Making Bio Relief a “Number One” Priority

By LCDR Jess Cameron, VAW-120

Let’s talk about the “elephant”—nay—the “Piddle Pak in the room.” That’s right: get all the giggles out. I’m talking about pee, people— the urge to purge. We need to dust off and reexamine the unnecessarily taboo subject of in-flight biological relief, or “bio relief” because it is unacceptable that we have not yet fully solved the problem. The more we openly discuss bio relief, the better we signal demand 641 with Omega throughout Naval Aviation for Right page: U.S. Navy photo by Mass Communication Specialist 3rd Class Alan L. Robertson safe and effective options for men and women across multiple Type/Model/Series (T/M/S) and at all stages in their flying career. The only thing more frustrating than not being collective future. I’ve been on numerous critical Bio relief isn’t a singular event, it doesn’t involve missions with a high degree of sea stories regarding weapons systems or task saturation and involved catastrophic equipment failure, yet everyone mission requirements. I was encounters it. Winged aviators at every level unable to step back from my seat shouldn’t feel like they don’t have a voice on the for what would realistically be at issue, or that they have to remain anonymous least 10 minutes for me to set because of perception or cultural stigma. up to “go” and return to my seat Bio relief can be embarrassing by nature and to resume the mission. Many humiliating in practice when we lack sufficient aviators sacrifice their normal functionality, funding, and supply to successfully bodily function by either holding and safely complete the mission. Let’s not sugar it in or “tactically dehydrating” coat it. It is a readiness issue, and being human is (deliberate dehydration to integral to being a warfighter! minimize the need to urinate) for able to pee safely or effectively in the plane is Approach featured the relation not being heard. I’m not the first aviator to openly between dehydration and fatigue confront this problem throughout the decades in the article, “Hydration and and across multiple aviation communities. Why Fatigue: What’s the Connection?” do we seemingly reach dead ends on this critical (Jul-Aug 2014) which highlights problem that affects the health of our aviators, the negative effects of dehydration safety of flight, and mission success? I’ll highlight on mental and physical some of these concerns with anecdotes through performance. Simply put, aircrew the lens of my Hawkeye-Greyhound (HEGH) often resort to “not going” by community, which remains underrepresented either means rather than dealing on the issue of bio relief, yet strives to make with subpar bio relief options, with significant progress matter for all aviation both measures causing negative communities. While doing this, I’ll share voices impacts to the health and safety from years past and recommendations for our of aircrew. the flight.

Relief is not a small aside to the mission; in fact, lack of suitable bio relief options affect Naval Aviation readiness at its core. Underneath the surface, the problem is more than just about our bladders; it’s about inclusivity, equity, dignity, and above all—safety. The Navy spends exorbitant time and money to produce highly trained safe and lethal aviators but hasn’t sufficiently applied similar time, funding, and energy toward fully solving the bio relief dilemma. We haven’t fully realized progress despite repeated efforts by aviators, whose stories mirror my own, to make progress over the decades through published community articles, squadron-level, and community HAZREPS across T/M/S, or via Naval Aviation symposia.

Today, over 17 years after a VAQ aviator wrote the March 2003 Approach article entitled, “Female Aviators Face a Dilemma: To Pee or Not To Pee,” the dilemma persists for men and women. And although bio relief tends to affect women disproportionately, it is a gender-neutral problem that depends on the type of survival equipment, aircraft, mission, weather, and even crewmember role. For instance, Aircraft Commanders flying with a less experienced pilot may never have the opportunity to relieve themselves. In addition, even if it were easy and convenient to go, many aircrews must still forego safety to unstrap from their seats to use Urinary Collection Devices (UCDs) or relief tubes. Moreover, the struggle is

real for both men and women if dry suits are mandatory, as cold weather survival gear demands improved bio relief options regardless of gender. Therefore, including everyone in the conversation may lead to more creative solutions with perspectives from all angles.

So why bring this up now—or should I say—why now, again? Well, imagine not being able to urinate at work. There’s been a resurgence on the bio relief topic with the advent of Aerial Refueling (AR) in the E-2D Hawkeye with extended sortie durations making urination in flight an inevitability. With E-2D AR Fleet transitions underway, our community struggles to solve the “#1” dilemma.

So, why can’t every aviator safely and effectively relieve themselves in flight? By “safely,” I’m referring to having access to bio relief devices that comply with the OPNAV N98 requirement not to remove aircraft restraint systems in flight. But UCDs that are cheaper and more widely available such as the Lady J Adapter, Freshette, Piddle Pak, and GoGirl (no, I am not making these brand names up) are not within regulations for every aviator because they generally require removal of flight gear for use. Yet they are the products most commonly purchased by squadron 7F funds, thereby forcing aviators into an unsafe position in flight when they need to urinate.

By “effectively,” I’m referring to easy-to-use devices that are both hygienic and costeffective. This could include the aforementioned UCDs in conjunction with E-2/C-2 relief tubes, depending on how comfortable each aviator feels going, as well as when they can be bothered to go depending on the mission. And again, they can be time-consuming depending on one’s anatomy, aircrew role, and mission that day. Fumbling around and detracting from the mission is neither safe nor effective.

Some may say that the Advanced Mission Extender Device Max (AMXDmax) is a clear solution to the bio relief dilemma, as it complies with the N98 requirement to allow everyone (jet, rotary, and prop aviators) to urinate while seated, and it has male and female variants. The device is partially funded, with the Navy having already invested $1 million in UCDs and uniforms (like two-piece flight suits) more conducive to bio relief efforts and planning to spend an additional $2 million to complete those endeavors.

Military.com featured these goals in its 19 December 2019 article, “The Navy is Buying Equipment that Makes it Easier for Female Pilots to Pee.” The same article noted that the AMXDmax funding initiative began when the issue was raised at the 2018 Female Aviator Career Training Symposium (FACTS).

While the AMXDmax funding and supply initiatives are steps in the right direction, the device itself is no panacea for the bio relief dilemma. First, although the AMXDmax offered improvements from its legacy pump and battery life, it came with a $3K price tag per starter kit in 2017. Many squadrons informed their aircrew that they could perhaps purchase the device, but couldn’t afford to fund the system’s use and maintenance. The cost remains excessive today and often does not include the cost of upkeep and consumables.

The acquisition process for the AMXDmax and similar devices remains a significant hurdle, with only slight improvements made along the way. VAW-120 (the only E-2/C-2 FRS) has yet to receive such devices, and they are not projected to become available to staff and student aviators until 2022.

Additionally, the AMXDmax is bulky and poses numerous health risks to its users. A 2017 combined all T/M/S HAZREP entitled, “Current In-Flight Bladder Relief Options are Inadequate and Potentially Unsafe,” outlines not only bio relief procurement concerns, but also disadvantages to the AMXDmax specifically. The HAZREP argues that the AMXDmax has taken a step backward from its legacy system in hygiene and usability, causing health problems and infections in users and requires an unsustainable process for upkeep. User feedback in the HAZREP included disturbing personal stories, detailing persistent UTIs with usage, aviators forced to use the same pad for multiple urinations in a single sortie, and skin irritation or sores on the body from sitting where the wires go through the pad. With that, the marketing and contract must also be addressed properly, as “multiple urinations on the same flight is very different from using the same pad for multiple flights and the word ‘disposable’ indicates that they are not to be reused” (p 3). Every reader should cringe to think our final solution might be a clumsy, cost-prohibitive product with deceptive advertising that causes unsanitary conditions and discomfort while being awkward to use.

To make matters worse, funding and supply still plague the Naval Aviation community with already-approved and tested systems. The 2017 all T/M/S HAZREP cautions against ambiguous timelines on when devices of any kind should be procured, issued, and trained in an aviator’s pipeline. And as if procurement hurdles were not enough, many squadrons do not recognize the extent of the problem because their aviators remain uncomfortable about voicing bio relief concerns or discussing their options (or are simply unaware of their options). Likewise, there is an inconsistent funding policy regarding UCD options between squadrons and Type Wings. We are still uncertain as to whether or not our community was provided a CNAP-approved CVWP 7F fund augment of $167,400 in June 2017 to procure AMXDmax devices for male and female aircrew, and a one-time plus-up of TYCOM 7F funds to assist the procurement of approved bladder relief systems.

Note: Across the Naval Enterprise, all requirements must compete for funding in the OPNAV N98 portfolio. When portfolio managers don`t prioritize the requirements enough, those requirements go unfunded.

Photo by Petty Officer 3rd Class Joshua Leonard

And if we were, what exactly were those funds used to purchase? Our questions have gone unanswered.

So, where do we go from here?

First, we must collectively rethink our solutions when a device is difficult to procure due to cost and when health, safety, and mission success is on the line. Progress is underway through multiple channels and increasingly coordinated efforts such as the System Safety Working Groups (SSWGs), the Aircrew Systems Enabler Naval Aviation Requirements Group (ACS ENARG), FACTS, PMA-202 Aircrew System InService Support Center (ISSC) engagement and advocacy, as well as Small Business Innovation Research, or SBIRs. These working groups offer venues to voice top safety concerns for our communities, while the SBIR initiatives (in conjunction with NAVAIR) are working toward decreasing the price of the AMXDmax while simultaneously developing new and improved systems that address the litany of operational issues.

Meanwhile, VAW-120 strives to continue the dialogue and leverage the aforementioned outlets to advocate for better solutions for all aircrew across its platforms. Last year, HEGH FACTS (inspired by the overarching symposium and with the help of our allies at PMA-202, ACCLOGWING, Aviation Survival Training Center (ASTC), Airborne Command & Control Logistics Weapons School (ACCLWS), and VAW/VRC Flight Surgeons and Fleet leadership) was able to bring to light our E-2/C-2 bio relief issues. We then began shaping a plan to signal demand for better bio relief and flight suit options. Through those discussions, ACCLOGWING was able to procure hundreds of Lady Js, GoGirl, and Piddle Paks for VAW-120 staff and students in 2020. Unlike in previous years, new check-ins are now issued these devices from the beginning of their time in the squadron.

Although not the final answer, this small step in UCD procurement for our FRS also supports the 2017 All T/M/S HAZREP’s recommendation that the issuing and training of bladder relief systems begins in the training pipeline. Aviators shouldn’t arrive in the Fleet untrained and illequipped for bio relief. The 2017 HAZREP and our E-2/C-2 symposium also addressed the cultural aspects and shared burden that FRSs and operational squadrons share with regard to tactical dehydration and UCD use. It addresses how device supply, availability, and training should be reinforced in every aviation command. The 2017 HAZREP also goes a step further in recommending that bio relief devices are issued as required ALSS at CNATRA prior to carrier qualification for aviators (pp. 9-10). One small recommendation VAW-120 made was to establish revised Aviation Safety Awareness Program (ASAP) questions to be completed post-flight addressing bio relief issues. We included questions about tactical dehydration, whether crewmembers had to vacate their seats in flight for bio relief, or if aircrew had to remove any survival gear/equipment in-flight for bio relief purposes. Although ASAP is not truly anonymous, the questions can cover both men and women and are a step toward data collection to signal demand and properly document unsafe conditions that help justify future funding for improved products.

Additionally, VAW-120 sent aircrew to a Langley Air Force Base female fitment workshop in June 2019 that addressed flight suit fitment and bio relief devices. At the time, the companies Triton and Matech were awaiting the option to be awarded to work on new systems separate from the AMXDmax. Triton submitted a proposal to an Air Force initiative established in 2017 designed to circumvent bureaucracy and engage new entrepreneurs in Air Force programs, and ISSC believed they could produce a functional product in six months if Triton was awarded the contract. Squadrons eagerly await follow-up information on the matter. Regardless, increased competition has been working to drive down the cost of existing and potential future devices—a win for aviators of all services that should be supported.

Let’s go back to the topic of being heard. Related to our “#1” issue, and toilet humor notwithstanding, 2018 should not have been reported as the beginning of Naval Aviation’s bio relief initiative. There is a history of detailed evidence clearly demonstrating the demand for bio relief support and solidarity amongst aviators. Between the 2003 Approach article on the subject; the 2006 AMXD performance specification drafting; the 2008 PMA-202 AMXD starter kit purchase; a 2010 Deputy Director for Air Warfare release of “Requirements for Aircrew Endurance” outlining that bio relief systems will not require the removal of aircraft restraint systems; a 2015 SECNAV inquiry into bio relief; the 2017 All T/M/S HAZREP; 2018 and 2019 FACTS; and all the tales of pump and battery failures by aviators in theater…why must we bring this up again and why can’t we solve it now? This affects the aircrew of both genders across multiple platforms and we’ve been talking about it for years; therefore, we must call on the entire aviation community to get actively engaged in effecting real change and demand that our voice is heard.

This change should include safe and effective bio relief options for everyone so that a normal human process is neither embarrassing nor humiliating and isn’t a barrier to the safe and successful execution of our missions.

Holy cow, that is one Peeee-lemma and I agree it must be fixed! The key is not to suffer in silence. Although the author mentioned HAZREPs, only two have been submitted in the last two decades, compared to the 25 submitted for flashlights in the last five years! NAVAIR uses HAZREPs to prioritize funding, so let’s get them workin!