ADF Health April 2002 3(1): 1EditorialChange alone is unchanging*- Group Captain Peter S Wilkins MBE, MB BS, MHP, Mlitt, FRACMA, FAFOM, FAFPHM The Aviation Medical Section of Australia's Civil Aviation Safety Authority (CASA) sets and administers medical standards for pilots and air traffic control staff. With specialist and industry input, it recently reviewed and strengthened the requirements of its already high psychiatric standard, thus anticipating similar developments in the medical standards and recommended practices adopted by the International Civil Aviation Organization. A constant preoccupation for CASA and for other national aviation regulators is the mental health of aviation licence holders and applicants. Depression and suicidal ideation in pilots have caused many small aircraft losses and deaths, in addition to the notorious recent crashes of Silk Air and Egypt Air airliners in Indonesia and the Atlantic. However, suicide by aircraft is less worrisome than murder by aircraft: in the latter case, the stakes are higher and the pilots concerned need not show any signs of mental illness - witness the kamikaze of World War II, who held it honourable to die for their Emperor and their warrior code. With four hijacked US passenger airliners diverted to abuse as instruments of mass murder, international terrorism plumbed new depths of infamy on 11 September 2001. Just one of the many expensive and inconvenient after-effects of that terrible day has been extensive tightening of all requirements which might affect future aviation safety. Sky marshal seats have to be paid for, with extra costs ultimately borne by passengers; sequestrating luggage that contains a Swiss army knife or corkscrew defeats the convenience of a small carry-on bag; heightened security checks delay check-in and departure; and obtaining an aviation medical examination without producing acceptable photographic identification is no longer possible. An overextended and under-resourced ADF, the permeability of our borders to contraband and illegal entrants (including terrorists), and even the "half price" Australian dollar, all reflect the uncertainty of national life in the 21st century. Australia cannot be insulated from calamitous events and movements in the rest of the world. The "big moat" around Australia on which we have relied for so long is ever less effective as protection. Without resorting to the rhetoric of "guns or butter" disputation, the nation clearly faces difficult but unavoidable choices which will shape its immediate future and determine its eventual survival. The Defence Health Service, like CASA, must respond decisively to a changed world. As always, the greatest challenge is to eschew the obvious and easy responses (confiscation of passengers' nail files or mere reiteration of health doctrines which served well in former conflicts) and to produce utilitarian outcomes for all ADF members whose health and wellbeing are our responsibility, as well as to serve the national interests of Australia. *Heraclitus. Herakleitos and Diogenes, Part 1, Fragment 23.
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