Lt Paul R. Wolff, MC, USNR, saves crewmen during ordeal within collapsed aircraft fuselage after crash.

Lt Paul R. Wolff, MC, USNR, is the first to receive Pride and Professionalism recognition for his heroic and professional action while responding to the crash of a Japanese Maritime Self Defense Force PS-1 aircraft. At the time of the crash, Dr. Wolff was assigned as the senior flight surgeon representing the First Marine Aircraft Wing and Naval Regional Medical Center Branch Clinic, Marine Corps Air Station, Iwakuni, Japan. On 26 April, 1983, the aircraft crashed just outside the perimeter of the Marine Corps Air Station. Lt Wolff was the first medical person to arrive at the crash site and immediately took charge of the medical aspects of the rescue. Upon learning that several air-crew members were still trapped inside the smoldering wreckage, he unhesitatingly and with complete disregard for his personal safety while fully aware of the personal dangers involved, entered the wreckage to provide medical care to the injured during a 4-hour period. Lt Wolff's bravery, superlative knowledge, exceptional skills, and outstanding leadership abilities under extremely dangerous circumstances led to saving the lives of three crewmen who were trapped. Below is a narration of the events that took place after the crash and Lt Wolff's medical response in the ensuing hours. It is given by Lt Wolff as he recounts the events.

Physiological effect of high, sustained +Gz forces on man.

Two studies were conducted to evaluate physiological responses and possible tolerance to high sustained +Gz forces at the USAF School of Aerospace Medicine, using the 20-ft (6.10 m) radius Human Centrifuge. In the first study (A), 14 human volunteer subjects--fully protected with an anti-G suit and performing the M-1 or L-1 straining maneuver--were exposed to +Gz forces. These forces began at +6.5 Gz, and increased weekly in 0.5 G increments to +9.0 Gz, for a duration of 45 sec at each level. Physiological performance was based mostly on the subjects' ability to maintain clear vision during the 45 sec exposure. Of the 14 subjects, 9 were able to maintain vision and remain at the +9 Gz level for 45 sec. In the second study (B), 12 human volunteer subjects--also protected with anti-G suits and using the straining maneuvers--were exposed to levels of +1, 3, 6, and 8 Gz, for 60 sec at each level. Extensive physiologic parameters were recorded in order to detect objective criteria which could be used as determinants for a medical tolerance endpoint to the particular level of +Gz stress. In both studies, the reasons for stopping the runs at levels exceeding +7.5 Gz included: fatigue, cardiac arrhythmias, blackout, and one occurrence of ventricular tachycardia. Other physiological responses to the sustained +Gz stress (such as heart rate, arterial blood pressure, central venous blood pressure, arterial oxygen saturation, gastric pressure, and ankle venous pressure) did not furnish specific information that could be used as "physiological tolerance limit" criteria.

Calibration of a new ear oximeter in humans during exposure to centrifugation.

An optoelectronic ear oximeter (Hewlett-Packard, model 47201A) was evaluated as a noninvasive method for determining arterial oxygen saturation (SaO2) in human subjects during exposure to various levels of accelerative forces. This physiological calibration involved exposing five subjects, while breathing air and wearing the ear oximeter for 60 s to each of three levels of accelerative forces (3, 5, and 7 G); arterial blood samples were withdrawn concurrently. SaO2 was calculated indirectly from the oxygen tensions (PaO2) measured from the sampled arterial blood with a blood gas analyzer and corrected for pH and base excess. These data were compared, as were similar data taken from the same subjects breathing three different hypoxic gas mixtures while resitng at earth's gravity (1 G). Regression analyses of these data for both experimental groups (a, G exposure, or b, hypoxic exposure), comparing the ear-oximeter SaO2 with the calculated SaO2, showed the ear oximeter to be accurate with correlation coefficients of 0.95 and 0.98, respectively.

Stress responses of pilots flying high-performance aircraft during aerial combat maneuvers.

In aerial combat maneuvers (ACMs), at Luke AFB, Az, eight pilots flew their two F-15 aircraft against nine pilots in three F-106 aircraft. A total of nine flights, consisting of 23 ACMs, were accomplished in 5 successive days. The degrees of fatigue, stress, and sympathetic activity were quantified using both subjective analyses and the biochemical constituents in the urine of the pilots of the F-15 or F-106. Biochemical indicators, reported per 100 mg creatinine, included: epinephrine, norepinephrine, 17-OHCS, urea, inorganic phosphate, sodium, potassium, and sodium/potassium ratio. The F-106 pilots exerted more relative effort than did the F-15 pilots--effort which appeared to be associated with high-G experience. Both groups of pilots were equally fatigued following ACMs; however, only the fatigue of the F-106 pilots was directly correlated with the length of the ACM. Sympathetic and stress responses during the ACM--similar for both groups of pilots--showed postflight increases of 54% in epinephrine, 19% in norepinephrine, and 20% in 17-OHCS over preflight values, thus suggesting a moderate stress response. Resting levels of these same indicators, for days the pilots did not fly and for pre-ACM values, were similar but higher than control values previously reported for other stressful activities. By late afternoon, postflight values for these indicators had returned to near-preflight levels.

Physiologic effects of seatback angles 45degrees (from the vertical) relative to G.

Eight experimental subjects from the USAF Sschool of Aerospace Medicine (SAM) and four YF-16/17 test pilots were exposed to a simulated aerial combat maneuver (SACM) which included a maximum G exposure of 6 s at 8 G. The following physiologic parameters were examined relative to seatback angles of 23degrees, 28degrees, and 40degrees; heart rate and rhythm; arterial oxygen saturation; performance; intrathoracic (esophageal) pressure; arterial pressure; and subject comfort, effort, and fatigue. Relaxed and straining high sustained G (HSG) tolerances (6 G for 60 s) were also determined using only SAM subjects. The advantages of the 40 degree setback angle during the SACM included increased subject comfort, less fatigue and effort, greater pilot acceptance and a statisically significant reduction in the increased mean heart rate associated with G exposure. On the other hand, a statistically significant reduction in arterial oxygen saturation was obtained during the SACM at 40 degrees compared with the 23 degree back angle. An increase in relaxed G tolerance was found with the 40degree seatback angle--statistically significant only compared with the 28 degree seatback angle.

Ventricular activation process in minipigs.

Because the form of QRS from the body surface of pigs is different from that of carnivores or ungulates, and because that form is dependent upon pathways of ventricular activation, this study was designed to study pathways of ven tricular activation in pigs. Twelve pigs were anesthetized and right or left hemithoracotomies were performed to expose the heart. Contiguous bipolar electrograms were recorded from button electrodes on the epicardium and from both faces of the interventicular septum, and from multipolar plunge electrodes introduced into the intramural regions of both ventricles. Electrograms were recorded simultaneous with the Z-axis ECG at 625 mm/sec paper speed on a photographic oscillograph. Times of arrival of waves of activation at numerous points in the ventricle were referenced to the peak of the R-wave in the Z-axis ECG. During the initial 10 msec of QRS, the apical-third of the interventricular septum is activated from left to right. During the next 40 msec of QRS, waves of activation originating at the cranial portion of the right ventricle and the caudal portion of the left ventricle engulf the epicardium toward the interventricular septum and slightly in an apico-basilar direction. Activity begins slightly earlier at the caudal aspect of the left ventricular free-wall and terminates on the pulmonary conus region. During the terminal 30 msec of QRS, the basilar third of the interventricular septum is activated in a general apico-basilar direction. Through regions of either right or left ventricular free-walls was a general endocardial to epicardial activation observed. These pathways of ventricular activation may be explained by the rather complete penetration of Purkinje fibers through both ventricular free-walls in a manner similar to that of ungulates but different from carnivores and primates.