Longitudinal Changes in the Body Mass Index of British Army Pilots.

INTRODUCTION: Aircraft are manufactured according to design parameters that must account for the size and physical characteristics of the pilot. While cockpit dimensions, seats, restraints, and related components do not change substantially over the airframe lifecycle, it is conceivable that the occupant may, even if initially well-suited. This investigation focused on longitudinal body mass index (BMI) changes within a cohort of British Army Air Corps pilots.METHODS: The study was a retrospective examination of electronic medical record data to assess longitudinal change within a representative cohort of Army pilots. Voluntary subjects were assigned unique subject numbers matched with individual electronic medical record data. Subject's age, service length, height, weight, and BMI were extracted from routine historical aviation medical exams.RESULTS: Among 106 British Army Air Corps pilots, the mean age was 35.3 yr (SD = 7.4) with average length of service as a pilot of 9.0 yr (SD = 5.2). Within the observed cohort, the mean change in individual weight over time was an increase of 4.6 kg (SD = 7.3). Height remained relatively stable with a mean increase of 0.6 cm (SD = 1.9). Given the increase in weight, BMI was noted to increase longitudinally with a mean of 1.3 kg · m-2 (SD = 2.4).DISCUSSION: British Army pilots experience increases in BMI over time much like the general population. Results of this study serve to inform future policy related to the body composition of aviation applicants, the retention of previously qualified pilots, and the safety concerns of crashworthiness design specifications.Porter WD, Wilde GD, Jeffery NP, Walters PL, Eke AJ, Bushby AJR, Adams MS, Gaydos SJ. Longitudinal changes in the body mass index of British Army pilots. Aerosp Med Hum Perform. 2024; 95(2):118-122.

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.

UK Military Rotary-Wing Accidents: 2000-2015.

BACKGROUND: Analysis of mishap data is an obvious measure of performance for those who wish to improve flight safety and affect aviation capability development within military forces. METHODS: This study examined rotary-wing accident information held by UK Ministry of Defence authorities for the 16-yr (inclusive) period from January 2000 through December 2015 in order to ascertain incidence patterns. Serious accidents of military registered aircraft operated by Joint Helicopter Command, the Royal Navy, the Search and Rescue Force, and the Defence Helicopter Flying School were included in the analysis. A secondary intent of the review was to examine the influence of broad-based organizational changes on the overall incidence of rotary-wing accidents across the U.K. Ministry of Defence that grew out of the report published by Charles Haddon-Cave, QC, following his wide-ranging investigation into the catastrophic crash of Royal Air Force Nimrod XV230 that occurred during a routine mission in Southern Afghanistan. RESULTS: During the 16-yr period between January 2000 and December 2015, 53 rotary-wing accidents occurred. The overall accident rate was 2.32 accident events per 100,000 flight hours. Spatial disorientation accidents remain a prevalent risk in this study, being acknowledged in 43% of accidents. Prior to the Haddon-Cave report, the accident rate was 2.81 events per 100,000 flight hours. Following the report, the accident rate decreased to 1.24 events per 100,000 flight hours. DISCUSSION: The decrease in the accident rate between 2000 and 2015 shares a temporal association with the adoption and operationalization of the recommendations found in Haddon-Cave's report.Bushby AJR, Powell-Dunford N, Porter WD. UK military rotary-wing accidents: 2000-2015. Aerosp Med Hum Perform. 2018; 89(9):842-847.

Urinary tract calculi in military aviators.

BACKGROUND: Urinary tract calculi are a common affliction in the United States and estimates of the adult lifetime risk of developing this condition range from 10 to 15%. Although highly variable, the clinical presentation of someone afflicted with urinary tract calculi typically involves varying degrees of pain, nausea, hematuria, and dysuria. Current disease, as well as a history of urinary tract calculi, is potentially disqualifying for aviation duties in the United States military as well as for commercial aviators. METHODS: Utilizing population based data from the Defense Medical Epidemiology Database (DMED), the current descriptive epidemiology of urinary tract calculi among military aviators was examined. RESULTS: Based on the data collected, the overall annual incidence density of urinary tract calculi for DoD personnel is approximately 4.8 events/1000 PY. The overall annual incidence density of urinary tract calculi is slightly lower in aviators as compared to the nonaviator DoD population (4.4 events/1000 PY vs. 4.8 events/1000 PY). DISCUSSION: Even though in-flight incapacitation from this malady is believed to be exceedingly rare, the incidence of urinary tract stones and their related morbidity should remain an important area of clinical focus.

Imported malaria and conflict: 50 years of experience in the U.S. Military.

Over the last 50 years, members of the U.S. military have faced the threat of malaria in diverse geographical locations and operational situations, resulting in considerable morbidity and mortality. However, because malaria may be transported out of endemic areas and into areas that are free of malaria, the threat does not end with redeployment. Since the Korean Conflict, outbreaks of imported malaria have followed every major deployment of U.S. military forces to malaria endemic areas. By examining unique aspects of these outbreaks through the years, many similarities can be drawn. Repeated observations demonstrate that preventive efforts are only effective at reducing the impact of imported malaria when commanders are informed about the risks of malaria. Commanders must also understand the preventive resources that are available while deployed, and the potential for morbidity and mortality from malaria.

An outbreak of malaria in US Army Rangers returning from Afghanistan.

CONTEXT: With numerous US military personnel currently deployed throughout the world, military and civilian health care professionals may encounter imported malaria from this population. OBJECTIVE: To identify malaria in US Army personnel deployed to a combat zone. DESIGN, SETTING, AND PATIENTS: Case series in the US Army health care system. A total of 38 cases of malaria were identified in a 725-man Ranger Task Force that deployed to eastern Afghanistan between June and September 2002. MAIN OUTCOME MEASURES: Identification of malaria cases and soldiers' self-report of compliance with antimalarial measures. RESULTS: A total of 38 patients were infected with Plasmodium vivax, yielding an attack rate of 52.4 cases per 1000 soldiers. Diagnosis was confirmed a median of 233 days (range, 1-339 days) after return from the malaria endemic region, with additional laboratory findings noting anemia and thrombocytopenia. One case was complicated with acute respiratory distress syndrome during the patient's primary attack and a spontaneous pneumothorax during relapse. This case accounted for 1 of 2 relapse cases in the study population. From an anonymous postdeployment survey of 72% (521/725) of the task force, the self-reported compliance rate was 52% for weekly chemoprophylaxis, 41% for terminal (postdeployment) chemoprophylaxis, 31% for both weekly and terminal chemoprophylaxis, 82% for treating uniforms with permethrin, and 29% for application of insect repellent. CONCLUSIONS: Delayed clinical presentation can occur with P vivax. Symptoms are often vague, but malaria should be included in the differential diagnosis for soldiers returning from an endemic region. Suboptimal compliance with preventive measures can result in a malaria outbreak.