Data-Driven Estimation of the Impact of Diversions Due to In-Flight Medical Emergencies on Flight Delay and Aircraft Operating Costs.

INTRODUCTION: In-flight medical emergencies (IFMEs) average 1 of every 604 flights and are expected to increase as the population ages and air travel increases. Flight diversions, or the rerouting of a flight to an alternate destination, occur in 2 to 13% of IFME cases, but may or may not be necessary as determined after the fact. Estimating the effect of IFME diversions compared to nonmedical diversions can be expected to improve our understanding of their impact and allow for more appropriate decision making during IFMEs.METHODS: The current study matched multiple disparate datasets, including medical data, flight plan and track data, passenger statistics, and financial data. Chi-squared analysis and independent samples t-tests compared diversion delays and costs metrics between flights diverted for medical vs. nonmedical reasons. Data were restricted to domestic flights between 1/1/2018 and 6/30/2019.RESULTS: Over 70% of diverted flights recover (continue on to their intended destination after diverting); however, flights diverted due to IFMEs recover more often and more quickly than do flights diverted for nonmedical reasons. IFME diversions introduce less delay overall and cost less in terms of direct operating costs and passenger value of time (averaging around 38,000) than do flights diverted for nonmedical reasons.DISCUSSION: Flights diverted due to IFMEs appear to have less impact overall than do flights diverted for nonmedical reasons. However, the lack of information related to costs for nonrecovered flights and the decision factors involved during nonmedical diversions hinders our ability to offer further insights.Lewis BA, Gawron VJ, Esmaeilzadeh E, Mayer RH, Moreno-Hines F, Nerwich N, Alves PM. Data-driven estimation of the impact of diversions due to in-flight medical emergencies on flight delay and aircraft operating costs. Aerosp Med Hum Perform. 2021; 92(2):99105.

Modelos ARIMA para la predicción del gasto conjunto de oxígeno de vuelo y otros gases en el Ejército del Aire / ARIMA models to predict the joint expense of in-flight oxygen and other gases in the Air Force

INTRODUCCIÓN: la realización de expedientes de contratación para gases y elementos afines empleados en el Ejército del Aire se realiza desde el año 1997. La dirección se asignó, desde el inicio, al Centro de Farmacia del Aire de Madrid (CEFARMA). Las divergencias durante los últimos años entre las concesiones económicas asignadas y el gasto real ejecutado han sido notables. La falta de modelos matemáticos de predicción puede ser uno de los motivos de la ausencia de ajuste entre lo presupuestado y lo ejecutado. La elaboración de estimaciones estadísticas y econométricas es la base para realizar una prospectiva eficiente al plantear expedientes de contratación de gases de una manera adecuada y no basada en incrementos inerciales de los presupuestos históricos. OBJETIVOS: realización de estimación matemática para la predicción económica en las asignaciones presupuestarias de los expedientes de contratación de gases utilizados en Ejército del Aire. MATERIALES Y MÉTODOS: recopilación de los datos económicos de las facturas y pagos efectuados. Los importes de facturación se han deflactado, tomando como base el año 2016. Para el tratamiento matemático, estadístico y gráfico se han utilizado las aplicaciones informáticas Microsoft(R) Excel (2016), Eviews(R)10, Gretl (2017c) y Statistica v12 (StatSoft inc.). RESULTADOS: se han obtenido diferentes modelos Autorregresivos Integrados de Media Móviles (ARIMA), siendo el que mejor valida los resultados anuales y trimestrales el ARIMA (3,1,0). CONCLUSIONES: los modelos ARIMA permiten efectuar pronóstico y predicción en el cálculo de asignaciones económicas en los expedientes de contratación de gases en el Ejército del Aire

INTRODUCTION: contract records of gases and similar elements used by the Air Force are being signed from 1997. The management of this activity was appointed, from the very beginning, to the Air Force Pharmacy of Madrid (CEFARMA). However, the last divergences between the asigned economic licenses and the actual execution have been noticeable. The lack of mathematical predictive models may account for the disadjustment between the budgeted and the executed. The elaboration of statistic and economeric estimates is retained as the main basis to efficiently forward-looking through contract records of gases properly done, that is, not based on the inertial increment of historical budgets. AIMS: mathematical estimates of budgetary prediction in budget allocations of contract records of gases used by the Air Force. MATERIALS AND METHOD: gathering of the economic data from invoicing and payments. Billing figures have been deflated taking 2016 as the basis. For the mathematical, graphic and statistical treatment of the data the following computing apps have been used: Microsoft(R) Excel (2016), Eviews(R)10, Gretl (2017c) and Statistica v12 (StatSoft inc.). RESULTS: different ARIMA models have been obtained, being ARIMA (3,1,0) the best in annual and quarterly result validation. CONCLUSIONS: ARIMA models allow to predict the economic allocations in the contract records of fases in the Air Force

Results of AMHP Journal Survey on Open Access.

Day PC. Results of AMHP journal survey on Open Access. Aerospace Med Hum Perform. 2018; 89(1):70-71.

The clinical, occupational and financial outcomes associated with a bespoke specialist clinic for military aircrew-a cohort study.

OBJECTIVES: To assess the clinical, occupational and financial outcomes of a new Clinical Aviation Medicine Service (CAMS) for UK military personnel. METHODS: Consecutive patients over a 2 year period were included. Predictors of flying restrictions at referral and final outcome following consultation were modelled using logistic regression. National Health Service (NHS) Payment by Results tariffs and Defence capitation data were used to assess the financial impact of the service. RESULTS: Eight hundred and sixteen new referrals (94.5% male, median age 45 years (range 19-75)) were received and 1025 consultations performed. Cardiovascular disease was the commonest reason for referral. CAMS clinical activity cost at NHS tariff was £453 310 representing a saving of £316 173 (£137 137 delivery cost). In total, 310/816 (38%) patients had employment restrictions on referral and 49.0% of this group returned to full employment following their initial consultation. Compared with cardiology, general medicine and respiratory patients were more likely to have been occupationally restricted prior to referral (50 vs. 35%, OR 1.81; 95% CI 1.18-2.76, P values=0.006 and 53 vs. 35%, OR 2.12; 95% CI 1.15-3.90, P values = 0.016, respectively). Overall 581/816 (71.2%) of patients returned to unrestricted employment while 98/816 (12.0%) were unable to continue in any aircrew role. The service saved 7000 lost working days per year at an estimated occupational saving of ∼£1 million per annum. CONCLUSIONS: This bespoke service has allowed rapid, occupationally relevant clinical care to be delivered with both time and financial savings. The model may have significant occupational and financial relevance for other environmental and occupational medical organizations.

Pediatric emergencies on a US-based commercial airline.

OBJECTIVES: The purpose of this investigation was to determine the incidence and character of pediatric emergencies on a US-based commercial airline and to evaluate current in-flight medical kits. METHODS: In-flight consultations to a major US airline by a member of our staff are recorded in an institutional database. In this observational retrospective review, the database was queried for consultations for all passengers up to 18 years old between January 1, 1995, and December 31, 2002. Consultations were reviewed for type of emergency, use of the medical kit, and unscheduled landings. RESULTS: Two hundred twenty-two pediatric consultations were identified, representing 1 pediatric call per 20,775 flights. The mean age of patients was 6.8 years. Fifty-three emergencies were preflight calls, and 169 were in-flight pediatric consultations. The most common in-flight consultations concerned infectious disease (45 calls, 27%), neurological (25 calls, 15%), and respiratory tract (22 calls, 13%) emergencies. The emergency medical kit was used for 60 emergencies. Nineteen consultations (11%) resulted in flight diversions (1/240,000 flights), most commonly because of in-flight neurological (9) and respiratory tract (5) emergencies. International flights had a higher incidence than domestic flights of consultations and diversions for pediatric emergencies. CONCLUSIONS: The most common in-flight pediatric emergencies involved infectious diseases and neurological and respiratory tract problems. Emergency medical kits should be expanded to include pediatric medications.

Recent trends in workload, input costs, and expenditures in the Air Force Medical Service Direct Care System.

A study was conducted to examine the relationship between two types of trends in the Air Force Medical Service Direct Care System (AFMS/DCS): trends in expenditures, total and by categories; and trends in medical workload, defined as the sum of inpatient admissions and outpatient clinic visits. Expenditure and medical workload data were extracted from the Medical Expense and Performance Reporting System Executive Query System. Medical inflation data were obtained from the Bureau of Labor Statistics Producer Price Index series. Between fiscal years 1995 and 1999, the AFMS/DCS experienced a 21.2% decrease in medical workload, but total (nominal) expenditures declined only 3.6%. Of all expenditure categories, only inpatient medical care, outpatient medical care, and military-funded private sector care for active duty personnel (supplemental care) have any direct relationship with AFMS/DCS medical workload. Real expenditures for the three categories above decreased by 20.3% during the 5-year period. Accounting for inflation and considering only expenditures related to medical workload, these results suggest that the AFMS/DCS is spending approximately 20% less money to do approximately 20% less work.

In-flight continuous vital signs telemetry via the Internet.

BACKGROUND: Current methods available to assess a passenger's life threatening medical condition during in-flight emergencies are inadequate. Critical communication channels between the airplane and ground control rely only on voice communication via a two-way radio. The purpose of this study was to test the efficacy of cellular telephone technology via the Internet as a cost-effective way to obtain the "linking" pathway from an aircraft to a ground medical facility by conducting a simulated on line triage. METHODS: On July 31, 1997, we transmitted vital signs from a Boeing 757, flying from Chicago to Los Angeles, simultaneously to: The Saddle Back Memorial, in Laguna Hills, CA; Hospital Santojanni in Buenos Aires, Argentina; and the Medical Department of American Airlines in Dallas/Fort Worth, TX. Three lead EKG, heart rate, BP, arterial oxygen saturation, end tidal CO2, respiratory rate body temperature and real time video images were collected from a passenger and transmitted to each facility from the aircraft via the Internet. Access to the Internet was gained via the cellular phone aboard the aircraft. RESULTS: A total of 20 different simulated scenarios of an medical emergency condition were successfully transmitted, simultaneously, to all health care facilities. All data was received without any corruption with an average delay time of 1 s. CONCLUSIONS: Close monitoring of the patient can lead to a better understanding and assessment of a medical condition, improve in-flight patient care, accelerate the decision making process by making an early diagnosis, and correct a life-threatening condition before the patient arrives at the destination.

The cost effectiveness of Air Force optometry.

A study was performed which attempted to assess the relative value of a military optometric practice and to provide epidemiological information on ocular pathologies typical in that practice setting. A mock billing system was employed which assessed fees against patient examinations and procedures using Current Procedural Terminology codes. The fees were determined from a survey of the fee structures of local optometrists. The study showed that the military optometric practice was cost effective in relation to the cost that would be incurred through civilian referral. It also demonstrated that military optometric practice is full in scope and encounters a wide variety of pathological entities above and beyond standard refractive modalities.

Challenges of space medical operations and life sciences management.

The Kennedy Space Center (KSC) has been the premier launch and landing site for America's space program since the early 1960s. Visitors are cognizant of space vehicles, processing facilities and launch pads which are treasured national resources. However, most are unaware of the unique organization which supports launch and landing activities and manages the center's occupational medicine, environmental health, ecological and environmental monitoring functions, as well as human and plant research programs. Management of this multifaceted organization can be complex because funding its different functions comes from a number of sources. Additionally the diverse disciplines of personnel present a special challenge in maintaining professional competencies while assuring efficiency in cyclical operations. This article explains the organization's structure and reviews some of its accomplishments.

Screening for mitral valve prolapse: an analysis of benefits and costs in the U.S. Air Force.

Using the techniques of decision analysis, several possible mitral valve prolapse screening strategies for U.S. Air Force aircrew candidates are evaluated. Available clinical and epidemiological data are organized so that the relative merits of various strategies can be assessed by decision makers. The most efficient strategy is to screen pilot candidates with Quetelet's index (weight in kilograms/height in meters squared) and then eliminate those with an index at or below 15 who have an echocardiogram positive for mitral valve prolapse. The next most efficient strategy is to do echocardiograms on candidates with a heart murmur or click. Screening all candidates with an echocardiogram is much less efficient. Screening fighter pilot candidates only is a very inefficient strategy. Available data do not make a very convincing case for any screening program. Concerned and informed physicians will continue to have honest disagreements about screening for mitral valve prolapse in aircrew members.

When an indigent patient needs a helicopter: a case report and an accepted institutional policy.

Emergency aeromedical systems have become an integral part of the practice of critical care medicine. These systems provide specialized care to the severely injured, including transport to the nearest trauma center with the highest level. Aeromedical physicians and nurses called to care for injured indigent patients, however, may be placed at odds with the financial interests of their institution. "Patient dumping" in aeromedicine may lead to ethical, legal, professional, and regulatory dilemmas for emergency professionals and health care institutions. Institutional policy for aeromedical transport of severely injured patients must be instituted, regardless of their ability to pay.