THE ROLE OF AVIATION MEDICINE

THE ROLE OF AVIATION MEDICINE Aerospace Medical Association Dr Ioannis Dimitrakopoulos Authorised Medical Examiner JAR-FCL3 Class 1&2

AVIATION MEDICINE Branch of Preventive Medicine that deals with the clinical and preventive medical requirements of man in atmospheric flight Aerospace Medical Association

Approach to Aviation Medicine AVIATION Normal Physiology Abnormal environment CLASSICAL Abnormal Physiology Normal environment Aerospace Medical Association

HISTORY OF AVIATION MEDICINE With the advent of powered flight at the beginning of the 20th century, there was a need for selection of those who wished to fly. Aerospace Medical Association

Aerospace Medical Association HISTORY OF AVIATION Fitness criteria were developed, and the determination of who met the criteria and who did not created the need for a physician trained to make this determination. MEDICINE

THE FLIGHT SURGEON Initially this was driven by a need for qualified military pilots to fly planes in war Aerospace Medical Association

THE FLIGHT SURGEON Main function was to first develop and then apply physical qualifications for flight duty Driven by high losses of life due to physically unqualified pilots Aerospace Medical Association

THE FLIGHT SURGEON During World War II many technologic advances led to increasing functions in research to develop means of extending man s ability to function in an increasingly hostile environment. Led to aeromedical research Aerospace Medical Association

THE FLIGHT SURGEON Increasing numbers of aircrew needed to man the warfighting aircraft Aerospace Medical Association

HISTORY After World War II the technologic advances were applied to the airline industry. Increases in aircrew led to increases in civilian aviation medicine. Aerospace Medical Association

HISTORY In the 1960 s advances were made to meet the challenge of manned flight beyond the earth s atmosphere...aviation Medicine evolved to Aerospace Medicine Aerospace Medical Association

WHAT DOES AN AEROMEDICAL DOCTOR (FLIGHT SURGEON) DO? Aerospace Medical Association

He takes care of the Aviator a physiologically normal individual who works in the hostile environment of flight Aerospace Medical Association

THE HOSTILE ENVIRONMENT OF FLIGHT Man is an earth-bound creature who must have protection to enter the hostile environment of atmospheric or space flight Aerospace Medical Association

Environmental Requirements As altitude increases, available oxygen decreases Mt Everest 29,028 ft Aerospace Medical Association STRATOSPHERE TROPOPAUSE TROPOSPHERE Andes Oxygen ARMSTRONG S LINE PRESSURE SUIT NEEDED OXYGEN UNDER PRESSURE NEEDED Mt Whitney OXYGEN NEEDED Highest Human Habitation...18,000 ft Press Alt in mm Hg Thou. Ft 34 54 87 141 226 349 523 760 34 54 87 141 226 349 523 70 60 50 40 30 20 10 0 70 60 50 40 30 20 10 SEA 760LEVEL 0

Aerospace Medical Association Environmental Requirements Lack of oxygen will affect the brain and cause fatigue, sleepiness, headache, dizziness, blurred vision and will eventually cause you to lose consciousness. Oxygen must be provided at high altitudes Oxygen HYP XIA 10,000 MSL

Aerospace Medical Association Environmental Requirements A flight surgeon must be able to recognize when problems are due to lack of oxygen Altitude chamber training helps aircrew to discover their own hypoxia symptoms Oxygen

Environmental Requirements Pressure Press mm Hg Alt in Thou. Ft Normal atmospheric pressure at sea level is 760 mm Hg As you go up in altitude, atmospheric pressure decreases. ARMSTRONG S LINE PRESSURE SUIT NEEDED OXYGEN UNDER PRESSURE NEEDED 34 54 87 141 226 349 70 60 50 40 30 20 OXYGEN NEEDED 523 10 Aerospace Medical Association 760 0 SEA LEVEL

Environmental Requirements As atmospheric pressure decreases, the air tends to expand and get thinner The human body has several responses to changes in atmospheric pressure. Pressure FL 180 FL 250 FL 350 FL 430 Aerospace Medical Association BOYLE S LAW GAS EXPANSION

Trapped Air There are several places in the human body where air can get trapped. The ear, the sinuses, and the stomach and intestines are a few examples. Aerospace Medical Association

Trapped Air As you go up in altitude, air expands... if this air is trapped, expanding air can lead to pain. A blocked Eustachian tube could lead to pain in the middle ear. Ear Drum Eustachian Tube Aerospace Medical Association

Sinus Blocks and Ear Blocks There are spaces in the sinuses and middle ear where air can get trapped. Under normal conditions this air can escape through passages to the outside (Eustachian tube) FRONTAL ETHMOIDS SPHENOIDS MAXILLARY Aerospace Medical Association

Usually expanding air is not a problem since it can be released. When you come back down after being at altitude, the expanded air gets smaller... if this occurs in a closed space it creates a vacuum effect...this is a BIG problem. Trapped Air Aerospace Medical Association

Ear Block If you fly with a cold these passages can swell up enough to block the passage of air, especially when you are trying to get air in to equalize pressure on descent. Leads to a painful ear or sinus block! Do Not Fly with a Cold! Aerospace Medical Association

Other effects of pressure DECOMPRESSION SICKNESS Air bubbles can form in the body if you go to high enough altitudes These bubbles are made of nitrogen and usually dissolve as you descend. Aerospace Medical Association

Decompression Sickness Bubbles that do not dissolve can get trapped in the joints and cause pain (bends) If they form in the blood and go to the brain they can cause serious neurologic symptoms. Aerospace Medical Association

Decompression Sickness Prevention Prebreathing 100% oxygen for at least an hour before high altitude flights can decrease the amount of nitrogen in the body and decrease the chance of getting decompression sickness. Pressurized cabins or, if necessary, pressure suits can be used. Aerospace Medical Association

Decompression Sickness Treatment Decompression sickness can often be successfully treated in a hyperbaric chamber which dilutes out the nitrogen with high pressure concentrated oxygen Hyperbaric Chamber, Brooks AFB, TX Aerospace Medical Association

Aerospace Medical Association Acceleration Forces

Acceleration Forces The very rapid rate of acceleration used in most military jet fighters and in the space vehicles imposes another hazard on the aviator. Acceleration results in an increase in the force of gravity on the aviator which can be up to nine times what he experiences on earth Aerospace Medical Association

Acceleration Forces Acceleration forces tend to be directed downward, and as they increase, they cause an aviator s blood to be pushed downward in his body, moving blood from his brain to his feet. If this force is not counteracted, the aviator will first lose his vision (black-out) and then consciousness (G-induced loss of consciousness or GLOC) Aerospace Medical Association

Positive Acceleration (+Gz) (Sustained) POOLING BEGINS 1-3 G GREYOUT 3-4 G BLACKOUT 4-5 G UNCONSCIOUSNESS 5-6 G Aerospace Medical Association

Acceleration Countermeasures To counteract this force, G suits have been developed which squeeze the legs and abdomen during high G conditions to prevent blood from being pushed there. G suits are made up of five interconnected bladders covering the legs and abdominal region. Pressurization of the bladders occurs during increases in G forces. Aerospace Medical Association

Acceleration Countermeasures The aviator can also do a special straining maneuver and tighten all his muscles. An adequate straining maneuver can be mastered during centrifuge training Centrifuge Facility, Brooks AFB, TX Aerospace Medical Association

Spatial Disorientation A state characterized by an erroneous sense of one s position and motion relative to the earth s surface There are three types Type I: Unrecognized Type II: Recognized Type III: Incapacitating Aerospace Medical Association

Types of Spatial Disorientation Type 1 Unrecognized The pilot does not perceive that something is wrong Very dangerous in that the pilot will continue to operate his aircraft according to his misperception Type 2 Recognized Usually recognized in the sense that the pilot knows something is wrong or he feels vertigo; but may not recognize it as spatial disorientation May be that his instruments tell him something different from the seat of the pants sense Often the pilot can correct this by making the instruments read right Type 3 Incapacitating Pilot is disoriented, knows it, but can t do anything about it Overwhelmed by the strength of his vestibular response to the disorientation Aerospace Medical Association

Spatial Disorientation VISION VESTIBULAR SEAT-OF-THE-PANTS Aerospace Medical Association SENSES OF BALANCE ORIENTATION AND BODY RESPONSES

Spatial Disorientation While we are in contact with the earth, the pull of gravity squeezes pressure sensors in the various portions of the body, thus telling us in which direction the earth lies. Aerospace Medical Association

Spatial Disorientation In flight, however, G- forces combine with the pull of gravity to make the seat-of-the-pants sense completely unreliable as an attitude indicator. FORCE OF GRAVITY GRAVITY PLUS CENTRIFUGAL FORCE THE SEAT-OF-THE- PANTS SENSE Aerospace Medical Association

Spatial Disorientation Sense rotation SEMICIRCULAR CANALS OTOLITH ORGANS INNER EAR PERCEPTION PROBLEMS Aerospace Medical Association

Aviation Medicine Thus, there are many problems with the abnormal environment encountered in aviation. The flight surgeon is just one of many highly trained individuals working to minimize the effects of these adverse effects so that man can continue to have mastery over the air. Aerospace Medical Association

Aerospace Medical Association

ΑΠΑΙΣΗΔΙ ΙΑΣΡΙΚΗ ΚΑΣΑΛΛΗΛΟΣΗΣΑ ΚΑΣΑ JAR FCL3 ΓΙΑ ΔΠΑΓΓΔΛΜΑΣΙΔ ΥΔΙΡΙΣΔ Παποςζίαζη: Ι.Δημηηπακόποςλορ,Γενικόρ Ιαηπόρ Εξοςζιοδοηημένορ αεποϊαηπικόρ εξεηαζηήρ Authorised Medical Examiner AME

θαλνληζκνύο ζηνλ ΔΠΙΥΔΙΡΗΙΑΚΟ, ΣΔΥΝΙΚΟ ΚΑΙ ΙΑΣΡΙΚΟ ηνκέα ηεο ΠΟΛΙΣΙΚΗ ΑΔΡΟΠΟΡΙΑ Με ζκοπό ηην αζθάλεια ηων πηήζεων

oδήγεζε ζηα ηέιε ηνπ Β παγθνζκίνπ πόιεκνπ ζηελ ίδξπζε ηνπ ICAO 1944 (International Civil Aviation Organisation ) ECAC 1955 European Civil Aviation Conference ην (αληεπηζηέιινλ κέινο ηνπ ICAO) JAA 1990 Joint Aviation Authorities CYPRUS agreement (αληεπηζηέιινλ κέινο ηεο ECAC)

Από ηνλ JAA εθαξκόδνληαη ηα JARs: Joint Aviation Requirements: Αεξνπνξηθέο Απαηηήζεηο Κνηλέο ΑΦΟΡΟΤΝ Δ ΜΗΥΑΝΙΚΑ ΜΔΡΗ ΚΑΙ ΠΡΟΩΠΙΚΟ

ύκθσλα κε ηελ ππ. αξ. 3922/91 (νδεγία ηεο ΔΔ) όια ηα θξάηε κέιε ηεο πξέπεη λα εληαρζνύλ ζηνπο θόιπνπο ηνπ JAA θαη λα εθαξκόζνπλ ηα JARs

Η ελαξκόληζε επηηπγράλεηαη κέζα από ηελ ζπλεξγαζία θαη ηελ εθαξκνγή ησλ θνηλώλ θαλνληζκώλ σο θνηλέο απαηηήζεηο JOINT AVIATION REQUIREMENTS JARs

JAR s: Joint Aviation Για αδειοδόηηζη (FCL - Flight Crew Licensing) Requirements Απαηηήζεηο θαηά JAA JAR FCL-1 Αεποπλάνα JAR FCL-2 Ελικόπηεπα JAR FCL-3 Ιαηπικέρ απαιηήζειρ Tα JARs ικανοποιούν ηα κπιηήπια ηος ICAΟ και μάλιζηα είναι πιο αςζηηπά!

Η Διιάδα ελαξκνλίζηεθε κε ηελ Δπξσπατθή λνκνζεζία κε ην ΠΓ 247/02 πνπ απνηειεί αθξηβή κεηάθξαζε ησλ JAR FCL3 όζν αθνξά ζηελ πηζηνπνίεζε ηαηξηθήο θαηαιιειόηεηαο

Από ηα JARs εθδίδνληαη ηα θάησζη πηζηνπνηεηηθά: Ι) επαγγεικαηηώλ ρεηξηζηώλ Class 1 ΙΙ) ηδησηώλ ρεηξηζηώλ Class2

Η εθαξκνγή ησλ JARs FCL-3 ζπλδέεηαη άξξεθηα κε ηελ i) Αεξνηαηξηθή Αξρή (AMS) ii) ηα εμνπζηνδνηεκέλα θέληξα αεξνπνξηθήο Ιαηξηθήο (AMCs) iii) έλα εμεηδηθεπκέλν ζώκα ηαηξώλ, Δμνπζηνδνηεκέλνη Ιαηξνί Δμεηαζηέο (ΑΜΔs= Authorized Medical Examiners)

ΣΑ JARs FCL3 ΑΠΟΣΕΛΟΤΝ ΕΝΑ ΑΠΟΚΕΝΣΡΧΜΕΝΟ ΤΣΗΜΑ ΙΑΣΡΙΚΗ ΠΙΣΟΠΟΙΗΗ ΓΙΑ ΣΟΤ ΥΕΙΡΙΣΕ ΣΗ ΠΟΛΙΣΙΚΗ ΑΕΡΟΠΟΡΙΑ

εμεηαζηή ΑΜΔ, φπσο δηαηππψλεηαη ζηα JAR FCL 3, ΠΔ 247/02/3.090 θαηέρεη πξσηεύνληα ξόιν ζηε α) δηαπίζησζε ηεο ηαηξηθήο θαηαιιειφηεηαο ησλ ρεηξηζηψλ β) ζπκβάιιεη ζηελ αζθάιεηα πηήζεσλ απνθιείνληαο αηθλίδηα αληθαλφηεηα ηνπ ρεηξηζηή ιφγσ πξνβιεκάησλ πγείαο

Οη ΑΜΕs απνηεινχλ ηε βάζε γηα ηελ Ιαηξηθή εμέηαζε θαη πηζηνπνίεζε ηεο ηαηξηθήο θαηαιιειφηεηαο ησλ ρεηξηζηψλ. Σα AMCs (Κέληξα Αεξνπνξηθήο Ιαηξηθήο) απαξηίδνληαη θπξίσο απφ ΑΜΕs θαη είλαη πξνυπφζεζε ν δηεπζχλσλ ελφο AMC θαη ν αλαπιεξσηήο ηνπ, λα είλαη εμνπζηνδνηεκέλνη απφ ηελ ΤΠΑ γηα ηελ δηελέξγεηα αεξνταηξηθψλ εμεηάζεσλ Σάμεο 1

Οη εμνπζηνδνηεκέλνη εμεηαζηέο γηαηξνί, ΑΜΕs, δηελεξγνύλ θαη ζπληνλίδνπλ ηηο ηαηξηθέο εμεηάζεηο πνπ είλαη απαξαίηεηεο γηα ηελ έθδνζε, αλαλέσζε ή επαλεπηθύξσζε πηζηνπνηεηηθνύ ηαηξηθήο θαηαιιειφηεηαο Τπνγξάθνπλ ην πηζηνπνηεηηθό ηεο θαηεγνξίαο γηα ηελ νπνία έρνπλ εμνπζηνδνηεζεί.

ηόρνο ηεο αεξνταηξηθήο εμέηαζεο από ηνλ ΑΜΔ

Σξέρνπζα εηθόλα ηεο πγείαο ηνπ ρεηξηζηή

Η δπλαηόηεηα λα αληαπνθξηζεί ν εμεηαδόκελνο ζηα θαζήθνληά ηνπ, ζε ζπλζήθεο εξγαζίαο

Ο ΑΜΔ πξέπεη λα : είλαη θαιόο θιηληθόο γηαηξόο εμεηάδεη πξνζεθηηθά θάζε ζύζηεκα ηνπ ππνςεθίνπ λα εκβαζύλεη ζηηο ιεπηνκέξεηεο

Ο ΑΜΔ πξέπεη λα θάλεη ηνλ ππνςήθην λα λνηώζεη άλεηα θαη λα αληηιεθζεί όηη ν ζθνπόο απηήο ηεο εμέηαζεο δελ είλαη λα ηνλ απνξξίςεη ηαηξηθά, αιιά λα επηβεβαησζεί ην αιεζέο γηα ηελ θαιή θαηάζηαζε ηεο πγείαο ηνπ

ε θάζε πεξίπησζε πξέπεη λα ηεξείηαη ην απφξξεην ηεο δηαρείξηζεο ησλ πξνζσπηθψλ ηαηξηθψλ δεδνκέλσλ!

Γελ λνείηαη αεξνταηξηθή εμέηαζε αξρηθή γηα επαγγεικαηία ρεηξηζηή πνπ λα δηαξθεί ιηγόηεξν από 3-4 ώξεο ζε θέληξν αεξνπνξηθήο ηαηξηθήο, όπσο θαη απηή ηεο απιήο αλαλέσζεο ζε ΑΜΔ δηάξθεηαο κηθξόηεξεο ησλ 45 ιεπηώλ ηεο ώξαο

ηε ρώξα καο δηελεξγνύληαη πεξί ηηο 4000 αεξνταηξηθέο εμεηάζεηο πηιόησλ από 20 εμνπζηνδνηεκέλνπο ηαηξνύο ΑΜΔs θαη δύν AeMCs εηεζίσο εθ ησλ νπνίσλ νη 3500 πεξίπνπ ζην ιεθαλνπέδην ηεο Αηηηθήο θαη νη ππόινηπεο ζηε Θεζζαινλίθε

Κξηηήξηα Ιαηξηθήο Καηαιιειόηεηαο Έρνπλ ηε δνκή ελφο πνιχπινθνπ λνκηθνχ ζπζηήκαηνο(regulatory Medicine) Δηέπνληαη απφ αξρέο πνπ πξνθχπηνπλ απφ ηε αεποϊαηπική έπεςνα κε βάζε θαη ηελ εκηίμηζη ηηρ πιθανόηηηαρ για αιθνίδια ακαηαλληλόηηηα θαηά ηε πηήζε πνπ ζρεηίδεηαη κε ηηο επηκέξνπο λνζνινγηθέο νληφηεηεο θαη παζνινγηθέο θαηαζηάζεηο θαζψο θαη ηε ιήςε θαξκάθσλ γηα ηελ αληηκεηψπηζε ηνπο

Χο εθ ηνχηνπ ε αλαιπηηθή παξνπζίαζε ησλ θξηηεξίσλ θαηαιιειφηεηαο γηα επαγγεικαηίεο ρεηξηζηέο αεξνζθαθψλ δελ είλαη εθηθηή. Επεηδή ππάξρνπλ γεληθέο αξρέο, πξνυπνζέζεηο αιιά θαη πνιχπινθνη νξηζκνί θαη νξνινγία πνπ ε εξκελεία ηνπο πνηθίιεη αλάινγα κε ην ηζηνξηθφ ηελ θιηληθή θαη παξαθιηληθή εηθφλα θάζε ππνςεθίνπ

πκπεξαζκαηηθά πξνο απνθπγή λανθαζμένηρ επμηνείαρ ηνπ θαλνληζκνχ ζπληζηάηαη ζηνπο ππνςεθίνπο λα απεπζχλνληαη γηα πιεξνθνξίεο ζρεηηθά κε ηε δπλαηφηεηα ηαηξηθήο πηζηνπνίεζεο ηνπο ζην i) Γπαθείο Αεποποπικήρ Ιαηπικήρ (AMS) ii) ηα Κένηπα Αεποποπικήρ Ιαηπικήρ (AMCs- Κ.Α.Ι.) iii) Τοςρ εξοςζιοδοηημένοςρ Αεποϊαηπικούρ εξεηαζηέρ (AMEs)

Η πξφνδνο ηεο Αεξνταηξηθήο έξεπλαο θάλεη ηα θξηηήξηα θαηαιιειφηεηαο ιηγφηεξν απζηεξά κε ηελ παξνδν ηνπ ρξφλνπ Δελ πξέπεη λα επηθξαηεί ε αληίιεςε φηη γηα λα γίλεη θάπνηνο επαγγεικαηίαο ρεηξηζηήο πξέπεη λα έρεη απφιπηα θαζαξφ ηαηξηθφ ηζηνξηθφ Τπάξρνπλ επαγγεικαηίεο ρεηξηζηέο πνπ πεηνχλ κε πηζηνπνηεκέλα πξνζζεηηθά κέιε- βνεζήκαηα αθνήο Τπάξρνπλ εηδηθέο δηαδηθαζίεο πηζηνπνίεζεο ηθαλφηεηαο πηήζεο κε (test flight) ζε ζρεηηθέο κε ηηο παξαπάλσ πεξηπηψζεηο θαη πξνζζήθε θάπνησλ πεξηνξηζκψλ ζην πηζηνπνηεηηθφ πγείαο (π.ρ. OML)

Ιδηαίηεξε έκθαζε δίλεηαη ζηελ αμηνιφγεζε ησλ παξαθάησ: Καξδηαγγεηαθά (εθηίκεζε θαξδηαγγεηαθνχ θηλδχλνπ) Οθζαικνινγηθά Χηνξηλνιαξπγγνινγηθά Φπρηαηξηθά Νεπξνινγηθά Φπρνινγηθά Παξαθιηληθφο έιεγρνο

πρλέο εξσηήζεηο

Απαηηήζεηο όξαζεο? Διαθλαστικό συάλμα (i)καηά ηελ αξρηθή εμέηαζε ην δηαζιαζηηθφ ζθάικα πξέπεη λα είλαη κεηαμχ εχξνπο +5 έσο 6 δηνπηξηψλ

(ii)καηά ηηο εμεηάζεηο επαλεπηθχξσζεο ή αλαλέσζεο, ν ππνςήθηνο, πνπ ζεσξείηαη πεπεηξακέλνο απφ ηελ Αξρή, κε δηαζιαζηηθφ ζθάικα πνπ δελ ππεξβαίλεη ηηο +5 δηνπηξίεο ή κε πςειφ κπσπηθφ δηαζιαζηηθφ ζθάικα πνπ ππεξβαίλεη ηηο 6 δηνπηξίεο κπνξεί λα θξηζεί σο ηθαλφο απφ ην AMS

Υξσκαηηθή αληίιεςε? σκαηνκεηξηθά ραξαθηεξηζηηθά? Φάξκαθα θαη πηήζε? αθραξψδεο δηαβήηεο θαη πηήζε? Σξαπκαηηζκνί-κπνζθειεηηθά πξνβιήκαηα θαη πηήζε?

Πξέπεη λα ηνληζηεί φηη ν θαλνληζκφο είλαη πνιχ πην επηεηθήο γηα εμεηάζεηο αλαλέσζεο ε επαλεπηθχξσζεο πηζηνπνηεηηθψλ πγείαο πηπρηνχρσλ ρεηξηζηψλ ζε ζρέζε κε ηηο αξρηθέο αμηνινγήζεηο ησλ λέσλ ππνςεθίσλ Π.ρ. έκθξαγκα κπνθαξδίνπ Επαλαπηζηνπνίεζε κε OML πεξηνξηζκφ κεηά απφ εμάκελν εάλ πιεξνί ζπγθεθξηκέλεο πξνυπνζέζεηο κεηά απφ ιεπηνκεξή αμηνιφγεζε

ΕΡΧΣΗΕΙ;

Δπραξηζηώ γηα ηελ πξνζνρή ζαο