Aviation medicals

Designated Aviation Medicine Examiner/Designated Aviation Ophthalmologist
DAME Newsletter
October 2003

Acknowledgement

Distribution

Principal Medical Officer's column

Administrative matters

Medical Records Systems (MRS)

Greetings from Netty and Tara

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 tara.powell@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

The major event affecting all DAMEs, DAOs and DAEEs in 2003 is undoubtedly passage of CASR Part 67 (Medical) into law.

It introduces a number of extremely significant changes in the way we will all do business over coming years. The full text is available.

In summary, the principal changes are:

• Anticipation of full availability of MRS Online. An important corollary, effective immediately, is that 'tear off' Original medical certificates should no longer be issued to applicants.
• Applicants require ARN prior to undertaking first medical assessments - these will no longer be issued by Aviation Medicine Section.
• There are no material changes to DAMEs' recertification and renewal powers.
• DAMEs and DAOs are formally required to apply for appointment / reappointment, and to undertake relevant continuing professional education.
• Applicants will be routinely required (through MRS Online process) to give approval for further information concerning them to be obtained when necessary to assess their fitness for medical certification. DAMEs will complete the relevant forms with applicants, then forward them to CASA.
• Applicants require photo ID for all medical examinations.
• CASA will be permitted to exchange information with other Regulators concerning the performance of individual DAMEs, DAOs and DAEEs, also to obtain details of applicants' medical histories more readily.
• DAMEs' and DAOs' obligations to report the presence of a potentially medically significant in a medical certificate holder or applicant have been clarified.
• DAMEs have increased powers to direct applicants to undergo particular examinations etc, also to direct the practitioner who is to perform them.
• Indemnification has been further extended for reporting an applicant's condition which may adversely affect the safety of air navigation.
• The revised medical standards are set out more clearly and more closely follow ICAO standards.
• After 55 years, the position of CASA's Director of Aviation Medicine has been abolished and replaced by that of Principal Medical Officer. Our office is in the process of changing the signature block.

MRS Online really is coming very soon. Principal advantages for DAMEs, available by early 2004, will be the ability to review applicants' recorded previous history back to 1991, also the availability, in advance, of personalised medical forms (requiring all mandated tests / examinations) for every examinee.

Important legislative changes affecting DAMEs and DAOs

Introduction of CASR Part 67

Previous situation, from 1988
DAMEs had delegated powers

CAR 5.04(2) Issue Original 'tear off' medical certificate
CAR 6.06 Reissue recently expired medical certificate
CAR 6.26 Revalidate medical certificate prior to expiry date

Current situation: CASRs (1998)

• CASR Part 67 signed by the Governor General on August 27 2003
• Anticipates availability of MRS On-line
• Applicant requires ARN before undergoing Original medical
• 'Tear-off' Original medical certification no longer available
• DAMEs now have specified, legislated powers of issue ('reissue') and extension of medical certification period in force
• CASR 67.220 DAMEs may extend period in force of current medical certificate for 2 months, once only
• CASR 67.225 DAMEs may issue 'new' medical certificates, but ONLY for 'renewals', under specified conditions, within 3 months of expiry

Review of the new 'Rules'

• Numerous anomalies removed
• Definitions added - medically significant and safety relevant conditions
• DAOs (& DAEEs - Designated Aviation Eye Examiners) formally recognised
• Provision for non-regular examiners
• Ground rules laid down for DAMEs removal
• DAME Application process delineated
• CASA allowed to require more information from applicants
• CASA allowed to exchange information on applicants with other regulators
• Specific provision for minimum aviation medicine training required for DAMEs (and grand parenting)
• Specific provision for relevant CME requirements for DAMEs
• Specific provision for 'geographic' limitations on DAMEs' appointments
• Specific provision for limited term appointments for DAMEs
• Specific provision for holders of positions/'nonce' appointees to act as DAMEs
• Specific, defined conditions of DAMEs' appointments
• DAMEs' obligations to report safety relevant conditions in medical certificate holders/applicants, within 5 working days [cp. Previous uncertainty per CAR 6.16(2)]
• Extended indemnification for reporting failure to meet required medical standard: 'indemnified act' extended beyond medical practitioners!
• No civil or criminal liability for 'indemnified act' performed in good faith
• Medical standards recited exhaustively ?clearer than previous schedules
• 'Who meets medical standard X' (including provision for transition after failure)
• 'Applicability of medical standard X'
• 'Criteria for medical standard X'
• Power to direct applicant to undergo any relevant test (including non-medical) - also by DAMEs
• Power to direct testing by nominated person - also by DAMEs
• Applicants require photo identification
• Application for medical certificate - no substantive changes
• Refusal of medical certificate - no substantive changes
• Medical certificate may bear conditions [cp. Former requirement for 'special' medical certificate]
• Medical certificate may bear specific conditions re correcting lenses
• Medical certificate period in force - no substantive changes
• Extensions/renewals - no substantive changes [NB no more Original 'tear offs']
• Automatic suspension for pregnancy at 30 weeks gestation
• Extension possible, under defined conditions, for class 3 only
• Applicant may be directed to undergo ANY relevant examination or text, including multiples, AND authorise release of relevant information concerning applicant [cp. Limited previous powers per CAR 6.17]
• No effect on simulator use
• Suspension of medical certificate - no substantive changes
• Special arrangements for suspension in exigent circumstances ?more detailed provisions
• Effect of suspension of medical certificate - no change
• Obligation on medical certificate holder to tell CASA of changes in medical condition class 1 > a week, other > 30 days
• Obligation on medical certificate holder not to exercise privileges if impaired by medical condition and seek DAME clearance > a week (class 1), > 30 days (others)

Transitional Provisions

• All existing medical certificates remain in force, including 'special' medical certificates
• All existing DAMEs' appointments continue until renewal due/resignation etc
• Outstanding applications made per CAR 6 treated as made per CASR 67
• Actions taken by the Director of Aviation Medicine iaw CAR 5 & 6 ? taken to be made by the Principal Medical Officer iaw CASR 67
• After 55 years, position of Director of Aviation Medicine has ceased to exist ?'PMO'

CASA AvMed Statistics 2002

Turn Around Times

Received to dispatched:

• Uncomplicated case 3.4 days.
• Complicated case 22.9 days.
• Major problem is delay in DAME dispatch.

Administrative Matters

Locums under MRS Online

Following the implementation of MRS Online, locums will require an I-Key from the Health eSignature Authority. Please apply for locum approval at least 2 months prior to the dates requested to allow sufficient time for CASA to process your request and for the locum to obtain an I-Key if approved.

AsMA Medical Guidelines for Airline Travel

The Aerospace Medical Association has released its Medical Guidelines for Airline Travel Second Edition, Volume 74, Number 5, Section 2 Supplement May 2003. It is available at: www.asma.org/Publication/medicalguideline.html

Medical examination forms

Medical examination forms received with mismatched serial numbers on the pages are unacceptable and will not be processed by MRS. Incomplete medicals are not acceptable and will not be processed by MRS.

Diabetes Reports

Please submit diabetes reports in the following format:

Name, date of birth, address and Aviation Reference Number

Problem List

Current Therapy

1. Consultant Endocrinologist Report
2. Copy of the applicant's diary of ambulant blood glucose monitoring over the 3 months immediately prior to DAME examination - attached
3. Copy of the applicant's most recent annual ophthalmological assessment
4. Cardiovascular assessment by consultant physician
5. Results of renal function tests

ECGs

Please ensure ECGs are mounted using glue Invisible Tape only, as sticky tape reduces the ability of the scanner to read the text underneath. Our office uses Highland Invisible Tape.

All ECGs must be mounted with the calibration spike included.

Aviation Medicine does not have the resources to mount ECGs. Any ECG performed as part of a medical assessment which is received after 24 October 2003 will be returned to the DAME if it is unmounted or mounted without the calibration spike.

ECGs printed on A4 sheets are acceptable as long as they include tracings and ideally minimum of 3 complexes for each lead and full calibration. The ECG must be labeled with applicant's details (Name, dob and ARN) must be mounted on the back page of the medical form if it is not printed in A4 format. The A4 size constraint is to ensure the reports fit the scanner.

Previous DAME Newsletters have contained reminders of the required procedure, which is also detailed in the DAME Handbook.

Obviously, the need to return ECGs to your office delays the processing of an aircrew medical examination and may disadvantage the examinee.

V Forms (Eye Examination Forms)

Please ensure the applicants Aviation Reference Number is filled in.

All Medical Forms

CASA anticipates that it will no longer have the ability to process paper based medical forms from a date 3 months after the full implementation of MRS Online.

Please retain a copy of aviation medical examination forms and submit the forms as soon as possible in accordance with the Conditions of Appointment. If medical certification is required urgently please send the form in by Express Post or Registered Post.

Quality Survey

CASA will shortly conduct a survey of randomly selected applicants in regard to quality and customer satisfaction levels arising from their dealings with CASA and with examiners.

DAME Handbook

A complete revision of the DAME Handbook has been undertaken. It should be available from the CASA website within a month or so of release of this Newsletter.

DAME Qualifications

The number of DAMEs and DAOs who hold formal qualifications in aviation medicine are as follows:

• 56% of DAMEs in Australia
• 44% of DAMEs overseas
• 53% of all DAMEs
• 6.3% of all DAOs

Stationery Orders

CASA no longer provides stationery, which is available from J S McMillan using the order form available on the CASA website.

Please order forms in advance, as it may take a few days for orders to be processed and dispatched.

MRS Online - Project Manager's Update

Status and Schedule

Our schedule has been held up again, as we address some application issues. I am happy to report that we are now satisfied with the way the system will work for DAMEs, but we still have some work to do on how the system works for the CASA staff. I continue to be hopeful that the Pilot will commence in October 2003, so please proceed with your applications for the HeSA i-Key if you do not already have this.

Kind regards
Elenore Karpfen
MRS Project Manager

Greetings from Netty and Tara

Welcome to the October 2003 Newsletter.

Tara

I have travelled to Perth since the June newsletter and spoken to some of our WA DAMEs. It is a pleasure to put faces to the names and to answer queries face-to-face. I will also be travelling to the AMSANZ NSW Annual Dinner and Meeting in November with Dr David Emonson.

Netty

Some DAMEs and DAOs feel undermined by the rehashing of some issues by Aviation Medicine staff. We appreciate the professionalism of the DAMEs and DAOs, however there are a small number who require a reminder of our procedures.

RFDS staff would be aware there was a National Meeting on September 18 and 19 in Brisbane. Unfortunately no CASA representative was available to attend.

As a signatory to the Chicago Convention, Australia is obliged to comply with numerous directives that have been issued by the International Civil Aviation Organisation. Pending changes to legislation will require all applicants for appointment as a DAME to have completed an aviation medicine course. The legislation will provide for 'grand parenting' of some existing DAMEs who continue to perform CASA medical examinations satisfactorily.

Acceptable aviation medicine courses include:

Post Graduate Certificate in Aviation Medicine

Edith Cowan University, Centre for Post Graduate Medicine
Joondalup Campus, 100 Joondalup Drive, Joondalup WA 6027
Contact Ms Mignon Johnson mignon.johnson@ecu.edu.au
Telephone (08) 9273 8528
Facsimile (08) 9400 5449
postgradmed.ecu.ecu.au/courses/index.html

Aerospace Medicine, Griffith University - available online

Contact Ms Debbie Slater d.slater@griffith.edu.au
Telephone (07) 3875 5097
Facsimile (07) 3875 5204
www.griffith.edu.au/school/avn/content01/html

Australian Certificate of Civil Aviation Medicine (ACCAM)

Department of Epidemiology and Preventative Medicine, Monash Medical School
Alfred Hospital, Prahran VIC 3181
Contact Ms Carolyn Barrie Carolyn.barrie@med.monash.edu.au
Telephone (03) 9903 0588
Facsimile (03) 9903 0556
www.med.monash.edu.au/epidemiology/teaching.htm
At this stage, there is not an on-line course available.
The next course will be held November 24 to December 5 2003.

In preparation for the pending legislation our office has been reviewing the need for additional locums, as a result some applications for locum approval have been rejected. CASA has had an excellent relationship with the RFDS and will endeavour to work through the changes to the legislation together.

Please advise us of any change to your email or postal address by sending an email to tara.powell@casa.gov.au for ACT, NSW, VIC and overseas or jeanette.glasson@casa.gov.au for NT, WA, QLD, TAS and RFDS.

DAMEs and DAOs - new and resigned

Dr Douglas Walker of Narrabeen, NSW, and Dr John Apel of Brisbane, QLD, have retired after 33 years as DAME and DAO respectively. Dr Michael Rose of Griffith, NSW, a DAO, has resigned. Dr Melinda Truesdale of Wantirna, VIC, Dr Michael Guilfoyle of Caloundra, QLD, Dr Richard Buzacott of Cleveland, QLD, and Dr Walter Dietz of Mount Sheridan, QLD, have retired. Dr James Buchan of Salt Spring Island, Canada died on 1 July. CASA acknowledges their contributions over many years.

Dr Richard Dunning of Dhahran, Saudi Arabia, has been appointed as a DAME.
Dr Simon Slattery of Turks and Caicos Islands has been appointed as a DAME.
Dr Jean-Luc Bador has been appointed as a DAME in Port Vila, Vanuatu.
Dr Albert Liebenberg of Deniliquin, NSW, has been appointed as a DAME.
Dr Greg Horowitz of Maroubra, NSW, has been appointed as a DAO.
Dr Colin Worner of Muswellbrook, NSW, has been appointed as a DAO.
Dr Graham Pittar of Sydney, NSW, has been appointed as a DAO.
Dr Con Petsoglou has been appointed as a DAO in Bowral, NSW.
Dr Margaret Shannon has been appointed as a DAME in Norwood, SA.
Dr Anne Gridley has been appointed as a DAME in Mount Helen, VIC.
Dr Lawrence O'Halloran has been appointed as a DAME in Sunbury, VIC.
Dr Peter Wolf of Balwyn, VIC, has been appointed as a DAME.
Dr Joseph San Laureano has been appointed as a DAO in Richmond, VIC.
Dr John Elder has moved from Bondi Junction to Darlinghurst, NSW as a DAO.
Dr Mark Loeffler of Robinvale, VIC, has moved to WA and is now working at Jandakot Royal Flying Doctor Service.
Dr Johannes Giefing has moved from Broome, WA, to Evandale, TAS.

Dr Heather Parker of Buderim, QLD, is authorised to conduct medicals for the CAA South Africa.

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 tara.powell@casa.gov.au.