As U.S. Navy Blue Angels and U.S. Air Force Thunderbirds teams fly through the sky at upwards of 700 miles per hour during exhibitions, take daring twists, dips, and turns—there’s a team of health care professionals looking out for them on the ground.

The aviators couldn't do their thrilling and precise maneuvers 300 days a year without relying on flight surgeons to keep them at peak mental, physical, and nutritional levels.

The flight surgeons are so embedded in the daily lives of their demonstration teams that they can catch signs of problems early.

That's important when aviators like the Blue Angels are flying as close as 18 inches apart from one another in precision formations.

"It's a pretty unique level of trust we have," said U.S. Navy Lt. Cmdr. (Dr.) Monica Borza, the Blue Angels flight surgeon.

"I get to know them extremely well. I can recognize if someone's voice is even off one day," Borza said. "That's just how close we are here, and the way it's set up for me to fully know them.”

That includes the more than 100 enlisted ground crew who travel with each of the different service teams.

Preventive Care for Aviators

Preventive care has become more prominent for the teams and for the Department of Defense as a whole.

"That's really the razor's edge of what we're doing because we don't have back-up aviators," said U.S Air Force Capt. (Dr.) Travis Grindstaff, the flight surgeon for the Thunderbirds.

"The biggest part of that shift is finding ways to make sure people are taken care of before the problems are so big that team members are affected by it," Grindstaff said.

For example, some aviators may be only looking to their left, their right, or upwards at all times during the extremely close formations they fly. This creates muscle imbalances in the neck's ability to rotate in the opposite direction, Grindstaff said.

"Some of the training we've started adding is in trying to get those muscle imbalances corrected, because, over time, that can lead to injury."

"We'll fly in each position and see what are the demands on their body, how they're getting the injuries, how they're getting different imbalances,"Grindstaff explained. That information then gets relayed to athletic trainers.

The athletic trainers do measurements of body mobility, balance, and muscle imbalances. Combined with the observations made by the flight surgeons, "we're able to create a training plan and workout routine that can get pilots back to a normal state of health to prevent injuries," Grindstaff said.

The Thunderbirds record flights through the pilot's helmet heads-up display where they can hear them breathing and watch for any difficulties as the aviators reach gravitational force levels of seven to nine times the force of gravity (G forces).

The Blue Angels wear devices akin to the smart watches that capture sleep duration and level, heart rate, pulse oxygen levels, and body temperature. "It's just good knowledge for them to be more in tune with what's going on in their bodies," Borza said.

Mental Stresses and Team Responses

"Pilots are professional athletes; they are very good at what they do," Grindstaff said.

"Once the kickoff to the game has started, and the football is kicked off, they're in game mode, and for them, that would be when they get in the jet and turn the jet on," Grindstaff said, adding: "They're able to turn off a lot of the other outside things in their lives that could be affecting them during that flight."

However, the daily grind of travel, flight demonstrations, time zone changes, and lack of quality sleep create mental stresses.

The Thunderbirds provide chaplains once or twice a month for their flight teams to talk to if they wish. The Blue Angels have an embedded mental health professional who visits the squadron weekly.

The Thunderbird flight surgeon more specifically works with the first sergeant, an elite medic who has career experience and specialized training in talking to people about their problems to figure out how to help them, Grindstaff said.

"The first sergeant is very much a preventative, mental health person who is trained to help people keep their lives in order and in check," Grindstaff said.

"It takes people with the right personalities and the right motivations to do it, because you're basically signing up just to take care of people and their problems in order to help them perform. So, that could be any time of day, any day of the year," Grindstaff explained.

When little issues build "up to the boiling point, that's what really puts people in danger of having an accident or hurting themselves," he added.