According to the United States Air Force, an aerospace medicine specialist is a primary care physician for those that are pilots or crewmen. This includes those flying planes and astronauts.[1] Individuals trained in aerospace medicine understand the unique needs of those that are exposed to the extreme conditions encountered in the air or in space. They are trained to diagnosis and treat airmen so that they are in excellent physical health and able to complete their missions.
The primary goal of this specialty is to assist with the safety and promote the effectiveness of those individuals that work in air or space. There are specific conditions that come with working in the field of aeronautics. Those traveling in air or space may deal with oxygen deprivation, extreme temperature, noise, and the effects of inertia. Going beyond the Earth’s atmosphere adds even more possible problems such as weightlessness, motion sickness, and discomfort due to the lack of a day/night cycle.
History of Aerospace Medicine
While human flight is a relatively new occurrence, conditions affecting those that fly have been recorded as far back as the 1600s. A list of symptoms recognized as hypoxia, or lack of oxygen, was recorded by Spanish priest, Father Jose de Acosta. He found these symptoms in humans and animals that were ascending the Andes Mountains.
It wasn’t until 1783 that doctors were actually able to record physiological changes during real flight. It was in this year that the Montgolfier brothers sent the first manned hot air balloon to the height of 3,000 feet over Paris for approximately twenty-five minutes.
Immediately, those in the medical profession recognized the potential to study those in flight. John Sheldon, British physician, flew in hot air balloons in an attempt to record in-flight data. In 1786 John Jefferies, a Boston physician, published his in-flight findings after flying several times with Jean-Pierre Blanchard.
Blanchard also flew with Dr. Benjamin Rush. It was Rush who asked to record Blanchard’s heart rate during flight. Rush found that Blanchard’s heart rate increased during flight. Rush predicted that flight would one day become a safe mode of travel, perhaps even as safe as travel by boat.
Paul Bert, French physiologist, has earned the distinction of being the Father of Aviation Medicine. Dr. Bert conducted hundreds of experiments to study the effects that flight has on the human physiology. So extensive was his interest, that he didn’t limit his experiments to in flight. Bert actually built the first known hypobaric chamber. He was able to simulate conditions of flight up to 36,000 feet. The results from his experiments led him to believe that supplemental oxygen was needed during flights in hot air balloons. He encouraged balloon operators to start carrying oxygen on flights. [2] His findings and recommendations were widely used during World War II by balloonists.
Modern aviation is credited to the Wright brothers with their famous flight in Kitty Hawk, North Carolina. Shortly after the first flight at Kitty Hawk, governments began to look at aviation as a way to protect their countries. Soon, sailors and soldiers alike were learning to fly. The first fatality of modern aviation took the life of Thomas Selfridge, a young army lieutenant in 1908.
The Germans led the way in establishing aeromedical standards in 1910. Many countries, including the United States, followed their example. In 1912, the U. S. published a set of standards for physical examinations being given to those wishing to become pilots. Formal aeromedical standards were published in 1916. It is likely that these efforts were spearheaded by Brig. Gen. Theodore Lyster. It was Lyster that determined that a significant factor in flight safety was the physical condition of the pilot. He also developed the position of flight surgeon and pushed that every flight unit have one on staff. It was the job of these flight surgeons to understand the effect flight has on physiology and to help keep pilots in good health.
Dr. Charles Berry
Dr. Berry served in the military prior to the Korean War. When the Korean War began, rather than waiting to be called, he entered the air force. It is during this time that he was asked to take a course in aviation medicine that turned out to be a residency program. After completing one year of the program, Berry decided that he actually needed field experience. He spent the next three years stationed in Panama, before returning to complete the residency program at Harvard.
It was after his residency that he entered what would be consider the space program. He assisted in a secret program called Man in Space Soonest. He was the Aerospace Medical Specialist that was tasked with helping to define what an astronaut was and selecting the original seven United States Astronauts. He was also instrumental in designing the training program for these men. [3]
Hubertus Strughold
Hubertus Strughold was a German-born physiologist and medical researcher. He immigrated to the United States after World War II as part of Operation Paperclip. He was instrumental in editing an extensive summary of what the Germans had learned about aviation medicine during World War II. He was among the first to identify and study the possible challenges that would face humans travelling in space. Unfortunately, Strughold’s contributions to the field of aerospace medicine have been overshadowed by his involvement with human experimentation on prisoners of Dachau and epileptic children under the Nazi regime.[4]
Dr. Heinz Huber
Dr. Huber was a German scientist that was brought to the United States after World War II through Operation Paperclip. This Operation was set in motion so that the United States, rather than the Soviet Union, had access to some of the greatest academics of the time period. He along with other scientists brought to the United States as a part of Operation Paperclip made groundbreaking discoveries in the field of aerospace medicine. He was most well-known however, for his ability to explain complex scientific concepts in understandable layman’s terms. He published numerous articles and even hosted television shows with this goal in mind. One of his more memorable demonstrations was his explanation of a nuclear reaction with the use of hundreds of mouse traps, each loaded with two ping pong balls. [5]
Dr. Julielynn Wong
Dr. Wong is dual board certified in aerospace medicine and general preventative medicine. She is an accomplished individual that has authored thirty-five publications and has fourteen patents pending for medical devices. She was instrumental in providing 3D printers to astronauts. This innovative idea has allowed astronauts to print medical tools needed in space rather than taking them with them. [6]
Michael Barratt M.D.
Dr. Barratt was employed by NASA in 1991. He worked on medical systems for the Space Station Freedom. From there, he was made a flight surgeon in 1992 working in Space Shuttle Medical Operations. Beginning in 1995, Barratt served as the Medical Operations Lead for the International Space Station. In 2009, Dr. Barratt took his first of two voyages into space to work on the International Space Station. He spent a total of 199 days in space. His other flight was the final launch of the Space Shuttle Discovery in 2011. During this thirteen day mission he and the other crew members delivered parts to the space station.
Common Effects of Air/ Space Travel
Cardiac Problems
Cardiac rhythm issues have been noticed in astronauts. Whether these issues are due to the effects of space travel or a pre-existing condition are not known. However, there have been several observed changes in the cardiovascular system during flight. These changes happen when the volume of plasma is reduced, the left ventricle decreases in mass, and the nervous system adapts to the environmental gravity.
Decompression Illness
This occurs when there are nitrogen bubbles present in the blood that can damage tissue. Decompression is present when nitrogen enters the system and then forms gas bubbles. The condition is common in divers as well.
Barotrauma
This is damage done to the tissues due to differences in air pressure.Areas of the body that can be infected by barotrauma include the inner ears, the gastrointestinal tract, sinuses, and the lungs.
Decreased Immunity
Those that are traveling in space also tend to have a lower tolerance to illness or a weakened immune system. This causes any dormant illnesses to become active in the system. There are currently studies being done about the effects of space travel on the immune system, particularly the T-Cells.
There are also other known problems that can occur due to aerial travel. Among these include loss of balance, loss of eyesight, and even the loss of mental acuity.
Education
An Aerospace Medical Specialist is a medical professional and therefore requires a candidate to be a licensed physician. A D.O. or M.D. program must be completed at an accredited institution. In addition, there are other qualifications that must be met to work in the field. The age of a candidate may be no younger than 18 and no older than 48.
He or she must have completed a residency with a fully accredited program as well as completed a minimum of one year as a flight surgeon. Finally, the candidate must complete a five and a half week commissioned officer training and have the rating of Flight Surgeon, Senior Flight Surgeon, or Chief Flight Surgeon. [7]
With the wide range of symptoms that an aerospace medical specialist might encounter, there is a reasonable expectation that a candidate will need some amount of training in a variety of areas. These specialties include: pulmonology, cardiology, psychiatry, women’s health, and orthopedics. There is also a need for those training to work as a flight surgeon to study other specialties as well. It is helpful for residents to be exposed to areas such as neurology, ophthalmology, and internal medicine.[8]
Why are Aerospace Medical Specialists Required to Fly?
While it may seem confusing to require a doctor to fly a plane, there are several reasons for a minimum number hours being required. First and foremost, flight surgeons are required to treat airmen for a variety of different reasons. Not only are they a primary care provider, they must also treat conditions and illnesses that are unique to those in aviation. Academic study is crucial, but it is also important for a flight surgeon to experience the conditions their patients are in on a regular basis. This helps them to identify and educate preventative measures.
Aeronautics presents its own set of demands on a human body. Each mission that crews fly and each area that crews fly creates new challenges. Requiring that a flight surgeon clock a minimum number of hours each week with their crew, allows the doctor to experience these unique conditions.
Finally, there is the issue of trust. Normal people experience anxiety about seeing the doctor. Add to that the amount of stress and pressure that airmen experience and the anxiety increases. Having the flight surgeon fly and become truly part of the team alleviates this. It helps the doctor to become close to his or her patients and truly understand individual needs. [9]
Careers in Aerospace Medicine
One of the main careers available to those that become aerospace medical specialist (aka flight surgeons) is working within the military, particularly the United States Air Force. First and foremost, the job of a flight surgeon is to conduct examinations and see to the overall health of the pilots and flight crews. They also determine an airman’s fitness for flying. They also examine work and living environments to identify and control any health hazards.
In addition to medical duties, flight surgeons must also periodically participate in actual flights. This assists the professional in understanding and better treating the issues that airmen face. They also serve as a liaison between flight crews and medical staff. This allows them, when advising on issues such as emergency evacuation protocol, to manage the casualties that do occur.
Working at NASA is another possibility. The National Aeronautics and Space Administration has a limited number of positions for those with medical degrees wishing to work in aeronautics. Most of the positions available are research positions with the goal of making space travel safer for manned flights.
Compensation
The median entry level pay for an aerospace medical specialist is $255,000. The entry level is considered to be one to three years of experience. An average flight surgeon grosses approximately $376,000 and a Senior Flight Surgeon averages $460,000. A senior level flight surgeon is one that possesses eight or more years of experience.
Professional Organizations
The American Society of Aerospace Medicine Specialists
The ASAMS was founded in 1998. It is a constituent organization to the Aerospace Medical Association. The purpose of the organization is to serve as a voice and to advocate for the professional needs of those who choose to work in the field of aerospace medicine. They are dedicated to creating and maintaining professional standards as well as advocating for aerospace medicine specialists. They also work to recruit younger physicians into the field of study. [10]
The Aerospace Medical Association
The mission of this organization is to advance knowledge in the field of aerospace medicine in order to better serve the health and safety of those that choose to work in the field of aeronautics. The association was founded in 1929 by Louis Bauer. Their original goal was to provide information that would enhance the safety of pilots. The goals of the organization are much the same today. They strive to provide training and education as well as advocate for the professions. They also work to advance research and therefore further understanding and knowledge of flight. [11]
The Society of United States Air Force Flight Surgeons
This organization was founded in 1960 by a group of USAF flight surgeons. They felt that there was a need to aggressively improve practices and advance the status of aerospace medicine within the Air Force. The group is a constituent of the Aerospace Medicine Association and meets to discuss issues that are unique to those working within the Air Force rather than in the broader arena of aerospace medicine. [12]
Aerospace Physiology Society
In 1965, thirteen professionals officially created the Aerospace Physiology Society under the parent organization, The Aerospace Medical Association. The organization strives to present a unified voice for aerospace physiologists within the Aerospace Medical Association. They wish to promote cooperation between aerospace physiology and other disciplines. Under the umbrella of aerospace physiology, there are many sub disciplines.
Space Medicine Association
The Space Medicine Association was founded in 1950 with the help of Dr. Hubertus Strughold and fellow German scientist, Dr. Heinz Haber. Both were brought to the United States through Operation Paperclip. While the sanity of participants in the original meeting was questioned for stating that space travel would become a reality, another meeting was held in 1951. The next several years saw great growth for the organization. This is the only constituent of the Aerospace Medical Association in which the members do not have to be practicing doctors. This distinction was earned after much lobbying to the parent organization. Many of the members of this organization are researchers that hold PhDs rather than medical degrees.
Other Careers within Aerospace Medical Services
While an Aerospace Medical Specialist or Flight Surgeon is the primary occupation, there are other careers available to those wishing to go into aerospace medicine but prefer not to spend the time to become a doctor. There is the option to become a registered nurse (RN) or a licensed practical nurse (LPN) as part of this career. Individuals that are part of the aerospace medical services staff are considered to be a part of the nursing team and therefore have a variety of responsibilities.
Basic duties include those of any nursing staff. Tasks may be assigned such as taking vital signs, maintaining patient records, or even managing care from admission to discharge. They may also be asked to participate in or conduct trainings for things such as emergency evacuation or basic life support.
There may also be the opportunity for an individual to perform as an Independent Duty Medical Technician. In this situation, the individual will be called upon to serve as the medical staff for places like remote outposts without the supervision of a doctor. The IDMT may be called upon to perform any and all medical duties such as dispensing medicine, laboratory duties, and medical record maintenance.
There are certain requirements that must be met to work within the aerospace medical services field. For those wishing to work with the military, boot camp is the first stop. Once this has been completed, most will move onto basic medical technician training. From there, individuals will move onto take courses within their chosen specialty. [13]
The International Space Station (ISS)
Historically many of the experiments conducted in the field of aerospace medicine have been to prepare pilots and astronauts for air and space travel. There were also experiments conducted to determine the effects of staying in space for extended periods of time. These experiments have paved the way for researchers and scientists to work in a setting such as the International Space Station.
Now the ISS gives back. Scientists on the International Space Station conduct experiments in a variety of different disciplines. Among these is of course further research in the field of Aerospace Medicine. Perhaps what they are learning today will lead to travel to other planets or even other galaxies.
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