INTRODUCTION: U.S. Army aviators are required to maintain a level of physiological fitness as part of their qualifying process, which suggests that they are generally physically healthy. However, it has not been statistically proven that they are more “physiologically fit” than the general population.

METHODS: This retrospective study compares physiological measurements of U.S. Army aviators from the Aeromedical Electronic Resource Office database to the U.S. general population using the Center for Disease Control’s National Health and Nutrition Examination Survey data. To enable an accurate comparison of physiological metrics between U.S. Army aviators and the U.S. general population, aviators were categorized into the same age groups and biological genders used for segmentation of the national population data.

RESULTS: On average, pulse rate was 4.85 bpm lower in male aviators and 6.84 bpm lower in female aviators. Fasting glucose levels were, on average, 10.6 mg · dL⁻¹ lower in aviators compared to the general population. Key metrics like pulse rate and fasting glucose were lower in aviators, indicating cardiovascular and metabolic advantages. However, parameters like cholesterol showed less consistent differences.

DISCUSSION: While aviation physical demands and administrative policies selecting for elite physiological metrics produce improvements on some dimensions, a nuanced view accounting for the multitude of factors influencing an aviator’s physiological fitness is still warranted. Implementing targeted health monitoring and maintenance programs based on assessments conducted more frequently than the current annual flight physical may optimize aviator safety and performance over the course of a career.

D’Alessandro M, Mackie R, Wolf S, McGhee JS, Curry I. Physiological fitness of U.S. Army aviators compared to the U.S. general population. Aerosp Med Hum Perform. 2024; 95(4):175–186.

INTRODUCTION: The classical P300 brain potential method was used to assess the cognitive capacity during training of manual docking in space. The aim of the study was to enhance the safety of this operation during a mission.

METHODS: To examine this, N = 8 cosmonauts had to perform the manually controlled docking task simultaneously with an acoustic monitoring task. The P300 component was evoked by the acoustic stimuli of the secondary task. The docking task had to be executed at three difficulty levels: low (station not turning); medium (station turning around one axis); and difficult (station turning around three axes). In the secondary task, subjects had to discriminate between a low and a high tone, which occurred with a probability of 90% and 10%, respectively. Subjects had to count the high tones. After the 10th high tone, they had to inspect the power supply by giving an oral command.

RESULTS: A methodology for event-related potentials was successfully demonstrated under space conditions. The P300 amplitude was largest and the latency shortest during the medium difficult task.

DISCUSSION: The results suggest that P300 can be recorded during the complex manual docking task in space and could be used to assess individual available cognitive capacity of cosmonauts during a space mission.

Bubeev JA, Johannes B, Kotrovska TI, Schastlivtseva D, Bronnikov S, Hoermann H-J, Gaillard AWK. Free cognitive capacity assessed by the P300 method during manual docking training in space. Aerosp Med Hum Perform. 2024; 95(4):187–193.

INTRODUCTION: Exertional heatstroke (EHS) is a life-threatening condition that requires quick recognition and cooling for survival. Experts recommend using cooling modalities that reduce rectal temperature (T_REC) faster than 0.16°C/min though rates above 0.08°C/min are considered “acceptable.” Hyperthermic individuals treated in body bags filled with ice water (∼3°C) have excellent cooling rates (0.28 ± 0.09°C/min). However, clinicians may not have access to large amounts of ice or ice water when treating EHS victims. The purpose of this study was to determine if using a body bag filled with water near the upper limits of expert recommendations for EHS treatment would produce acceptable (>0.08°C/min) or “ideal (>0.16°C/min)” T_REC cooling rates or different nadir values.

METHODS: A total of 12 individuals (9 men, 3 women; age: 21 ± 2 yr; mass: 74.6 ± 10.2 kg; height: 179.5 ± 9.6 cm) exercised in the heat until T_REC was 39.5°C. They lay supine while 211.4 ± 19.5 L of 10°C (Ten) or 15°C (Fifteen) water was poured into a body bag. Subjects cooled until T_REC was 38°C. They exited the body bag and rested in the heat for 10 min.

RESULTS: Subjects exercised in similar conditions and for similar durations (Ten = 46.3 ± 8.6 min, Fifteen = 46.2 ± 7.8 min). T_REC cooling rates were faster in Ten than Fifteen (Ten = 0.18 ± 0.07°C/min, Fifteen = 0.14 ± 0.09°C/min). T_REC nadir was slightly higher in Fifteen (37.3 ± 0.2°C) than Ten (37.1 ± 0.3°C).

DISCUSSION: Body bag cooling rates met expert definitions of acceptable (Fifteen) and ideal (Ten) for EHS treatment. This information is valuable for clinicians who do not have access to or the resources for ice water cooling to treat EHS.

Miller KC, Amaria NY. Body bag cooling with two different water temperatures for the treatment of hyperthermia. Aerosp Med Hum Perform. 2024; 95(4):194–199.

INTRODUCTION: Coronary artery disease (CAD) is a cause of death in 75% of patients with diabetes. Its often asymptomatic nature delays diagnosis. In aeronautics, it can cause in-flight incapacitation, beyond which it represents a major fear for the medical expert. Screening for CAD is still a topical subject with the advent of new cardiovascular (CV) risk biomarkers and more effective screening tests. We report the experience of the Aeromedical Expertise Center of Rabat in this screening of diabetic pilots, with a recommendations review.

METHODS: A prospective study over 1 yr included diabetic pilots who benefited from systematic screening for CAD after a CV risk stratification. Coronary angiography is performed if a screening test is positive. Subsequent follow-up is carried out in consultation with the attending physician with regular evaluation in our center.

RESULTS: There were 38 pilots included in our study. The average age was 55 ± 4.19 yr and about 73% had a high CV risk. CAD was detected in 4 cases (10.52%) who had abnormal resting electrocardiograms and required revascularization with the placement of active stents. Approximately 75% of pilots with CAD returned to fly through a waiver with restrictions.

DISCUSSION: Screening for coronary disease in diabetics is controversial, and current recommendations are not unanimous. In our study, the screening did not identify coronary diabetic pilots who could benefit from bypass surgery. Nevertheless, coronary disease was diagnosed, justifying grounding to preserve flight safety, which is an absolute priority in aviation medicine.

Zerrik M, Moumen A, El Ghazi M, Smiress FB, Iloughmane Z, El M’hadi C, Chemsi M. Screening for coronary artery disease in asymptomatic pilot with diabetes mellitus. Aerosp Med Hum Perform. 2024; 95(4):200–205.

INTRODUCTION: Sleep inertia is the transition state during which alertness and cognitive performance are temporarily impaired after awakening. Magnitude and time course of sleep inertia are characterized by high individual variability with large differences between the cognitive functions affected. This period of impairment is of concern to pilots, who take sleep or nap periods during on-call work hours or in-flight rest, then need to perform safety-critical tasks soon after waking. This review analyzes literature related to sleep inertia and countermeasures applicable for aviation.

METHODS: The large part of scientific literature that focuses on sleep inertia is based on studies in patients with chronic sleep inertia. We analyzed 8 narrative reviews and 64 papers related to acute sleep inertia in healthy subjects.

DISCUSSION: Sleep inertia is a multifactorial, complex process, and many different protocols have been conducted, with a low number of subjects, in noncontrolled laboratory designs, with questionnaires or cognitive tests that have not been replicated. Evidence suggests that waking after sleep loss, or from deeper stages of sleep, can exacerbate sleep inertia through complex interactions between awakening and sleep-promoting brain structures. Nevertheless, no meta-analyses are possible and extrapolation to pilots’ performances is hypothetical. Studies in real life or simulated operational situations must be conducted to improve the description of the impact of sleep inertia and kinetics on pilots’ performances. Taking rest or sleep time remains the main method for pilots to fight against fatigue and related decreases in performance. We propose proactive strategies to mitigate sleep inertia and improve alertness.

Sauvet F, Beauchamps V, Cabon P. Sleep inertia in aviation. Aerosp Med Hum Perform. 2024; 95(4):206–213.

INTRODUCTION: Musculoskeletal injuries are one of the more common injuries in spaceflight. Physical assessment of an injury is essential for diagnosis and treatment. Unfortunately, when musculoskeletal injuries occur in space, the flight surgeon is limited to two-dimensional videoconferencing and, potentially, observations made by the crew medical officer. To address these limitations, we investigated the feasibility of performing physical examinations on a three-dimensional augmented reality projection using a mixed-reality headset, specifically evaluating a standard shoulder examination.

METHODS: A simulated patient interaction was set up between Western University in London, Ontario, Canada, and Huntsville, AL, United States. The exam was performed by a medical student, and a healthy adult man volunteered to enable the physical exam.

RESULTS: All parts of the standard shoulder physical examination according to the Bates Guide to the Physical Exam were performed with holoportation. Adaptation was required for the palpation and some special tests.

DISCUSSION: All parts of the physical exam were able to be completed. The true to anatomical size of the holograms permitted improved inspection of the anatomy compared to traditional videoconferencing. Palpation was completed by instructing the patient to palpate themselves and comment on relevant findings asked by the examiner. Range of motion and special tests for specific pathologies were also able to be completed with some modifications due to the examiner not being present to provide resistance. Future work should aim to improve the graphics, physician communication, and haptic feedback during holoportation.

Levschuk A, Whittal J, Trejos AL, Sirek A. Leveraging space-flown technologies to deliver healthcare with holographic physical examinations. Aerosp Med Hum Perform. 2024; 95(4):214–218.

BACKGROUND: Neonatal air transportation is a crucial means of moving critically ill or sick neonates to specialized neonatal intensive care units or medical centers for consultation, regardless of distance or geographical limits. Proper preparation and consideration of air transport can help alleviate medical emergencies and ensure safe delivery. However, crewmembers and neonates may face stress during transportation. To date, there are few studies on neonatal air transportation in Taiwan.

CASE REPORT: We present the case of a late preterm neonate born with neonatal respiratory distress syndrome and polycythemia, who was also diagnosed with patent ductus arteriosus and mild pulmonary arterial hypertension on echocardiography. Due to disease progression, the neonate underwent endotracheal intubation and was subsequently transported to a medical center in Taiwan via a rotary-wing aircraft at 3 d of age. During takeoff and landing, a temporary oxygen desaturation event occurred. The physiological changes in these patients have seldom been discussed. This case emphasizes the important considerations of neonatal transport in Taiwan.

DISCUSSION: The air transport process could be influenced by both the patient’s medical condition and environmental factors. In preterm infants with cardiopulmonary conditions, thorough assessment is necessary for ensuring safe transportation.

Li S-P, Hsu P-C, Huang C-Y, Wu P-W, Fang H-H. Air transportation impact on a late preterm neonate. Aerosp Med Hum Perform. 2024; 95(4):219–222.

BACKGROUND: In the early days of the National Aeronautics and Space Administration (NASA), medicine in support of the astronauts was led by military experts from the U.S. Air Force as well as experts from the U.S. Navy and U.S. Army. In the early years, a physician with expertise in aerospace medicine was assigned to the Space Task Group and then to NASA. One of these individuals was Dr. Stanley White, a U.S. Air Force physician. To capture more of the early space medicine pioneers, a contract was established between the National Library of Medicine and the principal investigator at the University of Cincinnati to conduct a series of interviews with these early pioneers. An interview with Dr. White took place in his home while he was in hospice care. This audiotaped interview and other written and oral histories within NASA archives and the literature were reviewed to support this work. A series of questions were prepared for the interaction with Dr. White. These questions provided further clarification on his background and contribution. Responses to questions elicited open-ended discussion. The conversation provided a historical summary of Dr. White’s contribution to NASA as one of its first flight surgeons.

Doarn CR. An interview with Dr. Stanley White, one of NASA’s first flight surgeons. Aerosp Med Hum Perform. 2024; 95(4):223–225.