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Original drawing of Senator Barry Goldwater parachuting away from an aircraft that is crashing and burning, behind him is a supersonic aircraft labeled "Casey."

Original drawing of Edwin Meese and Ronald Reagan aboard a crashed aircraft together; aircraft is named "Gen. Meese". They are amid several crashed aircraft; each with Meese's name and various ranks obtained: "Capt. Meese, "Lt. Meese", "Col. Meese", "Maj. Meese."

Original drawing of Yitzhak Shamir Prime Minister of Israel in a crashed Lavi jet fighter plane.

Changes in General Aviation (GA) accident rates, specifically in the go-around phase, are examined by comparing the number of accidents, the proportion of fatal accidents, and the proportion of certain causes of accidents over time.Two sets of accidents from 2000 to 2004 and from 2013 to 2017 were extracted from the National Transportation Safety Board (NTSB) online database.Although the total number of GA accidents per landing significantly decreased over time, the proportion of fatal accidents in the go-around phase increased. Fatalities most often occurred in instrument meteorological conditions.Advances in technology and training show improvements in GA accident rates, but not for accidents in the go-around phase.Scenario-based learning is recommended to include specific instruction concerning the timing of go-around procedures in unstable flights.

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: Accidents during start-up and shut-down procedures of aircraft can lead to fatalities or destroyed aircraft. Start-up procedures for propeller aircraft include the possibility of hand-propping, which may increase the occurrence of injuries from propeller strikes.METHODS: A set of 142 accidents from a 10-yr period were selected from the U.S. National Transportation Safety Board online database. Only fixed-wing aircraft in the “standing” phase of flight were included in the dataset. The significance of differences was determined using Pearson’s Chi-squared analysis.RESULTS: The severity of the injuries sustained in the accidents were inversely related to the amount of damage to the aircraft. Hand-propping without properly securing the aircraft was more likely to result in substantial damage to the aircraft. Pilots with less than a thousand hours of flight experience were significantly more likely to use an incorrect hand-propping procedure.CONCLUSIONS: It is recommended to make the advisory on hand-propping a regulatory article of the Federal Aviation Administration so that pilots’ knowledge of this procedure is mandatory and part of their initial training, especially securing the aircraft during hand-propping. Highlighting throttle positions in both regular and hand-propping procedures may optimize checklist design and further mitigate accidents during start-up procedures.de Voogt AJ, Kalagher H, Burns S. General aviation accidents involving fixed-wing aircraft on the ground. Aerosp Med Hum Perform. 2022; 93(7):597–600.

An Air India Express Flight AI1344 travelling from Dubai to Calicut (Kozhikode), when attempting to land, unfortunately, overshot the runway and crashed causing many casualties as the impact caused the aircraft to break up into multiple pieces. The response to a disaster, specifically an aviation disaster, is highly complex. It involves multiple government agencies and calls for a truly inter/multidisciplinary response from diverse domains including forensic experts, fire experts, aeronautical engineers, humanitarian experts who must together form an ideal post-rescue recovery team. The author was intricately involved in the recovery mission launched after the above air disaster. This case study considers the process of collecting and managing the personal effects of those affected along with the various challenges involved.

BACKGROUND: Sightseeing operations are characterized by the presence of passengers as well as favorable light and weather conditions. They include both fixed-wing aircraft and helicopters, an aspect that allows for a comparison of these two types of aircraft in similar operations.METHODS: A total of 95 accident reports from 2008 until 2018 were extracted from the NTSB online database, with each mentioning commercial sightseeing as their operation.RESULTS: Out of a total of 95 accidents, 16 were fatal with a total of 58 people suffering fatal injuries. On average 3.625 people died in each fatal accident. There were significantly more accidents in Alaska and Hawaii than expected. There were significantly more accidents caused by the maintenance crew in helicopters than in airplanes, but significantly more pilot-related accidents in fixed-wing aircraft compared to helicopters. Despite favorable light and weather conditions, 37 accidents reported the environment as a contributing factor to the accident.CONCLUSION: Sightseeing accidents show a pronounced difference between helicopters and airplane accidents that point to different approaches when improving safety in either category. Although night and instrument meteorological conditions are largely absent in the dataset, wind conditions and unsuitable terrain are frequently mentioned. The experience of the pilots and the specific geography of the sightseeing area are likely to affect operational safety the most. The specific dangers of unsuitable terrain affect both helicopters and fixed-wing operations and may be assuaged by specific training or briefings.de Voogt AJ, Hummel Hohl C, Kalagher H. Sightseeing accidents with helicopters and fixed-wing aircraft. Aerosp Med Hum Perform. 2022; 93(6):532–535.

Engine damage as a consequence of foreign object debris (FOD) during flight is frequently caused by birds. One approach to minimising disruption caused by this damage is to provide flight crew with accurate information relating to the continuing operational status of the aircraft’s engines. Before designing such avionic systems however, understanding of current procedures is needed. Hierarchical Task Analysis (HTA) and Systematic Human Error Reduction and Prediction Approach (SHERPA) were used to identify potential failures that flight crew may make when managing an engine bird strike. Workshops with commercial pilots generated insights into current practice and a commercial pilot SME reviewed outputs for accuracy. Over 200 potential failures were identified, most commonly related to communication. Remedial measures, considering future avionic systems, are proposed to mitigate identified failures. This analysis provides a starting point for future design concepts for assisting flight crew in dealing with engine malfunction due to FOD strikes. Practitioner summary: Hierarchical Task Analysis was conducted to show all tasks involved in dealing with an in-flight aircraft engine bird strike. Systematic Human Error Reduction and Prediction Approach analysis was performed and over 200 possible failures were identified when managing this event. Remedial measures are proposed to help mitigate possible failures.

This report orients general psychiatrists to assessment and care for "safety sensitive" aviation workers. Our case study of 30 sequential aviation patients consists of demographic, clinical, and aviation characteristics plus a 10-year follow-up. Relatively few pilots and other aviation workers self-identified their psychiatric condition. Aviation outcomes associated with psychiatric disorder included personnel injury and/or aircraft damage (three cases), imminent risk without injury or damage (nine cases), impaired aviation functioning without imminent risk (15 cases), and neither risk nor psychiatric disorder or impairment (three cases). Mood, anxiety, and substance use disorders comprised the most common diagnoses. Ten years later, 23 patients were employed (21 in aviation); seven were disabled or deceased. General psychiatrists will find aviation cases clinically familiar but requiring added evaluation for aviation safety and potential interaction with the Federal Aviation Agency and airline supervisors.

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):798805.

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.

BACKGROUND:This study examines the relationship between seat restraints and injuries of children and infants who were passengers on an aircraft and gives a detailed analysis of children whose behavior contributed to an accident.METHODS:A total of 58 accident reports from 1980 until 2015 were extracted from the NTSB online database in which children were mentioned. In at least 10 cases the childs behavior contributed to the accident.RESULTS:Violations of regulations by the Federal Aviation Authority (FAA) as well as the age and number of children and infants on board were each reported inconsistently. Violations of regulations were significantly more common when accidents occurred during the takeoff phase. Child behaviors that caused accidents included distraction of crew, not wearing a seatbelt, and running into dangerous areas.CONCLUSIONS:Pilots and crew, especially in General Aviation, need to be made aware of the need to enforce FAA regulations concerning child restraint systems. It is recommended that children both on the ground and inside an aircraft have adult supervision in addition to supervising aircraft crew to prevent distractions that harm the safe operation of an aircraft.Kalagher H, de Voogt A. Children and infants in aviation accidents. Aerosp Med Hum Perform. 2021; 92(5):353357.

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.

BACKGROUND: There is a paucity of research on general aviation accidents in Germany. The authorities investigate only a fraction of all national accidents. The current study analyzes existing accident reports and aims to identify injury severity in regard to concomitant risk factors.METHODS: Data of flight accidents was analyzed for aircraft of RESULTS: The authorities list 1595 aircraft accidents between 2000 and 2019, but only 17.9% of these were analyzed in detail. Accidents of aircraft of CONCLUSIONS: The annual count of aircraft accidents has almost halved during the previous 20 yr. Unfortunately, only a small number of mishaps were further investigated by authorities, which leads to a lack of evaluable data needed for in-depth investigations. The accumulation of larger aircraft mishaps in winter and the superior outcome of professional pilots in terms of safety, as well as the fewer number of mishaps in larger aircraft, should be further investigated.Liebold F, Hippler C, Schmitz J, Yücetepe S, Rothschild M, Hinkelbein J. Fixed-wing motorized aircraft accidents: analysis of injury severity and concomitant factors (2000–2019). Aerosp Med Hum Perform. 2022; 93(5):442–449.

There is a strong and growing interest in using the large amount of high-quality operationaldata available within an airline. One reason for this is the push by regulators to use data todemonstrate safety performance by monitoring the outputs of Safety P erformance Indicatorsrelative to targeted goals. However, the current exceedance-based approaches alone do notprovide sufficient operational risk information to support managers and operators makingproximate real-time data-driven decisions. The purpose of this study was to develop and testa set of metrics which can complement the current exceedance-based methods. The approachwas to develop two construct variables that were designed with the aim to: (1) create anaggregate construct variable that can differentiate between normal and abnormal landings(row_mean); and (2) determine if temporal sequence patterns can be detected within thedata set that can differentiate between the two landing groups (row_sequence). To assessthe differentiation ability of the aggregate constructs, a set of both statistical and visual testswere run in order to detect quantitative and qualitative differences between the data seriesrepresenting two landing groups prior to touchdown. The result, verified with a time series k-means cluster analysis, show that the composite constructs seem to differentiate normal andabnormal landings by capturing time-varying importance of individual variables in the final300 seconds before touchdown. Together the approaches discussed in this article present aninteresting and complementary way forward that should be further pursued. QC 20210527 PROSPERO

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

Comparison of post-mortem dental findings to ante mortem dental records is a well-established, frequently used scientific means of human identification. Dentistry has adapted a form of CT scanning that uses a cone-shaped beam and is thus termed cone beam computed tomography (CBCT). CBCT is presently being used in many aspects of dentistry including osseointegrated implant planning, orthodontics, endodontics, investigation of pathology, and assessment prior to complex dental extractions. The identification of seven individuals from multiple fatality incident was undertaken using a simple technique for completing comparative radiographic dental identifications using post-mortem medical computed tomographic (CT) image-acquisition techniques and commercially available dental software normally used in clinical care. The authors will show the means by which the harvesting of anatomically important data from medical CTs and conversion of these files was undertaken to provide crisp, clear post-mortem dental images for forensic comparison to assist in the identification of two adults and provide age stratification of three juveniles. The use of this technique has shown to be beneficial for expediting efficient identification of deceased individuals, helping to isolate which cases may need additional scientific methods of identification, saving time and money to the organization and eliminating biological/body substance or radiation exposure to the operator. The application of this software for use in forensic dental identification cases is presented, and the methodology to create post-mortem images suitable for comparison is detailed.

BACKGROUND: The applicants’ self-declaration of medical history is crucial for safety. Some evidence indicates that under-reporting of medical conditions exists. However, the magnitude in a population of aviation personnel has not been reported earlier.METHODS: A total of 9941 applicants for medical certificate/attestation for aviation-related safety functions during the last 5 yr up to December 2019 were registered at the Civil Aviation Authority Norway. E-mail addresses were known for 9027 of these applicants, who were invited to participate in a web-based survey.RESULTS: Among the 1616 respondents, 726 (45%) were commercial pilots, 457 (28%) private pilots, 272 (17%) air traffic controllers, and the remaining were cabin crew or crew in aerodrome/helicopter flight information service (AFIS or HFIS, respectively). A total of 108 were initial applicants. The age group 50+ constituted the largest proportion of respondents (53%). Aeromedical certification in general was believed to improve flight safety “to a high” or “very high extent” by 64% of the respondents. A total of 188 individuals (12%) admitted having under-reported information related to one or more categories, including mental (3%) or physical health (4%), medications (2%), and drug use, including alcohol use (5%). Among these, 21 participants believed their own under-reporting “to some” or “to a high extent” affected flight safety. In total 50% of noninitial applicants reported that they knew colleagues who had under-reported information. Analyses revealed that being a commercial pilot showed a higher risk for under-reporting compared with other classes and the perception of aeromedical examiners in a supportive or authoritative role reduced the risk.CONCLUSIONS: Under-reporting of medical conditions could be significant in aviation. Further studies should be conducted to investigate the true extent of under-reporting and its impact on flight safety and what mitigating measures might be recommended.Strand T-E, Lystrup N, Martinussen M. Under-reporting of self-reported medical conditions in aviation: a cross-sectional survey. Aerosp Med Hum Perform. 2022; 93(4):376–383.

INTRODUCTION: Pilot fatigue is a significant concern in aviation, where efforts are directed at improving rosters, developing models, and improving countermeasures. Little attention has been given to in-flight detection of fatigue/drowsiness. The aims of this research were to determine whether drowsiness is an issue and explore whether infrared reflectance oculography could prove useful for continuous inflight monitoring.METHODS: Nine university-based pilot trainees wore activity monitors and completed diaries, prior to a simulated navigational exercise of approximately 4 h, during the secondary window of circadian low. During the flight they wore a head-mounted device. Oculographic data were collected and converted into a single number, using the Johns Drowsiness Scale (JDS), with increasing values indicating greater drowsiness (range 0.0 to 10.0).RESULTS: Peak JDS values reached 6.5. Values declined from shortly before top of descent, continuing until landing. Two of the nine participants (22.2%), reached drowsiness levels at or above a cautionary warning level, below which is considered safe for driving a motor vehicle.DISCUSSION: The results of this study revealed the timeline and levels of fatigue that might be experienced by student pilots; showing that drowsiness is a potential issue for student pilots operating in flying conditions similar to those in the simulation. Analysis indicated that pilots are likely to experience levels of drowsiness above a cautionary warning level when modeling predicted effectiveness below 90%, indicating a potential drowsiness issue for pilots. It was concluded that oculography is worthy of further investigation for use as an objective fatigue detection tool in aviation.Corbett MA, Newman DG. Student drowsiness during simulated solo flight. Aerosp Med Hum Perform. 2022; 93(4):354–361.

BACKGROUND: The risks posed by flight illusions impacting pilot spatial orientation have been determined as a safety concern from numerous past aviation accident investigations. Early demonstration of the adverse effects of flight illusions on spatial orientation would be desirable for all pilots, especially at the early training stages to deeply embed good practices for onset detection, flight correction, and response mitigation.METHOD: Simulated flights on a disorientation demonstrator were performed by 19 pilots for 3 conditions: no illusion, somatogyral illusion, and Coriolis illusion. An objective approach for assessing pilot performance degradation due to flight illusions can be done by using a defined flight profile: instrument landing system (ILS) flight trajectory during final instrument approach. Deviations to the standard ILS profile were recorded to measure and evaluate the influence of the demonstrated flight illusion on pilot performance.RESULTS: The results show the expectation that the smallest deviations from the ideal trajectory are caused by pilot tracking error (no illusion), and the greatest deviations are caused by the Coriolis illusion. Results demonstrated a statistically significant effect of illusions on performance. According to statements from pilots, training for flight illusion response is essential to complement training in aircraft regulations and aerodynamics.DISCUSSION: Measuring the influence of vestibular illusions on flight profile with a simulator allows assessment of individual differences and improvement of pilot performance under the conditions of no illusion, the somatogyral illusion, and the Coriolis illusion.Boril J, Smrz V, Blasch E, Lone M. Spatial disorientation impact on the precise approach in simulated flight. Aerosp Med Hum Perform. 2020; 91(10):767775.

This study examines patterns of skeletal trauma in propeller-driven aircraft crashes and blast-related ground loss incidents from WWII. Specifically, descriptions and criteria used to characterize aircraft deceleration- versus blast-related skeletal injuries are examined from 35 recently identified forensic anthropology cases to determine possible diagnostic traits and characterize skeletal trauma associated with these events. Among these cases, blast trauma is more localized within the skeleton and is associated with one or few primary directions of force. It is recommended that analysts differentiate between secondary and nonspecific blast trauma categories. Conversely, aircraft crash deceleration trauma is more widespread throughout the skeleton, with torsional fractures and injuries occurring from multiple or indeterminate directions. These traits reflect factors such as more complex loading environments than is seen in blast events. Two case studies are presented in detail to further illustrate differences in aircraft crash and blast-related incidents. Both studies emphasize consideration of the body as a whole unit to facilitate interpretations. While the cases presented herein result from historic war-related casualties that characterize the Defense POW/MIA Accounting Agency's (DPAA) casework, these skeletal cases provide guidelines more appropriate than clinically derived criteria developed through assessments of soft tissue injuries. These guidelines can be used by anthropologists and pathologists working with skeletal remain from mass disasters and other complex contexts, as well as provide avenues for future research.

Objective This study examines whether the pilot flying’s (PF) scanning behavior is affected by the absence of the pilot monitoring (PM) and aims at deriving implications for the design of single-pilot cockpits for commercial aviation. Background Due to technological progress, a crew reduction from two-crew to single-pilot operations (SPO) might be feasible. This requires a redesign of the cockpit to support the pilot adequately, especially during high workload phases such as approach and landing. In these phases, the continuous scanning of flight parameters is of particular importance. Method Experienced pilots flew various approach and landing scenarios with or without the support of the PM in a fixed-base Airbus A320 simulator. A within-subject design was used and eye-tracking data were collected to analyze scanning behavior. Results The results confirm that the absence of the PM affects the PF’s scanning behavior. Participants spent significantly more time scanning secondary instruments at the expense of primary instruments when flying alone. Moreover, the frequency of transitions between the cockpit instruments and the external view increased while mean dwell durations on the external view decreased. Conclusion The findings suggest that the PM supports the PF to achieve efficient scanning behavior. Information should be presented differently in commercial SPO to compensate for the PM’s absence and to avoid visual overload. Application This research will help inform the design of commercial SPO flight decks providing adequate support for the pilot particularly in terms of efficient scanning behavior.

Introduction We aimed to describe the epidemiology and injury patterns of aviation sports crashes in the Austrian mountains and identify risk factors. Methods In this retrospective cohort study, out-of-hospital data on patients who sustained crashes when participating in aviation sports from January 1, 2006 through December 31, 2015 were assessed. The out-of-hospital data were merged with in-hospital data obtained from Innsbruck Medical University Hospital. Results A total of 2037 persons were involved in 1856 aviation sports crashes. Data on 126 in-hospital patients were available. Wind and pilot error were the most common causes. Most injuries occurred in paragliders (n=111, 88%). Most commonly, paragliders sustained injuries to the lumbar spine and hang gliders to the thoracic spine. Rescue operations were undertaken mainly by helicopter emergency medical services (n=87, 69%) or combined rescue forces (ground and helicopter, n=100, 79%.). The Injury Severity Score was 15±15, with a peak in patients with isolated injuries of the lower extremities (n=38, 32%) and a second peak in patients with multiple trauma (n=44, 35%). Conclusions In the Austrian mountains, wind and pilot errors are the most common causes of aviation crashes. Aviation sports crashes frequently resulted in severe injuries and multiple trauma. The lumbar spine is particularly at risk in paragliders, whereas the thoracic spine is commonly affected in hang gliders. Injuries frequently caused long-term paralysis and limitations in quality of life. To minimize long-term consequences and save lives, skilled and well-equipped teams may be beneficial to provide effective on-site care and safe transportation to a trauma center.

Gyroplanes are mainly used for sports aviation. Experience is required when flying these special aircraft because in 40% of gyroplane crashes, the passengers do not survive. Herein, a fatal gyroplane crash of a tandem-seat gyroplane with two occupants is reported. The occupants, both 49-year-old males, fell from a height of approximately 20 m to 30 m. In both cases, the cause of death was polytrauma with typical findings of deceleration trauma. The pilot, who probably lost his helmet in the crash, had a ring fracture at the base of his skull. As there is not much literature on autopsy findings in the case of light aircraft crashes, these autopsy findings are presented and discussed.

Sensing surfaces like a mosquito Although sonar or lidar are used by autonomous vehicles to detect nearby objects, these approaches incur significant equipment and signal-processing costs. Nakata et al. show that mosquitos detect surfaces using the flow fields caused by the movement of their own wings (see the Perspective by Young and Garratt). Near surfaces, there are small changes in the pressure and velocity that mosquitos can detect using their sensitive antennae. The authors translated this process into a simple, low-cost approach for detecting surfaces near a flying quadcopter. Science , this issue p. 634 ; see also p. 586

INTRODUCTION: Fatigue is a critical safety issue to U.S. Air Force (USAF) flight and ground crew. Nearly 15 yr of mishap reports were analyzed to determine how fatigue affects USAF operations with the goal of improving fatigue risk management policies and tools.METHODS: Summary data for 19,920 aviation mishap reports dating back to 2003 were collected from the Air Force Safety Automated System (AFSAS). Fatigue-related mishaps were identified based on designations provided within AFSAS. Other metrics examined were characteristics such as timing, cost, and aircraft metrics, among others. Contingency tables built from these metrics were used to assess fatigue-related trends across the aviation community.RESULTS: While only 3.88% of all mishaps were identified as fatigue-related, they are associated with 2.1 billion of medical expenses and property damage, or 18% of the 11.7 billion total cost of all mishaps included in the study. Nearly a quarter of the fatigue-related mishaps fall into the most severe mishap category and more than half occurred between 0100 and 0700, local time. Fatigue-related mishaps tended to be more common for Remotely Piloted Aircraft (RPA) and ground operations.DISCUSSION: Fatigue is very costly to the USAF despite the relatively low incidence rate of fatigue-related mishaps. This is because larger proportions of severe mishaps were found to be fatigue-related. RPA and ground maintenance operators might be especially susceptible to fatigue and potentially lack adequate fatigue mitigation support and training tailored to their unique operational environment, suggesting a need to improve upon fatigue mitigation tools and strategies.Gaines AR, Morris MB, Gunzelmann G. Fatigue-related aviation mishaps. Aerosp Med Hum Perform. 2020; 91(5):440447.

BACKGROUND: Spatial disorientation, poor situational awareness, and aerodynamic stalls are often causal/contributory to general aviation accidents. To mitigate against the occurrence of these mishaps Cirrus Aircraft has, since 2002, introduced advanced avionics into their piston airplanes (Cirrus SR20/22). These airplanes are also certificated to more rigorous crashworthiness tests than legacy aircraft approved prior to these standards being codified. Herein, using for comparison two legacy aircraft fleets manufactured prior to 2002, we determined whether a reduced mishap rate for all accidents or relating to the aforementioned causes/contributing factors and/or diminished injury severity for survivable accidents were evident for Cirrus SR20/22 airplanes.METHODS: Accidents (2008–2017) involving Cirrus SR20/22 airplanes (manufactured 2002 or later) and Beechcraft 35/36 (Bonanza) and Mooney 20 models (both manufactured no later than 2001) (14CFR Part 91 rules) were identified (N = 136, 259, 164, respectively) from the NTSB database. Statistical analyses used Poisson distribution/contingency tables/ t- and Mann-Whitney tests.RESULTS: For each year within the 2013–2017 timespan the Cirrus SR20/22 all-accident rate was diminished 39–75% relative to both legacy fleets. Temporally, the fraction of fatal Cirrus SR20/22 accidents, initially higher, declined 50% achieving a lower, or comparable, proportion to the two legacy airframes. Fatal accident rates involving spatial disorientation/situational awareness/aerodynamic stalls were > 80% lower for Cirrus SR20/22 airplanes. For survivable mishaps, Cirrus SR20/22 aircraft showed a lower proportion (0.13 compared with 0.20–0.35) of fatal/serious injuries.CONCLUSION: Toward improving legacy aircraft safety, owners should be encouraged to upgrade their avionics for mitigating against the occurrence of such human-factor-related mishaps and install airbags to minimize injury severity.Boyd DD, Howell C. Accident rates, causes, and occupant injury involving high-performance general aviation aircraft. Aerosp Med Hum Perform. 2020; 91(5):387–393.

Objective The aim is to provide a high-level synthesis of human factors research that contributed to the development of detect-and-avoid display requirements for unmanned aircraft systems (UAS). Background The integration of UAS into the U.S. National Airspace System is a priority under the Federal Aviation Administration’s Modernization and Reform Act. For UAS to have routine access to the National Airspace System, UAS must have detect-and-avoid capabilities. One human factors challenge is to determine how to display information effectively to remote pilots for performing detect-and-avoid tasks. Method A high-level review of research informing the display requirements for UAS detect-and-avoid is provided. In addition, description of the contributions of human factors researchers in the writing of the requirements is highlighted. Results Findings from human-in-the-loop simulations are used to illustrate how evidence-based guidelines and requirements were established for the display of information to assist pilots in performing detect-and-avoid. Implications for human factors are discussed. Conclusion Human factors researchers and engineers made many contributions to generate the data used to justify the detect-and-avoid display requirements. Human factors researchers must continue to be involved in the development of standards to ensure that requirements are evidence-based and take into account human operator performance and human factors principles and guidelines. Application The research presented in this paper is relevant to the design of UAS, the writing of standards and requirements, and the work in human–systems integration.

BACKGROUND: General Aviation (GA) pilots who encounter hazardous weather inflight have a high probability of incurring fatal accidents. To mitigate this problem, previous research investigated pilot decision making and the effects of new technology. Limited investigations have examined usability and interpretability of observation and forecast weather products available to pilots. Therefore, this study examined the interpretability of weather observation and forecast reports that GA pilots use for preflight weather planning and the impact of pilot certification level on the interpretability of these displays.METHOD: There were 204 GA pilots (Mean age = 22.50 yr; Median flight hours = 131.0) who completed a 90-item multiple choice Aviation Weather Product Test. The questions portrayed static weather displays available on the NOAA/National Weather Service Aviation Weather Center website. The questions were designed to have high cognitive fidelity in comparison with preflight weather planning tasks.RESULTS: The results revealed overall low mean interpretability scores (Mean percent correct= 59.29%, SD = 16.01%). The scores for observation products and product attributes were lower for student pilots than experienced pilots. Forecast product scores for student and private pilots did not differ, however, student pilot scores were significantly lower than instrument rated private and commercial pilots.DISCUSSION: The low interpretability scores indicate that GA pilots misinterpret weather information provided by most weather observation and forecast products. Possible contributing factors to the low product interpretation scores include poor usability and a lack of training. Future research should measure the usability of weather displays designed for pilots.Blickensderfer BL, Guinn TA, Lanicci JM, Ortiz Y, King JM, Thomas RL, DeFilippis N. Interpretability of aviation weather information displays for general aviation. Aerosp Med Hum Perform. 2020; 91(4):318–325.

BACKGROUND: Planning, whether preflight or in-flight, is a cause of accident that is presumably almost entirely preventable. Planning skills on the part of the pilot should assist in avoiding dangerous situations with regards to light conditions, weather, fuel shortage, and/or improper weight and balance. Fuel planning is noted as especially unnecessary, as fuel planning is not considered a complex skill but part of proper flight preparation and in-flight planning.METHODS: A total of 196 accident reports from 2015 until 2020 were extracted from the NTSB online database in which the probable cause included either preflight or in-flight planning as a cause attributed to the pilot. Of those accidents, the majority (N = 131, 67%) were attributed to fuel planning and were further analyzed.RESULTS: Fuel-planning related accidents were significantly less often fatal compared to all planning-related accidents and all fuel-related accidents. The majority of fuel planning accidents resulted in fuel exhaustion. Additionally, the cause attributed to the accidents was frequently the skill-based error of “fuel planning (pilot)” and the crew resource management issue of “fuel-fluid level”. Specific information regarding the pilot’s fuel plan was only available in 52 (40%) of the accident reports.CONCLUSIONS: The frequency of fuel-related planning accidents suggests that this aspect of pilotage is underestimated and requires more attention both in training and in standard operating procedures. In particular, more detailed information regarding the pilot’s fuel plan is necessary in order to determine which step in the process most frequently results in an accident.Kalagher H. Fuel planning errors in general aviation from 2015 to 2020. Aerosp Med Hum Perform. 2021; 92(12):970–974.

INTRODUCTION: Exposure to high G force is a known safety hazard in military aviation as well as civilian aerobatic flight. Tolerance to high G forces has been well studied in military pilots, but there is little research directed at civilian pilots who may have medications or medical conditions not permitted in military pilots.METHODS: In this case-control study, we identified 89 fatal high-G aerobatic accidents and 4000 fatal control accidents from 1995 through 2018 from the NTSB accident database and the FAA autopsy database. We retrieved medications and medical conditions from the FAA's pilot medical databases. Logistic regression models were used to explore the associations of drugs, medical conditions, height, and medical waivers with high-G accidents.RESULTS: Seven drugs (alprazolam, clonidine, ethanol, meclizine, phentermine, triamterene, and zolpidem) reached statistical significance in our models, but had such small case counts that we consider these findings to be uncertain, except for ethanol, which was found in seven cases. Of these, only triamterene was known to the FAA. Statistically significant medical predictors included only alcohol abuse (seven cases) and liver disease (only two cases).DISCUSSION: Our analysis found that the drug ethanol and the condition alcohol abuse are significantly associated with high-G accidents. Seven other factors were statistically significant, but should only be considered as hypothesis generating due to very low case counts. Our study does not suggest that restricting pilots with otherwise permissible medications or medical conditions from aerobatics is warranted.Mills WD, Greenhaw RM, Wang JMP. A medical review of fatal high-G U.S. aerobatic accidents. Aerosp Med Hum Perform. 2019; 90(11):959–965.

INTRODUCTION:Helicopter Emergency Medical Service (HEMS) is a mode of transportation designed to expedite the transport of a patient. Compared to other modes of emergency transport and other areas of aviation, historically HEMS has had the highest accident-related fatality rates. Analysis of these accident data has revealed factors associated with an increased likelihood of accident-based fatalities. Here we report the results of an analysis on the likelihood of a fatality based on various factors as a result of a HEMS accident, employing a Bayesian framework.METHODS:A retrospective study was conducted using data extracted from the NTSB aviation accident database from April 31, 2005, to April 26, 2018. Evidence from Baker et al. (2006) was also used as prior information spanning from January 1, 1983, to April 30, 2005.RESULTS:A Bayesian logistic regression was implemented using the prior information and current data to calculate a posterior distribution confidence interval of possible values in predicting accident fatality. The results of the model indicate that flying at night (OR 3.06; 95 C.I 2.14, 4.48; PoD 100), flying under Instrument Flight Rules (OR 7.54; 95 C.I 3.94, 14.44; PoD 100), and post-crash fires (OR 18.73; 95 C.I 10.07, 34.12; PoD 100) significantly contributed to the higher likelihood of a fatality.CONCLUSION:Our results provide a comprehensive analysis of the most influential factors associated with an increased likelihood of a fatal accident occurring. We found that over the past 35 yr these factors were consistently associated with a higher likelihood of a fatality occurring.Simonson RJ, Keebler JR, Chaparro A.A Bayesian approach on investigating helicopter emergency medical fatal accidents.Aerosp Med Hum Perform. 2021; 92(7):563569.

INTRODUCTION: Aerobatic flight operations involve a higher level of risk than standard flight operations. Aerobatics imposes considerable stresses on both the aircraft and the pilot. The purpose of this study was to analyze civilian aerobatic aircraft accidents in Australia, with particular emphasis on the underlying accident causes and survival outcomes.METHODS: The accident and incident database of the Australian Transport Safety Bureau was searched for all events involving aerobatic flight for the period 19802010.RESULTS: A total of 51 accidents involving aircraft undertaking aerobatic operations were identified, with 71 aircraft occupants. Of the accidents, 27 (52.9) were fatal, resulting in a total of 36 fatalities. There were 24 nonfatal accidents. In terms of injury outcomes, there were 4 serious and 9 minor injuries, and 22 accidents in which no injuries were recorded. Fatal accidents were mainly due to loss of control by the pilot (44.4), in-flight structural failure of the airframe (25.9), and terrain impact (25.9). G-LOC was considered a possible cause in 11.1 of fatal accidents. Nonfatal accidents were mainly due to powerplant failure (41.7) and noncatastrophic airframe damage (25). Accidents involving aerobatic maneuvering have a significantly increased risk of a fatal outcome (odds ratio 26).DISCUSSION: The results of this study highlight the risks involved in aerobatic flight. Exceeding the operational limits of the maneuver and the design limits of the aircraft are major factors contributing to a fatal aerobatic aircraft accident. Improved awareness of G physiology and better operational decision-making while undertaking aerobatic flight may help prevent further accidents.Newman DG. Factors contributing to accidents during aerobatic flight operations. Aerosp Med Hum Perform. 2021; 92(8):612618.

The aim of this paper is to reconstruct the hijacking case of an aircraft on the Mariánské Lázn#283; - Prague route in 1972 and the shooting of its pilot in command in light of new facts, mainly autopsy reports from both Germany and Czechoslovak Socialist Republic. These reports contained absolutely opposite findings, both in terms of the findings themselves and their resulting interpretations. Since it is still not yet known exactly what happened in the plane, a reconstruction was carried out in an identical aircraft in the Aviation Museum in Kunovice. During the reconstruction, all possible (including theoretical) situations that may have occurred in the aircraft were examined. It was found that this could not have been a premeditated intentional murder, but that the shot could only have occurred during a passenger skirmish, and one that must have resulted in a very rare situation at that. From a political-medical point of view however, there are still several questions that cannot be answered even with the best of intentions.