If one is asked to visualise the role of Aerospace Physician in emerging decades, especially in the Indian context, the need for redefining training is of foremost consequence to prepare the future practitioners who shall be armed with adequate knowledge, exploit the technology and actively apply the concept of holistic care.
Training methods for a Resident in Aerospace Medicine (RAM) in India are required to be focused more on hands-on practical aspects, with them evaluating and defining problem solving strategies. A vital source of learning can be interactions with field based subject experts, using video-conferencing, as a valuable tool. Use of Evidence based Medicine in Aeromedical Decision Making (ADM) is to become the norm, rather than an exception. This can be further facilitated by extensive exposure to the aviation and space facilities. More importantly, the RAM is to be trained be as per (her)his demonstrable flair – with various streams of Aerospace Medicine emerging in India – clinical, preventive, research and airline/industrial (occupational) branches of the speciality, after building a basic understanding, in turn qualifying in the broad specialty of Aerospace Medicine.
Elsewhere in the field, electronic-health (e-health) system is likely to become increasingly prevalent. Broadly, e-health today is limited due to communication procedures and technologies, ranging from telephone and fax through e-mail and digital data transmission of any kind of information in the healthcare sector. An advanced concept of e-health includes health information networks, electronic health records, personal wearable and portable communicable systems, and health portals (1). Here, the RAM shall have to learn to function utilising advanced e-health tools since this shall become the norm for health care management of a dedicated and personalised health care delivery systems for their clientele: the aircrew, the astronauts, and the air travelers.
Another important tool to master, unlike the conventional medical residency training, shall be the use of telemedicine. Telemedicine is defined by World Health Organisation (WHO) as “the practice of healthcare using interactive audio, visual and data communication. This includes healthcare delivery, diagnoses, consultation and treatment as well as education and transfer of medical data.” Though telemedicine promises to revolutionize healthcare delivery system, the issue to be addressed is the physical separation in aviation and space between the patient and the physician. In aviation, this reality would be all the more critical since the Aerospace Physician may be asked to render help to passengers from diverse backgrounds speaking different languages, miles above into the sky on a transcontinental flight. In the realm of space travel, telemedicine has been a reality for long. Yet, RAM shall be expected to master the same skills as expected in conventional healthcare of providing the healing touch, despite of distances not easily bridged (2).
Another area for the RAM to focus on is the holistic health care management. This is not a new concept, but aims at the classical definition of health – the prevention, treatment, and management of illness and the preservation of mental and physical well-being. As per WHO, the concept of health care embraces all the goods and services designed to promote health, including “preventive, curative and palliative interventions, whether directed to individuals or to populations” (3). RAM has to understand not just the conventional preventive and curative model of health care, but the vital social aspects of medicine for their select group of clientele. The paradigm shift required is to understand that the practice of Aerospace Medicine does not focus solely on the eradication of illness through diagnosis and effective treatment but treating each individual as a productive member of the Team Aviation, who must be made alert and aware to take responsibility of their own health as well. It defines illness from the point of view of the individual’s functioning within their society rather than by monitoring for changes in biological or physiological signs (3). In other words, the social model of health places emphasis on changes that can be made in society and in people’s own lifestyles to make the population healthier. And this ‘mantra‘ is more applicable in aviation today than any where else, with aviation safety being paramount.
An additional but vital call of duty for the Aerospace Physician is training and supervising the aviation paramedics. There shall be dedicated air ambulances for transferring casualties from the site of accident or critically ill patient from remote or primary health care centre to tertiary health care centre. The air evacuation is mostly required to be carried out by trauma and emergency trained paramedics (4). Aerospace Physicians can contribute significantly to this novel enterprise, bringing their knowledge about aviation stresses, with critical awareness of disease state for safe and timely evacuation with the help of dedicated team. Here again RAM needs to be trained in trauma and emergency care including interventional therapy to be able to stand up to this newly emerging challenge.
Aerospace Physicians shall play an increasingly active role in the days to come, not just in healthcare delivery but also for selection, evaluation and training of pilots and astronauts. So also, increasing aviation passenger traffic shall increase the need for active surveillance and monitoring for preventable illnesses like SARS and Swine flu, besides providing emergency medical care at the airports. And for all these deliverables, today’s RAM has to be moulded at the Institute of Aerospace Medicine, accordingly. So also, DGCA and the airlines, ISRO and aircraft industry have to ensure that they take Aerospace Physicians on board early and in adequate numbers, to provide appropriate and timely occupational healthcare to their precious employees.
3. Health care
4. Paramedics in the United States
Acknowledgement: Image courtesy www.freedigitalphotos.net
Well conceptualized from an Av Med Practitioner point of view. Should also take the view of the stake-holders of their perception of the role of an Aviation Medicine Specialist beyond just fitness disposal. Areas which may be included in the road map of Av Med Training are Medical Response to Mass disasters, proactive Mishap Prevention (Aviation Risk Management) and certified emergency medical care (BCLS / ALS).
Thank you Dr Baijal for your comments. Indeed, additional areas, as proposed by you, must be included to make the training all encompassing and all inclusive. Surely a food for thought for academics responsible for training at IAM.