1 Presented by: Dr. Harjot Singh J.R. 2 Dept. of Community Medicine SGRDIMS&R, ASR
Transcript
1. 1 Presented by: Dr. Harjot Singh J.R. 2 Dept. of Community
Medicine SGRDIMS&R, ASR
2. Definition The specialty of medical practice within
preventive medicine that focuses on the health of a population
group defined by the operating aircrews and passengers of air and
space vehicles, together with the support personnel who are
required to operate and maintain them. A military practitioner of
aviation medicine is called a flight surgeon and a civilian
practitioner is an aviation medical examiner. 2 Source: Public
Health & Preventive Medicine Wallace/Maxcy-Rosenau-Last,15th
edition
3. Beginning of aerospace medicine The father of Aviation
Medicine- Paul Bert Conducted experiments with barometric pressure
Proved the principle effects of altitude on the body Made the first
low pressure altitude chamber 3
4. History 1949 - deptt. of space medicine was established at
the US Air Force school of Aerospace medicine. 1953 - ABPM approved
the decision to authorize certification in aviation medicine. 1958
- The National Aeronautics and Space Administration (NASA) was
formed. Officially changed by the ABPM to Aerospace Medicine. 2000,
the ABPM initiated the development of a Certificate of Added
Competency in Undersea and Hyperbaric Medicine. 2005 1376
physicians have been certified in this specialty. 4Source: Public
Health & Preventive Medicine Wallace/Maxcy-Rosenau-Last,15th
edition
5. Approach to Aerospace Medicine AEROSPACE Normal Physiology
Abnormal environment CLASSICAL Abnormal Physiology Normal
environment 5
6. Aviation Regulatory Medicine Clinical Medicine Human Rights
Aerospace Medicine Preventive Medicine 6
7. 1% Rule (Aviation Medicine) It is the risk threshold applied
to the medical fitness of pilots Applying this would result in an
airline pilot being denied a medical certificate if their risk of a
medical incapacitation (e.g. heart attack, convulsion, stroke,
faint etc) was determined as being greater than 1% during the year.
(threshold between acceptable and unacceptable) It began in the
late 1980s & early 1990s in a series of British and European
cardiology workshops Its application is controversial 7
Source:http://en.wikipedia.org/wiki/1%25_rule_%28aviation_medicine%29
8. 8 Conditions that might cause problems in a flight include:-
Pregnancy beyond 36 weeks. New born babies during the first few
days after birth. Recent or current middle ear infections or
sinusitis. Unstable psychiatric illness or epilepsy. Recent
myocardial infarction or moderate/severe heart failure. Recent
chest, intra-cranial or abdominal surgery. Recent pnuemothorax or
moderate to severe hypoxic pulmonary disease. The presence of a
communicable disease. Previous record of causing disruption during
flight
9. 9 Problems Faced in Air Air Rage Altitude Sickness Parasitic
infections Respiratory infections DVT Jetlag Airplane Problems
10. Stresses in the Aerospace Environment Hypoxia Reduced
atmospheric pressure Thermal extremes Ionizing radiation Null
gravity fields Maintenance of situational awareness 10
11. Hypoxia Deficiency in night vision Drowsiness Thinking
slowed & calculations difficult Impaired memory & judgment
Delayed reaction time 11
12.
Source:http://thumbs.dreamstime.com/x/diagram-atmospheric-pressure-vs-altitude-12436225.jpg
12 Environmental Oxygen As altitude increases, available oxygen
decreases Atmospheric Pressure Normal atmospheric pressure at sea
level is 760 mm Hg As we go up in altitude, atmospheric pressure
decreases.
13. Acceleration Forces Acceleration forces tend to be directed
downwards moving blood from his brain to his feet. If this force is
not counteracted, the aviator will first lose his vision & then
consciousness (G-induced loss of consciousness or GLOC) This
phenomenon was first identified in Great Britain in World War I
(circa 1918-1919) as "fainting in the air." In US G-LOC was first
encountered in 1922 during the Pulitzer Trophy Air Race. .
13Source:http://www.ncbi.nlm.nih.gov/pubmed/3281645
14. 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.
Source:http://www.ncbi.nlm.nih.gov/pubmed/3281645
15. 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
16. Decompression Sickness Air bubbles can form in the body at
high altitudes. These bubbles are made of nitrogen & usually
dissolve as we descend Bubbles that do not dissolve can get trapped
in the joints and cause pain (bends) If they form in the blood
& go to brain- can cause serious neurologic symptoms 16
17. Decompression sickness: prevention & treatment
Prebreathing 100% oxygen for at least an hour before high altitude
flights can decrease the amount of nitrogen in the body &
decrease the chances of decompression sickness Pressurized cabins
or if necessary, pressure suits can be used 17
Source:http://www.archive.xray-mag.com/files/PRPChamber_Torque03.JPG
18. Operational Aerospace Medicine Three operational flight
environments are: Civil Aviation Military Aviation Space Operations
18Source: Public Health & Preventive Medicine
Wallace/Maxcy-Rosenau-Last,15th edition
19. Civil Aviation Category includes: Commercial aviation &
Private/recreational flying. In the US approx. 460,000 active
pilots, 167,000 general aviation aircraft, 10,000 air carrier
aircraft & 18,000 airports. FAA has designated 4800 physicians
as AMEs FAAs Civil Aeromedical Institute recomends standards on
emergency aircraft lighting, breathing equipments, emergency
breathing devices & floatation systems. Other activities
include air ambulance service, flight training, aerial application,
air cargo & new growth industry of commercial parcel delivery.
19
20. Military Aviation Air Force has the widest range of
aeronautical activities The flight surgeon is responsible not only
for health maintenance of the flight crews but also for maintaining
health surveillance for the 5000 people on board the carrier He
oversees all aspects of hygiene, epidemiological surveillance,
health maintenance & medical disaster preparedness abroad ship
20
21. Space Operations On feb.1,2003 the Columbia space shuttle
broke up on reentering earths atmosphere & all 7 crew members
were lost Biomedical challenges include- SAS(space motion
sickness), cardiovascular deconditioning, loss of red cell mass
& bone mineral loss SAS has been experienced by up to1/3 of
shuttle crew & this occurs in early segments of orbital flight
& may affect early mission performance. The international space
station operation introduces additional challenges for maintaining
astronauts on long duration missions. 21
22. AEROSPACE INDUSTRY 1 PERSONNEL 2 PASSENGERS 3 PATIENTS
22
23. Personnel Aircraft is dependent on the pilot to safely
complete the flight The clinical skills of AMS are in diagnosing
occult diseases & conditions that are risky for flight safety
Pilots on therapeutic medications can have side effects of their
medications leading to drowsiness & loss of consciousness Two
commonly used non- therapeutic drugs are cigarettes & alcohol.
Alcohol continues to be associated with approx. 11% of general
aviation accidents. Smokers have high carbon monoxide levels &
less oxygen levels in their blood, which compromises their altitude
tolerance 23
24. Contd. Work-Rest cycles: various factors in the aerospace
environment lead to the onset of fatigue in aviators. These
include: Excitement of a new place Insomnia in a strange bed
Circadian rhythm asynchrony Work related anxiety 24
25. Airline Aviation Medical Services Pre employment Medical
examination Drug abuse testing Psychological profile or personality
inventory Physiological training Wellness or health maintainance
programme Employee Assistance Programme Acute care Emergency
response service Periodic medical assessment Job related illness or
injury monitoring Return to work assessment Aircraft accident team
25 Source: Public Health & Preventive Medicine
Wallace/Maxcy-Rosenau-Last,15th edition
26. Passengers Common problems seen in passengers are: Air
rage: in the form of anger & increased tension Economy class
syndrome: this refers to the development of deep vein
thrombosis(DVT) in passengers who remain seated in the tight
confines of the cabin for long periods of time. It is seen that 10%
of air travel passengers older than 50yrs develop symptomless DVT
during prolonged flights Passengers are advised to remove tight
stockings, exercise the feet & legs while seated, move about
the cabin as conditions permit & maintain hydration 26
SOURCE:Ind. Journal of Aerospace Medicine 47(2), 2003
27. PATIENTS Medical center helicopter used to transfer
critically ill and injured patients and neonates to tertiary
medical facilities. Some aircraft, such as the Hercules C-130 can
be overpressurized to maintain the cabin below sea level pressure
provided flight is at a relatively low altitude. Prevention is the
hallmark of aeromedical support to personnel, passengers, and
patients: 27Source: Public Health & Preventive Medicine
Wallace/Maxcy-Rosenau-Last,15th edition
28. COMMUNITY & INTERNATIONAL HEALTH Aerospace flight
operations have the potential for disrupting the environment and
serving as a mechanism for the introduction of disease Even with
the use of maximum efficiency HEPA filters, infections have
occurred among both crewmembers and passengers. Infections
documented are TB, influenza, SARS. The potential for disease
transmission has been reduced with the implementation of
international sanitary regulations and other control mechanisms. 28
Source: Public Health & Preventive Medicine
Wallace/Maxcy-Rosenau-Last,15th edition
29. International Health Regulations published by WHO 1.
Promulgation of the application of epidemiological principles 2.
Enhancement of sanitation at international airports 3. Reduction or
elimination of factors contributing to the spread of disease 4.
Elimination of disease vector transportation 5. Enhancement of
epidemiological techniques to halt the introduction or
establishment of a foreign disease 29 Source: Public Health &
Preventive Medicine Wallace/Maxcy-Rosenau-Last,15th edition
30. Vector Control The principal objective of these procedures
is to kill mosquitoes and other insect vectors of disease. Current
regulations permit residual treatment of the aircraft with
permethrin. A common practice was the blocks-away disinfection
technique, in which insecticide would be introduced into the
passenger cabin immediately after the aircraft was closed and was
taxiing to take off. An alternative method was to use aerosol
insecticide prior to arrival at the destination airport 30 Source:
Public Health & Preventive Medicine
Wallace/Maxcy-Rosenau-Last,15th edition
31. IAM,BANGALORE IAM established as a centre for aeromedical
activities related to military and civil aviation in the late 50's.
Aeromedical evaluation of military & civil in aircraft design,
promotion of flight safety, human factor analysis of aircraft
accidents & aeromedical research form the major activities. The
need for a fullfledged Institute for imparting training in Aviation
Medicine was fully realised with the advent of the jet age. This
led to the establishment of the School of Aviation Medicine (SAM)
at Bangalore on 29th May, 1957. 31
32. 32 Role Of IAM includes : (a) Training medical officers,
paramedical personnel, military and civil aircrew. (b) Medical
evaluation of military and civil aircrew. (c) Aeromedical research
and development. (d) Aeromedical and human engineering consultancy
to the aerospace industry. (e) Aeromedical support to Indian Human
Space Programme. (f) Therapeutic activities through Hyperbaric
Oxygen Therapy (g)PrimaryHealthcare