Longitudinal Changes in the Body Mass Index of British Army Pilots.

INTRODUCTION: Aircraft are manufactured according to design parameters that must account for the size and physical characteristics of the pilot. While cockpit dimensions, seats, restraints, and related components do not change substantially over the airframe lifecycle, it is conceivable that the occupant may, even if initially well-suited. This investigation focused on longitudinal body mass index (BMI) changes within a cohort of British Army Air Corps pilots.METHODS: The study was a retrospective examination of electronic medical record data to assess longitudinal change within a representative cohort of Army pilots. Voluntary subjects were assigned unique subject numbers matched with individual electronic medical record data. Subject's age, service length, height, weight, and BMI were extracted from routine historical aviation medical exams.RESULTS: Among 106 British Army Air Corps pilots, the mean age was 35.3 yr (SD = 7.4) with average length of service as a pilot of 9.0 yr (SD = 5.2). Within the observed cohort, the mean change in individual weight over time was an increase of 4.6 kg (SD = 7.3). Height remained relatively stable with a mean increase of 0.6 cm (SD = 1.9). Given the increase in weight, BMI was noted to increase longitudinally with a mean of 1.3 kg · m-2 (SD = 2.4).DISCUSSION: British Army pilots experience increases in BMI over time much like the general population. Results of this study serve to inform future policy related to the body composition of aviation applicants, the retention of previously qualified pilots, and the safety concerns of crashworthiness design specifications.Porter WD, Wilde GD, Jeffery NP, Walters PL, Eke AJ, Bushby AJR, Adams MS, Gaydos SJ. Longitudinal changes in the body mass index of British Army pilots. Aerosp Med Hum Perform. 2024; 95(2):118-122.

Spatial Disorientation Scenarios for the AW159 Helicopter Within a Synthetic Training Environment.

BACKGROUND: Spatial disorientation (SD) remains a stubborn and formidable challenge among rotary wing (RW) aircrews, particularly during times of high workload and deceptive visual cues. With tri-Service agreement, British RW Forces employ a layered training approach that now includes simulator-based immersive scenarios.METHODS: Ten bespoke RW SD training scenarios were developed for the AW159 Wildcat helicopter simulator by a multidisciplinary team. Scenarios were embedded within advanced training packages that were not solely focused on SD. A voluntary, anonymous survey instrument was distributed post-SD sortie to assess hazard awareness, training effectiveness, role and mission relevance, and perceived ability to respond to future SD threat. A corresponding assessment from the simulator instructor was used for independent determination if the crew became disoriented during the training.RESULTS: Over a 6-mo training cycle, 69 surveys were completed. Seven-point Likert-scale assessments yielded elevated median scores (6.0, respectively) across all four categories, suggesting favorable aircrew perceptions of training objective success. Elevated scoring of previous SD training received suggests good penetrance among the RW community surveyed. Of all sorties flown, the majority of aircrew (68%) became disoriented at some point during the sortie.DISCUSSION: This report provides limited evidence in support of bespoke SD training scenarios within a synthetic training environment. The merits include flexible ability to address root causes, provision of an interactive and immersive environment, and compatibility with extant tactics and mission configurations. SD simulator-based training can serve as an important component of a layered, multimodal approach.Bushby AJR, Gaydos SJ. Spatial disorientation scenarios for the AW159 helicopter within a synthetic training environment. Aerosp Med Hum Perform. 2023; 94(5):377-383.

Asthma and Rotary-Wing Military Aircrew Selection.

BACKGROUND: From a population-based perspective, reports in the peer-reviewed medical literature suggest an increase in the overall prevalence of asthma in recent decades. Applicants for military aviation training with a current or past history of asthma are generally excluded in the United Kingdom.METHODS: In order to assess the impact of the prevalence of asthma on the available pool of military service candidates, the authors collected data on annual live births between 1916 and 2016 as well as peer-reviewed publications that provided insight into asthma prevalence trends within the United Kingdom across the last century (covering birth-year population cohorts ranging from 1924 to 1995). Regression techniques were used to estimate the prevalence of individuals who could reasonably expect to be found unfit for military aviation service due to asthma-like conditions within the birth-year cohorts between 2001 and 2016.RESULTS: Between 1916 and 2016, the number of live births in the United Kingdom has averaged approximately 802,000 per year. The reported prevalence of asthma, based on the assimilated data points, ranged from 2.3 cases per 1000 individuals among the 1924 birth-year cohort, to 29.8 cases per 1000 individuals among the 1990 birth-year cohort.DISCUSSION: Based on the data and analysis presented above, asthma continues to constitute a significant public health issue in the United Kingdom. Military services must base risk mitigation decisions on accurate and precise diagnostic categorizations, and prudently balance the benefits of allowing affected individuals to participate in military service with the potential for mission degradation or compromise.Porter WD, Powell-Dunford N, Wilde GD, Bushby AJR. Asthma and rotary-wing military aircrew selection. Aerosp Med Hum Perform. 2019; 90(7):606-612.

UK Military Rotary-Wing Accidents: 2000-2015.

BACKGROUND: Analysis of mishap data is an obvious measure of performance for those who wish to improve flight safety and affect aviation capability development within military forces. METHODS: This study examined rotary-wing accident information held by UK Ministry of Defence authorities for the 16-yr (inclusive) period from January 2000 through December 2015 in order to ascertain incidence patterns. Serious accidents of military registered aircraft operated by Joint Helicopter Command, the Royal Navy, the Search and Rescue Force, and the Defence Helicopter Flying School were included in the analysis. A secondary intent of the review was to examine the influence of broad-based organizational changes on the overall incidence of rotary-wing accidents across the U.K. Ministry of Defence that grew out of the report published by Charles Haddon-Cave, QC, following his wide-ranging investigation into the catastrophic crash of Royal Air Force Nimrod XV230 that occurred during a routine mission in Southern Afghanistan. RESULTS: During the 16-yr period between January 2000 and December 2015, 53 rotary-wing accidents occurred. The overall accident rate was 2.32 accident events per 100,000 flight hours. Spatial disorientation accidents remain a prevalent risk in this study, being acknowledged in 43% of accidents. Prior to the Haddon-Cave report, the accident rate was 2.81 events per 100,000 flight hours. Following the report, the accident rate decreased to 1.24 events per 100,000 flight hours. DISCUSSION: The decrease in the accident rate between 2000 and 2015 shares a temporal association with the adoption and operationalization of the recommendations found in Haddon-Cave's report.Bushby AJR, Powell-Dunford N, Porter WD. UK military rotary-wing accidents: 2000-2015. Aerosp Med Hum Perform. 2018; 89(9):842-847.

The Aeromedical Management of Allergic Rhinitis.

INTRODUCTION: Allergic rhinitis is a prevalent condition warranting special aeromedical consideration due to its potential for acute and painful manifestations involving the middle ear or paranasal sinuses during rapid barometric pressure changes. Although second generation antihistamines and intranasal steroids are safe and effective treatments for this common condition, aeromedical management varies. METHODS: An aeromedical policy review of 14 public access civil and military data repositories was undertaken. Policy within a convenience sample of nine countries (Australia, Canada, Croatia, France, New Zealand, Norway, Sweden, United Kingdom, and United States) was further ascertained through subject matter expert consultation. A convenience sample of recent primary care review articles and ENT guidelines were reviewed in order to substantiate the evidence basis for aeromedical practices. RESULTS: Policies range from disqualification of flight applicants with any history of allergic rhinitis to the authorization of short-term, select undeclared medication use for the management of mild symptoms, with military authorities applying a more conservative approach. A range of intranasal and oral therapies are approved and requirements for waiver vary across most authorities. DISCUSSION: Variation in practices must be considered when managing flight crews as part of military coalition peacetime and combat operations, as well as for international civil aviation missions conducted in support of natural disaster relief, rescue, and other stability efforts. Standardization of approved therapies for allergic rhinitis could be a useful starting point for the harmonization of aeromedical global policies in the future. Beneficial national specific policy updates may be undertaken on the basis of international experience.Powell-Dunford N, Reese C, Bushby A, Munkeby BH, Coste S, Pezer VL, Rosenkvist L. The aeromedical management of allergic rhinitis. Aerosp Med Hum Perform. 2018; 89(5):453-463.

Management of Sea Sickness in Susceptible Flight Crews.

INTRODUCTION: Sea sickness may greatly impact the readiness of Service personnel deployed aboard naval vessels. Medications used in the treatment of sea sickness may have adverse effects, limiting their use as flight crew. Although the prevalence of sea sickness in flight crews remains unclear, individual susceptibility and high sea states are established risk factors. Literature review can guide optimized management strategies for this population. MATERIALS AND METHODS: The first author conducted a PubMed search using the terms "sea sickness" "flight crew" "scopolamine," "hyoscine," and "cinnarizine," identifying 15 articles of 350 matches, which addressed potential impact to flight performance. Analysis also included two historic reports about motion sickness maintained within the U.K. Army Aviation Centre's aeromedical archives in Middle Wallop, Hampshire. Both authors reviewed aeromedical policy for the International Civil Aviation Organization, U.K. Civil Aviation Authority, U.S. Federal Aviation Authority, the National Aeronautics Space Administration, U.S. Army, U.S. Navy, and U.S. Air Force. RESULTS: Scopolamine, also known as hyoscine, has fewer operationally relevant side effects than cinnarizine or first-generation antihistamines. Although no aeromedical authorities endorse the unsupervised use of scopolamine, many will consider authorizing its temporary use following an initial assessment on the ground. Evidence supports the concomitant use of stimulant medication for augmenting antinausea effects and countering the potential sedative effects of scopolamine. CONCLUSIONS: Scopolamine should be considered as a first-line medication for flight crews at risk of sea sickness but such use must be guided by the appropriate aeromedical authority, ideally in conjunction with a ground trial to evaluate individual response. The limited evidence to support concurrent use of stimulants must be weighed against the challenges of maintaining accountability of controlled substances in the operational environment.

Spatial Disorientation Training in the Rotor Wing Flight Simulator.

BACKGROUND: This study is intended to identify efficacy, evolving applications, best practices, and challenges of spatial disorientation (SD) training in flight simulators for rotor wing pilots. METHODS: Queries of a UK Ministry of Defense research database and Pub Med were undertaken using the search terms 'spatial disorientation,' 'rotor wing,' and 'flight simulator.' Efficacy, evolving applications, best practices, and challenges of SD simulation for rotor wing pilots were also ascertained through discussion with subject matter experts and industrial partners. Expert opinions were solicited at the aeromedical physiologist, aeromedical psychologist, instructor pilot, aeromedical examiner, and corporate executive levels. RESULTS: Peer review literature search yielded 129 articles, with 5 relevant to the use of flight simulators for the spatial disorientation training of rotor wing pilots. Efficacy of such training was measured subjectively and objectively. A preponderance of anecdotal reports endorse the benefits of rotor wing simulator SD training, with a small trial substantiating performance improvement. Advancing technologies enable novel training applications. The mobile nature of flight students and concurrent anticollision technologies can make long-range assessment of SD training efficacy challenging. Costs of advanced technologies could limit the extent to which the most advanced simulators can be employed across the rotor wing community. DISCUSSION: Evidence suggests the excellent training value of rotor wing simulators for SD training. Objective data from further research, particularly with regards to evolving technologies, may justify further usage of advanced simulator platforms for SD training and research. Powell-Dunford N, Bushby A, Leland RA. Spatial disorientation training in the rotor wing flight simulator. Aerosp Med Hum Perform. 2016; 87(10):890-893.

Fatigue assessment: subjective peer-to-peer fatigue scoring.

INTRODUCTION: Fatigue is a complex entity with contributing factors that may include insufficient sleep, circadian dysrhythmia, high workload, extended duty periods, clinical sleep pathology, psychosocial aspects, environmental factors, and many others. It can contribute to significant performance deficits and crucial safety lapses. Despite maximal implementation of accepted techniques and best practices for mitigation strategies, the deployed military rotary-wing (RW) environment must still contend with substantial fatigue-related issues among aircrew. METHODS: We introduce a novel subjective peer-to-peer fatigue rating system recently demonstrated in a deployed military RW environment. Each pilot provides an anonymous weekly fatigue rating for every other pilot in the unit exclusive of self. Median and variance of the peer ratings for each pilot are recorded by the safety officer and tracked over time. RESULTS: The program allows for a multidimensional external perspective on a pilot's fatigue state, relative function, and degree of coping. Scoring is predicated upon the recognition of a significant deviation from a peer's baseline that may include social and interpersonal interactions or the observation of deficits in duty performance. DISCUSSION: The research basis for scientific validity and reliability regarding current peer fatigue scoring systems is exiguous. This novel approach may be of merit, particularly among military aircrew in a deployed-type setting with sustained high workload, operational stress, and limited time for supernumerary tasks. An anonymous subjective peer-to-peer fatigue scoring system is worthy of further scientific investigation, particularly warranting studies of reliability and validity.

Ten years of spatial disorientation in U.S. Army rotary-wing operations.

INTRODUCTION: Spatial disorientation (SD) has plagued aviation since its inception, contributing to numerous lost lives, destroyed or damaged aircraft, and a reduction in operational mission effectiveness. Military rotary-wing (RW) operations are not immune. The U.S. Army has retired many "legacy aircraft" represented in older studies, developed new training regimens for aircrew, continued to expand its night vision capabilities, and has prosecuted combat operations for some 10 yr utilizing new tactics, techniques, and procedures. For these reasons, it is important and relevant to re-engage the subject of SD among accidents within the Army's RW community. METHODS: The U.S. Army's Combat Readiness/Safety Center database at Fort Rucker, AL, was queried for the previous 10 yr RW mishaps from fiscal year (FY) 2002 through FY 2011 (FY11 current through 01 July). Accidents identified as having SD as a contributing factor were selected. RESULTS: From FY 2002 to FY 2011, there were 100 Class A through C rotary-wing flight mishaps involving SD. This represents 11% of all Class A through C rotary-wing flight accidents for this period. Of the 100 SD-related accidents, 22% involved fatalities, and 39% involved fatalities and/or injuries. The total number of RW SD-related accidents with fatalities represents 31% of the total helicopter accidents with fatalities for the 10-yr period. DISCUSSION: This review of accident data confirms that SD remains a substantial issue for the Army aviation community and reinforces the importance and relevance of SD awareness, research, education, and training in RW operations.