Flight Surgeon Research Articles

You're the flight surgeon: atrial fibrillation.

Rohrer RJ, Ostrofe AA, Zenk RL. You’re the flight surgeon: atrial fibrillation. Aerosp Med Hum Perform. 2016; 87(5):508–510.

You're the Flight Surgeon. Malaria prevention in U.S. Air Force aviators.

DeJulio P. You’re the flight surgeon: malaria prevention in U.S. Air Force aviators. Aerosp Med Hum Perform. 2016; 87(4):429–432.

Complication Rates in Altitude Restricted Patients Following Aeromedical Evacuation.

Military aeromedical evacuation, especially that associated with the present Middle East conflict, is seeing increasing research. This ecological study initiates research into the validating flight surgeon by looking at cabin altitude restriction (CAR), arguably the validating flight surgeon's prescription with the highest patient-mission impact, and its association with postflight complications. CAR rates from January 2006 through February 2008 were determined from the U.S. Transportation Command Regulating and Command and Control Evacuation System database. Postflight complication rates-the rate of patients with postflight complications (PFC) and the postflight complications per 100 patients (PFC-100)-from January 2007 through June 2008 were calculated from the Landstuhl Regional Medical Center trauma database. CAR and complication rates were examined before, during, and after the authors' deployment. In addition, the relationship between CAR and postflight complication rates was investigated; as the rates were nonlinear, a Spearman correlation was performed. CAR rates during the authors' deployments were significantly up compared to the authors' predecessors or successors; their predecessors and successors did not differ statistically. Likewise, the PFC rate during the authors' deployments was significantly lower than that of the before or after time frames. Furthermore, a statistically significant inverse relationship between CAR and PFC rates (Spearman rho = -0.587) as well as CAR and PFC-100 rates (Spearman rho = -0.568) was demonstrated. CAR rate was inversely correlated to PFC and PFC-100 rates. This finding suggests that aggressive prescribing of CARs may have a salutary effect on postflight complication rates and bears further investigation.

Assessing Sensorimotor Function Following ISS with Computerized Dynamic Posturography.

Postflight postural ataxia reflects both the control strategies adopted for movement in microgravity and the direct effects of deconditioning. Computerized dynamic posturography (CDP) has been used during the first decade of the International Space Station (ISS) expeditions to quantify the initial postflight decrements and recovery of postural stability. The CDP data were obtained on 37 crewmembers as part of their pre- and postflight medical examinations. Sensory organization tests evaluated the ability to make effective use of (or suppress inappropriate) visual, vestibular, and somatosensory information for balance control. This report focuses on eyes closed conditions with either a fixed or sway-referenced base of support, with the head erect or during pitch-head tilts (± 20° at 0.33 Hz). Equilibrium scores were derived from peak-to-peak anterior-posterior sway. Motor-control tests were also used to evaluate a crewmember's ability to automatically recover from unexpected support-surface perturbations. The standard Romberg condition was the least sensitive. Dynamic head tilts led to increased incidence of falls and revealed significantly longer recovery than head-erect conditions. Improvements in postflight postural performance during the later expeditions may be attributable to higher preflight baselines and/or advanced exercise capabilities aboard the ISS. The diagnostic assessment of postural instability is more pronounced during unstable-support conditions requiring active head movements. In addition to supporting return-to-duty decisions by flight surgeons, the CDP provides a standardized sensorimotor measure that can be used to evaluate the effectiveness of countermeasures designed to either minimize deconditioning on orbit or promote reconditioning upon return to Earth.

You’re the Flight Surgeon

Park B. You're the flight surgeon: white matter hyperintensities. Aerosp Med Hum Perform. 2015; 86(12):1075-1077.

You're the Flight Surgeon: Meckel's diverticulum.

Woodard TW. You’re the flight surgeon: Meckel’s diverticulum. Aerosp Med Hum Perform. 2015; 86(11):1006–1009.

You're the Flight Surgeon: Keratoconus.

Anderson-Doze E. You're the flight surgeon: keratoconus. Aerosp Med Hum Perform. 2015; 86(11):1004–1006.

You're the Flight Surgeon.

Lee M. You’re the flight surgeon: vitamin A toxicity. Aerosp Med Hum Perform. 2015; 86(10):920–922.

You're the Flight Surgeon.

Cagniart P-EC. You’re the flight surgeon: Miller-Fischer syndrome. Aerosp Med Hum Perform. 2015; 86(10):918–920.

Hypoxemia during aeromedical evacuation of the walking wounded.

Hypobaric hypoxemia is a well-known risk of aeromedical evacuation (AE). Validating patients as safe to fly includes assessment of oxygenation status as well as oxygen-carrying capability (hemoglobin). The incidence and severity of hypoxemia during AE of noncritically injured casualties have not been studied. Subjects deemed safe to fly by the validating flight surgeon were monitored with pulse oximetry from the flight line until arrival at definitive care. All subjects were US military personnel or contractors following traumatic injuries. Noninvasive oxygen saturation (SpO2), pulse rate, and noninvasive hemoglobin were measured every 5 seconds and recorded to electronic memory. Patient demographics and physiologic data were collected by chart abstraction from the Air Force Form 3899, patient movement record. The incidence and duration of hypoxemic events (SpO2 < 90%) and critical hypoxemic events were determined (SpO2 < 85%). Sixty-one casualties were evaluated during AE from Bagram Air Base to Landstuhl Regional Medical Center. The mean (SD) age was 26.2 (6) years, Injury Severity Score (ISS) was 8 (11), and mean SpO2 before AE was 96% (2%). The mean (SD) transport time was 9.3 (1.3) hours. Patients were monitored before AE for a brief period, yielding a total recording time of 10.28 hours. The mean (SD) hemoglobin at the time of enrollment was 13.2 (3.5) g/dL (9.4-18.0 g/dL). Hypoxemia (SpO2 < 90%) was seen in 55 (90%) of 61 subjects. The mean duration of SpO2 less than 90% was 44 minutes. The mean (SD) change in SpO2 from baseline to mean in-flight SpO2 was 4% (1.2%). Thirty-four patients (56%) exhibited an SpO2 less than 85% for 11.7 (15) minutes. Hypoxemia is a common event during AE of casualties. In patients with infection and concussion or mild traumatic brain injury, this could have long-term consequences. Epidemiologic/prognostic study, level V.

You're the Flight Surgeon: acute low back pain.

Duffy TD. You’re the flight surgeon: acute low back pain. Aerosp Med Hum Perform. 2015; 86(9):842–845.

You're the Flight Surgeon: optic neuritis.

Hatfield JM. You’re the flight surgeon: optic neuritis. Aerosp Med Hum Perform. 2015; 86(9):845–848.

You're the Flight Surgeon. Probable Herpes zoster.

Nelms JM. You're the flight surgeon: probable Herpes zoster. Aerosp Med Hum Perform. 2015; 86(8):754-756.

Eosinophilic Esophagitis with Dysphagia and Food Impaction in a Young Adult

Eosinophilic esophagitis (EoE) is an emerging esophageal disease associated with dysphagia and food impaction. Practice guidelines have only recently been developed. It affects 1/1000 individuals, predominantly young men. As this demographic represents a substantial portion of the military aviation population, aerospace medicine clinicians should be familiar with this diagnosis when evaluating dysphagia or impactions. A 23-yr-old Caucasian man, a U.S. Air Force air traffic controller, presented to Flight Medicine following an episode of food impaction requiring evaluation in the local emergency department. The patient reported a 5-yr history of recurrent episodes of food lodging in his throat, requiring fluid and body repositioning for resolution. Medical history was significant for eczema. Upper endoscopy revealed an abnormal esophagus with macroscopic features of EoE and biopsies were also consistent with EoE. After further work-up, the patient was diagnosed with EoE and treated. Significant symptom improvement was noted after 2 mo of therapy. This case outlines the evaluation of food impaction as well as the diagnostic criteria for EoE, which is a disease that affects patients with demographics common to the military aviation community. As the diagnostic and treatment guidelines for EoE are relatively new, it may easily be overlooked by the primary care physician, causing a delay in subspecialist consultation, thus delaying treatment. EoE is a condition with symptoms that pose high risk to the performance of aircrew duties; therefore, flight surgeons must be familiar with the aeromedical standards that accompany this diagnosis.

Vetting System for Pilots May Lessen Chances of Germanwings Repeat

Vetting System for Pilots May Lessen Chances of Germanwings Repeat

You're the Flight Surgeon: epilepsy.

Woolford JS. You're the flight surgeon: epilepsy. Aerosp Med Hum Perform. 2015; 86(4):500-503.

You're the Flight Surgeon.

Howard CT, Vu P. You're the flight surgeon: hand, foot, and mouth disease. Aerosp Med Hum Perform. 2015; 86(5):497-500.

You're the flight surgeon: myelolipoma.

Moore JL, Jackson CR, Ellis JC, Norrid C. You're the flight surgeon: myelolipoma. Aerosp Med Hum Perform. 2015; 86(4):421-423.

You're the Flight Surgeon.

Ramage MH. You're the flight surgeon: eosinophilic esophagitis. Aerosp Med Hum Perform. 2015; 86(4):418-421.

What makes a flight surgeon? The pre-world war I historical perspective.

What makes a flight surgeon? The pre-world war I historical perspective.