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Bulletin - January, 1981

Civil Aviation Medical Association

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Repository Citation Civil Aviation Medical Association (1981). Bulletin - January, 1981. .

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(Headquarters) 801 Green Bay Road Lake Bluff, Illinois 60044 BULLETIN 312/234-6330 CAAAA JANUARY, 1981

PANORAMIC VIEW OF KAUAI SURF & ISLAND - SITE OF 1981 CAMA MEETING THE CAMA PRESIDENTS TAKES A MESSAGE STAND 1980-81 may be a year of great changes for the aviation The following memo was sent to all Aviation medical examiner and the avia• Medical Examiners on May 29, 1980. tion medical community in "By order of the United States District Court for general. We are going to have the Northern District of Georgia, in Delta Air to decide on such basic issues Lines v. United States et a/., (Civil No. 78-445A, May 16, 1980), the FAA has been enjoined as as the desired frequency of ex• follows: aminations; the extension of "The defendants are hereby enjoined from HalfordR.Conwell,M.D. age limits for the professional issuing medical certificates to airmen pos• airline pilot; even perhaps major changes in the entire sessing any of the absolutely disqualifying structure of the AME system. It would seem impera• conditions enumerated in 14C.F.R. tt 67.13, tive that all AME's in the United States as well as .15, .17 and are enjoined from exempting those abroad would feel it was vital that our personal any airman from these provisions without a proper finding that such exemption is in the expertise and experience be a part of the decision public interest as elucidated in this opinion. making in these changes. CAMA represents your logi• The Federal Air Surgeon is further enjoined cal choice for a platform of your own personal values from placing any limitation on the medical in aviation medicine. Since we are not directly affili• certificate of an airman that describes the ated with a governmental agency, a professional pilots' flight functions that such airman may perform." association, or amateur airmen group, we can perform As a result of the above order, and until such time as a forum and advisory body to these organizations. as we receive further instructions from the Court As physicians we have all had the unfortunate experi• or the Court's order is stayed, amended, modified ence in recent years of seeing regulations and bureau• or dissolved, you are hereby instructed not to issue or reissue any FAA Airman Medical Certi• cratic nonsense constricting our professional judg• ficate which is based upon a Grant of Exemption ment. We have seen aspects of the ever-growing con• held by any airman." sumerism thrust upon us in direct affront to our own professional knowledge. Altogether too often we have H.L Reighard, MD Federal Air Surgeon been victimized by our own silence and apathy in the rule-making procedure and areas that form public At a meeting of the Board of Directors, the fol• opinion. I urge each one of us to recognize the prob• lowing resolution was drafted to indicate CAMA's lems that will be confronting us this year—to parti• position re the above: cipate in CAMA through increased membership— to "Resolution Re the Exemption Process express your own ideas—and to participate in our ex• Whereas, responsible judicature is essential for cellent and enjoyable annual meetings. the protection of individual rights, so precious in the free world; and The 1981 meeting will be on the lovliest of all Whereas, decisions regarding complex aviation the Hawaiian Islands, Kauai. As always when the FAA medical matters are best made by responsible participates in the meeting, we have the most econo• physicians who have expertise in that disci• mical acquisition of CME credits possible. Of equal pline; and or perhaps greater importance, we have the oppor• Whereas, interference with an airman's indivi• dual rights through arbitrary means can have tunity to widen our scope of international programs serious adverse long range international and friends in conjunction with the FAA seminars. consequences; therefore, You can be an AME in name, but you cannot be Be it resolved that the Civil Aviation Medical the best AME possible without membership in CAMA. Association supports the administration of an exemption process for airman medical certi• fication by the Federal Air Surgeon as being TABLE OF CONTENTS in keeping with the law as enacted, consistent President's Message 2 with the state of the art in aviation Medicine, CAMA Takes a Stand 2 and supportive of individual rights at no Recommendations on The Wearing of Contact Lenses 3 demonstrated risk to air safety, and further; Have You Heard? 5 Be it resolved that the Civil Aviation Medical Highlights of the 6th Annual Meeting 6 Association censures any interference with Legal Briefs this mandated medical exemption process by The Kauai Surf 10 the Judiciary as being arbitrary and unreason• Some X-Rayted Info on Checkups 11 able, having the potential of causing long Welcome Aboard 11 range adverse effect upon the rights, not only of airmen but all free men." Steven L Mintz, O.D., ob• ter which may adversely affect visual performance. tained a B.Sc. from the Univer• This disadvantage, however, is often minimized by sity of Manitoba in 1969, his the fact that contact lens wearers tend to be wearing O.D. from the University of sunglasses (ideally containing impact-resistant lenses) Waterloo (Ontario) in 1973. during daylight hours. Contact lens wearers can suffer He began his optometric prac• from fluctuations in visual acuity due to a poorly tice in Winnipeg, Manitoba, fit lens(es). that same year. Finally, the possibility of the loss of the contact He is a member of the lens while on duty must be considered. Experience Canadian Association of Op• has shown that, in relation to the total time lenses are tometrists and of the American worn, the rate of contact lens displacement is low. Optometric Association, and Most incidents of the contact lens displacement re• serves on the Executive Com• sult from the contact lens being forced from its nor• mittee of the Manitoba Optometric Society. He is mal position on the cornea to a position on the sclera. Director of the Environmental Vision Committee of These situations are easily identified and rapidly the Manitoba Optometric Society. (This committee is rectified by an adequately trained contact lens wearer. responsible for Highway Safety, Aviation Vision, and The occurrence of true lens loss, wherein the lens Occupational Vision.) ceases to remain in contact with the globe of the eye, is infrequent with 'hard' lenses and rare with 'soft' (hydrophilic) lenses. Studies conducted by two op• RECOMMENDATIONS tometrists, working independently, have indicated ON THE WEARING averages of from 1.5 to .5 lenses lost per year. 10'11 The majority of lens losses can be directly attributed OF CONTACT LENSES to poor lens fit or poor patient handling. The most important conclusion is that proper professional BY HOLDERS OF supervision of lens fit and proper training of contact CATEGORY 1 & 2 LICENCES lens wearers must be assured. DR. STEVEN L. MINTZ The letter referred to in the first paragraph here• WINNIPEG, MANITOBA, CANADA in states that "a recent FAA study indicates the ac• The purpose of this document is to make recom• cident frequency of contact lens wearers to be signi• mendations regarding the evaluation of the wearing ficant and deserving of further attention and analysis of contact lenses for those persons who require a in their 1976 aircraft accident data."1 Upon investi• Category 1 or 2 licence. My interest in this proposal gation of this statement, I received a letter from the stemmed from a letter directed to Mr. W.P. Paris, dated Acting Deputy Director General stating that the FAA October 24, 1978 (file number 2254-147 (LICP) study referred to was FAA-AM-76-7.2 However, Dr. 5330-6-11). H.L Reighard of the FAA states that this particular I wish to applaud this progressive step in aviation study "did not show a significant correlation between licensing as contact lens wear provides many advan• aircraft accidents and the wearing of contact lenses in tages over spectacle lenses without a significant in• 1974. Similar studies done on 1975 and 1976 data, crease in the number of problems that may occur. however, show correlations at the 0.1 and 0.01 levels Contact lenses, in most cases, give better visual acuity respectively . . . Review of accident reports has not than spectacles. Myopic individuals, (who make up explained the correlations noted and they could, of the bulk of contact lens wearers,) receive a retinal course, represent statistical artifact. We do not be• image which is significantly larger when wearing con• lieve the wearing of contact lenses, per se, represents tact lenses as opposed to spectacles. For example, a safety hazard and the Federal Aviation Regulations a 3.00 diopter myope obtains magnification 3.9% permit their use at the option of the pilot... We have greater with contact lenses than with spectacles. no knowledge, however, of accidents in which contact Furthermore, transmission of light is increased by lenses have been implicated as a contributing factor."3 the wearing of contact lenses, primarily because of The opinion of Dr. Peter Vaughn, Director of the reduced thickness of the lens and the reduction Medical Services of Air Canada supports this view. in the number of surface interfaces. Air Canada has permitted cabin personnel and some A major disadvantage of spectacle lenses occurs pilots to wear contact lenses during flight and "... when the line of sight deviates from the optical centre have had no incidents of difficulty among personnel of the lens, at which point spatial distortions increase. who wear such lenses ... We have had no difficul• However, since contact lenses do not move apprecia• ties reported with contact lenses worn during the few bly with relation to the cornea, the line of sight is incidents of decompression which we have had during directed through or near the optical centre thus eli• flight."* The Civil Aviation Medical Association minating most distortion of this type. In addition, states, "to our knowledge, there has never been any contact lenses provide an increased field of view when difficulty with the use of contact lenses by commer• compared to the decreased field produced by spectacle cial pilots."s The Aircraft Owners and Pilots Assoc• lenses and the accompanying frames. iation in a petition to the FAA dated 27 Aug/75 state Contact lenses eliminate the hazards created by the following: "... experience has shown that the the "fogging" of spectacle lenses which may occur use of contact lenses produces no sudden unpredic• during rapid changes in temperature and/or humidity. table hazards to flight, and that in some situations, There would also be less interference with the use of contact lenses are more appropriate than glasses. The protective headgear or headphones if contact lenses FAA . . . has issued Statements of Demonstrated were worn. Finally, due to the protection provided Ability . . . for the use of contact lenses to correct by the eyelids, contact lenses are less susceptible to distance visual acuity . . . These special issuances have damage caused by external forces. been made upon receipt and review of reports from There are, naturally, some disadvantages to the eye specialists indicating appropriate fit and absence use of contact lenses. Not all contact lens wearers can of complications. These reports have had limited pro• achieve better visual acuity or image magnification ductivity in uncovering significant pathology, or evi• than would be possible with spectacles. Contact lenses dence of complications that would contra-indicate do not adequately protect the eyes from foreign mat• the use of such lenses in the performance of aviation duties. In addition, the (Federal Aviation) Agency is the FAA does not even require the presence of a unaware of any accidents or incidents in which the back-up pair of spectacles for a contact lens wearer. use of contact lenses by airmen has been a contribu• Although in the interests of safety, it is my opinion ting factor."6 Shortly after this petition was received, that a spare pair of spectacles accompany any contact the FAA was sent 137 comments in response to the lens wearer in the performance of his duties. This last proposal from AOPA. Of these, five expressed no statement indicates that the U.S. experience has opinion and only one opposed the statements contain• shown few problems encountered with contact lenses. ed in the submission. The FAA ammended its regula• An area related to the contact lens field but not tions pertaining to the use of contact lenses on 12/ specifically covered by any regulation at this time re• Oct/76. quires some consideration. This is the practice of or- Mr. Gagnon's letter of 24 Oct/78 contains pro• thokeratology, a method by which the refractive state posed additions to Para. 3.34 Chap. 2 of the Personnel of the eye is altered so that an improvement in visual Licensing Handbook, Volume 3, which will require acuity can be attained without the use of spectacles contact lens wearers to have replacement spectacles or contact lenses. The means of achieving this refrac• available for immediate use; hard contact lens wearers tive state can be summarized as the controlled use of will be required to carry two pairs of spectacle lenses. a series of contact lenses each of which bring the pa• This latter provision is included because of the fre• tient's refractive state closer to emmetropia. When quent occurence of the condition clinically known as the program is completed, the patient is required to spectacle blur. Spectacle blur is a result of a number wear a 'retainer' lens which maintains the desired of changes in corneal physiology and/or topography corneal shape. This retainer lens may carry a small occurring with the wearing of some contact lenses prescription as well, or it may be a piano lens. The re• (hard or soft) under certain conditions. Topographi• tainer lens is worn for varying periods of time at var• cal changes are most often caused by the mechanical ious intervals (for several hours to several days) as effect of the lens on the cornea. These changes are determined by the orthokeratologist. Although there often due to improperly fit lenses. Ensuring the ade• is a tendency for the cornea to return to its original quacy of fit of the lenses at all times will reduce the curvature, the change in this direction is very slow. incidence of spectacle blur from this cause. The phy• Many patients would be able to achieve much better siological change which most frequently induces than the minimum visual acuity required (20/30) and spectacle blur is corneal oedema and the consequent maintain that standard long after the retainer lens swelling of the corneal tissues. Corneal oedema occurs has been removed. In many ways, this would be a with many types of hard contact lenses (and occurs superior form of correction to spectacles or contact less frequently with soft lenses) because the low oxy• lenses. If the individual were wearing the retainer gen permeability of the lens material reduces appre• lenses, his visual acuity would be similar with or with• ciably the amount of oxygen available to the cornea out the contact lens. Therefore, dislodgement of the to maintain physiological stability. However, new lens would pose no safety hazard to him. If, however, plastics have been developed for use in contact lens his tour of duty coincided with an interval of time therapy which, although classified as "hard lens" during'which he is not scheduled to wear his retainer materials, are readily permeable to oxygen. Standard lens, there would, naturally, be no risk of lens dis• hard lenses made from polymethylmethacrylate trans• lodgement, since no lens is worn. Once again, I re• mits little or no oxygen through its matrix. commend that it should remain as the responsibility of the eye practitioner to ensure that a licence holder By comparison, a silicon lens marketed in Canada who has undergone orthokeratology meets the visual as the Boston lens has an oxygen transmission of 7.4 requirements a) with the retainer lenses in place, b) x 10 11 ml 02 cm2/sec ml mm Hg which translates immediately after the removal of the retainer lens, to the more useable expression of equivalent oxygen and c) at some specified time (say six or eight hours) behind the lens of 7.1% 02 for a lens thickness of after the removal of the retainer. It should also be re• 0.20 mm. Cellulose acetate butyrate has an oxygen quired that these individuals should have spectacles transmission of 4.5 x 10 -11 ml 02 cm2/sec ml mm or spare retainer lenses available in the eventuality Hg or an equivalent oxygen of 2.70% at a thickness that the retainer lenses are lost or unable to be worn of 0.20 mm. Thus, the use of gas-permeable lenses for several days. Such back-up corrective devices will reduce or eliminate the occurrence of spectacle would not be available for immediate use but should blur. It is, therefore, unreasonable to treat the wearers be accessible in the event that the loss occurs prior of these lenses similarly to the wearers of convention• to or during a long lay-over in a location other than al hard lenses. The majority of conventional hard the owner's home. lens wearers do not suffer from enough spectacle blur to warrant the use of two pairs of spectacle lenses. Most lens wearers will still be able to meet the mini• mum visual acuity requirements (20/30) of their Recommendations licence category throughout the entire duration of the spectacle blur. These people should not be pena• 1. Category 1 and 2 licencees should be allowed to lized by having to carry a second pair of spectacles. wear contact lenses while exercising the privi• In summary, it should be the responsibilitiy of the leges of their licence. eye practitioner to ensure that visual standards can 2. The fit of the contact lenses should be monitored be met by one pair of spectacle lenses as a back-up yearly to ensure that the visual acuity meets the and only if the standards cannot be met in this way required standards at all times. would a recommendation for two pairs of spectacles 3. The fit of the contact lenses should be monitored be made. yearly to ensure that dislodgement is minimized. It is interesting to note that the FAA has such 4. A pair of spectacle lenses designed to correct the confidence in the efficiency and safety of contact vision defect upon removal of the contact lenses lenses that it no longer requires a special eye evalua• be carried at all times when contact lenses are tion to ensure the adequacy of the fit of the contact worn. lens. "Aviation Medical Examiners (AMEs) are expec• 5. A second pair of spectacles may be required at ted to identify any complications of contact lens the discretion of the eye practitioner if corneal wearing at the time of their certifying examination changes are likely to occur such as to make and act accordingly."8 It should also be added that one pair of spectacle lenses inadequate to correct 4 the vision defect at all times after the removal of the contact lenses. HAVE Licencees who have undergone orthokeratolo- gical treatment should be allowed to perform YOU their duties as long as assurances can be made by the eye practitioner that the licencee's visual HEARD? acuity will meet minimum standards with or Dr. Silvio Finkelstein, CAMA past president, has without the retainer lens for the duration of a been elected President of the Latin American Associa• normal work day. tion of Aviation Medicine at their second International Steven Mintz, O.D. Congress, held in Santiago, Chile. Silvio has started work on the development of an aviation medicine glossary. References ******************** 1. Personal Communication from Mr. Paul Gagnon The following was received from Dr. Gerald S. to Mr. W.P. Paris dated 24 Oct. 1978 file No. Backenstoe, one of CAMA's founders: A2254-247 (LICP) 5330-6-11. 2. Personal Communication from D. Lamont to Dear Editor: Dr. S. Mintz, dated 5 Apr., 1979 file No. A2204- Just read the June, 1980 issue of the CAMA Bul• 195 (LICP) 5330-6-11. letin. This issue deserves the highest commendation in all respects. My sincere thanks to all the authors, 3. Personal Communication from Dr. H.L. Reig- most especially to Dr. and Mrs. Robert S. Poole. Out• hard to Dr. S. Mintz dated 9 Aug., 1979. standing! Both of them. 4. Personal Communication from Dr. PeterVaughn, Sorry, my health is too precarious to travel. Still Director of Medical Services, Air Canada to Dr. my heart and mind are with CAMA always, and I S. Mintz dated 20 Mar., 1979 file No. 4400- always have my wonderful memories of the early 26-1B. days, of course. Best of everything to 5. Personal Communication from Mr. Albert Car- everyone, riere, Business and Public Relations Counsel, Gerald S. Backenstoe, MD Civil Aviation Medical Association, to Dr. S. Mintz dated 27 Feb., 1979. 6. United States of America, Federal Aviation Ad• NOW HEAR THIS! At the Director's meeting in Ar• ministration Regulatory Docket No. 13574 In lington, Virginia, it was recommended that any CAMA the matter of the petition of Aircraft Owners member involved in an inflight medical problem a- and Pilots Association, dated 20 Aug., 1975. board a commercial carrier make a brief report and mail it to CAMA Headquarters. 7. Morgan, John F., Experience with a gas perme• able hard lens—The "Boston" Contact Lens, ******************** Draft Copy. Dr. Robert L. Wick, Jr., was quoted in the Wall 8. Personal Communication from Dr. H.L. Reig- Street Journal for December 10, 1980. He was com• hard, Federal Air Surgeon, AAM-1, Federal menting on the incidence of ear-lock troubles during Aviation Administration to Dr. S. Mintz dated a flight on a commercial carrier. 13 Mar., 1979. ******************** 9. Grosvenor, T.P., Contact Lens Theory and Prac• Al and Harriett Carriere were elected to Honorary tice, The Professional Press, Chicago, 1963. Membership in both the Civil Aviation Medical Asso• ciation and the Flying Physicians Association. Need• 10. Personal Communication from Drs. R. & M. Des- less to say, they wear their pins with understandable Groseilliers, Rockland, Ontario to Dr. S. Mintz pride. dated 26 Oct., 1979. ******************** 11. Untitled Statistical study of the contact lens NEWS ITEMS WANTED. This is your publication. practice of Drs. B. Rosner and S. Mintz 1968-79. And this column is the only means we have of keeping our members informed abouteach other. So, PLEASE, send in items of interest. But be sure they are typed. We've received a couple of items that are absolutely illegible. ******************** Past President, Charles M. Starr, had a surprise party that well nigh overwhelmed him. Hundreds of his former patients and friends attended his birthday party (Charles says he's 39) and presented him with a huge birthday cake. The cake was topped by a pic• ture showing Charles on the banks of the Rio Grande fly fishing. His favorite hunting dogs were also in the picture, as was his plane. In this picture, you can see Charles cutting the cake, while Helen Starr looks on. HIGHLIGHTS OF CAMA'S 15TH ANNUAL MEETING - SEPTEMBER 28 - OCTOBE

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CAPTi

1. Drs. Herb Brickerand Bill Jor Glenn Wegener and RoyStewar cardiopulmonary technique. • CPR session. 5. Bill Jones den Kidder. 6. Bob Field learns th nauld Nicogossian, speaker on Director of the Aerospace Me< Winstanley and wife, Betty. 9 well pins Honorary Membersh 10. Mrs. Hal Walgren, (Leann (Florence). 11. Dr. Samir Jahshar Poole with burnoose. 12. Dr. Membership pin on Business C gressman Barry Goldwater, Jr

banquet, also recipient of Horr Young Stokes and wife, Betty Honorary Membership to Dr!' pins President's pin on incom Pat Palmer, first non-physician sents book on physical fitnesst Poole distributed two bushels doctors away?) 19. Dr. J.G. G and his wife, Mieke. 20. Dr. R Julie. 21. Mrs. Robert Kreischei Garber. 23. President Hal Conv 24. Dr. H.L. Reighard, Federa Mukherjee, Assistant Medical I Dale J. Ducommun. 26. Dr. luncheon speaker. 27. Dr. Poc Carriere. * 3, 1980 - STOUFFER'S NATIONAL CENTER HOTEL, ARLINGTON, VIRGINIA

s at Trustees meeting. 2. Drs.

3. Dr. Young Stokes watches Dr. Samir Jahshan attends snstrates maneuver on Criss CPR techniques. 7. Dr. Ar- PR, and Dr. Rufus Hessberg, cal Association. 8. Dr. Bob President-elect Dr. Hal Con- 18 3 pin on Dr. Paul E. Garber. ) and Mrs. Robert E. Field, Df Jordan presents Dr. Robert Hal Conwell pins Honorary >unsel, Al Carriere. 13. Con- was speaker at the annual rary Membership. 14. Dr. M. 15. Dr. Hal Conwell awards

:orrest Bird. 16. Bob Poole ig Hal Conwell. 17. Captain 1 * lected to CAMA Board, pre- \^ \ 22 Dr. Robert Poole. 18. Kathy f delicious apples. (To keep imm. Royal Dutch Airlines, wland H.S. Bedell and wife, (Jean). 22. Dr. & Mrs. Paul E. ;ll and First Lady, Margaret. Air Surgeon. 25. Dr. Amita irector of Air India, and Dr. ob Poole and Max Karant, s presents gift to Harriet C. 27 LEGAL BRIEFS The Annual Gift Contributed by Harold N. Walgren, MD. JD, CAMA Past President

The federal government imposes a tax on gifts made to persons. The person who makes the gift (the donor) has the duty to pay the tax. There is no tax due, however, if the gifted amount per calendar year does not exceed $3,000 per person. No gift tax return is required. The gift can be re- jMr-. peated each year. The gift is not considered taxable income to the recipient (the donee). There is no tax deduction for the donor because it is not a business expense. So, why make annual gifts? Well, it is one way to reduce one's gross estate, thus avoiding or at least reducing the eventual federal estate taxes due. For spouses, it is a way of bal• ancing the respective estates, which may save considerable estate taxes depend• ing on the sequence of death. A parent can give funds to his or her children and thus shift future income into the children's lower income tax brackets. For Harold N. Walgren, MD, JD minor children, funds can even be set aside in trust for college expenses. A husband and wife can join together and increase the annual gift tax ex• clusion amount from $3,000 to $6,000 per recipient per year. No gift tax would be required. Consent to the gift must be shown by filing a gift tax return. This could be avoided by each spouse making a $3,000 gift (or less) to each donee. If one makes a gift within three years of the date of death, the law presumes that the gift was made "in contemplation of death." The result is that the amount of the gift plus any gift tax paid plus any gain pro• duced are added back into the decedent's gross estate. Previously one could rebut this legal presumption by showing a systematic program of giving, a zest for life, apparent good health, etc. This presumption holds true for any gift that requires the filing of a gift tax return. An annual gift of $3,000 or less does not require a return. Therein lies the safe haven. Note that a gift of $3,001 would require the filing of a gift tax return; therefore, the whole amount of the gift would be presumed to be "in contemplation of death" and would be added back into the decedent's estate (not just the $1 excess). The same would hold true for a split gift of $6,000 or less made by joining spouses. Split gifts thus are made at some peril as one never knows precisely when death will occur. The type of gift is important. Gifts of present interests such as money, stocks, bonds and C.D.'s would qualify. Life insurance would not qualify for the exclusion if given within the three year period preceeding death. How about death bed gifts of $3,000 or less? Even if it seems logically apparent that the gifts were made in contemplation of death, no gift tax return is required and thus the sums would not be added back into the decedent's gross estate. Care must be given to insure that the donor has not given other sums to the donee that calendar year which would bring the total gift to more than the safe haven of $3,000. The annual gift of $3,000 or less to any number of persons is a simple and valuable estate planning tool. It can be used to reduce gross estates, balance estates between spouses, shift income production within the family, to utilize lower tax brackets, provide for college funds, and even distribute funds at the last minute from one's death bed. Care must be given to timing and to the type of asset gifted.

8 THE KAUAI SURF SITE OF OUR 1981 ANNUAL MEETING "Hawaii's most complete destination resort."

That is a term frequently used to describe the Kauai Surf, and one that is seldom challenged by any• one who has been exposed to the 200-acres of facili• ties that make up this diverse yet somehow cozy complex. Situated on Kalapaki Beach just a short drive from Kauai's main town of Lihue, the Kauai Surf is a member of the Surf Resorts Division of Interis- land Resorts, the Hawaiian hotel company which pioneered resort development on the state's Outer rigger canoe rides, sunfish sails, or just a beach towel Islands. It opened in 1960 as the first modern hotel and backrest to take to your quiet corner. structure outside of Waikiki and through expansion In the center of the award-winning grounds is and improvement has held its position of eminence a beautiful freshwater lagoon. Natural waterfalls fill ever since. sun-dappled pools in an utterly serene Japanese gar• den while great trees shade a broad expanse of im• The recent opening of a new wing gave the prop• maculate lawn. erty a total of 607 air-conditioned, island decorated guest rooms. Vacationers who occupy those rooms Restaurants run the gamut from seaside coffee have no problem finding activities to occupy their shop to penthouse gourmet. The latter, The Golden time and interests. Cape, offers continental cuisine along with a bird's- eye view of the bay. The Surf 'n Sirloin features broil• The resort has its own fine 18-hole championship er specialties and The Fisherman, of course, provides golf course whose fairways seldom take a golfer out an excellent seafood menu. These are all in addition of sight of the ocean and, on occasion, use the Pacific to the Kauai Surf's main dining room, The Outrigger, as a boundary. Tennis buffs have a choice of 10 lay- with its relaxing Polynesian decor. kold-surfaced courts, 2 are paddle tennis. Both facil• ities have complete pro shop services. For an evening's entertainment there's the Planters Lounge where the bar is made from an old sugar cane train and where there is a nightly Polynesian Revue. The Golden Cape Lounge takes care of the urge to go dancing as well as providing fine music, and The Des• tination (the former Prince Kuhio Bar) has been ex• panded and completely redone with an intriguing decor of the 50's. Musical entertainment is provided in this appealing setting. In its quest to be "the" complete resort, the Kauai Surf has not forgotten the meeting planner or conven• tion goer. The Kauai Surf Convention Center is a completely self-sustaining facility capable of serving up to 800 for banquets, and of accommodating as many as nine separate meetings simultaneously. This imposing new center is equipped with the latest in sound and lighting equipment and offers a very real alternative to busy Waikiki for the convention planner. Though there seems to be little reason for a guest to ever leave the Kauai Surf grounds, its location makes it an ideal home base for exploring the beauty of Kauai, the "Garden Island." To the north the road Kalapaki Beach, a half mile of clean white sand follows the shore past tiny villages and sugar cane fronting the hotel, is an irresistable magnet. There's fields to its end in idyllic Hanalei. In the other direc• room for surfing, there's room for swimming and tion lies spectacular Waimea Canyon and the cool snorkeling, there's room to beachcomb or simply mountain retreat of Kokee Park. Either way the sight• find a quiet spot for sunning. A completely new seer will find the drive well worth the effort. beach center opened in the summer of 1976 with a Kauai and the Kauai Surf are a scant 20 minutes large fresh water pool complete with an island for en• away from Honolulu by inter-island jet. The schedule tertainment. The new San Bar with three levels of is frequent and the fare low when travelers make use seating is on the garden side of the pool and has a of the airlines' common fare plan. All of which makes water curtain spilling from its roof to the pool be• it very easy to enjoy "Hawaii" most complete desti• low.. A beach service hut can arrange surf mats, out• nation resort."

9 3:00 PM COFFEE BREAK 3:30 PM PANEL DISCUSSION: AVIATION Would You Fly With This Pilot? MEDICAL Moderator: H.L. Reighard, MD, EXAMINERS Federal Air Surgeon FAA SEMINAR 4:45 PM Adjournment

CIVIL AVIATION MEDICAL ASSOCIATION WEDNESDAY OCTOBER 7 IN CONJUNCTION WITH THE FEDERAL AVIATION ADMINISTRATION 8:30 AM Transportation of III and Incapacitated PRESENTS THE by Air 16TH ANNUAL MEDICAL SYMPOSIUM Michael N. Cowan, MD, Physician Senior AME, Pilot Aviation Medical Examiners Seminar 9:20 AM CLINICAL SESSION - First of Four Each of the clinics listed below will be MONDAY OCTOBER 5 conducted four times so you may 8:30 AM Welcome and Opening Remarks attend each. President-Ha If ord R. Conwell, MD Ear, Nose & Throat Clinic, Civil Aviation Medical Association Eye Clinic Cardiology Clinic, 8:45 AM Aviation in the Pacific Psychiatric Clinic Robert O. Ziegler, Regional Director Pacific Region FAA 10:20 AM COFFEE BREAK 9:30 AM The AME as a Representative of the 10:45 AM * Clinical Session No. 2 - Select One Federal Air Surgeon Ear, Nose & Throat; Eye; Cardiology; Psychiatric Casimer Jasinski, MD, Regional Flight Surgeon Pacific Region FAA 12:00 PM Luncheon Intermission 10:20 AM COFFEE BREAK 1:15 PM An AME's Evaluation of Fitness to Fly 10:45 AM Federal Aviation Medical Programs Robert S. Poole, MD, Physician H.L. Reighard, MD, Federal Air Senior AME, Pilot Surgeon FAA 2:00 PM Clinical Session No. 3 - Select One 12:00 PM Luncheon Intermission Ear, Nose & Throat; Eye; Cardiology; Psychiatric 1:15 PM Ophthalmologic Examination Techniques 3:00 PM COFFEE BREAK 2:15 PM Aviation Physiology J. Robert Dille, MD, Chief, Civil 3:15PM Survival Skills for the Physician Pilot Aeromedical Institute FAA Joseph H. Nix, Instructor Aeromedi• cal Education Branch, CAM I, FAA 3.15 PM COFFEE BREAK 4:05 PM Clinical Session No. 4 - Select One 3:30 PM Otolaryngologic Examination Techniques Ear, Nose & Throat; Eye; Cardiology; 4:30 PM Adjournment Psychiatric 5:00 PM Adjournment TUESDAY OCTOBER 6 THURSDAY OCTOBER 8 8:30 AM Aviation Toxicology Still to be completed . . . J. Robert Dille, MD, Chief, Civil Aeromedical Institute FAA 9.20 AM Techniques of Screening for Psychiatric EDITORIAL STAFF Problems 10:20AM COFFEE BREAK Contributors Steven Mintz, O.D. 10:45 AM Cardiovascular Examination Techniques Harold N. Walgren, M.D. 12:00 PM Luncheon Intermission Robert L Wick, Jr., M.D. 1:15PM Medical Education for Pilots Halford R. Conwell, M.D. Joseph H. Nix, Instructor Aeromedical Photography Education Branch CAM I, FAA Dale J. Ducommun, M.D. 2:05 PM The AME in General Aviation Accident M. Young Stokes, III, M.D. Investigation Editorial and Production J. Robert Dille, MD, Chief, Civil Aeromedical Institute FAA Albert Carriere 10 SOME X-RAYTED WELCOME INFO ON ABOARD! We are happy to welcome the following new CHECKUPS members into the fellowship of CAMA: By Robert L. Wick, Jr., M.D. James R. Almand Most routine medical checkups include a chest Grand Prairie, Texas x-ray. But people sometimes question how useful it Dr. Octavio Amezcua P. is. The answer, in a nutshell, is: "quite useful." Mexico City, Mexico Most people think of a chest x-ray in terms of Earl F. Beard, M.D. lung cancer. It is true that a chest x-ray is a useful Houston, Texas tool when looking for early signs of this disease. All Forrest M. Bird, MD* Palm Springs, CA smokers, therefore, should consider a periodic chest x-ray absolutely essential. But lung cancer is only David K. Broadwell, MD Angleton, Texas one problem that will show up on an x-ray. Dr. M.D. Cabatu Tuberculosis is not as common as it once was but Fredericton, N.B., Canada is by no means a disease of the past. Early TB can be Dr. Robert Carrier pinpointed on a chest x-ray. We hear less about TB Sante-Foy, P.Q., Canada these days because long hospitalizations are no longer Albert Carriere* necessary for treatment, and TB sanitariums are rem• Wilmette, Illinois nants of the past. Most people with active TB can be Harriett C. Carriere* treated in a matter of weeks. Wilmette, Illinois Routine chest x-rays can also uncover a number Dr. Will iam Chernenkoff Saskatoon, Sask., Canada of other lung infections, hypertension, heart disease, certain manifestations of syphillis, arteriosclerosis, Alberto A. del Castillo, MD Miami, Florida emphysema, and even some types of arthritis. Peter Fenwick, M.D. A question about x-rays sometimes arises—"What Reno, Nevada about the radiation?" There is radiation but the medi• Gary W. Ferris, D.O. cal benefits far outweigh the radiation in a chest El Paso,Texas x-ray. Let's look at the numbers. Dr. Paul E. Garber* Radiation is measured in terms of units called National Air & Space Museum roentgens. There is natural radiation affecting us all Washington, D.C. the time. Some comes from space in the form of cos• Honorable Barry D. Goldwater, Jr.* mic radiation and some comes from natural radio• House of Representatives Washington, D.C. active isotopes in the earth's crust. The amounts Theodore E. Hauser, MD are small and vary from place to place. In Denver, for Carlsbad, New Mexico example, radiation averages about one-tenth of a roentgen per year. This is more commonly written in Richard A. Jones, MD Westminster, Maryland terms of milliroentgens, a very small unit equal to 1,000th of a roentgen. Adrian P. Landra, MD Nairobi, Kenya The background radiation in Denver, therefore, Dr. Michel Larose is about 100 milliroentgens per year. The size of this Dorval Airport, P.Q., Canada very small number becomes more apparent when Thomas L Lipscomb, MD you realize that cancer treatments can require up to Hapeville, GA 5,000 roentgens or an amount equal to 5,000,000 J. Rosnick Manning, MD milliroentgens. The average chest x-ray requires only Miami, FL 20 milliroentgens—a very small amount indeed. Dr. Victor B. Maxwell In other words, living in Denver exposes an indivi• Cheshire, England dual to five times as much radiation as does taking an George J. Miller, MD Washington, NC annual chest x-ray. Frank Vickers, MD It is wise to be concerned about radiation. How• Huntsville, Texas ever, the positive aspects of disease discovery and Mark Watson, MD treatment far outweigh the additional risks associated Cottage Grove, Oregon with an annual chest x-ray. Edward D. Williams, MD Lawndale, CA

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