<abstract><title style='display:none'>Abstract</title>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.</abstract>

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

<abstract><title style='display:none'>Abstract</title>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.</abstract>

CHALLENGES WITH AEROMEDICAL CERTIFICATION AFTER A ‘FUNNY TURN’

<abstract><title style='display:none'>ABSTRACT</title>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.</abstract>

CHALLENGES OF COVID-19 AEROMEDICAL RETRIEVAL: LESSONS LEARNT FROM CONDUCTING AEROMEDICAL TRANSFERS DURING A PANDEMIC

<abstract><title style='display:none'>ABSTRACT</title><sec id="j_asam-2019-003_s_001"><title style='display:none'>Aim</title>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.</sec></abstract>

THE PLACE OF PSYCHOMETRIC TESTING IN PILOT SELECTION

<abstract><title style='display:none'>ABSTRACT</title>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 21st 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?</abstract>

OBESITY IN AVIATION MEDICINE

<abstract><title style='display:none'>Abstract</title>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.</abstract>

SUDDEN VISUAL DISTURBANCE IN AN AIRCREWMAN – INVESTIGATION AND DIFFERENTIAL DIAGNOSIS

EDITORIAL

<abstract><title style='display:none'>ABSTRACT</title>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.</abstract>

FUNDAMENTAL LESSONS OF THE FIRST HUMAN VERTICAL ROCKET FLIGHT

<abstract><title style='display:none'>ABSTRACT</title>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).It is a common condition, with an estimated life-time risk of 8% and an annual incidence of 0.84-1 per 1000 population<xref ref-type="bibr" rid="j_asam-2020-005_ref_001">1</xref>, <xref ref-type="bibr" rid="j_asam-2020-005_ref_002">2</xref> and represents a significant economic burden: within Australia the annual estimated cost in 2018 being $1.72 billion AUD<xref ref-type="bibr" rid="j_asam-2020-005_ref_003">3</xref>.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”.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.</abstract>

VENOUS THROMBOEMBOLISM

<abstract><title style='display:none'>ABSTRACT</title><sec id="j_asam-2019-006_s_001"><title style='display:none'>Aim</title>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.</sec></abstract>

DANGERS OF DEFIBRILLATION IN FLIGHT

<abstract><title style='display:none'>ABSTRACT</title><sec id="j_asam-2019-002_s_001"><title style='display:none'>Aim</title>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.</sec></abstract>

CHALLENGES IN ANAESTHESIA DURING SPACE EXPLORATION MISSIONS

<abstract><title style='display:none'>ABSTRACT</title><sec id="j_asam-2019-008_s_001"><title style='display:none'>Aim</title>To compare occupational flying hours (a surrogate for occupational exposure to radiation) of commercial pilots subsequently diagnosed with melanoma, with those without melanoma.</sec><sec id="j_asam-2019-008_s_002"><title style='display:none'>Methods</title>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 (ORsadj; 95% confidence intervals (CIs)).</sec><sec id="j_asam-2019-008_s_003"><title style='display:none'>Results</title>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 (ORadj=1.00) nor did risk increase in pilots with highest vs lowest total flying hours (ORadj=1.18, 95% CI 0.44-3.15). Total flying hours were inversely associated with invasive melanoma development in pilots aged &lt; 50 (ORadj=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.</sec><sec id="j_asam-2019-008_s_004"><title style='display:none'>Conclusion</title>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.</sec></abstract>

FLYING HOURS OF AUSTRALIAN COMMERCIAL PILOTS AND RISK OF CUTANEOUS MELANOMA

<abstract><title style='display:none'>ABSTRACT</title>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.</abstract>

PREDIABETES AND THE NEED FOR CARDIOVASCULAR RISK ASSESSMENT IN AVIATION

<abstract><title style='display:none'>ABSTRACT</title>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.</abstract>

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

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Journal of the Australasian Society of Aerospace Medicine

The Journal of the Australasian Society of Aerospace Medicine [JASAM] is a peer reviewed, open access journal that publishes scientific papers related to aviation and space...

The Journal of the Australasian Society of Aerospace Medicine [JASAM] is a peer reviewed, open access journal that publishes scientific...