DAvMed – Regulations & Guidance

DAvMed – Regulations

The Faculty of Occupational Medicine of the Royal College of Physicians of London was established “to develop and maintain the good practice of occupational medicine with a view to providing for the protection of people at work by ensuring the highest professional standards of competence and ethical integrity”.

The Diploma in Aviation Medicine is designed for medical practitioners who wish to specialise in the practice of aviation medicine.

It is established to demonstrate that the holder has achieved a level of competence appropriate to the specialist working in aviation medicine. It is quite separate from other qualifications of the Faculty and is not part of the formal training route to Membership or entry onto the specialist register of the General Medical Council of the UK.

D1. Candidates for the Diploma are required EITHER

(a) to provide evidence of full or limited registration with the General Medical Council of the United Kingdom

(b) to possess a medical qualification acceptable to the Director of Assessment of the Faculty. These candidates must produce their original medical registration certificates, or diplomas of medical qualification, and official translations thereof if not in English.

D2. Candidates are also required to have EITHER

(a) completed a Faculty approved Diploma Training Course by the date of the examination. Candidates must provide a copy of their certificate of successful completion of such a course

(b) demonstrate experience in the practice or teaching of aviation medicine. The examination entry form must be accompanied by evidence of the candidate’s experience in aviation medicine.

EXAMINATION FORMAT

D3. The examination is in two parts, part one is in aviation physiology and psychology, and part two is in clinical aviation medicine. Candidates are required to pass both parts. Each part consists of two examination papers; a multiple-choice question paper and a modified essay question paper.

AWARD OF THE DIPLOMA

D4. Candidates who have successfully completed the requirements specified in D3 will be awarded the Diploma in Aviation Medicine and may use the postnominals DAvMed. This qualification is not registerable with the General Medical Council. Upon payment of a fee, successful candidates may then become an affiliate member of the Faculty.

ADVICE

D5. Any further advice on the Regulations may be obtained by writing to the Academic Dean.

DAvMed Guidance

INTRODUCTION

1. The Faculty of Occupational Medicine of the Royal College of Physicians of London took over the administration of this qualification in 1982 for doctors who wish to demonstrate a level of proficiency in aviation medicine appropriate to the practice of a specialist.

2. Regulations governing the Diploma in Aviation Medicine (DAvMed) have been published by the Faculty. It is the responsibility of candidates to ensure that they obtain the latest edition of the Regulations. These notes do not form part of the Regulations but are intended to provide guidance for candidates and those running courses to prepare candidates for this qualification.

DIPLOMA

3. This qualification is intended to meet the needs of registered medical practitioners who wish to demonstrate by a combination of training and examination, a level of knowledge and competence in aviation medicine consistent with the practice of a specialist.

TRAINING

4. A number of institutions may offer Diploma Training Courses covering the core syllabus. These courses may be full time, part time or by distance learning. The core syllabus covers the basic topics necessary to understand the principles and practice of aviation medicine.

5. Diploma courses are approved on behalf of the Faculty by the Director of Assessment to whom applications must be made in writing at least six weeks before the course is due to start. Approval is valid for one year only and it is the responsibility of Training Centres to reapply for approval.

6. The Diploma core syllabus requires a minimum of 300 hours direct training. To reach the required standard, candidates need to undertake further private study. This study includes reading appropriate books and journals, attendance at professional meetings such as those arranged by the Aviation Medicine Group of the Royal Aeronautical Society and other organisations, and visits to workplaces. Such private study is likely to require a minimum of 2-3 hours per week over six months. Those providing Diploma Training Courses should include advice about further study in their teaching.

EXAMINATION

7. Application for admission to the examination must be made by the advertised closing date and submitted via the Faculty’s online application system. All applications must be accompanied by the fee (see General Faculty Examination Regulations) and either a copy of the certificate of successful completion of a Diploma Training Course or evidence of the candidate’s experience in aviation medicine. The examination is generally held once a year in either March or April.

8. The examination is in two parts. Part one is in aviation physiology and psychology, and part two is in clinical aviation medicine. Each part consists of a two-hour modified essay paper and a one-hour multiple choice paper. It is designed to assess not only the factual knowledge of the candidates but also their understanding of the principles involved and their capacity to apply this knowledge to specific problems or scenarios.

9. For each of the two parts (physiology and psychology, and clinical aviation medicine) 50 marks are awarded for the multiple-choice question paper, and 75 marks are awarded for the modified essay question paper. Candidates are required to pass both part one and part two to be awarded the DAvMed. The multiple-choice questions are machine marked and the results are statistically analysed to ensure standardisation with previous DAvMed examinations and to exclude unsatisfactory questions. The modified essay questions will be marked independently by two Faculty trained examiners. A candidate’s performance in each paper will be assessed relative to a standard set by the examiners. Raw marks may be adjusted to preserve a common standard between examinations. The pass mark may therefore vary between sittings of the examination.

10. Examiners are appointed by the Assessment Subcommittee and are required to participate in training.

DAvMed – Syllabus

The aim of the syllabus is to provide medical practitioners with an outline of the knowledge base in advanced Aviation Medicine so as to prepare them for the examination for the Diploma in Aviation Medicine (DAvMed) of the Faculty of Occupational Medicine of the Royal College of Physicians of London. Details of the examination requirements and regulations can be found above.

Syllabus Summary

Physiology. General human physiology in the environment of flight with particular emphasis on the respiratory, circulatory and nervous systems, the special senses, the control of body temperature and the dynamic response of the body to forces.

Psychology. The scientific study of human behaviour with particular regard to perceptual processes, the making and implementation of decisions, and factors which affect skill, performance and learning.

Applied Aviation Physiology and Psychology. The application of physiology and psychology to the flight task and environment. The topics include characteristics of the work-space, personal equipment and survival equipment, environmental control and life-support systems, the safety of flying personnel, the assessment of skilled performance and fatigue, acquisition and interpretation of biological data, theory and practice of teaching, training design, the training of aircrew, emergencies, the conduct and management of field studies, the investigation of accidents, space biology.

Selection. The selection of flying personnel, their medical examination, medical standards, aptitude and personality tests, anthropometry, selection for special duties, standards for air traffic controllers and other ground staff, the carriage of the sick or injured, re-categorisation and disposal of aircrew, and the effects of ageing.

Clinical care. Duties of the flight medical officer, aeromedical examiner and aspects of the practice of clinical medicine and surgery of special significance in aviation.

Public Health. National and international regulations and their implementation, actuarial statistics, hours of work, circadian rhythms, sanitation and hygiene including the handling of food, immunisation, climatic factors, radiobiology, bacteriology and parasitology, and accident statistics.

SYLLABUS – CORE AVIATION AND SPACE MEDICINE KNOWLEDGE

The Earth’s atmosphere

Structure of the atmosphere
Composition of the atmosphere
Physics of the atmosphere
- Density and pressure
- Temperature
- Ionising radiation
- Standard atmosphere
- Gas laws

Cardiovascular and respiratory physiology

Cardiovascular physiology
- Measurement of cardiovascular pressures
- Peripheral resistance
- Capillary fluid exchange
- Pulmonary circulation
- Cardiac output
- Control of cardiovascular system
- Cardiovascular response to changes in posture
- Valsalva manoeuvre
- Cardiovascular response to exercise
Respiratory physiology
- Tissue respiration
- Carriage of gases by the blood
- Gas exchange in the lung
- Control of ventilation
- Gas tension gradients

Hypoxia and Hyperventilation

Types of hypoxia
Hypobaric hypoxia
- Cardiovascular response
- Neurological effects
- Clinical features
Hyperventilation

Prevention of hypoxia

Maximum and minimum acceptable concentration of oxygen
Pulmonary ventilation in flight
Respiratory gas flow in flight
External resistance to respiratory gas flow
Prevention of hypoxia below 40,000 ft
Prevention of hypoxia above 40,000 ft
- Respiratory effects of pressure breathing
- Circulatory effects of pressure breathing
- Effect of pressure breathing on the head and neck

Oxygen equipment and pressure clothing

General classes of oxygen systems
- Closed and open circuit oxygen systems
Oxygen system requirements
- Physiological and general requirements
Oxygen equipment
- Oxygen sources
- On-board oxygen production
Continuous and demand flow delivery systems
Oxygen masks
Pressure clothing
- Full and partial pressure garments

Principles of the pressure cabin and the effects of pressure change on body cavities containing gas

Physiological effect of pressure change at altitude
- Hypoxia
- Gas expansion
- Decompression illness
- Cabin air quality
Cabin pressurisation schedules
Principles of cabin pressurisation systems
Causes of failure of cabin pressurisation
Physics of rapid decompression
Effect of cabin depressurisation on occupants

Sub-atmospheric decompression sickness

Causes of decompression sickness
Clinical presentation of decompression sickness
Incidence of decompression sickness
Prevention of sub-atmospheric decompression sickness
Management of decompression illness
Evolved gas disease Arterial gas embolus
Ebulism White matter hyper-intensities Principles of recompression therapy

Effects of long-duration acceleration

Physical principles
Exposure to +Gz acceleration
- Musculoskeletal effects of +Gz acceleration
- Cardiovascular effects of +Gz acceleration
- +Gz induced loss of consciousness and A-LOC
- Pulmonary effects +Gz acceleration
- Tolerance to +Gz acceleration
Exposure to –Gz acceleration
Exposure to –Gz to +Gz acceleration (push-pull)
Exposure to Gx and Gy acceleration

Protection against long-duration acceleration

Anti-G straining manoeuvres
G-protective systems
- High-G training
- Physical conditioning
Positive pressure breathing
G induced neck injury

Short duration acceleration

Short duration v long duration acceleration
Nature of short duration impact
Human tolerance to short duration acceleration
Factors affecting human tolerance to impact
- Magnitude and duration of force
- Rate of onset
- Direction of force
- Site of application of acceleration
Occupant characteristics and tolerance to impact
Anatomical and physiological aspect of impact tolerance
- Skeletal injury
- Joints
- Abdomen
- Chest
- Head and face
- Spine
Survivability and tolerance to impact

Head injury and protection

Mechanics of head injury
Clinical presentation of head injury
Tolerance to head injury
- Direct impact
- Linear acceleration
- Rotational acceleration
Methods of preventing head injury
Mechanics of head protection by a helmet
Tests for helmet protection
- Penetration resistance
- Shock absorption
- Helmet retention
- Rotational acceleration
Other functions of helmets

Aircraft assisted escape systems

Escape from aircraft
- Ejection seats
- Canopy clearance methods
- Forces of assisted escape
- Escape parachutes
- Escape under extreme conditions
- Escape from helicopters
Unassisted escape
Parachute descent
Parachute landing
Injuries associated with emergency escape
Injuries associated with impact crashes
Management of escape injuries
Aeromedical disposition of ejection injuries

Restraint systems and aircraft crashworthiness

Restraint systems
- Lap belts
- Multipoint harnesses
Seat orientation
Airbags
Concept of crashworthiness
- Container
- Restraint
- Environment
- Energy attenuation
Post crash factors

Accident Investigation

UK investigations
Overseas investigations
Organisation of accident investigations
Agencies and aircraft accidents
- Military
- Civilian
- Aviation pathology
- Aeromedical expertise
- Aviation psychologist
- Human factors
On site investigation
Evidence gathering and preservation
Clinical outcome
Medical response to aircraft accidents
Mortuary
Identification
Post-mortem examination
Analysis of evidence
Disease in aircrew
Disease as a cause of accidents
Toxicology
Therapeutic drugs
Non-medical cause of accidents
Events before impact
Events at or after impact
- Accident reconstruction
- Aircrew equipment assemblies
- Survival equipment
Physiology of survival
- Sea survival
- Extreme environments
Aircraft fires and aircrew fire protection
Medico-legal considerations

Human physiology and the thermal environment

Thermal stress
- Heat and temperature
- Heat balance
Thermal environment and its assessment
Heat stress indices and measurement of body temperature
Physiological response to thermal stress
- Heat regulation
- Effectors responses

Thermal stress and survival

Hyperthermia
- Heat Syncope
- Heat exhaustion
- Heat stroke
Hypothermia
- Generalised hypothermia
- Non-freezing cold injury
- Freezing cold injury
Acclimatisation
Clothing and personal cooling systems
Environmental cooling systems
Survival in hot and cold environments

Vibration Principles of vibration

Natural and forced vibration
- Mechanical properties of tissues
Vibration sources
Measurement and analysis of vibration
Biomechanical effects of vibration
- Mechanical impedance of the body
- Body resonances
Effects of vibration
- Vision
- Cardiovascular
- Respiratory
Neuromuscular
Human tolerance to vibration
Protection against vibration
Occupational hazards of vibration

Anthropometry and aircrew equipment integration

Anthropometry
- Measurement techniques
Application of anthropometry data
Sizing and fitting of aircrew clothing
Aircrew equipment assembly integration
- Laboratory tests and evaluation
- Effect on aircrew procedures
- Effect on escape and survival
- Dynamic test
- Environments test
- Flight trials
In-cockpit functional and anthropometric assessment of aircrew and aircrew equipment assemblies

Sleep and wakefulness

Recording and classifying sleep stages
Sleep architecture
Sleep deprivation
Insomnia
Sleep disorders
Circadian rhythms and sleep cycles
Alertness management techniques
Crew work-rest scheduling
Pharmacological strategies

Vision

Characteristics of light
Light and dark adaptation
Colour vision
- Defects in colour vision
Image processing
Performance of the eye
- Visual acuity
- Contrast sensitivity
- Depth perception
- Differentiation of motion
- Constant relative bearing
- Retinal size
Aviation hazards to vision
Night vision goggles

Spatial orientation and disorientation

Spatial awareness
Vestibular system
- Semicircular canals
Otolith organs
Threshold of motion perception
Visual vestibular interaction
Disorientation in flight
- Orientation error accidents
- Input errors
- Inadequate orientation cues
- Central errors
False perception of attitude and linear motion
- Somatogravic illusions
- Oculogravic illusions
- G excess illusion
- The leans
False perception angular motion
- Somatogyral illusions
- Oculogyral illusions
- Cross-coupled (Coriolis) illusions
- Flicker vertigo
- Alternobaric vertigo
Disorientation in helicopter flight
Disorientation and night flying
Dissociative sensation (break-off)
Prevention of spatial disorientation
- Aircraft factors
- Aircrew factors

Motion sickness

Signs and symptoms
Aetiology
- Visual-vestibular conflict
- Intravestibular (canal-otolith) conflict
Incidence
Significance to aircrew performance
Prevention
- Behavioural measures
  - Adaptation
  - Desensitisation therapy
  - Aircrew selection
- Pharmacological measures

Noise and communication

Physical characteristics of sound
- Sound pressure
- Complex sounds and frequency analysis
- Propagation of noise
Mechanics of hearing
Subjective sensation of hearing
- Loudness and nosiness
- Measurement of noise
Aircraft noise
- Jet aircraft
- Rotary wing aircraft
Protection of aircrew against noise
Noise legislation
Hearing loss
Psychological and performance effects of noise
Communication in aircraft
Speech intelligibility

Aviation psychology: aircrew selection and training

Principles of selection
Evaluating selection
Practical aspects of selection
Principles of training
Practical aspects of training Simulation

Aviation psychology: crew resource management

CRM training and courses
Evaluation of CRM training
Psychology of small groups
Personality and leadership
Stress and workload

Human Factors:error and accidents

Predisposing factors
Disruptive factors
Enabling factors
Perception errors
Intention errors
Action errors
Decision making
Workload and fatigue
Human factors investigation taxonomies

Aircraft hygiene

In-flight catering
Water supplies
Disposal of waste
Pest control
Cleaning and disinfection

Medical standards and international regulation

Regulation of civil aviation
International Civil Aviation Organization
European Aviation Safety Agency
Federal Aviation Administration and other regulatory aviation authorities
UK Civil Aviation Authority
Civil aviation medical requirements
Civil aeromedical examiners
Airline medical requirements
Military aircrew medical requirements

Incapacitation risk

The ageing pilot
- Commercial pilots
- Private and sports pilots
- Military pilots
- Maximum and minimum age rules
Aeromedical fitness assessment
Acceptable levels of risk
One percent rule
Role of the aeromedical examiner

Medication and aircrew

Prescribed medication
Over the counter medication

Remotely Piloted Aircraft Systems

Challenges
Medical Standards for Controllers
Risks
Disorientation

Clinical Aviation Medicine

Candidates should have an understanding of the following clinical conditions. They should be able to understand how these clinical presentations can influence licensing decisions, future/continued employment, and passenger travel. Candidates should be able to formulate and implement an aeromedical management plan.

Aviation and cardiovascular disease

Aviation and cardiovascular risk
Crew
Passengers
Cardiovascular incapacitation
Coronary heart disease
Rate and rhythm disturbances
Atrioventricular conduction disturbances
Intraventricular conduction disturbances
Ion channelopathies
Endocardial pacemaking
Heart murmurs and valvular heart disease
Pericarditis, myocarditis, endocarditis
Cardiomyopathies
Congenital heart disease
Peripheral vascular disease
Venous thrombosis
Syncope
Hypertension

Aviation and respiratory disease

Crew and passenger risk
Asthma
Sarcoidosis
Pneumothorax
Obstructive sleep apnoea
Chronic obstructive pulmonary disease
Bullous lung disease and cysts
Bronchiectasis
Pulmonary tuberculosis
Atypical mycobacterial disease
Interstitial lung disease
Pulmonary thromboembolic disease
Pulmonary malignancies

Aviation and Gastrointestinal disease

Gastro-oesopahgeal reflux disease
Peptic ulcer disease
Inflammatory bowel disease
Coeliac disease
Travellers’ gastrointestinal infections
Liver disease
Gallstones
Pancreatitis

Aviation and metabolic and endocrine disorders

Diabetes mellitus
Endocrine disorders
Anterior pituitary hypofunction
Anterior pituitary hyperfunction
Hypothyroidism
Hyperthyroidism
Addison’s disease
Cushing’s disease
Conn’s syndrome
Phaeochromocytoma
Disorders of calcium metabolism
Lipid disorders

Aviation and renal disease

Renal response to the flying environment
Heamaturia
Proteinuria
Renal stone disease
Chronic renal failure
Benign prostatic hypertrophy
Bladder carcinoma

Aviation and haematology

Anaemia
Bleeding disorders
Deep vein thrombosis and anticoagulation
Thrombophilia

Infectious diseases

Infectious diseases
Malaria
Tropical diseases
HIV
Hemorrhagic fevers

Aviation and malignant disease

Certification and malignant disease
Certification assessment methods
Colorectal carcinoma
Lymphoid malignancy
Melanoma
Testicular tumours
Adenocarcinoma of the prostate
Renal carcinoma
Breast carcinoma
Lung carcinoma

Aviation and neurological disease

Injury to the nervous system
Cerebrovascular disease
Subarachnoid haemorrhage
Neurodegenerative disease
Tumours
Inflammatory disease
Infections
Myasthenia gravis
Paroxysmal disorders
Disturbances of consciousness

Aviation and ophthalmology

Visual requirements for aviation
Ophthalmic examinations for aircrew
Refractive error in aviation
- Management of refractive errors in aircrew
- Corrective flying spectacles
- Contact lenses
- Refractive surgery
Ophthalmic disease in aviators
- Ocular adnexae
- Ocular anterior segment
- Retinal disease
- Neurophthalmology
Ophthalmic drugs

Aviation and otorhinolaryngology

Otitic barotrauma
Sinus barotrauma
Hearing loss
- Hearing tests and certification
Vertigo

Aviation psychiatry

Occupational psychiatry
Adjustment disorders
Mood disorders
Self-harm, attempted suicide and para-suicide
Post-traumatic stress disorder
Panic disorders
Obsessive-compulsive disorder
Personality disorder
Substance misuse
- Drugs
- Alcohol
Psychoactive medication and fitness to fly
Fear of flying
Break-off
Psychiatric aeromedical evacuation
Conduct disorder in passengers

Aviation and orthopaedic disease

Aeromedical disposition after fracture management
Fracture fixation
Upper limb disorders
Lower limb disorders
Spinal injury
Ejection seats and spinal injury
Congenital deformities Osteoporosis

Aviation and obstetrics, gynaecology and sexual health

Pregnancy
Infertility
Menstrual disorders
Oral contraception
Transgender aircrew

Aeromedical evacuation

Principles of aeromedical evacuation
Categorisation of patients
Choice of aircraft
General medical considerations
- Gas expansion
- Hypoxia
- Vibration
- Temperature control
- Noise
- Motion sickness
- Fear of Flying
- Medication and time zones
Clinical considerations
Aeromedical transport of critically ill patient
- Team composition
- Equipment
- Effect of altitude and flight environment
- Air Transportable Isolator and the infectious patient

Aircrew and radiation

Cosmic radiation
Solar particle radiation
Radiation fields at aircraft altitude
Radiation dose limits
Computer models for predicting dose exposure
Space weather effects
Cancer risk in aircrews

Space medicine

Human Space Flight
Immediate medical problems
- Decreased pressure
- Acceleration
- Radiation
- Micrometeoroids
- Nutrition and waste management
Long-term medical problems
- Microgravity
- Neurovestibular system
- Cardiovascular system
- Musculoskeletal system
- Psychological and behavioural aspects
Commercial Space Flight

Aircrew roles, responsibilities and aeromedical requirements

Civilian aircrew and cabin crew
Military aircrew
Air Traffic Controllers
Remotely Piloted Air System Crews

Passenger health

Cabin air issues
Health hazards in the airline cabin
Long distance travel

Pilots with disabilities

Aeromedical assessment of disabilities
Medical flights tests

Aviation epidemiology

Aircrew and other licence holders
Statistical theory

Date last modified: 29/06/20

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DAvMed – Regulations & Guidance