and 34 multiparous) on a farm without flight action acted as controls. Cubs were counted 1, 3, 7, 14 and 49 days postpartum and at the beginning of July. Litter size (cubs per whelped vixen), reproductive performance (cubs per mated vixen) and cub losses (lost cubs per whelped vixen) were analyzed from both experimental farms (A and C). The flight action had no effect on reproductive success. Reproductive performance in primiparous vixens was 4.2+/-3.8 and 4.3+/-3.6 cubs (ns, Mann-Whitney U-test) in the control and aviation group, respectively, while in multiparous vixens the corresponding figures were 7.1+/-4.4 and 7.3+/-3.8 cubs (ns). In general, litter size declined from birth to weaning (in primiparous vixens from 8.1+/-3.8 to 5.4+/-3.2 cubs, and in multiparous from 9.7+/-3.8 to 7.2+/-3.8 cubs, P<0.001, GLM for repeated measures). The decline was greater in primiparous than in multiparous vixens (P<0.01). There were no differences in total cub losses between the experimental groups (ns). Accordingly, the present results show that exposure to severe and repeated aviation noise does not impair the reproductive success of farmed blue foxes.

Animal Husbandry↗

PubMed1991

Prevalence of spectacle wear among U.S. Army aviators.

The advanced avionic and electro-optical systems installed in Army rotary wing aircraft are becoming increasingly incompatible with spectacle wear. Therefore, the prevalence of spectacle wear among Army aviators is an important consideration in the development of future systems. A review of spectacle prevalence data from the Aviation Epidemiology Data Register (AEDR) for the years 1986, 1987, 1988, and 1989 was performed. Data were consistent across all 4 years, with mean prevalence of spectacle wear being 22% for active component forces. Reserve and National Guard components displayed mean spectacle wear prevalences of 27% and 32%, respectively. These prevalence rates are higher than those previously obtained in 1985 by a similar, but slightly different paradigm. Spectacle-wearing aviators exist in greater numbers than previously documented and represent a segment of the aviation population that will have increasing compatibility problems with advanced flight systems. Therefore, system planners will need to address these incompatibilities in future hardware developments.

Adult↗

PubMed1995

Oculomotor responses with aviator helmet-mounted displays and their relation to in-flight symptoms.

Previous experiments have raised the possibility that abnormal oculomotor functioning could be the substrate for visual problems among aviators who use helmet-mounted displays. However, until the present investigation, no direct evidence linked the two. In our experiments, experienced Apache helicopter pilots, using the same helmet-mounted display that they use in flight, viewed Apache symbology and sensor imagery while we measured their accommodation and vergence eye movements in the laboratory. We found three circumstances that frequently occur in flight in which aviators with visual symptoms had different oculomotor responses than did asymptomatic aviators. Further work needs to be done to determine why symptomatic aviators respond differently from asymptomatic ones.

Accommodation, Ocular↗

PubMed2004

Maryland State Police Aviation Division. A model emergency medical system for our nation.

This collective review has the following purposes. First we will describe each of the components of the Maryland State Police Aviation Division. We will then provide detailed information about the Atlas and Database of Air Medical Services (ADAMS) compiled by the center for transportation and injury research (Buffalo, New York) in alliance with the Association of Air Medical Services (Alexandria, Virginia) that provides a unique opportunity for each state to evaluate the comprehensive nature of their air medical services. The concept "the golden hour" has been molded into the world's premier public service aviation unit, which has proudly served the citizens of Maryland for over 24 years. This effort was initially made possible through a cooperative effort between the Maryland State Police Aviation Division and Dr. R Adams Cowley at the University of Maryland Hospital as a public service to the citizens of the state. This arrangement added a unique, economical, and life-saving component to the regionalized Emergency Medical Services and Critical Care system coordinated by the Maryland Institute for Emergency Medical Services Systems (MIESS). The Maryland State Police Aviation Division has four components: (1) aircraft, (2) state troopers, (3) system communications (SYSCOM) center, and (4) level I adult and pediatric trauma centers, as well as a regional burn center. ADAMS is a compilation of information of Air Medical Services in the United States to respond to traumas and other emergencies. Specifically, ADAMS provides descriptive and geographic information on Air Medical Service base locations, communication centers, rotor wing (RW) assets, and the major hospitals and transports that receive scene transports. The database includes all types of provider organizations including nonprofit, commercial, and public service (fire, police) air medical service providers, as well as several military units that routinely provide transport in remote areas. ADAMS provides national and statewide maps indicating air transport systems, trauma centers, and geographic population density. To provide a greater perspective on emergency medical care in individual states using the carefully tabulated ADAMS data, we compared the air emergency medical systems in Maryland to those of Oregon. Regardless of population density, Maryland provides air medical transport throughout the entire state, with the exception of only three small geographic areas. Maryland's 15 helicopter bases provide quick access for the seriously injured patient to either a Level I or pediatric trauma center within the "golden hour." In contrast, the air medical transportation system in Oregon is restricted to only three small geographic regions, making it an invitation to death for many seriously injured patients. It should be a federal mandate that the injured patient should gain access either by air transport or ambulance service to a Level I trauma center within that "golden hour." This federal legislation should include new criteria to initiate the dispatch of a helicopter to the scene of an accident or injury.

Air Ambulances↗

PubMed2000

Nonsustained ventricular tachycardia in 193 U.S. military aviators: long-term follow-up.

BACKGROUND: Despite its importance to the aeromedical community, the occupational implications of asymptomatic, nonsustained ventricular tachycardia (VT) are not well described. We sought to clarify this issue via a review of military aviators evaluated for nonsustained VT by defining event rates for sudden cardiac death, syncope, presyncope and sustained VT, and by determining whether any cofactors predicted a subgroup at increased risk for such outcomes. METHODS: We reviewed the records of 193 military aviators evaluated at the U.S. Air Force Aeromedical Consultation Service for nonsustained VT from September 1960 to December 1992. Follow-up information was available on 192 of the 193 aviators over a mean of 10.6 yr. Cofactor analysis focused on idiopathic VT (no associated underlying cardiac disease) and VT associated with mitral valve prolapse (MVP). RESULTS: There was no documented sustained VT; 9 (4.6%) had events including syncope (1), presyncope (5) and sudden death (3). Of these 9, 4 had idiopathic VT. The 3 deaths were associated with coronary artery disease, MVP and cardiomyopathy. No cofactors predicted events in aviators initially presenting with asymptomatic nonsustained VT. For asymptomatic nonsustained VT, the maximum predicted annual event rate was 0.33% for idiopathic VT and 2.3% for VT with MVP (95% confidence limit). CONCLUSIONS: Nonsustained VT did not predict future documented sustained VT. Cofactors failed to predict a subgroup at increased risk for events. Idiopathic nonsustained VT appeared to be a low risk population for whom expanded waiver criteria are proposed with suggested limits on duration and number of episodes of VT.

Adult↗

PubMed2001

Morbidity among airline pilots: the AMAS experience. Aviation Medicine Advisory Service.

BACKGROUND: Various cohort studies, military databases, and Federal Aviation Administration databases have characterized morbidity and disability in pilots. However, an overriding limitation of these studies is acquiring complete and accurate medical information from pilots with a profession, hobby, or aircraft investment to protect (6). The unique role of Aviation Medicine Advisory Service (AMAS) as pure pilot advocate with guaranteed patient confidentiality eliminates the aviator's need to conceal medical problems. Therefore, analyses of cases reported to AMAS might provide additional insight regarding the true prevalence of morbidity in airline pilots. METHODS: All AMAS cases of airline pilots and flight engineers from January 1996 through November 1999 were reviewed (n = 20,522). During that time, AMAS provided consultation to approximately 51 U.S. and Canadian airlines. Diagnoses were stratified by decades ranging from 20 to 69 yr of age. RESULTS: Notably, the five conditions most frequently inquired about at AMAS were similar to the major causes of long term disability found in a cohort of Air Canada pilots (5). Cardiovascular conditions accounted for almost 25% of the inquiries. However, the relative percentage especially in the older population was less than that reported previously. Interestingly, orthopedic and musculoskeletal cases (10-11%) rated second only to cardiovascular cases. CONCLUSIONS: These findings are limited by the inability to draw an exact reference population at risk, the use of proportional measures for description and the inherent difficulty in attempting to utilize an administrative index as an epidemiological tool. Further study addressing the impact of aviator nondisclosure of medical problems on the reported prevalence of disease among U.S. airline pilots may help target preventive efforts in the future.

Adult↗

PubMed2002

Pharmacologic considerations for serotonin reuptake inhibitor use by aviators.

Physicians frequently use serotonin reuptake inhibitors (SRIs) to treat a variety of psychiatric and medical conditions, many of which occur in aviators. SRIs are efficacious for treating acute conditions and may also prove useful for prophylaxis against recurrence through maintenance dosage. Aviators must meet standard safety criteria in order to use medications while performing flying duties, and must receive individual waivers as well. This article reviews the particular threats that serotonergic agents pose to aviation safety. Some SRIs may prove safer than others to use in the aviation environment, but such medications will require appropriate ground testing, and must provide aeromedically safe control of the symptoms for which they are prescribed.

Aerospace Medicine↗

PubMed2002

The Armstrong Laboratory Aviation Personality Survey: development, norming, and validation.

This work describes the development of a new psychological test for aviators. The Armstrong Laboratory Aviation Personality Survey was developed through the integration of clinical theory, psychometric methods, and empirical testing. It is currently given to all incoming U.S. Air Force pilot candidates. Using a sample of 6,047 student pilots, a thorough test development plan was accomplished. The 15 final test scales assess personality, psychopathology, and crew interaction styles. The scales have normative data and are demonstrated to be reliable and valid. The Armstrong Laboratory Aviation Personality Survey is recommended for use in the aviation community for both clinical and research purposes. Future research is recommended and needed in the areas of training, airframe, and special duty selection. Additional clinical work is indicated in the areas of psychiatric, psychological, and aeromedical evaluations.

Adult↗

PubMed2003

Diabetes mellitus type 2 in aviators: a preventable disease.

INTRODUCTION: The current epidemic of obesity and resultant diabetes mellitus type 2 (DMT2) is a tsunami that will impact healthcare worldwide and lap over into aerospace medicine. Metabolic syndrome (MBS) is the major link between obesity and DMT2. METHODS: A review of U.S. Air Force Aeromedical Consult Service (ACS) records was accomplished looking at aviators with a diagnosis of DMT2. Case reports of three flyers with DMT2 are presented and discussed. Other aeromedical agencies were contacted regarding their experiences and this information was summarized. A literature review on DMT2, obesity, and metabolic syndrome was accomplished. RESULTS: Of 70 charts for flyers identified with diabetes mellitus at the ACS between 1975 and 2000, over 95% were for DMT2. The mean body mass index for these aviators was 26.2. Currently, all services grant restricted waivers for some aviators with DMT2, none in high performance, single-seat aircraft. The FAA is currently allowing most flyers with stable DMT2 to operate aircraft in all categories with specific restrictions. DISCUSSION: Obesity and metabolic syndrome are becoming increasingly prevalent in the aviation community. Aggressive actions to limit weight gain and identify those at risk for developing DMT2 must be considered for all populations.

Adult↗

PubMed1992

Compulsive personality traits affecting aeronautical adaptability in a naval aviator: a case report.

This is a case report of a male naval aviator who demonstrated compulsive personality traits which adversely affected the performance of his duties as a pilot trainee, and later, as a naval flight officer. The Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-III-R) uses the term obsessive-compulsive to describe two conditions. A review of terminology is undertaken to present the reader with the distinguishing features of the personality disorder versus the anxiety disorder. The anxiety disorder, obsessive-compulsive disorder, is incompatible with safe performance of aviation duties. Obsessive-compulsive personality, on the other hand, describes a point on a continuum where useful, adaptive compulsive traits may become abnormally exaggerated and maladaptive, thus interfering with the aviator's normal routine, occupational functioning, relationships with others, and aviation safety.

Adaptation, Psychological↗

PubMed2005

Pneumomediastinum in student aviators: 10 cases with return to flying duty.

Pneumomediastinum (PnM) is an uncommon phenomenon, though it is one of the most common causes of chest pain in young adults. It may be particularly important among aviators, as it may result in in-flight incapacitation. Spontaneous PnM is a variant usually associated with the Valsalva maneuver, used during high-performance flight. This may increase the risk of PnM recurrence and raises concern regarding the return to flight duties of aviators after an episode of spontaneous PnM. We present 10 student aviators who experienced a single episode of uncomplicated PnM unassociated with flight. All were returned to flying duty following a normal pulmonary evaluation and are still in active duty. Follow-up was conducted for a mean period of 74.7 mo without any adverse consequences. These findings support the return of aviators to flying duty after a single episode of uncomplicated spontaneous PnM.

Adult↗