Medical Certification Modernization

Aviation Medical Examiners Guide Updates Reflect Progress

The medical certification branch of the FAA continues to take a more streamlined and transparent approach to airline pilot health and wellness. A good example of this is the number of important updates the agency has published this year in its Guide for Aviation Medical Examiners (AME).

The aeromedical certification standards for pilots can be found in 14 CFR Part 67 of the federal aviation regulations, and this language is further explained and interpreted in the AME guide. Through its monthly updates, the FAA continues to document policy improvements, quicker certification response times, and a broader range of options for pilots with medical certification and health questions.

The agency is taking a “good, hard look at your existing policies to make sure that they’re consistent with science-based, risk-based decisions,” said Dr. Susan Northrup, the federal air surgeon who leads the FAA’s Office of Aerospace Medicine. In a recent interview, she revealed that an internal working group has developed a risk-assessment tool that enables her office to evaluate different diagnoses. The tool allows her team to quickly determine the best course of action while ensuring aviation safety.

Recent Changes

Recent improvements announced in the guide include a new direction related to the application of the antidepressant program. Additionally, new guidance and protocols are given to special clinical visit documentation requirements for processing the AME-assisted special issuance (AASI) certification for conditions including anxiety, depression, and related issues.

Other recent AME guide updates:

• Four new ophthalmology disposition tables for dealing with amblyopia (lazy eye), chorioretinitis (inflammation of the retina and choroid), diplopia (double vision), and retinoschisis (separation of the retina layers).
• Three new vascular disposition tables for peripheral arteriovenous malformation (an abnormal connection between arteries and veins), Buerger disease/thromboangiitis obliterans (an inflammatory condition that causes blood clots and the swelling of certain veins), and postural orthostatic tachycardia syndrome (increased heart rate when an individual stands up).
• Two new gastrointestinal and musculoskeletal disposition tables for congenital sucrase-isomaltase deficiency (a condition preventing the small intestine from breaking down certain sugars/starches) and osteomyelitis (a bone infection).

  In addition, the following policy changes were announced:

• Asthma: An AASI revision removing the three-medication limit.
• Biologics and biosimilars (complex medications produced from living sources vs. chemical synthesis): Clarification that Food and Drug Administration–approved biosimilars are acceptable for the same brand-named medications and the addition of Bimzelx^® to acceptable interleukin inhibitors (medications that reduce inflammation by blocking specific interleukin proteins or their cell receptors).
• Chronic obstructive pulmonary disease: Disposition guidance clarifying the oxygen saturation measurement at rest on room air.
• Diabetes medications: Reorganization of the medication groups and revision of observation periods associated with starting, adding, or changing diabetes medications.
• Migraine medications: Revision of several required postdose, no-fly intervals related to triptans and calcitonin gene-related peptide rescue medications.
• Osteoporosis medications: The acceptable medication guidance was revised to include additional treatment options.
• Low testosterone/hypogonadism: The status summary was revised to use a hematocrit greater than the 54 percent threshold as disqualifying.
• Sarcoidosis (an inflammatory disease affecting the immune system): The disposition table was clarified regarding bilateral hilar lymphadenopathy (a symmetrical enlargement of the lymph nodes in a portion of both lungs) alone.
• Drug and alcohol monitoring/HIMS: FAA guidance and FAQs were revised to further clarify HIMS AME monitoring responsibilities.

There’s also new guidance for AMEs receiving subpoenas. When an AME receives an order to appear in court or before a legal authority for a case involving a pilot’s medical record or testimony, the updated guidance directs the AME to notify the regional flight surgeon and forward a copy of the subpoena. Importantly, the AME is instructed not to independently release the pilot’s FAA medical records or communicate further with the party seeking the records.

In a recent episode of the Air Line Pilot Podcast, Dr. Quay Snyder, the Association’s aeromedical advisor, noted, “There are some limitations given the politics, the resources, and the existing regulations, but my feeling is that U.S. Federal Air Surgeon Dr. Susan Northrup and her staff are fully committed to making positive changes.”

For the latest updates to the AME guide, visit the FAA website.