Fighter Pilots Research Articles

Fighter Pilot Syndrome: A Bow Hunter Syndrome Variant Identified With Dynamic Cerebral Angiography

Background Dynamic compression of extracranial arteries in the cervicocerebral circulation is a rare phenomenon of ischemic stroke. Methods Retrospective chart review. Results Here, we present a young fighter pilot who presented with recurrent embolic strokes of undetermined source. He endorsed flying fighter jets for 6 years, during which he was subject to high G‐force loads and extensive in‐flight head maneuvers. Extensive workup identified dynamic arterial compression of his right vertebral artery, which entered the transverse foramen at the C4 level. Dynamic cerebral angiography was used to reveal the specific vessel location and provocative maneuver leading to dynamic occlusion of his right vertebral artery. Conclusion This case highlights the utility of dynamic cerebral angiography in identifying previously unexplored causes of arteriogenic emboli formation, particularly in patients with predisposing anatomic and clinical risk factors.

Is the Pull-Down Effect Overstated? An Examination of Trust Propagation Among Fighter Pilots in a High-Fidelity Simulation

Research on trust propagation has primarily been conducted with undergraduates using low-fidelity scenarios. It is unclear if the pull-down effect (e.g., system-wide trust) occurs in more applied domains with actual operators. A sample of experienced US Air Force fighter pilots ( n = 13) engaged in six trials using a high-fidelity simulation for Collaborative Combat Aircraft (CCA). The pilots were given command of four CCAs to complete realistic targeting missions. They were asked to monitor the CCAs, report any errors, evaluate a number of potential targets, select a valid target, and select one of the CCAs to perform a strike. One of the CCAs evidenced an error in four of the six trials (17% of all observations), and if the pilots did not report the error, they were prompted to it by an experimenter playing the role of Air Battle Manager. After each trial, reliance intentions and subjective workload were assessed for each of the four CCAs. The presence of an error reduced trust and increased workload for that CCA referent only. There was no evidence of a pull-down effect, nor did the composition of the CCA group (homogenous vs. heterogenous) influence trust propagation. Implications for trust research are discussed.

Psychophysiological responses to a multimodal physiotherapy program in fighter pilots with flight-related neck pain: A pilot trial.

The physical and cognitive demands of combat flying may influence the development and persistence of flight-related neck pain (FRNP). The aim of this pilot study was to analyse the effect of a multimodal physiotherapy program which combined supervised exercise with laser-guided feedback and interferential current therapy on psychophysiological variables in fighter pilots with FRNP. Thirty-one fighter pilots were randomly assigned to two groups (Intervention Group: n = 14; Control Group: n = 17). The intervention consisted of 8 treatment sessions (twice per week) delivered over 4 weeks. The following primary outcomes were assessed: perceived pain intensity (Numeric Pain Rating Scale-NPRS) and Heart Rate Variability (HRV; time-domain, frequency-domain and non-linear variables). A number of secondary outcomes were also assessed: myoelectric activity of the upper trapezius and sternocleidomastoid, pain catastrophizing (Pain Catastrophizing Scale-PCS) and kinesiophobia (TSK-11). Statistically significant differences (p≤0.05) within and between groups were observed for all outcomes except for frequency domain and non-linear HRV variables. A significant time*group effect (one-way ANOVA) in favour of the intervention group was found for all variables (p<0.001). Effect sizes were large (d≥0.6). The use of a multimodal physiotherapy program consisting of supervised exercise with laser-guided feedback and interferential current appears to show clinical benefit in fighter pilots with FRNP. ClinicalTrials.gov: NCT05541848.

Sugar-Sweetened Beverage Consumption and Implications for Aviation Preflight Indoctrination Students.

BACKGROUND: Research has shown that excessive sugar-sweetened beverage (SSB) consumption has been associated with being overweight and obese and the military is not immune to this disorder. Being overweight/obese is one of the characteristics that comprise a condition known as Metabolic Syndrome (MetS). The global prevalence of MetS in the military population is estimated to be 21%, which varies depending upon the armed forces type and specialty. The purpose of this study is to identify the subset of the aviation population that may develop MetS at some future point and to put forth suggestions on how best to combat this and maintain operational readiness.METHODS: Data were collected by means of an anonymous 44-item survey administered and completed by 302 students enrolled in Aviation Preflight Indoctrination at the Naval Air Station Base in Pensacola, FL.RESULTS: Results indicated that 70.86% of students reported SSB consumption, with 95.3% preferring caffeinated to decaffeinated SSBs. 11.7% of personnel met the "at risk criteria" of consuming SSBs four times per week or greater (four 12-oz cans or more per week).DISCUSSION: Findings from this study indicate that approximately 11.7% of aviation pilots or flight officers are "at risk" of developing MetS. Given that it takes up to 4 yr to train a new fighter pilot, this could become a significant readiness issue on par with the impact seen with pilots leaving the services through natural attrition.Sather TE. Sugar-sweetened beverage consumption and implications for aviation preflight indoctrination students. Aerosp Med Hum Perform. 2024; 95(1):25-28.

История Гражданской войны в России через призму public history. Сухановский А. Ф. Штык решает. War Diary. Фронтовой дневник. Архангельск: СК-Россия: СК-Столица. 2020. 485 с.

In modern conditions, it seems that the study of the Civil War and the dissemination of knowledge about it is possible using the potential of public history. The attention of professional historians is attracted by a book prepared by the organizer of the search movement A. Sukhanovsky, who has been leading a group of enthusiasts studying the places of battles with the interventionists in the North of Russia for twenty years. The interventionist forces here numbered more than 40 thousand people in 1919. The participants of the search group carried out excavations on the territory of the Arkhangelsk region for 20 years, participated in the creation of the military historical park "Yuryevsky Frontier", which is the only well-preserved complex of fortifications of the Civil War period in Russia. It is now part of the military historical park "Railway Front" in the battlefields of 1918-1919 on the Arkhangelsk-Moscow railway. The title of the book is connected with the decision of the American soldiers of the 339th regiment, who included the motto of the Russian infantry of the Northern Rifle Regiments "Shtyck reshaet" (in Russian) in their coat of arms. It was a manifestation of Americans' respect for the heroism and dedication of political opponents. The book consists of an introduction, six blocks of information ("Soldier's gray hair", "Romance of company "A", "Catching up with the wind", "Combat Patrol", "Russian scars", "Extraordinary adventures of the British in Northern Russia"), divided into 32 parts, which the author called ‘blockhouses’. The author translated and published the memoirs of foreign participants of the events in his book. Among them are the memoirs of Corporal of company "G" 339 of the American regiment J. H. Turnman, fighter pilot K. van der Spye, commander of infantry company "M" J. Moore, J. R. Singleton-Gates. The study presents a translation of a fragment of the book by D. York "The romance of Company A 339th Infantry ANREF". The author presented and interpreted the material historical sources discovered during the survey work. The revealed materials make it possible to recreate the life of combatants and civilians in extreme conditions of armed conflict. A. Sukhanovsky describes the experience of reconstruction of military events in the Russian North in 1918-1919. The review points out the shortcomings of the work in question: the refusal to prepare a bibliographic list, the lack of a description of the history of the photographs given in the publication, taken by Signal Corps USA employees.

Rheoencephalography: A non-invasive method for neuromonitoring.

In neurocritical care, the gold standard method is intracranial pressure (ICP) monitoring for the patient's lifesaving. Since it is an invasive method, it is desirable to use an alternative, noninvasive technique. The computerized real-time invasive cerebral blood flow (CBF) autoregulation (AR) monitoring calculates the status of CBF AR, called the pressure reactivity index (PRx). Studies documented that the electrical impedance of the head (Rheoencephalography - REG) can detect the status of CBF AR (REGx) and ICP noninvasively. We aimed to test REG to reflect ICP and CBF AR. For nineteen healthy subjects we recorded bipolar bifrontal and bitemporal REG derivations and arm bioimpedance pulses with a 200 Hz sampling rate. The challenges were a 30-second breath-holding and head-down-tilt (HDT - Trendelenburg) position. Data were stored and processed offline. REG pulse wave morphology and REGx were calculated. The most relevant finding was the significant morphological change of the REG pulse waveform (2nd peak increase) during the HDT position. Breath-holding caused REG amplitude increase, but it was not significant. REGx in male and female group averages have similar trends during HDT by indicating the active status of CBF AR. The morphological change of REG pulse wave during HDT position was identical to ICP waveform change during increased ICP, reflecting decreased intracranial compliance. A correlation study between ICP and REG was initiated in neurocritical care patients. The noninvasive REG monitoring would also be useful in space research as well as in military medicine during the transport of wounded service members as well as for fighter pilots to indicate the loss of CBF and consciousness.

WHICH IS THE MOST RELIABLE MARKER TO ASSESS THE EFFECTS OF COSMIC RADIATION EXPOSURE IN POLISH MILITARY PILOTS: A MINI REVIEW OF LITERATURE

Abstract: Military pilots, similar to civilian pilots and crew members, receive larger doses of ionizing radiation than the general population. Exposition to small doses of ionizing radiation at prolonged durations has been related to slightly higher incidence of certain cancers. However, fighter jet pilots from time to time flight their airplanes at even higher altitudes, thus exposing themselves to higher doses of more energetic radiation than their civilian counterparts. In this mini review we discuss the procedures involved in controlling the radiation exposure to military and civilian pilots, as well as air crews. Markers of radiation exposure are discussed. Based on available literature, it appears that the biological markers of radiation, i.e., markers related to the actual changes in tissues, account also for individual differences in anatomy and physiology, as well as individual differences in sensitivity and lifestyle, as jet engine emissions, electromagnetic fields from cockpit instruments, ultraviolet radiation, carcadian rhythm disruption, etc. This mini review concludes that biological dosimetry methods, i.e., counting frequencies of chromosomal aberrations, appears to be most suitable to evaluate exposure to ionizing radiation in military pilots.

Hierarchical Reinforcement Learning for Air Combat at DARPA's AlphaDogfight Trials

Autonomous control in high-dimensional, continuous state spaces is a persistent and important challenge in the fields of robotics and artificial intelligence. Because of high risk and complexity, the adoption of AI for autonomous combat systems has been a long-standing difficulty. In order to address these issues, DARPA's AlphaDogfight Trials (ADT) program sought to vet the feasibility of and increase trust in AI for autonomously piloting an F-16 in simulated air-to-air combat. Our submission to ADT solves the high-dimensional, continuous control problem using a novel hierarchical deep reinforcement learning approach consisting of a high-level policy selector and a set of separately trained low-level policies specialized for excelling in specific regions of the state space. Both levels of the hierarchy are trained using off-policy, maximum entropy methods with expert knowledge integrated through reward shaping. Our approach outperformed human expert pilots and achieved a second-place rank in the ADT championship event. <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Impact Statement–</i> Significant performance milestones in reinforcement learning have been achieved in recent years, with autonomous agents demonstrating super-human performance across a wide variety of tasks. Before these algorithms can be extensively deployed in real-world defense applications, a greater level of trust must first be achieved. ADT was an important step towards developing the trust necessary to operationalize these algorithms, by demonstrating their effectiveness on a foundational yet relevant problem in a high-fidelity simulation environment. Developed for the program, our hierarchical reinforcement learning agent was designed alongside of and competed against active fighter pilots, and ultimately defeated a graduate of the United States Air Force's F-16 Weapons Instructor Course in match play.

My synthetic wingman must understand me: modelling intent for future manned–unmanned teaming

With advances in artificial intelligence, machine learning, and cognitive modelling, unmanned aircraft are expected to act as human-like wingmen in the near future. For fluent and effective manned–unmanned teaming, synthetic wingmen must be able to account for and adapt to their partners’ intent with little or no communication. To enable such abilities, it becomes crucial to identify the requirements that makes intent explainable to synthetic wingmen, necessitating approaches to describe and analyse intent from a human-centric perspective. To address this issue, this paper reports on findings from using Work Domain Analysis to design and analyse models of situated intent with six levels of cognitive control (frames, effects, values, generic, implementations, and physical). Through a literature review and seven subject matter expert interviews, a synthesized model was designed to represent fighter pilots’ intent in a manned–unmanned teaming scenario. Using the synthesized model as the context, a transfer of control and a link loss situation were further described and analysed. Experiences show that Work Domain Analysis can provide a practical and applicable means to model situated intent, particularly since designed models can be re-utilised to model intent in similar situations. Furthermore, the model analyses show the importance of accounting for fighter pilots’ adopted frames since small variations of the framing of the situations can propagate throughout the model resulting in conflicting or inconsistent intent. The paper concludes that synthetic wingmen must be able to reason about all six levels of cognitive control, requiring a more holistic approach to make intent explainable.

Inflammatory Modifications in Paranasal Sinuses and Ostiomeatal Complex Anatomical Variations in Jet Aircraft Pilots: A Computed Tomography Study.

Introduction Jet aircraft pilots are exposed to huge pressure variation during flight, which affect physiological functions as systems, such as the respiratory system. Objectives The objective of the present investigation was to evaluate inflammatory changes of paranasal sinuses of jet aircraft pilots before and after a jet aircraft training program, using multislice computed tomography (CT), in comparison with a group of nonairborne individuals with the same age, sex, and physical health conditions. A second objective of the present study was to assess the association between the ostiomeatal complex obstruction and its anatomical variations. Methods The study group consisted of 15 jet aircraft pilots participating in the training program. The control group consisted of 41 nonairborne young adults. The 15 fighter pilots were evaluated before initiating the training program and after their final approval for the presence of inflammatory paranasal sinus disease. The ostiomeatal complex anatomical variations and obstructions were analyzed in pilots after the training program. Results Jet aircraft pilots presented higher incidence of mucosal thickening in maxillary sinus and anterior ethmoid cells than controls. Prominent ethmoidal bulla showed significant association with obstruction of the osteomeatal complex. Conclusions Jet aircraft pilots present increased inflammatory disease when compared with nonairborne individuals. The presence of a prominent ethmoidal bulla is associated with ostiomeatal complex obstruction.

Effect of high-gravity acceleration forces and anti-gravity maneuver for cardiac function in fighter pilots

Abstract Background Environmental factors such as hypoxia and gravity affect to the human cardiovascular system. It’s more important for fighter pilots who are exposed to high altitude, harsh gravitational (G) acceleration, and perform anti-G maneuvers similar to the Valsalva maneuver. Experimental studies examining how high gravitational acceleration and anti-gravity maneuver affect cardiac function are rare. Purpose This study aimed to investigate the effect on cardiac function of fighter pilots exposed to high G acceleration forces. Methods From July 2019 to June 2020, fighter pilots underwent regular health check-up and echocardiogram. Data from trainees who did not experience a flight were used for control group. Echocardiographic data included left ventricle (LV) chamber size, systolic function, and diastolic function, as well as right ventricle systolic pressure (RVSP), inferior vena cava (IVC) collapsibility, and the tricuspid annular plane systolic excursion (TAPSE) to evaluate right heart function. The multiple linear regression analysis for TAPSE was performed with total flight time as an independent continuous variable in fighter pilots. Results We enrolled 29 fighter pilots (41±10years-old; male, 100%; mean flight time 1821±1186 hours) and 16 trainees (36±17years-old; male, 100%). There was no significant difference in age, blood pressure, LVEF, RVSP, and the IVC collapsibility between fight pilots and trainees. In multivariate linear regression analysis for fighter pilots, TAPSE was affected by total flight time with positive correlation. Conclusion The experience of fighter pilots exposed to the high G acceleration forces and anti-G maneuver might be associated with right heart function change, but not associated with the prominent cardiac structural changes.

Factors of significance for the ability of fighter pilots to visually indicate the magnitude of roll tilt during simulated turns in a centrifuge.

During coordinated flight and centrifugation, pilots show interindividual variability in perceived roll tilt. The study explored how this variability is related to perceptual and cognitive functions. Twelve pilots underwent three 6-min centrifugations on two occasions (G levels: 1.1G, 1.8G, and 2.5G; gondola tilts: 25°, 56°, and 66°). The subjective visual horizontal (SVH) was measured with an adjustable luminous line and the pilots gave estimates of experienced G level. Afterward, they were interrogated regarding the relationship between G level and roll tilt and adjusted the line to numerically mentioned angles. Generally, the roll tilt during centrifugation was underestimated, and there was a large interindividual variability. Both knowledge on the relationship between G level and bank angle, and ability to adjust the line according to given angles contributed to the prediction of SVH in a multiple regression model. However, in most cases, SVH was substantial smaller than predictions based on specific abilities.

Prevalence and risk factors of occupational neck pain in Chinese male fighter pilots: a cross-sectional study based on questionnaire and cervical sagittal alignment.

Neck pain (NP) is a common musculoskeletal disorder among fighter pilots and has become a rising concern due to its detrimental impact on military combat effectiveness. The occurrence of NP is influenced by a variety of factors, but less attention has been paid to the association of NP with demographic, occupational, and cervical sagittal characteristics in this group. This study aimed to investigate the prevalence and risk factors of NP in Chinese male fighter pilots using a questionnaire and cervical sagittal measurements. Demographic and flight-related data, as well as musculoskeletal pain information, were gathered from Chinese male fighter pilots via a self-report questionnaire. Cervical sagittal parameters were measured and subtypes were classified using standardized lateral cervical radiographs. Differences in various factors between the case and control groups were analyzed using t-tests or chi-square tests. Binary logistic regressions were conducted to explore potential risk factors contributing to NP. Predictors were presented as crude odds ratios (CORs) and adjusted odds ratios (AORs), along with their respective 95% confidence intervals (CIs). A total of 185 male fighter pilots were included in this cross-sectional study. Among them, 96 (51.9%) reported experiencing NP within the previous 12 months. The multivariate regression analysis revealed that continuous flight training (AOR: 4.695, 95% CI: 2.226-9.901, p < 0.001), shoulder pain (AOR: 11.891, 95% CI: 4.671-30.268, p < 0.001), and low back pain (AOR: 3.452, 95% CI: 1.600-7.446, p = 0.002) were significantly associated with NP. The high 12-month prevalence of NP among Chinese male fighter pilots confirms the existence of this growing problem. Continuous flight training, shoulder pain, and low back pain have significant negative effects on pilots' neck health. Effective strategies are necessary to establish appropriate training schedules to reduce NP, and a more holistic perspective on musculoskeletal protection is needed. Given that spinal integrated balance and compensatory mechanisms may maintain individuals in a subclinical state, predicting the incidence of NP in fighter pilots based solely on sagittal characteristics in the cervical region may be inadequate.

Neuro-Cardiovascular Responses to Sympathetic Stimulation in Fighter Pilots.

INTRODUCTION: The chronic effects of regular exposure to high acceleration levels (G-force) on the neuro-cardiovascular system are unclear. We compared the mean arterial pressure (MAP) and cardiac autonomic modulation between nonpilots (NP) vs. military fighter (FP) and transport (TP) pilots. Additionally, we correlated the cardiac autonomic indices with the cardiorespiratory fitness and flight experience of FP.METHODS: A total of 21 FP, 8 TP, and 20 NP performed a tilt test (TT), during which beat-to-beat blood pressure and heart rate were recorded.RESULTS: No difference was detected between groups for changes in MAP and heart rate variability indices during the TT. However, the analysis of areas under the curves showed a greater increase in MAP in FP vs. TP and NP. Conversely, there was a greater decrease in indices reflecting vagal modulation in TP vs. FP and NP (rMSSD, pNN50, and SDNN), and a greater increase in heart rate and sympathovagal balance in TP vs. other groups (LF/HF). The maximal oxygen uptake was strongly correlated with the vagal reserve in FP (r = -0.74). Moreover, the total flying hours of FP were positively correlated with resting HFnu (r = 0.47) and inversely correlated with resting LFnu (r = -0.55) and LF/HF (r = -0.46).CONCLUSION: FP had a higher pressor response to TT than TP and NP. Vagal withdrawal and sympathovagal increase induced by TT in FP were similar vs. NP and attenuated vs. TP. Greater cardiorespiratory fitness and accumulated flying hours in FP seemed to favor lower sympathetic and greater vagal modulation at rest.dos Santos Rangel MV, de Sá GB, Farinatti P, Borges JP. Neuro-cardiovascular responses to sympathetic stimulation in fighter pilots. Aerosp Med Hum Perform. 2023; 94(10):761-769.

The Effects of Varying Degrees of Information on Teamwork a Study on Fighter Pilots

A team of fighter pilots in a distributed environment with limited access to information rely on technology to pursue teamwork. In order to design systems that support distributed teamwork, it is, therefore, necessary to understand how access to information affects the team members. Certain factors, such as mutual performance monitoring, shared mental models, adaptability, and backup behavior are considered essential for effective teamwork. We investigate these factors in this work, focusing on how visually communicated information affects fighter pilots’ perception of these factors. For that, a questionnaire including the teamwork factors in relation to certain defined scenarios that contain various levels of information was distributed to fighter pilots. We show that the studied factors are affected by the level of information available to the pilots. Especially, mutual performance monitoring increases with the degree of available information.

Operational aeromedical training during COVID-19 pandemic

The Institute of Aerospace Medicine Indian Air Force regularly conducts Operational Training in Aerospace Medicine (OPTRAM) courses for the fighter, transport, and helicopter pilots, and navigators. The OPTRAM is directly linked with the pilots flying training and operational readiness as well. The COVID-19 pandemic halted training activities globally. Online training was not an option as it is a simulator-based training module. There was an urgent need to continue the course without compromising the safety of our pilots. A standard operating procedure (SOP) was prepared to conduct the course in a safe and timely manner within the available resources of the Institute. This paper intends to bring out the various rationale and considerations that go into formulating an SOP like this which has a huge implication on the operational preparedness of the organization and the operational readiness of our pilots.

Relationship between Total Flight Hours and Individual Factors with Low Back Pain in Indonesian Military Helicopter Pilots

Introduction: Helicopter pilots are potentially at risk of Low Back Pain (LBP) and are twice as likely as fighter pilots to experience it. Helicopter pilots’ LBP is caused by a combination of risk factors: engine and rotor vibration, ergonomic risks due to cockpit design, static seating position due to operations, and individual factors. These factors are incorporated into cumulative aviation risk exposure, which can be measured by total flight hours. The prevalence of LBP in Caucasians is high, at 50.5%-92%. However, there has not been any research on Indonesian military helicopter pilots who have a different posture from Caucasians.Objective: To determine the prevalence of LBP, to analyze the relationship between total flight hours and individual factors (age, height, BMI, exercise habits, and smoking habits) with LBP in Indonesian military helicopter pilots.Methods: The study was conducted at the Indonesian Army and Indonesian Air Force with total sampling method as many as 124 people. An explanation was carried out followed by filling in the consent to become a research subject, filling in personal data, anamnesis, Numeric Rating Scale (NRS), physical examination, neurological examination, and total flight hour data.Results: There were 124 subjects, consisting of 37.9% pilots and 62.1% copilots, 87.9% of pilots operate large helicopters, have average total flight hours of 450 hours, age of 30 years, the height of 172.66 cm, low intensity exercise habits of 61.3%, and smokers as much as 45.2%. A total of 57 people (46%) experienced LBP. Statistical results showed that total flight hours had an association with LBP (p = 0.035) where each 1 unit increase in total flight hours had a 1.02 times greater chance of LBP.Conclusion: The prevalence of LBP is 46% and there is an association between total flying hours and LBP in Indonesian military helicopter pilots.

Dissociating two aspects of human 3D spatial perception by studying fighter pilots

Human perception of 3D space has been investigated extensively, but there are conflicting reports regarding its distortions. A possible solution to these discrepancies is that 3D perception is in fact comprised of two different processes—perception of traveled space, and perception of surrounding space. Here we tested these two aspects on the same subjects, for the first time. To differentiate these two aspects and investigate whether they emerge from different processes, we asked whether these two aspects are affected differently by the individual's experience of 3D locomotion. Using an immersive high-grade flight-simulator with realistic virtual-reality, we compared these two aspects of 3D perception in fighter pilots—individuals highly experienced in 3D locomotion—and in control subjects. We found that the two aspects of 3D perception were affected differently by 3D locomotion experience: the perception of 3D traveled space was plastic and experience-dependent, differing dramatically between pilots and controls, while the perception of surrounding space was rigid and unaffected by experience. This dissociation suggests that these two aspects of 3D spatial perception emerge from two distinct processes.

Flight safety risk assessment of self-medication among fighter pilots: a cross-sectional study.

Fighter pilots are a specific population in which any adverse drug reaction can unpredictably interact with aeronautical constraints and thus compromise flight safety. This issue has not been evaluated in risk assessments. To provide a semi-quantitative assessment of the risk to flight safety of self-medication in fighter pilots. A cross-sectional survey that aimed at identifying the determinants of self-medication in fighter pilots was conducted. All medications consumed within 8h preceding a flight were listed. A modified Failure Mode and Effects Analysis was performed, and any adverse drug reaction reported in the French marketing authorization document of a drug was considered a failure mode. The frequency of occurrence and severity were evaluated using specific scales to assign each to three risk criticality categories: acceptable, tolerable, and unacceptable. Between March and November 2020, the responses of 170 fighter pilots were analyzed, for an overall return rate of approximately 34%. Among them, 78 reported 140 self-medication events within 8h preceding a flight. Thirty-nine drug trade names (48 different international nonproprietary names) were listed, from which 694 potential adverse drug reactions were identified. The risk criticality was considered unacceptable, tolerable and acceptable for 37, 325 and 332 adverse drug reactions, respectively. Thus, the risk criticality was considered unacceptable, tolerable and acceptable for 17, 17, and 5 drugs, respectively. This analysis suggests that the overall risk to flight safety of the current practice of self-medication in fighter pilots may be considered at least tolerable, or even unacceptable.

A Prospective Cohort Study on Risk Factors for Cervico-Thoracic Pain in Military Aircrew.

BACKGROUND: Military aircrew frequently report cervico-thoracic pain and injury. The relationship between risk factors and future pain episodes is, however, uncertain. The aim of this study was to identify risk factors for cervico-thoracic pain and to determine the 1-yr cumulative incidence of such pain.METHODS: A total of 47 Swedish aircrew (fighter and helicopter pilots and rear crew) without pain in the cervico-thoracic region were surveyed about work-related and personal factors and pain prevalence using the Musculoskeletal Screening Protocol questionnaire. They also performed tests of movement control, active cervical range of motion, and isometric neck muscle strength and endurance. Aircrew were followed for a year with questionnaires. Logistic regressions were used to identify potential risk factors for future cervico-thoracic pain.RESULTS: Previous cervico-thoracic pain (OR: 22.39, CI: 1.79-280.63), lower cervical flexion range of motion (OR: 0.78, CI: 0.64-0.96), and lower neck flexor muscular endurance (OR: 0.91, CI: 0.83-0.99) were identified as risk factors for reporting cervico-thoracic pain. At follow-up, 23.4% (CI: 13.6-37.2) had reported cervico-thoracic pain during the 12-mo follow-up period.DISCUSSION: The Musculoskeletal Screening Protocol can identify risk factors for cervico-thoracic pain. The link between cervico-thoracic pain and previous pain, as well as lower performance of neck range of motion and muscular endurance, highlights the need for primary and secondary preventive action. The findings from this study can facilitate the development of such pain prevention programs for aircrew.Tegern M, Aasa U, Larsson H. A prospective cohort study on risk factors for cervico-thoracic pain in military aircrew. Aerosp Med Hum Perform. 2023; 94(7):500-507.