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PTSHealth Factors
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Contents
…Filling out the Medical Form;
…Age as a Factor in Flying; …Fatigue; ...Subtle Fatigue…Sleep; …Medicine;
…Carbon Monoxide; …Cold
Weather; …Dehydration; …Ear Block; …Hyperventilation;
…Hypoxia; …Smoking;
…Coffee; …Spatial
Disorientation; …Stress; …Vertigo; …Nutrition:
…Over the Counter Medicine; …You vs. the FAA; …Diabetes;
…Marijuana; …Melanoma;
…Hypoxia and Carbon Monoxide;
…Sound; …Hearing;
…Noise; …Noise
Effects; …Hearing Damage;
…Alcohol; …
H. Task: AEROMEDICAL FACTORS
Pilot Operation - 1
References: AC 61-21, AC 67-2; AIM
Ex Explain cause, symptoms, effects, and correction for...
Filling
out the Medical Form
--Form was changed in 1991
--A lie can cost 250,000 + five years
--Notify FAA Security Division within 60 days of motor vehicle
action related to drugs of alcohol
--Actions are suspension, revocation, cancellation, denial, educational
or rehabilitation program.
--Authorizes use of National Driver Register
--Conviction includes a fine, forfeiting bond or collateral
--Clinical diagnosis of disorders puts your medical in abeyance.
Must be entered on form. 61.53
--Grounding because of broken arm is not reportable as a "general
medical deficiency" per FAR 67.
The average General Aviation pilot was 39 years of age in 1990. Pilots over 60 have 2.1 times more accidents than pilots in their 50's. Pilots over 60 are safer than pilots in their 20's and 30's. The accident rate goes up after 60 perhaps due to subtle age-related deterioration in cognitive function. The older you are the dumber you get! My wife agrees.
Older pilots like to think that what has been lost in ability has been made up in experience. By the age of 60 pilots lose some mental and physical abilities. By the age of 50 everyone has some vision loss known as presbyopia. Hardening of the lens causes this. As we age we become less efficient in getting and using oxygen and getting rid of carbon dioxide. Hearing by itself does not affect the ability to fly but it does make a difference in the communications area. Like vision, hearing the higher frequencies drops with age. Physically we become victims of some stiffness of the joints and extremities with age. Dehydration is going to have greater effect with age. We are all different in the way we age and the way our aging affects our flying.
Acute fatigue occurs when a long period passes with a lack of sleep. Chronic fatigue occurs when several acute fatigue periods occur without adequate recovery time between. While some fatigue is related to lack of sleep, not all is. Fatigue can result from inadequate nutrition and over exertion. More information needs to be obtained on fatigue distinguished from sleep as a factor in accidents.
Some factors of physical condition are controllable and some are not. Acute fatigue occurs when a long period passes with a lack of sleep. Chronic fatigue occurs when several acute fatigue periods occur without adequate recovery time between. Stress is the result of events causing preoccupation, reducing external awareness, and making activities subject to distraction. Stress causes the taking of risks that would otherwise be unacceptable. The mental/physical condition resulting from fatigue and stress may cause the pilot to make unwise decisions.
There are many causes of fatigue: lack of sleep, hypoxia, noise, time zone factors, temperature extremes, dehydration, stress and more. When you are fatigued you are more irritable and easily annoyed, you will suffer for lapses in short term memory, your attention will fixate to the exclusion of all else, your performance skills will decrease and you will be unaware of any impairment.
The causes of fatigue are primarily lack of recent sleep or a chronic sleep deficiency. Additional fatigue arises from our physiological reaction to noise and vibration, illness, hunger, caffeine "down time", unresolved stress, hypoxia, dehydration, errors in judgment and extended mental/physical demands.
What to Expect from Fatigue
Reduced vigilance
Increased temper excursions
Reduced ability to concentrate
Reduce awareness of deviations
Increased rationalization of errors
Increase in ‘know-better’ mistakes
Fatigue increases if you are "doing nothing"
Reduced comprehension of ATC instructions
On May 18, 2000 I flew a C-172 from Concord California to Akron,
Colorado. The flight took right on eleven hours of flying. On
my arrival, I was told by the weather service technician there
that left traffic for the active runway was the standard.
Not realizing the level of my fatigue I began my approach by making
a right 45 entry. I picked up my mistake but was puzzled that
I could do such a thing. On landing I thought it over and decided
to quit for the day even though I had several hours of daylight
left.
Fatigue lowers performance standards. You can become forgetful,
make poor decisions, react more slowly, and show reduced alertness.
Your ability to assimilate radio communications will deteriorate,
fixation on instruments is more likely. Your faults will be reacted
to with apathy and lethargy. You are more likely to react with
anger and be sleepy.
A few days later I flew for 12 hours. While I am not prone
to react with anger when it comes to flight delays, I did on this
occasion become angry due to a flight delay. I can now make fatigue
a cause of both my anger and tendency to want to sleep. I would
suggest, just as fuel is time in the air, time in the air causes
fatigue.
Subtle Fatigue
This problem often begins with a distraction that causes fixation on an instrument or occurrence. Complex flight operations are the first skills to deteriorate.
Silence prevails
Seat posture relaxes
Bad judgment prevails
Instruments are ignored
Attention and vision fixates
Eye/hand skills begin to fail
Writing becomes less linear
Heading excursions take place
Movements decrease and slow
Clearances cannot be copied in total
Knowing where you are becomes a problem
Pilot accepts what exists as O.K. without checking
External references begin to fade from consciousness
Sleep
The most common cause of diminished alertness and proficiency is lack of sleep. This condition is said to affect 30% of the U.S. population. This may be due to an actual loss of sleep or a change in a sleep pattern called the circadian rhythm. Pilots tend to neglect their need for sleep. The need for sleep is a defining limit to pilot mental capability. You must have sleep or your mind will fail. Once beyond the limit pilot performance deteriorates and can become irrational. Sleep is a restorative and can be both stored and deprived within limits set by the biological clock of the individual. As you grow older you will need less sleep. Jet lag sleep patterns are worse when flying from west to east. Accident rates climb precipitously when your body begins demanding sleep. The average American gets about one hour too little sleep each night.
Accident rates rise in the afternoon and become significant at night. Postponing sleep causes a sleep deficit that as it increases an accident becomes more likely. Jet lag is a type of sleep deficit. A sleep deficit can best be resolved by going to bed early, not by sleeping late. A large deficit cannot be made up in one night. 21% of aircraft accidents cite sleep deficiency as a factor.
When drowsiness occurs, you cease to monitor the instruments. You will tend to fixate and drift off mentally. We go into a mental autopilot not thinking of what we are doing. This is the lowest level of alertness. The next level of alertness is one in which you are in constant search-and-scan, seeing what you are looking at, hearing what is said and asking question. This is the flying" mode from pre-flight to shutdown. This gradual deterioration of alertness is best observed in watching others. It can creep up on you and influence your flying without your even noticing. Your alertness rises again when you have located a problem. You focus on it and prepare to execute a solution. This might occur when required to make a crosswind landing. The highest level of alertness is when adrenaline begins to flow and survival becomes a factor.
Any over-the-counter medication whose name ends in "ine"
should be checked in a flight medical examiner for use before
flying. Beware of any medicine that is supposed to make you feel
better. At altitude the effects may be damaging to flight safety.
FAA definitions of prohibited "over-the-counter' medicines
include any legal, non-prescription substance taken for relief
that have as side effects of reduced judgment, reduced attention,
reduced comprehension, affected vision, slower responses and dehydration.
The recommendation is that the wait period before flight be double
time as recommended for dosing.
Medicine taken is just as likely, even more likely, to be the
basis for grounding a pilot than is the ailment itself. Medicinal
side effects are both variable and unpredictable. Virtually all
medications have side effects. Never take a medication for the
first time and then fly. Make the safe decision if you are sick.
Most medicines, even nonprescription have side effects. Depressants
such as alcohol and valium are forbidden. Antihistam
ines dry up your mucous membranes, including those of your eyes.
The drowsiness caused by Advil makes you more
susceptible to vertigo as do all Non-Steroidal Anti-inflammatory
Drugs. Even after the above drugs leave the body there is a residual
effect causing amnesia. The amnesia is related to your short term
memory. (Reading back clearances and instructions.)
Stimulants should be the opposite of depressants but they aren’t.
Cold medicines can and do contain both depressants and
stimulants. The stimulant effect is general excitation, higher
heart and breathing rate, and higher blood pressure. Constriction
of blood vessels and a drying up of mucous membranes occurs. Muscle
tremor, inattention and eye spasms can and do occur subsequent
to ingestion of these medicines.
Motrin seems to be o.k. while flying.
Is poisoning due to the exhaust fumes resulting from carbon burning with insufficient oxygen to produce complete oxidation. The resulting gas has one atom of carbon and one atom of oxygen. CO is odorless, colorless and cannot be tasted. CO poisoning may not be distinguished from fatigue or hypoxia except that the occurrence can occur at any altitude. Engine exhaust in an aircraft has 7% CO. Very small amounts of CO over a period of time will reduce a pilot’s ability to fly safely. It is the length of exposure as well as the amount that makes the critical difference. Susceptibility to CO poisoning increases with altitude due to the propensity of CO to enter blood. CO is 200 times more attracted to the blood hemoglobin as is oxygen. As little as one part CO to 20,000 (.005%) parts of air is enough to begin the death process of the brain.
Above 10% CO poisoning you will suffer from a headache. Above
20% you will be sleepy and sick to your stomach, HEADACHE, vision
and speech problems. You will be incapacitated above 40% and dead
at 70%. If you get a headache while flying, open the window and
shut off heater. CO reduces ability of blood to carry oxygen.
Symptoms are similar to hypoxia. Headache, drowsiness, dizziness
should initially be corrected by opening outside air vents. CO
has a half-life in your body of about five hours. It will take
a full day to recover. 70% of exhaust system failures result in
CO poisoning. CO prevents the hemoglobin from both carrying and
releasing oxygen. Antihistamines, alcohol, lack of sleep, or blood
deficiency will exacerbate CO poisoning. Prevention of CO poisoning
is directly preventable by proper aircraft maintenance. Club aircraft
require extra alertness. You might suspect CO exists in your cabin
air as soon as you smell some engine exhaust fumes.
Descend
Land ASAP
Use any oxygen
Shut off the heater
Get medical treatment
When in doubt, get on the ground.
CO detectors: AIMSAS-696D Is an electronic CO detector.
Hot or cold temperatures affect the quality of the preflight. In the winter, as your body cools you tend to mentally and physically slow down. Flying in an unheated aircraft in the winter will drastically decrease your flying efficiency and effectiveness.
Human need for 2-4 quarts of water a day. You become thirsty with a deficit of 1.5 quarts of body fluids or 2% of body weight. The deficit causes a reduction in blood volume and triggers thirst. Thirst arrives too late and can be mollified too easily. At 3% of body weight fluid loss fatigue and weakness occurs. Symptoms are headache, sleepiness, dizziness and weariness. Avoid diuretics such as coffee and alcohol. Don’t rely on thirst as drinking trigger. Measure fluid intake daily.
Caused when the Eustachian tube becomes blocked. Earblock or sinus blockages can cause differential air pressures to exist between cavities of the skull and the exterior. If it is not possible to equalize these pressures by slowing or removing the pressure changes severe pain results. Do not fly if you suspect such a condition exists or above 8,000’ within 24 hours of scuba diving. Gum chewing and jaw movement are preventives. The Valsalva maneuver consists of opening the mouth wide with the jaw wide, as though yawning. Do this over and over because opening the mouth helps open the Eustachian tubes. Next, pinch your nose closed, shutting the mouth, and blow gently as through your nose.
Stress, anxiety and fear cause hyperventilation. The person begins abnormal rapid breathing. Reduction of carbon dioxide causes lightheadedness, suffocation, drowsiness, tingling, and coolness. Leads to incapacitation, spasms, and unconsciousness. Symptoms resemble hypoxia. Can be corrected by controlled breathing in a paper bag. Anxiety can affect judgment if it causes alkalization of the blood. Hold your breathlling rate to 4 per minute.
An adult will breath in 3,000 gallons (by volume) of air per day. This includes 600 (20% of total) gallons of oxygen. Your blood system has 25+ trillion (12 zeros) red blood cells (hemoglobin). Each one is capable of loading up four oxygen molecules for distribution throughout the body. When returning to the lungs for a refill they unload CO2 first.
Hypoxia is oxygen starvation. Lack of oxygen impairs the whole body but most importantly the brain. The first part of the body to show significant effect from oxygen deficiency is the retina of the eye. Every individual is affected but in different ways and to different degrees. The danger in hypoxia is that it occurs insidiously below the conscious threshold. Hypoxia makes you happy and such happiness in the cockpit is very dangerous. The best warning indicator for hypoxia is the altimeter. You will quickly recover by descent to a lower altitude.
Since hypoxia is due to reduced barometric pressure, low-grade hypoxia begins on takeoff. The percentage of oxygen is same but less is reaching the blood stream. Any stress or increase in activity requires more oxygen, up to 8 times more. Pilot performance deterioration begins at takeoff, as well. Slowed response times and inability to deal with complexities due to hypoxia compromise safety. Noticeable oxygen deficiency effects begins at 4000’ safety margins are beginning to erode. Hypoxic symptoms of difficulty breathing or headache may not be obvious or may not occur at all even though there are the foregoing changes in mental status.
20% of each breath is oxygen. Several different conditions can lead to a physical deficiency of oxygen called hypoxia. Hypoxia is not known to the victim. When an extremity 'falls asleep' the tingling is caused by the lack of oxygen being replaced. (stagnant hypoxia).
A high-G maneuver of over 6-Gs is capable of causing hypoxia by preventing blood from reaching the brain. Anemia is the result of reduced oxygen carried by the blood and is hypemic hypoxia. Hypemic hypoxia also results from the presence carbon monoxide because it attaches to hemoglobin more readily than does oxygen.
Altitude alone can cause hypoxic hypoxia. The body tries to correct for this by taking deeper breaths and increasing the rate of breathing. Then the pulse rate increases. Just when the body makes these adjustments is dependent upon the age and health of the individual. If you do not take supplemental oxygen above 5000' you may expect to make increasingly more procedural errors in your flying and communications. Current FAA oxygen requirements are not adequate.
There is a miniature oxygen device that makes it possible for
a pilot to get supplemental oxygen on a noncontinuous basis.for
about three hours. Call 775-572-3175 or 805-610-0491Cost is $159.
An additional $400 gets you the Nonin Onyx pulse oximeter for
hypoxia diagnosis.
I have seen complete personality changes occur after a couple
of hours around 12,000’. Symptoms such as headache, drowsiness,
dizziness, euphoria, tingling, perspiration, or belligerence are
typical. Tunnel vision and blue fingernails occurs within times
as little as 15 minutes above 15,000’. At 16,000’ disorientation,
lapses of judgment, loss of impulse control, risk-taking behavior,
decreased problem solving abilities, impaired memory, mood disturbances,
and lowered coordination are common. Unconsciousness occurs in
10 minutes at 20,000’.
All effects are made worse and happen at lower altitudes with
fatigue, age, smoking, health habits, and drinking. Oxygen recommended
above 10,000 day and 5,000 night. If oxygen is being used, the
pilot must be knowledgeable about the operation of the system
and be able to recognize his and the system’s warnings of
oxygen deficiency. FARs require oxygen if 1/2; hour above 12,500’,
crew above 14,000’, everybody above 15,000’.
--50,000 You need a pressure suit
--16-45,000 You need a regulator to get oxygen without lung injury.
--30,000 Watch out for bends.
--26,000 Blood oxygen pressure greater than ambient pressure
--15,000 Everybody reqires oxygen.
--14,000 Oxygen reqired for crew if over 30-minutes
--12,000 Night vision decreases by 50%
--5,000 Night vision decreases
--S.L. One cigarette gives 5000' oxygen pressure
The smoking of tobacco is a form of self imposed physical and psychological stress that constitutes an immediate and on-going threat to health and safety. A smoker may deny that drugs are a part of his life. He lies in the face of facts. The whole purpose of a cigarette is to get a nicotine fix. Different from cocaine or heroin? How? The person who smokes is a health and economic hazard to everyone. The residue remains on his person, clothes, possessions, and associates.
Susceptibility to CO poisoning increases with altitude due to the propensity of CO to enter blood. This prevents the blood from being able to transport adequate oxygen to the body’s cells. The hypemic hypoxia of the smoker reduces his oxygen intake by 5-10 % of normal capacity. The fact that smokers are hypoxic means that we can expect smokers to feel anxiety, forgetfulness, irritability, confusion, altered judgment with every cigarette. Judgment, math ability, and reasoning will be affected. The indication is that smokers are more likely to enter into personal arguments and show lack of both good judgment and logical reasoning ability in those arguments. Very small amounts of CO over a period of time will reduce a person’s ability to perform safely. It is the length of exposure as well as the amount that makes the critical difference. This lack of oxygen to the brain impairs judgment and diminishes the ability to make reasoned decisions.
Any onset of sluggishness, warmth, and tightness across the head is an early symptom of CO poisoning. A headache, weakness, dizziness and dimming of vision comes next. You won’t be aware when you lose strength, vomit, convulse, and enter a coma. A breath of fresh air will not revive you. Several days may be required for full recovery. The smoker is betting against a CO impairment that has already occurred and can only become worse. Carbon monoxide and other toxins in tobacco smoke interfere with the oxygen-carrying capacity of red blood cells. Less oxygen means less energy. Smoking causes an accumulation of mucus in the windpipe and bronchial tubes constricts blood vessels and reduces the supply of oxygen to cells.
The pilot who smokes is a hazard to himself and other pilots. The fact that smokers are hypoxic at relatively low altitudes means that we can expect smoking pilots to feel anxiety, forgetfulness, confusion, irritability, and altered judgment at relatively low altitudes. The applicable question is, should smoking pilots have any more right to fly than drinking pilots? Know your limitations. Don’t fly if you are not 100%.
Half of the American population is addicted to coffee. 25% drink ten or more cups a day. Quitting coffee is both difficult and painful. At age 71 I dropped coffee primarily to lower my blood pressure. I had a two-week headache. Now I take afternoon naps. The lure and temptation of coffee still exists.
Coffee has some negatives:
1. Raises the adrenaline level.
2. Linked to heartburn and ulcers.
3. Leading cause of sleep disturbance.
4. Constricts blood vessels of the eyes.
5. Contains at least five cancer causing compounds.
6. Contains pesticides that are not allowed in the U.S.
7. Contributes to iron loss, zinc loss, and sex drive loss.
8. Increases risk of stroke by increasing blood pressure.
9. Blocks adenosine, a brain chemical that calms you down.
10. Can cause panic attacks by increasing lactate in the body.
11. Can addict babies whose mothers drank during pregnancy
12. In conjunction with diet, cold, anti-depressants will dramatically
raise blood pressure.
13. Causes excretion of calcium, potassium, magnesium and sodium
before being used by the body due to diuretic effect.
Spatial disorientation is the No. 1 cause of military fatal accidents. Even the best pilot will become disoriented under the right conditions. Effects on inner ear can cause a mentally and physical compelling move in a given direction. This can be the after effect of a gradual turn, spiral, spin, acceleration, leveling off, updraft, false horizon, autokinesis, (lights that move), runway illusions.
No pilot is immune to the harmful effects of stress. Stress results as a reaction to a challenge. The reaction is both mental and physical. Increases occur in metabolism, blood pressure, and breathing rate. If release does not occur by an action we have a surplus of adrenaline that can cause both physical and mental problems. The better your close personal relationships the better you will handle stress of any kind. Next best catharsis is adequate sleep and food of the right kind. Some people react to stress by eating, usually the worst kinds of food. Solitude and quiet can restore your clarity of thought and creativity.
Stress management involves finding way to solve stressful problems. The hardy come up with creative solutions that prevent them becoming victims. The hardy actually benefit from stress. These people refuse to let stress situations direct their lives. The person who has commitment to a purpose is more apt to take control. He wants to influence the outcomes rather than coming under the influence of them. .
Human performance is mitigated by physical stresses such as fatigue, fitness, sleep, food, age and illness. Psychological stressors such as personal family problems, work load, situational awareness. External dynamic stresses are due to weather, turbulence, aircraft performance and time factors. Stress is the result of events that cause preoccupation reducing external awareness and making activities subject to distraction. Stress causes the taking of risks that would otherwise be unacceptable.
Stress in moderate amounts is both necessary and desirable when flying. It prevents boredom and inhibits fatigue. The other extreme of stress leads to panic and impaired capability. Accidents happen when flying requirements exceed capability. Time in the air will decrease capability and lower the stress/panic threshold. 69% of accidents occur in the landing phase of flight operations. This is when time in the air is greatest and the stress/panic threshold lowest.
Whenever excessive tension exists, the ability to make considered judgments deteriorates. The concepts of what is best or safest become an emotional decision based more on fears or concerns rather than realities. Under tension the ability to make correct decisions deteriorates and compounds both the tension and the reliability of the selected solution. The pilot MUST recognize areas of tension and undertake an instructional program to raise a proficiency level to where competence reduces tension. Failure to resolve any tension-producing problem will eventually lead to an unforeseen situation where a decision will produce an accident. The instructional program must expose the student to those tension producing situations before the student goes solo. Stress exposure is a form of stress inoculation.
The most common tension producer is through use of the radio. At a given point in airspace the student knows that he should be prepared to say a given sequence of communication facts. Where to start talking, what to say, in what sequence, and the fear of the unknown ATC create tension. After being lost or disoriented the most dramatic tension producer is x-wind landings, next I would place unfamiliar airports, especially if they are small, followed closely by radio procedure uncertainty. Night flight over unfamiliar terrain certainly raises cockpit temperature. Turbulence produces tension in the best of us as does proximity to the ground. All of these tension producers can be reduced or eliminated by gradual programmed exposure. Stress reduction, according to one expert, can be achieved by only landing at airports and peeing every chance you get.
Unrecognized spatial disorientation is caused by some combination of channeled attention, distraction and target fixation. These most often occur in conjunction with loss of situational awareness due to excessive workload. A 10-degree bank with only the approach lights visible can cause an illusion that the lights are sloping from above. The future microwave landing system flown mostly with curved approaches is going to require special illusion training.
Recognized spatial disorientation is when the pilot is aware of his disorientation and should be able to work through a recovery sequence by establishing recommended power and attitude changes. Pilots have, over the radio, acknowledged their vertigo and inability to overcome it prior to crashing.
Incapacitating spatial disorientation occurs when the motion of aircraft is so severe that pilot may be incapable of rationally perceiving and processing information and making decisions. May cause nystagmus (trembling of the eyes) which makes reading of instruments impossible. Rare but can occur in extremes of weather or flight conditions. Other types of spatial disorientation are illusions such as caused by runway/cloud sizes, shapes, or slope.
Vertigo is the #1 cause of Air Force fatal accidents. Vision is the pre-installed vertigo preventative. A moments glance out-the-window is all it takes. This will overcome any sensations from other sources. However, without vision, the organs of balance in the inner ear take over. The semicircular canals approximate the three axes. They contain a fluid that stimulates our senses of angular acceleration in these axes. The otolith organs establish our sense of uprightness. Tiny stones affect hair sensors in reaction to "gravity". Otoliths sense linear accelerations, not angular accelerations, and regardless of the direction interpret such accelerations as gravity. In our muscles and joints we have sensors which give additional information about push or pull. Unless one or all of these sensors are confirmed by vision we are on our way to vertigo.
Food when converted into glucose is the source of brain energy. Glucose cannot be stored. As blood sugar it requires constant renewal. If glucose is not renewed the body and the mind shows evidence of fatigue, mental confusion, faintness, headache, memory loss, dizziness, vision problem, cold hands and feet.
Reduced blood pressure, tension, depression and hunger are all symptoms of hypoglycemia. This can be caused by the lack of a balanced meal within the past five hours. Ten hours without food will severely affect decision-making ability, alertness, coordination, and perception. Skipping breakfast causes fasting hypoglycemia. All hypoglycemia types can be aggravated by other physiological factors.
Altitude can incapacitate a pilot through dehydration. Increase your fluid intake prior to and during flight. What you eat is just as important as just eating. Reactive hypoglycemia can cause lack of consciousness. This is a reaction to the doughnut/candy bar meal. The student pilot who does not eat because of possible airsickness is endangering himself if flying solo. High sugar meals cause the pancreas to create excess insulin. Insulin allows the body to use sugar. Too much insulin and deplete sugar to such a low level as to incapacitate the body and mind. Adding caffeine, alcohol and nicotine acerbates the problem. Flying should be preceded by a balanced meal. Neuronutriments are the vitamins and minerals that the body can change into neurotransmitters. Trace minerals such as potassium, zinc, iron, and chromium are essential to control the body’s sugar burning process. The more balanced our meals the better will be our mental functioning and memory.
Over
the Counter Medicine
It is the unpredictability of side effects possible from ingestion
of over-the-counter medicines that makes the FAA question
their use.
--As a pilot you must consider that any medicine will have an
effect on your flying.
--You become both the doctor and pharmacist when buying over-the-counter
medicines.
--Ground yourself when not well…OtCs only conceal symptoms,
they do not cure..
--Allergy is unpredicable reaction to OtCs.
--Allergic reactions include drowsiness, upset stomace, affected
vision, hyperactivity, itching and poor
judgment.
--Read label and follow directions
--Double the time label sets for side effects before flying.
--Your condition may be as disqualifying as the medicine taken
--Consult medical professional
--You will not pass 'preflight' if an illness requires medicine
--An illness that requires medication, means you should not be
flying.
--Flying with a cold could cause serious ear and sinus problems.
--Avoid mixing decongetants and caffeine
--Beware of medications that use alcohol as a base.
The very possibility of any reduction of judgment, comprehension
and fine attention, decreased ability to see, slowing of system
reflex, and dehydration is enough to put a medicine on the prohibited
list. Even when not prohibited it is the wise pilot who doubles
the time between use and flight. AOPA has a list for pilot use.
You
vs the FAA
FAR 61.15(c) defines a motor vehicle action as an alcohol or drug
offense that affects your right to drive. Any official action
against your right to drive must be reported within 60 days to
the FAA Civil Aviation Security Division. Subsequent actions such
as convictions must also be reported. FAR 61.15(e) specifies the
required reports and procedures. Reference the FAA web page at
http://www.mmac.jccbi.gov/cas/duidwi
Diabetes
I've read that the FAA will allow Type I diabetics to fly now,
but they have to have a 5 year history of no hypoglycemic
episodes and good control. Anyone have first hand knowledge? We
really could use a bit of hope and good news here.
For everyone's information. Some of the first symptoms can include
a change in vision, persistent thirst, frequent urination
and lethargy. We dismissed the symptoms as jet lag and trying
to get acclimatized to the Australian summer.
Sorry to hear about your dilemma, ma'am. Agreeing with another
poster, though, sounds like the worst thing that could
happen would be that your husband will have to occupy the right
seat . . .as soon as you get off your bum and get YOUR
certificate. ;) Anyway, perhaps your regulations mirror the American
FAA in the following regard:
"General medical condition
This is the "catch-all" that applies to just about everything
that hasn't been specified in the previous sections. Diabetes
requiring insulin or other hypoglycemic drugs is listed here as
a disqualifying medical condition. Use of oral medications to
control blood glucose has been approved for many years under special
issuance. In late 1996, the FAA began considering
applicants who use insulin for diabetes management. The policy
currently allows only 3rd class certification, but 1st and 2nd
class issuance might be possible in the future. For applicants
who use diet or oral medications, an initial evaluation includes
reports of 3 monthly fasting blood glucose readings and a report
of glycohemoglobin (A1C). Certification is possible if there is
no evidence of significant organ disease and the blood glucose
levels indicate good control. "Good" control to the
FAA means a fasting blood glucose of no higher than 140 milligrams/deciliter
(mg/dl.) and an A1C glycohemoglobin of no more than 9%.
For insulin using diabetics, the process is more complex. A comprehensive past medical history and a detailed current clinical evaluation are necessary. These reports should confirm the absence of any recent significant diabetes-related events and no evidence of significant cardiovascular, kidney, retinal, or other organ disease. After approval is granted, the special issuance guidelines require pilots to monitor blood glucose (with an approved glucometer) before the flight begins, periodically during flight, and one half hour prior to landing. Although the process is complex and time consuming, special issuance medical certificates are being issued to a small but increasing number of applicants. (Detailed information about the special issuance process for diabetes and many other medical conditions can be obtained by calling the AOPA Medical Certification Department at 800-872-2672, by using the fax on demand service, 800-462-8329, (800 Go AvFax) and requesting documents in the 2000 range menu, or by visiting AOPA's web site at www.aopa.org.)
"No other organic, functional, or structural disease,
defect, or limitation." rounds out the regulation. The FAA
considers high blood pressure to be one of these organic conditions
and formulates a blood pressure certification "policy"
within the
regulation.
Regulations are codified in print for everyone to see and are
broad in scope. Policies, though, are based on operating
procedures known internally to the FAA and those outside the FAA
who find out about them on their own. Policies are
not necessarily secrets that only people with top security clearances
know about. The FAA just doesn't routinely volunteer
information about how a particular policy influences the certification
decision. "
"Diabetes Specifications
Initial and Follow-up
Pilots with a diagnosis of diabetes mellitus controlled by diet
alone are considered eligible for medical certification under
the revised Part 67 medical standards. Medical documentation as
described below is required at the time of examination. The aviation
medical examiner may issue a certificate to applicants with this
history, provided the necessary documentation is provided, and
they are otherwise qualified. Applicants who report using oral
medications may not be issued a certificate by the aviation medical
examiner. After initial clearance, the FAA may authorize the examiner
to issue future certificates, as long as there are no significant
adverse changes noted on the follow up reports.
Applicants who are controlling diabetes by diet or with oral
medications, including glucophage (metformin), or precose
(acarbose) will be expected to demonstrate for 60 days evidence
of adequate control, stabilization, and no evidence of
adverse side effects or complications from medication.
After the 60-day control period is completed, and within the next
30 days, a glycosolated hemoglobin (A1C) should be
done. Normal laboratory values for A1C hemoglobin will range from
about 4.0%-7.5%. The FAA will allow up to 9%.
There should also be no evidence of significant medical or surgical
complications, including cardiac, peripheral vascular,
renal, neurological, or ophthalmologic disease.
No beta-adrenergic blocking antihypertensive agents should be
used. These medications may increase blood glucose.
Minimum requirements for follow up evaluation will vary with the
class of medical certificate held. 1st and 2nd Class
certificate holders will usually be required to submit follow
up evaluations annually. 3rd Class holders will submit evaluations
at the time of their regular FAA medical renewal. Individual cases
may require more frequent evaluations based on case history. "
"Aeromedical Certification of Individuals with Insulin-Treated
Diabetes Mellitus
The FAA is now considering certification, under the Special Issuance
provisions of the Federal Aviation Regulations, of
some individuals with insulin-treated diabetes mellitus (ITDM).
The following restrictions apply:
ITDM individuals: may be issued only a third-class medical certificate;
may exercise only the privileges of a student,
recreational, or private pilot certificate; are prohibited from
operating an aircraft as a required crew member on any flight
outside the airspace of the United States of America; are required
to be in compliance with the monitoring requirements of
the protocol outlined below while exercising the privileges of
a third-class medical certificate. In order to be considered for
aeromedical certification, an individual with ITDM should have
been receiving appropriate insulin treatment for at least 6
months prior to submitting a request for medical certification.
Consideration will be given to individuals using a combination
insulin/oral medication regimen, however, Rezulin is not currently
considered an acceptable oral agent for combination use.
Additionally, the following criteria must also be met:
For initial certification:
Applicants must have no otherwise disqualifying conditions, especially
significant diabetes-related complications such as
arteriosclerotic coronary or cerebral disease, retinal disease,
or chronic renal failure, and must have had no recurrent (two
or more) hypoglycemic reactions within the past 5 years: that
resulted in a loss of consciousness or seizure; that required
intervention by another party; or that resulted in impaired cognitive
function which occurred without warning symptoms.
A period of 1 year of demonstrated stability is required following
the first episode of hypoglycemia. In order to provide an
adequate basis for an individual medical determination, the applicant
seeking special issuance of a medical certificate must
submit the following:
Copies of all medical records concerning the individual's diabetes
diagnosis and disease history and copies of all hospital
records, if admitted for any diabetes-related cause, including
accidents and injuries; Copies of complete records of any
incidents or accidents, particularly involving moving vehicles,
whether or not the event resulted in injury or property damage,
if due in part or totally to diabetes complications; Results of
a complete medical evaluation by an endocrinologist or other diabetes
specialist. This report should detail the individual's complete
medical history and current medical condition. The report must
include a general physical examination and the following:
Two measurements of glycated hemoglobin (total A1 or A1C concentration
and the laboratory reference normal range),
the first at least 90 days prior to the second measurement; (b)
A detailed report of the individual's insulin dosages (including
types) and diet utilized for glucose control; Appropriate examinations
and tests to detect any peripheral neuropathy or circulatory compromise
of the extremities and any other tests deemed necessary by the
treating specialist, or that are clinically indicated; and Confirmation
by an ophthalmologist of the absence of clinically significant
eye disease. The eye examination should assess visual acuity,
ocular hypertension, and presence of lenticular opacities, if
any, and include an
examination of the retina for evidence of any diabetic retinopathy
or macular edema. Individuals with active retinopathy or
vitreous hemorrhages will not be considered until the condition
has been confirmed as stabilized by an ophthalmologist.
If the applicant is age 40 or older, a report of a maximal graded exercise stress test, including ECG tracings. The applicant shall submit a statement from his/her treating physician, aviation medical examiner, or other knowledgeable person attesting to the applicant's dexterity and ability to determine blood glucose levels using a recording glucometer.
Verification that the individual has been educated in diabetes
and its control and has been thoroughly informed of and
understands the monitoring and management procedures for the condition
and the actions that should be followed if
complications of diabetes, including hypoglycemia, should arise.
The examining physician should also verify that the
applicant has the ability and willingness to properly monitor
and manage his or her diabetes.
The individual must agree to immediately report any adverse
medical changes to the FAA. Applicants shall maintain
appropriate medical supplies for glucose management while preparing
for flight and while exercising piloting privileges.
Such supplies shall include:
--a whole blood digital glucose monitor with memory;
--supplies needed to obtain blood samples and to measure whole
blood glucose;
--and an amount of rapidly absorbable glucose, in 10 gram (gm)
portions, appropriate for the planned duration of the
flight.
--All disposable supplies listed above must be within their expiration
dates.
Preflight:
Not more than ½ hour before takeoff, the pilot shall establish
and document a blood glucose concentration equal to or greater
than 100 milligrams/deciliter (mg/dl) but not greater than 300
mg/dl. If the concentration is within 100-300 mg/dl, flight operations
may commence. If less than 100 mg/dl, an appropriate glucose snack
(at least 10 gm.) must be ingested and a recheck done. If over
300 mg/dl, the flight must be postponed.
Inflight:
One hour into the flight, at subsequent hourly intervals,
and within one half-hour of landing, the pilot shall monitor the
blood glucose concentration. If the concentration is less than
100 mg/dl, a 20 gm snack shall be ingested. If the concentration
is between 100-300 mg/dl, no action is required. If the concentration
is greater than 300 mg/dl, the pilot must land at the nearest
suitable airport and may not resume flight until the glucose concentration
can be maintained in the 100-300 mg/dl range.
With respect to determining blood glucose determinations in flight,
the airman must use good judgment in deciding whether measuring
concentrations or operational demands of the flight environment,
such as adverse weather, air traffic control concerns, or engine
trouble should take priority. In cases where operational considerations
take priority, the airman should ingest a 10 gm glucose snack,
fly the airplane, and measure blood glucose concentrations one
hour later. If measurement is not practicable at that time, the
airman must ingest a 20 gm glucose snack and land at the nearest
suitable airport until a determination of the blood glucose concentration
can be made.
For subsequent recertification:
Individuals who are granted special issuance of third-class airman
medical certificates must: Submit to a medical evaluation by a
specialist every 3 months. This evaluation must include a general
physical examination, a review of the interval medical history,
and a report of glycated hemoglobin (total A1 or A1C) concentrations
and any other tests deemed necessary by the treating specialist
or that are clinically indicated. Also, the examining physician
must review the record of the airman's daily blood glucose measurements
and comment on the results. The evaluation shall also contain
an assessment of the individual's continued ability and willingness
to monitor and properly manage his or her diabetes and whether
the diabetes or its complications could reasonably be expected
to adversely affect the airman's ability to safely control an
aircraft.
Provide to the FAA, immediately upon request, a report by a specialist
or other physician, of any evidence of loss of diabetes control,
significant complications, or inability to manage the diabetes.
In such a case, the individual shall cease exercising the privileges
of his or her airman certificate until again medically cleared
by the FAA."
Marijuana
Studies have shown that even 24 hours after smoking a single marijuana
cigarette pilot skills are impaired. The pilot tests
found that skills were never to normal skill level when tested
at one, four and 24 hours after drug use. At one hour pilots
landed an average of 32 feet from the runway centerline. At 24-hours
the pilots made far more throttle and trim adjustments than usual.
It was the use of ailerons that showed the most change. On average the pilots made 76 aileron changes on approach and were off the centerline by 24 feet. Before smoking there were 60 changes of aileron and 12 feet off the centerline. Tests were not made beyond the 24 hour period.
Melanoma
Critical thickness is .75mm. Less has good prognosis
Hypoxia
vs Carbon Monoxide
A lack of oxygen is called hypoxia. Carbon monoxide causes a denial
of oxygen. Effectively, the results are identical to the
human body. The first means that there is no oxygen available,
and the second means that available oxygen is being replaced
by carbon monoxide.
Fatigue, excess weight, illness will increase the body's demand
for oxygen. A pilot is far more likely to encounter a carbon
monoxide situation than an hypoxia situation. Monoxide is odorless,
colorless, tasteless and invisible. It adheres to human
hemoglobin with 200 times more attraction than does oxygen. Once
attached it has a half-life of five hours. 10 PPM shows
no effects on humans. 15 PPM gives you a headache. 22 PPM causes
nausea, vomiting plus a headache. 30 PPM
increases the intensity of the illness. 35 PPM causes incapacity.
Any more renders a person unconscious or dead. At the
first symptoms open the windows, turn off the cabin heat, lean
the mixture and land. An extended period at low levels is
more insidious and deadly than are high levels. A digital CO2
read out device is available for $75 at www.Aeromedix.com
Precautions:
--Shut off heater and engine compartment openings
--Open window
--Use 100% oxygen if available
--Land as soon as possible
--Refer problem to maintenance
Highflyer wrote:
I have found that a flushed face, deepening of the rosy color
under your fingernails, and a growing nausea to be pretty
good indicators in my case. It does take a while to recover from
CO poisoning. I
believe you have to MAKE new red blood cells to replace the ones
that are permanently bound by the CO molecule.
David Rind wrote:
You do not have to actually make new red blood cells. CO binds
extremely strongly to hemoglobin, but over time it does dislodge.
This process can be sped up by increasing the partial pressure
of oxygen to try to get the O2 to displace the CO. 100% O2 at
increased pressure (such as in a hyperbaric chamber) will lower
CO levels reasonably quickly..
Sound
Mechanical radient energy transmitted by variation in air
pressure different from ambient pressure. Hearing is the ability
to
sense these pressures and associated variables of frequency, intensity
and duration. Frequency of the pressure waves gives
sound its pitch. Pitch is measures in wave oscillations per second
called (Hz) hertz. The intensity of a sound is a measure
of pressure level. Hearing loss is measured from a threshold of
25 dB. Duration is a time measure of the sound. Hearing
damage results from a combination of these three elements.
Hearing
--Second to vision in acquiring critical information
--Variables of sound are in frequency, intensity and duration
--Conversation frequency range from 500 to 3000 Hz
--Over 90 dB will accumulatively damage hearing above 4000 Hz
--Hearing protection needed at 90 dB and louder
--Active noise reduction is effective against low-frequencies
--Moaaaaaaldable earplugs lose over 30 dB over all frequencies.
--Hearing sensitivity decreases with age from above 30 years old.
Noise
--Noise is unpleasant, loud , unwanted and annoying.
--Aircraft noise comes from ;elngines, propellers, rotors, alarms,
monitors and air movements
--A pilot learns to differentuate between types of noises the
good, bad, and useful.
Noise
Effects
--Causes distraction, fatigue, irritable, startle responses, loss
of sleep, loss of appetite, headache, vertigo, nausea, and
affects concentration and memory.
--Interferes with ability to understand speech
--Increases errors in tasks requiring vigilance, concentration,
calculations and time awareness
Hearing
Damage
--Temporat impairment at 90 dB for several hours
--Permanent impairment at 90 dB 8-hours per day for several years
--Discomfort occurs above 120 dB
--Pain above 130 dB
--Eardrum rupture above 140 dB
Alcohol
--Over 50% of Am,erican adults consume alcohol
--Per capita use is 25 gallons per year
--Wine and beer are mostliked and used
--Alcohol content of a beverage is 'Proof" divided by 2 =
% alcohol
--Alcohol is a sedative, hypnotic and addicting
--Critical effects of alcohol are to the brain, eyes, and inner
ear
--Brain effects include impaired reactions, reasoning, judgment
and memory
--Altitude exacerbates the negative effects above on the brain.
--Visual symptoms have to do with eye muscle imbalance, double
vision and inability to focus.
--Inner ear effects are dizziness and lack of perception. (Why
drinking parties are loud)
--Toxic effects determined by gender, body weight, time and amount
--Rate of elimination is constant at 1/3 oz. per hour
--After effects of alcohol can extend 48 to 72 hours as a hangover
--Experience has no effect on the accident potential
--Pilot skills are affected at .025% blood alcohol and decrease
dramatically at.04%.
--A hangover may be as hazardous as the alcohol level that occurred
previously.
--Hangover symptoms are headache, dizziness, dry mouth, stuffy
nose, fatigue, upset stomach, irritability,
impaired judgment and bright light sensitivity.
--FAA perceives a pilot with a hangover as being under the influence.
FAR 91.17 prohibits aircraft operation….
--within 8 hours of consuming alcohol
--under the influence of alcohol
--With blood alcohol of 0.04% or greater
--Using any drug that affect safety
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