Document 6424816

Transcription

Document 6424816

Dear members, dear colleagues, dear friends,
I am proud to present to you today the programme for our European Congress of
Aerospace Medicine “ ECAM - 2008”.
My special thanks go to our Hungarian colleagues and the ESAM conference
committee who made this congress possible. It is proof of how cooperation
between the European aerospace medicine associations can lead to an exchange
of scientific and practical knowledge of the highest international standard.
Roland Vermeiren
President of ESAM
From the ideas of a few pioneers on the need for a common European Society
of Aerospace Medicine - just 3 years ago - to the ESAM of today with its 31
member associations representing about 3,400 professionals, impressive
progress has already been made. We are now legally registered, have our website,
our scientific advisory board, meetings at international congresses and are now
also holding our congress. In the meantime we are developing close relations with
our international friends such as AsMA and IAASM.
It is our common task to further develop ESAM into a strong and acknowledged
scientific and pan-European partner with a view to improving the safety and health
of all involved in aviation and space operations.
We can do it if we work together.
Kind regards, amicaliter,
ESAM
The European Society of Aerospace Medicine
Under the Patronage of
Distinguished Ladies and Gentlemen,
We would like to extend our warm welcome to all the participants of the ESAM
Budapest. Since 1993 Hungary hosted a number of significant meetings on the
field of Aerospace Medicine, the National Transport Authority is proud to support
this Conference as well. We hope that this meeting will provide all of You again the
best of Science with the well-known Hungarian hospitality.
Zsolt Csaba Horváth
President
National Transport Authority
József Vágó
Director
Directorate of Air Transport
The Exclusive Sponsor of
European Conference on Aerospace Medicine
Budapest 2008
Dear Delegates,
On behalf of HungaroControl Hungarian Air Navigation Services Pte. Ltd. Co. – as
the exclusive sponsor of the event – I am glad to welcome you at the European
Conference on Aerospace Medicine in Budapest. I hope that with our support
the efforts of the Association of Hungarian Aerospace Medicine will result in a
successful professional gathering.
Dr. Laszlo Kiss
I understood that at this year’s conference you have a special focus on the medical issues regarding the air traffic control operations. As part of our Corporate
Social Responsibility Program, HungaroControl strives to ensure to its employees
the access to the highest level of medical attention. This year we have taken a
new initiative by extending this service to the field of psychological assistance in
handling stress.
CEO HungaroControl Pte. Ltd. Co.
I hope that besides the professional program you will also have a chance to
see some of the sights of our beautiful capital, and enjoy the famous Hungarian
hospitality. I wish you a successful conference and a great time in Hungary.
Best regards,
Dr. Laszlo Kiss
CEO HungaroControl Pte. Ltd. Co.
European Conference on Aerospace Medicine
12th – 15th November 2008 BUDAPEST
ECAM Scientific Conference
Thursday 13th November 2008
Registration 08:00 - 18:00
HungaroControl Conference Centre
9:00 - 9:30
Opening Ceremony
9:45 – 11:00
Keynote Presentations
Chair: H. Pongratz G. Hardicsay
No 1.
PANDEMIC PREPAREDNESS PLANNING IN AVIATION – THE ROLE OF AIRPORT PERATORS
W Gaber, R.Gottschalk
No 2.
CORONARY REVASCULARISATION 2008. - OVERVIEW
David Becker and Béla Merkely
11:00 – 11:30
Break
11:30 – 13:00
Passenger health and medical evacuation
Chair: M. Bagshaw and S. Ries
No 3.
DOC ON BOARD - MEDICAL EMERGENCIES ON BOARD COMMERCIAL AIRCRAFT
J. Huber, G. Huber, D. Gabriel
No 4.
LESS HYPOGLYCEMIC EVENTIS WITH EXENATIDE IN TYPE 2 DIABETES
F. Strollo, M. Morè, M. Corigliano, G. Corigliano and G. Strollo
No 5.
AIR EVACUATION UNDER BIOSAFETY CONTAINMENT OF PATIENTS WITH HIGHLY CONTAGIOUS INFECTIOUS
DISEASES
M. Lastilla, P. Tosco, R. Biselli, O. Sarlo
No 6.
FAINTING PASSENGERS: THE ROLE OF CABIN ENVIRONMENT
R. Simons, H. de Ree
No 7.
THE AEROTOXIC SYNDROME
M. Bagshaw
No 8.
THE PERFORMANCE OF BLOOD PRESSURE MEASURING DEVICES AT GROUND LEVEL AND AT 8,000ft
M. F. Hudson
13:00 – 14:00
Lunch
14:00 – 15:30
Aircrew health I
Chair: C. Stern, H.-W. Teichmüller
No 9.
WOULD YOU FLY WITH THIS PILOT AFTER TRAUMATIC BRAIN INJURY (TBI)
A. Martin St Laurent
No 10.
FUNDUS IMAGING IMPROVES EFFICACY AND SAFETY OF MEDICAL EXAMS
R. Quast, H. Wilhelm
No 11.
VISUAL OUTCOME AFTER CORNEAL REFRACTIVE SURGERY
C. Stern, G. Kluge
No 12.
CORNEAL REFRACTIVE SURGERY AMONG HUNGARIAN PILOTS FROM 2001 TO 2008
L. Ungváry
No 13.
MESOPIC CONTRAST SENSITIVITY IN A YOUNG POPULATION
B. Haughom, T.-E. Strand, I. Berg
No 14.
AEROMEDICAL CERTIFICATION IN PROGRESSIVE MITRAL VALVE PROLAPSE
E. Cataman, A. Batrinac
15:30 – 16:00
Coffee break
16:00 – 17:00
Aircrew health II
Chair: L. Tjensvoll, E. Cataman
No 15.
OVERWEIGHT IN MILITARY PILOTS AND WSOS IN GERMANY 1977-2006
H. Glaser
No 16.
FRAMINGHAM CORONARY RISK FACTORS AT MALE AVIATION PERSONNEL –
COMPARISON WITH NON AVIATION POPULATION IN SLOVAK REPUBLIC
P. Daxner
No 17.
PSYCHOLOGICAL DIAGNOSTICS OF FOREIGN AIR STAFF IN AIR MILITARY HOSPITAL
J. Mayerova, E. Slovenska, M. izmárik
No 18.
NEUROCOGNITIVE PERFORMANCE IN AIRCREW IN TREATMENT WITH
ANTIDEPRESSANT SSRIS AND SNRIS
S. Izzo,. G. Arduino, E. Velardi,. S. Mosticoni
17:00 – 18:00
Poster – Inspection & Discussion
Friday 14th November 2008
9:00 – 10:30
Hypoxia
Chair: A. Wagstaff, H. Pongratz
No 28.
CONSIDERATIONS CONCERNING PRACTICAL HYPOXIA TRAINING FOR COMMERCIAL AIRCREW
R. Simons (Intro by Virgilijus Valentucevicius ESAM) (30 min and 15 min discussion)
No 29.
CARDIAC ARREST DURING HYPOBARIC CHAMBER EXPOSURE AT A YOUNG PILOT
M. Anghel, I. Capanu, M. Muresan
No 30.
RESISTANCE ASSESSMENT TO HYPOBARIC-HYPOXIC STRESS THROUGH SIMULTANEOUS MONITORING OF THE
ECG RECORDING AND OXYGEN SATURATION
I. Capanu, D. Vlad, S. Berbecar
No 31.
HYPOXIA AWARENESS: THE PRESENT AND FUTURE OF HYPOXIC TRAINING OF HUNGARIAN MILITARY AIRCREW
S. Szabó, A. Grósz, Zs. Tótka
10:30 – 11:00
Coffee Break
11:00– 12:30
Regulations
Chair: R. Vermeiren, V. Valentukevicius
No 23.
MEDICAL REQUIREMENTS FOR LEISURE PILOT LICENCE
V. Valentukevicius (with discussion 30 min)
No 24.
IMPLEMENTATION OF EU DIRECTIVE « NOISE » INTO GERMAN LAW AND CONSEQUENCES FOR FLIGHT CREWS
D.-M. Rose, H.-J. Kimpflinger, M. Vierdt, J. Hedtmann
No 25.
EVALUATING WHOLE BODY VIBRATION LEVELS IN MILITARY AND CIVILIAN HELICOPTERS ACCORDING TO LEVELS
DEFINED BY EC (2002/44/EC)
J. I. Kåsin, A. Wagstaff
No 26.
NEW REGULATIONS OF EASA NPA 2008-17C, PRACTICAL OPHTHALMOLOGICAL ASPECTS
G. van Setten
No 27.
THE ‘IRISH’ VIEW ON THE NEW REGULATIONS FOR MEDICAL CERTIFICATION. WILL IT ALL CHANGE?
A. Roodenburg
12:30 – 13:30
Lunch
13:30 – 14:30
Special senses and aviation medicine
Chair: A. Wagstaff, G. Hardicsay
No 19.
VESTBULAR ANALYZER AND DESORIENTATION IN SPACE OF MILITARY PILOTS
M. Spahieva, L. Aleksiev, A. Petkov, K. Kanev
No 20.
THE ITALIAN AIR FORCE (ITAF) EXPERIENCE ON SPATIAL DISORIENTATION TRAINING
M. Lucertini, P. Trivelloni, O. Sarlo
No 21.
TINNITUS AND HEARING IN A NORWEGIAN AIRLINE PILOT POPULATION
A. S. Wagstaff, P. Blum
No 22.
EFFECTS OF HYPOXEMIC HYPOXIA ON PATTERN REVERSAL VISUAL EVOKED POTENTIALS (VEPs)
D. di Blasio, G. C. Appiani, A. Carboni, N. Pescosolido
14:30 – 15:00
Break
15:00 – 16:30
Would You Fly with this Pilot? Case discussions’
Moderator: Gabor Hardicsay
16:30 – 16:45
Closing Remarks
Posters
Thurday / Friday 13th -14th November 2008
No 32.
ASSESSMENT OF PUSH-PULL EFFECTS:
A NEW PROCEDURE BASED ON A TEXTILE WEARABLE SYSTEM FOR VITAL SIGNS RECORDING
A. G. Guadagno, S. Cacopardo, P. Trivelloni, F. Rizzo, P. Meriggi, M. di Rienzo
No 33.
INJURY- AND FATALITY-RATES IN GERMAN GENERAL AVIATION ACCIDENTS – A FIVE YEAR REVIEW
C. Neuhaus, M. Dambier, E. Glaser, J. Hinkelbein, H. Pongratz
No 34.
ADVANCED CORONARY DIAGNOSTICS: MULTI-DETECTOR COMPUTER TOMOGRAPHY (MDCT) TO
DIAGNOSE CORONARY HEART DISEASE (CHD) IN MILITARY PILOTS
C. Wonhas, J. Hausleiter, C. Ledderhos, S. Martinoff, A. Schömig
No 35.
DEVELOPING A METHOD FOR THE QUANTITATIVE ASSESSMENT OF G-MEASLES
C. Ledderhos, B. Debrabant, K. Debrabant, R. Mörlin, A. Gens
No 36.
COMPARISON OF STUDIES ON GENERAL AVIATION ACCIDENTS IN DIFFERENT COUNTRIES USING
THE HFACS MODEL C.
J. Hinkelbein, M. Dambier, E. Glaser, C. Neuhaus, H. Pongratz
No 37.
A SIMPLE TECHNIQUE FOR GRAVITY SIMULATION (+1GZ, 0GZ, AND -1GZ)
DEMONSTRATES COMPROMISED LUNG FUNCTION
C. Neuhaus, M. Dambier, E. Glaser, J. Hinkelbein, H. Pongratz
No 38.
POSSIBILITIES FOR THE DETECTION OF IN-FLIGHT HYPOXIA – PULSE OXIMETRY
C. Ledderhos, A. Gens, G. Rall
No 39.
MEASURING PSYCHIC STRESS WITH BIOLOGICAL DATA
A. Grósz, E. Tóth, Á. Szatmári
No 40.
SIGNAL DETECTION IN HYPOBARIC HYPOXIA - A STRESS SITUATION
A. Grósz, E. Tóth, Á. Szatmári
No 41.
MARKOV STATE TRANSITION MODELS FOR THE PREDICTION OF CHANGES IN SLEEP STRUCTURE
INDUCED BY AIRCRAFT NOISE
M. Basner, U. Siebert
No 42.
THE PROBLEM OF A“HUMAN FACTOR” UNDER EXTREME AVIATION CONDITIONS
S. T. Mammadova
No 43.
PRECANCEROUS SIGNS IN THE MOUTH DETECTED DURING MEDICAL FITNESS EXAMINTIONS OF
COCKPIT AND CABIN CREWS
Z. Pácz, I. Melles
No 44.
STRESS RELATED SYNDROMES: A NEW NOSOGRAPHIC APPROACH TO THE PSYCHIATRIC
DISFUNCTIONS IN AIRCREW
G. Arduino, S. Izzo, D. Abbenante
No 45.
RESPIRATORY CO2, AS A PHYSIOLOGICAL AND NEURAL-PERCEPTION INDICATOR OF PILOTS’ VISUAL
MANAGEMENT, IN AVIATION-A REVIEW.
J. Sharma
ABSTRACT No 1.
Title: PANDEMIC PREPAREDNESS PLANNING IN AVIATION – THE ROLE OF
AIRPORT OPERATORS
Author(s) Name: W GABER (1), R.GOTTSCHALK (2)
Introduction:
Pandemics move as fast as the vectors that spread them. In the case of human infectious diseases,
spread via ships has been replaced almost completely by todays air traffic. Therefore public health
services across the world must focus their attention on the problem of epidemics being spread via
this means of transport. The global reach of flight connections is based on many non-stop routes
and only a few so-called hubs where up to 50% of their passengers connect. These hubs thus
represent the pivotal points in international air traffic.
Methods:
Since the main risk of pandemic influenza was, and remains, centred in Asia, the initial work was
undertaken in this region. A workshop was held in Singapore that brought together representatives
from different expert groups to develop a preparedness plan, including the WHO, ICAO, IATA,
CDC, FAA, ECAC and ACI. Work under the leadership of ICAO has now also commenced in Africa
and will be extended to Europe.
Results:
Guidelines for developing a national preparedness plan for aviation were developed that
coordinated the views of several different organizations. In particular, it was found that
communication and coordination between the national public health and aviation authorities is
essential to develop a satisfactory national preparedness plan, but in most States is still not
adequately developed. The role of the World Health Organization International Health Regulations
(2005) was found to be especially important.
Conclusion:
The concept of management of highly contagious and life-threatening diseases must continuously be
adjusted to the specific circumstances of air traffic. Apart from development of procedures and
checklists for all involved in the process, the provision of quarantine places in a sufficient number
(scenario: Airbus A 380 X, > 550 passengers; one patient suspected of having a highly infectious
disease) is a necessity.
Regular national and international exchange of coordinated information is essential and should be
organized under the auspices of the WHO.
Consequences of public health measures are immense and will quickly overwhelm even a major
airport and the logistics of the health authorities.
Name and address for correspondence: Dr. W. Gaber, Fraport AG, 60547 Frankfurt Airport
Telephone No.: 069-690-66031
Fax No.: 069-690-59642
E-mail: [email protected]
Date: 12.08.2008
ABSTRACT No 2.
Coronary revascularization 2008
- Overview A uthor(s) Name: David Becker and Béla Merkely
Semmelweis University Heart Center, Budapest, Hungary
Introduction:
Coronary artery disease is a leading cause of mortality and morbidity in the developed world.
Treatment of ischemic heart disease/coronary artery disease consists of adequate primary and
secondary prevention, control of symptoms (e.g. medications, as well as PCI or CABG for
angina) and in acute cases (like STEMI/NSTEMI) urgent revascularization of
stenosed/occluded coronary vessels. Risk factors of coronary artery disease have to be
examined and treated even in asymptomatic individuals with lifestyle-changes and
medications. After suffering an acute ischemic event, secondary prophylaxis is needed with
more strict decreases in blood pressure and lipid levels along with lifestyle changes. Not only
lifestyle changes and medications are available for these patients as mentioned earlier.
Revascularization with the implantation of stents (PCI) or by CABG surgery can be offered
for these patients, as well.
Methods and Results:
We can separate the patients according to their clinical presentation, and so we might divide them
into three major groups. 1: Stable symptoms (effort angina, dyspnea etc.); 2. UA/NSTEMI; 3.
STEMI patients. There is a different approach in all three patient groups.
Group 1: Coronarography might be indicated for diagnostic purposes (according to the ESC
Guidelines, 2007).
Class I. indications are (level of evidence): EAP CCS III, high probability of CAD,
especially if not adequately responding to meds (B); Survivors of cardiac arrest (B); Serious
ventricular arrhythmia (C); Previous PCI or CABG and moderate or severe EAP (C). High risk
patients by noninvasive tests, even if mild or moderate symptoms (B); EAP CCS III, high
probability of CAD, especially if not adequately responding to meds (B); Prior to major surgery,
especially vascular ones with intermediate or high risk features on noninvasive tests (B).
Class IIa. indication (level of evidence): Inconclusive noninvasive test(s), mod-high
probability of CAD (C); Patients with high risk of restenosis after PCI with important site
prognostically (C). Coronarography might be indicated for risk assessment in this patient group.
After the invasive test, a decision can be made regarding revascularization strategy – either PCI or
CABG can be used, according to the number of involved vessels, the presence or absence of
diabetes and whether normal or decreased left ventricular function is present.
The decision is influenced also by patient comorbidities (general status for surgery) and
the patient wishes. The role of PCI in stable, effort angina patients vs optimal medical therapy was
looked at by the COURAGE trial which showed equal results with medical treatment regarding
risk of death, myocardial infarction, or other major cardiovascular events, however less angina and
less subsequent revascularization was present in the PCI group during follow-up. Another study,
the Syntax study evaluated patients with LM (+1, 2 or 3 vessel) and triple-vessel disease (without
LM involvement) who underwent either drug eluting stent(s) implantation or CABG surgery. The
only significant differenc was a decreased risk of stroke in the PCI gourp at 1 year, but an
incresed risk of repeat revascularization in the PCI group. This brought total MACCE events in
favor of CABG surgery mainly driven by the high repeat revascularization in the PCI group. On
the other hand, if one looked at LM and LM+1 vessel disease, one year outcome was better for
the PCI group. In diabetics, CABG was more favorable.
Group 2: (UA/NSTEMI) coronarography/PCI is indicated by the ESC Guidelines according to
the clinical scenario, by using certain criteria (e.g. ongoing/recurrent ischemia; malignant
arrhythmia or hemodynamic instability makes a patient high risk; while the presence of decreased
ejection fraction, prior revascularization, positive Troponin, renal inssufficiency etc. moves the
patient into the moderate risk group), we can risk stratify the patient into high, moderate or low
risk. In the first group urgent coronarography/PCI isr ecommended; in the second group it is
indicated within 72 hours, while in the low risk group an invasive strategy should be followed
only if ischemia is proven.
Group 3: STEMI patients should be treated by PCI if symptoms are within 12 hours and it can
perfomed within 90 minutes. Exceptions are patients with cardiogenic shock, where PCI can be
performed if symptom onset is within 36 hours. After thrombolysis a coronarography is
indicated. If the lysis is successful, then within 24 hours; if unsuccessful, then as soon as
possible.
Follow-up
Regular follow-up with exercise stress test is indicated at 1-3-6-12 months and then yearly,
unless symptoms develop. Echocardiography is indicated according to the patient clinical
condition and prior echocardigoraphy results.
Name and address for correspondence: David Becker, Semmelweis University Heart Center,
1122. Városmajor u. 68 Budapest, Hungary
Telephone No.: +36-1-458-6810
Fax No.: +36-1-458-6842
Date: 15.09.2008
ABSTRACT No 3.
Title: DOC ON BOARD - MEDICAL EMERGENCIES ON BOARD COMMERCIAL
AIRCRAFT
Author(s) Name: Joachim Huber, Gustav Huber, David Gabriel
Introduction: At this very moment, approx. 1 million people around the
world are in the air. IATA airlines transport 2,000 million people
annually.
The total number of fatalities on the 250 IATA airlines is approx.
2500 a year.In spite of this, there has been no emergency medical provision un
now for the approx. 350 passengers who suffer acute illnesses each day.
Methods: What are the most common emergencies? What equipment is available on
board? What is the legal position? How do flight crews regard medical emergenc
and communication with these assistants? Are these assistants
(physicians/emergency paramedics) authorised to request a stopover? Who bears
responsibility and who meets the costs? What is the limit of
the paramedics’ competence in an emergency?
Results: In 2004, MTE - Medical Training Europe – initiated the “DOC ON BOARD”
project in collaboration with Austrian Airlines.
Physicians and emergency paramedics are specially trained to deal
with medical emergencies on board and are available
to provide skilled assistance to crews even during their private journeys.
On about 50% of all flights, there is a doctor, emergency paramedic or firstattendant present on board by chance and, according to European law, they are
obliged - even as passengers - to offer assistance.
Conclusion: This lecture presents the initial results of training
sessions, the experiences of physicians and paramedics, and reports on the lim
and future possibilities for First Aid
on board commercial aircraft.
Name and address for correspondence: Dr. Joachim Huber, A-1020 Wien, Heinestrasse 36
Telephone No.:+43/664/3017966
Fax No.: +43/1/2166007
E-mail: [email protected] Date: 30.06.2008
No 4. ABSTRACT
ABSTRACT No 4.
Title: LESS HYPOGLYCEMIC EVENTIS WITH EXENATIDE IN TYPE 2 DIABETES
Author(s) Name: F. Strollo, M. Morè, M. Corigliano, G. Corigliano and G. Strollo,
Introduction: One of the most threatening events in diabetic pilots is hypoglycemia,
especially if abrupt and under unawareness conditions. Sometimes the fear for
“hypo’s” puts AME’s into troubles and makes life less comfortable to patients too.
In fact, pilots suffering from type 2 diabetes mellitus (T2DM) may even experience
a progressive loss of self-confidence which may eventually lead to off-nominal
attitudes, like taking less pills or eating more to try and keep always above the
optimal glucose range and thus prevent hypoglycemia. A new drug, called
exenatide, seems to ameliorate glucose metabolism while preventing hypoglycemic
attacks. The aim of this study was to verify whether the rate of hypoglycemic
episodes might be really reduced in diabetic subjects treated with the new drug.
Methods: 30 men with T2DM switched from glibenclamide 7.5 mg + metformin
1200 mg per day to 10 mcg exenatide s.c. b.i.d. + lower daily doses of those two
drugs for 3 months without changing their diet habits. Daily glucose profile,
HbA1c and “hypo” events were recorded before and 3 months after the switch.
Results: During the new treatment regimen, HbA1c, mean glucose levels and the
rate of hypo’s decreased significantly (p<0,05).
Conclusion: Exenatide seems safe enough in T2DM and may be adviced for pilots,
who are engaged in a job potentially “dangerous” for their own and others’ lives.
Name and address for correspondence: Felice Strollo, M.D. Prof., INRCA-IRCCS, Via
Cassia 1167, 00189, Roma, Italy
Telephone No.: +39.06.30342534
Fax No.: +39.06.30342534
Date: June 28, 2008
ABSTRACT No 5.
Title: Air Evacuation under Biosafety Containment of Patients with Highly Contagious Infectious
Diseases
Author(s) Name: M. Lastilla*, P. Tosco**, R. Biselli**, O. Sarlo**
Introduction: Every year we have epidemics due to new-emerging or re-emerging highly contagious infectious
diseases, such as SARS, Marburg fever, pandemic avian flu, etc. Global travel, military contingency operations in
tropical environments and potential use of biological weapons by bioterrorists may place many people at risk for
potentially lethal contagious diseases. In order to evacuate such kind of patients by military aircraft reducing to
a minimum the risk for transmission to air crews, caregivers, and civilians, since 2005 the Health Department of
Italian Air Force formed the “Aeromedical Isolation Team” (AIT).
Methods: This is a rapid response team that can deploy to any area of the world, foreign or domestic, to transport
and provide medical care under high containment to a limited number of patients exposed to, or infected with
highly contagious, potentially lethal pathogens. For this duty, AIT includes two teams, each comprised of ten
people (three physicians and seven nurses) and two Aircraft Transit Isolator (ATI) systems. This isolator
completely separates the patient in a negative pressure envelope that protecting the accompanying medical team
and the surrounding environment. Half suits and gloved sleeves incorporated in the envelope walls enable the
attendants to examine and care for the patient. A battery powered air supply unit draws air through two inlet
microbiological (HEPA) filters into the envelope and exhausts it through a similar filter at the foot end.
Results: In January 2005 Italian Air Force AIT carried out its first transportation of a contagious patient using
an isolator system. The patient suffered from multidrug resistant (MDR) Tuberculosis, an infectious disease
transmitted by air way, more severe for the high resistance at medical treatment, and was transferred from
Alghero Airport, in Sardinia Island, to Linate Airport, in Milan, by Lockheed C-130J aircraft. The flight lasted
one hour in comparison with estimated twelve hours by ambulance and boat. The organization of Italian Air
Force AIT is basically founded on the model of U.S. Army Medical Research Institute of Infectious Diseases
(USAMRIID) AIT. In the second operative mission, in May of this year, Aeromedical Isolation Team was deployed
to Turin for a patient suspected of having a Congo-Crimea fever, after returning from Nepal where a tick bite
could be the reason of the disease.
The patient was moved aboard a C130J from Turin to Spallanzani Hospital in Rome, in order to manage the
patient in a BSL4 isolation facility and about the model of preparedness and response to highly contagious
infectious diseases, in Italy Spallanzani Hospital at the present time is the golden choice (together Sacco
Hospital in Milan). The patient died the day after, and the diagnosis of hemorrhagic fever was not confirmed by
laboratory test, but probably the hemorrhagic syndrome was due to a fulminant epatitis by Herpes virus.
The third deployment was three months ago, in July 2007, for a mission comparable to the first, this time for a
Congo citizen, living in Italy, always with multidrug resistant tuberculosis, transferred from Sardinia to
Bergamo, with destination the same Hospital near Milan specializing in tuberculosis
Conclusion: At the present, Italian and US teams are using the same procedures, training and equipments, and
this similar capability is a good starting point for a future collaboration in operational scenarios
Name and address for correspondence: Major Marco Lastilla, ITAF Health Department, Viale P. Gobetti, 2A 00185
Rome, Italy
Telephone No.: +390649865389
Fax No.: +390649864970
Date: 10 lug. 2008
ABSTRACT No 6.
Title: Fainting
Passengers: the Role of Cabin Environment
Author(s) Name:
Ries Simons, TNO Human Factors, Soesterberg, Netherlands
Hans de Ree, KLM Health Services, Schiphol Airport, Netherlands
Introduction:
Reported percentages of in-flight medical incidents caused by syncope
vary between 15% and 22%. Syncope is usually a benign medical event, but it may cause
fear and distress among passengers and the individual involved. Incorrectly diagnosed
benign syncope may lead to unnecessary flight diversions. In this context, the
incidence of in-flight syncope and possible relationships with cabin environmental and
passenger factors were studied.
Methods: In September 2005 questionnaires were handed out to the senior purser on
all KLM long haul flights. Pursers were asked to record all cases of in-flight syncope
and to answer questions concerning cabin climate. Literature data were analyzed
concerning in-flight and passenger factors that may cause or elicit syncope.
Results: With a response rate of 79%, 1625 forms were analyzed. The in-flight syncope
risk was 3-9 per 1000 passenger flight hours, depending on type of aircraft. The
frequency of syncopal events was weakly correlated with cabin climate conditions.
Literature analysis provides evidence that hypoxia is a sufficient cause for syncope
in a sub-set of healthy airline passengers. There is evidence that cabin pressure and
temperature may contribute to the occurrence of syncope.
Conclusion:
The syncope risk appears to be higher aboard an aircraft than on the
ground. Hypoxia is a sufficient cause for syncope in a sub-set of healthy airline
passengers. Airline passengers may become considerably hypoxic due to reduced
pulmonary ventilation caused by immobility, drowsiness, and gastro-intestinal
distension. In-flight hypoxia may reach levels sufficient to cause syncope. High cabin
temperature may further trigger this reaction.
Name and address for correspondence:
Ries Simons MD, TNO Human Factors – P.O. Box 23, 3769 ZG Soesterberg, Netherlands
Telephone No.:+31 346 356485
Fax No.: +31 346 354977
Date: 02-07-2008
ABSTRACT No 7.
Title: The Aerotoxic Syndrome
Author(s) Name: Professor Michael Bagshaw
Introduction: There has been an increased number of reported incidents of in-flight
smoke/fumes events since 1999, particularly in the UK, with a small number of crew
members reporting adverse health effects which they associate with the events. There is
wide interest in the UK media and at political level. However, the epidemiological evidence
is hampered by inconsistency in reporting and the numbers are small.
Methods: An empirical review of the prevalence and the reported symptoms and signs was
conducted, together with consideration of the known toxicology of cabin air constituents.
Results: There is wide disparity in reported symptoms and signs. Many of the symptoms
and signs are consistent with other medical conditions and are known to be experienced on
a daily basis by the normal population. A number of the tests employed to reach a diagnosis
are lacking in objectivity and scientific validity.
Conclusion: The evidence does not support the establishment of a new medical condition,
the so-called aerotoxic syndrome. However, there is known to be genetic variability in
individual sensitivity to chemical exposure and the aeromedical profession must remain
vigilant.
Name and address for correspondence: Prof M Bagshaw, 3 Bramley Grove, Crowthorne,
Berkshire, RG45 6EB, UK
Telephone No.: +44 7766 022158
Fax No.: +44 1344 775647
Date: 19 August 2008
ABSTRACT No 8.
Title: THE PERFORMANCE OF BLOOD PRESSURE MEASURING DEVICES AT
GROUND LEVEL AND AT 8,000ft.
Author(s) Name: M F Hudson, Medical Adviser Thomas Cook Airlines,: J Ernsting King’s College
London
Introduction: The blood pressure measuring device included in the majority of on board
medical kits is an aneroid sphygmomanometer which requires a trained operator.
Commercial Airlines are considering changing to an automatic sphygmomanometer that
can be used by untrained personnel. The performance of a Littman aneroid
sphygmomanometer and an Omron M5-I at ground level and an altitude of 8,000ft have
been studied.
Methods: Ten healthy volunteers aged between 21 and 63 were seated at rest breathing air
in a hypobaric chamber and their blood pressures repeatedly determined using the
aneroid and automatic devices together with orthodox Mercury sphygmomanometry. The
measurements were made by four trained observers at ground level and at 8,000ft. Each
of the three measurements on each subject at each altitude with the device were bracketed
by four orthodox measurements.
Results: The mean (+/-SD) systolic and diastolic pressures of the 10 subjects at ground
level (orthodox method) were 115.7 +/- 7.5 and 75.6 +/-5.5 mm Hg. Compared with the
orthodox values the mean systolic/diastolic pressures obtained using the aneroid device
were +1.52/ -1.11 mm Hg at ground level and 1.72/ -0.04 mm Hg at 8,000ft. The changes
in these differences between 0 and 8,000ft were not significant (P>0.2). The corresponding
mean differences when using the automatic device were +5.74/ -2.89 mm Hg at ground
level and 1.56/ +0.10 mm Hg at 8,000ft. The mean changes of 4.18/2.99 mm Hg with
ascent were significant (P<0.05)
Conclusion: Ascent to 8,000ft did not affect the accuracy of measurement of arterial
pressure using an aneroid device as compared with orthodox sphygmomanometry. A
small effect of altitude (3 – 4mm Hg) was found when using the automatic device, which is
of little clinical significance for medical emergencies occurring in flight. The replacement in
medical kits on aircraft of aneroid devices with an automatic device such as the Omron M5
I is justified and can be recommended. Real time measurements of the blood pressure taken
by untrained personnel, such as cabin crew, can provide valuable information to ground
based medical services which are currently used by most airlines in the management of
medical emergencies in flight.
Name and address for correspondence: Dr Martin F Hudson, MBBS, MRCP (UK), FRCP Edin, 7,
Swanwick Close, Goostrey, CW4 8NU Cheshire, UK
Telephone No.: +44 1477 532527
Fax No.: +44 1477 544059
Date: July 14th 2008
ABSTRACT No 9.
Title: Would you fly with this pilot after traumatic brain injury(TBI)
Author(s) Name: A. MARTIN St LAURENT
Introduction: TBI is a complex pathologic domain including mental and somatic
injury. At the time of the trauma dissipation of energy is responsible for the
cerebral lesions and the consequent neurological signs are dominated in loss of
motor and cognitive functions and in modification of psychological and behavior.
Among airmen the occurrence of TBI needs to adopt a physio -pathological
approach and to evaluate the post trauma sequellae after a clinical, electrical and
neuropsychological examination
Methods: We report two cases of head trauma among pilots during a roller blade
party. The AME analyses the initial lesions, taking into account GSC ( Glasgow
Coma Scale), loss of consciousness, PTA ( Post Trauma Amnesia ) TDM lesions. So
he may categorize the TBI and do the prognostication of the risk of PTE (Epilepsy).
Complete neurological examination exploring psychological, cognitive and
behavioral sphere is considered for a waiver to return to flying duties.
Results: TBI with moderate or severe gravity should be restricted from flying for
approximately 2 to 3 years to ensure that sequellae have disappeared. A request for
waiver requires complete assessment. One case of TBI was accepted to return to fly
after 3 y because of the loss of cortico -frontal substance, the risk of frontal
syndrome and PTE. The other case was grounded after 3 y of follow-up because mild
cerebellum deficit and cognitive defect at memory, attention and intellectual
efficiency test.
Conclusion: After TBI the AME has to consider the biomecanic phenomena that
caused cerebral damage. Evaluation before flying again includes physical,
neurological and cognitive expertise. But the risk of in-flight incapacitation by PTE
must be assessed and the possibility of depressed mood evaluated by a psychiatrist.
Name and address for correspondence: Dr A. MARTIN St LAURENT Alain
Aeromedical Center Roissy Continental Square, 3 place de Londres BP 11201
95703 ROISSY-CDG Cedex
Telephone No.:33(0)1 48 64 98 03
Fax No.: 33(0)1 48 64 17 43
E-mail:[email protected]
Date: 24 june 2008
ABSTRACT No 10.
Title: Fundus Imaging improves efficacy and safety of medical exams
Author(s) Name: Roland Quast / Helmut Wilhelm
Introduction: Purpose of the study: Examination of the ocular fundus requires both
skills and experience. For a non-ophthalmologist it is virtually impossible to evaluate
the ocular fundus with undilated pupils. We employed a non mydriatic fundus
camera and report our experience
Methods: We reviewed 956 consecutive photographs of 478 pilots taken with the
Nidek AFC-210 fundus camera equipped with a 12.8 megapixel digital camera
body (Canon 5D). This camera allows photographs at an angle of view of 45 or 37°
(adjustable), sufficient to image optic disc, macula and the major vessels
Results: On 904 of 956 photographs (94.5%) optic disc, macula, vessels and inner
30° of the retina could be assessed complete, on 43 (4.5%) images only disc and
vessels could be assessed, on 9 (1%) images the quality was too poor for
assessment of the optic disc. Repetition of those 9 photographs with dilated pupil
would have provided usable. The pathologic findings included markedly excavated
optic disc (7), definite glaucoma, not yet diagnosed (1), macular changes (7), other
pigment changes (3), optic disc drusen (2), choroidal naevus (1), myelinated nerve
fibres (1) suspected choroidal osteoma (1), vitreous deposits (1).
Conclusion: Even without pupil dilation fundus photography provided high quality
results in 94%. Only 1% of the images could not be evaluated sufficiently. The
number of pathologic findings was higher than expected according to our
experience. Fundus photography can be done by a technician, takes usually less
than 2 minutes per eye, does not require pupil dilation and has additionally the
advantage of a reliable documentation. Suspicious findings can be evaluated “off
line” by experts. Therefore this procedure increases both economy and quality of
medical licensing
Name and address for correspondence: Roland Quast
Aeromedical Center Germany, OPS-Gebäude, 70629 Stuttgart-Airport
Telephone No.:07117949466
Fax No.: 07117949467
Date: 30.07.2008
ABSTRACT No 11.
Title: VISUAL OUTCOME AFTER CORNEAL REFRACTIVE SURGERY
Author(s) Name: C.Stern, G. Kluge
Introduction: The aim of pilots or applicants who undergo refractive surgery is in most
cases a good visual acuity without visual aid. Therefore we were interested in the question
of how many patients do meet the 1.0 visual acuity criteria after the surgery. We were also
interested in the outcome of the near visual acuity after surgery because this is usually not
paid any attention to by the surgeons.
Methods: Refractive surgery leads to unfitness for flying after the European Requirements
JAR-FCL 3. We identified all pilots and applicants who came to our Aeromedical Center to
be reviewed to receive a waiver.
Results: 76 professional, private pilots or applicants with 145 treated eyes came from July
2001 to September 2007 to our Aeromedical Center. The first refractive procedures were
performed in 1988, the last in 2007. The highest treated myopia was -8.75 diopters, the
highest treated hyperopia was +7.75diopters and the highest treated astigmatism was 6.5
diopters. From the 145 treated eyes 59 (40.7%) eyes did not meet the uncorrected distant
visual acuity of 1.0. Of these 59 eyes 9 eyes were not correctable to 1.0 in the distance. In
30 eyes (20.7%) out of the 145 treated eyes the near visual acuity was not correctable to
1.0. Of these 30 eyes 25 eyes had a minimum visual acuity of 1.0 in the distance (corrected
or uncorrected).
Conclusion: 28 of the 76 patients need a correction to have normal visual acuity in the
distance. That means in 37% of patients the aim for the refractive surgery was not met. A
reduced corrected near visual acuity after refractive corneal surgery seems to go in most
cases along with corneal haze or other complications. It seems to make sense to send pilots
or applicants after refractive surgery with reduced best corrected visual acuity to an
Ophthalmological examination.
Name and address for correspondence: Dr. C. Stern; DLR; 51170 Köln, Germany
Telephone No.: 0049-2203-601-3368
Fax No.: 0049-2203-601-4776
Date: 24.07.2008
ABSTRACT
No 12.
No 12. ABSTRACT
Title: Corneal refractive surgery among Hungarian pilots from 2001 to 2008
Author(s) Name:L.Ungváry MD
Introduction: The purpose of this study was to describe the effect of corneal
refractive surgery on fit for aviation.We examined 110 applicants underwent
corneal refractive surgery from 2001 to 2008 . The complications and the results of
the different surgical methods were analised.
Methods:110 applicants were examined by the ophthalmologist . We use JAR
FCL3 requirements for the examinations and certifications.
Results: JAA Class1 (ATPL/CPL):17, Class 2 (PPL/steward):85, Class 3 (air
traffic controller):8 subjects were examined after corneal refractive surgery in our
Aeromedical Center in Budapest from 2001 to March 2008. The first refractive
surgery was performed in 1992. The types of the corneal refractive surgeries are:
PRK:92 LASIK:5 Intra LASIK:3 RK:8 LTK: 1.There was 1 therapic surgery for
map-dot-spot corneal dystrophy. The highest treated myopia was -8,5 diopters and
the highest treated hypermetropia was +6,0 diopters. No ophthalmologic
complications have occurred. The best corrected visual acuity was 1,0 for far and
for near.
Conclusion: There were no serious complication among our patients. There are
only 5 patients who have eyeglasses after the refractive surgery (4,7%). Based on
our experiences the refractive surgery among the well-selected population do not
has adverse effect on medical certification. We emphasise that all the pre- and
postoperative examinations should perform by the ophthalmologist.
Name and address for correspondence: Lilla Ungváry, Aeromedical Center Budapest
1097 Budapest Gyáli út 17.Hungary
Telephone No.:+36-702203148
Fax No.: +36-13580975
Date: 01/07/2008
ABSTRACT No 13.
Title: Mesopic Contrast Sensitivity in a Young Population
Authors: Bente Haughom, Trond-Eirik Strand, Irene Berg
Introduction: JAR-FCL requires that a candidate undergoing refractive surgery can be
considered fit for flying provided that glare sensitivity is within “normal standards ” and
mesopic contrast sensitivity is not “impaired ”. However, there is no standard examination
for measuring glare sensitivity, and no comparable population norms for mesopic (low
illumination) contrast sensitivity testing exists. Visual acuity measured by Snellens chart
can be acceptable even in persons with a disabling glare disability.
Methods: Mesopic contrast sensitivity, with and without glare, was measured as part of a
standard ophthalmological examination. We used sine wave gratings/FACT (Functional
Acuity Contrast Test) supplied by the Optec 6500, Vision Sciences Research Corp. Data
was collected from routine examinations of current civilian and military pilots at the
Norwegian Aeromedical Centre (AMC).
Results: Data from the contrast sensitivity examinations of about 150 candidates, mostly
males between 20-40 years, will be presented.
Conclusion: There is a need for comparable population norms to evaluate mesopic
contrast sensitivity. Refractive surgery has emphasized the need for objective parameters in
the examination of pilot candidates after surgery, and our material will be used in this
context. It can also be useful to evaluate side effects of refractive surgery, like night vision
disturbances.
Name and address for correspondence: Bente Haughom, Institute of Aviation Medicine
Postboks 14 Blindern, NO-0313 Oslo, Norway
Telephone No.: +47 92636391
Fax No.:
Date: 26.06.08
ABSTRACT
No 14.
No 14. ABSTRACT
Title: Aeromedical certification in progressive mitral valve prolapse.
Author(s) Name: Elena Cataman, Aurel Batrinac
Introduction: Mitral valve prolapse (MVP) is one of the most common heart valve
abnormalities, affecting 5-10% of the general population. Pilots are not an exemption. The
rate of MVP among pilots according to the data of different authors is 4,8% - 11%. The
majority of affected are asymptomatic. As long as regurgitation is not significant, prognosis
for aeromedical certification is favorable. Methods: We report a case of a 54-year-old
ATPL pilot who was incidentally detected to have MVP at the age of 31 years at
aeromedical examination for revalidation of medical certificate. He was asymptomatic with
constant degree of mitral regurgitation and stable dimensions of cavities with normal stress
ECG for a long period of time. From the moment when the left ventricular end diastolic
dilatation of the heart (5,9 - 6,1 cm) and systolic dimension (4,0 – 4,1cm) became boundary
to the normal for certification limits OML limitation was placed. The pilot was under
continuous control and treatment of AME with biannual ECHO and ECG investigations,
which made it possible for him to be issued with a medical certificate for a period of 8 years
(2000 -2007). He was only considered unfit after the onset of atrial fibrillation. The surgical
valve repair was recommended to pilot. 6 months after successful reconstruction of mitral
valve with annuloplasty he returned to his duties.Results: Presentation shows the evolution
of mitral valve prolapse in experienced pilot and the policy of aeromedical certification in
different stages of the disease. Conclusion: Good medical monitoring and effective plastic
surgery of MVP gives good prognosis for flight carrier. Rational approach to pilots with
MVP should be taken in boundary conditions when acceptance for aeromedical certification
is controversial.
Name and address for correspondence: E. Cataman, Aeroport MD 2026, Chisinau, Moldova
Telephone No.: + 373 22 52 64 36
Fax No.: + 373 22 52 91 18
Date: 30.07.2008
ABSTRACT No 15.
Title: Overweight in Military Pilots and WSOs in Germany 1977-2006
Author(s) Name: GLASER, Hansjoerg
Introduction:
In Europe the prevalence of overweight and obesity is rising. Military pilots on the other
hand are highly selected, continuously monitored, and health conscious. Therefore it
remained unclear, to which extent they would be affected by this trend.
Methods:
Retrospective analysis of open cohorts of all military pilots and weapon systems officers
re-assessed at the German Air Force Institute of Aviation Medicine with 47,273 data sets
of height, weight, and age from 1977 to 2006 in 5-year age classes.
Results:
With only few exceptions there is a trend towards an increase of mean BMI in all age
classes, starting around 1987. The proportions of aviators with overweight (BMI > 25)
and more severe overweight (BMI > 27,5) are growing. Even obese (BMI > 30) aviators
can be found in relevant numbers recently.
Conclusion:
The obesity epidemic has reached even the sub-population of military aviators, although
in a milder form than in the general population.
Name and address for correspondence: Dr. Hansjoerg Glaser, FlMedInstLw, Postfach 1264 /
KFL, D – 82242 Fuerstenfeldbruck, Deutschland
Telephone No.: +49 8141 5360 2200
Fax No.: +49 8141 5360 2166
Date: 23. July 2008
ABSTRACT No 16.
Title: Framingham Coronary Risk Factors at Male Aviation Personnel – comparison
with non Aviation Population in Slovak Republic.
Author(s) Name: DAXNER Peter, Dr.Av.Med., PhD
Introduction: The paper compares incidence of Coronary Heart Disease Risk Factors and
its relative risk score at three group of male population – civil aviation personnel, military
aviation personnel and non aviation population examined at 1997 and 2007 in Department
of Aviation Medicine of Aviation Military Hospital in Kosice – Slovak Republic.
Methods: The age, total cholesterol, HDL cholesterol, blood pressure, smoking and
occurrence of diabetes were examined at 1817 male civil aviation personnel + male military
aviation personnel and at 560 non aviation male subjects. Examination were performed
during years 1997 and 2007. Coronary disease prediction algorithm developed at
Framingham study was used for calculation of relative risk score for each examined subject.
Group results were compared each other.
Results: Relative risk score decreased in all groups since 1997 till 2007. The highest score
was in military aviation personnel ( in 1997 and also in 2007). Lowest score was in non
aviation group (in 1997 and also in 2007).
Conclusion: The possible reasons of highest incidence and dependence of coronary
disease risk factors at aviation population are discussed.
Name and address for correspondence: Dr. Peter Daxner, PhD, Aviation Military Hospital,
Murgas str. No 1, 040 86 Kosice, Slovak Republic
Telephone No.: + 421 960 516 751
Fax No.: +421 960 516 765
[email protected]
Date: 31.7.2008
ABSTRACT No 17.
Title: Psychological diagnostics of foreign air staff in Air Military Hospital, Koice,
Slovakia.
Author(s) Name: Dr. MAYEROVA Juliana, Dr. SLOVENSKA Eva, Mgr. IMÁRIK
Martin, PhD.
Introduction: The paper mainly deals with psychological testing of board crew (air-hostess
and stewardess) from India. They applied to work for one unnamed Slovak air company,
which also operate air route from Slovakia to India. Candidates undergone completely
medical inspection in our hospital and one part of that inspection were psychological
diagnostics and testing.
Methods: There were two inseparable parts of psychological procedure: first involve to tests
administration (performance tests, personality questionnaires, projective methods), second
involve to complex diagnostics interview.
Results: From 22 applicants (19 women, 3 men) were 14 consider like eligible for accession
(able for air staff position), 7 like able for air staff position, but less eligible, and finally, 1
(one) like unable. Summarily, there were a lot of intercultural differences (nature, behavior),
and in compare with our population (Slovak, central Europe) they were seems like more
slowly (especially in psychomotorical tempo).
Conclusion: Diagnostics of foreigners (especially from different cultural and value
conditions) may be great opportunity for intercultural comparisons and for new experience.
There is a question if it´s good idea to employ the people from absolutely different cultural
background and education in (for example) european conditions (in relate to trouble free
and safety cooperation with other staff members and travellers also, of course).
Mgr. Cizmarik Martin, PhD., psychologist,
Aviation Military Hospital, Murgas str. No 1, 040 86, Kosice, Slovakia
Telephone No.: +421 960 516 995
Fax No.: +421 960 516 765
Date: 31.7.2008
ABSTRACT
No 18.
No 18. ABSTRACT
Title: Neurocognitive Performance in Aircrew in treatment with antidepressant SSRIs
and SNRIs.
Author(s) Name: T.Col. CSArn Simeone IZZO* - Col. CSArn Prof. Gualberto ARDUINO** Br. Gen. CSArn Eugenio VELARDI*** - Prof. Stefano MOSTICONI ****
(*), (**), (***) Italian Air Force –Aviation Medicine Institute - (****) University of Rome “La Sapienza”
Introduction: Incidence of mood and anxiety disorders is getting higher in general
population as well as in the aircrew community. For this kind of patients specific
psychopharmacological treatments are not allowed by the currents rules for aviation
medical licencing, because of the potential side effects on the neurological system
(drowsiness, dizziness, lack of attention, etc…). On the other hand the symptoms linked to
the mood and anxiety disorder, whereas not treated, might affect the individual global
performance. The guidelines for the treatment of the mood and anxiety disorders are the
early and long-term use of the antidepressant Selective Serotonin Reuptake Inhibithors
(SSRIs) or Selective Noradrenergic Reuptake Inhibithors (SNRIs).
Methods: Comparison of two group, control (242) and pathological (32) taking
antidepressant on their performance at the: tachistoscope, tremor test, mental efficiency
test, visual response test, two-hands coordination.
Results: The only significant difference between the two groups is the shorter visual
response time of the control group. There have not founded differences in the other
parameters.
Conclusion: The results show that the neurocognitive performance of subject taking
antidepressant SSRIs or SNRIs are largely comparable with the control group. These
findings confirm that their use is effective for the treatment of mood and anxiety disorders
and suggest that, under a right specialistic monitoring, their use could be allowed even in
the aircrew population when the clinical condition need it.
Name and address for correspondence: T. Col. Simeone IZZO
Telephone No.: +39-06 49865663
Fax No.:
Date: 12/09/2008
ABSTRACT No 19.
Title: VESTBULAR ANALYZER AND DESORIENTATION IN SPACE OF
MILITARY PILOTS
Author(s) Name: M.Spahieva
1
1
, L. Aleksiev 2, A. Petkov 1, K. Kanev 1
Department of military medicine, 2 Centre of military medical expertise and aviation medicine , Military Medical
Academy, Sofia, Bulgaria
Introduction: Disorientation in space (DS) of the military pilot is one of the frequent
causes for flight accidents provoked by human factor.
Vestibular analyzer of the military pilot is adequately reconstructed in process of flight
duty and training.
Vestibular analyzer is increasing its resistance under the influence of the acceleration in
three plane sin flight time. These high requirements towards vestibular analyzer (VA) are
determined for high criteria concerning selection requirements for flight duty of candidates.
For this reason the method for determining of Vestibular Vegetative Resistance (VVR) of
the vestibular analyzer is maximal burden for semicircular canals and for Ottolit part of the
vestibular analyzer as well.
Goal of the research is investigation of the connection of vestibular analyzer, respectively
its VVR and cases of space disorientation during flight time in air force pilots.
Methods: This research is a result of anonymous data from questionnaires distributed
amongst pilots of air force and medical documents of pilots who had an accident because of
disorientation in space.
Results: Vestibular analyzer of pilots has high resistance at time of investigation. Perfect
and very good VVR have 70.40 % of the pilots participating in anonymous investigation and
73.90 % of them who have accidents during flight time.
It was not observed correlation connection between VVR and disorientation in space: r <
0. 33.
Conclusion: In author’s opinion appearance of disorientation in space is a result of
disturbances in three basic components: visual, cognitive, and operative.
High resistance of vestibular analyzer and mobilization of the will power permit getting
out from critical situation and determine low percent of flight accidents because of disorientation
in space.
Keywords: VESTIBULAR ANALYZER, DESORIENTATION IN SPACE, MILITARY
PILOTS
Name and address for correspondence: M.Spahieva
Telephone No. : (+ 359 2) 922 50 75
Fax No.:
Date: 25.08.2008
ABSTRACT No 20.
Title: THE ITALIAN AIR FORCE (ITAF) EXPERIENCE ON SPATIAL
DISORIENTATION TRAINING.
Author(s) Name: M. Lucertini, P. Trivelloni, O. Sarlo
Introduction: Spatial Disorientation (SD) represents one of the major threats in flight
safety, especially in military activities. In the period 1993-2001, SD was pointed out
as a causal factor in more than 20% of ITAF class A flight mishaps and this induced
the Inspectorate for Flight Safety to organize a dedicated program for SD
prevention and recovery, which included aeromedical aspects. This part of the
training was included within the global physiological training for ITAF aircrews. Thus,
SD courses started in May 2002 and were specifically dedicated to those aircrews
considered at higher risk for SD mishaps (i.e. fighter and helicopter pilots/navigators).
The present study aims at analyzing the results obtained in this initial 6 year period
of SD training. Methods: Globally 239 pilots and/or navigators from different ITAF
squadrons attended a 2 day SD course, that included both theoretical and practical
training sessions. They were distributed in 61 dedicated SD courses, calibrated for
four trainees each. To evaluate the appreciation of the course on the part of the
trainees, a questionnaire was administered at the end of the activities. The practical
outcome of SD training in terms of flight safety was evaluated with an analysis of
recent class A flight mishaps and of reports of in flight SD episodes. Results: The
course resulted highly appreciated by most aircrews, with a percentage of 98% of
extremely positive comments (also in anonymous formats). A steep increase in the
number and percentage of in flight SD reports was observed from year 2004. In the
period 2002-2007, two class A flight mishaps (out of a total of 15) were attributed to
SD, corresponding to 13.3%. Such a percentage is 8.3% lower than in the period
1993-2001, when the program was not active yet. Conclusion: Although these
data should be considered with caution, due to the short follow up period, a
significant contribution for flight safety can be hypothesized on the part of ground
based SD training.
Name and address for correspondence: Col. Marco Lucertini, MD
IML “Aldo di Loreto”, Via P. Gobetti 2, 00185 – Roma (Italy)
Telephone No.: +390649866140
Fax No.: +390649866610
Date: 30/06/2006
ABSTRACT No 21.
Title: Tinnitus and Hearing in a Norwegian Airline Pilot Population
Authors: Anthony S. Wagstaff, Peter Blum
Introduction: Noise is an important stressor in aviation work environments. Newer aircraft
types do not necessarily have less cockpit noise than older designs. A Norwegian Airline
experienced an increasing number of complaints with a possible relation to noise, including
tinnitus and fatigue – and also a worry for long-term hearing damage. Some of the concerns
were coupled with the phasing in of a new version of the Boeing 737 with a somewhat
higher cockpit noise level. To investigate hearing related complaints and possible flightrelated causes, a combined audiometric/questionnaire study was devised. The hypothesis
was that tinnitus or hearing damage might be more frequent with increasing flight hours if
these symptoms are related to the working environment.
Methods: All audiograms from pilots working in the airline were analysed and entered into
a worksheet together with answers from at comprehensive questionnaire regarding hearing
related complaints, noise and other personal and career data. After quality-control of data,
the database was anonymised.
Results: 39% of pilots answered the questionnaire. However, after comparative analysis of
the “answer ” and “no-answer ” groups regarding age and hearing thresholds, the data
were found to be representative regarding objective findings. 14% of those who answered
the questionnaire (N=133) reported daily tinnitus. Hearing damage for at least one
frequency (>20dB higher threshold than expected for the given age) with and without
tinnitus was found in 10,5% and 12,8% respectively. No certain correlations with total flight
hours or B737 flight hours in different versions were found for tinnitus or hearing
threshold change. Outside work, only a history of impulse-types noise exposure had a
significant correlation to hearing damage among those factors included in the questionnaire.
Conclusions: No certain connection was found between tinnitus and hearing damage on
the one side, and flight hours on the other. Impulse noise exposure outside work was found
to be related to hearing damage. Tinnitus prevalence was not clearly different from other
population-based tinnitus surveys although large differences between other studies mean
that this conclusion must be treated with caution.
Name and address for correspondence: Anthony S. Wagstaff, Institute of Aviation Medicine
Postboks 14 Blindern, NO-0313 Oslo, Norway
Telephone No.: +47 48010690
Fax No.: +47 22692037
Date: 21.07.08
ABSTRACT No 22.
EFFECTS OF HYPOXEMIC HYPOXIA ON PATTERN REVERSAL VISUAL
EVOKED POTENTIALS (VEPs)
Title:
Dario Di Blasio 1, Giuseppe Ciniglio Appiani 1, Alessandro Carboni 2,
Nicola Pescosolido 2
1 - It. Air Force Flight Test Center – Aerospace Medicine Department – Pratica di Mare AFB Rome
2 - “Sapienza” State University – Rome
Authors:
Introduction: Exposure to high altitude may lead to altered central nervous system
functions, induced by Hypobaric Hypoxia. Sensory systems like Visual and Auditory
systems are reported to be severely affected by Hypoxia. Hypobaric chambers are
traditionally used in this kind of survey, but they carry a risk of inducing decompression
sickness in trainees. An appropriate alternative is the use of low oxygen gas mixtures, in
order to simulate breathing conditions at high altitude.
Methods: The study was undertaken to assess the effects of Hypoxemic Hypoxia on pattern
reversal Visual Evoked Potentials (VEPs) simulating a 18,000 feet altitude. VEPs can provide
significant diagnostic information about the functional integrity of the visual system. Forty
healthy military aircraft pilots, formerly experiencing Hypoxia at high altitude, breathed a sea
level mixture of gases: 20.95% oxygen and 78.08% nitrogen. Subsequently, at simulated
High Altitude (18,000 feet) subjects breathed a reduced oxygen gas mixture (10 % oxygen),
inducing 70% of oxygen blood saturation, after approximately 5 - 8 minutes.
Results: Latency increased both at 15’ (foveal) and 60’ (parafoveal) checkerboard pattern.
Additionally, breathing a reduced oxygen gas mixture with 10 % oxygen, there was a
decrease of P-100 wave amplitude in both eyes (at 15’ of arc more significant than at 60’).
Conclusion: Exposure to simulated High Altitude (18,000 feet) may cause increase of
roughly 1,2% latency delay of P-100 wave. The mentioned increase of P-100 latency peak
times, along with the decrease of P-100 amplitude, at 15’ of arc checkerboard, may be due to
synaptic delay and/or altered neuronal processing. Upcoming objectives: to assess
pharmacological treatment expected to avoid altered sensory functions that reduce pilot’s
performance and safety levels.
LTC Dario Di Blasio, MD - Flight Test Center, Aerospace Medicine Dept. Pratica di Mare AFB
00040 Pomezia (RM) ITALY
Telephone: +39-06-91292729
Fax: +39-06-91292075
Date: June 27th 2008
ABSTRACT No 23.
Title: Medical requirements for Leisure Pilot Licence
Author(s) Name: Virgilijus Valentukevicius, M.D., D.Av.Med
Regulation 216/2008 requires the Agency to draft rules for a new leisure pilot licence (LPL).
This licence will be sub-ICAO Class 2 standard and is created to provide easier access to
general aviation. The medical requirements are less stringent than the former JAR-FCL 3
requirements for Class 2 and, if permitted under national law, the medical examination and
assessment can be done by the family doctor of the pilot. LPL medical requirements are in
line with limited flight privileges of licence holders. In this presentation the medical
requirements for the leisure pilot licence will be outlined in some detail.
Name and address for correspondence: Virgilijus Valentukevicius
Telephone No: +49 221 89990 5045
Fax No.: +49 221 89990 5545
E-mail:
[email protected]
Date: 03/09/2008
ABSTRACT No 24.
Title: Implementation of EU directive « Noise » into German law and consequences for
flight crews
Author(s) Name: Rose, D.-M., H.-J. Kimpflinger, Manuel Vierdt, J. Hedtmann
Introduction: The EU directive “Noise on workplace” had been implemented into
German law. Thus a reassessment of the noise burden of flight personnel had to be
done, because the threshold value of noise for an 8 h day period was reduced from
85 db(A) to 80 db(A). If the threshold value exceeds 80 db(A) personnel has to be
informed about possible health risks and personal hearing protection and
preventive medical checkups have to be offered.
Methods: Noise level measurements in a turboprop aircraft according to ISO
standards were performed and the average noise exposure for an 8 h day was
calculated for db(A).
Results: Noise exposure in the cabin of the aircraft exceeded with 81 dB (A) the
threshold value of 80 dB (A). Therefore the airline has to take actions in respect of
the national law and EU guidelines. That potentially interferes with the quality of
the on board service for passengers.
Conclusion: Health protection of flight personnel is mandatory, but wearing of ear
protection by flight attendants during on board service is not adequate. The exact
analysis of noise levels during the different phases of the flight showed highest
noise levels during the take-off period. Therefore, wearing individual hearing
protection during take-off by cabin crews might change the total noise level below
80 dB (A) and could allow working during the rest time of flight without ear
protection but without a health risk. However, further investigations are needed.
Name and address for correspondence: Dr. Dirk-Matthias Rose, IAS Institute of
Occupational und Community Medicine Foundation,
Steinhäuserstr. 19, D-76135 Karlsruhe, Germany
Telephone No.: (x49) (0)721 8204 111
Fax No.: (x49) (0)721 8204 440
Date: 01th July 2008
ABSTRACT No 25.
Title: Evaluating Whole body vibration levels in military and civilian helicopters
according to levels defined by EC (2002/44/EC).
Author(s) Name: Jan Ivar Kåsin, Anthony Wagstaff
Introduction:
Whole body vibration (WBV) is known to affect the muscular and skeletal system in the lower part of the spine.
On the background of these effects The European Parliament and the Council of the European Union proposed a
Directive in 2002 that stated the maximum levels of vibration exposure in a working environment. The action
level was set to 0.5 m/s2 . The limit level was set to 1.15 m/s2 . In July 2005 the directive was implemented in the
national labour inspection in every EU member countries. The national regulation makes the employers'
responsible for examine possible WBV vulnerable work places. The Helicopter working environment is well
known for substantial low frequency vibration. To be confident that different helicopter working environments
were according to the regulation, we measured three military and three civilian helicopters.
Methods:
The following helicopters were measured: Bell412, Westland Sea King MK43B, Westland Sea Lynx MK86,
Sikorsky S92, Eurocopter EC135 T2 and Eurocopter Super Puma L2.
All operationally relevant manoeuvres were included in the test. The vibration levels were measured and recorded
according to ISO 2631-1.
Results:
The Sikorsky S92 and Sea Lynx helicopter had the highest overall root-mean-square (RMS) acceleration values.
EC135 T2 was the only helicopter with consistent levels below action value for all manoeuvres and altogether the
helicopter with the overall lowest vibration levels. There are several possible reasons for the rather large
differences between helicopters, with implications for possible health effects for helicopter aircrew. Some
reservations regarding the results must be made based on individual airframe differences and helicopter
configurations.
Conclusion:
None of the helicopters in passed the action level during an eight hour working day. We believe that the daily
exposure level is lower in most of the helicopters since an eight hour flight time during a day is
extraordinary.
Name and address for correspondence: Institute of Aviation Medicine / Jan Ivar Kåsin – Sem
Sælands vei 2B – 0313 Oslo
Telephone No.: 22 93 03 40
Fax No.:
Date: 12.08.08
ABSTRACT No 26.
Title: New regulations of EASA NPA 2008-17c, Practical ophthalmological aspects
Author(s) Name: van Setten Gysbert
Introduction: The current version of new rules according to NPA 2008-17c as published by
today 220808 still has some disadvantage of heritage and several changes that makes an clinical
ophthalmologist wonder and, possibly, concerned. Main focus of this presentations is posed on
the recovery rate after cataract surgery and the rules given for visual stability after refractive
surgery. Rules proposed will be compared to the clinical reality and possible consequences.
Methods: The rules proposed as referred to above imply a being unfit for 3 month after cataract
surgery. Earlier, a fit assignment may be considered according to 9.5 p 47 if recovery is
complete. The current knowledge of ocular wound healing implies a visual recovery after cataract
surgery in usually less than 6 weeks. A complete recovery, that is no further improvements or
changes to be expected, may take longer.
Results: It will be shown the recovery rate after cataract surgery could be shortened to approx 6
weeks. The visual stability of +/- 0.75 dpt / day after refractive surgery raises the issue if the
pilot may be temporarily incapacitated without knowledge in flight. A contradiction to the visual
requirements is possible. The text in the rules could gain significantly in practical transparency
and applicability with minor revision.
Discussion: No rule is perfect, but it may be expected to reflect the state of the art.
Conclusion:. The concerns mentioned above, together with others, not mentioned here, have
been brought to EASA’s attention. With this there might be hope for implementation resulting
in a rulemaking a little step closer to the state of the art , making our skies safer and more pilot
friendly.
Name and address for correspondence: Gysbert van Setten, St Eriks Eye Hospital,
Polhemsgatan 50, 112822 Stockholm, SWEDEN
Telephone No.: 0046736504963
Fax No.: 004686723070
Date: 220808
ABSTRACT No 27.
Title: THE 'IRISH' VIEW ON THE NEW REGULATIONS FOR MEDICAL
CERTIFICATION. WILL IT ALL CHANGE?
Author(s) Name: Annetje. Roodenburg
In the JAA states the medical certification of professional and private pilots is
performed according to JAR-FCL-3.
The system is well established now and would appear to be working.
Pilots are being able to continue to undergo their medical examinations/assessments in
their home state while flying on an Irish licence. At the request of their airline the
majority of them needed to convert to an Irish licence.
In a few years the system will have changed under EASA and we will all be certifying
them according to the new ‘EASA-system’.
How will this affect them and us? Will the system really change? Will the individual,
industry and doctors, regulators and AaMEs be able to influence the rulemaking and
if so how?
As the Irish CMO, being responsible for the medical certification of many non national
pilots, I will try and discuss the possibilities with you.
I short overview of the legal basis will be given, followed by the rulemaking process
and possibilities.
Name and address for correspondence: Dr. Annetje Roodenburg , Aeromedical Section
Hawkins Street, Dublin 2, Ireland, <[email protected]>
Telephone No.: +1-603 1512
Fax No.: +1 603 1400
E-mail:
Date:
ABSTRACT No 28.
Title: Considerations concerning practical hypoxia training for commercial aircrew
Author(s) Name: Ries Simons, M.D.
The Accident Investigation Report concerning the Helios Airways Flight HCY 522 (14
August, 2005) recommends that “EASA/JAA require practical hypoxia training as a
mandatory part of flight crew and cabin crew training. This training should include the use
of recently developed hypoxia training tools that reduce the amount of oxygen a trainee
receives while wearing a mask and performing tasks”.
In this context, considerations are presented concerning usefulness, risks, and feasibility of
practical hypoxia training of flight crew and cabin crew. Practical hypoxia training can be
performed by exposure in a hypobaric chamber (hypobaric hypoxia), which has been the
regular practice in Air Force personnel all over the world. Recently, a new technique has
been advocated, using a Reduced-Oxygen-Breathing Device (ROBD) in a simulated flight
environment. Advantages and disadvantages of hypobaric chamber training and ROBD
hypoxia training will be discussed in terms of medical consequences, efficacy of training,
and consequences for the aviation industry.
Ries Simons, M.D., TNO Aerospace Medicine, P.O. Box 23, 3769 ZG Soesterberg, The
Netherlands
Telephone No.:+31 346 356485
Fax No.: +31 346 354799
Date: 23 August 2008
ABSTRACT No 29.
Title: Cardiac arrest during hypobaric chamber exposure at a young pilot
Author(s) Name: Mirela Anghel, M.D., Ph.D., Ilie Capanu, M.D., Marcela Muresan,
M.D.
Introduction: A case presentation of a sudden cardiac arrest during hypobaric
exposure of a young subject
Methods: A 28 years old supersonic pilot was exposed to hypobaric conditions
during regular scheduled training. Personal and professional records, ECG and
video recordings during exposure, as well as post-incident additional testing is
presented.
Results: Based on the clinical investigations, the conclusions regarding the
aeromedical status of the pilot will be presented
Conclusion: A typical case of a “Would you fly with this pilot?” decision in which
a top pilot had to consider a career change due to physiological limitations.
Name and address for correspondence: Ilie Capanu, National Institute of Aerospace Medicine,
88th M. Vulcanescu Street, Bucharest, Romania
Telephone No.: +40213187247
Fax No.:
Date: 23.06.2008
ABSTRACT
No 30.
No 30. ABSTRACT
Title: Resistance assessment to hypobaric-hypoxic stress through simultaneous
monitoring of the ECG recording and oxygen saturation
Author(s) Name: Ilie Capanu, M.D., Dragos Vlad, M.D., Simona Berbecar, M.D., Ph.D.
Introduction: The hypobaric hypoxia still remains a standard compulsory method
for aeronautical personnel, due to its comprising character through resistance
estimation, training and adaptive synergies of the tested subject.
Methods: A number of 39 subjects ( 12 candidates, 17 pilots, and 10 fight
instructors) were exposed to a simulated flight. Simultaneous ECG and oxygen
saturation (SO2) readings were performed. ESR (erythrocyte sedimentation rate)
were performed prior to exposure.
Results: We analyzed correlations between ECG variations and SO2 as a marker
of hypoxic resistance. Values and weaknesses of both are discussed. Furthermore,
we evaluated the impact of ESR as a predictor of hypoxia resistance. For the pilots
(27) group we found a 100% PPV and a 70% NPV and for candidates (12) a 100%
PPV and a 75% NPV
Conclusion: Monitoring of multiple parameters during hypoxia exposure leads to
a better understanding of a candidate adaptation profile. Candidates with high
ESR can be expected to have poor adaptation.
Name and address for correspondence: Ilie Capanu, National Institute of Aerospace Medicine,
88th M. Vulcanescu Street, Bucharest, Romania
Telephone No.: +40213187247
Fax No.:
Date: 23.06.2008
ABSTRACT No 31.
Title: Hypoxia awareness: the present and future of hypoxic training of Hungarian military
aircrew
Author(s) Name: S. Szabó1, A. Grósz2, Zs. Tótka1
Introduction: Practical pressure chamber and oral flight physiology trainings provide
confirmed benefits for military flight personnel in recognizing their own responses to
hypoxia. Although in the civilian area it was argued whether pressure chamber training was
necessary at all and could be replaced by less hazardous exercises providing the same
benefits for the pilots, in military aviation, even with the mask on, severe hypoxia can occur
due to the faults or malfunctions of the oxygene system. From our point of view, the
extensive indoctrination and recurrent training in pressure chambers is undoubtedly
necessary to familiarize military aircrews with the individual symptoms of imminent hypoxia.
Methods: Based on a real mishap in April, 2008, we made an attempt to overview what
might have happened on board a MiG-29 performing a final approach and touch-and-go too
low and late. We examined the possible role hypoxia and high Gs whether they could add
errors to the pilot’s acts during the approach. After the accident we reconstructed the
possible cockpit altitude profile in the pressure chamber.
Results: By the help of a simple psychological test we clearly demonstrated the
deterioration of cognitive functions during mild hypoxia. Graphically plotted against oxygen
saturation we managed to point out the decrease in monotony tolerance and the increase in
the number of errors. The aircraft did not have any malfunctions, thus we concluded that the
cause of the mishap was the improper position of the mask.
Conclusion: At certain subjects, previous high G-overloads, mild hypoxia and time
constraint can lead to pilot errors in critical flight phases.
Name and address for correspondence: Sándor András Szabó, M.D.
Dr. Radó György Military Medical Centre, Institute of Aviation Medicine, Militar Fitness and
Research
17, Balaton utca, Kecskemét 6000 HUNGARY
Telephone No.: 00 36 76 581 600/ext. 3451
Fax No.: 00 36 76 581 600/ext. 3466
Date: 8th September, 2008
ABSTRACT No 32.
Title: (POSTER)
ASSESSMENT OF PUSH-PULL EFFECTS: A NEW PROCEDURE BASED ON A
TEXTILE WEARABLE SYSTEM FOR VITAL SIGNS RECORDING.
Author(s) Name:
Anton Giulio Guadagno, MD*; Salvatore Cacopardo, MD*; Pierandrea Trivelloni MD*;
Francesco Rizzo **; Paolo Meriggi PhD**; Marco Di Rienzo, MSc.**
*Italian Air Force - Flight Test Center Aerospace Medicine Department, Pratica di Mare Air
Force Base, 00040 Pomezia (Rome).
** Polo Tecnologico, Fondazione Don Carlo Gnocchi ONLUS, Milano.
Introduction: The Push-Pull Effect (PPE) is a physiological phenomenon defined as a
reduction of +Gz tolerance induced by a previous exposure to a –Gz. This
phenomenon is considered a potential cause of G-LOC. Objective of this study was
the definition of a new procedure for the assessment of heart rate effects induced by
PPE during real military flights.
Methods: The developed procedure is based on the recording of ECG, respiratory rate
and 3D accelerations during flight maneuvres resulting in three different level of
gravitational stress: -1Gz/+3 Gz, -1G/+4 Gz, and -1G/+5G. In each flight, lasting about
60 minutes, these manoeuvres were repeated by using different G onsets. Biological
signals and accelerations were recorded by using a new textile system for the
unobtrusive assessment of vital signs. This device, named MagIC, was recently
developed by the Polo Tecnologico of Don Carlo Gnocchi Onlus Foundation, and is
composed of a vest embedding textile-based sensors, and a miniaturized electronic
module which stores data locally on a memory card. The new procedure was tested on
two subjects during real flights.
Results: From the analysis of the data we observed that: 1) the flight protocol can
be easily implemented by the pilots, 2) the quality of the signals collected by
MagIC is suitable for the subsequent elaborations, 3) the textile vest did not limit
the pilots comfort nor interfered with their movements during flight maneuvres.
Conclusion: The positive results we obtained, encourage the use of the procedure
as a tool for the evaluation of PPE in real flight conditions and for the evaluation
of the efficacy of possible countermeasure actions or devices.
Italian Air Force - Flight Test Center Aerospace Medicine Department, Pratica di Mare Air Force
Base, 00040 Pomezia (Rome).
Telephone No.: +390691292296
Fax No.: +390691292075
Date:
ABSTRACT No 33.
Title: Injury- and fatality-rates in German general aviation accidents – a five year review
Author(s) Name: Neuhaus C1 , Dambier M 1 , Glaser E1 , Hinkelbein J 1 , 2 , Pongratz H1
1
German Society of Aerospace Medicine(DGLRM), Workgroup Aviation Medicine
University Clinic for Anesthesiology and Intensive Care Medicine, Medical Faculty Mannheim, University
Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
Objective: Analysis of accident statistics, with special regard to injury and fatality rates, has great importance to
improve safety. Fairly accurate risk assessment is possible, since there is detailed data available on hours and
miles flown as well as the total number of passengers transported. Unfortunately, no such data is available for
general aviation (GA). The German Federal Bureau of Aircraft Accidents Investigation (Bundesstelle für
Flugunfalluntersuchungen, BFU), however, publishes detailed raw data (i.e. numbers) on german GA accidents,
including injury and fatality counts (but no information about POB). The aim of this study was to evaluate
probabilities for severe and/or fatal injuries sustained in german GA aircraft accidents.
Material and methods: Using official data from the 2002 – 2006 BFU annual reports [1], the total number of GA
accidents, number of GA accidents with severe or fatal injuries as well as the number of severely or fatally injured
persons was obtained for a five year period. Data was assigned to subgroups (according to the aircraft category) for
detailed analysis, including aircraft with MTOW < 2,0 to., aircraft with MTOW between 2,0 – 5,7 to., helicopters,
TMGs, gliders and hot air balloons. Analysis focused on the average number of injured (ANI) and average number
of killed (ANK) persons in accidents involving severe or fatal injuries, and the probabilies of sustaining severe
(POS) or fatal (POF) or both (POS/F) injuries in a GA accident. Data was corrected for double counts (accidents with
both severe and fatal injuries).
Results: There were a total of 1394 accidents involving GA aircraft in Germany, including 215 with severe and 179
with fatal injuries sustained, resulting in 301 injured and 279 killed persons. Looking at accidents resulting in
severe injuries, the highest ANI per accident was found in the MTOW 2.0 – 5.7to. category (4.0), albeit with the
lowest overall probability of 4.88% (meaning that 1 in 20.5 accidents in this category leads to serious injuries).
In contrast, the ANI in hot air balloon accidents is 1.3 with a highest overall probability of 77.91% (1 in 1.28).
The lowest ANI was found in glider accidents (ANI=1.12, POS=15.49%; ANK=1.06, POF=12.69%). The ANK was
also highest in the MTOW 2.0 – 5.7to. category (3.43) with a probability of 17.07% (1 in 5.86), but lowest in
hot air balloon accidents (ANK=0, POF=0.00%), where no fatal accidents were recorded during 2002 – 2006. The
POF was highest in helicopter accidents (20.00%) with an ANK of 1.67. Aircraft with MTOW < 2.0 to. (ANI=1.88,
POS=7.48%; ANK=1.81, POF=15.14%) and TMGs (ANI=1.45, POS=8.09%; ANK=1.45, POF=8.09%) are
somewhere in between. The POS/F was highest in hot air balloons (77.91%) followed by helicopters (30.00%),
gliders (26.87%), Aircraft with MTOW < 2.0 to. (20.00%), Aircraft with MTOW 2.0 – 5.7 to. (19.51%) and lowest
in TMGs (15.44%).
Conclusion: Understandably, the ANI and ANK in GA accidents increase with airplane size and capacity. However,
underlying reasons for the higher probabilities for injury and death in smaller airplane accidents remain unclear
(lower safety standards, training, proficiency?) and necessitate further investigation. Especially for hot air
balloons, new approaches for increased passenger safety should be explored.
References: [1] http://www.bfu-web.de
2
Name and address for correspondence: Christopher Neuhaus – Bergstrasse 97 – D-69121 Heidelberg
Telephone No.: +49-170-9079460
Fax No.:
Date: 25.08.2008
ABSTRACT
No 34.
No 34. ABSTRACT
Title: Advanced Coronary Diagnostics: Multi-Detector Computer Tomography
(MDCT) to diagnose Coronary Heart Disease (CHD) in military pilots
Author(s) Name: Wonhas C, Hausleiter J, Ledderhos C, Martinoff S, Schömig A
Introduction: Early detection of coronary artery disease (CAD) is of capital interest,
when as ymptomatic candidates are certified for military flying duties, especially, as 40%
of patients die with the first symptoms. 50% of them have a coronary risk score below 5
% per 10 years and a degree of coronary stenosis < 50%. Besides invasive coronary
angiography (ICA) as standard for the exclusion of obstructive CAD, cardiac
computertomographic angiography (CCTA) is able to exclude CAD. Studies
demonstrated a high negative predictive value of CCTA (>95%), compared with ICA.
Methods: Between June 2003 and September 2006 bicycle stress tests of 6910 subjects,
routinely performed at the German Airforce Institute of Aviation Medicine (GAFIAM),
were checked for higher degree ventricular rhythm disturbances (Lown class IIIb and
higher) or new ST-segment depressions (including non-significant changes). CCTA was
performed in subjects with positive bicycle stress tests. The presence of CAD was defined
as coronary angiosclerosis. ICA was recommended in airmen with lumen narrowing > 50%
in any major coronary branch.
Results: In 1.6% (110/6910) asymptomatic airmen CCTA was performed without
complications. In 29.1% (32/110) of them CAD was detected and excluded in 70.9%
(78/110). In 19 subjects ICA was performed subsequently, leading to 8 drug eluting stent
implantations and 1 coronary bypass grafting. A strict prevention strategy was
recommended. In 32% (6/19) extensive coronary calcifications were present by CCTA.
Two of 32 (6%) subjects with stenosis > 30% had a zero-calcium score. There were no
false positive CAD results by CCTA. No cardiovascular events were observed in the 78
airmen with exclusion of CAD by CCTA within the follow-up period.
Conclusion: Non-invasive CCTA is an attractive diagnostic method to rule out obstructive
CAD in asymptomatic airmen certified for military flying duties. The method is safe as well
as accurate and may help to reduce the number of ICAs, performed for diagnostic purposes
only.
Name and address for correspondence: Dr. Ch. Wonhas LtCol MC, FS, German Air Force
Institute of Aviation Medicine (GAFIAM), Strasse der
Luftwaffe, 82242 Fuerstenfeldbruck, Germany
Telephone No.:0049-8141-5360-2033
Fax No.: 0049-8141-5360-2989
Date: 12.08.08
ABSTRACT No 35.
DEVELOPING A METHOD FOR THE QUANTITATIVE ASSESSMENT OF GMEASLES
C. LEDDERHOS*, B. DEBRABANT#, K. DEBRABANT#, R. MÖRLIN* and A. GENS*
*
German Air Force Institute for Aviation Medicine, Fuerstenfeldbruck and Koenigsbrueck,
Germany, Darmstadt Technical University, Mathematics Department, Germany
Introduction: Until now, no standardized diagnostic method for quantitative assessment of
G-Measles following exposure to G-loads exists in aviation medicine.
Objectives: Therefore an attempt was made to develop such a method as part of a
comparative study on two different anti-G suits (AEA BAeS and Libelle G-Multiplus®).
Methods: For this, the subjects were exposed to eight standard profile runs over a total of
three days. Examination of subjects for the presence and the degree of severity of GMeasles was done by one and the same physician at the end of each day. The size of the
affected area and the degree of severity were documented on a datasheet showing the front
and the reverse of a standardized human silhouette. For the degree of severity of the GMeasles a three-level assessment scale (low, medium, severe) was used. Additionally a
photographic documentation served the verification of exact evaluation of affected areas on
the datasheet. Subsequently, all datasheets were digitized, the marked regions measured
(separately for each degree of severity) and their percentage with respect to the entire
surface was calculated. All data of the database were statistically evaluated for affected areas,
side of body and degree of severity.
Conclusions: Overall, this „method for the quantitative assessment of G-Measles “
allowed for the sufficiently accurate and reproducible quantification of the incidence of GMeasles in terms of the area of the affected region and of the corresponding severity using
a subjective scale. Tangible measurements exemplarily shown on the poster will
demonstrate this.
Name and address for correspondence: Dr. Carla Ledderhos
Telephone No.: +49 8141 5360 2145
Fax No.: +49 8141 5360 2999
Date: 04.09.08
ABSTRACT No 36.
Title: Comparison of Studies on General Aviation Accidents in different Countries using
the HFACS Model
Author(s) Name: Hinkelbein J1,2, Dambier M2, Glaser E2, Neuhaus C2, Pongratz H2
1
University Hospital Mannheim, Medical Faculty Mannheim of Heidelberg University,
Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
2
German Aerospace Society (DGLRM)
Introduction: Analyzing aircraft accidents may improve flight safety. The application of
the HFACS model [1] for aircraft accident analysis facilitates comparisons between
different studies and countries. The aim of the present study was to compare published
studies on aircraft accidents in the field of General Aviation (GA) and to identify and
compare causing factors by means of the HFACS model.
Methods: A systematic Medline research was performed to gather all published studies
on GA aircraft accidents between 1968 and 2007. Data was compared using the
HFACS model.
Results: A total of N=10 studies on GA accident analysis were identified. N=6 studies
were excluded from analysis due to their subject of investigation which was mainly military
and airline operation. N=4 studies dated 1978 to 2005 were analyzed [2-5]. The mean
time frame of these studies was 11±9 years. Three studies analyzed US and one
German GA accidents. A total of N=534 aircraft accidents was analyzed in these four
studies. None of the studies reported ergonomical or medical problems causing these
accidents. Only one study reports 7 % of accidents due to crew resource management
problems and 15 % due to organizational factors. All four studies state skill-based errors
as the main reason (mean 53±19 %) for accidents. Decision errors (21 % and 37 %)
were reported in only two studies. Only one study mentions perception errors (34 %)
and violations (8 %) as causing factors. Pilot errors were reported to contribute to GA
accidents homogenously in approx. 80 % of all analyzed cases.
Conclusion: Comparing different published studies on GA accidents is difficult due to
inhomogeneous denominator data. For future research it is essential to define uniform
denominator data and consistent data sets. Skill-based pilot errors were homogenously
reported as the main causing factors, but were not further divided and analyzed.
References: [1] Shappell SA et al. Human Factors and Aerospace Safety 2001;1:5986. [2] Dambier M et al. Air Med J 2006; 25(6):265-269. [3] Pagan BJ et al. Aviat
Space Environ Med 2006;77(9):950-952. [4] van Doorn RRA et al. Aviat Space
Environ Med 2007;78(1):26-28. [5] Gaur D. Aviat Space Environ Med
2005;76(5):501-505.
Name and address for correspondence: Dr. med. Jochen Hinkelbein, Neckarpromenade 16,
68167 Mannheim, Germany
Telephone No.: +49.621.383.3798
Fax No.: +49.621.383.732740
Date: 26.08.2008
ABSTRACT No 37.
Title: A simple technique for gravity simulation (+1Gz, 0Gz, and -1Gz) demonstrates compromised lung
function
Author(s) Name: Neuhaus C 1, Dambier M 1, Glaser E1,2, Hinkelbein J 1,3, Pongratz H1
1
German Society of Aerospace Medicine(DGLRM), Workgroup Aviation Medicine
Viasys Healthcare GmbH, Hoechberg, Germany
3
University Clinic for Anesthesiology and Intensive Care Medicine, Medical Faculty Mannheim, University Hospital Mannheim,
Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
2
Objective: During flight, gravity and acceleration can impose physical stress on the human body
[1,2]. While military pilots are both medically evaluated and routinely trained for G tolerance using
centrifuges, there is no such option for the civilian AME. However, severe acceleration and gravity
changes do also occur in General Aviation (GA), e.g. during acrobatic flight. The aim of this pilot
study was to analyze changes in basic lung function under the influence of gravity using a simple
technique for gravity simulation.
Material and Methods: After informed consent, 10 healthy pilots with a current flight medical
certificate (at least class 2) were investigated. Gravity simulation was performed using a previously
described technique [3]. Spirometry was performed in upright standing position (simulation of
+1Gz for 2 minutes, 2 values each), in lying position (0G z, 2 min, 2 values), and head down position
(-1Gz, 2min, 2 values) using a portable spirometer (SpiroPro, Viasys Healthcare GmbH, Hoechberg,
Germany). Lung function changes were calculated for common spirometry test values (FVC, FEV1,
FEV1%, PEF). Wilcoxon- and Mann-Whitney-U tests were used for statistical analysis of data, a
P<0.05 was considered significant.
Results: Ten healthy pilots (male, 32±7 years old, BMI 23.7±1.3 kg m-) were investigated. Change
from simulated +1G z to simulated 0Gz showed no difference (FVC 5.53±0.28 vs 5.43±0.26,
P=0.57; FEV1 4.71±0.33 vs 4.50±0.27, P=0.08; FEV1% 99.05±5.07 vs 94.65±5.55, P=0.11; PEF
11.79±0.90 vs 12.47±1.89, P=0.62). With simulated -1G z in head down position, change of FVC
(5.53±0.28 vs 5.40±0.29, P=0.43) and FEV1 (4.71±0.33 vs 4.51±0.39, P=0.11) remained
unsignificant. However, FEV1% decreased significantly from 99.05±5.07 to 94.20±6.02 (P=0.033)
and PEF dropped significantly from 11.79±0.90 to 10.44±0.49 (+1Gz vs. -1G z, P<0.001).
Conclusion: These findings under only minor Gz loading suggest that lung function is
significantly impaired with increasing (negative) Gz load. Although a simple technique for gravity
simulation was used, results are in concordance with current flight literature [4]. Especially for
pilots that hold less restrictive Class 2 medicals but suffer from existing (deemed non-hazardous)
lung conditions, the G forces possibly encountered in recreational aviation (recovery situations,
amateur aerobatics) could be potentially harmful. Also, with centrifuges not usually available for
medical evaluations, further investigation of screening methods for AMEs (such as the described
technique or a tilting table) may be recommendable to provide simple tools for advanced risk
assessment. Furthermore, G onset rates and integral load need to be considered as parameters for
further investigations.
Name and address for correspondence: Christopher Neuhaus, Bergstrasse 97, 69121 D-Heidelberg
Telephone No.: +49-170-9079460
Fax No.:
Date: 25.8.2008
ABSTRACT
No 38.
No 38. ABSTRACT
POSSIBILITIES FOR THE DETECTION OF IN-FLIGHT HYPOXIA – PULSE OXIMETRY
C. LEDDERHOS, C1. A. GENS1 G. RALL2 ;
1
German Air Force Institute for Aviation Medicine, Fuerstenfeldbruck,, 2 Fraunhofer Patent
Center for German Research, Munich
Introduction: Pilots are exposed to different burdens during high altitude flights. Among
others the reduction of PO2 is of special importance since the resulting effects of lack of
oxygen often occur fast and unexpected. The symptoms accompanied by this appear to be
very different not only interindividually but also intra-individually. Moreover they are often
not identically reproducible by consecutive simulations of oxygen deficiency situations. Of
particular danger is the possibility of an europhoric action of the hypoxia accompanied by
the absence of the ability for self-criticism. Under those circumstances the early detection of
hypoxia in pilots is of increasing importance. First practical attempts to do this are going
back to World War II. At that time oximeters were used. In 1972 Takuo Aoyagi developed
pulsoximetry; first commercially availabe units were available since the early 80s. Since than
the measurement of oxygen saturation of the blood by pulse oximetry has become an
objective, reliable and noninvasive method, even under adverse conditions. However devices
originally developed for a clinical setting have some limitations which restrict their
application in aviation and other operational conditions. Bright light as well as vibrations,
accelerations and movement artifacts, as they regularly occur in aviation, can limit their
usefulness dramatically. And although pulsoximetry is used frequently for demonstration
and training purposes in the Air Force, this technique could not gain acceptance during real
flight missions - until now.
Objectives: As a consequence of the mentioned shortcomings it therefore appeared
appropriate to validate an accepted clinical method under in-flight conditions, since it would
enable for a simple monitoring of the central key spot of danger, namely an undue drop in
blood oxygen saturation to a value, critical for health and flight safety.
Methods and results: For flight purposes we decided to use reflectance sensors, which can be
used at the forehead, with a low in-flight encumbrance of the pilot. However such reflectance
sensors are known to be prone to motion artifacts and vibrations. In a first study at a
hypobaric chamber we could show, that a sensor (NONIN company) working by the
reflectance principle is generally suitable as an early warning system for an arterial oxygen
deficiency. The only disadvantage – compared to the gold standard, the bloody measurement
of oxygen saturation - were slightly higher oxygen saturation readings. Following studies of
our group, mainly concentrating on the influence of vibrations and movements typical for
helicopters on the signal quality, could demonstrate that this type of sensor generated a
sufficient quality of signals in both simulated and real-world helicopter operations. During
physical loads such as running, bicycling and skating the failure rate was 3 - 4 % only. Even
runs in a human-use centrifuge up to 9 Gz still produced a good quality of signals.
Conclusions: Regarding the application of a reflectance pulse oximeter sensor under
operational real-flight conditions these results are very promising. The sensor appears to be
perfectly suitable to warn of sudden and unexpected in-flight oxygen deficiency events.
Name and address for correspondence: Dr. Carla Ledderhos
Telephone No.: +49 8141 5360 2145
Fax No.: +49 8141 5360 2999
Date: 04.09.08
ABSTRACT No 39.
Title: Measuring psychic stress with biological data
Author(s) Name: A. Grósz1, E. Tóth2, Á. Szatmári2
Introduction: Although nowadays the growing performance of computers largely
facilitates the work of humans controlling aerial man-machine systems and many aircraft
subsystems are becoming more automated, it is still the human being who makes decisions
and controls that system. Therefore only those applicants should be selected for this
occupation who can perform these tasks without particular mental efforts. In our experiment
we attempted to verify our hypothesis according to which heart period variability (HPV) can
be used as an appropriate index in the assessment of psychic load and its bearing in case of
future pilot applicants.
Methods: For this purpose we used a visuomotor coordination test to measure 28 male
subject’s accuracy, speed and level of coordination in space and time. At the same time we
equipped the subjects with an on-board data recording system (ECG, galvanic skin
resistance, body temperature, pulse and breath rate) which provided precise measurements
of the subjects’ HPVs. After a 3-minute initial resting period, the subjects familiarized
themselves with the controls and then practiced the task. After this they carried out the task
and finally had a 3-minute resting period again during which they filled in workload
questionnaires.
Results: Each subject accomplished the task successfully. After the analysis we used a
conventional coordinate system with axes of speed and accuracy to display the results. We
needed those subjects whose results were in the field surrounded by the positive part of the
mentioned axes (fast and accurate). The subjects’ resting HPV values were also compared
to their workload values. During heavier workloads the heart periods became shorter
(sympathetic reaction), while during resting they became longer (parasympathetic reaction).
We highlighted the subjects from among those selected previously whose HPV remained
low, i.e. who stayed calm during task accomplishment.
Conclusion: From the aspect of the pilot applicants’ medical selection, it is possible to
select the persons who performed the „easy and reassurring ” task quickly and accurately
with no particular mental efforts by two objective tests and a set of subjective responses.
(1) Prof. Andor Grósz, M.D.
Dept. of Aviation and Space Medicine, Faculty of Medicine, University of Szeged
17, Balaton utca, Kecskemét 6000 HUNGARY
Telephone No.: 00 36 76 481 254
Fax No.: 00 36 76 481 254, 00 36 76481 659
ABSTRACT No 40.
Title: Signal detection in hypobaric hypoxia - a stress situation
Author(s) Name: A. Grósz1, E. Tóth2, Á. Szatmári2
Introduction: On the ground and in the air the actions of aircraft pilots are fundamentally
influenced by their visual environment and the certain stimuli extracted from it. These stimuli
often require quick decisions and acts, however, the time for these is considerably limited. Pilots
can as well be and are exposed to hypobaric hypoxia during their flights which, according to our
hypothesis, has a deteriorating effect on their signal detection performance.
Methods: By the help of a darkened pressure chamber we used to model a stress environment
with, we attempted to follow and assess the visuomotor performance of 42 healthy male helicopter
pilots at a simulated altitude of 5500 m. During the signal detection test applied in this experiment
the subjects had to recognize certain patterns (squares) of white dots randomly appearing on the
otherwise black monitor display. In the first experiment 14 subjects performed the test at an
altutide of 0 m, while other 14 performed it in the pressure chamber at 5500 m. In the second
experiment 14 subjects performed the test at 0m, and then at 5500 m. During the tests we
measured the number of correct reactions, detection time, the number of not-detected crucial
stimuli and the number of incorrect reactions. The test computer also divided the screen into 4
quadrants and measured the previous criteria in each of them and on the whole screen as well.
Results: Neither exhaustion nor learning effects were observed in any of the groups, however,
the subjects remained motivated enough. The subjects’ oxygen saturation was around 70 per
cent. After analysis we found that hypoxia did not influence the subjects’ initial and overall
performance at all; however, they did not scan the screen evenly: the majority of the pilots
preferred the top left quadrant and neglected the bottom right one.
Conclusion: The explanation for this was that in the helicopter they fly (Mi-8, Mi-17) the
most important flight instruments frequently checked by the pilots are located in the top left
quadrant of the instrument panel, while the bottom right one contains gauges that are of low
importance from the aspect of flight safety. This seemingly pathological result was the effect
of a profession-based habituation and not that of deteriorated mental or visual performance
caused by hypoxia.
(1) Prof. Andor Grósz, M.D.
Dept. of Aviation and Space Medicine, Faculty of Medicine, University of Szeged
.17, Balaton utca, Kecskemét 6000 HUNGARY
Telephone No.: 00 36 76 481 254
Fax No.: 00 36 76 481 254, 00 36 76 481 659
ABSTRACT No 41.
Title: Markov State Transition Models for the Prediction of Changes in Sleep Structure
Induced by Aircraft Noise
Author(s) Name: Mathias Basner*, Uwe Siebert**
*German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany,
** UMIT, Department of Public Health, Medical Decision Making and Health Technology Assessment, Hall in
Tirol, Austria
OBJECTIVES:
To quantitatively assess the effects of the introduction of a nocturnal air traffic curfew at
Frankfurt Airport on sleep structure.
Methods:
A six state (Wake, S1, S2, S3, S4 and REM) Markov state transition sleep model was built.
Transition probabilities between states were calculated with autoregressive multinomial logistic
regression based on polysomnographic laboratory study data. Monte Carlo simulation trials were
performed for modelling a noise-free night and three noise scenarios: (1) traffic at Frankfurt
Airport on 16 August 2005, (2) as (1), but flights between 11 pm and 5 am cancelled and (3) as
(2), with flights between 11 pm and 5 am from (1) rescheduled to periods before 11 pm and after
5 am.
Results:
The results indicate that there will be a small benefit for airport residents compared to the
current situation even if all traffic is rescheduled (average time spent awake -3.2%, S1 -4.6%,
S2 -0.9%, S3 +3%, S4 +9.2%, REM +0.6%, number of sleep stage changes -2.5%). This
benefit is likely to be outweighed by the increase in air traffic during shoulder hours,
especially for those who choose to or have to go to bed before 10:30 pm or after 1 am.
Conclusion:
Alternative strategies might be necessary to both guarantee undisturbed sleep of airport residents
and to minimize economic and legal disadvantages accompanied by a traffic curfew. The models
developed in this investigation may serve as a valuable tool for optimizing air traffic patterns at
airports, and therefore guide political decision making.
Name and address for correspondence: Mathias Basner, German Aerospace Center (DLR),
Institute of Aerospace Medicine, Cologne, Germany
Telephone No.:
Fax No.:
Date: August 2008
ABSTRACT
No 42.
No 42. ABSTRACT
Title: The problem of a“Human factor” under extreme aviation conditions
Author(s) Name: candidate of psychological sciences Sitara Tariyel Mammadova
Introduction: presented is devoted to the problem of a “human factor” aviation
emergency, and studies the psycophysiological training of the flight operations and
traffic control personnel, their errors actions in extreme (emergency) situations. The
studies revealed that aviation events directly depend on pilots actions: particularly, on
their psycophysiological state, as well as on their individual psychological features,
especially on their sensor-motor reaction and on their intellectual and spatial abilities.
Methods: modern psychological tests at comp . and analiz mathematical and
statistical processing of psychological results
Results: of psycophysiological analysis of the rich empirical data reveals
psycophysiological, social and psychological, as well as individual and
psychological factors influencing the behavior (actions) of the flight operations
and traffic control personnel. Along with it, the dissertation presents
psycophysiological filatures and psychological training of the flight operations and
traffic control personnel. The mathematical and statistical processing of obtained
psychological results of psycodiagnostic pilots tests has been carried out.
Conclusion: The results of studies carried out have been summarized and
presented in Conclusion. The work presented is of great scientific and theoretical
as well as practical significance. Its data and findings (conclusions) can be
successfully used (applied) in developing ways and manners for studying error
actions of flight operations personnel (flying personnel).
Name and address for correspondence: Azerbaycan, Baku, Ahmedli,
M.Rustamov22,flat 23
Telephone No.:99450-361-27-00
Fax No.: 99412-456-25-93
Date: 10.09.2008
ABSTRACT No 43.
Title:
PRECANCEROUS SIGNS IN THE MOUTH DETECTED DURING
MEDICAL FITNESS EXAMINTIONS OF COCKPIT AND CABIN CREWS
Author(s) Name: Dr. Zoltán PÁCZ,
Dr. Imre MELLES
Introduction: With the average number of 3.500 oral cavity tumors detected
yearly, Hungary occupies the first place in the world. The average being 3, 5-5
percent tumors - mainly among the male citizens, although the number of female
patients is also growing.
Although, it is not usually obligatory to do this as a part of a medical fitness
examination, the ORL specialist of the Hungarian Aviation Medical Center is
carefully controlling also the larynx and the oral cavity of the average 2200 airmen
examined yearly, endeavoring to exclude preliminary precancerous signs of the
mouth, especially the leukoplakia.
Methods:Thanks to these efforts, we detect average 30-40 leukoplakia cases
yearly among the examined persons. These cases can be successfully treated in
initial period through medicine, excisions and Laser therapy. 5 % of these cases
would turn bad or fatal without treatment.
Results: In the past (during the last 20 years) we haven’t lost a single cockpit and
cabin crew personnel with oral or larynx carcinoma, detecting and treating the
precancerosus signs during medical fitness examinations on a very early stage.
Conclusion: Keeping first place of the world list of oral cavity tumors and exits,
the Hungarian Medical Center has to continue its good practice and service.
Name and address for correspondence: Imre MELLES M.D.
Telephone No.: 361 280 6809
Fax No.: 361 3580975
Date: 08/11/2008
ABSTRACT
No 44.
No 44. ABSTRACT
Title: Stress Related Syndromes: a new nosographic approach to the psychiatric
disfunctions in aircrew.
Authors: Col. CSArn Prof. Gualberto ARDUINO - T.Col. CSArn Simeone IZZO
Col. CSArn Domenico ABBENANTE-
Discussion: As reported by the WHO the incidence of mood and anxiety disorders
(dysthimia, depression, panic attack, phobia) is increasing and the “stress ” has been
identified as one of the most significant agent in the etiology of this kind of illness and their
related somathic disfunctions (cardiovascular, immunological, etc…) In fact, the
neurobiological mechanisms of stress reaction are considered as important factors in the
pathogenesis of many neuropsychological disfunctions (reduced cognitive performance and
situational awareness, memory impairment, sleep disturbance and lack of attention, etc…).
Several studies have well described the neuroanatomical and functional damages as
consequence of chronic and acute stress and their role in the clinical syndromes. On the base
of these evidences and in consideration of the new therapeutic protocols it is possible to
consider a different policy in the evaluation and the treatment of some clinical syndromes,
specially in the aircrew population which is known to try to avoid to be grounded. A
nosographic approach that underline the “stress ” as etiopathogenetic factor, in alternative to
the traditional diagnostic criteria, could be useful to lead to a more effective evaluation of the
stress related syndromes in the perspective to achieve global results in terms of:prevention
(psychoeducation, counseling, psychotherapy, problem solving, CRM, etc…); treatment
(controlled use of new effective medications);more flexibility in evaluating the fitness in the
renewal protocol of medical licence . If stated in the aviation medical rules, this kind of
approach might encourage the affected personnel to undertake the right treatments and to be
monitored by the medical authorities with the grounding time reduced to the minimum and
more positive outcomes instead to hide the condition, look for inappropriate prescriptions
and get self-medications. According to statistics data, in this case the risks to perform the
flying duty in a compromised state and the chronicity of the condition are very high. With the
current policy the paradox is that the “clever and safest ” people are grounded because of
their acceptance to the treatment and the “least safe” can fly without any control.
Conclusion: “Would you fly with this pilot ?”… a stressed pilot that hide his condition or
take inappropriate drugs because of the rules and the consequences on his duty ? A new
approach to the matter, in many cases, could allow to face an increasing problem with safe
and defined strategies in order to protect this category of professionals.
Name and address for correspondence: Col. Gualberto ARDUINO – Aviation Medicine Institute –
Via P. Gobetti 2 – 00185 ROME (Italy)
Telephone No.: +39-06 49865777
Fax No.:
E-mail:
[email protected]
Date: 17/09/2008
ABSTRACT No 45.
Title: Respiratory CO2, as a physiological and neural-perception indicator of pilots' visual
management, in aviation-A review
Author(s) Name: Dr. Jayashri Devi Sharma MBBS MD
Introduction: Glider pilots fly at near Earth-normal environmental conditions with
adaptive mechanisms that are Physiological- normal responses including to those to
hypoxia, hyperoxia, and hypercapnia. Gliding remained predominantly a European
historical precursor of aviation as we know it today and flying around 10,000ft has
always been believed to be within the physiological zone ( even with helicopters).
Plasticity of Visual management during take off until final landing takes precedent
importance over all other higher functions.
Review of Methods:Aviation related respiratory gas changes were initially studied as
cerebral-vaso-regulatory and sympathetic-parasympathetic baroreceptor and
chemoreceptor induced adaptations, to operational requirements of extreme
environments particularly, altitude and microgravity. The role of CO2 in a breath hold
and re-breathing as an antidote to hyperventilation is remarkably consistent, resulting in
better voluntary and autonomic cardio-respiratory balances. The human retinal
circulation, like the whole cerebral circulation, has been shown to be strongly dependent
upon PCO2 apparently outside strict autoregulatory controls. Phototransduction in the
outer retina by photoreceptors, have a high metabolic rate, which generates large CO2
loads. Inner retina cells then process the visual signal by anion exchangers by removing
photoreceptor-generated CO2 waste and maintain CO2-acid-balance. Further during dark
adaptation to dimmer green flash stimuli, scotopic threshold sensitivity is delayed by
hypoxia and hastened by hypocapnia and hyperoxia.
Results: Visual function is a keystone parameter for good flying and hypercapnia has
been shown to play a very important part in both blood flow to the retina and contrast
sensitivity. Higher than normal CO2, (2.5%), concentration in air affects cell activities
from the retina to the cortex, including the V1 area in the visual cortex, resulting in
impaired coherent motion. Similarly low-concentration CO2 (2.5%) resulted in a
temporary reduction in human stereoacuity, and a persistent but small increase in energy
expenditure.
Conclusion: The role of CO2 for visual perception and attentiveness in slow gliding flight
in physiological zones or aggressive higher energy requiring flight, is most importantly a
function of the air we breathe, hold, and exhale, in the atmosphere of Earth or Space.
Name and address for correspondence: Dr. Jayashri Devi Sharma MBBS MD Glider Pilot
B 205 Kendriya Vihar; Sector 56: Gurgaon , 122003 India
Telephone No.: Mobile 91 11 9818617813
Fax No.: NIL
Date: 7/10/2008
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