Aeromedical Decision Making Flashcards
What are the component of aeromedical decision making
1- Member/applicant - an open and honest declaration of any significant health issues
2 - Regulator - to assess this information and make a decision that is transparent reasonable and consistent
3- AVMO/DAME - to conduct a competent medical examination (in all its facets)
What makes a good decision
1 - Consistent - replicable
- with other decisions under comparable circumstances
- with other organisations
2 - Appropriate - reasonable
- consistent with present requirements or standards
- consistent with available information
- Makes sense to an informed lay person
3 - Just and fair - see by an impartial body
4 - Transparent and defensible - peer review and court of law
Evidence base
Benefits of EBM
Flexibility - keeps pilots in the air more often
Defensible - stands up to legal scrutiny
Fair and consistent - can’t hide behind “the rules”
Transparent. - pilots understand it
Ability reshape policy and regulation
Difficulties with EBM
Time consuming and complex Costly Access to articles Critical analysis difficult Evidence rarely specific to the case Diagnoses not always certain Evidence may be poor or conflicting Evidence may be misinterpreted
What is the difference between hazard and risk
Hazard - a source of potential harm or a situation with a potential to cause loss
Risk: the changes of something happening that will have impact upon objectives.
It is measure in terms of consequence and likelihood.
Describer of risk are likelihood and consequence. What are difference between likelihood and consequence
Likelihood: used as a qualitative description of probability or frequency
Consequence: the outcome of an event expressed qualitatively or quantitatively, being a loss, injury, disadvantage or gain. There may be a range of possible outcomes assoicated with an event
What is the 1% Rule
Acceptable risk of threshold
Should be <1% per year risk of sudden incapacitation deemed acceptable.
Assumes all - cause fatal accident rate of 1 per 10^7 flying hours
Same as risk of sudden catastrophic failure of airframe.
Based on
- Civilian incident data
- commercial air transport ops
- two pilots
- 10% of flight time “critical”
Establish Context in the risk management overview
Risk management overview
Establish context Identify risk Analysis risk Evaluate risk Treat risk
At anytime
- monitor and review
- communicate and consult
What are the 2 key questions to ask when identify risks
Does the medical condition impact upon flying safety or operational effectiveness?
- based on diagnosis, clinical history, prognosis, specialist report and medical evidence
Will the aviation environment affect the medical condition or its treatment?
- Based on known aviation-related risk factors.
Environmental stress checklist - consider when reviewing every patient
Altitude: hypoxia, pressure change Acceleration Motion sickness Disorientation Vibration Noise Thermal stress Smoke/fumes Escape/survival Fatigue Time zone shifts
When analysising risk what these should be considered
Likelihood of event occurring
Consequences if outcome occurs
Use the Australian/New Zealand standard for risk management
Approach to treating risk
Manage likelihood
- definitive intervention
- definitive intervention + ongoing meds + control
- Ongoing meds + control
- Time + control
- Time
Manage consequences
- safety pilot, no pax
- Safety pilot at all times
- solo, airspace restrictions
- restraints
- solo, no airspace restrictions
- as or with co pilot, pax
- single pilot, pax
A fundamental approach to aeromedical pt
Practice good medicine - treat
Are they fit to fly now?
- is there a risk of incapacitation? Do I need to impose TMUFF?
Manage the case
- IX and refer in order to making diagnosis and guide treatment. Diagnose and treat
Consider long term disposition
- Consider MECR, compile documents and consult as needed.
Other factors affecting decisions
Patient ADF experience Role in the aircraft, pilot vs non pilot Future career aspirations Single vs multi-crew Postings Flying pay
An example of risk managing “aeromedical consequence” could be
A. Controlling symptoms with medication
B. Performing coronary angioplasty
C. Applying an operational multi-crew restriction
D. Monitoring thyroid function
C applying an operational multi-crew restriction
