asam 2019 annual conference - iceberg events · cataract surgery in airmen 1140 - 1225 dr tony...

ASAM 2019 ANNUAL CONFERENCE19-22 SEPTEMBER 2019 | THE WESTIN SYDNEY

CONTENTSABOUT ASAM 3

CONFERENCE PROGRAM 4

ABSTRACTS - FRIDAY 20 SEPTEMBER 2019 8

ABSTRACTS - SATURDAY 21 SEPTEMBER 2019 13

THANKING OUR SPONSORS 18

ABOUT ASAMAustralasian Society of Aerospace Medicine (ASAM) is the authoritative professional body whose role is to cultivate and promote aerospace medicine and related disciplines in Australasia. Comprising more than 900 members from many fields of medical practice, the Society has been in existence for 70 years and has provided professional development for its members by hosting successful scientific meetings each year.

For more information, please visit the ASAM website at www.asam.org.au

http://asam.org.au

http://asam.org.au

http://asam.org.au

ASAM 2019 Conference Program Page 1

ASAM 2019 ANNUAL CONFERENCE

ASAM 2019 PROGRAM

THURSDAY 19 SEPTMEBER 20191400 - 1900 Registration Heritage Ballroom Foyer, Level 6, The Westin Sydney

1430 - 1630 CPR workshop (optional) Barnet Room, Level 6, The Westin Sydney

1700 - 1900 Welcome Reception Heritage Ballroom, Level 6, The Westin SydneyDress: Smart casual Sponsored by CASA

FRIDAY 20 SEPTEMBER 20190800 - 1700 Registration Ballroom Foyer, Level B1, The Westin Sydney

0845 - 0900 Conference welcome Ballroom 3 & 4, Level B1, The Westin SydneyDr Kate MandersonWelcome to CountryUncle Chicka MaddenMajor Sponsor - Go2Altitude Oleg Bassovitch

0900 - 1000 Patterson Trust Lecture Capt Dave Fielding ‘The right stuff’: curse of the modern pilot

1000 - 1025 Morning tea Ballroom Foyer, Level B1, The Westin Sydney

1025 - 1225 Session 1 Aviation medicine pot pouriBallroom 3 & 4, Level B1, The Westin Sydney

Chair: Dr Craig Schramm

1025 - 1510 Opthalmology workshopBarnet Room, Level 6, The Westin Sydney

Chair: Dr David Fitzgerald

1025 - 1045 Dr Russell Brown The A380 Captain with the shakes

1045 - 1105 Alana Tetley Health literacy in Australian aviation: pilots

1105 - 1125 Dr Kyoko Miura Prevalence of cataract in airline pilots in Australia

1125 - 1145 Dr John Affl eck Residual diplopia and functional accommodations by the neuroplastic brain after trauma

1145 - 1205 Dr Jonathan Cohen Vaccinations for travellers: required and/or recommended

1205 - 1225 Dr Germaine Gock Preventing and reversing chronic disease without medication

1025 - 1030 David Fitzgerald Welcome and introduction

1030 - 1100 Dr Graham Duguid Regulation of common retinal diseases in pilots

1100 - 1120 Dr Peter Heyworth & Dr Graham Duguid Pseudophakia, multifocal IOL’s and presbyopia in pilots

1120 - 1140 Dr Graham Duguid Improved multifocal implant lens technology with respect to cataract surgery in airmen

1140 - 1225 Dr Tony Gibson Visual fi eld update: what is a signifi cant fi eld loss

1225 - 1310 Lunch Ballroom Foyer, Level B1, The Westin Sydney

1310 - 1510 Session 2 IncapacitationBallroom 3 & 4, Level B1, The Westin Sydney

Chair: Dr Mike Hill

1025 - 1510 Opthalmology workshopBarnet Room, Level 6, The Westin Sydney

Chair: Dr David Fitzgerald



1310 - 1335 Greg Hood Pilot incapacitations: time for a new perspective?

1335 - 1400 Dr Jeffrey Brock AM Pilot incapacitation: can we be sure?

1400 - 1425 Dr Robert Liddell Pilot incapacitation

1425 - 1510 Panel discussion

1310 - 1400 Dr John Parkes Designated Aviation Ophthalmologists’ update workshop on colour vision in aviation

1400 - 1425 Dr John Parkes An experienced international jet pilot with hitherto undiagnosed tritanopia: do we need a tritan standard in aviation?

1425 - 1450 Dr Arthur Pape New Zealand CAA general directions on colour vision defi ciency 2019: explanation and implications

1450 - 1510 Dr Daya Sharma Case report of surgical management of Keratoconus to meet commercial pilot vision standard

1510 - 1530 Afternoon tea Ballroom Foyer, Level B1, The Westin Sydney

1530 - 1630 Session 3: Risk equals likelihood versus consequence Chair: Dr Rob Liddell

1530 - 1550 Dr John Gall Is aviation medicine too risk averse?

1550 - 1630 Heather Fitzpatrick Case studies on recent investigations with AvMed themes

1630 - 1635 Dr Peter Wilkins Tribute to Dr Malcolm Hoare RFD

1635 - 1700 ACAsM Annual General Meeting Ballroom 3&4, Level B1, The Westin Sydney

SATURDAY 21 SEPTEMBER 20190700 - 1630 Registration Ballroom Foyer, Level B1, The Westin Sydney

0730 - 0845 ACAsM Registrars and Supervisors Barnet Room, Level 6, The Westin SydneyBreakfast Meeting

0900 - 0905 Welcome and introductions Dr Kate Manderson

0905 - 1000 John Lane OrationDr Thomas Smith Human physiology in fl ight


1020 - 1230 Session 4: Now you’re fl ying, the Spirit of Australia Chair: Dr Jeremy Robertson

1020 - 1035 Dr Ian Hosegood Strategic considerations in airline medicine

1035 - 1050 Dr Sara Souter Pilots are humans too

1050 - 1105 Whitney Hughes A challenging airline medical clearance case!

1105 - 1120 Dr Kelly Bofkin “Dear crew, I am not feeling so well...”

1120 - 1135 Dr Rachel MacKellar Let me bend your ear

1135 - 1150 Dr Russell Brown A pilot and alcohol: an airline case

1150 - 1230 Airline panel discussion

1230 - 1315 Lunch Ballroom Foyer, Level B1, The Westin Sydney

1315 - 1435 Session 5: Patient centred care in the aviation milieu Chair: Dr Bernard Cresswell

1315 - 1335 Dr Aparna Hegde A guide for the aerospace medicine practitioner on the conduct of an operational check

1335 - 1355 Dr Caron Jander & Peter Thorpe Decisional diversity in a commercial pilot with multiple myeloma



1355 - 1415 Dr Kristin Roe “Floppy eye syndrome”: rare diagnosis of a serious ocular condition strongly associated with obstructive sleep apnoea in an air traffi c controller

1415 - 1435 Dr Annalyse Crane Pilots and cardiac arrest: two cases of pilots who survived a VF arrest and what we can learn about assessment and management

1435 - 1455 Afternoon tea Ballroom Foyer, Level B1, The Westin Sydney

1455 - 1635 Session 6: Care to the air Chair: Dr Ian Cheng

1455 - 1515 Dr Oliver Brock Renal artery stenosis in a commercial pilot: rare disease, good teamwork, perfect outcome

1515 - 1535 Dr Vini Gautam Khurana Aerospace implications of key neurological conditions

1535 - 1555 Capt Laurie Shaw HIMS in Australia: substance use disorder resources for pilots

1555 - 1615 Dr Dave Baldwin Living the dream with a mobile aviation medical clinic

1615 - 1635 Dr John Affl eck Clinical and non-clinical challenges in international air ambulance operations

1635 - 1700 ASAM Annual General Meeting Ballroom 3&4, Level B1, The Westin Sydney

1830 - 1930 ACAsM Cocktail Reception Location: The Terrace, Museum of Contemporary Art Australia (MCA)Dress: The Great Gatsby (attendees will move from this function to the conference dinner)

1930 - 2300 Conference Dinner Location: Foundation Hall, Museum of Contemporary Art Australia (MCA)Dress: The Great Gatsby

SUNDAY 22 SEPTEMBER 20190800 - 1630 Registration Ballroom Foyer, Level B1, The Westin Sydney

0900 - 1220 Session 7: CASA session

0900 - 0930 CASA AvMed updateMark Sullivan, Branch Head, Client Services Centre, CASA

0930 - 1010 Dr Michael Boissezon Syncope: the diagnostic chimera

1010 - 1025 Dr Caron Jander Tips for DAMEs


1050 - 1130 Dr Ganesh Anbalagan Renal Culculi revisited

1130 - 1210 Dr Sanjiv Sharma Problem of the problematic use of substances

1210 - 1225 Discussion

1225 - 1230 Closing remarks (conference concludes)

1230 - 1330 Lunch (optional)Ballroom Foyer, Level B1, The Westin Sydney

1300 - 1630 ADF WorkshopBallroom 3 & 4, Level B1, The Westin Sydney

This workshop is exclusive to ADF personnel who have pre-registered. Program will be provided separately.

This activity is accredited for 40 Category 1 points, as part of the RACGP Quality Improvement & Continuing Professional Development Program in the 2017-19 Triennium. ASAM is an authorised provider of accredited activities under the RACGP QI&CPD Program. This program is correct at time of publication, however the organisers reserve the right to change the topics and presenters if necessary.

Continuing professional development

Maintaining your designation as a Designated Aviation Medical Examiner (DAME) or Designated Aviation Ophthalmologist (DAO)

In order to maintain your DAME or DAO designation you need to fulfil continuing professional development (CPD) requirements and provide evidence of these to CASA when you renew your designation.

Designation renewal lengths vary depending on the type of professional development you undertake. See the table below for details.

Type of education Designation period

No education listed One year pending further CPD

Medical Review Officer (MRO) course One year pending further CPD

Rural Doctors Association of Queensland (RDAQ) course One year pending further CPD

Royal Flying Doctors Service (RFDS) – STAR Program One year pending further CPD

One attendance at a state-based conference Two years pending further CPD

Consecutive state-based education sessions within a two-year period Four years

Attendance at one Australasian Society of Aerospace Medicine (ASAM) conference Four years

Australasian Faculty of Occupational and Environmental Medicine (AFOEM) or other CPD provider

CASA’s Principal Medical Officer to assess

DAOs must have the Fellow of the Royal Australian and New Zealand College of Ophthalmologists (FRANZCO) qualification or equivalent as evidence of continuing education requirements. Renewal is granted based on relevant continuing professional development from their parent college (RANZCO CPD certificate must be provided).

Can’t attend a conference or course?Completion of our online eLearning course, CASA update and Class 2 medical certification, provides the equivalent of one year’s continuing professional development (for one time only).

You can find the course in the AviationWorx system on our website at casa.gov.au

https://www.casa.gov.au/avmed

FRIDAY 20 SEPTEMBER 2019 0900 - 1000

'THE RIGHT STUFF': CURSE OF THE MODERN PILOT

Patterson Trust Lecture - Capt Dave Fielding

The majority of pilots can only aspire to the standards set by Chuck Yeager and the early NASA test pilots, so memorably chronicled in Tom Wolfe’s 1979 book “The Right Stuff”. Their character qualities have been for many years the unofficial template for what was required to be a successful pilot, military or commercial. Through a combination of self-selection, actual selection and job training, pilots generally do share a number of characteristics which could easily be classified as ‘The Right Stuff’. These include decisiveness, emotional strength, high-achievement, independent problem solving, the ability to deal with stress, and the ability to set and maintain high personal standards.

The problem with this construct comes when things go wrong in a pilot’s life and long-term stressors start to have their effect. These positive character attributes can rapidly become barriers or even liabilities when it comes to dealing with deteriorating mental wellbeing.

This presentation examines possible reasons why pilots have historically been so reluctant to declare mental wellbeing issues, and outlines the various programmes around the world which are addressing the issue. This is a rapidly-evolving field, and the tragic Germanwings accident of 2015 has accelerated that process dramatically. This is particularly the case in Europe, where it is now hard legislation for every EU AOC to have a Pilot Peer Support Programme (PPSP) in place by August 2020.

This has led to a high degree of energy and innovation when it comes to design and implementation of PPSPs, along with an extraordinary level of international co-operation and resource-sharing. The presentation will detail the very exciting work currently going on in this area, along with a vision of how data collected via PPSPs can have a major impact in the field of Flight Safety.

1025 - 1225 (SESSION 1)

AVIATION MEDICINE POT POURI

The A380 Captain with the shakes – Dr Russell Brown

A case is presented of an airline captain diagnosed with Parkinson’s disease, the second most common progressive neurodegenerative disorder. It considers the challenges or other co-morbidities and how this impacts fitness assessment. The aeromedical considerations of this condition will be covered and recommendations for DAME management given. The prevalence in pilots and trends seen in the literature will be reviewed.

Health literacy in Australian aviation: pilots - Alana Tetley

Pilots are responsible for the lives on board an aircraft and must have the required health literacy to monitor their health and performance. Derived by the importance of health literacy in Australian aviation and current lack of literature in this area, the research investigated the health literacy level of Australian pilots. The health literacy of Australian pilots was determined using a self-administered anonymous online health literacy measurement instrument (METER) and was compared with the most recent Australian population health literacy data extracted from the Australian Bureau of Statistics Adult Literacy and Life Skills Survey (ALLS) in 2006. The research demonstrated a significantly higher percentage of responses within the functional health literacy level for pilots (87%) when compared to the Australian population (41%). The functional health literacy level for pilots was established via supplementary

analysis to be independent of age, education level, or location. It can be determined that participation in a flight training environment increases overall health literacy. In addition, there was no one single flying discipline that represented the majority of Australian pilots in the functional health literacy category and there was no significant difference in health literacy based on which aviation medical category had ever been held by the individual. Tertiary analysis on opinions on health literacy importance in the aviation environment was also conducted. Research into this area is a first and the results have the potential to impact to the aviation community.

Prevalence of cataract in airline pilots in Australia - Dr Kyoko Miura

Previous research has suggested that occupational exposure to cosmic ionising and/or ultra-violet (UV) radiation may increase risk of cataract in airline pilots, especially nuclear cataracts. These exposures may also advance the age of cataract diagnosis in pilots compared with the general population. However, precise epidemiological estimates of the prevalence of cataract in airline pilots is lacking. We therefore aimed to examine the prevalence of cataracts (of any type) in commercial pilots in Australia who held a Class 1 medical certificate in 2011–2016. With ethical approval, we manually reviewed de-identified data in the medical records system of the Civil Aviation Safety Authority and calculated the number of pilots diagnosed with cataract during the study period of the total undergoing medical examination, as point prevalence. Among the pilots, 220 (98% men) were diagnosed as cataract during 2011–2016. The median age at diagnosis was 63 years (interquartile range 57–69). Among them, 65% were bilateral, 71% were early or mild cases and 47% of known reported types were nuclear. Preliminary analyses suggest that the overall point prevalence of cataract in commercial pilots was 1.4%, and 13.0% in pilots aged over 60 years in the period 2011–2016. We will present the estimated comparisons with the prevalence of cataract among the general Australian population.

Residual diplopia and functional accommodations by the neuroplastic brain after trauma - Dr John Affleck

The structure of the brain is constantly changing in response to an unexpectedly wide range of experiential factors (Kolb, 2003). The healing passage of time, lived experience, and brain neuroplasticity enable recovery, complete or otherwise, from brain injury, stroke and other impairing neurological insults.

A case is presented describing the functional status of a pilot applicant with an oculomotor nerve lesion after head injury. The capacity of the ‘plastic’ brain to overcome the disability and allow functioning at a high level is discussed and the rehabilitation literature regarding outcomes considered. This paper goes on to consider how neuroplastic recovery impacts on pilot medical certification.

Pilot medical certification is based on regulated medical standards and a risk assessment concerning the extent to which any deviation from the standard places a significant risk on the safety of the air navigation. Certification decision-making is intended to be consistent and evidence-based. This paper provides examples of neuroplasticity and considers how neuroplastic recovery impacts on pilot medical certification.

Vaccinations for travellers: required and/or recommended - Dr Jonathan Cohen

This presentation will provide medical practitioners with an overview of commonly recommended vaccinations for travel-related diseases. Vaccines may be recommended for medical indications or required for legal or public health reasons. Practical details for prescribing and administering vaccines will be discussed.

Preventing and reversing chronic disease without medication - Dr Germaine Gock

As aviation medicine practitioners, we should be at the forefront of disease prevention. When a pilot presents with a lifestyle disease (hypertension, ischaemic heart disease, diabetes, Alzheimer’s, depression, anxiety, GORD, etc) it might be quicker to reach for the prescription pad than to spend an hour educating them. Medications are not without side effects and may have implications when flying. Can the food we eat be used as medicine? This talk deep dives into the science and evidence of the role played by diet, lifestyle and community. Some medication-free solutions will be provided for a variety of common chronic diseases encountered in clinical practice. Attendees may wish to change their diet and lifestyle after seeing the evidence, and may change their approach to chronic disease management.

1310 - 1510 (SESSION 2)

INCAPACITATION

Pilot incapacitations: time for a new perspective? - Greg Hood

ATSB occurrence data spanning 2015-2018 shows an increase in the number of pilot incapacitation events. Many of these were experienced by pilots of high capacity regular public transport operations. Does this pose an increasing risk for the industry? The reasons for incapacitation vary, with many due to illness and some reported as exposure to fumes on the flight deck.

This presentation will explore the key trends in reported incapacitation, and give consideration to the hierarchy of possible controls for this risk, including examining crew decision making and industry-wide initiatives such as the design of pilotless aircraft.

Pilot incapacitation: can we be sure? - Dr Jeffrey Brock AM

In recent years, increasing episodes worldwide of suspected in-flight incapacitation of professional and private pilots are being reported. Australia is no exception. But how can we be certain that this causal or contributory factor to a fatal accident or near miss has actually occurred beyond reasonable doubt?

The reasons for pilot incapacitation vary, so it is extremely important that the forensic analysis of these suspected events is conducted using systematic, evidence-based and scientific methodologies wherever possible.

This presentation provides a suggested forensic basis for approaching suspected pilot incapacitation. Some recent examples are discussed and evolving investigative approaches to these occurrences, particularly cardiological, are highlighted. Consequences of failing to establish the cause of an accident are also discussed.

Pilot incapacitation - Dr Robert Liddell

Typically incapacitation is thought of as sudden and total physical inability of the pilot of an aircraft to participate any further in the piloting of the aircraft. The reality is that incapacitation can take many forms and those forms can range from complete physical incapacitation to subtle mental performance incapacitation and to psychological incapacitation.

This presentation will consider the incidence of incapacitation as reported to ICAO and other regulatory authorities, and the possible under-reporting of such events due to criteria used for such reports.

1530 - 1630 (SESSION 3)

RISK EQUALS LIKELIHOOD VERSUS CONSEQUENCE

Is aviation medicine too risk averse? - Dr John Gall

There are many definitions of risk, but one definition is the probability of damage, injury, liability, loss or other negative occurrence that is caused by vulnerabilities that may be avoided through pre-emptive action. Medicine is all about risk management and this is especially so within aviation medicine. As many potential and current pilots have discovered, ticking ‘yes’ to questions in the CASA medical questionnaire may result in grounding, or restrictions of an adverse nature that renders them effectively grounded. Depending upon the medical condition declared, CASA may ground the pilot either for a set period of time or temporarily pending receipt of the requested information. This information usually is in the form of a medical report, perhaps with associated investigation results. Obtaining the required report/information may be onerous and costly. For significant medical conditions, the requirement for grounding and subsequent reports may be readily evident and accepted by pilots. For perceived less significant or trivial conditions, the CASA requirements may be perceived as being too risk averse and unnecessarily burdensome – and something to be avoided thus encouraging non-disclosure. Anecdotally, some pilots may not be declaring these perceived trivial conditions potentially increasing risk within aviation. Is aviation medicine, therefore, perhaps by being too risk averse, inadvertently increasing the risk due to non-disclosure by pilots? This is discussed with reference to two cases, one of a renal calculus and the other anxiety.

Case studies on recent investigations with AvMed themes - Heather Fitzpatrick

Exploring the role of human performance has become a routine feature of safety investigations, but how often do safety investigators apply aviation medicine expertise to understand how the performance (and health) of crew and other safety-critical personnel were affected?

Two case studies will be presented involving recently-published ATSB occurrence investigations that included AvMed themes, focusing on those where the findings reflected these themes. They will likely be covering findings relating to:

• Illicit and prescription medication use • Oxygen systems use • Physiological events including hypoxia and hyperventilation

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SATURDAY 21 SEPTEMBER 2019 0905 - 1000

HUMAN PHYSIOLOGY IN FLIGHT

John Lane Oration - Dr Thomas Smith

What actually happens to your body when you take a flight? How is this important for airline passengers, patients or pilots? What challenges will members of the public face on upcoming commercial suborbital space flights? Drawing from his own research, Dr Smith will explore recent advances in our understanding of the physiological effects of commercial air and space travel, together with their potential clinical implications.

1020 - 1230 (SESSION 4)

NOW YOU'RE FLYING, THE SPIRIT OF AUSTRALIA

Strategic considerations in airline medicine – Dr Ian Hosegood

Part of the role of the Airline Medical Department is to advise the Executive and Board about health threats or initiatives that may have an impact on the organisation as a whole. This paper in the airline medicine panel provides an overview and some examples of strategic health issues and the role of the Airline Medical Department in their management.

Pilots are humans too – Dr Sara Souter

Pilots are not immune from the stresses and strains of everyday life events. There is not always a medical diagnosis or problem perceived to be big enough to see the DAME or GP. The issues may compound themselves leading up to a simulator check or command course and present as under performance or even failures. Who is best placed to provide a listening and empathetic ear? Peer support networks are well established in many airlines, mostly facilitated by union groups with support of employers where possible. An airline doctor can provide support and guidance to the pilot peer and/ or the affected pilot, and work with both to facilitate support required within the airline and a return to flying.

A challenging airline medical clearance case! – Whitney Hughes

Airlines often require a medical clearance for passengers who wish to undertake airline travel and have a medical condition or recent illness/surgery that may be adversely affected by flying and altitude.

The process varies for medical clearances between airlines, however, airlines that have in-house medical departments provide rigorous review and oversight of submissions from passengers. Most clearances are relatively straight forward and meet the required criteria for fitness to travel. From time to time though, there is a need to go above and beyond, and to work with multiple business units within the airline, the passenger and their treating team, in order to make air travel safe for them.

This presentation will explore one such case where the passenger’s medical condition prevented them sitting upright for any period greater than 10 minutes.

Our challenge was to see how we could achieve safe air travel, maintain regulatory compliance and not adversely impact the passenger’s medical condition?

“Dear crew, I am not feeling so well...” – Dr Kelly Bofkin

Medical events inflight are commonplace, and types and patterns of medical events are well documented by airlines and their ground medical support providers. Care in the air can be challenging, not least because of the limited space and facilities aboard a commercial aircraft, but also because of the communication options to ground medical providers. The advent of inflight WiFi in the cabin has provided an opportunity for enhanced communication platforms in supporting medical events inflight, and the crew who are assisting with them.

Let me bend your ear – Dr Rachel MacKellar

Case report on a pilot who presented with vertigo symptoms after diving, and reviewing the diagnostic challenges and treatment.

A pilot and alcohol: an airline case – Dr Russell Brown

A case presentation of an Airline pilot grounded due to problematic use of alcohol. This discussion will explore how this issue was identified and compare this with trends seen in Australian airlines. The initial management and assessment process will be covered and the challenges DAMEs face. The surveillance plan will be reviewed and recommendations given. Considerations when dealing with CASA is addressed. The value of pilot peer monitoring will be presented. Finally, the safe return to flying and treatment plan will be discussed. This talk will provide a framework for DAMEs working to return pilots to flying as safe as possible, as quick as possible, and with supports to minimise relapse risk.

1315 - 1435 (SESSION 5)

PATIENT CENTRED CARE IN THE AVIATION MILIEU

A guide for the aerospace medicine practitioner on the conduct of an operational check – Dr Aparna Hegde

Operational checks are often required by the regulatory authority for the aircrew member with a significant medical issue as the final check to ensure flight safety. These checks may be required regularly as a condition of certification. Aerospace medicine practitioners are required to be involved with the process either to outline the aspects that need to be checked by a flight instructor, or to conduct these checks.

A checklist including the following points enables you, as the practitioner involved, to be confident in evaluating aircrew and write the reports required with your findings:

• Description of role of aircrew/ATC • Description of aircraft type/ workplace • Aeromedical issues • Conduct of check - how, who, what, where, when • Concerns • Conclusions

The aim of this presentation is to cover a standardised template on conducting the operational check using case presentations to highlight the universal applicability of this approach.

Decisional diversity in a commercial pilot with multiple myeloma – Dr Caron Jander & Peter Thorpe

When faced with a commercial pilot who presents with Multiple Myeloma, your instinctive thought may be to start discussions around the end of their career. However, in life and in medicine, it pays to press

the ‘Pause Button’. Resist the urge to jump into action and rather take a step back to explore the diverse options that await your discovery.

This presentation will take you along the winding path of a commercial pilot, diagnosed with Multiple Myeloma, passionate about both his family and his career. We will look at the tough choices he faced and the decisions he made. At several stages along his path, he experienced hurdles. Some, due directly to the nature of the medications and treatments, others, caused by their side effects.

Challenged by the opportunity to participate in various drug trials, he was presented with yet another fork in the road. These diverse challenges all impacted the pilot’s overall well-being, as well as his capacity to perform his duties under the requirements of the Civil Aviation Safety Authority (CASA)

Together with the support of his family, his medical team and CASA, he has chosen his own path and continues to lead an incredibly inspiring life. His story captures the essence of what it means to be involved in aviation medicine and the diversity that it brings.

“Floppy eye syndrome”: rare diagnosis of a serious ocular condition strongly associated with obstructive sleep apnoea in an air traffic controller – Dr Kristin Roe

In 2018 a 42 yr old male controller presented for his annual medical certification including a routine aviation eye examination. The ophthalmologist recommended a sleep study to be performed as he had diagnosed the controller with bilateral floppy eye syndrome (FES). Besides a BMI of 34 and a history of mild snoring there were no other symptoms or signs indicating obstructive sleep apnoea (OSA). Epworth sleepiness score was zero. The sleep study confirmed severe OSA in all postures with an overall of 44 apnoeic events per hour (AHI) and a supine AHI of 98. As the controller was restricted to office duties pending treatment, he chose to commence CPAP immediately which successfully reduced his AHI to less than 1 event per hour (normal). A year later he maintains an AHI of 1.1 and has lost 6 kg.

Floppy eye syndrome is an underdiagnosed disorder of unknown aetiology used to describe extreme laxity of the upper eyelid (easily everted) in combination with marked papillary conjunctivitis and is mainly seen in middle aged, obese males. It is a serious vision threatening condition associated with OSA, though it is unclear if there is a causal relationship. Studies have indicated the prevalence of OSA in a patient diagnosed with FES to range from 26% - 96% highlighting the importance in referring FES patients for a sleep study. For aviation medical officers it is important to be aware of this condition not only because of the impact on vision but due to the strong likelihood of OSA which has significant aeromedical implications.

Pilots and cardiac arrest: two cases of pilots who survived a VF arrest and what we can learn about assessment and management – Dr Annalyse Crane

In 2018, two general aviation pilots passed their aviation medical examination and experienced a cardiac arrest within months of attaining their medical certificate. Both cases will be reviewed and the learning points will be addressed with reference to pilot medical assessment and management of risk factors. Meet one of these survivors and listen to his story.

1455 - 1635 (SESSION 6)

CARE TO THE AIR

Renal artery stenosis in a commercial pilot: rare disease, good teamwork, perfect outcome – Dr Oliver Brock

Case presentation: a 63yr old commercial pilot shows up for a regular class 1 renewal examination. The timeline between initial findings with missing subjective symptoms via referral processes to specialists

over to surgical treatment and a full recovery to flying status in minimum time is being demonstrated. The seamless teamwork between all participating parties including the national CAA is emphasizing not only the good clinical outcome in this rare case but also the need for mutual understanding, strong motivation to "keep ‘em flying" and legal possibilities.

Take home message: motivated patients and professionals can prevent early career endings of pilots.

Aerospace implications of key neurological conditions – Dr Vini Gautam Khurana

The neurological impact (or lack thereof) of certain medical histories and imaging findings is important to understand in the context of aerospace/flight. There are a number of neurological conditions that, if present in pilots and astronauts, carry variable (and sometimes adverse) functional implications for safety and overall mission success. In this systematic overview, the authors will refer to the relevant clinical and radiological features of brain tumours and vascular anomalies, cerebral oedema and intracranial hypertension, concussion and the traumatic brain injury spectrum, hematomas, cerebral ischaemia, key demyelinating conditions, cerebrospinal fluid circulation anomalies including hydrocephalus and sequestrations, and spinal degenerative changes. A paradigm for practical neurological workup of symptomatic pilots and astronauts will be discussed, as will the controversial notion of pre-emptive radiological screening (versus not screening) in asymptomatic or clinically occult situations. The concept of medical surveillance in the setting of known or diagnosed pathologies will also be mentioned. We believe this presentation will contribute towards the enhancement of a broad understanding of neurological conditions, their clinical workup and their precautionary management in the setting of aviation and aerospace.

HIMS in Australia: substance use disorder resources for pilots – Capt Laurie Shaw

When pilots suffer most enduring types of illness they may become temporarily or permanently disqualified from holding the medical certificate that permits them to fly. Standards enforced by CASA for medical certification mean that a substance use disorder diagnosis can be career ending if pilots do not know where to turn.

Substance use disorders are a complex and multifaceted subject. HIMS is an industry proven option that guides pilots to health and sobriety through peer support, and is being made available as an appropriate “DAMP response” in Australia.

The presentation will summarise the HIMS approach being developed in Australia, to allow DAMEs and GPs access to the approach (and its proponents through the HAAG in Australia), to assist diagnosed pilots, and those considered to be facing problematic use issues.

Awareness is the focus of this presentation.

The HIMS system emerged in the 1970s in USA through a collaborative approach between major stakeholders and has helped over 5,500 commercial/airline pilots recover their careers and well-being, through peer support and a structured system of accountability.

It is being introduced in Australia through the efforts of pilots, their unions, airlines, addiction medicine specialists and other interested advocates, with support from CASA.

By the end of the presentation, delegates should understand how HIMS works, and how they can connect pilots with resources to assist them in their recovery and journey back to the cockpit.

Living the dream with a mobile aviation medical clinic – Dr Dave Baldwin

Most medical practitioners who take the aviation medicine career path have a longstanding interest in all things relating to flying. Subsequently many of these doctors becoming pilots themselves. This is my

scenario, however, I went a step further by developing a mobile aviation medical service using an aeroplane to take me about rural New Zealand in what is called the "Bulls Flying Doctor Service" - flying became part of the job (oh damn!). The initial development of the BFDS was presented to the 2003 Aviation Medical Conference held at Rotorua, New Zealand. Sixteen years later the BFDS is not only a very viable business that services over 1300 current pilots, but it also provides a very rewarding and exciting way of life that includes lots of flying through New Zealand's beautiful Southern Alps. In this presentation I will show how the business works from the practical point of view and about the many spinoff's that such a job provides. This talk will not only be of general interest but it will be useful for any other aviation medical practitioners out there who may be considering such a venture in rural Australia or New Zealand.

Clinical and non-clinical challenges in international air ambulance operations – Dr John Affleck

This paper describes some challenging issues that have arisen in international medical retrieval situations, especially with critical patients. The challenges are of two broad types:

Clinical challenges - where the patient is found to be in a worse condition than was presented by the client or sending hospital, or where the aviation environment presents issues not encountered in hospital settings - such challenges can be managed by well experienced and well-equipped clinicians.

Non-clinical challenges - these challenges are numerous and include language / communication difficulties, border control and foreign regulatory obstacles, personal security and civil unrest, mission planning and duty times, to name a few.

The challenges will be discussed by reference to specific examples.

0900 - 1225 (SESSION 7)

CASA SESSION

CASA AvMed update– Mark Sullivan, Branch Head, Client Services Centre, CASA

Syncope: the diagnostic chimera – Dr Michael Boissezon

Tips for DAMEs – Dr Caron Jander

Renal Culculi revisited – Dr Ganesh Anbalagan

Problem of the problematic use of substances – Dr Sanjiv Sharma

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asam 2019 annual conference - iceberg events · cataract surgery in airmen 1140 - 1225 dr tony...

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