MrMilkshake
Wow… I guess that medical didn’t work.
Wow… I guess that medical didn’t work.
Kinda like my recent class 2 a few years ago. Not long after getting it, discovered I was 90% blocked and need at least a triple bypass. My hanger neighbor, a retired FedEx Captain with a class 2, was sitting in his truck at the Ford dealership and fell over dead with a massive heart attack. They may have just told him how much his oil change was going to cost. Through the years, the FAA physical has become almost meaningless.
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It has always been meaningless. It has only recently been recognized as such. A serious medical would include a cat scan. That would tell the whole picture and provide a whole lot more incentive to make corrective changes in behavior if necessary.
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In the past any attempts by the FAA to make medical more stringent has been protested loudly by AOPA and others. The only change that the FAA actually snuck through was lowering the blood pressure numbers. All you have to do is look up the attempt to require sleep studies for sleep apnea to see how well that was received. Same with trying to establish a cholesterol standard about 20 years ago.
Nice job by that non certificated passenger landing that King Air safely.
Good point.
My own experience with vertigo was totally out of left field. I suddenly could not process objects moving in my visual field without nausea and a feeling of falling. It happened when I was in church one day, and I could barely manage the five minute drive home. My doctor ordered me not to drive until he cleared me. This was later determined to be the after effect of a head-cold. The scary part was that I had been well past the cold for over two weeks when this vertigo hit. Instead of having it happen in church, I could have instead been behind the wheel of a car, or up on a ladder, or operating power equipment. Even years later, when it was “cured”, my brain would suddenly go “zero G” on me. In a car that was bad enough – I can’t imagine that being OK flying a plane.
Interesting food for thought.
Some people will point out that no medical exam is infallible and I agree that single-pilot operations without an emergency autoland system have all of the redundancy of a single-engine operation, under IFR, at night.
It is my understanding that the essential difference between a Class 2 and Class 1 medical is the requirement for an ECG. In many other countries, an ECG is required for all levels of aviation medicals. For example, in Canada, a routine ECG is required for a Category 3 medical at the first examination after age 40 and then within 48 months proceding subsequent examinations. Category 4 medicals (which are required for Recreational Pilot Permits) are required after the age of 50 and then every 2 years.
After attending a forum on pilot medical reform at AirVenture several years ago, I thought it interesting watching so many overweight boomers, some driving electric mobility scooters, vehemently asserting that they were fit to fly and a requirement to visit an FAA examiner every 2 years was superfluous.
Same thing with me. I had a ferocious bout of vertigo that happened while I was taking my wife out for coffee. Just suddenly felt a little dizzy. By the time I pulled over I could barely walk. At least you got some sort of explanation. The best my doctor could manage is “It’s just one of those things. No telling why it happened.”
Yes, I have a new doctor. And I give myself a long thorough self-evaluation before I fly now. And until more time passes since the vertigo with no relapse, I do not carry passengers.
If that weren’t enough, the FAA just blew off the restriction for airman using experimental drugs.
The EUA modified gene therapy shot in no way met the threshold for pilot use……
But in typical alphabet agency fashion you just follow the money.
Pilot incapacitation is an infrequent event, and having a FAA medical is almost
useless in preventing from happening. Researching over 130 Cirrus Ballistic Parachute Deployment in 25 years of operation, not ONE was due to an incapacitated pilot, or the passenger firing the system because of one.
Source: Aviation Safety Network.
There seems to be a bit of disconnect on what medical examinations in general, and flight physicals for airmen do. They are not preventive health, but regulatory with the intent to answer the question: Will this airman be healthy enough to fly safely for the next 6 months, 12 months, 2 years, 5 years?
Much of our preventive annual exams (non-FAA) exams are focused on improving health and diagnosing common problems. Heart disease and cancer and diabetes are most common, but there are others that do happen. Some of them we catch by knowing personal or family history, and take a special look. Some we catch on routine and inexpensive lab tests. Some we miss because it is simply too expensive or invasive or the tests themselves can cause harm.
Where the consequences disease and the risk of a disease is high, CTs are used. Low Dose CT scans for smokers to diagnose early (potentially) curable lung cancer are a key example, but routine use in everyone without reason would potentially increase the risk and expense to the population with little gain.
An example is a fit airman carrying a Class I medical with current EKG demonstrating excellent cardiac health in his mid 40s with a regular training regimen, bicycling, downhill skiing, running were his activities. One warm summer day walking in town with his family, he died in his tracks from a ruptured aneurism. This could have just as easily happened several days later when he was on his trans-oceanic airliner headed to the EU. Or it could have happened on his way home on the interstate with the cruise control set. This type of event takes seconds and is mostly fatal. The USPHTF recommendations are not to screen for AAA until 65-70 and only in males, and even then they report a low probability of a positive result.
The FAA’s medical certification program has been questioned, sometimes appropriately, other times not. But the reality is that medical events are rarely the proximate cause of aviation accidents. They are not designed to catch health events, but to insure you meet FAA/regulatory criteria to fly your missions for the duration of the certificate.
The family doctor is the one who manages your overall heath. People with cancer, still die of heart attacks despite extensive diagnostic testing and work ups before they begin their treatments. I might be one of the higher risk not because I have any known or potentially detectable medical problems, but because I fly a lot of time solo, and maybe half of that is night or ifr. Then it doesn’t matter if I’m flying the King Air or the J3 on amphib floats. Class I medical or not.
Between medicals, pilots self regulate. According to a report in 1969 there were 6 accidents out of 6,000 due to heart attacks. Seems to me that eliminating pilot error would be more useful than a several hundred page rule to reduce medical incapacitation while flying?
I’d love to hear the ATC tape on that one.
Or perhaps MRI scan.
There are small EKG units you can use yourself to get a ‘6-lead’ EKG, Portable Six-Lead Heart Monitor | KardiaMobile 6L | Kardia.
Though I’d hope a physician giving you an aviation medical clearance would perform an EKG. (S/he can use the Kardia on you in the office and keep a record, probably having paid for the optional subscription to more data.)
‘Vertigo’ probably has different manifestations.
One definitely is visual field rotating, recognizable if you have heard of the phenomenon - so pull over to side of road.
In an airplane trickier of course, perhaps hold controls steady. Bending down to dial radio probably not wise.
Of course you fly on autopilot don’t you?
(At least some causes are known such as:
The Class two does not require an EKG. Even if it did, it might not detect an occlusion. A stress EKG or echocardiogram does a much better job. Anyone who is older or has multiple risk factors should have his heart checked every couple of years by a cardiologist. I do. So far so good. In three years the insurance company is taking my keys away anyway.
I am happy to give any pilot who requests one an EKG at the time of their flight physical, whether or not the FAA requires it. (I am an AME) After all, I have to pay for the machine. But…
It would be far better for them to get the EKG from their family doctor or cardiologist who can actually do something with any abnormal findings. Then call me to learn what the FAA will require for their medical certificate issuance so we can have everything ready for them to minimize the FAA review time.
As @goldsternp and @David_Steere note, unless there is additional history, a resting EKG might not show significant heart disease, while an exercise stress test might. Between those FAA mandated visits, airmen are self-certifying and in flight medical events are rare, just as they are in cars on the ground.
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Interesting discussion from probably mostly elderly ? I am 84 and happily aviating, including multiple summers in Alaska. When practicing for the Bruce Protocol test 2 years ago I decided that I would not have been able to go for the limit even 20 years ago and opted for Basic Med instead (thanks AOPA). According to AOPA, inflight medical events under Basic Med without EKG’s are no more than for 3rd class which might have included Bruce Protocol stress EKG?
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If you need a stress test and can’t complete the Bruce, I’m pretty sure the FAA can accept a chemical stress test, if your cardiologist can explain why you can’t do the treadmill. I agree with the AOPA with the caveat that if there is cardiac disease, folks should do what their cardiologist tells them to do. BMed is a good option.
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Thankyou.
Good old stethoscope and doctor ears-brain not to be overlooked, mine noted a little blip on occasion, just something to be aware of long term.
Pulling over is more difficult in an airplane, take someone with you who has some pilot training as I hope the lady who landed a Kingair in Bakersfield may now do. She did OK with advice from pilot but …
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What is a ‘chemical test’ in this context?
There’s also risk of blood clot.
I know someone who had one, fortunately near the bottom of brain so not as damaging.
Knew risk would increase but between that person and doctor were slow to reduce risk.
That person had a Master Mariners license but didn’t command more than a 60 foot yacht.
It is a cardiac stress test but instead of using exercise to bring the heart up to capacity, it uses drugs to increase the load on the heart, simulating heavy exercise. It can be used for those with poor exercise ability. For pilots, arthritis or lung issues sufficient to require a non-exercise stress test it could open up a new set of problems.
As for clots the main cardiac causes are irregular heartbeats and those are usually treated with anticoagulation. As for strokes, they can be devastating or fatal anywhere in the brain. Prevention and immediate treatment if they occur is essential a stroke or potential stroke is always a 911 lights and sirens call in my book. But we are far off the beaten path or this topic.
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Thankyou.
Using ‘drugs’ to stress heart sounds dangerous in itself.
Our path is pilot incapacitation, we are discussing screening for risk.
Ps: I went to a neurologist who specializes in dizziness. He is a former NASA flight surgeon and so really knows the vestibular system.
Since dizziness can be a symptom of serious disease , it is important to get to the bottom of it. My neighbor’s vertigo turned out to be from a brain tumor.
Thanks.
One dummo responded to a person’s recommendation to get checked out by saying he’d just stop and ‘have a pint’. (Not a pilot fortunately, he had spent time in England so meant a pint of booze.)
BTW, there are body maneuvers to move the crystals in your hearing system to a location where they won’t interfere, at least for a while. A doctor who suffered from them made a video of the contortions she recommends.