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Institute of Aviation Medicine

Why has aviation medicine been so successful in

establishing an international system compared to maritime

medicine?

Anthony S. Wagstaff Director, Institute of Aviation Medicine, Oslo, Norway

Associate professor, University of Oslo

The background for my views

• Institute of Aviation Medicine Oslo 22 years

• Military flight medical standards

– Rulemaking and clinical evaluation

• Civilian aeromedical centre (JAA – now EASA) in Norway 13 years.

• AME – military and civilian experience

• Specialist in occupational health.

• Vice president ESAM

Overview

• The big picture: Why do we do medical

examinations

• Some figures and comparisons

• Aviation Medical examinations harmonisation

in Europe

• Future improvements?

Big industries

• 3 billion airline passengers/yr

• 2 billion ferry passengers/yr, (20 million

cruise passengers/yr)

Why have we done medicals for

100 years?

1. Flight safety

2. Flight safety

3. Flight safety

If you think flight safety is

expensive

• Try an accident

Mean 2006-2010: 500 deaths in 2 000 000 000 = 2,5/10

mill/yr

Mean 2006-2010 500 deaths in 3 000 000 000 passengers : 1,6/10million/yr

Safety developments - comparison

• Shipping by a factor of 7in yrs:

– 1910: 1 hull loss/100/year

– 2012: 1 hull loss/670/year

• Aviation:

– Accident rate reduced by a factor of 50 in 50

yrs. since 1960´s

In other words

• Aviation has had huge growth

• Aviation medicine has followed

– Pressure cabin

– Oksygen requirements

– G-protection

– Crash protection

• So how are we doing?

Death risk of transportation 1999-2000 (Wikipedia)

Deaths/billion

journeys

Deaths/billion hours Deaths/billion

kilometers

Bus: 4,3 Bus: 11,1 Air: 0,05

Train: 20 Rail: 30 Bus: 0,4

Van: 20 Air: 30,8 Rail: 0,6

Car: 40 Water: 50 Van: 1,2

Foot: 40 Van: 60 Water: 2,6

Water: 90 Car; 130 Car: 3,1

Air: 117 Foot: 220 Space shuttle: 16,2

Bicycle: 170 Bicycle: 550 Bicycle: 44,6

Motorcycle: 1640 Motorcycle: 4840 Foot: 54,2

Space shuttle: 104

mill.

Space shuttle: 438000 Motorcycle: 108,9

What about the air crew: Are we

dealing with a high risk population?

• Civilian airline

aircrew

• Relative risk

Standardised mortality

• From disease – Low risk – Pilot SMR 0.56 (0.54-0.58)*

• From occupation – High risk – Pilot SMR 46 (39-54)*

– Fatal occupational accident rate 0,7/1000/yr (US)

*Hammer GP, et al. Occup Environ Med 2014;71:313–322.

doi:10.1136/oemed-2013-101395 (93771 crew members from 10

countries followed over a mean of 21 years)

We are ”only” interested in 2

aspects

• Sudden incapacitation ( the 1% rule)

• Function onboard

Why European harmonisation?

• Aviation very competitive, price-driven.

• “Level playing field”

• Common safety standards more

important as competition increases

The aviation

system seen from

a Norwegian AME

International level

Chicago convention

Annex 1

European level Rulemaking,

Acceptable means of

compliance

National level

Implementation

Civilian harmonisation

• More detailed in JAA (why?)

• Some simplifications in EASA

– Controversial

– Different traditions in Europe

Future developments?

The simple question is:

• Can we make a better contribution to

flight safety?

At the moment

• We are only really working on the low-

risk issues: the diseases

• Could we improve our work on the high

risk pilot occupation?

Clinical methods • Based on diagnostic tests for disease

• Screening doesn’t improve health outcomes, only in high risk

populations

• Sudden sudden incapacitation events only relevant for a few

conditions and the preventable risk is low

– Cardiovascular, neurological

– Only “physical” conditions screened

• What about 80% of accident causes which are human factors?

– Fatigue, life problems, stress, etc etc

Transparent

decision-making

• Collaborative process between pilot and AME with the aim of

keeping the pilot in the air safely.

• Clearly defined processes, pilot involvement in process

• Reduces “unknowns” – improve trust

• BETTER decisions

Conclusions

• Aviation has become “normal” and we do not accept

aircraft crashes – improvements are long term work.

• Aviation is still a high risk occupation, but not primarily

from disease - this is spurring new discussions in

Aviation Medicine – as we speak

• There are preventive tools, we may more

systematically apply, to add value to Flight safety in

the future

Thank you for your attention!