DAME Newsletter - December 1999
Contents
Acknowledgment
CASA AvMed E-mail contact
Distribution
New Medical Records System (Nu-MRS) developments
Aviation Reference Numbers (ARN)
Interpretation of Question 7 A
Update
Omissions from Medical Forms and other No-Nos
Correspondence to Director of Aviation Medicine
(and other staff)
Feedback
Acknowledgment
DAMEs / DAOs should confirm receipt of this Newsletter per return email to urban_ma@casa.gov.au Alternatively, please fax confirmation of its receipt to CASA AvMed at (02) 6217 1637.
CASA AvMed E-mail contact
Some DAMEs have begun forwarding scanned medical reports
and other documents to CASA per e-mail. Their pioneering spirit is welcomed.
When transmitting such materials by e-mail, please ensure that the applicant's
ARN and the DAME's stamp appear on each scanned sheet and note that the only
correct e-mail address for general materials of this type is
avmed@casa.gov.au
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 staff members who have dealings with CASA on behalf of practice principals.
New Medical Records System (Nu-MRS) developments
Migration of stored data from the existing MRS should be complete by the time DAMEs / DAOs receive this Newsletter. Inevitably, user testing continues to uncover unforeseen glitches and other problems with the new system, but generally the Nu-MRS appears robust and well suited to its intended tasks. Funding has been allocated for its improvement in the next financial year and thereafter, so AvMed anticipates that any initial defects will be corrected / eliminated soon after they are detected. Legal cover for the extension of the system's full interactive benefits to DAMEs / DAOs has been obtained and work on this "phase 2" aspect of Nu-MRS should begin as soon as the initial system is fully operational.
Aviation Reference Numbers (ARN)
Despite a number of requests from AvMed, there is still not available any simple means for DAMEs / DAOs who do not already have an ARN to obtain one. At this stage, it is still possible to obtain an ARN by mailing or faxing a written request on your letterhead to Ms Margaret Urban, DAME Liaison Officer.
At this stage, it is still possible for medical examination and report forms to be lodged for applicants who do not possess an ARN and for AvMed to arrange for allocation of an Aviation Reference Number to these applicants. DAMEs will be notified well in advance of the introduction of the mandatory requirement for ARNs, which will take effect once all medical forms are lodged electronically.
Interpretation of Question 7 A
Many DAMEs appear to misunderstand the import of Question 7 A in the current versions of the O and R forms. It was introduced late in 1998 to bring CASA into line with a requirement of the International Civil Aviation Organization to elicit from applicants any history of problematic use of a number of psychoactive substances. (Interestingly, both tobacco and ethanol were excluded from the list). Neither CASA nor ICAO is concerned with appropriate, medically supervised short term use of hypnotics such as temazepam. Where the only relevant history obtained from an applicant is of occasional, appropriate use of medically prescribed temazepam, the 'NO' box against this item should be completed.
Where an applicant gives a history of marijuana use / experimentation, the DAME should obtain a urine sample from the applicant at the time of the examination and submit it for drug screening by an appropriate pathology laboratory. Metabolites of cannabis remain detectable in urine for up to 28 days following last use, so this testing provides a sensitive test of the applicant's likely continuing use of cannabis. CASA is happy for DAMEs to exercise clinical judgement and not require urine testing in the cases of applicants who give a convincing history of earlier experimentation with cannabis, on one or two occasions only, some years previously. However, the general approach should be immediate urine testing for applicants who make positive responses to question 7 A. When in doubt - TEST!
Updates
Note that the CASA website contains an index of contents for this Newsletter and for those of August 1999 and of October 1999. This feature should assist DAMEs / DAOs to locate specific notes / other information more readily henceforth.
A revised proposal for extension of additional delegations to DAMEs has been prepared and is awaiting approval by the CASA Executive. These additional delegations are necessary in order for CASA, DAMEs / DAOs and applicants all to obtain the greatest benefit available from investment in the Nu-MRS.
A revision of the DAME Handbook is under way, intended to align CASA's procedures with ICAO Standards and Recommended Practices wherever appropriate. This should be completed before the end of December. A supplementary DAME Newsletter will then be produced, highlighting changes to requirements or procedures for future medical examinations etc.
New CASA medical certificates will be introduced this month. Per ICAO Standards, the new certificates contain a field for the holder's nationality. CASA has not previously sought information concerning this, but will do so hereafter in order to comply with ICAO's requirements. The new electronic form will require DAMEs to make an appropriate entry, but until it is deployed, DAMEs are requested to enter each applicant's nationality in the 'Comments' section of the existing examination forms.
As mentioned in the October 1999 Newsletter, AvMed wishes to hear from any DAMEs who have applicants with insulin dependent diabetes mellitus and who wish to undergo an in-flight assessment of their condition per the test protocol developed by Drs Chris Jambor and Hal Leaver.
Omissions from Medical Forms and other No-Nos
The interactive Nu-MRS will not permit lodgement of incomplete medical examinations. Meanwhile, pending its deployment, DAMEs should continue to pay close attention to frequently overlooked boxes on the existing O and R forms. It is frustrating for DAMEs to have forms returned because a BP reading has been omitted, or the 'positive identification of applicant' box has not been checked. These simple mistakes also result in much avoidable clerical work for CASA staff and ensuing delays in issue of medical certificates to applicants.
Regrettably, AvMed has recently had to contact a number of DAMEs because of unconscionably long delays between completing medical examinations and their dispatch to CASA. This is a perennial problem for some DAMEs, which has the potential seriously to disadvantage applicants. In one case, a medical was performed in early August but not received by AvMed until late October. Only with difficulty were the applicant and his CFI placated: there was talk of initiating legal proceedings against the tardy DAME for additional costs incurred by the applicant, also a request that the DAME's delegation should be removed. DAMEs should recall that a condition of appointment is their agreement to lodge completed medicals in a timely fashion. Other things being equal, AvMed believes that completed medical examination forms should be received by CASA no later than two weeks after the dates of examinations.
Correspondence to Director of Aviation Medicine (and other staff)
Much routine correspondence received by AvMed is addressed to the Director of Aviation Medicine, sometimes by name. AvMed's routine office procedures are such that mail received here - several hundred items per day - is opened in bulk and directed for action to wherever the clerical officer on the mail desk that day believes it should go. Consequently, DAMEs and other correspondents are sometimes annoyed when I have not personally seen or dealt with some item addressed to me. Similarly, I have several times been embarrassed by the system's failure to direct to me material which I wished to deal with personally.
To overcome this problem, DAMEs / DAOs who wish a matter to be dealt with personally by the Director or other particular member of staff should mark their correspondence 'FOR PERSONAL ATTENTION OF [NAME]', 'TO BE OPENED ONLY BY [NAME]', or some such formula.
Feedback
AvMed has been pleased to receive a considerable number of constructive suggestions arising from the last few Newsletters. Some have already been implemented and others are under consideration or delayed pending the full deployment of Nu-MRS. As always, suggestions and comments are welcome.
On behalf of all the staff at CASA Aviation Medicine, I wish DAMEs, DAOs, their staffs and families the compliments of the coming festive season.
Peter Wilkins
Acting Director, Aviation Medicine