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GP – CME 2014 workshop
Claude PreitnerFRNZCGP – FACASM
Senior Medial Officer
Civil Aviation Authority
Senior Medical Officer with CAA
No financial interest in any of my presentations
Picture: Glass Cockpit - Cessna 4 seats
General Aviation Aircraft ◦ CAA Private Pilot licence
◦ Class 2 CAA medical certificate
◦ GPs obligations to report changes in medical conditions suspected to affect flight safety
(s27C Civil Aviation Act)
If reasonable grounds to suspect a pilot “maybe unable to ….exercise safely …privileges”
Must inform the Director (i.e. the CAA doctors) and the pilot of doing so◦ Low threshold (suspect….may be)
◦ Indemnified Act
Incapacitation
Impairment of functional capacity
Impairment of cognitive function:◦ medication◦ drug / alcohol◦ organic brain disease◦ sleep apnoea
Behaviour ◦ Mental health◦ dangerous act◦ drug / alcohol
Recreational Pilot licence (RPL)
Licence issued by CAA Your average small Cessna / Piper / LSA 1 Passenger only No night flying / no instrument flying / no aerobatics
Commercial Driving Medical Certificate Class 2 or above with P endorsement - by GP – DL9 form
◦ “medical practitioners to consider medical aspects of fitness to drive when conducting a medical examination to determine if an individual is fit to drive”.
◦ GP responsibilities: Certify in accordance with guidelines
Under some circumstances, a licence may be granted with conditions to existing holders of these classes and/or endorsement types.
If there has been a full and complete recovery with no suggestion of recurrence over a period of three years,
the possibility of a return to driving may be considered by the Agency (via the Chief Medical Adviser). A supporting specialist physician or neurologist’s report will be required.
Acute uncomplicatedmyocardial infarction
Should not drive for at least fourweeks. Return to driving subject to specialist assessment.
Coronary artery bypasssurgery
Should not drive for at least threemonths. Return to driving subject to specialist assessment.
Self regulating organisationsCivil Aviation Rules - Part 149
• Microlight
• Gliding
• Hang-glider pilot
• Parachuting
• Balloon
Medical Declaration
Long flights
Dehydration
Hypoxia
Bends
Medical Advisor: Dr David [email protected]
Weight < 600 kg
2 seats max
Stall speed <45 Kts
No flight over congested areas
Some have balistic parachutes
Medical advisors
Dr Hugh Tapper, Invercargill - RAANZ
Dr. Krishnen Pillay, Cambridge – SAC
Medical Declaration
(a) Epilepsy and other periodic disturbances of consciousness, giddiness, history of severe head injury.
(b) Diabetes, requiring insulin therapy.
(c) High blood pressure, coronary artery disease.
(d) A history of alcoholism or drug addiction.
(e) Psychiatric disorder.
Medical Declaration for new participants
None for certificated sky divers
Class 2 CAA certificate for tandem masters
http://www.nzpf.org/
Several accidents in recreational aviation with fair paying passengers◦ Hang-glider accident
◦ Masterton Balloon accident
CAA has responded
by certifying “adventureaviation” (Part 115 of the Civil aviation Rules)
The Professional Association of Scuba Instructors (PADI )
http://www.padi.com/scuba/scuba-diving-trips/scuba-diving-resort-vacations/newzealand/
http://www.globaldive.net/wp-content/uploads/2009/04/10063_MedStmt_v201.pdf
Physician’s Impression
I find no medical conditions that I consider incompatible with diving.
I am unable to recommend this individual for diving.
Remarks……………
incapacitation◦ Cardiovascular
◦ Asthma / emphyzema / pneumothorax
◦ Eustachian tube / sinus
◦ Neurological i.e. seizures
◦ Poor physical fitness
Functional capacity ◦ Back / limbs / vision
◦ CV fitness
Cognitive function◦ Medication / alcohol / drugs
◦ Nitrogen Narcosis
Behaviour
Functional ability to do the task
No condition that could be made worst by the activity / (unless risk mitigation can be implemented)
No condition that may put others at risk
Condition being treated
◦ Pain – Sleep, mood, distraction
◦ Depression
◦ ENT
◦ Skin
◦ Respiratory
◦ Cardiac
◦ Cancer
Medication
◦ Side effects
Cognitive / mentation
Vision: i.eanticholinergic, isotretinoin
◦ Risk of incapacitation
Anticoagulants
Increase risk of seizure
QTc prolongation
Depression in full sustained remission ~ 3 months
Medication acceptable
Fluoxetine acceptable Citalopram acceptable Sertraline acceptable
Venlafaxin less/not acceptable Aropax less/not acceptable TCA generally not acceptable Multiple medication generally not acceptable
Case by case assessment by CAA
Chronic pain
Severity of condition◦ Functional capacity ◦ ADL ? i.e. sitting tolerance◦ Sleep ?◦ Mood / Frustration ?◦ Distraction
Medication◦ Cognitive function?◦ Impairment / Incapacitation ◦ i.e No opioids, no anti-epileptics
No flying while in pain
No flying on Prednisone until:◦ Dose reduced to below 10 mg per day
◦ Condition
No flying for one month
Return if no significant side effects, mood alteration etc.
Night flying restriction until one month after cessation
All this administered by CAA
Cardiovascular◦ CAD, Tachyarrhythmia (AF), Vasovagal syncope etc.
Neurological◦ Migraine
◦ Stroke
◦ Epilepsy
◦ Transient Global Amnesia
http://www.caa.govt.nz/medical/Med_Info_Sheets/Med_info_sheets.htm
Metabolic / Endocrine◦ Diabetes on insulin or sulfonylurea
Other incapacitating conditions◦ Crohn, Ulcerative colitis, Cholelithiasis
◦ Renal lithiasis
◦ Unstable Asthma
◦ COPD
Absence of side effects: ◦ Period of observation on the ground
Implement the change when the pilot is able to have down time ◦ i.e. increasing BP treatment or Metformin
◦ Introduction of an ACE inhibitor
Request to provide regular information:
◦ GP report i.e. every 3 months
◦ Biochemistry / blood count
◦ Psychiatrist report
◦ Psychologist report
◦ Drug and Alcohol counsellor report
◦ Oncologist report
◦ Cardiologist report………….etc
Mr X was seen today, he is well and continues to be fit to fly
“Mr X was seen today. He is in good spirit, he reports sleeping well and having no problem with concentration. He has resumed and enjoys sailing. He continues taking Fluoxetine 20 mg per day. He takes no other medication. On examination…..or,”
Write your notes in some details and give a copy to your patient
See NZMC guidelines on reporting to third parties.
GPs have an important safety role when certifying patients for any recreational activity (flying, diving)
Certify according to the applicable guidelines
Inform your patient of their “risk” of impairment or incapacitation – I concern report to us @ CAA
Stay factual, advocating may put the patient at risk
CAA and relevant Flying Organisations medical advisers can give assistance when in doubt
Condition may be limiting factor
Medication / treatment may be limiting factor
Ethical dilemma
◦ Best treatment for the condition ? or
◦ Lesser but acceptable treatment for certification ?
Duty to inform CAA 04 560 9400
aviation medicine team [email protected]
Please share your experience
