title: US commercial air tour crashes, 2000-2011: burden, fatal risk factors, and FIA Score validation.
abstract: BACKGROUND
  This study provides new public health data concerning the US commercial air tour industry. Risk factors for fatality in air tour crashes were analyzed to determine the value of the FIA Score in predicting fatal outcomes.
  
  
  METHODS
  Using the Federal Aviation Administration's (FAA) General Aviation and Air Taxi Survey and National Transportation Safety Board data, the incidence of commercial air tour crashes from 2000 through 2010 was calculated. Fatality risk factors for crashes occurring from 2000 through 2011 were analyzed using regression methods. The FIA Score, Li and Baker's fatality risk index, was validated using receiver operating characteristic (ROC) curves.
  
  
  RESULTS
  The industry-wide commercial air tour crash rate was 2.7 per 100,000 flight hours. The incidence rates of Part 91 and 135 commercial air tour crashes were 3.4 and 2.3 per 100,000 flight hours, respectively (relative risk [RR] 1.5, 95% confidence interval [CI] 1.1-2.1, P=0.015). Of the 152 air tour crashes that occurred from 2000 through 2011, 30 (20%) involved at least one fatality and, on average, 3.5 people died per fatal crash. Fatalities were associated with three major risk factors: fire (adjusted odds ratio [AOR] 5.1, 95% CI 1.5-16.7, P=0.008), instrument meteorological conditions (AOR 5.4, 95% CI 1.1-26.4, P=0.038), and off-airport location (AOR 7.2, 95% CI 1.6-33.2, P=0.011). The area under the FIA Score's ROC curve was 0.79 (95% CI 0.71-0.88).
  
  
  CONCLUSIONS
  Commercial air tour crash rates were high relative to similar commercial aviation operations. Disparities between Part 91 and 135 air tour crash rates reflect regulatory disparities that require FAA action. The FIA Score appeared to be a valid measurement of fatal risk in air tour crashes. The FIA should prioritize interventions that address the three major risk factors identified by this study.
authors: Johns Hopkins Bloomberg School of Public Health, Department of International Health, United States. sballard@jhsph.edu
authors: Sarah-Blythe
authors: SB
authors: Ballard
authors: Leland P
authors: LP
authors: Beaty
authors: Susan P
authors: SP
authors: Baker
mesh_terms: D000060:Accidents, Aviation / Q000401:mortality* / Q000706:statistics & numerical data*; D059028:Airports; D001359:Aviation / Q000706:statistics & numerical data*; D017281:Cost of Illness; D005390:Fires; D006801:Humans; D015994:Incidence; D011237:Predictive Value of Tests; D012372:ROC Curve; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014887:Weather
references: Aviat Space Environ Med. 2009 Jul;80(7):637-42
references: 19601506
references: Ulus Travma Acil Cerrahi Derg. 2005 Oct;11(4):318-23
references: 16341970
references: J Trauma. 2008 Dec;65(6):1278-83
references: 19077613
references: Aviat Space Environ Med. 1995 Feb;66(2):99-103
references: 7726791
references: Aviat Space Environ Med. 2003 Oct;74(10):1061-6
references: 14556568
references: JAMA. 2007 Apr 11;297(14):1596-8
references: 17426280
references: JAMA. 1998 Sep 16;280(11):997-9
references: 9749482
references: Aviat Space Environ Med. 2005 Aug;76(8):782-5
references: 16110696
references: Aviat Space Environ Med. 1999 Apr;70(4):305-9
references: 10223263
references: Ann Emerg Med. 2006 Apr;47(4):351-6
references: 16546620
references: J Trauma. 1989 Apr;29(4):415-22; discussion 423
references: 2709450
references: Am J Epidemiol. 2001 Dec 1;154(11):1037-42
references: 11724720