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Journal & Issues

Volume 12 (2021): Issue 1 (January 2021)

Volume 11 (2020): Issue 1 (January 2020)

Volume 10 (2018): Issue 1 (June 2018)

Journal Details
Format
Journal
eISSN
2639-6416
First Published
01 Apr 2004
Publication timeframe
1 time per year
Languages
English

Search

Volume 10 (2018): Issue 1 (June 2018)

Journal Details
Format
Journal
eISSN
2639-6416
First Published
01 Apr 2004
Publication timeframe
1 time per year
Languages
English

Search

20 Articles
Open Access

CHALLENGES WITH AEROMEDICAL CERTIFICATION AFTER A ‘FUNNY TURN’

Published Online: 27 Jun 2018
Page range: 4 - 5

Abstract

Abstract

Temporary loss of consciousness is unnerving for anyone, however the consequences in some professions can be devastating. This paper discusses the case of an Airline Transport Pilot License pilot who experienced a ‘funny turn’ resulting in loss of consciousness, with reference to the aeromedical decision-making process and a literature review.

Open Access

COLOUR VISION TESTING: SCIENCE OR JUST BAD HABITS?

Published Online: 27 Jun 2018
Page range: 6 - 8

Abstract

Abstract

Colour vision testing has been and remains a controversial subject in aviation. Despite this, colour testing methods have remained essentially unchanged in many years. This presentation reviews the relevance of colour testing methodologies to modern aviation and presents a review of recent literature relating to colour vision and how it is affected by various physiological states and changes occurring with various pathological conditions; and the relevance of these discoveries to current and future aeromedical certification processes.

Open Access

CHALLENGES WITH RECERTIFICATION (OF EAGLE’S SYNDROME) – WHO HAS THE TIME?

Published Online: 27 Jun 2018
Page range: 9 - 10

Abstract

Abstract

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 technology1)? 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.

Open Access

CRYPTOGENIC STROKE IN AN AIRLINE TRANSPORT PILOT

Published Online: 27 Jun 2018
Page range: 11 - 12

Abstract

Abstract

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.

Open Access

SUDDEN VISUAL DISTURBANCE IN AN AIRCREWMAN – INVESTIGATION AND DIFFERENTIAL DIAGNOSIS

Published Online: 27 Jun 2018
Page range: 13 - 15

Abstract

Abstract

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.

Open Access

A CASE OF CEREBRAL ANEURYSM IN FAST JET AIRCREW

Published Online: 27 Jun 2018
Page range: 16 - 18

Abstract

Abstract

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.

Open Access

SUBARACHNOID HAEMORRHAGE AND INTRACRANIAL ANEURYSM IN A MILITARY AVIATOR: FACTORS DETERMINING AEROMEDICAL DISPOSITION

Published Online: 27 Jun 2018
Page range: 19 - 21

Abstract

Abstract

A Royal Australian Navy aviator was diagnosed with a subarachnoid haemorrhage after sudden onset of occipital headache, the result of a small aneurysm of the left posterior inferior cerebellar artery. The aneurysm was surgically wrapped and clipped through a posterior fossa craniotomy, and the patient made a full and uncomplicated recovery. Except in rare cases, subarachnoid haemorrahge and intracranial aneurysms are generally considered to be disqualifying for military aviation. Even with good recovery of neurological functioning, complications such as seizures, risk of rebleeding, and de novo occurrence of other aneurysms are all significant concerns due to the risk of sudden incapacitation. This paper will examine the aeromedical factors particular to this case that influenced a favorable aeromedical decision-making outcome.

Open Access

GUIDELINES FOR TRAVELLING WITH PASSENGERS WITH A DISABILITY

Published Online: 27 Jun 2018
Page range: 22 - 25

Abstract

Open Access

ESSENTIAL TRAVEL MEDICINE. ZUCKERMAN J, BRUNETTE G, LEGGAT P

Published Online: 27 Jun 2018
Page range: 26 - 26

Abstract

Open Access

THE FIELD GUIDE TO UNDERSTANDING HUMAN ERROR. 3RD ED. SIDNEY DEKKER.

Published Online: 27 Jun 2018
Page range: 27 - 27

Abstract

Open Access

HIGH G FLIGHT: PHYSIOLOGICAL EFFECTS AND COUNTER-MEASURES. DAVID G NEWMAN.

Published Online: 27 Jun 2018
Page range: 27 - 27

Abstract

Open Access

PATIENT SAFETY CULTURE: THEORY, METHODS, AND APPLICATION. PATRICK WATERSON (ED).

Published Online: 27 Jun 2018
Page range: 28 - 28

Abstract

Open Access

THE LEADING EDGE: INNOVATION, TECHNOLOGY, AND PEOPLE IN AUSTRALIA’S ROYAL FLYING DOCTOR SERVICE. BY STEPHEN LANGFORD.

Published Online: 27 Jun 2018
Page range: 28 - 28

Abstract

Open Access

WHITE MATTER HYPERINTENSITIES IN ASTRONAUTS: POSSIBLE IMPLICATIONS FOR FUTURE SPACE OPERATIONS

Published Online: 20 Dec 2018
Page range: 1 - 5

Abstract

Open Access

PLEOMORPHIC SARCOMA IN A PILOT

Published Online: 20 Dec 2018
Page range: 1 - 3

Abstract

ABSTRACT

Sarcomas are rare malignant soft tissue tumours. This case report outlines a 45 year old pilot, presenting with a non-tender mass in his left medial thigh, subsequently diagnosed with a pleomorphic sarcoma. His management consisted of radiotherapy and surgical removal. Grading was considered FNCLCC grade 3 and there were no metastases. Surgery was followed by a structured rehabilitation program. The paper discusses aeromedical considerations for return to flying duties, regarding the natural history of the condition and recurrence risk as well as the operational mitigations to flight incapacitation risk.

Open Access

SEDATION IN MEDICAL RETRIEVAL – CHALLENGES AND FUTURE PRACTICE

Published Online: 20 Dec 2018
Page range: 1 - 4

Abstract

ABSTRACT

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.

Open Access

THE MIND CRAFT PROJECT – HEALTHY MINDS, HEALTHY PILOTS: A LITERATURE REVIEW ON MINDFULNESS MEDITATION PROGRAMS FOR COMMERCIAL AIRLINES PILOTS

Published Online: 20 Dec 2018
Page range: 1 - 6

Abstract

ABSTRACT

Following the 2015 Germanwings crash, aviation agencies around the world have drawn up new policies relating to management and monitoring of the mental health of pilots. The Mind Craft Project is a literature review that provides an overview of current practices in mindfulness meditation programs in the aviation industry and propose new mind-body programs for pilots for implementation. Mental health is an important issue for the aviation industry as it directly impacts on the wellbeing of pilots. Moreover, a pilot’s mental health can directly affect the safety of passengers and needs to be treated as a public safety issue.

This literature review has demonstrated that the implementation of a mindfulness training program could be a feasible and acceptable method for implementation in a commercial aviation environment to help ease stress, increase concentration and assist in mental health risk management. A few potential limitations to mindfulness interventions were uncovered such as the effectiveness of mindfulness for suicidal tendencies, and cultural behaviors in regards to mental health issues in the aviation industry. However, further research needed as there has been little research conducted on mind-body programs for commercial airline pilots. Recommendations were provided for a follow-up long term study.

Open Access

SIMULATOR SICKNESS IN AIRFOX® DISORIENTATION SIMULATOR

Published Online: 20 Dec 2018
Page range: 1 - 5

Abstract

ABSTRACT

Use of flight simulators has consistently increased over the years, a phenomenon known as simulator sickness upon simulator exposure (SE) has been of concern in aircrew. This Simulator Sickness (SS) has been largely considered to be a persistent limiting factor in continuing flying training. It is classically characterized by nausea, dizziness, postural instability, fatigue and general malaise. On cessation of SE, few symptoms may persist up to several hours and these may have an adverse impact on post-simulator training activities. AirFox® DISO, is widely used in Indian Air Force (IAF) to train aircrew on spatial disorientation. The paper presents a study carried out in IAF on the aircrew reporting to IAM, IAF Bangalore for training. The results are presented based on the Simulator Sickness Questionnaire (SSQ) administered to the aircrew.

Open Access

Editorial

Published Online: 20 Dec 2018
Page range: 1 - 1

Abstract

Open Access

PREDIABETES AND THE NEED FOR CARDIOVASCULAR RISK ASSESSMENT IN AVIATION

Published Online: 20 Dec 2018
Page range: 1 - 7

Abstract

ABSTRACT

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.

20 Articles
Open Access

CHALLENGES WITH AEROMEDICAL CERTIFICATION AFTER A ‘FUNNY TURN’

Published Online: 27 Jun 2018
Page range: 4 - 5

Abstract

Abstract

Temporary loss of consciousness is unnerving for anyone, however the consequences in some professions can be devastating. This paper discusses the case of an Airline Transport Pilot License pilot who experienced a ‘funny turn’ resulting in loss of consciousness, with reference to the aeromedical decision-making process and a literature review.

Open Access

COLOUR VISION TESTING: SCIENCE OR JUST BAD HABITS?

Published Online: 27 Jun 2018
Page range: 6 - 8

Abstract

Abstract

Colour vision testing has been and remains a controversial subject in aviation. Despite this, colour testing methods have remained essentially unchanged in many years. This presentation reviews the relevance of colour testing methodologies to modern aviation and presents a review of recent literature relating to colour vision and how it is affected by various physiological states and changes occurring with various pathological conditions; and the relevance of these discoveries to current and future aeromedical certification processes.

Open Access

CHALLENGES WITH RECERTIFICATION (OF EAGLE’S SYNDROME) – WHO HAS THE TIME?

Published Online: 27 Jun 2018
Page range: 9 - 10

Abstract

Abstract

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 technology1)? 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.

Open Access

CRYPTOGENIC STROKE IN AN AIRLINE TRANSPORT PILOT

Published Online: 27 Jun 2018
Page range: 11 - 12

Abstract

Abstract

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.

Open Access

SUDDEN VISUAL DISTURBANCE IN AN AIRCREWMAN – INVESTIGATION AND DIFFERENTIAL DIAGNOSIS

Published Online: 27 Jun 2018
Page range: 13 - 15

Abstract

Abstract

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.

Open Access

A CASE OF CEREBRAL ANEURYSM IN FAST JET AIRCREW

Published Online: 27 Jun 2018
Page range: 16 - 18

Abstract

Abstract

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.

Open Access

SUBARACHNOID HAEMORRHAGE AND INTRACRANIAL ANEURYSM IN A MILITARY AVIATOR: FACTORS DETERMINING AEROMEDICAL DISPOSITION

Published Online: 27 Jun 2018
Page range: 19 - 21

Abstract

Abstract

A Royal Australian Navy aviator was diagnosed with a subarachnoid haemorrhage after sudden onset of occipital headache, the result of a small aneurysm of the left posterior inferior cerebellar artery. The aneurysm was surgically wrapped and clipped through a posterior fossa craniotomy, and the patient made a full and uncomplicated recovery. Except in rare cases, subarachnoid haemorrahge and intracranial aneurysms are generally considered to be disqualifying for military aviation. Even with good recovery of neurological functioning, complications such as seizures, risk of rebleeding, and de novo occurrence of other aneurysms are all significant concerns due to the risk of sudden incapacitation. This paper will examine the aeromedical factors particular to this case that influenced a favorable aeromedical decision-making outcome.

Open Access

GUIDELINES FOR TRAVELLING WITH PASSENGERS WITH A DISABILITY

Published Online: 27 Jun 2018
Page range: 22 - 25

Abstract

Open Access

ESSENTIAL TRAVEL MEDICINE. ZUCKERMAN J, BRUNETTE G, LEGGAT P

Published Online: 27 Jun 2018
Page range: 26 - 26

Abstract

Open Access

THE FIELD GUIDE TO UNDERSTANDING HUMAN ERROR. 3RD ED. SIDNEY DEKKER.

Published Online: 27 Jun 2018
Page range: 27 - 27

Abstract

Open Access

HIGH G FLIGHT: PHYSIOLOGICAL EFFECTS AND COUNTER-MEASURES. DAVID G NEWMAN.

Published Online: 27 Jun 2018
Page range: 27 - 27

Abstract

Open Access

PATIENT SAFETY CULTURE: THEORY, METHODS, AND APPLICATION. PATRICK WATERSON (ED).

Published Online: 27 Jun 2018
Page range: 28 - 28

Abstract

Open Access

THE LEADING EDGE: INNOVATION, TECHNOLOGY, AND PEOPLE IN AUSTRALIA’S ROYAL FLYING DOCTOR SERVICE. BY STEPHEN LANGFORD.

Published Online: 27 Jun 2018
Page range: 28 - 28

Abstract

Open Access

WHITE MATTER HYPERINTENSITIES IN ASTRONAUTS: POSSIBLE IMPLICATIONS FOR FUTURE SPACE OPERATIONS

Published Online: 20 Dec 2018
Page range: 1 - 5

Abstract

Open Access

PLEOMORPHIC SARCOMA IN A PILOT

Published Online: 20 Dec 2018
Page range: 1 - 3

Abstract

ABSTRACT

Sarcomas are rare malignant soft tissue tumours. This case report outlines a 45 year old pilot, presenting with a non-tender mass in his left medial thigh, subsequently diagnosed with a pleomorphic sarcoma. His management consisted of radiotherapy and surgical removal. Grading was considered FNCLCC grade 3 and there were no metastases. Surgery was followed by a structured rehabilitation program. The paper discusses aeromedical considerations for return to flying duties, regarding the natural history of the condition and recurrence risk as well as the operational mitigations to flight incapacitation risk.

Open Access

SEDATION IN MEDICAL RETRIEVAL – CHALLENGES AND FUTURE PRACTICE

Published Online: 20 Dec 2018
Page range: 1 - 4

Abstract

ABSTRACT

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.

Open Access

THE MIND CRAFT PROJECT – HEALTHY MINDS, HEALTHY PILOTS: A LITERATURE REVIEW ON MINDFULNESS MEDITATION PROGRAMS FOR COMMERCIAL AIRLINES PILOTS

Published Online: 20 Dec 2018
Page range: 1 - 6

Abstract

ABSTRACT

Following the 2015 Germanwings crash, aviation agencies around the world have drawn up new policies relating to management and monitoring of the mental health of pilots. The Mind Craft Project is a literature review that provides an overview of current practices in mindfulness meditation programs in the aviation industry and propose new mind-body programs for pilots for implementation. Mental health is an important issue for the aviation industry as it directly impacts on the wellbeing of pilots. Moreover, a pilot’s mental health can directly affect the safety of passengers and needs to be treated as a public safety issue.

This literature review has demonstrated that the implementation of a mindfulness training program could be a feasible and acceptable method for implementation in a commercial aviation environment to help ease stress, increase concentration and assist in mental health risk management. A few potential limitations to mindfulness interventions were uncovered such as the effectiveness of mindfulness for suicidal tendencies, and cultural behaviors in regards to mental health issues in the aviation industry. However, further research needed as there has been little research conducted on mind-body programs for commercial airline pilots. Recommendations were provided for a follow-up long term study.

Open Access

SIMULATOR SICKNESS IN AIRFOX® DISORIENTATION SIMULATOR

Published Online: 20 Dec 2018
Page range: 1 - 5

Abstract

ABSTRACT

Use of flight simulators has consistently increased over the years, a phenomenon known as simulator sickness upon simulator exposure (SE) has been of concern in aircrew. This Simulator Sickness (SS) has been largely considered to be a persistent limiting factor in continuing flying training. It is classically characterized by nausea, dizziness, postural instability, fatigue and general malaise. On cessation of SE, few symptoms may persist up to several hours and these may have an adverse impact on post-simulator training activities. AirFox® DISO, is widely used in Indian Air Force (IAF) to train aircrew on spatial disorientation. The paper presents a study carried out in IAF on the aircrew reporting to IAM, IAF Bangalore for training. The results are presented based on the Simulator Sickness Questionnaire (SSQ) administered to the aircrew.

Open Access

Editorial

Published Online: 20 Dec 2018
Page range: 1 - 1

Abstract

Open Access

PREDIABETES AND THE NEED FOR CARDIOVASCULAR RISK ASSESSMENT IN AVIATION

Published Online: 20 Dec 2018
Page range: 1 - 7

Abstract

ABSTRACT

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.

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