AVIATION MEDICINE How many Nurse Practitioners are in Alaska? There are over 8,200 Registered pilots in Alaska Many other pilots live here and are registered elsewhere. Robert C Thomas MD DABFP FAA Senior Aviation Medical Examiner Former USN, USMC,NASA, USCG Flight Surgeon You most likely already have aviators, pilots, ATCs, A&Ps, and other aviation personnell in your practice. Most of you are either pilots, married to a pilot, or have a first degree relative who is a pilot WHAT IT TAKES TO BECOME A PROFESSIONAL PILOT 1. 8 or more years in the military and / or 2. Work a few years as a civilian to earn ratings First, earning a private pilot s license, followed by an instrument rating, commercial pilot rating, then ATP (airline transport pilot). To even attempt to become an ATP, the minimum amount of hours needed is 1,500 pilot in command time (PIC). This number can be lesser if one is a military pilot or went to an Aeronautical University such as Embry-Riddle Aeronautical University (there are others) The cost of becoming an ATP as a civilian is often greater than $200,000 Both routes to become a Professional Pilot take a significant amount of time However, what is always the most important requisite? AN ABSOLUTE LOVE OF FLYING. 1
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WHAT DO PILOTS FEAR THE MOST? WHAT DO PILOTS FEAR THE MOST? Bad weather? Bad weather? Engine Failure? Fire? Mishap? Engine Failure? Fire? Mishap? NO 3
15 Disqualifying Conditions THIS ONE DAY THEY WILL LOSE THEIR MEDICAL CERTIFICATE (1) DIABETES MELLITUS REQUIRING HYPOGLYCEMIC MEDICATION (2) ANGINA PECTORIS (3) CORONARY HEART DISEASE THAT HAS BEEN TREATED OR, IF UNTREATED, THAT HAS BEEN SYMPTOMATIC OR CLINICALLY SIGNIFICANT (4) MYOCARDIAL INFARCTION (5) CARDIAC VALVE REPLACEMENT (6) PERMANENT CARDIAC PACEMAKER (7) HEART REPLACEMENT (8) PSYCHOSIS (9) BIPOLAR DISORDER (10) PERSONALITY DISORDER THAT IS SEVERE ENOUGH TO HAVE REPEATEDLY MANIFESTED ITSELF BY OVERT ACTS (11) SUBSTANCE DEPENDENCE (12) SUBSTANCE ABUSE (13) EPILEPSY (14) DISTURBANCE OF CONSCIOUSNESS AND WITHOUT SATISFACTORY EXPLANATION OF CAUSE (15) TRANSIENT LOSS OF CONTROL OF NERVOUS SYSTEM FUNCTION(S) WITHOUT SATISFACTORY EXPLANATION OF CAUSE. After thorough review of a special condition, the FAA may issue a Special Issuance. The pilot s medical condition will be reviewed by a panel of experts. This is called a waiver in the military. SPECIAL ISSUANCE THE FAA SPECIAL ISSUANCE Most Special Issuances require yearly letters from the treating physician or primary care provider. This letter is called a Current Status Report When writing this letter, please only answer the questions the FAA asks and do not put your recommendations. Do not worry, this applies to neurosurgeons, cardiovascular surgeons, as well as us primary care providers. The FAA makes the determination: not the author of the Current Status report. THE FAA SPECIAL ISSUANCE Examples of conditions that may be granted a Special Issuance: Myocardial infarction with CABG or PCTA and stinting Pacemaker without defibrillator Sleep apnea Hyperthyroidism Melanoma Intraocular hypertension Many others THE FAA SPECIAL ISSUANCE Conditions that do not require a Special Issuance but do require Current Status Reports for PCP Hypothyroidism- needs a yearly current status report and normal TSH (per the reference range of that lab) Hypertension: greater than 155/95 untreated. Once treated must have a yearly CSR and normal blood pressure. If on a diuretic, must have a yearly potassium. 4
MEDICATIONS HIMS There is no published list available to us for approved and non-approved medications Often, it is the underlying condition-not the medication which is grounding A medication will not be considered by the FAA until it has been approved and on the market for one year Off label use of medications is almost always disqualifying. Any medication which may alter consciousness is not approved Medications in the isotretinoin family are not permitted Human intervention motivation study A wonderful program started in the 70 with a lot of work and cooperative effort between the Airline Pilots Association, Airlines, FAA, and congress. A greater than 90% success rate Pilots must go through an evaluation by psychiatrist and neuropsychologist who have working knowledge of the FAA as proved by their CME and education. (initially and yearly -usually) Random alcohol and drug testing. Monthly meetings with a HIMS AME Once all this is met, the airman may be issued a Special Issuance while participating in the program FAA regulations on DUI. If one Arrest (not conviction) BAC <.149, and no extraordinary circumstance, the AME may issue but FAA will review unless two in less than 10 years or three in a lifetime. ZERO drug tolerance. DOT tests pilots randomly. The airman may get a call 30 minutes from landing and be testing immediately after landing. A lot of airlines do the same as well. ANTI-DEPRESSANTS Prozac, Zoloft, Celexa, and Lexapro MAY be considered for a Special Issuance HOWEVER Grounded for one year after starting (there was a grace period a couple of years ago) Enter a HIMS program with all of the work before requesting an SI just like the other HIMS My personal pet peeve ADD and ADHD is disqualifying Stimulants such as Ritalin, Adderall, and Concerta, disqualify ADD / ADHD If the medication is stopped: ground for one year and re-evaluated ADD / ADHD (CONT D) If a youth or adult truly has ADD, and want an aviation career, please have the tested by a neuro-pyschologist to confirm! Please do not let parents sway you into giving Adderall because their son or daughter got a C in physics or calculus (YES- I have seen this personally. This is not a hyperbole) MINOR CONSUMING/MINOR IN POSSESSION Please encourage youth in your practice not to fall into this trap. This, also, must be reported to the FAA It is heartbreaking to tell a motivated student pilot they can NEVER fly! When I see someone who is motivated to fly and branded with an ADD diagnosis, I refer them to a neuro-pyschologist familiar with FAA standards. This testing is not cheap. Many student pilots cannot afford it. 5
WHAT HAPPENS IF THE PHYSICAL EXAM The airman completes form 8500 on MedExpress Save AK USA GRAY BLUE USA FAA MEDXPRESS FEDERAL AVIATION ADMINISTRATION home logout help ame guide Enter all date in MM/DD/YYYY format unless otherwise specified. Click the question mark icon next to the item number to access the AME Guide page for that item. Instructions for completing the application can be found by clicking the help link above. Exam type selected: Pilot (non FAA) - Airman, Student Pilot, Non-FAA Air Traffic Controller, etc. 1. Application For: Airman Medical Cert. Airman Medical & Student Pilot Cert. 2. Class of Medical Cert.: 1st 2nd 3rd 3. Last Name: First Name: Middle Name: Suffix: 4. SSN: International/Declined to Submit (An SSN will generated be by the system) 5. Address: Telephone Number: City: State: Country: Zip Code: 6. Date of Birth: 7. Hair Color: 8. Eye Color: 9. Sex: Male Female Citizenship: 10. Type of Airman Certificate(s) You Hold: None ATC Specialist Flight Instructor Recreational Airline Transport Flight Engineer Private Other Commercial Flight Navigator Student 11. Occupation: 12. Employer: date: 13. Has Your FAA Airman Medical Certificate Ever Been Denied, Suspended, or Revoked? Yes No If yes, give Total Pilot Time (Civilian Only) 14. To Date: 15. Past 6 months: 16. Date of Last FAA Medical Application: No Prior App 17.a. Do You Currently Use Any Medication (Prescription or Nonprescription)? Yes No 17.b. Do You Ever Use Near Vision Contact Lens(es) While Flying? Yes No 18. Medical History - HAVE YOU EVER IN YOUR LIFE BEEN DIAGNOSED WITH, HAD, OR DO YOU PRESENTLY HAVE ANY OF THE FOLLOWING? Answer "yes" or "no" for every condition listed below (All "yes" answers require a comment. Click Add Comments to add or edit a comment). a. Yes No Frequent or severe headaches m. Yes No Mental disorders of any sort: depression, anxiety, etc. Substance dependence or failed a drug test b. Yes No Dizziness or fainting spell n. Yes No ever; or substance abuse or use of illegal substance in the last 2 years. c. Yes No d. Yes No e. Yes No f. Yes No g. Yes No h. Yes No Unconsciousness for any reason o. Yes No Alcohol dependence or abuse Eye or vision trouble except glasses p. Yes No Suicide attempt Hay fever or allergy q. Yes No Motion sickness requiring medication Asthma or lung disease r. Yes No Military medical discharge Heart or vascular trouble s. Yes No Medical rejection by military service High or low blood pressure t. Yes No Rejection for life or health insurance i. Yes No Stomach, liver, or intestinal trouble u. Yes No j. Yes No Admission to hospital Kidney stone or blood in urine x. Yes No Other illness, disability, or surgery k. Yes No Diabetes y. Yes No Medical disability benefits Neurological disorders: epilepsy, seizures, stroke, paralysis, etc. l. Yes No Arrest and/or Conviction and/or Administrative Action History a. Yes No Frequent or severe headaches m. Yes No Mental disorders of any sort: depression, anxiety, etc. Substance dependence or failed a drug test b. Yes No Dizziness or fainting spell n. Yes No ever; or substance abuse or use of illegal substance in the last 2 years. c. Yes No d. Yes No e. Yes No f. Yes No g. Yes No h. Yes No Unconsciousness for any reason o. Yes No Alcohol dependence or abuse Eye or vision trouble except glasses p. Yes No Suicide attempt Hay fever or allergy q. Yes No Motion sickness requiring medication Asthma or lung disease r. Yes No Military medical discharge Heart or vascular trouble s. Yes No Medical rejection by military service High or low blood pressure t. Yes No Rejection for life or health insurance i. Yes No Stomach, liver, or intestinal trouble u. Yes No j. Yes No Admission to hospital Kidney stone or blood in urine x. Yes No Other illness, disability, or surgery k. Yes No Diabetes y. Yes No Medical disability benefits Neurological disorders: epilepsy, seizures, stroke, paralysis, etc. l. Yes No Arrest and/or Conviction and/or Administrative Action History History of (1) any arrest(s) and/or conviction(s) involving driving while intoxicated by, while impaired by, or while under the influence of alcohol or a drug; or (2) history of any arrest(s), and/or conviction(s), and/or v. Yes No administrative action(s) involving an offense(s) which resulted in the denial, suspension, cancellation, or revocation of driving privileges or which resulted in attendance at an educational or a rehabilitation program. w. Yes No History of nontraffic conviction(s) (misdemeanors or felonies). 19. Have you visited any health professionals within the last 3 years?: Yes No 20. Applicant's National Driver Register and Certifying Declarations: I hereby authorize the National Driver Register (NDR), through a designated State Department of Motor Vehicles, to furnish to the FAA information pertaining to my driving record. This consent constitutes authorization for a single access to the information contained in the NDR to verify information provided in this application. Upon my request, the FAA shall make the information received from the NDR, if any, available for my review and written comment. Authority: 23 U.S. Code 401, Note. 6
WHAT CAN YOU DO TO HELP YOUR PILOT PATIENTS? Please do not list a disqualifying condition unless you are absolutely sure it is correct Inquire before starting medications Please write a good Current Status report Please call me or the FAA for questions And of course, continue to practice good medicine. First and foremost, the airman must be healthy QUESTIONS? Robert C Thomas MD DABFP FAA Senior Aviation Medical Examiner Former USN, USMC,NASA, USCG Flight Surgeon Phone: 907-868-2961 7