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Training NCO. Evaluation-; Ster, Deputy Comman R. Reimer, Assistant Standar- ". Gil- o '. Molineux, Operations NCO. Golden, isources. Morton, Jr. Stamper Jr. Basso, Jr. Vondriska, Jr. Burke, standardizations. Gagne, Operations NCO. Brown, Jr. McSally, Deputy Commander for Opera- tions.

Schneider, standardizations. Evaluations Officer; C Col Douglas p. Lostetter, Jr. Whiting, Training NCO. Haley, Training Officer. Hell, we even had it pretty good back then. We remember, in Beast, when the cadre told us how lucky we were to be basics.

With mud in our faces and fear in our hearts, we sure didn ' t believe them. We ' d get more sleep during BCT than any other time in our cadet career, they said. And we were really lucky to not hove academ- ics to worry about; academics ore more of a haze than BCT, they said. Right, we said. Now we know. But everything ' s different looking back on it, because you ' ve got some- thing to compare it to.

The worst part of Beast was the shock effect. No mat- ter how much you knew about the sys- tem before you got here, you couldn ' t be prepared enough. It ' s different when it ' s happening to you. Now, we have a hard time remembering just what we did know about Beast and the Academy before we got here. Our whole avant-Beast consciousness and mentality were depleted as we stepped off the busses on that dismal, gray 30th of June, and for the first time in our psuedo-odult lives we wanted our mommies.

The brainwashing start- ed then. Inprocessing itself may have been enough of a training session for us. With three laundry bags filled with heaven- knows-what in hand, we came to the awful realization that we really wouldn ' t be wearing civilian clothes for an entire year. The cadre weren ' t really so bad at first. They didn ' t hove much more hair than we did. We had to wonder, if upperclassmen had hair that short too, then where the heck did they get all those pictures of normal looking people in the catalog?

We were quick to learn that cadets are not normal, and the cadre are not nice. Then havoc sets in: the three 30 MILITARY weeks that seemed like eternity in which we learned to march to the rear, make hospital corners on our beds, ask for seconds and pull chins. We ignore the cadre as we sit hungrily at the table and they tell us if we don ' t learn this stuff now, we ' ll never get anything to eat during the school year, we ' d get more to eat now than ever, and the food ' s always best during BCT.

And we don ' t believe them as they tell us with our faces in the wet grass doing pu- shups at 5 a. Besides, they say, this is fun. Right, we soy. Over these three weeks, we never stopped to realize what was going on around us and between us. We pro- gressed from a group of bumbling strangers to a team, people who had to stick together and stick up for each other. And the true teamwork had not yet begun, continued on page 32 Taking the oath of allegiance gives the basic ca- det his first taste of the pride that comes from serv- ing his country.

Ivors: e fe [? But everything ' s different iooking bacl on it because you ' ve got something to compare it to. The worst part of Beast was the shocl effect. No matter how much you new about the system before, you couidn ' t be prepared enough. Jsapa i N ew cadre arrive wearing berets We also built a respect for our cad- re; a real respect, not just fear and opression.

They really know all ttiose quotes, and ttiey seemed to live by thie honor code, and they knew how to nnarch and could sound off and pull chins and what the hell did they do when we were at those heritage brief- ings anyway? It ' s hard to rennember the upperclassmen who seem so cool now ever being such jerks in Beast. But they were. They all were. And, we see now, it was oil part of BCT. It wasn ' t supposed to be fun. But we had breaks.

Like intramu- rals: twice a day, sometimes, we got to head on down to the playing fields and take out our frustrations on a piece of sporting equipment. Heritage wasn ' t so bad. Hell, we got to sit down. That was almost as cool as lying down. Some- times the briefings were even funny. And they taught us class unity.

And then, like a blessing from heav- en, came Doolie Dining Out. We stood by our designated letters on the same parking lot we had stood 20 days ago. We waited impatiently, as car after car drove up to pick up yet another lucky doolie. The rest of us looked on in antici- pation, hoping that the guy in the yel- low porsche would be our sponsor. But even the best of days could not counteract that traumatic event of a few days before: the arrival of the second BCT cadre.

The first BCT cadre, with whom we had come to identify as almost friends in light of the arrival of these monsters, had warned us of them. No warning was necessary. We knew they were mean; they wore ber- ets. And then, the moment we had been waiting for, the march to Jack ' s Valley. We felt prepared, having sur- vived the obstacle course what could be worse? At Jack ' s, we learned comeroderie like never be- fore.

Course after course, we learned to stick together. And we learned that the new cadre weren ' t as bod as they looked; they were actually quite sup- portive. We needed it. But just when everything seemed to be going okay after the confidence course how could we go wrong? Seventy minutes in hell, We hoped for rain, thinking we could actually escape the assault course.

No, we ran the course in the rain. Through puddles and mud, we emerged murky- brown instead of olive drab. And it felt good. The assault course got us back down to the basics: it ' s just you and mother Earth and some jerk trying to get the two of you even closer togeth- er. It looked comfortingly familiar, except for that each day, more and more upperclassmen ar- rived.

We were outnumbered. We never marched so proudly as we did on Acceptance Day. Our boards were pinned on by cadre whom seemed half proud as hell of us and half OS glad as we were that it was over. We turned and faced all the new upperclassmen and the new cadet life that faced us, and we realized for the first time that maybe the cadre really did go through basic cadet training once, too.

As this basic cadet takes the oath of honor, he rel alizes It ' s not the uniform or the haircut; It ' s thel honor code that separates the cadet from his civil Ian college countepart. This basic, happy to escape fo the confidence course, tests his balancino abilities In hopes of winning a coke from the confidence course cadre The basic cadet below suspends by a wire fifteen feet In the air. One of the high points of the Jacl ' s Valley experience.

And we realized for the first time that maybe the cadre really did go through BCT once tool MILITARY 33 w Will there be future hell weeks ' 92 says it won ' t be as tough hen I was a doolie When I was a 4 degree recogni- tion training, which marks the end of the Fourth Class Year, is un- doubtedly the single most anticipated event next to graduation.

The upper- classes look forward to a little peace and quiet, and the freshmen are ready to jump into some civilian clothes. The recognition weekend is com- monly Known as Hell Week, though it is actually only three days long, not an entire week like back when things were tough. Week or not, the hell part is fairly accurate, Like any year, there is always one great rumor setting the tone for the weekend.

This year, the common belief was that this would be the last Hell Week ever. This remained to be seen, but the Class of was ade- quately prepared to be the last class recognized just in case. As the Class of would be quick to point out, this year ' s recogni- tion was much easier than theirs it al- ways is because inclement weather closed the obstacle course to most of the squadrons. Disappointed 4 degrees found themselves running indoor courses instead.

Mighty Ninety had rifles, and Bold Gold 91 had push-ups. At ease on the terrozo and com- fortable in their civilian attire, the Class of can now sit back, look forward to CQ, and hope that 92 will someday have to go through Hell Week. But it wouldn ' t be, of course, as hard as the class of ' 91 had t Laine Harrington. Above: Almost ttiere.

Doolies look forwarc to running back soon. Only with possession of th class rock. Odom As the class of would be quick to point out this year ' s rec- ognition was much easier than theirs. S C Odom M The Soviets: a riddle to solve Unwrapping it ' s a task for us ilitary preparedness cannot forecast to you ttie action of Russia.

It is a riddle wrapped in a mystery inside an enigma. If Churchill is correct, the Soviets, by their very nature, ore o formidable adversary. In fact, they would be un- l nowable. After all, who could answer the riddle, solve the mystery and figure out the enigma that Churchill asserts is the Soviet Union?

No one, according to Churchill. It ' s beyond our grasp and our capabilities. The military implications of Churchill ' s observation are frightening. The So- viets are our greatest foe. Yet how could we ever hope to maintain peace, provide for national security or ensure military success if our adversary is unl nowable? The U. How do we resolve this apparent impasse? To begin with, recognize that Churchill was wrong. The Soviets are a riddle that can be solved.

States, lil e people, are riddles. The Soviet Union is no exception. It ' s a complex, closed society of great depth and breadth, possessing both apparent contradic- tions and inconsistencies. Hence the riddle - who ore the So- viets? What are their intentions?

Therefore the riddle, despite its complexity, can still be answered. We can know the Soviets. For the military professional, there are three steps to allow you to begin to unwrap and solve the riddle. First, do a personal inventory. Try and identify if you ' re mirror imaging the Soviets, emphasizing our similarities at the expense of our differences.

Second, honestly answer the ques- tion, " Do I have any hidden objectives or agendas I want to achieve that re- quire a certain opinion one way or the other about the Soviets? As a result, your knowledge will probably be distorted as long as your priorities re- main unchanged. Change your priorities, make knowing the Soviets a higher priority than achieving your hidden agendo. Third, increase your own depth of understanding about the Soviets.

Read more, listen more, and think more criti- cally about your key adversary. Keep your imput broad and varied. Read in- formation that contradicts your per- sonal opinion. Military preparedness is too vital and military failure is to devastating to our national security for us to hide be- hind Churchill ' s observation. The key to knowing the Soviets lies in unwrapping the riddle.

The responsibility for this task rests with us. Allen Dorn, Professional Military Studies, Cadets and academy personnel had the chance to acquaint themselves with various So- viet weapons. C4C Robert Borjo discusses soviet weapons witti tils classmates A display ol Russian artillerv was set up in ttie cadet library or Project War- rior day in April. C4C Jotin Sctiaefer sigtits Itirougti a tiondheld rocket launctier.

According to Capt Howard Wong, Osan project officer for the pro- gram. The program supports the mission of the Air Force Academy: to provide instruction and experience to cadets so that they graduate with the knowl- edge and character essential to lead- ership and the motivation to become career officers in the U.

Air Force. Cadets become eligible to partici- pate in the program after their sopho- more year. They will either visit a state- side or overseas location. Overall, more than 1, cadets will visit locations Air Force-wide to gain exposure to the Air Force way of life, according to Capt Wong. The nine-week summer period, when classes are not in session, is divid- ed into three phases. One phase is used for leave time, another for " Operation Air Force " and another for training.

The cadets will be assigned to spe- cific units. They will visit various support areas and each of the flying squadrons. Their uniform of the day will be fatigues with baseball cop. More than tOOO ca- dets will visit locations. Air Force wide. Top: Cadets also get ttie chance to see ttie sur- rounding area by way of Air Force van. Center C2C Sabina Wu prepares for a fighter ride.

Bottom left: No its not the base mascot. The cadets pose in front of the local beef. Split between two dif- ferent bases, cadets are usually affor- ded exposure to at least two of the major commands. The trip is often bogged down with long tours of facilities, but for some lucky ones a ride in a jet makes it all worth it. MILITARY i9 Another chance to see real AF, less stress, cadets return relaxed Squadron sponsor trip The school week is long and gruel- ing; you look in the nnirror and find little bruises on your forehead where you ' ve been playing forehead basket- ball in Aero class, while in the meantime the element took last in the squadron for the twelfth week in a row.

You need a break, but Colorado Springs, is not exactly a cure for boredom; at a nor- mal school, you ' d skip a few classes and go to the beach. Why did you turn down that scholarship to UCLA, any- way? Does this story sound familiar?

Fortunate- ly for them, CW has provided a pro- gram that allows cadets to keep in touch with the reality of the " Real Air Force " : the Squadron Sponsor pro- gram. Each squadron in the wing is as- signed a " sponsor base " somewhere in the continental US; sometime during the academic year, most squadrons are given a chance to visit their sponsor base for a weekend.

This not only gives the cadets a welcome break from the routine of the Cadet Wing, but it also provides a chance to see how an oper- ational Air Force squadron lives, works, and plays. Most trips start on a Thursday after- noon with a hectic hour or, more rea- sonably, ten minutes of furiously load- ing a garment bag to beyond full. The first night is usually hec- tic; a briefing with the base command- er, maybe dinner at the Airman ' s Dining Hall, and checking into the Visiting Offi- cer ' s Quarters.

Sleep is norm ally the first priority, although some cadets find that nothing relieves stress more than a bit of R and R. Friday consists of a tour of the base " This is the base gas station - see the pumps " " This is the base li- brary - would you like to go in and see the books? This is the educational part of the trip, and you can learn a lot of things here that you can ' t learn on the hill: how a mission gets planned how a real command post works, the differ- ence between field maintenance and operational maintenance.

But education isn ' t the only pur- pose of the trip. There ' s usually one day set aside for fun. If your base is close to something like, for instance. New York City or maybe Tulsa , then you can head downtown. Whatever activities are planned, however this is the part of the trip where cadets discover that life in the " real Air Force " is much different than life on the hill.

Left: C2C Peter Gersten studies the cockpit. Above: This squadron stands in front of their spon- sor ' s fighter. Each cadet hopes to be in the driver ' s seat one day. CS dreams of flying tfie plane tie poses In front of.

Ttie officers are stiown around ttie academy and ttie Springs. AFA, Military excellence One of a kind The Sabre Team is unique in that it is the only organization that utilizes sabres for drill and exposition at various functions throughout the year. There are also 24 fourthclassmen competing for membership status.

The Sabre Drill Team is one of a kind in the United States, and, because of this and the dedication of team mem- bers, is a very close knit group of individ- uals. Its mission is to repre- sent ttie Air Force Academy and ttie miiitary exceiience it fosters. Above: In action even the slightest mistake wil be noticed. Left: Discipline even before the per- formance. Members on the Honor Guard are also the general ' s flog bearers, cadet wing parade escorts, flag detail on duty days during the academic year, and wing color guard at all cadet forma- tions and any special activity in the lo- cal area.

The team took the trophy for best overall company at the Bowling Green State University drill meet with first and second place awards in areas such as inspection, exhibition drill, regulation drill and color guard. The team ' s underlying goal is to develop the character of its members through an emphasis on attention to detail, self-discipline, teamwork and pride so that better leaders for the Air Force ore produced. Our success in at- taining a significant amount of com- mand positions at Wing, Group and Squadron levels attests to this pact.

Besides acting as drill instructors, cadets performed inspections and monitored physical conditioning. There were also relaxing softball games on the Basic Military Training Squadron teams. Often, cadets marched as squad- ron commanders in the twice weekly parades.

The parade was a great ex- perience with cadets marching in all of the staff positions and with General Westbrook in attendance. Sometimes the cadets even got lucky and re- ceived T rides. They weren ' t quite an F or F ride, but we enjoyed them anyways.

Night life wasn ' t quite as limited as some of the other assignments. The city of San Antonio provided entertainment for all those nights off. They also learned skills of dealing with the enlisted corps that will be valuable to their careers as United States Air Force officers. Colwell T37 rides weren ' t as good as F or F rides, But fun anyways. Marctiing as squadron commander in thie parades. Hanging out with ttie Training instructors.

Eating at ttie student ' s ctiow hiali. The air- m craft is running smoothly, all the I clouds are thousands of feet below. All IS right with the world. Your breath is sucked from your lungs, fog is in the air. You know you only have sec- londs of consciousness left, after that, ' death. You instinctively don your oxy- gen mask, bringing back your breath; your life. The scenario can be real for aircrew members, but with proper training, the dangers involved with an explosive de- compression are minimized.

The cadets receive training at the Carter P. They receive class- room instruction in the physiological ef- fects of altitude, oxygen equipment, escape from air craft, and emergency procedures. This is all in preparation for the fun part - the altitude chamber. Cadets receive a demonstration in the chamber of pressure breathing, where the air is forced into the mask at the expense of plebian humor as air escapes from the sides of the mask, the chamber is brought up to 1 1 , feet.

At this altitude they check for problems with their ears and sinuses. Once every- one is checked out, it ' s back down to ground level. They spend 30 minutes at this alti- tude, allowing their body to rid itself of nitrogen, which can cause severe prob- lems at altitude. After the 30 minutes have passed, the real fun begins.

The chamber is quickly brought up to 25, feet. Two rubber gloves, tied off at the end, are hanging in the chamber. As the altitude is increased, the gloves expand, result- ing in a grotesque form of a hand. Unfor- tunately, this is how the cadets ' bodies feel.

Their bodies are continually, and uncomfortably, reminding them what they ate for the previous two days. C3C Chris Marchiori gets measured for an oxy- gen mask just like ttie real pilots wear. Inside tfne altitude ctiomber. Mitch ' s revenge! Once at 25, feet, the cadets take off their oxygen masks to experience the effects of hypoxia.

Hypoxia is the lack of oxygen to the body. They work problems on a clip- board, finding it difficult to do simple tasks. They notice everything moving in slow motion, their buddy next to them turning blue, a feeling of euphoria com- ing over them. They know something is wrong when a cadet feels euphoric. Most of them put their masks back on as soon as they notice the symptoms, some never notice any and wait out the entire seven minutes without masks. From 18, feet, the cadets use a small free-fall emergency bottle.

De- signed for use during emergency bail- outs, the bottle supplies a continuous flow of oxygen and last only a few min- utes. They don ' t have to worry about running out because free-fall time taken to descend from 18, feet to breath- able air is only a few seconds. The ca- dets are more worried about relieving pressure from their sinuses and ears, BANGl Air is suci ed from ftieir lungs.

Fog impairs tlieir vision. Tliey quicl iy put on tlieir masks than breathing. For the next phase, they move into a smaller chamber, which is comfortably set at 8, feet. They just sit there, without their masks on waiting. The explosive decompression takes them from the cozy 8, to 22, feet in less than a second. Air is sucked from their lungs. Fog in the air, impairs their vision, but they quickly and competent- ly put on their masks, setting its switchs properly and once again, all is right with the world.

The physiological training the ca- dets receive is to prepare them for the opportunities they will receive during the summer to fly in fighters or other Air Force aircraft. Accidents and emergen- cies don ' t usually happen, but being prepared can save not only your life, but others as well. Scott D. Too bad, there ' s a Saturday Morning Inspection and your room is filthy. You start searching your mind for excuses to get out of it or at least to put off cleaning it for a while.

When you come back from a few hours of relaxing at a downtown estab- lishment, you find the quiet squadron you left has transformed. Upperclass- men are scrounging for clean sheets, doors wide open, and stereos blasting a variety of tunes. You go back to your room, not to find the good fairy clean- ing, but an angry roommate telling you to clean the valet. By one a.

The manda- tory breakfast comes too soon and the four de- grees are scram- bling to fix the dam- age the upper- classmen did to the common use rooms while they weren ' t watching. You can tell whose rooms are in what kind of order by the amount of the time they spend at breakfast.

Some do a touch-and-go, while others sit and complain to one another about having to get up so early on a Saturday morning. Eight-thirty arrives and the SAMI begins. Most will spend the next hour standing in their room at parade rest waiting for an inspecting official to come in and break up the boredom.

To an outsider, and some of us to, it is hu- mourous to think of adults checking for dust in the back corner of a closet or becoming irate over underwear not being folded six- by-six-inches. Finally, the an- nouncement end- ing the SAMI is made and you ' re ready to climb back into bed to retrieve your lost sleep.

But before you can lay down, the four degrees sound out, " There are twenty minutes until first call for the parade Above: Three fourthclassrr await the dreaded inspector. Opposite pa Top: This guy demonstr ates the under the b tuck in method. You can tell whose rooms are in what kind of order by the amount of time they spend at breakfast. Out of all the cadet parades It ' s only 2 that really matter Try sleeping upright There are only two parades that mean a thing in a cadet ' s career: The parent ' s weekend and the gradu- ation parades.

When a cadet is a fresh- man just out of Basic Training and hasn ' t seen his or her family for almost two months, there is a small chance that the cadet might be looking forward to the parent ' s weekend parade to impress those members of his family.

When the cadets are seniors, they look forward to the graduation parade for no other reason than it is their last parade ever in their whole lives. Every other parade in a cadet ' s career is basically worthless. No one comes to watch, except some officers who have to go to one parade a year by order of the Commandant.

And let ' s not forget all the A. C ' s who go to parades because they love their ca- dets and want to see them do well. So, in summary, everyone has to go to a parade, but no one wants to. I think that there ' s a message in this some- where. Noon meal brings two things to mind for cadets. First, it is a welcome midday break, unless you are a 4 de- gree, then it is a living hell.

And then second, is the dreaded hassle of mar- ching to it. Walking out of fourth period class or if you are a four degree, then sneeking out the library everyone is trying to catch an indication of wheth- er or not we are marching. Hopes of high winds, rain, snow, or artic temper- atures are shattered by blue skies and mild temperatures.

C1C Kevin Missar Left: Before noon meal parade starts, doolie ; get in a little knowledge wtiile standing at attei tion. Above: Group Staff members at parad. Winfield W. Scott Jr. Gener- al Scott was the superintendent from June 15, until his retirement cere- mony June 25, General and Mrs.

Scott plan to re- side in Colorado Springs area after his retirement. General Scott, 59, ended a military career spanning more than 37 years. He graduated from the U. Military Academy at West Point in , and received his v ings upon completion of pilot training in August Throughout his year career.

General Scott has been a professor of aerospace studies, commanded a fighter squadron, pilot training wing, technical training center and a major air command. Prior to becoming the Academy ' s 10th superintendent in , he served as deputy commander, U. Forces Ko- rea; deputy commander in chief. United Nations Command Korea; chief of staff. General Scott is a command pilot with more than 5, flying hours in more than 25 different aircraft and is currently an instructor pilot in the non- powered gliders at the academy, and is also jump qualified.

Cadets and academy personnel feel honored for the privilege of serving under General Scott ' s command. Ca- dets will definitely miss his boisterous cheering on of the football team during the games. When the General says WIN! To the class of General Scott is just a name of a previous superintendent, but to the previous seven classes, he ' s the epit- ome of a real General.

General Scott gives tiis farewell speech before i turns over ttie command to Lt. Wek speecti. Courtesy photo jll speed M It Sffi. Oa wleS ' ' i General Scott is a command pilot with more ttian 5, flying tiours in more ttian 25 different aircraft and is cur- rently an instructor pilot in ttie non-powered gliders at ttie Academy, and is also jump qualified. I was reading your magazine late one Friday night as I tried to stay awake on CQ.

May I help you? A thousand times I had answered the phone like this, but this time was different. From the other end of the phone came the sexy hoarse voice of a woman asking for C1C Freedom. After several dates we fell helplessly in love with one anoth- er. Two and half years later we were married at the cadet chapel on June 1 and now we have our first child.

My wife is up to lbs, she lets me get car- ry out on Sundays instead of cooking, and we are very happy together. Everyone has heard the stories of CQ ' s meeting people over the phone, falling in love, and living happily ever af- ter. This only happens in the movies or " Dear Abby " stories. CQ is actually endless hours of silent monotony, espe- cially on the weekends, CQ ' s are sup- posed to represent the squadron com- mander, the AOC, the Comm, the Supt, and God, In reality the CQ is a go- pher and secretary for 1 10 people who would rather be any where than in their rooms, CQ is a thankless job by any mea- sure since the only time you hear about your performance is when someone is complaining about this or that.

It is a job every cadet since the dawn of time has dreaded, done and hated. Although most of the time CQ is a waste of a person ' s time, there are those occasions where the CQ is very helpful and important. CQ is one of the least liked duties of a cadet. Most cadets do not want to do the job and the rest gripe that the job is not done right. When all is said and done, CQ is one of those permanent things at the academy, just like the construction on the buildings that nev- er seems to get done.

Above: Even though he ' s doing dreaded J duty, he can still manage a smile. Left: Ano t form of CQ is sitting at group. One thing ed to another and we soon had :3 date. Below Yet another form o CQ sitting Command post where there ' s more than just a phone Command post gets to make announcements throughout the wing Bottom Then ol course there ' s the phone to answer.

A Catotrieii C. MachKXi 1 There ' s something to be said about plastic chairs; lectures asic Combat Survival Sitting in tiard, plastic chiairs and lis- tening to lectures for nearly eight hours may not be considered much fun by some folks standards.

But, com- pared to sleeping on cold, damp ground and eating wild vegetation, it ' s probably not so bad. Third-class cadets start their surviv- al, evasion, resistance and escape, better known as SERE, training in the classroom with academic theory.

Then without much warning, they ' re taken from their cozy plastic chairs to the frostbitten ground of Say- lor Park. It ' s in the mountain range park wide-eyed students get " hands-on " training in survival techniques. They learn to build shelters and live off the land. With this knowledge, the students put their imaginations to work. Acting out the role of downed-pilots, students spend three days and nights evading the enemy. All the while, these psuedo-pilots learn about friendly and not-so-friendly forces and how to navigate from one point to another without becoming pri- soners of war.

With a little luck, they ' re fortunate enough to get a helicopter ride when they ' re finally evacuated bock to the cadet area. Some students, however, aren ' t torn from the classroom chair to end up in the woods. The more fortunate ones end up in the frigid water of Kettle Lake. Cadets that " survive " water training earn a diploma for non-parachuting water survival.

But the " fun " isn ' t over until each student tests his resistance at the Resis- tance Training Laboratory. In retrospect, the training isn ' t so bad. Some students even volunteer to come back the next year as cadre to teach new three degrees the ins and outs of survival.

A survival student is i ept in ttie darl for what comes next. Anothier student prepares to be rescued from ttie chilly water of Kettle Lake. Hot pinl is for rescued. Evading cadets try to look like ttie surroundlno trees of Saylor Park Various type sling devices use to rescue are demonstrated In SERE This cadet tries on one lor size.

Planning atiead on paper. All the while, these psuedo-pllots learn about friendly and not-so- friendly forces and how to navi- gate from one point to another without becoming prisoners of war. But the ' ' fun ' ' isn ' t over until their tolerance is tested. Land as soon as conditions permit - well the IP has been token care of so I would continue to fly the mission as normal. The T program has been made to be as similar as possible to the UPT programs, thus giving cadets on edge when starting UPT, given that they ap- ply themselves the same way.

There are three times you can take T, fall, spring, and summer. The best time to take it ' s in the summer. Flying continuously mokes it easier to remem- ber flight pictures. Your plane may han- dle like a wallowing hog, however all you have to concentrate on is flying, no academics or military. The next best time is the Fall when cold weather makes flying like swim- ming through a crystal blue lake early in the morning.

It ' s possible to finish the program before the bad weather settles in. Finally the Spring offers the worst flying conditions. I managed to fly once a week, not enough to enhance profi- ciency. And when the weather finally clears, the change in temperature forces you to adapt your flight atti- tudes. One thing I did learn was chair- flying, an indispensable technique for any flying student. All you need is a good imagination and a chair. Sit through the mission and go through the motions as if you were there cruising at feet.

This is a tool I learned the hard way, almost not making it through the program, and one that I will continue to use through UPT and whatever platform I am as- signed. The best advice I have for T is to take it in stride and learn as much as possible the first couple days. It facili- tates flying later on. Relax in the air- plane and choir-fly.

The more you prac- tice, the more prepared you will be, and more able to cope with outside, diverting situations, such as Continental Airlines coming up your rear. True story. Near misses occur. Many a cadet come through T-4 1 with their first " there I was A view from above. It fa- c ' litates flying later on.

Relax in ttie rplane and ctiair-fly USAFA program one of largest, most active, excellent conditions Flying introduction The Academy soaring program is one of tine largest and most active in the world. The Academy ' s location provides the terrific scenery of the Pike ' s Peak region, v hile also possessing excellent soaring conditions.

All this is enhanced by the fact that 90 percent of the cadet training is done by cadet instructor pilots. The motorized gliders are oper- ated by 16 assigned and 30 attached Air Force pilots. All thirdclassmen re- ceive approximately three rides in the motorized gliders and 10 to 15 rides in the Schweizer s before soloing in the Approximately 10 percent of the students are selected to advance in the sailplane program to become cadet instructor pilots.

These cadets can receive civilian ratings from private licenses to certified flight instructor li- cense in gliders. After becoming an instructor pilot, the cadet may participate in the ad- vanced soaring programs provided for them.

In this program, the cadet will re- ceive a minimum of 15 flights before checking out in the Schleicher ASKs. He or she may then obtain aerobotic in- struction in this aircraft. After eight to ten aerobotic instructional flights, the cadets become proficient in the fol- lowing maneuvers; lazy eight, chan- delle, loop, cloverleaf, Immelman, splits ' , sliceback and barrel roll. The Schleicher ASK is capable of pulling positive 5. Top speeds of over mph are also rea- ched.

The instructor program and ad- vanced sailplane program provide the cadet with necessary skills that will clearly enhance his undergraduate pi- lot training experience. C-ZC Steve Nordhaus. Left and above: C1C John York enjoys the view.

There feet During that time many people lost their jum- ping slots ,. Then came the week of intense training. Every sunrise we were down at the AM building running, doing push- ups, and most importantly, learning what to do in the sky. Today, after donning our gear, and climbing on board the Baby Blue Otter, it ' s up to 4, feet for the big moment.

I scream the count but the wind carries the sound away so I can ' t hear myself. My heart beats at least three times its normal rate as I watch the Ot- ter quickly disappear from sight. There is a God. Now as I am floating un- der the chute, I can see for miles. There ' s Chapel Hills. Over there is Gar- den of the Gods, and below me, the jump zone, nicely plowed, just waiting for me to land in it, and I am headed straight or it.

It ' s time to prepare for landing. Feet, knees, hands, not exactly a perfect landing, but the question I would really like on answer to is who in the heck is the brilliant person who put this hard rood down the middle of the pit? Well, shake it off, walk back, don the gear and go for round two. C2C Cathy Kies- er 60 Every sunrise we were running, doing pusii- ups and most impor- fanfiy iearning wiiat to do in ttie si y.

American lags are abundantly disployed while cadet squadrons 15 and 12 proudly marcti to commemorate ttie th anniversary of ttie U. Con- stitution. In memory of this historic occasion, a parade was held Sept. Then came the students of the U.

The cadets stood tall, dis- playing the professionalism they had been taught. Spirits and emotions ran high as they felt the importance of this once-in-a-lifetime occurrence. The cadets were led by C1C Jim Black, squadron 15 commander. Sam W. Westbrook, III, commandant of cadets, chose Cadet Squadron 15 to march in the Parade because its members were selected as Outstanding Squadron in Ca- det Squadron 12 was the Outstanding Military Squadron for The gloomy weather had no effect on the spirit of the moment or the mag- nitude of the event.

Kenneth H. Fleming vice Dean of Faculty I Col. Malham M. Perry D. Luckett Assistant Dean of Faculty Capt. Paula G. Lt Col r. Gil- liam, Lt Col C. Longneckcr, Lt Col R. Maj P. Russell, Maj C. Veith, Ma j D. Wailis, Capt D. Adams, Capt O. Al- len, Capt 1. Barlow, Capt M. Bohtin, Capt W. Bowman, Capt D. Coffey, Capt W. Cris- ler, Capt J. Mouch, Capt C. Wissler, Capt C. Wood, Capt n. Youtsler, C. This is what the Aeronautical Engineer- ing major is concerned with. Choosing to be an Aero major opens the door to the science of aerodynamics to in- clude the behavior of moving air, the forces air produces, and how these factors can be used to design and con- struct an airplane.

In addition, the stu- dent w U explore the fundamentals of designing airbreathing engines and rocket propulsion systems. Sounds technical, doesn ' t it? It is but once in a while you actually do get a chance to work with real airplanes or models. In the senior design course, the student learns about the concep- tual design process as applied to de- signing an aircraft.

Have you seen stu- dents carrying balsawood models around? They were probably enrolled in the Flight Mechanics class where af- ter spending twenty-seven hours crunching numbers, a balsawood glider design popped out which was then built and test flown. In the Flight Test Techniques course, the student finally gets to see a real airplane if you call a T a real airplane and gets to serve as a flight test engineer taking performance or stability data or just heckling the " test pilot.

I ' ve always been interested in the art of flying so this major was the obvious choice for me. Being an Aero major takes dedica- tion and the realization that the Aero Department is unlike many other aca- demic departments. The faculty mem- bers advocate critical thinking by the student so their course policies have a tendency to be more harsh than oth- er departments. These policies reflect their emphasis on academic and mili- tary discipline.

This must be kept in mind when an assignment, QR, or grading policy seems unreasonable. This major requires hard work, but the result is well worth the effort. Don ' t let this discourage you, the benefits of becoming an aeronautical engineer are numerous and I ' m sure you will do well in the Aero major if you: 1 don ' t like driving your car; 2 don ' t let Capt. Spitler see you ride the elevator; 3 have lots of patience, and; 4 have a good sense of humor!

An Avi. The control panel for the J- H. ScntiInc isheinqtnntrollcd hv an dcio major, while an- olhersluclcntiswatc hinqthe cn ine ilscll. Two aero majors arc dis- cussinti Ihc clfccis of wind on the airfr. Kirkpatrick, Lt Col R. LisowskI, Maj D. Boden, Maj D. Cloud, Maj J. Davis, Maj D. Wagie, Capt B. Acker, Capt K. Barker, Capt D. Brett, Capt K. Bubb, Capt M. Drake, Capt R. Mall, Capt J. Hess, Capt T. Lash, Capt P. Leu- thauser, Capt M. Lorenz, Capt P. McQuade, Capt R. Rhoades, Capt T. Riggs, Capt J.

SIgnorelll, Capt P. Vergez, Capt T. War- nock. I want to let you in on some well-kept sec- rets about the Department of Astro- nautics and their creation, the astro- nautical engineering major. This means that the Air Force ' s role in space and the design of space systems is significant.

Astronautical engineers will help design, analyze, build, and operate the space systems of the fu- ture. The astronautical engineering majorat the Academy prepares cadets to do just this through a variety of courses. Two courses in particular prepare cadets for the design tasks they may face after graduation. The first is Astro , commonly know as " Build-a- Rocket.

The other course is Astro , Space Mission Design. This class gives budding engineers a chance to plan space shuttle missions and gain ex- tensive experience in FORTRAn pro- gramming. All of this you may have heard al- ready. Many outsiders look at just the engineering part of the department and the time we spend doing " projects " and label us " Astro Geeks " with no social lives. But, unless you too are one of us an astro major , you probably haven ' t heard the real rea- son so many cadets sign up for astro.

The Department of Astronautics is ac- tually a cover for a group of highly so- cial, partying kind of people. Look at the evidence I ' ve gathered during my four years and decide for yourself. The people of the Astro Depart- ment, in their efforts to stimulate so- cial interaction among their cadets, have provided three well-disguised opportunities for regular get-togeth- ers on base. My first exhibit is the Scheduling waiting area. This poshly- furnished room comes complete with couches and is where 1 have had many a rendezvous with fellow Astro majors.

The department first set us up in Scheduling by changing all the course numbers so we would have to revise our APSs. In case this wasn ' t enough, they pretended to forget Astro taught by Capt Tom " the Rocker " Riggs and Capt Paul " Partyman " Ver- gez was a double period class until af- ter school started.

In the endothelium, the enzyme nitric-oxide synthase catalyzes the reaction of oxygen and L-arginine to produce nitric oxide NO and citrulline. Nitric oxide can then diffuse into the bloodstream where it can inhibit adhesion of platelets and leucocytes. It can also diffuse into the adjacent smooth muscle cell. This initiates a series of reactions that result in relaxation of vascular smooth muscle.

This mechanism underlies the effect of agonists that interact with receptors on the endothelium cell, such as catecholamines. It has been demonstrated that vascular bubbles can injure the endothelium and reduce the vasoactive effects of compounds such as substance P and acetylcholine Nossum et al. Nitric oxide production can be up-regulated by exercise.

Indeed, studies in animals Wislff et al. Similarly, administration of nitroglycerine to animals prior to decompression stress can reduce venous gas embolism Mllerlkken et al. Whether either of these interventions will reduce decompression sickness in humans remains to be investigated. This was initially believed to be mostly caused by relative hypovolemia induced in space by diuresis due to central translocation of blood from the extremities Blomqvist and Stone, If this were the sole mechanism the syndrome should be preventable by volume loading prior to re-entry and landing.

However, evidence has accumulated suggesting impaired vasoconstrictive response to standing Buckey et al. Using a rat model designed to simulate weightlessness hind limb unloading with head down position impairment of the arterial vasoconstrictor response to norepinephrine was observed Delp et al. Another possible mechanism involves up-regulation of eNOS Nyhan et al. Such observations not only provide a more complete understanding of the problem, but will undoubtedly lead to more effective pharmacological or physiological countermeasures.

However, significant transients can be missed by steady state techniques. For example, in primary pulmonary hypertension, indwelling pulmonary artery catheters have shown that mean pulmonary artery pressure and pulmonary vascular resistance may change substantially from hour to hour Rich et al. Similarly, during acute immersion in cold water, quite large transient changes occur in both systemic and pulmonary artery pressure Wester et al. Another example is normal pressure hydrocephalus, a condition consisting of gait disturbance, cognitive decline and incontinence.

In this condition enlarged ventricles suggest that intracranial pressure ICP is elevated. Static measurements of ICP in this condition are usually normal, however long term observations of intracranial pressure in these patients reveal cyclical variations, with periodic elevations to high levels McGirt et al.

The pathophysiology of high altitude headache is unknown, but the possibility has been raised that it may be due to increased intracranial pressure, although with some contrary. The possibility that transients may be important has been suggested by a remarkable field study, in which ICP was directly measured in three subjects during an expedition to Hagshu Peak in the Himalayas altitude 6, m Wilson and Milledge, While under resting conditions CSF pressure was normal, intermittent pressure elevations occurred in two of three subjects studied.

Of these three subjects the only one to develop headaches was a subject in whom elevated CSF pressure was observed. SUMMARY Measurements at the level of the whole organism provide fundamental observations and remain the bedrock of our descriptions of environmental physiology.

Whole human or animal studies should provide the impetus to look beyond our original observations into the cellular and molecular mechanisms. By so doing, we may gain an understanding of not only phenomena of immediate interest, but of physiology in general. Further advances will require widening of the scope of research traditionally based on steady state methods to include techniques that can detect and measure transients.

By implementing a wider array of investigative techniques to include transient phenomena and cellular and molecular methodologies, a clearer understanding might be obtained of hitherto elusive phenomena such as high altitude pulmonary edema and decompression sickness. Prasad, S. Chugh, K. Rao, D. Cornfield, C. Milla, N. Singh, S. Singh, W. Effects of inhaled nitric oxide and oxygen in high-altitude pulmonary edema. Circulation Bailey, D. Roukens, M. Knauth, K. Kallenberg, S. Christ, A.

Mohr, J. Genius, B. Storch-Hagenlocher, F. Meisel, J. McEneny, I. Young, T. Steiner, K. Hess, and P. Free radical-mediated damage to barrier function is not associated with altered brain morphology in high-altitude headache. Journal of Cerebral Blood Flow and Metabolism Barometric Pressure La Pression Baromtrique.

Blomqvist, C. Cardiovascular adjustments to gravitational stress. In Shepher, J. Abboud, eds. The Cardiovascular System. Boycott, A. Journal of Hygiene Cambridge Buckey, J. Lane, B. Levine, D. Watenpaugh, S. Wright, W. Moore, F. Gaffney, and C. Orthostatic intolerance after spaceflight. Journal of Applied Physiology Dehnert, C. Berger, H. Mairbaurl, and P. High altitude pulmonary edema: a pressure-induced leak. Respiratory Physiology and Neurobiology Delp, M.

Holder-Binkley, M. Laughlin, and E. Vasoconstrictor properties of rat aorta are diminished by hindlimb unweighting. Doherty, M. James Glaishers account of balloon sickness: altitude, decompression injury, and hypoxemia. Neurology Duplani, I.

Marinovi-Terzi, D. Bakovi, V. Ivanev, Z. Valic, D. Eterovi, N. Petri, U. Wisloff, and A. Aerobic exercise before diving reduces venous gas bubble formation in humans. Journal of Physiology 3 Erzurum, S. Ghosh, A. Janocha, W. Xu, S. Bauer, N. Bryan, J. Tejero, C. Hemann, R. Hille, D. Stuehr, M. Feelisch, and C. Higher blood flow and circulating NO products offset high-altitude hypoxia among Tibetans. Proceedings of the National Academy of Sciences Fred, H.

Schmidt, T. Bates, and H. Acute pulmonary edema of altitude. Grocott, M. Martin, D. Levett, R. McMorrow, J. Windsor, and H. Arterial blood gases and oxygen content in climbers on Mount Everest. New England Journal of Medicine Groves, B.

Droma, J. Sutton, R. McCullough, R. McCullough, J. Zhuang, G. Rapmund, S. Sun, C. Janes, and L. Minimal hypoxic pulmonary hypertension in normal Tibetans at 3, m. Hackett, P. Medical therapy of altitude illness.

Annals of Emergency Medicine Hampson, N. Near-infrared optical responses in feline brain and skeletal muscle tissues during respiratory acid-base imbalance. Brain Research Hultgren H. Lopez, E. Lundberg, and H. Physiologic studies of pulmonary edema at high altitude. Hultgren, H. Grover, and L. Abnormal circulatory responses to high altitude in subjects with a previous history of high-altitude pulmonary edema. Maggiorini, M. Melot, S. Pierre, F. Pfeiffer, I.

Greve, C. Sartori, M. Lepori, M. Hauser, U. Scherrer, and R. High-altitude pulmonary edema is initially caused by an increase in capillary pressure. Brunner-La Rocca, S. Peth, M. Fischler, T. Bohm, A. Bernheim, S. Kiencke, K. Bloch, C. Dehnert, R. Naeije, T.

Lehmann, P. Bartsch, and H. Both tadalafil and dexamethasone may reduce the incidence of high-altitude pulmonary edema: a randomized trial. Annals of Internal Medicine Malconian, M. Rock, J. Reeves, A. Cymerman, and C. Operation Everest II: gas tensions in expired air and arterial blood at extreme altitude.

Aviation, Space, and Environmental Medicine McGirt, M. Woodworth, A. Coon, G. Thomas, M. Williams, and D. Diagnosis, treatment, and analysis of long-term outcomes in idiopathic normal-pressure hydrocephalus. Neurosurgery McMahon, T. Moon, B. Luschinger, M. Carraway, A. Stone, B. Stolp, A. Gow, J. Pawloski, P. Watke, D. Singel, C. Piantadosi, and J. Nitric oxide in the human respiratory cycle. Nature Medicine Menon, N.

High-altitude pulmonary edema: a clinical study. Moir, E. Tunnelling by compressed air. Journal of the Society of Arts Mllerlkken, A. Berge, A. Jrgensen, U. Wislff, and A. Effect of a short-acting NO donor on bubble formation from a saturation dive in pigs. Moon, R. Respiratory monitoring. In Miller, R. Philadelphia: Churchill Livingstone.

Nossum, V. Koteng, and A. Endothelial damage by bubbles in the pulmonary artery of the pig. Journal of Undersea and Hyperbaric Medicine Nyhan, D. Kim, S. Dunbar, D. Li, A. Shoukas, and D. Impaired pulmonary artery contractile responses in a rat model of microgravity: role of nitric oxide. Pugh, L. Gill, S. Lahiri, J. Milledge, M. Ward, and J. Muscular exercise at great altitudes.

Purdy, R. Duckles, D. Krause, K. Rubera, and D. Effect of simulated microgravity on vascular contractility. Rich, S. DAlonzo, D. Dantzker, and P. Magnitude and implications of spontaneous hemodynamic variability in primary pulmonary hypertension. American Journal of Cardiology Sampson, J. The environmental symptoms questionnaire: revisions and new filed data. Scherrer, U.

Vollenweider, A. Delabays, M. Savcic, U. Eichenberger, G. Kleger, A. Fikrle, P. Ballmer, P. Nicod, and P. Inhaled nitric oxide for high-altitude pulmonary edema. Singh, I. Kapila, P. Khanna, R. Nanda, and B. Highaltitude pulmonary oedema.

Lancet Sutton, J. Reeves, P. Wagner, B. Groves, A. Cymerman, M. Malconian, P. Rock, P. Young, S. Walter, and C. Operation Everest II: oxygen transport during exercise at extreme simulated altitude. Wester, T. Cherry, N. Pollock, J. Freiberger, M. Natoli, E. Schinazi, P. Doar, A. Boso, E. Alford, A. Walker, D. Uguccioni, D. Kernagis, and R. Effects of head and body cooling on hemodynamics during immersed prone exercise at 1 ATA. Wilson, M. Direct measurement of intracranial pressure at high altitude and correlation of ventricular size with acute mountain sickness: Brian Cummins results from the Kishtwar expedition.

Wislff, U. Richardson, and A. Exercise and nitric oxide prevent bubble formation: a novel approach to the prevention of decompression sickness? Decompression Illness DCI , Decompression Sickness DCS , Dysbaric Illness DI , disorder, syndrome are terms associated with the clinical signs or symptoms originally generated by a reduction of absolute pressure surrounding the patient.

For years the definition of the disease is a matter of disputes or consensi. We understand nowadays that it is not enough to know how to cure evident clinical manifestations, but also to reduce or virtually eliminate the primary physical cause for the physiological damages: the gas separation phase from saturated tissues stationary or circulating bubbles. To achieve this goal, research is more oriented on the decompression procedures or the diver pre-conditioning heat exposure, physical activity, whole body vibration, antioxidant medication, oxygen breathing, hyperbaric oxygen therapy, hydration or dehydration and post-conditioning different decompression procedures or models, deep stops, shallow stop followed by a deeper one, post exposure hydration, speed of ascent, exercise during decompression.

Some factors that were believed to be crucial, such as patency of the cardiac Foramen Ovale or gender, are considered less important than modified decompression procedures that are studied today with sharper technology. Schaller, Auderghem, Belgium. Any significant organic or functional decrement in individuals who have been exposed to a reduction in environmental pressure must be considered as possibly being DCI until proven otherwise.

This applies to acute, sub-acute and chronic changes related to decompression and may be related to acute clinical symptoms or to situations that may develop subclinically and insidiously. It is in fact generally accepted that subclinical forms of DCI, with little or no reported symptoms, may cause changes in the bones, the central nervous system and the lungs Kelemen, ; Shinoda et al.

Generally, a disorder is a physical derangement, frequently slight and transitory in nature. A disease is considered a condition of an organ, part, structure, or system of the body in which there is abnormal function resulting from genetic predisposition, diet, or environmental factors. A disease is typically a more serious, active, prolonged and deep-rooted condition. DCI should be considered a disorder due to a physical primary cause that can transform into a disease unless adequate and timely action is undertaken to abort or to minimize the pathophysiological effects of bubbles on the body tissues.

The predominant physical cause of DCI is the separation of gas in the bodys tissues, due to inadequate decompression, leading to an excessive degree of gas supersaturation Kumar et al. Rapid decompression rate of ascent or omission of decompression stops is a primary cause of gas separation in tissues Figure 1.

The most obvious prevention strategy for DCI is, therefore, determining and observing appropriate ascent and decompression procedures Marroni and Zannini, ;. Intravascular bubbles in rodent submaxillary capillaries Courtesy of Divers Alert Network.

Marroni et al. Unfortunately, the recommendations for decompression are largely empirical and not always reliable. This is confirmed by the finding that more than half of the DCI cases managed by Divers Alert Network DAN worldwide over the past several years have not been associated with an obvious violation of decompression procedures, dive table or dive computer limits; they have been unpredictable.

This has led to a search for other contributing factors to the development of DCI, such as a Patent Foramen Ovale, in an effort to explain the wide variation in individual susceptibility to DCI. Other factors include complement activation in the presence of gas bubbles as well as an uncertain relationship between gas bubbles, blood cells, and the capillary endothelial lining in response to bubble presence and development of DCI. The manifestations of DCI are sometimes trivial and subtle. These are likely to be ignored or denied by individual divers, training organizations, and emergency physicians unless they are made aware of them and offered specific information on the manifestations of DCI.

However, there appears to be growing evidence that under-reported, under-estimated and under-treated signs and symptoms of DCI may result in permanent organic or functional damage so that raising the level of suspicion amongst divers and physicians alike becomes increasingly important. Although the presence of Doppler-detectable gas bubbles in the blood is not necessarily predictive of clinically evident DCI, the appearance of DCI in the absence of detectable pulmonary artery and venous bubbles is rare.

There is even growing experimental and clinical evidence that suggests that asymptomatic silent bubbles in the body may be causing cellular and biological reactions that release secondary potentially damaging biochemical substances in the blood. Unfortunately, there is great disparity in the application of this classification of DCI amongst specialists when asked to define similar cases of decompression disorders using this traditional classification.

Consequently, a descriptive form of classification has appeared that uses the common term DCI, followed by a description of the clinical signs and symptoms and their onset and development characteristics. The latter has been considered both more universally understandable and simpler to teach. It also shows a much higher degree of correlation among specialists describing the same DCI cases.

For purposes of clarity and consistency, DCI refers to disorders of decompression that are clearly due to DCS or where the origin or embolized gas cannot be definitively attributed to pulmonary barotrauma. Where the cause of arterial embolization is the direct consequence of pulmonary overexpansion, the term AGE is used.

Epidemiologically, there is universal consensus among the international diving medical community that the incidence of DCI is generally very low and that there is no significant gender-related susceptibility. There is also consensus that neurological manifestations are by far the most common form of DCI amongst recreational divers.

Many yet unknown aspects of DCI are the subject of ongoing international studies. These include: the relationship between gas separation and DCI injury, the relationship between clinical symptoms and the severity of the disease, the relationship between initial clinical onset, treatment results, and permanent sequelae, the reason for the large variation in individual susceptibility to DCI, the lifespan of gas bubbles; and the true incidence of DCI.

The first clinical recording of DCI was in compressed-air workers. Triger reported that two men had suffered very sharp pain in the left arm and another had pain in the knees and left shoulder 30 minutes after emerging from a seven-hour exposure at pressure the pressure could have ranged between 2. Although not knowing what it was, Triger also reported the clinical treatment for DCI as rubbing with spirits of wine soon relieved this pain in both men and they kept working on the following days.

Pol and Watelle wrote that they were justified in hoping that a sure and prompt means of relief would be to recompress immediately, then decompress very carefully. Yet it was only many years later that their advice was heeded. In , Paul Bert demonstrated that the cause of DCI was dissolved nitrogen going into gas phase in body tissues and that this bubble formation was responsible for symptoms.

Bert also highlighted the existence of silent bubbles in the venous blood. He understood that recompression was the key treatment of value and that it should be applied promptly. He also used oxygen at one atmosphere following very rapid decompression. Moir published his work on the excavations of the Hudson River tunnel. Following this intervention there were only a further two deaths out of men employed over the following 15 months. Moir wrote: With a view to remedying the state of things an air compartment like a boiler was made in which the men could be treated homeopathically, or reimmersed in compressed air.

The pressure was then lowered at the very slow rate of one pound per minute or even less. The time allowed for equalization being from 25 to 30 minutes, and even in severe cases the men went away quite cured. Unknowingly, Moir was recording both the means of prevention and treatment of DCI. Variations of his techniques, now called surface decompression, are currently still used. Even though few subsequent publications appeared on recompression treatment for the next 30 years, it was the widely accepted notion that, to be effective, recompression should commence promptly followed by slow decompression.

These principles remain in effect to this day even though the pressures used, breathing gases applied, and rates of decompression observed, have undergone much modification. The probable explanation is that increased perfusion during exercise leads to a corresponding increase in inert gas uptake, which must be subsequently eliminated during decompression. Exercise during ascent has differential effects. During decompression stops, mild exercise appears to be helpful.

On the other hand, increased activity during pressure change appears to increase the DCI risk. At least three mechanisms may help to explain this effect: 1. It follows the appearance of gas bubbles produced by the excessively rapid lowering of ambient pressure. This reduction enables inert gas dissolved in tissue to enter the gas phase causing the formation of gas bubbles in tissues and body fluids.

The clinical syndrome is known by a multitude of names including decompression sickness, DCI, decompression injury, caisson disease, bends, chokes, staggers, dysbarism and gas bubble injury. Although arterial gas embolism is usually associated with pulmonary barotraumas, decompression bubbles can also lead to embolization if there is shunting between the venous drainage and systemic circulation e.

This blurs the boundaries between decompression sickness and arterial gas embolism, which is why the term DCI was created. Many languages do not differentiate between sickness and illness so that the terms dysbarism, dysbaric illness, or dysbaric injury have become equivalent terms for DCI. Clinical settings of DCI include diving, aviation, hyperbaric oxygen therapy i. The formation of gas micronuclei. Rapidly flowing blood, especially in the area of vessel bifurcation, may create foci of relative negative pressure through a venturi effect.

Molecules of gas from the surrounding supersaturated blood may then diffuse into these foci down a partial-pressure gradient. The resulting localized collections of small numbers of gas molecules called micronuclei are thought to act as a nidus for further bubble growth formation; Increased local CO2 production by exercising muscle may play a role since CO2 is a highly diffusible gas that could contribute to the formation of gas micronuclei.

The mechanism of this effect is not clearly understood; and, Increases in core body temperature due to increased muscle activity may reduce the solubility of gas in body tissues leading to bubble formation. However, very recent research results are questioning some of these assumptions regarding exercise and diving, in particular that of exercise prior to diving. The latter appears to lower DCI incidence depending on when the exercise is performed. The explanation of these findings is still hypothetical, although nitrous oxide seems to be protective when it is produced by an increase in physical exercise 20 hours before diving Wisloff and Brubakk, ; Wisloff et al.

There is an association between recent local musculoskeletal injuries and an increased incidence of DCI at or near the site of the injury. The mechanism responsible for this phenomenon is unclear. Changes in local perfusion and increased gas micronuclei formation in injured tissue are postulated mechanisms.

Inert gas uptake is generally not affected because the exercising diver is usually warm and has increased tissue perfusion due to exercise Martini et al. However, as the diver cools during the dive and at the safety or decompression stops, the divers tissues experience a reduction in blood flow due to the cold and an increase in solubility tends to retain more gas.

As the diver rewarms after the dive, the excess gas may be released as bubbles. AGE Advancing age increases the incidence of DCI for reasons that are not yet clearly known but may be related to the reduction in pulmonary function or the reduction of tissue microvascularization. The mechanism is again unclear. Changes in the surface tension in serum favoring bubble formation have been postulated. Anecdotal reports suggest that prior alcohol ingestion increases the incidence of DCI, possibly through this mechanism.

Some recent papers add insight on the mechanism and advocate new approaches, considering hydration of the tissues more important than plasmatic volume or surface tension Gempp et al. It is uncertain whether the fatigue is a subtle indicator of some unidentified biochemical factor or a non-specific warning of general hemodynamic factors.

Vascular obstruction may occur as bubbles enter the circulation from supersaturated tissues and slow down venous return or due to embolization of vascular beds by bubbles formed elsewhere. Such disturbances may be clinically invisible in non-critical areas such as fatty tissue, but may be life-threatening in critical organs such as the central nervous system and heart. Diffuse peripheral vascular obstruction and stasis with resultant tissue hypoxia or anoxia may lead to metabolic acidosis.

Acidosis and hypovolemia may considerably impair cardiovascular function. Vascular obstruction of pulmonary capillaries, secondary to embolization of bubbles or bubble-formed complexes in venous blood, results in increased pulmonary vascular resistance, bronchiolar constriction and peribronchiolar oedema.

These changes may lead to alterations in ventilation-perfusion ratios with resultant arterial hypoxemia, a condition called the chokes. Bubbles are thought to be capable of activating Hageman Factor Factor XII with activation of coagulation, contributing to vascular obstruction. Bubbles constitute a foreign element in the blood and activate the complement and coagulation cascades. They may even cause denaturation of lipoproteins with the release of large quantities of lipid.

Electron-micrographic studies in animals have shown vascular obstruction by a complex that appears to be composed of a gas bubble surrounded by a layer of lipid, to which platelets are agglutinated. This and similar observations have given rise to a variety of experimental work investigating inter alia the possible usefulness of anticoagulants in DCI.

To date there is no firm experimental evidence to indicate that disseminated intravascular coagulation occurs in DCI, nor that routine anti-coagulation is therapeutically useful. Enhanced coagulation at local sites in tissue, however, may contribute to the pathogenesis of DCI. Coagulation Factor XIIa is, however, capable of triggering the reaction of the complement system. The sequence of reactions of this system produces factors that increase capillary permeability and factors that are chemotactic to leukocytes.

Bradykinin may cause local pain. Both are capable of increasing capillary permeability. Webb et al. They also demonstrated a correlation between the presence of gas and the occurrence of localized pain. The effectiveness of local pressure in relieving such pain, such as by inflating a blood-pressure cuff, adds legitimacy to the hypothesis.

Importantly, DCI often occurs simultaneously in several sites and limb pain may distract physicians from more sinister neurological abnormalities Figure 2. While bubbles within tissues are clearly a cause for concern, significant numbers of venous gas emboli may be recorded without any clinical manifestations.

In fact, precordial Doppler. However, high degrees of bubbling are associated with an increased risk of developing symptoms. On the other hand, Brubakk et al. Nevertheless, Nishi has reported that DCI is always accompanied by bubbles, if all monitoring sites are considered. Brubakk et al. Gas bubbles affect cells and disrupt biochemical processes as has been demonstrated by in vitro studies. Thorsen et al. The degree of aggregation seems to be independent of the gas content of the bubble, but rather is related to its surface properties.

Independently, Ward and Bergh et al. This also supports the hypothesis that the bioactive properties of bubbles are related to their surface characteristics. Ward and Bergh et al. The latter was also related to clinical manifestations of DCI. Individuals with low C5a levels before dives produced many gas bubbles and a single air dive seemed to reduce C5a levels suggesting that gas bubbles may activate both C5a and C5a receptors. This phenomenon has been confirmed by Stevens et al. Complement activation Kilgore et al.

This also causes the leukocytes to adhere to the endothelium as they circulate over damaged endothelium. Such neutrophil activation has been demonstrated during decompression Benestad et al. C5a activation may be related to some of the skin changes seen in DCI: erythema, edema and infiltration of inflammatory cells Swerlick et al.

Another important effect of C5a is vasoconstriction and blood flow reduction Martin et al. If circulation of blood is restricted during decompression, gas elimination is similarly reduced leading to possible critical supersaturation local bubble formation. Post ischemic hyperemia is not seen, possibly due to C5a activation, leukocyte adherence or even persisting vascular or perivascular bubbles Bergh et al. Vik et al. Lungs exposed to significant amounts of bubbles for approximately minutes after decompression developed considerable leukocyte invasion.

Complement activation was therefore considered to be the most important mechanism for acute lung injury Ward, ; Ward et al. Certain pulmonary function changes have been observed in divers. These include a reduction in carbon monoxide diffusion capacity and compliance Thorsen et al.

They are believed to support the growing evidence that inflammatory processes may follow decompression. In fact, the reduction in carbon monoxide diffusion capacity is rapid and is associated with the development of bubbles Dujic et al. Indeed, the concept of the lungs serving as a bubble trap has been purported for many years, but we are only now looking at the impact that this function has on the filter itself.

Although removal of bubbles by the lungs prevents more harmful distribution of bubbles to the arterial system, the process of doing so also has consequences for the lung. Huge bubble found in an aviator in Courtesy of R. Bubble grade 0 I-IV 64 1.

Vascular bubbles do not seem to be an important pathophysiological feature of spinal cord DCI. In a group of 10 amateur and 10 professional divers, five of whom had neurological DCI, no changes could be seen Morild and Mork, However, the same authors reported changes in the endothelial layer of the brain ventricles in a group of divers Morild and Mork, ; Mork et al.

Brubakk has entertained the possibility that this may not so much be evidence of intravascular gas bubbles in the brain as it may be indicative of an increase in venous pressure due to venous gas embolism of the lung interfering with venous return. Another possible explanation may be gas bubbles in the spinal fluid adhering to the lining of the ventricles and causing changes in the adjacent endothelium.

Chryssanthou et al. Further studies in rabbits have shown that bubble-endothelium contact causes endothelial damage and progressive reduction of cerebral blood flow and function Helps and Gorman, DCS was then divided into two broad categories based on the severity of symptoms and the associated treatment regimens. Therefore, in the application of the traditional classification that follows, a modifier DCS or DCI is added to indicate where such pathophysiological ambiguity exists.

Certain manifestations of decompression disorders are known never to be associated with arterial gas embolism and therefore can confidently be classified as decompression sickness. These include limb bends and lymphatic DCS. Time of symptom onset in cases all manifestations :. This is reversed for caisson workers and in commercial saturation diving. The pain can range from slight discomfort to a dull, deep, boring or even unbearable pain.

It is usually unaffected by movement of the joint and there may be overlying edema and regional numbness. The manifestations can include pain and swelling of lymph nodes, with lymphedema of the tissues drained by the obstructed lymph nodes.

New data are suggesting that normobaric oxygen may improve the flow of lymph and may assist in resolving inert gas bubbles contained within the lymphatic system or even to remove some tiny micronuclei that can behave like proteins and thus be captured by the lymphatics Balestra et al. Oxygen preconditioning is a known factor to reduce venous gas emboli post diving, which may be explained by micronuclei elimination by the lymphatic system.

This condition, sometimes called divers lice, is thought to be the result of gas dissolving directly into the skin and causing cutaneous irritation and the release of histamines with subsequent itchiness upon decompression.

This is not a true or systemic form of DCI and does not require recompression. On the other hand, itchiness of the skin following a dive in which the skin was wet, is more likely to be true cutaneous DCI.

Note that some in-water dives are performed in drysuits. Under these conditions the skin is in direct contact with compressed gas and divers lice may appear. However, this is usually accompanied by some degree of skin rash or visible skin change. Cutis marmorata is a form of DCI which is thought to result from a complex interaction between bubbles, venous congestion and the immune system. It usually manifests itself as bluish-red blotches, frequently affecting the upper back and chest.

Prominent linear purple markings are also frequently observed. These manifestations are a systemic form of DCI and suggest significant bubble formation that may also be affecting other areas of the body. As a result, prompt recompression is. The neurological manifestations of DCI are therefore unpredictable, and any focal neurological symptom or sign may be a manifestation of its presence. Any neurological abnormality following a dive should always be assumed to be of central origin and treated accordingly.

Bubble score after 30 min. This sign frequently heralds more serious forms of DCI and there is a statistical association with PFO even if the physiopathological link is currently not fully understood. Substernal pain that usually burns and progressively increases. Initially, the pain may be noted only when coughing or with deep inspiration.

Over time the pain may become constant; b Cough that is initially intermittent and provoked by cigarette smoking Behnkes sign. Paroxysms of coughing may become intractable; and, c Progressive respiratory and dyspnea. The manifestations of pulmonary DCI are believed to result from the combined effects of gas emboli in the pulmonary artery and obstruction of the vascular supply to the bronchial mucosa.

Untreated pulmonary DCI may be fatal. These mechanisms have different latencies and show different responses to. Brain involvement in DCI appears to be especially common in high altitude aviators i. In this group pulmonary venous gas embolism is also common and hypoxia and positive-pressure breathing may facilitate the transfer of bubbles or immunological products into the systemic circulation.

Not surprisingly, a migraine-like headache accompanied by visual disturbances is a common manifestation of DCI. In divers, brain involvement usually presents more overtly with stroke-like symptoms. If it does occur, it represents a very grave form of DCI. Bladder paralysis with urinary retention and fecal incontinence frequently accompany such paraplegia. Recent years have seen a decline in both the proportion and absolute number of cases of serious paralysis in recreational divers from Similarly, loss of consciousness has dropped from 7.

The incidence of loss of bladder function has dropped from 2. Interestingly, the reduction in severe neurological symptoms has not been balanced by a proportional rise in pain-only or skin manifestations. Rather, there has been an unexpected appearance of mild, ambiguous neurological manifestations, such as paresthesia or tingling, which appear to respond well to oxygen administration and recompression.

Usually both the cochlea and vestibular apparatus are involved and the presenting symptoms include tinnitus, deafness, vertigo, nausea, vomiting, and ataxia. Nystagmus may be present on physical examination. It is not clear whether the situation depends predominantly on bubble formation in the perilymph or is due to embolization of the auditory vestibular Inner ear DCI is a serious medical emergency and must be treated immediately to avoid permanent damage.

Multiple mechanisms may contribute to the pathogenesis of shock in DCI, including loss of vascular tone from spinal cord involvement, myocordial depression from hypoxemia and acidosis, pulmonary embolization, and hypovolemia due to increased capillary permeability resulting in loss of plasma water and hemoconcentration. Pain in these areas, in contrast to limb pain, should be considered with great attention, as it frequently represents spinal cord involvement.

However, the biochemical and pathophysiological mechanism of this symptom are unknown. However, two separate studies Kemper et al. For instance, cerebral. DCI could not in many cases be distinguished from arterial gas embolism or vestibular barotrauma. Other studies have shown that solely articular symptoms are rare, as they are usually accompanied by central nervous system symptoms Vann et al. Extreme fatigue can be classified as a minor symptom, but could also be a sign of subclinical pulmonary embolism Hallenbeck et al.

Francis and Smith therefore suggested the currently widely adopted term DCI, to include the two previously used definitions of decompression sickness and arterial gas embolism. Using this classification scheme, a very high degree of concordance between different specialists was possible Pollard et al.

Francis and Smith proposed the following Classification Table for Decompression Injuries Table 2 , which is a useful guideline to correctly describe the various possible manifestations of a decompression disorder. The early treatment theory was conceptually homeopathic in trying to decide how deep to take the injured diver.

The original depth of the dive was used as a guide. For example, if decompression from a depth of 40 meters caused the symptoms, recompression to the same pressure should alleviate them. However, there were controversies as others thought that the situation of the diver should lead the decision and that the depth of relief should mark the initial treatment pressure.

Still others argued that bubbles may be compressed but never disappear and should always be assumed. For these reasons the recommendation was to compress the patient to the depth of relief plus at least one atmosphere. The rationale was that if a bubble became extremely small, surface tension may cause it to collapse and disappear. It was generally realized that bubbles remaining in the tissues and circulation would continue to take up inert gas, as more nitrogen was absorbed during the recompression treatment.

In the edition of the U. The U. Navy published treatment tables again in without much improvement in the results. Van Der Aue and Behnke experimented with better treatment methods that resulted in the publication of the U. The principles of these tables were:. Recompression to depth of relief plus at least one atmosphere. In practice, this meant going to a minimal depth of 30 meters; A maximum treatment depth of 50 meters. This depth was considered a good compromise between optimal recompression of any bubble while minimizing nitrogen narcosis risk and subsequent decompression; The use of a hour stop at 9 meters before surfacing.

Theoretically, this overnight soak was intended to allow all the tissues to saturate or desaturate to the 9-meter level, from where, according to Haldane, direct decompression to the surface would be safe; and, The use of intermittent oxygen breathing during the last hours of treatment.

Despite their great length, from 6 hours 20 minutes for Table I to 38 hours 11 minutes for Table IV, they represented the only available therapeutical solution at the time.