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

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Aviation Medical Exams

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Aviation medical exams

Aviation Medical Exams

John W. Hariadi, M.D.


What are all those initials

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)



  • Medicine: Abnormal physiology in a Normal environment

  • Aviation: Normal physiology in an Abnormal environment

Topics of discussion

Topics of Discussion

  • Airmen examination and certification

  • Preflight Clearance

The faa s medical standards and certification process

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:




What is an ame

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.

What is a senior ame

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.

Criteria for ame designation

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

Ame credentials requirements

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

Faa classifications

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

Airman s applicant information

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

Airman s instruction page

Airman’s Instruction Page

  • Self-explanatory

  • Excellent guide for the Airman.

Front of faa form 8500 8

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

Front of faa form 8500 81

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”

Report of personal medical history

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

Report of personal medical history1

Report of Personal & Medical History

  • Must be done at the AME’s office

  • Fill in everything !

  • Only the Airman can write on the front

The applicants checklist

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

The applicants check list

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

The applicants check list1

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

The applicants check list2

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

The applicants check list3

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

The applicants check list4

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”

The applicants check list5

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

The applicants check list6

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

The applicants check list7

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

Report of medical examination

Report of Medical Examination

Faa medical standards october 1999

FAA Medical Standards (October 1999)

The faa medical exam form

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

The faa medical exam form1

The FAA Medical Exam Form

  • Items 25..48 - General examination

    • If not examined type “NE” and explain why


The faa medical exam form2

The FAA Medical Exam Form

  • Items 49..60 - General Screening Laboratory

    • These items may be completed by a PA, RN, or lab assistant


Faa medical standards

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”

Faa medical standards1

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

Faa medical standards2

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

Faa medical standards3

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

Faa medical standards4

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 #

15 disqualifying conditions

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

15 disqualifying conditions1

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

Disqualifying conditions

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

Faa points of contact

FAA Points of Contact

Melchor J. Antunano, M.D.


PO Box 25082

Oklahoma City,OK 73125-9944

TEL: (405) 954-4832

FAX: (405) 954-8016

Preflight clearance

Preflight Clearance

  • Clinicians frequently asked to make recommendations regarding travel safety

  • Review risks posed by Commercial Air travel

General screening health counseling

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

General screening and health counseling

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

General screening and health counseling1

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)

General screening and health counseling2

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

Asma fitness screen

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

Specific conditions

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



  • 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

Pacemakers and icds

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



  • 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



  • 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

Deep vein thrombosis

Deep Vein Thrombosis

  • Two Meta-analyses found increased risk of DVT in flights >8 hours or >5000 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



  • 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

Nasal and sinus disease

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



  • 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

Other conditions

Other Conditions

  • Fractures

    • Casts should be bivalved

    • Pneumatic splints should be partially deflated

  • Anemia

    • Hemoglobin <8.5 should be given supplemental oxygen

  • Mental Illness Contraindications

    • Violent, disruptive unpredictable behaviors

    • Drug or alcohol withdrawal

Scuba diving and decompression sickness dcs

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

Points of contact

Points of Contact

  • Aerospace Medical Association (ASMA)

    • Website: http://www.asma.org/index.php

    • Telephone: (703) 739-2240

    • Medical Guidelines for Airline Travel

    • Referral source for Aerospace Medicine specialists (ABPM)

Any questions

Any Questions ??

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