59th Annual Conference of Indian Society of Aerospace medicine

at Institute of Aerospace Medicine Bangalore, 20 to 21 November 2020 Institute of Aerospace Medicine

A warm welcome to all the participants

Conference Logo

Designed and conceptualised by Wg Cdr AVK Raju Logo Description

1. The theme of the 59th Annual Conference of the Indian Society of Aerospace Medicine (ISAM) is ‘Extraordinary Times: Changing Aeromedical Paradigms’.

2. Due to the recent pandemic, the Aviation environment has witnessed sea changes in its role, capacities, reach, and challenges. On one extreme, the traditional Commercial aviation has suffered significantly, whereas, on the other hand, aviation capacities have been used maximally to bring back stranded passengers and to maintain critical medical supply chains. Public health activities in aviation sphere, such as passenger screening at airports, aircraft disinfection, implementing social distancing norms etc. have been enhanced. Military aviation, as per the need of the hour, has had to adapt significantly towards force protection and maintenance of operational capabilities by prevention of infection, increased synthetic flights etc. Rescheduling of Space Flights has had an effect on space crew training and preparedness. These testing times have brought out new processes, practices, innovations and adaptations in aviation and aerospace domains, that need to be scrutinized through the aeromedical spectrum. The changed way of life and operational practices need to be deliberated to publicize the changes, comprehensively understand them and optimize the solutions for future.

3. The design of the logo for the conference is in consonance with the theme of the Conference, “Extraordinary Times: Changing Aeromedical Paradigms”. Pandemic due to COVID-19 is an extraordinary situation which has had adverse effect on aviation. It demanded novel and out of the box solutions for the resurrection of the industry and ensuring safe flying.

4. Description of the Conference logo with its individual components is as under: -

(a) Centre of the logo is a ‘triangle’ signifying a Prism which can split invisible light into bright and colorful array of colours (VIBGYOR).

(b) Left of the logo is a ‘Golden Arrow’ which represents the light rays entering the Prism. This beam signifies the myriad of challenges and problems that the Aviation Industry is facing due to the Pandemic.

(c) At the bottom on the triangle is ‘image of a microorganism’ which represents COVID-19.

(d) Centre of the triangle is image of a ‘Bulb’ and signifies novel ideas needed to tackle the problems due to novel virus.

(e) Top of the triangle has an ‘aircraft’ which signifies Aviation which bore the maximum brunt of the pandemic.

(f) Bright and colourful array of colours (VIBGYOR) emerging from the triangle represents the viable solutions to the problem.

5. The logo in totality conveys that the unique and unprecedented challenges faced by the aviation environment which require innovative thinking coupled with bright ideas and diligent deliberation, to come out with suitably matching solutions which will facilitate, promote and sustain safe flying operations.

MESSAGES

COMMITTEES

ISAM Conference 2020 Changing Paradigms in Aerospace Medicine

Conference Advisory Committee Society President Air Mshl MS Butola PHS

Society Secretary Gp Capt Prathu Rastogi

Chief Coordinator AVM Deepak Gaur AVSM

Executive Coordinator Air Cmde Vijay V Joshi VSM

Conference Organising Committee

Organising Secretary Gp Capt MS Nataraja

Asst Organising Secretaries Wg Cdr V Raghunandan Sqn Ldr Polash Sannigrahi

Organising Secretariat Sqn Ldr Ashish Nagpurkar Surg Lt Cdr Harsh V Sqn Ldr YS Thakur

Treasurer Sqn Ldr GJ Reddy Flt Lt Misha P Scientific Programme Committee Gp Capt NK Tripathy Dr CHN Sowgandhi Lt Col Srihari Iyer Sqn Ldr Nandeshwar Rathore Dr Suryakiran

Poster Committee Col VK Malhotra Dr Kalpna Anand Dr Sanjay purushothaman Dr Pooja K

Business Committee & KMC Wg Cdr V Raghunandan CME Credits Sqn Ldr Polash Sannigrahi Surg Lt Cdr Harsh V Dr Harshit

SMOs’ Conference Sqn Ldr Sarah Praveen

TMS & IJASM Publication Gp capt NK Tripathy Wg Cdr P Biswal Wg cdr Stuti Mishra Maj Mithun kumar Maj Deepan Rai

Stage Management Wg Cdr P Biswal Wg Cdr Stuti Mishra Wg Cdr Neha Gupta Wg Cdr Vinita Binny Sqn Ldr Shobhana Gupta Flt Lt Rahul Dev Surg Lt Cdr Sachin Bharadwaj Dr Suma Deepika

Invitation, RSVP, Seating and Wg Cdr Ajay kumar Ushering Sqn Ldr Sneha Dinakar Sqn Ldr Anitha Surg Lt Cdr Karthikeyan S Printing, Delegate Kit Wg Cdr Sachin Waghmare Procurement and Awards Sqn Ldr Pooja Negi Lt Col Drona Sharma Maj Mithun Kumar Maj Deepan Rai

Souvenir Lt Col Binu Sekhar M Wg Cdr Ajay Kumar Maj Hemanth Kumar Ayyappa

Catering Committee Gp BP Thomas Gp Capt PK Sharma Surg Cdr Ranjan Sarkar Surg Lt Cdr Venkatesh Maj DR Bhatt Surg Lt Cdr Vinod Dr Akshay Shirur

Reception, Registration and Col PT Selvaraj Distribution of Delegate Kits Dr SR Santhosh Dr B Aravindakshan Lt Col Maninder Kaur Dr Shivani K Dr Neha Rao

Accommodation Gp Capt BP Thomas Sqn Ldr Navin Bhati Surg Lt Cdr PS Reddy Maj Swapnil Mishra

Society Banquet Gp BP Thomas Gp Capt PK Sharma Surg Cdr Ranjan Sarkar Lt Col Manu N Surg Lt Cdr Venkatesh Maj DR Bhatt Surg Lt Cdr Vinod

Lunch in Honour of Wg Cdr Stuti Mishra President AFWWA Flt Lt Misha P Flower Decoration Gp Capt Sadhana Joshi Surg Lt Cdr Shruthi B Chandran

Transport and Technical Support Wg Cdr Asuthi Sqn Ldr Pooja Negi Sqn Ldr Shobana Gupta Lt Col Manu N Maj DR Bhatt Maj Hemanth Kumar Ayyappa

Adm Support Gp Capt V Tripathi Gp Capt Sanjay Kumar Wg Cdr Mrinal Trikha Sqn Ldr Anitha

Medical Support Wg Cdr Rajendran

PRO Dr Biswajit Sinha

SCIENTIFIC PROGRAMME

59TH ANNUAL CONFERENCE OF INDIAN SOCIETY OF AEROSPACE MEDICINE

SCIENTIFIC PROGRAMME

20 NOV 20

0830h- 1030h Inaugural Session

0830h Arrival of the Chief Guest Air Chief Marshal RKS Bhadauria PVSM AVSM VM ADC Chief of the Air Staff, Indian Air Force

0831h Audiovisual Presentation

0835h Welcome Address Air Cmde Vijay V Joshi VSM Commandant,IAM

0845h Presidential Address Air Mshl MS Butola PHS, DGMS(Air) and President ISAM

0855h Address by chief guest Air Chief Marshal RKS Bhadauria PVSM AVSM VM ADC Chief of the Air Staff,Indian Air Force

0910h Award of Trophies and Releases

0915h Vote of Thanks Gp Capt MS Nataraja Organising secretary

0925h - JHF Manekshaw Panel (live) 1025h Chairperson: Lt Gen Anup Banerjee SM PHS, DGAFMS and Sr Col Comdt

“Human Space Missions: Design Dr VR Lalithambika, Challenges & Strategies” Director DHSP ISRO

“Building Cutting-Edge Healthcare Dr Taslimarif Saiyed, Innovations: Discussion on Efforts Director C-CAMP Towards a Point-of-Care Test for Detection of Sleep Deprivation”

ii

1000h - Poster Session I 1200h ‘Crunch Situation’ - Diagnostic Gp Capt A Kumar Challenge in a Fighter Aircrew with Acute Abdominal Pain

Evacuation of Casualty: An Uphill Col S Bharadwaj Task at ‘Operation Meghdoot

Gall Bladder Polyps & Their Gp Capt M Bhatia Management Guidelines

Prevalence of Tobacco Abuse Gp Capt SK Kaushik Habituation Among Personnel Posted at a Large Air Force Base

1115h- Scientific Session I: Clinical Aerospace Medicine 1215h Chairperson:AVM SK Aggarwal

Development of Single Method for Dr SanthoshSR, Sc ‘E’ Trace Level Analysis of 19 Drug (Live) Residues Simultaneously in Postmortem Blood & Urine Specimens by LCMS/MS to Augment Aircrash Investigation

Retrospective Study of Parajump Gp Capt R Pipraiya Injuries in (Online)

Superficial Temoral Artery Aneurysm Lt Col Binu Sekhar M in a Helicopter Pilot at High Altitude (Live) Area

Association of Ischemic ECG Col Navreet Singh Changes in High Altitude Areas with (Online) Coronary Angiography

1215h – Scientific Session II: Operational Aerospace Medicine 1300h Chairperson:Air Cmde A Agarwal VSM

Operational Training in Aerospace Wg Cdr Ajay Kumar Medicine in Corona Times (Live)

Autonomic Cardiovascular Variability Dr B Sinha Sc ‘E’ During 24h Dry Supine Immersion (Live)

iii

Effect of -17 Degree HDT Simulated Dr S Gaur Sc ‘E’ microgravity on Blood Pressure & (Online) ERP P300 in Young Indian Personnel

1400h - Poster Session II: 1600h Biomedical enhancement in Indian Col Shashivadhanan Armed Forces:Issues and challenges

Epidemiological investigation of Wg Cdr A Kulakarni Dengue cases in Miltary Training Establishment

Management of Gun Shot Wound Wg Cdr Omesh Nath (chest)in SMC and CASEVAC – Aeromedical implications and Lessons Learnt

Pre-Enrolment Medical Evaluation for Sqn Ldr P Sannigrahi Air Warriors in IAF during COVID-19 Pandemic:Concerns &Lessons Learnt

1400h- Scientific Session III: Panel on Civil Aviation in COVID Times 1500h Chairperson: Air Cmde R Vaidya VSM

Regulatory Perspective Gp Capt YS Dahiya (Live) Airline Perspective in Handling Col KN Rao(Retd) COVID-19 Challenges (Online)

Boarding Center Perspective Gp Capt BP Thomas (Live) 1500h- Subroto Mukerjee Memorial Oration 1600h Chairperson: Air Mshl MS Butola PHS, DGMS (Air)

Developing Novel Intervention Dr Scott A Shappell Strategies Using Human Factors (Online) Intervention Matix (HFIX)

iv

21 NOV 20

0800h- DGMS (Air) address to Air Officers 0900h (Engineer Auditorium)

0900h- Scientific Session IV: - Approach to COVID-19 Conundrum 1000h Chairpersons: :AVM DeepakGaur AVSM

Management of COVID-19 Patients: Air Cmde Salil Gupta CHAF Bangalore Experience (Live)

Aeromedical Training: NATO Best Wg Cdr AVK Raju Practices (Live)

Aircrew Screening, Medical Surg Cdr Ranjan Examination & Reflighting: NATO Sarkar Perspectives During COVID-19 (Live)

1000h- Poster Session III 1200h

Aeromedical Decision Making in Sqn Ldr D Ghosh Inducible Ischemia with Patent Epicardial Coronaries in an Aircrew

Colour Vision in Civil Aviation Wg Cdr AKSingh

High GTraining: Reaching Greater Wg Cdr S Mishra Heights

UV-C Technology for COVID-19: Dr S Gaur Sc‘E’ Surface Disinfection by Exposure to Germicidal 254nm UV Light

1030h- Scientific Session V: Human Engineering & Optimising Human 1130h Factors Chairperson: Air Cmde Vijay V Joshi VSM

Variation in Contrast Sensitivity under Wg Cdr Different illumination Conditions while V Raghunandan using NL-93 and GEO1 NVG (Live)

Defining Operational Limitations: Wg Cdr Biswal Approach to Further Analysis of Wind (Live) Blast Test Data

v

Optimising Functional Evaluation of Flt Lt Rahul Dev Aircrew: Establishment & Validation of (Live) IAM-Exercise Maneuver Protocol (IAM-EMP)

Diurnal Variation in Measurement of Dr Pooja Kumari Anthropometric Parameters (Live)

1130h- Scientific session VI: Changing Paradigms for Infectious Diseases 1230h in Aircrew Chairperson: :AVM Sandip Mukherji

Aeromedical Decision Making for Dr Punita Masrani Reflighting Aircrew After an Infectious (Online) Disease

Hepatitisin Aviators: Aeromedical Dr Suma Deepika Disposal (Live)

Tuberculosis in Aircrew: Challenges & Lt Col Manu N Aeromedical Decision Making (Live)

COVID-19 in Aircrew: Aeromedical Lt Col Srihari Iyer Decision Making in Uncharted Waters (Live)

1230h- Session VII: Free Papers 1330h Chairperson: :Air Cmde S Bhargava

Critical Care Air Transport Team (C- Gp Capt PR Ravi CAT) & Patient Transfer Unit(PTU):A (Live) DecadeofExperiencein a ZonalHosp

Inflight Medical Emergencies & Their Gp Capt BK Umesh Outcomes in a Commercial Airliner Kumar (Retd) (Online)

Psychological Capital & Engagement Dr Kalpna AnandSc ‘E’ Among Junior Leadership in IndianAir (Live) Force

PTU & Medevac: Our Experience Gp Capt Piush Renjhen (Online)

vi

1300h- Poster Session IV: 1500h

Study of Subjective Assessment for Efficacy of Septoplasty in Armed Maj L Goyal Forces Personnel with Septal Deviation

Evaluation of Fighter Aircrew with Sqn Ldr Sneha Dinakar Hypertension under +Gz Acceleration

Comparative Study on Temporal Flt Lt Gaurab Ghosh Database of Physical Parameters of Military Personnel in IAF

ResponOptimised Methods to Test Maj J Bothra Frequency Specific Thresholds Objectively in AIRCREW

1400h- Scientific Session VIII: Aeromedical Support During COVID-19 1515h Pandemic Chairpersons : AVM Ashutosh Sharma

Air Evacuation of Indian Citizens from Wg Cdr A Kulkarni Wuhan, China: (Online) A Field Experience

Aeromedical Evacuation of COVID-19 Sqn Ldr Subhasish Patient from a Zonal Hospital Patnaik (Online) Development of Negative Pressure Wg Cdr MD Sharma Patient Isolation Unit During the (Online) COVID-19 Pandemic

The United Kingdom’s Aeromedical Dr Ian Mollan Evacuation Experience During (Online) COVID-19

1515h – Srinagesh Memorial Oration 1615h Chairperson: AVM Daljit Singh VSM

Coronary Artery Disease: Wg Cdr (Dr) Pathophysiology & its Therapeutic SN Sharma (Retd) implications (Live)

vii

ORATIONS

1

Air Marshal Subroto Mukerjee Memorial Oration

Air Marshal Subroto Mukerjee, OBE

Air Marshal Subroto Mukerjee OBE (05 Mar 1911- 08 Nov 1960) lived a life of determination, dedication and total commitment to the cause of the service that he guided from its inception until its transformation into the Air Arm of independent India. In the early 1930’s, when the British government in India could no longer ignore the growing demands of the Indian people for greater representation in the higher ranks of the defence services, it grudgingly began the process of ‘Indianisation’ of the services. As a result, the Indian Air Force (IAF) came into being on 08 October 1932. While the older services were marked for partial Indianisation, the IAF became the first truly Indian service, as only Indians could be granted commission or enrolled in its ranks. In those early days, a career in the Air Force was an uncharted path for Indians, made all the more difficult by the prevailing discriminatory and obstructive mindset of the majority of the British in India who were extremely skeptical of the ability of the ‘natives’ to fly military aeroplanes. Air Marshal Subroto Mukerjee was one of the six Indians selected for training as pilots at the RAF College, Cranwell. The date of commission of this small pioneering band coincided with the date of formation of the Indian Air Force. In July 1938, he was put in command of 'B' of the No.1 IAF in the rank of Flying Officer. He became the first Indian Officer to command a Squadron when he took over No.1 on 16 March 1939. After converting to the , the Squadron moved to Miranshah in the North West Frontier Province (NWFP). It was here that he led the Squadron into action against the tribals of the NWFP. When the war broke out in the East, Mukerjee was at the Air HQ as a . He served in various staff assignments during the war and for his services, during World 2

War-II, Mukerjee was given the Order of the British Empire (OBE) in 1944. At the time of Independence, Mukerjee was the senior most serving with the IAF. On 15 August 1947, when India achieved Independence, the Armed Forces too became independent forces. They were no longer under the British Army or the King. However, as there was a lack of senior officers, it was decided to put serving British Officers as Commanders. Accordingly, Air Marshal Sir became the Air Force Chief. Air Commodore Mukerjee was promoted to and posted as the Deputy Chief of the Air Staff at Air HQ. He served as the Vice Chief for over 6½ years. Working under three different British Chiefs helped him groom himself for the top post. On 01 April 1954, he took over from Air Marshal Gerald Gibbs as the Chief of the Air Staff of the Indian Air Force. At that time, he was just about 43 years old. Upon him fell the task of re-equipping and restructuring the Air Force with newer aircraft & equipment. Under his tenure, the Air Force inducted a variety of state-of-the-art aircraft. The Dassault Mystere, the Hawker Hunter, the BAe Canberra and even the Folland Gnat was inducted during his tenure. Over the next few years, he was to lead the fledgling service through its trials and tribulations, taking it from strength to strength, till it was ready to take its place amongst the leading Air Forces of the world. Mukerjee took care to see that even the personnel and human resources planning, and development received much attention. His task was commendable for he had to deal with the post independence non-violence driven defence policy. Tragically, Air Marshal Subroto Mukerjee’s brilliant career was cut short in its prime in 1960 at the age of 49. Yet, his legacy lives on, and forms the cornerstone of the hallowed traditions of the service whose very foundations he laid, and whose edifice he built in the early years of its history. Air Marshal Subroto Mukerjee not only laid the foundation of our Air Force but also the Medical Services of IAF. It is largely due to his unfailing interest and foresight that a well-established medical service, to cater to the needs of the Air Force was formed. The well-known Institute of Aerospace Medicine, which is the first of its kind in Asia, owes its existence mainly due to his patronage and support. The Aeromedical Society of India (now Indian Society of Aerospace Medicine) was formed in 1952. Air Marshal Subroto Mukerjee was its first patron and remained so till his untimely demise in 1960. He took keen personal interest in the affairs of the Society and was the main pillar of support in its formative years. As a gesture of the Society’s gratitude and appreciation, in 1971, the Aeromedical Society of India instituted an oration in his name to be delivered during the inaugural function of the annual meeting of the Society. A medal is also presented to the eminent personality who delivers the oration.

3

Air Marshal Subroto Mukerjee Memorial Orations 1972-2019

Sl Year Orator Topic No 1. 1972 Mai Gen Inder Singh Rehabilitation of Cases of Ischemic Heart Disease In The Armed Forces

2. 1973 Dr Rustom Jal Vakil Electro-Cardiographic Abnormalities in Normal and Apparently Normal Individuals

3. 1974 Gp Capt Peter Howard Current Research in Aviation Medicine In The Royal Airforce 4. 1975 AVM MM Srinagesh The Values of Aviation Medicine In The Changing World 5. 1976 Dr PN Chuttani Alcohol: The First Drug of Addiction 6. 1977 Lt Gen RS Hoon (Retd) Incidence of Cardiovascular Problems Among Flying Personnel and Their Evaluation

7. 1978 Dr Raja Rammanna Aviation and Radiation Hazards 8. 1981 Dr MMS Ahuja The Art and Science of Adaptation 9. 1986 Dr Madan Mohan Recent Advances in Ophthalmology and The Development World

10. 1989 Dr MR Girinath Role of Coronary Bypass in The Treatment of Ischaemic Heart Diseases. 11. 1990 Padmashri Dr S Vertigo: Recent Advances Kameshwaran 12. 1992 Dr MS Devanandan Peripheral Organization of Movements of The Hand 13. 1995 Dr CA Varghese Perspectives of Aeromedical Research 14. 1996 Air Mshl MS Boparai AVSM Horizons of Visual Performance and Aviation (Retd) 15. 1997 Dr Kenneth N Ackles Ultimate Air Combat Protection of Pilot

4

Sl Year Orator Topic No 16. 1998 Dr SK Sikka On Indian Explosions 11-13, 1998 17. 1999 Padmashri Dr Naresh New Frontiers in The Management of Cardiac Trehan and Cardiovascular Disorders 18. 2000 Dr K Kasturirangan Space Medicine and Exobiology: Emerging Scenario 19. 2002 Padma Bhushan Aeronautics Technologies – Present and Dr VK Atre Future1 20. 2002 Prof Dougla Weigmann A Human Factors: Accident Analysis andPrevention 21. 2003 Dr Ulf L Baldin How Important Is Scientific Research and Testing of Life Support Equipment for High Performance Aircraft? 22. 2004 Mr. MB Varma Ergonomic Design of Cockpit of An Advanced Combat Aircraft 23. 2005 Dr Devi Shetty Converting Atom into Bytes 24. 2006 Shri G Madhavan Nair Indian Space Programme 25. 2007 Capt GR Gopinath Integrating Civil Aviation and India’s Economic Growth: A Vision and Perspective 26. 2008 Dr K Radhakrishnan Human Presence in Solar System Director, VSSC 27. 2009 Dr SNA Zaidi Challenges &Opportunities in Civil Aviation Sector 28. 2010 Wg Cdr Rakesh Sharma AC Space Exploration: Where Do We Go from (Retd) Here? 29. 2011 Dr AK Gupta Role of Interventional Radiology in Present Day Medicine 30. 2012 Bharath Ratna Aerospace System: A Possible Profile Dr APJ Abdul Kalam

31. 2013 Dr AK Chaturvedi Aerospace Toxicology: An Emerging Multidisciplinary Field of Medical Sciences

5

Sl Year Orator Topic No 32. 2014 Dr Prabhat Kumar, IAS, How to Keep Indian Skies Safe DGCA 33. 2015 Ms Shika Sharma Beyond Glass Ceilings: Challenges and MD & CEO Axis Bank Opportunities for Women In 21st Century 34. 2016 Sr Soumya Swaminathan The Relevance of Making Data Relevant Translational Research in Medicine 35. 2017 Air Cmde Harish Malik Civil Aerospace Medicine in India (Retd) 36. 2018 Air Mshl NB Amaresh The Pilot Physician – What Has Been and VSM(Retd) What Can Be! 37 2019 Prof K Vijay Raghavan The Role of Science & Technology - From India – For the Future of Our planet

6

7

Air Marshal Subroto Mukerjee Memorial Oration: Speaker

DR SCOTT SHAPPELL

Professor and Chair of the Department of Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University

Dr. Shappell is currently a Professor and Chair of the Department of Human Factors and Neurobiology at Embry Behavioral -Riddle Aeronautical University. Before joining the faculty at ERAU in the fall of 2012, Dr. Shappell was professor of Industrial Engineering at Clemson University from 2005-2012. Before that, he was the Human Factors Research Branch Manager at the Civil Aerospace Medical Institute. In addition, he has served nearly 20 years (11 years on active duty) in the U.S. Navy as an Aerospace Experimental Psychologist. During his time in the US Navy, Dr. Shappell served as the Human Factors Branch Chief at the U.S. Naval Safety Center and as a human factors’ accident investigation consultant for the Joint Service Safety Chiefs. He has published/ presented well over 200 papers, books, and presentations in the fields of accident investigation, system safety, behavioral stressors, sustained operations and fatigue. While noted for his work in aviation, Dr. Shappell has been involved in a variety of industries including petrochemical industry, forensic science, mining, and medicine.

Dr. Shappell received a B.S. in psychology (1983) from Wright State University graduating Summa Cum Laude with honors in psychology and followed with a Ph.D. in Neuroscience from the University of Texas Medical Branch in 1990. Dr. Shappell is a fellow of the Aerospace Medical Association, fellow and past-president of the Aerospace Human Factors Association; fellow of the American Psychological Association and past-president of Division 21 - Applied Experimental and Engineering

8

Psychology, past-secretary/treasurer of the Human Factors and Ergonomics Society, and fellow of the American Heart Association.

. Developing Novel Intervention Strategies Using Human Factors Intervention Matrix (HFIX)

Human error continues to plague even the best-intentioned industries. The problem is not that individuals are necessarily poorly trained, careless, or operating in a flawed system. Rather, it is the nature of traditional responses to sentinel events that continue to impact safety. While traditional investigations of adverse outcomes may be thorough and complete, we often resort to the same interventions regardless of the etiology, rather than targeted strategies aimed at the underlying causal sequence of events. Indeed, just as antibiotics are not the cure-all for everything patients present with, simply providing non-specific training across the board, rewriting policies and procedures, or punishing honest mistakes has proven ineffective at appreciably reducing threats to safety. This oration will provide a novel approach to developing targeted intervention and mitigation strategies using the Human Factors Intervention Matrix (HFIX) and FACES, an algorithm for rating and rank-ordering potential interventions. Both tools have proven effective at reducing human error throughout a variety of high-risk industries including aviation and healthcare.

9

Air Vice Marshal MM Srinagesh Memorial Oration

Air Vice Marshal MM Srinagesh

Air Vice Marshal MM Srinagesh PVSM AVSM VSM was born on 02 Oct 1912. As a young Lieutenant, MadhukarMallanahSrinagesh was among the first Medical Officers of the IAF whovolunteered to join the IAF Medical Service in 1940while serving inthe Indian Medical Service (IMS). He was the first Medical Officer tobe posted as Deputy Principal Medical Officer (DPMO) IAF with thecreation of this post on the RAF PMO’s staff at Air HQ. He was promoted to the rank of Squadron Leader, to fill this appointment, in1943. Subsequently, in 1945, Sqn Ldr MM Srinagesh was promotedto the rank of Wing Commander to fill the same appointment. On 15 Aug 1947, he was appointed PMO Air HQ in the rank of Gp Capt and he later became DMS (Air) with the same rank. He retired from IAF at the rank of Air Vice Marshal on 10 Sep 1971. Trained in Aviation Medicine in USA, AVM MM Srinagesh was keenpractitioner of the then fledgling specialty of Aerospace Medicine. He contributed enormously to the progress and advancement of this area of expertise in India. The fruits of his labour are being reaped even by the present generation of Aviation Medicine specialists. He was truly the father of Aviation Medicine in India. As a gesture of our thankfulness and gratitude, the Indian Society of Aerospace Medicine (ISAM) instituted an Oration in his name in 2007. The Oration is delivered during the Annual Conference of the ISAM. A memento is also presented to the eminent personality who delivers this oration.

10

Air Vice Marshal MM Srinagesh Memorial Orations 2007-2019

Sl no. Year Orator Topic

1. 2007 Dr CA Vargheese 50 Years of Aeromedical R&D in India: A Ring Side View

2. 2008 Mr M Madhavan Nambiyar Civil Aviation In India In 2020

3. 2009 Dr Ashok Seth Coronary Intervention – Is the Interventionalist a Threat to The Cardiac Surgeon

4. 2010 Dr PD Navathe (Retd) From Srinagesh To Srinagesh: The Journey from Operation Aviation Medicine to Clinical Aviation Medicine

5. 2011 Dr Jeffery R Davis An Earthling to An Astronaut: Medical Challenges

6. 2012 Prof Stephen DR Harridge Skeletal Muscle in Aviation Medicine

7. 2013 Dr Manas K Mandal The Cognitive Science of Uncertain and Unknown Environment

8. 2014 Dr Jarnail Singh Fatigue Risk Management in Airlines Operations

9. 2015 AVM G Gomez VSM (Retd) “The Earthlings Are Coming” Mission Mars Challenges

10. 2017 AVM P Kharbanda VSM Stress and Fatigue In Aviation (Retd)

11 2018 AVM Pankaj Tyagi VSM Indian Space Program: Past, Present, (Retd) Future

12 2019 AVM JS Kulkarni (Retd) Aeromedical Research in India: Past, Present and Future

11

Air Vice Marshal MM Srinagesh Oration: Speaker WG CDR SN SHARMA (RETD) Senior Cardiologist, BadrAl SamaaHospital

Wg Cdr SN Sharmapursued his MBBS from RNT Medical College Udaipur where he passed out with two gold medals and the honour of “Best Student”. He was commissioned in the Indian Air Force in 1975 andcompleted his MD in Internal Medicine from the prestigious Armed Forces Medical College, Pune and DM Cardiology from All India of Medical Sciences, . He has served as Associate Professor of Medicine and Cardiology at Institute of Aerospace Medicine and Command Hospital Air Force, Bangalore. He was also involved in the evaluation of Indian Cosmonaut Wg Cdr Rakesh Sharma AC (Retd) before and after the space flight and also the assessment of the changes in the cardiovascular system due to prolonged space stay. He continued to serve the armed forces with distinction for almost two decades.

He was pivotal in establishing the Department of Cardiology at Kempegowda Institute of Medical Sciences Bengaluru, where he served as a Professor and Head of the Department of Cardiology.He has been serving as a senior cardiologist at Badr Al Samaa Hospital, Al Khaoud, Muscat, Sultanate of Oman, since 2007. He has acquired multiple fellowships, which include Fellowship of Indian College of Cardiology, Indian College of Cardiology Physicians Indian Society of Electrocardiology and Indian Society of Aerospace Medicine. His status as an International Consultant is approved by Royal College of Physicians, London and Specialist Training Authority, UK. He is also the recipient of Medical Scientist Award for his outstanding contribution to Medical Science

12 and education from his alma mater, RNT Medical College Udaipur.He has 133 publications to his credit in both National and International Journals. He has also served as the editor of Journal of Aviation Medicine at IAM, IAF and Referee for Scientific Papers published in JAPI, MJAFI and Journal of Aerospace Medicine.

Coronary Artery Disease: Pathophysiology & its Therapeutic implications

CAD is a disease of multifactorial origin, with few reversible risk factors and others beyond human control. It is a disease which impacts not only heart but overall body and more importantly the Psyche of both patient and the Family.The difference in CAD in young and old patient age groups will show how the preventive Cardiology is of paramount importance in these trying times of stressful living. Also, why the women in child bearing period are less prone to CAD, compared to men. The impression of grave consequences of CAD makes the patient and family anxious, nervous and desire to do anything to save the affected person who may be the sole breed winner of the family. Apart from Emergency care, the long-term management of patient and family should be aimed at returning the person to the near normal life style. This oration will aim to make the subject of CAD awfully simple, from the perspective of common man and Scientific community alike who are engaged in patient care. Many Whys and Hows will be answered as we flow along the oration. Are the interventions panacea for CAD in all the settings or should be selectively applied to the target patient population, instead of exploiting the situations for considerations other than therapeutic recommendations. Detail pathophysiology and management will be discussed. Some sample patients managed by the author will be discussed to highlight practical information about the decision making. Author is confident to ensure that learned audiences will be on the edge of the seat during the oration. HEART beats incessantly to keep us alive. So, keep the Heart Happy, Becit yours or Other's.Have a Hearty Laughter and enjoy.

13

Air Vice Marshal JHF Manekshaw Panel

Air Vice Marshal JHF Manekshaw Born on 28 Oct 1916, Air Vice Marshal Jemi Harmusji Framji Manekshaw, PVSM, AVSM joined Air Force as a doctor after doing MBBS from Punjab University on 22 Jul 1943. He became an Aviation Medical Specialist and served the Armed Forces Medical Services (AFMS) with distinction. He was associated with the School of Aviation Medicine (later Institute of Aviation Medicine) while the transformational changes in the form of advanced simulators were commissioned. He was instrumental in establishing the first Hyperbaric Oxygen Therapy (HBOT) facility at the Institute of Aviation Medicine (IAM). He commanded the Institute of Aerospace Medicine from 29 Sep 1959 to 05 Sep 1960 and 14 Apr 1967 to 28 Feb 1973 as a SqnLdr, Wg Cdr, Gp Capt & Air Cmde. After this he was posted at the office of DGAFMS as the DMS (Medical Research) as an AVM. The Unit Crest with ‘Nabahsi Arogyam’ was given by the then Shri VV Giri during his command of the Institute of Aviation Medicine. He was awarded the AVSM in 1971 and PVSM in 1976 by the President of India. Field Marshal Sam Hormusji Framji Jamshedji Manekshaw, MC, the Chief of Army Staff was his brother. In the field of Aerospace Medicine, JHF Manekshaw achieved heights no lesser that his brother, whom the nation reveres. In the memory of this exceptional professional in the speciality of Aerospace Medicine, the Indian Society of Aerospace Medicine, in its 57th Annual Conference has decided to start a Panel on Emerging Trends in Aerospace Medicine dedicated to the memory of JHF Manekshaw. In the Panel of 57th ISAM Conference in 2019, Dr Girish S Deodhare, Director CA & ADA delivered a talk on Challenges in Development of Modern and Dr Unnikrishnan Nair, Director HSFC delivered a talk on Human Space Programme.

14

15

Air Vice Marshal JHF Manekshaw Panel Speaker

DR. VR LALITHAMBIKA Director, Directorate of Human Space Project, ISRO

Dr. VR Lalithambikagraduated in Electrical Engineeringin 1984 and followed on with Masters in Control Engineering from College of Engineering, Trivandrum. Shejoined Vikram Sarabhai Space Centre (VSSC), ISRO in 1988 after a brief stint in teaching at the NIT, Kozhikode.She later did her PhD in 2009.She is a fellow of the Institution of Engineers, India and Member of Astronautical Society of India, Aeronautical Society of India and Systems Society of India.

She has been associated with the autopilot design of the operational ISRO launch vehicles right from inception. She later assumed responsibility for guidance and control design, mission analysis and simulation activities for all ISRO launch vehicles. She was an active contributor to the Task Group which has formulated ISRO's Vision 2020, much of which has currently been achieved. Her team has played a role in the success of the launch vehicle missions, including the Reusable Launch Vehicle technology demonstrator, and the Crew module recovery experiment.

For her contributions to Indian Aerospace , she has been conferred with the various awards and recognitions such as INAE Woman Engineer of the Year Award2020 (To be conferred in December 2020), Marie Curie MahilaVijnanaPuraskara,by the Swadeshi VijnanaAndolana, Karnataka, Doctor of Science (Honoris Causa) by Sathyabama University,BharathiyaNariki Udaan Shakthi by International Women Professionals in Aviation and Aerospace, ISRO performance excellence award, ISRO merit award, Queen of the Skies Felicitation at Aero-India 2019 for contributions to Indian Aerospace and Astronautical Society of India Space Gold Medal in 2001, which she received from the then President of India, Dr A P J Abdul Kalam.

16

Her research interests are in the field of Aerospace mission, navigation, guidance, control, and simulation, space robotics and human spaceflight. She has guided a large number of M Tech student projects and in-house R & D projects and is currently guiding three PhD students. She has more than sixty publications in international and national journals and conference proceedings.

At present she is designated as Distinguished Scientist, and Director, Directorate of Human Space Programme at ISRO Headquarters, which is responsible for framing the policies and charting out the course of ISRO’s human space program. She was earlier holding the post of Deputy Director, VSSC.

Human Space Missions: Design Challenges and Strategies

In a human space mission, the emphasis of the system designer is on human safety rather than performance. While a conventional space mission is designed to optimize the payload, all aspects of design in a human space mission are guided by the requirement to maximize human safety. The design challenges and the strategies to achieve this objective are outlined in this talk. Enhanced robustness and fault tolerant features areto be built into the design of the onboard avionics and the autonomous flight control systems. Human intervention capabilities are also built into the system as a contingency measure. Extensive ground simulations are necessary for validation of the autonomous systems, and the crew are to be trained for normal and contingency situations. Over and above the enhanced robustness in crewed missions, a provision of safe abort during the ascent mission is required. This calls for mission profile shaping, a highly reliable crew escape system and a fool proof mechanism to detect any anomaly which might call for abort.

17

Air Vice Marshal JHF Manekshaw Panel Speaker DR. TASLIMARIF SAIYED CEO &Director, Centre for Cellular & Molecular Platforms (C-CAMP)

Dr. TaslimarifSaiyed is the CEO and Director at Centre for Cellular and Molecular Platforms (C-CAMP), an initiative of Dept of Biotechnology, Govt. of India. His initial training has been in neurosciences, where he received his PhD from Max-Planck Institute for Brain Research, Germany and followed it up by postdoctoral training at University of California San Francisco (UCSF). At the same time, he also underwent training in management for Biotech and Innovation from QB3 at UC Santa Cruz, UC Berkeley and UC San Francisco. In the bay area, he also served as a Management Consultant with QB3 New Biotech Venture Consulting and in an individual capacity, he also consulted for many biotech firms in the US.

Dr. Saiyed is also an Adjunct Faculty at Amrita Institute - School of Biotechnology and working on Neurodegeneration. He also heads the Discovery to Innovation Accelerator program at C-CAMP. He is actively involved in promoting innovation in life science/ healthcare by supporting translation of discoveries to application, entrepreneurship and technology development.

18

Building Cutting-Edge Healthcare Innovations: Discussion on Efforts Towards a Point-of-Care Test for Detection of Sleep Deprivation

In this oration, the speaker will talk about emerging lifescience/healthcare innovations and different pillars of this ecosystem. Self-inflicted sleep loss is a global health disorder which has become prevalent amongst the Aviators of the Indian Air force due to the rampant use of social media and multiple streaming platforms. This is of concern since sleep loss has been a contributory factor to mishaps in aviation. Recent studies conducted to understand the effects of using mobile phones and other electronic gadgets at bedtime have shown that the blue light emitted from the screen causes reduction in melatonin secretion making it harder to fall and stay asleep thus disrupting the circadian rhythm leading to lower efficiency of task performance and increase in errors.

At present no quick and reliable objective type of assessment of sleep deprivation is available which could screen sleep deprived individuals. Medical officers rely primarily on patent’s self-reported levels of sleepiness or cumbersome time- consuming psychological tests. The need for quick, easy and accurate objective methods to diagnose sleep disorders is especially important in the sectors like defence. Therefore, an urgent need to develop sensitive measurable biomarkers in easily accessible specimens like urine, plasma or saliva for screening of sleep deprived individuals is felt in the Indian Air Force.

C-CAMP, an initiative supported by Department of Biotechnology, Ministry of Science and Technology, Govt of India, has created and fostered a culture in and around academic environment through its various activities which spans facilitating early stage discoveries made in the lab to very early stage ideas to proof-of concept stage and validation studies for commercialization.

19

ABSTRACTS: PODIUM PRESENTATIONS 19

Session-I Development and Validation of a Single Method for Trace Level Analysis of 19 Drug Residues Simultaneously in Post Mortem Blood and Urine Specimens by LCMS/MS Method to Augment Aircrash Investigation and Enhanced Flight Safety

Santhosh SR, S Sampath, A Gupta, V Sharma, A Agarwal Introduction. During fatal aircraft accident investigations, the autopsy specimens are collected from pilot fatalities and toxicologically evaluated for the presence of foreign substances like combustion gases, ethanol/ethanol biomarkers, and drugs to establish whether the foreign substance(s) induced performance impairment/behavioral abnormality was the cause or a factor in a particular aviation accident. It is most essential for accurate detection and quantification of performance impairing substances to augment aircrash investigation and to study the trends in drug usage in pilots involved in air crashes. Methods. Simultaneous determination of 19 drug residues in human blood/urine by Triple Quadrupole liquid chromatography mass spectrometry (LC/MS/MS) for post mortem samples of aircrash has been developed in the present study. Results. The mass spectral parameters were optimized within using MassHunter Optimizer software, which identifies the most abundant product ions in a mass spectrum along with the most suitable fragmentor voltages and collision energies required for generating these product ions. A simple protein precipitation followed by SPE sample preparation technique was developed using Bond Elut Captiva ND Lipid SPE cartridges to extract the nineteen drug analytes from just 250 μL of blood/urine. Linear calibration curves were achieved over the concentration range of 25 - 400 ng/mL for all the target analytes in human blood/urine with good reproducibility.

Retrospective Study of Parajump Injuries in Indian Armed Forces

Pipraiya R, Sashindran VK, Chawla A

Introduction: A number of studies on military and civil parachuting injuries have been published in past. Most of the studies place the incidence of parachuting injuries to vary between 0.22 to 0.89 %. The profile of injuries sustained during jumps by Indian Paratroopers from Paratrooper Training School (PTS), Agra between 2013 to 2019 was analyzed. Methodology: A retrospective analysis of Indian military parachuting injuries, was done to asses injury patterns from the records of static line and combat free fall jumps, available at the PTS. Results: The incidence of injuries ascertained from the records varied from 0.054 to 0.10% with a mean incidence of 0.083% from 3,06,986 jumps recorded over 7 years. A total of 270 injuries sustained from 256 jumps were analysed. There were three fatalities recorded in this period, all owing to failure of main 20 and standby parachutes. Most of the injuries were sustained at the time of landing i.e 218 (86.17%). Lower limb injuries accounted for maximum injuries, i.e. 109 (40.37%) followed bytruncal injuries 95 (35.19%) and upper limb injuries, which were 33 (12.22%) Conclusion: Present study is probably the first attempt to study parachuting injuries in India involving such a high number of jumps. The study brings out an interesting aspect of significantly less military parachuting injuries seen in the present study visà-vis reported in literature.

Superficial Temporal Artery Anuerysm in a Helicopter Pilot at High Altitude Area Lt Col Binu Sekhar M Back ground: Spontaneous aneurysm of superficial temporal artery in a helicopter pilot while operating in extreme cold climatic conditions of very high-altitude area led to a thorough search for etiological possibilities related to this case. Case report: A 38-year old military helicopter pilot while flying at altitudes ranging from 4500m to 6000m reported with an acute onset of a subcutaneous swelling on his left temple. History and clinical profile did not suggest any traumatic, hematologic or vasculitic etiology. His inflammatory markers, anti nuclear antibody, anti neutrophil cytoplasmic antibodies, complement levels and whole-body PET scan did not suggest any evidence of vasculitis. Presence of any other intracranial aneurysms was also ruled out. He underwent curative excision biopsy which showed perivascular inflammation. He was diagnosed as a case of left superficial temporal artery aneurysm. The recovery period was uneventful and the follow up Color Doppler Flow Imaging of the temporal artery and acute phase reactants were normal Discussion: Spontaneous aneurysms involving superficial temporal artery is a very rare diagnosis. Occurrence of such an aneurysm in a young pilot without any identifiable predisposing factors led the authors to hypothesize possible etiological combination of environmental and mechanical factors along with aviation stressors with the likely compounding role of the helmet. Management and aeromedical aspects of this unique case have been discussed in this paper.

Association of Ischemic ECG Changes in High Altitude with Cororary Angiogrpaphy

Col Navreet Singh, Dr Krishan, Gp Capt Anil Kumar, Brig Naveen Agarwal, Maj Gen Rajat Datta, Maj Gen Rashmi Datta, Brig Prashant Bharadwaj, Gp Capt DS Chadha, Col AK Ghosh, Lt Col Ratheesh

Background: Pilots, air warriors and soldiers native to lowlands, while sojourning at high-altitude (HA) for various operational duties, are referred to tertiary care centers with

21 electrocardiographic (ECG) abnormalities. Exposure to HA may precipitate myocardial ischemia in subjects with underlying Coronary Artery Disease (CAD). Conversely, it may produce physiological ECG changes mimicking those of CAD, causing a diagnostic dilemma. This study sought to correlate the presence of CAD on coronary angiography (CAG) with a putative diagnosis of CAD based on clinical findings and ECG. Methods: A prospective study was conducted on patients from HA areas, referred for evaluation for CAD to a single center at near-sea-level. Thirty-five minimally symptomatic/ asymptomatic military personnel with ECG changes suggestive of CAD, underwent CAG. Correlation was sought between ECG and CAG evidence of CAD., Results: The association of CAD on CAG with clinical and ECG diagnosis of CAD was not significant, 4 of the 35 soldiers (11.4%) showing CAG evidence of CAD (Chi square 3.849, p = 0.697). The association between symptoms and coronary artery lesions was, also, not significant, only four of twenty-three (17.4%) minimally symptomatic subjects having CAD on CAG. Conclusion: Insignificant numbers of previously healthy persons, who present with minimal symptoms and ECG changes suggestive of CAD while sojourning at HA, have coronary artery involvement on CAG. Those with incidental ECG changes, without symptomatology, do not have CAD on CAG.

Session II Operational Training in Aerospace Medicine in Corona Time

Wg Cdr Ajay Kumar, Wg Cdr Mishra S, Sqn Ldr Sneha Dinakar

Introduction. Operational Training in Aerospace Medicine (OPTRAM) is a flagship course of IAF that deeply integrates with the operational training and preparedness of our pilots in the IAF. Like everywhere else, the COVID-19 pandemic has thrown new challenges in this regard. Keeping our the most precious commodity- our pilots safe and operationally oriented at all times needed to strike a balance to ensure that the required OPTRAM course continues without any additional threat to their health. Since the IAM IAF is a hub for many other activities where people visited from all over the country travelling from different corners and hence, resulting into perceived higher risk of spread of infection to our clientele. Further, the city itself has been witnessing rising trend of COVID-19 cases, threatening all the staff especially those reporting on work from outside the Air Force campus. OPTRAM being a simulator-based training course, required to keep in mind that simulators had sophisticated, sensitive electronic components and medical monitoring systems- throwing a new challenge for disinfection and sanitization. Keeping all this in view, a SOP was formulated where training, simulator safety and threat assessment of COVID-19 to the pilots reporting for OPTRAM were balanced. Methodology. Disinfection, sanitization of simulators and electronic equipments were studied using google scholar. Guidelines issued by the

22

Director of Armed Forces Medical Services, Original Equipment Manufacturer, World Health Organisation were studied and a comprehensive practical guideline was formulated to keep the COVID-19 threat at bay during the OPTRAM in the institute. Results. 20 pilots have been trained and the SOP was tested on ground for its ease of implementation and effectiveness. No case of COVID-19 was reported due to the OPTRAM in the institute. Discussion. Preventing an infection during a pandemic where the native population is itself at high risk and community transfer is suspected, is likely to fail very often. IAF work under all odd to keep itself operationally ready at all times. In aviation, such risk estimation and mitigation is a common problem. The same principle of risk estimation and mitigation may be applied in our day today life to improve the outcomes rather than relying on luck. The SOP inherently used the same principle of risk estimation and used methods to mitigate them at the very basic level. The success of the SOP lies on its simplicity and practicability. The successful training of ground staff is one of the important aspects of such endeavors which usually dictates the outcome. Motivation and will to implement and succeed in the implementation of the processes, no matter what, is the key to the success. Conclusion. The successful implementation of SOP to keep our pilots safe during OPTRAM has resulted in a newfound confidence. This enhanced the workplace safety with respect to the COVID-19 not only for the visiting pilots for training but also for the faculty and residents who had to imbibe these subtle but important changes. This paper brings out various steps taken during this process to make our training safer, especially for COVID-19 pandemic threat.

Autonomic Cardiovascular Variability during 24-h Dry Supine Immersion

Dr Sinha B, Air Cmde Agarwal A, Col Selvaraj PT, Lt Col Manu N, Kola H, Mana MP, Stanly AV

Introduction: Dry Supine Immersion (DSI) is one of the ground-based models to simulate the physiological effect of microgravity on the earth. Physical inactivity, withdrawal of support and removal of hydrostatic gradient on assuming supine position in dry floatation facilitates redistribution of body fluid towards cephalic side, a condition which is akin to actual spaceflight. Headward fluid shift causes several physiological changes. The most prominent changes are observed on the cardiovascular system. Autonomic cardiovascular system undergoes several adaptive changes during dry supine immersion. Power spectral analysis of R-R interval in the ECG, also known as Heart Rate Variability (HRV), have been used by researchers to noninvasively investigate the sympathovagal balance of the autonomic control of the cardiovascular system. Similarly, spectral analysis of Blood Pressure Variability (BPV) yields significant information about the autonomic control of the cardiovascular system. Studies on heart rate and blood pressure variability on exposure to DSI for 24 h is lacking. The 23 presentstudy was undertaken to examine the HRV and BPV indices on exposure to DSI of short duration (24 h) in healthy male volunteers. Materials & Methods: Four healthy male volunteers were exposed to 24 h DSI in a thermoneutral environment. Their HRV indices and continuous blood pressure were measured at baseline supine position. They were then immersed into a water tank of a capacity of 1250 L. The temperature of the water inside the tank was maintained at Mean Skin Temperature of the individuals at about 33.5±0.5°C. The HRV and beat by beat blood pressure of the individuals were monitored every 6 h. Results: Heart rate was found to be increased by 7 bpm after 6 h of DSI and thereafter it was found to be maintained throughout DSI. There was a significant decrease in RMSSD, a time domain parameter of HRV and a measure of parasympathetic activity, at 6 h of DSI. Mean arterial pressure after an initial fall from baseline showed an increment from 18 h and remained higher after 24 h of immersion. Conclusion: Autonomic cardiovascular dynamics in four prospective male astronaut candidates was studied during immersion to 24 h of DSI. HRV and BPV were measured during immersion.

Effect of -17 Degree HDT Simulated Microgravity on Blood Pressure and ERP P300 in Young Indian Personnel: Review and Preliminary Trial

Dr Savita Gaur, Ms Divya Bhatt, Dr Usha Panjwani, Dr Bhuvnesh Kumar

Background: Microgravity state in outer Space and inside Spacecraft is a hostile and unfriendly environment and changes the body physiology and neurology. As a consequence, there are alterations in the brain event related potential (ERP) amongst other changes that poses challenge to space crew, and their performance drops critically. P300 is an ERP component elicited in the process of decision making. There are very few research articles on the ERP P300’s response to head down tilt (HDT) of - 17 degree in human subjects. Methods: The neurological (P300) and physiological (BP) response of the -17-degree HDT for 20 min was studied. Changes in ERP P300, Blood pressure (BP) and Pulse was determined in young healthy human subjects. The study was carried out with 18 (11 males and 7 females) healthy volunteers aged 20-40 years. Result: The P300 latency (ms) increased and P300 amplitude (μV) decreased post exposure to simulated microgravity for given sound stimulus and task. The blood pressure (systolic and diastolic) was observed to decrease under this exposure. Conclusion: The HDT efficiently simulates the microgravity condition. The changes in the ERP P300 characteristics can be proposed as a potential marker of waning attention under simulated microgravity. This is preliminary trail and further study is required with more sample population under controlled environment

24

Session III Civil Aviation in Covid Times: The DGCA Perspective

Gp Capt YS Dahiya Introduction: Humankind has witnessed and survived many crises of mammoth magnitudes in the past but the SAS CoV-2 pandemic seems to be the gravest crisis ever, causing the most brutal body blow to the aviation and tourism industry. The crisis was/is a true test of organizations and the approach to survive and revive in the ‘new normal’ is winning the ‘confidence’ of air travelers and operators, employing scientific and evidence-based solutions and uncomplicatedness of procedures. Mitigation Strategies: The mandate for Medical Directorate at DGCA HQ was facilitate a pandemic-proof safe air travel. This paper highlights the challenges that HQ DGCA faced due to the impact of COVID19 in planning and implementing the mitigation measures to prevent spread of infection as well as maintaining safe air operations. Measures implemented: The apprehension of the airline companies and passengers was addressed, while working strictly within the safety framework and regulatory requirements of ICAO. The highpoint of the crisis was, an opportunity for the regulators to collaborate with various ministries and airline companies to place on board scientific & implementable processes to ensure safe flying experience. Definite facets and the challenges therein, that Med Dte at DGCA confronted, will be expounded in the paper. Some of those are; laying down the specifications for creating a ‘Health Corridor’ for air travel (in consultation with international agencies especially CAPSCA), adopting safety management principles (like PDCA cycle) while issuing guidelines for flying crew for extension of medical validity period, for quarantine/isolation, for COVID testing & reflighting thereafter and introduction of special ‘COVID exempt Medical Examination’ (CEME) to facilitate timely renewal medicals for aircrew. Conclusion: The three Cs highlighted in the ICAO Doc 10144 i.e. Collaborate, Cooperate and Communicate, with the stakeholders resulted in a successful resumption of air operations in India during COVID pandemic

Civil Aviation in Covid Times: The Airline Perspective Col (Dr) KN Rao Introduction: This paper brings out the challenges that airlines faced due to the impact of COVID19. It also summarizes the thought process and planning that went in to reopen the skies on 25 May 20. Measures implemented and Discussion: The concerns of the passengers, the airline staff, the regulatory safety requirements, and evolution of the new normal are addressed in this paper. Specific areas and the challenges with respect to many aspects that were faced are as listed below General awareness – Awareness and training of crew and staff to empower them with

25 knowledge and combat the spread of COVID19 was the first priority to be addressed. Thermal screening guidelines, Personal Protective Equipment (PPE) guidelines, Safety risk assessment (SRA), Guidelines w.r.t suspected passenger on board, Quarantine guidelines for Crew and ground staff, Contact tracing guidelines, Aircraft cleaning and disinfection guidelines, Office space disinfection guidelines, Carriage of Virus Samples/ Dead bodies guidelines, Stress & Anxiety management guidelines, Guidelines for Layovers, COVID testing, Modification of BA testing and preflight medical procedures evolved due to COVID19. Crew reflighting after testing covid positive issues are addressed. The role of an aviation medicine specialist in every aspect of aircraft and airline operations came to the fore in times of COVID19. An aviation medicine specialist, by virtue of his/her comprehensive and all-round training can play a major role in Airline operations as seen in the current Crisis.Conclusion: The collective effort between all the concerned – the Ministry, the Regulator, the Airline, the Airports, Medical Boarding Centres, Class 1 examiners has played an immensely important role in resumption of operations during tcurrent COVID times. It is important that this coordination continues as the COVID situation is likely to continue for a foreseeable future. Further the Medical teams at various levels have proven to be an extremely useful and integral part of any crisis response. A coordinated effort will go a long way in addressing any similar challenge in future.

Civil Aviation in Covid Times: The Boarding Center Perspective Gp Capt BP Thomas Introduction: The outbreak of Novel Corona Virus - Covid19 caused preventive measures to change not only for clientele but also for the entire fraternity of Health Care Providers (HCP). Once the draconian Pandemic took charge, new strategies to control and prevent the spread were defined and are in place to optimize resources and confront the Pandemic and to protect the clientele (Personnel reporting for Medical Evaluation) without compromising the health of the HCP. Without any vaccine in place, the risk of contagion is potentially high and would compromise Air Operations and Medical Evaluation. Ground Zero: Understanding the Covid-19; it’s characteristics and mode of spread and applying the knowledge on ground Zero – The Medical Boarding Center has been the standard. Comprehensive conduction of Medical Evaluation during the Pandemic without compromising the safety of the clientele as well as the HCP is paramount. It’s an arduous continuous challenge and is being meticulously carried out to keep the skies operational. Steps towards Clientele safety: Awareness of personal conduct during the pandemic and specifically at the Boarding Centre is reiterated to Aircrew. Standard Operating Procedures are laid down covering from prior Commencement to post completion of Medical evaluation. Movement Protocols of both Men and material, Area and equipment sanitization with

26 strict vigilance of Personal protection and social distancing has been incorporated as a routine. Strict compliance is inculcated and enforced. Measures for working environment, Medics and Paramedics: Thermal Screening and testing of Air Crew, Fast processes have been devised with minimum contact. Effective que management and rotation of staff wherever possible is being done to keep the viral load to bare minimum. Equipment sanitization is meticulously carried out after every use. Briefing and inter-departmental discussions are restricted to the online platform. Curtailment of socialization both at work and off work are stringently followed and has been the norm. Conclusion: A well-coordinated effort between the Ministry, DGCA, the Airline and the Boarding Centre has been adopted in our functioning and has resulted in effective Air Ops. A new outlook in continuation to suit evaluation processes to the ever-mutating virus will go a long way in maintaining an operational Air crew and an ever-motivated Health Care Provider. The future is quite challenging and yet to reveal its wrath. Team effort keeping People First and mission always will lead to an emphatic success

Session IV Management of COVID 19 Patients: CHAF Bangalore Experience Air Cmde Salil Gupta

At the end of 2019, a novel coronavirus was identified as the cause of a cluster of pneumonia cases in Wuhan in China. It rapidly spread, resulting in a global pandemic. The disease was designated as COVID-19 (coronavirus disease 2019) by WHO. The virus that causes COVID-19 was designated as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first few cases occurred in India around Jan 2020; however, it was in May 20 when cases started to appear in the city of Bangalore and in CHAF. Since then we have had approximately 2200 cases with around 80 fatalities (3.63%). The sicker patients have been managed at COVID designated gender and rank neutral wards at CHAF while the patients who were asymptomatic or had mild disease have been managed at Jalahalli facility (completely managed by CHAF staff). Overall, the younger patients have had mild disease while older patients (mean age around 57 years) have had moderate to severe disease. The most common symptoms have been fever, cough and dyspnoea. Around 17-18% needed oxygen during the hospital stay while ventilator requirement was around 5%. Majority of patients who needed a ventilator succumbed to the illness. Mild cases were treated with symptomatic therapy, while moderate to severe cases received antibiotics, steroids and low molecular weight heparin for 5 days. Around 200 patients have received the anti-viral drug remdesivir so far. Along with the management of patients, CHAF team has also spear headed research in the field, some which has been published while others are in the process of being published. 27

Aeromedical Training: NATO Best Practices

Wg Cdr AVK Raju

Introduction.Transmission of COVID-19 disease occurs typically when a healthy individual comes in contact with a symptomatic/asymptomatic carrier. The mode of spread is usually by means of aerosol and fomites. In light of this, conduct of aeromedical training in confined spaces having elevated aerosol concentrations and for an extended period offers a formidable challenge NATO Practices for safe Aeromedical Training: Individual NATO countries have their own practices. This paper summarises and brings out the best practices. All routine and refresher courses have been suspended with focus on conduct of essential courses only. Trainees for the courses come in batches preferably from the same Squadron. Trainee intake strength for the courses has been reduced to 50%. Screening of the trainees before entry into training facility is done by means of diligent history taking, temperature monitoring, SpO2 monitoring and RT PCR if indicated. All necessary COVID precautions like social distancing, masks and use of hand sanitisers are strictly practiced. Didactic lectures are carried out in well ventilated rooms with adequate spacing between the seats. UK has migrated from physical classes to e-learning. Altitude chamber training is carried out with 50% of the seats occupied and with occupants wearing chamber mask over the surgical masks. Protocols have been modified so that it involves minimal or no removal of the masks. After the training session, the individual masks are cleaned with 70% Isopropyl Alcohol and quarantined for 72 hours and the Chamber cleaned with approved disinfectants (Isopropyl Alcohol/H2O2/Commercial Disinfectants). For the acceleration training, only the tradesman (equivalent of SEW of IAF), clothed in a PPE comes in contact with the trainees. He helps them with donning and doffing of flying clothing and helps them with strapping/unstrapping too. Instructors are in contact with the trainees only by Radio Communication. Post training session the seat and interiors of the centrifuge training capsule is cleaned with 70% Isopropyl Alcohol and the flying clothing cleaned with approved disinfectant and hung for air drying. Conclusion It is observed that by adopting necessary precautions, aeromedical training can be safely carried out while effectively minimising the risk of spread of the COVID 19.

Aircrew Screening, Medical Examination& Reflighting: NATO Perspectives During COVID-19 Surg Cdr Ranjan Sarkar

Introduction: Isolation of contacts and screening of suspected individuals is a cornerstone of COVID-19 management and prevention. With the spread of the pandemic amongst the developed NATO nations, it was imperative that the NATO

28

Human Factors & Medicine (HFM) panel convened a series of meetings to exchange views and perspectives towards aircrew screening, medical examination and re- flighting. India (IAF) was invited as a special guest participant to these web-based meetings. Individual NATO countries have developed their own practices. This paper summarises and brings out their best practices depending on their own experiences and present understanding of the disease. Present Scenario & Established Practices. In most NATO countries the disease appeared to have afflicted the population in the first quarter of 2020 and numbers started peaking by April-June 2020. It sent alarm bells amongst countries with an ageing population (esp. European partners) and the Public Health Authorities of each nation came out with guidelines majorly based on their present experiences and prior knowledge from the SARS outbreak in 2003-04. Most NATO forces have imposed a cut off >91% Spo2 saturation, febrile status on mercury thermometer and a non-contact history, as a generally accepted norm for ruling out infection for non-deployed aircrew. Post and about to be deployed aircrew have to produce a –ve RT-PCR report immediately on reporting on duty or back from a deployment. Routine medical examinations have either been suspended or are being carried out virtually. Aerosol generating procedures are not asked for as a routine or in inevitable circumstances, resorted to only after a pulmonology consult along with –ve Antigen testing. No specific policy exists on grounding of aircrew post COVID, however prior to re-flighting, a negative RT-PCR along with normal blood reports and a Chest X- Ray and a pulmonology consult is being resorted to. In certain cases, a CT-chest is being asked for as per the pulmonologist’s recommendation. Conclusion. As the disease evolves and more scientific evidence is emerging regarding the pathophysiological changes and reinfection, definite and more concrete protocols will evolve regarding short- and long-term sequelae of the disease and will defiantly be considered in formulating established policies towards aircrew reflighting and medical evaluation. In case a safe vaccine is developed, a mandatory vaccination will certainly form a part of the preventive strategy

Session V

Variation in Contrast Sensitivity under Different illumination Conditions while using NL-93 and GEO1 NVG

Raghunandan V, Biswal P, Binu Sekhar M Introduction. Visual acuity is often used to assess vision through Night Vision Goggles (NVGs). However, in an operational scenario, contrast sensitivity (CS) through NVG is a better indicator of NVG performance than visual acuity alone. Previous studies have shown changes in visual acuity through NVG during variations in light intensity. This study was carried out to compare contrast sensitivity under different illumination 29 conditions for NVGs presently in use by IAF. Material and Methods. 12 subjects participated in the study. Each subject was evaluated for contrast sensitivity through both NL-93 NVG and Geo 1 NVG in three different illumination conditions of full moon, half-moon and quarter moon. CS was measured using Pelli-Robson chart. The CS recorded in log units was compared between the two NVGs. Results. The results illustrate the profile of contrast sensitivity through NL-93 NVG and Geo 1 NVG. It was observed that CS through NL-93 NVG was significantly better than that of Geo 1 NVG under the three illumination conditions tested. Also CS values recorded for of NL-93 was significantly decreased with decrasing illumination Conclusion. The study has shown significant decrease in CS values with lowering light intensities within stated range of operational range of NVGs. Recommendation. Since the results obtained in this study are of operational concern, it is recommended to undertake the study with larger samples of NVGs to confirm the findings. . Defining Operational Limitations: Approach to Further Analysis of Windblast Test Data

Biswal P, Agarwal A

Objective. Ejection from a fighter aircraft is a life saving measure for the aircrew. Even with the most modern ejection systems, there remains a certain amount of risk of injury associated with all phases of ejection. Quantification of this risk has been by experimental studies under standard test conditions. At present, failure to meet the test criterion for the small or the large anthropomorphic dummy leads to an impasse. This paper presents a novel approach to analysis of helmet windblast test data so that scientifically derived limitations on the size of the aircrew who may be within acceptable risk probability can be suggested. Material and Methods. The authors studied neck load data of an aircrew helmet which had failed to clear the windblast test during evaluation at 600 knots and in smaller pilots even at 450 knots. Using multiple linear regression equations, the neck load and neck moment values in all three axes were calculated for intermediate body weight between the smallest and largest test manikins. Using fourth order polynomial equations, the critical neck load and critical neck moment values for each of the intermediate body weights was calculated from available critical value tables. The Multi Axial Neck Injury Criteria (MANIC) scores for each 1 kg body weight interval was calculated from the above two data. Suitable correction factors were applied for matching the calculated scores with the experimental data from the original tests. The final corrected MANIC scores were then converted to injury risk probability percentage at each body weight. Results. The injury risk probability of a severity corresponding to Abbreviated Injury Scale (AIS) 2 was calculated for each 1 kg body weight interval from 47 kg to 112 kg. Considering an acceptable injury probability of 5% for a severity of AIS 2+, the lowest body weight aircrew who could safely eject at wind

30 speeds of 450 knots was 66 kg. At 600 knots airspeed, considering an injury probability of 15% of AIS2+ severity as acceptable, the lowest body weight aircrew who could safely eject was 77 kg. Conclusion. In case of an aircrew helmet that fails the windblast tests, there is no methodology available to scientifically impose operational restrictions such that aircrew above a certain body weight may be considered safe. This novel approach provides this operationally relevant answer to the user, based on mathematical methods. It is important to understand the assumptions made and therefore the limitations of the overall model, prior to applying this method to any test data. The results of this study are unique to this particular helmet and test conditions.

Optimising Functional Evaluation of Aircrew: Establishment and Validation of Institute of Aerospace Medicine – Exercise Maneuver Protocol (IAM-EMP)

Flt Lt Rahul Dev

Introduction: Musculoskeletal Injuries (MSK-I) are amongst the most common contributors of disabilities world-wide. Aircrew given their charter of duties have a higher risk of developing MSK-I. Functional assessment of aircrew after recovery is conducted at Institute of Aerospace Medicine (IAM) Bengaluru. The maneuvers utilized in the present assessment lack objectivity and scorability. Hence, this study aimed at establishing an exercise maneuver protocol which could overcome the existing shortcomings. Materials & Methods: 202 age matched aircrew (180 male/ 22 female) were selected and classified into control (100 healthy aircrew) and experimental (102 aircrew with MSK-I) groups. All aircrew underwent the complete Human Engineering (HE) assessment. In addition, Functional Movement Screen™ (FMS™) was carried out. Jump test was added to FMS™ after defining its scorability criteria to form the IAM- EMP. Exercise Maneuver Protocol (EMP) was scored on a scale of 0-24. The scores were compiled and analyzed. Results: Descriptive analysis showed comparable male and female FMS™ and EMP Scores. Cut off scores of FMS™ and EMP for the study population were defined using Receiver Operating Characteristic (ROC) curve analysis. Area Under the Curve (AUC) for EMP was found to be statistically better than FMS™ (p<0.05) in predicting fitness of an aircrew keeping complete HE assessment as gold standard. EMP was validated on randomly selected 50 aircrew (25 from each group). Discussion: IAM-EMP is an objective and scorable tool which can be used on both male and female aircrew between 18-45 years of age for their functional assessment post recovery from an MSK-I. Incorporation of the tool with other components of HE assessment would improve the yield of overall evaluation

31

Diurnal Variation in Measurement of Anthropometric Parameters Pooja K, Raghunandan V, Biswal P Introduction: Present IAM protocol mandates the conduct of anthropometry before 1100h of the day. However, there is no such study till date to scientifically validate the same. This study was carried out to quantify the change in anthropometric parameters with time and to establish the cut-off time for conduct of anthropometric measurements on the IAM anthropometric platform. Methods: Prospective - Repeated measure design Anthropometric parameters of a total thirty-five subjects were recorded starting from 0800 h to 1600 h, at an interval of every 02 hours using IAM anthropometric platform. This time interval was chosen for its relevance in the conduct of anthropometry at IAM.Results: Statistically significant diurnal variation was seen in gravity dependent parameters which could be due to the time of day and the effects of erect posture on the intervertebral disc height. It had shown a decrement in measurement as the day progressed from morning to evening, the change in parameters were minimal till 1200 h and slightly more thereafter. The gravity independent parameters had not shown significant change from 0800 h to 1600 h, which could be because of minimal effect of gravity over them. Conclusion: The study revealed that anthropometric measurements should be done in the early part of the day between 0800 h to 1200 h to minimize the possibility of diurnal variation. Hence, the present IAM protocol is recommended to be continued.

Session VI Aeromedical Decision Making for Re-Flighting Aircrew after an Infectious Disease P Masrani, V Masrani, P Navathe

Introduction: Acute or active infections, whether respiratory, blood borne, parasitic, bacterial or viral are common causes for temporarily grounding pilots and cabin crew. After adequate treatment they usually return to flying, sometimes with restrictions. Assessments for return-to-flight are made by the airline doctor along with the treating clinician. Methods: Infection in an aircrew poses various risks to flying in terms of sub- optimal health to safely exercise privileges of the license/duty due to the infection load itself, sequelae or complications of illness, side effects of medications, need for frequent monitoring and the likelihood of passing the infection to other crew/ passengers. Even after clinical treatment, complete recovery, e.g. malaise after viral illness or anaemia after malaria could take long, which is of aeromedical significance. Carrier states (e.g. hepatitis), prophylaxis (e.g. malaria), long term medications (e.g. tuberculosis) or sequelae (e.g. COVID-19) pose additional concerns. Is it required to wait until complete

32 recovery and cessation of medications or can we re-flight once stable and non-infective by assessing functional capability and risk acceptability? Can an evidence-based medicine approach be taken for such aeromedical decisions? A novel Aeromedical Decision Making (ADM) paradigm is proposed to help consistent decision patterns within the industry.

Viral Hepatitis in Aviators: Aeromedical Disposal Dr Suma Deepika L, Dr P masrani, Dr P Navathe, Dr S P Patwardhan, Col (Dr) KN Rao Introduction: Effective performance of aircrew in cockpit is hampered due to physical or psychological disabilities/ diseases that could result in occurrence of subtle or obvious incapacitation. Viral hepatitis is one such leading cause of mortality and morbidity in the world. In India, it is a major public health problem posing an equal threat comparable to that of HIV/AIDS, Malaria and Tuberculosis. Currently, there are no laid down guidelines about the aeromedical evaluation or disposal of aviators diagnosed with viral hepatitis by ICAO (International Civil Aviation Organization) or DGCA (Directorate General of Civil Aviation). Aim: An Aeromedical Decision Making (ADM) Paradigm was developed by Navathe and Masrani (under publication) to make an evidence-based approach in aeromedical disposal of aviators with infective diseases. A comprehensive review of literature on various key points like symptomatology status, treatment, medications- tolerance and side effects, recovery, infectivity, chronicity and co-morbidities associated with viral hepatitis was done to propose an objective approach in aeromedical certification. This paper discusses the aeromedical disposal for the same; with an emphasis on awarding fitness to fly to aircrew having chronic disease and on medication. Discussion: In an attempt to streamline aeromedical decision making to be more evidence based, the authors have adopted a novel paradigm to assess aviators with infectious diseases. Viral hepatitis is most commonly caused by Hepatotropic viruses like Hepatitis A, B, C, D and E. Symptomatology of acute illness includes headache, fatigue, myalgia, arthralgia, anorexia, nausea, vomiting, diarrhea and abdominal discomfort, affecting the flight safety. This renders aviators with acute illness unfit to fly. Aircrew could be considered for reflighting after the resolution of symptoms, serological demonstration of non infectivity, normalization of elevated transaminases and after being evaluated for possible complications like acute liver failure, cholestatic hepatitis, aplastic anemia, relapse and progression to chronic disease. However, aircrew having an abnormal biochemical picture could be evaluated and could be given restricted fitness to fly; if the risk is considered to be clinically and aeromedically insignificant. Aircrew diagnosed with chronic hepatitis (Hepatitis B and C) are to be assessed to determine the likelihood of medical incapacitation with ongoing infection and medication. Considering the likelihood of occurrence of unacceptable outcome inflight with pilot being infective and on medication like nucleotide analogs or 33 ribavirin or interferons; aircrew is not recommended to fly with unacceptable risk. Aeromedical certification could only be granted with an acceptable risk as per the ADM paradigm, if medication is well tolerated with complete clinical recovery and achievement of sustained virological response (no active viral replication). Serial surveillance is mandatory to monitor for probable development of long-term complications like cirrhosis, HCC, reactivation/ relapse and extra hepatic manifestations like fatigue, depression, cognitive dysfunction, glomerular disease, insulin resistance. Further decision to award fitness to fly without any restrictions can only be weighed case-by-case basis depending on the clinical, serological and biochemical picture using the proposed Aeromedical Decision Making (ADM) paradigm. Conclusion: Implementation of the proposed ADM paradigm deciphers a rational and scientific approach in aeromedical disposal of an aviator with viral hepatitis; minimizing the wastage of trained pilot hours on ground by not compromising the flight safety. Tuberculosis in Aircrew: Challenges and Aeromedical Decision Making

Lt Col (Dr) Manu N, Dr P Masrani, Dr P Navathe, Dr S Patwardhan, Col (Dr) KN Rao

Introduction: Tuberculosis (TB) is a preventable and curable disease caused by Mycobacterium Tuberculosis. It most commonly affects the lungs but may also affect other systems of the human body. As per the WHO fact sheet published in March 2020 TB is among the top 10 causes of death amounting to 1.5 million deaths worldwide in 2018. In the same period, the 30 high TB burden countries accounted for 87% of new TB cases. With India leading the count among eight countries that account for two thirds of the total cases across the globe, it would be common that aircrew would also be affected with the disease. Currently, aircrew diagnosed with TB are grounded until completion of treatment followed by phased upgradation. AimThis paper attempts at using the Infectious diseases aeromedical decision making (ADM) paradigm developed by Navathe and Masrani (under publication) for disposal of aircrew affected with tuberculosis. A literature search on complications, risks involved in flying and adverse effects of anti-tubercular drugs was done to assess whether an aircrew can be declared fit to fly while still on medication. DiscussionThe authors have adopted a novel paradigm to assess aircrew with infectious diseases to streamline the aeromedical decision making to be more evidence based. A case of tuberculosis needs to be compulsorily grounded as long as the acid-fast bacilli are detected in the sputum. The extent and progression of the disease is noted by the radiological evidence for cavitary or non-cavitary lesion. Once the crew is asymptomatic and has been assessed to be non-infective by routine sputum examination or sputum culture, re-flighting could be considered. The microbiological examination is coupled with imaging to evaluate the degree and progress of the disease. This is followed by determination of functional

34 capability taking into consideration the extent of the initial disease, the organ system(s) involved and sequelae/ complications if any. The abnormalities found in the evaluation are further assessed to determine the likelihood of inflight incapacitation which may be the outcome of disease itself or the side effects of the antitubercular drugs administered. The common documented side effects of anti-tubercular drugs and the extent of complications involved can be assessed by investigations like lung function test, liver function tests, creatinine and ophthalmic examination. If a pilot shows no symptoms, no acid-fast bacteria detected in staining, no growth in culture with normal or clinically/ aeromedically insignificantly abnormal investigations while still on medications, there may be reasonable evidence in considering return to flight. As the individual may still be under medication, restricted flying may be considered along with periodic investigations. ConclusionThe implementation of the novel ADM paradigm can help to give a systematic and scientific approach in evaluating case of tuberculosis. Evaluation of an aircrew as discussed may help in early re-flighting of aircrew thus facilitating optimal usage of a trained pilot without compromising on flight safety.

Covid 19 in Aircrew: Aeromedical Decision Making in Uncharted Waters

Srihari I, Masrani P, Navathe P, Rao KN, Patwardhan S

Introduction.Coronavirus Disease 2019 (COVID 19) is a viral disease caused by the novel Severe Acute Respiratory Syndrome - Coronavirus 2 (SARS-CoV-2). It was first identified in Wuhan, China and has since then spread across borders to the whole world. As on 03 Oct 2020 more than 35 million people have been infected with the virus leading to a death of over 1 million people worldwide with India accounting for over 6.5 million cases and over 100,000 deaths. Aim. The Infectious Diseases Aeromedical Decision Making (ADM) paradigm developed by Navathe and Masrani (under publication) has been considered in this paper for disposal of aircrew affected with COVID 19. The disease is evolving, and lessons will be learnt from early experiences clinically and aeromedically. Key areas for aircrew disposal are discussed which include infectivity, sequelae, preexisting co-morbidities, investigations required and aeromedical significance. Discussion. The novel paradigm to assess aircrew with infectious diseases has been adopted in this study. The spread of SARS-CoV-2 is most commonly by contact and droplet transmission. It mainly causes respiratory illness ranging from mild disease to Acute Respiratory Distress Syndrome and death, and some may never develop any symptoms. Studies have shown that it affects various other systems of the body too. There may be sequelae in aircrew which may lead to potential inflight incapacitation. A positive Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) merely reflects the presence of the virus in the body and does not provide information

35 on the infectivity. This may lead to restrictions for those who continue to have a positive swab test but may not pose a significant risk of infection, leading to loss of man hours, affecting military operations or causing a financial burden on a civil airline. As per the Director General of Civil Aviation the aeromedical disposition of an aircrew who has been tested positive on RT-PCR for SARS-CoV-2 is essentially dependent on the clinical presentation. The flight surgeon needs to take into account the age, clinical presentation, treatment given, preexisting comorbidities, sequelae and current status of health. Due consideration also needs to be given to evaluation of functional capacity depending on the aeromedical requirements for the operations the aircrew is to engage in. Conclusion.The current one-of-a-kind pandemic poses an augean task to the aerospace medicine specialist in deciding fitness to fly. Based on the implementation of the novel ADM paradigm, the key considerations which a flight surgeon needs to take before declaring any aircrew fit to fly are the interpretation of RT-PCR, determining infectivity, assessing any sequelae and whether they are serious enough to cause inflight incapacitation and the systems which need to be assessed irrespective of the presentation of the disease. Evaluation of an aircrew on these lines will help in an evidence-based approach in reflighting aircrew facilitating optimal usage of a train pilot without compromising flight safety

Session VII Critical care Air transport team (C-CATT) and Patient Transfer unit (PTU): A Decade of Experience in a Zonal Hopital

Gp Capt Parli Raghavan Ravi, Gp Capt MC Joshi, Gp Capt M Dhawan, Gp Capt MN Vijai, Lt. Col Sarubh Sud

Patient Transport unit (PTU) and its team CCATT (Critical Care Air Transport Team) has been operating as a savior of the critically ill in the north-east since 2008. It is an indigenously developed, stretcher modified unit. It houses the critical monitoring and life support electro-medical equipment. The inhospitable terrain of north-eastern sector coupled with 'the need for speed' makes aeromedical retrievals (MEDEVAC) of the critically ill an essential and very often the only choice. There have been significant number of MEDEVAC using this equipment and the experience gained over the years has caused several modifications in its basic design and procurement of better lightweight airworthy medical equipment. There have been issues pertaining to its use in terms of criticality of patients, hours of its use in long term flying, on board interventions, communication related events and operational and administrative support. To utilize it judicially and gainfully it was proposed to study all the related aspects and formulate a severity protocol so that the indenting, administrative and delivering units are on same platform.

36

Inflight Medical Emergencies and Their Outcome in a Commercial Airliner Dr BK Umesh Kumar, Dr Waleed Al Shukaili In the year 2019 nearly 4.3 billion passengers flew by commercial Airliner. Old, aged Passengers travelling with pre-existing medical conditions are on the rise. There has been a steady increase in the Inflight medical emergencies. A review of all the Inflight medical emergencies (IME)from 01 Mar 2015 to 31 Mar 2019 in a commercial airline of middle eastern country was studied. There were 614 Inflight emergencies during the period of steady. One inflight emergency for every 336 flights. These emergencies occur in an unfamiliar and restricted environment such as lack of space and at a cabin altitude of 5-8000 feet along with aviation stresses noise, vibration and reduced humidity. The most common IME was syncope /Presyncope (35.5%) followed by trauma (27.3%) and difficulty in breathing (17. 2%). Gastrointestinal symptoms accounted for 16% of cases. Diversion of aircraft carried out in 16 IME.Main causes of diversion were Stroke, myocardial Infarction, epilepsy and bell’s palsy. There were 9 onboard deaths during the period of steady. Causes of deaths Myocardial Infarction in 2 cases, malignancy in 2 cases Cardiac failure and arrest in one case. Cause of death could not be ascertained in 4 cases. Onboard physician help was sought in 62 % of cases and paramedic help was sought in 26% cases. Oxygen was used in 74% of IME and on-board medication was used in 94% cases. There is no standard internationally accepted reporting and management of Inflight medical emergencies. Every airline has its own protocols for the same. Onboard health care professionals play a vital role in the outcome of inflight emergencies

Psychological Capital and Employee Engagement among Junior Leadership in Indian AirForce

Dr Kalpna Anand

Military constitutes 30% of the total workforce of Central Government making it the largest employer. According to reports there is an acute shortage of PBORs in all the three forces. Junior leadership is an important link between officers and staff and at present they are shouldering increased responsibilities because of manpower shortage. The present study seeks to explore the relationship between psychological capital and employee engagement among junior leadership in military. 57 junior leaders in warranted rank in supervisory roles from Indian Air Force with mean age of 42.7 years in the pay level six to eight and minimum 18 years of experience participated in this study. Data was collected using Utrecth Work Engagement Scale and Psychological Capital Questionnaire. Results revealed that psychological capital was significantly

37 related with employee engagement. Regression analysis showed that out of four dimensions of psychological capital hope came out as a significant predictor of employee engagement accounting for 13.9% variance. Hope and self-efficacy together predicted 19.1% variance in employee engagement whereas optimism and resilience did not come out as significant predictors of employee engagement. It is evident that the psychological capital of employee engagement making it pertinent for the organization to ensure sound psychological capital through regular trainings and personality development programs.

PTU and MEDEVAC: Our Experinence Gp Capt Piush Renjhen Modern conflict is short of a full-scale war and is characterized by short duration, high intensity combat resulting in a large number of casualties. Medical evacuation (MEDEVAC) or medivac, means provision of timely and efficient movement of casualty and provision of en-route medical care provided by a team of specialists (medical personnel) to the wounded. Critical Care Air Transport Team (CCATT) is a unique, highly specialized medical asset of the Armed Forces that can create and operate a portable intensive care unit (ICU) on board (patient transport unit-PTU) in any available transport aircraft. Patient Transfer Units (PTUs) have been designed in the IAF and are equipped with medical equipment to cater to the needs of patient during the air evacuation. The paper discusses the composition of CCATT team, communication protocols, cases evacuated and way forward iro use of PTU from a premier transport base in IAF. The paper also highlights the changes envisaged in the current PTU to ensure ease of operations. Session VIII Air Evacuation of Indian Citizens from Wuhan, China: a Field Experience

Wg Cdr A Kulkarni, Gp Capt S Agrawal, Wg Cdr Surendra Kumar, Gp Capt P Rastogi, Gp Capt D Salimath, AVM S Mukherji, Flt Lt Avantika Rai

Novel Corona Virus (nCoV) outbreak occurred in China in Dec 19 where large number of people got infected with the disease. An IAF special aircraft C 17 was sent to China on 26 Feb 20 with 15 tonnes of medical supplies for coronavirus affected people in China and on return it brought back 112 passengers. Disease was restricted to China during those times with Wuhan in Hubei province being the epicenter. Little was known about this mysterious disease. A Medical team consisting of public health spl, physician, two nursing officers, two medical and one health assistants from Hindan volunteered to

38 be part of this mission when the anxiety and uncertainty about the disease persisted all over. This paper describes the preparation by medical team for this evacuation and various precautions undertaken at Wuhan airport, en route journey and landing at Palam and Hindan. This paper also describes quarantine and testing protocol followed for aircrew, ground crew and medical team. During this public health mission, medical team was actively involved in off-loading of medical supplies at Wuhan, conversion of aircraft in to passenger mode, entry screening and inflight care of passengers on board and daily monitoring and medical cover to C 17 team during 14 days of quarantine at AF Stn Hindan. This paper also deliberates on various lessons learnt during the exercise.

Aeromedical Evacuation of a COVID-19 Patient from a Zonal Hospital Sqn Ldr Subhasish Patnaik In this era of ongoing global pandemic, the patient surge for aeromedical evacuation is going to increase. The risk of contamination of COVID-19 to medical team and the air crew during the transport cannot be ignored. Whether to use aisolation pod or not is still a debatable topic. We have evacuated a case of COVID-19 Bilateral extensive pneumonia patient from a zonal hospital in northeast part of India to Delhi by a fixed wing aircraft. The Airborne rescue pod for isolated transportation (ARPIT) was used to isolate the patient during the transport. The patient was put on NIV support throughout the transport. He was stable maintaining an oxygen saturation of 93-95% and a heart rate of 70-78/min. Here we share the preflight preparation, inflight management and challenged faced during the entire aeromedical evacuation. Some suggestions for modifications of ARPIT are also enclosed.

Development of Negative Pressure Patient Isolation unit During the COVID-19 Pandemic

MD Sharma

Introduction: The ongoing COVID-19 pandemic has raised unprecedented challenges for the Nation’s public health care system. The disease is transmitted through droplet route and close contact with an infected patient. Even after physical barriers like masks and measures like social distancing are put in place, transportation of an infected patient to a healthcare facility or between facilities poses a unique challenge in terms of exposing the doctors, paramedics and attendants to this infection. A system for isolating the patient inside the vehicle/aircraft and preventing contamination of the air inside the vehicle with the patient’s aerosols can help in slowing down the transmission of the disease. A patient isolation unit with a negative pressure generation system can be an

39 answer to these challenges. Aim: To describe the process of development and testing of the negative pressure patient isolation unit. Materials and Methods: A negative pressure patient isolation unit was fabricated in one of the IAF units using locally available material and expertise and was tested for functionality. Negative pressure was generated using a commercially available vacuum cleaner of 800W power. Unidirectional airflow was taken as evidence of negative pressure.Results: Unidirectional flow of smoke was observed on switching on the unit, which was taken as evidence of adequate functionality of the unit.Conclusion: This unit is a scientific and costeffective way of reducing transmission of nCoV (or any other respiratory pathogen) from an infected person, while transporting the latter to or from a healthcare facility.

The United Kingdom’s Aeromedical Evaluation Experience During COVID-19

Wg Cdr Ian Malan

Background. Since the first report of coronavirus in Dec 19 in Wuhan, China, the disease has spread to all continents and new cases continue to grow globally at exponential rate. In response, the UK Armed Forces has provided Aeromedical Evacuation (AE) support to its citizens stranded overseas and also internally within the UK, to the National Health Service.Overview. In assistance to the UK Foreign and Commonwealth Office, AE personnel conducted repatriation flights for over 380 of its citizens on chartered commercial aircraft from China, Japan and Cuba. Patients with COVID can be safely transferred in an open manner without the need for an air transport isolator. Internally within the UK, specialist AE support has been provided on 4 missions transferring patients on extra-corporeal membrane oxygenation to the National specialist centre. Separately 16 other missions have been conducted with COVID positive patients. Discussion. Total numbers of AE patients are lower than in pre-COVID times, this reflects the reduction in global Exercises being undertaken at this time. Over 300 AE missions have been conducted since the UK went into lockdown in Mar 20; currently, missions are more complex due to the lack of civilian scheduled flights and border restrictions, and require more planning and detailed Infection Prevention Control risk assessments. In addition to existing AE platforms, the RAF commissioned the conversion of The Royal Flight BAe-146 aircraft to enable AE; this gives operational flexibility should the need be required. Ready access to Public Health and Infection Prevention Control advice has been invaluable for mission planning; more broadly embedding this access at the very heart of the RAF COVID operations has enabled timely response to problems

40

41

ABSTRACTS: POSTER PRESENTATIONS

Session I 'Crunch Situation' - Diagnostic Challenge in a Fighter Aircrew with Acute Upper Abdominal Pain Gp Capt Ameet Kumar, Gp Capt Sumesh Kaistha, Acute abdomen is a common surgical emergency forming 5-10% of all emergency room visits and a definitive diagnosis is not reached in upto 25% of cases. At times, the diagnosis remains elusive because of rarer causes of the pain and hence takes additional time for the final diagnosis and definitive management. We report this interesting case of a fighter pilot presenting with acute upper abdominal pain who was admitted with a diagnosis of acute coronary syndrome. The case posed a significant challenge in reaching the correct diagnosis of abdominal crunch syndrome. Abdominal crunch syndrome is an extremely rare entity and there are only 07 reports of it in literature so far. To the best of our knowledge, this is the first ever report of this condition in an aircrew. Acute abdomen is a Pandora’s box and the cornerstone of approach to it is meticulous history taking and clinical examination. In this case, the aviator did not associate his vigorous abdominal crunches with the occurrence of pain and therefore, did not mention it. If the history was forthcoming in the initial evaluation, a lot of unnecessary investigations would have been avoided. And had it not been elicited later, it would have led to more investigations with a high possibility of totally missing the diagnosis and consequently putting the pilot in a period of observation before he could be returned to flying. From the aero-medical safety aspect, it is pertinent to highlight that had the aviator flown on the morning of the day he developed abdominal pain, there was a definite possibility of patient developing severe pain exacerbated by the pressure of G force and G suit causing worsening of pain and sudden in-flight incapacitation.

Evaluation of Casualty: An Uphill Task at ‘OPERATION MEGHDOOT’

Bhardwaj Saurabh; Sud Saurabh

Introduction: The mission of health service support during military operations is to conserve fighting strength through: 1) prevention of injury and illness, 2) effective treatment of casualties to expedite their return to duty and 3) timely evacuation of casualties who cannot be effectively treated in forward echelons. To employ field medical support assets effectively, a medical officer needs to be aware of the potential impact of environmental factors on soldiers and medical assets. High altitudes are characterized by extreme cold, strong winds, 'thin" air, intense solar and ultraviolet radiation, and rapidly changing weather including severe storms which can cut off contact for a week or longer. Acute mountain sickness, high altitude pulmonary edema,

and cerebral edema are frequently fatal consequences of working at high altitude. High- altitude mountainous terrain imposes great strains on individuals, units, and the health services designed to protect them. Medical personnel are challenged to minimize the damaging effects of the harsh environment, to maximize survival rates, and to preserve combat effectiveness by optimizing physiological and behavioral adaptation. They are exposed to the same danger of working in high altitudes and much of their normal medical equipment do not function, or function effectively, at high altitudes. Amidst all these environmental challenges the biggest constraints lie in not only diagnosing and managing casualty at hand but timely evacuation of the same so as to ensure preservation of life/limb. Aim: The present paper aims to bring out the challenges imposed on health services set up especially towards evacuation of casualties while being deployed at ‘OP MEGHDOOT’. Methodology: Environment factors, which impact on health service support in high altitude terrain, are discussed. Also, information about the use of field medical unit assets to provide treatment and evacuation in a high- altitude terrain are brought out and recommendations towards preventive measures to mitigate the influence of high-altitude terrain are also discussed. Conclusion: Medical support in mountain environments requires familiarity with the threat and adequate planning to accomplish the mission. The high-altitude mountain environment can severely hamper the function of medical support. Medical personnel should be trained to treat the constellation of environmental medical problems of high altitude and provisioned with appropriate equipment and supplies to do so. In addition, to conform to the tactical mission and to operate efficiently under the restrictions imposed by the topography and climate, medical support units will need to be augmented to maintain flexibility in their configuration and deployment.

Gall Bladder Polyps and their Management Guidelines Gp Capt Mukul Bhatia Gall bladder polyps are elevated mucosal lesions that protrude into the lumen. The prevalence of gallbladder polyps in the general population is between 0.3 to 12.3%. The majority of gallbladder polyps are detected incidentally on radiological imaging or histological examination after cholecystectomy. Only 5% of polyps are considered “true” polyps meaning thereby that that they are malignant or have a malignant potential. The remaining lesions are called “pseudopolyps” and include cholesterol, inflammatory polyps and adenomyomatosis. The radiological modality used for evaluation, including follow up is transabdominal ultrasonography. Gallbladder cancer is common cancer in our country with the incidence being high in northern and central India. Diagnosis at an early stage is important to achieve good therapeutic outcome. Joint guidelines between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES),

International Society of Digestive Surgery – European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE) have been evolved in 2017. The guidelines recommend cholecystectomy for gallbladder polyps sized 10 mm and greater, although this threshold is lowered to 6mm in individuals of ‘Indian’ ethnicity. The sonological features of gall bladder polyps and ‘pseudopolyps’ will be reviewed and the rationale behind the paradigm shift in the management of these incidental lesions from a highly proactive approach to watchful waiting in the Air Force will be discussed.

Prevalence of Tobacco Abuse among Personnel Posted at a Large Airforce Base

Gp Capt SK Kaushik

Introduction: Consumption of tobacco products is increasing globally, though it is decreasing in some high-income and upper middle-income countries. Chewing and smoking of tobacco along with consumption of alcohol beverages have become common social habits in India. The main determinants for any indulgence in any substance abusive habituation are educational qualification, occupation and income. The study aimed at finding the magnitude of tobacco related habituations amongst personnel at a large Air Force Base.Material and methods: The study involved routine screening of air warriors who report for annual medical examinations. Tobacco habituation behaviours were measured by four indicators: Habit status, tobacco consumption, health risks related to tobacco, and tobacco dependence. The habit history was noted as Tobacco abuse habit presence or absence. If there was positive history, then the type, chronicity and frequency were noted. Their occupation trade/ branch was recorded. During intra oral examination, presence of signs of tobacco related lesions like leukoplakia, erythroplakia oral sub mucous fibrosis was also noted. Results: The study period was between Apr 2019 to Jul 2020 at a premier tertiary care dental centre at a large frontline airbase. A total of 3530 personnel was examined during routine annual Dental inspection. 654 (18.4%) had positive tobacco related habituation. Defence Service Corps personnel, non combatant (Enrolled) had higher prevalence as well as personnel from Auto Tech and Adm asst trades. Conclusions: The trend of tobacco abuse habitation amongst serving personnel is on the rise due to ease of availability, financial freedom, occupational stressors, peer pressure, poor health awareness and for want of cheap simple thrill. In view of the long-term ill effects of increased predilection for cancer of the aerodigestive tract, poor oral hygiene, increased risk for stroke and COPD, there is an urgent need to sensitise the personnel of the ill effects and dissuade them from pursuing the habit .

Session II Biomedical Enhancement in Indian Armed Forces: Issues & Challenges

Col Shashivadhanan

Science and technology have greatly advanced fighting capabilities of Indian Armed forces. In spite of possessing the most lethal and developed aircrafts & armamentarium, the best of the world forces have to rely on the personnel fighting in the battle zone. They happen to be the weakest link. Hunger, fatigue, emotions, adrenaline and “fog of war” can seriously hamper his decision making and physical capabilities. Combating sleep deprivation and improving attention span has been one of the major areas of research across the world. In addition to the overall force multiplier effect, attenuating the effects of sleep loss also has some specific benefits. It improves the ability to undertake operations through the circadian trough of warfighters and pilots. Night-time operations have many important advantages. For example, conducting aerial operations under the cover of darkness increases aircraft and pilot survivability. Also, raiding residential compounds in the pre-dawn hours maximizes the likelihood of individuals being at home and the resulting confusion for the people awakened can make detainees easier to handle. Furthermore, reducing the effects of sleep loss facilitates continuous operations. America and its modern allies have undertaken various projects to strengthen the bodies and minds of its personnel so as to create the super soldier. In order to keep pace with modern warfare other countries too are following suit. The race for creating the Enhanced warrior has begun. In order to continue its war on terror there is need for warrior who is independent, network integrated, more lethal and endowed with physiological reserves that empower him to deliver peak performance for a longer duration as compared to his unenhanced counterpart. This paper attempts to define biomedical enhancement, its advantages, risks and challenges with Indian Armed Forces in backdrop. In the ultimate analysis, it’s evident that India has no option but to rise up to this challenge and devise its own policy and guidelines. Issues of morality and ethics need to be restructured accordingly

Epidemiological investigation of Dengue cases in a Military Training Establishment

Wg Cdr A Kulkarni, Wg Cdr GS Basra, Gp Capt AS Prasad, Air Cmde Roy T

Background: 09 cases of dengue reported from one of the military training establishment within short period (21 July – 12 Aug 2018). The military station was located close to civil area which was also reporting rise in cases of dengue

fever. Methods: The epidemiological investigation was carried out to identify the circumstances which led to occurrence of this outbreak and to recommend control measures for prevention of such outbreak in future. Diagnosis of each case was made based on the clinical definition and lab testing. Line listing of cases was made and epidemiological case sheet was prepared. Spot map of cases was plotted to identify any clustering of cases. All cases were admitted and treated conservatively who recovered without any squeal. Environmental survey was done to check mosquito breeding sites. Observations were brought in the notice of administration which was subsequently rectified. Results: During environmental survey, mosquito breeding was observed inside blocked drains and the block was identified at places where these drains were joining civil drains. Mosquito breeding was also observed inside uncovered manholes, dessert coolers, construction scraps, household discarded items, pot plates, flower pots, broken washbasin, plastic sheet kept in open, broken bucket, manual stone grinder, etc. Clustering of cases was around this mosquito breeding sites. Conclusion: Presence of mosquito breeding and high transmission of dengue virus within local population contributed to occurrence of the outbreak. Special precautions related to sanitation are to be taken when our military establishments are surrounded by civilized areas. Dengue is proven to be a disease of poor civic sense and each individual has to contribute in maintaining sanitation of our own premises.

Management of a Case of Gunshot Wound (chest) in SMC and casaevac-Aeromedical Implications and lessons learnt Wg Cdr Omesh Nath Management of critical emergencies at peripheral set up involves chores of clinical judgement, treatment rendered and transfer to a higher medical echelon with minimal complications and stable management during evacuation. This paper deals with management of a gunshot wound chest in SMC of a remote base followed by CASAEVAC considering the aeromedical implications thereby drawing certain conclusions. Maintaining of vital parameters during transfer is of utmost importance thereby minimizing the complications and improving probability of recovery of the case. This paper also deals with dilemma in decision making of aeromedical transfer and certain lessons learnt for future reference.

Pre-Enrolment Medical Evaluation for Air Warriors in IAF during COVID-19 pandemic: Concerns and Lessons Learnt

Sannigrahi P, Anshul A, Debnath P, Kumar S, Nataraja MS

Recruitment of air warriors is an on-going and continuous process for the smooth functioning of the Armed Forces around the world. Assessment of individuals for their

fitness to join Air Force complying the extant medical standards is of prime importance in selection of a healthy individual. Pre-Enrolment Medical Evaluation for air warriors in IAF was carried out in a training establishment in Southern India during the prevailing Covid conundrum. A total of 3800 candidates reported in 03 batches from different parts of the country including zones of high transmission of Covid 19 rendering them at risk of acquiring the infection during travel. In an effort to prevent spread of infection, medically declared FIT candidates of each batch were placed under quarantine for 14 days and a similar interval was ensured before calling in the next batch for medicals. A team of 07 medical officers took part in the process of medical evaluation, screening and sick reports of trainees under quarantine, evaluation of suspected and symptomatic trainees using Rapid Antigen Kit for Covid 19, sample collection for RT PCR, administration of HCQ prophylaxis to primary contacts and management of Covid 19 positive cases at local Isolation facility. In view of the extraordinary situation prevailing due to Covid 19 pandemic, meticulous planning was done and precautionary measures were practised following the guidelines of medical authorities. All-out efforts by each member of the team ensured smooth conduct of the pre-enrolment medicals. The Covid 19 positive trainees were effectively managed and spread of infection was controlled. All the medical officers involved tested Negative for Covid 19 at the end of the successful exercise. This paper deals with the concerns and lessons learnt during the course of medical evaluation of 3800 trainees who were subsequently taken over for quarantine and further into all activities of training.

Session III

Aeromedical Decision Making in Inducible Ischemia with Patent Epicardial Coronaries in an Aircrew

Ghosh DD Introduction: Early detection of the presence and characterization of the severity of inducible myocardial ischemia in asymptomatic population may help identify individuals at risk, in whom aggressive preventive risk management would be most beneficial. Aeromedical decision making in TMT +ve asymptomatic cases focuses on evidence- based approach. Case report: A 31 years old, chronic smoker and occasional alcohol consumer helicopter pilot was detected with T inversion in lead III, flat ST in aVF, Q wave in V1, T inversion in V4-V5. He was prescribed prophylactic tablet Ecosprin, Clopidogrel and Atorvastatin. On further evaluation, although his 2D Echocardiography was normal, he was found to be positive for inducible ischemia in TMT. He underwent coronary angiography that eventually revealed proximal mild ectasia in left anterior descending (LAD) and left circumflex coronary artery (LCx). However, he had patent epicardial coronaries. Discussion: Aeromedical disposal of such a case needs

comprehensive physical, radiological and biochemical evaluation along with rational consideration for flying without compromising flight safety. In this case, the aircrew underwent comprehensive cardiac evaluation and remained asymptomatic with normal coronary circulation and NYHA-I cardiac status. Mild ectasia in LAD and LCx were not associated with CAD or atherosclerotic lesion. With proper precaution and follow up, chance of cardiac event was negligible. Moreover, being an asymptomatic rotary wing pilot, risk-benefit ratio was in favor of full flying certification. Conclusion: Appropriate and timely usage of advanced cardiac evaluation for suspected cases along with rational consideration regarding flight safety are immensely important in assessment and disposal of such cases.

Colour Vision in Civil Aviation Wg Cdr AK Singh

Colour Vision Deficiency (CVD) is a condition that results in individuals being unable to distinguish differences between certain colours. Occupational colour vision standardswere introduced in aviation in 1919 by The Aeronautical Commission of the International Civil Air Navigation Authority. Concern has been expressed during the last few years that the current colour vision standards in aviation may be too stringent and, at the same time, also variable across the world. The tests employed do not always reflect the tasks pilots encounter in today’s aviation environment. This ambiguity leads to the possible exclusion of deserving applicants for selection as aircrew. The compatibility of CVD with crewing aircraft is assessed by medical personnel using clinical diagnosis tests on the ground level. These clinical tests were developed specifically to detect the presence, nature and severity of CVD. No clinical tests yet provide a measure of operational performance in operating an aircraft. Arbitrary pass marks have been assigned to clinical tests such that a failing candidate will either be subject to operational restrictions or excluded completely. The prescribed clinical tests and associated pass marks vary considerably between regulators. While an individual may be subject to no restrictions in one jurisdiction, they may be excluded in another. This article highlights newer diagnostic techniques adopted by different countries for assessing colour vision to see for the scope of evidence-based guidelines for minimum colour vision requirements for flight crew as well as for civil aviation in India

High G Training: Reaching Greater Heights Mishra S, Ajay Kumar, Dinakar S

Introduction: In the present era of modern high-performance combat aircrafts, training for high G is undoubtedly the most important activity for the aircrew. The increase in

performance of fighter aircrafts with respect to engine power, airspeed, maneuverability and structural integrity has led to making the pilot a limiting factor with respect to his physiological tolerance to high sustained G. They get exposed to new combinations of high translational accelerations and rotational motions in these aircrafts. With this in view the Indian Air Force started with high G training for the fighter pilots in 1991. Brief History: The high G training course in the Human centrifuge started in March 1991 at IAM, IAF. This was followed by a reinforcement Advanced fighter aeromedical indoctrination course of two weeks. With the induction of the high-performance human centrifuge (HPHC) in 2009, operational training started for the aircrew in the OPTRAM courses regularly conducted at the Institute. The HPHC is capable of producing multi- axial acceleration with very high onset rates and is able to sustain high G forces. This centrifuge is capable of simulating G onset rates of almost all modern fighter jets. The simulator dynamically generates G-forces in all desired axes simultaneously, in order to authentically replicate the stresses of the tactical flight environment in a realistic scenario. The Present and future: The HPHC has been under upgradation to Dynamic Flight Simulator (DFS) since December 2019. The DFS has provided ultimate versatility to the HPHC training. It leverages on advanced simulation capabilities to recreate a wide variety of training and operational scenarios, from entry level to advanced tactical flying, missile jinking manoeuvres etc, exposing the aviator to a realistic flight environment with physiological stressors. This paper brings out the upgraded features of the HPHC and additions to the High G Training under near realistic operational scenario. This upgrade shall instill a level of confidence and preparedness in the aviator which will aid him when adverse flight conditions are experienced in a realistic mission environment.

UV-C Technology for COVID-19: Surface Disinfection by Exposure to Germicidal 254 nm UV light

Dr Savita Gaur, Dr Rajeev Varshney, Dr Anju Bansal, Dr Bhuvnesh Kumar

World encountered COVID-19 viral infection in later 2019 and WHO declared it as pandemic in early 2020. The COVID-19 virus is highly contagious and spreads through droplets generated when a person coughs, sneezes or exhales. To control the spread of viral infection, various precautionary measures were implemented. As a part of preventive measures against transmission of Corona virus and in its mission to contribute towards war against COVID-19, Defence Institute of Physiology & Allied Sciences (DIPAS), DRDO has quickly utilized UV-C disinfection technology for surface sanitization of daily used items. This cntact-less UV-C radiation-based sanitization technology is fundamentally superior tactic in the fight against COVID-19 as it has the potential to prevent the spread of viruses before they enter the body the high energy from short wavelength UVC light is absorbed in the cellular RNA and DNA, damaging nucleic acids and preventing micro-organisms from infecting and replicating. The UV-

C Dose (mJ/cm2) that is received by the Viruses DNA/RNA, is the integration of its intensity (mW/ cm2) and duration (sec) of exposure. The dose is related to irradiance by: Dose (D) =Irradiance (E) x Irradiance time. In regards to COVID-19, a UV-C dose of 100 mJ/ cm2 can bring out 4-log inactivation. Antibacterial activity of UVC light @254nm was tested against bacterial species showed growth inhibiting effect.

Session IV

Study of subjective assessment for efficacy of septoplasty in Armed Forces Personnel with septal deviation Maj Lovraj Goyal, Gp Capt PK Sahu & Maj Jitendra Bothra Background and objectives. Septal deviation is one of the leading causes of chronic nasal obstruction. Chronic nasal obstruction effects Eustachian tube functioning thereby affecting normal middle ear pressure. Septoplasty is procedure of choice for treating these patients. Difficulty in nasal breathing and complaints of nasal obstruction both are highly subjective. Depending on patient’s perception and satisfaction the benefits of the surgery vary. Our study aimed at assessing the disease specific quality of life outcomes of septoplasty by means of a questionnaire. A modification of NOSE scale was used to compare the pre- and post-operative symptoms. Type of septal deviation was classified as per Mladina’s classification of septal deviation. Patients above 20 years of age, with anatomical deviation of nasal septum as the sole cause of obstruction and symptoms persisting for more than three months, underwent septoplasty. Patients Modified Nasal Obstruction and Symptom Evaluation (NOSE) score were documented and analyzed pre and post operatively. Methods. Prospective study conducted at Command Hospital Air Force Bangalore in department of ENT for period of 1 year from 2019 to 2020 in 30 patients who underwent septoplasty. Results. Present study included total of 30 subjects. Minimum age was 20 years and maximum age was 40 years. Postoperative subjective evaluation by evaluating Modified NOSE score depicted a significant improvement. There was improvement in nasal obstruction in all patients postoperatively. Conclusion. Study concluded that Modified NOSE Scale addresses wider range of symptomatology and is a good tool for assessment of efficacy of septoplasty. Use of Modified NOSE scale will help patient to know his expected outcome following septoplasty and can be used as a predictor of successful surgery in patients undergoing septoplasty.

Evaluation of Fighter Aircrew with Hypertension under +Gz Acceleration

S Dinakar, VV Joshi, S Mishra, A Kumar

Introduction. Hypertension and the cardiovascular disease risk associated with it is a continuous one. Retaining a trained aircrew with primary hypertension is a challenge in military aviation, in particular aircrew of high-performance aircraft (HPA). The IAF allows an aircrew on a single drug therapy to fly HPA. Such aircrew are evaluated in HPHC since 2009 before reflighting. The aircrew on medication are observed on ground for dose adjustment and any idiosyncrasies. Once the blood pressure is stabilised, the aircrew have to undergo the full OPTRAM protocol (9Gz for 5s qualifying run) before returning to flying duties. +Gz is known to be arrhythmogenic. Anti-hypertensives primarily act by changing the pre-load, after-load or acting on the hormonal axis involved in blood-pressure control. Exposure to +Gz stress is known to alter heart rate (and pulse pressure), cardiac contour, position of heart in the chest, and cardiac output. Use of drugs will exaggerate these changes and the effects of these are unknown. Methods. Retrospective study of evaluation of hypertensive aircrew at the Dept of Acceleration Physiology and Spatial Orientation, 2009-2019. Results. Descriptive analysis applied due to small sample size. Discussion. There are no standards for cardiovascular tolerance of +Gz. This is primarily because ECG monitoring is not part of all training programs, as this would be a potential aeromedical disqualification of aircrew from flying. Hence, subjecting aircrew to +Gz stress before reflighting is a topic that is open to discussion. The IAP 4303 is under revision and the Institute is an advisor in making these policy decisions that have to be evidence based. This paper discusses issues on the same subject matter.

Comparative Study on Temporal Database of Physical Parameters of Military Personnel in IAF

Ghosh G, Taneja N

Background: In view of increasing prevalence of obesity in IAF, several lifestyle modification programmes have been instituted to encourage healthy dietary practices and exercise. In continuation to these programmes, this paper attempts to analyze the physical parameters of IAF personnel to pick up important time events when weight gain has been significant during their career. It also aims to recommend healthy dietary preparations at IAF messes, to curtail unhealthy food habits amongst young air warriors. Method: Annual physical parameters of 150 air warriors aged below 30 years were analysed on Microsoft Excel®. Results: Mean age was 26.19 ± 3.15 years. Mean Height at entry was 170.53 ± 5.83 cm. At the end of three years there was a mean increase of height by 2.02 cm and BMI by 2.64 Kg/m2. After height stabilization, an increase was noticed in mean weight by 1.29 Kg/year and Waist & Hip circumferences by 0.60 and 0.42 cm respectively. Discussion: Contrastingly in comparison to previous

studies done on NDA candidates, there was an increase in height of air warriors in the same age group. Despite the increase in height, there was an increase in BMI, which indicated proportionately higher weight gain. There was also a constant increase in weight and other physical parameters during their stay in living-in accommodation. Additional samples from SNCOs and officer population are being collected for data augmentation and segregated at four yearly intervals to monitor influence of confounding factors like introduction of social media, sedentary lifestyle, etc. The results will be further discussed after appropriate statistical analysis. Conclusion: The role of healthy food habits in restricting loss of trained manpower to obesity cannot be overlooked. Hence, a fitting dietary regime along with appropriate calorific values is recommended at messes and squadron cafeterias.

Auditory Steady State Response and Auditory Brainstem Response: Optimized Methods to Test Frequency Specific Thresholds Objectively in Aircrew

Maj Jitendra Bothra, Gp Capt Himanshu Swami, Gp Capt Pankaj Kumar Sahu & Maj Lovraj Goyal

Background and Objective. Occupational hearing loss is one of the most common work-related injuries especially in aircrews. To detect hearing loss Pure Tone Audiometry (PTA) is the gold standard however it is a subjective test. This study compared Auditory Steady State Response (ASSR) and Auditory Brainstem Response (ABR) with PTA and establish a correlation between the thresholds determined by subjective test- PTA and objective test – ASSR and ABR at 500 Hz, 1 kHz, 2 kHz and 4 kHz. Methods. In this prospective study we have included 40 subjects (n = 80 ears) of both genders. All subjects underwent ASSR, tone burst ABR and PTA to record frequency specific hearing threshold at 500 Hz, 1 kHz, 2 kHz and 4 kHz. Data was recorded and analyzed with SPSS IBM Software. Results. Mean difference between PTA and ASSR was 14.2 dB and between PTA and ABR was 18.8 dB. The overall correlation between PTA-ASSR and PTA- ABR thresholds for each frequency were strong with Pearson correlation coefficients (r) for ASSR were 0.767, 0.815, 0.877 and 0.889 at frequencies of 500, 1000, 2000, and 4000 Hz, respectively (p < 0.01) and Pearson correlation coefficients (r) for ABR were 0.832, 0.801, 0.907 and 0.895 at frequencies of 500, 1000, 2000, and 4000 Hz, respectively (p < 0.01). The overall reliability was better in high frequency for both ASSR and ABR.Conclusion. Results of this study concluded that both ABR and ASSR both can be used to predict frequency specific hearing thresholds objectively in aircrew. ASSR was more reliable than ABR for accurate prediction of frequency specific hearing threshold as mean difference between ASSR and PTA was smaller than mean difference between ABR and PTA.

Indian Society of Aerospace Medicine Wishes All the Delegates Healthy Scientific Interactions & Comfortable Stay

Institute of Aerospace Medicine Indian Air Force Vimanapura Post, Bengaluru-560017 Karnataka, India http:/www.isam.in

Phone No: 080-25224666 080-25223458