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Gravitational (G) stress during aerobatics flights, both military and civilian, can suddenly incapacitate pilots in agile and supermaneuverable aircrafts. High +Gz stress, up to +9Gz, has two different physiological consequences: the first is the drop in head-level blood pressure that is proportional to the G load; the other, slightly delayed, is the blood pooling in the lower part of the body and the abdomen. This blood shift results in a decreased return of venous blood to the heart, decreased cardiac output, and decreased blood pressure, leading to a likely loss of consciousness. The natural countermeasure against the effects of high G stress is the baroreceptor reflex. The human physiological tolerance to the gravito-inertial forces developed in flight operations can be increased by physiological and technological means.

The complexity of the instrumentation installed on the last version of AgustaWestland helicopters requires the pilots to have a higher level of skills and abilities gained through a training more and more focused and effective. On the basis of these considerations the THSS (Training and Helicopter Support Systems) department of AW has experienced a non-conventional instructional methodology based on the Behavior Analysis, in particular a form of training called "Precision Teaching" This methodology is characterized by the fact that takes into account the SPEED not only the ACCURACY of learning.

The study of the cardiovascular and respiratory modifications in extreme environments could be useful for the understanding of the adaptive mechanisms of the body in particular conditions. The knowledge of how different environmental conditions in terms of extreme pressure, temperature and gravity modify the neurovegetative and cardiovascular system could be useful in daily practice for hypobaric and hyperbaric sports.

The Italian Air Force medical service, in order to attend to its duty, has to deal with the search, rescue and aero-medical evacuation of the wounded and sick. Due to the increase of air transportation, the likelihood of contracting disease, such as haemorrhagic fevers has risen and it is necessary to know how to treat a patient abroad suffering from severe infectious disease without running any risk either for the medical personnel or for the air crew. The military sanitary service of the Air Force has been preparing for this purpose through a meticulous preparation in Italy and in the USA in order to satisfy these need and through the use of stretchers specifically designed to transport highly contagious patients: Aircraft Transit Isolators (ATIs) and Stretcher Transit Isolators (STIs). These particular medical tools are provided by filter HEPA and they are completely insulated in a PVC envelope. The former (ATI) is used to transport the patient by airplane, the latter is used for road travel. Last January 24th the first real mission was performed transporting a severe TBC-MDR (case) from Alghero to Milan. All went well and the patient left the hospital of Sondalo two months later.

Repeated loads and vibration stress in professional settings are relevant risk factors for back pain. Aim of this cross-sectional study was to estimate: a) the prevalence of back pain in two high-risk professional samples (helicopter pilots and bus drivers); b) the association between physical/sports exercise and back pain subjective perception across age. Prevalence of back pain is 94% in helicopter pilots and 74% in bus drivers; prevalence of back pain significantly increases with age. The positive effect of regular physical/sports exercise on subjective back pain significantly decreases with age. Physical or sports exercise adapted to structural characteristic of patients can result effective in diminishing personal impairment in subjects at professional risk.

The problems of the use/abuse of alcohol need a special attention by the Public Authorities, based on the scientific evidences related to the subject. We would like to define in the present paper the procedures for alcohol testing (and drug testing) in the sailors, following the international aviation authorities (ICAO, JAR-OPS-1, FAA) recommendations. A Working Group was established to study both the scientific and the legal aspects of the problems related to alcohol testing in Italy. Experts from the Università "La Sapienza" and from Alitalia studied the alcohol testing issues abroad to set out criteria, guidelines and procedures for random testing in Italy.

Background: The ever-increasing use of air travel suggests the need to study health risks in flight personnel, by means of correct exposure assessment and evaluation of genotoxic effects., Objectives: After taking into consideration occupational risk and possible confounding factors, we studied 48 pilots and flight technicians engaged on long-haul flights together with a control group of 48 ground staff, with the aim of evaluating genotoxic effects of cosmic radiation exposure. On 36/48 subjects we also evaluated the presence of DNA damage (single and double strand breaks)., Methods: Traditional cytogenetics, the micronucleus test and FISH analysis, were used to study chromosome aberrations, micronuclei and translocations. The Comet test was used to analyze direct DNA damage (single and double strand breaks)., Results: Our findings indicated a significant increase in gaps and breaks and a significant increase of frequency ratio for translocations in pilots compared to controls, but revealed a non-significant difference in unstable aberrations and micronuclei. The Comet test did not show any significant increase of DNA damage in flight personnel with respect to ground staff., Conclusions: The possibility of a correlation between translocations and cancer risk emphasizes the need to adopt preventive measures for air flight personnel.

The subject of this dissertation is the diet of flight personnel. A rapid review of the general question of diet in general and that of flight personnel in particular is given. On this basis, the various aspects of the problem (energy sources, calorie requirements, activity of the individual, etc.) are examined. The conclusion is drawn that no fixed diet can be established. Diet should be adaptable to individual requirements, though it is necessary to follow certain general recommendation for the diet of pilots in general.

A number of cardiology problems connected with altitude are discussed. Dietetic and pharmacological measures of service to heart patients in high mountain environments are suggested. It is concluded that the more serious patients (belonging to the IVth and Vth N.Y.H.A. functional classes), those suffering from myocardial infarction in the acute phase or from serious pulmonary hypertension, should not go higher than 1.000-1.500 metres above sea level. All other patients (with angina, hypertension, non-serious aortic and mitral arteriosclerotic cardiopathy) can go as far as 3.000 metres without inconvenience, providing the outlined dietetic and pharmacological measures are respected.

The medical aspects of journeys by air are often of practical interest. They obviously depend on the constitution of each passenger. Their clinical picture varies considerably and may occassionally be severe. The incidence of such affections in civil aviation has not been determined, though experience shows that they are by no means rare. Evaluation of the harmful effects of flying must clearly take individual habits and histories must be taken into each account, since predisposing factors will lead to unusual features.

Aircrews frequently display acoustic traumas owing to the heavy sound stresses to which they are exposed. Audiometric screening should thus be carried out at regular intervals to assess hearing loss and set in motion measures for its prevention. A brief account of the pathological forms most commonly encountered is followed by expression of the hope that the methods generally used to appraise the percentage of disability in the hearing will be revised, since they are particularly unfavourable to aircrews.

Air transport to highly specialized centres would appear to be indispensable for newborns suffering from severe immaturity and for children suffering from emergency forms of cardiorespiratory insufficiency. The microclimatic conditions in the passenger compartment during normal airline flight are examined. The characteristics of the immature newborn are then discussed together with the main aspects of the care of these patients. The principal physiopathological consequences of congenital cardiopathies are also considered. Finally, the autonomous arrangement of single passenger air transport and operating modalities are illustrated.

A permanent health education campaign was begum some months ago among air force personnel designed to persuade men of all functions and ranks and suffering from refraction defects, to use prescribed corrective means permanently. The causes of failure to use them on the part of many subjects are analysed and the desirability of the health education campaign and the most suitable means of conducting it are illustrated.

In civil and war traumatology, 33% of deaths are due to chest traumas although this involves only 25% of cases. Examination of the physiopathy clinical medicine and treatment of the various traumatic lesions of the chest and their complications shows that rapid transfer of such patients to suitable places of treatment following adequate first aid is indispensable. The use of fully equipped aircraft is thus vital. Transport criteria are dictated by the environment, first aid resources, meterorological conditions, cruising altitude, available equipment [an automatic respirator and aspirator are essential], the training of staff, and the conditions of the patient. Above all, however, the situation is a function of the handling of the patient on the ground in relation to the facilities available on board the craft. It can be stated in conclusion that aircraft in traumatology are the best way of saving lives, not only when the patient's chest is damaged.