Cardiac Autonomic Activity in Commercial Aircrew During an Actual Flight Duty Period

Organizational Risk Factors for Aircrew Health: A Systematic Review of Observational Studies

Addressing the field of health and safety at work, the primary objective of the present systematic review was to analyze the organizational risk factors for aircrew health according to professional category (flight attendants and pilots/co-pilots) and their consequences. The secondary objective was to identify the countries in which studies were carried out, focusing on the quality of content of the publications. The Medline/Pubmed, Cochrane, Web of Science, and Scopus databases were searched for eligible studies according to PRISMA statements. The risk of bias and the methodological quality of the studies were assessed using the Newcastle-Ottawa scale and Loney tools. Of the 3230 abstracts of articles screened, 36 studies met the inclusion criteria. Most of the research conducted on risk factors for the work organization of aircrew was carried out in the United States and the European Union and had moderate or low-quality methodology and evidence. However, the findings are homogeneous and allow the most prevalent organizational risk factors for the health of aircrew to be determined, namely, high work demand, long hours, and night work. Consequently, the most pervasive health problems were sleep disturbances, mental health disorders, musculoskeletal disorders, and fatigue. Thus, the regulation of the aircrew profession must prioritize measures that minimize these risk factors to promote better health and sleep for these professionals and, consequently, to provide excellent safety for workers and passengers.

Cardiovascular Concerns from COVID-19 in Pilots

BACKGROUND: Cardiovascular disease, now complicated by the COVID-19 pandemic, remains a leading cause of death and risk for sudden incapacitation for pilots during flight. The capacity for aeromedically significant cardiovascular sequelae with potentially imperceptible clinical symptoms elicits concern both during and following resolution of acute COVID-19 in pilots.OBJECTIVE: We summarize the current state of knowledge regarding COVID-19 cardiovascular implications as applied to the aviation environment to better understand their significance toward flight safety and application toward a focused cardiovascular screening protocol following recovery from infection.METHODS: A narrative review of the cardiovascular implications of COVID-19 infection was performed using the PubMed literature search engine and existing organizational guidelines. In addition, to established medical aviation benchmarks, surrogate populations examined included high performance athletes (as a correlate for high G-forces), and scuba divers (as an environmental work analog). Conditions of primary concern included myocardial injury, proarrhythmic substrates, risk of sudden death, myopericarditis, pulse orthostatic lability in response to vigorous activity, cardiovagal dysfunction, and thromboembolic disease.LITERATURE REVIEW: Cardiovascular screening guideline recommendations post-infection recovery are suggested based on profile stratification: airperson flight class, tactical military, and aerobatic pilots. This provides an approach to inform aeromedical decision making.CONCLUSION: Aviation medical examiners should remain cognizant of the clinically apparent and occult manifestations of cardiovascular dysfunction associated with COVID-19 infection when applying return-to-work screening guidelines. This will ensure high flight safety standards are maintained and sudden incapacitation risk mitigated during and following the ongoing pandemic.Elkhatib W, Herrigel D, Harrison M, Flipse T, Speicher L. Cardiovascular concerns from COVID-19 in pilots. Aerosp Med Hum Perform. 2022; 93(12):855-865.

Extended Work Shifts Increase Subjective Pain Complaints Among Cabin Crewmembers, but Not Among Airline Pilots or Healthcare Workers: A Repeated-Measures Study

OBJECTIVE

To determine whether four consecutive extended work shifts are associated with an increased risk of subjective pain complaints, sleep duration, and sleep disturbances.

METHODS

Forty-three healthcare workers, 41 cabin crewmembers, and 18 airline pilots working 4 consecutive extended workdays reported subjective pain complaints and sleep after the 1st and 4th workday.

RESULTS

The risk of headache (odds ratio [OR] 21.4, 95% confidence interval [CI] 1.85 to 246.5) and pain in the hands, arms, or wrists (OR 3.78, 95% CI 1.84 to 7.76) increased after workday 4 versus workday 1 in cabin crewmembers. Sleep duration was longer (0.6 to 1.1 hours), and sleep disturbances fewer, the night before the fourth extended workday, compared with before the first workday, in all occupations.

CONCLUSIONS

We found no general support for an association between extended work shifts and subjective pain, whereas sleep duration was improved, and sleep disturbances reduced after 4 consecutive extended workdays.

Short and Long Haul Pilots Rosters, Stress, Sleep Problems, Fatigue, Mental Health, and Well-Being

OBJECTIVE: This research was conducted to compare short haul (SH) and long haul (LH) pilots regarding sleep restrictions and fatigue risks on flight duty, stress, sleep problems, fatigue severity, well-being, and mental health. METHOD: There were 406 international SH and LH pilots who completed the cross-sectional online survey. Pilots sleep restrictions and fatigue-risk profiles (e.g., time pressure, late arrivals, minimum rest), sleep problems, fatigue severity, well-being, and symptoms of depression, anxiety, and common mental disorders (CMD) were measured and compared for SH and LH pilots. RESULTS: Although SH and LH pilots were scheduled for only 51.465.4% of the legally allowed duty and flight hours, 44.8% of SH pilots reported severe fatigue (FSS 4 to 4.9), and an additional 31.7% high fatigue (FSS 5), compared with 34.7% and 37.3% LH pilots. Considerable sleep problems in 8 nights/mo were reported by 24.6% SH vs. 23.5% LH pilots. Positive depression screenings were reported by 18.1% SH and 19.3% LH pilots. Positive anxiety screenings were reported by 9.6% SH and 5% LH pilots. Of all investigated pilots, 20% reported significant symptoms of depression or anxiety, and 7.23% had positive depression and anxiety screenings. LH pilots reported significantly better well-being than SH pilots. CONCLUSIONS: Our results show that even far less duty and flight hours than legally allowed according to flight time limitations lead to high levels of fatigue, sleep problems, and significant mental health issues among pilots. SH pilots were even more affected than LH pilots. Pilots fatigue should be considered an immediate threat to aviation safety and pilots fitness to fly by promoting fatigue and burnout. Venus M, grosse Holtforth M. Short and long haul pilots rosters, stress, sleep problems, fatigue, mental health, and well-being. Aerosp Med Hum Perform. 2021; 92(10):786797.

Fatigue in Aviation: Safety Risks, Preventive Strategies and Pharmacological Interventions

Fatigue poses an important safety risk to civil and military aviation. In addition to decreasing performance in-flight (chronic) fatigue has negative long-term health effects. Possible causes of fatigue include sleep loss, extended time awake, circadian phase irregularities and work load. Despite regulations limiting flight time and enabling optimal rostering, fatigue cannot be prevented completely. Especially in military operations, where limits may be extended due to operational necessities, it is impossible to rely solely on regulations to prevent fatigue. Fatigue management, consisting of preventive strategies and operational countermeasures, such as pre-flight naps and pharmaceuticals that either promote adequate sleep (hypnotics or chronobiotics) or enhance performance (stimulants), may be required to mitigate fatigue in challenging (military) aviation operations. This review describes the pathophysiology, epidemiology and effects of fatigue and its impact on aviation, as well as several aspects of fatigue management and recommendations for future research in this field.