David | Aviation Medic
David has spent his career in Aviation Medicine, a field we knew very little about prior to this conversation. He is one of those people who is extremely humble about what is in fact an incredibly interesting and varied career! It was a pleasure hearing about his experiences and learning what working as a Chief Medical Officer of an airline involves.
I graduated in 1986 and my first paycheck as a house surgeon went on flying lessons; it was something I had always wanted to do.
Straightaway, I wondered if there was a way to combine aviation and medicine.
I did a bit of research into what options were out there and that led to me joining the Royal New Zealand Air Force. I did a total of eight years as a medical officer which was fantastic. There were only six of us - doctors, not the entire Air Force! - so we got to do a bit of everything. There was general practice, aeromedical evacuation, training, deployments. I spend a couple of months in Bahrain during the first Gulf War, and was involved in the follow up and investigation of air crashes. It was a great way to apply skills I had learned in medicine to a different environment.
But it has always been challenging to recruit doctors to the military as you do have to relinquish control over your existence to an extent. So, although I found it endlessly interesting, four years in I decided to go and get a ‘real job’. I became an anaesthetic registrar for just over a year and although I did enjoy it and it was a very viable career pathway, I decided I couldn’t face decades of being locked in a room with no windows! So, I returned to the military for a further four years.
My next move was to Air New Zealand as Chief Medical Officer, which I did for 12 years. I then went into consulting and part-time work before I got tempted out to work with Virgin Australia, so my beloved and I spent a fun couple of years in Sydney! I then had the opportunity to become IATA’s (International Air Transport Association) medical advisor, which is the trade organisation for most of the world’s airlines. I thought that would a great way to ease into semi-retirement…that was until January 2020! Trying to stay on top of everything that relates to aviation in the context of COVID has been a challenge to say the least!
My role in a nutshell
An airline Chief Medical Officer essentially focuses on occupational medicine role in the context of the flying environment with an added dimension of public health as it relates to passengers. At first glance, it is a role that might sound really boring but actually it is incredibly varied. You are responsible for the occupational health of thousands of staff but also the needs of the passengers. If someone has a medical problem and is seeking approval to fly, those systems need to be in place. If someone gets sick on board, the crew need to be trained for that and there needs to be adequate medical equipment onboard with support from the ground. That is all within your jurisdiction.
Dealing with medical emergencies in flight
This is not a typical part of our case studies, but it is an issue that comes up amongst medics a lot so we wanted to include it!
Firstly, it is always the pilot’s final decision whether or not to divert a flight in the instance of a medical emergency. They supersede anyone else’s opinion on the ground or the plane because ultimately, they are responsible for the safety of everyone on board.
All airlines will have a doctor on call that you can speak to – most use a specialist contracted service based in the USA. As context, Air New Zealand and Qantas employ around four doctors each. Singapore Airlines and most US airlines have a different model – they have none of their own doctors but draw on a consulting service; Emirates and Qatar have big teams that also provide primary care to their staff.
As for what happens on board - 50% of the time or more it is going to be syncope – I blame 4 A’s: age, anxiety, altitude and alcohol! Once we had to divert a plane flying from London to LA to Iceland because someone on board was having a fairly florid allergic reaction. By the time they landed, two more people were having a similar reaction. It turned out the fish served on the plane had developed a toxin called Scombroid that flourishes when fish spoil in the heat. It can cause an exogenous histaminic reaction that can be quite violent! It was a good job we diverted that one!!
My ‘average’ day
Every day is different. I might be counselling a pilot in the morning who has to stop flying due to a significant medical problem then attending a meeting about a disease outbreak somewhere and advising the airline about how to respond to that in the afternoon, with a session teaching cabin crew about managing a cardiac arrest in flight in between!
My experience of ‘going beyond’
Often in aviation organisations you are one of a few, if not the only, doctor which I have found to be both a privilege and a responsibility. While you appreciate not being second guessed, you do have to get it right! The way to achieve that is through international networks. For example, during COVID-19 I have been on the phone to colleagues in the CDC in the USA, the International Civil Aviation organisation, European Aviation Safety, the WHO, and so on. You are working on a broad geographical level.
Reactions from others when you decided to pursue a non-clinical path
When you first start the discussion with your colleagues about doing something that isn’t mainstream, there’s always a sense that you’ve sort of left the monastery! And then as the conversation continues, you see them realising there actually is a different and very interesting world out there.
If someone wanted to pursue a similar role, how could they go about it?
Aerospace medicine is a small world. People generally end up in the military, working for airlines or within civil aviation authorities. It can be a little lonely at the start but over time you develop this international family because it is such a small field.
Skills & Experience
Aerospace Medicine is a specialty that is not recognised in all countries. It has been in the USA for decades due to their large military contingent and more recently in the UK and Singapore. We have a college of Aerospace Medicine in Australasia, though the specialty is not yet recognised by the medical councils in Australia or New Zealand. But we did set up and recruit to rotations between Qantas, Virgin Australia and the local Civil Aviation Authority that were due to be a year at each. We were just getting to the end of the first rotation when COVID struck- so that arrangement is obviously now disrupted!
However, a lot of the skills you need for these types of roles can be drawn from your medical experience. What we look for is general experience and a few postgraduate years under the best. General practice, rural medicine and/or emergency medicine are all great foundations.
In terms of qualifications, I did a postgraduate diploma in Aviation Medicine with Otago University, which is now a masters course, and later taught on the Faculty for many years. Interestingly, that course is the leading provider of distance-learning for aviation medicine internationally, from little old New Zealand. I work with a committee of 10 airline medical directors from around the world and half are Otago graduates! There are also a handful of other courses in places like the UK, USA, India and South Africa.
If you could go back to your medical school graduation day and give yourself one piece of advice, what would it be?
Honestly, I would say a lot of the stuff that you have just learned is going to turn out to be wrong, even more of it will turn out not to be important, and in many situations you are going to have to find your own way over time; that makes it very, very exciting.