Asthma and Rotary-Wing Military Aircrew Selection.

BACKGROUND: From a population-based perspective, reports in the peer-reviewed medical literature suggest an increase in the overall prevalence of asthma in recent decades. Applicants for military aviation training with a current or past history of asthma are generally excluded in the United Kingdom.METHODS: In order to assess the impact of the prevalence of asthma on the available pool of military service candidates, the authors collected data on annual live births between 1916 and 2016 as well as peer-reviewed publications that provided insight into asthma prevalence trends within the United Kingdom across the last century (covering birth-year population cohorts ranging from 1924 to 1995). Regression techniques were used to estimate the prevalence of individuals who could reasonably expect to be found unfit for military aviation service due to asthma-like conditions within the birth-year cohorts between 2001 and 2016.RESULTS: Between 1916 and 2016, the number of live births in the United Kingdom has averaged approximately 802,000 per year. The reported prevalence of asthma, based on the assimilated data points, ranged from 2.3 cases per 1000 individuals among the 1924 birth-year cohort, to 29.8 cases per 1000 individuals among the 1990 birth-year cohort.DISCUSSION: Based on the data and analysis presented above, asthma continues to constitute a significant public health issue in the United Kingdom. Military services must base risk mitigation decisions on accurate and precise diagnostic categorizations, and prudently balance the benefits of allowing affected individuals to participate in military service with the potential for mission degradation or compromise.Porter WD, Powell-Dunford N, Wilde GD, Bushby AJR. Asthma and rotary-wing military aircrew selection. Aerosp Med Hum Perform. 2019; 90(7):606-612.

Safety Implications of 6-Month vs. 1-Year First-Class Aeromedical Certificates.

INTRODUCTION: This study explores the safety risk due to delayed detection of hazardous health conditions that would result from increasing the duration of U.S. first-class aeromedical certificates from 6 mo to 12 mo for pilots ages 40 yr old through 60 yr old.METHODS: All pilots who submitted a U.S. first-class application in 2014 with no electrocardiogram and with the previous exams 4.5 to 7.5 mo prior were selected from the FAA pilot medical database. Proportions of Federal Aviation Administration (FAA) denial pathology codes and Aviation Medical Examiner (AME) deferrals were compared for these exams within and between age groups from 40 yr old through 75 yr old. The absolute incidence rates for delayed detection were calculated and relative incidence of these proportions was compared graphically.RESULTS: The relative risk between age groups for delayed identification of disqualifying medical conditions showed that the 56-60-yr-old group would be at about twice the risk as the 40-45-yr-old group. The absolute incidence for the 56-60-yr-old group was 0.46% for denial conditions and 0.60% for AME deferrals over 6 mo.DISCUSSION: Increasing FAA first-class medical certificate duration from 6 mo to 12 mo would put 56-60-yr-old pilots at double the currently accepted risk for delayed detection of significant medical conditions. The absolute risk for this 6-mo delayed identification for the 56-60-yr-old group would average 0.53%.Mills WD, DeJohn CA. Safety implications of 6-month vs. 1-year first-class aeromedical certificates. Aerosp Med Hum Perform. 2019; 90(5):484-487.

Systems Safety Risk Analysis of Fatal Night Helicopter Emergency Medical Service Accidents.

INTRODUCTION: In the United States, the proportion of Helicopter Emergency Medical Service (HEMS) fatal accidents remained unchanged despite an overall decreasing accident rate. Previous research showed night HEMS operations influenced fatal outcomes. Pilots with <6 yr of HEMS domain task experience (low-DTE) had a higher likelihood of a night operational accident in conditions associated with adverse weather. This study sought to determine whether a difference existed between day and night fatal accident rates and identify influences contributing to night fatal HEMS accidents. Any risk factors identified will be used for a risk analysis to inform future operational safety of the night visual flight rule (VFR) HEMS transport system.METHODS: Historical accident data and industry hours were obtained. Both pilot DTE groups (low and high) and mission VFR and instrument flight rule (IFR) capability were identified using data from 32 night VFR operational fatal HEMS accidents. Accidents were stratified by loss of control and controlled flight into terrain, pilot DTE, and flight rule capability. The effectiveness of both DTE groups and both flight rule capabilities were measured using system safety risk analysis techniques.RESULTS: Night fatal accident rates were statistically different from daytime. Low-DTE pilots and the VFR capability combination had the highest likelihood of night operational nonsurvivable accident.CONCLUSION: Low-DTE pilots and the VFR capability were the least effective mission combination to avoid hazardous conditions at night and maintain spatial orientation, respectively. The analysis identified measures to reduce likelihood of night fatal operational accidents.Aherne BB, Zhang C, Chen WS, Newman DG. Systems safety risk analysis of fatal night Helicopter Emergency Medical Service accidents. Aerosp Med Hum Perform. 2019; 90(4):396-404.

An introduction to aviation cardiology.

The management of cardiovascular disease (CVD) has evolved significantly in the last 20 years; however, the last major publication to address a consensus on the management of CVD in aircrew was published in 1999, following the second European Society of Cardiology conference of aviation cardiology experts. This article outlines an introduction to aviation cardiology and focuses on the broad aviation medicine considerations that are required to manage aircrew appropriately and optimally (both pilots and non-pilot aviation professionals). This and the other articles in this series are born out of a 3 year collaborative working group between international military aviation cardiologists and aviation medicine specialists, many of whom also work with and advise civil aviation authorities, as part of a North Atlantic Treaty Organization (NATO) led initiative to address the occupational ramifications of CVD in aircrew (HFM-251). This article describes the types of aircrew employed in the civil and military aviation profession in the 21st century; the types of aircraft and aviation environment that must be understood when managing aircrew with CVD; the regulatory bodies involved in aircrew licensing and the risk assessment processes that are used in aviation medicine to determine the suitability of aircrew to fly with medical (and specifically cardiovascular) disease; and the ethical, occupational and clinical tensions that exist when managing patients with CVD who are also professional aircrew.

In-flight cardiac arrest and in-flight cardiopulmonary resuscitation during commercial air travel: consensus statement and supplementary treatment guideline from the German Society of Aerospace Medicine (DGLRM).

By the end of the year 2016, approximately 3 billion people worldwide travelled by commercial air transport. Between 1 out of 14,000 and 1 out of 50,000 passengers will experience acute medical problems/emergencies during a flight (i.e., in-flight medical emergency). Cardiac arrest accounts for 0.3% of all in-flight medical emergencies. So far, no specific guideline exists for the management and treatment of in-flight cardiac arrest (IFCA). A task force with clinical and investigational expertise in aviation, aviation medicine, and emergency medicine was created to develop a consensus based on scientific evidence and compiled a guideline for the management and treatment of in-flight cardiac arrests. Using the GRADE, RAND, and DELPHI methods, a systematic literature search was performed in PubMed. Specific recommendations have been developed for the treatment of IFCA. A total of 29 specific recommendations for the treatment and management of in-flight cardiac arrests were generated. The main recommendations included emergency equipments as well as communication of the emergency. Training of the crew is of utmost importance, and should ideally have a focus on CPR in aircraft. The decision for a diversion should be considered very carefully.

Results of AMHP Journal Survey on Open Access.

Day PC. Results of AMHP journal survey on Open Access. Aerospace Med Hum Perform. 2018; 89(1):70-71.

[Military aviation dentistry].

The aim of this article is to introduce the concepts of military aviation dentistry, including facial barotraumas (external otitic barotrauma, barosinusitis and barotitis- media), dental barotrauma, barodontalgia, and dental care for aircrews. Special considerations have to be made when planning restorative, endodontic, prosthodontic and surgical treatment to an aircrew patient. The article supplies the military dental officer with diagnostic and treatment guidelines, and the principles of prevention, periodic examination, and dental-related flight restriction.

US Air Force Behavioral Health Optimization Program: team members' satisfaction and barriers to care.

BACKGROUND: Research has shown significant contribution of integrated behavioural health care; however, less is known about the perceptions of primary care providers towards behavioural health professionals. OBJECTIVE: The current study examined barriers to care and satisfaction with integrated behavioural health care from the perspective of primary care team members. DESIGN: This study utilized archival data from 42 treatment facilities as part of ongoing program evaluation of the Air Force Medical Service's Behavioral Health Optimization Program. SETTING: This study was conducted in a large managed health care organization for active duty military and their families, with specific clinic settings that varied considerably in regards to geographic location, population diversity and size of patient empanelment. STUDY PARTICIPANTS: De-identified archival data on 534 primary care team members were examined. RESULTS: Team members at larger facilities rated access and acuity concerns as greater barriers than those from smaller facilities (t(533) = 2.57, P < 0.05). Primary Care Managers (PCMs) not only identified more barriers to integrated care (ß = -0.07, P < 0.01) but also found services more helpful to the primary care team (t(362.52) = 1.97, P = 0.05). Barriers to care negatively impacted perceived helpfulness of integrated care services for patients (ß = -0.12, P < 0.01) and team members, particularly among non-PCMs (ß = -0.11, P < 0.01). CONCLUSIONS: Findings highlight the potential benefits of targeted training that differs in facilities of larger empanelment and is mindful of team members' individual roles in a Patient Centered Medical Home. In particular, although generally few barriers were perceived, given the impact these barriers have on perception of care, efforts should be made to decrease perceived barriers to integrated behavioural health care among non-PCM team members.