Simulación clínica y seguridad en urgencias y emergencias: Emergency Crisis Resource Management (E-CRM) / Clinical simulations and safety in emergencies: Emergency Crisis Resource Management

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Fatal accident rates for instrument-rated private pilots.

BACKGROUND: The fatality rate for general aviation, 82 times that of air carriers and even higher for those involving aeromedical transportation, has not declined over time. Although noncommercial (private) pilots are increasingly seeking the instrument rating (IFR), which offers safety advantages, there is a paucity of research on causes of fatal crashes for this aviator subset. METHODS: The NTSB accident database was queried for general aviation fatal accidents involving private pilots. Exact two sample proportions, linear regression model outcomes (log-odds), and Poisson rate ratio tests were used for statistical analysis. RESULTS: The fatal accident rate for flights in instrument conditions decreased 55% over 10 yr (2002-2011) although an increased fatality rate was evident for pilots > 65 yr of age. Instrument approach deficiency (lAD), spatial disorientation/failure to maintain control (SD/FMC), and failure to maintain obstacle/terrain clearance (FMOTC) were common causes of fatal accidents in reduced visibility. However a > 55% decline in fatal accidents due to IAD was evident over the decade. Under visual conditions, engine/air-frame malfunction, aerodynamic stall, and FMOTC represented frequent causes. Of these, FMOTC showed a statistically significant decline over 10 yr. Comparing day and night operations, fatal crashes attributed to FMOTC and IAD were more frequent at night. CONCLUSION: For the IFR-rated private pilot, our study argues for an emphasis on training and currency in SD/FMC and aerodynamic stall recovery. Likewise training to remedy IAD, the frequent cause of fatal night accidents, and flying by instrument flight rules to assure obstacle/terrain clearance should be encouraged for pilots undertaking such operations.

Toxicological findings in fatally injured pilots of 979 amateur-built aircraft accidents.

BACKGROUND: Specimens from aviation accident pilot fatalities are submitted to the Civil Aerospace Medical Institute (CAMI) for toxicological analyses. Trends of fatal amateur-built aircraft accidents and toxicological findings in the associated pilot fatalities have not been examined. METHODS: Fatal amateur-built aircraft accidents that occurred during 1990-2009 were evaluated by retrieving information from the CAMI toxicology database. Probable cause/factor in the amateur-built aircraft mishaps were obtained from the National Transportation Safety Board's (NTSB's) aviation accident database. RESULTS: Of 6309 fatal aviation accidents from which CAMI received postmortem samples, 979 (16%) were related to amateur-built aircraft. There was a decreasing trend in non-amateur-built aircraft accidents, but an increasing trend in amateur-built aircraft accidents. In the 979 accidents, 392 pilots (40%) were positive for ethanol and/or drugs. In these 392 accidents also, the review showed a decreasing trend with non-amateur-built aircraft and an increasing trend with amateur-built aircraft. Percentages of pilots with prescription drugs were 26% for amateur-built aircraft, 16% for non-amateur-built aircraft, and 18% for all aircraft. Ethanol/drug use and medical condition were determined to be a cause/factor in 42 (11%) of the 385 ethanol/ drug-positive amateur-built aircraft accidents investigated by the NTSB. DISCUSSION: Drugs found in the pilots were consistent with commonly used medications in the general population. The contributory role of mechanical malfunction of home-built aircraft cannot be ruled out in the observed increasing trends in their accidents, with or without ethanol and/or drugs. Regardless, the increasing trends of such accidents are of significant concern.

Reductions in transport mortality in Australia: evidence of a public health success.

OBJECTIVE: To describe trends in transport mortality for a range of common transport types in Australia over a 30-year period (1975-1977 to 2005-2007). METHODS: Mortality data on all-cause and transport-related causes of death were supplied by the Australian Institute of Health and Welfare (AIHW). Mortality rates, expected number of deaths and probabilities of death were compared for three time periods: 1975-1977, 1990-1992 and 2005-2007. RESULTS: There were significant decreasing trends between 1975-1977 and 2005-2007 in all-cause and most other transport mortality types for both men and women. There were significant reductions in the contribution of transport-related mortality to all-cause mortality; however the difference in mortality between men and women (higher for men) changed little over the evaluated period. CONCLUSIONS: Between 1975-1977 and 2005-2007 there were marked reductions in key causes of transport-related mortality amongst Australian adults, and the reductions in transport-related mortality exceeded reductions in all-cause mortality. The reductions could be attributed to better preventive measures and improved medical treatment for people involved in transport crashes. Although there is scope for further improvement, the reductions are evidence of a success in the prevention of crashes and the medical treatment of crash victims.

Persistence of airline accidents.

This paper expands on air travel accident research by examining the relationship between air travel accidents and airline traffic or volume in the period from 1927-2006. The theoretical model is based on a representative airline company that aims to maximise its profits, and it utilises a fractional integration approach in order to determine whether there is a persistent pattern over time with respect to air accidents and air traffic. Furthermore, the paper analyses how airline accidents are related to traffic using a fractional cointegration approach. It finds that airline accidents are persistent and that a (non-stationary) fractional cointegration relationship exists between total airline accidents and airline passengers, airline miles and airline revenues, with shocks that affect the long-run equilibrium disappearing in the very long term. Moreover, this relation is negative, which might be due to the fact that air travel is becoming safer and there is greater competition in the airline industry. Policy implications are derived for countering accident events, based on competition and regulation.

Accidents associated with aerobatic maneuvers in U.S. aviation.

BACKGROUND: Aerobatic flights are the most significant risk factor for fatal injury and make up 50% of U.S. accidents in general aviation involving airport transport pilots. METHOD: An analysis of the dangers of these maneuvers is presented using 25 yr of U.S. reported accidents. RESULTS: More than 80% of the 494 accidents were fatal. The main cause of accident was not maintaining (proper) altitude while adverse weather was not present as a cause of accident. Nearly half the number of pilots had over 7500 h of flight experience. Homebuilt aircraft appear significantly more likely to be part of a fatal accident, showing more structural, engine, and system failures. CONCLUSION: Although there is a downward trend in the number of aerobatic-related accidents, the reduction of accidents is much assisted by either regulation or awareness training of pilots using homebuilt aircraft in aerobatic maneuvers.

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.

Flying in the face of danger. A spate of air ambulance crashes has raised questions about safety, but providers say the service offers overwhelming benefits.

The first six months of 2008 brought a distressing number of air ambulance crashes, including one in late June that claimed six lives. But providers say the benefits far outweigh the risks. "Our job is to provide healthcare to our patients as quickly as possible," says Art Chance, left, of East Texas Medical Center Regional Healthcare System. "We see helicopter service as a vital part of that".

Pilot error in air carrier mishaps: longitudinal trends among 558 reports, 1983-2002.

BACKGROUND: Many interventions have been implemented in recent decades to reduce pilot error in flight operations. This study aims to identify longitudinal trends in the prevalence and patterns of pilot error and other factors in U.S. air carrier mishaps. METHOD: National Transportation Safety Board investigation reports were examined for 558 air carrier mishaps during 1983-2002. Pilot errors and circumstances of mishaps were described and categorized. Rates were calculated per 10 million flights. RESULTS: The overall mishap rate remained fairly stable, but the proportion of mishaps involving pilot error decreased from 42% in 1983-87 to 25% in 1998-2002, a 40% reduction. The rate of mishaps related to poor decisions declined from 6.2 to 1.8 per 10 million flights, a 71% reduction; much of this decrease was due to a 76% reduction in poor decisions related to weather. Mishandling wind or runway conditions declined by 78%. The rate of mishaps involving poor crew interaction declined by 68%. Mishaps during takeoff declined by 70%, from 5.3 to 1.6 per 10 million flights. The latter reduction was offset by an increase in mishaps while the aircraft was standing, from 2.5 to 6.0 per 10 million flights, and during pushback, which increased from 0 to 3.1 per 10 million flights. CONCLUSIONS: Reductions in pilot errors involving decision making and crew coordination are important trends that may reflect improvements in training and technological advances that facilitate good decisions. Mishaps while aircraft are standing and during pushback have increased and deserve special attention.

Military fatality rates (by cause) in Afghanistan and Iraq: a measure of hostilities.

BACKGROUND: Military fatalities occur in clusters, and causes differ between theatres of operation or within-theatre over time. AIM: Based on around 500 coalition deaths, identify major causes in Iraq and Afghanistan. For consecutive periods (1: May 1 to September 17, 2006, 2: September 18, 2006 to February 4, 2007), ascertain UK and others' numbers deployed to compare fatality rates per 1000-personnel years. Take account of clustering: deaths per fatal improvised explosive device (IED) incident, and in making short-term projections for Afghanistan. METHODS: Cause and date of coalition deaths in Iraq and Afghanistan are as listed in http://www.iCasualties.org, where each death is designated as hostile or non-hostile. Numbers deployed in 2006 were available for UK and Canada, and for US to Iraq. FINDINGS: Out of 537 coalition fatalities in Iraq in 2006 to September 17, 2006, 457 (85%) were hostile, but only half were in Afghanistan (October 2001 to September 17, 2006: 52%, 249/478). Air losses accounted for 5% fatalities in Iraq, but 32% in Afghanistan. IEDs claimed three out of five hostile deaths in Iraq, only a quarter in Afghanistan. Deaths per fatal IED incident averaged 1.5. In period 1, 50/117 military deaths in Afghanistan were UK or Canadian from 6750 personnel, a fatality rate of 19/1000/year, nearly four times the US rate of 5/1000/year in Iraq (based on 280 deaths). Sixty out of 117 fatalities in Afghanistan occurred as clusters of two or more deaths. In period 2, fatality rates changed: down by two-thirds in Afghanistan for UK and Canadian forces to 6/1000/year (18 deaths), up by 46% for US troops in Iraq to 7.5/1000/year (416 deaths). INTERPRETATION: Rate, and cause, of military fatalities are capable of abrupt change, as happened in Iraq (rate) and Afghanistan (rate and cause) between consecutive 140-day periods. Forecasts can be wide of the mark.

Are hook turns a major obstacle to safe skydiving? A study of skydiving fatalities in the United States from 1992 to 2005.

Landing errors account for most of the skydiving fatalities today in more experienced skydivers. The United States Parachute Association (USPA) states that this is due to a new generation of parachutes with higher wing loading. Using data on fatalities from 1992 to 2005 as reported by the USPA, hook turns were found to be a major cause of death but not significantly associated with higher wing loading. Fatalities caused by not having a functional parachute have decreased over the years, possibly due to introduction and widespread use of safety devices.

Analysis of 2004 German general aviation aircraft accidents according to the HFACS model.

INTRODUCTION: The number of aircraft accidents remains on a constant level since the late 1990s. Routine analysis in detail of the causative factors is not carried out in Germany. The analysis of flight mishaps has been demonstrated to be an important basis for flight safety. The Human Factors Analysis and Classification System (HFACS) model is best suitable for aircraft accident analysis. The aim of this study was to classify aircraft accidents in the General Aviation (GA) of Germany according to the HFACS model and to figure out the underlying causes. MATERIAL AND METHODS: The analysis was performed with the HFACS model and on the basis of the regularly published reports of the German state department for aircraft accident analysis (BFU) including accidents (but not incidents) of GA aircraft flown by German pilots in Germany and in other countries. The underlying reasons were classified as follows: pilot errors, organizational factors, ergonomic factors, aeromedical problems, and crew resource management. Additionally, the phase of the flight was classified. RESULTS: Two hundred thirty-nine GA aircraft accidents were registered in 2004 in Germany. Eighty-seven (36%) were reported in the class up to 2 tons, six (3%) in the class of 2.0 to 5.7 tons, 28 (12%) for Touring Motor Gliders (TMG), and 118 (49%) for gliders. Of these accidents, 54 (35 crewmembers and 19 passengers) aircraft occupants survived slightly injured, 35 (23 crewmembers and 12 passengers) were seriously injured, and 34 (21 crewmembers and 13 passengers) were killed. Data for uninjured aircraft occupants were not available. Most accidents happened on summer weekends during approach and landing (53%) due to pilot errors (84%). CONCLUSIONS: Our data mainly seem to be in concordance with previously published data on GA. An improvement of flight safety can be achieved only with a detailed analysis of the accident data. Therefore, more data on aircraft accidents in Germany are needed, for example, by adapting the German aircraft accident report form. Pilots should train in approaches and landings to conduct a higher level of proficiency.

Error humano: La influencia de la fatiga y el estrés en los accidentes aéreos / Human error: Air accidents by the influence of fatigue and stress

Análisis del factor humano en este tipo de accidentes, especialmente en lo que se refiere a patologías como la fatiga y el estrés. También se incluyen algunas recomendaciones para los miembros de la tripulación

Error humano: La influencia de la fatiga y el estrés en los accidentes aéreos / Human error: Air accidents by the influence of fatigue and stress

Análisis del factor humano en este tipo de accidentes, especialmente en lo que se refiere a patologías como la fatiga y el estrés. También se incluyen algunas recomendaciones para los miembros de la tripulación(AU)

Geophysical variables and behavior: C. Increased geomagnetic activity on days of commercial air crashes attributed to computer or pilot error but not mechanical failure.

Global geomagnetic activity (aa values) for the days of crashes of airplanes and for each of the three days before and after the crashes were compared for 373 events (years 1940 through 2002) attributed to unknown factors, mechanical errors, electronic/computer failures or pilot errors. Interactions between days and classifications of the crashes were due to the significantly greater geomagnetic activity on the days of crashes attributed to pilot or computer error but not to mechanical or unknown factors. Successive temporal analyses indicated that the elevated activity on the days of crashes attributed to pilot error have not changed over time, but there was an increase in those attributed to electronic errors after 1965. No more than 9% of the variance in geomagnetic activity on the days of the crashes was associated with the type of crash. These results are consistent with our hypothesis that some factor or factors associated with relative increases in geomagnetic activity may affect complex electronic systems composed of either silica (computer) or carbon (brain) aggregates.

Aeromedical waiver status in U.S. Naval aviators involved in Class A mishaps.

PURPOSE: U.S. Naval aviators are subject to stringent aeromedical standards. Aeromedic waivers are considered when a naval aviator develops a medical condition that is deemed safe for flight, allowing that aviator to continue in a flying status. No Class A (serious) mishap to date has been directly attributable to an aviator's waivered condition. However, to date no study has been conducted to review the overall mishap rate among aviators who are flying with a waiver. This study evaluated the aeromedical waiver status of naval aviators involved in Class A mishaps from 1992-1999. METHOD: Aviation mishaps in the U.S. Navy are investigated by trained personnel, who report their detailed findings to the U.S. Naval Safety Center (NSC). The Navy Operational Medicine Institute (NOMI) maintains a database of all aviation physicals, including the waiver status of individual aviators. A collaborative NSC/NOMI study was done to investigate the prevalence of waivers in mishap and non-mishap aviators. Records were retrieved on 234 naval aviators who were the "pilot at the controls" of Class A mishaps occurring from 1992-1999. This mishap waiver rate was compared with the baseline waiver rate for all pilots in 1994 (midpoint). Odds Ratios were calculated of having a Class A mishap if the aviator had a waiver. RESULTS AND CONCLUSIONS: Analysis failed to find a statistical difference in waiver rates between mishap aviators and the general naval aviator population indicating that the U.S. Naval Aeromedical Service is providing aeromedically safe naval aviators to the fleet.

Human factors analysis of accidents involving visual flight rules flight into adverse weather.

BACKGROUND: General aviation (GA) accident statistics indicate that visual flight rules (VFR) flight into instrument meteorological conditions (IMC) is a major safety hazard. However, little research has been conducted to identify the factors that influence VFR pilots' decisions to risk flying into deteriorating weather. The purpose of the present study was to further examine the causes of GA accidents associated with VFR flight into IMC. METHOD: A comprehensive review of GA accident reports maintained by the National Transportation Safety Board (NTSB) was conducted to identify accidents involving VFR flight into IMC between January 1990 and December 1997. These accidents were compared with other GA accidents that occurred during the same time period. RESULTS: Analyses of these accidents revealed that VFR flight into IMC accidents were more likely to involve less-experienced pilots and to have passengers aboard the accident aircraft compared with the other GA accidents. In addition, most VFR flight into IMC accidents were considered by the NTSB to have involved intentional flight into adverse weather by the pilot. DISCUSSION: These findings are interpreted in terms of their implications for the underlying causes of VFR flight into IMC, including situation assessment, risk perception, and social pressure. Intervention programs that address all of these factors are needed.

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.