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Federal AviationAdministrationNWOC
Aerospace Medicine Updates
New Orleans
27 February 2015
Susan Northrup, MD, MPH
Regional Flight Surgeon
Southern Region
2Federal AviationAdministrationFebruary 2013
3Federal AviationAdministrationFebruary 2013
Overview
• Regional Program• Safety Data• Certification Data• Recent Decisions and Issues• Medical Condition Update• Questions
4Federal AviationAdministrationFebruary 2013
Office of Aerospace Medicine
Federal Air Surgeon
Deputy Federal Air Surgeon Director, Civil Aerospace Medical Institute
Medical Specialties Division
Aerospace Medical Certification Division
Program Management Division
Aerospace Medical Education Division
Drug Abatement Division
Aerospace Human Factors Research Division
Regional Aerospace Medicine Divisions
Aerospace Medical Research Division
Occupational Health Division
Chief Psychiatrist Clinical Psychologist
5Federal AviationAdministrationFebruary 2013
9 FAA Regions
6Federal AviationAdministrationFebruary 2013
Southern Region Stakeholder Base
• 700 Aviation Medical Examiners• 147,000 Pilots
• 6,700 FAA Employees
Includes 4,800 Safety-Related Employeesoyees
7Federal AviationAdministrationFebruary 2013
8Federal AviationAdministrationFebruary 2013
Certification and AME Staff• Dr John Barson and Dr Arnie Angelici• Cert analysts
– Sharon Baker, Kadesha Lawson, Areta Williams
• AME Program analyst: – EE Williams
• Quality Assurance analysts– Hope Wright, Cristi Willbanks
• Phone: 404-305-6150• Analysts can handle 99% of calls – rarely do
they need flight surgeon input.
9Federal AviationAdministrationFebruary 2013
Airman Medical Certification
• Share certification workload with CAMI• Handle re-certification of special issuances
and SODAs• Handle hotline & inflight incapacitation
reports.• Work enforcement cases - FAA Legal &
Flight Standards
10Federal AviationAdministrationFebruary 2013
Airman Medical CertificationRegion vs CAMI
• CAMI handles all initial Class I and II Pacemaker, Valve, MI/Angina Coronary Interventions
• Regions can handle other Special Issuances and SODA. Workload sharing with CAMI.
• Try not to work same cases at both Region and CAMI simultaneously
11Federal AviationAdministrationFebruary 2013
12Federal AviationAdministrationFebruary 2013
Regional Medical Programs
• Airman Medical Certification• Aviation Medical Examiner System• Air Traffic Controller Health Program• Occupational Health Program• Internal Substance Abuse Program• Airman Education
13Federal AviationAdministrationFebruary 2013
Aviation Medical Examiner Program • Initial AME designations• Senior AME designation• Performance tracking with CAMI• Seminar training, phone support• Investigate complaints• Termination of AME designations
14Federal AviationAdministrationFebruary 2013
AME Surveillance Program • Visit all new AMEs within 1 year of
designation– document all equipment is as stated on list– Evaluate office policies and procedures relating to
conduct of airman medical examinations– Provide guidance and assistance as needed – Evaluate AME performance on an on-going basis,
including reviewing sample of examinations completed and transmitted through AMCS to AMCD
• Visit all AMEs in a 5 year cycle
15Federal AviationAdministrationFebruary 2013
16Federal AviationAdministrationFebruary 2013
Safety Data
17Federal AviationAdministrationFebruary 2013
Federal AviationAdministration 18
Federal AviationAdministration 19
Certification
Federal AviationAdministration 20
Airman Medical Certification Review and Appeals Process
AME
AEROSPACE MEDICAL CERTIFICATION
DIVISION OR REGIONS
FEDERAL AIR SURGEON
NATIONAL TRANSPORTATION SAFETY BOARDADMINISTRATIVE LAW JUDGEFULL BOARD
U.S. COURT OF APPEALS
SUPREME COURT
U.S. DISTRICT COURT
Federal AviationAdministration 21
Aeromedical Certification( CY 2013)
382,990 Total applications received
Class 1 Class 2 Class 3 TOTAL
208,876 71,257 102,857 382,990
Federal AviationAdministration 22
Aeromedical Certification(CY 2013)
3,405 denials (0.9% of all applications)
3,193 failed to pursue or failed to provide requested information
212 denials (0.06% of all applications) when all information requested is provided
Federal AviationAdministration 23
Aeromedical Certification(CY 2013)
Class 1 Class 2 Class 3 TOTAL
16,920 6,778 13,474 37,172
Special Issuance Certificates Granted
Federal AviationAdministration 24
Special Issuances Categories(CY 2013)
Diagnosis Total
Cardiovascular 6,501
Diabetes 4,524
Cancer 1,833
Psychiatric 853
Substance use 795
SSRI 174
Neurologic 399
Transplants 106
Federal AviationAdministration 25
Recent Events
• DIWS Web deployment
• Furlough
• Backlog in AMCD medical certification processing
• Personnel changes
27Federal AviationAdministration
Certification Issues
Federal AviationAdministration 28
Effort to Safely Decrease Number of Special Issuances Required
• 2011 – Early discussions of process
• 2012 – Review all SIs, determine low risk diagnoses, determine simple process for AMEs to issue
• 2012 – 18 conditions and protocols proposed to Federal Air Surgeon (15% of all SIs)
Federal AviationAdministration 29
Conditions AME Can Issue - CACI 18 Proposed Conditions
ArthritisAsthmaCarotid StenosisColitisGlaucomaHepatitis CHypertensionHypothyroidismKidney Stones
MigrainesPre-DiabetesBladder CancerColon CancerHodgkin’s DiseaseLeukemiaProstate CancerRenal CancerTesticular Cancer
Federal AviationAdministration 30
Postponed Conditions
Colon CancerLymphomaLeukemiaCarotid StenosisHodgkin’s Disease
Federal AviationAdministration 31
Hypothyroidism Worksheet The Examiner must review a current status report by the treating physician and any supporting documents to determine the applicant’s eligibility for certification. If the applicant meets ALL the acceptable certification criteria listed below, the Examiner can issue. Applicants for first- or second- class must provide this information annually; applicants for third-class must provide the information with each required exam.
AME MUST REVIEW ACCEPTABLE CERTIFICATION CRITERIA
Treating physician finds the condition stable on current regimen and no changes recommended
[ ] Yes
Symptoms and signs [ ] None of the following: fatigue, mental status impairment, or symptoms related to pulmonary, cardiac, or visual systems
Acceptable medications [ ] Levothyroxine sodium (Synthroid, Levothyroid), porcine thyroid (Armour), liothyronine sodium (Cytomel), or liotrix (Thyrolar)
Normal TSH within the last 90 days
[ ] Yes
AME MUST NOTE in Block 60 one of the following: [ ] Airman meets certification criteria for hypothyroidism.
[ ] Airman had a previous Special Issuance for this condition and now meets the regular issuance certification criteria for hypothyroidism.
[ ] Airman does NOT meet certification criteria for hypothyroidism. I have deferred this exam. (Mail the supporting documents to FAA identifying which criteria were not met.)
Federal AviationAdministration 32
Obstructive Sleep Apnea
Federal AviationAdministration 33
OSA – Brief History
• NTSB has recommended improved OSA screening for all modes of transportation. “Most Wanted List”
• FAA released proposed guidance late 2013• Pushback by many (AOPA, ALPA, AMAS…)• Legislative Action was taken• After considering feedback, revised OSA
guidance• Scheduled for deployment March 2, 2015
Federal AviationAdministration 34
What you can expect
• No change to the front of the 8500-8 for right now• Questions from AME• Education• Risk factors as stipulated by the American Society of
Sleep Medicine• Airman will be placed in one of six groups• Nearly everyone will be issued at the time of exam
• May need to provide evaluations and studies within 90 days
• Airman considered an immediate safety risk will be deferred
Federal AviationAdministration 35
OSA Groups
• Group 1, airmen with an existing authorization• Will follow the authorization guidance
• Group 2, airmen currently receiving treatment but not yet on an authorization• Will receive a Specification Sheet A and be given 90
days to submit documentation to the FAA• AME will issue if the airman is otherwise qualified
• Group 3, airmen with no risk factors• AME will issue
Federal AviationAdministration 36
OSA Groups
• Group 4, OSA risks but not determined to be High Risk• AME will provide educational materials• Issue if otherwise qualified
• Group 5, High risk for OSA• Given OSA Specification Sheet B, with 90 days to
comply• AME will issue if otherwise qualified
• Group 6, OSA with Immediate Safety Risk• Given OSA Specification Sheet B• Defer
Federal AviationAdministration 37
Risk Factors
• High Risk for OSA
• Obesity, congestive heart failure, atrial fibrillation, refractory hypertension, Type 2 diabetes, nocturnal dysthythmias, stroke, pulmonary hypertension, high-risk populations, preoperative for bariatric surgery
• OSA related questions
• Is the patient
• Obese
• Retrognathic
• Daytime sleepiness
• Snorer
• Hypertension
38Federal AviationAdministration
Certification Issues
39Federal AviationAdministration
Certification Issues
LIGHT SPORT AIRCRAFT (Sport Pilot)
1. “Sport” pilots are required to hold either valid airman medical certificate or current valid U.S. driver’s license *
2. Must comply with restrictions and limitations of driver’s license
* Sport pilot medical provisions: Under Title 14 of the Code of Federal Regulations (14 CFR), Part 61.3, 61.23, 61.53, 61.303 and Guide for
Aviation Medical Examiners, page 8
40Federal AviationAdministration
Certification Issues
LIGHT SPORT AIRCRAFT (Sport Pilot) *
1. Meet eligibility requirements (speak, read, write, understand English)
2. Must be 17 (16 for a student)3. Current valid Driver’s License or current
airman certificate issued under part 67
* Sport pilot medical provisions: Under Title 14 of the Code of Federal Regulations (14 CFR), Part 61.3, 61.23, 61.53, 61.303 and Guide for Aviation Medical Examiners, page 8
41Federal AviationAdministration
Certification Issues
LIGHT SPORT AIRCRAFT (Sport Pilot) *
1. NOT been denied (if applied for airman medical certificate)
2. NOT had most recent medical certificate revoked or suspended
3. NOT had most recent Authorization withdrawn (if ever granted authorization)
4. A Special Issuance is not a denial * Sport pilot medical provisions: Under Title 14 of the Code of
Federal Regulations (14 CFR), Part 61.3, 61.23, 61.53, 61.303 and Guide for Aviation Medical Examiners
42Federal AviationAdministration
Certification Issues
SPORT PILOT *
* FAR 61.23/303, and AME Guide
Sport pilots may NOT use driver’s license in lieu of valid airman certificate if they know or have reason to know of any medical condition that would make them unable to operate a light-sport aircraft in a safe manner. *
43Federal AviationAdministration
Certification Issues
45Federal AviationAdministration
Certification Issues
Validity of Medical Certificates *
• 1st Class: Airline Transport Pilot, valid for 1year if under age 40, and 6 months if over age 40.
• 2nd Class: Commercial Pilot (receiving compensation) and flight engineer, navigator, air traffic controller, valid for one year.
• 3rd Class: Private Pilot valid for five years under age 40, and two years over age 40.
46Federal AviationAdministration
Certification Issues
Exemption of need for 3rd Class Medical Certificate
47Federal AviationAdministration
Certification Issues
House Bill – 3708 Senate Bill – 2103
General Aviation Protection Act 2014
10 limiting conditions covering the pilot, aircraft and flight parameters
48Federal AviationAdministration
Certification Issues
FAA Announcement of Rule Making Project
April 2, 2014
49Federal AviationAdministration
Certification Issues
Part 61.53 *
• Prohibition on operations during a medical deficiency
• (a) . . . A person who holds a current medical certificate issued under part 67 of this chapter shall not act as pilot in command, or in any other capacity as a required pilot flight crewmember, while that person:
* Under Title 14 of the Code of Federal Regulations (14 CFR), Part 61, and AME Guide page 11
50Federal AviationAdministration
Certification Issues
Part 61.53 *
– (1) Knows or has reason to know of any medical condition that would make the person unable to meet the requirements for the medical certificate necessary for the pilot operation; or
* Under Title 14 of the Code of Federal Regulations (14 CFR), Part 61, and AME Guide, page 11
51Federal AviationAdministration
Certification Issues
Part 61.53 *
– (2) is taking medication or receiving other treatment for a medical condition that results in the person being unable to meet the requirements necessary for the pilot operation.
* Under Title 14 of the Code of Federal Regulations (14 CFR), Part 61, and AME Guide, page 11
52Federal AviationAdministration
Certification Issues
Part 61.15 *
• Applicant must report alcohol or drug offenses (i.e. motor vehicle violation) on the history part of the medical application. It does not relieve the airman of responsibility to report each motor vehicle action to the FAA Security Division within 60 days: Civil Aviation Security Division, AAC-700, P.O. Box 25810, Oklahoma City, OK 73125-0810
* Under Title 14 of the Code of Federal Regulations (14 CFR), Part 61.15, and AME Guide page 33
53Federal AviationAdministration
Certification Issues
54Federal AviationAdministration
Certification Issues
Airman Does NOT Meet Standards:
• AMCD or RFS * informs applicant medical conditions not meeting FAA standards require further evaluation
• Many common medical problems just require additional information for approval
• FAA depends on the quality of the medical report to determine pilot is safe to fly
* AMCD – Aeromedical Certification Division RFS – Regional Flight Surgeon
55Federal AviationAdministration
Certification Issues
Airman Does NOT Meet Standards: FAA expects that a pilot will not resume piloting
aircraft until: • The medical condition has stabilized • No significant adverse effects or complications • Airman meets the appropriate FAA standards,
or is granted a waiver for standards (as determined by medical records forwarded, reviewed by Aerospace Medical Certification Division)
56Federal AviationAdministration
Certification Issues
What is a Waiver ?
Two types of FAA waivers for medical conditions that do not meet standards of Federal Aviation Regulations (FAR), 14 CFR, Part 67.401:
• Special Issuance: Waiver for medical condition has stabilized, but potentially progressive. The Federal Air Surgeon, may grant an Authorization for Special Issuance of a Medical Certificate (Authorization Letter), valid for a specified period
• SODA:(Statement of Demonstrated Ability) for fixed defect (monovision, loss of limb, etc). The Federal Air Surgeon may authorize a special medical flight test.
57Federal AviationAdministration
Certification Issues
58Federal AviationAdministration
Certification Issues
Denials
• Final denials: To be issued for only one of the 15 specifically disqualifying conditions or a denial by the FAS for any other condition not part of this group
• General denials: Generally used for all other conditions requiring a denial.
• The AME should only deny when the airman clearly does not meet the standards
59Federal AviationAdministration
Certification Issues
Medical Appeal of Denial *Within 30 days after the date of the denial, airman
appeals to:
Federal Air Surgeon Attention: Manager, Aeromedical Certification Division, AAM-300 Federal Aviation Administration P.O. Box 26080 Oklahoma City, Oklahoma 73126
* Section 67.401 under 14 CFR sets forth the appeal process within the FAA for applicants
60Federal AviationAdministration
Certification Issues
How the Appeal Process Works
• AMCD or RFS* inform applicant of right to appeal• AMCD will review the application and inform the
applicant of the decision• Denial is final for specifically disqualifying conditions set
forth under Part 67 and is appealed to the NTSB• A General Denial is appealed to the Federal Air
Surgeon (FAS). • Denial NOT specifically disqualifying (denied by FAS)
appeal to the National Transportation Safety Board (NTSB).
61Federal AviationAdministration
Certification Issues
How the Appeal Process WorksUnfavorable decision by the FAS may be appealed to the NTSB*
Administrative Law Judge (ALJ) holds a hearing on the applicant’s eligibility
ALJ’s decision (if) unacceptable to applicant or the FAA, then appealed to the full board (NTSB).
If full board affirms the denial, applicant may seek review by a U.S. Court of Appeals, then review by the U.S. Supreme Court.
* NTSB – National Transportation Safety Board
FAS – Federal Air Surgeon
62Federal AviationAdministration
Certification Issues
63Federal AviationAdministration
Certification Issues
• Over-the-counter (OTC) medications• As with all drugs, side effects may vary with the
individual, and with changes in altitude and other flight conditions, such as:*
• Drowsiness• Impairment of judgment• Disturbance of vision
Any of these could cause an impairment that might lead to incapacitation while flying.*
DRUGS-Regulations, Rules, & Guidelines
64Federal AviationAdministration
Certification Issues
• Common sense advise:• Read and follow the label directions for use of OTC
medication*.• If the label warns of side-effects, do not fly until
twice the recommended dosing interval has passed*.
• Remember, the condition being treated may be as disqualifying as the medication*.
• *(see Publication AM-400-92/1) available from the Aerospace Medical Education Division
DRUGS-Regulations, Rules, & Guidelines
65Federal AviationAdministration
Certification Issues
• Generally, drugs that affect the Central Nervous System (CNS) are not acceptable for aeromedical purposes.
• CNS depressants: sedatives, hypnotics, narcotics, antidepressants (including SSRI’s) {can cause drowsiness and/or impaired performance}
• CNS stimulants: amphetamines, and related drugs such as methylphenidate (Ritalin,Concerta), pemoline (Cylert), modafinil (Provigil), etc. [not all inclusive] {over-stimulation may cause agitation, confusion, or psychosis}. Discontinuance after prolonged use or high doses may cause fatigue and/or depression.
DRUGS-Regulations, Rules, & Guidelines
66Federal AviationAdministration
Certification Issues
• Anti-seizure medication
• If used for treatment of a seizure disorder, the condition and the medication are disqualifying.
• If used for other than seizure disorder (e.g. pain control) is not acceptable because it may cause drowsiness or depression.
DRUGS-Regulations, Rules, & Guidelines
67Federal AviationAdministration
Certification Issues
• Misc. drugs:• Drugs that can cause a person to suddenly
fall asleep during activities of daily living (e.g., pramipexole[Mirapex], ropinirole[Requip], pergolide[Permax])
• Others-Anticholinergics, Chemotherapy, Investigational or Experimental drugs.
DRUGS-Regulations, Rules, & Guidelines
68Federal AviationAdministration
Certification Issues
• Intraocular Lenses (Multifocal or Accomodating Intraocular Lens Implant)
• 3 Month recovery after cataract surgery
• 1 month recovery after multifocal contact lenses
Binocular Multifocal Devices
69Federal AviationAdministration
Certification Issues
70Federal AviationAdministration
Certification Issues
General Comments on Certification• Falsification and Omissions…
– Don’t let us find it, report it– Block 18 “have you ever in your life…”– Medical interactions
• Please don’t ignore letters from the FAA• Keep copies
71Federal AviationAdministration
Certification Issues
72Federal AviationAdministration
Certification Issues
Questions?