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According to 40 yr of data, the fatality rate for a helicopter crash into water is approximately 25%. Does warning time and the final position of the helicopter in the water influence the survival rate?The National Transportation Safety Board (NTSB) database was queried to identify helicopter crashes into water between 1981 and 2011 in the Gulf of Mexico and Hawaii. Fatality rate, amount of warning time prior to the crash, and final position of the helicopter were identified.There were 133 helicopters that crashed into water with 456 crew and passengers. Of these, 119 occupants (26%) did not survive; of those who did survive, 38% were injured. Twelve died after making a successful escape from the helicopter. Crashes with15 s warning had a fatality rate of 22%, compared to 12% for 16-60 s warning and 5% for1 min. However, more than half of fatalities (57%) came from crashes for which the warning time could not be determined.Lack of warning time and how to survive in the water after the crash should be a topic for study in all marine survival/aircraft ditching courses. Investigators should be trained to provide estimates of warning time when investigating helicopter crashes into water.

Background: A key strategy to reduce unintended adolescent pregnancies is to expand access to long-acting reversible contraceptive (LARC) methods, including intrauterine devices and subdermal contraceptive implants. LARC services can be provided to adolescents in school-based health and other primary care settings, yet limited knowledge and negative attitudes about LARC methods may influence adolescents’ utilization of these methods. This study aimed to evaluate correlates of knowledge and acceptability of LARC methods among adolescent women at a school-based health center (SBHC). Methods: In this cross-sectional study, female patients receiving care at 2 SBHCs in Seattle, Washington completed an electronic survey about sexual and reproductive health. Primary outcomes were (1) LARC knowledge as measured by percentage correct of 10 true-false questions and (2) LARC acceptability as measured by participants reporting either liking the idea of having an intrauterine device (IUD)/subdermal implant or currently using one. Results: A total of 102 students diverse in race/ethnicity and socioeconomic backgrounds completed the survey (mean age 16.2 years, range 14.4-19.1 years). Approximately half reported a lifetime history of vaginal sex. Greater LARC knowledge was associated with white race (regression coefficient [coef] = 26.8; 95% CI 13.3-40.4; P < .001), history of vaginal intercourse (coef = 29.9; 95% CI 17.1-42.7; P < .001), and current/prior LARC use (coef = 22.8; 95% CI 6.5-40.0; P = .007). Older age was associated with lower IUD acceptability (odds ratio = 0.53, 95% CI 0.30-0.94; P = .029) while history of intercourse was associated with greater implant acceptability (odds ratio 5.66, 95% CI 1.46-22.0; P = .012). Discussion: Adolescent women in this SBHC setting had variable knowledge and acceptability of LARC. A history of vaginal intercourse was the strongest predictor of LARC acceptability. Our findings suggest a need for LARC counseling and education strategies, particularly for young women from diverse cultural backgrounds and those with less sexual experience.

INTRODUCTION: The hazards inherent in flight operations in the Gulf of Mexico prompted investigation of the number and circumstances of crashes related to oil and gas operations in the region. METHODS: The National Transportation Safety Board (NTSB) database was queried for helicopter crashes during 1983 through 2009 related to Gulf of Mexico oil or gas production. The crashes were identified based on word searches confirmed by a narrative statement indicating that the flight was related to oil or gas operations. RESULTS: During 1983-2009, the NTSB recorded a total of 178 helicopter crashes related to oil and gas operations in the Gulf of Mexico, with an average of 6.6 crashes per year (5.6 annually during 1983-1999 vs. 8.2 during 2000-2009). The crashes resulted in a total of 139 fatalities, including 41 pilots. Mechanical failure was the most common precipitating factor, accounting for 68 crashes (38%). Bad weather led to 29 crashes (16%), in which 40% of the 139 deaths occurred. Pilot error was cited by the NTSB in 83 crashes (47%). After crashes or emergency landings on water, 15 helicopters sank when flotation devices were not activated automatically or by pilots. DISCUSSION: Mechanical failure, non-activation of flotation, and pilot error are major problems to be addressed if crashes and deaths in this lethal environment are to be reduced. Language: en

Crashes of sightseeing helicopter flights in Hawaii and the resulting tourist deaths prompted the FAA to issue regulations in 1994 specific to air tours in Hawaii. Research was undertaken to examine the effect of the 1994 Rule and to describe the circumstances of such crashes.From National Transportation Safety Board data, 59 crashes of helicopter air tour flights in Hawaii during 1981-2008 were identified; crash investigation reports were read and coded. Crashes in 1995-2008 were compared with those in 1981-1994.The 1994 Rule was followed by a 47% decrease in the crash rate, from 3.4 to 1.8/100,000 flight hours. The number of crashes into the ocean decreased from eight before the Rule to one afterwards. VFR-IMC crashes increased from 5 to 32% of crashes. There were 46 tourists and 9 pilots who died in 16 fatal crashes. Aircraft malfunctions, primarily due to poor maintenance, precipitated 34 (58%) of the crashes and persisted throughout the 28-yr period. Pilot errors were apparent in 23 crashes (39%). Flight from visual to instrument conditions occurred in two cases before the Rule and seven cases after. Terrain unsuitable for landing was cited in 37 crashes (63%).Decreases occurred in the overall number and rate of crashes and in ocean crash landings. The increase in VFR-IMC crashes may be related to the requirement that tour helicopters fly at least 1500 ft. above terrain. Attention is still needed to maintenance, pilot training, and restricting flights to operating areas and conditions that enable safe emergency landings.

Throughout the period 1977–1994, scheduled commuter flights had far higher crash rates than major airlines (3,8,9). The safety record of commuter aircraft has long been of concern (11). In the early 1990s, Baker and colleagues described the circumstances of commuter crashes during 1983–88 and suggested that commuter flights should be subject to some of the stricter safety standards that protect passengers flying on Part 121 airlines (1,2). In 1994, the National Transportation Safety Board (NTSB) published the findings of a study of commuter airline safety and recommended that the FAA revise its regulations so that the provisions of Part 121 would be applied to all scheduled service in aircraft with 20 or more passenger seats and, wherever feasible, to aircraft with 10–19 seats (12). The NTSB based its recommendations on findings regarding Part 135 practices, including the following: flight time and crew rest regulations had resulted in many commuter pilots flying when fatigued; the short periods of time between flights increased the risk that pilots would make critical mistakes in planning for the next flight; many airlines failed to provide adequate training in crew resource management; and newly trained pilots might not be adequately trained. For decades, scheduled flights of aircraft with > 30 passenger seats have been subject to Part 121 regulations. In 1995 the FAA published new requirements for commuter operations (7) in response to the high crash rates of Part 135 flights and the NTSB recommendations (12), as well as to several highly publicized fatal crashes of commuters with 10–30 seats in 1993–94 (10). The new rule stated that after March 20, 1997, all scheduled flights of aircraft with 10–30 passenger seats would be required to operate under Part 121 rules (7) (aircraft with 10–30 passenger seats are primarily turboprops, unlike the larger turbojet aircraft that have always been subject to Part 121 rules). A decade of data on flight operations and crashes since 1997 is now available, but has not been used to evaluate the effect of the rule change. A major reason for failure to examine the trend is that the FAA and NTSB categorize and publish the numbers of scheduled flight departures and crashes not by aircraft size but by whether they are governed by Part 135 or Part 121 rules. Prior to 1997, published data on departures and crashes of Part 135 flights combined aircraft having 10–30 passenger seats with aircraft having < 10 passenger seats; after 1997, crashes and departures of aircraft with 10–30 seats could not be separated from crashes and departures of aircraft with more than 30 passenger seats because they were combined in Part 121 data. Whether there was any change in crash rates of aircraft with 10–30 seats—the operations that were the focus of the rule change—could not be determined from the published data. This paper determines and reports crash rates of three categories of scheduled aircraft flights—those with 30 passenger seats—before and after the rule change. Our primary objective was to identify any apparent effect of the regulatory change on aircraft with 10–30 seats, since these flights were specifically targeted by the FAA rule change. Additional objectives were to determine trends in crash rates of all scheduled flights, categorized by size—i.e., the number of passenger seats.