Document created: 23 September 03
Air University Review,
March-April 1974
Brigadier General
George E. Schafer, USAF, MC
When the term “medical research” is used, one tends naturally to think of medical research in the classic sense involving health care and searching for better ways to soothe man’s ills. The Air Force does some of this type of research in several of its medical facilities across the country. However, “aerospace biotechnology” is the term used to describe that research designed to meet specific Air Force needs, and it is conducted almost exclusively by the Aerospace Medical Division of the Air Force Systems Command.
These efforts in aerospace biotechnology are oriented toward the care and protection of man as a key element in every aerospace military operation. Such research is aimed at determining and defining man’s performance and his ability to function in an Air Force system in an operational environment. The knowledge gained can be applied toward enhancing his ability to perform as well as toward systems design and operations plans that take full advantage of his optimum ability.
Aerospace biotechnology research, then, considers human disease only when it affects Air Force operations, such as the effect disease may have on a pilot’s ability to operate an aircraft or perform a certain mission. Another area of aeromedical research that considers human disease is directed toward establishing criteria for selection, retention, and care of aircrew members in order to develop and maintain the most viable and effective Air Force possible.
During the past twelve years, thousands of aircrew members have been referred to the Aeromedical Consultation Service of the USAF School of Aerospace Medicine for evaluation of clinical conditions that put their flight status in jeopardy. The data gained from these individuals, together with the data available from over 750,000 electrocardiographic records in the school’s USAF Central Electrocardiographic Library, have served as a valuable research data base. In addition, approximately 46 percent of the individuals referred have been returned to flying status, including 71 with minor heart maladies. Considering the high cost of training today, the return of these aircrew members to flight status represents a substantial dollar savings to the Air Force. This work is the subject of another article in this issue by Colonel Malcolm C. Lancaster and Colonel William H. King of the Clinical Sciences Division, USAF School of Aerospace Medicine.
Aerospace medicine as a specialty is only about 24 years old, but research in aviation medicine and the study of problems concerning the care of the flyer began during World War I. An aeromedical laboratory was established at Mineola, Long Island, in 1917 when it was discovered that 60 percent of the aircraft accidents were caused by pilots who were not physically qualified to fly. This organization grew into what is now the USAF School of Aerospace Medicine at Brooks AFB, Texas, a part of the Aerospace Medical Division (AMD).
In the early thirties a young physician, Captain Harry Armstrong, was given a budget of $500 to do aeromedical research at Wright-Patterson AFB, Ohio. A part of this money was used to build the first human centrifuge that the Air Force had. Armstrong went on to achieve general officer rank and become Surgeon General of the Air Force. His laboratory is now the 6570th Aerospace Medical Research Laboratory, also a part of the Aerospace Medical Division.
Because of work done in the early days by both these organizations, we now enjoy many creature comforts on commercial airlines, and we have many effective life-support systems in military aircraft that we take more or less for granted. In fact, so great have been the accomplishments in aerospace medicine in the last half century, it is easy to assume all has been done and little is left to learn by continuing aeromedical research.
Nothing could be further from the truth. Military man is a key element in any military operation, and new technology, new systems, and new requirements pose changing and continually increasing demands on the military man. While new technology makes possible conceptual breakthroughs and provides new and different forms of weaponry, the man operating and maintaining the equipment remains essentially unchanged. Though he is unchanged, the environments in which he must function are becoming more severe, his tasks more complex, and his responsibilities more awesome.
We tend to expect man to utilize untapped reservoirs of strength, skill, and experience that are not programmable to enhance his ability to survive and perform effectively in increasingly demanding and hostile environments. The tacit assumption that these untapped reservoirs are limitless is invalid. Maximum effectiveness of current and future systems can only be achieved when we have a clear understanding of the actual limits which constrain man’s performance, adaptability, and survivability. Biotechnology research is aimed at establishing just such a clear understanding of man’s capabilities and limitations.
Technological advances in aircraft structures and power plants have placed the military pilot in an aircraft capable of creating and withstanding gravitational forces that were unheard of a decade ago. In order to enable pilots to survive and operate effectively under these stresses, AMD has inaugurated a two-phase approach to the problem. First, we are trying to determine what slight modifications to current equipment and what instructions to the pilots will enable them to tolerate these increased G forces and function under them. We are passing this information on to the Tactical Air Command as it is developed. Second, we are looking at long-range solutions to the high G problem, perhaps by repositioning the pilot in the cockpit. Such a solution, of course, will require considerable research from the point of view of mission accomplishment.
The theme of yet another article in this issue deals with the man/machine interface; it is written by Colonel Neville P. Clarke, Director of Research and Development for the Aerospace Medical Division.
Often research performed in one area will reveal potential uses that, with additional research and development efforts, may result in the utilization of a new-found capability. One such instance is work being done by the Human Engineering Division of the Aerospace Medical Research Laboratory at Wright-Patterson. These are the people who conceived the idea of firing laterally out of an aircraft and developed a gunsight that would permit it. It was their work that culminated in the gunship that was so successful in Southeast Asia. Some of the things they discovered during this work appear to have application in improving the precision of weapons delivery. They include the use of flares, target image enhancement, and visually coupled systems. The latter show great promise for delivering a weapon onto any target that can be seen. They also show possibilities for application to a variety of other tasks for both military and civilian use. This work is the subject of another article in this issue, entitled “Visually Coupled Systems,” coauthored by Lieutenant Colonel Joseph A. Birt, Chief, Human Performance Division, Aerospace Medical Division, and Thomas A. Furness III, a supervisory research engineer of the Aerospace Medical Research Laboratory.
Because of the vast collection of data and its expertise in a variety of areas, AMD is constantly involved in “fire fighting.” Never a week passes that some problem doesn’t surface and AMD is asked to assist in finding a solution. Over the years, these problems have ranged from back injuries sustained during pilot ejection to problems with escape oxygen systems used in underground silos; from long-range development of aircraft cockpits and safety devices to retrofit of present equipment to alleviate existing problems.
Many such problems come to us from sources outside the Air Force. During its short history, AMD has been involved in some way with almost every federal agency as well as with commercial corporations and Allied air forces on problems associated with aerospace medicine. Among its teaching programs, AMD, through the USAF School of Aerospace Medicine, provides the Residency Program in Aerospace Medicine. Through its Wilford Hall USAF Medical Center, it provides residencies and fellowships in 21 other medical specialties. In fact, the Aerospace Medical Division trains approximately 65 percent of the residents trained by the Air Force in USAF medical facilities.
Because of the equipment and expertise that we have, we are called upon to lend support to the civilian community in certain areas. One such area is in the field of hyperbaric medicine.
Although our hyperbaric chambers exist primarily as research and teaching facilities, we also treat aircrew members who happen to have an air embolism or an occasional case of the bends. We also treat cases of the bends and air embolism in skin divers referred to us from the surrounding area.
The use of a hyperbaric chamber in medicine is not new. The first recorded attempt was made in England in 1662 by a gentleman named Henshaw. There have been numerous attempts to use hyperbaric chambers to treat many types of diseases and with a variety of claims of success, some of which were exaggerated. As was pointed out by Dr. Julius H. Jacobson II, at the 1st International Congress on Hyperbaric Oxygenation in Amsterdam in 1963, “If this form of therapy is to achieve a worthwhile and lasting place in the medical world, it can only do so on a firm basis of accurate physiological data on the effects of both pressure and oxygen obtained in experiments as well as controlled clinical medicine will permit.” In recent years it has been discovered that oxygen therapy can be used in the treatment of gas gangrene, which is a general term applied to various conditions of acute infection with gas-forming organisms growing only without oxygen.
Prior to the use of hyperbaric oxygenation in the early sixties, gangrene was treated with massive doses of antibiotics and surgical debridement and/or amputation. Even with these drastic measures, the fatality rate was over 50 percent. Hyperbaric oxygenation inhibits the production of alpha toxin, and the circulating toxin may be neutralized. Prompt application of hyperbaric therapy saves tissue by making it easier for the surgeon to determine the tissue that must be removed when amputation is required. It is generally lower on the limb, making the fitting and functioning of a prosthesis easier.
Normal treatment requires between three and six dives to 66 feet below sea level for 90 minutes with 100 percent oxygen. During the past 8 years, 60 cases of gas gangrene have been treated by compression therapy teams at the USAF School of Aerospace Medicine. Those cases that received early diagnosis were treated successfully.
It is difficult to say what biotechnology research will be performed in the future, but as we make technological advances in weapon systems, man, the key to such systems, will no doubt find his environment changing and perhaps exposing him to new stresses.
It is difficult to predict the specific future of biotechnology research or treatments in aerospace medicine, but judging from the past and from today’s problems engendered by technological advances, biotechnology research will play an important role in fitting man into weapon systems and military operations.
Each breakthrough in technological advancement brings with it associated problems. We can never attain full benefit of our technological advancements until we can make them compatible for man. To achieve that benefit is the aim of the Aerospace Medical Division.
Hq Aerospace Medical Division, AFSC
Brigadier General George E. Schafer (M.D., University of Cincinnati) is Commander, Aerospace Medical Division, AFSC, Brooks AFB, Texas. Since his first assignment in 1947 as Flight Surgeon, 4th Fighter Group, he has headed USAF medical activities at Hq ATC; Hq USAFE; Fürstenfeldbruck Air Base, Germany; Davis-Monthan AFB; The School of Aerospace Medicine; Seventh Air Force, Vietnam; and Hq MAC. General Schafer is a member of numerous professional societies and author of several publications on aerospace medicine. He is a graduate of Air War College.
Disclaimer
The conclusions and opinions expressed in this
document are those of the author cultivated in the freedom of expression,
academic environment of Air University. They do not reflect the official
position of the U.S. Government, Department of Defense, the United States Air
Force or the Air University.
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