By MIKE MARTIN
On average, aviation-related injuries result in 1,013 U.S. hospital admissions each year — and 753 deaths, claims a first-ever study published in the journal “Aviation, Space, and Environmental Medicine.”
Most hospital patients (32%) were injured in civilian, noncommercial aircraft, the study found. Lower limb fractures were the most common injury (27%); followed by head injury (11%); open wounds and upper extremity fractures (10%); and internal injuries (9%). Head injuries caused 38% of fatalities, while burns, seen in only 2.5% of patients, caused 13% of deaths.
“Our findings provide valuable information that was not previously available,” said the study’s lead author, Susan Baker, Ph.D., a professor at the Johns Hopkins University (JHU) Center for Injury Research and Policy in Baltimore, Md. (pictured).
The National Transportation Safety Board (NTSB) and FAA have not systematically recorded injury and hospitalization data for civil aviation crash survivors. But such data is valuable because it “can be used to recognize needed improvements in aircraft design and safety features,” explained Baker, a private pilot and aircraft accident researcher.
Pointing to the effectiveness of similar military studies, “this civilian aircraft study is highly valuable and its recommendations are right on target,” said Don Maciejewski, an aviation law attorney with Zisser, Robison, Brown, Nowlis, Maciejewski & Cabrey in Jacksonville, Fla.
“The U.S. military has led the aviation industry in documenting how impact and crash forces cause injury to aircraft occupants,” he said.
Without such surveys, civilian aviators draw on military experience, said Maciejewski, a pilot and retired U.S. Army aviation safety officer and certified aircraft accident investigator. “Dr. Baker and her colleagues have shown that civilian surveillance of injuries in civil aviation crashes is plainly inadequate,” he concluded.
Without a comprehensive civil aviation injury database, Baker and her team turned to the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, which contains information about some 20% of annual hospital admissions in the United States.
In the six-year period from 2000 to 2005, hospitals admitted 6,080 patients with aviation-related injuries. From there, the researchers extracted the other data, including two findings that stand out for study co-author Guohua Li, M.D., Dr.PH, the Finster Chair in Anesthesiology and Epidemiology at the Columbia University College of Physicians and Surgeons, whose doctoral thesis examined commuter and air taxi crashes. At roughly 20%, the fatality rate in civil aviation accidents “is about 200 times as high as in car crashes,” Li explained. “Secondly, over 80% of fatal injuries in aviation crashes occur at the scene or before victims reach the hospital.”
Preventive measures that mitigate injury severity — from better restraints to crash-resistant fuel systems — are therefore all important, the researchers say. The study, Baker explained, can help aircraft designers zero in on which measures may work best.
“The high numbers of lower limb fractures we reported suggest modifications to structures likely to contact feet and legs when a crash occurs,” she said, noting a device that alleviates impact force under the floor, below the rudder and brake pedal for instance, could reduce leg injuries.
Aircraft controls located away from the front of the pilot, and upper torso constraints may likewise reduce head and chest injuries. While Airbus and some military aircraft do have side-mounted controls, “many general aviation aircraft do not have upper torso restraints or a detachable shoulder belt,” study co-author and Columbia University anesthesiology and epidemiology researcher Joanne Brady explains in the paper. “The study’s points regarding occupant injuries from impact into aircraft controls are exactly what we experienced during the development and certification of the seatbelt airbag during testing on general aviation aircraft,” said Joe Smith, a vice president at Phoenix-based aircraft safety manufacturer AmSafe. Given the relevance of their findings to injury prevention, study co-author Dennis Shanahan, M.D., a pilot and JHU aviation expert, “strongly recommends that a group such as the NTSB or FAA establish an injury-reporting program modeled after the military or the National Highway Traffic Safety Administration.”
Despite the lack of official monitoring, aviation injuries have decreased “remarkably” over the years, Li explained.
“In many ways, aviation serves as a living example of safety improvement through technology, human factor engineering, risk management, and intervention,” he said.