FAA Office of Aerospace Medicine 
Civil Aerospace Medical Institute 

Report No: DOT/FAA/AM-23/31

Title and Subtitle:Assessing Pilot Aeromedical Risk Using Commercial Healthcare Data

Report Date: September 2023

Authors:D. Slater, F. Bradbury, Z. Slater, S. Bapat

Abstract: The Federal Aviation Administration (FAA) Office of Aerospace Medicine is responsible for the medical certification of pilots such that the risk of pilot acute incapacitation is below a target risk threshold. This study sought to design a repeatable method of using commercial healthcare datasets to segment pilots with existing chronic conditions into acute incapacitation risk groups for the purpose of informing medical standards and certification policy guidance. Based on availability to the researchers, Merative’s Explorys electronic health record dataset, comprising 11-years of data, was used for method development. In collaboration with FAA medical officers, researchers operationalized pilot acute incapacitation as a composite outcome of 16 medical conditions and their associated diagnostic codes. These conditions were identified based on the scenario that a pilot is medically qualified to fly, conducts an adequate preflight selfassessment, and during flight experiences the acute onset of a state incompatible with active aircraft control such that orderly transfer of control to another pilot or automation is unlikely. Approaches to developing quantitative risk models for the outcome of pilot acute incapacitation were explored for four chronic conditions: diabetes, obstructive sleep apnea, chronic obstructive pulmonary disease, and atrial fibrillation. Three general approaches were explored: wholepopulation risk, disease severity models, and a de novo method. Using whole-population risk resulted in over- and - under estimation of pilot acute incapacitation risk for a significant portion of the population. Using existing disease severity scores produced poor risk stratification for pilot acute incapacitation. The de novo method was designed to be broadly applicable to any condition of interest. The method was comprised of the following steps: (1) define the cohort for the condition of interest; (2) use a clinical reference tool (DynaMed, UpToDate, etc.) to produce relevant clinical factors; (3) use a clinical mapping tool (e.g., Unified Medical Language System) to link clinical factors to medical codes; (4) use information gain to select risk factors (relevant to both the chronic condition of interest and the outcome) from clinical factors for inclusion in pilot acute incapacitation risk models; (5) compute stratified incidence rates for pilot acute incapacitation; and (5) compare incident rates to the target risk threshold.

Key Words: Safety Management Systems (SMS), Aeromedical Certification, Aviation Safety Risk Management

No. of Pages: 27