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Aerospace medicine is a preventive medicine specialty focusing on the health of crewmembers and passengers of air and space vehicles, and the people who support the operation of such vehicles. In contrast to most physicians who evaluate and care for persons with abnormal physiology (illness) in normal (terrestrial) environments, aerospace medicine specialists evaluate and assist healthy individuals and individuals with abnormal physiology to function optimally in abnormal (nonterrestrial), remote, isolated, extreme, or enclosed environments under conditions of physical and psychological stress. While aerospace medicine began with the balloon flights of the Montgolfier brothers in the late 1700s and the experiments of Paul Bert a century later, the field grew quickly after the demonstration of controlled powered flight by the Dayton, Ohio-based Wright brothers at Kittyhawk, North Carolina, in 1903. Thousands of civilian and military aircraft were built and flown before and during World War I, with rapid technological advances. Commercial aviation began in the 1920s, initially in unpressurized aircraft flying short distances at low altitudes. Pressurized aircraft in the 1930s allowed higher, further, and faster flights. During World War II, the need for air superiority dictated the development of breathing systems and pressure suits to allow pilots to fly even higher and faster, and with greater maneuverability.1

In April 1961, Soviet cosmonaut Yuri Gagarin was the first to orbit the earth, followed in February 1962 by American astronaut John Glenn. After a successful series of orbital, lunar, and space laboratory missions, the United States, Russia, and 14 other nations began construction on the International Space Station (ISS) in 1998. The ISS, a habitable artificial satellite in low earth orbit, has been continuously occupied since 2000. Manned missions to lunar orbit, Earth’s moon, asteroids, and Mars are now in the planning stages.2

From the earliest days of flight, there have been thousands of aviation accidents resulting in injury and death—including 18 cosmonaut and astronaut fatalities during spaceflight. Nevertheless, aviation safety has greatly improved over time (Fig. 12-1).


Yearly accident rate per million flights.Adapted with permission from Airbus (2017). A Statistical Analysis of Commercial Aviation Accidents 1958-2016. Retrieved from


Shortly after World War II, the Aero Medical Association initiated activities, which led to the establishment of a training program for medical specialists in the field of Aviation Medicine. In 1953, the Advisory Board for Medical Specialties and the American Medical Association (AMA) Council on Medical Education and Hospitals authorized the American Board of Preventive Medicine (ABPM) to offer certification in Aviation Medicine. The ABPM certified the first group of specialists in Aviation Medicine that same year. In 2018, there were 1231 physicians holding active certificates of specialization in Aerospace Medicine issued by the ABPM.3

With the advent of ...

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