The US Army Aeromedical Activity (AAMA) reviews and recommends disposition of flying duty medical examinations and waivers. Flight Surgeons are considered rated crewmembers, not rated aviators, and are responsible for clinical and preventive medicine, unit readiness, and clinical support. Aeromedical psychologists provide clinical consultations and support to flight surgeons. The primary goal of the Aviation Medicine Program is preventative medicine services. There are two categories of Flying Duty Medical Examinations: initial examinations and comprehensive examinations every 5 years (or annually after age 50). A flight student's status changes from class 1 to class 2 after completing flight school, taking the physical by the last day of their birth month within a 3-month window.

1. What does the US Army Aeromedical Activity (AAMA) do?
Review and recommends disposition of flying duty medical examinations and medical waivers for continued
flying duty.
What are Flight Surgeons (FS) considered to be?
Physicians are considered to be rated crewmembers, NOT rated aviators.
Flight Surgeons, Aeromedical PA’s and Nurse Practitioners are responsible for what?
Clinical and preventive medicine, unit readiness, staff function, clinical support
Aeromedical psychologists are responsible for what?
Clinical consultations and support to flight surgeons, consultatnt to commanders, education and training.
What is the primary goal of Aviation Medicine Program?
Preventative medicine services
There are two broad categories of the Flying Duty Medical Examination (FDME).
What are they?
A. Initial FDME – (class 1-4) accession purposes. Good for 18 months
B. Comprehensive FDME (class 2-4) – every 5 years < 50 years old then annually. Good
for 12 months expiring on the last day of the soldiers birth month
What is the requirement for a flight student’s status to change from class 1 to 2 of FDHS?
The physical must be completed by the last day of the birth month after the soldier completes flight school.
However, the soldier may take the examination within a three-month period preceding the end of the birth
month.
Ex. Q: If your B-day is Jan 20th, what month/date can you begin to take the exam?
A: November 1st.
What form is the Medical Recommendation for flying duty?
DA Form 4186 or “UPSLIP”
-An official document used to notify the aviation commander of the initial recommendation for certification of
medical fitness for all classes of military and civilian aviation personnel.
Who is the final approval authority for the form in question #6?
Unit Commander - may agree or disagree. -Remember “UNIT” Co.
What is a temporary disqualification and what is it likely to result in?
Imposed by the FS/APA for a temporary aero medical disqualifying condition, that are minor, self-limited and
likely to result in re-qualification within 365 days.
What are the temporary restrictions due to exogenous factors?
Medications, Anesthesia, Dietary supplements, alcohol (12 hrs), immunization, tear gas exposure, blood or
plasma donations, altitude chamber, diving, tobacco smoking, strenuous sporting activities, simulator
sickness (12 hrs), centriguge runs (6 hrs)
What is a “medication” under class 1 IAW AR40-8 that may be used without a waiver?
Protein supplements, antacids, artificial tears, aspirin/acetophetomine, cough syrup, decongestant, pepto
bismal, multiple vitamins, nasal sprays, Metamucil, throat losenges

2. How many classes are under Herbals and Dietary Supplements?
3 --- Class 1, Class 2, and Class 3
Which class of Herbal Supplements may be used without approval of a FS/APA?
CLASS 1 -- most water soluble
Which class may be used only with prior approval of the FS/APA?
CLASS 2
What is an essential component of the Army Aviation Medicine Program?
Occupational Medicine -- do not confuse this for the PRIMARY purpose of the Army Aviation Medicine
Program (which is Preventative medicine services)
What are the three types of hazards?
Physical, Chemical, Biological
What is exposure?
The actual contact of the harmful substance with the biological organism
What is the exposure of an agent over a short period of time that can cause adverse health changes?
Acute Exposure
Route of Entry Principle: What are the 3 principle ways a toxin can enter the body?
1. Inhalation 2. Absorption 3. Ingestion
What are the physiological principles related to toxins?
Metabolism slows with age, amount of body fat, genetics
What are the environmental principals related to toxins?
Atmospheric pressure, temperature, humidity
What is a product of incomplete combustion?
Carbon Monoxide
You’re using JP8, what is toxic about it?
Carbon monoxide
What are the three protective measures needed to prevent or reduce toxic substance exposure?
1. Individual 2. Cockpit 3. General
What are the four safety features provided by an aircraft?
1. Structural shell - prevent intrusion of structure in the occupiable living space
2. Landing gear and crashworthy seats
3. Personnel restraint system
4. Post-crash factors - crashworthy fuel systems, self sealing fuel cells, break free self
sealing fuel lines, and fire extinguishing systems

3. Which one of the safety features are essential for survival?
(Structural Shell) PROVIDED AN OCCUPIABLE LIVING SPACE
What is an example of a safety feature of the aircraft?
BREAK RESISTANT FUEL LINES (Post-crash factors)
What are the ONLY 3 types of material that ARE allowed for underwear?
COTTON, WOOL, NOMEX = flame resistant
Can the three types of underwear material be combined?
YES
What MAY be used in the rinse cycle to remove body oils?
FABRIC SOFTENERS
What setting can you IRON the NOMEX flight suit and at what temperature?
PERMANENT PRESS SETTING @ MEDIUM TEMPERATURE
What temps can you wash flight suits and NOMEX?
Flight suits < 180 NOMEX < 120 degrees
What can you NOT wear on your flight suit?
Metal Badges
Define acceleration
The rate of change of velocity with respect to time.
What are the factors that determine the effects of acceleration on the human body?
(BIRDI)
Body Area and site – Greater area = lesser effects
Intensity – increases effect
Rate of onset – increases effect
Duration -- increases effect
Impact direction – increases effect
Define Inertia
The resistance to a change in the state of rest or motion.
What are low magnitude accelerations?
G’s that range from 1 to 10 G’s and last for several seconds
What are the factors that reduce the overall efficiency of the body, especially the circulatory system, to
withstand G’s called?
Decremental factors
What are the factors that enhance the ability of the body to withstand G-forces called?
Incremental factors

4. Name a criteria that occupant survivability is contingent upon during an accident?
Occupiable living space: Two objects cannot occupy the same space
What are aircraft design features that enhance crash survivability?
(CREEP)
Container, Restraint System, Encironment, Energy Absorption, Post Crash Factors
__________ is the mechanical radiant energy that is transmitted by __________ pressure waves.
Sound, longitudinal
Noise is a ________ that is ______, ___________, or ___________.
Sound, loud, unpleasant, unwanted
4 NOISE effects are:
1. Annoyance 2. Fatigue 3. Speech Interference 4. Hearing loss
True or False? Noise has measurable characteristics.
TRUE
What are the three measurable characteristics of NOISE?
F.I.D Frequency Intensity Duration
What is Sensorineural hearing loss?
The cochlea is damaged (permanent hearing loss)
What are the three types of stressors?
Psychosocial stressors, Cognitive Stressors, Physiological stressors
In Army aircraft, the overall noise levels are generally equal to or exceed what?
100 dB
What is Amplitude?
The maximum displacement of an object from its position at rest
What are the three components of VIBRATION?
F.A.D
Frequency
Amplitude
Duration
What are the short-term effects that vibration can cause?
FCMDR- (flight commander)
Fatigue
Circulatory effects
Motion sickness
Disorientation
Respiratory effects

5. What are some long term effects of vibration?
Raynauds disease, Bachache/back pain, Kidney/lung damage
What are the physical divisions of the atmosphere?
Troposphere - Extends to an Alt. Of 30,000 ft. at the poles and 60,000 ft. at the equator
Tropopause – boundary between troposphere and stratosphere
Stratosphere – tropopause to about 50 miles upward. Constant -55 degree C temp
Ionosphere – end of stratosphere upward to 600 miles
Exo sphere – end of ionosphere to about 1200 miles (true space)
What are the three physiological zones of the atmosphere and at what altitudes?
1. Efficient Zone: Sea level to 10,000 ft.
2. Deficient Zone: 10,000ft. To 50,000 ft.
3. Space Equivalent Zone: Above 50,000 ft.
Which physiological zone is lethal to humans?
Space equivalent zone
What is the standard sea level atmospheric pressure?
760mm/Hg (reduces by half at 18,000 ft)
What are the substances that make up the mixture of air?
Nitrogen – 78%, Oxygen – 21%, Other – 1%
What are the functions of the circulatory system?
Transport O2 and nutrients to cells
Transport metabolic wastes to organ removal sites
Assists in temperature regulation
What are the components and functions of blood?
Plasma – transports CO2 in blood, White Blood Cells – fights infection
Platelets – aid in blood coagulation,
Red blood Cells (RBCs or erythrocytes) – transports nearly 98.5% of all O2 in blood
What are the functions of respiration?
Provide O2 to cells, Remove carbon dioxide from cells
Assist in maintaining body temperature, Assist in maintaining body acid-base balance
What are the two phases of external respiration?
Active - inhalation
Passive - exhalation
What are the four types of hypoxia?
1. Hypemic – caused by anemia and blood loss
2. Stagnant - varicose veins, pooling of blood
3. Histotoxic – interference with use of O2 by tissues usually due to poisons
4. Hypoxic - insufficient O2, partial pressure (most likely to be encountered at altitude)

6. What are the four stages of hypoxia?
(like ACDC)
1. Indifferent 2. Compensatory 3. Disturbance4. Critical
Which of the four stages of hypoxia is the most dangerous and kills the most soldiers?
Indifferent
What is the only significant effect of mild hypoxia at the indifferent stage?
Night vision deteriorates at about 4,000ft.
______________ is an ______________ and ________ of respiration leading to abnormal loss of _______ from
the blood.
Hyperventilation, excessive rate, depth, CO2
What is the difference between signs and symptoms?
Symptoms are observable by the individual and signs are observed by the crew members
Distinguish the difference between hyperventilation and hypoxia.
A. Above 10,000 ft. is _______________.
B. Below 10,000 ft. is _______________.
A. Hypoxia B. Hyperventilation
Your co-pilot has pain in one tooth, what is it and what do you do?
Barodontalgia (trapped gas disorders of the teeth). Land and seek dental care.
What occurs as pressure decreases and gases dissolved in the body fluids are released as bubbles?
Evolved Gas Disbars (decompression sickness)
What are the primary symptoms Skin Manifestations where N2 bubbles are trapped under the skin?
Paresthesia which is a tingling and itching, reddish discoloration (occurs to the skin)
What are the components of the human eye and their functions?
1. Cornea - protective tissue located over front of eye
2. Iris - regulates the amount of light entering the eye by adjusting pupil
3. Pupil - Center of iris, allows light to enter eye
4. Retina - contains the rod and cone cells - permit us to see
What are the four common visual deficiencies?
1. Astigmatism, 2. Myopia, 3. Hyperopia, 4. Presbyopia
Which one of the four common visual deficiencies occurs with natural aging process?
Presbyopia
What occurs when the natural aging process causes the lens to harden and lose its elasticity?
Presbyopia

7. What are the four terms associated with spatial disorientation?
1. Vertigo
2. Sensory illusion
3. Spatial disorientation
4. Orientation or equilibrium
What are the different Monocular Cues?
1. Geometric Perspectives
(LAV) – Linear Perspective, Apparent foreshortening, vertical position
2. Retinal Image Size
(KITO) – Known size, Increasing/Decreasing size, Terrestrial assoc, Overlapping
3. Arial Perspective
4. Motion Parralax
The sensory inputs that provide orientation and equilibrium are the ___________,
______________, and ________________.
Visual, vestibular and proprioceptive systems
What is the most important bodily sense of orientation?
Vision
Role of visual cues: Orientation by vision requires what 3 things:
R.I.P.
Recognition
Identification
Perception
What are the different visual illusions?
False Horizon
Fascination/Fixation
Flicker Vertigo
Confusion with Ground Lights -- Gives the aviator a false horizon thus descending
Relative Motion
Altered Planes of Reference – wrong reference point
Structural Illusions
Height/Depth Perception
Crater Illusion
Size-Distance
Autokinesis – when a static light appears to move after staring at it for several seconds
Reversible Perspective – at night an aircraft may appear moving away instead of approach
What visual confusion occurs when an aviator mistakes ground lights for stars?
Confusion with ground lights
What illusion promotes the aviator to place aircraft in an unusual attitude?
confusion with ground lights
What three major reasons make the function of the vestibular system extremely important?
VOR (v for vestibular)
1. Visual tracking
2. Orientation in the absence of vision
3. Reflex information

8. What are components of the vestibular system?
Semicircular canals
Otolith organs
What are the three types of Vestibular illusions?
The leans -- turning in wrong direction without knowing it
Graveyard Spiral – difficulty maintain straight flight after continuous curve
Coriolis illusion – rapid movement while feeling weightless
What is the most dangerous vestibular illusion?
Coriolis illusion
What proprioceptive mechanism is unreliable in the absence of vision while in flight?
Seat of the pants flying
What type of spatial disorientation is the most dangerous and why?
Type 1 (unrecognized) is the MOST DANGEROUS because the pilot doesn’t perceive any indications of spatial
disorientation.
What are the 3 dynamics of spatial disorientation?
1. Visual dominance
2. Vestibular suppression
3. Vestibular opportunism
How do you prevent spatial disorientation?
Learn instruments
What is the definition of sleep inertia.
Sleep inertia is the short term grogginess experienced right after awakening.
What are the factors that influence your sleep cycle.
(METAL)
Medication
Environment
Timing of sleep
Age
Level of fatigue
What is the best fatigue countermeasure.
Strategic Napping
What are the countermeasures for shift lag
Reduce mental demands on night flights
Minimize administrative duties after the shift
Implement shorter continous periods at the controls
Maximize every sleep opportunity
Determine if circadian readjustment is neccessary
Ensure the crew double checks everything.