Health and Well BeingChapters 1 & 2

Aim

To understand the physiology of the human pilot.

To appreciate the warning signs of ill-health and the dangers associated

Objectives1. To understand the circulatory and respiratory

systems and their limitations in aviation2. To understand and manage the physiological

effects of altitude3. To learn the indicators of poor health and how

various illnesses can be managed in the aviation environment

4. To appreciate the importance of keeping physically and mentally fit

1. Circulatory & Respiratory Systems

• Blood cells (plasma) contain an iron-rich pigment, haemoglobin, which moves around the body under pressure to deliver oxygen and other nutrients as well as removing waste products

• Oxygenated blood (red) leaves the heart through arteries, delivering oxygen/nutrients to the various organs and returns de-oxygenated (blue) to the heart through veins

• It is at the lungs, under partial pressure, where blood swaps Carbon Dioxide for Oxygen (ratio 1:4 - haemoglobin:O2)

• The brain monitors Carbon Dioxide in the bloodstream and makes inference of oxygen levels. It responds as necessary with the body’s heart rate and rate of breath

• The brain does not monitor O2 levels directly, only CO2 levels! What’s the risk here?

Circulatory System

1. Circulatory & Respiratory Systems

Circulatory System• Blood pressure is measured at the walls of the main arteries and has two

values (max: systolic and min: diastolic)

A typical heart rate monitor showing Systolic (118) and diastolic (78) pressures

1. Circulatory & Respiratory Systems

Respiratory System• As we inhale…

Oxygen diffuses through thin walls of the lungs and is absorbed into the blood, carried to the organs and used in the production of energy.

• As we exhale…Waste Carbon Dioxide, a by-product of the production of energy, is carried by the blood to the lung, where it is excreted through the lung walls and exhaled with spent air.

• At each organ, Oxygen is required in the production of energy.

2. Physiological Effect of Altitude

Expansion of gases

• As we climb through the atmosphere, environmental pressure decreases

• Inside the body, where pressure is comparably higher, gases inside cavities expand. (E.g. Gastro-Intestinal gases, imperfect teeth fillings, Eustachian tube gases - especially during a cold!)

Hints:• Avoid leafy greens, legumes, broccoli, breads, beans before you fly• Make sure you have a good dentist!• Don’t fly with a cold

2. Physiological Effect of Altitude

Hypoxia• For Oxygen to be absorbed into the blood stream, it needs to be

delivered at a partial pressure

By 9000’ altitude, O2 partial pressure reduces by approx. half.

2. Physiological Effect of Altitude

Hypoxia • At 10,000’, the blood remains about 90% saturated with O2, however

above this, partial pressure of O2 starts to reduce below allowable limits.

The handwriting of a subject who was taken to 25,000ft without Oxygen.

2. Physiological Effect of Altitude

Hypoxia• CASA 20.4 (6.1)A flight crew member who is on flight deck duty in an unpressurised aircraft must be provided with, and continuously use, supplemental oxygen at all times during which the aircraft flies above 10 000 feet altitude. Oxygen is required under pressure for continuous flight above 10,000’.

CASA Hypoxia Video

• Why do smokers have it worse?

2. Physiological Effect of Altitude

Other effects• Barotrauma

• Avoid equalising pressure too quickly

• Dehydration• Keep fluids up, even in cold cockpits

• Decompression Sickness “The Bends” (greater than 33ft)• Min. 4 hrs after dive not requiring decompression stops• Min. 12 hrs after a dive >4 hrs requiring decompression stops• 48 hours after a 4+ hour dive requiring decompression stops

• Hyperventilation• Restore CO2 levels

• CO poisoning• Avoid heaters if suspected faulty.

3. Health & Well Being

Health Indicators• Blood Pressure

• Systolic pressure is the maximum pressure applied at the artery walls when the heart pumps (120-130mmHg). Diastolic is the minimum pressure when the heart pauses between pumps (80-85mmHg).

• Lower pressures are better, high blood pressure (hypertension) needs to be managed.

Optimal blood pressure is around 120/80 (mmHG)

3. Health & Well Being

Health Indicators• Cholesterol

• Occurs naturally as High Density Lipo-Protein (HDL) and Low-Density Lipo-Protein

• LDL (‘bad cholesterol’) rises with the intake of Trans-Fatty acids and animal fats and needs to be managed

• As cholesterol increases (especially LDL), arteries can become clogged leading to Angina, atherosclerosis and other Coronary disease

• As total and LDL cholesterol increase, Cardiac Risk Factor increases

3. Health & Well Being

Health Indicators• Obesity

• Obesity can have significant health, social and economic impacts, and is very closely related to lack of exercise and to diet. Being overweight or obese increases the risk of suffering from a range of health conditions, including coronary heart disease

• Australian Bureau of Statistics, 2010, Measures of Australia's Progress, 2010, www.abs.gov.au. Accessed May 2013

• Hints:• Eat in moderation and in proportion with exercise. Eat high

calorie foods only in moderation• Consider foods with a low Glycemic Index.• Don’t get caught out by ‘99% fat free’ as high sugar levels can

metabolise to fat storage

3. Health & Well Being

Medical Certificates• Initial issue – ECG, Audiogram, Opthamology exam, blood and urine test

• Class 1 (Valid 12 months)• Required to exercise the privileges of an ATPL, CPL, flight engineer• Renewals thereafter may include:

• ECG (25th, 30th, 32nd, 34th, 36th, 38th and 40th birthdays, then annually)

• Audiograms and lipids/blood glucose (after the 25th birthday then every fifth birthday)

• Ophthalmologist (60th birthday and then two-yearly intervals)

• Class 2 (Valid 4yrs if age <40; or 2yrs if age>40)• Required to exercise the privileges of an SPL, PPL, FROL

• Class 3 (Valid 2 years)• Required to exercise the privileges of an ATC

3. Health & Well Being

I.M.S.A.F.E.

Handout ‘Should I Have Flown’ CASR 67.265

• Illness• Certain illnesses should never be taken into the air. Physical

impairments, heart attacks, strokes, diabetes, kidney stones, ulcers, colds & ear infections, stress/ anxiety, headaches, nausea.

• Would you fly a sick aeroplane?

• Medication• What are you masking? • Prescribed drugs require DAME certification. Even over the counter

drugs are on the banned substance list (e.g. codeine)• DO NOT FLY unless a DAME has authorised you

3. Health & Well Being

I.M.S.A.F.E. • Stress

• A reasonable level stress is normal, e.g. a looming exam or assignment

• Deal with your stress by prioritising workload and breaking tasks down into smaller, more achievable goals

Cognitive Symptoms Emotional Symptoms•Memory problems •Inability to concentrate •Poor judgment •Seeing only the negative •Anxious or racing thoughts •Constant worrying

•Moodiness •Irritability or short temper •Agitation, inability to relax •Feeling overwhelmed •Sense of loneliness and isolation •Depression or general unhappiness

Physical Symptoms Behavioural Symptoms•Aches and pains •Diarrhoa or constipation •Nausea, dizziness •Chest pain, rapid heartbeat •Loss of sex drive •Frequent colds

•Eating more or less •Sleeping too much or too little •Isolating yourself from others •Procrastinating or neglecting responsibilities •Using alcohol, cigarettes, or drugs to relax •Nervous habits (e.g. nail biting, pacing)

Stress Warning Signs & Symptoms

• Alcohol• 0.02% BAC, 8 hours before aviation sensitive activities• Alcohol is a depressant and can become a dependence• Hangover effects can last up to 72 hours

3. Health & Well Being

I.M.S.A.F.E. • Fatigue

• Similar effects to alcohol – reduced concentration and reaction time• Chronic fatigue needs to be addressed at the underlying problem• High cockpit workload can be fatiguing – ensure sufficient sleep and

bring snacks and water!

• Eat & Drink• Avoid Hypohydration - On longer flights, (especially high altitudes,

hot days) your body can lose a lot of water. Water is required to dissolve nutrients, carry waste products, lubricate joints and regulate temperature. Avoid diuretics, KEEP HYDRATED!

• Avoid Hypoglycemia - In high workload flights, your mental energy level can exceed your glucose supply. When supply of glucose to the brain, you become impaired. Consider low GI snacks.

3. Health & Well Being

Tips for keeping fit• Keep hydrated with 1-2L of water per day

• Eat a substantial breakfast and consider smaller wholesome snacks throughout the day

• Exercise daily consisting of aerobic (cardio) exercises and strengthening of muscles. Always opt for the stairs instead of lift/escalator and consider walking to or even parking a little further away from your destination. Exercise should be enjoyed!

• Ensure 6-8 hours of sleep per night

• Don’t smoke

• Limit alcohol to 21-28 standards per week (men) or 14-20 (women)

• Monitor calorific content and limit foods high in fat (especially saturated fats)

• Eat fish twice a week, or introduce fish oil supplements into your diet

3. Health & Well Being

Drugs• Never take non-prescribed drugs. If you think drugs are necessary, see

your DAME

• Questionable Prescription Drugs (see your DAME)• Antihistamines: Hayfever & allergy (may cause drowsiness)

• Decongestants: Blocked nose/hayfever (may cause drowsiness)

• Analgesics: Pain relief (may cause nausea and/or hypertension

• Antacids: Relief from reflux/heartburn (generally safe)

• Antimalerial: To stave off malerial infection (may cause vertigo)

• Anti-diarrhoa: Relief from diarrhoea. Must be free of opiods. (Dehydrating and debilitating)

3. Health & Well Being

Illicit Drugs• Cannibis (THC)

• Detrimental effect on situational awareness and management of aeroplane states

• Effects can last up to 24 hours however THC remains detectable in the urine for up to 20 days (one off) or 90 days (heavy use)

• Amphetamine (speed, ecstasy)• Stimulate CNS to increase focus and maintain wakefulness, however

the affect on serotonin re-uptake and norepinephrine system can cause psychoses, especially schizophrenia.

• Certain medications (especially those used in ADHD & narcolepsy metabolise into amphetamines (Benzedrine, Vyvanse)

• Side effects also include hyperactivity, headache, blurred vision, dizziness, twitching, numbness, palpitations, arrhythmias, convulsions. Enough said!

3. Health & Well Being

Illicit Drugs • Opiates

• Commonly morphine and heroin, however many medications metabolise to opiates (codeine, oxycodone, poppy seeds)

• Side effects include sedation, psychomotor impairment, respiratory depression, constipation, euphoria.

• Opioids also tend to be dangerously addictive

• Cocaine• Derived from the coca plant, common effects include feelings of

euphoria and invincibility, increased energy and apparent pace, anxiety, agitation, paranoia, aggressive and unpredictable behaviour, hypertension. Higher doses can lead to nausea, tremors, chest pain, kidney failure, seizures, brain haemorrhage and death.

• Also highly addictive (so I’m told…)

Questions?