Obesity in Aerospace Operations

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1 Obesity in Aerospace Operations Rebecca Blue, MD, MPH James Pattarini, MD UTMB/NASA Aerospace Medicine Galveston, Texas RAM 2013

2 Disclosure Information 84 rd Annual Scientific Meeting Drs. Rebecca Blue and James Pattarini We have no financial relationships to disclose. We will not discuss off-label use and/or investigational use in our presentation.

3 Case Presentation A 37 year-old Obese White Male Submitted application for suborbital spaceflight as a spaceflight participant Weight 298 pounds, height 70 inches; BMI 42.8 Waist circumference 45 inches, waist: hip ratio >0.9 PMH unremarkable, exercises daily at low intensity

4 FAMILY HISTORY: Case Presentation Parents both alive and healthy, father moderately obese with medication-controlled HTN; mother without documented medical problems SOCIAL HISTORY Negative MEDICATIONS None ALLERGIES NKDA

5 Physical Exam Vitals: BP 128/76 HR 83 RR 12 Significant findings: Well developed, well nourished Central obesity Otherwise unremarkable exam Patient able to manage two flights of stairs to office without significant discomfort, mild increase in HR and RR (RR18, HR 104 after stair climb)

6 Procedures/Imaging EKG: NSR 81bpm without LVH by voltage criteria Normal PR, QT intervals LABS CBC, BMP, LFTs, TSH all normal. Lipid profile with mild

7 Aeromedical Concerns Central Obesity According to the CDC, 35.7% of U.S. adults are obese Obesity related to heart disease, stroke, diabetes, certain types of cancer Concern specific to commercial spaceflight: VEHICULAR WEIGHT AND BALANCE ANTHROPOMORPHIC SEAT LIMITATIONS EMERGENCY EGRESS SAFETY OF VEHICLE AND OTHER PASSENGERS *

8 Fig. 1: Central Obesity

9 Aeromedical Concerns Confined Space: According to the Space Passenger Task Force, specific concerns include: The space vehicle interior will be small and confining, with a capacity for 4-6 passengers Passengers should be able to demonstrate the capability to perform required emergency egress procedures for the vehicle Should not have a condition that would either compromise this capability or impede others to safely and expeditiously egress Space Passenger Task Force. Medical Guidelines For Space Passengers II. Aviat Space Environ Med 2002; 73:

10 Aeromedical Concerns If SFP exceeds recommended anthropomorphic dimensions, what should be required? Demonstration of ability to safely and swiftly egress Studies demonstrate need for greater passage way width Obese individuals are generally demonstrated to move more slowly and can impede other passengers exits Templar, J. The staircase: studies of hazards, falls, and safer design. MIT press; Atlanta, GA, Pauls, J. Selected Human Factors Aspects of Egress System Design, presentation at CIB TG50 and W14 Joint Symposium on Tall Buildings and Fire. Sept 2006.

11 Aeromedical Concerns Seat design Hip width limitations for seat fit Poor fit = potential for discomfort, spectrum of injury If SFP required to handle own restraints, maneuverability and ability to fully manage restraint system High G-loading portions of flight: seat weight limitations for G-load?

12 Aeromedical Concerns Weight and Balance All flight vehicles must carefully balance weight for aerodynamic efficiency and stability Vehicle dependent: Can weight limits be waived by decreasing number of passengers? Are there strict limitations on location and fullyequipped weight of the passenger/vehicle that cannot be exceeded or waived? Can seating configuration compensate for an obese passenger?

13 American Airlines Airline Precedents When available, second seat provided to oversized passenger Comfort and safety precaution If no additional seat available, passenger may be required to purchase a second seat United Airlines Passengers required to purchase a second seat if: Unable to secure their seatbelt Unable to lower their armrests Encroach too much on the personal space of the person sitting adjacent

14 Delta Airlines Airline Precedents Passenger required to purchase second seat if unable to fasten seatbelt without an extender Jet Blue Airlines Overweight passengers can be required to purchase an additional seat without question and will not be permitted to board without doing so

15 Aeromedical Legal Concerns In what circumstances can a paying passenger be denied a flight? Passenger safety: egress, block of flow Vehicular safety: balance and aerodynamics In what circumstances must a company accommodate an overweight passenger? Extra seat? (Who pays?) Restraints can they be safely extended? Emergency egress parachute weight limitations?

16 Aeromedical Disposition SFP was counseled: Currently, weight and balance limitations are nonwaiverable SFP was counseled on weight loss, recommended regular medical evaluation Case to be re-evaluated

17 Summary Obesity: Decision: vehicle-specific Concerns include weight and balance, emergency egress, passenger/vehicle safety Ongoing issue in both aviation and space medicine Commercial and legal implications likely to be a disputed issue

18 Questions?

The aeromedical challenges of commercial space flight

The aeromedical challenges of commercial space flight Lt.Col. Francesco Torchia 2 nd International Symposium Hypersonic Flight: from 100.000 to 400.000 ft 1983 2001 Charlie(Walker( 1 Commercial(payload(