Currently based at RAF Henlow in Bedfordshire but within the next couple of years planned to be move to RAF Cranwell in Lincolnshire, the RAF Centre of Aviation Medicine (RAF CAM) is an internationally recognised organisation comprising highly specialised teams of Aviation and Space Medicine professionals and support staff.
An absolutely component of military aviation but one whose importance is all too rarely sung, the RAF CAM mission is to deliver expertise and high-quality training in aviation, occupational, environmental medicine and related sciences to support current and future air operations.
RAF CAM provides specialist capability and high-level medical expertise focussed on advancing knowledge and delivery of training to UK military aviators and medics. The mission is based on provision of full spectrum evidence-based, air-minded medical and other related aspects of aerospace medical support that enables safe delivery of air power in what is an increasingly complex, contested and connected operational space.
RAF CAM is best known by many that will read this commentary piece for providing fast jet pilots and aircrew with a full understanding and ability to recognise hypoxia, for High G training, altitude chamber runs to understand the rigours of fast decompression, being spun in the spatial disorientation demonstrator, the importance of measurement in terms of ability to eject and understanding the dangers of fatigue.
But there is much more to the organisation than this and the bottom line is that RAF CAM is there to serve aircrew across the whole of the military in order to enhance aspects of operational effectiveness and flight safety.
RAF-CAM’s raison d’etre is thus to provide aviation medicine services and expertise that will, for service personnel who are obligated to attend regular hypoxia and other human factors course training at RAF Henlow, enhance mission effectiveness and flight safety of each individual involved. It its present form, RAF CAM was established in 1998 through the combining of the former Institute of Aviation Medicine that had until then been based at the former RAE Farnborough, the Aviation Medicine Training Centre that had been based at RAF North Luffenham and RAF Halton ICOM.
With a Whole Force Approach throughout and providing support not just to the Royal Air Force, Royal Navy and Army but also to international air forces RAF CAM has approximately 140 personnel of whom 96 (69%) are military posts including Royal Navy, Army and US Exchange Officers and 44 (31% civilian posts.
Training of aircrew includes initial and refresher training, rear crew and parachutists along with in respect of human factors, remotely piloted air systems (RPAS) crews along with medical professionals which may include Military Aviation Examiners Course (MAME) Aeromedical evacuation, speciality training and DAvMed (Diploma in Aviation Medicine)
The Aerospace Physiology Section
This includes APS that includes hypoxia training and which is described below and also the AvMed Flight which operates a BAE Systems built Hawk Jet that is used for a number of specialist aerospace medical related training aspects and in which aircraft the author has previously flown.
In practical terms, all safety and health related aspects of required specialist aircrew training and operational activities come under the responsibility of RAF CAM. These include, but are not limited to, food and water quality, being the ultimate design authority on all aircrew related equipment including helmets and breathing systems, crash survival, ab initio NVG training and, as already mentioned, training in altitude, acceleration, travel medicine, fatigue and stress, spatial disorientation and other human factors issues.
RAFCAM provides some or all of these services for the whole military aviation community which includes fixed wing and rotary requirements for all the service – Royal Air Force, Royal Navy and the Army. The RAF Medical Board is also part of RAF CAM.
Aviation medicine training for the military aviation community is a NATO requirement that comes under NATO Standardization Agreement (STANAG) 3114 “Aviation Medicine Training of Flight Personnel” and to which the UK fully subscribes. This document lays out the requirements for ab initio, OCU (Operational Conversion Unit) and required refresher training in detail and internationally, RAF CAM is recognised as being a world in its field.
Although under revision, the whole range of aviation medicine instructional programmes that RAF CAM provide to military aircrew together with requirements that aircrew are require to meet come under are driven by the existing NATO standard. As the considered leader in this field, the UK is in regular contact with NATO allies and is the primary sponsor of changes that it believes are required in all aspects of aviation medicine training. RAF CAM also actively engages with the ‘end user’ of equipment for which it has regulatory responsibility to ensure that their views are fully taken into consideration.
No organisation such as this can stand still and RAF CAM is no exception:
Five yearly hypoxia training courses are a requirement for all aircrew flying above 10,000 ft. Traditionally, this was provided by aircrew being taken through a decompression chamber of which there are four at RAF Henlow in order to experience hypobaric conditions.
Speaking from personal experience, exposure at high altitudes and release of subsequent pressure in order to provide a full hypoxia experience is not exactly pleasant although this form of aircrew training remains very relevant.
The importance of training relates to the user who will almost always be fixed wing aircrew having a full understanding of the risk of decompression sickness. The decompression chamber training method was recognised some years ago as not being without risk and that, although extremely rare, has resulted in medically related consequences.
Importantly, new developments in hypoxia training equipment in recent years mean that hypoxia training can and is increasingly now being provided at ground level through the user breathing gas with a gradually reducing level of oxygen content. This change has the added benefit of making use of simulator-based training even more practical and in providing aircrew with the opportunity to experience hypoxia as they perform actual flying tasks in a simulator.
Fast jet pilots are required to have regular hypoxia training and those passing through RAF Henlow are now all being provided with scenario-based hypoxia training in BAE Systems Hawk flight simulators. On my last visit to RAF Henlow a few months ago I believe that only two of the four hypobaric chambers are still in semi-regular use mainly for hypoxia training for other aircrew including rotary and Ab initio students who continue to experience one hypobaric hypoxia rapid decompression flight in the altitude chamber flight in order that they may experience the effects of pressure change in a controlled environment as well as a rapid decompression.
Aviation Medicine Services had already been launched when I had previously visited RAF Hendon in 2016. The aim of this is to provide rapid, comprehensive clinical and occupational opinions for RAF, Royal Navy and Army aircrew.
Essentially Aviation Medicine Services was set up in 2011 in order to provide an innovative one-stop medical service for aircrew that could facilitate, where possible, a rapid return of those using the service to flying duties. Cost effective and one of many aviation medicine policy developments in recent years, the service is staffed by medical specialists who have all received training in aviation medicine. Future intentions include increasing the range of medical conditions that can be seen by this service through the addition of other specialists such as ophthalmologists. Th Aviation Medicine Service provided to aircrew has undoubtedly improved timeliness and quality of medical care of aircrew and enhanced flight safety across defence.
TheNoise and Vibration Division (NVD) provides a very important element of service to aircrew personnel by measuring and documenting ambient and at ear noise levels of military aircraft and work environments in order to ensure that in the hazardous work-place that personnel work potentially dangerous levels of noise are identified in order to ensure adequate protective measures can be provided.
Whilst communications ear Plugs (CePs) are fielded to all personnel working in a high noise environment in order to provide adequate levels of hearing protection, military aircraft pilots and aircrew and ground staff are exposed to very high levels of noise that require protection provided by a helmet or noise reducing headset.
This is the provision of a functional assessment of egress (leaving or moving from one particular point of an aircraft to another) and this remains a tool of choice for assuring fitness for this particular role.
Aircrew Equipment and Integration Group Clothing and Life Support Equipment
The Aircrew Equipment Integration Group (AeIG) have a continuous flow of new projects on the go that directly impact on life support equipment and improvements to aircrew kit in respect of safety, comfort of use and performance covering all airborne platform types.
Around 60% of AeIG work (validation of design and function through practical testing and evaluation of new items in a realistic cockpit environment including potential effects from the impact of flame, cold and heat on aircrew the kit being used) is in direct support of operations. Additionally, AeIG ensure that kit warn by aircrew is not only user-friendly but has been designed to include all elements of safety related requirement. Recent and ongoing work of AeIG includes:
Evaluation of new body armour for transport aircraft under an Urgent Operational Requirement (UOR).
Mk10R light weight helmet; evaluation and testing.
Facial masks in order to better protect rotary rear crew from flying dust, debris and stones.
Evaluation, assessment and integration of tri-laminate aircrew immersion protection clothing for which field trials are being conducted
Newer, more fire-resistant fabrics for aircrew clothing have undergone evaluation via manikin burn testing
Base layer clothing, new aircrew boots and new eye wear are all under scrutiny.
Custom fit Aircrew Equipment Assemblies (AeA) service for aircrew, to include helmet custom fitting.
Minimizing G-LOC (G-induced loss of consciousness)
RAF CAM has long held responsibility to provide centrifuge training for fast jet aircrew in order to minimize the chances of G-induced loss of consciousness. Replacement of the former RAE Farnborough based High G centrifuge facility which dated from the mid 1950’s was long overdue and in February 2019 a new state-of-the-art replacement High-G Training and Test Facility operated by Thales UK was formally commissioned at RAF Cranwell and where ultimately all RAF Cam activities will be centred.
The new centrifuge training facilities at RAF Cranwell provides military pilots with a much higher level of induced G experience and is a vital component for aircrew providing knowledge, understanding, experience and ultimately confidence that allows them to better handle High G in flight.
The centrifuge facility has the potential to accelerate pilots up to 9-G (nine times the normal gravitational pull of the Earth) in just one second but also to rotate them at a rate of 34 times per minute. The importance of what has been a £44 million investment by the MOD in the RAF Cranwell facility cannot be understated. Put simply, apart from this being a required safety training pre-requisite for fast jet pilots, due to the state of the art centrifuge cockpit layout and design, this means that for the first time Royal Air Force and Royal Navy fast jet pilots are now able to fully replicate flight and likely anticipated G-forces they could experience in fifth and sixth generation fast jet capability such as the BAE Systems Hawk, Typhoon and Lockheed Martin F-35 Lightning.
Air Accident Investigation and Human Factors Section (AAIHF)
On call 24/7 and engaged in all military air accidents including parachuting and on request, civilian air related accidents, AAIHF are also specialist in ejection seats. Advising aviation related authorities such as the Military Aviation Authority on human factors and aspects of operational taskings which often require the specialist staff involved traveling into theatre in order to participate in accident investigations, AIHFS is a hugely important aspect of aerospace medicine within RAF CAM’s area of responsibility.
Providing strategies for risk mitigation, investigating and analysing all aspects of equipment worn by pilots and aircrew killed or injured in accidents, reporting to the MAA and assisting in writing of formal accident reports, AIHFS personnel provide established standards for helmet impact and helmet impact testing of parachuting helmets along with impact test criteria standards for crashworthy seating for rotary wing platforms.
AIHFS also provides aviation medicine, impact biomechanics and escape system advice to aircraft design project teams. RAF CAM provides a range of advice, design and development related support to Project Teams concerning all related safety and life support systems and within this, any potential limitations that may be found in existing aircrew life support equipment employed in Typhoon, JCA, Hawk and other platforms including rotary.
One interesting example is research that is currently in progress on RAF Chinook operated Chinook helicopters in order to provide evidence for flight clearance of a personnel-mounted oxygen system to be used in flight. This must of necessity be more user-friendly and compact than older systems that have been used and it must also be less susceptible to damage by enemy fire than past systems.
Other examples include trials related to aeromedical evacuation equipment such as hypobaric chamber testing of equipment that is used in aeromedical evacuation missions, as well as clinical trials of new in-patient monitoring systems
RAF CAM teaching staff provide periodic presentations on fatigue, stress and human error mitigation during courses of instruction for the MAA Flying Supervisors’ Course and Flight Safety Officers’ Course. In addition, CAM provides an informal consultation service for station level doctors who have queries concerning their practice of aviation medicine. The organisation also participates in aviation medicine and human factors conferences worldwide.
The Environmental and Occupational Health Squadron provides SME support to the RAF and wider defence in respect of health protection expertise for units, med ops, specialist environmental and Occupational Health, 24 hours cover for joint aircraft recovery and investigation and environmental risk assessments to all 6 RAF Stations that have major accident control regulation requirements.
The RAF Medical Board awards permanent Joint Medical Employment Standards to all RAF personnel including aircrew and also medical assessment on behalf of RAF Manning in order to assess suitability to fulfil any role.
Aviation Medicine Clinical Services provides an outpatient service for tri-S aircrew and aircraft controllers collocated with the RAF Medical Board. They provide clinical and operational opinion on fitness to fly.
CHW (London – 24th June 2020)
Howard Wheeldon FRAeS
Wheeldon Strategic Advisory Ltd,
M: +44 7710 779785