original article (continued) - The Australasian Society of Aerospace

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T h e
J o u r n a l
o f
t h e
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A u s t r a l a s i a n
S o c i e t y
A e r o s p a c e
M e d i c i n e
Volu me 5
Num ber 1
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Aug ust 2010
JASAM Vol 5: No 1 – August 2010 | 1
ORIGINAL ARTICLE (CONTINUED)
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2 | JASAM Vol 5: No 1 – August 2010
CONTENTS
Editorial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
ORIGINAL ARTICLE
Hypoxia recognition training in civilian aviation: a neglected area of safety?
Gordon G. Cable, Roderick Westerman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Effectiveness of the Go2Altitude® Hypoxia Training System
Roderick Westerman, Oleg Bassovitch, Gordon Cable, Derek Smits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
JAL123: An illustration of the impact of acute hypoxia on measures of speech
Adrian M Smith . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Historical Article
Results of tests in a decompression chamber of 213 flying personnel
John B Craig . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Letters to the Editor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
2009 Annual Scientific Meeting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
ASAM news
The President’s Logbook. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
News of Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Honours and Awards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Vale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Regional reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Foundation and Honorary Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Calendar of events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
ASAM Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
2010 Membership List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Aviation Medicine Courses in Australia & New Zealand. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Information for Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
JASAM (ISSN 1449 – 3764) is the official journal of the Australasian Society of Aerospace Medicine.
© Copyright ASAM 2006
Website: www.asam.org.au
Address: PO Box 4022, BALWYN, VIC, 3103, AUSTRALIA
EDITORIAL
SIXTY YEARS ON BUT HYPOXIA REMAINS AN ISSUE
This larger than usual edition of the Journal commemorates the 60 years
since the formation of the Society from its beginnings in Melbourne on 25
November 1949 as a Special Group on Aviation Medicine of the British Medical
Association of Australia. The fifteen doctors present at that first meeting were
appointed Foundation Members.
Our two surviving Foundation and now Honorary Members, John Craig and Brian
Costello, must be delighted at the evolution of the Society into its present form
with around 800 members, its Australasian focus and quality presentations at
regional and annual scientific meetings. They must marvel at the changes that
have occurred in aerospace technology since the formation of their Special
Group. The rockets of World War II have evolved into reusable space vehicles,
with the first of these, the Space Shuttle, now being withdrawn from service,
while Pioneer and Voyager satellites are now heading into interstellar space1.
Human beings can survive in space for months and there is now collaboration
between five participant space agencies for the assembly of the international
space station research facility in low Earth orbit2. Computers and satellites
and have revolutionised both travel and communications. Average private pilots
(and motorists) can now find their way by means of cheap global positioning
satellite receivers. Despite these scientific achievements, hypoxia remains an
issue, being an immediate hazard to life for persons exposed to the higher
altitudes of the aerospace environment.
Dr Paul Bert, as a professor of physiology, discovered in the 1860s that
altitude sickness was caused mainly by a lack of oxygen and the effects were
proportional to the partial pressure3. His demonstration of the protective effects
of oxygen at altitude prompted Croce-Spinelli and Sivel to carry oxygen on their
balloon flights attempting to break the altitude record previously established
by Glaisher and Coxwell. In 1874, with Tissandier, they ignored Bert’s advice
to take more oxygen than they had planned and reached 28,200 feet before
all lost consciousness due to hypoxia; Tissandier was the only one to survive.
”They leap up and death seizes them, without a struggle, without suffering,
as a prey fallen to it on those icy regions where an eternal silence reigns. Yes,
our unhappy friends have had this strange privilege, this fatal honour, of being
the first to die in the heavens.” was part of Paul Bert’s eulogy at the funeral of
these two early altitude explorers4. These two men died of hypoxia despite the
knowledge and equipment, albeit rudimentary, being available to them for the
prevention of hypoxia.
The incidence of decompression illness was thought to be rare, and so for
decades hypoxia experience training was conducted in hypobaric chambers
at an altitude of 25,000 feet. However, a number of cases of decompression
illness were noted at RAAF Institute of Aviation Medicine about a decade ago5.
Whether this increased incidence was a cluster, an increased recognition of
subtle decompression illness symptoms6, a reflection of increasing awareness
from occupational health and safety considerations, or even anxiety from riskaverse medical officers, or maybe a combination of the above factors, it led
to cessation of the previous usage pattern of hypobaric chambers for hypoxia
experience training.
Alternative and cheaper methods of delivering low oxygen mixtures at
normobaric pressures have been developed. The article by Westerman et
al (page 8) demonstrates one such simple, cost-effective yet sophisticated
method. However, looking to the next 60 years, one wonders how long
inducing hypoxia to reach cyanosis in normal individuals will be permitted by
occupational health and safety authorities, compensation insurers or ethics
committees.
A question to be asked is why in this highly sophisticated and technologically
advanced aerospace industry are we still training the human to be the detector
of hypoxia? Hypoxia recognition, even among trained aircrew, is poor in the
aerospace environment because hypoxia is not only uncommon, but its
symptoms are often vague, subtle and non-specific if they are recognised at
all. Adrian Smith presents some very interesting observations about changes in
speech that can help accident investigators determine whether flight deck crew
were hypoxic at the time of an accident (page 14).
In modern test parlance, detection of hypoxia by recognition of symptoms lacks
both sensitivity and specificity. It is time to insist that the aviation safety industry
develop better means to detect and warn flight crew of the loss of cabin
pressure, as well as warn flight crew early of the onset of hypoxia. Technology
and engineering solutions for this are now feasible and comparatively cheap.
This Society could take a lead to encourage the introduction and retrofitting
of such detection and warning systems in commercial aircraft as a matter of
priority. All such hypoxia deaths remain preventable.
Warren Harrex
1.
http://voyager.jpl.nasa.gov/faq.html
Engineering solutions now effectively isolate humans from the environment
in aerospace. However, as Cable and Westerman elucidate in this issue (page
5), hypoxia still remains a cause of death despite it being preventable. A
common cause in these deaths from hypoxia is an unrecognised loss of cabin
pressurisation. This appears to be the reason of a loss of a RAAF FA18 around
1990, the death of the golfer Payne Stewart in a Lear Jet 35 in 1999 and loss
of the Helios Airlines737 in 2005, to name three high-profile instances.
2.
http://en.wikipedia.org/wiki/International_Space_Station
3.
http://www.faqs.org/health/bios/29/Paul-Bert.html
4.
Man in Flight - Biomedical achievements in aerospace. E. Engle & A. Lott. Leeward
Publications, USA: 1979. p38. Cited at http://aeromedical.org/Articles/XOHP_1212.html
5.
Smart TL, Cable GG. Australian Defence Force hypobaric chamber training, 19842001. ADF Health. 2004;5(1):3-10.
Gaining experience in recognition of hypoxia using decompression chambers
to simulate altitude was common for decades. Some individuals develop
decompression illness at altitude as indicated in the historical article by John
Craig (page 19) on the incidence and risk factors in Australian aircrew around
1952. This article is interesting, not only for this reason, but because such
research is unlikely to be reproduced because modern ethics committees
would not agree to such research being conducted.
6.
Cable GG, McFarlane A. Is neurological hypobaric decompression illness a more
common phenomenon than we think? JASAM 2006; 2(2):3-11
ORIGINAL ARTICLE
HYPOXIA RECOGNITION TRAINING IN CIVILIAN
AVIATION: A NEGLECTED AREA OF SAFETY?
Gordon Cable1 MB, BS, DAvMed, MRAeS, Roderick Westerman2 MB, BS, PhD, MD, FRACGP
ABSTRACT
Since the earliest days of aviation, hypoxia at altitude has been recognised
as a safety hazard, and this hazard continues to this day, such that a recent
Australian Transport Safety Bureau report on hypoxia and loss of cabin
pressure describes 517 incidents in Australia between 1975–200612. The
risk of hypoxia in civilian aircraft may be increasing as the performance and
flight envelope of civil registered aircraft expands. There is good evidence
that hypoxia training of flight personnel aids early recognition of symptoms,
and this has been a routine in the military for several decades since World
War II. However, there has been no easily accessible and cost-effective
method of such aircrew safety training in the civilian sector in Australia. This
review examines the published incidence of hypoxia events in military and
civilian aviation, and presents data on the benefits of hypoxia training. New
developments in hypoxia training are discussed which could provide more
accessible, cost-effective and safer training to civilian aviators to offset this
ever-present risk.
Why the CONCERN?
Hypoxia is a condition of reduced oxygen bio-availability caused by
decreased oxygen diffusion from lung to blood, impaired oxygen transport
in blood, decreased tissue perfusion or histotoxicity. Hypoxia triggers various
cardiovascular and respiratory adjustments to occur in the body, but despite
such compensations it causes impaired function in vision, cognition, motor
control, and ultimately severe incapacitation, unconsciousness and death1.
Since the earliest balloon ascents, hypoxia has been recognised as a
physiological threat which increases with altitude. In April 1875, two young
Frenchmen, Croce-Spinelli and Sivel, became the first fatalities from aviation
hypoxia during their attempt to reach 26,200 feet in an open balloon with
colleague Gaston Tissandier, even though the famous physiologist Paul Bert
had provided them with oxygen for the ascent2. Harding, in Ernsting’s learned
textbook, states that acute hypobaric hypoxia is the most serious single hazard
during flight at altitude3 and it continues to be a threat today. Most jurisdictions
mandate theoretical training in altitude physiology and hypoxia. Now a few
require practical experience including the US Federal Aviation Administration
(FAA) which advertises and highly recommends hypobaric chamber training
courses at the Civil Aerospace Medical Institute (CAMI) for General Aviation
pilots4. Further, the UK Civil Aviation Authority (CAA) also recommends practical
training to supplement theoretical knowledge. It almost appears there has been
a prevailing perception in the civil aviation industry until recently that hypoxia
incidents are rare, and if they do occur, emergency oxygen systems, warning
systems and rapid descent will save the situation and prevent hypoxia, with no
need for symptom recognition on the part of the crew.
So how common is the problem of hypoxia in aviation? Many fatal accidents
occurring as a result of hypoxia may not be immediately recognised as such,
Aerospace Medical Services Pty Ltd
Level 1, Control Tower Building, Anderson Drive,
Parafield Airport SA 5106.
Correspondence
Dr Gordon G Cable
PO Box 235 Marden SA 5070
[email protected]
given the numerous other potential causes of fatal accidents. However, a
few recent hypoxia accidents have occurred in a dramatic and sensationally
publicised fashion to remind all aviators of this ever-present altitude threat.
In October 1999, a Lear Jet 35 crashed near Aberdeen, South Dakota having
departed Orlando, FL, four hours earlier, and flown on autopilot across the
United States with an apparently incapacitated crew5. The aircraft attained an
altitude of 45,000 feet before it crashed due to fuel exhaustion, killing all on
board including professional golfer Payne Stewart. Cabin pressurisation failure
and hypoxia have been widely mooted as the probable causes of this accident.
In 2005 the crash of a Helios Airlines B737 in Greece again re-iterated the
danger of undetected hypoxia leading to crew incapacitation, reminding the
aviation community about the importance of altitude physiology knowledge
even in airline operations.
Although fatalities due to hypoxia as seen in these high profile examples are
relatively rare, hypoxia incidents are common – particularly in military aircraft.
There were 656 reported incidents, including one fatality and aircraft loss
in the paper by Island and Frayley6 analysing USAF hypoxia incidents from
January 1976 to March 1990. Rayman and McNaughton7 reviewed 298 cases
of in-flight hypoxia in the USAF. Of the incidents, 144 occurred in trainers, 48
in fighters, 28 in transport aircraft, 23 in bombers, and 1 in U2 reconnaissance
aircraft. Therefore in total, 193 cases (64.7%) occurred in aircraft despite
oxygen equipment being routinely used and a mask worn by aircrew at all
times. The predominant symptoms experienced were paraesthesia, lightheadedness, dizziness, decreased mentation, and visual changes, while other
symptoms were extremely variable including 16 cases who described loss of
consciousness. These symptoms clearly indicate the constant dangers of even
mild hypoxia to the aviator. In 98 cases (33%) the cause was not determined,
but 134 (45%) were due to problems or failures in oxygen mask, regulator, hose
or oxygen supply. There were 58 (19%) due to cabin pressurisation failure, and
8 (3%) due to mask removal in flight. The US Navy reported 18 cases of loss of
consciousness and 4 fatalities over a 21 year period8, while the Canadian Forces
had no fatalities from 1963–19849. A review of Australian Defence Force (ADF)
incidents for the period 1990–2001 reported 27 hypoxia incidents involving 29
aircrew, and one fatality, the majority occurring in fighters and unpressurised
training aircraft10. More recently Files, Webb and Pilmanis described the US
military experience of cabin depressurisation occurring between 1981 and
200311. Of a total of 1055 incidents found, hypoxia occurred in 221 resulting
in 3 deaths. The vast majority (83%) of these incidents were slow in onset,
which implies that onset of hypoxia symptoms would be more insidious. All
these reports demonstrate that even today, hypoxia remains a serious threat
to military aviators.
Thus hypoxia in military aircraft is widely reported. Reliable civilian data relating
to hypoxia incidents and loss of cabin pressure is harder to find than military
data. In the USA, National Transportation Safety Bureau (NTSB) statistics reveal
40 aircraft accidents related to hypoxia between 1965 and 1990, resulting in
67 fatalities. This data cited in Island and Frayley6 suggests that on average
there were more than 2 deaths per year due to hypoxia related accidents in
the US prior to 1990. A report on depressurisation incidents and accidents
commissioned by the Australian Transport Safety Bureau (ATSB) in 2006
found that there were 517 pressurisation failure events involving aircraft on
the Australian civil register between January 1975, and March 2006. One
event involved multiple fatalities, and in all 10 events involved death, hypoxia or
minor injury12. Pressurisation system failures rather than rapid decompression
occurred in most cases. The report concluded that there is a “high chance of
surviving a pressurisation system failure, provided that the failure is recognised”.
Recognition of such failures relies mostly upon warning systems, but these
can go unheeded as hypoxia begins to impair neurocognitive functioning. This
Hypoxia Recognition Training
was graphically demonstrated in a military KingAir B200 in 1999 with three
senior aircrew on board which failed to pressurise on climb. When the pilot
in command lost consciousness the co-pilot recognised the emergency and
treated him with oxygen but failed to don oxygen himself, yet nevertheless
managed to descend the aircraft to safety. The master caution for cabin altitude
was never recognised13. This incident involved highly experienced aircrew who
had been trained in their hypoxia symptoms.
IS THERE A SAFETY BENEFIT IN TRAINING?
Early recognition of hypoxia is important in preventing incapacitation to enable
corrective actions to be taken1, 6. Explosive decompression is self-evident,
but hypoxic symptoms from unrecognised depressurisation are often subtle
and may be difficult to recognise without previous training. There is often
very limited time for flight crew to recognise any hypoxia symptoms before
consciousness is lost. Impaired cognitive ability due to hypoxia may negate the
effectiveness of automated warning systems. But what do pilots think about
training for this contingency? In a survey of 67 professional pilots in the USA,
almost all indicated that they believed that altitude chamber hypoxia training
should be conducted initially and recurrently, especially for commercial and
airline transport flight crews, and most believed that the need for training should
be based on the altitude capabilities of the types flown 14. Unfortunately there
has not been any similar survey of Australian aircrew conducted. Theoretical
knowledge of the effects of altitude on human physiology and performance is
required by the Civil Aviation Safety Authoritiy15, 16, but practical hypoxia training
for flight crew has not been readily available.
Military forces have always recognised that practical training substantially
reinforces knowledge of hypoxia and adds a further level of safety through early
detection. Based on the sort of incident data presented above, most air forces
have conducted hypoxia familiarisation training for aircrew for at least the last
70 years, traditionally using hypobaric altitude chambers17, 18. Such recurrent
training throughout an aviator’s career refreshes their awareness of symptoms
and identifies any changes in an individual’s symptoms. Although symptoms
are idiosyncratic to the individual, they are usually rather consistent over time
for that person19. There is published data that suggests such training works and
saves lives. In the report of 656 USAF hypoxia incidents described above6, 606
of the cases involved trained aircrew, and only 3.8% of these experienced loss
of consciousness as a result. Of 50 passengers in the study, 94% experienced
loss of consciousness. This study concluded that this major difference in hypoxia
susceptibility between trained aircrew and untrained passengers emphasises
the benefit of hypobaric chamber training in the recognition of hypoxia. Of the
520 trained aircrew who recognised their own symptoms, 26.2% stated that
they were “just like the chamber”. Similar results were found in the ADF study10
in which 86% of hypoxia-trained aircrew recognised symptoms in themselves
or in others and took corrective actions.
Increasing numbers of Very Light Jets (VLJs) are already being sold and
operated overseas in the General Aviation sector by high net-worth individuals
and corporations21. These include aircraft such as Embraer’s Phenom 100, the
Eclipse 500 and the Cessna Citation Mustang, which like their larger “bizjet”
counterparts such as Learjet, are pressurised and normally operate well above
40,000 feet. The need for advanced military style jet training including hypoxia
recognition has been suggested21. For airline operators, the Airbus A380 is
already in service and carries between 555 and 840 passengers (depending on
configuration) at cruise altitudes of 43,000 feet22. The technological advances
in materials and systems required for the A380 developments will reduce fuel
and other costs, and improve environmental friendliness. However, the need for
improved safety training requirements will correspondingly increase and the
need for added hypoxia protection has already been realised at those higher
cruise altitudes22.
Generally civilian aviators are unable to access practical hypoxia training, and
there are very few civilian owned and operated hypobaric chambers in the
world. One noteworthy exception is the FAA Civil Aeromedical Institute (CAMI)
chamber in Oklahoma City which has been training engineers, airline flight
crew, student pilots and flight attendants by theoretical instruction in aviation
physiology and an altitude chamber flight since 196218. In addition, there are
14 other cooperating military installations throughout the U.S.4. In Australia the
only operational hypobaric chamber is at RAAF Base Edinburgh near Adelaide,
however this is not routinely available for civilian training. Despite the known
risks of hypoxia and the documented aviation incidents listed above, practical
hypoxia training for civilian aircrew has not been implemented in emergency
procedure training yet. Because normobaric systems are now available,
perhaps it is time for the civil aviation regulatory authorities to recommend that
practical hypoxia training experience be included in the emergency procedures
training, where practicable.
IS THERE A NEED FOR CIVILIAN TRAINING?
The major factors inhibiting the ability to conduct hypoxia training for civilian
aircrew has been the poor availability of hypobaric chambers, their capital
cost and maintenance expense, and the risk of decompression illness14. Given
the perception of minimal risk of hypoxia in the industry, it is therefore not
surprising that training is dismissed as impractical on the basis of cost-benefit
analysis. However, if a simple, inexpensive, effective and accessible alternative
was available, the financial equation may look much more favourable. Over
the last 10–15 years, physiologists and aerospace medicine researchers have
developed and trialled ground-based methods of training which use reduced
oxygen gas mixtures to simulate the physiology of high altitude. Hypoxia can
be produced by lowering inspired oxygen partial pressure either by barometric
pressure reduction (hypobaric hypoxia-HH) or by lowering the fractional
concentration of O2 in inspired air (normobaric hypoxia-NH). Some research
suggests that there may be slight physiological differences between HH and
NH23, but the risks of barotrauma and decompression illness associated with
the use of hypobaric chambers for hypoxia familiarisation training17 have made
alternative methods almost obligatory.
Advancements in aircraft design have led to an ever increasing envelope of
performance in aircraft that are readily accessible to the general aviation
community. Light aircraft, such as Mooney’s M20TN “Acclaim” are powered
by 6 cylinder dual turbocharged, dual intercooled engines allowing cruise
altitudes of 25,000 feet 20. Other examples include the Lancair IV which can
cruise at 24,000 feet and 330 kts, and comes with an optional pressurised
cabin. In most cases pressurisation is not the norm, yet these aircraft can
effortlessly climb and cruise at altitudes above 10,000 feet necessitating the
use of constant flow oxygen systems. These systems have little redundancy
and no warning systems to indicate failure.
Due to the risk of decompression illness in traditional hypobaric chamber
training at altitudes up to 25,000 feet, in 2001 the Royal Australian Air
Force developed a Combined Altitude Depleted Oxygen (CADO) technique of
hypoxia training which utilises a reduced oxygen gas mix delivered by mask
at an altitude of 10,000 feet in a hypobaric chamber17, 24, simulating a total
physiological altitude of 25,000 feet much more safely but this chamber
technique is not accessible for training civilian aviators. The Canadian Forces
have also adopted CADO hybrid hypobaric & reduced oxygen gas-mix system
for its training. The Reduced Oxygen Breathing Device (ROBD) developed jointly
by Duke University, and the US Naval Aerospace Medical Research Laboratory
Hypoxia Recognition Training
(NAMRL) uses a closed-loop breathing circuit with computer controlled fraction
of inspired oxygen25, 26. This device has been proven effective in inducing
hypoxia in subjects under normobaric conditions, and has been used effectively
in military flight simulators to demonstrate physiological emergencies in a
dynamic flight environment27. Hypoxia induced by normobaric ROBD has
been found equivalent physiologically and symptomatically to that induced
by altitude hypobaria in US Navy studies28. Non-rebreathing normobaric
systems have also been studied and found effective in demonstrating hypoxic
symptoms to students and Air Ambulance personnel at Monash University. This
reduced oxygen breathing method described by Westerman29 uses reduced O2
gas-mix and a non-rebreathing mouthpiece to produce normobaric hypoxia,
with continuous pencil and paper tests of cognitive function. This is largely a
research laboratory development, and relatively inaccessible for civil aviators,
although it has been used for 15 years to train mobile intensive care air
ambulance personnel in Victoria and the Australian Capital Territory.
A very recent and innovative development in Australia is the GO2Altitude
hypoxia training system30, 31 which can provide an accessible means of hypoxia
training for civilian flight crews where no facility has been previously available.
GO2Altitude® hypoxia training utilises a semi-permeable membrane technology
to concentrate nitrogen gas from room air to produce a gas with the desired
low oxygen concentration, unlike other normobaric methods25, 26, 29 which
utilise bulky gas cylinders and have higher maintenance and running costs.
The GO2Altitude system has the advantage of being designed specifically
for aviation training purposes, and provides detailed automated printout of
physiological data, continuous cognitive test results and video-recorded
behaviour30,31. Validation of this new technology is ongoing and preliminary
results of research have been published30,31.
CONCLUSION
Hypoxia remains the most serious threat of high altitude flight, and this is
evident by reviewing the statistics of incidence and fatalities. It is arguable that
the changing nature of the general aviation industry means that perhaps civilian
aviators today face an even greater threat from hypoxia than previously, which
introduces new imperatives and challenges in training. Advances in hypoxia
training techniques over the last decade mean that these challenges can now
be met with safe, accessible and more cost effective training technologies
which can only result in better safety through improved defences.
REFERENCES
1.
Ernsting JE, Hypoxia in the aviation environment. Proc R Soc Med 1973 June,
66(6):523-527
2. Engle E, Lott AS. From Montgolfier to Stratolab. In: Man in Flight. Biomedical
Achievements in Aerospace. Annapolis: Leeward Publications; 1979. p. 31-8.
3. Harding RM. Hypoxia and hyperventilation. In: Ernsting J, Nicholson AN, Rainford DJ,
editors. Aviation Medicine. Oxford: Butterworth Heinemann; 3rd ed.1999. p. 43-58.
4. FAA Hypoxia Safety Brochure: www.faa.gov/pilots/safety/media/hypoxia.pdf
5. Newman DG. Runaway plane. Flight Safety Australia. 2000 Mar-Apr, 42-44.
6. Island RT, Fraley EV. Analysis of USAF hypoxia incidents January 1976 through March
1990. In: 31st Annual SAFE Symposium; 1993; Creswell OR: SAFE Association;
1993. p. 100-106.
7. Rayman RB, McNaughton GB. Hypoxia: USAF experience 1970-1980. Aviat Space
Environ Med. 1983;54(4):357-9.
8. Bason R, Yacavone DW. Loss of cabin pressurisation in US Naval aircraft: 19691990. Aviat Space Environ Med. 1992;63(5):341-5.
9. Brooks CJ. Loss of cabin pressure in Canadian Forces transport aircraft, 19631984. Aviat Space Environ Med. 1987;58(3):268-75.
10. Cable GG. In-flight hypoxia incidents in military aircraft: Causes and implications for
training. Aviat Space Environ Med. 2003;74(2):169-72.
11. Files DS, Webb JT, Pilmanis A. Depressurisation in military aircraft: Rates, rapidity,
and health effects for 1055 incidents. Aviat Space Environ Med. 2005;76(6):523-9.
12. Newman, DG., Depressurisation accidents and incidents involving Australian civil
aircraft. 1 January 1975 to 31 March 2006., in ATSB Research and Analysis Report.
2006, Australian Transport Safety Bureau.
13. Australian Transport Safety Bureau. Aviation Safety Investigation Report – Final:
Raytheon Aircraft Super King Air 200, VH-OYA, Feb 2001. http://www.atsb.gov.au/
publications/investigation_reports/1999/AAIR/aair199902928.aspx.
14. Hackworth C, Peterson L, Jack D, Williams C. Altitude training experiences
and perspectives: Survey of 67 professional pilots. Aviat Space Environ Med .
2005;76(4):392-4.
15. Civil Aviation Safety Authority. Air transport pilot (aeroplane) licence, Aeronautical
knowledge syllabus. Issue 1.1 – June 2000.
16. Civil Aviation Safety Authority. Day VFR syllabus – aeroplanes. Student, private and
commercial pilot licences. Day VFR operations below 10,000 feet AMSL. Issue 4 :
01 March 2008.
17. Smart TL, Cable GG. Australian Defence Force hypobaric chamber training, 19842001. ADF Health. 2004;5(1):3-10.
18. Valdez C. The FAA altitude chamber training flight profiles: a survey of altitude
reactions – 1965-1989. In: Pilmanis AA, editor. The Proceedings of the 1990
Hypobaric Decompression Sickness Workshop: Armstrong Laboratory; 1992. p.
457-463.
19 Smith AM. Hypoxia symptoms in military aircrew: long-term recall vs. acute
experience in training. Aviat Space Environ Med. 2008;79(1):54-7.
20. Grimstead B. Acclaim. Flying high in Mooney’s M20TN. Australian Aviation. 2008;
249: 66-73.
21. Robinson T. VLJs: Here to stay? Aerospace International. 2008; 35(5): 14-17.
22. Marotte HC. Protection of crewmembers against altitude hypoxia in case of
an in-flight rapid decompression at 35,000-45,000 ft in commercial aviation.
(Abstract). Aviat Space Environ Med. 2008;79(3):231.
23. Savourey G, Lounay JC, Besnard Y, Guinet A, Travers S. Normo- and hypobaric
hypoxia: are there any physiological differences? Eur J Appl Physiol. 2003 Apr;
89(2):122-126.
24. Hampson G. Hypobaric training Downunder: Where to from here? [Abstract]. . Aviat.
Space Environ Med. 2007; 78(3): 265.
25. Sausen KP et al The reduced oxygen breathing paradigm for hypoxia training:
physiological, cognitive and subjective effects. Aviat Space Environ Med. 2001
June; 72(6): 539-545.
26. Sausen KP et al. A closed-loop reduced oxygen breathing device for inducing
hypoxia in humans. Aviat Space Environ Med. 2003;74(11):1190-7.
27. Artino AR, Folga RV, Swan BD. Mask-on Hypoxia Training for Tactical Jet Aviators:
Evaluation of an Alternative Instructional Paradigm. Aviat. Space Environ Med. 2006;
77: 857-863.
28. Vacchiano CA, Vagedes K, Gonzales D. Comparison of the physiological, cognitive
and subjective effects of sea level and altitude-induced hypoxia. [Abstract] Aviat
Space Environ Med. 2004; 75, (4 Suppl): B56.
29. Westerman RA. Hypoxia familiarisation training by the reduced oxygen breathing
method. ADF Health. 2004;5:11-15.
30. Westerman RA and Bassovitch O. Hypoxia familiarisation training using Flight
Personnel Simulated Altitude Training System. Aviat Space Environ Med. 2007;78(3):
305 Abstract.
31 Westerman RA, Bassovitch O., Smits D. Simulation In Aviation: Hypoxia
Familiarisation Training Using The GO2Altitude® System. SimTect 2008 Simulation
Conference Proceedings, 12-15 May 2008 Melbourne Australia.
EFFECTIVENESS OF THE GO2ALTITUDE® HYPOXIA
TRAINING SYSTEM
Roderick Westerman1 MB, BS, PhD, MD, FRACGP, Oleg Bassovitch2 BSc, MSc,
Gordon Cable3 MB, BS, DAvMed, MRAeS, Derek Smits2 MSc.
ABSTRACT
Aim. This study evaluates the effectiveness of the GO2Altitude® Hypoxia
Training System method of normobaric hypoxia awareness training of aircrew
by demonstrating and measuring (1) cardio-respiratory adjustments in
healthy volunteers to a simulated altitude of 25,000 feet (7620 m); (2) the
spectrum of signs and symptoms accompanying such hypoxia; (3) individual
variability in susceptibility to hypoxia and oxygen paradox and (4) time of
useful consciousness.
Methods. The The concentration of oxygen in air was reduced by the
GO2Altitude® device, and delivered by hand-held mask to 92 subjects,
with continuous recording/display of physiological parameters and
cognitive functions.
Results. The GO2Altitude® system shows levels of blood oxygen saturation,
heart rate and respiratory frequency displayed on the user screen. The type
and frequency of impairments were reaction time (79%), simple mathematical
processing (72%), short term memory (65%), colour perceptual acuity (69%),
shape discrimination (38%), spatial orientation (18%), and thought block
(21%). These are similar to those reported using a reduced oxygen gas mix
method. Results may be printed or stored on video CD.
Conclusions. The GO2Altitude® system simulates 25,000 feet altitude as
effectively, safely, and more conveniently than a reduced oxygen gas mix
method. Subjects experience their personal time of useful consciousness and
hypoxic symptoms without risks of barotrauma or decompression sickness.
The GO2Altitude® system provides theoretical revision and practical training
for familiarisation with the physiological and cognitive effects of hypoxia and
should enhance hypoxia awareness for aviation personnel.
A recent review by Cable and Westerman1 highlighted that problems
associated with hypoxia have been common throughout aviation history from
the first hypoxia induced fatalities of two French balloonists through to the
recent major crash of a Helios Airways B737 in 2005. A number of papers
have documented how common and dangerous hypoxia associated aviation
1
Dr Roderick Westerman
Consultant Neurophysiologist
Caulfield General Medical Centre
260 Kooyong Road, Caulfield Victoria, 3162 AUSTRALIA
[email protected]
incidents are, especially in military operations1. Hypoxia at increasing altitude is
recognised as the most serious single hazard during flight1-3.
Although knowledge of the effects of altitude on human physiology and
performance is required by CAO20:11, practical hypoxia training for civilian
flight crew has not been readily available until recently. Such training would
substantially reinforce the required knowledge of and add a further level of
safety in the early detection of loss of cabin pressure and hypoxia.
Over the last 10–15 years, physiologists and aerospace medicine researchers
have developed and trialled a number of techniques that use normobaric low
oxygen gas mixtures to simulate hypoxia at high altitude4-8 and which reduce
the costs and risks associated with hypobaric chambers. The Reduced Oxygen
Breathing Device (ROBD) developed jointly by Duke University, and the US
Naval Aerospace Medical Research Laboratory (NAMRL) uses a closed-loop
breathing circuit with electronically controlled fraction of inspired oxygen5-6.
This device has been proven effective in inducing hypoxia in subjects under
normobaric conditions and hypoxia induced by normobaric ROBD was
concluded to be equivalent physiologically and symptomatically to that induced
by altitude hypobaria. A non-rebreathing normobaric system has also been
studied and found effective in demonstrating hypoxic symptoms to students
and Air Ambulance personnel at Monash University4.
AIMS
The primary aim of the study was to evaluate the new GO2Altitude® Hypoxia
Training System7-8, in particular (1) to obtain feedback from participating
students and pilots about the educational impact of the GO2Altitude® hypoxia
training system; (2) to validate the efficacy of GO2Altitude® system as a
hypoxia training method for civilian and military aircrew; (3) to demonstrate the
reliability, utility and convenience of this hypoxia training system for the aviation
sector; and (4) to consider issues of training fidelity by seeking comment
from experienced pilots about using a hand-held mask for hypoxia training.
The second aim of this study was to compare the GO2Altitude® Hypoxia
Training System with normobaric hypoxic training (using published results
of the Westerman Reduced Oxygen Breathing Method4) by demonstrating
and measuring (1) cardio-respiratory adjustments in healthy volunteers at a
simulated altitude of 25,000 feet (7620 m); (2) the spectrum of signs and
symptoms accompanying such hypoxia; (3) individual variability in susceptibility
to hypoxia and oxygen paradox; and (4) time of useful consciousness.
METHODS
Study Design
2
Oleg Bassovitch, CEO,
Biomedtech Pty Ltd
17 Roberna Street Moorabbin, Victoria 3189 AUSTRALIA
[email protected]
This study compares data derived from examining the performance of the
GO2Altitude® Hypoxia Training System7-8 with data derived from previous
experimentation using the Reduced Oxygen Breathing Method4; seeking
differences which could be significant.
3
Induction of Hypoxia
Dr. Gordon Cable,
Aerospace Medical Services Pty Ltd
Level 1, Control Tower Building, Anderson Drive,
Parafield Airport SA 5106.
PO Box 235 Marden SA 5070
[email protected]
Correspondence
Dr Roderick Westerman
[email protected]
Hypoxia was induced by exposing subjects to the GO2Altitude® system8
which provides a normobaric reduced oxygen breathing exposure for hypoxia
training previously shown to be an efficient and cost-effective tool (Westerman,
Bassovitch and Smits7-8). The GO2Altitude® system utilises air separation
technology to produce two air streams with the desired low and high oxygen
concentrations. It provides continuous computer monitoring of cognitive and
physiological functions during programmed exposure to simulated altitudes up
to 40,000 feet. Time of Useful Consciousness (TUC) was estimated by the
presence of more than one cognitive function error. Exposure of subjects to
hypoxia was limited to five minutes, with rapid recovery effected by breathing
Hypoxia Awareness Training
oxygen. The layout of a GO2Altitude® hypoxia training session is illustrated
in figure 1.
Results from this study were compared to those from a previous study4 using a
normobaric Reduced Oxygen Breathing Method (ROBM). In that study subjects
breathed a commercial gas mixture (6.5%–7% oxygen, balance nitrogen),
via a SCUBA mouthpiece with one-way valves expiring to air via a Wright
respirometer. The 452 subjects in that study were continuously monitored for
blood oxygen saturation (SpO2) pulse rate, blood pressure, and ventilation4. A
written cognitive function test battery lasting approximately 90 seconds was
administered repeatedly until obvious impairments were observed4.
Subject selection and screening
In total, ninety-two (92) healthy male and female, non-smoking subjects, aged
18 to 50 years volunteered for this study and 59 of the subjects were naïve
to hypoxia training or hypobaric exposure. Subjects all gave written informed
consent after receiving verbal and written information on the study design, risks,
and voluntary nature of their participation. The research protocol was approved
by The Alfred Hospital Human Research Ethics Committee (project 40/07).
All subjects held current Australian Class 1 medical certificates and underwent
a screening medical examination by a Designated Aviation Medical Examiner.
Subjects were to be excluded from the study if they suffered from any
aeromedically significant illnesses, abnormalities on physical examination or
adverse medical history. No subjects were excluded from GO2Altitude® study.
Figure 1 Shows the physical arrangement of the human interface
portion of GO2Altitude® hypoxia training system. Visible are the
facemask held in the non-dominant left hand, index finger SpO2 probe/
pulse plethysmograph, the touch screen displaying physiological
parameters in the top right quadrant, altitude in lower right quadrant
and cognitive tests continuously displayed in the left half-screen. Also
seen are the desktop altitude control unit with LCD display, reservoir
bag and a backup oxygen cylinder.
A physician or an Advanced Cardiac Life Support accredited Medical Intensive
Care Ambulance paramedic monitored the conduct of the simulated altitude
hypoxic exposure at all times.
Education and Briefing:
All subjects received a standard briefing on the effects of simulated altitude,
nature of hypoxia, and measurements to be taken prior to the experimental
intervention. They were briefed on the potential hazards of hypoxia from
simulated altitude exposure and medical conditions which would exclude actual
hypoxia exposure. The computerised educational package in the GO2Altitude®
hypoxia training system delivers part of this briefing. In addition, the opportunity
was given to ask questions and clarify the standard spiel if necessary.
Physiological Testing:
During GO2Altitude® hypoxia exposures the following physiological
measurements were recorded at simulated 8,000 feet and 25,000 feet
altitude: SpO2, heart rate, respiratory frequency, heart rate variability by the
fully integrated monitoring system.
Figure 2 Closeup of touch screen displaying physiological parameters
oxygen saturation (SpO2), Heart rate (HR) and ventilation frequency
(Vf) in the top right quadrant, altitude and fractional inspired oxygen
concentration (FiO2) in the lower right quadrant and cognitive tests
continuously displayed in the left half-screen. Note the ABORT button.
Neurocognitive Testing:
Cognitive function was assessed continuously during each hypoxia exposure.
In the GO2Altitude® hypoxia training system, a computer-presented repeating
cognitive test battery was developed and refined from standard subtests similar
to those employed in the aviation modules of neuropsychological test batteries.
Parameters assessed included simple and choice reaction times, simple maths
processing, spatial orientation, memory, shape discrimination and colour
vision (BK, Ishihara or similar plates). Subjects were allowed sufficient time
before the hypoxia exposure to fully familiarise themselves with the cognitive
test batteries.
perception, deteriorated handwriting, and perseveration – even “freezing” or
failure to respond. These cognitive effects of hypoxia are printed for each of
the subtests – maths, manikin spatial orientation, shape discrimination, colour
vision and delayed recall. The actual responses are shown with trend lines
superimposed. The trend in all responses to these subtests was declining
accuracy and lengthening response time to task completion.
Varying degrees of motor incoordination were demonstrated by more than half
the participants. The hypoxia resulted in impaired coordination, degradation of
motor control and ultimately, inability to continue. A representative handwritten
sentence from one subject before and at the end of five minutes of hypoxia at
a simulated altitude of 25,000 feet is shown in Figure 4.
Figure 3 Shows examples of cognitive subtests: A – group of 4 simple
maths statements; B – presentation to remember: a group of 4 different
cards; C – Standard Manikin, facing towards or away, upright or
inverted, holding a flag in left or right hand; D –Shape discrimination of
subtly different or identical shapes; E – remember the location of one
card from the previously presented group of 4; F – Colour recognition of
embedded numbers (Ishihara or BK plates).
Symptom Survey:
After each hypoxia experience subjects were asked to complete a survey
containing a list of hypoxia-specific, non-hypoxia-specific and non-hypoxia
symptoms. Key hypoxia symptoms were analysed and compared between
the two hypoxia exposures. Comments about the educational impact of the
GO2Altitude hypoxia training system, as well as criticisms and suggestions
for improving this training system were also sought in the last section of the
symptom survey.
Data Analysis and Reporting:
Data was stored on video CD and database and could be analysed from a
printed report, together with a graphical plot of cognitive function throughout
the hypoxic exposure. Physiological responses were averaged over 15 second
intervals to assist estimation of Time of Useful Consciousness (TUC). All data
was de-identified and tabulated in Excel 2003 files. Where appropriate,
comparative analysis was undertaken from Excel files with Statistical Package
for Social Sciences (SPSS v 6.1) using a notional significance level of p<0.05.
RESULTS
Normobaric hypoxia induced by GO2Altitude® produced falling SpO2, and
increased heart rate in subjects, as illustrated for one typical subject at the
top right in Figure 2. The expected cognitive effects of GO2Altitude® hypoxia
at the simulated 25,000 foot altitude were cognitive performance degradation,
reduced accuracy, lengthened response time to subtest completion for maths,
spatial orientation and shape discrimination, impaired memory and colour
Figure 4 Shows deterioration in handwriting with impaired visual-motor
coordination after 5 mins hypoxia at 25,000 feet simulated altitude.
Of the 92 pilots and students tested there was one instance of ‘syncope’ and
one episode of pre-syncopal bradycardia. All subjects who completed the
hypoxic exposure were cyanosed. The range of SpO2 was 48%–74% when the
observed impairments of cognitive function led to termination of the hypoxia
automatically by the GO2Altitude® system or by the supervisor.
Comparison of group results between ROBM and the
GO2Altitude® hypoxia training system.
The 92 subjects showed changes in oxygen saturation (SpO2), heart rate (HR)
and ventilation frequency (Vf) displayed on the touch screen monitor. These
changes were similar to those observed with ROBM and are summarised
for comparison in Table 1. Results of the continuously monitored changes
in these physiological parameters, including heart rate variability, symptoms
experienced and a graphical plot of their cognitive function throughout the
hypoxic exposure are presented to each subject in an individual printed report,
and video CD.
In Table 1 there were no significant differences between the mean physiological
adjustments resulting from the hypoxia at a simulated altitude of 25,000 feet
using the ROBM and the GO2Altitude® method. Although the mean Time of
Useful Consciousness (TUC) estimated from the presence of more than one
cognitive function error in the GO2Altitude® group was shorter (2.80min vs
3.20min) and the SpO2 was greater (58% vs 52%), neither difference was
significant (p>0.10). Differences observed between the mean HR and Vf
increase in the two methods were not significant.
Subjects’ n
gender is
abbreviated as
M, F
Mean Heart
rate
TUC
(min) (/min)
RespiraMean Oxygen
Saturation tory rate
Δ
at nailbed (/min)
HR
(bpm)
Start End
Start
End
Start End
ROBM
452
3.20
(M274, ± 0.65
F178)
87
120
33
96%
52%
±7.4
11
14.5
GO2Altitude®
N= 92
(M81,
F11)
91
117
26
93%
58%
±7.6
11
16.5
2.80
±0.85
ROBM 19952004 (n=452)
GO2Altitude®
2007 (n=92)
27
Subjects experienced a high level of difficulty with the novel presentation of
the simple maths computational tasks in the GO2Altitude® system. However
they exhibited less memory impairment (only one or two digits incorrect) using
the GO2Altitude® method of presenting a seven digit number on a computer
screen, compared to writing it from memory in the ROBM study.
ROBM 19952004 (n=452)
Table 1: Cardiorespiratory adjustments to reduced oxygen breathing
using theGO2Altitude® training system at inspired oxygen level
equivalent to 25,000 feet.
SYMPTOMS
In these 92 subjects there was an impairment of math processing, an increase
in simple and choice reaction time, and impairment of short term memory,
spatial orientation, shape discrimination and colour perceptual acuity, impaired
visual-motor coordination in writing and prolongation of task completion time.
These are summarised in Table 3 for comparison with ROBM data.
29%♦↓
GO2Altitude®
2007 (n=92)
IMPAIRED MEMORY FUNCTIONS
401
89%
59
64%
Impaired immediate recall (serial 7
subtractions and card locations)
288
64%
46
50%
Impaired delayed recall (name,
address and 7 digit number)
213
47%
Impaired graphic memory (clock
drawing or screen writing)
84
19%
19
21%
Semantic memory errors (proverbs)
82
18%
n/a
n/a
207
46%
76
83%♦↑
13/51 25% ♦↓
Visual symptoms
295
65%
Tunnel vision
152
34%
Colours reduced
124
27%
20
22%
Blurred vision
61
13%
16
17%
CNS/autonomic symptoms
299
45%
Headache
169
37%
9
10%♦↓
IMPAIRED COMPUTATIONAL
FUNCTIONS
Dizziness, light-headedness
94
21%
57
62%♦↑
Maths Completion time increased
n/a
n/a
81
88%↑
Mental impairment or difficulty in
concentration
87
19%
63
68%♦↑
Simple arithmetic errors
207
46%
65
71%♦↑
Euphoria
84
19%
37
40%♦↑
IMPAIRED CNS DECISIONS or
EXECUTIVE FUNCTIONS
175
39%
38
41%
Fading of ambient noises
82
18%
11
12%
Anxiety or feelings of apprehension
42
9%
9
10%
Perseveration (repetition) in writing or
calculations
175
39%
29
32%
Flushing of face
39
9%
30
33%♦↑
Impaired visual motor functions
113
25%
33
36%
Tiredness, sleepiness
23
6%
19
21%♦↑
Neuromuscular symptoms
147
38%
36
39%
Motor incoordination (illegible writing,
poor drawing)
98
22%
30
33%↑
Sensory disturbances (eg, dysaesthesia,
tingling)
98
22%
24
26%
Poor geometric figure reproduction
81
18%
33
36%↑
Motor incoordination
81
18%
47
51%♦↑
73
16%
19
21%
Tremor
76
17%
35
38%♦↑
Thought or motor block in writing or
calculations
NEUROMUSCULAR DISTURBANCES
96
21%
35
38%↑
Tremor or muscle twitching
96
21%
35
38%↑
COLOUR VISUAL DISTURBANCE
n/a
n/a
25
27%
Colour Detection (prolonged)
n/a
n/a
59
64%
CYANOSIS
452
100%
92
100%
Table 2: Symptoms from reduced oxygen breathing from use of
GO2Altitude at inspired oxygen level equivalent to 25,000 feet.
In Table 2, the symptoms reported by subjects after the hypoxia produced by
ROBM were compared with symptoms reported after the GO2Altitude® sessions.
Some very large disparities were found in the incidence of some reported
symptoms. In the GO2Altitude® group there was significantly greater reporting
of difficulty concentrating, mental impairment, dizziness, light headedness,
euphoria, facial flushing, motor incoordination and tremor, but fewer reports of
visual symptoms and headache. All the other symptoms were reported to a very
similar extent in the two methods and were not significantly different.
Table 3: Observed cognitive effects from use of GO2Altitude at inspired
oxygen level equivalent to 25,000 feet
DISCUSSION
®
This paper presents results from a new training technique using the GO2Altitude
hypoxia training system7-8 and compares them with hypoxia induced by a more
established method of inducing hypoxia under normobaric conditions. Systems
such as GO2Altitude® can provide an accessible means of hypoxia training for
civilian flight crews where no facility has been previously available. GO2Altitude®
hypoxia training utilises a nitrogen concentrator to produce a gas on site with
the desired low oxygen concentration, unlike other normobaric methods4-6 which
utilise bulky gas cylinders and have higher maintenance and running costs.
The US Navy ROBD5-6 uses a mixture of oxygen and nitrogen from cylinders to
provide normobaric hypoxic experience in a dedicated aircraft simulator. The
reduced oxygen breathing method described by Westerman4 used a reduced
oxygen gas mixture and non-rebreathing mouthpiece to produce normobaric
hypoxia, with continuous pencil and paper tests of cognitive function. Both were
research laboratory developments, relatively inaccessible for civil aviators and
neither provided detailed automated printout of physiological data, continuous
cognitive test results and video-recorded behaviour.
Limitation in comparison of reduced oxygen methods
Although one aim of the present study was to compare effects of hypoxia using
two normobaric reduced oxygen methods, the two studies were not originally
designed to be compared and each had different specific objectives, which
affected the protocol and conduct of the training. Consequently the two studies
and their data were unmatched, which precluded formal statistical analysis in
comparison of the data. The descriptive statistics used for comparing the data
sets are indicative of possible significant differences. The tabular summaries
comparing effects of hypoxia using the two methods are set out in Tables 1,2,3.
In Table 1 only minor (non-significant) differences in objective physiological
responses were observed. In Tables 2,3 there were possibly significant
differences in the frequency of some reported symptoms, but not others. The
significant differences in symptom reporting are likely to reflect the different
pre-test briefing strategy, test protocol and aims of the two studies. ROBM
used a briefing lecture and question session prior to the testing and subjects
with medical reasons for not continuing opted out. Consenting subjects, in
groups of 5 or 6, performed different roles in rotation. The primary emphasis
of the hypoxia exposure was to produce some obvious performance deficits in
the pencil and paper cognitive function tests being conducted continuously on
every subject. Other group members were recorders and observers throughout
each hypoxic exposure. In this way the entire group became familiarised with
the varying effects of hypoxia on individuals. Reporting of symptoms was
undertaken by writing them on a sheet of paper after full recovery had been
achieved by breathing 100% oxygen for 2-3 minutes. Individual variability in
physiological adjustments, TUC, symptoms and performance deficits were
discussed as group feed back after all volunteers had been subjected to
hypoxia and results tabulated on a blackboard. The SCUBA mouthpiece, hose
and tap connexions to the Douglas Bag constituted a considerable resistance
to breathing and some subjects could not tolerate the dyspnoea evoked.
In contrast, GO2Altitude® training commenced with a standardized briefing
lecture to a small group, and then individual subjects in pairs sat at the two
parallel consoles and independently worked through the educational preamble
on the computer. This re-iterated the signs, symptoms, physiological and
cognitive effects, and possible risks of hypoxic exposure. Then an explanation of
the method, and protocol sequence and touch screen practice, was followed by
a consent form, a pulse oximeter was attached to a finger of the hand holding
the breathing mask, the face mask was applied, and testing commenced,
followed by hypoxia. Immediately at the termination of the hypoxia, cursive
writing of their name on the touch screen was followed by presentation of
a pictorial and written list of all symptoms from which subjects selected
and ticked the symptoms they had experienced. There were several word
descriptors for each symptom, and this may have enhanced the likelihood of
reporting a symptom. Recovery was effected by breathing 40% oxygen rich air
automatically delivered by the GO2Altitude system® rather than 100% oxygen
and this may have reduced the incidence of oxygen paradox.
There was a very detailed briefing of effects and risks of hypoxia both before the
training and embedded in the software, as part of the ethical informed consent
protocol, which potentially raised anxiety levels, resting heart rate, and symptom
awareness in the GO2Altitude® group. The ROBM subjects ascended directly
to 25,000 feet simulated altitude from sea level, while the GO2Altitude® test
started at simulated 8,000 feet for two minutes before the ascent to 25,000
feet. This probably contributed to their somewhat shorter mean estimated TUC
and lower SpO2, having used some of their dissolved oxygen reserves at “cabin
altitude”. Differences in the respective resistances of the two different breathing
circuits are most likely to have contributed to the higher incidence of headache
with increased work of breathing in the ROBM group. The overall higher
incidence of symptom-reporting in the GO2Altitude® group is most likely to be
attributable to the method of reporting by ticking the multiple word descriptors
of symptoms very soon after the end of hypoxia, while fresh in memory or
still evident. Finally, 59 of 92 subjects in GO2Altitude® training were naïve to
hypoxia, but it is not known how many of the subjects in the earlier ROBM
study were naïve. Approximately the same proportion of subjects (>60%) was
aborted by the supervisor in both methods of inducing hypoxia. This emphasises
the euphoria experienced by subjects, in spite of obvious cognitive impairment.
Efficacy
All subjects in both studies showed some physiological changes, some
neurocognitive impairment and reported experiencing some symptoms of
hypoxia. ROBM subjects received photocopies of their own written sheets and
the tabulated blackboard group summary showing 8-12 individual responses
as examples of the variability and range of responses. In the GO2Altitude®
hypoxia training, these are individual for each subject, and their personal
results are provided to each subject as printed graphs, written material, and
a video CD record of their behaviour and responding before, during and after
the hypoxia exposure. This included their individual estimated time of useful
consciousness and their personal reported symptoms. Clearly, there was a
more memorable list of subjective symptoms generated by the GO2Altitude®
reporting method. Certainly the GO2Altitude® training system was just as, or
more, effective than the previous ROBM – both in recording physiological effects
of hypoxia at simulated 25,000 feet altitude, and in continuously monitoring
cognitive effects. The overall incidence of cognitive deficits was just as high
in the GO2Altitude®, but performance was better captured and compared in
relation to group data. The subjective feedback about the educational impact
of the GO2Altitude® system was almost unanimous – two persons wanted less
theory in the preamble, but these were both student pilots. All the experienced
pilots, 48 in total, strongly endorsed the educational preamble and the training
value of the practical experience.
Safety
As with ROBM, the GO2Altitude® system allows for a hypoxia session to be
aborted by either the subject or a safety observer standing by throughout.
However, it also automatically aborts if heart rate exceeds a pre-set safety
level or if SpO2 falls below a pre-set safety minimum. Recovery from hypoxia
is hastened by the GO2Altitude® device switching to an oxygen-rich air stream
through the hand-held mask. The ultimate safety feature is, if a subject became
unforeseeably incapacitated, the mask would fall away from the face allowing
room air to be breathed.
Convenience.
REFERENCES:
GO2Altitude® is a fully integrated hypoxia training package. It starts with
theoretical educational material, including full explanation of the risks and
effects of hypoxia. A consent form follows, then explanation of the system and
instructions for starting and aborting hypoxia, explanation of the monitoring
display and how to complete the cognitive tests. Each subject has physiological
monitoring of heart rate, breathing, SpO2, heart rate variability and continuous
cognitive function testing throughout the full altitude exposure. There is
continuous video recording of the subject’s behaviour and responses on the
touch-screen. Results are presented on an individual comprehensive report
printed, stored on video CD and database. Feedback for the GO2Altitude®
training was strongly positive about the convenience and benefits of an
integrated system.
1.
Cable GG, Westerman RA. Hypoxia recognition training in civilian aviation: a
neglected area of safety? JASAM, in press.
2.
Harding RM. Hypoxia and hyperventilation. In: Ernsting J, Nicholson AN, Rainford DJ,
editors. Aviation Medicine. Oxford: Butterworth Heinemann; 3rd ed.1999. p. 43-58.
3.
Ernsting J. Hypoxia in the aviation environment. Proc R Soc Med.1973 June,
66(6):523-527
4.
Westerman RA. Hypoxia familiarisation training by the reduced oxygen breathing
method. ADF Health 2004;5:11-15.
5.
Sausen KP, Bower EA, Stiney ME, Feigl C, Wartman R, Clark JB. The reduced oxygen
breathing paradigm for hypoxia training: physiological, cognitive and subjective
effects. Aviat Space Environ Med. 2001 June; 72(6): 539-545.
6.
Sausen KP, Bower EA, Stiney ME, Feigl C, Wartman R, Clark JB. A closed-loop
reduced oxygen breathing device for inducing hypoxia in humans. Aviat Space
Environ Med. 2003;74(11):1190-7.
7.
Westerman RA, Bassovitch O. Hypoxia familiarisation training using Flight Personnel
Simulated Altitude Training System. Aviat Space Environ Med. 2007;78(3): 305
Abstract.
8.
Westerman RA, Bassovitch O, Smits D. Simulation In Aviation: Hypoxia Familiarisation
Training Using The GO2Altitude® System. In: Leigh E, editor. Proceedings of the 13th
SimTecT Simulation Conference, Melbourne, 12-15 May 2008. Melbourne: MUP; p
130-135.
9.
Savourey G, Lounay JC, Besnard Y, Guinet A, Travers S. Normo- and hypobaric
hypoxia: are there any physiological differences? Eur J Appl Physiol. 2003 Apr;
89(2):122-126.
Given the limitations of the current study and the significant difference found
in the incidence of some symptoms, as well as the findings of Savourey et al9,
it is suggested that a further study specifically designed for direct comparison
of ROBM and GO2Altitude®, or better still, hypobaric hypoxia in a chamber and
GO2Altitude®, could be conducted to clarify any differences.
CONCLUSIONS
Normobaric reduced oxygen breathing by the GO2Altitude® hypoxia training
system simulates preselected altitude profiles (eg 25,000 feet) in a safe,
convenient and effective way. This instructs and familiarises aviators,
aeromedical and paramedical personnel with the subjective, objective,
cognitive and behavioural effects of altitude hypoxia. They experience their
individual “time of useful consciousness” and hypoxic symptoms, without
risks of barotrauma or decompression illness. Such a system, which increases
recognition and awareness of hypoxia at altitude, has the potential, if
implemented, to prevent or reduce hypoxia related flight accidents.
Keywords
Normobaric Hypoxia, Aerospace Physiology, Aviation Personnel Training,
Cognitive Impairment, Hypoxia Awareness, Hypoxia Familiarisation, Flight
Safety, Human Factors.
There may be policy implications or recommendations stemming from
this study. Australian aviation policy does not currently make provision for
routine practical hypoxia training of flight crews and other flight personnel:
only theoretical safety training is mandated by CAO20:11. In the future, with
an easily accessible, safe, inexpensive, user-friendly and effective training
method now available, legislative changes to training requirements may be
contemplated. At least, perhaps it is now time for the civil aviation regulatory
authorities to recommend that practical hypoxia training experience be included
in emergency procedures training, where practicable.
ACKNOWLEDGEMENTS
The Reduced Oxygen Breathing Method (Westerman4) had Monash University
Human Research Ethics Committee Approval; GO2Altitude® hypoxia training
system7,8 has Alfred Hospital Human Research Ethics Committee Approval
(project 40/07), and complies with CAO20:11.
JAL123: AN ILLUSTRATION OF THE IMPACT
OF ACUTE HYPOXIA ON MEASURES OF SPEECH
Adrian M Smith, BMBS, DAvMed, MAerospaceMed(Hons)
ABSTRACT
Air safety investigators often report impaired speech from aircrew believed to
have experienced hypoxia. Unfortunately, many of these reports do not further
explore the nature of the speech impairment. This paper reviews the literature
that describes effects of acute hypoxia on a range of speech parameters.
Methods. The cockpit voice recorder transcript and accident report of the
1985 explosive decompression of JAL123 were analysed to explore collective
speech metrics, characteristics of silent pauses, utterance intelligibility, and
reported voice acoustics. Speech measures were obtained from four threeminute windows: immediately after decompression, fifteen and twenty-five
minutes after decompression, and prior to impact.
Results. The progression of speech changes is a useful scenario within which
to describe effects of hypoxia on speech. Fifteen minutes after decompression
collective measures of verbal output fell by 70%, 15% fewer utterances were
intelligible, the duration of silent pauses increased by 150% and the proportion
of pauses longer than 11 s doubled, and the proportion of time occupied by
silent pauses within a 3-minute window of dialogue increased from 40% to
85%. Harmonic frequencies were more frequently obscured, but only one of
the three aircrew exhibited a transient decrease in fundamental frequency.
Conclusions. Compared to the other periods examined, the transcript
corresponding to fifteen minutes after decompression illustrates changes
characteristic of hypoxia across a number of speech parameters. The JAL123
cockpit voice recorder transcript and accident report illustrate several effects
of acute hypoxia on speech.
Investigators of aviation mishaps in which pilots are believed to have become
hypoxic have on several occasions reported degradation of pilots’ speech.
Verbal communications have been described as “flabby”1 or “slurred”2,
becoming “significantly impaired”3 and “unintelligible”4 with advancing hypoxia.
Impairment of verbal communication is a common feature of hypobaric hypoxia.
In a survey of United States Air Force aircrew who had experienced in-flight
hypoxia, 14% described “speech impairment” as one of the features they
experienced5. In a survey of Australian Army helicopter aircrew, 17% of aircrew
described “communication difficulties” at altitudes approaching 10 000 ft, and
26% reported similar problems in their colleagues6. Notably, two loadmasters
developed slurred speech, and another loadmaster was unable to speak during
a critical phase of landing. The observation that the affected individuals regained
normal speech function when the aircraft descended to a lower altitude suggests
that hypoxia may have been a contributing factor in these cases6.
Unfortunately, Rayman and McNaughton5 and Smith6 do not describe the
speech impairments in sufficient detail to enable meaningful interpretation of
underlying neuro- and psycholinguistic processes, and few other authors have
explored the effect of acute hypobaric hypoxia on phonetic, semantic, morphosyntax, pragmatic, or prosodic features of speech and communication. The
tragedy of JAL123 affords an opportunity to observe changes in voice acoustics
and verbal output over the course of an unfolding emergency complicated for
a short time by hypoxia.
Pegasus Aeromedical Consulting
PO Box 244
Surrey Downs SA 5126
Correspondence
[email protected]
JAL FLIGHT 123
At 18:24 hours Japan Standard Time on 12th August 1985, the rear pressurebulkhead of a Japan Air Lines 747 failed and the aircraft experienced an
explosive decompression at 24 000 ft. Having lost a portion of the tail fin
and hydraulics for the elevators, ailerons, and rudder, the aircraft became
uncontrollable and remained so until it crashed into a mountain 32 minutes
later. The nature of this emergency exposed the flight crew simultaneously to
two stressors reported to have an effect on speech: hypobaric hypoxia following
loss of cabin pressure, and the high workload and psychological stress of the
resulting emergency situation.
Mishap investigators divided the unfolding emergency sequence into four
discrete phases7:
• Immediately after the explosive decompression (D +0). Aircraft altitude
between 24 000 ft to 22 000 ft. The flight crew would be experiencing a
stress response but would not yet have become hypoxic.
• Fifteen minutes after the explosive decompression (D +15). Aircraft
altitude approximately 22 000 ft. By this stage, the flight crew (who were not
using supplemental oxygen) would have been above 20 000 ft for more than
15 minutes and are likely to have become hypoxic.
• Twenty-five minutes after the explosive decompression (D +25).
By this time, the aircraft had descended to approximately 9 000 ft. At this
altitude, the partial pressure of oxygen is sufficient to reverse the effects
of hypoxia, but the flight crew would be experiencing an ongoing stress
response to the continuing emergency.
• Immediately before impact (D +28). The flight crew would no longer
have been hypoxic but would have experienced a stress response to the
continuing aircraft emergency.
Even though the flight crew are believed to have been experiencing significant
psychological stress throughout the unfolding emergency7, they are believed to
have been hypoxic only during the second phase of the emergency. The time
before this would have been insufficient to develop hypoxia, and shortly after
this phase the aircraft had descended to an altitude where hypoxia would not
have been a significant physiological hazard. Accident investigators made two
interesting observations regarding speech during this brief period of hypoxia:
that flight crew produced “remarkably little” “volume of conversation” during
this period, and that the amount of conversation increased after the aircraft
descended below 20 000 ft.
AIM
The aim of this study was to undertake a limited analysis of the cockpit voice
recording transcript to explore the investigators’ observations that the amount
of conversation produced from the flight deck decreased during the period
of hypoxia, with a specific objective to provide a quantitative description of a
number of speech and language parameters during the different phases of the
emergency. This project also had two secondary aims: to see if changes in the
communication within a group during hypoxia reflected changes reported in the
literature for individuals, and to see if features of hypoxia could be extracted
from a written transcript.
METHODS
The JAL123 accident investigation report7 contained an English-language
transcript of the cockpit voice recording (CVR) covering the time shortly before
the bulk-head failed until the time of impact. Flight crew utterances from the
English-language CVR transcript – including errors and corrections, silent and
Hypoxia and speech
filled pauses, and incomplete or unintelligible speech – were coded according
to conventions for Systematic Analysis of Language Transcripts [SALT]
software8. The duration of non-speaking segments was calculated from the
second-interval time scale printed alongside the utterances. SALT generated
collective measures of verbal output, pausing, and utterance intelligibility for
three-minute windows corresponding to the beginning of each phase of the
emergency, and these were analysed by a commercial statistics programme.
FINDINGS
VERBAL OUTPUT: UTTERANCES AND WORDS PER MINUTE
The collective number of utterances and words spoken by the flight crew gives
an approximate measure of the relative amount of conversation produced during
the period of hypoxia and the periods without hypoxia. In the three minutes
following the loss of cabin pressure, the flight crew collectively produced verbal
output at an approximate rate of 14 utterances and 42 words per minute.
During the period of hypoxia, the rate at which utterances and words were
produced decreased by 57%; however, when the aircraft descended below 10
000 ft – in the third phase of the emergency – the number of words per minute
increased by 258%, and the number of utterances per minute increased
by 266% (see Figure 1). The flight crew produced words and utterances at
approximately the same rate in each of the non-hypoxia phases (Table 2),
however collective verbal output during hypoxia was 69% lower than during the
non-hypoxia phases (see Figure 2), for both utterances (15.1 and 6 utterances
per minute respectively; t-test, t 16.4, p=0.004) and words (45.8 and 14
words per minute respectively; t 13.2, p=0.006).
Figure 1. Verbal output during each of the four phases
of the emergency.
Figure 2. Verbal output during hypoxia and the combined non-hypoxia
phases of the emergency.
INTELLIGIBILITY
The proportion of utterances recorded with segments that were wholly or
partly unintelligible was significantly higher during the period of hypoxia (17%)
than for the non-hypoxia periods (in which only 2% of utterances overall were
unintelligible) (Figure 3). The proportion of utterances that were intelligible
was 15% lower during hypoxia than during the non-hypoxia periods (t-test,
t=12.99, p<0.01).
Figure 3. Utterance intelligibility during each of the four phases of
the emergency.
PAUSES
PAUSE FREQUENCY
The distribution of pauses across the four phases of the emergency was
not statistically significant (chi-sq 1.77, p=0.62), suggesting that pauses
occurred evenly throughout the emergency. Although pauses occurred slightly
more frequently in the non-hypoxia phases (collectively) than during hypoxia
(17.7 and 12 pauses, respectively; t-test, t 6.43, p=0.02), differences in the
number of pauses per minute (5.9 and 4 pauses per minute, respectively; t 6.3,
p=0.02) are too small to be operationally relevant.
Hypoxia and speech
FUNDAMENTAL FREQUENCY
The accident report describes the fundamental frequency for 55 utterances
made by the flight crew in the minutes before the explosive decompression,
and at intervals approximating the four phases thereafter. Accident
investigators were unable to identify the fundamental or harmonic frequencies
for 11 utterances, all of which occurred during hypoxia (accounting for 55%
of the utterances made during this period). By contrast, fundamental and
harmonic frequencies could be determined for all utterances made during the
non-hypoxia periods. The distribution of utterances for which the fundamental
frequency could not be determined is significantly during hypoxia than during
the non-hypoxia periods (Chi square 24.06, 4 df, p<0.001).
Figure 4. Frequency and mean duration of pauses during each of the
four phases of the emergency.
PAUSE DURATION
The mean duration of pauses during the period of hypoxia (13.2 s) is
significantly longer than during non-hypoxia phases (5.3¬ s overall) (t-test,
t -3.2, p=0.002) (Figure 4). The median time of pause during hypoxia is
also significantly longer than during the non-hypoxia phases (7 s and 2 s,
respectively; z -3.25, p=0.002). Figure 5 illustrates that pauses during hypoxia
were significantly longer than during the other periods, with pauses as long
as 48 seconds in contrast to a maximum duration of 17 s seen during the
combined non-hypoxia phases.
The accident investigation report recorded the fundamental frequency for 37
utterances at intervals during the different phases of the emergency. Figure 6
illustrates that the pilot (Spearman rho 0.819, p<0.001) and flight engineer
(Spearman rho 0.35, p=0.32) displayed an increase in fundamental frequency
at each phase of the unfolding emergency, even during the period of hypoxia.
By contrast, the co-pilot’s fundamental frequency decreased by 13% during the
period of hypoxia (from 265 Hz to 230 Hz, t-test p=0.035) and then increased
by 23% (from 230 Hz to 285 Hz, t-test p=0.04) during the subsequent nonhypoxia phase.
Figure 6. Changes in fundamental frequency exhibited by the three
flight crew during the hour before the decompression, and the four
phases of the emergency.
DISCUSSION
Pauses during the non-hypoxia phases tend to be short, whereas those
during hypoxia tend to be longer. The distribution of short (≤ 5 s) and long (≥
11 s) pauses during hypoxia and the non-hypoxia phases demonstrates an
abundance of long pauses during hypoxia (chi sq 5.29, p=0.02). Compared
to the non-hypoxia phases, the proportion of short pauses during hypoxia
decreased from 69.8% to 25%, and the proportion of long pauses increased
from 15.1% to 33.3%.
Although the flight crew and air traffic controllers are known to have
communicated both in English and Japanese during the emergency9, the CVR
transcript did not identify the language in which individual utterances were
made. However, the English-language translation of the CVR transcript was
considered to be adequate for the purpose of obtaining an overview of relative
changes in verbal output, pausing, and intelligibility of flight crew members’
speech during the stages of the emergency. Notwithstanding, observations
made in this paper should be interpreted in terms of trends they suggest
rather than provide detailed quantitative information of changes in language
performance of an individual.
Although the conversation during hypoxia contained slightly fewer pauses than
the non-hypoxia phases, the significantly-longer pauses occupied a greater
proportion of the 3-minute hypoxia phase (86.7% and 51.4% respectively,
p=0.06), an increase of 69% compared to the combined non-hypoxia phases.
A structured analysis of the JAL123 CVR transcript produced findings
consistent with the observations made in the accident report: the flight crew
collectively produced less conversation during the period in which they are
believed to have been hypoxic.
Figure 5. Distribution of silent pauses during hypoxia and the combined
non-hypoxia periods.
Hypoxia and speech
The volume of conversation produced collectively by the flight crew during
hypoxia and the non-hypoxia periods mirrors trends that have been reported
in the literature. Verbal output – both the number of utterances and the
approximate number of words per minute – decreased by 69% during the
period of hypoxia. These findings are in agreement with observations made
by other authors. Ponomarenko and Alpatov are cited as reporting that aircrew
who are hypoxic speak at a rate approximately half their non-hypoxic rate3,
and analysis of speech from two recent hypoxia-related aircraft accidents
in Australia found that the pilots’ speaking rate decreased by approximately
30-50% during the period of hypoxia3.
Although hypoxia has been associated with a decrease in the rate of spontaneous
speech3, rehearsed speech (eg. a pilot’s call sign)1, 3, and reading aloud1, the
overall reduction in verbal output could reflect the combined effect of several
factors. Pilots who become hypoxic tend to activate the microphone without
speaking for longer periods before and after a verbal transmission1, 3. Reduced
verbal output could reflect distraction3 or impairment of higher cognitive
functions3, 7, 10, both of which can make it difficult for a pilot to formulate a
meaningful utterance11. Impairment of articulation seen during hypoxia1, 3, 12
also could reduce verbal output by making the speech act more difficult.
A hypoxic pilot may take longer to respond to a verbal command1, 3 or produce
an utterance that is hesitant, faltering, and dysfluent3. This was seen with the
crew of JAL123, where even though the number of pauses per minute did
not change substantially, the pauses during hypoxia were significantly longer
compared to the non-hypoxia phases and occupied a greater proportion of the
3-minute window of dialogue.
The finding that speech during the period of hypoxia had a greater number of
unintelligible segments that the non-hypoxia phases is consistent with reports
made by other aviation mishaps investigators, who have described as “flabby”1
or “slurred”2, becoming “significantly impaired”3 and “unintelligible”4 the speech
of pilots with known or suspected hypoxia. The unintelligibility of speech during
hypoxia has been attributed to impaired neuromuscular control of articulatory
muscles1, 3, 12, which in turn has been associated with misarticulated words or
phrases with indistinct word boundaries3, obscured pre-voice-onset gap1, 3, 12,
and ill-defined harmonic frequencies1, 7.
The stress response that would be expected after an explosive loss of cabin
pressure – such as with JAL123 – could magnify acoustic changes seen in
speech during hypoxia13, or the effects of hypoxia and stress could partially
offset each other1.
The literature is inconsistent regarding the effects of hypoxia on changes to
fundamental frequency. Although Schultz14 claims that fundamental frequency
is unaffected by hypoxia, other authors have found hypoxia to be significantly
associated with changes in the fundamental and harmonic frequencies of
speech. The ATSB3 reported an increase of up to 38% in the fundamental
frequencies of two pilots who had become hypoxic. On the other hand, Saito
et al1 reported a progressive decrease in fundamental frequency with hypoxia
in a fast jet pilot (by more than 34% overall), even during stressful periods
of flight where an increase would be expected. Subsequent experimental
exposure of three subjects to hypoxia, however, produced equivocal changes:
the fundamental frequency increased for one subject, decreased for other,
and remained unchanged in the other. Changes in fundamental frequency of
the JAL123 flight crew showed an inconsistency that reflects the literature:
hypoxia produced a clear decrease in the fundamental frequency of only one of
the three flight crew. Conflicting observations in the literature and the present
study probably reflect variability in the manifestation of hypoxia in speech
amongst individuals3, 7. The drop in the flight engineer’s fundamental frequency
immediately before impact can be explained by Belan’s observation11 that
pilots can exhibit a sudden drop in fundamental frequency “when they face
imminent death”.
SECOND-LANGUAGE PERFORMANCE
Notwithstanding possible confounding from a mixed-language voice recording
and from an analysis of collective verbal output from a crew rather than from
an individual, relative changes in verbal output reported here are somewhat
higher than reported in the literature. The flight crew of JAL123 and air traffic
controllers communicated only in English before 18:31 hrs, but the captain and
flight engineer are known to have used a mixture of English and Japanese after
this9. The potential for hypoxia to compromise English-language performance in
bilingual aircrew was discussed at length by air safety investigators of the crash
of Helios HCY522 in 200515. This might explain why the slowing of speech
during hypoxia in this mishap is greater than reported for other mishaps, and
would benefit from additional research.
SUMMARY
A structured analysis of the JAL123 cockpit voice recorder transcript (and
accident report) identifies evolution of a number of speech parameters. During
the period in which the aircrew are believed to have experienced significant
hypoxia, collective measures of verbal output fell by 70%, 15% fewer
utterances were intelligible, the duration of silent pauses increased by 150%
and the proportion of pauses longer than 11 s doubled, and the proportion of
time occupied by silent pauses within a 3-minute window of dialogue increased
from 40% to 85%. Harmonic frequencies were more frequently obscured, but
only one of the three aircrew exhibited a transient decrease in fundamental
frequency. These changes are characteristic of hypoxia.
In addition to illustrating several effects of hypoxia on speech, this paper has
demonstrated two interesting points. First, the paper has demonstrated that
the collective communicative performance of a group of flight crew exposed
to hypoxia mirrors changes that have been reported for individuals. Secondly,
the paper has demonstrated that it is possible to identify features of hypoxia
from a structured analysis of a CVR transcript. This could be a useful adjunct
tool to assist the forensic investigation of an aircraft accident. It is therefore
imperative that accident investigators ensure that cockpit voice recordings
are transcribed accurately to capture speech and pause characteristics. With
the interesting possibility that aircrew communicating in English as a second
language may experience a more-pronounced degree of impairment during
an aircraft emergency or during hypoxia, the linguistic background of the flight
crew should be documented, and where communications from the flight crew
and air traffic controllers can occur in more than one language, the transcript
should record each utterance’s language.
The progression of speech changes seen in JAL123 provides a useful illustration
of the effect of hypoxia on speech: verbal output decreases, utterances become
unintelligible, and silent pauses become longer until they dominate a window
of dialogue; however, although harmonic frequencies became obscured, the
response of fundamental frequency differs from person to person and is not a
reliable indicator of hypoxia.
REFERENCES
1.
Saito I, Fujiwara O, Utsuki N, Mizumoto C, Arimori T. Hypoxia-induced fatal aircraft
accident revealed by vocal analysis. Aviation, Space, and Environmental Medicine.
1980;51(4):402-6.
2.
National Transport Safety Board. Factual Report – Aviation: Incident on 17 February
1982 at Toadlena, NM involving Piper PA-28RT-201T N29665. Washington, D. C.:
National Transport Safety Board; 1983. Report No.: FTW82FQA13.
3.
Australian Transport Safety Bureau. Pilot and passenger incapacitation. Beech Super
Hypoxia and speech
King Air 200 VH-SKC, Wernadinga Station, QLD, 4 September 2000. Canberra:
Australian Transport Safety Bureau; 2001. Report No.: 200003771.
4.
Air Accidents Investigation Board Jet Provost T3A G-BVEZ. London, U.K.: Air
Accidents Investigation Board; 2003. Report No.: AAIB Bulletin 8/2003.
5.
Rayman RB, McNaughton GB. Hypoxia: USAF experience 1970-1980. Aviation,
Space, and Environmental Medicine. 1983;54(4):357-9.
6.
Smith A. Hypoxia symptoms reported during helicopter operations below 10,000 ft:
a retrospective survey. Aviation, Space, and Environmental Medicine. 2005;76:7949.
7.
Aircraft Accident Investigation Commission. Aircraft Accident Investigation Report:
Japan Air Lines Boeing 747SR-100 JA8119, Gunma Prefecture, Japan; August 12,
1985 [Official Translation]. Tokyo, Japan: Aircraft Accident Investigation Commission,
Ministry of Transport; 1987.
8.
Miller J, Iglesias A. Systematic Analysis of Language Transcripts (SALT): Student
Version 2008 [computer programme]. Version 2008.0.1. Madison, Wisconsin: SALT
Software; 2008.
9.
Job M. JL123 – Uncontrollable! Air Disaster. Canberra, Australia: Aerospace
Publications; 1996. p. 136-53.
10. National Transport Safety Board. Factual Report – Aviation: Accident on 29
December 1997 at Guyton, GA involving Cessna 414A N414MT. Washington, D. C.:
National Transport Safety Board; 1997. Report No.: MIA98FA047.
11. Brenner M, Mayer D, Cash J. Speech analysis in Russia. Washington DC, USA: Office
of Aviation Medicine; 1996. Report No.: DOT/FAA/AM-96/10.
12. Lieberman P, Kanki BG, Protopapas A. Speech production and syntax comprehension
deficits on Mt. Everest. Aviation, Space, and Environmental Medicine. 1997:In
press-.
13. Milovanovic R, Gojkovic V. [The effect of hypoxia and mental stress on the distribution
of energy in the phoneme ’a’.] Abstract. Article in Serbian. Vojnosanitetski Pregled
[Military Medical and Pharmaceutical Review]. 1993;50(4):387-92.
14. Schultz I. [Importance of the nonverbal characteristics of the speech signal for
evaluating the mental and physical state of a pilot.] Abstract. Article in Russian.
Kosm Bio Aviakosm. 1976;10(6):54-8.
15. Helios Investigation Board. Helios Airways Flight HCY522 Aircraft Accident Report.
Athens, Greece: Hellenic Republic Ministry of Transport and Communications; 2006.
Report No.: 11/2006.
HISTORICAL ARTICLE
Published August 1952
R.A.A.F. MEDICAL SERVICE REPORTS – REPORT NO. 1:
RESULTS OF TESTS IN A DECOMPRESSION CHAMBER
OF 213 FLYING PERSONNEL
WGCDR John B Craig
1.
Since the introduction of a standardised testing procedure a year ago,
whereby classification for fitness for high altitude training is made, 213
flying personnel have been tested and classified.
2.
Classification is based on a single standard test, failure being recorded
if collapse, chokes or unbearable bends pain develops during the test
period. The details of heights and times are:
Ascent 3,000 ft/min to 20,000 ft.
2,000 ft/min to 30,000 ft
1,000 ft/min to 33,000 ft
Remain 15 mins at 33,000 ft
1,000 ft/min to 34,000 ft
Remain for 15 mins at 34,000 ft
1,000 ft/min to 37,000 ft
Remain for 1 hour at 37,000 ft.
There is thus 1 hour at 37,000 ft and 1 hour 37 mins above 30,000 ft.
3.
Subjects had no unusual exercise before or during runs and were not
pre-oxygenated. Time of day is not taken into account.
4.
All subjects were members of the R.A.A.F.. The tests were conducted
principally by two medical officers of widely separated units. No account
is taken of temperature, climate or locality except as reflected in
individual weight.
5.
Weight for height and age has been based on R.A.F. figures (F.P.R.C.
653 by Dr G.M. Morant) no allowance being made for the higher average
weight of Australians (3lbs) over U.K. personnel, and no allowance being
made for weight of clothing. As R.A.A.F. aircrew are medically examined
annually, it is likely that some record of their weight nude, others clothed,
and no differentiation of the two was possible from the records. If the
average allowance for clothing is reckoned at 7 lbs., and tables used, as
mentioned above, average 3 lbs. below the comparable Australian figure,
then for those who recorded their weight clothed, the error will be +4 lbs,
for those who recorded nude weight, the error will be – 3 lbs.
6.
From Table 1 it is seen that of the total 213 men, 43 (32 + 11) had to
descend, i.e. 20%. The distribution of the causes of descent were:
Collapse
Chokes
Bends
(4)
(7)
(32)
9.3%
16.3%
74.4%
100%
7.
Cases of collapse recorded (4) are primary, and not following severe
bends pain or chokes symptoms, although one such case did occur.
Record is also made that one case, contrary to instructions, was subjected
to a further decompression test, and the collapse, a severe one, was
reproduced almost identically. In every case, recovery after descent was
rapid and no cases of post-decompression shock have occurred, though
there have been 3 cases of scintillating scotomota (one in flight) and one
of post-decompression pain and oedema of the L. ankle occurring 12
hours after descent and persisting for 24 hours.
8.
In Table II an analysis of the effects of age on the incidence of symptoms
is given. It will be noted that the majority (172) of subjects were below
the age of 30; that the incidence of bends is greater with increasing age,
especially after the age of thirty, and the percentage of descents dur to
chokes or collapse also increases with age, and markedly so after the age
of 35. This compares with R.A.F. findings (F.P.R.C. l795) , and American
(Fulton – “Decompression Sickness”).
9.
In Table III, analysis of the effects of excessive weight are shown, and
it is interesting to note that, overall, there is a very great increase in
incidence of symptoms in those overweight and there is a definite
increase of incidence of collapse and chokes as compared to bends. The
total incidence of cases for those over standard weight rises to 23% as
compared to 20% for the group as a whole; for those more than 14–28
lbs overweight, the incidence of descents was 30.7%, and for those more
than 28 lbs. overweight, 33%.
10. The incidence of descents from all causes of those not over standard
weight is 16% and, thus, by comparison an increase of 28 lbs. or more in
weight over standard for age and height results in double (100% increase)
the incidence of decompression sickness. In view of this remarkable
finding, an analysis of personnel more than 14 lbs. below standard was
taken; there were only 5 of these, but it is interesting to note that there
were no cases of chokes or collapse.
11. In view of the obvious significance of the finding, it is worth repeating
the figures from Table I in percentages, which shows that of the series
reported:
15.5% were more than 28 lbs. overweight
21% were between 14 – 28 lbs overweight
37% were between 1 – 14 lbs overweight
which suggests that R.A.A.F. aircrew are improperly fed or too little exercised,
or both, remembering that the majority of this series is young men.
And the incidence rate among aircrew were:
Collapse
Chokes
Bends
(4)
(7)
(32)
1.7%
3.3%
15%
20%
HISTORICAL ARTICLE (CONTINUED)
Decompression Chamber Complications
Not over
1-14 lbs over
14-28 lbs over
> 28 lbs over
TOTALS
standard weight
standard weight
standard weight
standard weight
Chokes
Total
Chokes
Total
Chokes
Total
Chokes
Total
Chokes
Total
&
Bends No. of
&
Bends No. of
&
Bends No. of
&
Bends No. of
&
Bends No. of
Syncope
subjects Syncope
subjects Syncope
subjects Syncope
subjects Syncope
subjects
18–24
1
–
23
3
5
44
1
2
16
2
8
5
9
91
25–29
–
5
26
2
22
7
20
1
2
13
1
16
81
30–34
1
2
5
–
7
1
1
7
1
4
7
3
7
26
35–39
–
–
2
1
1
6
1
2
1
–
5
2
2
15
TOTALS
2
7
56
4
8
79
2
11
45
3
8
33
11
34
213
AGE
Table 1. Incidence of different types of decompression sickness necessitating descent in 213 subjects classified by age and weight
AGE
18–24
25–29
30–34
35–39
TOTALS
% CHOKES &
SYNCOPE
4.4 (5)
1.2 (1)
11.5 (3)
13.3 (2)
5.16 (11)
% BENDS
10
19.3
26.9
13.3
16
NO. OF SUBJECTS
(9)
(16)
(7)
(2)
(34)
91
81
26
15
213
RATIO AS A PERCENTAGE OF CHOKES &
SYNCOPE TO OTHER DESCENTS
44
7.1
43
100
34
Table 2. Influence of age on percentage incidence of descents due to symptoms of decompression sickness in 213 subjects
WEIGHT
Not over standard Weight
1–14 lbs over standard weight
12–28 lbs over standard weight 4
> 28 lbs over standard weight
TOTAL
% CHOKES
1.8
2.5
.4
6
3.3
(1)
(2)
(2)
(2)
(7)
% SYNCOPE
1.8 (1)
2.5 (2)
–
3 (1)
1.9 (4)
% BENDS
12.5
10
24.4
24.2
16
(7)
(8)
(11)
(8)
(34)
NO. OF
SUBJECTS
RATIO % CHOKES & SYNCOPE
TO ALL OTHER DESCENTS
56
79
45
33
213
22
33
15
27
34
Table 3. Influence of weight on percentage incidence of descents due to decompression sickness in 213 subjects
INVITED COMMENTARY
Given the revolution in the conduct of hypoxia awareness training that has been pioneered by the RAAF Institute of Aviation
Medicine (AVMED) within the past few years, it is most interesting to note the way in which our Aviation Medicine forebears
determined pilots’ fitness to operate at high altitude, by their ability to tolerate decompression illness.
The findings of this study demonstrate that concepts of ”occupational health and safety” and an employer’s ”duty of care” have certainly evolved over time.
Although the threats of hypoxia and decompression illness (DCI) remain as perilous today as in the 1940s and 1950s, our methods of screening aircrew and
training them to manage these threats are now far more conservative and safety oriented and fitness to fly is now determined by specialised medical examination
rather than tolerance to a known physiological hazard.
Even though “times have changed”, the nature of physiological hazards facing aircrew remain the same and AVMED is proud to acknowledge the research done
by WGCDR Craig and determined to continue these early efforts to enhance the safety of aerospace operations by providing a unique aviation medicine research
capability to the Australian Defence Force.
WGCDR Adam Storey
CO AVMED
RAAF Base Edinburgh, SA
LETTERS TO THE EDITOR
Screening passenger fitness to fly and medical kits onboard commercial aircraft
The Editor
I read with interest the article by Ian Cheng, ”Screening passenger fitness to fly
and medical kits onboard commercial aircraft” (Volume 4, No. 1, August 2009,
pages 14–18)
Over the last year I have twice been called to attend to the medical needs
of passengers whilst travelling to or from international conferences. The last
occasion was as recent as a week ago, when a colleague and I both attended
a young, otherwise healthy lady who collapsed in the toilet on a flight from
Frankfurt to Singapore.
I note in the article by Dr Cheng that the emergency medical kit stipulates the
need for a sphygmomanometer and stethoscope but nowhere does it stipulate
that these important examination tools are suitable for use in a very noisy
environment and without such consideration they are totally useless pieces
of kit.
In both of my recent experiences there was the worry of cardiac compromise
and in both circumstances the stethoscope was absolutely useless. It was
clearly a very cheap, sub-standard piece of equipment that would be of
questionable benefit within a doctor’s practice, let alone within the noisy
environment of a large passenger jet. Obviously for a stethoscope to work,
within this environment, it needs to be of the highest standard, with the
best insulating tubing and have proper bell and diaphragm facilities to make
auscultation viable.
Where a patient has a thready pulse, which makes determination of systolic
blood pressure by palpation almost impossible, it follows that the mere stipulation
of the need for sphygmomanometer and stethoscope offers meaningless lip
service and the emergency medical kit contents are useless starting from the
top of the list down. The sphygmomanometers that are provided as part of
the medical kit should be automated and self-reporting, battery operated or
alternatively plug into the airline’s internal electricity system, to provide reliable
determination of the patient’s blood pressure and pulse rate.
It has been my experience that stethoscope and sphygmomanometer are the
most important pieces of equipment required and never have I been on a flight
where these pieces of equipment were useable or reliable.
As an aside it is also worth mentioning that on both occasions, when I
attended passengers on flights, I was offered a bottle of wine in return for
services rendered and on the previous occasion that same bottle of wine was
confiscated by the same airline when reboarding, having been in transit at the
airline’s home airport. It is quite clear that the services provided by doctors, on a
voluntary and not fee-for-service basis, are vastly underrated and undervalued
as the responsibility for the patient’s wellbeing continues for the duration of
the flight. In both circumstances, as described above,the patients had to be
monitored long after the initial attendance had been concluded.
It is imperative that airlines appreciate that provision of sub-standard equipment
is equal to the provision of no equipment at all. Senior consultants should
be involved in the purchase of equipment that would allow a non-medical
specialist provide appropriate care, hence the suggestion for automated
sphygmomanometer and possibly a stethoscope with sound magnification as
part of the bell and diaphragm apparatus.
Professor Roy G. Beran
Chatswood NSW
Response from author
Professor Beran has raised similar issues to that of the Melbourne General
Practitioner,1 which became the impetus for an airline and regulatory authority
panel session during the 2008 ASAM annual scientific meeting in Darwin,
Northern Territory.
I acknowledged in my article that there have been some complaints about
the quality of stethoscopes together with requests for equipment such as
glucometers, digital syphgomanometers and pulse oximeters and that some
have opined that the value of a stethoscope onboard is nothing more than
a “badge of rank”.2,3 During my 9 years at Qantas I had the opportunity to
discuss and correspond with many doctors regarding aviation medicine issues
including ‘brickbats and bouquets’ directed towards the Qantas physician kits.
Professor Beran has kindly taken the time to write and assert that the
provision of in-flight medical equipment, specifically sphygmomanometers
and stethoscopes, should be of the highest standard. This is a laudable
opinion, but one that is not readily accepted in a commercial environment
despite what an airline medical unit or medical director might advocate. As
Lovell has recognised, in-flight medical resources are a balance between
competing needs of cost effectiveness, storage space, staff training, security
concerns and the short shelf life of drugs.4 While one might argue that the cost
savings associated with the purchase of basic equipment could be offset by
improved in-flight medical care and customer satisfaction (for both passenger
and volunteer health professional) with better equipment, there is no current
evidence to support or refute this.
Professor Beran’s view is, however, shared by the handful of airlines that have
equipped their long-haul aircraft with telemedicine devices that were referred
to in the article. A few airlines have automated sphygmomanometer in their
kits, but the majority of airlines implement the “keep it simple” approach to
medical equipment for reasons outlined in the article.
The pioneering introduction of AEDs and enhanced medical kits by a few
airlines like Qantas subsequently led to other airlines following suit, with such
equipment later being mandated by various regulators. Similarly, it may well
be that those few airlines who have now initiated the provision of telemedicine
devices and more expensive equipment have started a trend that other airlines
might follow, not because the evidence exists that better care will follow or
that diversions might be reduced (current limited medical evidence suggests
not5), but to negate a perceived commercial marketing advantage that these
pioneering airlines might have.
Professor Beran also suggests that senior consultants should be involved in
the purchase of equipment. As indicated in the article, Qantas Aviation Medical
Services has workshopped its physician kits at various specialist college
forums. Emergency physicians, cardiologists and occupational physicians are
some of the specialist physicians that are already part of, or are directors of, a
number of airline medical units and industry medical advisory groups. While the
regulations are prescriptive for some of the medications and equipment that
should be carried, there is recognition for individual airlines to be able to choose
the form of the medications and medical equipment based on the structure of
LETTERS TO THE EDITOR (CONTINUED)
their routes and own experience with in-flight medical emergencies.
Dr QANTAS retires
The remaining issue that Professor Beran raised concerned appropriate
acknowledgment for the assistance rendered to unwell passengers by
volunteer health professionals. This particular issue was not addressed by the
panel or in my article, as it is deserving of a forum on its own. Nevertheless,
Professor Beran raises a legitimate viewpoint that has been widely debated with
polarised opinions in medical journals, on-line and in lay and medical media.6-8
Different airlines have different approaches as to how they acknowledge
volunteer health professionals. The only airline that I am aware of that has a
structured recognition program for doctors who are prepared to assist in-flight
is Lufthansa.9
The editor
Ian Cheng
Editor’s note: Dr Cheng resigned from Qantas in June 2009 and is currently
working at Royal North Shore Hospital as an occupational physician.
I see that an article on my retirement from Qantas has been included in the
ASAM News section.
Whilst I’m happy to see that included in the News section, I need to point out
that the credit for introduction of defibrillators into Qantas was in no way due
to my initiatives, but due to the hard work and persistence of the then Medical
Director, Dr Eric Donaldson.
The Public Affairs department in Qantas had simply assumed that I had been
the one to credit for this reform given that I had been in the airline 25 years.
There was not one person in that department last February who was there
when Eric was the Medical Director. Regrettably, I was not given the article to
review before publication.
So, give credit where credit is certainly due and that is to Eric Donaldson.
References.
1.
Weaver C. Doctors demand upgrades. The Daily Telegraph; Sydney. 2007
September 30.
2.
Cheng I. Screening passenger fitness to fly and medical kits onboard commercial
aircraft. JASAM 2009;4:14-18.
3.
Ashworth A. What use a stethoscope? In: Rapid Responses for Tonks A. Cabin
Fever. BMJ 2008; 336:584-6. Available from URL: http://www.bmj.com/cgi/
eletters/336/7644/584#192125.
4.
Lovell M. In-flight medical emergencies – a difficult medical and legal environment.
Australian Anaesthesia 2003;63-71.
5.
Rennie F. An introduction to airline medical telemetry. Proceedings of the 79th
Annual Scientific Meeting of the Aerospace Medicine Association; 2008 May 14-18.
Boston, Massachusetts.
6.
Rapid Responses for Tonks A. Cabin Fever. BMJ 2008; 336:584-6. Available from
URL: http://www.bmj.com/cgi/eletters/336/7644/584#192125
7.
Rapid Responses to Dyer C. Doctor demands payment for helping airline passenger.
BMJ 1998; 317:701. Available from URL: http://www.bmj.com/cgi/content/
full/317/7160/701
8.
Nisselle P. Flying the question of reward. Available from: http://www.australiandoctor.
com.au/articles/3c/0c050d3c.asp
9.
Lufthansa with special offer for doctors. Available from: http://konzern.lufthansa.
com/en/html/presse/pressemeldungen/index.html?c=nachrichten/app/show/
en/2006/10/628/HOM&s=0
Ion Morrison
Darling Point, NSW
2009 ANNUAL SCIENTIFIC MEETING
2009 ANNUAL
CONFERENCE – VANUATU
The end of August saw a bunch of hardy ASAM members
again troop off to the annual scientific meeting – but this
year was an extraordinary year and the meeting came with
a twist. 2009 was ASAM’s 60th birthday and after hosting
several joint meetings in recent years ASAM was the guest of
the Kiwis. The venue – Le Lagon Resort in tropical Vanuatu.
While most arrived by commercial air, David Fitzgerald and
his party island hopped all the way from Tasmania in an
Aerocommander, picking up passengers on the way, only to
arrive in Port Vila with an unserviceable radio.
Little wonder many of our members either arrived early or stayed a little
longer to sample the delights of this seductive little country. Some sunbathed,
other sailed or golfed and a few dived. In the evening many stories flowed
over interesting meals lubricated with ample refreshing tropical beverages.
Old friendships were rekindled and new ones made. In the background the
committee toiled to ensure a seamless meeting with the assistance of Anne
Fleming working on behalf of Leishman Associates.. The Kiwis must be
congratulated for staging a truly fantastic meeting....and that’s not just the
kava speaking!
Highlights of the meeting including the annual John Lane Oration given by Bill
Griggs (2009 South Australian of the Year) in which he addressed the issue of
Aeromedical Retrieval. The 2009 Patterson Trust speaker, Petra Illig an AME
from Alaska, spoke on Space Tourism and Medical Guidelines for Commercial
Space Travelers. A initiative at this meeting was to run the meeting as an
RACGP Category 1 educational activity. As a result of Dr. Kate Manderson’s
outstanding efforts, participants were able to examine debate and review their
aeromedical practices against the framework of college preventive health
guidelines, while at the same time earning required CME points. The CASA
viewpoint was provided by the new CASA PMO, Dr Pooshan Navathe, who
provided a different perspective from the traditional CASA case presentations.
ASAM’s 60th Birthday was celebrated in style on the Saturday night with
a tropical beach party, with participants encouraged to display their ‘bling’.
A wonderful meal, good wine, fine company and entertainment from local
musicians, fire dancing, and conference participants including David Powell
on sax and Andrew Marsden on bass drum.
In 2010 ASAM will again stage its ASM… in sunny Canberra (a return to the
national capital where previously we had to cope with the demise of Ansett
Airlines the last time we met there in 2001). We look forward to seeing you
all there.
Photos published by permission Dr Nader Abou-Seif and Dr Arthur Pape.
2009 ANNUAL SCIENTIFIC MEETING (CONTINUED)
2009 ANNUAL SCIENTIFIC MEETING (CONTINUED)
ASAM NEWS
THE PRESIDENT’S LOGBOOK
The Society celebrated its 60th year in style at the annual scientific meeting in
August 2009 in Vanuatu. This was the first venue for the Society outside of New
Zealand or Australia and was most successful. Over 70 delegates attended,
many accompanied by their partners, and were educated and entertained by
a range of diverse cultural activities as well as our usual scientific program.
Our two keynote speakers, Dr Bill Griggs (Adelaide) and Dr Petra Illig (Canada),
delighted the attendees with their presentations on aeromedical evacuation
and space travel respectively. The renamed Aviation Medical Society of New
Zealand most ably hosted the conference, with this being the last function for
Dave Powell as their outgoing President. At the annual dinner, everyone joined
in the festivities wearing bling or top hats. These were brought to Vanuatu
by Anne Fleming, who was detained at customs for some time on arrival for
importing commercial quantities of goods. When the two Presidents toasted the
Society, Heather Parker sang ‘Happy birthday, Mr Presidents ‘.
Dr Brian Spackman has now taken over as President of AMSNZ, while Dave
Powell will chair the Patterson Trust. Sadly, Graham Robinson, the charming
AMSNZ treasurer, was killed in a bicycle accident in Auckland on 14 October only
a few weeks after the annual scientific meeting. The Society sent condolences
to his wife, Lin, who, like Graham, made many friends in Vanuatu. I expressed
my gratitude to Dave Powell on behalf of the Society for his wonderful efforts in
re-establishing a warm, friendly and constructive relationship between AMSNZ
and ASAM during his term as NZ President. I am sure that Brian Spackman will
continue the good work to maintain the goodwill that has been re-established.
One of the other notable initiatives at Vanuatu was the Society’s first venture as
an accredited trainer for RACGP Category 1 points. Feedback from attendees
was very positive and there were some diverse and robust discussions in the
small group breakout sessions that followed presentations of ‘the evidence’.
The Society is most grateful for the effort that Dr Kate Manderson put into
preparation of the evidence for the discussions and for her able facilitation.
Participants in the small group learning sessions were thoroughly entertained
and amused by Andrew Marsden‘s outstanding performance of the classical
signs of an individual presenting with excessive alcohol use. His performance
would bring credit to any amateur dramatic society. Given the success of this
format and the positive feedback, the Society will continue to arrange this
important RACGP training at future conferences.
The other important news is that ASAM was successful in its bid to host the
International Academy of Aviation and Space Medicine (ICASM) conference
in Melbourne in 2012. Iceberg won the tender for the role as Professional
Conference Organiser (PCO) for ASAM conferences for the next three years.
Many members may remember Jodie Parker from previous conferences and
we welcome her and her team. Iceberg was our PCO when the Society hosted
the ICASM conference in Sydney in 2000, so has experience in running a large
international conference on aerospace medicine.
Also in Vanuatu, Dr Michelle Liew (Cathay), indicated that formation of a Hong
Kong Society of Aerospace Medicine was being contemplated and inquired
about affiliation with ASAM. Dr Patrick Chan has since been elected as their
inaugural President and we look forward to developing a mutually beneficial
relationship with HKSAM.
Warren Harrex
ASAM NEWS (CONTINUED)
NEWS OF MEMBERS
HONOURS AND AWARDS
Colonel (Dr) John Turner
Dr John Fuller
Colonel (Dr) John Turner has completed his command of the Institute of Aviation
Medicine, a post he has held since October 2008. John has returned to his
newly re-built house in Townsville, and is undertaking part-time clinical work
in occupational medicine. John will continue his interest in aviation medicine
through support to 5th Aviation Regiment as an Army Reservist.
Dr John Fuller of Richmond, Victoria has been a member of the Society since
1987. He was awarded an OAM in the 2010 Australia Day Honours List for
service to medicine, particularly in the field of coronary artery disease.
Wing Commander (Dr) Adam Storey
Wing Commander (Dr) Adam Storey has been promoted and appointed
Commanding Officer of the Institute of Aviation Medicine following John’s
departure. Adam completed the Diploma in Aviation Medicine (UK) in 2007,
and was previously AVMED’s Chief Instructor.
Squadron Leader (Dr) Collette Richards
Squadron Leader (Dr) Collette Richards has been posted into AVMED as the
new Chief Instructor. Collette completed the Diploma in Aviation Medicine (UK)
in 2008, and was the senior Medical Officer of the 4th Expeditionary Health
Squadron, RAAF Edinburgh.
Dr Tak Sham
Dr Tak Sham has retired from the Civil Aviation Safety Authority. Tak was
responsible for the initial development and population of the CASA ‘Difficult
Case Management’ database which allowed CASA to monitor its decisions.
Tak also actively contributed to many case presentations and discussions at
annual scientific meetings of the Society in his unique style. We wish him well
in his retirement.
Colonel (Dr) Craig A. Schramm
Colonel (Dr) Craig A. Schramm was awarded a Conspicuous Service Cross in
the 2010 Queen’s Birthday Honours List for outstanding achievement as the
Commanding Officer of 2nd Health Support Battalion and Senior Health Officer,
South East Queensland. Colonel Schramm CSC is now based in Canberra.
Errata
2009 Honours – Dr Alex Cato AM was awarded an AM, not an OAM as
published in JASAM Volume 4 Number 1
Our apologies, Alex
VALE
IAN GRAHAM ROBINSON MB CHB, DIP OBST, FRNZCGP, DAVMED
1946–2009
General practitioner and long time member of the Aviation
Medical Society, Graham Robinson lost his life in mid-October,
when he was tragically killed while cycling north of Auckland,
New Zealand.
who won friends easily through his wonderful
sense of humour, kindness, and his wise and
gentle manner. Testimonies from patients spoke
of a man who knew how and when to reassure,
and how and when to take action.
In his twenties, already a qualified and experienced pharmacist, Graham moved
with his wife, Lin, and family of two small girls, to embark on medical training in
Otago in 1973. By working as a pharmacist’s locum during university holidays,
the Robinsons made ends meet. The family continued to grow, with the arrival
of three more children, including twins, by the time Graham’s MB ChB was
finished in 1978. Graham graduated with distinction in medicine and won the
Marjorie McCallum Medal.
He was a fit and athletic man. As a Mount Albert
Grammar School student he was the Auckland
Schools’ Cross Country Champion and the
Intersecondary Schools Champion in the
880 yards. His best mile time was 4 minutes
4 seconds. Throughout his life, he jogged for
pleasure and fitness, becoming a cyclist in recent years when a persistent
Achilles tendon problem made running difficult. A popular Rangi Rocket, he
rode long distances and lapped up the companionship and the coffee which
followed each ride.
As Wanganui Hospital offered accommodation which was sufficiently big to
cater for two adults and five children, Graham took up his house surgeon
position there. There were no registrars, which meant house surgeons carried
heavier responsibilities. While at Wanganui, Graham gained his Diploma
of Obstetrics.
His house surgeon years completed, Graham moved to Taihape to a vacant
practice – one of only two practices in the town. The community action
committee set up surgery for him in a house donated by a local motel. The
rugby club provided couches for the waiting room. Boards were put over
the bath to make an examination bed. Two years later, a Keith Hay home
was trucked in, providing a new surgery. Graham enjoyed Taihape, where
he delivered around 100 babies each year and carried out much of the
emergency work in the area, as local hospitals had limited facilities. In 1984
he gained his MRNZCGP.
The family moved to the North Shore as Graham joined the Mairangi Medical
Centre, where he became an FRNZCGP. Described as an extraordinary family
doctor, Graham will be missed by colleagues and patients. During his 23 years
at the medical centre, Graham was on the Boards of Procare and Shorecare
and was the Chairman of PreMec.
Around 600 mourners gathered at Graham’s funeral to honour the life of a man
In his fifties, Graham took up flying and gained his private pilot’s licence, further
developing a long-held interest in aviation. He was one of the country’s earliest
doctors to gain a Diploma of Aviation Medicine from the Univeristy of Otago. In
1995 he became an Aviation Medicine Assessor, AMA – 1, which allowed him
to issue medical certificates to pilots. He was medical advisor to the Gliding
Association. He was a member of the Aviation Medicine Society of New Zealand
for over 20 years, many of these years on the committee and the last few of
these as Treasurer.
Graham was an outstanding example of how to live life. Recent highlights
included seeing the sun rise on Macchu Picchu and doing a tandem parachute
jump on a day out with his family.
Above all, Graham was a family man. He was loved by his best friend Lin,
his wife of 40 years, and his five adult children, who speak of the way that
Graham was always there for them. His seven grandchildren adored him.
Deepest sympathy is extended to Lin, Nicki, Tracey, Brenda, Bridget and Brett
and their families.
(by Diana Wood )
DR CATHY GALBRAITH
29 May 1953 – 15 September 2009
Dr Galbraith ran a DAME practice at Moorabbin Airport in Melbourne. She attended a couple of ASAM conferences and was a regular participant at
AMSVIC meetings.
Cathy passed away after a yearlong battle with duodenal cancer. She packed a lot into her short life. Born and trained in Scotland, her love of the sea brought
her to Townsville in 1989. Cathy’s work in Townsville, and then in Melbourne from 1993, involved part time general practice and part time as a senior doctor in
BreastScreen. She was passionate about breast cancer prevention and early diagnosis.
In fact, Cathy was passionate about everything in life. She loved flying and medical work at Moorabbin Airport. She was a keen sailor (even in Scotland!) and some
of her most cherished times were sailing with her husband and children. She was a wonderful, attentive mother.
Patients and colleagues loved Cathy. Her broad Scottish accent, her quick wit, her compassion and energy could not fail to leave a smile. She was an excellent
doctor, a caring citizen and a beautiful person. It has been very hard to say goodbye…
Dr Joan Kaaden
Friend and colleague
REGIONAL REPORTS
AVIATION MEDICINE NSW
The 2009 Annual Meeting of Aviation Medicine NSW held in
Canberra marked the 10th Anniversary of Aviation Medicine
NSW, but the 17th Anniversary of the NSW body.
Some 60 DAMEs and DAOs from Queensland, NSW, ACT, Victoria, SA and the
ADF attended the second “Sight for Flight” meeting, held in the historic Hyatt
Canberra Hotel.
The keynote speaker, and David Lowy lecturer was Associate Professor Ingrid
Zimmer-Galler of the Wilmer Eye Institute at Johns Hopkins Medical School in
Baltimore. Ingrid works as a consultant to the US FAA and US AOPA, and is a
qualified pilot.
private tour of the Museum and pre dinner drinks on the mezzanine during two
short videos. The after dinner speaker, Matt Hall captivated the audience with
his experiences and video of his latest Red Bull races.
Meetings for 2010 will be Sydney at the Sydney Harbour Marriott Hotel on
March 28, and at the Mercure Hunter Valley Resort on November 06-07.
Susan Maclarn
Secretary/Treasurer
In addition to the main theme of Ophthalmology, a range of interesting topics
were discussed, including Aviation Psychiatry and Law. David Jordan, Aviation
Barrister, raised doubts about DAME indemnity as provided by both the
regulator and insurers. A topic for next year!
Aviation Medicine NSW will hold a meeting on 06–07
November: ”Drug and Alcohol Abuse in Aviation: Is it a
problem?” The meeting will feature two international keynote
speakers and will be held at the Mercure Resort Hunter Valley
Gardens, cnr Broke and McDonald’s Roads, Pokolbin.
75 guests attended the black tie dinner, which was held at the Aircraft Hall
of the Australian War Memorial under the port wing of ‘G for George”, after a
The social program will include a trip to the Tiger Moth Museum at Luskintyre
and the Annual Dinner to be held at McGuigan’s Winery.
AMSVIC
AMSVIC will hold its Annual General Meeting and Scientific Meeting at the Hotel Grand, Mildura from 31 July – 1 August.
The program will include a CASA presentation, and a variety of other papers and case presentations from DAMEs. The social
program will include dinner at the fabulous Stefano’s Restaurant.
WESTERN AUSTRALIA
On the 22nd of May the Western Australian Government kindly issued a waiver allowing our colleagues from other states to
visit without the need for passports or visas. Consequently 10 members of our Society made the crossing from east to west
to attend the meeting of the Western Australian chapter of the Society. Those who attended the meeting (over 70 all up)
included the society’s federal committee who used the occasion as a chance to have their quarterly committee meeting on the
following morning.
This meeting which was held at the Esplanade Hotel in the harbour city of Fremantle was conducted on a Saturday and timed to follow the meeting run by CASA
on the Friday. The CASA meeting was attended by over 50 DAMEs who were given the opportunity to use a trial version of the CASA on line medical examination
report form. The consensus was that the format was getting close to a workable solution although there was still the feeling that the online form would take about
twice as long to complete as the paper form. There was also the opportunity for helpful dialogue between the DAMEs and CASA’s Principal Medical Officer Pooshan
Navathe and his deputy Michael Drain.
On the Saturday the meeting was treated to a wide variety of excellent papers ranging from the ATSB presentation by Chris Walker on the near accident in WA of
a 30 passenger Brasiliar aircraft to a personal account of a night ditching of a Twin Otter in Vanuatu by orthopaedic surgeon Nicole Leeks. Updates on eye surgery
from Robert Paul and papers on the introduction of the RFDS Jet in WA, and several case reports were a feature of the day.
All speakers put in a fantastic effort to make the day one of great interest and valuable information.
The day finished with a dinner at the Esplanade and the prospect of a Sunday free to explore the many attractions of this old harbour town.
MUSINGS FROM NEW ZEALAND
It’s been a long time between drinks so I’ll try to catch you up
with what’s been happening over the ditch.
I must first apologise for the poor NZ attendance at the conference in Vanuatu
last year and I hope it doesn’t imply that we regard such events as irrelevant.
The increasing pressures of work these days mean that MEs have to get the
most bang for their buck and for that reason we have downsized to two small
conferences in NZ this year split between the North & South Islands and
involving only a one-day event. Not only are these a great deal cheaper but
surprisingly they have been very well attended and in that regard have been a
great success. This has suited the 60% of our members who are GPs but there
will likely be a move back to combining with Occupational Medicine next year
when winter snow and the Rugby World Cup in September will put pressure
on the date and the venue, which will probably be Queenstown. To those of
you interested in either of those pastimes, we would welcome you joining us
next year.
The reports I received about the Vanuatu conference were all very positive
and I have to congratulate the Tasmanian organisers (Leishman & Associates)
for being able to achieve all this by remote control from NZ. Again I apologise
to those few who were affected by the Vanuatu food and hope there were no
long-term effects.
Some of you who attended Vanuatu will have met our Treasurer, Graham
Robinson, who very sadly was killed when cycling just 2 months after the
event in Vanuatu. Graham was universally liked and admired and his death
was a huge shock to us. He is survived by his wife, Lin and children. His friends
donated over $21,000 towards a ‘heart ride’ that he was intending to take part
in and we are still considering some form of appropriate memorial for him.
A month after the Vanuatu conference we put on a mini-conference for those
who could not attend and were fortunate to have two excellent speakers on
the space theme – Dr. Kira Bacal who worked with NASA developing medical
systems in space, and Dr Karen Willcox, an engineering specialist in aeronautics
and astronautics who will probably be NZ’s first astronaut. We wound up the
year with a social visit to the Auckland Stardome to experience space in a
different way.
Our annual fly-in event was taken over by the around New Zealand Air Safari in
March 2010. Unfortunately no members took part but the event was a popular
and spectacular 2 week tour around the country for teams from all over the
World and ended at the Warbirds over Wanaka event.
The Patterson Trust took some pride in being able to offer a substantial
education grant for the first time in what will be an annual prize. The initial grant
was won by Dr Genevieve Weeber who is using it to study at the Otago Medical
School of Occupational & Aviation Medicine towards her higher qualifications.
[photo enclosed of Brian Spackman presenting the award to Genevieve with
David Powell as MC]
Lastly, and I stress that this is in a move to remove confusion rather than
separatism, the New Zealand Society has changed it’s name to the ‘Aviation
Medical Society of New Zealand’. Our website currently retains the www.
amsanz.org.nz but will be updated later in the year. We continue to value highly
the history and links we have with your Society in Australia and especially
the friendships that have been forged over many years. We look forward to
catching up in Canberra soon.
Brian Spackman
FOUNDATION AND HONORARY MEMBERS
FOUNDATION MEMBERS
HONORARY MEMBERS
Dr EH Anderson
Dr NEH Box
Dr B Costello
Dr WD Counsell
Dr RD Fisher
Dr G Kaye
Dr D Lampard
Dr JC Lane
Dr T Millar
Dr H Mitchell
Dr FS Parle
Air Commodore EA Daley
Group Captain RB Davis
Squadron Leader JB Craig
Squadron Leader RG Skinner
Year awarded
Dr (non-medical) JH Martin,
Director of Physics at the Melbourne Cancer Institute
1956
Air Vice Marshal EA Daley CBE, KHP, QHP
1961
Dr FS Parle OBE
1975
Dr HJ Mail
1978
Dr JC Lane AM
1979
Air Vice Marshal LK (Kiwi) Corbet
1979
Mr Doug Patterson
1981
Dr AW Erenstrom
1987
Dr Derek Dawes
1997
Dr Dorothy Herbert OAM
1997
Dr Ron Wambeek DFC
1999
Dr Bert Bailey
1999
Dr Eric Donaldson OAM
1999
Dr Len Thompson
1999
Dr John Colvin AM
1999
Air Vice Marshal Eric Stephenson AO, OBE, QHP
1999
Air Vice Marshal Glen W (Bill) Reed
2001
Dr Jeanette TB Linn OAM
2002
Dr Richard Williams (Chief Medical Officer NASA)
2003
Capt Glenn Todhunter
2003
Dr Michael Lischak
2003
Dr Malcolm Hoare RFD
2007
Dr Graeme Dennerstein
2007
Dr B Costello (Foundation Member)
2008
Dr J B Craig (Foundation Member)
2008
CALENDAR OF EVENTS
CALENDAR OF EVENTS
Date
Conference
Location
31 July–1 August 2010
AMSVIC Flyaway Weekend
Mildura
16–19 September 2010
ASAM Annual Scientific Meeting
The Shine Dome, Canberra
6–7 November 2010
Aviation Medicine NSW Meeting
Mercure Resort, Pokolbin
4–5 March 2011
AMSVIC Airshow Downunder Scientific Meeting
Melbourne
ASAM Annual Scientific Meeting
Crowne Plaza, Newcastle
60th International congress of Aviation & Space
Medicine (hosted by ASAM)
Melbourne Convention Centre
THE ASAM COMMITTEE
President
Dr Warren Harrex
[email protected]
Vice-President
Dr Tracy Smart
[email protected]
Treasurer
Dr Greig Chaffey
[email protected]
Secretary
Dr Barney Cresswell
[email protected]
Public Officer
Dr Peter Wilkins
[email protected]
Committee
Members
Dr Gordon Cable
[email protected]
Dr Ian Cheng
[email protected]
Dr David Emonson
[email protected]
Dr Andrew Marsden
[email protected]
Dr Heather Parker
[email protected]
2010 MEMBERSHIP LIST
AUSTRALIAN
CAPITAL TERRITORY
David Batagol
Dorothy Coote
Belinda Doherty
Alan Ferguson
Andrew Gordon
Eleanor Harrex
Warren Harrex
John Howe
Vince Joseph
Steven Kennealy
Danielle Klar
Doug Lee
Rob Lee
Elicia McGinniss
Graeme Moller
Somnuk Phonesouk
Andrew Pitcher
Dennis Roantree
James Ross
Craig Schramm
Mike Seah
Tak Sham
Tracy Smart
John Smiles
Eric Stephenson AO
OBE
Kelly Teagle
Tamsin Travers
Carmel Van Der Rijt
Neil Westphalen
Peter Wilkins
Felicity Williams
NEW SOUTH WALES
George Abraham
Paul Adler
Manjul Agarwal
Peter Aldridge
Roger Allan
Rick Alterator
Grahame Ambrose
Philip Arber
Peter Arnaudon
Tony Austin AM
Yvonne Bailey
Eric Baker
Arthur Ban
Geoff Bayliss
Tom Bennett
Roy Beran
Andrew Berry AM
Keith Betts
Priti Bhatt
Chris Blainey
Diane Bridger
Margaret Brown
Asthika Chara
Ian Cheng
Leanne Cheung
Simon Chua
Michael Clements
Paul Coceancig
Trish Collie
David Cooke
David Cooper
Timothy David
Gordon Davies
Peter Davis
Darren Delaney
Barry Den
Ian Doust
Peter Duffy
Vincent Duffy
Johan Duflou
Dean Durkin
Creswell Eastman
Charlie Edwards
John Elder
John Evans
Chris Fenn
Shiran Fernando
Joe Ferris
Catherine Field
Guy Fitzgerald
Izaac Flanagan
Jennifer Foong
Bradley Forssman
Paul Foster
Kim Frumar
Justin Game
Trevor Gardner
David Garne
Laurie Garrard
Margaret Gibson
Jane Givney
Max Gorbach
Pedita Hall
Richard Hartley
Phillipa Harvey-Sutton
Luke Hazell
Ken Hazelton
Cameron Henderson
Marc Heyning
Graham Higgins
Dolores Hill
Michael Hill
Christopher Hopwood
Terry Horgan
Greg Horowitz
Stephen Howle
Paul Hughes
Richard Hurst
Ian Hutchins
Mark Jacobs
Christopher Jambor
Caron Jander
Colin Johnston
Larry Jongbloed
Andrew Keller
Bernard Kelly
Phil Keys
Ijaz Khan
Jennifer Khan
Azhar Khan
Nee Chen Khoo
Len Kloosman
Sanna Kontkanen
Neville Kwon
Peter Lawson
Hal Leaver
Janet Lee
Wayne Lehmann
Vinoo Lele
Steve Leppard
Rob Lewin
Robert Lewin
Albert Liebenberg
Craig Lilienthal
Hardy Lim
Elizabeth Livingstone
Lawrence Loh
John Lose
Eddie Lurie
Philip Lye
Tim Lyons
Col MacDonald
Graeme Maclarn
Marion Magee
Javed Mahmood
Helen Maloof
Kate Manderson
Mehm Manku
Vincent Manners
Peter Martin
David Mathews
Lisa Maus
Steven McGilvray
Mary McGinty
Peter McInerney
Al McKay
Robyn Meades
Robert Micallef
Andrew Milliken
Ross Mills
David Moore
Kerry Moroney
Ion Morrison
Kelvin Mychael
Phillip Myers
Rae Nelson-Marshall
Neil Nerwich
David Ng
Peter O’Brien
Joseph Ohana
Gabrielle O’Kane
Matthew Orde
Karen Oswald
Doug Oxbrow
Jitendra Parikh
Roger Parrish
Glenn Pascoe
Jeffrey Pinkstone
Graham Pittar
Stuart Porges
Eddie Price
Peter Purches
Jey Randhawa
Tim Rankin
Balaji Rao OAM
Brian Richardson
Natasha Richardson
Rob Robertson
Howard Roby
David Rockman
George Rowe
Mark Ryan
Ain Saareste
Darshan Sachdev
Puru Sagar
Alan Saunders
Gary Schiller
Jack Shepherd
Garry Simpson
Murray Sinclair
Rod Sloane
Justin Smith
Richard Smith
Jeff Stephenson OAM
Harry Stern
Gavin Stringfellow
Frank Summers
Derek Tang
Kong Chan Tang
Christopher Taylor
Giles Taylor
Lewis Thatcher
Geoff Thomas
Michael Thomas
Vin Thomas
Clyde Thomson
Paul Thorogood
Dick Tinning
Annemarie van der
Walt
Deon Viljoen
Malcolm Webb
Chris Webber
Alvin Hock Peng Wee
Leon Wicks
Shane Wiley
Bruce Williams
Stephen Windley
Richard Wingate
Dean Wright
Ivan Young
Andrew Zdenkowski
Northern Territory
Michael Brotherton
David Brummitt
Margaret Fuller
Richard Giese
Doug Hardcastle
Andrew MacDonald
Asha Mahasuria
Tharmalingam
Mahendrarajah
Bill Pettigrew
Jill Pettigrew
Colin Rubin
Jim Scattini
Mike Stacey
Geoffrey Thompson
QUEENSLAND
Jim Abrahams
Geoffrey Adsett
Waseem Ahmed
Stuart Allaburton
John Ambler
Christopher Andrews
Andrew Apel
Peter Beeston
Ann Bennett
Simon Birchley
Dan Black
Don Bowley
David Bradley
Jeff Brock
Michael Bromet
Andrew Bryant
Patrick Byrnes
John Cameron
Martin Carr
Edwin Castrisos
Greig Chaffey
Jan Chaffey
Aaron Chambers
Alan Chater
Bill Collyer
Ian Cormack
Dennis Costigan
Peter Cranstoun
Sheilagh Cronin
Greg Cunningham
Marc Daniels
Ian Davies
Tim Dawbarn
Walter Dietz
Eric Donaldson OAM
Peter Dowd
Heidi Dreiling
Tom Dunn
Elaine Dunne
David Easton
Norm Edwards
John Evans
Peter Fenner
Hiroyoshi Fukuzawa
Amanda Gardner
Chris Gilford
John Goldston
Jim Griffin
Greg Hampson
Tim Hardy
David Hawes
Rosemary Hay
Richard Heath
Bandu Herat
Dorothy Herbert
Ross Hetherington
Michael Hickey
Lee Ho
Geoff Holt
Michael Horwood
Ian Hosegood
Ian Housego
John Hudson
Carolyn Jack
Tony Jenkins
Paul Joice
Deep Joseph
John Kearney
Michael Keating
Tom Kelly
Robert Kennedy
Richard Keyes
Scott Kitchener
Daniel Kleinig
Blair Koppen
John Lahanas
Eric Lai
John Lamb
Paul Lanham
Stephen Lawson
Robin Lee
Peter Leggat
Gary Lillicrap
Richard Lim
Gary Litherland
Simon Little
Peter Marendy
Warwick Marks
Ian Marshall
Jodie Marshall
Ian Maxwell
Margaret McAdam
Don McCombe
Jodie McCoy
Michael McDonnell
Ewen McPhee
Maria Moon
Josh Munn
Pat Naidoo
Greg Norman
Petar Novakovic OAM
Csongor Oltvolgyi
Judith O’Malley-Ford
Robin O’Toole
Kym Palmer
HeatherParker OAM
Geoff Pascoe
Graeme Peel AM CSC
Shawn Perera
Tom Pietzsch
Ben Powell
Max Rankin
Michael Read
Stuart Reader
Grahame Readshaw
Bill Reed
Ian Rivlin
Phil Rosewarne
Carl Rubis
Peter Ruscoe
Stan Seliga
Anita Sharma
Anil Sharma
Paul Shumack
Shane Smith
Andrew Spall
Paul Spicer
Sue Steel
John Stone
Allan Sutch
Craig Swanson
William Talbot
Dean Taylor
Ross Taylor
Alison Thomas
Bob Thomas
Dale Thomas
Glenn Todhunter
Douglas Tong
John Turner
Matthew Valentine
Willem Vogel
Andrew Whitworth
Chester Wilson
Max Wong
Jane Woodward
Phil Yantsch
Patrick Yoke Choon Lip
Kevin Zischke
SOUTH AUSTRALIA
Bruce Alcorn
Feroz Ameerjan
Daniel Anderson
Suresh Babu
Iwona Baczyk
Tony Barker
Mike Beckoff
Martin Bloom
Geoff Bryant
George Bulyga
Timothy Burrough
Gordon Cable
Roger Capps AM RFD
V Chadha
Peter Charlton
John Crompton
Glyn Davies
Peter Del Fante
Colin Fernando
Arthas Flabouris
Graham Fleming
Roy Francis
Geoff Graham
Bill Griggs AM
Richard Heah
Clive Hume
Reece Jennings
Richard Jolly
Jonas Kasauskas
George Kokar
Scott Lewis
Jeanette Linn OAM
Stewart Martin
Alan Miller
Neil Murray
Htun Htun Oo
Brett Oppermann
Nicholas Page
Ian Partridge
Lincoln Pike
David Ramsey
Anupama
Shivashankaraiah
Bhupinder Singh
Adrian Smith
Adam Storey
Bryan Thompson
Peter Thorpe
Andrew Trappitt
Grant Tschirn
Richard Tucker
Chris Waite
Kym Ward
Christopher Watson
Richard Wilson
Tim Wood
TASMANIA
Jeff Ayton
Doug Dow
Ian Emmett
John Farmer
Stewart Graham
Paul McCartney
Ian Roddick
Pauline Rowan
Michael Tooth
Michael Treplin
Anthony Tymms
Bob Walker
VICTORIA
Nader Abou-Seif
Robert Allen
Noel Alpins
Alex Amini
Malcolm Anderson
Peter Antonenko
Peter Atkinson
Ken Baddeley
Andrius Balnionis
Jim Barry
Oleg Bassovitch
Michael Baynes
Allan Bernstein
Sam Birman
Rhyll Black
Philip Bloom
Phillip Boltin
Graham Boothby
Wilfrid Brook
Russell Brown
Robert Buttery
Don Cameron
Paul Cartwright
Alex Cato AM
Christopher Chesney
Philip Cheung
Rowena Christiansen
Andrew Clift
Michael Connor
David Conron
Max Cooper
Brian Costello
Mark Daniell
Ivor Davis
Geoff Day
Max De Clifford
Tony De Sousa
Nicholas Demediuk
Graeme Dennerstein
Fio Devincentis
John Dickman
Greg Dimond
Yock Seck Ding
Ian Douglas
Colin Duncan
Bill Dwyer
John Dyson-Berry
Greg Ellis
Khaled El-Sheikh
David Emonson
Ian Farmer
Jeff Farrow
Rodney Fawcett
Malcolm Ferguson
Scott Fifield
Mike Forster
Stuart Franks
John Fuller OAM
Vince Galtieri
Scott Gardiner
Doug Gaze
Murray Gee
Tony Gibson OAM
Cecil Gill
Carl Grace
Catherine Green
Barry Gunn
Peter Habersberger
Lucinda Ham
Angas Hamer
George Haralambakis
Andrew Harris
Phil Harris
Andrew Heath
Monica Hince
Marcus Hirschfield
Julian Hoare
Tamaris Hoffman
Martin Hogan
Annette Holian
Michael Homewood
Sue Homolka
David Hooke
Campbell Hunt
Gerald Irvine
Stephen Jelbart
Roger Johnston
Marina Kefford
Warren Kemp
Peter Keppel
Peter Kudelka
Sonny Lau
Mark Lazarus
Robert Lazell
Rodney Lee
Priscilla Leow
David Lia
Andrew Ling
Mark Loeffler
Luigi Lucca
Richard Lunz
Geoff Macaulay
Ileene MacDonald
Heather Mack
Noel Mackey
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John Martiniello
David Marty
Julian Mazzetti
Anthony McCarthy
Colin McDonald
Ian McInnes
Matt McKenzie
David McKnight
John McLean
Liz McLeod
Hal McMahon
Phyllis McMahon
Andrew Merrett
Ian Millar
Graham Miller
Peter Milne
Rob Moffitt OAM
David Monash
Ramanathan
Narendranathan
Adrian Neath
Carmel Newitt
David Newman
Weng Toon Ng
Geoff Nicholson
Nick Nicolettou
Rob North
Karen O’Brien
Justin O’Day
Michael O’Gorman
Lawrence O’Halloran
Chris O’Kane
James Olesen
Stan Osman
Mark Overton
Om Pahuja
Arthur Pape
Gregory Papworth
John Parkes
Ian Paterson
Matthew Pattison
Andrew Peters
David Phan
B Pillai
Ian Price
Christopher Priest
Melissa Reed
Ruth Reid
Mark Renehan
Kath Reynolds
John Roberts
Shelley Robertson
Norman Roth
Les Sandor
Anthony Schneeweiss
Russell Searle
Roger Serong
Meg Shannon
Rajeev Sharma
Colin Sheppard
Richard Shields
Simon Shute
John Silver
Michael Smith
Ian Stapleton
Laurence Sullivan
Ron Tomkins
Geoff Toogood
Duc Nguc Tran
Melinda Truesdale
Arthur Tsiglopoulos
Raoul Tunbridge
Tony Van Der Spek
Rosemary Vandenberg
Algis Vingrys
Richard Ward
Salena Ward
John Warren
Laurance Watson
Philip Webster
John Weinrich
Rod Westerman
Peter Wolf
Rick Wolfe
David Workman
David Worsnop
Janet Wright
WESTERN
AUSTRALIA
Stuart Adamson
Adegbuyi Adeoye
Olajumoke Afolabi
Omar Al Qubaisy
Reg Andrews
James Aniyi
Stephen Arthur
Tony Barr
John Bateman
Michael Benson
Patrick Briggs
Frances Cadden
Andrei Catanchin
Mohan Chandran
Bernard Christensen
Brian Collings
David Collis
John Craig
Bernard Cresswell
Dru Daniels
John Davies
Chris Denz
Ron Dobson
Zaki Dorkham
Jane Dymond
Nicholas Forgione
Paul Gorman
Bill Griffiths
Graeme Hartill
Ross Harvey
Anthea Henwood
Peter Hernaman
Peter Heyworth
Malcolm Hoare
Anthony Hochberg
Matthew Hodge
Airell Hodgkinson
David Holt
Andi Howes
Allan Hutchinson
Yoshi Inoue
Reimar Junckerstorff
Stephen Kearney
Darren Keating
Chee-Hoong Khong
Theo Kitchen
Frank Kotai
John Laney
Stephen Langford
Colin Lee
Rob Liddell
Christine Marsack
Andrew Marsden
Phillip Martin
Christine McConnell
Mike Mears
Nazmi Mikhaiel
John Miller
Cathryn Milligan
Kent Morison
Paul Newman
Phillip Noble
John Parry AM JP
Chris Perry
Trevor Pleass
Noel Plumley
Jan Ravet
Jenny Robson
Chris Rose
Elizabeth Ryan
Chris Rynn
June Sim
Harpreet Singh
DougStarling
Andrew Stewart
Barb Stott
Paschal Stynes
Ebbie Swemmer
Jane Talbot
Hui Tan
Charles Thelander
Andrew Van
Ballegooyen
Olga Ward
Craig White
Glenda Wilson
Yim-Kong Wong
Tom Woods
Adrian Zentner
OVERSEAS
MEMBERS
CANADA
Tarek Sardana
CHINA
Robyn Searl
DENMARK
Steffen Lyduch
FIJI
Ram Raju
HONG KONG
Samuel Fu
Hay Tung Lau
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Rose Ong
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Benjamin Pei
INDIA
Girish Patil
IRAN
Iman Ronaghi
KINGDOM OF
SAUDI ARABIA
Islam Issa
MALAYSIA
Khiew Siaw Kwong
NEW ZEALAND
Dave Baldwin
Robert Blackmore
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John Mackerell
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Kim Soo Joang
Raymond Wong
SRI LANKA
Nimal Heart-Gunaratne
THAILAND
Sethanai
Banasamprasit
Sumait Premmanisakul
UNITED ARAB
EMIRATES
John Chalkley
Eleanor Luna
UNITED KINGDOM
Dewi Morgan
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UNITED STATES
OF AMERICA
Joseph Contiguglia
Michael Lischak
Richard Williams
AVIATION MEDICINE COURSES IN AUSTRALIA & NEW ZEALAND
POSTGRADUATE CERTIFICATE IN AVIATION MEDICINE
(PGCAvMed)
Edith Cowan University, Perth, Australia
The Postgraduate Certificate in Aviation Medicine (M41) has been developed for medical practitioners seeking certification to
undertake medical examinations of pilots and air traffic controllers. This course is also relevant to practitioners involved in air
transportation of patients.
What Qualifications Are Required For Admission?
• A recognised university qualification in medicine (MBBS or equivalent).
• The status of overseas medical qualifications will be referred to the National Office of Overseas Skills Recognition if any doubt exists about suitability.
• Applications will be expected to be proficient in English and evidence of this will be sought if the applicant’s undergraduate medical degree was taught in a
language other than English.
Comments: External or Online Distance Education
http://www.ecu.edu.au/future-students/our-courses/view?id=M41
Please call 134 ECU (134 328), email [email protected] or visit www.snmpm.ecu.edu.au
The Aviation medicine course coordinator is Assoc. Professor Moira Sim.
AUSTRALASIAN DRUG AND ALCOHOL MEDICAL OFFICER REVIEW
OFFICER TRAINING COURSE
November 2010
Expressions of interest are sought from registered medical practitioners who would like to attend a Medical Review Officer
(MRO) training course to be held over two days during the third week of November 2010.
This will be the second Australasian course designed specifically for Australian MROs who provide medical input into workplace drug and alcohol management
programs, in particular to meet the requirements of CASR part 99 for the aviation industry.
Please contact Anne Fleming on 03 9899 1686 or [email protected] for further information and to express your interest.
AUSTRALIAN CERTIFICATE OF CIVIL AVIATION MEDICINE
2011
School of Public Health
and Preventive Medicine
Each comprehensive course offers an exciting programme which includes visits to the Melbourne Air Traffic Control Centre and
hands-on airline flight simulator experience. Course participants will gain knowledge of the fundamental aspects of aviation
medicine & physiology, including the effects of hypoxia and spatial disorientation, as well as a comprehensive overview of
clinical aviation medicine.
The course covers all the principles involved in assessing fitness of aircrew and air traffic controllers to perform their duties. The course is suitable for Medical
staff from international retrieval organisations, International airline medical staff, Medical staff from other aviation authorities (eg Nigeria, Maldives) as well as
nurses – no previous Aviation Medicine knowledge is required.
This qualification enables doctors to register with the Civil Aviation Medical Authority as a DAME (Designated Aviation Medical Examiner) to examine pilots and air
traffic controllers for fitness to work.
The course venue is located in Melbourne. This garden city is the scenic capital of the southern Australian State of Victoria.
For further details please visit our website: http://www.med.monash.edu.au/epidemiology/shortcrs/
Enquiries:
Ms. Suzy Giuliano
Telephone: (61) 3 9903 0693 Facsimile: (61) 3 9903 0556 E-mail: [email protected]
Web address: http://www.med.monash.edu.au/epidemiology/shortcrs/ Course Convenor: Dr. David Newman
DISTANCELEARNING
UNIVERSITY OF OTAGO, WELLINGTON
OCCUPATIONAL AND AVIATION MEDICINE UNIT
OUR PROGRAMMES COVER
s Aviation Medicine
We offer part time
one-year Postgraduate Certificates,
two-year Postgraduate Diplomas,
four-year Masters and five-year PhDs.
s Occupational Medicine
s Aeromedical Retrieval and
Transport for doctors
s Aeromedical Retrieval and
Transport for nurses and
allied health professionals
s Research
Our programmes are all fully distance taught
and research-supervised – you stay in your
own country and continue with your regular
job while you learn and apply your new
knowledge in the workplace.
The University of Otago’s Occupational and
Aviation Medicine Unit is the world’s leading
provider of education in occupational and
aviation medicine. Our qualifications are
accredited in most countries.
Our papers are taught via a web-based
learning platform featuring real-time
web-based audio-conferences, interactive
forums and wikis, chat, video streaming,
archives from past sessions, podcasts and
access to a huge range of relevant readings
and articles. A feature is the one-week
residential school, held in a different
country each year.
The papers are led by accessible and
knowledgeable tutors who are working in
the industry themselves.
FOR FURTHER INFORMATION OR TO ENROL PLEASE CONTACT:
Katherine Harris
Programme Manager
Occupational and Aviation Medicine
University of Otago, Wellington
New Zealand
Email [email protected]
Tel +64 4 385 5590
www.otago.ac.nz/aviation_medicine
WELLINGTON
1666
INFORMATION FOR AUTHORS
JOURNAL OF THE AUSTRALASIAN SOCIETY OF
AEROSPACE MEDICINE
Information for Authors
JASAM is usually published twice yearly and contributions are welcome at any time. Deadlines for each edition are 10 April and 10 October.
JASAM welcomes contributions including letters to the Editor on all aspects of aviation medicine.
Manuscripts must be offered exclusively to JASAM unless the manuscript is accompanied by a copyright exemption.
All manuscripts and contributions are subject to peer review and to editing.
Contributions are preferred by e-mail to: [email protected]
Contributions should be sent to:
[email protected]
or
The Editor
JASAM
Australasian Society of Aerospace Medicine
P O Box 4022
BALWYN VIC 3103
Requirements for Manuscripts
JASAM follows the agreed conventions for medical journals. Full details of the requirements for manuscript preparation are available on the internet at the site
http://www.icmje.org
An electronic copy (on disc or sent by e-mail) should be submitted. The copy should be able to be read in MS Word and formatted to A4 paper, using Arial or Times
New Roman 10 font. Reviewers will be provided with a copy with the authors’ names, affiliations and acknowledgements removed.
The title page should contain the title, list the names and qualifications of all authors as well as the position and institutional address at the time of submission.
One author should be identified as the correspondent along with his or her postal address, telephone number and email address.
An abstract of no more than 250 words should be included with headings for background, methods, results and conclusion.
Abbreviations should be avoided and if used only after they have appeared in brackets after the completed expression – eg, Journal of the Australasian Society
of Aerospace Medicine (JASAM). SI units should be used but altitude may be expressed in feet.
Figures and Tables are encouraged and should be entered on separate pages and numbered sequentially underneath eg Figure 1 or Table 1 with an appropriate
self-explanatory legend. Their preferred location should be indicated in the manuscript.
References should be presented in the “Vancouver” style. References should be numbered consecutively as they appear in the text as superscript numbers (eg,
text1,2). An example of the format for journals and books is given below:
1. Cable GG, MacFarlane A. Is neurological hypobaric decompression illness a more common phenomenon than we think? J Aust Soc Aerospace Med 2006;
2(2):3-11.
2
Heath D, Williams DR. Man at high altitude, 2nd ed. Edinburgh: Churchill Livingstone, 1981: 56-65
Permission to reprint articles will be granted by the Editor, subject to the author’s agreement, provided that an acknowledgement giving the original date of
publication in JASAM is printed with the article.
Review
All articles will be subject to blind review by at least two reviewers. Members with expertise who are willing to join the panel to review articles for publication are
invited to contact the Editor.
Editorial Staff
Editor:
Assistant Editor:
Editorial Staff:
Reviewers:
Dr Warren Harrex [email protected]
Dr Adrian Smith
Drs Peter Wilkins and Dave Emonson
Drs Adrian Smith, Dougal Watson, Dave Emonson, Peter Wilkins, Gordon Davies, Bhupi Singh, Adam Storey, Aparna Hegde, Jeff
Stephenson and Gordon Cable
Editorial Assistant: Anne Fleming [email protected] Tel: 03 9899 1686
Registrations are now open!
ASAM 2010 CONFERENCE
The Shine Dome,
Australian Academy of Science, Canberra
16-19 September 2010
Welcome reception - National Portrait Gallery
Thursday, 16 September 2010
Gala dinner - Australian War Memorial
Saturday, 18 September 2010
Register now at www.asam2010.org.au
Heart of the Nation
running header

original article (continued) - The Australasian Society of Aerospace

Transcription

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