[Aeromedical Decision-Making in Psychiatry]. / Fliegerärztliche Entscheidungsfindung in der Psychiatrie.

This paper reviews aeromedical decision-making in psychiatry. It explains the "one-percent rule", the general medical criteria for fitness for flying and how they are applied to psychiatric disorders.

Letter to the Editors. Professional confidentiality applicable to psychiatrists.

Psychiatrists performing activities under the Mental Health Protection Act who in connection with their performance of such activities become aware of information that, if kept confidential, can constitute a threat to the life or health of the patient or other people, are released from the duty to keep such information confidential. In such a case, they have a moral and legal duty to disclose such information to law enforcement authorities and cannot be prosecuted under criminal law for disclosing such confidential information. An attempt to interrogate a physician who files such a report regarding circumstances of which he became aware while performing activities under the Mental Health Protection Act will, however, be illegal. Yet, that leads to disputes and controversies in the medical and legal communities, and, therefore, the issue requires a prompt, uniform interpretation. Due to the expected increase in attempted dyadic deaths (after the Germanwings plane crash,) the problem should be carefully regulated so that psychiatrists know the legal boundaries of dealing with patients - potential suicides.

Syncope and driving, flying and vocational concerns.

When advising a syncope patient about resumption of driving, flying or vocational activities, physicians must consider relevant laws and regulations, the etiology of the syncope, and the risk of recurrence and the impact of recurrence on the safety of the patient and others. Guidelines from professional cardiology societies may aid the physician. In the United States, private driving is regulated by individual states and their laws show significant variance. Commercial driving and flying are regulated at the federal level. These regulations tend to be more uniform, but are significantly stricter due to the potential risk to the public posed by commercial drivers or pilots with syncope. For many diagnoses, both regulations and professional society recommendations incorporate an observation period following the index syncopal event. This is due to the natural history of syncope recurrence and to allow time to monitor the response to treatment.

Investigation of a fatal airplane crash: autopsy, computed tomography, and injury pattern analysis used to determine who was steering the plane at the time of the accident. A case report.

A fatal accident is reported in which a small single-engine light airplane crashed. The airplane carried two persons in the front seats, both of whom possessed valid pilot certificates. Both victims were subject to autopsy, including post-mortem computed tomography scanning (PMCT) prior to the autopsy. The autopsies showed massive destruction to the bodies of the two victims but did not identify any signs of acute or chronic medical conditions that could explain loss of control of the airplane. PMCT, histological examination, and forensic chemical analysis also failed to identify an explanation for the crash. A detailed review of an airplane identical to the crashed airplane was performed in collaboration with the Danish Accident Investigation Board and the Danish National Police, National Centre of Forensic Services. The injuries were described using the abbreviated injury scale, the injury severity score, 3-dimensional reconstructions of the PMCT, and an injury pattern analysis. We describe how, on basis of these data, we reached a conclusion about which of the two victims was the most likely to have been in control of the airplane at the time of accident. Furthermore, we argue that all victims of fatal airplane crashes should be subject to forensic autopsy, including PMCT and forensic chemical analysis. The continuous accumulation of knowledge about injury patterns from "simple" accidents is the foundation for the correct analysis of "difficult" accidents.

Promoting learning, memory, and transfer in a time-constrained, high hazard environment.

Two methods of metacognitive reflection for promoting compliance with an aviation safety rule were tested in a transfer design. Two groups of pilots (n = 10) conducted a simulated flight entailing a search for a target on the ground. During this flight, only 35% of the pilots stayed above an altitude of 500 ft, the minimum allowed by relevant regulations. Following the flight, one group completed a self-explanation questionnaire, in which they explained their actions during the initial flight and what they would do in future flights. The other group completed a relapse-prevention questionnaire, in which they identified the circumstances leading to safety lapses and their future avoidance. A third group (n = 10) formed a rest control; they conducted a familiarization flight without a ground target or debriefing. One week later, all pilots conducted a series of test flights with the same or different ground targets as the initial flight. The self-explanation group showed 100% compliance when the ground target remained the same, but less so (<70%) when the ground target was different. The relapse-prevention group and control groups both showed low levels of compliance across all test flights (<30%). The results are discussed from theoretical and applied perspectives.

Cabin safety and emergency evacuation: passenger experience of flight CI-120 accident.

Aircraft evacuation effectiveness is a critical but challenging issue in the civil aviation industry. This paper explores the cabin safety perceptions of passengers from their emergency evacuation experiences in an actual aviation accident. A questionnaire survey and in-depth interviews were conducted with China Airlines flight CI-120 passengers. The qualitative and quantitative results provide insights into passengers' views of cabin safety. The in-depth interview results show that passenger safety education requires more instructions about the use of emergency equipment. The data from the passenger perception questionnaire were analyzed using the factor analysis method; the findings indicate that crew assistance and emergency procedures are the most important factors. The results are likely to be of value to the aviation industry when taking into account passenger perceptions in implementing safety programs.

[Medicolegal identification of victims in mass disasters using the example of aircraft accidents]. / Rechtsmedizinische Identifizierungsaufgaben bei Katastrophen am Beispiel von Flugunfällen.

In mass disasters, the main task of the medicolegal expert is to support the victims' identification. As such events are rare, the knowledge obtained during previous operations should be evaluated and published to improve the quality and effectiveness of the identification work in future disasters. This report describes the experience gained at the Institute of Forensic Medicine of the Humboldt University in Berlin during the identification of the victims of three aircraft accidents (1972, 1986, 1989). The advantages and disadvantages of the identification methods used are discussed. Medicolegal experts should make themselves familiar with available experiences to be adequately prepared for the responsible task of identifying the victims in an emergency.

[Causes of death among pilots: "acute myocardial infarction"--are the present examination methods for airworthiness sufficient?]. / Todesfälle bei Piloten: "Der akute Myokardinfarkt"--Sind die derzeitigen Flugtauglichkeitsuntersuchungen ausreichend?

The European Union plans to harmonize the aviation requirements, in particular the flight crew licensing requirements. On 23 May 2007, the German Federal Ministry of Transport, Building and Urban Affairs published the Flight Crew Licensing Requirements, which are based on the Joint Aviation Requirements, Flight Crew Licensing 3, Amendment 5. These guidelines also list the examination methods to be used for testing the medical fitness of pilots. In this Amendment some examinations which were part of the routine tests before JAR-FCL3 became effective have been deleted, e.g. the exercise ECG. This article presents two cases from the autopsy material of the Institute of Legal Medicine in Hanover and discusses the problems associated with the new examination guidelines.

[Medico-legal study on crashes of fighter planes of the National People's Army]. / Rechtsmedizinische Betrachtungen über Abstürze von Jagdflugzeugen der NVA.

In the years 1974 to 1990, 39 pilots died in 34 crashes of fighter planes of the National People's Army; 32 victims were examined forensically. For the present study all autopsy protocols and examination reports available in the German Federal Military Archives in Freiburg could be evaluated. Both officer cadets and experienced pilots of high military ranks were among the victims. The majority of the crashes (24 out of 34) was caused by human failure. Health problems or the use of alcohol and medications did not play a role in the aircraft accidents. All killed pilots were identified. The injury patterns after fatal ejection are different from the patterns seen after impact with a plane. Such patterns of findings are meaningful in the reconstruction of unknown sequences of events leading to the accidents and for the assessment of the pilots' capacity to act at the moment of the incident

Crash rates of scheduled commuter and air carrier flights before and after a regulatory change.

INTRODUCTION: In 1997, in an effort to reduce the crash rate of scheduled commuter flights, the FAA required aircraft with 10-30 passenger seats to operate under stricter rules. Training and other requirements of 14 CFR Part 121 rules were applied to these midsize commuters, which previously had operated under the less strict Part 135 rules. Published crash rates obscured changes related to aircraft size. This research was undertaken to determine whether the rule change affected crash rates of aircraft with 10-30 passenger seats. METHOD: We determined the number of passenger seats on each Part 135 or Part 121 aircraft that crashed between 1983 and 2007. For aircraft with < 10, 10-30, and > 30 seats, we estimated the numbers of departures and crash rates, adjusting for changes in total departures and numbers of in-service aircraft. RESULTS: The Part 135 crash rate tripled in 1997 when commuters with 10-30 seats were excluded, reflecting the administrative change. However, the crash rate of aircraft with 10-30 passenger seats began to decline 4 yr before the rule change; thereafter, their rate was lower than for larger aircraft. The fleet size of aircraft with 10-30 passenger seats increased from 1983 to 1997, then declined as they were replaced with larger aircraft in response to the rule change. DISCUSSION: No effect of the rule change on crash rates of 10-30-seat aircraft was apparent. The decline in their crash rates began before the rule change and may have been related to the 1992 requirement for ground proximity warning devices.

Pilot medical history and medications found in post mortem specimens from aviation accidents.

INTRODUCTION: Federal Aviation Administration (FAA) regulations require pilots to report all medications and medical conditions for review and consideration as to the overall suitability of the pilot for flight activities. METHODS: Specimens were collected by local pathologists from aviation accidents and sent to the Bioaeronautical Sciences Research Laboratory for analysis. The results of such tests were entered into the Forensic Case Management System. This database was searched to identify all pilots found positive for medications used to treat cardiovascular, psychological, or neurological conditions over the period January 1, 1993, through December 31, 2003. RESULTS: Toxicological evaluations were performed on 4143 pilots. Psychotropic drugs were found in 223 pilots. Cardiovascular medications were found in 149 pilots. Neurological medications were found in 15 pilots. Pilots reported psychological conditions in 14 of the 223 pilots found positive for psychotropic drugs. Only 1 of the 14 pilots reporting a psychological condition to the FAA reported the psychotropic medication found after the accident. Cardiovascular disease was reported by 69 of the pilots found with cardiovascular drugs in their system. Cardiovascular medications found in the pilots were reported by 29 of the 69 pilots reporting a cardiovascular condition. Only 1 of the 15 pilots reported having a neurological condition to the FAA; none of the pilots found with neurological medications reported the medication. CONCLUSIONS: Toxicology successfully identified 93% of the medications reported by the pilots. Pilots involved in fatal accidents taking psychotropic or neurological medications rarely reported the medication or their underlying medical condition to the FAA.

[Principles of medical and trace examinations in expert evaluation of transport accident traumas based on roentgenological methods].

Airtraffic and car traumas illustrate possibilities of x-ray methods in expert examination of transport trauma. X-ray data is most important in clarification of traumatic mechanisms and defects on the clothes of the victims which point to the accident details. Further accumulation of the material will allow introduction of more precise assays of the signs assessment.