Study Rationale

As the Helicopter Emergency Medical Service (HEMS) remains a cornerstone in the management of severe emergencies in both urban and rural settings, however, chronic back pain among aircrew members is underestimated. Particular operational environments and equipment may place high physical stress on the back and influence a significant rate of emerging patients in this specific category of inflammatory pain.  Individual characteristics like anthropometrics, static posture, personal lifestyle, but also flight-related causes such as degenerative changes of the spine because of vibration¹, mission length, prolong sitting, may influence. The aim of this study was to estimate self-reported pain prevalence and to evaluate potential risk factors for chronic pain among HEMS aircrew members.

Methods

An anonymous structured questionnaire was submitted to 106 aircrew cabin members of HEMS, who were randomly and voluntary enrolled via WhatsApp or e-mail sharing. Inclusion criteria was profession as a helicopter pilot or crewmember. The questionnaire concerned both individual risk indicators: sex, qualification, pre-existing pain episodes, site of pain (cervical, dorsal or lumbar), frequency of pain episodes and disability perception expressed through Visual Analogue Scale (VAS) related to flight-related risk indicators such as: use of helmet load, night vision goggles (NVG), belt fit, seat design, mission dynamics.

Results

A total of 19 helicopter pilots and 87 other crewmembers, (62 males, 44 females) with a mean age of 44,3 years, mean BMI 24,2 kg/m2 participated in the study held on 2020. The 12-month pain prevalence was 79,2%. The 27,3% of participants declared to suffer from pre-existing pain issues. Most of the aircrew members suffered from lumbar (58%), followed by cervical (35%) and dorsal (7%) pain. Results showed that aircrew members have a higher risk of diagnosed lumbar problems than pilots, while pilots are more likely to experience cervical pain. Through VAS volunteers expressed how different flight-related factors influence their pain perception (no pain correlation: 0, mild correlation: 1-3, moderate correlation:4-6, absolute correlation: 7-10). Helmet had moderate correlation with the experienced pain (37,7%) and only the 21% of pilots using NVG attribute absolute correlation of pain to them. Belt fit is mildly responsible of pain (38,6%) while seat design is unlikely to provoke pain (64,1%). Conversely, mission dynamics had a high correlation with pain (63,2%) and also vibration (65%). Only 15% employ physio kinetic therapy, while 45% use pharmacological therapy. In the meanwhile, 40% do not seek any treatment.

Conclusions

When flying in helicopter, it is the ergonomic setting whole-body vibration, mission dynamics and heavy equipment worn on the head that have been suggested as risk factors for chronic pain among aircrew members. Despite the high number of helicopter aircrew members suffering from pain, very few individuals seek treatment for the disorder. The focus should, therefore, be directed toward a solution that addresses to add flight-specific exercise therapy²as a further preventive treatment perspective of pain management.

Bibliography

1. Joo Hyeon Byeon et all.Degenerative changes of spine in helicopter pilots;Ann Rehabil Med.2013Oct;37(5):706-12

     2. Pelham TW et all. The etiology of low back pain in military helicopter aviators:prevention  and treatment.Work.2005;24(2):101-10