In September 2012, the Aerospace Medical Association published and distributed recommendations from its Pilot Mental Health Working Group to improve awareness and identification of pilot mental health issues during the aeromedical assessment of pilots. Following the crash of Germanwings Flight 9525 in March 2015 with pilot suicide as the probable cause, the Pilot Mental Health Working Group reconvened to review their recommendations. As a result, the working group revised the recommendations which are provided here and which were distributed worldwide. The Working Group continues to emphasize the importance of assessing and optimizing pilot mental health, while providing additional recommendations on building trust and rapport between the aeromedical examiner and the pilot, on utilizing aviation mental health and aeromedical specialists, and on the balance between medical confidentiality and risk to public safety. The working group encourages all organizations involved in flight safety to review and consider implementing these recommendations within their usual operations.

Aim: This study is one of the largest ever completed to examine the prevalence of cardiovascular disease (CVD) risk factors among commercial aircrew.Method and results: A retrospective cross-sectional study comparing prevalence of CVD risk factors age, body mass index (BMI), overweight and obesity, current smoking status, hypertension, and diabetes among commercial aircrew and the UK general population. A total of 14,379 subject records were eligible for the study. The age-sex group mean BMI was significantly lower in almost all pilot age groups compared to the general population. Overweight age-sex group prevalence was significantly higher in the <25, 35-44, 45-54, 55-64 age groups for male pilots, and lower for female pilots in the 25-34 and 45-54 age groups. Male and female pilots had significantly lower age-sex-group prevalence of obesity and current smoking compared to the general population. For hypertension, the male <25 and 35-44 year age groups had significantly higher prevalence, and the 45-54 and 55-64 year age groups had significantly lower prevalence than the general population. Age-standardised mean BMI and prevalence of overweight and hypertension were not significantly different from the highest income quintile of the general population. Age-standardised obesity and current smoking prevalence were significantly lower in pilots compared to the highest socio-economic quintile of the general population.Conclusion: Even when comparisons were made with the highest income quintile of the general population to control for socio-economic status, pilots had a significantly lower prevalence of obesity and smoking. This finding is consistent with a strong 'healthy worker effect'.

Introduction: It has been suggested that integrated cardiovascular risk management guidelines and absolute cardiovascular risk prediction scores should be used routinely in aeromedical risk assessment. In this study a cardiovascular disease (CVD) risk prediction model has been applied to UK commercial pilots as an occupational group. Method: This retrospective cross-sectional study measured the variables age, sex, body mass index (BMI), blood pressure, use of antihypertensive medication, current smoking, and diabetes status of commercial pilots. Individual 10-yr absolute CVD risk scores (also referred to as 10-yr global CVD risk) were calculated using a non-laboratory based Framingham Heart Study developed model. Results: Of the 14,379 subjects eligible for the study, none had missing values for risk factors. None of the female pilots and 9.7% of all male pilots were found to be high risk. The mean 10-yr absolute CVD risk for the entire pilot population was 8.41% (median 5.6). High-risk pilots are concentrated around 60 yr of age, (mean 59, median 60 yr) with an age range of 40-81 yr. A sub-analysis of high-risk pilots younger than 65 revealed 1137 pilots in this group. Conclusion: The application of a 10-yr absolute CVD risk prediction model identified a group of pilots, previously unidentified, who may require a more comprehensive risk assessment. Pilots are continuing to fly commercially beyond the age of 60, which results in substantial increase in the CVD risk burden of the pilot population as a whole.