2012 ABSTRACTS OF THE AsMA SCIENTIFIC SESSIONS 83RD Annual Scientifi c Meeting Atlanta Hilton May 13-17, 2012 Atlanta, GA

The following are the abstracts accepted for presentation after blind peer-review—in slide, poster, or panel sessions— at the 2012 Annual Scientifi c Meeting of the Aerospace Medical Association. The numbered abstracts are keyed to both the daily schedule and the author index. The order and numbering of some abstracts may have been changed.

CONFLICT OF INTEREST: All meeting planners and presenters completed fi nancial disclosure forms for this educational activity. All potential confl icts of interest were resolved before planners and presenters were approved to participate in the educational activity. Any confl icts of interest that could not be resolved resulted in disqualifi - cation from any role involved in planning, management, presentation, or evaluation of the educational activity.

Sunday, May 13 9:00 AM Sunday, May 13 12:00 PM Salon C Salon D WORKSHOP: AIRCREW FATIGUE: WORKSHOP: AEROSPACE MEDICINE CAUSES, CONSEQUENCES, AND FACULTY DEVELOPMENT WORKSHOP COUNTERMEASURES [2] AEROSPACE MEDICINE FACULTY DEVELOPMENT [1] AIRCREW FATIGUE: CAUSES, CONSEQUENCES, AND WORKSHOP COUNTERMEASURES D. RHODES J.A. CALDWELL1 AND J. CALDWELL2 Aerospace Medicine, USAFSAM, Wright-Patterson AFB, OH 1 2 Fatigue Science, Honolulu, HI; 711 HPW, Wright-Patterson WORKSHOP OVERVIEW: The purpose of this workshop is to AFB, OH provide presentations on current topics of interest to faculty of Aerospace Medicine residencies and fellowships. These presentations WORKSHOP OVERVIEW: In modern aviation operations, may also be of interest to faculty of other Preventive Medicine aircrew fatigue has become a serious but often unrecognized problem. Residencies including General Preventive Medicine and Occupational The unpredictable work hours, long duty periods, circadian disrup- Medicine. The presenters are all experienced faculty for Aerospace tions, and disturbed or restricted sleep that are commonly experienced Medicine programs. They will present topics aimed at improving by aviation personnel strain the body’s adaptive capabilities. The result teaching skills and providing proven methods for evaluating residents in is that crewmembers often report for duty in a fatigued state, and aerospace medicine. Any current or future aerospace medicine faculty because of this they make mistakes, respondIP: 192.168.39.151more slowly, experience On: Sun, 26 Sep 2021 17:39:09 Copyright: Aerospace Medicalmembers mayAssociation benefi t from these presentations and are invited to attend. cognitive diffi culties, and suffer mood disturbances that taken together Continuing Medical Education (CME) and Maintenance of Certifi cation often lead to performance problems and compromised safety.Delivered Aircrew by(MOC) Ingenta credit will be available for completion of this workshop. fatigue can be effectively mitigated, but only if scientifi cally validated strategies are systematically applied. These include 1) the implementa- tion of crew scheduling procedures that are based on up-to-date [3] EVALUATING RESIDENTS IN AEROSPACE MEDICINE scientifi c information about the underpinnings of fatigue; 2) the D. RHODES implementation of scientifi cally-based in-fl ight counter-fatigue Aerospace Medicine, USAFSAM, Wright-Patterson AFB, OH practices; 3) educating crew and crew schedulers on the importance of sleep and circadian rhythms in effective fatigue management; and 4) INTRODUCTION: The objective evaluation of residents in the utilization of effective strategies for optimizing off-duty sleep Aerospace Medicine can take many forms, from the multiple choice periods. Once comprehensive, scientifi cally-validated fatigue-risk examination to a structured evaluation of their clinical skills in a fl ight mitigation processes are fully integrated into the aviation safety system, medicine clinic environment. Another evaluation tool is the oral exam, fatigue can be effectively managed, and safety and performance can which can be utilized to not only evaluate knowledge fund on a subject, be optimized. The proposed fatigue workshop will outline the but also to view more subjective areas such as poise, competence, and importance of addressing fatigue as a danger in aviation, the basic how they organize their thoughts on the fl y to answer an aerospace physiological mechanisms underlying fatigue, and the most common medicine question. Other forms of evaluation can utilize simulated patient causes of fatigue in air transport and other settings. In addition, the encounters to evaluate a resident’s skill in taking a good history and workshop will present ways to recognize fatigue in operational physical examination to arrive at a diagnosis while being observed. All environments, and it will provide information about the relative of these methods can allow the aerospace medicine preceptor to gather effi cacy of various fatigue countermeasures. Participants will be suffi cient information to evaluate a resident’s ability to show mastery of provided with hard-copy materials that summarize the topics discussed the various competencies within Aerospace Medicine and to fi nally make as well as reference bibliographies that can be used to obtain further the judgment of that resident’s ability to practice independently. These information on specifi c issues. This workshop is aimed at those with a techniques and tools for evaluation of residents will be discussed. basic understanding of the problem of fatigue in operational environ- ments, and/or those who are anticipating new duty assignments in Learning Objectives: which they will bear some responsibility for the alertness management 1 The participants will learn various techniques and tools to evaluate of aviators or other personnel. No prior education in fatigue manage- aerospace medicine residents clinical skills and fund of knowledge ment, sleep, or circadian rhythms is required. in aerospace medicine

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 209 ASMA 2012 MEETING ABSTRACTS

[4] USE OF SERIOUS GAMING APPROACHES IN TRAINING medicine programs versus the spectrum of our stakeholder’s AEROSPACE MEDICINE SPECIALISTS expectations (ACGME, ABPM, Sponsoring institutions, future L. STEINKRAUS employers/organizations, faculty, residents and patients). Topics Mayo Clinic, Rochester, MN presented shall include: specifi c consideration stakeholder expecta- tions and their impact on curriculum; Subject matter weighting; INTRODUCTION: Serious Gaming (also referred to as Virtual effective communication of expectations, competencies and Reality) educational uses have grown steadily over the last two outcomes of the curriculum to the residents, residents and stakehold- decades, especially as computer-based Information Technology ers; weighting ACGME required subject matter and stakeholder capabilities have advanced. Faster processor speeds, larger memory, expected competencies versus the limitations of curriculum-time; the and improved software allow for multi-player, multi-level, high fi delity challenge of weighing experiential learning (rotations) versus didactic training scenarios. The challenge for the educator is to ensure educational units; and, the role of the faculty member in assessing appropriate educational goals and objectives are translated into resident competency. appropriate algorithms and heuristics within the simulated settings. Learning Objectives: METHODS: The process for developing a virtual aeromedical clinical teaching case will be presented and discussed. The trainee is presented 1 Participants will improve their knowledge and system-based with a pilot requiring an FAA medical certifi cation examination. As practice in the education of the 1 July 2011 ACGME Preventive part of the encounter the trainee interviews the patient, reviews and Medicine Program Requirements. completes the 8500-8, and makes decisions regarding further 2 Participants will recognize their roles in feedback process of cur- diagnostic testing, aeromedical disposition, and answers patient riculum weighting and assessing resident competency. questions. Evaluation of the encounter with respect to fund of 3 Participations will gain insight into the various residency programs’ knowledge, behaviors, and ACGME competencies will be discussed. stakeholder expectations. RESULTS: The use of this type of computer based training presents multiple opportunities for trainee assessment. Advantages to this type of training include accessibility, lower cost per training session, and [7] DEVELOPMENT OF RESIDENT TRAINING AND reliability with respect to training experience. Disadvantages include RESEARCH OPPORTUNITIES lack of direct hands-on clinical examination, possible loss of fi delity R.T. JENNINGS AND J.M. VANDERPLOEG based on the quality of the simulation, and need for computer access. UTMB, Galveston, TX Other advantages and disadvantages will also be presented and discussed. Initial results from a pilot study comparing Serious Gaming INTRODUCTION: Resident training and aerospace medicine and Standardized Patient simulation educational modalities will be specialty competency development can be augmented by numerous included in the presentation. activities outside of the classroom and traditional practicum rotations. This presentation will explore the role of Aerospace Learning Objectives: Medicine Grand Rounds and Journal Club and how these activities 1 The audience will understand the steps required to develop a Seri- can be developed, shared between residency programs, and attended ous Gaming based educational event for learners. by residents at practicum sites at any location. Techniques will be 2 The audience will be able to list two advantages and disadvantages presented to develop of a wide variety of practicum site rotations that of the use of Serious Gaming based simulation for educators. provide specialty competencies to comply with the residency’s specifi c mission and ACGME program requirements. The use of analog non-traditional training activities and PHTLS courses to [5] STATE OF THE ART AEROSPACE MEDICAL PHYSICAL develop clinical competencies, leadership, confi dence, and EXAMINATION point-of-injury care capability will be discussed. While residents are A.C. EMMEL usually focused on developing operational skills, their careers can be Aerospace Medicine, USAFSAM, Wright-Patterson AFB, OH maximized if they also fully understand the value of research in the IP: 192.168.39.151 On: Sun,fi 26eld Sepof aerospace 2021 17:39:09medicine. This session will include information on INTRODUCTION: Modern clinical practiceCopyright: requires aAerospace Medicalintegrating Association a resident research component into the aerospace suffi ciently complete and accurate physical exam despite theDelivered increased by medicineIngenta residency program. reliance on laboratory or imaging diagnostic evaluations, whether for rendering care, or simply for medical surveillance/fi tness for duty Learning Objectives: purposes. Effi cient performance of such a pertinent examination is too 1 Participants will gain an understanding of the value of Grand often assumed, infrequently taught beyond medical school, and even Rounds and Journal Club in teaching aerospace medicine to more rarely evaluated and validated on an individual practitioner residents basis. Effective and effi cient evidence-based physical examinations will 2 Participants will learn the value of non-traditional training activities be discussed. in aerospace medicine residencies 3 Participants will learn the value of the research component in the Learning Objectives: training of residents in Aerospace Medicine 1 The participants appreciate an understanding of an effective and effi cient evidence-based examination using current techniques and methods by which to evaluate and validate a provider’s ability to [8] INTEGRATING LEARNING MANGEMENT SYSTEMS INTO perform such exam independently in practice. RESIDENT EDUCATION AND MILITARY TRAINING USING SAKAI AS AN EXAMPLE J.T. WOODSON [6] CURRICULUM WEIGHTING OF THE ACGME PRE- Military and Emergency Medicine, Uniformed Services Univer- VENTIVE MEDICINE COMPETENCIES: PROGRAMMATIC sity of the Health Sciences, Bethesda, MD CHALLENGES FOR RESIDENTS, FACULTY, PROGRAMS AND STAKEHOLDERS INTRODUCTION: In the modern classroom or residency S.W. SAUER program, faculty members are faced with numerous challenges in US Army School of Aviation Medicine, Pensacola NAS, FL delivering academic content in a manner that supports students with diverse learning styles. While traditional lecture based or textbook INTRODUCTION: A podium presentation, with audience based approaches to coursework may be more familiar and more participation, to explore the challenges of curriculum weighting comfortable to the faculty member, the innovative application of a under the 1 July 2011 ACGME program requirements for preventive variety of teaching methodologies is more conducive to student

210 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS learning and more likely to result in long-term understanding. Many Monday, May 14 10:00 AM faculty members in both military and academic learning environments are in search of course delivery models that support varied teaching Exhibit Hall methods and are unfamiliar with the use of web-based learning management systems (LMS) to accomplish this goal. This session will POSTER: AIRCREW HEALTH AND MEDICAL focus on the techniques of integrating the innovative features of a popular open-source learning management system into graduate STANDARDS: I medical education and military training environments. Educators will fi nd the library of highy confi gurable tools in the LMS uniquely [11] THE ROLE OF NEW MEDICAL STANDARDS & adapted to providing cohesive presentation of diverse and multi-modal REGULATIONS IN ENHANCING THE AVIATION SAFETY IN course content in both distributed and physical classrooms. This sesion JORDANIAN CIVIL AVIATION REGULATORY COMMISSION will discuss the use of fl exible LMS tools such as blogs, graded K. KHALIL1, N. AL-KHAZALEH2, A.M. REFAI3 AND discussion boards, calendars, messaging, resource libraries, content W. RAMADAN4 distribution, gradebook functions, testing, surveys, polling, and 1Aviation Medicine Department, CARC, Amman, Jordan; integration with other teaching tools such as TurningTechnologies’ 2Medical Facility, Jordan Air Force, Amman, Jordan; 3Field audience response systems. Medicine, Royal Medical Services, Amman, Jordan; 4Medical Learning Objectives: department, Royal Jordanian Airlines, Amman, Jordan 1 After this discussion, you will better understand the means by INTRODUCTION: In Jordan for the last ten years all aspects of which you can use a Learning Management System (LMS) to sig- Aviation business has expanded fast including passenger and cargo nifi cantly improve the overall quality of your educational delivery transport. This expansion has led to an increase in the demand for model. other aviation industry branches to support that expansion to operate safely and successfully. One of these essential services that are [9] TIPS AND TRICKS USING NEW INNOVATIONS required is the medical service. To keep the operation in aviation R. ALLNUTT industry safe, secure and economical, the Civil Aviation Regulatory Commission (CARC) governed the aviation medical services by rules USAFSAM, Wright-Patterson AFB, OH and regulations to suit and matches the physical, mental and psycho- logical fi tness of the staff who operate and people who use that INTRODUCTION: New Innovations is a residency manage- business to the physiology of the aviation environment. METHODS: ment tool with incredible power for keeping track of many details for The Aviation Medicine System in Jordan consist of four sectors, The a residency program. Using this tool for aerospace medicine Aviation medicine department which rules all others sectors, The residencies involves some creative tinkering with the available Aviation Medicine Supreme Committee, The Aviation Medical options. METHODS: This presentation will concentrate on building Consultants and The Aviation Medical Examiners However this system useful evaluations (questionnaires) for faculty, resident, and program conduct and ruled the fi tness or disqualifying the AIRMEN by evaluation. Attendees will be polled for methods to improve faculty implanting new medical standards for class 1 & 2 medical certifi cate to participation in evaluations. RESULTS: Methods useful in scheduling, compensate with the European medical standards. RESULTS: During collecting evaluations, fi ling program letters of agreement, collecting the last 5 years, the number of disqualifying airmen was decreased to license and CV information, and general tips and tricks will be the half percent in comparison to the years before implanting the shared and collected from the attendees. aviation medicine system and the fl ight environments become more Learning Objectives: safe, secure and economical. DISCUSSION: The aviation sector keeps developing as a result of industry demand and because of fast 1 The overall objective will be achieved if all participants are more technology developments in the world, so the aviation medicine familiar with the program. system must be developed also to compensate the industry 2 The secondary objective will be to walkIP: away 192.168.39.151 from the presentation On: Sun,development. 26 Sep 2021 17:39:09 with a new trick that can be used. Copyright: Aerospace Medical Association Delivered byLearning Ingenta Objectives: [10] PREPARING RESIDENTS FOR THE BOARD 1 The Study shows how important are to establish a close and reli- CERTIFICATION EXAM, MAINTENANCE OF CERTIFICATION able contact relationship between the AIRMEN, Airlines companies and the AME with the Authority where the AIRMEN or the Airlines AND CONTINUING MEDICAL EDUCATION companies can seek advice when problems occur S. NORTHRUP 2 The Aviation Medicine System is important for making more spe- FAA, Atlanta, GA cialized evaluation and giving advice to the AMEs, the Airmen and to the Airlines industries. INTRODUCTION: Among the goals of Aerospace Medicine Residencies, establishing that the resident can practice aerospace [12] HEMOGRAM PARAMETER DIFFERENCES IN MILITARY medicine independently is likely the most important. Also important is that they complete the residency prepared to take the Aerospace PILOTS WITH OR WITHOUT NON ALCOHOLIC FATTY Medicine Board Certifi cation Examination. Faculty should devise a LIVER DISEASE 1 1 2 1 plan to ensure that residents are academically equipped to succeed in Z. DULKADIR , S. METIN , N. ATA AND A. AKIN board certifi cation. This presentation will discuss several ways this can 1Dept. of Aerospace Medicine, Gülhane Military Medical be accomplished along with discussing continuing education in Academy, Eskisehir, Turkey; 2Aircrew’s Health Research and aerospace medicine in general, and more specifi cally, the need to Training Center, Eskisehir, Turkey continue their education after graduation with Maintenance of Certifi cation. INTRODUCTION: Non-alcoholic fatty liver disease (NAFLD) is a group of conditions ranging from simple steatosis to fulminate Learning Objectives: hepatic failure. NAFLD is the most common chronic liver disorder in 1 Participants will learn methods of assisting residents in their prepa- the general population of industrialized countries, prevalence of 20% ration for the board certifi cation examination to 30%. The aim of this study is to determine the hemogram (complete 2 Participants will appreciate the importance of instilling in blood count) parameter differences in pilots with or without non residents habits of continued learning through Maintenance of alcoholic fatty liver disease (NAFLD). METHODS: The study popula- Certifi cation tion consisted of 1074 military pilots who applied for fi ve yearly

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 211 ASMA 2012 MEETING ABSTRACTS aircrew periodic medical examination between January 2007 and [14] AN ANTERIOR TALOFIBULAR LIGAMENT INJURY CASE December 2010. NAFLD was identifi ed in 78 pilots. 186 pilots did not AFTER G-LAB TRAINING get any diagnosis, that were used as control group. Pilots were S. ILBASMIS1, E. ERCAN1, T. KENDIRLI2, C. CENGEL3 AND excluded if they consumed more than 20 g of alcohol per week or get G. OKUR4 any diagnosis except NAFLD in the medical examination. Hemogram 1Health and Research, Aircrew’s Health, Research and Training (complete blood count) parameters of pilots with NAFLD were 2 compared with healthy group’s. Statistical analysis was performed Center, Eskisehir, Turkey; Neurology, Military Hospital, 3 using SPSS version 16 (Statistical Package for the Social Sciences: Eskisehir, Turkey; Orthopedics, Military Hospital, Eskisehir, Tur- Chicago, IL, USA). For comparing the two groups, the Mann-Whitney key; 4Radiology, Military Hospital, Eskisehir, Turkey U test was used. A signifi cance level of p < 0.05 was used throughout the study. RESULTS: In the NAFLD group, hemoglobin was INTRODUCTION: Human centrifuge (G-LAB) training allows 15.4661.10, hematocrit was 45.8163.13 and white blood cells was the trainer to re-establish and maintain his optimum performance by 6.9261.49. In the control group, hemoglobin was 15.0561.07, applying proper Anti-G straining Maneuver. During the training the hematocrit was 44.9062.96 and white blood cells was 6.4561.54. effects of hazardous high G environment is shown and the pilot is Signifi cant differences were found between two groups in hemoglobin trained how to cope with it. The objective of this study is to report an (p=0.005), hematocrit (p=0.027) and white blood cells (p=0.022), but interesting case of anterior talofi bular ligament injury after G-LAB not in Mean Corpuscular Volume, Red Cell Distribution Width and training. METHODS: A 26-year-old navy pilot candidate has applied Mean Platelet Volume. DISCUSSION: In the general population, with a left ankle pain and lateral malleol swelling complains after G-LAB patients with NAFLD often have elevated alanine aminotransferase training. RESULTS: The case had a G-LOC (G-induced loss of conscious- (ALT) and aspartate aminotransferase (AST) levels, with ALT > AST. The ness) during the training. After taking off his boots the pain became differences which we found in hemogram parameters should also be severe and he became not able to walk. His vital signs were blood taken into consideration for the further studies concerning NAFLD. pressure: 110/70 mmHg, heart rate: 67 beat/min, body temperature: 36,7°C. He was diagnosed as left ankle distortion after physical Learning Objectives: examination, laboratory analysis, and X-ray. Any foot or ankle fracture 1 The hemogram parameter differences relationship in military was not located. According to the left ankle MRI, anterior talofi bular pilots with or without non-alcoholic fatty liver disease (NAFLD) is ligament rupture was detected. A complete neurological examination described. containing EEG revealed no abnormality. The case is restricted from fl ying for 2 months with a left limb cast to recover. After recovery, he applied and completed his G-LAB training without any problem and [13] PROSTATA SPECIFIC ANTIGEN MEASUREMENTS AND returned his fl ight training. DISCUSSION: During the centrifuge training PROSTATE CANCER IN CIVILIAN PILOTES V.B. SOERENSEN some trainees develop G-LOC and session stops. While recovering from AND K. JESSEN AVIATION MEDICAL CLINIC, THE HEART G-LOC a kind of myoclonic contractions may develop. In addition to CENTER, RIGSHOSPITALET, UNIVERSITY HOSPITAL OF incapacitation period, due to these uncontrolled movements of COPENHAGEN, DENMARK extremities may risk fl ight safety. With this case we concluded that while recovering from G-LOC uncontrolled movements due to myoclonic V.B. SOERENSEN AND K. JESSEN contractions may give rise to this kind degree of injury. Also this case 4621 Aviation medical Clinic, Rigshospitalet, University Hospi- can be classifi ed as one of the complications of G-LOC. tal of Copenhagen, Copenhagen, Denmark Learning Objectives: INTRODUCTION: Screening of prostate cancer has been 1 Learning an extreme case that may be classifi ed in G-LOC discussed during the last years. The purpose of our study is to evaluate complications. the serum prostata-specifi c-antigen (PSA) blood samples and the occurrence of prostate cancer in civilian pilots. METHODS: Over a [15] RELATIONSHIP BETWEEN BODY MASS INDEX AND period of four years (June 2007- May 2011) 1962 PSA-samples from 846 Class 1 pilots were taken at renewalIP: of their192.168.39.151 medical certifi cate. On: Sun,APNEA-HYPOPNEA 26 Sep 2021 17:39:09 INDEX IN U.S. AIR FORCE AVIATORS The PSA was taken at the pilot’s request and/orCopyright: occurrence ofAerospace MedicalEVALUATED Association AT THE AEROMEDICAL CONSULTATION hematuria or known family history of prostate cancer. If the DeliveredPSA-value by SERVICEIngenta FROM 1999-2009 was > 4.0 µg/l the pilot was evaluated by the examiner and either W.A. RYDER, J. WOOD, J. HEATON AND J. HAYNES controlled with a second PSA or referred to an urologist for further USAFSAM, Wright-Patterson AFB, OH examination. Statistic analysis with one-proportion test was performed. RESULTS: In a population of 846 pilots with a mean age 5166,3 years INTRODUCTION: Obstructive sleep apnea (OSA) is a condition and mean PSA value 1,2561,2. 31 pilots had elevated PSA-value > 4.0 that is increasingly prevalent in both the civilian and U.S. Air Force µg/l. We found 9 pilots (mean age 54 years) with prostate cancer with (USAF) population. Due to the potential for neurocognitive defi cits, mean PSA-value 6,6 61,1 (5 with Gleason score 7 and 4 with Gleason including reduced attention and concentration, slower reaction time, score 6)(2 with clinical stage T1, 4 with T2 and 2 with T3). 7 prostate and impaired decision-making capability, OSA is disqualifying for cancers were registered in 2008, 1 in 2009, 0 in 2010 and 1 in 2011. fl ying status. USAF aviators with disqualifying medical conditions are In a second test 13 pilots exhibited a PSA-value < 4.0 µg/l, 6 pilots had often referred to the Aeromedical Consultation Service (ACS) for waiver normal biopsies and 3 pilots were awaiting follow up. The National consideration. The ACS has tracked several variables related to OSA Board of Health (NBH) in Denmark latest published incidence for including body mass index (BMI) and apnea-hypopnea index (AHI). cancer in 2007 is 1.37 pr. 1000 men. Our observed incidence in 2008 This study will examine the relationship between BMI and AHI in is higher showing a 6.5 fold higher incidence than expected. The aviators who have been evaluated for OSA at the ACS at least two incidence was less than expected in the other years. DISCUSSION: In times. METHODS: Patient data collected on USAF aviators with a our screening of prostate cancer over 4 years we observed a signifi cant diagnosis of sleep apnea from 1999-2009 who were seen at the ACS higher incidence than expected in 2008 and than published in 2007 multiple times will be reviewed. RESULTS: The relationship between by NBH. This suggests that our screening detects prostate cancer in a BMI and AHI will be analyzed. DISCUSSION: This study will elucidate cohort of pilots in 2007 and 2008 and only a few of this cohort the relationship between weight gain and severity of OSA. Flight developed prostate cancer in the following years. PSA is a poor surgeons should stress the importance of behavioral interventions to predictor for cancer staging in our cohort of pilots. aviators, such as weight loss through regular exercise and healthy diet, to minimize the potential impacts of OSA on fl ight safety. Learning Objectives: 1 Discussion of the present data. Learning Objectives: 2 Understand the interpretation of elevated PSA-values and the 1 Understand the importance of weight management for aviators concequences. with OSA.

212 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

[16] PREVENTION AND MANAGEMENT OF NECK AND accommodate the fl ying discipline and battle mission as soon as LOW BACK PAIN AMONG THE FINNISH AIR FORCE PILOTS possible. T. HONKANEN1, M.J. MÄNTYSAARI1, T.K. LEINO2 AND S. SIITONEN3 Learning Objectives: 1Aero Medical Centre, Centre for Military Medicine, Helsinki, 1 Pilot physical training 2 3 Finland; Air Force Command, Tikkakoski, Finland; Defence [18] THE RESULTS OF ELECTROPHYSIOLOGICAL Command, Helsinki, Finland STUDY OF TWO JET PILOTS WITH 1ST DEGREE INTRODUCTION: Both neck and low back pain are common ATRIOVENTRICULAR BLOCK DETECTED IN SURFACE among military pilots often limiting their fi tness to fl y. In a cross-sec- ELECTROCARDIOGRAPHY 1 2 2 2 2 tional survey in the Finnish Air Force (FINAF) 45 % of the pilots had C. OZTURK , T. CAKMAK , S. METIN , A. AKIN AND A. SEN experienced fl ight induced pain in neck and 31 % in low back during 1Dept.of Cardiology, Military Hospital, Eskisehir, Turkey; 2Dept. the previous year. The aim of this project is to prevent FINAF pilots’ of Aerospace Medicine, Gülhane Military Medical Academy, limitations in fi tness to fl y caused by dysfunction and overuse injuries Eskisehir, Turkey in neck and back. METHODS: Pilots undergoing annual aeromedical examination participate also a physical therapist’s (PT) examination INTRODUCTION: We present the results of electrophysiological and counseling session based on valid and reliable physiotherapeutic study of two jet pilots with 1st Degree Atrioventricular (AV) Block in measures. The procedure includes pain and disability questionnaire. their ECG, who applied for aircrew periodic medical examination. The examination includes assessment of posture and muscle length, METHODS: The fi rst case was a 29-year-old RF-4 jet pilot with 1st measures of spinal active range of movement (AROM), static muscle Degree AV Block (PR interval 24 ms). An electrophysiological study endurance tests and functional assessment. Posture is viewed from (EPS) was performed and the measurements were found as follows; front, back and sides. Muscle length of hip fl exor and hamstring Basic Cycle Length (BCL): 710 ms, Atrium His Interval (AH): 94 ms, muscles are measured with goniometer. Lumbar and thoracolumbar His Ventricular Interval (HV): 50 ms, AV Node Wenckebach Point: AROM is measured with Tape Measures and cervical AROM is 330 ms, Corrected Sinus Node Recovery Time (CSNRT): 300 ms. The measured with CROM -device. Static muscle endurance tests include sinus and atrioventricular node functions assessed as normal. The three minute trunk extensor test and fl exor tests and one minute neck second case was a 37-year-old F-16 jet pilot with 1st Degree AV block fl exor test. Functional assessment is done with squat and one-legged (PR interval 32 ms). EPS was performed and the measurements were as squat tests to defi ne functional lumbar and pelvic AROM and stability. follows BCL: 1026 ms, AH: 264 ms, HV: 34 ms, AV Node Wenckebach After examination pilot is given feed back and individually tailored Point: 680 ms, CSNRT: 728 ms. After 1 mg atropine administration, exercise program. Training involves mainly weight bearing exercises BCL was 728 ms, AH was 108 ms and after performing incremental made with resistant tubes or exercise balls. Use of standard resistance atrial pacing, AV Node Wenckebach Point decreased to 480 ms. training machines is limited. Exercises are focusing on power, strength, RESULTS: Both pilot had no signifi cant medical history. Physical balance and fl exibility and most of them are targeted at core muscles examination and biochemical tests were normal. Transthoracic of the abdomen and lower back muscles. DISCUSSION: Pilots’ echocardiography showed no structural heart disease. 24 hour attitude towards this project has been good. Pilots with back or neck rhythm Holter monitor records showed 1st Degree AV Block and dysfunctions are actively searched in the annual aeromedical Wenckebach AV Block in sleep period. The fi rst case with normal examinations. Pilots are given guidance regarding physical training EPS study measurements is permitted to fl y and he has been fl ying for methods as well as pre- and post-fl ight musculoskeletal care. Testing 6 months without having any problem. The second case was perma- and exercise methods are fi nancially feasible and easily adjustable to nently grounded due to supra-His defect (Vagotonic personality). fi eld conditions. The follow-up of the FINAF pilots using these methods DISCUSSION: 1st Degree Atrioventricular Block may indicate an is expected to reveal the individuals with high risk of neck or back underlying conduction disease or it can be seen in a totally healthy dysfunction and injuries. individual. EPS can be performed on aircrew as an effective and dependable method in order to decide whether they are fi t to fl y. Learning Objectives: IP: 192.168.39.151 On: Sun, 26 Sep 2021 17:39:09 1 The audience will learn the FINAF practice Copyright:for neck and backAerospace pain MedicalLearning Objectives:Association prevention and management. Delivered by1 Ingenta Emphasize that EPS is an effective and dependable method in aircrew with 1st degree Atrioventricular Block to decide whether [17] EFFECT OF PHYSICAL TRAINING ON THE PILOTS IN they are fi t to fl y HOSPITAL X. J.WANG AND L. ZHANG [19] IN-HOSPITAL MORTALITY IN PATIENTS ADMITTED The Center of Clinical Aviation Medicine, General Hospital of WITH CONCOMITANT THORACIC AND NON-THORACIC the Air Force, Beijing, China INJURIES AFTER CIVILIAN AIRCRAFT-RELATED ACCIDENTS P.H. LEE AND P. BENHARASH INTRODUCTION: To discuss the physical training prescription Surgery, UCLA, Los Angeles, CA and analysis the effect of physical training on the pilots in hospital with the medical supervision. METHODS: The physical training prescription INTRODUCTION: Survivors admitted after aircraft-related is decided according to the performance of health, function of organ, accidents are often associated with signifi cant injuries. A previous condition of usual train and age of pilot. The medical staff of the study demonstrated that approximately 11% are associated with a training center plan the item, time, intensity and frequency of training thoracic injury. In the face of multiple injuries, the impact of concomi- on the basis of the physical training prescription and hobbies of pilot. tant thoracic and non-thoracic injuries on clinical outcomes is RESULTS: In the 52 cases of pilots in hospital, the 27 cases (51.92%) unknown. METHODS: The Nationwide Inpatient Sample (NIS) from have signifi cant effectiveness, the 10 cases(19.23%) have better 2004 to 2008 was used to identify patients who had been admitted effectiveness, and the 15 cases(28.85%) have general effectiveness. The after an aircraft-related accident. Based on ICD-9 codes, patients were effective power is 71.15%. The intensity and frequency of train have a categorized based on the type of injury they sustained, including signifi cant effect to the train effectiveness (P<0.05). The item of train injuries to the thorax, spinal cord, long bones, pelvis, internal have a signifi cant effect to the train effectiveness (P<0.01). The item of abdominal and pelvic cavities, and brain. Patient age, sex, and training has a signifi cant effect to BMI. The effect of running plus ball in-hospital mortality were determined. RESULTS: Of the 40.3 million games or power train plus ball games is better than simple ball game patient discharges between 2004 and 2008 in the NIS database, 995 P<0.01). DISCUSSION: The physical training of pilot in hospital is patients were admitted with an aircraft related accident. Of these, effectively improve cardiopulmonary function, decrease the body 42.6% had thoracic and/or non-thoracic injuries, 11.4% had thoracic weight, and keeps the physical ability of pilots. It will profi t the pilot to with or without non-thoracic injuries, 31.3% had only non-thoracic

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 213 ASMA 2012 MEETING ABSTRACTS injuries, 4.5% had only thoracic injuries, and 6.8% had concomitant for aircrew periodic medical examinations in 3 months period selected thoracic and non-thoracic injuries. The mortality rates were 1.0% with for the study. Of 63, 33 determined as high performance aircraft pilots no injury, 4.8% with only non-thoracic injuries, 2.2% with only group (Group A) and 30 transport/helicopter pilots determined as thoracic injuries, and 10.3% with concomitant thoracic and non- control group (Group B). All selected pilots had over 1000 fl ight hours thoracic injuries. Although not statistically signifi cant (p=0.15), the and had no cardiovascular or respiratory health problems. Doppler mortality rate with concomitant thoracic and non-thoracic injuries echocardiographic MPI measurements of pilots were recorded and compared to only non-thoracic injuries was 2.14 times greater. Patients mean values of groups were compared. MPI is calculated as the sum of who died were older that than those who survived, regardless of the isovolumetric contraction time and isovolumetric relaxation time type of injury (48.7 vs. 53.4 years). DISCUSSION: Hospital admissions divided by ejection time. RESULTS: Mean values of left ventricle MPIs after aircraft-related accidents are relatively uncommon in the U.S. of group A and group B pilots were 0.50 6 0.18 and 0.52 6 0.10 However, when they do occur, they frequently present with multiple respectively. Mean values of right ventricle MPIs of group A and group injuries, including those associated with the thoracic cavity. There is a B pilots were 0.40 6 0.17 and 0.36 6 0.15 respectively. The differ- trend towards higher mortality when injuries include those to the ences between the mean MPI values of group A and group B pilots thoracic cavity and also with increasing age. Given the infrequent were not statistically signifi cant (p>0.05). DISCUSSION: There were nature of admissions after aircraft-related injuries, further analysis with not any statistically signifi cant differences between the mean values of larger data points is warranted to better determine factors that affect right and left ventricle MPIs of two groups. We concluded that long clinical outcomes among these patients. term G exposure has no negative effects on the right and left ventricu- lar myocardial performance. Learning Objectives: 1 To understand the impact thoracic injury has on outcomes after Learning Objectives: civilian aircraft accidents. 1 Learning one of the cardiac responses of long duration and high magnitude +Gz exposure. [20] ASCENDING AORTIC ANEURYSM AND AORTIC INSUFFICIENCY IN AN ASYMPTOMATIC HELICOPTER [22] DELIBERATE REINTEGRATION IN COMBAT CASUALTY PILOT EVACUATION: A FOCUS ON THE PATIENT C. OZTURK1, A. SEN2 AND A. YILDIRIM3 P.H. NELSON1, J. DANNER2 AND S. RINEER3 1TUR MC Eskisehir Military Hospital, Eskisehir, Turkey; 2TUR 181st Medical Group, Biloxi, MS; 2349 ASTS, Travis AFB, CA; AF, Eskisehir, Turkey; 3Emergency Medicine, Gulhane Military 3Naval Aerospace Medical Institute, NAS Pensacola, FL Medical Academy, Ankara, Turkey INTRODUCTION: Optimally, combat casualty evacuation INTRODUCTION: We present a case report of an asymptomatic decisions should be focused on the needs of each patient while helicopter pilot who was diagnosed with ascending aortic aneurysm applying the theater evacuation policy as a guide to meet operational and aortic insuffi ciency when a transthoracic echocardiogram requirements. These “Deliberate Reintegration” decisions, made by performed during annual fl ight physical. 35 year old male U-17 physicians, executed by nurse partners, and supported by a robust helicopter pilot visited our Aeromedical Examination Center for annual administrative function, should support service specifi c reintegration physical. It was the fi rst time the pilot was seen at our center. His programs. This joint multidisciplinary poster presentation will anamnesis, lab tests including metabolic panel and blood count, and introduce the concepts of deliberate reintegration, describing the EKG was normal. His height: 180cm, weight: 86kg, BP: 110/70 effects on joint and coalition medical and line units in a combat mmHg, HR: 76. Chest radiograph showed enlargement of ascending support role. The authors will explain how such a back-to-basics aorta. Transthoracic Echocardiography demonstrated an aneurismatic strategy will help patients while better supporting the line command- dilation of 6 Cm diameter in proximal ascending aorta and a mild (1+) er’s mission. Additionally, they will explain how this Deliberate aortic valve insuffi ciency. There was no sign to consider any other Reintegration can shape the future of patient evacuation by identifying aortic disease such as Ehlers Danlos diseaseIP: 192.168.39.151aortic or Marfan syn- On: Sun,and 26 mitigatingSep 2021 current 17:39:09 and future gaps, leading both to increased drome. The pilot was right away referred to CardiovascularCopyright: Surgery.Aerospace Medicalevacuation Association optimization and effi ciency. After CT and MRI performed, patient was operated. Pt was disqualifiDelivered ed by Ingenta from fl ying duties and being followed up by regular clinic visit. In Learning Objectives: conclusion, we consider that annual fl ight physical and echocardio- 1 Understand how “Deliberate Reintegration” decisions can change gram revealed a potentially fatal condition in this pilot. If left unde- combat casualty fl ow through the echelons of care tected, this condition could have resulted fatal consequences such as 2 Understand how “Deliberate Reintegration” strategies support cardiovascular collapse or aortic dissection either in daily activities or service specifi c reintegration programs during fl ight and causing aircraft mishap due to medical incapacitation. [23] COMPREHENSIVE DESCRIPTIVE STATISTICS OF U.S. Learning Objectives: CIVIL AVIATION AIRMEN AND AVIATION MEDICAL 1 Audience will learn about a case of an interesting and important EXAMINERS condition which might cause treat to fl ight safety. V. SKAGGS, A. NORRIS AND R. JOHNSON Civil Aerospace Medical Institute, FAA, Oklahoma City, OK [21] LONG TERM EFFECTS OF HIGH G EXPOSURE ON MYOCARDIAL PERFORMANCE INDEX INTRODUCTION: The annual Aeromedical Certifi cation Statistical Handbook reports descriptive characteristics of all active A. AKIN3, C. OZTURK1 AND S. ILBASMIS2 1 2 U.S. civil aviation airmen and the aviation medical examiners (AMEs) Cardiology, Military Hospital, Eskisehir, Turkey; Aircrew’s that perform the required medical examinations. This information has 3 Health, Research and Training Center, Eskisehir, Turkey; Aero- not been published since 1998. Recently, there has been a need and space Medicine, Gülhane Military Medical Academy, Eskisehir, interest to reinstate the annual report. The 2010 annual handbook Turkey documents the most recent and most widely relevant data on active airmen and AMEs. METHODS: Medical certifi cation records from INTRODUCTION: Myocardial performance index (MPI) has 2006-2010 were selected from the Document Imaging Workfl ow been defi ned as echocardiographic index of combined systolic and System (DIWS) which is the FAA medical certifi cation database. All diastolic myocardial performance. The objective of this study was to medical data were abstracted from the most recent medical exam. determine the long term effects of G exposure on myocardial Only those with a non-expired medical certifi cate remained in the performance index. METHODS: 63 military pilots who have applied dataset. AME records were selected from the Aviation Medical

214 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

Examiner Information System (AMEIS). The current status of each AME Monday, May 14 10:00 AM was determined for each year of the study period from 2008-2010, retaining only those with an active status. Airman variables include Exhibit Hall age, issued and effective medical classes, height, weight, BMI, gender, and FAA region of residence. AME variables include AME type, age, POSTER: TOPICS IN CLINICAL MEDICINE gender, medical specialty, pilot license status, senior examiner status, and region. RESULTS: As of December 31, 2010, there were 598,642 [25] CREW STRESS MANAGEMENT DURING JAPAN medically certifi ed airmen aged 16 and older, and 30.9%, 22.1%, and ENVIRONMENTAL CRISIS (MARCH 2011) 47.0% were issued a Class 1, Class 2, and Class 3 medical certifi cate, S. STEVENS, G. DESMARIS AND C.A. MOUSSU respectively. Across all medical classes, the average age was 44 years Air France, Roissy Charles de Gaulle, France and 93.5% of the airmen were male. The mean BMI for both females and males was 24.2 and 27.3 respectively. Of the 3,651 active AMEs, INTRODUCTION: An unprecedented combination of crises - 93% were civilian, 2.4% federal, and 4.6% military. Nearly 50% uncommon earthquake, tsunami, nuclear disaster - has impacted Japan reported their medical specialty as family practice. The AMEs had an since March 11th. The worldwide community was quickly concerned average age of 59.4 years, the majority (52%) did not hold a pilot as the global atmosphere could be affected by radiations. Was the license, and 82% were male. DISCUSSION: This report contains safety of travellers, employees, and supplies endangered? METHODS: widely requested data on the active U.S. civil airmen population that Several Air France crew were staying in Tokyo and Osaka at that time. has not been readily accessible since 1998. This report will be updated Some were blocked during 36 hours, though they did not suffer annually and will be used by the aerospace community including FAA physical injury. Flights continued since there were no restrictions on leadership, aerospace researchers, advocacy groups, legislative staff air travel to Japan by statement of WHO, OACI, IATA on March 18th. and the general public. Nevertheless, many questions arose like food safety, radiation related Learning Objectives: health problems, information support, concern about a new nuclear explosion. Risk assessment and employee protection were required 1 Descriptive statistics of active U.S. civil aviation airmen and avia- hour by hour. Mostly psychological and radiation exposures were tion medical examiners in 2010 will be presented. constantly monitored .Specifi c measures were taken as the situation evolved quickly and will be described. RESULTS: Radiation is often a [24] NASAL DEVIATED SEPTUM VERSUS INCIDENCE OF source of polemic .The medical department was right in the center of BAROTITIS the emergency response team. Communication and international I.S. ABDOU cooperation were key. Occupational Health Services gave continuous advice and mediation in the discussion between unions and Manage- Otorhinolaryngology, Egyptian Aeromedical Board, Misr Elgedida, Egypt ment. This experience expresses the importance of the occupational medicine at a time when medical demography in France is decreasing INTRODUCTION: Introduction: the purpose of this study was to and government reforms are expected soon. know the effect of different forms and degrees of nasal septum deviation on the incidence of barototis. Egyptian AF cadet applicants Learning Objectives: attempt an altitude chamber fl ight to access their suitability as future 1 to share a specifi c experience in a worldwide crisis fi ghters. Recording of the incidence of Barotitis was done and 2 to show psychological and radiation monitoring and the impact of analyzed with character of deviation were analyzed to know whether communication in these topics or not play a role on development and/or degrees of barotitis. METHODS: 224 healthy male Egyptian AF cadets divided into 2 [26] ULTRASOUND CHARACTERIZATION OF CERVICAL groups, received a thoroughly ENT examination by an otolaryngolo- SPINE ANATOMY gists.114 cadets group(1),control group where all of them have fair E. ANTONSEN1, D. BUCKLAND3, D. PALLIN1, S. SHEEHAN1 nasal anatomy and function.110 cadets group(2),a group where all of 2 cadets have variable forms and degrees ofIP: septal 192.168.39.151 deviation. before On: Sun,AND 26 SepA. LITEPLO 2021 17:39:09 1 chamber rides 11 cadets of group 2 were excludedCopyright: because ofAerospace having MedicalEmergency Association Medicine, Brigham and Women’s Hospital, Boston, (acute rhinitis, common cold,...etc) the remaining 99 cadets representDelivered byMA; Ingenta 2Emergency Medicine, Massachusetts General Hospital, the stem of group 2.all cadets attempted an altitude chamber fl ight to Boston, MA; 3Massachusetts Institute of Technology, 10.000 feet, the rate of ascent and descent3000 ft/min. followed by Cambridge, MA otoscopic examination to detect the side (Rt.,Lt.,bilateral) and the degree of barotitis. RESULTS: of the group(2), 82 out of 114 cadets INTRODUCTION: Back and neck pain allegedly related to developed no barotitis (72%)and 32 cadets develope barotitis intervertebral disc (IVD) disease is a frequent problem among Army (28%),the cadets with barotitis were as follows ( bilateral, 13 aviators and NASA astronauts. Currently, there is no validation of static cadets(41%),right barotitis 8 (25%),left barotitis 11 (34%) in ultrasound measurements of spinal parameters when compared with group(2),33cadets develop no barotitis(33%)and 66 cadets developed CT scan. Given issues of shadowing and artifact, future use of ultrasound barotitis(66%).the cadets with barotitis were as follows ( bilateral, 22 for static and dynamic spinal measurements depends on validation and cadets(33%),right barotitis 15 (23%),left barotitis 29 (43%).it also noted characterization of normal anatomic features. We show that clinical that in 46%of group(2),septum was deviated to the left,40% to the ultrasound (U/S) can provide a portable imaging modality to quantify right,6.5% with septal spure and 6.5% have s-shaped deviated septum. cervical spine IVD height and anatomic features when compared with it`s also noted. DISCUSSION: Eustachian opening is closely related to other CT imaging. We also assess normal IVD stretch in fl ex-ex the nasal septum being posterior & in the lateral wall of nasopharynx, ultrasound imaging. METHODS: Adult human subjects in an Emergency Blocking the nasal passage by deviated septum can lead to repeated Department setting were evaluated with U/S imaging of the cervical infection and nasal dryness .a higher incidence of Barotitis Media was spine after having clinically required CT scan. Volunteers were scanned noted at 66% with septal deviation compared with 28% in control with U/S only to assess typical changes in IVD height with changes in group.as regard the location of septal deviation, anterior location is neck positioning. U/S image measurements of spinal parameters were much less (8 cadets)than posterior (35) and anroposterior(43).and consistent with CT measurements for IVD height and vertebral body incidence of barotitis was 5%,53%,65% respectively. height, and Cobb angle when positioned similar to positioning in those scanners. Artifact did not compromise the comparison. RESULTS: Static Learning Objectives: IVD height vertebral disc height, and Cobb angle measured by U/S was 1 in otorhinolaryngology.barotrauma is very important,barotitis is the consistent with the data from CT. Flex-ex positioning allows character- most common followed by barosinusitis, ization of IVD compression and stretch. DISCUSSION: We demon- 2 barotitis media is the commonest of all types of barotitis and it strated that U/S measurements of cervical spinal anatomy is consistent almost occur during descent with measurements from CT. This suggests that current clinical

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 215 ASMA 2012 MEETING ABSTRACTS

U/S systems can be used to provide a low cost, portable, non-irradiative [29] HYPERBARIC OXYGEN THERAPY IN BRANCH RETINAL method to measure cervical spine and cervical IVD disc anatomy. ARTERY OCCLUSION SECONDARY TO ACUTE RHEUMATIC Flex-ex ultrasound imaging of the cervical spine provides characteriza- FEVER tion of IVD anatomy with positioning changes. G. GOKCE1, S. METIN2 AND Y. GOKOGLAN3 1 Learning Objectives: Ophthalmology, Sarikamis Military Hospital, Kars, Turkey; 2Aerospace Medicine, Gulhane Military Medical Academy, 1 Learn how ultrasound can be used to image the cervical spine IVD 3 anatomy and how it compares to other imaging modalities. Eskisehir, Turkey; Cardiology, Gulhane Military Medical 2 Characterize anterior IVD dimensions with positioning changes. Academy, Ankara, Turkey

[27] THE CANCERS IN KOREAN AIR FORCE PILOTS INTRODUCTION: The purpose of the study is to report a J. LIM 18-year-old woman who presented with sudden right visual acuity (VA) loss from a branch retinal artery occlusion (BRAO) secondary to Aerospace Medical Center, Chungwongun Chungbuk, Republic acute rheumatic fever (ARF) and underwent hyperbaric oxygen (HBO) of Korea treatment. METHODS: A 18-year-old woman was referred for acute onset of blurred vision in her right eye. Ocular and extra ocular INTRODUCTION: Pilots are exposed to carcinogenic substances fi ndings, optic coherence tomography (OCT) and fl uorescein like radiation, ozone, exhaust gas from jet engine, and electromagnetic angiography (FA) results, echocardiographical images were described. wave, their environment can be very hazardous. I designed this study to RESULTS: She had a history of ARF when she was 12 year old and she know if there is any difference between pilots and general people in had been given penicillin-G benzathine at a dose of 1.2 million U IM cancer incidence. METHODS: I analyzed cancer cases between 1999 q4wk for seven months as a prophylaxis which must have been given and 2008, and investigated their age, site, aircraft types, and sex. at least for 10 years from the last episode. When she came, 28 hours I compared pilot’s cancer incidence with general people’s during same had passed through the acute event. Ophthalmological examination period. Statistical analysis was done with standardized incidence revealed a VA of 20/30 with a superior altitudinal scotoma in the right ratio(SIR). RESULTS: 10 cases were high performance pilots, 5 cases eye. Anterior segment examination was normal. Fundoscopic were low performance pilots. The average age when the diagnosis had examination of the right eye showed a white calcifi ed embolus been made was 3967.8. Pilot’s incidence ratio was lower than occluding the inferior temporal branch of the central retinal artery, people’s, the most common cancer was kidney, and there was no lung associated with mild retinal oedema. FA confi rmed the non-fi lling of cancer. DISCUSSION: Cancer is infl uenced by gene and environment, the inferotemporal branch retinal artery. OCT proved the retinal nerve each country has different patterns. The low incidence ratio in Korean fi ber enlargement. In consultation with the cardiologist mitral valve pilots might be due to “healthy worker effect”. I think we should disease was diagnosed. Echocardiographical assessment demon- perform further investigation on kidney cancer. strated thickened and calcifi ed mitral valves. HBO therapy was decided to perform on the patient. The patient was treated by a single Learning Objectives: session of 2 hours of HBO at 2.5 ATA for 11 days. VA rised to a level 1 Cancer patterns in pilots of 20/20 for the right eye but the scotoma were not completely disappeared after using of the HBO treatment. The scheduled [28] CORTISOL INCREASES HYPOXIA-INDUCIBLE treatment was completed succesfully without any complication or FACTOR-1 TARGET GENE EXPRESSION ESSENTIAL FOR coincidental medical event. DISCUSSION: BRAO can occur anytime WOUND HEALING IN SKIN FIBROBLAST CELLS in patients with a history of ARF and inadequate prophylaxis and T. HIGASHINO1,2, T. HISADA2, S. TACHIBANA2, K. OGATA2 HBO therapy can be used as an effective treatment for BRAO even in AND Y. SAKURAI2 the late period. 1 Japan Air Self-Defense Force Air Staff Offi ce, Tokyo, Japan; Learning Objectives: 2National Defense Medical College, Tokorozawa, Japan IP: 192.168.39.151 On: Sun,1 26 Adequate Sep 2021 prophylaxis 17:39:09 is essential for preventing the cardiac and ophthalmic complications of acute rheumatic fever INTRODUCTION: Relative hypoxia plays a pivotal role in Copyright: Aerospace Medical2 HBO Associationtherapy is an effective treatment for arterial occlusions even wound healing, and expression of the transcription factor hypoxia- Delivered by Ingentain the late period inducible factor 1 (HIF-1)-related genes such as heat shock protein 90 (HSP-90) and stem cell factor (SCF) is suggested to be essential for this wound healing. Many dermal ointments contain the endogenous [30] THE USE OF HYPERBARIC OXYGEN THERAPY IN glucocorticoid cortisol, and previous studies have reported that TRAUMATIC OPTIC NEUROPATHY ASSOCIATED WITH synthetic glucocorticoid dexamethasone modulates HIF-1-dependent BLUNT HEAD TRAUMA FOLLOWING AN AIRCRAFT gene expression in non-fi broblast cells such as HeLa cells. Therefore, ACCIDENT- CASE REPORT we conducted the present study to investigate the effects of cortisol on S. METIN1, G. GOKCE2, T. CAKMAK1, U. ERDEM3 AND HIF-1-induced gene expression essential for wound healing in skin 1 fi broblast cells. METHODS: Human skin fi broblast cells were exposed A. AKIN 1 to 21% O2 (normoxia) or 1% O2 (hypoxia) in the presence or absence Aerospace Medicine, Gülhane Military Medical Academy, of cortisol. Luciferase assay was performed using 3× HRE-tk-Luc Eskisehir, Turkey; 2Department of Ophthalmology, Sarikamis reporter plasmid to investigate HIF-1-mediated transcriptional activity. Military Hospital, Kars, Turkey; 3Department of Ophthalmology, mRNA levels of the HIF-1 target genes HSP-90 and SCF were Gulhane Military Medical Academy, Ankara, Turkey measured using real-time quantitative PCR. RESULTS: HIF-1-mediated transcriptional activity under hypoxia increased 3.4-fold compared INTRODUCTION: Optic nerve injuries occur commonly after a with that under normoxia and an additional 1.7-fold on cortisol traffi c accident or head injury from fall. It may happen loss of visual treatment compared with that of the vehicle. mRNA levels of HSP-90 function. We present a case who had an optic nerve injury associated and SCF under hypoxia increased 1.6- and 2.8-fold, respectively, with blunt head trauma following an aircraft accident and the usage of compared with those under normoxia and in additional 1.5 fold by the Hyperbaric Oxygen (HBO) Therapy as an alternative treatment treatment with cortisol under hypoxia. DISCUSSION: Our data suggest method. METHODS: A M-18B Dromader aircraft ran off the runway that cortisol enhances HIF-1-induced gene expression, thereby and tumbled. 47-year-old male pilot had a blunt head trauma. In his indicating possible infl uences on wound healing. brain MRI there were multiple milimeter sized gliosis formations in supratentorial subcortical and deep white matter localized in both Learning Objectives: frontoparietal areas. The images of other parts of the brain were 1 The audience will learn about the effect of cortisol on HIF-1 in- assessed as normal. The (patient presented with) PILOT HAD a duced gene expression essential for wound healing. complaint of blurred vision which was developed 3 days after the

216 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS accident. On ophthalmic examination; his best corrected visual acuity [32] A PRELIMINARY STUDY FOR ACUTE EFFECTS OF (BCVA) was 20/40 in the right eye and 20/32 in the left eye. Slit lamp [|#11#|]NIGHT VISION GOOGLES ON MULTIFOCAL ERG anterior segment examination and intra ocular pressure were normal in F.C. GUNDOGAN1, U. ERDEM2, A. BAYER2 AND G. SOBACI2 both eyes. Dilated fundus examination showed bilateral optic disc 1Ophthalmology, Etimesgut Military Hospital, Ankara, Turkey; pallor particularly affecting the temporal segments. Humphrey Visual 2Ophthalmology, Gulhane Military Medical Academy, Ankara, Field Analyzer revealed bilateral centrocecal scotomas. The patient was treated by a single session of 2 hours of HBO at 2.5 ATA for 17 Turkey days. RESULTS: BCVA rised to a level of 20/25 for the right eye and 20/20 for the left eye and the scotomas were completely disappeared INTRODUCTION: The multifocal electroretinogram (mfERG) is immediately after HBO treatment. DISCUSSION: Compression and a technique devised in the early 1990s by Sutter. It allows for the contusion of the optic nerve worsens the ischemia by causing a simultaneous recording of many, spatially localized ERGs and has compartment syndrome. The decreased blood supply of the ganglion proved to be very useful in identifying areas of decreased retinal nerve cells causes cell death. Some neurons surrounding the dead responsiveness in diseases affecting the retina. We aimed to analyze neurons called ‘‘idling neurons’’ are little effected by hypoxia and the acute effect of night vision goggles (NVG) usage on retinal infl ammation. They are alive but dysfunctional. HBO treatment functions via multifocal electroretinogram (mfERG) values. reactivates these neurons, decreases the intra-compartmental pressure, METHODS: Thirty healty male subjects without any known systemic ameliorates the mitochondrial mechanism and inhibits lipid (including diabetes and systemic arterial hypertension) and ocular peroxidation. disease were included. The mean age of the participants was 27.364.2. The mfERGs were recorded at the same room illumination Learning Objectives: (10 cds/m2) and temperature levels (20°-22°) with Roland RetiScan system (Wiesbaden-Germany) before and after one-hour use of ANVIS 1 HBO therapy can be used as an alternative treatment for traumatic NVG (with Omnibus IV tube). All the recordings were made in optic neuropathy caused by blunt head trauma following an aircraft accordance with ISCEV guidelines. Concentric ring analysis including accident. the central hexagon (CH) and Ring 1-4 were considered to compare P1 and N1 amplitude and implicit times. The differences between the [31] THE ITALIAN AIR FORCE MEDICAL ADVISORS TEAM before- and after-recordings were compared using independent EXPERIENCE IN SHINDAND AIR BASE samples t test. RESULTS: There was signifi cant reductions in P1 and A. AUTORE, P. CARROZZO, P. TRIVELLONI, G. ANGELINO, N1 amplitudes in after-NVG use in the CH, R1 and R2 (p<0.01). However, the lower P1 and N1 amplitude obtained in after-NVG R. TREZZA, R. VITALONE, F. PIRRI AND G. CINIGLIO usage in R3 and R4 were not statistically signifi cant (p>0.05). The APPIANI differences between the implicit times in the CH and in all rings were Flight Test Center, Aerospace Medicine Department, Italian Air signifi cant. DISCUSSION: The results of this study showed the acute Force, Pomezia (RM), Italy depressing effects of NVG use on retinal functions and may help explaining the macular functional impairments in long-term use of INTRODUCTION: Since November 2010, the Italian Air Force NVG in the literature. The time-relevance of this acute depressing Medical Personnel is involved in the NATO Training Mission for effect warrants further studies. Afghanistan (NTM-A), whose mission is to support the Government of the Islamic Republic of Afghanistan in the development and training of Learning Objectives: the new Afghan National Security Forces (ANSF). One Medical 1 The relationship between night vision googles and multifocal Advisor/Surgeon and one Medical Advisor/Nurse are working within elecroretinogram the 838th Air Expeditionary Advisory Group of the U.S. Air Force in Shindand Air Base, destined to become the main fl ight training center of the Afghan Air Force (AAF). Their duty is to help the training of the [33] EFFECTS OF THE ECONOMIC RECESSION ON THE LIFE- AAF Medical Staff of the base clinic, with particular reference to STYLE AND WORKLOAD: MEDICAL CONSEQUENCES FOR aerospace medicine related activities. METHODS:IP: 192.168.39.151 To establish the On: Sun,MILITARY 26 Sep 2021AIRCREW 17:39:09 priorities, the Medical Advisors conducted an initialCopyright: assessment Aerospace whose MedicalE. TÓTH 1Association, Z. ADORJÁN2, M. DUDÁS1, E. TÓTH1 AND results were the following: requirements for emergency medical care, Delivered byA. Ingenta GRÓSZ3 requirements for ground and air medical evacuation capabilities, 1 assignment of permanent Flight Surgeon to implement base medical Research Dept., Aeromedical, Health Evaluation and Research 2 planning and assignment of medical personnel and equipment to fully Institute, Military Hospital HDF, Kecskemét, Hungary; Central manage all the clinic activities. RESULTS: The main activities under- Dietetics Service, Military Hospital, HDF, Budapest, Hungary; taken during the fi rst year covered different areas. The base clinic was 3Aerospace Medicine, Faculty of Medicine, University of rearranged and a new emergency room was set up. The afghan staff Szeged, Kecskemét, Hungary was instructed on how supplies are ordered, collected and inventoried. The emergency response training was started with exercises involving INTRODUCTION: The authors performed a survey of the other AAF agencies (Firefi ghters and Security Forces). The Medical military pilots, who arrive for annual medical evaluation at Aeromedi- Advisors worked to collect all the medical equipment and in the cal, Health Evaluation and Research Institute, focused on their lifestyle training for MEDEVAC operations. The AAF Medical Personnel was and workload, at the beginning and end of a fi ve-year period including therefore able to fl y real missions. DISCUSSION: The new task for the the economic recession as well. The evolution of the degree of the Italian Air Force Medical Personnel in Shindand has shown since the infl uence of these factors on the risk of cardiovascular diseases and the beginning to be challenging, involving complex medical and operative pilots’ compliance with the strict professional requirements were issues, having the advisors to create interpersonal relationships with studied. METHODS: The study involved 100 people selected from the the afghan counterpart based on trust, but specially having to deal with pilot population on a random basis, and was performed using a afghan culture and logistics still unfamiliar with the needs of a modern questionnaire survey based on a questionnaire compiled by the air force. authors (“Lifestyle”), and a psychological questionnaire (“Changes in Life in the Near Past”). The assessment took into account such data Learning Objectives: taken during the fi tness evaluation which was important from the 1 To understand the continuing need of international engagement for aspect of risk of IHD (circumference of the waist, blood lipid param- developing of credible Afghan National Security Forces. eters, resting blood pressure values, performance with submaximal 2 To understand specifi c challenges facing coalition forces members load with bicycle ergometry), and the cortisol levels measured in saliva with the sustainment of AAF Medical Services samples taken in the morning of the day of the survey. The menus used 3 To stimulate future conversation and approaches in the at the service locations were used in the analysis of eating habits. development of a nation’s military medical service. RESULTS: A comparison of the results received at the beginning and

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 217 ASMA 2012 MEETING ABSTRACTS end of the study period showed that adverse changes in lifestyle and hypoxia and hypobaria. This study was performed to compare the workload resulted in increased stress/mental tension, the occurrence changes of hematologic and biochemical parameters in the blood and severity of IHD risk factors increased, as well as the risk of between beginner pilots and estabilshed pilots during altitude occurrence of a fatal cardiovascular event within 10 years. chamber training. METHODS: Seventy beginners and 65 estabilshed pilots were recruited for this study. Before and after the altitude Learning Objectives: chamber training (39,000 ft, 75 mins for beginners; 35,000 ft, 1 Improving the situation is a complex commanding, logistic, 85 mins for estabilshed pilots), hematologic (RBC, WBC, hemaglobin, medical and psychological task, but the adoption of risk-reducing hematocrit and platelet) and biochemical parameters (AST, ALT, total nutrition and lifestyle unconditionally requires the pilots’ active bilirubin, direct bilirubin, total protein, gamma-GT, BUN, creatinine, participation as well. uric acid, LDH, inorganic phosphorus, calcium, amylase and CPK) were measured in each subject. The differences of the parameters before and after the training were compared to each group with a [34] ZOTAROLIMUS INHIBITS HYPOXIA-INDUCIBLE t-test. RESULTS: WBCs were slightly increased in both beginners FACTOR-1-DEPENDENT NOS3 EXPRESSIONS IN HUMAN (29061730/mm3) and established pilots (47061310/mm3). All UMBILICAL VEIN ENDOTHELIAL CELLS hematologic parameters, except WBC, were decreased after the T. HISADA1, T. HIGASHINO2, S. TACHIBANA1, K. OGATA1 training in both groups and there was no statistical signifi cant AND Y. SAKURAI1 difference between beginner and estabilshed pilots. The serum levels 1National Defense Medical College, Tokorozawa, Japan; (IU/L) of total bilirubin, direct bilirubin, inorganic phosphorus were 2Japan Air Self-Defense Force Air Staff Offi ce, Tokyo, Japan decreased after the training, but the extents of the decrease were signifi cantly greater in beginners (-0.3360.49, -0.1060.54 and INTRODUCTION: Drug-eluting stent (DES) implantation is -0.6560.54, respectively) than those of the established group widely used for treating coronary stenosis because its rate of in-stent (-0.1160.32, -0.0360.07 and -0.2460.56, respectively). The serum restenosis is lesser compared with that of bare-metal stents. However, level of amylase was more signifi cantly increased in beginners previous studies have reported several side effects such as prolonged (11.8628.1) than in established pilots (4.1615.1) BUN levels were endothelial dysfunction after DES implantation. Nitric oxide synthase decreased in beginners but slightly increased in established pilots. DISCUSSION: The changes of biochemical parameters of beginner 3 (NOS3), also known as endothelial NOS, generates nitric oxide in endothelial cells and regulates vascular tones by vascular smooth pilots during the altitude chamber training signifi cantly differ from muscle relaxation. The NOS3 gene is also known as a target gene of those of established pilots, but the hematologic parameters do not the transcriptional factor hypoxia-inducible factor-1 (HIF-1). differ. Zotarolimus, a semi-synthetic derivative of rapamycin, is an antiproliferative agent used for DES implantation. Rapamycin Learning Objectives: reportedly inhibits HIF-1-dependent gene expression through 1 To understand how the hypobaric condition causes different inhibition of activity of mammalian target of rapamycin (mTOR). changes of hematologic and biochemical parameters by his/her Therefore, this study aimed to investigate the effects of zotarolimus fl ight experience or tolerance on HIF-1-induced NOS3 expression essential for endothelial function in human umbilical vein endothelial cells (HUVEC). METHODS: HUVEC were cultured under normoxia (21% O2) or hypoxia [36] EFFECTS OF 29 HOURS SLEEP DEPRIVATION ON (1% O2) in the presence or absence of zotarolimus or rapamycin. LOCAL COLD TOLERANCE IN HUMANS Luciferase assay using 3x HRE-tk-Luc reporter plasmid was performed F. SAUVET to investigate HIF-1-mediated transcriptional activity. mRNA levels IRBA, Bratigny sur Orge, France of NOS3 and adrenomedullin (ADM; positive control) were analyzed by real-time quantitative PCR. RESULTS: Hypoxia induced INTRODUCTION: To study the effects of a 29-h total sleep HIF-1-mediated reporter activity in 5.3 fold compared to normoxia deprivation (TSD) on local cold tolerance, 10 healthy men immersed and both zotarolimus and rapamycin treatmentsIP: 192.168.39.151 signifi cantly On: Sun,their 26 Sepright hand2021 for 17:39:09 30 min in a 5°C water bath (CWI) after a 30-min inhibited this inducition by hypoxia. mRNA levelsCopyright: of NOS3 Aerospace and Medicalrest period Association in a thermoneutral environment (Control), after a normal ADM under hypoxia increased by 1.4- and 3.1-folds, respectively,Delivered by nightIngenta (NN) and after a 29-h TSD. CWI was followed by a 30-min compared with those under normoxia, and the levels were attenuated passive rewarming (Recovery). METHODS: Finger 2 and 4 skin by zotarolimus and rapamycin treatments. DISCUSSION: Our data temperatures (Tfi 2, Tfi 4) and fi nger 2 cutaneous vascular conduc- suggest that not only rapamycin but also zotarolimus inhibit tance (CVC) were monitored to study cold-induced vasodilation HIF-1-induced NOS3 gene expression, thereby indicating its possible (CIVD). Moreover, rectal temperature (Tre), mean skin temperature ( ), infl uences on endothelial dysfunction. heart rate (HR) and blood pressure (BP) were measured. Blood samples were collected at the end of Control, at the lower and at the Learning Objectives: fi rst maximal Tfi 2 values during CWI and at Recovery. RESULTS: Tfi 2, 1 The audience will learn about the inhibitory effect of zotarolimus Tfi 4 and CVC didn’t differ after TSD at Control, whereas they were on HIF-1 induced NOS3 gene expression essential for vascular lowered during CWI (-2.6+/-0.7°C for Tfi 2; -2+/-0.8°C for Tfi 4, tone. -79+/-25% for relative CVC, P<0.05) as during Recovery (-4.9+/-1.9°C for Tfi 2, -2.6+/-1.8°C for Tfi 4, -70+/-22% for relative [35] COMPARISON OF THE CHANGE OF HEMATOLOGIC CVC, P<0.05). After TSD the lower CVC values appeared earlier AND BIOCHEMICAL PARAMETERS BETWEEN BEGINNER during CWI (-59+/-19.6s, P<0.05). After TSD at Control and CWI, AND ESTABLISHED PILOTS DURING THE ALTITUDE plasma endothelin levels were higher and negatively correlated to CHAMBER TRAINING Tfi 2, Tfi 4 and CVC. However, no effet of TSD was found in the number and amplitude of CIVD and in Tre, HR, BP and catechol- E. JEON1, H. KIM1, B. CHUN2, J. CHUNG1 AND S. BYUN3 1 amines, whatever the period. DISCUSSION: We conclude that TSD Aerospace Medical Center, Cheongwon-gun, induces thermal and vascular changes in the hand which impair the 2 Chungcheongbuk-do, Republic of Korea; Department local cold tolerance suggesting that TSD could increase the risk of of Preventive Medicine, Korea University College of Medicine, local cold injuries. Seoul, Republic of Korea; 3Venture & Information, Seoul, Republic of Korea Learning Objectives: 1 Evaluate impact on sleep deprivation on local tolerance to cold INTRODUCTION: Altitude chamber training is used to 2 Assess the cardiovascular adaptation to cold simulate the effects of high altitude on the human body, especially 3 Assess consequencies of sleep deprivation in healthy subjects

218 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

[37] THE ROLE OF AEROMEDICAL CENTER ON A CIVIL [39] EVALUATING SLEEP AND REST GUIDANCE FOR AN AIRLINE ULTRA LONG-RANGE (ULR) FLIGHT OPERATION Y. CHOI, Y. JEONG AND Y. YUN S. ALBAYAT1 AND A.L. HOLMES2 Aeromedical center, Koreanair, Seoul, Republic of Korea 1Qatar Airways Medical Centre, Doha Qatar; 2Clockwork Research, London, United Kingdom INTRODUCTION: The activities of an airline medical depart- ment are different for each nation and airline. We plan to identify the INTRODUCTION: To maximize in-fl ight alertness during ULR major activities of an airline operated medical department and from (fl ight time > 16h) operations, commercial airline crew are typically the basis of it, we plan to look at how a medical department provided with science-based guidelines on when to rest and sleep contributes to an airline and the future direction. Aeromedical center pre-fl ight, in-fl ight and during layover. This study explored the is made up of 80 professional medical personnel. The center is effectiveness of guidance provided to crew working a ULR operation divided into 4 major roles: *Aeromedicine: Under the audit of The between Doha (DOH), Qatar, and Houston (IAH), United States. The Ministry of Land, Transport and Maritime Affairs of Korea, we have study also explored the infl uence ‘siesta culture’ may have on pilots’ been issuing about 2,700 airman medical certifi cates, and performing operational sleep patterns. 11 augmented crews, each consisting of about 100 the Federal Aviation medical examination of the United 4 pilots (2 operating pilots; 2 relief pilots), participated in the study. States annually. *Industrial Health: We provide a comprehensive The average age of Captains and First Offi cers was 48 +/-4 and health management with out-patient clinic, and physical examinations 34 +/-3 years; respectively. 64% (n = 28) of pilots were from regions for roughly 20,000 employees. In order to improve the basic physical with a siesta culture (South America, North Africa, Middle East). fi tness and prevent musculoskeletal disorder of crew, we offer a Crews collected data across the same 9-day roster pattern: 2 nights physical fi tness program with customized consultation. In addition, off; DOH-IAH 09:50-02:10 (DOH); approximately 27h layover; we monitor workplace environment including potential hazards for IAH-DOH 20:30-11:40 (IAH); 3 nights off. Sleep was assesses by safety and preventing occupational diseases. *Air transportation of actigraphy and pilots self-rated their sleepiness, sleep quality and invalid passenger: EMCS is a group for air transportation of invalid requirement for more sleep. Crews were provided with detailed passengers. By operating EMCS separately in the center, we are able guidance on how to structure in-fl ight rest such that all pilots achieve to make medical decisions promptly for MEDIF, and provide medical two rest periods (4h and 2h). Of the 10 crews that followed this suggestions 24 hours a day for passengers with medical emergencies advice, on the outbound fl ight 98% slept successfully (54% slept in fl ight. *Health education: The center is a BLS training site, and we twice). Mean sleep duration was 2h 26min +/- 1h 24min. Siesta train all employees including our cabin crew CPR and fi rst aid. culture increased the number of successful sleep periods and total Furthermore, we educate the residents in the community CPR and sleep duration. On the return fl ight, all pilots slept (72% slept twice); provide voluntary medical services to help the community grow. mean total sleep duration was 3h 42min +/- 1h 0min. As the layover Upon reviewing the various activities and roles of Aeromedical center, is relatively short, crew were advised to sleep on DOH or UTC time it is able to access the latest medical information quickly, and during layover. Although 80% of pilots said they tried to follow this contribute to safe fl ight and improve the health of employees as well advice, almost two thirds of crew (64%) slept on IAH time, 32% slept as passengers through accumulated aeromedical knowledge and on UTC time and only 5% slept on DOH time. The results indicate experienced know-how by operating a medical department in the that rest guidance was effective in promoting in-fl ight sleep. While airline. As a result, it can be evaluated to improve the productivity of it makes sense from a circadian perspective to advise pilots to airline. maintain base time during short layovers, the results suggest that this advice is often not realistic and alternative guidance should also be Learning Objectives: provided. Siesta culture may increase sleep propensity during 1 Aeromedical center, medical department daytime fl ights. Learning Objectives: Monday, May 14 10:30 AM 1 To look at ways of maximising sleep and minimising fatigue for Ballroom A IP: 192.168.39.151 On: Sun, 26crews Sep operating 2021 17:39:09 Ultra Long Haul (ULR) fl ights. Copyright: Aerospace Medical Association PANEL: AIRCREW FATIGUE--A REVIEWDelivered OF by[40] Ingenta IDENTIFYING FATIGUE RISK PROACTIVELY. A TOP OF DESCENT STUDY FATIGUE RISK MANAGEMENT M.F. HUDSON1 AND R.A. COCKS2 1Thomas Cook Airlines UK, Cheshire, United Kingdom; [38] AIRCREW FATIGUE; A REVIEW OF FATIGUE RISK 2Cathay Pacifi c Airways, Hong Kong, Hong Kong MANAGEMENT M.F. HUDSON AND D.C. POWELL INTRODUCTION: As an initial step in designing and imple- Thomas Cook Airlines UK, Cheshire United, Kingdom menting a data-driven Fatigue Risk Management System (FRMS) for a large Hong Kong-based international airline, a baseline top of descent Aircrew fatigue: a review of Fatigue Risk Management . Fatigue study was undertaken to establish prevailing levels of pilot fatigue on Risk Management Systems (FRMS) apply scientifi c methodology and rostered fl ying patterns. METHODS: Fatigue report forms, including the approach in an operational setting to manage fatigue amongst airline Samn-Perelli (S-P) fatigue scale, were included in fl ight documentation crews. They are linked to Safety Management Systems (SMS), and both packs for all scheduled fl ights during a two-month period (November- FRMS and SMS are now the subject of Standards under the Interna- December 2010). Duties featuring over 10 times in results were tional Civil Aviation Organisation (ICAO). In this panel, a range of selected for further detailed study, including S-P score, recovery score, presenters from airlines in very different countries discuss different prior rest data and crew complement. RESULTS: 27,847 complete aspects of how FRMS has been introduced in their operations, forms were returned, containing data for 34,989 sectors, The response including reactive, proactive and predictive measures to identify rate was 83%.372 duty patterns were selected for further study, of fatigue hazards, and methods to analyse and quantify the fatigue risk. which 21 were identifi ed as having mean reported S-P fatigue score The challenges facing airlines in the introduction and effectiveness of exceeding 5.0, These including 10 single-sector, 7 two-sector and 4 FRMS will be stressed. Learning objectives: To increase awareness of three-sector duties. 6 duties were identifi ed as priorities for attention fatigue in modern airline operations and to consider the impact of and one was modifi ed as a matter of urgency. DISCUSSION: This top fatigue on airline operations. The panel will also emphasise the role of of descent study represented a key fi rst step in the implementation of Fatigue Risk Management Systems in the detection, prevention and an FRMS, allowing an overview of prevailing fatigue management of fatigue with the overall aim of increasing safety levels,identifi cation of priorities and development of methods for standards. ongoing surveillance.

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 219 ASMA 2012 MEETING ABSTRACTS

Learning Objectives: Monday, May 14 10:30 AM 1 To discuss the elements of a Fatigue Risk Management System Ballroom B (FRMS. 2 To explore the role of a top of descent study in establishing a base- line for the proactive management of fatigue within an FRMS. PANEL: ADVANCES IN UNDERSTANDING 3 To outline the opportunities and barriers infl uencing the success- HEAD, BRAIN, AND SPINAL INJURY ful implementation of an FRMS within the operation of a large international airline. MECHANISMS: PART I

[41] FIT-FLY-TOOL FOR FATIGUE RISK MANAGEMENT [43] ADVANCES IN UNDERSTANDING HEAD, BRAIN, AND TRAINING SPINAL INJURY MECHANISMS: PART I M.F. HUDSON1 AND R. SIMONS2 B.S. SHENDER, G.R. PASKOFF AND C. MATTINGLY 1Thomas Cook Airlines UK, Cheshire, United Kingdom; 2TNO Human Systems Dept, NAVAIR, Patuxent River, MD Aerospace Medicine, Soesterberg, Netherlands Warfi ghters are exposed to acceleration forces during normal INTRODUCTION: FIT-TO-FLY TOOL FOR FATIGUE RISK and emergency operations in air and sea that load the head and spine MANAGEMENT TRAINING Ries Simons TNO Aerospace Medicine, and can lead to pain and injury. Incidents of blast induced mild Soesterberg, Netherlands Fitness of commercial aircrew is affected by traumatic brain injury (mTBI) continues to rise. In order to develop circadian disruptions, shift-work, high workload, long duty hours, effective means of injury mitigation, it is essential to understand the impaired sleep, health, and lifestyle factors. Impaired fi tness is associ- underlying injury mechanisms resulting from exposures to dynamic ated with fatigue, reduced alertness, and error-prone behaviour. Pilot’s events. Historically, injury criteria have been generated using manikin awareness and understanding of fatigue risks and countermeasures for responses or data from cadaveric studies on specimens too aged to risk reduction is necessary to further improve fl ight safety. Therefore, provide relevant material properties for a young and fi t force. The US training on these issues is a building stone of fatigue risk management Offi ce of Naval Research funded Naval Air Systems Command head/ programs. Based on relevant literature and an extensive database of brain/spinal injury prediction program was created to address the gaps pre- and in-fl ight study results, the Fit-to-Fly Tool (FTF) has been in our clinical knowledge and to develop tools to create optimal developed and evaluated using objective vigilance and sleep measures design guidelines. This double panel presents the results from ten as reference. By using the FTF Tool pilots are made aware of the studies of spinal trauma from ejection, lumbar pain, and mTBI. After an principal determinants of pre-fl ight and in-fl ight fi tness. Items include overview of the model, a discussion of how loading rate affects pre-fl ight sleep, alertness, health, medication, alcohol, recent workload, thoraco-lumbar spinal injury pattern (Medical College of Wisconsin (MCW)) and intervertebal disc response to ejection (CFD Research operational load, and risk reduction. The FTF Tool uses risk factors, risk multiplying factors, and risk reducing factors to enable aircrew to Corp.) is presented. A new injury criteria for repeated lumbar vertical loading and a description of spinal cord properties is provided (Duke evaluate their fi tness related risk and to provide them with information how to reduce this risk. Numerical values are assigned to each item of University). The second panel begins with a description of a fast the FTF, enabling aircrew to calculate their risk and to make them aware running cervical injury prediction tool and its use in risk assessment of the effect of the various factors on risk and risk reduction. Risk areas (Southwest Research Institute and Criterion Analysis, Inc.). MCW then and opportunities to improve fi tness are identifi ed. The FTF is a personal describes axial force/bending moment cervical injury thresholds software tool that enables interactive individual training of aircrew and resulting from side impacts. The panel concludes with three blast managers in the context of Fatigue Risk Management programs. related studies including cranial bone properties (University of Virginia), behavioral response to repeated blast (MCW), and alternative Learning Objectives: paths to simple geometry to blast and blunt trauma interspecies scaling (Duke). 1 To understand factors which can lead to fatigue among aircrew 2 To understand how Fatigue Risk ManagementIP: 192.168.39.151 Systems can assist On: in Sun,[44] 26 SepANATOMICALLY 2021 17:39:09 BASED PROBABILISTIC HEAD/BRAIN/ the detection and prevention of fatigue Copyright: Aerospace Medical Association 3 To learn how a Fit-to-fl y Tool can assist in an FRMS system SPINAL PAIN AND INJURY PREDICTION MODEL Delivered by B.S.Ingenta SHENDER1, G.R. PASKOFF1, C. MATTINGLY1, W. FRANCIS2, D.P. NICOLELLA2, P.E. WHITLEY3, [42] IDENTIFYING FATIGUE RISK PREDICTIVLEY: 4 4 5 OPERATIONAL USE OF BIOMATHEMATICAL MODELS N. YOGANANDAN , B.D. STEMPER , A. PRZEKWAS , C.R. BASS6 AND R. SALZAR7 J. MANGIE 1 2 Flight Operations, Delta Airlines, Atlanta, GA Human Systems Dept, NAVAIR, Patuxent River, MD; South- west Research Institute, San Antonio, TX; 3Criterion Analysis In- 4 INTRODUCTION: Data-driven Fatigue Risk Management corporated, Miami, FL; Department of Neurosurgery, Medical Systems (FRMS) in commercial airlines frequently make use of College of Wisconsin, Milwaukee, WI; 5CFD Research Corpora- biomathematical models. This presentation will discuss the roles of tion, Huntsville, AL; 6Duke University, Durham, NC; 7Center for such models stressing the strengths and weaknesses of such models. Applied Biomechanics, University of Virginia, Charlottesville, VA METHODS: One large US-based carrier, Delta Airlines, has been using a range of different fatigue-predictive biomathematical models in its INTRODUCTION: Development of head-supported devices and FRMS including rostering and scheduling processes. RESULTS: The life support equipment to optimally protect against crash and ejection experiences of the carrier in using the models in fatigue risk manage- is hampered by specifi c gaps in our knowledge of spinal injury in ment, including their strengths and limitations, will be presented. aerospace environments. During normal helicopter operations, back DISCUSSION: Discussion: Biomathematical models have a place in pain continues to be an issue. The injury mechanisms underlying mild FRMS but must be applied intelligently, taking into account their traumatic brain injuries (mTBI) are unclear. Since 2002, the Offi ce of limitations and implementing them in the context of good scientifi c Naval Research has sponsored NAVAIR’s multidisciplinary effort to advice and guidance. quantitatively determine pain and injury risk to the head, brain, and spine. METHODS: New test fi xtures were developed and biomechani- Learning Objectives: cal data obtained during dynamic conditions using post mortem 1 To discuss the features of biomathematical fatigue models. human specimens (PMHS) whose age and size refl ect US naval 2 To explore the role of biomathematical models within an FRMS. population. Geometric, materials properties and constitutive equations 3 To outline the opportunities and barriers infl uencing the successful describing skull and spinal hard and soft tissue sub-failure and failure implementation of biomathematical models within the rostering/ responses were determined. These data were used to create an scheduling systems of a large international airline. anatomically based parameterized probabilistic spine model. High-rate

220 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS brain and spinal cord tissue properties were determined using porcine spectrum and associated clinical biomechanics of spinal injuries in subjects. During development, a hierarchical verifi cation/validation military environments. Ejections, helicopter crashes, and underbody approach was employed to confi rm model performance at increasing blast loadings constitute the most common modes of injuries to this levels of complexity. A hazard assessment tool (HAT) relating region of the human body. The purpose of this paper is to analyze individual spinal structure injury probability to functional outcome has clinical, descriptive, and biomechanical studies in these areas. been developed. RESULTS: A full spine fi nite element model was METHODS: A review of clinically-related literature reporting developed and validated using component and full body PMHS test thoraco-lumbar spinal injury sustained in military environments. data. Pain studies include developing a new computational model of RESULTS: While ejection-related injuries occur to the entire vertebral intervertebral disc metabolism, and an MRI spinal study comparing column, helicopter crash and underbody blast-related injuries are geometric vertebral differences between asymptomatic and volunteers biased towards the dorsal region. Injuries are focused in the mid- with pain have been conducted. High rate brain properties using thoracic areas for ejection and in the middle regions of the lumbar indentation testing and Acoustic Radiation Force Imaging in ex vivo spine for the higher-rate loading scenarios. DISCUSSION: These and in vivo porcine subjects have been characterized. The cervical patterns indicate that the primary mode of external load transmission, HAT has been used to predict the effect of posture and head weight on as well as rate at which the loading is applied, affect injury distribu- fl exion ejection injuries. DISCUSSION: Validated anatomically based tions within the anatomical structure. These distributions contrast methods have been developed to help design protective systems civilian populations wherein the thoracolumbar junction is the most applicable to all acceleration environments. vulnerable region for acute trauma. Important biomechanical factors affecting trauma included loading rate, dynamic load level, occupant Learning Objectives: anthropometry, and posture/alignment with respect to the loading 1 Gain a better understanding about efforts to predict head, brain vector at the time of the transmission of the external load. The and spinal injury level and severity and the use of probabilistic changing injury patterns resulting in caudal migration for underbody techniques to aid in development of mitigation technologies. blast and rostral migration for ejection loadings may have implications in the treatment regimen.

[45] RESPONSE OF A FUNCTIONAL SPINAL UNIT Learning Objectives: POROELASTIC DISC MODEL TO EJECTION SEAT 1 To understand the pattern of spinal trauma resulting from high-rate CATAPULT ACCELERATION loading ranging from ejection to crash and underbody vehicle G. CHEN, P.E. WHITLEY AND A. PRZEKWAS blast. CFD Research Corporation, Huntsville, AL

INTRODUCTION: Spinal pain and injury is a persistent problem [47] INJURY RISK MODEL FOR REPEATED VERTICAL for military vehicle operators. Modeling techniques have been used to LOADING OF THE LUMBAR SPINE study the spine biomechanical response under various injury A.L. SCHMIDT1, C.R. BASS1, G.R. PASKOFF2 AND mechanisms. This study focuses on spine biomechanical modeling 2 under the military loading conditions with high level and onset B.S. SHENDER 1 2 accelerations. The stresses and deformations of the functional spinal Duke University, Durham, NC; Human Systems Dept, unit (FSU) can help predict the risk of spinal injury and ultimately NAVAIR, Patuxent River, MD provide guidelines to reduce spinal pain and injury in military personnel. METHODS: A 17G ejection catapult acceleration of INTRODUCTION: Exposure to repetitive vertical loading and 200 ms duration was applied to a seated whole body articulated vibration are suspected to be the cause of widespread morbidity from human model, which generated the forces transmitted to an L1-L2 chronic neck and back pain (Schmidt, 2011). High performance FSU. A fi nite element model of the FSU was constructed consisting fi ghter jet and rotary wing aircrew and naval Special Forces operators of the L1 and L2 vertebrae (modeled as rigid bodies) with a poroelastic are particularly at risk. Total injury rate of the latter population is intervertebral disc. The model dynamic response driven by the forces 5x of overall Navy rates, with one-third of injuries involving the applied to L1 and L2 vertebrae was simulatedIP: 192.168.39.151 using CFDRC’s in-house On: Sun,lower 26 Sepback. 2021 METHODS: 17:39:09 A human spinal injury risk assessment for code (CoBi). The relative displacement betweenCopyright: L1 and L2 was Aerospace used to Medicalrepeated axialAssociation loading was developed using results of 78 male and investigate the compression of the intervertebral disc. The displace-Delivered by29 Ingenta female human cadaveric spine fatigue tests from six different ment of vertebrae and the Von-Mises stresses at the disc represented studies. All injuries for this analysis were classifi ed as damage to the biomechanical response due to the applied loading. RESULTS: the endplate or general bony structure. The segments were fi xed Under the applied loads, the L1-L2 FSU was compressed while moved at each end and exposed to pure axial, cyclic compression ranging upward for about 1.05m. The poroelastic disc model had less from 404 to 7100 N. In the fi rst analysis age, loading cycles, peak compression strain (up to 10%) than an elastic disc (up to 34%). stress and gender were used as separate variables. In the second, a Von-Mises stresses were highest at the posterior and anterior annulus. modifi ed version of the ISO 2631-5 R-value was used to quantify the DISCUSSION: The poroelastic disc model better represents the cumulative load in terms of one composite variable. RESULTS: For biological feature of FSU. Our model will be further validated using such accelerated fatigue tests, the formulation reduces to R = SMax (1/6) vibration and repetitive impact loads. C /(6.50-Sage.Age), where SMax is the maximum stress during a cycle, C is the number of cycles, and Sage is the age-dependence coeffi cient. Learning Objectives: Sage was determined heuristically to remove the effect of age from the 1 To understand the biomechanical response of the spine under fi nal model. This model does not account for healing after sustaining military loadings with high acceleration. microdamage in spinal loading. DISCUSSION: This study provides the fi rst lumbar spine repeated axial loading failure risk model and [46] RATE DEPENDENCY OF THORACO-LUMBAR SPINE demonstrates that the risk of vertebral column failure under repeated loading is strongly sex and age dependent. By identifying an FRACTURES IN MILITARY LOADING 1 1 1 appropriate value for age dependent risk this model allows for the B.D. STEMPER , N. YOGANANDAN , J.L. BAISDEN , use of experimental results from cadaveric specimens of a variety of 2 2 G.R. PASKOFF AND B.S. SHENDER ages in determining the injury risk for any target population, 1Department of Neurosurgery, Medical College of Wisconsin, especially important for assessing risk in a younger military Milwaukee, WI; 2Human Systems Dept, NAVAIR, Patuxent population. River, MD Learning Objectives: INTRODUCTION: With increasing reports of traumas in 1 To understand the age and sex dependencies of lumbar injury risk ongoing wars around the world, it is important to delineate the resulting from repetitive vertical loading.

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 221 ASMA 2012 MEETING ABSTRACTS

[48] VISCOELASTICITY OF THE LUMBAR SPINAL CORD Thus, we produced a standard scatter plot with which it was a N. KLOPPENBORG1, M. PANZER1, C.R. BASS1, relatively simple curve fi tting exercise to identify the equation that G.R. PASKOFF2 AND B.S. SHENDER2 describes the percent ocular trauma as a function of year. RESULTS: A 1Duke University, Durham, NC; 2Human Systems Dept, simple exponential growth function described the data with an NAVAIR, Patuxent River, MD adjusted R-square of 0.7118. The function ‘predicts’ that ocular trauma is currently about 13% of nonlethal battlefi eld injuries. This INTRODUCTION: Understanding the biomechanics of spinal regression predicts that in 2030 this number will be about 17%, with cord injury is of critical importance since it can affect motor and a 95% probability of being between 12.5% and 22%. DISCUSSION: sensory signals throughout the body. While it is known that compres- One extraordinary thing is that this approach is based on a 150 year sion is the most common cause of injury, the injury mechanics are history that includes the advent of modern warfare over all manner of not fully understood. Previous testing of the spinal cord has come terrain, with all the differences this implies; yet, a single monotonic from excised tissue samples, ignoring the effects of its natural spinal function seems suffi cient to describe about 72% of the variability in canal boundaries. Furthermore, there is little data regarding the effect the data, which suggests that the future will not be much different of temperature during testing of central nervous system tissue. The from the past. objective of this study is to characterize the viscoelastic behavior of Learning Objectives: the spinal cord in situ, as well as investigate the effect of temperature on the results. METHODS: Whole spines were harvested immediately 1 To call attention to the fact that ocular trauma is an increasing following sacrifi ce from young domestic pigs (sus scrofa). Spines percentage of nonlethal battlefi eld injuries were then dissected into sections of two or three vertebrae (lumbar and lower thoracic) and windows were cut through the soft tissue 10:45 am and bone to the spinal cord on the posterior side. Indentation testing, [50] LONG TERM FOLLOW-UP RESULTS OF “HIPERBARI consisting of stress relaxation and oscillation tests, was performed on each of the spinal cords. Half of the samples (n=9) were tested at OXYGEN AND MITOMYCIN-C ASSISTED LIMBAL - room temperature, and the other half (n=9) were tested in a MINITRANSPLANTATION” FOR ALKALINE CORNEAL temperature-controlled box simulating body temperature (~37.2°C). BURNS ASSOCIATED WITH SEVERE Numerical models were fi t to the force data recorded from the stress NEOVASCULARIZATION relaxation tests based on quasilinear viscoelastic methods. Five time U. ERDEM, S. YILDIZ AND K. SIMSEK constants, each an order of magnitude apart, were used to character- Gulhane Military Medical Academy & Hospitals, Ankara, ize the viscoelastic behavior. At the same time, a fi nite element Turkey model of the test was developed and utilized to inversely extract material properties of the spinal cord, based on experimental data. INTRODUCTION: To describe a new treatment method with the RESULTS: Results showed that there were no signifi cant differences support of Hyperbaric Oxygen Therapy (HBO) and, Mitomycin C between the room-temperature and the body-temperature samples (MMC)and, give long term follow-up results for severely neovascular- in either the reduced relaxation functions or in the instantaneous ized cornea with total limbal dysfunction after alkaline burn. elastic force. This study is the fi rst to investigate such viscoelastic METHODS: In 27 eyes (24 cases), scar tissues was removed, surface and temperature phenomena of the spinal cord. DISCUSSION: These was smoothed with a diamond burr, and the cornea and corneal data will be incorporated into the NAVAIR spinal pain prediction limbus exposed to 0.02mg¬/ml MMC for 1 min, and the superior model. limbus grafted with 4x3 mm size autograft from the fellow eye (21 eyes) or allografted (6 eyes). Patients were underwent to HBO Learning Objectives: therapy ( 2.4 ATA, %100 oxygen saturation, 90 minutes exposure time) 1 To understand the temperature dependence on spinal cord visco- for 14 days after surgery to support reepitelization. Topical, steroid elastic properties. (and cyclosporine-A drop for allograft) was applied after reepitheliza- IP: 192.168.39.151 On: Sun,tion. 26 SepAnatomic 2021 and 17:39:09 histological evaluations were done. RESULTS: In Copyright: Aerospace Medicalall eyes, cornealAssociation surface recovered in 14 days and NV regressed in Monday, May 14 Delivered 10:30 AM by 1Ingenta month, the anatomic and histological features maintained during Ballroom C 33.565.6 months of mean follow-up. Transient corneal hypotony has seen in 3 cases is main but manageable complication after surgery. One patient had allograft rejection in his both eyes managed with SLIDE: EYES AND EARS prednisolone and cyclosporine A. CONCLUSIONS: MMC and HBO assisted-LMT surgery seems to be one of the best treatment option for severe corneal burns with severe neovascularization. DISCUSSION: 10:30 am Limbal transplantation had been using for severe limbal stem cell [49] ESTIMATING BATTLEFIELD OCULAR TRAUMA IN 2020 insuffi ciency, and neovascularizations but transplanted tissue is large AND BEYOND and recovery time is long, graft survival is limited and allograft D.L. STILL, L.A. TEMME AND J. CAPO-APONTE rejection is high. We developed a new surgical technique and also Sensory Research Division, USAARL, Fort Rucker, AL give long term results of minitransplantation of limbal tissue using additive effect of Mitomycin C for it’s toxicity to fi broblastic activity INTRODUCTION: Combat ocular trauma remains a major and limited effect on epithelium mitosis. HBO therapy for it’s growing concern for military medicine. The recent literature contains supportive effect of corneal oxygen consumption and epithelial a number of reports that include the incidence of battlefi eld ocular healing. MMC and HBO assisted-LMT surgery seems to be one of the trauma. From these reports is it clear that ocular trauma represents an best treatment option for severe corneal burns with severe increasing percentage of nonlethal battlefi eld injuries. But estimates of neovascularization. the percent of non-lethal battlefi eld injuries have been reported in the literature for the nearly 160 year period from the present to the Learning Objectives: Crimean War (1854). This information is invariably presented in a 1 Limbal transplantation had been using for severe limbal stem cell tabular or narrative form but seems not to have been addressed insuffi ciency, and neovascularizations but transplanted tissue is quantitatively. METHODS: The literature was reviewed to identify the large and recovery time is long, graft survival is limited and al- date of the confl ict and the reported percent of the nonfatal battlefi eld lograft rejection is high injuries that involved the eye. A horizontal time line of the 16 battles 2 MMC and HBO assisted-LMT surgery seems to be one of the was constructed; the time line was really the ordinate of a graph with best treatment option for severe corneal burns with severe the abscissa being the reported percent of trauma involving the eye. neovascularization

222 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

11:00 am Learning Objectives: [51] BALLISTIC OCULAR INJURY CHARACTERISTICS AND 1 To show the impotence of double hearing in reducing noise expo- VISUAL OUTCOMES IN HIGH-ORDER AND LOW-ORDER sure of pilots. EXPLOSIVES IN TERROR ACTS 2 To show the importance of aircraft noise characteristics in A. ILHAN, U. ERDEM AND G. SOBACI determining hearing protection performance Gulhane Military Medical Academy &Hospitals, Ankara, Turkey 11:30 am INTRODUCTION: To explore the differences between high- [53] A LIGHTWEIGHT NOISE PROTECTION CONCEPT FOR order explosives (HOE) and low-order explosives (LOE) in terror act. MIITARY AIRCREW METHODS: Use of Ocular Trauma Classifi cation System (OTCS) and S.H. JAMES review of terror-related injuries in 154 patients presenting to the Advisory Services, QinetiQ, Farnborough, United Kingdom tertiary referral center. RESULTS: Zone-I injuries in LOE (75%) and zone-III (70 %) in HOE were common. Stones were the most commom INTRODUCTION: Many military personnel are exposed to type of IOFB in HOE (%78) and LOE (%53). Tendency but not high noise during operations and an upgrade in hearing protection is signifi cance in enucleation rate was evident in HOE (p=0.08). Rates required. Additionally, increases in head-borne mass due to helmet of ambulatory vision (≥5/200) and central vision (>10/200) were not mounted equipment are an issue and a requirement for a ‘light- different in both the fi rst and the last visit.(p=0.05 for both). weight’ noise protection device has been identifi ed. A technical DISCUSSION: Use of Ocular Trauma Classifi cation System (OTCS) in demonstrator programme has investigated a diverse range of 154 patients with terror-related ocular injuries and minimum 6 months commercially available solutions and technology under develop- of follow-up showed that stones were the most common type of ment, with the potential to address the requirements of military intraocular foreign body(IOFB), which is located posterior in high- aircrew. METHODS: A study was initially conducted to understand order explosives; severity of injuries at presentation, and the fi nal the current capability gap and defi ne requirements for system outcomes were not statistically different from low-order explosives. functionality. Relevant technologies were identifi ed through a search Vulnerability of ocular tissues to secondary blast effect may be of manufacturers, technology companies and research organisations. responsible for similar visual outcomes in LOE and HOE trauma to the Available technologies were then mapped to the requirements to eye. select suitable devices for integration to technology readiness levels 6 & 4. RESULTS: The studies culminated in a design comprising a Learning Objectives: lightweight earmuff assembly and a communications earplug with 1 Vulnerability of ocular tissues to secondary blast effect may be adaptable attenuation. Performance measures showed that the responsible for similar visual outcomes in LOE and HOE trauma to required levels of protection and speech intelligibility could be the eye. achieved with a signifi cant reduction in system mass. DISCUSSION: The priority requirements for the demonstrator were to be lighter than legacy helmets and to aid compliance with noise exposure legisla- 11:15 am tion. A weight saving of 25% was achieved for the TRL6 solution and [52] USER EVALUATION OF CUSTOM MOULDED EAR- 18% for the TRL 4 system. Compliance with noise exposure legislation was demonstrated for a range of fast-jets, rotorcraft and PLUGS WITH COMMUNICATION FOR PILOTS OF THE heavy transport aircraft. ROYAL NETHERLANDS AIR FORCE FLYING THE F-16 AND PC-7 PILATUS AIRCRAFTS Learning Objectives: Y. STEINMAN Aerospace Physiology Department, Center for Man in Aviation, 1 To understand how commercially available acoustic technologies could be integrated to provide a lightweight noise protection solu- Soesterberg, Netherlands IP: 192.168.39.151 On: Sun, 26tion Sep for military2021 17:39:09aircrew. Copyright: Aerospace Medical Association INTRODUCTION: During the pilots of the F-16 and theDelivered PC-7 by Ingenta pilatus are exposed to cockpit levels that range between 100 and 110 dB(A). The helmets currently in use by these pilots are the HGU-55/P 11:45 am and JHMCS. Research has shown that the attenuation provided by [54] NOISE EXPOSURE AND HEARING PROTECTION OF these helmets isn’t suffi cient to lower pilot exposure below the Dutch KLM CABIN ATTENDANTS national standard of 80 dB(A) for an eight-hour workday. The aim of H.D. REE AND B. VELDHUIJZEN VAN ZANTEN this study was to evaluate and compare the performance of three KLM Health Services, Schiphol, Netherlands custom moulded earplugs with communications in the following aspects: 1) attenuation, 2) speech intelligibility , 3)fi tting and comfort, INTRODUCTION: KLM cabin attendants fl y on short, medium and 4) user friendliness. METHODS: Fourteen pilots participated in ánd long-haul routes. Each KLM cabin attendant is certifi ed to work this study of them ten F-16 and four PC-7 pilots. All participants on three types of aircraft, which may differ in noise level inside the received instructions in proper use of the systems. After a habituation cabin. In 2006 an EU directive came into effect stating that noise period, they provided feedback using a questionnaire and a short exposure should be assessed by daily or weekly dose. METHODS: interview. Sound attenuation of the HGU-55/P and JHMCS helmets in Based on dose measurements in all aircraft types the weekly dose combination with the three systems was determined using a real-ear was estimated because large variations in exposure from day to day attenuation method (REAT). RESULTS: Using the systems in combina- could occur. As a result of these estimates it was concluded that KLM tion with the helmets increased attenuation with 10 to 15 dB in cabin attendants could exceed the equivalent of a weekly dose of comparison with the helmets alone. All participants reported a 80 dB(A), fi ve days per week, eight hours per day. Based on the signifi cant improvement in speech intelligibility and the clarity of the results KLM has provided their cabin attendants with ear plugs. These audio warning system in comparison with the current situation. earplugs have a special fi lter to preserve speech intelligibility. A However, with all three systems the predicted exposure of the PC-7 randomised sample of the cabin attendants was invited to test their pilots is still high (85 dB(A)) reducing the maximum exposure time to hearing and to evaluate the use of the hearing plugs. RESULTS: approximately two hours. In the other aspects no signifi cant difference Results show that a proportion of cabin attendants show mild hearing was found between systems. DISCUSSION: Based on the results of damage caused by noise exposure. It is unclear whether work related this study it was advised to provide all F-16 and PC-7 pilots in the noise exposure is the cause of this hearing loss. Only a small Royal Netherlands Air Force with custom moulded earplugs with proportion wears the ear plugs that were issued to them. Suggestions communications. for follow-up measures are given.

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 223 ASMA 2012 MEETING ABSTRACTS

Learning Objectives: be offered to facilitate the evaluation of a given project. In this way, an 1 To know about European rules for hearing protection investigator who considers his/her project is NHU can preview IRB 2 Method to assess risk of heaing damage deliberations and be better prepared to present his project for an IRB 3 Effectiveness of hearing protection review. Learning Objectives: Monday, May 14 10:30 AM 1 To understand the regulatory defi nitions of “research” and “human Ballroom D subject.” 2 To understand the importance of research intent in making a non- human use determination. PANEL: HUMAN SUBJECT RESEARCH ISSUES 3 To understand how to use a practical algorithm for non-human use IN OPERATIONAL RESEARCH determinations in order to better prepare for IRB review.

[55] HUMAN SUBJECT RESEARCH ISSUES IN OPERATIONAL [57] OPERATIONAL RESEARCH: A MEDICAL MONITORING RESEARCH PROCESS FOR NON LETHAL WEAPONS WORK W.P. BUTLER1, E.M. FORSTER2, M. BRYCE3, K.E. LONDON1 M. BRYCE AND P.D. NAVATHE4 Research & Development Division, Offi ce of USAF Surgeon 1Institutional Review Board, Air Force Research Laboratory, General, Washington, DC Wright-Patterson AFB, OH; 2Civil Aerospace Medical Institute, Federal Aviation Administration, Oklahoma City, OK; 3Division INTRODUCTION: New challenges for the military drive operational needs and research. An even more important role for of Research & Development, USAF Surgeon General’s Offi ce, 4 non-lethal weapons will continue as the need arises for use of Pentagon, DC; Offi ce of Aviation Medicine, Civil Aviation non-lethal force for missions. With each weapon system, new ground Authority, Canberra City, ACT, Australia is explored. As an example, for one particular non-lethal weapon, human-use testing was conducted from 2002 through 2008. As this With the recent revelations of historical syphilis inoculations by was a new weapon system, bioeffects research was required as part of US researchers using Guatemalan inmates a renewed interest in the the acquisition process. Since this work had not been done before, a ethical use of human subjects in research has been stimulated. Indeed, medical monitoring process needed to be developed. All human-use this 64 year-old incident prompted not only a presidential apology, but research must be conducted under the discretion of an IRB. Addition- also taskings to the Presidential Commission for the Study of Bioethical ally, it must meet regulatory requirements. Research may or may not Issues. Today, in the US, we have defi ned regulations to prevent this require a medical monitor. In creating a medical monitor process, sort of egregious research activity. The most visible aspect of the discussions between the research team may include defi nitions of regulations is the Institutional Review Board (IRB). Essentially, all adverse events, safety issues, monitoring, risk, and protection of government funded human subject research must be reviewed and subjects. The development of this non-lethal weapon program is approved by an IRB. Other countries have their own approach to considered the poster child for future work. Likewise, the medical human subject research protections. While some have processes monitor process was integral to the success and validity of the similar to the US, others do not. What is common, however, is the program. This research was instrumental in AFRL‘s Bioeffects Division focus on ethical human use. Research within the Aerospace Medicine receiving a Scientifi c Advisory Score of One (meaning world class (AM) arena often has an operational as opposed to a clinical fl avor. For research) on two consecutive evaluations. Lessons learned from this example, it is more likely that an AM researcher will investigate the unique program will be discussed and should be applied to future physical maneuvers required to prevent G-induced loss of conscious- non-lethal weapon research. Furthermore, it is suggested that the ness or the layout of cockpit monitors to avoid spatial disorientation principles used in this medical monitoring process may be applied to than the chemotherapy required to treat otitis media. In fact, use of any human-use research. patients as subjects is uncommon. As a result,IP: 192.168.39.151 the operational research On: Sun, 26 Sep 2021 17:39:09 world is different. This panel will focus on thatCopyright: world. Three Aerospacepresenta- MedicalLearning AssociationObjectives: tions will focus on specifi c US issues --- Medical Monitor dutiesDelivered in by 1Ingenta To understand the principles of sound medical monitoring Greater than Minimal Risk research, non-human use determinations, 2 To understand how to apply those principles to construction of a privacy and security issues with a genetic focus --- while one medical monitoring program presentation will focus outside the US experience --- privacy, research 3 To understand how a medical monitor functions within the research and ethics in Australia. milieu

[56] NON-HUMAN USE DETERMINATIONS [58] PRIVACY AND SECURITY WITH A GENETICS FOCUS W.P. BUTLER K.E. LONDON Institutional Review Board, Air Force Research Laboratory, Institutional Review Board, Air Force Research Laboratory, Wright-Patterson AFB, OH Wright-Patterson AFB, OH

INTRODUCTION: Many investigations in Aerospace Medicine INTRODUCTION: Research involving genetics is increasingly use human subjects. However, not every project using human subjects seen in many contexts, to include genome-informed medical practice, is human subject research. Indeed, the determination of Non-Human environmental genetics, and pharmacogenetics. In some instances, Use (NHU) research comes down to two regulatory defi nitions --- genetics is being studied to better understand correlations to athletic, “human subject” and “research” --- and research intent. The regulatory physiological, and cognitive performance. The collection, storage and defi nitions are found in the so-called Common Rule (45 CFR 46) --- in use of specimens in genetic research brings complex and unique DoD it is 32 CFR 219 --- and research intent is inferred from the privacy and security implications. With appropriate tailored privacy defi nition of “research.” Without human subjects or research, there can protection methods, such as coding, key control, and access agree- be no human subject research; this will be explained within the ments, genetic-related data can be properly handled and used in both defi nitional context and examples will be presented. Where the current and future research. The consent and other terms in place for determination often becomes diffi cult is with the research intent. For the original DNA collection are of paramount consideration because regulatory purposes the intent of research is to “…develop or those terms will signifi cantly impact future uses of the specimen data. contribute to generalizable knowledge.” This is not always the case. Health Insurance Portability and Accountability Act (HIPAA) covered Specifi c categories of intent (eg, clinical practice) will be discussed entities, when transfer of genetic information is involved, must along with examples. Consequent to the discussion, an algorithm will determine if the original HIPAA authorization (when the DNA

224 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS specimen was collected) is suffi cient or if another HIPAA authorization Learning Objectives: is required. The issues are more vexing when the military is engaged in 1 Attendees will be introduced to the research questions formulated or the subject of genetics-related research because genetics privacy by AMC SMEs which have been published for researchers to submit laws are different in the military compared to the civilian sector with proposals. The funding available for enroute care research will be the 2008 passage of the Genetic Information Non-Disclosure Act discussed. (GINA). 2 Attendees will be briefed on evolutionary technology advances in AE/Enroute care capability and introduced to revolutionary capabil- Learning Objectives: ity advancements being purused. 1 To understand protection methods to maintain privacy and confi - dentiality of bio specimens (e.g. coding, limited/controlled access, honest broker mechanisms, de-identifi cation process, limited data 10:45 am use agreements). [61] THE CREATION OF A NEW FELLOWSHIP IN EXTREME 2 To recognize that the data use terms in place at initial collection ENVIRONMENTAL MEDICINE of DNA for genetic research is suffi cient for the future/follow-on K. LEHNHARDT, D. MACANDER AND J. MARINUCCI research using the same DNA. Department of Emergency Medicine, George Washington 3 Become familiar with the Genetic Information Non-Disclosure Act University, Washington, DC (GINA) and its applicability to the military. INTRODUCTION: The unquenchable desire to explore, coupled [59] PRIVACY, RESEARCH AND ETHICS: THE AUSTRALIAN with many technological advances, has enabled humanity to venture PERSPECTIVE to places never before dreamed of in the past. Every one of these P.D. NAVATHE adventures takes humans into extreme environments, where they face Offi ce of Aviation Medicine, Civil Aviation Safety Authority, a number of signifi cant issues: a paucity of resources, a lack of access Canberra, ACT, Australia to defi nitive medical care, and environmental conditions that challenge their physiology. Each year, the number of these expeditions increases, and with it, so too does the need for a physician who is INTRODUCTION: Many investigations in Aerospace Medicine trained to handle any medical eventuality related to exploration. use human subjects. Data held about these individuals is often However, training a physician for this purpose is a daunting task, given invaluable -if one can access it for the purpose of research. Longitudi- the breadth of information that must be learned in a relatively short nal studies often require data over many years, and some of the older period of time. Therefore, it is imperative to focus on the basic consents may not have releases for research. The Privacy Act in principles inherent to this type of medical care and eliminate Australia makes specifi c provision for research by overtly making any duplication to streamline learning. In order to accomplish this task, it is such use of data as lawful provided that it has been approved by a necessary to take key elements from a number of related disciplines Human Research Ethics Committee (HREC). The National Statement on and combine them together in a synergistic fashion. The newly created Ethical Conduct in Human Research provides guidance to the HRECs Fellowship in Extreme Environmental Medicine was designed with the about how to assess these projects. Most HRECs divide the types of aforementioned principles in mind. Thus, elements of the following research into high risk and low risk research. Based on this primary disciplines were incorporated into this Fellowship: Aerospace categorisation, more factors such as utility and benefi cence are Medicine, Diving and Hyperbaric Medicine, Wilderness Medicine, considered in making a determination. Clarity of research intent is a and Disaster Medicine. The result is a unique training experience that central factor in acceptance of projects by ethics committees. The will prepare physicians to support future human exploration to the national statement enables the reader to plan studies while maintain- ends of the Earth and beyond. ing as low a risk as possible - while still being able to attain the objective. Learning Objectives:

Learning Objectives: 1 The audience will gain an understanding of the increasing need IP: 192.168.39.151 On: Sun, 26for Sep physicians 2021 who 17:39:09 are trained to handle any medical eventuality 1 To understand the ethical principles that underpin research Copyright: Aerospace Medicalrelated Association to human exploration. 2 To understand the importance of privacy in the conduct of research 3 To understand the risk stratifi cation in types of human researchDelivered by Ingenta 11:00 am [62] PHYSIOLOGY TRAINING IN THE NEW IRAQI AIR Monday, May 14 10:30 AM FORCE Salon AB A.N. ABED AND H.N. ABDULLAH Aeromedical Center, IqAF SG, Baghdad, Iraq SLIDE: DEVELOPING NEW PROGRAMS INTRODUCTION: PHYSIOLOGY TRAINING IN THE NEW IRAQI AIR FORCE The physiology training represent one of the most 10:30 am important parts to make well-trained, professional pilot and other [60] ENROUTE CARE MODERNIZATION aircrews, this fact is true in all air force all over the world, it’s true for K. FAUBION all types of airframes. The Iraqi air force, like all Iraqi military forces Medical Modernization, HQ Air Mobility Command, after 2003, keep rebuilt as part of the overall program to establish a Scott AFB, IL new Iraqi defense force. The old Iraqi aeromedical system had been completely destroyed by 2003, and this created the need to rebuild the INTRODUCTION: AMC is committed to saving lives through new Iraqi aeromedical program. Major challenges to establish the new providing a rapid, agile, and highly capable medical response and aerospace physiology training program to my air force are: 1-the time rapid evacuation of casualties across the full spectrum of military required to establish the aeromedical center. 2-the great shortage in operations including war, military confl icts, humanitarian assistance the number of the fl ight surgeons and trained medical staff. 3-The and disaster response. AMC SG is leading advancements in research, expensive aerospace physiology training equipments (despite we have modernization and training to expand support to patients needing our ROBD2, Barany chair, building for fl ight physicals). 4-The security services. This presentation will review: 1.) Clinical research efforts to situation and bureaucracy. mitigate stresses of fl ight 2.) Modernization updates include medical equipment, aircraft adjuncts to enhance in fl ight patient care environ- Learning Objectives: ment, alternative aircraft for AE, patient staging, electronic health 1 To show the current situation of physiological training program in record, etc. the new Iraqi airforce.

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 225 ASMA 2012 MEETING ABSTRACTS

11:15 am Learning Objectives: [63] CERTIFICATION MEDICINE AND THE LAW 1 Apply a unique instructional matrix to the development of D. FITZGERALD AND P.D. NAVATHE simulation-based curriculum. Civil Aviation Safety Authority, Canberra, ACT, Australia 11:45 am INTRODUCTION: Certifi cation medicine differs from clinical [65] MEDICAL SUPPORT TO NORTHERN OPERATIONS; medicine in terms of the interaction with the law. A good understand- A CANADIAN FORCES CRASH RESPONSE EXPERIENCE ing of the legal framework in which Aviation Medical Examiners (AMEs) work assists the AME in making appropriate and fair decisions DURING OPERATION NANOOK 11 in certifying aircrew. This aspect of the interplay between law and S. ROUX medicine is often poorly taught and appreciated. This presentation will Aerospace Medicine, Royal Canadian Air Force, Chicoutimi, outline some of the legal issues that are important in aeromedical QC, Canada decision making. DISCUSSION: International and domestic anti- discrimination laws will be discussed regarding their relevance and INTRODUCTION: The medical support to northern military application to making decisions regarding aviation safety on the basis operations poses multiples challenges and one of which being the of medical conditions. Principles of sound aeromedical administrative medical crash response and subsequent air evacuation of potential decision making will be outlined - the importance of gathering casualties to higher level of care. Aside from the challenges of medical detailed information, understanding and applying the relevant state support in isolated areas, we will review the preparation, the equipment, legislation and policy to the facts, applying (and defi ning) natural the training and medical staffi ng that contributed to the success of the justice, exercising discretion (e.g ICAO fl exibility cause), and rescue mission following the crash of First Air Boeing 737 fl ight 6560 appropriately communicating reasons for decisions made . An in Resolute Bay, Nunavut, on August 20th 2011 where 3 survivors were overview of the mechanisms of applicants to appeal aeromedical rescued by Canadian Forces personnel. METHODS: Due to the remote decisions around the world will be presented, and the advantages and location of the operation and to the relative high tempo of fl ying activity disadvantages of external review will be discussed. The infl uence of that was scheduled to take place during the month long exercise, a review Tribunals on aeromedical policy will also be discussed. heavy Unit medical Station (UMS) was established in order to be ready for an air or ground disaster.With a mixed team of regular and reserve Learning Objectives: force medical technicians, teaching and training was essential in 1 To increase awareness of the importance of the use of legal prin- developing cohesion and effectiveness and individual and collective ciples in aeromedical decision making. training was conducted leading to a camp wide exercise just seven days before the actual crash. RESULTS: Within 30 minutes of the confi rmation of the crash, the three casualties arrived in the UMS. The fi rst responders 11:30 am quickly stabilized the injured before they were rapidly evacuated by [64] PRACTICAL IMPLEMENTATION OF THE DREYFUS Griffon helicopters to the UMS. ATLS care was given and the three MODEL IN AN INSTRUCTIONAL FRAMEWORK FOR patients were further stabilized before getting air evacuated to Iqaluit. MEDICAL EDUCATION Help and support from non-medical personnel was pre-arranged and R. WILSON, J. STEPANEK AND D. FORTUIN was essential during the medical intervention. Three American Coast Mayo Clinic, Phoenix, AZ Guard divers, Emergency Medical Technician (EMT) qualifi ed, were also incorporated to the medical team and played a signifi cant role for one of INTRODUCTION: Traditional teaching in medical education is the casualty. DISCUSSION: Medical support to Northern Operations is a challenging issue that can be overcome with the appropriate medical based on an apprenticeship model. As a result, many assumptions regarding learning are based on modeling and are not specifi cally equipment, planning and most importantly, appropriate and focused articulated, but rather implicit to the trainee-teacher relationship. The collective training. The camp response to First Air Boeing 737 fl ight advent of increasing restrictions on trainee duty hours, maintenance of 6560’s crash was a true example of collaborative effort. Op Nanook 11 certifi cation, evidence based medicine andIP: guidance192.168.39.151 from the On: Sun,personnel 26 Sep deployed2021 17:39:09 to train in isolated areas and, unexpectedly, ended American Board of Medical Specialties (ABMS)Copyright: requires educators Aerospace in Medicalup saving Association three lives due to their professionalism, initiative and medicine to embrace new avenues of thinking and designingDelivered their by dedicationIngenta in developing an effective and effi cient crash response plan. curricula. Ideally curriculum content should cover the scope of the 6 core competencies as spelled out by the ACGME (Accreditation Learning Objectives: Council for Graduate Medical Education). METHODS: The core faculty 1 Identifying the main challenges to medical support in Northern at the Mayo Clinic in Arizona Multidisciplinary Simulation Center Operations modifi ed the mission essential competencies model by Bennett et al. 2 Identifying the main aspects of an effi cient crash response plan such that it is suitable for use in medical education contexts. Utilizing 3 Discussing the potential roles of non-medical personnel in an this instructional framework, clinical experts are prompted to provide isolated catastrophic medical response. clear articulation of learner competencies, with analysis of antecedent knowledge and skills, incorporation of cultural competencies and challenges to performance. Combined with the Dreyfus model of skill Monday, May 14 10:30 AM acquisition, the instructional framework allows faculty to target Salon D training across the spectrum of novice to master practitioners. These decisions then drive scenario development and learner evaluations. DISCUSSION: Utilization of a framework that allows a comprehensive PANEL: DESIGNING MEDICAL SUPPORT assessment of the state of skill acquisition (Dreyfus model) of a given FOR A NEAR-EARTH ASTEROID MISSION learner as well as an instructional model that covers knowledge, skills, essential competencies, cultural competencies and challenges has [66] DESIGNING MEDICAL SUPPORT FOR A NEAR-EARTH been a very useful combined tool to design curriculum and assess ASTEROID MISSION progress. The use of the category “cultural competencies” allowed for S.D. WATKINS1, J.B. CHARLES2, C. KUNDROT2, Y.R. BARR1, introduction of aspects that center on communication, team work and K.N. BARSTEN3, D. CHIN4, E.L. KERSTMAN1 AND C. OTTO5 human factors; taken together the framework creates a useful matrix 1The University of Texas Medical Branch, Galveston, TX; 2NASA for curriculum design, briefi ng and debriefi ng of an educational 3 experience. Conclusions: The combination of the Dreyfus model and a Johnson Space Center, Houston, TX; Enterprise Advisory 4 clear, quantifi able instructional framework offers optimal opportunity Services, Inc., Houston, TX; Wyle Integrated Science and En- to quantify learner centric outcomes while encompassing the 6 core gineering, Houston, TX; 5Universities Space Research Associa- ACGME competencies tion, Houston, TX

226 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

This panel will discuss the design of medical support for a Astronaut Health (LSAH) in-fl ight occurrence data, The Space Shuttle mission to a near-Earth asteroid (NEA) from a variety of perspectives. (STS) Medical Checklist, The International Space Station (ISS) Medical The panelists will discuss the proposed parameters for a NEA mission, Checklist, and subject matter expert opinion. Each medical condition the NEA medical condition list, recommendations from the NASA listed has been assigned a clinical priority and a clinical priority telemedicine workshop, an overview of the Exploration Medical rationale based on incidence, consequence, and mitigation capability. System Demonstration planned for the International Space Station, use Implementation: The condition list is a “living document” and as such, of predictive models for mission planning, and mission-related new conditions can be added to the list, and the priority of conditions concerns for behavioral health and performance. This panel is intended on the list can be adjusted as the DRM changes, and as screening, to make the audience aware of the multitude of factors infl uencing diagnosis, or treatment capabilities change. The NEA medical medical support during a NEA mission. condition list was used recently as the basis for identifying gaps in in-fl ight medical evaluation (screening) capabilities. [67] WHY SHOULD HUMANS EXPLORE A NEAR EARTH Learning Objectives: ASTEROID AND WHAT FACTORS DRIVE THE MEDICAL RISKS? 1 The audience will become familiar with the approach taken by NASA’s Exploration Medical Capability element in addressing the C. KUNDROT1, S. STEINBERG2, M. ARYA2 AND 1 risk of inability to recognize and treat medical conditions in the J.B. CHARLES setting of a NEA mission. 1Human Research Program, NASA / JSC, Houston, TX; 2 Human Research Program, Wyle Integrated Science and [69] TELEMEDICINE IN SPACE FLIGHT - SUMMARY OF A Engineering Group, Houston, TX NASA WORKSHOP K.N. BARSTEN1, S.D. WATKINS2, C. OTTO3 AND INTRODUCTION: The National Aeronautics and Space D.K. BAUMANN4 Administration (NASA) is currently considering plans for the human 1 exploration of a Near Earth Asteroid (NEA). Reasons for undertaking Enterprise Advisory Services, Inc., Houston, TX; 2 the human exploration of a NEA include increasing the scientifi c The University of Texas Medical Branch, Galveston, TX; understanding of the origins of our solar system, and developing 3Universities Space Research Association, Houston, TX; 4NASA technology for the exploration of more distant destinations such as Johnson Space Center, Houston, TX Mars. Most mission scenarios have a duration on the order of several months or a year, most of which is spent in transit to and from the INTRODUCTION: The Exploration Medical Capability Element NEA. The choice of a particular NEA destination determines the of the Human Research Program at NASA Johnson Space Center mission duration and guides the types of exploration activities that can hosted the Telemedicine Workshop in January 2011 to discuss the be performed on and near the NEA. NASA’s Human Research Program medical operational concept for a crewed mission to a near-Earth (HRP) has identifi ed short and long-term health risks associated with asteroid (NEA) and to identify areas for future work and collaboration. such missions and begun characterizing the level of risk. Some risk With the increased likelihood of a medical incident on a long duration drivers are well known from missions to low Earth orbit and the Moon exploration mission to a NEA, as well as the fact that there will likely (e.g., the limited mass, volume, and power available for the medical be limited medical capabilities and resources available to diagnose care system). Other factors emerge as major drivers for NEA missions. and treat medical conditions, it is anticipated that a more structured Some are fundamental characteristics of the mission parameters (e.g., use of telemedicine will become highly desirable. The workshop was mission duration, distance) and others are strongly dependent on the convened to solicit expert opinion on current telemedicine practices specifi cs of how the mission is implemented (e.g., isolation and and on medical care in remote environments. Workshop Objectives: confi nement). Careful consideration of these factors will be required The workshop brought together leaders in telemedicine and remote for safe and effective missions to NEAs. medicine from The University of Texas Medical Branch, Henry Ford Hospital, Ontario Telemedicine Network, U.S. Army Institute of Surgical Learning Objectives: IP: 192.168.39.151 On: Sun,Research, 26 Sep University 2021 17:39:09 of Miami, American Telemedicine Association, 1 We consider risks to performance of the mission,Copyright: crew health Aerospace dur- MedicalDoctors Without Association Borders, and the Pan American Health Organization. ing the mission and their lifetime after return. The primary objectives of the workshop were to document the medical Delivered byoperations Ingenta concept for a crewed mission to a NEA, to determine gaps [68] THE NEAR-EARTH ASTEROID MEDICAL CONDITION LIST between current capabilities and the capabilities outlined in the operations concept, to identify research required to close these gaps, Y.R. BARR, E.L. KERSTMAN AND S.D. WATKINS and to discuss potential collaborations with external-to-NASA organiza- The University of Texas Medical Branch, Houston, TX tions with similar challenges. Summary of Discussions and Conclusions: The discussions held during the workshop and the conclusions reached INTRODUCTION: Purpose: The Exploration Medical Capability by the workshop participants were grouped into seven categories: (ExMC) element is one of six elements within NASA’s Human Research Crew Medical Offi cers, Patient Area in Spacecraft, Training, Electronic Program (HRP) and is responsible for addressing the risk of “the Medical Records, Intelligent Care Systems, Consultation Protocols, inability to adequately recognize or treat an ill or injured crewmem- Prophylactic Surgical Procedures, and Data Prioritization. The key ber” for exploration-class missions. The near-Earth asteroid (NEA) points discussed under each category will be presented. Medical Condition List, constructed by ExMC, is the fi rst step in addressing the above-mentioned risk for the 13-month long NEA Learning Objectives: mission. The NEA mission is being designed by NASA’s Human Space 1 The audience will become familiar with the conclusions reached Flight Architecture Team (HAT). The purpose of the condition list is to by leaders in telemedicine and remote medicine on the medical serve as an evidence-based foundation for determining which medical operational concept for a human exploration mission to a NEA. conditions could affect a crewmember during the NEA mission, which of those conditions would be of concern and require treatment, and for which conditions a gap in knowledge or technology development [70] EXPLORATION MEDICAL SYSTEM DEMONSTRATION exists. This information is used to focus research efforts and technology PROJECT 1 2 2 3 development to ensure that the appropriate medical capabilities are D. CHIN , T. MCGRATH , B. REYNA AND S.D. WATKINS available for exploration-class missions. Scope and Approach: The NEA 1Wyle, Houston, TX; 2NASA, Houston, TX; 3University of Texas Medical Condition List is part of a broader Space Medicine Exploration Medical Branch, Galveston, TX Medical Condition List (SMEMCL), which incorporates various exploration-class design reference missions (DRMs). The condition list INTRODUCTION: A near-Earth Asteroid (NEA) mission will contains 85 medical conditions which could occur during space fl ight present signifi cant new challenges including hazards to crew health and which are derived from several sources: Lifetime Surveillance of created by exploring a beyond low earth orbit destination, surface

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 227 ASMA 2012 MEETING ABSTRACTS proximity operations, and the effects of variable micro-gravity Learning Objectives: environments. Limited communications with ground-based personnel 1 The audience will learn how an evidence-based decision support for diagnosis and consultation of medical events require increased tool can be used to help assess risk, develop mitigation strategies, crew autonomy when diagnosing conditions, creating treatment plans, and optimize medical systems for exploration space fl ight missions. and executing procedures. Scope: The Exploration Medical System Demonstration (EMSD) project will be a test bed on the International [72] BEHAVIORAL FACTORS RELATED TO REDUCED Space Station (ISS) to show an end-to-end medical system assisting the HABITABLE VOLUME DURING A NEAR EARTH ASTEROID Crew Medical Offi cers (CMO) in optimizing medical care delivery and MISSION medical data management during a mission. NEA medical care C. OTTO1, A. WHITMIRE2 AND L. LEVETON3 challenges include resource and resupply constraints limiting the 1 2 extent to which medical conditions can be treated, inability to Universities Space Research Association, Houston, TX; Wyle 3 evacuate to Earth during many mission phases, and rendering of Integrated Sciences and Engineering, Houston, TX; NASA medical care by a non-clinician. The system demonstrates the Johnson Space Center, Houston, TX integration of medical technologies and medical informatics tools for managing evidence and decision making. Project Objectives: The INTRODUCTION: Future NEA missions will be up to 13 months objectives of the EMSD project are to: a) Reduce and possibly in duration and occur well beyond LEO. There are only four humans eliminate the time required for a crewmember and ground personnel who have fl own in space for a year or longer, continuously- a to manage medical data from one application to another. b) Demon- signifi cant lack of long duration mission experience. As a species, strate crewmember’s ability to access medical data/information via a Homo sapiens have spent over 99 percent of their evolutionary history software solution to assist/aid in the treatment of a medical condition. in the sensory rich natural world. During the transit portions of a NEA c) Develop a common data management architecture that can be mission, there will be few or no planned EVAs or casual egress to break ubiquitously used to automate repetitive data collection, management, the monotony. The limited volume will curtail the amount of science and communications tasks for all crew health and life sciences performed, the primary activities will be maintenance, performance of activities. d) Develop a common data management architecture that countermeasures, and activities of daily living, resulting in low levels of allows for scalability, extensibility, and interoperability of data sources stimulation. Current evidence reveals that a long term reduction in and data users. e) Lower total cost of ownership for development and sensory input across the senses has negative consequences on neural sustainment of peripheral hardware and software that use EMSD for processing, cognition and psychological well being. A NEA crew will data management f) Provide better crew health via the reduction in experience a prolonged and continuous absence of social connections. crew errors, crew time, and ground time. Humans are a social species, and such a lack of human contact will cause profound emotional deprivation which negatively impacts Learning Objectives: cognitive and behavioral performance. Individuals experiencing 1 The audience will become familiar with the EMSD project prolonged isolation are higher in negative state affect, perform worse objectives on cognitive tasks, and engage in maladaptive behaviors. Crew members will require regular and frequent contact with Earth-bound family, friends, and colleagues via transmitted audio-visual messages, [71] THE USE OF THE INTEGRATED MEDICAL MODEL FOR FORECASTING AND MITIGATING RISKS FOR A and regular asynchronous private psychological conferences with mission psychologists. Temporary withdrawal is the primary means that NEAR-EARTH ASTEROID MISSION E.L. KERSTMAN1, L.G. SAILE2, M. FREIRE DE CARVALHO2, individuals can interrupt the stress-strain cycle; thus, privacy and personal crew quarters are essential, offering one of the few opportuni- J. MYERS3, M. WALTON2, D. BUTLER2 AND V. LOPEZ4 1 ties crew members have to escape the monotony of their daily routine. University of Texas Medical Branch, Galveston, TX; Finally, selection of individuals with prior experience in isolated and 2 3 Wyle Integrated Science and Engineering, Houston, TX; NASA confi ned environments, and those who possess the requisite personal- 4 Glenn Research Center, Cleveland, OH; JESTech, Houston, TX ity traits, will be better able to adapt to the NEA mission environment characterized by sensory deprivation and social isolation. INTRODUCTION: The IntegratedIP: Medical 192.168.39.151 Model (IMM) is On:a Sun, 26 Sep 2021 17:39:09 decision support tool that is useful to space fl ightCopyright: mission managers Aerospace MedicalLearning AssociationObjectives: and medical system designers in assessing risks and optimizingDelivered by 1Ingenta The audience will learn about risks to behavioral health and medical systems. The IMM employs an evidence-based, probabilistic performance, countermeasures, and enabling technologies for risk assessment (PRA) approach within the operational constraints of exploration-class space missions. space fl ight. METHODS: Stochastic computational methods are used to forecast probability distributions of medical events, crew health metrics, medical resource utilization, and probability estimates of Monday, May 14 2:00 PM medical evacuation and loss of crew life. The IMM can also optimize Ballroom A medical kits within the constraints of mass and volume for specifi ed missions. The IMM was used to forecast medical evacuation and loss of crew life probabilities, as well as crew health metrics for a SLIDE: TRAINING, GAMING, AND near-earth asteroid (NEA) mission. An optimized medical kit for this SYSTEMATIC EVALUATION FOR ENHANCED mission was proposed based on the IMM simulation. RESULTS: The IMM can provide information to the space program regarding medical HUMAN PERFORMANCE risks, including crew impairment, medical evacuation, and loss of crew life. This information is valuable to mission managers and the 2:00 pm space medicine community in assessing risks and developing [73] EFFECTS OF ONLINE TRAINING ON AIRCREW mitigation strategies. Exploration missions such as NEA missions will MONITORING BEHAVIORS: A FIELD STUDY have signifi cant mass and volume constraints applied to the medical 1 2 2 system. Appropriate allocation of medical resources will be critical to B.A. POTTER , A. BOQUET , E. BLICKENSDERFER AND 2 mission success. The IMM capability of optimizing medical systems N.D. MACCHIARELLA based on specifi c crew and mission profi les will be advantageous to 1U.S. Coast Guard, Washington, DC; 2Embry-Riddle Aeronauti- medical system designers. DISCUSSION: The IMM is a decision cal University, Daytona Beach, FL support tool that can provide estimates of the impact of medical events on human space fl ight missions, such as crew impairment, evacuation, INTRODUCTION: Data from aircraft accidents and line and loss of crew life. It can be used to support the development of observation studies indicate that inadequate pilot monitoring is a mitigation strategies and to propose optimized medical systems for growing safety concern. Pilots who fail to properly manage their specifi ed space fl ight missions. workload commit more monitoring errors. Given the lack of training

228 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS programs available to pilots which emphasize monitoring skill as a experience. DISCUSSION: Varying task selection and diffi culty will competency, more research is needed to assess the effi cacy of optimize the prefl ight acquisition of skills when performing novel various types of training that can be used to improve pilots’ monitor- operational tasks. An operational manual control simulation will ing. This research project set out to determine if the potential existed provide functionally relevant evidence regarding the impact of to enhance pilots’ monitoring skills through online training. sensorimotor adaptation on early surface operations and what METHODS: Forty military helicopter pilots were divided into two countermeasures are needed. groups: a training group, which completed a web-based training module which emphasized altitude monitoring during vertical phases Learning Objectives: of fl ight, and a control group, which did not receive training. Within 1 The use of a motion-based simulation to investigate decrements in each group, the pilots were paired off and fl ew two training events in the profi ciency to operate pressurized rovers during early surface a full-motion, full-visual fl ight simulator. The effects of the online operations of space exploration missions, along with the acquisi- training were then evaluated using Kirkpatrick’s four-level frame- tion of skill profi ciency needed during the prefl ight phase of the work: reactions, learning, behaviors, and results. The pilots rated mission. their satisfaction with the training and were given a multiple-choice knowledge test. Researchers also observed the groups’ behaviors during fl ight simulator events - recording occurrences of four 2:30 pm behavior markers as the crews fl ew instrument approaches. Two [75] IMPLEMENTATION OF HUMAN PERFORMANCE MOD- markers were used to study training transfer and two were used to ERATORS IN A COMMERICAL GAMING ENVIRONMENT examine outcomes of critical in-fl ight tasks. RESULTS: Results W. FRASER showed the online training was effective based on the trainees’ DRDC Toronto, Toronto, ON, Canada reactions, learning, and behavior measures, lending support to the hypothesis that relatively inexpensive online training can effectively INTRODUCTION: Open-source and commercial gaming teach monitoring skills. DISCUSSION: It is proposed that the reason technologies are in common use for military and civilian training, for the lack of effectiveness at the outcome level was the use of simulation of complex human-machine systems, and the development highly-motivated, experienced pilots in a moderate workload and analysis of artifi cial intelligence methods for non-player charac- scenario. Future studies would benefi t from placing participants ters (NPCs) in these applications. In most cases, the capabilities of the under higher workload conditions to increase the task diffi culty, NPCs are fi xed and do not degrade as a result of factors within the using eye-tracking software as a measure of behavior change, and by simulated environment, such as workload, or due to simulated examining the duration of the training effects by conducting (six environmental and cognitive stresses. METHODS: The Epic Games months or more) follow-up analyses. Unreal game engine (UT3) and the Unreal Development Kit (UDK) was used to implement a high fi delity video game of an infantry Learning Objectives: bounding maneuver involving four non-playing characters (NPCs). The 1 The use of online training for teaching non-technical skills to pilots navigation skills and artifi cial intelligence capabilities of the NPCs will be discussed. were implemented with the Pogamut GameBots/Java enhancement to the Unreal environment, developed at Charles University in Prague. A 2:15 pm general purpose performance moderator class was developed in Java [74] ACQUISITION OF SKILL PROFICIENCY OVER to implement a set of functions to calculate the degradation in cognitive and physical performance of the the NPCs over the course MULTIPLE SESSIONS OF A NOVEL ROVER SIMULATION 1,2 1,2 1,5 4 of the simulation. RESULTS: The UDK/Pogamut environment, S.L. DEAN , Y. DE DIOS , S.J. WOOD , S. MOORE AND implemented in the Oracle NetBeans Java Integrated Development 3 H. MACDOUGALL Environment (IDE) allows full control of game play and the behaviour 1Wyle Integrated Science and Engineering, Houston, TX; 2NASA of NPCs in Unreal Tournament video games without the need to Johnson Space Center, Houston, TX; 3University of Sydney, Syd- modify the Unreal scripting language normally required for game ney, NSW, Australia; 4Mount Sinai SchoolIP: 192.168.39.151 of Medicine, On: Sun,customization. 26 Sep 2021 The 17:39:09inheritance, composition, and method overloading New York, NY; 5Universities Space ResearchCopyright: Association, Aerospace Medicalcapabilities Association of the Java language allows the rapid coding of classes Houston, TX Delivered byand Ingenta objects to modify NPC capabilities and behaviours with models of performance degradation due to mental and physical fatigue, INTRODUCTION: Following long-duration exploration transits, thermal stress, terrain and load carriage, etc., in native Java code, with adaptive changes in sensorimotor function may impair the crew’s algorithms coded in other languages, or in applications running on ability to safely perform manual control tasks such as operating networked servers. DISCUSSION: The combination of the Unreal pressurized rovers. Postfl ight performance will also be infl uenced by environment, the Pogamut application, and a custom package of Java the level of prefl ight skill profi ciency they have attained. The purpose code implementing AI capabilities of NPCs that are subject to of this study was to characterize the acquisition of skills in a motion- performance degradation, provides a powerful tool to simulate the based rover simulation over multiple sessions, and to investigate the impact of complex stresses on small unit team operations in rural or effects of varying the simulation scenarios. METHODS: Twenty urban environments. healthy subjects were tested in 5 sessions, with 1-3 days between Learning Objectives: sessions. Each session consisted of a serial presentation of 8 discrete tasks to be completed as quickly and accurately as possible. Each task 1 The audiance will learn about the implementation of artifi cial intel- consisted of 1) perspective-taking, using a map that defi ned a docking ligent agents in a gaming environment that can simulate physical target, 2) navigation toward the target around a Martian outpost, and and cognitive performance degradation. 3) docking a side hatch of the rover to a visually guided target. The simulator utilized a Stewart-type motion base (CKAS, Australia), 2:45 pm single-seat cabin with triple scene projection covering 150° horizontal by 50° vertical, and joystick controller. Subjects were randomly [76] AN OBJECTIVE METHOD FOR FUNCTIONAL COCKPIT assigned to a control group (tasks identical in the fi rst 4 sessions) or a ASSESSMENT R.M. MONBERG, M.J. TRUDGILL 2,1 2 varied-practice group. The dependent variables for each task included R. MONBERG AND M.J. TRUDGILL accuracy toward the target and time to completion. RESULTS: The 1US Air Force, North Pole, AK; 2AEIG, RAFCAM, Henlow, greatest improvements in time to completion occurred during the United Kingdom docking phase. The varied-practice group showed more improvement in perspective-taking accuracy. Perspective-taking accuracy was also INTRODUCTION: The last decade has witnessed incredible affected by the relative orientation of the rover to the docking target. advances in the number of new systems introduced into aerospace Skill acquisition was correlated with self-ratings of previous gaming service. These range from unmanned aerial systems and ground crew

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 229 ASMA 2012 MEETING ABSTRACTS stations to helmet mounted displays to full coverage anti-g suits and improved with the XMD symbology. DISCUSSION: The results of this the list goes on. Some of these systems are completely new in design study indicate that fl ight performance is not improved with the XMD and some involve retrofi tting existing equipment. All of these systems symbology and, in some instances, may actually be worsened. This take some account of ergonomics and human interface into their may relate to the disruption of normal instrument scanning while design concepts. A more progressive aeromedical waiver system is viewing the symbology. Whether or not these decrements could be also considering aircrew for return to fl y status in the presence of eliminated with additional training on the use of the XMD requires some functional impairments. Additionally, the ISR mission has further investigation. increased the need for additional aircrew and workspaces that do not meet the standards set for traditional aircrew and cockpit design. The Learning Objectives: Royal Air Force Centre of Aviation Medicine (RAFCAM) has developed 1 The audience will learn how primary fl ight displays can be used to a formalized and objective process to assess the incorporation of new improve attitude awareness. equipment and impact of functional impairment in aircrew cockpit 2 The audience will understand the importance of artifi cial attitude and work spaces. METHODS: The RAFCAM Aircrew Equipment information for mitigating spatial disorientation. Integration Group has developed a consistent and repeatable 3 The audience will appreciate the relationship between attitude algorithm to assess: borderline anthropometrics, cockpit / workstation information and aircraft performance information. engineering changes, modifi cations of aircrew life support equipment, and return to fl y waiver cases with functional impairment. The algorithm has grown out of a need to replace a haphazard approach 3:15 pm with an institution wide standard and is based on occupational [78] SUBJECTIVE EFFECTS OF A NOVEL HEAD-MOUNTED medicine work place assessment principles. The method is taught to SYMBOLOGY ON SPATIAL DISORIENTATION AND Flight Medical Offi cers (RAM equivalents) at yearly re-fresher courses. FLIGHT PERFORMANCE IN UNITED STATES Assessments are designed to be conducted in the fi eld by a fl ight AIR FORCE PILOTS surgeon in conjunction with a position specialist (e.g. pilot for cockpit R. EVANS1, F.H. PREVIC1, N. DILLON2, R.W. MARESH3, issues, crew chief for backend transport aircraft issues etc.) DISCUS- W.R. ERCOLINE1 AND J. FISCHER1 SION: A systematized, repeatable, consistent, objective and legally 1 2 defensible functional assessment is now in place for aviation Wyle, San Antonio, TX; USAF School of Aerospace 3 medicine in the UK. The system ensures that aircrew can do the Medicine, Wright-Patterson AFB, OH; USAF Academy, required job without having to rely on a potentially ineffective and Colorado Springs, CO extensive set of standards and regulations to be implemented for each novel case. INTRODUCTION: Countering spatial disorientation (SD) by improving attitude awareness through enhanced, aircraft-centric Learning Objectives: visual displays has been spotty. The present study investigated the TM TM 1 Understand the methodology to developing a standard, repeatable subjective effects of the X-Motion Device (X-Motion ), a approach to cockpit functional assessment. see-though, head-worn device with dual-axis symbology for 2 Understand the benefi ts of developing an algorithm like the one head-centric pitch and roll, on fl ight performance, awareness of SD, TM described into a service wide standard. and workload in a simulator. The X-Motion symbology displays two large static intersecting lines--a horizon reference and a vertical reference perpendicular to it--and a moving line depicting head 3:00 pm orientation relative to gravity. METHODS: Ten United States Air Force pilots, each with at least 450 fl ight hours, participated. [77] THE EFFECTS OF A NOVEL HEAD-MOUNTED SYMBOLOGY ON FLIGHT PERFORMANCE IN UNITED During one half-day session, they were trained on two profi les: a 19-min profi le involving a takeoff and series of climbs and turns STATES AIR FORCE PILOTS 1 2 1 3 before descent into a night visual approach; and a 12-min profi le F.H. PREVIC , N. DILLON , R.H. EVANS , R. MARESH , involving a takeoff and turn into turbulence before fi nal approach 1 1 IP: 192.168.39.151 On: Sun, 26 Sep 2021 17:39:09 W.R. ERCOLINE AND J. FISCHER to a day instrument landing. Pilots were then tested over two 1 2 Copyright: Aerospace Medical Association Wyle, Inc., San Antonio, TX; USAFSAM/FHC, Delivered by separateIngenta days on the profi les and given a 13-question, 7-pt, Likert Wright-Patterson AFB, OH; 3HQ USAFA/DFB, Scale survey at completion. RESULTS: Although objectively Colorado Springs, CO X-MotionTM had a slight negative effect on performance in two conditions, subjectively it showed a slight benefi t for attitude INTRODUCTION: One way to counter spatial disorientation is awareness, particularly in roll, and was commended by most pilots. by improving attitude (pitch and roll) awareness through enhanced Two questions: “awareness of aircraft roll” and “overall awareness visual displays. The present study investigated the effects of the of aircraft attitude/orientation) resulted in a mean difference from X-Motion Device (XMD), a see-though head-worn device with a the neutral rating of “4” of at least one rating point at p = .032 and head-tracker and dual-axis symbology, on fl ight performance and p = .009 signifi cance, respectively. A majority of pilots rated the other measures in a simulator. The XMD symbology displays two X-MotionTM symbology as benefi cial and, with one exception, large static intersecting lines--a horizon reference and a vertical predominately rated it either neutral or helpful on specifi c aspects reference perpendicular to it--as well as moving line depicting the of fl ight. DISCUSSION: Results indicate that the X-MotionTM orientation of the head relative to gravity. METHODS: Ten United symbology has favorable qualities for maintaining attitude aware- States Air Force pilots, each with at least 450 fl ight hours, participated ness, especially regarding the critical parameter of roll, and in this study. During one half-day session, they were trained on two subjectively causes no harm to instrument fl ying and other cockpit profi les: a 19-min profi le involving a takeoff and series of climbs and tasks. The discrepancy between objective and subjective fi ndings turns before descent into a night visual approach; and a 12-min may suggest need for additional training on integrating the profi le involving a takeoff and turn into turbulence before fi nal symbology into an established crosscheck. approach to a day instrument landing. Pilots were then tested over two separate days on the profi les. In each profi le, deviations from Learning Objectives: specifi ed fl ight parameters, including airspeed, altitude, heading, 1 Understand the philosophy behind a head-centric approach to vertical velocity, bank, glide-slope and course deviation, were attitude awareness. measured using root-mean-square error. RESULTS: There was little 2 Gain insight into the possibility of successfully integrating a new difference overall between fl ight performance with and without the attitude awareness approach into established fl ight habits and XMD. The XMD symbology resulted in poorer performance on two cockpit instrumentation. measures -- vertical velocity error during Profi le 1 and altitude error 3 Appreciate the value of disparate subjective and objective results of during the turbulence phase of Profi le 2. In no case was performance scientifi c studies.

230 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

Monday, May 14 2:00 PM vertebral level. The hazard score weights the ligaments’ risk contribu- tion based upon the resulting severity of injury given ligament failure. Ballroom B RESULTS: FAST is able to calculate the probability of failure of cervical spine soft tissues from C3 to C7 for an ejection given the PANEL: ADVANCES IN UNDERSTANDING helmet design parameters of the user. The resulting hazard scores can be used to compare the relative risk between different helmet designs. HEAD, BRAIN, AND SPINAL INJURY DISCUSSION: FAST has been developed to quickly investigate the MECHANISMS: PART II effect of various design choices and head/neck initial positions on the risk of cervical injury during an ejection. This tool leverages CSM in [79] ADVANCES IN UNDERSTANDING HEAD, BRAIN, AND that it has been exercised at thousands of design points to generate a SPINAL INJURY MECHANISMS: PART II series of response surfaces representing the model predicted head/neck B.S. SHENDER, G.R. PASKOFF AND C. MATTINGLY response within the desired design space. While the tool is highly effi cient in capturing the response of the CSM, it is only applicable Human Systems Dept, NAVAIR, Patuxent River, MD within the design space considered.

Warfi ghters are exposed to acceleration forces during normal Learning Objectives: and emergency operations in air and sea that load the head and spine and can lead to pain and injury. Incidents of blast induced mild 1 Learn how response surface modeling can be used to aid in spinal traumatic brain injury (mTBI) continues to rise. In order to develop injury prediction. effective means of injury mitigation, it is essential to understand the underlying injury mechanisms resulting from exposures to dynamic [81] ANALYSIS OF A CERVICAL SPINE HAZARD events. Historically, injury criteria have been generated using manikin ASSESSMENT TOOL USING A FAST RUNNING INJURY responses or data from cadaveric studies on specimens too aged to PREDICTION MODEL provide relevant material properties for a young and fi t force. The US P.E. WHITLEY1, L. FRANCIS2 AND D.P. NICOLELLA2 Offi ce of Naval Research funded Naval Air Systems Command head/ 1Criterion Analysis Incorporated, Miami, FL; 2Southwest brain/spinal injury prediction program was created to address the gaps Research Institute, San Antonio, TX in our clinical knowledge and to develop tools to create optimal design guidelines. This double panel presents the results from ten INTRODUCTION: Injury severity determination is an essential studies of spinal trauma from ejection, lumbar pain, and mTBI. After an aspect in health hazard assessment of potential operational equipment. overview of the model, a discussion of how loading rate affects A hazard assessment tool (HAT) was developed that translated major thoraco-lumbar spinal injury pattern (Medical College of Wisconsin posterior cervical spinal ligament failure probabilities into a hazard (MCW)) and intervertebal disc response to ejection (CFD Research score (HS) and severity categories. The HAT was evaluated using a fast Corp.) is presented. A new injury criteria for repeated lumbar vertical running cervical spine (C3-C7) injury prediction model. METHODS: loading and a description of spinal cord properties is provided (Duke Four occupant sizes (two female and male) were modeled using the University). The second panel begins with a description of a fast Naval Air Systems Command fast running cervical spine model and the running cervical injury prediction tool and its use in risk assessment vertical ejection catapult pulse of 14Gz and 230 msec duration. Four (Southwest Research Institute and Criterion Analysis, Inc.). MCW then added head weights (AHW) of 2, 3, 4 and 4.9 lbs with 16 centers of describes axial force/bending moment cervical injury thresholds gravity (CG) distributed between forward (X) CG of -1 to 1.5 inches and resulting from side impacts. The panel concludes with three blast vertical (Z) CG of 1.5 to 4 inches placement with no y axis deviation. related studies including cranial bone properties (University of The head was positioned forward at 12o. The HS was calculated using Virginia), behavioral response to repeated blast (MCW), and alternative a weighted sum of the model predicted posterior longitudinal ligament, paths to simple geometry to blast and blunt trauma interspecies scaling facet joint capsule, ligamentum fl avum and intra/supraspinous ligament (Duke). failure probabilities with increasing weight given to more anterior IP: 192.168.39.151 On: Sun,ligaments. 26 Sep Hazard 2021 severity17:39:09 was rated negligible, marginal, critical and [80] DEVELOPMENT AND IMPLEMENTATION OF A FAST catastrophic using the HS. RESULTS: For this fl exion event, the most RUNNING INJURY PREDICTION TOOL Copyright:FOR THE CERVICAL Aerospace Medicalposterior ligamentsAssociation exhibited the highest failure probabilities which SPINE Delivered bydeclined Ingenta proceeding in anterior order. Accordingly, HS increased as the L. FRANCIS1, D.P. NICOLELLA1, J. MCFARLAND1, more anterior ligaments exhibited higher failure probabilities. P.E. WHITLEY2 AND B.S. SHENDER3 Increasing AHW, X and Z placed CG, and the effect combination was 1Southwest Research Institute, San Antonio, TX; 2Criterion Anal- associated with increased HS and greater hazard severity. This HS 3 effect was modulated by occupant size where increased occupant size ysis Incorporated, Miami, FL; Human Systems Dept, was associated with decreased HS and severity. DISCUSSION: The NAVAIR, Patuxent River, MD hazard severities classifi ed from the HS were indicative of the loading conditions presented by the predicted ligament failure probabilities and INTRODUCTION: A fast running cervical spine injury assess- current AHW neck loading limits. Further evaluation of the HS method ment tool (FAST) was developed to determine the risk of injury of with the full ejection sequence is ongoing. different helmet designs for the catapult phase of an ejection. The NAVAIR high fi delity probabilistic fi nite element cervical spine model Learning Objectives: (CSM) typically takes 8h to perform an ejection simulation. Given that 1 To demonstrate a method of describing hazard severity for the a full probabilistic analysis can require over 100 simulations, it was cervical spine based upon structural element failure. determined that a faster tool was required. METHODS: Response surface modeling combined with analytical probabilistic analysis was utilized to create FAST. Response surface modeling was used to create [82] NECK INJURY TOLERANCE TO SIDE IMPACT LOADING a single quadratic equation (regression model) that can calculate a N. YOGANANDAN, F.A. PINTAR, B.D. STEMPER AND response for given values of all random variables. For the CSM there D.J. MAIMAN are 21 random variables, therefore, 253 simulations must be performed Department of Neurosurgery, Medical College of Wisconsin, to build a full quadratic response surface. To facilitate ease of use, Milwaukee, WI FAST was implemented using Microsoft ExcelTM. A user interface was created with two drop down menus for selecting the appropriate INTRODUCTION: The human cervical spine sustains forces/ model and data fi eld for the user to input the helmet design param- bending moments during physiologic/traumatic loads. Automotive, eters. The ExcelTM interface uses Visual Basic to call a dynamically military, and aviation events may cause traumatic injuries. Neck injury linked library that contains all the response surfaces as well as the criteria are needed to advance occupant safety. In the automotive fi eld, probabilistic routines. A hazard score is then calculated for each criteria are based on matching upper neck injuries from piglet tests to

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 231 ASMA 2012 MEETING ABSTRACTS airbag deployment loads and paired-kinematics from child dummies Learning Objectives: and on extrapolating child data to the adult human using results from 1 To understand the regional variation in skull bone material post mortem human subject (PMHS) tests and scaling processes. While properties. interaction-based neck injury criteria are known for fl exion-extension/ frontal impacts, they are not available for side impacts. The objective of this study is to synthesize data from experiments conducted by the [84] BEHAVIORAL OUTCOMES FOLLOWING REPEATED authors for determining axial force/bending moment injury thresholds MILD TRAUMATIC BRAIN INJURY under side impacts. METHODS: Sled tests were conducted using intact B.D. STEMPER1, F.A. PINTAR1, N. YOGANANDAN1 AND PMHS positioned with three-point/full restraints and tested at 9-, 12-, B.S. SHENDER2 and 17-m/s velocities. Isolated head-neck complexes and intact PMHS 1Department of Neurosurgery, Medical College of Wisconsin, tests were also subjected to side impacts with an electro-hydraulic Milwaukee, WI; 2Human Systems Dept, NAVAIR, Patuxent testing device. Specimens were positioned such that the occiput was River, MD connected via a custom apparatus to the testing device to induce coronal bending moments. In both series, head angular and linear INTRODUCTION: The objective was to compare post-injury accelerations and angular velocities were computed using a pyramid behavioral defi cits in rats subjected to either single or repeated nine accelerometer package; specimen-specifi c physical properties concussion using an experimental model that induces concussion including center of gravity and moments of inertia; and equations of using a biomechanically-correct mechanism. METHODS: Under equilibrium. These kinematic and physical property data were used to general anesthesia, adult female Sprague Dawley rats sustained mTBI determine occipital condyles forces/moments, and x-ray, CT, and through rapid head rotation using the MCW Rotational Injury Device. autopsy were conducted to identify injuries. RESULTS: Sled tests from The fi rst group sustained a single injury. The second group sustained a 8 PMHS produced neck injuries (AIS 0-3); 23 tests from two PMHS single injury, followed by a second injury seven days later. A third using the electro-hydraulic device produced no trauma. Curves group of controls was subjected to a sham procedure that involved representing injury reference values were determined using axial forces placement in the injury device without head rotational acceleration. and lateral bending moments. DISCUSSION: These data can be used All rats were exposed to fi ve minutes in the Elevated Plus Maze (EPM) to evaluate dummy biofi delity, derive injury criteria, and set perfor- on the sixth post-injury day and fi ve minutes in the Open Field Test mance standards for occupant safety in military and aviation (OFT) on the seventh post-injury day. RESULTS: Rats with repeated environments. injury spent signifi cantly less time in EPM closed arms (p<0.05), along Learning Objectives: with a greater number of rearing events per 60s in the closed arms and a greater number of head dips. These metrics were not markedly 1 To learn about axial force/bending moment cervical injury thresh- different between controls and rats with single injury. In the OFT, rats olds resulting from side impacts. with repeated injury had a signifi cantly higher number of rearing events (p<0.05), along with 20% greater ambulatory time/distance and [83] LOCATION BASED VARIATION OF MATERIAL a larger number of center entries. These metrics were not markedly PROPERTIES OF THE ADULT HUMAN SKULL different between controls and rats with single injury. DISCUSSION: S. BORUAH, D. SUBIT AND R. SALZAR As expected, no motor defi cits were seen, as the injury level was Center for Applied Biomechanics, University of Virginia, graded as concussion. The repeated concussion group demonstrated Charlottesville, VA increased aggressive behavior than single injury and control groups with a greater number of rearing events (OFT, EPM), open arm INTRODUCTION: Head trauma can result from various events exploration (EPM), and center explorations (OFT). Spatial learning ranging from sports activity, civilian traffi c accidents, to military defi cits (MWM) have been reported in other studies of ‘mild’ injury, but were not evident in this study. One possible explanation is that the activity. In order to understand the mechanism of head injuries and to augment modeling design to mitigate these injuries, accurate material current injury level is less severe than ‘mild’ injuries induced using properties of the materials associated with the head is necessary. The other mechanisms (e.g., fl uid percussion) that require craniotomy and limited nature of existing literature, and IP:in some 192.168.39.151 cases the total On: Sun,induce 26 Sep some 2021 level 17:39:09of local pathology. Behavioral defi cits resulting from absence of data, especially in high rate loadingCopyright: regimes, demands Aerospace Medicalrepeated Associationexposure to previously non-injurious head accelerations more extensive experimentation. The variation of bone materialDelivered by highlightIngenta increased susceptibility for second injury following initial properties over the entire skull might have signifi cant infl uence in the concussion event. outcome of such traumatic events. This study attempts to characterize location based variation of stiffness, porosity, and thickness in the Learning Objectives: cadaveric calvarium. METHODS: Computed Tomography scans were 1 To understand the consequence of repeated as compared to single performed on six male adult Post Mortem Human Surrogates mild concussive events on post-exposure behavior in a rodent (54.067.3yr, 107.7650.0kg, 163.8623.0cm). Cortical bone coupons model. from the outer table and through the thickness cores comprising both tables and diploe were extracted from 10 anatomically separate [85] INTERSPECIES SCALING IN INJURY BIOMECHANICS: locations on the skulls. Micro-computed tomography scanning and BLAST AND BLUNT TRAUMA analysis were done on these harvested specimens to estimate the C.R. 'DALE' BASS1, M. PANZER1, G. WOOD1, thicknesses of the tables and diploe and also the porosity of the various 1 1 2 layers. The coupons were tested on an Instron test machine using a J. SHRIDHARANI , C. COX , G.R. PASKOFF 2 custom designed holding jig at rates of 0.5/s. These tests yielded force AND B.S. SHENDER displacement data. High speed photography at 10,000fps was also 1Duke University, Durham, NC; 2Human Systems Dept, performed during these tests. The high speed images were later NAVAIR, Patuxent River, MD analyzed using an image correlation software package (ARAMIS) to determine tri-dimensional strain fi eld in the coupons. RESULTS: The INTRODUCTION: In the current military confl icts, blast skull material properties have been mapped to the skull anatomy. The exposure has been the preeminent cause of injury. Pre-clinical studies outer table was found to be softer on the superior aspect of the with animal models are necessary to advance our knowledge of calvarium by 16.6%. It was observed that the stiffness of the outer blast-related TBI (bTBI). Indeed, most of blast and blunt trauma injury table depends signifi cantly on its porosity. Also, the standard deviation research has used animals as models for humans, primarily for lung of the outer table stiffness increases with age. DISCUSSION: This injury. The spectrum of animal models used range from small rodents anatomical variation of skull bone material properties will result in a to large livestock. Nearly all current models, however, are constrained more accurate and biofi delic numerical model that allows the refracted by one or more shortcomings. In fact, Bell (2008) specifi cally calls for shock wave to be realistically absorbed into the skull with varying a new approach to animal models of bTBI. Among the defi cits of degrees of energy accumulation. current TBI models is an unclear relationship of injury force to actual

232 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS military situations and species of animal model. These defi cits are [87] SELECTION, TRAINING AND INTERFACES FOR UAS: related to the inability to scale blast forces and subsequent animal ENABLING THE FUTURE UAS OPERATOR COMMUNITY model physical and physiological response to human values. Most J. COHN scaling techniques use gross physical ratiometric techniques. These Offi ce of Naval Research, Arlington, VA techniques cover geometrical measurements, i.e. length, mass, area, as well as material properties, i.e. stiffness, mass density, material INTRODUCTION: Beginning in FY 12, the Navy and Marine composition. Geometric scaling often scales mass as a third power of Corps will signifi cantly increase their acquisition of a wide range of mass to get a length scale. This scaling technique has successfully been UAS platforms and in doing so, will face several critical human used for blast lung injuries and blunt trauma head injuries for years performance challenges. These UASs will continue to be more (Fisher, 1941). Another scaling technique often used for physiological complex, blending automation with dynamic, decentralized control to and biological phenomena scales mass to multiples of one-quarter support a wide range of missions. At the same time, current UAS power, including cellular metabolism and circulation (West, 1997). capabilities are not well-supported by current control station inter- This study outlines fruitful paths to blast and blunt trauma interspecies faces, training technologies or selection tools - as indicated by the fact scaling using mechanical and physiological techniques on both that as much as 50% of all UAS mishaps are attributed to human macroscopic and microscopic scales. This includes an assessment of factors, despite advances in UAS capabilities. Successful UAS assumptions regarding similitude between species. For lungs, for operations require selecting a new kind of Air Warrior, more effi ciently instance, this scaling technique may be appropriate, as all mammals trained to effectively process information using better-designed have similar lung mechanical function and structural determination of interfaces. Efforts to support these requirements can leverage the gas exchange. The human brain, however, differs from other mammals similarities between selection, training and design using cognitive in the proportional size of their various sub-regions and in local engineering techniques to characterize the types of knowledge, skills microscopic organization. These scaling techniques include structural and abilities necessary to operate current and future UASs., and anatomical, body mass and physiological parameters relevant to the advanced computational cognitive modeling to develop representa- animal models investigated for both blast and blunt trauma. tions of these KSAs around which new tools can be developed. These tools include: - Selection Tools for UAS Personnel: Develop and Learning Objectives: integrate new algorithms, based on UAS specifi c capabilities, into 1 Learn about scaling techniques other than geometric to relate ani- existing aviation selection tools to select for UAS skills sets - Dynamic, mal to human structure for injury modeling and prediction. Adaptive Synthetic Entities for UAS: Generate synthetic behaviors directly from raw sensor data, providing realistic training simulations across platforms, positions and missions - UAS Control Station Human Monday, May 14 2:00 PM Machine Interface solutions: Create adaptive interface designs that Ballroom C enable effective and safe monitoring & control of multiple UASs, reducing operator workload, and enabling multi-vehicle operation PANEL: AEROSPACE EXPERIMENTAL with reduced mishaps These tools will help the DoN reduce man- power costs by: a) Providing the data & tools to select non aviation PSYCHOLOGY AND THE FUTURE OF rated sailors, leading to a signifi cant cost avoidance; and, b) Reducing NAVAL AVIATION manpower requirements by enabling fewer operators to effectively control multiple UASs.

[86] AEROSPACE EXPERIMENTAL PSYCHOLOGY AND THE Learning Objectives: FUTURE OF NAVAL AVIATION 1 The learner will obtain a broader understanding of the D. SCHMORROW requirements necessary to effectively select, train, and equip Offi ce of the Assistant Secretary of Defense (Research and UAS operators to effectively meet mission requirements. Engineering), Rosslyn, VA IP: 192.168.39.151 On: Sun, 26 Sep 2021 17:39:09 The AEP community was established in OctoberCopyright: 1942 Aerospacewith an Medical[88] CONSIDERATIONS Association RELEVANT TO UAS MANNING initial focus on aviation personnel selection. The face of navalDelivered aviation byH. Ingenta PHILLIPS is very different today than it was in 1942. Modern aviation capabili- Naval Air Systems Command, Patuxent River, MD ties have redefi ned concepts of power production, battlespace management, and the nature and speed of intelligence gathering and INTRODUCTION: This presentation will discuss considerations utilization. These changes have created new challenges and opportuni- relative to manning of UA crews. Across services and platforms, four ties and the AEP community has evolved in response. While aviator broad categories of UA crew include mission commanders (MCs), air selection remains a critical focus area, the role of the AEP community vehicle operators (AVOs), sensor operators (SOs), and payload has expanded to include science and technology program manage- operators (POs). The fi rst two of these positions closely parallel ment, human factors, operational neuroscience, aviation training positions typically fi lled using winged offi cers in the manned aviation design, system acquisition, and safety research. Experts in the AEP community. This makes it extremely likely that the AVO and MC community have also been tapped to lead efforts in areas such as positions will be manned by previously winged aviators, with SO and virtual environment research, biometrics, and PTSD / TBI research and PO positions manned by enlisted aircrew. Over time, the manning development. Today’s group of panelists will highlight some of the model of the UA fl eet may shift to accommodate the use of enlisted work that the AEP community is doing in these areas. A key focus of aircrew for AVO and MC positions, but this is not the initial model. the panelists today will be on how the AEP community is actively This policy decision serves to mitigate one source of risk, in that a engaged in supporting the various Unmanned Aerial System (UAS) previously trained aviator is less likely to make some kinds of errors communities meet their program and mission objectives by addressing than will a newly trained aircrewman. However, the prior training and manning considerations, designing appropriate selection tools for UAS baseline skill levels of an operator population are critical drivers of personnel, building effective and effi cient training devices, and both interface design and training design. An AVO population of developing common control interfaces. Panelists will also discuss how previously winged aviators will likely be able to handle more task selection in the area of manned aviation has recently undergone an loading, is likely to able to divide its attention among competing tasks, evolutionary change in how it is conducted and describe how and may enjoy the benefi ts of effective cockpit habits, such as advances in the area of network analysis has enabled AEPs to redefi ne well-established scan patterns and communications experience how aviation training curriculum are evaluated and reworked. The relative to a population of inexperienced, previously untrained aircrew. topics discussed today highlight the essential nature of the work done On the other hand, these same habit patterns that work so well for by AEPs and only represent a small subset of the work done by AEPs in winged aviators in the cockpit may not be suited for use in a UA support of naval aviation. control station environment. Many of the elements of a single seat

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 233 ASMA 2012 MEETING ABSTRACTS tactical aviator’s scan pattern may be driven by the spatial and [91] AEROSPACE EXPERIMENTAL PSYCHOLOGY AND physiological limitations of a dynamic cockpit, limitations that will not ADVANCEMENTS IN AVIATION SELECTION be present in a UA control station on the ground. Use of experienced B. COX, R. FINDLAY AND C. FOSTER aviators as operators may make it easy to fall victim to the implicit Naval Aerospace Medical Institute, Pensacola, FL assumption that “what worked in the cockpit” is the best model for how things should work in a UA control system. This assumption can INTRODUCTION: Since the boom of naval aviation sparked by be very dangerous, particularly during training or interface design. WWII, aviation psychologists have examined a variety of measures for These differences in environmental requirements, crewmember inclusion in the Aviation Selection Test Battery (ASTB), the primary skillsets, and their implications for manning decisions will be tool for selecting pilots and fl ight offi cers into naval aviation training. explored. The current version of the ASTB, which predicts performance and attrition in the early stages of aviation training, contains subtests Learning Objectives: focused on candidates’ cognitive abilities, to include math skills, 1 The learner will obtain an understanding of issues relevant to reading skills, mechanical compression, spatial apperception, and manning decisions for unmanned aerial systems. aviation and nautical knowledge. Cognitive ability tests are common components of personnel selection systems as they rank among the [89] APPLYING NETWORK ANALYTIC TECHNIQUES TO strongest predictors of future performance in nearly any job. NAVAL ADVANCED STRIKE TRAINING However, numerous other personal and psychological characteristics P. WALKER1, C. FOSTER2 AND E. MIDDLETON2 can add value to a selection system when based on a proper job 1Chief of Naval Air Training, Corpus Christi, TX; 2Naval Aero- analysis. To this end, Aerospace Experimental Psychologists are space Medical Institute, Pensacola, FL preparing to release an updated version of the ASTB featuring three new non-cognitive subtests designed to provide a whole person INTRODUCTION: The Chief of Naval Air Training (CNATRA) is assessment of candidates’ fl ight aptitude. These subtests include: (a) tasked with training student Naval and Marine Corps aviators. the performance-based measures battery, which assesses psychomotor However, due to the high costs of training, it remains imperative that aptitude, auditory information processing, ability to visualize CNATRA provide current, relevant, and effi cient training programs. three-dimensional relationships, and ability to divide attention among Training within CNATRA is organized such that fl ights are grouped competing tasks; (b) the naval aviation trait facet inventory, which into blocks and stages. Whereas blocks are designed to focus on assesses aviation-relevant personality traits using an adaptive specifi c learning objectives, a stage consists of blocks containing forced-choice format designed to reduce faking; and (c) the biographi- training of a particular type (i.e., familiarization, navigation, etc.) cal inventory with response verifi cation, which assesses factors in within a phase of training. For example, in Advanced Strike (A Stk) candidates’ personal history related to success in aviation training. Preliminary results indicate that the addition of these measures should pilot training, there are a total of 65 blocks of training grouped into stages such as Night Forms, Carrier Qualifi cation Landings, and Basic improve the prediction of performance and attrition in aviation Flight Maneuvers. The primary focus of this paper will be to validate training as well as reduce subgroup differences during the selection the groupings of fl ights according to blocks and stages by applying process, thereby resulting in a more qualifi ed and diversifi ed aviation network/graph analytic approaches to the A Stk syllabus. In this study, training pool. a network, consisting of nodes and a set of edges (or connections), is used to represent the data. Each edge that connects two nodes Learning Objectives: suggests there is a relationship between both nodes in the graph and 1 The learner will develop familiarity with psychological constructs the distance between nodes indicates a measure of similarity between relevant to aviation selection and work underway to include them the nodes. in aviation selection instruments.

Learning Objectives: [92] AEROSPACE EXPERIMENTAL PSYCHOLOGY IN A COIN 1 The learner will be able to describe theIP: process 192.168.39.151 of network analysis On: Sun,CONTEXT 26 Sep 2021 17:39:09 and its applicability to Naval aviation training. Copyright: Aerospace MedicalD. COMBS Association [90] SIMULATION-BASED TRAINING RESEARCH INDelivered THE US by NavalIngenta Research Laboratory, Washington, DC NAVY INTRODUCTION: Over the last decade, as a result of US J.D. GRUBB engagements in Iraq and Afghanistan, the United States Military has Naval Air Warfare Center Training Systems Division, had to relearn how to conduct counterinsurgency (COIN) operations. Orlando, FL Rather than fi ght conventional state on state wars, the US military has found itself transitioning to a focus on conducting irregular warfare. INTRODUCTION: The United States Navy has identifi ed The conduct of COIN operations puts coalition personnel in close simulation-based training as a potential way to maintain fl eet readiness contact with the local population. In Iraq and Afghanistan, coalition while simultaneously reducing costs. By replacing training evolutions forces have constantly found themselves interacting closely with the that are currently conducted in fl ight or while under way, simulation Iraqi and Afghan population. In such a context, a deep understanding training would decrease wear on ships and aircraft and reduce the of the dynamics of the local population is key to success of any COIN amount of fuel and other expendables necessary to ensure sailors’ operation. In response to the needs of COIN practitioners, the Offi ce readiness. However, to achieve these savings, simulation-based of Naval Research has created a Social, Cultural and Behavioral training must provide the same quality of training as the live evolutions Sciences Program that is designed to help coalition personnel function that it replaces. In this presentation, we will provide an overview of more effectively. This program helps coalition forces by developing Navy sponsored research to develop new simulation technologies for approaches to help forces better understand the culturally, ethnically, the air, surface, and subsurface communities. Although the develop- and historically, diverse societies they operate within. The Aerospace ment of the hardware and software necessary to build the new devices Experimental Psychology (AEP) community contributes to the Social, is clearly necessary, we will argue that techniques to compare the Cultural, and Behavioral Sciences Program in a number of ways. For effectiveness of simulation-based training to legacy training are equally example, the US Military’s COIN manual notes that development of important. Consequently, experimental psychologists will play a key trust between coalition forces and the local populace is critical and role realizing the Navy’s vision for simulation-based training. that practitioners of COIN should work hard to establish trust between forces and the populace. Recent research by AEPs is examining Learning Objectives: techniques designed to enhance the trustworthiness of COIN 1 Learner will be able describe current Navy research in simulation- practitioners. This research has examined how trustworthiness can be based training. enhanced across ingroup-outgroup lines, even when certain

234 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS outgroups are seriously disliked by an ingroup. Future research is Learning Objectives: planned which will examine whether the techniques examined 1 Identify the key aero medical certifi cation factors that need to be by AEP researchers are effective at repairing trust lost as a result considered in a pilot who has had a Pancreatic Islet Cell Transplant. of betrayal.

Learning Objectives: [95] MOTION SICKNESS DESENSITIZATION: A REVIEW OF ADF EXPERIENCE OF “SUCCESS” 1 Learner will gain a basic understanding of the meaning and impor- A. SMITH1 AND S. QURESHI2 tance of counterinsurgency (COIN) operations in irregular warfare 1 2 and see how recent research is helping to change the way COIN RAAF AVMED, Surrey Downs, SA Australia; University of practitioners operate. Adelaide, Adelaide, SA, Australia

INTRODUCTION: Motion sickness is a well-known phenom- Monday, May 14 2:00 PM enon in aviation, predominantly amongst student pilots early in their Ballroom D fl ying training. As many other air forces, the Royal Australian Air Force runs a motion sickness desensitisation (MSD) programme. Similar programmes around the world have reported ‘success’ rates between PANEL: GONE WITH THE “WILLY-WILLY”: 70-90%; AVMED claims a success rate of 91%. However, in reviewing EPIC TALES FROM THE TRUE DEEP SOUTH different MSD programmes, the lack of a standard defi nition of ‘sucess’ made it diffi cult to compare one programme with another. METHODS: [93] GONE WITH THE “WILLY-WILLY”: EPIC TALES FROM An attempt was made to identify and contact people who had undergone the MSD programme during the period 1997 to 2011. THE TRUE DEEP SOUTH 1 2 Those who were contacted participated in a structured interview T.L. SMART AND B.J. BARKER looking at their symptoms before MSD and the perceived success of 1 Australian Defence Force, Campbell Park, AC,T Australia; the programme when they resumed fl ying. Interview data was then 2RAAF Institute of Aviation Medicine, Edinburgh, SA, Australia linked to data collected during the MSD, including symptom scores, vertigo times, and rate of progress through the MSD. RESULTS: During Spinning in from the great land to the south we present a the period 1997-2011, AVMED performed 33 MSD courses on 30 variety of papers exploring clinical aspects of aerospace medicine. aircrew. Of the 33 sessions, only 16 (48%) fully met the criteria for Our Aviation Medical Offi cers will explore the 1% rule in aeromedi- successful completion of the protocol, with another 13 (39%) being cal disposition, and consider whether islet cell transplants offer a considered partial success and encouraged to return to fl ying, giving a solution to diabetic pilots who want to fl y. They will also spin some notional ‘success’ rate between 48% and 87%. However, of the 20 yarns about centrifuge training with our regional neighbors and student pilots followed up by interview, only 10 (50%) completed present our experience with motion sickness desensitization over the basic fl ying training, although the extent to which their failure was past 14 years. Finally we will look at dealing with patients who may attributed to motion sickness was not recorded. Of the pilots who be spinning yarns of their own by examining how to manage completed their fl ying training, 75% describe persistent operationally- potential malingerers. There is no doubt that you will be blown signifi cant motion sickness during the 1000’s of hours fl own since. away by our Australian “willy-willy”, an aboriginal word for a Likelihood of successful completion of fl ying training was unrelated to whirlwind. initial motion sickness score, initial vertigo time, or rate of improve- ment during MSD. DISCUSSION: This presentation will explore why so many people who passed the MSD protocol did not complete fl ying [94] PANCREATIC ISLET CELL TRANSPLANTATION: IS IT A training, and will discuss improvements to the way MSD candidates NEW HOPE FOR INSULIN DEPENDANT PILOTS? are followed up and managed when they return to fl ying in order to M.S. CLEMENTS determine the extent to which motion sickness persists in student pilots RAAF Townsville, Royal Australian AirIP: Force, 192.168.39.151 Douglas, Australia On: Sun,despite 26 Sep them 2021 having 17:39:09 undergone MSD. Copyright: Aerospace Medical Association INTRODUCTION: Dr H is a 36 year old United KingdomDelivered byLearning Ingenta Objectives: trained family medicine practitioner who moved to Australia to fl y. 1 Understand that it may be diffi cult to defi ne ‘success’ when Requiring insulin for his Type 2 Diabetes means that his only chance managing motion sickness in aircrew. for certifi cation in the United Kingdom was a National Private Pilots License which he felt was too restrictive, and his research showed [96] SPINNING WITH OUR NEIGHBOURS: A REVIEW OF that his chance of attaining a Private Pilots License would be much JOINT CENTRIFUGE TRAINING BETWEEN THE ROYAL greater in Australia due to more liberal Civil Aviation Safety Authority (CASA) guidelines. His only goal was to fl y for pleasure, never for AUSTRALIAN AIR FORCE AND ROYAL MALAYSIAN AIR profi t, and he even convinced his wife to undertake fl ying training so FORCE IN 2010-2011 that she can act as a safety pilot. Dr H is having trouble with his M.G. BINER AND B.J. BARKER blood sugar levels and is curious at to whether CASA would let him RAAF Institute of Aviation Medicine, RAAF Base Edinburgh, fl y if he were to receive a Pancreatic Islet Cell Transplant. Current SA, Australia CASA policy regarding diabetes is complex and is designed to manage, amongst other things, the risk of potential hypoglycaemia in INTRODUCTION: The Royal Australian Air Force Institute of fl ight. Evidence from trials of Pancreatic Islet Cell Transplantation Aviation Medicine (RAAF AVMED) has conducted regular high-G shows a signifi cant reduction in the incidence of severe hypoglycae- centrifuge training with the Royal Malaysian Air Force (RMAF) since mic episodes and therefore there is the potential hope that the 2010. This review summarises the objectives of the training as well as transplantation will allow more pilots to fl y solo. At the current time, a qualitative study conducted on the aircrew. METHODS: Four Pancreatic Islet Cell Transplantation remains primarily a research tool training serials were conducted in 2010-2011 with a total of 67 RAAF and the patients selected for the procedures are not a good match for aircrew (Pilot and Air Combat Offi cer) participants. There was joint a potential pilot demographic. Also, the research is showing only instruction by RAAF and RMAF Aviation Medicine staff, for a mixture temporary benefi ts in hypoglycaemia prevention which quickly of RAAF and RMAF aircrew students. The centrifuge profi les were become outweighed by the risks of immunosuppression. Future identical to those used by the RMAF. Assessment of AGSM technique research into Pancreatic Islet Cell Transplantation is looking to reduce and debriefi ng was carried out jointly by RAAF and RMAF Aviation the dangers of immunosuppression and it is at that stage that we might Medicine staff. At the completion of each serial, the RAAF aircrew fi nd that patients requiring insulin will have the chance of achieving surveyed to subjectively evaluate their satisfaction with the training. certifi cation for solo fl ight. RESULTS: During the fi rst three training serials, 20 of the 48 RAAF

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 235 ASMA 2012 MEETING ABSTRACTS aircrew (42%) experienced G-LOC and/or A-LOC. Of these, the be malingering. Malingering behaviour should always be considered majority (15 of the 20) experienced their G-LOC/A-LOC event during when there are claims for compensation or opportunities for second- the Gradual Onset Run (GOR) profi le. The majority of those who had ary gain and evidence suggests that malingering is frequently a G-LOC/A-LOC experience did not successfully complete the experienced in civilian and military patients. Depending on the subsequent 6G and 8G Rapid On-set Run (ROR) profi les. The GOR background of the doctor we can expect a variety of different was modifi ed for the fourth serial, with only 2 of the 19 students responses, for example a junior medical offi cer may be less likely than (10%) experiencing G-LOC/A-LOC. All G-LOC/A-LOC events a senior offi cer to challenge behaviour and a civilian medical occurred on Day 1 of each course, with an improved AGSM contractor is likely to respond differently to a uniformed doctor. The technique observed with all students on Day 2. 64 of the 67 (95%) response to this diffi cult situation will also be dependent on the RAAF students responded to the post-course survey with universally assessment of the risk of facing legal action versus the estimate of the positive responses. They all reported a much greater confi dence in potential harm to the military if the behaviour is not challenged. In their AGSM technique post-training, and regarded this training as discussions with medical insurance providers, safety authorities and essential for RAAF fast jet aircrew. Most reported that the centrifuge with senior clinicians the author found a number of competing views training should be targeted prior to initial conversion onto the BAE and complexities that need to be considered. A medical offi cer may Hawk (introductory fast jet, after graduating from initial aircrew be legally liable if they do not challenge malingering behaviour or at training). DISCUSSION: Reducing the G-LOC / A-LOC events during least document the possibility that it is occurring. The doctor may face centrifuge training (from 45% to 10%) required a modifi cation to the medico-legal action if they breach medical in confi dence information GOR centrifuge profi le and instructional technique. The centrifuge or do not provide an appropriate standard of medical care. Opportuni- training greatly improved the confi dence of all RAAF aircrew in being ties for optimal management include preserving the doctor patient able to apply the correct AGSM techniques, which was observed to relationship through allocation of an appropriate clinician who will be sound at the completion of the training. act as the patient advocate. The maintenance of military discipline and integrity of legal processes should be a consideration and this can Learning Objectives: fall to an appropriate supervisor who is not actively managing the 1 To identify methods of reducing G-LOC and A-LOC events for patient. The key to management is that the frontline medical offi cers aircrew during centrifuge gradual on-set run profi les. should take very considered steps as they navigate these diffi cult patients and ensure that they can balance the dual responsibilities of

[97] A MILITARY TRANSPORT PILOT WITH POORLY- ethical obligation to the patient with their inherent obligation to the military. CONTROLLED EPILEPSY - HOW THE 1% RULE COULD ALLOW THEM TO KEEP FLYING Learning Objectives: B.J. BARKER AND A. SMITH 1 An understanding of the obiligations of the Military Medical Offi cer RAAF Institute of Aviation Medicine, Adelaide, SA, Australia to their command and to their patient when they are managing a patient who is potentially malingering. INTRODUCTION: The ‘1% Rule’ is widely used by military and civil regulators in assessing medical certifi cation. It is convenient, easy to use and appears to be scientifi cally valid. However the 1% rule can Monday, May 14 2:00 PM be used without understanding its nature or the assumptions that Salon AB underpin it. Regulators must understand it is a statistical tool of a population risk, not a clinical predictor for individuals. It is also important to appreciate that the 1% rule does not guarantee accident PANEL: EN ROUTE MEDICAL CARE free fl ying. METHODS: A number of assumptions that underpin the 1% CONTINUUM: USAF’S CRITICAL CARE rule are challenged and it is assumed that tolerance of failure is proportional to fl ight time. Slight modifi cation of: average fl ight time, SPECIALTY TEAMS period of critical time of fl ight, and co-pilot recovery rate are substituted into the 1% rule algorithm andIP: results 192.168.39.151 discussed. RESULTS: On: Sun,[99] 26 SepEN ROUTE 2021 17:39:09MEDICAL CARE CONTINUUM: A military transport pilot fl ying 500-750 hoursCopyright: per year, assuming Aerospace 30% MedicalUSAF’S AssociationCRITICAL CARE SPECIALTY TEAMS of fl ight time is critical; and that the co-pilot will recover fl ightDelivered control by S.Ingenta TAN1 AND R. FANG2 in 99% of incapacitations during the critical period of fl ight; may have 1HQ AMC/SGP, USAF, Scott AFB, IL; 2USAF CSTARS, R Adams a medical incapacitation rate of 3 to 5 incapacitations per year (311-460%) and still meet the safety tolerance for a target accident rate Crowley Shock Trauma Center, Baltimore, MD similar to the current all-cause military accident rate. DISCUSSION: The 1% Rule is widely used in aviation medicine as a tool to deter- This panel will highlights capabilities and training of USAF’s mine a pilot’s fi tness to fl y - an incapacitation rate of more than 1% is critical care specialty teams and how they contribute to the overall en generally considered incompatible with fl ight safety. However, the 1% route medical care of severely ill and trauma patients in both combat Rule is predicated on a number of assumptions. Given its origin in the and non-combat environments. A panel of critical care subject matter commercial aviation domain, it is important to evaluate whether the experts will present differences in the type of mission support, skill 1% Rule provides relevant guidance for the management of military sets, competency/profi ciency requirements, and equipment used aircrew. This presentation will explore the assumptions that underpin among current USAF’s critical care teams. the 1% Rule, and challenge our understanding that poorly controlled epilepsy is “unsafe” for a military pilot. [100] SPECIAL OPERATIONS CRITICAL CARE AND Learning Objectives: EVACUATION TEAM (SOCCET) DEVELOPMENT AND UTILIZATION: A DECADE OF EXPERIENCE 1 Review the 1% Rule K. RILEY HQ AFSOC, Hurlburt Field, FL [98] MANAGING MALINGERING BEHAVIOUR IN THE DEFENCE FORCES: CHALLENGES FOR THE FRONT LINE INTRODUCTION: The creation of Special Operations Forces MEDICAL OFFICER (SOF) critical care and transport teams early in Operation Enduring M.S. CLEMENTS Freedom was in response to the need for rapidly deployable teams RAAF Townsville, Royal Australian Air Force, Douglas, Australia possessing operational profi ciency and a capacity to thrive in austere locations. DISCUSSION: SOCCET composition includes 3 personnel: INTRODUCTION: For a frontline medical offi cer there are critical care physician, respiratory therapist, and critical care nurse. many frustrations and challenges when managing a patient who may This team trains with and typically deploys along with a Special

236 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

Operations Surgical Team. The equipment package to support SOCCET [103] CRITICAL CARE AIR TRANSPORT TEAM (CCATT) missions has continued to evolve and provide a robust critical care SEVERE TRAUMATIC BRAIN INJURY (TBI) SHORT TERM capacity that is portable. Air Force Special Operations Command OUTCOMES DURING FLIGHT FOR OIF/OEF BETWEEN 1 (AFSOC) organizes and equips these teams. These teams have JUNE 2007 AND 31 AUGUST 2010 responded to a number of worldwide confl icts ranging from humani- L. BOYD tarian to medical support of combat. This presentation will highlight lessons learned in the organization, equipment selection, and USAF, O’Fallon, IL deployment of this critical asset. INTRODUCTION: The purpose of this study was to describe the Learning Objectives: short term outcomes of patients with severe traumatic brain injuries (TBI) managed by the USAF Critical Care Air Transport (CCATT) teams 1 Understand important developments necessitating the development deployed in support of Operation Iraqi Freedom and Enduring of SOF-specifi c critical care teams. Freedom between 1 June 2007 and 31 August 2010 and provide data for the future development of guidelines for air transport for validating [101] TCCET and clearing fl ight surgeons. Collection of such data was used to V. JOHNSON AND J. JACKSON provide refi nement of CCATT training, improve air transport of TBI Langley AFB, Joint Base Langley-Eustis, VA patients, and improve fl ight surgeon knowledge of the challenges these patients face in the operational fl ying environment. DISCUSSION: INTRODUCTION: The tactical critical care evacuation team After reviewing the literature, the published data of patients trans- was developed out of a need for a higher level of care to be provided ported by CCATT teams is limited. Data from the largest compilation of on transport from Role 2 to Role 3 facilities in country. Traditionally patients transported by CCATT that has been presented or published this mission is performed by Army UH-60 Medevac units. TCCET was detailed the experience of 656 patient moves from Beninati. This study designed to augment this team and provide in-fl ight support for will expand on the available data and specifi cally look at those critically injured patients. METHODS: The team is comprised of an patients with traumatic brain injury (TBI) and describe their progress Emergency Medicine physician and two nurse anesthetists. Prior to during fl ights from the Iraq and Afghanistan to Germany to the United deployment, training consists of completing the Critical Care Air States. This information provided necessary insight into the current Transport Team (CCATT) course, C-STARS CCATT course in Cincinnati, experiences of our deployed CCATT assets and the care that our troops Joint En-route Care Course (JECC), and Combat Skills Training (CST). received while in their care. RESULTS: While deployed to Afghanistan, TCCET was under the Army TF 44 Medical tactical command. The three members were grouped [104] LANDSTUHL ACUTE LUNG RESCUE TEAM (ALERT) with En-route Critical Care Nurses (ECCNs) from the Army and 1 2 2 dispersed to several different locations. As a group the team fl ew 97 R. FANG , G.R. DORLAC AND W.C. DORLAC 1 patients (ongoing), over 80% of which were vented. There were no US Air Force Center for Sustainment of Trauma and Readiness 2 near-miss or adverse outcomes in fl ight on any of these missions. Skills, Baltimore, MD; US Air Force Center for Sustainement of DISCUSSION: The fl ight medics aboard the Medevac unit are required Trauma and Readiness Skills, Cincinnati, OH to have at least one year of combat medic experience, be registered as an EMT-Basic, and have completed a four-week fl ight medic course. A INTRODUCTION: The US Air Force’s capability to evacuate higher level of provider is appreciated by the unit and often necessary critically ill patients created dramatic changes in medical force when transporting these complicated patients to a Role Three facility. deployment and casualty care practices. In 2005, a specialty team was The patients urgently evacuated out of a Role Two facility are early on created at Landstuhl Regional Medical Center (Germany) to augment in their course and have received initial resuscitative efforts and the US Air Force aeromedical evacuation (AE) system for the rare damage control surgery. The majority of the patients the team assists patient exceeding the system’s Critical Care Air Transport Team with have multi-organ trauma and require mechanical ventilation, (CCATT) capabilities. METHODS: The Landstuhl Acute Lung Rescue sedation, pain management, and ongoing resuscitation, as well as an Team (ALeRT) Mission Registry was queried for US Central Command understanding of chest tubes, open abdomens,IP: 192.168.39.151 and invasive lines. On:In Sun,(CENTCOM) 26 Sep 2021 activations 17:39:09 between November 1, 2005 and June 30, previous years, a nurse was often grabbed fromCopyright: the Role Two Aerospace facility to Medical2011. Patient Association data was obtained from the LRMC Trauma Program assist with these patients on the helicopter. The creation of a Delivereddedicated byRegistry, Ingenta the Joint Theater Trauma Registry, the CCATT Pilot Unit team decreases the risk of adverse events in transport with a better Registry and the in-patient medical records. RESULTS: For the review understanding of the transport equipment, safety in fl ight, and the period, CENTCOM activated ALeRT on forty-seven occasions. constraints of care in the back of the helicopter. Twenty-fi ve requests originated from the Iraqi and 22 from the Afghani theater. Thirty-three patients sustained trauma-related and 14 non- Learning Objectives: trauma related acute severe lung injuries. The ALeRT launched from 1 To better understand the mission of TCCET Landstuhl and evacuated patients on 30 of 34 missions (88%). Three patients were too unstable for evacuation: two patients expired in theater and one required additional stabilizing surgery prior to [102] ADVANCED MECHANICAL VENTILATION IN eventual ALeRT evacuation three days later. Of the 13 remaining CRITICAL CARE AIR TRANSPORT: UNILATERAL LUNG activations, 4 patients expired and 9 patients improved suffi ciently for INJURY REQUIRING INDEPENDENT LUNG VENTILATION CCATT movement prior to ALeRT launch. The ALeRT initiated P. MASON extracorporeal lung support (ECLS) on two casualties in the combat San Antonio Military Medical Center, San Antonio, TX theater to enable evacuation. When compared to the overall CCATT patient population, ALeRT activations required signifi cantly more INTRODUCTION: The presentation will begin with a historical oxygenation support and non-conventional mechanical ventilation overview the CCATT program and a discussion of how it fi ts into the modalities for movement. DISCUSSION: A multi-disciplinary critical deployed military medical system. The capabilities of the CCATT care air transport team created to augment the US Air Force AE system, system be discussed and then reinforced with a case presentation the ALeRT successfully transported thirty patients to Germany. Without involving a patient with unilateral lung injury requiring independent the ALeRT, these patients would have remained in the combat theater lung ventilation. as consumers of limited medical resources with high potential mortality. Modern adult ECLS systems are feasible for strategic AE. Learning Objectives: 1 Apply aeromedical principles to the transport of critically ill Learning Objectives: patients. 1 The audience will comprehend “rescue” therapies for severe 2 Describe the history and composition of the US Air Force critical lung failure that may be utilized to enable strategic aeromedical care air transport program. evacuation.

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 237 ASMA 2012 MEETING ABSTRACTS

Monday, May 14 2:00 PM circadian pacemaker; a photo-responsive input pathway; and a non-photic input pathway that includes sleep/wake timing and Salon D associated behaviors including postural changes, meals and social interactions; it predicts circadian phase and amplitude. The output of PANEL: FATIGUE MANAGEMENT FOR the circadian model interacts with a sleep inertia component and a homeostatic component driven by sleep and wake duration to predict CURRENT AND FUTURE SPACEFLIGHT subjective alertness and objective neurobehavioral performance. Both OPERATIONS subjective and objective measures of alertness are important, since an individual’s choice to use countermeasures frequently relies on [105] FATIGUE MANAGEMENT FOR CURRENT AND subjective assessment of alertness. RESULTS: Our models simulate the FUTURE SPACEFLIGHT OPERATIONS circadian, performance, and alertness response to schedules including A. WHITMIRE1, S.L. JOHNSTON2, W. SIPES2, non-24-hr days (e.g., Mars 24.6-hr day or shuttle mission ~90-min light-dark cycles), and up to 80-hr sleep deprivation. It also accurately R.C. MOOMAW1, S. LOCKLEY3, S.T. VANDERARK1 AND 2 captures the effects of abrupt shifts in sleep of up to 12-hours as L. LEVETON encountered in shift-work and multi-time-zone air travel. We have also 1 Wyle Integrated Sciences and Engineering, Houston, TX; developed a countermeasure optimization algorithm for timing light 2NASA Johnson Space Center, Houston, TX; 3Harvard Medical interventions at times of predicted poor performance. DISCUSSION: School, Boston, MA The model can be used by individuals in transportation, medical, security and other industries to plan countermeasures or alternative Sleep loss and fatigue remain an issue for crewmembers on the schedules for those who work at night or early morning, after time ISS. Schedule shifting is sometimes required for conducting mission shifts or at adverse circadian phases. Model development support: operations. These shifts lead to tasks being performed during the AFOSR, DoD, NASA, NIH, NSBRI. Current support: NIH, NSBRI biological night, and sleep scheduled during the biological day. Even without schedule shifting, sleep is often disrupted. Other stressors have Learning Objectives: been recognized as hindering sleep in space including workload, 1 Describe the use of mathematical models of neurobehavioral thinking about tasks, noise, heat and humidity, and given that light performance and alertness for evaluating schedules and predicting levels on ISS are reportedly dim, insuffi cient exposure to strong times of poor performance and alertness. light-dark cycles to maintain circadian entrainment. It is unknown if and how other factors such as microgravity, carbon dioxide or [107] THE ROLE OF LIGHT AS A CIRCADIAN RHYTHM increased radiation may also disrupt sleep. Prefl ight training requires DISORDER AND FATIGUE COUNTERMEASURE IN SPACE that crewmembers travel frequently overseas. The jet lag caused by S.W. LOCKLEY changes in time zones is challenging to sleep, performance and 1 well-being, and crewmembers suffer from sleep loss, circadian Sleep Medicine, Brigham & Women’s Hospital, Boston, MA; 2Sleep Medicine, Harvard Medical School, Boston, MA desynchronization and fatigue well before their space mission. Ground crews are often scheduled to work at night or on unusual schedules, and many NASA personnel also travel and suffer the same jet INTRODUCTION: Space missions often expose crew members lag-related disorders as crew members. Efforts are underway to to unusual light-dark cycles that lead to misalignment between the standardize and provide care for crewmembers, ground controllers circadian pacemaker and the sleep-wake schedule, resulting in and other NASA personnel. Through collaborations between research disturbed sleep and impaired waking function. Sleep disturbances due and operations, evidence-based clinical practice guidelines are being to other reasons (e.g., noise, temperature, operational requirements, developed to equip fl ight surgeons with the tools and processes microgravity) further exacerbate cognitive defi cits and these factors needed for treating circadian desynchrony and subsequent sleep loss. jointly increase the risk of fatigue-related accidents and injuries. An Scheduling tools allow for the proper implementation of countermea- effective countermeasure is required to facilitate more rapid adaptation of the circadian system and directly enhance alertness and performance. sures such as lighting protocols and medications.IP: 192.168.39.151 Training and On: Sun, 26 Sep 2021 17:39:09 cognitive behavioral education can also hasten phase shifting, enhance In addition to permitting vision, light also therefore has the potential to be sleep and optimize performance. This panel willCopyright: focus on Fatigue Aerospace Medicalan effective, Association safe, well-tolerated, non-invasive and non-pharmacological Management in current and future spacefl ight operations. SpeakersDelivered by countermeasureIngenta to reduce the risk of circadian misalignment and will present on research-based recommendations and technologies performance defi cits during space fl ight. Recently, we and others have aimed at mitigating sleep loss, circadian desynchronization and fatigue shown that short-wavelength (blue) light exposure at night is the most during training and on-orbit. Sleep and performance in an exploration effective wavelength for phase-shifting the circadian pacemaker, spacefl ight analog (the Mars-500 Study) will also be discussed. enhancing subjective alertness, improving performance and inducing EEG-derived brain activation that indicates a more alert state. These data are consistent with a recently-discovered novel blue-light [106] USING MATHEMATICAL MODELING OF CIRCADIAN sensitive photoreception system that is anatomically and functionally RHYTHMS AND SLEEP TO EVALUATE SCHEDULES AND distinct from the rods and cones that are used for vision. We have also PREDICT PERFORMANCE recently shown, however, that visual photoreceptors can contribute to E. KLERMAN circadian resetting responses under particular conditions, and that the Medicine/ Div. Sleep Medicine, Brigham and Women’s Hospi- wavelength sensitivity of the circadian photoreception system may tal/Harvard Medical School, Boston, MA depend on the intensity, duration and timing of light. We can take advantage of these differences in the circadian and visual responses to INTRODUCTION: Circadian rhythms are an important light and recent advances in solid-state lighting technology to develop physiological factor infl uencing sleep quality and duration, hormone ‘smart’ lighting countermeasures that optimize both the visual and levels, mood, alertness, and cognitive performance. Changes in light non-visual responses to light simultaneously and have the ability to exposure, sleep-wake timing and circadian rhythms associated with change the properties of light emitted according to operational needs. human travel and work schedules have been documented to have Ongoing ground-based studies are optimizing these approaches with profound effects on cognitive performance. Decrements in human the aim of deploying prototypes for fl ight testing in the near future. performance levels can cause errors and accidents. In order to understand and predict these known changes due to circadian Learning Objectives: rhythmicity and sleep/wake patterns, and to design countermeasures, 1 To understand the physiological basis of sleep, circadian rhythm our research concentrates on developing mathematical models. disorders and fatigue in space METHODS: We have developed linked mathematical models of 2 To understand how light affects human physiology and how it can human circadian rhythms, neurobehavioral performance and alertness. be used as a circadian rhythm and fatigue countermeasure in space The circadian portion of this model contains three components: the and ground-based applications

238 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

[108] SLEEP EDUCATION AND TRAINING FOR Learning Objectives: SPACEFLIGHT OPERATIONS 1 The audience will learn the medical constraints, countermeasures, R. MOOMAW and enabling technologies to track and mitigate crew fatigue during UTMB, Houston, TX space exploration missions.

INTRODUCTION: Sleep Education and Training (SET) is an [110] SLEEP-WAKE PATTERNS AND PSYCHOMOTOR VIGI- evidence-based practice commonly used to help treat insomnia, and is LANCE PERFORMANCE DURING A 520-DAY SIMULATED part of NASA’s countermeasure regimen for Fatigue Management. SET MISSION TO MARS addresses lifestyle and habits that are maladaptive to managing stress M. BASNER1, A. DI ANTONIO1, A. ECKER1, D. MOLLICONE2 and fatigue. This training includes addressing learned behavioral AND D.F. DINGES1 responses that may cause stress and lead to an increased sense of 1Department of Psychiatry, University of Pennsylvania Perel- fatigue. While the initial cause of onset of fatigue in the individual may 2 be no longer present, the perception and engrained anticipation of man School of Medicine, Philadelphia, PA; Pulsar Informatics fatigue persists, and this perception can cause an exaggerated state of Inc., Philadelphia, PA tension. SET, combined with relaxation training, allows the individual to unlearn the maladaptive beliefs and behaviors and replace them INTRODUCTION: The Mars520 project of the Russian Institute with routines and techniques that allow cognitive restructuring and for Biomedical Problems (IBMP) focused on the effects of 520 days of resultant relief from stress. SET allows for elimination of unwanted isolation and confi nement on a crew of 6 professionals (astronaut ruminating thoughts and anticipatory anxiety by, for example, training surrogates) living in a facility that simulated a spacefl ight to/from the individuals to practice responses to stressful situations while in a Mars. METHODS: For our experiment, each crewmember (3 Russian, relaxed state. As a result of SET, relaxation can be accomplished in 1 French, 1 Italian, 1 Chinese, all male, mean age 32, range 27-38 many ways, such as progressive muscle relaxation, meditation and years) continuously wore a wrist actigraph (Philips Actiwatch guided imagery. SET is not therapy, but rather the synthesis of Spectrum) to measure changes in sleep-wake behavior and activity behavioral countermeasures. SET utilizes progressive relaxation as a levels throughout the mission. Once weekly, each crewmember means of reinforcing educational and cognitive countermeasures. performed two test bouts of a 3-min version of the Psychomotor These countermeasures include: masking, elimination of distracting Vigilance Test (PVT-B). Sleep deprivation induces reliable changes in thoughts, anxiety control, split attention, cognitive restructuring and PVT-B performance (Basner et al. , 2011), causing an overall slowing of response times, a steady increase in the number of errors of other advanced psychological techniques. SET can serve as an effective countermeasure for sleep loss in spacefl ight operations. omission (i.e., lapses of attention), and a more modest increase in errors of commission (i.e., responses without a stimulus). RESULTS: Learning Objectives: Data acquisition rates were >98.3% complete for actigraphy (ca. 73,000 hours) and >99% complete for the PVT-B (ca. 900 test bouts). 1 The audience will learn the process for educating and training a Crewmembers exhibited considerable inter-individual differences in subject to initiate sleep, reduce fatigue and decrease anticipatory the variability of both sleep-wake behavior and PVT-B performance anxiety. across the mission. This difference in variability between subjects 2 The audience will learn to basic concepts of relaxation, split atten- exceeded the variability seen within subjects across time in mission. tion, masking both distracting stimuli and thought. Overall, both sleep time and performance on the PVT-B tended to 3 The audience will be introduced to counter measures for learned increase with time in mission, while actigraphically measured maladaptive behaviors. activity levels continuously decreased, especially during the fi rst 150 days of the mission. DISCUSSION: Crewmembers on a simulated [109] INTEGRATED CLINICAL CARE SUPPORT mission to Mars exhibited substantial differences in sleep-wake TECHNOLOGIES TO MITIGATE ASTRONAUT FATIGUE IN behavior and PVT-B performance variability that may pose a SPACE challenge to effective crew coordination and performance during long-duration missions. The observed reduction in activity levels in D. MOLLICONE IP: 192.168.39.151 On: Sun, 26 Sep 2021 17:39:09 Copyright: Aerospace Medicalmost crewmembers Association may aggravate microgravity-induced muscle and Pulsar Informatics Inc., Philadelphia, PA bone loss during long-duration missions. Supported by NSBRI Delivered bythrough Ingenta NASA NCC 9-58, and the Institute for Experimental INTRODUCTION: Space is an operational environment where Psychiatry Research Foundation. mission success is highly reliant on a small number of individuals that must consistently perform at the highest possible level. Fatigue Learning Objectives: resulting from endogenous disturbances of sleep (e.g., circadian 1 The audience will learn about possible impacts of long-duration desynchrony), environmental disruptions, and curtailment of sleep due space fl ight missions on sleep-wake behavior, activity, and psycho- to work demands can negatively impact individual performance motor vigilance performance. capability. Given the scientifi c evidence that there are systematic differences in how individuals respond to fatigue stressors, it is essential for fatigue management strategies to account for biologically- Monday, May 14 2:30 PM based differences among individuals. Individually tailored fatigue countermeasures can be implemented by adopting an approach that Exhibit Hall involves tracking each astronaut’s unique response to a given fatigue stressor. METHODS: We are developing an integrated clinical care POSTER: AEROMEDICAL TRANSPORTATION support technology to enable astronauts (and the fl ight surgeons responsible for supporting them) to track and mitigate fatigue in EVALUATION real-time during space exploration missions. Objectively quantifi ed fatigue levels based on tests such as the PVT, WinSCAT, and Neuro- [111] THE EPIDEMIOLOGY OF MEDICAL AIR CATS will be integrated with other behavioral health indicators and TRANSPORTATION IN BANGKOK, THAILAND displayed within the context of mission stressors (e.g., scheduled J. SURIYACHAISAWAT AND E. SURAKARN dockings) and environmental stressors (e.g., CO2 levels). Multiple data Bangkok Hospital, Bangkok, Thailand points will be collected throughout a mission to track changes relative to mission stressors or time-in-mission. DISCUSSION: This approach INTRODUCTION: To describe the air-transported patients allows for a more contextual understanding of astronaut fatigue and included fi xed and rotor wing. Because there are limited epidemio- behavioral health, so that informed assessments and diagnoses can be logical data available on the diagnosis, costs, and transport charac- made, and that appropriate and individually optimized countermea- teristics of medical air transported cases in Bangkok, Thailand. sures can be implemented. METHODS: Participants were patients who were air-transported

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 239 ASMA 2012 MEETING ABSTRACTS during 2011 by aviation teams of private hospital in Bangkok. Data Monday, May 14 2:30 PM were collected retrospectively from the medical and transport records. Data included demographic information, patient diagnosis, Exhibit Hall fl ight time, mode of transport, type of aircraft and fi nancial data. RESULTS: During the study period 199 patients (132 males (66 %), POSTER: CRUNCH & LOAD: TOPICS IN 67 females ( 34 % ), aged 1 day -105 y, median 50 y) were included in the study. Helicopter and fi xed wing transports comprised 60 and ACCELERATION/ESCAPE/IMPACT 139, respectively. The nationalities were mostly Thai in rotor wing and European in fi xed wing. The top diagnosis for adults was trauma [113] DYNAMIC ULTRASOUND IMAGING OF THE especially in helicopter transportation. Transports were carried out CERVICAL SPINE IN AN EXTREME ENVIRONMENT with an air ambulance (n = 69, 35%, 161.8 $/min),a helicopter K. SHIUAN1,2, D. BUCKLAND1,4 AND B. SNYDER1,3 ( n=60, 30%, 64.28 $/min ),a stretcher in a scheduled aircraft 1Center for Advanced Orthopaedic Studies, Beth Israel Dea- (n = 31, 15.5%, 33.58$/min), a scheduled aircraft with regular coness Medical Center, Boston, MA; 2Biomedical Engineering, seating (n = 39,19.5%, 11.58$/min). DISCUSSION: As the demand 3 for medical air transportation is likely to increase in the future from Boston University, Boston, MA; Orthopedics, Children’s 4 travelers and medical tourism. The cost-effectiveness and selection of Hospital Boston, Boston, MA; Aeronautics and Astronautics, the appropriate form of air transportation are likely to be more Massachusetts Institute of Technology, Cambridge, MA importance . INTRODUCTION: Back and neck pain allegedly related to Learning Objectives: intervertebral disc (IVD) disease is a frequent problem among Army 1 To compare epidemiological data , cost per fl ight time, disease aviators and NASA astronauts. Currently, there is no method to assess between several modes of fi xed wing and rotor wing. the forces and/or displacements acting on the spine during fl ight or fl ight simulations. We show that clinical ultrasound (U/S) can provide a portable imaging modality to quantify cervical spine IVD health and provide insight on IVD response to applied static and dynamic loads in [112] EVALUATION OF CARDIAC OUTPUT MEASUREMENT fl ight. METHODS: Pfi rrmann grades (disc degeneration) were assigned BY BIO-REACTANCE DURING LONG-RANGE to MRI images of adult human cadaveric spines and compared to U/S AEROMEDICAL EVACUATIONS compliance measures to establish U/S as a disc degeneration S. COSTE3,1, C. DUBOST2, S. DUSONCHET3, M. SAMUEL3, diagnostic. For in-vivo trials a cervical collar was developed to T. VILLEVIEILLE4 AND P. CHRISTOPHE4 maintain placement of the U/S transducer, and two inertial measure- 1French Forces, Villacoublay Air France; 2Intensive Care Unit, ment units were used to understand how external kinetics experienced Val de Grace Hospital, Paris, France; 3Medical Centre of Forces, in simulated operational environments are transferred into the cervical French Forces, Villacoublay, France; 4Intensive Care Unit, Begin spine at the IVD level with and without head supported mass (HSM). RESULTS: Statistical tests (ANOVA, post-hoc Tukey) indicated that Hospital, St Mandé, France compliance measures were signifi cantly different for each Pfi rrmann grade. In the human subject trials, the cervical collar provided a INTRODUCTION: The Health Department of French Forces feasible platform for maintaining a constant imaging window of the carried out an average of 42 aeromedical evacuations per year over cervical spine, and a transfer function was derived to simulate how the the last decade in favor of the servicemen in Operations. The Afghan applied loads are translated into the IVD spaces. Additionally, it was confl ict has changed the epidemiology of missions by evacuations found that the transfer function with HSM differed from the one longer for more serious injuries related to combat and requiring without HSM. DISCUSSION: We demonstrated that it was possible to intensive care during fl ight. In fl ight hemodynamic monitoring measure IVD health properties using compliance measures. This includes heart rate, non-invasive or invasive blood pressure, SpO , 2 suggests that current clinical U/S systems can be used to provide a low EtCO and may be supplemented by ultrasound. Several aeronautical 2 cost, portable, non-irradiative method to diagnose IVD health. We also factors may affect the patient’s hemodynamicIP: 192.168.39.151 status during a fl ight: On: Sun,demonstrated 26 Sep 2021 that 17:39:09U/S can provide valuable insight into the IVD transfer, acceleration during take-off, turbulence,Copyright: hypoxia, Aerospacedehydra- Medicalresponse Associationto applied loads experienced in fl ight, and how HSM affects tion. Continuous analysis of cardiac output and vascular resistanceDelivered by thisIngenta response. Some improvements in the temporal and spatial by bio-reactance is a modern, non-invasive and simple implement resolution of the U/S platform should be developed for future studies. that could be interesting in air transport. We propose a study of its This project is supported by the Army Research Offi ce. assessment during aeromedical evacuations. METHODS: From 01/09/2010 to 01/09/2011, a bio-reactance monitor NICOM was Learning Objectives: taken on board in the long range aeromedical evacuations bringing patient back to France. Exclusion criteria were the refusal of the 1 Learn how ultrasound can be used to measure IVD health. patient or the technical impossibility of positionning the electrodes. 2 Learn how ultrasound can be used to provide insight on IVD The analysis focused on the fi rst 10 minutes after take-off and then response to applied loads experienced in fl ight. the evolution per hour. RESULTS: 18 patients were enrolled including fi ve under respiratory assistance. No interference and no signal abnormality was found. Median cardiac output decreased [114] SUBJECTIVE AND OBJECTIVE DETERMINATION OF signifi cantly between the 6th and 10th minute after take-off THE +GZ PROTECTION AFFORDED BY THE TYPHOON LIFE (p <0.05). The median cardiac index also decreased by 14% during SUPPORT SYSTEM the fi rst 30 minutes to return to the normal value after one hour A.T. STEVENSON1,2, J.P. SCOTT1, J. JUNGIUS1,3, (p <0.05). DISCUSSION: The study shows the feasibility of hemody- D. LYTHGOE4, M. BAGSHAW2 AND S. HARRIDGE2 namic monitoring by bio-reactance in plane. It emphasizes on the 1Human Sciences, QinetiQ, Farnborough United Kingdom; aircraft take-off effects upon the hemodynamic status of the patient 2Centre of Human and Aerospace Physiological Sciences, lying down. The interest of cardiac output monitoring is illustrated by King’s College London, London, United Kingdom; 3School of a case report. Pharmacology and Physiology, Bristol University, Bristol, United Kingdom; 4Molecular and Clinical Cancer Medicine, University Learning Objectives: of Liverpool, Liverpool, United Kingdom 1 To assess the feasability of non-invasive cardiac output monitoring during aeromedical evacuations. INTRODUCTION: Modern fast-jets are capable of rapidly

2 To objectivize the aircraft take-off effects on hemodynamic status of generating and sustaining high +Gz accelerations. Standard-coverage patient lying down. anti-G trousers (AGT) are typically employed to increase pilot +Gz

240 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS tolerance. Full-coverage anti-G trousers (FCAGT) afford comparatively Analysis of the variance components indicated that between subject greater G protection, which is further enhanced by the addition of differences accounted for 91% (0.431) of the total observed variation pressure breathing for G protection (FCAGT+PBG), as determined by in RGT, with within-subject (Run-to-Run) variation accounting for the subjective visual endpoints. To better quantify the protection provided remaining 9% (0.044). Based on the within-subject variation compo- we measured cerebrovascular parameters during sustained +Gz nent, variation around a single run was 60.21Gz, reducing to 60.12Gz acceleration with three different anti-G confi gurations. METHODS: with 3 runs. Based on a 95% CI (2 SE), the accuracy of a 3 Run ‘test’

Eight participants had their relaxed +Gz tolerance (RGT) measured was 60.24Gz. DISCUSSION: This system provides a reliable one-off during a gradual onset (0.1Gs-1) centrifuge run using; a) AGT; b) measurement of RGT, which is not infl uenced by prior experience nor FCAGT, and; c) FCAGT+PBG (Typhoon), with and without the G subject to a learning effect, even with novice participants. It was protection system activated. Systolic blood pressure at eye-level possible to reach a degree of precision of <0.5 +Gz (95% CI) with three (SBPeye), heart rate (HR), the fi ltered (<0.1Hz) ear photoplethysmo- consecutive runs. graphic signal (PPG), cerebral oxygenation (CtO2) and cerebral haemoglobin volume (CHb), an index of cerebral perfusion, were Learning Objectives: measured. All data, except RGT, were averaged over 5s periods, 1 The audience will learn of a simple, but repeatable, method to normalised to baseline and subjected to linear regression. Statistical determine relaxed +Gz tolerance. analysis was performed on regression coeffi cients. RESULTS: Collapsed across G protection confi gurations, mean RGT increased from +4.9 6 [116] CERVICAL MUSCULOSKELETAL RESPONSE TO 1.1 to +7.0 61.0 Gz with G protection system activation, and was associated with a signifi cantly reduced (P<0.05, Student’s t test) HIGH-G MANEUVERING LOADINGS IN AVIATORS Δ -G X. ZHOU, P.E. WHITLEY AND A. PRZEKWAS slope ( % ) for SBPeye (-15 65 vs -24 64), HR (6.8 63.9 vs 12.1 66.5); PPG (-4.6 61.7 vs -8.7 64.1); CtO2 (-1.7 6 0.5 vs -2.2 60.8) and CFD Research Corporation, Huntsville, AL CHb (-1.5 6 0.7 vs -2.1 60.8). Analysis by One-Way ANOVA revealed a signifi cant (P<0.05) main effect of G protection confi guration on INTRODUCTION: Cervical spine injury in military aviators is of

RGT, SBPeye, HR and CHb. Post hoc tests revealed a greater (P<0.05) continued research interest. This work studied the cervical musculo- RGT (+7.9 61.0 vs +5.7 60.7Gz), and reduced slope for SBPeye (-12 skeletal fatigue response to high-G maneuvering loads on military 63 vs -19 68 Δ%-G) and CHb (-0.9 60.8 vs -2.3 61.1 Δ%-G) with aviators to understand injury mechanisms for injury prevention and FCAGT+PBG compared with AGT. DISCUSSION: The Typhoon G mitigation. METHODS: A 50th percentile male whole body articu- protection confi guration (FCAGT+PBG) provides an additional 1.9Gz lated model with detailed neck musculoskeletal structure was of protection compared with standard-coverage AGT and better developed, and a HGU-68/P fl ight helmet was modeled as a rigid maintains head level systolic blood pressure and cerebral perfusion body fi xed on the head. An F-18 maneuvering acceleration profi le under +Gz. with maximum Gz of 7.5G and 300s duration was applied to the model in two seating postures: seating straight, looking ahead and Learning Objectives: seating with torso and head tilted in the “check-6” position. While the 1 The benefi ts of FCAGT+PBG on G tolerance and cardiovascular fl ight acceleration was directly applied to the pelvis of the model in and cerebrovascular parameters will be discussed. the inverse dynamics sense, other parts of the body were controlled 2 The audience will learn about the G protection capability of the by either neck joint torques or muscles forces to maintain the given Eurofi ghter Typhoon’s life support system. postures. The muscle forces were predicted based on a min-max effort optimization that produced the required cervical joint torques. A muscle fatigue model based on the fatigue-rest-recovery mechanism [115] A SIMPLE, LIGHT-BASED SYSTEM FOR THE MEASURE- was incorporated to predict fatigue of neck muscles. RESULTS: The joint forces, muscle forces/stresses, and cervical movement represent- MENT OF RELAXED +GZ TOLERANCE: A REPEATABILITY STUDY ing the biomechanical dynamic response to the applied loads were 3 2 2 2 1 obtained and compared. While vertical vertebral forces were similar D. LYTHGOE , S. CHIESA , G. COATES , D. SIN , J.P. SCOTT for the two postures, signifi cant muscle force variations were observed 1,2 IP: 192.168.39.151 On: Sun, 26 Sep 2021 17:39:09 AND A.T. STEVENSON for the two postures where the “check 6” absolute value for lateral 1 Human Sciences, QinetiQ, Farnborough, Copyright:United Kingdom; Aerospace Medicalneck moment Association was four times that in the head forward confi guration. 2Centre of Human and Aerospace Physiological Sciences,Delivered byDISCUSSION: Ingenta The posture variations during high-G fl ight signifi - King’s College London, London, United Kingdom; 3Molecular cantly affect the cervical musculoskeletal loads leading to greater and Clinical Cancer Medicine, University of Liverpool, fatigue in an engagement. Further simulation which varies the helmet Liverpool, United Kingdom weight and center of gravity would defi ne fatigue limits for system design.

INTRODUCTION: The measurement of relaxed +Gz tolerance (RGT) by reference to visual disturbances is limited by the reliance on Learning Objectives: the participant to report subjective symptoms. This is compounded by 1 To understand the biomechanical response and injury potential of the individual variation in symptoms ranging from classic peripheral the cervical musculoskeletal structures during high-G maneuvering light loss (PLL) to more diffuse light loss across the whole visual fi eld. fl ight. We investigated the repeatability of a simple, light-based measurement system for the estimation of RGT. METHODS: : Nine, male experi- [117] INERTIAL PARAMETERS FOR DYNAMIC SIMULATION enced centrifuge users (EX) and 8 (6 m, 2 f) novices (≤ 4 runs at ≤ +4Gz - NOV), had their RGT assessed during fi ve, consecutive, slow (0.1Gs-1) DUMMIES AT THE 97TH PERCENTILE onset runs separated by 2 min. Participants were presented with Q. HE AND S. LIU three lights at eye level comprising a central continuous white light Institute of Aviation Medicine, Air Force, P.R.China, Beijing, with fl ashing red lights to either side at visual angles of 15° along China the horizontal meridian. Participants were asked to gaze at the white light and stop the centrifuge when no red light was perceived. INTRODUCTION: To establish the regression equations of Data from Run 1 were excluded from analysis. RESULTS: There was inertial parameters for the whole human body and different motion no signifi cant difference between EX and NOV for mean (1SD) RGT segmentation parts. Inertial parameters of dynamic simulation

(+3.92 60.73 vs +3.79 60.62Gz, P = 0.350) or variance in RGT dummies at the 97th percentile were identifi ed and developed. (Levene’s test, P = 0.478). For the whole group (n = 17), mean RGT METHODS: A sample of 74 pilots were selected, egression equations was +3.86 (0.68)Gz. The standard error (SE) of measurement (within- of the inertial parameters were established by the test data of 50 pilots subject standard deviation) [95% CI] was 0.26 [0.22-0.34] +Gz and the with CT methods and verifi ed by the test data of 24 pilots. Got the test¬retest intraclass correlation co-effi cient was 0.94 [0.88-0.97]. center of gravity by fl at barycenter instrument. Three positions (supine

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 241 ASMA 2012 MEETING ABSTRACTS position, sitting posture for lower body and lateral position for upper INTRODUCTION: Laser illuminations of aircraft have resulted body, supine horizontal arm lift) were tested for each sample. Got the in pilots reporting distraction, disruption, disorientation, adverse visual moment of inertia by three-wire pendulum. Five positions (lateral effects, and operational errors that put at risk the safety of the aircraft position, supine position, sitting posture, sitting posture for lower body and those onboard. FAA Order 7400.2 was revised in 1995 to establish and lateral position for upper body, supine horizontal arm lift) were lower laser exposure limits that protected fl ight crewmembers in tested for each sample. RESULTS: Centroid regression equation of for specifi c zones of airspace around airports. However, helicopters dynamic simulation dummies at the 97th percentile is Y = -160.328 - (including police, air ambulance, military, and news media aircraft that 2.8349 X1 + 0.6439 X2 + 0.155 X3 + 0.0519 X4. Regression equations routinely operate at low altitudes outside these zones) continue to be for moment of inertia are: Y = 0.0113 X1 + 0.0019 X2 - 2.8296 (lateral exposed to hazardous levels of laser radiation. This study examines the position), Y = 0.0126 X1 + 0.0017 X2 - 2.6651 (supine position), Y = frequency and adverse effects of laser illuminations involving 0.0048 X1 + 0.0002 X2 - 0.3964 (sitting posture), Y = 0.0085 X1 + helicopters compared with fi xed-wing aircraft for a 31-year study 0.001 X2 - 1.5292 (sitting posture for lower body and lateral position period (1980 - 2010). METHODS: Reports of helicopters and for upper body). DISCUSSION: Regression equations obtained with CT fi xed-wing aircraft illuminated by high-intensity light have been methods are suitable for pilots. The data in this paper could be used as collected from various sources and entered into a database maintained the design parameters of the simulation dummies. by the Vision Research Team at the FAA Civil Aerospace Medical Institute. The frequency of laser illumination events involving aircraft in Learning Objectives: the United States from January 1, 1980, to December 31, 2010, were 1 The methods of establishing the regression equations of inertial stratifi ed into 1,000-foot increments, categorized, and analyzed. parameters will be discussed. Analysis included adverse effects experienced by helicopter pilots compared to those experienced by pilots of fi xed-wing aircraft. RESULTS: The majority of helicopter laser exposures (71% or 509/718) [118] HYPOXIA EVENTS IN US MILITARY TACTICAL JET were within the altitude limit equivalent to that set for the Laser Free AIRCRAFT: A COMPARATIVE ANALYSIS 1993-2010 Zone (LFZ, ≤ 2,000 feet) versus only 20% (1327/6526) for fi xed-wing R.B. HAYS aircraft. More than 90% (185/205) of all adverse effects reported by Residency in Aerospace Medicine, Naval Aerospace Medical helicopter pilots were in this altitude range, compared to 27% Institute, Pensacola, FL (148/550) of all fi xed-wing effects reported. DISCUSSION: Special protective measures may be needed for helicopters and other INTRODUCTION: Hypoxia is a leading aeromedical threat to low-fl ying aircraft outside of designated airport hazard zones due to military aviation and is a common reason for the submission of the higher percentage of adverse effects associated with these events. hazard reports. The primary objective of this study is to determine the rates of in-fl ight hypoxia as experienced by aircrew in tactical jet Learning Objectives: aircraft and compare the incidence rate between the US Air Force, 1 Individuals will understand the fundamental differences associated US Navy and US Marine Corps. A Secondary objective is to identify with the laser illumination of fi xed-wing and rotary-wing aircraft trends or risk factors associated with developing in-fl ight hypoxia. as they relate to, frequency, altitude, and the severity of adverse METHODS: The Defense Safety Enterprise System (DSES) database effects experienced by pilots. was queried for all fl ight related mishaps that identifi ed hypoxia as contributing or causal factor among six tactical jets (AV-8, EA-6B, [120] AN ANALYSIS OF BUOYANCY ACENT TRAINING F-18, F-15, F-16, F-22) during the 17 year period FY1993-FY2000. (BAT) IN HELICOPTER UNDERWATER ESCAPE Flight Hour data specifi c to branch of service and aircraft type were TRAINING (HUET) used to analyze incidence rate (IR), and incidence rate ratios (IRR). RESULTS: A total of 239 in-fl ight hypoxia events meeting case D. CAREY defi nition were identifi ed in the USAF (110), USN (107), and Royal Navy, HM Naval Base, Portsmouth, United Kingdom USMC (22). Mean Cabin Altitude was 16,076 ft MSL with 34% of incidents occurring under 10,000 feet MSL. The most common cause INTRODUCTION: Buoyancy Ascent Training (BAT) was IP: 192.168.39.151 On: Sun,introduced 26 Sep 2021at Royal 17:39:09 Naval Air Station (RNAS) Yeovilton in order to was identifi ed as failure of cabin pressure (34%)Copyright: and the most Aerospace Medical Association common symptom was tingling (21%). The overall incidence rate of mitigate the high incidence of ear and sinus barotrauma experienced hypoxia per 100,000 fl ight hours in the study population wasDelivered by byIngenta Royal Naval aircrew during Helicopter Underwater Escape Training 1.36 [95%CI 1.18, 1.55]. The USN has the highest IR of hypoxia at (HUET) which previous studies had revealed. Analysis of accident 2.28 [95%CI 1.86, 2.8] while the F-22 has the highest IR for all reports also revealed a number of incidents where aircrew failed to aircraft at 8.3 [95%CI 4.15, 16.6]. Compared to the USAF the USN infl ate Life Saver Jackets (LSJ) whilst escaping from survivable has an unadjusted IRR of 1.9 [95%CI 1.45, 2.51] and an even helicopter ditchings. BAT attempted to improve HUET by: 1. Acting as higher IRR of 2.49 [95%CI 1.38, 4.52] compared to the USMC. a screening tool to prevent aircrew undertaking HUET with conditions DISCUSSION: For the aircraft studied, the unadjusted USN in-fl ight likely to lead to barotrauma. 2. Illustrate competence at maintaining a hypoxia rate is nearly twice the unadjusted rate of the USAF and 30 sec breath hold. 3. Provide experience of infl ating Life Save Jackets 2.5 times that of the USMC. The F-22 Raptor has the highest rate among (LSJ) under water. 4. Improve confi dence in aircrew undertaking the tactical jets while the F-18 Hornet appears to have a worsening HUET. Analysing data that was already collected as part of HUET rate that is over 8 times higher compared to a decade ago. Further would therefore demonstrate if there was any difference in symptoms investigation between various aircraft models may assist us in better between those undertaking HUET pre and post BAT implementation understanding the casual factors that are associated with these events. and therefore provide evidence of its effectiveness as a screening tool. METHODS: As part of normal HUET procedures questionnaires are Learning Objectives: completed by aircrew after undertaking HUET for Health and Safety 1 Increase the reader’s awareness of the incidence of hypoxia for reasons and in order to ensure adequate provision of care for those US military tactical jet aircraft as well as the comparative rates experiencing diffi culties during training. This includes symptoms and between services. signs of barotrauma. A direct comparison was made between 2 Familiarize the reader with the Defense Safety Enterprise System symptoms experienced by aircrew before the introduction of BAT and (DSES) as a data source for further enterprise-wide research. those after during a 6 month period. RESULTS: There was a signifi cant reduction in the incidence of sinus and ear barotrauma in post-BAT aircrew. DISCUSSION: Reasons for the difference can be accounted [119] LASER ILLUMINATION OF HELICOPTERS: for by BAT being a sensitive and specifi c screening tool. However, A COMPARATIVE ANALYSIS WITH FIXED-WING AIRCRAFT sinus barotrauma post-BAT still occurred which may have been due to FOR THE PERIOD 1980 - 2010 repeated exposure or the lack of sensitivity of BAT due to the R.W. MONTGOMERY, V.B. NAKAGAWARA AND K.J. WOOD difference between rate of descent in HUET and BAT. Or may be due FAA/CAMI, Oklahoma City, OK to the use of STASS in HUET (it is not used in BAT).

242 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

Learning Objectives: 1Wyle Integrated Science and Engineering Group, Houston, TX; 1 Buoyancy Ascent Training (BAT) may be a sensitive and specifi c 2MEI Technologies, Houston, TX; 3Massachussets Institute of screening tool for aircrew undertaking Helicopter Underwater Technology, Boston, MA; 4USRA, Houston, TX; 5NASA Johnson Escape Training (HUET). Space Center, Houston, TX 2 Buoyancy Ascent Training (BAT) may increase confi dence in air- crew undertaking Helicopter Underwater Escape Training (HUET). INTRODUCTION: Astronauts experience disturbances in 3 Buoyancy Ascent Training (BAT) provides an opportunity to experience sensorimotor function after spacefl ight during the initial introduction to a and demonstrate the infl ation of a Life Saver Jacket (LSJ) under water for gravitational environment, especially after long-duration missions. Our aircrew undertaking Helicopter Underwater Escape Training (HUET). goal is to develop a countermeasure based on vestibular stochastic resonance (SR) that could improve central interpretation of vestibular [121] EXPERIENCES IN FLIGHT AND G-TRAINING AFFECT input and mitigate associated risks. SR is a mechanism by which noise THE EXTENT OF CHANGES IN SERUM BIOCHEMICAL AND can assist and enhance the response of neural systems to relevant, COMPLETE BLOOD COUNT COMPONENTS imperceptible sensory signals. We have previously shown that impercep- H. KIM1, E. JEON1, J. LIM1, B. CHUN2, J. CHUNG1 AND tible electrical stimulation of the vestibular system enhances balance H. CHOI1 performance while standing on an unstable surface. METHODS: Eye 1 movement data were collected from 10 subjects during variable radius Aerospace Medical Center, Republic of Korea Air Force, centrifugation (VRC). Subjects performed 11 trials of VRC that provided Cheongwon-gun, Chungcheongbuk-do, Republic of Korea; equivalent tilt stimuli from otolith and other graviceptor input without 2 Department of Preventive Medicine, Korea University Medical the normal concordant canal cues. Bipolar stochastic electrical College, Seoul, Republic of Korea stimulation, in the range of 0-1500 microamperes, was applied to the vestibular system using a constant current stimulator through electrodes placed over the mastoid process behind the ears. In the VRC paradigm, subjects were accelerated to 216 °/s. After the subjects no longer sensed rotation, the chair oscillated along a track at 0.1 Hz to provide a maximum tilt stimuli of 10°. Eye movements were recorded for 6 cycles while subjects fi xated on a target in darkness. Ocular counter roll (OCR) movement was calculated from the eye movement data during periods of chair oscillations. RESULTS: Preliminary analysis of the data revealed that 9 of 10 subjects showed an average increase of 28% in the magnitude of OCR responses to the equivalent tilt stimuli while experiencing vestibular SR. The signal amplitude at which performance was maximized was in the range of 100-900 microamperes. DISCUS- SION: These results indicate that stochastic electrical stimulation of the vestibular system can improve otolith specifi c responses. This will have a signifi cant impact on development of vestibular SR delivery systems to aid recovery of function in astronauts after long-duration spacefl ight or in people with balance disorders. Learning Objectives:

1 Physiological, and functional performance effects of vestibular WITHDRAWN electrical stimulation by imperceptible stochastic noise will be reported.

IP: 192.168.39.151 On: Sun, 26 Sep 2021 17:39:09 Copyright: Aerospace Medical[123] NANOSOLUTIONS Association FOR THE FLIGHT SURGEON: Delivered byINTRODUCING Ingenta PROTEOMICS IN FUNCTIONAL MEDICINE M. GANAU2, L. PRISCO1 AND L. GANAU3 1Training School of Anaesthesiology, Intensive Care and Hyper- baric Medicine, Trieste, Italy; 2Graduate School of Nanotech- nology, University of Trieste, Trieste, Italy; 3School of Medi- cine, Cagliari, Italy

INTRODUCTION: To date, the majority of space exploration has involved healthy young individuals who have undergone intensive medical screening and remain in space only for relatively short periods. Given the alteration of normal human physiology in micro- gravity, what countermeasure can be taken for longer or repeated period? How functional medicine can mitigate the risks of infectious or degenerative illness during space missions? METHODS: Genomic and proteomic research is providing a new level of functional information about the molecular basis of cancer but also of chronic infectious diseases. Molecular diagnostics devices are becoming smaller: with Monday, May 14 2:30 PM the advancement of miniaturization technologies, microchip-based Exhibit Hall systems will soon be available for genetic testing. RESULTS: The goal of developing reliable early detection approaches from serum, other POSTER: SPACE MEDICINE ISSUES biological fl uids, or any sample obtained through minimally or non-invasive procedures remains of paramount importance. Several nanotechnologies are realistic candidates for early detection platforms, [122] ENHANCEMENT OF OTOLITH SPECIFIC OCULAR starting with surface patterning approaches including fi rmly estab- RESPONSES USING VESTIBULAR STOCHASTIC RESONANCE lished technologies such as DNA- directed-immobilization microar- 1 1 2 3 M.J. FIEDLER , Y. DE DIOS , J. ESTEVES , R. GALVAN , rays, SELDI-TOF mass spectroscopy, or atomic force microscopy for S.J. WOOD4, J.J. BLOOMBERG5 AND A. MULAVARA4 proteomic analysis. In this optic, tools such as microelectromechanical

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 243 ASMA 2012 MEETING ABSTRACTS systems, nanowires, or nanocantilevers promise to directly affect the INTRODUCTION: Patent foramen ovale (PFO) is common diagnostic power in terms of analytical detection of relevant changes among healthy adults, without symptoms and/or hemodynamic in physical and chemical molecular properties. DISCUSSION: The consequence (prevalence approximately 25% in the general popula- above-described nanotechnological approaches are creating the basis tion). However, PFO has been considered as a potential source of to enhance the hyper-early recognition of genetic and proteomic cryptogenic stroke and other diseases such as migraine. In the pathways alteration, namely the basis of any kind of pathology. Further aerospace medical fi eld, PFO can potentially represent an increased improvements might enable not only prefl ight but also infl ight risk for decompression sickness/arterial gas emboli. Transesophageal diagnosis and treatment. echocardiography (TEE) with agitated saline injection and Valsalva maneuver has been a gold standard method for detecting PFO, but it is Learning Objectives: an invasive and unpleasant examination. We have previously shown 1 Evaluate the risk of infectious and degenerative illnesses during that 320-slice multi-detector computed tomography (MDCT) can detect space missions PFO with fl ow directional information in the same enhanced CT images 2 Discuss the usefulness of a nanotechnological approach in a pre- obtained for evaluation of coronary arteries. METHODS: In 2009, JAXA fl ight diagnostic setting of astronauts selected astronaut candidates (now they are certifi ed as astronauts). At 3 Forecast the future of functional medicine in the continuous moni- the last stage of structured sequence of the selection, we performed toring of astronauts detailed medical examinations including cardiac evaluations using ECG-gated 320-slice MDCT, for ten fi nalists (9 men, 1 woman, age [124] MEDICAL CONSTRAINTS IN SPACEFLIGHT: distribution: 30-40y 100%). RESULTS: Using 320-slice MDCT, we were able to examine whether a patent foramen ovale was present in each VENTURING BEYOND LOW EARTH ORBIT astronaut applicant, in addition to obtaining other cardiac information S. FONDY including status of coronary arteries. Radiation exposure was reduced 1 Naval Aerospace Medical Institute, NAS Pensacola, FL; more than approximately 40% compared to 64-slice CT. The enhanced 2US Army School of Aviation Medicine, Ft. Rucker, AL CT image of subjects with a diagnosis of PFO revealed a structure with a channel-like appearance and a fl ow of contrast agent between left INTRODUCTION: NASA has generated a list of thirty-three gaps and right antrums. DISCUSSION: The 320-slice MDCT provides wide in medical capability that need to be addressed in order to extend the range of cardiovascular information and it is less invasive than current model of medical care used in spacefl ight in low-earth orbit to conventional TEE or coronary angiography. Therefore, we believe that a model of medical care that will be conducive to exploration space enhanced 320-slice MDCT can be a preferred procedure to evaluate missions. The intent of this project is to identify organizations that are cardiovascular status for astronauts and related aerospace medical doing research and development or have established products that subjects, including detection of PFO with fl ow directional information. will fulfi ll the closure criteria of these gaps, enabling NASA researchers to focus on those remaining gaps for which no product exists. Learning Objectives: METHODS: Initial approach involved internet searches on specifi c 1 To learn about detection of PFO using 320-slice MDCT. medical orgs, comparing their research to the list of gaps. Orgs included WHO, CDC, Gates Foundation, Carter Foundation, Doctors [126] SURROUND SIZE, VISUAL COMPLEXITY, AND w/o Borders, and NIH. Secondary approach was a systematic search of military medical research, again searching for research in areas with SICKNESS IN A VIRTUAL ENVIRONMENT active gaps. Tertiary approach involved internet searches specifi c to the A. BUBKA AND F. BONATO still unaddressed gaps, w/o limitation on organizations performing the Saint Peter’s College, Jersey City, NJ research. RESULTS: Three of the thirty-three gaps are as follows: * Lack of biomedical monitoring equipment for exploration EVA (Extravehicu- INTRODUCTION: It has been reported that Space Motion lar Activity) suits - Worcester Polytechnic Inst. is currently working on Sickness (SMS) is more common in larger spacecraft (e.g., Shuttle, International Space Station) compared to symptoms that occur in smaller biomedical monitoring equipment etc - Farm is a biomedical design company etc - Cleveland Clinic has expertise in electronics and craft (e.g., Apollo, Soyuz). One hypothesis is that larger compartments biomedical monitor development. *LackIP: of capability192.168.39.151 to treat radiation On: Sun, allow 26 Sep for more 2021 movement 17:39:09 and it is increased body movements that lead sickness, specifi cally blood product replacementCopyright: - Hemopure Aerospace is a Medicalto more SMS.Association We propose another hypothesis that larger environments blood substitute manufactured and used in South Africa. It isDelivered shelf- by presentIngenta a more complex and infl uential perceptual framework that stable for three years and is universal to all blood types. - Oxycyte is a increases the salience of visual/vestibular confl icting sensory inputs. blood substitute undergoing Phase II trials in Switzerland and Israel - METHODS: Twenty subjects viewed the interior of a cube-shaped virtual The Defense Sciences Offi ce has developed a method for freeze-drying room in stereo (interpupillary distance = 6 cm) using a head-mounted platelets etc * Lack of capability to auscultate internal sounds of the display for fi ve minutes. The black and white checkered room moved body in a space fl ight environment - The Army and the Navy have around the subject (60°/sec) on two axes (yaw and roll). There were developed prototype noise-immune stethoscopes for use in aviation three room conditions in the experiment: 1) a three-meter room with a and submarine environments. DISCUSSION: Many civilian and 6x6 checkered pattern, 2) a 30-meter room with a 6x6 pattern, and 3) a military orgs perform research that relates to the identifi ed gaps; 30-meter room with a 60x60 pattern. Sickness symptoms were assessed however this research doesn’t close all of the gaps. With this info, using a 0-10 subjective scale and the Simulator Sickness Questionnaire NASA can better focus their internal research on those remaining gaps (SSQ). Subjects indicated vection using a 0-10 subjective scale. for which no product exists. RESULTS: Sickness and vection scores were signifi cantly highest when the 30-meter room with the 60x60 pattern was viewed. DISCUSSION: Learning Objectives: These results suggest that a larger surround can provide a more 1 The audience will gain an appreciation for the challenges inherent infl uential perceptual framework that can lead to a higher degree of in transition of medical capabilities to exploration space missions. sensory confl ict and subsequently, sickness. However, it may not be 2 The audience will gain an appreciation for the variety of sources pos- increased size per se that enhances the framework. When spatial sible for fi lling the gaps in current medical capabilities in space fl ight. frequency was controlled for, differences were not signifi cant. Only when the number of visible surfaces increased with size was sickness [125] DETECTION OF A PATENT FORAMEN OVALE USING exacerbated. Care taken in designing vehicle interiors may lead to less visual-vestibular confl ict, and hence a lessening of sickness symptoms. 320-SLICE MULTI-DETECTOR COMPUTED TOMOGRAPHY 1 2 Although suggesting a contributing factor for SMS, these results do not A. MATSUMOTO AND N. FUNABASHI rule out the possible effects of increased body movements on SMS. 1Astronaut Medical Operations Group, Japan Aerospace Exploration Agency, Tsukuba, Japan; 2Dept. of Cardiovascular Learning Objectives: Science and Medicine, Chiba University Graduate School of 1 To understand how size and visual complexity of a surrounding Medicine, Chiba, Japan environment can affect motion sickness-like symptoms.

244 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

[127] MED KITS IN SPACE: AN EVOLUTIONARY TALE OF Learning Objectives: PHARMACIST SUPPORT 1 Share a new vision of off-world basic life support T.M. BAYUSE1, C. LEBLANC2, K. LANGFORD2 AND 2 Discuss different scenarios of cardiopulmonary arrest, and suggest L. MAGALHAES2 appropriate CPR actions 1Wyle/JSC Pharmacy, Houston, TX; 2JES Tech, Houston, TX 3 Understand the need for CPR protocols in space and the complexity of performing it effectively INTRODUCTION: Pharmacist support for both the Shuttle Orbiter and the International Space Station Medical Kits has increased [129] CEREBROVASCULAR EFFECTS OF THE VALSALVA in both time and substance over the last decade. There has been a steady progression from the initial support provided by a pharmacist, MANOEUVRE UNDER +GZ: IMPLICATIONS FOR originally isolated to the packing of the medication. The support has COMMERICAL HUMAN SPACEFLIGHT advanced the pharmacist responsibility into a full member of the J. JUNGIUS1,4, A.T. STEVENSON1,2, J.P. SCOTT1, Operations team. METHODS: A review of the support provided by a D. LYTHGOE3, M. BAGSHAW2 AND S. HARRIDGE2 pharmacist at Johnson Space Center was conducted. Topics include: 1Human Sciences, QinetiQ, Farnborough, United Kingdom; quality control, cost containment, regulatory compliance, medication 2Centre of Human and Aerospace Physiological Sciences, safety as well as drug information. RESULTS: The review provides a King’s College London, London, United Kingdom; 3Molecular timeline of pharmacist involvement and highlights the increasing and Clinical Cancer Medicine, University of Liverpool, Liver- demand for pharmacist support. Examples of each of the topics will be 4 explored. DISCUSSION: The evolution of pharmacist support for the pool, United Kingdom; School of Physiology and Pharmacol- medical kits in space has grown to become an integral part of Medical ogy, Bristol University, Bristol, United Kingdom Operations. The benefi ts of in-house pharmacist support will be discussed. Future areas of pharmacist support have been identifi ed. INTRODUCTION: Human commercial spacefl ight (HCSF) clients will be exposed to accelerative forces of suffi cient magni- Learning Objectives: tude to produce G-induced loss of consciousness (G-LOC). To 1 The audience will learn the positive impact the pharmacist has had prevent G-LOC, lower body muscle tensing combined with a with the Med Kits in Space. valsalva-like breathing manoeuvre (VM) can be employed. 2 Future pharmacist support will be explored. However, application of VM without associated muscle contraction may be counterproductive, inducing G-LOC in otherwise +Gz tolerant individuals. In order to assess this we examined cerebral [128] HOW TO MANAGE OFF-WORLD BASIC LIFE blood fl ow velocity (CBFV) and oxygenation (CtO ) responses to VM SUPPORT? PROPOSAL FOR AN OPERATIVE FLOW-CHART 2 under +Gz. METHODS: Eight experienced centrifuge subjects L. PRISCO2, M. GANAU1 AND L. GANAU3 performed two, 40 mmHg VMs for 15s during a 120s plateau at 1 Graduate School of Nanotechnology, University of Trieste, +2.6Gz, avoiding contraction of the abdominal and leg muscula- 2 Trieste, Italy; Training School of Anaesthesiology, Intensive ture. The nadir in eye level BP (BPeye), CBFV (transcranial doppler Care and Hyperbaric Medicine, Cattinara University Hospital, ultrasonograhy) and CtO2 (near infrared spectroscopy) were Trieste, Italy; 3School of Medicine, Cagliari, Italy recorded during the two VMs and the mean response compared with mean values derived from three VMs performed at +1G using z INTRODUCTION: Preservation of astronaut crew’s health a two-way repeated measures ANOVA. RESULTS: Pre-VM, BPeye, during suborbital or interplanetary missions will be crucial for their CBFV and CtO2 were all signifi cantly lower at +2.6Gz compared 6 6 6 6 success. To this regard providing emergency medical care in with +1Gz (55 15 vs 73 13 mmHg; 42 8 vs 55 10 cm/s; 71 6 6 hypogravity will undoubtedly be the most diffi cult obstacle in any 4 vs 74 5 %, P < 0.001). Compared with VM at +1Gz, VM at Δ 6 operations and contingency planning. METHODS: In this proposal +2.6Gz induced comparable decreases in BPeye, ( 16 5 mmHg vs for an implementation of BLS in space we propose some algorithms Δ13 6 12 mmHg) and CBFV (Δ14 6 5 cm/s vs Δ15 6 6 cm/s) on how to behave in case of adverse cardio-respiratoryIP: 192.168.39.151 events 1) On: Sun,resulting 26 Sep in 2021a lower 17:39:09 (P < 0.01) absolute BPeye (40 6 15 mmHg) and during in-space fl oating EVAs, 2) during ground-basedCopyright: EVAs, Aerospace 3) on a MedicalCBFV (27 Association 6 8 cm/s) under Gz. In contrast, for CtO2, ANOVA space station or ground-based installation. RESULTS: 1) DuringDelivered byrevealed Ingenta a signifi cant interaction between VM and +Gz, with a fl oating EVAs the environmental conditions and the space suits wore greater (P < 0.001) reduction during VM at +2.6Gz compared with by astronauts represent an obstacle for an effective CPR, yielding to +1Gz (-6.2 6 1.4 vs 2.7 6 1.4%). DISCUSSION: VM and +Gz an ineluctable bad outcome. Effective solution may come only from a produce an additive effect on BPeye and CBFV, whilst the cerebral scrupulous screening and prevention of cardio-respiratory adverse de-oxygenation associated with VM was enhanced under Gz. In events. 2) In case of emergency while walking on a planet’s surface combination, VM and +2.6Gz transiently reduced CBFV and CtO2 in a microgravity environment, it will be advisable to start chest by approximately 50% and 12% respectively. Similar percent compressions as soon as possible, even through the space suit, in the reductions in these indices are associated with syncope in clinical standard side straddle position. ECG self-adhesive pads with studies suggesting that the use of VM without muscle tensing under defi brillation function are advisable. 3) Each space station or +Gz might increase susceptibility to G-LOC. These fi ndings should ground-based installation require an emergency area with resuscita- be considered by HCSF providers when determining the content of tion equipment and drugs, along with an alertness system through pre-fl ight training programmes for potential clients. emergency buttons. Rescuer should start CPR in the reverse “bear-hug” position. A supraglottic airway device and self-infl ating Learning Objectives: bag, or bag-mask should be applied. Waveform capnography should 1 The audience will learn about the cerebrovascular consequences of be available for confi rming tracheal tube placement and subsequent performing a valsalva manoeuvre under +Gz monitoring in case of intubation. Supplemental oxygen should be 2 The potential risks to human spacefl ight participants of G-LOC added as soon as possible, ventilation (10 breaths/min) and chest following inappropriate use of protective measures will be compressions (100/min) should be uninterrupted. If no airway and discussed ventilation equipment are available, mouth-to-mouth ventilation is mandatory. Whenever necessary self-adhesive defi brillation pads [130] RECOGNITION OF THREE FACIAL EXPRESSIONS should be applied without interrupting chest compressions, which AS A FUNCTION OF FACIAL EDEMA AND ORIENTATION should be restarted immediately after defi brillation and continued until the patient shows signs of life. DISCUSSION: All proposed C.J. CORTESE, L.E. ENRICO, J. FALCO, K.L. HESS, algorithms recognize the rule of the survival chain both during EVAs O.H. OGUNMUKO AND L.T. GUZY and on ground based installations, therefore indicate a clear need for Psychology, State Universitty of New York at Oneonta, a system of alertness in every space scenario. Oneonta, NY

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 245 ASMA 2012 MEETING ABSTRACTS

INTRODUCTION: When astronauts encounter microgravity, 2010 and FY 2011, there were 549 fatal accidents involving 623 fl uids that normally drain from the head as a result of earth’s gravity pilots. In 2010, there were 276 fatal accidents involving 337 pilots, instead remains in the head, resulting in facial edema. This swollen 53% had been issued class 3 medical certifi cates, and their average face masks unique changes in the face that accompany different age was 53. In 2011, there were 273 fatal accidents involving 286 emotions. The problem is compounded as astronauts encounter each pilots, 54% had class 3 medical certifi cates, and their average age other in numerous orientations other than the upright. Astronauts may was 54. In 2010, 96% of fatal pilots were male; in 2011, the number fail to react appropriately to an expression displaying underlying showed no change. Finally, there was a slight decrease in the number happiness, anger, or pain resulting in crew miscommunication or of fatal accidents from 2010 to 2011. disharmony. We selected these expressions as they displayed similar facial characteristics, e.g., teeth were clearly visible in each emotion Learning Objectives: photographed. We examined accuracy and speed in identifying the 1 The audience will learn about advances in aerospace accident three facial expressions with a normal and swollen face in an upright medical data collection and hazard analysis. and inverted orientation. METHODS: Participants: Thirty-fi ve college men and women volunteered. Procedure: Three photographs were taken of a woman’s face while she was standing upright and three that 4:15 pm simulated microgravity by her lying on a tilt table at a six degrees head [131B] COMPARISON OF POST-MORTEM down position. Images were presented using E-Prime 1.0 software. PATHOLOGY FINDINGS BETWEEN THE FEDERAL Each image was randomly presented for four trials upright and inverted AVIATION ADMINISTRATION (FAA) MEDICALLY for a total of 48 trials. Participants practiced pressing each of the three CERTIFIED THIRD-CLASS AND SELF-CERTIFIED PILOTS, keys associated with facial expressions with the instructions to press CY 2010. PART 1 OF 2 the key corresponding to the facial expression. RESULTS: Facial edema G. CASAS1, L.N. CASTRO1, E.M. RICAURTE2, C.A. DEJOHN2, resulted in a signifi cant reduction in mean accuracy (64%) regardless N. WEBSTER2, M. SELENSKY2 AND M. SANCHEZ2 of orientation of the face as compared with no edema (84%). 1Aerospace Medicine Residency Program, National University, Regardless of orientation, facial edema for the happy expression 2 showed accuracy of 82% while pain and anger were accurately Bogota Colombia; Civil Aerospace Medical Institute, Federal detected only 54% of the time. DISCUSSION: Facial edema changed Aviation Administration, Edmond, OK the outward facial manifestation of the underlying emotion. Pain and anger were most often misidentifi ed. Failure to recognize and respond INTRODUCTION: Self-certifi ed pilots require only a U.S. driver’s appropriately to a fellow astronaut’s mood may bring negative license to operate any light sport aircraft (LSA). From an aviation safety repercussions. perspective, no study has been published analyzing accident data to evaluate the affect of this rule. The purpose of this study was to identify Learning Objectives: and compare hazards to aviation safety of self-certifi ed pilots to FAA third-class medically certifi ed pilots. METHODS: Data on fatally injured 1 Misidentifi cation of an underlying emotion while in space may sport and third class pilots, including hazards identifi ed on FAA lead to miscommunication. medical certifi cation records and autopsy results, were obtained from 2 The misidentifi cation of an underlying emotion while in space may the Medical Accident Review Hazard Analysis Program (MARHAP) lead to miscommunication among the crew. database for CY 2010. Pathological data were confi rmed with autopsy 3 The misidentifi cation of an underlying emotion while in space may reports. Data analysis was conducted using SPSS Statistical Package lead to a negative and/or inappropriate response to the needs of V.18. RESULTS: There were 302 fatally injured pilots entered into the that astronaut. MARHAP database. Autopsies were performed on 285 pilots (94%). After excluding overseas accidents, missing data, severe body damage, Monday, May 14 4:00 PM and fi rst and second medical class, a total of 122 cases were analyzed: Ballroom A Fifteen self-certifi ed (12%) and one hundred and seven third class pilots (88%). Fourteen out of fi fteen self- certifi ed (93%) and seventy nine out IP: 192.168.39.151 On: Sun,of 26 one Sep hundred 2021 and 17:39:09 seven pilots (74%) had at least one pathological SLIDE: MEDICAL ISSUES INCopyright: AIRCRAFT Aerospace Medicalfi nding in Association the autopsy. A cardiovascular pathological condition was Delivered by foundIngenta in thirteen out of fi fteen self-certifi ed (87%) compared to sixty ACCIDENTS nine out of one hundred and seven third class pilots (65%). The percentage of coronary artery disease, CAD in self-certifi ed and third 4:00 pm class pilots were 80% (12 cases) and 49% (52 cases) respectively. The [131A] MEDICAL REVIEW OF U.S. FATAL ACCIDENTS: FY percentages of self-certifi ed and third class pilots with an aviation hazard related to an autopsy fi nding were 13% (2 cases) and 3% (3 2010 - FY 2011 cases), respectively. DISCUSSION: More research needs to be N. WEBSTER, M. SELENSKY, C. HILEMAN AND C.A. DEJOHN conducted to determine if there is a statistically signifi cant difference Aeromedical Research Division, Civil Aerospace Medical Insti- between aviation hazards related to autopsy fi ndings in self certifi ed tute, Oklahoma City, OK and third class pilots.

INTRODUCTION: Introduction: The Federal Aviation Adminis- Learning Objectives: tration (FAA) Offi ce of Aerospace Medicine has been conducting 1 The audience will learn the value of autopsy analysis as a tool to medical case reviews for fatal aerospace accidents since 2008. In a evaluate the impact of aeromedical certifi cation decisions in avia- collaborative effort between the CAMI Autopsy Program Team and tion safety the Medical Research Team, aeromedical data on each fatal accident are collected and analyzed to identify potential aeromedical hazards and report that information to the FAA accident investigator. 4:30 pm Investigators use this hazard analysis to identify possible medical [131C] COMPARISON OF POSTMORTEM TOXICOLOGICAL factors that require further attention during their investigation of the FINDINGS BETWEEN THE FEDERAL AVIATION ADMINIS- accident. Purpose: This presentation will discuss the results of TRATION (FAA) MEDICALLY CERTIFIED THIRD-CLASS AND medically reviewed cases in FY 2010 and 2011. METHODS: SELF-CERTIFIED PILOTS, CY 2010. PART 2 OF 2 Methods: Data on pilots involved in fatal aircraft accidents were 2 2 1 1 collected from the FAA Document Information Workfl ow System L.N. CASTRO , G. CASAS , E.M. RICAURTE , C.A. DEJOHN , 1 1 1 1 (DIWS), CAMI Toxicology Database and pilot autopsy reports and R.J. LEWIS , N. WEBSTER , M. SELENSKY AND M. SANCHEZ entered into a Microsoft Access® workfl ow system to be analyzed for 1CAMI, Federal Aviation Administration, Oklahoma City, OK; demographics and trends. DISCUSSION: Discussion: During FY 2Aerospace Medicine, National University, Bogota Colombia

246 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

INTRODUCTION: Postmortem toxicology is an important ling explanation for the ethanol found, particularly in the vitreous, it aspect of aircraft accident investigation. While there are several is possible that the extensive exposure to ethanol-containing published studies by the FAA Civil Aerospace Medical Institute’s automotive fuel is a source for the ethanol detected on post-mortem Bioaeronautical Sciences Research Laboratory reporting various toxicology testing in this case. Over the last 10 years, ethanol has toxicology results for general aviation pilots involved in aircraft become nearly ubiquitous in U.S. automotive fuels, and this fi nding accidents, this study identifi es and compares hazards to aviation has substantial potential application to accidents involving extensive safety of self-certifi ed pilots and third-class medically certifi ed pilots post-mortem automotive fuel exposure. involved in fatal aircraft accidents in CY 2010, based on toxicology fi ndings. METHODS: Fatally injured U.S. pilot data, including Learning Objectives: hazards identifi ed on FAA medical certifi cation records and 1 To be able to identify incongruous aspects of ethanol detected on toxicology results, were obtained from the Medical Accident Review post-mortem toxicology. Hazard Analysis Program (MARHAP) database for CY 2010. Data analysis was conducted using SPSS Statistical Package V.18. RESULTS: There were 302 fatally injured pilots entered into the MARHAP 5:00 pm database. After excluding overseas accidents, missing data, pending [133] FATIGUE REPORTING AMONG AIRCREW: INCIDENCE toxicological reports, and fi rst and second FAA medical class, a total RATE AND PRIMARY CAUSES of 137 cases were analyzed: Seventeen self-certifi ed (12%) and one S.J. HOUSTON hundred and twenty third class pilots (88%). Nine out of seventeen Aero-Medical Service, BMI, British Midland International, self-certifi ed pilots (53%) were reported positive for any drug or London, United Kingdom substance compared to fi fty fi ve out of 120 third-class pilots (46%). Aviation hazards related to toxicological fi ndings between the INTRODUCTION: In this study we describe our experience of self-certifi ed and third class pilots was 18% (3 cases) and 9% (11 voluntary fatigue reporting among pilots and cabin crew. METHODS: cases) respectively. The most common class of medications reported This was a prospective study to determine the crude incidence rate and on both groups of pilots were: Psychotropic/neurological (18%); primary cause of Fatigue Report Form (FRF) submission among cabin Cardiovascular (15%); Non-steroidal anti-infl ammatory drugs crew and pilots within one airline. All crew duties had already (NSAIDs)/analgesic (14%); and Antihistaminic (13%). When undergone scrutiny at the ‘roster build’ stage to ensure compliance comparing cardiovascular medications found in the group of with fatigue control measures. FRFs were investigated by the airline’s self-certifi ed versus third-class pilots a signifi cant difference in medical offi cer to determine the primary cause of fatigue and then percentage was found: 35% and 12% respectively. DISCUSSION: allocated to one of fi ve categories. The frequency and proportion of Treated cardiovascular conditions were found to be more prevalent reports within each category was determined. RESULTS: The crude in the group of self-certifi ed pilots as compared to the third class incidence rate of FRF submission was 103 and 68 cases per 1000 group. More research needs to be conducted to determine the persons per year for pilots and cabin crew respectively. The primary signifi cance of this fi nding in terms of the value of medical certifi ca- cause for 27% of reports was attributed to the rostered duty pattern. tion process. 24% of reports were primarily caused by roster disruption, 17% by problems with layover accommodation or transport, 23% by a Learning Objectives: domestic issue and 9% had no obvious cause or were deemed invalid. 1 The audience will learn the importance of postmortem toxicologi- A sub-analysis of the ‘domestic’ category revealed that half had a primary cause attributable to commuting to or from the workplace. cal fi ndings in evaluating and comparing aviation hazards in both medically certifi ed third-class and self-certifi ed pilots. DISCUSSION: In this study we measured the incidence rate of reported fatigue events. This rate was specifi c to a given airline in a given timeframe but may be useful for comparison with future similar 4:45 pm studies by other airlines in an attempt to establish a benchmark [132] ALCOHOL FREE? - UNUSUAL POSSIBLE ETHANOL standard within the industry. The study demonstrates that the number SOURCE IN A LIGHT SPORT PILOTIP: 192.168.39.151 On: Sun,and 26 trend Sep of 2021 fatigue 17:39:09 reports received per month can provide valuable M.A. GARBER1 AND D. CANFIELD2 Copyright: Aerospace Medicalinsight into Association the effectiveness of fatigue management and identify where 1Engineering Systems, Inc., Norcross, GA; 2Civil AerospaceDelivered byimprovements Ingenta can be made. Fatigue reports allow individual crew- Medical Institute, Oklahoma City, OK members to give vital feedback on ‘whole-of-life’ fatigue risks, both inside and outside the workplace. INTRODUCTION: A kit-built light sport aircraft crashed Learning Objectives: following a loss of power, killing the pilot, whose body was exposed to fuel during a prolonged extraction. On autopsy, the body exhibited 1 The audience will discover one airline’s experience of voluntary chemical burns on face and chest, and a portion of the aircraft fatigue reporting among pilots and cabin crew. wreckage had penetrated the posterior chest wall. The pilot’s injuries 2 In time, the incidence rate of reported fatigue events might be used included extensive fractures of the chest and extremities but no injury to establish a benchmark standard within the industry. was noted to the globes of the eyes or the urinary bladder. The cause of death was noted as multiple blunt force injuries. At autopsy, the Monday, May 14 4:00 PM pilot’s body and the pouch in which it was contained were noted to Ballroom B smell of fuel. Toxicology testing noted ethanol in the vitreous (28 mg/ dL) and the blood (27 mg/dL), but none in the urine. The spouse of the pilot described the pilot as a “non-drinker,” and additional SLIDE: CLINICAL MEDICINE: CARDIOLOGY toxicology testing was not consistent with ethanol ingestion. Investigation subsequently revealed that the aircraft engine could 4:00 pm operate using automotive fuel, and that such fuel was routinely utilized in the aircraft. Though the Federal Aviation Administration [134] FAA EXPERIENCE WITH HEART TRANSPLANTS IN does not permit the use of ethanol-containing fuels in aircraft PILOTS engines, investigation determined that the fuel utilized in the aircraft J.R. DEVOLL was automotive fuel that contained 10% ethanol. Exposure to Offi ce of Aerospace Medicine, Federal Aviation Administration, automotive fuel has not been previously described as a source of Washington, DC ethanol in post-mortem specimens. Ethanol is, however, known to penetrate even intact skin, and given the extensive exposure of the INTRODUCTION: A history of heart transplantation remains pilot’s body to ethanol, both through direct surface contact and specifi cally disqualifying for FAA airman medical certifi cation. In through penetrating wounds, and the absence of any other compel- 2005, McGiffi n analyzed data from 6510 transplant patients with up

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 247 ASMA 2012 MEETING ABSTRACTS to 12 years follow-up ( J Heart Lung Transplant 2005;24:259-69), 4:30 pm showing that a subset of heart transplant patients had a low risk for [136] ANALYSIS ON CORONARY ARTERY DISEASE OF ROK incapacitation similar to the general population. Possible criteria for CIVIL AVIATION WORKERS IN 2010 selection of low risk patients was suggested by the study, and in Y. KWON1, E. CHOI2 AND E. JUNG2 9/2006 new criteria were adopted to begin considering pilots with 1Aerospace Medical Association of Korea, Seoul, Republic of heart transplants for special issuance of third-class (general 2 aviation) medical certifi cates. The objective of this current study Korea; Aeromedical Center, Koreanair, Seoul, Republic of was to review the FAA medical certifi cation experience with heart Korea transplantation from 2006 through the present. METHODS: The Medical Appeals Branch database of cases reviewed by the Federal INTRODUCTION: Coronary artery disease (CAD) is a major Air Surgeon was queried to identify all cases involving heart disease that induces in-fl ight incapacitation, and it is a major cause transplantation from 2006 on and extract pertinent de-identifi ed of permanent medical disqualifi cation for pilots. The Aerospace information. RESULTS: As of 10/2011, 8 male airmen had applied Medical Association of Korea (AsMAK) reviews the data on aviation for certifi cation under the policy, with averaging 63.4 years (53-74), physical examination of coronary artery disease and makes decisions 36.4 months (13-61) since transplant, 1050 hours median fl ight accordingly. This research seeks to verify the common risk factors of time (0-25,000 hrs). Two airmen were denied certifi cation (unre- CAD, characteristics of coronary artery stenosis, treatment, and the lated non-cardiac conditions). 6 airmen have been certifi cated and results of follow up. METHODS: Subjects were 27 civil aviation followed for a total of 11.6 person-years. There has been no known workers who have been diagnosed with CAD. The subjects were adverse medical change or in-fl ight incapacitating event reported selected based on documents submitted in AsMAK in 2010. Prior medical records of these workers were reviewed to investigate the for the group. 1 airman voluntarily withdrew with no reported period of diagnosis, the risk factors of CAD, the test results and adverse events, with 2 airmen dropped out without explanation. decision. Prior medical records of workers selected from the DISCUSSION: Study limitations include small sample size, standards indicated above were reviewed, and data was analyzed in relatively short follow-up and unexplained losses to follow-up. retrospect. RESULTS: During 2010, the total numbers of aviation The available evidence suggests that current strict selection criteria medical examination was 5,850, and 27 among these exams were have thus far allowed safe certifi cation with low risk for adverse workers with CAD. The average age of these workers were 55.1 years medical events. The current data is not suffi cient to support of age and average BMI was 24.7. The 27 workers were males. The expanded consideration for fi rst- or second-class medical certifi ca- CAD risk factors at the time of diagnosis were obesity (40.7%), tion. The policy should continue under review based on additional hyperlipidemia (29.6%), hypertension (7.4%), diabetes mellitus case follow-up and advances in heart transplant practice and (7.4%), and taking of hyperlipidemia medicines (7.4%). Also, other outcomes. risk factors were smoking and family history. 8 workers (29.6%) were newly diagnosed with CAD during 2010 and 19 workers have been Learning Objectives: diagnosed from 2000 to 2009. In regard to coronary angiography, 1 Understand the current experience of the FAA with medical certifi - blood vessels were with coronary stenosis in the following respective cation of pilots post heart transplant. order: LAD 51.5%, RCA 24.3%, LCX 21.2%, and LM 3.0%. Also 2 Understand how criteria were developed for selection of heart Single vessel disease was 66.7%, Double vessel disease was 24.2%, transplant patients, and how future FAA experience and heart trans- and Triple vessel disease was 9.1%. The ranges of stenosis were mild plant science and practice may guide future policy. (12.1%), moderate (24.3%), and obstructive (63.6%). The treatment 3 Understand the implications of the FAA heart transplant for CAD was medication (44.4%), percutaneous coronary angioplasty certifi cations selection experience applies to solid organ with stent placement (55.6%). The AsMAK determined 23 (85.2%) transplantation. cases as waiver and 4 (14.8%) cases as denial. The period of follow up after initial diagnosis and treatment was on average 53 months. Also, there were no cases of major adverse cardiac events such as cardiac death or myocardial infarction during the period. 4:15 pm IP: 192.168.39.151 On: Sun, 26 Sep 2021 17:39:09 [135] THE AEROMEDICAL IMPLICATIONSCopyright: OF MECHANICAL Aerospace MedicalLearning AssociationObjectives: PROSTHETIC HEART VALVES Delivered by 1Ingenta Coronary artery disease, Aerospace medical Association, civil avia- T. JAGATHESAN tion worker UK Civil Aviation Authority, Gatwick, United Kingdom

INTRODUCTION: The implantation of mechanical prosthetic 4:45 pm cardiac valves to treat haemodynamically signifi cant valve disease [137] ROLE OF MYOCARDIAL PERFUSION IMAGING IN has become increasingly common in recent years. The complication risks following mechanical valve implants include endocarditis, CARDIAC EVALUATION OF AVIATORS primary valve dysfunction, valve thrombosis, thrombo-embolism and A. KUMAR anticoagulant-related haemorrhage. All of these complications can Dept of Nuclear Medicine, Command Hospital, Bangalore, potentially present with aeromedically relevant symptoms. This study India considers the risks posed in the aviation environment following the implantation of mechanical prosthetic cardiac valves. METHODS: A INTRODUCTION: Nuclear myocardial perfusion imaging has meta-analysis of the available published data on complications evolved into a very sensitive and accurate modality for detecting, following the implantation of various mechanical prosthetic valves is prognosticating and following up CAD. It has the advantage of being undertaken. RESULTS: The complication risks of different mechanical able to detect even mild ischemia when only fl ow heterogeneity is heart valves are evaluated and compared. DISCUSSION: The present Stress ECG is based on ECG changes which require higher aeromedical implications of mechanical prosthetic heart valves are degrees of ischemia. All the data available today indicate that a discussed. Methods to mitigate their complication risks to a level safe normal stress MPI means <1% chances of hard cardiac events per for a return to fl ying are considered. A policy for civilian pilot year and this fi gure has particular relevance for certifi cation of certifi cation following mechanical prosthetic valve implantation is aviators. There is a need to analyze the present trends of its usage in proposed. Air force. METHODS: 50 consecutive Air force offi cers who were referred for MPI were retrospectively analyzed. Siemens ECAM dual headed gamma camera was used for imaging. Stress gated images Learning Objectives: were obtained and Emory tool box auto cardiac software was used 1 To consider the aeromedical risks of mechanical prosthetic cardiac for processing the image. RESULTS: 52%(n=26) cases were referred valve implants. for asymptomatic ECG abnormality. Out of this 13 cases (26% of

248 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS total) were for changes in Inferior leads. Only 4 out of the 26 cases INTRODUCTION: Due to the potential for cardiovascular were detected to have perfusion defects and later underwent disease (CVD) to cause pilot incapacitation, screening of pilot coronary angiography followed by revascularization. Three MPIs cardiovascular risk to detect and treat disease and prevent sudden were done for patients who underwent primary PTCA to check for the onset events is current practice. In New Zealand, the Civil Aviation success of revascularization. Nine cases were follow up cases of Authority has routinely applied an adjusted Framingham-based CAD. There were 7 cases referred for atypical chest pain out of which cardiovascular risk prediction score to do this. This study examined one case turned out to have RPD in inferior segments There were 5 cardiovascular disease (CVD) events occurring in a commercial pilot cases referred for having positive TMT to exclude false positivity. population, and examined the sensitivity and specifi city of the current Only one out them (20%) was detected to be positive with reversible cardiovascular risk score in predicting these events. METHODS: A perfusion defect in the apical segments. DISCUSSION: MPI has the matched case-control design was applied to assess the association of advantage of detection of CAD at a very early stage when only fl ow 5-year cardiovascular risk score and cardiovascular events in an heterogeneity is present. MPI has a much better diagnostic accuracy Oceania based airline pilots. Cases were pilots with cardiovascular than stress ECG alone. Although coronary angiography provides events as recorded on their medical records. Each case was age and clinically valuable information, its invasive nature and costs gender matched with 4 controls that were randomly selected from the precludes its routine use in the evaluation of patients after interven- pilot population. Five-year retrospective evaluations were conducted to tion. MPI with its ability to provide information about the physiologi- collect data before the events. RESULTS: Fifteen cases of cardiovascu- cal signifi cance of stenosis, extent of ischemia and scar, global LV lar events were identifi ed over a 16-year study period, 9 (60%) of function, viability and prognosis is ideally suited to assess patients which were sudden clinical presentations, and only 6 (40%) of which after intervention. were detected using cardiovascular screening. Eight cases (53%) and 16 controls (27%) had a 5-year risk of ≥10-15%. Almost half of the Learning Objectives: events (7/15) occurred in pilots whose highest 5-year risk was in the 5-10% range. Cases were nearly 4 times more likely to have highest 1 Conclusion- The aviators are a special group of people in whom we 5-year risk score of ≥10-15% than controls (OR = 3.91, 95% CI need to use MPI more liberally due to its high negative predictive 1.04-16.35, p = 0.04). The accuracy of the highest risk score were value, non-invasive nature and lower costs. moderate (AUC = 0.723, 95% CI 0.583-0.863). The cut-off point of 10% is valid with specifi city of 0.73 but low sensitivity (0.53).

5:00 pm DISCUSSION: Despite a valid and appropriate cut-off point, the tool had low sensitivity and was unable to predict almost half of the [138] AEROMEDICAL DECISION MAKING IN CORONARY ARTERY DISEASE REVISITED cardiovascular events. The majority of CVD events remain sudden onset clinical presentations. P.D. NAVATHE, D. FITZGERALD, M. DRANE AND M. DODSON Learning Objectives: Offi ce of Aviation Medicine, Civil Aviation Safety Authority, 1 The association between the cardiovascular risk score and cardio- Canberra City, ACT, Australia vascular events in airline pilots is described INTRODUCTION: Coronary Artery Disease (CAD) is a common condition in the pilot population, and presents as a diffi cult aeromedi- Monday, May 14 4:00 PM cal problem. METHODS: The spectrum that this condition can present Ballroom C is impressive, ranging from asymptomatic pilots who are detected to have CAD, asymptomatic CAD which has been detected, or pilots with symptomatic CAD who have had a multiplicity of surgical cardiologi- SLIDE: DECOMPRESSION SICKNESS AND cal or medical interventions. The number of aviators affected by this HYPOXIA condition is more or less stable, but with new treatment and new diagnostic methods being evolved, there IP:is a 192.168.39.151plethora of different On: Sun, 26 Sep 2021 17:39:09 situations that can apply in otherwise similar cases. RESULTS: 4:00 pm Copyright: Aerospace Medical[140] DCS Association IN THE SWEDISH AIR FORCE. A SURVEY AND Appropriate and consistent aeromedical decision making is becomingDelivered by Ingenta an increasingly diffi cult process. DISCUSSION: CASA has proposed a EXPERIMENTAL STUDY paradigm for the assessment and follow-up of these aviators, which is L.G. HÖK1, R. WETTERHOLM1, B. WALL1 AND evidence based, and balances the national safety needs with the issues D.R. LEMMING1,2 of individual liberty. The paradigm is presented as a starting point for 1Dept of Aerospace and Naval Medicine, Swedish Armed possible harmonisation in such decision making. Forces, Linköping and Gothenburg, Sweden; 2Rehabilitation Medicine Dept of Clinical and Experimental Medicine, Faculty Learning Objectives: of Health Sciences, Linköping University, Sweden 1 Understanding how to detect CAD 2 The best methods of dteceting jeopardised myocardium INTRODUCTION: High altitude aircraft operations with 3 Follow up of pilots with CAD unpressurized cabin or hypobaric chamber demonstrations are well known high risk activities for decompression sickness (DCS). Results 5:15 pm of a recently distributed questionnaire in the Swedish Air Force indicated symptoms of DCS Type 1 (joint and skin symptoms) among [139] DOES CARDIOVASCULAR RISK ASSESSMENT OF personnel during normal high altitude operations, despite compli- PILOTS DETECT CARDIOVASCULAR DISEASE AND PREVENT ance with current regulations and preventive measures. The results of SUDDEN CLINICAL PRESENTATIONS? the survey will be discussed. The primary aim of the experimental A. WIRAWAN1,4, S. ALDINGTON2,1, R.F. GRIFFITHS1, study was to establish the presence and magnitude of venous- and/or C.J. ELLIS3 AND P. LARSEN1 arterial bubble formation during a simulated fl ight mission at 8000 1Occupational and Aviation Medicine Unit, Department of meters (26,247 feet). The secondary aim was to evaluate the Medicine, University of Otago Wellington, Wellington, New simultaneous use of the two ultrasonography techniques in chamber. Zealand; 2Air New Zealand Aviation Medicine Unit, Auckland, METHODS: A questionnaire concerning history of hypoxia and 3 decompression symptoms was sent to C130 crew members. The New Zealand; Green Lane CVS Service, Cardiology survey confi rmed that DCS symptoms occurs among the crew. Six Department, Auckland City Hospital, Auckland, New Zealand; subjects were recruited. Transthoracic Echocardiography and 4Occupational Health Department, School of Public Health, transcranial Doppler were used for evaluation of bubble formation at Faculty of Medicine, Udayana University, Denpasar, Indonesia ground level and after three periods of standardized arm work and

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 249 ASMA 2012 MEETING ABSTRACTS knee-fl exion at 8000 meters. (26,247 feet). RESULTS: The incidence INTRODUCTION: Neurological decompression is associated of venous bubble formation was low to moderate. No arterial with unique-appearing necrotic white matter (WM) lesions composed bubbles could be detected. None of the subjects developed any of a necrotic region with enhanced boundaries on fl uid attenuated symptoms related to DCS. The presenters will discuss the ultrasonog- inversion recovery (FLAIR) images. We hypothesized the presence of raphy techniques and relate the current fi ndings to the outcome of these lesions alters the normal relationship among markers of WM the survey. DISCUSSION: We conclude that similar chamber integrity. We tested this hypothesis in a cohort of high-altitude pilots exposures and fl ight missions are associated with venous bubble (N=25, age=37.4±5.5, range=29-49); nine subjects (36%) had formation and a subsequent possible risk of DCS. Higher workload necrotic WM lesions. The results were compared to those observed in and longer exposure times would further increase the risk of DCS. In a normal elderly cohort. METHODS: We analyzed the relationship future studies the described transthoracic and transcranial techniques among three quantitative indices of WM health: fractional anisotropy seem reliable and can be used in this experimental setting. (FA) of water diffusion, volume of hyperintense WM lesions, and concentrations of biologically important indices of cellular metabo- Learning Objectives: lism measured by magnetic resonance spectroscopy (MRS) in pilots 1 The presenters will discuss reported DCS symptoms and the outcome with and without necrotic WM lesions. These data were used to of an experimental study with two ultrasonography techniques measure whole-brain and anterior corona radiata (ACR) FA values, deep-cortical and periventricular WM lesion volume, and ACR 4:15 pm choline-containing compounds (GPC+PC), phosphocreatine plus [141] THREE INCIDENTS OF DECOMPRESSION ILLNESS AT creatine (PCr+Cr), and N-acetylaspartate (NAA) concentrations. THE RAF CENTRE OF AVIATION MEDICINE RESULTS: There were no differences in age and fl ight hours between A. MANTON pilots with and without necrotic WM lesions. The relationship between FA of ACR and metabolite concentrations from MRS was Centre of Aviation Medicine, Royal Air Force, Bedfordshire, altered by the presence of necrotic lesions. The correlation coeffi - United Kingdom cients between FA and MRS-based markers of cellular metabolic activity (PCr+Cr) were similar for pilots with no necrotic WM and the INTRODUCTION: This is a review of three separate incidents of normal aging population (r=.44 and .49, respectively). This correla- decompression illness (DCI) involving the use of hypobaric chambers tion coeffi cient was negative in pilots with necrotic lesions (r=-.57). at the Royal Air Force Centre of Aviation Medicine (RAF CAM). In each The correlation between FA and MRS-based markers of cerebral case the operation of the hypobaric chamber was as agreed by integrity (NAA) was similar in pilots with no necrotic lesions and in protocol and standard operating procedures. METHODS: The fi rst normal elderly (r=.60 and .74) while weak in pilots with necrotic incident involved a rotary student undergoing low level hypoxia lesions (r=.26). DISCUSSION: Pilots with no necrotic lesions are training. The run profi le was to 17500ft with a total of 30 minutes ‘off similar to normal elderly for markers of WM integrity relationships. oxygen’ and above 10000ft. The student went on to develop constitu- Our preliminary data suggest pathology associated with neurologic tional symptoms of DCI. The second incident involved a medical decompression may alter these relationships; however, with the small offi cer who was undergoing hypoxia demonstration and rapid number of subjects the authors are hesitant to make such conclu- decompression training as part of an Initial Medical Offi cers’ course. sions. Data from more subjects will be used for the fi nal presentation. The run profi le included an 8000 ft – 25,000 ft rapid decompression in

12 seconds followed by hypoxia training. The student developed Learning Objectives: symptoms compatible with arterial gas embolism. The third incident 1 Understand the white matter injury that is occurring with high involved a subject participating in a research trial at CAM. The run altitude exposure in U-2 pilots. profi le was to 15748 ft for a period of 2 hours 45 minutes ‘off oxygen’. The subject went on to develop symptoms of limb pain decompression sickness. RESULTS: The incidents were different in terms of run profi le 4:45 pm and presentation. Two of the cases are unusual in that the exposure [143] VALIDITY OF TISSUE RATIO TO ESTIMATE altitude did not exceed 18000ft. All threeIP: required 192.168.39.151 therapeutic On: Sun,DECOMPRESSION 26 Sep 2021 17:39:09 SICKNESS RISK hyperbaric treatment. DISCUSSION: Episodes of DCI are uncommon J.T. WEBB below an exposure altitude of 18000ft. Two ofCopyright: these cases remind Aerospace us Medical Association that, although uncommon, DCI is still a risk at these lower altitudes.Delivered by ScientifiIngenta c Aerospace Research Consulting (SARC), LLC, San Although termed a rapid decompression (RD) in the RAF, the 8000 ft to Antonio, TX 25,000 ft in 12 seconds profi le would not generally be classed as an RD in the USA (where the accepted defi nition is less than 3 seconds). INTRODUCTION: Tissue Ratio (TR) is the ratio of initial partial This case reminds us that AGE is still a risk with ‘rapid’ decompression pressure of nitrogen in body tissues divided by total fi nal pressure to profi les greater than 3 seconds. which a human is exposed. TR has been used to describe the supersaturation of human tissues as a measure of decompression Learning Objectives: sickness (DCS) risk. NASA has used TR for estimating the level of 1 The three relatively benign hypobaric chamber profi les described DCS risk and level of prebreathing required prior to extravehicular resulted in DCI. This is a reminder that excursions to altitudes in activity (EVA). The equation for TR includes a term for prebreathe excess of 15000ft are potentially hazardous and the risk of DCI is with 100% oxygen to reduce risk of DCS, but no factor is included present at lower altitudes than is generally acknowledged. for oxygen consumption (OC) during exposure. In this study, results from previous research efforts were used to determine the correlation between DCS incidence and the TR at the beginning of those 4:30 pm exposures with and without a term for OC. METHODS: The source [142] PRELIMINARY EVIDENCE THAT VOLUME OF data were research reports on DCS incidence from four-hour NECROTIC LESIONS DUE TO NEUROLOGIC exposures to altitudes from 378 mm Hg (18,100 ft; 5,517 m) to 226 DECOMPRESSION ALTERS RELATIONSHIP AMONG mm Hg (30,000 ft; 9,144 m). The TRs were calculated with multiple MARKERS OF WHITE MATTER INTEGRITY variables (MV) of altitudes of exposure, prebreathe time, and OC or S. MCGUIRE1,3, P. SHERMAN4, D. TATE3, P. KOCHUNOV2, with a single variable . Calculations of TR with MV were accom- P. FOX3, A. WIJTENBURG2 AND L. ROWLAND2 plished to show the effect of correction for OC during exposure. The TR values included exposures where DCS incidence was 0% to 87% 1USAF School of Aerospace Medicine, Dayton, OH; 2University 3 following 0 to 240 min of prebreathe at the altitudes described of Maryland School of Medicine, Baltimore, MD; Research above. RESULTS: Incidence DCS vs. TR showed high correlation Imaging Center, University of Texas Health Sciences Center, (0.92) when prebreathe times were either zero or 60 min with San Antonio, TX; 4Department of Neuroradiology, 59 Medical altitude as the only variable. Analysis of exposures with three Wing, San Antonio, TX variables shows lower correlation, 0.79, which improved to 0.83

250 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS with inclusion of a factor for OC. DISCUSSION: TRs may remain a 20min at plateau (MH), and 10min recovery at SL, then following a useful tool in evaluation of relative DCS risk with single variables. rest, repeat sequence with a SH plateau) once at 21°C (W) and again Inclusion of a term for OC while decompressed only marginally at -21°C (C) on a separate day. Subjects trained on SYNWIN (Ver. improves predictive value of the TR metric. 1.2.39, Chula Vista, CA) until achieving profi ciency in short term memory (STM), math (M), visual (VM) and auditory (AM) monitoring Learning Objectives: tasks. A composite score (CS), individual task scores and reaction 1 Be able to defi ne tissue ratio as it relates to decompression sickness times (RT) were determined every 20s and %change from SL risk calculated. ANOVA (Tukey-Kramer post-hoc) were used to determine 2 Be able to state the two variables which determine tissue ratio performance differences based on temperature (p=0.05). SpO2 at the

3 Be able to state the relationship between high or low tissue ratio fi nger (SpO2f) and forehead (Nonin model 9847, SpO2h), respiratory and high or low decompression sickness risk rate (Equivital®, RR), heart rate, core, fi nger and toe temperatures were monitored. 7620m exposures were terminated and 100% O2

administered at SpO2f= 60%. RESULTS: Drop in SpO2h (2; 4%) and 5:00 pm RR rise (18; 54%) was greater in C vs. W (MH; SH, respectively). To [144] PHYSIOLOGICAL EXPERIMENTS ON EXTREME HIGH relate cognitive with physiologic responses, changes in task ALTITUDE performance were calculated when the SpO2 dropped between 70 A.M. OSPINA-OBANDO1,2, C. BERNAL2 AND L. SANCHEZ2 and 80% (a) and between 60 and 70% (b). While SpO2h fell below 1Medicina, Universidad de los Andes, Bogotá, Colombia; 80% more rapidly in the cold at MH (69±45s (C) vs. 83±27s (W)), 2Centro de Medicina Aeroespacial, Fuerza Aérea Colombiana, during SH it took longer (45±43s (C) vs. 37±27s (W)). Under SH at Bogotá, Colombia (a), CS performance was worse in W (-13±31% (C) vs. -17±19% (W)), while STM score was lower and RT slower in C (-33±37% (C) vs. INTRODUCTION: Since the Colombian Air Force has one of the 2±5% (W); (28±70% (C) vs. 16±14% (W), respectively). Whereas newest and high performance hypobaric chamber and considering the under MH at (a), STM score was higher and RT faster in C (8±22% importance of doing new researches on Aerospace Medicine basics; (C) vs. -17±34% (W); (21±15% (C) vs. 30±33% (W), respectively). the aim of this project is to generate a series of studies on high altitude Similar trends were found in (b). However, these differences were not physiology performed in the Colombian Air Force Aerospace Medical signifi cant. DISCUSSION: The impact of cold on performance varies Center (CEMAE) in order to develop investigative skills and knowledge. with hypoxic severity. These data will aid in the development of a The principal objective of the fi rst study was to recognize the physiologic-based hypoxia warning system. Armstrong limit and describe the ebullism phenomenon in human corporal fl uids exposed to hypobaric high altitude reaching at 1000 FL. Learning Objectives: METHODS: The study was performed in two phases: the fi rst one using 1 To understand how task performance and physiologic response non biological homologous fl uids that had the same composition in changes with temperature and level of hypoxia. terms of electrolytes. And a second one using biological samples such as human blood, plasma, urine and saliva. A fl ight profi le was designed in order to standardize the accent rate and all fl ight Monday, May 14 4:00 PM procedures, having a fast climb rate until 630FL and then a lower Ballroom D climb rate to 1000FL so that the changes in the samples could be observed. RESULTS: It was found that after suffering ebullism the red blood cells observed by microscope presented a roleaux phenomenon, PANEL: RELEVANCE OF MAXIMUM ENTRY but, no erythrocyte damage was evidence , it was also seen as well, a AGE REQUIREMENT FOR AIR TRAFFIC very important conglomeration of nitrates and calcium in urine samples. Also was recognized that at 630FL in some cases the CONTROL SPECIALISTS biological samples fl uids showed ebullism but not in a constant way. Though, more research is needed. IP: 192.168.39.151 On: Sun,[146] 26 Sep RELEVANCE 2021 17:39:09 OF MAXIMUM ENTRY AGE REQUIRE- Copyright: Aerospace MedicalMENT FOR Association AIR TRAFFIC CONTROL SPECIALISTS Learning Objectives: Delivered byC. Ingenta MANNING AND K. BLECKLEY 1 Study the phenomenon of ebullism on biological samples such AAM-520, FAA CAMI, Oklahoma City, OK as corporal fl uids and recognize the changes described before by Armstrong This panel will discuss the maximum entry age requirement for 2 Perform basic physiology experiments using the facilities of the Co- air traffi c control specialists (ATCSs). Public Law 92-297 (approved lombian Air Force Aerospace Medical Center in order to develop May 16, 1972) specifi ed that the Secretary of Transportation could research culture in hypobarics establish a “maximum limit of age within which an original appoint- 3 Show the quality and capabilities of the Colombian Air Force ment to a position as an air traffi c controller may be made.” DOT Aerospace Medical Center to perform a high standard research on Document 3330.2, dated February 28, 1973, established the maximum basic fl ight physiology entry age of 30 for an original appointment into a controller position. However, people age 31 or older who previously held a position as an 5:15 pm FAA ATCS and people who had certain other prior ATC experience are eligible to be hired as air traffi c controllers. Questions are being asked [145] EFFECT OF EXTREME COLD ON MULTITASK PERFOR- about whether the FAA should continue to specify a maximum entry MANCE DURING EXPOSURE TO MODERATE AND SEVERE age for ATCSs considering an apparent lack of empirical evidence NORMOBARIC HYPOXIA directly linking entry age with job performance. Participants in this B.S. SHENDER, C. MATTINGLY, M.B. WARREN, panel will provide different perspectives on the maximum entry age S.M. COLEMAN, G.K. ASKEW AND A.L. TUCKER requirement. The fi rst speaker will review the history of the maximum Human Systems Dept, NAVAIR, Patuxent River, MD entry age requirement for ATCSs and will discuss how the age rule has evolved over time in keeping with circumstances, available data, and INTRODUCTION: This study compared the physiologic and some common sense. The second speaker will review historical cognitive response to moderate (5486m, MH) and severe (7620m, research, conducted between the 1960s and 1990s, that found an SH) normobaric hypoxia while under ambient and cold conditions. inverse relationship between entry age and performance in early ATC METHODS: Six males (39±7yr, 178±6cm, 86±7kg) gave their training. The third speaker will update the data regarding the maximum informed consent and continually performed multiple cognitive tasks entry age into the ATCS occupation with recent fi ndings and provide a while exposed to a simulated altitude profi le using a Reduced cost-benefi t analysis of this policy in the current work environment. Oxygen Breathing Device (5min at sea level (SL), 10min at 3048m, The fourth speaker will describe a project that involves both

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 251 ASMA 2012 MEETING ABSTRACTS cross-sectional and cross-lagged longitudinal research that provide the success declined with age. Heil (1999) conducted the only study that FAA with an updated scientifi c basis for its policies concerning ATCS entry compared age at entry with a job performance measure for 828 age. Finally, panel members will discuss issues and answer questions. operational en route controllers tested in 1997. Entry age had a small, but statistically signifi cant, negative correlation with performance [147] HISTORY AND EVOLUTION OF MAXIMUM ENTRY AGE ratings but not with a computerized performance measure. Overall, REQUIREMENT FOR AIR TRAFFIC CONTROL SPECIALISTS these results support the conclusion that there has historically been an inverse relationship between entry age and training performance for J. AUL ATCSs. FAA, Offi ce of Human Resource Management ATO Support Team, Washington, DC Learning Objectives: 1 The audience will learn about historical fi ndings of an inverse INTRODUCTION: Public Law 92-297 (signed in 1972) relationship between entry age and performance in early stages of allowed the Secretary of Transportation to establish a “maximum limit training for air traffi c control specialists. of age within which an original appointment to a position as an air traffi c controller may be made.” DOT Document 3330.2, (1973) established the maximum entry age of 30 for employees originally [149] THE RELATIONSHIP BETWEEN ENTRY AGE AND FAA appointed into a controller position. Exceptions allowing hiring after ACADEMY TRAINING SUCCESS: THE CURRENT STATUS age 30 were made for applicants who previously held a covered (by C. BYRNE PL 92-297) position in the federal civil service and those who had AAM-520, FAA CAMI, Oklahoma City, OK certain prior ATC experience (e.g., military controllers with certain types of experience). In 1999, the FAA Administrator set up the INTRODUCTION: In the 1960s, Trites and Cobb fi rst began Employment of Retired Military Air Traffi c Controllers Program, which reporting on the negative relationship between chronological age and was intended to reduce the loss of experienced active duty military air traffi c control specialist (ATCS) work and training performance air traffi c controllers by providing special opportunities for time- (Trites, 1961; Trites & Cobb, 1962; Trites, 1965; Cobb, 1967). They limited appointments to active duty military air traffi c controllers who found age at entry into training was a factor impacting training and have retired from the military. In 2005, another exception was made on-the-job performance of ATCSs. Their fi ndings and recommendations for surplus or displaced FAA employees (primarily including Flight contributed to the establishment of a maximum age limit for entry into Service Specialists who were displaced when the function was the ATCS occupation. This presentation will update the data regarding contracted out). The application of the maximum entry age rule has the maximum entry age into the ATCS occupation and provide a changed over time to accommodate applicants who had prior ATC cost-benefi t analysis of this policy in the current work environment. experience that they obtained at an early age. Nevertheless, the rule We examined the relationship between chronological age and is still in effect for new hires with no prior experience. The maximum performance verifi cation status at the end of Academy training. entry age rule was originally supported by data obtained from Specifi cally, we analyzed performance data from 877 ATCS trainees that entered FAA Academy training between 2005 and 2010. controllers who entered training over a period of many years. Nevertheless, there is a need to conduct research to determine the Furthermore, we will present a utility analysis that demonstrates the reason for a decrease in training performance over a short age span. value of the entry age limitation in terms of ATCS performance after Such research would contribute to a continuation of the justifi cation age 40 and the length of time needed for training. Finally, we will for the maximum entry age rule. discuss key considerations regarding age of entry into training and research needed in this area. Learning Objectives: Learning Objectives: 1 The audience will learn about the history of the maximum entry age rule for air traffi c controllers. 1 To inform the audience about a research study that investigated the relationship between chronological age and performance verifi ca- [148] HISTORICAL RESEARCH ONIP: INVERSE 192.168.39.151 RELATIONSHIP On: Sun, 26tion Sep status 2021 at the 17:39:09 end of Academy training. BETWEEN ENTRY AGE AND TRAINING Copyright:PERFORMANCE Aerospace FOR Medical Association AIR TRAFFIC CONTROL SPECIALISTS (ATCSS) Delivered by [150]Ingenta RELATIONSHIP BETWEEN ENTRY AGE AND PERFOR- C. MANNING MANCE FOR RECENT ATCS HIRES: PLANS FOR FUTURE AAM-520, FAA CAMI, Oklahoma City, OK RESEARCH K. BLECKLEY INTRODUCTION: This presentation discusses historical AAM-520, FAA CAMI, Oklahoma City, OK research examining the relationship between entry age and ATCS training performance. Before 1973, no maximum entry age was INTRODUCTION: The purpose of this presentation is to specifi ed. Consequently, researchers analyzed training performance of discuss plans for conducting both concurrent and cross-lagged ATCSs older than 30. Trites and Cobb (1964) examined the relationship studies of the relationship between air traffi c control specialist between entry age and Academy training performance for 1,210 ATCS (ATCS) entry age and job performance. Our goal is to provide the trainees. They observed inverse relationships between entry age and all FAA with updated scientifi c basis for its policies concerning ATCS criterion measures. Using an occupational status criterion incorporat- entry age. A plan is being developed to conduct cross-sectional and ing objective and subjective indicators of fi eld training and job cross-lagged longitudinal research that should provide insight into performance, they found an inverse relationship between entry age the nature of age-related differences in ATCS performance. The and occupational status. Cobb, Lay, and Bourdet (1971) examined the research plan is based on outcomes of a workshop that brought performance of 710 ATCSs entering training between 1968 and 1970. together leading researchers in adult development, skill acquisition Performance of ATCSs between ages 18 and 34 was similar, but those and retention, and cognitive abilities to discuss how to assess the 35 and older were less successful. A 1973 policy specifi ed a maximum relationship between ATCS age and performance. This research will entry age of 30, but research conducted after 1973 continued to reveal have three targets: a longitudinal examination of age-at-entry and entry age effects. VanDeventer and Baxter (1984) found a signifi cant progress through fi eld training; a cross-sectional study examining inverse relationship between entry age and pass rates for 8,573 ATCSs younger and older controllers; and a cross-lagged study using entering Academy training between 1977 and 1983. Collins, Nye, and multiple cohorts of controllers across a number of years. The Manning (1990) found an inverse relationship between age and researchers at the workshop recommended that a battery of Academy training performance for 3,578 ATCSs hired between 1985 cognitive abilities and personality tests, combined with three levels and 1987. Schroeder, Broach, and Farmer (1998) examined relation- of outcome measures, would produce a research study that would ships between ATCS entry age and performance in both en route yield the results necessary to update the scientifi c foundation for Academy and fi eld training. Both Academy pass rates and fi eld training FAA policy.

252 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

Learning Objectives: [153] VIGILANCE EFFECTS IN A NEXTGEN ATC 1 To inform the audience about a plan to conduct ENVIRONMENT cross-sectional and cross-lagged longitudinal research on E.J. STEARMAN AND J. MCDONALD the nature of age-related differences in air traffi c control School of Psychology, Georgia Institute of Technology, specialist performance. Atlanta, GA

Monday, May 14 4:00 PM INTRODUCTION: As we move towards the future, the amount of air traffi c in our skies is expected to increase to a level Salon AB that would put an enormous strain on the current air transportation system. The Joint Planning and Development Offi ce have proposed a PANEL: HUMAN SYSTEM INTEGRATION Next Generation Air Transportation System (NextGen). In the NextGen environment, separation responsibilities would be moved RESEARCH OF CIVILIAN AVIATION from the air traffi c controller (ATCo) to the fl ight deck. The ATCo BY GA TECH would be moved from actively controlling air traffi c to the supervi- sory role of separation assurance monitor. The future task of the ATCo [151] HUMAN SYSTEM INTEGRATION RESEARCH OF would require sustained attention in a vigilance task of monitoring CIVILIAN AVIATION BY GA TECH air traffi c. This raises some concerns about potential vigilance E.M. FORSTER1 AND B.S. SHENDER2 decrements in which the ATCo’s performance declines as a function 1 2 of time on task. It is likely that during transitional states towards the FAA CAMI, Oklahoma City, OK; Human Systems Dept, NextGen environment, some aircraft will require active control from NAVAIR, Patuxent River, MD the ATCo, while others are able to use sky-based separation procedures. It is unclear how this will affect performance. It is also The AsMA Science and Technology Committee solicited unclear if the future ATCo will require the same skill set as the abstract submissions from universities in the Atlanta, Georgia area current ATCo. Therefore, the objective of this paper is to examine the to showcase local talent as part of AsMA’s community outreach and relationship of attentional focus, training, traffi c density, and event to expose students to the aerospace medicine and human factors rate on an air traffi c control (ATC) vigilance task. METHODS: Five fi elds. This panel comprises three studies of civilian aviation and air studies were conducted at the Georgia Institute of Technology in traffi c control from the Georgia Institute of Technology. The fi rst which the effects of attentional focus, the amount time spent discusses the interaction between pilots and automation. Next, is a controlling air traffi c, traffi c density, and failure rate were examined study of how air traffi c controller vigilance tasks may be impacted in an ATC vigilance task. RESULTS: Using a Venn diagram with these by the new Next Generation Air Transportation System environ- factors, we attempt to determine the likelihood of a vigilance ment. Finally, we learn about a study to develop a common decrement occurring. In situations where there is high density traffi c workstation for both Terminal Radar Approach Control and En to monitor, time spent controlling air traffi c without monitoring was Route facilities. detrimental to the vigilance task. However, with high density traffi c and frequent automation failures, dividing the ATCo’s attention [152] PILOTS’ PERCEPTIONS OF HUMAN AUTOMATION between monitoring air traffi c and controlling air traffi c was INTERACTION benefi cial. DISCUSSION: Results of this paper suggest ways in which V.L. POP AND A.N. FERGUSON the NextGen environment may be structured to aid the performance School of Psychology, Georgia Institute of Technology, of the ATCo in a vigilance task. Atlanta, GA Learning Objectives: INTRODUCTION: Human-automation interaction (HAI) 1 To understand the relationship of attentional focus, training, traffi c takes place in virtually every phase of flIP: ight 192.168.39.151 under a variety of On: Sun, 26density, Sep and2021 event 17:39:09 rate on an air traffi c control vigilance task. environmental conditions. Pilots must decideCopyright: when to engage Aerospace Medical Association and disengage automation, which automation to use, the extentDelivered to by Ingenta which they should monitor and crosscheck the automation, and so on. We consider pilots’ perception of HAI situations to be a [154] BUILDING A COMMON WORKSTATION function of the automation, the task, the context, and the pilot. FOR EN ROUTE AND TERMINAL RADAR AIR TRAFFIC METHODS: In the current investigation, we created a set of 48 CONTROL scenarios based on ASRS (Aviation Safety Reporting System) S. KAZI AND C. DARLING reports, each of which involved crew interaction with automated School of Psychology, Georgia Institute of Technology, systems in the performance of some task(s). Each family in the set Atlanta, GA included a core HAI scenario describing a particular task situation. Variants involving changes in automation (e.g., mode), context INTRODUCTION: The existing systems used by today’s air traffi c (e.g., weather), pilot characteristics (e.g., fatigue) based on the controllers were designed to fi t a particular Air Traffi c Control facility. core, parent scenario were created to yield a family of four Despite commonalities in tasks performed by each controller, the scenarios. We asked twelve Part 121 pilots to judge the extent to uniqueness of each workstation prevents shared use by Terminal Radar which scenarios containing a variety of HAI tasks in different Approach Control (TRACON) and En Route facilities. However, with situations affected their assessment of the HAI situation. The expected changes via the Next Generation Transportation System judgments were in terms of various aspects of automation use, (NextGen), such a common workstation may be viable. Such a system workload, awareness, and coordination. RESULTS: We are still in could be more fl exible by reducing maintenance costs and making the process of analyzing the data, however, the objective is to personnel training more effi cient. The goal of our research was to make predict the pilots’ judgments from characteristics of the scenarios, recommendations for building a workstation that could be used both in terms of the scenario as a whole, where complex interac- effectively by both TRACON and En Route controllers. METHODS: We tions among variables are allowed to play out, and by looking at analyzed the information used by each facility to help determine the how specifi c scenario characteristics affect pilot judgments across extent of overlap between the information required by En Route and tasks and events. TRACON controllers. We used previously constructed task analyses to obtain the information used by each facility. Subject Matter Experts Learning Objectives: helped us verify how the information was used in each facility and 1 To learn about an effort at GA Tech to predict pilot behavior based whether that information was common to both facilities. RESULTS: We on an analysis of typical fl ight scenarios. calculated standardized relevance scores for each piece of information

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 253 ASMA 2012 MEETING ABSTRACTS using the task analyses. Relevance refl ects the criticality, frequency, and independently, in part, due to the expectation that communication variety of tasks that require the information. It can be computed for one quality between the ground and exploration crews will be more facility, but of importance to our project, it can also be computed limited by communication delays. Given this context, both researchers across the two facilities. When information is highly relevant to a and operational training and engineering experts have suggested that controller in both facilities, this information should be placed in an communication delays and the impact these delays have on the quality easily accessible and noticeable location on the display. Prestige value, of communications to the crew will create performance decrements if which is the number of sources that may give rise to a particular piece crews are not given adequate training and tools to support more of information, was calculated within each facility. By comparing the autonomous operations. This presentation will provide an overview of prestige of a piece of information to its relevance score we can look at a research study led by the Behavioral Health and Performance how well the structure of the workstation corresponds to a controller’s Element (BHP) of the NASA Human Research Program that examines information requirements. With these data collected, we hope to move the impact of implementing a communication delay on the Interna- to a comparison of task fl ows allowing us to visualize the extent of tional Space Station (ISS) on individual and team factors and out- overlap between how similar information fl ows through each facility. If comes, including performance and related perceptions of autonomy. we fi nd that the fl ow of information in the two options is similar, we The methodological design, use of analog environments, and can better judge the feasibility for constructing a common workstation. implementation of this study will be discussed. In addition, the effective collaborations between research and operational personnel at Learning Objectives: NASA JSC that have provided the adequate support needed in order to 1 To learn about an effort to design a workstation that could be used make this study successful will also be reviewed. Results of this study effectively by both Terminal Radar Approach Control and En Route will provide a preliminary understanding of the impact of communica- air traffi c controllers. tion delays on individual and team performance as well as insight into how teams perform and interact in a space-like environment.

Monday, May 14 4:00 PM Learning Objectives: Salon D 1 Understand how research and operations can successfully work together to produce high quality research. PANEL: CO-OPERATIVE ADVANCES IN 2 Understand how to design a methodologically sound research study in space analog environments. BEHAVIORAL HEALTH AND PERFORMANCE

RESEARCH AND OPERATIONS [157] IMPROVING TEAM PERFORMANCE THROUGH STRUCTURED DEBRIEFINGS: A FIELD TEST OF TEAM [155] CO-OPERATIVE ADVANCES IN BEHAVIORAL HEALTH DIMENSIONAL TRAINING 1 1 1,2 AND PERFORMANCE RESEARCH AND OPERATIONS K. SMITH-JENTSCH , M. SIERRA , W.L. BEDWELL , S. VANDER ARK1 AND L. LEVETON2 E. SALAS1,2 AND S.M. FIORE3,2 1 2 Wyle, Houston, TX; NASA Johnson Space Center, Houston, TX 1Department of Psychology, University of Central Florida, Orlando, FL; 2Institute for Simulation & Training, University of In organizations that engage in both operations and applied 3 Central Florida, Orlando, FL; Department of Philosophy, research, with operational needs guiding research questions and University of Central Florida, Orlando, FL research informing improved operations, the ideal goal is a synergy of ideas and information. In reality, this ideal synergy is often lacking. INTRODUCTION: This presentation will describe a strategy for Real-time operational needs driving day-to-day decisions, lack of debriefi ng teams called Team Dimensional Training (TDT). TDT was communication, lag time in getting research advances plugged into developed and validated by the U.S. Navy and is currently being tested operations can cause both areas to suffer from this gap between for use by NASA. TDT has been shown to improve the performance of operations and research. The Behavioral Health and Performance IP: 192.168.39.151 On: Sun,teams 26 Sep and of2021 multi-team 17:39:09 systems that are undergoing simulation-based (BHP) at Johnson Space Center strives to bridge this gap by following Copyright: Aerospace Medicaltraining. ThisAssociation strategy has fi ve key instructional features: 1) teams are a Human Research Program framework: Expectations of future encouraged to engage in self-correction, 2) trained TDT debrief operational needs identify the knowledge gaps; the gaps inDelivered turn guide by Ingenta facilitators create and maintain a psychologically safe learning climate, research leading to a product that is transitioned into operations. 3) goals set during debriefs are explicitly process oriented (rather than Thus, the direction research takes is in direct response to current and outcome oriented), 4) discussion during debriefs is balanced in terms of future operational needs and plans. Likewise, operations actively the amount of time spent discussing positive and negative aspects of seeks knowledge that is supported by evidence-based research. The team performance, and 5) discussion during debriefs is organized BHP team makes an ongoing effort to bridge the gap through working around an expert model of teamwork defi ned in prior research. Under closely with each other and making a conscious effort to keep each contract with BHP, researchers from the University of Central Florida other informed. The objective of the proposed panel is to demonstrate the results of a successful, close collaboration between research and (UCF) conducted an analysis to determine the generalizability of this operations and to provide AsMA participants with more practical technique for U.S. fl ight crews and fl ight controller teams employed by knowledge and examples from BHP’s experience at NASA. The panel NASA. This analysis involved structured interviews and observations of will consist of six presenters from BHP operations, internal and training-related debriefs. On the basis of this analysis, UCF researchers external BHP research projects, who together represent the BHP recommended that a pilot study be conducted to evaluate TDT in Research Transition to Operations Framework. conjunction with fl ight controller team training in integrated simulation exercises. This presentation will describe the strategy and the evaluation [156] AN EXAMINATION OF AUTONOMY UTILIZING ISS AS process used to test TDT in detail and will present the initial results A TESTBED FOR ANALOG RESEARCH: COLLABORATIONS obtained. Multiple options for implementation will be discussed. BETWEEN RESEARCH AND OPERATIONS Learning Objectives: 1 1 1 K.E. KEETON , K. SLACK , L.L. SCHMIDT , R. PLOUTZ- 1 To develop knowledge of the fi ve instructional elements of Team SNYDER2 AND P. BASKIN1 Dimensional Training (TDT) and the ways in which they work. 1Behavioral Health & Performance, Wyle/NASA, Houston, TX; 2 To develop knowledge of the four dimensions of the TDT expert 2USRA, Houston, TX model of teamwork and to be able to identify critical incidents that represent each. INTRODUCTION: Operational conjectures about space 3 To develop knowledge of the multiple options for implementing exploration missions of the future indicate that space crews will need TDT and to be able to develop a plan for applying TDT within a to be more autonomous from mission control and act and operate specifi c training or on-the-job situation.

254 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

[158] STRESS MANAGEMENT AND RESILIENCE TRAINING Learning Objectives: FOR OPTIMAL PERFORMANCE (SMART-OP) 1 A method for evaluating the effi cacy of training programs for long R.D. ROSE1, J.C. BUCKEY2, T. ZBOZINEK1, D.E. GLENN1, duration spacefl ight. S.J. MOTIVALA1, J. CARTREINE3 AND M.G. CRASKE1 2 The purpose (and defi nition) of psychosocial competencies for sup- 1Psychology, University of California, Los Angeles, Los Angeles, porting health services. CA; 2Medicine, Dartmouth Medical School, Lebanon, NH; 3 Decisions tools for developing training programs will be discussed. 3Psychiatry, Brigham and Women’s Hospital, Boston, MA [160] TRANSLATING EVIDENCE INTO REQUIREMENTS: INTRODUCTION: Stress-related problems before, during and A FLEXIBLE LIGHTING SYSTEM ON ISS 1 2 2 2 after space missions can seriously compromise crew effi ciency and A. WHITMIRE , L. LEVETON , S.L. JOHNSTON , J. MAIDA , safety. The time involved in training and carrying out a long-duration G. BRAINARD3 AND A. KUBEY3 mission poses certain challenges (e.g., time spent away from family, 1Wyle Integrated Sciences and Engineering, Houston, TX; communication delays, isolation and confi nement, and maximizing 2NASA Johnson Space Center, Houston, TX; 3Jefferson Medical crew autonomous functioning). When addressing behavioral health College, Philadelphia, PA issues such as stress, it is important to maximize privacy and the validity and acceptability of a countermeasure designed to mitigate the INTRODUCTION: Schedule shifts on the International Space effects of stress. This presentation will report on the development and Station (ISS) are required for conducting mission operations. These shifts evaluation of an autonomous, multimedia, computer-based stress lead to tasks being performed during the biological night, and sleep management and resilience training program, which was funded by a scheduled during the biological day, for both fl ight and ground crews. It is National Space Biomedical Research Institute (NSBRI) grant. This also recognized that lighting on the ISS does not provide adequate evidenced-based countermeasure called SMART-OP (Stress Manage- day-night cues for helping crewmembers stay entrained to a consistent ment and Resilience Training for Optimal Performance) is designed for sleep cycle. As a result of schedule shifts, poor lighting and other use in pre-fl ight training, where the skills learned prior to a mission contributors, sleep remains reduced in fl ight. Research demonstrates that would help to “inoculate” fl iers to severe stress reactions thereby the appropriate use of light and dark can hasten schedule shifting and building resilience and enhancing fl ight-task performance and crew facilitate circadian entrainment. Recent results further indicate light health, safety and effi ciency. Outcome data from a randomized enriched in specifi c wavelengths can minimize illumination requirements controlled trial of SMART-OP with a sample of healthy but stressed while optimizing the effectiveness of light. Technical specifi cations for a individuals (N=66) will be presented. SMART-OP was compared to an fl exible lighting system on the ISS were recently developed based on attention control (AC) group that watched videos and read material on fi ndings from investigations assessing neurobehavioral and physiological stress management. Outcome measures include: performance during a effects of light. The process of defi ning the hardware requirements and the laboratory social stress test (i.e., Trier) where participants give a speech, operational regimens for using light on orbit, required integrating the latest do arithmetic, and complete memory and non-verbal tasks in front of a scientifi c research into feasible recommendations in fl ight that fi t within critical audience; psychophysiology (heart rate, skin conductance, the constraints of the ISS environment, while minimizing crew time. The blood pressure); biomarkers (cortisol and alpha amylase); and NASA Behavioral Health and Performance Element along with Space self-report questionnaires on stress, sleep, resilience, perception of Human Factors and Habitability and the Division of Space Medicine, control, and acceptability and usability of the program. Initial analyses worked extensively with external lighting experts, engineers, the ISS of self-report data indicate that SMART-OP signifi cantly reduced vehicle offi ce, and the Astronaut Offi ce developed specifi cations for an perceived stress and increased perceived control over stress as LED-based light installed on the International Space Station. This compared to the AC group. SMART-OP users also rated the program as presentation will provide an overview of scientifi c fi ndings regarding the more useful than AC group and highly easy to use. use of light as a non-pharmaceutical countermeasure for shift work and jet lag, and the process for translating these recommendations into opera- Learning Objectives: tional requirements. While a fl exible system will help mitigate fatigue 1 Understand the content and developmentIP: 192.168.39.151 of an autonomous multi- On: Sun,related 26 Sep risks on2021 orbit, 17:39:09 continued efforts are needed to enhance our media stress management and resilience training program. understanding of the biological and behavioral effects of light, so that 2 Understand the outcome data from a randomizedCopyright: controlled Aerospace trial Medicalhabitat requirements Association and operational regimens can be effectively examining the effi cacy of the stress management programDelivered and its byimplemented Ingenta for future long duration missions. implications. Learning Objectives: [159] USING PSYCHOSOCIAL COMPETENCIES TO 1 The audience will learn about translating the use of a counter- EVALUATE SPACEFLIGHT TRAINING (AKA HOW TO measure based on fi ndings from laboratory investigations, into the EVALUATE OUR TRAINING DRAGONS) constraints of the spacefl ight environment L.L. SCHMIDT1, K. SLACK2, K.E. KEETON1 AND A.W. HOLLAND3 [161] DEVELOPING AN OBJECTIVE MEASURE OF 1Behavioral Health & Performance, EASI/ Wyle at NASA, Hous- PARTICIPANT PERFORMANCE IN LONG-DURATION ton, TX; 2BHP, LZ/ Wyle at NASA, Houston, TX; 3Space Medi- BED REST STUDIES 1 2 3 4 cine, NASA-JSC, Houston, TX K. SEATON , K. SLACK , J. PORITZ AND W. SIPES 1UTMB, Galveston, TX; 2LZ Technology, Houston, TX; 3University of INTRODUCTION: The Behavioral Health and Performance Houston, Houston, TX; 4NASA Johnson Space Center, Houston, TX group has a long history of advocating the inclusion of psychosocial competencies in astronaut selection and training (c.f. NASA TM INTRODUCTION: Head-Down Bed Rest (HDBR) methodology 2008-214775, NASA TP 2007-213726), but less attention has been has been used for over 20 years to study the effects of microgravity paid to using these same competencies to evaluate the effi cacy of the (Traon, Heer, Narici, Rittweger, & Vernikos, 2007). Although used training itself (rather than just student effi cacy). This presentation will primarily as an analog for studying physiological effects of spacefl ight, summarize one proposed method of evaluating training effi cacy using HDBR produces psychological effects as well. Compared to the existing psychosocial competencies for ISS crewmembers. Ideas for pre- and post- phases of HDBR, participants have exhibited increased collecting both quantitative and qualitative measures of training levels of depression (Ishizaki et al., 2002; Styf, Hutchinson, Carlsson, effi cacy and for how to relate these measures to the development of & Hargens, 2001) and stress (Chouker et al., 2001) during the psychosocial competencies will be included. The costs and benefi ts head-down phase. Thus, selecting participants who are capable of typically associated with such training evaluations in general, and how performing under the psychologically demanding conditions of HDBR such evaluation results may be used to better inform decisions is essential. METHODS: Candidates for participation in a NASA HDBR regarding future crew training will also be reviewed. study are screened by a licensed clinical psychologist for the presence

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 255 ASMA 2012 MEETING ABSTRACTS of psychological disorders or traits that could interfere with their radiation release into the air, land, water, sea and soil. This event successful completion of the study, and for positive characteristics that resulted in signifi cant aeromedical issues including leadership make them well-qualifi ed to participate in a HDBR study (Seaton, challenges, medical pre-treatment decisions, aviation hazards, risk Bowie, & Sipes, 2009). To validate and further improve the selection management and risk communication. This is a combined panel of the process, a standardized measure of participant performance that could International Association of Military Flight Surgeon Pilots (IAMFSP), be used by multiple raters was needed. Behaviorally Anchored Rating Society of US Naval Flight Surgeons (SUSNFS), and Society of USAF Scales (BARS; Smith & Kendall, 1963) were developed through the use Flight Surgeons (SUSAFFS). The panel will explore the compounded of the critical incident technique (CIT; Flanagan, 1954), along with humanitarian disaster that occurred in Japan. Emphasis will be on traditional BARS development procedures, and the use of focus groups. aviation impacts as they relate to international, interagency, and These methodologies yielded 86 usable critical incidents, which were inter-service cooperation in dealing with the unprecedented disaster. used as anchors for the scales. DISCUSSION: The scale developed, the HDBR-BARS, is the fi rst objective outcome measure designed to assess Learning Objectives: the performance of NASA HDBR participants. Current and future bed 1 The audience will learn about International Cooperation during an rest participants will be rated using the HDBR-BARS, and results of the unprecedented natural and manmade disaster. analyses will help to validate and refi ne the selection process. In 2 Medical considerations for Aviation operations in Radiation con- addition, the HDBR-BARS could serve as a model for the development taminated environments will be discussed. of outcome measures for other spacefl ight analogs. 3 The audience will gain insight into International, Interagency disas- ter medical response. Learning Objectives: 1 The audience will learn how how Behaviorally Anchored [164] AVIATION IN RADIATION, OPERATION TOMODACHI Rating Scales can assist in selection of participants for a H. GOTO bed rest study which may also apply to selection of subjects in other studies. JGSDF, Japanese Ground Self Defense Force, Tokyo, Japan INTRODUCTION: Lt Col Hiroya, MD, Japan Ground Self Defense Tuesday, May 15 8:30 AM Force (SDF) will summarize SDF response in general and precautions for our aviators fl ying Fukushima area from radiation exposure. Ballroom A [165] AVIATION IN RADIATION, OPERATION TOMODACHI PANEL: AEROSPACE MEDICINE GRAND L.B. GREEN DoD, US Air Force, Pentagon, DC ROUNDS: PART I INTRODUCTION: USAF Surgeon General Lt GEN Green, USAF, [162] AEROSPACE MEDICINE GRAND ROUNDS I, II, AND III MC will provide an Inter-service and Inter-Agency perspective with D. RHODES respect to Operation Tomodachi. Aerospace Medicine, USAFSAM, Wright-Patterson AFB, OH [166] AVIATION IN RADIATION, OPERATION TOMODACHI This panel consists of a series of clinical case presentations M.H. MITTELMAN from the residents in Aerospace Medicine. Each of the clinical cases DoD, US Navy, Oahu, HI will be presented by two residents. One will present the case concentrating on pertinent history and physical fi ndings with INTRODUCTION: At the time of Operation Tomodachi the supporting lab data leading to the diagnosis, the clinical outcome PACOM Surgeon was RADM Michael Mittelman, SHCE, USN. RADM and fi nally the aero medical disposition. The second resident will Mittelman is currently selected for Deputy Surgeon of the United States describe the actual disease with usual presentation,IP: 192.168.39.151 natural history On: Sun,Navy. 26 Sep RADM 2021 Mittelman 17:39:09 will provide an Inter-agency perspective from and treatment. The emphasis of these clinicalCopyright: cases is the aeroAerospace Medicala Combatant Association Commanders perspective. medical disposition. Cases will be presented by Residents inDelivered by Ingenta Aerospace (RAM) from each of the four accredited residency [167] AVIATION IN RADIATION, OPERATION TOMODACHI programs in the United States: USAF School of Aerospace Medicine, L. HARVIS Wright-Patterson AFB, OH; Naval Operational Medicine Institute, DoD, USAF, Yokota, Japan Pensacola Naval Air Station, FL; University of Texas Medical Branch, Galveston, TX; Wright State University, Dayton, OH. INTRODUCTION: ICOL Lee Harvis, USAF, MC, served as the Joint Task Force Surgeon during Operation Tomodachi and will provide a unique perspective of Inter-service and Inter-agency coordination Tuesday, May 15 8:30 AM and cooperation. Ballroom B

PANEL: AVIATION IN RADIATION, Tuesday, May 15 8:30 AM Ballroom C OPERATION TOMODACHI: PART I SLIDE: QUALITY OF VISION IN AVIATION [163] AVIATION IN RADIATION, OPERATION TOMODACHI (FIRST PANEL) H. GOTO2, C.B. GREEN4, M. MITTELMAN3, L.H. HARVIS5 8:30 am AND K.M. BELLAND1 [168] ATTAINING SUPER-VISION: THE EFFECT OF HIGHER 1DoD, US Navy, Coronado, CA; 2Japanese Self Defense Force, AND LOWER ORDER ABERATIONS ON SIMULATED JGSDF, Tokyo Japan; 3DoD, US Navy, Oahu, HI; 4DoD, OPERATIONAL VISUAL PERFORMANCE BEFORE AND US Air Force, Washington, DC; 5DoD, US Air Force, AFTER LASIK SURGERY Yokota, Japan D.M. MURDOCH, N. DELALLANA, S. KAUPP, E. HOFMEISTER, T.J. BRUNSTETTER AND D. TANZER On 11 March, 2011, Japan experienced a 9.0 earthquake off of Naval Refractive Surgery Center, Naval Medical Center San Daichi prefecture triggering a tsunami and resulting in a nuclear Diego, San Diego, CA

256 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

INTRODUCTION: The U.S. Navy Aircraft Carrier Landing LASIK was equivalent to preop, and increased by the equivalent of 1/3 Simulator Visual Performance (ACLS-VP) System was designed to line of acuity (+0.027 logMAR) at 3 months. No differences were evaluate the effect of ocular aberrations on visual task performance found between outcomes of PRK and LASIK subjects 3 months after within a simulated operational environment measuring optical treatment (t=0.227, p=0.82). The group means were not different when aberrations before and after LASIK surgery and the impact on visual comparing pre- to 3 months post-surgery (t=0.225, p=0.41). Subject performance. METHODS: The mean age of the subjects was 28.3 +/- visual and NVG acuity were signifi cantly correlated preoperatively, 4.57 years and all were myopes (spherical equivalent of 3.18 +/- 1.59). and 1 and 3 months after surgery (r’s = 0.24 - 0.70). Four control Testing occurred prior to LASIK surgery, one week, one month and three subjects were tested 6 times over 6 months and no learning effect was months after surgery. Higher and lower order optical aberrations were detected (F=1.95, p=0.17). DISCUSSION: Subjects treated with normalized to the smallest pupil diameter. We performed a multivariate modern PRK and LASIK performed as well with night vision goggles at analysis of variance to determine what factors affected the subject’s one and three months after surgery as they did prior to surgery. Modern measured detection distance for glide slope and glide path deviation. LASIK and PRK are considered effective and to have the potential to LASIK outcomes for all subjects in the study were excellent. RESULTS: increase operational effectiveness. Twenty-four subject s’ three month post LASIK uncorrected visual acuity exceeded their pre-LASIK best corrected visual acuity, 17 stayed the Learning Objectives: same and 1 had a decreased visual acuity. However, only one eye 1 Understand the effects of LASIK and PRK refractive surgery on night exceeded 20/20 after surgery. For glide slope, “ball center” (no vision goggle performance. deviation) was the most diffi cult to detect. Our analysis indicated that 2 Recognize the relationship between best corrected vision and night residual sphere refractive error (ball center, p=0.0021) had the most vision goggle performance. infl uence on operational visual performance during the preoperatively. During the postoperative tests, at one month and three months for all ball states and, glide angles residual cylinder errors were most infl uential 9:00 am of performance, (3 month: ball center, p=0.0026, angle center [170] MULTIFOCAL INTRAOCULAR LENS AND p=0.0033). Third order aberrations, also had some signifi cant infl uence AERONAUTIC MEDICAL CERTIFICATION (3 month: ball center p=0.0381, angle center p=0.0042). For glide path, C. CORBE1, J. BOURGES2 AND P. CREPY3 similar results were found, although performance was more variable. 1 Civil Aviation Medical Board, French Civil Aviation, Paris, Preoperative glide path performance was infl uenced by residual sphere France; 2Ophtalmology department, Hotel Dieu Assistance refractive errors (p=0.042), and 3 months after treatment residual 3 publique Hopitaux de Paris, Paris, France; Clamart Aeromedi- cylinder had an infl uence on center (p=0.025) and left (p=0.029) path cal Center, French Army Medical Services, Paris, France detection distances. DISCUSSION: Refi ned technologies for corneal refractive surgery that better correct cylinder and other aberrations will INTRODUCTION: Visual abilities should be optimized for any allow us to take another step closer to achieving “super-vision” and pilot to interact safely with complex aeronautic systems. While enhanced performance in the operational environment. ergonomics are constantly perfected within cockpits, cataract microsurgery has now turned into refractive surgery.European Aviation Learning Objectives: Safety Rules does not allow using multifocal intraocular lenses (mIOL) 1 The purpose of this study is to determine which lower and higher on pilot’s eyes whereas monofocal IOL are tolerated under derogation order aberations affect operational visual accuity before and after along with additional correction for near vision. We investigated LASIK surgery. whether the quality of vision provided by mIOL would fulfi ll ophthal- mological requirements for implanted pilots to safely fl y. METHODS: 8:45 am Between August 2009 and October 2011, the medical board of the French civil aviation has tested pilots who consecutively underwent [169] ENHANCING THE OPERATIONAL CAPABILITY OF THE WARFIGHTER THROUGH REFRACTIVE SURGERY: VISION cataract surgery to state on their fl ying medical certifi cation. Visual and neurosensoricognitive abilities, optical high order aberrations (HOA) PERFORMANCE USING THE LATESTIP: GENERATION 192.168.39.151 NIGHT On: Sun,and 26 point Sep spread 2021 function 17:39:09 of mIOL implanted pilots were compared to VISION GOGGLES FOLLOWING LASIK Copyright:AND PRK Aerospace Medicalcontrols implanted Association with spherical IOL.Items for class 1 and 2 R. ZEBER, S. KAUPP, M. MIRZAOFF, N. DELALLANA,Delivered bycertifi Ingenta cation were checked on the basis of European Aviation Safety D.M. MURDOCH, E. HOFMEISTER, T.J. BRUNSTETTER rules. RESULTS: Among hundred and eighty four pilots tested, 54 AND D. TANZER underwent unilateral and 44 bilateral surgery. Four pilots received Ophthalmology - Refractive Surgery, Naval Medical Center San mIOL and 134 received monofocal or aspheric IOL. One pilot is unfi t. Diego, San Diego, CA Incapacitation was decided for one pilot implanted with mIOL while all monofocal IOL implanted pilots were authorized to fl y under INTRODUCTION: Refractive surgery has been shown to be derogation. DISCUSSION: Monofocal or aspheric IOL provide enough effective in freeing aviators from glasses and thus enhancing their quality of vision for pilots to meet standards in ophthalmology for operational effectiveness. One important aspect of their effectiveness is aviation medical certifi cation, under derogation class 1 and 2. Visual their ability to utilize night vision goggles NVGs. This study assessed function of implanted pilots should however be carefully analyzed the effect of modern PRK and LASIK refractive surgery on the visual when provided by multifocal IOLs, by testing comprehensively visual performance of ametropic personnel using the latest generation NVGs. and neurosensoricognitive functions, as well as pilot’s abilities under METHODS: This prospective study included 30 ametropic subjects aeronautic environment. Data collected, along with a longitudinal (treatment range -0.41 to -5.4D MRSE); 15 PRK subjects and 15 LASIK follow-up, might support further possible evolutions regarding subjects. All excimer surgery was Wave-front Guided. LASIK fl aps were ophthalmologic requirements for European aviation safety rules. created utilizing a femtosecond laser (150 Hz). NVG binocular visual acuity was assessed (50% threshold ±95% CI) pre-operatively, 2 Learning Objectives: weeks, and at 1 and 3 months post-operatively. NVG performance was 1 Analysis of fi tness rules assessed at the “NITE” Vision laboratory at MCAS Miramar, CA at 2 Knowledge of functional examinations to practice after ocular “quarter-moon” illumination. Subjects adjusted and looked through surgery mounted, ANVIS-9 F4949R goggles at Landolt C charts (50% contrast 3 Knowledge of means of cataract correction gray) 5m away. RESULTS: The mean pre-operative NVG acuity of 15 PRK subjects was 20/63.8 and 20/61.5 for the 15 LASIK patients. Post PRK the mean NVG acuity at two weeks decreased by 0.4 of a lines of 9:15 am Snellen acuity (-0.036 logMAR), and averaged the same at 1 month, [171] PRESBYOPIC CORRECTION FOR AVIATORS and increased by the equivalent of 1/2 line of acuity (+0.050 logMAR) R. POKROY at 3 months. The mean NVG acuity at 2 weeks and 1 month post Israel Air Force Aeromedical Center, Tel Hashomer, Israel

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 257 ASMA 2012 MEETING ABSTRACTS

INTRODUCTION: Presbyopia is the natural loss of accommo- decreased to lower values to ensure that all CVN subjects achieved a dation associated with age. This manifests as diffi culty in near true contrast threshold (standard vs. staircase: F=0.66, p>0.43). vision and becomes signifi cant between 45 and 50 years of age. DISCUSSION: Both CVN and CVD subjects achieve comparable Aviation requires good near and distant vision. Therefore, the scores on standard and staircase CCT with no loss of test sensitivity or presbyopic aviator requires different optical correction for near and specifi city. Since the staircase CCT requires only half the time to distant visual tasks. This study aims to assess aviator preferences administer (3 vs. 6 min) it is the preferred method for clinical and the advantages/disadvantages of multifocal, bifocal and reading application. glasses. METHODS: Presbyopic Israel Air Force aviators > 49 years of age, or younger if using near correction, were consecutively Learning Objectives: questioned regarding the visual demands for their specifi c aviation 1 To understand the prevalence of color defi ciency in the general environment and the near-optical correction used. The choice of population. near-optical correction was analyzed according to refractive status 2 To understand how a staircase presentation of visual stimuli can and platform. RESULTS: One-hundred and twelve aviators were rapidly measure threshold. studied. Average age was 54.3 + 3.3 (range, 47-63). Nineteen, 43, 3 To understand how the Cone Contrast Test diagnoses type and 35 and 15 aviators used multifocals, bifocals, readers- severity of color defi ciency. in-pocket or none as their near vision correction of choice. Regarding multifocal use, 5/28 high- and 14/26 low-performance ametropic (0.50 diopters or more of hyperopia or myopia) aviators 9:45 am chose multifocals (P=0.01), but only 1/37 high- and 1/21 low-per- [173] RESPONSE TIME ON THE CONE CONTRAST TEST formance emmetropic aviators used multifocals. Bifocal-use B. STEWART1, J. RABIN1, V. WONG1, T. TRAN1, M. RUELLE1, analysis showed no difference between high- and low-performance J. BOSTER1, J.M. GOOCH2 AND S.T. WRIGHT2 platforms for ametropic aviators (17/28 vs 10/26, respectively, 1 2 P=0.17), but for emmetropic aviators, bifocals were used more by UIWRSO, San Antonio, TX; USAFSAM, Dayton, OH high- than low -performance aviators (14/37 vs 0/21, respectively, P=0.001). Readers alone were rarely used by ametropes and INTRODUCTION: Color vision defi cient (CVD) individuals commonly used by emmetropes (2/54 vs 33/58, respectively, P< often require more time to complete color tasks, a fact that could 0.001). DISCUSSION: Multifocals are less preferred for high-perfor- potentially provide an additional metric sensitive to color perfor- mance aviation than bifocals. Refractive status signifi cantly affects mance: reaction time. The purpose of this investigation is to the aviator’s choice of near-optical correction: emmetropes prefer establish normative values for the Cone Contrast Test (CCT) readers-in-pocket, ametropes prefer bifocals and multifocals. response time and to determine how the response times of color vision defi cients compare to normal values. METHODS: 20 color Learning Objectives: vision normal (CVN) and 10 color vision defi cient (CVD) subjects 1 To understand the factors infl uencing aviator choice between multi- were tested monocularly on the CCT, a computer-based program focal, bifocal and reading glasses. which presents letters visible only to red, green or blue cones to 2 To understand the advantages and disadvantages of multifocal, bifo- diagnose type and severity of CVD. The program recorded response cal and reading glasses on different aviation platforms. time in seconds from the time of letter presentation to the time of the subject’s mouse-click to select the letter seen. Each subject’s mean response time for the red, green and blue cone tests were 9:30 am calculated. RESULTS: CVN response times showed no difference [172] THE CONE CONTRAST TEST: STANDARD VS. between right and left eyes (p > 0.5) and right eyes were used for STAIRCASE METHOD normative values. Mean (±SD) CVN response times were: Red CCT J. RABIN1, B. STEWART2, V. WONG2, J. BOSTER2, 1.6 ± 0.5 sec; Green CCT 1.6 ± 0.4 sec; Blue CCT 1.8 ± 0.9 sec. M. RUELLE2, T. TRAN2, J.M. GOOCH3 AND S.T. WRIGHT3 92% of red defi cient (protan) and 38% of green defi cient (deutan) 1UIWRSO/USAFSAM, San Antonio, IP:TX; 192.168.39.1512UIWRSO, On: Sun,eyes 26 Sepshowed 2021 higher 17:39:09 than normal red CCT response times (>2SD San Antonio, TX; 3USAFSAM, Dayton, OHCopyright: Aerospace Medicalabove mean), Association and 42% of protan and 88% of deutan eyes showed Delivered by higherIngenta than normal green response times. 100% of CVD eyes INTRODUCTION: Most color tests detect the presence of color showed normal blue CCT response times. DISCUSSION: A majority vision defi ciency (CVD) but few reveal type (red, green, blue) or of CVDs showed increased CCT response times for the color of their severity. The computer-based Cone Contrast Test (CCT) stimulates defi ciency, indicating that response time may serve as an additional individual retinal cones to diagnose type and severity of CVD. The measure of color defi ciency. standard CCT proceeds from highest to lowest color contrast while the staircase CCT uses a response-driven algorithm to rapidly reach color Learning Objectives: threshold. Our purpose was to determine if the staircase CCT yields 1 To understand how cone contrast can be used to assess color scores equal to those obtained with the standard CCT. METHODS: The vision. CCT displays a series of colored letters visible only to red, green or 2 To understand how color test response time id distributed in color blue cones. During testing a single colored letter appears on the screen vision normal subjects. and the observer uses a mouse to select the letter seen from a 3 To understand how color defi cient observers take more time to matching display. Letter visibility (contrast) gradually decreases to respond. determine the lowest contrast visible for each cone type. In the standard CCT contrast decreases sequentially from highest to lowest levels; in the staircase contrast changes up and down according to correct or incorrect responses reaching an endpoint in half the time Tuesday, May 15 8:30 AM taken by the standard CCT. Standard and staircase CCTs were Ballroom D conducted on 20 color vision normal (CVN) and on 10 CVD subjects confi rmed as CVD on a battery of screening tests. RESULTS: All CVD PANEL: NEW AIRCRAFT, NEW PROBLEMS? subjects (5 protan, 5 deutan) had CCT scores signifi cantly below the lower limit of normal (lower limit = 75; CVD mean ± SD = 40 ± 15; [174] NEW AIRCRAFT, NEW PROBLEMS? p<0.00001). However, in both CVN and CVD subjects there was no 1 2 3 signifi cant difference between CCT scores obtained with standard and J.W. DAVIS , R.V. FOLGA AND D.A. ROBERTS 1 2 staircase methods for right and left eyes (CVN: F= 0.21, p>0.64; CVD: 509th Medical Group, Whiteman AFB, MO; Aviation Survival F = 0.11, p>0.74). Moreover, there was no difference between Training Center, Whidbey Island, WA; 3359th Medical Group, staircase and standard CCT in CVN even when CCT contrast was Randolph AFB, TX

258 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

INTRODUCTION: Since the dawn of aviation, aircraft [176] THE NIGHT VISION GOGGLE MULTI-COLOR HEADS systems, technology, and performance have evolved as mankind has UP DISPLAY - MITIGATING THE IMPACT OF VISUAL- sought to improve performance. Technological advancements and VESTIBULAR AVIATION ILLUSIONS OCCURRING DURING innovations have resulted in the capability to fl y higher, faster and CLANDESTINE NIGHT OPERATIONS longer than ever before and introduced a multitude of sensors to monitor aircraft parameters and enhance awareness. The human K. HIGGINBOTHAM body has not changed, and the implementation of newer, more Air Force Special Operations Command, Human Systems advanced aircraft and technologies outpaces the physiological Integration, Navarre, FL capability of the operator. Aircrew have witnessed evolutions in oxygen masks and oxygen delivery systems, instrumentation and INTRODUCTION: In support of special operations, aircrews displays and improved anti-G garments, but must still address the routinely fl y covertly in the clandestine world of night time opera- same fundamental physiologic challenges of aviation. Regardless tions. The operating environment has been described as an environ- of the sophistication or complexity of an aircraft, it is still operated ment requiring a “varsity-level” skill set due to factors such as by the same generation body and brain. DISCUSSION: Whether a reduced visibility, low illumination, featureless and mountainous new aircraft is developed with improved avionics and advanced terrain, and high landing zone elevations. Visual illusions during maneuvering capabilities, or updated hardware and software night operations are not uncommon to any aviator, but the risks can integrated into an existing platform, it is necessary to consider the be intensifi ed by the inherent limitations of night vision goggles human element and impact on performance. Aircraft with (NVGs), low illumination levels, various types of terrain and an enhanced maneuverability, capable of turning faster requires insuffi cient cockpit instrument scan. Even with the proper planning, integration of improved anti-G technology. Integration of enhanced training and oversight, there has been a trend of night time visual- sensors and integrated viewing capability necessitate the vestibular illusions during approach/landing and takeoff fl ight capability to control the stream of information while maintaining segments contributing to human error based SOF aviation mishaps. awareness and orientation. Modern oxygen systems still present a DISCUSSION: This presentation will illustrate the operational impact risk of failure or malfunction leading to hypoxia and of night time visual-vestibular illusions through the use of mishap incapacitation. Regardless of the type of technology or the potential case studies in which illusions played a key role in human error benefi t, human performance training remains an effective risk leading to controlled fl ight into terrain and how the use of the NVG mitigation method of physiological risks. This panel will discuss the multi-color Heads Up Displays can mitigate future visual-vestibular evolution and mitigation of physiological risks presented by related mishaps. advancements in aviation technology. The goal is to highlight and overcome these challenges through research and application of Learning Objectives: human factors, reducing risk and preserving aviation resources and 1 The audience will understand the sensory illusions common to SOF human life. aircrew during night time and low visibility operations. The audience Educational Objective: Educate the aerospace medicine will understand the capability gaps and identifi ed solutions, includ- community on the existing human performance challenges and trends ing technologies in development to mitigate spatial disorientation and encourage research and application of Aerospace and Operational in poor visual environments. Physiological and Human Factors principles associated with advanced aviation systems and technology. [177] IMPROVING COCKPIT DESIGN STANDARDS TO ENHANCE AWARENESS F. PATTERSON [175] AEROMEDICAL SAFETY CONCERNS INVOLVING Naval Medical Research Unit, Dayton, OH NEWLY ACQUIRED NAVY PRIMARY FLIGHT TRAINERS T. JONES INTRODUCTION: Advanced communications, weapons, and Naval Air Training, Aeromedical Safety Offi ce, Corpus Christi, TX sensor technologies, coupled with rapidly changing combat IP: 192.168.39.151 On: Sun,conditions, 26 Sep 2021often present 17:39:09 information-load conditions that challenge INTRODUCTION: In 2009, the fi rst productionCopyright: T-6B Aerospace Texan Medicalthe modern Association warfi ghter’s ability to maintain spatial awareness. rolled off the assembly line as the future Primary Flight TrainerDelivered for byOperators Ingenta responsible for piloting complex moving systems, such as Naval Aviation. While the goal of training the fi nest aviators in aircraft, are tasked with continuously resolving complex, real time, world has not changed, the paradigm in which the Navy would spatial information (satellite, video, radar, sonar, etc.) supplied to have to accomplish that goal has been affected drastically. This new them by multi-modal display systems. The fl ight environment high performance aircraft is equipped with new and unique presents a particularly challenging situation due to its inherent high aviation life support systems, MK-16B ejection seats, an On Board volume and rate of information fl ow. DISCUSSION: Recent research Oxygen Generation System, Canopy Fracture System, a Heads Up has documented spatial awareness in fl ight is dependent upon Display, three multi function displays, a cabin pressurization system specifi c sensory spatial refl exes that pilots use to formulate spatial and the capability to execute maneuvers up to +7Gz. Along with all strategies, which are in turn used to make control input decisions. of these advanced capabilities came an all new series of aeromedi- Pilot spatial strategies can be defi ned as visual interpretation of cal safety concerns. A signifi cant number of physiologic episodes interactions between retinal images of the horizon (primary cue) and hazard reports related everything from cockpit ergonomics to and peripherally viewed airframe/cockpit structures (secondary rapid decompressions has Navy Aeromedical Safety Offi cers cues); the relationship between primary and secondary cues is working overtime to identify solutions. DISCUSSION: This critical to spatial awareness because it provides visual feedback for presentation will focus on the design of the T-6B, aeromedical interpreting effectiveness of control inputs related to aircraft training and standardization concerns associated with the cockpit attitude, velocity, and acceleration. Both simulator and in-fl ight confi guration, changes to anthropometric standards, man-mounted research has demonstrated that sensory spatial refl exes modulate and aircraft life support equipment challenges, standard naval visual spatial information in a manner that enhances spatial egress system designs and aviation survival training requirements interpretation. Unfortunately, compatibility with spatial for this aircraft. refl exes and spatial strategies is often overlooked by current human factor engineering standards. Consequently, aircraft design Learning Objectives: environments sometimes produce sub-optimal specifi cations for 1 The audience will learn about the hazards associated with newly cockpit displays and controls, with respect to supporting spatial designed aviation life support systems for the T-6B. 2. The audience awareness. During extremis and high workload situations may take away vital design lessons learned on this joint project sensory spatial incompatibilities, created by shortcomings in cockpit and apply them to the acquisition, training and logistics process of design, have been shown to cause specifi c types of spatial future joint aircraft endeavors. disorientation.

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 259 ASMA 2012 MEETING ABSTRACTS

Learning Objectives: employed the Nonin 3150 model pulse oximeter with fi nger mounted 1 This presentation will identify known cockpit display fl aws involv- sensor. To date over 2000 sorties were fl own with this monitor. The ing head-mounted, head-down, and head-up designs and will F-22 data captured provided the researcher with ample fl ight also discuss current human compatibility issues with directional parameter data for analysis of pulse oximeter in relation to numerous controls. Examples for design solutions related to human engineer- fl ight parameters. Oxygen saturation drops were noted and easily ing standards will be introduced as a means of helping to reduce correlated with high G maneuvers. Algorithms in the device control incidences of spatial disorientation. for drops in blood fl ow, however, data artifacts require interpretation during highly dynamic phases of fl ight. The capture of in-fl ight pulse [178] TECHNOLOGY ADVANCES IN AVIONICS DESIGN: oximetry data will greatly enhance the ability of researchers to better HIGH-TECH PERPETUATION OF LEGAGY DESIGN ERRORS? characterize pilot physiology during dynamic phases of fl ight in high J.D. ALTON performance aircraft. Naval Operations, Manpower, Personnel, Training and Learning Objectives: Equipment, Washington, DC 1 The audience will be introduced to challenges for in-fl ight use of pulse oximetry and analytical techniques for interpretations of error INTRODUCTION: The basic information about aircraft attitude 2. The audience will be introduced to areas for future development presented by fl ight instruments has not changed in decades. While of oximeter sensors better suited for in-fl ight use. the method to display information has advanced from steam-gauges to the newest in “glass cockpit” technology, the information that is conveyed is largely the same as a pilot using 40-year old gauges. In certain circumstances, the design of the standard gauges has led to Tuesday, May 15 8:30 AM spatial disorientation with subsequent control reversals and worsen- Salon AB ing of unusual attitude for both novices and experienced pilots. DISCUSSION: This panel discussion will focus on the design of SLIDE: PERFORMANCE FACTORS primary fl ight instruments using the latest technology with an eye toward how to best present information to aid human perception and IN AVIATION cognition. As aviation technology progresses, there are many options to display the information representing fl ight parameters and air 8:30 am vehicle status. Early electro-mechanical gauges were designed to [180] THE RELATIONSHIP OF GENERAL AVIATION display usually just a single piece of information: airspeed, altitude, heading, etc. limited by the design of the moving parts. Multi-func- PILOT PERFORMANCE TO AGE, EXPERIENCE AND COGNITIVE HEALTH IN LOW AND HIGH WORKLOAD tion displays are now commonplace and can display whatever parameters the operators choose with many different confi gurations ENVIRONMENTS that can be easily changed during fl ight. However, we should ask R.G. TOLTON1, K.D. VAN BENTHEM2 AND whether or not we are using these displays most effectively since we C.M. HERDMAN2 have the opportunity to program the displays in whatever way we 1Occupational and Aviation Medicine, University of Otago, choose, or whether we are simply using new technology to represent Wellington, New Zealand; 2Institute of Cognitive Science, information that was the best available at the time due to mechanical Carleton University, Ottawa, ON, Canada or design limitations. Because of the early mechanical, engineering, or fi nancial limitations, gauges were often designed in opposition to INTRODUCTION: As the general aviation population is aging, Human Factors principles with an emphasis on training the operator there is great interest in pilot performance in their later years. to fi t the system rather than designing the system for the operator. Experience is often said to mitigate effects of aging. This study looked With respect to Human Factors design principles, the question is at pilot performance in a simulator as related to age, experience and whether or not the current features of the “basic T” organization of cognitive health in low and high workload conditions. METHODS: fl ight instruments is the best way to displayIP: 192.168.39.151information, or are weOn: Sun, 26 Sep 2021 17:39:09 Between 2010 and December 2011 general aviation pilots were simply using newer technology to perpetuateCopyright: a less-than-optimal Aerospace Medical Association recruited for the study. Participants fl ew patterns in a Cessna 172 instrument display. Delivered by Ingenta simulator in low and high cognitive workload conditions. Terrain Learning Objectives: complexity and traffi c volume were used to manipulate the workload conditions. Using analysis of variance, the relationship of pilot age, 1 The audience will learn how the standard design of fl ight instru- experience and cognitive health to simulator performance as well as ments can lead to spatial disorientation and errors in aircraft con- occurrences of crashes and loss of situation awareness were trol. 2. The audience may think about how to use newer technology examined. RESULTS: In the low and high workload conditions pilots to rectify ambiguities in fl ight design even though it may confl ict who averaged less than one hour per month as pilot-in-command with current standards. (PIC) over the past 12 months had signifi cantly more simulated crashes and loss of situation awareness than those with higher PIC [179] U.S. AIR FORCE USE OF PULSE OXIMETRY IN THE hours. Additionally, older pilots had more crashes or loss of situation F-22 RAPTOR awareness than younger pilots. In the high workload condition older P.R. GARDETTO pilots fl ew signifi cantly less time with overall correct pattern Aerospace & Operational Physiology, Air Combat Command, requirements and had higher error rates for altitude maintenance. Langley AFB, VA Cognitive health indices of working memory and speed of processing showed signifi cant positive correlations with lower error in altitude INTRODUCTION: In August of 2011, the US Air Force maintenance in both low and high workloads. DISCUSSION: Pilot employed in-fl ight use of Pulse oximetry by F-22 Raptor pilots in age, recent PIC hours and cognitive health show important associa- response to a series of hypoxia episodes. In-fl ight hypoxia is a tions with pilot error and overall quality of pattern maintenance. frequent occurrence in fi ghter aircraft that is easily remedied by Results suggest that individual pilot factors may be useful in application of 100% oxygen through the aircraft oxygen regulator. predicting pilot performance in both low and high workload Cases of hypoxia generally occur due to loss of cabin pressurization conditions. and/or failure of the oxygen regulator and associated life support systems. Recent development of on-board oxygen generating systems Learning Objectives: (OBOGS) provide numerous benefi ts to fl ight operations. However, 1 General aviation pilot performance in low and high workload these OBOGS systems do have failure modes different than those environments will be discussed in relation to age, experience and found in legacy liquid oxygen systems. DISCUSSION: This study cognitive health.

260 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

8:45 am These fi ndings suggest that suffi cient MT practice may protect against [181] PROSPECTIVE MEMORY OF GENERAL AVIATION functional and relational impairments associated with high-stress PILOTS IN LOW AND HIGH WORKLOADS contexts for peak-performance populations. The results also points K.D. VAN BENTHEM1, R.G. TOLTON2, C.M. HERDMAN1 AND towards some possible limitations to mindfulness in such populations. 1 J. LEFEVRE Learning Objectives: 1Institute of Cognitive Science, Carleton University, Ottawa, 2 1 A viable way of introducing mindfulness to military pilots and ON, Canada; Occupational and Aviation Medicine, University crew. of Otago, Wellington, New Zealand 2 The audience will learn of possible effects of mindfulness in a military peak-performance cohort. INTRODUCTION: Prospective memory is the ability to 3 Possible limitations to mindfulness in military populations remember to perform acts in the future and is essential in the aviation domain because it supports a wide range of aviator tasks including 9:15 am remembering to complete critical radio communications. In laboratory studies younger adults outperform older adults on many prospective [183] PSYCHOTIC DISORDERS AND THE AVIATOR memory tasks. In naturalistic settings however, older adults can J. HEATON AND K.D. MCDONALD perform as well as or better than younger adults. Research suggests that Neuropsychiatry, USAFSAM, Wright-Patterson AFB, OH lower working memory load from on-going background tasks, context cues and the habitual nature of the tasks are reasons for the improved INTRODUCTION: Aircrew and special duty personnel are often performance by older adults in naturalistic settings. METHODS: referred to the Aeromedical Consultation Service (ACS) at the USAF General aviation pilots were subjected to low and high workload School of Aerospace Medicine (USAFSAM) for thorough evaluations due scenarios. Their communication task completion rates using a Cessna to disqualifying medical or psychiatric conditions, for the purpose of 172 simulation were recorded. Multiple regression models were used obtaining a waiver. Due to the nature of mental health disorders, to analyze the data. RESULTS: In contrast to the trends reported in the presentations of each disorder, their precipitants, their treatment and literature, this study found that older pilots had signifi cantly lower chance for recurrence can vary dramatically. All factors must be weighed communication task completion rates than younger pilots in both the in consideration of a waiver to return to fl ying duty. Due to the incapaci- low and high workload conditions. Age and working memory scores tating nature of psychosis, and its unpredictable course, members have a were identifi ed as strong individual predictors of prospective memory poor outlook for waiver yet some cases of short duration have been task performance in the low workload condition. However, in the high waived. Several factors are taken into account when considering a RTFS workload condition working memory and recent pilot-in-command waiver recommendation for any condition. Those with psychotic disorders hours were the signifi cant predictors of performance. DISCUSSION: must be symptom free and off all mental health treatments including Results suggest that even in a low workload condition, a naturalistic psychotropic medications for one year. Depending on the cause of the aviation context did not afford advantages to older pilots. Also, psychotic episode, other waiver requirements may take precedence (i.e., substance-induced psychotic disorder requiring substance use treatment). prospective memory task performance appears associated with age and cognitive health, as indexed by working memory function. The aim of this study is to identify/review the recurrence of symptoms for all airmen evaluated at the ACS/Neuropsychiatry Branch for a condition Learning Objectives: involving psychotic symptoms. This will establish rates of recurrence and 1 Prospective memory in low and high workloads situations will be improve the accuracy of the ACS evaluation/waiver recommendations. discussed. METHODS: The author of this study reviewed records of 8 aviators/special duty personnel with a Psychotic Disorder diagnosis who received one or 2 The relationship between prospective memory and age in various more evaluations at the ACS. We examined the return to fl ying status rates situations will be examined. per type of psychotic disorder (i.e., Brief Psychotic Disorder, Schizophreni- form, etc.) and recurrence of symptoms in those evaluated. RESULTS:

9:00 am Rates of recurrence and waiver outcomes will be analyzed. DISCUSSION: IP: 192.168.39.151 On: Sun,Members 26 Sep referred 2021 to 17:39:09 the ACS for psychotic disorders can be waived to fl y [182] EFFECTS OF A 12MONTH MINDFULNESSCopyright: BASED Aerospace Medicalwhen the durationAssociation of symptoms is short and the precipitant cause is MENTAL TRAINING INTERVENTION ON F-16 FIGHTERDelivered byknown. Ingenta Recurrence of symptoms is unlikely for those approved for waiver. PILOTS A. MELAND AND V. FONNE Learning Objectives: Norwegian Institute of Aviation medicine, Oslo, Norway 1 To better understand the recurrence of symptoms and RTFS rates of those diagnosed with a psychotic disorder. INTRODUCTION: We investigated the impact of mindfulness training (MT) on mindfulness, job-engagement, workload, burnout and 9:30 am work-home interaction. These parameters may all have important impact [184] NEUROPSYCHOLOGICAL AND PERSONALITY AT- on health and performance in stressful environments. We hypothesized TRIBUTES DISTINGUISHING HIGH VS. LOW TRAINING that MT would lead to less cognitive failures and emotional distur- bances, mitigating the deleterious effects of stress, improving parameters PERFORMANCE OF MQ-1B PILOT TRAINEES 1 1 1 related to worker satisfaction. METHODS: We recruited 2 Norwegian W. CHAPPELLE , K.D. MCDONALD , J. HEATON , military f-16 fi ghter squadrons and provided MT to 1 (MT, n_29) but not W. THOMPSON2 AND J. HAYNES1 the other squadron (control group, n_16). The MT group attended a 12 1FECN, USAFSAM, Wright-Patterson AFB, OH; 2NeuroStat month course and logged the amount of out-of-class time spent Analytical Solutions, LLC, San Antonio, TX practising formal MT exercises. In addition to formal interviewing we used the following subjective measures: Job engagement (Schaufeli & INTRODUCTION: Among the variety of USAF RPAs, the Bakker, 2003) Total workload (TAB; Maardberg, Lundberg & Franken- MQ-1 Predator has emerged as a dominant weapon’s bearing hauser, 1990), Maslach Burnout Inventory (MBI; Maslach, Jackson & platform in support of aerial intelligence, surveillance, reconnais- Leiter, 1996), Survey Work Home Interaction - Nijmegen (SWING; sance (ISR) and close air support (CAS) operations. As a result, such Geurts, 2001). To measure the degree of mindfulness we used the FFMQ pilots are a critical asset in a challenging, high-risk, high-precision (Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006). RESULTS: profession. According to Chappelle, McDonald, & McMillan Compared to the control group the MT group improved on mindfulness, (2011), the use of objective cognitive and non-cognitive testing is and on both on a number of the engagement factors. There were essential to empirically validating psychological attributes that indications that those accumulating the most practice time had better distinguish high vs. low training performance and failure among effect. The formal interviews revealed further cognitive, physiological MQ-1 Predator pilot training candidates. Such information is and relational effects important to peak-performance. DISCUSSION: essential for selecting candidates with the “right stuff.” METHODS:

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 261 ASMA 2012 MEETING ABSTRACTS

Authors of this study obtained computer-based intelligence testing standing of the human factor in aviation accidents and helps the (MAB-II), neuropsychological screening (MicroCogTM), and identifi cation of critical processes to develop alternative intervention personality testing (NEO PI-R) from MQ-1 Predator pilot training strategies that favor the health promotion of pilots and prevention of candidates (n = 260). The results of psychological aptitude testing aviation accidents. are compared with outcome performance ratings from MQ-1 Predator Initial Qualifi cation Training (IQT). Statistical procedures Learning Objectives: were implemented to: (a) establish normative testing values for 1 Discuss alternative approaches to the human factor in aviation. Predator pilot trainees; (b) assess for operational signifi cance 2 To show the socio-cultural approach and qualitative methods as between high vs. low performers and failures; and (c) perform a important complements to traditional analyses of the human factor series of regression analyses to determine which cognitive aptitudes in aviation accidents. (e.g., attention/concentration, memory, spatial reasoning/analyses, reaction time, etc.) and personality traits (e.g., stress tolerance, social disposition, competitive nature, etc.) were predictive of Tuesday, May 15 8:30 AM training outcomes. RESULTS: Findings reveal measures of cognitive Salon D aptitude and personality traits distinguish high levels of functioning among those selected for this career fi eld as well as high vs. low performance and failure outcomes. DISCUSSION: The results of PANEL: THE LEGACY OF BIOMEDICAL this study shed light on cognitive aptitudes and personality traits RESEARCH DURING THE SPACE critical to successful performance and adaptation to this platform. The results can be applied to medical evaluations of training SHUTTLE PROGRAM applicants and incumbents seeking an aeromedical waiver following disqualifi cation and recovery from a medical or psychiat- [186] THE LEGACY OF BIOMEDICAL RESEARCH DURING ric illness that affected their psychological disposition. The results THE SPACE SHUTTLE PROGRAM may also guide aeromedical selection processes for selecting future J.C. HAYES training candidates. Space Life Science Directorate, NASA, Houston, TX

Learning Objectives: The Space Shuttle Program provided many opportunities to 1 Recognize the cognitive attributes and personality traits critical to study the role of spacefl ight on human life for over 30 years and successful performance during Initial Qualifi cation Training that are represented the longest and largest US human spacefl ight program. necessary for adaptation to the Predator platform. Outcomes of the research were understanding the effect of 2 Gain an understanding of how comprehensive psychological test- spacefl ight on human physiology and performance, countermea- ing improves the aeromedical waiver evaluation process as well sures, operational protocols, and hardware. The Shuttle fl ights were as future selection of candidates for such a challenging, high-risk, relatively short, < 16 days and routinely had 4 to 6 crewmembers high-precision profession. for a total of 135 fl ights. Biomedical research was conducted on the Space Shuttle using various vehicle resources. Specially constructed pressurized laboratories called Spacelab and SPACEHAB housed 9:45 am many laboratory instruments to accomplish experiments in the [185] THE HUMAN FACTOR IN COLOMBIAN AVIATION Shuttle’s large payload bay. In addition to these laboratory fl ights, ACCIDENTS. PART II: QUALITATIVE RESEARCH USING nearly every mission had dedicated human life science research SOCIO-CULTURAL APPROACH experiments conducted in the Shuttle middeck. Most Shuttle L. SANCHEZ astronauts participated in some life sciences research experiments Aerospace Medical Center, Colombian Air Force, Bogota, either as test subjects or test operators. While middeck experiments Colombia resulted in a low sample per mission compared to many Earth- IP: 192.168.39.151 On: Sun,based 26 Sep studies, 2021 this 17:39:09 participation allowed investigators to have INTRODUCTION: The statistics in aviationCopyright: safety in theAerospace world Medicalrepetition Association of tests over the years on successive Shuttle fl ights. In continue showing the human factor as the main challenge forDelivered aviation by addition,Ingenta as a prelude to the International Space Station (ISS), NASA safety. Most research mainly employs quantitative methods in order to used the Space Shuttle as a platform for assessing future ISS provide a systematic analysis of the types of human factors occurring hardware systems and procedures. The purpose of this panel is to in aviation accidents increasing the body of knowledge in order to provide an understanding of science integration activities required implement prevention measures. However, it usually identifi es to implement Shuttle research, review biomedical research, fragmented information that generally leads to focalized intervention characterize countermeasures developed for Shuttle and ISS as well strategies. This research study proposed to explain and understand the as discuss lessons learned that may support commercial crew structure of the human factor in aviation accidents in Colombia using endeavors. Panel topics include research integration, cardiovascular qualitative methods. It utilized a socio-cultural approach that physiology, neurosciences, skeletal muscle, and exercise physiol- complemented quantitative data with an aim for identifying critical ogy. Learning Objective: The panel provides an overview from the processes and integrated intervention strategies. METHODS: This was Space Shuttle Program regarding research integration, scientifi c a descriptive-interpretative study that gathered the perspectives of 132 results, lessons learned from biomedical research and countermea- pilots, 16 physicians, 16 psychologists, 10 air traffi c control operators, sure development. 8 aeronautical maintenance personnel, and 2 aeronautical administra- tors, through 120 in-depth interviews, 6 focus groups, and 12 [187] MISSION POSSIBLE: BIOMEDICAL EXPERIMENTS ON observations in-fl ight. RESULTS: Several critical processes emerged in THE SPACE STATION the general, particular, and individual dimensions, such as: globaliza- E.A. BOPP AND K. KREUTZBERG tion and harmonization, political and economic social situation, Space Medicine, Wyle, Houston, TX technological transition, operational pressures, perception of risk, pilot’s professional education, human factors education in mainte- INTRODUCTION: Biomedical research, both applied and nance and air traffi c control personnel, selection processes, language basic, was conducted on every Shuttle mission from 1981 to 2011. profi ciency, Crew Resources Management, safety culture, health The Space Shuttle Program enabled NASA investigators and promotion, aerospace medicine role, fatigue, development of criteria, researchers from around the world to address fundamental issues adaptation to change, and discipline. DISCUSSION: This research concerning living and working effectively in space. Operationally study showed the socio-cultural approach to human factor as a focused occupational health investigations and tests were given complementary, integrating, trans-disciplinary and participative priority by the Shuttle crew and Shuttle Program management for analytical framework that contributes to the explanation and under- the resolution of acute health issues caused by the rigors of

262 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS spacefl ight. The challenges of research on the Shuttle included: [189] WHICH WAY IS UP? LESSONS LEARNED FROM SPACE limited up and return mass, limited power, limited crew time, and SHUTTLE SENSORIMOTOR RESEARCH requirements for containment of hazards. The sheer capacity of the S.J. WOOD1, M.F. RESCHKE2, D. HARM2, W.H. PALOSKI3 Shuttle for crew and equipment was unsurpassed by any other AND J.J. BLOOMBERG2 launch and entry vehicle and the Shuttle Program provided more 1Unversities Space Research Association, Houston, TX; 2NASA opportunity for human research than any program before or since. 3 To take advantage of this opportunity, life sciences research Johnson Space Center, Houston, TX; University of Houston, programs learned how to: streamline the complicated process of Houston, TX integrating experiments aboard the Shuttle, design experiments and hardware within operational constraints, and integrate requirements INTRODUCTION: The Space Shuttle Program provided the between different experiments and with operational countermea- opportunity to examine sensorimotor adaptation to space fl ight in sures. We learned how to take advantage of commercial-off-the- unprecedented numbers of astronauts, including many over multiple shelf hardware and developed a hardware certifi cation process with missions. Space motion sickness (SMS) severity was highly variable across the fl exibility to allow for design changes between fl ights. We crewmembers. SMS generally lasted 2-3 days in-fl ight with ~1/3 of learned the importance of end-to-end testing for experiment crewmembers experiencing moderate to severe symptoms, and decreased hardware with humans-in-the-loop. Most importantly, we learned incidence in repeat fl yers. While SMS has proven diffi cult to predict from that the Shuttle Program provided an excellent platform for susceptibility to terrestrial analogs, symptoms were alleviated by conducting human research and for developing the systems that are medications, restriction of early activities, maintaining familiar orientation now used to optimize research on the International Space Station. with respect to the visual environment and maintaining contact cues. This presentation will include a review of the types of experiments Adaptive changes were also refl ected by the oculomotor and perceptual and medical tests fl own on the Shuttle and the processes that were disturbances experienced early infl ight and by the perceptual and motor used to manifest and conduct the experiments. coordination problems experienced during re-entry and landing. According to crew self-reports, systematic head movements performed Learning Objectives: during reentry, as long as paced within one’s threshold for motion 1 Learning Objective: This paper provides a description of the chal- tolerance, facilitated the early readaptation process. The Shuttle provided lenges related to launching and implementing biomedical experiments early postfl ight crew access to document the initial performance aboard the Space Shuttle. decrements and time course of recovery. These early postfl ight measure- ments were critical to inform the program of risks associated with [188] CARDIOVASCULAR ASPECT OF SPACE SHUTTLE extending the duration of Shuttle missions. Neurological postfl ight defi cits FLIGHTS: AT THE HEART OF THREE DECADES OF were documented using a standardized subjective rating by fl ight AMERICAN SPACEFLIGHT EXPERIENCE surgeons. Computerized dynamic posturography was also implemented as a quantitative means of assessing sensorimotor function to support crew J.B. CHARLES AND S.H. PLATTS return-to-duty assessments. Towards the end of the Shuttle Program, more Space Life Sciences Directorate, NASA, Houston, TX emphasis has been placed on mapping physiological changes to functional performance. Future commercial fl ights will benefi t from INTRODUCTION: The advent of the Space Shuttle era pre-mission training including exposures to launch and entry G transitions elevated cardiovascular deconditioning from a research topic in and sensorimotor adaptability assessments. While SMS medication usage gravitational physiology to a concern with operational conse- will continue to be refi ned, non-pharmacological countermeasures (e.g., quences during critical space mission phases. NASA has identifi ed sensory aids) will have both space and Earth-based applications. Early three primary cardiovascular risks associate with short-duration postfl ight fi eld tests are recommended to provide the evidence base for (less than 18 d) spacefl ight: orthostatic intolerance; decreased best practices for future commercial fl ight programs. maximal oxygen uptake; and cardiac arrhythmias. Orthostatic hypotension (OH) was observed postfl ight in Mercury astronauts, Learning Objectives: studied in Gemini and Apollo astronauts, and tracked as it IP: 192.168.39.151 On: Sun,1 26Overview Sep 2021 of the 17:39:09 Space Shuttle Program regarding adaptive changes developed in-fl ight during Skylab missions. A putative hypotensive in sensorimotor function, including what was learned from re- episode in the pilot during an early shuttle landing,Copyright: and well Aerospace Medicalsearch, Association what was implemented for medical operations, and what is documented postfl ight hypotension in a quarter of crewmembers,Delivered by Ingentarecommended for commercial fl ights. catalyzed NASA’s research effort to understand its mechanisms and develop countermeasures. Shuttle investigations documented the onset of OH, tested mechanistic hypotheses, and demonstrated [190] USE IT OR LOSE IT: SKELETAL MUSCLE FUNCTION countermeasures both simple and complex. Similarly, decreased AND PERFORMANCE RESULTS FROM SPACE SHUTTLE aerobic capacity in-fl ight threatened both extravehicular activity J. RYDER and post-landing emergency egress. In one study, peak oxygen Universities Space Research Association, Houston, TX uptake and peak power were signifi cantly decreased following fl ights. Other studies tested hardware and protocols for aerobic INTRODUCTION: The Space Shuttle Program provided a wealth conditioning that undergird both current practice on long-duration of valuable information regarding the adaptations of skeletal muscle to International Space Station (ISS) missions and plans for interplan- weightlessness. Studies conducted during the Extended Duration etary expeditions. Finally, several studies suggest that cardiac Orbiter Medical Project (EDOMP) represented ground breaking work arrhythmias are of less concern during short-duration spacefl ight on the effects of spacefl ight on muscle form and function from applied than during long-duration spacefl ight. Duration of the QT interval human research to cellular adaptations. Results from detailed was unchanged and the frequency of premature atrial and ventricu- supplementary objective (DSO) 477 demonstrated that muscle strength lar contractions was actually shown to decrease during extravehicu- losses could occur rapidly in response to short-duration spacefl ight. lar activity. These investigations on short-duration Shuttle fl ights The effects of spacefl ight-induced unloading were primarily restricted have paved the way for research aboard long-duration ISS missions to postural muscles such as those of the back as well as the knee and beyond. Efforts are already underway to study the effects of extensors. DSO 606 provided evidence from MRI that the observed exploration class missions to asteroids and Mars. strength losses were partially accounted for by a reduction in the size of the individual muscles. Muscle biopsy studies conducted during Learning Objectives: DSO 475 were able to show muscle atrophy in individual muscle 1 Learning Objectives: Overview of the Space Shuttle Program fi bers from the quadriceps muscles. Reduced quadriceps muscle size research results related to cardiovascular risks, including the and strength was also observed during the 17-d Life and Microgravity description the deleterious cardiovascular effects of short-duration Spacelab mission aboard STS-78. Multiple maximal strength tests were spacefl ight and a discussion of the development of countermea- conducted in fl ight on the calf muscles and it has been hypothesized sures against the cardiovascular risks. that these high force contractions may have acted as a countermeasure.

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 263 ASMA 2012 MEETING ABSTRACTS

Muscle fi ber mechanics were studied on calf muscle samples pre- and [192] THE SERIAL EVALUATION OF DEPRESSIVE SYMPTOMS postfl ight. While some responses were crewmember specifi c, the IN OLDER AVIATORS general trend was that muscle fi ber force production dropped and J.L. MOORE, S.E. LINNVILLE, F. SEGOVIA AND R.E. HAIN shortening velocity increased. The increased shortening velocity RE Mitchell Center for POW Studies, NOMI, Pensacola, FL helped to maintain muscle fi ber power. Numerous rodent studies performed during Shuttle missions suggest that many of the effects INTRODUCTION: The 30-item Geriatric Depression Scale reported in Shuttle crewmembers could be due to lesions in the (GDS) has become the “gold standard” self-report screening instrument cellular signaling pathways that stimulate protein synthesis as well as for geriatric depression. Research has demonstrated the scale’s an increase in the mechanisms that up-regulate protein breakdown. reliability, as well as it’s concurrent and predictive validity. We have The results have important implications regarding the overall health previously suggested that a GDS cut-score of 5 and/or a 5-point and performance capabilities of future crewmembers that will venture post-treatment reduction be used with older aviators. Data on the use beyond low-Earth orbit. of the GDS to monitor depressive symptoms over time in older aviators Learning Objectives: has not been previously reported. METHODS: One hundred and fi fty psychiatrically healthy older military aviators completed the GDS 1 Overview of the Space Shuttle Program regarding adaptive twice between 1999 and 2007 as part of a medical follow-up program changes in skeletal muscle function and performance, including for Repatriated Prisoners of War. At each administration the group was what was learned from research and what was implemented for also divided into a younger and an older subgroup using the median countermeasures. age. RESULTS: The mean GDS scores for this psychiatrically healthy convenience sample were 2.3 (Time 1) and 2.7 (Time 2). Members of [191] ORBITAL FITNESS: AN OVERVIEW OF SPACE the older subgroup endorsed a statistically higher, but clinically SHUTTLE CARDIOPULMONARY EXERCISE insignifi cant, number of GDS items over time (+0.91 points different). PHYSIOLOGY FINDINGS The Time 1 and Time 2 scores for members of the younger subgroup A.D. MOORE were nearly identical (+0.04 points different). Cut scores for the 85th Space Medicine, Wyle, Houston, TX and 95th percentiles are provided for both GDS raw scores and GDS change scores. A review of the most commonly endorsed items INTRODUCTION: Limited observations regarding the cardiopul- suggests that while reduced energy, diffi culty starting new projects, and monary responses to aerobic exercise had been conducted during a less exciting life may be endorsed by older aviators, hopelessness, short-duration spacefl ight before the Space Shuttle program. This emptiness, and worthlessness are rarely endorsed. DISCUSSION: presentation focuses on the fi ndings regarding changes observed in the Published norms and established GDS cut-score (> 9) appear cardiopulmonary exercise responses during and following Shuttle fl ights. inappropriate for older aviators. Using these preliminary “norms” will During fl ight, maximum oxygen uptake (VO2max) remained unchanged allow the Aeromedical professional, psychiatrist, and psychologist to as did the maximum work rate achievable during cycle exercise testing better document an airman’s illness severity, symptom change over conducted during the last full fl ight day. Immediately following fl ight, time, and response to treatment. An awareness of those depressive the ubiquitous fi nding, confi rmed by investigations conducted during symptoms that are rarely endorsed by psychiatrically healthy older the Spacelab Life Sciences missions 1 and 2 and by NASA Detailed aviators may also facilitate the diagnosis of mood disorders. Supplemental Objective studies, indicated that VO2max was reduced; however, the reduction in VO2max was transient and returned to Learning Objectives: prefl ight levels within 7 days following return. Studies regarding the 1 Become familiar with symptoms of geriatric depression. infl uence of aerobic exercise countermeasures performed during fl ight 2 Distinguish between normal and pathological change in depressive on postfl ight performance were mostly limited to the examination of the symptoms over time in an older aviator. heart rate (HR) response to submaximal exercise testing on landing day. 3 Be able to distinguish the symptom profi le of a depressed older These studies revealed that exercise HR was elevated in individuals who aviator. performed little to no exercise during their missions as compared to individuals who performed regular exercise.IP: In192.168.39.151 addition, astronauts On: who Sun, 26 Sep 2021 17:39:09 performed little to no aerobic exercise during fl Copyright:ight demonstrated Aerospace an Medical[193] RARE Association OCCURRENCE OF AN ABDOMINAL increased HR and lowered pulse pressure response to the standardDelivered stand by NEUROENDOCRINEIngenta TUMOR IN A MALE AVIATOR WITH test on landing day, indicating a decrease in orthostatic function in these SUCCESSFUL REMOVAL AND FULL RETURN TO FLYING individuals. With regard to exercise modality, four devices were DUTIES examined during the Shuttle era: two treadmills, a cycle ergometer, and a rowing device. Although there were limited investigations regarding E.J. PROCHAZKA the use of these devices for exercise training aboard the Shuttle, there Long Beach, CA was no clear consensus reached regarding which proved to be a “superior” device. Each device had a unique operational or physiologic INTRODUCTION: This presentation is a rare case report of a limitation associated with its use. In conclusion, exercise research 44 year old male aviator with about 9 800 hrs who unexpectedly conducted during the Shuttle Program demonstrated that attenuation of developed a non-functioning neuroendocrine tumor of the pancreas post fl ight deconditioning was possible through use of exercise with local invasive growth. METHODS: Without any preceding signs countermeasures and the Shuttle served as a test bed for equipment and symptoms, the previously very healthy and athletic pilot destined for use on the International Space Station. suddenly developed abdominal discomfort, which was persistent in nature. Due to a very quick and rapid work up, the source of the Learning Objectives: patient’s pain and abdominal discomfort was rapidly determined and 1 Overview of the Space Shuttle Program research results are related a computer tommographically guided biopsy revealed the fi nal to aerobic capacity and performance, including what was learned diagnosis. RESULTS: The surgical / ocological evaluation team from research and effectiveness of exercise countermeasures. decided on a Whipple procedure and the aviator recovered post- operatively without any problems. After about 12 months post-opera- tively, a waiver was granted and the pilot returned both to military Tuesday, May 15 9:30 AM and civilian fl ying duties. Today all follow up exams are unremark- Exhibit Hall able, all liver function tests are normal, clotting times normal, INR normal; alkaline phosphatase, GOT, GPT , are and no local or distant metastasis has been determined. The aviator is symptom free and without any complains or need for substitution therapy. He resumed POSTER: AIRCREW HEALTH AND MEDICAL his previously very active life style. DISCUSSION: This case STANDARDS II presentation stresses the need for high level of diagnostic consideration

264 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS and vigilance when dealing with aviators with abdominal discomfort. of refractive error among airline pilots in China. METHODS: 26018 Beside very common disorders, such as gastroesophageal refl ux pilots including student pilots, were undertake a detailed ocular disease, gastritis, ulcers, gallstone just to mention a few, a high index examination when they applied for airman medical certifi cate during of suspicion needs to be maintained in even otherwise healthy the period 2010-2011. Vision was test by using Landolt chart. aviators and aircrew. This case illustrates a rare occurrence of a Refractive error was diagnosed if uncorrected vision was lower than neuroendocrine tumor of the head of the pancreas and successful 0.7 and then best corrected vision was test. Spherical equivalent (SE) removal without reoccurrence and disease free interval of three years of correcting lens was used for calculations of refractive errors. postoperative, at the present time. The aviator has returned to full RESULTS: 2624 pilots were considered as refractive error. The fl ying duties without any problems. prevalence of refractive error was 10.09%. Among 2442 pilots with complete refraction data, the prevalence of refractive error in age Learning Objectives: group of <30 years old, 30-39 years old, 40-49 years old, 1 Increased diagnostic consideration in a male aviator with unspe- 50~59years old, and ≥60years old was respectively 9.8%, 6.2%, cifi c abdominal pain, to include rare and unexpected presentation 8.2%, 18.0% and 23.0% .Pilots younger than 30 years old were the and diagnosis. main group (62.9%). The percentage of simple myopia, simple myopic astigmatism, compound myopic astigmatism, simple hypermetropia, simple hyperopic astigmatism, compound hyperme- [194] MULTIPLE TUBERCULOMA BRAIN IN A FIGHTER tropic astigmatism and mixed astigmatism was respectively 74.4%, PILOT - A DIAGNOSIS LEAST EXPECTED 6.3%, 15.6%, 2.0%, 0.2%,0.5% and 1.0%. Refractive errors in pilots are characterized by low level of simple myopia with a mean A. KUMAR spherical equivalent power of -1.11 diopters (D). DISCUSSION: General Medicine, SUT Academy of Medical Sciences, Refractive error prevalence among Chinese airline pilots was Trivandrum, India signifi cantly lower than that of the general Chinese population. But there was a tendency that the number of airman with refractive error INTRODUCTION: Tuberculoma is the commonest infective is increasing annually. Pilot with low level refractive error had not granuloma of the central nervous system (CNS) in many developing affected adversely fl ight safety. However they should be educated on countries. Before the introduction of antituberculous drugs, visual care and protection. tuberculoma of the brain was one of the most common diagnoses for intracranial space-occupying lesions. Tuberculoma of the brain Learning Objectives: may be single or multiple. The high incidence of tuberculosis makes 1 To know the epidemiology of refractive error among airline pilots tuberculoma a likely diagnosis in patients from developing in China. countries presenting with symptoms of raised intracranial pressure. Multiple brain tuberculomas are unusual and rare, even in [196] EFFECTS OF RAPID DECOMPRESSION ON THE immunocompromised patients. The situation becomes more complex and intriguing when the patient with coexistent multiple STABILITY OF CORNEAL FLAP AFTER LASIK IN RABBITS tuberculomas and tuberculous meningitis in an aviator especially a R. ZHAO, H. J. XIAO, D. C. YIN AND E. P. WANG fi ghter pilot. METHODS: A 29-year-old fi ghter pilot presented with Center of Clinical Aviation Medicine, General Hospital of Air sudden onset of fever, headache, vomiting, blurring of vision and an Force, PLA, Beijing, China episode of disorientation with loss of touch with environment suggestive of complex partial seizure. Contrast magnetic resonance INTRODUCTION: To study the effect of rapid decompression imaging of the brain revealed multiple ring enhancing lesions in on the stability of corneal fl ap after laser in situ keratomileusis posterior fossa with meningeal thickening, suggestive of multiple (LASIK) in rabbits. METHODS: 36 eyes (18 Japanese white rabbits) tuberculomas. He was treated with antituberculous therapy (ATT), with one week postoperative LASIK were randomly divided into 3 steroids and antiepileptic drugs (AED). There was an initial groups: the control group; the slow decompression group which exacerbation in the number and extent IP:of tuberculomas 192.168.39.151 during On:ATT Sun,ascended 26 Sep to 2021 5500m 17:39:09 at the speed range from 30m/s to 40m/s, and due to paradoxical response. He also developed Asymptomatic stayed at the altitude for 1 to 2 min, then descended to ground at Transaminitis during treatment. He respondedCopyright: well to therapy Aerospace and Medical Association Delivered by200m/s; Ingenta and the rapid decompression group which ascended to lesions healed without any sequelae. The individual was declared 5500m at the speed range from 30m/s to 40m/s, and stayed at the permanently unfi t for fi ghter fl ying in view of multiple tuberculoma altitude for 1 to 2 min, then ascended rapidly to an altitude of brain and seizure disorder and he is under regular follow up. 12000m in 0.13s by adjusting pressure-releasing device, and stayed RESULTS: Intracranial space occupying lesions and seizures can at the high altitude for 3 to 5s, fi nally, descended to ground at result in sudden in-fl ight incapacitation which can jeopardise 200m/s. The stability of corneal fl ap was observed with optical aircrew and fl ight safety. These conditions require prompt diagnosis, microscope and transmission electron microscope (TEM). RESULTS: optimal treatment, long term follow up and critical aeromedical The images under optical microscope and TEM showed that the decision making to optimise the outcome. DISCUSSION: This case interface tissue healing between the fl ap and stromal bed was clear is discussed in view of the rarity of the condition and the absence with no separation, and surrounding by regular collagen fi bers in of proper guidelines in the management of intracranial slow and rapid decompression groups. DISCUSSION: Both slow tuberculomas. decompression and rapid decompression could not impact on the stability of corneal fl aps after LASIK in rabbits. Learning Objectives: 1 Clinical presentation and diagnosis of tuberculoma brain 2 Emphasis is laid on the rarity of such a condition and its effect on Learning Objectives: fl ight safety 1 LASIK in rabbits. 3 Aeromedical decision making in a case of Intracranial Tuberculoma

[195] REFRACTIVE ERROR IN AIRLINE PILOTS: [197] OCULAR VESTIBULAR EVOKED MYOGENIC A RETROSPECTIVE STUDY OF PREVALENCE IN CHINA POTENTIALS AND MOTION SICKNESS SUSCEPTIBILITY Y. LIANG, L. WANG AND S. WANG S. XIE Civil Aviation Medicine Center, CAAC, Beijing, China Institute of Aviation Medicine, Air Force, Beijing, China

INTRODUCTION: Vision of airline pilot is still critical for INTRODUCTION: A functional vestibular system is a pre-requi- fl ight safety. Refractive error is tightly related with vision, but the site for motion sickness (MS) to occur. The otolithic organs (saccule prevalence is unclear. We retrospectively studied the epidemiology and utricle) are currently considered to be important in the pathogenesis

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 265 ASMA 2012 MEETING ABSTRACTS of MS. Recent investigations have demonstrated that the ocular manner with constant feedback and monitoring provided by the vestibular evoked myogenic potentials (oVEMP) test is an objective observer. evaluation of utricular function. So far, there exists no functional guide that can serve as a diagnostic tool for individual susceptibility to MS. Learning Objectives: So we investigated the link between oVEMP and MS susceptibility. 1 Hypobaric assessments are a useful tool in deciding if an aircrew METHODS: The oVEMP test was performed on 31 MS susceptible and member is fi t for fl ight. 23 non-susceptible individuals. MS susceptibility was determined by 2 Assessments were conducted on all age groups and experience self-declaration and by using MS susceptibility questionnaire (MSSQ) levels. and Hamilton Anxiety Scale (HAS). RESULTS: Bilateral oVEMP 3 Hypobaric assessments can be used to evaluate the success of responses were obtained in all subjects. HAS and MSSQ scores surgical intervention. between the susceptible and non-susceptible group were 18.27±5.23 vs 2.34±1.21 and 28.12±6.53 vs 2.34±1.45 respectively. Statistically signifi cant differences in MSSQ and HAS scores were found between the MS susceptible and non-susceptible group. No differences were [199] EVALUATION OF THE HEARING LOSS VARIATION ON found between MS susceptible and non-susceptible subjects in N10 949 PILOT STUDENT and P15 wave latencies, N10-P15 interval, and peak-to-peak N10-P15 M. HUANG, Y. JI, X. ZHU AND R. GUO amplitude. However, there was a trend towards greater asymmetry ENT Department, Air Force General Hospital, ratio in the MS susceptible group than in the MS non-susceptible group Beijing, China (18.55±10.24 % vs 13.25±9.47 %), although statistical signifi cance was not reached. DISCUSSION: It appears that no relation exists INTRODUCTION: To follow the tracts of pilot student between oVEMP results and MS susceptibility. Nevertheless, the hearing. Inquire into the infl uence of highly frequency hearing loss differences in the asymmetry ratios of oVEMP inter-peak amplitude to the linguistic frequency hearing and predict the change of between the two groups revealed a trend towards marginal statistical hearing. METHODS: 949 pilot student from an fl ying college in signifi cance. random, who were detected hearing degree. Analysis the hearing degree between the highly frequence hearing loss in 252 student Learning Objectives: pilot within now and 2 years before. RESULTS: There were signifi cant diffi erence between the highly frequence hearing loss in 1 To investigate the relationship between ocular vestibular evoked 252 student pilot within now and 2 years before. And there were no myogenic potentials and motion sickness susceptibility infl uence in highly frequence hearing loss to the linguistic fre- quency hearing. DISCUSSION: There were signifi cant change in highly frequency hearing loss in 2 years, no infl uence in linguistic [198] A REVIEW OF CLINICAL ENT ASSESSMENTS frequency hearing. CONDUCTED IN THE RAF CENTRE OF AVIATION MEDICINE HYPOBARIC CHAMBER J BLACKADDER- COWARD,M J A TRUDGILL Learning Objectives: J.C. BLACKADDER-COWARD AND M.J. TRUDGILL 1 Have any infl uence in linguistic frequency hearing within highly Aircrew Equipment Integration Group, Royal Air Force Centre ferquency hearing loss. of Aviation Medicine, Henlow, United Kingdom [200] EVALUATION OF THE HIGH FREQUENCY HEARING

INTRODUCTION: The Royal Air Force Centre of Aviation LOSS VARIATION ON NEWLY ENROLLED STUDENT PILOTS Medicine conducts clinical ENT assessments on aircrew returning to R. GUO, M. HUANG, Y. JI AND X. ZHU fl ight status following illness, injury or surgery. Patients are reviewed ENT Department, Air Force General Hospital, Beijing, China by an experienced fl ight surgeon prior to clinical examination and a hypobaric chamber assessment. The hypobaricIP: 192.168.39.151 assessment is tailored On: Sun, 26 SepINTRODUCTION: 2021 17:39:09 Its objective is to follow the tracts of variation to the aircraft type and profi les typically includeCopyright: ascents and Aerospace descents Medicalin hearing Association of newly enrolled student pilots two years after enrollment to a maximum of 18000ft with climb/descent rates betweenDelivered 500 and by andIngenta discuss the impact of certain high frequency hearing loss on 8000ft/min. This study examines these referrals and their outcomes for linguistic frequency hearing as well as assess the variation trend. the period 2005 to 2011. METHODS: A retrospective study of referrals METHODS: audiological detection on more than 1,000 student pilots and the subsequent clinical reports was conducted for the period enrolled into some aviation university in random is performed and the between 1st January 2005 and 1st August 2011.These were all results of hearing of 26 student pilots with high frequency hearing loss available as paper archives and data was collected on role, hours at the time of enrollment and their hearing levels two year later are fl own, airframe, reason for referral, investigations performed and analyzed. RESULTS: no striking variation in linguistic frequency outcome of referral. The audit protocol is attached at appendix 1. All hearing of student pilots occurs two years later and there is no referrals were reviewed, including those deemed not suitable for a statistically signifi cant difference between the hearing of student pilots chamber run and those referred by external bodies. RESULTS: 55 cases with high frequency hearing loss and the hearing reexamination result were examined and of these 41 underwent hypobaric chamber obtained two years later (p>0.05), meanwhile it exerts no signifi cant assessments. The average age for subjects was 25 but this varied impact on linguistic frequency hearing. DISCUSSION: the hearing of between 18 and over 50. 16% of subjects were female. 40% of all 26 pilots has no signifi cant difference in the two years of physical subjects were pilots and of this group 54% were classifi ed as qualifi ed. examination, namely, no signifi cant changes occur two years later on Interestingly 36% of the pilot group were instructors. Fast jet crews the hearing of such 26 examinees who suffered high frequency hearing accounted for only 27% of the pilot group with the majority coming loss when entering school. However, the comparison among hearing from multi engine transport background. 63% of referrals followed indexes for the above-mentioned 26 pilots shows that changes (hearing ENT surgical procedures that were not treating pressure related gain or loss) only take place on the hearing of specifi c individuals at symptoms however in 22% of cases surgical procedures had been specifi c frequency points within the range of 250Hz and 3,000Hz at conducted to alleviate recurrent otitic or sinus barotrauma. 11% of the time of entering and changing school. Binaural hearing within the subjects suffered mild or moderate symptoms during the chamber range of 4,000Hz and 8,000Hz and total high frequency hearing assessment with 63% experiencing no diffi culties. 80% of subjects increases somewhat, namely, high frequency hearing suffers loss returned to full fl ying status. DISCUSSION: Hypobaric chamber though it is not signifi cant, however, such change merits attention. assessments are a useful tool in confi rming the success of treatment of pressure related symptoms. They can also be used to assess the Learning Objectives: suitability of subjects for work in environments subject to large 1 If certain high frequency hearing loss could change signifi cantly pressure changes. This can be conducted in a safe and progressive during two years in aviation university.

266 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

[201] STONES IN THE SKY; THE DESCRIPTIVE electronic full-text articles, allowing the global users to access full-text EPIDEMIOLOGY OF URINARY TRACT STONES articles. RESULTS: An ERL solution can provide a multidisciplinary AMONG MILITARY AVIATORS collection of full text articles. This approach improves effi ciency W. PORTER1, A. CAJIGAL2 AND G.M. RICE1 in obtaining and storing reference material while greatly reducing 1Naval Aerospace Medical Institute, Pensacola, FL; 2US Army labor, purchasing and duplication costs. Most importantly, increasing collaboration across research groups provides unprecedented access Aeromedical Activity, Fort Rucker, AL to information relevant to NASA’s mission. DISCUSSION: This project expands and leverages cost-effective centralized library solution. INTRODUCTION: Population based studies suggest the overall Adding key word and author search capabilities and an alert function incidence and prevalence of urinary tract stones is increasing for notifi cations about new articles, based on users’ profi les, represent worldwide. Military aviators represent a subset of the general examples of future enhancements. population, and one could expect similar changes in the incidence and prevalence of urinary tract stones in aviators. As the development Learning Objectives: of acute renal colic during fl ight operations is a potentially incapacitating 1 The learner will be able to verbalize a mechanism to facilitate condition, an increase in the incidence/prevalence of urinary tract collaboration between colleagues. stones amongst military aviators could potentially have a signifi cant operational impact. This project was undertaken to examine the rates of urinary calculi among military aviators. METHODS: This project [203] THE STRATEGY OF INFORMATION ACQUIREMENT utilizes data from the Defense Medical Epidemiology Database FOR MEDICINE RESEARCHERS (DMED) to examine the current descriptive epidemiology of urinary L. ZHANG, Y. LIU AND X. J.WANG tract stones among military aviators. DMED data is readily available through a web-based interface for population based analysis of disease Department of Medical Information, General Hospital of the and injury rates by demographic category. RESULTS: Over the fi ve-year Air Force, Beijing, China period 2006-2010, the rate of outpatient encounters for urinary tract stones (ICD-9 592 and 594) in Army aircrew was 17.9 events/1,000 INTRODUCTION: To analyze the literature information person-years (PY). Aviators in the Navy, Air Force and Marine Corps requirement for aviation medicine researchers, and the types of experienced similar rates (14.1 events/1,000 PY in the Navy, 18.0 aviation medical literature resources as well as their quantity and events/1,000 PY in the Air Force, and 12.4 events/1,000 PY in the characteristic, so as to study the methods and counter measures on Marine Corps). DISCUSSION: Urinary tract stones represent a how to use information effectively. METHODS: Numerous correlative potential aeromedical threat to military aviators. Research efforts specialized items are retrieved from the resources of bibliotheca agencies, the network resources, many bibliographies of published directed at prevention, early diagnosis/detection, treatment, and evidence-based fi tness for duty determinations related to this disease books and journals, to obtain various information sources of aviation process should continue. medicine. RESULTS: Information involved in Health service for the Air Force, special environment medicine, standards for aviation Learning Objectives: medicine, and applicable clinic study are the main requirements of 1 Understand the descriptive epidemiology of urinary tract stones aviation medicine researchers. More than 30 database resources are among military aviators the primary database resource at domestic and abroad. More than 130 major work departments, more than 150 kinds of major journals, and more than 20 kinds of important index are proven. More than 20 Tuesday, May 15 9:30 AM websites of conspicuous institutions and academic resources are selected. DISCUSSION: Measures such as holding the trend of Exhibit Hall aviation medicine study, browsing kernel professional books and periodicals of choice, effectively utilizing electronic information POSTER: OTHER RELATED TOPICS resources, mastering and perfecting the skills of retrieve, and IP: 192.168.39.151 On: Sun,applying 26 Sep the 2021 principle 17:39:09 of evidence-based medicine to literature [202] ENTERPRISE REFERENCE LIBRARYCopyright: Aerospace Medicalevaluation Association and utilization, are suggested as strategy of information L.G. SAILE1, G. BICKHAM1, J. HAVELKA2 AND M. FITTSDelivered3 byacquirement. Ingenta Effectively use of specialized databases is benefi t to 1Advance Projects, Wyle, Houston, TX; 2Lockheed Martin, obtain documentation information. Browsing professional classic and Houston, TX; 3NASA, Johnson Space Center, Houston, TX the core publication frequently is helpful for systematically update professional knowledge. The use of specialized indexes is a shortcut for fi nding literature clues, and will facilitate to access profession- INTRODUCTION: Johnson Space Center (JSC) offers two specifi c information. extensive libraries that contain journals and research resources. Searching capabilities are available to those residing onsite or Learning Objectives: through a librarian’s search. Many individuals have rich collections of references, but no mechanisms to share across researchers, projects, 1 Aviation medicine information retrieval or directorates. Likewise, information regarding which references are provided to which individuals is not available, resulting in duplicate requests, redundant labor costs and associated copying fees. This [204] AGE DIFFERENCES IN BODY COMPOSITION tends to limit collaboration between colleagues and promotes the OF CHINESE CIVIL AIRLINE PILOTS establishment of individual, unshared silos of information. The D. WANG, W. JIANG AND J. FAN Integrated Medical Model (IMM) team has utilized a centralized Civil Aviation Medicine Center, BeiJing, China reference management tool during the development and operational phases of this project. The Enterprise Reference Library (ERL) project INTRODUCTION: Obesity is one of the greatest challenges expands the capabilities developed for IMM to address the above facing global health experts today. Body composition is an issues and enhance collaboration across JSC. METHODS: After important index related to obesity. But there are little studies to signifi cant market analysis for a multi-user reference management examine the age difference of body composition, especially in civil tool, no available commercial tool was found. A software program airline pilots group. The purpose of the current study was to identify was built around a commercial tool, Reference Manager 12. A use the age difference in body composition in the group of civil airline case approach guided the requirement development phase. The pilots in China. premise of the design is that individuals use their own reference management software and export to SharePoint when their library is Learning Objectives: incorporated into the ERL. This results in a searchable user-specifi c 1 Age group comparison in the population of Chinese civil library application. An accompanying share folder will warehouse the airline pilots

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 267 ASMA 2012 MEETING ABSTRACTS

[205] STUDY OF APPLIED FOQA DATA IN AEROMEDICAL considerations must be factored into account when deciding what data DRUG EVALUATION AND PHARMACOVIGILANCE can be shared and how - from the Privacy Act of 1974 and the Health Y. ZHOU Insurance Portability and Accountability Act (HIPAA), to NASA’s Health Civil Aviation Medicine Institute, Beijing, China Information Management System (10HIMS) and Human Experimental and Research Data Records (10HERD) access requirements. Additional INTRODUCTION: Monitoring and evaluating the adverse considerations include the presence of the data in the repositories effects, particularly the adverse effect to fl ight performance and safety and vetting requesters for legitimacy of their use of the data. is very important for the pilots who need long-term drug treatment Additionally, fair access must be ensured for intramural, as well to alleviate chronic disease. It is not enough to rely on self-reporting as extramural investigators. All of this must be considered in the of symptoms because the individual with impaired cognition is often formulation of the charters, policies and workfl ows for the human data incapable of recognizing such impairment. FOQA (Flight Operational repositories at NASA. Quality Assurance) is a Digital fl ight date monitoring technique Learning Objectives: which routinely obtain and analyze data recorded in fl ight and provide objective, quality data to assess fl ight operational quality. 1 The goal is to communicate the challenges NASA encounters when This study was to investigate the value of FOQA data in monitoring releasing human data for analysis. and evaluating the adverse effects of medicines by analysing the fl ight data of the pilots who were undertaking antihypertensive [207] APPLICATIONS OF NANOTECHNOLOGY IN medication. METHODS: A retrospective cohort study was conducted PHYSICAL EXAMINATIONS FOR RECRUITING AIRCREWS for a year period ,which involved 103 pilots who were undertaking Z. CHEN, Q. LI, Y. QI, D. ZHU, Y. WANG AND Y. LIU antihypertensive medication and 99 healthy pilots as control group. Civil Aeromedicine Center of CAAC, Beijing, China The fl ight data from FOQA ( Flight Operation Quality assurance ) system and the medical data were statistical analyzed and compared INTRODUCTION: Nanotechnology leads to a large between tow group . Multivariate logistic regression analysis was development of laboratory medicine by providing sensitive, rapid performed to determinate the sensitive fl ight parameter and triggered and convenient examinational methods such as several kinds of test event which indicates the impaired fl ight performance caused by strips. This study aimed to apply nano-gold test strips to physical medicines. RESULTS: Of 2372 fl ight, 78 type of operational risk existed examinations for recruiting aircrews in order to screen drug addicts. in medication pilots, with 1.35% of event rates, 28615.85sec of Avg METHODS: Three kinds of nano-gold test strips of drug in human Time Exposure and 14.85658.7 of Avg Max value. DISCUSSION: urine ( morphine, amphetamines, and ketamine) were selected There are no signifi cantly difference in the fl ight parameters, event for the study. 20603 aircrew applicants were tested with the rates and the scale of event between tow groups . however, zero event three kinds of nano-gold test strips during 8 months. RESULTS: rates is higher in the control group than in the medication group. From There were 40 applicants appeared morphine positive results, 22 logistic regression analysis, medication dosages, period of grounding applicants appeared ketamine positive results, and 12 applicants and blood pressure control is associated with fl ight events. 16 fl ight amphetamines positive results. The test procedures were rapid parameter and triggered event type are sensitive indicators of impaired within 5 min. and test results were very clear. The test screened fl ight performance caused by medicines drug addicts to avoid them into aircrews. DISCUSSION: The test stripe methods based on nanotechnology showed advantages such Learning Objectives: as rapid and convenient compared with instrumental methods. In 1 Human aspects of accident prevention and investigation will be the near future, nanotechnology is much likely to apply other discussed fi elds of aeromedicine, for example pharmaceutical safety evaluation for pilot use, environmental medicine. We believe that nanotechnology [206] THE CHALLENGES OF RELEASING HUMAN provide large chances and challenges in almost all fi elds of aviation DATA FOR ANALYSIS medicine. M. FITTS3, M. VAN BAALEN2, K. JOHNSON-THROOP3, IP: 192.168.39.151 On: Sun,Learning 26 Sep Objectives: 2021 17:39:09 J. HAVELKA1, L.R. LEE2, M. WEAR2 AND D.M. THOMAS1 Copyright: Aerospace Medical1 To aplly Association nanotechnology to the aeromedical physical examinations 1Life Sciences Data Archive Repository, NASA JohnsonDelivered Space by Ingenta Center, Houston, TX; 2Lifetime Surveillance of Astronaut Health Repository, NASA Johnson Space Center, Houston, TX; 3Medi- [208] LONG TERM RESULTS OF HYPERBARIC OXYGEN cal Informatics and Healthcare Systems Branch, NASA Johnson THERAPY IN THE TREATMENT OF ACUTE SEVERE Space Center, Houston, TX CHEMICAL INJURY OF THE CORNEA AND THE CONJUNCTIVA INTRODUCTION: The NASA Johnson Space Center’s (NASA U. ERDEM, S. YILDIZ AND K. SIMSEK JSC) Committee for the Protection of Human Subjects (CPHS) recently Gulhane Military Medical Academy &Hospitals, Ankara, Turkey approved the formation of two human data repositories: the Lifetime Surveillance of Astronaut Health Repository (LSAH-R) for clinical data INTRODUCTION: Chemical corneal burns have been major and the Life Sciences Data Archive Repository (LSDA-R) for research problem of eye clinics.Complications are very serious such as data. The establishment of these repositories forms the foundation severe limbal insuffi ciency, corneal neovascularization, and rapid for the release of data and information beyond the scope for which syblapharon formation. We have presented a new and successful the data was originally collected. The release of clinical and research treatment option for rapid recovery of ocular surface and prevent late data and information is primarily managed by two NASA groups: the complications. METHODS: Thirty-four eyes of 30 patients presented Evidence Base Working Group (EBWG), consisting of members of both to our hospital after severe chemical ocular injury were included in repositories, and the LSAH Policy Board. The goal of unifying these the study. The eyes with large corneal or scleral necrosis excluded repositories and their processes is to provide a mutually supportive from study. Patients were underwent to HBO therapy (2.4 ATA, %100 approach to handling medical and research data, to enhance the oxygen saturation, 90 minutes exposure time) for 14 days use of medical and research data to reduce risk, and to promote after presentation to the hospital., Doxycycline, 200mg/day and the understanding of space physiology, countermeasures and other Vitamin C 1000 mg/day, and prednisolone, 1 mg/kg/day in tapering mitigation strategies.

Over the past year, both repositories have doses for 21 days, were co-administered. Structural and functional received over 100 data and information requests from a wide variety integrity of the ocular surface were evaluated by serial photographs of requesters. The disposition of these requests has highlighted the and, clinical fi ndings. RESULTS: Mean follow up was 2967.4 months. challenges faced when attempting to make data collected on a unique Re-epithelization is completed within 3 weeks of the therapy in set of subjects available beyond the original intent for which the data 32 eyes (94.1%).Two eyes developed small membrane in the inferior were collected. As the EBWG works through each request, many and superior fornix. No structural and functional abnormalities

268 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS including recurrent corneal erosions, dry eye, or important [211] AVIATION IN RADIATION, OPERATION TOMODACHI symblapharon formation were noted in 32 eyes. DISCUSSION: J. STINSON Chemical corneal burns have been major problem of eye clinics US Navy, Coronado, CA especially in the military areas. Complications are very serious such as severe limbal ischemia and, insuffi ciency, corneal neovascularization, and rapid symblapharon formation. Corneal and INTRODUCTION: CAPT Jon Stinson, MC, USN, served conjunctival epithelium is essential for ocular health and functions. as the Carrier Strike Group Senior Medical Offi cer aboard the USS After alkaline burns of corneal surface developing vascular RONALD REAGAN (CVN-76) during Operation Tomodachi. CAPT collapse and liquefaction necrosis deteriorate limbal and, total Stinson will provide a unique service specifi c, and Naval Aviation corneal oxygen consumption. This new treatment option (HBO) perspective. supports ocular surface with oxygenation to allow the tissues for rapid recovery during acute phase of chemical burns and, prevents corneal neovascularizations and other late complications. With these [212] MEDICAL LIAISON TO THE JAPAN SELF DEFENSE outstanding results, use of HBO new and promising and essential FORCE DURING OPERATION TOMODACHI supportive treatment option in the cases with acute severe ocular chemical injury C.Y. CASTILLO DoD, US Air Force, Yokota, Japan Learning Objectives: 1 HBO new and promising and essential and successful supportive INTRODUCTION: The presentation Craig Castillo, Col, USAF, treatment option in the cases with acute severe ocular chemical MC, CFS, will address various roles the Medical Liaison to the Japan injury to prevent early and late complications Self Defense Force (JSDF) played during OPERATION TOMODACHI. 2 surface vascular collapse and likefaction necrosis detoriorate Namely, the liaison functioned as a conduit to pass information about limbal and, total corneal oxygen consumption. the JSDF Medical situation to the US Forces Japan Surgeon General as HBO treatment supports the limbus and cornea during acute phase well as relayed information about the US Forces Japan (USFJ) Medical of the alkaline burns. Efforts to the JSDF. As a robust, resilient country, Japan required very little additional medical support from the international community. DISCUSSION: The JSDF Medical’s two major concerns were the Tuesday, May 15 10:30 AM mental health status of the relief workers and the radiation exposure of Ballroom B those individuals working in proximity to the Fukushima Reactor. The USFJ Medical desired to assist the Japanese government in any way but PANEL: AVIATION IN RADIATION, the liaison offi cer was able to relay that little medical assistance would be required from the US. OPERATION TOMODACHI: PART II Tuesday, May 15 10:30 AM Ballroom C [209] AVIATION IN RADIATION, OPERATION TOMODACHI (SECOND PANEL) K.M. BELLAND PANEL: STEREO VISUAL ACUITY STANDARDS DoD, US Navy, Coronado, CA FOR AIR REFUELLING OPERATORS

On 11 March, 2011, Japan experienced a 9.0 earthquake off of Daichi prefecture triggering a tsunami and resulting in a nuclear [213] STEREO VISUAL ACUITY STANDARDS FOR radiation release into the air, land, water,IP: sea 192.168.39.151and soil. This event On: Sun, 26 Sep 2021 17:39:09 resulted in signifi cant aeromedical issues including leadership AIR REFUELLING OPERATORS 1 2 challenges, medical pre-treatment decisions, aviationCopyright: hazards, Aerospace MedicalT.L. SMART Association AND B. SINGH risk management and risk communication. This is the secondDelivered part by1 AustralianIngenta Defence Force, Campbell Park, ACT, Australia; of a combined panel of the International Association of Military 2Australian Defence Force, RAAF Institute of Aviation Medicine, Flight Surgeon Pilots (IAMFSP), Society of US Naval Flight Surgeons Edniburgh, SA, Australia (SUSNFS), and Society of USAF Flight Surgeons (SUSAFFS). The panel will explore the compounded humanitarian disaster that occurred in Japan. Emphasis will be on aviation impacts as they relate to The Boom Enhanced Vision System (BEVS) of the Airbus international, interagency, and inter-service cooperation in dealing A-330-203 Multi Role Tanker Transport (KC 30A MRTT) provides with the unprecedented disaster. remote vision of the refuelling scenario to the Air Refuelling Operator (ARO). The system uses two image generators and a 50% split mirror Learning Objectives: at the ARO station to superimpose polarised images from two 1 The audience will learn about International Cooperation during an cameras under the aircraft. The ARO will view the superimposed unprecedented natural and manmade disaster. images through a pair of polarised goggles to see a synthetic 3-D 2 Medical considerations for Aviation operations in Radiation con- image. The KC-30A Transition Team (TT) raised several questions taminated environments will be discussed. regarding the visual requirement for AROs of our Institute of Aviation 3 The audience will gain insight into International, Interagency disas- Medicine (AVMED). After obtaining limited, generic information from ter medical response. the aircraft manufacturer, AVMED approached the manufacturers of the BEVS who stated that “certain tests for determining 3D vision ability would also be needed”, but were unable to indicate what standards and tests would be required. AVMED then decided to investigate the [210] AVIATION IN RADIATION, OPERATION TOMODACHI stereo acuity requirements for depth perception (stereopsis) D.M. O’BRIEN and for viewing stereo images in general; investigate the visual DoD, USAF, Hickham, HI acuity standards of the air forces of the allied nations; and investigate any other systems similar to BEVS that may be in service with other INTRODUCTION: Col David O’Brien, USAF, MC, militaries. This panel will explore the outcomes of this research in served as the13th Air Force Surgeon General during Operation association with colleagues from other nations and will attempt to Tomodachi and will provide a Inter-service and service specifi c defi ne stereopsis standards and tests appropriate to operators using perspective. these systems.

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 269 ASMA 2012 MEETING ABSTRACTS

[214] BOOM ENHANCED VISION SYSTEM OF KC-30 Learning Objectives: TANKER AIRCRAFT 1 To understand some of the diffi culties in obtaining reliable B. SINGH assessment of stereopsis for aircrew. RAAF Institute of Aviation Medicine, Edinburgh, SA, Australia 2 To understand some of the diffi culties in linking performance on a stereopsis test to real-world task completion. INTRODUCTION: The Boom Enhanced Vision System (BEVS) of the Airbus A-330-203 Multi Role Tanker Transport (KC 30A MRTT) [216] STEREOPSIS STANDARDS FOR US AIR FORCE provides remote vision of the re-fuelling scenario to the Air Refueling BOOM OPERATORS Operator (ARO). The system uses two image generators and a 50% J.M. GOOCH split mirror at the ARO station to superimpose images from two cameras located on the under surface of the aircraft. The ARO is able USAF School of Aerospace Medicine, Dayton, OH to view the superimposed images through a pair of polarised goggles to see a synthetic 3-D image with an element of depth perception. INTRODUCTION: Currently US Air Force boom operators Military aircraft with such systems are currently in service in Australia, directly observe and guide the refueling boom during aerial refueling Japan, Netherlands, and Italy, and are likely to enter service in the operations; however, the next generation US Air Force aerial refueling United Kingdom and Singapore. This is a relatively new system, platform will utilize a similar binocular display system as the KC- which may have signifi cant implications in terms of medical fi tness 30 Boom Enhanced Vision System (BEVS). Current vision standards requirements of AROs for optimum and safe performance during for US Air Force boom operators are essentially the same as pilots. refueling operations. Aeromedical Questions: A. Is stereoscopic visual Additionally, the waiver criteria used when stereopsis standards are not acuity needed to use BEVS, and if so, what is the minimum level of met are essentially the same for boom operators as for pilots. Stereopsis stereo acuity required? B. Is there a need to screen for the stereo standards and waiver criteria have evolved over the years for US Air acuity of the potential AROs, and if so, what tests should be used? C. Force aircrew based on occupational visual demands, measured Are there other potential issues in the usage of BEVS, like fatigue physiologic limitations and aeromedical experience accumulated and eye strain? D. Is the usage of BEVS compatible with corrective from following aircrew with subnormal clinical examination fi ndings. glasses? METHODS: To answer these questions, one needs a thorough However, the introduction of stereo displays into aerial refueling operations produces a new challenge, and opportunity, to re-evaluate understanding of the system and the visual and psychomotor tasks required of the operator. This paper describes the BEVS system from our vision standards and accepted testing methods. METHODS: A review of current applicable US Air Force vision testing methods, as an aeromedical perspective, and explores the role of the ARO. RESULTS: BEVS is a complex system which requires a certain well as current oculomotor and stereopsis standards will be presented. minimum level of stereo visual acuity for its safe and effective use. The rationale for using these tests and standards within the US Air The precise level of stereopsis that is compatible with safe and effective Force will also be discussed. DISCUSSION: As technology performance is not clearly understood, and is debatable. The advances, aeromedical specialists are called upon to conduct relevance of clinical tests of stereopsis, and their equivalence to the appropriate human performance research in areas where operational task required of the ARO, is also not clearly established. There is tasking is evolving. A knowledge gap currently exists for establishing a need to study the ARO performance while using the system and the appropriate level of stereo acuity required to safely and effectively operate the boom with stereo displays during aerial refueling the relationship of such performance with their stereo visual acuity determine d by a clinical test in the laboratory. Prolonged use of BEVs operations. No known studies have examined the various clinical testing methodologies available to determine the best method to may contribute to aircrew fatigue, and may also be incompatible with spectacle use. assess operators’ ability to adequately use stereo displays. Likewise, little data exists that can be used to set appropriate limits for Learning Objectives: oculomotor function (e.g. limits for amount of phoria and tropia). The US Air Force will be looking at these issues with our international 1 Familiarisation with Boom Enhanced Vision System (BEVS) of the partners over the next few years in an effort to validate requirements Airbus A-330-203 Multi Role Tanker Transport (KC 30A MRTT) IP: 192.168.39.151 On: Sun,and 26 setSep standards 2021 to17:39:09 ensure fl ight safety and mission effectiveness is maintained. [215] STEREOPSIS OF AIR REFUELLINGCopyright: OPERATORS Aerospace IN THE Medical Association ROYAL AUSTRALIAN AIR FORCE: THE INITIAL COHORTDelivered by LearningIngenta Objectives: A. SMITH 1 The audience will learn the vision testing methods and standards RAAF AVMED, Surrey Downs, SA, Australia used by the US Air Force for stereopsis and oculomotor function. 2 The rationale for present stereopsis and oculomotor standards will INTRODUCTION: The Australian Defence Force does not be discussed. have a stereopsis standard for aircrew, however with the introduction of the Boom Enhanced Vision System (BEVS) AVMED was asked to advise an appropriate standard of stereo acuity for boom operators [217] STEREO VISION TEST FOR JASDF AVIATORS selected to undergo conversion to the new synthetic 3D display. T. KONISHI METHODS: Eight experienced boom operators were selected to 1Research Flight, RAAF IAM, Golden Grove, SA, Australia; undergo conversion training to operate the BEVS. These operators 2Aeromedical Laboratory, JASDF, Saitama, Japan were referred for basic stereopsis testing by local ophthalmologists. After they returned from the conversion training, their experience in INTRODUCTION: All aviators in the Japan Air Self-Defense training was captured by interview, and their performance using the Force (JASDF) are required to have normal stereo vision. Therefore, BEVS was assessed by interview with the member and their instructors. their stereo visual acuity is evaluated during initial and periodic RESULTS: Results of the initial stereo testing will be discussed in detail, fl ight physical examination as a matter of routine. These aviators are along with the experience in obtaining suitable testing and results subjected to “three rods test” which is a classic method of dynamic for interpretation. Interview fi ndings regarding performance during stereo vision testing and the same standard is applied to all aviators. training and subsequent experience operating the system will also be However, pilots operating tanker aircraft engaged in air-to-air refueling presented. DISCUSSION: This presentation will review how AVMED operations, and the personnel operating the refueling boom may be obtained stereo acuity measurements for the boom operators, and required to have more advanced stereo vision, so a new test method describe the process to arrive at an interim ‘standard’. The presentation and a new standard for stereo vision may need to be introduced. will also review the subsequent experiences of the boom operators Meanwhile, static stereo vision tests such as stereo fl y test (SFT) and with regard to their stereoacuity and performance on the BEVS, OVT-DP are widely used in many countries during fl ight physical and outline AVMED’s plans for refi ning the stereoacuity standard to examination and in general clinical fi eld. In this study, we compared provide operationally-relevant advice on the selection and training of the results of static and dynamic stereo vision tests with visual personnel operating synthetic 3D displays. performance to determine if there was any correlation between the

270 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS two. The eventual aim was to assess the adequacy of the current Tuesday, May 15 10:30 AM methods of stereo visual acuity testing and the need, if any, for a new Ballroom D method and a new standard for the evaluation of stereo vision in aviators. METHODS: Subjects for this study were 333 aviators who underwent fl ight physical examination in our facility and volunteered PANEL: THE CONTRIBUTIONS OF to participate in the study. RESULTS: There was no specifi c correlation AEROSPACE NURSING AND RESEARCH between dynamic and static stereo vision and visual performance. However, there was some evidence of a weak correlation between age DESIGN FOR THE FUTURE IN A DIVERSE and stereo vision. DISCUSSION: The subjects in this study AND GLOBAL SOCIETY had normal stereo vision, so that the resulting data fell within a relatively narrow range. Therefore, it was diffi cult to fi nd a correlation with visual performance. Secondly, the three rods test cannot be [219] THE CONTRIBUTIONS OF AEROSPACE NURSING used as quantitative test, and factors like experience in the use AND RESEARCH DESIGN FOR THE FUTURE IN A DIVERSE of this test might affect the results. Based on these fi ndings, we feel AND GLOBAL SOCIETY there is a need to investigate some new methods of stereo vision N. TAYLOR testing and to develop a new standard which may be more suitable for Aerospace Nursing Society, Belleville, IL aviators. The purpose of this panel is to present quintessential aerospace Learning Objectives: nursing components and credentials, establishing nursing perspective 1 Stereo visual acuity for air to air refueling operations on needed research in the various fi elds of aerospace medical practice. The literature cites that clinically researched data does impact nursing practice. It affects diverse health program designs and is utilized to impact global health as related to aerospace nursing. The [218] DESIGNING AND EVALUATING A STEREO-VISION overview is meant to provide a foundation for nursing process and SYSTEM FOR IN-FLIGHT REFUELLING procedure or protocol design that can be used in furthering research in L.V. BREDA AND P. BIJL specialty fi elds that include preventive medicine, medical readiness, Perceptual and Cognitive Systems, TNO, Soesterberg, aeromedical transportation, occupational health arenas and hyperbaric medicine. Methodology: The panel members will present an Netherlands introduction to the inherent pertinence of nursing to all the aerospace medicine disciplines with a focus on future research into evidence INTRODUCTION: Since 2009 the Royal Netherlands based application of nursing process. They will discuss a brief history Air Force (RNLAF) operates a new, sophisticated surveillance and of nursing in the various components in order to provide a foundation stereoscopic Tanker Remote Vision System (TRVS) that enables fi ghter for suggestions on clinical research data that will be effective in future aircraft to be re-fuelled mid-air by KDC-10 tanker aircraft. TRVS was global nursing and health care practice. Since nurses have a pivotal developed by TNO in close cooperation with the RNLAF. Design, impact on medical readiness and preventive medicine the focus will development and production of two systems were carried out at TNO, be nursing measures, travel medicine and research implications for the with much of the work being outsourced to partners in Netherlands future. Results: Multiple topical areas for research will be uncovered Industry. METHODS: TNO Perceptual & Cognitive Systems has as they relate to the role of nurses in aerospace medicine. Discussion unique expertise in the fi eld of stereo-vision when it comes to will address nurses’ willingness and ability to move forward with requirement specifi cation, measurement, modeling, and improvement focused attention on betterment of nursing practice through an of visual performance with the aided and unaided eye, for both increase in evidence based theory. Conclusions: A discussion of the military and civilian applications. TNO’s involvement with concentration of attention provided by nurses in their specifi c areas remote vision goes back to 1994 when we specifi ed requirements of endeavor offers credibility to their proposals for the future. The for the fi rst boom operated system built by McDonnell Douglas. In unique perspective of aerospace nurses will provide special insight 2003 we applied the gained knowledge forIP: a 192.168.39.151new remote vision On: Sun, 26 Sep 2021 17:39:09 Copyright: Aerospace Medicalto the necessity Association of continuing research in all the major disciplines of system (TRVS) for the RNLAF. Especially designing a stereo-vision aerospace nursing. system with very strict requirements related to stereo acuity, Delivered by Ingenta dynamic range and latency contains many pitfalls. TNO developed and applied (world-wide) standards for sensor system performance [220] A HISTORY OF DIVERSE AEROSPACE NURSING (TOD), stereo acuity (TNO stereo defi ciency test), vision acuity, COMPONENTS AS FOUNDATION FOR RESEARCH DESIGN contrast sensitivity, color and depth perception (developed for N. TAYLOR the RNLAF). TNO, KLM and their subcontractors designed and Aerospace Nursing Society, Belleville, IL built both the TRVS production systems. With respect to the current operational stereo-vision system, stereo acuity exceeds that of the INTRODUCTION: As with most things, if we don’t have a unaided eye by more than a factor of 3, and boom operators foundation in history we are doomed to repeat it. As with all things report no visual discomfort at all. RESULTS: Its leading role in the aeromedical, the best practice is to work from history through TRVS project made TNO become a unique center of knowledge in current actions and gain the research to allow for an evidence-based the area of stereoscopic performance in air-to-air refueling conditions. protocol or procedural framework for the future. This presentation will The current presentation reveals how we applied the standards, and attempt to provide the historical framework for nursing perspectives how we measured visual performance (e.g., stereo acuity, vision to follow. METHODS: A review of articles, text books, historical acuity, contrast sensitivity, color and depth perception, and visual references and other peer reviewed published information as well as (dis)comfort) to test, produce, and certify TRVS onto an operational interview provided a brief sketch of each of the aerospace medicine system. DISCUSSION: The current presentation reveals how TNO nursing disciplines. Briefl y looking over the information that speaks developed and applied standards for (stereo)-vision in the design and to the origins of fl ight nursing, space nursing, medical readiness and development of an air-tanker remote vision system, measured visual aeromedical evacuation, hyperbaric nursing, occupational health and performance and visual comfort. The system is operational now, and preventive medicine allows us to look ahead to potential research boom operators report opportunities. A review of literature cites that clinically researched data no visual discomfort at all. does impact nursing practice. Evidence-based practice affects diverse health program designs and is utilized to impact global health as Learning Objectives: related to aerospace nursing. RESULTS: This history is meant to provide 1 Human factors aspects of stereo-vision: requirement defi nition, a foundation for nursing process and procedure or protocol design standards, visual performance measurement, eye strain, visual that can be used in furthering research in specialty fi elds that include comfort preventive medicine, medical readiness, aeromedical transportation,

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 271 ASMA 2012 MEETING ABSTRACTS occupational health arenas and hyperbaric medicine. DISCUSSION: pre-treatment education, hyperbaric nurses contribute comprehensive The presenter will provide the basis on which other panelists will clinical expertise to patients needing hyperbaric oxygen therapy. build to point out necessary nursing research in the various fi elds of Through literature review, coupled with an operational perspective aerospace medical practice. of the unique contributions of nurses to the holistic care of patients in the hyperbaric chamber setting, this review identifi es areas of Learning Objectives: research important for the advancement of evidence-based practice 1 To present an overview of historial practice related to health in hyperbaric nursing care, a fundamental step in the development prevention, management, transmission of infectious diseases and of an Aerospace Nursing Primer. METHODS: A review of published prevention programs that affect nursing’s global practice on the literature through online databases was conducted to identify ground and in the air. areas important for research to affect progress in nursing standards and practice in the hyperbaric chamber setting. RESULTS: While [221] PREVENTATIVE MEDICINE: GLOBAL hyperbaric medicine services are delivered most often involving a team approach, nursing has evolved to become an integral part of the FLIGHT PROGRAM DESIGN care plan in hyperbaric oxygen therapy. Specifi c areas of potential J.L. SANNER research to progress nursing care in this setting include pre- and Medical Case Management/Utilization Review, Central Florida post-treatment assessment, patient selection and safety education, Healthcare Alliance, Leesburg, FL wound care, critical care and physiologic monitoring, and dosing, administration and effi cacy of medications. Understanding the INTRODUCTION: Preventive medicine or preventive care impact of lung function on the effectiveness of respiratory support refers to measures taken to prevent diseases rather than curing them apparatus in the chamber and defi ning best practice in fi re safety to or treating their symptoms. As the health care system has evolved and prevent patients from carrying ignition sources into the chamber are is in the process of reorganization, one has to take a more active role examples of issues for research with the potential to progress evidence in preventative medicine related to fl ight travel. For the purpose of this based practice hyperbaric nursing care. DISCUSSION: This survey of presentation, disease prevention will be a main priority. METHODS: operational nursing care in the hyperbaric chamber setting and the Evidence-based medicine (EBM) evidenced-based nursing (EBN) is a supporting literature demonstrates opportunities for ongoing research formalized system for helping the medical and nursing to cope with to refi ne practice standards. Findings will become an integral part of this information explosion. It’s about formal protocols that are applied the comprehensive descriptions of research opportunities within the to the latest fl ight travel related to infectious disease transmission to Aerospace Nursing Primer. determine what data best support the best outcomes. This fi ltering and prioritizing process requires an enormous effort to sift through Learning Objectives: large volumes of information, but the end result helps physicians and 1 To describe quintessential hyperbaric nursing components related nurses to identify the best health program design. RESULTS: Infectious to pre- and post-treatment assessment, patient selection and safety disease management in air travel has been established to be one of the education, wound care, critical care and physiologic monitoring, priority settings for health promotion in the 21st century. It infl uences and dosing, administration and effi cacy of medications. physical, mental, economic and social well-being and offers an ideal infrastructure to support the promotion of health of a large population. [223] EVIDENCE-BASED AEROMEDICAL EVACUATION AND The health care provider’s approach to prevention is known as evidence-based medicine, applying the best evidence to prevent the MEDICAL READINESS WITH RESEARCH FOR THE FUTURE transmission of infectious diseases. DISCUSSION: There are three IN A GLOBAL SOCIETY levels in preventative medicine and nursing in healthcare. The levels M. SIDES are primary, secondary, tertiary and quaternary prevention. Primary Education Enterprises Inc, Chicago, IL prevention avoids the development of a disease. Most population- based health promotion activities avoid the development of a disease. INTRODUCTION: This presentation will provide an overview Most health promotion activities are primary preventative measures. of the capability and operational necessity of aeromedical evacuation Secondary activities are aimed at early diseaseIP: 192.168.39.151 detection, thereby On: Sun,and 26 medicalSep 2021 readiness. 17:39:09 The protocols in place for determining a increasing opportunities for interventions to preventCopyright: progression Aerospace of Medicalpatient’s fiAssociation tness for fl ight and the functionality which allows transport the disease and emergencies. Tertiary prevention reduces theDelivered negative by ofIngenta “stabilized” versus “stable” patients are determined by analysis of impact of an already established disease by restoring function and outcomes and will need further supporting research to ensure best reducing disease-related complications. Quaternary prevention is practices continue to grow. Recent changes in military applications the set of health activities that mitigate or avoid the consequences of of medical readiness will be reviewed as well, in terms of personnel unnecessary or excessive interventions in the design of health systems. and platforms, again with an ongoing research focus. METHODS: The panelist will present aeromedical evacuation and medical readiness Learning Objectives: from an operational perspective. The application of the physiologic 1 To defi ne preventive medicine or preventive care in disease stresses of fl ight provides a framework to apply analysis of past and management related to global fl ight traveling. current guidelines in use to determine criteria to maximize preventive 2 To determine that evidence-based medicine and evidenced-based support for aircrew and optimal outcomes for patients traveling by nursing is a formalized system for helping medical and nursing air. A consideration of global nursing and health care practice on prosessionals cope with the global information explosion. medical readiness and patient transport will illuminate research 3 To identify the development of effective practice program designs implications for the future. The diversity of nursing applications for preventative medicine related to fl ight travel. within these core areas include not only the criteria and protocols previously mentioned, but also areas like mass casualty triage, trauma care and support, behavioral health, crew rest and fatigue as well as [222] A REVIEW OF THE HYPERBARIC NURSING DISCI- maintenance and training of skill sets. All those components offer areas PLINE AND OPPORTUNITIES FOR ADDITIONAL RESEARCH for targeted analysis and research which will be explored. RESULTS: 1 2 R.B. GUSTAVSON AND Y.M. DEBOIS Multiple topical areas for research will be uncovered as they relate 1Oxyheal Health Group, Las Vegas, NV; 2Corporate & to the continued application of evidence-based practice in aerospace Sustaining Membership Committee, Chicago, IL medicine. Outcomes of the panel will include the conclusions which are supported by the change in operations practice. DISCUSSION: INTRODUCTION: Once involving the participation of mostly A discussion of the impact of stresses of fl ight on the ill and injured divers, medics, and operational military specialists, hyperbaric as well as on air crew will be discussed, as relevant. This discussion medicine has grown in clinical indications, requiring the abilities will not be exhaustive, but will provide examples and scenarios that of a variety of healthcare clinicians, especially skilled nurses. From will stimulate thought and trigger ideas for areas in need of further complex monitoring of critical care patients in the chamber to research.

272 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

Learning Objectives: pc-based air traffi c control simulator. Segmented reaction times 1 To provide a brief history of aeromedical evacuation now and pres- were compared to mental state transitions as identifi ed by EEG ent evidence-based changes to the medical readiness of aircrew recordings collected over two hours. METHODS: Ten college and patients alike. students were trained to participate in a pc-based simulated air traffi c control microworld. Using a computer mouse and menu participants were required to activate aircraft and route them to Tuesday, May 15 10:30 AM their destination. Aircraft were initially presented in an “inactive” Salon AB state and participants were trained to activate them as soon as they could. Activation times were averaged across ten minute segments. The pattern of aircraft presentation was the same across all time SLIDE: FATIGUE, HYPOXIA, AND segments. EEG data were collected using a Net Amps 300 Amplifi er COGNITIVE FUNTION IN THE OPERATOR (EGI, Eugene, OR) connected to a 128-channel electrode cap for high spatial sampling. EEG data were segmented into ten-minute windows, each of which consisted of 600 one- second epochs. 10:30 am Spectral power analyses were conducted separately for theta, [224] MEASURING SLEEP DEPRIVATION WHEN TYPE II alpha, and beta bands. RESULTS: T-tests (corrected for multiple ERRORS MAY LEAD TO DANGEROUS CONCLUSIONS comparisons) were conducted comparing later time segments to the K. NEMETH, L. QUILL AND N. ARBUCKLE mean of the fi rst 10-minute segment. Eight out of 10 participants University of Dayton, Dayton, OH (80%) experienced a statistically signifi cant increase in activation times within the seventh and eighth time segment. This was the INTRODUCTION: Sleep deprivation reduces cognitive same region that the EEG results revealed a transition from one function and may impair one’s ability to perform in a safe and mental state into another, which previous research suggested was effective manner. Furthermore, when operator errors can lead to an indication of cognitive fatigue. DISCUSSION: The activation catastrophic events, such as piloting aircraft or treating patients, task used in this study is similar to a controller accepting a shifts often last longer than 24 hours. This potentially dangerous hand-off from another sector/facility. The results suggest that with careful planning high fi delity air traffi c control scenarios may be combination has spurred research into the potential for predicting fatigue vulnerable individuals by using cognitive tests applied developed with embedded reaction time tasks suitable for use in throughout a period of sleep deprivation; however, this method monitoring the effects that time on task fatigue has on controller is intrusive, and takes signifi cant time during data collection, and performance. participant recruitment. These diffi culties motivate research into the possible use of medical imaging technologies where researchers Learning Objectives: can collect a snapshot of brain activation to predict and visualize 1 To understand how embedded reaction times can be used to fatigue vulnerability. METHODS: Our team prepared a two stage monitor the development of time on task fatigue. study which fi rst evaluated military personnel in a controlled 30hr sleep deprivation period. Participants were monitored to ensure that they did not nap, consume caffeine, or other stimulants. The 11:00 am second phase of the study used medical residents during their [226] WORK SHIFT ROTATION AND PERFORMANCE normal extended shift work conditions. Participants kept a log, EFFECTIVENESS OF AIRFIELD OPERATORS wore an activity monitor, and were allowed to consume stimulants M. COAKWELL2 AND T. KING1 and take naps when time permitted. An fMRI was conducted at the 1 86th Airlift Wing, U.S. Air Force, Ramstein Air Base, Germany; beginning and end of the sleep deprivation period in both studies. 2Headquarters, US Air Forces in Europe Command Surgeon’s RESULTS: The results of the two studies were markedly different. Offi ce, U.S. Air Force, Ramstein Air Base, Germany In the lab study, vulnerable participants were clearly identifi ed by a signifi cant drop in cognitive performanceIP: 192.168.39.151 using an α=.05. Using On: Sun, 26 Sep 2021 17:39:09 this same criteria the naturalistic study of medical residents, showed INTRODUCTION: On-duty fatigue was subjectively Copyright: Aerospace Medicalidentifi ed Association as a concern at a US AFB during a standardized safety no drop in performance. DISCUSSION: Could the lack of Deliveredpower in by Ingenta the naturalistic study, lead to the dangerous decision that fatigue survey conducted among active duty air traffi c controller (ATC) does not affect cognitive functioning after 30 hours of alertness? Is and airfi eld management (AFM) personnel. The present study was it truly possible that 14 randomly selected residents were capable conducted to objectively determine the performance effectiveness of maintaining alert behavior for 30+ hours without a drop in of these workers within their existing work shift schedules. performance? This paper will discuss the potential for Type II errors. METHODS: Work/sleep cycles of 18 ATC and 9 AFM personnel Small samples in each study, the lack of control of behavior in the were tracked over a 4-week period. Participants were divided into second study, and the signifi cant danger of concluding continued two groups based upon shift rotations: 1) those consistently working human performance at 30 hours is “safe” requires us to investigate day/swing shifts (Group A); and 2) those exposed to continual shift conclusions from this study further. rotations including mid shifts (Group B). The following information was gathered daily from each participant: 1) the time of their shift Learning Objectives: and the duration of duty; and 2) the quantity of sleep and the time of day spent sleeping. These data were entered into the Fatigue 1 The relationship between Type I and Type II errors in research. Avoidance Scheduling Tool (FAST) program, and the performance 2 The difference between a lab and naturalistic research project. effectiveness of each participant was then calculated over the study period. RESULTS: The performance effectiveness of those in Group 10:45 am A dropped below 78%, which is equivalent to a 0.05% blood [225] IDENTIFYING TIME ON TASK FATIGUE IN AN AIR alcohol concentration (BAC), during 41 out of 256 total shifts (16%) and below 68%, which is equivalent to a 0.10% BAC, during 4 of TRAFFIC CONTROL SIMULATION 1 2 2 the 256 shifts (2%). In contrast, the performance effectiveness of L.L. BAILEY , D. DASARI AND L. DING those in Group B dropped below 78% during 77 out of 106 total 1 NAS Human Factors Safety Research Lab, FAA/CAMI, shifts (73%) and below 68% during 28 of the 106 shifts (26%). Oklahoma City, OK; 2Computational Imaging Laboratory, DISCUSSION: Participants exposed to continual work shift rotations University of Oklahoma, Norman, OK including mid shifts appeared to perform less effectively than their counterparts that worked a consistent day/swing shift schedule. INTRODUCTION: We evaluated the effi cacy of an embedded These results were utilized to design a rotating shift schedule to air traffi c control reaction time task to detect the presence of mitigate this effect, tailored to the size of the unit and the mission cognitive fatigue associated with sustained task performance in a demands.

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 273 ASMA 2012 MEETING ABSTRACTS

Learning Objectives: altitude levels viz. ground, 8,000 feet and 12,000 feet and two 1 To demonstrate the relationship between subjective perception of different illumination conditions viz. half moon and quarter on-duty fatigue and objective on-duty performance effectiveness moon (QM) simulated in an altitude chamber. The results were among a group of airfi eld operators. analyzed using ANOVA and Bonferroni post hoc test for pair-wise 2 To objectively compare the on-duty performance effectiveness as- signifi cance. There is a signifi cant overall effect of altitudes (F = sociated with different work shift rotation schedules among a group 10.09, P< 0.0001) on visual acuity. The post hoc analysis revealed of airfi eld operators. that there is a signifi cant fall in VA between Ground level and 12000 feet at QM illumination and this fall is reversed by use of 100% Oxygen. The study shows that visual acuity with Gen II ++ NVG is 11:15 am adversely affected at altitudes of 12000 feet (and above) in QM (and [227] EFFECT OF SLEEPINESS ON PERFORMANCE AND worse) illumination condition. This deterioration can be reversed by WORKLOAD DURING SPACE ROBOTICS TASKS use of 100% oxygen. Therefore use of Oxygen should be made C. LOWENTHAL, A. LIU, A. NATAPOFF AND C.M. OMAN mandatory in NVG fl ying at high altitude of more than 12000 feet Aeronautics and Astronautics, MIT, Cambridge, MA in unacclimatized aircrew. Keywords - NVG, Visual acuity, Hypoxia, Illumination

INTRODUCTION: Astronauts are expected to maintain a Learning Objectives: high level of performance during space robotics operations, despite sleep schedules that hinder their cognitive function, response time, 1 The audience will understand that acute mild to moderate hypoxia and attention. This study aimed to determine the usefulness of can degrade Night Vision Goggle visual performance secondary tasks to assess sleepiness and workload during simulated space robotics performance. METHODS: 13 naïve subjects were trained to perform two types of simulated robotics tasks and two 11:45 am types of secondary tasks designed to measure response time. [229] POST-HYPOXIC RECOVERY OF COGNITIVE AND Subjects completed two 2-hour robotics sessions, one at midday PERCEPTUAL FUNCTION after approximately 4 hours awake, and one at night after 18 J.B. PHILLIPS, R.G. SIMMONS AND D.S. HORNING hours awake. RESULTS: Comparing 18 hours awake versus 4, Naval Medical Research Unit - Dayton, Karolinska Sleepiness Scale scores increased by at least 2 points. Wright-Patterson AFB, OH Subjects were able to maintain primary robotics task performance at the night session, but secondary task measures such as inverse INTRODUCTION: Researchers often assume that response time showed signifi cant changes, with moderate Hedges’ cognitive-perceptual function recovers in concert with blood g (0.35 to 0.74) effect sizes. For a passive monitoring of arm O2 saturation levels following hypoxic exposure. However, movement primary task, a simple response secondary task metric recent studies have shown that cognitive-perceptual impairments proved more sensitive to time awake than a two choice response continue for a signifi cant period of time after subjects’ blood O2 secondary task, but the converse was found when the primary concentration is restored (Phillips et al., 2009). The purpose of task involved track and capture manual control. DISCUSSION: this study was to establish the effects of moderate hypoxia on a Our visual secondary task was sensitive to changes in primary selected set of cognitive-perceptual abilities, and to determine task workload and sleepiness. A secondary task does not require the time course for restoration of function following return to separate testing like the Psychomotor Vigilance Task because it can normoxic conditions. METHODS: Twenty subjects practiced six be imbedded in a real world primary task. Increased response time cognitive-perceptual tests for six 10 min blocks, including: simple can be interpreted as sleepiness provided primary task workload and choice reaction time (RT), executive function, color vision, is constant and training effects have disappeared. Secondary task visual contrast sensitivity, and visual acuity. Using the Reduced workload measures are a potentially useful adjunct to primary Oxygen breathing Device (ROBD), subjects breathed an air task drowsiness metrics like PVT and deserve further investigation. mixture equivalent to 18,000 ft for a period of 30 min followed by Supported by the National Space BiomedicalIP: 192.168.39.151 Research Institute On: Sun,a 26 normoxic Sep 2021 recovery 17:39:09 period. Subjects performed three blocks of through NASA Cooperative Research AgreementCopyright: NCC9-58, Aerospace Project Medicalthe cognitive-perceptual Association tasks during the 30 min hypoxia exposure NBPF02001. Delivered by andIngenta during four 30 min recovery assessments. The fi rst assessment began immediately following exposure, with recovery assessments Learning Objectives: 1 hr, 2 hr, and 24 hr post-exposure. RESULTS: Hypoxic exposure 1 The audience should understand the usefulness of an embedded signifi cantly affected simple RT, choice RT, and contrast sensitivity. secondary workload task to detect sleepiness during a simulated Contrast sensitivity recovered within minutes of subjects’ return to primary space robotics task. normoxic conditions. However, simple RT and choice RT failed to return to pre-exposure levels until the 24 hr recovery assessment. No signifi cant hypoxia-associated effects were detected for tests 11:30 am of visual acuity, color vision or executive function. DISCUSSION: [228] STUDY OF CHANGES IN VISUAL ACUITY WITH USE The present study examined only a single experimental hypoxic OF NVG IN ACUTE HYPOXIA OF AVIATION exposure protocol; however, the results highlight the need for S. VERMA AND V. JOSHI continued investigation. The persistent post-exposure effects of Acceleration Physiology and Spatial Orientation, Institute of different levels and durations of hypoxia, not just on cognitive- Aerospace Medicine, Bangalore, India perceptual functions, but also on pilot performance, are presently unknown. This line of research can be used to improve operating INTRODUCTION: The importance of vision in fl ying and emergency procedures following the occurrence of an in-fl ight tasks cannot be overemphasized. Understandably, the infl uence hypoxic event. of hypoxia on vision has been extensively studied in aerospace medicine. Various studies have shown that night vision or rod Learning Objectives: vision is adversely affected by hypoxia induced by altitudes as low 1 Does an individual’s blood O2 saturation level directly as 4000 feet and progressively worsening thereafter. The photopic correspond with cognitive-perceptual function during recovery or cone vision, however, is more resistant to hypoxia and starts from hypoxia? degrading only after about 17,000 feet. The NVG convert scotopic 2 Which aspects of perceptual, psychomotor and cognitive function vision to mesopic vision. Therefore this study was conducted to are most affected by hypoxia exposure? study the effects of the two opposing factors on night visual acuity 3 Why is the assessment of cognitive-perceptual function viz. hypoxia and NVG. 30 non-aircrew subjects were assessed for during recovery from hypoxia an important operational changes in visual acuity with Gen II ++ NVG in three different concern?

274 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

Tuesday, May 15 10:30 AM like energy intake, was lower than required. However, sodium intakes Salon D were elevated during fl ight and likely related to other concerns such as calcium turnover and other health-related issues. NASA is making efforts to have tasty foods with much lower salt levels to reduce sodium PANEL: LEGACY OF ENVIRONMENTAL intake and to promote fl uid intake on orbit. Red blood cell studies RESEARCH DURING THE SPACE SHUTTLE conducted on the Shuttle found decreased erythrogenesis and increased serum ferritin levels. Given that the diet is high in iron there may be PROGRAM iron storage health concerns, especially related to the role of iron in oxidative damage, complicated by the stress and radiation. The Shuttle [230] LEGACY OF ENVIRONMENTAL RESEARCH DURING nutrition research lead to new monitoring and research on ISS. These THE SPACE SHUTTLE PROGRAM data will be valuable for future NASA and commercial crewed missions. H. LANE Space Medicine, Wyle, Houston, TX Learning Objectives: 1 The Shuttle nutrition research led to new monitoring and research The Space Shuttle Program provided many opportunities to on ISS. These data will be valuable for future NASA and study the role of spacefl ight on human life for over the last 30 years commercial crewed missions. and represents the longest and largest U.S. human spacefl ight program. Risks to crewmembers were included in the research areas of nutrition, [232] MICROBIOLOGICAL LESSONS LEARNED microbiology, toxicology, radiation, and sleep quality. To better FROM THE SPACE SHUTTLE understand the Shuttle environment, Crew Health Care System was M. OTT1, R. BRUCE2, V. CASTRO2, S.K. MEHTA2 developed. As part of this system, the Environmental Health Subsystem AND D.L. PIERSON1 was developed to monitor the atmosphere for gaseous contaminants 1 2 and microbial contamination levels and to monitor water quality and Space Life Science Directorate, NASA, Houston, TX; Space radiation. This program expended a great deal of effort in studying Life Science Directorate, Enterprise Advisory Services, Inc., and mitigating risks related to contaminations due to food, water, Houston, TX air, surfaces, crewmembers, and payloads including those with animals. As the Shuttle had limited stowage space and food selection, INTRODUCTION: After 30 years of highly successful Space the development of nutritional requirements for crewmembers Shuttle missions, the Shuttle program provided many valuable was imperative. As the Shuttle was a reusable vehicle, microbial lessons for the International Space Station (ISS) and future spacecraft. contamination was of great concern. The development of monitoring Major microbiological risks to crewmembers include the presence instruments that could withstand the space environment took several of medically signifi cant microorganisms in food, water, air, years and many variations to come up with a suitable instrument. surfaces, payloads, and animals. The exposure of astronauts to other Research with space radiation provided an improved understanding crewmembers and ground support personnel also creates another of the various sources of ionizing radiation and the development route for microbial transmission. Adverse effects of microorganisms of monitoring instrumentation for space weather and the human are varied and can jeopardize crew health and safety, spacecraft systems, and mission objectives. Astronaut immune functions were exposure within the orbiter’s cabin. Space toxicology matured to include the management of offgassing products that could pollute the found to be altered and selected microorganisms were found to crewmembers’ air quality. The Shuttle Program implemented a 5-level become more virulent during spacefl ight. To minimize problems toxicity rating system and developed new monitoring instrumentation associated with microorganisms, appropriate steps must begin in the to detect toxic compounds. The environment of space caused circadian design phase of new spacecraft or space habitats and must include desynchrony, sleep defi ciency, and fatigue leading to much research requirements to control accumulation of water, including humidity, and major emphasis on countermeasures. Outcomes of the research leaks, and condensate on surfaces. The use of appropriate materials in these areas were countermeasures, operational protocols, and and the implementation of robust housekeeping will prevent high levels hardware. Learning Objectives: This symposiumIP: 192.168.39.151 will provide an over On: Sun,of 26 microbial Sep 2021 growth 17:39:09 on surfaces. Other preventive measures such as view of the major environmental lessons learnedCopyright: and the development Aerospace Medicalfi ltration systems Association can ensure low levels of bioaerosols and particulates of countermeasures, monitoring hardware, and procedures. in the air. By disinfecting drinking water and using a fi ltration system, Delivered bysafe Ingenta drinking water can be provided. In addition, thorough prefl ight [231] NUTRITION RESEARCH: BASIS FOR STATION examination of fl ight crews, consumables, and the environment can REQUIREMENTS greatly reduce pathogens in spacecraft. Research conducted during the H. LANE1, B. RICE2 AND S.M. SMITH1 Shuttle program resulted in an improved understanding of the effects of spacefl ight on human physiology, microbial properties, and specifi cally 1Space Life Science Directorate, NASA, Houston, TX; 2 host-microbe interactions. These advances formed the foundation for Space Life Science Directorate, Enterprise Advisory environmental microbiology requirements and operations for the ISS Services Inc., Houston, TX and future spacecraft, decreasing health risks to both current and future crewmembers. While vehicle design and prefl ight prevention measures INTRODUCTION: Prior to the Shuttle program, all decrease the incidence of health risks associated with microorganisms, understanding of nutritional needs in space came from Skylab these risks are not eliminated. Overly conservative risk mitigation metabolic research. Because Shuttle fl ights were short, most less measures are costly using valuable resources both before and during than 14 days, research focused on major nutritional issues: energy spacefl ight. By understanding the lessons learned from successful (calories), protein and amino acids, water and electrotypes, with some vehicles, like the Space Shuttle, future spacefl ight missions can more general physiology studies that related to iron and calcium. optimize this resource use while maintaining crew health. METHODS: Using stable isotope tracer studies and diet intake records, we found that astronauts typically did not consume adequate calories to meet energy expenditure. To monitor energy and nutrient intake [233] WHAT THREATS TO HUMAN HEALTH DOES SPACE status and provide feedback to the fl ight surgeon and the astronauts, RADIATION POSE IN ORBIT? the International Space Station (ISS) program implemented a weekly H. WU, E.J. SEMONES, M.D. WEYLAND, N. ZAPP food frequency questionnaire and routine body mass measurements. AND F.A. CUCINOTTA Other Shuttle investigations found that protein turnover was higher Space Life Science Directorate, NASA, Houston, TX during fl ight, suggesting there was increased protein degradation and probably concurrent increase in protein synthesis, and this occurred INTRODUCTION: The Space Shuttle Program spanned more even in cases of adequate protein and caloric intake. RESULTS: These than the entire length of a solar cycle. Investigations aimed towards results may partially explain some of the loss of leg muscle mass. understanding the health risks of the astronauts from exposures to Fluid and electrolyte fl ight studies demonstrated that water intake, space radiation involved mostly physical measurements of the dose

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 275 ASMA 2012 MEETING ABSTRACTS and the linear energy transfer (LET) spectrum. Measurement of the Learning Objectives: dose rate on the Shuttle provided invariable new data for different 1 Toxic compounds used aboard the Space Shuttle pose a health periods of the solar cycle, whereas measurement of the LET hazard to crewmembers. Commercial builders and users of human spectrum using the tissue equivalent proportional counter produced rated spacecraft must learn to avoid the use of toxic compounds the most complete mapping of the radiation environment of the whenever possible and to properly control those compounds that low-Earth orbits. Exposures to the Shuttle astronauts were measured cannot be avoided. by the personal dosimeter worn by the crewmembers. Analysis of over 300 personal dosimeter readings indicated a dependence on the mission duration, the altitude and inclination of the orbit, and [235] SLEEP AND FATIGUE MANAGEMENT DURING the solar cycle. The crewmembers on the launch and repair of the THE SHUTTLE PROGRAM 1981 TO 2011 Hubble telescope received the highest doses due to the altitude of S.L. JOHNSTON1, L. BARGER2, C. CZEISLER2, D.F. DINGES3, the mission. Secondary neutrons inside the Shuttle were determined R.T. JENNINGS4, L. LEVETON1, S. LOCKLEY2, W. SIPES1, by recoil protons or with Bonner spheres and may contribute A. WHITMIRE5 AND J.P. LOCKE1 signifi cantly to the risks of the crewmembers. In addition, the 1Space Life Sciences Directorate, NASA, Houston, TX; 2School skin dose and doses received at different organ locations of a 3 human phantom aboard a Shuttle mission were compared. A of Medicine, Harvard University, Cambridge, MA; School of number of radiobiology investigations were also performed. The Medicine, University of Pennsylvania, Philadelphia, PA; 4 biological doses were determined on six astronauts/cosmonauts Medical Branch, University of Texas, Galveston, TX; on long-duration Shuttle-Mir missions and on two crewmembers 5Space Medicine, Wyle Integrated Science and Engineering, on a Hubble repair mission by analyzing the damages in the Houston, TX chromosomes of the crewmembers’ white blood cells. Several experiments were also conducted to address the question of INTRODUCTION: The Space Shuttle Program embraced possible synergistic effects of spacefl ight, microgravity in particular, many challenges, milestones, and lessons learned for managing on the repair of radiation-induced DNA damages. The experimental circadian desynchrony, sleep defi ciency, and fatigue during all design included exposure of cells before launch, during fl ight, or mission phases. Inherent in the Shuttle operational environment after landing. These physical and biological studies were invaluable were a number of factors affecting circadian synchronization, in predicting the health risks for astronauts on ISS and future sleep and performance including unusual shift work schedules and exploration missions. non-24-hour work days, inappropriate lighting cues, noise, high and low temperature, high carbon dioxide levels, gravitational Learning Objectives: transitions, high workloads, and other factors experienced during 1 This paper is intended to educate the general public of research pre, in, and post-fl ight operations. Spacefl ight research and fl ight activities aboard the Space Shuttles that were aimed at surgeon debriefs demonstrated that crewmember sleep on Shuttle understanding the health effects of astronauts from exposures often averaged less than 6 hours per night with astronauts routinely to space radiation. exposed to chronic sleep defi ciency (Barger etal.,2010). Notably, sleep medications were one of most frequently used medications in [234] MANAGING TOXICOLOGICAL RISKS: THE LEGACY the US Shuttle program (Putcha, et al. 1999; Kertzman 2011). There were also ground-based risks. Shuttle Mission Control personnel OF SHUTTLE OPERATIONS were often required to undertake shift work or work unusual J.T. JAMES work schedules and a large proportion of spacefl ight personnel Space Life Sciences Directorate, NASA, Houston, TX were regularly required to travel overseas for training purposes, further impairing sleep due to Jet Lag Disorder. This presentation INTRODUCTION: Space toxicology greatly matured as will review the ground and in-fl ight research conducted during a result of research and operations associated with the Shuttle. the Shuttle Program and present the lessons learned and Materials offgassing had been a manageable concern since the IP: 192.168.39.151 On: Sun,recommendations 26 Sep 2021 17:39:09 for future International Space Station mission Apollo days, but we learned to pay careful attention to compounds operations and short-duration vehicle development. Ramifi cations that could escape containment, to combustionCopyright: events, to toxic Aerospace Medicalfor missions Association beyond low-Earth orbit to asteroids or Mars will also be propellants, to overuse of utility compounds, and to microbialDelivered and by highlighted.Ingenta It will briefl y discuss the recent implementation plans human metabolites. We also learned that fl ying real-time hardware for the development of a Fatigue Management Team and additional to monitor air pollutants was a pathway with unanticipated speed countermeasures, for example specialized lighting, by the NASA bumps. Each new orbiter was tested for any excess offgassing JSC Behavioral Health and Performance Element of Space Medicine products that could pollute the air during fl ight. In the late 1990s Division, Human Research Program in collaboration with the toxicologists and safety experts developed a 5-level toxicity rating Clinical Services Branch in the Space Medicine Division. system to guide containment of toxic compounds. This system is now in use aboard the International Space Station (ISS). Several Learning Objectives: combustion events during Shuttle Mir and also during Shuttle 1 Understand the major sleep and fatigue management challenges free-fl ight impelled toxicologists to identify hardware capable encountered during the Shuttle Program and the subsequent of monitoring toxic products; however, rapid adaptation of the operationally directed ground and in-fl ight research efforts and hardware for the unique conditions of spacefl ight caused unexpected fi ndings. Appreciate the lessons learned and applications to future missteps. Current and planned combustion analyzers would be useful Space mission scenarios and research efforts. to commercial partners that wish to manage the risk of health effects from thermal events. Propellants received special attention during the Shuttle program because of the possibility of bringing them into Tuesday, May 15 2:00 PM the habitable volume on extravehicular activity suits. Monitors for Ballroom B the airlocks were developed to mitigate this risk. Utility materials, such as lubricants, posed limited toxicological problems because water was not recovered. One clearly documented case of microbial PANEL: AEROSPACE MEDICINE metabolites polluting the Shuttle atmosphere was noted, and this has INTEROPERABILITY implications for commercial fl ights and control of microbes. Finally, carbon dioxide, the major human metabolite, episodically presented air quality problems aboard Shuttle, especially when nominal [236] AEROSPACE MEDICINE INTEROPERABILITY air fl ows were obstructed. Commercial vehicles must maintain D. ROSS robust air circulation given the anticipated high density of human 1AF/SG3, Air Force, Arlington, VA; 2Royal Air Force, occupants. High Wycome, United Kingdom

276 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

International and inter-service interoperability continues to INTRODUCTION: Recent research has questioned the benign increase in scope and intensity. This panel will highlight initiatives nature of operating below 3048 m (10,000 ft) in resting subjects as and projects that are forging partnerships and common practice. indicated by aviation texts and handbooks. DISCUSSION: Using the Presentations are from Canada, USAF/RAF, US Navy, and US Army Environmental Symptoms Questionnaire and pulse oximetry, Smith covering strategies for dealing with mild hypoxia; UAS Human Factors (2005, 2007) showed that in 6 subjects, physical activity as low as interoperability in OEF;commonality in DoD credentialing; MEDEVAC 2134 m (7000 ft) can produce hypoxemia and symptoms of hypoxia interoperability in OEF and development of standards for medical similar to that which would normally be expected in a person resting cover of airfi elds. This will provide a platform to showcase current at approximately 3658 - 4572 m (12,000 - 15,000 ft). The results of work and potential for future interoperability. cognitive performance during mild hypoxia are also controversial. Whilst some past research suggested that mild hypoxia does not affect well learned cognitive, vigilance and motor performance tasks [237] DEVELOPMENT OF COMMON U.S. DEPARTMENT OF (Fiorica et al. 1971; Green and Morgan 1985; Fowler et al. 1985, DEFENSE AEROSPACE MEDICINE PRIVILEGES Paul and Fraser 2007), other studies (Denison et al. 1966; Crow and R.A. BEANE Kelman 1969; McCarthy et al. 1985; Farmer et al. 1992) suggest that U.S. Navy, Bureau of Medicine and Surgery, Washington, DC mild hypoxia can affect the performance of novel complex cognitive tasks involving multiple demands. It should be noted that the hypoxic INTRODUCTION: As part of the efforts to develop joint stimuli (hypobaric chamber versus hypoxicator device through a infrastructure across all U.S. DOD service, U.S. military Aerospace mouthpiece and wearing a nose clip.), methodology (appropriate Medicine and Risk Management experts are developing a system of cognitive test battery versus self perceived risk judgment through provider privileging that includes a common set of core privileges and questionnaires), testing conditions (resting versus physical activity) supplemental privileges. METHODS: The presentation will describe and the paucity of experimental subjects varies among these studies. the current process, the individual service areas of interest and Therefore, it is not possible to assess and compare the results of these concern, and the proposed common core privileges and methodology. studies. In order to achieve the goal of the Air Space Interoperability RESULTS: Common core privileges and methodology. DISCUSSION: Council (ASIC) in standardization of doctrine, operational Opportunities to merge areas of commonality while still preserving procedures, material and equipment in dealing with mild hypoxia, a unique service specifi c elements. common approach is needed to further investigate the effects of mild hypoxia on aircrew. In addition, investigations should be extended Learning Objectives: into studying the effects of intermittent hypoxia exposure frequency

1 Educate Aerospace Medicine specialists on forthcoming develop- and duration. We recommend that representatives from all ASIC ment within the joint aviation environment. nations commit resources to establish a common approach in this subject area.

[238] AIRFIELD MEDICAL COVER STANDARDS Learning Objectives: D. ROSS 1 The audience will be presented with a review of mild hypoxia and AF/SG3, Air Force, Arlington, VA current inadequacies.

INTRODUCTION: Currently, there is no system to categorise [240] AEROMEDICAL ASPECTS OF JOINT USA AND UK airfields on the medical cover available to respond to airfield emergencies or to accept medical diversions. Additionally, MEDIUM ALTITUDE, LONG ENDURANCE REMOTELY there are no defined standards for the level of cover required at PILOTED AIRCRAFT OPERATIONS airfields in operational areas relevant to the operations conducted. B. SHEPHERD Therefore, The Air and Space Interoperability Council Aerospace USAF, Dayton, OH Medicine Group have set out a new categorization and standards proposal. METHODS: A special projectIP: group 192.168.39.151 was set up by ASIC On: Sun, 26 SepINTRODUCTION: 2021 17:39:09 The United States Air Force (USAF) has over 3 days to derive standards based on bestCopyright: practice in otherAerospace Medicalbeen operating Association Remotely Piloted Aircraft (RPA) since the early organizations and airfield disciplines. RESULTS: This paperDelivered outlines by1960s. Ingenta However, since 2001, the demand for them has grown the proposed new standards and explains the basis upon which exponentially and by 2010, the Predator had operated for over 1 they were derived using ICAO, NATO and the 5 member nations’ million hours. The insatiable demand for RPAs has not been isolated existing standards and mirroring fire/crash categories that are to the United States of America. In 2006, the Royal Air Force (RAF), familiar to the airfield operators. It explains how acceptance of announced that it would be purchasing the General Atomics MQ-9 these standards will aid creation of new multinational operational Reaper and since 2007, the RAF has operated RPAs alongside USAF airfields and can mitigate overlap and duplication of medical from Creech AFB, Nevada. One of the greatest challenges to both provision when several nations’ aircraft deploy to the same airfield. USAF and RAF has been providing suitably selected personnel It includes ambulance capability guidance and response time who can be adequately trained to operate these “unmanned” standards and discussion of the merits of introducing information systems as they deploy in a broad range of international operational on the level of aerospace medical advice available at the airfield environments. Both nations have experienced comparable human to the published airfield data. DISCUSSION: It is hoped that this factors challenges: Selection of the appropriate operators to meet paper can form the basis of a recognised international standard for manpower and personnel needs; Medical standards for operators; medical cover at airfields. Training pipelines for operators from aircrew backgrounds and other career fi elds; Shift-work and other occupational health Learning Objectives: issues. Despite operating RPAs for many years, human factors 1 To explain basic requirements for medical cover at airfi elds based continue to play a predominant role with signifi cant fi nancial on its operational mission and aircraft types. expense and operational limitations and feasible solutions are still 2 To show how medical cover standards must be aligned with exiting being explored. The co-location of USAF and RAF RPA squadrons fi re and crash standards. at Creech AFB has provided a unique opportunity for the Armed Forces of the United States of America and the United Kingdom to collaborate and learn from one another as they have jointly [239] THE IMPORTANCE OF A COMMON APPROACH FOR supported operations in Afghanistan and plan for the future ahead. MILD HYPOXIA INVESTIGATION WITHIN ASIC B.S. CHEUNG1 AND D. ROSS2 Learning Objectives: 1DRDC Toronto, Toronto, ON Canada; 2AF/SG3 EO, USAF, 1 Human factors of Remotely Piloted Aircraft will be explored in the Washington, DC context of USA/UK joint operations.

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 277 ASMA 2012 MEETING ABSTRACTS

[241] INTEROPERABILITY ISSUES IMPACTING 2:15 pm ROTARY WING MEDEVAC [243] MOTION SICKNESS PREVENTION BY 8 HZ J.F. MCKEON STROBOSCOPIC ENVIRONMENT DURING AIR TRANSPORT US Army Aeromedical Activity, Fort Rucker, AL C.M. WEBB, A. ESTRADA AND J.R. ATHY US Army Aeromedical Research Lab, Fort Rucker, AL INTRODUCTION: While Coalition Forces numbers and combat activity have lessened recently in Iraq, there has been no comparable INTRODUCTION: Previous research has shown that diminution of casualty producing operations in Afghanistan. This has retinal slip can be a signifi cant factor in causing motion sickness. necessitated a robust and far-reaching MEDEVAC capability to retrieve Stroboscopic illumination may prevent retinal slip by providing casualties at the point of injury, as well as to transfer stabilized, but snapshots of the visual environment that are brief enough so each not always stable, post-surgical patients from one level of care to a image is stationary on the retina. The purpose of this study was to higher echelon of care. Despite doctrinal differences between services determine the effectiveness of an 8 Hz stroboscopic environment and nations, the died of wounds rates are at historic lows. This is a as a motion sickness countermeasure during a nauseogenic fl ight testament to the creativity and cooperation that exists between nations, in a helicopter. METHODS: The study population consisted of 18 services, and sometimes within aircrews comprised of personnel from motion sickness susceptible participants with an average age of 26.0 different nations. years (6 4.12). Each participant experienced two fl ights (with and without 8 Hz stroboscopic illumination in the cabin) during which Learning Objectives: they read selected passages. The fl ights occurred one week apart and 1 This presentation will illuminate some of the best practices and lasted approximately 30 minutes. Participants completed a motion lessons learned within the rotary wing MEDEVAC communities of sickness symptom questionnaire, cognitive tasks, reaction time tests, various services and nations. and weapons utilization tasks after each fl ight. RESULTS: Self-reported nausea scores were signifi cantly reduced in the stroboscopic condition. However, there was an increase in oculomotor symptoms (e.g., eye Tuesday, May 15 2:00 PM strain and headache). The stroboscopic condition resulted in signifi cantly Ballroom C better performance on tests of sustained attention post-fl ight than the non-stroboscopic condition. DISCUSSION: These results support the SLIDE: MOTION SICKNESS THEORY AND use of stroboscopic illumination as a non-pharmacologic countermeasure for motion sickness related to retinal slip. This PREVENTION technology should be investigated in other forms of transportation (e. g., ground vehicles). The relationship between motion sickness and fatigue will also be discussed. 2:00 pm [242] THERAPY OF A SOMATOFORM AUTONOMIC Learning Objectives: DYSFUNCTION AND THE PSYCHOLOGICAL AND 1 To evaluate a non-traditional, non-pharmacologic BEHAVIORAL FACTORS ASSOCIATED WITH KINETOSIS countermeasure for motion sickness to benefi t the operational 1 2 U. WESEMANN AND T. RÜTHER military community. 1Flight Medical Institute, Fuerstenfeldbruck, Germany; 2Department of Psychiatry, LMU, Munich, Germany 2:30 pm [244] MOTION SICKNESS: AN EVOLUTIONARY INTRODUCTION: For decades, numerous pilots have been dismissed from their fl ying training due to airsickness. However, since AND GENETIC BASIS FOR THE NEGATIVE pilots are already checked for kinetosis during their fi rst medical REINFORCEMENT MODEL examination, this can be ruled out as the sole cause. The diagnosis G. KNOX should furthermore include the psychologicalIP: 192.168.39.151 component; we On: Sun,University 26 Sep 2021 of Florida, 17:39:09 Jacksonville, FL suggest diagnosing a “somatoform autonomic Copyright:dysfunction” (ICD-10;Aerospace Medical Association F45.3), if the psychological factors are predominant. FocusingDelivered on the by IngentaINTRODUCTION: Bowins (1) theorized that motion sickness relevant physiological symptoms, the diagnosis of “psychological evolved as a negative reinforcement system which terminates and behavioral factors associated with kinetosis” (F54 plus T75.3) is motion involving postural instability and/or sensory confl ict. to be preferred. METHODS: Hence, we hypothesize that therapy is A hypothetical example is provided by a “thought experiment” always more successful, if it concentrates on adaption to movement in whereby protohominids are in a tree looking for food. Selection case of a major impairment of the equilibrium sense, or on cognitive pressure results when the organisms that have an aversion to behavioral elements in case of a major psychogenic component. All motion producing sensory confl ict do not venture out to far on the pilot trainees and pilots with permanent airsickness symptoms who tree limbs and therefore tend to survive. METHODS: In order to participated in the program in the last 12 years were included in this support an evolutionary model for motion sickness there must be study. RESULTS: By using Fisher’s exact test, it was determined that evidence for genetic and/or heritable predisposition. The present the therapeutic strategy is signifi cantly associated with the therapeutic study involves a retrospective literature review which reveals result (α < 5%). The duration of the program and the severity of the abundant evidence for genetic/heritable factors in motion sickness. symptoms did not infl uence the therapeutic effect. The newly developed Examples include genetic polymorphism of the alpha-2-adrenergic therapeutic strategy predominates over the old “standard program” receptor which has been shown to increase susceptibility to motion (B < .005). DISCUSSION: Before the beginning of therapy, the used sickness (2); examination of family trees revealing heritable motion tests enable us to identify the primary cause of the manifest symptoms sickness susceptibility (3); evidence indicating that Asians are in a simple manner. Consistent work in this direction then rapidly leads hyper-susceptible to motion sickness (4); and twin studies (5, 6) to success and a signifi cantly improved outcome, also in the sense of just to mention a few. RESULTS: The theory of heritable negative prophylaxis of recidivism. As a result, we recommend diagnosing a reinforcement as a basis for motion sickness is supported by special form of somatization disorder. A ready-made therapy that does extensive evidence in the medical literature. Twenty-four studies not address the various causal components of airsickness and that does were identifi ed demonstrating a genetic/heritable basis for motion not adapt to the individual factors of each patient is not reasonable. The sickness. No negative studies were identifi ed. DISCUSSION: The only standardized program is the “Smoke-Free Program”. theory of heritable negative reinforcement as a basis for motion sickness is supported by extensive evidence in the Learning Objectives: medical literature. This theory is compared and contrasted 1 The audience will learn the various causal components of airsick- with other theories. Further areas for research in this area are ness and the different therapeutic strategies. suggested.

278 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

Learning Objectives: (using the Simulator Sickness Questionnaire; SSQ). RESULTS: 58 % 1 To be able to demonstrate that genetic and heritable factors of the fl ight instructors and 42 % of the student pilots experienced determine motion sickness susceptibility. simulator sickness. In both groups, the SSQ values differed with regard 2 To learn an evolutionary theory of the development of motion to pre- and post-testing (F = 94.46, p < .000). The severity of simulator sickness susceptibility. sickness symptoms regarding fl ight instructors was signifi cantly greater than a cut-off value of 20 in the SSQ (M = 54.10, t = 6.30, p < .000) and signifi cantly more severe than the symptoms of the student 2:45 pm pilots (F = 23.76, p < .000). These differences also occurred for the [245] BRAINSTEM PROCESSING OF VESTIBULAR SENSORY three subscales Nausea, Disorientation, and Oculomotor of the SSQ. REAFFERENCE: IMPLICATIONS FOR MOTION SICKNESS During the fi rst seven training phases, it was found that student pilots ETIOLOGY had adapted to simulator training (b = -1.81, p = .087, R^2 = .47), C.M. OMAN1 AND K.E. CULLEN2 however, this was not true for fl ight instructors. Simulator sickness 1Department of Aeronautics and Astronautics, Massachusetts correlated negatively with subjectively rated vitality (r = -.60, Institute of Technology, Cambridge, MA; 2Department of p < .01), and vigilance (r = -.63, p < .01). DISCUSSION: Based on the results, a rest period of at least 12 hours between simulator training Physiology, McGill University, Montreal, QC, Canada and real fl ights should be complied. Furthermore, half of the subjects experienced fl ashbacks following simulator use. The responsible fl ight INTRODUCTION: This paper reviews studies of “Vestibular surgeon should inform pilots and heighten their awareness of possible Only” (VO) vestibular nucleus neurons, and considers their simulator sickness symptoms. implications for motion sickness etiology. METHODS: Cullen and coworkers (2001, 2004, 2009) demonstrated a population of neurons Learning Objectives: in the brainstem vestibular nucleus (VO neurons) that principally 1 The audience will learn about symptoms, causes, and respond to passive rather than active head movement. RESULTS: consequences of simulator sickness. Vestibular responses to active movement (“reafference”, von Holst, 2 Moreover the audience will be informed about associated 1950) appear to be suppressed by signals from an “internal model” psycho-physiological factors affecting pilot performance negatively. , probably partly located in cerebellum, that predicts the sensory consequences of self-generated movement, and discriminates postural disturbances. These fi ndings provide the fi rst evidence for the existence 3:15 pm of “sensory confl ict” neurons postulated by the sensory-motor [247] SUBCONSCIOUS SENSITISATION OF confl ict theory for motion sickness (Reason, 1978; Oman, 1982, 1990). DISCUSSION: Other vestibular nucleus neurons code head MOTION SICKNESS 1,2 1 2 gravitational orientation, and couple to cardiorespiratory neurons to J.F. GOLDING , D. ALUND , M.A. GRESTY maintain oxygenated blood fl ow to the brain. These orientation and AND M.B. FLYNN1 movement control systems normally function independently from the 1Psychology, Univ. Westminster, London, United Kingdom; brainstem emetic system. Projections from vestibular nucleus neurons 2Imperial College, London, United Kingdom to brainstem emetic centers are known to exist, although it has not yet been shown that VO neurons do, and produce emesis when INTRODUCTION: Habituation to motion has been studied stimulated. However we hypothesize that during prolonged passive extensively because of its therapeutic applications to motion sickness transport (e.g. by boat, beginning 150-200 generations ago), sensory and to vestibular rehabilitation. However less attention has been rearrangement (Held, 1961) or vestibular disease, sensory confl ict devoted to an opposite process: sensitisation. METHODS: Subjects signals cross couple into the neurotoxin expulsion and avoidance (n=50) were randomly allocated, with approximately equal group system, producing the well known motion sickness phenotype. sizes, across the four possible following sequences: First Visual stimulus; 15 min time gap; Cross-Coupled (CC) motion OR Control Learning Objectives: (Sham CC); time gap 15 min OR 2 h; Re-test Visual stimulus. Each 1 To understand responses of vestibularIP: afferents 192.168.39.151 and vestibular On: Sun,motion 26 Sep exposure 2021 was 17:39:09 for 10 minutes or until moderate nausea, nucleus neurons to active and passive movement.Copyright: Aerospace Medicalwhichever Association was the sooner. Visual stimulus (optokinetic motion) was a 2 To understand why VO neurons can be said to code “sensoryDelivered byscene Ingenta rotating at 0.2Hz with a superimposed ‘wobble’. CC motion was confl ict”. whole body rotation on a turntable during which subjects executed 3 To understand the implications for motion sickness etiology. a set of eight head tilts of approximately 45° during each 30s period. Rotational velocity commenced from stationary and incremented as a staircase profi le in steps of 3°/ s step every 30 s. RESULTS: All 3:00 pm subjects had fully subjectively recovered before any motion exposure. [246] THE ROLE OF SIMULATOR SICKNESS IN FLIGHT There were no signifi cant differences between groups for Total Motion SIMULATORS Sickness Symptom scores (Total Symptoms) for the fi rst visual stimulus M. STEIN, M. ROBINSKI AND F. GRELL (all combined: mean+/-SD 10.8+/-8.4). CC produced greater Total Human Factors and Ergonomics, German Air Force Institute of Symptoms (20.3+/-6.8) than Control (3.1+/-3.7) (p<.001). For the Aviation Medicine, Manching, Germany re-test visual stimulus Total Symptoms were higher following CC (15.1+/-9.0) than following Control (8.3+/-7.1) (p<.01), the effect INTRODUCTION: Apart from the benefi ts of simulator use, being only slightly greater for the 15 min re-test than 2 h re-test. Times however, adverse physical and psychological effects can occur during to achieve sickness rating stages mirrored these patterns of results. and/or after simulator use. These effects are subsumed under the DISCUSSION: Sensitisation to motion was shown by increased motion term of simulator sickness. Simulator sickness symptoms and related sickness symptom scores and faster times to achieve sickness stages mental effects may result in reduced training performance or also the for visual motion following CC. This effect could cross modalities, i.e. acquisition of bad habit patterns. METHODS: The objective of the CC to visual. It occurred despite full subjective recovery and could last conducted studies was to determine the incidence and severity of for at least 2 h later. There may be some similarity to the phenomenon simulator sickness, for instance in the EC 135 helicopter simulator, of ‘fl ashbacks’. For some individuals what had been formerly an as well as the incidence of fl ashbacks and to use these fi ndings as innocuous visual stimulus became nauseogenic on re-test. This may a basis to derive recommendations for fl ight duty. To this end, a have implications for use of visual displays after exposure to motion. long-term study was conducted with 19 measurement times and 70 subjects. Each subject fl ew identical training missions at the Learning Objectives: defi ned measurement times. Visual fatigue, psychological wellbeing, 1 The audience will gain a greater understanding of the importance workload, chronic fatigue over time as well as ergonomic simulator of sensitisation as opposed habituation in the context of motion characteristics were determined in addition to simulator sickness sickness and vestibular rehabilitation.

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 279 ASMA 2012 MEETING ABSTRACTS

Tuesday, May 15 2:00 PM processed in 2010. These services generated an annual turnover of Ballroom D 13 million for LH medical services and 20 million for passenger medical care. Annual profi t over the last fi ve years was on average 3.5 million for LH Medical Services and 8 million for Passenger PANEL: STRATEGIES FOR COST Medical Care. RESULTS: Under my leadership since 2003, we EFFECTIVENESS AND PRODUCTIVITY transformed Medical Services from a cost to a profi t center, growing from a small medical service to a comprehensive full service profi t IN INTERNATIONAL AIRLINE MEDICAL center. To be successful, it is critical to understand and speak the OPERATIONS language of our economic controllers . We must focus,not only on budget cutting, but on cost savings in good decision making, to reduce lost days due to sickness, minimizing service delays for [248] STRATEGIES FOR COST EFFECTIVENESS staff and expediting return to work. DISCUSSION: To counter the AND PRODUCTIVITY IN INTERNATIONAL modern business trend of outsourcing every department which AIRLINE MEDICAL OPERATIONS may likely constitute a cost center and which benefi ts do not seem M. SIDES essential for the airline, a Medical Service can only survive if a Education Enterprises Inc, Grayslake, IL number of principles are considered. These include: (1) a highly effi cient operations with minimal staff; (2) permanent consideration INTRODUCTION: Airline medicine has operated within with regard to the medical needs and problems of the airline; (3) medical departments since the 1930’s. Due to current challenges, permanent innovative readiness to solve problems and fulfi ll the in-house airline medical departments are shrinking or disappearing, needs; (4) unbeatable innovations compared to cheaper suppliers; principally in the United States. Despite trends and challenges, (5) a profi table business strategy; (6) a strong foundation of trust to many international airlines continue to operate successful and the management board. effective in-house medical programs. Will this trend extend to the international community in the future? Medical services may be Learning Objectives: provided in-house, or they may be outsourced. What is best for the 1 Participants will learn strategies employed by Lufthanza Airline airlines, the aircrew and the traveling public? The purpose of this to ensure cost effective and effi cient operations in an in-house panel is to provide international perspectives on the role of the medical service airline medical department in light of current trends and challenges. METHODOLOGY: Panel members will discuss the dynamics that [250] CATHAY PACIFIC CORPORATE MEDICAL drive cost effectiveness and productivity in their airline medical DEPARTMENT - AN EXAMPLE OF A VALUED departments. They will discuss strategies employed by medical AND INTEGRAL PART OF THE AIRLINE offi cers within their airlines on issues regarding health and safety, R.M. ONG with key examples that highlight the best of their departments Medical Department, Cathay Pacifi c Airways Ltd., Lantau, and operations in such promotion. Programming examples would Hong Kong include their management of infectious diseases, like SARS, volcanic ash diversions, and decision making in medical emergency management. Airlines will have different strengths which will lend INTRODUCTION: We will share an example of a multi- a unique perspective to each of the presentations. Discussion will cultural medical department playing an important role within the address legal/regulatory requirements, supporting them, company daily operations and long-term success of the airline. There are a culture and communication structure impacting their ability number of unique factors which contribute to this. The Corporate to prevent injury, manage health and promote safety, through Medical Department is engaged in a wide variety of key business evidence based medical management. RESULTS: Perspectives on areas and work processes, including aeromedical licensing issues, occupational health programs to ensure fi tness to operate and the important role and benefi ts of aerospace medical providers will be shared. Problems that could arise as a result of the lack of a optimal productivity, safety initiatives, passengers’ medical issues IP: 192.168.39.151 On: Sun,including 26 Sep disability2021 17:39:09 handling and in-fl ight medical provisions and qualifi ed airline medical director will be speculated.Copyright: A best Aerospace practice Medical Association program will be modeled through strengths that are presented. upstream new product risk assessment. We monitored our key CONCLUSIONS: A discussion of operational programmingDelivered within by programsIngenta using a number of metrics. We address the needs using international airlines offers unique perspectives on “best medical a balance of in-house and out-sourced resources. We will discuss practices” in light of shrinking in-house medical departments in the these as well as future challenges. METHODS: We will discuss United States. the Hong Kong environment, our corporate culture, factors in the aviation community and the local regulatory framework to highlight how they infl uence the role of the Corporate Medical Department [249] LUFTHANSA MEDICAL SERVICE: within Cathay Pacifi c. We will describe our organizational structure, A PROFIT CENTER FOR THE AIRLINE how we interface with senior management and how we work U. STUEBEN with key stakeholders to support the operational requirements. Lufthansa Airlines, Friedrichsdorf, Germany We will highlight the range of programs, key metrics used and share some successes. We will summarize by discussing a few INTRODUCTION: The Lufthansa Medical Service was of our Departmental strengths and possible opportunity areas in founded in 1957 in Hamburg. At that time two doctors and three the horizon. RESULTS: As each airline has a unique history and nurses treated 6000 employees. Over time, the staff has grown to corporate culture, operating in different competitive, economic 20 full time doctors, supported by 66 nurses and numerous medical and regulatory environment, the role that is played by its medical specialists, who treat more than 70,000 employees. Physicians department will necessarily be different. We hope that by sharing are board certifi ed in a wide diversity of specialist designations our experience at Cathay Pacifi c, this provides one example of a and service fi ve departments, including Occupational Medicine, vibrant medical department which can serve as a best practice Tropical Medicine, Aviation Medicine, Passenger Medical Care and for others. DISCUSSION: A discussion of various international Social Counseling Services. METHODS: The Lufthansa Medical medical airline medical departments will help audience members Services works under the supervision of the HR Management Board. to appreciate the diversity and challenges of in-house medical Medical care for employees in 2010 totaled more than 80,000 departments globally service related events, of which occupational health medicals for staff comprised half of the services. Other projects include Learning Objectives: supervision of fi rst aid training, leadership training, pandemic plans, 1 To gain insight into how an airline medical department has telemedicine and a Doctor on Board Program. Passenger medical become an integral part of the organization and in contributing care and medevac operations for more than 20,000 inquiries were to its successes

280 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

[251] THE DEVELOPMENT OF A NEW IN HOUSE airline business, the brand and the culture and physicians can AEROMEDICAL CENTER: THE EXPERIENCE OF IBERIA also be rapidly accessed for medical advice for urgent operational MEDICAL DEPARTMENT issues. EMS is autonomous; budgeting and managing growth but is R. DOMINGUEZ-MOMPELL required to be accountable and cost effective and must align with Universidad Rey Juan Carlos I, Madrid, Spain the corporate environment, matching capacity to organisational growth. An annual workshop is convened between EMS and the performance development department to formulate the business INTRODUCTION: Iberia runs its own Medical Department plan and identify KPI’s which are then linked to deliverables. (IMD) in-house for the last 50 years. Of course during this period Audits, productivity reviews and surveys are some of the ways of time changes had to be undertaken, updating new concepts and to ensure deliverables are met. In 2007 EMS was awarded optimizing services. Iberia continues to operate successful and accreditation from the Australian Council on Healthcare Standards. effective in-house medical programs. METHODS: A review of key This gives users the confi dence that the service is safe and will operations of the IMD, highlighting objectives and metrics used in provide consistent high quality care, demonstrated by the fact that decisions of health, medicine, and safety management in airline in 2011 when non aircrew staff were given the option of accessing operations was conducted. Factors, contributing to the department’s external providers the majority chose to stay with EMS. Maintaining related decision-making, including (regular and episodic senior accreditation status requires regular review of policies, procedures management interactions, regulatory infl uences, and company and guidelines which must be evidence based and align with the structural compartmentalization of health, medical and safety regulatory requirements. EMS is proud of pilot; antidepressant, BMI, processes were identifi ed. Successful health, medical and safety and alcohol treatment programs which have improved productivity programming facilitating workplace productivity, while generating and may enhance fl ight safety and the success also solidifi es the profi table revenue streams, were recognized. RESULTS: 1. Health, position with management. DISCUSSION: Discussion will include medical, and safety programming is managed systematically (as new initiatives used to ensure cost effectiveness and employee opposed to episodically) at Iberia with number of days/pilot/year satisfaction, how EMS retains uniqueness, remains of value to the of medical absenteeism as the most commonly used to analytically company and why it continues to expand despite the downsizing of assess their effect on productivity. 2. Iberia Medical works in a many airline medical departments. coordinated manner with departments with similar objectives (safety - hygienist and occupational med) to uniformly use business Learning Objectives: metrics to guide management decisions. Issues that impact all of us are evaluated in a more comprehensive manner throughput 1 To understand the strategies and structure an airline medical department should use to make them unique, cost effective and of airline operations. 3. IMD programmings that support productivity but also generate revenue is an important component. a.) Pilot value to the airline Medical Operations. IB AMC is actually carrying out 91% of the medical examinations for pilots and 100% for cabin attendants, plus 1,000 class 1 medical examinations for other companies per year which means something close to one million euros/year. b.) Clearance department for stretchers and oxygen. Charging [253] ADVANTAGES AND BENEFITS OF AN INTEGRATED money for both concepts. A stretcher cost a twelve full fare ticket MEDICAL SERVICE IN AN AIRLINE for the round trip. c.) Aviation Medicine refreshing courses for V. FEUILLIE AND P. RODRIGUEZ-REDINGTON aircrews. The revenue generated by the course vs cost to deliver it Air France Medical Department, Roissy CDG Cedex, France is much cheaper doing them in house, with doctors in the pay roll. DISCUSSION: Successful medical health and safety management INTRODUCTION: Our medical department has several decisions at Iberia have been accomplished through integral use of activities: - Occupational Health Service This activity is regulated business metrics employed systematic and across various lines of by the laws of the French Labour Department that set the number management. Department functions that support productivity and of medical doctors and nurses. - Approved Civil Aviation Medical generate revenue can bolster the viabilityIP: of 192.168.39.151 medical departments On: Sun,Center 26 Sep The center2021 has17:39:09 the opportunity to receive pilots and cabin within airline organizations. Copyright: Aerospace Medicalcrew (mandatory Association by local law) very quickly due to its proximity Delivered byto Ingenta Paris Charles de Gaulle airport and the headquarters of the Learning Objectives: company. There is great fl exibility to get an appointment quickly. 1 the audience will learn medical health and safety management - The fi rst aid medical training crews are set by our department decisions that can be accomplished through integral use of busi- according to medical incidents on board and the current ness metrics systematically across various lines of management. regulations. - Sick passengers Medical Control The repatriation is part of the services we offer to medical assistance companies and sick passengers. This control is achieved by us with an immediate response from any direct contact with the captain on board. We found a small number of medical diversions due to the fi rst [252] A MODEL OF EXCELLENCE IN AIRLINE MEDICINE aid training air crew and medical control. - Station Doctors We F. RENNIE maintain a local doctors network on all our stations. Theses doctors Emirates Airline, Dubai, United Arab Emirates are familiar with aeronautics environmental and they know medical infrastructures in place. These doctors give fi t to fl y advice for crews INTRODUCTION: Emirates Medical Services (EMS) employs and passengers. We know them all personally which facilitate 28 physicians supported by 150 ancillary staff, servicing 28,000 direct exchanges. We meet every four years to update them with patients and continues to expand in line with the growth of the our medical procedures - Crises Our service is taken him to act airline. It is unique in providing primary care as well as aviation immediately to all aspects of health crises(epidemics, radiocativity, and occupational services for eligible employees of Emirates. food) and disaster (crash). In this situation, the image of the All physicians are aero medical examiners and qualifi ed to company damage must be taken into account as quickly. We help perform regulatory medicals for aircrew. Because management our crisis center and our communication lines to provide answers. recognises the potential impact of crew medical conditions on The airline industry must respond continuously to new situations fl ight safety, it is mandatory that aircrew use in house services for in an emergency. Proximity to a medical service integrated into the both their licensing medicals and their primary care. EMS also company can respond quickly to requests. sets employment standards, manages sickness absence, on board incidents and equipment, provides scientifi c advice, MRO reviews, Learning Objectives: pandemic planning, MEDIF’s and education. Emirates values and 1 To know Advantages and benefi ts of an integrated medical service supports EMS for many reasons; the physicians understand the in an airline

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 281 ASMA 2012 MEETING ABSTRACTS

Tuesday, May 15 2:00 PM with the history of fl ight surgery and contemporary knowledge of the Salon AB important issues in aviation medicine. The presentation was itself an excerpt of Dr. Jones’ forthcoming book.

PANEL: AVIATION MEDICINE 75 YEARS Learning Objectives: AGO: WELCOME TO THE EIGHTH 1 The audience will learn of the history, issues and challenges in ANNUAL MEETING OF THE AERO MEDICAL aviation medicine of 1936. ASSOCIATION: PART I--USS LEXINGTON [258] EQUILIBRATORY FUNCTIONS IN INSTRUMENT FLYING [254] AVIATION MEDICINE 75 YEARS AGO: WELCOME TO W.W. DALITSCH1 AND L. MANDEL2 THE EIGHTH ANNUAL MEETING OF THE AERO MEDICAL 1Naval Air Force, U.S. Pacifi c Fleet, San Diego, CA; 2Naval ASSOCIATION Safety Center, Norfolk, VA C.A. CICCONE2, J.R. HEIL2 AND W.W. DALITSCH1 1Naval Air Force, U.S. Pacifi c Fleet, San Diego, CA; 2Naval INTRODUCTION: The original presentation of August 29, 1936 Aerospace Medical Institute, Pensacola, FL will be presented by a physician playing author Lt. Cmdr. John R. Poppen, Medical Corps, U.S. Navy, complete with original follow-on commentary by a special guest from the U.S. Army. This presentation This panel will welcome and introduce the audience to the deals with contemporary knowledge of the vestibular system, Eighth Annual Meeting of the Aero Medical Association of 1936. The particularly in relation to instrument fl ying. meeting was held Friday, August 28 through Sunday, August 30 in the Biltmore Hotel in Los Angeles, California, as well as aboard the Navy’s Learning Objectives: second aircraft carrier USS Lexington (CV 2). This will be presented by an author playing John A. Tamisea, MD, sixth president of the 1 The audience will learn of the relationship of the vestibular system association, who will introduce the individual authors and their papers to instrument fl ying as understood in aviation medicine of 1936. for presentation. [259] NEUROCIRCULATORY ASTHENIA - ITS NATURE AND [255] AN ANALYSIS OF THE CAUSES OF RELATION TO FLYING PERSONNEL 2 1 DISQUALIFICATION OF FIVE HUNDRED APPLICANTS P. WALKER AND W.W. DALITSCH 1Naval Air Force, U.S. Pacifi c Fleet, San Diego, CA; 2Chief of REJECTED FOR FLYING TRAINING A.J. PARMET2 AND W.W. DALITSCH1 Naval Air Training, Corpus Christi, TX 1 Naval Air Force, U.S. Pacifi c Fleet, San Diego, CA; 2USC Viterbi School of Engineering, Los Angeles, CA INTRODUCTION: The original presentation of August 29, 1936, complete with original follow-on commentary, will be presented by a physician playing author Lieut. (j.g.) David C. Gaede, Medical Corps, INTRODUCTION: The original presentation of August 29, U.S. Navy serving with the U.S. Marines. This presentation deals with 1936, complete with original follow-on commentary, will be presented contemporary knowledge of a condition known as neurocirculatory by a physician playing author Capt. Otis O. Benson, Medical Corps, asthenia and its importance in aviation and aviation medicine. U.S. Army. This presentation deals with the demographics and medical reasons for rejection of applicants for military fl ight training. Learning Objectives:

Learning Objectives: 1 The audience will learn of the fl ight consideration of the condition neurocirculatory asthenia as understood in aviation medicine of 1936. 1 The audience will learn of the causes of rejection in military avia- tion applicants as understood in aviationIP: 192.168.39.151medicine of 1936. On: Sun, 26 Sep 2021 17:39:09 Copyright: Aerospace MedicalTuesday, Association May 15 2:00 PM [256] EAR SYMPTOMS INCIDENTAL TO SUDDEN ALTITUDEDelivered by SalonIngenta D CHANGES, AND THE FACTOR OF OVERCLOSURE OF THE MANDIBLE PANEL: LEGACY OF OPERATIONAL SPACE C.A. REESE2 AND W.W. DALITSCH1 1Naval Air Force, U.S. Pacifi c Fleet, San Diego, CA; MEDICINE DURING THE SPACE 2Naval Aerospace Medical Institute, Pensacola, FL SHUTTLE PROGRAM

INTRODUCTION: The original presentation of August 29, [260] LEGACY OF OPERATIONAL SPACE MEDICINE 1936, complete with case presentations, will be presented by a DURING THE SPACE SHUTTLE PROGRAM physician playing author Dr. Glenn E. Willhelmy of Kansas City, MO. P.C. STEPANIAK1, S.L. JOHNSTON1, M.R. CHANDLER1, This presentation deals with contemporary knowledge of the ear, G. BEVEN1, S. GILMORE1 AND R. PATLACH2 its proximity to the temporomandibular joint, and their relation to 1 changes in altitude. Medical Operations, NASA/Johnson Space Center, Houston, TX; 2Wyle Integrated Science and Engineering, Houston, TX Learning Objectives: 1 The audience will learn of the otologic system and related consid- The Johnson Space Center’s Medical Science Division branches erations in aviation of 1936. were involved in preparing astronauts for space fl ight during the 30 year period of the Space Shuttle Program. These branches included the Flight Medicine Clinic, Medical Operations and the Behavioral [257] A RESUME OF AVIATION MEDICINE Health Program. The components of each facet of these support 2 1 W.A. MCDONALD AND W.W. DALITSCH services were: the Flight Medicine Clinic’s medical selection process 1Naval Air Force, U.S. Pacifi c Fleet, San Diego, CA; 2Naval and medical care; the Medical Operations equipment, training, Aerospace Medical Institute, Pensacola, FL procedures and emergency medical services; and the Behavioral Health and Performance operations. Each presenter will discuss INTRODUCTION: The original presentation of August 29, the evolution of its operations, implementations, lessons learned 1936, complete with original follow-on commentary, will be presented and recommendations for future vehicles and short duration space by a physician playing Dr. Isaac H. Jones. This presentation deals missions.

282 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

[261] ASTRONAUT MEDICAL SELECTION AND FLIGHT and environmental medical risks along with the medical equipment MEDICINE CARE DURING THE SHUTTLE ERA 1981 TO 2011 and communications needed for space fl ight were reviewed with all S.L. JOHNSTON1, R.T. JENNINGS2, P.C. STEPANIAK1, crewmembers. The components for the pre-fl ight, on-orbit and W.J. TARVER3, J.F. SCHMID1 AND G.W. GRAY4 post-fl ight periods will be presented together with the implementations 1Medical Operations, NASA/Johnson Space Center, Houston, and lessons learned from these missions. Recommendations will also 2 be presented for medical involvement to ensure success for future TX; Aerospace Medicine, University of Texas Medical Branch, vehicles and short duration space fl ights as no space shuttle mission 3 Galveston, TX; Clinical Services, NASA/Johnson Space Center, was terminated as a result of a medical event. Houston, TX; 4Defence R&D Canada, Toronto, ON, Canada Learning Objectives: INTRODUCTION: The NASA Shuttle Program began with 1 Understand the basic components of training crews on the congressional budget approval in January 5, 1972 and the launch of physiological, psychological and environmental risks in STS-1 on April 12, 1981 and recently concluded with the landing of preparation for space fl ight. STS-135 on July 21, 2011. The evolution of the medical standards and care of the Shuttle Era Astronauts began in 1959 with the fi rst [264] DEVELOPMENT OF SPACE SHUTTLE RESCUE Astronaut selection. The fi rst set of NASA minimal medical standards AND RECOVERY OPERATIONS were documented in 1977 and based on Air Force, Navy, Department M.R. CHANDLER1, R. PATLACH2, D.F. DOERR3, M.G. LINDE4 of Defense, and the Federal Aviation Administration standards. Many AND G. HOGGARD5 milestones were achieved over the 30 years from 1977 to 2007 and the 1 subsequent 13 Astronaut selections and 4 major expert panel reviews Medical Operations, NASA/Johnson Space Center, 2 performed by the NASA Flight Medicine Clinic, Aerospace Medicine Houston, TX; Wyle Integrated Science and Engineering, Board, and Medical Policy Board. These milestones of aerospace Houston, TX; 3NASA, Kennedy Space Center, FL; 4DCI-Services medicine standards, evaluations, and clinical care encompassed the and Consulting, Houston, TX; 5KSC Fire Services, NASA, disciplines of preventive, occupational, and primary care medicine Kennedy Space Center, FL and will be presented. The screening and retention standards, testing, and specialist evaluations evolved through periodic expert reviews, INTRODUCTION: As the fi rst Space Shuttle launch was still in evidence based medicine, and Astronaut medical care experience. our future, many from NASA, the Department of Defense (DoD) and The last decade of the Shuttle Program saw the development of NASA contractors were busy planning for not only a nominal launch the International Space Station (ISS) with further Space medicine and return, but contingency operations at the launch pad and landing collaboration and knowledge gained from our International Partners sites. Prior to the fi rst launch, detailed coordination, planning and (IP) from Russia, Canada, Japan, and the European Space Agencies. The simulations were conducted at all three locations and internal rescue Shuttle Program contribution to the development and implementation procedures were taught at Kennedy Space Center (KSC). Later in the of NASA and IP standards and waiver guide documents, longitudinal Program, the Transoceanic Abort Landing (TAL) sites were added in data collection, and occupational surveillance models will be Europe and Africa. For the 51L mission a new TAL site was brought presented along with lessons learned and recommendations for future on line in Morocco. However, upon launch, the Shuttle Program vehicles and missions. experienced it’s fi rst lost. During the following months a complete review of all contingency operations (launch and landing) was Learning Objectives: completed. Many enhancements were made based on the reviews 1 Understand the presented milestones of medical screening stan- following. A Mode VIII water rescue was developed for NASA by the dards and care during the Shuttle Program with lessons learned for DoD before the STS-26 launch. Different concepts were explored future Space missions and terrestrial applications. and being debated by NASA. Training of the contingency forces was required before fi nal decisions were made forcing the teaching of [262] SPACE SHUTTLE MEDICAL EQUIPMENT two different sets of procedures. To assist with training, a video was S. GILMORE, P.C. STEPANIAK, S.L. JOHNSTONIP: 192.168.39.151 On: Sun,developed 26 Sep for 2021 the fi 17:39:09re/crash/rescue personnel. This accompanied the AND M.R. CHANDLER Copyright: Aerospace Medicaldetailed extraction Association procedures that were developed by a combination Medical Operations, NASA/Johnson Space Center, Houston, TX of KSC and DoD fi remen. Training for the fi re/crash/rescue personnel at Delivered byVandenberg Ingenta AFB was also being planned before the accident happen. INTRODUCTION: During the 30 years of the space shuttle The fi re/crash/rescue mockup that was being built at Chanute AFB was program, the mission profi le change substantially. However, throughout diverted to Edwards AFB. the program, the medical mission remained unchanged and continued to provide for crew medical and operational needs that ensured crew Learning Objectives: health, safety and medical care. Changes to the medical equipment 1 With the emphasis on Commercial Crew Programs for space fl ight and consumables to support the evolving mission will be discussed. it is important that all involved understand what is required to Lessons learned for operations and sustaining the kits during the lifetime prepare for contingencies. Cost effective means of being prepared of the program will be presented. Recommendations for the design of for contingencies are needed. medical kits and support of crew for future programs will be provided. [265] BEHAVIORAL HEALTH AND PERFORMANCE Learning Objectives: OPERATIONS DURING THE SPACE SHUTTLE PROGRAM 1 1 2 1 Understand the components of Space Shuttle medical kit and what G. BEVEN , A.W. HOLLAND , R.C. MOOMAW , had been added during the program. Present medical equipment W. SIPES1 AND S.T. VANDERARK3 recommendations for future vehicles and their crews. 1Behavioral Health and Performance, NASA/Johnson Space Center, Houston, TX; 2The University of Texas Medical Branch, [263] MEDICAL OPERATIONS ASTRONAUT TRAINING Galveston, TX; 3Wyle Integrated Science and Engineering, P.C. STEPANIAK, S. GILMORE, S.L. JOHNSTON Houston, TX AND M.R. CHANDLER Medical Operations, NASA/Johnson Space Center, Houston, TX INTRODUCTION: Prior to the Columbia STS 107 disaster in 2003, the Johnson Space Center’s Behavioral Health and Performance INTRODUCTION: The Johnson Space Center’s Medical Group (BHP) became involved in Space Shuttle Operations on an Operations Branch was involved in the Space Shuttle Program for as needed basis, occasionally acting as a consultant and primarily astronaut medical care and training in preparation for space fl ight. addressing crew-crew personality confl icts. The BHP group also This training was conducted by operational fl ight surgeons and assisted with astronaut selection at every selection cycle beginning in biomedical engineers. Aspects on the physiological, psychological 1991. Following STS 107, an event that spawned an increased need of

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 283 ASMA 2012 MEETING ABSTRACTS behavioral health support to STS crew members and their dependants, Learning Objectives: BHP services to the Space Shuttle Program were enhanced beginning 1 The relationship between information throughput and MATB infor- with the STS 114 Return to Flight mission in 2005. These services mation rate is described. included the presence of BHP personnel at STS launches and landings for contingency support, a BHP briefi ng to the entire STS crew at L-11 [267] PRELIMINARY FIELD EVALUATION OF months, a private prefl ight meeting with the STS Commander at L-9 A SELF-ADMINISTERED FATIGUE SCREENING TOOL months, and the presence of a BHP consultant at the L-1.5 month Family Support Offi ce briefi ng to crew and family members. The later J. CHANDLER, R.D. ARNOLD, D.S. HORNING, development of an annual behavioral health assessment of all active A.E. TURNMIRE, B.M. HARTZLER AND C.B. SILL astronauts also augmented BHP’s Space Shuttle Program specifi c Naval Medical Research Unit - Dayton, services, allowing for private meetings with all STS crew members Wright-Patterson AFB, OH before and after each mission. The components of each facet of these BHP Space Shuttle Program support services will be presented, along INTRODUCTION: Fatigue continues to pose a serious threat with valuable lessons learned, and with recommendations for BHP to the health, safety, and operational effectiveness of military aircrew. involvement in future short duration space missions. Recent efforts to mitigate the effects of fatigue have focused on the identifi cation of individualized “readiness-to-fl y” screening measures. Learning Objectives: Oculometric indices, such as saccadic velocity in a simple visual 1 With the new focus on Commercial Space Vehicles for space fl ight, tracking task, have shown promise in the laboratory setting for their the human element is a critical piece of the system. It is important ability to detect and quantify fatigue-related performance decrements for all to understand the lessons learned from previous space in a military aviation population subjected to sleep restriction. vehicles, specifi cally the Space Transportation System. Selection Despite their effectiveness under controlled laboratory conditions, it of astronauts, training, and providing behavioral health services to is uncertain whether such tools are sensitive enough to detect subtle the astronauts and their families in Shuttle nominal and off nominal variations in fatigue resulting from nightly variability in sleep quantity. operations will assist future services to those professionals Objective: To assess the relationship between naturally varying sleep planning, supporting, and operating future space vehicles. quantity and oculometric indices of fatigue. METHODS: 34 volunteer fl ight students from Naval Air Station Pensacola participated. Subjects were equipped with actimeters (to track sleep) and enrolled in the PMI Tuesday, May 15 2:30 PM FIT 2000© eye-scanning system at the beginning of fl ight training. Exhibit Hall Subjects wore the actimeters for 9 - 12 weeks, and completed an eye-scan prior to each training fl ight. The relationships between naturally occurring sleep and oculometric measures were analyzed POSTER: HUMAN PERFORMANCE using correlation and survival analysis. RESULTS: Saccadic velocity AND PSYCHOPHYSIOLOGY was signifi cantly correlated with sleep quantity, but only among a subset of subjects with highly variable amounts of sleep each night. [266] INFORMATION THROUGHPUT AS A Preliminary survival analyses suggest that subjects exhibiting high variability in nightly sleep quantity were less compliant with study MULTI-TASKING PERFORMANCE METRIC FOR MULTIPLE-ATTRIBUTE-TASK-BATTERY (MATB) requirements. DISCUSSION: These preliminary results suggest that oculometric measures sensitive to fatigue in the laboratory may also C.A. PHILLIPS, C.M. WALTERS, D.B. REYNOLDS be sensitive to naturally occurring patterns of fatigue in an actual AND D.M. KENDER training context. Survival analyses indicate that subject attrition bias BIE, Wright State University, Dayton, OH may have produced range restriction in sleep quantity and oculometric measures. Thus, these results may underestimate a larger true effect. INTRODUCTION: The Multiple-Attribute-Task-Battery (MATB) Detailed compliance patterns are discussed to further frame this result. was developed by NASA and is one of the existing multiple task environments that can be used to evaluateIP: human 192.168.39.151 performance. On: Sun,Learning 26 Sep Objectives: 2021 17:39:09 Copyright: Aerospace Medical Association However, performance is relative to one or more of the six MATB test 1 The audience will gain an understanding of oculometric indices levels (easiest to hardest). Furthermore, the performance measuresDelivered by Ingentaused to quantify fatigue. for the individual tasks are variable. Metrics for the lights and dials 2 The audience will learn about current issues regarding the develop- (monitoring) include percentage of participants detecting failure, speed ment of “readiness-to-fl y” fatigue screening tools. of detection (reaction time). Metrics for channels and frequencies (communication) include reaction time and percentage responding. [268] EXAMINING FATIGUE ASSOCIATED WITH Tracking metrics are RMS error and time-on target. Resource management is RMS error from ideal fuel levels. This makes it diffi cult SCHEDULING PRACTICES AMONG AIR TRAFFIC to develop an overall measure of system performance. METHODS: CONTROLLERS 1 2 Hick-Hyman alternatives-of-choice (bits) was used to quantify spatial J. CRISTALDI AND A.V. PHAM information content for monitoring, communication and resource 1Embry-Riddle Aeronautical University, Daytona Beach, FL; management components of MATB. Temporal information was 2Florida International University, Miami, FL defi ned as the inter-stimulus- interval for the various component tasks. Targeting spatial information was defi ned by Fitts’ index-of-diffi culty INTRODUCTION: Fatigue is a weariness that affects one’s and temporal information defi ned by the cursor velocity movement work performance negatively. This is especially true among air off-center. By this method, information rate was defi ned for all traffi c controllers, who are responsible for the safety of passengers components as bits per second. Four levels of machine information and air crew. One factor usually overlooked in the air traffi c control rate were presented to subjects at 0.70, 1.21, 1.73 and 2.18 bits per environment is scheduling. Negative effects of fatigue include second (total input baud rate). Human information rate is defi ned by inability to stay awake, boredom, inability to maintain awareness, the fractional correct response to the machine input rate. RESULTS: and improper decision-making. The purpose of this pilot study was to For a group of 35 subjects at 0.70, 1.21, 1.73 and 2.18 bits per second examine the relationship between scheduling practices and fatigue in machine information rate, the group mean information throughput the air traffi c control environment. METHODS: Thirty-fi ve air traffi c was 0.81, 0.70, 0.59 and 0.51 respectively. The standard deviation at controllers completed an online survey to gather both quantitative each of the four information throughput levels was 0.03, 0.04, 0.04 and qualitative data about their level of fatigue in the workplace and and 0.04 respectively. DISCUSSION: This work indicates that an their perceptions on how current scheduling practices contribute to information throughput provides an overall measure for the four MATB their fatigue. Additional questions were asked to determine whether components. This overall measure of system performance is based upon participants believed current preventative measures were effective an information throughput model of the human-machine-interaction. in mitigating the effects of fatigue. RESULTS: Of the 35 participants,

284 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

97% responded that they experienced a high level of fatigue when INTRODUCTION: Technological advances have allowed working multiple shifts with minimal hours of rest between shifts. centrifuges to become more than physiological testing and Participants who worked a counter-clockwise rotation also reported training devices; sustained-G fully interactive fl ight simulation fewer hours of rest between shifts and lack of sleep. Additionally, 77% is now possible. However, head movements under G can result percent of participants responded not receiving adequate education in vestibular stimulation that can lead to motion sickness (MS) on preventative methods of dealing with fatigue. DISCUSSION: symptoms that are potentially distracting, nauseogenic, and Scheduling practices contributed to air traffi c controllers’ fatigue in limiting. In the current study an MS adaptation protocol was tested multiple ways. Participants who work on a counterclockwise rotation for head movements under Gz+. METHODS: Eight experienced reported sleep defi cit which contributed to fatigue in the workplace. aerobatic pilots made 14 predetermined head movements in a Recommendations from this study include scheduling adjustments sustained G fl ight simulator (at 3 Gz+) on fi ve consecutive days, such as incorporating midday shifts in their weekly schedule. and 17 days after training. Perception of motion artifacts and Improving education and knowledge of fatigue and integrating motion sickness symptoms were measured after each head turn breaks in the schedule can also prevent air traffi c controllers from using a subjective 0-10 MS and artifact scale. The Simulator experiencing high level of fatigue during work hours. Additional Sickness Questionnaire (SSQ) was also administered before and preventative measures will be discussed to address fatigue and after each daily training session. RESULTS: After fi ve daily training scheduling practices in the air traffi c controllers’ environment. sessions normalized mean MS scores were 58% lower than on day one. Mean total, nausea, and disorientation SSQ scores were Learning Objectives: 55%, 52%, and 78% lower, respectively. During retesting 17 days 1 The relationship between fatigue and scheduling practices among after training, nearly all scores indicated 90-100% retention of air traffi c controllers is described. training benefi ts. DISCUSSION: The reduction of motion artifacts and motion sickness symptoms associated with sustained-G fl ight simulation using an adaptation training protocol may enhance the [269] A LOW-COST OPTOKINETIC DRUM FOR effectiveness of simulation. Practical use of sustained-G simulators THE PRODUCTION OF VECTION is also likely to be interspersed with other types of ground and C. BRILL AND B.N. NEILSON in-fl ight training. Hence, lose of adaptation after a short gap in simulator use would limit the utility of such authentic tactical fl ight Department of Psychology, Old Dominion University, Norfolk, VA simulation. However, current results suggest that training gaps in excess of two weeks may be permissible with almost no loss of INTRODUCTION: Experimental investigations of motion adaptation training benefi ts. sickness require devices to present gravitoinertial acceleration, induce vection, or produce visual rearrangement. Vection is commonly Learning Objectives: produced by an optokinetic drum (OKD). The purpose of this 1 To understand how humans adapt to rotating environment investigation was to build a low-cost OKD capable of producing in order to improve training effi cacy for sustained-G fl ight motion sickness and sopite syndrome. METHODS: The OKD consists simulators of a steel wire-frame cylinder (4’ height, 4.75’ diameter) covered by white “blackout” fabric. The inner walls are lined with randomly placed 3” black fabric circles. The interior is illuminated, and lighting [271] THE RELATIONSHIP BETWEEN AIR SICKNESS is controlled by a dimmer switch. The cylinder is suspended and driven SYMPTOMS AND MARKSMANSHIP by a rheostat-controlled ceiling fan motor. Rotation speed varies from M. KING, C.M. WEBB, B. ERICKSON, A. ESTRADA, 12 to 25.5 RPM. An adjustable pneumatic chair is positioned inside J.R. ATHY AND A. KELLEY the OKD to standardize participant seated height. Three undergraduate psychology students at Old Dominion University were used to test US Army, USAARL, Ft. Rucker, AL the effectiveness of the design. Participants were exposed to vection INTRODUCTION: Marksmanship is an essential skill at 12 RPM for up to 10 minutes. Subjective responses were assessed IP: 192.168.39.151 On: Sun,in 26 military Sep forces.2021 Combat17:39:09 troops are often transported to the using the Mild Motion Questionnaire (MMQ) and the Motion Sickness Copyright: Aerospace Medicalbattlefi eld Association in rotary wing aircraft that can produce motion Questionnaire (MSQ) at three intervals: pre-exposure, immediate Delivered bysickness Ingenta symptoms in susceptible individuals. The present study post-exposure, and 15-min post-exposure. RESULTS: All participants investigated the relationship between motion sickness symptoms perceived vection after 2-3 minutes, once terminal velocity was following a nauseogenic helicopter fl ight and Soldiers’ basic achieved. One participant ceased participation after 9 minutes of rifl e marksmanship. METHODS: The study population consisted exposure. On average, MSQ and MMQ scores increased 14 points of 18 U.S. Army Active and Reserve Soldiers age 19 to 40 years and 7.5, respectively, from pre- exposure to immediate post- exposure. with a history of motion sickness susceptibility. They experienced From immediate post- exposure to 15-min post- exposure, average nauseating fl ights approximately 30 minutes in length and MSQ and MMQ scores dropped 8 and 19 points, respectively. completed a motion sickness questionnaire immediately following DISCUSSION: Our low-cost, low-technology OKD was effective for the fl ight. Marksmanship performance was also measured after the inducing vection and produced self-reported symptoms of motion fl ight using the Engagement Skills Trainer 2000, a computerized sickness within a short duration. However, greater variability was marksmanship simulator. RESULTS: Motion sickness symptoms observed for the production of sopite syndrome, possibly due to the after the fl ight were signifi cantly greater than symptoms at baseline. strength of the stimulus. A potential method for producing sopite There were signifi cant positive correlations between shooting syndrome might be to expose participants to vection for intermittent accuracy and total symptoms reported for the kneeling and prone intervals over a longer duration of time. unsupported positions. For the same two positions, there were Learning Objectives: signifi cant negative correlations between total symptoms reported and shot radius and root mean square error, respectively. There 1 To learn cost-effective approaches to studying motion sickness. were no signifi cant correlations in the prone supported position. DISCUSSION: These results suggest that motion sickness during [270] MOTION SICKNESS ADAPTATION TO air transport may not affect a person’s performance on a basic CORIOLIS-INDUCING HEAD MOVEMENTS IN marksmanship task. The alternative explanation could be a learning effect however; performance didn’t improve in all marksmanship A SUSTAINED-G FLIGHT SIMULATOR dependant measures. M. NEWMAN1, G.W. MCCARTHY1, S.T. GLASER1, F. BONATO2 AND A. BUBKA2 Learning Objectives: 1ETC, Southampton, PA; 2Human Perception and Performance 1 To understand that motion sickness symptoms are independent of Laboratory, Saint Peter’s College, Jersey City, NJ simulator marksmanship performance.

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 285 ASMA 2012 MEETING ABSTRACTS

[272] PULSE OXIMETRY AND VENTILATION unsafe due to decreased performance and alertness. As part of ongoing DATA DURING EXPOSURE TO 7620M (25,000 FEET) research into this issue, the object of this study was to develop a fi eld- NORMOBARIC HYPOXIA deployable helicopter-specifi c psychomotor vigilance test (PVT) for A. ROOD1, D. DIETRICH2, K. SPARKS4, D. DASHEVSKY1, the purpose of daily performance monitoring of pilots. METHODS: D. WAJDA1, J. MATEUS3, A. JOHNSON3 AND D. NEWMAN3 The PVT consists of a laptop computer, a hand-operated joystick 1 2 and a set of rudder pedals. Screen-based compensatory tracking task Orbital Research Inc, Cleveland, OH; NASA John Glenn software includes a tracking ball (operated by the joystick) which moves 3 Research Center, Cleveland, OH; Massachusetts Institute randomly in all directions, and a second tracking ball which moves of Technology, Cambridge, MA; 4Cleveland State University, horizontally (operated by the rudder pedals). The 5-minute test requires Cleveland, OH the pilot to keep both tracking balls centered. RESULTS: This helicopter- specifi c PVT’s portability and integrated data acquisition and storage INTRODUCTION: Hypoxia is a lack of oxygen content within system enables daily fi eld monitoring of the performance of individual the body’s tissues and vital human organs. Aviation mishaps are often helicopter pilots. The test allows tracking of a pilot’s psychomotor skill attributed to hypoxia. This reality was seen with the recent grounding performance as they become fatigued while on sustained operations. of the entire U.S. F-22 fl eet due to pilots experiencing apparent, but The inclusion of a simultaneous foot-operated tracking task ensures unquantifi ed, hypoxia symptoms. The symptoms of hypoxia are highly convergent validity for helicopter pilots as the movement of both individual and often go unrecognized until the subject has reached tracking balls requires control inputs similar to those of a helicopter the more advanced stages of the condition, making the early detection pilot on approach to landing. DISCUSSION: Countermeasures such as and prevention of hypoxia diffi cult.Orbital Research Inc. (ORI), NASA fl ight and duty time limitations and fatigue risk management systems Glenn Research Center (GRC) and university partners are developing (FRMS) are used to mitigate against the adverse effects of fatigue in the Pilot Physiologic Assessment System (PPAS) for the Naval Air aviation. However, these countermeasures do not specifi cally take into Systems Command. The PPAS is an aircraft independent monitoring account individual variation, environmental conditions or the high level system that will predict the onset of hypoxic state and alert the pilot. of sustained cognitive demand inherent in some dynamic helicopter The approach is to use non-invasive sensors to monitor the pilot and operations which may be detrimental to safety and performance. generate a warning signal based on systemic physiologic changes be This PVT enables fi eld monitoring of individual helicopter pilots’ associated with hypoxia. The purpose of this project is to develop a psychomotor performance on a daily basis. Data acquired from the monitoring system that can detect physiologic changes, predict the use of this test will help further our understanding of fatigue and its onset of symptoms and alert the user. Physiologic data collected during effects on helicopter pilot performance, and may lead to improved exposure to 7620 m normobaric hypoxia is presented. The collected countermeasures. data serves as input for the development of a hypoxia prediction algorithm. METHODS: Altitude was simulated through the use of Learning Objectives: Reduced Oxygen Breathing Device (ROBD, Tolland, CT) Subjects 1 The audience will learn about the development of a were exposed to a simulated ascent up to 7620 meters (25,000 feet). helicopter-specifi c Psychomotor Vigilance Test for fi eld monitoring A subsystem of the prototype PPAS collected HR, SPO2 and VE of pilot performance on a daily basis. throughout the exposure. RESULTS: 20 healthy males have completed the profi le. Data of HR, SPO2 and VE were processed with modifi ed [274] DEVELOPING A LATENT TRAIT MODEL TO PREDICT equations used originally to predict susceptibility of acute mountain SOPITE SYNDROME IN AEROSPACE SYSTEMS sickness (AMS). These modifi ed equations showed trends of prediction of hypoxia symptom/ loss of functional consciousness earlier then B.N. NEILSON AND C. BRILL SPO2 values alone. DISCUSSION: Data from the PPAS system suggest Department of Psychology, Old Dominion University, that physiologic changes may be tracked with a computational Norfolk, VA algorithm to provide a warning signal of an eminent hypoxic state. Future work will focus adding cognitive tests that verify the functional INTRODUCTION: Commonly cited sources of performance decrements in aerospace systems are fatigue, workload, and stress. impairments associated with hypoxia. ThisIP: will 192.168.39.151 allow validation of On: Sun, 26 Sep 2021 17:39:09 more complex algorithms for the prediction of hypoxia. An often overlooked contributor to performance decrements is sopite Copyright: Aerospace Medicalsyndrome, Association a response to motion characterized by intense drowsiness, Learning Objectives: Delivered by lethargy,Ingenta and decreased concentration. Other than previous incidences, 1 This poster is meant to describe the current status of the Pilot it is presently unknown what other factors predict sopite susceptibility. Physiologic Assessment(PPAS)System being developed by Orbital The purpose of this study was to determine the relationship between Research (Cleveland,Ohio).PPAS is meant to be ahypoxia potential predictors of self-reported sopite syndrome in order to monitoring system that can detect physiologic changes, predict the improve assessment methods. METHODS: Three hundred and forty- onset of symptoms, and alert the user. six undergraduate psychology students at Old Dominion University participated in an online study that included the Epworth Sleepiness Scale (ESS), Mild Motion Questionnaire (MMQ), and Motion Sickness Tuesday, May 15 2:30 PM Questionnaire (MSQ). Questionnaires were completed anonymously Exhibit Hall and administered simultaneously with medical history and demographic questionnaires. RESULTS: Multiple regression was used to predict MMQ composite scores based on ESS composite scores, MSQ composite POSTER: HUMAN PERFORMANCE: scores, and participant sex. All variables were entered simultaneously because there was no theoretical basis for considering any trait prior to OPERATIONAL INSIGHTS another. The model produced an R2 of .51, F(3, 342) = 118.82, p < .001. However, the only signifi cant predictor was MSQ composite scores, [273] DEVELOPMENT OF A FIELD-DEPLOYABLE t = 18.22, p < .001. ESS composite scores (t = 1.29, p = .198) and HELICOPTER PILOT PSYCHOMOTOR VIGILANCE TEST gender (t =1.20, p = .231) were not statistically signifi cant predictors. TO MONITOR PERFORMANCE DISCUSSION: Based on this study, motion sickness trait scores are the T.W. MCMAHON, P.J. BRUCE AND D.G. NEWMAN best predictor of sopite-like symptoms, as indicated by MMQ composite Aviation, Swinburne University, Hawthorn, VIC, Australia scores. Trait sleepiness and sex did not account for a signifi cant amount of variability among sopite-like symptoms. While other traits need INTRODUCTION: Flying a helicopter is a complex psychomotor to be measured and considered, this is the fi rst study to consider a skill. Fatigue is a serious threat to operational safety, particularly for predictive model for sopite syndrome. A predictive model of sopite sustained helicopter operations involving high levels of cognitive syndrome could be utilized to better screen individuals for susceptibility information processing and sustained time on task. An unresolved issue and eventually provide information for developing sopite syndrome is at what level of fatigue does an individual helicopter pilot become countermeasures.

286 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

Learning Objectives: equipment assembly (AEA) and protective clothing, particularly 1 To identify potential predictors of self-reported sopite syndrome for heavy textiles and armours. Crew adopted awkward postures to the improvement of assessment methods. perform routine load and cabin checks. DISCUSSION: Postures in Chinook and Puma were more complex and had a higher REBA [275] MONITORING OF PREFRONTAL OXYGEN STATUS score than those in C130, refl ecting the confi ned environment IN HELICOPTER TEST PILOTS USING NEAR-INFRARED and greater range of tasks conducted outside of RW aircraft. REBA assessment is currently being supplemented by human modeling to SPECTROSCOPY: EFFECTS OF AUTO FLIGHT CONTROL better prioritize MSD risk by task(s) and understand how these can SYSTEM ON COGNITIVE DEMAND DURING FLIGHT be mitigated through modifi cations to job-task, clothing A. KIKUKAWA, K. KURAMOTO, A. KOBAYASHI and / or training. AND Y. MIYAMOTO Aeromedical Laboratory, Japan Air Self-Defense Force, Learning Objectives: Tachikawa, Tokyo, Japan 1 To apply principles of observational task analysis to assist understanding of the routine risks faced by aircrew. INTRODUCTION: Near-infrared spectroscopy (NIRS) has emerged as an easily manageable non-invasive method for the [277] UK MOD AIRCREW CLOTHING AND ISSUED continuous monitoring of cerebral cortical oxygenation during EQUIPMENT - FINDINGS OF AN AIRCREW various cognitive tasks including helicopter mission fl ights. This study evaluates the effect of Auto Flight Control System (AFCS) on pilot’s PERCEPTION SURVEY prefrontal cortical responses during fl ight using NIRS. METHODS: V.M. LEE AND S. DAY Two male test pilots, who have 4934 hours and 1279 hours of QinetiQ, Farnborough, United Kingdom fl ying experiences, volunteered in this study to perform an in-fl ight examination of a light scout and observation helicopter, OH-1. Each INTRODUCTION: Maintaining aircrew effi ciency and pilot performed 12 sorties including 6 instrument fl ights and 6 level effectiveness in high tempo operational and non-operational turn fl ights, with and without Auto Flight Control System (AFCS). environments is dependant, in part, on the provision of clothing and items of personal survival equipment, (collectively referred During the fl ight, oxyhemoglobin (O2Hb) was continuously recorded from right side of the forehead using NIRS. Mean O Hb concentration to as Aircrew Equipment Assemblies (AEA)), that meet the specifi c 2 demands of the environment and the mission. In order to optimise changes (ΔO2Hb) from the baseline before starting maneuver were calculated at each fl ight phase (e.g. cruise, left and right turns). ECG future design and procurement of currently supplied AEA it is and head movements were also monitored during the fl ight. RESULTS: important to understand the user’s perceived shortfalls. The aim of There were signifi cant AFCS effects to keep ΔO Hb lower level in the this study was to understand any usability and comfort shortfalls 2 associated with all core items of AEA and issued equipment. less experienced pilot. The ΔO2Hb was signifi cantly lower in the level turn with AFCS (Mean 6SD of 0.9860.56 µmol ● L-1) than that without METHODS: An anonymous questionnaire was developed that AFCS (3.161.25µmol ● L-1). During the instrument fl ight, the AFCS covered all aspects of current in-service UK AEA (operational, reduced ΔO Hb by approximately one thirds in the less experienced non-operational and environment specifi c) including questions 2 pilots. In the experienced pilot, however no signifi cant AFCS effect was on discomfort and pain associated with use of an item, and how observed during the fl ight. There was no signifi cant change in the ECG any pain is manifested. The questionnaire was distributed to rotary recordings of either pilot. DISCUSSION: Our results demonstrated wing and multi-engine aircrew from eight UK fl ying units. The questionnaire was completed by 297 aircrew, comprising 188 AFCS may reduce the prefrontal O2Hb increase induced by the cognitive demand during the fl ight. The study also suggested NIRS may rotary wing (RW) and 91 multi engine (ME) aircrew. RESULTS: The provide a sensitive method for the monitoring of prefrontal activation comfort data associated with all items of equipment used within in helicopter pilots. the previous twelve months identifi ed that the following items of equipment resulted in discomfort and pain: Night Vision Devices Learning Objectives: (NVDs) (combined with a helmet), 53% RW and 32% ME aircrew IP: 192.168.39.151 On: Sun,reported 26 Sep comfort 2021 as 17:39:09 less than acceptable, and 69% of all aircrew 1 The audience will learn prefrontal oxygenationCopyright: changes during Aerospace Medical Association cognitive demands during helicopter fl ight. who had used NVDs associated pain or strain with their use; 45% Delivered byof Ingenta all aircrew associated their helmet with the development of pain [276] OBSERVATIONAL TASK ANALYSIS OF REAR AIRCREW or strain. Pain, that was rated as greater than moderate in severity, was attributed to the use of the helmet alone and the helmet USED TO PROVIDE EVIDENCE ON ERGONOMIC RISKS FOR with NVDs by 15% and 30% of the RW rearcrew respectively. MUSCULO-SKELETAL DISORDERS DISCUSSION: These results provide recent evidence from M. LLEWELLYN AND P. LONGMAN operational aircrew that supports previous studies in indicating the QinetiQ Ltd, Farnborough, United Kingdom ongoing need to investigate methods to optimize head-mounted equipment mass properties. INTRODUCTION: The UK Ministry of Defence aims to minimize the risk of occupational Musculo-Skeletal Disorders Learning Objectives: (MSD) in all aircrew. The purpose of this study was to use 1 To understand UK aircrew perceptions associated with comfort of observational task analysis, based on review of video recordings of UK AEA. rotary wing (RW) and multi-engine (ME) aircrew activities during fl ight, in order to characterize tasks and the impact that posture, [278] HEIGHT AND LOW BACK PAIN ASSOCIATION load and environment has on injury risk. METHODS: A range of AMONG NAVY HELICOPTER PILOTS fl ights, crews and operationally-relevant roles were monitored over 1,3 2 a total of 60 hours of fl ight. Aircrew operating in the rear of RW C. ORSELLO AND A. PHILLIPS 1 2 (Chinook Mk2/2A, Puma Mk1) and ME aircraft (C130-J) with current Naval Aerospace Medicine Institute, Pensacola, FL; Naval high operational usage were fi lmed. Video sequences were selected Postgraduate School, Monterey, CA; 3University of West Florida and encoded using Observer XT software (Noldus Information School of Public Health, Pensacola, FL Technologies), and a Rapid Entire Body Assessment (REBA) was conducted based on posture(s), load, coupling and repetition. REBA INTRODUCTION: Low-back pain among helicopter pilots is a scoring scheme widely used as a means to assess posture for is a well-recognized problem, with prevalence ranging from 61 risk of work-related MSDs. RESULTS: REBA scores revealed that RW to over 80%. Studies indicate association with total fl ight hour environment was especially demanding of crew, with some periods exposure, and lack of association with height or body-mass-index spent in posture(s) with REBA scores of 11-15 (Risk Level = Very (BMI); however those that have excluded pilots with back injuries High). Additional limitations on movement resulted from aircrew unrelated to fl ying are limited. METHODS: Data analyzed in this

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 287 ASMA 2012 MEETING ABSTRACTS study was obtained from a population-based survey by Phillips Tuesday, May 15 2:30 PM in 2011 of 642 Navy helicopter pilots. This study was previously Exhibit Hall approved by Naval Postgraduate Institutional Review Board prior to administration. 83 pilots or 12.9% who reported back injuries unrelated to fl ying, and 5 without necessary data were excluded POSTER: PUSHING THE ENVELOPE from the study; yielding a fi nal n=554. Statistical analysis was IN VISUAL ASSESSMENT performed with logistic regression for body height, BMI, and total fl ight hours on signifi cant back pain (>30% of each fl ight) versus [280] MONTE CARLO SIMULATION OF FOUR CONTRAST not; with chi-square analysis on median split of each, and ANOVA on helicopter airframes. RESULTS: BMI and total fl ight hours were THRESHOLD ESTIMATION TECHNIQUES: CLINICAL VISION not related to likelihood of signifi cant back pain during fl ight, TEST SELECTION FOR OPERATIONALLY-BASED VISION but male body height was positively related (p=0.48, p=0.072, ASSESSMENT n=554; p<0.016, n=498; respectively). Those equal or taller than M. WINTERBOTTOM1, J.P. GASKA1, S.T. WRIGHT2 median height had twice the odds (p=0.0008; OR: 2.092, 99%CI, AND J.M. GOOCH1 1.18 to 3.71; n=498). There were no differences in mean back 1USAF School of Aerospace Medicine, Wright-Patterson AFB, OH; pain frequencies reported between pilots with greatest exposures 2TASC, Inc., Wright-Patterson AFB, OH to airframes H-60, TH-57, H-53, or H-46 (p=0.99, n=554). DISCUSSION: Although caution should be used when interpreting INTRODUCTION: The USAF School of Aerospace Medicine this survey based study, the data implies that ergonomic stressors (USAFSAM) is testing computer-based vision screening methods for capable of adversely impacting lumbar symmetry, such as fl ight aircrew. Traditionally, this involved the use of paper charts; however, control geometry, may be a predominant factor in back pain during newer methods use digital displays. USAFSAM is also assessing fl ight. Signifi cant prevalence rates may persist in the absence of vision-testing procedures for Operationally-Based Vision Assessment design enhancements specifi c to the mitigation of these stressors. (OBVA), where the goal is to research quantitative relationships CONCLUSION: This data suggest that male Navy helicopter pilots between clinical tests and operational performance. Thus the accuracy who are equal or taller than median (71 inches) have twice the and test-retest reliability of the clinical test is of utmost importance. odds of suffering from back pain during at least 30% of each Using a Monte Carlo simulation approach, we evaluated test-retest fl ight as compared to those shorter. Further analysis on reliability of four methods of estimating contrast thresholds: 1) anthropometric measurements with prospective designs traditional chart (method of descending limits), 2) customized staircase, and preventive strategies are needed for this very common 3) QUEST, and 4) traditional staircase. METHODS: The trial-by-trial aeromedical concern. identifi cation accuracy of a simulated observer was computed using a Weibull psychometric function and a weighted coin fl ip. The sensitivity Learning Objectives: parameter of the Weibull was defi ned to simulate contrast thresholds of 1 Review related research fi ndings and discuss lumbar spine both normal and color defi cient observers. Each threshold estimation imaging abnormalities commonly cited among helicopter pilots procedure was simulated 1,000 times. RESULTS: In terms of both with low-back pain accuracy and test-retest reliability the QUEST method was the superior 2 Discuss recent spine biomechanical research fi ndings with respect method, resulting in an average error, relative to the known threshold to mechanical stressors involved in pathophysiology levels, of about 0.1%, and a 95% confi dence interval of less than 3 Consider how fl ight control geometry obligates the lumbar disc +/- 0.02. For comparison, we chose a QUEST trial size of 10. Errors and vertebral endplates of the seated helicopter pilot to these for the other 3 methods ranged from about 5 to 12%. However, these mechanical stressors differences may refl ect the fact that the various methods converge to differing levels of probability correct. Test-retest reliability of the [279] AIR FORCE HUMAN SYSTEMS INTEGRATION: other 3 methods, in terms of 95% confi dence interval, ranged from CLOSING THE CAP GAP 18% to 200% larger than those obtained for the QUEST method. J. SCOTT IP: 192.168.39.151 On: Sun,DISCUSSION: 26 Sep 2021 The 17:39:09 Monte Carlo approach allowed us to compare SAF/AQ-AFHSIO, USAF, Joint Base Andrews,Copyright: MD Aerospace Medicalthreshold Association estimation procedures without fatigue, lapses of attention, Delivered by etc.Ingenta affecting the results. Thus, any differences in accuracy or reliability can be attributed to the threshold estimation techniques themselves. INTRODUCTION: This presentation will discuss Human The QUEST procedure resulted in very good test-retest reliability in Systems Integration (HSI) activities in Air Force (AF) requirements comparison to the other 3 methods. Implications of these fi ndings for and acquisition processes and how the Offi ce of the Air Force clinical screening and for OBVA are discussed. Surgeon General (AF/SG) and the Offi ce of the Assistant Secretary of the Air Force for Acquisition (SAF/AQ) support these processes. Learning Objectives: Air Force Instruction (AFI) 48-101, Aerospace Medicine Operations, directs Team Aerospace (TA) to identify and document Human 1 Advantages and disadvantages of different threshold estimation Weapons System Capability Gaps (CAP GAPs) for fi elded weapons techniques available for use for clinical vision screening. systems. Despite good intentions and noble purpose, this CAP GAP process doesn’t have a mechanism to feed TA’s observations and [281] VALIDATION OF A COMPUTERIZED analyses back to the weapon system program offi ce. AFI 63-131, COLOR VISION TEST Modifi cation Program Management, explains the formal Air Force D. PICKEN, W. MANN AND M. RINGS process to identify, vet, route, approve, and fund modifi cations to NAMI, Pensacola, FL fi elded weapons systems. This process starts at the warfi ghter, goes up through the Major Command (MAJCOM), and to the program INTRODUCTION: Currently most civilian and military offi ce to implement fl eet-wide corrective action. This presentation aeromedical vision testing centers use a combination of the will explain the process described in AFI 63-131 so TA personnel pseudoisochromatic plates (PIP) and the Farnsworth Lantern can execute the CAP GAP intention and purpose as directed by (FALANT) to screen for color vision discrepancies in aviation AFI 48-101. applicants. Although these screening tests are useful they do have limitations. With existing tests subjects may fail the PIP but pass Learning Objectives: the FALANT, both of which are subject to operator errors (lighting, 1 The audience will learn about the Air Force acquisition process to timing, fading), memorization, and fail to delineate the type modify in-service weapon systems. and degree of color defi ciency. The Naval Aerospace Medicine 2 The audience will learn how Air Force Medical Service personnel Institute (NAMI) has developed a novel Computerized Color Vision optimize, sustain, and enhance human performance through the Test (CCVT) that detects, classifi es, and quantifi es the degree integration of human capabilities with systems. of color vision defi ciencies. Our study compares the sensitivity

288 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS and specifi city of the CCVT with current color vision screening [283] FAMILIAL ASSESSMENT OF PROTAN COLOR tests. METHODS: Twenty color defi cient aviation applicants who DEFICIENCY fail the PIP test will be tested with the FALANT and the CCVT. V. WONG2, J. RABIN1, J. BOSTER2, M. RUELLE2, T. TRAN2, Fifty consecutive controls will also be tested with the three tests. B. STEWART2, J.M. GOOCH3 AND S.T. WRIGHT3 Color defi ciency and normal color vision will be confi rmed with 1UIWRSO/USAFSAM, San Antonio, TX; 2UIWRSO, the Nagel Anomaloscope. Comparison of the tests will be done 3 utilizing a Chi square analysis. RESULTS: As part of an applicant San Antonio, TX; USAFSAM, Dayton, OH examination clinical process improvement the CCVT was tested on normal color vision and color defi cient applicants. Applicants INTRODUCTION: Hereditary color defi ciency affects 8% of who passed the PIP and FALANT were found to have normal color males and 0.5% of females. Among the 8% with red or green color vision using the CCVT. The CCVT correctly identifi ed color defi cient defi ciency, 6% have green (deutan) defi ciency of varying severity applicants, as confi rmed by the Nagel Anomaloscope. The CCVT while 2% have red (protan defi ciency) also varying from mild to appears to be a more sensitive test and removes operator error. severe. Hence protan defi ciency is uncommon particularly in females. DISCUSSION: Initial fi ndings have shown the CCVT to be a valid We encountered a rare opportunity to evaluate an entire family test that accurately determines normal color vision or the type and with protan color defi ciency. Herein we compare and contrast their degree of color defi ciency. These fi ndings suggest that the CCVT will fi ndings on multiple color tests and consider how experience and provide more accurate and standardized testing ensuring the proper familial environment may impact awareness of color perception and disposition of aviation applicants. More formalized studies of the performance. METHODS: A family of Asian descent consisting of the CCVT are currently underway and will be discussed along with the father (age 62), mother (age 59), daughter (age 25) and son (age 19) preliminary fi ndings during the conference. were evaluated as subjects in an IRB approved color vision protocol. All were in good general health and free of signifi cant eye disease. Learning Objectives: All patients were evaluated with Dvorine, Ishihara, and HRR pseudo- isochromatic plate (PIP) tests as well as the Cone Contrast Test (CCT), 1 To learn about a new computerized color vision test and how it a computer-based test which diagnoses type and severity of color compares to existing tests for color vision screeing in aviation ap- defi ciency. CCT data were collected under multiple test conditions plicants (extended contrast range, binocular vs. monocular) as part of the larger protocol and included color reaction time data for all subjects. [282] INFERRED EFFECT OF SPHERICAL ABERRATION RESULTS: All family members failed PIP tests with the HRR indicating ON VISUAL ACUITY AS MEASURED BY THE RABIN SMALL protan defi ciency in 3 of 4 members (one case undetermined due to LETTER CONTRAST TEST (SLCT) a passing score on HRR diagnostic series). All subjects exhibited a M. LATTIMORE selective decrease on the red cone CCT with normal values on green USAARL, Fort Rucker, AL and blue cone tests confi rming the diagnosis of protan defi ciency. A spectrum of severity was observed among family members indicating INTRODUCTION: Twenty volunteer Soldiers were examined different degrees of protanomaly. Reaction time was selectively in preparation for possible treatment of their myopia by photo- increased on red CCT tests. DISCUSSION: Protanomalous color refractive keratectomy (PRK). As a part of this baseline examination, defi ciency, albeit rare, can manifest in both males and females manifest and cycloplegic refractions were performed, in order to impacting color perception, brightness sense for long wavelengths, as insure an accurate degree of ablation was programmed and achieved. well as occupational performance and well-being. In circumstances Spherical aberration can have a mildly adverse effect on visual acuity where all family members share a common color defi ciency, as measured with the Snellen Chart. However, the effect of spherical awareness of color choice and confusions may be less pervasive aberration upon other aspects of vision, such as contrast sensitivity, leading to unique adaptation strategies to cope with color defi ciency. is largely unknown. In this instance, a fi xed amount of spherical aberration was induced via the cycloplegic/dilation process (all pupils Learning Objectives: dilated to at least 8 mm). Spherical aberration can be established as a 1 To understand what protan color defi ciency is. base element upon which less noticeableIP: aberrations 192.168.39.151 can later be built,On: Sun,2 26 To Sepcomprehend 2021 17:39:09the prevalence of color defi ciency. when modeling the optical qualities of the visualCopyright: system. METHODS: Aerospace Medical3 To understand Association color confusions by protan observers. The chart uses a uniform, 20/25 letter-size , with log unit decrementsDelivered by Ingenta in contrast, progressing from the top line downward. Applying a [284] NEUROFUNCTIONAL ACTIVATION OF display of 10 letters per line, combined with the 1 log-unit sequential contrast defi cits, provides a logMAR scoring system which permits HUMAN VISUAL CORTEX IN AMBLYOPIA INDUCED continuous variable data analysis, something traditional Snellen BY S/NRI TREATMENT AND SENSORY STIMULATION: acuity (as a discrete variable) does not afford. The 20 patients were A CASE REPORT refracted to best visual acuity under both manifest and cycloplegic S. IZZO, G. ARDUINO, D. DI BLASIO AND D. DI MEGLIO conditions, with SLCT contrast acuity measurements recorded in the Aviation Medicine Institute, Italian Air Force, Rome, Italy LOGMAR format. RESULTS: Mean manifest contrast acuity was 1.159 +/- 0.006; the mean cycloplegic contrast acuity was 1.006 +/- 0.008. INTRODUCTION: Neurogenesis/synaptogenesis and increased In descriptive terms, this represents a loss of 1.5 lines in contrast acuity Brain Derived Neurotrophic Factor(BDNF)expression has been under the cycloplegic condition compared to the manifest baseline. demonstrated after long term antidepressant(ADs)use. Restored A paired t-test demonstrated the visual sensitivity responses for the plasticity has been found in the visual cortex of amblyopic adults two conditions to be signifi cantly different (p<0.0001). DISCUSSION: rodents treated with SSRIs. Amblyopia,or“lazy eye”, consists of poor Clearly, the Rabin SLCT is able to elicit subtle contrast sensitivity vision in one eye due to the incomplete growth of the neuronal functional losses at a level previously unavailable. Moreover, the network in the corresponding brain cortex. These evidences suggested impact can be measured in a statistically graduated fashion, and to focus our attention on a 43 years old male, left amblyopic,also therefore modeled. Such modeling will be extended to a combined treated with Duloxetine,a Serotonin/Noradrenaline RI AD)60mg/ analysis of a series of complex, ablated corneal surfaces, using the eye day for “mild dysthymia”. METHODS: Measurements at T0 and as a sub-unit of varied military optical systems (e.g., NVGs, rifl e scope, T1(18 months)of: Eyesight,UC/BCVA in left eye; Visual Evoked binoculars). Potentials(VEPs)with pattern reversal chek-size of 15° and 60°(minute of arc). Recommendations: two hours of daily visual stimulation Learning Objectives: (watching TV) for the amblyopic eye and Duloxetine 60 mg/ die,for 1 To illustrate the effect of spherical aberration upon contrast sensitivity at least 15 months. RESULTS: Measures at T1 showed:increase of 2 To demonstrate the sensitivity of the Rabin SLCT BCVA from 4/10 to 7/10 in the amblyopic eye;increase of VEPs 3 To establish a framework for consideration as to why the eye should N75-P100 Amplitude in µV from 0.42to 4.14 and from 3.76 to 5.57 be portrayed as a subset of an optical system in patterns 15°/60°; decrease of VEPs P100 Latency peak time in

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 289 ASMA 2012 MEETING ABSTRACTS msec from 117.77 to 111.91 and from 112.5 to 102.5 in patterns Tuesday, May 15 4:00 PM 15°/60°. Remission of the dysthymic symptoms. DISCUSSION: In the case observed,the increased Eyesight and VEPs N75-P 100 and the Ballroom C decreased VEPs P100 at T1 in left eye BCVA, if compared to the values at T0, can be related to a stabilized synaptic enhancement within SLIDE: VISION STRESSORS IN THE the visual cortical area,as observed after 3 months from the stop of AD intake and stimulation.Thus,the lower Latency and the increased AEROSPACE ENVIRONMENT Amplitude improve the global phototransduction mechanisms.The results confi rm other experimental fi ndings and gives evidence that 4:00 pm also the human adult’s neuronal cortex can be activated for its natural/ [286] THE EFFECT OF ILLUMINATION, VIBRATION AND specifi c function through the mechanism of neuroplasticity,likely enhanced by an S/NRI AD related production of BDNF and the active HYPOXIA RELATED TO HELICOPTER OPERATIONS ON visual-sensory stimulation. Since an adaptation seem to occur also CONTRAST SENSITIVITY 1 1 2 in cortical area never properly developed before or considered as T. STRAND , B. HAUGHOM , B. BJØRLAND irreversible, as the amblyopic one, a potential clinical application AND V.F. KOEFOED3 might be investigated in neurological conditions where the network/ 1Institute of Aviation Medicine, Oslo, Norway; 2University of functions are unexpressed or compromised. Oslo, Oslo Norway; 3University of Bergen, Oslo, Norway

Learning Objectives: INTRODUCTION: Contrast sensitivity is important for visual 1 The concept of neuroplasticity might have clinical applications in function and it is affected by illumination. However the effect of ophthalmology vibration and hypoxia experienced in helicopter operations in relation 2 New possible combined treatment for amblyopia in adulthood to different light settings is not known. This study aims to explore this relationship. METHODS: 16 subjects with uncorrected or corrected visual acuity at minimum 1.0 (20/20) Snellen units underwent a Tuesday, May 15 4:00 PM contrast sensitivity test on a Tomey TCP-2000A chart panel in 5 Ballroom A different light settings (0.02, 0.12, 0.22, 1.5 and 54.0 lux). They were in randomized order also exposed to hypoxia corresponding to 0.69 atm (mean SpO2 values = 91%) and vibration in the z-axis frequency PANEL: RESIDENTS IN AEROSPACE 17Hz with amplitude 1ms-2 alone and in combination. The sum MEDICINE (RAM) BOWL 2012 of the score value from the 5 single frequencies of the CS test was calculated and a general linear model (GLM) procedure was carried out to identify the effect of the different factors. RESULTS: The effect [285] RESIDENTS IN AEROSPACE of the different light settings in incremental order with scotopic (0.02 MEDICINE (RAM) BOWL 2012 lux) as reference was 153.7 for 0.12 lux, 177.8 for 0.22 lux and 336.2 R. JOHNSON1,8, A.J. PARMET2, J. STEPANEK3, N.S. ERIKSON4, for photopic conditions (54 lux), p<0.001. Vibration gave a signifi cant 5 6 7 8 D. RHODES , F. SAHIAR , S. SAUER AND R.T. JENNINGS negative effect of -22.8, p=0.031. Hypoxia at this level was not found 1FAA/ CAMI, Oklahoma CIty, OK; 2University of Kansas, important (p=0.14). DISCUSSION: Vibrations from a typical helicopter 3 4 signifi cantly decreases contrast sensitivity. The effect on contrast Kansas City, KS; Mayo Clinic, Scottsdale, AZ; US Navy, NAMI, Pensacola, FL; 5USAF, USAFSAM, Dayton, OH; sensitivity corresponds to that of a reduction in illumination from 0.22 to 0.12 lux. 6Wright State University, Dayton, OH; 7US Army, 8 Pensacola, FL; UTMB, Galveston, TX Learning Objectives: 1 Which factor (illumination, vibration and hypoxia) during a typical INTRODUCTION: Aerospace medicine residents must acquire helicopter operation has the largest infl uence on contrast sensitivity? multiple competencies to satisfy the requirementsIP: 192.168.39.151 of the ACGME On: Sun, 26 Sep 2021 17:39:09 and the ABPM to serve as qualifi ed specialists Copyright:in the fi eld. Multiple Aerospace Medical Association tools are available for developing appropriate didactic knowledgeDelivered in by 4:15Ingenta pm aerospace medicine, and academic competition furthers aerospace [287] USE OF 3-HYDROXYKYNURENINE (3HKG) medicine education. This session includes competition between teams FOR PREVENTING THE PHOTO-PROCESSING of current residents from aerospace medicine residency programs, DAMAGE IN FLIGHT and teams are invited from the programs at the U.S. Air Force, U.S. D. DI BLASIO1, E. TOMAO2 AND N. PESCOSOLIDO3 Navy/Army, Wright State University, and University of Texas Medical 1 Branch. METHODS: Teams will compete in College Bowl format Main Medical Wing, Italian Air Force - Logistic Command, 2 that tests aerospace medicine specialty competencies, certain core Villafranca AB, Italy; Health Service, Italian Air Force - Logistic competencies, recall speed, and teamwork. Questions are toss ups Command, Rome, Italy; 31st Medical School - Aging Sciences, followed by a bonus question for the team capturing the toss up. Rome University, Rome, Italy Toss up questions are based on speed and individual knowledge, and the bonus questions stress teamwork, knowledge, and effective INTRODUCTION: The human eye, mainly during fl ight, is communication. Topics include the specialty aerospace medicine exposed to sunlight and artifi cial lighting: UV-B, UV-A, and blue competencies such as the fl ight environment (atmosphere, radiation, light. Damage to the young and adult eye by intense ambient light vibration, acceleration, microgravity), clinical aerospace medicine, is generally avoided because the eye is protected by a very effi cient aircraft and space vehicle systems/operations, aerospace physiology, antioxidant system. In addition, there are protective pigments such as human factors/ergonomics, selection and retention medical standards, the kynurenines, located in the human lens, and melanin, in the uvea crash protection/restraint systems, mishap prevention, safety, and and retina, which absorb ambient radiation and dissipate its energy accident investigation, Federal Aviation Regulations, and aeromedical without causing damage. According to this theory, particularly the transport. Also covered will be passenger acceptance criteria, escape exposure to blue and ultraviolet light can induce the production of free systems, fatigue, cockpit resource management, and the history of radicals. So far, a large variety of methods have been developed for the aerospace medicine. CONCLUSIONS: This session offers fast-paced prevention, both pharmacological and physical, with unpredictable competition that covers the breadth of the specialty competencies and unsatisfactory results. METHODS: We analyzed a new substance, expected of an aerospace medicine practitioner. The winning team will 3-Hydroxykynurenine (3HKG), a metabolite of tryptophan, which be crowned the 2012 RAM Bowl Champion and receive the Louis H. fi lters UV light in the human lens, which theoretically can prevent the Bauer trophy. Those attending will experience an extensive review of free radicals damage. The fi rst question was to ensure that its topical current aerospace medicine topics. preparation crosses the corneal surface and reaches the eye anterior

290 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS chamber. We used rats for experiments placed in a closed cage. The Learning Objectives: Right Eye was treated topically with two drops of 3HKG; 5 minutes 1 The effect of altitude on the Ocular Muscle Balance has got a after the administration, aqueous humour was taken from the anterior direct bearing on depth perception which will have an effect on chamber. Other rats were treated the same way, at different times of the landing performance at high altitude areas. administration. The liquid removed from the anterior chamber was 2 It makes a strong case for the improvement of oxygen management then analyzed by spectrophotometric investigation. RESULTS: We for the pilots fl ying over high altitude areas in an unpressurised evaluated the penetrance of 3HKG, using the absorbance of blue helicopter cockpit with a rudimentary oxygen system. UV light. The initial spectrophotometric uptake was detected, as administered 3HKG after 10 minutes. The maximum absorption was obtained after 20 minutes of treatment (0.2168 Abs). The maximum 4:45 pm fl ow at 20 ‘ was approximately 20% of the initial concentration and [289] SPATIAL CHARACTERISTICS OF CONTRAST the total amount absorbed represented about 45% of the total one SENSITIVITY IN MILITARY PILOTS administered. DISCUSSION: The results obtained showed that the R. ZHAO AND E. P.WANG maximum absorption is achieved between 20 and 45 minutes. In Ophthalmology Department, General Hospital of the Air Force, conclusion, antioxidants such as 3HKG penetrate into the aqueous Beijing, China humour and might play the expected protective role during prolonged fl ights, in order to defend the eyes from excessive exposure to harmful INTRODUCTION: To test the contrast sensitivity(CS) in military UV-B, UV-A and blue light radiation, sources of keratopathy, cataracts pilots so as to obtain reference values. METHODS: The contrast and macular degeneration. sensitivity was recorded in 73 pilots (146 eyes) with CSF-1000(Vector vision Corp, USA), under photopic,scotopic and scotopic+glare Learning Objectives: environments.The different spatial frequencies(3,6,12,18cpd) were 1 The eye is the organ most susceptible to sunlight induced compared on gender, eyes, aircraft type. RESULTS: The contrast damage. While light transmission through the eye is fundamental sensitivity function in military pilots at the spatial frequency of 6cpd to its unique biological functions of directing vision and circadian was best. There was no signifi cant difference between eyes, and rhythm, at the same time exposure to the intense light of the sun the aircraft (fi ghter and transporter). There was a decline in the CS can correspond to a particular hazard: it can lead to impaired of all spatial frequencies in photopic,scotopic and scotopic+glare vision and eventually, blindness. Such exposure can come with environments. The 3cpd and 18cpd of scotopic and scotopic+glare outdoor employment as well as living at low latitudes or high conditions were not different apparently while remains were altitudes. statistically signifi cant different (P<0.05). The CSF of various spatial frequencies in female pilots was better signifi cantly than in male (P<0.05), except photopic 12cpd and 18cpd. DISCUSSION: The spatial 4:30 pm characteristics of contrast sensitivity in military pilots are detected, which [288] STUDY OF OCULAR MUSCLE BALANCE IN may provide reliable reference values for aeromedical service. SIMULATED HYPOBARIC HYPOXIA B. RAJ AND K.K. TRIPATHI Learning Objectives: Dept of Acceleration Physiology & Spatial Orientation, IAM, 1 Vision contrast sensitivity IAF, Bangalore, India 5:00 pm INTRODUCTION: Vision is the foremost aid in aviation.One [290] FIFTY YEARS OF OPHTHALMOLOGY AND VISUAL of the attributes of vision is an adequate ocular muscle balance, which is an essential determinant of binocularity. A good ocular SCIENCE AT THE USAF SCHOOL OF AEROSPACE MEDICINE 1 2 muscle balance and binocularity are essential for fl ying performance T.J. TREDICI AND D.J. IVAN 1 in terms of adequate depth perception. Hypoxic exposures are Department of Ophthalmology, University of Texas Health known to affect ocular muscle balance. IP:The 192.168.39.151present study examined On: Sun,Science 26 Sep Center, 2021 San 17:39:09 Antonio, TX; 2ADI Consultants, ocular muscle balance after exposure of subjectsCopyright: to 10,000’ Aerospace and MedicalSan Antonio, Association TX 18,000’ in an altitude chamber for a period of 30min and 15Delivered by Ingenta min respectively. METHODS: Fifteen healthy, male, non smokers INTRODUCTION: This paper presents a brief review that volunteered for the study. Subjects were ascertained to be healthy documents historically the notable contributions of the Aerospace through a detailed history and a general & systemic examination. Ophthalmology Branch of the USAF School of Aerospace Medicine Experiment was in the form of serial measurements (repeated (USAFSAM) at Brooks AFB to aviation visual science in support of measure or within subject design) involving evaluation of subjects national defense. METHODS: Branch records, publications and for accommodation, convergence (both subjective & objective) and personal recollections were utilized in compiling this paper. RESULTS: lateral phoria (both at 33 cm & 6 m) at ground level at, altitudes The original aviation medical laboratory at Mineola, New York in 1918 of 10,000’ and 18,000’ on two occasions and during recovery. considered vision of critical importance in fl ying, a lesson learned The minimum time which elapsed between recordings for the two during World War I that remains equally valid today. Those early altitudes was 24 hours. RESULTS: No effect of altitude was seen in beginnings established the foundations upon which Branch personnel subjective convergence (F=1.858; p= 0.177) and lateral phoria at 33 began to perform laboratory and clinical vision research in support of cm measured with Maddox Wing (F=2.240; p= 0.152). There was a early US military aviators. Over the years, USAFSAM established itself signifi cant effect of altitude (18,000’) on the objective convergence as an internationally renowned center of aeromedical excellence, a (F=5.094; p= 0.02), accommodation (F= 5.61; p= 0.02) and lateral key component of which was the Aerospace Ophthalmology Branch. phoria at 6 m (F= 7.020; p= 0.00).However, the effect of altitude of This paper will address the major contributions of the Branch over the 10,000’ was not signifi cant on the objective convergence (p= 0.06). last fi fty years, including those research projects that dealt with the The level of signifi cance at 10,000’ for accommodation was p= 0.04 visual effects of electromagnetic radiation from nuclear weapons and and that of lateral phoria at 6 m was highly signifi cant at p= 0.01. lasers, as well as the protective devices developed to counter those DISCUSSION: Signifi cant changes were observed in subjective threats. In addition, advances in clinical ophthalmology were carefully convergence and accommodation at 18,000’ and in lateral phoria studied and applied to the military aviator resulting in over 75% for 6 m both at 10,000’ and 18,000’. These changes, even though of aircrew with certain ocular pathologies being safely returned to signifi cant in statistical terms, were well within the acceptable range aviation duties. Similarly, new optical devices, such as contact lenses, of these attributes for the employment of individuals for fl ying related and surgical techniques, such as cataract and refractive procedures, duties.Nevertheless, in view of an empirical association of ocular preserved fl ying careers and successfully opened the fi eld of military muscle balance with the depth perception ability, a degradation in aviation to a large segment of previously restricted applicants. the latter is surmised. DISCUSSION: From 1960 to 2010, the Aerospace Ophthalmology

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 291 ASMA 2012 MEETING ABSTRACTS

Branch was one of the most prolifi c research units of USAFSAM and INTRODUCTION: During high +Gz loads, pilots may the USAF with over 690 publications and 812 major presentations experience arm pain; when fl ying the Gripen aircraft predominantly produced, a noteworthy contribution to visual science, the safety of in the distal part of the upper left arm. It is commonly assumed that aviators, the mission of the USAF, and to national defense. such pain is caused by pressure distension of blood vessels and that vascular distensibility adapts to meet the demands set by the prevailing Learning Objectives: transmural pressure. The aim was to investigate whether a few weeks 1 The visual problems encountered by USAF aviators and the of vascular pressure habituation is as effi cient in alleviating G-induced techniques and programs utilized in solving them is described. arm pain as using local counter-pressure/support garments around the arm. METHODS: In series I, 7 subjects underwent a 5-week pressure habituation (PH) regimen, consisting of fi fteen 40-min sessions, Tuesday, May 15 4:00 PM during which local intravascular pressures in one arm were elevated Ballroom D by 65-105 mmHg. Before and after PH, G-induced arm pain was determined during incremental +Gz-load exposures in a centrifuge. In series II, the effect on G-induced arm pain of wearing protective SLIDE: TRAIN-PROTECT-EJECT garments around the lower part of the upper arm was investigated. 10 subjects were tested in four conditions:(1) active counter-pressure 4:00 pm (2) rigid support (3) sham support (4) no support (control). Pain was [291] USEFULNESS OF THE DC COMPONENT OF THE rated using a 10-graded scale. RESULTS: The PH regimen reduced arm pain at 7.5 G from (median (range)) 4 (2-9) to 2 (0-5) in the pressure PULSE WAVE FOR AN OBJECTIVE EVALUATION OF GZ habituated arm (p=0.01) and to 3.5 (1-7) in the control arm (p=0.08). PROTECTION The sham support did not affect pain compared to in the control C. LEDDERHOS1, A. GENS1 AND G. RALL2 condition (5.2; 3.0-10.0), whereas pain was reduced (p<0.05) by 1Research, Science and Training Division, German Air both the rigid support (3.7; 1.0-8.0) and the counter-pressure device Force Institute for Aviation Medicine, Fuerstenfeldbruck, (2.5; 0.0-5.5). PH was as effi cient in alleviating pain as the active Germany; 2Fraunhofer Patent Center of the German counter-pressure and more effi cient than the rigid support (p<0.05). Research, Munich, Germany DISCUSSION: The results support the notion that G-induced arm pain is caused by vascular overdistension. Repeated moderate elevations INTRODUCTION: During the development of anti-G of local intravascular pressure markedly reduce G-induced arm pain, ensembles (AGS), the question of how to assess their effi ciency presumably because such pressure habituation reduces vascular regarding Gz protection is paramount. Generally subjective as distensibility. well as objective criteria can be used. The latter, especially if gathered noninvasively, are of utmost importance in this context. Learning Objectives: One of the key elements for Gz protection is the AGS’ impact on 1 Counter-measures against G-induced arm pain the pilot’s performance and cardiovascular system. Within this frame the usefulness of the direct current component (DCC) of 4:30 pm the pulse wave for an objective evaluation of Gz protection was [293] BIOPHYSICAL MODEL SIMULATION STUDY investigated. METHODS: Different comparative studies of various AGS (CSU13, Libelle and variants (AUTOFLUG), AEA (BAE) and OF BIOFEEDBACK CONTROLLER FOR G STRESS G-RAFFE (G-NIUS)) were conducted in the human-use centrifuge MANAGEMENT of the German Air Force Institute for Aviation Medicine. Non- M. KHAN1, A.K. SALHAN1,2, AND S.K. GUHA1,3 invasive measurements of cardiovascular parameters were taken 1Electrical Engineering, Jamia Millia Islamia (Central University), during gradual (GOR) and rapid onset runs (ROR) (+6 to +9 Gz, 10 Delhi, India; 2Biomedical Instrument Division, Defence s plateaus) and in exhaustive simulated aerial combat manoeuvres Institute of Physiology and Allied Sciences, Delhi, India; (ESACM, duration: 150 s). Altogether 52IP: pilots 192.168.39.151 participated. The On: Sun,3 School26 Sep of 2021 Medical 17:39:09 Sciences & Technology, Indian Institute AGS’ impact on the cardiovascular system andCopyright: the volume Aerospace loss Medicalof Technology Association Kharagpur, Kharagpur, India towards the periphery was characterized by recording ECG,Delivered heart by Ingenta rate and DCC, monitored at the forehead. In the ESACM pilot’s INTRODUCTION: Advance technology anti gravity suit performance was determined using the integral over consecutive (ATAGS) and positive pressure breathing during G (PBG) are protective Gz-values (for instances between 2 and 9 Gz) and by determining methods to increase the G tolerance of fi ghter aircraft pilot. A number the area between selected Gz values. RESULTS: In GOR the DCC of crashes of fi ghter aircrafts because of G Loss of consciousness gradually rose with G-load. The higher the rise of the DCC the (G-LOC) indicate that current protective methods plus above counter lower was the performance (relaxed G-tolerance level). In ROR the measures are inadequate. Therefore an attempt has been made to ratio of mean Gz and mean DCC (termed as volume loss indicator design and develop a biophysical model of biofeedback controller (VLI)) was determined during the G load. Pilot performance was (BMBC) for ATAGS based on integration of different principles of higher when the VLI was low. DISCUSSION: By implementing the Engineering and Applied Sciences. METHODS: In the BMBC, electrical DCC analysis into the assessment process of AGS it is possible to impedance plethysmograph (EIP) was used to provide online blood uncover even small differences in the performance of AGS and to pooling signals to relay. The output of relay was in turn fed to a driver make them objectively verifi able. and then connected to anti G-suit and pressure gauge. The level Learning Objectives: of pressure gauge was in turn fed back to driver. The driver sensed signals from blood pooling in the calf and pressure level at thigh; then 1 Objective, non-invasive evaluation of Gz protection BMBC delivered suitable amount of air/ oxygen from compressed 2 Pulse wave components source to ATAGS. A pressure transducer was also developed to measure simulated anti G straining maneuver (AGSM) of aircraft pilots 4:15 pm during simulated high G conditions. RESULTS: Experimental studies [292] LOCAL INTRAVASCULAR PRESSURE HABITUATION conducted on animal and human models show a correlation between ALLEVIATES G-INDUCED ARM PAIN blood pooling and electrical impedance change. The correlation was suffi ciently reproducible to be useful in arriving at the biofeedback O. EIKEN1, I. MEKJAVIC2, M.J. GRONKVIST1 1 strategy. The time of infl ation of ATAGS was slow (about 5 sec) AND R. KOLEGARD according to the operation controlled by biofeedback controller. 1 Environmental Physiology, Royal Institute of Technology, DISCUSSION: The design of BMBC could easily be modifi ed for fast Stockholm Sweden; 2Department of Automation Biocybernetics operation comparable to human response by incorporating the fast and Robotics, Jozef Stefan Institute, Ljubljana Slovenia motors with associated circuits. The biophysical model simulation

292 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS study was made using results obtained from the study of blood indicated anthropmetary had been a factor in the accident were accumulation on computer model, animal model and human model. identifi ed. RESULTS: Four ejectees were above the qualifi ed ejection Finally, a BMBC was designed; control approach validated using seat boarding mass. Their injuries were a direct consequence of the a prototype of an anti-G suit, and developed under an application dynamics of the ejection sequence and were no more severe than program in the laboratory. aircrew ejecting within the seat limits. One ejectee was below the boarding mass and their parachute drift may have been altered by the Learning Objectives: low mass. No ejections occurred outside the functional reach, stature, 1 Design and development of electronic controller for infl ation/ sitting height, buttock knee and buttock heel limits. 7 Hawk ejectees Defl ation of advance technology anti G suit. had evidence of limb strikes, fi ve were within the limits, but data was unavailable on two. Tornado and Tucano ejectees had damage to their AEA from contact with cockpit structures. The lower leg pockets were 4:45 pm damaged by contact with the leg tunnels and were associated with [294] CHRONIC PULMONARY EFFECTS OF minor shin bruising. For each anthropometry measurement there was OCCUPATIONAL HIGH +GZ EXPOSURE no signifi cant statistical difference between those who sustained and S. ILBASMIS1, E. ERCAN1 AND S. YILDIZ2 those who did not sustain spinal fractures. For non-ejection accidents 1Aircrew’s Health, Research and Training Center, individuals at the upper extremes of the anthropometric limits sustained Eskisehir, Turkey; 2Pulmonary Medicine, Military no more severe injuries than those closer to the median of the size Hospital, Eskisehir, Turkey ranges. There was one case where the anthropometry of the aircrew hindered an emergency egress. DISCUSSION: Aircrew anthropometry has had limited effects on the causation and severity of injuries in INTRODUCTION: Sustained acceleration occurs during both ejection seat and non-ejection seat accidents. The safety critical aerobatic fl ight. Physiological effects of high G exposure (especially measurement limits, excepting weight, had not been exceeded. +Gz) has received most of research attention. Besides the acute effects of G exposure on pulmonary functions it has been thought that it Learning Objectives: may have some effects on pilots after repetitive G exposures for years. METHODS: We have compared pulmonary function tests of high 1 This presentation identifi es the safety critical anthropometry performance aircraft pilots with transport/helicopter pilots. 87 military measurements and relates these to injury causation during an pilots who have applied for aircrew periodic medical examinations, aircraft accident. 42 high performance aircraft pilots (HPP) and 45 transport/helicopter pilots (THP) were selected for the study. Subjects who had less than 5:15 pm 1000 total fl ight hours, age less than 30 or more than 45 years were excluded from this study. A survey which required general information [296] OPTIMIZING AIRCREW’S HELMET FIT: and smoking history was applied to the subjects. RESULTS: According THE EFFECT ON NECK LOAD 1 2 1 2 to the demographic parameters there were not any statistically M. VAN DEN OORD , , Y. STEINMAN , J.K. SLUITER AND signifi cant differences between HPP and NHP groups. Means of all M.H. FRINGS-DRESEN2 pulmonary function test parameters were lower in HPP group but only 1Center for Man in Aviation, The Royal Netherlands Air Force, FEV1% was statistically signifi cant (p<0.05). The same calculation Soesterberg, Netherlands; 2Coronel Institute of Occupational was made to the pilots who have fl ights over 2000 fl ight hours, Health, Academic Medical Center, Amsterdam, Netherlands again means of all pulmonary function test parameters were lower in HPP group and FVC, FEV1, FEF25-75 and FEV1% were statistically INTRODUCTION: One solution to prevent fl ight-related signifi cant. When non-smoker subjects were selected and compared, neck pain in military helicopter pilots and loadmasters is to initiate all parameters were lower for HPP and only FEF25-75 and FEV1% ergonomic improvements in the equipment used. A recent qualitative were signifi cant. And also when smoker subjects were selected VC, study among pilots and loadmasters of the Royal Netherlands Air Force FVC and FEV1 parameters were lower in HPP group and statistically fl ying the Chinook and Cougar helicopter revealed that while the fi t signifi cant (p<0.05). Since the number ofIP: smoker 192.168.39.151 subjects in HPP On: Sun,of 26 their Sep fl ight 2021 helmet 17:39:09 was an important factor indirectly related to their group was 8, non-parametric test was used to compare.Copyright: DISCUSSION: Aerospace Medicalexperienced Association neck load, an optimal helmet fi t was not easily achieved. According to this study long term exposure to occupational highDelivered G byThe Ingenta aim of the present study was to optimize aircrew’s fl ight helmet exposure may have some negative effects on pulmonary functions. fi t and to evaluate its effect on neck load and neck pain during fl ight. Signifi cant differences were more relevant in the pilots over 2000 METHODS: We used a within subject design that consisted of two fl ight hours. However chronic cigarette smoking has also the same consecutive interventions of optimizing the aircrew’s helmet fi t. There negative effects on pulmonary functions. More subjects are needed were three measurement periods within a period of three months: to distinguish these negative effects resulted whether from smoking or before intervention, after the fi rst intervention and after the second high G exposure. Further studies including wide series are needed to intervention. The fi rst intervention involved a new helmet fi t using a reveal high performance aircraft pilots’ tendency to respiratory system renewed protocol: a stepwise checklist, illustrated with clear d diseases. rawings and practical cues. The second intervention involved the replacement of a thermoplastic liner with a liner made of viscoelastic Learning Objectives: foam. The outcome measures were: helmet gliding, neck load, neck pain, 1 Learning the long term pulmonary effects of repetitive high +Gz hot spots, irritation/distraction, and comfort during fl ight. A total of 18 exposure. pilots and loadmasters rated the different outcome measures using Visual Analogue Scales (0-100mm scale) immediately after they returned from fl ying a night mission, for three night fl ights in total per measurement 5:00 pm period. The means of each dependent variable were compared [295] AIRCREW ANTHROPOMETRY - ACCIDENT within subjects using ANOVA-repeated measures. RESULTS: The INJURY AND SURVIVABILITY optimized helmet fi t showed a signifi cant decrease in helmet gliding, M.E. LEWIS neck load and hot spots (p<0.05), a nearly signifi cant decrease in neck AIHF, RAF CAM, Henlow, United Kingdom pain (p=0.058) and irritation/distraction (p=0.057), and a signifi cant increase in overall comfort (p < 0.05). DISCUSSION: This study INTRODUCTION: The introduction of new aircraft into the demonstrates the importance of an optimized helmet fi t for both health RAF fl eet prompted a review of anthropometry to determine its and safety concerns. contribution to accident injury causation and survivability. METHODS: Data on 259 ejections (1973-2011) and 89 non-ejection aircraft Learning Objectives: accidents (1993-2011) were analysed. Accidents where aircrew 1 The audience will learn about the importance of an optimized hel- anthropometry was outside the limits or where the accident report met fi t for the health and safety of helicopter pilots and loadmasters

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 293 ASMA 2012 MEETING ABSTRACTS

Tuesday, May 15 4:00 PM Learning Objectives: Salon AB 1 The audience will learn of the nature of fatigue and related tests as understood in aviation medicine of 1936.

PANEL: AVIATION MEDICINE 75 YEARS [301] INFERIOR SUN GLASSES VERSUS EYESTRAIN AGO: WELCOME TO THE EIGHTH ANNUAL IN THE PILOT J.J. WYLAND2 AND W.W. DALITSCH1 MEETING OF THE AERO MEDICAL 1Naval Air Force, U.S. Pacifi c Fleet, San Diego, CA; ASSOCIATION: PART II--BILTMORE HOTEL, 2Naval School of Aviation Safety, Pensacola, FL

LOS ANGELES INTRODUCTION: The original presentation of August 30, 1936 will be presented by a physician playing author Dr. E. H. Padden, [297] CARBON MONOXIDE POISONING 2 1 Flight Surgeon for United Air Lines and Pacifi c Division, Pan American R.A. BEANE AND W.W. DALITSCH Airways. This presentation deals with contemporary knowledge of sun 1 2 Naval Air Force, U.S. Pacifi c Fleet, San Diego, CA; Bureau of glasses and their role in eyestrain in aviation. Medicine and Surgery, Bethesda, MD Learning Objectives: INTRODUCTION: The original presentation of August 30, 1936, 1 The audience will learn of eyestrain induced by sun glasses in complete with case presentations and original follow-on commentary, will aviation as understood in aviation medicine of 1936. be presented by a physician playing former president of the Association, Dr. Charles H. Gowan. This presentation deals with contemporary [302] WRAP-UP: WHAT HAS CHANGED IN knowledge of carbon monoxide poisoning and its relation to aviation. SEVENTY-FIVE YEARS? 1 7 2 Learning Objectives: W.W. DALITSCH , R.A. BEANE , C.A. CICCONE , N.A. DAVENPORT4, T.E. HATLEY5, J.R. HEIL2, L. MANDEL4, 1 The audience will learn of the aviation considerations of carbon 2 2 6 2 monoxide poisoning as understood in aviation medicine of 1936. W.A. MCDONALD , E.Y. PARK , A.J. PARMET , C.A. REESE , P. WALKER8 AND J.J. WYLAND3 [298] STATISTICS OF A THOUSAND PHYSICAL 1Naval Air Force, U.S. Pacifi c Fleet, San Diego, CA; 2Naval 3 EXAMINATIONS FOR AVIATION Aerospace Medical Institute, Pensacola, FL; Naval School of T.E. HATLEY2 AND W.W. DALITSCH1 Aviation Safety, Pensacola, FL; 4Naval Safety Center, Norfolk, 5 1Naval Air Force, U.S. Pacifi c Fleet, San Diego, CA; VA; Civil Aerospace Medical Institute, Oklahoma City, OK; 2Civil Aeromedical Institute, Oklahoma City, OK 6USC Viterbi School of Engineering, Los Angeles, CA; 7Bureau 8 of Medicine and Surgery, Bethesda, MD; Chief of Naval Air INTRODUCTION: The original presentation of August 30, Training, Corpus Christi, TX 1936, complete with original follow-on commentary, will be presented by a physician playing Dr. Harry Vanderbilt Würdemann, an aviation INTRODUCTION: Aviation medicine as experienced through medical examiner with the Bureau of Air Commerce from Seattle, WA. the original presentations at the Eighth Annual Meeting of the Aero This presentation summarizes statistics of 1022 physical examinations Medical Association of August 29-30, 1936 will be compared to of student and private pilots over a two-year period. corresponding topics in aviation medicine today.

Learning Objectives: Learning Objectives: 1 The audience will learn of the demographics and medical 1 The audience will learn of advances in our understanding of se- conditions of those undergoing aviationIP: physical192.168.39.151 examinations On: in Sun, 26lected Sep aviation 2021 17:39:09medicine topics as compared to 1936. the mid-1930s. Copyright: Aerospace Medical Association [299] FATIGUE - ITS RELATION TO AND THE VALUEDelivered OF THE by Tuesday,Ingenta May 15 4:00 PM SCHNEIDER INDEX Salon D E.Y. PARK2 AND W.W. DALITSCH1 1Naval Air Force, U.S. Pacifi c Fleet, San Diego, CA; 2Naval PANEL: EUROPEAN SPACE MEDICINE Aerospace Medical Institute, Pensacola, FL ACTIVITIES INTRODUCTION: The original presentation of August 30, 1936, complete with original follow-on commentary, will be presented [303] EUROPEAN SPACE MEDICINE ACTIVITIES by a physician playing author Dr. Herbert F. Fenwick of Chicago, IL. C. PRUETT1, S.N. EVETTS1 AND V.R. DAMANN2 This presentation deals with contemporary knowledge of fatigue and 1Wyle GmbH, Cologne, Germany; 2Crew Medical Support its relation to the Schneider Index. Offi ce, European Space Agency, Cologne, Germany

Learning Objectives: As federal and commercial human spacefl ight continues to 1 The audience will learn of fatigue in aviation and its relation to the develop and refi ne in Europe, a growing number of European space Schneider Index as understood in aviation medicine of 1936. medicine and support activities are concomitantly maturing. There is an accumulating experience, skill set and knowledge base in Europe [300] FATIGUE - SOME SPECIAL EFFECTS AND TESTS based on this increasing exposure to long duration human spacefl ight. 2 1 N.A. DAVENPORT AND W.W. DALITSCH The European medical and life science communities are capitalizing 1Naval Air Force, U.S. Pacifi c Fleet, San Diego, CA; 2Naval on this increasing experience to develop new space medicine Safety Center, Norfolk, VA operational procedures and hardware, health protection measures, engaging the next generation of space industry professionals and INTRODUCTION: The original presentation of August 30, providing medical certifi cation and support for the expected boom of 1936, complete with original follow-on commentary, will be presented commercial spacefl ight participants. Nearly every aspect of human by a physician playing Dr. Wade Hampton Miller of Kansas City, MO. This spacefl ight activity involves risk mitigation strategies to protect as presentation deals with contemporary knowledge of the effects of fatigue, much as possible the extremely valuable asset of the human being tests for identifying fatigue, and the relationship of fatigue to aviation. fl ying into space, the extensive ground support personnel and general

294 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS public. While human spacefl ight is inherently risky, many will choose European human space fl ight setting. The workshop programme was to engage in this activity because the rewards are perceived to far developed around the themes of Cardiopulmonary Resuscitation outweigh the risks. Thus, refi ning human spacefl ight risk mitigation (CPR) in Hypogravity, Artifi cial Gravity and Crew Medical Data strategies is a never-ending task that dynamically evolves to be as Management. After receiving introductions to each theme by comprehensive as possible. This panel will present current European renowned space medicine experts from Europe, the US and space medicine activities related to these points including: the Canada, students worked together in small groups to devise new various CPR techniques and decision paths for different hypo-gravity concepts within a chosen fi eld, proposing solutions to problems environments; an overview of the ESA Medical Projects Roadmap; pertinent to current and future space missions. The workshop space radiation monitoring and protection for astronauts; a medical participants produced a number of creative, innovative proposals, data management system for ESA astronauts; a space medicine including several new techniques for CPR in hypogravity, an workshop model for engaging students as the next generation of space interesting approach to space mission data transfer, and a new industry professionals; and developing European space medicine countermeasure concept drawing from the trials undertaken by Pete support and certifi cation capabilities for commercial spacefl ight Conrad in Skylab in the early 1970s. It was evident that the format participants, including pilots of private spacecraft. These are just a and nature of the workshop successfully elicited novel and in some few of the countless European space medicine activities underway cases unexpected solutions to the tasks presented. Educational to support human spacefl ight success in federal and commercial programmes of this nature offer an effective means of transferring endeavors. the knowledge and expertise from today’s space professionals to Europe’s youth, who will become tomorrow’s human space [304] PRIVATE HUMAN SPACEFLIGHT: fl ight managers, scientists, doctors and crew. At the same time, the unbiased views of the students and their unconventional CHALLENGES FOR EUROPE approaches to the given tasks introduced the space health R. GERZER professionals present to new ideas and perspectives, illustrating Institute for Aviation Medicine, DLR, Cologne, Germany the potential of this education medium to serve as a resource for novel, viable solutions to today’s and tomorrow’s space medicine INTRODUCTION: Several private companies are currently problems. preparing space vehicles for suborbital or orbital human spacefl ight. While the US is strategically preparing for this new era, Europe is Learning Objectives: currently still not very active in this fi eld and still has to provide 1 The audience will be informed of an educational programme answers for several questions. These tasks include: Licensing/ designed to help develop the next generation of space industry certifi cation of private spacecraft; Specifi c ruling for launch sites/ health professionals and how this model can benefi t the industry airports; Medical fi tness criteria for private spacefl ight participants more broadly. (suborbital or orbital); Medical certifi cation for passengers who fl y outside of Europe; and Medical fi tness criteria for pilots of [306] TOWARDS A EUROPEAN SPACE AGENCY MEDICAL private spacecraft (suborbital or orbital). Thus government agencies PROJECTS ROADMAP such as EASA or the german “Luftfahrt-Bundesamt” as well as 2 2 1 the European aerospace medical community need to be active A. FRECHETTE , S.N. EVETTS AND V.R. DAMANN 1 in the upcoming years to allow success for this upcoming new Crew Medical Support Offi ce, European Astronaut Centre, industry in the future. The DLR Institute of Aerospace Medicine in Cologne, Germany; 2Wyle GmbH, Cologne, Germany Cologne is currently upgrading its infrastructure to be able to serve as a European competence center for private human spacefl ight. INTRODUCTION: The recent reorganization of ESA Private human spacefl ight will also provide research opportunities. directorates has resulted in the formation of the Human Space As private suborbital space planes will provide microgravity for Flight and Operations Directorate. Departmental changes within several minutes and will fl y individuals for $100,000 to $200,000 the directorate will facilitate an increase and improvement in per fl ight or less, they can certainly fl y life science experiments at collaboration between the domains of life science and medical costs much lower than, e.g., a soundingIP: rocket 192.168.39.151 fl ight, that currently On: Sun,operations. 26 Sep 2021This opportunity 17:39:09 and previous work has cumulated costs several million Euros per fl ight. In addition,Copyright: participants Aerospace of Medicalin the redefi Association nition of the Crew Medical Support Offi ce (CMSO) private spacefl ight may also serve as test subjects or as investigatorsDelivered byMedical Ingenta Projects mission statement and has enabled the defi nition for life sciences experiments. Similar new opportunities will be of an ESA Medical Projects Roadmap. The decision was made to available in future private orbital fl ights. DISCUSSION: Thus, also augment global Space Medicine efforts by undertaking focused European Space Agencies and investigators, who are currently not activities in identifi ed capability gaps and thus; provide ESA necessarily considering private human spacefl ight as upcoming with a single entity responsible for Space Medicine; support the new opportunities, should get ready for this fascinating new era of development and operation of cutting edge health care devices human endeavor. and procedures for space and terrestrial use; enhance current ISS medical capabilities; utilise ISS as a platform to prepare for future Learning Objectives: medical needs and responsibilities; effectively collaborate with 1 The audience member will learn about the burgeoning European ESA internal and external entities, and support the integration medical support structure for the developing commercial space- of research and technology achievements into crew health fl ight market. related operations. The identifi ed gaps were drawn from NASA’s Bioastronautics Roadmap, the European THESEUS project and the CMSO Needs Table. Gaps and needs correlating with the ESA [305] EUROPEAN SPACE MEDICINE WORKSHOP; Medical Operations mission statement have been identifi ed and A MODEL FOR ENGAGING THE NEXT GENERATION OF require a plan of action. This presentation will introduce the CMSO SPACE INDUSTRY HEALTH PROFESSIONALS mission statement, highlight some of the fi elds and knowledge gaps M. CZYBULKA1, V.R. DAMANN2 AND S.N. EVETTS1 in question and present details of the direction and mechanisms 1Wyle GmbH, Cologne, Germany; 2Crew Medical Support to be employed to allow the ESA Medical Operations team to Offi ce, European Space Agency, Cologne, Germany successfully fulfi ll its mission and pursue a roadmap for European and global HSF benefi t. INTRODUCTION: In July 2011, the ESA Crew Medical Support Offi ce in conjunction with the Education and Promotion Learning Objectives: Offi ce of ESA’s Human Spacefl ight and Operations Directorate held 1 This presentation will introduce the CMSO mission statement, a Space Medicine Workshop to offer European medical and life highlight some of the fi elds and knowledge gaps in question science students an educational opportunity that would increase and present details of the direction and mechanisms to be their awareness of space life science and medical operations in the employed.

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 295 ASMA 2012 MEETING ABSTRACTS

[307] ESA’S OPERATIONAL -RADIATION PROTECTION Additional ESA astronaut medical data is currently being gathered by the AND -SPACE RADIATION RESEARCH; AN OVERVIEW OF CMSO from ISS counterparts, to be digitized and stored onto the server. CURRENT AND FUTURE RADIATION MONITORING Statistical analysis can be performed to identify signifi cant spacefl ight- HARDWARE AND EXPERIMENTAL MEASUREMENTS related health risks. DISCUSSION: Once all data has been analysed, OF ORGAN-DOSE DISTRIBUTIONS IN A HUMAN additional publications are intended to benefi t not only the space medicine group, but potentially the whole scientifi c community. PHANTOM TORSO U.H. STRAUBE1, T. BERGER2, M. DIECKMANN3 AND G. REITZ2 Learning Objectives: 1Medical Operations D/HSO-AM, European Space 1 The audience will learn about the unique features of the medical Agency - ESA; European Astronaut Center - EAC, Cologne, data management system for ESA astronauts. Germany; 2Radiation Biology Department, German Aerospace [309] EXTRA-TERRESTRIAL CARDIOPULMONARY Center, Aerospace Medicine, Cologne, Germany; 3D/TEC, RESUSCITATION TECHNIQUE DECISION FLOW PATH Directorate of Technical and Quality Management, European S.N. EVETTS1,2,3, R. ARCHIBALD4, S. LENGERER5 Space Agency, ESTEC, Noordwijk, Netherlands AND M. MALAJ6 INTRODUCTION: Personnel designated to work as crew in 1Crew Medical Support, European Space Agency, Cologne, space-based activities demand health and safety considerations that Germany; 2Wyle GmbH, Cologne, Germany; 3UK Space shall include radiation protection for the individual. The radiation Biomedicine Association, London, United Kingdom; 4University environment that a crew experiences during a space fl ight differs of Dundee, Dundee, United Kingdom; 5University of Tübingen, signifi cantly to that found on earth including commercial aviation, Tübingen, Germany; 6University of Nottingham, Nottingham, mainly due to particles with greater potential for biological damage. United Kingdom High-energetic charged particles, such as protons, helium nuclei (“alpha particles”) and heavier ions up to iron, originating from several sources, INTRODUCTION: The year 2010 marked the 50th anniversary of such as galactic cosmic radiation (GCR), energetic solar particle events modern cardiopulmonary resuscitation (CPR). The research, development (SPE) as well as protons and electrons trapped in the earth radiation and practice of CPR to date have lead led to many changes in the belts, are the main contributors. The exposure that a crew receives recommended guidelines and progress in the successful application of the during a space fl ight signifi cantly exceed exposures routinely received primary elements of external chest compression and artifi cial ventilation. by the public or even terrestrial radiation workers. The mutual interest Fundamentally, however, the basics remain the same and are able to be and lively cooperation of Operational Radiation Protection for humans used by most people under most circumstances. Research in recent years as a key activity in the domain of Space Medicine versus Space has shown that signifi cant modifi cation of the basic life support (BLS) Radiation Research as promoted by Space Life Science, has gathered technique (CPR without advanced aids) is necessary if ‘extra-terrestrial’ considerable information on astronauts radiation exposures, biological CPR is to be conducted under reduced gravity conditions (Moon, Mars) or effects and risk mitigation strategies up to date. This presentation will in microgravity as experienced on orbit. A number of BLS techniques have give an introduction to the state of the art means for radiation monitoring been developed and examined for use under altered gravity conditions, of astronauts, current European hardware and future developments. all of which have limitations according to the circumstances under which Besides the European Crew Personal Dosimetry, EuCPD, as the advanced they may be employed. At present no single technique is considered to be standard to assess individual exposures to low-LET- and high-LET the universal off-world method, and as such it is benefi cial for astronauts radiation, heavy charged- particles- and neutrons, t he MATHROSKA to be familiar with a number of techniques. This will be particularly experiment a human phantom study inside and outside ISS will be important once planetary exploration is restarted, with a return to the addressed. Measurements during the ISS fl ight trajectory of a full solar Moon or a human Mars mission. Exploration missions will require cycle, skin and depth dose distributions, organ dose of selected organs astronauts to be familiar with microgravity and hypogravity techniques, will be raised. Finally a brief sketch of an active dosimetry assembly for all of which have varying degrees of applicability depending upon the personal dosimetry of ESA astronauts in the future will be drawn. circumstances in which they may be required. Considering the crucial IP: 192.168.39.151 On: Sun, 26 Sep 2021 17:39:09 Learning Objectives: importance of immediate and effective application of external chest Copyright: Aerospace Medicalcompression Association when the need for CPR occurs, it will be of benefi t if crew 1 How to assess the exposure of the individual astronauts to ionizing Delivered by haveIngenta at their disposal a clear and simple procedure fl ow path to follow to radiation in space missions enable them to identify which CPR technique will be most effective under [308] DEVELOPMENT OF A MEDICAL DATA MANAGEMENT the extant conditions. This presentation will outline an example of a CPR SYSTEM FOR ESA ASTRONAUTS technique decision fl ow path for use in human space exploration missions M. KOMOROWSKI1,2, J. GILLHAM1, S.N. EVETTS1, Learning Objectives: M. SCHEER1 AND V.R. DAMANN1 1 The audience will gain an understanding of some of the limitations 1Crew Medical Support Offi ce, European Astronaut Centre, of extra-terrestrial CPR techniques and a procedure for the correct ESA, Cologne, Germany; 2Anesthesiology and Intensive Care choice of technique for a given circumstance. Department, University Hospital of Lille, Lille, France Wednesday, May 16 8:30 AM INTRODUCTION: The crew medical support offi ce (CMSO) of the European Astronaut Centre (EAC) has embarked on the project of Ballroom A collecting, collating and analyzing all ESA astronauts’ medical data, both mission related and annual examinations. METHODS: A research PANEL: ADVANCED AEROSPACE MEDICINE fellowship position has been created for this purpose, with the primary objectives of developing the hardware infrastructure and facilitating FOR INTERNATIONAL MEDICAL OFFICERS data analysis. As a result, an Electronic Health Record solution has been (AAMIMO) AEROMEDICAL CLINICAL installed on a secured server hosted within EAC. The system requires two levels of identifi cation and its degree of encryption surpasses current CASE PRESENTATIONS ESA medical data security policy. Periodic off-site backups will be [310] ADVANCED AEROSPACE MEDICINE FOR carried out to ensure data conservation if the room containing the server were to suffer structural damage. RESULTS: Now, ESA Flight Surgeons INTERNATIONAL MEDICAL OFFICERS (AAMIMO) and Nurses are able to securely access the medical data repository from AEROMEDICAL CLINICAL CASE PRESENTATIONS anywhere in the world, to retrieve stored medical records and to build B.H. REED on the database. An active collaboration is maintained with the German International Training Div, USAF School of Aerospace Centre Flight Clinic, where astronauts carry out annual examinations. Medicine, Wright-Patterson AFB, OH

296 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

The Advanced Aerospace Medicine for International Medical operations has conducted investigations into the underlying systems Offi cers (AAMIMO) course is an intensive 6 month training and circumstances that have led to these hypoxia-like events. ACC opportunity taught at USAFSAM Brooks City-Base San Antonio Texas. Surgeon General’s offi ce has been designated as the lead for medical As part of this course, these fl ight surgeons from around the globe and physiological investigation efforts. This paper provides an overview are able to bring aeromedical case presentations from either their of the F-22 aircraft systems, life support requirements and previous country’s Air Force experience or cases of interest from the USAFSAM hypoxia-like events. This paper further discusses the investigation Aeromedical Consult Service (ACS). Cases are selected for presentation process to include aircraft and system testing, pilot protection and in accordance with both the clinical learning interests of the student pilot monitoring during the search for the root cause of hypoxia-like and the topical currency of the diagnosis. Each case presentation will symptoms in F-22 pilots. include a powerpoint presentation with an introduction, case report, discussion, aeromedical disposition implications, and conclusion. Learning Objectives: Limited questions will be allowed as time permits for each presenter 1 Understand the unique physiological requirements of the F-22 by the panel chair. Learning Objective: Through the use of case Raptor aircraft presentations practical application of Aerospace Medicine principles 2 Understand the scope and magnitude of the hypoxia-like events in will be described MOC Questions - these cannot be composed until the F-22 the AAMIMO students complete thier case presentations; this will not 3 Understand the efforts underway to investigate, mitigate and eliminate happen until closer to the end of April 2012; these questions will be the root cause of these symptoms in F-22 pilots and crew chiefs. submitted ASAP prior to the AsMA meeting [313] FLIGHTLINE MEDICAL RESPONSE AND CLINICAL Wednesday, May 16 8:30 AM TESTING OF HYPOXIA-LIKE EPISODES IN THE F-22 RAPTOR Ballroom B A.C. MARCHIANDO Aerospace Medicine Division, Offi ce of the Command PANEL: OPERATIONAL AVIATION MEDICINE Surgeon, Air Combat Command, Langley AFB, VA ISSUES AND PROBLEM INVESTIGATIONS INTRODUCTION: Recent hypoxia-like events in the F-22 Raptor have led to a medical investigation for possible clues to the IN AIR COMBAT COMMAND causes of these symptoms. Medical response protocols and clinical testing will be reviewed. METHODS: The medical response and [311] OPERATIONAL AVIATION MEDICINE ISSUES AND investigation starts with an immediate evaluation and treatment of the PROBLEM INVESTIGATIONS IN AIR COMBAT COMMAND pilot and sampling of the pilot’s expired air on the fl ightline. Clinical A.C. MARCHIANDO1, D. WYMAN1, B. EDWARDS1, evaluation of the affected pilot or maintainer focuses on a thorough P. GARDETTO1, S.M. MARCHIANO2, P. BREED1, history of the event and physical examination emphasizing neurologic 4 3 status. Further evaluation consists of pulmonary function testing and S. MCGUIRE AND T.V. MERRIWEATHER laboratory sampling of blood and urine. Sampling protocol, tests being 1 Aerospace Medicine, Air Combat Command, Langley AFB, VA; run, reasoning for the tests selected and baseline comparison will be 2Aerospace Medicine, 23 Medical Group, Moody AFB, GA; reviewed. RESULTS: Utilizing the developed response protocols, initial 3Neuropsychiatry, U.S. Air Force School of Aerospace results of sampling thus far will be reviewed. Medicine, Wright-Patterson AFB, OH; 4Aerospace Medicine Consultation Service, U.S. Air Force School of Learning Objectives: Aerospace Medicine, Wright-Patterson AFB, OH 1 How to apply analytical approach to medical investigation of aircraft related physiologic events. This panel will review four operational aviation medicine issues 2 How to select clinical and test procedures in face of little evidence and problem investigations that have beenIP: undertaken 192.168.39.151 in the last two On: Sun, 26of Sepcause 2021for physiologic 17:39:09 (hypoxia-like) events. years in the US Air Force’s Air Combat Command.Copyright: A multi-disciplinary Aerospace Medical Association and multi-organizational approach has been utilized to developDelivered by[314] Ingenta 5TH GENERATION OXYGEN GENERATION SYSTEMS solutions. This panel will review the methods taken to try to solve the AND PULSE OXIMETRY IN THE F-22 RAPTOR diverse aviation medicine problems currently facing the Air Combat P. GARDETTO Command. Problems under investigation and being presented are Neurologic Decompression Sickness in U-2 Pilots, Hypoxia-like Events HQ ACC, Yorktown, VA in F-22 Pilots and Maintainers, Stress in Unmanned Aerial Vehicle Operators, Intelligience Operators and Cyber Operators and adapting INTRODUCTION: The F-22 employs a novel environmental fi xed wing Combat Search and Rescue assets for Casualty Evacuation control system different from legacy diluter demand systems. This in Afghanistan. Results of ongoing investigation and research will be optimized approach to oxygen delivery produces vulnerabilities not presented including magnetic resonance imaging of U-2 pilots’ brains, present in legacy jets. In August of 2011, the US Air Force employed F-22 pilot pulse oximetry data and aircraft environmental sampling and in-fl ight use of Pulse oximetry by F-22 Raptor pilots in response to a surveys of stress in UAV operators. To help solve the issues of casualty series of hypoxia episodes. Infl ight hypoxia is a frequent occurrence in evacuation the reorganization and utilization of a variety of medical fi ghter aircraft that is easily remedied by application of 100% oxygen personnel, to include pararescuemen, IDMTs, fl ight surgeons and through the aircraft oxygen regulator. Cases of hypoxia generally critical care nurses to promote the best standard of care in the midst of occur due to loss of cabin pressurization and/or failure of the oxygen limited resources and strenuous operating demands will be presented. regulator and associated life support systems. Recent development of on-board oxygen systems (OBOGS) provide numerous benefi ts to fl ight operations. However, these OBOGS systems do have different failure [312] USAF F-22 HYPOXIA-LIKE INCIDENTS - OVERVIEW modes than found in legacy liquid oxygen systems. DISCUSSION: OF PREVIOUS EVENTS AND INVESTIGATION EFFORTS This study will explain differences between legacy diluter demand B.M. EDWARDS oxygen systems and closed environmental control systems. This study ACC, USAF, Langley AFB, VA employed the Nonin 3150 model pulse oximeter with fi nger mounted sensor. To date over 2000 sorties were fl own with this monitor. INTRODUCTION: The USAF has experienced numerous infl ight The F-22 data captured provided the researcher with ample fl ight and ground level hypoxia-like events in the F-22 Raptor aircraft. These parameter data for analysis of pulse oximeter in relation to numerous events have ranged from mild hypoxia-like symptoms to neurological fl ight parameters. Oxygen saturation drops were noted and easily impairment in pilots and engine run qualifi ed crew chiefs. Air Combat correlated with high G maneuvers. Algorithms in the device control Command (ACC), as the lead in the Combat Air Force (CAF) for F-22 for drops in blood fl ow, however, data artifacts require interpretation

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 297 ASMA 2012 MEETING ABSTRACTS during highly dynamic phases of fl ight. The capture of in-fl ight pulse to the non-NDCS pilots (8.169; 3.062.8; p= 0.0039). Hyperintense oximetry data will greatly enhance the ability of researchers to better white matter lesions were signifi cantly increased in the NDCS pilots characterize pilot physiology during dynamic phases of fl ight in high relative to the non-NDCS pilots (5.768.4; 1.462.1; p= 0.0084). performance aircraft. Necrotic lesions, characterized by a necrotic core surrounded by a reactive gliotic halo, were not signifi cantly different (NDCS 0.661.1; Learning Objectives: non-NDCS 0.260.4; p=0.072). Ependymal lesions were not 1 The audience will be introduced to differences between legacy signifi cantly different (NDCS 1.861.2; non-NDCS 1.261.4; oxygen generating systems and those employed on the 5th p=0.247). There is no statistical difference in total hours, missions, generation F-22 and operational tempo between those with and without NDCS 2 The audience will be introduced to areas for future development of although there is a suggestion that less experienced pilots may oximeter sensors better suited for infl ight use be less resistant to operational tempo physiological stressors. No decline in neurocognitive functioning was demonstrated when comparing testing results now versus prior to entry into pilot training. DISCUSSION: The 13 pilots with NDCS had statistically [315] EXAMINATION AND CHARACTERIZATION OF signifi cant increases in overall number of cerebral lesions and AIR QUALITY IN THE F-22 hyperintense white matter compared to pilots without NDCS. P. BREED Necrotic lesions and ependymal lesions were similar in both groups. ACC/SGPB, USAF, Joint Base Langley-Eustis, VA Additional study is underway to explain the mechanism and clinical signifi cance of these lesions. INTRODUCTION: As the US Air Force’s fi fth generation fi ghter aircraft, the F-22 Raptor incorporated a new Environmental Control Learning Objectives: System (ECS) to provide adequate oxygen for pilots under extreme 1 Understand the prevalence and contributing factors to neurological conditions. A series of recent hypoxia-like events have generated decompression sickness in U-2 pilots. concern that the system may either be not producing enough oxygen, or may be periodically introducing a potential contaminant to pilot or ground-run maintainers. This presentation will discuss how engineers and health experts have examined material used in and on [317] EVOLUTION OF COMBAT SEARCH AND RESCUE the aircraft as well as the potential for them to affect air quality in the MEDICAL ELEMENTS WITHIN FIXED WING CASUALTY cockpit or in the On-Board Oxygen Generating System (OBOGS). EVACUATION IN AFGHANISTAN METHODS: Incident response teams and aircraft system engineers S. MARCHIANO1, D. PIZZINO JR.2, E. DESOUCY3, have developed sampling protocols to facilitate both local and 1 4 “fl y-in” teams in their efforts to detect contaminants in the aircraft. M. COOMES AND H.L. TANAKA 1 2 RESULTS: Results of both base-level Bioenvironmental Engineering 347 OSS, Moody AFB, GA; 38 RQS, Moody AFB, GA; 3 4 testing and specialized engineering team testing will be discussed. 48 RQS, Davis-Monthan AFB, AZ; 563 OSS, Nellis AFB, NV F-22 ECS systems reviews continue in an effort to ensure the success of this critical national asset. INTRODUCTION: Flight surgeons and independent duty medical technicians (IDMTs) of a Combat Search and Rescue Learning Objectives: Medical Element (CSARME) have three main missions in the 1 To comprehend complexities associated with conducting air quality deployed setting: to provide organic medical support to combat assessments search and rescue (CSAR) personnel, to provide medical oversight during pararescue operations, and to provide continued medical care during casualty evacuations (CASEVAC) involving transload from pararescue to “defi nitive care sites.” Traditionally, CSARME [316] NEUROLOGIC DECOMPRESSION SICKNESS IN personnel have been primarily involved in the fi rst two missions. HIGH-ALTITUDE PILOTS - SYSTEMATICIP: 192.168.39.151 APPROACH TO On: Sun,However, 26 Sep recently2021 17:39:09 during Operation Enduring Freedom they EVALUATION AND PRELIMINARY RESULTSCopyright: Aerospace Medicalhave been Association regularly utilized for casualty evacuation and medical S. MCGUIRE1,2,3, J. WOOD2, P. SHERMAN4 Delivered by transport.Ingenta Due to growing demands on coalition forces within AND P. KOCHUNOV5 Afghanistan, the tasking of USAF CSAR assets has evolved to include 1Neurology, USAF School of Aerospace Medicine, Dayton, OH; CASEVAC from point of injury locations, forward operating bases (FOBs), and more recently from Role 2 facilities. Since the HC-130 2Neurology, University of Texas Health Sciences Center San 3 CSAR platform was reintroduced to Afghanistan in May 2010, the Antonio, San Antonio, TX; Research Imaging Center, University CSARME mission has progressed primarily in aiding pararescuemen of Texas Health Sciences Center San Antonio, San Antonio, TX; with the care and immediate transport of critically injured post- 4Neuroradiology, 59th Medical Wing, Lackland AFB, TX; surgical patients from FOBs and smaller Role 2 facilities. This has 5Psychiatry, University of Maryland School of Medicine, required CSARMEs to develop, modify, and standardize medical Baltimore, MD equipment setup within the fi xed wing platform to allow for safe rapid evacuation of patients while balancing the operational INTRODUCTION: The USAF U-2 community has demands and tactical risks assumed during the CSAR mission. It experienced an increase in neurologic decompression sickness has also required the reorganization and utilization of a variety (NDCS). Evaluation of 50 pilots was undertaken to explain recent of medical personnel, to include pararescuemen, IDMTs, fl ight episodes. Earlier studies noted an increase in cerebral white matter surgeons and critical care nurses, in order to promote the best hyperintensities and necrotic lesions compared to population standard of care in the midst of limited resources and strenuous controls. Unknown is the prevalence of lesions in high-altitude operating demands. Most importantly it has allowed for the rapid pilots without NDCS or possible neurocognitive impairment. stable transport of patients from limited manned and supplied FOBs METHODS: The authors obtained brain images on 50 high- and Role 2 facilities to higher echelons of care, thereby providing altitude military pilots, 13 of whom had at least one documented better access to enhanced life saving treatments. NDCS episode. Imaging was performed at the Research Imaging Center using a Siemens 3T Trio scanner and a 12-channel head Learning Objectives: coil as previously described. The overall count of white matter 1 To educate medical professionals on current challenges faced in hyperintensities, ependymal lesions, and lesions with a necrotic fi xed wing casualty evacuation in Afghanistan appearance was compared between the 13 symptomatic pilots and 2 To review lessons learned and recommend road ahead to develop the 37 asymptomatic pilots. RESULTS: The overall lesion count for a more medically and operationally advanced intra-theater patient the 13 clinical NDCS pilots was signifi cantly increased compared transport system

298 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

[318] MEDICALLY SIGNIFICANT EMOTIONAL DISTRESS [320] A LIMITED COMPARISON OF LEGACY AND TWO AMONG REMOTELY PILOTED AIRCRAFT, INTELLIGENCE, FULL-COVERAGE ANTI-G SUITS UTILIZING INFLIGHT AND CYBER OPERATORS SUPPORTING “AROUND-THE- PHYSIOLOGICAL MONITORING, PRESCRIBED MANEU- CLOCK” OPERATIONS VERS, DAS F-16 AIRCRAFT, AND CENTRIFUGE TESTING T.V. MERRIWEATHER, W. CHAPPELLE D.A. HOLLAND1, C. GENTILE1, J. KANUCH1, J. COHEN1, AND K.D. MCDONALD M. HEMMINGSEN1, D. MASTEN1, J. SAMEK1, Neuropsychiatry, USAFSAM, Wright-Patterson AFB, OH D. VOGELSANG1, T. JORRIS1, K.G. HUGHES2, S. CULBRETH3 AND D. CARROLL4 INTRODUCTION: U.S. Air Force (USAF) remotely piloted 1Education Division, USAF Test Pilot School, Edwards AFB, CA; aircraft (RPA) operators, intelligence operators, and cyber operators 2Flight Medicine Clinic, 95th Medical Group, Edwards AFB, work in demanding and stressful environments that contain several CA; 3Human Systems Integration, HQ Air Combat Command, risk factors for the development of signifi cant emotional distress. 4 The increasing need for operators to sustain multiple, 24-hr Hampton, VA; Technical Support Division, USAF Test Pilot (“round-the-clock”) operations has led to a signifi cant increase in School, Edwards AFB, CA operational hours, shift work, and other exposure to various work- related stressors that increase the risk for occupational burnout INTRODUCTION: Comparisons between 13B/P ‘legacy’ G suit, and emotional distress. Having an accurate understanding of the Mustang 22/P Adv Tech G Suit (“ATAGS”), & RFD Beaufort Full-Coverage prevalence of burnout and signifi cant emotional distress is critical Anti-G Trouser (“Beaufort Suit”) were conducted by USAF Test Pilot to medical management and strategies for maximizing human School (TPS) Aug-Sept 2011. About 200 high-G events with centrifuge & performance. METHODS: The Aeromedical Consultation Service 7 dedicated F-16D sorties with in-fl ight recording of aircraft parameters collected operator self-reports of emotional and occupational were fl own. Prior in-fl ight evals of full coverage G-suits at Langley/Shaw stressors via an occupational questionnaire. Emotional stressors were AFBs by HQ ACC/A8XH were in operational sorties, with subjective identifi ed utilizing the psychological distress assessment instruments: evals. The Kirtland 2001 IOT&E report that failed the “ATAGS” suit Outcome Questionnaire-45 for clinical distress and Post-Traumatic was thusly “re-thought”. This study quantifi ed the differences between Stress Disorder Checklist-Military for post-traumatic stress disorder G-suits under prescribed, high-G profi les using in-fl ight physiological features from combat exposure and/or related trauma. The effects monitoring equipment, while addressing key concerns raised in prior of occupational stressors on attitudes towards work were identifi ed evals. METHODS: Four test pilots & 3 fl t tst engrs from TPS performed utilizing the Maslach Burnout Inventory-General Survey. RESULTS: maneuvers of 12 second dwells at 6, 7, 8, & 9 +Gz in the USAFSAM Analysis is on-going and will be compiled once an adequate sample centrifuge, and F-16D. Each block was conducted at approximately 1.5 size across active duty, Guard, and Reserve operators is obtained. Gz/sec & 6 Gz/sec. Heart rate, resp rate, O2 sats, core/superfi cial temps, strain estimation, & task workload data were collected for each maneuver. DISCUSSION: The survey examines RPA, intelligence, and cyber operators to assess their emotional disposition and how negative Questionnaire data were also collected for comparison to prior HQ ACC/ emotional states are related to stressors in their work environment. A8XH evals. RESULTS: Although the power was limited, objective physiol The descriptive data regarding the prevalence of burnout, medically & subjective data indicate increased performance with full-coverage suits. signifi cant emotional distress, and the sources of occupational stress Peak HR under +Gz was 30 bpm lower with full-coverage vs legacy suits, provide medical and line leadership with valuable insight into potential subjective strain rankings were 3-5 lower on a 10-point scale, & workload strategies for improving health and performance among such specialized ratings were 2-5 pts lower on the Bedford scale. No sig diff was found in populations of USAF airmen supporting 24-hr operations critical to either core/superfi cial temps between the 3 G-suits during the eval period, intelligence, surveillance, and reconnaissance and combat operations. despite elevated temps at Edwards AFB. Aircrew comments indicate a signifi cant increase in mission capability, with decreased physiol workload

Learning Objectives: using full coverage suits. Differences between the two full coverage suits indicate a slight, but not statistically signif preference for the Beaufort suit 1 Identify the prevalence and factors contributing to medically signifi cant emotional and occupational distress in RPA, intelligence over ATAGS. These results are preliminary, as the data is being analyzed and cyber operators. IP: 192.168.39.151 On: Sun,further. 26 Sep DISCUSSION: 2021 17:39:09 The TPS team attempted to address prior concerns Copyright: Aerospace Medicalin a controlled Association manner by collecting objective data through identical, Delivered byprescribed Ingenta profi les. Although w/small N, results indicate lower pilot Wednesday, May 16 8:30 AM workloads, increased spare capacity, & higher +Gz tolerance with full coverage G-suits. Ballroom C Learning Objectives: PANEL: EDWARDS AFB ENHANCING 1 Appreciate the difference provided by the performance-enhancing effects of full coverage g-suits at high Gz versus older 5 -bladder g HUMAN PERFORMANCE AND suit technology. HUMAN-SYSTEMS INTEGRATION FLIGHT TESTS AND ADDITIONAL TOPICS [321] A NEW APPROACH TO MITIGATING NECK PAIN DURING HIGH +GZ FLIGHT MANEUVERS [319] EDWARDS AFB ENHANCING HUMAN PERFOR- E. STURGELL AND D.A. HOLLAND MANCE AND HUMAN-SYSTEMS INTEGRATION FLIGHT United States Air Force, Edwards, CA TESTS AND ADDITIONAL TOPICS 1 2 D.A. HOLLAND AND G.A. BENDRICK INTRODUCTION: As the performance capabilities of today’s 1 Education Division, USAF Test Pilot School, Edwards AFB, CA; aircraft grow, so too do the forces applied to the pilot’s body and the 2NASA Dryden Flight Medicine Clinic, Dryden Flight Research likelihood of spinal injury. Over the last 15 years, research has shown Center, Edwards AFB, CA that 89% of pilots experience musculoskeletal neck pain while fl ying, while 34% of those surveyed stated that the neck pain was severe This diverse panel seeks to inform the audience about interesting enough to adversely affect their fl ight duty performance. A positive cutting edge research going on in the Human Systems Integration correlation has also been shown between neck pain and increased realm in a variety of areas such as: Test Pilot School (TPS) High Gz frequency of performing high +Gz maneuvers, resulting in 54% of Instrumented F-16 fl ights with comparative G Suit data with pilots reporting neck pain during or after fl ight. While several studies physiologic and data jet monitoring; some remotely piloted vehicle have found statistically signifi cant improvements in neck pain/disability studies; cervical neck injuries/mitigation; and Automated Ground following the performance of cervical strengthening exercises; none have Collision Avoidance Systems Issues and Testing. looked at the effectiveness of using prescribed single plane movement

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 299 ASMA 2012 MEETING ABSTRACTS patterns for decreasing the occurrence of neck pain in military pilots. [323] FLYING UNMANNED AIRCRAFT: A PILOT’S METHODS: A baseline measurement of all subjects will be taken using a PERSPECTIVE newly-developed modifi ed Neck Disability Index (NDI) to include fl ight M. PESTANA specifi c questions. Subjects will then be instructed on a standardized Dryden Flight Research Center, NASA, Edwards AFB, CA cervical musculature strengthening regime as well as specifi c single plane movement patterns for various fl ight maneuvers. Following a 30, INTRODUCTION: The National Aeronautics and Space 60 and 90 day performance of the strengthening program and movement Administration (NASA) is pioneering various Unmanned Aircraft patterns, subjects will again be given the modifi ed NDI for comparison to System (UAS). A century of aviation evolution has resulted in accepted their baseline. RESULTS: Increased strength and single plane movement standards in the design of human-machine interfaces - the displays and patterns should decrease the occurrence of reported neck pain both controls which serve to optimize safe and effi cient fl ight operations during and after fl ight maneuvers. The strengthening of specifi c cervical and situational awareness. The current proliferation of non-standard, musculature is required to enhance the performance of the single plane aircraft-specifi c fl ight crew interfaces in UAS, coupled with the movement patterns. DISCUSSION: The decreased pain levels will likely inherent limitations of operating UAS without in-situ sensory input and be due to the decreased amount of physiological stress that is placed on feedback (aural, visual, and vestibular cues), has increased the risk of the cervical spine during certain fl ying maneuvers. These decreased stress mishaps associated with the design of the “cockpit”. A concerted effort levels may also result in a long-term decrease in the number of severe is required to establish standards for the human-machine interfaces. cervical spine injuries, such as herniated discs, and arthritic sequelae. METHODS: NASA’s recent experiences with fl ying its MQ-9 Predator-B in the NAS for extended duration, for wildfi re geo-locaition, has Learning Objectives: enabled both NASA and the FAA to realize the full potential for UAS, as 1 Understanding basic cervical musculoskeletal injury prevalence well as understand the implications of limitations. This effort included with potentially new mitigation techniques. an extensive process to obtain fl ight clearance from the FAA to operate under special provisions, given that UAS in general do not fully comply [322] HUMANS ARE MORE IMPORTANT THAN with current airspace regulations. RESULTS: Missions up to 20 hours in HARDWARE - EFFECTS OF FATIGUE AND STRESS duration have yielded real time data, transmitted via satellite directly to the incident commanders. Their responses are indicative of this ON RPA CREWS success; e.g. “...lives and property saved.” The successes of this effort, 1,4 2,3 5 C. BAUGHMAN , D. BLAIR AND D. PATTERSON though outwardly evident by these results, were also contingent on 1 2 USAF Test Pilot School, Edwards, CA; Georgetown the ability of the fl ight crew to account for the limitations of operating 3 University, Washington, DC; Kennedy School, Harvard, UAS. DISCUSSION: Key factors that contribute to the limitations of Cambridge, MA; 4College of Engineering, University of Notre fl ying UAS as routinely as manned aircraft include inability to “see and Dame, Notre Dame, IN; 5College of Engineering, Embry Riddle avoid” other aircraft and the deprivation of sound and vestibular cues Aeronautical University, Prescott, AZ which contribute to a pilot’s situational awareness of the aircraft’s fl ying performance and navigation situation. It is imperative that the design of INTRODUCTION: The impact of Remotely Piloted Aircraft (RPA) the ground control station, with its suite of displays and controls, must has been hailed by combatant commanders leading to an unprecedented account for these limitations and allow for relative ease of the pilot to demand for armed RPA overwatch. Fielding the MQ-1 and MQ-9 interpret and respond in a safe and effi cient manner. The defi nition of platforms completely bypassed normal acquisitions process and systems “pilot” is experiencing a paradigm shift as knowledge and skill sets are engineering channels which led to many downstream emergent issues. recognized as unique to these aircraft. Air Force offi cials have scrambled to fi nd enough people to satisfy the Learning Objectives: growing need for RPA operations. TAMI-21, assignment freezes, and creation of entirely new career fi elds have put just enough aircrew on 1 The audience will understand some of the unique aspects of the line, but minimizing the effects on the people performing the mission piloting UAS without full sensory input. has taken a backseat to the mission itself. METHODS: Using mishap 2 The audience will understand the changing paradigm of the “pilot” rate data from the Air Force Safety Center IP:for number 192.168.39.151 of mishaps per On: Sun, 26associated Sep 2021 with 17:39:09 defi ning the skill sets and knowledge required for a 100,000 hours and data taken from rest and workCopyright: cycles of operational Aerospace Medicaldiverse Association array of UAS. RPA crew members, effects of fatigue and stress will be presentedDelivered from by Ingenta the viewpoints of fl ight test, social science, and warfi ghting. RESULTS: The MQ-1 and MQ-9 have 10 and 5 year averages of 18.04 and 10.8 [324] SOME HUMAN SYSTEMS INTEGRATION ISSUES Class A mishaps per 100,000 hours, respectively, while the combined WITH IMPLEMENTING AUTOMATIC GROUND COLLISION 10 year average for all USAF aircraft is 0.58. The disparity between these AVOIDANCE IN FIGHTER AIRCRAFT will be investigated, along with other operational and physiological issues J. KENNEDY1 AND D.A. HOLLAND2 encountered by RPA crews to answer the question “is quantity really 1416 Flight Test Sq/DOV, Edwards AFB, CA; 2Education better than quality?” DISCUSSION: Warfi ghters will always fi nd a way Division, USAF Test Pilot School, Edwards AFB, CA to accomplish the mission, at almost any cost. Canceling sorties due to low manning or high workload is simply not acceptable to ground force INTRODUCTION: Following technology demonstration commanders, especially when operators are not in “harm’s way”. The projects, the Automatic Ground Collision Avoidance (AGCAS) physical and emotional demands placed upon RPA crews cause fatigue system is being tested in the F-16. Development & testing of a and unique stresses that are aggravated by cognitive disassociations system that would maneuver the aircraft away from the ground between wartime, normalized peacetime operations at a US base, and without pilot input requires balancing safety of fl ight with mission home life. RPA crews receive little to no training on fatigue and stress non-interference. METHODS: Technology development has focused management, yet are called upon daily to make life or death decisions. on an AGCAS system that would prevent most Controlled Flight Fatigue-stress coupling leads to an unsustainable lifestyle that will Into Terrain (CFIT), operate in the background, minimize nuisance ultimately produce negative long-term effects on the operators’ physical fl y-ups, be intuitive to the pilot, provide cues prior to action, and mental well-being. This causes a vicious cycle - low sustainability will and respond predictably when required. Much of the work was lead to low retention, less-than-optimal performance, and higher mishap accomplished in simulators building the system and refi ning the rates. human-system interface for mode awareness, and aircraft state in terms of possible auto-fl y up action. RESULTS: A system is being Learning Objectives: tested that allows the pilot to chose settings/minimum altitudes 1 Gain an understanding of the relationship that cognitive disassocia- based on the mission, & provides cues 3 seconds to activation that tion of wartime and peacetime has on fatigue and stress. would allow the pilot to decide whether to adjust the fl ight path, 2 Examine short term and long term effects of the current RPA crew- disengage the system, or allow the fl y up. DISCUSSION: AGCAS member lifestyle. systems have been debated for a long time... leading to more losses

300 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS of pilots/aircraft due to CFIT. Losses attributed to CFIT-related 8:45 am causes (G induced loss of consciousness, spatial disorientation, [326] ESTIMATE OF THE CARDIOVASCULAR RISK FACTORS visual illusions, loss of situation awareness, etc) are signifi cant. AMONG AIRLINE PASSENGERS ARRIVING TO CARTAGENA The solution needed was for it to operate without input other than DE INDIAS-COLOMBIA initialization of the system, and be functional at any attitude. The M.A. SALAMANCA1,2 AND M. PERALTA1 system also needed to provide the alert pilot with enough cues 1 to recognize that the AGCAS system was preparing to execute Medicine Program, Corporacion Universitaria Rafael Nuñez, 2 the fl y-up. The chosen methodology is a set of converging arrows Cartagena de Indias Colombia; Aerospace Medicine, that start at either side of the heads-up-display 3 seconds prior to Universidad Nacional de Colombia, Bogotá Colombia activation and met in the center of the display as the AGCAS system started the fl y-up command. The size and rate of the convergence INTRODUCTION: With the development and evolution of were determined based on pilot reaction time and scan time, and air transport it is easier to travel distant destinations. Moreover, life balanced obstructing the pilot’s view forward of the aircraft and expectation is increasing so as the number of elderly passengers each other critical information in the HUD. The display allows the pilot year. According to the WHO the fi rst mortality cause is cardiovascular to maneuver the aircraft prior to the AGCAS trigger, disable the disease and in this population, cardiovascular events are a major concern. system by a paddle on the control stick, or allow the fl y up in the In fact, among medical incidents occurring in-fl ight they are second- case of disorientation. The recovery mechanics are a roll to wings ranked (10%) behind gastrointestinal disorders (25%). These events can level, and then execute a 5g pull to an attitude that will clear the represent for the air carrier a major economic and logistic problem and terrain. Placing this system in digital aircraft will result in lives and could impact the destination local health system. In the last year about aircraft saved. eight hundred thousand people arrive to Cartagena, but there are not studies in the fi rst touristical city of Colombia about the prevalence of Learning Objectives: cardiovascular disease among people arriving to its airport. METHODS: 1 Understand some of the issues surrounding Auto Ground Collision A representative sample of 1300 Spanish speaking people, arriving to Avoidance Systems. Cartagena’s airport is being interviewed, asking them age, departure site, cardiovascular diseases and risk factors, and common symptoms in fl ight. RESULTS: 743 airline passengers have been interviewed, their Wednesday, May 16 8:30 AM average age is 38 years (18 to 74). The most frequent symptoms reported Ballroom D are headache, palpitations, nausea, and dizziness (51%, 31%, 28% and 27%, respectively). The cardiovascular risk prevalence is 53%. The most common are hypertension (32.48%), smoking (20.9%), and dyslipidemias SLIDE: TRAVEL MEDICINE & TRANSPORT (14.82%). DISCUSSION: These results alert about high cardiovascular risk MEDICINE TOPICS prevalence among airline passengers arriving to Cartagena. It is needed to give medical advise to these passengers with cardiovascular risks before fl ight. In the other hand, the Cartagena health system has to evaluate its capacity to respond for these high risk visitors. 8:30 am [325] ASPECTS OF TRAVEL MEDICINE FROM MUNICH Learning Objectives: AIRPORT 1 The audience will learn about cardiovascular risk factors among B. SCHINDLER airline passengers and the needed to advise them before the travel. Medicare Munich Airport, Munich Germany 9:00 am INTRODUCTION: Over the last years travel medicine becomes an issue. People from all around the world are travelling [327] VOLCANIC EMISSIONS - AN AVIATION more due to business or to leisure purposes. Goods, animals and HEALTH HAZARD? foods from all places in the world are transportedIP: 192.168.39.151 via airfreight On: Sun,S. 26 EVANS Sep 2021 17:39:09 within hours to destinations on different continents.Copyright: With theAerospace MedicalMedical, AssociationUK Civil Aviation Authority, Gatwick Airport South introduction of the WHO International Health Regulations,Delivered byUnited Ingenta Kingdom which have to be implemented by June 2012, offi cial health authorities have to make sure that a 24 / 7 readiness is assured in INTRODUCTION: The past couple of years have seen several case a suspect individual is hitting ground at a country’s boarder. periods of disruption to air travel in both Northern and Southern Outbreaks with avian fl u, H1N1 and a lot of other pathogenic hemispheres from erupting volcanoes. Work has progressed on the risks to agents are spread within a few days over the globe. A large variety fl ight safety from ash in fl ight paths but has focussed on the airworthiness of other communicable diseases are known. RESULTS: MediCare risks, particularly effects on engines and airframes. As these risks are Munich Airport being a healthcare provider, located in one of the becoming better understood and mitigating actions are being put in two terminals, offers service and advise on a lot of travel medicine place by regulation, guidance and operating procedures, the potential issues, incl.: - Starting with the medical preparation of workers effects on the health of aircrew and passengers need to be considered. and travellers who are going to spend time in a foreign country. One concern is the potential risk of exposure of aircraft occupants to - Doing the medical check-up as well as providing a coordinated gaseous emissions and, in particular, sulphur dioxide. The Science sub- consultation concerning health hazards and countermeasures group of the International Civil Aviation Organization Volcanic Ash Task in terms of prevention. - Offering a large variety of vaccination Force (IVATF) has recommended that Standard Operating Procedures in programms adapted to the location. And last but not least giving a possible toxic gas encounter should be reviewed. It has also suggested advise to special conventions in different countries. In case that further research be undertaken to understand and mitigate the risk passengers return with an illness, our team gives medical assistance. of exposure. Any aircraft fl ying in the vicinity of an active volcano with a Serious cases sometimes have to be referred to larger hospitals. bleed air cabin conditioning system could potentially encounter emissions For the case of a suspected individual, carrying a communicable from the volcano and crew and passengers could inhale, ingest or come disease or even epidemic, we are contracted by the government of into contact with emitted particles or gases. The potential effects of these Bavaria to execute the tasks of the public health authority. encounters will be considered and areas for future research explored.

Learning Objectives: Learning Objectives: 1 We would like to give the reader and auditory an introduction 1 Understand the health implications of active volcanoes. to aspects of travel medicine from the view of a medical 2 Understand the potential aeromedical consequences of exposure to healthcare provider at one of the largest international airports gaseous volcanic emissions. in Europe. 3 Consider what further research needs to be undertaken.

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 301 ASMA 2012 MEETING ABSTRACTS

9:15 am 9:45 am [328] COMMERCIAL AIRLINES MEDICAL KITS. [330] MEDICAL VOLUNTEERS IN IN-FLIGHT EMERGENCIES A COMPARISON OF 20 INTERNATIONAL AIRLINES R.A. COCKS1, K.C. HUNG2,1, C.A. GRAHAM1 P.M. ALVES1, R. LEIGH1, K. MACKENZIE2, D. STREITWIESER3, AND T.H. RAINER1 R. DE JONGH5, J. DUTSCH4 AND N. NERWICH6 1A&E Medicine, Chinese University of Hong Kong, Hong Kong; 1MedAire Inc., Tempe, AZ; 2MedAire, Singapore, Singapore; 2School of Public Health and Primary Care, Chinese University 3Banner Good Samaritan Hospital, Phoenix, AZ; 4International of Hong Kong, Hong Kong SOS, Frankfurt Germany; 5International SOS, Singapore, Singapore; 6International SOS, Sydney, NSW, Australia INTRODUCTION: In-fl ight medical emergencies are diffi cult to manage and medical volunteers are valuable resources when these INTRODUCTION: Airlines are required to carry medical kits by events occur. The study objective was to examine whether the presence regional or international regulatory bodies. Advances in the practice of medical volunteers would reduce the number of medical diversions of medicine and pharmaceutical developments occur at greater speed or would lead to more appropriate diversions. METHODS: This was a than regulations are updated and/or internal changes take place. retrospective cohort study for a large Hong Kong commercial airline The objective of this study is to compare and analyze the contents from December 2003 to November 2008. The presence of medical of medical kits for international airlines. METHODS: The content list volunteers, the need for diversion and the outcome for all in-fl ight of medical kits of 20 international airlines clients of a telemedicine medical events were recorded. Correlations between the presence provider group was analyzed. Individual items were analyzed by 40 of medical volunteers and the need for diversion were sought using emergency physicians engaged in providing in-fl ight medical advice, the Chi squared test and logistic regression analysis. For diversions, through a survey. RESULTS: International airlines have a considerable the outcomes in terms of hospitalization, death or discharge were overlap in the list of drugs carried. A signifi cant number of drugs were compared between the groups with and without the presence of deemed to be unnecessary and not supported by current medical medical volunteers using Fisher’s exact test. RESULTS: Medical standards. Little uniformity was observed in regards to antibiotics. volunteers were available in 35.4% of the medical events. A total of 46 DISCUSSION: Revising the content of airline medical kits is important passengers required medical diversion in the fi ve-year period. Medical on a periodical basis to identify items that could be replaced or new volunteers were present in 39 diversions (85%). Similar to previous items the can be incorporated according to current best practices. studies, the presence of medical volunteers was positively associated International standardization of contents would benefi t telemedicine with diversions. There were no signifi cant differences in outcome providers and on board volunteers in handling medical events, and for those diverted with or without the input of medical volunteers. ultimately the ill-passenger. Removing items no longer recommended DISCUSSION: Medical volunteers were more often present the more by current practice from the medical kits will lessen the risks for serious events, indicating a possible reluctance to offer their help improper utilization and its consequences. for more minor cases. The need for medical diversion is a balance between the proximity and quality of ground resources, resources on-board the aircraft, and operational feasibility. Learning Objectives: 1 Review contents of international airlines’ medical kits. Learning Objectives: 1 To review the role of medical volunteers in the handling of in-fl ight 9:30 am [329] AN ANALYSIS OF TIMING, LOCATION emergencies onboard commercial aircraft. 2 To examine how medical volunteers infl uence the outcome of AND OUTCOME OF CARDIAC ARREST ON BOARD emergencies. COMMERCIAL PASSENGER AIRCRAFT OVER AN 8-YEAR PERIOD C.A. GRAHAM, R.A. COCKS AND M. LIEW Wednesday, May 16 8:30 AM A&E Medicine, Chinese University ofIP: Hong 192.168.39.151 Kong, Hong Kong On: Sun,Salon 26 Sep AB 2021 17:39:09 INTRODUCTION: Cardiac arrest onboardCopyright: commercial Aerospace Medical Association passenger aircraft has generally been found to carry a poorerDelivered prognosis by IngentaPANEL: ADDRESSING ETHICAL DILEMMAS than pre-hospital cardiac arrest on the ground, and this study aimed IN AEROSPACE MEDICINE to identify factors contributing to this difference. METHODS: All cases of cardiac arrest onboard the aircraft of a Hong Kong-based [331] ADDRESSING ETHICAL DILEMMAS IN AEROSPACE international airline from September 2003 - September 2011 in which MEDICINE the automated external defi brillator (AED) was deployed were studied. R. IRELAND1, A. PARMET2, S.R. MOHLER3, J.D. HASTINGS4 Cabin Safety Reports and AED data downloads were used to assess the AND C.A. BERRY5 timing, location on-board, witnessed/unwitnessed status, presenting 1 2 rhythm, treatment and outcome. RESULTS: 48 cardiac arrest incidents USAF Retired, Canyon Lake, CA; University of 3 with adequate information were available for study. 19 of these were Southern California, Los Angeles, CA; Wright State witnessed (40%). Of the unwitnessed arrests, 6 passengers were found University, Dayton, OH; 4Private Practice, Tulsa, OK; unresponsive during a meal service and 3 were found in the toilet. The 5NASA retired, Houston, TX presenting rhythm was ventricular fi brillation (VF) in 11 cases (23%), of whom 3 survived after defi brillation by the AED (27%). Overall initial Physicians new to aerospace medicine are usually the fi rst to survival was 6%. 2 deaths resulted from early pregnancy hemorrhagic recognize how being a fl ight surgeon raises signifi cant ethical dilemmas. complications. DISCUSSION: Survival from VF arrests in this group 3 decades ago, fl ight surgeons Ursano and Jones lucidly addressed such was comparable to rates in previous studies, but the large number dilemmas in terms of value confl icts. Confl icts can include issues such of unwitnessed events contributed to the high incidence of non- as outside infl uences on medical practice, loss of confi dentiality, the survivable presenting rhythms. The occurrence of diversion for futile authority of fl ight surgeons, and forced decisions. Competence is cases reduced in the second half of the period studied. demonstrated by aerospace medicine specialists who recognize value confl icts when they occur and articulate ethical perspectives relevant Learning Objectives: for dealing with them compassionately and medico-legally. Through 1 To review the factors distinguishing cardiac arrest onboard didactics, video vignettes, and seasoned aerospace medicine specialists’ commercial aircraft from similar events on the ground presentations of examples and follow-on discussions, this panel will 2 To review existing work relating to the outcome of in-fl ight demonstrate classic fl ight medicine value confl icts; review major ethical resuscitation efforts theories to address them; and unveil for discussion proposed Ethical 3 To identify factors contributing to successful outcomes Guidelines of the American Society of Aerospace Medicine Specialists.

302 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

Wednesday, May 16 8:30 AM challenges previously experienced by only a small group of carefully Salon D selected and highly trained individuals. The necessity to escape to, and return from the upper atmosphere will result in passengers and crew being exposed to sustained periods of acceleration in the z (+G ) and x SLIDE: FUTURE SPACE MEDICINE z (+/-Gx) axes. Whilst the physiological basis of these challenges are well OPERATIONS understood in aircrew and astronauts, their application to this new, naïve and unstudied population requires the aeromedical community to consider their likely signifi cance for passenger and crew well-being. 8:30 am Whilst the +Gz levels to be experienced by HCSF participants are [332] COMMERCIAL SPACEFLIGHT PASSENGER not high (≤ 4G ), they will not be insignifi cant. A recent study from TOLERANCE OF ACCELERATION EXPOSURE DURING z our centrifuge reported a mean (n = 17) 6 SD relaxed +Gz tolerance CENTRIFUGE-SIMULATED SUBORBITAL FLIGHT (RGT) of +3.9 60.7 Gz, suggesting that ~50% of the HCSF population R.S. BLUE1, J.M. RICCITELLO2,1, J. TIZARD4, R.J. HAMILTON3 will likely experience some visual symptoms during suborbital AND J.M. VANDERPLOEG1,4 spacefl ight. G-induced loss of consciousness (G-LOC) intervenes 1 at a G level ~1.3G above RGT (equivalent to 2SD of our sample Aerospace Medicine, University of Texas Medical Branch, z Houston, TX; 2Aviation Medicine Advisory Service, Englewood, population). Accordingly, approximately ~2.3% of HCSF participants 3 4 may be at risk of G-LOC. In agreement with this, we report a 1.3% CO; Drexel University, Philadelphia, PA; Virgin Galactic, incidence of G-LOC in a retrospective study of non-aircrew subjects Las Cruces, NM (n = 467) exposed, for the fi rst time, to low +Gz levels (< 4Gz) on the Farnborough (UK) centrifuge. Although human tolerance to increased INTRODUCTION: Medical knowledge of the human body in +/-G is considerably greater than to +G , the associated sensations, microgravity and hypergravity is based upon studies of healthy and x z particularly with +Gx, of pressure (and possibly pain) on the chest typically young individuals well-conditioned for such an environment. and increased resistance to normal breathing, will be disconcerting to There are little data regarding the effects of spacefl ight on untrained those with no previous experience. Furthermore, the +Gx levels and commercial passengers or those with chronic illness. We examined the exposure durations may be signifi cantly greater than that experienced response of a group of potential spacefl ight participants to centrifuge under +Gz. This paper, by reference to previous studies and original G-force exposure. METHODS: 77 individuals (65 males, 12 females), data acquired by our group, discusses these challenges, their likely 22-88 years of age, underwent four centrifuge runs over 48h. Day 1 signifi cance for the HCSF industry, and the measures that can be taken consisted of one run with a peak of 3.5+Gz and a second with a peak to ensure passenger safety and enhance the overall sub-orbital fl ight. of 6.0+Gx. Day 2 consisted of two runs approximating a suborbital spacefl ight profi le, separated by less than 5 minutes between profi les. Learning Objectives: Data included blood pressure measurement, EKG, and post-run 1 The audience will learn about the physiological challenges questionnaires regarding motion sickness, disorientation, greyout, and of acceleration with reference to future suborbital spacecraft other symptoms. RESULTS: Of the 77 participants, average age was

50.4 6 12.7 years. Average heart rate (HR) varied by sex and direction 9:06 am of G-exposure (+Gz: F 150619.7, M 123627, p=0.001; +Gx: F 135630.3, M 110627.1, P=0.006). There was an inverse relationship [334] SPACE MOTION SICKNESS: ANALYSIS OF MEDICAL between age and peak HR (HR<120bpm: 60.2612.2yrs, HR>120: DEBRIEFS DATA FOR INCIDENCE AND TREATMENT 1 2 2 47.1610.9yrs, P<0.001). HR during peak G-exposure for the fi nal L. PUTCHA , D. YOUNKER AND V. DANIELS run was associated with imbalance afterward (no imbalance: HR 1Life Sciences Directorate, NASA Johnson Space Center, 2 126626.3, imbalance: HR 145.9621.7, p=0.002); there was no other Houston, TX; Pharmacotherapeutics, Wyle Integrated Science signifi cant hemodynamic change, sex, or age variation association with and Engineering, Houston, TX post-run imbalance. There was an inverse association between age and greyout (P<0.001); there was no signifi cant association between any INTRODUCTION: Astronauts use medications for the treatment vital sign change, sex, or direction of G-exposureIP: 192.168.39.151 with greyout. On: Sun,of 26 a variety Sep of2021 illnesses 17:39:09 during space travel. Results of data mining Baseline and pre-trial MAP was not associated Copyright:with any symptoms Aerospace or Medicalefforts to assessAssociation minor clinical conditions occurring during Shuttle intolerance. DISCUSSION: The results suggest that most individualsDelivered byfl Ingentaights STS-1 through STS-94 revealed that space motion sickness (SMS) with well-controlled medical conditions are capable of withstanding was the most common ailment during early fl ight days, occurring in acceleration forces involved in launch and landing profi les of ~40% of crewmembers, followed by digestive system disturbances (9%) commercial spacefl ight vehicles. Further research and experience will and infectious diseases, which most commonly involved the respiratory help refi ne which medical conditions present signifi cant risk during or urinary tracts. A more recent analysis of postfl ight medical debriefs suborbital fl ight and beyond. data to examine trends with respect to medication use by astronauts during spacefl ights indicated that ~37% of all prescriptions recorded Learning Objectives: was for pain followed by sleep (22%), SMS (18%), decongestion (14%), 1 The relationship between age and hypergravity tolerance will be and all others (14%). Further analysis revealed that about 150 of 317 described. crewmembers experienced symptoms of SMS. Nearly all (132 of 150) 2 The speaker will describe tolerance to hypergravity in patients crewmembers took medication for the treatment of symptoms with a total despite signifi cant medical history. of 387 doses. Promethazine was taken most often (201 doses); in most 3 The relationship between hemodynamic response to hypergravity cases this resulted in alleviation of symptoms with 130 crewmembers and the incidence of post-centrifuge neurovestibular imbalance (65%) reporting feeling much or somewhat better. Although fewer total will be discussed. doses of the combination of promethazine and dextroamphetamine (Phen/Dex) were taken (45 doses), slightly more than half of these 8:48 am doses resulted in improvement. The combination of scopolamine and [333] SPACE TOURISM: AN ACCELERATION dextroamphetamine (Scop/Dex) was reported to be effective in only 37% of cases, with 36 of 97 total doses resulting in improvement. A higher PHYSIOLOGIST’S PERSPECTIVE 1 1,2 1 percentage (24%) of Scop/Dex doses was reported to be ineffective J.P. SCOTT , A.T. STEVENSON AND H.T. LUPA compared with promethazine alone or as Phen/Dex (10% and 7%, 1 Human Sciences, QinetiQ, Farnborough, United Kingdom; respectively). Comparisons of the effectiveness of the different dosage 2Centre of Human and Aerospace Physiological Sciences, forms of promethazine revealed that intramuscular injection was King’s College London, London, United Kingdom most effective in alleviating symptoms with 55% feeling much better, 16% feeling somewhat better, and only 7% feeling no effect or worse. INTRODUCTION: The human commercial space fl ight (HCSF) Overall, it appears that promethazine alone was used more frequently industry will expose paying members of the public to physiological during fl ight and was reported effective for the treatment of SMS.

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 303 ASMA 2012 MEETING ABSTRACTS

Learning Objectives: Articles meeting search criteria were reviewed to extract medical 1 To learn metrics for the incidence of clinical conditions during conditions encountered in mass gathering events, patient presentation short duration space fl ight. rates (PPRs) and transport-to-hospital rates (THRs), factors affecting 2 To evaluate incidence and treatment history of space motion sickness medical utilization, and staffi ng ratio recommendations. Since many articles did not provide patient numbers, the number of articles that mentioned each condition was used as a surrogate measure 9:24 am for prevalence. Related diagnoses were combined into one of 43 [335] AN UPDATED REVIEW OF THE LITERATURE FOR conditions (13 traumatic, 23 non-traumatic, 7 environmental). Medical APPLICATION IN NEAR EARTH ASTEROID MISSIONS: utilization rates were converted to a common denominator to facilitate ANAPHYLAXIS, INTRA-ABDOMINAL INFECTIONS, SKIN comparison. RESULTS: Nineteen review articles provided information LACERATIONS AND BEHAVIORAL EMERGENCIES about medical conditions encountered in mass gathering events. N. CHOUGH Overall, soft tissue injuries (STIs) and cardiac problems were the Stanford Univeristy, Stanford, CA most common. In urban events, the most common conditions were: headache (9/9 articles); cardiac problems, respiratory illness (8/9); STIs, alcohol/drugs, and heat illnesses (7/9). In wilderness events, the INTRODUCTION: The transition of manned spacefl ight from most common conditions were: STIs, dehydration (6/10); fractures/ low-earth orbit (LEO) to further destinations such as Near Earth dislocations, sprains/strains, cardiac problems, and cold illnesses Asteroids (NEA) mandates that medical capabilities and resources (5/10). PPRs ranged from 0.14-90 patients per 1,000 attendees; aboard new vehicles must change as well. The Space Medicine THRs ranged from 0-0.55 patients per 1,000 attendees. Medical Exploration Medical Conditions List (SMEMCL) exists to address utilization factors included event duration, spectator mobility, weather, conditions that occur as a consequence of human space fl ight and to and attendance. A minimum of two paramedics per 5,000-10,000 create evidence-based clinical guidelines for treating potential medical spectators were recommended by several articles. DISCUSSION: conditions that may impact crewmembers in fl ight. By determining Despite statistical and reporting limitations in the mass gathering how these conditions are treated terrestrially in analogous, medicine literature, a review of the evidence base provides guidance resource-poor environments, we hope to establish what adaptations for emergency medical planning at commercial spacefl ight events. need to be made to current on-orbit medical practices in preparation for NEA missions. METHODS: Literature reviews were performed Learning Objectives: via PubMed, Scopus, Cinahl, National Technical Reports Library, 1 To identify medical conditions expected at commercial spacefl ight PsychINFO and Google Scholar. Secondary literature was prioritized events. over primary works; terrestrial analogs including Antarctic, wilderness 2 To summarize medical utilization rates and staffi ng ratio and submarine populations were prioritized unless no other suitable recommendations reported in mass gathering medicine literature. literature existed. RESULTS: 1) Anaphylaxis will continue to be treated 3 To provide commercial spaceport medical directors with data from similarly, but now has been shown to be treated safely in its early stages comparable mass gathering events to inform emergency medical by non-medically trained personnel. 2) Non-operative management planning for commercial spacefl ight events. of appendicitis is gaining popularity, although recurrence rates of up to 38% have been reported. If prophylactic appendectomies are to be performed, rates of SBO following laparoscopic appendectomy Wednesday, May 16 10:30 AM compared to open appendectomy are similar at 1.3-1.4%. 3) The Ballroom A infection rate of skin lacerations is largely abated by proper irrigation, though the impact of spacefl ight immunosuppression, wound infection PANEL: AIR TRAFFIC CONTROL OFFICERS: and healing warrants further research. 4) Psychiatric emergencies appear to be well-controlled with preventive measures and select- USING QUANTITATIVE RISK ASSESSMENT out criteria in both spacefl ight and analog environments; this model should be adapted for other SMEMCL conditions whenever possible. TO SET MEDICAL STANDARDS DISCUSSION: In reviewing current literature,IP: 192.168.39.151 the above should be On: Sun, 26 Sep 2021 17:39:09 [337] AIR TRAFFIC CONTROL OFFICERS: USING considered as updates for the SMEMCL. ContinuedCopyright: review of Aerospace resource- Medical Association limited analogs should guide medical risk stratifi cation and Deliveredclinical by QUANTITATIVEIngenta RISK ASSESSMENT TO SET guideline developments for long-duration missions. MEDICAL STANDARDS M.M. GIRGIS1, V. CHASE2 AND S. MITCHELL3 Learning Objectives: 1Occupational Health Services, NATS, Southampton, United 1 Audience will learn about updates in current literature regarding Kingdom; 2Operational Analysis, NATS, Southampton, United management of SMEMCL conditions in resource-poor analog Kingdom; 3Medical Department, United Kingdom Civil environments. Aviation Authority, Gatwick Airport South, United Kingdom

9:42 am Air Traffi c Control Offi cers (ATCOs) perform a safety critical role and have to undergo regular periodic medical examinations. The risks [336] EMERGENCY MEDICAL PLANNING FOR associated with incapacitation in ATCOs have never been previously COMMERCIAL SPACEFLIGHT EVENTS: MEDICAL systematically quantifi ed and the medical rules applied to ATCOs are CONDITIONS, MEDICAL UTILIZATION, often derived from those applied to commercial pilots. The various roles AND STAFFING NEEDS performed by ATCOs vary signifi cantly; some ATCOs work in large centres J. LAW AND J.M. VANDERPLOEG whereas other may single-man airport towers, so the consequences of Preventive Medicine and Community Health, University incapacitation in ATCOs will almost certainly vary depending on the of Texas Medical Branch, Galveston, TX circumstances. The expert panel consisting of physicians who work for air navigation service providers, regulators, and statisticians, will present INTRODUCTION: Commercial space companies will soon six papers outlining the current problems with medical standards applied begin fl ying paying passengers on suborbital and orbital fl ights. to ATCOs and provide evidence based upon simulator studies and A typical commercial spacefl ight event will last several hours and mathematical modelling on how the rules may be enhanced. The research attract large numbers of spectators. Commercial spaceports will papers include a study of the consequences of incapacitations acted out require emergency medical plans to support these events. We will in air traffi c control simulators. Obvious, sudden, complete, physical review medical conditions, medical utilization, and staffi ng ratios incapacitations are compared with subtle, gradual, partial, mental from comparable mass gathering events to guide emergency medical incapacitations. A second study timed how long it took ATCOs to “get the planning. METHODS: We conducted a literature review picture” in both familiar and unfamiliar airspace/traffi c conditions when of mass gathering medicine in urban and wilderness settings. there had been no-handover as would occur if a colleague unexpectedly

304 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS had to take over from an incapacitated ATCO. In a third research paper, case scenario, a subjective assessment was made by the ATCOs involved data from simulations of sudden catastrophic system failure have been concerning the potential risk to fl ight safety. Any period of no control studied to see how aircraft behave during short periods of no air traffi c and a subjective assessment of traffi c volume and complexity were control in what is considered to be some of the busiest and most complex recorded. RESULTS: 32 episodes of sudden, obvious, complete, physical airspace in the world. An assessment of the risk of collision is described and 15 episodes of gradual, subtle, partial mental incapacitations were and a mathematical model has been derived which can inform future acted out. In the former group, no incidents were considered to pose medical regulations in terms of quantitative incapacitation risk assessment. in a serious risk to fl ight safety. However, in the latter group 3 episodes were considered to pose a serious risk. DISCUSSION: Current medical [338] AIR TRAFFIC CONTROL OFFICER MEDICAL standards often focus simply on the medical problem rather than the STANDARDS - DERIVING INCAPACITATION STANDARDS type of incapacitation that may arise. Obvious problems such as collapse FROM SIMULATION DATA AND MODELLING are likely to be identifi ed and resolved very quickly. However, subtle M.M. GIRGIS1 AND S. MITCHELL2 problems such as cognitive dysfunction in depression may result in a delay in recognition and degraded performance may be missed for a 1Occupational Health Services, NATS, Southampton, United 2 period of time. In order to understand whether an ATCO can continue Kingdom; Medical Department, United Kingdom Civil to work safely, the illness needs to be considered in the context of the Aviation Authority, Gatwick Airport South, United Kingdom type if incapacitation that may arise and in the context of the role. Important factors regarding the illness include the level of insight and INTRODUCTION: Air Traffi c Control Offi cer (ATCO) Medical ability to call for help, or of colleagues to recognise incapacity. Standards are often derived from those applied to commercial pilots. However, the working environment and tasks performed by ATCOs Learning Objectives: vary signifi cantly from those performed by pilots. The standards 1 To understand how the type of medical problem might impact on applied to ATCOs may be too stringent in some circumstances as fl ight safety in the event of incapacitation. there is frequently considerable backup resource available for ATCOs 2 To understand how the context of the illness is important in working in large centres. Conversely, some ATCOs who work in determining the risk to fl ight safety. airport towers may fi nd themselves working alone especially during 3 To understand how periods of no control associated with delay night duties and the backup available is then signifi cantly reduced. in recognition of an incapacitation event may increase the risk to The working environment of ATCOs working in control centres varies fl ight safety. depending on the type of unit. In the UK, those working in “Area Control” work in large centres and often in pairs seated with another [340] WHAT IS THE TIME “TO GET THE PICTURE” FOR AIR ATCO; one ATCO performing “tactical” duties directing the traffi c TRAFFIC CONTROL OFFICERS WHEN THERE HAS BEEN NO whilst the other ATCO performs “planning” duties which includes HANDOVER FROM AN INCAPACITATED COLLEAGUE? liaison with other sectors and units. Other centre-based ATCOs work a M.M. GIRGIS1, S. MITCHELL2 AND V. CHASE3 single position without a planner. ATCOs also use different procedures 1Occupational Health Services, NATS, Southampton United to separate traffi c, some use radar, some use visual rules whilst others 2 procedural methods. Also, different degrees of lateral separation are Kingdom; Medical Department, United Kingdom Civil assured depending on the type of airspace. Therefore, the risks posed Aviation Authority, Gatwick Airport South United Kingdom; by incapacitation are likely to vary dependent on the task performed. 3Opertational Analysis, NATS, Southampton United Kingdom The last 2 decades have seen major advances in air traffi c control technology that are likely to mitigate incapacitation risk including INTRODUCTION: In the event of a sudden unexpected sophisticated tools such as fl ow control and short term confl ict alerts. incapacitation, Air Traffi c Control Offi cers (ATCOs) may be called upon Medical incapacitation standards have not kept pace with the changes to take over the work position of a colleague without a handover. The in technology and so current simulator based research into the risk study aim was to identify how long it takes ATCOs to “get the picture” associated with incapacitation is needed in order to ensure fairness following such an event. METHODS: Timings were taken for how long and consistency in the drafting and application of medical standards. it took ATCOs to get the picture both in live operations and also using Mathematical modelling similar to that usedIP: to192.168.39.151 create the 1% rule On:for Sun,simulators. 26 Sep This2021 was 17:39:09 tested in area control, terminal control and tower pilots could be used to inform ATCO incapacitationCopyright: medical Aerospacestandards. Medicaloperations. Association Timings were taken both in airspace familiar to a qualifi ed Delivered byATCO Ingenta and also in unfamiliar sectors where the ATCOs didn’t hold a Learning Objectives: valid rating. As well as the timing, a subjective assessment of traffi c 1 How the air traffi c control environment varies dependent on the levels and complexity was recorded and any loss of separation in the role performed. simulator was also documented. RESULTS: On average, valid ATCOs 2 How quantitative medical incapacitation risk assessment should be got the picture in 39 seconds and quicker than non-valid ATCOs at applied to ATCO medical certifi cation. 62 seconds. High complexity, high volume traffi c resulted in a longer time to get the picture. The time was shorter in tower simulators and [339] CONSEQUENTIAL RISK FROM MEDICAL in the live area control environment. However, no losses of separation INCAPACITATION IN AIR TRAFFIC CONTROL occurred during the simulator studies even in those without familiarity OFFICERS ESTIMATED DURING OPERATIONAL of the airspace. DISCUSSION: The ATCOs tested were able to establish the picture very quickly, even when there was no handover. Whilst TRAINING SCENARIOS 1 2 3 ATCOs take longer to get the picture in unfamiliar airspace, no losses M.M. GIRGIS , S. MITCHELL AND V. CHASE of separation occurred in any of the simulations suggesting that in an 1 Occupational Health Services, NATS, Southampton, emergency any qualifi ed ATCO would be able to assume control of any United Kingdom; 2Medical Department, United Kingdom Civil airspace temporarily. This has implications for procedures to be followed Aviation Authority, Gatwick Airport South, United Kingdom; in the event of incapacitation in ATCOs and consideration should be 3Operational Analysis, NATS, Southampton, United Kingdom given to formalising no jeopardy policies where needed to allow un- rated but qualifi ed ATCOs to take over any airspace in an emergency. INTRODUCTION: There is very little available data concerning consequential risk arising from medical incapacity of ATCOs. This is Learning Objectives: important in setting acceptable risk targets for medical standards. An air 1 To understand how long it takes for ATCOs to ‘get the picture’ traffi c control simulator based study was devised to investigate how when there has been no handover following medical incapacitation. different types of medical problem might impact on fl ight safety. 2 To understand how the “time to get the picture” is dependant on METHODS: Air Traffi c Control Offi cers (ATCOs) were asked to act familiarity of the airspace and the volume and complexity of the out a number of pre-determined medical case scenarios. The ATCOs traffi c situation. colleagues were not aware of the impending incapacitation and were 3 To consider how procedures to be followed in the event of asked to perform as they would in a real situation. At the end of each incapacitation could be enhanced to improve fl ight safety.

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 305 ASMA 2012 MEETING ABSTRACTS

[341] MODELLING OF THE RISK TO FLIGHT SAFETY FROM collisions were seen under 2 minutes. DISCUSSION: The estimate AIR TRAFFIC CONTROL OFFICER INCAPACITATION of the acceptable annual ATCO incapacitation risk is sensitive to V. CHASE1, M.M. GIRGIS2 AND S. MITCHELL3 assumptions in particular about the period of “no control” and also 1Operational Analysis, NATS, Southampton, United Kingdom; the “situational awareness recovery time”. The statistical modelling 2Occupational Health Services, NATS, Southampton, United shows that if the period of no control is demonstrated to be less than 2 3 minutes in either 99% or 99.5% of incapacitation events respectively Kingdom; Medical Department, United Kingdom Civil either a 1.7% or 3.5 %, incapacitation risk per annum is acceptable. Aviation Authority, Gatwick Airport South, United Kingdom Learning Objectives: INTRODUCTION: In order to assess risk to fl ight operations 1 To understand the risk of periods of no control and how this from incapacitation of an Air Traffi c Control Offi cer (ATCO) it is combines with parameters to give the overall estimate of risk to necessary to fi rst determine the acceptable level of risk and then to fl ight safety following an ATCO incapacitation. estimate the values of the parameters that contribute to actual risk. 2 To understand how an annual acceptable ATCO incapacitation risk The risk assessment is carried out by comparing the estimated risk to fl ight safety due to an ATCO incapacitation with a target acceptable can be calculated from simulation data level of risk. The risk to fl ight safety due to an ATCO incapacitation [343] USE OF QUANTITATIVE RISK ASSESSMENT IN is the product of the probability of an ATCO becoming incapacitated SETTING AND APPLYING MEDICAL STANDARDS FOR and the probability of a fatal accident given that an incapacitation has occurred. These two probabilities in turn are made up of a number of AIR TRAFFIC CONTROL OFFICERS 2 1 3 other factors, each of which needs to be estimated either theoretically M.M. GIRGIS , S. MITCHELL AND V. CHASE or empirically. European standards give the maximum tolerable 1Medical Department, United Kingdom Civil Aviation Authority, probability of Air Traffi c Management contributing to an accident as Gatwick Airport South, United Kingdom; 2Occupational Health 1.55x10-9 per fl ight hour. Using assumptions that have been widely Services, NATS, Southampton, United Kingdom; 3Operational accepted in aeromedical risk estimation, it can be assumed that Analysis, NATS, Southampton, United Kingdom ATCO incapacitation should account for no more than 1% of this risk. The currently accepted medical incapacitation standards applied INTRODUCTION: Although the International Civil Aviation to ATCOs relates to a risk over a year and therefore the time an ATCO Organization, through its Standards and Recommended Practices would spend controlling in a year also needs to be taken into account. provides general medical standards and a framework for assessment of Using information on ATCO shift patterns it can be estimated that individual cases, states making policy interpretations and individual case UK ATCOs spend between 12% and 14% of the year controlling. assessments sometimes have diffi culty in making a reasonable fair and European risk standards are defi ned against fl ight hours but ATCOs consistent assessment of the incapacitation risk that a condition in general, operate in ‘controller hours’. Hence, a further conversion is required or more specifi cally in an individual, poses to fl ight safety. In the UK the to assess against risk in controller hours. Based on these calculations, medical standards based on the aircrew “1% rule” were historically the authors suggest that the target maximum acceptable risk to fl ight ‘read across’ to Air Traffi c Control Offi cers (ATCOs) without detailed risk operations due to ATCO incapacitation is 1.57x10-10 fatal accidents analysis. Latterly in Europe, medical standards have been harmonised per controller hour. under the auspices of Eurocontrol. Research undertaken by NATS and Learning Objectives: UK Civil Aviation Authority has revived the principle of the use of quantitative risk assessments looking at the risks and consequences of 1 To understand the basis of mathematical risk modelling and ATCO incapacitation in different operational scenarios. Maximum acceptable levels of risk. acceptable incapacitation risk targets have been defi ned. Examples are 2 To understand how risk modelling can be applied to the air shown where medical standards for ATCOs might be relaxed in certain traffi c control environment to defi ne an acceptable ATCO operational environments, whereas for others the medical standards may incapacitation risk need to be higher. Many states operate a centralised regulatory function IP: 192.168.39.151 On: Sun,to 26 oversee Sep the2021 assessments 17:39:09 made by Aviation Medical Examiners, [342] THE RISK TO FLIGHT SAFETY FROMCopyright: AIR TRAFFIC Aerospace Medicaland if required Association make the fi nal certifi catory judgement. In these CONTROL OFFICER INCAPACITATION Delivered by circumstancesIngenta the ability to make individual assessments taking into V. CHASE1, M.M. GIRGIS2 AND S. MITCHELL3 account the local operational environment need to be facilitated whilst 1Operational Analysis, NATS, Southampton, United Kingdom; maintaining a consistent risk-based approach. A simple regulatory 2Occupational Health Services, NATS, Southampton, United approach would be (if the ATCO does not fully meet the standard) Kingdom; 3Medical Department, United Kingdom Civil an assessment against the risk arising from their particular subgroup Aviation Authority, Gatwick Airport South, United Kingdom of rated duties. Most states do not have the resources to make fully independent individual assessments. However, regulatory division INTRODUCTION: In order to assess risk to fl ight safety from into subgroups of the ATCO task may allow more fl exibility in incapacitation of an Air Traffi c Control Offi cer (ATCO) a number of decision-making whilst maintaining consistency of assessment from a different parameters must be estimated. The risk to fl ight safety due to regulatory perspective. an ATCO incapacitation is the product of the probability of an ATCO becoming incapacitated and the probability of a fatal accident given Learning Objectives: the incapacitation has occurred. The probabilities have been estimated 1 How quantitative medical incapacitation risk assessment should be using data from simulations of loss of control. METHODS: Radar data applied to ATCO medical certifi cation. was recorded for 183 simulations where there was a period of no control for 5 minutes. These traffi c samples were then analysed to identify any Wednesday, May 16 10:30 AM collisions that occurred and the times of these. The area considered Ballroom B in these simulations would usually be controlled by 35 ATCOs so the results were adjusted to consider the risk of incapacitation in an individual ATCO. The probability of a collision when there is no PANEL: ASAMS AEROSPACE MEDICINE control was then combined with an estimate of the expected time of no control following an incapacitation. This parameter was then PRACTICE GUIDELINES I combined with the probability of an ATCO incapacitation occurring to give an estimate of the risk to fl ight safety from ATCO incapacitation, [344] ASAMS AEROSPACE MEDICINE PRACTICE which was evaluated against the target maximum acceptable risk. GUIDELINES I & II RESULTS: The simulations show a number of traffi c samples where D. RHODES AND D.L. VAN SYOC there was a collision after 2 minutes of no control, however no Aerospace Medicine, USAFSAM, Wright-Patterson AFB, OH

306 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

The American Society of Aerospace Medicine Specialists The aeromedical disposition of abnormal and normal variant ECGs (ASAMS) has been a constituent organization of AsMA since December may thus be challenging for the fl ight medicine practitioner, especially of 1998. The mission of ASAMS is to serve as a voice for and represent whether further testing is occupationally warranted. The spectrum the professional needs of Aerospace Medicine specialists in the of ECG normal variants will be discussed, including fi ndings such United States. Among its several stated purposes, ASAMS is dedicated as incomplete right bundle branch block, sinus arrhythmia, and to promoting and preserving the highest professional standards of fi rst degree AV block. These do not typically warrant evaluation or care among practitioners of Aerospace Medicine. One of the ways it disqualifi cation; however, some extremes of variance may prompt achieves this purpose is with the publication of Aerospace Medicine further assessment in individual cases. The characteristics and practice guidelines. These guidelines are produced in conjunction with aeromedical disposition of some common ECG abnormalities will also AsMA. There are currently over 70 completed Aerospace Medicine be discussed, fi ndings such as left bundle branch block, complete right practice guidelines published on the ASAMS website (www.asams. bundle branch block, increased QRS voltage, nonspecifi c ST-T wave org) covering a range of diseases and medical issues which have changes and changes suggesting possible myocardial infarction. aeromedical consequences. This panel will present fi ve of these practice guidelines for discussion. The guidelines have a standard Learning Objectives: format consistent with other clinical practice guidelines but also 1 To understand the difference between normal, normal variant and include aeromedical consequences of the clinical entity as well as abnormal ECG fi ndings. waiver considerations. They are presented by experts in aerospace 2 To discuss the spectrum of normal variant ECG fi ndings in an medicine who have a clinical interest in the particular guideline. aircrew population. Topics for this panel are discussed in the abstracts that follow. 3 To learn the aeromedical evaluation and disposition of common abnormal ECG fi ndings. [345] CLINICAL AND AEROMEDICAL GUIDELINES FOR BICUSPID AORTIC VALVE [347] DRY EYE SYNDROME: USAFSAM EXPERIENCE E.D. DAVENPORT AND W.B. KRUYER AND MANAGEMENT Cardiology, Aeromedical Consultation Service, L.D. HURLEY AND J.M. GOOCH Wright-Patterson AFB, OH Ophthalmology, USAF School of Aerospace Medicine, Wright-Patterson AFB, OH INTRODUCTION: Bicuspid aortic valve (BAV) occurs in 1-2% of the general U.S. population and based on screening INTRODUCTION: Dry eye syndrome is caused by a echocardiograms is the most common congenital cardiac heterogeneous group of tear fi lm abnormalities that result in the malformation seen in United States Air Force pilot training candidates. disruption of the normal tri-layered anatomy of the tear fi lm. Dry Over 70% of BAV subjects will develop some degree of aortic stenosis eye disorders can be attributed to either a problem of reduced tear (AS) and/or aortic insuffi ciency (AI) during their lifetime. Additionally, production, known as aqueous tear dysfunction (AET) or excessive 30-40% will require surgical placement of a prosthetic aortic valve tear evaporation, know as evaporative tear dysfunction (ETD), or a during their lifetime. Aeromedical concerns surround the development combination of both mechanisms. Millions of people are affected by and progression of AS and/or AI that can cause symptoms and increase dry eye syndrome. It can be associated with blurred vision, burning, the risk of a sudden incapacitating event. The USAF Aeromedical pain, and photophobia which can lead to a decreased quality of life, Consult Service’s ECG library holds the largest longitudinal database of contact lens intolerance and even structural damage to the ocular aviators with Bicuspid Aortic Valves. This presentation will discuss the surface that can lead to permanent vision loss. Older age, female gender, incidence and prevalence of BAV and its association with AS, AI, and smoking, a history of refractive surgery, as well as many autoimmune other concomitant valvular diseases and aortopathies. We will also disorders are common factors associated with this condition. The discuss the hemodynamic changes infl uenced by fl ight in both low humidity and hypoxic environment common to the aerospace high-performance (>4Gz) and non high-performance aircraft. The environment can easily exacerbate the symptoms of an aviator who is current policy and follow-up recommended by the American College otherwise well controlled at ground level. The challenge for the aerospace of Cardiology and the American Heart AssociationIP: 192.168.39.151 for all patients asOn: Sun,specialist 26 Sep is 2021to utilize 17:39:09 the patient’s history, symptom presentation, and well as the USAF specifi c policy in aviators willCopyright: be reviewed. Aerospace Medicalclinical examination Association fi ndings to identify the specifi c cause for each Delivered bypatient’s Ingenta dry eye syndrome ( AET or ETD or both) in order to properly Learning Objectives: manage the condition. A review of the USAFSAM dry eye disease 1 To understand the pathophysiology and aeromedical concerns severity grading scheme will be presented along with a discussion of surrounding a Bicuspid Aortic Valve. the currently approved aviator dry eye syndrome treatment options. 2 To learn the appropriate risk stratifi cation and follow-up for bicuspid aortic valve associated aortic valve stenosis, aortic valve Learning Objectives: insuffi ciency, and aortopathies. 1 Augment the aeromedical specialist’s understanding of the 3 To understand the appropriate aeromedical disposition of Bicuspid diagnosis and management of dry eye syndrome in the aviator. Aortic Valves in aviators. [348] SPONTANEOUS PNEUMOTHORAX: [346] CLINICAL AND AEROMEDICAL GUIDELINES FOR AEROMEDICAL PRACTICE GUIDELINE ELECTROCARDIOGRAMS J.S. PICKARD W.B. KRUYER AND E.D. DAVENPORT Lackland AFB, San Antonio, TX Aeromedical Consultation Service, USAFSAM, Wright-Patterson AFB, OH INTRODUCTION: Spontaneous pneumothorax is not a common disorder, but for a number of reasons it has always been INTRODUCTION: Interpretation and disposition of ECGs is a of particular interest to aviation. The primary form of the disease frequent task for the fl ight medicine practitioner. Electrocardiograms typically targets young males. Pleural blebs, etiologic to the disease, (ECGs) may be classifi ed as normal, normal variant and abnormal. are rarely identifi ed before the index event, and when a bleb ruptures A normal variant is an atypical fi nding that is normally seen in some the resulting collapse is usually sudden and potentially incapacitating. percentage of the population. It generally has no clinical signifi cance Signifi cant barometric pressure changes may precipitate bleb rupture, and is considered within the spectrum of normal fi ndings. Pristine and will affect the size of an existing pneumothorax. Finally, while an normal ECGs are often not the “norm” in relatively young, healthy episode of pneumothorax usually heals without sequelae, about a third aircrew populations, who often have normal variant ECG fi ndings. of individuals will suffer a recurrence. This presentation will discuss the ECG recording equipment usually includes software that prints a clinical features of spontaneous pneumothorax, methods to potentially preliminary reading. Normal variant fi ndings are often interpreted by stratify the risk of a second episode, and the success of different modes such software as borderline or even abnormal. of intervention in reducing the rate of recurrence.

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 307 ASMA 2012 MEETING ABSTRACTS

Learning Objectives: INTRODUCTION: Nowadays, in-fl ight hypoxic incident 1 Discuss the clinical features of spontaneous pneumothorax remains an insidious danger for aviators. One report described the 2 Discuss methods to potentially stratify the risk of a second episode use of a self-report questionnaire to assess the prevalence of hypoxic of spontaneous pneumothorax symptoms experienced by aircrews during their hypoxia awareness 3 Discuss the success of different modes of intervention in reducing training in hypobaric chamber. Cognitive impairments dominated the rate of recurrence of spontaneous pneumothorax the symptoms reported, with one third of the aircrew members complaining of memory impairment. At the same time, in animal studies, the hippocampus, a key cerebral structure of memory, has been shown to be highly sensitive to hypoxia. Despite these fi ndings, Wednesday, May 16 10:30 AM the effects of acute hypobaric hypoxia (HH) on human memory have Ballroom C been poorly studied. This study was aimed to investigate the effects of acute HH on memory systems. METHODS: 47 healthy males (23.9 6 SLIDE: STRESSOR EFFECTS & ASSESSMENT 2.3 years old), French Air Force cadets participated to the study, during their hypoxia awareness training in hypobaric chamber (31,000 ft). They were submitted to memory tests before, during and after hypoxia 10:30 am exposure. 23 of them were not exposed to hypoxia and served as [349] CHARACTERIZING THE RELATIONSHIP BETWEEN normoxia control group. Memory tests included : i) an explicit faces OBJECTIVE, SUBJECTIVE AND PHYSIOLOGICAL MEASURES recognition task, based on the remember/know/guess paradigm, OF MENTAL WORKLOAD: A TRANSCRANIAL DOPPLER allowing to compare the contribution of recollection and familiarity to recognition memory ; ii) a perceptual priming task ; iii) the free SONOGRAPHY APPROACH recall (immediate and delayed) of 2 emotional word lists ; iv) the N. ARBUCKLE, K. EARL, D. KANCLER, L. QUILL Paced Auditory Serial Addition Test (PASAT), to assess working memory AND D. BOWERS performance during hypoxia. RESULTS: We found no effect of HH on Human Factors Group, University of Dayton Research priming and on the number of words recalled, although HH tends to Institute, Dayton, OH favour the recall of positive valence words. Interestingly, recognition memory was modifi ed. Indeed, although hit rates were equivalent, INTRODUCTION: It has been established that measures of we found defi cits in recollection whereas familiarity was unaffected. mental workload have a tendency to dissociate; that is, different types Finally, HH lowers working memory performance. DISCUSSION: of measures illustrate different trends when implemented within the Acute HH mainly impairs working memory and episodic memory same task or situation (Vidulich & Wickens, 1986; Yeh & Wickens, retrieval. These impairments could be due to neuronal activity and/ 1988). It has been hypothesized that these dissociations should not or to blood fl ow changes in brain areas that are required for these only be expected, but further, can explain the resource demand memory systems (the prefrontal cortex and the hippocampus mainly). and capacity characteristics of the task at hand (Tsang & Vidulich, 2006). While such dissociations between objective, subjective, and Learning Objectives: physiological measures could help explain the multidimensionality 1 The audience will learn the current neuropsychological view of of the workload within a specifi c task, this characterization has human memory systems and which one are sensitive to acute yet to be fully explored. Because of the ease of implementation hypobaric hypoxia. and analysis of Transcranial Doppler Sonography (TCD) technology (Funke, Warm, Matthews, Riley, Finomore, Funke, Knott, & Vidulich, 2010), current studies have explored the advantage of its utilization 11:00 am as a physiological measure mental workload (Shaw,Guagliardo, de [351] COMBAT CONTROLLER (CCT) AND TACTICAL AIR Visser, & Parasurman, 2010; Cerruti, Estepp, Miller & Christensen, CONTROL PARTY (TACP) ASSESSMENT AND SELECTION: 2010; Funke, Warm, Matthews, Riley, Finomore, Funke, Knott, & THE “RIGHT STUFF” Vidulich, 2010). However, the aforementionedIP: 192.168.39.151 studies have not On: Sun,W. 26 CHAPPELLE Sep 20211 17:39:09, W. THOMPSON1, R. HAYDEN2 comprehensively characterized the relationship between such AND R. YADRICK2 physiological, objective and subjective measures.Copyright: Presently, Aerospace research Medical Association Delivered by 1IngentaNeuropsychiatry, USAF School of Aerospace Medicine, is being conducted at the University of Dayton Research Institute 2 to understand under what parameters measures of workload vary. Wright-Patterson AFB, OH; Occupational Analyses Division, Preliminary fi ndings of this review are presented in matrix format AETC/A3, Randolp AFB, TX and serve as a tool for future researchers utilizing workload measures who wish to understand under what parameters workload measures INTRODUCTION: USAF Combat Controller (CCT) and Tactical associate and dissociate. Presented in addition to the matrix is an Air Control Party (TACP) airmen are in high risk, high demand aviation experiment in which researchers are collecting physiological (TCD), related career fi elds critical to battlefi eld operations. It is widely objective (performance) and subjective (NASA-TLX, MRQ, and SWAT) perceived both fi tness and psychological (cognitive and non-cognitive) measures during a sustained attention task. Results will help to clarify the aptitudes are necessary for adapting to training and operational rigors. associations and dissociations between these measures and will assist to However, traditional USAF personnel selection procedures for training illustrate the diagnosticity of various types of mental workload measures. candidates rely on general cut off scores for fi tness and cognitive aptitude without consideration of personality traits (e.g., emotional- Learning Objectives: social disposition). Annual attrition rates of selected candidates is high 1 To understand what task characteristics tend to make various (e.g., 70 to 80%) and costly in terms of manpower and economic measures workload associate and dissociate. resources. To improve selection processes, this study was designed to identify applicants with the “right stuff” by combining comprehensive standardized psychological (cognitive and personality) testing with 10:45 am current fi tness requirements. METHODS: Comprehensive standardized [350] EFFECTS OF ACUTE HYPOBARIC HYPOXIA testing regarding: (a) physical fi tness; (b) cognitive ability; and (c) ON HUMAN MEMORY personality traits was obtained on training applicants (n = 1045) the C. MALLE1,2, C. BOURRILHON1, P. QUINETTE2, M. LAISNEY2, initial week of Basic Military Training and before career fi eld training. Training outcomes (e.g., pass/fail) were matched with testing on F. EUSTACHE2 AND C. PIÉRARD1 1 each applicant. RESULTS: Using a series of statistical methodologies Operational Environments Department, French Armed Forces and discriminant analyses, predictive performance models were Biomedical Research Institute, Bretigny sur Orge, France; established that included variables of fi tness, cognitive ability, and 2Neuropsychology Department, University of Caen / Lower personality traits. The comprehensive models produce an overall Normandy, Caen, France adaptability rating for identifying those likely to succeed and adapt to

308 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS the high-demand, high-risk nature of training and operational missions. 3Electrical, Electronics & Communication Engineering, DISCUSSION: This study presents on the multivariate analyses of key ITM University, Gurgoan, India; 4Electronics, fi tness and psychological (cognitive aptitudes and personality traits) test Banasthali University, Jaipur, India scores essential to identifying those capable of adaptation to the rigors of CCT and TACP special duty career fi elds. The information provided INTRODUCTION: Human voice contains certain infrasonic regarding physical and psychological attributes serves to improve the components called as microtremor and not audible to the listeners. knowledge of fl ight medicine providers and line leadership tasked Microtremor is present in the vocal cord and vibrates around 10 with evaluating the suitability of direct accession applicants, as well as Hz frequencies during an emotionally relaxed state of the person. incumbents seeking an aeromedical wavier following disqualifi cation Recent research has indicated that when the person is in the state due to medical/psychiatric illness/injury. of psychological stress, the microtremor increases in frequency and decreases in amplitude. There is need to develop a deception tool Learning Objectives: that should be non-invasive and require no physical contact with the 1 Identifi cation of fi tness levels and psychological aptitudes body of speaker. METHODS: An attempt had been made to present (cognitive and non-cognitive) that distuinguish those who succeed data for supporting the validity of the hypothesis as a measure of shift versus those who struggle and/or fail is described. in fundamental frequency (F0). The real time acquisition of speech 2 Develop an understanding of how psychological testing improves achieved and processed using Data Acquisition Tool Box of MATLAB the aeromedical evaluation and selection of candidates for such software. Acquired speech was analyzed to measure the presence or aviation related special duty positions. absence of microtremor with frequency range from 9 Hz to 11 Hz. Algorithm has been developed to acquire speech for every 3 seconds 11:15 am to estimate shift in F0. The simulator was also developed for generation of pure tone of extremely low frequencies applicable in the inaudible [352] MANAGEMENT OF FATIGUE FOR FLYING range 1-20Hz. RESULTS: Autocorrelation function resulted to estimate OPERATIONS IN THE REPUBLIC OF SINGAPORE AIR FORCE the fundamental frequency (F0) of acquired speech. The research also S. CHEONG, D. CHUA, T. TEOH AND D. HONG suggests a non-invasive and remotely accessible technique to detect RSAF Medical Service, Singapore, Singapore speech under stress. General Questions asked did not show any signs of stress and represented in the green color. When the speaker was INTRODUCTION: Fatigue is a safety concern in fl ying in neutral state, graph represented the blue color. In response to the operations as it can adversely affect aircrew performance. The Republic questions directly asked to human volunteers for investigation of the of Singapore Air Force (RSAF) uses a 3-prong approach to manage issue, Stress refl ected in the acquired speech pattern and appeared aircrew fatigue, which is prevention, detection and intervention. in the red color. DISCUSSION: It is low intensity confl icts, therefore METHODS: The Performance Maximisation Branch (PMAX Br) in the voice stress analyzer (VSA) may be modifi ed to the rest/ tiredness status RSAF Aeromedical Centre is the consultant agency providing fatigue of war fi ghters on prolong mission. The system can also be used in the countermeasure advice and programmes to aircrew in the RSAF. fi eld condition to investigate/ interrogate suspected terrorist or their PMAX Br analyses the fl ying schedules, time zone crossings and sympathizer or accomplices. makes recommendations to the fl ying profi les, sleep-wake patterns and use of fatigue countermeasure medications (FCM) to mitigate the Learning Objectives: effects of fatigue. For demanding missions, a fl ight surgeon may be deployed with the aircrew to provide in-theatre fatigue support. The 1 Voice stress analysis fl ight surgeon is able to utilise a fatigue assessment suite consisting of subjective self-report, physiological measurement and cognitive 11:45 am performance assessment to detect and manage fatigue in a responsive [354] DENSE ARRAY ELECTROENCEPHALOGRAPHY AS A manner. In the RSAF, zolpidem is prescribed as a sleep promoting TECHNOLOGY TO IDENTIFY NEUROPHYSIOLOGICAL agent while caffeine and modafi nil are approved alert enhancing ASPECTS OF SPATIAL DISORIENTATION agents for aircrew. DISCUSSION: ManagementIP: 192.168.39.151 of fatigue will optimise On: Sun,D. 26 KANCLER, Sep 2021 N. 17:39:09ARBUCKLE, D. BOWERS AND L. QUILL aircrew performance and enhance fl ight safety.Copyright: Prevention should Aerospace be MedicalUniversity Association of Dayton Research Institute, Dayton, OH the fi rst line of fatigue management and good command emphasisDelivered is by Ingenta integral in adherence. The fl ight surgeon needs to advocate good INTRODUCTION: A wealth of cognitive and vestibular work-rest habits, sleep hygiene and educate aircrew when the research has been dedicated to the study of spatial disorientation opportunity arises. Fatigue interventions should only be used when all (SD) (e.g., Liggett, 2003; Patterson, 1997; Gregory, 1997;). However, possible preventive measures are exhausted and are not the panacea recent research involving human and animal neurophysiology has to fatigue avoidance. The use of FCM to manage fatigue should be resulted in the identifi cation of specifi c neurons directly responsible premised on a balance of operational demands and fl ight safety. Flight for spatial orientation and navigation (Doeller et al., 2010; Wiener & surgeons need to be calibrated in the use of FCM to avoid Taube, 2005). Because these neurons are only active during specifi c over-reliance and giving aircrew a false sense of security. spatially related movements, their activity may be indicative of a neurophysiological component to spatial awareness. Initial animal Learning Objectives: studies utilized neural probes, and found that individual neurons in the 1 The presentation aims to present an overview of the management of brain of a rat activated when the animal occupied a specifi c location fatigue in fl ying operations by the RSAF. Besides sharing the RSAF’s in space and tended to remain active when the animal changed experience, the presentation highlights the principles of fatigue location. Recent research, also involving rat and primate subjects, prevention and intervention. The presentation shares the tools that furthered the initial fi ndings by identifying specialized neurons which RSAF uses to detect fatigue, which includes an in-house designed activate when the head is oriented in a certain direction (Wiener & performance-based cognitive tool to assess degradation Taube, 2005). Overall, this neurological spatial system appears to of performance with fatigue. be comprised of areas of unique grid, boundary, and head direction cells that respectively serve as “primary map,” “refi ned primary map” 11:30 am and “head direction” cues. As this research has expanded to include [353] ONLINE OFFLINE VOICE STRESS ANALYZER human subjects, functional magnetic resonance imaging (fMRI) technology has been utilized to examine the existence of similar A.K. SALHAN1,2, M. KHAN1, S. SONDHI1,3 AND R. VIJAY1,4 1 neurologically based spatial display mechanism processes in humans Electrical Engineering, Jamia Millia Islamia (Central (Doeller et al., 2010). However, fMRI techniques do not permit subject 2 University), New Delhi, India; Biomedical Instrumentation motion. To address motion, dense-array electroencephalography (EEG) Division, Defence Institute of Physiology is currently being investigated as an additional technology for the and Allied Sciences, DRDO, Timarpur, India; study of neurological activity, during spatial tasks involving movement.

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 309 ASMA 2012 MEETING ABSTRACTS

Preliminary fi ndings are presented in matrix format to serve as a tool and aviation medicine as a specialty in its own right, and through his for future researchers to provide an initial association of motion-based endeavours nurtured the next generation of Australian leaders in the characteristics with specifi c neurological activation patterns. Overall, fi eld. DISCUSSION: Ninety years on Lawrence’s legacy is a RAAF health the addition of movement as a variable in this area of research will service that continues to provide exemplary service to our country. RAAF help to establish a neurological link to SD, and ultimately, a more health is now regarded not just as an enabler of Air Force capability holistic understanding of causal factors and potential countermeasures but a capability in it’s own right. Lawrence should properly be regarded to mitigate or prevent SD. as the Father of Air Force, and possibly aviation, medicine in this country.

Learning Objectives: Learning Objectives: 1 To understand neurophysiological aspects of spatial disorientation. 1 Understand the origins of medical services in the Royal Australian Air Force 2 Examine the importance of aviation medicine in a developing Air Wednesday, May 16 10:30 AM Force 3 Understand the contributions of Arthur Poole Lawrence to the Ballroom D RAAF health services. SLIDE: AEROSPACE MEDICINE 11:00 am IN HISTORY/HISTORY OF AEROSPACE [357] PERCY PRUNE’S PONDERINGS PROVIDED PERFECTLY MEDICINE PROTECTIVE PHLYING (FLYING) P.R. HURLY Directorate of Air Force Medicine, Royal New Zealand 10:30 am Air Force, Palmerston, North New Zealand [355] A CONCISE HISTORY AND RETROSPECTIVE OF AEROSPACE MEDICINE IN SAN ANTONIO INTRODUCTION: In 1940, Britain found herself in a very C. FISHER precarious position. The British Expeditionary Force had been AvMED Consultants, San Antonio, TX evacuated from the beaches of Dunkirk and Britain was now fi ghting for her life as she prepared to halt a German Invasion. The Royal Air INTRODUCTION: In 2011 the School of Aerospace Medicine Force was a key player in the Defence of Britain, but the RAF was short and the Air Force Research Laboratory left Brooks City Base after of aircraft and trained manpower. Many pilots were newly trained and 80+ years in San Antonio. This retrospective briefl y encapsulates not regular force. The Air Ministry became concerned that the RAF the highlights of decades of advancements. METHODS: This is a was losing more pilots and aircraft through accidents than through historical retrospective gleaned from documents and photos in the enemy action. New pilots were being pressed into service with only collection of the USAF and other sources. DISCUSSION: The decades about forty hours fl ying time. The Air Ministry was aware that this of research and education in San Antonio resulted in critical and now training was and that something had to be done to reduce the wastage. commonplace basic aviation knowlege and skills, understanding The type of men training were not interested in wading through large of disorientation, altitude and space science. Recent products of verbose training manuals, so a monthly short pamphlet called Training the aeromedical activities at Brooks included refractive eye surgery Memorandum, which became abbreviated as TEE EMM was produced. techniques and MRI. A repeating pattern of growth and contraction in The purpose of this monthly publication was to pass on advice and aeromedical research and advancements in education are highlighted. information regarding safe fl ying practices in a light hearted manner. A.A. Willis, the editor of this publication created a fi ctitious Learning Objectives: character - Pilot Offi cer Prune- as the main character in getting the 1 Attendees should develop a better understanding of the message home to the readers of the publication. TEE EMM survived foundational heritage of aerospace medicineIP: 192.168.39.151 and the critical roleOn: Sun,right 26 Septhrough 2021 the war. 17:39:09 DISCUSSION: This presentation looks at the aerospace medicine has played in medicalCopyright: science in general. Aerospace Medicalevolution Association of TEE EMM, messages conveyed and the attempts to attract Delivered by readers.Ingenta While it is unsure as to how effective the publication really was, fl ying accidents did decrease and the publication attracted a 10:45 am large number of readers. It is a good example of the KISS principle of [356] NINETY YEARS ON: THE ORIGINS OF ROYAL keeping information short and sweet. AUSTRALIAN AIR FORCE HEALTH T.L. SMART Learning Objectives: Australian Defence Force, Campbell Park, ACT, Australia 1 Information conveyed concisely and humorously often achieve the desired results. INTRODUCTION: The 31st of March 2011 marked the 90th anniversary of the formation of the Royal Australian Air Force (RAAF). 11:15 am Among the 21 Offi cers at the formation of the Service was a doctor, FLTLT Arthur Poole Lawrence. The RAAF Health Services therefore [358] DOCUMENTING PIONEERING HIGH-G also celebrated an important milestone on this date. METHODS: PHYSIOLOGY RESEARCH THROUGH ORAL HISTORIES Research was undertaken by examining early RAAF historical records, E.A. O’RANGERS1,2, D. DOERFEL2 AND K. ELLINGSON2 Service records, and information obtained from Lawrence’s family. 1Space Medicine Associates, LLC, Belcamp, MD; 2Southeastern This was analysed within a historical context to determine Lawrence’s Pennsylvania Cold War Historical Society, Jenkintown, PA contribution to Air Force and aviation medicine in Australia. RESULTS: Lawrence served with distinction in the Australian Army in World INTRODUCTION: The Southeastern Pennsylvania Cold War War 1, winning a Military Cross. After leaving the Army he took up Historical Society conducts oral history interviews of individuals who residence at Point Cook as the Central Flying School Medical Offi cer. participated in military and technology development projects during As one of our pioneering Aviation Medical Offi cers, FLTLT Lawrence the Cold War (1945 to 1989). METHODS: Several of the interviews developed medical standards for aircrew and self-experimented with have uncovered anecdotes from personnel who worked at the former the effects of hypoxia in fl ight. He was appointed as the RAAF’s fi rst Aviation Medical Acceleration Laboratory (AMAL), which was part of Director of Air Force Medical Services in 1925 and rose to the rank of the Naval Air Development Center (NADC) in Warminster, PA. AMAL GPCAPT before resigning in 1933. Lawrence was also the fi rst medical housed the world’s most powerful 40G human centrifuge/dynamic assessor for Australia’s civilian aviation department. During his career fl ight simulator, which remains intact (but non-operational). he fought, despite fi erce opposition, for the existence of air force RESULTS: Commissioned at the close of World War II to investigate

310 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS high-G physiology and to identify countermeasures to acceleration Sudden cardiac death (SCD) remains a nightmare for the exposure for pilots fl ying high performance aircraft, AMAL continued fl ight surgeon. Electrical disorders, as Brugada Syndrome, has been to build on the pioneering work of physiologists at the Mayo Clinic and described in the past years. More recently, early repolarization other acceleration research programs in the US and abroad. On Dec syndrome (ERS) consisting of a particular J point elevation with 7, 1958, R. Flanagan Gray rode the Johnsville centrifuge to 31.25 G a risk of ventricular fi brillation (VF), has been recognized and while submerged in water in the “Iron Maiden”, a record which stands associated with Brugada Syndrome (J-wave syndroms). The high today. The centrifuge was also used by Carl Clark and James Hardy to prevalence of this ECG-pattern (5%) is a matter of concerns for demonstrate the ability of man to withstand long-duration, constant 2G the aeromedical experts and needs further studies…As previously acceleration in a “trip to Mars” estimated to require days, not months, presented in our studies about Brugada Syndrom, a carefully and of interplanetary travel. The greatest notoriety for Johnsville, however, rigourous assesment is mandatory. Military fast jet and transport occurred during the early US Space Program, when “the Wheel” was crew are periodically examined for fi tness assessment at the same used for training Mercury, Gemini and several Apollo astronauts. aeromedical center (CPEMPN) with a standard 12-leads ECG at Later programs centered on ameliorating pilot disorientation, G-LOC every examination. ECG is computerized, analysed by one physician and A-LOC in high-performance military jet aircraft. DISCUSSION: and then saved in a data base. All the ECG performed, with ERS This presentation will highlight recollections of selected personnel were extracted in 2011 from the data base and the results of this who worked at the Johnsville centrifuge and will provide little known study are presented in this panel. However, the most frequent cause insights associated with key historical research, events that may have of SCD by VF remains hypertrophic cardiomyopathy, and needs a been otherwise forgotten. perfect screening process in our population of aircrew members. The treatment of ventricular arrhythymia by implantable cardioverter Learning Objectives: defi brillator (ICD) is a possibility in such a disease : the fi tness 1 Create awareness of the efforts of the Southeastern Pennsylvania of fl ight attendants with ICD will be discussed in this panel. Cold War Historical Society and its ongoing oral history Thrombosis and the risk of SCD by pulmonary embolism is also preservation efforts. of importance in aeronautical medicine, a ten-year retrospective 2 Pay tribute to the military and space program advancements study in aircrew members will be presented. The risk of in fl ight accomplished at the Aviation Medical Acceleration Laboratory. incapacitation related to urological or nephrological disease (kidney 3 Inspire future generations to pursue science and research careers. stones, infectious disease…) needs a very close screening to minimize its incidence in aircrew members. The panel will present the process 11:30 am used in the French military and civilian aeromedical centers. [359] SWEET SERENDIPITY: HOW A CHANCE MEETING IN NAPLES, ITALY BETWEEN TWO LEGENDS OF AEROSPACE [361] EARLY REPOLARIZATION SYNDROME: MEDICINE FOREVER CHANGED ITS HISTORY A NEW PROBLEMATIC ECG PATTERN. PREVALENCE G.M. RICE IN AIRCREW MEMBER Residency in Aerospace Medicine, NAMI, Pensacola, FL S. BISCONTE, D. PERMAL, O. MANEN, D. DUBOURDIEU, A. HORNEZ, F. BROCQ, J. OLIVIEZ, P. LEDUC, J. DEROCHE, INTRODUCTION: Good Friday, 1954, Dr. Ashton Graybiel, V. MARTEL, P. HENO, M. GENERO AND E. PERRIER found himself in an uncomfortable situation. Weary and fogged from a transatlantic fl ight to Naples, Italy, he was without lodging and in CPEMPN, Clamart, France search of a safe place to stay amidst the masses of Neapolitans that surrounded him. Fortunately he would fi nd it within an obscure INTRODUCTION: Early repolarization was defi ned as an US Naval infi rmary that served both as a small hospital and local elevation of the QRS-ST junction of at least 0.1 mV from baseline in apartment complex. The following morning, in the very same infi rmary, the inferior or lateral lead, manifested as QRS slurring or notching. Considered as benign for a long time, the interest for the infero- Dr. Robert E. Mitchell was about to perform morning rounds only to fi nd to his surprise a distinguished guest had arrived the previous night. lateral repolarization has been renewed since recent studies have IP: 192.168.39.151 On: Sun,underlined 26 Sep a2021 link with 17:39:09 the risk of sudden cardiac death (SCD).The The story of this serendipitous meeting, the friendshipCopyright: that developed Aerospace Medical Association between Dr. Graybiel and Dr. Mitchell and subsequent infl uence this high prevalence of this ECG-pattern (5%) is a matter of concerns for made on aviation medicine will be discussed. Delivered bythe Ingenta aeromedical experts and the link with SCD raise lot of questions for the fl ight surgeon. Some ECG characteristics appeared to be a Learning Objectives: strong predictor of death from cardiac causes like J point elevation > 0,2 mV, diffuse localisation in lateral and inferior leads and QRS 1 Identify 3 contributions Dr. Ashton Grabiel made to Aerospace notching. The Aim of this study was to estimate the prevalence of ERS Medicine in aircrew member (AM) and analyse the distribution of malignant 2 Identify 3 contributions Dr. Robert E Mitchell made to Aerospace ECG characteristics. METHODS: ECG of AM examined for fi tness Medicine assessment at the same aeromedical center (CPEMPN - PERCY 3 Appreciate the importance the role of serendipity plays in our Hospital) between September 2009 and august 2010 were collected personal and professional lifes and computerized. All ECG containing an early-repolarization pattern were double-checked and defi nitions of malignant characteristics Wednesday, May 16 10:30 AM were established by consensus. RESULTS: From 09/01/2010 to Salon AB 08/31/2011, 8780 ECG [91.6% male, mean age: 36 yo +/10,2y, range 18-60 yo] was collected. In our study, the prevalence of ERS is estimated at 2.74%. The malignant characteristics were found in PANEL: FRENCH SOCIETY OF AEROSPACE 6% for inferior and lateral leads, 22 % for the J point elevation > 0.2 mV and 38 % for notching aspect. DISCUSSION: Given the high MEDICINE (SOFRAMAS): UPDATES IN prevalence of ER, it seems to be unjustifi ed to consider it today to be CARDIOLOGY AND NEPHROLOGY, a marker for high risk for sudden cardiac deaths. But all this results do justify a careful and case by case evaluation of AM with this AEROMEDICAL CONCERNS electrocardiographic pattern. It’s necessary to identify by other studies the malignant electrocardiographic forms of this syndrome associated [360] FRENCH SOCIETY OF AEROSPACE MEDICINE with excess risk of mortality. (SOFRAMAS) PANEL: UPDATES IN CARDIOLOGY AND NEPHROLOGY, AEROMEDICAL CONCERNS Learning Objectives: E. PERRIER1 AND V. FEUILLIE2 1 All this results do justify a careful and case by case evaluation of 1CPEMPN, Clamart France; 2CEMA, Paris, France AM with this electrocardiographic pattern.

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 311 ASMA 2012 MEETING ABSTRACTS

[362] HYPERTROPHIC CARDIOMYOPATHY the nature of the cardiopathy, but also the possibility of inappropriate MANAGEMENT IN AVIATION MEDICINE shocks on board. A waiver may be considered depending on these F. BROCQ1, F. PONS2, R. POYET2, J. GOMIS1, elements. H. GOMMEAUX1, G. CELLARIER2, C. JEGO2 Learning Objectives: AND M. MONTEIL1 1Aeromedical Military Center, Sainte-Anne Military Hospital, 1 Knowledge of the most frequent ICD-associated complication. 2 Toulon Cedex 9, France; Cardiology, Sainte-Anne Military [364] THROMBOSIS: A TEN YEAR RETROSPECTIVE Hospital, Toulon Cedex 9, France STUDY IN AIRCREW MEMBERS C. CARDINES, C.A. MOUSSU AND G. DESMARIS INTRODUCTION: Hypertrophic cardiomyopathy (HCM), a relatively common primary heart disease (between 0.2 and 0.5 % Medical Service, Air France, Roissy, France of the general population), is the most common cause of sudden death in young people and thus a matter of interest in aviation INTRODUCTION: We conducted a ten year retrospective medicine. Because of marked heterogeneity in clinical expression, study(2001-2011) among the Air France aircrew members (about natural history and prognosis, HCM represents a challenge for fl ight 19164 people),concerning thrombosis and risk of sudden cardiac surgeons regarding screening and risk stratifi cation. RESULTS: We death by pulmonary embolism. METHODS: We extracted the present 2 HCM in pilots whom diagnosis were delayed because medical information via a computer request. Then we examined each of normal echocardiography. Cardiac Magnetic Resonance (CMR) individual fi le.Clinical concerns were thrombosis-phlebitis of lower allowed to confi rm the diagnosis and to precise risk stratifi cation. limbs and pulmonary embolism. We analysed each case: type of crew DISCUSSION: Flight safety, due to the risk of sudden death but also members, age, sex, different potential risk factors. RESULTS: 64 cases all type of incapacitation, is in favour to a systematic and periodically of thrombosis were accepted(61cases of phlebitis of lower limbs and screening of HCM among crew members by the way of family and 13 cases of pulmonary embolism)including 39%of women and 61%of personal history, physical examination and 12-lead ECG, ECG being men. No in-fl ight incapacity and no consecutive death were observed. often used as the principle tool for this screening. If clinical diagnosis For year 2010 the incidence was 10(cases). The mean age was 49.5 is customarily made with two-dimensional echocardiography, years old for pilots,38 years old for the cabin crew. The age distribution echocardiography missed the diagnosis in 6 % to 12 % of HCM is approximately the same as the AF crew members population. patients. It’s why we could recommend CMR in suspected HCM pilots Most of the cases of thrombosis were observed on long haul fl ight with practice such as high-performance aircraftss or commercial aircrew members: 80% pilots, 67.5% cabin crew. In almost 92% of airlines and inconclusive echocardiography. CMR has also the the cases, one or more risk factors were observed: - for 22% less than advantage of a better risk stratifi cation in case of confi rmed HCM 24 hours after a long haul fl ight(among them, 2/3 had this only risk and helps for differential diagnosis as physiologic hypertrophy or factor). - for 78% the risk factors were independent of the fl ight. In “athlete’s heart”. Risk stratifi cation must include “conventional” and order of frequency these risk factors observed were: immobilization “potential” risk factors for primary prevention implantable cardioverter- and traumatism/abdominopelvic surgery/ venous insuffi ciency/ blood defi brillators but also risk factor for atrial fi brillation, most common disorders(coagulation). DISCUSSION: Although this pathology is sustained arrhythmia in HCM. If granted, fi tness requires waiver and rare among our aircrew members, it should not be ignored and restriction. Conclusion : Flight surgeons must know the heterogeneity underestimated, especially because of a possible temporary in- fl ight presentation of HCM, a relatively common disease with risk of incapacity. Preventive measures are necessary for reducing this unpredictable incapacitation. CMR can help in diagnosis and risk potentially serious disease : a better information and prophylactic stratifi cation. recommendations should be the basis .

Learning Objectives: Learning Objectives: 1 In suspected hypertrophic cardiomyopathy, with inconclusive 1 observation thrombosis among aircrew members echocardiography, cardiac magneticIP: resonance 192.168.39.151 is necessary to On: Sun, 26 Sep 2021 17:39:09 eliminate or confi rm the diagnosis [365] SCREENING FOR NEPHRO-UROLOGICAL DISEASES 2 In confi rmed hypertrophic cardiomyopathy,Copyright: cardiac magnetic Aerospace MedicalAMONG Association AIRCREW MEMBERS resonance is necessary to precise the risk stratifi cation Delivered by E.Ingenta PERRIER1, O. MANEN1, S. BISCONTE1, J. DEROCHE2, A. HORNEZ1, D. DUBOURDIEU1, V. MARTEL1, J. OLIVIEZ1, [363] IMPLANTABLE CARDIOVERTER DEFIBRILLATOR IN P. HENO2 AND M. GENERO1 FLIGHT ATTENDANTS: AEROMEDICAL ISSUES 1Aerospace Medicine, CPEMPN, Clamart, France; P. PICHEREAU1, J. PARIS1 AND P. AEBERHARD2 2Department of Cardiology, HIA Percy, Clamart, France 1Aeromedical Center, Air France, Paris CDG Airport, France; 2Centre Cardiologique du Nord, Saint-Denis, France INTRODUCTION: Nephro-urological diseases are for the fl ying surgeon a frequent and important challenge in the fi tness assessment INTRODUCTION: Implantable cardioverter defi brillator (ICD) process. Thus, the risk of infl ight incapacitation in case of renal colic is a major advance in the prevention of sudden cardiac death. It is for overseas deployed fi ghter pilot, the risk of recurrence of previously rarely encountered in fl ight attendants. Problems about fi tness to fl y treated calculi and its prevention are highly signifi cant facts. However, are always present, especially in terms of evolution of causal disease at AMC the fi tness assessment process is not only retrospective. and ICD-associated complications. RESULTS: Case presentations: 1.) Moreover, physical examination and urinalysis, as done at each A 35-yr-old male fl ight attendant has a history of tachycardia while visit, remain the cornerstone of the screening evaluation for nephro- playing rugby football. During the exercise stress test a ventricular urological diseases. METHODS: retrospective study (1997-2007) of the tachycardia appeared, which spontaneously disappeared. There medical fi les of the aircrew members (AM) admitted in the Department was a familial history of cardiomyopathy and heart transplantation. of Aerospace Medicine (HIA PERCY) for urolithiasis. RESULTS: Fifty Different diagnosis were discussed after cardiovascular workup seven AM of the French Air Forces were admitted [males, mean age (coronary angiography, heart magnetic resonance imaging, ...). An : 33,3 yo, 15 heli pilot (P), 15 fl ight engineer, 10 ATC, 9 transport P, ICD was implanted. The patient returned to duty. He is followed up 8 fi ghter P]. Microspic hematuria (confi rmed by usual methods) in at the Aeromedical Center. 2.) A 51-yr-old fl ight attendant survived of asymptomatic AM was present in 8 AM ; 1 had urinary infection, 1 AM cardiac arrest due to ventricular fi brillation. He was then hospitalised: had macroscopic hematuria, renal calculi was fortuitously discovered imaging studies (echocardiography and coronary angiography) showed at imaging (performed for another cause) in 7 AM and 40 AM (70%) a diminished left ventricular ejection fraction with hypokinesia of the had renal colic (1 in-fl ight, 3 during deployment). Echography and CT left ventricle. An ICD was implanted and, at the moment, the patient is scan confi rmed lithiasis in all. After treatment [extracorporeal shock grounded. DISCUSSION: The main aeromedical concerns are not only wave lithotripsy (ESWL) for 30, ureteroscopy (URS) for 12], 34 AM

312 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS remain “stone-free”. Recurrence occurred among 23 AM (40 events): and licensed, certifi ed athletic trainers. The ASCR group works within only 3 AM had renal colic, 37 recurrences were discovered during NASA’s Space Medicine Division providing direction and supervision the follow-up by Low Dose CT Scan (asymptomatic +/- microscopic to the astronaut corps with regards to physical readiness throughout hématuria). DISCUSSION: Urinary tract calculi is the most frequent all phases of space fl ight. The ASCR group is overseen by fl ight and important cause of nephro-urological disease among AM. At the surgeons specializing in sports medicine or physical medicine and AMC, physical examination and urinanalysis aremandatory and useful rehabilitation. The goals of the ASCR group include 1) designing and for the aeromedical expert. Furthermore, other nephro-urological administering strength and conditioning programs that maximize diseases may also be discovered (glomerulonephritis, polycystic kidney the potential for physical performance while minimizing the disease and elevated blood pressure...). These situations emphazise the rate of injury, 2) providing appropriate injury management and role of clinical aviation medicine. rehabilitation services, 3) collaborating with medical, research, engineering, and mission operations groups to develop and Learning Objectives: implement safe and effective in-fl ight countermeasures, and 4) 1 This study demonstrate the role of physical examination and uri- providing a structured, individualized post-fl ight reconditioning nalysis to screen aircrew members for urolithiaisis program for long duration crew members. This Panel will present the current approach to the management of musculoskeletal injuries [366] URO-NEPHROLOGICAL PATHOLOGIES AND AIR commonly seen in the astronaut corps and will present an overview TRAVEL ON COMMERCIAL AIRLINES of the pre-fl ight physical training, in-fl ight exercise countermeasures, V. FEUILLIE AND P. RODRIGUEZ-REDINGTON and post-fl ight reconditioning program for International Space Station astronauts. Air France Medical Department, Roissy CDG Cedex, France

INTRODUCTION: Over two billion people travel each year by [368] SHOULDER INJURIES IN U.S. ASTRONAUTS plane. Among those travelers, we are seeing an increase in passenger- RELATED TO EVA SUIT DESIGN carrying chronic diseases, the elderly and the disabled as para and R.A. SCHEURING1, P.C. MCCULLOCH2, M. VAN BAALEN1, quadriplegics. By studying the medical incidents on board our aircraft, 3 1 1 we investigated the importance of the uro-nephrological pathologies. C.G. MINARD , R.D. WATSON , S.G. BOWEN 1 They represent 2 percent of medical incident onboard. Kidney stone is AND T.A. BLATT found as major accident. Major analgesic contained in the emergency 1Space Medicine, NASA-Johnson Space Center, Houston, TX; medical kits can avoid medical diversion. Acute urinary retention due to 2Orthopedic Surgery, The Methodist Hospital, Houston, TX; benign prostatic hyperplasia is a problem found in the elderly. It is best 3Advanced Projects, Wyle, Houston, TX to advise the choice of a aisle seat more accessible to the restroom. Hydration onboard is important but should not be excessive either. INTRODUCTION: For every one hour spent performing Lower urinary tract infections are quite common in women because of extravehicular activity (EVA) in space, astronauts in the US space dehydration. Paraplegics and quadriplegics travelers have to do urinary program spend approximately six to ten hours training in the EVA catheterization during long-haul fl ights. We must advise prior to spacesuit at NASA-Johnson Space Center’s Neutral Buoyancy Lab departure on the choice of materials to take into the cabin. Since 2001, (NBL). In 1997, NASA introduced the planar hard upper torso Saphir, special commercial department for passengers with reduced (HUT) EVA spacesuit which subsequently replaced the existing mobility give all the informations. All our aircraft (Airbus A318-A319- pivoted HUT. An extra joint in the pivoted shoulder allows increased A320-A321, Airbus A330 and A340, Airbus A380, Boeing 777 and 747) mobility but also increased complexity. Over the next decade are equipped with an onboard wheelchair that is designed to circulate in a number of astronauts developed shoulder problems requiring aircraft aisles and access the restrooms during the fl ight. All of our long- surgical intervention, many of whom performed EVA training in the haul aircraft, as well as some of our medium-haul aircraft, are equipped NBL. This study investigated whether changing HUT designs led to with easy-access restrooms for passengers with reduced mobility. For shoulder injuries requiring surgical repair. METHODS: US astronaut aircraft that are not equipped with such restrooms, the placement of a EVA training data and spacesuit design employed were analyzed curtain in front of the restrooms located inIP: the 192.168.39.151back of the aircraft creates On: Sun,from 26 theSep NBL 2021 data. 17:39:09 Shoulder surgery data was acquired from the a private area. In conclusion, with the older populationCopyright: of travelers, Aerospace it is Medicalmedical record Association database, and causal mechanisms were obtained very likely to attend a greater number of uro-nephrological pathologies.Delivered byfrom Ingenta personal interviews. Analysis of the individual HUT designs was We must take this into account in the fi rst aid training of crews. performed as it related to normal shoulder biomechanics. RESULTS: To date, 23 US astronauts have required 25 shoulder surgeries. Learning Objectives: Approximately 48% (11/23) directly attributed their injury to training 1 The audience will learn about uro-nephrological pathologies and in the planar HUT, whereas none attributed their injury to training in air travel the pivoted HUT. The planar HUT design limits shoulder abduction to 90 degrees compared to approximately 120 degrees in the pivoted HUT. The planar HUT also forces the shoulder into a forward Wednesday, May 16 10:30 AM fl exed position requiring active retraction and extension to increase Salon D abduction beyond 90 degrees. DISCUSSION: Multiple factors are associated with mechanisms leading to shoulder injury requiring PANEL: NASA MUSCULOSKELETAL surgical repair. Limitations to normal shoulder mechanics, suit fi t, donning/doffi ng, body position, pre-existing injury, tool weight and SPACE MEDICINE AND RECONDITIONING confi guration, age, in-suit activity, and HUT design have all been PROGRAM identifi ed as potential sources of injury. Based on this preliminary analysis, crewmembers with pre-existing or current shoulder injuries [367] NASA MUSCULOSKELETAL SPACE MEDICINE or certain anthropometric body types should conduct NBL EVA training in the pivoted HUT. AND RECONDITIONING PROGRAM 1 2 3 E.L. KERSTMAN , R.A. SCHEURING , M. GUILLIAMS , Learning Objectives: 3 3 B. NEISCHWITZ AND D. HOELLEN 1 The audience will understand mechanisms of shoulder injury 1 2 University of Texas Medical Branch, Galveston, TX; NASA related to EVA suit designs Johnson Space Center, Houston, TX; 3Wyle Integrated Science 2 Alterations to normal shoulder biomechanics related to and Engineering, Houston, TX pivoted and planar hard upper torso (HUT) EVA suits will be discussed The Astronaut Strength, Conditioning, and Rehabilitation (ASCR) 3 The participant will understand which EVA HUT design predisposes group is comprised of certifi ed strength and conditioning coaches the user to shoulder injury leading to surgery

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 313 ASMA 2012 MEETING ABSTRACTS

[369] PREFLIGHT AND IN-FLIGHT EXERCISE the specifi c needs of the astronaut. Initially the program focuses CONDITIONING FOR ASTRONAUTS ON THE on basic ambulation, cardiovascular endurance, strength, balance, INTERNATIONAL SPACE STATION fl exibility and proprioception. The program advances through 45 days M. GUILLIAMS1, B. NIESCHWITZ1, D. HOELLEN1 and specifi c attention is given to each astronaut’s overall condition, AND J.A. LOEHR2 testing results, medical status, and assigned duties after their mission. 1 2 DISCUSSION: Astronauts will experience noticeable defi cits in their Wyle, Houston, TX; Retired, Houston, TX physical condition after living in microgravity for an extended length of time. After completing postfl ight reconditioning, it is shown that INTRODUCTION: The physiological demands of spacefl ight astronauts have regained, and in most cases improved upon, their require astronauts to have certain physical abilities. They must be able prefl ight baseline condition. to perform routine and off-nominal physical work during fl ight and upon re-entry into a gravity environment to ensure mission success, Learning Objectives: such as an Extra Vehicular Activity (EVA) or emergency egress. To 1 To have a better understanding of the reconditioning program and prepare the astronauts for their mission, a Wyle Astronaut Strength process of long duration US astronauts. Conditioning and Rehabilitation specialist (ASCR) works individually with the astronauts to prescribe prefl ight strength and conditioning programs and in-fl ight exercise, utilizing Countermeasure Systems [371] OVERVIEW OF PRE-FLIGHT PHYSICAL TRAINING, (CMS) exercise hardware.The purpose of this presenation is to describe IN-FLIGHT EXERCISE COUNTERMEASURES AND THE the prefl ight and in-fl ight exercise programs for ISS crewmembers. POST-FLIGHT RECONDITIONING PROGRAM FOR METHODS: Approximately 2 years before a scheduled launch, an INTERNATIONAL SPACE STATION ASTRONAUTS ASCR is assigned to each astronaut and physical training (PT) is E.L. KERSTMAN routinely scheduled. Prefl ight PT of astronauts consists of carrying out University of Texas Medical Branch, Galveston, TX strength, aerobic and general conditioning, employing the principles of periodization. Exercise programs are prescribed to the astronauts INTRODUCTION: International Space Station (ISS) to account for their individual fi tness levels, planned mission-specifi c astronauts receive supervised physical training pre-fl ight, utilize tasks, areas of concern, and travel schedules. Additionally, astronauts exercise countermeasures in-fl ight, and participate in a structured receive instruction on how to operate CMS exercise hardware and reconditioning program post-fl ight. Despite recent advances in receive training for microgravity-specifi c conditions. For example, exercise hardware and prescribed exercise countermeasures, astronauts are scheduled training sessions for the International Space ISS crew members still exhibit variable levels of deconditioning Station (ISS) treadmill (TVIS) and cycle ergometer (CEVIS), as well as post-fl ight. METHODS: This presentation provides an overview the Advanced Resistive Exercise Device (ARED). In-fl ight programs are of the ISS astronaut medical certifi cation requirements, pre-fl ight designed to maintain or even improve the astronauts’ pre-fl ight levels physical training, in-fl ight exercise countermeasures, and the of fi tness, bone health, muscle strength, power and aerobic capacity. post-fl ight reconditioning program. RESULTS: Astronauts must In-fl ight countermeasure sessions are scheduled in 2.5 h blocks, six meet certifi cation requirements on selection, annually, and prior days a week, which includes 1.5 h for resistive training and 1 h for to ISS missions. In addition, extensive physical fi tness testing and aerobic exercise. DISCUSSION: Crewmembers reported the need for standardized medical assessments are performed on long duration more scheduled time for prefl ight training. During fl ight, crewmembers crew members pre-fl ight. Limited physical fi tness assessments and have indicated that the in-fl ight exercise is suffi cient, but would like medical examinations are performed in-fl ight to develop exercise more reliable and capable hardware. countermeasure prescriptions, ensure that crew members are physically capable of performing mission tasks, and to monitor Learning Objectives: astronaut health. Upon mission completion, long duration astronuats 1 The audience will learn the what and why of the pre- and in-fl ight must re-adapt to the 1 g environment, and be certifi ed to return exercise programs prescribed for US Astronauts. to space fl ight training and active duty fl ight status. A structured, supervised post-fl ight reconditioning program has been developed IP: 192.168.39.151 On: Sun,to 26 prevent Sep injuries,2021 17:39:09 facilitate re-adaptation to the 1 G environment, [370] POST FLIGHT RECONDITIONINGCopyright: FOR Aerospace Medical Association US ASTRONAUTS RETURNING FROM THE and subsequently return astronuats to training and space fl ight. Delivered by DISCUSSION:Ingenta The NASA reconditioning program is implemented INTERNATIONAL SPACE STATION 1 1 1 by the Astronaut Strength, Conditioning, and Rehabilitation (ASCR) B. NIESCHWITZ , M. GUILLIAMS , D. HOELLEN team and is overseeen by NASA fl ight surgeons. This program has 2 AND J.A. LOEHR evolved over the past 10 years of the ISS program and has been 1Wyle, Houston, TX; 2Contributing Author Retired, Houston, TX successful in ensuring that long duration astronauts safely re-adapt to the 1 G environment and return to active duty. Lessons learned INTRODUCTION: Prior to spacefl ight, each astronaut from this approach to managing deconditioning may be applicable to undergoes medical requirement testing to establish a prefl ight baseline terrestrial medicine and future exploration space fl ight missions. for physiologic functions. Astronauts returning from the International Space Station can experience defi cits in all or some of the following Learning Objectives: areas: aerobic capacity, muscular strength, power, endurance, 1 The audience will learn how NASA manages astronaut stamina, bone, balance, agility, coordination, orthostatic tolerances, deconditioning associated with long duration exposure to proprioception, neurovestibular function and fl exibility. These losses microgravity on ISS missions. occur from living in microgravity and are consistent with defi cits seen in terrestrial, de-conditioning individuals. Since 2001, the Astronaut Strength, Conditioning and Rehabilitation (ASCR) specialists have Wednesday, May 16 2:00 PM administered a reconditioning program, focusing on all defi cits, Ballroom A which improves the physical condition of all returning astronauts. In most cases, astronauts have reached or surpassed their prefl ight physical condition. This presentation will describe and explain the PANEL: JAPAN SESSION A: postfl ight reconditioning program for returning astronauts. METHODS: JAPAN-U.S. MUTUAL INTERCHANGE The postfl ight reconditioning program is designed to stress the body systems that affect the following: aerobic capacity, muscular strength, power, endurance, stamina, bone, balance, agility, coordination, [372] JAPAN SESSION A:JAPAN-U.S. orthostatic tolerances, proprioception, neurovestibular function, and MUTUAL INTERCHANGE fl exibility. Postfl ight reconditioning begins on landing day, is scheduled H. GOMI for two hours per day, 7 days a week for 45 days and is tailored to All Nippon Airways, Tokyo, Japan

314 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

Between U.S. and Japan, we have so long and profound respiratory function test at 60, echocardiogram at 60, respectively). relationship and coopperation in many aerospace fi elds. Especially Waiver is called “the Judgment of the Minister”, held every month. between USAF and JSDF in aeromedicine, and between NASA and Interestingly, as well as the minister, only medical offi cers of Civil JAXA in spacemedicine. In this panel, we have so many speakers from Aviation Bureau alone do not judge matters submitted to the waiver. Japan and U.S., and we talk about the history and the future We judge about 100 matters in 2 hour in collaboration to outside of Japan-U.S. mutual interchange, which is valuable for the 14 intellectuals (2 cardiovascular, 2 internal medicine, 2 surgical, future-building mutually benefi cial growing relationships between the 2 ophthalmology, 2 ear, nose and throat, 2 psychiatric specialists, two allied nations. And we have another speaker from Japan Ministry 1 airline pilot, and 1 doctor of government). In this way, the waiver of Transport(civil aviation bureau), who presents the aviation medical system keeps speedy and high quality. certifi cate and waiver system in Japan. We hope the advice for the improvement of aviation medical certifi cate system in Japan. Learning Objectives: 1 Aviation medical certifi cate and waiver systems in Japan [373] JAXA COLLABORATION WITH NASA-JSC IN FLIGHT SURGEON TRAINING AND OPERATIONAL [375] AEROMEDICAL LABORATORY, JASDF: MEDICAL RESEARCH AN OVERVIEW OF RESEARCH PROGRAMS K. SHIMADA AND COLLABORATION WITH THE USAF Med Ops, JAXA Tsukuba Space Center, Tsukuba, Japan A. KOBAYASHI Aeromedical Laboratory, Japan Air Self-Defense Force, INTRODUCTION: It has been 20 years since the fi rst JAXA Tachikawa, Tokyo, Japan (ex. NASDA) astronaut was launched with NASA medical operations support. One of the issues for JAXA to build up its medical operations INTRODUCTION: The Aeromedical Laboratory (AML) of the was how to train its personnel. RESULTS: JAXA trained 9 Flight Japan Air Self-Defense Force (JASDF) was established in November Surgeons for its space medical operations. Eight of them were sent 1957. The AML has conducted a wide range of studies to develop to aerospace medicine course at Wright State Univ. (WSU), Dayton, aeromedical certifi cations, aptitude tests, physical training procedures, Ohio. One was sent to Univ. of Texas Medical Branch, Galveston, and all of the life support equipment for JASDF pilots. We have also Texas. Since Space Shuttle mission STS-47 in 1992, 11 short duration conducted biochemical studies to understand physiological changes Shuttle missions and 3 long-duration International Space Station under stressful circumstances. Our investigations on pilot behavior and Japanese astronauts were fl own to orbit with medical support by this air accidents have contributed to the cockpit design of the T-1, T-2 and cadre. Two Flight Surgeon candidates are at WSU as of fall 2011. T-4 domestic jet trainers, the C-1 jet transport, F-2 fi ghter co-developed After completing these basic aerospace medicine training, On-The-Job with USAF based on F-16. We continue our research efforts to develop trainings continued at NASA-Johnson Space Center mission control futuristic aviation systems and to solve several aeromedical and human center, with the help of JSC Medical Operations Branch. For the factors issues, including situational awareness improvement, pilot ISS fl ight operations, JAXA took responsibilities of providing Flight aptitude test, fatigue, effective physiological training, and occupational Surgeons for its astronauts. For the Shuttle operations, JSC recognized health issues, and to offer support to the JASDF operations community. two NASDA Flight Surgeons with international medical operation International collaboration, especially co-investigation with the USAF certifi cation. Currently, ISS Multilateral Space Medicine Board certifi es has become essential to continue these research efforts as well as ISS Flight Surgeons. DISCUSSION: For operational medical research, to improve interoperability between the JASDF and the USAF. Since international collaboration is still to be expanded. Basic medical 2007, the cooperative research project “Human effects of exposure to science research is active, which is mostly based on international aviation jet fuels, JP-4 and JP-8, and their engine exhaust” has been Announcement of Opportunity system. Operational medical research, conducted with the Air Force Research Laboratory, USAF to identify however, depends on each ISS partner states. One example of biomarkers of exposure that will identify exposure to jet fuel even international collaboration is the cross-calibration of space radiation when an exposure is less than the occupational exposure limit. monitors, where ISS partners keeps cross-examinationIP: 192.168.39.151 at Japanese On:and Sun, 26 Sep 2021 17:39:09 US radiation research centers. Now that the Shuttle operations had Learning Objectives: ended, we are sharing medical responsibilities Copyright:among ISS partners. Aerospace Medical Association 1 The audience will learn about the development and current status Due to the WSU program, JAXA and NASA shares some commonDelivered basic by Ingenta of aeromedical research in JASDF. Flight Surgeon training. Each country’s medical licensure and residency education difference makes amalgamated training syllabus impractical, although practice under some restriction has been achieved. Beyond [376] CURRENT TRAINING PROGRAMS FOR FLIGHT the ISS program, we need to expand mutual recognition of each state’s SURGEONS AND AEROMEDICAL WAIVER CONCERNS IN Flight Surgeons. JAPAN AIR SELF-DEFENSE FORCE T. HISADA1, T. KONISHI2, T. HIGASHINO3, Y. NOGAMI2, Learning Objectives: K. YOSHIMURA2, S. TACHIBANA1, K. OGATA1 1 To understand how international collaboration affects Flight AND Y. SAKURAI1 Surgeons. 1National Defense Medical College, Tokorozawa, Japan; 2Japan Air Self-Defense Force Air Aeromedical Laboratory, [374] AVIATION MEDICAL CERTIFICATE Tokyo, Japan; 3Japan Air Self-Defense Force Air Staff Offi ce, AND WAIVER SYSTEMS IN JAPAN Tokyo, Japan K. TAKADA JCAB, Chiyoda-ku, Japan INTRODUCTION: The history of aerospace medicine in Japan Air Self-Defense Force (JASDF) began in 1957 when the JASDF INTRODUCTION: Aviation medical certifi cate of Japan is Aeromedical Laboratory was established. Although the current primary based on Annex 1 to the Convention on International Civil Aviation. course for fl ight surgeons (FSs) is conducted only in Japan, many other It is particularly worth noting that the medical certifi cate includes advanced courses for FSs, such as the Advanced Aerospace Medicine “the additional examination for airline pilot over 60 years old”. In for International Medical Offi cers (AAMIMO) course, are supported particular, since incapacitation during fl ight is a serious threat to fl ight by the U.S. Air Force School of Aerospace Medicine (USAFSAM) safety, the additional examination was made. If an airline pilot hope to and USAF staff. This presentation reviews and discusses the current work from 60 to 65, (S)he must be done 8 items examination (special training programs for FSs and aeromedical waiver concerns in Japan medical interview per 6 months, determination of serum lipids per a by comparing them with those of other countries, especially with year, electrocardiogram per 6 months, Holter monitor at 60 and 63, the USAF. (1) Current Training Programs for FSs: In Japan, medical the Bruce treadmill test at 60 and 63, MRI brain scan at 60 and 63, education is conducted in colleges or universities for a period of 6

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 315 ASMA 2012 MEETING ABSTRACTS years. On clearing the national examination for medical practitioners, Learning Objectives: graduates can obtain the degree of Doctor of Medicine (MD), after 1 Participants will learn how to effectively manage aviators with which they need to complete a primary FS course and acquire more ulcerative colitis. Treatment options will be discussed in detail. than two years work experience at Air Self-Defense Force bases to become JASDF FSs. (2) Aeromedical Waiver Concerns: FSs have to [379] MIGRAINE HEADACHE: AEROSPACE MEDICINE handle several diffi cult cases, especially cardiovascular cases such as Brugada syndrome, mitral valve prolapse, and vasospastic angina CLINICAL PRACTICE GUIDELINE pectoris. In such cases, which were not experienced previously, R.R. HESSELBROCK JASDF FSs often consult USAF FSs or staff during Aerospace Medical Aeromedical Consultation Service, USAFSAM, Association meetings, the AAMIMO course, etc. Wright-Patterson AFB, OH

Learning Objectives: INTRODUCTION: Migraine headache is a common condition with signifi cant aeromedical concerns. It affects approximately 6% 1 The audience will learn about training programs for fl ight surgeons. of men and 18% of women, with highest prevalence between 25- 55 years of age. Migraine attacks may vary in intensity, duration, [377] THE HISTORY OF THE RELATIONSHIP frequency of occurrence, and in associated features. Migraines are BETWEEN USAFSAM AND THE JASDF generally considered disqualifying for fl ying duties. Aeromedical B.H. REED concerns include impact on fl ight safety from the migraine attack USAF School of Aerospace Medicine, Centerville, OH itself, effects of medications used for migraine control, and risk of future migraine recurrence. Fortunately, many migraine patients INTRODUCTION: The USAF School of Aerospace Medicine experience less severe and less frequent attacks which are effectively (USAFSAM) has been in continuous operation since 1918. The 1st treated with simple medications such as nonprescription agents or international student to attend USAFSAM came in 1923. Since then NSAIDs. Aeromedical waiver consideration for migraine is based USAFSAM has been actively involved in international education and on attack severity, frequency, and the absence or presence of training work with countries from every corner of the world. The 1st associated symptoms such as aura or neurologic defi cits. A thorough recorded student from Japan attended the basic fl ight surgeon course neurologic evaluation should be obtained as part of aeromedical in Feb 1955. Since then there have been more than 120 Japanese waiver submission. The clinical evaluation, treatment options personnel who have participated in a variety of USAFSAM courses, and aeromedical disposition of migraine will be discussed in this including courses in basic aerospace medicine, aircraft accident presentation. investigation, aerospace physiology, bioenvironmental engineering, and aeromedical evacuation. The 6-month long Advanced Aerospace Learning Objectives: Medicine for International Medical Offi cers (AAMIMO) course 1 Participants will learn how to manage aviators with migraine represents the most advanced and comprehensive curriculum in including the consideration of diagnostic criteria, evaluation and aerospace medicine that USAFSAM can offer the international treatment strategies community. Forty-fi ve Japanese military medical personnel have 2 Participants will learn the aeromedical implications of migraine as attended this course in particular, beginning with the 1st course ever well as the military and civilian aeromedical standards for migraine offered in 1960. The details of that course’s current curriculum will be presented. Beyond the simple exchange of medical information [380] RENAL COLIC: AEROSPACE MEDICINE and facts that takes place in any academic setting, the greatest CLINICAL PRACTICE GUIDELINE result of the last 55 years of US/Japanese interactions at USAFSAM D.E. PEAKE has been the formation and sustainment of on-going relationships. These relationships have been not only between the two nations, but Aerospace Medicine, USAFSAM, Wright-Patterson AFB, OH between individuals, personal relationships that have enriched the INTRODUCTION: Renal colic is a relatively common condition aerospace medicine programs of both countries.IP: 192.168.39.151 This result remains On: Sun, 26 Sep 2021 17:39:09 the determined goal of USAFSAM for the future - building mutually among aviators especially in the 20-30 year old age group. It is benefi cial growing relationships between the twoCopyright: allied nations Aerospace of Medicalcharacterized Association by pain in the back, fl ank or abdominal which gradually Japan and the US. Delivered by becomesIngenta more severe over time. It can become severe enough to be incapacitating in fl ight. Renal colic is due to the presence of a stone Learning Objectives: in the renal collecting system and in most cases stones less than 8-10 mm in size will pass spontaneously. Once a renal stone is diagnosed, 1 To learn about the historical relationship between the JASDF and it is important to recover the stone to determine its composition. USAFSAM, including the underlying goals behind it. Approximately 75% of all stones are composed of calcium oxalate. Other stone compositions include struvite (magnesium ammonium Wednesday, May 16 2:00 PM phosphate), uric acid, calcium phosphate and cysteine. Laboratory work-up is necessary and should confi rm that metabolic and renal Ballroom B function is normal, as well as radiologic procedures to check for the location of the stone. Aviators with a history of a renal stone PANEL: ASAMS AEROSPACE MEDICINE are eligible for waiver provided there is no underlying condition predisposing to stone formation and they are not placed on a therapy PRACTICE GUIDELINES II that is not waivered for fl ying. Retained stones can be waivered provided that they are in the renal parenchyma or in an area where [378] ULCERATIVE COLITIS: AEROSPACE MEDICINE there is certainty that they will not enter the renal calyx. Urologic CLINICAL PRACTICE OVERVIEW evaluation is required. Aeromedical disposition is similar across the P.R. STORMS military services and for civilian aviators and will be discussed in this HQ AETC/SGR, Randolph AFB, TX presentation.

INTRODUCTION: Ulcerative colitis is a frequently encountered Learning Objectives: condition with considerable impact to the fl ying population. Both 1 Participants will learn how to manage aviators with renal colic the condition and its many treatments have the potential to render including the consideration of diagnostic criteria, evaluation and a patient disqualifi ed from fl ying status, in addition to the adverse treatment strategies impacts on patient quality of life. The current body of knowledge will 2 Participants will learn the aeromedical implications of renal colic be reviewed, with emphasis on treatment options. Service and FAA and retained renal stones as well as the application of military and guidelines will also be reviewed. civilian aeromedical standards

316 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

[381] MALARIA: AEROSPACE MEDICINE their uses, capabilities, weaknesses, idiosyncrasies, longevity, and CLINICAL PRACTICE GUIDELINE limitations. This panel session will discuss a) how LED spectral D.L. VAN SYOC characteristics differ from those of incandescent lights and possible Aeromedical Consultation Service, USAFSAM, Wright-Patterson consequences or necessary alterations to accommodate LEDs, b) AFB, OH the FAA’s implementation plan for LEDs into airport lighting, c) performance of individuals with abnormal color vision on LED color-coded tasks, and d) color appearance under LED light INTRODUCTION: Malaria is a serious febrile illness with sources. protean manifestations which rarely may be seen in susceptible travelers to endemic regions of the world. The prevention of infection through the use of prophylactic drugs taken during travel to areas of [384] THOSE NEW GREEN LED SIGNALS the world where there is a risk of malaria is generally quite effective, ARE MUCH EASIER TO SEE thus the fl ight surgeon is unlikely to encounter this disease in aviators. J.K. HOVIS However, there exists the possibility of infection through the bite of an University of Waterloo, Waterloo, ON, Canada infected female mosquito when this prophylaxis is not closely adhered to in susceptible aviators who have a history of travel to an endemic INTRODUCTION: As the transportation industry replaces area of the world. There are four species of malaria which are known traditional incandescent long-range signal lights with LED technology, to cause disease in humans. These include Plasmodium falciparum, the users of the system often comment that that the green LED signals Plasmodium vivax, Plasmodium ovale and Plasmodium malariae. are much easier to see than the older lights. Interestingly, they do Plasmodium falciparum causes the most serious form of malaria not make the same comments about the yellow and red signals. which when manifesting as cerebral malaria, can be rapidly fatal METHODS: The improved visibility is not necessarily a result that without immediate treatment. The prevention, chemoprophylaxis, and the LEDs may be more intense. This presentation will review why treatment of malaria infection as well as the aeromedical disposition of luminance and brightness are not equivalent for colored signal lights. It aviators post malaria infection will be discussed. will also summarize previous data, which looked at the ability to color- defective users to identify colors that fall within the LED color domain. Learning Objectives: RESULTS: Previous work on brightness and luminance indicates that 1 Participants will learn the clinical and laboratory fi ndings in the green and blue LED signals should be easier to detect because they patients with malaria are brighter than incandescent lights at equal luminance. The data also 2 Participants will learn the prophylaxis and treatment of malaria as suggests that the LEDs should be easier to identify of color-defective well as the aeromedical dispostion of aviators post-malaria pilots depending on the specifi c set of colors in the set. DISCUSSION: This data may be useful in fi ne tuning light standards for airports and [382] MANAGING HEARING LOSS IN AVIATORS: aircraft. AEROSPACE MEDICINE CLINICAL GUIDELINE Learning Objectives: D.G. SCHALL 1 To understand the relationship between luminance and chromatic FAA Great Lakes Regional, Des Plaines, IL information as they relate to brightness 2 To show the effect that color saturation has on the ability of INTRODUCTION: Temporary and Permanent Hearing loss is individuals with color vision defects to indentify signal light colors. not uncommon in the aviation community. An understanding of how to effectively prevent and manage hearing loss is essential for those caring for the fl ying population. An understanding of the dB and the [385] COLOR RENDERING OF LED SOURCES physics of sound as well as use of protective devices will be reviewed. Y. OHNO Additionally handling of Temporary and Permanent threshold shifts, NIST, Gaithersburg, MD common causes of hearing loss to be considered, when to remove from hazardous noise, rehabilitation andIP: how 192.168.39.151 much hearing loss can On: Sun, 26 SepINTRODUCTION: 2021 17:39:09 There are two aspects in color quality of you fl y with will be discussed. Service and FAACopyright: Guidelines and Aerospace OSHA MedicalLED sources, Association one is chromaticity, which is the color of light itself, standards will also be reviewed. Delivered byand Ingenta the other is color rendering, which is how color of objects are perceived under the given light source. METHODS: CIE 1-69 Color Learning Objectives: Rendtion of White Light Sources is fi nalizing new metrics for color 1 Participants will learn how to effectively manage aviators with rendering to replace CRI, to address issues with LED sources. One hearing loss. of the metrics considered is Color Qualilty Scale developed by NIST. 2 Participants will learn specifi cs regarding how to protect aviators RESULTS: NIST developed “Spectrally Tunable Lighting Facility” which from further loss and how to mitigate those who have hearing loss can simulate various light spectra illuminating a whole room to allow 3 Participants will gain an understanding of the civilian and vision experiments on how object colors are perceived under various military standards in regards to hearing conservation conditions. DISCUSSION: Color issues for applications of LEDs in aircraft and airports will be discussed.

Wednesday, May 16 2:00 PM Learning Objectives: Ballroom C 1 The audience will learn how chromaticity and color rendering of LED sources are aspecifi ed and measured and their effects on PANEL: LEDS ARE UBIQUITOUS human color perception. [386] HUMAN PERCEPTION AND EFFECTIVE INTENSITY [383] LEDS ARE UBIQUITOUS OF LIGHT EMITTING DIODES FOR AIRCRAFT J.K. HOVIS ANTI-COLLISION LIGHTING School of Optometry, University of Waterloo, C. YAKOPCIC1, J. PUTTMANN2, B.R. KUNZ3, N. MILBURN4 Waterloo, ON, Canada AND A.M. MEAD4 1Computer and Electrical Engineering, University of Dayton, LEDs (light-emitting diodes) are appearing seemingly 2 everywhere and are becoming an integral part of our everyday Dayton, OH; Department of Mechanical Engineering, 3 existence within our gadgets, tools, toys, and workplace. Although University of Dayton, Dayton, OH; Department of Psychology, LEDs are a relatively new technology, they are as commonplace and University of Dayton, Dayton, OH; 4Civil Aerospace Medical ubiquitous as batteries; but yet, like batteries, we are still exploring Institute, AAM-510, FAA, Oklahoma City, OK

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 317 ASMA 2012 MEETING ABSTRACTS

INTRODUCTION: Recently, Light Emitting Diodes (LEDs) have Learning Objectives: been used as replacements for the incandescent bulbs currently used 1 The audience will learn how individuals with color vision in aircraft anti-collision lighting. LEDs require less power to operate, defi ciencies perform on color-coded LEDs. and possess the ability to fl ash without the addition of moving parts. Compared to incandescent bulbs, however, LEDs yield a slightly [388] CIE DRAFT RECOMMENDATION FOR different spectral output and a different intensity profi le when fl ashing. PHOTOMETRY OF FLASHING LIGHTS The impact of these differences was examined to determine if LEDs Y. OHNO can be perceived equivalently to incandescent bulbs. METHODS: Using an automated system to drive an LED with variable intensity NIST, Gaithersburg, MD and duration, the light source was displayed to naïve participants to establish visibility thresholds for solid and short-pulsed LEDs. Once INTRODUCTION: The contents of the CIE Technical Report dark adapted, participants were asked to immediately respond after draft - Photometry of Flashing Lights - from CIE TC2-49 will be an auditory trial cue using two buttons indicating whether a light presented with special focus on measurement of LED warning lights. was present or absent. The intensity of the LED was varied in a wide METHODS: Modifi ed Allard method is to be recommended by CIE range thought to encompass each subject’s threshold intensity, and for all types of fl ash waveform. The method will be explained in the subject responses were used to precisely determine each subject’s comparison with traditional Blondel-Rey equation and Form Factor threshold for the steady and pulsed LED. Several different pulse widths method. RESULTS: Some results of vision experiments from an old for the short-pulsed LED were used to obtain values for the effective literature, for train of pulses in different intervals, are shown to intensity of the LED as a function of pulse duration. RESULTS: For LED demonstrate that Modifi ed Allard method works best. DISCUSSION: signal pulse widths between 26 and 226ms, the data collected appears The limitation of this recommended methods and future needs for to be closely related to the theoretical results produced by each of research will be discussed. the effective intensity models: the Blondel-Rey equation, the Allard Learning Objectives: method, and the Modifi ed Allard method. DISCUSSION: For the small pulse widths (26 to 226ms), the effective intensity models produced 1 The audience will learn appropriate methods to measure the equivalent results. Therefore, future work will test participants’ effective intensity of fl ashing lights. performance at pulses between 500 and 1000ms where the effective intensity values predicted by the Blondel-Rey and Allard Methods are [389] DIFFERENTIAL MEASUREMENT METHODS signifi cantly different. That data will aid in determining which effective FOR INCANDESCENT AND LED SOURCES intensity model should be used for LED aircraft anti-collision lighting. K.M. GILDEA AND N. MILBURN Civil Aerospace Medical Institute, Oklahoma City, OK Learning Objectives: 1 Human test subjects were presented a series of LED signals to INTRODUCTION: The aviation community and the FAA are determine if LEDs are a suitable means for aircraft anti-collision using Light Emitting Diodes (LEDs) increasingly in applications such lighting. as approach lights and navigation lights. The photometric properties of LEDs differ from incandescent sources, necessitating alternative [387] USABILITY OF LIGHT-EMITTING DIODE (LED) measurement devices. LEDs present challenges because of the PRECISION APPROACH PATH INDICATOR (PAPI) geometrical properties of the emissions. These geometrical properties infl uence intensity distribution, resulting in nonsymmetrical intensities. SIMULATOR BY COLOR-DEFICIENT AND COLOR-NORMAL OBSERVERS Thus, the axis and distance from which the LED source is viewed can signifi cantly affect the intensity. Measuring the fl ux of a light source is N. MILBURN AND K.M. GILDEA also problematic with LEDs. Flux measurement is complicated by the CAMI, Federal Aviation Administration, Oklahoma City, OK previously mentioned geometrical properties in addition to backward emission, measuring device design (e.g. baffl es and refl ectivity), and INTRODUCTION: The FAA is planning to convert from orientation. The spectral properties of LEDs differ from incandescent incandescent lights to light-emitting diodesIP: (LEDs) 192.168.39.151 in precision approach On: Sun, 26 Sep 2021 17:39:09 Copyright: Aerospace Medicallight sources Association in non-trivial ways. Additionally, the operating conditions path indicator (PAPI) systems to save energy. Preliminary work on the infl uence LEDs in different ways than incandescent bulbs. Because of usability of LEDs by color vision-waivered pilots (Bullough, et al.,Delivered in press) by theIngenta preceding factors and human factors issues, comparisons between indicated that red weak (protan) individuals made a few errors identifying LEDs and incandescent light sources often include experimental red. Hence, this follow-up study explored whether clustering LEDs of validation prior to fi elding of systems. different chromaticities of the same hue would aid users with color vision defi ciencies (CVD). METHODS: Participants, aged 18-30 years, included Learning Objectives: 45 with normal color vision (NCV). Additionally, 48 were diagnosed using 1 After this presentation, the listener will be able to list the three the Colour Assessment and Diagnosis (CAD) test as 27 deutans (including main challenges of measuring LEDs versus incandescent lights in 5 subjects with potential deutan defi ciencies), 11 protans, 2 tritans, and relation to human perception. 8 subjects evidencing both red-green and yellow-blue defi ciencies. Participants completed the Dvorine pseudoisochromatic plate test, the Signal Light Gun Test (which is the secondary test for issuing color vision Wednesday, May 16 2:00 PM waivers), the Cone Contrast Test, and a simulation of the PAPI system. Participants were asked to name the colors of a 4-light, color-coded Ballroom D PAPI simulation using typical red (R) and white (W) light confi gurations resulting in 5 possible patterns (WWWW, WWWR, WWRR, WRRR, PANEL: ACUPUNCTURE IN THE and RRRR) composed of either incandescent lights, or 3 monochromatic or 3 heterochromatic 5mm cylindrical LEDs. RESULTS: No signifi cant OPERATIONAL ENVIRONMENT YEAR 3 differences were found between the incandescent, monochromatic, and heterochromatic conditions. Between-group differences were found for [390] ACUPUNCTURE IN THE OPERATIONAL the group evidencing both red-green and yellow-blue defi ciencies, as ENVIRONMENT YEAR 3 they performed signifi cantly worse than all other color vision groups. M. BRYCE Performance was very good among all other groups. DISCUSSION: It is SG9S, AFMSA, Falls Church, VA important to note that the protan group performed perfectly on all light sources, even on the 16 trials without comparative color luminance cues. In Aug 2009, the USAF graduated the fi rst of two classes of This fi nding suggests that performance of color vision-waivered pilots, on certifi ed acupuncture physicians. The programs focus was for military red and white LED PAPI systems, will be comparable to their performance use on the battlefi eld and clinical medicine. Based on traditional use on the current incandescent system. of this ancient medical discipline, the foundation of this course has

318 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS been used by UCLA-Stanford to teach over 9000 physicians for the international travel with high level DoD offi cials. METHODS: The past 30 years. AsMA 2010’s panel presented a series on the challenges most common presenting condition is acute low back pain, but other and applications of acupuncture in the clinic and operational common conditions treated include: stress, headaches, fatigue, overuse environment and described areas of application, results, operational injuries and obesity. Auriculotherapy plus other Traditional Chinese impact, and potential future use. AsMA 2011’s panel focused on use of Acupuncture (TCM) techniques are used. RESULTS: Acupuncture often acupuncture with the wounded warriors. This year’s panel will return gives signifi cant pain relief during the patient’s clinic appointment. to acupuncture use in USAF clinics and research. Challenges and This allows patients to be returned to duty for conditions that without applications of acupuncture in the clinic and operational environment acupuncture treatment might have necessitated quarters or other duty will be provided. Summary data will describe areas of application, restrictions. Acupuncture cuts down on the amount of NSAIDs and results, operational impact, and potential future use. Current narcotics used for pain control and therefore on the side effects from acupuncture research projects and results will be discussed. Select these medications. It also gives a high quality of satisfaction to the cases will be presented. Most treatments are benign with minimal side- patients and also to the providers. Innovative treatment strategies will effects. Results across numerous clinical applications are extremely be discussed. DISCUSSION: Acupuncture has minimal side-effects, effective. Use in the fl ying community was challenging due to the especially when compared to NSAIDS and narcotics but there are restrictive grounding policy. While the relaxation effect may warrant some, and caution is advised, where indicated. a short (10 minutes) recovery period before resumption of normal activity, our recommendation is that acupuncture should utilize a Learning Objectives: verbal grounding period similar to immunization or dental restriction. 1 The audience will be given an overview of the acupuncture Following these presentations, a short discussion that encourages treatment techniques for stress, low back pain, headaches, fatigue, audience questions and participation will follow. overuse injuries and obesity.

[391] ACUPUNCTURE AT THE USAF [393] ACUPUNCTURE IN USAF SPECIAL OPERATIONS ACUPUNCTURE CENTER M.J. MCBETH M. BRYCE AFSOC, Hurlbert Field, FL SG9S, AFMSA, Falls Church, VA INTRODUCTION: Air Force Special Operations Command INTRODUCTION: Acupuncture was practiced one day a week (AFSOC) conducts Foreign Internal Defense (FID) missions world-wide, at the United States Air Force Acupuncture Center at Andrews AFB, typically deploying small Operational Aviation Detachments (OADs) Maryland. This had numerous challenges, opportunities, and successes. of Combat Aviation Advisors (CAAs) to live and work closely with our Numerous combinations of acupuncture techniques were shown to offer Partner Nation (PN) allies working toward a common goal of regional an alternative approach toward clinical applications and solutions. A stabilization. On these small teams, every position is crucial to mission sample of cases will be provided. METHODS: Acupuncture was used on success and there frequently is no redundancy in manning. Most PN about 300 patients for numerous conditions but the majority included units are also special operations units, who are often based in remote acute and chronic pain, hearing disorders, PTSD, TBI, viral syndromes, areas requiring all OAD team members to be in top condition for force orthopedics, weight control, operational conditions and concerns, protection and potential emergency egress situations. Acupuncture including post-deployment stress. Treatment was based on the “Medical has proven to be useful for keeping OAD members fi t to fi ght in Acupuncture for Physicians Course” developed by the USAF and the the deployed setting. METHODS: The most common presenting Helms Medical Institute. RESULTS: Acupuncture was highly successful condition is acute musculoskeletal pain, but other common complaints and case studies will be presented. The most common use was in pain amenable to acute acupuncture intervention include headache, control. Other applications were numerous and included insomnia, circadian rhythm disturbance and fatigue. RESULTS: Acupuncture low energy and fatigue, stress reduction, mental alertness, PTSD, TBI, frequently spares patients narcotics and other medications that human performance, and boosting the immune system. DISCUSSION: would prevent them from being fully capable of performing their Acupuncture continues to show great promise for application in the duties, including fl ying operations. Acupuncture has proved to be operational environment. Most treatments IP:are benign.192.168.39.151 However, On: Sun,successful 26 Sep for 2021 various 17:39:09 conditions. Success stories will be discussed. use in the fl ying community was challenging dueCopyright: to the restrictive Aerospace MedicalDISCUSSION: Association Acupuncture has minimal side-effects, making it ideally grounding policy. While the relaxation effect may warrant a shortDelivered (10 bysuited Ingenta to treating aircrew members. minutes) recovery period before resumption of normal activity, our recommendation is that acupuncture should utilize a verbal grounding Learning Objectives: period similar to immunization or dental restriction. 1 The audience will become familiar with the applications of acupuncture to treat members of a small team conducting fl ying Learning Objectives: operations in an austere environment. 1 The audience will appreciate acupuncture use in clinics and operational applications. [394] ACUPUNCTURE AT NELLIS AFB AND FAMILY PRACTICE RESIDENCY [392] ACUPUNCTURE, CLINICAL APPLICATIONS IN THE H. PICKETT NATIONAL CAPITAL AREA Nellis Family Practice Residency, Nellis AFB, NV D. SMALLMAN Pentagon, Washington, DC INTRODUCTION: Home of the Fighter Pilot,” Nellis AFB is home to the U.S. Air Force Warfare Center, the largest and most demanding INTRODUCTION: The Pentagon is the nerve center of the advanced air combat training mission in the world. It is also home to Department of Defense (DoD). It is a fast paced work environment the USAF Thunderbirds F-16 Aerial Demonstration Team. The USAF requiring long duty hours and frequent overseas travel. The rigors of Thunderbirds pilots are required to maintain extreme musculoskeletal Pentagon jobs are like no other. Pentagon-assigned military members positions for at least 45 minutes straight for the demanding and precise often develop stress related somatic symptoms such as back pain task. Prior to the aviation medicine restrictions on acupuncture use in and headaches. Others cope by over eating or indulging in fast food pilots, traditional full body and auricular acupuncture was used with good outlets and rapidly gain weight. Patients relieve job related stress anecdotal success in Thunderbird pilots. METHODS: The most common with strenuous exercise which predictably result in musculoskeletal presenting condition was chronic musculoskeletal pain. Because pain from overuse injuries. Acupuncture employed by the Pentagon Battlefi eld Acupuncture (BFA) was so quick and effective it fi t well into Flight Medicine Clinic has been used successfully to treat back pain, the schedule of the Thunderbird Team. Having a team fl ight surgeon in headaches, stress, musculoskeletal injuries and obesity. In addition, support of the intervention and having the acupuncturist as a prior fl ight these same techniques have been uniquely employed during offi cial surgeon enhanced the acceptance of the procedure. RESULTS: Although

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 319 ASMA 2012 MEETING ABSTRACTS the typical Thunderbird pilot was rarely in a DNIF status, the acupuncture The panel will focus on civilian and military pilots in Germany improved their range of motion, tolerance in prolonged positions and with impairments for fl ying. Case reports will demonstrated, what allowed more pain-free intervals during their down time. DISCUSSION: the Flight Surgeon can do in the fi eld of prevention and diagnostics. Acupuncture had minimal side-effects for these high performance “To keep them fl ying” new approaches will be reported in the fi eld aviators. Unfortunately current limitations on acupuncture prevent of hearing reduction or loss. Test results will show problems with effective use of this for our fl yers. Acupuncture is otherwise in use at the Positive Pressure Breathing. From the ophthalmological point of view Nellis Family Medicine Residency on a daily basis. Acupuncture success the danger of handheld laser devices will be presented out of the stories, current policy, and 2 research trials will be discussed. authorities’ point of view. Finally the not very well known Brugada Pattern and its benefi t for the diagnostics will be presented in another Learning Objectives: case report. 1 : The audience will become familiar with the applications of acupuncture to treat members of a high performance aerial [397] THE AGING AVIATOR FROM AN AEROMEDICAL demonstration team. PERSPECTIVE CASE REPORT: COGNITIVE IMPAIRMENT- FROM VAGUE SUSPICION [395] AURICULAR ACUPUNCTURE AND THE EFFECT ON TO CLINICAL DIAGNOSIS G-TOLERANCE I. CHAUDHURI-HAHN, G. KLUGE AND M. TRAMMER P.A. PANKEY DLR, Cologne, Germany 711 Human Performance Wing, WPAFB, OH INTRODUCTION: According to JAR FCL, an established INTRODUCTION: Acupuncture has been used for thousands of medical history or clinical diagnosis of any neurological condition years and is very attractive to patients who do not like the use of multiple which is likely to incapacitate an individual shall result in an unfi t medications or wish to avoid side effects of medications. It is relevant assessment for professional and private pilots. This rule seems to be for a military aviation population that has limited use of medication a clear instruction for the AME. Degenerative central nervous system especially in the realm of musculoskeletal disorders that often arise in diseases will be more and more common in a population of increasing an operational setting. Auricular acupuncture, specifi cally the protocol age, also in commercial and private pilots. METHODS: By giving a known as Battlefi eld Acupuncture (BFA) has been widely used within case report of a 64 years old private pilot, who developed a severe, the military population with good results. However, its use has been rapidly proceeding dementia, I would like to demonstrate the gap minimal in the aviation population due to a poor understanding of its between the fi rst vague suspicion and the established clinical diagnosis long and short term effects in an aerospace environment. The hypothesis in the fi eld of reduced cognition. RESULTS: Background: Cognitive is auricular acupuncture applied to the BFA points will have a non- impairment starts subtle - the patient often himself denies or does not negative effect on G-tolerance (no effect or an increased G-tolerance) even realize any problem. In addition, regular upcoming tasks are in the aviator at 20 minutes and two hours post insertion. The objective successfully fulfi lled for a long period of time. Most patients with the is to demonstrate BFA does not cause any signifi cant decrease in established medical history of dementia show already years before G-tolerance for aviators. Results of this study should further study in the cognitive impairments, realised or accepted only retrospectively. A fi eld of acupuncture in the aerospace environment. METHODS: Study short overview concerning age pattern, pathophysiology, clinical design consisted of healthy centrifuge proven subjects that served as occurrence and therapeutical options from mild cognitive impairment their own controls. Subjects underwent a baseline spin in full aviator’s to dementia is given. DISCUSSION: The examination of mental gear to assess their G-tolerance for the day. The study utilized the gradual abilities is not defi ned within JAR FCL, as it is regulated for the onset relaxed centrifuge run without straining maneuvers until 50% cardiovascular system (ECG; blood pressure), hearing (audiometry) central or 100% peripheral subjective light loss. BFA was then placed in or the genitourinary system (urine analysis). I would like to point out bilateral ears immediately after baseline spin was completed. Subjects clinical warning signals, so called “red fl ags”, and present clinical were then re-spun in two hours and G-tolerance from the baseline spin tools to evaluate and document cases of even vague suspicion for was compared. Phase two of the protocol was similar except the second cognitive impairment. run was run twenty minutes after the baselineIP: 192.168.39.151 spin to further mimic On: an Sun, 26 Sep 2021 17:39:09 operational setting. RESULTS: Results will be discussedCopyright: in detail Aerospace at the MedicalLearning AssociationObjectives: conference along with statistical analysis. DISCUSSION: DemonstratingDelivered by 1Ingenta The audience will learn aspects of cognitive impairments in pilots the effect or lack of effect of BFA on G-tolerance should further study in and will receive information about evaluation tools. the fi eld of acupuncture in the aerospace environment. This researach will contribute greatly to policy applied to acupuncture used in the operational and fl ying environment. [398] THE DISABLED (HANDICAPPED) PILOT (ORTHOPEDIC DISORDERS) Learning Objectives: T.M. PIPPIG 1 The audience will appreciate the effects of acupuncture in the GAFIAM, Fuerstenfeldbruck, Germany aerospace environment. INTRODUCTION: Musculoskeletal problems affect the health of all of us. Orthopedic disorders are cost-intensive, they need a lot Wednesday, May 16 2:00 PM of time for rehabilitation and the fi nal results are often: impairment, Salon AB disability and handicap. METHODS: By defi nition disability means restriction or lack resulting from an impairment of ability to perform an activity in the manner or within the range considered normal for a PANEL: CIVILIAN AND MILITARY PILOTS human being. Disabilities are description of disturbances in function WITH REDUCED FITNESS: PREVENTION, at the level of the person. Orthopedics disorders are one of the top three causes of disability. There are no strong differences in causes DIAGNOSTICS AND THERAPEUTIC of disability between men and women, but disability is a function of STRATEGIES IN GERMANY age. RESULTS: The basic principles of an “orthopaedic” disability are: functional limitation, loss of function, functional incapacity, reduced performance, limited physical fi tness and higher risk for complications [396] CIVILIAN AND MILITARY PILOTS WITH REDUCED (e. g. primary/secondary osteoarthritis). For example in 2010 in Europe FITNESS: PREVENTION, DIAGNOSTICS AND THERAPEUTIC were done 900.000 hip and knee replacement surgery. DISCUSSION: STRATEGIES IN GERMANY I would like to present a case study that refl ects all possible facets of H.A. PONGRATZ1 AND C.H. STERN2 orthopedic aeromedical examinations, but also problems occurring 1AME, Munich, Germany; 2DLR, Cologne, Germany when evaluating the medical fi tness to fl y, according JAR-FCL 3. It is

320 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS about a 60 year-old civil engineer who has been active fl ying pilot high-Gz loads with and without PBG on the complete breathing chain since 1968, 1700 fl ying hours, predominantly on gliders. I saw this (ventilation-diffusion-perfusion) could be found. DISCUSSION: Based private pilot for the fi rst time on 31 may 2011. By the AMC fi le the on this review, the necessity of a structured approach to investigating following diagnosis are known: SLE, diagnosed for the fi rst time in the effects of PBG on pulmonary performance becomes strikingly 1972, history of recurring pneumothorax right lung in 2004, history of evident. To prevent permanent damage it is time to take a closer look THA on the left side due to necrosis of the femoral head in 2002 and on the effects of PBG on our pilot’s health. The ancillary tools for that history of arthrodesis in the left forefoot due to osteoarthritis in 2009 are available by now. with postsurgical infection by MRSA. I will report in what condition the pilot was when I saw him on 31 May 2011. Learning Objectives: 1 Positive-Pressure Breathing anti-G System (PBG) Learning Objectives: 2 Methods to enhance G-level and G-time tolerance 1 Orthopedic disorders 2 disability, caused by orthopedic disorders [401] INCIDENCE OF AIRCRAFT EXPOSURE TO 3 aeromedical decision meaking HANDHELD LASER DEVICES: EXPERIENCE FROM MILITARY AND CIVILIAN AUTHORITIES [399] HEARING AIDS IN AIRCREW MEMBERS F.M. JAKOBS A. KNOEFFLER Ophthalmology, German Institute of Aviation Medicine, GAFIAM, Fuerstenfeldbruck, Germany Fuerstenfeldbruck, Germany

INTRODUCTION: Throughout the last fi fteen years, there INTRODUCTION: Development in laser technology has led has been a signifi cant leap in the development of hearing aid to the universal availability of handheld laser devices for everybody’s devices which, unfortunately, has not yet been analyzed suffi ciently use. Laser Pointers are available in red, green, and even blue spectral concerning its aeromedical signifi cance. METHODS: CI Cases were wave-lengths and are obtainable via Internet with a power of up to reportet RESULTS: By training hearing performance could be improved. several thousand mW. This has created a situation in which private DISCUSSION: It is certainly no longer in keeping with the times to users are able to track aircrafts, thus seriously interfering with fl ight- forbid people with hearing aids to fl y, just as it is no longer appropriate safety, passengers and pilot’s health. METHODS: Civilian and military to deny pilots with an already partly impaired hearing performance fl ight safety authorities in the European area were contacted and being provided with hearing aids simply because they want to fl y. By asked to provide data on known aircraft exposures to laser beams now, there are quite a few pilots who use hearing aids and fulfi ll their from handheld laser devices. Incidence of exposure rates, fl ight fl ying duties without problems. The presentation will look deeper into incapacitations and effects on vision and perception were recorded this and provide some typical examples.For a long time now, however, and statistically evaluated. Data were compared to data of the United the rehabilitation of hearing-impaired people has not been limited States as previously published in USAF and FAA reports. RESULTS: anymore to conventional hearing aids. Increasingly, bone anchored There is a substantial increase of worldwide reports regarding laser hearing aids (BAHA), middle ear implants and cochlear implants (CI) attacks on aircrafts. Preliminary data suggest an up to 10fold increase are being preferred when treating serious hearing impairments. of exposure within the 2005 to 2010 time period. Exposures concern civilian as well as military aircrafts and include all types of aircrafts Learning Objectives: including airliners, small business jets, and helicopters. DISCUSSION: 1 Basically, treatment with hearing aids can never be indicated too Current safety regulations on aircraft exposure to handheld laser early, only too late, in the worst case. devices appear to be insuffi cient. According to the globalisation of air-traffi c, internationally harmonized procedures on laser incident [400] POSITIVE-PRESSURE BREATHING ANTI-G SYSTEM information and reporting are required. Laser protection systems are (PBG) AND ITS EFFECTS ON OUR PILOT’S HEALTH. WHAT needed, as well as pilot education and post-exposure fl ight-medical DO WE REALLY KNOW? IP: 192.168.39.151 On: Sun,evaluation. 26 Sep 2021 17:39:09 C. LEDDERHOS1, A. GENS1 AND E. GLASER2 Copyright: Aerospace MedicalLearning Objectives:Association 1Research, Science and Training Division, German Air DeliveredForce by Ingenta Institute for Aviation Medicine, Fuerstenfeldbruck, 1 Laser Exposure 2 Flight Safety Germany; 2Center for Space Medicine Berlin, Charité Berlin, Berlin, Germany [402] THE BRUGADA PATTERN (BP): ECG VISUAL INTRODUCTION: In an effort to match the physiology of DIAGNOSIS ALSO FOR FLIGHT SURGEONS! man to the technical ceiling of aircrafts positive-pressure breathing C. WONHAS (PPB) was implemented at the end of WW II. It was fi rst introduced Department Clinical Flight Medicine, German Airforce Institute to enhance altitude protection. Later on, its’ ability to enhance both, of Aviation Medicine, Fuerstenfeldbruck, Germany G-level and G-time tolerance (endurance), to sustained +Gz was discovered and used since. Meanwhile clinical studies revealed that INTRODUCTION: To ensure fl ight safety, the risk of sudden continuous PPB, even at values lower than those used in aircrafts, incapacitation has to be minimized. Discussion of diagnosis and results in lung damages. Pathogenetically different causes are treatment of BP, illustrated by two cases from 2008. METHODS: discussed. There are distinct differences between forms of PPB in the BP bears a higher risk of sudden cardiac death (SCD) through clinical and aeronautical setting. Nevertheless, it cannot be excluded dysfunction of a myocardial sodium channel. The characteristic ECG that PBG of modern anti-G-ensembles, even if short in duration, will pattern is divided into 3 types. A typical BP ECG is similar to a right potentially cause lung damage. Hence experimental studies appear bundle branch block with characteristic ST segment elevations in the inevitable. Beforehand, however, a literature search is indicated. electrocardiographic leads V1-V3. A positive SCD family history is METHODS: Therefore the literature (MedLine, AsMA CD 2007) has reported in 20 to 30%. In literature, the annual risk of SCD varies from been reviewed using the combination of terms “Gz and Positive 1-8%. In a BP register of 1029 patients, the event rate per year was Pressure Breathing” (38 hits) and “Gz and Atelectasis” (7 hits) with no 7.7% for patients with aborted sudden cardiac death, 1.9% for patients language restriction set. RESULTS: A total of 45 articles were found with syncope and 0.5% for asymptomatic patients. For BP Type 1, the and divided into different groups. Criteria applied were maximum Gz- mortality rate amounted to 0% after implantation of an implantable load and Gz-duration, PPG pressure schedule, type of anti-G suit used cardioverter defi brillator (ICD), to 26% with medical treatment, and and parameters monitored. The search revealed the vastly different to 31% without treatment. RESULTS: Case Reports: 1: Helicopter approaches to PPG. However, only a few papers dealt with the impact pilot Bell UH 1 D, 33 years old, BP Type 2, incidental fi nding after of PBG on our pilot’s health. No systematic analysis of the impact of multiple trauma. 2: Loadmaster Airbus A310, 45 years old, BP Type

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 321 ASMA 2012 MEETING ABSTRACTS

1, incidental fi nding during fl ight surgeon routine checkup, treatment (TBI) and Post Traumatic Stress Disorder (PTSD), are largely unfamiliar with ICD. Both patients are symptom-free and have a healthy heart. to many communities welcoming home their warriors. All these factors No indication of extracardial disease features, medicinal infl uence has combine to threaten a successful transition for returning service members been ruled out. DISCUSSION: Aeromedical Relevancy In BP Type 1, who desire stability, good jobs, and educational opportunities. Our ICD implantation is the preferred therapy. An ICD implantation is not combat ill and injured will require additional assistance for achieving compatible with fi tness to fl y. That is also true for ATC service, tactical success in this reintegration process which should be provided at every air command and control service and for operating unmanned aerial step along the joint casualty care continuum. This presentation will begin vehicles (UAV). Due to the low complication rate, an aeromedical with a focus on the end state of reintegration into civilian society for our special permit is also possible for military personnel, but only with BP combat veterans and suggest implications of this end state on evacuation Types 2 and 3. Summary: BP seems to be more frequent than assumed. decisions from combat zones. After ICD implantation, fl ying assignment is excluded. Learning Objectives: Learning Objectives: 1 Understand the challenges that combat veterans face as they 1 BP bears a higher risk of sudden cardiac death. reintegrate into civilian society after discharge from the military. 2 BP seems to be more frequent than assumed. 2 Consider the role of aeromedical evacuation in helping to create 3 After ICD implantation, fl ying assignment is excluded. an end state of successfully reintegrated combat veterans.

[405] VIEW FROM THE FRONT: JOINT THEATER Wednesday, May 16 2:00 PM TBI PROGRAM AND PATIENT MOVEMENT Salon D G.K. NAGASAWA Wright-Patterson Medical Center, Wright-Patterson AFB, OH PANEL: WHEN FASTER ISN’T ALWAYS INTRODUCTION: Traumatic Brain Injury (TBI) and concussive BETTER, PART I injuries resulting from improvised explosive devices, either isolated or associated with poly trauma, have become an increasingly [403] WHEN FASTER ISN’T ALWAYS BETTER important concern to medics supporting military forces involved in D. ROBB counterinsurgency operations. Much attention has been paid on how The Pentagon, Washington, DC to manage patients exposed to single and multiple concussive injuries optimizing their care while preventing inappropriate force attrition and Forward resuscitation and damage control surgery, coupled with mission degradation. Such battlefi eld improvements in assessment and rapid movement from point of injury to defi nitive surgical management treatment of concussive injury have reversed the percentage evacuation and beyond, have saved thousands of lives in the past decade of confl ict. rate of isolated concussive head injury (also known as minimal This triumph of military medicine has depended on rapid advances in Traumatic Brain Injury or mTBI) from 90% evacuation to 80% to 90% our critical care evacuation system, manned by a remarkable joint team or better retained in the battle space. This briefi ng explores the current of dedicated and highly capable medics. With velocity and capability, in-theater management strategies for concussive injuries, describing this modular system has extraordinary resiliency and fl exibility built in, screening, evaluation, common co-morbidities, management, and allowing us to dramatically shrink our medical footprints in theater while evacuation decisions and timing. It will then suggest possible future providing signifi cantly better long term surgical outcomes. However, the directions in concussive casualty management based upon most current nature of combat continues to evolve, as will the types and quantities fi eld experience, and describe concepts that may impact joint medical of injuries it will inevitably produce. Our system, no matter how many casualty evacuation decisions and capabilities in the future. accolades it has received or how good it has been, must also continue to evolve to meet the changing needs of those we send into harm’s way. Learning Objectives: Further, we can’t permit ourselves to fall into the trap of viewing success 1 Understand the current approach to management of casualties with only as survival or limb salvage after the kineticIP: 192.168.39.151 effects of war. We must On: Sun, 26concussive Sep 2021 injuries 17:39:09 in Afghanistan. consider optimal treatment of our entire in-theaterCopyright: patient population, Aerospace Medical2 Understand Association the implications of current concussive injury including those with disease, battle, and non-battle injuries. WeDelivered must by Ingentamanagement strategies on aeromedical evacuation. also broaden our measure of success by looking at the impact our 3 Consider aeromedical management of patients with concussive medical system has on the mission of our ultimate customer, the military injuries and poly trauma or other co-morbidities. commander, as well as on successful short and long term reintegration of the individual casualty. This panel will review the current status of joint [406] OSCAR AND M-TBI WITHIN USMC: IMPLICATIONS combat casualty care and movement from the fi eld and discuss initiatives FOR COMBAT CASUALTY TRANSPORT to move us forward. It will review historical vignettes and current joint S. RINEER fi eld experience to defi ne strategies for fi lling our next generation of gaps USN School of Aerospace Medicine, Pensacola, FL in combat casualty care. Finally, we will look at doctrine, tactics, future research, and training to continuously adapt our joint combat casualty INTRODUCTION: Behavioral Health (BH) and mild Traumatic care system for the future. Brain Injuries (mTBI) are well known issues that our warriors face daily. Timely and coordinated care remains essential in the mitigation of [404] MILITARY TO CIVILIAN TRANSITIONS: PREPARING their long-term sequale. Integration at all echelons of care, including WARRIORS FOR LONG TERM SUCCESS aeromedical considerations, should allow for best outcomes. The Marine D. LEWIS Corps’ Operation Stress Control and Readiness (OSCAR) program Texas Tech University, Lubbock, TX embeds behavioral health personnel with ground combat elements at the regimental level for primary prevention, early detection, intervention and INTRODUCTION: Service members who separate from the command consultation. This successfully embraced and line-led effort military following combat zone deployments face multiple simultaneous includes religious personnel as OSCAR Extenders and trained Marines transitions. These include not just changes from military to civilian life, but as OSCAR Mentors. It promotes resiliency at both the individual and also possible moves from danger to safety, chaos to unit level. Using the BICEPS (Brevity, Immediacy, Centrality, Expectancy, order, discomfort to comfort, camaraderie to solitude, mistrust to Proximity, Simplicity) principles, prevention of combat stress reactions trust, and lawlessness to law. The number of veterans facing civil legal (CSRs) and referrals when required remain essential. Combat and infractions is on the rise across our nation, and college degree completion Operation Stress Control (COSC) continues to be a top priority with rates for veterans are lower than expected. Injured service members goals to maintain a ready fi ghting force, and to protect and restore the face additional transitions, depending on the nature and severity of their health of Marines and their family members. Based on the principles injuries. The signature injuries of today’s confl icts, Traumatic Brain Injury of embedded medical care and unit integrity, the USMC designed and

322 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS deployed a concussion restoration care center (CRCC) to address mTBI 20,000 persons were missing or presumed dead afterwards because a and musculoskeletal injuries with the delivery of tailored and far forward tsunami was generated. The relief effort was supported by 24 countries care. This center achieved a 97.7% return to battle rate since its August and 5 international organizations. Above all, we were supported by a staff 2010 opening in Helmand Province, Afghanistan. Maintenance of unit of more than 20,000 personnel, 20 war vessels, and 160 planes under level integrity and keeping effective combatant strength intact has been the purview of “Operation Tomodachi” from the U.S. forces and they also realized along with delivery of timely and focused care to the affected had the military units such as CBIRF provide support for the nuclear plant warrior. This panel will, discuss line and medical coordination of care with accident again. Of course, the Japanese Self-Defense Forces made every the Oscar model and Concussion Restoration Care Center as examples, possible effort for disaster response, too. We dispatched total of 9,800,000 and consider its implications for integrated in-theater medical capabilities members, 4,500 war vessels, and 46,000 planes. Furthermore, we saved and aeromedical evacuation in future confl icts. 20,000 people and offered 5 million meals. For reasons of the above, the author will introduce a summary of the earthquake and tsunami disaster Learning Objectives: and host the session in which the activities of the Self-Defense Forces 1 Understand USMC OSCAR (Operational Stress Control and which dealt with them will be analyzed. I give great thanks to all of the Readiness) model and how it impacts evacuation decisions. countries of the world who supported Japan regarding the great disaster 2 Understand the importance of the partnership between line and that struck our country in the last year. 1.The audience will learn about medical assets inherent in the OSCAR model. the whole aspect of the damage caused by the huge earthquake and know what kind of activity the Japanese Government, the Self-Defense Forces, [407] SOLDIER REINTEGRATION: NEW OPPORTUNITIES and various groups carried out. 2.The audience will learn the process to FOR JOINT PARTNERSHIPS IN EVACUATION engage in work while doing radioprotection on the occasion of a serious D. WILLIAMS nuclear plant accident. Warrior Transition Command, Alexandria, VA [409] ACTIVITIES AND PROBLEMS OF JAPANESE HEALTH INTRODUCTION: The United States Army Warrior Transition CARE SYSTEM FOR NATURAL DISASTER Command is committed to helping Wounded, Ill, and Injured Soldiers Y. KANATANI heal, rehabilitate, and reintegrate, either back to duty or into their civilian Health Crisis Managment, National Institute of Public Health, communities as productive citizens. When a Soldier is wounded, he Wako, Japan or she passes through a structured process beginning with evacuation and ending in successful reintegration at the highest possible level of INTRODUCTION: Great East Japan Earthquake was associated functioning. Throughout this process, each Soldier is assigned a “Triad of with tsunami, which magnifi ed damages of life support infrastructure. Care”, composed of a primary care manager, a nurse case manager, and a Therefore, patients using life support devices such as respirators should squad leader, the Soldier’s link to supervision and the Chain of Command. be evacuated until their batteries run down. Unfortunately, tsunami The Triad of Care will develop and execute a Comprehensive Treatment washed out airports located seacoast and many patients should be Plan (CTP) with support from an interdisciplinary team that includes evacuated with helicopters. In order to cross over mountains, helicopter licensed clinical social workers, physical and occupational therapists, had to maintain its altitude over 4,000 meters sea level. At this altitude, behavioral health professionals, chaplains, and other medical and support many patients complained dyspnea, however it was diffi cult to use personnel. This systematic framework provides a consistent method nebulizer without A/C power source in JSDF helicopter. Moreover, lack of addressing whole person rehabilitation and integration, spanning of medical staff trained aeromedicine worsen situation. METHODS: multiple domains of well being, including physical, emotional, spiritual, Ministry of Health, Labor and Welfare (MHLW) organized special research social, career, and family parameters for the Soldier. Because the process team consisted with public health specialists from Iwate, Miyagi, and of reintegration begins with evacuation, we have functionally moved Fukushima prefectures. These specialists assessed prefectural and national reintegration forward into the battlespace in much the same way that we support on medical health care system for victims. RESULTS: In Japan, have moved resuscitation forward towards point of injury. This opens up MHLW fi nancially supports Amyotrophic Lateral Sclerosis (ALS) patients exciting opportunities for joint evacuation assets to become partners in when respirator should be necessary for improving their quality of life at early rehabilitation of our Wounded WarriorsIP: while 192.168.39.151 they ensure safe travelOn: Sun,home 26 Sepcare. Prefectural2021 17:39:09 government decided to transport 9 ALS patients through the echelons of care. This presentation willCopyright: describe the Aerospace United Medicalsupported. Association During wide area medical transportation, some patients States Army Warrior Transition Program and consider the opportunitiesDelivered bycomplained Ingenta dyspnea and slight cyanosis in helicopters. Moreover, it for joint aeromedical assets to become more engaged in interdisciplinary is diffi cult to use nebulizer in helicopter because of lack of A/C power rehabilitation of wounded Soldiers. source. DISCUSSION: Recently, wide-area medical transportation has become popular in Japan. However, most doctors are not trained with Learning Objectives: aerospace medicine and respirator management. Therefore, education and 1 Understand the systematic process that the United States Army uses training for aerospace medicine should be necessary for doctors in case of to reintegrate wounded Soldiers huge disasters. 2 Consider opportunities for Joint evacuation assets to work together to enhance Soldier reintegration Learning Objectives: 1 How to educate and train doctors for aerospace medicine. 2 How to establish medical evacuation system for huge disasters. Wednesday, May 16 4:00 PM 3 What kind of specialists are necessary for airborne medical Ballroom A evacuation. [410] MEDICAL ACTIVITIES IN JAPAN SELF-DEFENSE PANEL: JAPAN SESSION B: DISASTER FORCES DISASTER RELIEF MISSION FOR THE GREAT EAST MEDICINE - COPING WITH THE EAST JAPAN EARTHQUAKE ON MARCH 11,2011 JAPAN EARTHQUAKE DISASTER M. FUJITA1, Y. YAMAMOTO1, S. TACHIBANA1, H. SOMEDA2, Y. KANATANI3 AND K. OGATA4 1 [408] JAPAN SESSION B: DISASTER MEDICINE - COPING Division of Environmental Medicine, National Defense WITH THE EAST JAPAN EARTHQUAKE DISASTER Medical College Research Institute, Tokorozawa, Japan; 2 H. GOMI AND K. OGATA Department of Military and Disaster Medicine, National 3 All Nippon Airways, Tokyo, Japan Defense Medical College, Tokorozawa, Japan; Department of Health Crisis Management, National Institute of Public Health, The East Japan great earthquake disaster ravaged the Tohoku district, Wako, Japan; 4Vice President for Military Affairs, National on a scale of magnitude 9.0 on March 11, 2011.In total approximately Defense Medical College, Tokorozawa, Japan

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 323 ASMA 2012 MEETING ABSTRACTS

INTRODUCTION: The Great East Japan Earthquake occurred Fukushima Daiichi Nuclear Power Plant and during those operations, at 14:46 JST on Friday, March 11, 2011. It was the greatest earthquake we monitored radiation levels around the Fukushima Daiichi nuclear in Japanese record and triggered destructive tsunami waves up to 40 power plant area. We offered docontamination support and food meters attacking the seashore area within 30 minutes after the quake. supply support for local residents and for local patients who could The affected area was the pacifi c coast of northeastern Japan. The huge not move by themselves, we offered medical evacuation support. For tsunami attacked the Fukushima I Nuclear Power Plant complex and accomplishing these missions, JGSDF nuclear disaster medicine expert caused large evacuation affecting hundreds of thousands of survivors played important role especially in coordinating cross organization due to the radiation problem. METHODS: Retrospective analysis operation, information exchange and training staff. We will introduce was performed on the rescue and relief mission by the Japan Self- our anti-nuclear disaster activities and medical support, anddiscuss Defense Forces according to the offi cial report of Japan Ministry of about current problem and future anti-nuclear disaster operation. the Defense on June 30, 2011. We focused on the medical activities in this study. RESULTS: Casualties included more than 15,000 Learning Objectives: deaths, 5,000 missing, 5,000 injuries and 120,000 refugees. Japan 1 What we can do in nuclear disaster Self-Defense Forces sent over 100,000 personnel and rescued about 20,000 survivors. More than 800 medical personnel including 80 physicians and dentists were deployed and offered medical services Wednesday, May 16 4:00 PM on over 17,000 cases. We report rough summary of medical activities. Ballroom B Majority of evacuation were performed by stretchers, ambulances or helicopters. Only a few cases of evacuation were performed by PANEL: JOURNAL SEMINAR: WRITING AND fi xed-wing aircraft. DISCUSSION: The devastating damage of local authorities and local hospitals were the trouble for coordinated rescue REVIEWING FOR AVIATION, SPACE, AND and support in the initial phase. The establishment of wide-area ENVIRONMENTAL MEDICINE evacuation system was considered to be necessary in the acute phase of such a huge disaster. Subsequent public health assistance were also a major role of us in the situation where local organizations collapsed. [413] JOURNAL SEMINAR: WRITING AND SUBMITTIING A PAPER TO ASEM Learning Objectives: F. BONATO1, P. DAY1, R. TRIGG1, D. SVENTEK1, 1 How to assist and accommodate the affected area when local D.P. GRADWELL2 AND E.A. BOUDREAU3 authorities and hospitals were devastated. 1Aviation, Space, and Environmental Medicine, Alexandria, VA; 2 How to prepare and establish the medical care readiness for 2RAF Centre of Aviation Medicine, Bedfordshire, disaster. United Kingdom; 3NINDS, NIH, Bethesda, MD 3 How to establish a wide-area evacuation system in a huge disaster. Peer-reviewed journals such as Aviation, Space, and [411] JAPAN SESSION B:DISASTER MEDEICINE- RESCUE Environmental Medicine (ASEM) publish formal reports on scientifi c OPERATION BY CIVIL AVIATION IN THE studies and clinical observations. Publication in a journal like ASEM is EAST JAPAN EARTHQUAKE a worthwhile achievement, but many potential authors are intimidated H. GOMI by journal requirements or have been disappointed by having All Nippon Airways, Tokyo, Japan manuscripts rejected. The fi rst hour of this presentation will provide authors with a systematic overview to writing an informative, readable In case of East Japan Disaster(Earthquake and Tsunami), I will paper and submitting it to ASEM using our web-based system, Editorial report the civil aviation’s support for this huge disaster. All Nippon Manager. The journal staff will discuss the requirements for various Airways is one of major airline in Japan. We started the rescue article types as set forth in the Information for Authors. They will operation for this disaster as below. 1)Operation through aviation Extra explain how the author can avoid problems as a manuscript passes and temporary fl ight for north and east Japan.IP: 192.168.39.151 Free transport of rescue On: Sun,through 26 Sep three 2021 sets 17:39:09of hands: the editorial offi ce for review of content, staffs and supplies Exemption from refund andCopyright: fl ight-charge Aerospacefee 2) Medicalthe publishing Association offi ce for copy editing, and the printer for conversion Indiredt support Donation and contributory mileages RescueDelivered supplies by andIngenta typesetting. The fi nal half hour of the presentation will be devoted In this earthquake, Sendai airport(located at the center of north-east to peer review, a widely accepted process by which journals assure Japan) suffered big damage by Tsunami. (Sendai airport has restored the quality of published papers. This presentation will acquaint authors so quickly by U.S.Navy) So we could not use this airport for rescue with the peer review process and help new reviewers understand what supplies transport at fi rst. We started temporary fl ight to 3 other is expected of them and how the editor uses their reports. Journal staff north-east Japan airports close to Sendai. And we also started members will be available throughout the week to talk with authors free transport of medical staffs and rescue supplies. First 2 weeks and referees regarding journal content and processes. after earthquake, we transported around 5,500 rescue staffs and 16tons rescue supplies as requested from Japanese Government Learning Objectives: and municipality. We have mileage services, and we got so much 1 Provide authors with a systematic approach to writing and submit- contributory mileages(260 million miles=260 million yen) from our ting a manuscript for publication. customers in fi rst 2 weeks. 2 Acquaint authors with the peer review process.

[412] ANTI-NUCLEAR DISASTER ACTIVITIES AND Wednesday, May 16 4:00 PM MEDICAL SUPPORT OF JAPAN GROUND SELF-DEFENSE Ballroom C FORCE FOR NUCLEAR POWER PLANT ACCIDENT IN THE EAST JAPAN EARTHQUAKE B. HATANO PANEL: FEAR OF FLYING Medical Department, JGSDF, Falls Church, VA [414] FEAR OF FLYING INTRODUCTION: The East Japan Earthquake occurred M.F. HUDSON on March 11, 2011 and huge Tsunami caused nuclear disaster of Thomas Cook Airlines UK, Cheshire, United Kingdom Fukushima Daiichi Nuclear Power Plant. For dealing with this nuclear disaster, Japan Ground Self Defense Force (JGSDF) offered several Panel on “Fear of Flying” Sponsored by the Air Transport Medicine anti-nuclear disaster activities and medical support. We dispatched Committee Panel overview; Despite the safety of commercial aviation CH47 and fi re engine for supporting the nuclear power plant cooling (no fatalities on US Carriers in the period 2007 - 2010), fear of fl ying operation. We also offered medical check for people working at is a widespread problem crossing all cultures and socio-demographic

324 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS groups. A 1980 study from a major airline manufacturer reported that Virtually Better (Atlanta, Georgia) specializes in treating Anxiety 18% of the US population were afraid to fl y and a community media Disorders utilizing a cognitive-behavioral therapy (CBT) approach, poll 10 years later indicated that approximately half of adults who incorporating Virtual Reality Exposure Therapy (VRET) where fl ew commercially were frightened at least sometimes. This panel indicated. Clinical trials of VRET for FOF began at our offi ce in 1999. will consider the problem of “Fear of Flying” from the treatment/ Results from open and controlled trials revealed VRET to be effective management viewpoints. The extent of the problem will be discussed and generalizable: 76% of participants completed the graduation and various national and international programmes that have been fl ight post-VR treatment; 70% continued to fl y at one year and report introduced to help alleviate passenger anxiety will be reviewed. The positive attitudes towards fl ying. During and following the research, factors that can lead to aerophobia will be identifi ed and the role of the need and niche for this treatment was highly realized. Treatment pilots, psychologists, cabin crew, airline ground based personnel, not only demonstrated effectiveness empirically, but people reported (e,g, maintenance), air traffi c control and other personnel in helping “liking” the VR, seeking the treatment both in response to press and passengers will be analysed. The effectiveness of ‘Fear of Flying’ word of mouth. The VRET practice for FOF burgeoned from there, prevention and management systems will be reviewed and the role of locally (in metro Atlanta), then regionally. For clients out-of-state, the use of psychology, in particular cognitive behavioural techniques intensive treatment (several hours over a few day period) has proven and virtual reality, medication, exposure/de-sensitization and other equally effective as a traditional weekly model. VRET is founded on techniques will be discussed. The success or otherwise of these various the same principles as standard in vivo exposure therapy - gradual national and international programmes will be analysed. Learning and repeated exposure to the feared stimulus (i.e., airplanes, or objectives To increase airlines awareness of the problem of aerophobia panic) with a controlled and hierarchical approach. VRET, however, and to encourage the development of effective systems to identify and exposes the patient to a virtual environment versus accompanying mange this problem. the patient in the real environment or having the patient imagine the trigger (imaginal exposure). VRET offers several advantages: situation [415] FEAR OF FLYING; A GENERAL OVERVIEW recreation via visual, auditory, and kinesthetic cues; precise control DR MARTIN HUDSON, COMPANY MEDICAL and dosing of stimuli (e.g., repeating take-offs, turbulence, landing); protection of client confi dentiality (vs in vivo airport exposure); and ADVISER, THOMAS COOK AIRLINES UK time, cost, and logistical advantages for both client and clinician. M.F. HUDSON Limitations include rare technological “glitches” and rarer simulator Thomas Cook Airlines UK, Cheshire, United Kingdom sickness. The FOF treatment protocol follows a CBT model, providing psychoeducation, anxiety management skill-building, and INTRODUCTION: Fear is a normal human reaction: a phobia exposure. VRET is effective for specifi c phobia, panic disorder, and occurs when this fear becomes an overeaction to a circumstance that agoraphobia. is not particularly dangerous or harmful. 60% of the population have some anxiety related to fl ying as a result of adverse publicity about Learning Objectives: aircraft accidents, terrorism, claustrophobia or previous experience 1 Learning Objective Virtual reality exposure therapy is an of an unpleasant fl ight. Many passengers know that this fear is empirically based cognitive-behavioral intervention and irrational but have a sense of unease while fl ying. A few will develop exposure modality highly effective in treating fear of fl ying. The panic symptoms and 10% of the population avoid fl ying. Aviophobia multisensory stimuli, control, and convenience (in offi ce can lead to signifi cant symptoms: trembling, sweating, fast heart implementation) afforded by VRET are some of the variables rate, breathing diffi culties, dry mouth and dizziness being the most that make this an advantageous approach for practitioners and common. Hyperventilation may follow which results in worsening researchers working in the area of fear of fl ying. symptoms and an increasing panic. Occasionally aggressive behaviour to other passengers or cabin crew occurs. Aviophobia can [417] FEAR OF FLYING; HOW A PROACTIVE SPECIALISED be treated and simple remedies such as pre-fl ight discussion with relatives, friends or the passenger’s General Practitioner will help. CLINIC CAN HELP PASSENGERS Obtaining reassuring knowledge about the remarkable safety record P. ZIMMERMAN of airline travel and having knowledge ofIP: the 192.168.39.151 high level of pilot and On: Sun,Fear 26 ofSep Flying 2021 Clinic, 17:39:09 San Francisco, CA cabin crew training can be reassuring. InformingCopyright: passengers Aerospace about Medical Association safety equipment on board a modern airliner such as radar, DeliveredTCAS by IngentaINTRODUCTION: The Fear of Flying Clinic is a nonprofit and the excellence of Air Traffi c Control can help. ‘Fear of Flying’ organization created by two women pilots, Fran Grant and Jeanne Courses including a general introduction to the problem, meeting the McElhatton, in 1976 to combat one of our society’s most pervasive pilots and cabin crews and visits to see the aircraft as well as short and debilitating phobias. It has been estimated that as much as familiarisation fl ights can be most benefi cial though their cost is a 25% of the population experiences anxiety about flying, and disadvantage. Simpler measures can include providing information that as many as 1 in 8 Americans avoid commercial air-travel as to passengers, stressing that fear of fl ying is common and there is a result. The FOF clinic has filled a need in the San Francisco no shame in experiencing this normal human emotion. Muscle Bay Area for 35 years. Using a two pronged approach, the relaxation, breathing techniques, rehearsing calmness and practising clinic provides information delivered first-hand by professionals active strategies can be successful with 80% of passengers reporting from inside the commercial aviation industry, as well as the signifi cant improvement. psychological structure through which to make that information useful. Volunteer pilots, flight attendants, air traffic controllers, Learning Objectives: and maintenance workers share insider knowledge about their 1 To understand aviophobia and how it can be successfully managed. training and procedures. Armed with this new information, as well as key cognitive-behavioral techniques to assist them in changing their old belief systems, clients are encouraged to confront their [416] COGNITIVE BEHAVIORAL THERAPY FOR FEAR OF fears on an “orientation” flight with other fearful flyers. Each clinic FLYING: USE OF VIRTUAL REALITY EXPOSURE THERAPY IN enrolls between 10-25 participants. The group therapy structure, AN OUTPATIENT TREATMENT SETTING led by a behavioral therapist, provides a supportive environment L. TANNENBAUM for tackling the fear of flying. Since flying is such an integral part Virtually Better, Atlanta, GA of modern life, programs for fearful flyers provide a much needed service. Paula Zimmerman, M.S., MFT Behavioral Counselor, Fear INTRODUCTION: Cognitive Behavioral Therapy for Fear of of Flying Clinic Flying: Use of Virtual Reality Exposure Therapy in an Outpatient Treatment Setting L. Tannenbaum Virtually Better, Atlanta, Georgia Learning Objectives: Fear of fl ying (FOF) is a signifi cant clinical problem estimated 1 To understand the problem of aerophobia and how it can be to affect 10-40% of adults in the U.S. The clinical practice at actively managed

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 325 ASMA 2012 MEETING ABSTRACTS

[418] PHYSIOLOGICAL RESPONSES TO PHOBIC ANXIETY collaborative effort that began 35 years ago; witness the topics on IN PEOPLE WITH AVIOPHOBIA both civil and military aviation, the creation of a space agency and its L.J. VAN GERWEN research goals, and the active participation of the IAAM in enhancing Valk Foundation, Leiden, Netherlands world aviation safety. As always, the panel offers an opportunity to learn from our colleagues in Iberoamerica. INTRODUCTION: The relationship between physiological and subjective responses in phobic subjects remains unclear. Phobics [420] 35 YEARS OF THE IBEROAMERICAN ASSOCIATION OF are often considered to have a heightened physiological response AEROSPACE MEDICINE or a heightened perception of a normal physiological response. In L.A. AMEZCUA-G. this study, we examined both subjective measures of anxiety and Iberoamerican Association of Aerospace Medicine, Mexico autonomic responses (heart rate [HR] and cardiac vagal activity) to City, Mexico stimulated fl ight stimuli in a cohort (127 individuals) who presented for fear-of-fl ying therapy at a specialized treatment centre. The control INTRODUCTION: Thirty-fi ve years ago, on 10 November 1976, group comprised 36 individuals without Aviophobia. We found a the Latin-American Association of Aerospace Medicine (ALMAE) was large increase in subjective distress during exposure to simulated founded under the auspices of the Mexican General Directorate of fl ight stimuli in the Phobics but no change in this parameter in the Civil Aviation (DGAC), by Dr. Luis Angel Amezcua, then the Medical controls. In contrast, the physiological responses of both groups Director of the DGAC Medical Department. The event took place at were indistinguishable. However, for the phobic cohort, increases the International Civil Aviation Training Center (CIAAC) in Mexico in subjective fear during exposure were coupled to heart rate [HR] City, which at the time was hosting the 10th basic course on aviation and cardiac vagal reactivity. In contrast to predictions from the medicine offered by the DGAC and sponsored by the International psychological perspective, anxiety sensitivity did not modulate Civil Aviation Organization (ICAO). Attendees included physicians this coupling. We conclude that subjective fear and objective (i.e. from Mexico, South America, and Portugal. ALMAE was founded autonomic) responses are only modestly correlated during exposure to with 68 members, 42 of which were present that momentous rainy simulated fl ight conditions. However, one limitation of our study is the afternoon in November. Three of them continue as key leaders of use of fl ight simulation as a means of generating phobic stimuli. the association today - Dr. Luis Amezcua, Dr. Silvio Finkelstein of Argentina, and Dr. Carlos Staff of Panama. The fi rst congress held Learning Objectives: by the association was celebrated 7-11 November 1978, at the 1 TO IMPROVE THE UNDERSTANDING OF PHYSIOLOGICAL AND Hotel Chapultepec in Mexico City. The scientifi c sessions included SUBJECTIVE RESPONSES IN PHOBIC ANXIETY several civil aviation medicine topics including medical certifi cation, 2 TO IMPROVE METHODS FOR THE MANAGEMENT OF ophthalmology, use of contact lenses by aviation personnel, AVIOPHOBIA accident investigation, medical issues of ground and air traffi c control personnel, and airport medical services. Session participants included Dr. Modesto Garay of Guatemala and Dr. Lorenzo Vargas Wednesday, May 16 4:00 PM of Peru, who continue to set an example amongst our members Ballroom D with their dedication to the associations’ goals. The second ALMAE conference was hosted by our colleagues in Chile, who realized a PANEL: ADVANCES IN AEROSPACE magnifi cent event in Santiago with the sponsorship of that nation’s military authorities. The 3rd congress was held in October 1985, MEDICINE IN IBEROAMERICA in Guadalajara, Mexico. It was a diffi cult time then, as the nation’s capital had just suffered the 1985 earthquake. Several other successful [419] ADVANCES IN AEROSPACE MEDICINE IN ALMAE events were held in Colombia, Spain, Argentina, Brazil, IBEROAMERICA and other nations. In 19 June 1998, ALMAE changed its name to the E.M. FORSTER1, M.M. GARAY2 ANDIP: E.M. 192.168.39.151 RICAURTE3 On: Sun,Iberoamerican 26 Sep 2021 Association 17:39:09 of Aerospace Medicine (AIMA). Another 1Civil Aerospace Medical Institute, FAA, Oklahoma City, OK; key event that year was AIMA’s introduction of a panel conducted in Copyright: Aerospace MedicalSpanish duringAssociation the annual AsMA conference. Today, 15 such panels 2Dirección General de Aeronáutica Civil, Guatemala, DeliveredGuate- by Ingenta 3 have been held and likely inspired those now presented in other mala; Civil Aerospace Medical Institute, Cherokee Nations languages. The presentation will provide the rich history and success Distributors, Oklahoma City, OK of the AIMA organization (http://sites.google.com/site/aima1976org/ home), which currently counts with 254 members and friends. This year, the panel sponsored by the Iberoamerican Association of Aerospace Medicine (IAAM) celebrates 15 years of sharing scientifi c Learning Objectives: advances in the Spanish language. Chaired by the IAAM president, Dr. 1 Learn the rich history and success of the Iberoamerican Associa- Estrella Forster, and co-chaired by the esteemed Dr. Modesto Garay of tion of Aerospace Medicine and its accomplishments in support of Guatemala and past president of the IAAM, the panel will commence international aviation safety during the last 35 years. with a presentation by the distinguished Dr. Luis Amezcua, the founder and fi rst president of the association, who will discuss the history of IAAM and its development to date in celebration of its establishment [421] AEROMEDICAL EVACUATION IN THE COLOMBIAN in Mexico City 35 years ago, on November 1976. Dr. Lina Sanchez AIR FORCE will continue the session with a presentation regarding aeromedical L. SANCHEZ, C.A. GARCIA AND B.I. SANCHEZ evacuation in the Colombian Air Force (CAF). Next, Dr. Daniel Colombian Air Force, Bogota, Colombia Aparicio will discuss a comparative study concerning body mass index and bioelectrical impedance metrics in CAF personnel. The panel will INTRODUCTION: Because of Colombia’s internal public order continue with Dr. Carlos Staff of Panama, past president of the IAAM, situation, the Armed Forces have had to confront diverse delinquent who will provide a description of the International Civil Aviation groups from 1960. Also, Colombia has been affected by natural Organization (ICAO) Cooperative Arrangement for the Prevention disasters such as Armero fl oods where more than 25,000 people of Spread of Communicable Disease through Air Travel (CAPSCA) died, as well as the Armenia and Popayan earthquakes. Therefore, program. Dr. Karina Flores will complement the session by discussing consistent with its mission, the Colombian Air Force (COLAF) has medical certifi cation in Chile, including special issuance cases. acquired a great deal of fl ight operational experience and a high level Dr. Carlos Salicrup will then conclude the session by presenting an of specialization in aeromedical evacuation (AE) to provide support for update on the research activities at the recently established Mexican casualties in military operations as well as to the civilian population Space Agency. This year’s panel is especially meaningful to the affected by either natural disasters or medical emergencies that require aerospace community as it demonstrates the results of an international air transport from remote areas of the country and ensure proper

326 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS medical intervention. However, it was until 2003 where the necessity Learning Objectives: of organizing an Aeromedical Evacuation system that would cover 1 Understand the value of bioelectrical impedance analysis with the entire country was established. In order to optimize the available respect to body mass index measurements. resources, it was necessary to work with the Colombian Secretary of Health and gain the support of the US Armed Forces, to structure a [423] THE CAPSCA PROGRAM plan with the fi nal objective of creating an AE system that would cover C. STAFF not just military population but also civilian people from the distant boundaries of the country. A study was conducted to identify the right Iberoamerican Association of Aerospace Medicine, Panama aircraft according to Colombian geography, as well as the number of City, Panama people which would be fl own in each mission. It was concluded that it was necessary to have helicopters, pressurized planes that would INTRODUCTION: The Cooperative Arrangement for the be able to fl y over the Colombian mountains, and non-pressurized Prevention of Spread of Communicable Disease through Air Travel planes to fl y over the Colombian valley. Also, pilots and medical (CAPSCA) program is a proposal by the International Civil Aviation staff were trained in all the aeromedical fi elds with an aim to support Organization (ICAO) that incorporates public health measures and mass casualties and to deal with the special requirements of severe World Health Organization’s International Health Regulations in injured patients. In addition, administrative facilities were built to the Annexes of the International Civil Aviation Convention and accommodate the civilians and military organizations that would its amendments. Participants of this effort are the Member States be involved in the effort. Today, the COLAF AE system has UH-60L and diverse organizations such as the International Air Transport Helicopters, C-208 Caravan, and K-350 planes situated throughout Association (IATA), the Airports Council International (ACI), the the Colombian territory. To date, more than 1000 patients have been U.S. Centers for Disease Control (CDC), and other participants. fl own in the last 4 years. The presentation will describe the COLAF The purpose of the program is to assist the member States and AE system, emphasizing the role of the aerospace medicine specialist, Territories in the implementation of new requirements, established relative to several areas of concern, including: organizational structure, by ICAO Standards and Recommended Practices as well as policies & procedures, treatment modalities, evacuation criteria, cabin Orientation Material from ICAO Annex 6 (Aircraft Operations), confi guration, equipment usage, communication systems, and training Annex 9 (Facilitation), Annex 11 (Air Transit Services), Annex 14 of multidisciplinary teams. (Aerodomes), Annex 18 (Hazardous Merchandise), Document No. 4444 (PANS-ATM), and the directives for the ICAO Member States. Learning Objectives: The program was implemented in phases; fi rst in the Asian-Pacifi c 1 To understand the importance of aeromedical evacuation system region in 2006. In 2008, it was launched in the region of Africa, implementation in different emergency scenarios in nations such as and in 2009 in the Americas. It was recently addressed by the EUR/ Colombia. NAT regional offi ce in Paris, France, 20-22 September 2011. The experience gained from the Severe Acute Respiratory Syndrome [422] BMI AND BIOELECTRICAL IMPEDANCE METRICS IN (SARS) outbreak in 2003, the Avian Infl uenza (H5N1) threat in 2005, and the H1N1 pandemic of 2009, demonstrated the harmful COLOMBIAN AIR FORCE AIRCREW effects of transmissible diseases on various aspects related to public D.F. APARICIO health emergencies of international importance, the role of air Aerospace Medical Center, Colombian Air Force, Bogota, travel in spreading these diseases; the vulnerability of the aviation Colombia sector and the economies that depend on them. The objectives of the CAPSCA Program are: the promotion of public health to reduce INTRODUCTION: With the exception of weight, anthropometric the propagation of transmissible diseases through air travel; the techniques or measures to determine corporal composition such as size protection of passengers, fl ight crews, general public, and airport and body mass index (BMI) are seldom used in daily clinical practice personnel. The project includes the collaboration and coordination and are fundamentally reserved for clinical or epidemiologic studies. amongst Civil Aviation Authorities, Public Health Authorities, In Colombia, several diverse anthropometric population studies have Airports, Air Navigation Service Providers, Customs and Immigration been realized, but few are those that addressedIP: 192.168.39.151 the principal validation On: Sun,Authorities, 26 Sep 2021Tourism 17:39:09 Agencies, and those responsible for disaster techniques to assess corporal composition: hydrostaticCopyright: densitometry, Aerospace Medicalmanagement. Association The foundations are established by Article 14 of the dual-energy X-ray absorptiometry, and bioelectrical impedanceDelivered analysis byCivil Ingenta Aviation International Convention. (BIA); the fi rst two techniques are diffi cult to access and very expensive, so the study focused on BIA. METHODS: A cross-sectional descriptive Learning Objectives: study was conducted at the Exercise Physiology Laboratory of the 1 Learn the objectives and benefi ts of the Cooperative Arrangement Colombian Air Force (CAF) Aerospace Medical Center to assess how for the Prevention of Spread of Communicable Disease through Air BMI correlated to BIA (% FAT and FAT MASS). The study participants Travel (CAPSCA) program were 3,996 military members of the CAF (3,675 males and 321 females), both offi cers and non-commissioned personnel. The Pearson [424] MEDICAL CERTIFICATION IN CHILE: SPECIAL correlation statistic was utilized to assess results. RESULTS: The majority ISSUANCE 2003-2011 of the study participants were overweight (46.57%) or obese (8.68%). K. FLORES-ROJAS1, L. ROJAS-CARDENAS2 AND R. DE LA The others showed a weight within normal limits. The measurements 1 of % FAT and FAT MASS derived from BIA showed a low sensitivity for FUENTE-ESPINOZA 1 BMI values below 18.5 and moderate sensitivity for patients classifi ed Sección Medicina de Aviación, Dirección General de normal, overweight, or obese. The BMI - % FAT Pearson correlation Aeronáutica Civil, Santiago, Chile; 2Departamento de Medicina was good (74.8%) for both genders, but the strength of the relationship Ocupacional, Hospital Mutual de Seguridad, Santiago, Chile diminished when taking into account gender or BMI classifi cation separately. Also, BMI alone did not offer an adequate interpretation of INTRODUCTION: In Chile, the Aviation Medicine Department body composition at the individual level. Thus, its reliability to predict of Aeronautical Authority issues medical certifi cates for airmen. adiposity was low, especially for underweight subjects. DISCUSSION: The Committee of Special Issuance from the Aviation Medicine BMI evaluation has a low or moderate correlation with BIA so that it is Department reviews the medical history of the airman diagnosed with not suffi cient to determine the nutritional state of an individual person. diseases under treatment and issue o deny the medical certifi cate. A This fi nding is especially signifi cant in terms of quality standards, study was conducted to analyze the total special issuance issues or particularly for the subject population under study, which special work denials over an 8 year period (2003-2011) and determine the main environment poses high risks, such as those faced by military personnel, causes of aeromedical disqualifi cation in Chilean airmen. METHODS: including aircrew. BMI is better used to evaluate members of the Special issuance fi les during the period 1 January 2003 through 31 general population that normally would not count with the resources August 2011 were reviewed and subdivided into age groups, medical necessary to use other methods that offer more specifi c results. certifi cate classes, and diagnostic categories. RESULTS: The Aviation

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 327 ASMA 2012 MEETING ABSTRACTS

Medicine Department issues more than 6000 medical certifi cates every [426] RAF MEDICAL STANDARDS - DRIVERS FOR CHANGE year and the Committee reviews almost 100 cases of potential medical A.C. TIMPERLEY1, D.C. MCLOUGHLIN2 AND disqualifi cation cases every year. A total of 501 special issuances were R. MATTHEWS3 identifi ed over the 8 year period. The 501 special issuances were 1Aviation Medicine Wing, Centre of Aviation Medicine, RAF sorted into 243 class 1 (49%), 222 class 2 (44%), 29 class 3 (6%) and 2 7 general certifi cation (1%). The most common medical condition Henlow, United Kingdom; Medical Boards, RAF Henlow, Unit- was cardiovascular disease (44%), followed by Diabetes Mellitus ed Kingdom; 3Aviation Medicine, Headquarters Air Command, (26%), ophthalmologic disease (8%), cancer (5%), and others. The RAF High Wycombe, United Kingdom most common diagnoses resulting in permanent disqualifi cation were cardiovascular, psychiatric, and neurologic diseases. DISCUSSION: In the United Kingdom, the Standing Committee for Aircrew This study showed that cardiovascular disease was the most common Medical Standards (SCAMS) advises on medical standards for cause of special issuance and permanent medical disqualifi cation. These aircrew from all 3 services; the Royal Air Force, the Royal Navy fi ndings are compatible with other results regarding medical certifi cation and the British Army. The Deputy Director of Aviation Medicine issuance. We must develop strategies for early diagnosis and to prevent chairs SCAMS and the President of the Medical Board and specialist chronic disease in airmen. Consultant Advisors of all 3 services sit on the committee. Advances in medical knowledge and lessons identifi ed from air accidents can Learning Objectives: lead to changes in policy. In addition, new policy may not survive 1 Discuss the main causes of aeromedical disqualifi cation in Chilean fi rst contact with real clinical cases and early amendments may airmen. be required. The panel will illustrate how these drivers for change have infl uenced the development and evolution of RAF medical [425] AEROSPACE MEDICINE AND LIFE SCIENCES IN THE policy and standards. The new treatments used in type 2 diabetes mellitus, use of permanent pacemakers in recurrent syncope, MEXICAN SPACE AGENCY risk stratifi cation in Brugada syndrome, functional assessment in C. SALICRUP ankylosing spondylitis and accuracy of self-reporting in aircrew will Mexican Space Agency, Mexico City, Mexico be considered.

INTRODUCTION: On July 30th 2010, the Mexican Space Agency (AEM) was created. It was the wish of many Mexicans and [427] FITNESS TO FLY WITH ANTIDIABETIC DRUGS internationals for many years. Since prehispanic times, ancient Mexicans A.C. TIMPERLEY have explored the space and the movement of the cosmos. In 1957, Aviation Medicine Wing, Centre of Aviation Medicine, Mexico was already participating in the construction of rockets, and RAF Henlow, United Kingdom also contributed to the Mercury project with the construction of the Earth station at Guaymas, Sonora. Today, Mexico has the chance to INTRODUCTION: Type 2 diabetes mellitus (T2DM) is participate in the development of space sciences. With the enactment of characterized by a peripheral resistance to the actions of insulin government law that created the AEM, the government initiated a public and accounts for over 80% of all diabetics in North America consultation in order to develop its space policy. Aspects of said policy included Industrial Development, International Relationships, Legal and Europe. The complications of T2DM include infection, fl uid Issues, Science and Technology Research, and Human Resources. A imbalance, metabolic derangement, and vascular disease and are group of Mexican aerospace physicians participated in this consultation, a function of duration and adequacy of control of the disease. and with the help of many international specialists, they aimed to Aircrew with T2DM must have adequate glycaemic control incorporate aerospace medicine and the life sciences in the AEM policy without hypoglycaemia and an acceptable cardiovascular risk guidelines. Mexico needs research and development in profi le before being considered for a return to fl ying duties. The acceptance that the biguanides do not cause hypoglycaemia has telecommunication services, Earth observation satellites, astrophysics, Earth sciences, life sciences, and aerospace medicine. Aerospace allowed a relaxation of the Royal Air Force policy on metformin medicine and other research and developmentIP: 192.168.39.151 opportunities are On: Sun,in 26 aircrew Sep 2021and prompted 17:39:09 a review of the newer antidiabetic drugs incorporated in one of the AEM policies, AnnexCopyright: 7, which also Aerospace Medical(ADDs). AssociationInsulin, sulphonylureas and meglitinides can all cause includes aspects of telemedicine. Specifi c topics discussed inDelivered Annex by hypoglycaemiaIngenta and are incompatible with fl ying. In addition to 7 are an introduction to aerospace medicine, the history of aerospace biguanides, alpha-glucosidase inhibitors, thiazolidinediones, medicine in Mexico, programs, research goals, benefi ts, aerospace glucagon-like peptide-1 analogs and dipeptidyl peptidase IV medicine in Latin-America, history of telemedicine in Mexico, and a list inhibitors are unlikely to cause hypoglycaemia and may be of related research and development opportunities. Mexico already has compatible with a return to restricted or even solo fl ying duties. a residency program in aerospace medicine, sponsored by the Mexican When considering these drugs in aircrew, the short and long- Air Force and the Armed Forces University, but there is an important term side effects as well as possible drug interactions must be need for agreements and arrangements with international institutions considered. Because of the lack of long-term data of some of the and universities in order to develop this specialty in the country, along newer ADDs, their use in aircrew will naturally be cautious and with related undergraduate and graduate programs, research in the life conservative. This presentation will focus on the aeromedical sciences and telemedicine, so as to cooperate with other nations and concerns of T2DM, its pharmacological treatment and the current interchange knowledge and research fi ndings in aerospace science and RAF policy on the management of T2DM in aircrew. technology. Defi nitively, the creation of the AEM and the insertion of programs in aerospace medicine and the life sciences will improve the Learning Objectives: research and development of space related sciences in the region. 1 Well controlled diabetes mellitus may be compatible with solo fl ying. Learning Objectives: 2 The new meglitinides can cause hypoglycaemia. 1 Understand the goals of the newly formed Mexican Space Agency. 3 The new glucagon-like peptide-1 analogs and dipeptidyl peptidase IV inhibitors are unlikely to cause hypoglycaemia.

Wednesday, May 16 4:00 PM Salon AB [428] PACEMAKER INSERTION IN A MILITARY PILOT WITH RECURRENT SYNCOPE D.C. MCLOUGHLIN PANEL: RAF MEDICAL STANDARDS - Centre of Aviation Medicine, Royal Air Force, UK, RAF Henlow, DRIVERS FOR CHANGE United Kingdom

328 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

INTRODUCTION: The aeromedical disposal of cases of and is characterised by endochondral ossifi cation of ligaments syncope in aircrew can be contentious. Decisions depend on around the spine and sacro-iliac joints. In advanced cases, bony a detailed history and appropriate investigations to identify any bridging between vertebrae signifi cantly reduces spinal mobility and underlying cardiac or neurological cause. Cardiac causes of results in a typical stooped posture with a loss of lumbar lordosis syncope can be treated with a pacemaker. However, the effects of and accentuation of the thoracic kyphosis. The spine may become electromagnetic interference on pacemakers have led to concerns osteoporotic and prone to fracture with minimal trauma. The UK relating to their use in the aviation environment. This presentation prevalence of AS is approx. 0.15%. Aside from any extra-articular highlights the case of a 35 year old single seat fast jet pilot with complications of the disorder, AS is of aeromedical signifi cance a history of recurrent episodes of syncope since the age of 7. The because prolonged sitting in cramped cockpits may exacerbate pain, majority of episodes had been provoked by venepuncture. During an while loss of spinal mobility may affect lookout and emergency echocardiogram, a syncopal episode with a 20 second sinus pause egress. AS is incompatible with fl ying ejection seat aircraft as was observed. This pilot meets criteria for the insertion of a permanent weakness of the axial skeleton make it prone to fracture. Other pacemaker. However, this would preclude him from fl ying in the Royal impact forces may also need to be protected against. A recent mid- Air Force and the United States Air Force. Civilian aviation authorities air accident in the UK involved an instructor with AS. The Service in the UK and the US do, in contrast, allow a pilot to fl y in a multi- Inquiry identifi ed a number of medical factors that contributed crew role following the insertion of a pacemaker, as long as there are to the fatal outcome prompting a review of medical policy and no other disqualifying conditions. Should military aircrew be allowed standards. The review emphasised the importance of independent to fl y following the insertion of a pacemaker? objective functional assessment of aircrew and highlighted aspects of the disorder that could not be assessed adequately by functional Learning Objectives: assessment alone. 1 Insertion of a pacemaker may be compatible with a return to fl ying duties in military aircrew. Learning Objectives: 1 The aeromedical signifi cance of ankylosing spondylitis will be [429] BRUGADA PATTERN ECG IN ROYAL AIR FORCE outlined. AIRCREW 2 Limitations of functional assessment of aircrew will be discussed. D.C. MCLOUGHLIN Centre of Aviation Medicine, Royal Air Force, UK, RAF Henlow, [431] HOW RELIABLE IS THE MEDICAL HISTORY WHEN United Kingdom ASSESSING FITNESS OF AIRCREW NOT REGISTERED FOR PRIMARY CARE SERVICES WITH THE AEROMEDICAL INTRODUCTION: Brugada syndrome was fi rst described EXAMINER? OUTCOME OF AN RAF AUDIT in 1992. It is a condition caused by defective cardiac ion channels R. MATTHEWS and it is associated with sudden cardiac death due to polymorphic COS Health - Deputy Director Aviation Medicine, Royal Air ventricular tachycardia and ventricular fi brillation. The only treatment Force, Walters Ash, United Kingdom for patients with Brugada syndrome is placement of an implantable cardiac defi brillator, which may reduce the annual risk of sudden INTRODUCTION: Most medicals conducted by RAF cardiac death to as low as 0.8 to 3%. Aircrew with Brugada syndrome aeromedical examiners are completed with the benefi t of a full are generally considered not fi t to fl y because of the risks associated primary care record as all regular aircrew are registered with military with sudden cardiovascular incapacitation during fl ight. However, 3 primary care providers. However, reserve aircrew on Air Experience types of Brugada have been described, differentiated by the type of Flights or Volunteer Gliding Squadrons and contractors’ aircrew ECG abnormalities. There is marked variation in prognosis between are normally registered with civilian general practitioners - these individuals who are symptomatic with spontaneous type 1 ECG aircrew do not have their full primary care records available at their changes, compared to asymptomatic individuals with type 2 or type military aircrew medical examination. Following an AEF accident 3 ECG changes. This presentation will highlightIP: 192.168.39.151 the case of an RAF On: Sun,in 26 2009, Sep the 2021 fl ying 17:39:09executive introduced a requirement to have a Weapon System Operator with Brugada type 2 ECG pattern and a medical attendance report (MAR) raised for all aircrew not registered positive Ajmaline challenge. Current UK militaryCopyright: policy is that Aerospace this Medical Association Delivered bywith Ingenta military medical centres when attending their annual medical individual should be permanently unfi t to fl y. However, a review of examination. A year after its introduction, the MARs were audited recent published data on Brugada syndrome challenged this policy and to establish whether they identifi ed any conditions that were not suggested that it is possible to risk stratify some individuals to a low known about by the aeromedical examiner when determining fi tness risk group, compatible with fl ying duties. The presentation will discuss for fl ying duties. Seven percent of MARs revealed conditions that the aeromedical decision making process, highlight the role of cardiac were not identifi ed at the time of the medical re-certifi cation; of investigations, and compare the approaches to certifi cation by the UK these, 43% could have affected the medical examiner’s assessment. military, the UK Civil Aviation Authority and US authorities. Most cases related to unauthorised use of medication and temporary Learning Objectives: grounding conditions that had resolved during the course of the year, but also included sleep apnoea, autoimmune hepatitis, migraine 1 Recent published data can challenge policies that aircrew are unfi t and undeclared childhood seizures that were incompatible with to fl y. unrestricted fl ying. The reasons for discrepancies between the MAR 2 It is possible to risk stratify some individuals to a low risk group and the history available at the time of the medical clearance are that is compatible with fl ying. unclear but are likely to include amnesia and deception on the part of the aircrew and inadequate history taking by the aeromedical [430] ANKYLOSING SPONDYLITIS - LIMITATIONS OF examiner. Following the audit, a strengthened self-declaration was FUNCTIONAL ASSESSMENT IN DETERMINING FITNESS FOR introduced for all aircrew not under military primary care and the AIRCREW DUTIES MAR was brought forward to ensure that it was available in time R. MATTHEWS to be taken into account when certifying aircrew fi tness. A re-audit COS Health - Deputy Director Aviation Medicine, Royal Air is planned for early 2012 when the assurance process will be re- Force, Walters Ash, United Kingdom assessed.

INTRODUCTION: Ankylosing spondylitis(AS) is a type of Learning Objectives: chronic arthritis of unknown aetiology primarily affecting the axial 1 Limitations in the quality of health information provided by aircrew skeleton, though peripheral joints and extra-articular organs may also at annual periodic medical examinations will be described. be affected. The disease usually begins in the second or third decade 2 Methods to improve the reliability of health information will be and is most common in males. The disorder causes pain and stiffness discussed.

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 329 ASMA 2012 MEETING ABSTRACTS

Wednesday, May 16 4:00 PM [434] DESIGNING THE FUTURE OF COMBAT CASUALTY Salon D CARE: SOUND APPLICATIONS OF PERFORMANCE ENHANCEMENT AND HUMAN SYSTEMS INTEGRATION STRATEGIES PANEL: WHEN FASTER ISN’T ALWAYS V.E. MARTINDALE BETTER, PART II 711 Human Performance Wing, Wright-Patterson AFB, OH

[432] THE ART OF CARING ACROSS THE CONTINUUM INTRODUCTION: Advances in any fi eld of human endeavor B.J. JOHNSON involve changes in doctrine and traditions to make use of new Air Mobility Command, Scott AFB, IL technologies and capabilities and to meet the challenges of new threats and environments. Such changes must be evidence-based INTRODUCTION: Research, technology and coordinated care with sound reasoning and traceable processes behind them. Human from battlefi eld to stateside have revolutionized care of the wounded Systems Integration (HSI) is a process that considers all of the roles over the past decade, but what have we missed? Looking into the of humans in the system, and brings together stakeholders to defi ne eyes of a patient can reveal more about a patient than a medical both the challenges and the solutions. HSI improves total system monitor. As we continue to advance care across the continuum, it is performance while reducing total ownership cost. In an increasingly important to incorporate psychosocial care to facilitate healing at all resource constrained environment, an unyielding commitment to both stages. Nurses are the eyes and ears of the healthcare system and play mission success and patient care demands just such an approach. a critical role in planning and carrying out holistic care. The speaker This presentation will cover the application of HSI tools to a front- will highlight opportunities to enhance the en route care system by end analysis of Aeromedical Evacuation. Concrete examples of HSI inserting psychosocial healing. applied to casualty care lead to actionable recommendations that joint Aerospace Medicine professionals can advocate for in the Learning Objectives: design of enhanced combat casualty care systems. With the end 1 The audience will understand the importance of incorporating goal clearly in mind, task analysis and task allocation are applied to psychosocial care in the healing process. create models of mission accomplishment that improve workfl ow and 2 The audience will identify opportunities to personalize care in the workload for all stakeholders. Solutions will not be static, purple, or en route evacuation system to promote healing. one-size-fi ts-all, but rather be designed for fl exibility, interoperability, and integration in a joint partnership. The construct of Doctrine,

[433] DELIBERATE REINTEGRATION: BACK TO BASICS Organization, Training, Materiel, Leadership, Personnel, Facilities and Contracting (DOTMLPF-C) provides a joint underpinning for 360 WITH A FOCUS ON THE PATIENT P.H. NELSON degree analysis. Aeromedical professionals are already familiar with such tools as Reason’s model of mishap prevention and human factors 81st Medical Group, Keesler AFB, MS analysis. Applied proactively to system performance, they provide a foundation to consider casualty care, including patient movement, as INTRODUCTION: Patient movement is medical intervention, a capability, and to engineer optimal means of successfully providing no less than the delivery of oxygen, administration of antibiotics, or a that capability. surgical procedure. Applied indiscriminately, patient movement can have unintended negative consequences for patients, both recognized Learning Objectives: and invisible. Therefore, the decision of whether to perform the “procedure” of patient movement and its timing should be considered 1 Describe how the Human Systems Integration (HSI) process can by the aeromedical team to be as important as how movement is enhance joint patient movement assets (including AE/CCATT) as military medical capabilities. actually carried out. Furthermore, like any other procedure, patient movement should be ordered by a credentialed physician, executed 2 Describe how the DOTMLPF-C construct leads to more thorough IP: 192.168.39.151 On: Sun, 26solutions Sep 2021 to capability 17:39:09 shortfalls. by a team of nurses and technicians in consultationCopyright: with physicians, Aerospace Medical Association and supported from, not driven by, administrative functions.Delivered For the by Ingenta commander, movement is not an isolated event but rather another [435] DOCTRINE AND THE FUTURE OF COMBAT patient care event to help facilitate care and reintegration. For our most CASUALTY CARE AND EVACUATION seriously injured casualties, this movement will initially be driven by D.C. RITTER the surgical interventions necessary to preserve life, limb, and function. Air University, Maxwell AFB, AL However, for a majority of our casualties with less severe wounds, disease, and non-battle injuries, parameters such as psychological INTRODUCTION: Joint and Service specifi c doctrine provide well being and mitigation of the sequelae of mTBI should be the templates for how future combat operations will evolve based considered concurrently with the evacuation decision. Through a upon what worked in the past. Because threats and battle space series of clinical cases from the author’s recent experiences from continuously evolve so, too, does the nature of combat which Camp Bastion in support of Operation MOSTARAK in spring of 2010, changes casualty projections, casualty management, and ultimately the author will introduce the concept of “deliberate reintegration” to future doctrine. Revolutions in military affairs, with a current focus patient movement decisions related to combat casualty care. Through on rapid overwhelming force applied with pin point precision and audience participation, the panel will consider whether or not an controlled with information dominance have parallels in casualty individual patient should move, and if so when, by considering both care including aeromedical evacuation. These same principals have surgical and non-surgical parameters in each patient centric movement enabled such innovations as forward surgical resuscitation and critical decision. care aeromedical evacuation to dramatically change how we care for wounded military members. The doctrine for the future is being written Learning Objectives: today based upon lessons learned from a decade of combat operations. 1 Redefi ne patient movement decisions as medical with admin- This doctrine will drive our future organizational alignment, resources, istrative implications, not administrative with medical implica- and training, on both line and medical departments, and will shape tions. our future combat operations. This presentation will take a multiservice 2 Understand that both the decision to move a patient, and its tim- look at how doctrine is written, where it is going, and how this ing, may be as important as how the patient moves. doctrine may affect how we care for and move the combat casualties 3 Consider the role of the clinical team (physicians, nurses and of the future. Ultimately, it argues for joint aerospace medicine technicians) as patient advocates at all points in patient trans- professionals of all disciplines to be mission-focused patient advocates port. and capture the lessons from today. From these lessons we will shape

330 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS the future of combat casualty care and patient movement using sound ophthalmology, orthopaedics, GI, GU, and cardiology which have a principals of aerospace medicine. bearing on fi tness for fl ight

Learning Objectives: [438] THE AGING PILOT AND THEIR EYES 1 Understand how Joint and Service specifi c doctrine impacts F.W. BROWNING combat medical support and evacuation. Flying Physicians Assoc, Orange, GA 2 Understand how doctrine changes in response to revolutions in military affairs, and how this will shape patient evacuation in the INTRODUCTION: The Most Freguently Seen Maladies future. of the Eye that Will Effect the Aging Pilot ability to be medically 3 Consider our role as aerospace medicine professionals in shaping certifi ed. METHODS: Examples of the most frequent maladies of future doctrine that impacts patient care. the aging eye will be discussed and the most likely outcome to their medical certifi cation will be reviewed. RESULTS: To give the non [436] PRISONER OF WAR REPATRIATION STRATEGIES: WHY ophthalmologist a quick overview of what the most likely problems THEY MATTER TODAY the aging pilot will have with their visual requirements. DISCUSSION: T.M. MCNISH The talk will be a brief review for the non-ophthalmologist Aviation Biodynamic Research Corporation, San Antonio, TX Medical Examiner of the ocular problems most likely to be encountered by the aging pilot.

INTRODUCTION: Well-planned Prisoner of War repatriation Learning Objectives: strategies emphasize close relationships between medical departments, line, and civilian agencies for successful reintegration of former 1 The audience will be presented with the most commonly seen POWs into society. Key elements in the initial phase of successful ocular maladies that can affect to aging pilot; the likely outcome of repatriation include immediate access to appropriate medical care, these maladies will be discussed. transportation to a decompression site where basic needs are met, rapid re-connection to military structure (including rank appropriate [439] PROSTATE SEED IMPLANTS FOR CURE: LONG-TERM military escorts, exposure to familiar faces, and a return to uniform), RESULTS AND IMPLICATIONS FOR THE AVIATOR and supportive debriefi ngs to help the former prisoner process past D.W. JOHNSON events. Conducted in a positive and reinforcing environment, with an 1Florida Radiation Oncology Group, Jacksonville, FL; 2Radiation expectation of a return to a new normalcy, this strategy successfully Oncology, Baptist Medical Center, Jacksonville, FL enabled reintegration of repatriated POWs after the Vietnam war. These lessons were forgotten for a generation, but were relearned to INTRODUCTION: Prostate cancer is discovered in 192,000 successfully repatriate POWs after Operation DESERT STORM. These American males annually, and causes >27,000 deaths. Indeed, prostate principals have real implications for successful reintegration of combat cancer represents 29% of all cancers diagnosed, and 11% of all casualties today. This brief will review common reintegration themes cancer deaths in men. The lifetime risk of developing prostate cancer fi rst from the perspective of a POW, then as a repatriated POW, and is 1 in 6. With earlier detection and improved treatments, the 5-year later as a director of care for subsequent repatriated Prisoners. As a survival has improved from 69 % in 1976 to 100% in 2006. Now, community of aerospace medicine practitioners from all disciplines, more emphasis on quality of life issues and long-term survival have we have a responsibility to continually refi ne these back-to-basics taken top priority for active individuals, including pilots. METHODS: lessons and apply them whenever appropriate to current and future Current controversies in screening for prostate cancer are reviewed, casualties. As we design advanced movement capabilities or make as are as modern treatment options, toxicities by treatment type, risk patient evacuation decisions, we must all be patient care advocates, factors for treatment failure, and indications for seed implant therapy. whether we consider ourselves operational, aerospace, or preventive Long-term survival and morbidity rates for curative surgical and medicine specialists or human factors experts. As such, we should radiation treatment modalities are compared, and the increasing role advocate to expand our defi nition of success for joint combat casualty of radioactive prostate seed implantation is discussed in detail. Our care to include not only life or limb saved,IP: but 192.168.39.151 also success in holistic On: Sun,Florida 26 Sep Radiation 2021 Oncology 17:39:09 Group (FROG) has maintained a database reintegration. Finally, we must then ensure thatCopyright: past lessons fromAerospace POW Medicalof over 4000 Association consecutive seed implant patients since 1997. Subsets of repatriation are not forgotten in the future. Delivered bypatients Ingenta with long-term follow-up were analyzed to determine disease- free survival and toxicity. RESULTS: At 10 years, long-term control Learning Objectives: rates of 96% were noted in low-risk patients, and 85% in high-risk 1 Consider the implications of the lessons from POW repatriation on patients in our series, with very limited risk of signifi cant toxicity: <1% the reintegration of combat casualties. urinary incontinence, <5% urinary bleeding, and 10% intermittent 2 Consider the implications of the lessons from POW repatriation on rectal bleeding. These results compare favorably to published radical the aeromedical evacuation of casualties. prostatectomy series. DISCUSSION: Conservative seed implantation techniques now afford control and cure rates exceeding 90% at 10- 15 years. Seed implant therapy for early stage patients provides an Thursday, May 17 10:00 AM excellent way to get the active patient “back in the saddle” quickly, an Ballroom A idea especially appealing to the active pilot. Learning Objectives: PANEL: FPA PANEL ON CLINICAL MEDICINE 1 Know the scope of the prostate cancer problem in the United UPDATES RELEVANT TO AVIATORS PART I States. 2 Understand the technique of, and role for, radioactive seed [437] FPA PANEL ON CLINICAL MEDICINE UPDATES implantation in prostate cancer patients. RELEVANT TO AVIATORS 3 Know the long-term outcome results for patients undergoing radioactive seed implantation (both disease-free survival and F.R. TORMES complications). Orthopaedic Surgery, Naval Hospital, Pensacola, FL

This panel will address clinical topics with applicability [440] UPDATE ON NEW SURGICAL MANAGEMENT OP- to civil and military aviators. Panel members are all FPA (Flying TIONS IN CERVICAL DISK DISEASE IN MILITARY AND CIVIL Physicians Assoc) members in clinical practice and active pilots. AVIATORS Three of 6 speakers are AMEs. Focus of panel is to discuss current F.R. TORMES trends and update latest advances on selected topics in the fi elds of Orthopaedic Surgery, Naval Hospital, Pensacola, FL

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 331 ASMA 2012 MEETING ABSTRACTS

INTRODUCTION: Neck pain due to degenerative disk disease reviewed using the Human Factors Analysis and Classifi cation System in aviators, particularly when accompanied by radicular symptoms, (HFACS). DISCUSSION: During FY11 there were 9 Class A fl ight can degrade performance. When imaging studies demonstrate a clear mishaps in the US Navy (0.96 per 100,000 fl ight hours) and 7 Class A correlation between symptoms and a pain generating lesions, conservative fl ight mishaps in the US Marine Corps (2.47 per 100,000 fl ight hours). management is typically initiated with NSAIDs, PT and injections. If that A review of Class A fl ight mishaps over the past 11 years demonstrated treatment fails, surgical management is advised. Traditional treatment that human factors were predominant with crew resource management has been fusion, but recently, total disk replacement has been available (CRM) failures the most common HFACS Precondition identifi ed. in selected centers. METHODS: Not applicable to this presentation. Fatigue was the most common adverse physiologic Precondition and RESULTS: Review the results of several recent studies comparing fusion was associated with a different distribution of Acts compared to non versus disk replacement in the cervical spine. DISCUSSION: Painless fatigue-related mishaps. range of neck motion is highly desirable in civil aviators and critical in military aviation. Important factors to consider in tactical military aviators Learning Objectives: who undego disk replacement is the potential risk of G force induced 1 Review the overall trend in US Navy and Marine Corps fl ight damage to the implant, particularly in the case of an ejection. mishaps and the most common human factors identifi ed as causal factors. Learning Objectives: 1 Explain the criteria for selection of the newer disk replacement op- [444] U.S. AIR FORCE AVIATION SAFETY: FY 2011 YEAR IN tion in the cervical spine versus traditional surgical fusion REVIEW 2 Explain the aeromedical consequences of limitation of motion in A.B. BERG, T. STRONGIN, N. WEST, J. PUGLIESE AND R. the cervical spine as a result of fusion versus disk replacement in FARLEY the cervical spine Human Factors Division, USAF Safety Center, Kirtland AFB, NM

Thursday, May 17 10:00 AM INTRODUCTION: Discuss fi scal year (FY) 2011 statistics and Ballroom B analysis for USAF Class A Aviation mishaps including classifi cation with DoD Human Factors Analysis and Classifi cation System PANEL: AVIATION SAFETY: 2011 YEAR IN (DoDHFACS). METHODS: FY2011 data was obtained from the USAF Safety Center database for Class A Aviation mishaps and reviewed REVIEW for human factors as determined by the Safety Investigation Boards (SIB). The human factors present were categorized for the present year [441] AVIATION SAFETY: 2011 YEAR IN REVIEW and the preceding 6 years. RESULTS: The US Air Force experienced T. GARDNER 15 Class A rate producing Aviation mishaps during FY11 (a rate of Naval Safety Center, Norfolk, VA 0.77 per 100,000 fl ight hours) with eight destroyed aircraft and two fatalities. A review of Class A Aviation mishaps over the past 6 years Representatives from the military and civil aviation will present demonstrated that on average 73% are attributed to human factors. The respective information on aviation safety and adverse aviation events top factors identifi ed were cognitive factors, judgment and decision during 2011. Discussion will center on mishap/accident analysis of making errors, and skill based errors. DISCUSSION: Overall, the both mechanical and human causal factors. Hazardous trends will be number and rate of Class A Aviation mishaps increased slightly from further discussed and compared with previous years. Updates will be FY10, making FY11 the second best level in USAF history. However presented on the progress of ongoing intervention strategies designed the majority of human factors identifi ed as contributing to these to help mitigate and eliminate identifi ed hazards. mishaps has remained largely consistent in proportion and type. Learning Objectives: [442] U.S. CIVIL AVIATION IN 2011IP: 192.168.39.151 On: Sun, 26 Sep 2021 17:39:09 C.A. DEJOHN, N.L. WEBSTER AND J.G. LARCHER 1 The audience will know the overall trend in USAF mishaps and Copyright: Aerospace Medicalhuman Association factors contributing to current year mishaps in comparison Medical Research Divsion, FAA Civil Aerospace MedicalDelivered by Ingenta Institute, Oklahoma City, OK with data from previous years.

INTRODUCTION: The Civil Aerospace Medical Institute’s, Medical Research Team supports Federal Aviation Administration (FAA) Thursday, May 17 10:00 AM safety programs. The Team provides aviation safety research fi ndings Ballroom C to the FAA, National Transportation Safety Board, industry, other government agencies, academia, and the media. In addition, the team PANEL: NIGHT VISION PROBLEMS AND works with other safety elements within the FAA such as the Offi ce of Accident Investigation, Offi ce of System Safety, and the Offi ce of SOLUTIONS IN AVIATION Aviation Research to promote safe and effi cient aviation operations worldwide. Safety statistics for 2011 will be presented and compared [445] NIGHT VISION PROBLEMS AND SOLUTIONS IN with previous years as well as a review of an aircraft accident of AVIATION signifi cance to aerospace medicine. S. HADLEY Ophthalmology, USAF School of Aerospace Medicine, Learning Objectives: Wright-Patterson AFB, OH 1 FAA performance goals and safety performance measures will be discussed. Modern military aviation operations are frequently performed 2 Chronological trands in aircraft accident rates for different types of under conditions of reduced illumination. This mandates that the operations will be examined. human visual system rely more heavily on rod based input for visual function and results in reduced visual acuity, contrast sensitivity and [443] NAVAL AVIATION SAFETY: FY 2011 YEAR IN REVIEW color perception. Additionally, pupillary dilation increases optical L. MANDEL, T. GARDNER, L. FINLAYSON AND A. ANGLERO aberrations due to the aspheric nature of the peripheral cornea and Naval Safety Center, Norfolk, VA lens, which further degrades the resolving capability of the human eye. Optical devices have been developed to aid visual function at night INTRODUCTION: All Class A fl ight mishaps in US Navy through amplifi cation of ambient illumination. These offer a powerful and Marine Corps fl eet aircraft during the interval FY00-FY11 were warfi ghting advantage; however, they have limitations including

332 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS reduced fi eld of view, reduced depth perception and typically provide INTRODUCTION: Aviation, military and law enforcement only a monochromatic image. Further, the use of night vision aids can operations are often conducted at night or under conditions of limited affect normal vision function after they have been removed. This panel visibility. Night vision goggles (NVGs) amplify surrounding light will discuss quality of vision limitations at night as it pertains to the making it possible to see in the dark and function at night. But despite aviation environment and will describe some of the solutions that have their utility, NVGs can limit the extent and quality of vision compared been devised to address these limitations. to standard conditions. NVGs reduce the visual fi eld from 200 to 40 degrees, limit the color spectrum to a single green, and present [446] QUALITY OF VISION DURING DARKNESS imagery decreased in brightness (luminance) and contrast. Because H. LESTER1 AND B. LESTER2 NVG display luminance varies directly with outside lighting, a dark, 1Federal Aviation Administration, Jamaica, NY; 2Department of moonless night results in a dim NVG image. It is critical that NVG Transportation, Washington, DC users have adequate vision to meet the demands of NVGs, particularly in conditions such as early cataract, keratoconus, and optical aberrations from refractive surgery, which test normal on standard INTRODUCTION: Night vision challenges haunt the aviator as tests (high contrast VA) but show impairment at low luminance and/or well as drivers and others who must navigate after sunset, and pose safety low contrast. Hence vision testing through NVGs is critical to ensure risks. We lose contrast discrimination at twilight. The atmosphere greys adequate performance, but direct measures through NVGs require and we experience color spectral shifts. With dark our pupils dilate, low intensity, specially calibrated stimuli not available for clinical causing a refractive shift towards myopia. Our acuity and visual fi elds use. We describe a rapid, expedient approach to assess NVG user change as we change from photopic to mesopic and scotopic vision, and performance in a clinical setting. A calibrated dark green fi lter the rods become more primary than the cones. Optical and physiological placed directly in front of visual acuity (VA) and contrast sensitivity changes interplay in the eye, and the brain puts the picture together as (CS) letter charts accurately simulates the brightness and color of best it can. Even at peak performance, at night we are still limited by a an NVG display. Hence high contrast VA and low contrast CS can central blind spot, and the physiological time required to dark adapt. Bad be rapidly assessed in a clinical setting which simulates the visual weather stresses our adaptations, so do unexpected glare sources from challenge of NVGs. We describe theoretical basis, specifi city and lasers and other bright lights. Refractive devices and interfaces can impact sensitivity of this approach for quantifying NVG user performance night vision. A pathological eye, with cataract or rod disease, or massive in a clinical setting. A computer-based automated NVG test will retinal wipeout, is vulnerable at night, and will not function as well. also will be described. Hypoxia degrades function, as does brain disease. Aviators can experience visual illusions including false perception. DISCUSSION: Myopic Learning Objectives: shift, loss of depth perception, central blind spot, contrast and color vision changes occur at night. Our rods require time to adapt. A better 1 The basic operation of night vision goggles (NVGs) is described. 2 The benefi ts and limitations of NVGs are described. understanding of potential problems and available adaptations can help the aviator and other types of navigators to maximize their safety at night. 3 Clinical simulation of NVG display luminance and display color are described. Learning Objectives: 1 Identify critical quality of vision issues at night [449] FILTER EFFECTS ON NIGHT VISION GOGGLE ACUITY 2 Understand physiological correlates AND PRESERVATION OF DARK ADAPTATION 3 Understand possible adaptations to night vision challenges S.T. WRIGHT1, R. THOMAS2, P. CLARK3 AND J.M. GOOCH1 [447] EUROPEAN USE OF NIGHT VISION DEVICES 1Ophthalmology, USAF School of Aerospace Medicine, C.H. STERN AND G. KLUGE Wright-Patterson AFB, OH; 2Keesler Ophthalmology, DLR, Cologne, Germany Keesler AFB, MS; 3Air Force Research Lab, San Antonio, TX

INTRODUCTION: International TraffiIP: c in192.168.39.151 Arm Regulation controls On: Sun, 26 SepINTRODUCTION: 2021 17:39:09 Military aviation missions are often the export of defence related articles out of the U.S.A...Copyright: Night Vision Aerospace Medicalconducted Association at night under low light conditions. Night vision goggles Goggles fall under the ITAR. NVGs import to Europe was limitedDelivered to by(NVGs) Ingenta are often used to amplify ambient illumination and aid in special permission. Therefore the use of NVGs was mainly reserved to human visual performance. However, the high luminance output of police and coast guard. METHODS: As the civilian fl ying with NVG is NVGs can cause a loss of dark adaptation for the user, which could the exemption, there are no European standards or requirements for the impact visual performance when the goggles are removed. Filters training and use of the NVGs. In the meantime most of the police forces of have been developed to help mitigate this problem by reducing the the European countries use NVGs for their night time fl ying. Besides NVG overall luminance and modulating the spectral transmission of the they also use the FLIR (Forward Looking Infrared) and obstacle warning NVG output. METHODS: This repeated measures study utilized 15 system HELLAS (Helicopter Laser Radar). RESULTS: Nevertheless there subjects and evaluated three aspects of visual performance associated had been some smaller European Air Rescue Services having NVGs in use with NVG use at light levels simulating quarter moon and starlight: for several years now. The REGA of Switzerland has now an experience 1) Visual acuity through the goggles was measured with and without of about 20 years of NVG use, there are also small companies in Norway, fi lters using a 25% contrast ETDRS chart. 2) Prior to goggle use, and the Netherlands and Luxembourg that are allowed to use NVGs. Many after dark adapting for 45 minutes, baseline retinal sensitivity was Air Rescue Services try to get the permission to use NVGs for night fl ying established using a Scotopic Sensitivity Tester. Subjects were exposed operations. DISCUSSION: The Federal Police in Germany has a long to NVG output for two minutes with and without fi lters and the time tradition of NVG use and NVG training. It offers training courses for police required to return to baseline sensitivity levels was measured. 3) Prior forces in Europe. The three week training course consists of 36 hours to goggle use, and after dark adapting for 45 minutes, low light visual theory and 15 fl ying hours. It would be desirable if EASA decides on some acuity was measured using a 25% contrast ETDRS chart overlaid with requirements in NVG training and certifi cation. a 3.3 log neutral density fi lter. Subjects were exposed to NVG output for two minutes with and without fi lters and the time required to Learning Objectives: return to baseline acuity levels was measured. RESULTS: Under both 1 The civilian use of Night Vision Goggles in Europe is described. light levels there was a statistically signifi cant loss of NVG acuity of about one half of one line while using the fi lters. Use of the fi lters reduced the time required to return to baseline retinal sensitivity [448] CLINICAL ASSESSMENT OF NVG USER levels by 50% under the low light level and 30% under the high PERFORMANCE: NVG SIMULATOR light level, however, this fi nding was only signifi cant for the former. J. RABIN Low light acuity fi ndings were equivocal. DISCUSSION: Filters 1USAFSAM, DAYTON, OH; 2UIWRSO, SAN ANTONIO, TX worn in conjunction with NVG’s help to preserve the dark adapted

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 333 ASMA 2012 MEETING ABSTRACTS state of the retina, although this was only signfi cant at starlight medicine. Sometime the data presented are incorrect, but brief illumination. However, they also result in a small loss of visual acuity aeromedical scenes of conditions and events serve as an excellent while viewing through the goggles. These factors, as well as mission basis for medical education and thoughtful scientifi c discussion. requirements, should be considered prior to implementing use of METHODS: Over 350 commercial movies with aviation and space NVG fi lters. fl ight themes or scenes that were released from 1927 to the present were reviewed for aeromedical factors and gaps in the current Learning Objectives: aerospace medicine knowledge base. Factors identifi ed included 1 The effects of NVG fi lters on visual acuity through the goggles and the effect of prolonged duty hours, fatigue, circadian shifting, and preservation of the dark adapted state of the retina after goggle use fatigue countermeasures on crew performance and fl ight safety. Other are described. gaps identifi ed included medical selection and medical support of commercial spacefl ight passengers, crew medical disqualifi cation for [450] ALTERATION OF COLOR VISION AFTER NVG WEAR fl ight, and the aeromedical responses to accidents and loss of life. J.K. HOVIS Representative fi lm clips from these medical areas were edited for School of Optometry, University of Waterloo, Waterloo, ON, presentation and discussion by the panel members and attendees. In Canada addition to these knowledge gaps, each of the four panelists selected short aeromedical scenes from a single movie that they consider most INTRODUCTION: One of the consequences of wearing valuable to the audience. CONCLUSIONS: Aerospace medicine night vision goggles (NVGs) is that the green display may alter one’s factors are often depicted in movies, and many times the scenes are color perception after removal due to chromatic adaptation effects. scientifi cally incorrect. However, many of the scenes are well done Surveys of military pilots report that between 1.6% and 65% of the and serve as a sound basis for fi lling gaps in aeromedical knowledge respondents experienced altered color vision after NVG wear. For the and provide a basis for discussion in aviation and medical forums. majority of these pilots, the aftereffect lasted less than 10 minutes, although 18% reported that the effect lasted more than 30 minutes. The most common alteration was a brownish afterimage. METHODS: Thursday, May 17 10:00 AM Given the large disparity in the surveys, we asked 10 subjects to wear Salon AB goggles that simulated a NVG color, brightness and visual fi eld for 30 continuous minutes to determine the extent and duration of any SLIDE: EFFECTS OF ENVIRONMENT & color after effects. After the goggles were removed, the locations of their spectral unique blue and yellow were measured periodically TRAVEL ON AIRCREW for 24 hrs. In the second experiment, 10 subjects performed the Lanthony Desaturated D15 test after wearing goggles for 30 minutes. RESULTS: As expected, the unique blue shifted to a longer wavelength 10:00 am immediately after removing the goggles. Their unique blue settings [452] SAFETY PROFILE OF TRAVEL VACCINES WITH SPECIAL returned to baseline by 40 min post-wear. The unique yellow location RELEVANCE TO AIRLINE CREW was unaffected by the color after effect. In the second experiment, R. POMBAL there was slight increase in the time required to complete the Lanthony UCS (TAP Portugal Group), Lisbon Portugal Desaturated D15 test for the fi rst 6 minutes post- wear, but a decrease in the frequency of errors relative to baseline. Only one subject INTRODUCTION: Pilots and cabin crew are professional reported perceiving a purplish after image in either experiment. travellers and as such can be exposed to infectious hazards that are DISCUSSION: The time course of the color after effects in this typical of short trips and layovers to the most diverse destinations. experiment resembled short-term adaptation effects and were relatively Vaccination is one essential tool for their protection within the scope mild. Nevertheless, long-term and contingent form-color after effects of occupational health. The risk:benefi t analysis, expected frequency could also occur and these will be reviewed in the context of NVG IP: 192.168.39.151 On: Sun,and 26 timingSep 2021of vaccine 17:39:09 adverse reactions is especially relevant to the wear. aviation medical practitioner. METHODS: A review was conducted Copyright: Aerospace Medicalof national Association and international guidelines, European Medicines Agency Learning Objectives: Delivered by SummariesIngenta of Product Characteristics, and review papers on the safety 1 To understand the characteristics of chromatic adaptation after profi le of travel vaccines. Vaccines were divided in three groups: removing NVGs Routine, Required, and Recommended (case-by-case). RESULTS: 2 To understand how chromatic adaptation can affect color Universal precautions, false contraindications, and multivaccination perception and color discrimination. issues are discussed. An overview is given of the pattern and expected timing of adverse reactions to vaccines commonly used in crew, including the tetanus, diphtheria, hepatitis A and B, yellow Thursday, May 17 10:00 AM fever, meningitis, infl uenza, polio (booster), and typhoid vaccines. Ballroom D DISCUSSION: Travel vaccines given routinely to airline crew seem to have a favourable risk profi le. Serious adverse events are very rare PANEL: AEROSPACE MEDICAL FACTORS IN and tend to occur either immediately after inoculation or in specifi c clinical contexts. Local and other minor reactions are frequent and COMMERCIAL MOVIES early, and could be of relevance for the timing of fl ight operations.

[451] AEROSPACE MEDICAL FACTORS IN COMMERCIAL Learning Objectives: MOVIES 1 Multivaccination safety, universal precautions, false contraindica- 1 4 2 R. JENNINGS , A.J. PARMET , S.R. MOHLER AND J.A. tions for commonly used travel vaccines. CALDWELL3 2 Safety profi le of travel vaccines as relevant to fl ight operations. 1UTMB, Galveston, TX; 2Wright State University, Dayton, OH; 3 4 Fatigue Science, Honolulu, HI; Occupational Medicine, Kan- 10:15 am sas City, MO [453] A PROPOSED FLUID MAINTENANCE SCHEDULE FOR INTRODUCTION: The aerospace environment, aircrew medical ROTARY WING AVIATION CREWS IN HOT WEATHER conditions, and fl ight surgeon medical support of aviators is often ENVIRONMENTS depicted in commercial entertainment movies. For the public, this is R.A. SCHEURING often the only exposure that they have to the specialty of aerospace HHC 1-171st GSAB, COS Taji, Iraq

334 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

INTRODUCTION: The US Army has well-established tables for would persist for some time and manifest as reduced arterial oxygen oral fl uid maintenance in soldiers based on ambient wet-bulb globe tension even after ‘descent’ from altitude. Data were analysed with a temperatures (WBGT) and physical exertion. However, guidance for Student’s paired ‘t’ test. RESULTS: In Study- I, arterial oxygen tension aviators and rated crewmembers operating in the aviation environment increased from its value in normobaria of 96 6 8 mmHg to 175 6 is lacking and may be a signifi cant aeromedical issue. Consequently, 35 mmHg in hypobaria, The increase was statistically signifi cant (t = aircrew’s operating in hot weather environments (> 42° Celsius) are at -6.237; p = 0.0002) and was attributed to a higher (than required to potential risk for dehydration and subsequent complications from heat maintain strict normobaria) concentration of oxygen delivered from injury and electrolyte disturbances. The use of nutritional supplements the regulator. Changes in arterial CO2 tension, pH, serum electrolytes in aircrew’s further complicates the clinical presentation. This pilot (Na+, K+, Cl-, HCO3-) were not signifi cant, statistically. In Study- II, no study aimed to develop in-fl ight fl uid maintenance schedule for rated signifi cant variation was observed in the any of the above mentioned aircrew’s operating in hot weather environments. METHODS: Data variables before and after the exposure to non hypoxic hypobaria. (from a case study) was collected over 100 hours of combat aviation DISCUSSION: It could be concluded that exposure of human subjects missions in Iraq from July-Oct, 2011. Data consisted of post-fl ight to non hypoxic hypobaria for a few hours does not cause any variation urine collection for volume analysis, measurement of urine specifi c in ABG, pH, serum electrolytes and PRA gravity (SG), urinary protein and blood, in-fl ight fl uid intake, and outside air temperature (OAT) at mission start. RESULTS: Post-fl ight Learning Objectives: data was stratifi ed based on OAT prior to take off. Between OAT’s 1 To learn the effect of hypobaria on arterial blood gases, pH, serum of 42°-48° Celsius, oral intake of 500-800ml water or commercial electrolytes & plasma renin activity in human subjects electrolyte solution per hour maintained urine output (UO) 30-40ml/ kg/hr and SG <1.030 . For OAT’s >49° Celsius, oral intake of 1000ml water alternated with 591ml electrolyte solution resulted in UO 30- 10:45 am 40ml/kg/hr and SG <1.030. DISCUSSION: Based on this feasibility [455] CLOSE ENCOUNTERS OF THE OZONE KIND study, it is suggested that aircrew’s fl ying in hot weather for greater R.A. COCKS than 1 hour should alternate oral intake with 800-1000ml of water A&E Medicine, Chinese University of Hong Kong, Hong Kong and/or 591ml of commercial electrolyte solution per hour to maintain intravascular volume status and reduce risk for dehydration and INTRODUCTION: This study describes the investigation of its complications. Factors such as use of the Microclimate Cooling 5 separate episodes of probable ozone exposure occurring over a System (MCS) may mitigate fl uid losses from sweat and insensible loss. 13 month period in the freighter operations of a Hong Kong-based Nutritional supplements promoting increased lean body mass is highly international airline. Specifi c risk conditions and characteristic discouraged due to high caffeine content reducing renal blood fl ow symptomatology are described. METHODS: Review of Air Safety and diuretic agents which promote fl uid loss. Reports, clinical records and personal accounts of the 15 pilots involved in the 5 incidents, supplemented by meteorological Learning Objectives: reviews of prevailing ozone activity along the relevant fl ight paths. 1 The observer will be familiarized with current US Army fl uid RESULTS: : 5 incidents occurred at altitudes ranging from Flight maintenance guidelines related to exertion levels in hot weather Level 38-43 in large, lightly-loaded freighter aircraft, 4 in March- environments April 2010 and one in April 2011. All 15 pilots involved in these incidents provided unprompted reports of mild dyspnea and the 2 Participants will be engaged in discussions regarding developing guidelines for rated aircrew members operating in hot weather urge to cough on deep inspiration. Symptoms were relieved by environments descending to a lower altitude and no pilot suffered long-term 3 Case reports will be presented to highlight the clinical issues sequelae. DISCUSSION: All exposed pilots had characteristic resulting from inadequate fl uid intake and supplement use during symptoms of ozone exposure. A combination of high-altitude aviation missions fl ight in lightly-loaded freighter aircraft not fi tted ozone converters provided the conditions for exposure. Peak months for the risk of such incidents are March-May each year. 10:30 am IP: 192.168.39.151 On: Sun, 26 Sep 2021 17:39:09 [454] EFFECT OF HYPEROXIC HYPOBARIACopyright: ON Aerospace MedicalLearning Objectives:Association Delivered by Ingenta ARTERIAL BLOOD GASES(ABG), PH, SERUM ELECTROLYTES 1 To review the meteorological factors affecting ozone changes in the & PLASMA RENIN ACTIVITY(PRA)SIMULATING COCKPIT atmosphere, including seasonal variations CONDITIONS IN AN IAF AIRCRAFT DURING LONG 2 To review the symptoms and health effects of ozone exposure DURATION FLYING 3 To discuss the relevance of ozone to aircrew health in commercial M.S. MARWAHA aircraft operations Station Medicare Centre, Indian Air Force, Lucknow, India 11:00 am INTRODUCTION: Arterial desaturation and disturbances of [456] A BASELINE SURVEY ON THE NUMBER OF BACTERIAL body water volume regulation in animal models are reported, in peer COLONY AND DENSITY OF COCKROACH IN AIRCRAFT reviewed physiological literature, during exposure to non-hypoxic CABIN hypobaria. Present study examined changes in ABG, pH, serum B. QIU1, G. BAI1, Y. ZHOU1, C. LIANG2, X. FENG2, W. PENG2 electrolytes & PRA during 5h exposure of human volunteers to non- 1 hypoxic hypobaria during their exposure to 15,000’, simulating cockpit AND S. LI 1 conditions in an IAF aircraft during long duration fl ying. METHODS: Civil Aviation Medical Institute, Civil Aviation Medical Center, The study was conducted in two parts and comprised of exposure of CAAC, Beijng, China; 2China Southern Airlines, Guangzhou, 15 and 13 human volunteers, respectively in Study- I and Study- II, China to hypobaria. During the above exposures, subjects breathed ‘air-ox’ mixture to prevent hypoxia. In both the studies, initial measurement INTRODUCTION: By means of fi eld research, to study the was made at ground level (3,159’ AMSL; 0.92 ATA) while breathing distribution of bacterial colony number and density of cockroaches in ambient air. The subsequent (second) measurement was made, at cabin. METHODS: Select 10 different categories of aircrafts. Monitor the end of 5 hour exposure to hyperoxic hypobaria, from the blood bacterial colony and density of cockroaches in front row, middle samples drawn at 15,000’ when the subjects were still breathing row and back row, as well as catering area and toilet in accordance ‘air-ox’ mixture in the Study- I. On the other hand, in Study- II, the with the relevant national standards. Chemical stimulating method second measurement was made from the blood samples drawn after and glue catching method were used during the survey. RESULTS: ‘decent’ of subjects to ground level and while breathing ambient air. There were most bacterial colonies in catering area, mean value is It was expected that a diffusion defect and subsequent desaturation 21 colonies / dish, followed by the toilet, which has a mean value of

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 335 ASMA 2012 MEETING ABSTRACTS

18 colonies / dish. The bacterial colony number in catering area is greatly every year. The total fi tness rate is up to 78.51% in 2010, from signifi cantly different from that in the middle row. There’s no signifi cant 66.67% of the fi rst year. But the fi tness rate for the fi rst time applicants difference in bacterial colony among the front, middle and back row. dropped to 61.02% in 2010, which was up to 66.67% in 2008. The After cleaning the cabin of the aircraft, the density of cockroaches drop of fi tness rate might due to the huge variation in the loss rate, monitored by glue catching method was 0.11 per box, and the density which was increased up to 22.22% in 2010 from 8.33% in 2008. The of cockroaches monitored bychemical stimulating method was 0, most important disease in the denials of medical certifi cation is coronary there’s no signifi cant difference in the cockroach density by two artery disease (47.50), followed by cervical aortic atheromatous plaque monitoring methods. (27.50%) and hypertention (10.00%). The fl ight experiences analysis showed that the average fl ight time is 587.81 hours per pilot per year, Learning Objectives: which accumulated to 64659 hours for all three years. And there were 1 The audience will learn the environmental health technology. no fl ight safety issues or any abnormal fl ight records for all of the certifi cated over 60-age-old pilots. DISCUSSION: Since the International Civil Aviation Organization (ICAO) amended the upper age limit for 11:15 am commercial pilots in 2006, there will be an increase in the number of [457] EFFECT OF PASSIVE AND ACTIVE COOLING ON senior pilots worldwide. With cautious medical assessment, fi tness of THERMAL STRAIN DURING A SIMULATED DESERT PATROL pilots at the age from 60-65 and its fl ight safety was proved in short term U. CIUHA4,3, M.J. GRONKVIST1, I. MEKJAVIC2 AND O. EIKEN1 in China. It’s no doubt that there are huge economic effects in this pilots 1Environmental Physiology, Royal Institute of Technology, Stock- group, which will be a huge attraction for civil aviation industries and holm, Sweden; 2Department of Automation, Biocybernetics pilots themselves. As the medicine technology and the civil aviation and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia; 3Inter- industries develop dramatically, Aeromedical decision makers must keep working on the improvement of medical standards for senior pilots, national Postgraduate School, Jozef Stefan Institute, Ljubljana, 4 which involved the relationship between age, health, and safe piloting Slovenia; Biomed d.o.o., Ljubljana, Slovenia in the modern fl ight environment.

INTRODUCTION: The present study evaluated the effi ciency Learning Objectives: of two types of cooling strategies for soldiers wearing body armor (BA) 1 Senior pilots medical certifi cate during patrol in simulated desert conditions. METHODS: Ten male subjects participated in three conditions, during which they conducted two 35-min walk (0.9m*s-1)/20-min rest cycles in a climatic chamber 10:15 am maintained at 45°C (113°F) and 22% relative humidity. The conditions [459] ARE PILOTS HEALTHIER THAN THE GENERAL were: 1) full protection (FP): BA and complete uniform, 2) BA with POPULATION? A STUDY OF MORBIDITY IN reduced clothing and active cooling by a ventilated vest (AC), and 3) NEW ZEALAND PILOTS BA with reduced clothing with passive cooling in the pauses (PC), A.J. SYKES1, S. ALDINGTON1,2, D.M. POWELL1,2, P. LARSEN1 i.e. removal of BA, water spraying of dry body surfaces and fanning AND R.F. GRIFFITHS1 the body. RESULTS: All subjects completed the AC and PC trials, and 1 only 7 the FP trial. Core temperature did not stabilize in any of the Department of Occupational and Aviation Medicine, Uni- 2 conditions, and the largest increases were observed in the FP and AC versity of Otago, Auckland, New Zealand; Air New Zealand trials. DISCUSSION: Ballistic body protective armor enhances the Medical Unit, Auckland, New Zealand risk of heat exhaustion whilst performing even low-intensity exercise in a hot climate. Heat loss can be increased by reducing the clothing INTRODUCTION: There is a widely held belief that airline thermal resistance and enhancing evaporative heat loss. Results of the pilots are healthier than the general population. There are a number present study demonstrate that removing the body armor during the of reasons why this should be the case, however there is very little rest periods and spraying the chest and thighs with water combined evidence to support this belief as fact This study describes the health with fanning of the exposed areas (PC condition) most effectively of the pilot population of Air New Zealand, and compares it with the achieved the latter. IP: 192.168.39.151 On: Sun,health 26 Sep data 2021of the New 17:39:09 Zealand general population. METHODS: Pilots Copyright: Aerospace Medicalwho conducted Association their CAA medical certifi cate renewal at the Air New Learning Objectives: Delivered by ZealandIngenta Medical Unit between 1st November 2009 to 31st October 1 Heat strain while wearing body armor in desert conditions 2010 were included in this study. Pilots who were due for licence renewal during this period but who were disqualifi ed from fl ying due medical reasons were also included. The medical questionnaire was Thursday, May 17 10:00 AM entered into a database as well as BMI, blood pressure, lipid profi le and Salon D blood glucose level. The proportion of pilots with a given condition was compared to the proportion of the New Zealand general population with the same condition, using a Chi-squared test. RESULTS: The airline pilots SLIDE: TOPICS IN CLINICAL MEDICINE I in the study have signifi cantly lower rates of asthma, ischaemic heart disease, depression, type 2 diabetes, anxiety, stroke, bowel disorders, 10:00 am prostate disease, and migraines. They have signifi cantly lower rates of GP registration and fewer visits to a GP within the last 12 months compared [458] MEDICAL STANDARDS OF AIRLINE PILOTS OVER 60 to the general population. New Zealand airline pilots have signifi cantly YEARS OLD IN CHINA, FROM YEAR 2008 TO 2010 higher rates of kidney/bladder disease (due to calculi) and malignant L. SONGLIN, M. LIANG, S. WANG, Y. JIAN AND L. WANG melanoma when compared to the New Zealand general population. Civil Aviation Medical Center of Civil Aviation Administration of DISCUSSION: This study has demonstrated that pilots are healthier that China, Beijing, China the general population with respect to most medical conditions. The two medical conditions that were identifi ed as being overrepresented in pilots INTRODUCTION: Since 2008, the Civil Aviation Administration (melanoma and kidney calculi) may be the result of the occupational of China has allowed pilots over the age of 60 to continue fl ying for environment, namely sun exposure during layovers and dehydration in the airlines. To assess and improve the medical standards, we reviewed fl ight. Further work is needed to determine the signifi cance of these results. all the medical data of the senior applicants. METHODS: Medical data from all pilots over 60 ages old in China, including applicants, Learning Objectives: diagnosis, examination fi ndings, reasons of unfi tness, were collected 1 Pilots are healthier than the general population and statistically analyzed. Postal personal fl ight experiences were 2 Pilots have higher rates of kidney disease and malignant melanoma generally surveyed. RESULTS: There were 203 applicants in these three 3 The higher prevalence of these two medical conditions may be due years. The number of applicants and involved industries kept growing to the occupational environment

336 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

10:30 am uses a chemoprophylaxis. As a consequence fl ight crews acquiring [460] STARTING ALCOHOL & DRUG TESTING AND NOT falciparum malaria are not infrequent. Thus, efforts to reduce the PUNITIVE PROGRAM FOR FLIGHT CREW-MEMBERS IN risk of infection should be encouraged by repetitive education about BRAZIL the disease, symptoms and prevention of malaria. Regular medical examinations are a good opportunity to do so. V. MELHADO AND M.M. SANTOS Medical Service, Azul Linhas Aereas, Sao Paulo, Brazil Learning Objectives: 1 Malignant malaria may be an occupational hazard of fl ight crews INTRODUCTION: Suggested treatment protocols for the operating in risk areas. alcoholic and/or chemically dependent airline pilots are well 2 A proper prophylactic regimen including exposure prophylaxis and established in many countries of the world. The programs developed chemoprophylaxis are important precautions for protection of those by companies for their employees aimed at prevention of alcohol at risk. and psychoactive drugs have been widely recognized due to high 3 Flight crew should be educated about infectius hazards and how to rate of success in recovery and prevention of employees and their proect themselves. Malaria awareness has to be encouraged. families. The introductions of testing for illicit drugs in companies tend to induce an inhibitory effect of the use of these. According to the behaviorists, one of the best predictive of future behavior is past 11:00 am behavior. Azul Brazilian Air Line started operational work in Brazil in [462] AEROMEDICAL CERTIFICATION: SELECTIVE December 2008.Flight Crew and maintenance technicians were drug SEROTONIN REUPTAKE INHIBITORS tested since company day1. METHODS: During the Assessment day all E.M. FORSTER, S.J. VERONNEAU, D. NELMS AND candidates are subjected to complete physical examination including N. WEBSTER testing for drugs. The drug test used is Keratin-hair test and the drugs Civil Aerospace Medical Institute, FAA, Oklahoma City, OK are; Cocaine ,Marijuana ,Amphetamines ,Methamphetamine, Ecstasy , Opium ,Morphine ,Heroine ,Codeine ,Vicodin ( synthetically form INTRODUCTION: A review of aeromedical records of pilot of morphine ),PCP. All candidates had a pr-employment positive test applicants who reported use of Selective Serotonin Reuptake Inhibitors are invited for an interview with the doctor. RESULTS: We observed (SSRIs) was conducted. The objective of the study was to determine the positive drug test for a 0, 95% of pilots and 2,78 % for fl y attendants status and disposition of the pilots’ application for a special issuance fi rst year, 1.15% second year for all crew people. The more frequently medical certifi cate. This process includes the review by the FAA Offi ce drugs are marijuana, cocaine and ecstasy. DISCUSSION: The medical of Aerospace Medicine of several neurocognitive tests and other history and the wide window testing can identify the pattern of use. reports from the treating psychiatrist, the airman, and other sources. A person who is not dependent, but behavior has harmful use of the Four SSRIs were considered, as approved by the FAA on 4/5/10 (http:// substance, may be unused for one and, for example, in order to be edocket.access.gpo.gov/2010/pdf/2010-7527.pdf): escitalopram accepted into the company and after this period re-use and suffer the (Lexapro), citalopram (Celexa), fl uoxetine (Prozac, Sarafem), and consequences of use. sertraline (Zoloft). METHODS: Airmen medical records stored in the FAA Document Imaging and Workfl ow System (DIWS) were queried Learning Objectives: for the SSRI pathology code as assigned by the FAA. Aeromedical 1 discussion Starting Alcohol & Drug Testing and not Punitive Pro- records dated from Jan 2010 through Sep 2011 were reviewed. gram for Flight Crew-members RESULTS: A total of 454 pilot applicants resulted from the query, 395 male (87%) and 59 female (13%). Reported distribution of the SSRIs: 10:45 am 134 (29%) Escitalopram, 125 (27%) Sertraline, 116 (25%) Citalopram, and 79 (17%) Fluoxetine. As of 9/29/2011, 51 (11%) of the cases had [461] MALARIA IN FLIGHT CREWS AND ITS PREVENTION been granted a medical certifi cate: 8 Class-1, 7 Class-2, and 36 Class-3. J. SIEDENBURG A total of 34 cases were denied (8%), and 369 (81%) were undergoing Medical Department, Lufthansa Medical Department, review. The 51 approved cases were represented by 46 males (90%) and Frankfurt, Germany IP: 192.168.39.151 On: Sun,5 females26 Sep (10%). 2021 Their 17:39:09 average (6SD) age was 51 6 11 years, height Copyright: Aerospace Medicalwas 70 6 Association4 in., and weight was 201 6 37 lbs. The reported distribution INTRODUCTION: Malaria is an insidious protozoan infectionDelivered byof Ingenta the SSRIs for the certifi cated pilots was 21 (41%) Escitalopram, endemic in tropical countries, which is transmitted by night and dawn 14 (27%) Citalopram, 12 (24%) Sertraline, and 4 (8%) Fluoxetine. active Anopheles mosquitoes. By means of mortality, complications Associated diagnoses for these SSRIs: 35 (69%) for depression, 13 (25%) and frequency malaria caused by Plasmodium falciparum is by far for anxiety, and 3 (6%) for their combination or obsessive compulsive the most prominent one. The worldwide mortality is almost a million disorder. No aviation accidents involving these pilots have been annually. Most of the infections diagnosed in Western Europe and the reported to date. DISCUSSION: The FAA SSRI medical certifi cation US are imported from West Africa. Flight crews operating in the high program, though cumbersome, has been successful in returning airmen risk areas of West Africa are at considerable risk as well. DISCUSSION: undergoing treatment with common SSRIs to fl ying status. Albeit layovers rarely exceed 48 hours - which means 2 nights at risk, staying in 5-star hotels in urban areas, and fl ight crews being Learning Objectives: familiar with the hazard of malaria, the risk is in the range of about 1: 1 Review the current medical certifi cation status of pilot applicants 100. It can be reduced by the factor of 10 by meticulous prevention who reported use of SSRIs. of insect bites (exposure prophylaxis) and, furthermore, to about 1 : 10.000 by using a chemoprophylaxis. For the time being, medications 11:15 am like mefl oqine or doxycycline or a combination of Atovaquon and Proguanil are available. The latter is as effective as the others, is well [463] FROM THE LAND OF MISFIT TOYS: AEROMEDICAL tolerated in most patients and - different from the other medications CERTIFICATION OF U.S. CIVILIAN AIRMEN WITH - may be used by cockpit crew as well. It is in dispute, whether their MULTIPLE COMPLEX CONDITIONS prophylactic regimen should be restricted to this combination, too, C.T. COWL or the other medications may be used by cabin crew. Furthermore, Section of Aerospace Medicine, Mayo Clinic, Rochester, MN it is critical to educate fl ight crews to raise suspicion or malaria in case of symptoms, including fever and to seek medical attention INTRODUCTION: Over the past several decades, Mayo immediately. The majority of malaria fatalities in Western countries is Clinic’s Section of Aerospace Medicine has participated in complex related to delays in diagnosis and treatment. Even though most airlines aeromedical evaluations of hundreds of civilian pilots, many with operating to the endemic areas educate their crew about prevention of rare and multiple conditions. METHODS: In this presentation, several tropical diseases in general and malaria in particular, most fl ight crews cases are analyzed in order to review the clinical fi ndings and only adhere more or less to exposure prophylaxis. Only a minority better understand the forensic issues associated with evaluation of

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 337 ASMA 2012 MEETING ABSTRACTS these unique cases. DISCUSSION: Several cases involving diffi cult 3 The participant will be able to list the medications that are allowed diagnoses and complex treatments are discussed. In addition to by the FAA for treatment of hypertension in aviators, and also those reviewing the clinical aspects of each case, the administrative variables medications that are disqualifying for fl ight status. are also reviewed and sequential outcomes revealed.

Learning Objectives: Thursday, May 17 1:30 PM 1 Review several rare, complex medical conditions. Ballroom B 2 Better understand the need for a stepwise, organized approach to evaluating multiple conditions. SLIDE: STUDIES IN AVIATION SAFETY

Thursday, May 17 1:30 PM 1:30 pm Ballroom A [467] STUDYING THE RELATIONSHIP BETWEEN SAFETY CULTURE AND FATIGUE IN REGIONAL AIR CARRIER PANEL: FPA PANEL ON CLINICAL MEDICINE FLIGHT OPERATIONS PERSONNEL UPDATES RELEVANT TO AVIATORS PART II T.L. VON THADEN 1University of Illinois, Champaign, IL; 2Illumia, [464] ATRIAL FIBRILLATION:TREATMENT MODALITIES AND Champaign, IL IMPLICATIONS FOR AIRMEN W.K. AUSTIN INTRODUCTION: U.S. regional air carrier fl ight operational employees (N = 2553) who had recently developed fatigue risk Piedmont Heart Institute, Jasper, GA management policies participated in safety culture assessments using the Safety Culture Indicator Scale Measurement System (SCISMS). INTRODUCTION: Atrial fi brillation is a very common cardiac Using a 7-point Likert scale, fatigue and risk are reverse-scored rhythm disturbance.There are several ways to treat this dysrhythmia (higher scores indicate less fatigue/risk). Across organizations, including medical treatment, surgical methods, and radio frequency fatigue items had relatively low means. “Pilots who call in fatigued ablation.These will all be discussed especially as they relate to airmen. or not fi t for duty are scrutinized by chief pilots or management” Learning Objectives: received a negative score, below the scale midpoint of four (M = 3.15, sd = 1.76). The scores were again negative when asked if they 1 The impact of Atrial Fibrillation especially as it relates to aviation had “Reported for duty when fatigued, ill, or under unusual stress” will be discussed. (M = 3.32, sd = 1.59) and in response to “My airline’s leadership 2 The factors which contribute to Atrial Fibrillation will be discussed. schedules pilots as much as legally possible; with little regard for 3 The audience will learn the medical, surgical, and ablative treat- pilots’ sleep schedule or fatigue” (M = 3.42, sd = 1.71). While it was ments for Atrial Fibrillation. hypothesized that recent attention to fatigue management principles at each carrier would prompt positive responses, improvements in

[465] 2012 UPDATE: DIAGNOSIS AND MANAGEMENT OF practice and employee perceptions, the original supposition did not prove accurate. Fatigue items correlated moderately strongly GASTROESOPHAGEAL REFLUX DISEASE with frontline supervisors’ (r = .42, .16, and .33, p’s < .01) and B.A. HECKMAN organizations’ commitment to safety (r = .40, .19, and .54, p’s < George Washington University, Silver Spring, MD .01). Additionally, the fi rst and third items correlated moderately strongly with organizational risk (r’s = .34 and .27, p’s < .01) and INTRODUCTION: Medical and surgical management safety behaviors (r’s = .24 and .28, p’s < .01). Organizational and of gastroesophageal refl ux disease and its complications has supervisory commitments to safety were good predictors of fatigue improved over the past three years due IP:to improvement 192.168.39.151 in On: Sun,(R 26 = .585),Sep 2021with organizational 17:39:09 commitment the stronger of the two diagnostic techniques, endoscopic therapeuticCopyright: techniques, Aerospace and Medical(standardized Association betas = .40 and .23, respectively, p’s < .01). Results release of medications. DISCUSSION: A discussion of medicalDelivered by suggestIngenta misaligned perceptions between air carrier leadership and and surgical therapy to include proper administration of drugs, pilots, increased operational pressures, and the vulnerability on part appropriate endoscopic surveillance intervals for Barrets epithelium of the pilots to assure they are supported to consistently achieve and adenocacinoma, avoidance of use of unproven therapeutic fi tness for duty. maneuvers, and implications regarding symptomatic GERD and aeromedical concerns. Learning Objectives: 1 The audience will learn that safety culture and organizational com- Learning Objectives: mitment provide indications of fatigue relationships in regional air 1 To learn what symptoms can be ascribed to gastroesophageal refl ux carrier operations. disease. 2 The audience will learn that to promote fatigue awareness, air carriers should consistently monitor and measure the usefulness of [466] BLOOD PRESSURE ISSUES FOR AVIATORS fatigue programs among their employees. D.R. MAURITSON 1:45 pm Grammer & Mauritson LLC, Tuscaloosa, AL [468] ACCIDENTS IN FIXED-WING AIRCRAFT DURING INTRODUCTION: The panelist will discuss hypertension and its INSTRUCTIONAL FLIGHTS therapy, and the effects of both with regard to functioning as an aviator M.B. O’CONNOR1, N.A. MODE2,1 AND J.M. LINCOLN1 and FAA fl ight status. 1APRO, CDC/NIOSH, Anchorage, AK; 2Nicolle Mode & Associ- ates, Pleasanton, CA Learning Objectives: 1 The participant will be able to list the potential adverse conse- INTRODUCTION: Flight training is generally considered quences of hypertension, in particular with regard to functioning as one of the safest categories of general aviation; however no type an aviator. of fl ying is without risk. The purpose of this study was to identify 2 The participant will be able to describe the drug classes, and risk factors for accidents involving fl ight instruction in fi xed- individual drugs within those classes, available for treatment of wing aircraft. METHODS: National Transportation Safety Board hypertension. accident data were used to identify accidents that occurred

338 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS during instructional fl ights in fi xed-wing aircraft during 1999- hours. DISCUSSION: Airmen who had an NTSB event had more 2010. Instructional fl ights were a part of fl ight training, those that measureable pilot profi ciency (p<0.001). Further analyses will be required instructor supervision or presence onboard. Narrative conducted to determine if other variables confound or interact with reports were reviewed to determine primary or secondary student these variables to determine risk of an event. Descriptive data from status and whether a fl ight instructor was present. Data were then this study will provide the basis for a case-control study examining analyzed to determine phase of fl ight, location, circumstances and the exposure variables associated with risk of an accident. These causes. RESULTS: During 1999-2010, 2488 instructional fl ights results will be presented along with the descriptive statistics. were involved in 2474 accidents during civilian fl ight training operations, resulting in 491 fatalities and 290 serious injuries. The Learning Objectives: majority of these instructional fl ights involved primary students 1 The relationship between pilot exposure variables and accident (67%, 1673) and over half (55%, 1370) occurred with a certifi cated rates for U.S. civil airmen in 2005. fl ight instructor in the airplane. The most frequent occurrences were loss of control on ground or water (24%), loss of control in fl ight (15%), hard landing (15%) and loss of engine power (13%). One 2:15 pm hundred accidents resulted from fuel starvation or exhaustion; 65 of [470] BRITISH ARMY HELICOPTER ACCIDENTS: these accidents had instructors in the aircraft. Instructor’s inaction A REVIEW OF TWO CONTRASTING DECADES or improper action was identifi ed by the NTSB as a primary factor M.S. ADAMS1, M. HARRIGAN2 AND A. BUSHBY2 in almost half (48%, 659) of the accident fl ights with an instructor 1Royal Air Force, Centre of Aviation Medicine, RAF Henlow, onboard. A majority of the accidents occurred on an airstrip (68%); United Kingdom; 2HQ, Army Air Corps, Army Aviation the most common phases of fl ight in which accidents took place Medicine, Middle Wallop, United Kingdom were landing (34%, 857) and takeoff (12%, 297). DISCUSSION: These data indicate a need for increased attentiveness and improved INTRODUCTION: The decades 1991-2000 and 2001-10 have supervision of students by fl ight instructors. Instructor profi ciency seen contrasting theatres of operations, with the challenges of severe in emergency procedures and maneuvers and setting conservative brownout landing conditions in the latter period, compared with a criteria for safe fl ight operations, including fuel reserves, winds and more European focus in the earlier period. A review was undertaken altitudes may prevent future accidents. Capable instructors may of aircraft accidents in these contrasting decades to determine trends prevent accidents during dual fl ight and by imparting the skills, in causation; an essential task for the development of strategies and knowledge and judgment for safe solo fl ight by students. technologies to reduce accident rates. METHODS: All British Army helicopter accidents reports for the period Jan 2001 - Dec 2010 were Learning Objectives: reviewed, and compared with those in the previous decade. Accidents 1 To describe accidents that occur during instructional fl ights in caused by hostile fi re were excluded. RESULTS: : 31 Category 4 and 5 fi xed-wing aircraft. accidents occurred in 7 aircraft types. The proportion of fatal accidents 2 To describe the most frequent causes of accidents that occur during increased from 26.3% to 33.3% in the most recent decade. The solo and dual instructional fl ights. percentage of accidents caused by Human Factors (aircrew) increased 3 To understand possible strategies to prevent instructional accidents from 78.9% to 83.3%, whilst the percentage due to Technical Failure in fi xed-wing aircraft. fell from 21.1% to 8.3%. However, the percentage of Human Factors (aircrew) accidents involving fatalities increased from 13.3% to 30.0%, whilst the percentage of these accidents in which spatial disorientation 2:00 pm (SD) was a major or contributory factor, reduced slightly from 66.7% [469] FLIGHT HOURS AND ACCIDENT RISK IN THE U.S. to 60.0%. On operations, SD was a major contributory factor in CIVIL AIRMAN POPULATION 83.3% of Human Factors (aircrew) accidents in the fi rst decade and A. NORRIS, V. SKAGGS AND R. JOHNSON 80% in the second. DISCUSSION: Since 2005, efforts have been Civil Aerospace Medical Institute, FAA, Oklahoma City, OK made to extend in-fl ight SD refresher training to include type specifi c IP: 192.168.39.151 On: Sun,training 26 Sep for Apache2021 17:39:09and fi xed wing aircrew. The overall accident rate INTRODUCTION: The objective of thisCopyright: study is to identifyAerospace Medicalhas reduced Association since 2005 as has the percentage of SD accidents when and describe pilot variables in a group of airmen who hadDelivered an bycompared Ingenta with the periods 1991-2000 and 2001-4. Conclusions: The accident or incident. On average, more than 80% of general percentage of accidents due to Human Factors (aircrew) has increased aviation accidents are due to pilot error. The prevailing view is that in the most recent decade, with 80% of those on operations due to lack of fl ight experience is one of the major factors contributing SD. Improvements to SD refresher training in the British Army have to the risk of an accident. However, there is a limited amount been introduced to enhance awareness amongst all aircrew. Overall of literature about this topic published from data gathered later accident rates have reduced markedly since 2005 and may in part be than 2004. This study aims to contribute more recent and relevant due to these enhanced SD training initiatives. knowledge. METHODS: Data for all U.S. civil airmen in 2005 were collected from the Scientifi c Information System database Learning Objectives: developed at the Civil Aerospace Medical Institute. Study variables 1 To understand the changing causes of British Army helicopter ac- of interest included age, gender, current medical class, last six cidents over a 20 year period. months and total fl ight hours recorded, body mass index (BMI), 2 To understand the potential benefi ts of in-fl ight SD training. and documentation of an NTSB event. Descriptive statistics were created for all airmen in 2005 and then repeated for only those with 2:30 pm an NTSB-documented event within that calendar year. P-values [471] SPATIAL DISORIENTATION-RELATED MISHAPS: A TEN were generated from the Wilcoxon rank-sum test to assess if the YEAR AUDIT OF U.S. ARMY ROTARY-WING OPERATIONS distribution of hours fl own was the same in both groups. RESULTS: 1 2 1 1 In 2005, 687,715 U.S. civil airmen were medically certifi ed, and S. GAYDOS , , M. HARRIGAN AND A. BUSHBY 1 17.6%, 20.1%, and 62.3% held fi rst, second, and third effective Headquarters Army Air Corps, Army Aviation Centre, Middle medical class certifi cates, respectively. Females comprised 6.2% Wallop, United Kingdom; 2U.S. Army Aeromedical Research of the population. The overall mean age was 44.4 years, and mean Laboratory, Fort Rucker, AL BMI was 27.4. Mean total fl ight time was 2,974 hours while the median fl ight time was only 450. Mean fl ight time within the last INTRODUCTION: Spatial disorientation (SD) and its untoward 6 months was 83 hours, with the median only at 15. For the 1,862 effects have contributed to numerous lost lives, destroyed or damaged airmen with an NTSB event, mean total fl ight time was 3,908 aircraft and a reduction in operational mission effectiveness since the hours and median time was 1,310. Mean fl ight time recorded early days of aviation. Military rotary-wing (RW) operations are not within the last 6 months was 122 hours, with the median at 50 immune. The U.S. Army has retired many “legacy aircraft” represented

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 339 ASMA 2012 MEETING ABSTRACTS in older studies, developed new training regimens for aircrew, 2 Understand the relative impact of TAG among aircraft cockpit continued to expand its night vision capabilities, and prosecuted members on the mishap rates between the two military services combat operations for some 10 years utilizing new tactics, techniques, USN/USMC and the USAF. and procedures. For these reasons, it is apposite to re-examine the 3 Understand the magnitude of various rates of TAG between the two subject of SD among accidents within the Army’s RW community. military services USN/USMC and the USAF. METHODS: The U.S. Army’s Combat Readiness/Safety Center database at Fort Rucker, Alabama was queried for the previous 10 years’ RW Thursday, May 17 1:30 PM mishaps from fi scal year (FY) 2002 through FY 2011 (FY11 current Ballroom C through 01 July). Accidents identifi ed as having SD as a present and contributing factor were selected for analysis. RESULTS: From FY 2002 to FY 2011, there were 100 Class A through C rotary-wing fl ight PANEL: INTERNATIONAL RELATIONS: mishaps implicating SD. This represents 11 percent of all Class A AN AEROMEDICAL PERSPECTIVE through C rotary-wing fl ight accidents for this period. Of the 100 SD- related accidents, 22 percent involved fatalities, 39 percent involved [473] INTERNATIONAL RELATIONS: AN AEROMEDICAL fatalities and/or injuries, and 44 percent resulted in total loss of aircraft. PERSPECTIVE The total number of RW SD-related accidents with fatalities represents B. MUSSELMAN2 AND F. BONATO1 31 percent of the total helicopter accidents with fatalities for the 10- 1 2 year period. DISCUSSION: This review of accident data confi rms that Saint Peter’s College, Jersey City, NJ; U.S. Air Force, SD remains a substantial issue for the Army Aviation community and Joint Base Andrews, MD reinforces the importance and relevance of SD awareness, research, The international aviation industry has received increased education and training in RW operations. visibility the past several years. International air traffi c has increased Learning Objectives: 7% since 2008. Highly publicized accidents have been present in the news, including Colgan Air Flight 3407 (Buffalo, NY, killing 50), 1 Appreciate the signifi cance of SD-related mishaps in the military Air France Air Flight 447 (Atlantic Ocean, killing 228), the Asiana RW environment. Airlines Flight 991 (a 6-year old Boeing 747-400 that crashed in the 2 Understand the characteristics associated with Army RW East China Sea killing 2), the Russian Yak-42 accident (Russia, killing SD-related losses. 48 including players of the Kontinental Hockey League (KHL) team Lokomotiv), and the Air India Express Flight 812 (Mangalore, India, 2:45 pm killing 158). Increased air operations and accidents have led to the [472] EVALUATION AND COMPARISON OF THE EFFECTS need for changes. This panel will provide a potpourri of aeromedical perspectives on recent international regulations, operations and OF TRANSITIONAL AUTHORITY GRADIENT (RANK DISPARITY) OBSERVED IN MULTI-PILOTED AIRCRAFT training protocols including personnel selection, training, fatigue management, safety management, education, etc. MISHAP RATES BETWEEN THE US NAVY / MARINES AND THE USAF [474] FATIGUE RISK MANAGEMENT SYSTEM (FRMS) S.P. ADAMS APPLICATION PROPOSED IN PART 117—FLIGHT AND DUTY Navy, NAMI, Pensacola, FL LIMITATIONS AND REST REQUIREMENTS: FLIGHTCREW MEMBERS INTRODUCTION: Differences in military rank have been T.E. NESTHUS associated with military aircraft mishaps and are aggressively addressed in their crew resource management (CRM) training. However few if any FAA Civil Aerospace Medical Institute, Oklahoma City, OK military studies have evaluated its relative impact on military mishap INTRODUCTION: In 2009, the FAA chartered the Flight and rates. This study investigates the relative impact of the differences in Duty Time Limitations and Rest Requirements Aviation Rulemaking military rank (Transitional Authority GradientIP: /192.168.39.151 TAG) among aircraft On: Sun,Committee 26 Sep 2021(ARC) comprised17:39:09 of labor, industry, and FAA representatives. cockpit members on the mishap rates between twoCopyright: military services Aerospace MedicalIn 2010, theAssociation President signed the Airline Safety and FAA Extension (USN/USMC & USAF). METHODS: This is a retrospective cohortDelivered study by Act,Ingenta P.L. 111-216. Among other fatigue-related sections, the FAA which examined mishaps rates in dual piloted USN/USMC & USAF was directed to issue new regulations specifying fl ight/duty time and aircraft where TAG was greater than one pay grade vs. similar piloted rest requirements and to consider factors impacting pilot alertness aircraft where this TAG was not present between 2001-2011. RESULTS: including time of day, number of takeoffs and landings, multiple time Based on the overall mishap rate (OMR) a mishap is 1.30 x 10-5 more zone crossings, and commuting. The resultant Notice of Proposed likely to occur in USN/USMC vs. USAF (p = 0.97 C.I. = -0.000760 / Rule Making was consistent with the statute. After addressing 8,000 0.000786). A TAG mishap is 1.39 x 10-6 more likely to occur in USAF comments, fi nal rule language has incorporated additional fatigue vs. USN/USMC during decade under study (p = 0.99 C.I. = -0.000774 mitigation options and provides diverse requirements based on factors / 0.000771). Thus, two sample proportion test applied to OMR & TAG just mentioned and unique operational circumstances. The rule mishap rate and TAG proportional mishap ratio suggests USN/USMC & recognizes shared physiological factors that lead to fatigue and regulates USAF are statistically the same populations for the decade under study. universally, whereby current distinctions between domestic, fl ag and The incidence rate ratio (IRR) for OMR suggests the incidence rate of supplemental operations are eliminated. METHODS: This presentation mishap per total fl ight hours exposed is 32.7% greater for USN/USMC focuses on optional FRMS application offered in the new rule. FRMS vs. USAF with statistical signifi cance (p = 0.00 / IRR: 1.33 / 95% C.I. = provides a way to safely conduct specifi c fl ight operations by offering 1.19/1.48). IRR for TAG mishap rate suggests the incidence rate of TAG fl exibility not available within regulatory limits, as long as alternative in the cockpit at mishap per total fl ight hours exposed is 13% lower procedures demonstrate a level of safety equal to or greater than the for USN/USMC vs. USAF with p-value approaching (but not satisfying) prescriptive rules. RESULTS: The FAA’s Operation Specifi cation process statistical signifi cance for the decade under study (p = 0.14 / IRR: 0.87 / provides an effective method for establishing safety standards that can 95% C.I. = 0.68/1.11). Contingency table for TAG PMR suggests 17.6% be adapted to specifi c certifi cate holder’s class, size of aircraft, and of USN/USMC & 26.8 % of USAF mishaps involve TAG in the cockpit at type of operation. This is the mechanism by which FRMS proposals will time of mishap for the decade under study (p=0.00). DISCUSSION: The be processed and will include the requirement for data acquisition to identifi cation and subsequent quantifi cation of these factors may prove verify safety of fl ight and ensure that fatigue mitigation is equivalent or useful in guiding future pilot/cockpit air crew training. better than under the prescriptive rules. DISCUSSION: This presentation discusses critical elements of the new regulations for Part 121 operations Learning Objectives: as well as implementation guidance offered to certifi cate holders for 1 Understand the concept of Transitional Authority Gradient (TAG) or FRMS OpSpec submission and provisions for demonstrating equivalent rank disparity in the cockpit of military aircraft. levels of safety, otherwise managed in the new rules.

340 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

Learning Objectives: Learning Objectives: 1 This presentation discusses critical elements of the new regulations 1 To show how the EASA regulations on medical standards for cabin for Part 121 operations as well as implementation guidance offered crew can be implemented at national level. to certifi cate holders for FRMS OpSpec submission and provisions 2 To demonstrate the costs and benefi ts of the regulations. for demonstrating equivalent levels of safety, otherwise managed in 3 The audience will recognise the potential impact of the the new rules. regulations.

[475] SAFETY AND ERROR MANAGEMENT IN EUROPEAN [477] CABIN AIR CONTAMINATION: AN UPDATE ON THE AVIATION MEDICINE CRANFIELD UNIVERSITY AND INSTITUTE OF J. SIEDENBURG OCCUPATIONAL MEDICINE STUDIES Medical Department, Lufthansa Medical Department, N. DOWDALL Frankfurt, Germany Aviation Health Unit, Medical Department, Civil Aviation INTRODUCTION: Aviation and aviation safety in Europe Authority, Gatwick Airport South, United Kingdom are in a process of transition. Integration and harmonisation have taken place. As a fi rst step the member states of the JAA (Joint INTRODUCTION: In recent years a number of individuals Aviation Authorities) committed themselves to develop common and organisations have expressed concern at the possible health requirements and use them as sole codes. By Standardisation and safety implications of incidents involving contamination of identical interpretation and application was achieved. From 2003 cabin air on commercial aircraft. The UK Committee on Toxicity on EASA (European Aviation Safety Agency) started as a new player carried out an extensive review of the evidence and its 2007 report that will cover all areas of aviation in the near future. As Personal concluded that further research was necessary. Following this Licensing has been integrated into the new architecture recently, report, the Department for Transport commissioned research from medical fi tness and regulatory aspects of aviation medicine are fully Cranfi eld University, addressing the in-fl ight sampling of cabin air, covered as well. DISCUSSION: Quality and safety management, and from the Institute of Occupational Medicine (IoM), Edinburgh, standard procedures and their effect on aviation safety have been looking specifi cally at evidence of organophosphate contamination studied and improved from the very start of aviation and became in aircraft and other environments. This presentation will review the elements of medicine and aviation medicine as well. Aviation fi ndings of the Cranfi eld studies and present the results of the IoM research. medicine is an important element of aviation safety and safeguards physical and mental fi tness of pilots, fl ight attendants and air traffi c controllers. International and national provisions prescribe standards Learning Objectives: of examination and assessment. A human factors perspective is 1 To assess the outcome of the research, including the strengths and the basis of quality management. Albeit human error is inevitable weaknesses of the studies. in modern technical systems, one goal of safety management is 2 The audience will be able to assess the signifi cance of the research to minimise their negative impacts on safety and to increase the and what it adds to our understanding of the issues of cabin air resilience of systems. Safety culture is key factor of safety; its failure contamination. is the major factor in safety problems, incidents and accidents rather than individual failure. Audits verify compliance standards. Medical [478] INFECTIOUS DISEASE SURVEILLANCE: THE CASE standardisation assess the compliance of civil aviation authorities, FOR A GLOBAL BIOSURVEILLANCE KNOWLEDGE in particular in their supervision of the work of Aeromedical Centres MANAGEMENT TOOL (AeMCs) and Aeromedical Examiners (AMEs). According to the new European requirements AeMCs have to have a Quality Management G.L. HATHAWAY System installed. However, elements of quality management and a Naval Medical Research Unit Two, Pearl Harbor, HI system for a permanent improvement of working quality should be integral work of AMEs and physicians inIP: general. 192.168.39.151 More and more, On: Sun, 26 SepINTRODUCTION: 2021 17:39:09 A comprehensive disease surveillance elements of safety management - i.e. PDCA accordingCopyright: to James Aerospace Medicalsystem is Associationlacking in the Pacifi c (and elsewhere) for both civilian Reason - are used to improve their daily work. Delivered byand Ingenta military health agencies. Signifi cant resources and time are required to cobble together a clear picture of disease threats to Learning Objectives: military and civilian populations in any particular geographic 1 European aviation and aviation safety requirements have been har- area using current data sources (NCMI, WHO, CDC, PacNet, monised to form a new integrated system in the past twenty years. ProMed, etc.). DISCUSSION: Different organizations may report 2 A human factor approach is an inevitable element of safety and on similar disease topics but tend to focus on their particular quality managment to obtain optimal aviation safety. geographic and/or thematic area(s) of responsibility with inconsistent 3 Audits and medical standardisation team visits ensure compliance documentation type and formatting. Moreover, data are often of authorities with regulations and in safety oversight. scattered with no central repository and an ultimate lack of geospatial pictorial representation for analysis. Currently no system exists to comprehensively compile human, animal, vector, and environmental [476] THE EUROPEAN AVIATION SAFETY AGENCY data for interpretation and analysis of their relationships as it affects REQUIREMENTS ON CABIN CREW MEDICAL STANDARDS: human health in order to form usable force health protection data IMPLEMENTATION IN THE UK for military forces. To address these challenges, a collaborative N. DOWDALL partnership was formed between US Army Public Health Command- Aviation Health Unit, Medical Department, Civil Aviation Pacifi c, the Naval Medical Research Unit-2 and the Pacifi c Disaster Authority, Gatwick Airport South, United Kingdom Center (PDC) to develop the Biosurveillance Information Service (BioServ). BioServ will enable access to multiple data sets related to INTRODUCTION: In recent years there has been considerable current and projected health risks in a GIS representation, allowing debate about the need for regulatory medical standards for cabin crew. enhanced force health protection and mission readiness at all levels In 2012 the European Aviation Safety Agency (EASA) will assume as a single entry point for medical threat information. BioServ responsibility for regulatory standards in Licensing and Operations in is intended to be a credible and recognized geospatially-based all member States. The new regulations include requirements covering knowledge management platform, enabling analysts to assess existing medical standards for cabin crew. This presentation discusses the and emerging infections by combining human, animal, and vector implementation of these requirements in the United Kingdom and their data. BioServ and its unique capabilities will enhance the mission potential impact on safety, the industry and both current and potential of protecting DoD servicemembers and the global public health cabin crew. community.

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 341 ASMA 2012 MEETING ABSTRACTS

Learning Objectives: and ICP levels greater than 40 mm Hg. (difference: 0.5175 6 0.3710, 1 Learner will understand the challenges of collecting data for rou- p = 0.1693). DISCUSSION: This study demonstrates that a porcine tine surveillance and for mission planning in the Pacifi c AOR. animal model can be used to mimic changes in ICP and ONSD with 2 Learner will be able to describe the surveillance gaps in human, increases in cephalad venous fl uid pressure. In the future, this model animal, and vector populations. can be used to look at changes in ICP, cerebrovascular blood fl ow, 3 Learner will be able to describe the benefi ts of a civil-military and cerebrovascular autoregulation with exposure to other risk factors collaborative effort in a Geospatial Information System format. believed to contribute to the elevated ICP and visual changes associated with spacefl ight, as well as to evaluate other non-invasive modalities for estimating intracranial pressure. [479] CIVILIAN USE OF NVGS: REASONS AND REGULATIONS Learning Objectives: J.C. ANTONIO 1 The relationship between cephalad venous fl uid pressure and Self employed, Gold Canyon, AZ intracranial pressure will be described. 2 The relationship between intracranial pressure and optic nerve INTRODUCTION: The use of night vision goggles (NVGs) in sheath diameter will be described. the civilian (non-military) sector both within the US and internationally has increased signifi cantly over the past two decades. Regulations for controlling aircraft lighting modifi cations, operational procedures, 1:45 pm NVG specifi cations, continuing airworthiness, and training have been [481] IHH (PSEUDOTUMOR CEREBRI) FOLLOWING slowly developed during that time, and are critical in helping civilian HYPOBARIC TRAINING--OPHTHALMIC ISSUES users fl y smartly and safely. This presentation will describe how various H. LESTER1 AND M.W. JACKSON2 civilian communities within the US, Canada and the European Union 1Federal Aviation Administration, Jamaica, NY; 2Federal Aviation use NVGs; the process for creating guidelines that were used in the Administration, Chicago, IL development of regulations; and the status of regulations within each of the respective aviation agencies (FAA, Transport Canada and the INTRODUCTION: Idiopathic intracranial hypertension (IIH), European Aviation Safety Agency). or pseudotumor cerebri, is a diagnostic and therapeutic dilemma lacking clear etiology. The ophthalmic manifestations of disc edema Learning Objectives: can lead to severe loss of visual fi eld. No defi nite link exists between 1 How civilians use NVGs and how the use of NVGs is regulated IIH and aviation, however this case report explores a new possible internationally will be discussed. association with hypobaric training. In this and a subsequent slide, we will explore this from both an ophthalmic and neurologic perspective. The third class airman is a 32 year old woman who Thursday, May 17 1:30 PM works as an aerial photographer at altitudes ranging from 10 to Ballroom D 15,000 feet. 4 months prior to diagnosis, she trained in an altitude chamber, followed immediately by a severe sinusitis that resolved over weeks. Over the next months she developed hypersensitivity to SLIDE: SPACE MEDICINE RESEARCH light and sound, neck stiffness, intractable headaches, and then felt like she was going to seize while watching television. She went to 1:30 pm the ER, and was sent home, then she went to her optometrist, who [480] CHANGES IN INTRACRANIAL PRESSURE AND OPTIC diagnosed bilateral papilledema that appeared old. She also had markedly elevated intraocular pressures, visual fi eld compromise and NERVE SHEATH DIAMETER WITH INCREASING CEPHALAD decreased visual acuity. She went back to the ER, where MRI and MRV FLUID SHIFTS IN A PORCINE MODEL were unremarkable, but lumbar puncture opening pressure was 470 D. NUSBAUM, R. EASLEY, J.B. CLARK,IP: 192.168.39.151K. BRADY, K. KIBLER On: Sun,mmHg. 26 Sep The 2021 workup 17:39:09 also showed an iron defi ciency anemia. After AND J.P. SUTTON Copyright: Aerospace Medicaltreatment Association of the anemia, as well as treatment with acetazolamide and Internal Medicine, Baylor College of Medicine, Houston,Delivered TX by systemicIngenta steroids, the symptoms resolved. The airman would like to fl y. She has persistent minimal disc swelling without pallor on 500 INTRODUCTION: An animal model would prove useful to study mg acetazolamide twice daily. Her visual fi eld has minimal blind spot changes in intracranial pressure (ICP) and vision when introduced to enlargement, and she misses one color plate, but otherwise she has exposures believed to be risk factors for developing space related visual normal visual function. She has not had a repeat lumbar puncture, nor changes, as well as to evaluate non-invasive methods for characterizing shunting, nor optic nerve sheath decompression. DISCUSSION: The ICP during spacefl ight. This study looks at the utility of a porcine animal onset of symptoms following hypobaric training is unique, however model to mimic changes in ICP and optic nerve sheath diameter the time lag until diagnosis and the presence of iron defi ciency anemia (ONSD) with increases in cephalad venous fl uid pressure. METHODS: and high BMI are confounding. In the context of recent reports of For this study, simultaneous measurements of ICP and internal jugular optic nerve edema related to space fl ight, it is timely to explore this pressure (IJP) were made in juvenile piglets (N=4) at various levels different aerospace association of disc edema/pseudotumor cerebri of superior vena caval (SVC) pressure. To artifi cially raise the level of with hypobaric exposure. SVC pressure, a Fogarty occlusion catheter was inserted and infl ated to create various levels of venous pressure. Each subject was exposed Learning Objectives: to 10mm, 20mm, and 40mm Hg. of cephalad venous pressure, as 1 Explore the possible association of IHH (pseudotumor cerebri) with measured by IJP monitor, for an hour at each pressure level. ONSD hypobaric exposure. was measured by ultrasound at each pressure level. RESULTS: There 2 Review the constellation of ophthalmic fi ndings, course, and was a linear correlation between increasing IJP and ICP (slope: 1.039 treatment of IHH. 6 0.007860, y-intercept: -1.685 6 0.1758, r = 0.7955, p < 0.0001). There was a difference in ICP from 10mm to 20mm Hg IJP (difference: 2:00 pm 6 9.640 3.803, p = 0.0444) and from 20mm to 40mm (difference: [482] EFFECTIVE DOSE ESTIMATE FOR ASTRONAUTS 19.26 6 6.851, p = 0.0483). There was a difference observed in ONSD USING HUMAN PHANTOM DATA between low levels of ICP vs. high levels as defi ned by the cutoff of 20 1 1 2 mm Hg. (difference: 1.435 6 0.1862, p < 0.0001). Of note, however, G. REITZ , T. BERGER AND U.H. STRAUBE 1 there appeared to be a plateau effect above an ICP of 20 mm Hg. where Radiation Biology Department, German Aerospace Center, there was little or no further increase in ONSD. There appeared to be Cologne, Germany; 2Medical Operations D/HSO-AM, no difference in ONSD between ICP levels from 20 mm. to 40 mm Hg. European Space Agency, Cologne, Germany

342 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

INTRODUCTION: The radiation exposure of astronauts in DoubleSensor technique is able to monitor BCT in humans in space causes a major concern in long duration and interplanetary weightlessness. However, thermoregulation seems to be missions. The knowledge of the radiation doses to radiosensitive attenuated due to changes in heat transfer adaptations. We organs within the human body is a prerequisite for an accurate conclude a higher load in BCT in Astronauts during long term radiation risk assessment. There are two approaches to determine space fl ights which might have an impact on human physiological the organ exposures, one way is by calculations only, the other regulation. one is measurements combined with calculations. The radiation exposure of European astronauts is determined with personal Learning Objectives: dosemeters, consisting of thermoluminescence dosemeters 1 Base body core temperature increases during long term Space and nuclear track detectors . Whereas the fi rst ones are used to fl ights about 1.5°C. measure the contribution of the sparsely ionizing components 2 During exercise body core temperature increases higher compared -such as electrons and fast protons - to the exposure , the latter to exercise on Earth. ones are used to determine the contribution of densely ionizing 3 The convective heat transfer from the human body is altered in radiation, namely heavy ions and neutrons. These measurements weightlessness and might have an impact on physiological and are considered to provide an upper estimate of the exposure. In biochemical pathways. order to calculate organ doses the depth dose distribution in the human body has to be known. The provision of this information is the scientifi c objective of the ESA facility MATROSHKA, under the 2:30 pm scientifi c and project lead of DLR. The MATROSHKA experiments [484] DEVELOPMENT OF ANESTHESIA PROTOCOLS FOR use a human phantom equipped with radiation detectors in EXPLORATION MISSIONS different depth and at organ sites to measure depth dose profi les M. KOMOROWSKI1,2, S.D. WATKINS2 AND and organ doses. MATROSHKA was launched in January 2004, J.B. CLARK3 since this time 4 data sets, one from an outside exposure and three 1 from an inside exposure are generated . Combining measurements Anesthesiology and Critical Care Department, 2 from personal dosemeters with the depth dose results enable a University Hospital of Lille, Lille, France; Exploration determination of the organ doses and hence the effective dose, Medical Capability, NASA Human Research Program, 3 defi ned as some of all organ doses. Houston, TX; Center for Space Medicine, Baylor College Of Medicine, Houston, TX Learning Objectives: 1 What are the differences and what is the motivation to asses INTRODUCTION: During exploration missions, medical different dosemetric quatities such as absorbed- and/or effective conditions requiring surgery are of a high level of concern dose for example? regarding the incidence versus crew health and impact on mission. Currently the exact level of surgical capability during an exploration mission is still to be defi ned. This research evaluated 2:15 pm anesthesia procedures enabling the treatment of most surgical [483] CHANGES IN THERMOREGULATION IN conditions. Autonomous medical capability will become a ASTRONAUTS ON ISS USING A NEW NON-INVASIVE requirement beyond low Earth’s orbit as no medical evacuation HEAT FLUX DOUBLESENSOR - PRELIMINARY DATA is possible. Providing safe anesthesia to allow surgery in this A. WERNER1,2, T. SCHLABS1, A.D. MOORE3, F. SATTLER4, context will be a highly challenging task. METHODS: Among the medical conditions considered by the NASA Human Research J. KOCH4 AND H. GUNGA1 1 Program (HRP) Exploration Medical Capability (ExMC) Team, Dept. for Physiology, Center of Space Medicine Berlin those potentially requiring anesthesia techniques have been 2 (ZWMB), Charité Berlin, Berlin, Germany; Dept. for Flight identifi ed, evaluating the most appropriate technique for each Physiology Diagnostics, Institute for AviationIP: 192.168.39.151 Medicine - On: Sun,condition. 26 Sep Furthermore2021 17:39:09 the large aspect of training time necessary German Air Force, Königsbrück, Germany;Copyright: 3Exercise Physiology Aerospace Medicalto implement Association regional anesthesia capability is discussed. Among Laboratory, Wyle Labs/NASA-JSC, Houston, TX; 4ResearchDelivered Unit, bygeneral Ingenta anesthetics, ketamine appears to be the most suitable, Draeger Werke, Lübeck, Germany because it combines the unique advantages of preservation of the cardiovascular stability, protective airway refl exes and spontaneous INTRODUCTION: Studies on thermoregulatory adaptations ventilation. The extensive experience of ketamine use gathered in of humans during space fl ight have been very limited to date or are remote environments, with minimal equipment and often by poorly even missing due to methodological constraints; last measurements trained care providers, certifi es its high degree of safety. Ketamine have been done nearly 30 years ago and could not answer side effects have tempered enthusiasm for its use for decades, but questions to body core temperature (BCT). But this elementary recent advances in mitigation means and evolutionary perspectives parameter infl uences several physiological and biochemical are analysed. For example, with the appropriate premedication, key pathways. With the new developed heat fl ux DoubleSensor psychomimetic effects occur in less than 2% of the patients. technology research on International Space Station (ISS) becomes RESULTS: Three different ketamine-based general anesthesia possible. We hypothesized that heat balance and thermoregulation protocols are described, with their corresponding indications. They are altered in humans in weightlessness. METHODS: Changes in have been designed taking into account the physiological changes BCT in conjunction with a submaximal exercise test performed pre- occurring in microgravity and the specifi c constraints of exploration , in- and post-fl ight in 12 Astronauts on ISS will be obtained. The missions. DISCUSSION: This analysis produced proposals for study started in 2009 with launching to the ISS and ends in 2012. anesthesia techniques in space, an HRP identifi ed gap in current The double Sensors will be placed on the head and a second one research. on the sternum. RESULTS: Out of 12 we have collected full data sets from 8 Astronauts so far. During three times pre-fl ight exercise BCT amplitude increased about 2.0°C compared to baseline; Learning Objectives: similar to a control group on Earth. On fl ight day (FD) 15 and 1 The audience will learn why having to perform anesthesia 45 we obtained a decrease in temperature amplitude of BCT during an exploration mission will be a highly challenging (1.0°C). On day FD135 and FD165 BCT amplitude increased to task. more than 3.5°C compared to prefl ight. In all FD measurements it 2 The audience will learn the differences between general and re- was recorded a prolonged elevation of BCT during the test. Post- gional anesthesia in the context of spacefl ight. fl ight BCT amplitude and elevation was not re-adapted and did 3 The audience will learn which general anesthesia protocol is best not reach pre-fl ight levels. DISCUSSION: The new non-invasive suited for surgery during an exploration mission.

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 343 ASMA 2012 MEETING ABSTRACTS

Thursday, May 17 1:30 PM acceleration loads during aeromedical evacuation in the CH-47 helicopter are generally unlikely to infl uence clinical outcomes, and that sustained Salon AB acceleration is not a critical consideration in casualty orientation. SLIDE: MULTIPLE AEROMEDICAL Learning Objectives: 1 The audience will learn whether the G loads experienced during EVACUATION VENUES helicopter aeromedical evacuation are of suffi cient magnitude to cause potential clinical concern in compromised patients. 1:30 pm [485] CHALLENGES IN PAIN MANAGEMENT FOR THE 2:00 pm AEROMEDICAL EVACUATED PATIENT [487] MEDICAL CARE DURING SEARCH AND RESCUE T. SVEINBJORNSON MISSIONS BY THE NETHERLANDS DEFENCE HELICOPTER Aeromedical Evacuation Flight, Royal Canadian Airforce, COMMAND: A RETROSPECTIVE ANALYSIS Trenton, ON, Canada R.P. WEENINK, M.G. VAN DER AA AND F. TERLOUW Aeromedical Service, Royal Netherlands Navy, Den Helder, INTRODUCTION: Soldiers wounded in the recent confl icts have sustained devastating and severely painful injuries. Vibration & Netherlands acceleration forces experienced during aeromedical evacuation (AE) INTRODUCTION: The Netherlands Coastguard can employ the will only exacerbate their pain. The consequences of inadequate pain helicopters of the Defence Helicopter Command for search and rescue management range from delayed recovery, post-operative pneumonia to (SAR) tasks at sea. A physician is part of the SAR crew in all missions. We chronic pain and PTSD. The conventional method of providing analgesia were interested in the medical aspects of the SAR missions. METHODS: for these patients through IV bolus dosing of opioids is potentially unsafe We reviewed the reports of all SAR missions performed from 2004 as it is diffi cult to monitor these patients and may be ineffective for a up to and including 2009, as fi led by the SAR team’s physician. We signifi cant portion of the evacuation. Patient controlled analgesia (PCA), extracted information on type of SAR mission, fl ight times, patient epidural analgesia (EA), and peripheral nerve blocks (PNB) are newer pain characteristics, diagnosis and treatment. RESULTS: 207 SAR missions management modalities such that have been safely utilized by military were performed from 2004 up to and including 2009, in 75% of which aeromedical evacuation teams with great success. The US & UK militaries medical care was delivered by the SAR team’s physician. Time between have published reports on their use of these techniques during AE.This notice and arrival with the patient was less than 90 minutes in 92% of presentation will: Review the challenges faced when managing pain cases. A total number of 174 patients was seen, in almost all cases the during aeromedical evacuation Describe the Royal Canadian Air Force patient was a single adult male. Some form of medical treatment was experience on the use of these novel analgesia modalities during AE. provided in 76% of the patients, the most common interventions being intravenous access, oxygen therapy and administration of medication Learning Objectives: and intravenous fl uids. Most common diagnoses were musculoskeletal, 1 Describe the techniques of PCA, EA, & PNB, including potential neurological or cardiological. In 11% of cases the diagnosis made by adverse effects the SAR physician did not match the fi nal diagnosis. DISCUSSION: The 2 Review the effectiveness and safety profi le of PCA, EA & PNB for large variation of clinical problems as well as the unique circumstances aeromedical evacuation pain management in which medical care has to be delivered call for the continuing 3 Describe the nursing challenges of caring for a patient with a PCA, presence of physicians during all SAR missions. EA, & PNB in fl ight. Debate the merits of nurses caring for these patients in fl ight without a physician present. Learning Objectives: 1 In Dutch offshore SAR missions, the typical patient is a single adult 1:45 pm male. [486] ACCELERATION LOAD DURINGIP: 192.168.39.151 CASUALTY On: Sun,2 26 In Sep Dutch 2021 offshore 17:39:09 SAR missions the kinds of clinical problems RETRIEVAL TRAINING IN THE CH-47 CHINOOKCopyright: Aerospace Medicalencountered Association are variable, but most diagnoses can be categorized Delivered by Ingentaas musculoskeltal, neurological or cardiological. HELICOPTER 3 The variation of clinical problems and the unique circumstances N.D. GREEN AND J. MCLEOD in which medical care has to be delivered during Dutch offshore Centre of Aviation Medicine, Royal Air Force, Bedfordshire, SAR missions require the presence of physicians on board SAR United Kingdom helicopters.

INTRODUCTION: Exposure to sustained linear and radial acceleration has been thought to have a potentially deleterious effect 2:15 pm on casualties during aeromedical transfer, particularly in those with [488] DETERMINATION OF THE INCIDENCE OF cardiovascular or circulatory compromise. However, little empirical MICRO-ASPIRATION IN CRITICALLY ILL PATIENTS data exist as to the magnitude of the forces involved. The need to UNDERGOING AEROMEDICAL EVACUATION understand these potential effects has become more important S. TURNER as the performance specifi cations of unmanned casualty retrieval RAF, CCAST, Otley, United Kingdom aircraft are developed. METHODS: A linear tri-axial accelerometer was mounted on an unoccupied NATO stretcher in the rear cab of INTRODUCTION: Critically ill patients, who are invasively a CH-47 helicopter. Measurement of acceleration load was made ventilated, are at risk of developing ventilator associated pneumonia during a training sortie for aeromedical evacuation, which included (VAP); in part, as a consequence of micro-aspiration of supra-glottic 12 landing/take off casualty collection events and ground threat material. This risk is recognised in civilian intensive care practice and avoidance maneuvers. Data were digitally acquired at a sample rate care bundles have been developed to mitigate this. No published of 50Hz and were lowpass fi ltered during software analysis. RESULTS: studies have looked at the incidence of micro-aspiration in fl ight Peak acceleration in the casualty Gz axis was +0.1G and -0.2G, where patients are exposed to the additional physiological stresses sustained for a maximum duration of approximately 20 seconds. Peak of vibration, g-forces and alterations in barometric pressure. In a acceleration in the Gx axis was +2.5G and in the Gy axis was 60.3G. patient population of service personnel returning from Afghanistan The largest changes in Gz acceleration were associated with take off to the UK between June 2009 and October 2010, 19% had evidence and landing. DISCUSSION: A maximum hydrostatic pressure change in of micro-aspiration at embarkation and this increased to 50% mid- head level blood pressure of around -3 to +5mmHg would be expected fl ight. This work also demonstrates the utility of pepsin as a marker for from the Gz values observed in this study. This suggests that typical micro-aspiration in the austere environment of military aeromedical

344 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS evacuation. While micro-aspiration remains a surrogate marker for the Thursday, May 17 1:30 PM subsequent development of VAP, potential mechanisms to reduce the occurrence of micro-aspiration in fl ight will be discussed. Salon D Learning Objectives: SLIDE: TOPICS IN CLINICAL MEDICINE II 1 To describe the factors infl uencing incidence of micro-aspiration in patients undergoing aeromedical transfer. 1:30 pm 2 To describe a method for determining the incidence of microaspira- tion appropriate to the austere environment of military aeromed. [491] PREVALENCE OF PERIODONTITIS AMONG FLYING CLASS II AVIATORS: A CROSS-SECTIONAL STUDY M. YAZDANIAN1 AND A. KHAMAKI2 2:30 pm 1Periodontology, Shahed University of Medical Sciences, Fac- [489] THE EUROPEAN AIR TRANSPORT COMMAND ulty of Dentistry, Tehran, Islamic Republic of Iran; 2Clinical AEROMEDICAL EVACUATION CONTROL CENTRE : Aviation Medicine, School of Aerospace and Diving Medicine, A STATUS REPORT AFTER A FIRST YEAR OF OPERATIONS Army University of Medical Sciences, Tehran, Islamic Republic F.H. CALLEWAERT, L. BRESSEM AND B. RENARD of Iran AECC, EATC, Eindhoven, Netherlands

INTRODUCTION: The European Air Transport Command ( EATC) and its Aeromedical Evacuation Control Centre (AECC) started working in September 2010. The organisation has been presented at last year’s ASMA meeting in Anchorage. After a full year of Aeromedical Evacuation missions, the AECC can give an overview with statistical analysis of these missions, highlight problems encountered and lessons learned, and provide give insight in the future projects of the AECC Learning Objectives:

1 The audience will receive a short introduction/reminder about the EATC-AECC structure and organization 2 The audience will learn about the numbers of patients evacuated, with a short statistical analysis of the distribution of these patients (Nationality, clas- sifi cation) and the assets used for these missions 3 Attendants will learn about the problems encountered regarding interoperability between the EATC nations and the organization of cross-national missions, and the projects developped to improve future cooperation between the EATC nations in the AE fi eld.

2:45 pm WITHDRAWN [490] UTILIZATION OF THE AIR FORCE RESCUE CENTER AND THE NATIONAL GAURD FOR THE EMERGENCY TRANSPORTATION OF A 1000LB PATIENTIP: 192.168.39.151 On: Sun, 26 Sep 2021 17:39:09 S.W. POWELL Copyright: Aerospace Medical Association Dartmouth Hitchcock Medical Center, Windsor, VT Delivered by Ingenta

INTRODUCTION: This will involve the presentation of a patient with a weight of over 1000+ lbs who drove himself to a rural ED. METHODS: Please see other sections RESULTS: Successful transfer and patient outcome of the patient after an extensive amount of resources were utilized. DISCUSSION: This patient was previously unknown in the community regarding his weight. After admission, the pt went into respiratory arrest requiring innovative resuscitative measures. The transport of this pt was extremely complicated, and after multiple considerations, ended up requiring the resources of the Air Force Rescue Coordination Center in Washington, DC, with eventual dispatch of an Army Reserve Chinook Helicopter that could handle the pt’s weight. Myself, and two paramedics fl ew with the patient to Dartmouth Hitchcock Medical Center where challenges in his care continued. He was, however, able to be discharged in one month, and is now engaged with a weight loss program. The presentation can involve a discussion format if desired, has multiple videos and pictures of the transport, and has a section at the end that involves education regarding emergency care of the super obese if desired and time allows. 1:45 pm [492] HEMOCHROMATOSIS: AEROMEDICAL Learning Objectives: CONSIDERATIONS 1 To understand challanges in the transportion of the superobese. R.B. RAYMAN 2 To understand the role of the Air Force Rescue Center in Washing- Aerospace Medical PLC, Alexandria, VA ton, DC in arranging emergency transportion. 3 To explore the local ground and air transportation methods in the INTRODUCTION: Hemochromatosis is an illness caused by local communites of attendees. mutation in the HFE gene resulting in increased iron absorption. The

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 345 ASMA 2012 MEETING ABSTRACTS iron can accumulate in multiple organ systems including the heart, RESULTS: During the 47th session at 2.5 ATA in hyperbaric oxygen liver, and pancreas. As a result, patients can develop congestive (HBO) the patient lost consciousness, she had tonic seizures lasting 46 heart failure, conduction defects, cirrhosis, hepatocellular cancer, seconds with hyperextension of the neck and the legs and fl exion of and diabetes. Treatment includes phlebotomy and chelation therapy. the upper limbs, followed by a phase of clonic seizures of 30 seconds This paper describes the basics of this illness including therapy of the upper and inferior limbs with urinary loss and lockjaw. It has with special emphasis upon its effects in an aviation environment. been immediately suspended the delivery of hyperbaric oxygen to Factors which must be considered in determining aeromedical the patient with the help of other patients present in the chamber disposition of aircrew with hemochromatosis will be discussed. who removed the face-mask of the woman, while the dedicated staff reached the patient in 90 seconds through the airlock, took the Learning Objectives: patient to the ground and put her in lateral recovery position. The 1 In determining aeromedical disposition of aircrew with hemochro- seizures ceased as the nursing staff entered the chamber without matosis, the factors that must be considered will be understood. the need for antiepileptics. The session was suspended and the ATA gradually reduced. In the post-critical phase there was recovery of consciousness after 45 minutes with retrograde amnesia. In the 2:00 pm Emergency Department the patient had a brain-CT scan, an EEG and [493] SLEEP-APNEA IN AIRCREW MEMBERS neurological examination without evidence of injury. DISCUSSION: A. KNOEFFLER It was formulated the proper diagnosis of HBO neurotoxicity, a grand ENT, GAFIAM, Fuerstenfeldbruck, Germany mal seizure expression of neurotoxicity due to hyperbaric oxygen in patients without previous epilepsy or specifi c risk factors. Although INTRODUCTION: The obstructive sleep apnea syndrome is this type of event is extremely rare, pre-treatment clinical evaluation characterized by periodically recurring obstructions of the upper and monitoring during the sessions via audio/video system makes it respiratory tract during sleep resulting in a decreasing partial possible to avoid more serious consequences to patients undergoing pressure of oxygen. Associated symptoms are snoring, daytime HBO. As demonstrated in our case, it is a self-limited event that does not fatigue, obstructive changes in the area of the upper respiratory tract, require anticonvulsant therapy without neurological sequelae. Although cardiovascular symptoms, obesity, hypertension, and an increased the patient had no risk factors, the sessions were suspended after the event without recurrence at a median follow-up of 10 months. risk of stroke. Approx. 1% of the overall population is affected, i.e. mainly men aged between 40 and 65. Predisposition of overweight people regarding obstructive sleep apnea in connection with an Learning Objectives: arterial hypertension has been adequately proven. Furthermore, 1 Increase the awareness of hyperbaric professionals on HBO neuro- additional questions arise in the fi eld of military aviation. It has toxicity. to be evaluated, for example, to what extent fi tness for foreign 2 Highlight the diagnostic features of HBO neurotoxicity. assignments is applicable to aircrew members who are equipped 3 Open the discussion on prevention and further treatments of rare with an nCPAP mask. METHODS: In the course of an aeromedical cases of HBO neurotoxicity. evaluation, the following must be taken into account: The diagnosis must be validated by polysomnography; apnea-hypopnea index (AHI) 2:30 pm > 5 occurrences per hour (in serious cases, up to 30). Successful [495] ANALYSIS OF THE UNITED STATES CIVIL PILOT therapy must be objectifi ed by a medical sleep examination. A multi-channel recording device (MESAM 4) is used for this purpose. POPULATION: 1983-2005 Should the suspected sleep-related respiratory dysfunction be P. ROGERS confi rmed, measurements are carried out on an in-patient basis, Federal Aviation Administration, Oklahoma City, OK which includes the possibility of adjusting an nCPAP mask. Different measurement parameters such as BMI, AHI, O2 saturation, vigilance (ESS = Epworth Sleepiness Scale), type of aircraft, age, etc. are set in relation to one another. RESULTS: FirstIP: results 192.168.39.151 show that the BMI On: Sun, 26 Sep 2021 17:39:09 e.g. is positively correlated with the HI and theCopyright: AHI, but negatively Aerospace Medical Association correlated with the AI. The corresponding fi gures gathered Deliveredthrough by Ingenta examination of approx. 50 subjects are going to be presented. DISCUSSION: Considering sleep-related respiratory dysfunction regularly when evaluating a patient’s medical history leads to a high reliability of the diagnosis.

Learning Objectives: 1 Sleep Apnea 2 Releveant measurement parameters of sleep apnea 3 Correlation between different parameters

2:15 pm WITHDRAWN [494] HYPERBARIC OXYGEN NEUROTOXICITY: REPORT OF A NEW CASE L. PRISCO1, M. GANAU2, I. BATTICCI1, G. BERLOT1 AND A. RINALDI1 1Training School of Anaesthesiology, Intensive Care and Hyper- baric Medicine, Trieste Italy; 2Graduate School of Nanotechnol- ogy, University of Trieste, Trieste Italy

INTRODUCTION: A recent review demonstrated an overall incidence of oxygen-toxic seizure of 1:3,388 treatments (0.03%). METHODS: A 69-years old woman with no history of epilepsy for some years now complained of algodystrophy of the left femur with initial cephalic necrosis of the bone. The patient started a cycle of 60 sessions of 90 minutes each at 2.5 Absolute Atmospheres (ATA).

346 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS

2:45 pm evaluation of these applicants. The US aeromedical examiners’ perspective [496] THE BLAND-ALTMAN STATISTICAL APPROACH FOR will be compared with other certifi cation authorities. The neurological and ASSESSING AGREEMENT AMONG MEASURES: ARE WE neuropsychological consultant’s approach to recertifi cation after a stroke MEASURING THE SAME THING? will be outlined and policy development for FAA certifi cation of aviators L.A. TEMME, J. CAPO-APONTE AND D.L. STILL with cerebrovascular disease will be discussed. Sensory Research Division, USAARL, Fort Rucker, AL [498] FAA AEROMEDICAL CERTIFICATION OF PILOTS WITH INTRODUCTION: Over the past 20 years, the Bland- HISTORY OF STROKE OR TRANSIENT ISCHEMIC ATTACK Altman approach has essentially become the standard method for W.D. MILLS quantifying the agreement between two sets of measures of the FAA Civil Aerospace Medical Institute, Oklahoma City, OK same construct made with two different measurement devices or the same device repeating the measurements. INTRODUCTION: Cerebrovascular disease is a potential The Bland-Altman approach is the preferred alternative to the more aviation safety hazard that has recently been the subject of increased traditional approach that typically incorporates plotting one set of aeromedical attention. Stroke and transient ischemic attack (TIA) measurements against the other, and looking for linear regressions represent a growing challenge to aeromedical certifi cation authorities and statistically signifi cant correlations and R-squares. The purpose due to aging of the pilot population and the trend for increasingly of this presentation is to call the Bland-Altman methodology to complex certifi cation procedures to assure adequate recovery and the attention of the AsMA scientifi c community, highlight the suffi ciently low risk of recurrence. There are more than 450 pilots shortcomings of earlier correlational approach, illustrate the currently certifi ed by the FAA who are known to have a history of differences between the two methods, and identify statistical stroke or TIA. FAA procedures for certifi cation of applicants with software that performes the Bland-Altman analysis. METHODS: A history of stroke have recently been updated. Descriptive statistics for set of data will be analyzed using both the traditional correlational history of stroke and TIA in U.S. civilian aviators will be presented and and the Bland-Altman methods to illustrate the difference between compared with population data. The new certifi cation procedures will the two approaches, as well as to highlight the ways in which the be detailed and contrasted with historical protocols. traditional correlational analysis may be misleading, for example, when the extent of the agreement between the two measurement Learning Objectives: devices changes over the range of measurements, when the 1 To appreciate the prevalence of stroke and TIA in the US Pilot data deviate from normalcy, and when there is a constant bias. population. RESULTS: Although the Bland-Altman has replaced the traditional 2 To understand the updated FAA procedures for certifi cation of correlational analysis, SPSS does not support the Bland Altman aviators with history of a stroke. analysis, but it can be relatively easily performed with Excel or with SPSS syntax. Both methods will be illustrated. Other software systems that incorporate the Bland-Altman method are also [499] APPROACH TO THE MANAGEMENT OF PILOTS WITH identifi ed. DISCUSSION: The Bland-Altman methodology seems STROKE; AN INTERNATIONAL AVIATION MEDICAL to be an approach to equivalence testing in which one concludes EXAMINER PERSPECTIVE that the measurements obtained with method A are not D.A. BRYMAN signifi cantly different from the measurements obtained with Aviation Medicine, Scottsdale, AZ method B, which is the challenge of proving the null hypothesis. INTRODUCTION: Stroke is the third leading cause of death in Learning Objectives: the USA. Each year, approximately 795,000 people suffer a stroke. As 1 To call attention to and illustrate the strength of the Bland-Altman stroke will result in a sudden incapacitation, it is of particular interest methodology over the correlational analyses that has historically in the aeromedical community. The disease is typically a result of a been used for the same purposes. cumulative effect of multiple risk factors such as obesity, hypertension, IP: 192.168.39.151 On: Sun,high 26 cholesterol Sep 2021 and 17:39:09 advanced age. The aviation medical examiner’s Copyright: Aerospace Medical(AME) role Association is to determine if a pilot meets standards of part 67. In Delivered byreviewing Ingenta a pilot’s history and performing a physical examination, Thursday, May 17 3:30 PM the AME also has the opportunity to provide advice and counseling Ballroom A regarding the airman’s health as it may relate to the development of sudden incapacitation. This presentation will discuss the AME’s role in certifying pilots with stroke not only within the FAA system but also PANEL: AEROMEDICAL CERTIFICATION OF abroad in Europe, Canada, Australia and New Zealand. AVIATORS AFTER STROKE Learning Objectives: [497] AEROMEDICAL CERTIFICATION OF AVIATORS AFTER 1 To understand the AME’s role in medical certifi cation of pilots with STROKE stroke To understand the different international approaches in the W.D. MILLS1, D.A. BRYMAN3, J.D. HASTINGS5, K.P. O’BRIEN4 certifi cation of pilots with stroke 2 To understand the importance of identifying risk factors in pilots AND M.A. BERRY that can lead to stroke 1FAA Civil Aerospace Medical Institute, Oklahoma City, OK; 2Federal Aviation Administration, Washington, DC; 3Aviation Business Center, Scottsdale, AZ; 4Arizona Neuropsy- [500] NEUROLOGICAL PERSPECTIVES IN PILOT chology, Scottsdale, AZ; 5Neurologic Medicine PLLC, ASSESSMENT FOLLOWING TRANSIENT ISCHEMIC ATTACK Tulsa, OK AND STROKE J.D. HASTINGS Pilots with history of a stroke present an increasing challenge to 1Neurologic Medicine PLLC, Tulsa, OK aeromedical certifi cation authorities due to the aging pilot population and growing concern regarding this condition. There have been recent INTRODUCTION: Clinical manifestations of stroke include changes in the FAA’s procedure for medical certifi cation of US aviators motor or somatosensory defi cit, special sensory defi cit, language after a stroke that increase the evaluation required for aeromedical disturbance and cognitive impairment. Risk of recurrence and residual recertifi cation. Continued evolution of these certifi cation protocols is neurological defi cit that may result in sudden or subtle incapacitation likely. This panel will present demographics of US aviators certifi ed are major considerations in medical certifi cation policy and individual with a history of stroke and detail the newly updated FAA protocols for aeromedical disposition following stroke. Stroke may be thrombotic

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 347 ASMA 2012 MEETING ABSTRACTS or hemorrhagic, and is a heterogeneous entity with many etiologies. wait time post stroke and TIA before considering medical certifi cation. This hampers development of a uniform regulatory policy toward The status of FAA neurologic special issuance policy today will be certifi cation following stroke and transient ischemic attack. Individual discussed as well as plans for the future. aeromedical disposition following stroke or TIA is similarly problematic for the aeromedical evaluator. There is considerable variability in policy Learning Objectives: among medical certifi cation authorities. These vexing issues will be 1 How FAA medical policy is developed. highlighted. Neurological concepts for pilot assessment following 2 The importance of having data driven FAA medical policy regard- stroke or transient ischemic attack will be offered. ing neurologic diagnoses. 3 Current FAA special issuance medical certifi cation policy for stroke Learning Objectives: and TIA. 1 To understand the heterogeneous nature of stroke 2 To understand the diffi culty of uniform regulatory policy for stroke 3 To understand neurologic concepts important in individual pilot Thursday, May 17 3:30 PM assessment following stroke and transient ischemic attack Ballroom B [501] TITLE: APPROACH TO THE MANAGEMENT OF PILOTS SLIDE: AVIATION SAFETY POTPOURRI WITH STROKE; A NEUROPSYCHOLOGICAL PERSPECTIVE K.P. O’BRIEN 3:30 pm Arizona Neuropsychology, P.C., Scottsdale, AZ [503] A MISSED APPROACH OF A F-18 AND AN EJECTION INTRODUCTION: Stroke risk increases with age; annual WITH NVG. A CASE REPORT 1 1 2 3 incidence doubles approximately every decade after age 45. As stroke R. SOVELIUS , L. TIITOLA , T. KARSTILA AND T.K. LEINO may result in acute and chronic changes in cognitive and physical 1Centre for Military Medicine, Tampere, Finland; 2Suomen abilities, it is relevant to older pilots, particularly those in general Terveystalo, Tampere, Finland; 3Finnish Air Force Headquarters, aviation. While marked defi cits are obvious, subtle diffi culties may not Tikkakoski, Finland be fully appreciated without formal assessment. Neuropsychologists familiar with aviation can provide relevant input to the AME and INTRODUCTION: A Finnish Air Force (FINAF) F-18 pilot medical certifi cation process regarding neurocognitive abilities and landed accidentally on the taxiway parallel to the runway when using capacities as they relate to aviation safety. Given the diversity of stroke night vision goggles (NVG). At the end of taxiway the aircraft ended etiologies, localization and extent of neurological involvement, as to the snow wall resulting in a risk of overturn. Pilot ejected from the well as individual differences among pilots, it is important to use a aircraft without removing the NVG from the helmet. METHODS: The fl exible neuropsychological assessment approach that takes these accident investigation board made human factors analyses of visual multiple factors into account. There is no one battery appropriate for perception and decision making process of the pilot by interviews, all pilots who have suffered neurovascular events (e.g., TIA, embolism, head-up display video and other in-fl ight recorded data. Pilot’s ischemia). This presentation will discuss the neuropsychologist’s role in cervical spine was examined by computer tomography (CT) and evaluating pilots with stroke and propose guidelines as to when and how magnetic resonance imaging (MRI) right after the accident and MRI neuropsychological input might best be utilized in the certifi cation process. was performed again after nine months follow-up time. Similarly, the mobility of spine and the muscular performance was conducted by Learning Objectives: physiotherapist immediately after the accident and upon completion 1 To understand neuropsychologist’s role in medical certifi cation of of nine months follow-up. RESULTS: The reason of the accident was pilots with stroke NVG-inexperienced pilot’s wrong visual perception due to the taxiway 2 To understand the diffi culty of detecting subtle neurocognitive lights during the fi nal approach. NVG dropped off during ejection defi cits and it did no harm to the pilot. No injuries or changes were found 3 To understand the importance of identifyingIP: 192.168.39.151 neurocognitive On: Sun,in 26 clinical Sep or2021 imaging 17:39:09 examinations and long-term effect did not changes relevant to aviation safety Copyright: Aerospace Medicalappear. DISCUSSION: Association The statements and conclusions of the accident Delivered by investigationIngenta report are described. The possible reasons for the good [502] FAA POLICY DEVELOPMENT FOR RETURN TO FLYING clinical outcome of the NVG-ejection in this case were slow ground AFTER STROKE OR TIA speed (~50 kts), pilot’s neutral posture and the disconnection of the M.A. BERRY NVG-device during ejection. These factors as well as present potential Medical Specialties Division, FAA - HQ, Washington, DC risks for ejection with helmet mounted devices are discussed.

INTRODUCTION: The Federal Aviation Administration (FAA), Learning Objectives: Medical Specialties Division at Headquarters in Washington, D.C. is 1 Human aspects of accident investigation are described. responsible for developing medical certifi cation policy for the Federal 2 Factors affecting to the clinical outcome of ejection with helmet Air Surgeon. In April 2010, the Medical Specialties Division convened mounted device are discussed. a Neurology Summit for the purpose of examining existing special issuance medical certifi cation policy for neurologic diagnoses in light 3:45 pm of the many advances in technology and the practice of neurology. [504] WHEEL WELL STOWAWAY SURVIVAL: The Summit brought together prominent FAA neurology consultants and medical certifi cation physicians. Prior FAA medical policy on 20 YEAR REVIEW neurologic diagnoses was based on published data (Neurological S.J. VERONNEAU and Neurosurgical Conditions Associated with Aviation Safety. Aerospace Medical Research Division, FAA Civil Aerospace Arch Neurology 1979. 36:731-812). The FAA’s desire was to update Medical Institute, Oklahoma City, OK current policy and move towards data-driven certifi cation policy and decisions (evidence-based medicine). Among the Summit’s major INTRODUCTION: A fatal stowaway case occurred in 2010, areas of discussion was medical certifi cation of airmen post stoke and representing the fi rst USA-origin stowaway case since 1972. A body was transient ischemic attack (TIA). Stroke poses a potential safety hazard found in Milton, MA on November 15. The numerous severe injuries due to possible sudden incapacitation from recurrent stroke or from and the location in a residential area hundreds of miles from Charlotte, post-stroke seizure. There is also risk of subtle incapacitation due to NC where the young teenager lived were unusual. The body was neurocognitive defi cits or depression. Policy changes recommended by found near the LOM for the 4R ILS approach to Boston Logan airport. the Summit were in the areas of use of neurology expert consultation, Aviation grease was noted on the body of the 15 year old. METHODS: the scope of the required medical work-up and by whom, and the At the FAA Civil Aerospace Medical Institute such stowaway events

348 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS in the wheel wells of commercial aircraft have been studied since a Learning Objectives: well publicized event in 1993. A review of media reports from the NY 1 Understand the causes of aerobatic aircraft accidents Times was begun in the fi rst study and is on-going today. Google News 2 Understand the survival outcomes in aerobatic aircraft accidents Alerts automate the surveillance and enable a worldwide scope. Close cooperation with the DHS and FAA Offi ce of Public Affairs had gone on for more than a decade. RESULTS: The fi rst case of an aircraft stowaway 4:15 pm was 27 November, 1918. A review (Véronneau 1996)1 highlighted the [506] SPATIAL DISORIENTATION: MORE THAN JUST problem and documented 5 of 11 attempts were successful. The most ILLUSIONS recent survivor was that of a young Russian teenager, who endured B.S. CHEUNG a 50 minute, 300 km, fl ight in a turboprop aircraft, an Antonov An- National Defence, DRDC Toronto, Toronto, ON, Canada 24, on 29 October 2010. The most recent fatal case was a 23 year old male stowaway of Cuban nationality, who was discovered with INTRODUCTION: Despite aggressive efforts in spatial crush injuries in the Airbus A340-300 wheel well of Iberian Airlines disorientation (SD) research, hardware development and aircrew fl ight 6620 from Havana, Cuba to Madrid, Spain on 13 July 2011. training, the operational impact of SD in terms of crew and aircraft The highest altitude exposure of a known survivor was FL390. As of losses remains signifi cant. METHODS: Spatial orientation (SO) training abstract submission there have been 89 person-attempts, involving was re-examined. RESULTS: Current SO training is primarily composed 79 fl ights, with 71 fatalities and 18 survivors. Survivorship of 20.3% of didactic lectures on the sensory systems. Signifi cant effort has been has been stable for several years as suffi cient cases were accumulated concentrated on reproducing various types of visual and vestibular over the years. DISCUSSION: Wheel well stowaway survival had been “illusions” that pilots might encounter in fl ight, with limited success. thought to be impossible. The phenomenon has a 20% survivor rate, DISCUSSION: The terms of “SD” and “illusion” inadvertently have including very high altitude exposures, providing a challenge to what been used synonymously. It is the general belief that if one were to we know about human physiology in extreme environments. The recent be exposed to a specifi c type of illusion, one can prevent or avoid domestic case highlights the security concerns that were raised in the SD mishaps. Another setback is due to the inability of ground-based 1996 publication and technical report DOT/FAA/AM-96/25: Survival devices to reproduce the fl ight envelope; deception was used in at High Altitudes: Wheel-Well Passengers; Veronneau SJH, Mohler SR, reproducing some illusions. The demonstration of a specifi c illusion Pennybaker AL, Wilcox BC, Sahiar F. Aviat Space Environ Med 1996; often ends abruptly without further explanation on pilot performance. 67:784-6. Imprecise training strategy could precipitate negative training. It should be emphasized that there is not a single causal factor in most accidents Learning Objectives: nor is it often due to a specifi c illusion. The aetiology of SD involves 1 What is the fatality percentage of known wheel well passengers? input error where there is an absence, inadequate or confl icting sensory 2 What are the security implications of these wheel well stowaway inputs, and central error where correct and consistent sensory inputs attempts? were misinterpreted by the central nervous system. Demonstration 3 What are some new methods of scrutinizing media in the internet of illusion only explains the consequences of inadequate or absence age? of sensory input but not the precipitating factors or central error. We should provide the pilots with skills to anticipate and assess the risk of SD during mission planning. Pilots should be sensitized to the 4:00 pm physical and mental performance decrement during sensory confl icts [505] AN ANALYSIS OF ACCIDENTS INVOLVING and inadequacies. Recommendations should also be made on possible AEROBATIC AIRCRAFT IN AUSTRALIA, 1980 - 2011 ways to recover from SD should they become disoriented. Special D.G. NEWMAN attention is drawn to the properties of various fl ight displays that may Aviation, Swinburne University, Hawthorn, VIC, Australia contribute to SD. G-tolerance and disorientation should be examined together in high performance aircraft as there is a close relationship INTRODUCTION: Aerobatic fl ight operations involve a between exposure to acceleration and maintaining orientation. In higher level of risk than standard fl ight operations.IP: 192.168.39.151 Aerobatics On: Sun,conclusion: 26 Sep 2021Train as 17:39:09 you fl y, be prepared, anticipate and react properly. imposes considerable stresses on both the aircraftCopyright: and the pilot, Aerospace Medical Association and the physiological consequences of exceeding the G toleranceDelivered byLearning Ingenta Objectives: of the pilot have been well described. The purpose of this study 1 The audience will learn about the mechanism of spatial orienta- was to analyse civilian aerobatic aircraft accidents in Australia, tion, why illusion demonstration is inadequate and the profi ciency with particular emphasis on the underlying accident causes and spatial orientation training strategies. the survival outcomes. METHODS: The accident and incident database of the Australian Transport Safety Bureau was searched for all events in which the type of operation was identifi ed as aerobatic 4:30 pm fl ight. The period chosen was a thirty-year period, from 1980-2010. [507] THE IMPACT OF A WEATHER TRAINING TOOL RESULTS: For the study period, a total of 51 accidents involving (WEATHERWISE) ON PILOT DECISION-MAKING aircraft undertaking aerobatic fl ight operations were identifi ed, C. KIM1, D.A. WIEGMANN2 AND S.A. SHAPPELL1 involving 70 aircraft occupants. Of these accidents, 27 (52.9%) 1Industrial Engineering, Clemson University, Clemson, SC; were fatal, resulting in a total of 36 fatalities. There were 24 non- 2Industrial and Systems Engineering, University of Wisconsin - fatal accidents. In terms of injury outcomes, there were 3 serious Madison, Madison, WI and 9 minor injuries, and 22 accidents in which no injuries were recorded. Fatal accidents were mainly due to loss of control by the INTRODUCTION: Previous studies of general aviation (GA) pilot (44.4%), in-fl ight structural failure of the airframe (25.9%) accidents have shown that decision errors are often associated with and terrain impact (25.9%). There was 1 mid-air collision during a fatal GA accidents, particularly those involving continued visual formation aerobatic display. Non-fatal accidents were mainly due to fl ight rules (VFR) fl ight into instrument meteorological conditions powerplant failure (41.7%) and non-catastrophic airframe damage (IMC). Existing literature suggests that knowledge, experience, (25.0%). DISCUSSION: The results of this study highlight the risks motivation, and weather information frequently have all been involved in aerobatic fl ight. Exceeding the physiological limits of the identifi ed as causal factors of weather-related GA accidents. Put pilot (with loss of control including episodes of G-induced loss of simply, many GA pilots simply did not realize the extent of the consciousness), the operational limits of the maneuver and the design adverse weather they were fl ying into. Therefore, the purpose of this limits of the aircraft are all major contributors to a fatal aerobatic study was to examine the effects of weather recognition training on aircraft accident. Improved awareness of G physiology and better GA pilots’ in-fl ight decision-making under gradually aggravating operational decision-making while undertaking aerobatic fl ight may weather conditions. METHODS: Forty GA pilots were recruited help prevent further fatal accidents. locally in South Carolina and randomly split into two groups: 20

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 349 ASMA 2012 MEETING ABSTRACTS pilots (experimental group) received roughly 30 minutes of pre- Thursday, May 17 3:30 PM fl ight training using WeatherWise (a Federal Aviation Administration approved computer-based weather training program developed to Ballroom D improve GA pilot weather-related decision-making) and 20 pilots (control group) received training on the effects of mental fatigue. PANEL: DATA ACCESSIBILITY FOR After computer-based training, fl ight planning, and a weather briefi ng, all subjects were tasked with fl ying a simulated fl ight over a OCCUPATIONAL SURVEILLANCE AND LIFE mountain ridge into progressively deteriorating weather conditions. SCIENCE RESEARCH They were instructed that the aircraft (a Cessna 172) was not certifi ed for instrument fl ight and that the fl ight was to be fl own using [509] DATA ACCESSIBILITY FOR OCCUPATIONAL VFR only. RESULTS: The WeatherWise training group exhibited a SURVEILLANCE AND LIFE SCIENCE RESEARCH signifi cantly better weather assessment as measured by their ceiling M. VAN BAALEN estimation and decision accuracy as measured by the distance NASA, Houston, TX fl own into adverse weather condition. Moreover, the WeatherWise training group was more conservative when deciding whether to fl y Experts from NASA, international partners, commercial into adverse weather conditions. Of note, no signifi cant differences sector, and military will discuss data accessibility for occupational between groups were found in the pilot’s risk assessment or decision surveillance and life science research. Each group must protect the confi dence. DISCUSSION: WeatherWise training was effective at data according to each agency’s and/or country’s laws while enabling increasing the accuracy of weather decision-making and reducing the use of the data in an effective manner. The issues and overcoming likelihood that pilots would fl y into adverse weather. challenges provide a good discussion topic. Learning Objectives: [510] SHARING AND PROTECTION OF DATA IN NASA’S 1 Describe how general aviation pilot’s decide to proceed into dete- LIFETIME SURVEILLANCE OF ASTRONAUT HEALTH riorating weather conditions. PROGRAM 2 Identify useful tools for training general aviation pilots on in-fl ight M. VAN BAALEN weather decision-making. NASA, Houston, TX

4:45 pm INTRODUCTION: NASA’s Lifetime Surveillance of Astronaut [508] DEVELOPMENT OF A FIRE RETARDENT COMBAT Health (LSAH) program aims to not only provide occupational SHIRT FOR APACHE AIRCREW medicine throughout the astronaut’s lifetime but also develop policy M.J. TRUDGILL1 AND M.S. ADAMS2 and tools to effectively maintain privacy and protection of medical 1Royal Air Force, Centre of Aviation Medicine, RAF Henlow, data. With this in mind it is LSAH’s goal to support operational, health 2 care, and research analyses with the many collaborators who may United Kingdom; Royal Air Force, Centre of Aviation Medicine, successfully use the data. The stakeholders of LSAH data include NASA RAF Henlow, United Kingdom researchers and clinicians, international partners, the commercial spacefl ight sector, other government agencies, academia, researchers INTRODUCTION: UK Apache crews deployed in Afghanistan in industry, and the LSAH participants themselves. The large number of suffered with thermal stress during the summer’s months in part due collaborators and importance of data privacy provides a unique set of to the extensive Aircrew Equipment Assemblies (AEA) required for challenges for LSAH to resolve. operations. The UK employs a layered approach to clothing ensembles for aircrew that provides protection from fl ash fi re whilst giving the Learning Objectives: user the ability to select the appropriate clothing for the mission. As 1 The balance between data sharing and data protection for a small minimum crews are required to wear a fi re retardant next to skin layer sample size is described. over which a further fi re retardant combatIP: jacket 192.168.39.151 and trousers are On: Sun, 26 Sep 2021 17:39:09 worn. When this was coupled with fragmentationCopyright: vest, survival Aerospace jacket Medical[511] EXPANDING Association USE OF NASA LIFE SCIENCES RESEARCH and ballistic plates the burden became too great. Ground troopsDelivered by by DATAIngenta BEYOND THE ORIGINAL PURPOSE contrast were able substitute their vest and jacket for a thinner Under M. FITTS Body Armour Combat Shirt but this was deemed unsuitable for aircrew as non FR fabrics were employed in its construction. METHODS: The NASA, Houston, TX Aircrew Equipment Integration Group at the RAF Centre of Aviation INTRODUCTION: NASA’s Life Sciences Data Repository Medicine undertook an accelerated development and testing program Archive houses data and information collected during space fl ight- to provide a suitable solution for Apache aircrew. This drew on feedback related research. Making this data available beyond the original intent from operational crews to defi ne design criteria and strove to reduce has been challenging but remains a primary goal of the repository due thermal burden whilst retaining adequate protection from fl ash fi re. to the limited opportunities to conduct such research and collect this The completed garment employed a double layered sleeve design type of data / information. that reduced to single kermel viscose layer in the axilla and in areas coved by the fragmentation vest. Pockets were designed to carry the Learning Objectives: morphine auto injectors in positions where they remained accessible but minimised the snagging hazard. Testing included integration assessments 1 The balance between data sharing and data protection for life comfort trials and burn tests using an instrumented mannequin. sciences research data is described. RESULTS: Test results were satisfactory and the reduction of clothing layers under the body armour system did not degrade protection from [512] PROTECTION AND SHARING OF MEDICAL DATA fl ash fi re. The fi nal production garments were fi elded within 4 months of OBTAINED FROM COMMERCIAL SPACEFLIGHT the initial request and feedback from theatre remains positive. PARTICIPANTS AND FLIGHT CREW J.M. VANDERPLOEG Learning Objectives: 1University of Texas Medical Branch, Galveston, TX; 1 Accelerated development, testing and production of aircrew 2Virgin Galactic, Houston, TX equipment can be achieved. 2 The layered approach to FR clothing may include survival aids or INTRODUCTION: As the commercial sector becomes ballistic protection. increasingly involved in spacefl ight, considerations must be made for 3 Incorporation of a double layered sleeve ensures aircrew the sharing of medical data obtained from commercial spacefl ight compliance with fl ash fi re minimum protection requirements. participants in a useful manner while protecting the data according

350 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS to industry and government guidelines. With these issues in mind, Dr. neurological symptoms provide data that allow determination of Vanderploeg will discuss plans for creating a database that meets the differences and similarities in the mechanisms of energy compromise needs of the medical support and research communities. of the different alterations that produce LOC. DISCUSSION: LOC is an important and widespread aspect of the human and animal Learning Objectives: life experience as well as necessary survival, economic, clinical, 1 The similarities and differences between data handling of fl ight social, and scientifi c topics for investigation. These data provide key crew and spacefl ight participants will be discussed. parameters that may be input to computational physiological modeling to improve our understanding of these alterations. [513] TOWARDS INTERNATIONAL OPEN DATA PRINCIPLES IN HUMAN SPACE LIFE SCIENCES RESEARCH: TRANSLAT- Learning Objectives: ING SUCCESS FROM OTHER RESEARCH DOMAINS 1 Learn the key parameters that may serve as input in computational M. SAARY1,2 AND M. TURNOCK2 physiological models to improve our understanding of loss of consciousness. 1Canadian Forces Environmental Medicine Establishment, Toronto, ON, Canada; 2Department of Medicine, University of Toronto, Toronto, ON, Canada 3:45 pm INTRODUCTION: International Space Agencies must follow [515] CERVICAL-VESTIBULAR EVOKED MYOGENIC the laws and practices of their respective countries and agencies with POTENTIALS IN AIRCREWS EXPOSED TO EJECTION regards to data sharing. Among other issues, small sample sizes can SEAT LAUNCH sometimes be a barrier in space medicine research. Examining other M. LUCERTINI, E. BUCCINO, F. PICCOLI AND research domains that have used open-data principles could shed light M. CINIGLIO APPIANI on how to enable more effective data processes in space medicine. Institute of Aviation Medicine, Italian Air Force, Rome, Italy

Learning Objectives: INTRODUCTION: Cervical Vestibular Evoked Myogenic 1 By examining the successes of different communities, some alter- Potentials (c-VEMPs) represent a non-invasive method to analyse native data-sharing strategies as well as the foreseeable barriers can the saccular maculae of the vestibular system. The orientation of be addressed. such sensors within the skull indicates a high sensitivity for vertical acceleration (i.e. on the z-axis), in contrast with the utricular maculae, which are horizontally oriented in the standing subject. Ejection Thursday, May 17 3:30 PM seat launchs (ESLs) produce a very high and potentially hazardous Salon AB stimulation on the z-axis (around + 15 Gs). Since this level of acceleration exceeds by far the saccular physiological range of activity, SLIDE: EFFECTS OF ACCELERATION this might also induce a damage of the sensory epitelium, as already documented for the utricular organs after sudden accelerations on the ENVIRONMENTS x-axis. Therefore, aim of this study was the investigation of the saccular physiology, as analysed with the c-VEMPs, in a sample of pilots with previous exposure to ESL. METHODS: Ten male pilots aged between 3:30 pm 29 and 51 yrs, with a past history positive for ESL from different types of [514] MINIMUM TIME TO ALTERED NEUROLOGICAL aircrafts, underwent a ENT investigation, with removal of possible wax/ FUNCTION: THE VERTICAL ASYMPTOTE OF THE +GZ-TIME debris from the external ear canal, PTA and impedance testing, and TOLERANCE CURVE analysis of the vestibular system, which included c-VEMPs recording. T. WHINNERY1, E.M. FORSTER2 AND D.A. SELF2 The data were compared with those of ten healthy pilots with a similar 1University of Oklahoma, OklahomaIP: City, 192.168.39.151 OK; 2Civil Aerospace On: Sun,age 26 and Sep fl ight 2021 history, 17:39:09 but no previous ESL. RESULTS: The c-VEMPs Medical Institute, FAA, Oklahoma City, OK could be bilaterally recorded in all control subjects, where normal Copyright: Aerospace Medicallatency and Association amplitude values were observed. In those pilots with Delivered byprevious Ingenta ESL, the c-VEMPs could be bilaterally recorded in only 8 out INTRODUCTION: Conservative estimates suggest that 21 of 10 subjects, while in the remaining 2 individuals the response could million animal and 141,000 human loss of consciousness (LOC) not be obtained unilaterally in one case and bilaterally in the other. The episodes occur daily. Understanding the complex signs and symptoms statistical analysis did not show signifi cant differences between the two associated with LOC is therefore an essential aspect of understanding samples. DISCUSSION: Despite the lack of statistical support, our study life in our environment. Consciousness is an integrated organismal shows an atypical absence of c-VEMPs in a population exposed to ESLs process requiring an adequate supply of energy (oxygen) to cephalic (20% of cases). Such a fi nding should be taken into account, specially neurological substrates. These substrates tolerate energy reductions when aircrews with past history of ESL report balance disorders. for only a minimal amount of time. A complex of time dependent Nevertheless, further investigation is certainly needed, due to the small signs and symptoms results in organisms when normal oxygen supply sample size that could be analysed in the present study. is compromised. Alterations that compromise adequate oxygen supply through ischemia and hypoxia include exposure to altitude, Learning Objectives: acceleration, choking, hanging, asphyxiation, exsanguination, cardiac 1 improve the knowledge on the clinical investigation of the vestibu- rate and rhythm disturbances, and vascular compromise. METHODS: lar system Minimum time to neurological compromise and LOC resulting from 2 to focus attention on possible vestibular derangements in pilots these various alterations was established from a meta-analysis of who underwent an ESL studies associated with LOC. The time course of the symptom complex 3 when needed, to produce objective fi ndings aiming at facilitating a (LOC syndrome) was also analyzed for each type of alteration. The rehabilitation process in pilots after an ESL minimum time to acceleration (+Gz) induced loss of consciousness (G-LOC) was determined from the horizontal asymptote of the G-time tolerance curve resulting from the analysis of over 800 G-LOC 4:00 pm episodes in healthy USAF and USN personnel. RESULTS: Plotting +Gz-onset rate (y) versus time (x) gives the equation y= 15.603x-0.0607 [516] ROLE OF HEAD-UP TILT TABLE STUDY IN THE describing a hyperbolic curve with the limiting value of time being EVALUATION OF G-LOC: A CASE REPORT 6.1s. This limiting value of the vertical asymptote was then compared K. CHIANG to the minimum time to produce LOC by other alterations. Comparison Aviation Physiology Research Laboratory, GangShan Armed of the minimum time to induce G-LOC and other time-dependent Forces Hospital, Kaohsiung City, Taiwan

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 351 ASMA 2012 MEETING ABSTRACTS

INTRODUCTION: A previously healthy fl ying cadet who 2 Can ETCO2 be included as an objective parameter in predicting suffered G-force induced loss of consciousness (G-LOC) twice in syncope during HUT. human centrifuge, accompanied with hypotension and bradycardia. 3 To fi nd out the infl uence of ETCO2 on Cerebral Blood Flow and its We followed this case for the underlying pathophysiological role in the phenomenon of orthostatically mediated syncope mechanism. METHODS: After the fi rst G-LOC event, cardiovascular and neurologic evaluation including brain neuroimage, 4:30 pm electroencephalogram and passive head-up tilt table study (HUT) were arranged. Human centrifuge training was repeated two months [518] LATENCY OF UNCONSCIUOSNESS IN ALTITUDE AND later. Isoproterenol-stimulated Head-up tilt table test (HUT) was ACCELERATION ENVIRONMENTS scheduled after the second G-LOC event to evaluate the cause of D.A. SELF, C.T. WHINNERY, D. MOORCROFT, syncope. RESULTS: (1) Passive head-up tilt table study (HUT) revealed R.M. SHAFFSTALL AND E.M. FORSTER cardiovascular responses compatible with the postural orthostatic Aeromedical Research Division, Civil Aerospace Medical tachycardia syndrome (POTS). (2) Isoproterenol-stimulated HUT study Institute, Oklahoma City, OK showed vasovagal response. The cadet was declared fi t for fl ying duties, but not for single-seat high G load airplanes. DISCUSSION: INTRODUCTION: A variety of environmental and other Loss of consciousness during centrifugation could be due to poor alterations have been identifi ed that result in loss of consciousness straining technique, or organic cardiac diseases. However, in rare (LOC). Altitude chamber and centrifuge studies have demonstrated circumstances, underlying dysautonomia could be the causative factor. that under very rapid onset and offset conditions, where the attitude The cause of repeated G-LOC in the cadet was due to dysautonomia- and acceleration profi les approach a square wave. The latency of the associated orthostatic intolerance and inadequate cardiovascular physiological response can be analyzed. Previous studies have shown response (vasovagal syncope). When no obvious causes or diseases it is possible to cycle the +Gz and the altitude forcing functions faster of other organ system could explain the cause of G-LOC, HUT study than the human physiological response. When a critical value of should be included in work up paradigm. Conditioned two step exposure time is achieved, LOC ensues even though the altitude or HUT study could distinguish between different degrees of orthostatic +Gz load have already returned to asymptomatic levels. This suggests intolerance and should be considered for thorough investigation of the an aviator can experience LOC at +1 Gz after an abrupt exposure cause of G-LOC. to high +Gz levels with rapid return to +1 Gz. Similarly, the aviator could experience LOC in a normal oxygen environment (the aviator Learning Objectives: has donned an oxygen mask or returned to near ground-level pressure) 1 When no obvious causes or diseases of other organ system could following recovery from rapid decompression to high altitude. We explain the cause of G-LOC, HUT study should be included in have applied previously characterized individual response latencies work up paradigm. of cardiovascular, pulmonary, and neurological systems to account for these altitude and acceleration stress phenomena. By separation of the mechanistic sequence of events associated with rapid decompression 4:15 pm to high altitude and with rapid onset +Gz acceleration, we have [517] USE OF END TIDAL CARBON DIOXIDE (ETCO2) AS A constructed a computational model that predicts the conditions under PREDICTOR OF IMPENDING SYNCOPE DURING HEAD UP which LOC will lag the actual stress perturbation to the extent of TILT TEST (HUTT) occurring during normal conditions. The model is a multi-order system A. KUMAR that accounts for fi rst-order latencies in alveolar gas composition, General Medicine, SUT Academy of Medical Sciences, Trivan- circulation time, blood-tissue diffusion rates, and the metabolic drum, India rundown of neurons. These latencies may represent an adaptive self- preservation strategy. The implication of the LOC latency found in the INTRODUCTION: Syncope is the sudden episodic and transient studies analyzed suggests there is potential risk associated with specifi c loss of consciousness with the inability to maintain postural tone. in-fl ight acceleration/altitude profi les. This should be accounted for Occurrence of syncope is dangerous in aviatorsIP: 192.168.39.151 as it can jeopardise On: Sun,in 26 both Sep rapid 2021 decompression 17:39:09 emergency oxygen requirements and in fl ight safety. So the assessment of syncope in aviatorsCopyright: is important. Aerospace The Medicalhigh-performance Association fl ight. These phenomena should also be recognized Head up tilt table testing (HUTT) has become a widely acceptedDelivered tool by inIngenta mishap investigation. in the medical evaluation of syncope. This study examines whether the ETCO2 changes during HUTT can be used as a predictor of impending Learning Objectives: syncope. METHODS: : 10 healthy male volunteers (age 20-40 yr) 1 The relationaship between LOC latencies under conditions of served as controls and 10 patients where HUTT was indicated as cases. hypoxic and +Gz acceleration stress will be discussed. Cardiovascular and respiratory parameters are measured during pretilt, 70° HUT for 45 minutes and post tilt. Analysis of variance, Kruskal Wallis test with Mann Whitney U test for pair wise and Student t test 4:45 pm (two tailed, independent) has been used for individual comparisons. [519] THE EFFECTS OF ACUTE HYPOBARIC HYPOXIA ON RESULTS: All controls (N=10) showed normal response to HUTT. HEART RATE VARIABILITY PARAMETERS IN PILOTS Among Case groups, Group-2 (N=5) showed positive response to T. CAKMAK1, C. OZTURK2, S. METIN1, A. AKIN1 AND A. SEN1 HUTT. In Case Groups, the HR rise occurred at 26th, 34th and 38th 1Dept. of Aerospace Medicine, Gülhane Military Medical Acad- min of tilt was statistically Signifi cant (0.05

352 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 ASMA 2012 MEETING ABSTRACTS using 7-lead digital Holter monitoring. The HRV parameters were role and to seek specialist aviation advice prior to the initiation of analyzed and compared according to SPSS 15.0 software. RESULTS: medication or supplements / alternative medicines. In group 1 and 2, the mean ages were 30.3863.27 and 32.66 62.90, smoking rates were 6/26 and 10/24, total fl ight hours were Learning Objectives: 1184.386760.42 and 2116.6661055.36 hours, systolic blood 1 To understand the use of medication and supplements / alternative pressures were 141.54624.45 and 144.20616.74 mmHg, diastolic medicines by ATC personnel. blood pressures were 82.72615.13 and 91.30611.25 mmHg respectively. HRV parameters were analyzed for the both groups. 3:45 pm In group 1 and 2, the mean heart rates were 89.69613.66 and [521] INFLUENCE OF BMI & WAIST SIZE ON THE PHYSICAL 83.3369.49 beat per minute, standard deviation of all R-R interval (SDNN) was 85.23623.27 and 100.83635.71 ms; SDNN Index was FITNESS OF AVIATORS 3 1 2 61.30615.76 and 64.91610.96 ms; root mean square of successive K.Z. SHIRANI , E. BLACK AND J. ELLIOTT 1 R-R interval differences (RMSSD) was 34.92613.37 and 31.6668.03 Flight Medicine, Wright-Patterson AFB, Dayton, OH; ms; proportion of adjacent normal-to-normal (NN) intervals differing 2Aerospace Medicine, Wright State University, Dayton, OH; by >50 ms (pNN50) was 14.61610.65% and 10.5867.37%; high 3Hyperbaric Medicine, Upstate University, Syracuse, NY frequencies were 426.446234.49 and 344.646102.85 ms2; low frequencies were 1091.876497.47 and 1382.556760.68 ms2; total INTRODUCTION: Physical fi tness is an imperative for selection power values were 3632.2061659.98 and 4294.3561624.48 ms2 and retention of active duty US Military personnel. Since the US respectively. DISCUSSION: We found no statistically signifi cant population is both aging1 and gaining weight2, we assessed the difference between jet pilots and transport/helicopter pilots when we infl uence of these demographic factors on the physical fi tness test compared the HRV parameters during hypobaric chamber (PFT) scores of aviators on fl ying status. METHODS: Following an IRB training. approval, we reviewed the most recent one-year records of all 324 aviators (286 men, 88%, 38 women, 12%, age range 18-59 years), Learning Objectives: who had undergone annual physical examination and had completed 1 Understand the effects of acute hypobaric hypoxia on heart rate their PFT which required age & gender based passing score of 75%. For each individual, we calculated the body mass index (BMI), variability parameters in pilots. from weight and height, measured waist size (WS) in inches, and recorded the use of dietary supplements (DS). We analyzed data with Thursday, May 17 3:30 PM the statistical package R3. RESULTS: Aviators as a group had mean age 37 years, WS 34 inches, BMI 26, and PFT scores 89. Group-1 Salon D with normal, ≤24.9, BMI (n=125, 39%) compared to group-2 with abnormal, ≥25, BMI (n=199, 61%) had respectively lower mean BMI SLIDE: TOPICS IN CLINICAL MEDICINE III (23 vs. 28), lower mean WS (32 vs. 36), and higher mean PFT scores (94 vs. 87; all p<0.001***). Despite similar mean ages (group-1, 37 yr. & group-2, 38 yr.) 90% of group-1 & only 58% of group-2 scored 3:30 pm ≥90 on PFT (p<0.001***). All PFT failures (n=11, 3%) were seen in [520] MEDICATION USED BY AIR TRAFFIC CONTROL group-2. BMI and WS increased linearly with age. None of 44 (13.6%) PERSONNEL IN THE ARMED FORCES IN RELATION TO THE aviators who used DS failed on PFT. DISCUSSION: For every 1-inch IMPLICATIONS FOR FLIGHT SAFETY increase in WS or 1-unit rise in BMI, the PFT scores fell by about one unit. While DS use may have helped, both abnormal BMI and ample R. WYLIE RNAS Culdrose, Helston, United Kingdom waist size degraded the physical performance of aviators. References: 1. http://www.aoa.gov/aoaroot/aging_statistics/index.aspx 2. http:// www.cdc.gov/obesity/data/trends.html 3. http://www.r-project.org/ INTRODUCTION: The aims of thisIP: study 192.168.39.151 were to identify the On: Sun, 26 Sep 2021 17:39:09 medication taken by air traffi c control (ATC) personnel, to identify Learning Objectives: the source of occupational prescribing advice andCopyright: to identify Aerospace whether Medical Association personnel continued to control when taking medication whichDelivered may by1 Ingenta In view of the infl uence of national US demographics on the have fl ight safety implications. Medication use was compared with that selection and retention of active duty aviators, US Military service criteria may require modifi cations in the future. of pilots. METHODS: This was a retrospective cross-sectional study in 2 How do the changing US national demographics affect the physical which a medication questionnaire was completed by an anonymised performance of active duty aviators. sample of Royal Navy, Royal Marine and Royal Air Force Air Traffi c 3 The use of Complementary and Alternative Medicine (CAM) includ- Control Offi cers, Fighter Control Offi cers and Pilots. Medications ing dietary supplements by the aviators as physical performance used were classed as safe, restricted use, prohibited, or supplements enhancers. / alternative medicines. RESULTS: There was no signifi cant difference between ATC personnel and pilots in overall short term (<3 months) medication use. ATC personnel took signifi cantly more long term 4:00 pm (>3 months) medication than pilots. Classes of medications used [522] ASSOCIATION OF ELEVATED BMI WITH DAYTIME showed no signifi cant differences between groups. Of medications SLEEPINESS IN GERMAN MILITARY AVIATORS consumed, for short term medication at least 12.5% were classed as H. GLASER prohibited and 9.8% were supplements / alternative medicines; and for German Air Force Institute of Aviation Medicine, Fuerstenfeld- long term medication up to 8.3% were classed as prohibited and more bruck, Germany than 46.2% were supplements / alternative medicines. At least 50% of personnel taking short term and 61.5% of personnel taking long term INTRODUCTION: The relation between elevated body medication or supplements / alternative medicines obtained no prior mass index (BMI) and quality or duration of sleep is discussed occupational prescribing advice. ATC personnel were signifi cantly less controversially. Own hyptheses were derived from this discussion. The compliant with guidance on taking short term (p=0.036) and long term main hypotheses stated, that insuffi cient sleep and high BMI are linked. (p=0.035) medication than pilots / aircrew. There is a high prevalence METHODS: 235 German military pilots visiting the German Air Force of supplement / alternative medicine use. DISCUSSION: A defi nitive Institute of Aviation Medicine for routine assessment were surveyed prescribing policy is recommended for all aviation personnel. Human anonymously with a questionnaire with regard to duration and quality factors training, including refresher training, should be extended to of sleep. The information gained was compared to the BMI of the include ATC personnel. Advice on medication should be revised to subjects. Data of control groups of other personnel and of applicants require all aviation personnel to inform prescribers of their specialist for fl ying duties were compared. RESULTS: 4 out 5 hypotheses had to

Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012 353 ASMA 2012 MEETING ABSTRACTS be rejected. No correlation between quality or duration of sleep with successful, CSF diversion via lumboperitoneal shunting is an option BMI was found in the sample studied. Only 1 hypothesis could be as is optic nerve fenestration to treat optic nerve edema. Medical accepted: 42.7 % of pilots reported to suffer from daytime sleepiness and surgical management stratagems have proven successful despite at least occasionally. These pilots with 25.79 (+/- 2.67; n = 99) had a a complete understanding of how these maneuvers affect positive higher BMI, than the 25.09 (+/- 2.66; n = 133) of those who suffered change in the patient. rarely or never from daytime sleepiness. DISCUSSION: The hypotheses that insuffi cient sleep, whether by quality or by duration, would be Learning Objectives: associated with elevated BMI were not supported by own data, while 1 Clinical defi nition of IIH and the dilema surrounding these criteria daytime sleepiness did go along with higher BMI values. As daytime 2 Neurologic manifestations sleepiness can pose a threat to fl ight safety, it should be evaluated in 3 Medical and surgical treatment pilots with signifi cantly elevated BMI.

Learning Objectives: 4:30 pm [524] DESIGN AND VALIDATION OF THE AVIATION LASER 1 Elevated BMI and daytime sleepiness are interrelated. EXPOSURE SELF-ASSESSMENT (ALESA) 2 Daytime sleepiness should be evaluated in aviators with elevated 1 2 BMI. S.E. WAGGEL AND E.J. HUTCHISON 1 3 Other relations between duration or quality of sleep need further George Washington University School of Medicine, investigation. Washington, DC; 2Medical Department, Civil Aviation Authority, London, United Kingdom

4:15 pm INTRODUCTION: There has been a steady increase in the [523] IIH & HYPOBARIC TRAINING: NEUROLOGIC ISSUES number of reports of aircrafts exposed to lasers directed from the 1 2 M.W. JACKSON AND H. LESTER ground. In the fi rst six months of 2011, there were 671 cases reported 1Aerospace Medicine, Federal Aviation Administration, to the Civil Aviation Authority of the United Kingdom (UK CAA) Chicago, IL; 2Aerospace Medicine, Federal Aviation and there have been many thousands more worldwide. While the Administration, New York, NY likelihood of any injuries directly resulting from laser exposure is currently extremely low, the increasing power of available lasers INTRODUCTION: Idiopathic intracranial hypertension raises the possibility. A project was undertaken to develop a rapid (IIH) has been a diagnostic dilemma since its initial description. self-assessment tool to assist in determining if permanent injury has As diagnostic and treatment options have improved, the disease occurred after eye illumination from a laser and whether professional defi nition became clear, despite the pathophysiology remaining treatment should be sought. The Aviation Laser Exposure Self- elusive. There is no evidence of a clear link between IIH and aviation Assessment (ALESA) was then evaluated using a population of pilots in the current literature. This case report explores a new potential who had experienced illumination. METHODS: The project included etiology. METHODS: The third class airman is a 32-year-old woman a literature review, a study of laser incidents reported to the UK CAA, is an aerial photographer who underwent hypopbaric training that and a discussion with experts and individuals who had experienced included a rapid decompression and recompression cycle. Post illumination. The ALESA was produced using the key aspects of training, she experienced progressive symptoms suggestive of sinusitis. illumination that are important to determine the risk of harm. An Additional symptoms developed over the subsequent months, such Amsler grid was included to enable quick self-assessment of vision. A as hypersensitivity to light and sound, neck stiffness and intractable study was undertaken using a questionnaire with a fi ve point Likert- headaches. Initial evaluations revealed bilateral papilledema, type scale to assess the attitudes of pilots on the use of the ALESA. The concomitant elevated optic pressures, visual fi eld compromise and study population consisted of 25 male and female pilots and fl ight decreased visual acuity. RESULTS: Follow-up MRI and MRV were crew members who have experienced aviation laser beam exposure. unremarkable, and lumbar puncture demonstrated an opening RESULTS: Content validity was established by the expert’s judgment pressure of 470 mmHg. There was no evidenceIP: 192.168.39.151 of vitamin A defi ciency On: Sun, of 26 the Sep appropriateness 2021 17:39:09 of the ALESA and face validity was found by but a mild anemia was treated with iron replacementCopyright: therapy. Aerospace The Medicalthe participant’s Association responses. The proportion agreeing (responding airman has been successfully treated with acetazolamide andDelivered systemic by favorably)Ingenta was found to be signifi cant for most aspects of the ALESA. steroids. DISCUSSION: The onset of symptoms following hypopbaric DISCUSSION: The ALESA was shown to be of use to the aviation training is unique. The airman’s course is consistent with the disease community and the UK CAA is currently making the tool available defi nition. Moreover the airman is within the peak age range and within the United Kingdom. None of the participants experienced any has a BMI of 36.9 kg/meter2, which is greater than 20% of her ideal laser-related damage from their exposure, and the probability of such body weight. There was no evidence of venous outfl ow obstruction or damage at this time is extremely low. As the power of lasers purchased impaired CSF fl ow dynamics. Magnetic resonance imaging shows no by the public increases in the future, it will be desirable to establish evidence of parenchymal or optic nerve edema, though histology is the sensitivity and specifi city of the ALESA. not available to confi rm this fi nding. Well known changes in systemic blood pressure, venous oxygen saturation, and regional cerebral Learning Objectives: blood fl ow compromise may potentially serve to initiate or accelerate 1 The salient features of a laser exposure incident will be discussed in the progression of symptoms. If medical management is no longer relation to the risk of retinal injury.

354 Aviation, Space, and Environmental Medicine x Vol. 83, No. 3 x March 2012