Emergency drug usage during flight and airline safety management for passengers.

During flight, passengers may experience aviation-related symptoms such as headache, nausea, respiratory failure, and panic disorders. To treat patients with these symptoms, emergency drugs are prepared in the cabin and crews treat patients according taking into account usage and dose guidelines described on the drug containers. However, certain types of drugs are limited and not adequately prepared in the cabin. The aim of this study was to examine (1) emergency drugs used during flight and frequency of symptoms experienced in passengers and (2) cognizance of drug usage among crews was also determined in low-cost carriers. Most frequent symptoms recorded were headache (74.1%), abdominal pain (72.3%), nausea (70.5%), and ear pain (60.7%). Panic disorder (50.9%) is the fifth frequent syndrome in passengers, but emergency drugs are not available for this condition in the cabin. The cognizance survey showed that 21% of crews out of 112 who responded were not interested in usage guidelines of emergency drugs or simply ignored. Thirty-seven percent of crews failed to pay attention to drug expiration dates. Our findings suggest that crews need to be better trained for preparation and usage of emergency drugs in the cabin for passengers suffering from various symptoms. Further, it is recommended that airline companies need to consider to improve the emergency drug management system by requesting training from pharmacists and doctors for safe drug usage.

BASE Jumping Injuries Presenting to Emergency Departments in the United States: an Assessment of Morbidity, Emergency Department, and Inpatient Costs.

BACKGROUND: BASE (building, antenna, span, earth) jumping involves jumping from fixed objects with specialized parachutes. BASE jumping is associated with less aerodynamic control and flight stability than skydiving because of the lower altitude of jumps. Injuries and fatalities are often attributed to bad landings and object collision. METHODS: We performed a retrospective analysis of the 2010-2014 National Emergency Department Sample database, a nationally representative sample of all visits to US emergency departments (EDs). BASE jumping-associated injuries were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes [E004.0]. Outcomes evaluated included morbidity, mortality, inpatient admission, and costs. Adjusted analyses accounting for survey methodology were performed. RESULTS: After weighting, 1790 BASE-associated ED presentations were identified with 358±28 injuries annually. A total of 1313 patients (73%) were aged 18 to 44 y, and 1277 (71%) were male. Nine hundred seventy-six (55%) multiple body system injuries and 677 (38%) isolated extremity injuries were reported. There were 1588 (89%) patients discharged home from the ED; only 144 (7%) were admitted as inpatients. On multivariate logistic regression, only anatomic site of injury was associated with inpatient admission (odds ratio=0.6, P<0.001, 95% CI 0.5-0.8). Including ED and inpatient costs, BASE injuries cost the US healthcare system approximately $1.7 million annually. No deaths were identified within the limitations of the survey design. CONCLUSIONS: Although deemed one of the most dangerous extreme sports, many patients with BASE injuries surviving to arrival at definitive medical care do not require inpatient admission.

A Method of Applying Flight Data to Evaluate Landing Operation Performance.

Pilots' operation has an important effect on flight safety and performance, particularly in the final landing stage when pilots need to deal with complicated operations. This study aims to determine the potential value of flight data and develop a method of evaluating a pilot's performance during landing phase based on flight quick access recorder (QAR) data from the perspective of risk assessment. First, a Landing Operation Performance Evaluation Model was developed based on risk evaluation principles. Three landing parameters, which are touchdown distance, touchdown vertical acceleration and touchdown pitch angle, were selected as indicators to evaluate the pilots' landing operation performance in this model. Second, the flight landing operation performance evaluation system (FLOPES) was set up based on the evaluation model. Test results showed that FLOPES can accomplish all calculation flow of operation performance evaluation. Finally, it concluded that this method is a more accurate and effective way for evaluating the landing operation performance of a flight. It could be as a practical tool for airlines to manage landing risk quantitatively and to provide a more practical support for improving training and design in aviation.Practitioner summary: This study aims to determine the potential value of flight data and to develop a method of evaluating pilot's landing operation performance from the risk evaluation perspective. Test results showed that this method is effective and could be as a practical tool for airlines to manage landing risk and improve training.Abbreviations:QAR: Quick Access Recorder; FLOPES: Flight Landing Operation Performance Evaluation System; ICAO: International Civil Aviation Organization; IATA: International Air Transport Association; SMS: Safety Management System; CAAC: Civil Aviation Administration of China; FOQA: Flight Operations Quality Assurance; VBA: Visual Basic for Applications.

Comparison of NASA-TLX scale, modified Cooper-Harper scale and mean inter-beat interval as measures of pilot mental workload during simulated flight tasks.

The sensitivity of NASA-TLX scale, modified Cooper-Harper (MCH) scale and the mean inter-beat interval (IBI) of successive heart beats, as measures of pilot mental workload (MWL), were evaluated in a flight training device (FTD). Operational F/A-18C pilots flew instrument approaches with varying task loads. Pilots' performance, subjective MWL ratings and IBI were measured. Based on the pilots' performance, three performance categories were formed; high-, medium- and low-performance. Values of the subjective rating scales and IBI were compared between categories. It was found that all measures were able to differentiate most task conditions and there was a strong, positive correlation between NASA-TLX and MCH scale. An explicit link between IBI, NASA-TLX, MCH and performance was demonstrated. While NASA-TLX, MCH and IBI have all been previously used to measure MWL, this study is the first one to investigate their association in a modern FTD, using a realistic flying mission and operational pilots. Practitioner summary: NASA-TLX scale, MCH scale and the IBI were evaluated in a flight training device. All measures were able to differentiate most task conditions and there was a positive correlation between NASA-TLX and MCH scale. An explicit link between IBI, NASA-TLX, MCH and performance was demonstrated. Abbreviations: ANOVA: Analysis of Variance; ECG: Electrocardiograph; F/A: fighter/attack; ft: feet; FTD: flight training device; G: Gravity; km: kilometer; m: meter; m/s: meters per second; MWL: mental workload; MCH: modified cooper-harper; NASA-TLX: NASA Task Load Index; NM: Nautical Mile; NN: normal-to-normal; IBI: inter-beat interval; ILS: Instrument Landing System; RR: R-Wave to R-Wave; SD: standard deviation; TTP: tactics, techniques and procedures; WTSAT: Weapon Tactics and Situation Awareness Trainer.

What went right? An analysis of the protective factors in aviation near misses.

Learning from successful safety outcomes, or what went right, is an important emerging component of maintaining safe systems. Accordingly, there are increasing calls to study normal performance in near misses as a part of safety management activities. Despite this, there is limited guidance on how to accomplish this in practice. This article presents a study in which using Rasmussen's risk management framework to analyse 16 serious incidents from the aviation domain. The findings show that a network of protective factors prevents accidents with factors identified across the sociotechnical system. These protective networks share many properties with those identified in accidents. The article demonstrates that is possible to identify these networks of protective factors from incident investigation reports. The theoretical implications of these results and future research opportunities are discussed. Practitioner Statement: The analysis of near misses is an important part of safety management activities. This article demonstrates that Rasmussen?s risk management framework can be used to identify networks of protective factors which prevent accidents. Safety practitioners can use the framework described to discover and support the system-wide networks of protective factors.

Understanding Human Error in Naval Aviation Mishaps.

OBJECTIVE: To better understand the external factors that influence the performance and decisions of aviators involved in Naval aviation mishaps. BACKGROUND: Mishaps in complex activities, ranging from aviation to nuclear power operations, are often the result of interactions between multiple components within an organization. The Naval aviation mishap database contains relevant information, both in quantitative statistics and qualitative reports, that permits analysis of such interactions to identify how the working atmosphere influences aviator performance and judgment. METHOD: Results from 95 severe Naval aviation mishaps that occurred from 2011 through 2016 were analyzed using Bayes' theorem probability formula. Then a content analysis was performed on a subset of relevant mishap reports. RESULTS: Out of the 14 latent factors analyzed, the Bayes' application identified 6 that impacted specific aspects of aviator behavior during mishaps. Technological environment, misperceptions, and mental awareness impacted basic aviation skills. The remaining 3 factors were used to inform a content analysis of the contextual information within mishap reports. Teamwork failures were the result of plan continuation aggravated by diffused responsibility. Resource limitations and risk management deficiencies impacted judgments made by squadron commanders. CONCLUSION: The application of Bayes' theorem to historical mishap data revealed the role of latent factors within Naval aviation mishaps. Teamwork failures were seen to be considerably damaging to both aviator skill and judgment. APPLICATION: Both the methods and findings have direct application for organizations interested in understanding the relationships between external factors and human error. It presents real-world evidence to promote effective safety decisions.

Common mental disorders among US army aviation personnel: Prevalence and return to duty.

OBJECTIVES: Assess the prevalence of US Army aviation personnel with common mental disorders, the percentage that return to duty following mental health treatment, and predictors of return to duty. METHODS: Examined the prevalence over a 5-year period. The percentage of personnel who were granted a waiver to return to flying duty following treatment was also determined. RESULTS: The results revealed a 5-year prevalence of 0.036 (95% CI = 0.034-0.038) for personnel experiencing one or more of the mental disorders (N = 1,155). Prevalence was highest for adjustment disorders and for nonpilot participants. Overall, personnel were granted a waiver 55.3% of the time and suspended or disqualified 44.7% of the time. Waivers were more likely to be granted for an adjustment disorder and for pilots. CONCLUSIONS: Discussion focuses on the importance of aviation personnel receiving mental health treatment when problems are not severe to maximize the likelihood of returning to duty.

[The prevalence of hearing impairment in transport workers and peculiarities of management of occupational loss of hearing (as exemplified by the situation in the air and railway transport)].

This article presents data on the prevalence of hearing impairment among the workers engaged in the main means of transportation(air and railway transport). They show that the relative frequency of occupational loss of hearing in the cockpit members of commercial aviation amounts to one third of all cases of analogous diseases in this country. The main professional groups of transport works suffering from hearing impairment are constituted by the representatives of the so-called elite specialities, such as flying crew personnel, locomotive engineers, and their assistants. This fact constitutes an important aspect (not only of medical but also of socio-economic significance) of the problem under consideration. The high prevalence of professional hearing impairment among the transport workers is attributable to the high noise level in the cabins of locomotives and aircraft cockpits as well as to the inadequate expert and diagnostic work or imperfection of the regulatory documentation.

Risk Analysis for Unintentional Slide Deployment During Airline Operations.

We present a risk analysis undertaken to mitigate problems in relation to the unintended deployment of slides under normal operations within a commercial airline. This type of incident entails relevant costs for the airline industry. After assessing the likelihood and severity of its consequences, we conclude that such risks need to be managed. We then evaluate the effectiveness of various countermeasures, describing and justifying the chosen ones. We also discuss several issues faced when implementing and communicating the proposed measures, thus fully illustrating the risk analysis process.

[Clinical and hygienic aspects of occupational neurosensory deafness in civil aviation flight personnel].

The article covers implementation of regulatory and legal concepts in prevention of risk caused by hazardous effects of noise in civil aviation flight personnel. The authors analyzed case histories of civil aviation flight personnel patients examined in occupational diseases clinic, with first diagnosed occupational neurosensory deafness.

Mortality among a cohort of U.S. commercial airline cockpit crew.

BACKGROUND: We evaluated mortality among 5,964 former U.S. commercial cockpit crew (pilots and flight engineers). The outcomes of a priori interest were non-chronic lymphocytic leukemia, central nervous system (CNS) cancer (including brain), and malignant melanoma. METHODS: Vital status was ascertained through 2008. Life table and Cox regression analyses were conducted. Cumulative exposure to cosmic radiation was estimated from work history data. RESULTS: Compared to the U.S. general population, mortality from all causes, all cancer, and cardiovascular diseases was decreased, but mortality from aircraft accidents was highly elevated. Mortality was elevated for malignant melanoma but not for non-chronic lymphocytic leukemia. CNS cancer mortality increased with an increase in cumulative radiation dose. CONCLUSIONS: Cockpit crew had a low all-cause, all-cancer, and cardiovascular disease mortality but elevated aircraft accident mortality. Further studies are needed to clarify the risk of CNS and other radiation-associated cancers in relation to cosmic radiation and other workplace exposures.

Comparative clinical and radiographic study of the lumbar spine between parachute infantry soldiers and non-parachute infantry soldiers in Japanese Ground Self-Defense forces.

BACKGROUND: The long-term effect of repetitive trauma by military parachuting on the lumbar spine is not well investigated. Therefore, the purpose of this study was to examine the development of lumbar degenerative changes during a 30-year follow-up in Japanese Ground Self Defense Forces (JGSDF) parachute infantry soldiers with normal lumbar radiographs at entry by comparison with those with non-parachute infantry soldiers. METHODS: 79 non-parachutists and 65 parachutists were included for radiological examination and questionnaires for low back pain (LBP). All subjects were non-commissioned officers with similar socioeconomic status and life styles. The number of parachuting descent during the 30-year in the parachute group ranged from 208 to 630, with an average of 322. RESULTS: The mean age of the subjects was 18.3±0.5 years at entry and 48.5±0.3 years at follow-up. LBP had been experienced by 37% in the non-parachute group and 25% in the parachute group with no significant difference. The nature of their LBP was judged as mild. The prevalence rate of degenerative changes was similar in both groups. Disc space narrowing was detected 37 subjects (47%) in non-parachute group an 23 subjects (35%) in parachute group without significant difference. Vertebral osteophytes were detected in 52 subjects (67%) in non-parachute group and 47 subjects (72%) in parachute group without significant difference. CONCLUSIONS: This study did not identify any significant differences in the development of lumbar degenerative changes between the parachutists and non-parachutists over a 30-year follow-up, suggesting that military parachuting itself does not accelerate the development of intervertebral disc degeneration. Further studies are needed using large cohorts assessed by MRI as well as plain X-ray.

The identification of factors contributing to self-reported anomalies in civil aviation.

The main objective of this study was to analyze anomalies voluntarily reported by pilots in civil aviation sector and identify factors leading to such anomalies. Experimental data were obtained from the NASA aviation safety reporting system (ASRS) database. These data contained a range of text records spanning 30 years of civilian aviation, both commercial (airline operations) and general aviation (private aircraft). Narrative data as well as categorical data were used. The associations between incident contributing factors and self-reported anomalies were investigated using data mining and correspondence analysis. The results revealed that a broadly defined human factors category and weather conditions were the main contributors to self-reported civil aviation anomalies. New associations between identified factors and reported anomaly conditions were also reported.

[The problems of hearing impairment in the flying staff of commercial aviation in Russia].

The authors discuss the problems pertaining to the growing incidence of hearing impairment in the members of the flying staff employed in commercial aviation of Russia and the main criteria used to elucidate the causes behind occupational diseases of the organs of hearing. Special attention is given to the principal normative documents regulating the methodological basis on which the acoustic factor in the aircraft cockpit is evaluated, peculiarities of occupational sensorineural hearing impairment and the methods for its detection. The main errors in the determination of the relationship between the working conditions and the diseases of the organs of hearing are discussed.

The epidemiology of severe and catastrophic injuries in BASE jumping.

OBJECTIVE: To report the demographic characteristics, injury rate, severity, and morbidity in BASE jumping. DESIGN: Cross-sectional survey. SETTING: BASE jumping group meetings from 2006 to 2010. PARTICIPANTS: Heterogenic group of 102 International BASE jumpers. ASSESSMENT OF RISK FACTORS: Injuries reported as function of jumps made, jumping days, age, experience, and sex. MAIN OUTCOME MEASURES: Incidence, severity, and type of injuries. RESULTS: Responses from 68 subjects were available for analysis. The median number of jumps was estimated at 286 per respondent. The median time respondents had participated in BASE jumping was 5.8 years. There were 39 reported severe injuries sustained by 29 different jumpers. Nineteen thousand four hundred ninety-seven jumps were reported, resulting in 2 severe injuries per 1000 jumps (0.2% severe injury rate) or 2.6 severe injuries per 1000 jumping days. Forty-nine respondents (72%) had witnessed the death or serious injury of other participants in the sport. Twenty-four accidents (61%) involved the lower limbs, 8 (20%) the back/spine, 7 (18%) the chest wall, and 5 (13%) were a head injury. The mean Abbreviated Injury Score was 3.2 (range, 2-5). Fifteen (52%) of the 29 injured jumpers required 20 acute surgical interventions, which were mostly orthopedic related. There was a significant correlation between number of jumps made and injuries sustained (P < 0.05). CONCLUSIONS: BASE jumpers have an average of 1 severe injury for every 500 jumps. Most active BASE jumpers have witnessed death or severe injury of a participant and have experienced a "close call" incident.

Flight hours and flight crew performance in commercial aviation.

OBJECTIVE: To examine the relationship between a pilot's flight hours and their performance. BACKGROUND: There is current debate in the aviation industry on the minimum hours required for first officers to gain before they can fly for an airline. Despite years of pilot training and licensing, there are very little data available to determine whether or not pilot performance varies as a function of total hours within an airline environment. METHOD: Flight crew performance was measured during 287 sectors of normal operations against a set of technical and nontechnical measurements. Flightcrew were grouped into a categorical variable which defined low and high experience groups according to industry accepted thresholds. RESULTS: There were no statistically significant differences between experience groups for First Officers or Captains against the set of technical measures; however, there were minor differences with regard to nontechnical measures as a function of crew composition. There was also a difference in automation use, with First Officers with less than 1500 h keeping the autopilot engaged until a significantly lower altitude. DISCUSSION: Despite on-going debate that low-hour First Officers are not as capable as their more experienced colleagues, we found no evidence of this in our study.

Impact of aviation non-CO2 combustion effects on the environmental feasibility of alternative jet fuels.

Alternative fuels represent a potential option for reducing the climate impacts of the aviation sector. The climate impacts of alternatives fuel are traditionally considered as a ratio of life cycle greenhouse gas (GHG) emissions to those of the displaced petroleum product; however, this ignores the climate impacts of the non-CO(2) combustion effects from aircraft in the upper atmosphere. The results of this study show that including non-CO(2) combustion emissions and effects in the life cycle of a Synthetic Paraffinic Kerosene (SPK) fuel can lead to a decrease in the relative merit of the SPK fuel relative to conventional jet fuel. For example, an SPK fuel option with zero life cycle GHG emissions would offer a 100% reduction in GHG emissions but only a 48% reduction in actual climate impact using a 100-year time window and the nominal climate modeling assumption set outlined herein. Therefore, climate change mitigation policies for aviation that rely exclusively on relative well-to-wake life cycle GHG emissions as a proxy for aviation climate impact may overestimate the benefit of alternative fuel use on the global climate system.

In-flight hypoxia events in tactical jet aviation: characteristics compared to normobaric training.

INTRODUCTION: Hypoxia continues to be a significant threat in military aviation. In an attempt to counter the hypoxia threat, military jet aviators receive periodic training using a reduced oxygen breathing device (ROBD). This study explored the characteristics of in-flight hypoxia events among tactical jet aviators and compared reported symptoms to those experienced during ROBD training. METHODS: An anonymous survey was administered to naval aviators prior to aviation physiology training. The survey queried them about previous in-flight hypoxia encounters and the symptoms they experienced. These data were then compared to symptom data from a previous ROBD training survey using Chi-square analyses. RESULTS: Of the 566 aviators who completed the survey, 112 (20%) reported experiencing hypoxia symptoms in a tactical jet aircraft and 64 aviators (57%) indicated they were not wearing the required oxygen mask when the incident first occurred. The results also revealed only 21% of hypoxia events were reported in aviation hazard reports and the three most commonly recorded in-flight hypoxia symptoms were tingling (54%), difficulty concentrating (32%), and dizziness (30%). Chi-square analyses revealed statistically significant differences in frequency of reporting between 5 of 16 symptoms encountered in flight compared to ROBD training. DISCUSSION: The present investigation is the first survey-based study of hypoxia events in U.S. naval aviation. The study reveals in-flight, mask-on hypoxia has a similar overall reported symptom profile to ROBD training. Further, results suggest increased oxygen-mask compliance among these aviators may be necessary to effectively combat in-flight hypoxia.