An Analysis of Medical Unfitness among Civil Aviation Aircrew in South Africa
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1 An Analysis f Medical Unfitness amng Civil Aviatin Aircrew in Suth Africa
2 Evlutin f Aviatin Medicine ICAO Requirements Operatinal Requirements Medical Causes f Aircraft Accidents Acceptable Medical Risk Applicatin f Safety Management t Medical Requirements Analysis f cmmn mrbidity amng civilian crew Analysis f In-flight Incapacitatin, Medical Appeals Enfrcement Cases Cnclusin
3 The field f aviatin medicine came int existence during Wrld War I, when it was realized that mre pilts died due t reasns f medical incapacity, than as a result f enemy gunfire.
4 The aircraft envirnment differs frm ther ccupatinal envirnments with respect t the fllwing altitude stressrs: Hypxia, nise and vibratin Lw humidity, leading t dehydratin Fatigue, decmpressin syndrme, acceleratin and spatial disrientatin. Because f these stressrs, the aircrew is required t maintain a high level f physical and mental fitness t perate in that envirnment. Aviatin persnnel are legally required t assess their fitness t carry ut their prfessinal duties.
5 With the intrductin f medical standards fr pilt duties, the fatality rate drpped significantly. This led t the develpment f ICAO Medical Standards which are fund in Annex 1,Chapter 6.
6 Oversight f medical certificatin Rutline cllectin and analysis f medical findings t identify areas f increased medical risk Peridic auditing f the cmpetence f the medical examiner (AME) by the medical assessr Applicatin f the ICAO Flexibility Clause and ensure accredited medical cnclusin Rutine cllectin and analysis f incapacitatin in-flight and n active duty Enfrcement - (Medical Certificate applicants and DAMES) Training f Designated Examiners
7 Aid in the apprach and management f intricate brderline cases (AMEs/CAA) Medical assessment; the relevant perating envirnment shuld be brne in mind Risk f incapacitatin - Single pilt vs. Multicrew cmmercial peratins carrying passengers Impsing an peratinal cnditin r limitatin applied t the licence. Harmnisatin f medical standards by Cntracting States
8 Operatinal Cnsideratins/Disabilities
9 Operatinal Cnsideratins
10 Operatinal Cnsideratins
11 Recreatinal Pilts Cabin Crew
12 What is an acceptable incapacitatin risk fr different tasks,eg ATP vs. Helicpter ATC Envirnment 12
13 Medical Causes f Accidents The incidence f incapacitatin f aircrew due t medical cnditins r physilgical impairment is lw - Study West Attributed t stringent & established medical certificatin prcesses Despite stringent medical requirements - N medical examinatin can entirely exclude the pssibility f incapacity (Aneurysm) Medical Causes f Aircraft Accidents in SA /Africa nt knwn. Limited Research & Capacity
14 Wrld-wide medical causes fatal accidents Year Aircraft Medical Cnditin 1982 DC 8 Schizphrenia 1982 Citatin Alchlic impairment 1982 Metr Vmiting 1983 Learjet Use f marijuana 1988 Metr Use f ccaine 1989 FH 227 Alchl 1990 Learjet Slurred speech, Cause? 1993 Learjet Alchl/ccaine 1994 ATR 42 Suicide
15 ICAO-Medical Causes f Accidents ICAO - physical disease is very rarely a significant factr in twcrew airliner accidents invlving yunger pilts - West Anxiety and Depressin are mre cmmn in the under-40s age grup Illicit drug use and alchl cnsumptin als cause a cnsiderable, increasing disease burden It represents a serius ptential threat t flight safety.
16 Medical Causes f Aircraft Accidents in SA Frensic Pathlgist (Determine cause f death) Aviatin Psychlgy Txiclgy Research Limited Medical Aspect f Aircraft Investigatin
17 Acceptable Medical Risk - Assessment Many diseases nt amenable t numerical analysis Psychiatric (Acceptable Cut-Off Memry,Cncentratin,etc) cmpared t BP Mnitring Expert pinin that seems reasnable, ften based n similar precedents, is likely t hld sway Expert pinin differs with legal implicatins t the CAA (Biplar Md Disrder ) Subtle cgnitive impairment substance/alchl abuse
18 Acceptible Medical Risk- CVS & NS Medical Assessments Sme cmmn medical cnditins (e.g., heart disease) Where high quality epidemilgical data exist and can be used in assessing the aermedical risk Sme cnditins are are nrmally fund incidentally(aneurysm)
19 An Analysis f Medical Unfitness amng Civil Aviatin Aircrew in Suth Africa UP Univ-Masters Thesis Unfit
20 An Analysis f Medical Unfitness amng Civil Aviatin Aircrew in Suth Africa UP Univ-Masters Thesis r < 31 t t r > Age Distributin f pilts
21 An Analysis f Medical Unfitness amng Civil Aviatin Aircrew in Suth Africa Categry f licences f aviatin crew
22 An Analysis f Medical Unfitness amng Civil Aviatin Aircrew in Suth Africa
23 An Analysis f Medical Unfitness amng Civil Aviatin Aircrew in Suth Africa
24 Desktp Analysis - Aermedical Cases: June 2010 t December 2012
25 Desktp Analysis - Aermedical Cases: June 2010 t December 2012
26 Desktp Analysis - Aermedical Cases: June 2010 t December 2012
27 Desktp Analysis - Aermedical Cases: June 2010 t December 2012
28 Desktp Analysis - Aermedical Cases: June 2010-Dec-2012 Distributin f Substance and Alchl Abuse acrss Age grups
29 Desktp Analysis-Aermedical Cases: June 2010 t December 2012
30 An Analysis f In-flight Incapacitatin Reprted t the CAA Neurlgy/Psychiatry Categry Other Cnditins Categry Epilepsy ATP Palpitatins/Tachycardia Cabin Crew Brain Stem Infarct ATP Epistaxis Cabin Crew Anxiety Disrders PPL Gastric Ulcers Cabin Crew Seizure Disrder Syncpe Strange Behaviur Bizarre Behaviur Seizure Cabin Crew Cabin Crew Cabin Crew Cabin Crew PPL
31 An Analysis f Medical Appeals & Nn-Cmpliance t Civil Aviatin Regulatins Aircrew in Suth Africa
32 Cllectin f Data and challenges fr In-flight Incapacitatin Challenges In-Flight Medical Reprting Obtaining such data Fear adverse repercussins Paperwrk regarding such an event may be nerus Cnfidentiality issues may be a cncern The initial reprt will almst always be made by crew members with little r n medical training This can hinder subsequent analysis A minr event may nt be bvius t the passengers r cabin crew and there may be a temptatin nt t reprt it if nly the flight crew are aware f the event.
33 Cnclusin CAA Cncerns Failure t disclse medical infrmatin that Threat f litigatin - May hinder may impact safety decisin-making. Reprting f Nn-Cmpliance & Psychlgical Tests - lack f validatin Incapacitatin by Industry is encuraged. regarding lcal ppulatin. Cnflict f interest-caa/iam & DAMEs Labratries - limited Chain f Custdy Oversight f DAMEs & Medical Turism IT - Address delay in the prcesses f medical certificatin Delay tactics suspected case f substance abuse & alchl Research Incnsistent Psychiatric Reprts (BMD)
34 Cnclusin (cnt.) Operatinal / Labur Issues /Training vs. Medical Diagnsis Psychlgical Testing Limited knwledge f certain peratinal envirnments (ATC) Cultural-bund syndrme Decisins are taken fllwing clse examinatin and assessment f all the medical facts, their relatinship t ccupatinal demands and persnal perfrmance. Define acceptable medical risk Evlving and learning Minimize the threat f litigatin
35 Thank yu
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