How old is too old for a military pilot? Around the old buoy again! - PowerPoint PPT Presentation

How old is too old for a military pilot? Around the old buoy again! RAeS Aerospace Medicine Group Symposium, 2017 Gp Capt Andy Timperley RAF Centre of Aviation Medicine

SCOPE • The problem • The past: previous regulation • The present: current regulation • The RAF’s approach to policy making • The future: recommended regulation

The problem % Air accident rates with age (1) Broach et al, FAA, 2003 (2) Melzer et al, Age UK, 2015 Comorbidity % (2) Melzer et al, Age UK, 2015 (2) Melzer et al, Age UK, 2015

The size of the problem Number of Regular and Reserve Pilots by age as of 1 Feb 17 1,400 1,200 1,232 1,000 1,043 800 600 400 200 264 189 36 2 2 1 0 under 40 40-44 45-49 50-54 55-59 60-64 65-69 70-75 (3) Timperley & Greenish, RAF CAM, 2017

The past: previous regulation 1919 International Commission for Air Navigation Age limit 45 years Life expectancy 57 years 1972 International Civil Aviation Organisation Age limit 60 years Life expectancy 75 years 2006 International Civil Aviation Organisation Age limit 65 years Life expectancy 82 years (4) Life expectancies from Human Mortality Database, accessed 22 Apr 17

The present: current regulation Civil Regulation Solo Multicrew ICAO 60 65 EASA / CAA 60 65 Military Regulation Solo Multicrew BEL -- -- FRA -- -- GER -- -- RNALF 60 65 MAA 65 --

RAF AvMed policy development •SCAMS policy development •AMSSG policy endorsement •AP1269A policy publication

RAF approach to policy making Consideration to employment law •European Employment Directive 2000/78/EC •UK Equality Act 2010 •Legitimate age-based practices must be objectively justified •Ensuring combat effectiveness is deemed legitimate Other considerations •Civilian standards are used as a baseline: •Consideration of other Nations Air Forces’ policies •The One Percent Rule is used cautiously •1 st , 2 nd and 3 rd party risk

Civilian approach to acceptable risk Acceptable accident fatality rate set at •1 in 10 7 flying hour •1 in 10 9 flying hours due to medical incapacitation For multi-pilot ops: 1% per annum •10% critical flight •1% unsuccessful handover For single pilot ops: 0.001% per annum •Whole flight is critical •No opportunity to hand over control •Not achievable other than in young adults

RAF approach to acceptable risk Risk Boundaries Risk of death per annum Boundary 3 rd Party 1 st Party 2 nd Party Intolerable > 1 in 1000 > 1 in 1000 > 1 in 10,000 Tolerable ≤ 1 in 1000 ≤ 1 in 1000 ≤ 1 in 10,000 Broadly Acceptable ≤1 in 1,000,000 ≤ 1 in 1,000,000 ≤ 1 in 1,000,000 Taken from Military Aviation Authority Regulatory Article RA 1210 - Ownership and Management of Operating Risk (Risk to Life)

All cause mortality Age standardised mortality rates for England and Wales 100,000 10,000 1,000 1% per annum 0.1% per annum 100 10 1 0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90 + Male All Cause Female All Cause Data from Office of National Statistics, UK, 2015

Age standardised mortality rates for England and Wales 100,000 10,000 1% per annum 1,000 100 0.1% per annum 10 1 0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90 + Male IHD Female IHD Male CVA Female CVA Male All Cause Female All Cause Data from Office of National Statistics, UK, 2015

Cardiovascular mortality Age standardised mortality rates for England and Wales 10,000 1% per annum 1,000 0.1% per annum 100 10 1 0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90 + Male IHD Female IHD Male CVA Female CVA Data from Office of National Statistics, UK, 2015

Focusing in on cardiovascular risk 10 year cardiovascular risk 30 25 20 15 % 10 5 0 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 Male Female Age (years) Data calculated from QRISK 2 (2014) App, using default clinical information and values

My thoughts The risk defining disease is cardiovascular disease (5) Wigglesworth, Joint •Sudden incapacitation Epeliepsy Council of the UK and Ireland, 2011 •Hidden until it happens •Risk easily reaches the 1% threshold in the older pilot Other risks are sub-threshold or visible •Epilepsy doesn’t reach 1% per annum •Visual acuity and hearing are easily tested •Cognitive decline can be spotted at medicals / sim checks •Reduced mobility can be assessed functionally

Final DRAFT recommendations Age Test Notes Annually Medical (plus ECH as per schedule) As per current practice. 50 an annually QRISK2 10% over 10 year threshold for further thereafter investigation. 60 and 5-yearly CT angiogram Scoring system to be agreed. thereafter 60 and 2-yearly Exercise ECG, echocardiogram and thereafter ambulatory ECG

No age limit, just risk tolerance (6) YIU K.H. et al. 2012. Age- and gender-specific differences in the prognostic value of CT coronary angiography. Heart 98: 232.

References (1) BROACH D., JOSEPH K.M. & SCHOREDER D.J. 2003. Pilot age and accident rates report 4: An analysis of professional ATP and commercial pilot accident rates by age. US Federal Aviation Administration. (2) MELZER D., DELGADO J.C., WINDER R., MASOLI J., RICHARDS S. & BLE A. 2015. The Age UK almanac of disease profiles in later life: A reference on the frequency of major diseases, conditions and syndromes affecting older people in England. Age UK. (3) TIMPERLEY A. & GREENISH T. 2017. RAF Regular and Reserve Pilots by Age and MES Flying Category [unpublished]. (4) Human Mortality Database . University of California, Berkeley (USA), and Max Planck Institute for Demographic Research (Germany). Available at www.mortality.org or www.humanmortality.de (data downloaded on 22 Apr 17). (5) WIGGLESWORTH S. 2011. Epilepsy prevalence, incidence and other statistics. (6) YIU K.H., DE GRAAF F.R., SCHUIJF J.D., VAN WERKHOVEN J.M., MARSAN N.A., VELTMAN C.E., DE ROOS A., PAZHENKOTTIL A., KROFT L.J., BOERSMA E., HERZOG B., LEUNG M., MAFFEI E., LEUNG D.Y., KAUFMANN P.A., CADEMARTIRI F., BAX J.J. & JUKEMA J.W. 2012. Age- and gender-specific differences in the prognostic value of CT coronary angiography. Heart 98: 232. Regulatory articles •ICAO: Annex 1 to the convention on International Civil Aviation – Personnel Licensing. •EASA: Commission Regulation (EU) No 1178/2011. •CAA: CAP 804 - Part I Flight Crew Licensing - Mandatory Requirements, Policy and Guidance. •CAA: CAP 393 - The Air Navigation Order 2016 and Regulations. •RNALF: MAR-FCL 1.060. •MAA: RA2135 - Aircrew Medical Requirements. •MAA: RA 1210 - Ownership and Management of Operating Risk (Risk to Life) •EU: European Employment Directive 2000/78/EC •UK: Equality Act 2010 •RAF: AP1269A – Assessment of Medical Fitness.