This study provides new public health data about U.S. civil air shows. Risk factors for fatalities in civil air show crashes were analyzed. The value of the FIA score in predicting fatal outcomes was evaluated. With the use of the FAA's General Aviation and Air Taxi Survey and the National Transportation Safety Board's data, the incidence of civil air show crashes from 1993 to 2013 was calculated. Fatality risk factors for crashes were analyzed by means of regression methods. The FIA index was validated to predict fatal outcomes by using the factors of fire, instrument conditions, and away-from-airport location, and was evaluated through receiver operating characteristic (ROC) curves. The civil air show crash rate was 31 crashes per 1,000 civil air events. Of the 174 civil air show crashes that occurred during the study period, 91 (52%) involved at least one fatality; on average, 1.1 people died per fatal crash. Fatalities were associated with four major risk factors: fire [adjusted odds ratio (AOR) 5 7.1, 95% confidence interval (CI) 5 2.4 to 20.6, P < .001], pilot error (AOR 5 5.2, 95% CI 5 1.8 to 14.5, P 5 .002), aerobatic flight (AOR 5 3.6, 95% CI 5 1.6 to 8.2, P 5 .002), and offairport location (AOR 5 3.4, 95% CI 5 1.5 to 7.5, P 5 .003). The area under the FIA score's ROC curve was 0.71 (95% CI 5 0.64 to 0.78). Civil air show crashes were marked by a high risk of fatal outcomes to pilots in aerobatic performances but rare mass casualties. The FIA score was not a valid measurement of fatal risk in civil air show crashes.