Aviation Medical Exams

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Aviation Medical Exams

• John W. Hariadi, M.D.
• NFS, AME, HMO, SSMSO

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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)

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Introduction

• Medicine Abnormal physiology in a Normal
  environment
• Aviation Normal physiology in an Abnormal
  environment

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Topics of Discussion

• Airmen examination and certification
• Preflight Clearance

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The FAAs 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

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What is an AME ?

• A physician designated by the FAA to perform PEs
  necessary to determine qualifications for the
  issuance of a 2nd/3rd Class Airman medical
  certificate.

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What is a Senior AME ?

• An AME with the additional authority to perform
  PEs necessary to determine qualifications for
  the issuance of 1st Class Airman medical
  certificate.

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Criteria for AME Designation

• Professional qualified physician (MD or DO)
• The physicians region of practice must have an
  area of need
• AME to Pilot Ratio of 1100 within 50 miles

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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

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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 applicants age less than 40 years
  at time of PE

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Airmans 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 DUIs

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Airmans Instruction Page

• Self-explanatory
• Excellent guide for the Airman.

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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
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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

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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
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Report of Personal Medical History

• Must be done at the AMEs office
• Fill in everything !
• Only the Airman can write on the front

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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

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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
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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

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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 cant issue a certificate without a
  written FAA clearance, If no proof, defer case

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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

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The Applicants Check List

• Item 17a. - Medications
• If YES state type and purpose (even OTCs)
• Much faster certification if marked previously
  reported

• 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.

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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

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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

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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 - Applicants Signature
• Signed and dated in INK (check correct date)
• Third page applicants copy to applicant

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Report of Medical Examination
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FAA Medical Standards (October 1999)
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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

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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

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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

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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 - Color Vision
• Record as either Pass or Fail

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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 its a resting pulse

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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

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FAA Medical Standards
This is the most important documentation block
for the History and Physical Exam

• 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.

• Item 61 - Applicants name
• Needs to by typed

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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 AMEs Name and Address with AME Serial

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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

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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

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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

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FAA Points of Contact

• Melchor J. Antunano, M.D.
• FAA MMAC/CAMI/AAM-400
• PO Box 25082
• Oklahoma City,OK 73125-9944
• TEL [phone]
• FAX [phone]

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Preflight Clearance

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

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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

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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

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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)

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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.a
  sp

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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

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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

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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

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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

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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

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Pulmonary

• Hypoxia is major problem
• ASMA Screening Test
• Resting preflight PaO2 lt72mmHg _at_ sea level
  predicts need for supplemental O2 in flight
• Contraindications
• Pneumothorax
• Severe asthma/COPD

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Deep Vein Thrombosis

• Two Meta-analyses found increased risk of DVT in
  flights gt8 hours or gt5000 km
• Frequent stretching, walks, isometric calf
  exercises, adequate hydration
• Graduated compression stockings decreased
  incidence of DVT in 6 studies
• Lovenox can be used in high risk patients (given
  2-4 hours before flight)
• Aspirin has been shown not to be effective

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Pregnancy

• Generally not considered a risk to normal
  pregnancy
• ACOG recommends no flying after 36 wks
• High risk (probably not fly)
• Risk of premature delivery, cervical incompetence
• IUGR, preeclampsia, placenta previa
• Pregnant women at high risk for DVT

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Nasal and Sinus Disease

• Eustachian tube blockage from colds, nasal
  sinus conditions can precipitate barotrauma
• Oral decongestants (Sudafed) and nasal
  vasoconstrictors (Afrin, Neosynephrine) can help.
  Use approx 30 minutes prior to descent
• Good hydration

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Surgery

• Air in body cavities expand at altitude
• Patients should postpone air travel until at
  least 10-14 days after open surgery
• Laparoscopic procedures? can usually fly in 24
  hours if no bloating
• Colonoscopy? 24 hours
• Colostomies? no increased risk inflight, but may
  have increased fecal output

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Other Conditions

• Fractures
• Casts should be bivalved
• Pneumatic splints should be partially deflated
• Anemia
• Hemoglobin lt8.5 should be given supplemental
  oxygen
• Mental Illness Contraindications
• Violent, disruptive unpredictable behaviors
• Drug or alcohol withdrawal

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Scuba Diving and Decompression Sickness (DCS)

• The bends-Nitrogen precipitating out of blood
  at altitude
• Symptoms musculoskeletal pain, neurological
  signs, confusion
• After Scuba diving No flying until 24 hours
  after last dive
• Treatment Descend to lowest altitude and
  immediate hyperbaric chamber

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Points of Contact

• Aerospace Medical Association (ASMA)
• Website http//www.asma.org/index.php
• Telephone [phone]
• Medical Guidelines for Airline Travel
• Referral source for Aerospace Medicine
  specialists (ABPM)

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Any Questions ??