Long-term disability among aviators in Japan Air Self-Defense Force: analysis of 260 cases

BACKGROUND: As part of a study of the risks associated with aviator incapacitation, we identified the diseases that caused long-term disability (LTD) among aviators in the Japan Air Self-Defense Force (JASDF), and then assessed the magnitude of the problem that each group of diseases represented with regard to the safety of flight. METHODS: Case-notes for JASDF aviators who stopped work for more than 3 mo during 1980-2002 were identified from all files kept at the Medical Evaluation Section of the Aeromedical Laboratory. The case-notes were divided into four age groups and analyzed by diagnostic category or injury. RESULTS: We identified 260 aviators with LTD, including 217 active-duty pilots and 43 navigators with flying status. Of those, 59 cases (22.7%) had permanent disability for flight. About 75% of LTD cases could be attributed to five diagnostic categories: neoplasms, nervous system and sense organs, circulatory system, digestive system, and musculoskeletal system. Peaks in LTD were found in the 20-29 and 40-49 age-groups. In the younger group, 78.2% of the patients were students, of whom 23 were found to have a disability associated with a preexisting medical condition which was not detected in the initial screening process for pilots. In the 20-29 yr age-group, the most common reason for LTD was the nervous system and sense organs, while in the 40-49 yr age-group it was the circulatory system. CONCLUSION: Reduction in the frequency of LTD might be accomplished by improving the medical screening process for applicants and emphasizing the prevention of circulatory diseases during a pilot's career.     

Self-rated changes in cognition and piloting skills: a comparison of younger and older airline pilots

BACKGROUND: The relationship of chronological age to self-rated changes in cognition has been studied extensively. However, the relationship of these changes to age-related changes in piloting skills is not well understood. OBJECTIVE: This study aims to determine whether airline pilots report age-related changes in cognitive abilities, and whether these changes are related to self-rated changes in piloting skills. METHODS: A total of 1310 airline pilots (28-59 yr, mean age = 45.5 yr; mean total flight time = 11,992 h) currently employed by a major U.S. commercial air carrier participated in the study. A 13-item Aviation Experience Survey (AES) was completed by each pilot, using 5-point Likert ratings and yes/no responses comparing current cognitive abilities (e.g., concentration, reaction speed) and piloting skills (e.g., piloting in adverse weather, decision making while flying) with those of 10 yr ago. RESULTS: Cognitive abilities and piloting skills were more likely to be rated as "better' or "much better" than 10 yr ago by pilots age 39 or under than by pilots in their 40s and 50s, who were more likely to rate their abilities and skills as "the same." Fewer than 20% of pilots in any age group rated their cognitive abilities or piloting skills as "worse" or "much worse" than 10 yr ago. Pilots who reported more anxiety or stress while flying reported more negative changes in abilities, skills, and health status regardless of age. CONCLUSIONS: Self-ratings of cognition and piloting skills vary by age, but older pilots are not more likely to report negative changes in their abilities and skills than younger pilots. Further research is needed to verify whether these self-appraisals reflect true changes in skills over time.     

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.     

Phobic fear of flying in aircrews: epidemiological aspects and comorbidity

BACKGROUND: Phobic fear of flying may affect aircrew members during any phase of their flying careers. Symptoms are beyond voluntary control and may lead patients to avoid flying and seek medical advice. METHODS: Of 1101 psychiatric files from our institute for 1985-2002, 150 represented cases of fliers who suffered from phobic fear of flying. Data collected from those files included assessment of fear-evoking situations, type of aircraft, class of aircrew duties, aircraft accident history, past medical history, age, and associated psychiatric comorbidity. RESULTS: We compared a group of 56 pilots with 94 other aircrew members. Results included 143 cases of flight phobia behavior and 7 cases of anxiety about parachuting. Flight phobia was less frequent among pilots (37.4%) than the other aircrew members (62.6%). We found a history of aircraft accident to the patient or an acquaintance in 25% of the cases. Observed comorbid psychiatric disorders (54%) consisted of depressive disorders (22%), anxiety disorders (16%), and personality disorders (7.4%). Fixed-wing pilots and aircrews members had a higher incidence of depression than did rotary-wing pilots and crewmembers (p < 0.05). Rotary-wing pilots and crewmembers had a higher rate of anxiety disorders (p < 0.05). DISCUSSION: Flight phobia encompasses a wide spectrum of clinical origins that may lead pilots or other aircrew members to refuse to fly. We recommend a careful psychiatric evaluation and close follow-up to adequately diagnose fliers with flight phobic reactions, as well as establishing adequate medical and/or psychological treatment.     

Flight safety in Alaska: comparing attitudes and practices of high- and low-risk air carriers

INTRODUCTION: Aircraft operations are a vital component of the transportation system in Alaska. Between 1990-2002, a total of 481 people died in Alaska in aviation accidents. The purpose of this study was to examine the practices and attitudes of Alaska commuter and air taxi operators and their pilots as they relate to company fatal accident rates. METHODS: A case-control analysis based on accident statistics was performed, grouping operators and their pilots into cases and controls, based on operator fatal accident rates, during January 1990 to June 2001. Responses from two aviation safety surveys-one of air carrier operators and one of active commercial pilots-were compared between cases and controls. RESULTS: The average case pilot had less career flight experience than control pilots and worked 13 h x d(-1) and 81 h x wk(-10; that is, 1 h x d(-1) and 10 h wk-1 more than controls. Case operators were less likely to consider pilot fatigue a problem when scheduling flights (p = 0.05) and more likely to depend financially on timely delivery of bypass mail (p = 0.04). Case pilots were three times as likely as controls to fly daily into unknown weather conditions. Nearly 90% of case pilots reported that they never flew when so fatigued that they wanted to decline the flight, compared with 64% of control pilots (p = 0.01). CONCLUSIONS: Pilots of high-risk operators differed from those working for the other operators, both in experience and working conditions. The combination of pilot inexperience and longer work hours and workweeks may contribute to Alaska's high aviation crash rate.     

Analysis of changes in the pilot population and general aviation accidents.

General Aviation pilots have been involved in a steadily decreasing number of accidents over the past 20 years. Changes in the age distribution, certification, and flying habits of these pilots make direct comparison of accident statistics inaccurate. This study reviews changes in the pilot population over the past 20 years to analyze their impact on accident statistics. Pilot age and certificate distributions from 1968 to 1987 were assembled from annual Federal Aviation Administration (FAA) surveys. Information about pilots involved in accidents was collected from annual National Transportation Safety Board (NTSB) reports. Trends in pilot age distribution, certification, aircraft use, flight planning, and weather were reviewed. The accident experience from the first 5 years of the study period was used to construct an adjusted plot of expected aircraft accidents. From 1968-87, the mean pilot age increased from 35 to 40 years and the number of pilots over the age of 60 increased five-fold. The number of pilots with Air Transport Pilot (ATP) certification tripled and instrument certification increased 80%. Accidents where an Instrument Flight Rules (IFR) flight plan was filed increased from 3.6% to 6.6% without a corresponding increase in the number of accidents in weather at or below instrument meteorologic conditions (IMC). The accident experience from 1968 to 1973 predicted 116,000 accidents from 1968 to 1987. The actual number of accidents was 40% less than predicted. The average pilot age has increased both due to more pilots over the age of 50 and less young student pilots.(ABSTRACT TRUNCATED AT 250 WORDS)     

Surgical correction of disc pathology in fighter pilots: a review of 14 cases

BACKGROUND: Disorders of the spine are common in fighter crewmembers. The high cost of training and experience for pilots makes it important to use all reasonable clinical means to restore grounded pilots to their flying duties, provided that all safety standards are maintained. To date, there has been limited research into specific surgical treatment of spine injury in pilots. This study was designed to examine the efficacy of surgical procedures in Spanish Air Force fighter pilots with injuries to the spine, as well as the aeromedical disposition of such pilots. METHODS: A retrospective study was conducted using the medical records of 14 fighter pilots with symptomatic spinal disorders treated by surgery. RESULTS: The 14 pilots underwent surgery: 12 cases involved fusion of vertebral structures (arthrodesis), while 2 pilots underwent discectomy. All pilots were subsequently given waivers to resume flying duties. DISCUSSION: The successful return to flight status of these pilots indicates the practical application of surgical techniques that safely stabilize the spine. However, due the sample limited size of the sample, further studies are needed.     

军事飞行员原发性青光眼的医学鉴定分析

目的 探讨因原发性青光眼和可疑青光眼住院的军事飞行员的疾病特点、飞行结论 及放飞观察情况. 方法 对95例因青光眼或可疑青光眼住院的飞行员资料进行回顾性临床分析.结果 95例住院患者中56例诊断为原发性开角型青光眼(POAG),其中停飞15例,飞行暂不合格3例,飞行合格38例,放飞观察中延长飞行年限1～26年,平均6.36±1.43年.36例怀疑青光眼者进行青光眼排除检查,33例排除了青光眼,飞行合格;3例临床可疑,飞行暂不合格.3例诊断为高眼压症,飞行合格. 结论 飞行员最多见的青光眼类型是开角型青光眼;患POAG的飞行员若视功能稳定,在严密观察下能够继续飞行;早期发现和及时治疗是控制疾病的关键.     

Intraocular lenses in aviators: a review of the U.S. Army experience

Intraocular lenses are known to be efficacious in the correction of aphakia, but their suitability and durability in Army aviators has not been previously evaluated. Eight experienced pilots (preoperative flight time average: 7,660 hours), who had intraocular lens implants following removal of cataractus lenses, were studied. All had returned to flight duty, seven as pilots, with a total of 2,700 hours postoperative flight time accumulated. All were very pleased with the surgery and with the effectiveness of their lenses. Minor problems included: halos around lights in low illumination (5/8 pilots), erythropsia (2/8), and difficulties with a fixed focal length (2/8). Two aviators reported significant visual problems: complications associated with a platinum loop iris supported intraocular lens, and discomfort and glare stemming from traumatic corneal scarring. A detailed ophthalmological examination revealed abnormalities (5/8 pilots), but none which would be directly attributed to flying. Modern intraocular lenses appear to be an acceptable means of correcting aphakia in Army aviators.     

Human factors analysis of accidents involving visual flight rules flight into adverse weather

BACKGROUND: General aviation (GA) accident statistics indicate that visual flight rules (VFR) flight into instrument meteorological conditions (IMC) is a major safety hazard. However, little research has been conducted to identify the factors that influence VFR pilots' decisions to risk flying into deteriorating weather. The purpose of the present study was to further examine the causes of GA accidents associated with VFR flight into IMC. METHOD: A comprehensive review of GA accident reports maintained by the National Transportation Safety Board (NTSB) was conducted to identify accidents involving VFR flight into IMC between January 1990 and December 1997. These accidents were compared with other GA accidents that occurred during the same time period. RESULTS: Analyses of these accidents revealed that VFR flight into IMC accidents were more likely to involve less-experienced pilots and to have passengers aboard the accident aircraft compared with the other GA accidents. In addition, most VFR flight into IMC accidents were considered by the NTSB to have involved intentional flight into adverse weather by the pilot. DISCUSSION: These findings are interpreted in terms of their implications for the underlying causes of VFR flight into IMC, including situation assessment, risk perception, and social pressure. Intervention programs that address all of these factors are needed.     

Ultralight aviation accident factors and latent failures: a 66-case study

INTRODUCTION: Little research has been done on ultralight aviation accidents. A better understanding of accident factors allows for better development of preventive measures. This study analyzes ultralight accidents with respect to significant factors related to active and latent failures, as referred to in Reason's Swiss cheese model of human error. METHODS: There were 66 National Transportation Safety Board (NTSB) ultralight accident reports that were examined from 1985-2004. Contextual information about active and latent failures was identified, compiled, and cross-referenced with pilot, aircraft, and accident information for evidence of significant relationships. RESULTS: Pilots with less than 40 make/model-specific flying hours were significantly more likely to crash fatally (chi2 = 9.07; p < 0.005; df=1) than other pilots and/or because of losing control (chi2 = 7.24; p < 0.05; df=1) than other accident causes. In contrast, pilots with 40 or more make/model-specific flying hours were significantly more likely to crash as a result of engine failure (chi2 = 9.33; p < 0.005; df = 1). Loss of control as an active failure was usually associated with such latent failures as strong winds and insufficient mission planning, while the engine failure accidents involved inadequate maintenance. CONCLUSION: In order to reduce accident prevalence, ultralight self-regulation organizations should focus on training in mission planning, aircraft familiarity, and proper maintenance procedures. Further research should concentrate on explaining the prevalence of the active and latent failures shown here and determining the effects of the FAA's new light sport aircraft category.     

飞行人员胆囊结石特点（4218名飞行人员临床调查）

为了了解飞行人员胆囊结石发病、诊治情况、临床特点以及对飞行安全影响等，我们于１９９５年５ 月至 １９９７ 年５ 月随机对４２１８ 名飞行人员进行了临床调查。结果：４２１８ 名中发现胆囊结石患者１８９例，患病率为 ４．５％ 。临床特点：男性多（１８５ 例占 ９７．８％ ）；４０ 岁以上者多（１４３ 例占７５．７％ ）；单纯胆囊结石多（１６８ 例占８８．８％ ）；胆囊多发结石多（１４４ 例占 ７６．２％ ）；有症状胆囊结石多（１１０ 例占 ５８．２％ ）；带石飞行多（１０４ 例占５５．０２％ ）；手术治疗少（７０ 例占３７．０３％ ）。临床调查证实：胆囊切除术是治疗飞行人员胆囊结石安全、可靠、有效的方法，术后能够达到飞行合格标准。结论：对空军飞行人员和民航驾驶员的胆囊结石不论有无症状，在恢复飞行之前必须施行航空医学性胆囊切除术以保障飞行安全     

特发性一侧前庭功能异常与航空航天飞行

目的　探讨特发性一侧性前庭功能异常与航空航天飞行的关系。　方法　分析30例飞行人员特发性一侧前庭功能异常的病例。　结果　右前庭功能减弱者19例，左前庭功能减弱者9例，左前庭功能丧失者2例；11例飞行合格，19例永久停飞。　结论　一侧前庭功能异常可因飞行错觉和/或运动病反应而危及飞行安全；航空航天飞行也能诱发或加重前庭功能损害。     

The occurrence of the vection illusion among helicopter pilots while flying over water

U.S. Coast Guard helicopter pilots were questioned on the occurrence of the vection illusion while flying over water under different light and sea conditions. A total of 267 (79.9%) pilots completed the study questionnaire. The illusion of vection was experienced by 248 (92.5%) of these pilots. The majority of the pilots, 209 (84.6%), reported that dark rather than light visual conditions increased the likelihood of experiencing vection. Vection was considered likely to occur over rough seas by more pilots [114 (46.2%)] then over smooth seas [81 (37.8%)]. Several pilots commented that they had responded to the illusion with aircraft movement. The vection illusion is a common experience among helicopter pilots while flying over open water. Low light conditions and rough sea states are conducive to experiencing the vection illusion. Pilots may respond to the illusion with aircraft control movements, which raises flight safety concerns.     

A multisite study of Air Force outpatient behavioral health treatment-seeking patterns and career impact

This study examined 1,068 cases of active duty Air Force service members seen in eight Air Force outpatient mental health clinics during a 1-year period. Age, gender, rank, marital status, special duty status, diagnostic category, treatment completion, and recommendations to the member's unit were examined across referral sources (i.e., self-referred, supervisor-referred, or commander-directed). Results showed significant differences across all variables, with self-referred members being more likely to be older, single, higher ranking, and without special duty status, as well as to have a less significant axis I diagnosis. Self-referred members were less likely to have confidentiality broken and to have career-affecting recommendations made. The implications of these findings, in terms of targeting interventions to increase self-initiated help-seeking behavior, and recommendations for future research are discussed.     

首批女歼击机飞行员心理健康状况调查与分析

目的探讨首批歼击机女飞行员心理健康状况,为制定相应的心理卫生保障措施作参考。方法采用症状自评量表(SCL-90)对空军某飞行学院女歼击机飞行员16例进行心理健康测评,并与中国男飞行员、军校女学员、中国军人常模以及中国成年人常模比较。结果女飞行员未检出阳性例数,男性检出阳性5例,占该院受调查男飞行员的31.3%,无因子分值≥3分者。男女飞行员之间恐怖因子分值没有差异(P>0.05);女飞行员SCL-90总分、阳性项目数、阳性项目平均分及各因子分值均显著低于中国男飞行员、军校女学员、中国军人常模或中国成年人常模(P<0.01)。结论歼击机女飞行学员心理健康水平总体良好,优于男飞行学员,为其高难飞行课目训练奠定了良好的心理基础。     

甲状腺彩色超声检查在飞行员健康体检中的临床价值

目的 调查飞行员甲状腺彩色超声检查结果及鉴定情况,为航空卫生保障提供依据.方法 回顾分析在解放军第四五六医院因健康体检行甲状腺彩色超声检查的629名飞行员的超声检查结果、病理诊断以及医学鉴定情况,并进行统计学分析. 结果 ①629名飞行员中,检出甲状腺疾病139例,阳性率22.10％.②随年龄增长,飞行员甲状腺疾病发病率逐步增高（x2=35.564,P＜0.01）.③甲状腺疾病与飞行员所飞机种无关.④139例患甲状腺疾病的飞行员中飞行合格124例,其中桥本甲状腺炎6例,急性/亚急性甲状腺炎4例;暂时飞行不合格13例,其中原发性甲状腺功能亢进2例,桥本甲状腺炎合并甲状腺功能亢进3例,甲状腺腺瘤术后5例;飞行不合格（停飞）2例,均为甲状腺癌. 结论 结节性甲状腺肿在飞行人员中较常见,对飞行安全无明显影响.甲状腺癌及继发性甲状腺功能亢进患病率有增加趋势,且对飞行安全有着直接或间接影响,应加强预防和早期治疗.甲状腺彩色超声检查对甲状腺疾病的早发现、早诊断、早治疗具有重要意义.     

Pilots' perception of risks and hazards in general aviation

A sample of licensed pilots completed the Aeronautical Risk Judgment Questionnaire (ARJQ) which was developed to obtain data on pilots' perceptions of their abilities, willingness to take risks, hazard awareness, and judgments of the risks of general aviation. A subset of these subjects was tested on a computerised test of flight decision-making involving a proposed VFR flight in marginal weather conditions. Results from the ARJQ indicate relatively low levels of risk and hazard awareness combined with a generally optimistic self-appraisal of abilities by this sample of general aviation pilots. Younger subjects (under 30) were found to rate the likelihood of being involved in an accident more highly than did older pilots. Experienced pilots obtained higher scores on a measure of "personal invulnerability" from factors commonly associated with accidents. This does not appear to be due simply to overconfidence in their abilities, since it was the younger and less experienced pilots who held the most unrealistically optimistic appraisals of their ability. Pilots who proceeded with the computerised flight rate themselves as having a greater willingness to take risks, and were likely to be younger and have higher total hours than those who rejected the flight. They were also found to have significantly higher scores on the measure of "personal invulnerability." The results are discussed in relation to previous epidemiological findings and possible safety prevention strategies.     

Hazards of mountain flying: crashes in the Colorado Rockies

Between 1964 and 1987, 232 airplanes crashed within 50 nautical miles of Aspen, CO; 90% were general aviation crashes. A total of 202 people died and 69 were seriously injured. The societal cost averaged more than $4 million annually. Most pilots were experienced and many were flight instructors, but 44% had flown less than 100 hours in the type of plane in which they crashed. Forty-one percent of the pilots were out-of-state residents. Crashes in the study area were more likely to be fatal than in the rest of Colorado. Airplanes with three or four occupants and low-powered four-seater aircraft were over-represented among crashes involving failure to outclimb rising terrain. In a subset of crashes examined for restraint use, 50% of the front seat occupants using only lap belts were killed, compared to 13% of those who also wore shoulder restraints. Preventive recommendations include shoulder restraint use and better training in mountain flying, with incentives provided by the FAA and insurance companies.