Aviation medicine

Aviation medicine

Feb 10, 2020 0
general practice,onthejobs,onthepods

James chats to Squadron Leader Nicola Boyd about her experience in the Royal Australian Air Force, specifically around aviation medicine, education and career path options available for aviation medicine.

Summary Writer: Eloise Sobels

Script Writers: Carla Roscoe and Angus Pagett

Editor: Angus Pagett

Interviewee: Nicola Boyd

About Squadron Leader Nicola Boyd

Squadron Leader Nicola Boyd commissioned into the Royal Australian Air Force in January 2008 under the Graduate Medical Program. Previously, she had a career as an Occupational Therapist. On completion of her medical degree in 2011, she completed two years of civilian hospital training.

Squadron Leader Boyd attended Officer Training School in 2014. After that, she has enjoyed postings as an Aviation Medical Officer to 2 Expeditionary Health Squadron (2EHS) and 1 Expeditionary Health Squadron (1EHS). Furthermore, Nicola spent a period as Officer in Charge at 1EHS Detachment East Sale. She later returned to 2EHS as Senior Medical Officer.

Nicola deployed to the Middle East on OP ACCORDION in support of OP OKRA in 2015. During that time, she enhanced heat illness prevention and management through the development of a heat illness training program.

Education, degrees and experience

In 2018, Nicola was selected to attend Kings College London. This was to undertake the Postgraduate Diploma in Aerospace Medicine. Additionally, she was also awarded a Diploma of Aviation Medicine from the Faculty of Occupational Medicine, Royal College of Physicians London.

Nicola returned from the UK in 2019. Now, her posting is at the Institute of Aviation Medicine. There, she is undertaking a range of duties in clinical, research and training.

Squadron Leader Boyd holds the following:

  • A Bachelor of Occupational Therapy, a Bachelor of Medicine, and a Bachelor of Surgery.
  • A Diploma of Child Health.
  • A Postgraduate Diploma of Aerospace Medicine.
  • A Diploma of Aviation Medicine.

She is a Fellow of the Royal Australian College of General Practitioners. Moreover, she is currently a Registrar of the Australasian College of Aerospace Medicine. Finally, Nicola is commencing a Masters in Forensic Medicine part-time due to a special interest in aviation crash investigation.

Nicola and her partner Steve are proud parents to their daughter, Charlotte. In her free time, Nicola enjoys hiking and photography. She is also passionate about training in a variety of dog sports with her three dogs.

 

Aviation medicine

With Dr Nicola Boyd, Squadron Leader in the Royal Australian Air Force (RAAF), Aviation and Aerospace Medicine specialist and general practitioner.

 

Introduction

James chats to Squadron Leader Nicola Boyd about her experience in the Royal Australian Airforce, specifically around aviation medicine, education and the diverse medical specialist career path options available in the Air Force.

  • Sense of belonging and wanting to do something that was a bigger part of the community
  • Sense of adventure and travel
  • Ultimately it provided an exciting career path with some unique opportunities
  • Before medicine, I was an Occupational Therapist and tossed up for a few years whether medicine was what I wanted to do. Eventually, I decided to take the plunge and apply for the graduate medical program. I undertook a 4-year medicine degree and did my internship and residency at a regional New South Wales Hospital.
  • Once I put on the Australian Defence Force (ADF) uniform I had two postings, one to 2 Expeditionary Health Squadron (2EHS) in Williamtown, near Newcastle, and the other was to 1 Expeditionary Health Squadron (1EHS) in East Sale, Victoria. I was largely responsible for primary care, general practitioner (GP)-type work, aviation crash response and being on-call for humanitarian and disaster relief. During that time, I also completed my GP specialty training.
  • Upon completion of my specialty training I was promoted and posted back to 2EHS where I was appointed the senior medical officer (SMO). It was at this point I realized my passion for aviation medicine and I decided to take the plunge and undertake another specialty training.
  • It is a four year, relatively new program which involves undertaking a diploma in aviation medicine and on-the-job training.
  • One of the big ones is being able to take part in lots of courses to expand your skills, all paid for by the ADF.
  • I have really enjoyed being able to travel a lot and work in a number of unique places.
  • Of course, the highlight is my deployment to the Middle East where I was the sole Doctor looking after the Australian’s with a small team of medics and nurses. So, a lot of variety for sure.
  • A two-week course in Phoenix, Arizona, America working with the United States Air Force where I got to fly in the back of F16 fighter jets. That was a course for what they called ‘Flight Surgeons’ which is our equivalent to an Aviation Medical Officer
  • Completing my Diploma of Aviation Medicine at Kings College in London with the Royal Air Force. It was a six-month degree with full time study, fully paid for by the ADF. We went on awesome side trips where we visited British Airways for a week, the European Space Agency in Germany and the Martin Baker ejection seat factory to see where ejection seats are made. I had a lot of experiences there that you wouldn’t normally have had in a civilian career, which was fantastic.
  • It wasn’t one single thing. I think for me, I love aviation and come from a long line of pilots and so I was brought up in and around aircraft. The Air Force combines my love of aviation with my love of medicine, so I was really attracted for those reasons.
  • I’m also not stuck doing the same thing day-in, day-out in the same four walls that I might have been in the normal suburban general practitioner’s office. This might be fine for other people but I tend to get bored very easily. One day I might be doing primary care and the next I might be off somewhere else supporting an exercise or on deployment. There’s a lot of variability and some degree of unpredictability there.
  • Primarily we’re there to make sure our people are fit and well to do their job. We do provide care to all members of the ADF. So, even though I am Air Force, I do see those from the Army and Navy as well, providing primarily general practice, coughs, colds, mental health, sporting injuries and all of those sorts of things you would usually see in ‘GP-land.’ We also do a lot of surveillance and preventative care as well.
  • We are responsible for airfield crash response, which involves us being on call just in case one of the aircrafts has an issue, fingers crossed they never do! But we’re there just in case.
  • We are also on call for the humanitarian aid and disaster relief efforts, for example, the Bali bombings, Tsunamis, or the recent New Zealand Volcano events.
  • Of course, there’s also the support with deployment and exercises which is a big one. You could find yourself anywhere in Australia or overseas doing that sort of thing.
  • It depends where you are posted and what sort of squadron you are part of, usually we’re trained in general practice, so most people will either be a GP registrar or be a GP specialist. But everyone in the RAAF who is a doctor will have completed the Aviation Medical Officer course which is a 5-week course we complete down at RAAF Base Edinburgh at the Institute of Aviation Medicine. This allows us to see and work alongside the aircrew teams.
  • A typical day would be, rock-up at 07:30 and start with what we call, ‘the sick parade,’ which is like a walk-in GP clinic. So, if you’re not feeling well that day or something is going on in your life you can walk into the clinic and see a doctor. After a few hours, there are the booked appointments. You might also have a visit down to the flying squadrons where you listen to a briefing or give information on an aviation medicine issue, or if you’re lucky enough, you may get to go flying for the afternoon, which is obviously a lot of fun!
  • There’s also the mundane stuff such as meetings, but there are opportunities to run education sessions for other doctors, or nurses and medics and things like that.
  • Each day is different and it’s very variable so that’s one of the really good things about working in Defence.
  • Obviously, we don’t see a lot of paediatric patients, unless we’re on deployment. Our typical population we see usually range between 18-60 years old. It is a young, fit, healthy population so that does skew some of the things we see. There’s a range of sporting injuries, mental health and general coughs and colds.
  • We do have some interesting presentations. We have some people with chronic disease, so we do get a fairly wide variety considering the population we have.
  • It is a field of medicine that relates to all different types of aviation. Whether it is military aviation or civilian, recreational or commercial, or even sporting aviation like the Red Bull aviation races.
  • There is also another area called Aerospace Medicine which includes space flight and astronauts.
  • Ultimately the field is concerned for the health and safety of anyone that flies, whether that be aircrew or passengers. To achieve this we draw on all different areas of medicine such as occupational medicine, preventative health and a whole raft of clinical medicine. We combine that with our knowledge of what happens to the physiology and psychology of humans when they’re in flight.
  • I think it’s a really interesting field within medicine because we cover across a bunch of different fields.
  • It is really variable and as I said I tend to get bored very easily so there’s a lot of autonomy and flexibility within the role. At the moment I’m a Senior Aviation Medical Officer at RAAF base Edinburgh at the Institute of Aviation Medicine. I wear three hats, there’s the clinical work, training and further research.
  • A typical day for me would be, going down to the flying squadrons in the morning to attend their weekly brief, which allows me to maintain an understanding of the roles they do in that squadron and keep aware of some of the issues they might be having and assist with anything particularly aviation medicine related. I might then go to the clinic and spend the morning seeing patients which are again, mostly aircrew doing mostly GP stuff. Whenever we see an aviator, we have to make sure that they’re fit to fly as well.
  • Once back at the Institute I might be delivering training to the Air Force Aviators. We deliver a lot of aviation medicine training so that our pilots and our aircrew have an understanding of the environment and are able to recognize any issues that might come up. Or we might be running a course for our doctors or nurses on aviation medicine in order for them to be able to see aircrew as well.
  • In the afternoon, I may be reviewing some really complex cases. Aircrew who have been diagnosed with some significant conditions which could have a significant impact on their fitness to fly. Hence, we do a lot of work behind the scenes working out what the risk is for being able to let people fly.
  • Or… it could be that I’m not doing any of those things and I’m spending the day flying with one of the Squadrons. It can really vary, and we have full control over what we do in our day so it’s really nice.
  • Ultimately the limiting factor of aircraft performance has always been the human. Historically that has always been the case and I think that will be the case for a long time in the future.
  • In aviation, we’re flying at altitude, and with increasing altitude is an increasingly hostile environment. It gets colder, the availability of oxygen reduces so we get hypoxic, there’s a risk of decompression illness similar to what you have with diving, you can get pressure changes that lead to expansion of gases so that can cause pain in teeth, sinuses and in the gut. Flying also puts extra stresses on the pilot as well, so acceleration like G-forces, spatial disorientation (where the pilot might not know where they or the aircraft are in relation to the ground), fatigue, vibration, noise, and a whole raft of psychological and human factors as well.
  • We were designed to live at sea level at 1G, so for us to survive in that environment we really need a bunch of things as part of the aircraft to keep us alive and healthy, things like oxygen or cabin pressurization, anti-G suits and ejection seats.
  • For those in aviation medicine, flight safety is paramount and so what we do is provide inputs into the risk assessment, e.g. what is the risk of incapacitation of someone with breast cancer or a pneumothorax (collapsed lung). We keep abreast across all those health conditions, but it is also about the passengers who might be flying with existing disease.
  • As I said previously, we’re not just concerned with the health and wellbeing of the pilots but also with the airline passengers and crew as well. So, based on that it has implications for anyone that has ever flown on an aircraft before.
  • Where this becomes really important is for other doctors who have patients with chronic disease like emphysema, for example or even acute issues like recent surgery. Those doctors need to be aware of the potential health implications of the aviation environment. As I stated before it’s not a totally benign environment and there are some risks there, even the cabin of a Qantas jet or a Virgin Australia jet, the cabins are pressurized to 7000-8000 feet which has implications for passenger health.
  • A healthy passenger at 8000 feet might saturate their oxygen at about 90% which is quite low, and a healthy person will hyperventilate to increase their saturation levels to 95%. Hence, if someone has emphysema where their oxygen saturations are already low, and you put them on a jet then that is going to have significant implications for their fitness to fly.
  • It is really important for ADF and broader society to provide those opportunities. I think careers in STEM are really interesting, challenging, important and rewarding roles. One of the major issues in aviation medicine at the moment, particularly from a military perspective is that fighter jet anthropometrics (size, weight, height standards) were based on men and so that really restricts a lot of women from entering. Some of the faster jets aren’t designed for that typically smaller person. This generally means we have a male-centric pilot population. So that’s obviously had a lot of implications for women by narrowing down that population data. Another example is that crash test dummies were based on the height and weight of the average male and that’s influenced vehicle safety to the point where it might have implications for women in a crash, i.e. we might be more likely to have injuries.
  • Why is this important? “I think that people use their life experiences and perspectives to develop new ideas and create real innovation. If more women are involved in that process, it would not only be able to ensure the needs of women are addressed but it would also open doors to advances and progress that we haven’t seen before purely because we are adding different perspectives into the mix.” What is not only good for women is also good for everyone in the sense that everyone will benefit from those advances.
  • I think they should go for it!
  • Science and health in the ADF have a lot of unique opportunities and certainly would lead to a challenging and interesting career.
  • I think if any young girl or any woman, is interested in science and health, they should have that interest fostered. I think there are a lot of opportunities out there to make a difference, not only to the lives of other women as I spoke about but to the entire population.
  • It has certainly been an enjoyable career for me, and I would hope that other women would have that opportunity as well.

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Tags: #ADF,#aerospace medicine,#airforce,#army,#Aviation medicine,#defence force,#deployment doctor,#General Practice,#general practitioner,#human physiology,#jets,#navy,#Occupational Medicine,#pilot safety,#planes,#royal airforce,#travel,#unique places,#women in health,#women in science,#women in STEM

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