Wallace Scott A
OEM Residency Program, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Mil Med. 2024 May 18;189(5-6):1123-1128. doi: 10.1093/milmed/usad154.
Aviation personnel are expensive to train and challenging for the services to retain because of lucrative opportunities in the civilian aviation sector and a desire among pilots for agency. The military services' retention efforts have typically utilized a combination of high continuation pays and longer service commitments of up to 10 years following initial training. One area that the services have overlooked in their attempts to retain senior aviators is quantifying and reducing medical disqualifications. Much as aging aircraft require increasing maintenance to retain full operational capability, so may pilots and other aircrew members.
This article reports on a prospectively collected cross-sectional research study evaluating the medical status of senior aviation personnel who reported being considered or selected for command. The study was deemed exempt from human subjects research by the Institutional Review Board and a waiver of Health Insurance Portability and Accountability Act was granted. The study, which collected data at the Pentagon Flight Medical Clinic over 1 year, used a chart review of routine medical encounters and flight physicals to collect descriptive data. The goals of the study were to establish the prevalence of medically disqualifying conditions, assess the association between disqualifying conditions and age, and generate hypotheses for further research. Logistic regression of waiver need was performed for variables including prior waivers, waiver count, service, platform, age, and gender. ANOVA of readiness percentages vs. DoD targets were assessed between the services individually and in aggregate.
The study demonstrated medical readiness rates among command-eligible senior aviators ranging from 74% for the Air Force to 40% for the Army with the Navy and Marine Corps in the middle. The sample was insufficiently powered to demonstrate differences in readiness between the services; however, the population as a whole was significantly below the DoD's readiness target of >90% (P = .000).
None of the services met the DoD minimum readiness target of 90%. Markedly higher readiness was observed in the Air Force, the only service with a medical screening incorporated into its command selection process, but this difference was not statistically significant. Waivers increased with age and musculoskeletal concerns were common. A larger prospective cohort study should be considered to further elucidate and confirm the findings of this study. If further research confirms these findings, consideration should be made of screening command applicants for medical readiness.
航空人员的培训成本高昂,且由于民用航空领域的丰厚机会以及飞行员对自主选择权的渴望,各军种留住他们颇具挑战。军种的留用举措通常包括高额的续役津贴以及初始训练后长达10年的更长服役期承诺。然而,在试图留住高级飞行员的过程中,各军种忽略了一个方面,即量化并减少医疗不合格情况。正如老旧飞机需要增加维护以保持全面作战能力一样,飞行员和其他机组人员亦是如此。
本文报告了一项前瞻性收集的横断面研究,该研究评估了报告被考虑或选定担任指挥职务的高级航空人员的医疗状况。该研究被机构审查委员会认定为豁免人体受试者研究,并获得了《健康保险流通与责任法案》的豁免。该研究在五角大楼飞行医疗诊所进行了为期1年的数据收集,通过对常规医疗会诊和飞行体检记录进行审查来收集描述性数据。该研究的目标是确定医疗不合格状况的患病率,评估不合格状况与年龄之间的关联,并为进一步研究提出假设。对包括既往豁免情况、豁免次数、军种、平台、年龄和性别等变量进行了豁免需求的逻辑回归分析。分别对各军种以及总体进行了准备率与国防部目标对比的方差分析。
该研究表明,符合指挥条件的高级飞行员的医疗准备率,空军为74%,陆军为40%,海军和海军陆战队处于中间水平。样本量不足以证明各军种之间在准备率上的差异;然而,总体人群显著低于国防部>90%的准备目标(P = 0.000)。
没有一个军种达到国防部90%的最低准备目标。在空军中观察到明显更高的准备率,空军是唯一在指挥选拔过程中纳入医疗筛查的军种,但这种差异无统计学意义。豁免情况随年龄增加,肌肉骨骼问题较为常见。应考虑开展一项更大规模的前瞻性队列研究,以进一步阐明并证实本研究的结果。如果进一步的研究证实了这些发现,则应考虑对指挥岗位申请者进行医疗准备情况的筛查。