Designated
Aviation Medicine Examiner/Designated Aviation Ophthalmologist
DAME
Newsletter
March 2003
Performing Aviation
Medicals
Revalidating Medical Certificates
Stress
ECGs
Locum approval
Pregnancy and
Medical Fitness
Minors presenting for Class 1 Aviation
Medicals
Photographic identification required
Stationery
Orders
Aviation Medicine Unit takes flight at Monash
ARN
Needed for Medicals
MRS Online - Project Manager's Update
Status and Schedule
Testing the system
Demonstrations of the new system
Greetings
from Tara and Netty
DAMEs and DAOs - new and resigned
DAME
and DAO Applications
Acknowledgement
DAMEs/DAOs should confirm receipt of this Newsletter, noting their DAME stamp number, per return email to powell_t@casa.gov.au. Alternatively, please fax confirmation of its receipt to CASA AvMed on (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.
PMO's Column
Most DAMEs approach their CASA-related duties responsibly and "keep their eyes on the ball" when performing related assessments. Consequently, it is disappointing when some DAMEs (even experienced DAMEs) act without apparent thought for the possible aeromedical consequences. I have recently had occasion to admonish a number of DAMEs who have noted the presence of significant medical problems in examinees, then answered Part 6 questions on the examination and report forms 'NO' for further tests / reports / assessments required, 'NO' for concerns re safe exercise of privileges, and - astonishingly - 'YES' for issue of temporary certificates or revalidation of existing certificates. Sir Humphrey Appleby surely would have regarded all such actions as 'courageous'. The gravity of the situation is compounded when DAMEs who are also applicants' GPs fail to inform CASA of the presence of aeromedically significant conditions in applicants or licence holders.
In applying for (re-)appointment, DAMEs undertook to familiarise themselves with CASA's requirements and procedures. CAR 6.16 (2) imposes an obligation for DAMEs to inform CASA as soon as practicable when they become aware of applicants' / holders' potentially significant medical conditions. The DAME Handbook provides guidance on management of cases which do not clearly meet required medical standards - see Section 1.3.5.
More significantly, failure by a DAME to observe the terms of his / her appointment may lead to the cancellation of that appointment. The forthcoming enactment of CASR part 67 and the roll-out of MRS Online will do much to relieve existing problems, but these technological advances cannot replace the need for "switched on" DAMEs who exercise good clinical and aeromedical judgements.
As announced elsewhere in this Newsletter, a new Urology and Nephrology Section for the DAME Handbook has recently been released. Most of this document has now been reviewed and updated, except for Sections on Ophthalmology, GIT Disease and Gynaecology, which will shortly receive attention. CASA welcomes feedback on all sections and DOES make amendments in response to difficulties experienced by examiners. Proclamation of CASR Part 67 will require a complete re-write of Section 1 of the Handbook in coming months, and availability of MRS Online will also require redrafting of the advice contained in some Sections.
Administrative Matters
'Letter from a DAO'
Readers may be interested in the following exchange.
Dear Peter,
I recently
saw a lad doing Year 12, who wants to become an ATC, like his father, however,
he has the familial colour blindness and fails the Farnsworth Lantern Test miserably
(11 mistakes out of 18). His father, who is an ATC himself, tells me that there
are two streams as an ATC, either you work in towers under airport services or
you work with radar under air traffic management. He does not believe that you
need good colour vision to work with the radar. If that is the case, shouldn't
there be two streams of employment, such that those who have colour defects can
work with the radar? Perhaps I am being a bit simplistic, or his father rather
wishful. I gather that there is no risk of people being moved from one stream
to the other because it requires quite different credentialing.
I would be most grateful if you could let me know the real situation as to whether or not there would be possibility for employment of colour defective ATCs.
Many thanks.
Dear Doctor X
I am replying to your letter concerning
possible relaxation of the required colour perception standard for class 3 medical
certificate applicants, putatively justified on the basis of different requirements
for two different streams of ATC.
Firstly, you will wish to know that CASA is rather proposing to increase the colour perception standard for ATC work (so as to require a pass on Ishihara for all applicants) in the near future, once CASR Part 67 (and its associated / revised medical standards) has been enacted later this year. This came about because of requirements notified by Airservices Australia.
However, prompted by your letter, I sought expert advice on the matter you raised from the Licensing Standards Manager at Airservices Australia. Relevant parts of his response, and associated comments, are set out below.
At present, Airservices Australia is considering "dropping" stream training and giving all ab initio controllers training in all three streams. Certainly there are numerous examples of cross stream training occurring. Ever since stream training was introduced in 1992 (or shortly thereafter) there have been many examples of tower trained controllers moving either to approach or to en-route. There are also examples of en-route controllers moving to approach or tower. I am less certain about movement from approach to either of the other two streams but there certainly is no impediment to a controller submitting an application to do just that. Naturally, this poses a training impost on us, but sometimes this is judged as "worth it" rather than wait the long lead time to obtain a new ab initio controller trained in the stream where the shortage exists. Sometimes we also facilitate such cross stream training on compassionate grounds.
To have controllers in the system who have a medical impediment which would preclude them from moving to another stream would introduce another complication that Airservices Australia's operational management has determined it would rather avoid. Accordingly, Airservices Australia is seeking to employ as ATC only individuals who meet the Class 3 medical standard.
The duties and performance of an applicant for class 3 medical certification as an air traffic controller is very much related to the ability to differentiate and identify colours correctly and quickly. This is not something that has ever been tested - because as previously stated - Airservices Australia has no validated test to do so.
Even under existing circumstances, the stream into which a class 3 applicant might be trained if he/she were accepted for training as an air traffic controller is not clear. This would depend on Airservices Australia's need at the time. Because of the fairly frequent incidence of cross-stream training, Airservices Australia would not be prepared to accept an individual who could work in only one stream. Even in the tower stream, it is unlikely that an applicant could work in those towers that have TAAATS (ie the radar capital city towers). As previously stated, Airservices Australia also expects to expand the Tower Situation Displays to other towers over a period. These are already installed in 5 towers. The others will follow in due course - potentially causing further complications for the deployment of a colour deficient controller.
CASA, as the Regulator, must (as Airservices Australia must, as the service provider) be satisfied that an applicant will be able to do the job without compromising safety. CASA therefore cannot move away from requiring an applicant unable to pass Ishihara, instead to pass a validated practical test that simulates all of the potential operating environments into which he/she may be thrust - and no such practical test has been developed or validated. A special medical certificate which limited him/her to a particular stream (or indeed, a particular part of a stream) is not an outcome that would suit Airservices Australia.
In coming years, Air Services intends to upgrade both the colour palette and the screen technology. For a colour perception normal person, there is no question about the ability to perceive colours. But a colour perception deficient individual must "prove" to the Regulator that his/her particular colour deficiency will not compromise safety, and must do so in the context of the equipment he/she will be using.
I believe that this specialist advice adequately refutes the proposition put to you by the father of your recent examinee.
Medical Forms
Please do not retain aviation medical examination and report forms until you have multiple forms to send to the Office of Aviation Medicine as this inconveniences applicants and reduces the time available for applicant revalidatation, as well as unnecessarily putting AvMed staff under greater time pressure to turn the medical certificate around within the available "window".
Please complete employer details on the medical forms where appropriate (ie for class 1 applicants). If the applicant is not currently employed, please write Not Applicable or make a note at the end of the medical form.
Please include the applicants' residential and postal address and daytime contact numbers on R1 and N1. If the postal address is the same as the residential address please write As Above.
Please note PO Box addresses are not acceptable as a residential address, the system requires the applicants' street address.
DAME Handbook update
Section 2.2 Cardiology, 2.4.1 Endocrinology, 2.6.1 and 2.6.10 Psychiatry of the DAME Handbook have been updated. Chapter 2.7 'Nephrology and Genitourinary' has been replaced by 'Nephrology and Urology'. The revised DAME Handbook can be viewed at http://www.casa.gov.au/manuals/regulate/dame/index.htm. Please ensure that you and your staff read it, and keep a copy on hand for future reference to ensure we are all 'singing from the same hymn sheet'.
Performing Aviation Medicals
Applicants can have their medical examinations performed within 28 days of the medical anniversary date without the anniversary date being changed. CAR 6.14 refers.
Revalidating Medical Certificates
Please ensure you do not revalidate a medical certificate if you are unsure whether the applicant is fit to fly. In such a case, submit the medical form to CASA and leave the decision to CASA staff. Also see advice at Section 1.3.5 of the DAME Handbook.
Stress ECGs
A stress ECG is required when an applicant for class 1 or 3 medical certification has 15 points or more on the Coronary Heart Disease Risk Factor Prediction Chart. (Note that this chart was recently revised and updated to eliminate former numerical discontinuities).
Locum approval
Locums must have completed an aviation medicine training course acceptable to CASA. A request for locum approval must be submitted by the DAME prior to the dates the locum is requested for, to allow time for CASA to process and respond to the request.
Pregnancy and Medical Fitness
(Relevant text from Draft CASR Part 67. By agreement with Air Services Australia, CASA is already applying these principles).
67.235 Suspension of medical certificates - pregnancy
-
A medical certificate held by a pregnant woman who holds, or is an applicant for,
a licence is taken to be suspended:
- during the period beginning immediately after the end of the 30th week of gestation and ending when a DAME certifies that she is fully recovered following delivery or the termination of the pregnancy; or
- if in a particular case CASA directs in writing that a different period should apply - during the period so directed by CASA; or
- if, before the start of the period mentioned in paragraph (a), the pregnancy ends in miscarriage or premature labour, or is terminated by medical intervention - from the time of the miscarriage, premature labour or intervention until a DAME certifies that the woman is fully recovered.
Note This regulation
does not preclude a pilot who is pregnant from undertaking or receiving instruction
in a flight simulator at any stage of the pilot's pregnancy. - Despite subregulation
(1), a pregnant woman who holds an air traffic controller licence may continue
to exercise the privileges of the licence until the end of the 38th week of gestation
if:
- the medical practitioner who is attending the woman certifies her continued medical fitness to do so each week beginning at the 31st week of gestation; and
- a DAME certifies the woman's continuing fitness to do so each week beginning at the 31st week of gestation; and
- another person who holds an air traffic controller licence, and is medically fit and able to take over responsibility for the function, is on duty and available at the times when she does so.
Minors presenting for Class 1 Aviation Medicals
A minor presenting for Class 1 aviation medical examination are legally competent to sign the declaration as long as he/she understands the nature and consequences of the declaration. If more information is required, the DAME can request the information be obtained by the applicant, or the applicant can consent to the DAME obtaining the information.
Photographic identification required
Whenever attending a DAME or DAO for an examination or an assessment which CASA requires for medical certification, applicants must take current photographic identification as evidence of their identity. A passport, driver's licence, school or university identification card, military identification card or similar document is acceptable for this purpose. A DAME or DAO may not complete a CASA medical examination or other required assessment without certifying on the examination/report form that current photographic identification of the applicant has been sighted. Forthcoming changes to relevant legislation will reflect this requirement.
In anticipation of rare cases where an applicant does not have an acceptable, current photographic identification document, the applicant or examiner should contact CASA Aviation Medicine Section to determine an alternative means of establishing the applicant's identity.
Aviation Medicine Unit takes flight at Monash
An aviation medicine unit which will improve training for medical practitioners wishing to become DAMEs has been established at Monash University by Flight Medicine Systems Pty Ltd (FMS) and the university's Epidemiology and Preventive Medicine Department.
FMS and Monash University have been involved in aviation medicine training for several years and signed an agreement jointly to establish and develop an Aviation Medicine Unit within the university's Department of Epidemiology and Preventive Medicine.
For the past 12 years Monash University has offered a two week course to medical practitioners wishing to become DAMEs. The Australian Certificate of Civil Aviation Medicine (ACCAM) course is held twice a year and attracts students from all over the world.
Since 2001, FMS has conducted an annual series of aviation medicine seminars for DAMEs around Australia. These seminars are approved by CASA for the purposes of the continuing medical education and professional development of its DAMEs, as well as by the Royal Australian College of General Practitioners and the Australasian Faculty of Occupational Medicine.
The agreement will see the aviation medicine training activities of Monash and FMS combined into a single enterprise.
Professor John McNeil, Head of the Department of Epidemiology and Preventive Medicine, said the establishment of the unit confirmed Monash's position as the leading aviation medicine organisation in the Australasian region. "The real attraction of this agreement is that the Aviation Medicine Unit is able to offer 'cradle-to-grave' training for medical practitioners in aviation medicine," Professor McNeil said. "The internationally-renowned ACCAM course will be perfectly supplemented by these ongoing refresher seminars."
ARN Needed for Medicals
The new online medical records system (MRS) to be introduced in the next few months relies on a person presenting for a medical examination to have an ARN (Aviation Reference Number) issued by CASA before the medical.
To facilitate the transition to the new system and to allow CASA to accurately identify all license holders (additional to that required for a medical), CASA would encourage you to ensure that an ARN is held before conducting the examination. This could be ascertained at the time a booking is made for the medical.
Once the new system is online, it will not allow you to conduct/enter medical details without the person having an ARN.
An ARN Application (form 1162) can be downloaded from the CASA website and the completed form with supporting documents submitted to the nearest CASA office.
MRS Online - Project Manager's Update
Status and Schedule
The gestation for MRS Online has been lengthier and more complicated than anyone could have predicted. However the system has been undergoing testing for the last 4 months, and we are finally happy with it. CASA will make it available for you to test in the week beginning 31 March 2003. Once it is available, I will send out details of how to access the system, and some valid ARN/Date of Birth combinations that you can use to test the system. Remember that you must have installed the HeSA i-Key in order to log onto and test MRS Online.
If the Test is successful, we expect to pilot the system in late April/early May 2003, and I would like to hear from DAMEs interested in participating in the Pilot testing.
After three months in Pilot, we will evaluate how the system is operating, with a view to phasing out paper-based medical examinations from August/September this year.
Testing the system
While you are welcome to test the system in any way you wish, I will send out some test instructions that take you through a set of tasks, and invite your thoughts and feedback on a range of issues, such as:
- the process of installing the application on your computer
- ease of navigating within the system
- functional aspects of the system
- appearance, style, look, and feel of the system
- clarity of content, headings, vocabulary.
This feedback will help us judge the readiness of the system for use in Production. As I have indicated above, if we get the all clear, we will look to start the Pilot in May 2003, so your input is important.
Here are a few things to keep in mind as you work through the review:
- Be honest in your responses. I didn't build the system you are evaluating, so you won't hurt my feelings with any criticism. On that subject, it won't be absolutely perfect when you get it, and I will include a list of known problems that we are currently working to overcome. I expect that you will also find other issues that we have missed. One of the reasons for this test is to get fresh eyes to provide feedback.
- Think about how you will use the system to conduct real-life
aviation medical examinations, and provide feedback on any areas of concern. We
have purposely tried to build a flexible system, so there are a number of options
available to you. For example:
- you could request the tailored medical exam forms at the start of the week for all aviation medicals scheduled for that week, or you could do this at the start of each day, or you could do this just before the appointment is scheduled. The latter would be the riskiest approach since you may be affected by temporary access failures
- you could complete the examination form by entering information directly into the electronic form as the check-up proceeds, or you could print out the form and write the information down on the paper version, entering it on the system later. Again, the latter is riskier since you may miss a request for further information
- on completion, you can submit the medical form with the patient still in your rooms, and advise him / her immediately of the outcome, or you could submit the medical form at a later time and invite the patient to contact your office at an appropriate time for the outcome. With this option, you do not need to have an internet connection in your examination rooms.
Demonstrations of the new system
I will attend all of the Monash DAME seminars this year, as well as AMSANZ meetings in NSW and WA, to give an update on the project and answer any questions. I hope to meet many of you at these forums. I will have the most up-to-date version of the system with me, so anyone who has not yet been able to view and use the system will be welcome to do so then.
kind regards
Elenore Karpfen
MRS Project Manager
Greetings from Tara and Netty
Welcome to the March 2003 Newsletter. We hope you had a good Christmas break.
Netty has changed her name from Jeanette Coan to Jeanette (Netty) Glasson.
Netty will be looking after DAMEs and DAOs in NT, WA, SA, TAS, QLD and the Royal Flying Doctor Service. I will be looking after DAMEs and DAOs in ACT, NSW, VIC, overseas and at Defence bases.
It would be appreciated if all new staff members of the Royal Flying Doctor Service that want to perform aviation medicals request an application form from Netty. The Director of Aviation Medicine will then decide if the applicant is qualified and if there is a requirement for another DAME at the base.
Also would staff members please notify Netty of your movements between bases and when you will be on leave so that the DAME database can be kept up to date.
Please advise us of any change to your email or postal address by sending an email to powell_t@casa.gov.au or glasson_j@casa.gov.au.
DAMEs and DAOs - new and resigned
Dr Frank Tighe died recently. Dr Malcolm Le May of West Perth, WA, and Dr William Donaldson, of Scotland, have retired. Dr Christopher Rose of Carine, WA, Dr David Robson of Bermagui, NSW, Dr Wayne Meiklejohn of Sunnybank Hills, QLD, Dr David Moran of Port Macquarie, NSW, and Dr Ralph Chapman of Katanning, WA, Dr Paul Spicer of New Island Province, Papua New Guinea, and Dr Richard Blaxill, of Port Macquarie, NSW, have all resigned. CASA acknowledges their contributions over many years, noting that Dr Cox was first appointed in 1968.
Dr David Stewart of Bacchus Marsh, VIC, Dr Allan Kerr of Coonabarabran, NSW, and Dr Philip Furey have retired after 30 or more years as DAMEs. Dr Charles Roe of Yeronga, QLD, has retired after 57 years as a DAME. We thank them all for their long service to CASA and its antecedents.
Dr
Shane Wiley has been appointed as a DAME in Fairfield Heights, NSW.
Dr Timothy
Rankin has been appointed a DAME in Bargo, NSW.
Dr Edward Price has moved from
North Sydney to Parramatta, NSW.
Dr Colin Massie has been appointed as a DAME
in Wamberal, NSW.
Dr Andrew Pearce has been appointed as a DAME in North Terrace,
SA.
Dr David Fitzgerald has been appointed as a DAME in Hobart, TAS.
Dr
Ross Peterkin has been appointed as a part time DAME at Alice Springs, NT.
Dr
Joseph Benjamin of Leeds, United Kingdom, has been appointed as a DAME.
Dr
Aparna Hegde of Dubai, United Arab Emirates, has been appointed as a DAME.
Dr
Kenneth Ingham of Grand Central Airport, South Africa, has been appointed as a
DAME.
Dr Airell Hodgkinson has been appointed as a DAME in Karratha, WA.
Dr
Stuart Lynch has been appointed as a DAME in Mundingburra, QLD.
Dr Brennan
O'Dempsey has moved from Mount Isa to Townsville, QLD.
Dr Richard Buzacott
has moved from Alexandra Hills to Cleveland, QLD.
Dr Donald Ramsey has moved
from Cairns to Weipa, QLD.
Dr Walter Dietz has been appointed as a DAME at
Mount Sheridan, QLD.
Dr Erold Lanham has been appointed as a DAME at Imbil,
QLD.
Dr Michael O'Gorman has been appointed as a DAME in Tullamarine, VIC.
Dr
Paul Handley has been appointed as a DAME in Toorak, VIC.
Dr Nicholas Bare
has been appointed a DAME in Mulgrave, VIC.
DAME and DAO Applications
There is a shortage of DAMEs and DAOs in several parts of Australia. If you know of a doctor or ophthalmologist who is interested in performing aviation medical examinations, and is prepared to meet CASA's training and other requirements for appointment, please refer any such practitioners to CASA Av Med on (02) 6217 1642 or powell_t@casa.gov.au.