federal aviation administration nwoc aerospace medicine updates new orleans 27 february 2015 susan...

Federal AviationAdministrationNWOC

Aerospace Medicine Updates

New Orleans

27 February 2015

Susan Northrup, MD, MPH

Regional Flight Surgeon

Southern Region

2Federal AviationAdministrationFebruary 2013


Overview

• Regional Program• Safety Data• Certification Data• Recent Decisions and Issues• Medical Condition Update• Questions


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


9 FAA Regions


Southern Region Stakeholder Base

• 700 Aviation Medical Examiners• 147,000 Pilots

• 6,700 FAA Employees

Includes 4,800 Safety-Related Employeesoyees


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.


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


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


Regional Medical Programs

• Airman Medical Certification• Aviation Medical Examiner System• Air Traffic Controller Health Program• Occupational Health Program• Internal Substance Abuse Program• Airman Education


Aviation Medical Examiner Program • Initial AME designations• Senior AME designation• Performance tracking with CAMI• Seminar training, phone support• Investigate complaints• Termination of AME designations


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


Safety Data

Federal AviationAdministration 18


Certification


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


Aeromedical Certification( CY 2013)

382,990 Total applications received

Class 1 Class 2 Class 3 TOTAL

208,876 71,257 102,857 382,990


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


Aeromedical Certification(CY 2013)

Class 1 Class 2 Class 3 TOTAL

16,920 6,778 13,474 37,172

Special Issuance Certificates Granted


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


Recent Events

• DIWS Web deployment

• Furlough

• Backlog in AMCD medical certification processing

• Personnel changes

27Federal AviationAdministration

Certification Issues


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)


Conditions AME Can Issue - CACI 18 Proposed Conditions

ArthritisAsthmaCarotid StenosisColitisGlaucomaHepatitis CHypertensionHypothyroidismKidney Stones

MigrainesPre-DiabetesBladder CancerColon CancerHodgkin’s DiseaseLeukemiaProstate CancerRenal CancerTesticular Cancer


Postponed Conditions

Colon CancerLymphomaLeukemiaCarotid StenosisHodgkin’s Disease


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.)


Obstructive Sleep Apnea


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


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


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


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


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



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



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



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



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. *



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.



Exemption of need for 3rd Class Medical Certificate



House Bill – 3708 Senate Bill – 2103

General Aviation Protection Act 2014

10 limiting conditions covering the pilot, aircraft and flight parameters



FAA Announcement of Rule Making Project

April 2, 2014



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



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



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



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



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



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)



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.



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



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



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).



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



• 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



• 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




• 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.




• 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.




• 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.




• Intraocular Lenses (Multifocal or Accomodating Intraocular Lens Implant)

• 3 Month recovery after cataract surgery

• 1 month recovery after multifocal contact lenses

Binocular Multifocal Devices



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



Questions?

federal aviation administration nwoc aerospace medicine updates new orleans 27 february 2015 susan...

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