Aeromedical Certification of Aircrew and Controllers with Renal Calculi

Abstract

Acute renal colic is an incapacitating condition. Advances in understanding the pathogenesis of calculi and their detection and treatment require a new approach to aeromedical risk assessment. Can this new information support the stratification of aeromedical risk into "High" and "Low" categories, and fulfill the paramount responsibility of the Civil Aviation Safety Authority, Australia's aviation regulator, which isthe maintenance of aviation safety? This article reviews the epidemiology of calculi and finds 2-10% annual risk of a symptomatic event following incidental detection of a calculus. While calculi 4 mm or less in size may not require surgical intervention, this does not equate to a pain-free passage. Similarly, calculus recurrence rates may vary in different anatomical locations, but no location can be considered "safe." The recognition of parenchymal calcification and Randall's plaques as precursors to the development of calculi places such individuals at elevated risk of developing calculi. More recently evidence has supported a link between metabolic syndrome and calculus formation. In an occupational group where there is potential for elevated radiation exposure, appropriate imaging is of particular importance. CT, X-ray, and ultrasound modalities are reviewed with recommendations presented for aeromedical assessment and surveillance based on identification of those at high risk of colic and minimization of investigational radiation exposure.

Trends in Sudden Cardiac Death in Pilots: A Post COVID-19 Challenging Crisis of Global Perspectives (2011-2023) - A Systematic Review and Meta-Analysis

“…Healthcare providers should be trained in the application of the protocol and the interpretation of biomarker results. Regular monitoring and evaluation of the protocol’s impact on SCD incidence and aviation safety are essential to ensure its effectiveness and identify areas for improvement (36).…”

“…However, the benefits of enhanced aviation safety and the prevention of SCD in pilots far outweigh these challenges. Aviation regulatory bodies and airlines should work together to address these barriers and ensure the effective implementation of the protocol (35).…”

The clinical, occupational and financial outcomes associated with a bespoke specialist clinic for military aircrew—a cohort study

“…However, given the high medical standards required of military aircrew to perform their duties and the PMEs, which include a physical examination and screening ECG, that are performed, it is perhaps less surprising that the majority of referrals are cardiological and that early manifestations of clinical disease are uncovered and consequently referred. Cardiovascular disease, ophthalmology and renal medicine have a major impact on aviation medical certification in the civilian world [23][24][25] and welldefined algorithms have been developed for aviation medical 20 and other regulatory organizations. 26 What is less clear in the literature is the overall burden of pathology in military aircrew or whether a dedicated specialist service can deliver cost-effective and timely advice.…”

Fortalecimiento del proceso de certificación aeromédica en la Fuerza Aérea colombiana

“…Así se puede determinar qué exámenes son importantes y cuáles pueden ser eliminados en un proceso de recertificación. Como ejemplo, está el estudio Aeromedical Certification of Aircrew and Controllers with Renal Calculi (Drane et al, 2013), en el cual se establece una estratificación del riesgo a partir de la aplicación de un algoritmo que tiene en cuenta dentro de sus variables el tipo de vuelo (solo, cabina múltiple), para facilitar el proceso de toma de decisiones con respecto a la certificación.…”