When the envelope pushes back: a combat aviator experiences barotrauma after descending with an ear block

While deployed to a war zone, an aviator displayed poor aeromedical judgment and flew with an upper respiratory infection and an ear block. This resulted in a tympanic membrane perforation and the medical grounding of the member for 10 days. The discussion involves the probable mechanism of injury and the requirements of the Naval Aerospace Medical Institute regarding perforations, as well as the reasoning behind the flight surgeon's choice of treatment.     

美国空军的医疗保障体系

借鉴与学习美国空军医疗保障体系与先进理念,以及稳定航空军医队伍的有效手段.主要引用美国空军两个网络资料,文献4篇,军标1个.这些资料表明,美国空军高层已形成共识——良好的医疗服务是飞行安全与战斗力的重要保障.因此,每年预算庞大的经费,以维持75个医疗中心、医院、诊所或医疗站的专一而高效地运转.而军事人员通用医疗保险制度(TRICARE)使三军人员就近就诊,大幅节省费用.全球搜救、空运医疗服务系统和分级健康维护与治疗,构成完备的医疗保障体系.航空军医则是保障空军全体官兵健康的重要前哨,通过分级培训与较高待遇,使航空军医在专业与生活水平两方面均能不断提升,有效地稳定了这支队伍.美国TRICARE制度可以借鉴,稳定航空军医队伍的手段值得学习.     

The flight surgeon and psychiatry: interest and skills

Much of the flight surgeon's day-to-day clinical practice involves the use of psychiatric skills in the assessment and management of the problems of flyers and their families. Folklore holds that among nonpsychiatrists, the older, more experienced, nontrainee clinician is more interested in and knowledgeable about the psychiatric aspects of his practice. We studied this assumption in 170 flight surgeons who varied in age, experience, and whether or not they were presently in training or had already completed training in flight medicine. Measures of interest in psychiatry and self-assessed ability in seven areas of psychiatric skills and knowledge were obtained. Results indicate that age and experience are unrelated to interest in psychiatry, while being in training has a significant negative impact. Self-assessed ability is significantly related to training status, age, and experience. The flight surgeon's subjective assessment of needing further education was increased by being in a training status, but unaffected by age or experience.     

Simulator sickness in the U.S. Army UH-60A Blackhawk flight simulator.

Realistic training in aviation now includes the use of sophisticated flight simulators which can provide near total perception of aircraft flight. Reports of simulator sickness seem to be increasing in simulators with multi-directional motion, computer-generated imagery, and infinity optics. A voluntary, subjective, symptom-oriented questionnaire was completed by 141 pilots after training in the UH-60A 2B38 Blackhawk flight simulator. Thirty-six percent reported positive symptoms of motion sickness. Pilots may be at risk if they fly too soon after simulator training and a mandatory grounding time is advised.     

Variables affecting proper system grounding for radiofrequency ablation in an animal model

PURPOSE: The authors sought to determine which factors contribute to excessive thermal deposition and burns at the grounding pad site after high-current percutaneous, image-guided radiofrequency (RF) ablation. MATERIALS AND METHODS: Radiofrequency (1,000-2,000 mA) was applied for 10 minutes with use of an internally-cooled electrode placed into in vivo pig livers (n = 88). In separate experiments, the number of pads (1, 2, or 4), orientation of pads (horizontal, vertical, or diagonal), and distance between the pads and the electrode (10-50 cm) of mesh or foil grounding pads (12.5 x 8 cm; 100 cm2) were varied. Thermistors measured skin surface temperatures during ablation. Pathologic analysis of skin changes was performed. RESULTS: Temperature elevations at the grounding pad were observed for every trial, with a temperature elevation > or =12 degrees C (as high as 45 degrees C) observed in 60 of 88 trials (68.2%). Temperatures at the grounding site pad were dependent on all variables studied, including the grounding pad surface area, the amount of current deposited in the liver, the orientation of the pad, and the pad's distance from the electrode. Second-degree burns were seen with temperatures exceeding 47 degrees C and third-degree burns were observed when a temperature > or = 52 degrees C was noted. For a given set of RF parameters, reduced heating was observed for trials in which foil grounding pads were used (P < .001). Grounding pad burns did not occur at 2,000 mA (maximum generator output) when four foil pads were placed horizontally > or = 25 cm from the electrode. CONCLUSIONS: High-current RF ablation can induce severe burns at the grounding pad site if inadequate precautions are taken. To minimize the risk of burns, multiple large-surface-area foil pads should be placed on well-prepared skin and oriented with the longest surface edge facing the RF electrode.     

Posterolateral corner injuries of the knee: anatomy, diagnosis, and treatment

Injuries to the posterolateral corner of the knee continue to be a complex problem for orthopedic surgeons. Early recognition and treatment are important factors in the patient's long-term outcome. To properly treat these patients, the surgeon must have a clear understanding of the anatomic relationships amongst the structures in the posterolateral knee. This knowledge combined with a thorough physical examination and imaging studies, allows the surgeon to make the correct diagnosis and devise an appropriate treatment plan. This article will discuss the anatomy, diagnosis, and treatment options to improve the surgeon's understanding of posterolateral knee injuries. The senior author's technique for anatomic reconstruction of the posterolateral corner of the knee and the rehabilitation protocol are described.     

Psychiatric education in aerospace medicine.

In order to facilitate curriculum design for psychiatric education in aerospace medicine, three groups of physicians were surveyed: experienced flight surgeons, student flight surgeons, and psychiatrists trained in aerospace medicine. Two measures were obtained: 1) an assessment of the usefulness of particular psychiatric skills and knowledge in the practice of aerospace medicine, and 2) a rating of the clinician's abilities in these areas. Results support the primary importance of interviewing and diagnostic skills. Student flight surgeons show deficiencies in the areas of administrative knowledge and in knowledge of the impact of the flyer's environment upon his mental status. These findings link psychiatry in aerospace medicine with the emphasis on understanding the man/environment interface and on the flight surgeon's organizational function of boundary control through decisions on fitness to fly.     

The role of the flight surgeon in Greece

From 1915 [corrected], the first time a flight surgeon participated in an aeromedical evacuation, to the present, the role has become more fundamental by working in wars and operations, experiencing search and rescue aeromedical evacuations from mass accidents or motor accidents, treating seriously ill individuals, and caring for wounded victims of attacks either at the scene or at the hospital. The improvements in cognitive and technological standards of medical science and in the education available have contributed in upgrading the role of flight surgeons; however, their presence in flight is considered essential in 20-60% of aeromedical evacuations, with the remainder of the flights being covered by paramedical personnel. In the Greek territory, the development of Air Force medicine began with the U.S. education of Panagiotis Korombilis, founder of the Center for Flight Crew Health Examination in 1936. In 1976, the Air Force Medical Center was established in the General Air Force Hospital while the educational and medical work of Air Force physicians led to the development of Air Force Medicine and supported Olympic Airways and Military Air Force development, which provides aircraft and personnel for patient aeromedical evacuations. An organized aeromedical evacuation system based on the National Health System, however, began operating in 1982 and was upgraded in 1994. Currently, the flight surgeon's work remains important in supporting the Military Air Force by offering regular examinations at the Air Force Medical Center for all personnel flying on civil and military aircrafts, and by educating all the Greek territory and Cypriot Air Force surgeons (of the National Emergency Assistance Center and the Military Services) at the Air Force Medical Center. Their presence at Air Force bases is important, as is their support of the overall well-being of flight personnel, their assistance in upholding the territory's future by improving aircraft and equipment and by purchasing search-rescue aeromedical evacuation helicopters and hospital aeromedical transportation aircraft capable of transporting seriously ill patients, their promotion of collaboration with other countries in educating Air Force surgeons, and in support of valuable human life according to the Hippocratic Oath.     

Paper-free flight surgeon's office

Integration of evolving technology into the flight surgeon's daily practice offers revolutionary opportunities to improve professional effectiveness. The productivity of those involved in the practice of aerospace medicine will be enhanced through the use of information systems, including word processors, communications equipment, graphics displays, and computers. The use of these systems will eliminate "paper work" and add efficiency to the flight surgeon's office environment. The practice of medicine is changing with increasing emphasis on credentialing, activity tracking, incident reporting, and occurrence screening. These quality assurance measures are being followed through data base management. The implications regarding medical records management, productivity indicators, continuing medical education, preventive medicine and direct patient care are great. The ability to communicate electronically leads to potential consultant networks, allowing real-time advice on complex cases regardless of geography. Military physicians should also be mindful of the command, control, communications, and intelligence advantages offered by these systems. Although microcomputers exist in most flight surgeons' offices and new technical applications are planned, integrators and champions are needed.     

Saphenous nerve injury. An unusual arthroscopic complication.

The surgeon should use strict technical vigilance to prevent intraoperative arthroscopic complications. An expert understanding of the anatomy, along with visualization of all instruments during surgery, should prevent inadvertent injury to neighboring structures. This case report represents one unusual complication associated with arthroscopic knee surgery and should serve to heighten the surgeon's awareness that arthroscopy is not a benign procedure.     

PET scan as an aid for the return of a head-injured aviator to flying duty

Head injury is not a rare event in aviators, and poses a difficult dilemma for the flight surgeon regarding return to flying duty due to the fear of post-traumatic epilepsy. Positron emission tomography (PET) is a functional neuroimaging modality that provides additional localizing data in epileptic patients in the interictal phase. We describe a case of penetrating head trauma with no loss of consciousness in a military jet fighter pilot in which the magnetic resonance imaging revealed a minimal brain contusion. PET scan was used as an additional tool for predicting the epileptogenic potential of this finding, thus aiding the decision regarding the return of the aviator to flying duty.     

飞行员临时停飞心理学指征研究进展

目的 综述和分析与飞行员临时停飞相关的心理学指征的研究概况. 资料来源与选择该领域的研究论文、综述、研究报告和专著. 资料引用相关文献41篇.资料综合从飞行事故中的心理因素、飞行员临时停飞心理学指征的国内外研究现状及研究展望3个方面进行综合.结论 实施飞行员心理学临时停飞对保障飞行安全具有重要意义,研究制定适合我军飞行员的临时停飞心理学指征是一个亟待解决的问题.     

A flight surgeon's personal view of an emerging illness

The personal experience of a retired Air Force flight surgeon and instrument-rated civilian pilot with an illness that has achieved recent prominence in both the popular and medical press is recounted. The author believes that the illness is widely prevalent and its incidence is increasing. His experience and conviction is that, during certain phases of the illness, both cognitive dysfunction and orthostatic intolerance occur that can pose grave safety risks in the aviation environment, and must be taken seriously by the practicing flight surgeon. As in all emerging illnesses, clinical experience and judgment must precede more definitive proof of the effects of this illness.     

Breast imaging: a breast surgeon's perspective

Many changes have occurred in the past decade in the imaging of the breast. These improvements have led to more sensitive and specific breast imaging and to the widespread use of minimally invasive biopsy techniques. They have also facilitated a closer working relationship between breast imager and surgeon and have contributed greatly to the surgeon's ability to optimally diagnose and treat breast cancer.     

Airline pilot alcoholism: one airline's experience

The rehabilitation program at United Airlines strives for early identification of alcoholics, with constant monitoring by an educated team consisting of the flight surgeon, flight manager, and union representative. Confidentiality is essential and great caution and planning are required before confronting a suspected alcoholic pilot. UAL now has over 120 recovering pilots with an average rehabilitation time of 4 months and remission time of 3 years, by which time the probability of relapse has returned to baseline.     

Survey of USAF flight surgeons regarding clinical preventive services, using CHD as an indicator.

BACKGROUND: A recent Department of Defense study revealed that nonpharmacologic therapy is not well documented in medical records of individuals identified at risk for coronary heart disease (CHD). Exercise and weight control are often underemphasized relative to dietary and medication interventions, even in medical journal review articles on management of dyslipidemia. METHODS: A literature review of interventions consisting of exercise alone or with diet is presented. A brief survey was developed to assess the knowledge and beliefs of USAF flight surgeons regarding training received for, and delivery of, clinical preventive services. In addition, the respondents were given a scenario patient with high cholesterol to manage. RESULTS AND DISCUSSION: The literature review demonstrates the beneficial effect of exercise alone or with dietary interventions on reducing total cholesterol and increasing high-density lipoprotein (HDL). The survey reveals that USAF flight surgeons believe that more preventive medicine training is needed in the USAF flight surgeon course, graduate medical education, and medical school. Given a scenario patient with hypercholesterolemia, the flight surgeons believe that nonpharmacologic therapy with consults to the base Health and Wellness Center (HAWC), along with follow-up by the physician, is appropriate initial medical treatment rather than pharmacologic therapy. CONCLUSIONS: The primary treatment for prevention of CHD should be an organized exercise and diet program. This treatment is proven effective through clinical trials and is supported by the flight surgeon survey results. Additional benefits of an organized exercise and diet program include decreased obesity with its associated complications, decreased incidence of hypertension, decreased cancer risk, and decreased risk for diabetes mellitus.     

Central retinal artery occlusion by proxy: a cause for sudden blindness in an airline passenger

The use of gas media in ophthalmologic procedures is relatively commonplace. Scleral buckle and pneumatic retinopexy procedures using air-gas mediums are a widely accepted treatment for retinal detachment. We present a patient who had a scleral buckle with pneumatic retinopexy performed and subsequently flew in a commercial airliner 2 wk later. The patient experienced sudden blindness due to central retinal artery occlusion brought about by expansion of the air bubble when the aircraft reached cruise altitude and a cabin pressure of 8000 ft. The intraocular pressure exceeded the central artery pressure thereby collapsing the artery. The patient's symptoms were relieved when an onboard flight surgeon identified the problem and the cabin pressure was reset to 2000 ft. Flying after an ophthalmic procedure that incorporates intraocular gas may have complications due to the bubble expansion in accordance with Boyle's Law. The ophthalmologic surgeon must be diligent in forewarning patients of the potential complications of flying for weeks to months after a procedure that utilizes intraocular gas.     

Space motion sickness during 24 flights of the space shuttle

The incidence and severity of Space Motion Sickness (SMS) were determined from 24 flights of the Space Shuttle. A standardized questionnaire developed at the NASA-Johnson Space Center (JSC) was administered to all crewmembers postflight during an oral debriefing with the examining flight surgeon. Cases of SMS were graded mild, moderate or severe using criteria developed at the JSC. The incidence of SMS during a first Shuttle flight for 85 crewmembers was 67% (57 cases). There were 26 mild cases (30%), 20 moderate (24%), and 11 severe (13%). Differences were found between males and females, crew positions (Commander, Pilot, Mission Specialist, etc.), and age groups, which were not statistically significant (p greater than 0.05), but would suggest future research into the mechanism, prevention, and treatment of SMS. The 26 crewmembers with a second flight showed a reduction in SMS incidence to 46%, but the change was not significant compared with the first flight. Nine crewmembers (35%) showed a reduction in SMS severity comparing first and second flights, yet there was no significant difference in the mean time between flights for crewmembers with SMS versus asymptomatic crewmembers. Variability in crewmember training and flight experience may explain some of the differences observed.     

Case from the aerospace medicine residents' teaching file. Case #35. Renal cell carcinoma in an aviator with a long history of renal lithiasis

This case study discusses the presentation, evaluation, and aeromedical disposition of an aviator with renal cell carcinoma, a disease seldom seen in the military flying population. It emphasizes the necessity of flight surgeon awareness of preventive medicine aspects of waivered medical disorders.     

Sports after total hip replacement

The purpose of total hip replacement is to relieve pain, not to make better athletes. Still, the modern patient is likely to return to recreation and sports. There is no current consensus on the safety of resuming athletics, though a surgeon's judgment and a patient's common sense will serve as appropriate guidelines. The main concerns are instability, wear, loosening, and fracture. Each sport should be evaluated on its potential risk to a joint replacement, whether from the force of repetitive injury or the possibility of catastrophic failure. Likewise, a surgeon can use techniques, biomaterials, and implants that will maximize an athlete's chance of success over time.