1. AVIATION MEDICINE FOR GPS Dr Michael Clements FRACGP FRACMA FACAsM MRAeS Designated Aviation Medical Examiner With thanks to Dr Kate Manderson and Coast City Country GP training

2. OVERVIEW  Pilots  Passengers  You

3. PRINCIPLES OF AVIATION MEDICINE  Physiological environment  Hypoxia  Hypobaria  Acceleration  Spatial orientation  Human factors in performance  Commercial aviation  Private aviation  Military aviation  Retrieval medicine  Space

4. OXYGEN AT ALTITUDE? A. Partial pressure decreases B. Percentage decreases C. Both partial pressure and percentage decrease D. Both partial pressure and percentage stay the same

5. WHAT ALTITUDE DO MOST COMMERCIAL AIRLINES PRESSURISE TO? A. Ground level B. 2,000 feet C. 4,000 feet D. 6,000 feet E. 8,000 feet F. 37,000 feet

6. WHAT IS THE CHANGE TO OXYGEN SATURATIONS AT CRUISING ALTITUDE? A. No change B. 1-2% C. 3-4% D. 5-6% E. 7-8% F. 9-10%

7. TYPES OF CASA LICENCE  CLASS 1  Commercial Pilot *  Air transport Pilot *  CLASS 2  Private Pilot *  CLASS 3  Air traffic control*  Recreational Pilot License  Single engine, daylight, one passenger, good weather  RAA Medical Questionnaire and Examination  Military Aviation Medicine

8. CASA DAME  Designated Aviation Medical Examiner  Australian Certificate of Civil Aviation Medicine (Monash)  Aviation Medical Officer’s Course (ADF)  Further study  Diploma in Aviation Medicine  Fellowship in Aerospace Medicine (FACAsM)

9. CASA DRIVER LICENCE MEDICAL  Meets Australian Fitness to Drive unconditional private drivers requirements  Does not have a disqualifying condition  Cardiac, endocrine, neurological, vision….  http://www.casa.gov.au/WCMSwr/_assets/main/manuals /regulate/misc/form166.pdf

10. CASA DRIVER LICENCE MEDICAL  Clinical history  Alcohol use questionnaire  Clinical examination  Cardiovascular  Lungs  Abdomen  Neurological/locomotor  Vision  Hearing  Urinalysis  Neuropsychological

11. CASA DRIVER LICENCE MEDICAL

12. RECREATIONAL AVIATION AUSTRALIA MEDICAL ASSESSMENT  Clinical history  Examination  Cardiovascular  Vision  Hearing  Urine

13. CAUTION – WITH GP MEDICAL  Be aware of the potential for deceit  Be mindful that deaths and incidents will be investigated  Be diligent, thorough, declare everything  Pilot license has potential to cause a lot more harm than drivers license  You cannot claim a medicare reimbursement

16. YOUR OBLIGATIONS  Your patient who you know holds a CASA license has an AMI?  Your patient has a ‘funny turn’?  Your patient has a melanoma?  Your patient has depression?  http://services.casa.gov.au/avmed/contact.shtm http://services.casa.gov.au/avmed/contact.shtm  Email : avmed@casa.gov.au National : 1300 4 AVMED or 1300 4 28633avmed@casa.gov.au  DAME Liaison - 131 757

17. PASSENGER HEALTH  Public health  Cabin air quality  Fitness to fly as a passenger

18. FITNESS FOR PASSENGER FLIGHT Pregnancy – specific to airline, length of flight and pregnancy Greater than 28 weeks requires certificate Up to 36 weeks or 32 for twins (>4 hours flight) Up to 40 weeks or 36 for twins (<4 hours) Listed conditions Equipment Guidelines Medical Insurance Generally, walking 50 metres on flat ground without SOB or needing to stop

19. PICK THE TRUE STATEMENT A. Aspirin is useful for DVT prevention inflight B. There is an association between inflight dehydration and travel related DVT C. Women should cease CoCP prior to long haul flight D. Recommendations for women on CoCP who fly long haul include sitting in an aisle seat E. Recommendations are that people with no specific risk factors for VTE should wear compression stockings F. If it is to be given, low molecular weight heparin should be injected prior to, and after flight

20. RISK FACTORS FOR DVT  General risk factors for VTE include the following:  Older age (increasing risk after age 40)  Obesity (BMI >30 kg/m2)  Estrogen use (hormonal contraceptives or hormone replacement therapy)  Pregnancy and the postpartum period  Thrombophilia (such as factor V Leiden mutation or antiphospholipid syndrome) or a family history of VTE  Previous VTE  Active cancer  Serious medical illness (such as congestive heart failure or inflammatory bowel disease)  Recent surgery, hospitalization, or trauma  Limited mobility  Central venous catheterization

21. IS THERE A DOCTOR ON THE PLANE?

22. KEY POINTS  It is common  You are legally protected, even in the USA as long as:  You properly identify yourself, seek consent, act in good faith without reward, act within your scope  Declare any alcohol and act accordingly  Certification of death does not take place inflight  Almost all airlines have a hotline to a medical service  You do not always need to divert  The bigger the plane the better the medical kit – don’t forget to ask other patients

23. RESOURCES  www.casa.gov.au www.casa.gov.au  Driver Licence Medical (Aviation) and GP guidance material  www.austroads.com.au www.austroads.com.au  Assessing Fitness to Drive  www.qantas.com.au www.qantas.com.au  Travel clearance form

24. QUESTIONS