IERM VERSION IR OPERATIONS PERSONNEL DASR MED MEDICAL

Transcription

1 IERM VERSION IR OPERATIONS PERSONNEL MED.05 MED.10 MED.15 MEDICAL - CONTENTS AvMed Training Aviation Medical Certificate Medical Fitness Management (TMUFF) MED.05 AVIATION MEDICINE TRAINING (OAREG A) MED.05.A. The MAO must ensure aircrew are trained in aviation medicine awareness prior to conducting flight operations in a military Configuration Role or Environment with a training currency not exceeding 5 years. GM to MED.05.A Aviation Medicine Training (AUS) 1. Purpose. The purpose of this regulation is to ensure that aircrew are aware and appropriately trained in aviation medicine before commencing flying activity. 2. Prior awareness of the hazards that are present when humans operate high performance and complex military aircraft, combined with training in the knowledge and application of aviation medicine will result in the enhancement of human performance and contribute effective controls in ensuring aircrew safety and suitability for flight. 3. Applicability..05 does not apply to passengers, who are regulated separately under DASR ORO.70. Aircraft controllers, remote pilots and air vehicle operators (AVO) are normally employed in ground roles 1 ; however, there may be a requirement for limited aviation medicine training. The amount of this training, if any, may be determined by the MAO. Aircrew who are not performing military CRE flying related duties, for example flying under the ACFS, are exempt from aviation medicine training currency requirements; however, compliance is required prior to returning to a military CRE flying related position. AMC to MED.05.A Aviation Medicine Training (AUS) 1. The Single Service Aviation Medicine Advisor (SSAMA) is responsible for aviation medicine advice and ensuring aviation medicine awareness training meets COMAUSFLT/COMD FORCOMD/ACAUST requirements. Aviation medicine awareness training should: a. Address the common hazards that are present when aircrew operate Defence registered aircraft in the military CRE. b. Be tailored to target specific aircraft hazards associated within the operational commands delegation of responsibility. c. Regardless of Service, assure that Defence aircrew are equipped with an appropriate level of aviation medicine awareness training for their specific aircraft type. 2. Recognition of aviation medicine training Air and Space Interoperability Council (ASIC) Air Standards details the requirements for aviation medicine training of each ASIC member nation. Aviation medicine training that meets the ASIC requirements is considered acceptable to other ASIC member nations for the purpose of allowing aircrew to perform flying related duties with any ASIC member nation. Aviation medicine training conducted by non-asic member nations may be referred to the relevant SSAMA for advice regarding MAO recognition of prior learning (RPL). 1 Some ACO(ABM) are also employed as aircrew. In such cases, normal aviation medicine training requirements apply. AL 1 1

2 3. Currency. A five year period is made available to the MAO to set appropriate compliance periods and is harmonised to the ASIC Air Standard. Although the MAO may impose more stringent currency requirements, exemption requests for an aviation medicine training currency lapse greater than five years may not be considered. 4. Documentation. All aviation medicine training courses should be documented and recorded. An acceptable means includes certificates, PMKeyS reporting, or annotation in flying logbooks. Aviation Medicine Awareness Training 5. Aviation Medicine Awareness training should include: a. lectures in aviation medicine appropriate to CRE of aircraft type to be operated b. where appropriate, practical hypoxia awareness training that may include: i. exposure to a rapid decompression ii. exposure to pressure breathing iii. demonstration of the effect of hypoxia on night vision. c. where appropriate: i. demonstrations of spatial disorientation, including simulator-based demonstrations of spatial disorientation in fixed or rotary-wing aircraft ii. centrifuge training including exposure to the high-g environment and instruction in the correct application of the anti-g straining manoeuvre iii. iv. training in parachute descent and landing fall demonstration of physiology limitations with use of Night Vision Devices (NVD) v. demonstration of the ejection seat vi. other training related to fast jet, fixed wing or rotary wing aircraft peculiarities. d. Other specific aircrew needs. For example, instructional duties may require training detailing the aviation medical aspects of the instructional flight environment. Unit Aviation Physiology Training Officer (APTO). 6. A unit APTO may fulfil an aviation medicine support role 2 within the unit as first point of contact for aviation medicine issues specific to the unit operational requirements and may conduct informal unit-level aviation medicine training, oversighted by the relevant AVMO as required. APTO training may include: a. lectures in aviation anatomy, physiology, pathology and human factors b. introductory lectures to clinical aspects of aircrew health c. other aspects of aviation medicine training as approved by the SSAMA. Supplemental Aviation Medicine Training 7. The maximum refresher currency period of five years is set to afford maximum flexibility in resource management. If periods longer than three years will be utilised, as an effective aircrew safety control the MAO should consider provision of supplemental aviation medicine training as part of a unit s training programme Supplementary aviation medicine training may include: 2 An APTO is not likely to be a medical professional; rather, the APTO is intended to assist with general information only. 3 For example, during an Annual Safety Day. 4 Supplemental aviation medicine training is considered informal in nature, therefore there is no requirement for this training be formally recorded. 2 AL 1

3 a. Topics appropriate to the CRE of aircraft type being operated and/or current operations. For example, highlight aviation medicine related safety reports raised by the unit in previous month period. b. Related topics such as decompression illness (DCI) and effects of hypoxia. c. Ensuring aircrew knowledge of aviation medicine factors is assessed as part of aircrew general knowledge training. d. Aviation medicine aspects of recent aviation accidents or incidents relevant to the type of aircraft being flown. MED.10 AVIATION MEDICAL CERTIFICATE (OAREG B) MED.10.A. The MAO must ensure aircrew, aircraft controllers and remote pilots have a current aviation medical certificate that is: (1) For pilot aircrew: valid for a period not greater than 12 months. (2) For non-pilot aircrew: valid for a period not greater than 24 months. (3) For aircraft controllers and remote pilots: valid for a period not greater than 24 months. 5 GM to MED.10.A (AUS) 1. Purpose. The purpose of this regulation is to: a. Ensure an entry standard is established for a person to conduct flying related duties so that aircrew, aircraft controllers and remote pilots will not compromise suitability for flight due to deficiencies in Defence-prescribed physiological and psychological medical fitness standards. b. Support civil recognition of Defence aviation medical standards by facilitating an option to harmonise Defence aviation medical currency with CASA regulatory requirements. c. Provide a framework that allows the aviation command authority to direct aviation medical support requirements to the Defence health service provider. 2. Applicability Air vehicle operators (AVO). Unless the MAO determines otherwise, AVOs are not regulated under this regulation due to the category of the unmanned aircraft they may operate. For example, the medical requirements for an AVO who is operating a CAT 4 UAS are unlikely to exceed normal Defence periodic health exam (PHE) requirements; however, a CAT 3 UAS by definition has an increased risk of harm to other airspace users, people and property than a CAT 4 UAS. As such, the MAO may consider the need for certain CAT 3 UAS AVO to comply with the remote pilot medical standard or an extended remote pilot currency period. 3. Foreign aircrew operation of Defence registered aircraft. Circumstances may exist where a foreign aircrew member is expected/required to operate a Defence registered aircraft. In such cases, the MAO should ascertain if the foreign aircrew medical requirements are reasonably comparable and acceptable to Defence medical requirements. If found acceptable, the MAO may authorise foreign aircrew to operate the Defence registered aircraft. Advice may be sought from the relevant SSAMA regarding foreign aircrew medical requirements. 4. CASA medical certificates. Defence use of an appropriate CASA issued medical certificate is recognised as acceptable for Defence civilians who may provide Air Traffic Control services or civil pilots contracted to operate Defence aircraft, such as training flights, on condition that the CASA medical certificate supports only those duties directly related to the flying related duties the certificate was issued for. 5 OAR DB of 26 Apr 15 (AB ) AL 1 3

4 5. CASA medical certificates issued to Reserve members may not be used to support any deployed operations, either within or outside of Australia. In such cases, a Defence medical is required as Defence has special needs that are not covered under CASA requirements. Detailed advice may be sought from the relevant SSAMA. Reserve JBAC performing flying related duties at an airbase are not deemed as deployed. AMC to MED.10.A Flexibility Provisions (AUS) 1. Flexibility provision 1 employment in non-flying related duties. Aircrew, aircraft controllers and remote pilots not posted to flying related positions may maintain an aviation medical certificate currency period aligned to the normal Defence PHE currency. Medical certificate compliance is required prior to returning to flying related duties. Pilots participating in the ADF Currency Flying Scheme (ACFS) must maintain a current CASA medical certificate in addition to their normal Defence PHE requirement. 2. Flexibility provision 2 extensions. Circumstances may arise beyond a member s control to maintain medical currency that may impact operational requirements. Should a member s medical currency period expire, the MAO may issue a waiver; or authorise a command authority to issue a waiver, to extend the expiration date. The command authority should seek SSAMA advice before issuing a waiver past 60 days. 3. Flexibility provision 3 non pilot aircrew. The MAO may determine if it is more appropriate for non-pilot aircrew to maintain 12 month medical currency requirements. 4. Flexibility provision 4 aircraft controllers. Other than personnel who provide an Air Traffic Control (ATC) service, the MAO may determine what aircraft controller category/specialisations should comply with 24 month medical currency requirements. 5. Flexibility provision 5 medical certificate waiver. The MAO may approve waivers to specific medical requirements for the issue of an aviation medical certificate. The MAO should consult the SSAMA when using this provision to ensure understanding of risk before making a decision to approve a waiver. Medical Certificate Management 6. Issuing authority. An ADF aviation medical certificate is issued by an Aviation Medical Officer (AVMO). 7. Certificate Types. Medical certificates should be issued on appropriate forms using medical standards proposed by the SSAMA, endorsed by the Surgeon General ADF and approved by COMAUSFLT/COMD FORCOMD/ACAUST. Certificates may follow a class system, Specialist Employment Stream/Specialist Employment Classification (SPEC), occupation name or similar. The method of recording may vary from electronic means to a hard copy log book entry Initial currency date. The date the first aviation medical examination is completed. For example, a member who has never held a medical certificate has an examination for the issue of a medical certificate on 11 January The appropriate day for the certificate issue is 11 January Currency. A medical certificate is considered current (valid) from the date of examination for a period not greater than the applicable 12/24 months duration, or the period directed by the MAO if a relevant flexibility provision is used. Currency will vary depending on the currency management system used by the individual Service. Ongoing Currency Management Compliance: Civil Harmonised System 10. A renewed certificate will remain current if a medical examination is completed within 28 days or less before the certificate s expiry date, allowing another 12/24 months currency from the original expiry date. A certificate that is renewed more than 28 days before the certificate s original expiry date, or after the original expiry date, is current from the date of issue and resets the expiry date. The following currency examples would apply: 6 The Defence Medical Certificate should not be confused with a CASA Medical Certificate, which is issued under CASA provisions. 4 AL 1

5 a. If an aircrew medical examination was performed on 11 January 2015, the medical remains valid until the 11 January b. An aircrew member who holds a medical certificate that is due to expire on 11 January 2016 has an examination for a new certificate on 1 November 2015 (more than 28 days). The appropriate day for the new certificate is 1 November 2015, with an expiry date of 1 November c. An aircrew member who holds a medical certificate that is due to expire on 11 January 2016 has an examination for a new certificate on 20 December 2015 (28 days or less). The appropriate day for the new certificate is 20 December 2015, with an expiry date of 11 January d. An aircraft controller or remote pilot who held a medical certificate that expired on 11 January 2016 has an examination for a new certificate on 20 January 2016 (expired). The appropriate day for the new certificate is 20 January 2016, with an expiry date of 20 January Ongoing Currency Management Compliance: Service Specific 11. COMAUSFLT/COMD FORCOMD/ACAUST may decide harmonisation with the civil system is less important than the Service requirements and adopt a different method to allow flexibility in completing aircrew medical examinations. A renewed certificate will remain current if completed no later than the end of the month in which the certificate was issued the previous year. A certificate that is renewed in a different month to the certificate s expiry date is current from the date of issue with an expiry date to the end of the same month in the following year. The following currency examples would apply: a. If an aircrew medical examination was performed on 11 January 2015, the medical remains valid until the 31 January b. An aircraft controller or remote pilot who holds a medical certificate that is due to expire on 31 January 2016 has an examination for a new certificate on 20 December 2015 (different month). The appropriate day for the new certificate is 20 December 2015, with an expiry date of 31 December c. An aircrew member who holds a medical certificate that is due to expire on 31 January 2016 has an examination for a new certificate on 20 January 2016 (same month). The appropriate day for the new certificate is 20 January 2016, with an expiry date of 31 January d. An aircrew member who held a medical certificate that expired on 31 January 2016 has an examination for a new certificate on 5 February 2016 (expired). The appropriate day for the new certificate is 5 February 2016, with an expiry date of 28 February MED.15 MEDICAL FITNESS MANAGEMENT (OAREG C) MED.15.A. The MAO must establish a medical fitness management system that ensures aircrew, aircraft controllers and remote pilots maintain medical fitness standards for flying related duties. GM to MED.15.A Medical Fitness Management (AUS) 1. Purpose. The purpose of this regulation is to ensure personnel engaged in flying duties, noting they will already have a current medical certificate, remain medically fit to do so through effective health management. Factors such as injury or disease can adversely affect medical fitness, both in the short and long-term, but may not require assessment of the person s medical certificate. Apart from serious pathological conditions, fitness may be compromised as a result AL 1 5

6 of various extraneous factors that may require a member to be deemed temporarily medically unfit for flying duties (TMUFF). 2. TMUFF may be recommended by: a. any health care provider b. commanders and supervisors c. the individual concerned (self-imposed TMUFF). 3. Authority. The MAO, or a delegated command authority, has final authority regarding authorisation of personnel to perform flying related duties, including TMUFF reversal. AMC to MED.15.A TMUFF Management (AUS) 1. Flying related duties should not be performed when a medical or dental condition exists that may compromise suitability for flight. Table 1 TMUFF Rules provides minimum selfcancelling TMUFF periods for many conditions. The individual may extend the minimum periods where there is excessive pain, limitation of movement following a procedure, or other complication without seeking AVMO advice; however, if the issue persists longer than 7 days beyond the minimum periods provided an AVMO consult is required. 2. Documentation. A TMUFF recommendation, including all restrictions, should be documented in writing. 3. Medical certificate. TMUFF does not affect medical certificate validity unless the condition persists into the next medical certificate currency period. In such cases, a flexibility provision under.10.a may be used if the MAO deems this suitable and required. 6 AL 1

7 Table 1 TMUFF Rules Activity, condition or factor Minimum TMUFF periods Medical / Dental procedures Where local anaesthetic (including eye drops) is used: 8 hours. For general, spinal, epidural anaesthesia or IV sedation: 48 hours. Where Ketamine is used: 3 weeks. Eye examinations 24 hours following use of dilating eye drops. Administration of medication The period specified by the prescribing AVMO or dental officer. Ingestion of alcohol Blood alcohol content level (BAL) of zero and appropriate recovery time that ensures any after effects of alcohol consumption, such as hang over symptoms, are eliminated. Immunisation procedures 12 hours or as directed by an AVMO. Blood donation 72 hours for aircrew. Flying after use of a flight simulator training device Self Imposed TMUFF, includes fatigue issues 24 hours for aircraft controllers and remote pilots. TMUFF IAW unit policy. Limited to 48 hour period Notified to Flight Authorising Officer / Supervisor Return to duty must be approved by Flight Authorising Officer / Supervisor AL 1 7

8 Activity, condition or factor Minimum TMUFF Periods Psychosocial conditions TMUFF pending AVMO consultation. Critical Incident Mental Health Support (CMS) TMUFF pending AVMO consultation. Diving (aircrew only) There is no restriction placed on flying following snorkelling, breathhold diving or diving on pure oxygen. note: These restrictions should be considered guidance for other personnel carried on Defence aircraft Aircraft Pressurisation Check / Aircraft Wash Fluid/meal not consumed within the previous six hours Following a physiological aviation safety occurrence, whether symptomatic or asymptomatic Unplanned exposure above ft CA (aircrew only) Flying at or below ft Cabin Altitude (CA): 12 hours after a dive of less than 10 metres, with no decompression stops. 24 hours after a dive of greater than 10 metres, and/or decompression stops. 48 hours after a Heliox decompression dive of greater than 2 hours, or a Saturation dive. 9 hours after use of compressed air device, during Emergency Breathing System (EBS) training. This may be reduced to two hours if cabin altitude remains at or below ft AMSL. Flying above ft CA: 48 hours after a dive to any depth. Seven days after a Heliox decompression dive of greater than 2 hours, or a Saturation dive. 9 hours after use of compressed air device, during Emergency Breathing System (EBS) training. Individual exposure to be limited to a maximum of four aircraft pressurisation checks, lasting no longer than 30 minutes, to be a maximum of 0.5 atmospheres above ambient pressure in any 24-hour period. Flying at or below ft Cabin Altitude (CA): 24 hours Flying above ft CA: 48 hours For aircraft pressurisation associated with washing the aircraft or transitory functional checks: Nil TMUFF period required TMUFF pending fluid/meal consumption. TMUFF pending AVMO consultation. TMUFF pending AVMO consultation. TMUFF Considerations 4. Administration of medication. There is potential for almost any medication to generate unwanted side effects. Caution should be exercised and understanding obtained regarding the risks in taking any drug, including over-the-counter and herbal preparations. The effects of these drugs vary from person to person and may not be detected by the individual member 8 AL 1

9 concerned. In addition, adverse effects may be exacerbated when two or more drugs are taken together and interact. Herbal preparations are widely available in the community and are seen by many as a natural alternative to conventional medicine. Unfortunately, such agents are not always subject to the same stringent regulations that apply to registered medicinal compounds. In addition, many of these preparations contain agents that can interact with other drugs, and have the potential to cause side effects that are incompatible with flight safety. The use of agents to aid in sleep/wake cycle regulation have been advocated in some operational circumstances and is conducted in accordance with Health Directive policy. While not all specialist occupations are specifically addressed, an AVMO may prescribe sleep regulating medication to members of all aviation related occupations. 5. Prescribed medicine is administered as per AVMO instruction. Over the counter, herbal and other alternative medications may only be taken as permitted in relevant Health policy. 6. Alcohol use. Alcohol is a well-recognised cause of impaired performance. Evidence suggests that psychomotor skills can be degraded even at very low blood alcohol levels (BAL). The effects of alcohol are insidious; the person may be unaware of the extent of performance degradation. Prior experience and acquired skills do not protect against the effects of alcohol, as both newly acquired and older skills are affected. Similarly, the effects of hangover, even after BAL has returned to zero, can result in marked impairment of performance due to dehydration, hypoglycaemia, gastrointestinal upset and disturbances in vestibular function. Recovery time periods from alcohol ingestion will also vary amongst different people. 7. The histotoxic effects of alcohol are similar to those of hypoxia, and are magnified with increasing altitude such that a BAL that would have minor effects at sea level can cause significant performance decrement at ft. The detrimental performance effects of alcohol can also be potentiated and worsened by coexisting factors such as medication use or toxic gas exposure, such as carbon monoxide from cigarette smoke. 8. Performance impairments may include: a. impairment of motor function and slowed reaction times b. impairment of function of the vestibular system c. reduction in situational awareness and response to visual stimuli d. reduction of cognitive functions such as memory, judgment and problem-solving. 9. BAL will vary with the amount, timing and rate of consumption of alcohol. The presence of food in the stomach, the person s build and rate of elimination by the liver will also contribute to determining BAL. With such large individual variations, the following tools for the calculation of BAL provide guidance that should assist management of BAL: a. a standard drink contains 10 grams of alcohol. This is equivalent to 285 ml of full strength beer, 100 ml of table wine, 60 ml of fortified wine or 30 ml of distilled proof spirit b. the average rate of elimination is 10 grams per hour. This equates to one standard drink, or 0.01% per hour. There is wide variability between individuals in this rate of elimination c. peak BAL occurs between 30 minutes and two hours after the last drink is consumed. This reflects the finite period between drinking alcohol and its absorption into the bloodstream. 10. A BAL of zero and free from the physical or physiological effects of alcohol consumption is the requirement to perform flying related duties. The recovery time to achieve a zero blood alcohol level is different for each person. Although not definitive, personnel should not enter a safety critical area for a minimum of eight hours following their last drink. In the case of heavy alcohol consumption, the time period to recover from the physical or physiological effects of alcohol consumption may well exceed 24 hours from the time of the last drink. For example, the physiological effects of a hangover may continue many hours after reaching BAL zero. Therefore, self assessment is required to ensure a person is free from the physical or physiological effects of alcohol consumption that may still exist even after achieving a BAL of zero. AL 1 9

10 11. A person with a suspected BAL greater than zero or with the presence of any after-effects of alcohol consumption may not perform any flying related duties, nor may they perform any functions preparatory to commencing flying related duties. TMUFF should either be selfimposed or directed by medical staff or flight supervisors until such time as BAL has returned to zero and all symptoms of hangover have resolved. 12. Not withstanding the alcohol consumption guidance provided, AMC for abstinence from flying related duties after consumption of alcohol is outlined in table 2. Table 2 Minimum abstinence period prior to flying according to drinks consumed Number of standard drinks consumed Minimum period of abstinence from the last drink to commencement of flying related duties (hours) Immunisation Procedures. Localised or general reactions following immunisations or desensitisation therapy may present within minutes to hours, or even days following administration. TMUFF is imposed as directed by the relevant Health policy related to the immunisation. Personnel who have had prior reactions or allergic reactions require an AVMO consultation before receiving immunisations. 14. Blood Donation. Following blood donation, the circulating blood volume is depleted and will require time to return to normal. TMUFF is used as a precautionary measure to reduce the likelihood of temporary loss of consciousness, lethargy or other symptoms following acute reduction in blood volume. Post blood donation a person is increasingly vulnerable to hypoxia and G-induced loss of consciousness (GLOC) and will have decreased exercise tolerance. AVMO review post blood donation is not required unless the member has other health concerns. 15. Recovery time limits vary depending on whether a person performs flying related duties in the air or ground environment and are advised in regulation guidance material. For operational reasons, a desire to donate blood should consider TMUFF restrictions and plan accordingly. 16. Psychosocial conditions. Psychological health is as important as physical wellbeing in determining the aviation medicine fitness to undertake flying related duties. There are many environmental and personal factors that can adversely affect mental health and lead to increased risk of disorientation, loss of situational awareness, and training failures. Subjective expressions of stress, fatigue, mood liability, and decrease in work performance, along with non-specific physical symptoms such as loss of appetite or headache, are ways that poor psychological fitness can manifest. It is vital that personnel, their commanders, and medical staff are vigilant in ensuring that expression of symptoms indicative of psychosocial pressure are carefully assessed and appropriate specialist management is provided. If there is a significant risk to aviation safety, a psychologist, counsellor or AVMO may recommend TMUFF, notify the person s CO and arrange an AVMO review. Although management of psychosocial conditions may be undertaken by a variety of support staff the procedures outlined in this guidance material should be used to return a person to flying related duties. 17. Critical Incident Mental Health Support (CMS). CMS has been developed as a technique to assist coping with a crisis an event that is often traumatic, personally confronting and out of the person s normal range of experiences. The psychological response to a crisis, regardless of aetiology, should be correctly managed in order to ensure quick return to normal activities, including the work environment. After undergoing CMS debriefing, an AVMO recommendation as medically fit to return to flying related duties should be obtained. 18. Fatigue. Fatigue causes deterioration of individual performance levels, manifesting initially as irritability and progressing to loss of judgment, difficulty with complex or multiple tasks, load shedding, mental apathy and tiredness. Fatigue may exacerbate the effects of coexisting operational stresses such as noise and heat, and may be worsened by numerous other factors such as illness, domestic stress, alcohol and ingestion of medications. Individual self-assessment of fatigue levels is notoriously poor, and for this reason it is vital that the 10 AL 1

11 relevant policy on crew-rest and duty limitations be followed; however, maintenance of appropriate by the book crew rest hours does not guarantee absence of fatigue. Commanders, supervisors and health personnel should be watchful for symptoms, particularly where irregular duty/rest hours are undertaken. 19. Fatigue may be classified several ways: a. Acute fatigue. Strenuous physical or mental activity may cause acute fatigue, especially if recent workload has been high. Engaging in physical exercise programs will assist fatigue management, but heavy exercise is likely to worsen fatigue and disrupt sleep if undertaken directly before or during allocated rest periods. b. Circadian dysrhythmia. The term circadian dysrhythmia indicates a disturbance to the normal human diurnal cycle of wake and sleep. Without adequate conditioning and rest, these natural rhythms can be upset by rapid or prolonged travel across time zones, or by activities that rapidly alter normal periods of wakefulness and sleep. These difficulties are worsened by continually shifting duty patterns such that a new circadian rhythm can never be set. In general terms, recovery to a normal circadian rhythm occurs at about one hour per day towards the new time or duty period. On prolonged flights across time zones, or where duty rapidly cycles through periods of night and day, personal fatigue should be expected, regardless of the number of hours allocated to rest. c. Chronic fatigue. Chronic fatigue is largely a result of cumulative periods of poor or insufficient sleep. Sleep is a physiological need, and the average number of hours required is between seven and eight hours per 24-hour period. Sleep quality is best if it is uninterrupted and falls over an individual s circadian low point, which is around 0300 by the body s internal clock. Repeatedly interrupted sleep or disturbed circadian rhythms will result in the accumulation of a sleep debt. 20. Crew rest, crew duty and rostering limitations should be designed to avoid the performance deficit associated with fatigue. Where fatigue is still suspected despite appropriate provision of crew-rest, TMUFF should be imposed until a cause and solution to the fatigue can be identified. 21. Diet and meals. Failure to eat an adequate nutritionally balanced meal prior to performing flight duties, or not being properly hydrated, may reduce tolerance to flight stresses. Meal and/or fluid consumption immediately prior to flying should avoid food and drink known to produce intestinal gas as this can result in abdominal discomfort and even incapacitation during flight, especially at high altitude. 22. Consumption of foods with high caloric values and high glycaemic index as a substitute for planned meals may result in inappropriate levels of blood sugar, and in the longer term may contribute to nutritional disorders such as obesity. 23. Consumption of contaminated food can lead to gastrointestinal upsets, and subsequent sudden incapacitation. This is of particular concern for flight crew who may be required to consume in-flight rations. The type and severity of food poisoning is influenced by the following factors: a. the hygiene standards of the food handlers b. cooking procedures and activities c. types of foodstuffs d. storage, hygiene and reconstitution procedures e. susceptibility of the consumer. 24. To avoid food poisoning be cautious and selective when eating, especially when in remote areas or overseas. In-flight meals should be handled hygienically at all times, and transit times between cold storage and aircraft refrigeration should be minimised. After frozen meals are heated, they should be eaten immediately and not refrozen for future use. Where two pilots are part of one flight crew, they should eat different meals at least one hour apart. In-flight rations provided for consumption in aircraft without a refrigerator should be supplied in an insulated bag with a cooling block, or be supplied in a collective cooling facility such as an esky. All perishable foodstuffs should be removed from the aircraft at the end of each flight and either AL 1 11

12 consumed or destroyed in keeping with local quarantine rules. Perishable foodstuffs should not to be reused for subsequent flights. 25. In the event of actual or suspected food poisoning, samples of suspect food or water should be retained for investigation and arrangements made for investigation of the possible source of contamination to be investigated as soon as possible. 26. Return to flying related duties following a physiological aviation safety occurrence, whether symptomatic or asymptomatic. TMUFF duration after involvement in a physiological aviation safety incident requiring AVMO consultation 7 will vary according to the extent of physical and/or psychological injury sustained. Incidents that require AVMO assessment prior to a Commander authorising a return to flying related duties may include: a. proven or suspected hypoxia b. decompression illness (DCI) due to cabin pressurisation issues c. unintentional explosive or rapid cabin decompression d. evolved gas or severe reaction to trapped gas resulting in incapacitation or flight modification e. hyperventilation f. spatial disorientation resulting in an unusual attitude g. loss of consciousness for any cause, including GLOC h. toxicological exposures such as carbon monoxide poisoning or smoke/fumes/gases in the cockpit i. physiological, pathological, physical, psychological or psychiatric conditions, including simulated flight j. aircraft accident, aircraft incident or related critical incident. 27. Flight Simulation Training Device (FSTD). Use of FSTD carries the risk of simulator sickness, a form of motion sickness relating to the disparities between the visual and motor components of the trainer. Simulator sickness risk is enhanced if training is conducted with visual displays, but no comparative motion. The small, but significant differences between simulator and real time flying is sufficient to warrant consideration for a period of TMUFF in circumstances directly related to the person s well being vice any other safety effects that might occur when flying. 28. Diving. Diving using self contained underwater breathing apparatus (SCUBA) using compressed air carries a significant DCI risk. This risk relates to the length and depth of the dive, the timing of subsequent dives and individual variables such as physical fitness, concurrent illness or injury, age, and fatigue. The risk of DCI is increased by exposure to altitude soon after diving. 29. Aircraft Pressurisation Checks. Aircraft pressurisation checks involve post maintenance checks of an aircraft s pressurisation system, where personnel working within the pressurised section of an aircraft are exposed to atmospheric pressures greater than ambient. TMUFF Reversal 30. TMUFF reversal is dependant on a combination of risk assessment, mission essential requirements and AVMO advice. 31. TMUFF reversal. The MAO, or a delegated command authority, has final authority regarding authorisation of personnel to perform flying related duties including TMUFF reversal. The decision should be based on AVMO advice, normally provided in writing or the periods specified in Table 1 TMUFF Rules. Some TMUFF issues may be managed administratively rather than seeking or returning for additional AVMO consultation. In such situations, the person may be TMUFF for a specified period and return to duty without seeing a health care provider. Such circumstances include the following: 7 AVMO consultation is not required to be conducted face to face. 12 AL 1

13 a. defined time limits prescribed in Table 1 TMUFF Rules. b. where the AVMO has set a defined time limit or conditions based return to flying related duties for uncomplicated, self-limiting conditions (eg gastric problems, cold, flu or similar) not prescribed in Table 1 TMUFF Rules. 32. Remote AVMO consultation. Direct consultation with an AVMO may not always be possible 8. Where the AVMO is located or by whom the AVMO contact is established is not important, only that an AVMO is consulted. AVMO consultation is not intended to stop isolated personnel who cannot achieve medical advice to support command decision making. For example, a crew member, who might be unable to fly to home base from an isolated location, would be better supported to fly home under Aircraft Captain authority if the member feels well enough to do so and there is no chance of gaining AVMO advice in the current location. 33. Use of a Designated Aviation Medical Examiner (DAME). For Defence personnel who operate under oversight of a CASA medical certificate, a CASA DAME consultation may replace the AVMO consultation. 8 AVMO telephone contact may be available. RAAF Institute of Aviation Medicine provides a duty AVMO service. AL 1 13