{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T02:39:30Z","timestamp":1777084770872,"version":"3.51.4"},"reference-count":30,"publisher":"Aerospace Medical Association","issue":"2","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2]]},"abstract":"\n INTRODUCTION:<\/jats:bold>\n Understanding how flight trajectories impact hemodynamically unstable patients is critical for maintaining high survival rates during aerial evacuation. We integrated an experimental model of hemorrhage in an aircraft during evasive maneuvers to capture the physiological response in healthy humans vs. simulated hemorrhage.\n <\/jats:p>\n \n METHODS:<\/jats:bold>\n Lower body negative pressure (LBNP), a validated method to simulate hemorrhage, and continuous physiological monitoring were integrated into a C-12J aircraft. Nine volunteers underwent incremental LBNP during wind-up turns, roller coasters, and level acceleration\/deceleration trajectories at cabin pressure altitudes of 5500\u20139500 ft (1670\u20132890 m). Environmental sensors recorded acceleration, vibration, temperature, and pressure.\n <\/jats:p>\n \n RESULTS:<\/jats:bold>\n Nine sorties totaling 27.5 flight test hours were completed. Wind-up turns produced G\n x<\/jats:sub>\n accelerations of 1.21 \u00b1 0.09 G (mean \u00b1 SD), 1.47\n \u00b1<\/jats:italic>\n 0.06 G, and 1.93\n \u00b1<\/jats:italic>\n 0.10 G, with additional G\n z<\/jats:sub>\n (0.05\u20130.18 G). Roller coasters produced rapid G\n x<\/jats:sub>\n transitions between 0.4\u20132.8 G. Level acceleration\/decelerations generated \u22120.1\u20130.3 G\n z<\/jats:sub>\n . Incremental LBNP was applied from 0\u201360 mmHg, simulating mild, moderate, and severe hemorrhage. G\n x<\/jats:sub>\n was driven by low-frequency aerodynamics; lateral by high-frequency mechanical inputs.\n <\/jats:p>\n \n DISCUSSION:<\/jats:bold>\n We have, for the first time, established a real-world in-flight experimental set-up to conduct direct crossover trials and capture the reductions in G\n x<\/jats:sub>\n -tolerance and vibration between healthy and hemodynamically unstable patients. Our method allows us to titrate LBNP level (degree of hemorrhage) and G-forces independently, thus providing a tool to understand both isolated and synergistic impact of acceleration and blood-loss to establish dose-response relationships. Our method provides important human data to directly quantify the delta between healthy human and simulated trauma (hemorrhage) to better understand the underlying mechanisms of cardiovascular decompensation in casualty evacuation.\n <\/jats:p>\n \n \n Tibbs ML, Lee C, Morse BG, Romero E, Petersen LG.\n In-flight assessment of simulated hemorrhage during aerial patient evacuation<\/jats:italic>\n . Aerosp Med Hum Perform. 2026; 97(2):123\u2013130.\n <\/jats:bold>\n <\/jats:p>","DOI":"10.3357\/amhp.6768.2026","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T13:44:36Z","timestamp":1770731076000},"page":"123-130","source":"Crossref","is-referenced-by-count":0,"title":["In-Flight Assessment of Simulated Hemorrhage During Aerial Patient Evacuation"],"prefix":"10.3357","volume":"97","author":[{"given":"Michael L.","family":"Tibbs","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiawei","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bria G.","family":"Morse","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Romero","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lonnie G.","family":"Petersen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1911","reference":[{"issue":"7","key":"B1","series-title":"JAMA Surg.","first-page":"600","article-title":"Use of combat casualty care data to assess the US military trauma system during the Afghanistan and Iraq conflicts, 2001\u20132017","volume":"154","author":"Howard JT","year":"2019","unstructured":"Howard JT, Kotwal RS, Stern CA, Janak JC, Mazuchowski EL, Use of combat casualty care data to assess the US military trauma system during the Afghanistan and Iraq conflicts, 2001\u20132017. JAMA Surg. 2019 Jul 1; 154(7):600\u20138."},{"key":"B2","article-title":"Safe ride standards for casualty evacuation using unmanned aerial vehicles","year":"2012","unstructured":"North Atlantic Treaty Organization. Safe ride standards for casualty evacuation using unmanned aerial vehicles. Neuilly-sur-Seine (France): NATO Science and Technology Organization; 2012. Report No.: TR-HFM-184."},{"key":"B3","series-title":"J Trauma Acute Care Surg.","first-page":"S431","article-title":"Death on the battlefield (2001\u20132011): implications for the future of combat casualty care","volume":"73","author":"Eastridge BJ","year":"2012","unstructured":"Eastridge BJ, Mabry RL, Seguin P, Cantrell J, Tops T, Death on the battlefield (2001\u20132011): implications for the future of combat casualty care. J Trauma Acute Care Surg. 2012 Dec; 73(6 Suppl 5):S431\u20137."},{"issue":"1","key":"B4","series-title":"J Appl Physiol (1985).","first-page":"20","article-title":"Graded lower body negative pressure induces intraventricular negative pressures and incremental diastolic suction: a pressure-volume study in a porcine model","volume":"133","author":"Berboth L","year":"2022","unstructured":"Berboth L, Zirngast B, Manninger M, Steendijk P, Tsch\u00f6pe C, Graded lower body negative pressure induces intraventricular negative pressures and incremental diastolic suction: a pressure-volume study in a porcine model. J Appl Physiol (1985). 2022 Jul 1; 133(1):20\u20136."},{"issue":"4","key":"B5","series-title":"J Appl Physiol (1985).","first-page":"1249","article-title":"Lower body negative pressure as a model to study progression to acute hemorrhagic shock in humans","volume":"96","author":"Cooke WH","year":"2004","unstructured":"Cooke WH, Ryan KL, Convertino VA. 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Am J Physiol Regul Integr Comp Physiol. 2019 Feb 1; 316(2):R88\u2013100."},{"key":"B8","series-title":"Eur J Appl Physiol.","first-page":"2225","article-title":"The combined effects of artificial gravity, temperature, and hypoxia on haemodynamic responses and limb blood flow","volume":"125","author":"Fisher JT","year":"2025","unstructured":"Fisher JT, Ciuha U, Denise P, McDonnell AC, Normand H, Mekjavic IB. The combined effects of artificial gravity, temperature, and hypoxia on haemodynamic responses and limb blood flow. Eur J Appl Physiol. 2025 Aug; 125:2225\u201339."},{"issue":"8","key":"B9","series-title":"Eur J Appl Physiol.","first-page":"2365","article-title":"Hemorrhage at high altitude: impact of sustained hypobaric hypoxia on cerebral blood flow, tissue oxygenation, and tolerance to simulated hemorrhage in humans","volume":"124","author":"Rosenberg AJ","year":"2024","unstructured":"Rosenberg AJ, Anderson GK, McKeefer HJ, Bird J, Pentz B, Hemorrhage at high altitude: impact of sustained hypobaric hypoxia on cerebral blood flow, tissue oxygenation, and tolerance to simulated hemorrhage in humans. Eur J Appl Physiol. 2024 Aug; 124(8):2365\u201378."},{"issue":"4","key":"B10","series-title":"J Appl Physiol (1985).","first-page":"1693","article-title":"Effect of hypoxia and hyperoxia on human +Gz duration tolerance","volume":"76","author":"Besch EL","year":"1994","unstructured":"Besch EL, Werchan PM, Wiegman JF, Nesthus TE, Shahed AR. Effect of hypoxia and hyperoxia on human +Gz duration tolerance. 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Report No.: TR-HFM-184."},{"key":"B3","series-title":"J Trauma Acute Care Surg.","first-page":"S431","article-title":"Death on the battlefield (2001\u20132011): implications for the future of combat casualty care","volume":"73","author":"Eastridge BJ","year":"2012","unstructured":"Eastridge BJ, Mabry RL, Seguin P, Cantrell J, Tops T, Death on the battlefield (2001\u20132011): implications for the future of combat casualty care. 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Am J Physiol Regul Integr Comp Physiol. 2019 Feb 1; 316(2):R88\u2013100."},{"key":"B8","series-title":"Eur J Appl Physiol.","first-page":"2225","article-title":"The combined effects of artificial gravity, temperature, and hypoxia on haemodynamic responses and limb blood flow","volume":"125","author":"Fisher JT","year":"2025","unstructured":"Fisher JT, Ciuha U, Denise P, McDonnell AC, Normand H, Mekjavic IB. The combined effects of artificial gravity, temperature, and hypoxia on haemodynamic responses and limb blood flow. Eur J Appl Physiol. 2025 Aug; 125:2225\u201339."},{"issue":"8","key":"B9","series-title":"Eur J Appl Physiol.","first-page":"2365","article-title":"Hemorrhage at high altitude: impact of sustained hypobaric hypoxia on cerebral blood flow, tissue oxygenation, and tolerance to simulated hemorrhage in humans","volume":"124","author":"Rosenberg AJ","year":"2024","unstructured":"Rosenberg AJ, Anderson GK, McKeefer HJ, Bird J, Pentz B, Hemorrhage at high altitude: impact of sustained hypobaric hypoxia on cerebral blood flow, tissue oxygenation, and tolerance to simulated hemorrhage in humans. Eur J Appl Physiol. 2024 Aug; 124(8):2365\u201378."},{"issue":"4","key":"B10","series-title":"J Appl Physiol (1985).","first-page":"1693","article-title":"Effect of hypoxia and hyperoxia on human +Gz duration tolerance","volume":"76","author":"Besch EL","year":"1994","unstructured":"Besch EL, Werchan PM, Wiegman JF, Nesthus TE, Shahed AR. Effect of hypoxia and hyperoxia on human +Gz duration tolerance. J Appl Physiol (1985). 1994 Apr; 76(4):1693\u2013700."},{"key":"B11","article-title":"Effect of headward and forward accelerations on the cardiovascular system","author":"Wood EH","year":"1961","unstructured":"Wood EH, Sutterer WF, Marshall HW, Lindberg EF, Headley RN. Effect of headward and forward accelerations on the cardiovascular system. Wright-Patterson Air Force Base (OH): Wright Air Development Division, Aerospace Medical Laboratory, ARDC, U.S. Air Force; 1961 Jan. WADD Technical Report 60-634."},{"key":"B12","series-title":"Aviat Space Environ Med.","first-page":"A14","article-title":"Physiologic effects of simulated +Gx orbital reentry in primate models of hemorrhagic shock","volume":"78","author":"Stepaniak PC","year":"2007","unstructured":"Stepaniak PC, Hamilton GC, Olson JE, Gilmore SM, Stizza DM, Beck B. Physiologic effects of simulated +Gx orbital reentry in primate models of hemorrhagic shock. Aviat Space Environ Med. 2007 Apr; 78(4 Suppl):A14\u201325."},{"key":"B13","article-title":"UAV for casualty transport: quantifying reduction in G-tolerance in hemorrhagic patients","author":"Petersen L","year":"2024","unstructured":"Petersen L, Morse B, Tibbs M, Petersen C. UAV for casualty transport: quantifying reduction in G-tolerance in hemorrhagic patients. Presented at: Aerospace Medical Association 94th Annual Scientific Meeting; 2024 May; Chicago, IL. North Palm Beach (FL): Aerospace Medical Association; 2024."},{"key":"B14","article-title":"Transformer vs. manual feature engineering of arterial waveforms for forecasting hemodynamic responses to combined G-force and hemorrhage","author":"Tibbs M","year":"2025","unstructured":"Tibbs M, Morse B, Siu H, Petersen L. Transformer vs. manual feature engineering of arterial waveforms for forecasting hemodynamic responses to combined G-force and hemorrhage. 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