Extra-alveolar air resulting from submarine escape training: a post-training roentgenographic survey of 170 submariners. Rep No 550.
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Adolescent↗
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A descriptive analysis of asthma in the U.S. Navy Submarine Force.
BACKGROUND: The U.S. Navy Submarine Force offers a unique opportunity to study asthma because of the relative socioeconomic and physical homogeneity of the population and the closed environment occupational exposure. Currently, asthma is disqualifying from submarine service, which results in a significant loss of experienced personnel. METHODS: We performed a retrospective analysis of 119 U.S. Navy submariner disqualification packages for asthma between 1989-1993. RESULTS: We found a 0.16% annual period prevalence of asthma in the active duty enlisted Atlantic Fleet Submarine Force. Two groups of asthma disqualifications were identified with a significant increase above their proportional representation in the fleet: enlisted personnel (p < 0.01) and submarine recruits (p < 0.0001). The proportion of African-American personnel also had a tendency toward increased asthma disqualification (p < 0.08). There were no differences in prevalence of asthma between crews of ballistic missile submarines or fast attack submarines. Asthma risk factors reported in the civilian literature (childhood history of asthma, family history of asthma and non-drug allergies) were highly represented in our study (41%, 46% and 68% of submariners, respectively). Most disqualified submariners had "mild" asthma based on the diagnostic work-up. The methacholine challenge test appeared to carry a disproportionate diagnostic weight despite its low specificity. CONCLUSION: Although the period prevalence of asthma is low in the U.S. Navy Submarine Force, submariners disqualified for asthma have similar historical and ethnic risk factors as the civilian population.
Adult↗
Health risks among submarine personnel in the U.S. Navy, 1974-1979.
This study evaluated health risks associated with U.S. Navy submarine duty by comparing hospitalization rates of submariners with surface ship personnel. The groups were compared using age-adjusted hospitalization rates for 16 major diagnostic categories and several specific diagnoses postulated to be submarine associated. Submarine personnel did not have significantly higher hospitalization rates for any diagnostic categories nor for any of the submarine-associated illnesses. Submariner relative risk of hospital admissions was greater for a few selected diagnoses but statistical significance was not attained. Submarine personnel had lower hospitalization rates for nearly all of the diagnostic categories examined. Reasons for these lower rates may be stringent screening of submariners, higher levels of education among submariners, difficulty of evacuation from a submarine, and the healthy-worker effect. The health status of U.S. Navy personnel does not seem to be adversely affected by submarine duty.
Adult↗
Carbohydrate metabolism in U.S. Navy submarine personnel.
One- and two-hour postprandial glucose and insulin values were measured in 58 submariners with 5 or more FBM patrols and in 58 non-submariners. An interrelationship between serum glucose and insulin for classifying defects in carbohydrate metabolism indicated that 55% of the submariners and 45% of the non-submariners exhibited some type of defect. Exercise appears to play an important role in the maintenance of normal carbohydrate metabolism in these subjects. Non-submariners reported engaging in significantly more exercise than did submariners. Negative correlation between exercise vs. 1 and 2-h glucose and 2-h insulin was significant for all subjects. An inverse relationship was observed between amount of exercise and the severity of carbohydrate metabolic defects in submariners and non-submariners as well as in normal weight and obese individuals. No statistical differences were found between the submariner and non-submariner groups with respect to age, % body fat, fatness (normal or obese), glycosylated hemoglobin, or family history of diabetes.
Adult↗
Chronic myeloid leukaemia and occupational exposure to benzene in a Royal Navy submariner.
A Royal Naval submariner recently developed Chronic Myeloid Leukaemia after 13 years in the submarine service. The Institute of Naval Medicine therefore reviewed the submariner's occupational exposure history to benzene with a view to determining whether this had been a causative agent in the development of the disease. Past atmosphere patrol reports taken from the submarines on which the submariner served were scrutinised to determine the maximum and median weighted levels of benzene to which he was exposed over the 13 year period. These were 830 micrograms m/m3 and 189 micrograms m/m3 respectively. To determine what increased risk, if any, is associated with the submariner's exposure to benzene at these levels it was necessary to compare the data with the results obtained from epidemiological studies of workers exposed to benzene in various industries. Industrial epidemiological studies have proved statistically that benzene induces leukaemia above occupational exposure levels of 16 mg/m3 (5ppm). Below this level there is no statistical evidence that benzene is carcinogenic and estimates of increased risk have therefore necessitated the use of mathematical modelling. The estimated range of increased leukaemia cases due to benzene exposure is 0.5-6.6 additional cases per 1000 workers exposed over a working lifetime of 40 years (40ppm-years). The increased risk to the submariner using the median submarine benzene levels was calculated to be 0.02-0.3 additional cases (of all types of leukaemia) per 1000 submariners. The increased risk of developing the rare Chronic Myeloid Leukaemia from benzene exposure in submarines is considered to be extremely small.
Benzene↗
The mortality of Royal Naval submariners 1960-89.
OBJECTIVES: To examine the mortality pattern of submariners in the Royal Navy to assess the long term effects on health of serving in submarines. Any specific cause of death which was increased was considered in advance to be of interest, but attention focused particularly on cancer mortality. METHOD: A mortality follow up study: 15 138 submariners who had conducted their first submarine training between 1960 and 1979 were followed up through their time in the Navy and into civilian life, up to the end of 1989. The main outcome measures were the numbers of deaths and standardised mortality ratios (SMRs) which indicate whether the mortality from all causes and specific causes, particularly cancers, exceeds that in men in England and Wales. RESULTS: Mortality in submariners was lower than that for men in England and Wales with an all cause SMR of 86; this was comparable with that found in other studies of armed forces personnel. Cancer mortality was particularly low with an SMR of 69 and there was no particular cancer site which showed an excess. Increased mortality from digestive diseases was found, the excess being attributable to cirrhosis of the liver, which had an SMR of 221 based on 12 deaths, alcohol being a contributory factor in eight. Deaths from accidents and violence were also higher than expected with an SMR of 115, but this was due to high levels of accidents occurring after discharge from the Navy. There was no apparent trend in mortality with time since starting submarine work. Likewise there was no pattern by calendar period, although the excess of cirrhosis of the liver was confined to the period 1970-9. CONCLUSION: The submariners seemed to be a healthy group with low mortality overall. Working in submarines was not associated with any increased cancer mortality. Excess deaths from cirrhosis of the liver, and from accidents and violence after leaving the Navy, were of some concern but they cannot be attributed directly to the submarine environment.
Accidents↗
Evaluating the sex ratio in the offspring of U.S. Navy submariners.
UNLABELLED: In 1970, a study completed in accordance with the Naval Submarine Medical Research Laboratory in Groton, Connecticut, concluded that U.S. Navy personnel serving aboard nuclear-powered submarines tended to have a higher ratio of female offspring compared with the general U.S. population. To date, there has not been an examination as to whether or not this remains true today. OBJECTIVE: Estimation of the sex ratio (SR) in the offspring of the current U.S. Navy submariner population, examining potential contributing factors, including rating, rank, and tobacco use, was the aim of this study. METHODS: Between November 2002 and May 2003, 597 male active duty U.S. Navy submariners were surveyed in reference to their age, rating, and rank, time in the submarine community, age and gender of their children, and their lifetime tobacco use. RESULTS: Of the 597 submariners who completed the survey, 259 of them had fathered children. A total of 413 submariner offspring were included in the results. Of these offspring, there were 222 boys and 191 girls, forming a SR (percentage of male offspring) of 53.75%. Unlike the study from more than 30 years ago, there was no statistically significant difference compared with the SR of the U.S. general population during this time, 51.17% (p = 0.29). However, within the study population, there was a trend toward lower SRs as the father's total time in the submarine community increased (p = 0.06). A stratified analysis by rating found that sonar technicians had a statistically significant lower SR of 34.5% (p = 0.03). Smokers were noted to have a higher ratio of male offspring compared with non-smokers, although this finding was not statistically significant (p = 0.46).
Adult↗
Evaluation of a contingency blood donor program on U.S. Navy submarines.
OBJECTIVE: Because the role of submarine warfare is shifting from strategic deterrence to littoral force projection, submarine providers will be required to manage combat trauma. Currently, submarine providers have only crystalloid available for the reversal of hemorrhagic shock. A proposal program to provide blood products on submarines was evaluated. METHODS: Existing military emergency blood transfusion protocols were reviewed. The restrictions of donation/transfusion onboard submarines were considered. RESULTS: A protocol to provide screening for, implementation of, and a reporting system for contingency blood donation and transfusion onboard submarines was created. The protocol contains all the safeguards of existing U.S. Navy contingency donor programs with the exception of pretransfusion infectious disease testing and cross-matching. However, because the program does not require laboratory capability, it can be implemented by an independent duty corpsman onboard a submarine. CONCLUSION: This protocol provides blood for the reversal of hemorrhagic shock onboard submarines in the event of traumatic injury.
Adult↗
Submarine escape trials 1999-2001--provision of medical support.
Since the early 1960s all Royal Navy submarines have been fitted with an escape system comprising a single escape tower (SET) and submarine escape immersion suit (SEIS). This system enables escape from a submarine at a depth of 180 metres (1.9 MPa) provided that the submarine compartment is at a pressure of no greater than 1 bar (0.1 MPa). Due to a variety of causes which may include flooding and leakage of high pressure air systems it is the highly probable that the submarine compartment will be at a pressure in excess of 1 bar (0.1 MPa) at the time of the escape. To investigate and determine what constitutes a 'safe' maximum escape depth from any given compartment pressure (the safe to escape curve), a purpose built chamber complex, the Submarine Escape Simulator (SES) has been constructed at the QinetiQ, formerly the Defence Evaluation and Research Agency (DERA), Alverstoke site. Unlike escapes from a submarine where once released from the submarine the escapee's ascent can not be halted, within the SES it is possible to halt the ascent phase. This article describes the systems and procedures developed to enable medical support to be provided rapidly to a subject at any stage of the compression decompression profile. The article also provides details of the results to date that have been obtained from this work.
Decompression↗
Long-term intermittent exposure to high ambient CO2 causes respiratory disturbances during sleep in submariners.
BACKGROUND: During most of the cruise, submarines are detached from their environment. Therefore, O(2) levels are relatively low (19 kPa, 144 mm Hg) and CO(2) levels are high (1 kPa, 7.6 mm Hg). There are, however, periods during ventilation of the submarine in which CO(2) levels drop and O(2) levels increase. The objective of this study was to determine whether these unique gas changes might result in sleep-disordered breathing in submariners. METHODS AND MATERIALS: The sleep of eight healthy soldiers was assessed three times: (1) control night, in submarine docking; (2) at the beginning of the cruise (reflecting acute exposure to gas changes); and (3) at the end of the cruise (chronic exposure to gas changes). Each night was divided to three parts because of different CO(2) levels (secondary to ventilation of the submarine). Sleep and breathing were measured using the portable Watch PAT100 device (Itamar Medical, Ltd; Caesarea, Israel) to detect breathing abnormalities during sleep. RESULTS: Sleep and breathing data were categorized according to four CO(2) conditions: acute moderate (inhaled CO(2) levels of 2.3 to 5 mm Hg during first 1 to 2 nights of the cruise); acute high (inhaled CO(2) levels of 5 to 9.2 mm Hg during the first 1 to 2 nights of the cruise); chronic moderate (inhaled CO(2) levels of 2.3 to 5 mm Hg during nights 9 to 10 of the cruise); and chronic high (inhaled CO(2) levels of 5 to 9.2 mm Hg during nights 9 to 10 of the cruise). Respiratory disturbance index (RDI) was significantly higher in the chronic moderate CO(2) condition than the chronic high condition (18.9/h vs 8/h, p < 0.005). RDI did not correlate with CO(2) levels during the first nights of the cruise (R = - 0.2, not significant), but significantly negatively correlated with it during the last nights of the cruise (R = - 0.56, p < 0.05). CONCLUSIONS: We conclude that during an 11-day cruise, submariners adapt to high CO(2) levels, as evidenced by the significant dependence of RDI on CO(2) during the final but not initial days of the cruise. This adaptation resulted in a significant increase in RDI when CO(2) levels declined during the later nights of the cruise.
Adult↗
Escape from a disabled submarine: decompression sickness risk estimation.
Individual crewmember escape from a disabled U.S. Navy nuclear submarine has never been necessary, but remains an important contingency. Decompression sickness (DCS) is one of the foreseeable risks and a robust mathematical model of DCS incidence has been used to estimate the magnitude of this risk under a variety of escape scenarios. The model was calibrated with over 3000 well-controlled human pressure exposures, less than 2% of which simulated pressure profiles of submarine escape. For disabled submarine depths < 300 ft of sea water (fsw) and internal submarine pressures of <11 fsw (arguably the most likely conditions), the DCS risks are comparable to those routinely undertaken by U.S. Navy divers--less than 5%. For progressively deeper depths and especially for higher submarine internal pressures, the risk of DCS becomes much greater, including unknown chances of permanent injury and death. Variations from the baseline escape procedure are explored, including equipment differences, delays in exiting the submarine and changes in the oxygen content of the breathing mix.
Accidents↗
[Functional status and seasonal changes in white blood cells in submarine personnel in the Kola Polar region].
Evaluated was potentiality of the blood leukocyte count analysis proposed by L.H. Garkavi et al. (1985-1990) within the program of submariners health monitoring. Leukograms of 573 sailors on active service in a large nuclear submarines unit and 455 divers of a formation of ships removed from an active unit of nuclear submarines for utilization. Seasonal variations in the functional state of submariners were revealed. The most noticeable differences in these two large groups of sailors were associated with particular months. Results suggest, first of all, serious adaptive loads on the physiology of submariners on military service in the Kola polar. Burden of these loads varies with seasons and has some peculiar features which means that health-improving programs should be developed for each season and each specific group of submariners, and Garkavi's method should be standardized to be applicable to the Kola polar population.
Adaptation, Physiological↗
[Epidemiology of mycoses in submariners based on the Kola Peninsula].
Subject of the study was spreading of mycoses in the troops based on the Kola Peninsula. Examined were the military serving on atomic submarines, maintenance crews of deactivated atomic submarines awaiting disposal, and coastal units. Spreading of skin lesions among the submariners was not same as among the coastal military. Signs of clinical mycoses were observed in 41.2% of submariners of the active unit, in 66.9% of the maintenance crews, and in 38.1% of the coastal military. Infection agents were fungi g. Candida (albicans, guilliermondii, krusei, pseudotropicalis), Epidermophytia plicarum, Ptyriasis versicolor, Trichophyton interdigitale. Among the fighters on active submarines, 53.8% of the clinical observations were accounted for onychomycosis and foot skin lesions and 38.5%--for erythema, maceration and suppuration. Among the maintenance crews 51.8% of the observations were accounted for onychomycosis and foot skin lesions and maceration; hyperkeratosis and fissures prevailed in the coastal military (31.1%). For submariners most common were Candida albicans (80.7%) and guilliermondii (11.6%), and Trichophyton interdigitale (7.7%). In the maintenance crew those were Candida albicans (84.1%) and guilliermondii (11.6%) and in the coastal military, Candida albicans (70.6%), guilliermondii (11.8%) and krusei (14.7%).
Candidiasis, Cutaneous↗
Cardiovascular risk factors in submariners.
A sizeable group of biochemical, hematologic and physiologic variables that significantly affect the prognosis for diseases of aging, especially for coronary heart disease (CHD), were studied in 1017 submariners. Skinfold thickness in these subjects was determined to be higher than in most other groups of men of similar age; the total level of body fat was within the range of high normality. Serum cholesterol levels, cigarette smoking, relative weight, and blood pressure appeared to be the factors most directly responsible for the extent of cardiovascular risk in this group of submariners. Though submariners as a group do not apparently have appreciably higher levels of CHD risk than other American men, there was a significant tendency for total risk to increase with length of submarine service as well as with age. A similar age-independent increase in serum cholesterol correlating with length of submarine service was reported earlier. Split-sample analyses support the reliability of the age-corrected correlations of CHD risk with time of submarine service. Although no attempt was made to prove a direct relationship between alcohol consumption or coffee drinking and cardiovascular risk, there were strong correlations noted. These factors, combined with serum cholesterol levels, cigarette smoking, and relative weight, deserve consideration as potentially modifiable CHD risks.
Adipose Tissue↗
[Tuberculosis in the crew of a submarine].
We report the apparent spread of mycobacterial tuberculosis among a submarine crew from a crew member with a low grade of infectivity. The air-conditioning system of submarines requires completely closed recirculation of ambient air. If a person with pulmonary tuberculosis were in a submarine, one would expect to find a high incidence of tuberculosis among others on the ship. The index patient was a 35-year-old member of a submarine crew. An abnormal shadow was found on a chest roentgenogram during an annual medical checkup, and he was hospitalized for examination. Acid-fast bacilli were found in his gastric secretions, but he did not complain of coughing and no tuberculosis bacilli were found in his sputum. All members of the submarine crew were examined, and some who were on board with the index patient reacted strongly. Because those who were also suspected to be infected were usually not close to the index patient's living quarters and had little contact with the patient in the submarine, we strongly suspect that the closed ventilation system contributed to the spread of the infection. Control of tuberculosis in a sealed environment requires detailed investigation of the environment and completion of chemoprophylaxis. Adequate ventilation and ultraviolet radiation are more effective than decontamination with disinfectants for the control of infectious droplet nuclei. Ships should be equipped with those systems.
Adult↗
Accidents and injuries among U.S. Navy crewmembers during extended submarine patrols, 1997 to 1999.
Accidents and injuries, the most common cause of morbidity in military populations, result in a significant number of work days lost each year and account for 75% of all active duty deaths. Rates of accidents and injuries during U.S. Navy submarine deployments have not been evaluated previously. A database designed to monitor the health of submarine crew-members was used to examine the rates and causes of accidents among deployed crewmembers aboard 196 submarine patrols between 1997 and mid 1999. The most common category of injuries was open wounds, followed by sprains and strains, contusions, superficial injuries, burns, and others. Rates of accidents and injuries decreased with increasing age and duration of military service. Among submariners working in supply departments, the rates were more than two times those of crewmembers working in other departments. Based on these data, among a submarine crew of 100 men at sea for 100 days, approximately four to five accidents or injuries might be expected and would result in an average of about 2 days of light or no duty per injury. Rates of accidents and injuries were very low; however, focused safety training could reduce rates among younger and less experienced crewmembers as well as among those working in particular areas of the submarine.
Absenteeism↗
The vision of submariners and National Guardsmen: A longitudinal study.
This study was designed to differentiate among possible causes of an increased incidence of myopia and related symptoms among submariners by making a longitudinal comparison of the visual functions of two groups of subjects, submariners and National Guardsmen. Refractive error, visual acuity, phorias, accommodation, and depth perception were measured. Submariners showed statistically significantly greater losses in visual acuity, accommodation, and depth perception over a 3.5-year period than did the guardsmen, but the differences were very small. Comparison with data in the literature gives evidence of large shifts in refractive error for young men, both submariners and guardsmen, born in recent years. it is suggested that whatever factors are responsible for the increase in myopia in the general population are operating even more effectively among submariners.
Accommodation, Ocular↗
Current submarine atmosphere control technology.
Air purification in submarines was introduced towards the end of World War II and was limited to the use of soda lime for the removal of carbon dioxide and oxygen candles for the regeneration of oxygen. The next major advances came with the advent of nuclear-powered submarines. These included the development of regenerative and, sometimes, energy-intensive processes for comprehensive atmosphere revitalization. With the present development of conventional submarines using air-independent propulsion there is a requirement for air purification similar to that of the nuclear-powered submarines but it is constrained by limited power and space. Some progress has been made in the development of new technology and the adoption of air purification equipment used in the nuclear-powered submarines for this application.
Air Conditioning↗