1. Aviation medicine has been more successful than maritime medicine in establishing an international system of medical standards due to the competitive nature and price-driven pressures of the aviation industry which require a "level playing field" with common safety standards. 2. While aviation has seen tremendous growth, aviation medicine has developed standards to ensure safety such as requirements for pressurized cabins, oxygen, and crash protection which has led to commercial aviation seeing its accident rate reduced by a factor of 50 since the 1960s. 3. However, being a pilot is still a high risk occupation with pilots having a standardized mortality rate of 46 for fatal occupational accidents compared to the general population, though disease risk is low, suggesting aviation medicine could improve

1. 1
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Institute of Aviation Medicine
Why has aviation medicine been so successful in establishing an international system compared to maritime medicine?
Anthony S. Wagstaff
Director, Institute of Aviation Medicine, Oslo, Norway
Associate professor, University of Oslo

2. The background for my views
•Institute of Aviation Medicine Oslo 22 years
•Military flight medical standards
–Rulemaking and clinical evaluation
•Civilian aeromedical centre (JAA – now EASA) in Norway 13 years.
•AME – military and civilian experience
•Specialist in occupational health.
•Vice president ESAM

3. Overview
•The big picture: Why do we do medical examinations
•Some figures and comparisons
•Aviation Medical examinations harmonisation in Europe
•Future improvements?

4. Big industries
•3 billion airline passengers/yr
•2 billion ferry passengers/yr, (20 million cruise passengers/yr)

5. Why have we done medicals for 100 years?
1.Flight safety
2.Flight safety
3.Flight safety

6. If you think flight safety is expensive
•Try an accident

7. Mean 2006-2010: 500 deaths in 2 000 000 000 = 2,5/10 mill/yr

8. Mean 2006-2010 500 deaths in 3 000 000 000 passengers : 1,6/10million/yr

9. Safety developments - comparison
•Shipping by a factor of 7in yrs:
–1910: 1 hull loss/100/year
–2012: 1 hull loss/670/year
•Aviation:
–Accident rate reduced by a factor of 50 in 50 yrs. since 1960´s

10. In other words
•Aviation has had huge growth
•Aviation medicine has followed
–Pressure cabin
–Oksygen requirements
–G-protection
–Crash protection

11. •So how are we doing?

12. Death risk of transportation 1999-2000 (Wikipedia)
Deaths/billion journeys
Deaths/billion hours
Deaths/billion kilometers
Bus: 4,3
Bus: 11,1
Air: 0,05
Train: 20
Rail: 30
Bus: 0,4
Van: 20
Air: 30,8
Rail: 0,6
Car: 40
Water: 50
Van: 1,2
Foot: 40
Van: 60
Water: 2,6
Water: 90
Car; 130
Car: 3,1
Air: 117
Foot: 220
Space shuttle: 16,2
Bicycle: 170
Bicycle: 550
Bicycle: 44,6
Motorcycle: 1640
Motorcycle: 4840
Foot: 54,2
Space shuttle: 104 mill.
Space shuttle: 438000
Motorcycle: 108,9

13. What about the air crew: Are we dealing with a high risk population?
•Civilian airline aircrew
•Relative risk

14. Standardised mortality
•From disease – Low risk
–Pilot SMR 0.56 (0.54-0.58)*
•From occupation – High risk
–Pilot SMR 46 (39-54)*
–Fatal occupational accident rate 0,7/1000/yr (US)
*Hammer GP, et al. Occup Environ Med 2014;71:313–322. doi:10.1136/oemed-2013-101395 (93771 crew members from 10 countries followed over a mean of 21 years)

15. We are ”only” interested in 2 aspects
•Sudden incapacitation ( the 1% rule)
•Function onboard

16. Why European harmonisation?
•Aviation very competitive, price-driven.
•“Level playing field”
•Common safety standards more important as competition increases

17. The aviation system seen from a Norwegian AME
International level Chicago convention Annex 1
European level Rulemaking, Acceptable means of compliance
National level
Implementation

18. Civilian harmonisation
•More detailed in JAA (why?)
•Some simplifications in EASA
–Controversial
–Different traditions in Europe

19. Future developments?

20. The simple question is:
•Can we make a better contribution to flight safety?

21. At the moment
•We are only really working on the low- risk issues: the diseases
•Could we improve our work on the high risk pilot occupation?

22. Clinical methods
•Based on diagnostic tests for disease
•Screening doesn’t improve health outcomes, only in high risk populations
•Sudden sudden incapacitation events only relevant for a few conditions and the preventable risk is low
–Cardiovascular, neurological
–Only “physical” conditions screened
•What about 80% of accident causes which are human factors?
–Fatigue, life problems, stress, etc etc

23. Transparent decision-making
•Collaborative process between pilot and AME with the aim of keeping the pilot in the air safely.
•Clearly defined processes, pilot involvement in process
•Reduces “unknowns” – improve trust
•BETTER decisions

24. Conclusions
•Aviation has become “normal” and we do not accept aircraft crashes – improvements are long term work.
•Aviation is still a high risk occupation, but not primarily from disease - this is spurring new discussions in Aviation Medicine – as we speak
•There are preventive tools, we may more systematically apply, to add value to Flight safety in the future

25. Thank you for your attention!