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ICAO Medical Briefing 2014 Dr. David Salisbury Director Medicine Civil Aviation.

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Presentation on theme: "ICAO Medical Briefing 2014 Dr. David Salisbury Director Medicine Civil Aviation."— Presentation transcript:

1 ICAO Medical Briefing 2014 Dr. David Salisbury Director Medicine Civil Aviation

2 Disclosure Information 85 th AsMA Annual Scientific Dr. David Salisbury I have the following financial relationships to disclose: Employee of: Transport Canada I will not discuss off-label use and/or investigational use in my presentation Facts are facts. Opinions are mine and not the official position of TC or the Government of Canada


4 Further Disclosures I’m a Canadian Board certified in Aerospace Medicine by Am. Brd. Of Preventive Medicine FRCPC in Public Health and Preventive Medicine 28 years in the CF as a flight surgeon, 5 years in Public Health as a Medical Officer of Health, 6 years at TC as Director Non-smoker, normotensive, minimal drinker who exercises hard 3 times a week and always wears his seatbelt. Immunized against most vaccine preventable diseases and all my first degree relatives have lived to 80+

5 Aerospace Medicine Branch of Preventive Medicine that deals with the clinical and preventive medical requirements of man in atmospheric flight and space

6 Approach to Aerospace Medicine AEROSPACE Normal Physiology Abnormal environment CLASSICAL Abnormal Physiology Normal environment

7 Aerospace and Regulatory Medicine Abnormal Physiology Abnormal environment

8 Source:

9 Aviation Regulatory Medicine Clinical Medicine Human Rights Aerospace Medicine Preventive Medicine

10 WW I Most Canadians flew with the Royal Flying Corps or The Royal Naval Air Service. Over 22,000 served. Canadian Air Force formed at end of war. RCAF given “Royal” designation Medical Standards applied by RFC Canada: “Perfect Vision Under 25 Hear a whisper at 20 Ft.” All MO’s from RAMC (Army)

11 Civil Aviation in Canada & the World Convention on International Civil Aviation Chicago 1944 Establishment of ICAO 1947 Standards & Recommended Practices (SARP) Annex 1 Personnel Licensing Medical Standards Canada Original Contracting State Canadian Aviation Regulations (CARs) CARs 404 & 424 (Medical Standards)

12 ICAO Annex 1 Annex 1 Chapter 1 ‘Medical Fitness’ All ICAO Contracting States must be in compliance How they achieve ‘compliance’ may differ New Manual of Civil Aviation Medicine 2012

13 TC Civil Aviation Medicine Established by ‘Order in Council’ 1946 " To provide medical advice & assistance in setting up physical standards for civil aviation personnel; To advise on all problems connected with the health of travelers by air". Civil Aviation Medicine Transport Canada Deputy Minister Safety & Security ADM Civil Aviation Director General Minister of Transport

14 Principal function - medical certification of aviation personnel Medical advisors to the Minister of Transport Custodians of confidential medical information Civil Aviation Medicine

15 Concern : The risk ofincapacitation Sudden Subtle During the validity period of the Medical Certificate Fitness Criteria

16 CAR ICAO Annex “ Accredited medical conclusion” Used for medical certification cases which are ‘technically’ outside the standards but are not deemed to be a threat to aviation safety ‘ Flexibility ’

17 1% Rule Evans ADB, Rainford DJ. Medical Standards for Aircrew in Aviation Medicine III Edition Goal is 1 in 10 7 for all cause fatal accidents Crew failure should contribute no more than 10% of risk Medical Incapacitation should contribute no more than 10% of crew failure risk Therefore Pilot Incapacitation should cause an accident no more often than one in 1000 million flying hours

18 1% Rule Continued CVD Mortality of 1 in 10 9 or annual rate of 1:100,000 is not achievable at any age, hence need for two pilots Simulator Studies (Chapman 1984) indicate successful takeover rate 1:100 Critical Area of flight (T/O and Landing) only 10% of time Incapacitation occurs randomly This gives a protection fact of 1000 sooooo…… Incapacitation Rate of 1 in 10 6 or annual rate of 1% is acceptable

19 1% Rule Summary

20 Human Rights Issues CHRC is a quasi-judicial body empowered under the Canadian Human Right Act CHRC investigates and tries to settle complaints of discrimination in employment and in the provision of services within federal jurisdiction CHRC is also empowered under the Employment Equity Act to ensure that federally regulated employers provide equal opportunities for four designated groups: women, Aboriginal people, the disabled and visible minorities CHRC acts as an advocate for human rights and issues, reports on various aspects of discrimination as well as educational materials designed to promote human rights and inform employers and the general public about human rights regulations

21 Human Rights II Prohibited Grounds of Discrimination  Race  Colour  National or ethnic origin  Sex (includes pregnancy)  Marital status  Family status  Age  Religion  Sexual Orientation  Pardoned Conviction  Disability (physical or mental, including drug or alcohol dependence)

22 Human Rights III There is a Duty to Accommodate : it is the LAW  The right to accommodation of needs is statutory  Supreme Court of Canada: accommodation of needs is necessary to ensure equality under the Charter and statutory human rights legislation (Meiorin + Grismer) Accomodation can be denied if  The rule, standard or practice is based on a bona fide occupational requirement (BFOR) or bona fide justification (BFJ),  It is made in good faith (bona fide), and  Putting aside the BFOR to accommodate would cause undue hardship to the provider, considering health, safety and cost  To establish BFOR: Meiorin- 3 stage test

23 Latest Framingham CVD Prediction Tool Performance The top sex-specific quintiles of predicted CVD risk identified ≈48% of men and 58% of women who experienced a first CVD event on follow-up (sensitivity). Proportions of men and women without events who were not in the top quintile of risk were 85% and 83%, respectively (specificity). Source:

24 Prev. 10%An Event +- FRS Sensitivity.48 Specificity.85 +PV.26 -PV.94

25 Source:


27 Conclusions Aerospace Medicine is Preventive Medicine Prevention is effective Regulatory Medicine will need more than a paradigm shift to effectively practice primordial prevention There are legal, human rights and logistical barriers to practicing prevention in a regulatory framework



30 How can you help? Accurate and complete MERs Good understanding of requirements Thorough history taking Synthesis of issues

31 Some Other Points If one of your pilots has received a letter with special conditions or investigation requirements you can make their application much more efficient if you order the extra tests. Cardiovascular screening. If there are other risk factors please get a lipid profile.


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