BACKGROUND: Accident analysis and empirical research have shown that the decision-making process of pilots after becoming lost is adversely affected by confirmation bias; this constitutes a serious threat to aviation safety. However, the underlying mechanism of confirmation bias
in the context of lost procedures are still unclear.METHODS: This study used scenario-based map-reading tasks to conduct two experiments to explore the mechanism of confirmation bias in the lost procedures. In Experiment 1, 34 undergraduate students and 28 flying cadets were enrolled
in a formal experiment to examine the effects of verbal-imagery cognitive style, experience level, and their interaction on confirmation bias. In Experiment 2, we further explored the influence of strategy as a core component of experience on confirmation bias with 26 flying cadets.RESULTS:
The study found that individuals were subject to confirmation bias in lost procedures. Visualizers (M = 0.78, SD = 0.75) were almost twice as likely to select the disconfirmatory features than verbalizers (M = 0.37, SD = 0.49). Visualizers exhibited a lower degree of confirmation bias than
verbalizers, and experience helps verbalizers to reduce their degree of confirmation bias. The protective effect of experience mainly lies in individuals’ choice of strategy.DISCUSSION: Future aviation safety campaigns could be aimed at adopting a candidate selection process
that focuses more on psychological attributes by testing for cognitive style, and enriching individual experience through adequate training. Such measures would reduce confirmation bias.Xu Q, Wang M, Wang H, Liu B, You X, Ji M. Cognitive style and flight experience influence on confirmation
bias in lost procedures. Aerosp Med Hum Perform. 2022; 93(8):618–626.
INTRODUCTION: In 2019, the Federal Aviation Administration (FAA) announced a protocol to evaluate pilots with insulin treated diabetes mellitus (ITDM) for special issuance (SI) medical certification for first-/second-class pilots. The protocol’s aim is improved assessment
of ITDM control/hypoglycemia risk and relies on continuous glucose monitoring (CGM) data. This study compares the characteristics of first-/second-class pilots with ITDM and certification outcome.METHODS: Data was collected retrospectively from the FAA Document Imaging Workflow
System (DIWS) for pilots considered for a first-/second-class SI under the ITDM program between November 2019 and October 2021. Inclusion criteria required submission of information required for certification decision (SI vs. denial). We extracted data on demographics and CGM parameters including
mean glucose, standard deviation, coefficient of variance, time in range (%), time > 250 mg · dl−1 (%), and time < 70–80 mg · dl−1 (%). We compared these parameters between pilots issued an SI vs. denial with Mann-Whitney U-tests
and Fisher exact tests using R.RESULTS: Of 200 pilots with ITDM identified, 77 met inclusion criteria. Of those, 55 received SIs and 22 were denied. Pilots issued SI were statistically significantly older (46 vs. 27 yr), had a lower hemoglobin A1c (6.50% vs. 7.10%), lower average
glucose (139 mg · dl−1 vs. 156 mg · dl−1), and spent less time with low glucose levels (0.95% vs. 2.0%).DISCUSSION: The FAA program has successfully medically certificated pilots with ITDM for first-/second-class. Pilots granted an
ITDM SI reflect significantly better diabetes control, including less potential for hypoglycemia. As this program continues, it will potentially allow previously disqualified pilots to fly safely.Stanwyck LK, DeVoll JR, Pastore J, Gamble Z, Poe A, Gui GV. Medical certification of
pilots through the insulin-treated diabetes mellitus protocol at the FAA. Aerosp Med Hum Perform. 2022; 93(8):627–632.
BACKGROUND: In-flight medical emergencies (IME) are challenging situations: aircraft cabins are noisy and narrow, medical supplies are scarce, and high-altitude related physiological changes may worsen chronic respiratory or cardiac conditions. The aim of this study was to assess
the extent to which anesthetist-intensivists and emergency physicians are aware of IME specificities.METHODS: A questionnaire containing 21 items was distributed to French anesthetist-intensivists and emergency physicians between January and May 2020 using the mailing list of the
French Society of Anesthesia and Intensive Care Medicine and the French Society of Emergency Medicine. The following topics were evaluated: high-altitude related physiological changes, medical and human resources available inside commercial aircraft, common medical incidents likely to happen
on board, and previous personal experiences.RESULTS: The questionnaire was completed by 1064 physicians. The items corresponding to alterations in the arterial oxygen saturation, respiratory rate, and heart rate at cruising altitude were answered correctly by less than half of the
participants (respectively, 3%, 42%, and 44% of the participants). Most responders (83%) were interested in a complementary training on IME management.DISCUSSION: The present study illustrates the poor knowledge in the medical community of the physiological changes induced by altitude
and their consequences. In addition to offering specific theoretical courses to the medical community, placing sheets in commercial aircraft summarizing the optimal management of the main emergencies likely to happen on board might be an interesting tool.Diop S, Birnbaum R, Cook F,
Mounier R. In-flight medical emergencies management by anesthetist-intensivists and emergency physicians. Aerosp Med Hum Perform. 2022; 93(8):633–636.
BACKGROUND: Occupational hazards facing high performance aircraft pilots (“fighter” pilots) can cause injury, time lost from flying, and voluntary or involuntary career termination. The high cost of training and retaining fighter pilots has spurred interest in the
cost effectiveness of preventative and rehabilitative health solutions.METHODS: We investigated the potential cost effectiveness of a 5-yr, $24.9M U.S. preventative health program using equivalent annual worth (EAW) analysis. The program benefits were assessed with a combination
of actual and estimated medical cost data and projected pilot retention improvement rates. Sensitivity analysis of variables such as discount rate, medical cost avoidance, and pilot retention improvement rate was conducted.RESULTS: Annualized costs of approximately $5M U.S.
were used as the basis of comparison for annualized benefits. A medical cost database was searched to find expected annual direct medical (outpatient) costs related to injury of roughly $531K U.S. for the pilots covered by the program. Using Centers for Disease Control recommendations,
approximately $4.7M U.S. was estimated to be the annual work loss cost. The program would presumably reduce a significant portion of these annual costs, but not all. Assuming various proportions of reduced costs by the program, the EAW was found to be consistently negative. However,
when pilot retention improvement is included, EAW is positive using conservative assumptions.DISCUSSION: While outpatient and work loss costs will unlikely be completely covered by preventative health programs in this context, a minor improvement in pilot retention (about 1–3
additional retentions per year) produces a net positive annual benefit.Erneston CG, Fass RD, Ritschel JD, Cox AM. A preliminary analysis of the costs and benefits of physical therapy and strength training for fighter pilots. Aerosp Med Hum Perform. 2022; 93(8):637–642.
INTRODUCTION: Heel-lift is a subjectively reported fit issue in planetary spacesuit boot prototypes that has not yet been quantified. Inertial measurement units (IMUs) could quantify heel-lift but are susceptible to integration drift. This work evaluates the use of IMUs and drift-correction
algorithms, such as zero-velocity (ZVUs) and zero-position updates (ZPUs), to quantify heel-lift during spacesuited gait.METHODS: Data was originally collected by Fineman et al. in 2018 to assess lower body relative coordination in the spacesuit. IMUs were mounted on the spacesuit
lower legs (SLLs) and spacesuit operator’s shank as three operators walked on a level walkway in three spacesuit padding conditions. Discrete wavelet transforms were used to identify foot-flat phase and heel-off for each step. Differences in heel-off timepoints were calculated in each
step as a potential indicator of heel-lift, with spacesuit-delayed heel-off suggesting heel-lift. Average drift rates were estimated prior to and after applying ZVUs and ZPUs.RESULTS: Heel-off timepoint differences showed instances of spacesuit-delayed heel-off and instances of
operator-delayed heel-off. Drift rates after applying ZVUs and ZPUs suggested an upper time bound of 0.03 s past heel-off to measure heel-lift magnitude with an accuracy of 1 cm.DISCUSSION: Results suggest that IMUs may not be appropriate for quantifying the presence and magnitude
of heel lift. Operator-delayed heel-off suggests that the SLL may be expanding prior to heel-off, creating a false vertical acceleration signal interpreted by this study to be spacesuit heel-off. Quantifying heel-off will therefore require improvements in IMU mounting to mitigate the effects
of SLL, or alternative sensor technologies.Boppana A, Priddy ST, Stirling L, Anderson AP. Challenges in quantifying heel-lift during spacesuit gait. Aerosp Med Hum Perform. 2022; 93(8):643–648.
INTRODUCTION: It has been proposed that pilots face a perceived barrier to seeking medical care due to what a change in health status might mean to their status as a pilot. While this is often common knowledge to pilots and some physicians, this phenomenon has limited research
or characterization in the medical literature. In this commentary, we propose a definition for the barrier pilots face in seeking healthcare in hopes of focusing future research efforts.Hoffman W, Bjerke E, Tvaryanas A. Breaking the pilot healthcare barrier. Aerosp Med Hum Perform.
2022; 93(8):649–650.
