Flying high

Resident Issues

CJEM 2001;2(3):210-211

A good residency program goes beyond assessing "weak and dizzy" patients. In fact, it goes beyond learning strategies to reduce the long waits our patients face. Once in a while unique opportunities arise, and we are exposed to new experiences that enrich our future practice.

Residents from the University of Alberta and University of Toronto RCPSC emergency medicine programs had the opportunity to participate in such an experience by enrolling in the Canadian Forces Flight Surgeon course. This 7-week program, taught at the Defence and Civil Institute of Environmental Medicine (DCIEM) in Toronto, is an annual course run for military and selected civilian physicians, to acquaint them with aviation medicine.

During the course, participants learned about the unique stressors aviators endure while operating a variety of airplanes and helicopters. Basic scientists and DCIEM engineers described their research into spatial disorientation, airsickness, hypothermia and other problems that influence aircrew health. Experts on decompression and high altitude sickness shared their expertise, and medical experts described the effect of high G-forces on human organ systems. (G-forces are the extreme acceleration forces experienced by occupants of high performance aircraft such as fighter jets and acrobatic planes.) Throughout the training, our instructors emphasized how the extreme environment of flight influences normal physiology. The course participants were also introduced to the principles of space medicine and the challenges that will face occupants of the future International Space Station and manned missions to Mars.

Civilian airline medical representatives discussed emergency care on commercial airliners. Aeromedical transport and SAR (search and rescue) experts shared military and civilian experiences. Canadian Forces personnel who responded to the Swiss Air disaster near Peggy's Cove, NS, discussed the practical considerations involved in planning the response to a major air disaster. The importance of human factors and how they influence flight accidents was covered.

Course participants experienced simulated high altitude by decompressing to 43,000 feet in a hypobaric chamber, all the while breathing positive pressure oxygen. Then we attempted simple psychomotor skills -- without oxygen -- at "25,000 feet," but two minutes of this rarefied air left all of us pre-syncopal.

Next, it was off to the pool to learn survival skills, because aircraft periodically "ditch" in the water. Extricating oneself from under a parachute in the water was challenging (especially for the non-swimmer in the group), and the difficulty of climbing into a life raft while weighed down by wet clothing quickly became apparent.

Finally, we went out into the field to spend a week with an operational squadron, witnessing, first-hand, the physiological stresses aircrew encounter while performing their jobs. One author joined a CF-18 Hornet squadron, and in this high performance jet environment, during air combat manoeuvres, gained a true appreciation of airsickness and G-intolerance. The other author, to his chagrin, had a tamer experience, flying with the Metro Toronto Air Ambulance Program.

The training program accomplished several objectives. It acquainted participants with aviation medicine. It gave us a better understanding of the medical care needs of aviators, who we are likely to see and treat in our EDs, and who are responsible for the lives of many people in our increasingly mobile society. Finally, it provided a better understanding of aeromedical transport and disaster response -- highly relevant and exciting areas for future emergency physicians.

For information regarding the Aerospace Medicine and Aeromedical Transport fellowships, please contact Dr. Chris Mazza at cmazza@basehospital.on.ca, 416 480-5559.

Dr. Sookram, being "dragged into" the Canadian Forces Search and Rescue helicopter, "The Labrador"

Drs. Andrea Kerr and
Michelle Lambeth,
standing with Drs. Lou Fraser
and Aaron Khan