Characteristics of general aviation crashes involving mature male and female pilots.

BACKGROUND: General aviation crashes in the United States were analyzed to identify differences between male and female pilots in the circumstances of their crashes and the types of pilot errors involved. METHODS: All 144 female pilots who were born between 1933 and 1942 and who were involved in general aviation crashes between 1983 and 1997 were matched 1:2 with 287 male pilots by age within 2 yr, medical certificate and pilot certificate, state or region of crash, and year of crash. RESULTS: Mechanical failure, gear up landings, improper IFR approaches, and collisions with wires or poles were more common in crashes of male pilots. Loss of control on landing/takeoff was more common in crashes of female pilots. Mishandling aircraft kinetics was the most common error of pilots of both genders and was noted more often in female pilots' crashes (81% vs. 48%) (p < 0.001). Males' crashes were more likely to involve flawed decisions (29% vs. 19% of females' crashes) (p = 0.027) or inattention (32% vs. 19%) (p = 0.004). Older pilots made fewer errors: among males age 55-63, 26% of crashes were without obvious pilot error compared with only 7% at age 40-49 (p = 0.003). CONCLUSION: There are large gender differences in the types of pilot error involved in general aviation crashes. Mishandling aircraft kinetics, poor decision making, and inattention are the most common pilot errors and merit increased attention in pilot training.

Secular trends of motor vehicle mortality in the United States, 1910-1994.

To examine the secular trends of mortality from motor vehicle crashes, the authors compiled annual population and mortality data for the United States from 1910 to 1994 and performed an age-period-cohort analysis through graphical presentation, median polish, and Poisson regression modeling. During the 85-year study period, death rates from motor vehicle crashes showed two peaks, first in 1935-39 and then in 1965-69. Age and period effects accounted for 94% of the variation in motor vehicle mortality in men and 84% of the variation in women. Age patterns of motor vehicle mortality varied greatly with birth cohorts: for those who were born before 1910, death rates increased with age; for those born after 1910, death rates peaked at age 20-24 years for men and at age 15-19 years for women. A crossover characterized by a downward trend in death rates among the elderly and an upward trend among adolescents and young adults was observed in both sexes. The complex age, period, and cohort patterns of motor vehicle mortality are likely to have been shaped by changes in traffic patterns and driver behavior, and by improvements in safety design and emergency medical service systems.

Factors associated with pilot error in aviation crashes.

BACKGROUND: The importance of pilot error in aviation crashes has long been recognized. However, understanding and preventing pilot error remains the foremost challenge in aviation safety. OBJECTIVE: This study aims to identify pilot characteristics and crash circumstances that are associated with the presence of pilot error in a large sample of aviation crashes. METHODS: Different data files compiled by the National Transportation Safety Board for 329 major airline crashes, 1,627 commuter/air taxi crashes, and 27,935 general aviation crashes for the years 1983-96 were merged; and the presence of pilot error was analyzed in relation to variables indicating the characteristics of the pilot-in-command, crash circumstance, and aircraft. Multivariate logistic regression modeling was performed to assess the associations of individual variables with the likelihood of pilot error given a crash. RESULTS: Pilot error was a probable cause in 38% of the major airline crashes, 74% of the commuter/air taxi crashes, and 85% of the general aviation crashes. Among the factors examined, instrument meteorological condition and on-airport location were each associated with a significantly increased odds of pilot error. The likelihood of pilot error decreased as pilot certificate rating increased in commuter/air taxi and general aviation crashes. Neither pilot age nor gender was independently associated with the odds of pilot error. With adjustment for pilot characteristics and crash circumstances, flight experience as measured in total flight time showed a significant protective effect on pilot error in general aviation crashes. CONCLUSIONS: The prevalence and correlates of pilot error in aviation crashes vary with the type of flight operations. Adverse weather is consistently associated with a significantly elevated likelihood of pilot error, possibly due to increased performance demand.

Medical relief personnel in complex emergencies: perceptions of effectiveness in the former Yugoslavia.

Humanitarian medical assistance and intervention during the civil war in Bosnia and Croatia was felt by national health workers to be relatively ineffective (2.8 on a 5-point Likert scale), compared to other forms of humanitarian assistance such as medical supplies (4.4/5) and non-medical materials (3.9/5). Bosnian physicians treating civilians noted that the most helpful types of personnel were surgeons and emergency physicians. This study suggests that assessment of personnel needs at the recipient level, in addition to standard relief assessments, is required early in models of complex emergencies. This study supports existing epidemiological models of complex emergencies, especially when high trauma-related mortality and morbidity are likely to occur.

The perceived effectiveness of total quality management as a tool for quality improvement in emergency medicine.

OBJECTIVES: To describe the perceived effectiveness of using the Total Quality Management (TQM) approach to quality improvement in both academic and nonacademic EDs, and to discuss some important barriers to effectiveness of TQM programs. METHOD: A mail survey of 100 EDs was conducted with telephone follow-up. Hospitals were randomly selected from three subgroups: university teaching hospitals, nonuniversity teaching hospitals, and private nonteaching hospitals. ED physician directors or nonphysician administrators with knowledge of departmental quality improvement initiatives were surveyed. RESULTS: The overall response rate was 60%. Of the respondents, 54 (90.0%) used TQM techniques as part of their quality improvement initiatives. TQM techniques were used more frequently and for a longer duration in academic programs. ED staff participation in TQM projects was relatively low; less than 25% in the majority (79.6%) of all EDs. TQM initiatives were ranked least effective in university settings, of which 11 of 13 (84.6%) rated their TQM programs as ineffective or having no effect. More mature programs (>5 years old) had a significantly higher ranking for effectiveness than those programs less than 2 years old. CONCLUSIONS: Total Quality Management is being utilized in a large number of EDs. TQM initiative is perceived as having little or no positive effect. This is particularly the case in academic EDs.