Article

The Annual Incapacitation Rate of Commercial Pilots

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Abstract

Scant data are available on the annual incapacitation rate of aircrew. This study analyzes all incapacitations occurring among UK commercial pilots, in flight and off duty, in 2004 to derive a baseline minimum annual incapacitation rate for the UK commercial pilot population. The study cohort was all professional pilots holding a valid UK/JAR (Joint Aviation Requirements) Class 1 medical certificate and license in 2004. Three data sources were used to identify episodes of incapacitation: the statutory notification of prolonged illness, personal injury, or pregnancy to the UK Civil Aviation Authority; Mandatory Occurrence Reports (MORs) for in-flight medical incidents; and death certificates. The total number of incapacitations was expressed as a proportion of the number of professional pilots to give an incapacitation rate. In 2004 there were 16,145 UK/JAR professional pilot license holders. Of the notified medical events, 36 presented as incapacitations; half were cardiac or cerebrovascular. In-flight incapacitations were predominantly of psychiatric cause. There were four sudden deaths. The type of incapacitation varied with age. A male pilot in his 60s had 5 times the risk of incapacitation of a male pilot in his 40s. The annual incapacitation rate was 40/16,145 = 0.25%. Aeromedical emphasis on minimizing cardiovascular risk and monitoring the mental health of pilots remains appropriate. Age should influence the content and periodicity of regulatory aeromedical assessments. The demonstrated annual incapacitation rate of 0.25% may provide a basis for quantifying the acceptable risk for a pilot undertaking single pilot commercial air transport operations.

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... Based on these assumptions, it was argued that medical incapacitation should result in a fatal accident no more often than one in 1000 million flying hours (1 in 10 9 ) (for details see text box). While this approach has been used for decades, the 1% rule has some limitations [96][97][98] and the concept of acceptable risk in commercial aviation remains debatable, with proposed risk limits ranging from 0.5 to 2% per year. 97,99,100 Additional requirements for older pilots have attracted additional controversy 89 since studies demonstrate an age-dependent risk of pilot incapacitation, although the value of experience is a significant factor in reducing accident risk. ...
... While this approach has been used for decades, the 1% rule has some limitations [96][97][98] and the concept of acceptable risk in commercial aviation remains debatable, with proposed risk limits ranging from 0.5 to 2% per year. 97,99,100 Additional requirements for older pilots have attracted additional controversy 89 since studies demonstrate an age-dependent risk of pilot incapacitation, although the value of experience is a significant factor in reducing accident risk. 99,101 In 2006, ICAO mandated the requirement for a co-pilot under age 60 to minimize the risk of single-pilot incapacitation in commercial flying. ...
... Maintenance of cardiovascular health among astronauts is important given the recognized cardiovascular adaptations associated with spaceflight. [94][95][96][97][98][99]115,[121][122][123][124][125] To date, there is contradictory evidence associating these physiological effects to an increased lifetime risk for cardiovascular disease (CVD). [126][127][128] In the past researchers have suggested that astronauts have a 3-5% risk of developing CVD by their fifth decade of life 128 but the absolute risk of all-cause mortality during space flight is unknown. ...
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Article
A review of the current occupational guidelines suggests that many organizations still rely on traditional CHD risk evaluation with or without the use of cardiac stress testing (whether exercise ECG or functional imaging). This approach runs the risk of missing important occupational CAD. The literature review performed has identified that a cardiac CT based approach to determining occupational cardiovascular risk can be valuable mainly due to the unparalleled negative predictive value a of coronary CTA. For risk assessment in individuals undertaking safety sensitive work, both CACS and coronary CTA can evaluate an employee’s risk for CVD events with a high degree of accuracy. Whether CACS or coronary CTA is performed is most likely determined by the level of risk accepted by an employer and the importance of determining non-calcified CAD as part of any occupational assessment. In most cases, the presence of mild CAD alone should not trigger untoward restrictions, even in pilots with no symptoms. Instead, the identification of subclinical CAD should serve as an opportunity to control modifiable ASCVD risk factors.
... On the basis of this rule, and calculated down to an individual pilot in commercial multi-crew operations, it does mean that for one commercial pilot on duty the maximum risk of a case of incapacitation per annum is at one percent. This rule included only cardiovascular diseases (Evans and Radcliffe, 2012). Nonetheless, physical health is addressed in all aspects in aeromedical examinations whereas the cognitive mental status is only examined if suspected. ...
... In practice, the occurrence of an in-flight incapacitation is thankfully very rare (Hinkelbein et al., 2008). A systematic analysis could not be undertaken because the studies reviewed varied in their methodology that, together with a low incidence rate, made precise calculation impossible (Australian Transport Safety Bureau [ATSB], 2016;DeJohn et al., 2006;Evans and Radcliffe, 2012;Newman, 2007). There were 36 in-flight incapacitations of commercial pilots in UK in 2004 (Evans and Radcliffe, 2012). ...
... A systematic analysis could not be undertaken because the studies reviewed varied in their methodology that, together with a low incidence rate, made precise calculation impossible (Australian Transport Safety Bureau [ATSB], 2016;DeJohn et al., 2006;Evans and Radcliffe, 2012;Newman, 2007). There were 36 in-flight incapacitations of commercial pilots in UK in 2004 (Evans and Radcliffe, 2012). About 37% of them were due to cardiovascular events, 14% were due to cerebrovascular events whereas the remaining half events arose from predominantly psychiatric issues. ...
Article
After the Germanwings flight 4U9525, mental health issues of pilots have been raised as a hazard to flight safety. Pilot homicide-suicide, as a special subtype of pilot incapacitation, can be examined at different levels of commercial aviation. We extended the System Theoretic Process Analysis (STPA), based on the System Theoretic Accident Modelling and Process (STAMP), to pilot behaviour to investigate how these knock-out events may be encountered in the whole system. Several safety actions have been identified to prevent hazardous pilot behaviour caused by medical incapacitation and homicidal-suicidal behaviour at different levels of the system. Pilot incapacitation is already handled very well in practice with respect to the regulations and procedures in current usage. In contrast, the prevention of pilot homicide-suicide is currently managed by aeromedical decisionmaking regulations and pilot support programs. The design of the flight deck compartment door and the balancing of privacy laws and public safety remain trade-offs amid a medical risk
... The identification of a possible sudden incapacitation during military flight is essential to maintain high aviation safety. Sudden incapacitation can be associated with syncope [3]. Medical assessment, including an evaluation of incapacitation risk, is mandatory for flight personnel who wish to obtain the medical certificate that is required for maintaining pilot licenses in European aviation [3,4]. ...
... Sudden incapacitation can be associated with syncope [3]. Medical assessment, including an evaluation of incapacitation risk, is mandatory for flight personnel who wish to obtain the medical certificate that is required for maintaining pilot licenses in European aviation [3,4]. ...
... In aviators, syncope is particularly problematic because syncopal events during flight can impair safety, possibly causing loss of the airplane and the crew's life [3,14]. In a previous study, vasovagal syncope and heart rhythm-associated syncope were found to be correlated with the sudden incapacitation of aviators [3]. ...
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Article
Syncope is a relevant health problem in military environments. Reliable diagnosis is challenging. Tilt table testing is an important tool for syncope diagnosis. The aim of this study was to determine whether signs such as prodromal symptoms, co-morbidity, frequency of syncopal events, body length, body mass index, and electrocardiography abnormalities can be used to predict the success of tilt table testing at diagnosing syncope. Data from 100 patients with histories of syncope or pre-syncope, who were diagnosed using head-up tilt table testing, were retrospectively analyzed in a cross-sectional analysis. The diagnostic procedure was based upon a modified version of the Westminster protocol without any pharmacological provocation. Patients showing pathological reaction patterns during tilt table testing suffered from prodromal symptoms, such as dizziness and sweating, significantly more often. The patients reported more injuries resulting from syncopal events and more previous syncopal events, and the prevalence of co-morbidity was greater among patients presenting negative findings during tilt testing. An asthenic-leptosomal physique was not confirmed as a risk factor for syncopal events as is the case for idiopathic arterial hypotension. However, patients with pathological reaction patterns during tilt table testing were significantly taller. This finding was detected for both females and males. No significant predictors were found in the electrocardiogram (ECG) patterns of patients showing syncope during tilt table testing. Frequency of prior syncope and prodromal symptoms, and increased body length with an otherwise good state of health influence the predictive value of tilt table testing for syncope diagnosis. In particular, if these factors are present, tilt table testing should be considered part of the diagnostic algorithm for soldiers with recurrent syncope.
... Other neurological disorders are more likely to onset later in life, after the age of 60 years, such as Alzheimer's disease (AD), Parkinson's disease (PD), amyotrophic lateral sclerosis (ALS) and stroke, but it is important to note that two per cent of Alzheimer cases onset before the age of 60 years (42,325 people were thought to be living with young-onset dementia in the UK in 2013 [Prince et al., 2014]) and one in four strokes occur in people under the age of 65 years. In the past the most common cause of pilot disqualification was cardiac disease, but recent epidemiological surveys of airline and regulatory body records suggest neurological problems such as vascular events are also a major cause of unfit notifications and incapacitation (Evans & Radcliffe, 2012;Arva & Wagstaff, 2004). Psychological problems have also been reported to be a major cause of in-flight incapacitation and loss of licence (Bor et al., 2002;Evans & Radcliffe, 2012) the most common problems being anxiety disorders, depression and alcohol abuse, all of which can impair cognitive function. ...
... In the past the most common cause of pilot disqualification was cardiac disease, but recent epidemiological surveys of airline and regulatory body records suggest neurological problems such as vascular events are also a major cause of unfit notifications and incapacitation (Evans & Radcliffe, 2012;Arva & Wagstaff, 2004). Psychological problems have also been reported to be a major cause of in-flight incapacitation and loss of licence (Bor et al., 2002;Evans & Radcliffe, 2012) the most common problems being anxiety disorders, depression and alcohol abuse, all of which can impair cognitive function. ...
... One of the most concerning aspects of incapacitation, especially during the flight, is cardiovascular events [4,5]. These are also one of the leading causes of disability and loss of licenses among commercial pilots [6]. Some of the causes of sudden incapacitation are myocardial infarction, cardiac arrhythmia and seizures [7]. ...
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Article
Cardiovascular accidents are the most disabling event for pilots, causing complicated situations during flight and the withdrawal of license. The study aims to assess the modifiable risk factors and the atherogenic index of plasma (AIP) associated with anthropometric, physiometabolic and lifestyle profiles in a sample of Spanish aviation pilots. Data from pilots’ clinical and professional history, anthropometric and bioelectrical impedance assessments of nutritional status, and diet and physical activity questionnaires. The sample comprised 304 men pilots. Up to 53.6% showed excess weight, of which 6.4% were obese, 64.3% presented high relative adiposity and 64.6% showed abdominal obesity. Regarding the physiometabolic profile, 10.0% had hypertension, 42.6% hypercholesterolemia, 9.4% high LDL and 10.6% low HDL, 9.4% hyperglycemia and 8.1% hypertriglyceridemia. The adherence to the Mediterranean diet (MedDiet) was high in 29.7% and low in 14.7%. Most of the sample showed a good physical activity level. The AIP risk increased with higher obesity indicators and LDL cholesterol levels. There was an inverse relationship between the MedDiet adherence and vigorous physical activity and the risk of atherogenicity. Elevated rates of overweight, abdominal obesity and hypercholesterolemia were found, contributing to the atherogenic risk of plasma (AIP). This parameter was significantly associated with all anthropometric indicators and LDL cholesterol. Prevention plans on reducing excess fat and blood cholesterol levels are recommended to reduce cardiovascular risk in Spanish aviation pilots and ensure flight safety.
... Incapacitation is not something happening frequently. In fact, an annual incapacitation rate of 0.25% was reported for UK commercial pilots in the year 2004, including in-flight and off-duty incapacitation events [105]. The authors of the study described this as an acceptable safety record for commercial aviation. ...
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Thesis
Due to the technological progress, increasingly sophisticated and highly automated systems have replaced human roles in the cockpit of commercial aircraft. Consequently, the crew size has been reduced from initially five to two cockpit crew members over the past decades. Nowadays, a captain and a first officer share the tasks throughout the flight by assuming the roles of pilot flying (PF) and pilot monitoring (PM). However, in light of the ongoing technological advancements, the logical next step seems to be a further de-crewing from two-crew operations (TCO) to single-pilot operations (SPO). To provide adequate support for the single pilot, a redesign of the cockpit is required. The present study contributes to this research area by adopting a human-centered perspective and investigating how the PF is affected by the absence of the PM during commercial SPO. A study was conducted in a fixed-base Airbus A320 flight simulator. Fourteen professional pilots participated. Their task was to fly short approach and landing scenarios at Frankfurt Airport both with and without a PM. A 2x3 factorial within-subject design was used with the factors crew (TCO and SPO) and scenario (baseline, turbulence, and abnormal). A combination of quantitative and qualitative data was collected in the form of subjective workload ratings, eye-tracking data, simulator parameters, video recordings, and debriefing interviews. The results showed that workload was not generally higher during SPO but particularly the temporal demand increased significantly. Additionally, checklist usage was less consistent and pilots handled the abnormal scenario differently when the PM was absent. The pilots’ scanning behavior was also significantly affected by the absence of the PM. Pilots had to spend considerably more time scanning secondary instruments at the expense of primary instruments. Moreover, transition behavior between the cockpit instruments and the external view was less efficient in SPO and was interpreted in terms of an overload on the pilots’ visual modality. This research will help inform the design of commercial SPO flight decks providing adequate support for the single pilot. Several implications for the design of SPO cockpits are discussed, such as headup displays, multisensory interfaces, augmented reality glasses, advanced automation, and additional support from ground operators.
... 129 Many PME (fire services and aviation) involve an annual measure of lipids, blood pressure, and anthropometric data. 14 Given the limitation of the resting ECG to detect occult CAD, many organizations that employ high-hazard workers use sub-maximal or maximal exercise testing (with or without ECG), at various age intervals, for Cardiovascular risk in high-hazard occupations the assessment of their workers. 135 Most occupational exercise testing is performed without an ECG with a view to assessing the minimal required exercise tolerance. ...
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Article
Work is beneficial for health, but many individuals develop cardiovascular disease (CVD) during their working lives. Occupational cardi-ology is an emerging field that combines traditional cardiology sub-specialisms with prevention and risk management unique to specific employment characteristics and conditions. In some occupational settings incapacitation through CVD has the potential to be catastrophic due to the nature of work and/or the working environment. These are often termed 'hazardous' or 'high-hazard' occupations. Consequently, many organizations that employ individuals in high-hazard roles undertake pre-employment medicals and periodic medical examinations to screen for CVD. The identification of CVD that exceeds predefined employer (or regulatory body) risk thresholds can result in occupational restriction, or disqualification, which may be temporary or permanent. This article will review the evidence related to occupational cardiology for several high-hazard occupations related to aviation and space, diving, high altitude, emergency workers, commercial transportation, and the military. The article will focus on environmental risk, screening, surveillance, and risk management for the prevention of events precipitated by CVD. Occupational cardiology is a challenging field that requires a broad understanding of general cardiology, environmental, and occupational medicine principles. There is a current lack of consensus and contemporary evidence which requires further research. Provision of evidence-based, but individualized, risk stratification and treatment plans is required from specialists that understand the complex interaction between work and the cardiovascular system. There is a current lack of consensus and contemporary evidence in occupational cardiology and further research is required.
... In a study conducted with commercial airline pilots, it was reported that smoking is among the risk factors for cardiovascular diseases [36]. The annual incapacitation rate among United Kingdom (UK) commercial pilots was found to be 0.25% [37] and most in-flight medical incapacitations were found to be cardiac pathologies [38,39]. In a study performed on 55 pilots and 35 cabin crew members who were asymptomatic, electrocardiographic recordings were obtained throughout the entire flight (takeoff, cruise, approach, and landing phases) and it was detected more electrocardiographic changes (sinus tachycardia /bradycardia, ventricular /supraventricular extrasystole) during the take-off and landing phases than the other phases [40]. ...
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Article
Aviation personnel, who are required to be healthy enough to tolerate the flight conditions in which airline transportation is carried out, and who are subjected to comprehensive examinations for this purpose, should stay away from the habits that will adversely affect their health. One of these habits is smoking. In this study, it was aimed to evaluate the effects of smoking on pulmonary functions of aviation personnel. Demographic data and PFT values of the patients were analyzed retrospectively in the Aero-Medical Center. Of the 69 people included in the study, 28 (40.6%) were female and 41 (59.4%) were male. 26 of the males (63.4%) and 4 (14.3%) of the females applied for pilot medical examinations, while 24 (85.7%) of the females and 15 (36.6%) of the males applied for cabin crew medical examinations. The smoking rate was found to be 24.4% (n=10) for males and 17.9% (n=5) for females. Among females, mean values of FEV1, FEV1/ FVC, PEF and MEF25-75 in smokers were found to be lower than non-smokers. The discrete effects of smoking status and gender on the changes of FEV1 / FVC mean values were found to be statistically significant (p<0.05). Although the decrease in PFT values of smokers show an asymptomatic course, it is evaluated that if these people continue to smoke, the clinical implications of decrease in PFT values may occur in the following years and this may negatively affect flight safety. Besides, to prevent some of the negativities that smoking habit will bring, it is considered that it will be beneficial for smoker aircrew to start activities and incentives for smoking cessation, especially at a young age, in a way that does not affect the flight status of the person.
... 14 In Arva's study, the main medical causes of EPMD in 257 Norwegian civilian pilots included cardiac, neurologic, and psychiatric. 15 Evans et al. and Mitchell et al, reported that heart, neurologic and psychiatric reasons were responsible for the sudden disability of British civilian pilots. 16,17 However, in all the studies mentioned and in our study, psychiatric, cardiac, and neurologic are the common causes leading to EPMD in IRIAF NPC. In our research, common diseases leading to EPMD in IRIAF NPC were GAD, MI, and lumbar discopathy. ...
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Article
Background Efficient personnel is the most important Armed Forces capital. Many studies have shown the relationship between health and performance. Understanding the factors leading to disability has preventive importance. This study was aimed to identify diseases leading to permanent disqualification of Islamic Republic of Iran Air Force (IRIAF) non-pilot crew (NPC) to identify existing deficiencies and prevent personnel disqualification. Methods The study was designed as descriptive, cross-sectional, retrospective research. Medical causes and diseases leading to early and permanent medical disqualification (EPMD) of IRIAF NPC from 1986 to 2016 were collected from their medical records and council files. Data were registered and sorted in predesigned electronic sheets for analysis by SPSS version 26. Results Of all the 155 cases with permanent disqualifications, 126 persons had medical disqualification, and others were killed or missed in actions. Flight engineers, navigators, and loadmasters had the most medical disqualification. The highest number of killed or missed persons in actions was for navigators, loadmasters, and crew chiefs. The main reasons for EPMD were psychiatric, cardiac, and neurologic, wherein common diseases included generalized anxiety disorder, myocardial infarction, and lumbar discopathy. The total lost service years were 1569 person-years. Its average was 12.45 person-years per individual with a standard deviation of ±2.4. Conclusion Due to the similarity in the work environment, we compared NPC results with similar studies in other flight crew. Nonetheless, the main causes and diseases leading to early EPMD of the flight crew were similar in different studies, but their orders and frequencies were different.
... Syncope is a usual etiology of cardiologist referral of military services officials, and has the third rank following palpitation and cardiac attack respectively. 10,15 This condition occurs mostly among younger military populations (10-30 years old). The range of age is consistent with the most common age that participants of military training services have. ...
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Article
BACKGROUND Syncope is a transient brief loss of consciousness accompanied with loss of postural tone. Of common places in which people experience syncope, military barracks can be named where training soldiers spend their military courses. The current study aimed to assess etiology and risk factors of syncope among military training soldiers. METHODS This was a retrospective case-control study conducted on training soldiers of Army-501 hospital in Tehran, Iran, during the years 2017-2018. Cases were consisted of 50 soldiers who experienced syncope during military training, and controls were 150 soldiers who had not experienced syncope during their military training. Demographic data were recorded for cases and controls. RESULTS Members of case and control groups were not statistically different regarding age (P = 0.46) and height (P = 0.70). Logistic regression test was performed and considering crude model, weight [odds ratio (OR): 0.94; 95% of confidence interval (95%CI): 0.90-0.98], body mass index (BMI) (OR: 0.72; 95%CI: 0.61-0.85), standing duration (OR: 1.007; 95%CI: 1.00-1.01), history of syncope (OR: 15.47; 95%CI: 4.15-57.60), positive family history of syncope (OR: 5.94; 95%CI: 1.66-21.25), smoking (OR: 3.5; 95%CI: 1.54-7.91), medical problems (OR: 7.97; 95%CI: 1.98-32.17), anxiety (OR: 2.02; 95%CI: 1.13-4.26), stress (OR: 6.68; 95%CI: 3.28-13.57), and depression (OR: 4.25; 95%CI: 2.15-8.39) were detected as significant predictors of syncope occurrence. CONCLUSION Based on the findings of this study, lower BMI, positive history of syncope, smoking, depression, and stress were significant risk factors of syncope occurrence among training soldiers. Higher BMI has protective role in syncope occurrence.
... In general, such cases of in-flight incapacitation are rare. For example, the annual incapacitation rate for commercial pilots was 0.25% in the UK in 2004 (Evans and Radcliffe 2012). This calculation was based on incidents reported to the UK Civil Aviation Authority. ...
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Article
One main hurdle towards commercial airliners’ Reduced-Crew Operations (RCO) is how to encounter pilot incapacitation. The aim of this modelling study is to evaluate the potential effects of a single-pilot’s incapacitation on a future design approach to RCO. Most solutions propose a ground support of the pilot by a remote operator whom control should be handed over in case of an emergency. Both incapacitation and homicide-suicide have been discussed in the literature but neither of these events have been modelled nor evaluated empirically. We introduce a future operational design concept for RCO which includes a remote-copilot as ground support and automation tools monitoring pilot’s health and entries into aircraft systems. The hazard analysis technique System-Theoretic Process Analysis (STPA) was used to model and analyse scenarios of incapacitation/homicide-suicide. A hierarchical control structure showed how RCO can be embedded into commercial aviation. The STPA of pilot incapacitation and two scenarios of pilot homicide-suicide showed how unsafe control actions leading to an incident or accident after incapacitation/homicide-suicide could be prevented. The possible detection and take-over of control by the ground support in the case of incapacitation raised the question for detailed procedures on how to react to its detection. Either an autoland by the remote-copilot or by an affiliated system is possible. An additional breakup of data-link may only be solved by an automatic landing system on-board.
... Thus, a research agenda for moving forward with SPO should include continuing research on groundbased and cockpit-based concepts for SPO and the technologies required to implement those concepts (e.g., CRM and HAT tools described earlier), as well as new research on pilot incapacitation and SPO certification. Although estimates of pilot incapacitation are low (e.g., annual rate of 40 cases, Evans & Radcliffe, 2012; 1 out of 34,000 flights, Australian Transport Safety Bureau, 2016), solutions for remote or automated piloting of the aircraft in cases of pilot incapacitation must be found. Several solutions for detecting pilot incapacitation have been proposed (e.g., Liu, Gardi, Ramasamy, Lim, & Sabatini, 2016), including methods for determining whether the pilot is alert (i.e., making appropriate inputs and decisions), and is capable of maintaining command of the aircraft. ...
Article
Objective: To provide an overview of concepts of operation for single pilot operations (SPO) and a synthesis of recently published work evaluating these concepts. Background: Advances in technology have made it possible for a commercial aircraft to be flown by a single pilot under normal conditions, and research is being conducted to examine the feasibility of implementing SPO for commercial aviation. Method: Context leading up to the consideration of SPO for commercial flight is provided, including the benefits and challenges. Recent studies examining issues relating to automation, operations, and communications in the SPO context are presented. Results: A number of concepts have been proposed and tested for SPO, and no one concept has been shown to be superior. Single pilots were able to successfully resolve off-nominal scenarios with either the ground-support or cockpit-automation tools examined. However, the technologies developed in support of these concepts are in prototype forms and need further development. Conclusion: There have been no obvious "show stoppers" for moving toward SPO. However, the current state of research is in its initial stages, and more research is needed to examine other challenges associated with SPO. Moreover, human factors researchers must continue to be involved in the development of the new tools and technologies to support SPO to ensure their effectiveness. Application: The research issues highlighted in the context of SPO reflect issues that are associated with the process of reducing crew members or providing remote support of operators and, more generally, human interactions with increasingly autonomous systems.
... Although the data are not definitive [22], ICAO Document 8984 "Manual of Civil Aviation Medicine" employs a "1% rule" where the risk of incapacitation is assumed to be one percent per annum or approximately equal to one event in 1 million flying hours. Research [ 23 ] shows that the incapacitation risk is "small under the age of 40, increases over the age of 50, and rises steeply over the age of 60." By age 60, the data show an average incapacitation rate of approximately 1.2%. ...
... DeJohn et al. (2004) observed that the safety of the flight was seriously impacted in only seven cases and resulted in two non-fatal accidents. A later study of UK commercial pilots by Evans and Radcliffe (2012) suggest that the annual in-flight incapacitation rate was 0.25%, however this study is seriously flawed in than it was not weighted by flight hour and the rate is expressed as a percentage of all UK registered pilots (irrespective of flight hours accumulated by each, per year). ...
Conference Paper
It is argued that the barrier to single pilot operation is not the technology, but the failure to consider the whole socio-technical system. To understand the socio-technical system we model single pilot operations using Cognitive Work Analysis and analyze those models using Social Network Analysis. Four potential models of single pilot operations were compared to existing two pilot operations. These analyses potentially form the basis for a distributed system architecture for the operation of a single crew aircraft.
... DeJohn et al. (2004) observed that the safety of the flight was seriously impacted in only seven cases and resulted in two non-fatal accidents. A later study of UK commercial pilots by Evans and Radcliffe (2012) suggest that the annual in-flight incapacitation rate was 0.25%, however this study is seriously flawed in than it was not weighted by flight hour and the rate is expressed as a percentage of all UK registered pilots (irrespective of flight hours accumulated by each, per year). ...
Article
It is argued that the barrier to single pilot operation is not the technology, but the failure to consider the whole socio-technical system. To better understand the socio-technical system we model alternative single pilot operations using Cognitive Work Analysis (CWA) and analyse those models using Social Network Analysis (SNA). Four potential models of single pilot operations were compared to existing two pilot operations. Using SOCA-CAT from CWA, we were able to identify the potential functional loading and interactions between networks of agents. The interactions formed the basis on the SNA. These analyses potentially form the basis for distributed system architecture for the operation of a future aircraft. The findings from the models suggest that distributed crewing option could be at least as resilient, in network architecture terms, as the current dual crewing operations. Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.
... Incapacitation is a well-known issue for safety in aviation. Evans et al [5] have defined two levels: incapacitation and impairment. The first one is defined as a medical event leading to an inability to act as flight crew for at least 10 minutes. ...
Article
This article focuses on an analysis of the strategies used by pilots of the civil aviation in case of an incapacitation during flight. Incapacitation is defined in this research as any situation where the level of available aircrew resources is lower than the required level of resources needed to maintain the optimum performance with common strategies. There are different types of incapacitation depending on their severity and operational consequences. Incapacitations are a contributing factor of several events in aviation. In case of an incapacitation, aircrews use strategies to maintain their performance and manage the overall level of flight safety. This work aims at developing a methodology to perform a risk management of crew incapacitation and to identify crew strategies in order to study the potential to integrate them in the design of future cockpits and pilot's training. This paper deals with the indentification of strategies.
... The major in-fl ight medical impairments reported in pilots were usually caused by cardiac diseases (ischemia, arrhythmia) or epileptic seizures ( 2 ). However, among these in-fl ight medical events that resulted in a notifi cation of unfi tness, acute sinusitis/vertigo have also been reported ( 3 ). Some of these cases may have been indirectly caused by a dental disease and could be ascribed to a referred barodontalgia ( 16 ). ...
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Article
Barodontalgia is dental pain triggered by a change in barometric pressure and can be severe enough to cause in-flight incapacitation. There is a large variation of in-flight barodontalgia incidence in the literature and most of the current epidemiological data on barodontalgia has been compiled from military aircrew. The aim of this study was to evaluate the frequency of barodontalgia in French military and civilian aircrew. A cross-sectional study was conducted in 2010. The pilots and crewmembers attending 10 medical units of the French Air Force and Navy, and 5 dedicated to civilian pilots and aircrew were given a standardized and anonymous questionnaire to complete regarding demographic and professional characteristics as well as their barodontalgia. Out of the 1475 questionnaires distributed, 1184 responded (response rate of 80.3%), and 6.6% of these participants (N = 74) reported at least one event of barodontalgia during their career (95% CI: 5.1-8.1%); 43 (6.8%) from the air force and 31 (6.5%) from a civilian service. Median pain intensity during barodontalgia was evaluated at 5.5 out of 10. Pain appeared most commonly during descent (47.3%) and was more frequent below 8000 m. In 10 cases (13.5%), the pilots reported that barodontalgia could have compromised flight security. Despite the improvement of aeronautical equipment and the quality of dental care, barodontalgias were still present in 2010 in the French military and in civilian aircrews. We recommend prevention programs be established in order to minimize the frequency of barodontalgias and their potential repercussions on flight safety.
Article
Single Pilot Operations (SPO) for commercial aircraft has been planned to be the core development direction of the next generation civil aircraft operating mode in 2030 by International Civil Aviation Organization (ICAO). Safety is a key airworthiness factor in the design of commercial aircraft. However, the increasing system integrity and a higher degree of air-ground task collaboration make safety the main challenge in implementing SPO, it is extremely hard to effectively identify potential hazard elements in the system using the traditional dual-pilot safety analysis methods. To address the above problems, this paper introduces the hazard pattern mining method and proposes different hazard pattern mining algorithms to identify potential hazard patterns implied in air-ground resource sharing, function fusion, and task collaboration. And a model-based simulation verification platform has been proposed to complete the safety assessment and verification of SPO air-ground task collaboration. It can provide a theoretical basis of safety analysis for further developing commercial aircraft based on SPO mode.
Article
INTRODUCTION: Pilots' mental health has received increased attention following Germanwings Flight 9525 in 2015, where the copilot intentionally crashed the aircraft into the French Alps, killing all on board. An investigation of this incident found that the pilot had a depressive disorder.METHODS: This systematic review investigated peer reviewed studies of pilot mental health published since 1980. A total of 58 papers were identified.RESULTS: Two main methodologies have been employed: questionnaires and database record searches. Anxiety, depression, and suicide were the most commonly investigated mental health conditions. There were almost an equal number of studies that found a higher prevalence of psychological symptoms in pilots as those that found a lower prevalence, relative to controls or the general population. Prevalence rates were higher in studies relying solely on questionnaires than in studies employing database record searches.DISCUSSION: Prevalence estimates are closely associated with methodology, so it is difficult to determine the true rate. Factors that might account for low prevalence estimates include under-reporting of symptoms by pilots and a reluctance to diagnose on the part of health professionals. Factors that might account for high prevalence estimates include anonymous assessment, the use of questionnaires that do not align with clinical disorders, and inconsistent cut-off scores. It is recommended that future studies on prevalence use well-validated clinical measures, and that more research be conducted on the effects of particular disorders on job performance.Ackland CA, Molesworth BRC, Grisham JR, Lovibond PF. Pilot mental health, methodologies, and findings: a systematic review. Aerosp Med Hum Perform. 2022; 93(9): 696-708.
Article
Occupational hearing loss in the civilian flight crew members prevails in the structure of occupational hearing loss. The study was aimed to assess errors made in forensic evaluation of flight personnel with hearing loss. A total of 213 definitive diagnoses of occupational hearing loss established in 2015–2021 were assessed. Expert errors were found in 73% of cases. The most common, typical errors were reported that were evident in 12 cases submitted for forensic evaluation. The main errors were as follows: incorrect assessment of the parameters of noise inside the aircraft cabin, lack of knowledge about the clinical and audiological features of noise-induced hearing loss, incorrect assessment of audiological indicators, underestimation of the role of comorbidities, etc. The findings showed that high proportion of occupational hearing loss in the civilian flight crew members was in large part due to imperfection of expert solutions resulting from the lack of knowledge about the basic criteria of the diagnosis and the relationship between the noise-induced hearing loss and profession. The major requirements for evaluation of the relationship between the noise-induced hearing loss and profession and the issues related to professional suitability set out in the current regulatory documents issued by the Ministry of Health of the Russian Federation and seminal publications were not taken into account. The cornerstones of expert work on the issues of the relationship between the hearing organ disorder and profession in the civilian flight crew members were underestimated. This resulted in unsubstantiated professional unsuitability, disability among working-age people, and economic losses.
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The unmanned piloted operations mode is the key development direction of the next generation of commercial aircraft. We propose the remotely piloted operations (RPO) mode of commercial aircraft which combines the autonomous piloting and remotely piloting technology, and describe its organization structure including ground station, airborne intelligent system, and air–ground data link in detail. Then, we take the cruising phase as an example to carry out model-based scenario design and verification. It is found that the RPO mode can basically cover the operations of dual pilots, and autonomous flight in authorized airspace can reduce the workload of the remote pilot and improve airspace utilization and flight safety.
Article
INTRODUCTION: Little has been studied to promote aviation health in South Korea. The aim of this study was to analyze the results of aviation medical examinations conducted in South Korea over the past 5 yr and, in doing so, provide evidence for establishing a health promotion, disease prevention plan.METHODS: Subjects of the study consisted of applicants who underwent aviation medical examinations from January 1, 2016, to December 31, 2020.RESULTS: Over the past 5 yr, the total number of aviation medical examinations in South Korea has shown an annual increase of more than 10%. In the presence of the COVID-19 pandemic in 2020, the number of aviation medical examinations, both renewal and initial, for all types of licenses, except renewal aviation medical examinations for the ATCL, decreased. Disqualification rates were generally higher in initial examinations than in renewal examinations. The examination results for license renewal showed the ATPL disqualification rate to be the highest at 3.5 per 1000 pilots per year in their 50s, with cardiology cases being the most common reason for disqualification, followed by ophthalmology cases and psychiatry cases. Diagnostic categories for those disqualified after initial aviation medical examinations were similar, though ophthalmological causes were most common, followed by cases of psychiatry and neurology.CONCLUSION: Main causes of disqualification in airmen and air traffic controllers were identified as the presence of cardiovascular, ophthalmic, and psychiatric diseases. The results of this study provide evidence for improving health promotion activity plans to manage risk factors of such diseases for aviation workers.Kim JS, Han BS, Kwon YH, Lim J. A 5-yr analysis of aviation medical examinations in South Korea. Aerosp Med Hum Perform. 2022; 93(6):499-506.
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Article
Background: The occupational demands of professional airline pilots such as shift work, work schedule irregularities, sleep disruption, fatigue, physical inactivity, and psychological stress may promote adverse outcomes to cardiometabolic health. This review investigates the prevalence of cardiometabolic health risk factors for airline pilots. Methods: An electronic search was conducted utilizing PubMed, MEDLINE (via OvidSP), CINAHL, PsycINFO, SPORTDiscus, CENTRAL, and Web of Science for publications between 1990 and February 2022. The methodological quality of included studies was assessed using two quality assessment tools for cross-sectional and clinical trial studies. The prevalence of physiological, behavioral, and psychological risk factors was reported using descriptive analysis. Results: A total of 48 studies derived from 20 different countries, reviewing a total pooled sample of 36,958 airline pilots. Compared with general population estimates, pilots had a similar prevalence for health risk factors, yet higher sleep duration, lower smoking and obesity rates, less physical activity, and a higher overall rate of body mass index >25. Conclusions: The research reported substantial prevalence >50% for overweight and obesity, insufficient physical activity, elevated fatigue, and regular alcohol intake among pilots. However, the heterogeneity in methodology and the lack of quality and quantity in the current literature limit the strength of conclusions that can be established. Enhanced monitoring and future research are essential to inform aviation health practices and policies (Systematic Review Registration: PROSPERO CRD42022308287).
Article
INTRODUCTION: An aviation safety management system should consider and mitigate against all potential risks to flight safety. In addition to in-flight incapacitation, pilots falling below regulatory standards who are assessed as unfit may have represented a risk prior to that assessment. An analysis was undertaken of Class 1 certificate holders to determine factors correlated with unfit assessments. METHODS: Fitness assessments of pre-existing Class 1 certificate holders following medical examinations (to EASA Part-MED standards) or between medicals were studied between 1 January 2016 and 31 December 2019. Assessments where the outcome was ‘fit’ ( N = 99,406) were compared with those where the outcome was ‘unfit’ ( N = 7925). Analyses for correlation between unfit assessments against age, declared coexisting medical conditions, and the number of days since last assessed as fit were undertaken using SPSS. RESULTS: Unfit assessment likelihood and age were strongly correlated; there is, however, evidence for the ‘healthy worker effect’, with a fall in unfit assessments between 60–65 yr of age. There was no association between coexisting medical condition declaration and the likelihood of becoming unfit. The time interval between a fit and unfit assessment was significantly lower when comparing 20–60 and 61–63 yr old individuals. DISCUSSION: The analysis of unfit assessments shows strong correlation with increasing age and the possible presence of the healthy worker effect among commercial pilots. The decreased time from a previous fit assessment to an unfit assessment supports the reduced certificate validity period of Class 1 applicants over 60 yr of age. Cairns MK. Unfit assessments of Class 1 Medical certificate holders . Aerosp Med Hum Perform. 2021; 92(12):945–949
Article
BACKGROUND: This article presents the results of an EASA-commissioned study aimed at analyzing the medical causes of grounding of a broad European pilot population and recommending measures to reduce the risk of in-flight incapacitation in commercial air transport pilots. METHOD: European National Aviation Authorities (NAAs) were requested to provide data concerning the total number of pilots that were examined, their age and license category, number of unfit pilots, and the medical causes of each case of grounding. Diagnoses were classified according to the format and definitions laid down in Commission Regulation (EU) No. 1178/2011 Part Med. RESULTS: Analyzed were 82,435 cases assessed by 6 NAAs. Of these cases, 2.1% were assessed as unfit to fly. Frequent causes for grounding a pilot were cardiovascular (19%), psychiatric (11%), neurological (10%), and psychological (9%). Cardiovascular conditions were the most frequent cause for grounding in the older age groups, with 21% in the age 51–60 cohort, 28% in the age 61–65 cohort, and 48% in those beyond 65 yr. Psychiatric and psychological diagnoses were most frequent in the age 20–40 cohort. DISCUSSION: Cardiovascular conditions were the most frequent cause for grounding. Cardiovascular diseases (CVD) are associated with modifiable risk factors. Tackling these risk factors gives aeromedical examiners the opportunity to improve the health of pilots and reduce CVD-related flight safety risks by reducing the number of pilots at risk of in-flight incapacitation. The mandatory periodical medical examination of pilots provides an excellent framework for risk prevention and follow-up of preventive measures. Simons R, Maire R, Van Drongelen A, Valk P. Grounding of pilots: medical reasons and recommendations for prevention . Aerosp Med Hum Perform. 2021; 92(12):950–955.
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Conference Paper
With the increasing number of flights in the recent years, airlines and aircraft manufacturers are facing a daunting problem: shortage of pilots. One solution to this is to reduce the number of pilots in the aircraft and move towards single pilot operations (SPO). However, with this approach, the safety and quality of the flights must be guaranteed. Due to the complex nature of piloting task, a form of human-machine teaming is required to provide extra help and insight to the pilot. To this end, it is natural to look for proper artificial intelligence (AI) solutions as the field has evolved rapidly through the past decades with rise of machine learning and deep learning. The ideal AI for this task should aim to improve the human decision-making and focus on interaction with human rather than simply automating processes without human intervention. This particular field of AI is designed to communicate with the human and is known as cognitive computing (CC). To this end, several technologies can be employed to cover different aspects of interaction. One such technology is augmented reality (AR) which as of today, has matured enough to be used in commercial products. As such, an experiment was conducted to study the interaction between the pilot and CC teammate, and understand whether assistance is required to enable safe transition towards SPO.
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Article
Background and Aim: Efficient manpower is the most important capital and studies have shown the relationship between health and performance. Understanding the factors leading to disability has preventive importance. Our aim is to determine the causes and diseases leading to early permanent medical disqualification of the Islamic Republic of Iran Air Force pilots based on their service categories. Methods: This is a descriptive, cross-sectional, retrospective study with a target population of the Islamic Republic of Iran Air Force pilots with early and permanent medical disqualification from 1986 to 2016. Results: Out of 508 cases of early medical discharges, 239 items were considered medical disqualification, 17 war captives, 34 service exchange, and the remaining 218 were for on-service killed or missed persons. The main medical causes were neurosurgery, cardiovascular and psychiatric, while common diseases include lumbar discopathy, myocardial infarction, and cardiac arrhythmia. The lost service years was 3233 person year and the average was 12.63 person-year per individual. Conclusions: Based on the previous similar studies, it was expected that the common cause includes neurosurgery, cardiovascular, and psychiatric with more prevalence in fighter, transportation, and helicopter service categories. In the end, we found that our results were in line with initial expectations. Keywords: disabilities, medical disqualification, health, prevention, performance
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Abstract: Background and Aim: Efficient manpower is the most important of military capital, and many studies have shown the relationship between personal health and organizational performance. The preparation of military cadet volunteers to enter aeronautical training and the provision of optimal services in the form of well-trained pilots requires many material spiritual resources that disabilities, make them waste. Methods: This is a descriptive, cross-sectional, retrospective study with a target population of Iranian air force cadets with early and permanent medical disqualification from 1986 to 2016. Results: 80 cases were detected, including 25 kills and 55 early and permanent medical disqualification. The main causes were ear, nose and throat, psychiatry and cardiac, respectively. Common diseases include motion sickness, generalized anxiety disorder, adjustment disorder, and epilepsy, respectively. The total number of lost service years was 1412 person-years and the average of lost service years was 25.67 person-years. Most of the lost service years were related to medical causes including ear, nose, and throat, psychiatric and cardiac, and diseases included motion sickness, generalized anxiety disorder, and adjustment disorder, respectively. Neurologic causes resulted in the highest average of lost service years and high blood pressure was the major disease, respectively. Conclusions: Due to the lack of similar studies, the results of this study were compared with the data, which extracted from previous studies in the pilot’s population. Because of occupational similarity between pilots and cadets, It was expected that the most common causes in pilots and cadets should be the same, but we found that the results are very different. Keywords: disabilities, medical disqualification, health, performance, prevention
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Article
With the operation of the KC-330 MRTT (Multi Role Tanker Transport), which had been fielded in 2019, the ROKAF (Republic of Korea Air Force) has given fighter pilots a new mission of air refueling. As a result, fighter pilots are more likely to be exposed to risks they have never faced before, and it is necessary to look at the risk factors associated with human factors in air refueling missions. Therefore, in this study, an analysis using the HFACS (Human Factors Analysis and Classification System) model was performed for fighter pilots with air refueling qualifications. This study tried to prevent hazard in advance by discriminating the risk factors according to the human factors related to the fighter pilot during the air refueling mission.
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Article
In accordance with ICAO SARPs, the states should implement appropriate aviation-related health promotion for airmen subject to an aviation medical examination to reduce future medical risks to flight safety. We aimed to analyze the results of the aviation medical examination to use as objective evidence for establishing an aviation-related health promotion plan. The results of the final issuance of airmen medical certificate from 2015~2017 were collected from the e-sky computer system. The 30 cases (0.3%) in 2015, 22 cases (0.2%) in 2016, 38 cases (0.3%) in 2017 were unfit for flight duty. The 34 unfit out of the total 90 cases were renewal physical examinations. The cardiovascular disease was most commonly in 11 cases, followed by 8 tumors, 4 psychiatric diseases, 3 ophthalmic diseases, 2 respiratory diseases, 2 neurologic diseases, 2 otolaryngological diseases, 1 endocrine disease and 1 digestive disease. The results of this study can be used as objective data in aviation-related health promotion plan. The health promotion activities based on objective data can contribute to improving aviation safety by improving the lifestyles of airmen.
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Article
The medical fitness of pilots is part of the civil aviation safety scenery. This study aimed to analyze the health problems occurring among Korean commercial pilots. Three data sources were used to identify the health problems: 7,574 aviation medical examination data, 5,400 sick leaves and 39 cases of a decrease in medical fitness during flight duty period and layover of Korean commercial pilots who have been working for K airline from Jan. 1, 2016 to Dec. 31, 2018. This study was retrospectively analyzed using SPSS 22 statistical program. Waiver of medical certificates was an average 11.9% of total issuance for 3 years, with a denial of 0.1%. The leading cause of denial of medical certificates was predominantly of cardiovascular cause (55.6%). Mild respiratory and digestive disease accounted for 82% of total sick prevalence and 68% of total sick days. The psychiatric and cardiovascular disease were ranked high according to the number of days lost per case. The most common cause of decrease in medical fitness during flight duty period was acute abdominal pain (36.4%) and musculoskeletal disorder (40%) when staying abroad. Aeromedical emphasis on minimizing cardiovascular risk remains appropriate. Major pilot health problems identified in this study should be considered in establishing pilot health promotion programs for aviation safety.
Article
INTRODUCTION: Many regulations for aeromedical assessments state that a ratio between forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) of < 0.7 should be evaluated by a pulmonary specialist. The Global Lung Initiative (GLI) reference values introduced the lower limit of normal (LLN 2.5), in which the lowest 2.5% of the population is regarded as abnormal, instead of a fixed ratio. This study assesses the impact of adopting GLI reference values on aeromedical evaluation and referrals.METHODS: The Royal Netherlands Air Force performed 7492 aeromedical assessments between February 2012 and April 2017. Cases with FEV1/FVC < 0.7 from three groups were selected: 1) men < 25 yr; 2) men > 40 yr; and 3) women, with twice as many matched controls. Pearson's Chi-squared and Fisher's exact tests were used to analyze the data.RESULTS: From the database, 23 (group 1), 62 (group 2), and 7 (group 3) cases were selected, with 184 controls. Respectively, 17%, 84%, and 29% would not be referred using the GLI. In the controls, this would lead to one additional referral (group 1). Qualitative analysis of the cases who would not be referred using the GLI showed that no significant diagnoses would have been missed.DISCUSSION: Using the GLI LLN 2.5 reference values for pulmonary function tests leads to significantly fewer referrals to a pulmonary specialist without missing relevant pulmonary pathology in our aircrew. This would reduce resources spent on the assessment of aircrew without compromising flight safety.Wingelaar-Jagt YQ, Wingelaar TT, Bülbül M, vd Bergh PP, Frijters E, Staudt E. The effect of using the lower limit of normal 2.5 in pulmonary aeromedical assessments. Aerosp Med Hum Perform. 2020; 91(8):636-640.
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Professional cardiology organizations have compiled guidelines for advising patients if and when they may drive a car or pilot an aircraft following a diagnosis of syncope. Legal jurisdictions have compiled laws governing driving and flying, but the laws range from being very specific to very broad. For driving, medical guidelines have largely adopted a mathematical model for risk stratification such that a private individual driving a passenger car should be allowed to drive if their annual risk of sudden incapacitation is less than 22% because they pose the same risk of harm to others as a commercial truck driver in North America who has been legally allowed to drive with medical conditions that carry no more than a 1% risk of sudden incapacitation. The aviation literature has adopted a “1% rule” such that commercial airline pilots should have no more than a 1% annual chance of sudden incapacitation. All pilots must be evaluated by a designated medical examiner with specific legal guidelines by which they cannot certify a pilot to fly without referral to their specific national aviation authority.
Article
The article discusses the issues of adjustment, developed in 2007 and supplemented in 2009, of the methodology for evaluating the equivalent level of cabin noise of civil aviation aircraft in Russia. The relevance of the problem is due to high levels of professional hearing loss among the aircrew members of the air force, which is directly related to the lack of unified and competent approaches to assessing the acoustic load on the hearing organ of the aircrew members. The updated methodology contains full-fledged data on noise levels in modern domestic and foreign airliners, data on certification of acoustic efficiency of aircraft accessories, a direct algorithm and formulas for calculating the noise load for the selected periods of flight operation.
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Article
A comparative analysis of the incidence rate related to the «Respiratory diseases» class was carried out among students studying in the conditions of the Baltic Sea climate: one civilian and two security agencies. Peculiarities in the registration of diseases by training courses, by nosological forms of diseases, among people from the local population and visitors have been revealed. The incidence of initially healthy and physically trained students of security agencies is higher. Peculiarities of training in higher education institutions of security agencies determine both the primary incidence and the incidence according to the nosological form of the diseases
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We applied a systems theoretical hazard analysis to the accident of JL350 to reanalyze this unique case of pilot homicide-suicide from a contemporary perspective. It is the only known case in which people had survived the crash. Having collected all information on the accident, we present a comprehensive analysis of the homicide-suicide and its countermeasures established afterwards. This sheds light on how the Japanese system of commercial aviation has responded. An aeromedical research center provides the Japanese aviation society with the latest knowledge on medicine, including mental health, to keep the stakeholders informed which enables them to react to changing requirements. In Europe, similar countermeasures were recommended decades later to address the mental health issues of pilots.
Article
Old-age limits are imposed in some occupations in an effort to ensure public safety. In aviation, the “Age 60 Rule” limits permissible flight operations conducted by pilots aged 60 and over. Using a retrospective cohort design, we assessed this rule's validity by comparing age-related change rates of cardiometabolic incapacitation risk markers in European helicopter emergency medical service (HEMS) pilots near age 60 with those in younger pilots. Specifically, individual clinical, laboratory, and electrocardiogram (ECG)-based risk markers and an overall cardiovascular event risk score were determined from aeromedical examination records of 66 German, Austrian, Polish, and Czech HEMS pilots (average follow-up 8.52 years). Risk marker change rates were assessed using linear mixed models and generalized additive models. Body mass index increases over time were slower in pilots near age 60 compared to younger pilots, and fasting glucose levels increased only in the latter. Whereas the lipid profile remained unchanged in the latter, it improved in the former. An ECG-based arrhythmia risk marker increased in younger pilots, which persisted in the older pilots. Six-month risk of a fatal cardiovascular event (in or out of cockpit) was estimated between 0% and 0.3%. Between 41% and 95% of risk marker variability was due to unexplained time-stable between-person differences. To conclude, the cardiometabolic risk marker profile of HEMS pilots appears to improve over time in pilots near age 60, compared to younger pilots. Given large stable interindividual differences, we recommend individualized risk assessment of HEMS pilots near age 60 instead of general grounding.
Article
Introduction: This survey was carried out to investigate the incidence of mental disorders in Aerospace Medicine at the Aerospace Medical Institute (Madrid) over the last 30 years (1983-2014). Material and Methods: A descriptive study was conducted by reviewing all the medical histories. Psychiatric disorders were encoded according to the International Classification of Mental Disorder (ICD-10, WHO). Results: The results show high incidence of stress responses, adjustment and phobic disorders. Other psychiatric disorders are mentioned. Conclusions: Finally, conclusions are suggested based on the high frequency and prognosis of the more common psychiatric disorders in order to reducing the effect on the population´s health and to increase Aviation Safety.
Article
Introduction: Lower back pain (LBP) is the most common complaint worldwide and the leading cause of disability in the workplace. In Colombia there are no epidemiological data on low back pain in aviation. This study aimed to characterize lower back pain in pilots and maintenance technicians in a Colombian commercial airline. Methods: Information was collected from the total population in a Colombian commercial airline in Bogota during the period from 2011 to 2013 using a voluntary survey which requested demographics, occupational (LEST survey) factors, back pain, and chronic pain (chronic pain grade scale). Results: The prevalence rate of LBP in pilot respondents was 71% and the factors associated previously have belonged to the military forces: occupational exposure to physical load and work time. Chronic low back pain was at a prevalence of 49%. The prevalence of LBP in maintenance technicians was 65%. Associated factors were again similar to military forces and included mental workload. Chronic pain had a prevalence of 65%. Factors associated with chronic low back pain were the technicians' time in office and physical load. Discussion: The prevalence of lower back pain in pilots is similar to that presented in the airline world population. In the case of maintenance technicians, the prevalence was higher than those found in other similar groups, but very similar to prevalences presented in different business industries, including the transport sector. Fajardo Rodriguez HA, Ortiz Mayorga VA. Characterization of low back pain in pilots and maintenance technicians on a commercial airline. Aerosp Med Hum Perform. 2016; 87(9):795-799.
Article
The risky working environments of divers and pilots, and the possible role of extreme ambient pressure in carotid stenosis, make ischemic stroke an important occupational concern among these professionals. In this study, we aimed to evaluate the association of being exposed to hyperbaric or hypobaric conditions with carotid artery stenosis by comparing common carotid intima-media thickness (CCIMT) and blood flow velocities of cerebral arteries in divers and pilots using carotid duplex ultrasound (CDUS) and transcranial Doppler (TCD). CDUS and transtemporal TCD were performed in 29 divers, 36 pilots and 30 control participants. Medical history, blood pressure, lipid profile and blood sugar were recorded to control the previously well-known risk factors of atherosclerosis. Findings of the CDUS and TCD [including: CCIMT and blood flow velocities of internal carotid artery (ICA), common carotid artery (CCA), and middle cerebral artery (MCA)] of divers and pilots were compared with those of the control group using regression analysis models. Both right and left side CCIMT were significantly higher in divers (P < 0.05) and pilots (P < 0.05) in comparison with the control group. Carotid index [peak systolic velocity (PSV) of ICA/PSV of CCA) of divers and pilots were also higher than the control group. TCD findings were not significantly different between divers, pilots, and the control group. Increased CCIMT and carotid index in diver and pilot groups appear to be suggestive of accelerated atherosclerosis of carotid artery in these occupational groups.
Conference Paper
This paper presents an integrated framework for crew-centric flight-deck operations within the FP7-EU funded ACROSS project. ACROSS is developing, integrating and testing new solutions to reduce pilots’ peak workload and stress, supporting them when dealing with difficult situations, thus enhancing safety and performance. ACROSS presented a number of human factors challenges: (1) diverse technologies being designed simultaneously and in parallel, (2) multiple partners throughout Europe with different needs and design philosophies (3) production of multiple technologies relating to different parts of the flight operations process. The global human factors challenge was to produce an integrated human factors approach that would facilitate the best outcome for ACROSS. To meet this challenge a crew-centric framework for flight operations was designed. This paper presents the framework itself, the development process and an illustration of the concepts behind it.
Conference Paper
This paper describes the requirements elicitation process and the subsequent system requirements for an advanced cockpit to reduce crew workload and stress. The paper outlines the need for a step-change in technology and operational practices to ensure the continued safety of a transport system which is predicted to grow. The ACROSS project aims to develop advanced cockpit solutions to reduce workload and stress in an increasingly congested aviation transport system. Six types of requirements were derived including aviate requirements, and navigate, communicate, manage systems, crew monitoring, and crew incapacitation requirements. The research project is currently specifying the human factors requirements for the technologies to achieve improved operational safety.
Article
The waiver system in aeromedical evaluation provides a method to grant permission for flying to pilots who are unable to meet all of the aeromedical requirements, as long as the medical condition does not threaten flight safety and the experience and skills of the pilot is considered to be sufficient. Some organizations like the United States Air Force already have a well-developed waiver system that has been made public in its waiver guide. According to this guide, the condition and situation in which the waiver will be granted are clearly described for each medical problem and for the flying status/class of the pilot. Necessary medical examinations and the observation period for the waiver application are also indicated. This guide is regularly revised based on recent aeromedical findings. In Japan, while there is no standard guideline for the waiver system, there are two aeromedical waiver authorities, the Civil Aviation Bureau which is responsible for civilian pilots and the Defense Ministry which has its own waiver system for military pilots. Both authorities seem to function well enough to manage this difficult responsibility. However, discrepancies arise as cases are evaluated individually based on the impressions of the medical expert rather than on clear standardized guidelines. Therefore, we aimed to develop a Japanese standardized waiver guideline for aeromedical disposition for both civilian and military pilots. Although the number of aeromedical experts in Japan is limited, we recommend a collaboration of civilian and military aeromedical experts to help establish this guideline. This team of experts should create the guideline by utilizing the guidelines from other countries and organizations, like that of the United States Air Force, in addition to past waiver cases and the current clinical medicine practices in Japan. There are three major advantages for establishing the new Japanese waiver guideline. First, information about the waiver system, medical conditions, necessary examinations or treatments, and application procedures are easily accessible by the waiver applicant (pilot). Thus, correspondence with pilots and the workload of waiver authority staff will be reduced. Second, more Japanese medical staff both in civilian and military aviation can acquire better aeromedical experience and knowledge for waiver judgments using the standard guideline. Third, each authority can make a fair and reasonable waiver judgment. That is, in the case of an accident inflight involving a pilot who was granted a waiver, accountability can be assured by the authority.
Article
The major causes of in-flight fatal incapacitation in civil pilots are acute coronary events, new onset idiopathic epilepsy, and physiological problems. Less than 1% of all air accidents are due to sudden incapacitaion. The problem with acute coronary disease is very serious when occurring during critical stages of the flight, such as takeoff or landing, rather than during the cruising phase. The authors describe the fatal in-flight incapacitation in a Czech airline captain during the approach for landing. In this case, the first officer tried to communicate with the captain, but there was no response and first aid was unsuccessful. The post-mortem examination showed the cause of the sudden death to be an aortic dissection with cardiac tamponade due to cystic medial necrosis (Erdheim disease). The authors describe the clinical and histological features of Erdheim disease. The normal aorta contains collagen, elastin, and smooth muscle cells that form the vessel wall. Degenerative changes lead to breakdown of the collagen, elastin, and smooth muscle, and an increase in basophillic ground substance with the formation of cysts and accumulation of mucopolysaccharide. Medical incapacitation in the cockpit is rare. The leading causes of fatal in-flight incapacitation are myocardial infarction, cardiac arrhythmias, and epileptic seizures; cystic medial necrosis is very rare and no similar cases were found in the aviation literature.
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Article
Medical incapacitation in the cockpit is rare, although it is a concern that has been the subject of several investigations over the years. With recent heightened interest in this problem, it seemed worthwhile to review all relevant scientific literature on the topic. Medline, PsychLit, the Aerospace Database, and other online databases were searched for studies of pilot in-flight medical incapacitation and impairment. The search revealed 13 articles during the years from 1968 to 2000. The studies represented several different approaches and were divided into five categories as follows: in-flight medical events, career termination, simulator data, questionnaires, and epidemiological analysis. The articles based on in-flight medical events showed that the leading causes of those episodes were myocardial infarctions, cardiac arrhythmias, and epileptic seizures. Few of the other types of studies used data from actual in-flight medical occurrences, instead relying on indirect measures such as career termination due to permanent medical grounding, loss of licensure insurance, or general epidemiological data to estimate the frequency of in-flight medical events. The reviewed studies provided only limited information on the frequency and categories of in-flight medical events and did not include incapacitation rates, making meaningful comparison between studies difficult. Future research needs to be based on actual in-flight medical events, and should be normalized to a useful denominator, such as flight time, to allow for meaningful comparison between studies.
Article
This report concerns 17 incidents of sudden incapacitation of professional airline pilots in flight in the period 1948-1972. The high incidence of cardio-vascular accidents is noteworthy: 13 cases of which 11 were due to coronary infarction. There were two cases of unperdictable epileptic fits. None of the above gave rise to an accident. For an accident to occur, several conditions must be fulfilled at the same time: 1) The incapacity must affect the pilot at the controls; (2) The incapacity must be sudden; (3) The incapacity must take place during a critical phase of take-off or final apprach.
Article
A survey, replicating one originally conducted by the International Federation of Airline Pilots' Associations (IFALPA) in 1967, was carried out to investigate the aetiology of inflight incapacitation on commercial flight decks. The questionnaire was constructed by IFALPA and distributed worldwide by its member associations. Since response to the questionnaire was voluntary, no control of the sample population was possible. The results indicate that 29% of the 4,345 respondents had been incapacitated at least once. As in 1967, gastro-intestinal symptoms accounted for the majority (58%) of incidents, other main causes being symptoms of nasal and sinus congestion ('blocked' ear and sinus pain), headaches, and faintness or general weakness. Of those who had experienced an incident of incapacitation, 48% claimed that safety was actually, or potentially, affected. However, when all respondents were asked whether they were concerned about safety in the event of incapacitation inflight (excluding take-off and landing), only 25% expressed concern. Slightly more pilots operating in three-man crews (50.5%) thought incapacitation affected the safety of the flight than those operating in two-man crews (45.3%).
Article
Sudden incapacitations can affect a pilot and even a whole crew during a flight, preventing them from performing their task in complete safety. In some cases, they could even cause an accident. Our study examines the causes of sudden in-flight incapacitation in Air France pilots and flight engineers from 1968-88. Ten cases were reported out of a population of 1,800 cockpit crew, each flying an average of 600 h/year. These incapacitations were due to cardiac disorders (1 atrial fibrillation, 1 sinus tachycardia), epileptic attacks (2 generalized seizures), duodenal hemorrhages (2 cases), infection (1 case of severe vertigo due to viral labyrinthitis), metabolic disorders (1 case of hypoglycemia), and sometimes disorders affecting the whole crew (1 case of hypoxia due to a pressurization deficiency, 1 case of CO2 intoxication caused by the inadequate packaging of a container refrigerated in dry ice). Seven times out of ten, incapacitations occurred during cruising, twice during approach, and once on the ground before starting up, with closed doors (CO2 intoxication). Two of these incapacitations led to flight diversions. None of them caused an accident. In this series, incapacitations of a cardiac nature were rarer and less serious than those caused by gastrointestinal or neurological disorders. Prevention is based on detection during systematic medical check-ups, and on crews being trained to recognize subtle incapacitations early and to ensure that the flight continues safely when such a case occurs.
Article
Aviation medical standards world-wide place much emphasis upon the cardiovascular (CV) status of the individual. This is justified, especially in the Western world, because of the high incidence of CV disorders in the population and their likely similar occurrence in the aircrew peer group. These standards do not in general require the demonstration of any objective short fall in performance, but rather guard against a potential threat, that of sudden incapacitation. However, some observers have sought to question whether or not this threat and its potential consequences is as great as it might appear and to quantify the risks. We have now carried out and analysed over 1,300 closely observed simulator exercises, using two protocols, in which sudden and subtle incapacitation has been programmed to occur to the handling pilot at a critical phase of flight. The results have been assembled and extrapolated with the recorded incidence of sudden incapacitation in flight in civil airline operations so the actual degree of risk can be identified. Conclusions can be drawn from this on the relevance of present cardiovascular standards and suggestions for improvement are made.