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Aviation Medicals

This case is loosely based on a true story, I have changed the specifics to comply with patient confidentiality but the message is evident.


July 6, 2007
By Tarek M. Sardana

Topics

218Is it that time of year again, is it time for your ‘dreaded’ aviation
medical with your friendly Civil Aviation Medicine Examiner (CAME), an
event that is akin to a root canal in the dental world. Well, this
article will hopefully shed some light on this event and allay any
fears or concerns that pilots may have toward their aviation medical
examination.


CASE REPORT

This case is loosely based on a
true story, I have changed the specifics to comply with patient
confidentiality but the message is evident. This patient is a senior
pilot with a small BC helicopter logging company. He is 47 years old
and has about 4,000 total flying hours. He is about 40 pounds
overweight, has slightly elevated cholesterol and he has the occasional
cigarette and beer. Due to his hectic schedule he does not exercise.
(Does this sound like anyone you know?) Over the past eight months he
complains to a close co-worker that he has the odd twinge of chest pain
with numbness going into his left arm lasting up to an hour. The
co-worker encourages the pilot to see his family doctor/CAME but the
patient refuses as “he doesn’t want to lose his licence.” (Does this
sound like anyone you know?) The patient continues on with his usual
dedicated manner, moving timber around the mountains. He sees his CAME
for his regularly scheduled aviation medical during one of his
scheduled weeks off, but he does not disclose his chest complaints as
he doesn’t want to go through the hassle of all the tests and is still
worried that Transport Canada will ‘pull his ticket.’ Unfortunately,
not too long after his medical, the pilot collapses while doing some
yard work at home on one of his days off. His wife calls 911 and the
pilot is rushed off to the ER but is pronounced dead from a large
myocardial infarction (heart attack). He leaves behind his wife and two
teenage children.


WHAT’S THE MESSAGE?

This case
illustrates the worst-case scenario of denial and withholding of
medical information. Had this pilot been forthcoming right from the
start, he may still be with us today.

Let’s look at the Aeronautics Act of 1985, which I will summarize (i.e., take out the legal jargon) below:

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AERONAUTICS ACT (1985) – MEDICAL AND OPTOMETRIC INFORMATION

6.5
(1) This section states that if your CAME or any physician thinks that
you may have a condition that is likely to constitute a flight safety
hazard, then he/she must inform the designated medical authorities at
Transport Canada.

(2) This section states that as a holder of an
aviation licence, you must inform all of your health care providers
(not just your CAME) that you are a pilot at every physician contact.

(5)
This section states that the information that either you or your health
care provider provides to Transport Canada is not subject to any legal
or disciplinary hearings. In fact this information shall not be used in
any proceedings.

(6) This section states that as a holder of an
aviation licence you agree to follow the Aeronautics Act. You don’t
have to sign anything, just the fact that you hold a certificate is all
that is required; therefore, stating that you were not aware that these
were the rules won’t cover you legally should an accident/incident
occur.

In a nutshell, the Aeronautics Act states that with any
medical contact a pilot is to disclose that he is an aviator and not
doing so is actually a violation of the law. More importantly, not
disclosing may have disastrous results on a more personal level as
illustrated in the case report.


THE 1% RULE

So, why do we
actually do aviation medicals? The primary reason is to ensure the
safety of the aviation system and the flying public. Also, we want to
ensure that the pilot is fit from an individual perspective and is not
going to become suddenly incapacitated. This is the bottom line, as
CAMEs we are concerned with medical conditions that may result in
sudden incapacitation. Obviously, a rash on your leg will not result in
you suddenly collapsing and causing a critical flight safety incident,
but chest tightness may lead to a heart attack, which may cause a
sudden incapacitating event. These are the type of issues we are
looking for when we conduct the medical.

The “1% Rule” is a
general guideline (not official policy) as the line in the sand. An
annual risk of 1% for any sudden incapacitating event (such as heart
attack, stroke, epileptic fit, etc.) is the loose boundary set between
acceptability and unacceptability in a pilot or air traffic controller.

As CAMEs we encourage you to be open and honest with your physician and we will do all that we can to keep you flying.


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