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An aviation researcher, writer, aviation participant, pilot & agricultural researcher. Author of over 35 scientific publications world wide.

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2015 changes to DAME Handbook

2015 changes to DAME Handbook

The problem of CASR part 61 continues, with unknown changes to Class 2 medicals and the private pilot caught in an ever widening web by CASA, as well as it’s focus group of commercial pilots [CPL]

The so-called use of evidence based medicine is horrific, as CASA Aeromed can over ride this if they “…believe…” they know better.

The ignoring of competent specialist reports is one area that beggars belief.

The previous head of aviation medicine in CASA [Pooshan Navarthe] who has now departed the scene. Navarthe leaves behind a series of decisions that are complex and difficult, if not impossible to interpret.

As Part 61 staggers forward under it’s weight of words and micro-management, the effectiveness is also negatively affected by the AVMED section who in general are slow to respond and have a variable response to requests for clarification or simply overturn reasonable specialist reports.

 The latest requirements are here:

casa dame

 Aeromedical Decision Making (ADM) at CASA

The interrelationships of CASA with DAMEs and clinical specialists

1. The medical practitioners involved directly in the Australian medical certification system include over 700 DAMEs spread throughout Australia and overseas and the medical staff of the CASA Office of Aviation Medicine. The role of the DAMEs is to carry out a focused examination, and provide the information to CASA. The medical officers at CASA review the information received from the DAMEs and make a regulatory decision as to whether, on the evidence available, an applicant is entitled to the issue of a medical certificate under Part 67 of the Civil Aviation Safety Regulations 1988. The CASA medical certification system also utilises the opinions of a wide variety of clinical medical specialists such as psychiatrists, neurologists, and cardiologists.

CASA’s Decision making

2. CASA’s aeromedical decision making is collegial and evidence based.

Collegial

3. The collegial aspect of the process involves using more than one medical officer in the consideration of complex cases. Those medical officers seek to achieve consensus with respect to the final conclusion, through a process called Complex Case management (CCM). This consists of peer review of complex cases, with each doctor annotating his/her comments. These are then discussed at a special meeting convened for this purpose (CCM meeting). This component of the philosophy is intended to ensure consistent outcomes, provide a degree of internal peer review and focus a high level of aviation medical expertise onto the case.

Evidence based

4. The evidence based aspect of the process is directed to ensuring that wherever possible and appropriate the relevant medical and scientific research literature is searched, reviewed and applied to the considerations of the case.

5. In assessing the evidence in support of any decision making, CASA uses the hierarchy of evidence provided by the National Health and Medical Research Council (NHMRC), which largely mirrors the hierarchies of many other august bodies internationally. A diagrammatic representation of this hierarchy is shown below:

NHMRC Hierarchy of evidence

6. By the very nature of the studies, any systematic reviews take time, and therefore will often deal with studies that are a few years “out of date”. This is recognised in the formation of these hierarchies, as the value of the rigorous review outweighs the recency of the information.

7. Additional medical clinical specialists, or others, may also be consulted to add clinical and other experience and expertise to the pool of information under consideration. In some medical conditions the published material has limited relevance to aviation considerations, and it may be necessary to take recourse to material presented at conferences.

8. Medical evidence is rarely perfect, or does not always perfectly relate to the case under consideration. Recognising the imperfection of medical evidence, CASA takes a view that medical evidence should not be ignored because of its imperfection, but that the best available medical evidence should be applied to a case in a reasonable manner. This may sometimes involve generalising or extrapolating findings from the medical literature.

Consulting Clinical Specialists and experts

9. Clinical medical specialists (e.g. cardiologists, neurologists, psychiatrists) are regularly consulted in relation to regulatory aviation medical considerations. In general, clinical specialists are consulted for advice about the diagnosis or prognosis of the medical condition under consideration.

10. In some cases CASA is presented with different opinions from different medical specialists. This most frequently occurs in the context of a disputed decision where an applicant subsequently engages clinical specialists to provide opinions, but it can and does happen even in opinions sought by CASA to assist in its decision making. When this occurs, CASA balances and weighs the various opinions in reaching a final decision concerning the case.

11. If a clinical specialist provides an opinion about eligibility or CASA medical policy, that opinion is considered in the context of the specialist’s experience and expertise in relation to aviation medicine and aviation medical certification decision-making.

Reconsiderations

12. Whenever a reconsideration is carried out, advice is obtained from the CCM. Where the decision was originally made through a CCM process, advice from an external expert is taken, and the expert participates in the collegial discussions during the CCM meetings.

Making Decisions

13. The civil aviation regulatory system requires decisions to be made in response to applications, and does not allow the luxury of waiting until more science is available. It requires those decisions to be both reasonable, and made in a timely manner. This, coupled with the sometimes varying medical history and specialist medical advice, leads to a situation where decisions made may be based on imperfect or contradictory information. In all cases, CASA’s approach is to make the best decision in the interest of public safety, based on the information available.