zGA Class 2 Medical

[Geoff_H]

I am due this month for my GA medical.  When does the new GP approved system start.  Last I saw was middle of the year.  Should I wait or do the old medical.  Don't intend to fly in the next few months.

 

 

[Jaba-who]

I am due this month for my GA medical.  When does the new GP approved system start.  Last I saw was middle of the year.  Should I wait or do the old medical.  Don't intend to fly in the next few months.

No don't wait. 

On another thread on this forum there has been a statement that current word is that CASA have quietly cancelled the expected due date without new one to replace it. 

 

Can't vouch for any of the accuracy if it but ....

 

If you  hold off there are two likely scenarios. 

 

1. No basic class 2 eventuates. You are left without a medical for prolonged period waiting and then going and getting the new one and the delay of delivery of it etc. 

 

2. It does come out and all the initially mooted exemptions and restrictions that they originally said would be added to the Ausroads  standard medical are in place and and you can't get the medical and you have to back and try to get a standard class 2. So you're  without a medical again fir protracted period. 

 

You have to understand that there is no actual relaxation of the medical standard - CASA  has never said there is going to be.  There has never been any statement saying that if you can no longer pass the Class 2 that we are introducing a lower standard so you can keep flying. 

 

They have said you can pass a test based on the Ausroads commercial medical. They then assume that everyone will just assume it's a lower standard.

 

 Which if you go through the standard  line by line ( the pages for doctors I mean where it actually tells you what the standard is) it is actually not that much different from a class 2.  There's a couple of very specific narrow medical states that you could be able to get it provided your medical condition is well controlled and stable - but if you work at it these now apply to the class 2 with effort and cost.

 

BUT the kicker is they said there will be restrictions as they feel appropriate to aviation. It's these kickers which may belt you back to needing to go to CASA for  a standard class 2. 

 

They have always said this is a administrative thing. If you are fit to pass the test you can get your GP ( if he is willing) to give you the licence instead of a DAME. But frequency of exams, same cost to see the doctor. 

 

Probably a small cost difference for the CASA part but that's about the only gain.

 

i wouldn't hold on. Buff yourself up and get your class 2.  

 

 

[Akromaster]

Geoff, are you referring to the "on the spot" issue of Class2 medical?...From CASA website:

 

On the spot Class 2 aviation medical certification (from 4 April 2018)

 

(https://www.casa.gov.au/standard-page/changes-medical-certification)

 

1@Jaba-who[/uSER] I haven't followed the other thread, but have they not implemented this?  I let my medical lapse because I was just flying RAA but I will want to get it back later this year so I was looking forward to this process.

 

[EDIT] Or do you mean the "Basic Class 2 medical" as Jaba-who inferred that allows the GP to approve?

 

Ak

 

 

[Nobody]

The change that allows the doctor to issue the certificate straight away has come into force. The doctors have to do some online training to do it but many have. I know because mine has. It means that the doctors decides if you meet the standard and not CASA and if you pass you have the certificate there and then. The changes that allow for a reduced medical standard have not yet come into affect(if ever)

 

 

[Geoff_H]

Just called CASA Medical.  They told me that the Basic Class 2 is still on track for July 1 and that they are doing testing in the near future.

 

 

[Jaba-who]

The change that allows the doctor to issue the certificate straight away has come into force. The doctors have to do some online training to do it but many have. I know because mine has. It means that the doctors decides if you meet the standard and not CASA and if you pass you have the certificate there and then. The changes that allow for a reduced medical standard have not yet come into affect(if ever)

Well the discussion that is going on on the Australian flying doctors Facebook page is that very few doctors have taken up the option. 

Theres a lot of concern about liability if a licence is granted and a pilot then has a problem. I’m certainly not applying for it until there had been plenty of people do it and not have any problems for a fair amount of time. 

 

The basic medical is not really a reduced standard. For all practical considerations The Austroads commercial is pretty much the same standard. 

 

 

[Birdseye]

Well the discussion that is going on on the Australian flying doctors Facebook page is that very few doctors have taken up the option. Theres a lot of concern about liability if a licence is granted and a pilot then has a problem. I’m certainly not applying for it until there had been plenty of people do it and not have any problems for a fair amount of time. 

 

The basic medical is not really a reduced standard. For all practical considerations The Austroads commercial is pretty much the same standard. 

From memory and it was a while ago that I read it, the Austroads standard does appear to give some hope to those with non-insulin medicated type II diabetes, that would have otherwise had to jump through a swag of CASA hoops.

 

 

[Nobody]

Well the discussion that is going on on the Australian flying doctors Facebook page is that very few doctors have taken up the option. 

CASA list the doctors who have done the extra training to be able to instantly issue the Class 2 medical (DAME2), you can search for them here:

https://www.casa.gov.au/licences-and-certification/aviation-medicine/search-medical-examiner-or-eye-examiner/delegated-dame2

 

While the list isn't as long as the DAME list it is a bit if an exaggeration to say it is "very few"

 

 

[Jaba-who]

From memory and it was a while ago that I read it, the Austroads standard does appear to give some hope to those with non-insulin medicated type II diabetes, that would have otherwise had to jump through a swag of CASA hoops.

Not quite. 

If you have it now you can still keep your licence as long as you are stable and well controlled but all the assessment must go through AvMed. 

 

With the new system as best we know ( because remember CASA Have not released whatbthe rules will be , they have suggested what might be involved ) CASA have stated that if you have a number of conditions that previously excluded you from having a simple straightforward medical ( and type 2 diabetes was one of these) you will still have to go through AvMed. You still won't be able to get a simple "pass" from a GP.  

 

But once again I have to add. That's just as it appears from the various press releases that have been made. It could all change ( for better or worse) when they actually publish what these rules will actually be. 

 

 

[Jaba-who]

CASA list the doctors who have done the extra training to be able to instantly issue the Class 2 medical (DAME2), you can search for them here:https://www.casa.gov.au/licences-and-certification/aviation-medicine/search-medical-examiner-or-eye-examiner/delegated-dame2

 

While the list isn't as long as the DAME list it is a bit if an exaggeration to say it is "very few"

Statistically of all the doctors who could use the capability of having the approval and are now instantly in a position to go and get the approval you're right,  it is "not very few". ,  it as actually almost zero! 

But thats of all doctors who could go get the qualification for anything from frequent to minimal need. 

 

According to the discussions on the Facebook page of doctors who fly and do medicals etc. and a reasonable need or use for it  ( those of us in the know) it's only about 10% of doctors who could use it.

 

That is actually have a sufficient clientele base who do need aviation  medicals ( DAMES, GPs with a sizeable pilot patient load etc  (who have not got DAME qualifications and want to do medicals etc) who have taken up the qualification. 

 

Whether that amount will increase remains to be seen. I suspect As soon as the first law suite happens for a wrongful clearance being given there will be a mass exodus. 

 

 

[pmccarthy]

After a period without a medical due to illness, my new medical arrived today. The Avmed people were courteous and helpful whenever I contacted them and really could not have renewed it any quicker because I had trouble getting specialist reports. But the renewal is only til January, a year since I saw the DAME, then I have to start over, which is a pain. I have a RAA flight review but now have to arrange a GA one and I am back to full flying. So it can be done, though I lost a bit of sleep about it.

 

 

[Nobody]

Statistically of all the doctors who could use the capability of having the approval and are now instantly in a position to go and get the approval you're right,  it is "not very few". ,  it as actually almost zero! But thats of all doctors who could go get the qualification for anything from frequent to minimal need. 

 

According to the discussions on the Facebook page of doctors who fly and do medicals etc. and a reasonable need or use for it  ( those of us in the know) it's only about 10% of doctors who could use it.

 

That is actually have a sufficient clientele base who do need aviation  medicals ( DAMES, GPs with a sizeable pilot patient load etc  (who have not got DAME qualifications and want to do medicals etc) who have taken up the qualification. 

 

Whether that amount will increase remains to be seen. I suspect As soon as the first law suite happens for a wrongful clearance being given there will be a mass exodus. 

Jabba-who I am not sure I follow your post. There are 2 changes to the medical system under way. The first allows for a DAME to issue a class 2 medical on the spot rather than just sending the report to CASA who would then take weeks (or months to review) and then they would issue it. This has come into effect.   The advantage of the this is that it should lead to simpler and faster medicals for people who want a full class 2 medical. The liability for the doctor shouldn't be any greater than under the old system as they are acting as CASAs representatives. To be able to do it the doctors have to undergo some online training and are now listed as DAME 2 on the CASA website. I posted the listing of doctors who have done this extra training to show that many of the DAMEs can now issue a class 2 on the spot if you meet the requirements.

 

The second change that is still coming is the introduction of a basic med medical to replace the RAMPC. Not a lot is know about this change. It could be great or not. The idea is that GP is able to issue some form of certification to allow (limited) flight privileges. I suspect that this is what the the doctors on the facebook group you mention are talking about.

 

 

[Jaba-who]

Jabba-who I am not sure I follow your post. There are 2 changes to the medical system under way. The first allows for a DAME to issue a class 2 medical on the spot rather than just sending the report to CASA who would then take weeks (or months to review) and then they would issue it. This has come into effect.   The advantage of the this is that it should lead to simpler and faster medicals for people who want a full class 2 medical. The liability for the doctor shouldn't be any greater than under the old system as they are acting as CASAs representatives. To be able to do it the doctors have to undergo some online training and are now listed as DAME 2 on the CASA website. I posted the listing of doctors who have done this extra training to show that many of the DAMEs can now issue a class 2 on the spot if you meet the requirements.

The second change that is still coming is the introduction of a basic med medical to replace the RAMPC. Not a lot is know about this change. It could be great or not. The idea is that GP is able to issue some form of certification to allow (limited) flight privileges. I suspect that this is what the the doctors on the facebook group you mention are talking about.

Yeah. I stuffed that one up didn’t I?

 

 That’s what happens when I try to quickly do things between cases. I have conflated the two different situations. 

 

What I was trying to say was: 

 

The numbers I quoted are the DAME figures who have taken up the authority to give on the spot medicals for Class 2 medicals. 

 

Of the total DAMEs who could do the on line process only 10% had done so. ( these were the figures a couple of weeks ago. ) 

 

The discussion we had was why such a low figure? Especially when the whole CASA premise of the change was that for the system to work basically all DAMEs would need to take up the authority. 

 

It was stated by those who had not, and from people’s information from others who had not, that fear of the risks of litigation if a candidate subsequently had a medical event after being given a clearance was the main cause. 

 

At no time is there any decrease in liability because a doctor is acting as a representative of CASA. This is not a defence because the practitioner is only covered by vicarious liability if he is an employee of CASA. 

 

The same applies for drivers licences. A doctor can’t claim any immunity from Ausroads  if they wrongly give out a medical and the driver then goes and causes some disaster. 

 

But even if they tried it CASA would very likely fire it back on the doctor. Their obvious defence would be the doctor is a private practitioner whose decisions are his/her own. If a mistake was made they will say it’s the doctors poor examination or judgement over which they have no control. And that if the doctor had acted correctly the candidate would not have been given a pass. Ipso facto  - doctor’s problem. 

 

 

[Birdseye]

Not quite. If you have it now you can still keep your licence as long as you are stable and well controlled but all the assessment must go through AvMed. 

 

With the new system as best we know ( because remember CASA Have not released whatbthe rules will be , they have suggested what might be involved ) CASA have stated that if you have a number of conditions that previously excluded you from having a simple straightforward medical ( and type 2 diabetes was one of these) you will still have to go through AvMed. You still won't be able to get a simple "pass" from a GP.  

 

But once again I have to add. That's just as it appears from the various press releases that have been made. It could all change ( for better or worse) when they actually publish what these rules will actually be. 

I wasn't referring to the Class 2. As I haven't held an AVMED for the past 17 years, I am regarded as a new application and it just wasn't worth the cost and trouble going for a Class 2. The AustRoads medical differentiates between those that do and do not require insulin treatment. That is what I hope will continue when the dullards in Canberra enact all of the changes.

 

 

[coljones]

Not quite. If you have it now you can still keep your licence as long as you are stable and well controlled but all the assessment must go through AvMed. 

 

With the new system as best we know ( because remember CASA Have not released whatbthe rules will be , they have suggested what might be involved ) CASA have stated that if you have a number of conditions that previously excluded you from having a simple straightforward medical ( and type 2 diabetes was one of these) you will still have to go through AvMed. You still won't be able to get a simple "pass" from a GP.  

 

But once again I have to add. That's just as it appears from the various press releases that have been made. It could all change ( for better or worse) when they actually publish what these rules will actually be. 

The non-insulin diabetes standard for RAMPC is a no to "Does the patient have end-organ complications that may affect driving, as per the Austroads publication, or has the patient had a recent ‘severe hypoglycaemic event’?".

AVMED don't get involved except to, maybe, check out the paperwork for defects. Insulin controlled diabetes is a no-no for RAMPC. (Drank the juice, got the T-shirt). 

 

Provided your insulin controlled diabetes is well managed you can get a class 2 Medical but probably not a Basic Class 2 as that is based on Ausroads commercial standards.

 

 

[Jaba-who]

The non-insulin diabetes standard for RAMPC is a no to "Does the patient have end-organ complications that may affect driving, as per the Austroads publication, or has the patient had a recent ‘severe hypoglycaemic event’?".AVMED don't get involved except to, maybe, check out the paperwork for defects. Insulin controlled diabetes is a no-no for RAMPC. (Drank the juice, got the T-shirt). 

 

Provided your insulin controlled diabetes is well managed you can get a class 2 Medical but probably not a Basic Class 2 as that is based on Ausroads commercial standards.

Yep. 

It’s all very complex and convoluted. 

 

Not helped by the covert way CASA goes about the lead up to the Basic Class 2. The first few releases they made they openly stated there would be restrictions on top of the Austroads standard ( but not saying what they would be - leaving us to assume they would be similar to those applied to the RAMPC) 

 

then since then the very few public announcements they have made  have not said anything about the restrictions. This is by the way as best I recall what they did with the RAMPC and which essentially made the RAMPC unusable for most pilots who wanted it. 

 

 

[facthunter]

I doubt they are acting in good faith.. The fix is often worse than the original problem. There's nothing in it for them. Avmed  has over ruled experts in  particular spheres of medicine in the past. They don't pay enough to get real expertise in Avmed . There's been some notorious personalities in that department, (they had some good ones too long ago now for most to recall  ) and they have their exposure to liability as their prime concern, primarily.  If YOU can't fly as a result , that's just too bad..Nev

 

 

[Jaba-who]

The non-insulin diabetes standard for RAMPC is a no to "Does the patient have end-organ complications that may affect driving, as per the Austroads publication, or has the patient had a recent ‘severe hypoglycaemic event’?".AVMED don't get involved except to, maybe, check out the paperwork for defects. Insulin controlled diabetes is a no-no for RAMPC. (Drank the juice, got the T-shirt). 

 

Provided your insulin controlled diabetes is well managed you can get a class 2 Medical but probably not a Basic Class 2 as that is based on Ausroads commercial standards.

This is a very convoluted topic as well.

 

For a number of reasons but - essentially the presence of significant  "End organ damage" is in the eye of the beholder.  We are blessed with an over-abundance of kidney function and blood tests looking for kidney function don't even begin to change until there is some degree of damage and don't hit the outer limits of "Normal" until significant damage is done.  Even just looking at the sensitive markers of damage like protein in the urine we know there has to be some damage going on for it to be detectable.

 

Then after that to decide will it affect driving   flying is like asking asking will the high tide tomorrow cause any damage to the beach.  Who knows? It might but but it might not.

 

Avmed have been infamous for their overly-conservative (almost ridiculously) use of anything to take peoples medicals away

 

Like the infamous  1% rule.

 

If something has a 1% chance or more of causing an inflight catastrophe then they take your medical away.  But they have historically used very dodgy statistics.  Like prostate cancer - fail!

 

Why?  Because there's a 1% chance it will spread without you being aware it has spread..

 

But to where?  bones 99%    Brain 1%

 

But what happens if it goes to the brain - A 1% chance of having a sudden  fit with no prior warning.

 

So a 1% X 1% x1% chance is cause for all people with prostate cancer to lose their medical

 

The new problem with Type 2 diabetes is that insulin is being used way more commonly for Type 2 (whereas it was once was  only used for Type 1) and there are multiple different types of insulin and multiple ways of using it.

 

In many people with Type two it forms a small part of their therapy and is in doses too small to cause hypoglycaemia. But everyone  is tarred with the same brush.

 

The new bogey man on the horizon are the SGLT 2 Inhibitors especially when the patient is taking insulin.  These are a new group of drugs which have statistically improved the risk of end organ damage (dramatically for coronary heart disease)

 

BUT ...  they significantly increase the risk of a brand new type of coma where the blood sugar stays normal and the coma is caused by ketones rising in the blood. And the prime trigger event appears to be stress.

 

Avmed undoubtedly will say flying is a stressor  if you are on one of these drugs even if you have never had a bad glucose level.

 

 

[coljones]

Thanks for this. Interesting. I had no trouble getting a RAMPC while on tablets but lost it when I started on insulin. Getting my HbA1c to between 6.5 and 8.0 for the Class 2 was a bit of a struggle as it is a lagging indicator and the apple pie takes a month or two to show up.  So does knocking off food, weight and doing more exercise.

 

I wish the aviation and diving endocrinologists would get their rules aligned.

 

 

[Jaba-who]

Thanks for this. Interesting. I had no trouble getting a RAMPC while on tablets but lost it when I started on insulin. Getting my HbA1c to between 6.5 and 8.0 for the Class 2 was a bit of a struggle as it is a lagging indicator and the apple pie takes a month or two to show up.  So does knocking off food, weight and doing more exercise.I wish the aviation and diving endocrinologists would get their rules aligned.

Do Avmed actually use advice from specialists in the appropriate field? 

All I’ve ever seen is they ignore it. 

 

They even  ignored world authority medical opinion ( like WHO) on some things. A few years ago the real medical world said a fasting blood sugar of anything up to 6 was normal. 

 

Avmed in their infinite wisdom said no, we will continue to use an old standard of 5.6 If your fasting sugar was eg 5.7 you would have to undergo additional tests ( glucose tolerance testing ) at your own cost and time despite the rest of the medical world saying it was not appropriate. 

 

Same with blood thinners. You could get a medical while on some thinners provided you had stable & frequent tests. And it was reasonable as the old thinners were prone to over and undershooting. 

 

Now there’s a bunch of new ones that are heaps safer heaps better but no test exists ( or was needed). But Avmed just said nope! No test no medical. Despite it not being even in existence and certainly not needed even it existed for safe clinical management. 

 

I don’t know if they’ve emerged into the real world on those fronts yet. 

 

 

[Jaba-who]

Thanks for this. Interesting. I had no trouble getting a RAMPC while on tablets but lost it when I started on insulin. Getting my HbA1c to between 6.5 and 8.0 for the Class 2 was a bit of a struggle as it is a lagging indicator and the apple pie takes a month or two to show up.  So does knocking off food, weight and doing more exercise.I wish the aviation and diving endocrinologists would get their rules aligned.

If you are having trouble with that it’s a distinct possibility that your endocrinologist May suggest going on a SGLT 2 inhibitor. The drug group I mentioned in an earlier post. 

These are drugs with chemical names that all end in “glifozin” 

 

The following drugs belong to the SGLT2 inhibitors class (trade name first, generic name in brackets):

 

• Forxiga (Dapagliflozin)
   
   
   
  
• Invokana (Canagliflozin)
   
   
   
  
• Jardiance (Empagliflozin)
   
   
   
  

 

 

There appears to be major advances for decreasing end organ ( kidneys, blood vessel and eyes) damage from diabetes. 

 

So a positive major advance for most diabetics and well worth recommending in most situations. 

 

But they have been recently shown to have a higher risk of producing coma ( still not a great risk but some) especially in stressful situations ( and the blood

 

sugar levels can be normal so can happen even when usual testing is normal. ) and perhaps moreso if the patient is also on insulin. 

 

This risk has recently resulted in advice that the drug should be stopped 3 days before major stressful events such as surgery. 

 

So here’s the problem. When Avmed catches up with this will they pull people’s medicals if they are put on glifozins in the grounds that flying is stressful? 

 

Who knows? But I guess I should keep quiet. If they don’t hear about them if past history is followed they may never learn about it. 

 

But if you are offered glfozins you have to think about all the ramifications both good and bad. Depends how much you want to risk taking on Avmed again. 

 

 

[Sloper]

Goodaye all

 

Passed my class 2  a couple of weeks ago, was talking to the DAME and he said all the testing for Ausroads will be the same.

 

So you might as well just get the class 2.

 

regards Bruce

 

 

[Jaba-who]

Goodaye allPassed my class 2  a couple of weeks ago, was talking to the DAME and he said all the testing for Ausroads will be the same.

 

So you might as well just get the class 2.

 

regards Bruce

And if the restrictions prove to be the same as RAMPC or more restrictive there may be no choice. Class 2 or nothing.