APRIL 15, 2022 – The Air Force continuously assesses the medical policies surrounding its aviators, updating policies as new data and research emerge.
This commitment to data driven medical decisions and policy updates keep Airmen flying safely and the mission on track.
In the last five years, the Air Force updated or created policies related to migraines, pregnancy, high cholesterol, Post-Traumatic Stress Disorder, refractive eye surgery and COVID-19.
“Policies are informed by extensive medical literature review and looking at clinical events that would affect the mission, flight safety and health of the aircrew,” said Col. Amy Hicks, Aeromedical Consultation Service Division Chief, U.S. Air Force School of Aerospace Medicine. “The Air Force’s aviator population tends to be younger and healthier than those found in regular medical literature, so we also rely on data specific to our population, and we have this amazing resource of clinical cases and data related to those cases.”
Much of the data analysis studies that inform aviation policy come from the Aeromedical Consultation Service, or ACS, at the 711th Human Performance Wing’s U.S. Air Force School of Aerospace Medicine, which is part of the Air Force Research Laboratory.
Research informs aviator medical policies and flying standards in two ways.
“There is a difference between research studies and analysis,” said Dr. Tanisha Hammill, Capability Development Division Chief, Office of the Air Force Surgeon General. “When we analyze a database, they tend to translate into policy changes more directly. Then there is research we do in a controlled laboratory environment where we take results, translating them into outcomes that then would be included in a risk assessment table. These long-term studies provide foundational data that can help make population-level assessments and decisions.”
Policy changes also happen incrementally as medical research and data evolves, and waivers are constantly monitored to either establish new standards or clarify existing policies.
“We have this amazing resource of clinical cases and data related to those cases,” said Dr. Maximilian Lee, Senior Aerospace Medicine Consultant with the Aeromedical Consultation Service, U.S. Air Force School of Aerospace Medicine. “Because of how we are able to collect data, we are able to identify issues or concerns that may impact standards, and can look at those aviators over a longer period of time to see if we are applying the correct standards.”
Policy Changes
The Air Force, for example, updated its migraine policy by comparing data between aviators and non-aviators. The ACS considered aspects such as frequency, symptoms and medications to determine a flight status. Previously, aviators had to be migraine-free for one year. Now, the policy allows a return to flight duties within a range of three to six months for most aviators.
In 2019, the Air Force updated its policy to allow certain fully qualified pilots to perform their assigned duties during pregnancy without a medical waiver. The Air Force further clarified this policy, explaining that aircrew members can voluntarily request to fly in the second trimester with an uncomplicated pregnancy in a non-ejection seat aircraft. All aviators who are pregnant can apply for a waiver regardless of trimester or aircraft.
While the majority of research and analysis has resulted in policy changes that have allowed more Airmen to keep flying, there are a few instances where research has supported the opposite.
The Air Force implemented a policy to monitor aviator recovery following a positive COVID-19 test.
“This policy enables the ability to detect heart inflammation following a COVID infection and allow full recovery to prevent worsening of that injury,” said Col. Micah Schmidt, Medical Standards Program Chief, Air Force Medical Readiness Agency. “With appropriate treatment, individuals do fully recover. But if this condition goes undetected, then overexertion that leads to worsening injury can be significantly harmful.”
Ongoing research
Every quarter, ACS members and major command representatives evaluate medical standards, looking at data trends to support policy updates and to identify what areas need additional research.
One condition of interest is the occurrence of coronary artery disease.
“Currently, aviators with coronary artery disease can’t fly high-performance aircraft, like an F-16, but we have been evaluating that,” said Hicks. “We have given waivers to allow Airmen with coronary artery disease to fly non-high-performing aircraft. We are also looking at the outcomes again to see if it is possible to broaden existing policy.”
The ACS is also looking to assess how aviators who have received cervical disc replacements could perform while flying. A cervical disc replacement is sometimes used to address herniated discs, but there is incomplete information on how those devices would work in a high-performance aircraft environment.
“Aerospace medicine provides confidence to our operators and leaders, and to do that we need to strike a dynamic balance between safety and operational duties,” said Lee. “If we are too cavalier, then we put both the member and the mission at risk. Finding a balance is a core challenge in aerospace medicine and we need to approach it with both experience and continual data to reassess our standards.”
Story by Shireen Bedi
Air Force Medical Service