Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download CHAP00R
Transcript
USAF School of Aerospace Medicine FLIGHT SURGEON'S GUIDE This book is a guide and reference for Air Force Flight Surgeons in the performance of their duties. It combines medical knowledge with engineering and aeronautical facts to provide basic information in the very specialized field of Aerospace Medicine. It also applies to the Air Reserve Forces and the Air National Guard. TABLE OF CONTENTS Chapter 1 Page THE AEROSPACE MEDICINE PROGRAM Introduction.................................................................................... The Aerospace Medicine Squadron............................................... Flight/Missile Medicine................................................................ Squadron Medical Element.......................................................... Health Promotion Flight.............................................................. Public Health Flight..................................................................... Medical Readiness Flight............................................................. Bioenvironmental Engineering Flight........................................... Aerospace Physiology/ Physiological Training Flight................... Aeromedical Staging Flight......................................................... Aerospace Medicine Squadron Leadership.................................. Why Aerospace Medicine............................................................... 1-1 1-1 1-1 1-2 1-2 1-2 1-2 1-2 1-2 1-3 1-3 1-3 Chapter 2 HIGH ALTITUDE RESPIRATORY PHYSIOLOGY Introduction.................................................................................... The Atmosphere.............................................................................. Composition................................................................................ Pressure....................................................................................... Temperature................................................................................ Cosmic Radiation......................................................................... Physical Meteorological Divisions of the Atmosphere................... Measurement of Altitude.............................................................. Physiological Divisions of the Atmosphere................................... 00-1 2-1 2-1 2-1 2-2 2-3 2-3 2-10 2-11 2-12 The Gas Laws................................................................................. Boyle's Law................................................................................. Dalton's Law................................................................................ Henry's Law................................................................................. The Law of Gaseous Diffusion..................................................... Avigadro's Law............................................................................ Charles' Law................................................................................ Absolute Temperature.................................................................. Physiology of Respiration................................................................ Introduction................................................................................. Ventilation Phase of Respiration................................................... Composition of Respired Air........................................................ Composition of Pulmonary Air..................................................... Blood Transport of Oxygen.......................................................... Oxygen Dissociation Curve.......................................................... Influence of the CO2 Partial Pressure........................................... Influence of Temperature............................................................. Transport of Carbon Dioxide (CO2)............................................. Summary of Transport Phase........................................................ Gas Exchange in the Tissues......................................................... Control of Respiration..................................................................... Neural Control............................................................................. Chemical Control of Respiration................................................... Hypoxia............................................................................................ Classification of Hypoxia.............................................................. Factors Influencing Hypoxia......................................................... Stages of Hypoxia........................................................................ Time of Useful Consciousness...................................................... Symptoms of Hypoxia.................................................................. Prophylaxis and Treatment of Hypoxic Hypoxia........................... Pressure Breathing....................................................................... PPB and Counterpressure Garments............................................. High Altitude Limits and Protection.............................................. Hyperventilation........................................................................... Treatment of Hyperventilation....................................................... Oxygen Toxicity................................................................................ Aircraft Pressurization and Decompression.................................... Methods of Pressurization............................................................. Limits to Pressurization................................................................. Cabin Depressurization.................................................................. Oxygen Equipment........................................................................... Oxygen Storage Systems............................................................... Oxygen Delivery Systems.............................................................. Oxygen Equipment Problems......................................................... PRICE Checklist............................................................................ 00-2 2-13 2-14 2-14 2-14 2-14 2-14 2-15 2-15 2-15 2-15 2-16 2-18 2-19 2-22 2-23 2-23 2-24 2-25 2-26 2-26 2-29 2-29 2-31 2-32 2-33 2-34 2-34 2-36 2-36 2-37 2-38 2-41 2-35 2-48 2-50 2-51 2-51 2-51 2-52 2-52 2-55 2-55 2-56 2-58 2-59 Chapter 3 EFFECTS OF DECREASED PRESSURE: DECOMPRESSION SICKNESS Introduction...................................................................................... History............................................................................................... Etiology of DCS................................................................................. Bubble Effects on the Body............................................................... Mechanical Effects......................................................................... Blood-bubble Interface Effects....................................................... Clinical Manifestations of Decompression Sickness......................... Type I DCS................................................................................... Type II DCS.................................................................................. Factors Affecting DCS Incidence and Severity................................ Treatment of DCS............................................................................. Initial Response During Flight........................................................ Medical Management..................................................................... Aeromedical Disposition Following DCS.......................................... 3-1 3-1 3-2 3-3 3-3 3-4 3-4 3-4 3-6 3-8 3-13 3-13 3-13 3-15 Chapter 4 EFFECTS OF ACCELERATION Introduction..................................................................................... Basic Principles................................................................................ Speed and Velocity....................................................................... Acceleration................................................................................. Basic Physiological Effects of Acceleration..................................... Cardiovascular System Effects...................................................... Respiratory Effects....................................................................... Central Nervous System Effects.................................................... Renal System Effects..................................................................... Musculoskeletal Effects................................................................. G Tolerance.................................................................................. G-induced Loss of Consciousness................................................. Sensory Effects of Acceleration....................................................... Basic Neurophysiology................................................................. Illusions........................................................................................ Spatial Disorientation.................................................................... Motion Sickness............................................................................ Vibration....................................................................................... 00-3 4-1 4-1 4-1 4-1 4-2 4-4 4-6 4-7 4-7 4-7 4-7 4-9 4-12 4-12 4-15 4-19 4-21 4-23 Chapter 5 THERMAL STRESS Introduction...................................................................................... Heat Transfer and Thermal Balance................................................... Measurement of the Thermal Environment........................................ Effect of Clothing............................................................................. Human Thermoregulation................................................................. Heat Stress Effects............................................................................ General............................................................................................. Exercise in Hot Environments........................................................... Heat Effects on Mental Performance................................................. Interaction with Other Environmental Factors................................... Pathophysiology of Heat Stress......................................................... Prevention of Heat Injury.................................................................. Evaluating Heat Stress Problems....................................................... Cold Stress Effects............................................................................. General.............................................................................................. Moderate Cold and Protective Clothing............................................. Non-freezing Injury........................................................................... Freezing Injury (Frostbite)................................................................. Systemic Hypothermia....................................................................... 5-1 5-2 5-3 5-4 5-5 5-8 5-8 5-9 5-10 5-10 5-11 5-12 5-17 5-17 5-17 5-17 5-18 5-18 5-19 Chapter 6 OTOLARYNGOLOGIC ASPECTS OF AEROSPACE MEDICINE Introduction...................................................................................... Mechanical Effects of Barometric Pressure Changes...................... General......................................................................................... Barotitis........................................................................................ External barotitis........................................................................... Barosinusitis................................................................................. Alternobaric vertigo...................................................................... Other Vertiginous Entities............................................................... General......................................................................................... Inner ear conditions....................................................................... Aeromedical implication of vertigo................................................ Miscellaneous ENT Conditions........................................................ Ear................................................................................................ Nose.............................................................................................. Paranasal sinuses........................................................................... Larynx........................................................................................... Facial nerve paralysis..................................................................... Equipment......................................................................................... 00-4 6-1 6-2 6-2 6-3 6-8 6-8 6-13 6-14 6-14 6-16 6-19 6-19 6-18 6-23 6-26 6-28 6-29 6-29 Chapter 7 NOISE, AUDIOMETRY, AND COMMUNICATION Introduction....................................................................................... Auditory Signals and Noise............................................................... Sound, Noise, and Signal............................................................... Types of Auditory Signal............................................................... Noise as a Human Factor............................................................... AEROSPACE SYSTEM NOISE...................................................... Acoustics - The Physics of Sound.................................................. Sound Pressure Measurement........................................................ Sources and Characteristics of Aerospace System Noise................ THE EFFECTS OF NOISE ON MAN............................................. Communication Effects.................................................................. Noise Induced Injury...................................................................... Other Effects of Noise................................................................... AUDIOLOGY - TESTING HEARING............................................ Pure Tone Threshold..................................................................... Speech Audiometry....................................................................... Tympanometry.............................................................................. Auditory Brainstem Response........................................................ NOISE PROTECTION..................................................................... Workplace Hazardous Noise.......................................................... Parameters of Hazardous Noise Exposure...................................... Noise Protection............................................................................ The USAF Hearing Conservation Program..................................... 7-1 7-1 7-1 7-2 7-3 7-3 7-3 7-5 7-6 7-7 7-7 7-8 7-9 7-9 7-9 7-12 7-13 7-15 7-16 7-16 7-17 7-18 7-19 Chapter 8 OPHTHALMOLOGY AND SPECIAL PROBLEMS OF THE EYE Introduction...................................................................................... General Effects of Altitude................................................................ Visual Effects of Hypoxia.............................................................. Effects of Glare at High Altitudes ................................................. Effect of Space Myopia (Empty Visual Field)................................ Sunlight and its Effect on the Eyes................................................. Brightness of the Field of View...................................................... Spectacles and Ophthalmic Filters................................................... Basic Issues................................................................................... Colored Filters.............................................................................. Neutral Filters............................................................................... Reflecting Filters........................................................................... Polarizing Filters............................................................................ 00-5 8-1 8-1 8-1 8-2 8-3 8-3 8-5 8-6 8-6 8-8 8-8 8-8 8-8 Transmission.................................................................................. Glare.............................................................................................. Color Perception............................................................................ Visual Acuity................................................................................. Sunsensor Lenses........................................................................... Selection of a Sunglass for US Air Force Use................................ Goggles or Visors.......................................................................... OTHER LIGHT HAZARDS............................................................ Nuclear.......................................................................................... Laser............................................................................................. VISUAL PROBLEMS OF HIGH SPEED/ACCELERATION....... Introduction................................................................................... Effect of Slanting Optical Surfaces................................................. Visual Effects Produced by Shock Waves...................................... Vibration....................................................................................... Effects of Acceleration on the Eye.................................................. Lag in Visual Perception................................................................ NIGHT VISION................................................................................ Introduction................................................................................... Mesopic Vision.............................................................................. Brightness Thresholds.................................................................... Central Blind Spot at Night............................................................ Dark Adaptation............................................................................ Photochromatic Interval................................................................. Operational Aspects of Night Vision.............................................. Night Vision Devices (NVD)......................................................... OCULAR DISEASES OF THE EYE............................................... Glaucoma...................................................................................... Contact lenses................................................................................ VISUAL ILLUSIONS....................................................................... Introduction................................................................................... Runway Aerial Perspective............................................................. Visual Autokinesis......................................................................... Linear and Angular Vection............................................................ The Black Hole Approach.............................................................. Sloping Cloud Decks...................................................................... Lean-on-the-Sun Illusion................................................................ False Horizon................................................................................. OPTICAL PRINCIPLES.................................................................. 00-6 8-9 8-9 8-9 8-10 8-11 8-11 8-12 8-13 8-13 8-14 8-17 8-17 8-20 8-20 8-20 8-21 8-19 8-24 8-24 8-25 8-25 8-25 8-28 8-28 8-29 8-32 8-32 8-32 8-34 8-35 8-35 8-35 8-36 8-36 8-36 8-36 8-37 8-37 8-37 Chapter 9 AEROSPACE PSYCHIATRY AND PSYCHOLOGY Introduction...................................................................................... Psychiatric Disorders........................................................................ Aircrew Selection............................................................................. The Pilot Personality......................................................................... Aerospace Clinical Psychology Program.......................................... Circadian Rhythm in Aviation......................................................... Stress and Fatigue............................................................................. Airsickness......................................................................................... Fear of Flying.................................................................................... Aircrew Briefings.............................................................................. Combat Fatigue................................................................................. Survival and Prisoner of War Considerations.................................. Psychiatric Aspects of Mishaps and Disasters.................................. 9-1 9-2 9-3 9-5 9-8 9-8 9-10 9-12 9-14 9-15 9-16 9-19 9-20 Chapter 10 ISSUES IN INTERNAL MEDICINE Introduction....................................................................................... Cardiovascular Problems.................................................................. Asymptomatic Coronary Artery Disease (CAD)............................. Valvular Heart Disease................................................................... Hypertrophic Cardiomyopathy........................................................ Dysrhythmias................................................................................. Hypertension.................................................................................. Metabolic Problems........................................................................... Diabetes Mellitus and Glucose Intolerance...................................... Hyperlipidemia............................................................................... Pulmonary Problems......................................................................... Chronic obstructive pulmonary disease (COPD)............................. Reactive airway disease.................................................................. Sarcoidosis..................................................................................... Gastrointestinal and Genitourinary.................................................. Gastrointestinal Hemorrhage.......................................................... Renal Stones.................................................................................. Aeromedical Management of Neoplasms.......................................... Actions to take at the Time of Diagnosis........................................ Obtaining a Waiver - Returning the Cured..................................... After the Waiver............................................................................ 00-7 10-1 10-1 10-1 10-3 10-6 10-6 10-9 10-10 10-10 10-10 10-11 10-12 10-12 10-12 10-13 10-13 10-13 10-14 10-14 10-15 10-16 Chapter 11 AEROSPACE NEUROLOGY Introduction...................................................................................... Review of Conditions........................................................................ Cerebrovascular disease................................................................. Intracranial tumors........................................................................ Head Injury................................................................................... Extrapyramidal and Movement Disorders...................................... Demyelinating Conditions.............................................................. Intellectual Disturbances................................................................ Dementias..................................................................................... Spinal Cord Syndromes................................................................. Peripheral Nerves.......................................................................... Seizure Disorders.......................................................................... Loss of Consciousness.................................................................. Infections...................................................................................... Migraines...................................................................................... Vertigo and Air Sickness............................................................... 11-1 11-1 11-1 11-3 11-3 11-5 11-6 11-7 11-8 11-9 11-9 11-11 11-12 11-12 11-13 11-16 Chapter 12 AEROSPACE DENTISTRY Introduction...................................................................................... Dental Classification......................................................................... DENTAL WARTIME READINESS............................................... ODONTALGIA................................................................................ Barodontalgia............................................................................... Acute Periapical Abscess.............................................................. Periodontal Disease and Soft Tissue Pathology............................... Periodontal Disease....................................................................... Soft Tissue Pathology................................................................... Problems Involving Tooth Structure............................................... Dental Caries................................................................................ Tooth Fracture.............................................................................. Tooth Avulsion............................................................................. Gingival Abrasion......................................................................... Local Anesthesia............................................................................... Armamentarium............................................................................ Maxillary Area.............................................................................. Mandibular Area........................................................................... TOOTH EXTRACTION.................................................................. Post Extraction Complications....................................................... 00-8 12-1 12-1 12-3 12-3 12-3 12-5 12-7 12-7 12-10 12-13 12-13 12-16 12-19 12-19 12-20 12-21 12-21 12-23 12-25 12-25 FACIAL FRACTURES.................................................................... Diagnosis...................................................................................... Temporary Stabilization................................................................ Emergency Release....................................................................... Evacuation.................................................................................... Dislocation of the Mandible........................................................... DENTAL IDENTIFICATION........................................................ Terminology.................................................................................. The Post-mortem Dental Examination........................................... ATTACHMENT 1 -Dental Fly Away Kit.......................................... 12-26 12-27 12-27 12-30 12-31 12-32 12-34 12-35 12-38 12-46 Chapter 13 DRUGS AND THE FLIER Introduction...................................................................................... Adverse Reactions of Prescription Drugs......................................... Antibiotics..................................................................................... Antimalarials................................................................................. Antihistamines and Decongestants................................................. Cardiovascular and Antihypertensive Drugs................................... Ocular Drugs................................................................................. Antiemetics.................................................................................... Oral Contraceptives....................................................................... Pyridostigmine bromide................................................................. Medication Use In Aviators.............................................................. General.......................................................................................... Allowable Medication Without Waiver......................................... Medications Requiring Waiver...................................................... Self-Medication............................................................................. Drugs of Abuse................................................................................... Caffeine......................................................................................... Tobacco........................................................................................ Alcohol........................................................................................... Conclusion......................................................................................... 13-1 13-1 13-3 13-4 13-4 13-5 13-6 13-6 13-6 13-7 13-7 13-7 13-8 13-9 13-10 13-10 13-10 13-10 13-11 13-11 Chapter 14 HEALTH, FITNESS, AND NUTRITION Introduction...................................................................................... Operational Stress......................................................................... Self-Imposed Stress...................................................................... 00-9 14-1 14-1 14-1 Physical Fitness................................................................................. Anaerobic (Muscular) Conditioning............................................... Aerobic Conditioning.................................................................... Physical Fitness and G Tolerance................................................... Nutrition........................................................................................... Basic Nutrition.............................................................................. Special Nutritional Considerations................................................. Flight Feeding................................................................................ Preflight Feeding........................................................................... Inflight Feeding............................................................................. Postflight Feeding.......................................................................... Between Meal Snacks.................................................................... Feeding of Patients........................................................................ Survival Feeding............................................................................ Deployment................................................................................... Sleep and Sustained Operations...................................................... Sleep Structure................................................................................. Napping Strategies........................................................................... The Short Nap............................................................................... The Long Nap............................................................................... Normal Sleep................................................................................ Sleep Debt and Disorders................................................................ Circadian Disruption....................................................................... Transmeridian Travel.................................................................... Shiftwork....................................................................................... Crew Rest...................................................................................... Health Promotion/ Intervention Programs.................................. Health and Wellness Centers......................................................... Clinical Preventive Medicine.......................................................... Obesity............................................................................................... The Problem.................................................................................. Weight Control and the Flier......................................................... Air Force Weight Program............................................................ Determination of Caloric Needs.................................................... Weight Loss Diets and Flying Safety............................................ Smoking............................................................................................. The Problem.................................................................................. Smoking and the Flier.................................................................... Quitting.......................................................................................... Stress.................................................................................................. 00-10 14-2 14-2 14-2 14-3 14-5 14-5 14-6 14-7 14-8 14-8 14-10 14-10 14-10 14-10 14-11 14-13 14-14 14-14 14-15 14-15 14-15 14-15 14-16 14-16 14-16 14-17 14-20 14-20 14-24 14-24 14-24 14-24 14-25 14-25 14-27 14-27 14-27 14-28 14-28 14-28 Coronary Artery Disease................................................................... Risk Factors................................................................................... High Density Lipoprotein (HDL) Cholesterol................................. Exercise.......................................................................................... Smoking......................................................................................... Obesity........................................................................................... Serum Triglycerides....................................................................... Behavioral Risk Factors................................................................. ATTACHMENT I. High Intensity Muscular Conditioning............ ATTACHMENT II. Major Nutrients And Diet Analysis................ ATTACHMENT III. Microbiology of Flight Meals ........................ ATTACHMENT IV. Possible "Gas Formers"................................. ATTACHMENT V. Caffeine Content of Foods and Drugs............. ATTACHMENT VI. Caffeine Content of Soft Drinks..................... ATTACHMENT VII. Put Prevention Into Practice (PPIP)........... 14-29 14-29 14-30 14-32 14-32 14-33 14-33 14-33 14-42 14-63 14-65 14-66 14-67 14-68 14-69 Chapter 15 AVIATION PATHOLOGY Introduction....................................................................................... Purpose.......................................................................................... Background................................................................................... Aircraft Mishap Investigation......................................................... Pathology Support............................................................................. Aircraft Mishap Investigation Readiness.......................................... Preparation.................................................................................... Photographic Kit............................................................................ Investigation Kit............................................................................. Basic Procedures................................................................................ Response Phase.............................................................................. Crash Scene Phase.......................................................................... Administration Phase...................................................................... External Examination Phase............................................................ Pre-Crash History Phase................................................................. Identification Phase......................................................................... Autopsy Phase................................................................................ Radiographic Phase........................................................................ Conclusion Phase........................................................................... Injury Analysis.................................................................................. Introduction................................................................................... Traumatic Injuries.......................................................................... 00-11 15-1 15-1 15-1 15-1 15-3 15-3 15-3 15-4 15-5 15-6 15-6 15-6 15-8 15-10 15-11 15-11 15-12 15-12 15-13 15-13 15-13 15-13 Environmental Factors...................................................................... Hypoxia.......................................................................................... Decompression Sickness................................................................. Fire................................................................................................ Water (Drowning).......................................................................... Toxins................................................................................................. Carbon Monoxide/Smoking/Combustion Products.......................... Alcohol and Drugs.......................................................................... Pre-existing Disease........................................................................... Laboratory Tests................................................................................ Specimens...................................................................................... Blood Carboxyhemoglobin............................................................. Blood Alcohol/ Volatiles................................................................. Drug Screen.................................................................................... Supplemental Local Laboratory Studies.......................................... Serology......................................................................................... Lactic Acid..................................................................................... Collection/Submission of Specimens................................................. Aircrew Fatalities............................................................................ Aircrew Survivors........................................................................... SUBMISSION OF SPECIMENS...................................................... Aircrew Fatalities........................................................................... AFIP Laboratory TELEPHONE Information.................................. Surviving Aircrew........................................................................... Forms, Documents, and Paperwork................................................ REPORTS REQUIRED.................................................................... Autopsy Report................................................................................. AF Form 711gA................................................................................. 15-17 15-17 15-17 15-18 15-19 15-20 15-20 15-21 15-22 15-23 15-23 15-23 15-23 15-24 15-24 15-25 15-25 15-25 15-25 15-25 15-26 15-26 15-29 15-29 15-29 15-30 15-30 15-30 Chapter 16 FLIGHT SURGEON IN FLIGHT SAFETY Introduction....................................................................................... USAF Program.............................................................................. Local Programs............................................................................. Flight Safety....................................................................................... Flying Safety Participation............................................................... Mishap Investigation......................................................................... Physiological Incidents.................................................................. Aircraft Mishap Investigation......................................................... Pre-response preparation, Response, Post Response Safety Investigation Board............................................................. The Formal Report........................................................................ Accident Investigation Board........................................................... 00-12 16-1 16-1 16-2 16-2 16-3 16-4 16-4 16-4 16-7 16-10 16-11 Chapter 17 EMERGENCY EGRESS FROM AIRCRAFT Introduction...................................................................................... Escape Systems................................................................................. Ejection Seat Operation.................................................................... Current Air Force Ejection Seats...................................................... Ejection Events................................................................................. Pre-ejection...................................................................................... Primary Acceleration......................................................................... Forces of Windblast........................................................................... Parachute Descent and Landing......................................................... Pattern of Ejection Injuries................................................................ Future of Escape Systems................................................................. 17-1 17-1 17-1 17-2 17-7 17-7 17-8 17-8 17-9 17-9 17-11 Chapter 18 UNIQUE MISSIONS Introduction...................................................................................... 18-1 Combat Search and Rescue.............................................................. 18-1 Military Assistance to Safety and Traffic........................................ 18-3 Concerns of Special Operations Forces and Low Intensity Conflict 18-3 Parachuting................................................................................... 18-3 Hot Refueling................................................................................ 18-4 Night Vision Goggles.................................................................... 18-4 Other Issues.................................................................................. 18-5 Manned Space Flight Support Office.............................................. 18-5 History and Structure of DDMS.................................................... 18-5 Emergency Medical Services System............................................. 18-6 DoD Medical Response Requirements............................................. 18-8 Overview...................................................................................... 18-8 Concept of Operation.................................................................... 18-8 Manning........................................................................................ 18-9 Training Requirements................................................................... 18-9 Medical Equipment and Configuration........................................... 18-10 Medical Operations and Coordination............................................ 18-11 Medical Condition Codes.............................................................. 18-14 Mission Profiles................................................................................. 18-15 Launch.......................................................................................... 18-15 Return to Launch Site..................................................................... 18-17 Transoceanic Abort Landing.......................................................... 18-17 Abort Once Around....................................................................... 18-18 Nominal Mission Progression......................................................... 18-20 Nominal End of Mission Landing................................................... 18-20 00-13 Contingency Response Modes.......................................................... Launch Pad Modes........................................................................ Landing Modes.............................................................................. Flight Modes................................................................................. Egress Condition Red.................................................................... Toxicological Hazards....................................................................... Command, Control, and Communications...................................... 18-20 18-20 18-21 18-21 18-21 18-21 18-23 Chapter 19 GLOBAL AEROMEDICAL EVACUATION Concept of Operations..................................................................... General......................................................................................... Contingency Operations................................................................ Organizational Roles and Missions................................................. Expanded AE Capabilities............................................................. The Aeromedical Evacuation Program.......................................... Aeromedical Evacuation Organization........................................... Aeromedical Evacuation program Responsibilities......................... Aeromedical Evacuation System Components............................... Aeromedical Evacuation Administrative Authority....................... Continental US Operations - The CONUS System......................... Overseas to CONUS Operations - (Intertheater Systems)............. Theater Systems............................................................................ Casualty Staging............................................................................ Administration.................................................................................. Patient Classification..................................................................... Patient Categories......................................................................... Aeromedical Evacuation Equipment.............................................. Flight Certified Medical Equipment............................................... Defense Medical Regulating Information System (DMRIS).......... Automated Patient Evacuation System (APES).............................. Do Not Resuscitate (DNR)................................................................ Aircraft.............................................................................................. Airlift Resources............................................................................ Aircraft Availability........................................................................ C-9A, C-141B, C-130B,E,H, C-21A, C-12F ................................ Civil Reserve Fleet (CRAF) .......................................................... 00-14 19-1 19-1 19-1 19-2 19-3 19-3 19-4 19-5 19-6 19-10 19-10 19-11 19-12 19-13 19-14 19-14 19-15 19-15 19-16 19-17 19-18 19-18 19-18 19-18 19-18 19-19 19-23 Clinical Aeromedical Evacuation Issues.......................................... Preparing Patients for AE............................................................... Diagnoses and Clinical Issues......................................................... Alcohol or Drug Abuse.................................................................. Anemia.......................................................................................... Burns............................................................................................. Cardiac Patients............................................................................. Decompression Sickness Patients................................................... 19-24 19-24 19-24 19-24 19-24 19-25 19-25 19-25 Chapter 20 THE MILITARY PUBLIC HEALTH PROGRAM Introduction...................................................................................... General............................................................................................. Public Health Responsibilities.......................................................... Epidemiology................................................................................ Communicable Disease Program.................................................... TB, STDs, HIV, and other reportable diseases Medical Entomology...................................................................... Food Safety Program..................................................................... Public Facility Sanitation................................................................ Occupational Health Program........................................................ Environmental Health Assessment/ Education................................ Immunizations............................................................................... Disaster Response.......................................................................... Medical Intelligence....................................................................... Consultation Services.................................................................... Summary.......................................................................................... 20-1 20-1 20-2 20-2 20-2 20-3 20-3 20-3 20-4 20-4 20-4 20-5 20-5 20-5 20-5 Chapter 21 OCCUPATIONAL MEDICINE Introduction....................................................................................... 21-1 Staff and Responsibilities.................................................................. 21-1 The Bioenvironmental Engineer Program....................................... 21-1 Occupational Health, Environmental Protection, and Health Physics The Public Health Officer............................................................... 21-4 Occupational Physical Exams, HAZCOM, Fetal Protection, Hearing Conservation, Occupational Illness/ Injury Reporting The Physical Examination Section.................................................. 21-5 The Flight Surgeon........................................................................ 21-5 00-15 Regulating Agencies.......................................................................... OSHA........................................................................................... NIOSH.......................................................................................... Independent Agencies.................................................................... United States Air Force Agencies.................................................. Principles of Diagnosis...................................................................... General......................................................................................... History.......................................................................................... Conflicts....................................................................................... Principles of Surveillance ................................................................ Exposure Values........................................................................... Biological Monitoring................................................................... Developing Base Standards........................................................... Preplacement Examinations........................................................... Impairment and Disability.............................................................. Removal From Duty...................................................................... APPENDIX A. Chemical Agent Quick Reference........................... Ionizing Radiation......................................................................... Nonionizing Radiation................................................................... Lasers............................................................................................ Jet fuels......................................................................................... Carbon monoxide........................................................................... Hydrazine...................................................................................... Degreasers..................................................................................... Cumulative Trauma Disorders (CTDs)........................................... APPENDIX B. Sample Occupational Health Forms........................ AF Forms 2755, 2766, and 2770 21-6 21-7 21-8 21-9 21-9 21-10 21-10 21-10 21-11 21-12 21-12 21-14 21-15 21-17 21-19 21-20 21-22 21-22 21-24 21-24 21-25 21-27 21-27 21-28 21-29 21-30 Chapter 22 DEPLOYMENT OPERATIONS Introduction...................................................................................... Historical Perspective.................................................................... Predeployment.................................................................................. Overview of Bare Base Facilities................................................... Personal Affairs............................................................................. Review of Operational Plans.......................................................... Medical Threat Assessment (Intelligence)...................................... Written Office Guidance................................................................ Supplies and kits............................................................................ Exercises....................................................................................... Immediately Predeployment Concerns........................................... 00-16 22-1 22-1 22-2 22-3 22-4 22-5 22-7 22-10 22-11 22-13 22-13 Deployment....................................................................................... General Issues............................................................................... Ensuring Safe Food....................................................................... Ensuring Safe Water..................................................................... Field Sanitation and Hygiene......................................................... Control of Vectorborne Disease & Animal Pests............................ Investigating Potential Epidemics................................................... Redeployment.................................................................................... ATTACHMENT I. Disease Threats by Geographical Area............ ATTACHMENT II. Deployment Checklist...................................... 22-15 22-15 22-15 22-17 22-24 22-26 22-36 22-37 22-43 22-46 Chapter 23 MEDICAL DISASTER PREPAREDNESS AND NUCLEAR, BIOLOGICAL, AND CHEMICAL (NBC) OPERATIONS Introduction...................................................................................... Echelons of Care............................................................................... First Echelon (1E)........................................................................ Second Echelon (2E).................................................................... Third Echelon (3E)....................................................................... Fourth Echelon (4E)..................................................................... Medical Triage.................................................................................. General Considerations.................................................................. Triage Categories.......................................................................... Emergency Patient Record............................................................ Casualty Estimation....................................................................... Wartime Role for Flight Surgeons.................................................... Squadron Medical Element (SME)................................................. Air Transportable Hospital (ATH)................................................. Aeromedical Staging Facility (ASF)............................................... Second Echelon (2E) Facilities...................................................... Third/Fourth Echelon Contingency Hospitals................................. CONUS Residual Clinics............................................................... Casualty Treatment Hospitals (CTH)............................................. MAJCOM, Special Operating Agencies, Air Staff.......................... Air Evacuation.............................................................................. 00-17 23-1 23-2 23-3 23-3 23-4 23-4 23-5 23-5 23-5 23-6 23-6 23-6 23-7 23-7 23-7 23-7 23-7 23-7 23-8 23-8 23-8 Medical Operations Planning.......................................................... 23-9 War and Mobilization Plan (WMP-1)............................................ 23-9 Contingency Support Plan (CSP).................................................. 23-10 Disaster Casualty Control Plan (DCCP)......................................... 23-10 Designed Operational Capability (DOC)........................................ 23-11 The Status of Resources and Training System (SORTS)................. 23-11 Time-Phased Force and Deployment Data (TPFDD)...................... 23-11 Base Mobility Plan......................................................................... 23-12 Mobility Operating Procedure 17 (MOP 17)................................... 23-12 Air Base Operability (ABO) Planning Consideration Guide............ 23-12 Other Plans and Outline for Med Est of Situation.............................. 23-12,14 Training............................................................................................. 23-15 Exercises....................................................................................... 23-15 Continuous Medical Readiness Training (CMRT).......................... 23-15 Combat Medicine Training............................................................ 23-16 Joint Operations................................................................................ 23-17 Medical Intelligence.......................................................................... 23-17 Command, Control, Communication, and Intelligence (C3I)......... 23-20 Air Force Blood Program................................................................. 23-21 Low Intensity Conflict...................................................................... 23-21 Nuclear Operations........................................................................... 23-22 Introduction................................................................................... 23-22 Nuclear Detonations...................................................................... 23-23 Effects of Nuclear Explosions........................................................ 23-23 Types of Bursts............................................................................. 23-23 Biophysical and Biological Effects................................................. 23-24 Cellular Effects of Ionizing Radiation............................................ 23-26 Acute Radiation Syndrome (ARS)................................................. 23-26 Treatment...................................................................................... 23-28 Combined Injuries.......................................................................... 23-29 Psychological Aspects of Nuclear Warfare..................................... 23-29 Nuclear Accidents Response Program............................................ 23-29 Other Regulations.......................................................................... 23-29 Biological Warfare............................................................................ 23-30 Introduction.................................................................................. 23-30 The Law....................................................................................... 23-30 Indications of Biological Attack.................................................... 23-31 Planning Considerations................................................................ 23-31 Casualty Management................................................................... 23-35 Defense......................................................................................... 23-34 Threats.......................................................................................... 23-31 Old Diseases.................................................................................. 23-31 New Diseases................................................................................ 23-32 00-18 Chemical Operations......................................................................... Introduction................................................................................... Factors Influencing Employment of Chemical Agents..................... Routes of Absorption..................................................................... Classes of Chemical Agents........................................................... Mission Oriented Protective Postures............................................ Chemtrec........................................................................................... 23-35 23-35 23-36 23-37 23-37 23-41 23-43 Chapter 24 MISSILE MEDICINE Introduction...................................................................................... Missileers.......................................................................................... Medical Qualifications...................................................................... Crew Duties..................................................................................... Strategic Missile Crew Facilities...................................................... Launch Control Center..................................................................... Strategic Missile Weapon Systems.................................................. Missile Fundamentals........................................................................ Minuteman II (LGM-30F)................................................................ Minuteman III (LGM-30G).............................................................. Peacekeeper (LGM-118A)................................................................ Space Operators............................................................................... Work Environment/ Human Factors.............................................. 24-1 24-1 24-2 24-2 24-3 24-3 24-5 24-5 24-6 24-6 24-7 24-7 24-8 Chapter 25 SPACE MEDICINE Introduction...................................................................................... History of Space Medicine................................................................ Space Medicine in the US Manned Space Program........................ Space Medicine Today................................................................... Space Medical Operations................................................................ Space Hygiene................................................................................... Life Support Systems and EVA..................................................... Radiation Protection...................................................................... Toxicology.................................................................................... Human Factors Issues.................................................................... Space Physiology............................................................................... Countermeasures........................................................................... 00-19 25-1 25-2 25-4 25-7 25-7 25-9 25-10 25-11 25-15 25-17 25-17 25-20 Clinical Space Medicine................................................................... Future Extended Duration Space Missions.................................... The Crew Health Care System (CHeCS)....................................... The Future Crew Medical Officer.................................................. Conclusion......................................................................................... 25-23 25-31 25-33 25-35 25-38 Chapter 26 OPERATIONAL ARMY AVIATION MEDICINE Introduction...................................................................................... Army Aviation’s Mission and Organization.................................... Mission of Army Aviation Operations............................................ Aircraft Supporting the Mission..................................................... Organization of Army Aviation Assets........................................... Aeromedical Support of the Mission................................................ Operational Aeromedical Support.................................................. Aeromedical Support at the Army Aviation Center, Fort Rucker, Alabama....................................................... Clinical Army Aviation Medicine.................................................... Selection of Army Aircrew............................................................ Army Aeromedical Consultation & Waiver Process....................... Aeromedical Problems of Rotary Wing Flight................................. Introduction................................................................................... Advanced Technology-induced Motion Sickness............................ Back Pain and Myalgia.................................................................. Break-off Phenomenon.................................................................. Disorientation................................................................................ Environmental Control.................................................................. Flicker Vertigo.............................................................................. Night Vision Goggles.................................................................... Vibration....................................................................................... Aeromedical Problems of Rotary Wing Crash Survival ................. Focus of Army Aeromedical Research and Development................ Glossary of Rotary Wing Flight Terms............................................. 26-1 26-1 26-1 26-1 26-2 26-4 26-4 26-4 26-6 26-5 26-6 26-7 26-7 26-8 26-8 26-8 26-9 26-9 26-9 26-10 26-11 26-11 26-13 26-14 Chapter 27 NAVY AEROSPACE MEDICINE Naval Flight Surgeon........................................................................ 27-1 Naval Flight Surgeon Training: Wings Of Gold............................. 27-1 00-20 Carrier Airwing Flight Surgeon....................................................... Airwing Composition.................................................................... The Deployment Cycle.................................................................. Predeployment, Haze Gray and Underway, Stand Down Flight Surgeon Responsibilities...................................................... Maritime Patrol................................................................................ Marine Aviation................................................................................ Operational Organization.............................................................. Administrative Organization.......................................................... Aerospace Medicine Residency........................................................ Clinical Requirements.................................................................... Integral Courses............................................................................ Other Responsibilities.................................................................... 27-3 27-3 27-4 27-6 27-7 27-7 27-8 27-9 27-10 27-10 27-12 27-12 Chapter 28 PHYSICS & AERODYNAMICS FOR FLIGHT SURGEONS Introduction..................................................................................... The T-37........................................................................................... Aerodynamics Terms....................................................................... Relative Wind............................................................................... Pitch............................................................................................. Bank............................................................................................. Yaw............................................................................................. Lift............................................................................................... Drag............................................................................................. Weight.......................................................................................... Thrust........................................................................................... Angle of Attack (AOA)................................................................. Stall.............................................................................................. Aircraft Parts and Controls.............................................................. Wings............................................................................................ Ailerons......................................................................................... Flaps............................................................................................. Horizontal Stabilizer...................................................................... Elevator........................................................................................ Vertical Stabilizer.......................................................................... Rudder.......................................................................................... Trim.............................................................................................. How A Wing Produces Lift.............................................................. Effects of Control Movements.......................................................... The Elevator................................................................................. The Ailerons................................................................................. The Rudder................................................................................... 00-21 28-1 28-1 28-2 28-2 28-2 28-3 28-4 28-5 28-5 28-5 28-5 28-5 28-6 28-6 28-7 28-7 28-7 28-7 28-7 28-8 28-8 28-8 28-8 28-11 28-11 28-12 28-13 How an Engine Produces Thrust..................................................... Basic Maneuvers............................................................................... Takeoff......................................................................................... Straight and Level Flight............................................................... Acceleration/Deceleration............................................................. Climb/Descent............................................................................... Turns............................................................................................ Landing........................................................................................ Basic Aerobatic Maneuvers............................................................. Aileron Roll.................................................................................. Loop............................................................................................ Mistakes........................................................................................... Stall.............................................................................................. Spin.............................................................................................. Conclusion........................................................................................ 00-22 28-13 28-14 28-14 28-15 28-15 28-15 28-15 28-17 28-17 28-18 28-19 28-19 28-19 28-19 28-20 TABLE OF TABLES Table No. Title Page TABLE 2-1. CHEMICAL COMPOSITION OF THE ATMOSPHERE (DRY) AT SEA LEVEL............................................................................. 2-2 TABLE 2-2. BAROMETRIC PRESSURE AND TEMPERATURE CHANGES WITH GEOMETRIC ALTITUDE.......................................... 2-5 TABLE 2-3. TABLE OF PULMONARY GASES AT EQUIVALENT ALTITUDES WHEN BREATHING AIR OR PURE OXYGEN................ 2-21 TABLE 2-4. TABLE TRACHEAL PARTIAL PRESSURE OF OXYGEN, PRESSURE BREATHING 100 PERCENT OXYGEN...............................2-22 TABLE 2-5. PHASES OF RESPIRATION..................................................................... 2-29 TABLE 2-6. SUMMARY OF CHEMICAL CONTROL OF RESPIRATION.................. 2-32 TABLE 2-7. STAGES OF HYPOXIA............................................................................. 2-35 TABLE 2-8. TIMES OF USEFUL CONSCIOUSNESS.................................................. 2-36 TABLE 4-1. NOMENCLATURE SYSTEM DESCRIBING THE REACTION FORCES IN ACCELERATION................................................................. 4-4 TABLE 4-2. THREE YEAR HISTORY OF ACCELERATION-RELATED DYSRHYTHMIAS AT USAFSAM........................................................... 4-6 TABLE 4-3. ROR G TOLERANCES OF 1000 SUBJECTS (1 G/SEC ONSET RATE).......................................................................... 4-8 TABLE 5-1. MAJOR FACTORS AFFECTING HUMAN THERMOREGULATION IN A GASEOUS ENVIRONMENT........................................................... 5-1 TABLE 5-2. THERMAL PROTECTIVE VALUE FOR SELECTED CLOTHING......... 5-5 TABLE 6-1. DISTRIBUTION OF ALTITUDE CHAMBER REACTIONS IN AIRCREW TRAINEES DURING CALENDAR YEARS 1979-1982........ 6-3 TABLE 6-2. MINIMAL EQUIPMENT FOR ENT EXAMINATION AND TREATMENT UNITS............................................................................... 6-30 TABLE 11-1. CAUSES OF VERTIGO............................................................................ 11-17 TABLE 12-1. TOOTH NAMES AND NUMBERS.......................................................... 12-35 TABLE 14-1. TABLE 14-2. TABLE 14-3. TABLE 14-4. TABLE 14-5. TABLE 14-6. MRE COMPONENT CHANGES.............................................................. 14-12 SLEEP HYGIENE TECHNIQUES............................................................ 14-18 SUGGESTED READINGS ON CIRCADIAN DISRUPTION................... 14-19 PROMOTING HEALTH 2000, 45 PRIORITIZED OBJECTIVES............ 14-20 RISK FACTORS FOR CARDIOVASCULAR DISEASE...........................14-29 EFFECT OF RISK FACTORS ON TOTAL CHOLESTEROL, HDL CHOLESTEROL AND THE TC/HDL RATIO..................................14-31 00-23 TABLE 17-1. EVENT-TIME SEQUENCE...................................................................... 17-4 TABLE 17-2. EJECTION SEQUENCE AND INJURY PATTERNS............................... 17-10 TABLE 18-1. SPACE SHUTTLE EMERGENCY LANDING SITES..............................18-7 TABLE 18-2. PHYSICIAN TRAINING REQUIREMENTS............................................ 18-9 TABLE 18-3A. DDMS MEDEVAC EQUIPMENT AND SUPPLIES............................... 18-12 TABLE 18-3B. DDMS MEDEVAC EQUIPMENT AND SUPPLIES............................... 18-13 TABLE 18-4. RETURN TO LAUNCH SITE SCENARIOS.............................................18-17 TABLE 18-5. TRANSOCEANIC ABORT LANDING SCENARIOS.............................. 18-18 TABLE 18-6. ABORT ONCE AROUND SCENARIOS.................................................. 18-18 TABLE 18-7. ABORT TO ORBIT SCENARIOS............................................................ 18-19 TABLE 18-8. ORBITER TOXICOLOGICAL HAZARDS...............................................18-22 TABLE 19-1. CONVERSION TABLE FOR INFLIGHT O2 ADMINISTRATION......... 19-31 TABLE 21-1. LASER WAVELENGTH AND EYE EFFECTS....................................... 21-25 TABLE 21-2. CARBOXYHEMOGLOBIN LEVELS AND THE EFFECTS....................21-27 TABLE 25-1. TABLE 25-2. TABLE 25-3. TABLE 25-4. TABLE 25-5. TABLE 25-6. TABLE 25-7. TABLE 25-8. TABLE 25-9. SPACE MEDICINE OPERATIONAL CONCERNS................................. SPACE HYGIENE CONSIDERATIONS.................................................. SOURCES OF RADIATION IN SPACE................................................... MICROGRAVITY INDUCED PATHOPHYSIOLOGY (PIP)................... RECORDED SPACE MORBIDITY.......................................................... SUMMARY OF MIP RELATED CLINICAL MANIFESTATIONS.......... MEDICATIONS AND SUPPLIES IN THE SOMS................................... POTENTIAL CLINICAL MANIFESTATIONS OF MIP........................... INJURY OR ILLNESS AS A CONSEQUENCE OF WORKING IN SPACE ................................................................................................ 25-4 25-10 25-13 25-17 25-24 25-28 25-31 25-32 25-32 TABLE 27-1. LOCATION OF NAVAL AIRCRAFT SQUADRONS............................... 27-13 TABLE 27-2. AIRCRAFT CARRIERS/ ASSIGNED CVW............................................. 27-14 00-24 TABLE OF FIGURES Figure No. Title Page Figure 2-1. Figure 2-2. Figure 2-3. Figure 2-4. Standardization of Terms Used in Respiratory Physiology Oxygen Dissociation Curves for Human Blood Oxygen Dissociation Curves Time of Consciousness with Varying Types of Exposure at High Altitude 2-16 2-24 2-28 2-43 Figure 4-1. Figure 4-2. Figure 4-3. Figure 4-4. Figure 4-5. Figure 4-6. Figure 4-7. Figure 4-8. Description of the Anatomical Axes G-Time Tolerance Curve The Vestibular End-organs Mechanism of Action of the Horizontal Semicircular Duct Mechanism of Action of the Otolith Organ The Mechanism of the Somatogyral Illusion Mechanism of the Coriolis Illusion Mechanism of the G-excess Illusion 4-3 4-9 4-13 4-13 4-14 4-16 4-17 4-19 Figure 5-1. Environmental heat gain vs. dry bulb temperature in the desert Figure 5-2. Psychrometric chart at sea level Figure 5-3. Range of core temperatures in humans under various thermal conditions Figure 5-4. Core-shell model of the human body for cold and hot environments Figure 5-5. Graph of voluntary tolerance time vs. dry bulb temperature Figure 5-6. Equilibrium rectal temperature for one subject, at three work rates, in a wide range of environmental conditions Figure 5-7. Acceleration tolerance time of seven subjects at +7 Gz for control and dehydrated conditions Figure 5-8. Acclimatization effects on final rectal temperature, heart rate, and sweat rate, for a group of men exposed daily to 2 hr of hard work in a hot environment Figure 5-9. Daily water needs vs. dry bulb temperature for men in desert conditions Figure 5-10. Example of rectal temperature overshoot in a heavily clothed subject, working hard and then resting,in a hot environment Figure 5-11. Fighter Index of Thermal Stress Figure 5-12. Chart of Equivalent Chill Temperatures Figure 5-13. Predicted times to reach 34oC for persons immersed in cold, calm water while wearing various clothing ensembles 00-25 5-2 5-4 5-6 5-7 5-9 5-10 5-11 5-13 5-14 5-15 5-16 5-19 5-21 Figure 6-1. Barometric Adjustment Within the Sinus on Change of Altitude 6-9 Figure 6-2. Occlusal Factors in Maxillary Antrum in Flight Figure 6-3. Frontal Sinus During Flight 6-11 Figure 7-1. Figure 7-2. Figure 7-3. Figure 7-4. Figure 7-5. Figure 7-6. Figure 7-7. Figure 7-8. Frequency Response for A B C Weighting Characteristics Normal Audiogram Conductive Hearing Loss Right Ear Bilateral High Frequency Hearing Loss Normal Tympanogram Negative Pressure Behind TM Fluid Behind Tympanic Membrane ABR Normal Right - Abnormal Left Figure 8-1. Visible portion of the radiant energy spectrum Figure 8-2. Light transmission of crown glass Figure 8-3. Light transmission of CR-39 Figure 8-4. Light transmission of polycarbonate Figure 8-5. Light transmission of N-15 glass (sunglass lens) Figure 8-6. Nuclear flash protection device Figure 8-7. The radiant energy (electromagnetic) spectrum Figure 8-8. Adverse effects of lasers Figure 8-9. Principal characteristics of common lasers Figure 8-10. Projectile moving at a speed of Mach 0.92 6-10 7-5 7-10 7-10 7-11 7-13 7-14 7-14 7-15 8-4 8-6 8-7 8-7 8-12 8-14 8-15 8-15 8-16 8-18 Figure 8-11. Projectile moving at a speed of Mach 1.31 8-18 Figure 8-12. Projectile moving at a speed of Mach 2.63 8-18 Figure 8-13. Behavior characteristics of air at subsonic and supersonic speeds 8-19 Figure 8-14. Visual effects produced by shock waves 8-20 Figure 8-15 (A-E). Latent perception time at 1,800 mph 8-22 Figure 8-16. Luminance in millilamberts under various natural conditions of illumination 8-25 Figure 8-17. Area of central blind spot under scotopic conditions 8-26 Figure 8-18. Eccentric fixation 8-27 Figure 8-19. Dark adaptation 8-27 Figure 8-20. Rod and cone spectral sensitivity curve 8-29 Figure 8-21. Divergence Figure 8-22. Convergence Figure 8-23. Prism refraction Figure 8-24. Convex and concave lenses Figure 8-25. The optical cross Figure 8-26. The cylinder lens 8-37 8-38 8-38 8-39 8-39 8-40 00-26 Figure 12-1. BARODONTALGIA: Pain emanating from teeth, Pulpalgia Figure 12-2. Parulis subsequent to periapical abscess Figure 12-3. Periodontal Abscess Figure 12-4. Pericoronitis of mandibular third molar Figure 12-5. Dental Caries Figure 12-6. Progression of Dental Caries Figure 12-7. Removal of Carious Material Figure 12-8. Drying the Cavity Figure 12-9. Placement of the Temporary Filling Figure 12-10. Fractured Tooth, Enamel Only 12-5 12-6 12-9 12-13 12-14 12-15 12-15 12-16 12-17 Figure 12-11. Tooth Fracture; Enamel and Dentin Involved Figure 12-12. Tooth Fracture; Enamel, Dentin, and Pulpal Involvement Figure 12-13. Gingival Abrasion Figure 12-14. Facial Injection Figure 12-15. Palatal Injection Figure 12-16. Locating the Mandibular Foramen Figure 12-17. Inferior Alveolar Lingual Injection Figure 12-18. Wiring Technique, Step A Figure 12-19. Wiring Technique, Step B Figure 12-20. Wiring Technique, Step C 12-18 12-19 12-20 12-21 12-22 12-23 12-24 12-28 12-29 12-29 Figure 12-21. Wiring Technique, Step D Figure 12-22. Intermaxillary Fixation Using Elastics Figure 12-23. Intermaxillary Fixation Using Wires Figure 12-24. Quick Release Mechanism - Rip Cord Figure 12-25. Repositioning of Dislocated Mandible, Step 1 Figure 12-26. Repositioning of Dislocated Mandible, Step 2 Figure 12-27. Repositioning of Dislocated Mandible, Step 3 Figure 12-28. Surfaces of Clinical Crown of Anterior Tooth #8 Figure 12-29. Surfaces of Clinical Crown of Posterior Tooth # 30 Figure 12-30. Anterior Teeth #8 and #9 in Mesial Contact at Midline of the Mouth 12-30 12-31 12-31 12-32 12-10 12-33 12-33 12-34 12-36 12-36 12-37 Figure 12-31. AF Form 697a, Dental Identification Chart 12-39 Figure 12-32. Two Amalgam Restorations in Upper Right Second Molar Indicating Surface Involvement Figure 12-33. A Three-quarter Cast Gold Crown on the Upper Right Cuspid 12-41 Figure 12-34. An Upper Partial Denture Replacing Teeth #3, 4, 10, and 15 12-42 and Method for Graphic Indication Figure 12-35. A Fixed (Cemented) Bridge Replacing Lower First Molar 12-43 by Means of Inlays on the Second Bicuspid and Second Molar 00-27 12-40 Figure 14-1. Determination of Ideal Body Weight (IBW) Figure 14-2. Determination of Caloric Needs Figure 14-3. Leg Press Figure 14-4. Bench Press Figure 14-5. Lat Pull Figure 14-6. Military Press Figure 14-7. Arm Curl Figure 14-8. Sit-up Figure 14-9. Leg Raise Figure 14-10. (A-C) Neck Series 14-26 14-26 14-48 14-48 14-49 14-49 14-50 14-50 14-51 14-51 Figure 14-11. Leg Extension Figure 14-12. Leg Curl Figure 14-13. Shoulder Shrug Figure 14-14. Seated Row Figure 14-15. Upright Row Figure 14-16. Triceps Extension Figure 14-17. Squat Figure 14-18. Bench Press Figure 14-19. Pull-up Figure 14-20. Arm and Chest Pullover (Modified) 14-53 14-53 14-54 14-54 14-55 14-55 14-56 14-56 14-57 14-57 Figure 14-21. Military Press Figure 14-22. Arm Curl Figure 14-23. Upright Row Figure 14-24. Bar Dip Figure 14-25. Knee Flexion and Extension Figure 14-26. Chest Press and Row Figure 14-27. Shoulder Press and Lat Pull Figure 14-28. Abdominal and Low Back Figure 14-29. Neck Lateral Flexion Figure 14-30. Neck Flexion and Extension 14-58 14-58 14-59 14-59 14-60 14-60 14-61 14-61 14-62 14-62 Figure 14-31. Preventive Care Protocol Figure 14-32. Preventive Care Flowsheet 14-70 14-71 Figure 15-1. Figure 15-2. Figure 15-3. Figure 15-4. Figure 15-5. Figure 15-6. Figure 15-7. Figure 15-8. 15-7 15-10 15-11 15-12 15-14 15-17 15-21 15-24 AFIP Photographic Guidelines at the Accident Scene Responsibilities of OAFME and Flight Surgeons AFIP Autopsy Photograph Guidelines AFIP Radiographic Examination (Autopsy) Guidelines AFIP Injury Analysis Consideration Unsuccessful Ejection Injury and Causes Carboxyhemoglobin Saturation (Blood) AFIP Drug Screen 00-28 Figure 15-9. Specimen Requirements Figure 15-10. Federal Stock Items Suggested For Shipping Figure 15-11. Dry ice requirements for shipment 15-26 15-27 15-28 Figure 17-1. Figure 17-2. Figure 17-3. Figure 17-4. Figure 17-5. Figure 17-6. Figure 17-7. Modern high technology ejection seat(ACES II) Mode envelopes Mode 1 operation Mode 2 operation Mode 3 operation ACES II functional breakdown Stability of ACES II seat demonstration 17-2 17-5 17-5 17-6 17-6 17-7 17-12 Figure 18-1. Figure 18-2. Figure 18-3. Figure 18-4. Figure 18-5. HH-60 Pave Hawk with DDMS internal configuration Medical Forces Staging Map, Kennedy Space Center Ascent Abort Profiles Orbiter Toxicological Hazard Areas AIRDOC Communications 18-10 18-16 18-19 18-22 18-24 Figure 19-1. Figure 19-2. Figure 19-3. Figure 19-4. Figure 19-5. C-9A C-141B C-130 C-21A C-12F 19-19 19-20 19-21 19-22 19-23 Figure 22-1. Figure 22-2. Figure 22-3. Figure 22-4. Figure 22-5. Figure 22-6. Figure 22-7. Predeployment Personal Affairs Checklist Holding Temperatures Holding Times Water Use Planning Factors Water Sources and Treatment Chlorine Required for Disinfection Field Sanitary Requirements 22-5 22-16 22-16 22-18 22-20 22-23 22-25 Figure 23-1. Outline for Medical Situation Report Figure 23-2. A Generalized Outline of a Predeployment Medical Intelligence Briefing Figure 23-3. Command and Control During Contingency Operations Figure 23-4. Chronological Development of an Air Burst Figure 23-5. Variation of Blast Effects Associated with Positive & Negative Phase Pressure with Time Figure 23-6. Relative Radiosensitivites of Various Organs Based on Parenchymal Hypoplasia 23-13 Figure 24-1. Launch Control Facility Figure 24-2. Minuteman and Peacekeeper Launch Facility Figure 24-3. Minuteman II, Minuteman III and Peacekeeper 24-4 24-5 24-7 00-29 23-17 23-18 23-22 23-23 23-25 Figure 25-1. Figure 25-2. Figure 25-3. Figure 25-4. Figure 25-5. Figure 25-6. Space Medicine Core Components STS-61 Astronauts during record breaking EVA Location of Hazardous Materials on the Shuttle Time Course of Microgravity Induced Pathophysiology International Space Station Alpha Operational Hazards Astronaut F. Story Musrave, MD, Preparing for EVA 25-8 25-12 25-16 25-20 25-34 25-37 Figure 28-1. The T-37 Figure 28-2. Pitch Figure 28-3. Bank Angle Figure 28-4. Yaw Figure 28-5. Balance of Forces Figure 28-6. Angle of Attack Figure 28-7. Components of a T-37 Figure 28-8. Flaps Figure 28-9. Various Airfoils Figure 28-10. Lift and Drag 28-2 28-3 28-3 28-4 28-4 28-5 28-6 28-7 28-8 28-9 Figure 28-11. Wing Approaching the Stall Figure 28-12. Effects of Back Stick Movement Figure 28-13. Aileron Effects Figure 28-14. Turbojet Engine Figure 28-15. Centrifugal Flow Jet Engine (T-37) Figure 28-16. Turn Lift Requirements Figure 28-17. Aileron Roll Figure 28-18. Loop 28-10 28-11 28-12 28-13 28-14 28-16 28-18 28-18 00-30 PREFACE The last few years of world history have brought great change to world politics. The Cold War has passed, leaving the United States as the only “super power”. As a result, the USAF and her sister services are down-sizing to meet a decreased threat. Yet despite downsizing, the operations tempo is faster than ever due to our services’ involvement in numerous worldwide contingencies. Our emerging defense strategy emphasizes regional conflicts, low intensity conflict, and military operations other than war. These new missions have called us to previously unfamiliar areas of the globe, including Saudi Arabia, Iraq, Oman, the United Arab Emirates, Somalia, Kenya, Rwanda, Haiti, Bosnia, and Croatia. No longer can we count on deploying to familiar bed down bases in Western Europe. Our country’s ability to project global power increasingly relies on our ability to mobilize and maintain forces at bare bases in third world nations. These remote environs introduce new and unfamiliar health threats to those of us accustomed to practicing medicine in western world confines. Fortunately, with adequate public health interventions, self-limited URIs, skin disease, and GI upset are still the most common afflictions among our healthy forces. New frontiers continue to open. The DOD’s support for the Space Shuttle involves us in the ever expanding challenges of extended duration travel in space. Closer to home, advanced fighters are introducing new challenges and solutions for g tolerance (combat edge and ATAGs) , oxygen supply (95% O2 by molecular sieve), and maintaining spatial orientation/ situational awareness in the night combat arena (Circadian rhythm adjustment, NVGs, FLIR, LANTIRN). Finally, new theories in health care management are emerging which could affect our daily clinical practice. TriCare, a system which regionalizes all DoD care, will attempt to increase DoD health care efficiency. We can anticipate relying more on health care providers in the sister services and in the civilian community. As preventive medicine specialists, our contribution to TriCare in the area of Health Promotions and Disease Prevention is potentially significant in terms of health and fiscal outcomes. Some things remain unchanged. The human factors contribution to aviation mishaps remains much the same as it was twenty years ago. Health promotions, despite its acknowledged benefits, remains a hard sell in our sedentary society. And, as flight surgeons we still have an exciting career, working with aviators and many other talented professionals in the USAF. It is our privilege to maintain and promote the health of our most critical asset, the men and women serving in our military forces. The 1995 edition of the Flight Surgeon’s Guide contains excellent information. If you are new to USAF Aerospace Medicine, Chapter 1 provides a great overview. Chapters 2-5 review aerospace physiology and relate it to USAF operational activities. Chapters 6-14 discuss classic clinical aviation subjects. Non-traditional medical subjects include chapters 12 (dentistry) and 14 (health and fitness). Many of the remaining of the chapters are related to specific operational issues including, flight safety, aeromedical evacuation, and missile medicine. The professional activities of other Team Aerospace members are discussed extensively in the public health and occupational medicine chapters. NASA shuttle activities and space medicine are well reviewed in chapters 18 and 25. Finally, critical reading for flight surgeons assigned to deployable units 00-31 are chapters 22 and 23, which extensively discuss medical deployment and disaster preparedness planning. Thanks to all who contributed to this guide. I have tried, when possible, to recognize those who either wrote or revised a chapter. I particularly thank the members of the 1996 RAM class who either wrote or solicited authors for the guide’s 28 chapters. Also thanks to Col. (Dr.) Mike Mork and Col. (Dr.) Tommy Church whose encouragement and guidance was timely and critical. Finally, a special thanks to our families who have supported us throughout this and many other aerospace medicine endeavors. In particular, I thank Lisa, my wife, who encouraged me and generously contributed many a late night assisting me with formatting, rewriting, and pasting this guide. Major David M. O’Brien Editor, 1995 edition Previous Editions: 1969 1989 1992 Your comments and suggestions are encouraged and appreciated. Please address comments and corrections to: Colonel Michael Mork Aerospace Medicine Residency Program Director USAFSAM/AF 2513 Kennedy Circle Brooks AFB, TX 78235 00-32 Preface to the 1989 Edition Aviation in itself is not inherently dangerous. But to an even greater degree than the sea, it is terribly unforgiving of any carelessness, incapacity, or neglect. The above is an old quotation, by an unknown author, often seen on a poster of an old biplane in a tree. The warning is perhaps even more true today in the world of supersonic flight than it was in the days of biplanes. This quotation summarizes the objectives of flight surgeons - to minimize the occurrence of carelessness, incapacity, or neglect. Much has happened in the Air Force and in aviation in the twenty years since this Flight Surgeon's Guide was last updated. The Viet Nam conflict is over. New international threats with new tactics have developed; e.g., the all out European war (World War III), terrorism, unconventional warfare, and small isolated wars between third world countries. There was a time in the early 1970's when aviation medical experts said that there was nothing new to learn about medicine and aviation. Then came the new generation fighter aircraft (F-14, F-15, F-16) with their undreamed of power and structural strength. With them came a whole new set of physiological problems to solve. The development of micro electronics and the advances in computers and radar have resulted in a markedly increased complexity in cockpits. The problems of pilot overload and information display, transfer, and processing are becoming even more important. The need for world-wide rapid response to conflict with minimal notice and preparation has intensified the need for readiness and deployment. This rapid response has made the human factors implications of rapid travel over long distances a primary operational concern. Along with necessity to revise the Flight Surgeon's Guide, there was a need to have an Air Force specific text on aerospace medicine for use in the training of new aerospace medicine personnel. With the increasing demands on the Air National Guard and Reserve forces to assume more prominent roles, there was need to provide a basic reference source to help the flight surgeons. The objectives set for the revision were: * To serve as a primary text for the USAF Aerospace Medicine Primary Course. * To serve as a reference manual for flight surgeons when they return to the field; therefore, the heavy use of references, so they can "look it up." * To be readiness or mobility oriented where appropriate. * To tell the flight surgeon the what, the why, and the how of aerospace medical operations in the Air Force. * To cover those clinical medicine issues unique to aerospace medicine. 00-33 Although these objectives may not have been met in all chapters, I hope that the totality will prove useful for the flight surgeon in the field doing the primary business of the medical service-supporting the flier. If nothing else, I hope this will be the beginning of an evolving guide and that another twenty years do not pass. The chapters could be revised, improved, expanded, or deleted as individual units as the need dictates rather than waiting for a revision of the total guide. Each chapter contains a listing entitled "References" which is a combination of references and a bibliography of useful sources for more detailed study. Because of the time period required to edit and publish a work as extensive as this, the reader should insure the currency of all references when the subject requires the latest position. The material in this guide is for instructional purposes and meant to illustrate the principles and rationale of the various issues. The material in this guide is not to be considered directive in nature. Specific regulations and policies should be consulted for the current directives. This revision involved the efforts of many people over a two year period of time. Listed below are the key people responsible for the reviewing, editing, revising, or authoring of the respective chapters (USAFSAM refers to the United States Air Force School of Aerospace Medicine, Brooks AFB, Texas). Special acknowledgment must be made of three valuable sources of help I received during this project: Judy Bryant (publications editor, HSD/DAPE), USAFSAM medical editing staff, and the USAFSAM medical illustrators. Col. John A. Bishop Editor, 1989 Edition Chapter 1: Richard A. Allnutt, Major, USAF, MC, USAFSAM/RAM88. Chapter 2: Staff, Aerospace Physiology Branch (USAFSAM/EDB). Chapter 3: Staff, Aerospace Physiology Branch (USAFSAM/EDB). Chapter 4: David A. Salisbury, Major, Canadian Forces, USAFSAM/RAM88. Chapter 5: Milton A. Meinhardt, Major, USAF, MC, USAFSAM/RAM88. Chapter 6: Verba A. Moore, Capt, USAF, MC, USAFSAM/RAM88. Chapter 7: Richard A. Allnutt, Major, USAF, MC, USAFSAM/RAM88. Chapter 8: Edmundo Reveron-Questell, LtCol, USAF, MC, USAFSAM/RAM88. Chapter 9: Geoffrey C. Ryder, LtCol, USA, MC, USAFSAM/RAM88. 00-34 Chapter 10: Patricia H. Barrier, LtCol, USAF, MC, USAFSAM/RAM88. Chapter 11: Joseph M. Palma, Major, USAF, MC, USAFSAM/RAM88. Chapter 12: Victor P. Salamanca, Captain, USAF, MC, USAFSAM/RAM88. Chapter 13: Gerald L. Strohmeyer, Colonel, USAF, MC, Aerospace Medicine Branch (USAFSAM/EDK). Chapter 14: Thomas T. Fabian, LtCol, USAF, MC, USAFSAM/RAM88. Chapter 15: Thomas T. Fabian, LtCol, USAF, MC, USAFSAM/RAM88. Chapter 16: Verba A. Moore, Capt, USAF, MC, USAFSAM/RAM88. Chapter 17: Milton A. Meinhardt, Major, USAF, MC, USAFSAM/RAM88. Chapter 18: E. George Wolf, Major, USAF, MC, Aerospace Medicine Branch (USAFSAM/EDK). Chapter 19: John G. Jernigan, Colonel, USAF, MC, 375th Aeromedical Airlift Wing Surgeon (375th/SG). Chapter 20: Staff, Environmental Health Branch (USAFSAM/EDZ). Chapter 21: Alton W. Powell, III, Major, USAF, MC, USAFSAM/RAM88. Chapter 22: Gerald L. Muehlberger, Colonel, USAF, MC, USAFSAM/RAM88. Chapter 23: Victor P. Salamanca, Captain, USAF, MC, USAFSAM/RAM88. Chapter 24: Allen J. Parmet, LtCol, USAF, MC, Aerospace Medicine Branch (USAFSAM/EDK). Chapter 25: Garrett R. Tucker, III, LtCol, USAF, MC, USAFSAM/RAM88; and Willis M. Simmons, Jr., LtCol, USAF, MC, USAFSAM/RAM89. Chapter 26: Kevin T. Mason, Major, USA, MC, USAFSAM/RAM88. Chapter 27: J. Rose, Cdr, MC, USN(FS); B. Bohnker, Cdr, MC, USN(FS); W. Ferrara, LCdr, MC, USN(FS); US Navy/RAM89,90; NAMI, NAS Pensacola, Florida. Chapter 28: William R. Gray, III, Capt, USAF, Instructor, 12th Student Squadron, Randolph AFB, Texas. 00-35 00-36
