ESAM Scientific Meeting at AsMA 2012 Wednesday 16 May 2012
Human factor FLIGHT SAFETY Technical Factor State of health, low professional fitness, low professional motivation, social vulnerability Aviation environment factors: hypoxia, acceleration, noise, vibration etc. The big reserve of thrust-toweight on board the aircraft, dynamic movement and changed gravitational vectors movement in 3-dimentional space. decrease in the reliability of individual elements and aviation system as a whole Aviation accidents, Aviation incidents
I Medical examination of flight crew members by Flight Expert Medical Commissions of Civil Aviation II Medical monitoring between examinations III Preflight medical check up
Contingent Candidates for flight training institutions The volume of examination Fasting blood glucose level (mandatory testing) Flight crew members applied for the issuance of medical certificates Fasting blood glucose level (mandatory testing at each medical examination)
Type WHO, 1999 ADA, 2003 Normal <6,1 <5,6 Fasting glycemia 6,1-6,9 5,6-6,9 Impaired glucose tolerance* 7,8-11 7,8-11 Diabetes mellitus 7,0 7,0 * - testing 2 hours after intake of 75 g of glucose Diabetes mellitus (WHO, 2011; ADA, 2012) HbA1c 6,5%; Fasting glycemia 7 mmol/l; Occasional glycemia 11,1 mmol/l with polyuria, polydipsia or unexplained weight loss; Glycemia 2 hours after glucose intake 11,1 mmol/l. Diabetes mellitus is confirmed by repeat test on glycemia (preferably the same protocol).
number of persons 0,12% from recognized as fit 0,17% from recognized as unfit Mild Medium severity Central Flight Med Expert Commission data, annual report of 2011
The main sign: presence central (abdominal) type of obesity waist circumference > 80 сm for woman; waist circumference > 94 сm for men Additional criteria: arterial hypertension (BP > 130/85 мм рт. ст.); high level of triglycerides (> 1,7 ммоль/л); reduced HDL-C (<1,0 mmol/l for men; <1,2 mmol/l for women); elevated LDL-C > 3,0 mmol/l; fasting hyperglycemia (plasma fasting glucose > 6,1 mmol/l); impaired glucose tolerance (plasma glucose 2 h+ post prandial >7,8 & <11,1 mmol/l); Diagnosis presence of central obesity and 2 additional criteria Cardiovascular therapy and prophylactics, 2007; 6 (6), annex 2
In hyperglycemia or the impaired glucose tolerance flight crew members are fit for flying duties; pilots are observed by the air company doctor, endocrinologist and follow their advises to control the blood glucose level and keep a diet. Assessment of fitness for flight duties includes the evaluation of obesity degree, BP level and effectiveness of antihypertensive therapy, clinical manifestations of atherosclerosis, degree of hyper-, dislipoproteinaemia and hypertriglyceridaemia.
% 16 14 12 10 8 6 4 2 0 5,5 Flight crew members Medical monitoring 14,3 Central Flight Med Expert Commission data, annual report of 2011
Candidates and students of flight training institutions (except graduating students) unfit for any aviation duties (статья 15 ФАП МО ГА 2002). Flight crew members and ATCOs, graduating students: - obesity I dg. [30,0 34,9 kg/m 2 ] fit; - obesity II dg. individual assessment. On final results of investigation the complex of treatment rehabilitation measures are recommended for weight correction to keep the BI < 35,0 kg/m2.
% 40 34,7 35 30 25 20 13,4 15 10 5 0 Flight crew members Medical monitoring Central Flight Med Expert Commission data, annual report of 2011
% 16 14,8 14 12 10 8 5,7 6 4 2 0 Flight crew members Medical monitoring Central Flight Med Expert Commission data, annual report of 2011
Diabetes mellitus type 1 unfit Diabetes mellitus type2 fit, assessment with condition that carbohydrate metabolism is normalized by diet alone, or diet and oral anti-diabetic medication.
Diabetes mellitus type 1 unfit Diabetes mellitus type2 fit assessment Some oral anti-diabetic medication is acceptable with OML limitation. The use of biguanides or alphaglucosidase inhibitors may be acceptable for a Class 1 fit assessment with multi-pilot ( OML ) Limitation.
Flight suspension In-patient examination in CA Central Clinical Hospital by: specialists (ophthalmologist, neurologist & others); in-depth carbohydrate metabolism analysis: fasting glucose blood test, glycemic profile, HbA1C etc.(on indications) Impaired glucose tolerance: fitness for flight duties; monitoring by air company doctor, endocrinologist and following of their recommendations in controlling the blood glucose level and observing dietary regime Diabetes mellitus type 1: unfit for flight duties; treatment recommendations Diabetes mellitus type 2, moderate and severe degrees of manifestation - unfit for flight duties; treatment recommendations Diabetes mellitus type 2, mild manifestation: anti-diabetic medication are not recommended; diet is advised for 3 months after release from the hospital, control of the blood glucose level and monitoring by air company doctor and endocrinologist. If measures were effective fitness for flight duties and further medical control
The role of aviation doctors in reducing risk factors influence Professional factors Social factors Life style all types acceleration altitude noise, vibration, toxic substances vestibular stimuli high demand for professional excellence low flight time Deterioration of health education personal income sedentary ; bad habits psychogenic and stress factor of social origin Ergonomic deficiencies of aircraft visual impairment disorientation decompression illness fatigue motion sickness hearing loss Perspective technologies for investigation of harmful environmental and flight factors impact Loss of professional health, Professional related diseases. Decrease of professional longevity, Decrease in working ability and professional reliability. Social and medical rehabilitation (antirisk) Imperfect the liquid crystal display The machine incompatibility with psycho-physiological abilities of the human Optimization of professional activity. Ergonomic expertise The main result perspective methods of evaluation and re-enfacement of body functions, professional health preservation of flight personnel and ATCOs.
Proposals for the changes of regulation in medical aspects of civil aviation of Russian Federation has been elaborated. These standards foresee: requirement of flight crews medical monitoring with various carbohydrate metabolism impairment. The individual conditions and the nature of flight operations are considered; periods of periodic follow-up are established individually in order to be able to make the necessary corrections early; treatment and rehabilitation using all available contemporary prophylactic measures
Priority tasks: - to elaborate regulation (with guidance material included); - reduction in morbidity and cases of disqualification among flight crew members; - increase in tolerance to harmful factors of the flight (acceleration, motion sickness, hypoxia etc.); - reduction of accidents; - increase of flight longivity. Proposed medical service structure of civil aviation in Russian Federation Central Flight Expert Medical ommission CA Central Clinical Hospital Flight Expert Medical Commission Scientific-methodological Center of psychophysiological training of pilots Department of Av. Med. Rus.aviation Civil Aviation Hospitals and sanatoriums AM groups Civil Aviation rehabilitation centers Medical-sanitary departments Aeromedical departments of technical aviation organizations
Putting off an easy thing makes it hard. Putting off a hard thing makes it impossible. George Lorimer Thank you for attention! 19