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Objective: to map the competencies of aerospace nurses in disaster situations., Method: a scoping review following the steps recommended by the JBI and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The review was conducted in three phases by two independent reviewers, with blinding, and supported by a third reviewer to resolve disagreements. Selection was based on the analysis of titles, descriptors, and abstracts, with specific eligibility criteria, followed by the full-text reading. At the end of the selection phase, 37 publications were included., Results: the results highlighted the need for the development of technical skills, knowledge of flight physiology, familiarity with aeronautical emergency procedures, communication skills, leadership, and responsibilities in aircraft preparation. During transport, nurses perform patient history taking (anamnesis), physical examinations, patient monitoring, clinical procedures, and manage in-flight complications. After the flight, they conduct documentation, develop procedures, sanitize clinical equipment, and replenish consumable materials., Conclusion: given the complexity of aerospace nursing practices in disaster situations, it is essential for professionals to develop competencies to ensure safe and effective care. There is a need to develop technologies, regulatory frameworks, and legal provisions for legal support, as well as future studies to validate and deepen the mapped competencies.

The concept of lifetime radiation risk of stochastic detrimental health outcomes is important in contemporary radiation protection, being used either to calculate detriment-weighted effective dose or to express risks following radiation accidents or medical uses of radiation. The conventionally applied time-integrated risks of radiation exposure are computed using average values of current population and health statistical data that need to be projected far into the future. By definition, the lifetime attributable risk (AR) is an approximation to more general lifetime risk quantities and is only valid for exposures under 1 Gy. The more general quantities, such as excess lifetime risk (ELR) and risk of exposure-induced cancer, are free of dose range constraints, but rely on assumptions concerning the unknown total radiation effect on demographic and health statistical data, and are more computationally complex than AR. Consideration of highly uncertain competing risks for other radiation-attributed outcomes are required in appropriate assessments of time-integrated risks of specific outcomes following high-dose (>1 Gy) exposures, causing non-linear dose responses in the resulting ELR estimate.Being based on the current population and health statistical data, the conventionally applied time-integrated risks of radiation exposure are: (i) not well suited for projections many years into the future because of the large uncertainties in future secular trends in the population-specific disease rates; and (ii) not optimal for application to atypical groups of exposed persons not well represented by the general population. Specifically, medical patients are atypical in this respect because their prospective risks depend strongly on the original diagnosis, the treatment modality, general cure rates, individual radiation sensitivity, and genetic predisposition. Another situation challenging the application of conventional risk quantities is a projection of occupational radiation risks associated with space flight, both due to higher radiation doses and astronauts' generally excellent health condition due to pre-selection, training, and intensive medical screening.An alternative quantity, named 'radiation-attributed decrease of survival' (RADS), known in past general statistical literature as 'cumulative risk', is recommended here for applications in space and medicine to represent the cumulative radiation risk conditional on survival until a certain age. RADS is only based on the radiation-attributed hazard rendering an insensitivity to competing risks or projections of current population statistics far into the future. Therefore, RADS is highly suitable for assessing semi-personalised radiation risks after radiation exposures from space missions or medical applications of radiation.

Yuri Gagarin was the first human in space in 1961 almost 60 years ago. Eight years later Neil Armstrong left his footprints on the Moon - the first human on the surface of a celestial body other than Earth. By now long-duration missions of up to 1 year have become a reality for humans in space. Nearly 19 years of continuous human presence at the International Space Station (ISS) have provided a unique insight into human life in space. Humans are reaching out for more - targeting missions to take us outside the protective hull of low earth orbit into deep space. The challenges to human health and well-being remain significant and increase with distance and time from Earth. The lack of gravity, the ubiquitous ionising radiation, remoteness, and confinement are just some examples of the hostile environment of space. More hurdles have to be overcome prior to the human endeavour of reaching out into deep space and radiation is one such primary and inevitable factor that is key to crew health, safety and overall mission success. This presentation will provide an introduction into operational space medicine and radiation protection for humans in space as executed on ISS, in low earth orbit and in preparation for the scenarios 'beyond'.

Introduction: Flight surgeons play a vital role in U.S. Air Force aviation operations by ensuring that pilots are medically prepared to meet the demands of military aviation. However, there is natural tension between pilots and flight surgeons. A pilot may be reluctant to share medical information with a flight surgeon who could negatively impact the pilot's career or flight status. In this preliminary study, we sought to identify pilot-perceived strengths and weaknesses in the relationship between U.S. Air Force aviators and their flight surgeons., Materials and Methods: An online survey regarding pilot-flight surgeon confidence and perceived values was distributed electronically to a convenience sample of U.S. Air Force aviators. Participants included U.S. Air Force active duty and Air Reserve Component (Air Force Reserve and Air National Guard) military aviators in addition to U.S. Air Force Academy aviation cadets., Results: One hundred and seventy-three aviators participated in the survey. Respondents reported variable comfort in approaching flight surgeons with medical concerns and suggested that they believed other pilots might be withholding medical information from flight surgeons or seeking care from civilian physicians for career protection., Conclusions: We sought to examine the pilot-flight surgeon relationship and its impact on daily flying operations. While limited, results suggest that there may be gaps in trust between pilots and their flight surgeons. These findings could present an opportunity to improve the pilot-flight surgeon relationship by identifying factors that contribute to closer pilot-flight surgeon relationships., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2019. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

INTRODUCTION: The value of aeromedical certification in reducing adverse medical outcomes is an especially important question for this era of increasing flight operations that do not require an FAA medical certificate. The study of this question has previously been thwarted by a lack of information about pilots when their medical certificates are not renewed. METHODS: We matched airmen in the FAA medical certification database to the U.S. Social Security Death Index to identify date of death for deceased pilots. Logistic regression models were used to explore associations of certification data with odds of death while holding a medical certificate and within 4 yr of expiration of a medical certificate. RESULTS: FAA aeromedical waivers were associated with 33% lower odds of death while holding a medical certificate and 35% increased odds of death within 4 yr after expiration of a medical certificate. Denial was associated with 21% increased odds of death in the next 4 yr. Only 13 of 47 medical conditions having significant associations were associated with increased odds of death during certification. DISCUSSION: We found that FAA aeromedical certification reduces the odds of death while holding a medical certificate compared to the 4 yr after certificate expiration. We believe this helps provide a positive answer to the question of whether medical certification reduces medically related events. Mills WD, Greenhaw RM. Association of medical certification factors with all-cause mortality in U.S. aviators . Aerosp Med Hum Perform. 2019; 90(11):938-944.

INTRODUCTION: Body composition (BC) measurements are used to determine qualification for enlistment and to ensure active members are meeting standards. Although there is extensive research on BC in active-duty military, very few have examined ROTC cadets. The purpose of this study was to identify and quantify differences in BC between freshman/sophomore [underclass (UND)] and junior/senior [upperclass (UPP)] ROTC cadets by using bioelectrical impedance spectroscopy (BIS). METHODS: UND ( N = 21) and UPP ( N = 15) Air Force ROTC cadets volunteered for this study. BIS was used to measure fat mass percentage (FM%), fat free mass percentage (FFM%), total body water percentage (TBW%), extracellular fluid percentage (ECF%), and intracellular fluid percentage (ICF%). Separate one-way ANOVAs were run between UND and UPP for all dependent variables with a Bonferroni correction factor. Additionally, a Pearson correlation between abdominal circumference (AC) and FM% was conducted. RESULTS: No significant differences were observed between the UND and UPP groups' BMI. However, significant differences were observed for ECF%, ICF%, TBW%, FFM%, and FM% in which the UPP had a higher TBW%, ICF%, FFM%, and a lower ECF% and FM% compared to the UND. CONCLUSIONS: This study observed significant differences in BC across class ranks in ROTC cadets. Findings from this study suggest that due to an increased exposure to ROTC training, UPP cadets have a more ideal body composition (FFM% and FM%) when compared to UND cadets. Johnson QR, Mackey CS, Muddle TD, Smith DB, DeFreitas JM. Body composition comparison of upper- and underclass Reserve Officers Training Corps cadets . Aerosp Med Hum Perform. 2019; 90(9):813-818.

BACKGROUND: For over 30 yr the global medical community has attempted to define the acceptable cardiovascular risk in pilots. This challenge is compounded by the ever-changing technological and medical landscape of air travel. We aimed to review the existing literature on estimating the risk of pilot cardiovascular incapacitation and determine if the current guidelines are founded in the best available evidence. METHODS: A detailed review of the guidelines and literature that supports them was completed. Relevant articles were identified by review of the source literature of the guidelines and the references of these source documents. All articles referenced were reviewed in full by both authors. Data that informed the existing recommendations were reviewed and compared to available modern data. The results of these findings were incorporated into a formula that allows for the calculation of acceptable pilot cardiovascular risk given any operator-determined set of variables. RESULTS: Among the evidence that informs current guidelines, there exists a need for further updating. A number of assumptions have been made in creating guidelines and these may no longer reflect the current technological or medical aviation environment. Incorporating the identified variables into a formula allows for the calculation of acceptable cardiovascular risk. This formula was tested using past data and reproduced existing results. DISCUSSION: Current guidelines for pilot cardiovascular risk assessment require review by the international aviation medical community. We propose a novel formula that may serve as a template for future guidelines and may be adapted as aviation technology and health data evolve. Mulloy A, Wielgosz A. Cardiovascular risk assessment in pilots . Aerosp Med Hum Perform. 2019; 90(8):730-734.

BACKGROUND: From a population-based perspective, reports in the peer-reviewed medical literature suggest an increase in the overall prevalence of asthma in recent decades. Applicants for military aviation training with a current or past history of asthma are generally excluded in the United Kingdom. METHODS: In order to assess the impact of the prevalence of asthma on the available pool of military service candidates, the authors collected data on annual live births between 1916 and 2016 as well as peer-reviewed publications that provided insight into asthma prevalence trends within the United Kingdom across the last century (covering birth-year population cohorts ranging from 1924 to 1995). Regression techniques were used to estimate the prevalence of individuals who could reasonably expect to be found unfit for military aviation service due to asthma-like conditions within the birth-year cohorts between 2001 and 2016. RESULTS: Between 1916 and 2016, the number of live births in the United Kingdom has averaged approximately 802,000 per year. The reported prevalence of asthma, based on the assimilated data points, ranged from 2.3 cases per 1000 individuals among the 1924 birth-year cohort, to 29.8 cases per 1000 individuals among the 1990 birth-year cohort. DISCUSSION: Based on the data and analysis presented above, asthma continues to constitute a significant public health issue in the United Kingdom. Military services must base risk mitigation decisions on accurate and precise diagnostic categorizations, and prudently balance the benefits of allowing affected individuals to participate in military service with the potential for mission degradation or compromise. Porter WD, Powell-Dunford N, Wilde GD, Bushby AJR. Asthma and rotary-wing military aircrew selection . Aerosp Med Hum Perform. 2019; 90(7):606-612.

INTRODUCTION: The Federal Aviation Administration Office of Aerospace Medicine (AAM) is required by law to identify pilots who have driving under the influence (DUI) convictions. It is the responsibility of AAM to determine, based on the DUI, if the pilot has a drinking problem and needs follow-up treatment. Pilots with alcohol problems are at risk to themselves and the public and need to have treatment to reduce the extent of the risk. It has been suggested by some that a blood alcohol concentration (BAC) of 0.15 g · dL -1 is evidence of tolerance and the pilot should be placed in an alcohol treatment program. METHOD: The National Institute on Alcohol Abuse and Alcoholism (NIAAA) Clinician's Guide considers a person at risk for a drinking problem when a man drinks 5 or more drinks or a woman drinks 4 or more drinks in a day and reaches a 0.08 g · dL -1 of ethanol in the blood. It is possible to estimate from a BAC or breath alcohol concentration (BrAC) the number of drinks consumed using the volume of distribution for ethanol and the weight of the individual. A spread sheet tool was developed to estimate the number of drinks consumed. RESULTS: It was determined that DUI/DWI concentrations could be used to determine the minimum number of drinks consumed. Overweight people reach binge drinking levels and higher Hingson levels at lower DUI/DWI concentrations than people with an average weight or lower. DISCUSSION: Using this tool there is a high probability (99.7%) of identifying a true binge drinker. Canfield DV, Forster EM, Cheong Z-I, Cowan JM. Breath/blood alcohol concentration as an indicator of alcohol use problems . Aerosp Med Hum Perform. 2019; 90(5):488-491.

INTRODUCTION: This study explores the safety risk due to delayed detection of hazardous health conditions that would result from increasing the duration of U.S. first-class aeromedical certificates from 6 mo to 12 mo for pilots ages 40 yr old through 60 yr old. METHODS: All pilots who submitted a U.S. first-class application in 2014 with no electrocardiogram and with the previous exams 4.5 to 7.5 mo prior were selected from the FAA pilot medical database. Proportions of Federal Aviation Administration (FAA) denial pathology codes and Aviation Medical Examiner (AME) deferrals were compared for these exams within and between age groups from 40 yr old through 75 yr old. The absolute incidence rates for delayed detection were calculated and relative incidence of these proportions was compared graphically. RESULTS: The relative risk between age groups for delayed identification of disqualifying medical conditions showed that the 56-60-yr-old group would be at about twice the risk as the 40-45-yr-old group. The absolute incidence for the 56-60-yr-old group was 0.46% for denial conditions and 0.60% for AME deferrals over 6 mo. DISCUSSION: Increasing FAA first-class medical certificate duration from 6 mo to 12 mo would put 56-60-yr-old pilots at double the currently accepted risk for delayed detection of significant medical conditions. The absolute risk for this 6-mo delayed identification for the 56-60-yr-old group would average 0.53%. Mills WD, DeJohn CA. Safety implications of 6-month vs. 1-year first-class aeromedical certificates . Aerosp Med Hum Perform. 2019; 90(5):484-487.

INTRODUCTION: Hypertension, also known as high blood pressure, is the "silent killer" and may lead to more severe conditions if left unmanaged. Hypertension in service members of the U.S. military has the potential to negatively impact readiness. The aim of this study was to assess the potential impact to readiness of active duty Naval aviators and aircrew under the new 2017 ACC/AHA blood pressure guidelines. METHODS: This cross-sectional study used the Military Health System Data Repository for 2015. The population included all active duty Naval aviators and aircrew. The absolute number and proportion of those with hypertension were compared based on previous Joint National Committee 7 and 2017 ACC/AHA guidelines. Impact to readiness was calculated based on lost work days and the number of individuals with hypertension that fit the criteria to be medically grounded according to the U.S Naval Aeromedical Reference and Waiver Guide. RESULTS: Hypertension diagnoses will increase by 2904 individuals (599%) in the 23,492 Naval aviators and aircrew included in the population. Impact to readiness will result in an estimate of 510 lost work days. CONCLUSION: The 2017 ACC/AHA hypertension guidelines will lead to a dramatic increase in hypertension diagnoses in this population. Depending on the U.S. Navy disposition on hypertension, the impact can be minor or substantial, but the early opportunity for care made available with the 2017 ACC/AHA guidelines may provide long-term benefits of a healthy fighting force worth the immediate impact to readiness. Johnson MC, Banaag AL, Condie KJ, Servies TE, Pérez Koehlmoos TL. New ACC/AHA blood pressure guidelines and the operational readiness of Naval aviators and aircrew . Aerosp Med Hum Perform. 2019; 90(4):409-414.

Introduction: En Route Care (ERC) is often an ad hoc mission for the USN. In a review of 428 Navy patient transports, a Flight Surgeon (FS) was the sole provider or a member of crew in 118 of the transports. Naval FSs receive approximately 4 hours of didactic ERC training during their 24-week Naval FS course. Regardless, an FS may be caring for a critically ill patient in a helicopter. We conducted a survey to evaluate FS confidence in their ability to perform ERC and to establish their understanding of the training of Search and Rescue Medical Technicians (SMT)., Materials and Methods: A convenience sample of FSs completed a needs analysis survey as part of a process improvement project. Flight Surgeons surveyed were actively assigned or had been assigned within the past year to a squadron with Search and Rescue/MEDEVAC capabilities., Results: A total of 25 surveys were completed. An average of 13 (range 0-100) patient transport missions were performed by the respondents. Twenty-five percent reported feeling confident in their ability to provide ERC without senior level direction, while 41% stated they would require direction. Nearly 70% of the FSs surveyed expressed "minimal" or less understanding of the training of the SMT., Conclusions: Our survey results reveal most FSs are confident in neither their ability to perform ERC nor the ability of their hospital corpsman to provide care during patient movement., (© Association of Military Surgeons of the United States 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Early aeromedical risk i was based on aeromedical standards designed to eliminate individuals ii from air operations with any identifiable medical risk, and led to frequent medical disqualification. The concept of considering aeromedical risk as part of the spectrum of risks that could lead to aircraft accidents (including mechanical risks and human factors) was first proposed in the 1980s and led to the development of the 1% rule which defines the maximum acceptable risk for an incapacitating medical event as 1% per year (or 1 in 100 person-years) to align with acceptable overall risk in aviation operations. Risk management has subsequently evolved as a formal discipline, incorporating risk assessment as an integral part of the process. Risk assessment is often visualised as a risk matrix, with the level of risk, urgency or action required defined for each cell, and colour-coded as red, amber or green depending on the overall combination of risk and consequence. This manuscript describes an approach to aeromedical risk management which incorporates risk matrices and how they can be used in aeromedical decision-making, while highlighting some of their shortcomings., Competing Interests: Competing interests: None declared., (© Her Majesty the Queen in Right of Canada, as represented by the Minister of National Defence, 2018.)

Introduction: The high acceleration (Gz) exposure among military pilots flying fighter aircraft has been associated with an increased risk for cervical and lumbar disorders. It has been suggested that an adequate level of physical performance could reduce the risk of experiencing these disorders. The Finnish Air Force has for several years used aerobic (bicycle ergometer) and muscular fitness tests (battery of five tests) in the selection process of military pilot candidates in order to evaluate their physical fitness level. The aim of the study was to determine if these selection phase tests and anthropometry measures can predispose those individuals who might be at risk of developing severe spinal disorders leading to permanent flight duty limitations later during their military pilots' career., Materials and Methods: The study population consisted of 23 pilots flying with Gz limitation (+2 Gz, +4 Gz or +5 Gz) due to spinal disorders and 50 experienced (+1,000 flight hours) symptomless controls flying actively in operative missions. Data obtained retrospectively for all subjects included anthropometry, physical (aerobic and muscular fitness) test results and self-reported physical activity levels at a pilot selection phase. Aerobic fitness was measured with a maximal ergometer test and muscular endurance was evaluated with a test battery (standing long jump, pull-ups, sit-ups, back extensions, and push-up tests)., Results: Fighter pilots flying without Gz limitation had significantly better mean (±SE) results in pull-up (14.4 ± 4.2 vs. 11.5 ± 2.0, p < 0.05) and back extension (71.1 ± 14.1 vs. 60.0 ± 12.2, p < 0.05) tests during the pilot selection when compared with the limited pilots. Similarly, the non-limited pilots had a better total muscular fitness test score (13.7 ± 1.7 vs. 12.4 ± 1.6, p < 0.05) during the pilot selection. They had also participated in significantly more competitive sports (54% vs. 22%, p < 0.05) at the time of selection when compared with pilots flying with Gz limitation due to spinal disorders. The aerobic fitness test results and anthropometric measures were not statistically different among the groups., Conclusions: Higher levels of muscular fitness, particularly axial strength in military pilot selection may have a protective role for reducing spinal disorders which if developed, can often lead to limiting the availability of pilots for flight duty. The present findings also do not support the assumption that aerobic fitness above the required minimum level would protect pilots from developing spinal disorders and, therefore, from limiting flight duty.

Introduction: Military prehospital and en route care (ERC) directly impacts patient morbidity and mortality. Provider knowledge and skills are critical variables in the effectiveness of ERC. No Navy doctrine defines provider choice for patient transport or requires standardized provider training. Frequently, Search and Rescue Medical Technicians (SMTs) and Navy Nurses (ERC RNs) are tasked with this mission though physicians have also been used. Navy ERC provider training varies greatly by professional role. Historically, evaluations of ERC and patient outcomes have been based on retrospective analyses of incomplete data sets that provide limited insight on ERC practices. Little evidence exists to determine if current training is adequate to care for the most common injuries seen in combat trauma patients., Materials and Methods: Simulation technology facilitates a standardized patient encounter to enable complete, prospective data collection while studying provider type as the independent variable. Information acquired through skill performance observation can be used to make evidence-based recommendations to improve ERC training. This IRB approved multi-center study funded through a Congressionally Directed Medical Research Program grant from the Combat Casualty Care Intramural Research Joint En Route Care portfolio evaluated Navy ERC providers. The study evaluated 84 SMT, ERC RN, and physician participants in the performance of critical and secondary actions during an immersive, high-fidelity, patient transport simulation scenario focused on the care during an interfacility transfer. Simulation evaluators with military ERC expertise, blinded to participant training and background, graded each participant's performance. Inter-rater reliability was calculated using Cohen's Kappa to evaluate concordance between evaluator assessments. Categorical data were reported as frequencies and percentages. Performance attempt and accuracy rates were compared with likelihood ratio chi-square or Fisher's exact test where appropriate. Tests were two-tailed and we considered results significant, that is, a difference not likely due to chance exists between groups, if p < 0.05. Confidence intervals were used to present overlap in performance between provider types., Results: Critical and secondary actions were assessed. A majority of providers completed at least one of the critical life-saving actions; only one participant completed all critical actions. Evaluation of critical actions demonstrated that a tourniquet was applied by 64% of providers, blood products administered by 46%, needle decompression performed by 51%, and a complete handoff report performed by 48%. Assessment of secondary actions demonstrated analgesic was accurately administered by 24% of all providers, and 44% reinforced the "hemorrhaging amputation site dressing.", Conclusion: Over 98% of participants failed to properly perform all critical actions during the interfacility transfer scenario, which in a real-life combat casualty transport scenario could result in a preventable death. Study results demonstrate serious skill deficits among all types of Navy ERC providers. These data can be used to improve the training of Navy ERC providers, ultimately improving care to injured soldiers, sailors, airmen, and marines., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2018.)

Aviation and healthcare are complex industries and share many similarities: the cockpit and the operating theater, the captain and the surgeon. While North American commercial aviation currently enjoys a tremendous safety record, it was not always this way. A spike of accidents in 1973 caused 3214 aviation-related fatalities. Over the past 20years, the rate of fatal accidents per million flights fell by a factor of five, while air traffic increased by more than 86%. There have been no fatalities on a U.S. carrier for over 12years. Last year, there were 251,454 deaths in the United States owing to medical error. Pilots pioneered ways to address risks through crew resource management (CRM), and threat and error management (TEM). Both strategies, which are aimed at minimizing risk and optimizing safety, are applicable to surgery and the healthcare industry. These strategies as well as the Swiss Cheese Model, Checklists and the Normalization of Deviance will be reviewed in this article., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Pre-flight risk assessments are currently recommended for all Interstitial Lung Disease (ILD) patients. Hypoxic challenge testing (HCT) can inform regarding the need for supplemental in-flight oxygen but variables which might predict the outcome of HCT and thus guide referral for assessment, are unknown., Methods: A retrospective analysis of ILD patients attending for HCT at three tertiary care ILD referral centres was undertaken to investigate the concordance between HCT and existing predictive equations for prediction of in-flight hypoxia. Physiological variables that might predict a hypoxaemic response to HCT were also explored with the aim of developing a practical pre-flight assessment algorithm for ILD patients., Results: A total of 106 ILD patients (69 of whom (65%) had Idiopathic Pulmonary Fibrosis (IPF)) underwent HCT. Of these, 54 (51%) patients (of whom 37 (69%) had IPF) failed HCT and were recommended supplemental in-flight oxygen. Existing predictive equations were unable to accurately predict the outcome of HCT. ILD patients who failed HCT had significantly lower resting SpO 2 , baseline PaO 2, reduced walking distance, FEV1, FVC and TLCO, but higher GAP index than those who passed HCT., Conclusions: TLCO >50% predicted and PaO 2 >9.42 kPa were independent predictors for passing HCT. Using these discriminators, a novel, practical pre-flight algorithm for evaluation of ILD patients is proposed., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

As the population ages and our ability to care for patients with cardiac disease improves, an increasing number of passengers with cardiovascular conditions will be traveling long distances. Many have had cardiac symptoms, recent interventions, devices, or surgery. Air travel is safe for most individuals with stable cardiovascular disease. However, a thorough understanding of the physiologic changes during air travel is essential given the potential impact on cardiovascular health and the risk of complications in passengers with preexisting cardiac conditions. It is important for clinicians to be aware of the current recommendations and precautions that need to be taken before and during air travel for passengers with cardiovascular concerns., (© 2017 Wiley Periodicals, Inc.)

In January 2015, the Russian aviation medical certification boards adopted the rule of medical certification with OML. The review analyzes the first hands-on experience in medical certification with limitations (OML) of pilots with cardiovascular pathologies in compliance with the guidelines of the International Civil Aviation Organization, European requirements, and overviews the Russian practices of pilots' medical certification.

Introduction: Medical Guidelines for Airline Travel provide information that enables healthcare providers to properly advise patients who plan to travel by air. Not everyone is fit to travel by air and physicians should advise their patients accordingly. They should review the passenger's medical condition, giving special consideration to the dosage and timing of any medications, contagiousness, and the need for special assistance during travel. In general, an individual with an unstable medical condition should not fly; cabin altitude, duration of exposure, and altitude of the destination airport are all considerations when recommending a passenger for flight.

Introduction: Medical Guidelines for Airline Travel provide information that enables healthcare providers to properly advise patients who plan to travel by air. Treating physicians should advise patients in need of special services to contact the airline well before travel to find out if the required services will be available. Ensuring the required services are available throughout a journey can be challenging, especially when different airlines and aircraft types are involved. For example, airlines carry a limited supply of oxygen for use in the event of an unexpected in-flight emergency; however, this supply is not intended for use by passengers needing supplemental oxygen. Arrangements must be made in advance with the airline. Therefore, early contact with the airline is helpful.

Introduction: Medical Guidelines for Airline Travel provide information that enables healthcare providers to properly advise patients who plan to travel by air. All airlines are required to provide first aid training for cabin crew, and the crew are responsible for managing any in-flight medical events. There are also regulatory requirements for the carriage of first aid and medical kits. AsMA has developed recommendations for first aid kits, emergency medical kits, and universal precaution kits.

Introduction: Medical Guidelines for Airline Travel provide information that enables healthcare providers to properly advise patients who plan to travel by air. Although there are no publicly available databases providing information on the number of in-flight medical emergencies, the few studies published in the literature indicate that they are uncommon. Minor illnesses such as near-fainting, dizziness, and hyperventilation occur more frequently. However, serious illnesses, such as seizures and myocardial infarction, also occur. In-flight deaths are also rare.

The article considers the influence of geographic and climatic conditions of the Arctic on a functional condition of aviation professionals. Marked possible effects of aggressive environmental factors on the health of the personnel. Studied the dynamics of the recovery functions of the cardio-respiratory system and of the indicators of general clinical blood test in a period of adaptation to the conditions of the middle latitudes after the return of the personnel from the Arctic. Identified the main activities to preserve the health of aviation specialists, depending on the length of stay in the Arctic region and age.

The spectral characteristics of the EEG recorded on two professional pilots in the simulator TU-154 aircraft in flight dynamics, including takeoff, landing and horizontal flight (in particular during difficult conditions) were analyzed. EEG recording was made with frequency band 0.1-70 Hz continuously from 15 electrodes. The EEG recordings were evaluated using analysis of variance and discriminant analysis. Statistical significant of the identified differences and the influence of the main factors and their interactions were evaluated using Greenhouse - Gaiser corrections. It was shown that the spectral characteristics of the EEG are highly informative features of the state of the pilots, reflecting the different flight phases. High validity ofthe differences including individual characteristic, indicates their non-random nature and the possibility of constructing a system of pilots' state control during all phases of flight, based on EEG features.

Blaginin A.A., Grebenyuk A.N., Lizogub LN. - The main ways of improvement of medical support of the Air Forces in modern conditions. Aircrew conducting active hostilities suffers from the whole spectrum of factors and conditions of the combat situation. The main task for the medical service of the Air Force is to carry out preventive and curative action for aviation specialists who are responsible for the combat capability of aircraft formations. The medical service of the Air Force must have forces and facilities for planning, organization and implementation of the treatment of lightly wounded and sick aviation professionals with short periods of recovery, medical rehabilitation of aircrew qfter suffering injuries, diseases, sanatorium therapy of aircrew with partial failure of health, outpatient and inpatient medical examination aircrew - flight commissions, preventive rest of aviation specialists with symptoms of chronic fatigue. Should be trained aviation physicians, including both basic military medical education and in-depth study of the medical aspects of various fields of personnel of the Air Force.

Introduction: Color is an important characteristic of the aviation environment. Pilots must rapidly and accurately differentiate and identify colors. The medical standards published by the International Civil Aviation Organization (ICAO) require that pilots have "the ability to perceive readily those colors the perception of which is necessary for the safe performance of duties." The general wording of that color vision (CV) standard, coupled with the associated flexibility provisions, allows for different approaches to the assessment of color vision deficient (CVD) pilots., Methods: Data was gathered and analyzed regarding medical assessment practices applied by different countries to CVD pilots., Results: Data was obtained from 78 countries, representing 78% of the population and 92% of the aviation activity of the world. That data indicates wide variation in the medical assessment of CVD pilots. Countries use different tools and procedures for the testing of pilots, and also apply different result criteria to those tests. At one extreme an applicant making one error upon Ishihara 24-plate pseudoisochromatic plate (PIP) testing is declined a class 1 medical assessment, while at another extreme an applicant failing every color vision test required by the regulatory authority may be issued a medical assessment allowing commercial and airline copilot privileges., Conclusions: The medical assessment of CVD applicants is not performed consistently across the world. Factors that favor uniformity have been inadequate to encourage countries toward consistent medical assessment outcomes. This data is not consistent with the highest practicable degree of uniformity in medical assessment outcomes, and encourages aeromedical tourism.

The authors researched the air-stuff and complex of adverse factors uncharacteristic for the air-staff of land-based aircraft. It was determined that adverse factors affect the air-staff foremost in 4-5 months of a blue-water sailing, except cardiovascular system diseases. In a month of a blue-water sailing was registered a hypotonic state. Systolic blood pressure varied from 100-105 mm Hg and lower, dystolic blood pressure varied from 60-65 mm Hg and lower. The lowest ranges of blood pressure were registered in three months after the beginning of the sailing. In the following, the hypotonic state, registered during the monthly medical examinations, remained till the end of the sailing. Normal averages of blood pressure were restored in two weeks after the end of sailing. Low red cell count (for more than 1100 points) was registered in 61.5% of patients, (for more than 550 points) in 38.4% of patients. Low white cell count (for more than 4800 points) was registered in 33.3% of patients, (for more than 3300 points) in 41% of patients, (for more than 1330 points) in 25% of patients. Input data was: red cell count--4250 points, white cell count--7300 points in 1 ml of blood. After the sailing haematological indices were restored. The authors suggested guidelines for primary and secondary disease prevention.

Flying is the most important way of travelling in the continually growing international tourism. Number of passengers and those with preexisting diseases, mainly with cardiopulmonary problems, is increasing over years. One of the main tasks of the pre-travel advice is to assess tolerance to hypoxia of the traveler, and specify the necessity, as well as the type and volume of supplementary oxygen therapy. It is indispensable to know the cabin-environment and impact of that on the travelers' health. Travel medicine specialist has to be aware of the examinations which provide information for the appropriate decision on the fit-to-fly condition of the patient. The physician who prepares the patient with chronic obstructive pulmonary disease for repatriation by regular flight and the escorting doctor have to be fully aware of the possibilities, modalities, advantages and contraindications of the on-board oxygen supply and therapy. In this review, the authors give a summary of literature data, outline the tools of in-flight oxygen therapy as well as discuss possibilities for the preflight assessment of patients' condition including blood gas parameters required for safe air travel, as recommended in international medical literature. The preparation process for repatriation of patients with chronic obstructive pulmonary disease is also discussed.

Following a March 27, 2012, incident in which a pilot of a major commercial airline experienced a serious disturbance in his mental health, the Aerospace Medical Association formed an Ad Hoc Working Group on Pilot Mental Health. The working group met several times and analyzed current medical standards for evaluating pilot mental health. The result of the working group was a letter sent to the FAA and other organizations worldwide interested in medical standards. The Committee found that it is neither productive nor cost effective to perform extensive psychiatric evaluations as part of the routine pilot aeromedical assessment. However it did recommend greater attention be given to mental health issues by aeromedical examiners, especially to the more common and detectable mental health conditions and life stressors that can affect pilots and flight performance. They encouraged this through increased education and global recognition of the importance of mental health in aviation safety.

Safety issues are paramount in aviation and careful treatment protocols have been developed to ensure fitness to fly among aviators recovering from major depressive episodes (MDE). Aeromedical examiners (AMEs) do not necessarily treat depressive patients frequently, so they often consult psychiatrists; however, psychiatrists are rarely familiar with aviator treatment protocols. U.S., Canadian, and Australian regulations allow several choices among antidepressant drugs for flying pilots recovering from an MDE. Symptom stability times before the possible return to flying duties vary from 4 wk to 12 mo. So far European regulations have not allowed antidepressants, but the situation may change.

During the last years attempts have been made to draw lessons from aviation to increase patient safety in medicine. In particular similar conditions are present in surgery as pilots and surgeons may have to support high physical and mental pressure. The use of a few safety instruments from aviation is feasible in an attempt to increase safety in surgery. First a "root caused" accident research may be established. This is achievable by morbidity and mortality conferences and critical incident reporting systems (CIRS). Second, standard operating procedures may assure a uniform mental model of team members. Furthermore, crew resource management illustrates a strategy and attitude concept, which is applicable in all situations. Safety instruments from aviation, therefore, seem to have a high potential to increase safety in surgery when properly employed., (© Georg Thieme Verlag KG Stuttgart ˙ New York.)

Codification of medical policy for the National Aeronautics and Space Administration (NASA) did not occur until 1977. Policy development was based on NASA's human spaceflight efforts from 1958, and the need to support the operational aspects of the upcoming Space Shuttle Program as well as other future activities. In 1958, the Space Task Group (STG), a part of the National Advisory Committee on Aeronautics (NACA), became the focal point for astronaut selection, medical support, and instrumentation development in support of Project Mercury. NACA transitioned into NASA in 1958. The STG moved to Houston, TX, in 1961 and became the Manned Spacecraft Center. During these early years, medical support for astronaut selection and healthcare was provided through arrangements with the U.S. military, specifically the United States Air Force, which had the largest group of subject matter experts in aerospace medicine. Through most of the 1960s, the military worked very closely with NASA in developing the foundations of bioastronautics and space medicine. This work was complemented by select individuals from outside the government. From 1958 to 1977, there was no standard approach to medical policy formulation within NASA. During this time, it was individualized and subjected to political pressures. This manuscript documents the evolution of medical policy in the NASA, and provides a historical account of the individuals, processes, and needs to develop policy.

Since World War I, the role of physicians who care for pilots has been to minimize the risks posed by the unique environment in airplanes and the demands of flying. Originally, that meant screening out those with any physical limitations that might affect their ability to fly such as vision or cardiac problems. Today, however, with the ability to better manage patients with multiple conditions, the physician's task is more nuanced and requires an estimation of risk based on the how well a pilot's condition can be managed and the type of flying he or she does. This article looks at how pilots are medically evaluated and how the standards for medical certification are evolving, allowing some pilots who have certain conditions to continue flying.

It is suggested that the Aerospace Medical Association convene an international expert body to determine the relevance of the pharmacological profiles of hypnotics to the practice of aviation medicine.

As directed by the Council of the Aerospace Medical Association, the Commercial Spaceflight Working Group has developed the following position paper concerning medical issues for commercial suborbital spaceflight crewmembers. This position paper has been approved by the AsMA Council to become a policy of the AsMA.

Background: Air medical transport has had problems with its safety record, attributed in part to human error. Flight crew members (FCMs) must be able to focus on critical safety tasks in the context of a stressful environment. Flight crew members' cognitive readiness (CR) to perform their jobs may be affected by sleep deprivation, personal problems, high workload, and use of alcohol and drugs., Objective: The current study investigated the feasibility of using a computer-based cognitive task to assess FCMs' readiness to perform their job., Methods: The FCMs completed a short questionnaire to evaluate their physiologic and psychological state at the beginning and end of each shift. The FCMs then performed 3 minutes of a computer-based cognitive task called synthetic work environment (SYNWIN test battery). Task performance was compared with the questionnaire variables using correlation and regression analysis. Differences between the beginning and end of each shift were matched and compared using a paired Students t test., Results: SYNWIN performance was significantly worse at the end of a shift compared with the beginning of the shift (p = 0.028) primarily because of decrement in the memory component. The SYNWIN composite scores were negatively correlated to degree of irritability felt by the participant, both before (r = -0.25) and after (r = -0.34) a shift and were significantly correlated with amount of sleep (0.22), rest (0.30), and life satisfaction (0.30)., Conclusions: Performance by FCMs on a simple, rapid, computer-based psychological test correlates well with self-reported sleep, rest, life satisfaction, and irritability. Although further studies are warranted, these findings suggest that assessment of the performance of FCMs on a simple, rapid, computer-based, multitasking battery is feasible as an approach to determine their readiness to perform critical safety tasks through the SYNWIN task battery.

Inflammatory bowel disease, such as ulcerative colitis or Crohn's disease, is not a rare entity among military aviators. This relapsing inflammatory condition which may also affect extra intestinal organs can cause recurrent symptoms with considerable morbidity. The unpredictable nature of the disease, side effects of medications, and potential surgical procedures are obvious aeromedical concerns let alone the disease's extra-intestinal manifestations, some of which may result in sudden incapacitation. We present 14 military aviators who were diagnosed with inflammatory bowel disease and returned to flight duty after stabilization of symptoms. Mean follow-up period was 102 months (total of 1,429 months) without any adverse effects on flight safety. Only 4 aviators were grounded for a cumulative duration of 35 months during that period. We believe that because adequate disease control is readily feasible in most cases, safe return to flight duty within a short period is reasonable in uncomplicated cases.

It was suggested as the main compositive fractions MSS to consider the base system of automated evaluation of blood redistribution (BR) in body means of crew members protection and prophylaxis (CMPP) of unfavourable effects of flight factors to organism and also the automated circuit of CMPP' control. The advanced MSS includes 4 original measuring channels for registration of the base physiologic indices (electrocardiogram, venous-arterial pulsegram of neck vessels, reogram of head, earlap vessels pulsegram) the dynamic of which allows to determine with the help of computer the BR-integral parameter. The CMPP automated control circuit unites the separate protecting means in common system and executes the individual selection of regimes and CM PP-composition in accord with, first of all, body reactions manifestation and, secondly, individual physiologic status of spaceman. As CMPP was selected the negative pressure production around lower body part. Approlation of constructed active laboratory engineering mock-up MSS has performed investigations with participation of 29 subjects (Volunteers) under the modeling of hemodynamic shifts, developing in human body in short-term antiorthostatic hypokinesia (-10 degrees), as well as, in combined effect of antiorthostatic hypokinesia (-10 degrees), Coriolis acceleration and optokinetic stimulation. Results of investigations have showed, that the use of advanced MSS gives the indices of operator professional activity on the average of 17-32% under the decrease of hemodynamic stressful.