1. An Overview of General Aviation Relative to Fatal Accidents Assessing the Mortality Risk of Pilot Applicants in a Heterogeneous Aviation Context Clifford S. Hale, MD, FACP, MBA, DBIM Associate Medical Director State Farm

2. Attributed to Captain Alfred Gilmer Lamplugh, British Aviation Insurance Group, London. c. early 1930's. A Culture of Safety

3. April 7, 2015, Midnight, Returning from Final Four in Indianapolis to Bloomington Illinois Pilot, aircraft, conditions, or type of flying? Weather was at legal minimums Weather was at legal minimums 200 foot ceiling 200 foot ceiling ½ mile visibility ½ mile visibility

4. An RV-10, a home-built (experimental) airplane with four seats crashed at 2:30 a.m. shortly after takeoff from a local airport near Savannah, Ga. All five passengers died in the crash. A 38 year-old farmer was the owner, the pilot, and found among the dead. There were four others in the plane, three men and a woman ranging from age 20 to 24. They were said to be friends, many of them classmates. Associated Press Article from September 17, 2015 Pilot, aircraft, conditions, or type of flying?

5. We do not act adversely on airline pilots because the risk has historically been very small. General aviation (GA) is all aviation operations other than military, scheduled airlines, and non- scheduled air transport operations for remuneration or hire (charters, FedEx, UPS, etc.) General aviation includes everything from gliders to corporate jets. We Will Focus on General Aviation

6. 98% of the planes flying and 80% of the hours flown 98% of the planes flying and 80% of the hours flown 91% of all crashes and 94% of aviation fatalities 91% of all crashes and 94% of aviation fatalities “Pilot Error” accounts for 85% of GA accidents “Pilot Error” accounts for 85% of GA accidents Weather is responsible for 23% of accidents Weather is responsible for 23% of accidents Majority of Fatal Aircraft Accidents are in General Aviation

7. Rank Ordered Causes of Fatal General Aviation Accidents Loss of control in flight (usually in clouds; usually resulting in a stall, spin, or spiral) Loss of control in flight (usually in clouds; usually resulting in a stall, spin, or spiral) Controlled flight into terrain (usually in clouds)* Controlled flight into terrain (usually in clouds)* Low altitude operations Low altitude operations Fuel exhaustion Fuel exhaustion Wind shear or thunderstorm Wind shear or thunderstorm Midair collisions (rare) Midair collisions (rare) Engine failure (relatively rare) Engine failure (relatively rare) Structural failure (rare) Structural failure (rare) * Remarkable recent reduction (GPS advances?) * Remarkable recent reduction (GPS advances?)

8. Fatality Rate Per 100,000 Hours of Flying 1982-1999 The Killing Zone: How and Why Pilots Die, Paul A. Craig, McGraw-Hill Learning from experience in a relatively new industry Learning from experience in a relatively new industry Regulations - airspace use and communications Regulations - airspace use and communications GPS GPS Cost barriers and more mature pilots Cost barriers and more mature pilots

9. Recently 1.1 to 1.3 Fatal Accidents/100K Hours 1987-2006 1.3 100,000 hrs. is 48 years of flying for 40 hours weekly

10. JAMA April 11, 2007 (Commentary) General aviation flying is often thought to be comparable to that of motorcycling. However, whereas motorcycle accidents are often caused by the actions of other drivers, aviation accidents are almost always the result of the pilot’s abilities and judgment. Getting a Feeling for Risk

11. General aviation flying is no more than 10 times as risky as driving per mile, and general Aviation flying is roughly 20 times as risky as driving per hour. Typically, pilots fly less than motorcycle riders ride. Motorcycle rider deaths are nearly 30 times more frequent than deaths from driving other vehicles Motorcycle riders aged below 40 are 36 times more likely to be killed than operators under age 40 of other vehicles. Motorcycle riders aged 40 years and over are around 20 times more likely to be killed than other drivers Crude Risk Statistics from Selected Sources

12. To Provide some Context for Underwriting Risk assessment may be easier with airplane flying than with motorcycle riding. Motorcyclists are constantly at the mercy of other drivers. Motorcyclists are constantly at the mercy of other drivers. We usually know more about pilots than we do about motorcyclists. We usually know more about pilots than we do about motorcyclists. We learn what they fly We learn what they fly We learn often they fly and how many hours they have We learn often they fly and how many hours they have We learn why they fly We learn why they fly We Learn what ratings they have We Learn what ratings they have We know most are medically cleared by the FAA We know most are medically cleared by the FAA

13. Providing and Underwriting Context Assume 1.3 Deaths/100,000 Hours Assume a pilot applicant flies 50 hours annually. Assume a pilot applicant flies 50 hours annually. Annual risk of fatality for one hour is 0.000013 Annual risk of fatality for one hour is 0.000013 So flying 50 hours increases this to 0.00065 So flying 50 hours increases this to 0.00065 Annual mortality is then 6.5 out of 10,000 Annual mortality is then 6.5 out of 10,000 Background mortality for a 50-year-old (non-select) from 2009 social security table is 52 out of 10,000 Background mortality for a 50-year-old (non-select) from 2009 social security table is 52 out of 10,000 So GA flying without further qualification adds 6.5 to the 52 For a 50-year-old, a little over 10% increased risk. So GA flying without further qualification adds 6.5 to the 52 For a 50-year-old, a little over 10% increased risk. Obviously it’s not this simple, but this helps provide a crude idea of the risk as a starting point. Obviously it’s not this simple, but this helps provide a crude idea of the risk as a starting point.

14. The pilot The pilot The aircraft The aircraft The conditions The conditions The type of flying The type of flying Few generalizations can be made Risk Modification Assessment Based Upon Variations in:

15. Risk Modification Assessment Based Upon Variations in: The pilot The pilot The aircraft The aircraft The conditions The conditions The type of flying The type of flying

16. Student Pilot: an individual who is learning to fly under the tutelage of a flight instructor (pre-solo and post-solo phases). Student Pilot: an individual who is learning to fly under the tutelage of a flight instructor (pre-solo and post-solo phases). Sport Pilot: an individual who is authorized to fly only light-sport aircraft. No medical required. Minimum 20 hours Sport Pilot: an individual who is authorized to fly only light-sport aircraft. No medical required. Minimum 20 hours Recreational Pilot: an individual who may fly aircraft of up to 180 horsepower and 4 seats in daytime for pleasure only. Multiple restrictions. No medical required. Minimum 30 hours Recreational Pilot: an individual who may fly aircraft of up to 180 horsepower and 4 seats in daytime for pleasure only. Multiple restrictions. No medical required. Minimum 30 hours Private Pilot: an individual who may fly for pleasure or personal business, without accepting compensation. Third Class medical exam required every two to five years depending on age. Minimum 40 hours. Private Pilot: an individual who may fly for pleasure or personal business, without accepting compensation. Third Class medical exam required every two to five years depending on age. Minimum 40 hours. Commercial Pilot: may, with some restrictions, fly for hire. Second Class medical exam required annually. Minimum 250 hours Commercial Pilot: may, with some restrictions, fly for hire. Second Class medical exam required annually. Minimum 250 hours Airline Transport Pilot (often called ATP): an individual authorized to act as pilot in command for a scheduled airline: First Class medical exam required every six to twelve months depending upon age. Minimum 1,500 hours Airline Transport Pilot (often called ATP): an individual authorized to act as pilot in command for a scheduled airline: First Class medical exam required every six to twelve months depending upon age. Minimum 1,500 hours Licenses All except pre-solo students require written, oral, and practical examinations

17. Medical Certification Not required for recreational and sports licenses Flying without a medical certification Flying without a medical certification Restrictions and limitations Restrictions and limitations Special issuance Special issuance FAA’s philosophy re private and commercial FAA’s philosophy re private and commercial Misrepresentation and its implications Misrepresentation and its implications Pending legislation Pending legislation

21. FAA and Sudden Incapacitation or Altered Sensorium Mood-altering medications Mood-altering medications Substance abuse; DUIs Substance abuse; DUIs Cardiovascular diseases Cardiovascular diseases Central neurological disorders Central neurological disorders Behavioral abnormalities Behavioral abnormalities Loss of consciousness Loss of consciousness A matter of public trust

22. Luck Experience The goal is to fill up the experience bucket before the luck bucket is empty Experience Matters

23. The Killing Zone: How and Why Pilots Die, Paul A. Craig, McGraw-Hill

24. Diversity of Pilot Experience and Currency Student pilots to retired airline pilots Student pilots to retired airline pilots 125 hours total vs. 20,000 hours 125 hours total vs. 20,000 hours 25 hours each year or 150 hours 25 hours each year or 150 hours Biennial proficiency checks Biennial proficiency checks Instrument competency checks Instrument competency checks

25. Second Learning Curve for Instrument-Rated Pilots The Killing Zone: How and Why Pilots Die, Paul A. Craig, McGraw-Hill

26. A “Post-Graduate” Course on Weather The Killing Zone: How and Why Pilots Die, Paul A. Craig, McGraw-Hill

27. Underwriting Considerations: The Pilot Experience and recent flying: skills erode fairly fast, especially with low levels of experience and complex tasks. Experience and recent flying: skills erode fairly fast, especially with low levels of experience and complex tasks. Complexity and recency of training Complexity and recency of training Health Health Maturity, intelligence, and judgment Maturity, intelligence, and judgment Risk appetite Risk appetite Lifestyle (stress, time pressures, alcohol) Lifestyle (stress, time pressures, alcohol)

28. The pilot The pilot The aircraft The aircraft The conditions The conditions The type of flying The type of flying Modifying Risk Assessment Based Upon Variations in:

29. The Aircraft Amateur-built and other experimental aircraft are involved in roughly 20% of U.S. fatal general aviation accidents. Experimental

30. Age and complexity of aircraft Instruments: Glass cockpit, terrain, traffic and weather? Engine time Maintenance Diversity of Aircraft Equipment

31. Aging fleet Aging fleet Annual or 100 hour inspection Annual or 100 hour inspection Time before overhaul (TBO) Time before overhaul (TBO) Airworthiness directives (ADs) Airworthiness directives (ADs) Variable personal standards Variable personal standards Poor Maintenance Poor Maintenance Cheating on maintenance. Cheating on maintenance. Aircraft Maintenance

32. The pilot The pilot The aircraft The aircraft The conditions The conditions The type of flying The type of flying Modifying Risk Assessment Based Upon Variations in:

33. Flight Conditions Visual flight rules (VFR) in visual meteorological conditions (VMC): 1,000 foot ceiling and 3 miles visibility. Visual flight rules (VFR) in visual meteorological conditions (VMC): 1,000 foot ceiling and 3 miles visibility. Marginal VFR (3-5 miles visibility: ceilings around 1,000 feet) Marginal VFR (3-5 miles visibility: ceilings around 1,000 feet) Instrument flight rules (IFR) and instrument meteorological conditions (IMC) Instrument flight rules (IFR) and instrument meteorological conditions (IMC) Wind, turbulence, and wind shear Wind, turbulence, and wind shear Precipitation (rain, thunderstorms, fog, snow, ice,) Precipitation (rain, thunderstorms, fog, snow, ice,) Day vs. Night Day vs. Night High altitude (temperature and oxygen) High altitude (temperature and oxygen)

34. Instrument Rating Instrument Meteorological Conditions (IMC) (Flying blind with a vision-based brain) #1 Spatial disorientation #2 Controlled flight into terrain

35. Ice

36. Thunderstorms

37. Embedded Thunderstorms “Steam gauges” and “glass”

38. Night Clouds Visual illusions, esp. related to depth perception Spatial disorientation Hypoxic affects at lower altitudes than during day

39. The pilot The pilot The aircraft The aircraft The conditions The conditions The type of flying The type of flying Modifying Risk Assessment Based Upon Variations in:

40. Personal and Family Recreation

41. Corporate Flying

42. Personal Business Flying

43. Firefighting

44. Racing

45. Airshow and Aerobatics

46. Flight Instruction

47. Industrial Heavy Lifting

48. Banner/Glider Towing and Skydiving

49. From 1990 to 1999, Alaska aviation accidents made up 39 percent of the nation's total air crashes, 24 percent of its fatal crashes and 21 percent of total air fatalities. Alaskan Bush Flying

50. Aerial Application (Crop Dusting)

51. Helicopter Emergency Medical Services

53. A Few More Aviation Niches Aerial survey Aerial survey Tourism Tourism Traffic reporting Traffic reporting Sky Writing Sky Writing Police Police Search and Rescue Search and Rescue Test pilot flying Test pilot flying Weather monitoring Weather monitoring

54. Aviation risk is depends upon context, so start with your manual but be curious about the pilot’s licenses and certification, experience, currency, personality, the aircraft, the type of flying, and the conditions commonly encountered. Questions?