INTRODUCTION: Aerial ports are being modernized with automated technologies, but the impact on musculoskeletal injury (MSKI) is unknown.METHODS: In this retrospective cohort study of U.S. Air Force aerial port technicians and traffic management technicians, we compared reported injury rates from January 2006–December 2016 and Veterans Benefits Administration disability compensation claims awarded from January 2001–March 2017. Ton-adjusted injury rates, associated lost/affected duty time, and percent risk attributable to lack of automation were compared at Dover Air Force Base (which features base-specific automation), Travis Air Force Base, Ramstein Air Base, and Yokota Air Base.RESULTS: Injuries most often occurred during aircraft/flight line activities and were typically sprains/strains, with extremities being most affected. Among aerial port technicians there were 8.0 injury reports per 1000 person-years compared to 5.2 per 1000 among traffic management technicians (incidence rate ratio = 1.5; 95% CI: 0.9, 3.0). Of the aerial port technicians with a compensation award, 70.7% included an MSKI component, whereas 75.7% of traffic management awards included an MSKI component. Aerial port technicians at Dover AFB experienced 1.4 injury reports per 1000 personnel per 1000 cargo-tons per year, lower than the other ports: 3.2 (Travis); 3.7 (Ramstein); and 7.6 (Yokota). Overall, 56% of injuries at Travis, 62% at Ramstein, and 82% at Yokota could be attributed to absence of Dover-like automation. However, mean lost/affected duty days at Dover (12.4) far exceeded those at the other bases (range: 4.5–8.6).DISCUSSION: Automating aerial ports may reduce injury rates, but the impact on lost/affected duty time requires further investigation.Bylsma VFH, Webber BJ, Erich RA, Voss JD. Musculoskeletal injuries and automation in aerial port operations. Aerosp Med Hum Perform. 2020; 91(8):669–673.