Aerospace medicine predicted to experience strong growth

‘Aerospace medicine has been a specialty internationally almost since the Wright brothers began flying in 1903,’ Dr Kate Manderson told newsGP.
 
‘During the world wars, as aircraft became more complex and operated in a more challenging environment with altitude and pressure, we started to recognise that human performance was a bigger and bigger issue in terms of losing aircraft through crashing or losing battles.’
 
Flying is becoming more and more common, with 4.6 billion passengers expected to fly this year.
 
Consequently, aerospace medicine is becoming increasingly important.
 
Combining medicine and flying has been an abiding interest for Dr Manderson, who began working in the area in 2002 after becoming a medical officer in the navy. Her interest is now being shared by more and more GPs, with the  RACGP Specific Interest Aerospace Medicine network launched in June this year. Dr Manderson is the new network’s Chair.
 
The move came after the Civil Aviation Safety Authority (CASA) relaxed rules around medical examinations for pilots of small planes flying at low altitude.
 
‘When that decision was made, we thought it would be appropriate to have a professional network for doctors who sign off on fitness-to-fly [documents],’ Dr Manderson said.   
 
Dr Manderson is also president of the Australasian Society of Aerospace Medicine (ASAM), founded 70 years ago. The society currently has 17 registrars and more than 100 fellows, and is seeking recognition as a full medical college.
 
Dr Manderson describes aerospace medicine as a growth area.
 
At the moment, 75% of the work for Designated Aviation Medical Examiners is providing medical advice and assessments to pilots and air traffic controllers. But passenger fitness to fly will be an increasing issue for GPs, Dr Manderson predicts, with ultra-long distance flights such as the 17-hour Perth to London leg now available, and the ‘Holy Grail route’ direct from Sydney to London now on the horizon.
 
‘In the last 10 to 15 years, global aviation has grown exponentially,’ Dr Manderson said.
 
‘Getting on a plane is what getting on the train or bus used to be. That means people with health problems – our patients – will be on the plane. 
 
‘With 17- or 19-hour flights with no option to get off and no inflight medical support – what happens if there’s a problem? It’s an increasing issue for airline medical departments.
 
‘Bigger players have higher standards of inflight medical care and training. But no one actually has a trained nurse or paramedic on the flight. If patients need it, they have to arrange a medical escort themselves.’
 
Passengers with health complaints can be directly affected by the flight environment. The internationally mandated cabin pressure is the equivalent of 8000 feet (around 2.4 km).

That means some people may struggle with the lower oxygen intake. Other issues include pain from trapped gases, such as inside a tooth after a dental procedure.
 
In coming years, Dr Manderson expects the ‘space’ part of aerospace medicine to come to the fore.
 
‘Space medicine is on the horizon. That’s a really fascinating thing, to watch that bubble to the surface,’ she said.
 
‘Virgin Galactic are selling tickets to space for $200,000. Richard Branson said there were no barriers, that anyone could do this. But we said, what about the 95-year-old with emphysema, needing oxygen? Will he survive a 5-G launch?
 
‘You can’t put them on only for them to die from the lack of pressure or G forces.’
 
With the launch of the Australian Space Agency last year, Dr Manderson predicts that aerospace medicine will be a key area of interest for many.
 
‘We’re not about to launch shuttles or missions to Mars. What we are going to be doing is value adding in niche areas with a high level of expertise,’ she said.
 
‘Australia has a really impressive group of specialists in the space life sciences who are working to keep humans alive in space. This is a niche we can very much occupy and consult to NASA or the European Space Agency.’

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