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Medication for Military Aircrew: Current Use, Issues

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Medication for Military Aircrew: Current Use, Issues RTO-TR-014 AC/323(HFM-014)TP/14 NORTH ATLANTIC TREATY ORGANIZATION RTO-TR-014 RESEARCH AND TECHNOLOGY ORGANIZATION BP 25, 7 RUE ANCELLE, F-92201 NEUILLY-SUR-SEINE CEDEX, FRANCE RTO TECHNICAL REPORT 14 Medication for Military Aircrew: Current Use, Issues, and Strategies for Expanded Options (les M´edicaments pour les equipages´ militaires : Consommation actuelle, questions et strat´egies pour des options elargies)´ Report of the Human Factors and Medicine Panel (HFM) Working Group 26. Published June 2001 Distribution and Availability on Back Cover 7KLVSDJHKDVEHHQGHOLEHUDWHO\OHIWEODQN 3DJHLQWHQWLRQQHOOHPHQWEODQFKH RTO-TR-014 AC/323(HFM-014)TP/14 NORTH ATLANTIC TREATY ORGANIZATION RESEARCH AND TECHNOLOGY ORGANIZATION BP 25, 7 RUE ANCELLE, F-92201 NEUILLY-SUR-SEINE CEDEX, FRANCE RTO TECHNICAL REPORT 14 Medication for Military Aircrew: Current Use, Issues, and Strategies for Expanded Options (les M´edicaments pour les equipages´ militaires : Consommation actuelle, questions et strat´egies pour des options elargies)´ Authors: EDIGER Mark, M.D. (US) Working Group Chairman BENSON, Alan J. (UK), DANESE, Daniele (IT), DAVIDSON, Ronald A., (CA), DOIREAU, Philippe (FR), ELIOPOULOS, Themis (GR), GRAY, Gary W. (CA), LAM, Berry (NL), NICHOLSON, Anthony A., (UK), PARIS, Jean-Fran¸cois, (FR), PICKARD, Jeb S., (US), PIERARD, C. (FR) Co-Authors: GOURBAT, Jean-Pierre (FR), LAGARDE, D. (FR), LALLEMENT G., (FR), PERES, M. (FR), RODIG,¨ E. (GE), STONE, Barbara M. (UK), TURNER, Claire (UK) Report of the Human Factors and Medicine Panel (HFM) Working Group 26. The Research and Technology Organization (RTO) of NATO RTO is the single focus in NATO for Defence Research and Technology activities. Its mission is to conduct and promote cooperative research and information exchange. The objective is to support the development and effective use of national defence research and technology and to meet the military needs of the Alliance, to maintain a technological lead, and to provide advice to NATO and national decision makers. The RTO performs its mission with the support of an extensive network of national experts. It also ensures effective coordination with other NATO bodies involved in R&T activities. RTO reports both to the Military Committee of NATO and to the Conference of National Armament Directors. It comprises a Research and Technology Board (RTB) as the highest level of national representation and the Research and Technology Agency (RTA), a dedicated staff with its headquarters in Neuilly, near Paris, France. In order to facilitate contacts with the military users and other NATO activities, a small part of the RTA staff is located in NATO Headquarters in Brussels. The Brussels staff also coordinates RTO’s cooperation with nations in Middle and Eastern Europe, to which RTO attaches particular importance especially as working together in the field of research is one of the more promising areas of initial cooperation. The total spectrum of R&T activities is covered by the following 7 bodies: • AVT Applied Vehicle Technology Panel • HFM Human Factors and Medicine Panel • IST Information Systems Technology Panel • NMSG NATO Modelling and Simulation Group • SAS Studies, Analysis and Simulation Panel • SCI Systems Concepts and Integration Panel • SET Sensors and Electronics Technology Panel These bodies are made up of national representatives as well as generally recognised ‘world class’ scientists. They also provide a communication link to military users and other NATO bodies. RTO’s scientific and technological work is carried out by Technical Teams, created for specific activities and with a specific duration. Such Technical Teams can organise workshops, symposia, field trials, lecture series and training courses. An important function of these Technical Teams is to ensure the continuity of the expert networks. RTO builds upon earlier cooperation in defence research and technology as set-up under the Advisory Group for Aerospace Research and Development (AGARD) and the Defence Research Group (DRG). AGARD and the DRG share common roots in that they were both established at the initiative of Dr Theodore von K´arm´an, a leading aerospace scientist, who early on recognised the importance of scientific support for the Allied Armed Forces. RTO is capitalising on these common roots in order to provide the Alliance and the NATO nations with a strong scientific and technological basis that will guarantee a solid base for the future. The content of this publication has been reproduced directly from material supplied by RTO or the authors. Published June 2001 Copyright RTO/NATO 2001 All Rights Reserved ISBN 92-837-1063-0 Printed by St. Joseph Ottawa/Hull (A St. Joseph Corporation Company) 45 Sacr´e-Cœur Blvd., Hull (Qu´ebec), Canada J8X 1C6 ii Medication for Military Aircrew: Current Use, Issues, and Strategies for Expanded Options (RTO TR-014 / HFM-014) Executive Summary Working Group 26 was originally chartered by the AGARD Aerospace Medicine Panel to study issues relating to use of medications in military aircrew. The group began its work in April, 1997 and was charged to continue its work by the newly created NATO Research and Technology Organization in 1998 following the dissolution of AGARD. Working Group 26 has completed its work under the auspices of the Human Factors and Medicine Panel. Working Group 26 was formed to seek out the means for cooperatively expanding our pharmacologic options in supporting military aircrew. Over the past decade the limited aeromedical drug armamentarium has become too restrictive for flight surgeons and their aircrew. There has been growing frustration with the difficulties in gaining knowledge of aeromedically significant effects of medication. Flight surgeons and the military aircrew they support currently share heightened interest in expanding the list of medications known to be suitable for use in the military flying mission. Flight surgeons have traditionally taken a conservative approach to use of medications in military. This conservatism, while enhancing mission safety, has led to relatively few options for treating military aircrew for medical conditions or for enhancing their performance. Working Group 26 surveyed NATO air forces regarding their current employment of medication in aircrew. Patterns emerge from this data in medication use for asthma, allergic rhinitis, gastroesophageal reflux/dyspepsia, hypertension, malaria prevention, and lipid disorders. Use of medications for operational indications primarily pertained to support of sustained operations with stimulants and hypnotics. The data also reveals trends in prohibition of certain medication use in military aircrew. Several areas of particular need for expanded medication options for aircrew emerged from the data and from the working group’s reviews of existing aeromedical issues. Areas of particular need include treatment of mild to moderate hypertension, prevention of malaria, treatment of depression/anxiety disorders, performance enhancement during prolonged sleepless periods, and aids for short periods of sleep during periods of sustained operations. Particular drugs are identified in review papers as candidates for these indications and aeromedical issues in need of further study before using these drugs in military aircrew are presented. Several drugs are identified by the working group as candidates for immediate study for the benefit of NATO military aircrew and their air forces. The working group proposes that the data on aeromedical medication usage will be of significant utility to NATO flight surgeons. We propose that this data be kept current with regular updates, perhaps as an official NATO publication. This data is of particular value to smaller air forces depending significantly on the research and experience of larger air forces when establishing aeromedical policy regarding medication use. The working group also finds the difficulty NATO air forces are encountering in evaluating the large number of new drugs on the market for aeromedical suitability could be addressed through cooperative research. Most air forces have some areas of aeromedical research capability but none have a completely comprehensive capability. Cooperative research on aeromedical issues for a particular drug would provide the needed knowledge about aeromedical effects without any single nation having to fund a comprehensive research protocol. The working group encourages prototype studies to demonstrate the feasibility of a cooperative approach. We encourage such prototype studies on one or more of the following drugs as candidates for immediate study: losartan (for hypertension), mefloquine (for malaria prevention), serotonin/norepinephrine reuptake inhibitors (for depression and anxiety), pemoline (for sustained operations), modafanil (for sustained operations), and ultra short-acting hypnotics (for brief rest periods during sustained operations). iii les M´edicaments pour les equipages´ militaires : Consommation actuelle, questions et strat´egies pour des options elargies´ (RTO TR-014 / HFM-014) Synth`ese Le groupe de travail 26 a re¸cu pour mandat initial du Panel AGARD de m´edecine a´erospatiale (AMP) d’´etudier les probl`emes li´es a` la d´elivrance de m´edicaments aux equipages´ militaires. Le groupe a commenc´e ses travaux en avril 1997 et a et´´ e autoris´e a` poursuivre ses activit´es par la nouvelle Organisation pour la recherche et la technologie de l’OTAN (RTO) qui a succ´ed´e a` l’AGARD en 1998. Le groupe de travail 26 a achev´e ses travaux sous
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