Designated
Aviation Medicine Examiner/Designated Aviation Ophthalmologist
DAME
Newsletter
June 2002
Acknowledgement
Distribution
The PMO's Column
Administrative
matters
- Poor quality specialist reports
- Stationery orders no longer acknowledged
- Adhesive tape on medical forms
- Photocopying medical forms
- Dr Rodney Carter - Security & Identification
- Elenore Karpfen - MRS Online
Problems and Suggestions (Steel Magnolias)
- Contact Lenses Examination
- Blood Glucose Test
- ARN to access MRS
- Nationality
- Response to "Call up for Australian DAMEs/DAOs who perform Overseas Medicals"
- Dr Grant Tschirn - locum for medical staff absences
- Dr James Ross - locum for medical staff absences
- Dr David Emonson - duty in East Timor
- Taxation
- Visitors from Thailand
- 50th Annual International Congress of Aviation & Space Medicine - Reminder
- False Statement - Breach of Regulation 283
Acknowledgment
DAMEs/DAOs should confirm receipt of this Newsletter, noting their DAME stamp number, per return email to dame.liaison@casa.gov.au. Alternatively, please fax confirmation of its receipt to CASA AvMed at (02) 6217 1640
Distribution
DAMEs/DAOs should read and digest the contents of this Newsletter, retain it for future reference, and make relevant sections of it available to other staff members who have dealings with CASA on behalf of practice principals.
The PMO's Column
CASA is revising Section 1 of The DAME Handbook, which deals with most administrative aspects of the duties and responsibilities of DAMEs. It will include advice on several FAQs which often cause problems for DAMEs. If there is any information you would like to see included, advise CASA Aviation Medicine asap so that timely consideration can be given to providing this assistance.
Legal drafting of CASR Part 67 is now well advanced. Its introduction will herald some significant changes to the way DAMEs do business. In the near future, a Summary of Responses to the NPRM on the Part will be published on CASA's website. This will include an updated version of the proposed Regulation and highlight many of the coming changes, which have also been detailed at a number of recent DAME seminars.
And now - a scoop! The following material will appear shortly in AMSANZ's publication AVMEDIA. But you saw it here first! Feedback on the issues raised will be welcomed.
Educational requirements for CASA DAMEs
As a signatory to the Chicago Convention, Australia has accepted the obligation to comply with numerous directives issued by ICAO. Annex I to the Convention on International Civil Aviation: Personnel Licensing is directly relevant to DAMEs as it specifies the following requirements.
- Contracting States shall designate medical examiners, qualified and licensed in the practice of medicine, to conduct medical examinations of fitness of applicants for the issue or renewal of [aviation] licences or ratings.
- Medical examiners shall have had, or shall receive, training in aviation medicine.
In Australia, this long-standing policy was often more observed in spirit than in practice, principally due to a lack of readily available training in aviation medicine. That situation has changed over the last decade with the creation of relevant certificate, diploma and degree courses at Monash, Griffith and Edith Cowan Universities. The combination of ICAO's organizational review of CASA in 1999, increased community and professional expectations for medical practitioners' involvement in continuing educational activities, and a more litigious medical practice environment has led CASA to introduce specific initial and continuation training requirements for DAMEs. Forthcoming changes to legislation (in CASR Part 67) will specify that new applicants for appointment as DAMEs must have undertaken an appropriate course in aviation medicine. The legislation will also provide for 'grandparenting' of existing DAMEs who continue to perform CASA medical assessments satisfactorily.
The following is a non-exhaustive list of appropriate courses whose completion will equip applicants for initial DAME appointment.
- Aviation medicine certificate, diploma or degree courses conducted by Monash, Griffith or Edith Cowan Universities.
- UK or NZ Diploma in Aviation Medicine.
- Master of Aerospace Medicine (Wright Patterson).
- USAF, USN or USA Residency in Aerospace Medicine.
- USAF Primary Course in Aerospace Medicine.
- Australian Defence Force Aviation Medicine Course (provided > 4 weeks duration).
- UK Civil Aviation Authority Aviation Medicine Examiners' Course.
Other courses may also be acceptable - CASA will require full details of individual course content and duration in order to assess them.
CASA's Application form for appointment as a DAME requires an undertaking to attend a relevant update meeting on aviation medicine at least once each two years. While CASA applies this criterion broadly, the number of suitable courses now conducted in Australia means that DAMEs who do not comply with it are unlikely to be reappointed. CASR Part 67 will make this explicit.
However, CASA believes it should encourage aviation medicine best practice and go beyond a minimalist model for DAME recertification. It has yet to determine the most appropriate means of objective validation of DAMEs' maintenance of relevant professional standards, and the task is complicated by the possible unsuitability of a rigid Australian-urban model for remote and overseas practitioners. Eventually, The DAME Handbook will be amended to provide detailed advice of requirements. Meanwhile, DAMEs are invited to consider and comment on the desirability of the following components of a recertification process now under consideration. (Comments to wilkins_ps@casa.gov.au).
- Requirements should apply equally to all DAMEs (subject to availability of suitable distance education tools).
- Costs of participation should be borne by DAMEs, who are expected to pass on costs incurred to their examinees (may not be feasible for some DAMEs who see very small numbers of applicants).
- CASA would develop educational content and participate in DAME training, track compliance, issue certificates and resolve disputes.
- DAME certification should continue (normally) to run for 4 years, with 25% of DAMEs completing recertification each year.
- DAMEs should be encouraged / required to participate in additional
activities drawn from the following list.
- Membership of aviation medical societies such as AMSANZ or AsMA
- Attendance at aviation medical conferences
- Presentation of papers at aviation medicine conferences
- Relevant publication in aviation medicine or associated journals
- Relevant peer-reviewed publications
- Teaching / lecturing in aviation medicine
- Participation in relevant journal clubs / journal reading
- Participation in relevant peer review meetings (either face-to-face or by distance means)
- Maintenance of an acceptably low error rate in performing medical examinations, certification / recertification of applicants
- Performing an individually agreed minimum number of CASA or equivalent medical examinations in each appointment period
CASR Part 67 will explicitly exclude DAOs from the DAMEs' requirements to undertake initial or continuing education in aviation medicine, although CASA will encourage them to do so as a means of increasing their understanding of the aviation environment and the unique stresses encountered there. Rather, DAOs will be required instead to demonstrate regular periodic completion of continuing educational programs of the RACO (or other accrediting professional organizations to which they belong). The rationale for this difference is simple: DAOs do not issue interim CASA medical certificates nor extend the validity of existing certificates - their role is consultant / adviser to CASA and to DAMEs, just like cardiologists, endocrinologists, or neurologists (although needed more regularly and in greater numbers, hence their specific designation by CASA).
Administrative Matters
Poor quality specialist reports
The April 2001 DAME Newsletter highlighted the unacceptably high level of posted, faxed (the biggest offenders) and photocopied specialist reports that are difficult to read on CASA's MRS (Medical Records System). The same Newsletter emphasized that these documents may be needed for presentation in court, and misinterpretation is distinctly possible. It is frustrating and time consuming for CASA's staff to assess medicals accompanied by specialist reports where sections are unreadable. Please ask your staff to take care when copying / sending reports to Aviation Medicine Section.
Stationery orders
Effective 1 June, CASA no longer acknowledges receiving either request for medical forms or stationery order forms. As previously advised, DAMEs and DAOs must order their own stationery directly from the manufacturer / supplier, J S McMillan. DAMEs /DAO s are reminded of the need to inform existing, temporary, or new staff members of correct procedure.
Adhesive tape
It is probably as annoying and time consuming for you as for CASA in dealing with the perforated strip on top of the medical questionnaire forms. There is no need to use adhesive - just tear off the perforated top and paper clip all pages of the medical together for submission to CASA.
Photocopying of medical forms
A small number of DAOs have resorted to photocopying the forms instead of purchasing them from the supplier. Please purchase the forms as the old forms contain a superseded CASA post office address. Photocopying the forms also reduces the size of the paper that in turn does not allow the MRS system to scan all the data boxes.
Medical Records Systems (MRS)
Security & identification - Dr Rod Carter
In response to the suicides/murders by aircraft in the USA on 11 September 2001, CASA has introduced more rigorous security and identification checks. For AvMed, this means a record of the applicant's nationality and the applicant identification on page N7/R6 of the medical questionnaire and examination form ("I, the designated aviation medical examiner, declare that I have sighted an identifying document with photograph or can personally identify the applicant.") are both mandatory. Nationality should be written on the comments section on Page R5/N6 of the examination form. Failure to answer these items will delay certificate issue while the report is returned to the examiner for completion in all cases. A fax or letter from the applicant is not an acceptable substitute for the examiner's attestation.
Handling of correspondence concerning medical certificate holders / applicants will also be unnecessarily delayed unless the applicant's Aviation Reference Number (ARN) is included. Once MRS Online is operational, it will be impossible for CASA Aviation Medicine to deal with applicants until they have an ARN - it will no longer be possible for Aviation medicine to issue these identifiers.
Elenore Karpfen - MRS Online - Project Manager's Update
Status and Schedule
We are now entering into the exciting phase of the project: testing and implementation! We will be testing the new system internally from next week, and will be looking for your help in testing the system towards the end of June. I will be writing to the DAMEs who offered to help with this phase, with more details of this exercise on 11 June.
I would like to thank everyone who has provided feedback on the prototype to date. Your comments have been passed on to the developers and the business area. There is also a new prototype up on the CASA website. This includes a log-in screen, and presents the exam form differently, using tabs for applicant personal details, medical exam questions, licence details and a fourth tab that will be used to display a report view of the exam form, with comments displayed beside the relevant questions.
Demonstrations of the new system
I will be at the following DAME Information sessions, where I will be demonstrating the new system. I will be happy to answer any queries and concerns at these meetings, or if you contact me at karpfen_e@casa.gov.au:
- DAME Aviation Medicine Seminar: Melbourne - 15 June 2002
- AMSANZ NSW Branch seminar: Port Macquarie - 7 July 2002
- DAME Aviation Medicine Seminar: Adelaide - 17 August 2002
- DAME Aviation Medicine Seminar: Perth - 19 October 2002
Reminder to apply for your i-Key
In the last newsletter I provided instructions for applying to the Health e-Signature Authority for an individual healthcare certificate. This will be absolutely vital to enable you to use the new system.
To apply for a certificate you will need to send HeSA:
- a signed copy of the Gatekeeper Individual Healthcare Agreement
- a completed Identification Reference form, including details of the Acceptable Referee (who can be another medical practitioner)
- copies of identification documents adding up to at least 100 points (so that would be one from the primary identification documents group plus one from Group 1 or Group 2 of the secondary identification documents group OR 2 from Group 3 of the secondary identification documents group listed on the Identification Reference form)
These will be processed, and you will receive an I-key and a PIN separately.
You can download the forms from the HeSA web site (http://www.hesa.com.au/apply.htm#a), or I can email them to you if you prefer.
Problems and Suggestions (Steel Magnolias)
Q. Should I test an original applicant's Pg N5, Q17 "distant visual acuity without correction if he / she is wearing contact lenses?
A. Where soft contact lenses are worn, it is necessary to record uncorrected visual acuity only at the initial issue examination and it is not necessary for the lenses to be removed at subsequent examinations.
Where hard contact lenses are worn, it is a requirement at each medical examination for the examinee to remove the lenses and for the visual acuity to be recorded with the examinee wearing spectacles immediately after removal of the lenses.
In this case, the visual acuity (corrected with spectacles) must be at least 6/9 binocularly.
This procedure is necessary because of the hazing associated with some hard lenses due to relative hypoxia of the cornea and related corneal swelling.
(Extracted from DAME Newsletter July 1990)
Q. When is a Fasting Blood Glucose estimation required?
A. Fasting Blood Glucose reports for Class 1 and 3 applicants are required at the same time as Serum Lipids estimations. Examiner's Handbook
Classes 1 and 3 Additional Requirements
The
table below gives the additional tests/examinations that are required at each
renewal examination for applicants for Class 1 and 3 Medical Certificates.
Age Tests/Examinations
25* Audio Serum Lipids and Blood Glucose
30* Audio Serum Lipids and Blood Glucose
35 Audio Serum Lipids and Blood
Glucose
*40* Audio Serum Lipids and Blood Glucose
45* Audio Serum Lipids
and Blood Glucose
50* Audio Serum Lipids and Blood Glucose
55* Audio Serum
Lipids and Blood Glucose
60* Audio Serum Lipids and Blood Glucose
65*
Audio Serum Lipids and Blood Glucose
70* Audio Serum Lipids and Blood Glucose
75* Audio Serum Lipids and Blood Glucose
Q. Do I require an Aviation Reference Number (ARN) to access the MRS prototype induction system and how do I know if I have an ARN?
A. Yes, you most definitely require an ARN for this purpose. If you are uncertain of yours, or unsure whether you have one, email your query to dame.liaison@casa.gov.au
Q. Where do I record the examinee's nationality on the medical form?
A. On all medical forms at this stage in the comments section - an appropriate new field will be incorporated in MRS Online.
Greetings from Netty
Response to "Call up for Australian DAME's/DAO's whom perform Overseas Medicals"
The respondents' details will be published on CASA's WebPages. Thank you to Drs Ivor Davis, Terry English, Heather Parker, Donald King, Greg Chaffey, Allan Hutchinson, Peter Lawson, Graham Maclarn and Geoffrey Graham.
Some overseas-based DAMEs who are approved examiners for other countries have also notified CASA of these appointments. In due course, their details will be published on CASA's WebPages. If you wish to be included and have not already done so, please submit your application with proof of appointment by other Regulator(s). Email dame.liaison@casa.gov.au and note that a copy of your relevant Certificate of Authority to perform these medical examinations (issued by another Regulator) will be required.
Dr Grant Tschirn
A former PAF medical officer, currently an Air Force Reservist, who has 10 years experience in military and civilian aviation medicine, will be relieving intermittently over the next few months to cover absences of Drs David Emonson & Tak Sham. The approachable Dr Tschirn looks forward to discussions of cases with DAMEs / DAOs from all parts of the country and oversea.
Dr James Ross
Dr James Ross, a currently serving PAF officer, who has worked as a locum in AvMed previously, will also be relieving over coming months.
Dr David Emonson
The Deputy Principal Medical officer, has returned to East Timor for 3 months as an Australian Defence Force (ADF) Reservist. He will be in charge of all UN - required aeromedical evacuation missions throughout the period.
Taxation
The following information, derived from an ATO letter of 27 July 1990, is provided once more in response to several requests from DAMEs.
'We refer to your letter of 24 May 1990 about the deductibility of expenses of designated aviation medical examiners in their continued involvement in aviation activities.
To qualify for deduction, it is necessary that the designated aviation medical examiners to be able to establish a positive connection between those expenses and the performance of their duties.
Based on the information provided in your letter, expenses necessarily incurred by the designated aviation medical examiners in the gaining of their assessable income or in their continued involvement in aviation activities would be deductible under the provision of section 51(1) of the income tax assessment act.
We must point out that the Commissioner cannot be bound by rulings given in advance of making an assessment. A proper ruling may only be given on lodgment of the income tax return. The law as then understood is applied to all the relevant facts established at the time'.
(signed)
Deputy
Commissioner of Taxation
Visitors from Thailand
Air Vice Marshal (Dr) Subin Chewprecha, the Director of Thailand's Institute of Aviation Medicine and GPCAPT Kanit Suwannate, Defence/Air Attache from the Royal Thai Embassy, recently visited CASA's Aviation Medicine Section to discuss aviation medical standards and other matters of mutual interest with the Principal Medical Officer.
Reminder - 50th Annual International Congress of Aviation & Space Medicine
Feedback
False statements - Breach of Regulation 283
A person shall not make, either orally or in writing, a statement that is false or misleading in a material particular in or in connection with:
- an application for the grant, issue, renewal or endorsement of a licence, rating, certificate, permit, permission, authority or approval under these Regulations
On a medical received by CASA recently, the applicant answered on the Original Form Pg N2 Section 4, yes to Q 7A, (has the applicant EVER, or is he/she NOW using any of the following substances; opiates, cannabinoid, sedatives ad hypnotics, cocaine, other psychostimulants, hallucinogens or volatile solvents)?
In accordance with medical standards, CASA failed the applicant.
To protect against the applicant simply having another medical examination and answering the question differently, an "Alert " was placed on our Medical Records System (MRS).
Approximately 12 months later, the applicant reapplied, this time answering no to question 7A. Fortunately, the Aviation Medicine Alert System worked as designed and flagged the applicant's medical examination for further scrutiny.
As a result, CASA contemplated prosecution of the applicant for a breach of Regulation 283. An infringement notice issued to him noted the following:
- The alleged offence was an isolated incident in respect to the applicant
- The applicant cooperated with CASA during the investigation
- The subscribed penalty appears adequate under the circumstances
- The alleged offence is not one of real gravity
In view of these determinations, CASA will likely reconsider the applicant for medical certification in future, following the efflux of a minimum of 6 months and subject to the following conditions:
- He undergo a new aviation medical examination
- He supply the results of 6 X urine drug screen tests done at monthly intervals
- The urine samples are produced under the direct supervision of the DAME, who will forward the samples to the testing laboratory
- The results of the testing should be sighted by the DAME, countersigned and forwarded to CASA
This matter is highlighted for DAMEs in case they need to perform a similar medical and follow up and to assure them that CASA has systems available to detect failed applicants who later reapply for medical certification.