The Role Of Aviation Medicine in Aviation Safety.

1. The Role Of Aviation Medicine in Aviation Safety. Presented by: Dr. Daniel W. Kirunda Aviation Medical Assessor / Consultant EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.

2. “Look to your health and if you have it, praise God, and value it next to a good conscience, for health is the second blessing that we Mortals are capable of, a blessing money cannot buy”. IZAAK Walton 1593 – 1683. EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.

3. EVOLUTION OF AVIATION MEDICINE. EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.

4. Many years ago, Aviators were lost due to poor medical selection techniques and practically non – existent physical standards than enemy fire. This resulted into:Founding of the Aero-medical Laboratory in Mineola, Long Island, New York, 1917, to begin aero-medical research. EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.

5. Purpose: To establish physical standards for Military Air Crew and investigate human factors as causes of aircraft losses during world war 1. Concepts of air crew physical standards, though primitive then, resulted into the reduction of aircraft losses.This formed the evolution of Aviation Medicine. EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.

6. INTERNATIONAL CIVIL AVIATION AUTHORITY ORGANISATION (ICAO) EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.

7. Consequent development of Medical Standards has been an evolutionary process based on scientific inquiry, accumulated experience that led to the formation of a United Nations Agency, ICAO. • The regulation of Aviation Safety is the global responsibility of Personnel licensing, pursuant to the provisions of Article 37 of the Chicago Convention on ICAO, 1944 designated as Annex I, effective 15.09.1949. EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.

8. Regulations are embodied in National Agencies e.g: Civil Aviation Authorities. • EAC CASSOA (East African Community Civil Aviation Safety and Security Oversight Agency). EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.

9. EAC CASSOA Centre For Aviation Medicine.

10. Partner States of the EAC have previously taken part in the Universal Safety Oversight Audit Programme (USOAP) of the International Civil Aviation Organisation (ICAO).Shortcomings in the implementation of ICAO Standards and Recommended Practices (SARPs) were identified.The need for the Regional CAAs to access an Aviation Medicine Centre that complies with ICAO Medical SARPs was noted.

11. An ICAO Aviation Medicine Consultant was Contracted to carry out a feasibility study of such a centre. Consequently a recommendation for the establishment of the Regional Centre for Aviation Medicine (CAM) was made.

12. The board adopted, approved the resumption of operations of the CAM. • Interim location, CASSOA Head Quarters. Entebbe, for relocation to the Recommended location, Nairobi, Kenya when ready. • A Medical Assessor / Consultant was engaged on 20.01.2014, work started 20.02.2014.

13. CORE FUNCTIONS OF THE CENTRE FOR AVIATION MEDICINE EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.

14. Core Functions of the Centre For Aviation Medicine continued. • Manage the Centre for Aviation Medicine and Assist the Regional Partner States in meeting the States security Oversight Obligations relating to Aviation Medicine under the Chicago Convention and its Annexes. • Develop and implement Regional Mission Schedules for evaluation of Aviation Medicine standards. • Carry out a skills Audit and develop a databank of designated Aviation Medical Examiners in the Region and build their capacity in training workshops. EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.

15. Core Functions of the Centre For Aviation Medicine continued. • Liaise with human resources to develop Aviation Medicine Training Programmes. • Develop harmonized personnel Licensing Standards. Regulatory formulation and amendments to ensure conformity to International Standards. • Evaluate amendment proposals to international Standards and Recommended Practices relating to Aviation Medicine and formulate a common Regional position. EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.

16. Core Functions of the Centre For Aviation Medicine continued. • Form a Specialists appeal and referral board . Investigate all appeals and be in charge of accredited medical conclusions. • Develop inputs and implement procedures and guidelines to be followed in obtaining and sharing Regional human resources for Medical related inspection activities, surveillance, audits and responding to requests for assistance in Aviation Medicine related matters. • Participate in the evaluations of Medical reports of Designated Medical Examiners in collaboration with the Regional Assessors where available. EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.

17. Some of the Medical problems identified following the evaluation of Medical assessment. EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.

18. Mental Health:- • Mood disorders. • Neurotic, stress related and somatoform disorders. • Disorders of personality and behaviour. • Flying and psychoactive drugs. • Alcohol abuse. EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.

19. Human Immune Deficiency Virus. • Fatigue and flight operations. • Hazards of Medications and drugs. • Hypertensive heart disease. • Metabolic / endocrine disease – Diabetes mellitus. EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.

20. IMPLIMENTATION / LICENCE ISSUE / MEDICAL CERTIFICATION. EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.

21. Implementation of the set ICAO medical Standards is done to ensure the Health or FITNESS of the Aviator and not to compromise the Aviation Flight Safety. • There is a need to check the competency of Personnel who perform flight activities which unless performed properly could jeopardise aviation safety. • THE RECOGNITION OF THIS COMPETENCY WAS MADE BY ISSUING A LICENCE EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.

22. Licence issued by a State through a delegated Authority on confirmation of medical Fitness of the license holder. • The process of establishing and issuing evidence guarantees that a licence holder meets the medical requirements is called MEDICAL FITNESS. EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.

23. MEDICAL FITNESS OF AIR CREW

24. The Hostile Operational environment : • Problems of altitude. Physical changes in the atmosphere on ascent to and descent from altitude have major clinical effects on Air crew and passengers. • Partial pressure changes. Ascent to altitude is associated with a fall in air pressure . The fall in total atmospheric pressure and consequent reduction of partial pressure of oxygen poses the GREATEST single threat to anyone who flies, HYPOXIA. EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.

25. Commercial aircraft pressurised to usually 5000 – 7000 ft as a safety margin to passengers and PSYCHOMOTOR PEFORMANCE OF AIR CREW. Air crew performance deteriorates at altitude above 8000ft. This is corrected by Cabin pressurization of aircraft. • Features of Hypoxia. • Personality changes (euphoria) • Lack of judgement • Loss of short term memory and mental in-coordination • Vision and auditory impairment. This process is INSIDIOUS and hence a GREAT DANGER.

26. Temperature decreases. • Effects on special senses in flight (eyes & ears-spatial orientation and disorientation). • Acceleration. • Vibration. These changes do have a compromising effect on unfit flight crew especially those with cardiovascular and respiratory disease, alcohol and any drug usage especially cold cures and obesity. EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.

27. MODE OF EXAMINATION

28. The 1% Rule Airworthiness Authorities have a safety target of better than ONE FATAL ACCIDENT in multi crew aircraft per 10 million flying hours. • Examinations: Done under the guidance of the set ICAO Medical regulations, Annex I, chapter 6. EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.

29. Examinations continued. • Medical examinations of Fitness done specifically by Doctors designated by the State Licensing Authority • Examiners must have received training in aviation medicine from a recognised institution plus refresher training on regular intervals. • Competence of the Medical examiner evaluated periodically by an appointed Medical Assessor.

30. Basic Principles as specified in Annex 1, chapter 6. • The applicant shall be Physically and Mentally capable of performing the duties of the Licence or rating applied for or held. • There shall be no medical reasons which make the applicant liable to incapacitation while performing duties .Sudden or insidious. EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.

31. Physical and Mental Assessment. • Done based on the following requirements. • Physical and mental, systems. • Cardiovascular • Respiratory • Central and peripheral nervous . • Gastro - Intestinal (abdominal). Rule Out: Any abnormality, congenital or acquired. EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.

32. Physical and Mental Assessment Continued: • Any active, latent, acute or chronic disability. • Any wound, injury or sequel from an operation. • Any effect or side – effect of any prescribed or non prescribed therapeutic, diagnostic or preventive medication taken such would entail a degree of functional incapacity likely to interfere with the safe operation of an aircraft or with the safe performance of duties. • Visual and colour perception. • Hearing. EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.

33. Examinations continued. • Detailed investigative/diagnostic procedures ,basic and specific inclusive of laboratory, radiology, electrocardiography, and audiometric, done. • Results analysed .Declaration form and medical certificate of fitness submitted to the relevant personnel in the Licensing authority. EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.

34. THANK YOU FOR LISTENING. EAC Aviation Symposium 9th May 2014, Kigali, Rwanda.