What is the main focus of the January/February 2013 FAA Safety Briefing?

The main focus is on aerospace medicine, including the FAA's responsibilities and key issues affecting medical certification for pilots.

What is the significance of the AOPA/EAA petition?

If granted, the petition would allow pilots to fly using a medical self-assessment process instead of the traditional third-class medical certificate.

Why are regular medical check-ups important for pilots?

Regular medical check-ups are vital for maintaining physical health, which is essential for safe flying.

What changes are being made to 14 CFR part 23?

The FAA plans to rewrite part 23 to be more performance-based and to better accommodate new safety technologies.

What new features have been added to FAASafety.gov?

New tools and updates have been introduced to improve functionality and user-friendliness, including a redesigned online course page.

FAA Safety Briefing — January/February 2013 — Safety Briefing Jan/Feb 2013 (2013)

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FAA Safety

Brie F ing January/February 2013

Your source for general aviation news and information w hat Your Medical c an d o for You, p. 14 t ake the (Med)XPress Lane, p. 20 f rom fda to faa , p. 28 Federal Aviation Administration www.faa.gov/news/safety_briefing/

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The Jan/ f eb 2013 issue of faa s afety Briefing focuses on aerospace medicine. a rticles explain the faa ’s responsibilities, cover key issues that affect medical certification for pilots, and discuss the pilot’s role in this process.

Graphic courtesy Nick Crawford

Features

No N e for the r oad

U.S. Department

Preventing dui in the s ky . . . . . . . . . . . . . . . . . . . . . . . . . . 4

of Transportation

BY S A B r I n A W OODS

Federal Aviation

a M e i N g for e xcelle N ce Administration

The Making of an a viation Medical e xaminer . . . . . . . . . . . . . . 9

ISSN: 1057-9648 BY T O m H O f f m A nn FAA Safety Briefing January/February 2013 Volume 52/Number 1

t he r ight Stuff

Raymond H. LaHood s ecretary of t ransportation

w hat Kind of Medical Must i Hold? . . . . . . . . . . . . . . . . . . . . 14

Michael Huerta a cting a dministrator BY J A me S W I l l I A m S Margaret Gilligan a ssociate a dministrator for a viation s afety John M. Allen d irector, f light s tandards s ervice Dennis Pratte a cting Manager, g eneral a viation and c ommercial d ivision

Navigati N g the Medical f light Path

Susan Parson e ditor

s pecial Pull- o ut i nfographic on the Tom Hoffmann Managing e ditor

James R. Williams a ssociate e ditor / Photo e ditor

Medical c ertification Process . . . . . . . . . . . . . . . . . . . . . . . . 18

Sabrina Woods a ssistant e ditor BY P AU l C I A n CIO l O Paul Cianciolo a ssistant e ditor Will Daniel Muddsimmons a ssistant c opy e ditor Nick Crawford a rt d irector

t ake the xP re SS l a N e

Published six times a year, faa s afety Briefing, formerly faa a viation n ews,

Learn How to f ast- t rack Your a irman Medical c ertificate . . . . . . 20

promotes aviation safety by discussing current technical, regulatory, and procedural aspects affecting the safe operation and maintenance of aircraft.

BY T O m H O f f m A nn Although based on current FAA policy and rule interpretations, all material is advisory or informational in nature and should not be construed to have regulatory effect. Certain details of accidents described herein may have

t he e ye S h ave i t

been altered to protect the privacy of those involved.

w hat Pilots s hould Know about r efractive e ye s urgery . . . . . . . 24

The FAA does not officially endorse any goods, services, materials, or prod- ucts of manufacturers that may be referred to in an article. All brands, product BY S US A n P A r SO n names, company names, trademarks, and service marks are the properties of their respective owners. All rights reserved.

f ro M fda to faa The Office of Management and Budget has approved the use of public funds

for printing faa s afety Briefing .

How the faa e valuates d rugs for a eromedical u se . . . . . . . . . . 28

BY S US A n P A r SO n CONTACT INFORMATION

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joh n m. A l l e n dir ect or , f ligh t sta n da r ds serv ice

Medical Check Rides

No offense to the medical profession, but if you are anything like me, you probably think of dieting and going to the doctor with the same kind of “enthusiasm” you have for, say, taking a checkride in lousy weather. But we all know that just as it is important to keep your flying knowledge and skills sharp enough to pass a checkride on any given day, it is also vitally important for us flyers to keep our physical health in tip-top shape.

Monitoring and Maintenance A key part of remaining physically healthy is an activity that is (I hope) already second- my wife, I went to the dermatologist to see about a weird nature to the things you do to keep your airplane mole on my left hand. I was shocked by the diagnosis of mechanically sound: constant monitoring and superficial spreading melanoma, which, as you probably regular maintenance. Annoyed by the “weight creep” know, can be one of the deadliest forms of cancer.

brought on by sloppy eating habits and a mostly Surgery removed a lot of the muscle mass under my left sedentary lifestyle, I am using technology to establish wrist along with the cancer, but I was lucky. By detecting new habits and better overall health. I now wear a and dealing with it at a very early stage, my cancer was tiny, belt-mounted device that not only tracks steps, cured, and regular (and I do mean regular!) visits to the stairs, activity, and estimated calorie burn, but also dermatologist have happily shown no recurrence.

wirelessly reports that information to a companion By now you might be wondering about the app installed on my smartphone, tablet, and desktop seemingly unrelated photo that accompanies this computer. This level of awareness has made an article. Taken a dozen years ago, it shows me in a favorite enormous difference both in what I do, and what I spot — the left seat of a C-141C. Seated to my right was don’t do. For instance, I have built a lot more walking my friend and fellow pilot, Lt. Col. Matt Harlan, who had into my day. And knowing that I have to track what just succeeded me as Chief of Standards and Evaluation I eat helps me avoid the kind of mindless snacking at a time when many of our aircraft had been upgraded that was making my clothing shrink. I can already from “steam gauges” to glass panels. We posed this see improvements and, if only because being healthy “ostrich maneuver” picture to illustrate the danger of will keep me flying longer, I am firmly committed to allowing all-heads-down programming.

my new habits.

Tragically, Matt got his own melanoma diagnosis just three years later. Unlike mine, his cancer was not Small Signs, Big Problems detected in time for effective treatment. He succumbed Regular visits to the doctor are another important to this insidious disease, leaving behind his wife, two part of keeping your flying physiology in top form. One daughters, and a host of grieving friends and colleagues.

of the earliest skills that we learn as pilots is to recognize In honor and memory of my too-soon-departed and address small signs (e.g., why is that gauge reading friend Matt Harlan, I want to encourage you to low?) before they become big problems (e.g., my engine remember that health is hugely important to pilots, but, just quit!).

more fundamentally, health is life. You owe it to yourself, Nearly 20 years ago, I learned first-hand how the your family, and your friends to cherish and protect it small-signs/big-problems equation also applies to every day.

human physiology. With the strong encouragement of January/February 2013 FAA Safety Briefing 1

Aviation News Roundup

A T I S

AOPA/EAA Medical Exemption Update New Improvements to Lockheed Martin The FAA’s Aviation Safety organization is Flight Services reviewing over 16,000 public comments to a recent Lockheed Martin Flight Services (LMFS) petition for exemption from the Aircraft Owners and recently unveiled two new tools designed to enhance Pilots Association and the Experimental Aircraft safety and convenience for pilots who use LMFS Association. AOPA and EAA (petitioning collectively to file flight plans: a new Pilot Web Portal and the on March 22, 2012) request relief for their members Adverse Condition Alerting Service (ACAS).

from some of the FAA’s medical certification The Pilot Web Portal, accessible through AFSS.com, requirements. If the FAA granted AOPA/EAA’s allows pilots to file flight plans directly with LMFS petition for exemption, pilots holding recreational, and retrieve the same briefing information and private, commercial, and ATP certificates would weather graphics provided to LMFS specialists. It be able to fly (with specific limitations) in many also allows pilots to add profiles based on the aircraft GA aircraft using a medical self-assessment and routes they typically fly. The Pilot Web Portal is process that would replace the third-class medical in the beta development stage and will continue to certificate currently required in 14 CFR part 61 of the evolve with new features.

regulations.

Pilots who register online and opt-in for ACAS Although the extended comment period for via the Pilot Web Portal will receive alerts of new the petition closed on September 14, 2012, you can adverse conditions specific to their filed flight plans review the petition from AOPA/EAA and all the via text, email, and Iridium satellite devices. This comments at regulations.gov, docket number FAA- can prove extremely helpful, especially with pop- 2012-0350.

up TFRs or last-minute weather changes. The alerts prompt pilots to call or radio LMFS to receive an General Aviation Pride on Display at abbreviated briefing addressing the new adverse condition.

AOPA Summit “We know pilots may miss safety-critical Balmy weather and a star-studded lineup information between verbal LMFS briefings,” says of aviation presenters set the stage for another Director of Lockheed Martin Flight Services Jim Derr.

successful Aircraft Owners and Pilots Association “Our new alerting service and Pilot Web Portal keep (AOPA) Summit held last October in Palm Springs, pilots up to date between voice communications Calif. The 2012 Summit included 100-plus hours with LMFS.” of safety seminars and workshops, more than 400 booths displaying the latest pilot gear and gadgets, New Changes Improve FAASafety.gov and a host of exciting keynote speakers including FAA Acting Administrator Michael Huerta and actor/ Experience pilot Harrison Ford. The event also featured the Last fall, the FAASTeam unveiled several new popular Parade of Planes where dozens of aircraft updates to FAASafety.gov to improve functionality taxied from the Palm Springs International Airport and user-friendliness. Several of the changes correct and then lined the streets outside the Convention bugs and browser display issues as well as help Center for the three-day event.

simplify certain tasks. For example, the online course Next year’s AOPA Summit is in Fort Worth, page has been redesigned, making it easier for you Texas, October 10–12, 2013. More information on the to use the course catalog and find any courses either event should be available in January at www.aopa.

in progress or completed. Employers using the AMT org/summit/ .

Awards Program can now use a new bulk upload 2 FAA Safety Briefing January/February 2013 14 Code of Federal Regulations (14 CFR) part 23 contains the certification requirements for small airplanes (up to a gross weight of 19,000 pounds). The regulation has not had a complete review in over 25 years.

“Since safety-enabling technology is advancing at such a rapid pace, the time is perfect to reorganize part 23 to be ready for those technologies 20 to 25 years in the future,” says Pat Mullen, the Standards Office Manager for SAD.

Today, part 23 regulations are a mix of safety Photo by Tom Hoffmann requirements and methods of compliance, and can be very prescriptive in nature. The FAA plans to rewrite part From R to L Craig Fuller, Harrison Ford, Tom Haines, and 23 such that the regulations are performance-based and Robert Goyer discuss GA issues at AOPA Summit.

focus strictly on the safety requirements.

Some methods of compliance will be moved into tool to upload annual training hours for all their an industry design standard, affording the FAA greater employees at one time. Also, AMTs with Inspection agility to address new technologies in the future without Authorization (IA) who use online courses at the burden of crafting new rule language. “This enables FAASafety.gov for credit toward IA refresher training the cost-effective installation of safety enhancing will now see course and credit hour information technology, with a subsequent positive impact on GA displayed on their completion certificates.

safety,” says Mullen.

Another new feature is the addition of Really The success of the ARC, which is well on its way of Simple Syndication (RSS) feeds for certain pages on achieving greater global harmonization for part 23, is a FAASafety.gov. The RSS Feed page is located under direct result of the collaboration between FAA, industry the Resources tab from the main page.

partners, and several foreign civil aviation authorities.

Go to www.faasafety.gov/files/notices/2012/ At press time, the FAA believes a substantial framework Oct/2012-10-31.pdf for more information on these for the future part 23 will be complete by January 2013.

updates.

An ASTM International committee was also launched in October 2012 to develop standards in support of the FAA Safety Briefing Offers New rulemaking effort.

E-Reader Files An easy-to-read version of our magazine is now available as an option for viewing through an Corrections e-reader device. Unlike downloading a PDF file, the e-reader formats the text according to device settings • In the article “Real Learning Through Flight Simulation” from the September/ and allows bookmarking and highlighting text.

To view on the Kindle, save the .mobi file to your October 2012 FAA Safety Briefing , we computer and drop it indicated on page eight that you could into your Amazon store accomplish an Instrument Proficiency Check (IPC) in a Basic Aviation Training folder. To view on an Apple iOS device, either Device. The IPC is, in fact, not allowed to save and drop the .epub be accomplished in a BATD.

file into iTunes, or click • In the article “A License to Skill” from the the online link and open November/December 2012 FAA Safety using the iBooks app.

Briefing , the statement “Currently there To view on an Android are 145,000 FAA-certified AMTs in the device, click the online U.S. If you do the math, this means there link and open using a are approximately 1½ AMTs available third-party e-reader app.

for every GA aircraft out there,” should actually have read, “If you do the math, Update on Part 23 Reorganization Effort this means there are approximately 1½ GA aircraft out there for each available The FAA’s Small Airplane Directorate (SAD) AMT.” launched the Part 23 Reorganization Aviation Our apologies for the errors and any Rulemaking Committee (ARC) in November 2011 to confusion they might have caused.

improve the safety of the general aviation fleet and reduce the cost of certification. For those unfamiliar, Title January/February 2013 FAA Safety Briefing 3 By S A B r i n A Wood S

Preventing DUI in the Sky

• A pilot departs into night instrument in an article? The answer was recreational drug and meteorological conditions and crashes. The alcohol abuse, and the above snippets from various accident site reveals a half empty bourbon accident reports show they have cause for concern.

bottle in the pilot’s pocket. Toxicological testing Flying Under the Influence reveals that the pilot’s blood alcohol content Your ability to process information is divided (BAC) was .11 percent.

into three stages: stimulus identification (seeing a • An airplane collides with a dirt berm during hazard), response selection (deciding to avoid the an aborted landing, killing the pilot and two hazard), and response execution (veering to avoid passengers. A bartender reports that prior to the hazard). Driving a car involves a complicated the accident, she served the pilot four alcoholic mix of all three. Flying, while exhilarating, is an even beverages, though he never seemed intoxicated.

more precise, demanding, and unforgiving endeavor.

At the time of the accident, the pilot’s BAC was at Any factor that impairs your ability to perform the .30 percent.

required tasks during the operation of an aircraft • Witnesses watch as an airplane doing aerobatics is an invitation for disaster. Alcohol, recreational goes straight up in the air, rolls over into a dive, drugs, and even some prescription drugs, are perfect and impacts the ground. The sheriff reports examples of just such a factor.

that the cockpit smelled strongly of alcohol and While this problem has been highlighted in toxicology tests identify the pilot’s BAC as .22 commercial aviation, it is not as well documented in percent.

the world of general aviation, where a pilot can step • A student pilot impacts mountainous terrain into a plane and fly with little to no interaction with while on an unauthorized cross-country night other people. There are no outside deterrents to help flight. Toxicological testing reveals that the pilot screen a person’s sobriety, thus data collection is had been using cocaine and two prescription encumbered unless a mishap occurs.

narcotics prior to flight.

“But I Don’t Feel Drunk” While researching topics for this medically- Fitness to fly goes far beyond making sure you focused edition of the FAA Safety Briefing , I put a have enough gas in the tank or favorable weather.

question to our aerospace doctors and physiologists It means thoroughly assessing your capability to — what topic would they most like to see us address 4 FAA Safety Briefing January/February 2013 reliably demonstrated. Some drugs linger in the body for a period of days or weeks, so just don’t do it!

When considering how alcohol affects you, at a .05 BAC, most people begin to feel warm, sedated, and may experience a slight decrease in reaction time and If you would like additional fine-muscle coordination.

training or someone to talk to your Between .07 and .09, there is organization/class about the effects usually a noticeable speech of drinking and flying, contact impairment. Balance, motor the Civil Air Patrol Drug Demand skills, hearing, and vision are Reduction team: also greatly impaired. At .12, mental faculties and judgment ddr@capnhq.gov are hampered. Over .14, and 877-227-9142 ext. 412 there is major loss of mental and physical control. A level of .30 or higher is classified as severe intoxication, and the potential for loss of consciousness is high.

Self-Assessment Time Don’t know if you have a problem? You owe it to yourself and to the flying community to find out.

Many websites offer quizzes to try and determine Photo courtesy of Civil Air Patrol your level of consumption, but one good one is www.alcoholscreening.org . This website lets The Civil Air Patrol demonstrates the effects of alcohol you anonymously click through straightforward through the use of “drunk goggles” during airshows as questions and then offers guidance based on your part of its Drug Demand Reduction program. Pilots are honest answers. Dr. Nicholas Lomangino, Deputy encouraged to test their reflexes and abilities through Manager for FAA’s Medical Services Division, various games and simulations.

recommends taking the self-assessment, even if you don’t think you have a problem. You just might be negotiate a safe flight. This includes recognizing the surprised with the results and regardless, the site Bloody Mary you had at breakfast, or even the few provides good data to consider for the future.

martinis you had with dinner the night before, could legally and physically impair you from flying, even if you don’t “feel” drunk. The real problem is that Sabrina Woods is an assistant editor for the FAA Safety Briefing . She spent 12 years in the active duty Air Force where she served as an aircraft mainte- quite often people just don’t realize that they have a nance officer and an aviation mishap investigator.

problem.

There are three things you need to know to help determine your level of alcohol consumption: how to count a standard drink, how alcohol affects your body, and the effects alcohol has on your behavior.

For a reference, a standard drink is equal to one 12-ounce beer, 1.5 ounces of liquor, or 5 ounces of standard wine. Be warned: Many mixed drinks (e.g., Long Island Iced Tea) give you far more than just one “drink” in your glass.

To factor your BAC, use Figure 1. Keep in mind that the legal limit for intoxication is .08, and that the use of alcohol and drugs by pilots is regulated by 14 CFR section 91.17, which states that no person Learn More may operate an aircraft within eight hours of having consumed alcohol, while under the influence of FAA Pilot Safety Brochure on alcohol and flying alcohol, or with a BAC of .04 or greater. www.faa.gov/pilots/safety/pilotsafetybrochures/media/alcohol.

pdf f As for illicit recreational drugs, there is no agreed-upon limit for which impairment has been January/February 2013 FAA Safety Briefing 5 F r e de r ick e . T i l T on, m . d .

fa a f eder a l a ir s u rgeon

FAA Safety Briefing is available as an annual

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Ask Medical Certification

required to have special issuance physicals. I, on the

Q: What is required before and at your next

other hand, have no prostate cancer. So why must physical after having a kidney stone pass? My doctor I, and others like me, be required to continue on says I have no more stones and no further signs of special issuance physicals?

any kidney stones.

A: Your point about the frequency of prostate

A: The airman needs to provide a current status

cancer is well made and recognized. Nevertheless, report from the physician who treated the kidney there is still some potential for aeromedical concern stones and a report of a radiographic image that with prostate cancer. Our current policy for prostate documents there are no residual stones. Repeat cancer is that if the condition is early and well taken episodes of kidney stones should also have an care of, as your case appears to be, the FAA only additional evaluation that assesses if there is a requires that the condition be followed for two years.

treatable cause. All this information should be taken In the near future, we anticipate delegating the to the AME.

requirement for the aeromedical assessment and

Q: Due to chronic diseases — Crohn’s Disease and

follow-up of early, uncomplicated prostate cancer hypertension — I am required to submit reports to the Aviation Medical Examiner (AME). This will from my doctors attesting to my continued ability to include the initial presentation of the disease and fly safely. My medical certificate was due to expire will greatly expedite medical certificates for airmen on August 31, so I sent in the reports over a month with prostate cancer.

before the expiration date, but that date has lapsed

Q: Will my medical status be affected if I decide to

and I have yet to receive a response due to backlog.

start medicine to aid in treating erectile dysfunction?

Rather than wait for the FAA doctor and being that And are there any specific medicines that are already my AME is familiar with my medical history, why on the FAAs “no-go” list or are there any side effects can’t she review my reports and issue my medical I should be aware of that might prohibit me from certificate, pending a review by FAA doctors?

flying? Right now I have a third-class medical that

A: The FAA is in agreement with you. We are in the

doesn’t come up for renewal until April 2013. Would process of changing this policy to exactly what you I have to get a special issuance?

propose. Look for something to happen on this in

A: There are a number of medications that are

early 2013. There are a number of other conditions currently allowable for erectile dysfunction that do that will be on this list. We are establishing specific not require special issuance. Some, however, do parameters for the diseases, but if those conditions require a “no fly after use for XX hours.” The latter are met, the AME will be able to go ahead and issue include the popular phosphodiesterase 5 inhibitors: your medical certificates.

sildenafil, vardenafil, and tadalafil. The no-fly

Q: I had successful prostate removal in December

time depends on the half-life of the medications.

2007. I was issued a special issuance with a yearly Tadalafil for daily use is not allowed. Alprostadil and requirement for a letter from “my treating physician Papaverine for self-injection are allowable. Your regarding my history of prostate cancer. …” My PSA AME can help guide you as to the requirements for has been zero and hopefully will be next month these medications.

when I get my fifth annual checkup. Two years ago my surgeon said that there was no need for me to take up office time if my annual PSA checks Dr. Courtney Scott is the Manager of the Aerospace Medical Certification remained zero. Eighty percent of men over 80 years Division in Oklahoma City, Okla. He is board certified in aerospace medicine and has extensive practice experience in civilian, and both military and non- of age have cancer cells in their prostates. Of that military government settings.

group, those who are pilots have prostate cancer by definition — but have not been diagnosed — are not 8 FAA Safety Briefing January/February 2013 By Tom h o F F m A n n

for

AMEing

Excellence

The Making of an

Aviation Medical Examiner

Pop Quiz: I am a private physician designated The aviation industry has a knack for rapidly and authorized to perform flight physical developing technology, with today’s pilots being examinations and issue airman medical certificates exposed to higher, faster, and more complex to qualified applicants. Who am I? environments. As a result, the role of an AME has Ok, I know, easy question. But ask yourself this: evolved, yet it remains a stable element in helping how much do you really know about your Aviation ensure safe skies. Keeping pace requires AMEs Medical Examiner (AME)? For example, do you know to stay attuned to changes from both the medical what it takes to become an AME? How about the arena and the aviation industry. Whether it’s type of training they receive? And how does the FAA understanding how a certain new drug may interact ensure AMEs are kept in the loop with procedure and with the rigors of IMC flight, or how an airman’s regulation changes as well as advances in aerospace history of surgical procedures could impact his or medicine? There’s a whole lot more than meets the her ability to aviate safely on a long cross-country, eye when it comes to being an AME. So allow me there are myriad ways these two worlds can interact, to offer a behind-the-scenes look that will help you too often with deadly consequences.

appreciate the service they provide.

The Support Staff The Background AMEs are not alone, however. Standing staunchly Although military flight surgeons have been behind them in support is a cadre of FAA employees around since the WWI era, it wasn’t until 1927 dedicated to education and safety outreach — the that the Aeronautics Branch of the Department FAA’s Aerospace Medical Education Division (AMED) of Commerce first designated qualified private in Oklahoma City, Okla.

physicians to perform airman medical examinations “It’s a small group, but we do a lot with regards and issue medical certificates. Today, there are to helping support, educate, and mentor AMEs,” says approximately 3,400 active AMEs, many of whom are Dr. Brian Pinkston, manager of the division. “Among family practitioners with a keen interest in aviation our responsibilities is to provide quality assurance for safety. AMEs from day one.” Pinkston’s team accomplishes January/February 2013 FAA Safety Briefing 9 that in a number of ways, including overseeing the education of AMEs on aerospace medicine topics, authoring designee management policy, and issuing annual report cards that monitor the quality of their airman medical applications.

To accomplish all these tasks, the AMED group relies greatly on the assistance of the Regional Flight Surgeon (RFS) offices across the country. “We couldn’t do it without the work of RFS, who executes the program on a daily basis. The RFS interacts directly with AMEs and provides interaction at a regional level,” says Pinkston.

AMED also maintains a library of education materials and articles to support AMEs as well as FAA policy-makers and researchers. In addition, the group produces pilot education materials — you’ve probably come across one of their many pilot safety brochures at an airshow or seminar. One of AMED’s more interesting responsibilities with regard to pilot education involves oversight of an aviation physiology training course (using an altitude chamber) and a one- day post-crash survival training course, both of which are available to the public. (For more information, see www.faa.gov/pilots/training/airman_education/) The Qualifications “Becoming an AME involves several steps,” says Pinkston. “First, all AME applicants must meet certain criteria for designation, including being a

Searching for the Right AME

By Tom h o F F m A n n Whether you’re moving to a new city, or just started your flight training, there are many instances throughout your aviation career when you may find yourself on the hunt for an AME. That can be a daunting experience, especially if you’re concerned about having to re-explain a few complicated medical issues from your history.

they have experience with A good place to start your search for an AME is the FAA’s special issuance cases, and what type of online AME Locator tool at www.faa.gov/pilots/amelocator. In connection they have to aviation (pilot, flight surgeon, etc.) You’ll addition to opening a master AME list (updated weekly), you can want to look for AMEs that are happy with their job and who also use the site to search by country, county, city, ZIP code, and display an interest in the passion pilots have for flying.” last name. And soon, a new improvement to the site will provide The search for a good AME doesn’t have to stop after a geographic layout of nearby AMEs based on a given city and your first appointment either. “Apply the same criteria you set ZIP code.

for choosing a family doctor during your exam to reassess your However, knowing the names and locations of AMEs in decision,” says Hastings. Did the AME and his/her support staff your area is only part of the challenge. “The best way to find a act professional? Did the AME show an interest in you as a good AME is by local word of mouth,” says Dr. John Hastings, a person and a pilot? Even a clean and comfortable office environ- senior neurological consultant to the FAA and former president ment can make a big difference.

of the Aerospace Medical Association. “I recommend finding a “A personal connection is key,” says Hastings. “The pilot or pilot organization in your area and ask which AMEs go the relationship you have with your AME has many of the same extra mile for pilots.” important ingredients that should exist with your own family Hastings, a 36-year AME, also suggests contacting an doctor.” AME’s office directly. “Ask how long they have been an AME, if 10 FAA Safety Briefing January/February 2013 qualified physician in good standing, and having a record that reflects professional performance.

“There must also be a need for an AME in the location in which they plan to practice,” says Pinkston. Physicians who express an interest in becoming an AME are asked to contact their RFS, who will then determine if there is a need for that area. If there is, the AME applicant will be directed to submit an application and provide any required credentials or documents (e.g., diplomas, licenses).

When being considered as an AME, applicants

alling

must also agree to comply with all policies and procedures as required by the FAA. This includes being familiar with aerospace medicine principles,

All

exam techniques, medical assessments, and airman certification. AMEs are also expected to maintain

Mechanics

an office address approved by the RFS and have the facilities necessary to perform the required medical exams. Required equipment for AMEs includes select diagnostic instruments, vision and audio

Keep Informed with

testing devices, and electrocardiogram machines for those providing first-class medicals. The Guide

FAA’s Aviation

for Aviation Medical Examiners (search www.faa.

Maintenance Alerts

gov) contains a full description of AME equipment requirements. And, for a more complete list of Aviation Maintenance Alerts (Advisory Circular overall AME qualifications, reference FAA Order 43.16A) provide a communication channel to share 8520.2G.

information on aviation service experiences.

The Training Prepared monthly, they are based on information Once an AME applicant has been accepted, FAA receives from people who operate and he or she will need to begin training. Initially, it’s maintain civil aeronautical products.

a three-part process starting with two distance learning courses: Medical Certification Standards The Alerts , which provide notice of conditions and Procedures Training (MCSPT) and the Clinical reported via a Malfunction or Defect Report or a Aerospace Physiology Review for AMEs (CAPAME).

Service Difficulty Report, help improve aeronautical Upon completion of those courses, the AME will product durability, reliability, and safety.

attend the third part of the training, a one-week Basic AME Seminar, which is offered three times a Recent Alerts cover: year at the FAA’s Civil Aerospace Medical Institute • Cracked isolator mounts on the (CAMI).

Air Tractor AT301 “The Basic Seminar allows AMEs to learn about • Cracked main gear on the Cessna 402C, airman physiology and environmental factors 414A, and 421C unique to pilots, as well as the specific FAA rules • Cracked cylinder head on Continental for aeromedical decision-making,” says Pinkston.

IO-550-N25 engine “In addition to medical didactics, the physiology course taught by CAMI exposes AMEs firsthand to the effects of hypoxia, night vision, and spatial Check out Aviation Maintenance Alerts at: disorientation — all subjects not generally taught in http://www.faa.gov/aircraft/safety/alerts/ traditional medical school programs. And although aviation_maintenance/ some AMEs are pilots with experience in these areas, many are learning this for the first time.” To stay active as an AME, refresher training is required every three years. AMEs can choose to attend a live FAA seminar or take the Multimedia Aviation Medical Examiner Refresher Course (MAMERC). However, AMEs are required to attend January/February 2013 FAA Safety Briefing 11 AMEs use simulators during training to experience first-hand the effects of spatial disorientation in flight.

a live seminar at least once every six years. The However, the FAA prefers to take a more seminars are offered several times a year at various proactive approach to oversight in order to head off locations. Training is also highly recommended any potential problem areas. AMED works regularly for any members of an AME’s staff that assist with with the RFS offices to provide performance reports, processing of medical certificates. share stakeholder feedback, and coordinate site visits to AME offices, especially for those who are newly The Responsibilities designated. The national site visit goal is to survey Once officially designated, an AME assumes every AME’s office at least once every five years, via several important responsibilities with regard to virtual site visits if necessary.

aviation safety. In addition to abiding by the ethical The Mission and operational standards set by the FAA and ensuring that medical certificates are issued only to As you can see, the role of an AME is rather those that meet the required standards, AMEs also complex. The challenges are many and the tolerance take on the role of being aviation safety advocates in for error is slim to none. There’s no doubt that the their communities and among the airmen they work efforts and skills of these men and women, ensuring with. Some are involved with delivering lectures and our fitness to fly on a daily basis, contribute directly to safety seminars on aeromedical topics, while others the success and safety of our national airspace system.

offer their assistance in the investigation of general aviation accidents.

Tom Hoffmann is the managing editor of the FAA Safety Briefing. He is a Although they are not FAA employees, AMEs commercial pilot and holds an A&P certificate are designees, which means they have been granted the authority to act as representatives of the FAA Learn More Administrator to help carry out the agency’s safety mission. But with such responsibility also comes Guide for AMEs accountability.

www.faa.gov/about/office_org/headquarters_offices/avs/ “We take monitoring the performance of offices/aam/ame/guide/ AMEs very seriously,” says Pinkston. “If we receive AME Training Requirements complaints or notice an increase of errors or www.faa.gov/other_visit/aviation_industry/ incomplete applications, we will coordinate with the designees_delegations/designee_types/ame/ametraining/ RFS and investigate the issue.” Failure to correct issues FAA Order 8520.2G such as careless or incomplete reporting, disregard for http://www.faa.gov/other_visit/aviation_industry/designees_ delegations/designee_types/ame/media/8520.2G.pdf FAA rules, or unprofessional behavior, could result in a suspension or termination of an AME’s designation.

12 FAA Safety Briefing January/February 2013

Fast-track Your

Medical Certificate

With FAA MedXPress, you can get your

medical certificate faster than ever before.

Here’s how: Before your appointment with your Aviation Medical Examiner (AME) simply go online to FAA MedXPress at https://medxpress.faa.gov/ and electronically complete FAA Form 8500-8. Information entered into MedXPress is immediately transmitted to the FAA and forwarded to your AME before your medical examination.

With this online form you can complete FAA Form 8500-8 in the privacy and comfort of your home and submit it before scheduling your appointment.

The service is free and can be found at:

https://medxpress.faa.gov/

Flying for an airline may require either a second or first class medical certificate.

The Right Stuff

What Kind of Medical Must I Hold?

By jA m e S W i l l i A m S

ou have probably seen or heard about the kind of “right stuff” physical

Y perfection required of early astronauts and, for that matter, the earliest

aviators obliged to obtain a medical certificate. In both cases, the standards

were such that many of today’s active airmen might have never passed the

exam.

14 FAA Safety Briefing January/February 2013 Fortunately, things are different now. The standards recognize that few of us are perfect physical specimens, and they also recognize that the level of certification required for personal recreational flying is different from that needed to command a large passenger airliner. Flexibility is good, but the range of available options can sometimes raise questions. A frequent query in the FAA Safety Briefing mailbox is some version of: “I have X condition and so I can only qualify for a third-class medical. Can I still get a flight instructor certificate?” A related area of confusion arises from the medical differences between holding a given pilot or instructor certificate and exercising the privileges of that certificate. Let’s take a look.

First Things First To take a practical test for your airline transport pilot (ATP) certificate, you only need a third-class medical. But if you want to exercise the privileges of the ATP certificate, you need to hold a first-class medical certificate. The same concept applies to acquiring a commercial certificate. You don’t need more than a third-class medical to take the practical test, but of course you will need a second- class medical if you want to exercise commercial certificate privileges. There are some nuances involved in exercising the privileges of a flight Being a flight instructor may not require a medical at instructor certificate, but we’ll come back to that all, but it might depending on the situation and the later on.

student.

So what level of medical certificate should you seek? Some experts and organizations advise Now let’s get back to the question raised at the pilots to seek only the level of medical certification beginning with respect to exercising the privileges required for the level of privileges they intend to of a flight instructor certificate. We’ve already exercise. Even if you have an ATP certificate that established that, assuming you pass the practical you have acquired for personal development, or test, all you need to earn the flight instructor maybe for insurance reasons, you may not need to certificate is a third-class medical. But what if you hold more than a third-class medical certificate for have a medical condition that limits you to that the kind of flying you actually do (e.g., private pilot level of medical certificate? Can you still exercise privileges). the privileges of a flight instructor certificate, which If you intend to fly professionally, though, it’s a is valid only with the individual’s commercial pilot good idea to apply at least once for a first- or second- certificate?

class medical. It makes sense to know up front if you The short answer is yes. The longer answer has can qualify for that level of medical certificate. Better nuances. Let’s look at both.

to discover a problem at the beginning rather than A pilot may exercise the privileges of a flight invest (literally) the time and resources needed for instructor certificate, act as pilot in command, and/ commercial or ATP certificates and then learn that or serve as required pilot flight crew member with no you will never be medically qualified to exercise more than a third-class medical certificate. And if the those privileges.

flight instructor is not acting as pilot in command, 14 CFR section 61.23(b)(5) states that he or she does not Who’s on Third?

need a medical at any level. Why the exception, since You might think of the third-class medical as the flight instructor is presumably being paid? The the foundational medical certification level and, for FAA determined that flight instructors may be paid most purposes, it is. Unless you are flying as a sport for their work without at least a second-class medical pilot (more on that later), you need at least a third- because they are being paid for their instruction, and class medical.

not specifically for piloting the aircraft.

January/February 2013 FAA Safety Briefing 15 No Medical, No Problem So are there things you can do without a medical certificate? Absolutely. As I have just explained, a flight instructor who is not acting as pilot in command can instruct without holding any kind of medical certificate. For instance, you could conduct proficiency training or a flight review for a certificated pilot who is rated in the airplane and current (i.e., current flight review).

There are other activities that do not require a medical. The regulations (14 CFR section 61.23(b)) list several operations not requiring a medical certificate. These include operating a glider or balloon.

As you probably know, a person exercising the privileges of a sport pilot certificate does not require a conventional medical certificate. This function is addressed in 14 CFR section 61.23(c), “operations requiring either a medical certificate or U.S. driver’s license.” This provision outlines the requirements and restrictions a sport pilot must observe when flying on the so-called driver’s license medical. For instance, a pilot using his or her driver’s license must comply with any restrictions placed on that license.

What medical certificate is required to take a And, if the pilot has ever applied for a medical practical test?

certificate, that pilot must have been found eligible for the issuance of at least a third-class medical A word to the wise, however: Some operators certificate at the time of the most recent application.

or insurance companies may still require a second- The driver’s license medical provision is similarly class medical even if the FAA does not. In addition, unavailable if the pilot’s medical certificate has been a flight instructor with anything less than a second- suspended or revoked, or if the FAA has withdrawn class medical must be mindful of potential regulatory the most recent special issuance. And, as with any minefields.

kind of medical certificate, the pilot cannot know or “It’s easy to find yourself on the wrong side of that have reason to know of any medical condition that issue,” Aviation Safety Inspector and Airman Training would render him or her unable to safely operate a and Certification Branch Manager Jeffrey Smith told light sport aircraft.

us. “Let’s say you’re working for a flight school and they As you can see just from this short summary, pay you to operate an today’s pilots have a great many more medical aircraft for something certification options than our flying forbears The medical standards recognize other than flight enjoyed. Use them; enjoy them; and fly safely!

that few of us are perfect physical instruction. Can you do that?” Smith explains that specimens, and they also recognize James Williams is FAA Safety Briefing’s associate editor and photo editor.

the answer may be no.

that the level of certification He is also a pilot and ground instructor.

“Depending on the flight, required for personal recreational you’d be conducting a flying is different from that needed commercial operation to command a large passenger that would require a airliner.

second-class medical.” Smith continued, “These pop-up requests could create a problem for a CFI with only a third-class medical.

If that’s your situation, it’s a good idea to have a talk with your local FSDO to be sure you understand the limitations on your operations with a third-class medical. Your employer might not realize those limitations when he or she asks you to do something, so it’s important for you to be knowledgeable.” 16 FAA Safety Briefing January/February 2013 By P A u l c i A nciol o Photo courtesy of Able Flight

Flying with Disabilities

You don’t have to be able to walk to take had an FAA medical exam that resulted in denial or wing and fly! As long as it is safe to do so, the FAA deferral. In this case, you need to “clear” the issue encourages everyone to experience the thrill and first by getting at least a third class medical; you can excitement of learning to fly. later allow it to expire and use the driver’s license Through sport pilot certification, people who use medical option.

wheelchairs due to spinal cord injury or loss of limbs Disabled pilots who seek a private pilot (or have the opportunity to earn their wings. Medically higher) certificate may also have the option to seek a speaking, all that’s needed is a valid and current state standard medical certificate issued with a Statement driver’s license. Pilots must follow any restrictions of Demonstrated Ability (SODA), which can include or limitations set for driving while using the driver’s aircraft and other types of restrictions.

license as a basis for flying. As you know, the driver’s Pictured to the left is a hand control system with license medical is an option only if you have not a stick for the rudder and integration of an additional brake handle, which can be installed in many light- sport aircraft. Specially modified aircraft allow people with disabilities to safely fly.

Pictured above is pilot Brad Jones, who earned his sport license in 2007 through Able Flight. Able Flight, online at ableflight.org, is a national non- profit organization that grants scholarships for flight and aviation career training to people with physical disabilities.

Paul Cianciolo is an assistant editor and the social media lead for FAA Safety Briefing. He is a U.S. Air Force veteran, and a rated aircrew member and Photo courtesy of Flight Design USA search and rescue team leader with the Civil Air Patrol.

January/February 2013 FAA Safety Briefing 17 18 FAA Safety Briefing January/February 2013 January/February 2013 FAA Safety Briefing 19 By Tom h o F F m A n n

Learn How to Fast-Track Your

Airman Medical Certificate

ho doesn’t love a shortcut? These days, electronic toll systems let you

breeze past miles of traffic. Smartphone-purchased movie tickets

W enable a beeline to the popcorn line. Even Disney World has perfected

the art of bypassing dreadfully long queues with their FASTPASS® system.

Evolving technology has certainly helped in facilitating these time, and money

(and sanity) savers which are finding their way into more and more segments

of business and society. Realizing the potential for improved cost-savings,

convenience, and accuracy, the FAA is also an avid proponent of leveraging

technology to improve efficiency in many of its tasks.

20 FAA Safety Briefing January/February 2013 A good example is the FAA’s MedXPress system for handling airman medical certification applications. Although hardly new, the system recently became a required means of obtaining a pilot medical certificate. As of October 1, 2012, the FAA said good-bye to the paper application and has embraced the online system as the sole means of obtaining an airman medical. However, with an average of less than 40 percent of airman medical applications being submitted via MedXpress the year prior to the new requirement, there are still quite a few pilots who will need to make the transition in the near future.

The good news is MedXPress is easy to use.

And you don’t have to take my word for how simple it is. Just ask anyone who’s used the system. In fact, before I began writing this article, I polled a few of my pilot friends to see how they felt about MedXPress. Those who had used it gave it an overwhelming thumbs up. Others — as I suspect and free-fill text boxes in the same order as the some of you who are reading this now — were questions from the old paper form. Once you get unfamiliar, but eager to learn, especially when it past all the standard background and demographic means less time in the doctor’s office!

bits, you’ll be asked for specifics on your medical history, beginning with what types of medication you First Step – Set Up an Account currently use.

For those brand new to MedXPress, your first According to Dr. Judith Frazier, a medical step is to set up an account. From the home page of officer with FAA Office of Aerospace Medicine’s MedXPress (https://medxpress.faa.gov/), find the Certification Division, this is one area that tends to Request Account link in the upper left corner. Click get some applicants hung up. “Be sure to specifically the link, and then enter your name, email address, list the dosage and frequency of all medications and three security questions. You’ll also be asked to you are taking,” says Frazier. “If the amount or acknowledge the Terms of Service Agreement and frequency options available on the form do not Pilot’s Bill of Rights Notification before hitting the match your personal usage, you’ll need to provide submit button (as well as any other time you log in, an explanation.” In cases like this, you can write in for that matter). Ideally, it should only take a few the explanation with the Add Comment button at the minutes for you to receive a confirmation message end of Question 18.

to the email address you supplied. If not, give it a Another consideration when entering a couple hours before making an inquiry.

medication is to make sure you use its specific Write down (or right-click and copy) the name, and not just the category it pertains to, (e.g., temporary password you receive from your beta-blockers or blood thinners). If you’re unsure confirmation email message and click the link of the spelling, MedXPress can help. It will verify that will enable you to log in and complete your the name of your medication (generic or name- registration. After entering your temporary brand) with a built-in dictionary. Even if it is not password, you will be asked to create a new an accepted drug, the system should find it. And password before continuing. Be sure you read and if for some reason your medication doesn’t show consider all the number, letter, and special character up, click the Medication Not Found box. Your AME parameters for a secure password when doing so.

can always review the form with you during your appointment and make any needed adjustments 8500.8 before submitting.

That’s how many questions are on the new form.

Just kidding; it’s actually the official form number Is This Better? How About This?

for a medical certificate. Once you’re logged in Frazier also advises pilots to pay particular and ready to get started, look for the link to Form attention to question 17b regarding near-vision 8500.8 in the top left corner. The link will open an contact lenses. “The intent of this question is really electronic version of the form with a combination to identify someone who is monocular and who of checkboxes, radio buttons, drop-down menus, may be using one far- and one near-sighted contact January/February 2013 FAA Safety Briefing 21 Know Your History Next up on the form is question 18, where users will need to provide information on their medical history. You must select either yes or no for each of the items lettered a through y. These cover everything from asthma to alcohol abuse. Any yes answers under the medical history will require a comment. To do so, just click the Add Comment button under the question after you’ve completed answering every part. The system will automatically provide individual comment boxes for each item you answered with a yes. If it is something you reported during a prior medical and there has been no change since, you can click the PRNC checkbox to indicate the condition or ailment was “previously reported, no change.” Otherwise, use the provided space to date and describe the condition to the best of your ability.

If there is a condition, disability, or surgery you’ve had that is not listed in Question 18, use option x to report it. Also remember that this question is asking if there are illnesses or conditions you may have now or had in the past. Once you’ve reported something, you’ll always need to include it on your medical application. This is an important point that can be easily overlooked, but can have serious consequences later on.

Question 19 of the medical application appears the same way as the old form, but has a much easier way to input any of your health professional visits from the last three years. Use the text boxes to fill in the data regarding a visit, and then click the add button, which will populate the information into organized rows below the question. If you make a mistake or need to make a change, use the edit or delete options that correspond with each visit. It may be helpful to gather the dates and reasons for each A screen shot from FAA MedXPress, which replaced the visit ahead of time. Routine eye or dental exams paper form 8500.8 in October 2012.

need not be reported.

Finally, Question 20 of the form is simply a lens.” The use of regular contact lenses is allowed. Even consent authorization for the National Driver bifocal contacts are allowed after an adjustment period.

form. You must select yes to continue and submit the However, if you choose to wear a contact in one form.

eye that give you near vision and a contact in the other eye that gives you far vision, you must check yes to box Validating … 17b. This is considered monocular vision and is not You’re almost there. All that’s left is validating allowed; Monocular vision can cause problems with your form, which is one of the features that really depth perception which is essential when flying and help this electronic form shine. “With the old hard landing a plane. If you have had eye surgery such as copy, both airmen and AMEs could easily miss LASIK, and you have permanent monocular vision, things on their applications,” says Frazier. “That often you may need to do a Medical Flight Test (MFT) to meant we had to issue the dreaded letter requesting show you can compensate. The other alternative is to more information. Spelling mistakes or illegible wear glasses after eye surgery to correct your vision.

handwriting also were frequent culprits of delaying Reference the AME Guide for more specifics on the use an airmen medical certificate, but they have now of contact lenses.

been all but eliminated with the MedXPress system.” 22 FAA Safety Briefing January/February 2013 By hitting the Show Validation Errors button at these forms, even after you hit the submit button.

at the bottom of the form, the system will save all In the old days, the minute you start writing on the your changes and check through your application form, you have ‘sealed the deal’ and it belongs to the for any mistakes. Anything the system discovers FAA. With MedXPress, until the AME enters your will be listed along with a corresponding section confirmation number and brings the exam into the number. Typical mistakes are blank fields or missing AME system, it’s not yet an official application and explanations. Once you have corrected the errors, you can still back out.” you’re ready to send. Just remember that you can’t A Win-Win change anything on the form after submitting, so In review, MedXPress has already proven to be check that everything is correct first.

a system that is faster, more accurate, and easier for If your form has been successfully submitted, both you and your AME. So, when it’s time for your you’ll see a screen with a unique confirmation next medical, you can replace any hesitation with number. “Write down the number, because you’ll exultation as you take a ride in the XPress lane!

need it when it comes time for your medical,” says Jana Weems, a program analyst with FAA’s Aerospace Medical Certification Division. The confirmation Tom Hoffmann is the managing editor of the FAA Safety Briefing. He is a number is what verifies your identity and completes commercial pilot and holds an A&P certificate.

the electronic signature process at your exam.

Weems also suggests that airmen click on the Exam Summary button, which takes the data from the online form and populates it into a PDF version that resembles the old paper Form 8500.8. “You can save this on your computer for your personal records as well as print a copy to bring to your doctor, especially since it also contains your confirmation number,” says Weems.

Remember to ask your AME for a copy of the finished exam. This will have all of the information you put in as well as the comments from the AME to help you with your next exam.

Help and Support The MedXPress website has everything you need for help in case you get stuck. From the login page you can access the MedXPress user guide, a Q&A on system basics, and a list of contacts for technical support and login issues. If you have problems with

Timeout!

how to answer a particular question on the form, The MedXPress system is designed to automatically time out try clicking the small grey question mark in front of after 20 minutes of inactivity, so make sure you’re saving your every section. This will help give you some direction work as you go. If you’re on the Form 8500-8 screen, you’ll on what specific information the FAA is looking for.

get a warning after 15 minutes of inactivity. If no actions are If you’re still unsure about a particular question, performed within five minutes of the warning, the session will consult your AME at the time of your exam. He or time out and any unsaved information will be lost.

she will be able to make corrections to the form before it is submitted.

During a recent MedXPress information seminar, Dr. Warren Silberman, a Pilot Protection Learn More Services Consultant with AOPA, stressed a number MedXPress Video of other important considerations that need to be www.faa.gov/tv/?mediaId=554 made when using MedXPress. Among them was to MedXPress User’s Guide remember that once your information is submitted, https://medxpress.faa.gov/medxpress/Guides/ it expires and is deleted after 60 days. Silberman MedXPressUsersGuide.pdf suggests pilots schedule their medical exams within AME Guide about 30 days of submitting the application.

www.faa.gov/about/office_org/headquarters_offices/avs/ Another benefit of MedXPress, according to offices/aam/ame/guide/app_process/general/ Silberman, is that “there is no one out there looking January/February 2013 FAA Safety Briefing 23 hen I woke up the morning after undergoing By Su SA n P A r S on laser eye surgery, I was simply astonished by

W the transformation. Accustomed to the blurry

view that had greeted me every morning since my early teens, the sharply-focused clarity was a most welcome surprise. Protective goggles prevented the mistake of rubbing my eyes in disbelief, but I blinked several times to be sure the new view was not some trick of my early-morning imagination.

Hindsight being 20/20, it’s easy now to wonder why I waited so long. Plenty of my non-flying friends have asked that very question, but my pilot pals all understand the hesitation. As we all know, the FAA can (and does) certificate pilots with a wide range of physical limitations. Sight, however, is one of the few “no go” items for FAA medical certification. So I thought long and hard about a procedure that — as the eye doctor put it — is “very safe, but not risk free.” And I did a lot of research, not only about the procedure itself, but also about the FAA’s approval and reporting requirements.

Reflections on Refraction A common cause of visual deficit is refractive error, which prevents light rays from being brought to a single focus on the retina. The three principal types of refractive conditions are myopia, hyperopia, and astigmatism.

• Myopia (nearsightedness) is a condition in which light rays are focused in front of the retina, which makes distant objects appear fuzzy. Myopia affects about 30 percent of Americans.

• Hyperopia (farsightedness) is a condition in which light rays are focused behind the retina, making near objects look fuzzy. An estimated 40 percent of Americans are hyperopic.

• Astigmatism is caused from an irregular curvature of the cornea, which prevents light from being focused to a single image on the retina. Astigmatism can cause blurred vision at any distance, and it can occur in

addition to myopic or hyperopic conditions. The

Approximately 60 percent of the population has some degree of astigmatism.

Another cause of blurred near vision — one that I have reluctantly come to know in the past decade — is presbyopia . Presbyopia is a progressive loss

Eyes

of accommodation, which is a fancy way of saying that age-related physiological changes in the eye’s crystalline lens and associated muscle reduce its ability to focus at near distance.

Have

It

24 FAA Safety Briefing January/February 2013 intraocular lens over the natural lens of the eye. Dr.

Optical Options Harriet Lester, FAA Regional Flight Surgeon for the Until I summoned the courage to try laser eye Eastern Region, colorfully describes this procedure surgery, I spent several decades using a combination as the “double-patty hamburger” approach.

of contacts and progressive lens glasses to correct Monovision : As a convenience, some eye for my particular blend of myopia, astigmatism, and, care providers recommend correcting one eye for more recently, presbyopia. Increasingly annoyed near vision and the other for distance. This option by the hassle and discomfort of this approach and requires the individual to develop visual cues to buoyed by the unbridled “you’ll love it” enthusiasm reestablish depth perception.

of several friends and colleagues, I decided it was time to look into (ahem) surgical alternatives.

Perfection Isn’t Possible (Yet) One of the first things I learned is that there are Refractive eye surgery has come a long way, a number of options for refractive surgical correction but it is still very important to recognize that these of vision. Some of the more common procedures are: procedures involve both risks and tradeoffs. As LASIK : For a number of reasons, including Lester notes, “Today’s technology and techniques post-operative comfort, LASIK (laser in situ for refractive eye surgery are very sophisticated keratomileusis) has become the preferred choice and allow for more customization to the optics of for refractive surgery by patients and many eye care an individual eye as well as fewer errors. Still, you practitioners. To perform LASIK, the eye doctor uses have to accept that any surgical procedure involves two Food and Drug Administration (FDA) approved risks.” These can include not just immediate post- devices: the excimer laser to reshape the cornea operative effects (e.g., irritation, light sensitivity), and either the femtosecond laser or microkeratome but also longer term effects (e.g., glare, “halos” or to make the flap. A thin flap is cut from the outside “starbursts”) that many people learn to ignore. There layers of the superficial cornea, leaving it connected may also be some loss of contrast sensitivity.

by a small hinge of tissue. The excimer laser reshapes Other possible risks include worsening of dry the underlying corneal stroma (according to the eye and ectasia, which is a progressive steepening optical needs and goals), and the corneal flap is or bulging of the cornea. As Lester explains, “LASIK returned to its original position.

can lead to ectasia in some individuals who are Originally, LASIK involved creating the corneal predisposed due to thin or abnormal corneas. That’s flap with a mechanical microkeratome manipulated why pre-operative screening and counseling is so by the surgeon’s hand. The femtosecond laser important.” keratome received FDA approval in December 1999 Lester also cautions middle-aged patients to as the first blade-free technology in the United States be mindful that “refractive surgery runs into the for creating the corneal flap. The laser keratome timeline for developing cataracts. Procedures that beam passes into the cornea at a predetermined modify the cornea may need to be revised after depth, producing a precise cut that may be more eventual cataract surgery — so keep that in mind in accurate than the microkeratome. Corneal flaps your decision-making process.” made with the laser keratome appear to adhere more As for tradeoffs, Lester observes that surgical tightly to the corneal bed at the end of the procedure, correction of myopia changes the focal point from and may reduce problems with long-term flap near to distant, which affects near vision clarity. I can displacement.

attest to that. Though I knew to expect the switch, it PRK : In October 1995, the FDA approved the was still strange to find that reading glasses were the use of the excimer laser to perform a refractive price of correcting my formerly fuzzy distance vision.

procedure called photorefractive keratectomy (PRK) It wasn’t a big deal to me since I am at an age where to correct myopia, hyperopia, and astigmatism.

readers rapidly become a requirement anyway. Still, As with LASIK, the laser photoablates (vaporizes) it requires an adjustment.

the corneal tissue to a predetermined depth and To that end, Lester advises anyone considering diameter by using a series of laser pulses. Some eye refractive eye surgery to think of it in much the same care providers still prefer surface ablation because way you might approach a marital commitment: the procedure is fairly close to LASIK, but without “You have to make compromises, so make sure the risks of creating a flap. Healing does take longer you can be happy with the ones you have to make.

however, since PRK creates a total corneal ablation.

Remember that when you opt for refractive eye ICL (Implantable Collamer Lenses): ICL is surgery, you are making a permanent change in used for correction of refractive error primarily for your vision. Do as much research as you can, and individuals who are not good candidates for laser don’t be afraid to ask lots of questions when you are procedures (e.g., thin corneas, dry eye, or very discussing options with your eye care provider. You high refractive error). ICL involves implanting an January/February 2013 FAA Safety Briefing 25 also want to find a top-notch eye surgeon who is There are a few more steps to take if you opt willing to say ‘no’ if you are not a good candidate for for monovision, since this procedure results in a these procedures.” monocular vision condition for purposes of FAA medical regulations. In other words, you do not Fit for Flight meet the 14 CFR section 67.103, 67.203, and 67.303 Like any other aviator, I was eager to know requirements for near and distant vision with each how these procedures would impact FAA medical eye separately. To regain medical certification after certification. Here’s the bottom line: The FAA allows a surgical procedure, the FAA requires a six-month most FDA-approved refractive procedures, including adaptation period. If you want to fly during this LASIK, PRK, and ICL for all classes of certification.

six-month interval, you must wear eyeglasses or The FAA accepts monovision after a six-month contact lenses that correct you to meet the vision stabilization period and a successful medical flight standard in each eye. Your medical certificate will test.

state this limitation. ( Note: The FAA does not permit Now for the details.

use of monovision contact lenses (wearing one lens to The FAA requires that civil airmen with correct for distance and one to correct for near vision) .

refractive surgical procedures (e.g., PRK, LASIK) In order to have this limitation removed at discontinue flying until the eye care specialist has the end of the minimum six-month adaptation determined adequate healing, with stable vision period, you need to ask the FAA Aerospace Medical and no significant adverse effects or complications.

Certification Division to authorize a medical flight For most FAA-allowed test with your local flight standards district office refractive procedures, you (FSDO). Successful completion of the medical The FAA allows most FDA-approved may resume exercising flight test will result in the issuance of a Statement refractive procedures, including privileges on your current of Demonstrated Ability (SODA) that removes the LASIK, PRK, and ICL for all classes of medical certificate under corrective lens limitation from your certificate.

certification.

14 CFR section 61.53 as New Perspectives soon as your eye care provider releases you to resume normal activities, There’s no question that I am now in the “I love and when your visual acuity meets the standard for laser eye correction” group. But I’d also be the first the class of medical you hold. to stress that refractive eye surgery is not a decision The FAA does require your eye care provider that any pilot — especially a professional or aspiring to complete a report of eye evaluation (FAA Form professional pilot — should make without thorough 8500-7), which you need to present to your aviation consultation with a qualified eye care professional medical examiner (AME) at the time of your next and serious consideration of the potential risks and scheduled FAA medical examination. This report inevitable tradeoffs. Although the FAA and most must verify complete healing, stabilization of visual major air carriers allow laser refractive surgery, acuity, no complications, and lack of significant professional aviators must consider how it could residual effects that may accompany these types of affect their occupational and certification status. As surgical procedures (e.g., night glare, vision haziness, with any invasive procedure, you should understand or eye discomfort). Sufficient healing typically both the risks and the benefits before electing to go occurs by six weeks, but up to a year or longer may forward. But if you do … enjoy the view!

be necessary in some cases. At the time of your next scheduled medical application, your AME may issue Susan Parson (susan.parson@faa.gov, or @avi8rix for Twitter fans) is editor the appropriate medical certificate if you are found of FAA Safety Briefing. She is an active general aviation pilot and flight to be otherwise qualified. You may also submit instructor.

this report directly to the FAA’s Office of Aerospace Medicine. In addition to including specific data on your condition, it should also state that: Learn More Information for Pilots Considering Laser Eye Surgery (T)he airman meets the visual acuity standards (Publication OK-06-148) and the report of eye evaluation indicates http://www.faa.gov/pilots/safety/pilotsafetybrochures/media/ healing is complete, visual acuity remains lasereye_ii.pdf stable, and the applicant does not suffer sequela, such as glare intolerance, halos, rings, impaired night vision, or any other complications.

26 FAA Safety Briefing January/February 2013 S u S A n P A r S o n

Checklist

Form and Function

How the Pilot’s Bill of Rights Affects Application for a Medical Certificate

You will find a new electronic form to sign And, similar to the “Miranda rights” notification as you prepare for your next visit to the Aviation that you’ve seen on television shows, the FAA is also Medical Examiner (AME) to renew your FAA medical required to tell you that: certificate.

Why another form, and what might it be? As Any response to an inquiry by a representative of the Administrator by you in connection with you have probably seen in the media, in August this investigation of your qualifications for 2012, the President signed Public Law 112-153, an airman medical certificate may be used as more commonly known as the Pilot’s Bill of Rights.

In accordance with this law, the FAA’s Aerospace evidence against you .

Medical Certification Division is now required to The notification you receive on MedXPress provide applicants for a medical certificate with will also advise you that you may obtain a copy of written notification(s) related to the investigation of the releasable portions of your airman medical file the applicant’s qualifications for an airman medical upon written request to the Aerospace Medical certificate.

Certification Division (AMCD) in Oklahoma City.

What the FAA Must Provide What You Must Provide Here’s the gist of it. In accordance with the new As part of the MedXPress initial registration and law, the FAA is required to tell you explicitly that the application process, you will also need to complete a FAA will use the information you submit on the FAA “Certification of Receipt” statement acknowledging Form 8500-8, Application for an Airman Medical that you have received written notification of your Certificate, as part of the basis for issuing an airman rights under the Pilot’s Bill of Rights. If you decline medical certificate to you under Title 49, United to complete and electronically sign this part of the States Code (USC) section 44703(a). The FAA must form, the system cannot continue to process or also “investigate” your qualifications (e.g., via the submit your application for a medical certificate.

medical examination that the AME performs on If you’re new to the MedXPress system, check behalf of the FAA). If the investigation shows you to out Tom Hoffmann’s Take the XPress Lane primer be qualified and physically able to safely perform the on p. 20. It’s fast, it’s easy, and it will greatly facilitate duties associated with the level of medical certificate your next application for an FAA medical certificate.

that you seek, the AME will issue the appropriate medical certificate.

As you know from previous reporting, the use Susan Parson (susan.parson@faa.gov, or @avi8rix for Twitter fans) is editor of the online MedXPress application system is of FAA Safety Briefing . She is an active general aviation pilot and flight now mandatory. The MedXPress registration and instructor.

application process now includes several statements required by the Pilot’s Bill of Rights: Learn More The nature of the Administrator’s investigation, Pilot’s Bill of Rights which is precipitated by your submission of http://www.faa.gov/pilots/rights/ this application, is to determine whether you meet the medical standards for airman medical certification under Title 14, Code of Federal Regulations (CFR) part 67.

January/February 2013 FAA Safety Briefing 27 By Su SA n P A r S on

From

FDA to

FAA

How the FAA Evaluates Drugs

for Aeromedical Use

n preparation for the private pilot flight training that I started in August

1991, earlier that summer I made my very first visit to an FAA Aviation

I Medical Examiner (AME) to acquire the necessary third-class medical and

student pilot certificate … a yellow-beige document that I still keep among

the treasured souvenirs and mementos of my status as a certificated pilot. I

upgraded the third-class medical to a second-class medical when I trained a

few years later for my commercial pilot certificate. And, for the first 16 years of

my aviation career, I was fortunate enough to breeze through both the many

check-boxes on the FAA Airman Medical Application (FAA Form 8500-8, now

exclusively online via MedXPress) and the exam itself.

28 FAA Safety Briefing January/February 2013 That all changed in 2007, when I was diagnosed issues, and oversight of the agency employee drug with a medical condition — multiple sclerosis — that and alcohol testing program.

made things a little more complicated. As is the case “The first thing to understand is that the for any passionate pilot, one of my biggest and most FAA does not ‘approve’ drugs,” stresses Berry.

immediate concerns was for the impact this annoying “Our colleagues in the FDA [Food and Drug and most unwelcome development would have on Administration] have that function.” Rather, Berry my ability to hold an FAA medical certificate. Since and his staff evaluate medications to determine I had always been able to take my health, and thus whether they can safely be used in the aviation my eligibility for FAA medical certification mostly environment. Another important point, says Berry, for granted, I had never had cause to investigate this is that the FAA does not look at drugs alone. “Our issue. But now I was motivated! primary concern is not just about the drug and its I was immensely relieved to learn several things. side effects, but also about the underlying medical First, the FAA’s special issuance process — which the condition it is intended to treat,” he notes. A drug FAA medical staff has worked very hard to improve in that successfully and effectively treats a particular the last few years — provides the means to certificate condition on the ground may not be safe or suitable an astonishing range of medical conditions and for use in the flying environment. “The airman’s limitations. My particular brand of MS (relapsing- overall fitness and aviation safety are the guiding remitting) is happily among the many certifiable principles,” says Berry, “and because we can conditions under the special issuance process, and so sometimes approve medications for some conditions, I threw myself into becoming an expert on what the but not for others, it’s almost impossible to have a FAA requires for special issuance. single policy that applies to all possible uses of a That process also made me aware of the fact given drug. Again, it’s about the drug’s impact on the that, while there is a long list of potentially certifiable underlying medical condition as well as the effect on medical conditions and limitations, the list of the individual, so we have to take almost a case-by- allowable medications is somewhat more limited. case approach.” Even more confounding was the fact that the FAA That’s partly why there is no “official” list of itself does not publish a list of such meds. Like many allowable medications, but Berry also points to pilots, though, I was able to get the information I other factors. “The number of possible medications needed from one of the many aviation advocacy and combinations is enormous, and there are new organizations that research this information medications coming on the market frequently” he with the FAA and maintain an “FAA-approved” observes. The agency would need a much larger staff pharmaceutical database for their members. simply to develop such a document. Keeping it up to date would also be prohibitively resource-intensive.

Why the Mystery on Meds?

“There are so many different products out there, with So why does the FAA decline to make this all- so many different uses. New information emerges important information directly available, and how almost every day, and we are constantly re-evaluating does the FAA go about approving drugs in the first our policies on the basis of that information.” place? For answers, I went to Dr. Michael Berry, This ongoing evaluation creates changes in both Manager of the Medical Specialties Division in the directions. “Sometimes,” says Berry, “we get FAA’s Office of Aerospace Medicine. This Division adverse information about a drug’s effects after we is responsible for a wide range of issues, including have accepted it for use in aviation, and we have Aerospace Medicine policy and procedures regarding occasionally had to withdraw our acceptance of that pilot medical certification, and medical clearances drug. At other times, new information acquired over for air traffic control specialists, the evaluation and several years of use persuades us that we can accept management of complex psychiatric cases and one we initially declined to allow.” necessary for the pilot operation”; or, (2) “Is taking medication or The Regulations receiving other treatment for a medical condition that results in The regulations are very clear about the FAA’s expectations with the person being unable to meet the requirements for the medical respect to an airman’s medical condition: certificate necessary for the pilot operation.” 14 CFR 61.53 prohibits a person from acting as pilot in command or 14 CFR 91.17 states (a) No person may act or attempt to act as a pilot as a required pilot flight crew member while that person (1) “knows crewmember of a civil aircraft...(3) While using any drug that affects or has reason to know of any medical condition that would make the the person’s faculties in any way contrary to safety.

person unable to meet the requirements for the medical certificate January/February 2013 FAA Safety Briefing 29 appears to be an appropriate cost-benefit ratio. “If there are a number of airmen with a given condition who request acceptance of a new drug to treat that condition, there is obviously a benefit in committing the resources to review it.” How Do I Decide?

Berry stresses that the FAA’s primary concern is whether the underlying medical condition being treated is compatible with safe flying, and then the safety of the medication being used. He also reiterates the wisdom of advice that some aviation advocacy groups offer their members: Even if the FAA allows a given medication for your condition, anyone taking a drug for the first time should conduct a “ground run” self-evaluation period for at least 48 hours before attempting to fly. The idea is to ensure that there are no unexpected adverse reactions. “There are wide variations in individual physiology,” says Berry, which is one of the reasons that drug evaluation is a process that defies a simple or cookie-cutter approach.

Another important point: No matter how much you want to fly, your health has to come first. “The fact that the FAA allows some medications and How Long, and Which Ones?

not others will obviously be of interest to airmen, The need for careful evaluation of a drug’s effects but never let that drive the decision,” he counsels.

is the reason for the FAA’s general policy of waiting at “You and your doctor have to make whatever least a year after a drug receives FDA approval before decision is best for your overall long-term health.

it will be considered for use by airmen. “The FDA And remember that things do change—new drugs obviously does extensive testing,” observes Berry, are developed all the time, and new information but testing inherently involves only a small segment may allow us to reconsider accepting drugs that we of a drug’s target population. “We wait at least a year initially declined to permit for use in aviation.” to let the FDA establish a more complete profile of benefits and side effects before we commit the Susan Parson (susan.parson@faa.gov, or @avi8rix for Twitter fans) is editor resources required for aviation evaluation,” he states.

of FAA Safety Briefing. She is an active general aviation pilot and flight And it is indeed a resource-intensive process.

instructor.

A small team of FAA physicians in Berry’s Division make up the Pharmacy and Therapeutics Committee headed by Dr. Arleen Saenger, which looks at Learn More everything it can find, starting with the FDA label FAA Frequently Asked Questions (FAQs) web site (i.e., officially approved uses), the FDA’s research http://faa.custhelp.com/app/answers/detail/a_id/261 and reviews (including post-market safety reviews), CAMI Pilot Safety Brochure “Medications and Flying” academic research, and publications such as www.faa.gov/pilots/safety/pilotsafetybrochures/media/ PubMed. Also of interest is the work and experience Meds_brochure.pdf that foreign pharmaceutical and aeronautical Aeronautical Information Manual, Chp 8 Medical Facts for authorities have had with a given combination of Pilots (medication section) medical conditions and drugs. Once the Committee http://www.faa.gov/air_traffic/publications/media/AIM_ reaches consensus on the possible aeronautical Change_1.pdf use of a drug, Saenger makes a recommendation to Berry. The Federal Air Surgeon, Dr. Fred Tilton, has the final say.

Another important point on FAA resources: “There is simply no way we could evaluate every new drug that appears,” notes Berry. Instead, the FAA chooses to evaluate a drug primarily when there 30 FAA Safety Briefing January/February 2013 S A B r i n A Wood S

Nuts, Bolts, and Electrons

AMTs vs. OTCs

u nderstanding the r isk when s elf-Medicating

You wake up from a restless night and it’s there even after reading them in their entirety. The FDA — the ominous tickle in the back of your throat. It has acknowledged this issue and is working with is the first warning sign. It might be accompanied pharmaceutical companies to ensure the labels are by a slightly stuffed up nose, or perhaps a general both prominently placed and easier to understand.

soreness in your lymph nodes and neck. Regardless, As for the rest, that is up to you.

you know what is coming — you’ve been here before. Going back to the previous scenario — you reach You are getting sick. for the gel-tabs known for easing cold symptoms, But morning has come and you have work. So, and for your favorite pain-reliever. You flip over the like most people do, you reach for the medicine cold medicine box and begin to read. You see that cabinet in attempt to arm yourself against the evil it is designed to ease a cough due to minor throat rhinoviruses that are invading your body. Maybe and bronchial irritation. It should also help relieve you will choose the latest in over-the-counter (OTC) a headache, minor aches and pains, a fever, and a antihistamines, or that popular bedtime, coughing, runny nose. This all sounds great and just what you stuffed up, so-you-can-sleep medicine. Whatever need, so what should you do now? The answer is you choose, as an aviation maintenance technician read on .

(AMT), you need to be aware of the hidden dangers The Fine Print of OTC medicines and what the risks might be on the You do, and you find that the active ingredients job.

in the cold medicine are acetaminophen, The guidelines for aircrew are explicit and, dextromethorphan, and doxylamine succinate.

although the FAA does not publish a master list of The pain meds list acetaminophen as the primary approved medicines, 14 CFR prohibits flying while ingredient. Normally, you would settle on taking a you have a condition or take a medication that might dose of each medicine, and hurry off to work hoping affect flight safety. Unfortunately, the guidance for the meds hold until you can get back home and back ground and maintenance crews isn’t as well defined, to bed. However, as you read even further down the which often leaves the decision of medication usage up to the individual.

Labels and Lug Nuts Rule number one of medication-taking: Always read the labels! The Food and Drug Administration (FDA) goes to great lengths to ensure that all drugs list indications (benefits) and contradictions (warnings) on their labels. In addition, labels must list active and inactive ingredients, dosages, and uses. The summation of these items can usually help you decide if a particular drug is worth considering when self-medicating. Studies show, however, that only about 54 percent of adults bother to read the official labeling on the back of the box. Instead, they defer to the more commercial advertising on the front. Those who do read labels often stop shortly after dosage and time requirements, and some note that they can’t make sense of the lists January/February 2013 FAA Safety Briefing 31 labels, you realize that this might not be the best plan or metabolizes another medicine. For after all. example, aspirin can change the way certain Warnings on the cold medicine expressly prescription blood thinning medicines work.

discourage mixing it with another drug containing acetaminophen. Doing so could damage your The Others liver. Next you read that you might incur marked Awareness doesn’t end with OTC meds. Some drowsiness when taking this particular drug. A quick other hazards to be aware of include psychoactive Internet search reveals that the active ingredient, drugs, such as anti-depressants or anti-anxiety doxylamine succinate, is an antihistamine that medications. These types of prescription drugs are can encourage lethargy.

specifically designed to act upon the brain to cause This would be good news, changes in behavior, mood, and consciousness, If it numbs the pain, then it probably and in fact desired if you which may be counterproductive on the job.

numbs the brain and is therefore best were taking it before bed.

The same holds true for psychostimulants, such avoided in the workplace.

However, you plan to work a as amphetamines or amphetamine-like drugs.

full day, so being drowsy on the job is not an option.

Quite a few of these are an automatic “no-go” for In fact, another warning on the label cautions operators and for air traffic controllers, but they against operating heavy machinery or driving. Your bear consideration for ground crew or maintenance plan to install a new engine on a Cessna 182 that day positions as well.

certainly requires you to be at the top of your game.

The same is true for the heavier duty pain That decides it, and both medicines go back in the relievers. Oral, injectable, and topical pain relievers, cabinet. So now what do you do? Are you left to brave and in particular those containing opiates (e.g., the workday cloudy-headed and runny-nosed?

codeine, oxycodone, morphine), bind to specific brain receptors that affect your perception of Gotta Keep ‘Em Separated pain, ability to think clearly, mood, and muscle “The Offspring” lyrics aside, a great way to coordination. All of these can most certainly have set yourself up for success is to organize your an adverse effect at work — so much so that this is medicine cabinet beforehand, and to keep the one of the categories that maintenance companies contents separated. Keep a set of meds that will and agencies, to include the Department of ease symptoms and encourage sleep — always a key Transportation and the FAA, screen for in mandatory factor in getting better — on one side of the cabinet, drug testing.

and the non-drowsy, work-friendly kind on the Dr. Michael Berry is the Manager of the Medical other. This way you always know which one to grab Specialties Division in the FAA’s Office of Aerospace depending on what part of the day it is.

Medicine. This Division is responsible for a wide Prior to stocking your cabinet, review and range of issues, including policies and procedures discuss your choices with your health care provider regarding pilot medical certification and medical to ensure that each medicine is right for you. The clearances for ATC specialists, the evaluation and last thing you’ll want is to use a drug that interacts management of complex psychiatric cases and negatively with something else you might be issues, and oversight of the agency employee drug taking, or with any other ailments you might have.

and alcohol testing program.

Medicinal interactions can fall into any of three His advice is that if it numbs the pain, then it harmful categories.

probably numbs the brain. That means it is best to be • Duplication : This means if you take two avoided in the workplace. Although the consequence medicines that have similar active ingredients, of a poorly executed maintenance action might not you may get more of an ingredient than you be as immediate or apparent as it could be in the need. Duplication with acetaminophen is a flight operations arena, it is still a hazard. And it is common example.

your responsibility to ensure that the strongest and most capable tool in your crib — your brain — is • Opposition (antagonism): This is when the alert and at its best.

active ingredients in different medicines have opposite effects on your body. For example, OTC decongestants can oppose certain Sabrina Woods is an assistant editor for the FAA Safety Briefing. She spent medicines intended to lower your blood 12 years in the active duty Air Force where she served as an aircraft mainte- pressure, because decongestants may raise nance officer and an aviation mishap investigator.

your blood pressure.

• Alteration : This is when a medicine may change the way your body absorbs, spreads, 32 FAA Safety Briefing January/February 2013 S A B r i n A Wood S

Angle of Attack

Flying Healthy: A Hazard IS your Health

Picture it. Clear, blue, and “CAVU” on a beautiful these are minor changes to the body’s biomechanics spring day. Perfect flying weather. You wait patiently that will regulate themselves in time with no adverse and watch as the Skyhawk ahead of you starts its takeoff effects. For a person with a pre-existing condition, roll, heads down the runway, and climbs into the air. however, this can become the catalyst for a significant, All is not well, however, and it is soon apparent that the and potentially debilitating, medical event.

aircraft is in distress. You watch in horror as it suddenly Since 1996 there have been over 190 recorded snaps left, noses over, and impacts the ground just past cases of incapacitation or impairment in the cockpit, the runway. After the subsequent investigation you resulting in 132 accidents and 115 pilot fatalities. Sifting find out that shortly after takeoff, the pilot experienced through one sobering report after another, I found sudden cardiac arrest, leaving her unable to maintain that most cited known, pre-existing conditions prior control of her aircraft. to the accident occurring. One particular incident Although identifying details have been altered noted that the pilot had a history of coronary artery slightly, this is a real event. It is listed under the disease, hypertension, lymphoma, and diabetes, and National Transportation Safety Board (NTSB) aviation was currently under deferment for review for issuance accident qualifier “medical incapacitation,” and the of a new medical certificate. And yet he stepped to his truly alarming fact is that it is not a unique scenario. aircraft that day and chose to fly.

In addition to the NTSB database, the Civil Aerospace A Hazard is your Health Medical Institute (CAMI) maintains a database that Now I am not advocating that you hang up your records information on pilots who suffer a medical flying-ace goggles and silk scarf simply because you impairment or incapacitation in flight. This information have a little bit of hypertension. What I am advocating includes pilot demographics (age, gender, flight time), is that you know your body. Know and respect the medical certificate information (class, pathology codes, parameters of your particular ailment and what it might special issuance), and event information (origin, injury entail as it progresses. Identify how certain medical status, NTSB-cited probable cause). Both databases list conditions may or may not preclude you from taking several events almost identical to this one.

part in flight activities. Before you fly, understand the Heart attacks, strokes, acute arrhythmia, and ramifications of taking certain medications and, in sudden loss of consciousness due to diabetic shock — particular, their timeframes.

these are all incapacitating circumstances that have The questions you need to ask yourself are: What caused general aviation accidents, and on more than if a known side-effect occurs in flight? Are you ready to one occasion, passengers were involved.

handle the situation? Or, conversely: What if your meds This understandably unnerving information is not run out in flight?

written with the intent to alarm or scare anyone, but Discuss any concerns you might have with your rather to elicit understanding and awareness about a primary health manager and your AME. Be honest very important issue: your health.

with your physicians and with yourself. Confront your Flying can be a stressful event. Studies have shown situation with an informed determination to make the that the most stressful aspects of flying are takeoff and best, and more importantly, safe , decision. A careful and landing. Coincidentally, these are also the two stages honest health assessment prior to flight is a hallmark of flight that have the highest propensity for mishap.

of good risk management. Don’t let the hazard be your These are the times when the mental and physical health.

effort required for successful execution can be at its most demanding. The heart rate and blood pressure elevate slightly. Breathing becomes heavier. The mind Sabrina Woods is an assistant editor for the FAA Safety Briefing. She spent is constantly trying to absorb, interpret, and act upon 12 years in the active duty Air Force where she served as an aircraft mainte- information it receives. In a perfectly healthy individual nance officer and an aviation mishap investigator.

January/February 2013 FAA Safety Briefing 33 m AT T r ig SB y

Vertically Speaking

Tired of Fatigue

Humans are designed to be awake during crew’s duty and rest times. Advisory Circular AC00- the hours of light and to sleep during periods of 64, Air Medical Resource Management, provides darkness. In scientific terms, this is called the body’s guidance for initial and recurrent training of air natural clock, or circadian rhythm. Disturbances to medical transport crew members.

the established circadian rhythm can reduce mental The Aeronautical Decision Making (ADM) and physical performance, which can be described chapter in the FAA’s Pilot Handbook of Aeronautical in one word — FATIGUE. Knowledge (http://go.usa.gov/Yz4H) calls out the I’m tired of seeing fatigue as a factor in so many IMSAFE checklist, something readers of this column of the accidents I investigate as part of my work. may have seen previously.

Let me tell you about one of them, which involved 1. Illness — Am I sick?

a friend I will call “Sam.” I did not know Sam 2. Medication — Am I taking medicines that was involved in the accident when I received the might affect my judgment or make me drowsy?

assignment. As I walked up to the wreckage, I made 3. Stress — Am I under psychological pressure an initial assessment of the helicopter’s condition.

from the job? Do I have money, health or The rotor and transmission had separated from the family problems? Stress causes concentration aircraft. Then I turned and saw Sam and his student.

and performance problems.

They were not injured physically, but both were 4. Alcohol — Have I been drinking within eight sitting on the ground in a shock-like state. The first hours? Within 24 hours? As little as one ounce thing Sam said to me was: “Matt, I knew I should not of liquor, one bottle of beer, or four ounces of have been flying, but I did it anyway.” A momentary lapse in judgment left no one at the controls during a wine can impair flying skills.

three-foot hover, and the rest is history.

5. Fatigue — Am I tired? Fatigue continues to What leads to that kind of lapse in judgment?

be one of the most insidious hazards to flight Mental and physical fatigue. Sam was going through safety, as it may not be apparent to a pilot until a divorce, a bitter custody battle, and financial serious errors are made.

troubles. He had moved out of his primary residence, 6. Eating — Have I eaten enough to keep me had a recent job transfer, and was dealing with the adequately nourished during the entire flight?

death of a close family member. Oh, and he also had Most pilots, mechanics, and flight crews are a sinus infection. Life’s many developments had task oriented and want to get the job done no taken their toll on Sam.

matter what we have going on in our lives. Everyone One of the worst places for a fatigue-related working in the aviation industry should use the accident is in the Helicopter Emergency Medical IMSAFE risk mitigation strategy. As the name Services (HEMS) world, which includes high suggests, it could make the difference between a safe demands and pressure to move quickly. For both flight, and “I knew I should not be flying, but I did it pilots and mechanics, HEMS is a unique helicopter anyway.” operation. Pilots fly most operations alone and predominately under visual flight rules (VFR). They generally work 12-hour day or night shifts. Medical Matt Rigsby is a transportation industry officer and accident investigator in crews typically work 24-hour-plus shifts. Fatigue can the FAA Rotorcraft Directorate. He is an A&P as well as a fixed and rotary be a significant factor in job performance, so HEMS wing pilot, who has worked in the helicopter community for 20 years. He has work needs to incorporate plenty of fatigue risk participated in more than 90 helicopter field accident investigations, both domestically and internationally.

management methods. As you may know, the FAA regulates requirements for pilot flight duty and rest, but the agency has no jurisdiction over the medical 34 FAA Safety Briefing January/February 2013

Flight Forum

search for the “best” unleaded replacement for 100LL Automotive Gas avgas. We are also collaborating with the EPA to My airplane and engine are STC’d to use support the transition to unleaded avgas. I hope this unleaded automotive gasoline. The STC is very clear helps and thank you for reading!

that all fuel must be free of alcohol of any kind. Why can’t we develop a ready source of ethanol-free PEGASAS Program automotive gasoline for all the low compression Can you give me the name of someone I can piston engines in the fleet? I have read that 60 talk to about working with the Partnership to percent of all GA piston aircraft are auto fuel STC Enhance General Aviation Safety, Accessibility and eligible. When I learned to fly there was 80 octane Sustainability (PEGASAS) program? I am a 70-year (red) and 100 octane (blue) avgas available. All us old pilot, aircraft owner, electrical and mechanical low performance guys used the red fuel, and the high engineer, computer geek, etc. I am intensely performance guys paid more for the 100 octane. We interested in GA safety, especially in the areas of could let the low performance aircraft run alcohol- aging aircraft maintenance and in the human- free auto fuel, and the high performance aircraft machine interface.

could run “Swift Fuel” or whatever.

— Bill — Steve We are thrilled you have such interests and that As you stated, the FAA has approved you are willing to contribute your experience to the Supplemental Type Certificates (STCs) for operation program. Please contact Holly Baker at (609) 485- with ethanol-free autogas on certain aircraft and 6253 and she can get you each individual university’s engines. We have also worked with industry to program lead and contact information.

approve other low or medium octane unleaded fuels, such as UL91, UL94, and UL82. As you noted, these unleaded fuels are not high octane fuels, and they FAA Safety Briefing welcomes comments. We may edit letters for style and/ do not provide the performance necessary for safe or length. If we have more than one letter on a topic, we will select a repre- operation of high performance aircraft which burn sentative letter to publish. Because of publishing schedule, responses may not appear for several issues. While we do not print anonymous letters, we most of the fuel and have the highest utilization.

will withhold names or send personal replies There is apparently an insufficient market demand upon request. If you have a concern with an to support the production levels and distribution immediate FAA operational issue, contact infrastructure that is necessary to make ethanol-free your local Flight Standards District Office or autogas and these other fuels available at airports.

air traffic facility. Send letters to: Editor, F AA Currently, 100LL is available and entrenched at all Safety Briefing , AFS-805, 800 Independence airports, and there are no driving forces to replace it Avenue, SW, Washington, DC 20591, or with any alternate, including ethanol-free autogas.

e-mail SafetyBriefing@faa.gov.

No other gasoline can satisfy the entire fleet of engines and aircraft, and most airports are currently only equipped to provide one fuel. The FAA Tech Center has Let us hear from you—comments, suggestions, conducted extensive research to identify a “drop in” and questions: e-mail SafetyBriefing@faa.gov unleaded replacement for 100LL, and has supported or use a smartphone QR reader to go “VFR- other research to identify octane requirements of the direct” to our mailbox.

GA fleet. Through the sponsorship of the Unleaded Avgas Transition Aviation Rulemaking Committee (UAT ARC) and the establishment of the Fuels Program Office to implement recommendations, we will continue to provide a leadership role in the January/February 2013 FAA Safety Briefing 35 S u S A n PA r S o n

Postflight

Getting to “Yes”

“We are all just one medical event away from Silberman (since retired) and now by Dr. Courtney flying as sport pilots.” Scott. Working for the FAA has given me the privilege A pilot friend made that statement at a of coming to know them not as names on a web page conference several years ago and, like most everyone but as people, and I can assure you that they are else in the audience, I nodded sagely (or was it people who care . Like everyone, the folks at AMCD smugly?) while I thought sympathetically of those are bound by the regulations. Their work and their who could “only” fly with the driver’s license medical. decisions have profound implications not just for Little did I know that life was about to give me pilots, but for the public … that is by no means an a visceral appreciation for that statement — and abstraction. You might not realize the extent to which even greater appreciation for the many medical aeromedical decisions are reviewed and second- certification options available to today’s pilots. guessed even in “routine” accidents. That level of Ironically, it was just after that week that a subtly scrutiny by the National Transportation Safety Board accumulating collection of odd symptoms finally (NTSB), the press, the public, and sometimes even drove me to the doctor, and eventually to a diagnosis Congress, goes off the charts when an accident of multiple sclerosis (MS). involves a public figure (think Ted Stevens or Cory My aviation friends all understood that my most Lidle).

immediate concern was not so much about the In that context, it is even more impressive potentially dire consequences of the disease itself. Its and heartening to know that, contrary to the jokes implications for my FAA medical certification were and fears and snide comments, the FAA’s medical the real source of the early tears and terror. Lucky for mindset is not a knee-jerk “no.” Rather, Tilton, Scott, me, several pilot pals (one of whom preceded me into and the dedicated folks who work for them are all the “MS Pilot Club”) knew that MS didn’t have to spell about getting to “yes.” Just as in the Roger Fisher the end of my PIC flying days. In addition to handing and William Ury book on Getting to Yes , which me hankies, they provided solid information and offers a toolbox for negotiating mutually acceptable support as I began to navigate this strange new world outcomes, the FAA’s medical professionals have of health and aeromedical management. developed a wide range of options for medical After eight years of working at FAA headquarters, certification of many conditions that would have once I’ve heard most of the jokes and snide comments grounded pilots for good. Even more encouraging about this agency. Having also attended several is the fact that aeromedical research continues to years’ worth of the Administrator’s meetings with air broaden both the list of certifiable conditions and show audiences, I’ve also heard lots of the frustration options for demonstrating compliance with medical that pilots experience when medical issues result in certification standards. Yes, there are still occasions delays or (occasionally) denial of the vital medical and conditions that require the FAA to say “no.” But certification. I get it — even though I worked for the it is increasingly uncommon to find cases that are FAA, I knew nothing about the people or processes permanently impossible to certify. In all other cases, involved in special issuance, and I was terrified the FAA medical team is more than willing to work of being ground into the gears of the medical with airmen and AMEs to find a path to certification.

bureaucracy. What I quickly learned, though, is that Thank you, colleagues, for all you do to help keep the people who count — that would be Federal Air so many of us flying.

Surgeon Dr. Fred Tilton and his team, many of whom are pilots themselves — get it, too.

Susan Parson (susan.parson@faa.gov, or @avi8rix for Twitter fans) is editor A particularly tough job belongs to the head of FAA Safety Briefing. She is an active general aviation pilot and flight of the Aerospace Medical Certification Division instructor.

(AMCD), headed until recently by Dr. Warren 36 FAA Safety Briefing January/February 2013

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f AA f aces

d r. c ourtney Scott

Manager, Aerospace Medical Certification Division

jumped on a new opportunity to continue to serve in the area of aeromedical certification through FAA.

“Aerospace medicine and medical certification are my roots, and I love this job.” Substantial experience with all the stresses that a pilot goes through — physiologically and mentally — help Scott make complex aeromedical decisions required to manage FAA’s Aerospace Medical Certification Division. The division is responsible for medical certification on behalf of the Federal Air Surgeon.

Medical conditions have been involved in a number of aircraft mishaps, which makes certification a critical function in aviation safety.

“Our role is to identify those medical conditions, including their treatment (especially medications) that may have adverse impacts on aviation safety.” If the conditions can be appropriately managed, Dr. Courtney Scott’s interest in medicine started FAA can work to assist the airman in understanding after graduating from the U.S. Merchant Marine what they need to be considered for a waiver that Academy and serving as a second and third mate would allow them to continue flying.

on transport ships traversing the Pacific Ocean to “Our first and foremost obligation is to safety, Vietnam and back. Merchant ships typically do but beyond that we do everything we can to enable not have any trained medical staff onboard, so the the airman to fly.” responsibility to take care of any medical issue fell to A common myth within the general aviation the deck officers.

community is that FAA is simply looking for reasons “Over time I found the medical challenges that to ground airmen. Scott and the division see I was faced with to be really interesting,” said Scott.

themselves in partnership with airmen to mutually “As the war wound down, I was blessed with the safeguard the airspace. In this partnership, the opportunity to go to medical school.” airman should understand that medical factors are Scott then spent several years as a general an important part of safety, and all parties must take practitioner in a rural community where he did responsibility.

everything from delivering babies to taking care of nursing home patients. But the experience and challenges at sea — and six hurricanes — fostered a Paul Cianciolo is an assistant editor and the social media lead for f AA need for something different. Safety Briefing. He is a U.S. Air Force veteran, and a rated aircrew member and search and rescue team leader with the Civil Air Patrol.

“In conventional medicine we take care of people who have or may develop abnormal conditions or illnesses, but in the setting of a normal environment. In classical aerospace medicine we take care of ‘normal’ people in the very ‘abnormal’ environment of air and space.” Scott signed up as a flight surgeon in the U.S.

Air Force and spent around a thousand hours flying on various aircraft. He served in several command positions including the chief of physical standards for the Air Force. After 22 years on active-duty, Scott

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Washington, D.C. 20591 forwarding service requested Official Business Penalty for Private Use $300 www.faa.gov/news/safety_briefing/

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w hat Kind of Medical Must i Hold? . . . . . . . . . . . . . . . . . . . . 14

Navigati N g the Medical f light Path

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Learn How to f ast- t rack Your a irman Medical c ertificate . . . . . . 20

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w hat Pilots s hould Know about r efractive e ye s urgery . . . . . . . 24

f ro M fda to faa The Office of Management and Budget has approved the use of public funds

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