Monitoring of Low-Level Wind Shear by Ground-based 3D Lidar for Increased Flight Safety, Protection of Human Lives and Health.

Low-level wind shear, i.e., sudden changes in wind speed and/or wind direction up to altitudes of 1600 ft (500 m) above-ground is a hazardous meteorological phenomenon in aviation. It may radically change the aerodynamic circumstances of the flight, particularly during landing and take-off and consequently, it may threaten human lives and the health of passengers, people at the airport and its surrounding areas. The Bratislava Airport, the site of this case study, is one of the few airports worldwide and the first in Central Europe that is equipped with a Doppler lidar system, a perspective remote sensing tool for detecting low-level wind shear. The main objective of this paper was to assess the weather events collected over a period of one year with the occurrences of low-level wind shear situations, such as vertical discontinuities in the wind field, frontal passages and gust fronts to increase the level of flight safety and protect human lives and health. The lidar data were processed by a computer algorithm with the main focus on potential wind shear alerts and microburst alerts, guided by the recommendations of the International Civil Aviation Organisation. In parallel, the selected weather events were analyzed by the nearby located meteorological radar to utilize the strengths of both approaches. Additionally, an evaluation of the lidar capability to scan dynamics of aerosol content above the airport is presented.

Association of Medical Certification Factors with All-Cause Mortality in U.S. Aviators.

INTRODUCTION: The value of aeromedical certification in reducing adverse medical outcomes is an especially important question for this era of increasing flight operations that do not require an FAA medical certificate. The study of this question has previously been thwarted by a lack of information about pilots when their medical certificates are not renewed.METHODS: We matched airmen in the FAA medical certification database to the U.S. Social Security Death Index to identify date of death for deceased pilots. Logistic regression models were used to explore associations of certification data with odds of death while holding a medical certificate and within 4 yr of expiration of a medical certificate.RESULTS: FAA aeromedical waivers were associated with 33% lower odds of death while holding a medical certificate and 35% increased odds of death within 4 yr after expiration of a medical certificate. Denial was associated with 21% increased odds of death in the next 4 yr. Only 13 of 47 medical conditions having significant associations were associated with increased odds of death during certification.DISCUSSION: We found that FAA aeromedical certification reduces the odds of death while holding a medical certificate compared to the 4 yr after certificate expiration. We believe this helps provide a positive answer to the question of whether medical certification reduces medically related events.Mills WD, Greenhaw RM. Association of medical certification factors with all-cause mortality in U.S. aviators. Aerosp Med Hum Perform. 2019; 90(11):938-944.

Equal to or better than: The application of statistical non-inferiority to fatigue risk management.

In December 2014, the Federal Aviation Administration (FAA) completed a major revision of the rules and regulations governing flight and duty time in commercial aviation (Federal Aviation Regulation (FAR) Part 117). Scientists were included in the revision process and provided insights into sleep, sleep loss, the circadian rhythm, and their effects on performance that were incorporated into the new rule. If a planned flight was non-compliant with the regulation, for example if it exceeded flight and duty time limits, it could only be flown under an FAA-approved Fatigue Risk Management System (FRMS) as meeting an Alternative Method of Compliance (AMOC). One method that a flight could qualify as an AMOC is if it could be demonstrated empirically that it was as safe as or safer than a similar flight, designated the Safety Standard Operation (SSO), that was compliant with the regulation. In the present paper, we demonstrate the FRMS process using a comparison between a non-compliant AMOC flight from the US west coast to Australia and a compliant SSO flight from the US west coast to Taiwan. The AMOC was non-compliant because it exceeded the flight time limits in the prescriptive rule. Once a data collection exemption was granted by the FAA, both the outbound and inbound AMOC and SSO routes were studied on four Safety Performance Indicators (SPIs). The SPIs studied were inflight sleep, cognitive performance, self-reported fatigue, and self-reported sleepiness. These measures were made at top of descent (TOD), a critical phase of flight. The study was designed as a paired comparison. Forty volunteer pilots studied flew both the AMOC and the SSO flights for a total of 80 studied flights. Using statistical non-inferiority applied to the AMOC and SSO SPIs, we demonstrated, as required by the new rule, that the US-Australia AMOC flight was "as safe as, or safer than" the US-Taiwan SSO flight. In the context of FRMS, statistical non-inferiority is a concept and technique of great utility, straightforward in application, producing clear visual representations of the findings, and providing a direct answer to the question posed by the regulation - is the AMOC flight "as safe as, or safer than" the SSO.

Systematic assessment of intrinsic factors influencing visual attention performances in air traffic control via clustering algorithm and statistical inference.

The intrinsic factors (IF) influencing visual attention performance (VAP) might cause potential human errors, such as "error/mistake", "forgetting" and "omission". It is a key issue to develop a systematic assessment of IF in order to distinguish the levels of VAP. Motivated by the Stimulus-Response (S-R) model, we take an interactive cancellation test-Neuron Type Test (NTT)-to explore the IF and present the corresponding systematic assessment. The main contributions of this work include three elements: a) modeling the IF on account of attention span, attention stability, distribution-shift of attention with measurable parameters by combining the psychological and statistical concepts; b) proposing quantitative analysis methods for assessing the IF via its computational representation-intrinsic qualities (IQ)-in the sense of computational model; and c) clustering the IQ of air traffic control (ATC) students in the feature space of interest. The response sequences of participants collected with the NTT system are characterized by three parameters: Hurst exponent, normalized number of decisions (NNoD) and error rate of decisions (ERD). The K-means clustering is applied to partition the feature space constructed from practical data of VAP. For the distinguishable clusters, the statistical inference is utilized to refine the assessment of IF. Our comprehensive analysis shows that the IQ can be classified into four levels, i.e., excellent, good, moderate and unqualified, which has a potential application in selecting air traffic controllers subject to reducing the risk of the inadequacy of attention performances in aviation safety management.

Aeromedical Risk Assessment of Pharmaceuticals Using Evidence-Based Medicine.

BACKGROUND: Using concepts from evidence-based medicine, systems theory, and risk assessment, a standardized model was developed to accept or reject medications for use in flight. The model calculates the risk scores of medications, which can then be compared to an organization's acceptable risk tolerance. METHODS: Risk scores for each medication were established by summing the products of incidence rates and severity scores for all published side effects. The incidence of each side effect was obtained in an evidence-based manner and each assigned a severity multiplier. Using statistical analysis of the calculated risk scores of approved medications, an acceptance control chart was generated. RESULTS: Range of calculated risk scores of historically approved medications was 10-9140. Six Sigma Acceptance Control Line was calculated at 1.5 SDs above the mean and was 9822. Risk score range of medications generally felt unsafe was 27,010-41,294. Risk score range of medications under consideration for approval was 986-6863. DISCUSSION: This novel approach to medication approval is the first in aerospace medicine to attempt to combine evidence-based medicine, risk analysis, and control charts to standardize and streamline the medication approval process within an organization. The model was validated by testing against medications generally accepted to be unsafe for use in flight. These medications fell several deviations above the control line. Other medications not yet authorized fall well below the acceptance line and could be considered for approval.

[Employees in high-reliability organizations: systematic selection of personnel as a final criterion]. / Der Mensch in Hochzuverlässigkeitsorganisationen: Systematische Personalauswahl als entscheidendes Kriterium.

Employees represent an important safety factor in high-reliability organizations. The combination of clear organizational structures, a nonpunitive safety culture, and psychological personnel selection guarantee a high level of safety. The cockpit personnel selection process of a major German airline is presented in order to demonstrate a possible transferability into medicine and urology.

Crew fatigue safety performance indicators for fatigue risk management systems.

INTRODUCTION: Implementation of Fatigue Risk Management Systems (FRMS) is gaining momentum; however, agreed safety performance indicators (SPIs) are lacking. This paper proposes an initial set of SPIs based on measures of crewmember sleep, performance, and subjective fatigue and sleepiness, together with methods for interpreting them. METHODS: Data were included from 133 landing crewmembers on 2 long-range and 3 ultra-long-range trips (4-person crews, 3 airlines, 220 flights). Studies had airline, labor, and regulatory support, and underwent independent ethical review. SPIs evaluated preflight and at top of descent (TOD) were: total sleep in the prior 24 h and time awake at duty start and at TOD (actigraphy); subjective sleepiness (Karolinska Sleepiness Scale) and fatigue (Samn-Perelli scale); and psychomotor vigilance task (PVT) performance. Kruskal-Wallis nonparametric ANOVA with post hoc tests was used to identify significant differences between flights for each SPI. RESULTS: Visual and preliminary quantitative comparisons of SPIs between flights were made using box plots and bar graphs. Statistical analyses identified significant differences between flights across a range of SPls. DISCUSSION: In an FRMS, crew fatigue SPIs are envisaged as a decision aid alongside operational SPIs, which need to reflect the relevant causes of fatigue in different operations. We advocate comparing multiple SPIs between flights rather than defining safe/unsafe thresholds on individual SPIs. More comprehensive data sets are needed to identify the operational and biological factors contributing to the differences between flights reported here. Global sharing of an agreed core set of SPIs would greatly facilitate implementation and improvement of FRMS.

Predictive models of safety based on audit findings: Part 2: Measurement of model validity.

Part 1 of this study sequence developed a human factors/ergonomics (HF/E) based classification system (termed HFACS-MA) for safety audit findings and proved its measurement reliability. In Part 2, we used the human error categories of HFACS-MA as predictors of future safety performance. Audit records and monthly safety incident reports from two airlines submitted to their regulatory authority were available for analysis, covering over 6.5 years. Two participants derived consensus results of HF/E errors from the audit reports using HFACS-MA. We adopted Neural Network and Poisson regression methods to establish nonlinear and linear prediction models respectively. These models were tested for the validity of prediction of the safety data, and only Neural Network method resulted in substantially significant predictive ability for each airline. Alternative predictions from counting of audit findings and from time sequence of safety data produced some significant results, but of much smaller magnitude than HFACS-MA. The use of HF/E analysis of audit findings provided proactive predictors of future safety performance in the aviation maintenance field.

Research and guidelines for implementing Fatigue Risk Management Systems for the French regional airlines.

This paper describes research that aims to provide the overall scientific basis for implementation of a Fatigue Risk Management System (FRMS) for French regional airlines. The current research has evaluated the use of different tools and indicators that would be relevant candidates for integration into the FRMS. For the Fatigue Risk Management component, results show that biomathematical models of fatigue are useful tools to help an airline to prevent fatigue related to roster design and for the management of aircrew planning. The Fatigue Safety assurance includes two monitoring processes that have been evaluated during this research: systematic monitoring and focused monitoring. Systematic monitoring consists of the analysis of existing safety indicators such as Air Safety Reports (ASR) and Flight Data Monitoring (FDM). Results show a significant relationship between the hours of work and the frequency of ASR. Results for the FDM analysis show that some events are significantly related to the fatigue risk associated with the hours of works. Focused monitoring includes a website survey and specific in-flight observations and data collection. Sleep and fatigue measurements have been collected from 115 aircrews over 12-day periods (including rest periods). Before morning duties, results show a significant sleep reduction of up to 40% of the aircrews' usual sleep needs leading to a clear increase of fatigue during flights. From these results, specific guidelines are developed to help the airlines to implement the FRMS and for the airworthiness to oversight the implementation of the FRMS process.

Modification of certain medical standards and procedures and duration of certain medical certificates. Final rule.

This rule extends the duration of first- and third-class medical certificates for certain individuals. A first-class medical certificate is required when exercising airline transport pilot privileges and at least a third-class medical certificate when exercising private pilot privileges. Certain conforming amendments to medical certification procedures and some general editorial amendments are also adopted. The intent of this action is to improve the efficiency of the medical certification program and service provided to medical certificate applicants.

Navigating towards improved surgical safety using aviation-based strategies.

Safety practices in the aviation industry are being increasingly adapted to healthcare in an effort to reduce medical errors and patient harm. However, caution should be applied in embracing these practices because of limited experience in surgical disciplines, lack of rigorous research linking these practices to outcome, and fundamental differences between the two industries. Surgeons should have an in-depth understanding of the principles and data supporting aviation-based safety strategies before routinely adopting them. This paper serves as a review of strategies adapted to improve surgical safety, including the following: implementation of crew resource management in training operative teams; incorporation of simulation in training of technical and nontechnical skills; and analysis of contributory factors to errors using surveys, behavioral marker systems, human factors analysis, and incident reporting. Avenues and challenges for future research are also discussed.

Development and validation of Aviation Causal Contributors for Error Reporting Systems (ACCERS).

OBJECTIVE: This investigation sought to develop a reliable and valid classification system for identifying and classifying the underlying causes of pilot errors reported under the Aviation Safety Action Program (ASAP). BACKGROUND: ASAP is a voluntary safety program that air carriers may establish to study pilot and crew performance on the line. In ASAP programs, similar to the Aviation Safety Reporting System, pilots self-report incidents by filing a short text description of the event. The identification of contributors to errors is critical if organizations are to improve human performance, yet it is difficult for analysts to extract this information from text narratives. A taxonomy was needed that could be used by pilots to classify the causes of errors. METHOD: After completing a thorough literature review, pilot interviews and a card-sorting task were conducted in Studies 1 and 2 to develop the initial structure of the Aviation Causal Contributors for Event Reporting Systems (ACCERS) taxonomy. The reliability and utility of ACCERS was then tested in studies 3a and 3b by having pilots independently classify the primary and secondary causes of ASAP reports. RESULTS: The results provided initial evidence for the internal and external validity of ACCERS. Pilots were found to demonstrate adequate levels of agreement with respect to their category classifications. CONCLUSIONS: ACCERS appears to be a useful system for studying human error captured under pilot ASAP reports. Future work should focus on how ACCERS is organized and whether it can be used or modified to classify human error in ASAP programs for other aviation-related job categories such as dispatchers. APPLICATION: Potential applications of this research include systems in which individuals self-report errors and that attempt to extract and classify the causes of those events.

My copilot is a nurse--using crew resource management in the OR.

Crew resource management (CRM) has been used for more than 20 years in the aviation industry to teach individual error countermeasures by developing nontechnical (ie, cognitive, social) skills based on the observed traits of successful individuals and crews. The health care industry began to investigate aviation CRM after the Institute of Medicine's report, To Err is Human: Building a Safer Health System, recommended that medicine adopt aviation's approach to safety and error management. Initial results of implementing CRM in health care arenas have demonstrated reduced adverse outcomes, reduced errors, reduced length of stay, improved nurse retention, and changed attitudes and behaviors toward teamwork.

From aviation to medicine: applying concepts of aviation safety to risk management in ambulatory care.

The development of a medical risk management programme based on the aviation safety approach and its implementation in a large ambulatory healthcare organisation is described. The following key safety principles were applied: (1). errors inevitably occur and usually derive from faulty system design, not from negligence; (2). accident prevention should be an ongoing process based on open and full reporting; (3). major accidents are only the "tip of the iceberg" of processes that indicate possibilities for organisational learning. Reporting physicians were granted immunity, which encouraged open reporting of errors. A telephone "hotline" served the medical staff for direct reporting and receipt of emotional support and medical guidance. Any adverse event which had learning potential was debriefed, while focusing on the human cause of error within a systemic context. Specific recommendations were formulated to rectify processes conducive to error when failures were identified. During the first 5 years of implementation, the aviation safety concept and tools were successfully adapted to ambulatory care, fostering a culture of greater concern for patient safety through risk management while providing support to the medical staff.

Enhancing patient safety through teamwork training.

The effective reduction of medical errors depends on an environment of safety for patients in both clinically-based and systems-oriented arenas. Formal teamwork training is proposed as a systems approach that will achieve these ends. In a study conducted by Dynamics Research Corporation, weaknesses and error patterns in Emergency Department teamwork were assessed, and a prospective evaluation of a formal teamwork training intervention was conducted. Improvements were obtained in five key teamwork measures, and most importantly, clinical errors were significantly reduced.