Aeromedical Training

“Nah, man – I don’t teach aeromed… We’re an Assault unit, not Medevac.”

I distinctly remember the moment I heard those words uttered to me by another flight instructor in 2002; I was amazed that someone had signed this guy off as qualified to teach upcoming crew chiefs. At the same time, my confidence in my own abilities was still rather shaky from being, essentially, self-taught through determined curiosity.

For Annual Proficiency and Readiness Tests (APARTs), the contemporary guidance offered by the associated Training Circular was quite clear:

Phase 2 – Oral Examination. The examinee must have a working knowledge and understanding of all applicable topics in the respective subject areas below. As a minimum, the evaluator will select two topics from each appropriate subject area. An evaluator/trainer will also demonstrate an ability to instruct and evaluate any topic.

Going through the list from the “digital pack rat archives” which reside on an external hard drive, the topics are familiar in their diversity. Regulations and publications… operating limitations and restrictions… aircraft emergency procedures and malfunction analysis… ah… aeromedical factors…

Flight restrictions due to exogenous factors.

Hypoxia.

Stress.

Middle ear discomfort.

Spatial disorientation.

When I first started performing crew duties in December 1996, this area was somewhat of a confusing blur. Everything was a confusing blur, really… but that can be attributed to the excitement of being paid to fly on a Black Hawk.

However, as I gained much more experience and insight, this became one of my more comfortable topics to teach. A conversation with my son the other night brought much of this back into sharp focus and reminded me that we never truly forget some things – no matter how trivial they might seem once they become professionally irrelevant.

The seed of this conversation was rooted in the most recent “Smarter Every Day” video where Destin Sandlin experienced vestibular discomfort while on a once-in-a-lifetime flight with the Thunderbirds. We got to talking about my experiences in helicopters and how to provide easy relevance to seemingly complex instruction.

In my case, it was the vision and spatial disorientation.

When teaching vision – especially night vision – I would start my classroom portion with one simple statement:

“For this first portion, I would like you to cover one eye – it doesn’t matter which – and keep it covered until I let you know.”

I would then go into the Department of the Army-approved breakdown of the anatomy of the eye, types of vision, limitations (this helped with illustrating the day blind spot), and visual problems/corrective measures. It usually took about 15 to 20 minutes to get through, giving the students’ covered eye enough time to fully adapt to the lack of light – plus, it provided some amusement for anyone who wandered into my class to see a handful of people sitting there with a hand over their eye.

“Ok, remember how I had you cover one eye? I’m going to turn the lights off and you will switch – cover the other eye. Tell me what you see.”

For most, the figurative lightbulb went off over their heads as I started discussing the difference they were seeing as they alternated between eyes. Off-center viewing, focal acuity, night blind spot… all these things suddenly made sense with the practical exercise. With that, I would transition into distance estimation and depth perception – teaching the mnemonics which were easily recalled years after I last taught it: GRAM/LAV/KITO (for those reading who remember: yeah, you never forget it…).

Of course, this was all associated with one of the historic causes for aviation accidents: spatial disorientation. Going into that topic was always more fun in direct demonstration than academic study, and I was fortunate enough to fly with great pilots who enjoyed assisting in a meaningful educational experience…

Without excessively boring the reader, the focus was two areas: the vestibular system and the proprioceptive system. The former comprises the semicircular canals in the ear which provide input to external changes in attitude, while the latter provided somewhat the same input due to forces on internal organs and external appendages/joints.

Demonstrating this was always entertaining. While in a sufficiently large area, we would transition from a hover to movement – laterally, vertically, or rotationally. With my head down to prevent reliance on the vestibular organs and eyes closed, I would announce which direction the pilots would start moving. The more I flew, the more tuned I was in providing accurate responses to the helicopter’s movement… and sometimes, it was even possible to note subtle changes in the noises of the transmission and rotor systems, but that was never the main point and only illustrates that I found things like this way too interesting.

When it came time for the student to do the same, it became a game for the pilots – if they were accurate in announcing what movement were perceived, then the pilots would try even more to make their control inputs more subtle and/or confusing. By the time they were hopelessly calling out the wrong direction – “sliding left” when we were actually moving right, I would have them raise their head and see how far off they were from what we were doing…

…At which point vertigo would hit many of them and I would see their hands either grip the metal frame of the seat tighter or reach out to brace against the frame of the gunners’ window.

Another firm teaching point achieved.

This nostalgia serves several purposes…

First, that overconfidence is usually due to ignorance. In the case of the “we’re not Medevac” instructor, he had other strengths when it came to instruction and evaluation. I realized that, at six years’ in, there was a lot that I knew but more that I didn’t know… More importantly, I learned that an ego can be detrimental to education – both for the student as well as the instructor.

Along with that, I found it fascinating that the material is still firmly embedded in my mind. Yes, I ended up referencing some of these old and outdated publications – for reference only, though. There were tons of odd tricks I developed over the years to either assist with folks gaining a more comprehensive understanding of what was being taught or evaluated; perhaps some of these methods might resonate with the odd instructor who happens along and prevents them from reinventing the wheel at the cost of precious blade time.

Finally, the issue of solving problems often comes from inquisitiveness. Rote memorization for the sake of meeting a standard never really sat well with me – especially when it came to topics which may or may not prove to be critical one day. In chatting about this, I listed off several instances where spatial disorientation claimed the lives of famous people – Patsy Cline, John F. Kennedy Jr., and – thought the official NTSB report is still pending – Kobe Bryant, as well as countless other not-so-famous but similarly tragic examples.

As always… yeah, I miss it.