President's Page

While traveling home from the August meeting of the AsMA Executive Committee, held at our head­ quarters in Alexandria, VA, I paused to reflect on the weekend effort. I would like to thank all the commit­ tee members who traveled to Alexandria: Phil Scarpa, Fanancy Anzalone, and Jeff Myers-Florida; Bob Weien, Glenn Merchant, President-Elect Andy Bellenkes­ Colorado; Carol Manning-Oklahoma; Marian Sides­ Illinois; Jarnail Singh-Singapore. I personally witnessed the dedication and hard work of the committee members who volunteer their services on behalf of the Association and its members. It struck me that this same volunteer spirit exists in the AsMA Council, the committees, and in the leadership John D. Hastings, M.D. of constituent and affiliate organizations. All of these entities are populated by AsMA members who contrib­ ute to the Association's success. I thank all. A second goal I chose was to emphasize the inter­ We began the Executive Committee meeting by national nature of AsMA and to nurture its further de­ learning about each other and then moved on to an velopment. One of the most rewarding aspects of my ambitious morning-long orientation session. We dis­ membership in the Association has been the depth and cussed our goals and expectations and studied the breadth of perspective for aerospace medicine given to principles of working as a group. We explored the me by my international colleagues. More importantly, boundaries of governance and management. The ori­ the friends I have made and the relationships I have entation session was very helpful in providing a work­ developed will be treasured forever. ing relationship that enhanced our ability to tackle I am mindful of some shortcomings at the recep­ Association issues. tion for international members at the New Orleans The second segment of the meeting was spent on meeting, and I wish to acknowledge those shortcom­ association finances. As you know, Glenn Merchant ings. At the 2008 meeting in Boston, I have decided was elected Treasurer of AsMA at the New Orleans to dedicate Tuesday, ordinarily a "free' night, to this meeting. Glenn did yeoman work in examining the fi­ reception. I urge all to attend. This event allows us nancial health of AsMA. His presentation ranged from to meet our international colleagues and friends, and I investments to accounting to records and procedures. invite our U.S. members to participate. I am confident that Glenn's efforts will give association Realizing that planned changes for the interna­ finances safe passage. tional member reception may play havoc with previ­ The third segment of the 1.5 day meeting was de­ ous attendance records, we want to take careful steps voted to the traditional agenda, in itself a hefty project. to insure that arrangements are sufficient to accom­ I mentioned previously that one of my goals for modate the event. There are logistical limitations in the year was to review the instruments by which adjusting to a large surge of on-site ticket requests, and AsMA communicates with the world of aerospace we ask your indulgence in dealing with this issue. We medicine and the processes giving rise to these instru­ are looking at measures such as requesting an early ments. These instruments include position papers, commitment for those wishing to attend. position statements, resolutions, letters, and appear­ I have mentioned only a few of the items covered ances on behalf of the Association. The purpose of this in our Alexandria meeting. I am honored to work review is to enhance AsMA participation in the current with such capable and dedicated colleagues. We conversation in aerospace medicine through timely will continue our efforts to justify the confidence you and responsible comment on important issues. We dis­ have shown in selecting us as crew for this leg of the cussed ways and means of conducting this review. Association's journey.

Aviation, Splice, lind Ellviro/1/llentlll Medicine· Vol. 78, No. 10· October 2007 1005 Medical News

opinions regarding astronaut fitness for duty. & Executive 3. Provide continuity of care for the astro­ Science Director's nauts with a single provider. 4. Establish good communication among Technology Column flight medicine personnel, behavioral health personnel, and the Astronaut Office. Watch Undoubtedly NASA will carefully examine the findings and recommendations with an eye toward improving their current health services. Interestingly, the overall medical record of the astronauts since we have been Rayman flying in space has been excellent. This is borne out by the fact that there has not been a significant in-flight medical event in the U.s. The Bachmann Report Space Program that has harmed an astronaut or degraded or aborted a mission. In February 2007, the NASA Administrator Keeping You Informed Of The Latest We look forward to the report of NASA's Advances In Science And Technology ordered a review of the medical and behav­ actions in the coming months. ioral health services for NASA astronauts. Consequently, an external committee of Nominations for So what do you mean when you talk about experts was organized under the chairman­ 2008 Awards "perfornwllce?" Doillg we/loll a test? Beillg able ship of AsMA member Col. (Dr.) Richard to move freely within a cockpit? This month's E. Bachmann, Jr., Commander of the USAF December 15 is the deadline for receiv­ columll discusses a nove/mathematical approach School of Aerospace Medicine. After inter­ ing nominations for awards to be presented to optimize human performance based on the con­ viewing a number of astronauts, their families, at the 2008 Annual Scientific Meeting in cept of resource availability. These resources are and NASA staff including medical personnel, Boston, MA. Nominations can be made determined by physical and physiologic parameters, the Committee submitted its report to NASA by any member of AsMA. The award tempered by experience and training. in mid-July. nomination form is available on the AsMA Although there were over 30 findings fol­ website. You may either submit the nomina­ lowed by a number of recommendations, the tion directly from the website or you may Human Performance Report opened on a positive note by stating download the nomination form into your that "the medical evaluation for acceptance computer for e-mailing as a Word docu­ Optimization of astronauts is rigorous and appears to be in ment attachment. Nomination forms sent accordance with NASA standards." The fol­ via e-mail should be addressed to the Valerie E. Martindale, Ph.D. lowing is not a comprehensive review of the Awards Committee Chair, Dwight Holland Bolling AFB, DC Bachmann Report, but rather a synopsis. at [email protected]; and Ms Gisselle One major issue of immediate concern was Vargas at AsMA Headquarters (gvargas@ "We've entered John Doe's tests and results the alleged use of alcohol by several crew asma.org). If e-mail is not available, you can into the computer, and his human perfor­ members just prior to flight. Because no fur­ send a hard copy of the form via normal mance score is 6. Based on that score, here are ther details were given, NASA will undoubt­ mail to: Dwight Holland the available career options." edly investigate this finding in detail. In any 4874 Glenbrooke Dr. The idea of defining a human being by a event, it was recommended that a policy be Roanoke, VA 24081 number is inherently absurd, but the idea that formulated with guidelines regarding the ap­ Phone: (540)761-1576 a human being's capabilities could be defined propriate use of alcohol by astronauts, particu­ AsMA FAX: (703)739-9652. by a large enough set of numbers is not un­ larly during the pre-flight period. Any auxiliary biographical material in likely. We already accept that premise when The Report also noted that while there is electronic or hard copy attachments must human capabilities are considered within a intense psychological testing for selection of be limited to 3 typed pages and will be re­ narrow context, for example athletes for whom astronauts, none is done for retention (an ex­ tained in Association files. a statistically significant set of performance ception is for long-duration missions). In other Nominations received by Dec. 15 will be measurements are available. With the ability words, once the astronaut is selected, there is considered for awards to be presented at the to handle massive amounts of data, the matu­ no routine behavioral health or psychological next annual meeting. Unsuccessful nomina­ ration of bioinformatics, genomics and pro­ assessment. This led to the recommendation tions will be retained in the active file teomics, and an ever increasing array of quan­ that behavioral health evaluations be inte­ through three award cycles. titative measurements such as functional MRI, grated into the annual astronaut flight medi­ To view a list of past recipients go to the we are approaching the point where much cal examination. Likewise, behavioral health AsMA website: www.asma.orglpdfl wider and potentially more valid conclusions providers should be available to train flight awrdwin.pdf about human capabilities can be inferred from surgeons in this critical area. (TIle report does input variables that are objective and quantifi­ recognize that even with a system of periodic The Journal Has New a Look able, either deterministically (e.g., DNA), or evaluation, some individuals might still slip stochastically (e.g., response time). We have through the net, resulting in inappropriate be­ already reached the point where we can alter You may have noticed that the printing havior.) In any event, NASA should determine performance, albeit within narrow limits, by of the "Front of the Book," Aviation, Space, what psychological testing should be per­ application of pharmaceuticals, nutriceuticals, and Envirollmental Medicine, has a new formed with appropriate personnel available human factors engineering, and performance loCi... If you Qldn't notice--take a look! We to administer this program. enhancing technologies. So far, however, have recently changed typesetters and Other important recommendations to enhancement of performance tends to be one­ have slightly revamped our style. We ASA based on findings were as follows: dimensional, and without a quantified goal. hope that the new look will make the con­ 1. Inform astronauts as to the purpose of We have not yet reached the point where we tent easier to read. Please let us know each medical test. Is the test for medical, safety, can enhance performance across an array of what you think. Contact Pam Day: or research purposes? human capabilities systematically, [email protected]; (703) 739-2240, x 101. 2. Give serious consideration to medical See SCIENCE & TECHNOLOGY, p. 1007

1006 Aviation, Space, and Environmental Medicine' Vol. 78, No. 10· October 2007 SCIENCE & TECHNOLOGY,jrom p. 1006. the Elemental Resource Model as an approach under our control. A systematic method of with the goal of optimizing total performance to classifying the resources comprising the applying that control promises benefit both within the context of a mission or goal. human system. Human elemental resources for mission accomplishment and for individu­ Optimization is a branch of mathematics come in four categories: life sustaining, envi­ als pursuing their careers. "We've entered devoted to determining the maxima and/or ronmental interface, central processing, and in­ John Doe's tests and results into the computer, minima of a function. A two-dimensional formation. These resources are determined by and his human performance profile has been example is shown in Fig. 1. This curve has a physical and physiological systems, combined determined. Based on that profile, here are local minimum, but no absolute minimum, with training and experience. Together they the available career options for Mr. Doe as is, as both arms tend to negative infinity, and form a large but finite set, from which an infi­ here are the available strategies to optimize his there are two maxima, both local, but one also nite number of higher order resources can be performance in those options, and here are the qualifying as the absolute maximum because created. An example of this model in practice recommended courses leading to other pos­ there is no higher point which satisfies the is described in Gettman et a!., "Assessment of sible career options for which Mr. Doe can be constraints of the equation. That point is the basic human performance resources predicts optimized." optimum. operative performance of laparoscopic sur­ Optimization is a well developed branch of gery" (1). The authors used a set of resources REFERENCES mathematics. Therefore, in principle it should predicted by a task analysis of laparoscopic 1. Gettman MT, Kondraske GV, Traxer 0, be possible to optimize human performance surgery. Results generally validated the Ogan K, Napper C, Jones DB, Pearle MS, (even if only stochastically) with a mathemati­ threshold model, but also included outliers Cadeddu JA. Assessment of basic human cal approach. In order to do this, human per­ where the threshold model predicted better performance resources predicts operative per­ formance must be represented as a function. performance than was actually achieved. The formance of laparoscopic surgery. J Am Coli There are many approaches with long histo­ authors attribute this to the presence of limit­ Surg 2003; 197:489-496. ries, but I want to highlight an approach called ing resources not accounted for in their task 2. Kondraske GY. The elemental resource General Systems Performance Theory (GSPT). analysis, i.e., the model resource construct was model for human performance. In: Bronzino J, George Kondraske provides a concise de­ not complete. ed. The biomedical engineering handbook, 3rd scription of GSPT, and its power for handling This approach has some interesting im­ ed.: Biomedical engineering fundamentals. systems involving humans, in "The Elemental plications. For instance, learning represents Boca Raton: CRC Press; 2006:75.1-75.19. Resource Model for Human Performance" progression toward optimal use of available ********** (2). Briefly, GSPT developed to address resources, an optimization function. Consistent The AsMA Science a/ld Technologtj Committee system performance, and can be applied to high performance is achieved by minimizing provides the Watch as aforum to introduce and dis­ systems with or without human elements, the total availability cost of the task, an opti­ cuss a variety of topics involving all aspects of civil or to humans as systems. A given system is mization function. Individuals with different and military aerospace medicine. Please send your considered as a "resource construct," that is, a resource sets may perform the same task differ­ submissions and comments via email to: barry. collection of resources available to accomplish ently, and therefore must be approached differ­ [email protected]. Watch columns are available a task. Systems can be machines, humans, or ently with respect to optimization. Tools based at www.asma.org in the AsMA News link under combinations thereof. on this model can be used to predict which re­ Publications. sources are performance-limiting. Most prom­ Performance of a high level task requires f~:0:%J::%~~~~;':''»J:;)'~~'"%~~'";S.~"'SZZ%;:;'(~:Z%}'--;';''"2)."S%7~ utilization of a mix of system resources to ising for tackling the complex human system, varying degrees. Success depends upon the this approach "provides the motivation and ~ Archival DVD for Sale! I. sufficiency of all resources. When resource potential to consider coordinated, collaborative ft ~ ~ ~ availability exceeds demand, performance is developments that allow rigorous and efficient ~ 73 years (1930-2002) of the Aerospace ~ solutions to complex problems by practitioners successful. When any given resource avail­ ~ Medical Association's Blue Journal U ability falls short, it becomes performance without extraordinary training" (2). In other words, to work the optimization problem the ~ on one convenient DVD! Free up ~ limiting, but when it is present in abundance, ~ ~ performance does not necessarily improve. practitioner does not have to be an expert in shelf space with this set of searchable Instead, some other resource becomes the every resource area. HPDF files! ~ performance limiter. Optimum performance Using GSPT to produce human perfor­ ~ ~ mance envelopes with defined boundaries ~ ~ is reached when availability of all required ~ ~ resources exceeds demand by a comfortable holds great promise for human performance ~ Members: $50 ~ margin. For human performance, the margin optimization. A given task, from walking >J Non-Members: $150 tl allows for the inherently stochastic nature of to air traffic control, can be represented as a ~ Institutions: $300 g systems involving humans. demand envelope. The human resource con­ ~ Plus shipping: $5 U.S.I$l 0 International N struct can then be tweaked by application of GSPT results in a model with non-linear ~ (VA reSidents please add 5% sales tax) human performance enhancement techniques, H behavior. The theory predicts that perfor­ ~ ~ to achieve specific goals (the threshold values mance will not correlate linearly with any single ~ ~ resource availability (independent variable). for resource availability) and with "finish lines" cl To order contact Sheryl Klldall at ~ (the upper boundaries beyond which enhance­ For example, there is a minimum strength ~ 703-739-2240 x 107; via e-mail at ~ ment does not improve performance) to truly ~ required to fly a high performance aircraft "[email protected],N or download the ,; (threshold of performance), a margin above optimize the human for the task. (Conversely, ~ ~ that in which increased strength results in the demand envelope of the task may be al­ #order form from www.asma.org/ ~ improved performance (zone of correlation), tered to accommodate the human.) ~ljournal/archives-order-form.pdf, fill ~ . " and an upper value above which improved It is well known that motivation is a power­ it out, and fax it to 703-739-9652. ij strength results in no improvement in per­ ful predictor of performance. We are moving :e:.~,,&~",?~~"Z.~,?,z--.!."Z."Z."3..<:"~~"?"'&U·"G:RW.:Z:"3:'?.:a:~?..z.~~~1 A formance (no correlation). The same is true of toward a world in which it is the primary reaction time, working memory, and the other predictor, as other variables increasingly come resources brought to the task by the pilot. AsMA Future Meetings The task model therefore can be represented as a performance envelope in multidimen­ May 11-15, 2008 sional space, each dimension corresponding to Sheraton Hotel a resource required to perform the task. The Boston, MA lower bounds of the envelope are defined by the thresholds at which the availability of each May 3-7, 2009 resource becomes just sufficient to allow suc­ Westin Bonaventure Hotel cessful performance. The upper bounds of the envelope are defined by the thresholds at Los Angeles, CA which increased resource availability no longer improves performance, i.e., all task demands May 9-13, 2010 Sheraton Hotel are fully met. Fig. 1. Two-dimensional function with no Within this context, Dr. Kondraske proposes absolute minimum. Phoenix, AZ

Aviation, Space, and Environl1lental Medicine· Vol. 78, No. 10· October 2007 1007 and planes. The cost of a modern airplane and increase the accuracy of certification This Month in Aerospace is enormous, and the loss of a single pilot decisions. Several means of adapting exams requires a great investment to achieve a re­ are based upon item response theory. Item Medicine History-­ placement of equal training and ability.... response theory allows one to empirically October 2007 "Any solution to this problem rests with describe a test item very precisely before it is the flight safety personnel and must of neces­ administered. Use of each item's description By Walter Dalitsch III, M.D., M.P.H. sity center about two major features; first, to and an examinee's response enables one to Seventy-five Years Ago find the cause of an accident and, second, to estimate the examinee's ability and select the propound its prevention. Aeronautical engi­ next item to best refine this estimate. An ex­ Flight surgeons must fly (Cleveland, OH): neers have kept pace in their investigations ploratory application of this technique to one "The responsibility of carrying passengers and concerning accident causation and preven­ step of the certification of private pilots has the knowledge that the majority of airplane tion which is well exemplified by their past raised several important questions.... accidents on established air lines are due to record. It now behooves the medical profes­ "The increasing use of computers for the errors in pilot judgment has prompted the air sion to offer further assistance in the field of administration of tests opens new possibili­ line operators to make every effort to keep flight safety. All aspects of 'the man' should ties for improving the information available their flying personnel in as efficient a state of be evaluated as to his possible role in major from tests and for decreasing the cost of mind and body as is possible. To this end the aircraft accidents, especially those classified giving them. One such possibility is the im­ routine examination of the active pilot person­ as 'cause undetermined.' Although the ef­ plementation of adaptive testing. This paper nel, every month or six weeks, is an estab­ forts of many medical specialties are required has described adaptive testing based on item lished practice on every air line of importance for such an endeavor, the field of pathology response theory and has discussed several is­ in the United States. That the operators of air is primarily concerned with the structural sues being considered during the application lines are satisfied with the practical results of and functional changes in disease and, con­ of this technique to private pilot certifica­ such medical supervision is evidenced by the sequently, it is believed offers considerable tion. Despite unresolved problems, adapting number of them who have established and prospect in the co-ordination of flight safety aviation certification exams appears to be continued aviation medical services on their information. The well established subspe­ generally desirable and will probably be rec­ lines.... cialty of forensic pathology has demon­ ommended for private pilot certification" (4). "The monthly medical examinations of strated this scientific discipline's usefulness Aerornedical aspects of a new malaria prophy­ the pilots themselves are usually much more in establishing cause of death and sequence lactic drug (USAF School of Aerospace Medicine, brief than the original examinations. The of events leading to it" (3). Brooks Air Force Base, TX): "Mefloquine more or less unchangeable factors, such as Prevalence and consequences of vertigo: hydrochloride (WR 142, 490) is a new inves­ color vision accommodation, fields of vision, "Vertigo is a phenomenon well known to tigational drug which is indicated for the reflexes, etc., are omitted from the monthly both military and commercial pilots. Most of prevention and treatment of cloroquine­ examinations. At the six months intervals them are familiar with it from personal expe­ resistant falciparum malaria thought to be re­ when the Dept. of Commerce examinations rience, and the remainder have heard it dis­ sistant to other drugs. Available information come due, the omitted tests are performed. cussed on frequent occasions. For pilots, ver­ on mefloquine, particularly its potential for Ordinarily, visual acuity, depth perception, tigo includes a wide variety of experiences, 'quinine-like' side effects, is of aeromedical ocular muscle balance, examination of the but generally speaking it involves confusions importance. These side effects, if present, throat and ears, the Schneider test [of circula­ regarding their position in space. Many of would be expected to alter performance and tory efficiency], and urinalysis, coupled with the factors contributing to vertigo are well body physiology to a degree which would the history of the amount of exercise since known, and a number of studies have been compromise flight safety. There is legitimate the last examination the number of hours made of its characteristics in low perfor­ concern for mefloquine's safe use in aircrew­ flown, accidents, injuries, or illnesses, give us mance, propeller-driven aircraft. However, no men. Mefloquine's potential for 'quinine­ a good picture of the condition of the pilot.... data are known to be available on its occur­ like' side effects should be evaluated before it "In becoming familiar with the pilot's rence in high performance aircraft, although is routinely used for suppressive prophylaxis environmental conditions we must adjure it might be predicted that the nature and oc­ in aircrewmen" (2). the flight surgeon to ride on the line as fre­ currence of vertigo would be much the same Automated eye examinations (National quently as possible. One might as well try in jets as it is in conventional aircraft. It was Aerospace Medical Centre, Soesterberg, to study medicine without the knowledge of the purpose of this study to obtain informa­ Netherlands): "Results of automated perin1­ anatomy, as to be a flight surgeon without tion concerning the characteristics of vertigo etry (Fieldmaster 200, Synemed) in 1,000 the experience of frequent trips by air in during flight in jet aircraft.... subjects are described. In 17 subjects (1.7%) varying weather conditions. It is only in this "It was the purpose of this study to obtain a serious field defect was found. In 9 sub­ % way that the real problems faced by these information on the occurrence of vertigo in jects (0.9 ), aspecific defects were found. pilots are understood by his medical advi­ jet pilots. Individual interviews and a check Computer aided perimetry was found to sor. We may talk for hours on end of the list were used to determine the occurrence give reliable results compared vvith kinetic nervous tension developed by frequent bad of vertigo in 137 naval and Marine Corps jet perimetry. Since the visual field is of the weather trips and irregular schedules, but pilots. It was found that 96 per cent of these utmost importance in aviation, while mass to really know what it is all about one must pilots had experienced vertigo in jets and that conventional visual field screening is not get in a mail plane once in a while. After the nature of vertigo was essentially the same possible, it is suggested that use should be one has landed on account of thick weather, as that found in low performance aircraft. made of automated perimetry testing" (5). discussed the weather situation with the The most frequently reported experience in­ pilot, found out his reasons for the decisions volved confusion with regard to the attitude REFERENCES he made, and perhaps gone on through the and motion of the aircraft, but visual vertigo 1. Clark B, Graybiel A. Vertigo as a cause of soupy stuff with him when even the wing and geographical disorientation were also pilot error in jet aircraft. J Aviat Med 1957; tips weren't visible, then, and then only, do reported. The causes and prevention of vertigo 28(5):469-78. their problems begin to mean something, and were also found to be essentially the same as 2. Stockwell JR. Aeromedical considerations the medical examiner graduates into a flight for conventional aircraft, however the jet pilots of malaria prophylaxis with mefloquine hy­ surgeon" (6). believe that certain aspects of jet flight may, drochloride. Aviat Space Environ Med 1982; contribute to spatial disorientation. Thus it is 3(10):1011-3. Fifty Years Ago obvious that vertigo continues to present a 3. Townsend FM. The pathologic investiga­ threat to flight safety in jet aircraft as it has in tion of aircraft accident fatalities. J Aviat Med The pathologist's role in aircraft investiga­ slower propeller driven aircraft" (1). 1957; 28(5):461-8. tion: "Aircraft accidents continue to be a 4. Trollip SR, Anderson RI. An adaptive problem within the United States Air Force. Twenty-five Years Ago private pilot certification exam. Aviat Space Concern regarding these accidents arises Environ Med 1982; 53(10):992-5. initially because of the humanitarian aspects Flexibility in aviation medical exanzinations 5. Van Dalen JTW. Automated visual field involved, a feature which defies ultimate (Aviation Research Laboratory, University of screening in the flying Dutch population. Aviat evaluation. The Air Force is also confronted Illinois at Urbana-Champaign): "Adapting Space Environ Med 1982; 53(10):1006-10. with the practical military viewpoint of con­ aviation certification exams to each exami­ 6. Wright HB. Medical supervision of air serving its combat capability in both pilots nee's ability may reduce administration costs lines. J Aviat Med 1932; 3(4):182-90. 1008 Aviation, Space, and Environmental Medicine • Vol. 78, No. 10 • October 2007 Send information for publication on this page to: Mark Campbell, M.D. 420 N. Collegiate Dr., #300 Paris, TX 75460 SPACE MEDICINE ASSOCIATION NEWS [email protected]

Space Medicine at Wyle Laboratories Vernon McDonald, Ph.D. ing sites, including international abort sites. This team assisted during the Columbia This is the first of a series of articles that disaster, deployed to Stennis and Michaud to will be submitted by Illell/bers of tile Space assist following Hurricane Katrina, and regu­ Medicine Association that will higillight various larly participates in training and simulation aspects of space medicine. The intent is to show exercises with the Department of Defense the widely different ways which organizations Shuttle support team. and individuals are involved in til is I11l1lti-spe­ Wyle's Space Medicine Information cialty field. Technology section has the responsibility for the design, development and hosting of Wyle Laboratories, a contractor for information management tools to enhance ASA since the Apollo program, has de­ productivity, improve workflow and provide a means for capturing space medicine data. veloped a comprehensive space medicine ASTRONAUT TRAI NING---Mark Gu iII iams, program for astronauts under NASA super­ These tools manage the acquisition and inte­ Wyle ASCR, is preparing to exercise on the vision. An overview of the Wyle services gration of data from a wide range of sources interim Resistive Exercise Device (iRED) at contracted by NASA gives insight into the including the ISS and Shuttle, as well as the NASA JSc. iRED was used on ISS to mitigate program. Wyle is the prime contractor for clinical facilities at Johnson Space Center, physiological changes due to microgravity. two premier NASA Johnson Space Center and other medical testing facilities around contracts. Under the Occupational Medicine the world. and Rehabilitation Specialists or ASCRS and Occupational Health contract, Wyle The Advanced Projects section is provide physical training and rehabilitation provides clinical and occupational health tasked with improving the standard of med i­ services to the astronaut corps to prepare care for ASA personnel and the astronaut cal care available for each phase of human them for the rigorous preflight training corps. Under the Bioastronautics Contract, spaceflight. This includes the identification schedule, the stress of spaceflight to human Wyle provides ground and flight research, and development of clinical diagnostic and physiology, and to guide the post-landing re­ spaceflight hardware development and therapeutic procedures and the definition of habilitation from the effects of long-duration fabrication, science and mission integration the clinical skills necessary to provide medi­ spaceflight. The ASCRS are responsible for for flight, habitability and environmental cal care in space. both preflight and inflight physical training factors, and (the focus of this article), space Wyle personnel work with experts from of the Shuttle and ISS crews as well as being medicine services in support of the Space academia, private industry, the military, consultants for the development of inflight Shuttle, International Space Station (ISS), and other Federal agencies to evaluate and exercise hardware. Constellation and Human Research pro­ develop the necessary medical technologies The Behavioral Health & Performance grams. Wyle's space medicine team is com­ and medical care systems for future space section identifies and mitigates psychiatric, prised of 10 core capabilities. missions. They are developing the requisite psychological, psychosocial, and psycho­ The Medical Operations section pro­ clinical knowledge, techniques, and proto­ physiological factors that could impact vides biomedical flight controllers who cols for space medical care and defining the extended-duration space missions and devel­ function as the direct link to the flight crew set of clinical skills required for certification ops countermeasures to facilitate adaptation through their aSSignment in the Mission as a space medical care provider. to the space environment. This section is Control Center. Wyle personnel develop The Astronaut Strength Conditioning responsible for supporting the astronauts and prepare flight rules, conduct simula­ and their family members during all mission tions, monitor crew health, prepare console phases, and includes assisting the astronauts references, and provide staffing for specific in monitoring and maintaining their behav­ medical needs. In addition, Wyle employees ioral health, well-being, and performance provide 24-hour crew health monitoring, during the ISS missions. A sampling of typi­ hazardous activities monitoring, and private cal tasks includes the development of crew medical and family conferences for both the care packages, recreational materials, and Shuttle and ISS crews. electronic photo albums. They also monitor The Contingency Support team is crew health inflight and coordinate private responsible for preparing and maintaining psychological conferences and communica­ contingency response plans and procedures tion between the crew and their families. for medical support at all launch and land- The Health Care Services section fulfills several specific clinical functions. The Clinical Laboratories support NASA's medical operations by performing medical clinical analyses, including bio-chemistry, immunology, hematology, and urinalysis for the astronaut corps, for participants in the Longitudinal Study of Astronaut Health, and for test subjects. The Laboratory maintains an active database that includes all analyses since the human space program began, and maintains a repository of biological speci­ mens from all astronauts. The Epidemiology team conducts The ADVANCED PROJECTS---Terry Guess, Wyle Longitudinal Study of Astronaut Health to Electrical/Mechanical Engineer, stabilizing examine the mortality and morbidity rates of MEDICAL OPERATIONS---Howard Better the NASA Crew Medical Officer, Dr. Jeff astronauts in comparison to the general pop­ and Jennifer Joiner, Wyle Biomedical Jones, who is performing an inverted CPR on ulation. It also determines the rate of illness Engineers, supporting the Medical Operations the manikin. The manikin has already been and accidents that might require medical interests for a Shuttle mission. intubated. See SPACE MEDICINE, p. 1010. Aviation, Space, and Environmental Medicine· Vol. 78, No. 10· October 2007 1009 Send information for publication on this page to: Cathy DiBiase Mail code: B10-1 Kennedy Space Center, Fl 32899 AEROSPACE NURSING SOCIETY NEWS email: Catherine.P.Dibiase@nasa.gov

bers' contributions to panels and presen­ flight crews are training, preparing for flight, President's Message tations through submitted abstracts. Most or returning from flight. My clinical skills present a familiar topic associated with the are kept up when I complete a shift every 3 Greetings to the ANS. It was hard to real­ work they perform. For example, at this past to 4 weeks in a local community ED. Flight ize that it was time for another article, but I year's conference some nurses, who were nursing can be very demanding, but after so enjoy staying in touch with each of you. 13 years I really love what I do. I was most My first priority in this message is to re­ involved in MEDEVAC, presented case sce­ narios that were most informative. Whatever happy with the successful mission of STS-Il7 mind you that abstracts are due by the end since it had been several months without a of this month (October). You have probably it is, we look forward to your submissions. Secondly, I wanted you to know me a mission due to technical problems. heard this every year and wondered if you Finally, I hope all of you who are de­ should submit something. I would like to little better. I am an Aerospace Flight Nurse ployed are coping with your work loads. We encourage you that, if you have any ideas at with the Bionetics Corporation, which is contracted to NASA. We provide support to appreciate your service to our country and all for a panel, paper, presentation, or poster the soldiers in need. and are unsure whether or not if you think the astronaut flight crews, assist in biomedi­ Remember you can e-mail me at any time your idea is worth pursuing, please, contact cal research, and provide medical education with any concern regarding ANS and AsMA me. I can put you in touch with the appro­ to medical students and interns. I wear many hats in this position and work with in general and I will do my best to get back priate education and scientific program ANS with you. members who may help you develop your many different types of professionals - doc­ idea into an abstract. tors, physiologist, and engineers. Like most For those of you not familiar with the sci­ professions, there are administrative duties, Regards, entific program's development, the annual but there are also "hands-on" duties, as well. Cathy DiBiase, RN, BSN scientific meeting is built around the mem­ The nursing care is only extensive when the ANS President 2007-2008

SPACE MEDICINE/rom p. 1009. medical standards, certification criteria, med­ sion since STS-I. The Shuttle Orbiter Medical care and the use of medical equipment and ical care requirements, preventive medicine System contains the medical equipment and supplies during space travel. guidelines, operational countermeasures, and supplies needed to diagnose and treat in­ Wyle also operates a full service the definition of operations concepts for ISS flight medical problems. Pharmacy for Flight Medicine and missions. Through a subcontract ASA recently endorsed the develop­ Occupational Medicine patients. This group to the University of Texas Medical Branch at ment of commercial crew and cargo ser­ manages the medical kits that fly on board Galveston, Wyle supplies flight surgeons who vices to the ISS through the awarding both the Shuttle and ISS, and the medical provide medical coverage to NASA and con­ of two funded Space Act Agreements to kits for a variety of terrestrial functions, tractor personnel in Star City, Russia, and in SpaceX and Rocketplace Kistler. ProViding including kits located across the facilities at both Mission Control Center-Houston and an experience to remember and safely Johnson Space Center. Mission Control Center-Moscow. returning space travelers to Earth in good Wyle's Multilateral and Program The Training Section defines, develops, health will be critical to the success of Support section provides support for inter­ and implements training requirements for these ventures. Wyle recently formed the national medical operations by coordinating a comprehensive health care program for Commercial Human Spaceflight business various multilateral board and panels, and spaceflight. Wyle personnel are responsible unit to capitalize on its history of support­ facilitating the exchange of information for training astronauts, flight surgeons, bio­ ing ASA's mission success and plan to among the medical organizations of the five medical engineer flight controllers, and other utilize that experience to become a part of International Partner agencies. Wyle person­ flight control disciplines for operations in commercial spaceflight mission success. nel assist with the development of common health maintenance, environmental health, With this previous experience in human and countermeasures systems. Wyle em­ spaceflight, Wyle is now already engaged ployees train crew medical officers for each in supporting the leading proponents spaceflight. This team also has provided the of private space travel, including Virgin medical equipment for every Shuttle mis- Galactic and Space Adventures.

MEETINGS CALENDAR 2007 Institute of Space Medicine and Terrestrial Sciences, International Institutes of Advanced October 10-13,2007, Marriott San Diego Research & Training, Chidicon Medical Mission Valley, San Diego, CA. Civil Aviation Center.Theme: Brain Neuroplasticity. Info: Medical Association Annual Scientific http://www.chidicon.com/Space.html Meeting. This meeting is certified as an AME October 29-31, 2007, Grand Sierra seminar by the FAA. For more information, Resort & Casino Hotel, Reno, NV. SAFE please contact Jim Harris at jimlharris@aol. Association 45th Annual Symposium. For com or call 405-840-0199. more info, call (541) 895-3012, Fax (541) October 11-12, 2007, NTSB Training 895-3014, e-mail [email protected]; www. Center, Ashburn, VA. Accident Investigation safeassociation.com; www.safeassociation.org. Orientation for Aviation Professionals. For November 1-2, 2007, Holiday Inn Regents more information, please visit http://www. Park, London, UK. Second Annual Aviation ntsb.gov/Academy/Courselnfo/ Health Conference. Details: www.quaynote. AS301_2007.htm. com. For sponsorship or speaking opportu­ October 15-19, 2007, NTSB Training nities, contact [email protected] or phone Centf'r, A.shburrI, VA. Survival Factors in 44-20-8531-6464. Aviation Accidents. For more information, NEW November 13-14, 2007, Holiday please visit http://www.ntsb.gov/Academy/ Inn, Kensington Forum, London, UK. Crisis Courselnfo/AS302_2007.htm. Management, Business Resilience and Business STAR CITY, RUSSIA---Blake Chamberlain, NEW October 21-23, 2007, Concorde Continuity for the Aviation Industry MD., Wyle/UTMB Flight Surgeon, supporting Hotel, Owerri Imo State, Nigeria. Mission Details: www.quaynote.com; Alison@ crew winter survival training near GCTC (Star to Mars: The African Perspective. Sponsors: quaynote.com; 44(0)20 7074 0241 City) at a place called Soyuz.

1010 Aviation, Space, and Environmental Medicine' Vol. 78, No. 10' October 2007 Send information for publication on this page to: Jennie Bendrick 8825 Redwood Blvd California City, CA 93505 WING NEWS & NOTES 760-373-810; [email protected]

A Word from the President ... one would you choose? Traditions give us members with delicious munchable tidbits stability, a sense of belonging, knowing and gifts for all. The Registration hours are About Traditions where we come from, and require a certain traditionally also a meeting time. We pay our discipline to be performed over and over dues, catch up on news, see who made it to Every country, village, family, or single again. Sometimes they become overwhelm­ the meeting, and who brought a friend. We person has them: traditions. Sometimes, they ing, outdated, often loosing their original admire those whose clothes from last year are what makes our lives interesting, some­ value, and need to be changed or eliminated. still fit, and envy others who bought new times they become a burden. Others remain steadfast and eternal, provid­ ones! We proudly show photos of babies, Thinking back to a wonderful childhood, ing the reassuring warmth and beauty which weddings, trips, pets, and the occasional new growing up on an estate as a member of our otherwise ever-busy souls crave. rose bush in our yard. an old Austrian family, I kno"v a lot about Looking back to my young days, in those The tours are one of the most beloved of traditions. As the widow of a Field Marshall heady impatient years of childhood, I re­ all our traditions. While waiting for the bus of the former Austrian Empire, my grand­ member thinking that the practice of some of we find a companion for a good chat during mother ruled her large family, domestics, and our traditions was, frankly, a bit annoying. the ride. Even my silly "yodluihi" on entering farm workers with both love and a strong For instance, after lunch or dinner at home, the tour bus has become a tradition. If I don't hand. Around the house and in the presence we children had to ask permission to get greet the crowd with my Tyrolean "yodel­ of older family members we children had up from the so called "Katzentisch" (kitten's huitiritio", the Wing knows something is to obey very strict rules. However, when table) and then circle around the adult's din­ wrong with Susi. we played with the village children around ner table, drop a curtsy or bow, kiss every And look at our Wednesday Luncheon; the farms we were free, in fact, much more lady's hand, and thank her for dinner. What isn't that just the best! Each year our so than most children nowadays. With my a nuisance, we thought, loosing at least 10 Luncheon Chairs find a very special place for neighbors and school friends (one of them minutes of valuable play time! Today, how­ our feast, decorate it with artistic grandeur, by the name of Arnold SChwarzenegger...per­ ever, it makes me happy indeed to hear my print menus so pretty that they often find haps you have heard of him) we spent days children and husband thank me for a dinner their ways into frames hanging in a special playing in nearby woods, skating on the that I had prepared with love (we eliminated "Wing corner" in many homes. While indulg­ ice of our lake, skiing the slopes behind our the curtsey, kiss, and bow!) ing in local delicacies, we listen to reports of house, climbing trees, and hiding in barns. What does my discourse on tradition hard work of our arrangements and financial Traditions gave our lives the frame in have to do with the AsMA WING? Our or­ team, then finally hand over the gavel and which we lived. We celebrated many reli­ ganization is now more than half a century cheer for the incoming Wing President... and gious holidays, of course, and they were old. During these 50+ years, the members of then we do it all over again each and every filled with wonderful customs, some very this wonderful group have, on purpose or year. ancient, that so enriched our culture. These not, created many unique traditions. For in­ One of the Wing's very important tradi­ traditions and rituals, celebrated each and stance, we have created a fixed time schedule tions is that we care for and think of mem­ every year, often gave the spark to our daily to which we stick unchangingly throughout bers unable to attend the meeting. Some of routine, dispelling boredom and giving us the entire Scientific Conference week. The us went back to school and are amidst their something very special to which we could Board meeting on Sunday, filled with of­ final exams, or they are just too busy to at­ look forward. Even today, we are still con­ ficial business.. .it could have become a very tend. Others, sadly, are sick or are grieving stantly creating and also abandoning tradi­ stodgy formal gathering. Happily, however, in sorrow and pain. Yet, despite their being tions. our traditions have not taken us in that di­ physically far from us, they remain in all of I like to compare traditions with a man rection; the Wing and their presidents have our hearts, thoughts and prayers; they know standing with one foot in a bucket of hard­ made our Sunday meeting a very pleasant that they are always a part of our gathering... ened concrete. This foot is standing firmly on reunion of dear friends! We serve light re­ our family. The Membership Chair collects the ground, unable to move into any direc­ freshments and then tackle the work at hand greetings and best wishes to send home to tion. It is heavily secured to the Earth. The with ease. those members. Yet it does not end there. other foot though, has no burden to carry; it Monday's reception is one of our fin­ Upon our return home, those who could not wants to run, flyaway to new lands. Which est traditions. We welcome old and new be with us receive many a letter or e-mail THE WING OF AsMA EXECUTIVE BOARD, 2007-2008 with photos, so as to better help them feel included in the adventure. ELECTED OFFICERS Resolutions Judy Waring Here are some of my favorite Wing tradi­ President Susanna Bellenkes MEETING COMMITTEES tions. Do you remember when the "Wives' 1st VP Peggy Trumbo & SUBCOMMITTEES Wing" met in elegant attire with hats and 2ndVP Dale Orford Registration Josie Borchardt gloves? How lovely they all looked, and it Secretary Nevonna Schroeder Co-Chairs Yvonne Silberman and was appropriate for the time. I do hope that Treasurer Jenifer Faulkner Jackie Jordan the luncheon will always stay an elegant af­ BOARD MEMBERS AT LARGE Advance Registration Debra Merchant fair. Wearing our ribbons, I wish, will stay a Air Force Josephine (0) Ivan Arrangements Susan Bassik tradition too. We have earned them through Navy Melinda Beane Hospitality Els Salisbury the many hours of work, and wear them Army Jennifer Crowley Luncheon Phyllis Hain with pride. New members may easily be rec­ Civilian Judy Kowalsky Co-Chair Jeanette Wells ognized by their red ribbon, so we can wel­ International Els Salisbury Reception Alison Gibson come and make them feel comfortable and at APPOINTED OFFICERS Favors Birgette Pongratz ease amidst us. Parliamentarian Harriet Hodgson Tours Susan Bassik, Paula As we look into the future, we shall see and Helen Lestage Landry and Jennie new and younger Wing members with good Past President Conoly Barker Bendrick ideas to keep our meetings interesting and Nominating Trish Trifilo Special Boston Consult Lois Moser fun. Some of those ideas will turn into tradi­ Special Advisor to COMMUNICATIONS tions. That is what keeps our group alive and the President Ludy Rayman Publicity Dale Orford vibrant! Honorary President Fonda Hastings and Jennie Bendrick With a happy "yodluitiritio" STANDING COMMITTEE CHAIRS Newsletter Jennie Bendrick Your President, Membership Conoloy Barker Web Mistress Trish Trifilo Susanna Bellenkes and Judy Waring Marketing Harriet Hodgson

Aviation, Space, and Environmental Medicine· Vol. 78, No. 10 • October 2007 1011 Send information for publication on this page to: Corporate News Aerospace Medical Association 320 S. Henry Street NEWS OF CORPORATE MEMBERS Alexandria, VA 22314-3579

Virtual Flight Surgeons AsMA's MedAire to Provide Medical supply agreement with the Department of Newest Corporate Services to Spirit Airlines Health that contains an option to purchase pandemic influenza vaccine in the event the Virtual Flight Surgeons, Inc. (VFS), located MedAire Inc. recently announced that U.s.­ World Health Organization (WHO) declares in Aurora, CO, have become the newest cor­ based Spirit Airlines will add MedAire's 24/7 a pandemic. Baxter will manufacture its pan­ porate members of the Aerospace Medical MedLink Global Response Services to its en­ demic vaccine in a serulll-free, vero cell-based Association (AsMA). This company provides tire fleet. During in-flight medical situations, system at one of the largest cell culture vac­ assistance with FAA certification, aeronLedi­ MedLink provides flight attendants and pilots cine facilities in the world. The use of vero cell cal advocacy, confidential consultations, and with a one-call solution to board-certified phy­ culture, rather than conventional egg-based expert witness testimony. VFS serves a wide sicians working in a level-one trauma center in technology, offers several advantages. Baxter's range of clients, including individual pilots Phoenix, AZ. vero cell culture process can be initiated more and aviation associations. They have a full­ As part of the 3-year agreement, crewmem­ rapidly due to its use of a "native" virus that time team of board-certified aerospace medi­ bers onboard Spirit's fleet of 36 aircraft will does not need to be modified to allow growth cine physicians who are experienced in com­ have 24-hour access to MedLink from any­ in eggs, thus accelerating vaccine availability. mercial and military aviation medicine. where around the world, using the aircraft's Vaccines produced using this process can VFS was founded in 1997 to provide aero­ existing communications system. MedLink be released within approximately 12 weeks, medical assistance to pilots in the general and physicians, who have extensive experience in significantly earlier than with traditional business aviation communities. It originally the field of aviation-specific medicine, manage egg-based systems. In addition, all influenza operated part-time, and then branched out thousands of medical enLergencies every year, strains with pandemic potential tested for into the air traffic controller community. VFS including more than 17,000 in-flight situations growth in vero cells have produced replicable is now a full-time business that is nationally in 2006. Since 2003, MedAire Inc. has also sup­ high yields, providing the company with the known for its aeromedical excellence. For plied and refurbished the airline's emergency flexibility to quickly respond to emerging vari­ more information, visit their website at www. medical kits and provided medical control for ant pandenLic virus strains. aviationmedicine.com. their prescription contents. Baxter is also working with the U.s. National Institute of Allergy and Infectious Become a Corporate Diseases, part of the National Institutes of Member of AsMAI Baxter Awarded Contract from Health, in partnership with Fisher BioServices For information on becoming a Inc., and with the U.S. Department of Health Dept. of Health and Human Services, in parh1ership with Corporate Member, please call Gloria DVC LLC, a Computer Science Corporation Carter at (703)739-2240, ext. 106, Baxter International Inc. announced recently Company, to further develop vero cell culture­ [email protected]; or Dr. Marian Sides that Baxter's European subsidiary in the based candidate pandemic and seasonal influ­ at [email protected] United Kingdom has entered into an advanced enza vaccines in the United States.

Send information for publication on this page to: News of Members Aerospace Medical Association 320 S. Henry Street Alexandria, VA 22314-3579 NEWS OF MEMBERS [email protected]

Col. Keith L. Hiatt, MC, USA, formerly Hayes, David W., LT, USN, MC POSITION AVAILABLE a Consultant in Preventive Medicine in Kohli, Sandeep S. S., M.D., Oakville, the Office of the Command Surgeon at Ft. ON, Canada Exciting opportunity for medical direc­ McPherson, GA, is now the Medical Director Krishnan, Ashok, M.D., Kuala Lumpur, tor in occupational medicine practice in at the U.S. Army Research Institute of Malaysia Washington State! The position is prima­ Environmental Medicine in Natick, MA. He Lamontagne, Jessica L., Capt., USAF, NC rily administrative requiring strong leader­ was promoted to Colonel in March. Rodriguez, Edgar, Lt. Col., USAF, MC, ship and political savvy skills. Previous San Antonio, TX government contracting experience with William A. Pollan, D.O., M.P.H., originally Waite, Bradley E., M.D., Olympia, WA DOE, DOD a plus. MRO certification, the Deputy Commander and Squadron experience in beryllium, toxicology, legacy Commander at Nellis AFB, Las Vegas, NV, health issues preferred. Current valid li­ Members--Remember! is now serving as Commander of the 355th cense to practice medicine in Washington AsMA Council Meetings are open to all MDC at Davis Monthan AFB, Tucson, AZ. state or ability to obtain. Three years members of the AsMA. Your input and at­ minimum medical directorship experi­ tendance are always welcome. Our next Donald E. Sprague, M.D., PA, previously at ence required. Requires NID or DO degree meeting will be on November 15, 2007, at South Coast Hyperbarics in Webster, TX, is with certification in either Occupational the Holiday Inn Eisenhower Ave., now a sole practitioner in Seabrook, TX. and EnvironnLental Medicine (OEM), Alexandria, VA. Aerospace Medicine (AM), or Public Health and Preventive Medicine (PM) by INDEX TO ADVERTISERS the appropriate Medical or Osteopathic New Members Aerospace Medical Association Medical certifying board. Excellent com­ Abhyankar, Sheetal A., M.B., B.S., Nadi, pensation package. Call for Papers iii Fuji Islands Please contact Jason Zaccaria, Clinic Corporate Members vi Anderson, Arthur M., M.D., Bellevue, WA Director, 1979 Snyder St., Ste 150, DVD for Sale v Anderson, Katherine, B.S., R.N., Bellevue, WA Richland, WA 99354 Bastaki, Nadia Q., M.B.B.S., Dubai, UAE Information for Authors Cover "' Email CV to [email protected] Gibb, Randall W., Col., USAF, Ph.D., Membership Application ii Fax (509) 376-2020, Phone (509) 376-4082 Monument, CO ETC...... Cover IV

1012 Aviation, Space, and Environmental Medicine • Vol. 78, No. 10 • October 2007