CONTENTSABOUT ASAM 3

CONFERENCE PROGRAM 4

ABSTRACTS - FRIDAY 24 AUGUST 2018 8

ABSTRACTS - SATURDAY 25 AUGUST 2018 14

THANKING OUR SPONSORS 19

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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 nearly 60 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

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CONFERENCE PROGRAMTHURSDAY 23 AUGUST 20181400 - 1900 Registration Alice Springs Convention Centre

1430 - 1630 CPR Workshop Tony Spencer Ellery D

1700 - 1900 Welcome Reception Courtyard, Alice Springs Convention Centre Dress: Territory formal

FRIDAY 24 AUGUST 20180800 - 1630 Registration Alice Springs Convention Centre

0845 - 0900 Conference welcome Dr Kate Manderson MacDonnell C Welcome to Country Kumalie Kngwarraye, local Arrernte Native Title Owner of Mpwarntwe (Alice Springs)

0900 - 1040 Session 1: The art and science of aerospace medicine Chair: Dr Kate Manderson

0900 - 1000 Patterson Trust Lecture Dr John Caldwell Sleep: it's not just for sissies anymore

1000 - 1020 Dr Peter Habersberger The real heart of the matter

1020 - 1040 Dr Peter Heyworth Cataract surgery: how far we have come and how near or far we need to go

1040 - 1100 Morning tea

1100 - 1220 Session 2: When it goes wrong Chair: Dr Jeremy Robertson

1100 - 1120 Dr Jeffrey Brock How long is too long?

1120 - 1140 Dr Meg O'Connell Injuries associated with Unmanned Aerial Vehicles (UAV)

1140 - 1200 Dr Collette Richards Post traumatic epilepsy: your assistance required

1200 - 1220 Dr Ross Mills Managed early return to flying post traumatic brain injury

1220 - 1310 Lunch

1310 - 1510 Session 3: “For the wise man looks into space and he knows there is no limited dimensions” - Lao Tzu Chair: A/Prof Gordon Cable

1310 - 1330 A/Prof Gordon Cable Australia's contribution to Space Life Sciences

1330 - 1350 Dr Meg O'Connell Strategies for reducing astronaut radiation exposure

1350 - 1410 Prof Steven Moore Long-duration spaceflight adversely affects post-landing piloting and driving ability

1410 - 1430 Dr Tim Squire Mars radiation exposure risks: the shielding effect of a graphene space suit and a storm shelter during transit

1430 - 1450 Dr Jeremy Robertson Parabolic flight: creating a microgravity research platform for Australia

1450 - 1510 Dr John Affleck No more motion sickness - a virtual reality

1510 - 1530 Afternoon tea

1530 - 1630 Session 4: Call 000 Chair: Dr Mike Hill

1530 - 1550 Dr Jeffrey Brock Nothing beats oxygen

1550 - 1610 Dr Russell Brown Passenger fitness to fly on a commercial airline

1610 - 1630 Dr Annemarie van der Walt Aviation vs medicine: how the one influences the other in an emergency

1645 - 1730 ACAsM Annual General Meeting MacDonnell C

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1845 Coach departs from Alice Springs Convention Centre

1900 - 2200 ACAsM Annual Fellows Dinner Museum of Central Australia, Cnr of Larapinta Drive and Memorial Avenue, Araluen, Alice Springs Dress: Territory formal

SATURDAY 25 AUGUST 20180700 - 1630 Registration open Alice Springs Convention Centre

0730 - 0845 ACAsM Trainees and Supervisors Meeting Ellery D

0900 - 1040 Session 5: The real heart of aerospace medicine Chair: Dr Craig Schramm

0900 - 0905 Welcome and introductions MacDonnell C

0905 - 1000 John Lane Oration Sam Bailey You don't need wings to fly

1000 - 1020 Dr Jeremy Robertson The FIFO DAME experience

1020 - 1040 Greg Hood Pilot incapacitation occurrences

1040 - 1100 Morning tea

1100 - 1220 Session 6: “Trust is like blood pressure. It's silent, vital to good health, and if abused it can be deadly” - Frank Sonnenberg Chair: Dr David Fitzgerald

1100 - 1140 Dr Trang Dáo “How can I trust you?” Ironing out issues in the partnership between pilot and Designated Aviation Medical Examiner

1140 - 1200 A/Prof Pooshan Navathe On the ethics of regulation

1200 - 1220 Dr Calder Hamill The use of genetic testing in assessing candidates for careers in aerospace: a review of the science, ethics and legality

1220 - 1310 Lunch

1310 - 1450 Session 7: “If Beethoven had been killed in a plane crash at the age of 22, it would have changed the history of music and of aviation” - Tom Stoppard Chair: Dr Ian Cheng

1310 - 1330 Dr Bernard Kelly Human factors, crew resource management and human error: what healthcare can learn from aviation and vice versa

1330 - 1350 Heather Fitzpatrick Bringing AvMed specialisation and safety investigation together: past and future challenges

1350 - 1450 Panel: Aviation accident investigation: human factors, and the role of the aviation medical examinerModerator: Dr Kate Manderson Greg Hood ATSB, Dr Shelley Robertson Forensic Pathologist and Capt Nathan Koch Qantas

1450 - 1510 Afternoon tea

1510 - 1630 Session 8: It’s a mixed bag Chair: Dr Priti Bhatt

1510 - 1530 Dr Vini Khurana Awake brain surgery versus piloting an aircraft

1530 - 1550 Dr Catherine Olsen Incidence of melanoma in commercial pilots in Australia

1550 - 1610 Capt Laurie Shaw and Hylton Ward Managing substance use disorder in a remote environment

1610 - 1630 Prof Ron Bartsch Drones in society: the benefits and the liabilities

1630 - 1640 Greg Hood ATSB Announcement

1645 - 1730 ASAM Annual General Meeting MacDonnell C

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1845 Coach departs from Alice Springs Convention Centre

1900 - 2330 Conference Dinner Airport Runway, South Stuart Hwy, Alice Springs Sponsored by CASA Dress: Territory formal - bring a warm jacket!

SUNDAY 26 AUGUST 20180800 - 1300 Registration open Alice Springs Convention Centre

0900 - 1155 Concurrent session 9A CASA DAME Session MacDonnell C

Chair: Dr Michael Drane

0900 - 1150 Concurrent session 9B Australian Defence Force (ADF) Session Ellery C

Chair: GPCAPT Greg Hampson

0900 - 0940 Rob Walker Regulation and safety

0900 - 1030 ADF Session

0940 - 1010 Dr Michael Drane “Beating who?”

1010 - 1030 Dr Michael Boissezon PREDICT and prediction: cardiovascular risk assessment

1030 - 1050 Morning tea 1030 - 1100 Morning tea

1050 - 1120 Dr Peter Clem A real headache!

1100 - 1150 ADF session continues

1120 - 1155 Dr Peter Clem “Nothing serious doctor!”

1200 - 1205 Closing remarks MacDonnell C

1205 - 1300 Lunch (optional) Poolside, Alice Springs Convention Centre

1300 Conference concludes

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.

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

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FRIDAY 24 AUGUST 2018 0900 - 1040 (SESSION 1) THE ART AND SCIENCE OF AEROSPACE MEDICINE

Patterson Trust Lecture - Dr John Caldwell

Sleep: it's not just for sissies anymore

Adequate restful sleep is vital from both a performance and health perspective. However, the importance of sleep is often overlooked despite evidence that chronic sleep curtailment is associated with obesity, diabetes, hypertension, heart disease, depression, performance impairments, and an increased risk of all-cause mortality. It is urgent that healthcare providers in the aviation sector and elsewhere understand the deleterious effects of short and disordered sleep so that they can better persuade crew members to obtain the 7 hours of daily slumber essential for all-around wellbeing.

The real heart of the matter - Dr Peter Habersberger

Electrocardiography is an integral part of cardiovascular assessment of pilots. The value of electrocardiography and functional exercise testing will be discussed, as well as the debate regarding the appropriate means of assessment of cardiovascular fitness in our community, particularly in view of impending changes to the Medicare Benefits Schedule. Examples of cases highlighting management of cardiovascular problems in pilots will be discussed.

Cataract surgery: how far we have come and how near or far we need to go - Dr Peter Heyworth

The talk will give an account of the history of cataract surgery beginning in Babalonian times, through to the current state of the art. Successive milestones will be discussed, and the implications for patients and for pilots will be illuminated; finally there will be some discussion about specific issues pertinent to aviators. The specific visual requirements under the various conditions in which they operate will be reviewed. The use of toric implants, and now the introduction of multifocal implants raises significant issues for aviation licensing authorities worldwide. At the moment there is no consensus on how to proceed. The subject is open to discussion.

1100 - 1220 (SESSION 2) WHEN IT GOES WRONG

How long is too long? - Dr Jeffrey Brock

In recent years there has been a massive swing in favour of ultra long-range, twin engine passenger aircraft for long distance air travel. There is enormous competition between Airbus and Boeing to develop, manufacture and market ultra-long range aircraft to reduce operating costs of commercial aviation. Non-stop flights in excess of 17 hours are now a reality. The endurance of some of these aircraft now looks as though it might exceed the endurance of some passengers on board. So how long is too long for commercial passengers to remain on board aircraft on these newer and proposed non-stop flights? This presentation looks at the history of long-distance passenger flight and the current fleet of newer commercial aircraft specifically designed for these trans-global routes. Recognised short and longer-term adverse health outcomes for passengers are discussed as well as the possibility newer and more concerning ones, perhaps previously not-considered.

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Injuries associated with Unmanned Aerial Vehicles (UAV) - Dr Meg O'Connell

The commercial development of recreational Unmanned Aerial Vehicles (UAVs) has seen an unprecedented number of ready to use unlicensed electronic devices entering the Australian airspace. Consumers with no training are able to immediately fly devices. This study aims to catalogue injuries experienced by pilots and bystanders due to UAVs.

Methods: A literature review was undertaken of Medline, Pubmed and Google Scholar. The Search terms "quadcopter" "UAV" " hexacopter" "octocopter" "drone" "remotely piloted aviation system" and "injuries" "accidents" "emergency" "hospital" and “medical” were used.

Results: A total of two published articles were found, one in which a Hyprid II test dummy was subject to live flight impacts and fall impacts. The other study listed common injuries experienced by engineering students working with quadcopters.

Discussion: Studies demonstrated that fall impact caused greater severity of trauma than live test flights, which is important given fall impacts are common in unexperienced UAV pilots. Other injuries included lacerations, eye injuries and minor head injuries. The fall impact forces were significant enough to cause severe morbidity, even mortality.

Conclusion: Currently, there are no laws requiring UAV manufacturers to warn consumers or bystanders of the safety implications of their products. With the increase in consumer availability and decrease in prices, more UAVs will be entering the airspace. Perhaps further engineering, including laceration prevention measures, crumple on impacts, or designs that deviate away from a fall impact on humans are necessary.

Post traumatic epilepsy: your assistance required - Dr Collette Richards

Clinical case presentation of a now 21 year old male who sustained a moderate head injury in 2013, under surveillance for post traumatic epilepsy until 5 years post injury.

Preparation for suitability for Air Traffic Controller duties began in early 2018, at which time the individual declared recent onset of visual disturbance, that remains undiagnosed.

His visual symptoms are considered to be aeromedically significant, and at the current time, he remains unfit to commence Air Traffic Control duties.

Audience interaction is requested to identify questions that remain unasked / unanswered, diagnoses that have not been considered, thoughts about suitability for controlling duties, other comments.

Managed early return to flying post traumatic brain injury - Dr Ross Mills

Severe Traumatic Brain Injuries (TBI) carry the risks of neurocognitive deficit and late onset epilepsy. Because of this, ADF aircrew typically are not cleared to fly until they can demonstrate having been free from complications for 5 years post injury. This case presentation discusses the case of a RAN Seahawk Aircrewman (Sensor Operator) who sustained a serious TBI in December 2015 and returned to flying duties in May 2018. This process involved a detailed literature search and clinical reviews to quantify the risks. Highly individualised risk controls were implemented to enable this Aircrewman to progress his flight training before the expiry of his 5 years post TBI.

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1310 - 1510 (SESSION 3) “FOR THE WISE MAN LOOKS INTO SPACE AND HE KNOWS THERE IS NO LIMITED DIMENSIONS” – LAO TZU

Australia's contribution to Space Life Sciences - A/Prof Gordon Cable

In September 2017 the Australian Government announced its intention to establish an Australian Space Agency based on the recommendations of an appointed Expert Reference Group (ERG) chaired by Dr Megan Clark AC. Although initially overlooked, biomedical science has now been recognised as a key element of Australia's future space industry and has been specifically noted as a priority of the new Agency. Australia has always had a strong track-record of high quality biomedical research and has already been contributing productively to the field of space medicine. This paper summarizes the background and current status of the Australian Space Agency, some of the current Australian capabilities in space life sciences, future global plans for human space exploration, and outlines some niche areas in which Australia could contribute to future missions. The aim of the panel that follows is to expand on these themes by examining some current specific areas of interest in space medicine.

Strategies for reducing astronaut radiation exposure - Dr Meg O'Connell

Reducing radiation exposure is a difficult but essential task in order to enable further manned spaceflight beyond low earth orbit. Radiation exposure can come from high-energy galactic cosmic rays, solar proton events and the radiation belts. Radiation poses not only short-term sequelae of acute radiation sickness and CNS disturbances, but also long term issues of multi-system soft tissue degeneration and radiation carcinogenesis. This study aimed to explore the current strategies and models planned to mitigate radiation exposure.

Methods: A literature review was undertaken of Medline, Pubmed and Google Scholar. The Search terms "radiation"’ “exposure”, "near earth orbit asteroids", " Orion”, “MPCV”, and “Lunar Orbital Platform Gateway”, in order to quantify the current strategies for radiation exposure reduction.

Results: The majority of studies were conceptual. Physical shielding was the most commonly mentioned strategy, but one study mentioned also a mini magnetosphere could also be employed for active radiation shielding. Additionally, crew behaviours, pharmacological prevention and dietary countermeasures were all found to have potential benefits for reducing radiation exposure.

Conclusion: Further research is required in this field, in particular, research to determine an appropriate model to conduct radiation exposure experiments in order to benefit manned spaceflight. The upcoming Orion missions will provide a unique insight into radiation exposure levels in the current Orion MPCV design.

Long-duration spaceflight adversely affects post-landing piloting and driving ability - Prof Steven Moore

Future exploration-class missions beyond low-earth orbit will require astronauts to perform landing and post-landing tasks following extended periods in microgravity. We assessed the abilities of a group of 8 ISS astronauts to perform full-motion piloting and driving simulations, as well as a cognitive/sensorimotor test battery, before and after 6-months aboard the ISS. Two ground-based controls, a shadow group (N=12) who performed the same tests at the same time intervals, and a sleep group (N=8), who performed a subset of tests following a 36-h sleep restriction protocol, were also assessed. On the day of return astronauts exhibited significantly higher fatigue, decreased manual dexterity and decreased performance on a manual tracking task with dual task loading, relative to pre-flight baselines. These

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adverse effects were not observed in the shadow or sleep groups (with the exception of increased fatigue following the sleep restriction protocol). Driving and piloting performance were significantly impaired in all astronaut subjects on landing day, but unchanged in the shadow and sleep groups. Astronaut performance on all tasks returned to baseline by four days post-landing. These results indicate that post-landing deficits in operator proficiency were due to spaceflight, rather than the pre/post-flight testing interval or fatigue alone. Funded through NASA grants NNX09AL14G and NNX12AM25G to STM.

Mars radiation exposure risks: the shielding effect of a graphene space suit and a storm shelter during transit - Dr Tim Squire

The number one health risk posed to astronauts travelling to Mars is radiation exposure. Galactic cosmic radiation (GCR) consists mostly of protons and a small amount of biologically significant heavy charged particles which are difficult to shield against. Spontaneous particle events (SPE) are mass ejections of protons from the sun. Strategies exist to mitigate effects from radiation including optimisation of shielding against heavy charged particles with large volume and heavy materials being impractical due to their limitation on spacecraft launch.

Access was granted from NASA to utilize the OLTARIS space radiation modelling tool to investigate thirty potential shielding materials. Their ability to decrease equivalent and effective radiation dose received by a phantom was assessed during GCR and SPE.

Thirty materials were tested during a simulated 360 day return trip to Mars. Promising materials were those that were light-weight and increased nuclear fragmentation. The optimal suit was composed of a single layer of carbon atoms known as graphene. The graphene suit reduced effective dose compared with a standard clothing by 32% (453mSv/yr vs 660mSv/yr). This equates to a relative cancer risk reduction from stochastic effects by 1% (2.5% vs 3.5%). The most effective shielding mechanism during a SPE was achieved by modelling a “storm shelter” where a large water/fuel tank was positioned to create a barrier surrounding the astronauts. The water barrier reduced effective dose by 98.8% (44mSv vs 3614mSv).

Parabolic flight: creating a microgravity research platform for Australia - Dr Jeremy Robertson

The recent announcement of the formation of an Australian Space Agency has prompted ASAM to investigate the current research projects and capabilities relating to the space life sciences that are currently available in Australia. One of the capability gaps identified was the lack of a microgravity environment simulator. These are available in the US and Europe through dedicated heavy jet aircraft, usually modified passenger aircraft, flying parabolic arcs to simulate various constant levels of reduced G. This presentation seeks to discuss the issues needed to be addressed in order to set up a similar capability in Australia.

No more motion sickness - a virtual reality - Dr John Affleck

Motion sickness (MS) is a common experience especially in novice aviators. For some student pilots it is a persistently recurring and debilitating condition that can interfere with their ability to continue flying training. The military in many countries, including Australia, devote resources to desensitise pilots who suffer MS so they can continue to function effectively as combat pilots. We have commenced a project in which pilots affected by MS are treated by repetitive exposure to virtual reality (VR) provocation for cross-desensitisation. In this paper we review relevant literature, describe our treatment methodology and present preliminary results. It is anticipated that these techniques can be used to assess the susceptibility of subjects for MS and to proceed to desensitisation where applicable. This will have application in civil pilot training and in military pilot recruitment and training. Space tourism presents another potential application as MS is experienced by a high proportion of space travellers. As the VR

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tool is developed it is hoped that space tourists will be able to undergo effective MS desensitisation before undertaking a space mission.

1530 - 1630 (SESSION 4) CALL 000

Nothing beats oxygen – Dr Jeffrey Brock

This presentation traces the history of oxygen as far back as its discovery by Joseph Priestley in 1774. He called it "dephlogisticated air". Its earliest reported use in aviation is discussed in some detail including subsequent use in World War I and World War 2 through to its use in modern day aviation and aerospace medicine. The chemistry of this incredible element is discussed along with its manufacture and use in early and modern oxygen systems. Some important aviation physiology will be revisited including the oxygen dissociation curve. The presentation is intended to refresh our knowledge about this most fundamental and life critical gas. The earliest manufacture and use of liquid oxygen is noted along with the most recent oxygen generation production techniques for commercial and high performance military aircraft. Recent major aviation accidents involving hypoxia are also highlighted.

Passenger fitness to fly on a commercial airline- Dr Russell Brown

This talk uses a collection of interesting cases and scenarios to illustrate DAME considerations relating to the Airline Passenger Health System. We know that pre-screening through the MEDIF process and gate screening are the most important elements contributing to reduction of inflight medical events. When problems do develop inflight we face a challenging environment to deal with medical emergencies. This presentation will give a high level review of frequency and types of inflight medical incidents. We'll reflect on how these events are used to improve airline processes and cabin crew training. Finally the role of the onboard medical volunteer will be considered.

Aviation vs medicine: how the one influences the other in an emergency - Dr Annemarie van der Walt

Aviation and aeromedical transfer is a hostile environment in which to practice Medicine. Starting with a sick cohort, one would assume more negative outcomes. This however is not the case. Due to risk assessment and risk mitigation, there are relative few unexpected negative outcomes (with death as the worse-case scenario). This is achieved by using a dedicated aeromedical retrieval service with specifically trained staff to work in this environment. During this presentation specific interactions and adaptions are highlighted to show how high quality medical care is ensured.

www.icrp2019.com

Hosted by Australian Radiation Protection and Nuclear Safety Agency

Radiation is a natural part of our environment and has been since long before humans walked the Earth. Even so, there are times when we need to take protective measures, such as for exposure to radon in mines, or for ensuring animals and plants are adequately protected. The ICRP 2019 programme looks at a range of issues associated with radiological protection in mining including the latest science on radon risk, waste management practices, and best practice in the protection of the environment.

This is an age of extraordinary advances in medicine, not least due to the novel and increasing use of radiation for diagnosis and treatment benefitting billions of people world-wide. ICRP 2019 examines cutting-edge technologies and techniques in medicine, and the advances in radiological protection needed to accompany them so that we can ensure the best possible quality of care for patients, and a safe workplace for healthcare professionals.

We have learned to fly high, work in orbit, and even travel to the moon. Now Mars is calling. On Earth we are protected from the harsh radiation of space. With advances in high-altitude air travel, space exploration, and the dawn of space tourism, we need to protect those working or travelling high in Earth’s atmosphere and beyond. ICRP 2019 brings together world-class experts to address protection of passengers and crew in modern aviation and space travel.

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SATURDAY 25 AUGUST 2018 0900 - 1040 (SESSION 5) THE REAL HEART OF AEROSPACE MEDICINE

John Lane Oration – Sam Bailey

You don't need wings to fly

While jackarooing in the Northern Territory Sam Bailey became a C6/C7 quadriplegic in a car accident. Despite severe physical limitations he went home to the family property and became a farmer. In 1999 he proposed to his wife Jenny – then a radio journalist - ‘live’ on ABC Radio and they now run a beef cattle property at Croppa Creek in North West NSW. Sam appeared on ‘Australian Story’, his book “Head Over Heels” is a best seller, and he’s now working towards becoming the first quadriplegic in the world to fly a helicopter.

The FIFO DAME experience - Dr Jeremy Robertson

Earlier this year the presenter achieved a long-standing goal by combining his interests of medicine and flying to initiate a fly-in-fly-out DAME service to two NSW country towns. This opportunity was possible as the established rural GP/DAMEs retired, and the next generation of rural GPs seemed reluctant to take on the role of DAME, a common theme across many rural communities in Australia. This presentation discusses the experiences and challenges faced by this newly qualified Sydney-based DAME in setting up and running a remotely based aviation medicine practice.

Pilot incapacitation occurrences - Greg Hood

Occasionally pilots become incapacitated during flight. Incapacitations can arise from different reasons. They include the development of an acute medical condition, changes in environmental conditions during the flight, or the effects of a pre-existing medical condition. The effect of incapacitation on a pilot can be restricting their flight duties for the remainder of the flight, or for single-pilot operations, a collision with terrain. ATSB Chief Commissioner Greg Hood will discuss prevalence, type, nature and significance of in-flight medical conditions and incapacitation events occurring in civil aviation.

1100 - 1220 (SESSION 6) “TRUST IS LIKE BLOOD PRESSURE. IT’S SILENT, VITAL TO GOOD HEALTH, AND IF ABUSED IT CAN BE DEADLY” – FRANK SONNENBERG

“How can I trust you?” Ironing out issues in the partnership between pilot and Designated Aviation Medical Examiner - Dr Trang Dáo

Context

The specific issues and assets at stake of professionals with high security responsibility (physicians, public personalities or pilots) require a customized clinical approach adapted to their occupational concerns to establish a trusting partnership with their physicians.

In aviation, DAME and Pilots share the fundamental ultimate principles of securing the pilots’ career and flights, yet their respective foci of concern differ and may interfere with trust development.

This presentation analyses trust development mechanism to facilitate the physician’s

- awareness of potential friction points early in their partnership with their pilot;

- adjustment of their interactions to the level of trust the pilot is yielding out;

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- detection of the pilot’s eventual misconceptions as soon as they come out;

- education on mental health hygiene, prevention of psycho-social issues;

- reframing of the relationship into realistic expectations towards workable alliance.

A repair kit will be proposed to face the eventual challenge of breach of trust.

Objectives:

This presentation intends to help the participant physicians to:

- Demonstrate a convincing cooperative attitude with their pilot patients

- Identify and deal early with threats to trust development early in their interaction towards a trustful healthy working alliance

- Apply clinical tricks to deal with potential risks of trust erosion.

Limitations

This method to tease out trust should be exclusively applied to pilots. It should not be used for other professionals (ATC, CC, physicians, public personalities) whose occupational issues at stake are different.

On the ethics of regulation - A/Prof Pooshan Navathe

Depending upon where you find the material, you will find four, five (Beauchamp & Childress, 1979), or more ‘fundamental’ ethical principles. These are, autonomy non-maleficence, beneficence, justice (four) fidelity (five) and proportionality (and so on). In making a choice of decision making models, it is important to decide which ethical perspective or perspectives are used in making the decision – utilitarianism, moral relativism, or moral absolutism. Defining the perspective differently can lead to different outcomes. The work of Corey identifies eight steps in making ethical decisions. The presenter applies these schema to the question of regulating aviation medical fitness, and discusses the decision of CASA to reduce regulation in Class 2 medical certification.

The use of genetic testing in assessing candidates for careers in aerospace: a review of the science, ethics and legality - Dr Calder Hamill

BACKGROUND: ‘Sudden death’ gene panels are available to identify hundreds of the most common genetic predispositions to sudden incapacitation and death. Governments and corporations in the aerospace industry may have an interest in applying these tests as part of their pre-employment assessments.

AIM: To describe the potential use of genetic testing in the aerospace industry, and to explore the extent to which such testing would be ethical and legal in an Australian context.

METHOD: A review of relevant commentary, policy documents, legislation and case law.

RESULTS/DISCUSSION: When the most select group of individuals are to be chosen for a mission to Mars, or to pilot multimillion-dollar fighter jets, there may be an interest in applying pre-employment genetic tests to identifying silent genetic predispositions to sudden-death or incapacitation.

There is no express prohibition on genetic testing by employers in Australia. There have been several attempts to regulate the use of genetic testing by employers in the past, including redacted legislation tabled before Federal Parliament in 1998.

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Without specific legislation, a mixture of privacy law, discrimination law, and occupational health and safety law remain relevant. These would act to limit genetic testing to situations where particular genetic mutations would make an applicant ‘unable to carry out the inherent requirements of the job’.

It is foreseeable that, where even a remote risk of sudden death or incapacitation would be unacceptable, aerospace employers could meet this test, and legally apply genetic testing to their pre-employment medical assessments.

1310 - 1450 (SESSION 7) “IF BEETHOVEN HAD BEEN KILLED IN A PLANE CRASH AT THE AGE OF 22, IT WOULD HAVE CHANGED THE HISTORY OF MUSIC AND OF AVIATION” – TOM STOPPARD

Human factors, crew resource management and human error: what healthcare can learn from aviation and vice versa - Dr Bernard Kelly

There are similarities between the environment of Safety Critical Areas in Healthcare and the Cockpit and other areas in the Aviation Industry. In Healthcare, Safety Critical Areas include but are not limited to Operating Theatres, the Intensive Care Unit and Accident and Emergency. In many areas Healthcare compares poorly to the Aviation Industry. Due to the high levels of death (third highest cause of death in the USA) and injury attributable to human error, there exists the potential for significant gains in safety.

This presentation will outline some of the efforts that are being made to introduce a Human Factors program into Safety Critical Areas and Healthcare including attempts to standardise across the Public and Private Sectors. This presentation will explore the possibility of collaboration that could benefit both industries.

Bringing AvMed specialisation and safety investigation together: past and future challenges - Heather Fitzpatrick

In some safety investigations, it's often important to consider aviation medical factors including crew pre-existing injuries and illness, their health and fitness (incl. the regulatory and operational systems and processes behind this), interpretation of pathology information, risks of crew incapacitation, physiological limitations, survivability including the effectiveness and suitability of safety equipment used and many other aspects. Gaining specialist input to explore these matters is of course critical. This presentation will discuss some recent investigations where examination of medical factors was undertaken. It will also discuss ways the ATSB is intending to enhance its capability to examine medical aspects during investigations.

Panel: Aviation accident investigation: human factors, and the role of the aviation medical examiner – Greg Hood (ATSB), Dr Shelley Robertson (Forensic Pathologist) and Capt Nathan Koch (Qantas)

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1510 - 1630 (SESSION 8) IT’S A MIXED BAG

Awake brain surgery versus piloting an aircraft - Dr Vini Khurana

The ‘miracle of flight’ and the ‘miracle of awake brain surgery’ have numerous similarities in their achievement, each building on innumerable person-years of invention, trial, error, and considered refinement. Having had an opportunity to be part of “both sides” as medical practitioners and pilots, we aimed to compare them and characterise what we have learned thus far in this journey. Our method of comparison is based on our cumulative personal and professional experience, gained and applied systematically and in the context of the current medical literature. We have found that the similarities between carrying out awake brain tumour surgery and piloting an aircraft far outweigh any material differences beyond the physical setting and stakeholders. The comparison can be characterised via six ‘T-factor” groups which we refer to as training, technique, technology, teamwork, terminus, and tuning. We believe that the factors comprising each of these groups underpin an ability to optimise performance and safety in the medical and aviation/aerospace sectors. Our presentation will detail and depict what comprises each of these T-factor groups, how they compare between the medical and aviation/aerospace sectors, and what the former has learned and can continue to glean from the latter. We believe that lessons learned in aviation have broad and important applications in public health medicine.

Incidence of melanoma in commercial pilots in Australia - Dr Catherine Olsen

Occupational exposure to cosmic and/or UV radiation may increase the risk of melanoma in commercial pilots. A recent meta-analysis showed a higher incidence of melanoma in pilots globally compared with the general population; however, all available included studies were conducted in the Northern Hemisphere. There are no published epidemiological data on melanoma incidence in pilots from the Southern Hemisphere. We therefore aimed to examine if commercial pilots in Australia have a raised incidence of melanoma compared with the general population. We examined melanoma incidence in all pilots holding a Class 1 medical certificate in 2011-2016 by manually reviewing de-identified data in the medical records system of the CASA. Their age-specific incidence rates were compared with corresponding population rates obtained from the AIHW using standardised incidence ratios (SIRs) as measures of relative risk. Expected numbers were calculated by multiplying age- and calendar period-specific person-years (PYs) with corresponding rates from the entire Australian population; 95% confidence intervals were calculated assuming a Poisson distribution of the observed cases. In this national cohort of commercial pilots, 114 developed a melanoma (confirmed by histology) during 97,549 PYs (51 invasive, 63 in situ). More than 50% of the melanomas occurred on the trunk, and the predominant subtype was superficial spreading melanoma. The SIR for invasive melanoma was 1.1 (95%CI 0.89-1.4) and for melanoma in situ, 1.2 (95%CI 0.9-1.6). Our findings are fully representative of current commercial pilots in Australia and show no elevation of risk of melanoma compared with the general population.

Managing substance use disorder in a remote environment - Capt Laurie Shaw and Hylton Ward

For pilots diagnosed with Substance Use Disorder, there can be significant challenges in regaining and maintaining a CASA medical certificate, especially in remote areas. Pilots left in isolation to manage this insidious disease often find themselves shunned by their colleagues and the general community which only exacerbates an already lonely position.

Industry involvement and participation via the Human Intervention Motivation Study (HIMS) process through education, awareness and peer monitoring serves to improve safety and the well-being of the

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individual concerned. The HIMS methodology employs a collaborative trust and accountability culture between the individual pilot, his peer monitor (or mentor), his employer, family and friends and CASA.

This presentation will focus on peer support and monitoring for a pilot based in a remote area without the resources available for pilots employed by organisations that have medical and peer support facilities available inhouse. Your speaker will convey first hand his journey of recovery from near hopelessness to now CEO of a successful General Aviation Company.

Managing Substance Use Disorder in aftercare requires strong commitment, honesty and trust from the both the pilot and his human connections to monitor and support his recovery process and assist CASA with medical recertification.

By employing structured, yet flexible strategies for pilots in remote areas, this insidious disease can be managed very effectively to not only satisfy regulations, but also reflect the community expectations of safety that Australians are accustomed to.

Drones in society: the benefits and the liabilities - Prof Ron Bartsch

There is no doubt that drone technology and applications can provide enormous benefits to society – not the least within a medical context. Professor Bartsch explores the opportunities that this new form of aircraft can provide to society and how Australia is uniquely placed to lead the world in their applications. There are, however, impediments to the uptake of this technology and accompanying hazards and liabilities that need to be effectively managed if these benefits are to be realised. Professor Bartsch has spent the past 35 years in the aviation industry and his recent thesis on the legal aspects of drone operations has uncovered some significant and interesting findings that he will share with the audience.

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