Physiological events: A Fighter pilot’s account

Editor’s Note: A former Navy F/A-18 Hornet and Super Hornet pilot who is now a pilot with the Navy Reserve details their experience with physiological events (PEs), symptoms, likely causes, diagnosis and treatment as well as offering advice for fighter pilots.

“I experienced three pressure-related PEs in the in the F/A-18C Hornet and F/A-18E Super Hornet in a span of three years, so my history likely made the third incident more catastrophic for me than it would have been for someone without previous insults.

After having a PE in 2016 and being treated for type 2 decompression sickness, I took a break from the cockpit for two years and returned in 2019. On May 1 and 2, 2019, I experienced two flights [my final ones in an F/A-18] in the span of 36 hours where the cabin pressure rapidly fluctuated +/- 500 feet for the entire flight. At the time, this was within Naval Air Training and Operating Procedures Standardization (NATOPS) limits and seemed very minor; in hindsight and knowing what we now know about acquired brain injuries, flying a second time and experiencing a repeated exposure should not have happened. I did not think I had any symptoms while airborne and did not experience much discomfort but upon recovery to the carrier from the second flight, my wingman noticed I had very slow speech and seemed tired. I had difficulty filling out my post-flight paperwork. I met with the flight surgeon and did some basic neurological tests. He observed slow speech and slowed cognition, but I passed all the basic neurological exams.

Over the next 48 hours my symptoms worsened. I had difficulty finding words, was very tired, slept an unusual amount and had a very flat affect. After a short unsuccessful decompression chamber treatment onboard the carrier, I was medically evacuated for concussion-like symptoms as the medical team decided the symptoms would not improve on the carrier and were very similar to a concussion.

After being evaluated at the National Intrepid Center of Excellence and Walter Reed National Military Medical Center, they determined I was experiencing concussion-like symptoms due to the repeated pressure fluctuations in the cockpit. My acute symptoms did not improve for six to eight weeks and I struggled with feeling visually overwhelmed in bright lights and crowded/cluttered rooms, sensitivity to noise, migraine headaches, and unusual amounts of sleep, short term memory issues and difficulty reading. The doctors prescribed a concussion protocol with rest, relaxation and avoiding over-stimulating environments. While the speech issues and word-finding improved, I suffered from cognitive exhaustion, chronic headaches and memory issues for months following the incident. Seven months later, I started the Post-deployment Rehabilitation Evaluation Program (PREP) at the Tampa Polytrauma Rehabilitation Center on Dec. 2, 2019.

The doctors in Tampa were wonderful. They wanted to help us heal and provided tailored therapies. They were accustomed to dealing with elite military Special Forces, so they understood the cognitive and performance norms of elite soldiers and pilots. It was the first time I felt like the doctors did not have a preconceived outcome in mind—they just treated the symptoms I had. They were extremely thorough, took a very detailed history of my career and previous pressure insults, and had a multi-disciplinary approach to evaluating all symptoms and treatment options.

The most effective therapy I received was from the combination of injections for pain management to reduce the tension in my neck triggering continual migraine headaches, and vision therapy to treat the brain-vision processing issues. The vision therapy was difficult and exhausting but yielded huge improvements and a decrease in my headache frequency and severity. I also did cognitive therapy and continued cognitive rehab after the Tampa program. The overall treatment was two months in Tampa and another two months completing out-patient therapy before I felt better.

I was not cleared to return to the F/A-18, but I did receive an up-chit to fly service group 3 aircraft (dual-piloted, land-based). I received a waiver from NAMI [Naval Aerospace Medical Institute] one year after the last incident in May 2020. I transitioned to the Navy Reserve in October 2020 and am currently flying the C-40A Clipper.

I agreed to share my story with Naval Aviation News to help other pilots who may have experienced similar issues. My advice to current aviators is to educate yourself about the Environmental Control System [ECS] and known issues in your jets. We know so much more about pressure-related injuries in pilots than we used to. Take it seriously; if you have a pressure event in the jet, rest and follow the protocols before returning to flight, even if you think you feel fine. Peak neural inflammation occurs 48-72 hours post insult—it can take a few days for symptoms to develop—and the worst thing you can do is have a repeat exposure in that timeframe. Know what symptoms to look for (concussion-like symptoms) and don’t hesitate to seek help from resources like the Tampa VA if you have lingering symptoms.”