Flight surgeon

Background: Preparation for exploration class space flight requires planning to support human life in many circumstances including healthcare emergencies such as the need for acute surgical care, a notable example of which is appendicitis. Although performing a laparoscopic appendectomy on Earth is routine for a trained general surgeon, it is far from routine for a non-surgeon working in microgravity where IVs do not drip, drains do not drain, and gaseous anesthetic is out of the question. Because the procedure for laparoscopic appendectomy is so well documented, it was the ideal procedure on which to base a study on how to deconstruct a surgical procedure to examine all actions, skills, equipment, and supplies needed for success by non-surgeons working in an extreme environment...

BACKGROUND: The aim of this retrospective registry study was to review the medical causes of RCAF pilot permanent grounding during the period 20082017 and to compare our findings to the previous study of 19781987 to determine if disease patterns had changed. METHODS: Material was obtained from the RCAF 1 Canadian Air Division Surgeons' medical registry of military pilots. Anonymized data for permanently grounded pilots were classified by medical diagnosis, age, and training status. RESULTS: During the period 20082017, there were a total of 162 pilots permanently grounded, of which 110 were trained and 52 untrained...

During long duration orbital space missions, astronauts experience immune system dysregulation, the persistent reactivation of latent herpesviruses, and some degree of clinical incidence. During planned NASA 'Artemis' deep space missions the stressors that cause this phenomenon will increase, while clinical care capability will likely be reduced. There is currently minimal clinical laboratory capability aboard the International Space Station (ISS). The ability to monitor the white blood cell count (WBC) and differential during spaceflight has been an unmet NASA medical requirement, primarily due to a lack of capable hardware...

Importance: Acuity circles (AC) liver allocation policy was implemented to eliminate donor service area geographic boundaries from liver allocation and to decrease variability in median Model of End-stage Liver Disease (MELD) score at transplant and wait list mortality. However, the broader sharing of organs was also associated with more flights for organ procurements and higher costs associated with the increase in flights. Objective: To determine whether the costs associated with liver acquisition changed after the implementation of AC allocation...

Carbon-ion radiotherapy (CIRT) is on the rise as a treatment choice for malignant tumor. Compared to conventional radiotherapy, particle beams have different physical and biological properties. Particle beam provides a low entry dose, deposits most of the energy at the endpoint of the flight path, and forms an asymptotic dose peak (the "Bragg peak"). Compared to protons, carbon with its larger mass decreases beam scattering, resulting in a sharper dose distribution border. We report a 50-year-old male who underwent CIRT without surgical resection on osteosarcoma of the mandible...

BACKGROUND: Unintentional injury remains the leading cause of death for adults worldwide. We aimed to investigate the rates and distribution of dead on arrival (DOA) patients according to emergency medical services (EMS) mode of transport (MoT), EMS transport time (TT), injury severity score (ISS), and type of injury. METHODS: This retrospective study utilized de-identified incident-based data from the American College of Surgeons Trauma Quality Improvement Program Participant Use File (ACS-TQIP PUF) dataset (2013-2018) to study Adult DOA patients...

Extrapulmonary Histoplasma capsulatum infections in the immunocompetent population are rare and pose a diagnostic challenge. Upper extremity histoplasmosis without a primary lung infection is uncommon. It is possible to acquire it by inadvertent trauma with direct inoculation. Our case describes an immunocompetent patient with progressive swelling with minimal pain in the wrist associated with a small puncture wound on the left dorsal forearm. The initial workup failed to identify a specific etiology. For the following six weeks, the patient experienced progressive worsening of symptoms, warranting a referral to an orthopedic hand surgeon...

No abstract text is available yet for this article.

Accepting surgical complications, especially those related to the learning curve, as unavoidable events in colorectal procedures, is like accepting to fly onboard an aircraft with a 10 to 20% chance of not arriving at final destination. Under this condition, it is very likely that the aviation industry and the concurrent reshaping of the world and of our lives would have not been possible in the absence of high reliability and reproducibility of safe flights. It's hard to imagine surgery without any intraoperative and/or postoperative complications...

BACKGROUND: Swyer-James-MacLeod syndrome (SJMS) is a specific form of bronchiolitis obliterans that occurs rarely, but represents recognized sequelae of common pediatric respiratory illness, and presents as unilateral hyperlucency on chest imaging. This case study describes such an incidental radiographic finding identified during the assessment of chest wall discomfort in a military pilot. CASE REPORT: A 35-yr-old military pilot presented to his flight surgeon with vague intermittent chest discomfort. Initial evaluation revealed an abnormal chest radiograph with unilateral hyperlucency and mild expiratory airflow limitation on pulmonary function testing...

BACKGROUND: The Air Force Special Warfare Medical Officer Course was created to address the lack of operationally focused, job-specific clinical training for medical officers (MOs). This course addresses the gap in knowledge, skill, and application of operational medicine, as well as the behavioral health, human performance, education, and medical oversight of Operators. METHODS: The course was designed around the senior author's decade of experience piecing together training for his own role as a pararescue flight surgeon and informed by 5 years of flight surgeon courses, lessons learned from case studies of ill-prepared deployed physicians, and input from prehospital medicine subject matter experts...

In the current coronavirus disease 2019 (COVID-19) pandemic, air medical transport has been faced with many challenges that have been taken for granted in the past. The transport of these patients has been shrouded in many controversies, from the appropriate level of personal protective equipment, what facilities are appropriate for which patients, and the appropriate means of transport for COVID-19 patients. When you add in multiple high-risk comorbidities, as well as specialized devices and treatment, the care becomes even more complicated...

INTRODUCTION: Neck pain among rotary-wing aviators has been established as an important issue in the military community, yet no U.S. Army regulation defines exactly what cervical spine range of motion (CROM) is adequate for flight. This lack of regulation leaves flight surgeons to subjectively determine whether an aviator affected by limited CROM is fit to maintain flight status. The U.S. Army Aeromedical Research Laboratory is conducting a study among AH-64 and UH-60 pilots to define CROM requirements in simulated and actual flight using optical head tracking equipment...

BACKGROUND: In order to deliver optimal patient care, spine surgeons must integrate technological changes to arrive at novel measures of functional outcomes. Historically, subjective patient-reported outcome (PRO) surveys have been used to determine the relative benefit of surgical treatments. Using smartphone-based accelerometers, surgeons now have the ability to arrive at objective outcome metrics. OBJECTIVE: To use Apple Health (Apple Inc, Cupertino, California) data to approximate physical activity levels before and after spinal fusion as an objective outcome measurement...

BACKGROUND: While Fairbanks, AK, USA, is a remote location with significant constraints on medical resources and specialty care, a small U.S. Air Force clinic was able to provide a pilot with definitive care for neurological decompression sickness. CASE REPORT: A 31-yr-old female patient presented to her flight surgeon in Anchorage, AK, USA, with migrating polyarthropathy and headaches 48 h after a flight which included planned aircraft decompression for high altitude low opening (HALO) jump operations. In order to get definitive treatment in a hyperbaric chamber, the patient typically would have to be flown to Seattle, WA, USA...

INTRODUCTION: Recent epidemiological studies of U.S. Army aviators have suggested higher than anticipated rates of hyperlipidemia and metabolic disorder. The goal of this study was to determine whether this finding has persisted in 20162018 and to subsequently determine whether this trend is genuine and warrants further evaluation. METHODS: Data were requested from the U.S. Army Aeromedical Electronic Resource Office (AERO) and retrieved from the publicly available Defense Medical Surveillance System (DMSS) utilizing similar inclusion/exclusion criteria, where possible, as the earlier studies...

There are several injuries potentially related to high-G exposure, including neck and back pain, spinal fractures, and pneumomediastinum. We present a young military pilot diagnosed with isolated fractures of the right 9th and 10th ribs via X-ray after high-G exposure (maximum G level: 9G). This patient presented with progressive and localized pain in the right anterior chest and flank region. After conservative treatment with rest and pain management, he recovered from the rib fractures and completed all profile challenges in the advanced high-G training program...

BACKGROUND: Increased frequencies of physiological episodes have been a significant concern for Naval Aviation for the last several years. These include several aircraft platforms, but no previously documented E-2D Hawkeye events. This report documents an episode in an E-2D, with multiple aircrew affected at the same time. CASE REPORT: While deployed aboard a U.S. aircraft carrier, five E-2D Hawkeyes aircrew were simultaneously exposed to the same over-pressurization during a routine sortie. Out of the five aircrew, four immediately reported hypoxic-like neurocognitive symptoms of mental slowing, difficulty concentrating, and headache...

Virtual reality and other technological advancements both inside and outside the operating room have shown an exponential increase in the past two decades. Surgical techniques and finesse in delicate procedures has become ever more important and the onus is on plastic surgeons and plastic surgery residents to meet these needs to provide the best outcomes possible to patients. The ability to learn, simulate, and practice operating in a fashion that poses no harm to any patient is truly a gift from technology to surgery that any surgeon could benefit from, whether trainee or attending...

BACKGROUND: The aims of this study were to quantify exposure of the surgeon's brain to radiation during short cephalomedullary (SC) nailing, to extrapolate lifetime dose, and to determine the effects of personal protective equipment (PPE) on brain dose. METHODS: Two cadaveric specimens were used: (1) a whole cadaveric body representing the patient, with a left nail inserted to act as the scatter medium, and (2) an isolated head-and-neck cadaveric specimen representing a surgeon, with radiation dosimeters placed in specific locations in the brain...