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Ask the Aviation Medical Examiner

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  1. Ask the Aviation Medical Examiner Sergio B. Seoane, M.D., Col., CAP Chief, CAP National Health Service FAA Senior Aviation Medical Examiner

  2. AME – Aviation Medical Examiner • Aviation Medical Examiner (AME) is a physician designated by the FAA and given the authority to perform flight physical examinations and issue aviation medical certificates. • AMEs are practitioners of Aviation Medicine • Many AMEs are also qualified in other medical specialties • The International Civil Aviation Organization have established basic medical rules for determining whether a pilot is fit to act in that capacity, and they are codified in Annex 1 to the Convention on International Civil Aviation. • Must be a Physician to be an AME, cannot be ARNP or PA

  3. Assisted Special Issuance Process (AASI) • A several years ago, FAA introduced the Aviation Medical Examiner Assisted Special Issuance process (AASI) • AASI permitted AMEs to issue applicants a special issuance certificate at the time of examination, provided the applicant had complied with a previously defined set of conditions. • The AASI process eliminated the wait time for a subset of airmen, but there were still a large number of pilots who had to wait for the FAA to make a decision in their case.

  4. New and Improved FAAAeromedical Certification • In 2011-2012, the Federal Air Surgeon, Fred Tilton MD decided to reduce the number of medical conditions requiring a special issuance. • Dr Tilton has identified 18 medical conditions that will no longer require a special issuance, • Protocols for 11 of them have been issued to AMEs • The rest will be published in 2013-2014 • These 18 conditions account for 10 to 15 percent of the special issuances.

  5. April 2013 AME Changes • Conditions the AME Can Issue (CACI) • Conditions that previously required an initial FAA Special Issuance authorization before the AME could issue a medical certificate • Now, the AME is authorized to directly issue the medical certificate. The pilot does not need to wait to receive the Medical Certificate from the FAA

  6. April 2013 AME Changes Conditions the AME Can Issue (CACI) Chronic Headaches Pre-Diabetes (IFG) Metabolic Syndrome Impaired Fasting Glucose Glucose Elevation Renal Cancer • Arthritis • Asthma • Glaucoma • Hepatitis C • Hypertension • Hypothyroidism • Migraine

  7. April 2013 AME Changes • The criteria and the required medical documentation has NOT changed • The only difference is that the local AME can issue the medical certificate without approval from FAA Aerospace Medical Certification Division in Oklahoma City • This should result in the Airman obtaining the FAA Medical Certificate sooner

  8. April 2013 AME Changes • The recovery time after coronary artery stenting has been decreased from 6 months to 3 months


  10. Legal Authority of Designated Aviation Medical Examiners Title 49, United States Code (U.S.C.) (Transportation), sections 109(9), 40113(a), 4701-44703, and 44709 (1994) formerly codified in the Federal Aviation Act of 1958, as amended, authorizes the FAA Administrator to delegate to qualified private persons; i.e. designated Examiners, matters related to the examination, testing, and inspection necessary to issue a certificate under the U.S.C. and to issue the certificate. Designated Examiners are delegated the Administrator's authority to examine applicants for airman medical certificates and to issue or deny issuance of certificates.

  11. Aviation Medical Examiner Population(3,465 as of March 31, 2012) 90 countries (Includes Guam, Marshall Islands, Saipan, Pacific Island Trust Territories, Puerto Rico and Virgin Islands) AMEs who are pilots 47% Female AMEs 7.5% 5/7/12

  12. Distribution of AMEs by Region 5/7/12

  13. Nine FAA Regions Similar to CAP Regions

  14. Distribution of AMEs by RegionAMEs/Senior AMEs 60% Senior AMEs 100% 0% 5/7/12

  15. Distribution of AMEs by Medical Specialty • Family Practice / General Practice 49% • Internal Medicine 19% • Aerospace Medicine 8% • Occupational / Industrial Med 6% • General Surgery 3% • Ophthalmology 2% • Emergency Medicine, Orthopedic Surgery, Otorhinolaryngology, OB/GYN, Urology 1% • All others <1% (ea) 5/7/2012

  16. AME Age Trends

  17. Distribution of AMEs by Number of Medical Exams Performed Annually 39% 30% Percent of AMEs Number of AMEs 18% 4.3% 5% 2% 0.8% 1.4% 0.05% 2/14/11

  18. 270 184 151 352 79 99 101 36 363 294 308 23 18 181 197 246 144 141 4 64 70 1 18 AME Distribution by Length of Service AMEs Senior AMEs 0 2/14/11

  19. AME Exams – CY 2011 1/26/12

  20. Aeromedical Certification Requests 1095 applications per day (2011) 33,312 applications per month (2011) 1/26/12

  21. Certificates Not Issued 56 18,971 1616 35,421 6322 1/26/12

  22. Most common causes for problems with issued certificates Jan to June 2011 compared to prior period Please note that there can more than one error in a single case

  23. Final Denials for 2011 • Total Denials: 5,012 • Denial for Failure to Provide or Failed to Pursue: 4,646 • 92% of Airman Fail to Provide info! • Final Denials (When all information requested is provided): 366 • 400,000 only 366 Denied by FAA .09% 1/26/12

  24. Final Certification Denials 2/14/11

  25. Medical CertificateTimeline • FIRST CLASS: • Airline Transport Pilots • Valid for 12 months under 40, 6 months 40 and over • SECOND CLASS: • Commercial Pilots, Flight Navigators and Flight Engineers • Contract Air Traffic Control Tower Operator • Valid for 12 months • THIRD CLASS: • Private and Recreational Pilots • Valid for 60 months under 40, 24 months age 40 and over

  26. FAA Authority to Disqualify • 1994, Bullwinkel vs. FAA & NTSB, challenged FAA authority to disqualify medications in absence of a disqualifying medical condition • As a result, the Federal Air Surgeon was given the authority to deny any “medications or other treatment that (a) makes the applicant unable to safely perform the duties or exercise the privileges of the airman certificate that the applicant holds or for which the applicant is applying; or (b) may reasonably be expected, within 2 years after the finding, to make the applicant unable to safely perform those duties or exercise those privileges.”

  27. Not everyone is Healthy • 650,000 Pilots in the USA • 400,000 Medicals Issued by FAA every year • They are not all healthy • The number of prescriptions for Type II Diabetes Drugs has doubled between 2002 and 2005, in children ages 5-19 years. From 0.3 per thousand to 0.6 per thousand. • There was a 106% increase in prescriptions for diabetic drugs in children ages 10-14 years from 2002-2005.

  28. How Healthy do you need to be? • You do not have to be very healthy • You need to be good enough • Kind of like being a pilot…. • You need to be healthy enough so you are not going to suddenly become incapacitated while operating an aircraft • Key Word…”Sudden Incapacitation”

  29. FAA Concerns Aeromedical Significant Disorders • Occurs suddenly or unpredictably • Is or may be incapacitating • Progresses at an unpredictable rate • May degrade flight safety

  30. The aviation environment is very complex and dynamic Good Health is critical functioning is this environment.

  31. Two key elements for safe flyingAircraft PerformanceAirman PerformanceBoth need to be adequate

  32. Medical Certification of AirmenSpecial Issuances – Cardiovascular (2005)

  33. FAA Policy on Medications FAR 61.53, prohibits acting as pilot-in-command or in any other capacity as a required pilot flight crewmember if that person: • “Knows or has reason to know of any medical condition that would make the person unable to meet the requirement for the medical certificate necessary for the pilot operation, or: • “Is taking medication or receiving other treatment for a medical condition that results in the person being unable to meet the requirement for the medical certificate necessary for the pilot operation.”

  34. FAA Policy on Medications • In addition, FAR 91.17, prohibits the use of: • “any drug that affects the persons faculties in anyway contrary to safety.” • “Severe Head Cold” maybe a “medical deficiency” under FAR 61.53

  35. Why the FAA Denies Certain Medications • Not exclusively the Medications, but rather the underlying medical condition associated with the Medications • Potential for Sudden Incapacitation • All Medications are evaluated based on this concept

  36. Anticoagulants Antiviral Agents Anxiolytics (anti-anxiety) Barbiturates Chemotherapeutic Agents Hypoglycemic Mood Altering Antidepressants (exceptions, 4/2/2010: Fluoxetine (Prozac), Sertraline (Zoloft), Citalopram (Celexa), or Escitalopram (Lexapro)  Narcotics Sedating Agents Antihistamines Decongestants Tranquilizers Stimulants (Diet Medications) Experimental or Investigational Medications Muscle Relaxants Motion Sickness Anticonvulsants Steroids Lomotil There is no “Official FAA Medication List” The condition is often the disqualifying issue, not the medication Generally Disallowed Medications

  37. Over The Counter Medications • Antihistamines and Decongestants • Any drug that produces drowsiness or other central nervous system effects and experimental or investigational drugs are prohibited

  38. Medications NOT Authorized • Anticoagulants (Maybe Yes, Maybe No --but ASA, Plavix OK…warfarin/coumadin…it depends…often yes) • Mood Altering Medications • Sedatives • No investigational Drug Treatments • No one currently receiving Radiation Treatment • Anti-seizure Medications • Antidepressants (off smoking cessations medications for 30 days before flying is OK) • Except –need “SI”..Fluoxetine (Prozac), Sertraline (Zoloft), Citalopram (Celexa), or Escitalopram (Lexapro) 

  39. AOPA Database • This database is compiled by the AOPA Medical Certification Department and is based upon confirmation with the FAA Aerospace Medical Certification Division in Oklahoma City. The list includes both allowed and non-allowed medications and, for the allowed medications, the conditions under which the drug is considered acceptable for flight duties. Although a medication might be listed as allowed, there are variables with each individual's situation that could render a particular medication inappropriate for flying because of case history or adverse side effects. For example, some medications are used "off label," meaning that a drug is prescribed for symptoms that do not fall within the FDA's approval guidelines for that drug. The FAA might not allow an otherwise acceptable drug in this circumstance.

  40. What the FAA doesn't know will not Hurt you • In a fatal crash, the remains of the crew will be tested for Prescription and Over the Counter Medications • 140,000 substances can be screened for by the FAA Civil Aerospace Medical Institute • In General Aviation, several hundred substances are routinely screened for after an accident • In Commercial Aviation, several thousand substances are screened for • DNA in the future – Genetic Markers to determine: Fatigue, Lack of Sleep

  41. It’s a Crime to Lie or Mislead • Whoever in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies, conceals, or covers up by any trick, scheme, or device a material fact, or who makes any false, fictitious or fraudulent statements or representations, or entry, may be fined up to $250,000 or imprisoned not more than 5 years, or both" (Title 18 U.S. Code. Secs. 1001; 3571). • TWO TYPES OF FALSIFICATION • Intentional False Statement – A False Representation of a Material Fact Made with the Knowledge of Falsity • Fraudulent Statement • A False Representation of a Material Fact Made with the Knowledge of Falsity • Made with the Intent to Deceive and Relied Upon by Another

  42. FAA Form 8500-8 • No more paper Form 8500-8 • Only online as of: 10/1/2012 • If you make a false statement..60 day suspension • Revocation of your Medical • The revocation will always show up on your airman record, you will never get another Medical from the FAA

  43. FAA Policy Regarding Falsification • Revocation of BOTH Medical Certificate and Airman Certificate • Revocation of Airman Certificate because you the Lack of Qualification of Hold Airman Certificate

  44. Honesty Best Policy • If you are taking a prohibited Medication and you LIE, and the FAA finds out, they may press charges, but you will NEVERget another Medical under ANY circumstances. • If you are taking a prohibited Medication and you state the truth, your Medical will be denied, if you apply at a future date and are not longer taking the Medication, you will almost certainly be approved for an FAA Medical. • FAA wants to encourage honesty, punish those who are not honest

  45. Follow the Rules • If you Fly with prohibited substance, you are in violation of your Medical and FAA regulations • Any Life Insurance, Accident Insurance, Aircraft Insurance, Liability Insurance will no longer be valid since you are not in compliance with FAA Regulations

  46. Certification of Airman • Approximately 400,000 applicants annually • Approximately 25,000 Special Issuances per Year • 400 Pilots in USA with Diabetes requiring Insulin (3rd Class Medical) • Cardiovascular conditions most common in Airmen • Final Denial are approximately 0.1%

  47. Privacy of Medical Information Within the FAA, access to an individual's medical information is strictly on a "need-to-know" basis. The safeguards of the Privacy Act apply to the application for airman medical certification and to other medical files in the FAA's possession. The FAA does not release medical information without an order from a court of competent jurisdiction, written permission from the individual to whom it applies, or, with the individual's knowledge, during litigation of matters related to certification. The FAA does, however, on request, disclose the fact that an individual holds an airman medical certificate and its class, and it may provide medical information regarding a pilot involved in an accident to the National Transportation Safety Board (NTSB) (or to a physician of the appropriate medical discipline who is retained by the NTSB for use in aircraft accident investigation. FAA Aviation Medical Examiner Guide, Version IV, July 31, 2005

  48. Disqualifying Medical Conditions • Angina pectoris • Bipolar disorder • Cardiac valve replacement • Coronary heart disease that has required treatment or, if untreated, that has been symptomatic or clinically significant; • Diabetes mellitus requiring insulin or other hypoglycemic medication • Disturbance of consciousness without satisfactory medical explanation of the cause • Epilepsy • Heart replacement • Myocardial infarction • Permanent cardiac pacemaker • Personality disorder that is severe enough to have repeatedly manifested itself by overt acts • Psychosis • Substance abuse and dependence; • Transient loss of control of nervous system function(s) without satisfactory medical explanation of cause