{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T02:37:59Z","timestamp":1777343879750,"version":"3.51.4"},"reference-count":48,"publisher":"Aerospace Medical Association","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:p>\n                    <jats:bold>INTRODUCTION:<\/jats:bold>\n                    The Republic of Singapore Air Force uses the Human Training Centrifuge (HTC) to train aircrew in effective anti-G straining maneuvers and improve G tolerance. Training comprises computer-controlled (open-loop) profiles for trainees and dynamic flight simulation (closed-loop) profiles for trained aircrew, where simulated aerial combat maneuvers allow for pilot-controlled G onset rates. This study investigated medical incidents related to HTC usage in aviation physiology training.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>METHODS:<\/jats:bold>\n                    A retrospective audit was conducted of 8013 HTC runs over 10 yr (2014\u20132023), during which 103 medical incident reports were documented. Data was collected through incident report forms and analyzed using descriptive statistics and statistical tests to compare training profile outcomes.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>RESULTS:<\/jats:bold>\n                    Musculoskeletal injuries were the most prevalent (76.70%), with back pain being the predominant condition within this category (41.77%). Other conditions included cardiovascular (13.59%) and ophthalmological (3.88%) events. There were 3 medical incidents out of 955 (0.314%) closed-loop profiles, compared to 100 in 7058 (1.42%) open-loop profiles. Among reported incidents, 35 aircrew (33.98%) had significantly related past medical history. Post-incident, 73 aircrew (70.87%) completed centrifuge training eventually and returned to flying.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>DISCUSSION:<\/jats:bold>\n                    HTC training demonstrates a favorable safety profile with low complication rates, and most affected aircrew completed their training requirements successfully. The yearly reported incidents of medical events post-HTC have shown a general downward trend. Compared with open-loop training profiles, closed-loop training provides dual benefits of providing realistic scenarios while allowing aircrew to control G exposure parameters, resulting in significantly lower medical complications while achieving training objectives.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>\n                      To YH, Woo JHA, Low JW, See B, Kwong J.\n                      <jats:italic>Medical events during centrifuge training in the Republic of Singapore Air Force: a 10-year analysis<\/jats:italic>\n                      . Aerosp Med Hum Perform. 2026; 97(5):308\u2013315.\n                    <\/jats:bold>\n                  <\/jats:p>","DOI":"10.3357\/amhp.6829.2026","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T01:59:02Z","timestamp":1777341542000},"page":"308-315","source":"Crossref","is-referenced-by-count":0,"title":["Medical Events During Centrifuge Training in the Republic of Singapore Air Force: A 10-Year Analysis"],"prefix":"10.3357","volume":"97","author":[{"given":"Yi Hui","family":"To","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jia Hao Alvin","family":"Woo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason Weizheng","family":"Low","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"See","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Kwong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1911","reference":[{"issue":"7","key":"B1","series-title":"Aviat Space Environ Med.","first-page":"675","article-title":"Greyout, blackout, and G-loss of consciousness in the Brazilian Air Force: a 1991-92 survey","volume":"66","author":"Alvim KM.","year":"1995","unstructured":"Alvim KM. Greyout, blackout, and G-loss of consciousness in the Brazilian Air Force: a 1991-92 survey. Aviat Space Environ Med. 1995 Jul; 66(7):675\u20137."},{"issue":"2","key":"B2","series-title":"Mil Med.","first-page":"163","article-title":"Visual symptoms and G-induced loss of consciousness in 594 Chinese Air Force aircrew\u2013a questionnaire survey","volume":"177","author":"Cao X-S","year":"2012","unstructured":"Cao X-S, Wang Y-C, Xu L, Yang C-B, Wang B,  Visual symptoms and G-induced loss of consciousness in 594 Chinese Air Force aircrew\u2013a questionnaire survey. Mil Med. 2012 Feb; 177(2):163\u20138."},{"issue":"5","key":"B3","series-title":"Aviat Space Environ Med.","first-page":"496","article-title":"G-induced visual and cognitive disturbances in a survey of 65 operational fighter pilots","volume":"76","author":"Rickards CA","year":"2005","unstructured":"Rickards CA, Newman DG. G-induced visual and cognitive disturbances in a survey of 65 operational fighter pilots. Aviat Space Environ Med. 2005 May; 76(5):496\u2013500."},{"issue":"6","key":"B4","series-title":"Aviat Space Environ Med.","first-page":"619","article-title":"G-induced loss of consciousness: retrospective survey results from 2259 military aircrew","volume":"77","author":"Green ND","year":"2006","unstructured":"Green ND, Ford SA. G-induced loss of consciousness: retrospective survey results from 2259 military aircrew. Aviat Space Environ Med. 2006 Jun; 77(6):619\u201323."},{"issue":"1","key":"B5","series-title":"Aviat Space Environ Med.","first-page":"12","article-title":"High-G training for fighter aircrew","volume":"59","author":"Gillingham KK","year":"1988","unstructured":"Gillingham KK, Fosdick JP. High-G training for fighter aircrew. Aviat Space Environ Med. 1988 Jan; 59(1):12\u20139."},{"key":"B6","article-title":"Minimum requirements for physiological training of aircrew in high \u201cG\u201d environment. Edition A, Version 1","year":"2017","unstructured":"NATO Standardization Office. Minimum requirements for physiological training of aircrew in high \u201cG\u201d environment. Edition A, Version 1. Brussels (Belgium): NATO Standardization Office, North Atlantic Treaty Organization; 2017 Oct. Allied Aeromedical Publication AAMedP-1.13. [Accessed 2025 Dec. 20]. Available from https:\/\/www.coemed.org\/files\/stanags\/04_AAMEDP\/AAMedP-1.13_EDA_V1_E_3827.pdf."},{"issue":"9","key":"B7","series-title":"Aviat Space Environ Med.","first-page":"849","article-title":"Prevalence and significance of spinal disc abnormalities in an asymptomatic acceleration subject panel","volume":"67","author":"Burns JW","year":"1996","unstructured":"Burns JW, Loecker TH, Fischer JR Jr, Bauer DH. Prevalence and significance of spinal disc abnormalities in an asymptomatic acceleration subject panel. Aviat Space Environ Med. 1996 Sep; 67(9):849\u201353."},{"issue":"4","key":"B8","series-title":"Aerosp Med Hum Perform.","first-page":"386","article-title":"Acute spinal injury after centrifuge training in asymptomatic fighter pilots","volume":"86","author":"Kang KW","year":"2015","unstructured":"Kang KW, Shin YH, Kang S. Acute spinal injury after centrifuge training in asymptomatic fighter pilots. Aerosp Med Hum Perform. 2015 Apr; 86(4):386\u201391."},{"issue":"11","key":"B9","series-title":"Aviat Space Environ Med.","first-page":"1067","article-title":"Vertebral fracture in a pilot during centrifuge training: finding of osteopenia","volume":"79","author":"Low R","year":"2008","unstructured":"Low R, Teoh T, Loh A, Ooi A. Vertebral fracture in a pilot during centrifuge training: finding of osteopenia. Aviat Space Environ Med. 2008 Nov; 79(11):1067\u201370."},{"issue":"7","key":"B10","series-title":"Aviat Space Environ Med.","first-page":"734","article-title":"Centrifuge-induced neck and back pain in F-16 pilots: a report of four cases","volume":"84","author":"Lange B","year":"2013","unstructured":"Lange B, Nielsen RT, Skej\u00f8 PB, Toft P. Centrifuge-induced neck and back pain in F-16 pilots: a report of four cases. Aviat Space Environ Med. 2013 Jul; 84(7):734\u20138."},{"issue":"8","key":"B11","series-title":"Aviat Space Environ Med.","first-page":"687","article-title":"Incidence of cardiac dysrhythmias occurring during centrifuge training","volume":"64","author":"McKenzie I","year":"1993","unstructured":"McKenzie I, Gillingham KK. Incidence of cardiac dysrhythmias occurring during centrifuge training. 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Aviat Space Environ Med. 1983 Aug; 54(8):691\u20135."},{"key":"B18","article-title":"The TITAN arena initiative: HPT prioritizes pilot health","author":"Tyler D.","year":"2024","unstructured":"Tyler D. The TITAN arena initiative: HPT prioritizes pilot health. Air Education And Training Command; 2024 May 14. [Accessed 2025 Dec. 20]. Available from https:\/\/www.aetc.af.mil\/News\/Article-Display\/Article\/3775612\/the-titan-arena-initiative-hpt-prioritizes-pilot-health\/."},{"issue":"8","key":"B19","series-title":"Aviat Space Environ Med.","first-page":"716","article-title":"The electrocardiographic response to high +Gz centrifuge training","volume":"61","author":"Whinnery JE.","year":"1990","unstructured":"Whinnery JE. The electrocardiographic response to high +Gz centrifuge training. Aviat Space Environ Med. 1990 Aug; 61(8):716\u201321."},{"issue":"6","key":"B20","series-title":"Aviat Space Environ Med.","first-page":"599","article-title":"Cardiac arrhythmias during aerobatic flight and its simulation on a centrifuge","volume":"82","author":"Zawadzka-Bartczak EK","year":"2011","unstructured":"Zawadzka-Bartczak EK, Kopka LH. Cardiac arrhythmias during aerobatic flight and its simulation on a centrifuge. Aviat Space Environ Med. 2011 Jun; 82(6):599\u2013603."},{"key":"B21","series-title":"Hippokratia.","first-page":"53","article-title":"Arrhythmias, sudden cardiac death and incapacitation of pilots","volume":"12","author":"Mantziari L","year":"2008","unstructured":"Mantziari L, Styliadis C, Kourtidou-Papadeli C, Styliadis I. Arrhythmias, sudden cardiac death and incapacitation of pilots. Hippokratia. 2008 Aug; 12(Suppl 1):53\u20138."},{"issue":"1","key":"B22","series-title":"Aviat Space Environ Med.","first-page":"60","article-title":"Serious arrhythmias coinciding with alteration of consciousness in aircrew during +Gz stress","volume":"65","author":"Tachibana S","year":"1994","unstructured":"Tachibana S, Akamatsu T, Nakamura A, Yagura S. Serious arrhythmias coinciding with alteration of consciousness in aircrew during +Gz stress. Aviat Space Environ Med. 1994 Jan; 65(1):60\u20136."},{"issue":"8","key":"B23","series-title":"Aviat Space Environ Med.","first-page":"688","article-title":"Arrhythmias observed during high-G training: proposed training safety criterion","volume":"75","author":"Hanada R","year":"2004","unstructured":"Hanada R, Hisada T, Tsujimoto T, Ohashi K. Arrhythmias observed during high-G training: proposed training safety criterion. Aviat Space Environ Med. 2004 Aug; 75(8):688\u201391."},{"issue":"7","key":"B24","series-title":"Eur J Appl Physiol.","first-page":"2625","article-title":"A centrifuge simulated push-pull manoeuvre with subsequent reduced +Gz tolerance","volume":"112","author":"Xu Y","year":"2012","unstructured":"Xu Y, Li B-H, Zhang L-H, Jin Z, Wei X-Y,  A centrifuge simulated push-pull manoeuvre with subsequent reduced +Gz tolerance. Eur J Appl Physiol. 2012 Jul; 112(7):2625\u201330."},{"issue":"7","key":"B1","series-title":"Aviat Space Environ Med.","first-page":"675","article-title":"Greyout, blackout, and G-loss of consciousness in the Brazilian Air Force: a 1991-92 survey","volume":"66","author":"Alvim KM.","year":"1995","unstructured":"Alvim KM. Greyout, blackout, and G-loss of consciousness in the Brazilian Air Force: a 1991-92 survey. Aviat Space Environ Med. 1995 Jul; 66(7):675\u20137."},{"issue":"2","key":"B2","series-title":"Mil Med.","first-page":"163","article-title":"Visual symptoms and G-induced loss of consciousness in 594 Chinese Air Force aircrew\u2013a questionnaire survey","volume":"177","author":"Cao X-S","year":"2012","unstructured":"Cao X-S, Wang Y-C, Xu L, Yang C-B, Wang B,  Visual symptoms and G-induced loss of consciousness in 594 Chinese Air Force aircrew\u2013a questionnaire survey. Mil Med. 2012 Feb; 177(2):163\u20138."},{"issue":"5","key":"B3","series-title":"Aviat Space Environ Med.","first-page":"496","article-title":"G-induced visual and cognitive disturbances in a survey of 65 operational fighter pilots","volume":"76","author":"Rickards CA","year":"2005","unstructured":"Rickards CA, Newman DG. G-induced visual and cognitive disturbances in a survey of 65 operational fighter pilots. Aviat Space Environ Med. 2005 May; 76(5):496\u2013500."},{"issue":"6","key":"B4","series-title":"Aviat Space Environ Med.","first-page":"619","article-title":"G-induced loss of consciousness: retrospective survey results from 2259 military aircrew","volume":"77","author":"Green ND","year":"2006","unstructured":"Green ND, Ford SA. G-induced loss of consciousness: retrospective survey results from 2259 military aircrew. Aviat Space Environ Med. 2006 Jun; 77(6):619\u201323."},{"issue":"1","key":"B5","series-title":"Aviat Space Environ Med.","first-page":"12","article-title":"High-G training for fighter aircrew","volume":"59","author":"Gillingham KK","year":"1988","unstructured":"Gillingham KK, Fosdick JP. High-G training for fighter aircrew. Aviat Space Environ Med. 1988 Jan; 59(1):12\u20139."},{"key":"B6","article-title":"Minimum requirements for physiological training of aircrew in high \u201cG\u201d environment. Edition A, Version 1","year":"2017","unstructured":"NATO Standardization Office. Minimum requirements for physiological training of aircrew in high \u201cG\u201d environment. Edition A, Version 1. Brussels (Belgium): NATO Standardization Office, North Atlantic Treaty Organization; 2017 Oct. Allied Aeromedical Publication AAMedP-1.13. [Accessed 2025 Dec. 20]. Available from https:\/\/www.coemed.org\/files\/stanags\/04_AAMEDP\/AAMedP-1.13_EDA_V1_E_3827.pdf."},{"issue":"9","key":"B7","series-title":"Aviat Space Environ Med.","first-page":"849","article-title":"Prevalence and significance of spinal disc abnormalities in an asymptomatic acceleration subject panel","volume":"67","author":"Burns JW","year":"1996","unstructured":"Burns JW, Loecker TH, Fischer JR Jr, Bauer DH. Prevalence and significance of spinal disc abnormalities in an asymptomatic acceleration subject panel. Aviat Space Environ Med. 1996 Sep; 67(9):849\u201353."},{"issue":"4","key":"B8","series-title":"Aerosp Med Hum Perform.","first-page":"386","article-title":"Acute spinal injury after centrifuge training in asymptomatic fighter pilots","volume":"86","author":"Kang KW","year":"2015","unstructured":"Kang KW, Shin YH, Kang S. Acute spinal injury after centrifuge training in asymptomatic fighter pilots. Aerosp Med Hum Perform. 2015 Apr; 86(4):386\u201391."},{"issue":"11","key":"B9","series-title":"Aviat Space Environ Med.","first-page":"1067","article-title":"Vertebral fracture in a pilot during centrifuge training: finding of osteopenia","volume":"79","author":"Low R","year":"2008","unstructured":"Low R, Teoh T, Loh A, Ooi A. Vertebral fracture in a pilot during centrifuge training: finding of osteopenia. Aviat Space Environ Med. 2008 Nov; 79(11):1067\u201370."},{"issue":"7","key":"B10","series-title":"Aviat Space Environ Med.","first-page":"734","article-title":"Centrifuge-induced neck and back pain in F-16 pilots: a report of four cases","volume":"84","author":"Lange B","year":"2013","unstructured":"Lange B, Nielsen RT, Skej\u00f8 PB, Toft P. Centrifuge-induced neck and back pain in F-16 pilots: a report of four cases. Aviat Space Environ Med. 2013 Jul; 84(7):734\u20138."},{"issue":"8","key":"B11","series-title":"Aviat Space Environ Med.","first-page":"687","article-title":"Incidence of cardiac dysrhythmias occurring during centrifuge training","volume":"64","author":"McKenzie I","year":"1993","unstructured":"McKenzie I, Gillingham KK. Incidence of cardiac dysrhythmias occurring during centrifuge training. 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Aviat Space Environ Med. 2004 Jan; 75(1):68\u201380."},{"issue":"12","key":"B14","series-title":"Mil Med.","first-page":"1233","article-title":"Relationships between physical fitness, demands of flight duty, and musculoskeletal symptoms among military pilots","volume":"180","author":"Rintala H","year":"2015","unstructured":"Rintala H, H\u00e4kkinen A, Siitonen S, Kyr\u00f6l\u00e4inen H. Relationships between physical fitness, demands of flight duty, and musculoskeletal symptoms among military pilots. Mil Med. 2015 Dec; 180(12):1233\u20138."},{"issue":"5\u20136","key":"B15","series-title":"Mil Med.","first-page":"e930","article-title":"Association between cumulative G-force exposure and cervical spine degenerative changes","volume":"190","author":"Keskim\u00f6l\u00f6 T","year":"2025","unstructured":"Keskim\u00f6l\u00f6 T, Oura P, Honkanen T, Niinim\u00e4ki J, Sovelius R,  Association between cumulative G-force exposure and cervical spine degenerative changes. Mil Med. 2025 Apr 23; 190(5\u20136):e930\u2013e937."},{"issue":"20","key":"B16","series-title":"Int J Environ Res Public Health.","first-page":"13413","article-title":"Pain in the cervical and lumbar spine as a result of high G-force values in military pilots-a systematic review and meta-analysis","volume":"19","author":"Mastalerz A","year":"2022","unstructured":"Mastalerz A, Maruszy\u0144ska I, Kowalczuk K, Garbacz A, Maculewicz E. Pain in the cervical and lumbar spine as a result of high G-force values in military pilots-a systematic review and meta-analysis. Int J Environ Res Public Health. 2022 Oct 17; 19(20):13413."},{"issue":"8","key":"B17","series-title":"Aviat Space Environ Med.","first-page":"691","article-title":"Effects of strength training on G tolerance","volume":"54","author":"Tesch PA","year":"1983","unstructured":"Tesch PA, Hjort H, Balldin UI. Effects of strength training on G tolerance. 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Hippokratia. 2008 Aug; 12(Suppl 1):53\u20138."},{"issue":"1","key":"B22","series-title":"Aviat Space Environ Med.","first-page":"60","article-title":"Serious arrhythmias coinciding with alteration of consciousness in aircrew during +Gz stress","volume":"65","author":"Tachibana S","year":"1994","unstructured":"Tachibana S, Akamatsu T, Nakamura A, Yagura S. Serious arrhythmias coinciding with alteration of consciousness in aircrew during +Gz stress. Aviat Space Environ Med. 1994 Jan; 65(1):60\u20136."},{"issue":"8","key":"B23","series-title":"Aviat Space Environ Med.","first-page":"688","article-title":"Arrhythmias observed during high-G training: proposed training safety criterion","volume":"75","author":"Hanada R","year":"2004","unstructured":"Hanada R, Hisada T, Tsujimoto T, Ohashi K. Arrhythmias observed during high-G training: proposed training safety criterion. 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