From Big Medical Encyclopedia

AIR MEDICINE — the industry of medicine studying conditions of professional activity of aviation specialists for the purpose of development of the medical recommendations submitted on preservation of health and increase in their working capacity, and also on safety of flights. And. the m has the expressed preventive focus.

Main objectives And. the m is the following.

1. Development of medical and engineering and psychological requirements to the aircraft equipment, to means of individual equipment and rescue; definition of requirements to physical development and state of health of candidates for flight and technical schools; research and improvement of methods of medical and psychological selection; development of the methods and means increasing resistance of the person to action of adverse factors of flight, and medical recommendations about increase in efficiency of flight activity, about safety of flights by rational training, preparation and a training of crews; scientific justification of the mode of work, rest, food, optimum norms of flight loading, indicators for assessment of the state of health and efficiency of aircrew; development of organizational and methodical questions of medical ensuring flights.

2. Medical studying of the reasons and premises of the flight incidents connected with the identity of the pilot and development of special methods of their medical investigation.

3. Development of medical actions for assistance to crews and passengers of airplanes, in distress at emergency landings, and also requirements to rendering medical aid in flight and to conditions of evacuation by air patients and victims.

4. Justification of the organizational principles of medical service in aircraft, a dignity. - a gigabyte. ensuring distant flights, medical service of passengers at the airports and flight personnel in airfields.

For the solution of these tasks And. the m, in addition to the clinical, physiological, hygienic, psychological and other methods of a research applied in usual conditions develops and applies special ways and methods of studying of influence of certain factors of flight on an organism (researches in pressures chamber, on centrifuges, at stands catapults, in special climatic cameras, on special installations or aircraft exercise machines, and also by airplanes or airplanes laboratories, etc.).

And. m arose with the advent of aircraft at the beginning of 20 century. Imperfection of designs of the first airplanes and lack of medical control of aircrew often led to flight incidents. On July 14, 1909 at a meeting of council of the Russian aero club the resolution on permission to members of aero club was accepted to make flights only after medical survey. A year later Military department published the first schedule of diseases, a pra pyatstvuyushchy to service in aeronautic and air units. It was the beginning of formation

And. m in Russia. Approximately during the same period And. m it began to be allocated in the independent industry of medicine in France, and since 1910 — in Germany, England, Italy and the USA.

In our country And. m gained especially broad development after Great October socialist revolution.

The main attention of aviation doctors was concentrated on questions of medical selection of candidates for flight schools, on definition and a prediction of flight abilities by means of psychometric tests, on recommendations about preservation of health of pilots, rationalization of a workplace of pilots.

In the early twenties at aviation schools psychophysiological laboratories were organized. In 1924 in Moscow the Central psychophysiological laboratory of the Air Force of RKKA where research work on justification of methods of medical selection of candidates for aircraft and medical ensuring flights was carried out was created.

In the 30th years in connection with development of high-speed and high-rise airplanes there was a need for detailed studying of influence on an organism of such adverse factors of flight as the lowered barometric pressure, acceleration, etc.

If during formation of aircraft And. m made use of experience of medical providing vozdukhoilavanpya, mountainous ascension and scientific achievements of general physiology and pathology of the end of 19 century [And. M. Sechenov, V. V. Pashutin, Bør (R. of Bert), A. Mosso, J. S. Haldane, etc.], during this period it was necessary to look for new ways of studying vestibular reactions, influences on an organism of height, accelerations, noise, vibration, temperature drops; to develop norms of oxygen providing and to prove medical requirements to the oxygen and respiratory equipment, to create anti-overload means, etc. There was a need for creation of institutions for carrying out special researches and training of specialists on And. m. Instead of the Central psychophysiological laboratory of the Air Force of RKKA the 4th sector Research test sanitary in-that RKKA which in 1935 was reorganized in Aviation research sanitary by in-t of RKKA was organized, and in 1936 it is renamed in Ying t of an air medicine of I. P. Pavlov. At Central in-those improvements of doctors (Moscow) in 1939 the department of an air medicine will be organized, and the faculty of training of aviation doctors the same year opens at the 2nd MMI. At department of physiology of VMA of S. M. Kirov the barolaboratoriya is created. At the same time in AN institutions and the Ministries of Health of the USSR, at VMA departments of S. M. Kirov are studied the problems having relevance not only for the general pathology and clinical medicine, but p for A. M. (a problem of air hunger, hypo - and a hyperthermia, acclimatization and adaptation of an organism to height, neuro and humoral regulation of functions, a role of a cerebral cortex in somatic and behavioural reactions, psychophysiology of sense bodys, etc.). Development of the above-stated problems was headed by prominent Soviet scientists of various specialties — physiologists, biochemists, therapists (L. A. Orbeli, I. R. Petrov, G.E. Vladimirov, N. N. Sirotinin, I. P. Razenkov, A. V. Lebedinsky, P. I. Egorov, M. P. Brestkin, etc.). Some aviation doctors, aiming to study more deeply influence of flights of a pas an organism, mastered a profession of the pilot and pilot observer (Yu. M. Volynkin, N. M. Dobrotvorsky, M. A. Pivovarov, etc.). It expanded possibilities of psychophysiological studying of activity of the pilot in flight, allowed to make more reasonable recommendations about training of aircrew, and also about rationalization of a workplace, the mode of work etc. The achieved results promoted development of the theory A.m.

By the beginning of World War II of A. m had wide experience of medical ensuring high-rise and long flights. There were achievements in studying high-rise and aeroembolism, a research of visual and acoustical functions in flight, and also resistance of an organism to accelerations in flight. Significant contribution to development otechestvenno and And. m both in premilitary, and V. I. Voyachek, K. L. Hilov, A. P. Popov, etc. brought the studying changes of a condition of an acoustic organ and a vestibular mechanism in the post-war period, under the influence of factors of flight; N. M. Dobrotvorsky, A. A. Sergeyev, D.E. Rozenblyum, etc., studying influence on an organism acceleration; B. V. Streltsov, V. G. Mirolyubov, And. P. Apollonov, V. A. Spassky, etc., the developing questions of providing with oxygen studying influence of height on an organism p; N. A. Vishnevsky, G. G. Kulikovsky, I. K. Sobennikov, Ya. F. Samter, etc., the developing questions of medical and flight examination; K. K. Platonov, S. G. Gellerstein p other, developing questions of psychology of flight work, etc.

Reached And. m achievements in the field of scientific research of influence of various factors of flight on an organism and development of methods of increase in resistance of an organism to adverse factors of flight, the accumulated experience of medical support of flights laid a strong basis for the organization of medical support of fighting of aircraft in the period of the Great Patriotic War of 1941 — 1945.

The organizational principles of creation of health service of the Air Force, distribution of its forces and means, the accepted system of stages of medical evacuation provided preservation of the qualified flight shots and return them in a system in perhaps short terms.

During the post-war period at a stage of mass development of high-rise jets there was a need of development of a method of breath by oxygen under excessive pressure, prevention of decompressive frustration, decrease in negative influence on an organism of long and shock loads. At development of flights at big and small heights, in clouds, at night out of visibility of terrestrial reference points, at sound and supersonic speeds of flight requirements to working conditions of the pilot and to his workplace changed (a microclimate, illumination, dashboards and so forth). These problems are solved by specialists on And. m together with designers and researchers of the aircraft equipment and specialists of engineering and aviation service.

Present stage of development And. the m is characterized by further in-depth studies of influence a condition and factors of flight on an organism of the pilot, more strict rationing of conditions of dwelling in cabins of aircraft, increase in requirements to professional selection of flight crews, to assessment of a condition of their health before a departure and in the course of performance of a flight task, creation of highly effective samples of protective and rescue equipment, means of ensuring of safety of crew and passengers in flight (sets of the oxygen equipment, protective and hermetic helmets, space suits, the catapulted seats, emergency stocks, the collective life saving equipment etc.). The considerable attention is paid to rationing of flight loading, the modes of work, food and rest, especially for pilots of advanced ages for the purpose of increase in their working capacity and flight longevity. New methods of medical investigation of the reasons of flight incidents, preparation and a training of crews are implemented into practice, methods of medical years are improved ache examinations, and also meditsnsky and psychological selection flight schools.

As, according to world statistics, apprx. 50% of all flight incidents it is connected with the identity of the pilot, And. the m pays a close attention to studying of all those reasons of flight incidents which with are knitted with the state of health, vocational training or wrong actions of crew in flight. For a research of professional activity of aircrew And. the m uses specially equipped airplanes, aircraft exercise machines allowing to model in vitro different types and stages of flight. Flights on the exercise machine became very effective remedy of training and a training, and also studying of specific psychological and physiological features of pilots.

Abroad by the beginning the second world howl developed wars of the greatest And. reached m in Germany where researches on all main problems of aviation physiology, hygiene and psychology were conducted. In post-war years the center of scientific research in the area A. the m moved to England, and then to the USA. Intensive researches in the area A.m. are carried out in France, Italy, Sweden, Holland, Japan, and also in the countries of the socialist camp.

The international organization combining national associations of specialists And. the m, is International academy of air and space medicine with the constant center in Paris. The European and international congresses but air and space medicine are regularly carried out. Specialists of air and space medicine in the USSR are united in section of air and space medicine of All-Union physiological society of I. P. Pavlov. The section once in 3 — 4 years holds an all-Union conference on urgent problems of air space medicine and periodically publishes the collection of scientific works.

And. m subdivide into four sections: aviation physiology, aviation hygiene, aviation psychology and medical examination of aircrew. Besides, in And. m the high-rise physiology, physiology of accelerations, hygiene of cabins and a workplace, hygiene of food, clothes and equipment received independent value; special toxicology, psychological selection, psychology of flight training and flight activity, aviation ophthalmology and otorhinolaryngology, the medical analysis of the reasons of flight incidents, etc. Due to the continuous complication of the aircraft equipment and expansion of tasks And. m its further differentiation was outlined. There were directions on development of engineering and psychological questions, methods of land preparation and a training of crews, profound studying of properties of the personality for the purpose of definition and forecasting of professional suitability. Actions for optimization of conditions for flight crews in cabins of aircraft, on rescue and survival of injured crews and passengers in case of flight incidents in the hardly accessible area, etc. are developed.

The aviation physiology studies influence of various factors of flight on physiological functions of an organism and reveals limits of its adaptation to them. The aviation physiology pays the main attention to studying of influence on an organism heights (see), differences pressure (see), different accelerations (see), noise (see), vibrations (see) also develops actions for prevention or reduction of impact of these and other adverse factors of flight on the person.

An adverse effect of high-rise factors on an organism is defined by decrease in the general atmospheric pressure and partial pressure of oxygen in inhaled air. For the prevention of disturbances of working capacity and the state of health at crew and passengers, since height of 2 — 3 km, it is necessary to increase the oxygen content in inhaled air. A perfect way of ensuring high-rise flights is use of hermetic cabins (see. High-rise equipment ).

In case of depressurization of a cabin the organism is exposed to adverse action of pressure difference; instant change of pressure leads to an explosive decompression and an acute hypoxia.

The outcome of a decompression depends on speed and the size of pressure difference, and also oxygen providing with the new (lowered) pressure. At bystry rise the gases dissolved in blood and fabrics that at the heights more than 7 km can bring to are emitted for height compressed-air disease (see). At the heights more than 19 km «boiling» of intercellular lymphs and emergence of fabric (hypodermic) emphysema on the unprotected body parts is possible. The high-rise compensating suits and space suits are applied to protection of pilots against an acute shortage of oxygen and an explosive decompression.

Specific factors of flight are accelerations (overload). Portability of accelerations in flight depends on their size, time of action and a gradient of increase, and also from the direction arising at the same time centrifugal force. Under the influence of accelerations in an organism there is a shift (reversible deformation) of fabrics and bodies that causes an extensive flow of the afferent impulses making an adverse effect on a functional condition of c. N of page concerning its adaptive and regulatory opportunities. Considerable sizes of accelerations lead also to various morphological changes in an organism. For the purpose of increase in resistance to the accelerations operating in the direction the head — legs, special anti-overload suits which at emergence of an overload create pressure upon area of an abdominal wall and the lower extremities that leads to a delay of outflow of blood in the lower half of a body and consequently, to increase in volume of the circulating blood in an upper half of a body and to improvement of blood supply of a brain are applied. The leading frustration at action of accelerations in the direction a breast — the back is difficulty, and then disturbance of external respiration owing to mechanical impact on a thorax, a diaphragm and changes of a hemodynamics in a small circle of blood circulation.

For ensuring efficiency of external respiration at influence of overloads a breast — a back it is necessary to apply to breath oxygen under supertension.

Considerable in size of acceleration (shock loads) affect an organism at ejection (see) or an emergency landing in the separated cabin. For increase in portability of shock accelerations the special chairs equipped with the corresponding devices for fixing of a body of the pilot are used (fastened belts, limiters of shift of extremities, profound zagolovnik, lodgments on a chair).

The adverse factors reducing efficiency of crew in flight are the noise and vibration resulting from operation of engines and aerodynamic loadings. Pilots and service personnel are exposed to the greatest impact of noise in airfield during take-off of the airplane and at approbation of engines on the parking. In addition to selective effect on an acoustic organ, an intensive and high-frequency noise, including sound blow, has adverse effect on all organism.

Decrease in adverse action of noise is reached by use of the general and individual means of protection: sound insulation of cabins of airplanes, workrooms, use of electronic inverter of sound waves, noise-protective suits, helmets, ear antinoise obturators and so forth.

Action of vibration belongs to constants and it is difficult for removable factors of flight. The effect of action of vibration is defined on an organism by the frequency of fluctuations, amplitude and duration of influence. The frequency range of vibration by airplanes and helicopters is very wide (from units to several thousand hertz), but vibrations in the range of 30 — 250 Hz take place more often. Low-frequency vibrations with a big amplitude arise during flight at small height in turbulent layers of the atmosphere. The low-frequency vibrations causing the phenomena of a resonance of internals (4 — 6 Hz), pelvic area (12 — 18 Hz), the head (20 — 30 Hz), eyeglobes (60 — 70 Hz) are especially adverse. At aircrew, especially helicopter aircraft, in connection with action of vibration changes in a backbone, hands and stupnyakh legs can meet, and also there is the general astenisation (see. Vibration disease ). For the prevention of negative effect of vibration on crew and passengers a floor, chairs and walls of cabins, and also panels with the instrument equipment cover with various vibration-absorbing materials.

Aviation hygiene studies influence on an organism of environmental factors, develops hygienic norms of work and rest of flight and land structure, develops hygienic requirements to airplanes and means of land service, plans the preventive actions providing necessary working conditions and preservation of health of staff of aircraft; develops hygienic requirements for cabins of airplanes, especially for many-placed modern passenger airplanes; establishes norms of flight food at different types of flights, develops hygienic requirements to clothes and spetssnaryazhennyu a flight and operating personnel taking into account climatic conditions. Important value has the solution of questions of accommodation of staff in airfields, occupational health of the specialists servicing various land equipment, preventions of occupational diseases, and also hygiene of the airports taking into account mass transportation of passengers.

The aviation toxicology studies influence on the flight and servicing technicians of aggressive fluids, toksiches ky substances in combination with factors of flight effect of toxic chemicals (in the village - x. aircraft) also develops a number of the actions directed to the prevention of poisonings with these substances.

The aviation psychology studies psychological features of flight activity, formation and development of the identity of the pilot in her professional and psychological aspect. Based on achievements of human engineering, specialists L.m. participate in development of a problem «the person — the technician», trying to obtain increase in overall performance of crew and its reliability in a control system of the aircraft.

Need of processing of extensive information, fear of wrong actions lead to tension of mental processes, bystry fatigue and impose increased requirements to the state of health and mental qualities of pilots. In some cases the mistakes and inaccuracies allowed by pilots in flight can be caused not by specific features of the personality, but constructive defects of systems of display of flight information or control of airplane, as creates afterwards at operation of airplanes of premises to wrong actions and emergencies. All this nominated need of detailed studying of professional activity of the pilot to the first place.

Medical and flight examination (see. Examination ) is the important section A. m in medical safety of flights. The Medical and Flight Examination (MFE) is carried out medical and flight commissions (see) on the basis of «The provision on medical examination of aircrew» according to «The schedule of diseases and disfigurations...» and other documents allowing to define degree of the validity to flight work or training depending on the state of health and physical development. VLE is closely connected with the constant medical observation and medical control which is carried out by aviation doctors to the intercommission period.

In work of the aviation doctor the increasing value gets preflight, interflight and postflight survey of aircrew, the medical analysis of flight loading taking into account complexity of flight tasks, features of flight activity and individual reaction of the pilot to separate types of flights.

Creation of the rocket and space equipment put in the mid-fifties before And. m a number of practical questions on providing life and safety of flight of the person in space. There were new biological and medical problems. For the solution of these problems on base A. m the new industry of medicine arose — space medicine (see).

Modern level of development And. m, theoretical and practical training of aviation doctors allow to solve successfully urgent problems of medical ensuring military and civil aviation.

Bibliography: Armstrong G. An air medicine, the lane with English, M., 1954; Geratevol 3. Psychology of the person in the airplane, the lane with it., M., 1956, bibliogr.; Ivanov D. I. and Hromushkin A. I. A life support system of the person at high-rise and space flights, M., 1968, bibliogr.; Human engineering in use to design of the equipment, the lane with English, under the editorship of B. F. Lomov and V. I. Petrov, M., 1971; Isakov P. K., etc. Theory and practice of an air medicine, M., 1971, bibliogr.; Lavnikov A. A. Bases of an air medicine, M. 1971, bibliogr.; Medicobiological problems of space flights, the Index of domestic and foreign literature, under the editorship of A. A. Gyurdzhian, M., 1972; Medical problems of safety of flights, the lane with in., under the editorship of P. K. Isakov, M., 1962; Platonov K. K. Psychology of flight work, M., 1960, bibliogr.; Platonov K. K. and Goldstein of B. M. Psikhologiya of the identity of the pilot, M., 1972; Sergeyev A. A. Sketches but stories of an air medicine, M. — L., 1962, bibliogr.; it, Physiological mechanisms of action of accelerations. L., 1967; it, Domestic literature on aviation, mountainous to both bioastronautics and medicine, the Bibliography, L., 1969; Aerospace medicine, ed. by H. W. Randel, Baltimore, 1970; A textbook of aviation physiology, ed. by J. A. Gillies, Oxford, 1965.

S. A. Goaulov.