CASA medical Standards Discussion Paper

[Jaba-who]

Dutch, Mike Borgelt is correct. Although I too don't have the studies available at present but I did read the statements by the EAA and American AOPA which summarised them and which used them as evidence when driving the American reform process and the results were undeniable and were the prime reason the US congress forced the FAA to adopt the essentially no medical position. The FAA did not dispute the studies beyond an initial and subsequently dismissed negative response. The congressional committee agreed with and believed the studies so I am prepared to accept they were adequately performed.

 

Essentially there were several studies which showed:

 

Medical incapacitation was extremely rare in all pilot groups. The rarity of the events makes it difficult to say anything about causes or preventions. Because of the rarity even single events cause mathematical skewing of results.

 

But:

 

When only medical incapacitation were considered - Almost all incapacitation were as a result of factors which would NEVER have changed by having a medical at some time prior to the event. Almost all were acute events that were completely unrelated to the pilot's general health such as food poisoning.

 

As I recall the rest were related to things like respiratory tract infections and acute illnesses that were not present at the pilots medical and would never have been predictable.

 

There was in my recollection a very very small number of cardiac events and as best I recall they were all in people who were commercial pilots and had actually passed their last medical. Again as best I recall - There were NO cardiac events in any of the medical incapacitations of any pilot who was NOT required to have a medical. BUT I have to stress that the numbers were so so incredibly small that the numbers were statistically not significant.

 

What they showed basically was that in the real world the effect of of having passed a medical offered no statistical safety benefit because the significant cardiovascular and cerebral events just happened to happen in the guys who had previously had a medical. The numbers of medical events were when you consider the hours flown and the numbers of pilots involved, is as good as zero in both groups.

 

That's the point of the whole thing - the immense cost, effort and inconvenience of medicals has been shown to not change anything. There is no gain in doing something that doesn't have any effect no matter how much we would like to think it seems like a good thing to do.

 

 

[Bennyboy320]

Lets all hope commonsense prevails & the changes happen soon, personally I think it will happen in conjunction with canceling the requirements for an ASIC.

 

 

[facthunter]

IF you're still doing SOME flying, they haven't succeeded yet. Nev

 

 

[davebutler]

davebutler, what did the NZCAA do? I was there about 16 months ago and their PPL medical system was more expensive and difficult than ours then. I'm looking to flee this dreadful penal colony.

I was told, over the Christmas holidays by a visiting Kiwi pilot that they, including this pilot, had a restricted medical that had similar flying restrictions to ours without the AvMed restrictions. I will contact him shortly and get further detail.

 

 

[Birdseye]

Is this just a load of nonsensical BS or am I just being unreasonable?

You were right first time, total BS. I've spoken to two AME, they both think the whole CASA AVMED operation is a farce.

 

 

[Mike Borgelt]

Guys, there is a post on the front page about the new FAA medical rule, also here: FAA Issues New GA Medical Rule - AVweb flash Article

 

I also have a copy of an ATSB report on medical incapacitation covering the period 1975 to 2006 in Australia. About 160,000 incidents/accidents in that period. 98 were said to have a medical incapacitation component but you should read the report as getting hit by a prop on the ground was one and getting hit by a rotor blade on the ground was another. I guess getting squashed flat as bug hitting a windscreen when the aircraft hits the ground at high speed counts as "medical incapacitation", then?

 

Another was an emergency evacuation of a 747 resulting in a broken collarbone of the F/O. I don't count hypoxia and carbon monoxide poisoning either as these are maintenance/operational issues.

 

I got the report as a pdf, I'll see if I can get the URL.

 

 

[Jaba-who]

Guys, there is a post on the front page about the new FAA medical rule, also here: FAA Issues New GA Medical Rule - AVweb flash ArticleI also have a copy of an ATSB report on medical incapacitation covering the period 1975 to 2006 in Australia. About 160,000 incidents/accidents in that period. 98 were said to have a medical incapacitation component but you should read the report as getting hit by a prop on the ground was one and getting hit by a rotor blade on the ground was another. I guess getting squashed flat as bug hitting a windscreen when the aircraft hits the ground at high speed counts as "medical incapacitation", then?

 

Another was an emergency evacuation of a 747 resulting in a broken collarbone of the F/O. I don't count hypoxia and carbon monoxide poisoning either as these are maintenance/operational issues.

 

I got the report as a pdf, I'll see if I can get the URL.

This is an ongoing problem with the ATSB and subsequently CASA who use their data inappropriately and classify events in inappropriate ways to (suspiciously) develop a spurious argument to bolster their preconceived position ( very similar to the Jabiru debacle where they used fuel exhaustion, airspace incursions etc as incidents of engine failures).

 

Makes you realise that you have to always read the actual studies not just the conclusions that are put forward. Or at least read other people's interpretations as well not just he authors opinion.

 

 

[Frankus1aust]

Well surely if you have a hidden vice which flags an alert as far as operating machinery like an aeroplane, then it should be investigated by an appropriately qualified doctor to ensure that it is not something which affects your abilities in that respect?I guess what I'm saying is that there should be a medical standard to meet of some description. However I do sometimes get the vibe when reading commentary about "easing" private pilot medical standards (something I don't inherently object to as long as it is done sensibly) that there is a small community out there which would like to advocate for zero medical standards to meet, or a situation which would have the same effect like relating the aviation medical standard to that of a drivers licence, which in practical terms is virtually none at all.

 

It is hard to collect data on whether medical standards have or haven't prevented accidents because by default, pilots with significant medical problems are grounded until those problems are resolved, like I was early last year (and was allowed back flying again when it had been fixed). So under the current regime you'll never know whether they would've ended up being a statistic or not. A certain level of gastro incapacitations in commercial pilots contributes little knowledge to this topic because by default, the inherent risk of eating out by necessity in weird and wonderful slip ports is going to sometimes result in consumption of a dodgy vindaloo, but in a two-pilot aircraft this risk is mitigated by default.

 

My wife was recently driving behind a truck driver on the M1. He coasted to a stop right in the middle of the motorway. As a doctor she stopped behind him and walked to the driver's side to check whether he was ok. He'd gone into a diabetic coma which had been undiagnosed. From a risk-management perspective, that's not the sort of thing you want to happen in a single-pilot aircraft.

Just regarding the Diabetic coma and diagnosed diabetes, that doesn't quite make sense as from my understanding to have a "hypoglycemic moment", a person would have too much insulin and too low bloodsugar. That is normally a risk factor for type 1 diabetics injecting insulin. There is a wide spectrum of control with type 1. Some people have no trouble with maintaining reasonably stable blood sugars and some are unstable. I would suggest the truck driver was on insulin and unstable. There is a whole protocol flying with diabetes type 1 set by Avmed and though it is rather convoluted, it does allow type 1 diabetics to fly. All be it geared to the lowest common denominator.

 

 

[Jaba-who]

Just regarding the Diabetic coma and diagnosed diabetes, that doesn't quite make sense as from my understanding to have a "hypoglycemic moment", a person would have too much insulin and too low bloodsugar. That is normally a risk factor for type 1 diabetics injecting insulin. There is a wide spectrum of control with type 1. Some people have no trouble with maintaining reasonably stable blood sugars and some are unstable. I would suggest the truck driver was on insulin and unstable. There is a whole protocol flying with diabetes type 1 set by Avmed and though it is rather convoluted, it does allow type 1 diabetics to fly. All be it geared to the lowest common denominator.

This is partly probable but is not strictly correct. Unfortunately for us and the current argument is a very convoluted story with diabetes nowadays.

for all intends and purposes type 1 (T1) and type 2 (T2) are completely different diseases whose common thread is the final denominator of high blood sugar with its concomitant side effects.

 

The old rule that T1 was treated with insulin and T2 was treated with diet and tablets no longer holds true.

 

Many many T2 are now treated with insulin ( usually as well as tablets)

 

Both types can have coma and both types can have coma from either too low or too high a sugar level.

 

The higher risk of coma is with patients on insulin - whether they are T1. Or T2 ( relative overdose causing low blood sugar) and this can happen rapidly from a reasonable normal feeling state.

 

There is less risk in a T2 person just on tablets.

 

Both types can have coma from from too high sugar levels but in both cases it is a slower onset and associated with being unwell for some time ( often days). Not commonly would a pilot going high feel well enough to go flying in the first place.

 

 

[dutchroll]

..... as from my understanding to have a "hypoglycemic moment", a person would have too much insulin and too low bloodsugar. That is normally a risk factor for type 1 diabetics injecting insulin. There is a wide spectrum of control with type 1. Some people have no trouble with maintaining reasonably stable blood sugars and some are unstable. I would suggest the truck driver was on insulin and unstable.

A bit of a typo there (edited by mod)

He was undiagnosed. As explained by Jaba above, he had a hyperglycaemic moment (blood sugar too high), not a hypoglycaemic (blood sugar too low) moment.

 

 

[Frankus1aust]

A bit of a typo there (edited by mod)He was undiagnosed. As explained by Jaba above, he had a hyperglycaemic moment (blood sugar too high), not a hypoglycaemic (blood sugar too low) moment.

Thanks for that

 

 

[ave8rr]

NZ seems to be having a discussion re PPL medical standards.

 

Review of Private Pilot Licence Medical Certification Requirements | Civil Aviation Authority of New Zealand

 

 

[Frankus1aust]

Regarding Diabetes, CASA/Avmed have lifted my diabetes type 1 safety pilot restriction so my C2 is now unrestricted. It took quite a while and the money I spent could have paid for a twin rating, however, they finally got there. The Avmed doctor was quite reasonable and I think an earlier incarnation of the system would have waited until I took them to court before acting. I think that is an improvement. All the same, the Avmed section was good and as soon as anything hit the CASA admin side, it was like they never read the doctor's letters. However change is possible and I wrote them a positive acknowledgement.