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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.

NFS, AME, HMO, SSMSO

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)

introduction
Introduction
  • 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:

http://www.cami.jccbi.gov/AAM-300/part67.html

or

http://www.faa.gov/avr/AFS/FARS/far-67.txt

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
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

“Remember… YOU ARE RESPONSIBLE FOR THE ACCURACY”

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

“Remember… YOU ARE RESPONSIBLE FOR THE ACCURACY”

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.

FAA MMAC/CAMI/AAM-400

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
cardiovascular
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
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
neurologic
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
pulmonary
Pulmonary
  • 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
pregnancy
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
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
surgery
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
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)