BASIC CLASS 2 - PRIVATE PILOT MEDICAL ANNOUNCED!

[ave8rr]

CASA talks about the Commercial Road Medical but have not said how (or if) it will be modified along the lines of the RAMPC with extra (Aviation) boxes to tick. I am at a loss to understand why they are calling the medical a "Basic Class 2". Give it a new number/name at least in my opinion. I believe they intend to charge the fee hence not just changing the privilages/validity of the RAMPC.

 

 

[phonetic]

Im stumped with my civilian drivers licence I can drive single axle truck upto 4.5 t GVM,but not able to fly any aircraft over 600kg MTOW ??

 

 

[poteroo]

The announcement was from CASA to say " we now have a policy to think about introducing a new version of a medical which we haven't actually written and don't have any idea what it's actually going to be. It will based on a standard which we will then modify to suit our perceptions but which have yet to be thought out. "

Right on the numbers!

 

The words simpler, easier, cheaper, better....... are impossible to link with the acronym CASA.

 

The air really is different in Canberra! Hypoxia at ground level.

 

happy days,

 

 

[djpacro]

You could even try reading the page properly. IF CLINICALLY INDICATED for private pilots.

I did indeed and I even went as far as reading the next clause: "... and every year for pilots over 60 years of age".

[aro]

While you are correct Mike that stress tests have a risk of inducing a cardiac event the risk is actually very low. And the CASA response would be that if you did have a cardiac event doing a stress test then it proves the point you had unstable disease so shouldn’t be flying till the cause is sorted out.

Is the risk low enough that you would go ahead with a test if for some reason the normal resuscitation equipment was not available, if the person looked fit and healthy? Or not that low?

 

The CASA response would be valid if you knew 100% that the person would have subsequently had an event in flight. However, if someone had a cardiac event during a stress test, but the chances (making up numbers) of having an event in flight would have been only 5% and they were 95% likely to have the event in bed, gardening, walking to the shops or not at all, then CASA would be saying that it is better to have 20 cardiac events during CASA testing than to have 1 in flight.

 

Private pilots typically spend less than 1% of the hours in a year in flight. If they are to have a cardiac event, odds are it won't be in flight. If there is any risk from a stress test, the probability might be that the stress tests will trigger multiple (maybe many) events for every in flight event you prevent. I'm not even sure whether it would be considered ethical for doctors to do these tests where not medically required, if the statistics were examined.

 

 

[Jaba-who]

Is the risk low enough that you would go ahead with a test if for some reason the normal resuscitation equipment was not available, if the person looked fit and healthy? Or not that low?The CASA response would be valid if you knew 100% that the person would have subsequently had an event in flight. However, if someone had a cardiac event during a stress test, but the chances (making up numbers) of having an event in flight would have been only 5% and they were 95% likely to have the event in bed, gardening, walking to the shops or not at all, then CASA would be saying that it is better to have 20 cardiac events during CASA testing than to have 1 in flight.

 

Private pilots typically spend less than 1% of the hours in a year in flight. If they are to have a cardiac event, odds are it won't be in flight. If there is any risk from a stress test, the probability might be that the stress tests will trigger multiple (maybe many) events for every in flight event you prevent. I'm not even sure whether it would be considered ethical for doctors to do these tests where not medically required, if the statistics were examined.

Health departments and the specialist colleges have rules about what equipment has to be in place to do the tests. So we have them in place regardless. Of course the great majority of people coming for tests have some symptoms or actual suspicion there is a disease process going on so they would justify having the resusc equipment. So when the occasional healthy pilot comes in you have the gear there already so you don't have to make any decisions about going ahead without it.

 

As far as the proportion of events stress testing would cause compared to events in flight - they are both so rare that you would probably have to test for decades before you could generate enough numbers to show any actual positive events comparison that was valid.

 

This is the problem of using statistical significance without considering the clinical significance. A problem that CASA often seems to not understand.

 

For example - if you have a rare event and it happens say once in a year across all of Australia. In a particular year it happens twice. Statistically the event has doubled in incidence and would cause red flags to rise in statisticians everywhere because a 100% increase is statistically significant. But in clinical reality an event that happens once in a million tests is as good as exactly the same as an event that happens 2 times in a million tests.

 

No sensible person would say that the rise from 1 to 2 would justify doing expensive tests with intrinsic risks and an incidence of false positives or false negatives ( as all tests have) on everyone to try to prevent that one extra case.

 

So yes as you ask, is it ethical to do tests that have a high risk of causing a problem in a population with a low risk of having the disease they are searching for?. And the answer is basically no it would not be ethical.

 

The saving grace is that in the pilot population having a stress test ( where no symptoms are present) is pretty much a no or very low risk. Almost certainly less than the already negligible risk of having a cardiac event in the air. But both are so small the mention of rather cause 20 events in the stress lab rather than 1 in the air is a non-sensical statement.

 

 

[aro]

Health departments and the specialist colleges have rules about what equipment has to be in place to do the tests. So we have them in place regardless.

Sure, but no-one would know they weren't there if you didn't need them anyway. So ignoring the rules is a risk you could take, but don't.

 

But both are so small the mention of rather cause 20 events in the stress lab rather than 1 in the air is a non-sensical statement.

Not really. If you test long enough on a big enough population of pilots you can gather statistics, at which point you can compare events in the stress lab vs. events in the air. 20 was a made up number, it might be 5 or 2, or you might surprise me and get a number less than 1. Probabilities still exist for rare events - they just become difficult to measure. You definitely need to know the probability of an event in the stress lab, and how much that test reduces the probability of an event in the air before you can justify the test.

 

Here's a hypothetical: A patient comes to you and requests an angiogram. They do manual laboring, and the company doctor has created a policy that workers over 50 must have an angiogram because they don't want people to have a heart attack on the job. There are no indications they need it, but if they don't get the test they will lose their job. Do you do the test?

 

 

[Happyflyer]

I did indeed and I even went as far as reading the next clause: "... and every year for pilots over 60 years of age".

You could read that, if you left out the bit in bracket, as applying to class 1 only. Classic CASA wording. I think the over 60 reference is back to class 1 as you can see on this chart.

avmed_reference_chart_2.png | Civil Aviation Safety Authority

 

 

[old man emu]

Here's a hypothetical: A patient comes to you and requests an angiogram. They do manual laboring, and the company doctor has created a policy that workers over 50 must have an angiogram because they don't want people to have a heart attack on the job. There are no indications they need it, but if they don't get the test they will lose their job. Do you do the test?

Of course you do. No doctor is fool enough to knock back a monetary windfall. If nothing comes up, the doc makes a small profit. If something does, "All aboard the gravy train!"

 

 

[GraemeK]

For example - if you have a rare event and it happens say once in a year across all of Australia. In a particular year it happens twice. Statistically the event has doubled in incidence and would cause red flags to rise in statisticians everywhere because a 100% increase is statistically significant. But in clinical reality an event that happens once in a million tests is as good as exactly the same as an event that happens 2 times in a million tests.

Jaba - statisticians are actually a whole lot smarter than that! Rare events have their own statistical treatment, and that would likely not be regarded as significant. The press, on the other hand, love to blow things out of proportion - as in reporting road deaths for instance ("Horror weekend on roads" when even quite large increases are not statistically significant).

 

 

[Jaba-who]

Sure, but no-one would know they weren't there if you didn't need them anyway. So ignoring the rules is a risk you could take, but don't.

Oh how I wish that were true. The health department's have HUGE lists of requirements for medical facilities depending on what they aim to do there. There they send inspectors ( "the dragon ladies" we called em ). They would come and check you had everything required in just the right places etc or you got no accreditation and then you got not provider number so you could not bill for it. You cannot undertake medical practice of certain procedures in an unaccr cited facility. Acccreditation happens at regular intervals varies according to the stuff you are going to do there.

 

Accreditation costs tens of thousands of dollars and they can close your practice down for ridiculous stuff. When we set up a small day unit for minor stuff we had all the required stuff you mentioned but some of the stuff that got knocked back was unbelievable:

 

Mop in the closet was on a hook too high above the bucket - fail cos drops could splash out and contaminate floor

 

Yellow curtains too bright - distract patients from reading safety signs.

 

Had to change tap handles to $800 long arm ones you can turn on and off with elbows because sink had a soap dispenser next to it - that made it a "scrub sink" despite no surgical scrub happening in that room. Ok we'll take away the soap dispenser - Ha Ha no you won't because you have submitted the room inventory and it has a soap dispenser. Can't go backwards only forward.

 

And even if you could get away with out accreditation requirements for sure Murphy's luck would be that your first patient would be the rare one and you could not defend the bad outcome. Negligent!! and the health department would be on your like the proverbial ton of bricks.

 

 

[Jaba-who]

Not really. If you test long enough on a big enough population of pilots you can gather statistics, at which point you can compare events in the stress lab vs. events in the air. 20 was a made up number, it might be 5 or 2, or you might surprise me and get a number less than 1. Probabilities still exist for rare events - they just become difficult to measure. You definitely need to know the probability of an event in the stress lab, and how much that test reduces the probability of an event in the air before you can justify the test.

Here's a hypothetical: A patient comes to you and requests an angiogram. They do manual laboring, and the company doctor has created a policy that workers over 50 must have an angiogram because they don't want people to have a heart attack on the job. There are no indications they need it, but if they don't get the test they will lose their job. Do you do the test?

First point - that's exactly what I was saying but I was implying a step further. Sorry you didn't get what I meant.

 

How many pilots are there in Australia? About 40000 I think, many of whom are not active. How many of the active ones would have clinical justification for needing say a stress test? Probably a few maybe. How many are forced to have one? Maybe a few hundred.

 

We already know that several hundred thousand stress tests are done per year in Australia alone and there are less than probably a hundred events needing resuscitation. Almost all ( Mabye all) of these are on patients who have some clinical reason to suspect heart disease. Therefore the risk of adverse event in a population with higher risk is negligibly small.

 

So it is reasonable to suspect that the risk in a population done purely as screening who have no cardiac risk must be even smaller.

 

But what we don't have in Australia is enough pilots or enough time to do enough tests to actually gain any usable information.

 

But what we do know is the raw numbers from the limited data we have is that the risk is probably near zero.

 

The practical lack of subjects makes the thought process hypothetical and its attempted use in clinical ( or administrative/ real world scenarios) futile.

 

 

[facthunter]

I think there's times in the past when we had plenty of DATA. Bruce's protocol stress ECG has been the "thing" for years, despite many learned medico's questioning it's value at predicting a heart event. It can even cause one (as you would know). Often some time later. Many airline Pilots I'm aware of having cardiac problems and several fatals had done the full medical (class 1) not long before. One died walking to the car park to drive home after a flight that was not such as to be stressful. at all. and he was about age 40. Nev

 

 

[Jaba-who]

Quote:

 

“Here's a hypothetical: A patient comes to you and requests an angiogram. They do manual laboring, and the company doctor has created a policy that workers over 50 must have an angiogram because they don't want people to have a heart attack on the job. There are no indications they need it, but if they don't get the test they will lose their job. Do you do the test?”

 

In today’s world of litigation and informed consent it’s a no brainer and easily answered.

 

We tell the patient of the risks and benefits, advise the patient what is clinically appropriate. Then the patient chooses to go ahead or not.

 

Informed consent by law now requires advice of the consequences of not going ahead with treatment. ( in this case - not fulfilling the employers demand but that’s already known to the patient. But they make the decision not the doctor.

 

We tell the patient all the risks and benefits.

 

The patient is then by law required to consider the options and sign a consent form outlining they have considered and understand the risks and they wish to go ahead. Some of our consent forms are simple , some go for several pages. The longest I have seen in our institution is 4 A4 pages long.

 

A consent form is not a waiver to prevent suing. It is an acknowledgement they have been advised of the risks and benefits and they accept those risks.

 

In the case of a work related test - it would be an intrinsic benefit that they get the job. And also intrinsic risk of the test is having a complication of the test ( or indeed failing the test and losing the job )

 

Now I don’t for a minute suggest every patient does much more than say “yeah doc, I’m fine on that give me the form. “

 

But the option is there to ask lots of questions and back out before going ahead.

 

 

[Jaba-who]

Jaba - statisticians are actually a whole lot smarter than that! Rare events have their own statistical treatment, and that would likely not be regarded as significant. The press, on the other hand, love to blow things out of proportion - as in reporting road deaths for instance ("Horror weekend on roads" when even quite large increases are not statistically significant).

Yep. You are completely correct.

I should apologize to statisticians.

 

Statisticians give us the numbers. It’s the media, the government and CASA which take the numbers and turn it into a numeric abomination for their own agendas.

 

There’s been heaps of examples over the years. But essentially I’m sure the statisticians would tell casa the figures should not be used because they are too small to be statistically or practically usable. But I doubt CASA bothers with that. That have a history of misusing statistics.

 

 

[facthunter]

It's pretty easy for someone with the power ( having to keep the job) to just make these requirements mandatory without having to justify their effectiveness. There's not insignificant risks with an angiogram that you are familiar with, no doubt. A stress ECG with an appropriate ultrasound examination seems like a useful combination.

 

.If you can walk up 3 flights of stairs fairly briskly and don't go red in the face or breathless, you are sort of, OK.

 

If you are carrying heaps of fat around your middle Don't exercise , smoke and drink alcohol a lot or even a large bottle of Coke regularly and eat cakes processed meat lots of sugar and salt stop kidding yourself .You have a dangerous, risky, lifestyle without the thrills.. You must decide whether you want to keep living and be healthy or you don't. There's a lot of information on Diabetes coming out lately that's quite interesting.. Fixing problems with pills is the "apparent" easy fix but there's side effects with all medicines and they make a lot of money for the Drug companies. Drugs can react adversely with each other and with some foods, and some are short term only, and some only treat symptoms. Not the cause. They can save your life in critical situations as can surgery, but if you don't change your lifestyle it's all wasted. Your pipes will still block up even though you just had a triple bypass, some end up as bad again within 3 years if they don't change permanently the CAUSES of the problem. Nev

 

 

[Jaba-who]

It's pretty easy for someone with the power ( having to keep the job) to just make these requirements mandatory without having to justify their effectiveness. There's not insignificant risks with an angiogram that you are familiar with, no doubt. A stress ECG with an appropriate ultrasound examination seems like a useful combination..If you can walk up 3 flights of stairs fairly briskly and don't go red in the face or breathless, you are sort of, OK.

If you are carrying heaps of fat around your middle Don't exercise , smoke and drink alcohol a lot or even a large bottle of Coke regularly and eat cakes processed meat lots of sugar and salt stop kidding yourself .You have a dangerous, risky, lifestyle without the thrills.. You must decide whether you want to keep living and be healthy or you don't. There's a lot of information on Diabetes coming out lately that's quite interesting.. Fixing problems with pills is the "apparent" easy fix but there's side effects with all medicines and they make a lot of money for the Drug companies. Drugs can react adversely with each other and with some foods, and some are short term only, and some only treat symptoms. Not the cause. They can save your life in critical situations as can surgery, but if you don't change your lifestyle it's all wasted. Your pipes will still block up even though you just had a triple bypass, some end up as bad again within 3 years if they don't change permanently the CAUSES of the problem. Nev

All true nev. but your last line is the stumbling block. We live in the age of “I want a quick fix or no fix!”

 

I would see at least one patient every day of my working life who has a disorder who is not managing it and the lifestyle which has caused it properly. Almost all are aware and started on the appropriate changes to manage it but have abandoned it somewhere along the way.

 

WRT angiograms vs stress tests ( of which there multiple different types). The problem with choosing a blanket test for everyone is that they actually show you different things and neither tells you everything.

 

And stress echos actually carry the highest risk you can’t do the test itself. Fat people sitting or standing while exercising are hard to get good images on ultrasound. So you often end up just saying the test was inconclusive. If you really wanted cover all bases you’d make everyone have both. But even then you’d still run into issues. Both have false positives and negatives and sadly the false + or - can create more problems sometimes.

 

It’s all compromises but the biggest issue is that no matter what the findings on the test (even positive findings ) there is no proven correlation with pilots having medical incapacitation in flight.

 

They might as well ask your eye color and ground all blue eyed pilots for all the good it will do.

 

 

[facthunter]

You are right on the money there. The echo was done immediately after I did the last Bruces protocol (plus 2 extra minutes on the incline). With out the ultrasound it would have only proved I didn't have a heart attack THEN. It's a bit like testing an old wooden bridge by putting 5 locomotives on it.. I didn't think it proved much but the Cardio fella was elated. I think I was some sort of test firing like a rocket or moon lander. If it buggered up I'm probably dead so I thought the risk was entirely mine.. Nev

 

 

[Mike Borgelt]

Pal of mine told me last week he gave up commercial flying at age 63 because of the stress ECG. The doc who did the third one said there was NO WAY she would have one.

 

Now all this talk of the Basic Class 2 is nonsense while we don't know the details which I'm sure CASA don't know yet. They are making it up as they go. Good to see Ben Morgan of AOPA is backtracking on his wholehearted endorsement of the CASA "announcement".

 

This all misses the point: You are a far greater risk to yourself, your passengers, other road users, pedestrians and even people minding their own business in their houses when you are driving an ordinary private motor vehicle than when you are flying a small aircraft. Hence the Basic Class 2, Class 2 etc is BS and the medical ability to drive a private motor vehicle is all that should be rationally required.

 

 

[Bruce Tuncks]

People are not rational when it comes to aircraft. It comes from being tree-dwellers in our recent evolutionary past .How many apes died from injuries from falling compared with being hit by a truck on the freeway?

 

So you win the argument on logic Mike but lose it on emotions.

 

I have said before, that you are at double the flying risk by being 5 kg overweight. Nobody wants to know that kind of stuff.

 

However, we should keep reminding the powers that be how their powers are based on nonsense.

 

 

[Mike Borgelt]

Saw a good quote the other day: "the people making the laws and regulations are no more qualified to do so than you are".

 

Which is why I'm a fan of sortition. Look it up.

 

 

[Mike Borgelt]

Or the Texas State congress which meets every second year for a few weeks, so I've heard . Less damage that way.

 

 

[Mike Borgelt]

Don't know about being tree dwellers in our recent evolutionary past. I've seen one theory that say we are descended from apes who could tolerate the alcohol in fermenting fruit. Which makes us the descendants of drunken monkeys. Don't believe it? Look around you.

 

 

[old man emu]

I wonder what would happen if CASA employees were told that they had to pass the professional drivers' medical to maintain their employment.

 

One way to get rid of Fat Cats.

 

 

 

[Bruce Tuncks]

Years ago, the fire service lost a bid to apply a "gender-biased" test of strength to new recruits. The reason they lost it was that they didn't require their fat cats to keep up to the standard.

 

So now, a small fire-woman might have to lift your body and climb down a ladder or else leave you there if she wasn't strong enough.

 

Personally, I reckon they should make the fat cats do the test and lose their operational status if they couldn't pass.