RIGHT AXIS DEVIATION AS A CRITERION FOR ECHOCARDIOGRAPHIC EVALUATION OF AIRCREW CANDIDATES

Background Significant pressures exist in the resource-limited environ ment of military aviation to select only those candidates for flight t raining who are both physically able to withstand the demands of the f light environment and likely to complete a career in aviation. As medi cal technology has advanced, uncertainty has arisen regarding the appr opriate use of additional studies in the screening of aircrew candidat es. At the Naval Operational Medicine Institute (NOMI), where all U.S. Navy aviation duty candidates' medical qualifications are reviewed, c urrent policy is to perform 2-echocardiography on all candidates who e xhibit a right axis deviation of +95 degrees or greater on their initi al electrocardiogram. Methods: The records of all aircrew candidates r eferred to the Department of Internal Medicine for evaluation of right axis deviation during the years 1993, 1994, and 1995 were reviewed. A cost benefit analysis was performed to assess the cost effectiveness of using echocardiography to screen candidates suspected of having dis qualifying physical defects based on a finding of right axis deviation on electrocardiogram. Results: Of the 69 cases reviewed, only 1 candi date was disqualified due to cardiovascular disease. He suffered from a large atria[ septal defect initially discovered on physical examinat ion. Conclusions: It is not cost effective to use 2D-echocardiography to screen aircrew candidates for disqualifying cardiac defects based o n a finding of a right axis deviation of +95 degrees or greater on ele ctrocardiogram.