Development of effective human factors interventions for aviation safety management.

Introduction: In the aviation industry, safety management has moved away from capturing frontline failures toward the management of systemic conditions through organizational safety management systems (SMS). However, subjective differences can influence the classification of active failures and their associated systemic precursors. With levels of professional experience known to influence safety attitudes, the present research examines whether experience levels among airline pilots had an impact on the classification of causal factors using the Human Factors Analysis and Classification System (HFACS). Differences in the paths of association between categories were evaluated in an open-system context. Method: Pilots working in a large, international airline were categorized into high (≥10,000 total flight hours) and low (<10,000 h) experience groups and asked to classify aircraft accident causal factors using the HFACS framework. One-way ANOVA tests were carried out to determine experience effects on the utilization of the HFACS categories, and chi-squared analyses were used to assess the strength of association between different categories within the framework. Results: Results from 144 valid responses revealed differences in the attribution of human factors conditions. The high experience group was more inclined to attribute deficiencies to high-level precursors and found fewer paths of associations between different categories. In contrast, the low experience group presented a greater number of associations and was comparatively more affected by stress and uncertainty conditions. Discussion: The results confirm that the classification of safety factors can be influenced by professional experience, with hierarchical power distance impacting the attribution of failures to higher-level organizational faults. Different paths of association between the two groups also suggest that safety interventions can be targeted through different entry points. Where multiple latent conditions are associated, the selection of safety interventions should be made with consideration of the concerns, influences, and actions across the entire system. Higher-level anthropological interventions can change the interactive interfaces affecting concerns, influences, and actions across all levels, whereas frontline-level functional interventions are more efficient for failures linked to many precursor categories.

Communicating social responsibilities through CSR reports: Comparative study of top European and Asia-Pacific airlines.

Recently the outbreak of major social incidents has put the airline industry in the forefront of the debate. However, studies related to the social dimension of the Global Reporting Initiative (GRI) Standards in aviation are limited. To fill the gap, this study explored the social themes of corporate social responsibility (CSR) practices between European and Asia-Pacific based airlines. Quantitative content analysis is employed for comparing the social topics in CSR reports of 20 top airlines from Asia-Pacific and European regions over a 3-year period. It concludes that both regions focused more on labor management relations and supplier assessment. The Asia-Pacific airlines have placed special attention to adequacy of social information provided in their CSR reports while the European airlines kept reporting with a comprehensive method. This paper informs both academics and practitioners on the differences of the social dimension of sustainability between the European and Asia-Pacific aviation industry.

Cabin crew health and fitness-to-fly: Opportunities for re-evaluation amid COVID-19.

Aircrew fitness-to-fly is among the elements that make aviation the safest form of long-distance transport. The health of cabin crew is a crucial determinant in carrying out safety-related duties. 'Fitness-to-fly' is associated with defined workplace conditions, for which airlines have a legal duty to ensure fitness for employment. We explored the literature on fitness-to-fly to obtain a pragmatic assessment of the challenges for aeromedical examinations. Regulations promulgated by aviation regulatory authorities and airline-internal policies have similar status and meaning, yet there is no harmonised approach internationally, and an inability to conform periodic medical assessments to actual operational fitness. The COVID-19 pandemic has highlighted the need to better understand fitness-to-fly criteria. Fitness-to-fly measures are mainly based on self-reported data and there is a need for a 'safety' factor for self-reports. Aeromedical evaluations should evolve from meeting medical standards to include pandemics as an element of the overall risk of aircraft operations. Re-evaluating criteria for fitness-to-fly assessment will further the goal of linking research to the actual needs of public health decisionmakers. If airlines are to resume operations at pre-pandemic levels, they must demonstrate to the public and public health agencies that fitness-to-fly assessment is appropriate and effective.

Technological innovation of Continuous Glucose Monitoring (CGM) as a tool for commercial aviation pilots with insulin-treated diabetes and stakeholders/regulators: A new chance to improve the directives?

Civil aviation pilots who develop insulin-treated diabetes and want to renew a Commercial Pilot License (CPL) represent a medical, social and regulatory problem. This depends on justified concerns about hypoglycemia, the most threatening event for people who carry out jobs requiring a high level of concentration and reliability. This negatively affects social and working aspects of pilots' lives, who have a high profile and a high-cost professional qualification. It could be possible now to revise this attitude thanks to the availability of Continuous Glucose Monitoring (CGM) devices. CGM clearly showed to prevent hypoglycemic events in insulin-treated diabetic patients by allowing strict monitoring and trend prediction of glucose levels. By systematizing available data on such devices and present regulations in CPL issuance worldwide, our review can be used as handy tool for a fruitful discussion among the scientific community, national and international civil aviation regulators, stakeholders and pilots, aimed at evaluating the evidence-based opportunity to revise CPL issuance criteria for insulin-treated diabetic pilots. For the above-mentioned reasons, there are, among the regulatory administrations of Civil Aviation around the globe, several different approaches and limitations set for the subjects with insulin-treated diabetes who want to obtain, or renew, a CPL.

The Episode of National Lockdown in the Pandemic: Air Traffic Restriction as the Control Strategy and Its Impact on Existing Cases and Recovery Rate of Novel Coronavirus Disease in Megacities of China.

OBJECTIVE: The effectiveness of air traffic restriction in containing the spread of infectious diseases is full of controversy in prior literature. In January 2020, the Civil Aviation Administration of China (CAAC) announced air traffic restriction in response to the coronavirus disease (COVID-19) pandemic. This study's aim is to empirically examine the policy effectiveness. METHOD: The data from 2 third-party platforms are used in this investigation. The COVID-19 data from the platform DXY and the air traffic data from Airsavvi are matched to each other. The robust panel regression with controlling city effect and time effect is conducted. RESULTS: The curvilinear relations are found between the air traffic restriction and the existing cases, and the recovery rate (quadratic term = 9.006 and -0.967, respectively). As the strength of air traffic restriction is growing, the negative effect (-8.146) of air traffic restriction on the existing cases and the positive effect (0.961) of air traffic restriction on the recovery rate, respectively, begin decreasing. CONCLUSION: On the macro level, the air traffic restriction may help alleviate the growth of existing cases and help raise the recovery rate of COVID-19 in megacities of China, but both these effects will marginally recede as the restriction strength is intensifying.

Incidence and risk factors associated with injuries during static line parachute training in Royal Thai Army.

BACKGROUND: Incidence and risk factors of parachute injuries has been studied in developed countries, but not in trainees of the airborne forces in the Royal Thailand Army. METHODS: A prospective cohort study was conducted among 992 military personnel who attended the basic airborne training program from February to July 2018. Information sheets were used to collect data about (a) personal demographics; (b) environmental conditions surrounding the parachute practice; and (c) parachute-related injuries. The incidence rate of injury was then calculated. Risk factors were examined using multilevel Poisson regression analysis and presented as incidence rate ratio (IRR) and 95% confidence interval (95% CI). RESULTS: A total of 166 parachute-related injuries occurred in 4677 jumps. The incidence rate of injury was 35.50 per 1000 jumps (95%CI: 30.04-41.21). Factors significantly related to parachute injury included: jumping with equipment versus without equipment [adjusted IRR (95% CI): 1.28 (0.88-1.87)], higher wind speed [1.54 (1.27-1.87) per knot], airplane versus helicopter exit [1.75(0.68-4.55)], side versus rear exit [2.13 (1.43-3.23)], night versus day jumping [2.19 (0.81-5.90)], and presence of motion sickness [3.43 (1.93-6.92)]. CONCLUSIONS: To prevent military static line parachute injuries, the following factors should be taken into consideration: type of aircraft, aircraft exit, time of the day, equipment, motion sickness and wind speed. TRIAL REGISTRATION: The project was certified by the Research Ethics Committee, Faculty of Medicine, Chulalongkorn University (IRB No. 697/60).

Selected Aspects of Navigation System Synthesis for Increased Flight Safety, Protection of Human Lives, and Health.

Accurate navigation systems allow us to optimize the trajectory of flying objects and thus solve environmental problems in aviation and their impact on public health. In this paper, we present one of the methods of assessment of accuracy and resistance to interference of distance-measuring equipment (DME). By using computer technology, the method enables us to determine the potential but also the real error measuring the distance of the flying object from DME. The credibility of the respective results of the solution on the task of DME optimal rangefinder synthesis depends on the accuracy of the previous data used, i.e., mathematical models of the respective flying objects flight dynamics, useful signals, and their parameters and interference. DME systems have an impact on air transport safety, and therefore the impact of interference on their operation must be investigated.

Aviation-Style Computerized Surgical Safety Checklist Displayed on a Large Screen and Operated by the Anesthesia Provider Improves Checklist Performance.

BACKGROUND: Many hospitals have implemented surgical safety checklists based on the World Health Organization surgical safety checklist, which was associated with improved outcomes. However, the execution of the checklists is frequently incomplete. We reasoned that aviation-style computerized checklist displayed onto large, centrally located screen and operated by the anesthesia provider would improve the performance of surgical safety checklist. METHODS: We performed a prospective before and after observational study to evaluate the effect of a computerized surgical safety checklist system on checklist performance. We created checklist software and translated our 4-part surgical safety checklist from wall poster into an aviation-style computerized format displayed onto a large, centrally located screen and operated by the anesthesia provider. Direct observers recorded performance of the first part of the surgical safety checklist that was initiated before anesthetic induction, including completion of each checklist item, provider participation and distraction level, resistance to use of the checklist, and the time required for checklist completion before and after checklist system implementation. We compared trends of the proportions of cases with 100% surgical safety checklist completion over time between pre- and postintervention periods and assessed for a jump at the start of intervention using segmented logistic regression model while controlling for potential confounding variables. RESULTS: A total of 671 cases were observed before and 547 cases were observed after implementation of the computerized surgical safety checklist system. The proportion of cases in which all of the items of the surgical safety checklist were completed significantly increased from 2.1% to 86.3% after the computerized checklist system implementation (P < .001). Before computerized checklist system implementation, 488 of 671 (72.7%) cases had <75% of checklist items completed, whereas after a computerized checklist system implementation, only 3 of 547 (0.5%) cases had <75% of checklist items completed. CONCLUSIONS: The implementation of a computerized surgical safety checklist system resulted in an improvement in checklist performance.

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.

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.

Analysis of development and evolution rules of civil aviation in China based on life cycle theory.

The development of CAAC began in the early days of 1949. From a comparatively less popular means of transport to the world's second largest by volume, this means of transport has undergone major and minor changes in the last 70 years. It is not known whether there are significant laws in the process of development. For this reason, we analyze the statistical indicators of the development of civil aviation transport and select representative indicators, namely, the total turnover of transport, the number of routes, the number of aircraft, the number of transport aircraft, and the number of domestic city connections. At the same time, the life cycle theory is introduced, and the typical growth curve model is used to fit the data. It is found that the evolution life cycle of civil aviation in China can be divided into three stages: the first life cycle stage from 1950 to 1981, the second from 1982 to 2003, and the third from 2004 to 2017. Each life cycle follows the growth characteristics of occurrence, growth and maturity, and each life cycle has a time range of approximately 30 years. At present, China's civil aviation industry is in the period of rapid growth in the third life cycle. This industry is expected to reach maturity in approximately 2026 and then to begin to grow slowly. Relevant departments can adopt corresponding development strategies to guide the smooth development of civil aviation in accordance with the growth law of the development and evolution life cycle of civil aviation in China.

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.

Evaluating non-technical skills and mission essential competencies of pilots in military aviation environments.

To develop and validate a classification of non-technical skills (NTS) in military aviation, a study was conducted, using data from real operations of F16 aircraft formations. Phase 1 developed a NTS classification based on the literature review (e.g. NOTECHS) and a workshop with pilots. The Non-TEChnical-MILitary-Skills (NOTEMILS) scheme was tested in Phase 2 in a series of Principal Component Analysis with data from After-Action-Review sessions (i.e. 900 records from a wide range of operations). The NTS were found to make a good prediction of Mission Essential Components (R2 > 0.80) above the effect of experience. Phase 3 undertook a reliability analysis where three raters assessed the NOTEMILS scheme with good results (i.e. all rwg > 0.80). To look into the consistency of classifications, another test indicated that, at least, two out of three raters were in agreement in over 70% of the assessed flight segments. Practitioner Summary: A classification scheme of Non-Technical Skills (NTS) was developed and tested for reliability in military aviation operations. The NTS scheme is a valuable tool for assessing individual and team skills of F-16 pilots in combat. It is noteworthy that the tool had a good capability of predicting Mission Essential Competencies.

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.

Duty of Notification and Aviation Safety-A Study of Fatal Aviation Accidents in the United States in 2015.

After the Germanwings accident, the French Safety Investigation Authority (BEA) recommended that the World Health Organization (WHO) and European Community (EC) develop clear rules for the duty of notification process. Aeromedical practitioners (AMEs) face a dilemma when considering the duty of notification and conflicts between pilot privacy and public and third-party safety. When balancing accountability, knowledge of the duty of notification process, legislation and the clarification of a doctor’s own set of values should be assessed a priori. Relatively little is known of the magnitude of this problem in aviation safety. To address this, the National Transportation Safety Board (NTSB) database was searched to identify fatal accidents during 2015 in the United States in which a deceased pilot used a prescribed medication or had a disease that potentially reduced pilot performance and was not reported to the AME. Altogether, 202 finalized accident reports with toxicology were available from (the year) 2015. In 5% (10/202) of these reports, the pilot had either a medication or a disease not reported to an AME which according to the accident investigation was causal to the fatal accident. In addition, the various approaches to duty of notification in aviation in New Zealand, Finland and Norway are discussed. The process of notification of authorities without a pilot’s express permission needs to be carried out by using a guidance protocol that works within legislation and professional responsibilities to address the pilot and the public, as well as the healthcare provider. Professional guidance defining this duty of notification is urgently needed.