某部飞行人员与地勤人员军事训练软组织损伤流行病学调查

目的通过调研沈阳战区陆航某部寒区飞行人员与地勤人员军事训练伤的发生与分布情况,分析其发生的流行病学特点及趋势。方法设计制作《部队训练伤管理情况调查问卷》,分别抽取陆航某部直升机飞行人员100人、地勤人员300人进行问卷调查。结果共回收有效问卷377份,其中,飞行人员有效问卷98份,地勤人员有效问卷279份。飞行人员训练伤发生率为30.6%(30/98),显著高于地勤人员的21.8%(61/279)。其中,飞行人员发生训练伤最多的部位是脚踝11例(36.7%)、膝盖11例(36.7%);地勤人员训练伤最多的部位是腰部25例(41.0%)。飞行人员与地勤人员发生训练伤的类型最多的均是腰肌劳损,分别为15例(50.0%)和26例(42.6%)。训练伤发生时间最多的是在春季,占全年的41.8%。结论飞行人员与地勤人员训练伤发生率均较高,有针对性地实施预防保护措施可降低训练伤的发生率。     

Civilian helicopter accidents into water: analysis of 46 cases, 1979-2006

BACKGROUND: When a helicopter crashes or ditches into water the crew and passengers must often make an escape from underwater and a number of the occupants do not survive. This paper examined fatality rates, human factors problems with escape, and causes of death in Canadian civilian registered helicopter accidents in water (1979-2006). METHOD: Data obtained from the Transportation Safety Board of Canada was reviewed. Key issues such as fatalities, injuries, warning time, sinking, and inversion were examined. RESULTS: There were 46 helicopters that ditched into water. There were 124 crew and passengers involved. Of those, 27 (23%) crew and passengers died. Lack of warning time (55%), rapid sinking (72%), and inversion (35%) were the most common issues in the accidents. CONCLUSION: Survival rates for Canadian registered helicopter accidents into water (78%) show little change from previously reported worldwide data. Lack of warning time, rapid sinking, and inversion were the significant factors in the survival rate. The practical implication is that crew and passengers involved in planned flights over water must wear all the life support equipment on strap-in and not have it stowed on the back of the seat or in the cabin.     

Analysis of injuries among pilots killed in fatal helicopter accidents

BACKGROUND: Despite advancements in the crashworthiness of helicopters, both the rate and severity of injuries sustained in helicopter accidents remain a cause for concern. The mechanism and pattern of injuries sustained in aircraft accidents can provide vital information for improving survivability. The purpose of this study was to analyze patterns of injuries sustained by pilots involved in fatal helicopter accidents. METHOD: Detailed information on the pattern and nature of injuries was retrieved from the Federal Aviation Administration's autopsy database for pilots involved in fatal helicopter accidents from 1993 to 1999. RESULTS: A review of 84 autopsies revealed that blunt trauma was cited as the primary cause of death in 88.1% of these cases. The most commonly occurring bony injuries were fractures of the ribs (73.8%), skull (51.2%), facial bones (47.6%), tibia (34.5%), thorax (32.1%), and pelvis (31.0%). Common organ/visceral injuries included injury to the brain (61.9%), lung (60.7%), liver (47.6%), heart (41.7%), aorta (38.1/), and spleen (32.1%). Injury patterns did not appear to be related to the age of the pilot or the phase of flight. The use of a shoulder harness afforded protection to the occupant against certain injuries. CONCLUSIONS: The findings and their significance are explained in the overall context of crash survivability and have implications for the design of crashworthy aircraft and making helicopter accidents more survivable.     

Results and recommendations from the helicopter EMS pilot safety survey 2005

INTRODUCTION: In 2005, the Pilot Safety Study Group (PSSG), consisting of members of the Association of Air Medical Services Research Committee, wrote, distributed, and analyzed a survey of helicopter pilots regarding their knowledge, attitude, and perspectives on safety in the field of air medical transport. METHODS: The Pilot Safety Survey 2005 (PSS2005) was based on another survey--one that was sponsored by Helicopter Association International (HAI) and National EMS Pilots Association (NEMSPA) and administered to pilots in 2001. The PSS2005 pared questions down so that the survey could be completed in 15 minutes on the internet, and the answers were organized in a manner to simplify analysis. An electronic link to the survey was distributed in a non-randomized fashion to HEMS pilots using the mailing lists of various operators and HEMS programs. Questions were clustered into eight groupings of safety, with a majority of responses being categorical, lending themselves to cross-tabulations. RESULTS: The information gathered indicated that Helicopter EMS (HEMS) pilots are very experienced, with the average pilot logging 6,625 flight hours. Collectively, they took responsibility for HEMS accidents; with 92% of total respondents citing "pushing weather minimums" and 82% citing "pilot decision making" as the main reasons for crashes. Crew resource management (CRM) was well appreciated by the pilots; there appeared to be a positive correlation with programs that offer their employees CRM and the pilots' general perspective on safety. The survey was also clear that amongst 40% of the respondents, mission-oriented training needs improvement, and 74% responded that more realistic training in flight simulators would improve safety overall. Finally, 57% of the pilots both desired night vision goggles or devices (NVG/NVD) and believed that their usage would improve safety in the field of air medical transport (55% vs 45%, P = .0025). CONCLUSIONS: Although the recommendations from the PSS2005 are lacking in definite evidence for a decrease in HEMS crashes, we consider the direct input from pilots as critical in the absolute elimination of crashes in Helicopter EMS (Vision Zero). Pilots are, after all, the very ones held responsible for HEMS crashes. Based on these findings, the PSSG hopes that the HEMS community will incorporate the following recommendations into their standard practices. We recommend that all HEMS operators have annual and regular CRM training. We recommend that all HEMS pilots have annual and regular training in realistic flight simulators. Finally, we recommend that all HEMS aircraft be in possession of NVGs, and if this is not possible (eg, light pollution from a highly urbanized region or cost-benefit issues), then to have annual and regular mission-oriented nighttime training.     

A new generation of U.S. Army flight helmets.

Head injuries are the most common cause of fatal injury in helicopter crashes. For over 80 years, the U.S. Army has used crash investigation studies to redesign flight helmets. This paper describes the evolution of the new fielded U.S. Army helmet, the Sound Protection Helmet No. 4B (SPH-4B), and compares its protective features to its predecessors, especially the SPH-4. A major contribution to the helmet design process was made by the Aviation Life Support Equipment Retrieval Program (ALSERP), a functional program at the U.S. Army Aeromedical Research Laboratory (USAARL). ALSERP has analyzed more than 500 helmets involved in crash events since 1972. Based on these studies of critical safety factors, the Army has developed and deployed the SPH-4B, a new helmet with improved energy absorption, retention, and stability.     

Personality types of flight crew members in a hospital-based helicopter program

PURPOSE: To determine the personality preferences of flight crew members in a hospital-based helicopter emergency medical service (HEMS) using the Myers-Briggs Type Indicator (MBTI), and to differentiate and compare these preferences between crew specialties and a historical control population. METHODS: A prospective cohort study was conducted of all active crew members (nurses, respiratory therapists and pilots) in a hospital-based flight program. Data collected included the results of the MBTI, gender, age and years of flight experience. RESULTS: Crew members were represented by 14 of 16 possible MBTI personality types, with three types predominating. For each crew specialty, extroversion preferences predominated over introversion, and perceiving characteristics predominated over judging characteristics. Differences existed by crew specialty for the sensing-intuition and thinking-feeling dimensions. CONCLUSIONS: A personality typology has been established for individual and group preferences within one hospital-based HEMS program. This data begins to develop a data base and an investigative protocol for understanding some of the human factors regarding flight programs. Future research should focus on expanding the data base and exploring specific crew interactions based on additional diagnostic and evaluative methodologies.     

Integrating emergency medicine residents into a well-established helicopter program

INTRODUCTION: The institution of an emergency medicine residency in a university-affiliated Level 1 trauma center in July 1993 provided a challenge to develop a curriculum and on-line learning experience for emergency medicine residents in a well-established helicopter program. The purpose of this study was to survey flight crew members, emergency medicine at tending physicians, and emergency medicine residents on the anticipated roles and educational experience of integrating the emergency medicine residents from a new emergency medicine residency into the flight crew of a well-established helicopter program. METHODS: A survey consisting of multiple choice, Likert scale, and open-ended questions was distributed to flight crew members (RN, RT, pilots, communication specialists, EM attendings, and EM residents [n=72]). RESULTS: 92% of surveys were returned. These surveys identified specific issues of concern and those areas believed to be of academic importance for the emergency medicine residents. CONCLUSIONS: The results of this study allowed for the creation and implementation of a progressive flight experience for EM residents that incorporates increasing responsibility on the flight crew as experience is gained.     

The incidence, nature, and severity of injuries in New Zealand civil aviation

BACKGROUND: Strategies to improve aviation safety can be directed at the pre-crash, in-crash, or post-crash phases of aircraft crashes. For resources to be made available for in-crash interventions, and for these to be well designed, it is necessary in the first instance to have a detailed understanding of the injuries sustained in crashes. The purpose of this study was to describe the incidence, nature, and severity of injuries sustained in aircraft crashes and other related events in civil aviation in New Zealand. METHODS: National injury databases were searched for fatalities and hospitalizations sustained in aircraft crashes and related events, and cases were linked with Civil Aviation Authority accident records to identify the aircraft involved. Rates were based on estimates of total hours flown by active pilots. RESULTS: There were 104 fatalities identified for the period 1988-1992, giving a rate of 2.57 per 100,000 flight hours. There were 120 hospitalizations identified for the period 1988-1993, giving a rate of 2.45 per 100,000 flight hours. Most fatalities involved injury to multiple body regions, with at least one injury being sufficient in itself to cause death in 48% of cases. For hospitalizations, the lower extremities (23%), spine (20%), and head and face (18%) were the body regions most commonly injured, with fractures being predominant. While the majority of fatalities and hospitalizations occurred in fixed- and rotary-wing aircraft, the highest rates were for microlight and home-built aircraft. CONCLUSIONS: Different patterns of injury were evident for fixed- and rotary-wing aircraft. Reasons for these are suggested. Future research will seek to determine the relative risk associated with potentially modifiable risk factors.     

SPH-4 helmet damage and head injury correlation.

Human tolerance to head impact was assessed by correlating the force levels required to duplicate damage seen in 14 SPH-4 aviator helmets retrieved from U.S. Army helicopter crashes with resulting head injury. Head injury occurred at peak acceleration levels far below 400 G, which is the value currently used by the U.S. Army as the pass-fail criterion in evaluating the impact attenuation performance of prospective aircrew helmets. Concussive head injuries occurred below Severity Index values of 1500 and below Head Injury Criterion values of 1000. These are considered concussive threshold values by the National Operating Committee on Standards for Athletic Equipment and by the Department of Transportation, respectively. Because peak transmitted force was the best estimator of the Abbreviated Injury Scale values assigned to the 14 cases, it may be a more effective criterion to use in the evaluation of helmet impact attenuation performance than is peak G, Severity Index, or Head Injury Criterion.     

Epidemiology of musculoskeletal and soft tissue injuries aboard a U.S. Navy ship

OBJECTIVE: The objective of this study was to characterize injuries occurring to crew members aboard a U.S. Navy ship. METHODS: A retrospective review of crew member medical records was conducted covering a 90-day period during which the ship was intermittently at sea. Data on new injuries were collected and sorted. Injuries were classified as soft tissue or musculoskeletal, acute or overuse, and occurring with the ship at sea or in port. RESULTS: There was a total incidence of 16.5 injuries per 100 man-months. Acute musculoskeletal injuries contributed 2.6 injuries per 100 man-months and resulted in 79 lost and 192.5 modified work days. Overuse musculoskeletal injuries were responsible for 9.3 injuries per 100 man-months and caused 1 lost and 255.5 modified work days. Soft tissue injuries had an incidence of 4.6 injuries per 100 man-months and resulted in no lost and only 106 modified work days. The relative risk of sustaining a soft tissue injury in port compared with at sea was 1.1, but this was not statistically significant. The relative risk of sustaining an acute musculoskeletal injury in port compared with at sea was 3.5 (p = 0.01). CONCLUSIONS: Overuse musculoskeletal injuries occurred with the greatest incidence, but acute musculoskeletal injuries were responsible for the greatest morbidity. Soft tissue injuries occurred with an intermediate incidence but had the lowest overall morbidity. The safest place for crew members assigned to this Navy ship was aboard that ship at sea. Further studies of this nature could help guide medical efforts at injury treatment and prevention for shipboard personnel.     

Only pilots get tired and other urban myths

Beginning in 1985, the Federal Aviation Administration (FAA) came to the realization that regulating crew rest for pilots was an overdue and effective risk-management tool. Fatigue was being increasingly recognized as a contributing factor in many emergency medical services (EMS) accidents. Federal aviation regulations were changed to include pilot crew rest and flight hour and duty time limitations.     

Cervical and lumbar spinal changes diagnosed in four-view radiographs of 732 military pilots

BACKGROUND: Pilots who fly jet fighters or helicopters frequently experience vertebral problems due to acceleration and vibration, wearing helmets and other headgear, and sitting in suboptimal postures. METHODS: We looked for spondylarthritic or spondylitic changes in 4-view radiographs (AP, lateral, left and right oblique) of the cervical and lumbar vertebrae of 732 pilots and 202 non-flying controls. The subjects included 91 F-16 jet pilots, 363 other jet pilots, 119 transport pilots, and 159 helicopter pilots. RESULTS: The prevalence of cervical changes in helicopter pilots was 19%, significantly higher than those for other pilots (8-13%) or controls (10%). There was no difference among groups with respect to prevalence of lumbar changes. Among all pilots, compression fractures were more common in the lumbar region than in the cervical region. Age was the most important variable related to spondylarthritic or spondylitic changes in all subjects, whereas height was an important factor only among jet pilots. CONCLUSION: We found an increased prevalence of cervical changes, especially osteoarthritis, in helicopter pilots. Increasing age and tall stature were associated with an increased prevalence of vertebral spondylarthritic or spondylitic changes in jet pilots.     

The effect of an in-flight, emergency training program on crew confidence

INTRODUCTION: Despite some progress, the air medical transport profession continues to experience widely publicized accidents that result in injuries and death to crew members and patients. An air medical crew member's experience, training and confidence may affect his or her ability to deal effectively with an in-flight emergency, and may also affect his or her behavior before and after the emergency. SETTING: A hospital-based, rural rotor- and fixed-wing program flying approximately 890 flights per year. Seventy-seven percent of these flights are interfacility. METHODS: A pretraining survey evaluated the experiences of air medical crew members and pilots. A 20-question assessment tool based on a 5-point Likert scale evaluated how confident the individuals were in their ability to react to in-flight emergencies. An extensive in-flight emergency training program was then conducted. Personnel were asked to complete the same questionnaire one month and six months after the training. RESULTS: On the pretraining questionnaire, flight crew members with neither prior training nor actual experience in in-flight emergencies showed the lowest level of confidence. Those with prior training, actual in-flight emergency experience or both, responded with higher levels of confidence. The mean confidence scores of the study participants increased from 82 pretraining to 89 at one month post-training and remained at the increased level six months after training. CONCLUSIONS: A training program focusing on in-flight, aircraft-related emergencies can increase the crew's confidence during such situations. This increase in confidence is most noticeable in those without previous training or experience and is maintained for at least six months. Several other benefits occur from the training program.     

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.     

Characteristics of general aviation crashes involving mature male and female pilots

BACKGROUND: General aviation crashes in the United States were analyzed to identify differences between male and female pilots in the circumstances of their crashes and the types of pilot errors involved. METHODS: All 144 female pilots who were born between 1933 and 1942 and who were involved in general aviation crashes between 1983 and 1997 were matched 1:2 with 287 male pilots by age within 2 yr, medical certificate and pilot certificate, state or region of crash, and year of crash. RESULTS: Mechanical failure, gear up landings, improper IFR approaches, and collisions with wires or poles were more common in crashes of male pilots. Loss of control on landing/takeoff was more common in crashes of female pilots. Mishandling aircraft kinetics was the most common error of pilots of both genders and was noted more often in female pilots' crashes (81% vs. 48%) (p < 0.001). Males' crashes were more likely to involve flawed decisions (29% vs. 19% of females' crashes) (p = 0.027) or inattention (32% vs. 19%) (p = 0.004). Older pilots made fewer errors: among males age 55-63, 26% of crashes were without obvious pilot error compared with only 7% at age 40-49 (p = 0.003). CONCLUSION: There are large gender differences in the types of pilot error involved in general aviation crashes. Mishandling aircraft kinetics, poor decision making, and inattention are the most common pilot errors and merit increased attention in pilot training.     

The basis for the development of a fuselage evacuation time for a ditched helicopter

HYPOTHESIS: When a helicopter ditches or crashes in water, unless the buoyancy bags are inflated, it commonly sinks inverted. Thus, crew and passengers must make an underwater escape. It is postulated that later passengers in the escape sequence do not have the breath-holding ability to conduct a successful escape, particularly if the water is cold. This contributes to the 20-50% mortality rate in survivable accidents. METHODS: There were 132 immersed subject evaluations which were conducted in daylight and darkness to measure escape times from a helicopter underwater escape trainer, configured to the Super Puma, seated for 15 and 18 passengers. The subjects were highly experienced instructors or Navy clearance divers. RESULTS: The time from when each subject's head disappeared underwater until each subject surfaced and total fuselage evacuation time were measured and any problems hampering escape were noted. Breath-holding for the last subject out ranged from 28 to 92 s. An emergency breathing system was used by a minimum of four subjects each time and a maximum of 11 subjects in one condition. The buoyancy of the survival suit was the principal component that hampered escape. CONCLUSION: Breath-holding times were too long for the later subjects to escape without resorting to an EBS, in spite of the fact that they were highly trained. For regular crew and passengers flying over water, this would explain the high mortality, etc. Therefore, a new helicopter standard should be developed requiring fuselage design to accommodate total evacuation within 20 s from underwater. For current helicopters, where this cannot be achieved, passengers should be provided with some form of air supply, or, after ditching, the helicopter should be modified so that it will stay afloat on its side and retain an air space in the cabin.     

The use of consumer-satisfaction surveys by an air medical program

Surveys were distributed to referring and receiving hospitals or to EMS agencies that used the air medical service. The respondents were asked to evaluate the dispatcher's, pilot's and flight crew's professionalism and courteousness on a Likert scale and through written comments. Phase 1 of the survey distribution was discontinued after problems were encountered due to the distribution process. Phase 2 consisted of the air medical program mailing surveys directly to the referring and receiving facilities or to the EMS agencies. In terms of courteousness and professionalism, 90% of the respondents' answers fell within the strongly agree to neutral range. Questions regarding pilots and dispatchers were often left unanswered. Two areas were identified as needing further work on the part of the medical flight crew: follow-up with referring hospitals on patient outcome and identification of flight physicians vs. flight nurses.     

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.     

Epidemiology of injuries and illnesses in America's Cup yacht racing

Objectives

To determine the incidence and severity of injuries and illnesses incurred by a professional America''s Cup yacht racing crew during the preparation for and participation in the challenge for the 2003 America''s Cup.

Methods

A prospective study design was used over 74 weeks of sailing and training. All injuries and illnesses sustained by the 35 professional male crew members requiring medical treatment were recorded, including the diagnosis, nature, location, and mechanism of injury. The volume of sailing and training were recorded, and the severity of incidents were determined by the number of days absent from both sailing and training.

Results

In total, 220 injuries and 119 illnesses were recorded, with an overall incidence of 8.8 incidents/1000 sailing and training hours (injuries, 5.7; illnesses, 3.1). The upper limb was the most commonly injured body segment (40%), followed by the spine and neck (30%). The most common injuries were joint/ligament sprains (27%) and tendinopathies (20%). The incidence of injury was significantly higher in training (8.6) than sailing (2.2). The most common activity or mechanism of injury was non‐specific overuse (24%), followed by impact with boat hardware (15%) and weight training (13%). “Grinders” had the highest overall injury incidence (7.7), and “bowmen” had the highest incidence of sailing injuries (3.2). Most of the illnesses were upper respiratory tract infections (40%).

Conclusions

The data from this study suggest that America''s Cup crew members are at a similar risk of injury to athletes in other non‐collision team sports. Prudent allocation of preventive and therapeutic resources, such as comprehensive health and medical care, well designed conditioning and nutritional programmes, and appropriate management of recovery should be adopted by America''s Cup teams in order to reduce the risk of injury and illness.