IndAeMed_F: Re: GLOC Disposal
- From: USM Bish <bish@xxxxxxxxxxx>
- To: indaemed@xxxxxxxxxxxxx
- Date: Sun, 4 Apr 2004 20:51:30 +0530
Thru IndAeMed@xxxxxxxxxxxxx:
--------------------------------------------
On Sun, Apr 04, 2004 at 06:35:36AM -0700, PK Tyagi, MD DNB wrote:
> >
> > What is the disposal of such cases, now that the IAP is revised
> > for GLOC episodes in flight ?
> >
Yup, this is very much the bone of contention:
>
> "Pilots who experience GLOC in flight will be referred to IAM
> with full history of sortie profile, flight data print out and
> AGS worn during that sortie. They will be placed in medical
> category A4G1 & expeditiously referred to IAM for evaluation.
> Here they would undergo full biochemical assessment with
> extended GTT, HC evaluation and possible tilt table study".
>
This is very much it. Since we have a policy in place, it is
obvious there must be some guidelines as to how to go about
evaluating such cases (besides exclusion of associated factors
like ANS anomalies, Glucose anomalies etc). In any case, if the
system of HPA medicals are still in place, these would be
detected in most cases, much earlier.
Further, there must be concrete guidelines for evaluation and
acceptance/ rejection as well. If these are not in place, it
defeats the purpose of "placed in Med Cat A4G1 and
expeditiously referred to IAM for evaluation".
As I understand, GLOC is a physiological phenomenon and most
cases would come out with a clean chit for pre-existing
maladies. The onus would therefore be on the Accn studies, for
which there should be clear guidelines. If none exist, it is
imperative that the existing policy be suspended in toto, till
such a time a justifyable protocol is formulated. The closed-
loop system may be of help here, but that would take a fair
amount of time to get any significant material evidence to
formulate a policy.
The risk of enforcing such a policy, is obviously, reluctance
of self reporting. This would be counterproductive. There is no
way of knowing cases of G-LOC in the air unless the person
affected comes forward to report. And he will NOT !
>
> My personal view is that GLOC is a physiological phenomenon,
> not uncommon in fighter & trainer flying (in-flight incidence
> being 10.8% & 10.5% in two IAF studies, 12% in USAF & 19% in
> RAF). If a pilot does suffer a GLOC, the only advise I would
> give to him is take a day off and resume normal flying the next
> day to ward off the effects of psychological suppression if
> any. Additionally, the Gz physiology, the importance of AGSM,
> physical fitness, & the necessity to avoid factors affecting Gz
> tolerance could be re-emphasised to him. I WOULD THEN LIKE TO
> LEAVE HIM ALONE.
I tend to second this view. It makes a lot of sense. This
suggestion of local follow up with re-inforcement of G-
tolerance enhancing techniques are the only things that should
be practiced at this stage. Ofcourse, local exclusion of
concurrent ailments or pre-dispositions like dehydration/ heat
stress etc would be needed. Cases may be referred only if some
non-transient anomaly is suspected/ found.
>
> Surprisingly, Modak in an article in the latest issue of IJASM
> did recommend that every case of GLOC be evaluated at IAM. I
> doubt if any other acceleration physiologist would agree to
> this poorly thought out recommendation.
>
I have no comment on this issue. Modak surely had something in
his mind ... in case he is reading this, he may be in a better
position to explain. This, however, is inconsequential.
What is more important, perhaps, is the stand taken by the
policy makers who should be in a position to clarify issues. I
am certain, policies are not formulated based on recommenda-
tions of authors in IJASM. It is an organisational decision.
> Grounding for evaluation, is in order only if the local av med
> physician & / or sqn flying supervisors have reason to believe
> that a particular pilot has been having recurrent episodes of
> GLOC which could possibly indicate low G tolerance.
Yes, this is a better approach ...
> Grounding for a single GLOC episode may have been a wise
> decision in 70s but is to be considered a regressive step in a
> modern air force like ours and that two in the 21st century.
^^^
Such things were not there in the 70s. I did my Introductory
and Primary Courses in 78-79. We were totally unaware of any
term called G-LOC. I can at least confirm, that I never heard
of this term then, or maybe, our instructor in those days (Sqn
Ldr Kuldip Rai) did not disclose the "latest" ! Very very
unlikely. It is definitely not there in Gilles and Randell, the
only text books available to us in the late 70s.
> You don't give a month's sick leave to recuperate from a benign
> headache. I am sure the IAP's recommendation is just an
> oversight & amendment to IAP section 6.10.9 (c) should be
> coming sooner than later.
"Oversights" are NOT accepted in policy decisions. It surely
needs to change. It would come only when the matter is taken up
... otherwise it would just be a matter of "let sleeping things
lie".
Just another header ...
Bish
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