International Civil Medicine-a personal history By Dr Silvio Dr Silvio Introduction I had the honour of being in ICAO s Medicine Section for 23 years, starting as an Officer at the beginning of 1971 and being promoted as Chief in 1975, retiring in 1994. Many important developments took place during that period. In my opinion, the prohibition of smoking in aircraft and the initial steps, in south East Asia towards improved management of public health events in the aviation sector are the most salient points! Other important points relate to the recognition by the ICAO Council of the importance of aviation medicine by granting the Edward Warner Award to the Academy and past presidents of both the Academy and the Aerospace Association. Usually textbooks describe the origins and development of aviation medicine as a separate discipline; this contribution intends to emphasize, as the title indicates, matters related to international standards, mostly in relation to the International Civil Organization (ICAO).
Brief historical review Shortly after the end of the First World War, the initial concrete step in effecting international regulation of air navigation was taken by the Aeronautical Commission of the Peace Conference when it drew up the International Air Convention of October 13, 1919, instituting the International Commission for Air Navigation (which came into being in July, 1922) in order to provide rules for air traffic. Later modifications in the text of the Convention were authorized in June, 1929. The Convention of 1919 indicates that its operation requires a permanent organization for the following purposes: (a) to receive reports of the contracting states; (b) to transmit this information to the other states; (c) to revise the numerous and detailed rules in the annexes to the convention so that they will meet the rapidly changing conditions of aviation; and, finally and most important of all; (d) to provide a means for the progressive revision of the text of the Convention. These duties were placed upon the International Commission for Air Navigation. Then, in 1944, as a result of a meeting in Chicago, the Provisional International Civil Organization (PICAO) was created. Three years later the word Provisional was dropped and ICAO began its work, based in Montreal, Canada. ICAO s Medicine Section With this information as a background, the table at the end of this paper reflects the evolution of the MED Section of ICAO s Air Navigation Bureau indicating periods, section name(s), incumbent(s), titles of the post(s) and significant developments in each period. I have elaborated on some specific events in the following text. A major event took place in 1981. Dr. Stanley Mohler (former AsMA President) nominated Dr. Harry Armstrong, also a past president of AsMA, to receive the prestigious ICAO Edward Warner Award. This award, in the words of a former Director of ICAO s Legal Bureau is the Nobel Prize equivalent for aviation. I was chief of the ICAO Medicine Section () at the time and was summoned by ICAO s President (who chairs the Council s Edward Warner Award Committee) to answer questions related to the nominee and the nominator. Very satisfied with my comments, the Committee recommended to Council that the award be given to Dr. Armstrong. It was the only time in ICAO s history that the Ceremony did not take place in connection with an ICAO Assembly (the three yearly gathering in Montreal of all ICAO member States). Since Dr. Armstrong was very sick, Dr. Assad Kotaite, President of the ICAO Council at the time, flew to San Antonio and presented the award there. It should be noted that the granting of the award was a recognition by ICAO s Council of the importance of the discipline of Medicine. On two more occasions the award was presented to an aviation medicine related organization or individual, once to the International Academy of and Space Medicine itself and the other, for the first time to a former
ICAO Staff member and a past president of the Academy (editorial note this was Dr ). During the 1970-1975 period the first edition of ICAO s Manual of Civil Medicine was published in English, French and Spanish and a programme of ICAO regional aviation medicine seminars was commenced, the first ones being held in Argentina, Nigeria and Thailand. Such seminars continue today, under the direction of the current, Dr Anthony Evans. During 1985-1994, a major study was conducted in cooperation with the Operations Section of ICAO s Air Navigation Bureau in order to avoid excessive fatigue from over-demanding flight crew rosters. Those initial studies could be considered as a starting point for further developments that resulted in the concept of Fatigue Risk Management. In addition, in 1985, the second edition of the ICAO Manual of Civil was published in four languages, and a French-speaking officer was appointed enabling the provision for improved teaching activities in the French-speaking African states. Studies were initiated in cooperation with WHO (Dr. Jonathan Mann) in order to ascertain the importance of AIDS in aviation. The 8 th World Conference on Tobacco or Health, held in Buenos Aires, Argentina during 1992 was the first public forum in which a joint ICAO-WHO presentation was made. This paved the way to ICAO s Resolution A 29-15 (1992), Smoking restrictions in aviation. This resolution was instrumental in facilitating a ban on smoking in aircraft, which occurred over the subsequent few years. Interestingly, an ICAO Annex provision was not needed, States or airlines themselves deciding to introduce their own ban without a mandate from an ICAO Standard. In conclusion, when retiring in 1994 from ICAO and returning to Argentina, I felt happy as having contributed to ICAO s Medicine Section programmes and activities. ICAO-MED Section s evolution PERIOD SECTION s NAME INCUMBENT(S) POST TITLE(S) SIGNIFICANT DEVELOPMENTS 1947-1961 Section (MED) Dr. Franz de Tavel (Switzerland) Adviser Development and adoption of first MED Standards and Recommended Practices (SARPs). Liaison with WHO on matters of Public Health and Quarantine Preparatory work for Licensing/MED: 1961 - Studies on incapacitation and loss of licence on medical grounds were presented in working papers for general discussion. Recognition by ICAO s Council that AsMA would be included in the list of international
organizations which could be invited to ICAO meetings. 1961-1965 The Section was not staffed during these four years. The Personnel Licensing/Training (PEL/TRG) Section was responsible (to the extent possible) for aviation medicine activities. 1965-1970 Medicine Section (MED) Dr. Lloyd Buley (Australia) Officer Major recognition by ICAO of the importance of human factors in aviation safety. Development of the concept of incapacitation and associated flight safety risks. Dr. James Alexander (U.K.) Expert Recognition by ICAO s Council that IAASM would be included in the list of international organizations which could be invited to ICAO meetings. Preparatory work for PEL/TRG/MED Divisional Meeting: 1970 - Working papers were presented by the Secretariat on incapacitation recognition and training to deal with such an event. 1970-1975 Dr. Arne Frykholm (Sweden) Dr. Silvio (Argentina) Officer (Chief, MED Section) Officer (AMO) Follow-up of the PEL/TRG/MED (1970) Divisional Meeting Recommendations. State Letters were sent on the subjects of incapacitation and the need to collect adequate information on this from States. Production of the first edition of ICAO's Manual of Civil Medicine in English, French and Spanish. Started teaching ICAO MED Seminars as a pilot project. Initial ones held in Argentina, Nigeria and Thailand. 1975-1985 Dr. S. Standardized courses for Designated Examiners (DMEs) commence. Second edition of the MED Manual published in English, French, Spanish and now Russian. Adoption of a Standard calling for obligatory training in AVMED for DME s (although it was not until 2005 that this training was made mandatory prior to appointment). ICAO Warner Award granted to a physician in recognition of AVMED (Dr. Harry Armstrong). Recruitment of French- Speaking aviation medical officer. Non-
smoking policy for ICAO meeting rooms 1985-1990 Dr. S. Dr. J.P. Chambion (France) AMO Assistance provided to French-speaking Contracting States. Improvements of French versions of MED Documents. Regional Seminars provided for francophone African States. Initiated major study on flight fatigue and on smoking in aircraft. 1990-1994 Dr. S. Studies on prevention of substance abuse in the workplace, human factors and implications of AIDS. Cooperation with the European Community on a major revision of ICAO medical standards and co-operation with Canadian authorities to develop programmes for post-graduate education and research in civil aviation medicine. Liaison with WHO on matters related to substance abuse and smoking in aircraft. Resolution A29-15 calling for a ban on smoking in aircraft was adopted by the ICAO Assembly. 1994-2005 Dr. Claus Curdt- Christiansen (Denmark) Dr. Anthony Evans (U.K.) Secondee (1997- six months) Major revision of Annex 1 SARPs. Mandated periodicity of periodic medical examinations reduced (becoming annual for Class 1 up to age 60 years and five yearly for the under forties in private pilots). Changes to SARPs on colour vision for pilots. Study groups on substance abuse, laser emitters and colour vision Two manuals developed and published (Lasers & Problematic use of substances) Assembly Resolution A35-12 indicating that protection of health on board international flights is an integral element of safe air travel adopted by ICAO Assembly. SARS!! Participation in ICAO Project, with WHO to improve confidence in air travel to/from Asia. 2005- Present Dr. Anthony Evans Annex 1 amendments on upper age limits for commercial pilots, preventive medicine and HIV. Third edition of ICAO Manual of Civil Medicine published in 2012.* Introductory e-learning course for DMEs produced. Collaborative Arrangement for the Prevention and Management of Public Health Events in Civil (CAPSCA)
http://www.icao.int/publications/pages/publication.aspx?docnum=8984 commenced in 2006 and developed into a global programme. Public health provisions introduced into several ICAO Annexes. ICAO coordination of multi-stakeholder transport task force for the Fukushima Nuclear Powerplant Accident (2011) and for the Ebola Virus disease outbreak (2014). invited to participate as advisor to four WHO Emergency Committees H1N1, MERS CoV, Ebola and Polio.