Needed: specialists in aerospace medicine. II. Clinical aerospace medicine.
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Military aerospace medicine requires a psychiatric selection and certification process that determines not only the absence of significant mental disorders, but also the presence of positive qualities in the realms of motivation, ability and stability: not all normal people are fit to fly. Other issues of aerospace psychiatry involve maintenance of mental resilience and hardiness during a flying career, aeromedical decisions about when to remove from flight duties and when to return, criteria for waivers for psychiatric conditions, use of medications for treatment of psychiatric symptoms, questions of substance abuse, and research in such areas as genetics. This report reviews the basis for military aerospace psychiatry, primarily as practiced in the United States Air Force (USAF), and presents some of its underlying principles as they apply to clinical situations.
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The contributions of aerospace medicine to clinical medicine far exceed the aggregate of the clinical applications of individual technologies which originated in aerospace medicine, important though these be. Contributions of aerospace medicine to clinical medicine will be discussed in seven categories: The raising of issues, questions, and need for systems for protection or support for man before such issues and needs were recognized by clinicians to be important or feasible; Contributing to the manpower pool of able clinical investigators through recruitment and special training in research; Providing fundamental insights into specific biologic processes of clinical significance; The recruitment of disciplines not previously involved extensively in addressing biologic problems and the creation or strengthening of hybrid disciplines such as bionics and bioengineering; Pioneering emphasis on safety, prevention and environmental health now being incorporated into clinical medicine; The development of specific research technologies which have been used to address an array of clinical problems; Specific technologies of clinical significance to which aerospace medicine has contributed, including systems for air transport of patients, many components of modern systems for patient monitoring, components of circulatory and ventillatory support systems, hypoxia warning systems, prevention of toxic exposure and treatment of toxic injury, prevention and treatment of burns, restraint systems, artificial organs, the application of models to clinical practice, and the ordering and automating of information processing.
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Aerospace medicine has evolved into a legitimate specialty through a long process of historical observation and technical achievement. However, most public literature on the topic has only covered information written through the late 1960s. This paper seeks to give a brief overview of the development of aerospace medicine and includes information about early advances in the field as well as more recent data. A MEDLINE search using "history," "aerospace medicine," and several other search terms as subject headings was the first step in gathering data. Also, personnel from the U.S. Air Force School of Aerospace Medicine library at Brooks AFB, TX, were consulted for current literature on the subject. From the earliest descriptions of mountain sickness, to the first manned balloon flight, and on to the invention of the airplane with man's forays into space, aerospace medicine has had a rich history. A great part of this rich history was contributed by pioneers, both past and present, of the U.S. Air Force.
BACKGROUND: The American College of Preventive Medicine (ACPM), with sponsorship from the Health Resources Administration (HRSA), has published core competencies that are common to all preventive medicine residencies-aerospace medicine (ASM), occupational medicine (OM), and general preventive medicine/public health (GPM/PH). Further development of specialty area competencies for ASM residents was addressed by a working group comprised of representatives from each of the four ASM residency programs. METHODS: Representatives from the U.S. Air Force School of Aerospace Medicine, Wright State University, University of Texas Medical Branch-Galveston, and the Naval Operational Medicine Institute convened to develop a set of broad competency statements for ASM residents that would encompass the breadth of ASM residency training as it is currently provided in the U.S. RESULTS: A listing of six ASM resident competencies, with supporting skill sets, are presented. In combination with the ACPM core competencies, the ASM resident competencies represent a refocusing of educational objectives on skills attainment. CONCLUSIONS: The ASM resident competencies identify the capabilities of graduating ASM residents as distinct from OM and GPM/PH residents. At the same time, they are broad enough to permit specific areas of emphasis (e.g., military, civil, or space) to be pursued within the various ASM residencies. This represents the first successful attempt to draft a consolidated statement of educational objectives that has universal acceptance and applicability across all U.S. aerospace medicine residencies.
This bibliographic guide is a comprehensive listing of international publications (books) in Clinical Aerospace Medicine, Operational Aerospace Medicine, Aerospace Physiology, Environmental Medicine/Physiology, Diving Medicine/Physiology, Aerospace Human Factors, as well as other important topics directly or indirectly-related to aerospace medicine. This guide will be useful as a primary source of consultation for bibliographic information; especially to those colleagues who are in their formative years, and to those who do not have easy access to computer-aided literature search systems. This bibliographic guide does not constitute a recommendation or an endorsement of any of the publications listed herein and the merits or limitations of each publication should be judged by the reader.
BACKGROUND: The American College of Preventive Medicine (ACPM) has just published. The Specialty of Preventive Medicine: Leadership in Medicine for the 21st Century (Forum Report). The Forum Report summarizes a 3-yr effort by leaders of the ACPM, American Board of Preventive Medicine (ABPM), professional organizations, residency training programs, and residents-in-training to examine the critical issues facing the specialty of Preventive Medicine (PM) and to develop a vision and strategies for the future. The Forum Report could have profound repercussions on the specialty of Aerospace Medicine (ASM). METHODS: The author reviewed the history behind the development of the Forum Report and assessed the Report's recommendations with respect to their possible ramifications on the specialty of ASM. RESULTS: The Forum Report includes 34 recommendations to enhance the specialty of PM. Of most interest to the ASM community is the Forum's conclusion that the most critical issue facing PM is unification of the specialty. It recommends, therefore, that the ABPM establish PM certification for all individuals at the end of the practicum year, with area certification [Occupational Medicine (OM), General Preventive Medicine/Public Health (GPM/PH), and ASM) occurring only after more specialized training and practice. DISCUSSION: The ASM community needs to be aware of the Forum Report's recommendations and enter the debate on the viability of the specialty of ASM. The Aerospace Medical Association should take the lead in this effort.
In the U. S. there are 23 recognized medical specialty boards. One of these is preventive medicine. Within preventive medicine there are three areas: Aerospace Medicine, Occupational Medicine, and Public Health/General Preventive Medicine. The preventive medicine specialties have a common core of required training including biostatistics, epidemiology, health services administration and environmental health. These, plus associated topics are covered during year one of training. Year two of training involves clinical rotations specifically tailored to the eye, ear, heart, lungs and brain, plus flight training to the private pilot level, and a Masters Degree research project for the required thesis. During year three the physicians in aerospace medicine practice full-time aerospace medicine in a NASA or other government laboratory or a private facility. To date, more than 40 physicians have received aerospace medicine training through the Wright State University School of Medicine program. Among these are physicians from Japan, Australia, Taiwan, Canada and Mexico. In addition to the civilian program at Wright State University, there are programs conducted by the U. S. Air Force and Navy. The Wright State program has been privileged to have officers from the U. S. Army, Navy and Air Force. A substantial supporter of the Wright State program is the National Aeronautics and Space Administration and a strong space component is contained in the program.
In order to facilitate curriculum design for psychiatric education in aerospace medicine, three groups of physicians were surveyed: experienced flight surgeons, student flight surgeons, and psychiatrists trained in aerospace medicine. Two measures were obtained: 1) an assessment of the usefulness of particular psychiatric skills and knowledge in the practice of aerospace medicine, and 2) a rating of the clinician's abilities in these areas. Results support the primary importance of interviewing and diagnostic skills. Student flight surgeons show deficiencies in the areas of administrative knowledge and in knowledge of the impact of the flyer's environment upon his mental status. These findings link psychiatry in aerospace medicine with the emphasis on understanding the man/environment interface and on the flight surgeon's organizational function of boundary control through decisions on fitness to fly.
The Union of Soviet Socialist Republics and the United States of America operate major aerospace medicine programs; each country has taken specific measures to assure the development of an adequate number of trained aerospace medicine physicians. This jointly prepared paper emphasizes the training of aerospace medicine physicians related to civil aerospace activities. Those working in the field of aerospace medicine will find of interest the aerospace medical approaches taken by the U.S.S.R. and the U.S.A. in achieving their respective aerospace objectives.
The development of the physiologic and hygienic principles of noise standardization in aerospace medicine is described. The contribution of aerospace medicine to the theory of noise standardization is emphasized. Also discussed are principles of standardization with respect to noise equivalent levels, dose-based standardization, as well as noise tolerance related to the work load. Further studies are needed to assess the applicability of the above principles for the evaluation of noise effects onboard flying vehicles.
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