Have you ever wondered who deems a pilot fit to fly a plane, and how? Dr. Claire Allanach, a specialist in Aviation Medicine as well as an Obstetrician and Gynaecologist at Pindara Private Hospital, explains the process. Aviation medicine is the medical specialty concerned with the interaction between the aviation environment and human physiology, psychology and pathology. Australia has a network of approximately 700 Designated Aviation Medical Examiners (DAMEs) who are practitioners of aviation medicine, although most are also qualified in other specialties or general practice. DAMEs are required to have a post graduate qualification in aviation medicine to be a member of the Australasian Society of Aerospace Medicine and to undertake appropriate continuing medical education. They are accountable to the Australian Civil Aviation Safety Authority (CASA) and are authorised to perform medical examinations and issue aviation medical certificates, which are required by pilots and air traffic controllers in order to be able to exercise the privileges of their licence. THERE ARE THREE TYPES OF MEDICAL CERTIFICATE: CLASS 1 - Commercial or Air Transport Pilot Licence Valid for one year (or six months if over age 60) CLASS 2 - Private Pilot Licence Valid for four years (or two years if over age 40) CLASS 3 - Air Traffic Controller (ATC) Valid for two years The aviation medical evaluates the functional ability to conduct aviation tasks, the effect of a medical condition on aviation, the effect of aviation on a medical condition and the stability of the condition for the period of the certification. Pilots and ATCs may need to undergo other tests in addition to the standard medical examination, depending on their age and class of licence applied for. These tests may include an ECG, audiogram, blood tests for fasting lipids and glucose, calculation of cardiovascular risk and an eye examination by a CASA Designated Aviation Ophthalmologist. Traditional bias has been to physical disease, although many high profile accidents have highlighted the importance of human factors in aviation. The study of human factors is about understanding human behaviour and performance, and optimising the relationship between people and the environment in which they work in order to improve safety and performance. There are similarities in this regard, between the medical industry and the aviation industry, and medical practitioners have been able to draw some valuable lessons from airline industry safety practices. Checklists, structured communication techniques, pre-event briefings, error reporting and simulator training are just a few of the aviation safety methods that have been implemented into the medical environment. There are very few medical conditions that are an absolute contraindication for aviation certification. Exceptions include epilepsy and psychiatric conditions such as bipolar disorder and schizophrenia. Similarly, there are few medications that pose an absolute contraindication to flying. Exceptions include insulin, narcotics and sedating medications. A ‘ground trial’ of one to two weeks is recommended when commencing new medications such as antihypertensives. Mental health in aviation is a major concern among airlines, regulators and passengers. This has become more prominent in recent times following high profile cases involving murder-suicide by commercial pilots, including the Germanwings flight 9525 in March 2015. In response to this incident, aviation authorities in Australia and many other countries implemented new regulations, which require the presence of two authorised personnel in the cockpit at all times. Serious psychological conditions involving sudden psychosis are rare and difficult to predict or screen for but more symptomatic conditions such as depression, anxiety, mania and substance abuse do show patterns that facilitate early detection, and are more likely to be identified on screening tests. Increased resources are also being channelled into educating pilots, their families and others in the aviation community on what to look for and how to report it, in a manner that avoids retribution and social stigma for the pilot. For example, depression is common and some conditions associated with aviation can exacerbate the symptoms of people suffering from anxiety and depression e.g. fatigue, sleep deprivation, time zone changes, social isolation and irregular access to medical care and surveillance. Depressive episodes during aviation can lead to either overt or subtle incapacitation. Well-managed depression is compatible with medical certification and CASA makes aeromedical decisions on a case by case basis. Every pilot has an obligation under the Civil Aviation Act to report any change in medical condition or the diagnosis of any previously unknown medical condition that may interfere with flight safety. Pregnancy falls into this category and must be reported. Even a ‘normal’ pregnancy results in changes in physical size, shape and agility as well as the potential for mood and cognitive changes. There are approximately 37,000 pilots and ATCs in Australia, of which only five percent are female. A medical certificate held by a pregnant woman is automatically suspended until the end of the 12th week of pregnancy, and from the end of the 30th week of pregnancy due to the increased risk of potentially incapacitating complications such as miscarriage and premature labour in the early and late periods of gestation respectively. Australia has an excellent record of aviation safety, which must remain the top priority for airlines and all operators involved. It is the role of CASA to ensure airlines as well as other aviation organisations are meeting the necessary requirements and continually working to enhance safety. pindaramagazine.com.au Pindara Magazine 23
Pindara Private Hospital Magazine - Issue Eight
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