Fundamentals of Aerospace Medicine

754 Pages·2008·13.58 MB·English

by  Jeffrey R. Davis

F O U R T H E D I T I O N
FUNDAMENTALS OF
AEROSPACE MEDICINE
EDITORS
Jeffrey R. Davis, MD, MS Robert Johnson, MD, MPH, MBA
Professor AssociateProfessor
PreventiveMedicine PreventiveMedicineandCommunityHealth
andCommunityHealth TheUniversityofTexasMedicalBranch;
TheUniversityofTexasMedicalBranch StaffPhysician
Galveston,Texas AviationMedicalCenter
UniversityofTexasMedicalBranchUniversityHospitals
Jan Stepanek, MD, MPH Galveston,Texas
AssistantProfessor
Jennifer A. Fogarty, PhD
MedicalDirectorAerospaceMedicineProgram
DivisionofPreventive,Occupational AdjunctAssistantProfessor
andAerospaceMedicine PreventiveMedicineandCommunityHealth
DepartmentofInternalMedicine TheUniversityofTexasMedicalBranch
MayoClinic Galveston,Texas;
Scottsdale,Arizona; BiomedicalRiskCoordinator
AssistantProfessor SpaceMedicineDivision
PreventiveMedicineandCommunityHealth NASA
TheUniversityofTexasMedicalBranch Houston,Texas
Galveston,Texas
AcquisitionsEditor:SonyaSeigafuse MarketingManager:KimSchonberger
ManagingEditor:KerryBarett DesignCoordinator:TerryMallon
ProjectManager:NicoleWalz CoverDesigner:JosephDePinho
ManufacturingManager:KathyBrown ProductionServices:LaserwordsPrivateLimited,Chennai,India
2008byLIPPINCOTTWILLIAMS&WILKINS,aWoltersKluwerbusiness
2002,1996,1986byLIPPINCOTTWILLIAMS&WILKINS
530WalnutStreet
Philadelphia,PA19106USA
LWW.com
CreditLinesforCoverPhotos
FromToptoBottom:
SpaceShipTwo:CourtesyofVirginGalactic
InternationalSpaceStation:CourtesyofNASAMarshallSpaceFlightCenter(NASA-MSFC)
ApolloSoyuz:CourtesyofNASAMarshallSpaceFlightCenter(NASA-MSFC)
MercuryCapsule:CourtesyofNASAHeadquarters—GreatestImagesofNASA(NASA-HQ-GRIN)
SR-71:CourtesyofNASADrydenFlightResearchCenter(NASA-DFRC)
BellX-1:CourtesyofNASAHeadquarters—GreatestImagesofNASA(NASA-HQ-GRIN)
FordTri-motor:CourtesyofNASALangleyResearchCenter(NASA-LaRC)
WrightFlyer:CourtesyofNASAMarshallSpaceFlightCenter(NASA-MSFC)
Allrightsreserved.Thisbookisprotectedbycopyright.Nopartofthisbookmaybereproducedinanyformorbyanymeans,including
photocopying,orutilizedbyanyinformationstorageandretrievalsystemwithoutwrittenpermissionfromthecopyrightowner,exceptfor
briefquotationsembodiedincriticalarticlesandreviews.Materialsappearinginthisbookpreparedbyindividualsaspartoftheirofficial
dutiesasU.S.governmentemployeesarenotcoveredbytheabove-mentionedcopyright.
Chapter11copyrightedbytheMayoFoundation
PrintedintheUSA
LibraryofCongressCataloging-in-PublicationData
Fundamentalsofaerospacemedicine/editors,JeffreyR.Davis...[etal.].—4thed.
p.;cm.
Includesbibliographicalreferencesandindex.
ISBN978-0-7817-7466-6
1.Aviationmedicine.2.Spacemedicine.I.Davis,JeffreyR.
[DNLM:1.AerospaceMedicine.2.SpaceFlight.WD700F9812008]
RC1062.F862008
616.9(cid:1)8021—dc22
2008003374
Carehasbeentakentoconfirmtheaccuracyoftheinformationpresentedandtodescribegenerallyacceptedpractices.However,the
authors,editors,andpublisherarenotresponsibleforerrorsoromissionsorforanyconsequencesfromapplicationoftheinformation
inthisbookandmakenowarranty,expressedorimplied,withrespecttothecurrency,completeness,oraccuracyofthecontentsofthe
publication.Applicationofthisinformationinaparticularsituationremainstheprofessionalresponsibilityofthepractitioner.
The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in
accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in
governmentregulations,andtheconstantflowofinformationrelatingtodrugtherapyanddrugreactions,thereaderisurgedtocheck
thepackageinsertforeachdrugforanychangeinindicationsanddosageandforaddedwarningsandprecautions.Thisisparticularly
importantwhentherecommendedagentisaneworinfrequentlyemployeddrug.
SomedrugsandmedicaldevicespresentedinthispublicationhaveFoodandDrugAdministration(FDA)clearanceforlimitedusein
restrictedresearchsettings.ItistheresponsibilityofthehealthcareprovidertoascertaintheFDAstatusofeachdrugordeviceplannedfor
useintheirclinicalpractice.
Topurchaseadditionalcopiesofthisbook,callourcustomerservicedepartmentat(800)638-3030orfaxordersto(301)223-2320.
Internationalcustomersshouldcall(301)223-2300.
VisitLippincottWilliams&WilkinsontheInternet:atwww.LWW.com.LippincottWilliams&Wilkinscustomerservicerepresentatives
areavailablefrom8:30AMto6:00PM,EST.
10 9 8 7 6 5 4 3 2 1
F O R E W O R D
UnlikemostForewords,Ihaveelectedtocommencebygoing followed with the third in 2002 jointly edited with Dr. Jeff
backward.Forthebenefitofthereaderofthisfourthedition Davis.
of ‘‘Fundamentals’’ I begin with a very brief review of this Nowwegoforwardtothisthefourthedition;timeand
texts’progenitors. circumstance combined with age and wisdom to place the
The foundation for this series of textbooks was laid challenge of editorship into younger and willing hands to
by Dr. Louis Bauer in 1926 when he published the first moveforwardwiththetask.Dr.Davishadbeenrequestedto
volumeonthistopicintheUnitedStates—AviationMedicine. assistasco-editorofthethirdeditionwiththecommitmentto
Dr.Baueralsoplayedanimportantroleinthedevelopmentof takeontheresponsibilityofthefourtheditionasIwithdrew.
CivilAviationaswellasthespecialtyofAerospaceMedicine ThistextisnowinthehandsofDr.Davisandhisco-editors.
andbecameapresidentoftheAmericanMedicalAssociation. Thereaderwillquicklynotethatwhilemilitarytopicsfade
In 1939, building on the foundation established by Dr. they are replaced with more contributions found on space
Bauer, Dr. Harry Armstrong authored his first edition of medicine with commercial and general aviation holding
The Principles and Practice of Aviation Medicine. As Dr. their own. This reflects the changing allocation of research
Armstrong’scareerprogressedintheArmyAirCorp:from commitments in the United States. From the first edition
laboratorycommander,to GeneralOfficer,to Commander of Aviation Medicine through the current fourth edition
of the School of Aviation Medicine culminating as the Air of ‘‘Fundamentals’’ the goal has not changed—to provide
Force Surgeon General—his textbook progressed from the informationonthephysiologyofflight,thehazardsofflight,
second to the third editions. His next book carried a new and the selection and health maintenance of those who fly
titlein1961reflectingthegrowinginterestof‘‘maninspace’’ andthosewhofacilitatesuchactivities.
andwaseditedbyDr.Armstrongashewasjoinedbyother New to this edition are chapters on Radiation, Toxi-
contributorstoAerospaceMedicine.Thesecondedition,the cology,EmergingInfectiousDisease,Dental,andWomen’s
mantle for editing which fell to Dr. Hugh Randel, a flight Health.Thenewsectiononthefuturediscussesthegovern-
surgeon and Preventive Medicine Specialist, was published ments’roleinAerospaceandCommercialspaceactivities.
in1971. This text is for the most part written from the
In1980asIdepartedtheArmstrongAerospaceMedical perspective of the United States. This is not intended to
ResearchLaboratoryatWright-Pattersontotakecommand be an international tome but it is anticipated that as with
oftheUSAFSchoolofAerospaceMedicine,aneweditionwas the prior editions other nations will find it useful. The
needed in response to the new research and developments audience has remained unaltered over time—physicians,
in the field that had occurred during the past decade since physiologists, researchers, residents, and interested readers
the last textbook had appeared. Unfortunately, it was not on the challenges to people in flight—whether in the
possible to use the title introduced by Dr. Armstrong due terrestrialenvironmentorthevastnessofspace.
to issues of clearing the copyright restrictions. Although This edition proves the merits of my decision to leave
Dr. Randel had visions of a third edition, he found thestageforthenextgeneration,andIthankreadersforthe
he had neither the time nor the resources to proceed. kindwordsofferedtothecontributorsandmeforourbest
At this point, it became necessary to change both the efforts.
publisher and the title if the book was to continue,
and I introduced Fundamentals of Aerospace Medicine and RoyL.DeHart,MD,MPH,MS
proceededtoidentifyothercontributorswhowillinglyjoined ColonelandChiefFlightSurgeon,USAF(Ret)
in writing the chapters. This textbook was published in ProfessorandMedicalDirector,CorporateHealthServices
1985 under my editorship. In 1996, the second edition VanderbiltUniversityMedicalCenter
iii

F O R E W O R D T O T H I R D E D I T I O N
This third edition of the already classic textbook Funda- Overtheyears,aviationandmedicalauthoritiesrealized
mentals Of Aerospace Medicine reflects and covers in detail that research was needed and studies began to assess
contemporarytrendsintheevolutionofafascinatingmedi- human performance and limitations related to aerospace
caldiscipline,whichinmanyareasoftheworldhasachieved environmentsandaneedaroseforamoreprecisedefinition
thelevelofapostgraduateuniversityspecialty. oftheobjectiveofthespecialty.
Aviation medicine (later on, by natural extension, In relation to civil aviation, most of these studies were
Aerospace Medicine) started as an indispensable response conducted at national levels; it soon became apparent that
toaneedtoregulatethepresenceofhumankindinaviation to achieve proper international standardization, medical
inrelationtooperationalsafety.Morerecentlyitsscopehas requirements for aviation duties had to be adopted by an
beenbroadenedgloballybygivingemphasistoitspreventive International Organization of the United Nations System,
aspect;greaterattentionisadditionallygiventoalloccupants namelytheInternationalCivilAviationOrganization.
ofairandspacecraft,includingpassengersandspacetourists. These requirements were incorporated in Annex 1
The magnitude of global air transportation of healthy and to the Chicago Convention and they include physical,
lesswellpassengersestablishedtheneedtohaveacontinuous mental, hearing, visual and color perception requirements.
update of knowledge of operational and environmental As a result of these standards and recommendations and
conditions (potentially) affecting humans. Such need is of their evaluation in the context of flight safety, it became
paramount importance and this edition includes the most indispensabletofurtherstudyindetailtheproperassessment
current information available in contemporary Aerospace ofhumanperformance,limitationsandtheconsequencesof
Medicine. exceedingthoselimitations.
Humanshaveadjustedtheirbiologicalsystemstolifeat Paraphrasing two sentences of General Howard W.
or near sealevelwheretheyfunctionat agivenbarometric Unger’s foreword to the first edition of this textbook, it
pressure and a given partial pressure of oxygen with a is worthwhile to emphasize that the specialty of Aerospace
normalhemoglobinrange.Departurefromthisenvironment Medicinereflectsadynamicandprogressivenatureandthat
to altitude brings about the need to have adaptation theneedtoopenlysharethewealthofinformationgathered
mechanisms, which encompass ventilatory, circulatory and isreadilyapparent.
hematologicaladjustmentsovertime. Several definitions of Aerospace Medicine are available
Exposure to altitude conditions by aviation is almost to readers; it seems indispensable to emphasize that, as
immediate and does not allow the time for adaptation far as crew members are concerned, it should be viewed
mechanism to appear, therefore technological aids are as a multidisciplinary specialty related to valid mental and
indispensable and as such, a classical example is given by physicalrequirementsinresponsetorealisticoperationalneeds
cabinpressurizationsystems. toproperlyperformdutieswithanoptimumlevelofsafety.
Proper interaction of humans, machines and environ- Relatedtopassengers,clinicalandenvironmentalaspectsare
mentsisneededtoachieveanoptimumlevelofOperational significantinordertoachieveagoodlevelofsafety,health,
Safety.Emphasizingagaintheneedforproperinteraction,we comfortandwellbeing.
shouldrememberthathumansarenecessaryforthedesign, Summarizing, it is indispensable for practitioners of
operationandmaintenanceofaircraft. Aerospace Medicine to continuously assess the adequate
Everyyear,almostonequarteroftheworld’spopulation interactionneededbetweenhumans,machinesandenviron-
travel byair onscheduledflightswith an optimumlevelof ments.Therefore,thiseditionofFundamentalsofAerospace
safety compared to othermeansofmass transportation. In Medicineprovidesinformationandreferencesusefulto the
tryingtosatisfytheneedsofthetravelingpublic,expertsare medical examiners as well as to specialists in all aspects of
working hard in providing solutions to problems, or even the discipline. The wealth of information presented in this
betterinpreventingtheappearanceofthoseproblems.Our thirdeditionallowspractitioners,specialistsandresearchers
specialty,asignificantcontributortosuchlevelofsafety,has toacquireitinaverywellorganizedpresentation.Suchac-
seenasignificantevolutionofwelldefinedanddocumented quisitionwillallowustohaveoptimumexchangesofviews
periods:itsbeginningswereempiricalandwerefollowedby andtoperformdutiesinlinewiththerequirements.
observational,experimental,humanfactorsandergonomic
stages. More recently the legal implications attracted the SilvioFinkelstein,MD,MSc
attention of the experts and, in this respect, more studies FormerSeniorOfficial,InternationalCivilAviationOrganization
are being conducted in jurisprudence and ethics before an Past President, International Academy of Aviation and Space
aeromedicaldecisiontakesplace. Medicine
v

F O R E W O R D T O S E C O N D E D I T I O N
In introducing this impressive volume, I believe it most of the pilot, relate this to the flying environment, and
importanttobeginwithadefinitionofthesubject.Aerospace render a decision regarding fitness for flying. Therefore,
medicine is that specialty area of medicine concerned with the Fundamentals of Aerospace Medicine must cover a large
thedeterminationandmaintenanceofthehealth,safety,and amountof information. Aerospace medicineis of necessity
performanceofthosewhoflyintheairorinspace.Thisspecialty very dynamic. It must keep pace with the ever-increasing
isnecessarybecausesuchflightsubjectshumans,withtheir technology of both medicine and aviation. Increases in
earth-bound anatomy, physiology and psychology, to the fighter aircraft capabilities have forced a re-evaluation of
hostile environment of air and space. Humans must adapt a physiologic problem once thought to be solved. Current
to or be protected from the changes in total environment social assaults on the necessity of physical standards for
pressure,reducedpartialpressuresofvitalgasses,accelerative those who fly have even forced a re-evaluation of med-
forcesofflight,andchangesingravitationalforces,toname ical standards. Aircraft are getting larger, and faster, and
justafewofthehazardsencounteredinflight. more and more people are flying. Such dynamic changes
Historically, the early balloon flights in the late 1700’s indicated the necessity for a current, comprehensive text.
producedreportsofphysicaleffectsonthehumansengaged Dr. DeHart built upon the efforts of his predecessors,
in such ascents, but they were treated as interesting such as General Harry Armstrong, in gathering material
physiological observations. The advent of powered flight forthe firsteditionofFundamentalsofAerospaceMedicine.
92 years later by the Wright brothers on December 17, In the second edition, he has assembled the aid of re-
1903 and then human spaceflight by Gagarin on April 12, spected authorities in their individual areas to add new
1961 revealed additional effects and potential obstacles to chapter, update others with recent data and completely
human performance in this new environment. However, rewriteothers.
theseobstacleswereviewedaschallengestobesolvedbythose We must understand our past if we are not to repeat
individualssupportingtheexplorersoftheseenvironments. the errors of the past. The section ‘‘Aerospace Medicine
Theylearnedthattheenvironmentsofairandspacewerea in Perspective’’ covers some of this important history very
continuumandthatbasicphysiologicfundamentalsapplied well.Thesections‘‘Physiologyof theFlightEnvironment,’’
throughout this continuum. It is these environmental and ‘‘ClinicalPracticeofAerospaceMedicine’’and‘‘Operational
vehicular stresses upon those who fly that are of ultimate AerospaceMedicine,’’havechaptersprovidingfundamentals
concerntotheaerospacemedicinespecialist. withbasicreferences.Thesection‘‘ImpactoftheAerospace
The specialty area of aerospace medicine is young IndustryonCommunityHealth’’includesachapterconcern-
compared to some other medical specialties. Even though ingtransmissionofdiseasebyaircraftwithcurrentconcerns
physicianshadsupportedthosewhoflewfromthebeginning, about an old and nearly forgotten nemesis, tuberculosis.
thespecialtywasnotrecognizeduntil1953.Thoughrelatively Fundamentalsrevisitedagain.Newchaptershaveappropri-
young,aerospacemedicalresearchandextensiveoperational atelybeenadded:‘‘ThermalStress,’’‘‘InternationalAviation
experience has been accumulated and well documented. Medicine’’ and ‘‘Management of Human Resources in Air
Thesedatesareinnumerousscientificjournals,reports,and TransportOperations.’’
books. It is the rare individual today who does not have some
Specialized knowledgein manymedical as wellas non- contactwiththeaviationenvironmentinsomemanner.All
medical areas is required of the practitioner of aerospace physicians should have some basic knowledgeof aerospace
medicine. The medical specialties of otolaryngology, oph- medical problems they or their patients might experience,
thalmology, cardiology, neurology, psychiatry/psychology, as well as understand the breadth of knowledge possessed
and pathology are of particular importance. The human by the specialist in aerospace medicine. This text can serve
cannot be separated from the vehicle, therefore certain en- asthebasisofthisknowledgeforthegeneralphysician,the
gineering principles are also important. The total support aerospacemedicinespecialist,thestudent,oranyonedealing
of those who fly becomes a team effort. The aerospace with the medical support of military, general, or airline
medicinespecialistmustbeabletocommunicatewithother aviation,spaceflight,ortheaerospaceindustry.
specialists. He or she must be able to gather all of this It has been my privilege in 45 years of practice in
information and evaluate its impact on the health status Aerospace Medicine to participate in the Air Force, NASA,
vii
viii FOREWORD TO SECOND EDITION
andcivilianareas.IcongratulateDr.DeHartandhisauthors achieving safe flight. This volume makes that knowledge
for their excellent coverage of all these areas. If we adhere available.
tothefundamentalsandprovideproperaerospacemedical
support, the human will continue to be able to adapt to CharlesA.Berry,MD,MPH
zerogravityandre-adapttoearth’sgravitywitheverlonger President,Preventive&AerospaceMedicineConsultants,P.A.
sojourns in space. I believe we will see many of earth’s PastPresident,AerospaceMedicalAssociation
inhabitantsexperiencingspaceflightandevenonedayliving Past President, International Academy of Aviation and Space
in far flung space stations and colonies. The fundamentals Medicine
willbethebasicknowledgeandthesteppingstonesmaking Past President, University of Texas Health Science Center in
such progress possible. This knowledge must be used Houston,Texas
by the planners, designers, operators, and participants in FormerDirectorofLifeSciences—NASA