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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

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

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)