Up, up and away

The medicine of flight and space travel is a burgeoning field filled with exciting prospects

SINCE astronaut Scott Kelly fell back to Earth after his record-breaking 340-day stay on board the International Space Station, there has been a raft of stories and articles written about just how his prolonged visit to space affected his body and his health.

He came back taller (albeit briefly), his hair probably stopped growing, he lost bone mass, his muscles atrophied and his risk of a fatal cancer is increased, probably for the rest of his life, due to being exposed to 10 times the radiation of a person on Earth.

His blood pressure was increased, and his risks of cardiac arrhythmia and atrophy were greater.1

Add to the mix the fact that Kelly has a twin brother, retired astronaut Mark Kelly, and you can see why the doctors and scientists at NASA couldn’t wait to get their hands on him once he was again gravity-bound.2

Many of those poking and prodding the Kelly brothers are aviation and aerospace medicine specialists.

In Australia there are about 800 members of the Australasian Society of Aerospace Medicine (ASAM), around 500 or so of which are Designated Aviation Medical Examiners (DAMEs).3

The current president of the ASAM, Dr Ian Cheng tells the MJA that despite being a “niche area” aviation and aerospace medicine was “fascinating”.

Aerospace medicine is, according to the Australasian College of Aerospace Medicine (ACAM), “concerned with the interaction between the aviation environment and human physiology”.4

“It is concerned with the physiological stresses experienced by a healthy person in flight, and the interaction between the aviation environment and underlying health problems — in passengers as well as in aircrew.

“It is also concerned with sustaining and enhancing the performance of those engaged in flight operations.

“Aerospace medicine also encompasses the health, safety, and working environments of those ground personnel engaged in support of air operations.”

Dr Cheng is a founding fellow of the ACAM, is a staff specialist in Occupational Medicine at Royal North Shore Hospital in Sydney, and also conducts a private practice in Aviation and Occupational Medicine while periodically providing aviation medical services for the Civil Aviation Safety Authority’s (CASA) Aviation Medicine division.

But it wasn’t always going to be that way.

Dr Cheng began his academic life as an engineering student at the University of New South Wales.

“I was coming to the end of my engineering degree and I interviewed for a Master of Biomedical Engineering,” he says.

“Biomedical engineering had always been my plan, but then I looked at the opportunity to do a medical degree as well and thought that was a good idea.”

The lure of space and the dream of being an astronaut floats in the minds of many a young person, and Dr Cheng was no different, so it was probably no surprise to find him walking away from university with both an engineering and a medical degree.

Unlike many aviation medicine specialists, Dr Cheng did not come through the ranks of the Royal Australian Air Force, but flying itself is definitely on his bucket list.

“I’ve had a few lessons,” he says. “It’s definitely on my bucket list, but it’s an expensive hobby to have. One day … ”

Like many other specialties, aviation medicine faces particular challenges in rural and remote Australia.

“There is quite a community of flyers in rural and remote Australia,” Dr Cheng says.

“Whether it’s farmers doing their mustering by plane, or others doing agricultural spraying — all those pilots need to be certified as fit to fly and sometimes finding a qualified doctor to do that can be a problem.”

Medical students do not receive any aviation training in their undergraduate years. ACAM’s Aerospace Medicine Training Program is a 4-year plan. Trainees must have 5 years’ primary care experience or 3 years of specialty training; must have completed, or planned to complete during the training period, post-graduate training in aerospace medicine at the level of a Diploma or Master’s degree from an approved institution and taken part in the 4-year mentored training program and assessments.

The ASAM also offers a scholarship to its Annual Scientific Meeting to help foster student participation and interest in the field. According to Dr Cheng, one such student is now “living the dream”, working at the European Space Agency.5

You can almost see Dr Cheng become starry-eyed as he tells that story. Becoming an astronaut “was certainly a dream in my younger years”, he admits.

“It's a frontier world. Very exciting.”

To qualify as a DAME, a doctor must have completed a post-graduate degree in aviation medicine.

DAMEs, according to the Civil Aviation Safety Authority website, “conduct medical examinations as required by the Civil Aviation Act 1988, the Civil Aviation Regulations 1988 and the Civil Aviation Safety Regulations 1998”. Their duties include:

• personally examining applicants requiring medical certification

• discussing the applicant’s medical history and medical record during the course of the medical examination

• referring applicants for follow-up testing when required

• issuing certificates for fitness to return to flying

• undertaking appropriate aviation medicine Continual Medical Education (CME).6

Occupational medicine, including aviation and aerospace medicine, is an intriguing two-way street, says Dr Cheng.

“Occupational medicine is about how a person’s work environment might affect their health,” he says. “But it also goes the other way: how does a person’s health affect their work?”

For all his youthful dreams, Dr Cheng has no regrets about the path his career has taken.

“My pathway may not have been what I initially thought it would be,” he says. “But no, no regrets at all. It’s a fascinating area.”