1. 1. 1 Presented by: Dr. Harjot Singh J.R. 2 Dept. of Community Medicine SGRDIMS&R, ASR
2. 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. 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. 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. 5. Approach to Aerospace Medicine AEROSPACE Normal Physiology Abnormal environment CLASSICAL Abnormal Physiology Normal environment 5
6. 6. Aviation Regulatory Medicine Clinical Medicine Human Rights Aerospace Medicine Preventive Medicine 6
7. 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. 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. 9 Problems Faced in Air Air Rage Altitude Sickness Parasitic infections Respiratory infections DVT Jetlag Airplane Problems
10. 10. Stresses in the Aerospace Environment Hypoxia Reduced atmospheric pressure Thermal extremes Ionizing radiation Null gravity fields Maintenance of situational awareness 10
11. 11. Hypoxia Deficiency in night vision Drowsiness Thinking slowed & calculations difficult Impaired memory & judgment Delayed reaction time 11
12. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 22. AEROSPACE INDUSTRY 1 PERSONNEL 2 PASSENGERS 3 PATIENTS 22
23. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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
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