1. NWOC Aerospace Medicine Updates New Orleans 27 February 2015
Susan Northrup, MD, MPH
Regional Flight Surgeon
Southern Region

3. Overview Regional Program Safety Data Certification Data
Recent Decisions and Issues
Medical Condition Update
Questions

4. Office of Aerospace Medicine

5. 9 FAA Regions
[Seminar city] is in the [which one] region right here. There are 8 other geographical regions, along with the international, military and federal “region”.

6. Southern Region Stakeholder Base
700 Aviation Medical Examiners
147,000 Pilots
6,700 FAA Employees
Includes 4,800 Safety-Related Employeesoyees
Self explanatory

8. Certification and AME Staff
Dr John Barson and Dr Arnie Angelici
Cert analysts
Sharon Baker, Kadesha Lawson, Areta Williams
AME Program analyst:
EE Williams
Quality Assurance analysts
Hope Wright, Cristi Willbanks
Phone:
Analysts can handle 99% of calls – rarely do they need flight surgeon input.
Here are the people in this region who are here to help you in any way we can.

9. Airman Medical Certification
Share certification workload with CAMI
Handle re-certification of special issuances and SODAs
Handle hotline & inflight incapacitation reports.
Work enforcement cases - FAA Legal & Flight Standards
When you defer a case, it goes into a queue. Regional Flight Surgeons as well as medical certification officers at CAMI have access to that queue and work those cases. Call your region if you have questions.

10. Airman Medical Certification Region vs CAMI
CAMI handles all initial Class I and II Pacemaker, Valve, MI/Angina Coronary Interventions
Regions can handle other Special Issuances and SODA. Workload sharing with CAMI.
Try not to work same cases at both Region and CAMI simultaneously

12. Regional Medical Programs
Airman Medical Certification
Aviation Medical Examiner System
Air Traffic Controller Health Program
Occupational Health Program
Internal Substance Abuse Program
Airman Education
Here’s what we do in the region

13. Aviation Medical Examiner Program
Initial AME designations
Senior AME designation
Performance tracking with CAMI
Seminar training, phone support
Investigate complaints
Termination of AME designations
For the AME program, here is what the region is responsible for.

14. AME Surveillance Program
Visit all new AMEs within 1 year of designation
document all equipment is as stated on list
Evaluate office policies and procedures relating to conduct of airman medical examinations
Provide guidance and assistance as needed
Evaluate AME performance on an on-going basis, including reviewing sample of examinations completed and transmitted through AMCS to AMCD
Visit all AMEs in a 5 year cycle
New AMEs, we mentor you. Our goal is that you have all the support you need to make good aeromedical decisions. We don’t want anyone feeling like they are operating in a vacuum.

16. Safety Data

19. Certification

20. Airman Medical Certification Review and Appeals Process
AME
AEROSPACE MEDICAL CERTIFICATION
DIVISION OR REGIONS
FEDERAL AIR SURGEON
NATIONAL TRANSPORTATION SAFETY BOARD
ADMINISTRATIVE LAW JUDGE
FULL BOARD
U.S. COURT OF APPEALS
U.S. DISTRICT COURT
SUPREME COURT

21. Aeromedical Certification ( CY 2013)
382,990 Total applications received
Class 1
Class 2
Class 3
TOTAL
208,876
71,257
102,857
382,990

22. Aeromedical Certification (CY 2013)
3,405 denials (0.9% of all applications)
3,193 failed to pursue or failed to provide requested information
212 denials (0.06% of all applications) when all information requested is provided

23. Special Issuance Certificates Granted
Aeromedical Certification (CY 2013)
Special Issuance Certificates Granted
Class 1
Class 2
Class 3
TOTAL
16,920
6,778
13,474
37,172

24. Special Issuances Categories (CY 2013)
Diagnosis
Total
Cardiovascular
6,501
Diabetes
4,524
Cancer
1,833
Psychiatric
853
Substance use
795
SSRI
174
Neurologic
399
Transplants
106

25. Recent Events
DIWS Web deployment
Furlough
Backlog in AMCD medical certification processing
Personnel changes

26. Medical Certification Update
Transition brings change…
Loss of Docs and training new ones brings many challenges to keep up with the workload
Looking at new ways to reduce the workload (CACI)
Directing AME calls to specific departments depending on the case type
PLEASE BE PATIENT WITH US

28. Effort to Safely Decrease Number of Special Issuances Required
2011 – Early discussions of process
2012 – Review all SIs, determine low risk diagnoses, determine simple process for AMEs to issue
2012 – 18 conditions and protocols proposed to Federal Air Surgeon (15% of all SIs)

29. Conditions AME Can Issue - CACI 18 Proposed Conditions
Arthritis
Asthma
Carotid Stenosis
Colitis
Glaucoma
Hepatitis C
Hypertension
Hypothyroidism
Kidney Stones
Migraines
Pre-Diabetes
Bladder Cancer
Colon Cancer
Hodgkin’s Disease
Leukemia
Prostate Cancer
Renal Cancer
Testicular Cancer

30. Colon Cancer Lymphoma Leukemia Carotid Stenosis Hodgkin’s Disease
Postponed Conditions
Colon Cancer
Lymphoma
Leukemia
Carotid Stenosis
Hodgkin’s Disease

32. Obstructive Sleep Apnea

33. FAA released proposed guidance late 2013
OSA – Brief History
NTSB has recommended improved OSA screening for all modes of transportation. “Most Wanted List”
FAA released proposed guidance late 2013
Pushback by many (AOPA, ALPA, AMAS…)
Legislative Action was taken
After considering feedback, revised OSA guidance
Scheduled for deployment March 2, 2015

34. What you can expect
No change to the front of the for right now
Questions from AME
Education
Risk factors as stipulated by the American Society of Sleep Medicine
Airman will be placed in one of six groups
Nearly everyone will be issued at the time of exam
May need to provide evaluations and studies within 90 days
Airman considered an immediate safety risk will be deferred

35. OSA Groups
Group 1, airmen with an existing authorization
Will follow the authorization guidance
Group 2, airmen currently receiving treatment but not yet on an authorization
Will receive a Specification Sheet A and be given 90 days to submit documentation to the FAA
AME will issue if the airman is otherwise qualified
Group 3, airmen with no risk factors
AME will issue

36. OSA Groups
Group 4, OSA risks but not determined to be High Risk
AME will provide educational materials
Issue if otherwise qualified
Group 5, High risk for OSA
Given OSA Specification Sheet B, with 90 days to comply
AME will issue if otherwise qualified
Group 6, OSA with Immediate Safety Risk
Given OSA Specification Sheet B
Defer

37. Risk Factors High Risk for OSA
Obesity, congestive heart failure, atrial fibrillation, refractory hypertension, Type 2 diabetes, nocturnal dysthythmias, stroke, pulmonary hypertension, high-risk populations, preoperative for bariatric surgery
OSA related questions
Is the patient
Obese
Retrognathic
Daytime sleepiness
Snorer
Hypertension

39. LIGHT SPORT AIRCRAFT (Sport Pilot)
“Sport” pilots are required to hold either valid airman medical certificate or current valid U.S. driver’s license *
2. Must comply with restrictions and limitations of driver’s license
* Sport pilot medical provisions: Under Title 14 of the Code of Federal Regulations (14 CFR), Part 61.3, 61.23, 61.53, and Guide for Aviation Medical Examiners, page 8

40. LIGHT SPORT AIRCRAFT (Sport Pilot) *
Meet eligibility requirements (speak, read, write, understand English)
Must be 17 (16 for a student)
Current valid Driver’s License or current airman certificate issued under part 67
* Sport pilot medical provisions: Under Title 14 of the Code of Federal Regulations (14 CFR), Part 61.3, 61.23, 61.53, and Guide for Aviation Medical Examiners, page 8

41. LIGHT SPORT AIRCRAFT (Sport Pilot) *
NOT been denied (if applied for airman medical certificate)
NOT had most recent medical certificate revoked or suspended
NOT had most recent Authorization withdrawn (if ever granted authorization)
A Special Issuance is not a denial
* Sport pilot medical provisions: Under Title 14 of the Code of Federal Regulations (14 CFR), Part 61.3, 61.23, 61.53, and Guide for Aviation Medical Examiners

42. SPORT PILOT *
Sport pilots may NOT use driver’s license in lieu of valid airman certificate if they know or have reason to know of any medical condition that would make them unable to operate a light-sport aircraft in a safe manner. *
* FAR 61.23/303, and AME Guide

44. What is a Medical Certificate?
Under Title 14, Code of Federal Regulations (14 CFR), Part 1:
FAA defines a medical certificate as “acceptable evidence of physical fitness on a form prescribed by the Administrator.”
Goal to protect not only those who would exercise the privileges of a pilot certificate but also air travelers and the general public.
Individuals required to hold a medical certificate must have it in their personal possession at all times when exercising the privileges for which they are licensed.

45. Validity of Medical Certificates *
1st Class: Airline Transport Pilot, valid for 1year if under age 40, and 6 months if over age 40.
2nd Class: Commercial Pilot (receiving compensation) and flight engineer, navigator, air traffic controller, valid for one year.
3rd Class: Private Pilot valid for five years under age 40, and two years over age 40.

46. Exemption of need for 3rd Class Medical Certificate

47. House Bill – Senate Bill – General Aviation Protection Act limiting conditions covering the pilot, aircraft and flight parameters

48. FAA Announcement of Rule Making Project April 2, 2014

49. Part 61.53 * Prohibition on operations during a medical deficiency
(a) A person who holds a current medical certificate issued under part 67 of this chapter shall not act as pilot in command, or in any other capacity as a required pilot flight crewmember, while that person:
* Under Title 14 of the Code of Federal Regulations
(14 CFR), Part 61, and AME Guide page 11

50. Part *
(1) Knows or has reason to know of any medical condition that would make the person unable to meet the requirements for the medical certificate necessary for the pilot operation; or
* Under Title 14 of the Code of Federal Regulations
(14 CFR), Part 61, and AME Guide, page 11

51. Part *
(2) is taking medication or receiving other treatment for a medical condition that results in the person being unable to meet the requirements necessary for the pilot operation.
* Under Title 14 of the Code of Federal Regulations
(14 CFR), Part 61, and AME Guide, page 11

52. Part *
Applicant must report alcohol or drug offenses (i.e. motor vehicle violation) on the history part of the medical application. It does not relieve the airman of responsibility to report each motor vehicle action to the FAA Security Division within 60 days: Civil Aviation Security Division, AAC-700, P.O. Box 25810, Oklahoma City, OK
* Under Title 14 of the Code of Federal Regulations
(14 CFR), Part 61.15, and AME Guide page 33

54. Airman Does NOT Meet Standards:
AMCD or RFS * informs applicant medical conditions not meeting FAA standards require further evaluation
Many common medical problems just require additional information for approval
FAA depends on the quality of the medical report to determine pilot is safe to fly
* AMCD – Aeromedical Certification Division
RFS – Regional Flight Surgeon

55. Airman Does NOT Meet Standards:
FAA expects that a pilot will not resume piloting aircraft until:
The medical condition has stabilized
No significant adverse effects or complications
Airman meets the appropriate FAA standards, or is granted a waiver for standards (as determined by medical records forwarded, reviewed by Aerospace Medical Certification Division)

56. What is a Waiver ?
Two types of FAA waivers for medical conditions that do not meet standards of Federal Aviation Regulations (FAR), 14 CFR, Part :
Special Issuance: Waiver for medical condition has stabilized, but potentially progressive. The Federal Air Surgeon, may grant an Authorization for Special Issuance of a Medical Certificate (Authorization Letter), valid for a specified period
SODA:(Statement of Demonstrated Ability) for fixed defect (monovision, loss of limb, etc). The Federal Air Surgeon may authorize a special medical flight test.

58. Denials
Final denials: To be issued for only one of the 15 specifically disqualifying conditions or a denial by the FAS for any other condition not part of this group
General denials: Generally used for all other conditions requiring a denial.
The AME should only deny when the airman clearly does not meet the standards

59. Medical Appeal of Denial *
Within 30 days after the date of the denial, airman appeals to:
Federal Air Surgeon Attention: Manager, Aeromedical Certification Division, AAM-300 Federal Aviation Administration P.O. Box Oklahoma City, Oklahoma 73126
* Section under 14 CFR sets forth
the appeal process within the FAA for applicants

60. How the Appeal Process Works
AMCD or RFS* inform applicant of right to appeal
AMCD will review the application and inform the applicant of the decision
Denial is final for specifically disqualifying conditions set forth under Part 67 and is appealed to the NTSB
A General Denial is appealed to the Federal Air Surgeon (FAS).
Denial NOT specifically disqualifying (denied by FAS) appeal to the National Transportation Safety Board (NTSB).

61. How the Appeal Process Works
Unfavorable decision by the FAS may be appealed to the NTSB*
Administrative Law Judge (ALJ) holds a hearing on the applicant’s eligibility
ALJ’s decision (if) unacceptable to applicant or the FAA, then appealed to the full board (NTSB).
If full board affirms the denial, applicant may seek review by a U.S. Court of Appeals, then review by the U.S. Supreme Court.
* NTSB – National Transportation Safety Board
FAS – Federal Air Surgeon

63. DRUGS-Regulations, Rules, & Guidelines
Over-the-counter (OTC) medications
As with all drugs, side effects may vary with the individual, and with changes in altitude and other flight conditions, such as:*
Drowsiness
Impairment of judgment
Disturbance of vision
Any of these could cause an impairment that might lead to incapacitation while flying.*

64. DRUGS-Regulations, Rules, & Guidelines
Common sense advise:
Read and follow the label directions for use of OTC medication*.
If the label warns of side-effects, do not fly until twice the recommended dosing interval has passed*.
Remember, the condition being treated may be as disqualifying as the medication*.
*(see Publication AM /1) available from the Aerospace Medical Education Division

65. DRUGS-Regulations, Rules, & Guidelines
Generally, drugs that affect the Central Nervous System (CNS) are not acceptable for aeromedical purposes.
CNS depressants: sedatives, hypnotics, narcotics, antidepressants (including SSRI’s) {can cause drowsiness and/or impaired performance}
CNS stimulants: amphetamines, and related drugs such as methylphenidate (Ritalin,Concerta), pemoline (Cylert), modafinil (Provigil), etc. [not all inclusive] {over-stimulation may cause agitation, confusion, or psychosis}. Discontinuance after prolonged use or high doses may cause fatigue and/or depression.

66. DRUGS-Regulations, Rules, & Guidelines
Anti-seizure medication
If used for treatment of a seizure disorder, the condition and the medication are disqualifying.
If used for other than seizure disorder (e.g. pain control) is not acceptable because it may cause drowsiness or depression.

67. DRUGS-Regulations, Rules, & Guidelines
Misc. drugs:
Drugs that can cause a person to suddenly fall asleep during activities of daily living (e.g., pramipexole[Mirapex], ropinirole[Requip], pergolide[Permax])
Others-Anticholinergics, Chemotherapy, Investigational or Experimental drugs.

68. Binocular Multifocal Devices
Intraocular Lenses (Multifocal or Accomodating Intraocular Lens Implant)
3 Month recovery after cataract surgery
1 month recovery after multifocal contact lenses

70. General Comments on Certification
Falsification and Omissions…
Don’t let us find it, report it
Block 18 “have you ever in your life…”
Medical interactions
Please don’t ignore letters from the FAA
Keep copies

72. Questions?