AN ALGORITHM FOR PULMONARY SCREENING OF MILITARY PILOTS IN ISRAEL

Background: Medical screening is used routinely to qualify and classif y candidates for pilot training. The respiratory system assumes even g reater importance owing to the increased stress of flying high-perform ance aircraft in a hostile environment characterized by high altitude, varying acceleration (''G'' forces), and the possibility of rapid dec ompression. Any respiratory dysfunction may threaten the pilot's healt h, night safety, and completion of the mission. Only those candidates with the highest psychophysical score are accepted to undergo special aeromedical screening, physical suitability is an important factor in the selection and classification of candidates for flight training pro grams, and pulmonary function testing is central within this screening protocol.Methods: We developed a respiratory algorithm for this uniqu e screening process. The algorithm represents a practical and efficien t approach for large-scale screening of healthy candidates for flight training. The algorithm deals with the major pulmonary health problems encountered in a previously screened healthy population aged 17 to 25 years. If by anamnesis, physical examination results, or baseline spi rometry findings there is reason to suspect a respiratory problem that could emerge to endanger the pilot's life, a specially designed evalu ation is performed according to the algorithm. We explain, step by ste p, the basis for each suggested test in order to reach a decision (ope rational specifications). The pulmonary function studies we recommend are reasonably priced and can be easily and reliably performed by regu lar medical staff technicians. The major justification for performing pulmonary function studies in a healthy population that has already go ne through a preliminary medical screening and has been found fit is t o identify occult or latent abnormalities. These abnormalities may hav e no or minimal clinical expression under ordinary circumstances but, under the stress of night during the ensuing 5 to 10 years, may produc e serious limitation in function. Results: Two cases, seen in the Air Force Medical Center, are presented to illustrate how the algorithm is implemented. The algorithm has been in use for more than 5 years, and has been applied to the screening of several thousand candidates. Fol low-up of the accepted candidates has not revealed any significant def ects in the decision-making process. Conclusion: Use of the algorithm is highly cost-effective since it allows for nonspecialist physicians to carry out pulmonary screening and involves the pulmonary specialist only infrequently, ie, when a particularly complicated and/or borderl ine case is encountered. It is our contention that a similar algorithm would be useful in many other settings where large-scale screening is required.