Aerospace medicine (aviation medicine)
Aerospace medicine, also known as aviation medicine, is a specialized branch of medicine focused on the health implications of flight and space travel. This field addresses unique medical conditions caused by the atmospheric pressures and environments associated with air and space travel, including issues like hypoxia, barotrauma, and decompression sickness. Aerospace medicine merges the disciplines of aviation medicine and space medicine, reflecting the diverse challenges faced by astronauts, pilots, and passengers in confined, high-stress settings. Practitioners in this field come from various medical backgrounds and undergo specialized training to address the biological and psychological effects of environments beyond Earth’s atmosphere.
Historically, the need for aerospace medicine emerged as early as the sixteenth century, as explorers noted health issues at high altitudes. With advancements in aviation, particularly during the World Wars, the discipline evolved to include extensive training and research. Aerospace medicine encompasses not only treatment but also preventative measures and research into the effects of air and noise pollution, psychological impacts of confinement, and the physical demands of space travel. Specialized education and training programs exist, primarily in the United States, to equip medical professionals with the skills necessary to navigate the complexities of aerospace health care. Overall, aerospace medicine plays a crucial role in ensuring the safety and well-being of individuals operating within and traveling through unique atmospheric environments.
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Aerospace medicine (aviation medicine)
Aerospace medicine (ASM), or aviation medicine, is the branch of medicine specifically oriented toward the treatment of conditions related to flight or space travel. Aerospace medicine is usually regarded as the combination of the specialties of both aviation medicine and space medicine, although the terms aerospace medicine and aviation medicine may sometimes be used interchangeably. In particular, ASM is concerned with treating the health of people experiencing the atmospheric conditions related to air and space travel. These may include conditions related to heavy inertia, extreme changes in air temperature, oxygen depletion, and air sickness. With regard to space travel, doctors specializing in ASM study the biological and psychological effects of travel outside Earth's atmosphere, such as radiation exposure, the effects of weightlessness, the body's reaction to the lack of alternating days and nights, and the psychological effect of being enclosed in small spaces for lengthy periods. ASM specialists may be found in both the civilian and military sectors of medicine.
Background
Aviation and aerospace conditions are different from virtually all other environments. The passengers and crew of air and space travel vehicles must adapt to confinement in small spaces for lengthy periods in environments that can result in extreme physical, mental, and emotional stress. Other medical disciplines are not traditionally trained to treat the sorts of illnesses that can result from these conditions, so a branch of specialized medicine that can quickly and efficiently offer solutions to the immediate and long-term effects of environments to which the human body has not adapted is necessary. ASM specialists are trained to treat all potential conditions resulting from air and space travel and activities that mimic these environments, such as deep-sea diving and mountaineering. Patients may include astronauts, pilots, passengers, air traffic controllers, undersea divers, and mountain climbers.
The recognition of the unique health conditions arising from movement through the upper atmosphere was first recognized by Spanish conquistadors during their sixteenth century high-altitude war campaigns in Mexico and the Andes Mountains of South America. Their soldiers developed a range of symptoms, including appetite loss, nausea, pain, and vomiting, during their crossings of high mountain passes. However, these symptoms would disappear once they returned to lower altitudes.
More advanced studies on the potential effects of vacuums and atmospheric pressure on the human body were conducted from the seventeenth through the nineteenth centuries by such scientists as Evangelista Torricelli, Jacques Alexandre César Charles, and Robert Boyle. These studies occurred in conjunction with major advancements in flight. The first balloon pilots reported problems with altitude that affected their ears, necessitating the need for a greater understanding of how aviation practices could negatively impact people. By the nineteenth century, pilots had succeeded in attaining heights of twenty to thirty thousand feet (six to nine thousand meters). Some of these flights resulted in pilots' deaths from hypoxia (the lack of oxygen). In the late nineteenth century, balloons were used in support of military efforts to transport patients from the battlefield. This required special personnel trained to understand the conditions associated with this new technology.
The Wright brothers' first heavier-than-air flight in 1903 initiated a new era of air travel, and with it came an increased emphasis on the field of aviation medicine. The increasing use of airplanes in World Wars I and II led to further advances in this growing field of study. Over the course of the twentieth century, aviation medicine increasingly became seen as a distinct discipline, requiring special skills and knowledge and, eventually, the development of aviation-oriented medical degrees. The advent of space travel led to the fusion of aviation and space medicine into aerospace medicine by the late twentieth century.
Overview
Aerospace medicine is open to specialists in a number of fields, including doctors, nurses, psychologists, bioenvironmental engineers, industrial hygienists, environmental health practitioners, and other medical personnel. ASM physicians are required to gain a standard medical degree (either an MD or DO) before starting their specialization in aerospace medicine. As of 2016, non-military programs typically demanded the completion of an additional full internship year of direct patient care before starting a residency, while military programs required a master's degree in public health. Some programs also require a master's degree in aerospace studies. Military programs are oriented to help prepare candidates in all ASM fields for potential eventualities through specialized training in a variety of ASM-related clinical environments. Other programs are geared less toward specific sectors and can be variously applied to commercial ASM specialties, the National Aeronautics and Space Administration (NASA), and military avenues. Many ASM specialists receive flight training so that they may apply these skills in the same environments in which they occur. Some medical professionals in this discipline may seek training in other specialties, such as ophthalmology and internal medicine.
Like all doctors, ASM specialists must periodically seek recertification so they remain up to date on all the latest medical discoveries and treatments in their discipline. Due to its highly specialized nature, ASM training is offered at only a few universities in the United States, including Wright State University in Dayton, Ohio; the Mayo Clinic in Rochester, Minnesota; the University of Texas-Medical Branch in Galveston, Texas; and military programs in Dayton, Ohio, and Pensacola, Florida.
Aerospace medicine has a number of practical applications. For instance, the effect of air and noise pollution is one area studied by research specialists in this field. However, the treatment of patients remains the primary focus of health care workers in the ASM discipline. While ASM specialists need to have a background in general medicine that allows them to treat any medical condition that arises, ASM physicians are more apt to encounter certain conditions resulting from the special circumstances that arise in air and space environments. As a result, they have a greater ability to treat such conditions as barotrauma (damage to the body caused by changes in air or water pressure), decompression sickness (an illness that develops during depressurization), spatial disorientation, hypoxia (a loss of oxygen to the body), ebullism (the development of gas bubbles in bodily fluids at high altitude), and microgravity-induced bone loss.
Beyond ASM physicians, ASM transportation specialists focus on the safe movement of patients via AirEvac transport. ASM psychologists study the effects of space travel and confined spaces on the minds of travelers and aerospace crews. ASM is also concerned with determining pilots' physical ability to fly using the medical certification process required by the Federal Aviation Administration (FAA).
Bibliography
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Barratt, Michael R., and Sam Lee Pool. Principles of Clinical Medicine for Space Flight. Springer, 2008.
"Definition of Aerospace Medicine." MedicineNet, 9 June 2016, www.medicinenet.com/script/main/art.asp?articlekey=31752. Accessed 27 Dec. 2016.
Dille, J. Robert, and Stanley R. Mohler. "The Beginnings: Past and Present." Fundamentals of Aerospace Medicine. Edited by Jeffrey R. Davis., et al., Lippincott Williams & Wilkins, 2008, pp. 1–18.
Doarn, Charles R., and Stanley R. Mohler. "Physician Training in Aerospace Medicine—An Historical Review in the United States." Aviation, Space, and Environmental Medicine, vol. 84, no. 2, 2013, pp. 158–62.
Doarn, Charles R., et al. "Training in Space Medicine." Space Physiology and Medicine: From Evidence to Practice. 4th ed., edited by Arnauld E. Nicogossian, et al., Springer Science and Business Media, 2016, pp. 463–79.
Gradwell, David P., and David J. Rainford, eds. Ernsting's Aviation and Space Medicine. 5th ed., CRC Press, 2016.
"Pilot Medical Certification Questions and Answers." Federal Aviation Administration, www.faa.gov/licenses‗certificates/medical‗certification/faq/. Accessed 27 Dec. 2016.
Rayman, Russell B., et al., eds. Rayman's Clinical Aviation Medicine. 5th ed., Castle Connolly Graduate Medical Publishing, 2013.
"What Is Aviation Medicine?" International Civil Aviation Organization, www.icao.int/safety/aviation-medicine/Pages/desc.aspx. Accessed 27 Dec. 2016.