US commercial air tour crashes, 2000–2011: Burden, fatal risk factors, and FIA Score validation

• Part 91 air tour flights were significantly more likely to crash than their Part 135 counterparts.
• Fatal air tour crashes were more likely than non-fatal crashes to involve fire, occur during instrument meteorological conditions, and take place away from the airport.
• The four-point FIA Score appears to be a valid tool for measuring fatality risk in air tour crashes.

IntroductionThis 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.MethodsUsing 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.ResultsThe 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).DiscussionCommercial 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.