The Empire Strikes Back! on Colour Defective Pilots
Join Date: Oct 2010
Location: Styx Houseboat Park.
Posts: 2,055
Likes: 0
Received 0 Likes
on
0 Posts
Now is the time....
Creampuff –"I'm doing as much as I can (making submissions and writing letters) to express support for CVD pilots and abject disappointment at the regulator's actions."
As CP suggests, 'we', the ills of society (IOS) should do what we can; if you decide to weigh in and send a letter to your local member, do not hesitate to copy (plagiarise) some of the very good work done in the TAAF, AIPA, AFAP or VIPA letters. A letter to not only support the CVD tribe, but the TAAAF suggested strategy is better. There are many good reasons for you to do so and it only requires 20 minutes to draft a half decent letter and email it. Here's one reason:-
The latest letter to Bill Smith very neatly displays one of the most despicable lines of attack CASA will use. It has been used numerous times and is a proven winner; essentially it goes like this. Bill, at next medical requiring an 'eye' test fails to meet the latest CVD standard; or, maybe even without a 'test', his show cause will be worded to declare him a 'danger to navigation', because of his CVD, by CASA 'expert' opinion and given a show cause; just like that. Unbelievable you all shout; no says I; true dat and very provable.
No; don't laugh – there are no 'guidelines' or constraints on this 'being a danger' line getting trotted out, as and when required along with the infamous Not a Fit and Proper. All that it needs is someone to sign the letter. They don't have to prove or justify making this statement, just an opinion passed into 'fact' and produced as evidence. Honourable men made the provision in law, but in the hands of the less honourable it becomes a lethal weapon, which can be and is used with complete impunity...
I could find at least ten prime examples and as many again which would serve to illustrate; some are extraordinary. There's one I've seen, from the PMO as it happens, which would rock you, although the gent concerned would not thank me for making it public. So just take my word for it when I say you can very easily be declared a 'danger' and given a show cause. This means that you have to prove your 'innocence' in an AAAT hearing.
"CASA declare you a danger Mr. Smith, what say you?.
"No I'm not, I've a 20 year accident and incident free history, so I'm safe as houses".
"Sorry, the expert from the government safety authority says you are not, my hands are tied, I uphold the administrative decision; off to the dole queue for you, my dangerous friend".
The AAT are 'administrative' : must 'stand in the shoes of the regulator' and are not concerned with the niceties of evidence. Some of the most outrageous fairy tales ever told have been spun, polished and embellished through the AAT system. Mind you, in their (AAT) defence I notice lately that the 'Members', particularly in WA are onto the CASA game and seem to be getting a little tired of it.
Pragmatically the odds are in favour of Bill not being 'declared' and the AAT would probably stand by the previous findings; but who knows. The Shambollic system is extraordinarily litigious, dangerous and just at the moment, desperate enough to try it on. Your loss of time and money, your inconvenience and misery, don't trouble them at all. The fact that while the wretched process drags on your life is a living hell; or, that living with an axe over your head spoils quality time at home and is, of itself, creating a danger to navigation through a tired, irritable, distracted pilot being on the job, just don't signify..- Here- for an example of a stress related mishap.
It would be a fairly simple matter to copy, paste and CC a copy of the AIPA, AFAP, VIPA letters and TAAAF statement to your local member; perhaps adding a sentence of support for the stance taken by the industry associations who care.
So do what you can, where you can if not for the CVD tribe, then for yourself. I'll let Creamy do the closing remarks.
Everyone must step up and express support for CVD pilots. Don't watch from the sidelines people, or you'll be next: An isolated minority, grounded and bankrupt at the whim of an 'expert' with a populist theory to prove, despite the evidence.
Last edited by Kharon; 26th Jun 2014 at 02:03. Reason: Suspect CP is doing a little more than he modestly claims, over and above the call of duty.
Administratively embuggered.
The Kharon post & Creamy quote (below) should be very carefully read in combination with Bill’s latest PMO correspondence by all CASA medical certificate holders, which includes ATC, aircrew (backenders) and anyone dependent on a valid MC as a condition of their employment.
CP (my bold)
IMO there is no question that while the current (DAS sanctioned) PMO remains in position he will continue to hold this ‘beyond all sensible reason’ approach to CVD pilots. Why? He is merely following his former colleague, mentor and ex-pat (bloody traitor) Watto’s approach to the issue (link for NZed CAA Notice of Proposed General Directions Impaired Colour Vision GD/VIS/01/2013.1 of [DATE] 2013):
Class 1
(c) assess the applicant for a class 1 medical certificate as having a colour
vision deficiency that is of aeromedical significance, or
(d) assess the applicant for a class 1 medical certificate as having a colour
vision deficiency that is not of aeromedical significance only if the medical
certificate that is issued is endorsed with the following restrictions —
(i) Not valid for air operations carrying passengers; and
(ii) Not valid for night flying; and
(iii) Not valid for flight under Instrument Flight Rules; and
(iv) Not valid for flight in the vicinity of a controlled aerodrome unless the
aircraft is in radio contact with aerodrome control; and
Class 2
(e) assess the applicant for a class 2 medical certificate as having a colour
vision deficiency that is of aeromedical significance, or
(f) assess the applicant for a class 2 medical certificate as having a colour
vision deficiency that is not of aeromedical significance only if the medical
certificate that is issued is endorsed with the following restrictions —
(i) Not valid for night flying; and
(ii) Not valid for flight under Instrument Flight Rules; and
(iii) Not valid for flight in the vicinity of a controlled aerodrome unless the
aircraft is in radio contact with aerodrome control;
However, as Creamy & Kharon highlight, it will not stop at CVD if the PMO has his way and is not replaced ASAP.
Referring to the meeting minutes of the NZed CAA ACMLG (THE AVIATION COMMUNITY MEDICAL LIAISON GROUP - 11 March 2014), you will see several references to CVD, example:
There is also a reference to AOPA and their ASRR submission:
However one of the more interesting discussions was on the avmed issue of Sleep Apnoea:
Now I would suggest that there is a high probability that OSA will be the next aeromed issue that Associate Prof Shambolic will be banging on and on about, with Dear Watson providing the lead for future pineappling of all pilots.
While on my Dear Watson, and in regards to Creamy’s post #247, apparently in 2010 Watto won the Boothby-Edwards Award… ‘for outstanding research and/or clinical practice directed at the promotion of health and prevention of disease in professional airline pilots’.
Which you can read all about on pdf page 6-7 of the Aviation, Space, and Environmental Medicine ( Vol. 81, No. 7 July 2010)journal. However I want to focus on just one paragraph in the rather large list of achievements of our Dear Watson:
Q/ If Dear Watson was so outspoken in the argument against the old ICAO “age 60 rule”, I wonder if he was then also instrumental in putting in place the onerous, costly, over the top, medical recertification that all professional pilots now must subject themselves to if they wish to continue in their profession beyond age 60??
{Comment: I would suggest that, much like Bill’s letter, every time an over 60 ATPL/CPL pilot signs his/her recertified medical they are also effectively green lighting a possible future FF SCN enforcement action.}
Note with passing interest…that our ‘dearly beloved’ STBR DAS also claims to have been involved in the beyond age 60 rule...
"..Mr McCormick : I appreciate what you are saying. As I said we can move forward with the science and with what we know—in other words, empirical and the other types of evidence we can gather. As far as doing that now and why we have not gone and done it, it is because we are looking at a very small number of pilots compared with the population of pilots in Australia. It comes down to resources. I cannot fund a study into colour vision deficiencies moving forward. As for increasing the age to 65, many countries in the world are involved in that. I was involved in that outside of Australia. In fact the interesting thing, just as an aside, is that one of the few countries that opposed it was an African country, where they pointed out that with the age of 60 for a commercial pilot now, their average life expectancy was 58, so what was the point of putting it up to 65. So there has been a great deal of discussion around the world about age. I agree that when it comes to treating depression—and Professor Navathe may wish to add more—we have done very well. There are people flying in Australia who I know would not fly in other jurisdictions. And I think it is a worthwhile project to review colour vision deficiencies and to review the data we have. I just cannot fund it and it is not a high priority to me..."
So take heed of what Creamy & Kharon are forewarning, because these sociopath, Mephistophelian, Messiah syndrome, bureaucrats will not stop at CVD, it is simply not in their nature…
MTF…
Addendum
Good timing CVDPA...
: Further Enlightenment
And excellent (on behalf of) submission PAIN..: Professional Aviators Investigative Network. Supplementary submission-2.Prepared for CVDPA.
CP (my bold)
Everyone must step up and express support for CVD pilots. Don't watch from the sidelines people, or you'll be next: An isolated minority, grounded and bankrupt at the whim of an 'expert' with a populist theory to prove, despite the evidence.
Class 1
(c) assess the applicant for a class 1 medical certificate as having a colour
vision deficiency that is of aeromedical significance, or
(d) assess the applicant for a class 1 medical certificate as having a colour
vision deficiency that is not of aeromedical significance only if the medical
certificate that is issued is endorsed with the following restrictions —
(i) Not valid for air operations carrying passengers; and
(ii) Not valid for night flying; and
(iii) Not valid for flight under Instrument Flight Rules; and
(iv) Not valid for flight in the vicinity of a controlled aerodrome unless the
aircraft is in radio contact with aerodrome control; and
Class 2
(e) assess the applicant for a class 2 medical certificate as having a colour
vision deficiency that is of aeromedical significance, or
(f) assess the applicant for a class 2 medical certificate as having a colour
vision deficiency that is not of aeromedical significance only if the medical
certificate that is issued is endorsed with the following restrictions —
(i) Not valid for night flying; and
(ii) Not valid for flight under Instrument Flight Rules; and
(iii) Not valid for flight in the vicinity of a controlled aerodrome unless the
aircraft is in radio contact with aerodrome control;
However, as Creamy & Kharon highlight, it will not stop at CVD if the PMO has his way and is not replaced ASAP.
Referring to the meeting minutes of the NZed CAA ACMLG (THE AVIATION COMMUNITY MEDICAL LIAISON GROUP - 11 March 2014), you will see several references to CVD, example:
GENERAL DIRECTIONS COLOUR VISION DEFICIENCY – Appendix II
Dougal discussed his handout. It was taking a long time for the consultation to conclude due to the GD extension periods. Dougal had written a paper in the Blue Journal (the Official Journal of the Aerospace Medical Association) which looks at variation and disposition throughout the world. Colour vision deficiency can be caused by injury, congenital disease or surgery. The wide
range of deficiencies result in different outcomes making it a complex issue. Colour vision issues may not need to come through AMC and therefore could be handled by the Medical Examiner.
Dougal discussed his handout. It was taking a long time for the consultation to conclude due to the GD extension periods. Dougal had written a paper in the Blue Journal (the Official Journal of the Aerospace Medical Association) which looks at variation and disposition throughout the world. Colour vision deficiency can be caused by injury, congenital disease or surgery. The wide
range of deficiencies result in different outcomes making it a complex issue. Colour vision issues may not need to come through AMC and therefore could be handled by the Medical Examiner.
Medical Application Fee
AOPA members wondered why has OMCS been dropped? Why are we paying for things outside certification? AOPA were not successful in their appeal to the Aviation Safety Regulation Review panel. They thought a statute had been breached. The Group feels that we will lose pilots and lose aeroclubs due to the high CAA medical fee. Pilots shouldn’t be paying for the bigger picture.
AOPA members wondered why has OMCS been dropped? Why are we paying for things outside certification? AOPA were not successful in their appeal to the Aviation Safety Regulation Review panel. They thought a statute had been breached. The Group feels that we will lose pilots and lose aeroclubs due to the high CAA medical fee. Pilots shouldn’t be paying for the bigger picture.
Assessing against the standard of aeromedical significance. In the example of OSA (obstructive Sleep Apnoea) this does mean more screening or using CV risk to go down that path. As yet, no decision has been made (CASA has a different approach). It was agreed that we need to ensure a fatigue risk management system is in place, easy to diagnose, easy to treat. There are a significant number of OSA cases seen and once diagnosed and treated the buy in is excellent.
This is due to the transformation of their life post treatment. Once diagnosed it is usually an effective fix.
The Group discussed the difficulty in screening everybody with a BMI of 30, 32 or 40. Is there a problem with people falling asleep in the aircraft?
The Group proposed a Collection of data to support OSA being of aeromedical significant based on accident statistics.
Dougal suggested that analyzing in this way is problematic because the OSA may not be the sole reason for an accident. This correlates with the road statistics and co morbidity conditions.
Claude concluded that scoring systems could be an option eg; neck circumference, present symptoms, etc. Presently this is not in any guidelines and it would require consistency.
Tim advised that at Emirates, any pilot with a BMI over 35 is grounded (based on 75% risk of OSA). Benchmark of normal BMI is around 25.
This is due to the transformation of their life post treatment. Once diagnosed it is usually an effective fix.
The Group discussed the difficulty in screening everybody with a BMI of 30, 32 or 40. Is there a problem with people falling asleep in the aircraft?
The Group proposed a Collection of data to support OSA being of aeromedical significant based on accident statistics.
Dougal suggested that analyzing in this way is problematic because the OSA may not be the sole reason for an accident. This correlates with the road statistics and co morbidity conditions.
Claude concluded that scoring systems could be an option eg; neck circumference, present symptoms, etc. Presently this is not in any guidelines and it would require consistency.
Tim advised that at Emirates, any pilot with a BMI over 35 is grounded (based on 75% risk of OSA). Benchmark of normal BMI is around 25.
While on my Dear Watson, and in regards to Creamy’s post #247, apparently in 2010 Watto won the Boothby-Edwards Award… ‘for outstanding research and/or clinical practice directed at the promotion of health and prevention of disease in professional airline pilots’.
Which you can read all about on pdf page 6-7 of the Aviation, Space, and Environmental Medicine ( Vol. 81, No. 7 July 2010)journal. However I want to focus on just one paragraph in the rather large list of achievements of our Dear Watson:
Other areas he has addressed include in-flight medical events in long-haul flying (a major concern for Air New Zealand) and considerations related to age- or individually determined criteria for retirement of airline pilots, where he marshaled arguments against the arbitrary “age 60” rule then extant in the U.S.
{Comment: I would suggest that, much like Bill’s letter, every time an over 60 ATPL/CPL pilot signs his/her recertified medical they are also effectively green lighting a possible future FF SCN enforcement action.}
Note with passing interest…that our ‘dearly beloved’ STBR DAS also claims to have been involved in the beyond age 60 rule...
"..Mr McCormick : I appreciate what you are saying. As I said we can move forward with the science and with what we know—in other words, empirical and the other types of evidence we can gather. As far as doing that now and why we have not gone and done it, it is because we are looking at a very small number of pilots compared with the population of pilots in Australia. It comes down to resources. I cannot fund a study into colour vision deficiencies moving forward. As for increasing the age to 65, many countries in the world are involved in that. I was involved in that outside of Australia. In fact the interesting thing, just as an aside, is that one of the few countries that opposed it was an African country, where they pointed out that with the age of 60 for a commercial pilot now, their average life expectancy was 58, so what was the point of putting it up to 65. So there has been a great deal of discussion around the world about age. I agree that when it comes to treating depression—and Professor Navathe may wish to add more—we have done very well. There are people flying in Australia who I know would not fly in other jurisdictions. And I think it is a worthwhile project to review colour vision deficiencies and to review the data we have. I just cannot fund it and it is not a high priority to me..."
So take heed of what Creamy & Kharon are forewarning, because these sociopath, Mephistophelian, Messiah syndrome, bureaucrats will not stop at CVD, it is simply not in their nature…
MTF…
Addendum
Good timing CVDPA...
: Further EnlightenmentAnd excellent (on behalf of) submission PAIN..
: Professional Aviators Investigative Network. Supplementary submission-2.Prepared for CVDPA.Last edited by Sarcs; 26th Jun 2014 at 04:43.
Choccy frog to whoever’s the first to nominate the authors of the paper that says this in the Conclusion:
The existence of a colour vision standard inherited from 19th century marine navigation and collision avoidance rules is not “high level evidence” of the efficacy of that standard when applied to pilots in the 21st century. Facts like the actual safety record of hundreds of CVD pilots over decades and tens of thousands of hours do count as “high level evidence”.
… Despite the growth and acceptance of evidence-based practice throughout most fields of medicine, we still find ourselves routinely using the lowest level of evidence (expert opinion, unsupported by a systematic review) for regulatory aeromedical decisions. Such decisions are often not based on the explicit acceptance of any particular level of aeromedical risk. ...
A cornerstone of a successful future for regulatory aviation medicine is consistent decision making by Licensing Authorities using high-level evidence. …
A cornerstone of a successful future for regulatory aviation medicine is consistent decision making by Licensing Authorities using high-level evidence. …
Another choccy frog to whoever’s the first to correctly guess the missing words from this extract from an ATSB report:
It is readily apparent from this data set that the majority of in-flight medical and incapacitation events in Australian civil pilots for the study period were due to […guess what…], most commonly associated with […guess what…].
Choccy frog please!
'Gastro' & 'food poisoning'
And the quote was derived from this research paper...
Pilot Incapacitation:Analysis of Medical Conditions Affecting Pilots Involved in Accidents and Incidents1 January 1975 to 31 March 2006
Don't give the PMO anymore ideas Creamy, he'll have all pilots being fed from sanitized IV tubes next..
And the quote was derived from this research paper...
Pilot Incapacitation:Analysis of Medical Conditions Affecting Pilots Involved in Accidents and Incidents1 January 1975 to 31 March 2006
Don't give the PMO anymore ideas Creamy, he'll have all pilots being fed from sanitized IV tubes next..
Another choccy frog please!
Arthur, Creamy is referring to my original link.. Aviation, Space, and Environmental Medicine ( Vol. 81, No. 7 July 2010)...which if you read above the part that I quoted has this to say with a reference:
"In 2004, he presented to the AsMA meeting his expert views on evidence-based risk management, followed by publication of a landmark paper on that topic in Aviation, Space, and Environmental Medicine (Aviat Space Environ Med 2005; 76:58–62)."
If you then follow the link to its penultimate conclusion you will be led to this paper: Safety Management as a Foundation for Evidence-Based Aeromedical Standards and Reporting of Medical Events
Where you will find both the relevant (original quote) & the authors names:
Authors: Evans, Anthony D; Watson, Dougal B; Evans, Sally A; Hastings, John; Singh, Jarnail; Thibeault, Claude
Conclusions
Despite the growth and acceptance of evidence-based practice throughout most fields of medicine, we still find ourselves routinely using the lowest level of evidence (expert opinion, unsupported by a systematic review) for regulatory aeromedical decisions. Such decisions are often not based on the explicit acceptance of any particular level of aeromedical risk. Without guidelines concerning acceptable risk levels, and with reliance on expert opinion for individual aeromedical decisions, consistent decision making is impeded, and comparisons between States are more difficult.
Interestingly enough, in further explanation of EBAS, the same author wrote his own paper that better explains the principles of EBAS &
risk management, titled - Aeromedical Decision-Making: An Evidence-Based Risk Management Paradigm. Which you can download here...
AP the following is also of interest in light of ADM, you will see a reference to the 1% rule and that same author gets a mention (Note: A 2010 publication):
Further relevant links:
Pilot Incapacitation: Debate on Assessment, 1% Rule etc.
Pilot Incapacitation: Extent of the Problem.
Pilot Incapacitation: What is?
MTF...
"In 2004, he presented to the AsMA meeting his expert views on evidence-based risk management, followed by publication of a landmark paper on that topic in Aviation, Space, and Environmental Medicine (Aviat Space Environ Med 2005; 76:58–62)."
If you then follow the link to its penultimate conclusion you will be led to this paper: Safety Management as a Foundation for Evidence-Based Aeromedical Standards and Reporting of Medical Events
Where you will find both the relevant (original quote) & the authors names:
Authors: Evans, Anthony D; Watson, Dougal B; Evans, Sally A; Hastings, John; Singh, Jarnail; Thibeault, Claude
Conclusions
Despite the growth and acceptance of evidence-based practice throughout most fields of medicine, we still find ourselves routinely using the lowest level of evidence (expert opinion, unsupported by a systematic review) for regulatory aeromedical decisions. Such decisions are often not based on the explicit acceptance of any particular level of aeromedical risk. Without guidelines concerning acceptable risk levels, and with reliance on expert opinion for individual aeromedical decisions, consistent decision making is impeded, and comparisons between States are more difficult.
Interestingly enough, in further explanation of EBAS, the same author wrote his own paper that better explains the principles of EBAS &
risk management, titled - Aeromedical Decision-Making: An Evidence-Based Risk Management Paradigm. Which you can download here...
AP the following is also of interest in light of ADM, you will see a reference to the 1% rule and that same author gets a mention (Note: A 2010 publication):
Unravelling ADM (Aeromedical Decision Making) Categories: ADM
by Av Med
Aeromedical Decision Making (ADM) is a paradigm, a template and a tool. ADM as a paradigm presently consciously practiced by Civil Aviation Authority, New Zealand; and it is a logical template to be applied by other regulators as well, while it is a useful tool in the hands of Aviation Medical Examiners (AME).
To unravel ADM, one needs to first understand that this is an amalgamation of two concepts: evidence-based medicine (EBM) and structured risk management. The aim of ADM, in the context of regulatory medical licensing, is to ensure assessment of individual fitness for aviation duties without compromising the aviation safety. Meaning thereby, that irrespective of the fitness awarded, the possibility of subtle or sudden incapacitation in flight is not likely to jeopardize the safety of flight, with existing safety measures in place: be it the presence of a second pilot, or applying the prevalence rates of illness/disease in the population, or aircraft automation like audio-visual warnings or auto-pilot, or applying the airmanship or crew resource management principles or any other safety mechanism. It must be understood though, that while evaluating a disability, the available safety mechanism listed above are not considered (except applying the 1% rule for multi-crew operations only), except the professional responsibilities of the pilot under assessment; however the restrictions imposed on the pilot, in case of disabilities, may consider the safety mechanisms listed above.
Let us first understand the concept of Risk Management [1]. The broad elements of Risk Management are: establishing the context, risk assessment (by identification, analysis and evaluation) and risk treatment.
These elements of Risk Management are continuously governed by two vital processes throughout: “monitoring and review” and “communication and consultation” [1]. Without delving into these self-explanatory concepts, it is important to understand that this paradigm of systematic risk management is useful for the ADM as well. In case of ADM, acceptable parameters are required for defining the context, broad risk assessment is undertaken by identifying/defining the risks requiring observation/ intervention/management, to enable the analysis of the disease/disability, its management and the operational (read aviation) environment; for an evaluation of acceptable or non-acceptable risks under operational environment, to finally define the flying fitness (unrestricted or with limitations) or denial of it.
Now to answer as to how does EBM help in ADM? It is said that “the practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research” [2]. Furthermore, it is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” [2]. It is important here to understand the broad meaning of the word ‘care’ in the context of aviation regulatory functions. It starts with the AME and the individual’s family/general physician (if both are not the same, which may be the case many a times) who have to responsibility of offering the best available treatment in case of a disease/disability to their pilot-patient. It then extends to the medical regulators, who determine the status of such an individual pilot for determining his/her fitness for aviation duties. To quote, Sackett et al, “Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients’ predicaments, rights, and preferences in making clinical decisions about their care [2]”. This has to be extended, where the vital principles of EBM viz. individual patient’s predicaments, rights and preference, need to be applied by the regulators while evaluating fitness of a pilot. It is important that EBM is applied holistically by all concerned and not in an arbitrary or piece meal manner.
Therefore, it has to become a conscious practice by all those who are party to the ADM process determining the medical fitness of pilots for aviation duties.
There are certain pitfalls in applying ADM, the biggest being the absence of evidence pertaining to the niche population of pilots. But as 1% rule, initially propounded for assessment of cardiovascular morbidity based on the data from the age and sex matched population [3], has proven its usefulness as a rule of thumb in determining the fitness in case of multi-crew operations; it is envisaged that the principles of ADM, if applied earnestly, shall provide fair, just and transparent outcomes. Thus ADM, in the context of the regulatory purposes, is to align itself with the due scientific basis of EBM within the structured risk management paradigm. So also it is the onus of the AME/medical licensing authority to apply the current best evidence, within the structured risk management processes to provide the “reasonable, replicable and reviewable” [4] fitness outcomes for the benefit of the individual pilot without compromising aviation safety.
References
1. ISO 31000: 2009: Risk Management Principles and Guidelines [Abstract at http://www.iso.org/iso/catalogue_detail?csnumber=43170]
2. Sackett DL, Rosenberg WMC, Gray JAM, Hynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ 1996; 312: 71.
3. Evans ADB. International regulation of medical standards. In Rainford DJ, Gradwell DP (editors) Ernsting’s Aviation Medicine. Fourth Ed. Hodder Arnold: London; 2006: 547-566.
4. Watson DB. Aeromedical decision-making: an evidence-based risk management paradigm. Aviat Space Environ Med 2005; 76: 58-62.
by Av Med
Aeromedical Decision Making (ADM) is a paradigm, a template and a tool. ADM as a paradigm presently consciously practiced by Civil Aviation Authority, New Zealand; and it is a logical template to be applied by other regulators as well, while it is a useful tool in the hands of Aviation Medical Examiners (AME).
To unravel ADM, one needs to first understand that this is an amalgamation of two concepts: evidence-based medicine (EBM) and structured risk management. The aim of ADM, in the context of regulatory medical licensing, is to ensure assessment of individual fitness for aviation duties without compromising the aviation safety. Meaning thereby, that irrespective of the fitness awarded, the possibility of subtle or sudden incapacitation in flight is not likely to jeopardize the safety of flight, with existing safety measures in place: be it the presence of a second pilot, or applying the prevalence rates of illness/disease in the population, or aircraft automation like audio-visual warnings or auto-pilot, or applying the airmanship or crew resource management principles or any other safety mechanism. It must be understood though, that while evaluating a disability, the available safety mechanism listed above are not considered (except applying the 1% rule for multi-crew operations only), except the professional responsibilities of the pilot under assessment; however the restrictions imposed on the pilot, in case of disabilities, may consider the safety mechanisms listed above.
Let us first understand the concept of Risk Management [1]. The broad elements of Risk Management are: establishing the context, risk assessment (by identification, analysis and evaluation) and risk treatment.
These elements of Risk Management are continuously governed by two vital processes throughout: “monitoring and review” and “communication and consultation” [1]. Without delving into these self-explanatory concepts, it is important to understand that this paradigm of systematic risk management is useful for the ADM as well. In case of ADM, acceptable parameters are required for defining the context, broad risk assessment is undertaken by identifying/defining the risks requiring observation/ intervention/management, to enable the analysis of the disease/disability, its management and the operational (read aviation) environment; for an evaluation of acceptable or non-acceptable risks under operational environment, to finally define the flying fitness (unrestricted or with limitations) or denial of it.
Now to answer as to how does EBM help in ADM? It is said that “the practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research” [2]. Furthermore, it is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” [2]. It is important here to understand the broad meaning of the word ‘care’ in the context of aviation regulatory functions. It starts with the AME and the individual’s family/general physician (if both are not the same, which may be the case many a times) who have to responsibility of offering the best available treatment in case of a disease/disability to their pilot-patient. It then extends to the medical regulators, who determine the status of such an individual pilot for determining his/her fitness for aviation duties. To quote, Sackett et al, “Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients’ predicaments, rights, and preferences in making clinical decisions about their care [2]”. This has to be extended, where the vital principles of EBM viz. individual patient’s predicaments, rights and preference, need to be applied by the regulators while evaluating fitness of a pilot. It is important that EBM is applied holistically by all concerned and not in an arbitrary or piece meal manner.
Therefore, it has to become a conscious practice by all those who are party to the ADM process determining the medical fitness of pilots for aviation duties.
There are certain pitfalls in applying ADM, the biggest being the absence of evidence pertaining to the niche population of pilots. But as 1% rule, initially propounded for assessment of cardiovascular morbidity based on the data from the age and sex matched population [3], has proven its usefulness as a rule of thumb in determining the fitness in case of multi-crew operations; it is envisaged that the principles of ADM, if applied earnestly, shall provide fair, just and transparent outcomes. Thus ADM, in the context of the regulatory purposes, is to align itself with the due scientific basis of EBM within the structured risk management paradigm. So also it is the onus of the AME/medical licensing authority to apply the current best evidence, within the structured risk management processes to provide the “reasonable, replicable and reviewable” [4] fitness outcomes for the benefit of the individual pilot without compromising aviation safety.
References
1. ISO 31000: 2009: Risk Management Principles and Guidelines [Abstract at http://www.iso.org/iso/catalogue_detail?csnumber=43170]
2. Sackett DL, Rosenberg WMC, Gray JAM, Hynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ 1996; 312: 71.
3. Evans ADB. International regulation of medical standards. In Rainford DJ, Gradwell DP (editors) Ernsting’s Aviation Medicine. Fourth Ed. Hodder Arnold: London; 2006: 547-566.
4. Watson DB. Aeromedical decision-making: an evidence-based risk management paradigm. Aviat Space Environ Med 2005; 76: 58-62.
Pilot Incapacitation: Debate on Assessment, 1% Rule etc.
Pilot Incapacitation: Extent of the Problem.
Pilot Incapacitation: What is?
MTF...
Last edited by Sarcs; 26th Jun 2014 at 11:44.
Two choccy frogs to Sarcs.
I wonder whether Dougal B Watson will be among the 'experts' lined up by CASA for the AAT matter. His answer to the question: "What is the 'high-level evidence' to prove any causal link between pilot CVD and risks to air safety?" will be interesting.
Given that the only high-level evidence supports the conclusion that there is no causal link, he might end up looking a little silly.
"Aeromedical Decision Making" sounds very impressive and sensible in principle, but in practice it means a beauracrat prying into and taking control of every aspect of your medical 'conditions', justified on the ground of 'safety'.
I wonder whether Dougal B Watson will be among the 'experts' lined up by CASA for the AAT matter. His answer to the question: "What is the 'high-level evidence' to prove any causal link between pilot CVD and risks to air safety?" will be interesting.
Given that the only high-level evidence supports the conclusion that there is no causal link, he might end up looking a little silly.
"Aeromedical Decision Making" sounds very impressive and sensible in principle, but in practice it means a beauracrat prying into and taking control of every aspect of your medical 'conditions', justified on the ground of 'safety'.
More bad press for Fort Fumble on CVD
Oz Flying:
CASA Moves on Colour Vision
A lawyers perspective (courtesy 'The Oz'):
There are legal remedies for CASA’s decisions based on pilots’ colour impairment
CASA Moves on Colour Vision
Dr Arthur Pape, Director of the Colour Vision Deficient Pilots Association (CVDPA), has slammed the letters claiming they are linked to a pending AAT appeal of a CVD pilot fighting licence restrictions.
"Let me tell you that this trio of letters represents outright thuggery, particularly when it is realized that there has not been a scratch on a single aeroplane, let alone an accident or incident that can be attributed to the colour vision deficit of any pilot in over 25 years in Australia, and in over 60 years in the USA," he told Australian Flying.
"Furthermore, none of the three references cited by [CASA Principal Medical Officer] Dr Navathe in his letter to the DAMEs contain any evidence of accidents or incidents attributed to colour vision defectiveness of any pilot.
"There appears to be a link between these letters and the matter of the appeal by John O’Brien against the restrictions he has on his licence stemming from his colour vision defect."
"Let me tell you that this trio of letters represents outright thuggery, particularly when it is realized that there has not been a scratch on a single aeroplane, let alone an accident or incident that can be attributed to the colour vision deficit of any pilot in over 25 years in Australia, and in over 60 years in the USA," he told Australian Flying.
"Furthermore, none of the three references cited by [CASA Principal Medical Officer] Dr Navathe in his letter to the DAMEs contain any evidence of accidents or incidents attributed to colour vision defectiveness of any pilot.
"There appears to be a link between these letters and the matter of the appeal by John O’Brien against the restrictions he has on his licence stemming from his colour vision defect."
The Australian Aviation Associations Forum (TAAAF) was not impressed with CASA actions. In a statement released recently they said:
"TAAAF expressed considerable concern with CASA’s recent letter to operators and pilots regarding colour vision deficiency which seeks to place an unreasonable burden on the industry for no identified safety benefit despite many years of safe operation by colour vision deficient pilots.
"TAAAF calls on CASA to withdraw its current colour vision deficiency letter."
"TAAAF expressed considerable concern with CASA’s recent letter to operators and pilots regarding colour vision deficiency which seeks to place an unreasonable burden on the industry for no identified safety benefit despite many years of safe operation by colour vision deficient pilots.
"TAAAF calls on CASA to withdraw its current colour vision deficiency letter."
There are legal remedies for CASA’s decisions based on pilots’ colour impairment
KATHRYN HOWARD |
The Australian |
June 27, 2014 12:00AM
THE Civil Aviation Safety Authority recently wrote to pilots querying the effect of colour impairment on aviation safety and encouraging them to consider whether it is safe for them to fly. This has many alarmed.
CASA’s letter refers to “recent medical research” but does not specify what that research is. It says the “possibility exists” that a pilot’s colour vision deficiency “could” adversely affect aviation safety to a greater degree than previously thought.
Media reports suggest CASA is referring to a comparative study recently completed by Dougal B. Watson of the Civil Aviation Authority in New Zealand. That study addresses not whether colour deficiency affects safety but how colour deficiency is assessed internationally.
The report’s author acknow*ledges the lack of high-quality medical evidence to support one threshold of safe colour deficiency versus another; the limited exploration of which colours are necessary for safe flying; and the small number of documented aircraft accidents or incidents where colour deficiency was identified as a contributory factor.
In the absence of other medical research, it is difficult to see the proper legal basis for a broad conclusion that colour deficiency affects aviation safety.
The Administrative Appeals Tribunal considered the effect of a pilot’s colour deficiency on safety in a detailed and well-reasoned decision in 1987 after hearing detailed medical and operational evidence. The medical evidence addressed what purposes colour was capable of serving in the operation of aircraft. The operational evidence addressed the use that pilots made of colour cues.
The tribunal concluded that in most situations colour was redundant because the information communicated by colour was otherwise rapidly and readily perceptible by the pilot. For example:
The indicator lights for the landing gear were green when down and locked, and otherwise red; but there were generally three green lights and one red light.
Lights flashed in emergencies.
Red was perceived by the pilot as yellow — still distinct from white.
The pilot’s perception of the intensity of light was unaffected by colour deficiency.
The approach to a runway in a city was identified by a competent pilot knowing where he was, and the black hole, runway lights and threshold lights — the tribunal accepted that pilots did not rely on finding a concentration of coloured lights to locate an airfield.
The tribunal granted the pilot a private licence to fly at night, subject to certain conditions. It held that this reduced the risk to air navigation safety to a level not significantly different from that of a pilot with normal vision at night. Two years later, the tribunal made a similar decision in respect of a commercial pilot’s licence.
The tribunal has recently shown a willingness to overrule CASA on safety-related issues. In March and last month, it rejected the evidence of CASA and cleared those pilots to fly.
Remarkably, in one of those cases the tribunal rejected the ultimate conclusion of CASA’s principal medical officer and made the following observations:
“We do not consider this aspect of (the PMO’s) evidence to have been well-supported or well-reasoned and we formed the impression that (it) may well have been influenced by his desire to justify the decision he had made ... We were also troubled by the significant differences between the opinions expressed in the (PMO’s) statement of 8 October 2013 … and his oral evidence.”
Pilots should feel reassured that there are legal standards for the assessment of safety relevant issues under aviation legislation.
The evidence to which CASA refers must be made available to pilots and the link between colour deficiency and safety established before adverse administrative action can properly be taken. Following the outcry, CASA has itself reassured the industry that there will be full consultation in respect of any change.
The tribunal has been willing to robustly assess safety issues and ensure that legal standards are met. An upcoming appeal against restrictions precluding a pilot with colour deficiency from acting as a captain will be a timely test of the current evidence.
Kathryn Howard is a senior associate at Sydney law firm Holding Redlich.
The Australian |
June 27, 2014 12:00AM
THE Civil Aviation Safety Authority recently wrote to pilots querying the effect of colour impairment on aviation safety and encouraging them to consider whether it is safe for them to fly. This has many alarmed.
CASA’s letter refers to “recent medical research” but does not specify what that research is. It says the “possibility exists” that a pilot’s colour vision deficiency “could” adversely affect aviation safety to a greater degree than previously thought.
Media reports suggest CASA is referring to a comparative study recently completed by Dougal B. Watson of the Civil Aviation Authority in New Zealand. That study addresses not whether colour deficiency affects safety but how colour deficiency is assessed internationally.
The report’s author acknow*ledges the lack of high-quality medical evidence to support one threshold of safe colour deficiency versus another; the limited exploration of which colours are necessary for safe flying; and the small number of documented aircraft accidents or incidents where colour deficiency was identified as a contributory factor.
In the absence of other medical research, it is difficult to see the proper legal basis for a broad conclusion that colour deficiency affects aviation safety.
The Administrative Appeals Tribunal considered the effect of a pilot’s colour deficiency on safety in a detailed and well-reasoned decision in 1987 after hearing detailed medical and operational evidence. The medical evidence addressed what purposes colour was capable of serving in the operation of aircraft. The operational evidence addressed the use that pilots made of colour cues.
The tribunal concluded that in most situations colour was redundant because the information communicated by colour was otherwise rapidly and readily perceptible by the pilot. For example:
The indicator lights for the landing gear were green when down and locked, and otherwise red; but there were generally three green lights and one red light.
Lights flashed in emergencies.
Red was perceived by the pilot as yellow — still distinct from white.
The pilot’s perception of the intensity of light was unaffected by colour deficiency.
The approach to a runway in a city was identified by a competent pilot knowing where he was, and the black hole, runway lights and threshold lights — the tribunal accepted that pilots did not rely on finding a concentration of coloured lights to locate an airfield.
The tribunal granted the pilot a private licence to fly at night, subject to certain conditions. It held that this reduced the risk to air navigation safety to a level not significantly different from that of a pilot with normal vision at night. Two years later, the tribunal made a similar decision in respect of a commercial pilot’s licence.
The tribunal has recently shown a willingness to overrule CASA on safety-related issues. In March and last month, it rejected the evidence of CASA and cleared those pilots to fly.
Remarkably, in one of those cases the tribunal rejected the ultimate conclusion of CASA’s principal medical officer and made the following observations:
“We do not consider this aspect of (the PMO’s) evidence to have been well-supported or well-reasoned and we formed the impression that (it) may well have been influenced by his desire to justify the decision he had made ... We were also troubled by the significant differences between the opinions expressed in the (PMO’s) statement of 8 October 2013 … and his oral evidence.”
Pilots should feel reassured that there are legal standards for the assessment of safety relevant issues under aviation legislation.
The evidence to which CASA refers must be made available to pilots and the link between colour deficiency and safety established before adverse administrative action can properly be taken. Following the outcry, CASA has itself reassured the industry that there will be full consultation in respect of any change.
The tribunal has been willing to robustly assess safety issues and ensure that legal standards are met. An upcoming appeal against restrictions precluding a pilot with colour deficiency from acting as a captain will be a timely test of the current evidence.
Kathryn Howard is a senior associate at Sydney law firm Holding Redlich.
Join Date: Oct 2010
Location: Styx Houseboat Park.
Posts: 2,055
Likes: 0
Received 0 Likes
on
0 Posts
Stuff of legend.
Creamy – while you've got the Choc frog box open, send one to Ms Howard, hell send two on account of the brilliant article. And, while you're at it, have a couple yourself to share with Sarcs; for one of the very best passages of play it has been my pleasure to watch.
Bravo fellaheen; bravo indeed. {insert round of applause and big, huge grin} I'll be smiling all day now.
Sponsor. The IOS chapter for Friday Embuggerance as a Blood Sport.
Still smiling _._
Still smiling
Bravo fellaheen; bravo indeed. {insert round of applause and big, huge grin} I'll be smiling all day now.
Sponsor. The IOS chapter for Friday Embuggerance as a Blood Sport.
Still smiling _._
Still smiling
Join Date: Oct 2010
Location: Styx Houseboat Park.
Posts: 2,055
Likes: 0
Received 0 Likes
on
0 Posts
Another happy customer – not.
Jandakot Joe # - 124 - From reading the documentation it sounds like this CVD issue has arisen from NZ medical and/or administrative processes. Since this "poohshan" fella has migrated (most latterly) from NZ it would not be unreasonable to wonder if the concept caught a ride in with him, possibly to be imported as his own personal cause celebre.
Everyone brings a personal style and a cultural background to a job and having done some time overseas and worked with various cultures, it is a fact that not all work cultures are as easy to deal with as the next. Some are downright difficult, underhanded, obnoxious, lacking in transparency and mired in conflict and confrontation.
Officiousness for the sake of officiousness, bullheaded adherence to poorly-thought out policies, defensive posture in a minority position combined with lofty arrogance from a perception of having been headhunted... I shudder to think what this guy must be like to deal with. Was there not a single DAME in the whole of Australia who could've adequately filled the role of CASA PMO?
It is disgraceful that the affected licence and AOC holders were not advised of this career and company-altering CVD fiasco by the CASA PMO himself. Having slyly hand-balled the ugly baby to Peter Fereday who is left with putting his name to the letters, it would appear the entire issue has exploded in "poohshan"s face. Maybe he didn't expect the backlash and has tried, predictably, to distance himself from the sorry affair. This is unacceptable; the PMO needs to own up to the shambles he has created and deal with it himself.
These gov't post-holders are answerable to the public. When this is over and the CVD issue has been rightly buried, poohshan, having dragged licence and AOC holders alike (not to mention the CASA itself) through this idiocy, should find himself looking for a new job. The handling of this issue has been unacceptably poor and the current PMO cannot be allowed to continue in the role after over-seeing such an adverse impact on so many fee-paying end-users.
This affair is disgraceful and shameful - I am actually embarrassed to be associated, as an Australian licence holder, with the designated "authority" which is so ignorantly trashing the Australian aviation industry. What pilots and operators have to deal with in this country is beyond the pale and sets up the country as a laughing stock when compared to first world aviation environments. This is the sort of bureaucratic stupidity I've seen persisting in third world aviation regions and now it is a reality in Australia too.
Good work, Sunfish, keeping the topic alive here. I had not heard about it until reading your thread. Although it doesn't affect me directly, please post links to any petitions, online protest logs, or other ways of registering disgust at this situation and its handling; I will be more than happy to put my name to it.
Everyone brings a personal style and a cultural background to a job and having done some time overseas and worked with various cultures, it is a fact that not all work cultures are as easy to deal with as the next. Some are downright difficult, underhanded, obnoxious, lacking in transparency and mired in conflict and confrontation.
Officiousness for the sake of officiousness, bullheaded adherence to poorly-thought out policies, defensive posture in a minority position combined with lofty arrogance from a perception of having been headhunted... I shudder to think what this guy must be like to deal with. Was there not a single DAME in the whole of Australia who could've adequately filled the role of CASA PMO?
It is disgraceful that the affected licence and AOC holders were not advised of this career and company-altering CVD fiasco by the CASA PMO himself. Having slyly hand-balled the ugly baby to Peter Fereday who is left with putting his name to the letters, it would appear the entire issue has exploded in "poohshan"s face. Maybe he didn't expect the backlash and has tried, predictably, to distance himself from the sorry affair. This is unacceptable; the PMO needs to own up to the shambles he has created and deal with it himself.
These gov't post-holders are answerable to the public. When this is over and the CVD issue has been rightly buried, poohshan, having dragged licence and AOC holders alike (not to mention the CASA itself) through this idiocy, should find himself looking for a new job. The handling of this issue has been unacceptably poor and the current PMO cannot be allowed to continue in the role after over-seeing such an adverse impact on so many fee-paying end-users.
This affair is disgraceful and shameful - I am actually embarrassed to be associated, as an Australian licence holder, with the designated "authority" which is so ignorantly trashing the Australian aviation industry. What pilots and operators have to deal with in this country is beyond the pale and sets up the country as a laughing stock when compared to first world aviation environments. This is the sort of bureaucratic stupidity I've seen persisting in third world aviation regions and now it is a reality in Australia too.
Good work, Sunfish, keeping the topic alive here. I had not heard about it until reading your thread. Although it doesn't affect me directly, please post links to any petitions, online protest logs, or other ways of registering disgust at this situation and its handling; I will be more than happy to put my name to it.
Still smiling.....
Level 5: Lowest form of Medical Evidence
Agree top post Jandakot Joe......& the article courtesy of Ms Howard is definitely worth at least 2 choccy frogs...
Noticed that the CVPA have an update which can be viewed here .
This bit is most interesting...
:
However coming back to Ms Howard's article and this quote...
“We do not consider this aspect of (the PMO’s) evidence to have been well-supported or well-reasoned and we formed the impression that (it) may well have been influenced by his desire to justify the decision he had made ... We were also troubled by the significant differences between the opinions expressed in the (PMO’s) statement of 8 October 2013 … and his oral evidence.”
Well I managed to track down the AAT hearing where Ms Howard extracted that quote: McSherry and Civil Aviation Safety Authority [2014] AATA 119 (6 March 2014)
It is somewhat unfortunate for PAIN, given the constraints of the ASRR submission closing dates, that the McSherry case couldn't be included in their submission prepared for CVDPA, see (here).
It would have fitted quite nicely in this part :
However Ms Howard's AAT quote does further highlight the conundrum Dear Watson, AP Shambolic may find themselves in, come the AAT hearing (now in October). From Watto's article:
Hmm...interesting times ahead for the PMO, Dear Watson & the Flying Fiend legal crew...
...& the article courtesy of Ms Howard is definitely worth at least 2 choccy frogs...Noticed that the CVPA have an update which can be viewed here .
This bit is most interesting...
:
AAT Update
The hearings which were scheduled for next month have now been adjourned at our side's request. This was due to the sheer amount of preparation that is still required and our limited resources. The new hearing date is scheduled to commence on October 21.
While we were looking forward to progressing to hearings next month, we don't want to rush this case given it's significance. CASA were not of the same view, arguing that they wanted to continue progressing to hearings ASAP as they were concerned we were running a campaign in the media to discredit them. Our lawyer's response was that CASA have been running a campaign to discredit CVD pilots by writing to all the DAME's and AOC holders.
The hearings which were scheduled for next month have now been adjourned at our side's request. This was due to the sheer amount of preparation that is still required and our limited resources. The new hearing date is scheduled to commence on October 21.
While we were looking forward to progressing to hearings next month, we don't want to rush this case given it's significance. CASA were not of the same view, arguing that they wanted to continue progressing to hearings ASAP as they were concerned we were running a campaign in the media to discredit them. Our lawyer's response was that CASA have been running a campaign to discredit CVD pilots by writing to all the DAME's and AOC holders.
“We do not consider this aspect of (the PMO’s) evidence to have been well-supported or well-reasoned and we formed the impression that (it) may well have been influenced by his desire to justify the decision he had made ... We were also troubled by the significant differences between the opinions expressed in the (PMO’s) statement of 8 October 2013 … and his oral evidence.”
Well I managed to track down the AAT hearing where Ms Howard extracted that quote: McSherry and Civil Aviation Safety Authority [2014] AATA 119 (6 March 2014)
50. We note that in expressing that opinion, Associate Professor Navathe differed from both Associate Professor Ward and Dr McRae, each of whom regarded the risk of an incompletely incapacitating bleed causing problems for Mr McSherry whilst he was flying to be extremely small. Further, we do not consider this aspect of Associate Professor Navathe’s evidence to have been well-supported or well-reasoned and we formed the impression that this aspect of his evidence may well have been influenced by his desire to justify the decision he had made, to impose conditions on Mr McSherry’s class 1 medical certificate. We were also troubled by the significant differences between the opinions expressed in Associate Professor Navathe’s statement of 8 October 2013 on the one hand, and his oral evidence on the other.
It would have fitted quite nicely in this part :
9) Dr Navathe’s decision making abilities have been called into question on numerous occasions, notably during previous coronial and AAT hearings; including the now infamous 'Hempel' case; 2013, in which Dr. Navāthe presented a diametrically opposed argument to that which he espoused during an almost identical medical scenario, ([FONT="Verdana]Hazleton v CASA[/FONT]); 2010, in which different rulings were made; but, the comments relating to Dr. Navathe performance and knowledge were similar. The Hazelton AAT findings are germane and support the CVD pilot construct...
Quality of Evidence
One of the core components of the evidence-based medicine paradigm is the quality of the evidence being considered. Often the evidence used in reaching an aeromedical decision comprises a mixture of published research reports and individual expert opinions.
Medical evidence can be sorted into a hierarchy based on evidence quality (2,3,5,7,8). Such a hierarchy could list systematic reviews and meta-analyses of randomized controlled trials as the highest quality evidence, and then descend through randomized controlled trials, non-randomized intervention studies, observational studies, and non-experimental studies, to unsupported expert opinion as the lowest quality of evidence. Table I illustrates this concept by categorizing evidence quality into levels 1–5. (refer PDF page 2 here)
One of the core components of the evidence-based medicine paradigm is the quality of the evidence being considered. Often the evidence used in reaching an aeromedical decision comprises a mixture of published research reports and individual expert opinions.
Medical evidence can be sorted into a hierarchy based on evidence quality (2,3,5,7,8). Such a hierarchy could list systematic reviews and meta-analyses of randomized controlled trials as the highest quality evidence, and then descend through randomized controlled trials, non-randomized intervention studies, observational studies, and non-experimental studies, to unsupported expert opinion as the lowest quality of evidence. Table I illustrates this concept by categorizing evidence quality into levels 1–5. (refer PDF page 2 here)
Last edited by Sarcs; 29th Jun 2014 at 08:51.
Join Date: Jun 2011
Location: Downunda
Posts: 562
Likes: 0
Received 0 Likes
on
0 Posts
CAsA really are mentally ill;
The only discrediting that takes place is done by themselves to themselves, the dopey f
wits. Every time they screw someone, or they themselves screw up, they blame everyone else for trying to discredit them. FFS, they themselves are a standing joke. Here's a thought you clowns - do the right thing and you wouldn't have to worry about being 'discredited'! Simple really, you bunch of nupties. A dung beetle has more intelligence.
And since when do CAsA want to do anything quickly anyway? The longer the process is drawn out the more likely it is that they will bankrupt the person appealing, that's a favourite trick of theirs taken from Volume 2 - 'How to pineapple the IOS'. If CAsA are trying to rush this case through that can only mean they are a little worried. Poor Flying Fiend must be very busy of late, what with all the grief Poohshan and Peter 'a ferret a day' are causing the Big 'R' regulator, not to mention all the endless senate shenanigans.
Tick Tock and 'off with their heads'
CASA were not of the same view, arguing that they wanted to continue progressing to hearings ASAP as they were concerned we were running a campaign in the media to discredit them.
wits. Every time they screw someone, or they themselves screw up, they blame everyone else for trying to discredit them. FFS, they themselves are a standing joke. Here's a thought you clowns - do the right thing and you wouldn't have to worry about being 'discredited'! Simple really, you bunch of nupties. A dung beetle has more intelligence.And since when do CAsA want to do anything quickly anyway? The longer the process is drawn out the more likely it is that they will bankrupt the person appealing, that's a favourite trick of theirs taken from Volume 2 - 'How to pineapple the IOS'. If CAsA are trying to rush this case through that can only mean they are a little worried. Poor Flying Fiend must be very busy of late, what with all the grief Poohshan and Peter 'a ferret a day' are causing the Big 'R' regulator, not to mention all the endless senate shenanigans.
Tick Tock and 'off with their heads'
Join Date: Nov 2011
Location: Australia
Age: 53
Posts: 547
Likes: 0
Received 0 Likes
on
0 Posts
I'm sure casa would like things 'sorted' before the new DAS takes over. The big R boys could be in trouble. Looks like Holding Redlich is in for a fight. Word is this firm has had success against casa before. Institutional bullying claims could get interesting.
004 your right if they played things straight they wouldn't be in this mess.
004 your right if they played things straight they wouldn't be in this mess.
Join Date: Oct 2010
Location: Styx Houseboat Park.
Posts: 2,055
Likes: 0
Received 0 Likes
on
0 Posts
Passing of strange things.
One of the more interesting aspects of the whole CVD business is the creation of the reasonable doubt, in public, with evidence and witness that the CASA don't play with a straight bat. This whole CVD event typifies the standard SOP approach to anything they wish to do; only now the putrid vileness can be seen, smelled and touched. I wonder how many hearings and court decisions have been 'affected' by the 'judiciary' being subconsciously influenced by the 'mystique'; the thought that this is the governments appointed safety 'expert' and the blood will be on my hands should I go contrary to their demands. In the 'judicial' mind, CASA residual, tacit 'credibility' must now be lost. No longer can it provide provide a hidden, but tangible barrier that needs to beaten down before any ruling against 'the authority' can be won: and that's before they start cheating.
The incontinent antics of the Shambollic regime have publicly revealed what many already knew; that the methodology of embuggerance is an art form team Sleepy Hollow have perfected; but now that is no longer a secret. Wodgers back room antics underneath the Pel Air thing only narrowly escaped public scrutiny, that time. That's not to say that perhaps, somewhere during 'in camera' evidence the beans weren't spilled; but that doesn't signify as publicly demonstrating the depths to which some of these catamites and drones will stoop, when commanded.
It is quite remarkable to see the beast, exposed to sunlight blinking in confusion as it desperately thrashes around looking for the gateway back to the underworld, away from daylight. The Senate nearly trapped it but allowed it to escape; Rev. Forsyth got a good shot presented to him, but declined to take the trophy; now the CVD tribe have dragged it into daylight, lets hope they manage, with our help to destroy the creature and send it back to hell it came from.
Fresh air and good 'unting for all.
A Sunday read for second coffee. – HERE – Luxury.....
Toot toot.
The incontinent antics of the Shambollic regime have publicly revealed what many already knew; that the methodology of embuggerance is an art form team Sleepy Hollow have perfected; but now that is no longer a secret. Wodgers back room antics underneath the Pel Air thing only narrowly escaped public scrutiny, that time. That's not to say that perhaps, somewhere during 'in camera' evidence the beans weren't spilled; but that doesn't signify as publicly demonstrating the depths to which some of these catamites and drones will stoop, when commanded.
It is quite remarkable to see the beast, exposed to sunlight blinking in confusion as it desperately thrashes around looking for the gateway back to the underworld, away from daylight. The Senate nearly trapped it but allowed it to escape; Rev. Forsyth got a good shot presented to him, but declined to take the trophy; now the CVD tribe have dragged it into daylight, lets hope they manage, with our help to destroy the creature and send it back to hell it came from.
I am a sportsman all over, and to the back-bone – 'Unting is all that's worth living for – all time is lost wot is not spent in 'unting – it is like the hair we breathe – if we have it not we die – it's the sport of kings, the image of war without its guilt, and only five-and-twenty per cent of its danger. Jorrocks....
A Sunday read for second coffee. – HERE – Luxury.....
Toot toot.
Join Date: Oct 2010
Location: Styx Houseboat Park.
Posts: 2,055
Likes: 0
Received 0 Likes
on
0 Posts
Food for thought
From a wise owl,
At an early point, as when any major conflict seems to be drawing to a close, it may be necessary to declare a form of “ceasefire” to ensure that the processes of reform are not further clouded by hyperactive over-regulation on the part of individuals or groups. We have in fact already heard reports of harassment that seem to suggest the reopening of old and not fully healed wounds, and some recent “initiatives” in the medical and airworthiness areas also appear to be indicative of a scorched earth philosophy. Surely any new regulatory interpretations or enforcement activity should receive close scrutiny for non-compliance with published procedures, due diligence, procedural fairness and the rule of law.