AEROSPACE MEDICINE

1
Presented by:
Dr. Harjot Singh
J.R. 2
Dept. of Community Medicine
SGRDIMS&R, ASR

Definition
 The specialty of medical practice within preventive medicine that
focuses on the health of a population group defined by the operating
aircrews and passengers of air and space vehicles, together with the
support personnel who are required to operate and maintain them.
 A military practitioner of aviation medicine is called a flight
surgeon and a civilian practitioner is an aviation medical examiner.
2
Source: Public Health & Preventive Medicine Wallace/Maxcy-Rosenau-Last,15th edition

Beginning of aerospace medicine
 The father of Aviation Medicine-
Paul Bert
 Conducted experiments with
barometric pressure
 Proved the principle effects
of altitude on the body
 Made the first low pressure
altitude chamber
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History
 1949 - deptt. of space medicine was established at the US Air Force school of
Aerospace medicine.
 1953 - ABPM approved the decision to authorize certification in aviation
medicine.
 1958 - The National Aeronautics and Space Administration (NASA) was formed.
 Officially changed by the ABPM to Aerospace Medicine.
 2000, the ABPM initiated the development of a Certificate of Added Competency
in Undersea and Hyperbaric Medicine.
 2005 – 1376 physicians have been certified in this specialty.
4Source: Public Health & Preventive Medicine Wallace/Maxcy-Rosenau-Last,15th edition

Approach to Aerospace Medicine
AEROSPACE
Normal Physiology
Abnormal environment
CLASSICAL
Abnormal Physiology
Normal environment
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Aviation Regulatory Medicine
Clinical Medicine
Human
Rights
Aerospace
Medicine
Preventive
Medicine
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1% Rule (Aviation Medicine)
 It is the risk threshold applied to the medical fitness of pilots
 Applying this would result in an airline pilot being denied a medical
certificate if their risk of a medical incapacitation (e.g. heart attack,
convulsion, stroke, faint etc) was determined as being greater than 1%
during the year. (threshold between acceptable and unacceptable)
 It began in the late 1980s & early 1990s in a series of British and
European cardiology workshops
 Its application is controversial
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Source:http://en.wikipedia.org/wiki/1%25_rule_%28aviation_medicine%29

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Conditions that might cause problems
in a flight include:-
 Pregnancy beyond 36 weeks.
 New born babies during the first few days after birth.
 Recent or current middle ear infections or sinusitis.
 Unstable psychiatric illness or epilepsy.
 Recent myocardial infarction or moderate/severe heart failure.
 Recent chest, intra-cranial or abdominal surgery.
 Recent pnuemothorax or moderate to severe hypoxic pulmonary
disease.
 The presence of a communicable disease.
 Previous record of causing disruption during flight

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Problems Faced in Air
Air Rage
Altitude
Sickness
Parasitic
infections
Respiratory
infections
DVT
Jetlag
Airplane
Problems

Stresses in the Aerospace Environment
 Hypoxia
 Reduced atmospheric pressure
 Thermal extremes
 Ionizing radiation
 Null gravity fields
 Maintenance of situational awareness
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Hypoxia
 Deficiency in night vision
 Drowsiness
 Thinking slowed & calculations
difficult
 Impaired memory & judgment
 Delayed reaction time
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Source:http://thumbs.dreamstime.com/x/diagram-atmospheric-pressure-vs-altitude-12436225.jpg
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Environmental Oxygen
As altitude increases,
available oxygen decreases
Atmospheric Pressure
Normal atmospheric pressure at sea level
is 760 mm Hg
As we go up in altitude, atmospheric
pressure decreases.

Acceleration Forces
 Acceleration forces tend to be directed downwards moving blood from
his brain to his feet.
 If this force is not counteracted, the aviator will first lose his vision &
then consciousness (G-induced loss of consciousness or GLOC)
 This phenomenon was first identified in Great Britain in World War I
(circa 1918-1919) as "fainting in the air."
 In US G-LOC was first encountered in 1922 during the Pulitzer Trophy
Air Race.
.
13Source:http://www.ncbi.nlm.nih.gov/pubmed/3281645

Acceleration
Countermeasures
 To counteract this force, “G” suits have been developed which
squeeze the legs and abdomen during high G conditions to
prevent blood from being pushed there.
 G suits are made up of five interconnected bladders covering the
legs and abdominal region.
 Pressurization of the bladders occurs during increases in G forces.
Source:http://www.ncbi.nlm.nih.gov/pubmed/3281645

Trapped Air
 As you go up in altitude, air expands... if this air is trapped,
expanding air can lead to pain.
 A blocked Eustachian tube could lead to pain in the middle ear.
Ear Drum

Decompression Sickness
 Air bubbles can form in the body at
high altitudes. These bubbles are
made of nitrogen & usually dissolve
as we descend
 Bubbles that do not dissolve can
get trapped in the joints and
cause pain (bends)
 If they form in the blood & go to
brain- can cause serious neurologic symptoms
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Decompression sickness: prevention &
treatment
 Prebreathing 100% oxygen for at least an hour before high altitude
flights can decrease the amount of nitrogen in the body & decrease
the chances of decompression sickness
 Pressurized cabins or if necessary, pressure suits can be used
17
Source:http://www.archive.xray-mag.com/files/PRPChamber_Torque03.JPG

Operational Aerospace Medicine
Three operational flight environments are:
 Civil Aviation
 Military Aviation
 Space Operations

Civil Aviation
 Category includes: Commercial aviation & Private/recreational flying.
 In the US approx. 460,000 active pilots, 167,000 general aviation aircraft,
10,000 air carrier aircraft & 18,000 airports.
 FAA has designated 4800 physicians as AMEs
 FAA’s Civil Aeromedical Institute recomends standards on emergency
aircraft lighting, breathing equipments, emergency breathing devices &
floatation systems.
 Other activities include air ambulance service, flight training, aerial
application, air cargo & new growth industry of commercial parcel
delivery.
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Military Aviation
 Air Force has the widest range of aeronautical activities
 The flight surgeon is responsible not only for health maintenance of
the flight crews but also for maintaining health surveillance for the
5000 people on board the carrier
 He oversees all aspects of hygiene, epidemiological surveillance,
health maintenance & medical disaster preparedness abroad ship
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Space Operations
 On feb.1,2003 the Columbia space shuttle broke up on reentering
earth’s atmosphere & all 7 crew members were lost
 Biomedical challenges include- SAS(space motion sickness),
cardiovascular deconditioning, loss of red cell mass & bone mineral
loss
 SAS has been experienced by up to1/3 of shuttle crew & this occurs in
early segments of orbital flight & may affect early mission performance.
 The international space station operation introduces additional
challenges for maintaining astronauts on long duration missions.
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AEROSPACE INDUSTRY
1
• PERSONNEL
2
• PASSENGERS
3
• PATIENTS
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Personnel
 Aircraft is dependent on the pilot to safely complete the flight
 The clinical skills of AMS are in diagnosing occult diseases & conditions
that are risky for flight safety
 Pilots on therapeutic medications can have side effects of their
medications leading to drowsiness & loss of consciousness
 Two commonly used non- therapeutic drugs are cigarettes & alcohol.
 Alcohol continues to be associated with approx. 11% of general aviation
accidents.
 Smokers have high carbon monoxide levels & less oxygen levels in their
blood, which compromises their altitude tolerance
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Contd.
 Work-Rest cycles: various factors in the aerospace environment lead
to the onset of fatigue in aviators. These include:
 Excitement of a new place
 Insomnia in a strange bed
 Circadian rhythm asynchrony
 Work related anxiety
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Airline Aviation Medical Services
Pre employment Medical
examination
 Drug abuse testing
 Psychological profile or
personality inventory
 Physiological training
 Wellness or health
maintainance programme
Employee Assistance
Programme
 Acute care
 Emergency response service
 Periodic medical assessment
 Job related illness or injury
monitoring
 Return to work assessment
 Aircraft accident team
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Passengers
Common problems seen in passengers are:
 Air rage: in the form of anger & increased tension
 Economy class syndrome: this refers to the development of deep
vein thrombosis(DVT) in passengers who remain seated in the tight
confines of the cabin for long periods of time. It is seen that 10% of
air travel passengers older than 50yrs develop symptomless DVT
during prolonged flights
 Passengers are advised to remove tight stockings, exercise the feet
& legs while seated, move about the cabin as conditions permit &
maintain hydration
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SOURCE:Ind. Journal of Aerospace Medicine 47(2), 2003

PATIENTS
 Medical center helicopter used to transfer critically ill and injured
patients and neonates to tertiary medical facilities.
 Some aircraft, such as the Hercules C-130 can be overpressurized
to maintain the cabin below sea level pressure provided flight is at a
relatively low altitude.
 Prevention is the hallmark of aeromedical support to personnel,
passengers, and patients:

COMMUNITY & INTERNATIONAL HEALTH
 Aerospace flight operations have the potential for disrupting the
environment and serving as a mechanism for the introduction of
disease
 Even with the use of maximum efficiency HEPA filters, infections have
occurred among both crewmembers and passengers.
 Infections documented are TB, influenza, SARS.
 The potential for disease transmission has been reduced with the
implementation of international sanitary regulations and other control
mechanisms.
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International Health Regulations published by
WHO
1. Promulgation of the application of epidemiological principles
2. Enhancement of sanitation at international airports
3. Reduction or elimination of factors contributing to the spread of
disease
4. Elimination of disease vector transportation
5. Enhancement of epidemiological techniques to halt the introduction
or establishment of a foreign disease
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Vector Control
 The principal objective of these procedures is to kill mosquitoes and
other insect vectors of disease.
 Current regulations permit residual treatment of the aircraft with
permethrin.
 A common practice was the “blocks-away” disinfection technique, in
which insecticide would be introduced into the passenger cabin
immediately after the aircraft was closed and was taxiing to take off.
 An alternative method was to use aerosol insecticide prior to arrival
at the destination airport
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IAM,BANGALORE
 IAM established as a centre for aeromedical activities related to military
and civil aviation in the late 50's.
 Aeromedical evaluation of military & civil in aircraft design, promotion of
flight safety, human factor analysis of aircraft accidents & aeromedical
research form the major activities.
 The need for a fullfledged Institute for imparting training in Aviation
Medicine was fully realised with the advent of the jet age.
 This led to the establishment of the School of Aviation Medicine (SAM)
at Bangalore on 29th May, 1957.
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Role Of IAM includes :
(a) Training medical officers, paramedical personnel, military and civil aircrew.
(b) Medical evaluation of military and civil aircrew.
(c) Aeromedical research and development.
(d) Aeromedical and human engineering consultancy to the aerospace
industry.
(e) Aeromedical support to Indian Human Space Programme.
(f) Therapeutic activities through Hyperbaric Oxygen Therapy
(g)PrimaryHealthcare

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