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Objective: The aim of the studies was to examine the role of implicit processes in aeronautical risk perception and risk taking., Background: Aeronautical decision making consists of both explicit processes (e.g., comparing options, seeking information) and implicit, or intuitive, processes (e.g., immediate affective reactions). The present studies utilized a novel methodology, adapted from studies in social cognition, to examine the relationship between general aviation pilots' implicit reactions toward risk and their involvement in hazardous events., Method: The Implicit Association Test was used to measure pilots' (Study 1: N= 23; Study 2: N= 32) implicit associations between good and bad weather conditions and perceptions of risk and anxiety., Results: There was a relationship between the pilots' implicit perceptions and previous involvement in hazardous aeronautical events as measured by D. R. Hunter's (1995, 2002) Hazardous Events Scale. The more weather-related hazardous events the pilots had been involved in, the less they associated implicit risk with adverse weather (Study 1) and the less implicitly anxious they were toward adverse weather (Study 2)., Conclusion: The results show a relationship between implicit associations and risk-taking behavior., Application: Pilots may be involved in risk-taking behavior because they perceive less risk in, and are implicitly less afraid of, hazardous conditions.

High power-distance has been implicated in many aircraft accidents involving Southeast Asian carriers where crew resource management (CRM) has been identified as a root cause. However, this commentary argues that the design of modern flight decks and their standard operating procedures have an inherent Western (low power-distance) bias within them which exacerbates these CRM issues.

We examined the general health and psychological symptoms among survivors of the 1996 Garuda Indonesia air disaster in Japan. We conducted a prospective study 6 months and 1 year (Study 1) after the disaster. A retrospective follow-up study was performed ten years after the disaster (Study 2). The mean score on the 28-Item General Health Questionnaire was 6.5 (SD=6.9) 1 year after the disaster. Those who witnessed the death of an acquaintance in the disaster were classified into the high risk group. In Study 2, more than one-third of respondents complained of a flying phobia. These findings indicate that the psychological burdens of air disasters may last as long as 10 years.

Introduction: According to Lopes [Lopes, L.L. (1987). Between hope and fear: The psychology of risk. Advances in Experimental Social Psychology, 20, 255-295] tolerance of risk may be governed by sensitivity to either the opportunities for gain or threats of loss involved., Methods: In the initial study, qualified pilots were presented with 36 written flight scenarios that varied in the levels of opportunity and threat present. The pilots rated the likelihood that they would undertake each flight. Pilots were largely risk averse, as their ratings were all significantly influenced by threat., Results: The pilots whose ratings were significantly influenced by opportunity had been involved in more hazardous aviation incidents than the other pilots. In the final study, 32 qualified pilots completed both the risk tolerance measure and a simulated flight into adverse weather. The pilots who continued flying into adverse weather were less risk averse compared to the pilots who diverted. This further highlighted the link between risk tolerance and risk-taking, and suggested that some pilots may fly into adverse weather because of a greater tolerance of risk., Impact on Industry: The studies provide evidence that a measure of risk tolerance can predict potential accident involvement amongst general aviation pilots.

Cognitions attributing health complaints to disaster exposure are associated with more severe health complaints and are therefore a promising target for interventions. Little is known about the best strategy to modify such cognitions following exposure to a technological disaster at the community level. In 1992, a Boeing 747 crashed in a residential area in Amsterdam, the Netherlands. Persisting rumours about the possible toxic cargo of the plane led to increasing health concerns among the residents and rescue workers involved in the disaster. The current study investigates (a) the effectiveness of providing information on the health consequences of exposure to the aviation disaster to residents and rescue workers with varying degrees of exposure to the disaster, and (b) individual characteristics which may moderate the effectiveness of the health information provided. A total of 1019 rescue workers and 453 residents involved with varying degrees in the disaster participated in an epidemiological investigation and 1736 rescue workers and 339 residents, all involved, participated in an individual medical examination. Participants were assessed at baseline and 6 weeks after communication of the results of the epidemiological study. Main outcome measures evaluated health anxiety, somatic sensitivity, reassurance by a physician, psychopathology, post-traumatic stress symptoms, fatigue and quality of life. All participants reported elevated levels of psychopathology and fatigue, increased anxiety and uncertainties about their health 6 weeks after communication of the study results irrespective of the degree of exposure to the disaster. In particular, the conviction that health complaints were caused by toxic exposure was related to more severe health complaints and worries in both rescue workers and residents. Our study shows that communication about the health consequences of exposure to an aviation disaster at the community level has no symptom reducing or reassuring effects. Tailoring of the communication to individual characteristics such as existing expectancies may enhance its impact.

Objective: We examined the willingness and ability of general aviation pilots to execute steep approaches in low-visibility conditions into nontowered airports., Background: Executing steep approaches in poor weather is required for a proposed Small Aircraft Transportation System (SATS) that consists of small aircraft flying direct routes to a network of regional airports., Method: Across two experiments, 17 pilots rated for Instrument Flight Rules at George Mason University or Virginia Tech flew a Cessna 172R simulator into Blacksburg, Virginia. Pilots were familiarized with the simulator and asked to fly approaches with either a 200- or 400-foot ceiling (at approach angles of 3 degrees, 5 degrees, and 7 degrees in the first experiment, 3 degrees and 6 degrees in the second). Pilots rated subjective workload and the simulator recorded flight parameters for each set of approaches., Results: Approaches with a 5 degree approach angle produced safe landings with minimal deviations from normal descent control configurations and were rated as having a moderate level of workload. Approaches with 6 degree and 7 degree approach angles produced safe landings but high workload ratings. Pilots reduced power to control the speed of descent and flew the aircraft slightly above the glide path to gain time to control the landing., Conclusion: Although the 6 degree and 7 degree approaches may not be practical for routine approaches, they may be achievable in the event of an emergency., Application: Further work using other aircraft flying under a wider variety of conditions is needed before implementing SATS-type flights into airports intended to supplant or complement commercial operations in larger airports.

Objectives: The purpose of this study was to determine the prevalence of acute distress-that is, clinically significant posttraumatic stress symptoms (PTSS) and depression-and to identify predictors of each in a sample of people who witnessed a fatal aircraft collision at the 2005 Saskatchewan Centennial Air Show., Design: Air Show attendees (N = 157) were recruited by advertisements in the local media and completed an Internet-administered battery of questionnaires., Results: Based on previously established cut-offs, 22 percent respondents had clinically significant PTSS and 24 percent had clinically significant depressive symptoms. Clinically significant symptoms were associated with posttrauma impairment in social and occupational functioning. Acute distress was associated with several variables, including aspects of Air Show trauma exposure, severity of prior trauma exposure, low posttrauma social support (ie, negative responses by others), indices of poor coping (eg, intolerance of uncertainty, rumination about the trauma), and elevated scores on anxiety sensitivity, the personality trait of absorption, and dissociative tendencies., Conclusions: Results suggest that clinically significant acute distress is common in the aftermath of witnessed trauma. The statistical predictors (correlates) of acute distress were generally consistent with the results of studies of other forms of trauma. People with elevated scores on theoretical vulnerability factors (eg, elevated anxiety sensitivity) were particularly likely to develop acute distress.

Objective: This investigation sought to develop a reliable and valid classification system for identifying and classifying the underlying causes of pilot errors reported under the Aviation Safety Action Program (ASAP)., Background: ASAP is a voluntary safety program that air carriers may establish to study pilot and crew performance on the line. In ASAP programs, similar to the Aviation Safety Reporting System, pilots self-report incidents by filing a short text description of the event. The identification of contributors to errors is critical if organizations are to improve human performance, yet it is difficult for analysts to extract this information from text narratives. A taxonomy was needed that could be used by pilots to classify the causes of errors., Method: After completing a thorough literature review, pilot interviews and a card-sorting task were conducted in Studies 1 and 2 to develop the initial structure of the Aviation Causal Contributors for Event Reporting Systems (ACCERS) taxonomy. The reliability and utility of ACCERS was then tested in studies 3a and 3b by having pilots independently classify the primary and secondary causes of ASAP reports., Results: The results provided initial evidence for the internal and external validity of ACCERS. Pilots were found to demonstrate adequate levels of agreement with respect to their category classifications., Conclusions: ACCERS appears to be a useful system for studying human error captured under pilot ASAP reports. Future work should focus on how ACCERS is organized and whether it can be used or modified to classify human error in ASAP programs for other aviation-related job categories such as dispatchers., Application: Potential applications of this research include systems in which individuals self-report errors and that attempt to extract and classify the causes of those events.

This study examined specific and general psychological distress 8.5 years following the 1992 cargo aircraft crash in Amsterdam. Participants included 334 occupationally exposed fire fighters and 834 occupationally exposed police officers compared with reference groups of 194 fire fighters and 634 police officers who were exposed to duty-related stressors other than the disaster. On the standardized instruments of psychological distress, exposed fire fighters reported more somatic complaints and fatigue, while exposed police officers reported higher psychological distress on all aspects. The degree and type of exposure at the disaster site and other background factors were associated with several outcomes of psychological distress levels of exposed rescue workers. The disasters' aftermath of rumors about potential health consequences due to toxic exposure likely contributed to the long-lasting psychological distress of some of the rescue workers as well.

Background: On 4 October 1992, a cargo aircraft crashed into apartment buildings in Amsterdam, the Netherlands. Fire-fighters and police officers assisted with the rescue work., Objectives: To examine the long term health complaints in rescue workers exposed to a disaster., Methods: A historical cohort study was performed among police officers (n = 834) and fire-fighters (n = 334) who performed at least one disaster related task and reference groups of their non-exposed colleagues (n = 634 and n = 194, respectively). The main outcome measures included digestive, cardiovascular, musculoskeletal, nervous system, airway, skin, post-traumatic stress, fatigue, and general mental health complaints; haematological and biochemical laboratory values; and urinalysis outcomes., Results: Police officers and fire-fighters who were professionally exposed to a disaster reported more physical and mental health complaints, compared to the reference groups. No clinically relevant statistically significant differences in laboratory outcomes were found., Conclusions: This study is the first to examine long term health complaints in a large sample of rescue workers exposed to a disaster in comparison to reference groups of non-exposed colleagues. Findings show that even in the long term, and in the absence of laboratory abnormalities, rescue workers report more health complaints.

Objective: To study whether the methods used to select participants in research on prevalence rates of the health effects of exposure to a disaster may cause bias. This study compared background characteristics, disaster exposure, and complaints reported by (1) police officers who participated in an epidemiological study and underwent a medical examination, and (2) police officers who only participated in an epidemiological study., Design and Setting: In 2000, an epidemiological study was started to investigate the health status among police officers who were involved in assistance work related to the air disaster in Amsterdam: the epidemiological study air disaster Amsterdam (ESADA). These police officers were personally invited to participate in the epidemiological study and were additionally offered a medical examination, providing them with the opportunity to have their health checked by a medical doctor., Participants: Of the total group of involved police officers who were invited, 834 (70%) participated in the ESADA: 224 (26.9%) only participated in the study, but 610 (73.1%) also underwent the medical examination., Main Results: Police officers who underwent a medical examination significantly more often reported one or more musculoskeletal complaints, skin complaints, general or non-specific complaints, had more often experienced an event with potentially traumatic impact, or had performed one or more potentially traumatic tasks., Conclusions: The methods of selection of participants are important in research on health effects after disasters and can result in an overestimation of some of the effects, on average, by a factor of 1.5 to 2.

Objectives: Although medically unexplained physical symptoms such as fatigue are frequently observed after exposure to trauma, the vast majority of health outcomes studies in trauma and disaster research relates to the psychological and psychiatric problems met by victims. The objectives of this study were to investigate the prevalence of (persistent) fatigue in the aftermath of a disaster and to analyze the predictive value of sociodemographic and various health-related variables for fatigue among both rescue workers and residents., Methods: A total of 1951 rescue workers and 753 residents involved in the Bijlmermeer aviation disaster participated in this study. Follow-up data were gathered in 70% of randomly selected rescue workers and 53% of the residents. Multiple regression analyses, multivariate logistic regression analyses, and crosslagged panel analyses examined sociodemographic variables and self-report measures for psychopathology, posttraumatic stress reactions, quality of life, somatosensory amplification, health anxiety, and tendency to be reassured by a physician as predictors of fatigue at baseline and fatigue from baseline to 13 to 28 months follow up., Results: Elevated levels of fatigue are common after involvement in a disaster in rescue workers (20.6%) and residents (45.4%). Higher levels of psychopathology, lower quality of life, and the tendency to be less reassured were multivariate predictors of both elevated and persistent fatigue. Tendency to be reassured was the most important causal factor for fatigue., Conclusions: These results suggest that early identification, adequate reassurance, and treatment of individuals at risk may be worthwhile to prevent chronic fatigue.

Background: In 1992 a cargo aircraft crashed into a residential area of Amsterdam. A troublesome aftermath followed, with rumors on potential toxic exposures and health consequences. Health concerns remained even though no excess morbidity was predicted in retrospective risk evaluations. This study aimed to assess to what extent the rescue workers attribute long-term physical complaints to this disaster, including its aftermath, and to examine associations between such attribution and types of exposure and background variables., Methods: Historic cohort study that collected questionnaire data on occupational disaster exposure, attribution of physical complaints, and background variables on average 8.5 years post-disaster. For the present study the workers who were exposed to the disaster were selected from the historic cohort, i.e. the professional firefighters (n = 334), police officers (n = 834), and accident and wreckage investigators (n = 241) who performed disaster-related tasks., Results: Across the three occupational groups, a consistent percentage (ranging from 43% to 49%) of exposed workers with long-term physical complaints attributed these to the disaster, including its aftermath. Those with more physical complaints attributed these to a stronger degree. Multivariate logistic regression analyses showed that attribution was significantly more often reported by firefighters who rescued people, and by police officers who reported the identification and recovery of or search for victims and human remains, clean-up, or security and surveillance of the disaster area; who witnessed the immediate disaster scene; who had a close one affected by the disaster; and who perceived the disaster as the worst thing that ever happened to them. Age, sex and educational level were not significantly associated with attribution., Conclusion: This study provides further cross-sectional evidence for the role of causal attribution in post-disaster subjective physical health problems. After on average 8.5 years, almost a third (32%) of all the exposed workers, and almost half (45%) of the exposed workers with physical complaints, attributed these complaints to the disaster, including its aftermath. The similarity of the results across the occupational groups suggests a general rather than an occupation-specific attribution process. Longitudinal studies are needed to determine whether causal disaster attribution leads to persistence of post-disaster complaints and health care utilization.

Introduction: Weather-related general aviation accidents remain one of the most significant causes for concern in aviation safety. Previous studies have typically compared accident and non-accident cases. In contrast, the current study does not concentrate on occurrence outcome. Instead, the emphasis is on the different behaviors that pilots exhibit in the face of adverse weather and, by inference, on the decision-making processes that underlie those behaviors., Methods: This study compares three weather-related behaviors that reflect different levels of risk: visual flight rules flight into instrument meteorological conditions ('VFR into IMC'); precautionary landing; and other significant weather avoidance actions. Occurrence data (n=491) were drawn from the Australian Transport Safety Bureau database of aviation occurrences, and included weather-related accidents, incidents, and 'normal operationsd.', Results: There were few significant differences between the three weather-related behavior groups in terms of pilot demographics, aircraft characteristics, geographic or environmental factors, or absolute flight distances. The pattern of relative flight distances (a psychological construct) was markedly different for the three groups, with pilots in the weather avoidance group being distinguished by taking timely action., Discussion: The relative distance results suggest that the mid-point of the flight can be a 'psychological turning point' for pilots, irrespective of the absolute flight distance involved. Hence, pilots' behavior was sometimes influenced by psychological factors not related to any particular operational aspect of the flight. The results of the weather avoidance group indicate that a safe pilot is a proactive pilot. Dealing with adverse weather is not a one-off decision but a continually evolving process. This aspect is discussed in terms of the concept of 'mindfulness'.

Background: In 1992, a cargo aircraft crashed into apartment buildings in Amsterdam, killing 43 victims and destroying 266 apartments. In the aftermath there were speculations about the cause of the crash, potential exposures to hazardous materials due to the disaster and the health consequences. Starting in 2000, the Epidemiological Study Air Disaster in Amsterdam (ESADA) aimed to assess the long-term health effects of occupational exposure to this disaster on professional assistance workers., Methods/design: Epidemiological study among all the exposed professional fire-fighters and police officers who performed disaster-related task(s), and hangar workers who sorted the wreckage of the aircraft, as well as reference groups of their non-exposed colleagues who did not perform any disaster-related tasks. The study took place, on average, 8.5 years after the disaster. Questionnaires were used to assess details on occupational exposure to the disaster. Health measures comprised laboratory assessments in urine, blood and saliva, as well as self-reported current health measures, including health-related quality of life, and various physical and psychological symptoms., Discussion: In this paper we describe and discuss the design of the ESADA. The ESADA will provide additional scientific knowledge on the long-term health effects of technological disasters on professional workers.

Objective: This study aimed to develop a multiple-indicator multiple-cause model (MIMIC) to describe the relationship among posttraumatic stress (PTSD) responses, general health problems, death anxiety, personality factors, and coping strategies among community residents exposed to the technological disasters of aircraft and train crashes., Materials and Methods: One hundred forty-eight community residents, after exposure to the aircraft or train crash, were assessed using the Impact of Event Scale, the General Health Questionnaire-28, the Death Anxiety Scale, the Eysenck Personality Questionnaire, and the Ways of Coping Checklist. The control group (n = 90) comprised members of the general public, who had not been exposed to the disasters, from another city., Results: The model showed significant associations between the impact of the disaster and general health problems, which varied depending on where community residents lived in relation to the disaster site, whether they were present when the disaster occurred, and the type of disaster. The model also suggested that death anxiety was associated with type of disaster and neuroticism. The model supported the interactive model in that personality factors interacted with coping strategies in maintaining or generating PTSD and general health problems., Conclusions: After exposure to technological disasters, community residents could develop PTSD and general health problems; however, increased death anxiety was a separate psychological reaction. The interaction between certain personality traits and coping strategies was one reason for PTSD and general health problems.

When human error is involved in the error chain of accidents in complex systems, the causes of the errors are very seldom the result of: a random slip, one inadvertent oversight, a single unintended action, one mis-perceived event, simple mal-performance of a complex action, or a poor training program for the human operators. Invariably, the cause of the break down is in a very poor conscious choice by someone from the operator back through system designer, the supervision, management and leadership through the entire organization. Usually the operator bears the burden of the blame and is either rebuked, retrained or replaced. In systems such as commercial aviation, complex manufacturing systems, power plants, process control systems, information-processing systems and communications networks, the replacement or retraining of individuals or even classes of individuals usually does not result in any long-term improvement of the safety or effectiveness of the system. What is needed is a system that identifies the reasons why the operators made the errors. Further a system is needed that can recommend what can be done to improve the future performance within the system. The professional performance analysis system (PPAS) has been developed and applied to more than 50 major aircraft accidents in the past 30 years. The PPAS is a direct outgrowth of the human performance analysis system developed by Robert Mager over 45 years ago. The PPAS system is applied after a complete and unbiased definition and description of the events of the accident or incident has been developed by the teams of accident investigation and accident reconstruction professionals. The PPAS then uses a systematic protocol and algorithm to determine the reasons as to why the humans committed the errors or why they performed at subnormal performance levels. This process is based on quantitative behavioral science principles and findings that have been demonstrated valid for many generations. The PPAS looks at five attributes of human performance to identify the factors that can be changed to improve performance in the future. The result is a series of objective definitions of changes that have been demonstrated to be the attributes that influence human performance. The PPAS provides a tool to the analyst, who lacks sophistication or experience in quantitative behavioral sciences, to arrive at recommendations that are based on validated human performance principles.

Objective: The events of Sept. 11, 2001, highlighted the importance of understanding the effects of trauma on disaster workers. To better plan for the health care of disaster workers, this study examined acute stress disorder, posttraumatic stress disorder (PTSD), early dissociative symptoms, depression, and health care utilization in disaster workers., Method: Exposed disaster workers (N=207) and unexposed comparison subjects (N=421) were examined at 2, 7, and 13 months after an airplane crash., Results: Exposed disaster workers had significantly higher rates of acute stress disorder, PTSD at 13 months, depression at 7 months, and depression at 13 months than comparison subjects. Those who were younger and single were more likely to develop acute stress disorder. Exposed disaster workers with acute stress disorder were 3.93 times more likely to be depressed at 7 months. Those with high exposure and previous disaster experience or who had acute stress disorder were more likely to develop PTSD. Similarly, those who were depressed at 7 months were 9.5 times more likely to have PTSD. Those who were depressed at 13 months were 7.96 times more likely to also meet PTSD criteria. More exposed disaster workers than comparison subjects obtained medical care for emotional problems at 2, 7, and 13 months. Overall, 40.5% of exposed disaster workers versus 20.4% of comparison subjects had acute stress disorder, depression at 13 months, or PTSD., Conclusions: Exposed disaster workers are at increased risk of acute stress disorder, depression, or PTSD and seek care for emotional problems at an increased rate.

When the psychosocial-care scheme for victims of the firework explosion in Enschede, the Netherlands (2000) was set up, lessons learned from the Bijlmer airline disaster (Amsterdam 1992) were put into practice. The aftermath of this incident showed that psychological and physical health problems can still occur many years later. The main failure of the aftercare of the Bijlmer disaster lay in the coordination of aid and the monitoring of health problems. In Enschede steps were taken to redress these problems. An information and advice centre (IAC) was set up to monitor the well-being of the victims, and to provide them with information and, where necessary, assistance. It is responsible for limiting the effects of the disaster. A total of 13,000 people have consulted the IAC. A residents' association was formed. This gave the victims a common voice during the process of attempting to restore normality in their lives. A specialized mental health-care unit was founded to treat disaster-related disorders using evidence-based treatments. So far approximately 1,300 people have consulted this body. A longitudinal study has been set up to map the consequences of the disaster and to advise aid organizations. This will also give information on the extent to which these methods have been able to limit the long-term consequences.

We investigated the effects of the 1998 Swissair Flight 111 (SA 111) disaster on a variety of indices of alcohol use among volunteer responders. We retrospectively administered standardized questionnaires and a semi-structured interview to 13 volunteer disaster workers recruited from the community. According to the interview, 54% of the volunteers were exposed to human remains. According to Modified Post-Traumatic Stress Disorder (PTSD) Symptoms Scale responses, 46% met DSM-IV criteria for PTSD. Frequency and severity of PTSD symptoms, but not human remains exposure, per se, were positively correlated with coping-motivated drinking (but not social or mood enhancement drinking) and with alcohol use to forget. The re-experiencing and hyper-arousal PTSD symptom dimensions showed the strongest and most consistent correlations with the alcohol use indices. We discuss ways in which the information gleaned from this sample can be used to improve disaster response planning to minimize the probability of maladaptive coping drinking among volunteers.

Introduction: Individual differences in locus of control have be shown to be associated with differential risk for accident involvement among industrial and hospital workers. Previous research has also de onstrated that pilots are higher on internality than externality., Hypothesis: This study was performed to assess individual differences on a new scale developed to assess locus of control with respect to aviation safe It was hypothesized that pilots would exhibit higher levels of internalility than externality on this new scale., Methods: An existing safety locuss of control scale was modified to place the items in an aviation context, and the items were administered to a sample of approximately 480 pilots. Internality and externality subscales were created, and construct valid was assessed by correlating these subscales with measures of resignation and involvement in hazardous aviation events., Results: The subscales exhibited acceptable internal consistency, and were negatively correlated (r = -0.419, p < 0.001). Consistent with previous research, pilots exhibited substantially higher internality than externality. Correlation the subscales with the measures of resignation and involvement hazardous events supported the construct validity of the scale., Discussion: Differences exist among pilots on the Aviation Safety Locusof Control scale that may be associated with increased accident risk. In its present form, the new scale might be employed as a self-awareness exercise for pilots or as a covariate in research investigating the effect of other factors on accident involvement.

Background: On 4 October 1992, an El Al Boeing 747-F cargo aeroplane crashed on two apartment buildings in Amsterdam. Thirty-nine residents on the ground and the four crew members of the plane died. In the years after, a gradually increasing number of people attributed physical signs and symptoms to their presence at the disaster scene., Aim: To investigate the consistency between patients' symptoms attributed to the crash and GPs' diagnoses and perception of the association with the crash., Design of Study: Comparison between self-reported symptoms to a call centre and GPs' medical records on onset and type of symptoms, diagnoses, and GPs' perception of association with the disaster, assessed by questionnaire., Setting: Consenting patients (n = 621) contacting the call centre and their GPs., Method: Patients were interviewed by the call centre staff and interview data were recorded on a database. Questionnaires were sent to the consenting patients' GPs, requesting their opinions on whether or not their patients' symptoms were attributable to the effects of disaster. Baseline differences and differences in reported symptoms between interviewed patients and their GP records were tested using the chi2 test., Results: The 553 responders reported on average 4.3 symptoms to the call centre. The majority of these symptoms (74%) were reported to the GP. Of the ten most commonly reported symptoms, fatigue, skin complaints, feeling anxious or nervous, dyspnoea, and backache featured in 80% of symptoms reported to the GP. One out of four symptoms was either reported to the GP before the disaster took place, or six or more years after (1998/1999, during a period of much media attention). Depression (7%), post-traumatic stress disorder (PTSD) (5%) and eczema (5%) were most frequently diagnosed by GPs. They related 6% of all reported symptoms to the disaster., Conclusions: Most of the symptoms attributed to a disaster by patients have been reported to their GP, who related only a small proportion of these to the disaster.

Background: General aviation (GA) accident statistics indicate that visual flight rules (VFR) flight into instrument meteorological conditions (IMC) is a major safety hazard. However, little research has been conducted to identify the factors that influence VFR pilots' decisions to risk flying into deteriorating weather. The purpose of the present study was to further examine the causes of GA accidents associated with VFR flight into IMC., Method: A comprehensive review of GA accident reports maintained by the National Transportation Safety Board (NTSB) was conducted to identify accidents involving VFR flight into IMC between January 1990 and December 1997. These accidents were compared with other GA accidents that occurred during the same time period., Results: Analyses of these accidents revealed that VFR flight into IMC accidents were more likely to involve less-experienced pilots and to have passengers aboard the accident aircraft compared with the other GA accidents. In addition, most VFR flight into IMC accidents were considered by the NTSB to have involved intentional flight into adverse weather by the pilot., Discussion: These findings are interpreted in terms of their implications for the underlying causes of VFR flight into IMC, including situation assessment, risk perception, and social pressure. Intervention programs that address all of these factors are needed.

This paper outlines a human error identification (HEI) technique called TRACEr--technique for the retrospective and predictive analysis of cognitive errors in air traffic control (ATC). The paper firstly considers the need for an HEI tool in ATC, and key requirements for the technique are noted. The technique, which comprises a number of inter-related taxonomies, based around a simple cognitive framework, is then described. A study concerning a real-world application of TRACEr is outlined-the evaluation of several options for reduced separation minima in unregulated UK airspace. In this study, TRACEr was used predictively and retrospectively, looking forward to pre-empt potential problems and looking back to learn from experience. The paper concludes that TRACEr is a valuable aid to design, development and operations in UK ATC, and has indeed been used as a basis for further applications in ATC both in Europe and the USA.

Background: General Aviation (GA) cross-country crashes, particularly those involving weather, continue to be a major source of fatalities, with a fatality rate more than four times greater than for GA crashes in general. There has been much speculation and little solid evidence on the causes of these crashes., Methods: We have designed a program of laboratory and database research into the causes of cross-country weather-related crashes including an analysis of air crashes in New Zealand between 1988 and 2000. There were 1308 reported occurrences in this period. We examined in detail 77 crashes where it could be determined that the aircraft was on a cross-country flight., Results: In our first analysis we compared the characteristics of crashes that occurred in response to externally driven failures with crashes where the aircraft continued to be flown at the pilot's discretion up until the point of the crash. Clear differences were found for visibility, altitude, crash severity, and for several pilot characteristics. These differences are highly consistent with those found for previous research on pilot characteristics and crash involvement. In the second analysis we made comparisons between the weather-related and nonweather-related crashes in the discretionary control group and between subcategories of weather-related crashes., Conclusions: These data show that weather-related crashes occur further into the flight and closer to the planned destination than other kinds of cross-country crashes in GA. Pilots involved in these crashes are younger and have more recent flight time than pilots involved in other crashes. Their increased involvement cannot be explained simply by exposure (flight-time) but must be due to other factors.

26 sailors who survived a Kamikaze attack during the battle for Okinawa in World War II were given two adapted forms of the Posttraumatic Stress Disorder Checklist-Civilian to assess the psychological reactions they had to the sinking of their ship. Depending on the assessment criteria used, their responses indicated significant stress reactions ranging from 8.3% to 44% of the sample. The findings provide evidence that a single combat experience can have lifelong, averse psychological effects.

Background: The Human Factors Analysis and Classification System (HFACS) is a general human error framework originally developed and tested within the U.S. military as a tool for investigating and analyzing the human causes of aviation accidents. Based on Reason's (1990) model of latent and active failures, HFACS addresses human error at all levels of the system, including the condition of aircrew and organizational factors. The purpose of the present study was to assess the utility of the HFACS framework as an error analysis and classification tool outside the military., Methods: The HFACS framework was used to analyze human error data associated with aircrew-related commercial aviation accidents that occurred between January 1990 and December 1996 using database records maintained by the NTSB and the FAA., Results: Investigators were able to reliably accommodate all the human causal factors associated with the commercial aviation accidents examined in this study using the HFACS system. In addition, the classification of data using HFACS highlighted several critical safety issues in need of intervention research., Conclusion: These results demonstrate that the HFACS framework can be a viable tool for use within the civil aviation arena. However, additional research is needed to examine its applicability to areas outside the flight deck, such as aircraft maintenance and air traffic control domains.

As the "last line of defence" pilots in commercial aviation often have to counteract effects of unexpected system flaws that could endanger the safety of a given flight. In order to timely detect and mitigate consequences of latent or active failures, effective team behaviour of the crew members is an indispensable condition. While this fact is generally agreed in the aviation community, there seems to be a wide range of concepts how crews should interact most effectively. Within the framework of the European project JARTEL the cultural robustness of evaluations of crew behaviour was examined. 105 instructor pilots from 14 different airlines representing 12 European countries participated in this project. The instructors' evaluations of crew behaviours in eight video scenarios will be compared in relation to cultural differences on Hofstede's dimensions of Power Distance and Individualism.

Travelling by airplane is of increasing importance in modern society. Psychiatric disorders seldom cause incidents in aircrafts. Scandal sheets and serious newspapers as well report on disturbances of a flight by psychiatric patients. Up until now psychiatric research is not engaging in unruly flight passengers suffering from psychotic symptoms. We describe a passenger who became psychotic during an international flight. In addition, we provide an overview over publications dealing with unruly passengers due to psychosis and describe similar cases.

Objective: To investigate the influence of an aircraft crash near the South of Limburg, the Netherlands, on the perceived physical and psychological health and annoyance of local residents., Design: Controlled, blinded, follow-up questionnaire survey., Method: Three months before an aircraft crash occurred, randomly selected local residents and control subjects who lived approximately 20 km from the crash site were asked to complete a health questionnaire. The study was repeated one year after the crash. The aim of the survey was not mentioned in the questionnaire. The questionnaire asked about demographic features, physical health, psychological health and environmental nuisance. In the first survey, 544/926 (59%) questionnaires were successfully returned, and after the disaster this figure was 677/900 (75%). Linear regression modelling was used to check whether or not any differences in outcome were due to confounding demographic variables., Results: There was no significant difference in the perceived physical and psychological health of local residents before and after the aircraft crash. A year after the crash, the nuisance level of aircraft noise reported by local residents had markedly increased. Aircraft noise was the major cause of disturbance. More than 1 in 3 residents perceived daily aircraft noise as a nuisance compared with 1 in 6 before the crash. The scores of local inhabitants for annoyance due to aircraft odour and dust doubled after the crash. Compared with control subjects, local inhabitants scored more than 20 times higher for annoyance due to aircraft odour and 40 times higher for annoyance due to dust. The reported nuisance caused by road traffic noise, odour and dust also increased, although to a lesser extent., Conclusion: Health was not influenced by the aircraft crash. A year after the crash, there was a strong drop in tolerance of aircraft nuisance. There was also a reduction in the tolerance of comparable nuisance due, for example, to road traffic, although this change was less marked.

Studies have shown that autonomous mode behavior is one cause of aircraft fatalities due to pilot error. In such cases, the pilot is in a high state of psychological and physiological arousal and tends to focus on one problem, while ignoring more critical information. This study examined the effect of training in physiological self-recognition and regulation, as a means of improving crew cockpit performance. Seventeen pilots were assigned to the treatment and control groups matched for accumulated flight hours. The treatment group contained 4 pilots from HC-130 Hercules aircraft and 4 HH-65 Dolphin helicopter pilots; the control group contained 3 pilots of HC-130s and 6 helicopter pilots. During an initial flight, physiological data were recorded on each crewmember and an instructor pilot rated individual crew performance. Eight crewmembers were then taught to regulate their own physiological response levels using Autogenic-Feedback Training Exercise (AFTE). The remaining participants received no training. During a second flight, treatment participants showed significant improvement in performance (rated by the same instructor pilot as in pretests) while controls did not improve. The results indicate that AFTE management of high states of physiological arousal may improve pilot performance during emergency flying conditions.

This article examined the relationship between traumatic stress and death anxiety among community residents who lived near woodlands in which an aircraft had crashed in Coventry, England. The hypothesis was that there would be a high level of impact of the crash experienced by residents and that the residents would experience psychological distress. It was also hypothesized that the impact of the crash and distress were associated with death anxiety. Eighty-two residents were interviewed for the study. They were asked to complete the Impact of Event Scale, the General Health Questionnaire (GHQ), and the Death Anxiety Scale. The results showed that Coventry residents were found to experience intrusive thoughts and display avoidance behavior. The residents' intrusive thoughts and avoidance behavior were significantly more severe than one group of Horowitz's standardized samples (i.e., the medical students), but not significantly different from another group (i.e., the stress clinic samples). Fifty-seven percent scored at or above the GHQ cutoff point, which meant that they were considered to be psychiatric cases. Community residents scored significantly lower in death anxiety than the standardized high-death anxiety patients but no differently from the standardized control patients. Correlations were found between the impact of the event, psychological distress, and death anxiety.

Objectives: Acute stress responses following a trauma indicate a sensitivity to posttraumatic stress disorder (PTSD), and is often comorbid with depression. Earlier exposure to a traumatic event can be an additional risk factor in PTSD development., Method: Eight injured patients hospitalized after a major air disaster were monitored and assessed for a month. The symptoms of acute stress response (ASR), PTSD, and depression were assessed using DSM-IV criteria immediately following the accident, then each week thereafter. The Impact of Event Scale (IES) was completed on the 30th day (D30)., Results: Four patients presented with an ASR, and 3 of them had a PTSD at D30. Of those 3 patients with PTSD, 2 presented with an associated depression. These 2 patients had been exposed to a traumatic event before the disaster; and a significant relation was found between the history of the earlier trauma and the PTSD associated with depression., Conclusion: The traumatized victims with a history of earlier traumas seem more susceptible to developing a PTSD associated with depression.

The importance of communication on the flightdeck is discussed and the application of a new computer-based linguistic method of text analysis is introduced. Preliminary results from a NASA B727 simulator study indicate that specific language variables are moderately to highly correlated with individual performance, individual error rates, and individual communication ratings. Also, language use was found to vary as a function of crew position and level of workload during the flight. Use of the first person plural (we, our, us) increases over the life of a flightcrew, and Captains speak more in the first person plural than First Officers or Flight Engineers. Language use in initial flights was associated with performance and error in subsequent flights. These are preliminary data, in that this method of linguistic analysis is currently being developed and integrated with a content-coding method of communication analysis and models of threat and error.

This report addresses the historical problem that a very high percentage of accidents have been classified as involving "pilot error." Through extensive research since 1977, the Federal Aviation Administration determined that the predominant underlying cause of these types of accidents involved decisional problems or cognitive information processing. To attack these problems, Aeronautical Decision Making (ADM) training materials were developed and tested for ten years. Since the publication of the ADM training manuals in 1987, significant reductions in human performance error (HPE) accidents have been documented both in the U.S. and world wide. However, shortcomings have been observed in the use of these materials for recurrency training and in their relevance to more experienced pilots. The following discussion defines the differences between expert and novice decision makers from a cognitive information processing perspective, correlates the development of expert pilot cognitive processes with training and experience, and reviews accident scenarios which exemplify those processes. This introductory material is a necessary prerequisite to an understanding of how to formulate expert pilot decision making training innovations; and, to continue the record of improved safety through ADM training.

In this paper we address three areas. First we review the literature on clinical intervention using debriefing, second we examine who attends debriefings by looking at a study of the 1989 plane crash at Ramstein, Germany and lastly we examine the effect of natural debriefing, i.e., talking to family and friends on psychiatric outcome in disaster workers by looking at a study of the Sioux City, Iowa United plane crash, 1989. Our data suggest that those with high exposure and females were more likely to attend a debriefing. People most likely to talk about the disaster with spouse/significant other, coworker and/or another person were: those with acute PTSD, higher total and intrusive Impact of Event symptoms, older, married, those with higher levels of education and higher levels of disaster exposure. Better understanding of who attends formal debriefings will help identify potential high-risk groups. Similarly, whether talking about the disaster is associated with fewer or greater psychological symptoms is important to understanding the outcome, mechanisms, and risks of debriefing.

The cumulative effects of trauma were examined in 108 workers at the site of a major air disaster at 4 time points over a year following the crash. The influence of trauma history on chronic distress and physiological arousal associated with the crash were examined. Stress levels were expected to differ on the basis of the similarity of prior trauma exposure to work at the crash site. Prior traumatic exposure that was "dissimilar" to this type of work was associated with greater vulnerability to crash-related stress, that is, more distress and crash-related intrusions during the year following the crash. Accumulation of a variety of different traumatic experiences appeared to sensitize workers to the new stressor and to perpetuate chronic stress. Understanding the role of trauma history is important for improving intervention efforts aimed at alleviating stress following a trauma.

An area of disaster response with high risk of inducing trauma in response workers is recovering and identifying human remains. Following a review of the literature addressing the significant stressors associated with handling dead bodies, we present a case study which describes professional social work intervention and support to disaster response workers and volunteers assigned to the morgue following a major air disaster. A primary task was helping workers cope with the unique stresses associated with recovering dead bodies. Opportunities for social workers to use their professional skills for disaster response work is discussed along with recommendations for social work education.