BACKGROUND/OBJECTIVE: The COVID-19 virus has caused over 582,000 deaths in the United States to date. However, the pandemic has also afflicted the mental health of the population at large in the domains of anxiety and sleep disruption, potentially interfering with cognitive function.
From an aviation perspective, safely operating an aircraft requires an airmans cognitive engagement for: 1) situational awareness, 2) spatial orientation, and 3) avionics programming. Since impaired cognitive function could interfere with such tasks, the current study was undertaken to determine
if flight safety for a cohort of single engine, piston-powered light airplanes was adversely affected during a period of the pandemic (MarchOctober 2020) prior to U.S. approval of the first COVID-19 vaccine.METHODS: Airplane accidents were per the National Transportation Safety
Board Access<sup/> database. Fleet times were derived using Automatic Dependent Surveillance-Broadcast. Statistics used Poisson distributions, Chi-squared/Fisher, and Mann-Whitney tests.RESULTS: Little difference in accident rate was evident between the pandemic period (MarchOctober
2020) and the preceding (JanuaryFebruary) months (19 and 22 mishaps/100,000 h, respectively). Similarly, a proportional comparison of accidents occurring in 2020 with those for the corresponding months in 2019 failed to show over-representation of mishaps during the pandemic. Although a trend
to a higher injury severity (43% vs. 34% serious/fatal injuries) was evident for pandemic-period mishaps, the proportional difference was not statistically significant when referencing the corresponding months in 2019.CONCLUSION: Surprisingly, using accidents as an outcome, the
study herein shows little evidence of diminished flight safety for light aircraft operations during the COVID-19 pandemic.Boyd DD. General aviation flight safety during the COVID-19 pandemic. Aerosp Med Hum Perform. 2021; 92(10):773-779.
BACKGROUND: A growing number of symptom reports suggestive of acceleration atelectasis in fast jet aircrew have raised the question as to whether traditional guidelines on inspired gas composition remain valid. The aim of this study was to assess the effects of inspired O2
concentration on the development of acceleration atelectasis when wearing modern anti-G garments.METHODS: There were 14 nonaircrew subjects who completed 5 centrifuge exposures to +5 Gz lasting 90 s. During exposures subjects breathed a gas mixture containing 21, 35,
45, 60, or 75% O2. To assess the extent of atelectasis post-Gz, forced inspiratory vital capacity (FIVC), regional FIVC (EITFIVC), shunt, respiratory resistance, reactance, and compliance and peripheral O2 saturation during a hypoxic exposure were
measured.RESULTS: Compared with baseline, FIVC was not statistically significantly altered. EITFIVC was 14.4% lower after the 75% O2 exposure only with a greater symptom reporting with higher FIO2 in some individuals. A significantly greater
shunt (3>6%) followed the 60 and 75% O2 exposures. O2 concentration during Gz had no effect on respiratory resistance, reactance, compliance, or hypoxemia.DISCUSSION: There is evidence of mild acceleration atelectasis present when breathing 60%
O2, particularly in susceptible individuals, with 75% O2 causing more obvious physiological compromise. An inspired oxygen concentration of <60% will prevent the majority of individuals from developing acceleration atelectasis.Pollock RD, Gates SD, Radcliffe
JJ, Stevenson AT. Indirect measurements of acceleration atelectasis and the role of inspired oxygen concentrations. Aerosp Med Hum Perform. 2021; 92(10):780-785.
OBJECTIVE: This research was conducted to compare short haul (SH) and long haul (LH) pilots regarding sleep restrictions and fatigue risks on flight duty, stress, sleep problems, fatigue severity, well-being, and mental health. METHOD: There were 406 international
SH and LH pilots who completed the cross-sectional online survey. Pilots sleep restrictions and fatigue-risk profiles (e.g., time pressure, late arrivals, minimum rest), sleep problems, fatigue severity, well-being, and symptoms of depression, anxiety, and common mental disorders (CMD) were
measured and compared for SH and LH pilots. RESULTS: Although SH and LH pilots were scheduled for only 51.465.4% of the legally allowed duty and flight hours, 44.8% of SH pilots reported severe fatigue (FSS 4 to 4.9), and an additional 31.7% high fatigue (FSS 5), compared with 34.7%
and 37.3% LH pilots. Considerable sleep problems in 8 nights/mo were reported by 24.6% SH vs. 23.5% LH pilots. Positive depression screenings were reported by 18.1% SH and 19.3% LH pilots. Positive anxiety screenings were reported by 9.6% SH and 5% LH pilots. Of all investigated pilots, 20%
reported significant symptoms of depression or anxiety, and 7.23% had positive depression and anxiety screenings. LH pilots reported significantly better well-being than SH pilots. CONCLUSIONS: Our results show that even far less duty and flight hours than legally allowed according
to flight time limitations lead to high levels of fatigue, sleep problems, and significant mental health issues among pilots. SH pilots were even more affected than LH pilots. Pilots fatigue should be considered an immediate threat to aviation safety and pilots fitness to fly by promoting
fatigue and burnout. Venus M, grosse Holtforth M. Short and long haul pilots rosters, stress, sleep problems, fatigue, mental health, and well-being. Aerosp Med Hum Perform. 2021; 92(10):786-797.
INTRODUCTION: Each year in Canada, there are a number of pilots and passengers who die in seaplane water accidents. A study examining the human factors and fatality rates associated with these accidents was conducted. METHODS: Seaplane water accident investigations
by the Transportation Safety Board of Canada (TSB) between 1995 and 2019 were reviewed. RESULTS: There were 487 accidents involving 1144 occupants (487 pilots, 657 passengers). There were less than 15 s warning in 86% of cases. There were 60 pilots and 88 passengers who dieda survival
rate of 87%. Drowning, trapped within the cabin was the principal cause of death (54%). Loss of control on landing, wheels down landings, and other landing problems (49%) were the principal causes of the accidents and 77% of the fatalities occurred in this group. These arose because the pilot(s)
misjudged wind, waves, and glassy water. Over 50% of seaplanes inverted and 10% floated briefly then sank, resulting in the highest percentage of fatalities. Wearing the seat harness incorrectly, injury, in-rushing water, and inability to locate and operate exit mechanisms (including rescuers
inability to open the exits external to the fuselage) all contributed to the fatalities. Life jackets would have been of benefit in several cases. Of the accidents, 57% were private flights. CONCLUSIONS: Passengers require a thorough preflight briefing, life jackets should be worn
by all pilots and passengers, and private and commercial pilots should receive Underwater Egress Training. MacDonald C, Brooks C, McGowan R. Survival from Canadian seaplane water accidents: 1995 to 2019. Aerosp Med Hum Perform. 2021; 92(10):798-805.
BACKGROUND: Fatigue is an insidious and costly occurrence in the aviation community, commonly a consequence of insufficient sleep. Some organizations use scheduling tools to generate prescriptive sleep schedules to help aircrew manage their fatigue. It is important to examine
whether aircrew follow these prescriptive schedules, especially in very dynamic environments. The current study compares aircrew sleep during missions to prescriptive sleep schedules generated by a mission scheduling tool. METHODS: Participating in the study were 44 volunteers (Mage=
28.23, SDage= 4.23; Proportionmale= 77.27%) from a C-17 mobility squadron providing 25 instances of sleep and mission data (80 flights total). Aircrew wore actigraph watches to measure sleep during missions and prescriptive sleep schedules were collected. Actual and prescriptive
sleep was compared with calculated performance effectiveness values per minute across mission flights. RESULTS: Prescriptive schedules generally overestimated effectiveness during missions relative to estimated actual sleep, potentially causing shifts in effectiveness to ranges
of increased risk requiring elevated fatigue mitigation efforts. Actual and prescriptive effectiveness estimates tended to increasingly diverge over the course of missions, which magnifies differences on longer missions. DISCUSSION: The current study suggests that aircrew sleep
during missions often does not align with prescriptive sleep schedules generated by mission planning software, resulting in effectiveness estimates that are generally lower than predicted. This might discourage aircrew from using mission effectiveness graphs as a fatigue mitigation tool. Additionally,
because fatigue estimates factor into overall operational risk management processes, these schedules might underestimate risks to safety, performance, and health. Morris MB, Veksler BZ, Krusmark MA, Gaines AR, Jantscher HL, Gunzelmann G. Aircrew actual vs. prescriptive sleep schedules
and resulting fatigue estimates. Aerosp Med Hum Perform. 2021; 92(10):806-814.
BACKGROUND: Neck pain (NP) is common among high performance aircrew, yet evidence remains insufficient to guide examination, treatment, and prevention. The purpose of this randomized pilot study was to collect baseline data for neck function for F-15E aircrew and determine efficacy
and feasibility of two separate exercise protocols in measuring short-term outcomes of subjective and objective neck function in order to inform future study design. METHODS: Randomized to either progressive (PRO) or general (GEN) exercise groups were 41 F-15E aircrew. Data collection
occurred at baseline, 3 wk, and 3 mo. RESULTS: At baseline, 39% of the subjects reported current NP, 79.5% reported a history of NP attributed to flying, 12.8% reported being removed from flying duties due to NP, and 10% reported receiving medical care for NP. PRO and GEN group
randomization showed similar baseline assessment data. Blinding was successful and exercise logs showed 31.6% compliance with prescribed exercise regimens. There were small but statistically significant increases in neck range of motion in both groups over the course of the study. Aircrew
with current NP had significantly higher F-15E flight hours. DISCUSSION: This study supports the high prevalence of NP in aircrew, yet low frequency of seeking care for NP. Future studies to assess NP prevention and treatment in aircrew require an integrated approach that includes
operational exercise policy and long-term data collection in flying units with dedicated resources for assessment and analysis. Lee MS, Briggs R, Scheirer V, Kearby G, Young BA. Exercise effects on neck function among F-15E aircrew. Aerosp Med Hum Perform. 2021; 92(10):815-824.
INTRODUCTION: Research has highlighted the significant impact that jet lag can have upon performance, health, and safety. International business travelers have an important role in economic growth; however, there is a lack of research investigating jet lag and jet-lag management
in international business travelers. This study aimed to investigate international business travelers use of jet-lag countermeasures. METHODS: International business travelers from Australia (N = 107) participated in a survey examining use of jet-lag countermeasures (pharmacological
and nonpharmacological). Chi-squared tests were conducted examining the association between duration of stay and traveling experience on jet-lag countermeasure use. RESULTS: Most subjects had traveled for business for less than 15 yr and 57% reported taking between 14 trips annually.
Durations of stay averaged 10 d (SD 13 d). Nonpharmacological countermeasure use was high. Pharmacological countermeasure use was less common. There were no significant associations between duration of stay and countermeasure implementation. Travel experience was only associated with nonpharmacological
countermeasures after arrival home. CONCLUSION: Education programs delivered through businesses would be beneficial for providing information on jet lag, its implications, and recommended countermeasures to travelers. Rigney G, Walters A, Bin YS, Crome E, Vincent GE. Jet-lag
countermeasures used by international business travelers. Aerosp Med Hum Perform. 2021; 92(10):825-830.
INTRODUCTION: Military aviators are likely to be first diagnosed with inflammatory bowel diseases (IBD) during military service. Current recommendations support continuing flying with restrictions, but risks may be significant. The aim of the study was to document the long-term
results of aviators newly diagnosed with IBD. METHODS: A prospective observational study over a 23-yr period included all Israeli Air Force (IAF) aviators with IBD. Primary end point was the qualification and safety to continue operational flying following IBD diagnosis. RESULTS:
Subjects were 16 male aviators with an average follow-up of 130 mo. Average age was 27 (2045) and average time from symptoms onset to final diagnosis was 7.3 mo. Eight (50%) patients had Crohns disease (CD), and the other eight had ulcerative colitis (UC). Eight (50%) were high performance
platform aviators. Two patients received biologic treatment, two were treated with repeated corticosteroid courses, and four with immunosuppressive therapy. Two patients underwent surgery and four needed different lengths of hospitalizations. Eight (50%) aviators (3 CD, 5 UC) were grounded
for a mean of 177 d (5590). Altogether grounding for IBD aviators was 46/2087 mo (2.2%). Most grounding periods were short term and reversible. All aviators continued flying under annual monitoring or as needed and no compromise of their abilities was documented. CONCLUSIONS: All
aviators were able to continue flying and no events of sudden incapacitation or severe disabling flares have been seen among patients. Our study findings support the current recommendation to continue flying when IBD is in stable remission. Tehori O, Koslowsky B, Gabbai D, Shapira S,
Ben-Ari O. Military aviators with inflammatory bowel diseases continued flying. Aerosp Med Hum Perform. 2021; 92(10):831-834.
BACKGROUND: Heterozygous familial hypercholesterolemia (HeFH) is an autosomal dominant disease characterized by elevated low-density lipoprotein cholesterol (LDL-C) that increases risk for clinically significant atherosclerotic cardiovascular disease (ASCVD). This common (1:220)
disease is present within the fighter pilot community and hesitation to treat this condition at younger ages results in a higher risk for coronary artery disease (CAD), the presence of which can be catastrophic for flying safety. CASE REPORT: A 40-yr-old asymptomatic F-15 pilot
presented with persistently elevated LDL-C levels > 190 mg dL1 and a significant family history of CAD. Coronary artery calcium, CT angiography, and finally, invasive angiography were used to further stratify him as having mild CAD. Initiation of statin therapy significantly
lowered his LDL and subsequent risk for disease progression, allowing him to return to flying. DISCUSSION: Early recognition and treatment of HeFH is imperative for lowering the risk of ASCVD. Often the medical community supporting flyers is hesitant to diagnose or treat this condition,
due to nonrecognition, the young age of presentation, or reluctance to potentially ground a flyer. By intervening earlier, rather than waiting, aviators can remain on flying status longer with lower risk to themselves and their aircrew. Gatzke LC. Heterozygous familial hyperlipidemia
in a fighter pilot. Aerosp Med Hum Perform. 2021; 92(10):835-837.
BACKGROUND: Aerobatic pilots must withstand high and sudden acceleration forces (Gz) up to ±10 Gz. The physiological consequences of such a succession of high and abrupt positive and negative Gz on the human body over time remain mostly unknown. This case report emphasizes changes in physiological factors such as cerebral oxygenation and heart rate dynamics collected in real aerobatic flights. CASE REPORT: A 37-yr-old man, experienced in aerobatic flying, voluntarily took part in this study. During two flight runs (15-20 min), the pilot performed aerobatic maneuvers with multiple high (±10 Gz) positive and negative accelerations. During the flights he wore a Polar heart rate sensor while cerebral oxygenation was measured continuously over his prefrontal cortex via near-infrared spectroscopy (NIRS). NIRS allows for measurement of the relative concentration changes of oxygenated hemoglobin (O2Hb) and deoxygenated hemoglobin (HHb), making it possible to determine cerebral oxygenation and hemodynamic status. DISCUSSION: The continuous in-flight monitoring of O2Hb and HHb revealed the large effects of successive positive and negative Gz exposures on cerebral hemodynamics alterations. The results showed a significant and positive correlation between changes in Gz exposures and O2Hb concentration. This case report highlights that NIRS provides some valuable and sensitive indicators for the monitoring of cerebral hemodynamics during aerobatic flights exposed to multiple and high acceleration forces. To our knowledge, this first study quantifying cerebral oxygenation changes in aerobatics opens the way for the assessment of individual physiological responses and tolerance in pilots to repeated high Gz during real flights. Fresnel E, Dray G, Pla S, Jean P, Belda G, Perrey S. Cerebral oxygenation responses to aerobatic flight. Aerosp Med Hum Perform. 2021; 92(10):838-842.
Kreykes AJ, Vardiman J. Aerospace medicine clinic: aseptic meningitis. Aerosp Med Hum Perform. 2021; 92(10):845848.
