Asthma and Rotary-Wing Military Aircrew Selection

BACKGROUND: From a population-based perspective, reports in the peer-reviewed medical literature suggest an increase in the overall prevalence of asthma in recent decades. Applicants for military aviation training with a current or past history of asthma are generally excluded in the United Kingdom.METHODS: In order to assess the impact of the prevalence of asthma on the available pool of military service candidates, the authors collected data on annual live births between 1916 and 2016 as well as peer-reviewed publications that provided insight into asthma prevalence trends within the United Kingdom across the last century (covering birth-year population cohorts ranging from 1924 to 1995). Regression techniques were used to estimate the prevalence of individuals who could reasonably expect to be found unfit for military aviation service due to asthma-like conditions within the birth-year cohorts between 2001 and 2016.RESULTS: Between 1916 and 2016, the number of live births in the United Kingdom has averaged approximately 802,000 per year. The reported prevalence of asthma, based on the assimilated data points, ranged from 2.3 cases per 1000 individuals among the 1924 birth-year cohort, to 29.8 cases per 1000 individuals among the 1990 birth-year cohort.DISCUSSION: Based on the data and analysis presented above, asthma continues to constitute a significant public health issue in the United Kingdom. Military services must base risk mitigation decisions on accurate and precise diagnostic categorizations, and prudently balance the benefits of allowing affected individuals to participate in military service with the potential for mission degradation or compromise.Porter WD, Powell-Dunford N, Wilde GD, Bushby AJR. Asthma and rotary-wing military aircrew selection. Aerosp Med Hum Perform. 2019; 90(7):606-612.

Safety Implications of 6-Month vs. 1-Year First-Class Aeromedical Certificates

INTRODUCTION: This study explores the safety risk due to delayed detection of hazardous health conditions that would result from increasing the duration of U.S. first-class aeromedical certificates from 6 mo to 12 mo for pilots ages 40 yr old through 60 yr old.METHODS: All pilots who submitted a U.S. first-class application in 2014 with no electrocardiogram and with the previous exams 4.5 to 7.5 mo prior were selected from the FAA pilot medical database. Proportions of Federal Aviation Administration (FAA) denial pathology codes and Aviation Medical Examiner (AME) deferrals were compared for these exams within and between age groups from 40 yr old through 75 yr old. The absolute incidence rates for delayed detection were calculated and relative incidence of these proportions was compared graphically.RESULTS: The relative risk between age groups for delayed identification of disqualifying medical conditions showed that the 56-60-yr-old group would be at about twice the risk as the 40-45-yr-old group. The absolute incidence for the 56-60-yr-old group was 0.46% for denial conditions and 0.60% for AME deferrals over 6 mo.DISCUSSION: Increasing FAA first-class medical certificate duration from 6 mo to 12 mo would put 56-60-yr-old pilots at double the currently accepted risk for delayed detection of significant medical conditions. The absolute risk for this 6-mo delayed identification for the 56-60-yr-old group would average 0.53%.Mills WD, DeJohn CA. Safety implications of 6-month vs. 1-year first-class aeromedical certificates. Aerosp Med Hum Perform. 2019; 90(5):484-487.

Systems Safety Risk Analysis of Fatal Night Helicopter Emergency Medical Service Accidents

INTRODUCTION: In the United States, the proportion of Helicopter Emergency Medical Service (HEMS) fatal accidents remained unchanged despite an overall decreasing accident rate. Previous research showed night HEMS operations influenced fatal outcomes. Pilots with <6 yr of HEMS domain task experience (low-DTE) had a higher likelihood of a night operational accident in conditions associated with adverse weather. This study sought to determine whether a difference existed between day and night fatal accident rates and identify influences contributing to night fatal HEMS accidents. Any risk factors identified will be used for a risk analysis to inform future operational safety of the night visual flight rule (VFR) HEMS transport system.METHODS: Historical accident data and industry hours were obtained. Both pilot DTE groups (low and high) and mission VFR and instrument flight rule (IFR) capability were identified using data from 32 night VFR operational fatal HEMS accidents. Accidents were stratified by loss of control and controlled flight into terrain, pilot DTE, and flight rule capability. The effectiveness of both DTE groups and both flight rule capabilities were measured using system safety risk analysis techniques.RESULTS: Night fatal accident rates were statistically different from daytime. Low-DTE pilots and the VFR capability combination had the highest likelihood of night operational nonsurvivable accident.CONCLUSION: Low-DTE pilots and the VFR capability were the least effective mission combination to avoid hazardous conditions at night and maintain spatial orientation, respectively. The analysis identified measures to reduce likelihood of night fatal operational accidents.Aherne BB, Zhang C, Chen WS, Newman DG. Systems safety risk analysis of fatal night Helicopter Emergency Medical Service accidents. Aerosp Med Hum Perform. 2019; 90(4):396-404.

An introduction to aviation cardiology

The management of cardiovascular disease (CVD) has evolved significantly in the last 20 years; however, the last major publication to address a consensus on the management of CVD in aircrew was published in 1999, following the second European Society of Cardiology conference of aviation cardiology experts. This article outlines an introduction to aviation cardiology and focuses on the broad aviation medicine considerations that are required to manage aircrew appropriately and optimally (both pilots and non-pilot aviation professionals). This and the other articles in this series are born out of a 3 year collaborative working group between international military aviation cardiologists and aviation medicine specialists, many of whom also work with and advise civil aviation authorities, as part of a North Atlantic Treaty Organization (NATO) led initiative to address the occupational ramifications of CVD in aircrew (HFM-251). This article describes the types of aircrew employed in the civil and military aviation profession in the 21st century; the types of aircraft and aviation environment that must be understood when managing aircrew with CVD; the regulatory bodies involved in aircrew licensing and the risk assessment processes that are used in aviation medicine to determine the suitability of aircrew to fly with medical (and specifically cardiovascular) disease; and the ethical, occupational and clinical tensions that exist when managing patients with CVD who are also professional aircrew.

In-flight cardiac arrest and in-flight cardiopulmonary resuscitation during commercial air travel: consensus statement and supplementary treatment guideline from the German Society of Aerospace Medicine (DGLRM)

By the end of the year 2016, approximately 3 billion people worldwide travelled by commercial air transport. Between 1 out of 14,000 and 1 out of 50,000 passengers will experience acute medical problems/emergencies during a flight (i.e., in-flight medical emergency). Cardiac arrest accounts for 0.3% of all in-flight medical emergencies. So far, no specific guideline exists for the management and treatment of in-flight cardiac arrest (IFCA). A task force with clinical and investigational expertise in aviation, aviation medicine, and emergency medicine was created to develop a consensus based on scientific evidence and compiled a guideline for the management and treatment of in-flight cardiac arrests. Using the GRADE, RAND, and DELPHI methods, a systematic literature search was performed in PubMed. Specific recommendations have been developed for the treatment of IFCA. A total of 29 specific recommendations for the treatment and management of in-flight cardiac arrests were generated. The main recommendations included emergency equipments as well as communication of the emergency. Training of the crew is of utmost importance, and should ideally have a focus on CPR in aircraft. The decision for a diversion should be considered very carefully.

Results of AMHP Journal Survey on Open Access

Day PC. Results of AMHP journal survey on Open Access. Aerospace Med Hum Perform. 2018; 89(1):70-71.

[Military aviation dentistry]

The aim of this article is to introduce the concepts of military aviation dentistry, including facial barotraumas (external otitic barotrauma, barosinusitis and barotitis- media), dental barotrauma, barodontalgia, and dental care for aircrews. Special considerations have to be made when planning restorative, endodontic, prosthodontic and surgical treatment to an aircrew patient. The article supplies the military dental officer with diagnostic and treatment guidelines, and the principles of prevention, periodic examination, and dental-related flight restriction.

[Stages of development of flight medical expertise in Russia]

Flight medical expertise (FME) in military aviation is one of the most important areas of medical support of flight crews manning, maintaining of aircrew health and flight safety. The authors analyse the main stages of development of this area of medical practice. The priority in creation of FME system belongs to our country. Domestic scientists, prominent organizers of military medicine and a large group of aviation physicians developed organizational and methodological basis for studying different impacts of flight factors on the health of flight personnel, development of criteria for admission to flight operations, principles of organization of the examination, implementation of effective methods of disease diagnosis. At the present stage FME development is determined by the needs of medical, technical and psycho-physiological support of supersonic aircraft, the need to adjust to the requirements of aircrew health, advanced diagnostics of the functional state and the search for means to improve the stability of his body to flight factors. The main principles of the FME remains the complexity of the study of the human body in terms of its professional and individual approach to a medical examination, a thorough clinical, clinical and physiological and psychological examinations, regular medical supervision of the health of flight crews.

[Marine, aviation and space physician, psychologist and physiologist (To the 90th anniversary of the birth of G. M. Zarakovskii)]

In the current paper authors discuss problems of marine and aerospace medicine and psychophysiology, which Georgii Zarakovskii (1925-2014), a prominent domestic experts in the field of military medicine, psychology and ergonomics, solved. Authors focused on methodological approaches and results of the study of psychophysiological characteristics and human capabilities took into account for design of tools and organization of flight crews, astronauts and military experts. Authors marked the contribution to the creation of a system integrating psychophysiological features and characteristics of the person neccessary for development, testing and maintenance of aerospace engineering and organization of its professional activities. The possibilities of using the methodology of psychophysiological activity analysis in order to improve the reliability of psychophysiological military specialists, are shown.

[Scientific and research experimentation center of aviation and space medicine and human engineeing celebrates 80th anniversary]

The article is devoted to the history of the Research Test Center Aviation and Space Medicine and military ergonomics, now included in the Central Research Institute of the Air Force Defense Ministry. The center throughout 80 years history is a leding research organization in the country for the integrated study of the human factor in aviation and problems connected with it. The world-famous scientific schools in aviation physiology, hygiene and radiolorgy, emergency medicine, aviation psychology and ergonomics have been grounded on the basis of this center. With a high qualified scientific staff and laboratory-and-bench-scale base including unique seminatural airplanes and helicopters complexes, posters and installation simulating the impact of flight factors (centrifuge, hyperbaric chambers, shakenr vestibulyar-WIDE stands, etc.) the center has. successfully slved tasks concerning an improvement of flight crews protection from occupational hazards, ergonomic demands to capabilities of aircraft, professional and psycho-physiological training. Automatic systems of medical decision-making on assessment of the health status in the medical-flight expertise and dynamic medical supervision, planning, treatment and preventive and remedial actions aircrew training are currently 'being developed

[Medical Service of the Finnish Defence Forces]

Thee article is a brief description of the current state of the Finnish Defence Forces medical service and is based on the study of the open access foreign sources. At the beginning, the general information about Finland, the Finnish Defence Forces, and their medical service is presented. Then some particular features are described with more detail, namely, the organization of the inpatient and outpatient treatment, medical supply, scientific research, combat medicine, medical staff education and training, medical , service personnel income.

[Actual problems of medical care of aviation specialists in the Arctic region]

The article considers the influence of geographic and climatic conditions of the Arctic on a functional condition of aviation professionals. Marked possible effects of aggressive environmental factors on the health of the personnel. Studied the dynamics of the recovery functions of the cardio-respiratory system and of the indicators of general clinical blood test in a period of adaptation to the conditions of the middle latitudes after the return of the personnel from the Arctic. Identified the main activities to preserve the health of aviation specialists, depending on the length of stay in the Arctic region and age.

[Suppositions for development of preventive military air medicine]

It is shown that on the basis of scientific concepts for regenerative medicine and organizational principles of prevention as a result of the research were revealed fundamental laws of life of the organism in an unusual environment. It is concluded that the need to integrate the methodology of research and testing aircraft and medical equipment on a single scientific basis. This will enable more productive use of research results in the field of ergonomics, ecology, and computer science in order to preserve the life and health of military personnel and maintain their combat capability.

[Professional psychological selection system in the Air Force - 50 years]

Given the data about the establishment of the professional psychological selection system in the Air Force in 1958-1964 in the NIIIAM Air Force by the team psychological department under the leadership of K.K.Platonova. Given the names of the developers of this system and given the results of their research. The result of all made work the order of Air Force Commander about the introduction of the psychological selection in Higher Military Aviation School of Pilots, starting from a set of 1964 became. Recommendations for professional psychological selection of a wide range of aviation professionals in various fields, and in the future - and other professionals of the Armed Forces, became the results of future work.

[The main ways of improvement of medical support of the Air Forces in modern conditions]

Blaginin A.A., Grebenyuk A.N., Lizogub LN. - The main ways of improvement of medical support of the Air Forces in modern conditions. Aircrew conducting active hostilities suffers from the whole spectrum of factors and conditions of the combat situation. The main task for the medical service of the Air Force is to carry out preventive and curative action for aviation specialists who are responsible for the combat capability of aircraft formations. The medical service of the Air Force must have forces and facilities for planning, organization and implementation of the treatment of lightly wounded and sick aviation professionals with short periods of recovery, medical rehabilitation of aircrew qfter suffering injuries, diseases, sanatorium therapy of aircrew with partial failure of health, outpatient and inpatient medical examination aircrew - flight commissions, preventive rest of aviation specialists with symptoms of chronic fatigue. Should be trained aviation physicians, including both basic military medical education and in-depth study of the medical aspects of various fields of personnel of the Air Force.

[Main concepts of preventive health care for the air staff of sea-based aviation]

The authors researched the air-stuff and complex of adverse factors uncharacteristic for the air-staff of land-based aircraft. It was determined that adverse factors affect the air-staff foremost in 4-5 months of a blue-water sailing, except cardiovascular system diseases. In a month of a blue-water sailing was registered a hypotonic state. Systolic blood pressure varied from 100-105 mm Hg and lower, dystolic blood pressure varied from 60-65 mm Hg and lower. The lowest ranges of blood pressure were registered in three months after the beginning of the sailing. In the following, the hypotonic state, registered during the monthly medical examinations, remained till the end of the sailing. Normal averages of blood pressure were restored in two weeks after the end of sailing. Low red cell count (for more than 1100 points) was registered in 61.5% of patients, (for more than 550 points) in 38.4% of patients. Low white cell count (for more than 4800 points) was registered in 33.3% of patients, (for more than 3300 points) in 41% of patients, (for more than 1330 points) in 25% of patients. Input data was: red cell count--4250 points, white cell count--7300 points in 1 ml of blood. After the sailing haematological indices were restored. The authors suggested guidelines for primary and secondary disease prevention.

[Founder of domestic bioastronautics (to the 100th anniversary of the birth of V.I. Yazdovskiy)]

The article is concerned to the anniversary of the founder of domestic bioastronautics, leader and organizer of realization of biomedical programs, preparations and supply of the first space flights in our country, V.I. Yazdovskiy. The authors underlined significancy of his shining merits, which helped to develop domestic bioastronautics. In cooperation with S.P. Korolyov, V.I. Yazdovskiy launched the first manned spaceflight. With this flight our country became a leader in space exploration.

[Enhancement of the medical care system for crews on space missions]

An overview of structural, operational and research aspects of the Russian system of medical support to health and performance of cosmonauts on the International space station (ISS) is presented. The backbone of the current tactics of cosmonauts' health maintenance is the original Russian medical care system developed for long-term piloted space fights. Over 12 years of its existence, the ISS has been operated by 33 main crews. The ISS program entrusted the established multilateral medical boards and panels with laying down the health standards as well as the generic and specific medical and engineering requirements mandatory to all international partners. Due to the program international nature, MedOps planning and implementation are coordinated within the network of working level groups with members designated by each IP. The article sums up the experiences and outlines future trends of the Russian medical care system for ISS cosmonauts. The authors pay tribute to academician Anatoli I. Grigoriev for his contribution to creation of the national system of medical safety in long-term piloted space missions, setting the ISS health and environmental standards and uniform principles of integrated crew health management, and gaining consensus on medical policy and operational issues equally during the ISS construction and utilization.

[Aviation medicine: yesterday, today and tomorrow]

The article describes the history and current state of medical support of the Air Force. On December 1, 2009 Air Force Medical Service was renamed into the service of aviation medicine of Command Air Forces, and many of the functions of medical support of the Air Force transferred to the newly formed Air Force Center of Aviation Medicine. April 29, 2011 office of Aviation Medicine of the High Command of the Air Force has stepped 95-year milestone. The changes affected all structures entrusted with the issues of medical support of the Air Force. Today, the medical service of the Air Force faces challenges--ensuring safety, the study of flight conditions and their impact on health, job performance and psychological characteristics of flight personnel.

[The contribution of military aviation and space medicine to the biomedical support of the first flight into space]

April 12, 2011 Humanity celebrated 50 years of one of the greatest achievements of the twentieth century--the legendary flight of Y. Gagarin into space. In this study are highlighted the role and importance of military aviation and space medicine, and in particular, the State Scientific Research Testing Institute of Aviation and Space Medicine, Ministry of Defence of the USSR (now--the State Scientific Research Testing Institute of Military Medicine, Military Medical Academy named after S.M. Kirov) in the preparation and conduct of flight of Yu.A.Gagarin.

[Famous scientist and organizer of the surgical service of military air forces]

The article is concerned with the biography of professor, Doctor of Medicine Petr Lazarevich Seltsovsky (1898-1961), who was surgeon-in-chief of Air Force during the Great Patriotic War. He enunciated suggestions about the problems of surgery during his service in Air Force in his scientific works "Head injury of aircraft personnel of Air Force", "Traumatism of aircraft personnel", "Traumatism in Air Force". During the 30-year period of academic and research practice professor P. L. Seltsovsky published more than 120 scientific works including 7 monographs and 2 manuals.

[Some approaches to the countermeasure system for a mars exploration mission]

In article discussed physiological and methodical principles of the organization of training process and his (its) computerization during Martian flight in conditions of autonomous activity of the crew, providing interaction with onboard medical means, self-maintained by crew of the their health, performance of preventive measures, diagnostic studies and, in case of necessity, carrying out of treatment. In super long autonomous flights essentially become complicated the control of ground experts over of crew members conditions, that testifies to necessity of a computerization of control process by a state of health of crew, including carrying out of preventive actions. The situation becomes complicated impossibility of reception and transfer aboard the necessary information in real time and emergency returning of crew to the Earth. In these conditions realization of problems of physical preventive maintenance should be solved by means of the onboard automated expert system, providing management by trainings of each crew members, directed on optimization of their psychophysical condition.

[On-board medical support system (MSS) of flights of promising aerospace sets (design)]

It was suggested as the main compositive fractions MSS to consider the base system of automated evaluation of blood redistribution (BR) in body means of crew members protection and prophylaxis (CMPP) of unfavourable effects of flight factors to organism and also the automated circuit of CMPP' control. The advanced MSS includes 4 original measuring channels for registration of the base physiologic indices (electrocardiogram, venous-arterial pulsegram of neck vessels, reogram of head, earlap vessels pulsegram) the dynamic of which allows to determine with the help of computer the BR-integral parameter. The CMPP automated control circuit unites the separate protecting means in common system and executes the individual selection of regimes and CM PP-composition in accord with, first of all, body reactions manifestation and, secondly, individual physiologic status of spaceman. As CMPP was selected the negative pressure production around lower body part. Approlation of constructed active laboratory engineering mock-up MSS has performed investigations with participation of 29 subjects (Volunteers) under the modeling of hemodynamic shifts, developing in human body in short-term antiorthostatic hypokinesia (-10 degrees), as well as, in combined effect of antiorthostatic hypokinesia (-10 degrees), Coriolis acceleration and optokinetic stimulation. Results of investigations have showed, that the use of advanced MSS gives the indices of operator professional activity on the average of 17-32% under the decrease of hemodynamic stressful.

[Medical care for Russian cosmonauts' health on the ISS]

Established with the personal participation of O.G. Gazenko, the Russian system of medical care for cosmonauts' health has been largely preserved till this day. The system was fully functional on board the orbital complex MIR and, with appropriate modifications, has been adopted as a core of the medical care for Russian members of the ISS crews. In the period of 2000-2008, 22 cosmonauts were members of 17 ISS increments from 140 to 216 days in duration. The main functions of the medical care system were to control health, physical and mental performance, and to support implementation of space researches. The flow of readaptation to the normal gravity was, in most cases similar to what has been typical on return from the Russian orbital stations; some deviations are accounted for by application of the in-flight countermeasures. The paper familiarizes reader with some aspects of the theoretical work of academician O.G. Gazenko in the field of medical care in space flight. It outlines the principles of ISS medical management. The integrated medical support system combines medical equipment and items available on the Russian and US segments; the integrated medical group consists of flight surgeons, medical experts and biomedical engineers of the international partners and coordinates planning and implementation of medical operations. Also, challenges of health care on the phase of ISS utilization are defined.