rss_2.0Journal of the Australasian Society of Aerospace Medicine FeedSciendo RSS Feed for Journal of the Australasian Society of Aerospace Medicine of the Australasian Society of Aerospace Medicine Feed IN AVIATION MEDICINE<abstract><title style='display:none'>ABSTRACT</title><p>This paper will examine the impacts of obesity in aviation medicine. The World Health Organisation (WHO) has described the problems of obesity and being overweight as one of the greatest public health challenges of the 21<sup>st</sup> century (<xref ref-type="bibr" rid="j_asam-2020-001_ref_001">1</xref>) and this will certainly lead to increasing numbers of obese aviators (or potential aviators) presenting for medical certification. These people may not realise the impact their increased weight could have on their flying career and is often going to be an incidental finding in their examination rather than the specific problem they present with. This leads to the question for the medical examiner, does being overweight/obese matter in aviation and how might it increase a person’s risk of incapacitation in the cockpit?</p></abstract>ARTICLEtrue THROMBOEMBOLISM<abstract><title style='display:none'>ABSTRACT</title><p>Venous thromboembolism (VTE) is the condition in which blood clots form within the venous circulatory system, and consist of DVT (deep vein thrombosis) and PEs (Pulmonary emboli).</p><p>It is a common condition, with an estimated life-time risk of 8% and an annual incidence of 0.84-1 per 1000 population<sup><xref ref-type="bibr" rid="j_asam-2020-005_ref_001">1</xref></sup>, <sup><xref ref-type="bibr" rid="j_asam-2020-005_ref_002">2</xref></sup> and represents a significant economic burden: within Australia the annual estimated cost in 2018 being $1.72 billion AUD<sup><xref ref-type="bibr" rid="j_asam-2020-005_ref_003">3</xref></sup>.</p><p>The condition is considered aeromedically significant for both aircrew and passengers; diagnosis and treatment may have implications on an aviators medical certificate and the general public are often concerned about developing “economy class syndrome”.</p><p>This paper reviews the pathophysiology of VTE, the relationship between VTE and its treatment in the aviation environment. It also reviews some of the international aeromedical regulatory guidelines and provides a suggested approach to certification in case of VTE.</p></abstract>ARTICLEtrue LESSONS OF THE FIRST HUMAN VERTICAL ROCKET FLIGHT<abstract><title style='display:none'>ABSTRACT</title><p>This paper examines the historic but tragic first human vertical rocket flight which took place in south-western Germany on 1 March 1945. The primary lesson learned from the flight was that, as a result of the combination of psychological and physiological stresses, a human pilot could not be expected to fly a vertically launched rocket manually. An autopilot would be essential for the guidance of the Natter rocket interceptor up to its operational altitude. No further human vertical rocket flights took place until 1961 when Major Yuri Gagarin was launched into orbit. In early April 1945 a fully operational Natter flew successfully into the lower stratosphere under the control of a three-axis autopilot and crewed with a dummy pilot. Both dummy pilot and rear fuselage were recovered successfully under separate parachutes. In less than a year the engineers and scientists in collaboration with aviation physicians and physiologists at research institutions across Germany had laid down the basic principles which still apply to human rocket flight today.</p></abstract>ARTICLEtrue OF COVID-19 AEROMEDICAL RETRIEVAL: LESSONS LEARNT FROM CONDUCTING AEROMEDICAL TRANSFERS DURING A PANDEMIC<abstract><title style='display:none'>ABSTRACT</title><p>The COVID-19 pandemic has presented a unique and challenging environment for aeromedical organisations. We present lessons learnt during the development and implementation of our operational processes and procedures at The Royal Flying Doctor Service (RFDS) Western Operations for the transfer of suspected COVID-19 patients. To date, we have conducted 105 such fixed-wing transfers. The unique geography and health care system of Western Australia mandates that long-range, fixed-wing transfers are often required to centralised tertiary care. These lessons learnt provide a framework for the essential logistical, equipment and human factor considerations for developing an effective system. The translation of predominantly hospital-centric protocols into the aviation environment requires careful forethought, effective leadership and teamwork. Conducting COVID-19 suspected aeromedical retrievals significantly impacts all aeromedical retrieval operations and aeromedical personnel that should be realised by an aeromedical organisation.</p></abstract>ARTICLEtrue HOURS OF AUSTRALIAN COMMERCIAL PILOTS AND RISK OF CUTANEOUS MELANOMA<abstract><title style='display:none'>ABSTRACT</title><sec id="j_asam-2019-008_s_001"><title style='display:none'>Aim</title><p>To compare occupational flying hours (a surrogate for occupational exposure to radiation) of commercial pilots subsequently diagnosed with melanoma, with those without melanoma.</p></sec><sec id="j_asam-2019-008_s_002"><title style='display:none'>Methods</title><p>Nested case-control study of de-identified male commercial pilots in Australia 2011-2016, ascertained through the Civil Aviation Safety Authority (CASA). Cases were pilots diagnosed with melanoma 2011-2016; controls were randomly-selected pilots age-matched 1:2 with invasive cases. Total flying hours and hours flown in the last 6 months in 2011, date of birth and state of residence were also obtained. We estimated the association between total flying hours (in tertile groups), and melanoma by odds ratios adjusted for age and state (ORs<sub>adj</sub>; 95% confidence intervals (CIs)).</p></sec><sec id="j_asam-2019-008_s_003"><title style='display:none'>Results</title><p>During 2011-2016, 51 pilots developed invasive melanoma and 63, in situ (mean ages 47 and 49 years, respectively). Their median cumulative flying hours in 2011 were 6,108 and 6,900 respectively, compared with 7,500 for 102 control pilots (mean age 48.6). Risk of invasive melanoma did not increase per 1000 total hours flown (OR<sub>adj</sub>=1.00) nor did risk increase in pilots with highest vs lowest total flying hours (OR<sub>adj</sub>=1.18, 95% CI 0.44-3.15). Total flying hours were inversely associated with invasive melanoma development in pilots aged &lt; 50 (OR<sub>adj</sub>=0.37, not significant), and not associated with melanoma on exposed sites. Recent flying hours were not associated with melanoma. Results were unchanged with inclusion of in situ cases.</p></sec><sec id="j_asam-2019-008_s_004"><title style='display:none'>Conclusion</title><p>Risk of melanoma in Australian commercial pilots is unrelated to cumulative or recent occupational exposure to radiation as indicated by total and recent flying hours.</p></sec></abstract>ARTICLEtrue TO MARS: RADIATION SAFETY OR RADIATION DISASTER? SPACE TRANSIT AND MARS RADIATION EXPOSURE RISKS – THE POTENTIAL SHIELDING EFFECT OF AN INTRAVEHICULAR GRAPHENE SPACE SUIT AND A STORM SHELTER DURING SPACE TRAVEL<abstract><title style='display:none'>ABSTRACT</title><sec id="j_asam-2019-001_s_001"><title style='display:none'>Aim</title><p>The purpose of this research was to employ radiobiological as well as physics principles to investigate materials for an intravehicular spacesuit and a “storm shelter” that might minimize radiation exposure to astronauts during a mission to Mars.</p></sec><sec id="j_asam-2019-001_s_002"><title style='display:none'>Methods</title><p>NASA’s OLTARIS space radiation modelling tool was used to investigate thirty-two potential shielding materials. Radiation exposure was estimated during a return transit to Mars of 360 days duration. We assessed each shielding material by its ability to decrease effective radiation dose received by a computerized phantom during the constant galactic cosmic radiation (GCR) and a single solar particle event (SPE). For the “storm shelter” a large liquid fuel tank was modelled adjacent to the phantom during a SPE.</p></sec><sec id="j_asam-2019-001_s_003"><title style='display:none'>Results</title><p>At standard conditions, graphene appeared to be a promising shielding material when comparing other materials including polyethylene and lithium. The shielding efficacy became comparable to polyethylene but inferior to lithium when materials were normalised to 10g/cm2, 20g/cm2 and 30g/cm2. The graphene around the phantom reduced effective dose from GCR compared with an unshielded transit by 34% (162mSv/yr vs 213.3mSv/yr). A “storm shelter” using a liquid fuel tank was positioned to create a barrier adjacent to the astronauts. The liquid barrier reduced effective dose by 98.8% (44mSv vs 3614mSv). Other mitigation strategies were deduced and divided into launch, transit and habitation considerations.</p></sec><sec id="j_asam-2019-001_s_004"><title style='display:none'>Conclusion</title><p>A graphene based intravehicular suit could decrease astronaut exposure to harmful radiation during transit to Mars. A storm shelter using fuel as a barrier also decreased radiation dose during a solar particle event.</p></sec></abstract>ARTICLEtrue (Doctor) Lana Jennifer Lynnelle Davies ELEVATED RISK OF MELANOMA AMONG PILOTS – COULD UVA BE IMPLICATED?<abstract><title style='display:none'>ABSTRACT</title><p>A number of studies indicate that pilots have approximately double the risk of developing melanoma compared to the general population. It is not clear which aetiological factors underpin this increase in risk. Possibilities include leisure time sun exposure, cosmic radiation, circadian rhythm disruption and UV exposures in the cockpit. This brief review presents some of the key research on exposures of interest, with a focus on UV radiation. It highlights the need for further research assessing UVA levels within the cockpit of flying aircraft, given the possibility that glass windscreens may not be particularly effective at blocking UVA.</p></abstract>ARTICLEtrue IN ANAESTHESIA DURING SPACE EXPLORATION MISSIONS<abstract><title style='display:none'>ABSTRACT</title><sec id="j_asam-2019-002_s_001"><title style='display:none'>Aim</title><p>NASA and private spacefaring companies plan to send exploration missions to mars within the next two decades. The environment of space, duration of the mission, distance from earth, and limited available resources present significant challenges for the provision of health care. It has been estimated that at least one medical emergency is likely to occur during such a mission, which may necessitate surgical treatment, and therefore anaesthesia. The provision of safe anaesthesia faces challenges arising from physiological adaptations to space, difficulty achieving and maintaining personnel expertise, possible pharmacological changes in anaesthetic agents used, limited consumable shelf-life and provision of intravenous fluids and blood products. In this review article we discuss these challenges in the context of a hypothetical case.</p></sec></abstract>ARTICLEtrue OF DEFIBRILLATION IN FLIGHT<abstract><title style='display:none'>ABSTRACT</title><sec id="j_asam-2019-006_s_001"><title style='display:none'>Aim</title><p>Defibrillation is a critical aspect of advanced life support, but the inherent risks in the procedure are increased when used during an aeromedical retrieval. The dangers of defibrillation in flight can be divided in to fire, electrical, avionic interference and physical carriage and packaging. A limited body of evidence exists concerning defibrillation in flight, in part, due to under-reporting. Changes in incident reporting, increased team based simulation training and awareness of the dangers of defibrillation should allow aeromedical teams to defibrillate patients safely and expediently.</p></sec></abstract>ARTICLEtrue PLACE OF PSYCHOMETRIC TESTING IN PILOT SELECTION<abstract><title style='display:none'>ABSTRACT</title><sec id="j_asam-2019-003_s_001"><title style='display:none'>Aim</title><p>Pilot training has always been a relatively expensive undertaking. So attempts to control these costs by predicting the likelihood of success or failure is a constant that is almost as old as aviation itself. Incorporation of Psychometric testing was made to pilot selection in the years between the first and second world wars. Despite the many changes that have occurred in this area, psychometric testing continues to feature in modern systems of pilot aptitude testing. This paper reviews some of the history of psychometric testing in pilot selection.</p></sec></abstract>ARTICLEtrue AND THE NEED FOR CARDIOVASCULAR RISK ASSESSMENT IN AVIATION<abstract><title style='display:none'>ABSTRACT</title><p>Obesity, the disease of the twenty-first century, has a range of serious consequences to health. These are related in part to abnormal glucose levels, resulting in inflammatory and atherogenic response, hypertension and abnormal lipid profile. This increases the risk of cardiovascular disease significantly besides developing diabetes later. Hyperglycaemia is diagnosed with impaired fasting glucose and/or impaired glucose tolerance or elevated glycated haemoglobin (HbA1c). The Royal Australian College of General Practitioners (RACGP) guidelines for diagnosis using oral glucose tolerance test (or HbA1c) recognise the importance of extending diagnosis beyond simply identifying diabetes. This is relevant in view of the risk of composite cardiovascular events, coronary heart disease, stroke, and all-cause mortality associated with abnormal blood glucose. Since the pilot population mirrors this morbidity, the aviation regulator has an obligation to consider the impact in terms of aviation safety. Furthermore, although primary care literature predominantly focusses on the importance of diagnosing diabetes, from a regulator’s perspective there are incapacitation risks originating outside that narrow diagnosis. They arise once the control of glucose has begun to deteriorate. This article considers the regulatory importance of pilots and controllers who present with hyperglycaemia, or what is sometimes termed “prediabetes”. This includes the evidence for the risk assessment to help minimise the likelihood of an adverse event due to atherosclerotic cardiovascular disease among those holding aviation medical certificates, in turn promoting aviation safety.</p></abstract>ARTICLEtrue WITH RECERTIFICATION (OF EAGLE’S SYNDROME) – WHO HAS THE TIME?<abstract><title style='display:none'>Abstract</title><p>A 50 year old male airline transport pilot licence (ATPL) pilot had been on a CASA audit requirement (CAR) for Non-Hodgkin’s Lymphoma since 2010. As part of his ongoing haematological medical surveillance a neck, chest, abdomen and pelvis CT scan in 2014 reported an “incidental” abnormality in his neck. Perusal of the first several articles raised from a “Google” search of the abnormality linked it with possible stroke, carotid dissection and death. Would CASA now cancel or suspend this pilot’s medical? Could this pilot become a casualty of VOMIT (victim of modern imaging technology<sup><xref ref-type="bibr" rid="j_asam-2015-003_ref_001">1</xref></sup>)? If DAMEs were delegated the responsibility to be able to issue Class 1 certificates, how many would spend the time (and charge commensurately) to perform a more detailed literature search and critical appraisal to support an aero-medical decision one way or the other? This paper discusses the process and time taken to aero-medically assess a pilot who had an incidental radiological diagnosis of a rare condition.</p></abstract>ARTICLEtrue VISUAL DISTURBANCE IN AN AIRCREWMAN – INVESTIGATION AND DIFFERENTIAL DIAGNOSIS<abstract><title style='display:none'>Abstract</title><p>This case report is about an Australian Army aircrewman who developed a sudden incapacitating visual disturbance. The case study explores the investigation pathway, differential diagnoses and the aeromedical implications. Although not all cases of visual disturbance have an underlying ophthalmological or neurological cause, and in fact might be quite benign, there is a possibility of a serious pathology of vascular or ischaemic aetiology affecting fitness to fly and recertification. History, signs, symptoms and investigation results are discussed in the context of the aeromedical handling of the case, and eventual return to flying duties after a restriction period. Unusual facets and possible contributors in this case study are the exposure to noxious fumes and vaporised nicotine (e-cigarettes). The implications of the latter are still unexplored in the aviation environment.</p></abstract>ARTICLEtrue CASE OF CEREBRAL ANEURYSM IN FAST JET AIRCREW<abstract><title style='display:none'>Abstract</title><p>An asymptomatic 33 year old male Air Combat Officer was recommended to have a CT cerebral angiogram, based on a family history of a vascular anomaly. A 1-2mm aneurysm located in the cavernous portion of the internal carotid artery was discovered. Neurosurgical advice was obtained which indicated that the risk of haemorrhage from this aneurysm in this location is ‘practically zero’, and that there is no indication for any intervention. The fast jet environment does impose significant stress on the individual however, and aeromedical decision making is often more difficult when, despite the depth of evidence available, the risks remain unquantifiable. This paper discusses the literature review conducted, the risk factors for rupture and risks of rupture, precipitating events, treatment, monitoring, and advice for the affected individual. The aeromedical disposition of the affected individual is outlined.</p></abstract>ARTICLEtrue IN MEDICAL RETRIEVAL – CHALLENGES AND FUTURE PRACTICE<abstract><title style='display:none'>ABSTRACT</title><p>Anaesthetic Awareness is the recall of events that occur during sedation and is a serious complication thought to occur in 0.1 to 0.2 % of the general surgical population. Sedation is an important tool used in medical retrieval, however its use in the aerospace environment is unique in its challenges for clinicians. Many of the patients carry risk factors for anaesthetic awareness and the mode of anaesthesia appropriate for the aerospace environment, total intravenous anaesthesia, also carries a higher risk compared to other methods. In addition the aerospace environment has other challenges not specific to sedation including noise distractions and the physiological effects of high altitude on patients which can impact on the ability to provide adequate sedation. Given all this, patients receiving sedation during medical retrieval would seem to be at a higher risk of anaesthetic awareness than many of their counterparts on the ground. For many high risk patients in hospitals technology such as brain monitoring has been shown to be effective in reducing awareness. Therefore as patients in the air are as likely, if not more likely to be at risk of awareness the use of this aid in medical retrieval is raised for consideration. However this technology will only ever be an adjunct to clinical expertise and an overall understanding of the flight environment and its challenges will allow for best patient care possible and the reduction of awareness during sedation.</p></abstract>ARTICLEtrue STROKE IN AN AIRLINE TRANSPORT PILOT<abstract><title style='display:none'>Abstract</title><p>This case presentation discusses an airline captain who suffered a cerebrovascular event. Despite extensive investigation, no underlying cause or contributing factors could be identified. He went on to make a full recovery from his stroke, and after two years applied for renewal of his medical certificate. This presentation discusses the aeromedical certification process, including the restrictions and health surveillance measures put in place once he was recertified.</p></abstract>ARTICLEtrue FOR TRAVELLING WITH PASSENGERS WITH A DISABILITY