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Human Factors and Medicine Panel Chairman: Vice-Chairman: Dr M.C. WALKER Col. W. C. M. TIELEMANS, MD Director, Centre for Human Sciences RNLAF/SGO DERA P.O. Box 20703 F138 Building - Room 204 Binckhorstlaan, 135 Farnborough, Hants GU14 OLX 2500 ES The Hague United Kingdom The Netherlands LtCol. Dr. FRANCISCO RIOS TEJADA PROGRAMME COMMITTEE Chairmen Dr. A. J. F. MACMILLAN SPAF Aeromedical Center (CIMA) Royal Air Force Centre of Aviation Medicine Arturo Soria 82, 28027 Madrid - SPAIN Farnborough, Hants GU14 6SZ - UK Tel: 34 91408 4028 Fax: 34 91408 4027 Tel: 44- 1252 392 635 Fax: 44 1252 393 469 Email: francisco.rios@aero.cima.es Email: farnborough@rafcam.org.uk Members Col. Med E. ROEDIG Surgeon Capt. Dr W. GRONFELDT Generalartz der Luftwaffe. Fachdienstliche Abteilung II Danish Armed Forces Health Services PO Box 902500, BW 356 Jaegersborg Alle 150, PO BOX 96 Koeln-Wahn 552 - GERMANY DK-2820 Gentoffe - DENMARK Tel: 49 2241 95 80 236 Tel: 45 3977 1241 Fax: 45 3977 1220 Fax: 49 2241 388 036 Email: fsusls@hotmail.com Email: recce52@aol.com Col. Dr D. IVAN Med. Chef J. P. MENU Chief Clinical Services HIA Saint Anne/IMNSSA/D USAFSAM/AFC Boulevard Saint Anne 2507 Kennedy Circle 83800 Toulon Naval - FRANCE Brooks AFB, TX 78235-5117 - USA Tel: 33 4 9409 9168 Fax: 33 4 9409 9251 Tel: 1 210 536 3241 Email: jp.menu@wanadoo.fr Col. Dr G. WOLF Chief Division Hyperbaric Medicine USAFSAM/FEH, 2602 West Gate Road Brooks AFB, San Antonio, TX 78235 - USA Tel: 1 210 536 3281 Fax: 1 210 536 2944 Email: george.wolf@brooks.af.mil Email: douglas.ivan@samafc.brooks.af PANEL EXECUTIVE Dr C. WIENTJES BP 25 - 7, Rue Ancelle 92201 Neuilly-sur-Seine, France Tel: +33 1 55 61 22 60 Fax: +33 1 55 61 22 98 E-mail: wientjesc@rta.nato.int or pelatd@rta.nato.int viii
Introduction Technical Evaluation Report Otto I. Molvær N-5555 Forde, Norway Hypo-and hyperbaric exposures are encountered in many routine and special military operations in most of the alliance member countries. Specific operational medical issues affecting air, sea and land forces have not previously been addressed in a NATO forum. The <strong>HFM</strong> Panel identified the need to discuss these issues in a wide forum. Symposia are held in conjunction with the bi-annual business meeting of the <strong>HFM</strong> panel, which is hosted in turn by the alliance nations. On this occasion it was Canada’s turn, and since the present issues have been extensively studied in Canadian research establishments, it was natural to choose these topics this time. Man is adapted to tolerate relatively small and slow pressure fluctuations, but can under certain circumstances manage earth-bound, self-propelled travel to any altitude on the planet. Likewise, human physiology functions normally only within narrow boundaries of oxygen partial pressure. Differences in individual tolerance to stress of any kind, including the two mentioned, are great. Accordingly, appropriate selection of personnel for special operations is critical. Also, adequate training and time for adaptation and acclimatisation are important. If something goes wrong during operations outside normal environmental conditions, causing disease or injury, effective treatment must be available. In any hypo- or hyperbaric operation, technical solutions are critical. The present symposium addressed all these aspects. Decompression illness (DCI) DCI has been a central problem since the technical development allowed man to exceed the narrow pressure limits defined by self-propelled surface travel. Early encounters were during flights in balloons and work in caissons. Much knowledge about how to avoid the problem, and how to treat it, has been gathered. Nevertheless, a final solution is yet not found. This reflected the fact that 19 (41%) of the 46 presentations in the symposium focussed on that problem. Even routine operations of air and sea forces, and special operations of land forces, all the time expose personnel to environments where this is a threat. Hyperbaric exposure Eight (17%) of the 46 presentations focussed mainly on DCI during hyperbaric diving. Although, according to paper 29, the risk of DCI is as low as 8.5 cases per 100,000 dives in shallow air diving, in deeper diving it increases to 14.8 on nitrox and 52 on heliox. In air dives exceeding 44 msw, the incidence was 166. Even though the incidence is relatively low, for those stricken, it may have serious consequences. Traditionally, one has distinguished between type I and type II DCI, mainly depending on severity. When clinically obvious symptoms and signs from the nervous system are present, the condition is thought to be serious and is classified as DCI II. I am not convinced that this distinction is important. A short delay between symptom onset and treatment is generally accepted as important for the final outcome, based on theoretical considerations and practical experience. In paper 10 it is documented that when treatment started later than 6 hrs after T-1
Page 1 and 2: RTO-MP-062 NORTH ATLANTIC TREATY OR
Page 3 and 4: NORTH ATLANTIC TREATY ORGANIZATION
Page 5 and 6: Operational Medical Issues in Hypo-
Page 7 and 8: Contents Executive Summary iii Synt
Page 9: Respiratory Changes and Consequence
Page 13 and 14: In addition to cabin pressurisation
Page 15 and 16: critical. The so-called technical d
Page 17 and 18: levator veli palatini, like when sw
Page 19 and 20: Present and Future Compromises in A
Page 21 and 22: KN1-3 (RGE) as the safety criterion
Page 23 and 24: Pulmonary Barotrauma KN1-5 Free ven
Page 25 and 26: KN1-7 Future fighter aircraft may w
Page 27 and 28: KN1-9 Figure 1 Cabin Pressurisation
Page 29 and 30: KN1-11 Figure 3 The relationships b
Page 31 and 32: +\SHUEDULF 2[\JHQ $ 6FLHQWLILF 8SGD
Page 33 and 34: KN2-3 recovers spontaneously withou
Page 35 and 36: KN2-5 Hg or less. The attendant hyp
Page 37 and 38: KN2-7 8 Tompach PC, Lew D, Stoll JL
Page 39 and 40: USAF Experience with Hyperbaric The
Page 41 and 42: Exposure Results and Discussion The
Page 43 and 44: Symptomotology Symptom presentation
Page 45 and 46: Air Force Altitude DCS Treatment Al
Page 47 and 48: References 1. Atlas of Injuries in
Page 49 and 50: Headache and Decompression Sickness
Page 51 and 52: Numerous studies have been done to
Page 53 and 54: 8. Madeline LA and Elster AD. Sutur
Page 55 and 56: Figure 2. Sutural Movement with Spi
Page 57 and 58: Patent Foramen Ovale as a Risk Fact
Page 59 and 60: 90 minutes prior to the start of th
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The Relevance of Patent Foramen Ova
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In a human population, Glen et al (
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Studies evaluating PFO detection me
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References 1. O’Rahilly, R., Mull
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55. Giroud, M., Tatou, E., Steinmet
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Introduction Altitude DCS Susceptib
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Cumulative DCS Incidence, % 100 90
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Pharmacological Correction of the H
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metabolic regulation remedies [A.S.
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asis of these indicators there were
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liquidation of energetic debt in mu
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Analysis of correlation structures
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Interesting data on bemithylum pres
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to high altitude hypoxia and allows
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35. Shanazarov, A.S., Ryskulova, G.
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Prognozing of the Resistance to Hyp
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autonomic cardiac control whereas i
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METHOD Subjects 21 male military pi
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mean R-R interval (X), STV, LTV (ms
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• Significant negative correlatio
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DISCUSSION Hypoxic Tolerance Our re
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8. Casa M., Casa H., Pages T., Rama
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66. Sheffield P., Heimbach R. Respi
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Abstract Alternobaric Vertigo: Inci
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12. Nagai H. et al. Effect of incre
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Neuropsychometric Test in Royal Net
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Table 4 Results of neuropsychometri
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Summary: Spanish Navy Up to Date Da
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Hypobaric Training for Royal Air Fo
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c. Fast jet high level. Climb to 18
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Introduction Hypobaric Training Iss
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To be able to tolerate breathing pr
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during the change in ambient pressu
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Designing Efficient and Effective,
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The Type II profile involves positi
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Pressurized, Cabin below 10,000 ft
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than 10 minutes at a hypoxia level
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Military Personnel Selection and Di
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expressed by them, are closely inte
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of shortage of blood circulation fu
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The results of the conducted resear
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15-9
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15-11
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In norm there is A > B, and the reg
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Burger, M., 1921, Uber der klinisch
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In: Sbornik nauchno-prakticheskih r
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Templeton, A.W., 1965, Renal Aortog
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Some Psycho-Physiological and Cogni
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Testing in hypobaric chamber condit
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supply immediately recovered. Subje
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The Role of PWC in Declaring a Dive
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Out of 1200 ergometric examinations
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Application of Hypo and Hyperbaric
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evaluation of mountain-climber's hy
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Figure 2 % oxyhemoglobin saturation
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The Effects of Normobaric Hypoxia i
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Memory Scanning Task: Cadets with p
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The statistical analysis of the beh
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ACKNOWLEDGMENTS The authors wish to
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Severe Decompression Illness Follow
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In this set of studies, observation
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pulmonary oedema, a diuretic may be
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Decompression Sickness Research: Ne
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Figure 3. Pigs treated with methano
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Abstract Using “Technical Diving
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ecreational diving training agencie
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After the intermediate or “deco
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include paresthesia, headache, dizz
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practice. Some dives were conducted
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Abstract Into the Theater of Operat
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Procedures: The FCT evaluation init
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The matrix of tests conducted, some
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6. Kennedy, T. Concept of Operation
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The Relevance of Hyperbaric Oxygen
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In reperfusion injury, HBO diminish
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HBO has long been known to favorabl
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3-Nitrotyrosine Predicts Healing in
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corresponded respectively to the si
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that in these diabetic subjects, ne
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Summary Role of a Clinical Hyperbar
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Benefits to the Defence Secondary C
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The study has been deferred due to
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ABSTRACT Incidence of Decompression
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Table 1: Number of Diving Incidents
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Introduction Evaluation of Treatmen
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Table 6A (CF TT6A, initial recompre
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INTRODUCTION Modelling and Validati
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moved to the treatment chamber. Fiv
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Figure 3 The predicted gas in bubbl
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Table 5 shows the same information
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CONCLUSIONS Although it would have
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Respiratory Changes and Consequence
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Table 2 Inspired-expired oxygen dif
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Figure 2 Respiratory patterns, expe
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Apnoea is characteristic of herniat
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Effect of Exercise on Bubble Activi
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The KISS is an index derived from i
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DISCUSSION: In all group comparison
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Thermography - A Method for the Eva
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level atmospheric pressure O2 parti
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lower extremities cephalic extremit
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1-st group - flying crews We divide
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ABSTRACT Altitude Decompression Sic
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Table 1. Results of validation Prof
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Summary Altitude Decompression Illn
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17 oxygen demand regulator with a p
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During these altitude exposures a n
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Subject Number Subject Number Subje
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that this discrepancy in the incide
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Extrapolation of the data presented
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MITCHELL SJ & LEE VM. (2000) A surv
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Expression of Neuronal and Inducibl
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Experimental procedures Groups of 1
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immunoreactive Purkinje cells were
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Western blotting Cerebral cortical
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certain proteins as substrates for
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Griffiths, T., Evans, M.C. and Meld
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Simon, R.P., Griffiths, T., Evans,
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RESUME Intérêt du caisson d’alt
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3. TYMPANOMETRIE La tympanométrie
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quelconque douleur. Dans ce cas, il
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Altitude DCS Research in Support of
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Altitude, feet X 1000 30 25 20 15 1
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2. POST-LANDING EXERCISE AND RISK O
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addition to observed or reported DC
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% DCS 100 80 60 40 20 0 25,000 30,0
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Modeling Approach for Oxygen Exchan
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The first equation states that the
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may cause the remaining discrepanci
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0 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 F
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Sa (%) Pa (mmHg) 100 80 60 40 V’E
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Sa (%) Pa (mmHg) V’E (L/min) 100
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Changes of Ventilator Generated Vol
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Emergency descent : Oxylog 2000 : C
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&DELQ $OWLWXGH IHHW Table 6 &DELQ D
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The Effect of Increased Full Covera
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assembly incorporating FCAGTs infla
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Following garment fitting, subjects
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Mean CBV (cm/s) 70 60 50 40 30 20 1
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Alveolar Carbon Dioxide Tension Alv
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Phase 2 All experimental exposures
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Diffusion coefficient for carbon mo
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Mean arterial pressure (mmHg) 140 1
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In previous studies (Ernsting, 1966
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Determination of the Most Effective
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Decompression Sickness, Extravehicu
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As a corollary, what about the alle
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Introduction Optimizing Denitrogena
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Cumulative % DCS 100 90 80 70 60 50
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Benefit of Acclimatization to Moder
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. Following completion of the quest
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Discussion This study demonstrated
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12. White, D.P., K. Gleeson, C.K. P
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Introduction: Physiological and Cli
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The steepness of hypoxia-induced de
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RESUME Évaluation d’équipements
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2.1. Règlement TSO-C99 Le règleme
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autre personne s’assure que, sans
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Il est équipé de l’équipement
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REPORT DOCUMENTATION PAGE 1. Recipi
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NORTH ATLANTIC TREATY ORGANIZATION
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