Identifying Predictors of Pressurized Submarine Escape Training (PSET) Attrition.

Pressurized Submarine Escape Training (PSET) physically prepares submariners to safely escape a submarine at depth. Failure to complete PSET is not a submarine service disqualification. Serious medical incidents are rare, but the safety record tradeoff has been low throughput. From 2009 to 2015, only 34% of students screened completed PSET. Students may be medically screened out of the training altogether (disqualified), or dropout during the physical training (attrite). Training records from 12,122 U.S. Navy students were used to identify factors contributing to training disqualification and attrition. Multivariate logistic regression model predictors included demographic and screening items. Association to PSET disqualification included cold/congestion/cough (ORadj 12.34), limited duty status (ORadj 4.29), Physical Readiness Test failure (ORadj 3.37), pneumonia or bronchitis in last 2 years (ORadj 3.17) and nervousness or anxiety in tight spaces (ORadj 2.37). Basic Enlisted Submarine School students were more likely to be disqualified and attrite than other submariner groups, and black/African American (ORadj 1.53) students were more likely to attrite than white students. Only cold/congestion/cough (ORadj 1.52), trouble swimming (ORadj 1.53), and screening during cold/flu season (ORadj 1.28), were associated with training attrition. Recommendations to modify screening requirements are listed in conclusions.

The submarine service of the future?

Space missions, although now routine, are unique in terms of their environment and logistical requirements. The number of missions (man-hours) remains relatively small and planning still relies on comparisons with analogous missions, including submarine operations. Antarctic missions, which tend not to be classified, have provided more information about isolated communities because of the number of personnel per base. Space medicine has traditionally been an extension of aviation medicine with high g-forces involved in the transition from Earth to orbit and astronauts such as Neil Armstrong recruited from the test pilot fraternity. As the length of a mission increases and the space habitation relies more on regenerative systems, the environment becomes more analogous with today's nuclear submarines. As well as the air purification implications, radiation still is a significant hazard with even greater impact on future Mars missions requiring the provision of health physics monitoring, advice and countermeasures well established in the submarine flotilla. Nevertheless, the specialty space medicine will progress as a specialty in its own right, pooling expertise from other specialties such as aviation, radiation, emergency and occupational medicine taking human exploration beyond the confines of land and sea.