Medicine for the wild blue yonder

An international congress on aviation and aerospace medicine recently convened in Jerusalem, where participants discussed everything from pregnant women pilots to the psychological problems associated with running wars via unpiloted vehicles.

October 19, 2013 22:27
A plane at Ben Gurion Airport.

Plane at Ben Gurion emergency370. (photo credit: Magen David Adom, Courtesy)

To the layman, aerospace and aviation medicine sounds like a specialty of physicians who help select and train astronauts and treat passengers who feel unwell on flights. In fact, it is a broad field in which, among other things, would-be passengers or soon-to-be passengers on sub-orbital trips to space will be checked and the health of air traffic controllers, pilots and flight attendants is periodically examined. In addition, medical conditions of people working with remotely piloted vehicles are also checked, as they have to see and hear well.

Thousands of physicians – some of them pilots – around the world work in aerospace and aviation medicine, and nearly 250 foreigners from 36 countries, as well as Israelis, recently attended the 61st International Congress of Aviation and Space Medicine (ICASM) at Jerusalem’s Inbal Hotel. The last time such a convention was held in Israel was in 1996, and the one before that was way back in 1971. The last congress was held in Australia, while Mexico has been chosen as next year’s location.

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The week-long event was hosted by the Israel Society of Aerospace Medicine, headed by Dr. Jossy Faktor, and the congress was presided over by Dr. Yehezkel Caine, a specialist in the field even though he is director-general of Jerusalem’s growing psychogeriatric institution, Herzog Hospital.

The foreign participants not only listened to lectures and exchanged ideas but also toured the Medevac unit at Tel Nof, the Israel Aircraft Industry factory and the Hatzerim air base of the Israel Air Force in the Negev Desert on the western outskirts of Beersheba.

“In addition to being president of the Israel society, I am a civil air surgeon at Israel’s Civil Aviation Authority,” said Faktor in an interview with The Jerusalem Post during the conference.

“I served for three years as chief medical officer of the IAF, director-general of Emek Medical Center in Afula and deputy director-general of the Rabin Medical Center- Beilinson Campus in Petah Tikva.”

Faktor, who came on aliya from South Africa in 1963, is fascinated by aviation and space flight. There are 40 aviation medical examiners in Israel who are designated by the Civil Aviation Authority to give pilots their annual physicals, he said.

“I have to appoint these doctors, oversee them and look at quality assurance. This congress is a required ‘refresher event’ for examiners; it gives them a chance to learn about the latest developments and to update themselves in the field. All the examiners have other specialities such as internal medicine, cardiology, obstetrics/gynecology and ophthalmology.

Four of the 40 are women – two of them senior – and two of them have pilot’s licenses.”

Faktor himself has a pilot’s license, but since reaching the age of 60, he has not flown.

“Pilots are getting older, as people in general are living longer. There is no age ceiling for private pilots. We have some even in their 90s. In commercial airlines, the limit for pilots used to be 60 years old, but now it is 65. Some countries have no official limits, but there are international regulations.”

As more and more women study medicine and find their way into aviation and aerospace medicine as a specialty and there are even women commercial, private and military pilots, the issue of pregnancy is also widely discussed.

“It had been thought that it was dangerous for pregnant women to fly due to exposure to radiation in the higher atmosphere, but studies have shown there is only minimal exposure at certain altitudes and latitudes. Most of us believe a woman can fly between their 12th and 26th week of pregnancy, but not afterwards, so [that] she is not in the air if there is a premature delivery.”

There are women air traffic controllers at airports who work through their 34th week of pregnancy, said Faktor, who notes that lifestyle – sitting in the sun on beaches between flights and not drinking enough water – are responsible for higher rates of melanoma and kidney stones among flight attendants.

As for vision, it was long a practice to prevent young people who didn’t have perfect vision or underwent Lasik surgery to improve their eyesight from becoming pilots. Some, desperate to become pilots, even lied about it.

But today, all these restrictions have been abandoned if the surgery or glasses makes it possible for them to see well.

DR. MELCHOR Antunano, the Mexican- born director of the US Civil Aerospace Medical Institute in Oklahoma City, loves his profession. “I studied medicine in my native country, and then in 1985 I went to the US to do my medical specialty. I was a postdoctoral research fellow at the US National Academy of Science. When he was seven years old, he recalled, he “wanted to be a physician. And then I decided I also wanted to be an astronaut, but I couldn’t be one because I had glasses; pilots can be bespectacled, but astronauts cannot. So for me, the next best thing was to go into aerospace medicine.”

Now that Richard Branson of Virgin Galactic plans suborbital flights to space next year, the matter of civilians going at least 100 kilometers up is a new interest of aerospace physicians.

“I led an effort to set guidelines for ‘space flight participants.’ They are not called passengers, because eventually they will include scientists carrying out experiments. And those who man the space vehicles, which will not go into orbit, will be called aviation pilots, not astronauts. The medical officer of Virgin Galactic is here at the congress,” he said.

There will be fewer flights by the US National Aeronautics and Space Administration (NASA) but the company is making agreements on supplies with commercial companies.

“Now that Virgin Galactic is going to allow ‘normal’ participants to go to space, we have to make sure they don’t have serious physical conditions such as cardiovascular or respiratory disease, that they aren’t depressed, are not claustrophobic or afraid of heights. Anyone who wants to go will have to have strict tests, but these will be more flexible than tests for pilots,” said Antunano.

“With these flights, we will learn more about space medicine, because for the first time, people with medical problems will go and not only those who are perfectly healthy.

Today, when a passenger goes on a jet flight, nobody asks if he’s addicted to drugs or alcohol or take medications. If somebody goes into space, these are the questions you have to ask.”

“The actual flight will launch them into space and then fall back to Earth and land at the same place from which they took off a few hours later, but they will enjoy weightlessness for only three or four minutes. Participants will float and not be held down because one of the main reasons why they wanted to go to space is to see out the window and take photos. The second reason is to enjoy weightlessness. If they’re buckled down in their seat, they won’t be able to do either.”

PROF. ANTHONY Batchelor, a retired professor of aviation medicine at Kings College of Medicine in the UK, attended the 1996 congress in Jerusalem and serves as president of the International Academy of Aviation and Space Medicine, which is a sponsor of this congress.

“I’m not a pilot. I was a hospital physician in the Royal Air Force and visited bases all over, including Germany, Cyprus and the US, where I worked for two years with the US Air Force,” he said. “I was involved for years in education, examining air personnel and fortunate to have career in several avenues of interest. I felt I ought to know a lot more about equipment and other challenges, so I went off as hospital doctor to get diploma in aviation medicine from the Royal College of Physicians in London.”

Israel, says Batchelor, “punches beyond its weight in aviation medicine. It’s a great privilege for me to end my presidency in international academy to have this congress in Jerusalem.”

“There are no more than 20 full-time physicians in aviation medicine in the UK; the others practice their medical specialty as well.

There are quite a lot of women; for example, Dr. Sally Evans – who is here at the congress – is head of the UK’s Civil Aviation Authority.

As people improve their lifestyles – exercise, eat right, have a normal weight and don’t smoke – they will live longer, including the pilots among them, who are taught about dangers from flight. But radiation in the air is not considered significant.”

A CANADIAN consultant in occupational health and aerospace medicine, Dr. Claude Thibeault is medical adviser of the International Air Transport Association. “I wanted to be a surgeon, but I went for training as a ‘flight surgeon,’ which doesn’t mean a surgeon but a physician who looks after people who fly – pilots, navigators and stewards and stewardesses, as well as air traffic controllers on the ground.”

Although he travels by air often, he has rarely had to treat a passenger. “There was a well-known case of a man who had a road accident on the way to the airport. The patient had suffered broken rib and a collapsed lung without him knowing it. When he deteriorated, a British doctor successfully performed a pneumothorax with a coat hanger! There was no surgical equipment on the plane except a small emergency medical kit,” said Thibeault.

“Planes are pressurized, but not all the way to the ground, and most physicians are not familiar with altitude physiology,” said the Canadian doctor. “They should be taught this in medical school or as young doctors at the latest. As nearly every doctor in the world has to give advice to patients who fly, they are not equipped. A rather common problem during flight is deep vein thrombosis, in which a blood clot blocks a vein in the legs, but it does not necessary result from flight. It can happen as a result of immobility anywhere, in trains or in bunkers in wartime.

“On a plane, passengers have to move around periodically to get the circulation going. DVT can easily be treated with drugs.

One must be careful so a pulmonary embolism, which is serious, does not form.”

As for pressure in the ears, for which flight attendants used to hand out chewing gum to equalize pressure, most passengers today have no problem with takeoff and landing. But if they are congested from a cold, it can be annoying, and if pressure is not relieved, it can cause trauma to the ear, he continued.

Another unpleasant situation is if passengers enter the plane drunk or get inebriated on board. “Attendants are trained to deal with such people; if they arrive drunk, they try to avoid giving them alcoholic beverages, but it isn’t always easy,” Thibeault said.

DR. ELENA Cataman from Moldova is well aware that the city she comes from is known to many Jews, and not for positive reasons. “I come from Kishinev,” said the cardiac surgeon.

In April 1903, the Christian population o f t h e town rioted and killed nearly 50 Jews, wounding 92 severely and looting and destroying many homes and businesses.

“This is my first time in Israel, but it will not be my last,” said Cataman, who is married to an international pilot of an Airbus with a commercial airline. Her son is also a pilot. “I have lots of former classmates here. Israel is a beautiful country and has wonderful people.

Immigrants from the former Soviet Union have same mentality and education, and we have so much in common. In Moldova, we miss the Jews who went to Israel and would love to have them back.”

Women doctors are the majority in her country. After becoming an accomplished cardiac surgeon, she was offered a job as a medical assessor because of her excellent English. Today, she is her country’s main assessor of aviation personnel and traffic controllers.

Unlike most of the other experts at the conference, Cataman believes that radiation in planes can be harmful to pregnant women and advises them not to work as pilots or flight attendants when they learn they are pregnant.

“The higher the altitude, the greater the amount [of radiation]. Stewardesses fly on a daily basis, and the conditions disturb their biological balance and hormonal regulation,” she says.

NUMEROUS EXPERTS from the IAF attended the congress. Colonel Erez Barenboim, commercial of medical services and supplies, is retiring from military service and studying medical administration at Sheba Medical Center at Tel Hashomer. A veteran flight surgeon, he wonders how long aviation medicine will exist, “because we are facing a future of unmanned flights. Cynics say that in 30 years, there will no longer be manned attack planes. A plane without a human pilot will need no lifesaving equipment, no oxygen,” said Barenboim.

“But operators on the ground of unmanned vehicles will suffer from physiological and mental problems, because they will fight battles opposite plasma screens without feeling that they are in the battlefield and causing enemy soldiers to die. This can make them feel disconnected – and this is something new for us.”

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