Aviation Medical Exams

1. Aviation Medical Exams John W. Hariadi, M.D. NFS, AME, HMO, SSMSO

2. What are all those initials? • NFS: Naval Flight Surgeon • US Navy (Department of Defense) • AME: Aviation Medical Examiner • Federal Aviation Administration (FAA) • HMO: Hyperbaric Medicine Officer • American Academy of Hyperbaric and Dive Medicine (AAHDM) • SSMSO: Space Shuttle Medical Support Officer -National Aeronautics and Space Administration (NASA)

3. Introduction • Medicine: Abnormal physiology in a Normal environment • Aviation: Normal physiology in an Abnormal environment

4. Topics of Discussion • Airmen examination and certification • Preflight Clearance

5. The FAA’s Medical Standards and Certification Process • Title 14 of Code of Federal Regulation Part - 67 • This is the regulation that governs what is physically qualified and what is physically disqualified for civilian aviation. • The WEB Site for current standards: http://www.cami.jccbi.gov/AAM-300/part67.html or http://www.faa.gov/avr/AFS/FARS/far-67.txt

6. What is an AME ? • A physician designated by the FAA to perform PE’s necessary to determine qualifications for the issuance of a 2nd/3rd Class Airman medical certificate.

7. What is a Senior AME ? • An AME with the additional authority to perform PE’s necessary to determine qualifications for the issuance of 1st Class Airman medical certificate.

8. Criteria for AME Designation • Professional qualified physician (MD or DO) • The physician’s region of practice must have an area of need • AME to Pilot Ratio of = 1:100 within 50 miles

9. AME Credentials Requirements • Initial application - FAA Form 8520-2 • Diploma from medical school • Certificate of any Postgraduate professional training • State License to practice medicine • Notice of certification by an American specialty board • References from three physicians in the geographic area that you are applying in

10. FAA Classifications • 1st Class - Certificate good for 6 months • Airline Transport Pilot (ATP) • 2nd Class - Certificate good for 12 months • Commercial Pilot, Flight Engineer • Flight Navigator, Air Traffic Controller • 3rd Class - Certificate good for 24 (36 months)* • Private Pilot, Recreational Pilot, Student Pilot * 3 years if applicant’s age less than 40 years at time of PE

11. Airman’s Applicant Information • All information is mandatory (except SSN) • SSN not required by law • Used as a tracking number • Provides the informed written consent for FAA to check the National Drivers Registry for DUI’s

12. Airman’s Instruction Page • Self-explanatory • Excellent guide for the Airman.

13. Front of FAA Form 8500-8 • “Medical Certificate” • Must have had a prior FAA certificate • Needs to *write, read, speak & understand English • Any age is “OK” • “The White Ticket” *Change 1 Oct 1999

14. Front of FAA Form 8500-8 • “Medical and Student Pilot Certificate” • No previous license • Age Limitations • 16yo student pilot • 17yo private pilot • 18yo for com pilot • 23yo for ATP • “The Yellow Ticket”

15. Report of Personal & Medical History • Current FAA PE form is the “FF” series • Now in Triplicate. * • The 3rd page is for the applicant to take home for subsequent use. *Change 1 Oct 1999

16. Report of Personal & Medical History • Must be done at the AME’s office • Fill in everything ! • Only the Airman can write on the front

17. The Applicants Checklist • Item 1 & 2 - Certificate being applied for • Check where appropriate • Any Age - for Airman Medical Certificate (white ticket) • 16 y.o. - Airman Medical and Student Pilot Certificate (yellow ticket) • 17 y.o. - Private Pilot Certificate • 18 y.o. - Commercial Pilot Certificate • 23 y.o. - Airline Transport Pilot

18. The Applicants Check List • Item 3 - Print Last, First then Middle Name • Item 4 - SSN (Optional) • Item 5 - Needs full address with Zip & Phone • Item 6 - DOB (Month/Day/Year format) • * Citizenship now added *Change 1 Oct 1999

19. The Applicants Check List • Item 7- Hair Color (No abbreviations) • Brown, Black, Blonde, Gray, Red, Bald • Item 8 - Eye Color (No abbreviations) • Brown, Black, Blue, Hazel, Gray, Green • Item 9 - Sex • Item 10 - Type of Airman Certificate • Check all that apply

20. The Applicants Check List • Item 11 - Occupation • Indicate major employment, student, retired,etc. • Item 12 - Employer • Specify your employer • Item 13 - FAA Adverse Certification ? • If “YES” you can’t issue a certificate without a written FAA clearance, If no proof, defer case

21. The Applicants Check List • Item 14/15 Flight time • Required, if no flight time enter Zero • Item 16 - Last FAA Physical • if none, so State: give month and year

22. The Applicants Check List • Item 17b. Contacts • Use of bifocal or unifocal lens for near is prohibited • If “Yes” AME must record in block #60 of their informing the applicant of this prohibition. • Item 17a. - Medications • If YES state type and purpose (even OTC’s) • Much faster certification if marked “previously reported”

23. The Applicants Check List • Item 18 Medical History • Most errors made here ,Must be checked “Yes” or “No” • “Ever in their life” had a condition - Check “Yes” and explain • 18 n* - Substance abuse in past 2 years (previously 5 years). • The AME needs to comment on each “Yes” answer • This is done on Item 60 block • If you need more paper use plain sheets; airman signed

24. The Applicants Check List • Item 18V - Record of Traffic Convictions • Airman needs to report ALL Moving violations that are convictions • Item 18W - Record of Other Convictions • Airman needs to report ALL misdemeanors and felonies • Needs to include nature of offense, date and locality

25. The Applicants Check List • Item 19 - Visit to the Docs • List ALL Treatments within last 3 years • The AME needs to comment on EACH visit on back page, block # 60 • Item 20 - Applicant’s Signature • Signed and dated in INK (check correct date) • Third page “applicant’s copy” to applicant

26. Report of Medical Examination

27. FAA Medical Standards (October 1999)

28. The FAA Medical Exam Form • Item 21 - Height to the nearest whole inch • Item 22 - Weight to the nearest whole pound • Item 23 - Waiver • If the Airman has a “Statement of Demonstrated Ability” • Each waiver will indicate the level of class allowed • Item 24 - Waiver Serial Number • Usually Not Applicable

29. The FAA Medical Exam Form • Items 25..48 - General examination • If not examined type “NE” and explain why “Remember… YOU ARE RESPONSIBLE FOR THE ACCURACY”

30. The FAA Medical Exam Form • Items 49..60 - General Screening Laboratory • These items may be completed by a PA, RN, or lab assistant “Remember… YOU ARE RESPONSIBLE FOR THE ACCURACY”

31. FAA Medical Standards • Items 49 - easiest to get the audiogram • Items 50,51a, 51b - Vision • Use a Snellen 20-foot or AFVT • Insure contacts are removed 24 hours prior to exam • 51b* Needed for1st and 2nd Class applicants over the age of 50 • Use EXACT visual defect wording on page 57 Guide for AMEs. • Item 52 - ColorVision • Record as either “Pass or Fail”

32. FAA Medical Standards • Item 53 - Field of Vision • Report as Normal / Abnormal • Item 54 - Phorias’ • Not required for Class III • Item 55 - Blood Pressure (Sitting)-max 155/95 mmHg • Item 56 - Pulse • Make sure it’s a resting pulse

33. FAA Medical Standards • Item 57 - UA • Done with dipstick • Item 58 - EKG • 1st Class Airman at 35yo then annually after 40 years of age. • Be sure to mail in with the examination • Item 59 - Any Misc. tests completed

34. FAA Medical Standards • Item 60 - Comments • Comment on ALL “YES” answers on front and on abnormal findings marked on the back. • May use additional paper that you SIGN & DATE. This is the most important documentation block for the History and Physical Exam • Item 61 - Applicant’s name • Needs to by typed

35. FAA Medical Standards • Item 62 - Medical Certificate Issuance • Item 63 - DQ Defects noted • Item 64 - Medical examiners declaration • Be sure to type date of exam in Month/Date/Year format • Type the AME’s Name and Address with AME Serial #

36. 15 Disqualifying Conditions • Diabetes mellitus requiring insulin or other hypoglycemic medications • Angina pectoris • Coronary artery disease that requires treatment or has been symptomatic • Myocardial infarction • Cardiac valve replacement • Psychosis • Bipolar disorder

37. 15 Disqualifying Conditions • Personality disorder that is severe enough to have repeatedly manifested itself by overt acts • Substance dependence • Substance abuse • Disturbance on consciousness without satisfactory medical explanation of the cause • Transient loss of control of nervous system functions without satisfactory medical explanation of the cause

38. Disqualifying Conditions • Medications • Any condition that can cause SUDDEN INCAPACITATION • Think: “Do I want this person with this condition flying my airplane?” • FAA Waiver process

39. FAA Points of Contact Melchor J. Antunano, M.D. FAA MMAC/CAMI/AAM-400 PO Box 25082 Oklahoma City,OK 73125-9944 TEL: (405) 954-4832 FAX: (405) 954-8016

40. Preflight Clearance • Clinicians frequently asked to make recommendations regarding travel safety • Review risks posed by Commercial Air travel

41. General Screening & Health Counseling • Air Carrier Access Act of 1986 • Requires DOT to ensure persons with disabilities are able to fly w/o being discriminated • In general, individuals with unstable medical conditions should NOT fly on a commercial aircraft • Airlines may require travelers to have a medical certificate from their clinician • Stating fit for travel, not contagious

42. General Screening and Health Counseling • Screening questions should include: • Length of journey • History of tolerating prior air travel • Conditions of destination • Altitude, public health risks, access to medical care • Assess any worsening of the patients chronic medical conditions. Of concern: • Cardiovascular disease • Thromboembolic disease • Asthma, COPD • Epilepsy, CVA, recent surgery/trauma, diabetes, infectious disease & mental illness

43. General Screening and Health Counseling • All patients preparing for air travel should be counseled on adjusting timing of meds (especially if crossing time zones) • 3 strategies: • Maintain normal schedule using time of home country (best for short trips, keep watch on home time) • Gradually adjust schedule by an hour or two daily until med taken according to local time • Abruptly change schedule so medication is taken according to local time (may lead to extended delay between doses; not to be used with insulin)

44. General Screening and Health Counseling • Items for carry-on luggage • List of all medications • Meds that may be needed during flight (eg. insulin, bronchodilator, nitroglycerine) • Medical alert bracelet • Copy of recent EKG (Cardiac patients) • Vaccinations /Travel Advisory • CDC Website: http://wwwn.cdc.gov/travel/default.asp

45. ASMA Fitness Screen • Recommended by the Aerospace Medical Association (ASMA) and Airline Industry • Fitness to fly : walk 50 yards at normal pace or climb 1 flight of stairs without symptoms • No objective validation for this as a screening test

46. Specific Conditions • Partial pressure of oxygen decreases with altitude • Average commercial cruising altitude: 35,000ft • Typical pressurized cabin: 8000 ft • Typical PaO2 • 95mmHg (sea level) • 50-60mmHg (8000 ft) • Specific attention to cardiac, pulmonary and neurovascular conditions

47. Cardiovascular • Patients with uncomplicated MI or PTCA should not fly until 2-3 weeks after and tolerating daily activities • Contraindications to travel • Unstable angina • Severe CHF • NY III or IV need to be assessed to determine Oxygen requirement • Symptomatic valvular heart disease

48. Pacemakers and ICDs • Generally stable patients are low risk for inflight emergencies • Carry pacemaker card with copy of EKG • No evidence that airline electronics or airport security devices interfere w/ implanted pacemakers or ICD • Theoretical risk that ICD might detect alternating magnetic field created by the handheld wand

49. Neurologic • Stroke patients should not fly within 2 weeks of their event • Migraines might be exacerbated by air travel • Epilepsy is generally not a contraindication unless uncontrolled

50. Pulmonary • Hypoxia is major problem • ASMA Screening Test • Resting preflight PaO2 <72mmHg @ sea level predicts need for supplemental O2 in flight • Contraindications: • Pneumothorax • Severe asthma/COPD