FPP223 - The Human Factor

0:00The views expressed in this episode are those of the participants and do not reflect the official policy or position of the United States government. Today we're talking about a part of fighter aviation that doesn't always get the attention it deserves. Human performance. Our guest is Commander Kevin Bernstein, MD, who is helping build a new approach to human performance across the Navy, bringing together physical performance, psychology, recovery, and readiness to help keep our sailors operating at their best. We'll talk about what this new program actually looks like, what fighter squadrons can expect from it, and what Kevin learned from his time working with Naval Special Warfare. Turn in, fights on! KB, welcome to the show. Thanks for having me, Senka, how's it going? I'm too well, man. Well, please, let's just start off by being like, tell the listeners a little bit

1:01about yourself. So I'll try to tell a long story short, but probably not possible. I like to tell people I came out of the womb wanting to do sports medicine. I always knew growing up that I love sports, I love being around the athlete, and I knew that I did not have the talent or the capability to make it at a very high level, but I always enjoyed being able to take care of the athlete from a medical standpoint, especially when I started shadowing and doing side-line coverage for football games, working with other sports medicine physicians, and just truly got passionate about the profession. So join the Navy. I was a one-year HPSP scholarship, and I wanted to learn what it was like to practice in a military setting where I didn't need to worry about all these different insurance companies or whether or not my patient was covered by insurance. So that led me to join the Navy. I wanted to do sports medicine right away, but not many people get

2:06to go straight through after their initial training to sports medicine. So I did a toward failing medicine and was able to graduate from Pensacola. So went to Fleet Surgical Team 7 out of Okinawa, Japan, and implemented some human performance efforts there. That was my first go at really looking at all the lifestyle pillars going on board the ship, doing one-on-one consultations, hitting every lifestyle pillar, and really trying to improve the quality of life for sailors and Marines when I was deployed on amphibious ships. So that was cool. Had a great time, met my wife on one of the ships, so a Naval Aviator as well. She's a Naval Flight Officer, so I like to tell people she does the real Navy stuff. I'm just a doctor. Yeah, got lucky there, and ended up going to sports medicine fellowship right after that. Camp Pendleton spent a year in fellowship training, working with all of human performance team members, and to be clear, sports medicine training is really the only

3:10fellowship training that you actually work with sports dietician. You actually work with strength conditioning, exercise physiology, sports science, and cognitive and mental health, really all the members of the team. So really got passionate about human performance just going through the sports medicine training programs. Ended up doing a tour in Mayport, working next to where the HSM Wing is, as well as the waterfront there, and then also teaching family medicine residents in sports medicine. So had a really good time, got to mentor quite a few people, got to teach, and then I went up to the Naval Academy where I spent three years there, two years covering Navy football, and spent some time covering some of the other D1 sports that they had as well as the entire brigade in midshipment. We had a concussion clinic because they like to do plea boxing, so I got to learn a lot about TBI concussion and the cognitive realm there, as well as covering football. We saw a bit of that as well. And then from there went to Naval Special Warfare Group

4:112, where we got to work sports medicine along with dive medicine and the rest of the human performance team. And then I had Riyama Brofi up into one of our spaces where he was able to see exactly what we do, and he got the itch to want to do that for Naval Aviation. So I told them, sir, well, if you want to do this, I could likely help you. You just need to figure out how to get me on your staff. And I guess he said challenge accepted because here I am on a staff. Well, you got you know, you got to find the right people. They're going to be supportive. And I think we we need to recognize the role of a leader is to bring those people, whatever it takes on to not necessarily on our staff in this situation on our staff, but empower them in a fashion that allows them to make the difference that you can jointly share the vision on. So I really appreciate his willingness, his fight to bring you on. And then it sounds like we're going to have a very

5:11fascinating conversation about how that turned into transforming the way the Navy thinks about human performance, which is near and dear to my heart. And yeah, let's get into it. Your sports medicine physician, how did you end up trying to change the way Naval Aviation approaches human performance? That's a great question. We have been attempting to implement human performance throughout our communities for quite some time now. And it looks a lot different in a lot of areas right now. I will say that a lot of the subject matter experts that we work with in Navy medicine have really been shopping at the bit to try to get this moving for quite some time. We've put together work products. We've put together what a human performance center should look like. We've put together what a mobile human performance team could look like going ship the ship or squadron a squadron. So we've been working on these products for quite some time. And now we finally have a champion to bring this to DC to bring this to Naval Aviation in rear

6:13animal brophy my current boss. And it's really exciting. It's an exciting time in the Navy. It's an exciting time in Naval Aviation to move this forward. Yeah, absolutely. I mean, this is such an important conversation. Absolutely. I am curious. So as we get started here and we get into the details, when you say human performance, what exactly do you mean? So it's not really going to be another one of these fitness programs. It's not going to be just a wellness initiative or something like that. And we hear about resiliency training. What we really want to look at is true performance and making the war fighter and no matter what occupation they are or wherever their seat is in the aircraft, making them more resilient to the known occupational stressors that we already know happen to the body due to that aircraft or that platform. So when we mean true human performance, we're looking at ways to make the body more resilient to the forces, but also to restore the

7:19body after the forces are applied as well as preserve every single human that works with no matter what airframe they work with. From there, we want to baseline take a look at their physical and cognitive data, measure things and figure out what are ways we can make them even better. So we want to build them up to make sure that they're going to be as resilient as possible to the injury patterns, the known injury patterns we know that the aircraft does to them and we want to do even more than that. So putting together the entire team to work together in one program is really important. Having everyone working under the same roof and then working with the same population also very important. So by true human performance, it's the people, the entire human performance team, as well as really emphasizing the entire human performance continuum, not just injury, not just injury prevention, but truly optimizing the war fighter, especially against our

8:21adversaries. You know, it actually kind of rings true to me. I wrote a book recently, not here to promote that, but I think the reality was as I'm telling my aviation stories and I'm talking in my book about kind of potential, like how do we optimize our human potential and I talk about balance and I actually discuss, and when I say balancers, like four pillars for a person, a mental social physical and spiritual pillar and staying in tune with that harmonized across those pillars allows you to be most effective. And I do think that, you know, when I look back to some of the most herodine challenging situations that I found in a cockpit, it came down to more than just like being physically fit, right? It came down to being aware of my surroundings and being focused with what's going on, being present, but that goes all the way back to like, what did I eat the night before? How did I sleep the days up to? How was I not distracted or centered so that my mind is not

9:25distracted by anxiety from the world or the situations that I have at my home or other challenges we face, like compartmentalizing in the moment actually requires this awareness and I think this balance of these different pillars, which then speaks to human performance more broadly, which I feel like you're getting at. It's not just being able to pull G forces because you did a good leg workout. It allows you to be most successful because it doesn't just myopically look at one aspect of what it is to be a fighter pilot. 100% and it really is getting after every and it's already evidence-based, it's already in the literature and it's throughout medicine right now, lifestyle and performance medicine. It truly gets after all the pillars you're describing, including spiritual, including the social connectedness, but what you were describing is a lot of the rehearsing and visualization and mindfulness and centering, which like you said is more than just a leg workout. It really is getting every single lifestyle pillar in alignment centered so that when

10:30you have to put yourself through all of those stressors, cognitive stressors and physical stressors, you have the capability from a mental and cognitive standpoint to withhold all of that because let's be honest, when it comes down to it, a lot of people are physically fine to be able to take on whatever they're about to take on, but it really comes down to the mental grit and the cognitive ability to get through it, especially when you're looking at prolonged operations overnight, things like that where there are significantly more stressors on the body and just having that true mental grit to get through it. That really takes all of the lifestyle pillars firing on all cylinders. I think fighter pilots tend to think, I'm healthy, I've passed my flight physical, I can pull G-forces, why do I need human performance program? I think that we're kind of alluding to it now, we're talking about it because it takes more than just being physically fit, but there is this really important physical aspect, right? Like I'd say, yeah, there are challenges that fighter pilots

11:32face because it's a very strenuous job, it demands a lot from you, it demands a lot from your body as well. So there is an important physical piece to this as most of my friends are damaged from being fighter pilots through their neck and their backs being destroyed and what have you. So let's discuss some of the different occupational exposure that a fighter pilot has to deal with. Absolutely. So when you're talking about everything that a fire pilot has to deal with, you're talking about G-loads, vibration, helmet, NVG loading, prolonged sitting, ergonomics, sleep disruptions, circadian disruption, we're talking about all the lifestyle pillars, like this just goes into all of those things. Repeated deployment cycles, you have the USS Ford, you're talking about the Lincoln right now, like pro long deployment cycles, and then the cumulative musculoskeletal and cognitive wear and tear that goes along with it. And all these things play together in all of the

12:33organ systems in the body, not just the brain, not just the muscles, but hormones, it can affect a lot of the neuroendocrine pathways, it can affect a lot of the metabolic pathways, you talk about cortisol and stress load. That has significant downstream effects because cortisol will upper downregulate various pathways throughout the body. So all of these specific loads, especially in prolonged operational settings, will have a significant occupational stressor, not just on the people in the aircraft, but also your maintainers that are taking care of the aircraft. Yeah, this type of performance is not simply applied to fighter pilots, it really can be more broadly applied to individuals. And I do think that from students to teachers, to medical professionals to fighter pilots, right, you do need to have an awareness of how are you optimizing your performance in that moment, and how are you taking care of yourself in such a fashion that allows you to be successful, and whatever that success may look like, and that varies depending

13:37on the individual and their goals and their purpose. What have you? I'm curious when I think about this program, and it is fighter centric, correct? Yeah. I also flew the MC12W, it's a King Air 350, it was the Eisen Ears Special Operators in Afghanistan, and so we are tactical, manned, intelligence surveillance reconnaissance ISR. And that was some real stress, right? You're in combat, at times you're getting shot at, you're living in very difficult situations, you got the burn pit around the corner for those that remember Bogram, or Candahari, you have the poo pond, we call it, I'm not sure if listeners are familiar, but it's a large pond of fecal matter that smelled very badly, affected the entire base. And so you have those stressors, but then you're on a mission for like six plus hour, we do six hour missions, and you're like managing a lot of different radios and communications, and you have laptops out and you're watching video feeds, and your eyes are getting strained, and you're dealing with like 20,000 foot, you know, mountains,

14:41and people like getting shot out on the ground, and right, like there's all these things that are just really challenging, and then that's every day, you're just churning every single day, you do a six hour mission, you go to sleep, you wake up, you do it again, and it is really hard in those moments to stay centered, to stay balanced, you know, so how do we approach that, and then how do we kind of apply that to some of the fighter aviation challenges? So you're talking about all the operational stressors that the body just has to be prepared for when we set you off into the operational setting. So we need to put folks through stressors in a similar fashion in the workups in the training pipeline, and we need to figure out what that load is doing from a cognitive and physical standpoint. We need to figure out how we can make the war fighter more resilient to those stressors so that we can overcome them when we're in the operational setting. You're talking

15:43about multiple data inputs that your brain has to process at all times every day, repeat, until the operational cycle is complete, and with current operational cycles, you're looking at significant amount of time having to do that. So how do we look into nutrition and optimizing sleep, and how do we look at various cognitive tools, and during my time in Naval Special Warfare, we had a whole cognitive team that has a cognitive gym, there's like their brain gym, where there's a bunch of different tools and cognitive resources that they utilize with the operators to help them with those overbearing and overwhelming inputs that they have to take in at all times, not just for survival, but also for mission accomplishment. So really getting after the cognitive side is going to be so important, especially in the fighter population, mainly because of everything

16:45you've described. If we don't make the fighter pilot more resilient to all these inputs, the war of the next generation is going to be even more inputs that they're going to have to process. You're talking about unmanned aircraft, you're talking about various drone warfare, multi-domain, right? So it's not going to be what it was 10, 20 years ago. The amount of inputs that the human is going to have to process at all times is going to be significantly increased. So how do we leverage things like AI and technology, and in the lack thereof in certain settings where you may not even have it, how do we make the brain and the body more capable to overcome those scenarios? As we get into some more details about this program that you guys have put together, I mean, you're a medical doctor and you were a naval special warfare for a long time. Like, what drove you into this aviation front? And what did you really learn from that time with

17:47Navy special warfare? So before special warfare, I spent time with the Naval Academy and covered Navy football. So I was able to utilize my lessons learned from a Division I football program where they have strength in conditioning, dietitians, mental health, obviously the athletic training staff, and the entire coaching staff. How they're truly integrated with the medical team was something that really truly rang home to me because I've seen a lot of programs where they try to separate the clinical and nonclinical side. And I think that is not the right approach. And then seeing that replicated a naval special warfare, especially as it was founded at the development group, but also what we were able to take to naval special warfare was the ability to really synergize the sports medicine, physical therapy side of the house with our human performance team. And that true synergy between medicine and performance really helped drive home the point to me that anywhere in the Navy

18:52that's lacking a program right now really needs to replicate this team, these resources, when possible, with the highest functioning populations when possible. So taking those lessons learned and I'm married to a naval flight officer. So she's told me the culture I've lived with the culture for the past 11 years, maybe a friend went out into town and sought care and paid out a pocket so that they keep it off their medical record because they had the expected soreness from the aircraft that they were exposed to. And they didn't need to be put in a down status. It was like a football player having a two a day practice and they were sore. So they should be able to see a professional like a strength coach or an athletic trainer or sports met dock or a physical therapist to take care of that. And they don't need to be put in a down status. So just hearing her stories about what's going on in the aviator culture and then seeing what we were doing in the

19:54naval special warfare culture. And we really were able to shift a lot of that to get a lot of the guys to actually come in and see us. So really the personal passion is seeing my wife what she went through and seeing what all of you all have went through and not having those resources. I love using this example. I toured the Yankees head team physician through strike fire weighing over here in Oshiana. And he has 20 to 30 million dollar investments walking around that Yankees clubhouse at all times. And they have sauna. They have contrast therapy. They have all of the recovery tools. They have the training staff. They have the cognitive performance team. They have the sports med dock on site. So they have a true embedded performance team in their clubhouse. And then he asks, why do you have 20 to 30 million dollar investments in training flight hours, experience walking around this clubhouse. And there's absolutely nothing for them to recover

20:58to optimize to improve. So that really is a story I like to tell because it truly gets after how much of a difference there is between the resources that the fighter pilots and aviation as a whole have currently versus collegiate professional sports. And even down the road at Naval Special Warfare. Yeah, no, I mean, absolutely, this this is a frustration that I've shared for so many years because we never seem to care. It was always like reactive almost like someone would get hurt and then they would just go get seen. But I will say the Air Force over the past decade, maybe not that long, go close to has been investing more and more in programs that right like you can sit down, you get a physical therapist and you can do preventative kind of care where they really, you know, give you strength training, they give you strength coaches. But even those programs kind of ebb and flow, oh, we don't have the funding this year. And so we're not going to be able to do that. And we're going to combine, you know, that with this other

22:00organization over there. So we're not going to have our dedicated person like we used to and I mean, we used to have flight docs as well like in our squadron that there were like assigned to the squadron. And they would take care of the pilots and they would take care of the pilots families even. And I do feel like yeah, they're loosely still assigned I think to squadrons, but it's not such a personable relationship. It's more like, well, they're with the hospital and you can go see that doctor. So I feel like they've taken some steps forward, but they've also I think taken some steps back and they haven't fully invested in what this could look like. And I do think your analogy is that prep oh, like dude, yeah, you have all these people that you've invested so much money into and their expertise is so vital. And then, you know, you're not giving them the care they need to actually continue to be successful and successful, you know, like five years from now, 10 years from now, 15 years from now, because these individuals, even if they stop flying, their bodies still need to work, right? They need to be, you know, contributing to society because

23:03they don't have like slip discs throughout their back, which is very common among my friends, it seems. And I mean, we're not even getting into some of the cancer challenges that I think are community faces because we haven't fully understood some of the occupational hazards of being around radars that are like, you know, always on. And of course, I think there's some good evidence that there is a tie into that, but there's also, you know, people that argue against it for some reason, but I don't want to digress into that kind of conversation, but human performance nonetheless, I think it's really important. And I do think that when we think about aviation, we think about maintenance and we treat the vehicle almost better than we treat the human. And I'm curious your thoughts on that. Yeah. So you brought up a bunch of very good points, specifically about the Air Force program optimizing the human weapon system. That's their whole take home is trying to optimize the human because we've spent so much money on trying to improve the aircraft that you

24:06fly on to try and make it safer without truly getting after the human sitting in the cockpit, getting all those stressors applied to them. So if we were to spend the fraction of the amount of money that we've invested into the aircraft to make it a safer environment for the AFAIR, we would have a program like the Air Force optimizing the human weapon system program. Like you said, a lot of these programs, they kind of have been flow mainly because they haven't done a very good job at gathering the data to justify themselves. So for example, the Air Force's program is very good at demonstrating through potentially subjective data when it has to come with surveys. Did the human performance program increase your likelihood of wanting to stay in the Air Force as a retention tool? You know, questions like that. And of course, a lot of people are going to say yes, but what are the other quantifiable things to justify the program? So I think that's truly something that we have to get after. It's something Air Boss wants us to get after when we

25:11roll out the program. And we really truly need to measure what makes the most sense to capture that return on investment, as well as at the end of the day, make sure that the end user, the Air Ground Crew, are getting the information, the tools and the resources they need to be able to 10, 20, 30 years from now play with their kids without as much pain or with minimal pain, be able to think through things and process things from a brain standpoint, 20, 30 years from then with better brain power. So really getting after again, all those lifestyle domains while you're in uniform while you're in the cockpit and optimizing them with a program of record that truly gathers the data needed to provide sustainment and justifying his existence to all stakeholders, as well as proving its value to the taxpayer. And by that, I mean, do we really want everyone to be

26:14100% VA disabled rating at the end of their career? I know that that's a loaded question we could probably spend an hour on how there's incentive in there for folks to want to get 100%. But at the end of the day, we're talking about quality of life. I'd rather be able to think, I'd rather be able to play with my son, I'd rather be able to enjoy sports for the rest of my life without pain. I can't put a value to that from myself when it comes to, was it worth more than 100% VA check every two to four weeks? For me, I would say, yeah, absolutely. I'd rather have less VA benefits than the ability to improve the quality of my life. Yeah, there's a lot that goes into that. I mean, for instance, pilots and we're kind of famously known for not telling the doctor what's really wrong with us. We don't want to be placed into down status. And so, yeah, like we'll go in when we have to our annual physical, we're like, no, everything's fine. And we don't talk about it. And I think we

27:14kind of suffer silently in many ways. And that's just on the physical side, especially the mental side. You can't even be like, no fighter pilot, at least when I was a younger fighter pilot, whatever go talk about anything when it comes to their mental health, right? Like that was verboten. And so now you have pilots that kind of go through their career, not really talking about this. And and you're right, the preponderance of fighter air crew that I know are really damaged. You know, they finish up their 20 years and near the end, they start kind of may a copa like, nope, I really do actually have a bad back or bad knees or bad whatever. They are rightfully being treated at that point. And yeah, I think there is a lot of 100% disabled, but like they have so many different issues. And their bodies have just been put through the ringer for so long with very little preventative help. And so yeah, I think that there is actually a value with having a program like this just for their quality of life later on and not being so disabled, right? Because they will.

28:19You're right, have an ability to like go ski with their kids and all of the different activities without being completely sideline because of an injury that they sustained and then never talked about for 10 years, right? What I will say is there are so many good resources now. So for those listening, if you're experiencing these things, especially from the mental health and the chronic pain standpoint, programs like home base up in Boston through Harvard, mass general places like the National and Treppett Center of Excellence, TBI, COE, there are lots of programs that provide comprehensive, weak plus long programs that will get after helping you. That being said, and when I speak to the leadership at all of these various programs, because they were very integral in helping us in the special warfare community, they will tell you our goal at some point is for nobody to need these programs. Our goal would be for us to look at the problems experienced by every single occupation that flies or maintains the aircraft.

29:23And just point at the problems that we know they're going or have developed throughout their careers and really get after a community blueprinting model where we have someone who goes through very, and I wouldn't say vigorous, but just continued maintenance, like you're talking about, maintenance of the human maintenance of the aviator to prevent a lot of these predictable injury patterns from progressing to a disabling state. Shout out to home base. I'm on their leadership council. What a fantastic organization. You know, I'm up in Austin and yeah, they're really impactful and I know the Blue Angel Foundation is a big part of what they do as well, which I love. And I'm curious, what did you do at training wing six? So I know you wrote a white paper initially, but what are you guys doing now to really get this program on the right footing? So this is really the genesis of where we are

30:26at the current moment. So Sinatra at the time, Real Animal Brophy. Can you tell for the listeners what Sinatra stands for? The Chief of Nail Air Training. So basically your flight schools. So all of the training air wings and the FRSs are under Sinatra. And the Chief of Nail Air Training at the time, my current boss, but their boss at that time, Real Animal Brophy, he tasks one of the training air wings training air wings six, their Commodore, to assemble a human performance team with active duty assets and to create a program. And that was his instruction, his intent, and they had to figure it out. So their Commodore Captain Doug Cricket calls on white. He reached out to a couple of folks that he knew in his back pocket about the subject matter experts in Navy medicine that were chomping at trying to get a human performance program started in any of these communities.

31:28And we got our physical therapy specialty leader. I am the Navy sports medicine specialty leader. We were all involved from the starting point, the clinical psychology specialty leader. And what we tried to do is put together a team without resources, without funding, just billets. And they found gaped funded billets throughout the Chief of Nail Air Training enterprise. And we were able to identify billets that let's be honest with a retention rate in the teens currently in naval aviation. They weren't going to be filled any time soon, which is a problem, right? So we temporarily flipped those billets to a sports medicine physician, a physical therapist, a clinical psychologist, an aerospace experimental psychologist. And we put that team together in Pensacola at training airwang six. And then we said go. So when we said go, we didn't have the

32:31programmatic stuff in place, but we knew we had the right team. The sports medicine physician and physical therapist have what we call the human performance specialist, AQD, or Qualifier Designator Code, which identifies them as an expert in human performance. They have to meet criteria for their PFA. So they have to get outstanding on their PFA. That's no physical fitness assessment. And then in addition to that, what they have to do is they have to provide proficiency in strength and conditioning. So certification in a strength and conditioning program, or bachelors in exercise physiology, they also have to have proven a track record in performance, improvement or quality improvement program, implementation in human performance. So truly, folks that have not only walked the walk, but talked to talk in human performance. So both the sports medicine and physical therapist clinicians had those designators. The aerospace clinical

33:34psychologist is a leader in her field. She's an incredible asset to the team and is their team leader and really provided some great programmatic effects as well as the cognitive and mental health side of the house. And then the aerospace experimental psychologist who happens to also be a pilot was able to put together all the data analysis. They were able to build dashboards and able to track data with help from the NAMRU, which is the Aviation Research Center in Dayton, as well as assistance from O&R and some other entities to help with the data analysis. So again, no resourcing, no dollars, but they were able to leverage already pre-existing research dollars to help with their data part of the house. They had the sports medicine physician go through flight school to learn the culture and they put the physical therapist through knife, which is their

34:34primary start to trading in the flight school. So they were able to gain the cultural competency as well. The aerospace clinical psychologist already had her wings and then of course the experimental psychologist already had her wings as well. So we had them not only assemble the dream team from human performance side, but we also made sure that they understood the culture from the aerospace medicine side so that they could also know the guardrails left and right, but their intent and their overall goal is never to down somebody. And they've been incredibly successful over the past year. They got a hard start this past spring after their flight training was done for the sports doc, and they've hit the ground running. They've had over 2,000 contacts with flight students, student aviators, with the instructor pilots for sure. They have already proven to prevent weeks or months, and you know the traditional model. It takes weeks after seeing your

35:35flight certain to see a physical therapist or a psychologist, and then weeks after that, if you need a waiver or you need to provide stability, and then you might need to do a requalification, which is money and flight hours to get back into an up status. So the amount of return on investment just from a single, let's say instructor pilot who maybe have tweaked their knee, didn't need to wait to see the physical therapist. They saw them the same day, both the physical therapists in the sports medicine physician was deemed not to need a down status, and they already had the sports medicine specialist on the book saying that they were good to fly. So they didn't need the wait to see an orthopedist or sports medicine doc. You're talking a three months return on investment right there, just on refunded instructor pilot time. Yeah. Well, I feel like that's a strong argument, but I also feel like some of the senior leaders have short memories, and when you try to scale this to the entire Navy, that there's going to be a lot of admirals

36:35that are like, well, you know, is it really like that beneficial or are we really helping them out? Because I have to decide, you know, what programs to cut, and it always comes down to funding resources. You're right. So how do you scale this and how do you sustain it? So it takes more than a village for this, right? So I'm not sure if you're aware of the warfighter performance optimization acceleration program that's currently underway, but there was a sec war memo that came out about tasking all the services to accelerate a program called warfighter performance optimization, and with it, they provided the operational control over to undersecretary data, who then delegated it out to further the various offices in the services. So for the Navy, our acting sec death, secretary cow, he delegated out to the assistant secretary of the Navy for manpower and reserve affairs, and their leads are currently responsible for the rollout for the Navy,

37:38which I've been in direct communication with. And really what it comes down to is gathering the resources from those types of resources, rather than having airboss having to pay the entire bill, which I don't think is reasonable or even feasible, especially given that he needs to pay for flight hours, fuel, dropping bombs, you know, maintaining aircraft carriers, etc. So that shouldn't be his bill to pay. And we have a very interesting alignment of stars at the moment, because most of the senior leaders in the Navy are currently aviators. So all these senior aviators that are in positions of significant influence may have a friend, maybe it's themself, that have accumulated a lot of these occupational stressors that are currently experiencing pain or currently having cognitive issues. They all have a vested interest in this. Further,

38:40if you think about the retention issues, there are so many gap department head billets, there are so many gaped instructor pilot billets. It's really non sustainable at this point. So we have to do something. And when warfighter performance optimization, the program itself is trying to accelerate its efforts. We're really looking at communities that have the biggest opportunity for return on investment and communities that have the highest needs. And to be objectively clear, the biggest return on investment is going to be aviation. If you just retained 5% to 10% more fighter pilots, just multiply that math by 20 to $30 million each. That's a pretty significant return on investment. Saving a single fighter pilot will pay for the entire active duty manpower request for an entire year to two years, depending on their level of training, which is pretty incredible. So if we increase or improve retention by 10%, and we can say that the human performance

39:43program has something to do with that, it is one of the lines of effort for quality of life for the commander from Naval personnel, who is also an aviator, their line of effort for retention for aviation. So it really gets after the systemic things. Will the human performance program specifically be the 100% reason that we retained X number additional fighter pilots at the end of the day? I hope so. But it really takes an entire systematic approach to be able to create a scenario where at the end of your eight to 10 year commitment, you say, I want to stay flying navy. I want to stay flying Air Force because I feel valued and they're taking really good care of me. And if I flew for the airlines, I don't know if I would get this level of care or be treated like the athlete that I've been told I am on a consistent basis. Yeah, you know, that it is a really good point. We often forget that leadership is of course about inspiring other people encouraging

40:47them to some objective in a fashion that is kind of uplifting for those involved. And I think that there's something to be said about just conveying value. And most of my friends that got out before 20 years, they just didn't feel valued. They felt like the assignment process, like didn't take into account their personal desires that they were just a cog in the machine, the military wasn't investing in them as a aviator, war fighter. And it comes down to some of these programs weren't available, it was hard enough to get to the gym. It really gets after Maslow's hierarchy of needs. And if you're familiar with the chart, right? So if we can't meet the physiological needs, the safety and security, and then the belonging, that's not going to get to the the higher levels of what everyone really is trying to get after. So if we're trying to get after performance, we're trying to get after retention. If we can't meet the basic physiological needs,

41:49safety, security, and belonging, then I'm not sure how we're going to be able to retain the war fighter, the aviator. So we really have to get at all of those things. It's not just going to be the human performance program, but that's going to be a significant piece of the puzzle. Well said. So what does this look like? You're an aviator. So for our listeners that are aviators out there in the Navy, are they going to have a specialized gym and a strength trainer? What does this data day look like? So what you're describing is end state. So we're going to have to scale it. If we get a lot of these war fighter performance optimization resources, we can accelerate it. That's what they're trying to do. So we've already identified gym spaces, squadron spaces, what training airwings six did was they repurposed a classroom that was just storing chairs and desks. It wasn't even being used into a gym. They were able to tactically acquire through the

42:51dermal recycling process of the EOD school down the road and got some of their equipment to purpose and outfit their fitness spaces. And they actually got some equipment that the naval hospital wasn't using anymore to be able to utilize in their space as well. So like I said, it takes a village, but truly if we're going to do the right thing, like right now we're looking at blueprints of these spaces. We're working with vendors like Beaver Fit and some others to get quotes. And we'd like to partner with the Navy MWR fitness program to see if we could order from their catalog. So whatever makes the most sense to get it done correctly, I think is really the way forward as far as the spaces are concerned. We do have flight line gyms that could use some renovations so that all hands could enjoy those resources. So from a structural standpoint, we can identify spaces, we can repurpose, we can renovate. And lastly, if we needed a build,

43:52we could potentially build. And if we are going to build the hanger and squadron and wing spaces of the future, absolutely have to include recovery spaces, should include things like contrast, sauna, you should include resources like a nutrition-based facility. You should have the ability to have an athletic training room where the athletic trainers are located in your ready rooms. You should have ready recovery rooms where you have normatec boots to put on or you have a shift wave chair where you can utilize some tools to help you down-regulate cognitively as well as a total sensation down-regulation after a long day in flight operations. So end-state-wise, I'd like to see all of that take place. Current state, we're looking at throwing together some prototype sites under the Naval Air Force Atlantic Enterprise. We are looking at putting physical therapists in Mayport at the

44:57HSM wing, which will also cover Jacksonville, Florida. We are looking at putting a physical therapist at the Commander Strike Fire Wing at Atlantic here at Oceana for their fighter pilots. We already have a civilian contracted program stood up at HSC at Atlantic in Norfolk for the Hilo wing there. So we already have the ability to get data from a civilian-only contracted human performance effort. We're going to put physical therapists with the already billeted clinical psychologists that are in these locations to team up. So we are getting after both the musculoskeletal, the physical domains, the cognitive as well as the sleep and the sports realm. Because at Commander Naval Air Force Atlantic you have a sports medicine physician that can also help with programming, that being me. So what we're trying to do is we're trying to interject within the training syllabus. So at 106 for the fighter pilots when they're going through

46:03the rest of their flight training through the Strike Fighter training program, we are implementing human performance education within the syllabus there. We've already implemented syllabus in human performance integration at training airwings 6, which we would replicate at all the training airwings. So there is that educational piece. We also want to make sure that we're doing one-on-ones with the senior leaders that have already accumulated all the stressors that have not been taken care of during their careers because it's really important for them to experience the capability themselves as well as optimize their own performance to make them better leaders. So it really is getting after all of the levels of leadership, but also making sure that we are developing programming that really is precision in how it approaches every type of occupation. And again, it shouldn't matter where you are in the aircraft or if you are on the ground maintaining the aircraft, we want to make sure that there's a program that gets after the

47:07known occupational stressors that are accumulated for you. To round out that active duty team, we'd love to get the strength and conditioning coaches. We'd love to get the dietitians. We'd love to get additional cognitive specialists. And how that looks for certain platforms, strike fighter, probably and likely from an end user survey perspective, which we'd like to get some data on. Probably a good mix between cognitive and physical domains versus maybe rotary wouldn't need more of a physical domain. Still some cognitive, but probably some added some strength and conditioning just from all of the rotational, vibrational, and other loads that are applied to the body. So really getting after what each platform does and then how those teams should look is really what the end state is looking at. But we need all of the professionals working in the same spaces. And we want this to be a true partnership with aerospace medicine. Aerospace

48:08medicine, occupational medicine for the aviator sports medicine, occupational medicine for the athlete. In this case, the tactical athlete, it truly is a really good blend and synergy between two communities that are trying to get after not just the safety, but also the preservation and optimization of the aviator. Yeah, I'd love it all. I am curious if you have any of this data, it just was kind of running through my mind of what are the main issues that a fighter pilot faces quantitatively. Is it all back issues like for the listeners out there that are wanting to go into naval aviation or our aviators, what are the like the biggest concerns that they need to be aware of? So number one spine preservation program has to be in there. So with all the the G loading, with all the rotational forces and with just the cumulative load of loading the spine for various

49:11directions landing on an aircraft carrier, taking off from an aircraft carrier, there's just so many different loads that are applied to the spine in various angles and at various velocities, accelerations and decelerations that we truly need to make the spine resilient to all those forces. And that includes pelvic floor training. So we're going to be getting after the spine preservation program for sure. There's no question about that. It has to be from the neck all the way down to the lower spine has to be including the pelvic floor, which is the underlying support of the spine as well. In men 2, that's one of the footstompers for me is we need to focus more on pelvic floor training for all service members, men and women. So that's going to be for sure. The other thing is the cognitive side. So we know that there are mental health issues throughout the communities in the military in general, whether or not there is an increase or decrease. If you're looking at tactical air, how many people are actually going to report that they are

50:16experiencing a mental health problem, probably not until later in their career or not at all. But really getting after a true cognitive performance program to address these stressors that there's known stress, there's okay stress, and then there's your reaction to stress. And how do we coach people on how to react to stressors while also showing them how to stimulate various systems in their body to help down regulate vagus nerve stimulation, deep breathing techniques, mindfulness, all those different strategies that may be different from person to person. But having the clinical psychologist, having the cognitive coach in the spaces to be able to help the aviators through what's going to work for them, I think that cognitive program is going to be just in line with the spine preservation program. And then from there, it really gets down to what occupation you're required to do. So if you're a rotary, you may need to do more upper

51:17extremity work just because you're reaching up, down, back, all around, and then with vibrational. So likely a little bit more upper extremity work in that population. But for the fighter pilots, it's going to be a lot of spine preservation, pelvic floor, and cognitive, probably be your top three things we'd be getting after. Awesome. Thank you for that. I appreciate it. What's the biggest misconception fighter pilots have about human performance? I think, I mean, in the Navy, they just don't know really what it means because they don't have it. So I think if we were to have a program in place, they'd be able to see what human performance is. I think a lot of the perception currently is we hear a lot about human performance. I don't see it in my spaces, but I'd like to be better in the operator community. It's I'd like to suck less. So how can these resources be put together to really get after the things to make me better? And at the end of the day, we're talking about

52:18mission accomplishment. And a lot of those missions are, let's face it, life or death scenarios. What's going to make me more capable able to come home to my family, cognitively, physically, all of the things to make sure that I'm able to beat the adversary so that I can return home with honor to my family. That's truly what human performance should be getting after at the end of the day. Let's just hypothetical. You know, if you had five minutes of the Airbus, and could ask for only one thing, what would that one thing be? Advocacy. And we actually got several minutes with the Airbus last week to pitch the program. So we were able to get a lot more than five minutes, thankfully. Okay, good. He's a math guy. He's really smart. He knows what he's doing. He wouldn't have gotten there if he didn't. But it's all about data. Get him the data. Continue to show how we can sustain it. But the biggest thing for us is advocacy, helping us advocate to all stakeholders, all of the folks that are involved with resourcing

53:24to help fund the program to get it started and to sustain it. I think would be the biggest things. But his support and advocacy, I think, are the biggest things that we would need. And five minutes just to have that discussion, I think, would provide significant value. Yeah. Well, I'm a huge advocate for what you're trying to do. I think ultimately, if we were to actually optimize human performance, and we'd look at it through the medical lens, and we think about it through the four pillars that I talked about earlier, you know, we're going to have more available elevators. We're going to have more instructor capacity. You're going to get better training throughput, longer careers. You'll get better decision making. I think you'll get, of course, fewer preventable injuries. I think that will also turn into fewer mishaps, man. I think that there's a lot to be said about human error when it comes into mishaps and where someone's mind is at and where their bodies at when they're going through some of those situations of channelized attention and all of the other typical factors that are ultimately at the root of them human error. And I think that speaks to greater readiness. And

54:25ultimately, as we hope, you know, greater combat lethality, I think the real tough questions become like, how do you convey, once you start garnering the data and you start expanding the scaling this, that it's because of this, right? People sometimes are blind to the benefits of a program that could actually be decreasing, you know, mishaps and increasing lethality because it's not as measurable, seemingly measurable. So that's sometimes the harder challenge with these programs is proving that it actually is working on a very objective level. Yeah, I think that becomes challenging, but like we were talking about before, the entire system wide approach to retention, to take and care of the basic needs. I think human performance needs to be a factor. It obviously needs to have the data to support it, but at the same time, it needs to be a whole system approach to retention. And as long as we're approaching the existence of a human performance program as part

55:25of the whole system approach to retention, to lethality, to optimization, to just doing right for our service members, I think we'll be measuring the right things. If we were to just focus on the human performance program itself without looking the entire big picture and trying to tease out just data from that, to see if that only alone specifically got after the retention problem, the decreased mishaps, et cetera, I think we would be significantly challenging ourselves in a way that would be unnecessary. Because at the end of the day, it's about retaining the significant investments that our taxpayer and our military has put into all of these aviators. And at the end of the day, it's the rest of their life, taking care of their kids, enjoying life, being present with their spouse. Things that just truly matter more at the end of the day. So challenging questions, but I think if we look at it in a big picture system wide approach lens, I think we'll get the data

56:30we want to support it. Yeah, Kaby, thank you for what you're doing. Thanks for ensuring that the decision makers are considering and being thoughtful about how to optimize human performance for our Navy special warfare, for our aviators, I think for our maintainers, you know, for really, ultimately everyone is what we're looking to do. And it starts here and you're doing the hard work. So thank you, very meaningful. I would love to just ask what's next for you. If there's one message you want to be able to share, I think you've kind of encapsulated a really strong argument here. But is there anything else that you wanted to be able to share with our listeners before we send you off to do the hard work? I think at the end of the day, we're just looking for everyone's support and advocacy. So if there are people of influence that you know, if there are people that you know are suffering because of not having a program like this in place to take care of them, we need as many supporters as many advocates as possible to help us continue the momentum that we've

57:33had the past several months to truly get this across the finish line. So honestly, like without a doubt, your support, your help, your assistance in continuing our momentum is really critical at this time. All right. Listeners, you heard it here. Support advocacy. That's what we need to be able to do. I think that this is important. Of course, you have my support. Not that it matters as a retired Air Force pilot that has no influence on the Navy, but regardless, I love what you're doing, and I hope others out there can also show and demonstrate that they're their right beside you. So KB, thanks for joining us. Given us a look inside, this new approach to human performance in naval aviation. It's exciting to see the Navy putting this much emphasis on keeping its people healthy, ready, and performing at their best, and we'll definitely be watching to see how this program develops across the fleet. KB, thanks for your time. That's it for this episode of the Fighter Pilot Podcast. These conversations matter because the future of air power, autonomy and warfare is being shaped right now by people who understand

58:36both the technology and the responsibility that comes with it. Thanks for listening, and thanks to our guests for pushing the conversation forward. If you want to support the show, you can subscribe, leave a review, or check out the Fighter Pilot Podcast dot com. Fly smart, take care of your people, deliver the future. Sink o'out.