Exercise ECG for Screening in Military Aircrew

Area of Science:

• Aerospace Medicine
• Cardiology
• Occupational Health

Background:

• The exercise electrocardiogram (ExECG), or stress test, is utilized in occupational medicine to detect coronary artery disease and assess fitness.
• Its application in aviation medicine for aircrew screening is debated, particularly concerning public safety implications.

Purpose of the Study:

• To evaluate the utility and yield of screening exercise electrocardiograms (ExECGs) in aircrew applicants and active-duty pilots within the German Armed Forces.
• To determine the rate of abnormal findings and subsequent disqualifications from flying duties based on ExECG results.

Main Methods:

• Analysis of 7,646 ExECGs from aircrew applicants (pilots and nonpilots) and 17,131 ExECGs from active-duty pilots at the German Air Force Centre of Aerospace Medicine.
• Evaluation of ECG abnormalities, performance capacity, blood pressure, and heart rate response.

Main Results:

• Only 0.2% of pilot applicants and 1.2% of nonpilot applicants required further investigation, with minimal disqualifications.
• Among active-duty pilots, 0.5% of ExECGs led to further investigation, resulting in only 2 disqualifications from flying duties.

Conclusions:

• The low incidence of significant findings and disqualifications suggests that routine ExECG screening for aircrew may not be cost-effective.
• Performing ExECGs based on clinical indication alone might be a more appropriate strategy for this population.