Factors associated with pilot fatality in work-related aircraft crashes, Alaska, 1990-1999.

Work-related aircraft crashes are the leading cause of occupational fatality in Alaska, with civilian pilots having the highest fatality rate (410/100,000/year). To identify factors affecting survivability, the authors examined work-related aircraft crashes that occurred in Alaska in the 1990s (1990-1999), comparing crashes with pilot fatalities to crashes in which the pilot survived. Using data from National Transportation Safety Board reports, the authors carried out logistic regression analysis with the following variables: age, flight experience, use of a shoulder restraint, weather conditions (visual flight vs. instrument flight), light conditions (daylight vs. darkness), type of aircraft (airplane vs. helicopter), postcrash fire, crash location (airport vs. elsewhere), and state of residence. In the main-effects model, significant associations were found between fatality and postcrash fire (adjusted odds ratio (AOR) = 6.43, 95% confidence interval (CI): 2.38, 17.37), poor weather (AOR = 4.11, 95% CI: 2.15, 7.87), and non-Alaska resident status (AOR = 2.10, 95% CI: 1.05, 4.20). Protective effects were seen for shoulder restraint use (AOR = 0.40, 95% CI: 0.21, 0.77) and daylight versus darkness (AOR = 0.50, 95% CI: 0.25, 0.99). The finding that state of residence was associated with survivability offers new information on pilot survivability in work-related aircraft crashes in Alaska. These results may be useful in targeting safety interventions for pilots who fly occupationally in Alaska or in similar environments.

Alaska's model program for occupational injury prevention: applying surveillance for effective public health practice.

BACKGROUND: NIOSH established its Alaska Field Station in Anchorage, Alaska, in 1991, after identifying Alaska as America's highest-risk state for traumatic worker fatalities. Since then, NIOSH established comprehensive occupational injury surveillance in Alaska, and formed and facilitated interagency working groups (of state and federal agencies) and industry, labor, and professional organizations to address major factors leading to occupational death and injury in the state. STUDY DESIGN: Descriptive epidemiologic study of registry surveillance data obtained via direct on-site investigation of incidents and data-sharing with jurisdictional agencies. METHODS: We established a surveillance system, obtaining information via data-sharing with jurisdictional agencies and from direct on-site investigation of incidents. Also, we collaborate with state and regional government agencies, industry, workers, and non-governmental organizations to develop interventions. RESULTS: During 1991-1999, Alaska experienced a 50-percent overall decline in work-related deaths, including a substantial decline in commercial fishing deaths, and a very sharp decline in helicopter logging-related deaths. These efforts have lead to major national and international government-industry collaborative efforts in improving the safety of helicopter lift operations, and a concomitant improvement in fishing industry mortality rates among workers fishing Alaskan seas. CONCLUSIONS: Using surveillance data as information for action, these collaborative efforts have contributed to reducing Alaska's high occupational fatality rate. This reduction has been most clearly demonstrated in the rapidly expanding helicopter logging industry. The application of surveillance data also has played an important supportive role in the substantial progress made in reducing the mortality rate in Alaska's commercial fishing industry--historically, Alaska's (and America's) most dangerous industry, and the worst killer of Alaskan workers. Results suggest that extending Alaska's approach to occupational injury surveillance and prevention to other parts of the country, and application of these strategies to the entire spectrum of occupational injury hazards, could have a broad impact on reducing occupational injuries.

Is it safe on deck? Fatal and non-fatal workplace injuries among Alaskan commercial fishermen.

BACKGROUND: Commercial fishing in Alaska accounts for an occupational fatality rate that is 28 times the rate for all U.S. workers. Most deaths are attributed to vessel sinking or capsizing. However, many deaths and most non-fatal injuries are not related to vessel loss. This paper describes injuries that occur on the dock or on the fishing vessel. METHODS: Data from fishing fatalities and non-fatal injuries between 1991-1998 were analyzed using the Alaska Occupational Injury Surveillance System and the Alaska Trauma Registry. RESULTS: There were 60 workplace deaths unrelated to vessel loss; most from falls overboard, others from trauma caused by equipment on deck. There were 574 hospitalized injuries, often from falls on deck, entanglement in machinery, or being struck by an object. SUMMARY: Fishing boats are hazardous working environments. Further efforts are required to prevent falls overboard and on deck, and to redesign or install safety features on fishing machinery and equipment.

Controlled flight into terrain accidents among commuter and air taxi operators in Alaska.

BACKGROUND: Between 1990 and 1998, aviation accidents in Alaska caused 100 occupational pilot deaths (equivalent to 430/100,000 pilots/ year, approximately 86 times the overall U.S. worker fatality rate). Although Alaskan geography and climate increase aviation risks, many accidents were attributed to pilot error. While most accidents occurred during takeoff/landing, most fatalities resulted from Controlled Flight Into Terrain (CFIT). The purpose of this study was to examine risk factors for CFIT. METHODS: Using National Transportation Safety Board airplane accident data we identified CFIT from flight phase and event description fields, and calculated odds ratios for CFIT/non-CFIT accidents for visual conditions, aircraft features, and pilot experience. RESULTS: Between 1991 and 1998, 351 single aircraft commuter and air taxi accidents occurred in Alaska; 59 (17%) were CFIT. Of 140 total fatalities, 82 (59%) occurred in 30 CFIT accidents. There was a twelve-fold risk for death in CFIT vs. non-CFIT accidents (OR = 12.42, 95% CI = 8.19-18.88). Accidents while flying Visual Flight Rules (VFR) into poor visibility were more likely CFIT than non-CFIT (Odds ratio = 46.06, Confidence Interval = 19.32-112.46), and caused 37% of all deaths. Additionally, flights in Instrument Meteorological Conditions (IMC) were 47 times more likely to be CFIT than non-CFIT. No risk for CFIT was shown for flight hours, number of engines, passenger presence, or pilot age. All CFIT were attributed to pilot error, often for continuing VFR into poor visibility. CONCLUSION: CFIT caused most aviation deaths. Further research into human factors contributing to CFIT is needed. Implementation of global-positioning, ground-proximity/avoidance technology, might reduce CFIT incidence.

Preventing commercial fishing deaths in Alaska.

OBJECTIVES: To evaluate the effectiveness of the United States Commercial Fishing Industry Vessel Safety Act of 1988 in reducing the high occupational death rate (200/100,000/year in 1991-2) among Alaska's commercial fishermen. METHODS: Comprehensive surveillance of deaths in commercial fishing was established by our office during 1991 and 1992 for Alaska. Demographic data and data on risk factors and incidents were compiled and analysed for trend. RESULTS: During 1991-8, there was a significant (p < 0.001) decrease in deaths in Alaska related to commercial fishing. Although drownings from fishermen falling overboard and events related to crab fishing vessels (often conducted far offshore and in winter) have continued to occur, marked progress (significant downward trend, p < 0.001) has been made in saving the lives of people involved in vessels capsizing and sinking. CONCLUSIONS: Specific measures tailored to prevent drowning associated with vessels capsizing and sinking in Alaska's commercial fishing industry have been successful. However, these events continue to occur, and place fishermen and rescue personnel at substantial risk. Additional strategies must be identified to reduce the frequency of vessels capsizing and sinking, to enable parallel improvements in the mortality among crab fishermen, and to prevent fishermen falling overboard and drownings associated with them.

Alaska's model program for surveillance and prevention of occupational injury deaths.

The National Institute for Occupational Safety and Health (NIOSH) established its Alaska Field Station in Anchorage in 1991 after identifying Alaska as the highest-risk state for traumatic worker fatalities. Since then, the Field Station, working in collaboration with other agencies, organizations, and individuals, has established a program for occupational injury surveillance in Alaska and formed interagency working groups to address the risk factors leading to occupational death and injury in the state. Collaborative efforts have contributed to reducing crash rates and mortality in Alaska's rapidly expanding helicopter logging industry and have played an important supportive role in the substantial progress made in reducing the mortality rate in Alaska's commercial fishing industry (historically Alaska's and America's most dangerous industry). Alaska experienced a 46% overall decline in work-related acute traumatic injury deaths from 1991 to 1998, a 64% decline in commercial fishing deaths, and a very sharp decline in helicopter logging-related deaths. Extending this regional approach to other parts of the country and applying these strategies to the entire spectrum of occupational injury and disease hazards could have a broad effect on reducing occupational injuries.

Epidemiology of work-related aviation fatalities in Alaska, 1990-94.

Alaska, with less than one-half of 1% of the United States workforce, accounts for 9% of all occupational aviation fatalities nationally; 30% of all occupational fatalities in Alaska are related to aviation. To understand this high mortality, we investigated occupational aviation crashes to identify risk factors. Occupational aviation fatalities in Alaska during 1990-94 were examined using National Transportation Safety Board reports and merged with records from the Alaska Occupational Injury Surveillance System. There were 876 aircraft crashes; 407 (46%) were work-related. Occupational crashes were 2.2 times (CI: 1.5, 3.2) more likely to result in fatalities than non-occupational crashes. Risk factors identified included poor weather conditions defined as Instrument Meteorological Conditions (IMC). A crash during IMC was 5.3 times (CI: 3.5, 7.9) more likely to result in fatalities than crashes in other conditions. Of aircraft involved in fatal occupational incidents, 33% were not completely destroyed, allowing the potential for survivors. An estimated 30% reduction in fatalities could have occurred if current technology in occupant protection had been used.

Surveillance for nonfatal work-related injuries in Alaska, 1991-1995.

Historically, Alaska has had an occupational fatality rate five times greater than that for the United States. This article reports recent surveillance results for hospitalized nonfatal work-related injuries in Alaska, using the population-based Alaska Trauma Registry (ATR) from 1991 through 1995. The fishing, construction, and logging industries led with the highest number of reported cases in the ATR. Workers in the logging, water transportation, and wood product manufacturing industries had the highest injury rates. Cause, severity, type, and body region of injury were examined for each target industry. For industries with the highest numbers and rates of injuries, in most cases, falls were identified as a common cause of injuries. A fractured bone was the most common type of injury, and the extremities were the most common body region affected. The ATR has proved to be a reliable tool for work-related injury surveillance and will be helpful in planning research priorities and targeting injury prevention efforts.

Preventing deaths in Alaska's commercial fishing industry.

BACKGROUND AND PURPOSE: The arctic and sub-arctic waters of Alaska provide a very hazardous work setting, with special hazards posed by great distances, seasonal darkness, cold waters, high winds, brief fishing seasons, and icing. Our intent is to reduce the remarkably high occupational fatality rate (200/100,000/year in 1991-1992) among Alaska's commercial fishing workers. Over 90% of these deaths have been due to drowning or drowning plus hypothermia, primarily associated with vessel capsizings and sinkings. METHODS: Comprehensive surveillance for commercial fishing occupational fatalities was established during 1991 in Alaska. During 1990 through 1994, the U.S. Commercial Fishing Industry Vessel Safety Act of 1988 required the implementation of comprehensive prevention measures for all fishing vessels in offshore cold waters, including immersion suits and other personal flotation devices, survival craft (life rafts), emergency position-indicating radio beacons, and crew training in emergency response and first aid. Parallel to this, voluntary training efforts by nonprofit organizations have greatly increased. RESULTS: During 1990-1994, drowning was the leading cause of occupational death in Alaska. During this period, 117 fishers died, 101 of them from drowning or drowning/hypothermia. During 1991-1994, there was a substantial decrease in Alaskan commercial fishing-related deaths, from 34 in 1991 to 35 in 1992, 22 in 1993, and 10 in 1994. While man-overboard drownings and some other categories of deaths (falls, fires) have continued to occur, the most marked progress has been in vessel-related events. CONCLUSION: Specific measures tailored to prevent drowning in vessel capsizings and sinkings in Alaska's commercial fishing industry have been very successful so far. Additional efforts must be made to reduce the frequency of vessel events and to prevent man-overboard events and drownings associated with them.

Occupational aviation deaths in Alaska, 1990-1995.

PURPOSE: In Alaska, aviation was the leading cause of work-related death in 1995 and the second leading cause for the period 1990-95. A descriptive study of aviation crashes was completed to characterize occupational aviation crashes and fatalities in Alaska. METHODS: Aviation-related incidents were abstracted from the Alaska Occupational Injury Surveillance System and National Transportation Safety Board preliminary reports. RESULTS: Records for a total of 1065 aviation crashes were abstracted. There were 285 aviation-related fatalities (8.5/100,000/yr) for all Alaskans; 135 (47%) of the fatalities (7.3/100,000/yr for Alaskan workers) were occupationally related. Helicopters accounted for 55 (17%) of the total occupational aviation crashes and 14 (10%) of the fatalities. The most common phase of flight cited in all crashes was takeoff (59 [18%]) and landing (136 [41%]); in contrast, only 9 (13%) of the fatal crashes occurred during takeoff and landing combined. In fatal crashes, the cruise phase (27 [38%]), followed by maneuvering (16 [23%]), were the most frequent phases of flight cited. Thirty-one percent (n = 22) of aircraft involved in fatal occupational incidents were not completely destroyed, allowing for potential survivors. Shoulder harnesses and helmet use, improved cockpit design, and energy-absorbing seats could reduce aviation-related injury and death.

Effective injury prevention using surveillance data: helicopter logging, Alaska, 1992-1995.

BACKGROUND AND PURPOSE: To reduce the fatality rate in helicopter sling-load logging in Alaska. These operations--on rugged terrain, due to environmental restrictions and economics--are an emerging technology application worldwide. During 1992 and 1993, crashes during these operations in Alaska resulted in multiple fatalities. METHODS: During 1992, comprehensive surveillance for these events was established, combining electronic media and interagency notification with active investigation to identify preventable risk factors. These data were applied in mid-1993 by an interagency working group, which included representatives of the Alaska Department of Health and Social Services, Alaska Department of Labor, Federal Aviation Administration, National Transportation, Safety Board, U.S. Coast Guard, Occupational Safety and Health Administration, U.S. Forest Service, and National Institute for Occupational Safety and Health. In response to surveillance data, consensus safety recommendations were developed. Working closely with industry, immediate improvements were made in worker training, work/rest cycles, and oversight. Surveillance results are being used to evaluate the effectiveness of interventions. On March 1-2, 1995, an international workshop was convened in Ketchikan, Alaska, to involve industry and government agencies in planning for durable prevention in this industry. RESULTS: In Alaska between January 1, 1992, and June 30, 1993, there were 6 helicopter crashes, with 9 fatal (4 in pilots) and 10 severe nonfatal injuries, out of only 25 helicopters flying in helicopter logging operations. Alaska logging helicopters thus had the extraordinarily high annual crash rate of 16% and a catastrophic pilot fatality rate of 5,000/100,000/year. Investigation revealed that all crashes involved improper operational and/or maintenance practices. Since these recommendations were implemented in July 1993, there have been no additional helicopter logging fatalities in Alaska through 1995. The 1995 meeting resulted in further recommendations, including more vigorous oversight; development of rigorous voluntary industry standards for equipment, maintenance, and training; exclusive use of multi-engine rotocraft; and more vigorous controls on alcohol and drug use in this industry.

Urban encroachment on the wilderness: moose-vehicle collisions in Anchorage, Alaska, 1991-1995.

BACKGROUND: Moose have successfully adapted to urban sprawl in Anchorage, Alaska, using greenbelt areas for shelter, forage, and protection. However, the proximity of moose to people poses unique hazards: a collision with a moose may cause significant injury and vehicle damage. METHODS: Moose-vehicle collisions were identified using Municipality of Anchorage records. Completeness of reporting was assessed from Alaska Department of Fish and Game records. RESULTS: The moose-vehicle collision rate increased significantly from 38 to 49.2/100,000/yr during the study period (p = .005, x2 = 7.795). Of 519 reported moose-auto collisions, 120 (23%) resulted in injury to 158 people, with no human fatalities. Most collisions (291 or 56%) occurred between 1800 and 0200 hours; 411 (79%) occurred after dark; 154 (30%) occurred during December and January; and slick road conditions were identified in 280 (54%) incidents. Incidents occurred primarily near greenbelt areas. CONCLUSIONS: Moose-vehicle collisions often occur at night, on unlighted, slick road surfaces. Moose-vehicle collisions may be prevented by: reducing speed limits around green-belt areas, brighter vehicle headlights, placement of street lights in known moose areas, underpasses for wildlife at known crossings, and snow removal to reduce berm height in known moose areas.

Drowning in Alaskan waters.

OBJECTIVE: To enumerate drowning fatalities in Alaska in order to identify risk factors and areas for intervention. METHODS: Information from death certificates, state troopers' reports, and medical examiner reports were abstracted and analyzed. Rates were calculated using 1990 census figures as denominator data. RESULTS: There were 542 drowning fatalities in Alaska for the years 1988 to 1992. The 20-29 age group had the highest frequency and rate of drownings. The incidence rate for the state was 20 drownings per 100,000 population per year, almost 10 times higher than the overall U.S. rate of 2.11 per 100,000 per year. Incidence rates were highest among adolescent males (10-19), young adult males (20-29). Alaska Natives, and rural residents. Alaska Native males, ages 30-39 averaged 159 drownings per 100,000 per year, the highest drowning rates in the state. CONCLUSIONS: Drowning is a major public health concern in Alaska. People who fish commercially and young Native males are groups at high risk for drowning. Intervention efforts should be concentrated on these two populations.

Years of potential life lost and lost future productivity due to occupational fatalities--Alaska, 1990-1994.

INTRODUCTION: Alaska had the highest occupational fatality rate of any state for the 1980s. The impact of these events is estimated by the index of years of potential life lost before age 65 (YPLL), which was developed to measure the potentially preventable mortality occurring early in life. METHODS: Lost future productivity (wages) and YPLL were calculated from surveillance statistics for all workers killed on the job during this 5-year period. RESULTS: During 1990-1994, Alaska experienced 343 work-related deaths among civilians under age 65. YPLL was 9,690 years with an estimated lost future productivity of $367,000,000. DISCUSSION: Premature death due to occupational traumatic injury in Alaska for 1990-1994 was extremely costly to society. Premature death not only adversely affects the deceased workers' family, friends, and coworkers, but also society economically. Effective intervention strategies are needed to significantly reduce both the number and the cost of fatal occupational trauma in Alaska.

Prevalence of human T cell lymphotropic virus type II in American Indian populations of the southwestern United States.

We investigated the seroprevalence of human T cell lymphotropic virus type II (HTLV-II) using a screening enzyme-linked immunosorbent assay (ELISA) and immunoblot confirmation among the predominant tribes (Pueblo and Athapaskan) served by two large Indian Health Service facilities in New Mexico. Among persons being treated for sexually transmitted diseases, eight (3.2%) of 250 were seropositive for HTLV II, compared with eight (2.1%) of 385 women attending prenatal clinics. In a survey of unselected patients at one of the facilities, 15 (3.4%) of 446 were seropositive. Of 31 seropositive subjects, 25 were infected with HTLV-II and six infections could not be typed. Sera from nine (29%) of the 31 infected subjects had absorbance values less than the manufacturer's cutoff in the ELISA. Both Pueblo and Athapaskan groups had similar overall seroprevalences, but women tended to have a slightly higher seroprevalence than men, and seroprevalence tended to increase with age. These data show that HTLV-II infection is present among diverse groups of American Indians in the southwestern United States. Present ELISA screening tests, such as those used in this study, lack sensitivity to HTLV-II infection unless a reduced absorbance cutoff is used.

Prevalence of antibody to the human immunodeficiency virus among clinical laboratory specimens: findings from a survey of primary care physicians.

To evaluate human immunodeficiency virus type 1 (HIV-1) infection among patients of primary care physicians, we performed anonymous, unlinked HIV-1 antibody testing on leftover blood specimens submitted to 10 large commercial clinical laboratories for complete blood cell count or hematocrit determination, the most commonly ordered diagnostic tests. From January through August 1990, 55,613 specimens submitted by general internists, pediatricians, and family practitioners were sampled; 1,104 (2.0%) had HIV-1 antibody. Seroprevalence among the laboratories varied 50-fold, from 0.3 to 12.4%. The HIV-1 prevalence at each laboratory was not always consistent with the AIDS incidence in the area served by the laboratory. Overall the seroprevalence was almost eight times higher in men (3.9%) than in women (0.5%). Specimens from seropositive persons, especially from men, were unevenly distributed among the physician practices; only three practices submitted approximately 50% of all specimens from seropositive men. These data indicate that a few physicians treat the majority of HIV-1-infected primary care patients. The HIV-1 prevalence among specimens at a clinical laboratory is thus determined by whether few physicians submit specimens to that laboratory. These results could be of use, for instance, in analyzing proposals to mandate physician reporting of HIV-1 infection. The high HIV-1 prevalence among laboratory specimens underscores the potential for exposure to HIV-1-infected blood by clinical laboratory personnel and emphasizes the need for universal precautions for all blood specimens.

Trends in HIV prevalence among disadvantaged youth. Survey results from a national job training program, 1988 through 1992.

OBJECTIVE: To describe trends in the prevalence of human immunodeficiency virus (HIV) among socially and educationally disadvantaged US youth. DESIGN: Analysis of demographic and geographic trends of HIV infection among Job Corps students from January 1988 through December 1992. SETTING: The Job Corps is a national training program for disadvantaged and out-of-school youth. POPULATION SCREENED: Youths aged 16 to 21 years who entered the Job Corps residential training centers during the survey period. MAIN OUTCOME MEASURE: Trends in prevalence of HIV infection among Job Corps students stratified by sex, age, race, and region of the country. RESULTS: Of the 269,956 Job Corps students screened, 812 (0.3%) tested positive for the antibody to HIV type 1. Seroprevalence of HIV for young men decreased from 3.6 per 1000 in 1988 to 2.2 per 1000 in 1992 (chi 2 test for trend, P < .001). Seroprevalence for young women increased from 2.1 per 1000 in 1988 to 4.2 per 1000 in 1990 (P = .001), with seroprevalence remaining stable from 1990 through 1992. The decreasing trends in HIV prevalence among men and increasing trends among women were primarily due to changes in seroprevalence in African-American students. CONCLUSIONS: The overall prevalence of HIV infection of three per 1000 is high, given the youth of Job Corps students. The significant rise in HIV rates among female Job Corps students provides evidence of the increasing risk of infection for socioeconomically disadvantaged young women. Reasons for the declining trend in HIV prevalence among male Job Corps students are not clear. Efforts to prevent the spread of HIV infection among adolescents must focus on the group that is hardest to reach--out-of-school and impoverished youth.

HIV infection in American Indians and Alaska Natives: surveys in the Indian Health Service.

A network of surveys of HIV seroprevalence in American Indians and Alaska Natives (AI/AN) was begun in 1989. From July 1, 1989 through June 30, 1991, 37,681 serologic specimens were collected from prenatal and sexually transmitted disease patients in 58 facilities operated or funded by the Indian Health Service. Specimens from AI/AN women receiving initial prenatal care showed an overall HIV prevalence of 0.3/1,000, while specimens obtained during the third trimester of pregnancy showed an overall prevalence of 1.0/1,000. The rate for rural third trimester prenatal patients (0.9/1,000) was similar to that for urban patients (1.1/1,000). HIV rates among third trimester AI/AN patients in three western states were 4 to 8 times higher than rates observed in childbearing women of all races in those states. The overall HIV seroprevalence in AI/AN seeking care for sexually transmitted diseases was 4.5/1,000 for males (urban 10.8/1,000; rural 2.0/1,000) and 0.7/1,000 for females (urban 0.9/1,000; rural 0.6/1,000). Approximately 1,210 to 4,250 (midpoint of range = 2,730) AI/AN in the U.S. are projected from survey findings to be currently infected with HIV. The presence of HIV in multiple specimens from rural areas and the similarity of HIV infection rates for female patients from rural and urban locations provides evidence of diffusion of the HIV epidemic to rural AI/AN, and emphasizes the need for effective HIV prevention for this population.