IBERO PANEL Asma 2008

C-130 DITCHING IN THE ATLANTIC OCEAN: A PILOT´S SURVIVAL EXPERIENCE C. BERMUDEZ-PINILLA1 AND E.M. RICAURTE2 1SEARCA S.A., Bogota, COLOMBIA ; 2Cherokee Nations Distributors, Oklahoma City, Oklahoma

On October 16th, 1982, a C-130 Colombian Air Force cargo aircraft departed from the Azores Islands to Bermuda with 13 occupants, including 11 crewmembers, one observer and one journalist. Subsequently, according to the investigation report, the airplane suffered primary navigational failure, resulting in the aircrew´s geographical and situational disorientation. With fuel exhaustion imminent, the aircraft ditched 190 miles northeast of Cape Charles, VA. After one and a half hours at the mercy of the elements and 15 ft tall waves, eight survivors were rescued by the merchant ship Cornerbrook en route to Newfoundland. The injured were airlifted by the U.S. Coast Guard to the Naval Medical Center in Portsmouth, VA with symptoms of hypothermia. Unlike this accident, virtually all survivable water-related accidents have been inadvertent and have occurred near airports. The first author of this presentation, currently a commercial pilot with more than 19,000 hours of flight experience, is one of the survivors of this fatal accident. He was flying as an observer in the cockpit and will be discussing factors influencing survival in water-landing emergencies based on his experience; including communications, crew leadership, occupant´s behavior (from panic to denial), aircraft damage, emergency evacuation, life support equipment, water conditions, and rescue operations. There were a total of 5 fatalities in this accident (including 4 crewmembers and the journalist) and 8 survivors. The hull floated for 52 hrs. The Lockheed C-130 Hercules is a four-engine turboprop cargo aircraft and the main tactical airlifter for military forces worldwide. Key lessons were learned from this accident and have been applied in several training programs world-wide, including issues concerning: 1) decision making process before starting a ditching process; 2) operational training requirements for over-the- water flights; 3) egress training requirements for C-130 crews; 3) survival in high sea conditions; 4) life support equipment modifications; and 5) C-130 flight manual modifications.

2 USE OF THE HYPOBARIC CHAMBER TO PRE-DIAGNOSE DISEASE VR Ciancio, PV Oliveri, L De Benedetti, V Ciancio, M Buzurro, and G DiGiovan Institute of Aeronautical Medicine, Buenos Aires, Argentina

The aeronautical profession is one of the most regulated and controlled in the planet. Also, Argentina’s most prevalent diseases cause the most impact to these careers in that they may lead to the temporary or definitive termination of flight duties. Thus, a primary preventive measure may be the medical evaluation of aircrew in a hypobaric chamber. Evidence supporting this approach will be discussed in terms of six case study results including: 1) A group of 30 individuals who presented cardiovascular, pre-diabetes, and metabolic syndrome risk factors underwent radioisotopic studies and ergometric tests at altitudes of 2,400 m (1 m = 3.28 ft). Compromised myocardial perfusion was detected in 8 of these individuals, which was not detected at sea level; 2) Evidence of thrombogenesis was evaluated at altitude in 10 individuals with a history of varicose veins, feeling of heaviness, or edema in the lower limbs. Four of the cases were confirmed by way of biomarkers of coagulation activation. Radioisotope studies ratified and even identified the location of the problem in the venous system as well as in the pulmonary tissue affected by the embolism. After treatment, the study was repeated and confirmed the complete reversion of the problem; 3) In 8 cardiopathic individuals who had been treated with bypass surgery, dilatation, and/or stents, while asymptomatic at the time of the study, it was possible to detect, at 2500 m, areas that were insufficiently revascularized, which were not present at ground level; and 4) ischemic cardiopathy rehabilitation in the hypobaric chamber, with controlled ascent to altitude, has shown to permit a faster and more effective recovery, with improved functional capacity, as compared with rehabilitation conducted at sea level. In our experience, specialized complementary studies, practiced in a hypobaric chamber, have been of great utility to detect evidence of different types of pathologies hidden in pre-clinical phases and which permit the early management and more effective control of the same.

4 5 AEROMEDICAL HISTORY OF FATALLY INJURED CIVIL AVIATION ACCIDENT PILOTS WITH DIABETIC CONDITIONS A. K. Chaturvedi,1 R. J. Abbas,2 and D. V. Canfield1 1FAA Civil Aerospace Medical Institute, Oklahoma City, OK2Iraqi Board for Medical Specializations, Ministry of Higher Education and Scientific Research, Government of Iraq, Baghdad, Iraq. Introduction: At the Civil Aerospace Medical Institute (CAMI), vitreous fluid and urine samples from pilots fatally injured in aviation accidents are analyzed for glucose. This monitoring is conducted to establish if diabetes of diabetic pilots was in control at the time of the accident and to identify pilots with undiagnosed or unreported diabetes. In this study, the pilots' aeromedical history was compared with the analytical findings. Methods: The CAMI Toxicology Database was searched for 1998–2005 during which biosamples were received from the pilots with elevated vitreous fluid (> 125 mg∙dL−1) and/or urine (> 100 mg∙dL−1) glucose levels and with a history of diabetes. Additional pilot information was retrieved from the CAMI Medical Certification Database. Results: Of the total 2498 pilots, 44 had a history of diabetes (Group I). Vitreous fluid and/or urine samples from 1335 of the 2498 pilots were analyzed for glucose, and 41 had elevated glucose levels (Group II). Twelve pilots who had a history of diabetes also had elevated glucose levels. Both vitreous fluid and urine were unavailable in 17 Group I pilots. In Group II, 29 had no history of diabetes. Urinary glucose levels were elevated in 12 Group I and 36 Group II pilots—11 were common in these two groups. Of these 37 (12+36−11) pilots, 26 (70%) had body mass index ≥ 25 (25–42) and 28 (76%) were > 50 (51–82) years old. Conclusion: The disease was not in control in approximately half of the diabetic pilots whose urine samples were analyzed. Also, there were a considerable number of pilots with high glucose levels with no associated history, suggesting undiagnosed or unreported diabetes and/or an acute stress-caused transient hyperglycemia, particularly when only vitreous fluid glucose levels were elevated. The practical implications of these findings will be discussed.

6 TITLE 1AK Lopez-Acevedo, 2FL Perez, 3XJ Mayer Mirales Organization 1, Organization 2, Organization 3 INTRODUCTION. A study was conducted at _____to examine what because why. METHOD. HOW: Equipment, Subjects, Types, Procedures RESULTS. Quantities/Specific Findings that support your conclusion: A total of X records, subjects, cases, patients, airplanes, pilots, age, weight, height, female, male, n = X were classified as X: From X to Y. average, standard deviation, p-value, F, t, Chi Square statistic, alpha, power, confidence level, X ± Y, X%, X ≤ Y, CONCLUSION. What conclusion does the result of the study support/or not support? Why is this important?