NIOSH Aviation Safety Publications

Various NIOSH Aviation Safety Publications.
Various NIOSH Aviation Safety Publications. Photo Credit - NIOSH

The following is a chronological list of NIOSH-published and NIOSH-authored publications on aviation safety. You will also find relevant documents from external organizations in this list as well. Most documents are available for download in PDF format. You can also search for NIOSH aviation safety publications in the NIOSHTIC-2 Database.

NIOSH and the Mid-Air Collision Avoidance Working Group Prevent Aircraft Collisions in Alaska
DHHS (NIOSH) Publication No. 2015–120 (January 2015)
After several mid-air collisions in Alaska, a working group was formed to address communications confusion in the busy airspace north of Anchorage. Recommendations for Common Traffic Advisory Frequency areas were provided and adopted by the Federal Aviation Administration. This impact sheet describes how partners worked together to make changes and disseminate the information to pilots.

NIOSH Partners with Organizations and Industry to Reduce Aviation Fatalities in Alaska
DHHS (NIOSH) Publication No. 2013–137 (March 2013)
The number of fatal crashes among air taxi and commuter operations in Alaska decreased 53% between 2000-2009 and the prior decade. This impact sheet describes how multiple safety partners coordinated their efforts to achieve this success.

Survey and Analysis of Air Transportation Safety Among Air Carrier Operators and Pilots in Alaska
DHHS (NIOSH) Publication No. 2007–102 (November 2006)
This document describes a comprehensive survey of air taxi and commuter operators and pilots in Alaska in which company and pilot demographics, flight practices, and attitudes about safety were examined. It provides information about current practices and how industry views potential safety measures, which is critical to designing effective prevention strategies.

Surveillance and Prevention of Occupational Injuries in Alaska: A Decade of Progress, 1990-1999
DHHS (NIOSH) Publication No. 2002–115 (May 2002)
A Decade of Progress provides a good overview of the dangerous conditions that many workers in Alaska face in the commercial fishing and aviation industries. The book contains a chapter on commercial aviation that describes the safety problems commercial pilots in Alaska encounter, common situations associated with commercial aircraft crashes in the State, and other risk factors that contribute to the high fatality rate for Alaska commercial aviators.

(for a complete list, please refer to NIOSHTIC-2 search results on Alaska Aviation)

Research gaps and needs for preventing worker fatigue in the transportation and utilities industries.
Sieber, WKChen, GXKrueger, GPLincoln, JEMenéndez, CCO’Connor, MB. Am J Ind Med. 202265857– 866.
The transportation and utilities industries include establishments engaged in the movement of passengers and freight, or the provision of public power, water, and other services. Along with the warehousing industry, they make up the US National Occupational Research Agenda’s Transportation, Warehousing and Utilities (TWU) industry sector. In 2018 the sector composed 5% of the US workforce, with approximately 8 million workers. TWU workers experienced 19% of all fatalities among U.S. workers in 2018 and 7% of total occupational injuries and illnesses

Characterization of fatal injuries in oil and gas industry-related helicopter accidents in the Gulf of Mexico, 2004–2014.
Yeoman, K., O’Connor, M.B., Sochor, S. et al. Inj. Epidemiol. 7, 64 (2020).
Transportation events are the most common cause of offshore fatalities in the oil and gas industry, of which helicopter accidents comprise the majority. Little is known about injury distributions in civilian helicopter crashes, and knowledge of injury distributions could focus research and recommendations for enhanced injury prevention and post-crash survival. This study describes the distribution of injuries among fatalities in Gulf of Mexico oil and gas industry-related helicopter accidents, provides a detailed injury classification to identify potential areas of enhanced safety design, and describes relevant safety features for mitigation of common injuries.

Workers’ compensation injury claims of aviation industry worker injuries in Alaska, 2014–2015.
KM Moller, MB O’Connor, JR Lee, DL Lucas, JR Watson. International Journal of Circumpolar Health 79(1). (2020)
Aviation operations in Alaska often occur in remote locations and during inclement weather. Limited infrastructure and staff in some locations often requires aviation workers to perform tasks outside of their specific job descriptions. Researchers identified workers’ compensation claims as a valuable data source to characterize nonfatal injuries among Alaskan aviation workers. Keyword searches of injury claim narrative fields and industry codes were used to identify potentially aviation-related workers’ compensation claims during 2014–2015.

Persistent and emerging hazards contributing to work‐related fatalities in Alaska. DL Lucas, E Fitzgerald, S Case, M O’Connor, L Syron. American Journal of Industrial Medicine, 63:693–702. (2020)
Workers in Alaska have an elevated risk of dying on the job compared to workers in the rest of the United States. The purpose of this study was to measure and describe the trend in fatalities during the 15‐year period 2004 to 2018,and to identify lingering and emerging hazards that result in fatalities.

Using workers’ compensation claims data to describe nonfatal injuries among workers in Alaska.
DL Lucas, JR Lee, KM Moller, MB O’Connor, LN Syron, JR Watson. Safety and Health at Work, 11:165-172. (2020)
To gain a better understanding of nonfatal injuries in Alaska, underutilized data sources such as workers’ compensation claims must be analyzed. The purpose of the current study was to utilize workers’ compensation claims data to estimate the risk of nonfatal, work-related injuries among occupations in Alaska, characterize injury patterns, and prioritize future research.

Work-related nonfatal injuries in Alaska’s aviation industry, 2000–2013.
SL Case, KM Moller, NA Nix, DL Lucas, EH Snyder, & MB O’Connor. Safety Science, 104, 239–245. (2018)
Aviation is a critical component of life in Alaska, connecting communities off the road system across the state. Crash-related fatalities in the state are well understood and many intervention efforts have been aimed at reducing aircraft crashes and resulting fatalities; however, nonfatal injuries among workers who perform aviation-related duties have not been studied in Alaska. This study aimed to characterize hospitalized nonfatal injuries among these workers using data from the Alaska Trauma Registry.

Aviation-Related Wildland Firefighter Fatalities — United States, 2000–2013
Morbidity and Mortality Weekly Report: July 31, 2015 / 64(29); 793–796
Airplanes and helicopters are integral to the management and suppression of wildfires, often operating in high-risk, low-altitude environments. Among 298 wildland firefighter fatalities identified, 26.2% were aviation-related occupational fatalities. Pilots, copilots, and flight engineers represented 68% of these fatalities. The leading causes of fatal aircraft crashes were engine, structure, or component failure; pilot loss of control; failure to maintain clearance from terrain, water, or objects; and hazardous weather. To reduce fatalities from aviation-related wildland firefighting activities, stringent safety guidelines need to be followed during all phases of firefighting, including training exercises. Crew resource management techniques, which use all available resources, information, equipment, and personnel to achieve safe and efficient flight operations, can also be applied to firefighting operations.

Fatal Injuries in Offshore Oil and Gas Operations — United States, 2003–2010
Morbidity and Mortality Weekly Report: April 26, 2013 / 62(16); 301–304
During 2003–2010, the U.S. oil and gas extraction industry had a collective fatality rate seven times higher than for all U.S. workers. Researchers found that 128 fatalities in activities related to offshore oil and gas operations occurred during this period. Transportation events were the leading cause (51%); the majority of these involved aircraft (75%). To reduce fatalities in the offshore oil and gas industry, employers should ensure that the most stringent applicable transportation safety guidelines are followed. The International Association of Oil and Gas Producers has developed guidelines for aircraft operations in the oil and gas industry that exceed FAA safety regulations. According to these guidelines, pilots and passengers should complete helicopter underwater escape training and wear life jackets during flights over water. Floatation gear fitted to the helicopter should automatically inflate on impact with water and be capable of supporting the helicopter on the surface of the water. Companies should provide personal locator beacons for pilots, passengers, and life rafts. Life rafts should be externally mounted on the helicopters. Where appropriate, engine and vibration monitoring equipment should be installed to detect incipient failure.

A Multifaceted Public Health Approach to Statewide Aviation Safety
American Journal of Industrial Medicine: 2012 / 55:176–186
During the 1990’s, Alaskan pilots had one of the most hazardous occupations in the US. In 2000, a multifaceted public health initiative was launched, focusing on Alaskan air taxi and commuter operations, including risk factor identification, improved weather information, and the formation of an industry-led safety organization. This document assesses effectiveness of this initiative by comparing rates of crashes using Poisson regression, comparing trends in annual numbers of crashes, and assessing changes in the number and type of controlled flight into terrain (CFIT) events. The greatest improvements were seen in Alaska fatal air taxi and commuter crashes with a 57% decrease in rates between time periods. While the number of air taxi and commuter crashes in the rest of the US steadily declined during 1990–2009, Alaska only showed significant declines after 2000. CFIT crashes declined but remained more deadly than other crashes. This coordinated effort was successful in reducing crashes in the Alaskan air taxi and commuter industry, and might be applied to reduce occupational fatalities and injuries in other industries.

Occupational Aviation Fatalities – Alaska, 2000-2010
Morbidity and Mortality Weekly Report: July 1, 2011 / 60(25);837-840
An average of five fatal occupational aircraft crashes and eight fatalities occurred per year during 2000-2010 in Alaska. Most of these crashes were due to weather, pilots ’ loss of aircraft control and pilots’ failure to maintain clearance from terrain, water or objects. Thirty-nine percent of crashes were associated with intended departures or destinations at sites not registered with the Federal Aviation Administration, (such as gravel bars, mountain tops and lakes) which may have little information on weather and landing conditions there or en route, and may have minimal, if any safety equipment on site. Pilots need to be proficient and exercise good judgment when flying to and from such locations. Passengers should be prepared for worst case scenarios and should not push pilots to make unsafe decisions. Future safety interventions should focus on providing weather information and improving pilots’ situational awareness; proficiency in piloting skills and aeronautical decision making should be emphasized.

Safe Flights in Alaska
Northwest Public Health: Fall/Winter 2006 / Vol 23, No2, p7.
Between 1990 and 1999, 52 commercial pilots flew a working plane into either the ground or a mountainside in Alaska. Controlled flight into terrain (CFIT) is the aviation terminology for the seemingly impossible act of flying an airworthy aircraft into the ground. It is the leading cause of fatal commercial aviation accidents worldwide including 25 percent of all fatal airline accidents and 38 percent of international airline fatalities (3,631 lives lost from 1987 through 2004). In the 1990s several federal agencies came together, with financial support from Congress, to address the high rate of aviation accidents in Alaska. These agencies included the National Institute for Occupational Safety and Health (NIOSH), NOAA’s National Weather Service, the Federal Aviation Administration, and the Medallion Foundation. The collaborative approach of federal agencies, in concert with local nonprofit organizations, has had a tangible effect. Since 2000, not only has the average number of fatal occupational crashes per year decreased but also the percentage of fatal occupational accidents due to CFIT has declined by 13 percent. In 2005, there were no occupational pilot fatalities in Alaska.

Flight Safety in Alaska: Comparing Attitudes and Practices of High- and Low-Risk Air Carriers
Aviation, Space, and Environmental Medicine: 2005 / 76:52–57
This study examined the practices and attitudes of Alaska commuter and air taxi operators and their pilots as they relate to company fatal accident rates. A case-control analysis based on accident statistics was performed, grouping operators and their pilots into cases and controls, based on operator fatal accident rates, during January 1990 to June 2001. Responses from two aviation safety surveys-one of air carrier operators and one of active commercial pilots-were compared between cases and controls. The average case pilot had less career flight experience than control pilots and worked more than controls. Case operators were less likely to consider pilot fatigue a problem when scheduling flights and more likely to depend financially on timely delivery of bypass mail. Case pilots were three times as likely as controls to fly daily into unknown weather conditions. Nearly 90% of case pilots reported that they never flew when so fatigued that they wanted to decline the flight, compared with 64% of control pilots. Pilots of high-risk operators differed from those working for the other operators, both in experience and working conditions. The combination of pilot inexperience and longer work hours and workweeks may contribute to Alaska’s high aviation crash rate.

Alaska Air Carrier Operator and Pilot Safety Practices and Attitudes: A Statewide Survey
Aviation, Space, and Environmental Medicine: 2004 / 75:984–991.
Aviation crashes are a leading cause of occupational fatalities in Alaska, with Alaskan pilots having nearly 100 times the fatality rate of U.S. workers overall. A survey was designed to study pilot and company practices and attitudes in order to develop intervention strategies that would reduce aviation fatalities. Methods: Two surveys were administered: one of air carrier operators and one of active commercial pilots. Surveyed operators and pilots generally agreed that improved weather information and regional hazards training would be effective ways to prevent crashes. Operators were more in favor of operator financial incentives and better pre-employment hiring checks on pilots compared with pilots’ survey responses. The results of operator-pilot comparisons suggest that financial pressures on operators may influence their views on what measures would be effective in preventing crashes, and that Alaskan pilots underestimate their occupational fatality risk.

Factors Associated with Pilot Fatality in Work-related Aircraft Crashes, Alaska, 1990-1999
American Journal of Epidemiology: 2001 / 154:1037-1042
Work-related aircraft crashes are the leading cause of occupational fatality in Alaska, with civilian pilots having the highest fatality rate (410/100,000/year). To identify factors affecting survivability, the authors examined work-related aircraft crashes that occurred in Alaska in the 1990s, comparing crashes with pilot fatalities to crashes in which the pilot survived. Using data from National Transportation Safety Board reports, the authors carried out logistic regression analysis with several variables, including age, flight experience, use of a shoulder restraint, weather and light conditions, type of aircraft, postcrash fire, crash location, and state of residence. In the main-effects model, significant associations were found between fatality and postcrash fire, poor weather, and non-Alaska resident status. Protective effects were seen for shoulder restraint use and daylight versus darkness. The finding that state of residence was associated with survivability offers new information on pilot survivability in work-related aircraft crashes in Alaska. These results may be useful in targeting safety interventions for pilots who fly occupationally in Alaska or in similar environments.

Controlled Flight into Terrain Accidents Among Commuter and Air Taxi Operators in Alaska
Aviation, Space, and Environmental Medicine: 2000 / 71:1098-1103
Between 1990 and 1998, aviation accidents in Alaska caused 100 occupational pilot deaths (equivalent to 430/100,000 pilots/ year, approximately 86 times the overall U.S. worker fatality rate). While most accidents occurred during takeoff/landing, most fatalities resulted from Controlled Flight Into Terrain (CFIT). Using National Transportation Safety Board accident data, researchers identified CFIT from flight phase and event description fields, and calculated odds ratios for CFIT/non-CFIT accidents for visual conditions, aircraft features, and pilot experience. Between 1991 and 1998, 351 single aircraft commuter and air taxi accidents occurred in Alaska; 59 (17%) were CFIT. Of 140 total fatalities, 82 (59%) occurred in 30 CFIT accidents. There was a twelve-fold risk for death in CFIT vs. non-CFIT accidents. Accidents while flying Visual Flight Rules (VFR) into poor visibility were more likely CFIT than non-CFIT, and caused 37% of all deaths. Additionally, flights in Instrument Meteorological Conditions (IMC) were 47 times more likely to be CFIT than non-CFIT. No risk for CFIT was shown for flight hours, number of engines, passenger presence, or pilot age. All CFIT were attributed to pilot error, often for continuing VFR into poor visibility. Further research into human factors contributing to CFIT is needed.

Alaska’s Model Program for Surveillance and Prevention of Occupational Injury Deaths
Public Health Reports: 114:550-558 (1999)
This article discusses the usefulness of a collaborative approach to safety programming using Alaska’s Model Program for surveillance and prevention of occupational injury deaths. Collaborative efforts have contributed to reducing crash rates and mortality Alaska’s helicopter logging industry.

Epidemiology of work-related aviation fatalities in Alaska, 1990-94
Aviation, Space, and Environmental Medicine: 1998 / 69:1131­6
Alaska, with less than one-half of 1% of the United States workforce, accounts for 9% of all occupational aviation fatalities nationally; 30% of all occupational fatalities in Alaska are related to aviation. To understand this high mortality, researchers investigated occupational aviation crashes to identify risk factors. Occupational aviation fatalities in Alaska during 1990-1994 were examined using National Transportation Safety Board reports and merged with records from the Alaska Occupational Injury Surveillance System. There were 876 aircraft crashes; 407 (46%) were work-related. Occupational crashes were 2.2 times more likely to result in fatalities than non-occupational crashes. Risk factors identified included poor weather conditions defined as Instrument Meteorological Conditions (IMC). A crash during IMC was 5.3 times more likely to result in fatalities than crashes in other conditions. Of aircraft involved in fatal occupational incidents, 33% were not completely destroyed, allowing the potential for survivors. An estimated 30% reduction in fatalities could have occurred if current technology in occupant protection had been used.

Epidemiology and Prevention of Helicopter External Load Accidents
Journal of Safety Research: August 1998 / 29(2): 107-121
From 1980 through 1995, there were 230 helicopter external load accidents resulting in 57 fatalities and 74 serious nonfatal injuries in the United States investigated by the National Transportation Safety Board (NTSB). Helicopter external load operations, such as helicopter logging, place unique demands on the helicopters and the pilots who fly them. A descriptive analysis of NTSB reports indicates that mechanical failure, pilot error, and maintenance errors were cited as the most common probable causes of the accidents. Recent experience in Alaska has shown that by adhering to existing regulations and manufacturer recommendations, and by implementing improved training and frequent maintenance, helicopter external load operations are safer with fewer accidents, crashes, and injuries.

Work-Related Aviation Fatalities – Alaska, 1990 – 1994
Morbidity and Mortality Weekly Report: June 6, 1997 / 46(22); 496-498
Aviation-related fatalities are the second leading cause of occupational death in Alaska. During 1990-1994, a total of 876 aircraft crashes occurred in Alaska; of these 405 (46%) were occupational and 106 (12%) resulted in at least one fatality, and 69 (65%) of these were classified as occupational. The NTSB determined that pilot error was a cause in 53 (77%) of the fatal occupational aviation crashes in Alaska. The frequency of pilot error in the incidents underscores the need for the development of Alaska-specific Aeronautical Decision Making and training. The Alaska Interagency Working Group for the Prevention of Occupational Injuries has formed an aviation-working group to determine strategies for reducing such crashes.

Risk for Traumatic Injuries for Helicopter Crashes During Logging Operations- Southeastern Alaska, January 1992 – June 1993
Morbidity and Mortality Weekly Report: July 8, 1994 / 43(26); 472-5
Helicopters are used by logging companies in the Alaska panhandle to harvest timber in areas that are otherwise inaccessible and/or unfeasible for conventional logging. Helicopter logging operations often place heavy demands on helicopter machinery and associated equipment. The National Transportation Safety Board (NTSB) investigated six helicopter crashes related to transport of logs by cable. According to NTSB investigations to determine probable cause, all six crashes involved “…improper operational and/or maintenance practices” that reflected a lack of inspection of long-line helicopter logging operations.

Fatal Aviation Crashes in Alaska – A Need for Renewed Caution and Diligence
State of Alaska Epidemiology Bulletin: September 22, 2010 / No. 30
Although the number of aviation crashes and fatalities has declined over the past decade in Alaska, the number of fatal crashes and fatalities between January and August 2010 were higher than average. The reasons for the increase are currently unclear since many investigations are still ongoing. However, the study sites stable weather systems that have produced one of the coldest, gloomiest, and wettest summers on record for Southcentral Alaska as having created a potential crash hazard. Weather may have affected pilot proficiency by limiting time in the air, and pilot hours may have been further reduced due to the high price of aviation fuel and other operational costs. Recommendations to increase aviation safety and pilot proficiency include a continued focus on crash prevention through efforts such as the Medallion Foundation’s simulators and training programs, and Federal Aviation Administration and Alaskan Aviation Safety Foundation-sponsored safety seminars; weather information should be continually enhanced and made easily available for pilots; and pilots should be encouraged to install Automatic Dependent Surveillance-Broadcast (ADS-B) equipment (similar to equipment used in the Capstone Project).