The aerospace medicine community is made up of lots of specialty groups that meet throughout the year and around the world. There’s the “mother group,” the Aerospace Medical Association (AsMA), that convened in April in Atlantic City. The meeting included the Society of United States Air Force Flight Surgeons, Aerospace Human Factors Association, Airlines Medical Directors Association, the International Association of Military Flight Surgeon Pilots, Society of NASA Flight Surgeons, Space Medicine Association, the International Academy of Aviation and Space Medicine, the Civil Aviation Medical Association, to name several, but the list goes on!
I was just at the Atlantic City AsMA meeting, one of two major medical meetings I attend each year. AsMA represents a broad cross section of the aerospace medicine community, so the diversity of papers presented over the four-day meeting is impressive. This year, there was quite a bit of interest in the follow-up to the Germanwings accident in the Alps in March 2015. A tragedy such as this offers lots of “lessons learned” to prevent another occurrence. As a result, mental health of pilots was a topic for discussion.
I spent much of my time this year in the FAA aviation medical examiner seminars. AMEs are physicians designated by the FAA to conduct airman medical examinations and issue medical certificates. As part of their continuing medical education, they are required to attend refresher training to stay sharp on the FAA certification policies and practices.
There is a lot of change going on in the FAA with respect to medical certification. Aside from the current legislation regarding third class medical reform, the FAA is working internally to improve the efficiency of a very complex bureaucratic certification process. If you have a special issuance or have ever had your medical application deferred for review by the FAA, you are most likely aware that it can take quite a while to obtain your certificate.
The FAA undertook the CACI (Conditions AMEs Can Issue) program several years ago to move some medical conditions from the “special issuance” category to an office issuance by the AME. There are currently 16 conditions that qualify for a CACI, and it is reasonable to conclude that there will be more coming down the road as the FAA continues to “decentralize” the certification process and allow AMEs more latitude to make certification decisions.
Another administrative change that is evolving now is the use of checklists for certain conditions that will make it easier for your treating doctor and the AME to determine that an airman with a medical condition can be reissued a medical certificate more quickly by providing the treating doctor with a specific set of guidelines to determine that the pilot is eligible for issuance.
In the mid-1990s, AOPA was actively involved in the efforts to allow insulin-treated diabetics to qualify for special issuance. That change in 1996 allowed certification for third class certification only, and that policy restriction is still in effect today. At any given time there are about 300 insulin-treated pilots safely operating under special issuance. In fact, I met three of them recently at Sun 'n Fun in Lakeland, Florida, and they are all doing great and actively flying.
In recent years, several countries have allowed certification for commercial pilots under a limitation called “with or as a co-pilot.” There were several interesting presentations at the meeting on this subject, and the FAA is currently evaluating a protocol that might well result in a change in policy that allows applicants for first and second class privileges to fly under a special issuance. The monitoring technology available today for diabetics is quite good; especially with continuous glucose monitoring that provides consistent readings of blood sugar. Coupled with a motivated patient who really wants to fly professionally and pays close attention to managing their diabetes, the consensus is that a reasonable and satisfactory regulatory protocol can be created to safely allow commercial operations for a subset of insulin-treated pilots.
There are still plenty of things that need fixing in the aeromedical certification process, but the effort to improve the timeliness of certification review is a priority for the FAA, and AOPA will continue to work all avenues to advocate for a certification system that is safe and more efficient.
Fly safe and stay healthy!
