Clemente Fuentes Roselyn W., Chung Connie
USUHS
Uniformed Services University
With over 16,100,000 flights annually carrying 1 billion travelers in the 29 million square miles monitored by the Federal Aviation Administration’s (FAA) Air Traffic Organization (ATO) and the recent changes governing unmanned aerial vehicles (UAV) - otherwise known as drones – increased use in shared air space highlights the importance of military, civil, and international regulations that ensure the health and safety of those both keeping the aircraft in flight as well as the passengers. Each U.S. military branch has its aviator health regulations: the Air Force’s Medical Standards Directory and Waiver Guide, the Army’s Regulation 40-501, and the Navy’s Aeromedical Reference and Waiver Guide. The FAA uses the Guide for Aviation Medical Examiners, and the International Civil Aviation Organization (ICAO) utilizes the Manual of Civil Aviation Medicine. Human factors are cited as the most common cause of aviation accidents, with 79% of fatal accidents in 2006 in the U.S. attributed to human error. This fact has been recognized by the ICAO, which has set the annual rate of pilot incapacitation at 1% or less as the standard. To mitigate concerns about human error, the concept of a pilot checklist was introduced in 1937 to standardize the process and reduce the margin of error. Military aviation also has a long history of checklist use, instituted in 1952 after the Korean War, to reduce the high loss rate of aircraft and pilots. Additionally, following the U.S. National Transportation Safety Board's investigation of a 1978 crash, the crew resource management (CRM) technique was developed, using training procedures that emphasized communication, decision-making, and leadership to improve overall aviation safety. The ICAO began using James Reason’s “Swiss cheese model of accident causation” in 1993 to understand the role of human error better. The "Swiss cheese model" and CRM added additional layers of defense to aviation mishap prevention. Crew resource management is now considered to be the global standard. The medical professional’s role in reducing errors secondary to human factors includes thorough screening for disqualifying medical and mental conditions, which also includes a detailed medication reconciliation to avoid pharmacological side effects, substance misuse screening, and counseling on major human performance threats seen in aviation (ie, fatigue mitigation with sleep hygiene techniques, mental and physical countermeasures to stress, etc).
美国联邦航空管理局（FAA）空中交通组织（ATO）监测的2900万平方英里区域内，每年有超过1610万架航班搭载10亿乘客。最近，无人驾驶飞行器（UAV）——也就是无人机——在共享空域的使用增加，这凸显了军事、民用和国际法规的重要性，这些法规确保了飞行中的飞机和乘客的健康与安全。美国每个军事分支都有其飞行员健康规定；空军的《医疗标准目录与豁免指南》、陆军的《条例40 - 501》以及海军的《航空医学参考与豁免指南》。FAA使用《航空医学检查员指南》，国际民用航空组织（ICAO）则采用《民用航空医学手册》。人为因素被认为是航空事故中最常见的因素，2006年美国致命事故中有79%归因于人为失误。这一事实已得到ICAO的认可，ICAO设定了每年飞行员失能率在1%或更低的目标作为标准。为了减轻对人为失误的担忧，1937年提出了飞行员检查表的概念，以规范流程并减少误差范围。军事航空使用检查表的历史也很长，始于1952年朝鲜战争结束后，以遏制飞机和飞行员的高损失率。此外，1978年美国国家运输安全委员会对一起坠机事故进行调查后，机组资源管理（CRM）技术应运而生，它利用培训程序强调沟通、决策和领导能力的重要性，以提高整体航空安全。ICAO于1993年开始使用詹姆斯·瑞森的“事故因果关系瑞士奶酪模型”理论，以便更好地理解人为失误的作用。“瑞士奶酪模型”和CRM为航空事故预防增加了更多层防御。机组资源管理现在被视为全球标准。医疗专业人员在减少人为因素导致的失误方面的作用包括对不合格的医疗和精神状况进行全面筛查，这还包括详细的用药核对以避免药物副作用、药物滥用筛查，以及就航空中常见的主要人为表现威胁提供咨询（例如，通过睡眠卫生技术缓解疲劳、应对压力的心理和身体对策等）。
