DAME newsletter - September 2017
From Principal Medical Officer, Dr Michael Drane
I’d like to start with a big thank you to the organisers of this year’s AMSNZ and ASAM conference for an interesting and well-run annual meeting. The conference was held in Queenstown, New Zealand, from 31 August to 3 September and featured a great mix of visiting speakers and presenters from within the societies. More opportunities for professional development and networking are coming up, with the NSW ASAM meeting to be hosted in Canberra on 25 November. We are particularly fortunate to be guests of the Australian Transport Safety Bureau, and able to visit the exhibits too.
On a separate note, sickness has had a significant impact on our staffing levels this year. There are not many of us on deck and we have been missing some people for a while. Thank you all for your patience – and work as a DAME – in sometimes tricky circumstances. We greatly appreciate your ongoing support and efforts.
Dr Sanjiv Sharma provided a review of the results of sleep apnoea screening at the International Academy of Aviation and Space Medicine meeting in Rome in mid-September. The results showed 88 per cent of applicants triaged and referred for sleep studies had obstructive sleep apnoea (OSA). This is a strikingly high figure. The triage questionnaire is certainly identifying those at risk of reduced alertness and other important sequelae. As far as treatment is concerned, CPAP is often prescribed. We need to know that people are using it, and that it is effective when they do, hence the need for follow-up reports.
We know that some pilots have bariatric surgery to assist with weight management, but what happens to OSA post-surgery? A recent study demonstrated that 20 per cent of patients had persistent, moderate or severe OSA 12 months following surgery, leading to the recommendation to repeat the sleep study to identify those who needed ongoing treatment [Peromaa-Haavisto P 2017].
Reporting safety-relevant problems
We have seen a number of medicals recently where important and safety-relevant medical problems that have been disclosed to a DAME have not been fully recorded and added to the medical problem list in the Medical Records System (MRS). This obviously raises a range of safety and ethical issues.
When you are completing a medical for a pilot or air traffic controller please ensure the problem list accurately reflects the applicant’s history. The DAME doing the medical next time will also love you for this!
On the subject of MRS, development continues and we are looking at making some minor and major enhancements next year. Please keep your suggestions coming as we do look at these when we are refining the system. We’ll be on the lookout for some assistance in honing the next upgrade, so be warned - we’ll want your feedback.
If you tick that an ECG has been read by a cardiologist, please ensure you attach the trace and the report to the record in MRS. This will help prevent unnecessary delays in issuing an applicant’s aviation medical certificate. You also need to attach the report if you conduct a stress ECG/echo. Having the trace is particularly important for equivocal results, as it allows for comparison against later reports. This has proven invaluable in difficult cases.
Please also note that you should not tick ‘read by cardiologist’ if the ECG is machine-read.
Long PR interval in ECG
If an applicant has a long PR interval, please repeat the ECG with the applicant having a slightly faster heart rate.
Cardiac risk score indicator update in June release of MRS
In the June MRS release we included a prominent display of the calculated Cardiac Risk Score (CRI) on the summary page, with a note to remind you to refer the applicant for a stress ECG if the CRI was 15 or more. We received feedback from some DAMEs indicating that this can be confusing, and in response we emailed all DAMEs in late June to address the issue.
Since the release last June, the calculated CRI score from a previous medical will still be displayed, even if the current medical application does not require the CRI score to be calculated due to the age of the applicant.
If you have not entered a value for serum lipids for this medical because a CRI calculation is not required – but a CRI score is still displayed – then the score is from a previous medical. In this case, even if the note to refer for a stress ECG is displayed, it is not required for this medical.
To address any potential confusion, we are looking at making further enhancements to the system to display the year the CRI score was calculated.
Contacting AvMed by email
If you have any queries about a medical or an applicant that you want to be directed to either a CASA doctor or our clinical assessment facilitator, Georgie Hill, please email firstname.lastname@example.org.
Please do not send those enquiries to individual email addresses as there may be a delay in receiving a response if the person you email is away from work.
If you are forwarding reports to be attached to an applicant’s record, please either attach the reports directly in MRS or send them to email@example.com.
If you have an enquiry about a complex case that Georgie is managing, please email firstname.lastname@example.org.